Characterising the impact of COVID-19 environment on mental health, gender affirming services and socioeconomic loss in a global sample of transgender and non-binary people: a structural equation modelling

A Microfinance Intervention With or Without Peer Support to Improve Mental Health Among Transgender and Nonbinary Adults (the Creating Access to Resources and Economic Support Study): Protocol for a Randomized Controlled Trial

BACKGROUND

Transgender and nonbinary (TNB) people experience economic and psychosocial inequities that make them more likely to be subject to financial and mental health harms exacerbated by the COVID-19 pandemic. Sustainable, multilevel interventions are needed to address these harms. The onset of the COVID-19 pandemic galvanized many TNB-led organizations to provide emergency financial and peer support for TNB people negatively impacted by the pandemic. However, the efficacy of these interventions has not been evaluated. The Creating Access to Resources and Economic Support (CARES) study seeks to assess the efficacy of feasible, acceptable, and community-derived interventions to reduce economic and psychological harms experienced by transgender people in the wake of the COVID-19 pandemic.

OBJECTIVE

The study aims to (1) compare the efficacy of microgrants with peer mentoring with that of microgrants without peer mentoring in reducing psychological distress, (2) examine mechanisms by which microgrants with or without peer mentoring may impact psychological distress, and (3) explore participants' intervention experiences and perceived efficacy.

METHODS

We will enroll 360 TNB adults into an embedded, mixed methods, 3-arm, and 12-month randomized controlled trial. Participants will be randomized 1:1:1 to arm A (enhanced usual care), which will receive a single microgrant plus monthly financial literacy education, arm B (extended microgrants), which will receive enhanced usual care plus monthly microgrants, or arm C (peer mentoring), which will receive extended microgrants combined with peer mentoring. All intervention arms last for 6 months, and participants complete semiannual, web-based surveys at 0, 6, and 12 months as well as brief process measures at 3 and 6 months. A subset of 36 participants, 12 (33%) per arm, will complete longitudinal in-depth interviews at 3 and 9 months.

RESULTS

Full recruitment began on January 8, 2024, and, as of July 26, 2024, a total of 138 participants have enrolled. Recruitment is expected to be completed no later than March 31, 2025, and the final study visit will take place in March 2026.

CONCLUSIONS

This national, web-based study will demonstrate whether an intervention tailored to reduce material hardship and improve peer support among TNB adults will reduce psychological distress. Its equitable, community-academic partnership will ensure the rapid dissemination of study findings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05971160; https://clinicaltrials.gov/study/NCT05971160.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63656.

Depressive and Anxiety Symptoms Were More Common for Transgender Individuals Whose Gender-Affirming Surgeries Were Cancelled or Delayed Due to COVID-19: A Global Cross-Sectional Study

Gender-affirming surgeries, which have well-established mental health benefits, were cancelled and delayed for transgender people worldwide during the COVID-19 crisis. Of 253 scheduled gender-affirming surgeries among transgender adults across 35 countries in late 2020, 27% (n=69) reported that the COVID-19 crisis limited their access to gender-affirming surgery (i.e., cancelled, postponed indefinitely, or rescheduled). In adjusted models, respondents with reduced access to surgeries were somewhat more likely to screen positive for depressive or anxiety symptoms, whereas those who maintained access were more likely to report higher levels of happiness. Our findings illustrate the transgender-specific harms of the COVID-19 crisis on gender-affirming surgeries and mental health.

How does working time impact perceived mental disorders? New insights into the U-shaped relationship

Based on a large-scale nationally representative survey in China, this paper uses the exogenous impact of automation on working hours as the instrumental variable to examine working time's impact on perceived mental disorders, on the basis of dealing with endogeneity. Different from existing literature, it is found that the impact of working time on perceived mental disorders is U-shaped, rather than linear. Mental disorders firstly decrease with working hours. After working more than 48.688 h per week, further increases in working time carry notable mental health costs, leading to a positive relationship between working hours and depression. The turning point of this U-shaped relationship is almost in line with the International Labor Organization's 48 working hours/week standard, justifying it from a mental health perspective. In addition, we further exclude the possibility of more complex nonlinear relationships between working time and perceived mental disorders. Furthermore, heterogeneities are found in the effects of working hours on mental disorders across different subgroups. Males are more depressed when working overtime. Older workers have a lower tolerance for overwork stress. The turning point is smaller for the highly educated group and they are more sensitive to working longer. Those with higher socioeconomic status are less depressed after exceeding the optimal hours of work. The increase in depression among rural workers faced with overwork is not prominent. Perceived mental disorders are lower among immigrants and those with higher health status. In addition, labor protection and social security help to weaken mental disorders caused by overtime work. In conclusion, this paper demonstrates that working time has a U-shaped impact on perceived mental disorders and highlights the vulnerability of certain groups, providing a reference for setting optimal working hours from a mental health perspective.

