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Mental Health Needs of People Who Identify as Transgender: A Review of the Literature
Abstract
Transgender people face many challenges in society including accessing and using healthcare systems. However, little is known about the specific mental health service needs and concerns of transgender people in this regard. The aim of the study was to establish the mental health service needs of transgender people through a review of relevant studies that address the experiences and views of this group. A comprehensive search of CINHAL, Cochrane, Google Scholar, PubMed, PsychInfo, PsychLit, Sociological Abstracts, Scopus, and Web of Science databases from inception to January 2014 was conducted. Studies were identified that met specific criteria that included: using qualitative methods, involving transgender people, and addressing issues related to mental health services. The search yielded 217 papers in total. Following the application of rigorous inclusion and exclusion criteria 33 papers were included for retrieval. Finally, 10 papers were considered suitable for the review. The data were analyzed and key themes identified. The review highlighted distinct challenges that exist in terms of mental health service provision. These included accessing appropriate services and treatments, responsiveness of practitioner’s, the provision of family supports and potential mental health service developments. The review findings are discussed and key recommendations are made in terms of mental health nursing practice developments, education and research.
... While we were unable to identify research comparing barriers to service access between TGDNB and cisgender populations, several studies have identified a range of barriers experienced by TGDNB individuals that are likely to limit their capacity to access and continue with mental health support. These barriers include the cost of services, time constraints, and distance to services (McCann & Sharek, 2016;Shipherd et al., 2010). ...
... Specific needs of TGDNB people accessing services include being treated with understanding, sensitivity, and respect and for interventions to attend to minority stressors specific to the individual (e.g. discrimination, internalised stigma; Austin & Craig, 2015;McCann & Sharek, 2016). It is likely that these needs are not being consistently addressed by mental health professionals when providing services to TGDNB people, and this might explain the high rates of dissatisfaction with services in the present study. ...
... Thus, we cannot assume that the results generalise to cultural minority groups. Despite this, results were similar to those found in previous national and international research in this area, including service use and barriers to accessing services McCann & Sharek, 2016;Shipherd et al., 2010). It is important to note that we used medium effect sizes for sample size calculations in order to identify meaningful effects when accounting for a relatively small sample size. ...
Introduction
Transgender, gender diverse, and non-binary people (TGDNB) access mental health services more frequently compared to the cisgender population, yet they continue to experience significant unmet mental health needs. The present study examined rates of mental health service use, satisfaction with services, barriers to service access, and help-seeking intentions in a sample of TGDNB adults in Australia. In addition, we examined whether barriers to service access were associated with help-seeking intentions.
Methods
Participants were 150 TGDNB adults (Mage = 37.19, SD = 15.73) who reported transfeminine (n = 77), transmasculine (n = 37), or non-binary (n = 36) genders. Self-reported recency of service use, satisfaction with services, barriers to service access, and help-seeking intentions were obtained in an online questionnaire, completed in 2016.
Results
Most participants had accessed mental health services in the past 6 months (55.3%). However, less than two thirds were either very satisfied (28%) or somewhat satisfied (32.7%) with these services. Common barriers to accessing services included a lack of professionals adequately trained and competent to work with TGDNB people, the cost of services, and concern with being treated poorly. Barriers to accessing services were negatively associated with help-seeking intentions, and stigma-related barriers had a greater negative effect on help-seeking intentions when satisfaction with prior services was low.
Conclusions
TGDNB adults face multiple barriers to accessing mental health services, many of which appear to predict help-seeking intentions.
Policy Implications
Implications and future research directions are discussed, with particular emphasis on ways to reduce barriers to service access for TGDNB adults.
... Because transgender people are more likely to experience poor mental health than cisgender people, being able to access adequate clinical psychology care is crucial . Transgender people often struggle to access care from a clinical psychologist who is affirmative of their gender identity (McCann & Sharek, 2016;Riggs et al., 2015). Providing transgender-affirmative care is an important competency for clinical psychologists, as recognized by recent guidelines issued by the American Psychological Association (2015; see also Singh & dickey, 2016). ...
... A current deficiency of training on how to provide culturally competent care for transgender individuals means mental health practitioners are often unaware of the stressors faced by transgender people, tend to pathologize transgender clients' experiences, and put the onus on transgender clients to educate them about transgender issues (McCann & Sharek, 2016), which is known as "educational burdening" (Mizock & Lundquist, 2016). Riggs and Sion (2017) demonstrated that cisgender psychology students and mental health practitioners held negative perceptions of transgender people, more so among cisgender men than cisgender women. ...
... Social and institutional stigma around gender identity has long limited the amount of education about transgender health care included in health curricula; for example, in medical schools (Poteat et al., 2013). Though many academics and institutions such as the American College of Physicians have recently recommended that education about transgender health care be included in health professionals' training (e.g., Daniel & Butkus, 2015;Jaffee et al., 2016;Korpaisarn & Safer, 2018;McCann & Sharek, 2016), this education remains scarce or nonexistent (Gamble Blakey & Treharne, 2019;Korpaisarn & Safer, 2018;Obedin-Maliver et al., 2011;Taylor et al., 2018). Most research into this issue focusses on medical schools. ...
Transgender people experience physical and mental health disparities relative to cisgender people. These health disparities are maintained by a paucity of health care practitioners with knowledge of transgender health care. Clinical psychologists who apply gender affirming care are one of the central health care practitioners for transgender people. Educational interventions involving transgender community members can improve health practitioners’ knowledge and attitudes about supporting transgender clients, particularly when delivered during training programs. The study aimed to explore the perspectives and educational needs of clinical psychology students in Aotearoa New Zealand around providing culturally competent care for transgender clients. Three focus groups were conducted with eight clinical psychology students across all years of training (n = 3, 3, 2) alongside transgender community members (n = 2, 2, 3) who attended as community “ambassadors” after community consultation. Thematic analysis of focus group data led to the development of three themes. The first theme was about how participants wanted to learn more about the experiences of transgender people so they could more confidently support transgender clients. The second theme was about how participants found that participating in a focus group with transgender ambassadors helped fill some gaps in their knowledge about transgender health care. The third theme was about the ways participants thought transgender community members could be included in teaching sessions, while balancing some logistical constraints in the clinical psychology program. These findings support the notion that clinical psychology students would benefit from learning about transgender health care during their training, particularly with input from transgender community members.
... Finally, while attitudes toward help-seeking behavior in transgender populations have been explored extensively in developed countries (for reviews, see [54][55][56]), only a handful of studies have studied transgender populations in non-Western developing countries such as Pakistan [57][58][59]. ...
... Consistent with the theory of minority stress [56], transgender individuals in many regions worldwide suffer rejection, discrimination, and prejudice, resulting in both lack of opportunities and resources; that is, conditions that impart high levels of distress and risk to mental well-being and health. The adverse effects of the multiple levels of stigma are captured in the concept of "gender stress theory", the idea that stigma-related stressors attached to one's gender identity may seriously affect both one's health and their health-related opportunities for treatment [71][72][73][74]. ...
Barriers to help-seeking behaviors in transgender populations in non-Western contexts are both understudied and poorly understood. Using a quantitative cross-sectional design, this study examined the psychological help-seeking attitudes of 109 transgender persons from Pakistan in relation to their psychological distress and attitudes toward sexuality. This research further identified which components of distress (stress, anxiety, or depression) were stronger predictors and assessed the role of particular demographic/behavioral factors in help-seeking attitudes. Participants completed three validated assessment tools translated into Urdu: Beliefs about Psychological Services Scale, the Depression, Anxiety, and Stress Scale (DASS-21), and the Sexual Attitude Scale. The results indicated that psychological distress predicted expertness and intent but not stigma tolerance. Post hoc analysis using DASS-21 subscales revealed that stress and anxiety were the stronger predictors of attitudes related to expertness and intent. The Sexual Attitude Scale marginally predicted stigma tolerance directly and also moderated the relationship between psychological distress and help-seeking attitudes for stigma tolerance. Finally, a role for demographic/behavioral factors-possibly serving as a proxy for mental health literacy-was identified for stigma tolerance. These findings reiterate the importance of tailored mental health awareness initiatives within the transgender community in non-Western settings and highlight the need for qualitative research to further understand the dynamics of psychological distress along with other linked factors.
... The results on connection to the TGD community in terms of contact with other TGD people were surprising. It would be expected that especially isolated TGD service users, who have no or little community contact, would benefit more clearly by being connected to a TGD-specific e-health service (James et al., 2017;McCann & Sharek, 2016;Renner et al., 2021;Rosenkrantz et al., 2017). It should be emphasized, however, that due to the COVID-19 pandemic, social contacts were limited for all TGD people and shifted more to the digital Koehler et al., 2023). ...
... The strength of the study lies in its inclusion of TGD people from remote areas often neglected in research (Renner et al., 2021), highlighting the heterogeneity within the TGD community. These considerations underscore the need for HCPs to empower their TGD service users in a diversity-sensitive manner, acknowledging the varied experiences within this population (de Vries et al., 2020;McCann & Sharek, 2016). ...
Background
Transgender and gender diverse (TGD) people, particularly those living in underserved remote areas, often face barriers to accessing primary and specialty healthcare services due to geographic isolation and the scarcity of trained professionals in these regions. While e-health interventions have gained prominence in TGD-informed healthcare, no research to date has examined their subgroup-specific effectiveness in addressing the challenges faced by TGD people.
Aim
This study aimed to investigate the responsiveness of various subgroups within the TGD population in Germany to the i²TransHealth e-health intervention, shedding light on its potential to mitigate disparities in healthcare access and outcomes through digital solutions such as video consultations and chat conversations.
Methods
In this secondary analysis of a randomized controlled trial (RCT) conducted in Hamburg, Germany, involving 174 TGD study participants from four northern federal states of the country, we assessed the impact of the i²TransHealth e-health intervention on psychological distress.
Results
Subgroup analyses revealed that i²TransHealth demonstrated effectiveness for TGD individuals overall, with higher age and education levels being associated with greater reductions in psychological distress. Clinically meaningful differences in treatment effectiveness were not observed in other subgroup variables, including residence size.
Conclusion
E-health interventions like i²TransHealth offer promise in addressing the specific challenges faced by TGD people, particularly those in underserved remote areas. To enhance inclusivity and equity, interventions should consider the diverse needs of this population, emphasizing the importance of tailored approaches that accommodate varying educational backgrounds and geographic contexts.
The trial was pre-registered at Clinicaltrials.gov (NCT04290286).
