ORCID
https://orcid.org/0000-0001-7000-0004
Date of Award
Spring 2025
Language
English
Embargo Period
4-29-2025
Document Type
Dissertation
Degree Name
Doctor of Public Health (DrPH)
College/School/Department
Department of Health Policy, Management and Behavior
Program
Public Health
First Advisor
Emily Leckman-Westin
Committee Members
Marleen Radigan, Eric Y Frimpong
Keywords
Non-Binary Adults, Gender Recognition Act, Mental Health Services, Legal Gender Identity, New York State Policy
Subject Categories
Health Services Research
Abstract
This dissertation explores the impact of the 2021 New York State Gender Recognition Act (GRA) on mental health outcomes and service utilization among non-binary adults in the public mental health system. The GRA introduced pivotal legal reforms—including the option for an “X” gender marker and self-attestation for gender identity changes on state-issued documents—designed to affirm gender diversity and reduce structural barriers for transgender and non-binary populations. Guided by gender affirmation theory and minority stress frameworks, this study investigates how these legal shifts relate to changes in mental health service engagement and psychological well-being among non-binary individuals.
Using a difference-in-differences (DD) approach, this study draws on data from the New York State Office of Mental Health’s Patient Characteristics Survey (PCS) and linked Medicaid service claims to analyze patterns in mental health service encounters between 2019 and 2022. Analyses focus on adults identified as “Non-Binary (X)” or “Unknown” and compare them to a matched reference population of cisgender, heterosexual adults. Key outcomes include utilization patterns across outpatient (OP), inpatient (IP), and emergency services, as well as shifts in diagnostic profiles.
Findings reveal a marked increase in the number of individuals identifying as non-binary between 2019 and 2022, alongside elevated rates of mood and anxiety disorders. The largest changes occurred in outpatient mental health services, where non-binary individuals used these services much more frequently. Increased identity recognition and legal affirmation may encourage earlier and more frequent community-based care engagement, according to this change. At the same time, there was a non-significant but noticeable decline in the use of inpatient services. This trend might indicate a shift away from acute or crisis-driven care and toward longer-term, preventative outpatient interventions, which could be made easier by enhanced psychological health and less stigma after legal gender recognition. The findings imply that policy measures like the GRA may help reduce the severity and escalation of mental health conditions among non-binary individuals by promoting access to affirming, lower-intensity care pathways.
This study contributes to a growing body of literature on non-binary health by offering empirical evidence on the intersection of legal policy and mental health systems. It emphasizes how important inclusive laws are in determining access to care and the ongoing need for outpatient services that are gender affirming and catered to the unique requirements of non-binary communities.
License
This work is licensed under the University at Albany Standard Author Agreement.
Recommended Citation
Chaudhry, Sahil, "Impact of the New York State Gender Recognition Act on Mental Health Outcomes among Non-binary Adults Served by the New York Public Mental Health System" (2025). Electronic Theses & Dissertations (2024 - present). 159.
https://scholarsarchive.library.albany.edu/etd/159
