Exploring the Relationship Between Transgender Inclusive Providers and Mental Health Outcomes Among Transgender/Gender Variant People

Background and Purpose:

An estimated 0.3 – 5.0% of adults identify with a gender identity that falls somewhere within the transgender/gender variant umbrella, where their gender identity does not match the sex they were assigned at birth. These individuals experience higher rates of discrimination across multiple contexts than cisgender (non-transgender) individuals, including in health care settings. This study examines the mental health differences of transgender/gender variant people comparing those who report having transgender inclusive providers and those who do not. Specifically, it explores whether transgender/gender variant individuals who have transgender inclusive providers have different rates of current depression, lifetime anxiety, or suicidality within the past year compared with transgender/gender variant individual whose providers are not perceived to be transgender inclusive. Secondly, we examine how various socio-demographic variables further impact these relationships.

Methods:

Using the 2014 Colorado Transgender Health Survey (N=417) which collected health information and experiences regarding accessing health care from transgender/gender variant Coloradans, researchers compared rates of current depression, lifetime experience of anxiety, and suicidal thoughts within the past year between transgender/gender variant individuals who report having trans inclusive health providers and those who do not using Chi-Square tests of independence. Logistic regressions are then used to examine the relationship between having a trans inclusive health provider and likelihood of experiencing current depression, lifetime anxiety or suicidal thoughts in the past year, controlling for a number of correlates including access to health insurance, age, race/ethnicity, gender identity, and education level.

Results:

Data indicate that while many transgender/gender variant individuals experience current depression, lifetime anxiety, or suicidal thoughts in the past year, those who did not have trans inclusive providers were significantly more likely to experience current depression (X² (1, n = 351) = 8.552, p < .05) and suicidal thoughts (X² (1, n = 383) = 13.898, p < .001) in the past year. No differences were found in likelihood of lifetime anxiety. Having a trans inclusive provider was also significant when regressed for both current depression (OR = 0.56, 95% CI =[0.33, 0.96]) and suicidal thoughts (OR = 0.49, 95% CI =[0.29, 0.82]).  Gender was significant regarding suicidal thoughts in the past year, and educational levels were also significant across all three mental health outcomes.

Conclusion and Implications:

The findings suggest that increasing provider competence and inclusivity in working with the transgender community may be an important contributor to improving mental health outcomes for transgender/gender variant individuals. This might occur at the level of incorporating transgender cultural competence in the initial educational process for providers within their discipline, within the context of in-service trainings at provider institutions, or as continuing education opportunities. Educating health providers around transgender/gender variant cultural responsivity will prepare them to better serve their patients, and support the mental health of the transgender/gender variant individuals they interact with in their practice.