Transgender and Gender Diverse Identity, Mental Health Conditions, and Mental Health Care in U.S. Prisons.
Wilkinson L, Thompson M, Collett J • Journal of correctional health care : the official journal of the National Commission on Correctional Health Care • 2026
Transgender and gender diverse (TGD) individuals in U.S. prisons experience disproportionate mental health burdens relative to cisgender men and women, and disaggregating the TGD group reveals important within-group differences that methodological categorization decisions can obscure.
Key Findings
Results
TGD individuals in U.S. prisons experience a disproportionate mental health burden relative to cisgender men and women who are incarcerated.
Data source was the public-use 2016 Survey of Prison Inmates (SPI), a nationally representative survey of people incarcerated in U.S. state and federal prisons.
The study builds on the 'gendered pains of imprisonment' literature to contextualize mental health disparities.
TGD individuals were compared against both cisgender men and cisgender women as separate reference groups.
The stressful carceral environment is highlighted as a key theoretical mechanism contributing to psychological well-being differences.
Results
Disaggregating the TGD group reveals different mental health burdens among subgroups within the TGD population in prisons.
The study explicitly disaggregated the TGD group rather than treating it as a homogeneous category.
Within-group differences among TGD individuals would be obscured by aggregating all TGD respondents into a single category.
The paper emphasizes the 'methodological importance of understanding how decisions around the categorization of gender identity can differently impact our understanding of diverse individuals within the already-marginalized TGD population.'
This disaggregation approach expands on previous research that had treated TGD individuals as a single group.
Results
Methodological decisions about how to categorize gender identity significantly affect findings about mental health in prison populations.
The paper identifies the 'methodological task of categorizing gender identities' as a key analytic concern.
Different categorization schemes can produce different understandings of mental health burden among TGD subgroups.
The 2016 Survey of Prison Inmates is described as a 'public-use' dataset, meaning the gender identity measures available are those captured in that existing instrument.
The authors frame this as both a theoretical and methodological contribution to the correctional health literature.
Background
Prisons as total institutions organized around the sex/gender binary create gendered experiences of incarceration that vary dramatically by gender identity.
The theoretical framework draws on the concept of prisons as 'total institutions organized around the sex/gender binary.'
The 'pains of imprisonment' are experienced differently depending on gender identity.
This framework is used to explain why TGD individuals face elevated psychological burdens in carceral settings.
The study situates individual mental health outcomes within the broader structural context of gendered carceral environments.
Methods
The study used the 2016 Survey of Prison Inmates to examine mental health conditions and mental health care access among TGD and cisgender incarcerated people.
The 2016 Survey of Prison Inmates (SPI) is a nationally representative, public-use dataset.
Outcomes examined included mental health conditions and mental health care utilization.
The sample included TGD individuals, cisgender men, and cisgender women who are incarcerated.
This is described as an expansion of previous research on TGD mental health in correctional settings.
What This Means
This research suggests that transgender and gender diverse (TGD) people held in U.S. prisons face significantly higher rates of mental health problems compared to cisgender (non-transgender) men and women who are also incarcerated. The researchers used a large, nationally representative survey of people in U.S. prisons from 2016 to examine these differences. They argue that prisons, being institutions built around a strict male/female binary, create especially stressful conditions for people whose gender identity does not fit neatly into that binary, contributing to worse psychological outcomes.
Importantly, the study went beyond simply comparing 'transgender versus cisgender' people and instead broke down the TGD group into smaller subgroups. This revealed that not all TGD individuals in prison experience the same mental health burdens — there are meaningful differences within the TGD population that would be hidden if everyone were grouped together. The researchers also highlight that decisions researchers make about how to classify and group gender identities in data analysis can substantially change what the data appears to show, which has implications for how future studies should handle gender identity data.
This research suggests that correctional health systems may need to pay particular attention to the specific needs of TGD individuals, and that policy and research approaches that treat all TGD people as a single uniform group may miss important variation in who is most at risk. The findings underscore the role of the prison environment itself — not just individual characteristics — in shaping mental health outcomes for this already-marginalized population.
Wilkinson L, Thompson M, Collett J. (2026). Transgender and Gender Diverse Identity, Mental Health Conditions, and Mental Health Care in U.S. Prisons.. Journal of correctional health care : the official journal of the National Commission on Correctional Health Care. https://doi.org/10.1177/10783458261447499