Gender-related self-reported mental health inequalities in primary care in England: Cross-sectional analysis using the GP Patient Survey
What were we trying to do?
The aim of this study was to estimate – for the first time – gender-based inequalities experienced by people in 15 gender groups in England when they self-reported mental health conditions or tried to access mental health support.
The 15 categories consisted of 3 cis/trans identity groups, with each one containing 5 gender groups:
- Cis/Trans identity groups: Cisgender / Transgender / Prefer not to say
- Gender groups: Female / Male / Non-binary / Prefer to self-describe / Prefer not to say
We also explored factors that could potentially reduce mental health inequalities.
Why was it important?
Previous evidence has shown that trans, non-binary and gender diverse people face discrimination and barriers to accessing and receiving healthcare, while also suggesting that, among those groups of people, there were higher rates of mental health conditions, such as depression and anxiety, than in binary, cisgender groups.
To see improvements that would help to reduce discrimination and make accessing mental healthcare easier, we needed to have a better understanding of the gender-related inequalities in mental health conditions for trans, non-binary and gender diverse people.
How did we do it?
We analysed data from .5 million people in England, including nearly 8,000 transgender people, from the 2021 and 2022 GP Patient Surveys (GPPS), because the survey questions from 2021 onwards have been updated to record gender diversity and cis/trans identity. This allowed us to compare the responses from people in the 15 gender groups with responses from binary, cisgender groups.
Using the GPPS data, we looked for people who had experienced two particular outcomes:
- a mental health condition, and
- they did not feel the healthcare professional at their last GP appointment understood the mental health needs they had.
Using a method called logistic regression models, we then calculated an England-wide estimate of the total number of people from each group we would expect to self-report these two outcomes.
From the GPPS data, we were able to look at the how people within the 15 study groups were affected by inequalities and how the inequalities they experienced could potentially be reduced. The factors that we considered included:
- socioeconomic factors,
- other long-term health conditions,
- variation in GP appointment histories, and
- relationships with healthcare professionals.
Findings:
Overall, findings from the study suggest that transgender, non-binary, and gender diverse people in England are more likely to have a long-term mental health condition than cisgender people.
Specific findings included:
- The risk of having a long-term mental health condition in England is roughly one in six for transgender men and women (16.4% and 15.9% respectively) and one in ten for cisgender men and women (8.8% and 12.0%).
- The risk of reporting a mental health condition was almost one in two (47.2%) for non-binary transgender individuals.
- Approximately one in six cisgender men and cisgender women reported their mental health needs were unmet (15.6% and 15.9% respectively), compared to all other gender identity groups which ranged between one in five (20.0%) and one in four (28.6%).
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More information
Senior Programme Lead
Mike Spence
mike.spence@healthinnovationmanchester.com