COVID-19, lockdowns, and the mental wellbeing of LGBTQ people in Australia

LGBTQ communities around the world entered the COVID-19 pandemic with generally high rates of poor mental health and faced additional challenges including stigma, discrimination, and barriers to care. This study sample was drawn from a survey of 3135 LGBTQ adults residing in Australia during the pandemic. Regression analysis was used to explore individual differences in psychological distress and perceived change in mental wellbeing since the onset of the pandemic as well as the impact of lockdowns, by taking advantage of a natural experiment comparing the states that experienced more extensive lockdowns (Victoria and New South Wales) to the rest of Australia. The burden of mental health was found to vary across gender, sexual orientation, age, and area of residence. While no impact of lockdowns on psychological distress was observed, participants living in the states of Victoria (β = -0.15; 95% CI = -0.23, -0.07) and New South Wales (β = -0.13; 95% CI = -0.21, -0.05) self-reported a more negative impact of the pandemic on their mental wellbeing compared to the rest of the country. The findings suggest that the COVID-19 pandemic had a negative impact on the mental wellbeing of LGBTQ populations, particularly among those who experienced extensive lockdowns and highlight the need for increased efforts to enable access to mental health supports during times of crisis.

Non-binary gender, vulnerable populations and mental health during the COVID-19 pandemic: Data from the COVID-19 MEntal health inTernational for the general population (COMET-G) study

BACKGROUND

The COVID-19 pandemic has brought significant mental health challenges, particularly for vulnerable populations, including non-binary gender individuals. The COMET international study aimed to investigate specific risk factors for clinical depression or distress during the pandemic, also in these special populations.

METHODS

Chi-square tests were used for initial screening to select only those variables which would show an initial significance. Risk Ratios (RR) were calculated, and a Multiple Backward Stepwise Linear Regression Analysis (MBSLRA) was followed with those variables given significant results at screening and with the presence of distress or depression or the lack of both of them.

RESULTS

The most important risk factors for depression were female (RR = 1.59-5.49) and non-binary gender (RR = 1.56-7.41), unemployment (RR = 1.41-6.57), not working during lockdowns (RR = 1.43-5.79), bad general health (RR = 2.74-9.98), chronic somatic disorder (RR = 1.22-5.57), history of mental disorders (depression RR = 2.31-9.47; suicide attempt RR = 2.33-9.75; psychosis RR = 2.14-10.08; Bipolar disorder RR = 2.75-12.86), smoking status (RR = 1.15-5.31) and substance use (RR = 1.77-8.01). The risk factors for distress or depression that survived MBSLRA were younger age, being widowed, living alone, bad general health, being a carer, chronic somatic disorder, not working during lockdowns, being single, self-reported history of depression, bipolar disorder, self-harm, suicide attempts and of other mental disorders, smoking, alcohol, and substance use.

CONCLUSIONS

Targeted preventive interventions are crucial to safeguard the mental health of vulnerable groups, emphasizing the importance of diverse samples in future research.

LIMITATIONS

Online data collection may have resulted in the underrepresentation of certain population groups.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

Are Cisgender Women and Transgender and Nonbinary People Drinking More During the COVID-19 Pandemic? It Depends

PURPOSE

This narrative review of research conducted during the first 2 years of the COVID-19 pandemic examines whether alcohol use among cisgender women and transgender and nonbinary people increased during the pandemic. The overarching goal of the review is to inform intervention and prevention efforts to halt the narrowing of gender-related differences in alcohol use.

SEARCH METHODS

Eight databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, Gender Studies Database, GenderWatch, and Web of Science) were searched for peer-reviewed literature, published between March 2020 and July 2022, that reported gender differences or findings specific to women, transgender or nonbinary people, and alcohol use during the pandemic. The search focused on studies conducted in the United States and excluded qualitative research.

SEARCH RESULTS

A total 4,132 records were identified, including 400 duplicates. Of the remaining 3,732 unique records for consideration in the review, 51 were ultimately included. Overall, most studies found increases in alcohol use as well as gender differences in alcohol use, with cisgender women experiencing the most serious consequences. The findings for transgender and nonbinary people were equivocal due to the dearth of research and because many studies aggregated across gender.

DISCUSSION AND CONCLUSIONS

Alcohol use by cisgender women seems to have increased during the pandemic; however, sizable limitations need to be considered, particularly the low number of studies on alcohol use during the pandemic that analyzed gender differences. This is of concern as gender differences in alcohol use had been narrowing before the pandemic; and this review suggests the gap has narrowed even further. Cisgender women and transgender and nonbinary people have experienced sizable stressors during the pandemic; thus, understanding the health and health behavior impacts of these stressors is critical to preventing the worsening of problematic alcohol use.

