Exploring substance use and mental health for minority transgender youth: Implications for advanced practice nurses

Abstract

Background: Transgender youth, particularly if they are transgender female and of a minority racial or ethnic group (i.e., minority transgender youth [MTY]), are known to have higher incidence of new HIV infections, substance abuse, and suicidality when compared with cisgender youth. Mental health disparities and substance use among MTY, between the ages of 13–24 years, have been underexplored in the United States, although they have serious public health concerns contributing to morbidity and mortality. Objectives: To examine the US literature to discover what is known about the intersection of substance use, mental health disorders, and associated health risks for MTY. Data sources: An integrative review exploring experimental and nonexperimental research was conducted from 2010 to 2018 using Cumulative Index for Nursing and Allied Health (CINAHL), PsycINFO, and PubMed. Articles were selected if the research identified MTY, mental health and/or substance use risks, data-driven outcomes, or considerations that could potentially influence MTY outcomes. Ten articles were included in the final selection. Conclusions: All studies addressed mental health, substance use, and/or health risks, although many of the articles explored all transgender youth outcomes without a particular focus on MTY. Identified factors linked to poor health outcomes included socioeconomic vulnerability, substance use, mood disorders, self-harm, and risky sexual behaviors. Implications for practice: The authors have provided recommendations regarding culturally appropriate, compassionate, evidence-informed practices for engaging MTY and their families to promote greater well-being for all youth, regardless of gender identity.

Health Inequities in LGBT People and Nursing Interventions to Reduce Them: A Systematic Review

“…After the search, we obtained a total of 381 records, of which 16 articles were selected: 1 systematic review and meta-analysis [28], 5 systematic reviews [29][30][31][32][33], 1 cross-sectional descriptive study [34], 4 qualitative studies [35][36][37][38], and 5 quasi-experimental pre-testpost-test studies [39][40][41][42][43]. Regarding the variables of the reviews, 6 articles addressed the specific health needs of LGBT people [28,29,[31][32][33][34], 3 focused on LGBT people's experiences and perceptions [35][36][37], and 10 presented nursing interventions in the LGBT community [30][31][32][33][38][39][40][41][42][43].…”

“…According to the classification by the World Bank [44], 8 articles were from high-income economies (the USA, Canada, and Ireland) and 2 were from upper-middle-income economies (Turkey and Thailand). Of the articles selected, 4 studies centred their investigation on LGBT people in general [34][35][36][37], 3 focused on LGBT youth [29,32,33], 1 specifically analysed trans youth [31], and another examined trans women and trans men [28]; 7 studies assessed the training of health professionals and students [30,[38][39][40][41][42][43], some of which focused on nurses [40,43] or nursing students [38,41].…”

“…Both bisexual men and women appeared to have a higher risk of MH problems and suicide compared to homosexual people [32,33], and trans people were especially vulnerable to these risks compared to cisgender people [31][32][33]. Among trans people, trans women, particularly those belonging to racial/ethnic minorities and in prostitution, had an increased risk of MH problems, risky behaviours, STIs, or substance abuse because of their social context [28,31].…”

“…The results of the selected studies [28,29,[31][32][33][34] showed that the LGBT population collectively exhibited increased rates of MH problems, substance abuse, risky sexual behaviours, STIs, self-harm, and suicide. These problems were closely associated with experiences related to anti-LGBT attitudes and minority stress such as bullying, isolation, marginalisation, victimisation, and social, family, or peer rejection.…”

“…These problems were closely associated with experiences related to anti-LGBT attitudes and minority stress such as bullying, isolation, marginalisation, victimisation, and social, family, or peer rejection. Furthermore, LGBT people from racial/ethnic minorities [31][32][33], as well as those who found themselves in poverty [34] or in prostitution [28,31], were more vulnerable to the health disparities mentioned above.…”