Gender-related self-reported mental health inequalities in primary care in England: Cross-sectional analysis using the GP Patient Survey

Ruth Elizabeth Watkinson, Aimee Linfield , Jack Tielemans, Igor Francetic, Luke Munford

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Trans, non-binary, and gender diverse people face discrimination and barriers to healthcare. Existing evidence suggests higher rates of mental health conditions amongst these groups compared to binary, cisgender groups. However, information is limited by poor gender recording in health records and surveys. We aimed to provide the first national estimates of gender-related inequalities in self-reported mental health conditions and mental health support across 15 gender groups in England.

Methods
We exploited changes to the 2021 and 2022 nationally representative cross-sectional English GP Patient Surveys and used age-adjusted logistic regression to predict probabilities of two outcomes (1) self-reporting a mental health condition and (2) self-reporting unmet mental health needs. We report results for 15 exposure groups: five gender groups (Female, Male, Non-binary, Prefer to self-describe, Prefer not to say), each within three cis/trans identity groups (Cisgender, Transgender, Prefer not to say). We explored potential mediation by adding covariates.

Findings
Of the 1,520,457 respondents in the estimation sample, 861,017 (51.4%) were female, 645,300 (47·4%) were male, 2,600 (0·3%) were non-binary, 2,277 (0·2%) self-described their gender, and 9,263 (0·7%) preferred not to state their gender. 1,499,852 (98·3%) respondents were cisgender, 7,994 (0·7%) were transgender, and 12,611 (1.0%) preferred not to say their cis/trans identity. We found wide gender-related inequalities in the probability of self-reporting a mental health condition, with the highest probabilities amongst non-binary patients who were transgender (47·21% [95% CI 42·86%-51·60%]) or preferred not to say their cis/trans identity (32·90% [26·50%-40·00%]), and amongst transgender patients who self-described their gender (35·03% [27·39%-43·53%]). With the exception of non-binary patients in each case, probabilities were lowest amongst cisgender patient groups (range: male 8·80% [8·69%-8·92%] to female 11·97% [11·86%-12·07%]) and patients who preferred not to say their cis/trans identity (range: female 7·15% [6·06%-8·42%] to prefer to self-describe 10·37% [7·13%-14·86%]). Inequalities in other health conditions and socioeconomic factors may mediate some of these inequalities. Probabilities of self-reported unmet mental health needs were lowest amongst cisgender male (15·55% [95% CI 15·33%-15·76%]) and female (15·93% [15·76%-16·10%]) patients with increased probabilities amongst all other groups, ranging from 19.95% [17·57%-22·57%] amongst transgender male patients to 28·64% [26·23%-31·17%] amongst patients who preferred not to say their gender and cis/trans identity. Inequalities in interactions with healthcare professionals may mediate much of these inequalities.

Interpretation
Together with existing evidence, our findings showed large gender-related inequalities in self-reported mental health outcomes in England. Given the existence of self-reported unmet mental health needs, we suggest that better healthcare system inclusivity and healthcare professional training are needed, alongside broader improvements
Original languageEnglish
Pages (from-to)E100-E108
JournalThe Lancet Public Health
Volume9
Issue number2
DOIs
Publication statusPublished - 1 Feb 2024

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