Background: Those who identify as transgender or gender nonbinary (TGNB) report
increased substance use and higher rates of mental health concerns when compared to cisgender populations. People with disabilities also report increased substance use and adverse mental health outcomes when compared to non-disabled samples. People with disabilities may be at risk for increased pain, which has been associated with adverse mental health outcomes. Research on substance use and mental health within samples of TGNB individuals with disabilities is lacking. In fact, the intersection of disability identity and TGNB identity is desperately understudied, even though this multi-marginalized group has been shown to be at risk of numerous adverse health outcomes.
Method: A survey of disabled TGNB adults in the United States (N=289) was conducted using the Prolific platform. Participants completed measures assessing demographics, depression (PHQ-9), anxiety (GAD-7), pain (Global Pain Scale), cannabis use, and potential cannabis use disorder (Cannabis Use Disorder Identification Test; CUDIT).
Results: Participants had a mean age of 31.5 years; 60.6% of the sample identified their gender as nonbinary, and 66.1% of the sample identified as White/European-American. In terms of disability, 78.2% had a cognitive impairment, while 49.5% had a mobility-related disability; 60.6% reported having a disability that was invisible in nature while 35.5% reported a disability that was semi-visible in nature. 56.1% of the sample reported cannabis use in the past 6 months. Among those who reported cannabis use, 46.3% had CUDIT scores suggesting hazardous use, and 30.9% indicated potential cannabis use disorder. CUDIT scores were correlated with pain (r = .29, p<.001) and depression (r=.25, p<.01), but not with anxiety (r=.10, p<.25). In a multiple regression analysis controlling for demographic factors (age, race/ethnicity, income, education), both depression (β = .33, p<.01) and pain (β = .23, p<.01) significantly predicted CUDIT scores.
Discussion: These results indicate that disabled TGNB individuals with elevated pain and depression levels may be turning to cannabis as a solution. This could mean that disabled TGNB individuals may not be receiving adequate care for their pain and depression. Future research should explore why disabled TGNB individuals are turning to cannabis and how to better serve this underrepresented community.