(see Poster Gallery) Bathroom Access and Suicide Risk Among Transgender, Nonbinary, and Gender-Questioning Youth

Background:

Transgender youth are at elevated risk for suicide compared with their cisgender peers- including those who are lesbian, gay, or bisexual- due to minority stress. Recent anti-transgender legislation targets transgender youth by restricting their access to gender-affirming healthcare, school sports, and bathroom facilities that align with their gender identity. This study examines bathroom access among transgender, nonbinary, and gender-questioning (TNBGQ) youth ages 13 to 24, as well as the relationship between avoiding public restrooms and suicide risk.

Methods:

Data were collected from an online survey conducted between September 2021 and December 2021 of 33,993 LGBTQ youth recruited via targeted ads on social media. 19,970 respondents reported their gender identity to be TNBGQ and were included in this analysis. Adjusted logistic regression models were conducted to determine the association between avoiding public bathrooms in the last year and recent anxiety, recent depression, seriously considering suicide in the last year, and attempting suicide in the last year, while controlling for age, Census Region, socioeconomic status, race/ethnicity, gender identity, and sexual identity.

Findings:

TNBGQ youth reported various negative experiences while trying to access bathroom facilities. 43% of respondents reported that they had been prevented or discouraged from using a bathroom that corresponds with their gender identity. This occurred in a number of settings: 36% of youth experienced it at school, 22% at a place of business, 17% at a bar or restaurant, 13% at a doctor’s office or hospital, 10% at their workplace, and 10% in a government building.

TNBGQ youth also reported negative consequences due to avoiding using bathrooms in public. 65% of respondents reported not using the restroom when they needed to in public. 36% reported that they had avoided eating and drinking to try to prevent needing to use the restroom. 9% reported that they had gotten an urinary-tract infection due to not using the bathroom when they needed to. 1% reported kidney infection, and 1% reported other kidney-related problems.

The majority of TNBGQ respondents (69%) reported that they had avoided using public restrooms in the last year because they were afraid of having problems. 48% of respondents reported that they sometimes avoided bathrooms and 21% reported that they always avoided them.

Avoiding bathrooms due to fear in the last year was associated worse mental health and greater suicide risk. TGNBGQ youth who reported that they sometimes or always avoided bathrooms in the last year had greater odds of recent anxiety (aOR=1.72, p<.001), recent depression (aOR=1.66, p<.001), seriously considering suicide (aOR=1.61, p<.001), or attempting suicide in the last year (aOR=1.87, p<.001).

Conclusions:

These findings highlight the need to protect TNBGQ youths’ access to bathrooms that align with their gender identities in all public spaces. Recent attempts to restrict TNBGQ youths’ access to bathrooms and other single-gender facilities pose a threat to TNBGQ youths’ physical and mental health. Schools, workplaces, and public establishments should develop policies protecting bathroom access and establishing gender-neutral bathrooms.