Change in Finances, Peer Access, and Mental Health Among Trans and Nonbinary People During the COVID-19 Pandemic

Purpose: Due to structural transphobia, trans and nonbinary (TNB) individuals were particularly vulnerable to the negative effects of social isolation and financial instability resulting from COVID-19. The present study examined the effect of change in finances and access to TNB peer gatherings on anxiety and depression during the COVID-19 pandemic. Methods: Participants were 18 years and older (mean = 30) and completed prepandemic baseline (Fall 2019) and pandemic follow-up (Fall 2020) surveys. Multivariable regressions examined associations between mental health and change in (1) finances and (2) access to TNB peer gatherings (in person or online). Results: Of 780 participants, 50% reported that the COVID-19 pandemic had a negative impact on personal income and 58.3% reported negative impact on access to TNB peer gatherings. Depression and anxiety symptoms increased from prepandemic to follow-up, and most participants were above measurement cutoffs for clinical levels at both time points. Change in finances and access to TNB peer gatherings interacted with prepandemic depression scores to predict depression symptoms during the COVID-19 pandemic. For participants with high prepandemic depression scores, financial stability predicted pandemic depression scores comparable to that predicted by negative financial change. No interaction was found between these variables when predicting anxiety symptoms during the COVID-19 pandemic. Conclusion: Findings underscore the influence of inequality and prepandemic mental health when considering the impact of COVID-19 on wellbeing. Results suggest need for multifaceted programs and services, including financial support and meaningful TNB community engagement, to address barriers to health equity posed by systematic gender oppression.

How do perceptions of Covid-19 risk impact pregnancy-related health decisions? A convergent parallel mixed-methods study protocol

INTRODUCTION

Pregnant people have a higher risk of severe COVID-19 disease. They have been disproportionately impacted by COVID-19 infection control policies, which exacerbated conditions resulting in intimate partner violence, healthcare access, and mental health distress. This project examines the impact of accumulated individual health decisions and describes how perinatal care and health outcomes changed during the COVID-19 pandemic.

OBJECTIVES

Quantitative strand: Describe differences between 2019, 2021, and 2022 birth groups related to maternal vaccination, perinatal care, and mental health care. Examine the differential impacts on racialized and low-income pregnant people.Qualitative strand: Understand how pregnant people's perceptions of COVID-19 risk influenced their decision-making about vaccination, perinatal care, social support, and mental health.

METHODS AND ANALYSIS

This is a Canadian convergent parallel mixed-methods study. The quantitative strand uses a retrospective cohort design to assess birth group differences in rates of Tdap and COVID-19 vaccination, gestational diabetes screening, length of post-partum hospital stay, and onset of depression, anxiety, and adjustment disorder, using administrative data from ICES, formerly the Institute for Clinical Evaluative Sciences (Ontario) and PopulationData BC (PopData) (British Columbia). Differences by socioeconomic and ethnocultural status will also be examined. The qualitative strand employs qualitative description to interview people who gave birth between May 2020- December 2021 about their COVID-19 risk perception and health decision-making process. Data integration will occur during design and interpretation.

ETHICS AND DISSEMINATION

This study received ethical approval from McMaster University and the University of British Columbia. Findings will be disseminated via manuscripts, presentations, and patient-facing infographics.

TRIAL REGISTRATION

Registration: Clinicaltrials.gov registration number: NCT05663762.

Investigating the Psychosocial Impact of COVID-19 Among the Sexual and Gender Minority Population: A Systematic Review and Meta-Analysis

Purpose: The purpose of this study was to utilize a systematic review and meta-analysis to assess the existing body of literature to understand the mental health impacts of the coronavirus disease-19 (COVID-19) pandemic among sexual and gender minority (SGM) people. Methods: The search strategy was developed by an experienced librarian and used five bibliographical databases, specifically PubMed, Embase, APA PsycINFO (EBSCO), Web of Science, and LGBTQ+ Source (EBSCO), for studies (published 2020 to June, 2021) examining the psychological impact of the COVID-19 pandemic among SGM people. Articles were screened by two reviewers. The quality of the articles was assessed using the National Institutes of Health quality assessment tool for observational studies. A double extraction method was used for data abstraction. Heterogeneity among studies was assessed by I2 statistic. The random-effects model was utilized to obtain the pooled prevalence. Publication bias was assessed by Funnel plot and Egger's linear regression test. Results: Of a total of 37 studies, 15 studies were included in the meta-analysis with 17,973 SGM participants. Sixteen studies were U.S. based, seven studies were multinational studies, and the remaining studies were from Portugal, Brazil, Chile, Taiwan, the United Kingdom, France, Italy, Canada, and several other countries. A majority of studies used psychometric valid tools for the cross-sectional surveys. The pooled prevalence of anxiety, depression, psychological distress, and suicidal ideation was 58.6%, 57.6%, 52.7%, and 28.8%, respectively. Conclusions: Findings of this study serve as evidence to develop appropriate interventions to promote psychological wellbeing among vulnerable population subgroups, such as SGM individuals.

A Single Center Review of COVID-19 Testing and Vaccination in the Transgender and Nonbinary Population

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected transgender and nonbinary (TGNB) persons. We evaluated COVID-19 testing and vaccination rates among TGNB patients at our institution. Methods: We compared COVID-19 testing and vaccination rates between TGNB patients and a cisgender population matched by age, race, and ethnicity. Data were collected through September 22, 2021. Demographic variables, testing rates, and vaccination rates were collected. Descriptive statistics were calculated, and regression was performed on outcomes of interest: any vaccination dose, at least one test, and at least one positive test. Gender modality was the exposure of interest. Results: There were 5050 patients: 1683 cisgender men, 1682 cisgender women, and 1685 TGNB individuals. TGNB patients were more likely to be on Medicaid/Medicare and more likely to be single. The number of patients with at least one test was similar between TGNB (n = 894, 53.1%) and cisgender (n = 1853, 55.1%) groups. The number of patients who had at least one positive test was higher among cisgender patients (n = 238, 7.1%) compared with TGNB patients (n = 73, 4.3%). Vaccination rates were significantly greater among TGNB patients. Compared with cisgender patients, TGNB patients had greater odds of vaccination (adjusted odds ratio [aOR] = 1.25 [95% confidence interval; CI 1.06-1.48]). Compared with cisgender patients, TGNB patients had lower odds of having at least one positive COVID-19 test (aOR = 0.51 [95% CI 0.36-0.72]). Conclusion: Our institutional experience found that vaccination rates for TGNB patients were higher and COVID-19 positivity lower than for cisgender patients.

