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Abstract
Background: Within the United States, sexual and gender minorities (SGM), face unique barriers when seeking health services, such as uninsurance, postponing care, and lack of competent services. Within SGM, transgender and gender-expansive (TGX) individuals are more vulnerable as they have higher rates of discrimination and face more barriers to accessing healthcare services. Purpose: Identify differences in mental health outcomes and services by gender identity among sexual and gender minorities residing in Texas during the COVID-19 pandemic. Methods: This study is a secondary data analysis of the SGM participants of the COVID-19 and You Survey study (n=1288). Descriptive statistics, bivariate associations by gender identity, and adjusted odds ratios (adjOR) and 95% confidence intervals (CI) using multiple logistic regression. Results: A total of 346 TGX participants were included in the study. For each unit increase in the Patient Health Questionnaire (PHQ) Subscales for anxiety (adjOR: 1.2; 95% CI: 1.1,1.3) and depression (adjOR: 1.2; 95% CI: 1.1,1.3) subscale there was an increase in the likelihood that the participant as TGX. TGX were more likely to report difficulty accessing mental health services than cisgender sexual minorities (adjOR: 1.8; 95% CI: 1.2, 2.7). Individuals who reported they had difficulty accessing mental health services, compared to those who reported no difficulty, are almost twice as likely to be TGX (adjOR: 1.8; 95% CI: 1.2, 2.7). There were no significant adjusted associations between gender identity and insurance and trusting providers during COVID-19. Conclusions: Among participants in this study, there were significant associations between gender identity and mental health outcomes. Recommendations: Recommendations include supporting needs assessments for TGX in the state of Texas and training health professionals on evidence-based approaches for TGX individuals.