It is So Much More than Therapy: Mental Health and Mental Healthcare Utilization Among Transgender and Gender Non-Conforming University-Enrolled Students in the United States

Abstract

Transgender and gender non-conforming (TGNC) people are at a greater risk of experiencing poor mental health than their cisgender peers (Carter et al., 2020). These mental health disparities are exacerbated by unsupportive structural and political environments (Gonzales et al., 2022). At the same time, university-enrolled students are reporting poorer mental health outcomes at a growing rate (Oswalt et al., 2020). However, there is little research studying the mental health and formal and informal mental healthcare utilization of TGNC university-enrolled students. To begin to close this gap, this study used data from the 2021-22 Healthy Minds Dataset to investigate gender identity-related differences in the prevalence of depression, anxiety, and flourishing scores as well as gender identity-related differences in mental healthcare utilization, timing of receipt of services, and the perceived helpfulness of those services. Data analyses revealed that TGNC university-enrolled students report higher depression and anxiety scores, lower flourishing scores, and utilized mental health services more than their cisgender peers. Notably, the widest gender identity-related gaps in mental health symptoms existed among students who had never utilized therapy/counseling. A higher proportion of TGNC students, compared to cisgender students, reported relying on a friend or professional clinician during serious emotional distress, while a lower proportion reported relying on a family member for mental health support. Finally, the perceived helpfulness of therapy/counseling services was approximately the same for TGNC and cisgender students, and slightly improved with the longevity of care. These results show that while mental healthcare access does work to lessen gender identity-related mental health disparities in university-enrolled students, it does not close the gap. These findings reveal that simply providing mental healthcare is not enough to improve mental health equity and structural changes must accompany nuanced TGNC-informed mental healthcare. This thesis discusses several implications of the current findings including increasing representation in the field, including training university therapists/counselors on TGNC-affirming mental healthcare, group therapy and support, and creative sources of mental healthcare.