Transgender-Inclusive Health Care and Delaying Care Due to Fear: Connections to Mental Health and General Health Among Trans* Adults

Background/purpose

Transgender and gender non-conforming individuals face a variety of risks for discrimination, harassment, and violence that impact their psychosocial well-being. Discrimination occurs even at the hands of healthcare professionals who are supposed to improve patients’ well-being. Fear of discrimination can prevent transgender people from pursuing the health care that they need.

However, few studies have assessed how access to transgender-inclusive healthcare and fear of provider discrimination relate to mental health and general health. With this background in mind, the present study utilizes statewide health data from 417 transgender adults to explore: Do lack of access to transgender-inclusive health care and delaying medical care due to fear of discrimination predict poorer mental health and general health among transgender adults?

Methods

This project involved secondary data analysis of a statewide community-based survey of 417 transgender adults in the Rocky Mountain region. Survey questions were modeled on the CDC's Behavioral Risk Factor Surveillance System, with input from community organizations and transgender individuals. The sample was recruited in 2014 through advertisement by LGBT organizations, health providers, universities, and religious communities.

Predictor variables of interest included delaying care due to fear of discrimination, as well as measures of health care provider inclusivity—such as comfort with transgender patients, ability to address transgender-specific health needs, and inclusive policies and forms—as reported by transgender respondents. Dependent variables included current depression, being told by a provider that one has depression, lifetime suicide attempt, suicidal ideation, being told by a provider that one has anxiety, poor mental health, and general health. We utilized multiple linear regression and logistic regression to examine the research question of interest.

Results

Almost half (45.3%, n=178) of this sample identified as women/transgender women, 30.5% (n=120) as men/transgender men, and 18.3% (n=72) as gender queer/gender fluid. The majority (88.4%, n=352) were White, and 8.8% (n=35) were multiracial; 6.8% (n=28) were Hispanic. Compared to CDC data for the state, the sample had high rates of depression (63.4% to 18.2%) and a physical, mental or emotional problem that limits activities (47.3% to 18.8%).

Multiple and logistic regression results suggest that delaying health care due to fear of discrimination is significantly predictive (p < .05) of poorer health for each outcome examined. Additionally, having a health care provider who did not address transgender-specific health needs predicted greater likelihood of being told one has depression (B=0.93, AOR=2.52, p < .05) or anxiety (B=0.72, AOR=2.06, p<.05).

Conclusions and Implications

This study highlights the ways that transgender-inclusive health care and delaying care due to fear of discrimination are associated with mental health and general health among transgender adults. Delaying care due to fear of discrimination was an over-arching risk factor associated with poorer health outcomes in this population, highlighting the importance of enacting transgender-affirming health care practice. Further, results suggest that providers’ inability to respond to transgender-specific health care needs, such as hormone therapy, relates to poorer mental health among transgender patients. This presentation will highlight key implications for social work practice in health and mental health settings.