Transgender and nonbinary young people's bathroom avoidance and mental health.

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, 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.