Unmet Mental Health Need and Barriers to Care Among Transgender and Cisgender Adults

Transgender and gender-diverse adults have worse mental health than cisgender adults, yet few studies assess unmet mental health needs. This study compares frequent mental distress, access to care, and barriers among transgender and gender-diverse and cisgender adults.

Using the 2022 KFF/The Washington Post Trans Survey of U.S. adults (n=1,338), unadjusted prevalence differences in frequent mental distress, unmet mental health need, and reasons for unmet mental health need were described. Logistic regression models assessed unmet mental health need likelihood, adjusting for sociodemographic characteristics and distress. Data were analyzed in 2024.

Among transgender and gender-diverse adults, 64% were nonbinary or gender nonconforming, 22% were transgender women, 12% were transgender men, and 2% were of another gender. Transgender and gender-diverse adults were more likely to have Medicaid (21% vs 14%, p=0.01) or be uninsured (15% vs 10%, p=0.04) and less likely to have Medicare (6% vs 25%, p<0.001) than cisgender adults. Transgender and gender-diverse adults reported more frequent mental distress (47% vs 21%, p<0.001) and unmet mental health need (48% vs 26%, p<0.001) than cisgender adults. In multivariable models, transgender and gender-diverse adults had higher unmet mental health need than cisgender adults (OR=1.62, 95% CI=1.08, 2.43). Transgender and gender-diverse adults were more likely to report cost as the main care barrier than cisgender adults (30% vs 15%, p=0.01).

Transgender and gender-diverse adults reported higher rates of frequent mental distress, unmet mental health need, and cost-related barriers to mental health care than cisgender adults. Efforts to improve the affordability and availability of mental health treatment could reduce high levels of unmet need among transgender and gender-diverse adults.