LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People (original) (raw)
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Canadian Journal of Community Mental Health, 2011
While depression is understudied in transgender and transsexual communities, high prevalences have been reported. This paper presents original research from the Trans PULSE Project, an Ontario-wide, community-based initiative that surveyed 433 participants using respondent-driven sampling. The purpose of this analysis was to determine the prevalence of, and risk and protective factors for, depression among female-to-male (FTM) Ontarians (n=207). We estimate that 66.4% of FTMs have symptomatology consistent with depression. In multivariable analyses, sexual satisfaction was a strong protective factor. Conversely, experiencing transphobia and being at the stage of planning but not having begun a medical transition (hormones and/or surgery) adversely affected mental health in FTMs.
Assessment of Health Conditions and Health Service Use Among Transgender Patients in Canada
JAMA Network Open, 2020
IMPORTANCE Transgender individuals experience stigma, discrimination, and socioeconomic disadvantages, leading to a myriad of poor health outcomes and high rates of disease burden; however, transgender health continues to be an understudied area. OBJECTIVE To examine sociodemographic characteristics, health conditions, and health service utilization patterns among transgender individuals compared with the general population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 2085 transgender individuals from 3 large cities in Ontario, Canada, compared characteristics and health service use among transgender individuals with the general population in the province. Transgender individuals were identified through data obtained from 4 outpatient community and hospital clinics, which were linked with health administrative data between. Individuals were age-matched 1:5 to a random 5% sample of the general Ontario population (10 425 individuals). MAIN OUTCOMES AND MEASURES Sociodemographic variables, health service use, and chronic conditions among transgender individuals and the general population were compared. RESULTS This study included a sample of 2085 transgender individuals with a mean (SD) age of 30.40 (12.81) years; 771 (37.0%) identified as transgender women. Compared with 10 425 cisgender controls, trangender individuals were more likely to live in lower-income neighborhoods (lowest-income quintile: 625 [30.0%] vs 2197 [21.1%]; P < .001) and experience chronic physical and mental health conditions, including higher rates of asthma (489 [23.5%] vs 2034 [19.5%]; P < .001), diabetes (115 [5.5%] vs 352 [3.4%]; P < .001), chronic obstructive pulmonary disease (51 [2.4%] vs 156 [1.5%]; P < .001), and HIV (34 [1.6%] vs 12 [0.1%]; P < .001). Comorbid chronic health conditions were higher among the transgender population compared with the cisgender population (702 [33.7%] vs 2941 [28.2%]; P < .001). Transgender individuals also had higher health service use compared with the general population, particularly for mental health and self-harm, including mean (SD) number of psychiatrist visits between January 2012 and December 2016 (8.25 [23.13] vs 0.93 [9.57]; standardized difference, 5.84). CONCLUSIONS AND RELEVANCE This study found higher rates of mental and physical comorbidities and higher health service use among transgender individuals compared with cisgender individuals. Further research should explore reasons for these findings. Clinicians caring for transgender individuals should be aware of the high potential for mental health issues and self-harm.
Transgender Health, 2016
This study assessed within a Midwestern LGBT population whether, and the extent to which, transgender identity was associated with elevated odds of reported discrimination, depression symptoms, and suicide attempts. Methods: Based on survey data collected online from respondents who self-identified as lesbian, gay, bisexual, and/or transgender persons over the age of 19 in Nebraska in 2010, this study performed bivariate t-or chisquare tests and multivariate logistic regression analysis to examine differences in reported discrimination, depression symptoms, suicide attempts, and self-acceptance of LGBT identity between 91 transgender and 676 nontransgender respondents. Results: After controlling for the effects of selected confounders, transgender identity was associated with higher odds of reported discrimination (OR = 2.63, p < 0.01), depression symptoms (OR = 2.33, p < 0.05), and attempted suicides (OR = 2.59, p < 0.01) when compared with nontransgender individuals. Self-acceptance of LGBT identity was associated with substantially lower odds of reporting depression symptoms (OR = 0.46, p < 0.001). Conclusion: Relative to nontransgender LGB individuals, transgender individuals were more likely to report discrimination, depression symptoms, and attempted suicides. Lack of self-acceptance of LGBT identity was associated with depression symptoms among transgender individuals.
Depression in Male-to-Female Transgender Ontarians: Results from the Trans PULSE Project
Canadian Journal of Community Mental Health, 2011
The authors thank Rupert Raj for providing valuable comments with regard to the mental health of trans people at the initial phases of this paper, Todd Coleman for translation of the abstract into French, and Michael Rotondi for his assistance in coding clustering variables. The authors also thank the Trans PULSE Community Engagement Team and the many trans people who shared their experiences for this study. Finally, N.K. Rotondi is currently affiliated with the Health Systems and Health Equity Research Group at the Centre for Addiction and Mental Health (Toronto, ON). Support to CAMH for salary of scientists and infrastructure has been provided by the Ontario Ministry of Health and Long-Term Care.
Health & social care in the community, 2017
This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ-9 Questionnaire for Depression was completed by 704 people via Internet or pen-and-paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction...