Instability in Housing and Medical Care Access: The Inequitable Impacts of the COVID-19 Pandemic on U.S. Transgender Populations

Purpose

To assess whether the COVID-19 pandemic has inequitably impacted key social determinants of health (SDoH), specifically employment, housing, and health care, for U.S. transgender populations.

Methods

Between April 13, 2020 and August 3, 2020, we conducted a national, cross-sectional online survey of sexual and gender minority individuals (N=870). We used logistic regression to calculate both unadjusted and adjusted odds of unemployment, homelessness/housing instability, and interruptions in medical care owing to the pandemic by gender and gender modality. Adjusted models controlled for age, race/ethnicity, and region.

Results

In adjusted models, transgender and gender diverse people had 2.12 times the odds of reporting homelessness/housing instability and 2.88 times the odds of reporting medical care interruptions compared with cisgender peers. Transgender men, women, and nonbinary people had 4.12, 3.29, and 3.48 times the adjusted odds of interruptions in medical care compared with cisgender men, respectively. We did not observe significant differences in employment.

Conclusions

Findings add empirical support to the hypothesis that socioeconomic consequences of COVID-19 are inequitably impacting transgender people. To contextualize our results and support future research in this area, we present a conceptual model of the short- and long-term impacts of COVID-19 on transgender populations using a framework of stigma as a fundamental cause of health inequities. Our findings emphasize that public health professionals must urgently consider-and intervene to address-the pandemic's SDoH-related impacts on transgender populations.

A mixed-methods approach to understand university students' perceived impact of returning to class during COVID-19 on their mental and general health

PURPOSE

This study investigated the prevalence and risk factors of mental and general health symptoms among university students attending in-person and online classes during COVID-19. We also explored their experiences returning to in-person classes and their views on the university's COVID-19-related policies.

METHODS

In this sequential explanatory mixed-methods study (2020-2021), U.S. university student respondents (N = 1030; 603 women [58.5%], 907 [88.1%] aged 18-24 years) completed a quantitative, cross-sectional survey assessing their mental and general health symptoms experienced while taking classes during the COVID-19 pandemic. The survey link was distributed through social media and email invitations. Three separate follow-up focus groups (n = 27), consisting of an average of nine focus group respondents who had completed the quantitative survey per group, were conducted using a semi-structured interview guide. Focus group respondents provided qualitative responses on their experiences returning to class during COVID-19 and adhering to COVID-19-related policies.

RESULTS

The prevalence of mental health symptoms among survey respondents were 57.6% (n = 593) for depression, 41.5% (n = 427) for anxiety, and 40.8% (n = 420) for stress. Over 90% of respondents reported perceptions of good general health. Female respondents and respondents identified as non-binary gender had an increased risk for mental health symptoms compared to male respondents. Respondents with preexisting medical conditions had an increased risk for worse general health. Themes identified through qualitative analysis included (1) attending class during COVID-19 is associated with unhealthy behaviors, and poor health, (2) perceived challenges of online learning and increased feelings of isolation, (3) demand for COVID-19 policy reform and greater transparency of COVID-19 statistics; (4) difficulties in adhering to COVID-19 policies; and (5) concerns about acquiring and transmitting COVID-19.

CONCLUSIONS

Our findings indicate that university students attending classes during the pandemic are experiencing negative mental health impacts. Although students were aware of COVID-19-related policies, many found it challenging to comply. Broad acceptance of COVID-19 policies will require greater transparency and information sharing.

Trans and Gender Diverse People's Experience Wearing Face Masks During the COVID-19 Pandemic: Findings from Data Across 4 States in the USA

Introduction

Social isolation and reduced access to public life in response to SARS-CoV-2 (COVID-19) challenges health and well-being for many. Marginalized communities, including transgender and gender diverse (TGD) people, have been disproportionally impacted. Experiences of TGD people should be centered in pandemic-related research to better inform policy.

Methods

A diverse sample of TGD people (N = 158) were recruited from Michigan, Nebraska, Oregon, and Tennessee to participate in the Trans Resilience and Health Study. Participants ranged from 19 to 70 years old (M = 33.06; SD = 12.88) with 27.2% identifying as trans men/men, 26% identifying as trans women/women, and remaining identifying with terms like genderqueer and nonbinary. Thirty percent identified as people of color. Participants completed a monthly COVID-19-related questionnaire April 2020-March 2021 including open-ended questions to learn what contributed to resilience during this time. Thematic analyses of responses enabled identification of salient themes.

