Sample characteristics by mental health outcomes (n=849)
| Total sample N (%) or M (SD) | Anxiety | Depression | |||||
| Screened positive N (%) or M (SD) | Screened negative N (%) or M (SD) | χ2 or t-test | Screened positive N (%) or M (SD) | Screened negative N (%) or M (SD) | χ2 or t-test | ||
| Total | 849 (100.00%) | 389 (45.82%) | 460 (54.18%) | 432 (50.88%) | 417 (49.12%) | ||
| Demographic (control) variables | |||||||
| Gender | |||||||
| Non-binary | 583 (68.67) | 248 (63.75) | 335 (72.83) | 0.017* | 276 (63.89) | 307 (73.62) | 0.004** |
| Trans feminine | 233 (27.44) | 124 (31.88) | 109 (23.70) | 140 (32.41) | 93 (22.30) | ||
| Trans masculine | 33 (3.89) | 17 (4.37) | 16 (3.48) | 16 (3.70) | 17 (4.08) | ||
| Age (years) | |||||||
| 18–29 | 437 (51.47) | 213 (54.76) | 224 (48.70) | <0.001*** | 243 (56.25) | 194 (46.54) | <0.001*** |
| 30–39 | 249 (29.33) | 129 (33.16) | 120 (26.09) | 137 (31.71) | 112 (26.86) | ||
| 20–49 | 112 (13.19) | 39 (10.03) | 73 (15.87) | 42 (9.72) | 70 (16.79) | ||
| 50+ | 51 (6.01) | 8 (2.06) | 43 (9.35) | 10 (2.31) | 41 (9.83) | ||
| Education attained | |||||||
| Less than college | 177 (20.97) | 95 (24.48) | 82 (17.98) | 0.021* | 112 (25.99) | 65 (15.74) | <0.001*** |
| Some college or more | 667 (79.03) | 293 (75.52) | 374 (82.02) | 319 (74.01) | 348 (84.26) | ||
| Socioeconomic level status | |||||||
| Lower | 127 (14.99) | 79 (20.31) | 48 (10.48) | <0.001*** | 87 (20.19) | 40 (9.62) | <0.001*** |
| Middle | 683 (80.64) | 293 (75.32) | 390 (85.15) | 323 (74.94) | 360 (86.54) | ||
| Upper | 37 (4.37) | 17 (4.37) | 20 (4.37) | 21 (4.87) | 16 (3.85) | ||
| WHO region | |||||||
| Europe | 382 (46.30) | 189 (49.74) | 193 (43.37) | <0.001*** | 224 (53.21) | 158 (39.11) | <0.001*** |
| South-East Asia | 215 (26.06) | 64 (16.84) | 151 (33.93) | 64 (15.20) | 151 (37.38) | ||
| Americas | 81 (9.82) | 48 (12.63) | 33 (7.42) | 46 (10.93) | 35 (8.66) | ||
| Eastern Mediterranean | 76 (9.21) | 47 (12.37) | 29 (6.52) | 48 (11.40) | 28 (6.93) | ||
| Western Pacific | 40 (4.85) | 16 (4.21) | 24 (5.39) | 21 (4.99) | 19 (4.70) | ||
| Africa | 31 (3.76) | 16 (4.21) | 15 (3.37) | 18 (4.28) | 13 (3.22) | ||
| Immigrant status | |||||||
| Yes | 103 (12.32) | 53 (13.84) | 50 (11.04) | 0.352 | 62 (14.62) | 41 (9.95) | 0.075 |
| No | 662 (79.19) | 295 (77.02) | 367 (81.02) | 323 (76.18) | 339 (82.28) | ||
| Unsure | 71 (8.49) | 35 (9.14) | 36 (7.95) | 39 (9.20) | 32 (7.77) | ||
| Natural environmental-level variable | |||||||
| COVID-19 pandemic environment | |||||||
| Ever lack masked | |||||||
| Yes | 112 (13.22) | 69 (17.74) | 43 (9.39) | <0.001*** | 76 (17.59) | 36 (8.67) | <0.001*** |
