Food Insecurity and Mental Health Outcomes Among Transgender and Gender-Diverse Communities in the United States Post-COVID-19

Abstract

A growing body of literature has shown that people in the transgender and gender-diverse (TGD) community have worse health outcomes than cisgender (cis) people, including higher rates of poor mental health. Additionally, during COVID-19, TGD persons experienced higher rates of food insecurity. In this article, we extend the literature by looking at new data in the post-COVID-19 period, a period of greater stability. Using data from the U.S. Census Household Pulse Survey (HPS), we explore the relationship between gender identity and health outcomes. The HPS began collecting data on gender identity of participants from July 2021. We analyze responses from 1.2 million survey participants between July 2021 and May 2023. Using an ordinary least squares regression model with state and week fixed effects, we show that, on average, TGD people are seven percentage points more likely to report experiencing food insecurity compared with cis persons. TGD persons also report more symptoms of depression (six percentage points) and anxiety (four percentage points) than cis persons. These results hold after controlling for the socioeconomic, demographic, and sexual identity characteristics of the individuals, suggesting that this gender identity imposes an additional cost that cannot be explained by social determinants of health. We find that health insurance and the Supplemental Nutrition Assistance Program do not provide very much protection to TGD individuals. In summary, our article suggests the need for safety nets that target specific contextual and institutional challenges faced by TGD communities to reduce health disparities across the country.