Associations Between Transgender Identity, Sleep, Mental Health and Suicidality Among a North American Cohort of College Students

Abstract

The purpose of this study is to examine the associations between transgender identity, sleep, and mental health among a North American cohort of cisgender and transgender college students. Participants and Methods: This cross-sectional study surveyed 221,549 North American college students from the 2016-2017 American College Health Association-National College Health Assessment II. Bivariate and multivariable analysis examined associations among transgender identity and outcomes of insomnia symptoms, daytime sleepiness, sleep disorder diagnoses and treatments. Mental health outcomes included mood symptoms, suicidal behaviors, anxiety and depression diagnoses and treatments. Results: Transgender identity was reported by 1.6% (n=3471) of United States (US) and 1.7% (n=717) Canadian students, respectively. Mean age was 22.5 ±6. Transgender college students have an increased prevalence of daytime sleepiness, insomnia symptoms, diagnoses and/or treatment of insomnia and other sleep disorders as compared to cisgender college students. Mental Health symptoms are more prevalent with a 2-fold increase in depression and anxiety and nearly a 4-fold increase in suicide attempts among transgender students. A higher burden of mood symptoms exists among transgender college students in the US in comparison to Canadian students. Conclusion: Transgender college students have an alarmingly high rate of mood, sleep disturbances and sleep diagnoses, and suicidality. Colleges and universities must provide sufficient resources to address the sleep and mental health needs of transgender students. Institutions must adopt gender affirming policies that promote an inclusive environment. Increased allocation of resources and adoption of policies that enhance the physical and mental health of transgender students could improve sleep, mood, and potentially lower the suicide risk among a population that often experiences health inequities.

Nonconforming gender expression and insufficient sleep among adolescents during COVID-19 school closure and after school reopening

“…Sleep may be a health disparity in sexual and gender minority individuals (i.e., lesbian, gay, bisexual, transgender, queer, or other identities) [34], and the potential mechanism underlying the observed sleep disparity is social and minority stress [16]. And social stress has a similar role regarding self-perceived and self-rated GNC.…”

A Pilot Study of Symptoms of Major Depressive Disorder in Medical Students at an Osteopathic Medical School Before and After High-Stakes Examinations

“…This study only differentiated between self-identified male and female medical students and does not specifically address symptoms or differences among students who identify as non-binary or gender nonconforming. Given the well-documented rates of MDD among this population in general, 39,40 it is worth exploring the specific effect of medical school exams on their mental health in future research. Additionally, we only surveyed students within a three-day period before and after exams, so we do not know what the lasting consequences of these symptoms are, or how long these symptoms truly exist both before and after exams.…”

Sleep disturbance and suicide risk among sexual and gender minority people

“…Sleep quality was found to be an independent predictor of quality of life controlling for gender-affirming hormone therapy or gender-affirming surgeries ( Auer et al, 2017 ). Since the review by Butler et al (2020) was published, a large-scale study examining sleep, mental health, and suicide reported that transgender college students were more likely than cisgender students to experience inadequate sleep, daytime sleepiness, insomnia symptoms, and sleep disorder diagnosis ( Hershner et al, 2021 ). Additionally, an expanded report from a qualitative study of 40 gender minority people examined associations between sleep quality and mental health, and found that most participants endorsed some difficulties with sleep ( Harry-Hernandez et al, 2020 ).…”

“…Regarding gender minority people, few studies have examined the association between sleep disturbance and STBs. In an analysis of data from the 2016–2017 American College Health Association National College Health Assessment II, transgender college students had higher rates of sleep disturbance including inadequate sleep, daytime sleepiness, insomnia symptoms, and a diagnosis of a sleep disorder as well as 3–4 times increase in the odds of reporting suicide ideation or suicide attempt ( Hershner et al, 2021 ). Although this study did not evaluate whether sleep disturbance functioned as a mechanism in the association between transgender identity and STBs, this study suggests that both sleep disturbance and STBs co-occur at high rates among gender minority people.…”