Bridging Clinical and Scientific Gaps: A Systematic Review of Trauma-Informed Care for Transgender Individuals in India

Background and Purpose: This presentation summarises a systematic review that assesses healthcare disparities for transgender individuals in India, alongside insights into transgender mental health issues globally, particularly in the United States. In accordance with the Sustainable Development Goals' inclusivity principle of "Leave No One Behind," it emphasises the widespread prevalence of trauma within transgender communities, notably severe socio-familial adversities in the U.S. that lead to homelessness and mental health crises among LGBTQ+ youth. This review highlights a critical shortage of specialised health services for transgender individuals in India, exacerbated by cultural and systemic barriers. There is an urgent need for enhanced research and understanding to develop policies and clinical practices that address the trauma experienced by this community. Implementing trauma-informed care is crucial for improving health outcomes and ensuring the full societal participation of transgender individuals, aligning with global human rights standards. Method:This systematic review focused on the trauma and mental health challenges of transgender individuals in India. We conducted a detailed search across multiple electronic databases including PsycINFO, ProQuest, Cochrane CENTRAL, and Medline, restricted to peer-reviewed journals in English. Search terms such as 'transgender,' 'trauma,' 'mental health,' 'discrimination,' 'abuse,' and 'healthcare access' were used to ensure comprehensive coverage of relevant studies. The inclusion criteria, based on the PICO framework, targeted societal discrimination, abuse, healthcare accessibility, and mental health outcomes. Initially, 19,200 records were identified and screened using Covidence software to facilitate data extraction and review management. Results: Seven pivotal studies were included in the review, focusing on mental health disparities among transgender individuals in India. These studies targeted trauma-informed care interventions in clinical settings, aiming to reduce discrimination, violence, and improve healthcare access. Analysis of a comprehensive survey involving 4,072 individuals, including 485 transgender respondents, revealed significant barriers to HIV services (aOR: 3.80), increased instances of gender-based violence (aOR: 2.63), and severe mental health symptoms. Additionally, a literacy study across Indian states highlighted pronounced disparities, with literacy rates varying from over 84% in Kerala and Mizoram to as low as 44.35% in Bihar, indicating substantial regional differences in health education accessibility. The review also reveals significant gaps in the clinical and academic understanding of transgender trauma in India, highlighted by alarming statistics such as a 50% suicide attempt rate by the age of twenty. Conclusion: The systematic review identifies significant challenges for transgender individuals in India, including pervasive trauma histories, mental health disparities, systemic discrimination, limited healthcare access, and a notable deficiency in specialised services and clinical understanding, necessitating urgent implementation of trauma-informed care and inclusive policy reforms. Such efforts could aim to establish a more inclusive and empathetic healthcare framework, thereby enhancing discourse on gender equality and mental health and highlighting the importance of trauma-informed care in improving the mental well-being of India's transgender population.