A Call to Action: The Urgent Need for Trans Inclusive Measures in Mental Health Research
Transgender (trans) is a term used to describe people whose gender identity does not match the sex assigned to them at birth. 1 Gender expansive refers to a wide range of gender identities and expressions that expand and broaden definitions of gender-normative identities and are neither "male" nor "female," including nonbinary, genderqueer, and gender fluid. 2 Population studies yielding prevalence data for transgender (trans) people have estimated that 0.5% to 1.3% of adults identify as trans and that there are approximately 25 million trans people worldwide. 3 However, decades of poor data collection and a lack of understanding and acknowledgment of the wide range of gender identities that exist along the gender spectrum have resulted in underestimates of the size of the trans population. Trans and gender expansive people frequently face discrimination, stigma, violence, and barriers accessing housing, employment, and education. 3 Trans and gender expansive people also experience major challenges accessing trans competent and affirming physical and mental health services, leading to a high prevalence of adverse health outcomes. The Trans PULSE study 6 investigated the health and wellbeing of trans people living in Ontario through surveys administered to 433 trans participants over the age of 16. Numerous significant and alarming findings were reported, including that 77% of trans people had seriously considered suicide and 43% had attempted suicide at some point in their lives and that 21% of trans people reported avoiding the emergency department when they needed it because of previous stigma and discrimination associated with their gender identity. The Canadian Transgender Youth Health Survey 9 investigated the health of trans and gender expansive youth between 14 and 25 years across Canada. Nine hundred surveys were completed by young people in all provinces and territories except Nunavut and the Yukon. Key findings included that only 15% of youth with a family physician felt comfortable discussing their trans related health needs, 1 in 3 young people reported not having an adult in their family with whom they could talk about problems, 7 in 10 young people that felt their family did not understand them, and young people living in their felt gender all of the time were 50% more likely to report good or excellent mental health. Stigma associated with gender identity can be further intensified when individuals experience the intersection of trans identities and marginalizing conditions such as preexisting mental illness. 10
Differential Experiences of Mental Health among Trans/Gender Diverse Adults in Michigan
International Journal of Environmental Research and Public Health, 2020
Transgender and gender diverse individuals experience high rates of health disparities, as compared with their cisgender (non-transgender) counterparts. One area in which these disparities is most grave is that of mental health, with some studies indicating transgender and gender diverse individuals as having a 40% rate of lifetime suicide attempts and similarly high rates of depression, anxiety, and suicidal ideation. These rates vary further within this population, with differential rates seen across sociodemographic factors, including race/ethnicity, gender, sexual orientation, disability status, education level, and income. This study explores mental health experiences across different social identities, using data from the 2018 Michigan Trans Health Survey (N = 659), a community-based participatory action research project collected in Michigan, United States, analyzed using chi-square tests of independence and logistic regressions. Findings indicate incredibly high rates of men...
BMC health services research, 2017
Evidence suggests that transgender (trans) individuals in Canada are a medically underserved population; barriers range from lack of provider knowledge on trans issues to refusal of care. This paper provides the first formal estimation of health care inequalities between trans and cisgender individuals in Ontario, Canada. Weighted statistics from the Ontario-wide Trans PULSE Project (n = 433) were compared with age-standardized Ontario data from the Canadian Community Health Survey (n = 39,980) to produce standardized prevalence differences (SPDs). Analysis was also conducted separately for trans men and trans women, each compared to the age-standardized Ontario population. An estimated 33.2% (26.4,40.9) of trans Ontarians reported a past-year unmet health care need in excess of the 10.7% expected based on the age-standardized Ontario population. Inequality was greatest comparing trans with cisgender men (SPD = 34.4% (23.0, 46.1). While trans Ontarians evaluated health care availabi...
PLOS ONE, 2021
There is a paucity of population health data on the experiences of transgender, non-binary, and other gender minority gay, bisexual, and queer men, and Two-Spirit people in Canada. To address this gap, this article presents a socio-demographic and health profile of trans and non-binary participants from the community-based bilingual 2018 Sex Now Survey. Participants were recruited in-person from Pride festivals in 15 communities to self-complete an anonymous paper-and-pen questionnaire. To be eligible, participants needed to be at least 15 years old, live in Canada, either report a non-heterosexual sexual identity or report sex with a man in the past 5 years, and not report gender identity as a woman. Through community consultations the survey was inclusive of trans men, non-binary people, and Two-Spirit people. Three gender groups (cisgender, transgender, and non-binary) were created, and trans and non-binary participants were compared with their cisgender peers across a variety of...
Journal of affective disorders, 2018
Depression is a serious disorder which significantly impacts wellbeing and quality of life. Studies exploring mental wellbeing in the transgender population are mostly limited by small, non-homogenous samples and lack of matched controls. This study aimed to address these limitations and explore depression rates in a large sample of transgender people, compared with matched controls from the general population, as well as factors predicting depression in those taking cross-sex hormone treatment (CHT) compared to those not. Transgender individuals (n = 913) completed a measure of depression, measures which predict psychopathology (self-esteem, victimization, social support, interpersonal problems), and information regarding CHT use. Participants were matched by age and experienced gender with adults from the general population who had completed the measure of depression. Individuals were categorized as having no, possible or probable depressive disorder. Transgender individuals not o...