... Due to the increased prevalence of psychiatric diagnosis and likely complexities in clinical presentation resulting from repeated minority stress, it is important that mental health providers ensure that TGD patients receive adequate assessment and treatment that is both evidence-based and gender-affirming. Studies have highlighted that dissatisfaction felt by TGD individuals during the course of mental health treatment is largely due to inflexibility, treatment providers' lack of experience/competence with or sensitivity/responsiveness toward experiences related to gender, and enacted stigma and discrimination; conversely, satisfaction with treatment is associated with welcoming and inclusive environments, use of gender-affirming techniques, respect for patients' gender identity, experience/competence with gender experiences, and strong therapeutic alliance (Duffy et al., 2016;Kattari et al., 2016;McCann, 2015;McCann & Sharek, 2016;Panchal et al., 2021;Rachlin, 2002;Sheerin, 2009;Shipherd et al., 2010;White & Fontenot, 2019). ...
... TGD individuals are subjected to persistent and systemic minority stress in the form of stigma, discrimination, and trauma, that appear to increase their susceptibility for mental health concerns and formal diagnosis. Despite an increased need for access to quality mental health services, there are substantial, valid barriers experienced by TGD individuals that cause them to be less likely to receive needed treatment, and those who do are often dissatisfied with the quality of care due to clinician attitudes and behaviors that may inadvertently contribute to minority stress (Duffy et al., 2016;Kattari et al., 2016;McCann, 2015;McCann & Sharek, 2016;Panchal et al., 2021;Sheerin, 2009;Shipherd et al., 2010;White & Fontenot, 2019). The current study suggests that, despite these challenges, TGD patients receiving intensive mood disorder treatment in a behavioral health hospital setting evidence a resilience against these barriers and can still benefit significantly from intensive treatment to the same extent as cisgender patients. ...
Individuals who are transgender and gender diverse (TGD) are more likely to suffer from and to seek mental health services for mood disorders. Some literature suggests that TGD individuals, because of pervasive and systemic minority stress, may have more complex clinical presentations (i.e., psychiatric conditions and severity of symptoms) and may benefit from empirically based treatments to a lesser degree than their cisgender peers. However, research has yet to examine individuals who are TGD receiving treatment in specialized, intensive mood disorder treatment despite the propensity for them to be diagnosed with and treated for mood disorders. Using a sample of 1,326 adult patients in intensive mood disorder treatment (3.8% TGD), the clinical presentation and treatment outcomes were compared between patients who are TGD and cisgender. Contrary to previous research, TGD patients were largely similar if not healthier than their cisgender counterparts, including similar depression, quality of life, emotion dysregulation, and behavioral activation, and less severe rumination at admission. Despite similar to better reported mental health symptoms, TGD patients were diagnosed with more psychiatric conditions overall, including greater prevalence of social anxiety and neurodevelopmental diagnoses. Those who are TGD did not experience attenuated treatment response as predicted. Findings suggest that patients in intensive mood disorder treatment who are TGD may be more resilient than previously assumed, or supports may have increased to buffer effects of stigma on mental health, and emphasize the need to exercise discretion and sensitivity in diagnostic practices to prevent over-diagnosis and pathologizing of TGD individuals.
... Poor peer relations, victimization, discrimination, and abuse were found to be the most common risk factors for poor mental health among TGD youth (Tankersley et al., 2021). Moreover, TGD youth experience significant barriers to accessing screening and mental health treatment that are gender-affirming and trauma-informed due to a lack of trained mental health providers and tailored interventions (McCann & Sharek, 2016). ...
Transgender and gender diverse (TGD) adolescents and young adults experience disproportionately higher rates of trauma compared to their cisgender peers. Beyond adverse childhood experiences, TGD youth are also exposed to gender-based traumatic experiences, including interpersonal rejection, bullying, and physical attacks, resulting in greater symptoms of posttraumatic stress. Few tailored interventions have been developed and evaluated with TGD youth to address this crucial mental health need within our current sociopolitical context, including increasing bans on care for TGD young people. This pilot study examined the use of narrative exposure therapy (NET) to reduce posttraumatic stress symptoms and increase self-perceived resiliency and positive well-being in TGD adolescents and young adults. A community sample of 41 racially and ethnically diverse TGD youth (Mage = 17.15 ± 2.38) completed NET after screening at a Los Angeles-based medical clinic. Participants attended on average 12 sessions of NET (±5.96). Participants reported multiple traumatic events, with 85.4% reporting six or more different trauma types, including events related to gender-based discrimination. Findings show a statistically significant reduction in posttraumatic stress symptoms, as well as an increase in resiliency and positive well-being at discharge from treatment. Qualitative feedback from participants also highlighted their positive experiences with NET. This pilot study provides initial support for the use of NET to reduce posttraumatic stress symptoms for TGD adolescents and young adults. The implications for future studies utilizing NET with TGD youth are discussed further.
... TGD people experience significant barriers to accessing mental health services, with common reported factors including care services not being knowledgeable about TGD health and issues, financial barriers and discrimination (Safer et al., 2016). This lack of access to mental health services in turn impacts on mental health treatment and recovery (McCann & Sharek, 2016). ...
... The extra-medical use of substances to self-treat mental health concerns that went unaddressed because of a dearth of accessible and stigma-free health services was reported by participants. This was reflected by participants who noted the difficulties of locating affirming providers, encounters with providers reluctant to prescribe indicated medications, and the expressed concern about how quickly patientprovider relationships can disband because of staff turnover; given the challenge of locating affirming providers who are not stigmatizing and are knowledgeable about gender-affirming care, losing an affirming provider can be a profound loss that results in withdrawal from health services (McCann & Sharek, 2016). In addition to navigating TGD-specific barriers to health services, TGD PWUD contend with substance use-related stigma that is pervasive throughout healthcare (van et al., 2013). ...
Motivations for substance use and the substance use treatment experiences of transgender and gender diverse (TGD) people who use drugs (PWUD) are not well understood. From July to August 2022, 12 TGD PWUD in Rhode Island completed an in-depth interview regarding substance use treatment experiences. Integrated thematic analysis using a socio-ecological model of TGD stigma and health was conducted to understand substance use motivations and multilevel influences on substance use treatment experiences. Motivations for substance use that had generative and adverse outcomes ranged from enhancement of social and sexual experiences, facilitation of gender affirmation, and the self-treatment of mental health concerns. Interest in and utilization of substance use treatment varied, though most participants (n=9) accessed treatment in their lifetime and learned of treatment options through peers. Barriers to substance use treatment occurred at the structural (e.g., insurance coverage), institutional (e.g., limited bed capacity; inconvenient hours of operation) and interpersonal (e.g., transphobic staff) levels that varied across treatment types. While some participants recounted positive and gender-affirming substance use treatment experiences (e.g., use of pronouns, respect from other patients), others recalled transphobic experiences and challenging interpersonal dynamics with staff and clients. Future research should explore the various reasons TGD people use substances. Gender-affirming substance use treatment models should be implemented in substance use treatment settings and the hiring of TGD staff of color in substance use treatment settings is needed to improve the healthcare experiences of TGD PWUD.
... Given the heightened recognition of the difficulties encountered by the transgender community, who have reported greater psychological distress and experienced social and occupational marginalization compared to the LGB community (Walch et al., 2021), researchers have emphasized the distinct experiences of transgender individuals and the importance of conducting research that specifically addresses their needs (Matsuno & Israel, 2018). Consequently, there has been a surge in studies examining the mental health challenges encountered by the transgender comunity (McCann & Sharek, 2016). However, in recent years, there has been a strong push for researchers to examine not just the risk factors but also the protective factors that can mitigate the negative impacts of discrimination on mental health. ...
Purpose
The objective of this research was to explore a proposed moderation model that suggests the presence of internalized transphobia as a factor that moderates the relationship between internal and external resilience resources (including personal resilience and coping strategies utilized during distress, and social and family support) on the one side, and psychological distress on the other. Method: Information was gathered from a sample of 119 Israeli adults who self-identified as transgender via an online survey. We modified existing scales to assess the variables of interest. Pearson correlations, t-tests, multiple linear hierarchical regression, and a simple slopes analysis were applied to test our hypotheses. Results: The findings supported the argument that a lack of internal and external resilience resources is associated with higher levels of psychological distress experienced by transgender individuals. The moderation model showed that internalized transphobia moderated the correlation between social support and reported levels of psychological distress, as well as between the use of coping strategies and reported levels of distress. However, internalized transphobia did not moderate the relationship between personal resilience and psychological distress. Conclusions: It is imperative to prioritize raising awareness and providing support to this unique population, considering the associations observed between the study variables. Behavioral interventions are necessary to enhance awareness among policymakers in the domains of education, therapy, and health. In adition, given that young Israelis are obligated to join the army at 18, it becomes even more crucial to implement effective interventions that actively address and combat any discriminatory practices against sexual minorities within the Israeli military. Promoting inclusivity and equity within the armed forces is of utmost importance to ensure fair and respectful treatment of all individuals.
... Transgender individuals have worse education outcomes in comparison to cisgender (Coulter et al., 2020). Existing studies on transgender people focus on their health and social service needs (Kenagy and Bostwick, 2005); risk behavior (Sevelius, 2013); review of mental health (McCann and Sharek, 2016); suicidal behavior (Virupaksha et al., 2016); adolescent suicide behavior (Toomey et al., 2018); and measures of transgender behavior in terms of their experience and expression (Lee et al., 2020). ...
Purpose
This study aims to understand the unique financial behavior of transgender individuals compared to cisgender individuals. Furthermore, this study aims to demonstrate that understanding the financial behavior of transgender people will help financial institutions, regulators and policymakers to include them in the formal financial sector.
Design/methodology/approach
The qualitative approach to research aims at understanding a given phenomenon among the participants. Semi-structured interviews are conducted with 28 transgender and cisgender individuals each. Thematic analysis is used to understand the participants’ financial behavior and propose future research directions and implications to regulators and practitioners.
Findings
The transgender participants (TP) earn no stable income compared to cisgender participants. Due to a lack of regular income, TP faces hardships covering their spending. No fixed spending or financial planning pattern is found among the TP, and they are found to be highly uncertain of their income and spending. The TP is found wholly excluded from the financial system, and not even a single participant with an active bank account or insurance is found. TP has not visited a bank in their lifetime, and financial literacy is found completely missing among them. No TP has ever taken a bank loan or credit from a financial institution. A zeal among TP to be financially included is found, and such participation will undoubtedly help them live a financially independent life. Cisgender people (CP) are found to be earning a stable income, have full-time jobs, save money, transact through a formal financial system and are financially more independent than TPs. Gender is shown to play a role in the financial behavior of the participants.
Research limitations/implications
This study gathers information from transgender and CP and does not focus on the financial services providers; the decision not to interview the providers of financial services is a potential limitation of the present study. Another limitation is the small number of respondents who participated in the semi-structured interviews. Due to these limitations, the generalizability of the findings of this study regarding financial behavior will be restricted and require further evidence from future research.
Practical implications
The present study has several practical implications. First, the requirement of understanding the financial behavior of transgender people from their perspective is missing in the literature, and studies focusing on their behavior are required to help them be financially independent. The present study has implications for regulators, policymakers and practitioners to help transgender people improve their financial conditions.
