Transgender people are more likely to experience discrimination, isolation and lack of social support. This, along with negative psychosocial challenges, such as being denied access to gender-neutral toilets, combined with being a student, and you have some associate professor of neurology, Shelley Hershner MD† calls “a perfect storm” that can contribute to sleep disturbances and other mental health problems.
Hershner, who de College of Collegiate Sleep Disorders at the University of Michigan† studies sleep among college students, and now she and her colleagues are filling a void in research into the association of transgender people with sleep and mood disorders. Their 2021 study found that transgender students have considerable higher odds diagnosis of insomnia, sleep and mood disorders and suicidal behavior, compared to their cisgender — with a gender identity that matches the sex a person is assigned at birth — peers.
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The study is published in nature and science of sleep, where Hershner and fellow authors analyzed 221,549 self-reported data from North American college students from the American College Health Association-National College Health Assessment II survey. This research collects data from students about health, health behavior and perceptions.
Of the 221,549 participants, 3,471 students reported identifying as transgender in the US and 717 in Canada. The study found that compared to cisgender students, transgender students: were 35% more likely to have insufficient sleep; 51% more likely to have difficulty falling asleep; 41% more likely to feel sleepy during the day; and 245% more likely to be diagnosed or treated for a sleep disorder.
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Sleep quality can affect mood, academic performance, quality of life, GPA and school retention, Hershner explained.
“College students are already at significant risk for sleep and mood problems, and adding the added stress of transgender, marginalization, discrimination and exclusion increases their risk of being successful at a vulnerable time in their lives,” she said.
Researchers also found that the likelihood of depression and anxiety among transgender students compared to cisgender peers was also significant. According to their research, transgender people are 295% more likely to be diagnosed with depression and 253% more likely to be diagnosed with anxiety.
Hershner’s research also confirmed previous studies showing that: transgender students have higher chances of suicide attempts and suicidal ideation compared to cisgender students† Hershner reported that transgender students are 345% more likely to consider suicide and 421% more likely to commit suicide.
For Hershner, the next steps involve finding solutions and interventions to improve the sleep of transgender students. Future research is also needed on whether gender-affirming therapy can improve mood and sleep disorders.
Equally important for more research? — Advocacy.
Hershner wants to use this information and additional resources to advocate for gender-inclusive policies on college campuses.
Earlier this year, Michigan Medicine got a full score (100 points out of 100) on the Healthcare Equality Index, a national LGBTQ+ benchmarking tool developed by the Human Rights Campaign that evaluates health system practices and policies for LGBTQ+ patients, visitors and employees.
Hershner praises the review along with the Advisory Committee on the Promotion of LGBTQ Health at Michigan Medicine, designed to help care and support LGBTQIA+ patients, families and visitors. But her research shows that more colleges and institutions must act to help transgender people.
“Students should be able to use their chosen name; they must be able to list their pronouns in health systems to avoid gender mismatches. There should also be gender-inclusive bathrooms and gender-inclusive housing so that roommates are not chosen solely on the basis of legal gender. “Non-discrimination policies are crucial, and each state will have to decide where things go from a legislative standpoint,” Hershner said.
Paper authors include: Hershner, Shelley, MD, associate professor, Department of Neurology, Center for Sleep Disorders, University of Michigan, Ann Arbor, MI; Erica C Jansen, Department of Nutritional Sciences, University of Michigan School of Public Health; Ronald Gavidia, Center for Sleep Disorders, Department of Neurology, University of Michigan; Lisa Matlen, Department of Pediatrics, Center for Sleep Disorders, University of Michigan; Mary Hoban, American College Health Association, research firm; and Galit Levi Dunietz, Center for Sleep Disorders, Department of Neurology, University of Michigan.
Cited article: “Associations Between Transgender Identity, Sleep, Mental Health, and Suicidality in a North American Cohort of College Students,” Nature and science of sleep† DOI: 10.2147/NSS.S286131
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