Results

Analyses revealed pandemic-related changes in social experiences of marginalization and mask-wearing. Twenty-six participants mentioned face masks as contributing to resilience while also elaborating the influence of masks on experiences of misgendering. Participants identifying as trans women reported decreased misgendering while trans men and nonbinary participants reported increased misgendering.

Conclusions and Policy Implications

Mask-wearing helps reduce transmission of COVID-19. For some trans women, masks also reduce the threat of misgendering and possibly other forms of enacted stigma. However, increased risk for misgendering, as noted by trans men in our study, should be considered and increased supports should be provided.

Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022

Background

Evidence highlighted the likelihood of unmet mental health needs (UMHNs) among LGBTQ+ than non-LGBTQ+ populations during COVID-19. However, there lacks evidence to accurately answer to what extent the gap was in UMHN between LGBTQ+ and non-LGBTQ+ populations. We aim to evaluate the difference in UMHN between LGBTQ+ and non-LGBTQ+ during COVID-19.

Methods

Cross-sectional data from Household Pulse Survey between 21 July 2021 and 9 May 2022 were analyzed. LGBTQ+ was defined based on self-reported sex at birth, gender, and sexual orientation identity. UMHN was assessed by a self-reported question. Multivariable logistic regressions generated adjusted odds ratios (AODs) of UMHN, both on overall and subgroups, controlling for a variety of socio-demographic and economic-affordability confounders.

Findings

81267 LGBTQ+ and 722638 non-LGBTQ+ were studied. The difference in UMHN between LGBTQ+ and non-LGBTQ+ (as reference) varied from 4.9% (95% CI 1.2-8.7%) in Hawaii to 16.0% (95% CI 12.2-19.7%) in Utah. In multivariable models, compared with non-LGBTQ+ populations, LGBTQ+ had a higher likelihood to report UMHN (AOR = 2.27, 95% CI 2.18-2.39), with the highest likelihood identified in transgender (AOR = 3.63, 95% CI 2.97-4.39); compared with LGBTQ+ aged 65+, LGBTQ+ aged 18-25 had a higher likelihood to report UMHN (AOR = 1.34, 95% CI 1.03-1.75); compared with White LGBTQ+ populations, Black and Hispanic LGBTQ+ had a lower likelihood to report UMHN (AOR = 0.72, 95% CI 0.63-0.82; AOR = 0.85, 95% CI 0.75-0.97, respectively).

Interpretation

During the COVID-19, LGBTQ+ had a substantial additional risk of UMHN than non-LGBTQ+. Disparities among age groups, subtypes of LGBTQ+, and geographic variance were also identified.

Creativity in lockdown: Understanding how music and the arts supported mental health during the COVID-19 pandemic by age group

Recent research has indicated that many people around the world turned to artistic creative activities (ACAs) to support their mental health during COVID-19 lockdowns. However, studies have also shown that the negative psychosocial impacts of the pandemic have disproportionately affected young people, suggesting that the use of ACAs to support mental health in lockdown may have varied across age groups. This study investigated how Australians in four different age groups (18-24, 25-34, 35-54, and 55+) engaged in ACAs to support their mental health during the 2020 pandemic lockdowns. Participants (N = 653) recruited from the general public completed an online survey between May and October 2020, in which they reported which ACAs they had undertaken during the pandemic using an established list. Participants subsequently ranked undertaken ACAs in terms of effectiveness at making them "feel better," and those who had engaged in musical ACAs also completed the Musical Engagement Questionnaire (MusEQ). Additionally, ratings of anxiety (GAD7) and depression (PHQ9) symptoms were obtained and examined for potential variations across four diverse variables: age, exercise, gender and state/territory of residence. ACA rankings showed that younger participants overwhelmingly rated musical activities as most effective, while, with the exception of singing, those aged 55+ rated non-musical activities as being most effective. These differences were further supported by ratings for all six MusEQ subscales, with responses strongly indicating that the youngest participants (aged 18-24) used music in significantly different ways during the pandemic than participants in all other age groups. Specifically, these youngest participants were more likely to integrate music into daily life, use music for emotion regulation, respond to music in embodied ways, and use music to perform a social identity. In line with prior research, further analyses indicated that symptoms of anxiety and depression were lessened for older participants, as well for those who reported exercising more during the lockdowns. These findings provide insight into how ACAs can support mental health during a pandemic crisis for specific age groups, which may inform future policy directions, and suggestions for how this can be done are provided.

The Impact of the COVID-19 Pandemic on Depressive Symptoms in China: A Longitudinal, Population-Based Study

Objectives: We aimed to examine how COVID-19 incidence is associated with depressive symptoms in China, whether the association is transient, and whether the association differs across groups.

Methods: We used a longitudinal sample from 2018 to 2020 waves of the China Family Panel Study. We constructed COVID-19 incidence rates as the number of new cases per 100,000 population in respondents’ resident provinces in the past 7, 14, and 28 days when a respondent was surveyed. We performed linear or logistic regressions to examine the associations, and performed stratified analyses to explore the heterogeneity of the associations.

