History of anxiety, depression, and post-traumatic stress disorder diagnoses among midlife and older transfeminine and transmasculine adults in the United States: A cross-sectional analysis within the STRONG cohort

INTRODUCTION: Little is known about anxiety, depression, and post-traumatic stress disorder (PTSD) diagnoses among midlife and older transgender adults (aged 45 years and older). METHODS: This analysis used electronic health record data from the Study of Transition, Outcomes, and Gender, and included transfeminine (TF;n = 3080) and transmasculine (TM;n = 1705) adults aged 45+, along with demographically matched cisgender men (CM) and cisgender women (CW). History of anxiety, depression, and PTSD diagnoses among TF and TM adults and their CM and CW referents was examined. Estimates were calculated overall and stratified by age groups (45-54, 55-64, 65-74, 75+). Analyses were repeated among subgroups (gender-affirming hormone therapy (GAHT) receipt, minoritized ethnoracial status). Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated using Poisson regression. RESULTS: aPRs (95% CI) comparing TF to CM were 2.16 (2.08, 2.23) for anxiety, 2.77 (2.66, 2.89) for depression, and 7.11 (6.16, 8.20) for PTSD; corresponding TF versus CW estimates were 1.38 (1.34, 1.42), 1.65 (1.59, 1.71), and 3.27 (2.89, 3.71). Among TM adults, aPRs versus CM were 2.36 (2.26, 2.46) for anxiety, 3.18 (3.02, 3.34) for depression, and 11.12 (9.49, 13.04) for PTSD; corresponding estimates versus CW were 1.49 (1.44, 1.54), 1.80 (1.73, 1.88), and 4.76 (4.20, 5.39). Elevated prevalence was observed across age strata and among those with evidence of GAHT receipt and was more pronounced among individuals from minoritized ethnoracial groups. CONCLUSION: Anxiety, depression, and PTSD prevalence were substantially higher among TF and TM adults than among matched cisgender referents. Mental health disparities were evident across midlife and older adulthood, underscoring the need for interventions and policies that support equitable mental health among transgender adults.