| No | 735 (86.78) | 320 (82.26) | 415 (90.16) | 356 (82.41) | 379 (91.33) | ||
| In a stay-at-home order | |||||||
| Yes | 651 (76.86) | 299 (77.06) | 352 (76.69) | 0.898 | 326 (75.64) | 325 (78.12) | 0.391 |
| No | 196 (23.14) | 89 (22.94) | 107 (23.31) | 105 (24.36) | 91 (21.88) | ||
| Social/Community-level variables | |||||||
| Socioeconomic loss impact | |||||||
| Reduced income (anticipated) | |||||||
| Yes | 607 (72.87) | 278 (72.77) | 329 (72.95) | 0.955 | 315 (74.12) | 292 (71.57) | 0.408 |
| No | 226 (27.13) | 104 (27.23) | 122 (27.05) | 110 (25.88) | 116 (28.43) | ||
| Job loss/Unemployment (anticipated) | |||||||
| Yes | 132 (15.64) | 86 (22.11) | 46 (10.11) | <0.001*** | 87 (20.19) | 45 (10.90) | <0.001*** |
| No | 712 (84.36) | 303 (77.89) | 409 (89.89) | 344 (79.81) | 368 (89.10) | ||
| Insurance loss (anticipated) | |||||||
| Yes | 99 (16.39) | 57 (21.27) | 42 (12.50) | 0.004** | 63 (20.59) | 36 (12.08) | <0.005** |
| No | 505 (83.61) | 211 (78.73) | 294 (87.50) | 243 (79.41) | 262 (87.92) | ||
| Cutting meals | |||||||
| Yes | 299 (37.52) | 189 (51.50) | 110 (25.58) | <0.001*** | 201 (49.63) | 98 (25.00) | <0.001*** |
| No | 498 (62.48) | 178 (48.50) | 320 (74.42) | 204 (50.37) | 294 (75.00) | ||
| Reduction in gender affirmation services | |||||||
| Hormone therapy† (n=346) | |||||||
| Yes | 115 (33.24) | 70 (45.75) | 45 (23.32) | <0.001*** | 78 (46.99) | 37 (20.56) | <0.001*** |
| No | 231 (66.76) | 83 (54.25) | 148 (76.68) | 88 (53.01) | 143 (79.44) | ||
| Surgical aftercare† (n=318) | |||||||
| Yes | 99 (31.13) | 53 (39.55) | 46 (25.00) | 0.006** | 59 (40.97) | 40 (22.99) | 0.001** |
| No | 219 (68.87) | 81 (60.45) | 138 (75.00) | 85 (59.03) | 134 (77.01) | ||
| Cosmetic supplies and services† (n=459) | |||||||
| Yes | 168 (36.60) | 93 (46.27) | 75 (29.07) | <0.001*** | 102 (45.54) | 66 (28.09) | <0.001*** |
| No | 291 (63.40) | 108 (53.73) | 183 (70.93) | 122 (54.46) | 169 (71.91) | ||
| Mental health counselling† (n=407) | |||||||
| Yes | 168 (41.28) | 96 (52.46) | 72 (32.14) | <0.001*** | 102 (51.26) | 66 (31.73) | <0.001*** |
| No | 239 (58.72) | 87 (47.54) | 152 (67.86) | 97 (48.74) | 142 (68.27) | ||
| Body modifiers† (n=402) | |||||||
| Yes | 134 (33.33) | 75 (42.86) | 59 (25.99) | <0.001*** | 85 (44.50) | 49 (23.22) | <0.001*** |
| No | 268 (66.67) | 100 (57.14) | 168 (74.01) | 106 (55.50) | 162 (76.78) | ||
Column percentages are reported. Sample sizes stratified by variables may not add up to total sample size due to missingness.
*P<0.05, **p<0.01, ***p<0.001.
†Applicable to participants who received gender affirmation services prior to COVID-19 pandemic.
Trans, transgender.