Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults.

Kristie L Seelman,Marik Xavier-Brier,Leonardo Kattari,Matthew J.P Colón-Diaz,Rebecca H Lecroix

doi:10.1089/trgh.2016.0024

Kristie L Seelman, Marik Xavier-Brier + Show 3 more

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https://doi.org/10.1089/trgh.2016.0024

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Abstract

Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base.Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health.Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B=−0.26, p<0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation (p<0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health.Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare.

Highlights

Transgender and gender nonconforming people frequently experience exclusion and discrimination in healthcare settings.[1,2,3] Yet, they may need to seek medical attention in pursuit of gender-affirming hormones and surgical procedure(s)[4,5,6,7] in addition to other health or mental health conditions
Owing to the value of understanding which subgroups of transgender adults may experience noninclusive care from their primary care provider (PCP) and/ or may delay care because of fear of discrimination (31.1% of the sample), we descriptively explored associations between these two variables and some of the particular demographic and health variables from our models that would be of primary interest to practitioners (Table 2)
This study contributes to the literature by using a statewide sample of more than 400 transgender adults to examine the roles of a lack of transgender inclusivity among healthcare providers and delaying care because of fear of discrimination in relation to health indicators among this population

Summary

Introduction

Transgender and gender nonconforming people frequently experience exclusion and discrimination in healthcare settings.[1,2,3] Yet, they may need to seek medical attention in pursuit of gender-affirming hormones and surgical procedure(s)[4,5,6,7] in addition to other health or mental health conditions. In recent years there has been a growing amount of research documenting barriers to reliable healthcare for this population[1,2,8] and a lack of transgender competence among a Kristie L.

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