Prevalence of Common Mental Health Problems Among Transgender and Non-Binary Individuals During the COVID-19 Pandemic: A Systematic Review & Meta-Analysis

Abstract

Introduction:

The COVID-19 pandemic has exacerbated the mental health challenges globally and adversely affected the marginalised populations, including transgender and non-binary (TNB) individuals. Despite evidence, there is a lacuna of a systematic synthesis explicitly focussing on the prevalence of screen-positive common mental health problems, as prior reviews either examined sexual and gender minority populations as a whole or overlooked the full scope of pandemic-related mental health challenges, which the current review seeks to address through systematic review and meta-analysis.

Methodology:

A comprehensive literature search was conducted across PubMed, Scopus, PsycINFO, and Web of Science, applying the PRISMA 2020 guidelines between March and August 2025. Eligible studies reporting the mental health outcomes of TNB individuals during the pandemic were screened, extracted, and critically appraised with the help of the COVIDENCE and JBI checklists for analytical cross-sectional studies. Meta-analyses were performed using a DerSimonian–Laird random effects model with the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment to estimate pooled prevalence with 95% confidence intervals. Heterogeneity was quantified with I² statistics.

Results:

For depression (n = 4,832), the screen-positive pooled prevalence was estimated as 0.59 (95% CI [0.47, 0.70]; I² = 98.23%). The pooled prevalence for screen-positive anxiety (n = 2,833) and substance (n = 1,632) use was 0.50(95% CI [0.37, 0.63]; I² = 94.04%) and 0.47 (95% CI [0.16, 0.79]; I² = 98.58%), respectively. It is identified that the pandemic reinforced existing healthcare disparities, with disrupted gender-affirming care (e.g. hormone therapy, surgeries) significantly associated with increased psychological distress and gender dysphoria among transgender and gender diverse individuals.

Conclusion:

Mental health problems among TNB individuals were markedly elevated during the COVID-19 pandemic, highlighting the urgent need for tailored mental health interventions, uninterrupted gender-affirming care, and policies that address systemic social stigma and discrimination. Strengthening telehealth, community-based supports, and inclusive public health strategies are essential to mitigate disparities and promote resilience in this population.

Keywords

transgender non-binary anxiety depression substance use COVID-19

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