State-Level Pro- and Anti-Transgender and Gender-Diverse (TGD) Legislation and Mental Health Among TGD Young Adults in the United States

The United States has seen sharp increases in efforts to enact anti-TGD legislation at the state level, including limits on access to gender-affirming care, restrictions on access to public facilities, and constraints on public gender expression and presentation. Although existing research demonstrates that structural stigma generally leads to poorer mental health outcomes for TGD individuals and that protective laws (e.g., anti-bullying and non-discrimination laws) reduce such poor outcomes, the impact of newer anti-TGD state legislation on TGD mental health is unknown. Thus, the current study explores the relationship between state-level pro- and anti-TGD legislation and mental health outcomes of TGD Americans. Data are derived from the Healthy Minds Study from Spring 2022 to Spring 2023, yielding 8,149 TGD participants from 38 U.S. states. Multilevel modeling was used to examine relationships between state-level legislation passed in 2023 and individual-level mental health variables. State-level anti-TGD legislation was significantly associated with greater anxiety and suicidal ideation, whereas pro-TGD legislation was associated with reduced suicidal ideation. Education-related anti-TGD laws predicted higher anxiety and bathroom-related laws predicted more suicide attempts, while anti-bullying laws were associated with fewer suicide attempts and hate crime laws were associated with reduced anxiety. These results demonstrate the harm of anti-TGD state laws and the protective effect of pro-TGD laws on TGD mental health. Findings also highlight the importance of advocacy and civic engagement among clinicians working with TGD populations in order to effect structural changes that will improve TGD mental health.