In 2023, state legislatures across the United States passed an unprecedented number of laws targeting transgender and gender-diverse people. Restrictions on access to gender-affirming care, limits on the use of bathrooms and public facilities, and obstacles to expressing one’s identity multiplied across dozens of states. The obvious question followed: does that legislative climate leave a measurable mark on the mental health of those who live under it? A study published in American Psychologist has put numbers to that suspicion with a sample of 8,149 transgender and gender-diverse people drawn from 38 states.
The work draws on the Healthy Minds Study, a US college survey, and gathers the participants who identify as transgender or gender-diverse between the spring of 2022 and the spring of 2023. On that base, the authors applied a multilevel model — which separates the effect of the state from the individual effect — to relate the laws passed in 2023 to several mental health indicators: suicidal ideation, suicide attempts and depressive symptoms. This is not an experiment, but an observation of one particular year at the highest resolution available.
The results paint an uncomfortable pattern. Overall, living in a state with more legislation opposed to transgender people appeared to be moderately associated with greater suicidal ideation. The detail was even more telling: laws restricting sports participation predicted higher suicidal ideation, and laws limiting access to bathrooms predicted more suicide attempts among transgender youth in those states. Protective legislation — the kind that expands rights and shields against discrimination — was not, by contrast, associated with an equivalent improvement in mental health. The harm shows up more sharply than the benefit.
The authors’ reading connects to a concept already established in public health: structural stigma. When the norms and laws of a territory mark a group as suspect or second-class, that message does not stay at the symbolic level: it seeps into daily life, into the family, into school and into the clinic. The data suggest that growing up in an environment that recognises one’s identity is not the same as growing up in one that legally questions it. That difference is measurable, and it shows up in indicators of distress.
The study does not measure the biological basis of identity or of gender dysphoria: what it describes is how the mental health of transgender people responds to the legal environment around them. Even so, it speaks directly to the core of the clinical problem, because gender incongruence is lived in a concrete social context. For those who care for this population, the authors stress a practical consequence: clinical work does not end in the consulting room. Advocating for policies that protect transgender people, and the civic engagement of professionals, are part of the health response. They also warn of the risk that new restrictive federal policies would represent, whose impact on suicide in this population could be considerable.
Its limits should not be overlooked. It is an observational study, with self-reported data and an association that was moderate, not conclusive, across the whole sample; the cross-sectional nature itself prevents us from stating that the laws directly cause the observed changes. The sample also comes from college students, leaving out those who never reach that setting. But the signal is consistent with prior evidence on structural stigma and mental health, and it points to a clear message: when a law is written against an identity, it does not only cut back a right — it also leaves a measurable mark on those who live it.
Source: State-level pro- and anti-transgender and gender-diverse (TGD) legislation and mental health among TGD young adults in the United States. Pellicane MJ, Weixel T, Ciesla JA. American Psychologist 2026;81(6):785-795. DOI: 10.1037/amp0001661.
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