State-level gender-affirming healthcare policy and depressive symptoms among LGBTQ+ youth

U.S. states vary in their level of support and protection for transgender and gender diverse youth. Few studies have examined associations between state-level policy affecting access to gender-affirming healthcare (GAC) and mental health among these youth. This study examines the association between the GAC Index, a composite index that includes four state-level policies affecting access to GAC, and individual-level depressive symptoms in a national sample of LGBTQ + adolescents (N = 10,513) cross-sectionally in 2017. Multilevel linear regression models adjusted for individual and state-level demographic and socioeconomic covariates suggest that better access to gender-affirming healthcare (a higher score on the GAC Index) is associated with a lower frequency of depressive symptoms among gender diverse youth but not transgender youth or cisgender LGBQ+ youth. This research contributes to the understanding of the association between state policy environment and mental health for transgender and gender diverse youth.