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A study of the largest sample of transgender people ever surveyed found that possession of gender-concordant ID is associated with a lower rate of suicidal thoughts and suicidal planning, and a reduction in psychological stress among transgender people.

Published in The Lancet Public Health Journal, the study drew upon data from a survey of more than 20 thousand American trans adults.

1.4 million Americans identify as transgender and it is estimated more than half of them have clinical depression. In the general population 30 per cent have clinical depression. Among those who identify as transgender, 31 to 41 per cent attempt suicide during their lifetime, compared with less than 9 per cent in the general US population.

The researchers say that one of the factors behind this mental health disparity is lack of recognition of trans people’s gender identity.

“Legal gender recognition — a trans person's right to have identity documents that match their name and gender — is a critical policy issue for trans communities globally. ID is so fundamental for social and civic participation and access to basic services. Most non-trans people take their IDs for granted (notably excluding undocumented people), and we found it interesting that this topic had also been overlooked in trans health research to date,” Dr Ayden Scheim, co-author of the study and a researcher from Drexel University told Theravive. 

“My co-author Greta Bauer and I had conducted a study in Canada looking at a wide range of factors, including gender-concordant ID, that might impact suicide risk among trans people and we found that suicide risk was lower among trans men and women with gender-concordant ID. In conducting this study, we wanted to design an analysis specifically to address the relationship between gender-concordant ID and multiple measures of mental health for trans people (including non-binary trans people), and to consider both the name and gender marker listed on ID.” 

Trans people without a gender-concordant official document can struggle to access essential services like education, healthcare and employment. It also increases their risk for violence and harassment. 

Previous research has found that if trans people have at least one document that showed their preferred gender, this was associated with fewer thoughts of suicide and suicide attempts. As well as this, previous research has found that if a transgender adolescents’ preferred name is used socially, mental health risks are reduced.

In undertaking this research, the authors looked at data from 22 286 trans people surveyed in 2015. They were asked whether none, some, or all of their IDs including birth certificates, passports and drivers’ licences had their preferred name and gender marker. A scale of zero to 24 was used to measure psychological distress, with a score of 13 or more being indicative of serious psychological distress. Those surveyed were also asked whether they had considered suicide in the previous year, whether they had made plans for suicide or whether they had made an attempt at suicide.

The researchers found that just over 45 per cent of those surveyed didn’t have an ID with their preferred name or gender marker. Just over 44 per cent had at least some form of ID that matched their name and/or gender, but just under 11 per cent had their preferred gender and name on all of their identity documents.

“We think that there are multiple potential pathways by which gender-concordant ID impacts mental health. Having one’s gender affirmed in interpersonal interactions and by institutions may improve mental health. On the contrary, having ID that doesn’t match one’s identity and gender presentation can “out” people as trans in all types of interactions, for example purchasing, voting, entering secure buildings, going to bars and when accessing services,” Scheim said.   

“The US Transgender Survey found that people who presented an ID that did not match their gender presentation often had negative experiences — 25 per cent had been verbally harassed and 16 per cent had been denied service. In addition to those direct experiences, we know that fear and anticipation of harassment or discrimination can negatively impact mental health.” 

He argues that governments could play a crucial role in reducing psychological distress among members of the trans community, by making it easier to procure documents that accurately reflect their identity. 

“They can reduce barriers to making name and gender marker changes on ID: this includes eliminating requirements that trans people have surgery or any medical intervention in order to change their gender marker, reducing or eliminating fees, and not requiring court orders for name changes. Second, they can reconsider gender classification policies, including expanding options, for example, adding a gender-neutral X option) or eliminating gender markers on ID altogether, since they serve very little use for confirming one’s identity,” he said.