The Association Between Family Planning and Psychological Distress in Individuals With Minoritized Gender Identities in Germany: A Cross-Sectional Study During the COVID-19 Pandemic

Abstract

Background: Among transgender and gender diverse (TGD) individuals there is an increasing desire for parenthood. TGD individuals must overcome unique legal, social and physiological obstacles to realize their desire to become parents. Indeed, since the onset of the COVID-19 pandemic, TGD individuals have experienced a significantly higher prevalence of anxiety and depression, which may be strenuous to all areas of life, including family planning. The aim of this study was to evaluate the impact of the COVID-19 pandemic in Germany on decisions regarding family formation in TGD compared to cisgender individuals, and what role psychological distress might play in this. Methods: The online survey included general demographic questions, domain-specific questions including gender identity and sexual orientation, questions related to psychological distress, the desire for parenthood as well as motives for and against parenthood. Results: The desire for parenthood was lower and the level of depressive symptoms was higher in TGD (n = 187) than in cisgender individuals (n = 2135) during the COVID-19 pandemic. Moreover, the desire for parenthood was associated with a lower level of depressive symptoms, younger age, having one or more children and living in an urban area. Further associations are higher scores in the desire for emotional stabilization, as well as lower scores in fear of personal constraints and the desire for social recognition. Conclusion: Our findings revealed that TGD individuals reported significantly higher levels of depressive symptoms compared to cisgender participants and expressed a lower desire for parenthood. These results highlight the need for targeted support from social services and health care providers, particularly in times of crisis such as the COVID-19 pandemic. Tailored interventions are essential to address the mental health burden and to reduce the additional hurdles TGD individuals face when considering parenthood.