Results: Our sample included 13,655 adults. The 7-day incidence rate was positively associated with the CES-D score (coef. = 2.551, 95% CI: 1.959–3.142), and likelihood of being more depressed (adjusted odds ratio = 6.916, 95% CI: 4.715–10.144). The associations were larger among those with less education, pre-existing depression, or chronic conditions. We did not find any significant association between the 14- or 28-day local incidence rates and depressive symptoms.

Conclusion: The impact of COVID-19 incidence on mental health in China’s general population was statistically significant and moderate in magnitude and transient. Disadvantaged groups experienced higher increases in depressive symptoms.

COVID-19 stressors and symptoms of depression and anxiety among Black cisgender sexual minority men and Black transgender women during the initial peak of the COVID-19 pandemic

PURPOSE

To examine associations between COVID-19-related stressors and symptoms of depression and anxiety in Black cisgender sexual minority men (SMM) and transgender women during the initial peak of the COVID-19 pandemic.

METHODS

Participants from the N2 Cohort Study comprised Black cisgender SMM and Black transgender women in Chicago, IL, completed a face-to-face video or phone interview between April 20 and July 31, 2020. The survey included 18 measures of individual, network, and structural COVID-19 stressors such as income loss, network COVID-19 diagnoses, and housing loss, as well as 5 outcome measures: anxiety, depression, loneliness, worry and hope.

RESULTS

Of 226 participants, 56.6% experienced anxiety on at least 1 of the last 14 days, 48.7% experienced depression, 48.7% experienced loneliness, 42.0% experienced worry, and 51.8% did not experience hope. Completing the study during a later phase of reopening was associated with hopefulness, RR = 1.37 95% CI [1.02, 1.85]. Fifteen of the 18 multi-level COVID-19 stressors were associated with 1 or more symptoms of depression and anxiety, for example, physical stress reactions, income loss, food loss, medication loss, network COVID-19 diagnoses, partner violence, housing loss, and neighborhood pandemic concerns (aRRs = 0.61-2.78, ps < 0.05).

CONCLUSION

COVID-19-related stressors were associated with depression and anxiety symptoms in Black cisgender SMM and transgender women. Mitigation strategies to reduce virus transmission should be supplemented with measures to prevent depression and anxiety among marginalized populations, such as targeted economic relief and eHealth/mHealth interventions.

Experiences of violence and discrimination among LGBTQ+ individuals during the COVID-19 pandemic: a global cross-sectional analysis

Objectives

To characterise the extent to which the levels of violence and discrimination against lesbian, gay, bisexual, transgender and queer (LGBTQ+) people have changed amid COVID-19.

Design

Cross-sectional, secondary analysis.

Setting

79 countries.

Participants

All adults (aged ≥18 years) who used the Hornet social networking application and provided consent to participate.

Main outcome measure

The main outcome was whether individuals have experienced less, or the same or more levels of discrimination and violence from specific groups (eg, police and/or military, government representatives, healthcare providers).

Results

7758 LGBTQ+ individuals provided responses regarding levels of discrimination and violence. A majority identified as gay (78.95%) and cisgender (94.8%). Identifying as gay or queer was associated with increased odds of experiencing the same or more discrimination from government representatives (OR=1.89, 95% CI 1.04 to 3.45, p=0.045) and healthcare providers (OR=2.51, 95% CI 0.86 to 7.36, p=0.002) due to COVID-19. Being a member of an ethnic minority was associated with increased odds of discrimination and violence from police and/or military (OR=1.32, 95% CI 1.13 to 1.54, p=0.0) and government representatives (OR=1.47, 95% CI 1.29 to 1.69, p=0.0) since COVID-19. Having a disability was significantly associated with increased odds of violence and discrimination from police and/or military (OR=1.38, 95% CI 1.15 to 1.71, p=0.0) and healthcare providers (OR=1.35, 95% CI 1.07 to 1.71, p=0.009).

Conclusions

Our results suggest that despite the upending nature of the COVID-19 pandemic, around the world, government representatives, policymakers and healthcare providers continue to perpetuate systemic discrimination and fail to prevent violence against members of the LGBTQ+ community.

Impacts of COVID-19 on trans and non-binary people in Canada: a qualitative analysis of responses to a national survey

BACKGROUND

Emerging international evidence indicates the COVID-19 pandemic has exacerbated socioeconomic and health challenges faced by transgender (trans) and non-binary populations globally. This qualitative study is among the first to characterize impacts of the pandemic on these groups in Canada.

METHODS

Drawing on data from the Trans PULSE Canada survey (N = 820), we used thematic analysis to examine the free-form responses of 697 participants to one open-ended question on impacts of the pandemic. We first organized responses into descriptive themes, and then used this preliminary analytical process to construct more refined, higher order themes that provided a rich account of the pandemic's impacts.

RESULTS

Our results are organized into five themes that highlight the pandemic's impacts on trans and non-binary populations in Canada. These include: (1) reduced access to both gender-affirming and other healthcare, (2) heightened financial, employment, and housing precarity, (3) strained social networks in an era of physical distancing and virtual communication, (4) an intensification of safety concerns, and (5) changes in experiences of gender affirmation.

