Background: Transgender and nonbinary young people report disparities in both physical and mental health due to negative experiences associated with their identity. Despite bathrooms being an everyday necessity, transgender and nonbinary young people may avoid using them due to previous negative experiences or anxieties surrounding them, which may be related to poor health. This study examines the association of avoiding public bathrooms and mental health indicators among transgender and nonbinary young people.

Methods: Data were collected in 2021 via a cross-sectional survey of 33,993 lesbian, gay, bisexual, transgender, queer, and questioning young people ages 13-24, including 12,596 transgender or nonbinary young people. Bivariate analyses were used to examine the prevalence of avoiding public bathrooms and the health issues associated with that avoidance. Adjusted logistic regression models examined whether sometimes or always avoiding public bathrooms was associated with higher rates of anxiety symptoms, depression symptoms, and suicide risk.

Results: In the past year, 49% of transgender and nonbinary young people reported sometimes avoiding public bathrooms due to concerns around using them and 22% always avoided them. Respondents reported a number of negative physical effects from avoiding public bathrooms: 67% reported "holding it" when they needed to use the bathroom and 38% abstained from drinking or eating to avoid using these facilities. Transgender and nonbinary young people who reported sometimes or always avoiding public bathrooms reported significantly higher odds of all assessed mental health indicators. Notably, those who reported always or sometimes avoiding public bathrooms had almost twice the odds of attempting suicide in the past year (aOR = 1.95, 95% CI = 1.77-2.16, p < .001) compared to their transgender and nonbinary peers who never reported avoiding public bathrooms.

Conclusions: These findings highlight the need for policies protecting transgender and nonbinary young people's safety and access to public bathrooms, which align with their gender identity.

Implications and contributions: Transgender and nonbinary young people report poorer mental health and higher suicide risk than their cisgender peers. Avoiding public bathrooms when one needs to use them can result in negative physical health problems and, in our sample, is associated with worse mental health and higher suicide risk. These findings demonstrate that implementing inclusive bathroom policies may improve physical and mental health and decrease suicide risk among transgender and nonbinary young people.

Keywords: Bathroom access; LGBTQ youth mental health; nonbinary youth; suicide; transgender youth.

© 2024 Taylor & Francis Group, LLC.

背景: 变性人和非二元性别年轻人因与身份相关的负面经历报告了身体和心理健康方面的差异。尽管厕所是日常生活中的必需品，但变性和非二元性别年轻人可能会因为之前的负面经历或对使用公共厕所的焦虑而避免使用它们，这可能与健康状况不佳有关。本研究探讨了避开公共厕所与变性人和非二元性别年轻人群体的心理健康指标之间的关联。

方法: 2021年通过横断面调查收集了33,993名年龄在13-24岁之间、包括12,596名变性或非二元性别年轻人群体的LGBTQ年轻人的数据。使用双变量分析来研究避开公共厕所的流行率及其相关的健康问题。调整后的逻辑回归模型考察了有时或总是避免使用公共厕所是否与焦虑症状、抑郁症状和自杀风险较高相关。

结果: 在过去一年中，49%的变性人和非二元性别年轻人因担心而有时避开公共厕所，22%的人一直避开。受访者报告了许多由于避免使用公共厕所而导致的身体负面效果：67%的人表示他们在需要如厕时憋尿，38%的人为了不使用这些设施而减少了饮水或进食。变性人和非二元性别年轻人如果报告有时或总是避开公共厕所，则所有评估的心理健康指标的可能性显著更高。值得注意的是，那些报告一直或有时避开公共厕所的年轻人在过去一年中尝试自杀的几率几乎是从未报告避开公共厕所的年轻人的两倍（调整后的优势比=1.95，95%置信区间=1.77-2.16, p

结论: 这些发现强调了制定保护变性和非二元性别年轻人安全和公共厕所使用权的政策的重要性，这些政策与他们的性别认同相一致。

影响及贡献: 变性人和非二元性别年轻人群体的心理健康状况较差，自杀风险高于顺性别同伴。需要使用厕所时却避免使用会导致身体健康问题，并且在我们的样本中，这与更差的心理健康状况和更高的自杀风险相关。这些发现表明实施包容性的厕所政策可能会改善变性和非二元性别年轻人的身心健康并降低其自杀风险。

关键词: 厕所使用权；LGBTQ青少年心理健康；非二元青少年；自杀；变性青少年。