Abstract / Summary
Existing reviews of mental health outcomes among trans and gender diverse (trans)people have been limited by incomplete coverage, restricted or selected samples, afocus on youth populations, and insufficient exploration of heterogeneity. We aimed togenerate pooled prevalence estimates, and examine variation in mental disorders,suicidality, and non-suicidal selfinjury (NSSI) among trans adults globally. Weconducted a systematic review and meta-analysis of studies reporting current orlifetime prevalence of mental disorders, assessed using symptom screeninginstruments with validated general-population thresholds or clinical diagnoses,alongside self-reported suicidality and NSSI. MEDLINE, Embase, and PsycINFO weresearched from January 1, 1990-April 7, 2026. Restricted or highly selectedsubpopulations were excluded, except for gender-affirming clinic samples. Estimateswere calculated overall and by gender identity. Subgroup/meta-regression analysesexamined variation by study and sociodemographic characteristics. We identified 207studies with 134,071 trans participants across 52 countries. Pooled prevalenceestimates, combining symptoms exceeding screening thresholds and clinicallydiagnosed disorders, were 40.1% (95% CI 35.6-44.8) for depression, 29.8% (20.3-40.2) for anxiety, and 23.6% (14.9-33.5) for post-traumatic stress disorder. Past-12-month prevalence was 43.1% (38.9-47.3) for suicidal ideation, 9.3%(7.7-11.0) forsuicide attempts, and 26.1% (20.4-32.2) for NSSI. Limited data suggested higherprevalences among non-binary participants. Prevalence estimates varied significantlyby assessment method, recruitment setting, and geographic region. Trans peopleexperience a substantial burden of mental disorders, suicidality, and NSSI. Elevatedprevalence relative to general population comparator estimates indicates a need for affirming, accessible mental healthcare and improved approaches to assessing andinterpreting mental health outcomes in trans populations.