Health ramifications of antitransgender legislation: Trends in mental distress from 2016 to 2023 in a nationally representative sample of transgender adults.

Laws and policies that target and restrict transgender- and gender-nonconforming (TGNC) individuals are increasing in the United States. Despite limited prior research, studies using nationally representative samples are needed to examine how these policies relate to TGNC mental health. This study used two data sources: the Behavioral Risk Factor Surveillance System for population mental health metrics and the Movement Advancement Project policy tallies. Using pooled annual state-based data from probability-based samples of adults from 2016 to 2023, we examined differences in prevalence and temporal trends of frequent mental distress between TGNC and cisgender respondents and across legislative environments. Weighted chi-square analyses, adjusted for age, were conducted, followed by the margins command in Stata to produce age-adjusted prevalence by year and assess temporal and legislative trends. Among 1,856,961 respondents, 0.50% were categorized as TGNC (n = 9,306). TGNC individuals had significantly higher prevalence of frequent mental distress each year (e.g., 2023: 47.3% TGNC vs. 15.1% cisgender). Disparities were most pronounced among adults aged 18-39 (2023: 52.6% TGNC vs. 20.3% cisgender). Among TGNC individuals, there was a 12% increased odds of frequent mental distress each year compared with 5% for cisgender individuals (aOR = 1.12, 95% CI [1.07, 1.16], p < .001 TGNC; aOR = 1.05, 95% CI [1.05, 1.06], p < .001). Trends across policy environments were less consistent, with elevated mental distress among TGNC individuals regardless of legislative support. Overall, findings indicate a persistent and widening mental health burden among TGNC adults, underscoring the need for targeted interventions across policy contexts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).