Originality/value
The existing literature does not include studies focusing on understanding the financial behavior of transgender people or drawing a comparison of the financial behavior of transgender or CP. The present study explores the financial behavior of transgender people and highlights the unique financial behavior of transgender individuals.
... From a physical health perspective, some LGBTQ+ subpopulations are at increased risk of conditions such as HIV, sexually transmitted infections, hepatitis [16]. LGBTQ+ people are not a homogeneous group and their health profile and consequently the health needs of the subpopulations, such as gay men, lesbians, bisexuals and transgender people differ, necessitating specific care and supports [17,18]. Additionally, the health profile and health needs differ across the lifespan, with the needs of LGBTQ+ youth being different, for example, from those of seniors [19]. ...
Poor physical and mental ill-health is experienced by many LGBTQ+ people, compounded by a reluctance to access healthcare services. This reluctance is attributed to experiences of heteronormative assumptions and negative attitudes encountered. Despite increasing recognition of the need to include LGBTQ+ health in undergraduate healthcare programmes, inconsistencies and gaps in content, skills development, and assessment are still apparent. The aim of the study was to identify LGBTQ+ health content within nursing and midwifery pre-registration programmes and identify education best practice and innovation. A mixed-methods study involving a quantitative and qualitative design was undertaken. The qualitative findings from a nursing perspective were extracted from the dataset for further detailed analysis and are reported in this paper. Information about the study and an online survey were distributed to 135 Schools of Nursing and Midwifery in the UK and Ireland. Individual semi-structured online interviews took place with academics. Qualitative data from 29 survey responses and 12 follow-up interviews were thematically analysed. Eight of the 12 follow-up interviews were held with nursing academics and following data analysis three themes emerged: (i) LGBTQ+ health across the lifespan; (ii) taking the initiative for LGBTQ+ health inclusion; and (iii) identifying and overcoming challenges. The findings highlight the endeavours by nursing academics to integrate LGBTQ+ health within pre-registration programmes to meet the education needs of students and the opportunity to develop curriculum content to address the needs and concerns of LGBTQ+ people across the lifespan.
... 13 14 The negative impact of gender dysphoria, discrimination and victimisation on mental health and psychosocial functionality is well documented in the literature. [15][16][17] This higher burden of mental health needs includes a greater incidence of complex needs and dual diagnoses, as well as higher rates of suicidal ideation and attempted suicide. 18 In Ireland, transgender participants were 75.6% more likely to end their own life than gay males or lesbian females (who were already three times more likely than their heterosexual/cisgender peers). ...
Introduction
There has been a global increase in demand for gender-specific healthcare services and a recognition that healthcare access is complex and convoluted, even in countries with well-developed healthcare services. Despite evidence in Ireland supporting the improvement in physical and mental health following access to gender care, little is known about the local healthcare navigation challenges. Internationally, research focuses primarily on the experience of service users and omits the perspective of other potential key stakeholders. Youth experiences are a particularly seldom-heard group.
Methods and analysis
This study will use a sequential exploratory mixed-methods design with a participatory social justice approach. The qualitative phase will explore factors that help and hinder access to gender care for young people in Ireland. This will be explored from multiple stakeholders’ perspectives, namely, young people, caregivers and specialist healthcare providers. Framework analysis will be used to identify priorities for action and the qualitative findings used to build a survey tool for the quantitative phase. The quantitative phase will then measure the burden of the identified factors on healthcare navigation across different age categories and gender identities (transmasculine vs transfeminine vs non-binary).
Ethics and dissemination
This study has been approved by St Vincent’s Hospital Research Ethics Committee (RS21-019), University College Dublin Ethics Committee (LS-21-14Kearns-OShea) and the Transgender Equality Network Ireland’s Internal Ethics Committee (TIECSK). We aim to disseminate the findings through international conferences, peer-review journals and by utilisation of expert panel members and strategic partners.
... More than a quarter of surveyed transgender individuals report needing but not being able to obtain access to health care, 25% of whom needed but could not access counseling or psychotherapy; not surprisingly, not being able to obtain needed mental health care was associated with increased odds of having experienced discrimination (Bradford et al., 2013). Dissatisfaction with mental health treatment among transgender clients is associated with treatment providers' lack of competency and experience with trans clients, lack of sensitivity and responsiveness toward gender issues, inflexibility, and enacted stigma and discrimination toward trans clients (Duffy et al., 2016;Kattari et al., 2016;McCann, 2015;McCann & Sharek, 2016;White & Fontenot, 2019). ...
Gender and sexual minorities are subjected to minority stress in the form of discrimination and violence that leads to vigilance, identity concealment and discomfort, and internalized homophobia, biphobia, and transphobia. These experiences are related to increased susceptibility to mental health concerns in this population. Historically, the behavioral treatment of sexual orientation (SO) and gender-themed obsessive-compulsive disorder (OCD) has inadvertently reinforced anti-LGBTQ+ stigma and contributed to minority stress in clients, treatment providers, and society at large. We present updated recommendations for treatment of SO- and gender-themed OCD through a more equitable, justice-based lens primarily through eliminating exposures that contribute to minority stress and replacing them with psychoeducation about LGBTQ+ identities, exposures to neutral and positive stimuli, uncertainty, and core fears. We also present recommendations for equitable research on SO- and gender-themed OCD.
... Barriers to health and human services among nonbinary individuals include pathologizing attitudes, identity bifurcation (selectively sharing and withholding identity-related information based on necessity and comfort), and gender-based assumptions . In addition to addressing ignorance and biases, McCann & Sharek (2016) found cultural competence to encourage resilience and empowerment. The PRs personal and interpersonal recommendations provide concrete steps for self-work and how to engage with others in an affirming manner (Table 6). ...
Traditionally, gender has been viewed through an essentialist lens with fixed
biology-based traits or polarized gender norms between women and men. As awareness
of gender diversity grows, increasingly more people identify as nonbinary – or not
exclusively a man or woman. Despite a growing literature on the experiences of binary
transgender individuals, little has been explored regarding experiences unique to
nonbinary individuals. The research that does include nonbinary individuals focuses
primarily on adverse risks and outcomes. As such, a dearth of empirical research exists to
understand the unique experiences of nonbinary people and how they relate to wellbeing.
A qualitative participatory action study using PhotoVoice was conducted virtually to
address the identified gaps in the literature on nonbinary individuals concerning gendered
experiences and wellbeing. Prevailing theories of wellbeing informed the study along
with minority stress theory and the resilience literature to account for environmental
factors of oppression and individual and community resilience. A sample of 17 nonbinary
adults in the Midwestern United States was recruited using convenience sampling and
participated in online group discussions and individual interviews. The findings were
reported in sections corresponding with the three study aims: 1) Explore core dimensions
of wellbeing as defined by nonbinary individuals, 2) Identify promotive and corrosive
factors of that wellbeing, and 3) Provide recommendations to bolster nonbinary
wellbeing. The findings provided a thorough description of how nonbinary individuals perceive their wellbeing concerning their gender and as part of a marginalized
population. Thematic analysis identified nine wellbeing themes for how participants
conceptualized their wellbeing (e.g., Exploring gender identity and expression, Being
connected to community, etc.), seven themes of promotive and corrosive factors of
wellbeing (e.g., Positive, accurate, and nuanced representation, Coping skills to manage
minority stressors, etc.), and three themes of recommendations (e.g., personal,
interpersonal, and professional) with eighteen strategies to bolster wellbeing among
nonbinary individuals and communities. The significance of the findings to social work
was discussed, including practice application and advocacy. This study contributes to
PhotoVoice methodology, wellbeing literature, and trans literature.
... Literature strongly highlights that systems frequently fail transgender individuals, even in countries with progressive civil liberties . Multiple studies describe the arduous experiences of trans adults seeking healthcare [43][44][45][46][47][48][49][50][51][52]. Notably, most will report experiences of stigma and discrimination when accessing healthcare, from encounters with administrative staff to encounters with healthcare providers [53][54][55][56][57][58]. ...
Objective
Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths’ experiences accessing gender-affirming healthcare.
Method
A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908).
Results
Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the following themes: 1.) Disclosure of gender identity. 2.) The pursuit of care. 3.) The cost of care. 4.) Complex family/caregiver dynamics. 5.) Patient-provider relationships. Each dimension details a complicated set of factors that can impact healthcare navigation and are explained through a new conceptual model titled “The Rainbow Brick Road”.
Conclusion
This synthesis expands understanding into the experience of transgender and non-binary youth accessing gender-affirming healthcare. Ryvicker’s behavioural-ecological model of healthcare navigation is discussed in relation to the findings and compared to the authors’ conceptual model. This detailed analysis reveals unique insights on healthcare navigation challenges and the traits, resources, and infrastructure needed to overcome these. Importantly, this paper reveals the critical need for more research with non-binary youth and research which includes the population in the design.
... Cisgenderism is also implicated in the healthcare barriers trans and gender-diverse individuals encounter, and involved in a complex interplay of individual and institutional factors which compromise quality of care for these individuals (McCann & Sharek, 2016;Walls et al., 2019;Winter et al., 2016). Individual factors like discrimination from mental health professionals and workers (Grey & Janus, 2018;Riggs et al., 2014), and a lack of professional expertise and experience (Grey & Janus, 2018;McCann & Brown, 2017;Poteat • An improved understanding of these issues, which may assist service providers and the development of interventions to more effectively support and meet the needs of this population. ...
Crisis helplines are typically easily accessible and deliver interventions in a timely manner, regardless of geographical location. The efficacy and user experiences of these services are the subject of considerable interest within the field, but the experiences of trans and gender-diverse individuals remain unexplored despite high rates of mental ill health being documented in this population. 134 trans Australians were surveyed about their experiences of personal crises and of utilising crisis helplines. Within our sample, 84.2 % (n=113) of participants recognised at least one service – however, only 32.8% (n=44) utilised a service to cope with a personal crisis. Participants cited poor recognition and understanding of the challenges specific to trans individuals among helpline workers as a primary reason for avoiding these services, and articulated needs which were a poor fit for the one-off intervention model commonly employed by helpline services. In order for helpline services to be viable avenues of support for trans individuals during a personal crisis, helpline workers must be sufficiently equipped to work with trans callers, and to facilitate their enrolment in ‘traditional’ mental health services.
... bisexual, gay, integrative review, lesbian, mental health, qualitative, transgender experiences of those with direct mental health service experiences and had been asked about their specific needs. It has been argued that there is a need for further research that promotes affirmative care for the gender and sexual minorities (McCann & Sharek, 2016). ...
Accessible summary
What is known on the subject?
• There is evidence that the LGBT communities experience greater health disparities, particularly in relation to their mental health needs.
• The LGBT communities are often faced with stigma and discrimination within mental health services.
What the paper adds to existing knowledge?
• People within the LGBT communities have identified that their experiences of mental health services reinforce stigma and lack an understanding of their specific needs.
• Their needs can be addressed by mental health services that challenge heteronormative assumptions and promote self‐acceptance and equity.
