Transgender individuals are more likely to experience discrimination, isolation, and a lack of social support. This, coupled with negative psychosocial challenges, like denying access to gender-neutral restrooms, combined with being a college student, and you have that associate professor of neurology, Shelley Hershner MD, calls it “a perfect storm” that can contribute to sleep disturbances and other mental health problems.
Hershner, who directs the University of Michigan Sleep Disorders University Clinic, she studies sleep among college students and now she and her colleagues are filling a void in research on the association between transgender individuals and sleep and mood disorders. Their 2021 study found that transgender college students have significantly higher altitudes diagnoses of insomnia, sleep and mood disorders and suicidal behavior, compared to their cisgender – having a gender identity that aligns with the sex a person was assigned at birth – peers.
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The study was published in Nature and the science of sleep, where Hershner and other authors analyzed self-reported data of 221,549 North American college students from The American College Health Association-National College Health Assessment II survey. This survey collects student data on health, behaviors and perceptions of health.
Of the 221,549 participants, 3,471 students reported identifying as transgender in the United States and 717 in Canada. The study showed that compared to cisgender students, transgender college students were: 35% more likely to sleep poorly; 51% more likely to have difficulty falling asleep 41% more likely to be 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, school performance, quality of life, GPA, and school maintenance, Hershner explained.
“College students are already at significant risk for sleep and mood problems, and when the added stress of being transgender, marginalization, discrimination and exclusion is added, it worsens their risk of being successful at a vulnerable time in their life,” she said. .
The researchers also found that the odds of depression and anxiety among transgender students compared to cisgender peers were also significant. According to their study, transgender individuals 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 this transgender students have higher odds suicide attempts and suicidal thoughts compared to cisgender students. Hershner reported that transgender college students are 345% more likely to consider suicide and 421% more likely to attempt suicide.
For Hershner, the next steps include finding solutions and interventions to improve sleep among transgender college students. Future research is also needed on whether gender affirmation therapy can improve mood and sleep disorders.
Equally important for further research? —Advocacy.
Hershner wants to use this additional information and resources to support gender-inclusive policies on college campuses.
Earlier this year, Michigan Medicine received full marks (100 points out of 100) on the Healthcare Equality Index, a national LGBTQ + benchmarking tool developed by the human rights campaign that evaluates health systems practices and policies for LGBTQ + patients, visitors and employees.
Hershner commends the evaluation along with LGBTQ Health Advancement Advisory Board at Michigan Medicine, designed to help treat and support LGBTQIA + patients, families and visitors. But his research indicates that more colleges and institutions must act to help support transgender people.
“Students must be able to use the chosen name; they must be able to declare their pronouns in health systems to avoid gender errors. There must also be gender-inclusive bathrooms and accommodation so that roommates are not simply chosen by legal sex. “Non-discrimination policies are crucial and each state will have to decide where things go from a legislative point of view,” said Hershner.
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 Nutrition 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, Bureau of Research; and Galit Levi Dunietz, Center for Sleep Disorders, Department of Neurology, University of Michigan.
Document cited: “Associations between transgender identity, sleep, mental health and suicide among a North American cohort of college students”, Nature and the science of sleep. DOI: 10.2147 / NSS.S286131
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