BALTIMORE – A new global study has found the coronavirus pandemic has had a disproportionate impact on transgender people’s mental health and economic stability.

The study by a team of seven researchers from the Johns Hopkins Bloomberg School of Public Health and the University Center for Public Health and Human Rights found 77 percent of respondents expected a decrease in income. And more than half of them reported losing gender-affirming resources; including surgery delays, inability to purchase beauty products and other factors. 

The study is one of the first of its kind to analyze the intersections of economy, mental health and gender-affirming care for trans people.

The team was also purposeful in making the work community-based with equitably involving queer scientists in the study, said Brooke Jarrett, an author of the study who is a queer woman of color and a doctoral candidate in epidemiology at the university. 

“I think that this topic is something that … is always lit within us,” said Jarrett. “And so whenever I see an area where there’s an opportunity to highlight, to bring out our voices, I think it’s so important to do that.”

LGBT Foundation CEO Sean Howell, who is the founder of Hornet, a global queer dating app, also served as an author of the study.

He disseminated a survey on the app, as well as on the queer dating app Her, from April to August. It received responses from 76 countries that include Turkey, Thailand and Russia. More than 900 users participated in the survey, which was translated into 13 languages.

Howell said the team was purposeful in releasing and analyzing this data during the pandemic in hopes it will point to the need for changes to help trans and non-binary people economically and health-wise. 

The study found positive screens for depression and anxiety are correlated with access to gender-affirming care, and more than 40 percent of respondents reported losing access to mental health counseling. One in six respondents also expected to lose their health insurance.

Access to these resources is essential for trans and non-binary people, said Will Beckham, a study author and a queer trans man who focuses much of his work on trans research. Beckham also serves on Johns Hopkins University’s junior faculty.

He said delays in surgeries are related to symptoms of depression and anxiety. Beckham added losing access to health services or being unable to afford haircuts, binders and other gender-affirming products also have profound negative consequences on mental health.

“It’s not elective, it can be literally life-saving for someone to get a trans-related surgery when they need it,” he said. “Policies need to change, we need to grow the awareness that trans-related surgeries are not elective, but are actually essential medical services.”

Before focusing his research on LGBTQ and trans topics, Beckham focused his work on HIV and was completing research in Tanzania when he realized he was trans. He said he came back to the U.S. to “live fully” and transition. Beckham added limited access to gender-affirming care is a crucial issue that needs to be addressed, and medical and supply chain models need to be reformed to make surgeries deemed as essential.

In addition, a third of respondents reported an inability to live openly in their gender. This could be a result of youth moving back in with unsupportive families as a result of the pandemic, which correlated to positive screens for depression and anxiety.

“They’re having to live less in their affirmed gender, which certainly has an impact on mental health,” Beckham said. “I know very well personally, having been in the closet for a while in Tanzania.”

Jarrett said virtual health interventions, like therapy apps, need to be expanded and explored as a solution to this uptick in depression and anxiety. Beckham said health systems as a whole need to be more inclusive, as well.

Researchers said economic instability is also a notable aspect of the trans experience during the pandemic, with 77 percent of respondents indicating they expected a disruption in their income. More than half of respondents also reported needing and not receiving financial aid.

Jarrett said trans people already dealt with economic instability prior to the pandemic, and “live on the margins of society economically already, especially in places where there’s a lot of stigma and discrimination.” She added those who are employed often have unstable jobs that include casual labor and factory work.

“So when a thing like COVID hits, and there was a lot of job loss, they are the people already on those margins that are the most quickly kicked out of those places and spaces,” said Jarrett. 

Jarrett and Beckham said the amount of community-based assistance popping up during the pandemic for trans people in need is helpful, such as fundraising campaigns for rent payments or giving free haircuts. But they both said there is a need for systemic solutions, such as LGBTQ organizations expanding their advocacy for trans and non-binary people.

Howell said there aren’t government entities or non-profits that have been models in trans inclusion, and this study shows that fact. He said priorities need to be more balanced to better support trans and non-binary people.

“The community has often been put as an afterthought, and I think now we have evidence of a global health crisis that further exacerbated those things,” said Howell. “We’ve known this for quite a long time. But we have to take better action because there’s human factors that are being realized, more and more.”

The research team is currently expanding on this research and beginning new research focused on partner violence, surgery delays and digital mental healthcare during the pandemic.