What are the implications for practice?
• The existing heteronormative culture in mental health nursing practice needs to be challenged.
• Practice needs to demonstrate self-awareness of personal and societal LGBT biases, prejudices, and stigma.
• Practice needs to demonstrate knowledge of important LGBT health care and psychosocial issues.
• Practice needs to reflect LGBT clinical skills grounded in professional ethics, guidelines, and standards of care.
Abstract
Introduction
The lesbian, gay, bisexual and transgender (LGBT) communities are a minority population that experience a range of health disparities, including mental health. Because these groups have higher rates of mental disorder than the general population it is, therefore, pertinent to identify their specific mental health needs and their experiences when accessing mental health care.
Aim
To identify the mental health needs of the LGBT communities and their experiences of accessing mental health care.
Methods
An integrative review of qualitative studies was conducted.
Results
A total of fourteen studies were selected for this review. The studies identified that participants’ experiences of accessing mental health care were related to (a) experiencing stigma and (b) staff's lack of knowledge and understanding of LGBT people's needs. They identified a need for mental health care that promotes the principles of equity, inclusion and respect for diversity.
Discussion
The LGBT communities while not a homogenous group, face unique challenges when dealing with their mental health needs. Services that promote health equity and self‐acceptance are important for this group.
Implications for practice
It is vital that mental health nursing education incorporate models that promote equity, inclusion and respect for diversity regarding this group of people.
Transgender community consists of individuals whose gender identity is different from the sex assigned to them at birth. The present research focuses on assessing the determinants of social inclusion determinants for transgender people and understanding their perspective. The objectives of the research are to identify the challenges, understand the inclusivity of transgenders, examine family support and acceptance, and to examine social inclusion factors which include income, education, employment opportunities and access to housing. Our aim is to create a society which does not discriminate transgender people based on their gender and to rely more on the inclusion of them in our society. Through various research, it is to be said that they face many issues in our country in the form of employment opportunities, housing, health care, education, and more. This study adopts survey design method. Several literature reviews which highlight the vulnerability of transgender people and the challenges they face. Through analysis and interpretation, it is evident that they do not receive adequate support and find it difficult to live as transgender individuals. Due to discrimination, prejudice, and stereotypes they face barriers in accessing housing, transportation, employment, and healthcare. Many of them face rejection from their families and lack secure housing options.
We examine the prevalence of gender transitions in Sweden over time and document the sociodemographic characteristics of people transitioning in different periods. Using administrative data covering the transgender population from 1973 through 2020, we analyze two common events in a gender transition: the earliest diagnosis of gender incongruence and the change of legal gender. Our research note presents three main findings. First, the measured prevalence rates of diagnoses and legal gender changes are relatively low in all periods, although they have increased substantially since the early 2010s. Second, the recent increase in transition prevalence is most pronounced among people in early adulthood; in particular, young transgender men drive an increase in overall transition rates through 2018, followed by moderate declines in 2019 and 2020. Third, transgender men and women have substantially lower socioeconomic outcomes than cisgender men and women, regardless of the age at which they transition or the historical period. They are also considerably less likely to be in a legal union or reside with children. These findings highlight the continued economic and social vulnerability of the transgender population.
BACKGROUND
Although sex differences in pain are well documented, little is known regarding the relationship between gender and pain. Gender-diverse youth experience unique pain risk factors, including minority stress exposure, but are underrepresented in research.
OBJECTIVE
Elicit experiences of gender-diverse youth who live with chronic pain.
METHODS
Semistructured interviews were conducted with youth virtually using Zoom. Youth were recruited from a Canadian tertiary care pediatric hospital, community-based clinics, and the general population. Interviews were recorded, transcribed, and analyzed with a patient partner using reflexive thematic analysis, integrating relevant existing theoretical and empirical models for understanding gender and pain, identity development, minority stress, and intersectionality.
RESULTS
The final sample included 19 youth who represented a variety of gender identities and pain conditions and reported accessing a range of types and levels of care. Three themes were identified through qualitative analysis: (1) the fight to legitimize both their pain and gender, (2) the tension between affirming gender and managing pain and the role of gender euphoria as a buffer against pain, and (3) the role of intersecting (eg, neurodiversity and race) identities in understanding gender-diverse youths’ pain experiences.
CONCLUSIONS
In a diverse sample of gender-diverse youth who live with chronic pain, experiences of invalidation and difficulty managing pain were experienced in the context of unique stressors and sources of joy in living as a gender-diverse individual. These results point to the need for more intersectional and affirming pain research and integration of findings into clinical practice.
Background
There are an estimated 25 million transgender and gender diverse (TGD) individuals worldwide, with 1.2%–2.7% of this population being under the age of 18. Community studies describe increased rates of mental health difficulties such as depression, self‐harm, suicidal ideation and difficulties with peer relationships for TGD youth over cisgender peers. However, comparatively little is known about the mental health symptomatology of TGD youth attending specialist mental health services (CAMHS) in the UK.
Method
This cross‐sectional study explored data from 170 young people participating in the Beating Adolescent Self‐Harm (BASH) trial. Baseline data about self‐harm, depression, and impact on daily life was compared for those who identified as TGD (n = 18) with those who identified as cisgender (n = 152).
Results
In the transgender group, 18 (100%) scored ≥27 on the MFQ suggesting severe depression and had total scores on the SDQ impact scale of ≥3, in the very high range. In comparison in the cisgender group, 140 (92.1%) scored ≥27 on the MFQ and 103 (67.8%) had total scores on the SDQ impact scale of ≥3. The TGD group reported higher rates of self‐harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities and impact in the classroom. Both groups reported similar symptoms of depression.
Conclusions
Whilst this exploratory study has limitations, these results suggest that TGD youth attending CAMHS may experience greater mental health problems than their cisgender peers.
This research endeavors to bridge a vital gap in the study of transgender individuals’ participation in the labor market within the Gulf Cooperation Council (GCC) region. It is driven by the question: “What are the underlying factors contributing to the reluctance of GCC employers to hire transgender individuals, and how does this impact the labor market participation of this group?” In pursuit of comprehensive insights, the study aligns with the Cochrane Handbook for systematic research design. The methodology used encompasses an extensive review of academic literature from 2012 to 2023, in-depth interviews with transgender individuals in the UAE and Saudi Arabia, and thematic analysis to identify critical factors. The findings reveal that transgender individuals face significant legal challenges and widespread cultural discrimination in the GCC. These issues lead to workplace biases, unequal pay, and hindered career progression. A key factor in the limited employment opportunities for transgender individuals in the GCC is the reluctance of employers, stemming from cultural stigma and legal shortcomings. This reluctance propagates employment discrimination and a hostile labor market environment for transgender individuals. The study found that employers' hesitancy to hire transgender individuals leads to higher unemployment rates within this group, perpetuating poverty, social exclusion, and hindering economic diversity and innovation in the GCC. The study underscores the urgent need for holistic strategies and policy reforms in the GCC to ensure workplace equality and full labor market integration for transgender individuals, addressing a crucial research gap and emphasizing the need for dedicated efforts in this field.
Background
Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK.
Objectives
This systematic review aims to summarise the evidence regarding TNB people’s experiences of primary care to inform improvements in service and patient outcomes.
Methods
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative.
Results
Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities.
Conclusion
This review demonstrates TNB people’s mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.
Background
Respectful maternity care (RMC) emphasizes the social and relational elements of maternity care and is a crucial part of initiatives to improve service accessibility and quality. Women's perceptions have influenced much of what we know about RMC and contempt in the labor ward. In order to understand midwives' perspectives of RMC, this meta-synthesis focused on them.
Method
For this inquiry, the databases PubMed/Medline, Embase, Web of Science, and Scopus were searched to find studies on midwives' perceptions of RMC written between 2011 and April 20th 2023. The included articles were to English language restriction. The results of the included research were examined using thematic analysis. Using the inclusion criteria, 84 potentially relevant articles were carefully reviewed, and only 22 were ultimately selected for synthesis. The quality of the qualitative study was assessed using the CASP, a tool for quality evaluation and PRISMA guidelines were followed. Using the MAXQDA program, the cited quotes and the original authors' interpretations were combined.
Result
There were 22 studies total, thematic synthesis was determined to be appropriate for a total of 22 research studies. Following are the topics which we summarized our analysis: in six major themes: Midwives’ conceptualizations of RMC, Midwives commitment to woman’s rights, The value and impact of RMC to midwives, Midwife’s perception of disrespectful care, Challenges in providing respectful maternity care, and Midwives’ recommendations for optimal RMC practice.
Conclusion
In addition to specific focus on promoting cooperation, policies to enhance health systems and strategic consideration of the midwifery profession's future are required.
Emerging evidence confirms COVID-19’s negative impact on college students’ mental health; however, more research is needed to identify factors that promoted or hindered college students’ mental health early in the pandemic. This exploratory study addressed this need. Participants were 697 students attending a large, state, urban university in the southeastern United States. Using a cross-sectional survey design, participants completed an anonymous, online survey assessing socio-demographic variables, mental health issues, and activities during the lockdown period in 2020. Findings suggest college students in the southeastern US who were women or transgender men and had pre-existing mental health conditions, fewer routine activities, and high exposure to COVID-19 news reported more mental health problems early in the pandemic. Students who exercised daily had fewer symptoms of anxiety and post-traumatic stress than students who exercised monthly, but there were no differences in emotional responses to COVID-19 based on exercise frequency. Tailored strategies to address college students’ needs in response to the current or future pandemics are needed and should take into consideration factors that promote or hinder mental health. Patient or Public Contribution: College students were participants in this study. College students who were not participants in this study assisted with the implementation of this study.
Background:
Transgender and intersex populations have long remained under-documented in South Korea, largely due to the absence of comprehensive epidemiological data. With increasing societal acknowledgment, there's an urgent need to understand the demographics and health challenges faced by these communities.
Methods:
This retrospective, large-scale data study included people who received the F64 codes from the Korean Health Insurance Review & Assessment Service between January 2007 and December 2021. Demographics, gender-affirmative treatments, and psychiatric related medications were examined.
Results:
Between 2007 and 2021, 8,602 patients were diagnosed with "gender identity disorder" and 45 with "intersex." A steadily increasing annual prevalence was observed, peaking at 986 cases in 2021. The majority (79.8%) were aged between 10 and 30. Nearly half (53.2%) exhibited mental and behavioral disorders. Two-thirds had been prescribed anxiolytics or sedatives either before or after diagnosis. Merely 12.1% received hormone therapy covered by health insurance.
Conclusion:
This is the first large-scale study highlighting the demographics and clinical characteristics of the transgender and intersex populations in Korea. The study reveals a consistent growth of these communities over the past 15 years, with a significant proportion under 30 years of age facing mental and behavioral challenges. Findings underscore the need for targeted healthcare interventions, early psychological support, and comprehensive insurance coverage tailored to the specific needs of these individuals in Korea.
