Disparities in depression and anxiety at the intersection of race and gender identity in a large community health sample.

Background: Persons of color experience are disproportionately impacted by poor mental health compared to White individuals, as are gender diverse populations relative to cisgender individuals. Yet, few studies have assessed differences in common mental health disorders at the intersection of race and gender identity.

Methods: Using health record data from an urban US community health center in Massachusetts that primarily serves LGBTQIA + communities, we organized patients (N = 29,988) into 24 race and gender identity categories, pairing four race groups (White, Black, Asian, and another race, which was inclusive of Native American/Alaskan, Native Hawaiian, Multiracial, and other) with six gender identity groups (cisgender men and women, transgender men and women, nonbinary individuals assigned male and female at birth [AMAB/AFAB]). We compared the severity of self-reported symptoms of depression and anxiety and the likelihood of meeting diagnostic thresholds across the four race categories within three gender groups (cisgender and transgender men, cisgender and transgender women, nonbinary individuals).

Results: Depression and anxiety symptom severity differed within men and women; transgender men and women across races had higher severity than cisgender men and women. In nonbinary individuals, symptom severity was high and consistent across the race groups. Differences were observed in the likelihood of meeting clinical thresholds for depression and anxiety across races in men and women, reflecting the pattern described above. Nonbinary participants across races had high likelihood of meeting the thresholds for both diagnoses (29.2%-47.1%). The likelihood of meeting the depression and anxiety thresholds were highest among Black nonbinary AFAB adults (44.4%) and transgender women in the another race category (48.7%), respectively.

Conclusion: In this unique sample, differences in depression and anxiety symptom severity and likely diagnoses suggest disparities among nonbinary individuals across races, as well as among transgender men and women grouped into the another race category and women who identify as Black. Focused mental health strategies tailored to address race and gender identity may be critical to proactively address these disparities.