Psychological distress and COVID-19 pandemic-associated mental healthcare barriers among transgender and nonbinary adults with disabilities in the United States and Puerto Rico

Background Transgender and nonbinary (TNB) communities were disproportionately affected by the COVID-19 pandemic, experience significant mental health inequities, and are more likely to have disabilities than cisgender people. This study assessed how severe psychological distress among TNB adults with disabilities was affected by COVID-19 pandemic-associated barriers to mental healthcare in the US. Methods Self-reported data from 2,013 TNB adults from the LITE-Connect 2021–2022 cross-sectional online survey were analyzed. Participants were asked whether they had a disability as defined under the Americans with Disabilities Act. Severe psychological distress 30 days prior was measured using the Kessler-6 scale (score ≥13). Poisson regression examined the relationship between disability, distress, and mental healthcare barriers, adjusting for demographics and pandemic-related impacts. Results The sample median age was 23 years (range = 18–61 years); 70.7% were White, 13.8% Black, 7.1% another race, and 8.4% multiple races; 30.3% were transgender men, 28.1% transgender women, and 41.6% nonbinary. Overall, 30.3% of participants had a disability. Disabled participants had a significantly higher prevalence of severe psychological distress (76.6%) versus participants without disabilities (47.2%). Effect size was greater among those without mental healthcare barriers (adjusted prevalence ratio [aPR] = 2.29; 95% confidence interval [95%CI] = 1.64–3.20) than those with barriers (aPR = 1.25; 95%CI = 1.16–1.35). Conclusions Removing healthcare barriers alone may not sufficiently address severe psychological distress among disabled TNB adults and therefore may have implications on quality of life. Understanding this population’s needs remains essential, particularly during times of restricted inclusive services and widespread funding cuts targeting TNB and disabled communities, to inform interventions and services to address mental health needs.