Traditional research methods have not yet yielded highly effective long-term mental health treatments and might not reflect diverse lived experiences. Body mapping, which is an arts-based research method, could complement the verbal data of existing approaches through its focus on visual and symbolic processes to understand subjective, embodied experiences related to mental health. We did a scoping review on the use of body mapping in research on mental health experiences and outcomes. We searched Web of Science, PubMed, Scopus, PsycINFO, Embase, Ovid Medline, and Google Scholar to retrieve peer-reviewed articles in English. In 19 articles representing 17 studies, participant numbers for body mapping ranged from three to 48, and some studies exclusively recruited women or children and young people. Study domains included primary mental health experiences and mental health in relation to physical health or social experiences. The benefits of body mapping included its exploration of difficult-to-access emotions and experiences, its focus on strength and resilience, the therapeutic effect, its participatory and collaborative nature, its empowerment and dissemination of participants' voices, and the engagement of children and young people. Body mapping holds promise for research with marginalised groups typically excluded from mental health research.
Question:
What are the attitudes, beliefs and knowledge gaps of physiotherapists in Australia regarding working with patients who identify as LGBTQIA+?
Design:
Qualitative design using a custom online survey.
Participants:
Physiotherapists currently practising in Australia.
Methods:
Data were analysed using reflexive thematic analysis.
Results:
A total of 273 participants met the eligibility criteria. Participating physiotherapists were predominantly female (73%), aged between 22 and 67 years, residing in a large Australian city (77%) and working in musculoskeletal physiotherapy (57%), in private practice (50%) and hospital (33%) settings. Almost 6% self-identified as part of the LGBTQIA+ community. Only 4% of the participants had received training related to healthcare interactions or cultural safety for working with patients who identify as LGBTQIA+ in the context of physiotherapy. Three main themes regarding approaches to physiotherapy management were identified: treating the whole person in context, treating everyone the same, and treating the body part. Gaps in knowledge were primarily related to understandings of the relevance of sexual orientation and gender identity to physiotherapy and health issues specific to LGBTQIA+ patients.
Conclusion:
Physiotherapists can be considered to approach gender identity and sexual orientation in three distinct ways and suggest a range of knowledge and attitudes about working with patients who identify as LGBTQIA+. Physiotherapists who consider gender identity and sexual orientation to be relevant to physiotherapy consultations appear to have higher levels of knowledge and understanding of this topic and may also understand physiotherapy as multifactorial and not only biomedical.
Transgender persons constitute a non-negligible percentage of the general population. Physical gender-transitioning in trans persons is mainly achieved with hormonal cross-sex therapy and sex reassignment surgeries that aim to align bodily appearance with gender identity. Hormonal treatment acts via suppressing the secretion of the endogenous sex hormones and replacing them with the hormones of the desired sex. The administration of testosterone is the typical masculinizing treatment in trans men, whilst trans women are routinely treated with estradiol agents in combination with anti-androgens or gonadotrophin-releasing hormone agonists if testes are present. Exogenous androgenic steroids, estradiol agents, and anti-androgens have been implicated in a series of hepatotoxic effects. Thus, liver integrity is a major concern with the long-term administration of cross-sex therapy. Hepatic tissue is susceptible to coronavirus disease 19 (COVID-19) through various pathophysiological mechanisms. Special consideration should be paid to minimize the risk of hepatic damage from the potential cumulative effect of COVID-19 and gender-affirming treatment in transgender patients. Appropriate care is significant, with continuous laboratory monitoring, clinical observation and, if needed, specific treatment, especially in severe cases of infection and in persons with additional liver pathologies. The pandemic can be an opportunity to provide equal access to care for all and increase the resilience of the transgender population.
It is well documented that access to mental health services is obstructed by several barriers for certain people, that in turn perpetuate individual distress and future support-seeking. Awareness is continuing to grow, exacerbated by accounts of oppression and marginalisation of certain populations, and the health inequalities exhibited through the Covid-19 pandemic. Unfortunately, people with learning disabilities are often subject to ‘double discrimination’ if identifying with a marginalised group, making access to services even more difficult. Thus, it is imperative that learning disability teams are aware of current barriers, so widening access initiatives can be explored. This article highlights some of the research found regarding the inequalities faced for people with learning disabilities accessing psychology provision, as well as documenting our service evaluation project, to consider what can be done to create a more equitable service for our clients.
Easy read summary
Research shows that some people struggle more than others to be seen by learning disability teams.
We looked at who was reaching the psychology team in our service. We found that we are reaching men and women equally. But we might not be reaching as many older adults. We also might not be reaching as many people from Asian ethnic backgrounds.
We also looked at if the type of support we give people is equal. We found that there may be some differences in the care offered, dependent on gender, age, or ethnicity.
It is important that we understand what stops people reaching learning disability teams, so that we can solve any problems. This will help as many people as possible get the care and support they might need.
Despite increased research on lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual (LGBTQIA+) healthcare, information regarding the care of transgender and/or gender non-conforming (TGNC) individuals remains lacking. Social and health inequities rooted in insufficient training, discomfort, or stigma can present in a variety of ways in transplant evaluation, where psychosocial factors greatly impact management. In this setting, psychiatrists have a critical role in facilitating accurate and sensitive assessments of TGNC organ donor candidates. We describe challenges that arose in the diagnostic clarification, accurate risk stratification, gender-affirming risk mitigation, and medical management of a 40-year-old transgender man undergoing evaluation for living kidney donation. We discuss these challenge in context of three emergent themes: insufficient knowledge of TGNC health among individual providers, systemic limitations in addressing TGNC healthcare concerns, and broader sociocultural complexities impacting care. Finally, we provide recommendations for a TGNC-affirming approach to living organ donor candidates through which psychiatrists can act as advocates and educators.
Transgender individuals and their partners may face unique challenges that other couples do not. These unique challenges merit investigation, understanding and consideration by systemic practitioners in order to provide a culturally attuned service for transgender clients. A systematic review of the literature into the experiences of couples in which one member is transgender identified 22 qualitative papers. A translation and synthesis of constructs from these papers utilising a meta-ethnographic approach generated a number of third order constructs organised into nine overarching themes. These themes included experiences of stigma and discrimination, issues of power, privilege, visibility and identity, and experiences of dissonance and dysphoria that required adjustments and negotiations on the personal and relationship levels. Implications for practice and avenues for future research are discussed.
Introduction
Sexual, gender, and erotic minorities experience oppressions that psychologically harm and impact help seeking. The aim of this review was to integrate available evidence on the uptake, barriers, and facilitators of mental health help seeking in sexual, gender, and erotic minorities.
Method
Systematic searches were conducted in CINAHL, Medline, and Scopus for peer-reviewed articles and in Google for gray literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published in English in Organization for Economic Co-operation and Development countries between 2008 and 2018 regarding sexual, gender, and erotic minorities older than 18 years were eligible. Quality assessments were conducted and extracted data were analyzed thematically.
Result
Ninety documents were included in the review. Uptake is generally greater among sexual, gender, and erotic minorities, but worse in those who experience intersecting oppressions. Barriers to care manifest systemically, in services, and in individual mental health professionals (MHP) and contribute to psychological distress and impede help seeking. Protective factors (resilience, inclusion) and trained MHP counter these barriers.
Conclusion
Despite the general prevalence and risk of mental illness among sexual, gender, and erotic minorities due to external, modifiable oppressions, opportunities for inclusive psychological care exist.
Objective: Although researchers in higher education have focused more attention on transgender individuals, gaps remain, particularly related to aspects of health and wellness. Participants: Participants were a nationally representative sample of college students. Methods:Anova and follow up post hoc tests were utilized to examine measures of transgender college students' mental health in comparison to their cisgender peers who identify as heterosexual, lesbian, gay, and bisexual. Results: Findings indicate that transgender students were more likely to report physically harming themselves or attempt suicide, but responded similarly to peers on other measures. Conclusions: Individuals who work with transgender college students can benefit from this reserach by understanding how to support and avoid marginalizing these students.
Objective
The purpose of this study was to explore physical therapy through the stories of physical therapists who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other related identities (LGBTQIA+) to consider how the profession enacts and constructs gender and sexual orientation.
Methods
Physical therapists with clinical, academic, and professional roles who identify as LGBTQIA+ were recruited from Australia, the United Kingdom, Canada. and the United States. In-depth data were collected via narrative interviews. An iterative group discourse analysis was used to examine key discourses underpinning interview narratives and how these relate to the physical therapy profession.
Results
Twenty-two physical therapists were interviewed. Participants had between 1.5 and 40 years of experience across various clinical areas and settings. Participants identified with varying sexual orientations and gender identities. Analysis identified discourses discussed under the following headings: (1) normativity, which related to heteronormative assumptions about sexual orientation and to cisnormative assumptions about gender identity and the intersectionality among sexual orientation, gender identity, and other forms of marginalization; (2) stress and labor, which explored the stress experienced by physical therapists who are LGBTQIA+ (due to fear of discrimination or actual discrimination) and additional emotional and other types of labor or work done in the workplace to hide aspects of their lives to feel safe, educate colleagues, and be a role model; and (3) professionalism, which related to the heterosexual/cisnormative (and other) “norms” that comprised participants’ ideas of presenting as “professional” and positioning physical therapists who are LGBTQIA+ as “unprofessional.”
Conclusions
Findings suggest that cultural norms may need to be reconceptualized in physical therapy to promote inclusion and belonging of individuals who identify as LGBTQIA+. Approaches to upskill new and existing physical therapists may include elements such as individual and institutional reflexivity, learning and implementing appropriate terminology, displaying indicators of inclusivity, and cultural safety training. These elements may provide the first steps to promote inclusive and culturally safe environments for individuals who identify as LGBTQIA+ within the profession.
Impact
This is the first known study to explore the lived experiences of those who identify as LGBTQIA+ in the physical therapy profession. The findings highlight how prevailing normative discourses in Western society are also present in physical therapy and impact those who identify as LGBTQIA+.
Background
Despite national policy recommendations to enhance healthcare access for LGBT+ (lesbian, gay, bisexual, transgender, and those who do not identify as cisgender heterosexual) people, education on LGBT+ issues and needs is still lacking in health and social care curricula. Most of the available resources are focused on primary care, mental health, and sexual health, with little consideration to broader LGBT+ health issues and needs. The limited available educational programmes pertaining to LGBT+ individuals outside the context of sexual or mental health have mainly focused on cancer care or older adults.
Aim
To support palliative care interdisciplinary teams to provide LGBT+ affirmative care for people receiving and needing palliative and end-of-life care.
Methods
A 1½-h workshop was developed and evaluated using Kotter’s eight-step process for leading change. Across four hospices, 145 health and social professionals participated in the training. A quasi-experimental non-equivalent groups pre–post-test design was used to measure self-reported levels of knowledge, confidence, and comfort with issues, and needs and terminology related to LGBT+ and palliative care.