CONCLUSION

Our findings highlight the pandemic's systemic impacts on the lives of trans and non-binary people in domains such as healthcare, employment, and housing, and on the social networks of these groups, many of which reflect an exacerbation of pre-existing inequities. Based on our analysis, we recommend that public health researchers, policymakers, and practitioners attend to the structural impacts of the pandemic on these groups as primary sites of inquiry and intervention.

Avoidance of primary healthcare among transgender and non-binary people in Canada during the COVID-19 pandemic

Transgender (trans) and non-binary people experience barriers to culturally competent healthcare and many have reported avoiding care. COVID-19 and related mitigation strategies may have exacerbated avoidance, and poor mental health may be bidirectionally related to avoiding care. This study estimated the prevalence of primary care avoidance during the pandemic in a national sample of trans and non-binary people in Canada with a primary care provider and examined the association between poorer self-rated mental health and avoidance. In Fall 2019, Trans PULSE Canada collected multi-mode survey data from trans and non-binary people. In September to October 2020, 820 participants completed a COVID-19-focused survey. In this cross-sectional analysis, multivariable logistic regression models estimated odds ratios adjusted for confounders and weighted to the 2019 sample. The analysis included 689 individuals with a primary healthcare provider, of whom 61.2% (95% CI: 57.2, 65.2) reported fair or poor mental health and 25.7% (95% CI: 22.3, 29.2) reported care avoidance during the pandemic. The most common reason for avoidance was having a non-urgent health concern (72.7%, 95% CI: 65.9, 79.5). In adjusted analyses, those with fair or poor mental health had higher odds of avoiding primary care as compared to those with good to excellent mental health (adjusted odds ratio [AOR] = 2.37; 95% CI: 1.50, 3.77). This relationship was similar when excluding COVID-related reasons for avoidance (AOR = 2.52; 95% CI: 1.52, 4.17). Expansion of virtual communication may enhance primary care accessibility, and proactively assessing mental health symptoms may facilitate connections to gender-affirming mental health services.

Telehealth in Trans and Gender Diverse Communities: the Impact of COVID-19

Purpose of Review

This paper synthesizes current knowledge regarding telehealth and the impact of the SARS-COV2 pandemic on transgender and gender diverse (TGD) patients. We discuss the benefits and challenges of telehealth for patients, providers, and trainees.

Recent Findings

Mental health of TGD populations has been disproportionately challenged in the context of SARS-COV2, and telehealth interventions focused on gender affirmation and mental health are desired and acceptable by TGD populations.

Summary

Telehealth in the era of SARS-COV-2 has a mixed impact on TGD patients and families, increasing access, decreasing travel time, and allowing for comfort and safety during care while also leaving gaps in care for patients without web/phone access and/or without a confidential place to participate in appointments, or to manage health concerns that require in-person evaluation. Providers have benefitted from the ability to reach TGD patients that are far from practice sites and to provide remote consultation for procedures and other interventions. Trainees have challenges as a result of telehealth practice which can impair the ability to learn in-person care, but have benefitted from remote training opportunities, including surgical training. Alterations in compensation structures have allowed sustainable telehealth practice to be an option for providers and health systems. As telehealth evolves, quality improvement and research efforts aimed at resolving known challenges and expanding beneficial uses of telehealth should consistently include and consider not only the beneficiaries of telehealth but also those who may struggle with access.

Alcohol and cannabis use during the COVID-19 pandemic among transgender, gender-diverse, and cisgender adults in Canada

BACKGROUND

This study examined whether heavy episodic drinking (HED), cannabis use, and subjective changes in alcohol and cannabis use during the COVID-19 pandemic differ between transgender and gender-diverse (TGD) and cisgender adults.

METHODS

Successive waves of web-based cross-sectional surveys.

SETTING

Canada, May 2020 to March 2021.

PARTICIPANTS

6,016 adults (39 TGD, 2,980 cisgender men, 2,984 cisgender women, and 13 preferred not to answer), aged ≥18 years.

MEASUREMENTS

Measures included self-reported HED (≥5 drinks on one or more occasions in the previous week for TGD and cisgender men and ≥4 for cisgender women) and any cannabis use in the previous week. Subjective changes in alcohol and cannabis use in the past week compared to before the pandemic were measured on a five-point Likert scale (1: much less to 5: much more). Binary and ordinal logistic regressions quantified differences between TGD and cisgender participants in alcohol and cannabis use, controlling for age, ethnoracial background, marital status, education, geographic location, and living arrangement.

RESULTS

Compared to cisgender participants, TGD participants were more likely to use cannabis (adjusted odds ratio (aOR)=3.78, 95%CI: 1.89, 7.53) and to have reported subjective increases in alcohol (adjusted proportional odds ratios (aPOR)= 2.00, 95%CI: 1.01, 3.95) and cannabis use (aPOR=4.56, 95%CI: 2.13, 9.78) relative to before the pandemic. Compared to cisgender women, TGD participants were more likely to use cannabis (aOR=4.43, 95%CI: 2.21, 8.87) and increase their consumption of alcohol (aPOR=2.05, 95%CI: 1.03, 4.05) and cannabis (aPOR=4.71, 95%CI: 2.18, 10.13). Compared to cisgender men, TGD participants were more likely to use cannabis (aOR=3.20, 95%CI: 1.60, 6.41) and increase their use of cannabis (aPOR=4.40, 95%CI: 2.04, 9.49). There were no significant differences in HED between TGD and cisgender participants and in subjective change in alcohol between TGD and cisgender men; however, the odds ratios were greater than one as expected.

