Avoidance of primary healthcare among transgender and non-binary people in Canada during the COVID-19 pandemic

Tami, Abigail; Ferguson, Tatiana B.; Bauer, Greta R.; Scheim, Ayden I.

doi:10.1016/j.pmedr.2022.101789

Cited by 22 publications

(15 citation statements)

References 40 publications

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“…Non-binary individuals had greater risk for increased severity of psychiatric diagnoses in this study. Unfortunately, this group has been particularly avoidant of healthcare professional contact during the pandemic [ 58 ]. As such, MH care systems should optimally provide multiple options such as digital, telehealth and in-person sessions to accommodate individual preference and needs [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…Note. "Worsening due to COVID-19" is only asked of those reporting increased severity 1 Comprising other anxiety, PTSD, ADHD, tic, psychosis, and bipolar disorders 2 Comprising all disorders above 3 Ontario Child Health Survey reference for GAD, depression, any psychiatric disorder, respectively: 4-11 y: 3.4%,1.1%, 18.1%; 12-17 y: parent-report 5.5%, 5.2%, 18.2%; self-report 9.7%, 7.3%, 21.8% 4 Statistics Canada reference for GAD, depression, any psychiatric disorder, respectively: 15-24 y: 2.4%, 7.1%,18.5%; 25-64 y: 3.0%, 5.0%, 9.8% Unfortunately, this group has been particularly avoidant of healthcare professional contact during the pandemic [58]. As such, MH care systems should optimally provide multiple options such as digital, telehealth and in-person sessions to accommodate individual preference and needs [37].…”

Section: Table 3 Lifetime Psychiatric Diagnoses Increased Severity An...mentioning

confidence: 99%

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Age-specific determinants of psychiatric outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study

Ågren

Best

Selles

et al. 2023

Child Adolesc Psychiatry Ment Health

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Background Canadians endured unprecedented mental health (MH) and support access challenges during the first COVID-19 wave. Identifying groups of individuals who remain at risk beyond the acute pandemic phase is key to guiding systemic intervention efforts and policy. We hypothesized that determinants of three complementary, clinically actionable psychiatric outcomes would differ across Canadian age groups. Methods The Personal Impacts of COVID-19 Survey (PICS) was iteratively developed with stakeholder feedback, incorporating validated, age-appropriate measures. Baseline, cross-sectional online data collected between November 2020-July 2021 was used in analyses. Age group-specific determinants were sought for three key baseline MH outcomes: (1) current probable depression, generalized anxiety disorder, obsessive–compulsive disorder and/or suicide attempt during COVID-19, (2) increased severity of any lifetime psychiatric diagnosis, and (3) inadequate MH support access during COVID-19. Multivariable logistic regression models were constructed for children, youth (self- and parent-report), young adults (19–29 years) and adults over 29 years, using survey type as a covariate. Statistical significance was defined by 95% confidence interval excluding an odds ratio of one. Results Data from 3140 baseline surveys were analyzed. Late adolescence and early adulthood were identified as life phases with the worst MH outcomes. Poverty, limited education, home maker/caregiver roles, female and non-binary gender, LGBTQ2S + status and special educational, psychiatric and medical conditions were differentially identified as determinants across age groups. Interpretation Negative psychiatric impacts of COVID-19 on Canadians that include poor access to MH support clearly persisted beyond the first wave, widening pre-existing inequity gaps. This should guide policy makers and clinicians in current and future prioritization efforts.

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Section: Discussionmentioning

confidence: 99%

Section: Table 3 Lifetime Psychiatric Diagnoses Increased Severity An...mentioning

confidence: 99%

Age-specific determinants of psychiatric outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study

Ågren

Best

Selles

et al. 2023

Child Adolesc Psychiatry Ment Health

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“…This study expands the literature about TGI individuals’ healthcare experiences and utilization behaviors [ 1 , 2 , 3 , 4 , 10 , 12 , 18 ]; by documenting high rates of discrimination directed at TGI individuals in childhood, ranging from abusive (e.g., harsh language and refusal of care) to non-inclusive (e.g., lack of identity representation on medical documentation and forms). These findings indicate that TGI youth’s exposure to healthcare discrimination might diminish trust in healthcare institutions and providers necessary for their engagement in care (e.g., preventative care), trust in provider recommendations (e.g., vaccinations), and the improvement of their health outcomes (e.g., disease management) in adulthood.…”