Results
There was a significant increase in the reported levels of knowledge, confidence, and comfort with issues, needs, and terminology related to LGBT+ and palliative care after attending the training. Most participants reported that they would be interested in further training, that the training is useful for their practice, and that they would recommend it to colleagues.
Conclusion
The project illustrates the importance of such programmes and recommends that such educational work is situated alongside wider cultural change to embed LGBT+-inclusive approaches within palliative and end-of-life care services.
Background and objectives:
Referrals of transgender and gender-diverse (trans) youth to medical clinics for gender-affirming care have increased. We described characteristics of trans youth in Canada at first referral visit.
Methods:
Baseline clinical and survey data (2017-2019) were collected for Trans Youth CAN!, a 10-clinic prospective cohort of n = 174 pubertal and postpubertal youth <16 years with gender dysphoria, referred for hormonal suppression or hormone therapy, and 160 linked parent-participants. Measures assessed health, demographics, and visit outcome.
Results:
Of youth, 137 were transmasculine (assigned female) and 37 transfeminine (assigned male); 69.0% were aged 14 to 15, 18.8% Indigenous, 6.6% visible minorities, 25.7% from immigrant families, and 27.1% low income. Most (66.0%) were gender-aware before age 12. Only 58.1% of transfeminine youth lived in their gender full-time versus 90.1% of transmasculine (P < .001). Although transmasculine youth were more likely than transfeminine youth to report depressive symptoms (21.2% vs 10.8%; P = .03) and anxiety (66.1% vs 33.3%; P < .001), suicidality was similarly high overall (past-year ideation: 34.5%, attempts: 16.8%). All were in school; 62.0% reported strong parental gender support, with parents the most common support persons (91.9%). Two-thirds of families reported external gender-related stressors. Youth had met with a range of providers (68.5% with a family physician). At clinic visit, 62.4% were prescribed hormonal suppression or hormone therapy, most commonly depot leuprolide acetate.
Conclusions:
Trans youth in Canada attending clinics for hormonal suppression or gender-affirming hormones were generally healthy but with depression, anxiety, and support needs.
Trans women experience sexual violence at alarming rates; however, due to societal cisnormativity, people often remain unaware of such rates. As digital feminist movements, such as #MeToo, gain momentum, this moment represents an opportune time to illuminate how trans exclusionary discourses may exist in feminist movements. Using transfeminist theory as an analytic tool, we discuss how the #MeToo movement may displace trans women’s bodies allowing for further violence to occur. Through disrupting the phallus as the “source” of sexual violence, we hope to reduce the assumption that trans women are sexual predators. In this call to action, we invite clinicians to take a stance to end transgender oppression and advocate for transformative change.
Introduction
Transgender populations have high rates of many mental health diagnoses, but often delay or avoid mental health care due to prior poor experiences or fear of discrimination. This indicates a need for supportive and effective transgender mental health care. We aim to identify the features of such care through a systemized narrative review of the literature.
Methods
Comprehensive searches of six databases were run using index terms and keywords. Searches were limited to English language studies published from 2000 to August 2019 and followed SANRA criteria. Identified records underwent title/abstract screen for relevance and then were assessed for inclusion using predetermined criteria. Included articles were tabulated and their results synthesized with attention to areas of thematic overlap.
Results
The search returned 1928 unique articles with 35 meeting inclusion criteria and a further one article identified on bibliography screen. Articles reported a range of experiences and preferences across mental health care settings, with common themes emerging. Several reported on retention in care, satisfaction with care, helpfulness of care, or change in symptom burden after receiving care.
Discussion
We discuss preliminary features of supportive transgender mental health care, recommendations for clinical practice, gaps in the literature, and areas for future research.
Background
Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care.
Ethical considerations
No formal ethical approval was required.
Aim
To synthesize the literature and identify gaps about approaches to the provision of ethical and culturally competent care to transgender populations.
Design
A Scoping Review
Literature Search
Literature was searched within CINAHL, Science Direct, PubMed, Google Scholar, EMBASE, and Scopus databases using indexed keywords such as “transgender,” “gender non-conforming,” “ethically sensitive care,” and “culturally sensitive care.” In total, 30 articles, which included transgender patients and their families and nurses, doctors, and health professionals who provided care to transgender patients, were selected for review. Data were extracted and synthesized using tabular and narrative summaries and thematic synthesis.
Findings
Of 30 articles, 23 were discussion papers, 5 research articles, and 1 each case study and an integrative review. This indicates an apparent dearth of literature about ethical and culturally sensitive care of transgender individuals. The review identified that healthcare professionals should educate themselves about sensitive issues, become more self-aware, put transgender individual in charge during care interactions, and adhere to the principles of advocacy, confidentiality, autonomy, respect, and disclosure.
Conclusions
The review identified broad approaches for the provision of ethical and culturally competent care. The identified approaches could be used as the baseline, and further research is warranted to develop and assess organizational and individual-level approaches.
Jóvenes lesbianas, gays, bisexuales y trans (LGBT+) manifiestan más problemas de salud mental y consumo de sustancias que sus pares heterosexuales y cisgénero (HC), sin embargo, no hay suficiente evidencia de estas diferencias en Chile. El objetivo fue comparar la prevalencia de sintomatología depresiva, ideación suicida, consumo de sustancias y tratamiento de salud mental de jóvenes LGBT+ y HC. Se realizó un análisis secundario de la 9na Encuesta Nacional de Juventud 2018 (n = 9.700; 15-29 años) que incluyó auto-reporte de síntomas depresivos, ideación suicida, consumo de sustancias (alcohol, tabaco, marihuana, cocaína y pasta base), tratamiento de salud mental actual y percepción de barrera económica de acceso a tratamiento. Mediante modelos de regresión logística múltiple se estimaron razones de prevalencia ajustadas. Jóvenes LGBT+ tuvieron más sintomatología depresiva alta, ideación suicida, consumo de tabaco, marihuana, cocaína y/o pasta base y usan más servicios de salud mental que los/as jóvenes HC. No hubo diferencias en el consumo de alcohol y en la percepción de barrera económica de acceso a tratamiento. Los resultados muestran que jóvenes LGBT+ en Chile poseen peores resultados en salud mental y consumo de sustancias que jóvenes HC, por lo que las políticas públicas orientadas a disminuir los problemas de salud mental debieran considerar estas diferencias.
Purpose: Transgender and gender non-conforming (TGNC) individuals have difficulty accessing mental health professionals (MHPs) prepared to deliver culturally informed care. The current study aims to (1) explore the training experiences that had been available to MHPs who are actively providing care to TGNC individuals, (2) define which opportunities had been most beneficial in TGNC career development, and (3) determine the reasons MHPs sought training when it was absent in graduate curricula.
Methods: A voluntary cross-sectional electronic survey was distributed through professional listservs and public referral lists to interdisciplinary MHPs who self-identified as having experience in providing care to TGNC individuals.
Results: Two hundred and eighty-one (n=281) counselors, marriage/family therapists, social workers, psychologists, psychiatrists, or psychiatric nurse practitioners responded to the survey. The two most common motivators for seeking training in gender-affirming care were filling a need in the community (68.8%) and having met a TGNC person in a clinical setting who requested care (67.2%). Only 20.0% of our sample were exposed to relevant content in a graduate course, and 25.2% during clinical training. The most commonly -available training opportunities were professional conferences (76.4%) and mentorship (41.2%). Respondents were most likely to recommend that others in their field be trained via structured clinical experience.
Conclusion: This study identifies key strategies for graduate and post-graduate educators to better-prepare MHPs to serve TGNC individuals. Wider availability of structured clinical experiences, didactic content delivered during graduate school or at professional conferences, and direct clinical mentorship will increase access to welcoming and prepared mental healthcare providers for the TGNC population.
Background
There are for the time being no systematic studies exploring transgender and non-binary (TGNB) mental health in the Serbian context which, over the last three decades, has been characterized by profound social transformations.
Method
We draw upon 15 semi-structured interviews with members of a TGNB self-help group operating in Belgrade, Serbia. The material was analyzed using inductive thematic analysis.
Results
We identified three elements of group operation: 1) information, support, and community, 2) navigating the medical/psychiatric system, and 3) dealing with gender binarism. While the group is important for helping its members navigate the medical system in terms of mental health professionals’ expectations regarding “proper” candidates for gender affirmation procedures, it has a hard time escaping a gender binarism that characterizes its social context.
Conclusions
Despite significant improvements in the situation of TGNB people concerning psychiatric gatekeeping and legal gender recognition, the TGNB community is still marginalized with mental health being one of the main areas of marginalization. Activist organizations’ alternative forms of mental health care can help to transform mainstream mental health policies rendering them more sensitive to the needs of TGNB individuals.
Aim
To understand nursing activities, training and key supports needed to provide primary care to transgender individuals.
Background
Discrimination, limited practitioner knowledge and a deficiency of services contribute to health care barriers for transgender individuals. Literature demonstrating how primary care services are delivered, and more specially the role of nurses in this care, is lacking.
Methods
Qualitative description methodology and interviews were used to describe this phenomenon. Participants included nurse practitioners, registered nurses and registered practical nurses.
Results
Nurses are important in providing primary care to transgender individuals. While NPs worked to full scope of practice, RNs’ and RPNs’ roles could be optimized. A key challenge was lack of education; however, mentorship and collaboration contributed to competency development. Ensuring the workplace provided gender‐affirming care was key to a safe and inclusive environment.
Conclusions
Supporting nurses to develop capacity and work to full scope of practice can improve access to care. Ongoing opportunities for mentorship and ensuring an inclusive workplace will aid in the provision of care for this vulnerable population.
Implications for Nursing Management
Development of organisational policies, staff training and appropriate supports, for role optimization and team collaboration, can eliminate barriers experienced by transgender individuals.
This article describes the Transgender Recovery Program, a residential substance use treatment program for male-to-female transgender women receiving substance use treatment and mental health services at San Francisco’s Walden House. With an 81% success rate in retaining clients in its first nine months, the program provides male-to-female transgender women with transgender staff and support groups, helps transgender clients build ties among themselves and with other agency clients, and helps transgender women re-enter the community by building a network of employers and landlords who are friendly toward transgender individuals. The program also provides sensitivity training and education about transgender issues for clients, staff, and community agencies, as well as conducting outreach in the community. Elements of program success include affirming transgender people as women and individuals, developing peer support, and expanding clients’ social and vocational horizons.
Keywords: transgender, substance use treatment, recovery, peer counseling.
