Non-binary gender identity associates with decreased functioning during an exceptional societal stress. A university community study during COVID-19 pandemic in Finland

Abstract Background and Aim Individuals with non-binary gender commonly face minority stress such as invisibility, identity invalidation or even hostility within various social contexts. The COVID-19 pandemic represented an exceptional form of societal stress that presented mental health challenges in the population and probably even more so for vulnerable groups including non-binary gender individuals. We investigated whether there are gender differences in the impact of the COVID-19 pandemic on functional ability. Method University students and personnel (n=1998) responded to an online survey in May 2021, when the measures for preventing COVID-19 infections had sustained about a year and a half. Based on the gender option responses, groups of non-binary and binary (male or female) gender identity were formed. Current functioning (FUNCT), and subjective assessment of the effect of COVID-19 on functioning (COFUNCT) were recorded. Psychosocial and mental health characteristics were included in the statistical models. Results The non-binary group represented 3,6 % of all study participants. The gender option “Male” was selected by 23.8% and the gender option “Female” by 72.7% of respondents. Compared to the binary group, those in the non-binary group exhibited poorer socioeconomic living situation and less favourable previous psychosocial development. Non-binary participants reported lower FUNCT and more negative COFUNCT than binary participants. In non-binary participants, a poor work situation was directly associated with poor FUNCT, while multiple adverse childhood experiences and loneliness were indirectly associated with lower FUNCT via depressive symptoms. Conversely, high family support and previous mental health care were directly associated with more negative COFUNCT, and loneliness was indirectly associated with low COFUNCT via depression. In binary participants, family support, good economy, resilience and active physical exercise associated with good FUNCT, while age, family support, good economy, resilience, active physical exercise and adverse childhood experiences associated with good COFUNCT. Conclusions Individuals with non-binary gender are more vulnerable for functional deficits in a period of serious societal stress such as COVID-19 pandemic. The related psychosocial and mental health factors should be taken into account when planning tailored interventions for vulnerable groups during periods of exceptional societal circumstances. Graphical abstract