1 - (SYM 108) Disparities in Depression and Anxiety Symptom Severity at the Intersection of Race and Gender Identity in a Large Community Health Sample

Background: Black, Indigenous, and other persons of color (BIPOC) experience disproportionately high mental health symptom severity compared to White individuals, as do transgender and gender diverse populations relative to cisgender individuals. However, few studies have assessed differences in common mental health disorders at the intersection of race and gender identity, limiting our understanding of populations that may need to be prioritized for treatment.

Methods: Using electronic health record data from a community health center, we organized patients into 24 race*gender identity categories, with four race groups (White, Black, Asian, Other; Other was inclusive of Native American/Alaskan, Native Hawaiian, Multiracial) each paired with six gender identity groups (cisgender men and women, transgender men and women, nonbinary individuals assigned male and female at birth [AMAB/AFAB]). Inclusion criteria were: aged ≥18; attended a medical appointment between 10/2015 and 10/2018; and completed at least one PHQ-9 or GAD-7. For ease of interpretation, we compared the (1) severity of self-reported depression and anxiety and the (2) likelihood of meeting clinical thresholds (PHQ-9 >10, GAD-7 > 8) across the four race categories within three gender groups (cis and transmen, cis and transwomen, nonbinary individuals AMAB and AFAB).

Results: Participants (N=29,988) had an average age of 33.9 years (SD=13.1). There were significant differences in depression and anxiety symptom severity across race within men (F=43.3, F=27.3, ps< .001) and women (F=52.5, F=24.1, ps< .001), but not in nonbinary individuals. With respect to the likelihood of meeting clinical thresholds, significant differences were observed across race in men (χ²=177.8, p< .001) and women (χ²=259.6, p< .001), and the same was true for anxiety (χ²=123.8 and χ²=107.6, ps< .001); there were no significant differences across race among nonbinary participants. The likelihood of meeting for depression was highest among Black nonbinary AFAB participants (44.4%); the likelihood of meeting for anxiety was highest among Other transwomen (48.7%).

 




Conclusion:

There were striking differences in depression and anxiety symptom severity at the intersection of race and gender, with patterns suggesting significant disparities among nonbinary individuals across race, as well as among Black and transgender men and women who identified with Other races. Targeted prevention and treatment strategies that take intersectionality into account are critical to address these disparities.