Transgender and gender diverse (TGD) individuals are faced with various societal factors that contribute to health disparities. As COVID-19 spreads, health disparities that existed prior to the pandemic have become exacerbated. The current study aims to address factors that may be negatively impacting TGD individuals during the COVID-19 pandemic by exploring their experiences related to symptoms of depression, symptoms of anxiety, employment, and housing. TGD participants (N = 342) were recruited from an online participant recruitment platform and answered questions related to their psychological well-being and changes in employment and housing since the start of the pandemic. Adverse changes in employment since the start of the pandemic were reported by almost 1/3 of participants and were associated with higher depression and anxiety. Changes in housing were reported by almost 1/4 of participants and were associated with higher anxiety. Experiencing COVID-19 symptoms or receiving a COVID-19 diagnosis were also associated with higher anxiety. Findings indicate TGD individuals who experienced changes in employment and housing since the start of the COVID-19 pandemic experience greater levels of psychological distress. Findings may inform mental health providers and policymakers on the repercussions the pandemic has had on TGD individuals. Public Significance StatementThe current study explored the ways that housing and employment instability brought on by the COVID-19 pandemic contributed to heightened psychological distress among a sample of transgender and gender diverse (TGD) individuals collected using an online survey platform. Our findings indicate that TGD individuals experienced heightened levels of psychological distress directly related to employment and housing instability which is a crucial and timely concern given that TGD individuals experienced greater psychological distress, unemployment, and housing instability relative to the general population prior to the pandemic. Receiving a COVID-19 diagnosis or experiencing symptoms associated with COVID-19 also predicted heightened levels of psychological distress. It is recommended that additional TGD-specific protections be implemented and expanded upon in order to meet the current and impending needs of TGD individuals.

Transgender and gender-independent individuals (TGI) encounter myriad barriers to accessing affirming healthcare. Healthcare discrimination and erasure exposure among TGI individuals is vital to understanding healthcare accessibility, utilization behaviors, and health disparities in this population. Exposure to gender identity-related healthcare discrimination and erasure in childhood may contribute to TGI adults’ healthcare utilization behaviors. The commonality of childhood exposure to gender identity-related healthcare discrimination and its relationship to healthcare avoidance during the early months of the COVID-19 pandemic among TGI adults were explored. TGI adults aged 18 to 59 (N = 342) in the United States were recruited online during the summer of 2020. Among individuals who reported childhood exposure to gender identity-related healthcare discrimination, 51% reported experiencing two or more distinct forms of discrimination. Hierarchical logistic regression indicated that exposure to healthcare discrimination in childhood significantly increased the odds of healthcare avoidance during the early months of the COVID-19 pandemic, after accounting for demographic factors and self-reported COVID-19 symptoms (odds ratio = 1.30, 95% confidence interval = 1.10, 1.54). These findings suggest that childhood exposure to gender identity-related healthcare discrimination is a prominent barrier to the utilization of healthcare for TGI adults, even during a global pandemic.

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Transgender and gender diverse (TGD) individuals are often in a position where they face difficult and complex decisions about revealing their identity to others. Such revelations, referred to as “coming out,” have been suggested to have ambivalent relationships with mental health depending on circumstantial and environmental factors. To explore how negative (gender-identity related discrimination) and positive (community connectedness) environmental factors may influence the relationship between outness and psychological distress, data collected from a cross-sectional sample of TGD participants (N = 342) were analyzed to assess connections between outness, gender-related discrimination, community connectedness, and psychological distress. Using principles of decomposition and counterfactual frameworks, a mediation model was constructed to assess the direct effect of outness on psychological distress once accounting for indirect effects of outness on psychological distress as mediated by discrimination. To determine how this direct effect varied depending on the level of community connectedness, a follow-up moderated mediation model was constructed. Analyses showed a significant direct effect of outness on psychological distress after removing indirect effects, b = −.48, 95% CI [−.80, −.17]. This direct effect appeared greatest for those with moderate (b = −.39, 95% CI [−.76, −0.2]) and high (b = −1.31, 95% CI [−2.17, −.47]) levels of community connectedness. The relationship between outness and decreased psychological distress is one that appears to be highly influenced by environment into which one reveals their gender identity. Community and policy-focused interventions may ameliorate the mental health disparities faced by TGD populations.