CONCLUSIONS

Increased alcohol and cannabis use among TGD populations compared to before the pandemic may lead to increased health disparities. Accordingly, programs targeting the specific needs of TGD individuals should be prioritized.

The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic

OBJECTIVES

The SARS-CoV-2 (COVID-19) pandemic has had profound physical and mental health effects on populations around the world. Limited empirical research has used a gender-based lens to evaluate the mental health impacts of the pandemic, overlooking the impact of public health measures on marginalized groups, such as women, and the gender diverse community. This study used a gender-based analysis to determine the prevalence of psychosocial symptoms and substance use (alcohol and cannabis use in particular) by age, ethnicity, income, rurality, education level, Indigenous status, and sexual orientation.

METHODS

Participants in the study were recruited from previously established cohorts as a part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) study. Those who agreed to participate were asked to self-report symptoms of depression, anxiety, pandemic stress, loneliness, alcohol use, and cannabis use across five phases of the pandemic as well as retrospectively before the pandemic.

RESULTS

For all psychosocial outcomes, there was a significant effect of time with all five phases of the pandemic being associated with more symptoms of depression, anxiety, stress, and loneliness relative to pre-COVID levels (p < .0001). Gender was significantly associated with all outcomes (p < .0001) with men exhibiting lower scores (i.e., fewer symptoms) than women and gender diverse participants, and women exhibiting lower scores than the gender diverse group. Other significant predictors were age (younger populations experiencing more symptoms, p < .0001), ethnicity (Chinese/Taiwanese individuals experiencing fewer symptoms, p = .005), and Indigenous status (Indigenous individuals experiencing more symptoms, p < .0001). Alcohol use and cannabis use increased relative to pre-pandemic levels, and women reported a greater increase in cannabis use than men (p < .0001).

CONCLUSIONS

Our findings highlight the need for policy makers and leaders to prioritize women, gender-diverse individuals, and young people when tailoring public health measures for future pandemics.

Transgender-specific COVID-19-related stressors and their association with depressive symptoms among transgender adults: A nationwide cross-sectional survey in South Korea

Introduction

COVID-19 has disproportionately impacted marginalized groups, including transgender populations, reproducing and exacerbating inequalities and vulnerabilities that existed in those groups prior to the pandemic. This study aimed to assess the prevalence of transgender-specific COVID-19-related stressors and their association with depressive symptoms among South Korean transgender adults.

Methods

We conducted a nationwide cross-sectional study of 564 South Korean transgender adults (trans women, trans men, and nonbinary people) from October 7 to October 31, 2020. We measured four transgender-specific COVID-19-related stressors as follows: (A) had difficulty receiving gender-affirming healthcare due to economic hardship related to COVID-19, (B) had difficulty receiving gender-affirming healthcare due to limited access to hospitals under the COVID-19 situation, (C) had difficulty purchasing a public face mask due to gender information on an identification card, and (D) avoided getting a COVID-19 test in fear of unfair treatment and dirty looks due to gender identity, despite having COVID-19 symptoms. Past-week depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale.

Results

Of the total participants, 30.7% experienced any of the four transgender-specific COVID-19-related stressors, and 70.2% were classified as having depressive symptoms during the past week. We found statistically significant associations with depressive symptoms among participants who reported that they had difficulty receiving gender-affirming healthcare due to either economic hardship (adjusted prevalence ratio [aPR] = 1.20, 95% Confidence Interval [CI] = 1.05-1.37) or limited access to hospitals (aPR = 1.15, 95% CI = 1.00-1.32), respectively. Furthermore, those who had two or more of the four transgender-specific COVID-19-related stressors were 1.21 times (95% CI = 1.05-1.40) more likely to report depressive symptoms, compared to those who did not report any stressor.

Conclusion

Transgender-specific COVID-19-related stressors may negatively influence depressive symptoms among South Korean transgender adults. Given these findings, transgender-inclusive interventions should be implemented at the policy level during the COVID-19 pandemic in South Korea.

Beyond a Zero-Sum Game: How Does the Impact of COVID-19 Vary by Gender?

Epidemics and pandemics, like COVID-19, are not gender neutral. Much of the current work on gender, sex, and COVID-19, however, has seemed implicitly or explicitly to be attempting to demonstrate that either men or women have been hardest hit, treating differences between women and men as though it is not important to understand how each group is affected by the virus. This approach often leaves out the effect on gender and sexual minorities entirely. Believing that a more nuanced approach is needed now and for the future, we brought together a group of gender experts to answer the question: how are people of different genders impacted by COVID-19 and why? Individuals working in women's, men's, and LGBTQ health and wellbeing wrote sections to lay out the different ways that women, men, and gender and sexual minorities are affected by COVID-19. We demonstrate that there is not one group "most affected," but that many groups are affected, and we need to move beyond a zero-sum game and engage in ways to mutually identify and support marginalized groups.