The literature on the transgender/transsexual-spectrum persons is limited. Most studies are based on assumptions that trans persons are best understood within rigid and binary definitions of gender and sexuality and tend to focus on diagnostics, medical management and risk factors. Researchers and clinicians may assume that people who challenge cultural norms of gender and sexuality can be grouped together, which can result in harmful assumptions about the specific experiences of trans persons. The purpose of this study was to explore the gender and sexual identities of trans persons, investigate group differences, and examine factors that predict better psychological and physical well-being. Participants took part in an online study and provided information about their gender and sexual identity, social support, relationship quality, and mental/physical health. Results depicted diverse gender identities and sexual orientations among trans persons and emphasized that while many challenges faced by sexual and gender minorities are similar, trans persons report unique mental and physical health outcomes. Also, greater social support and relationship quality predicted mental, but not physical, health among trans persons. These results highlight the importance of acknowledging the complexity of trans identities and the key role of social and personal support.
http://utpjournals.metapress.com/content/g124p80727q2r278/
The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the SOC to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.
Increasingly, transgender individuals and loved ones (partners, family, and friends) are seeking assistance from mental health professionals working in the community rather than in university or hospital-based gender identity clinics. Drawing on published literature specific to transgender mental health, interviews with expert clinicians, the authors' clinical experience, and three key guiding principles (a transgender-affirmative approach, client-centered care, and a commitment to harm reduction), we suggest protocols for the clinician providing mental health services in the community setting. Practice areas discussed include assessment and treatment of gender concerns, trans-specific mental health issues, and trans-specific elements in general counseling of transgender individuals and their loved ones.
Very little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in relation to mental health services. Therefore, the overall aim of the current research was to explore LGBT people's experiences of mental health service provision in Ireland. The objectives were to identify barriers and opportunities, to highlight service gaps, and to identify good practice in addressing the mental health and well-being of LGBT people. A mixed methods research design using quantitative and qualitative approaches was deployed. A multipronged sampling strategy was used and 125 respondents responded to the questionnaire. A subset of phase 1 (n = 20) were interviewed in the qualitative phase. Quantitative data was analyzed using descriptive statistics. Qualitative data were analyzed thematically. The sample consisted of LGBT people (n = 125) over 18 years of age living in Ireland. Over three-quarters (77%) had received a psychiatric diagnosis. Findings include that whilst 63% of respondents were able to be 'out' to practitioners, 64% felt that mental health professionals lacked knowledge about LGBT issues and 43% felt practitioners were unresponsive to their needs. Finally, respondent recommendations about how mental health services may be more responsive to LGBT people's needs are presented.
This study examined mental healthcare use and barriers to mental healthcare utilization in a sample of 130 transgender volunteers. Roughly a third of participants sought treatment for mental health issues including depression, anxiety, and relationship problems. Sixty-eight participants (52% of sample) showed evidence of psychological distress but had not received mental health services in the past year. Results point to potential barriers to seeking mental health services. Specifically, cost of treatment, previous bad experiences with healthcare, fear of treatment, and stigma concerns were the most frequently endorsed barriers related to seeking mental health services. Implications for practitioners are discussed.
Categorizing certain gender identities as mental illness or disorder undermines human rights. The diagnosis of Gender Identity Disorder has contributed to stigma and bias against gender-variant people and to the restriction of their human and civil rights; however, in some cases, it has also facilitated validation and availability of necessary treatment. Although there was some disagreement within the work group about the underlying rationale, the Human Rights Work Group of the consensus process held by the World Professional Association for Transgender Health recommends a medical diagnosis for those who seek sex affirmation treatment without experiencing confusion about their gender identity, the continued availability of mental health support for those who require it, and the creation of a pathway enabling gender-variant people to be migrated from a mental health diagnosis to a medical one as life circumstances change. It is essential to ensure that Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, does not pathologize conditions of diversity in sex/gender identity formation and expression.
The transgender community is a population group that has experienced an increase in visibility, with only a small, concomitant increase in understanding. This study reports on four focus groups, in which 34 transgendered individuals discussed their experiences and interactions with the health care system.The specific aims of the study were as follows: •Identify the health needs of transgender and transsexual (TG/TS) individuals;•Hear the experiences and perceptions of TG/TS individuals who are using the current health care system;•Identify any barriers to obtaining services, support and/or resources;•Assess the extent to which health care providers and systems are able to offer sensitive, high quality and user friendly services that meet TG/TS consumers' needs; and•Identify ways that health care services can be enhanced to better meet the needs of the target population.What the study found was a system that was anything but high quality in meeting the needs of TG/TS individuals. Ignorance, insensitivity and discrimination appear to be the norm. Specifically, the focus groups found the following: •Transgendered and transsexual persons frequently encounter providers who will not treat them and blatantly say so. There is a need for education and a change in anti-discrimination law needed to change this.•The lack of provider training on transgender issues creates insensitivity to simple issues of respect for trans people. One example is the unwillingness to address TG/TS people by the pronoun preferred by the patient/client.•Many providers lack the knowledge to adequately treat many of the routine health care needs of TG/TS individuals when such treatment relates to issues of hormone use, gynecological care, HIV prevention counseling, or other concerns related to gender or sexuality.•Providers frequently refer to trans issues in unrelated health care situations such as setting a broken bone, filling a cavity or treating a cold. Greater familiarity with the health care needs of the trans population would reduce such incidents.•Mental health and substance abuse treatment providers need additional training in order to work cooperatively with TG/TS clients to identify when gender issues are or are not relevant to specific mental health or substance abuse treatment episodes. Sometimes gender issues are central to mental health or substance abuse treatment, sometimes they are peripheral and sometimes they are unrelated.•Discrimination in health insurance is the rule, not the exception. There is a need for education to encourage policy changes on the part of insurers and public policy changes on the part of legislators and regulators.
The conceptualization of gender variant populations within studies have consisted of imposed labels and a diversity of individual identities that preclude any attempt at examining the variations found among gender variant populations, while at the same time creating artificial distinctions between groups that may not actually exist. Data were collected from 90 transgender/transsexual people using confidential, self-administered questionnaires. Factors like age of transition, being out to others, and participant's race and class were associated with experiences of transphobic life events. Discrimination can have profound impact on transgender/transsexual people's lives, but different factors can influence one's experience of transphobia. Further studies are needed to examine how transphobia manifests, and how gender characteristics impact people's lives.
This qualitative study examined experiences with health and social service institutions and experiences related to education, employment, and other social networks among 18 ethnically diverse, male to female (MTF) transgender youth aged 16 to 24 years. Participants were recruited from a youth health clinic where they were receiving services for their transgender/transsexual identity. In-depth, semi-structured interviews explored youths' patterns of service utilization, reasons for seeking care, beliefs about the usefulness of services received, experiences with service providers, barriers to care, and suggestions for improving services tailored to them. Similar to other studies with this population, participants described a multitude of health and social risk experiences as well as complex needs related to healthcare, education, employment, housing, personal relationships, and safety. Results suggest a mixed pattern of both positive and negative experiences within the medical, social and mental health services arenas. To improve support for transgender youth and assist in their positive development, it is essential to improve and expand the availability of culturally competent and effective services for this population.
This study describes stress as derived from minority status and explores its effect on psychological distress in gay men. The concept of minority stress is based on the premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization. Minority stressors were conceptualized as: internalized homophobia, which relates to gay men's direction of societal negative attitudes toward the self; stigma, which relates to expectations of rejection and discrimination; and actual experiences of discrimination and violence. The mental health effects of the three minority stressors were tested in a community sample of 741 New York City gay men. The results supported minority stress hypotheses: each of the stressors had a significant independent association with a variety of mental health measures. Odds ratios suggested that men who had high levels of minority stress were twice to three times as likely to suffer also from high levels of distress.
This study used three focus groups to explore factors that affect the experiences of youth (ages 15 to 21) who identify as transgender. The focus groups were designed to probe transgender youths' experiences of vulnerability in the areas of health and mental health. This involved their exposure to risks, discrimination, marginalization, and their access to supportive resources. Three themes emerged from an analysis of the groups' conversations. The themes centered on gender identity and gender presentation, sexuality and sexual orientation, and vulnerability and health issues. Most youth reported feeling they were transgender at puberty, and they experienced negative reactions to their gender atypical behaviors, as well as confusion between their gender identity and sexual orientation. Youth noted four problems related to their vulnerability in health-related areas: the lack of safe environments, poor access to physical health services, inadequate resources to address their mental health concerns, and a lack of continuity of caregiving by their families and communities.
Even though there are many methods for conducting a literature review and techniques for it, as presented in Chapter 13, the actual writing is experienced as challenging, particularly by those new to research. This calls on skills how to write, how to express thoughts of others and how to keep one’s own voice. To support these skills for the actual writing, there are points of attention, techniques and tips that can help the writing to be more effective; this is the purpose of this chapter.
Mental health research and practice has traditionally maintained a view of transgender people through the narrow lens of gender identity disorder. Recently, broader understandings of gender have influenced affirmative therapy with transgender clients. The purpose of the present research is to critically review historical views of transgender clients and to highlight experiences of transgender clients in therapy. Feminist phenomenology informed in-depth interviews with seven people who self-identify as transgender. Four themes emerged: the purposes transgender clients sought therapy, problems in practice, therapist reputation, and transgender affirmative therapy. Transgender affirmative practice and training implications are discussed.
Increasingly, people are living their lives without strict attachment to one gender. In this paper, we discuss key discourses identified in a literature review of transgender and transsexual issues in nursing. Our aim is to highlight the power of dominant discourse and lack of adequate understanding of gender diversity on the part of nurses. We use stories of trans people to illustrate these discourses. An increased awareness may support respectful care of those who do not fit comfortably within culturally defined parameters of male and female.
The invisibility of gender diversity in health care remains a threat to ethical nursing care. The effects of invisibility of transgender people in health care result in a cycle of repetition where those who have been denied recognition in turn avoid disclosure. Key discourses addressing trans people in nursing literature include invisibility, advocacy, cultural competence, and emancipation.
There is a need for further education about gender diversity in order to dispel and counter misunderstandings, stigma, and invisibility. This can be achieved through sustained efforts in nursing research and educational curricula to include gender diversity and trans people. Policies for the protection of those who change their sex or identify outside the dominant gender schema are urgently needed.
Fifty-five transgender youth described their gender development and some of the stressful life experiences related to their gender identity and gender expression. More than two-thirds of youth reported past verbal abuse by their parents or peers related to their gender identity and nonconformity, and approximately one-fifth to one-third reported past physical abuse. The more gender non-conforming the youth were, the more abuse they reported. Four aspects of psychological resilience were examined: a sense of personal mastery, self-esteem, perceived social support, and emotion-oriented coping. A regression model of the selected aspects of resilience accounted for 40%–55% of the variance in relation to depression, trauma symptoms, mental health symptoms, and internalizing and externalizing problems. Emotion-oriented coping was a significant predictor of negative mental health as determined by each of the mental health variables.
This article presents a collective account of a qualitative study on the subjective experience of six Caucasian female subjects, ranging in age from 38 to 63 years, who are coupled with a trans-person undergoing a gender transition by means of hormones and/or surgery. A psychoanalytic case-study design was used to collect in-depth and reflective data that were analyzed and interpreted. Findings across cases are discussed. A summary of the core implications is critical to the mental health field, not only to provide more effective clinical services to this population, but to help remedy the scarcity of literature available at present.