Section: Discussionmentioning

confidence: 54%

“…The U.S. Centers for Disease Control and Prevention (CDC) estimated that by 30 June 2020, 41% of adults in the U.S. had delayed or avoided healthcare due to concerns related to COVID-19 [ 15 ]. Researchers have begun to highlight potential individual, structural, and social challenges faced by the TGI population in the context of the COVID-19 pandemic [ 16 , 17 , 18 ]. Despite the evidence of the impact of the COVID-19 pandemic on the healthcare utilization decisions of U.S. adults generally and the emergence of evidence of the impact of the COVID-19 pandemic on TGI individuals, the association between childhood exposure to healthcare discrimination and healthcare avoidance in adulthood in the context of the COVID-19 pandemic has not been explored.…”

Section: Introductionmentioning

confidence: 99%

Exposure to Childhood Healthcare Discrimination and Healthcare Avoidance among Transgender and Gender Independent Adults during a Global Pandemic

Mason

Smout

Wall

et al. 2022

IJERPH

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Transgender and gender-independent individuals (TGI) encounter myriad barriers to accessing affirming healthcare. Healthcare discrimination and erasure exposure among TGI individuals is vital to understanding healthcare accessibility, utilization behaviors, and health disparities in this population. Exposure to gender identity-related healthcare discrimination and erasure in childhood may contribute to TGI adults’ healthcare utilization behaviors. The commonality of childhood exposure to gender identity-related healthcare discrimination and its relationship to healthcare avoidance during the early months of the COVID-19 pandemic among TGI adults were explored. TGI adults aged 18 to 59 (N = 342) in the United States were recruited online during the summer of 2020. Among individuals who reported childhood exposure to gender identity-related healthcare discrimination, 51% reported experiencing two or more distinct forms of discrimination. Hierarchical logistic regression indicated that exposure to healthcare discrimination in childhood significantly increased the odds of healthcare avoidance during the early months of the COVID-19 pandemic, after accounting for demographic factors and self-reported COVID-19 symptoms (odds ratio = 1.30, 95% confidence interval = 1.10, 1.54). These findings suggest that childhood exposure to gender identity-related healthcare discrimination is a prominent barrier to the utilization of healthcare for TGI adults, even during a global pandemic.

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“…Transgender people may have experienced particular difficulties in accessing hormone interventions, given that healthcare systems canceled or postponed elective procedures during the pandemic (Wang et al, 2020 ). Furthermore, non‐binary and transgender people experience misgendering and transphobia in healthcare (Carlile, 2020 ; Dolan et al, 2020 ; Whitehead, 2017 ), which may translate to healthcare avoidance, particularly during the COVID‐19 pandemic when healthcare visits were discouraged unless urgent (Tami et al, 2022 ). Contrary to our hypothesis, loss of a loved one or relative due to COVID‐19 was associated with lower odds of new‐onset suicidal and/or self‐harm ideation, despite the fact that people were often unable to visit their loved ones in hospital or attend funerals during the pandemic (Eisma et al, 2021 ; Eisma & Tamminga, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Risk and protective factors for new‐onset binge eating, low weight, and self‐harm symptoms in >35,000 individuals in the UK during the COVID‐19 pandemic

Davies

Hübel

Herle

et al. 2022

Intl J Eating Disorders

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Objective: The disruption caused by the COVID-19 pandemic has been associated with poor mental health, including increases in eating disorders and self-harm symptoms. We investigated risk and protective factors for the new onset of these symptoms during the pandemic. Method: Data were from the COVID-19 Psychiatry and Neurological Genetics study and the Repeated Assessment of Mental health in Pandemics Study (n = 36,715).Exposures were socio-demographic characteristics, lifetime psychiatric disorder, and COVID-related variables, including SARS-CoV-2 infection/illness with COVID-19.We identified four subsamples of participants without pre-pandemic experience of our outcomes: binge eating (n = 24,211), low weight (n = 24,364), suicidal and/or

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Avoidance of primary healthcare among transgender and non-binary people in Canada during the COVID-19 pandemic

Cited by 22 publications

References 40 publications

Age-specific determinants of psychiatric outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study

Age-specific determinants of psychiatric outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study

Exposure to Childhood Healthcare Discrimination and Healthcare Avoidance among Transgender and Gender Independent Adults during a Global Pandemic

Risk and protective factors for new‐onset binge eating, low weight, and self‐harm symptoms in >35,000 individuals in the UK during the COVID‐19 pandemic

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