Gender identity continues to be a highly politicized topic of health and science, with very real consequences for gender minorities (e.g., transgender, nonbinary and gender-fluid individuals). At the same time, only a portion of American states have implemented policies aimed at ensuring access to gender-affirming healthcare services, like hormone therapy, reconstructive surgeries and mental health services.
Such services are considered as effective treatments for gender dysphoria—the persistent, significant distress associated with discordance between one’s gender identity and their assigned sex. However, the battle for gender-minority rights is hard won and requires evidence that such policies have a real-world, positive impact on individuals.
This was the goal of American researchers out of Boston, whose study on the association of nondiscrimination policies with mental health among gender minority individuals is published in JAMA Psychiatry. The study included information from 28,980 unique gender minority, pulled from the IBM MarketScan Commercial Database of deidentified private health insurance claims and enrollment data.
The authors looked at suicidality and hospitalization of gender-minority individuals in each of the states where gender-affirming policies have been implemented, including California, Illinois, Nevada, New York, Washington, and Maryland, among others. The states were grouped based on the year of implementation: 2013, 2014, 2015, and 2016.
The results of the study are somewhat mixed for certain cohorts, but globally, they tell a story of a moderate connection between gender-affirming policies and more positive outcomes for gender-minority individuals.
For example, the 2013, 2014 and 2016 cohorts all demonstrated significant reductions in hospitalization in the year following policy implementation. Likewise, in 2014, 2015 and 2016, nondiscrimination policies were associated with significant reductions in suicidality in the year following implementation.
There are some limitations. The authors note, for example, that the Difference-in-Difference statistical model they employ inherently assumes that trajectories between groups (gender-minority vs control) would remain stable if not for the implementation of policies.
However, there are a number of reasons why this may not be true, including policy changes beyond healthcare and insurance, and social, political and financial trends that may differentially impact gender-normative vs. gender-minority individuals.
Additionally, while the large sample size is decidedly advantageous, it is not representative in that not all gender-minority individuals have a diagnosis code related to this status. Indeed, in states where experience and education lags behind policy, healthcare workers may misassign diagnoses.
Nonetheless, the data seems to suggest that in a majority of cases, the implementation of gender-affirming healthcare policies in the United States results in fewer hospitalizations and reduced suicide rates among gender minorities. This is a crucial step towards eliminating gender discrimination in the United States, and studies like the present are necessary to ensure the importance of policy changes is widely recognized.