This article outlines recommendations for the World Professional Association for Transgender Health's (WPATH) Standards of Care (SOC) regarding the roles, responsibilities, and tasks of the mental health provider in assessing eligibility and readiness for medical and surgical treatment of gender nonconforming, transgender, and transsexual clients. It reflects a reconceptualization of the role of the mental health provider as a gender specialist and an advocate and educator for transgender people and their families utilizing a nonpathologizing assessment process. This article reflects a need for clinical SOC that minimize the role of “gatekeeping,” and increase the use of informed consent and harm-reduction procedures, while still providing guidelines for psychosocial evaluation. Recommendations are made for less pathologizing nomenclature, clearer definitions for the professional qualifications of those specializing in working with gender-variant people, and increased collaboration across disciplines. Suggestions are made for the SOC to recognize greater diversity in gender expression and identity, increased focus on the families and occupational environments of transgender people, and a broader view of gender issues throughout the lifecycle. Guidelines for psychosocial assessment and referral letters to physicians are outlined, including proposals to revisit the professional qualifications of letter writers and the need for two letters for surgical assessment. It is suggested that WPATH take leadership in the training and credentialing of gender specialists. These recommendations require a reorganization of the format of the SOC that will create a state-of-the-art standard of health care for transgender, transsexual, and gender nonconforming people and ensure the provision of high-quality clinical services for those individuals and their families.
This article is intended to assist mental health counselors, counselor educators, and counseling students who are already familiar with basic terms and concepts in transgender care. First, the authors briefly present an integrative approach for affirmative counseling with transgender clients that emphasizes empowerment, recognition of multicultural and sociopolitical contexts, social justice, and the use of client narratives in counseling. Second, the authors highlight resources within the transgender community and give examples of how counselors can access the transgender community for themselves and their transgender clients. Last, the authors provide a case vignette followed by a case analysis in an effort to challenge readers to consider the experiences of transgender individuals, and to demonstrate the application of the integrative approach and incorporation of transgender community resources.
This article presents findings from an investigation of health needs, service utilization, and perceived barriers to services among male-to-female (MtF) transgender persons of color in San Francisco. Focus groups (n = 48) and survey interviews (n = 332) were conducted with convenience samples recruited from the community. Participants reported a range of health and social services needed during the previous year, with African-Americans and Latinas showing particularly strong service needs. Rates of utilizing services were high for basic health care but lower for social services, substance abuse treatment, psychological counseling, and gender transition-related medical services. No significant ethnic group differences in health service utilization were found. Qualitative findings evinced the call for transgender-specific programs and advanced provider training on transgender issues such as hormone use, gender transition, HIV/ AIDS care and prevention, substance abuse, and mental health problems.
While transgender individuals receive increasing attention in both academia and the social services, their partners remain a hidden population. This study was undertaken to examine the experiences of lesbian, bisexual, and queer identified partners of transgender men through the transition process. Nine subjects were interviewed. Major themes included the impact of transition on identity, community, caretaking, peer support, the relationship itself, and mental health. Isolation and lack of services were identified as significantly impacting the transition experiences of partners. Understanding the transition experience of partners has important implications for researchers and practitioners, and recommendations for further research and service improvement are provided.
This is the first of three articles in this issue of The Journal of Gay and Lesbian Mental Health documenting the proceedings of the workshop “The Psychiatric Needs of the Transgender Homeless Population” at the 2009 American Psychiatric Association's Institute on Psychiatric Services Conference in New York City. This article describes some of the healthcare needs of the transgender homeless population and potential ways of addressing these needs. Homelessness disproportionately affects the transgender population for many reasons. Transgender persons are often rejected by their families and peers, and marginalized in our society, leading to increased risks of unemployment and homelessness. They are frequently not engaged in necessary mental health and medical care due to barriers arising from both their gender minority status and the barriers associated with homelessness. In order for this population to gain access to necessary mental health and medical care, all providers interfacing with them need to identify and assess their individual needs as well as have a basic understanding of this population's public health concerns.
This is one article in a three part series in this issue of The Journal of Gay and Lesbian Mental Health documenting the proceedings from the workshop “The Psychiatric Needs of the Transgender Homeless Population” at the 2009 American Psychiatric Association's Institute on Psychiatric Services Conference in New York City. In the United States, transgender youth are overrepresented among the homeless. The stigma and discrimination that causes and maintains homelessness among transgender people is also prevalent in the streets and at programs that serve homeless people. This makes life for transgender people in foster care, at shelters, and in transitional housing difficult and even dangerous. Shelter policies have been created and adopted to address safety concerns of transgender people. In addition, transitional housing and other services exclusively serving sexual/gender minorities have also been developed to provide safe shelter for this population.
There are significant health disparities according to sexual orientation and gender identity, particularly in mental health; however, very few mental health professionals specialise in caring for lesbian, gay, bisexual and transgender (LGBT) communities. The purpose of this study was to explore how providers with LGBT-focused practices have developed their capacity for working with these populations.
Eight semi-structured interviews were conducted with practising mental health service providers with extensive experience serving LGBT individuals. Participants represented four professional disciplines: psychiatry (n = 2); social work (n = 3); psychotherapy (n = 2), and psychology (n = 1). The data were analysed for themes that were identified using a descriptive phenomenological approach.
All providers self-identified as members of LGBT communities; however, most agreed that this membership was not necessary to provide supportive, appropriate care for LGBT individuals. Providers described their self-identity as members of LGBT communities, associated lived experiences and recognition of the need for mental health services that are sensitive to the unique needs of LGBT individuals as influential factors in their career decisions. The lack of training opportunities and resources specific to the provision of LGBT-sensitive mental health services was highlighted. Provider recommendations included the introduction of mandatory LGBT health content in education curricula that addresses basic LGBT-related terminology, appropriate interview questions to facilitate the disclosure of sexual orientation and gender identity, information regarding the health impact of heterosexism and homophobia, and specific health care needs of sexual and gender identity minority people.
Data from this study suggest there are few opportunities for medical providers to access training and gain expertise in the provision of care to LGBT people. Additional research is needed to consider whether the lack of LGBT health content in medical and psychiatric training programme curricula indirectly contributes to the health disparities experienced by these populations.
Historically, the pathologization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) orientations shaped research and professional practice, while the impact of stigma was not considered. Within a minority stress conceptualization however, stigma-related prejudice and discrimination experienced by LGBTQ people constitute chronically stressful events that can lead to negative health outcomes. Minority stress has been linked to psychological distress among gay men and lesbians and may contribute to elevated rates of distress frequently observed among LGBTQ youth. This study explored the impact of minority stress on psychological distress among LGBTQ youth in Ireland. Measures assessing three components of minority stress (sexual identity distress, stigma consciousness, and heterosexist experiences) were administered online to LGBTQ youth aged 16-24 years (N=301). Each minority stressor had a significant independent association with distress. Stepwise regression analyses identified the linear combination of minority stressors as significantly predictive of distress [F(3,201)=30.80, p≤0.001]. Results suggest that the oppressive social environment created through sexual/transgender identity-related stigma negatively impacts on the well-being of LGBTQ youth. These findings have implications for health professionals and policy makers interested in the concerns of LGBTQ youth experiencing difficulties related to minority status and will facilitate the development and tailoring of interventions aimed at reaching those most at risk.
Accessible summary:
• Transsexual persons are increasing their visibility in society, and health care providers and others (such as social workers) will be called upon to help with issues that transsexual persons face. Challenges that face transsexual persons often include issues involving relationships. Psychiatric and mental health nurses and other caregivers can increase their therapeutic skills in working with couples that include transsexual persons by becoming aware of these challenges and subsequent activities that can help with them. • This research study looks at couple relationships in which one partner reveals male-to-female transsexual identity. These are relationships that were established as man-woman and now will transition into relationships that include a male-to-female person and a female partner. • Common challenges for these couples include issues related to: (1) sexual identity and relationship uncertainty; (2) male-to-female transition decision making; and (3) presenting in public. • Relationship maintenance activities that helped the couples in the study maintain and strengthen their relationships through these challenges include: (1) communication; (2) self-talk (for example, putting the situation in perspective); (3) social networks; (4) positive interactions; (5) impression management (for example, managing displays of affection in public); and (6) social activism.
Abstract:
This qualitative study describes the relational dynamics that help sustain relationships of couples that include male-to-female transsexual persons (MTF) and their natal female partners (NF) following disclosure of transsexualism. Relationship challenges and relationship maintenance activities are identified. Each partner in 17 MTF-NF couples participated in individual surveys and interviews. The data were coded for themes related to relationship challenges and activities. MTF-NF couples experience challenges within the contexts of their relationships and of society. These challenges include: (1) sexual identity and relationship uncertainty; (2) male-to-female transition decision making; and (3) public presentation. Relationship maintenance activities enabled the study couples to maintain and strengthen their relationships through these challenges. These activities include: (1) communication; (2) self-talk; (3) social networks; (4) positivity; (5) impression management; and (6) social activism. Via this report, psychiatric and mental health nurses can increase their therapeutic skills in working with MTF-NF couples.
The prevalence of transsexualism in the Netherlands was estimated by counting all the subjects who were diagnosed as transsexuals by psychiatrists or psychologists and were subsequently hormonally treated and generally underwent sex-reassignment surgery. At the end of 1990, 713 Dutch-born transsexuals received treatment (507 men, 206 women). This amounts to a prevalence of 1:11,900 for male-to-female transsexualism and 1:30,400 for female-to-male transsexualism (population age 15 and above in both groups). The sex ratio was about 2.5 men to 1 woman. The most important reason for this relatively high prevalence seems to be the benevolent climate for the treatment of transsexualism in the Netherlands.
In clinical practice, we have come across people with intellectual disability who have gender dysphoria and cross-dress. Here, we review the literature on this subject and present an illustrative case example. We searched databases, followed-up references from relevant articles, and contacted colleagues in the field. We found nine papers with case examples and one survey. Gender identity problems certainly occur in people with intellectual disabilities, and developmental perspectives are important in assessing and treating them. In some cases autistic spectrum disorder was co-morbid, for individuals with and those without intellectual disability. Aggression was also common. Documented treatments were primarily psychological and social and did not include hormones and sex reassignment surgery. Capacity to consent is a factor that determines treatment.
Injustice at every turn: A report of the National Transgender Discrimination Survey.
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Closing the gap: Priorities for essential change in mental health.
- Department of Health
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- Taylor E.
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Ten questions to help you make sense of qualitative research.
- Critical Appraisal Skills Programme
Speaking from the margins: Trans mental health and wellbeing in Ireland.
- Transgender Equality Network Ireland
National standards for mental health services: National mental health strategy.
- Australian Government
A vision for change: Report of the Expert Group on Mental Health Policy.
- Department of Health and Children
Rights, relationships and recovery: The report of the National Review of Mental Health Nursing in Scotland.
- Government of Scotland