Mental Health Disparities at the Intersections of Gender Identity, Race, and Ethnicity

Robertson, Lee; Akré, Ellesse-Roselee L.; Gonzales, Gilbert

doi:10.1089/lgbt.2020.0429

Cited by 23 publications

(10 citation statements)

References 39 publications

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“…American Indian/Alaskan Native GM youth reported higher levels of GM prejudice events than White GM youth. These findings are supported by prior work indicating that American Indian/Alaskan Native GM adults are more likely to report elevated experiences of major discrimination than White GM adults (Miller & Grollman, 2015), and more frequent mental distress than White cisgender adults (Robertson et al, 2021). There were no other significant indirect effects for racial/ethnic differences in mental health via minority stressors.…”

Section: Discussionsupporting

confidence: 81%

Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents.

Jardas¹,

Ladd²,

Maheux³

et al. 2023

Journal of Psychopathology and Clinical Science

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Gender minority (GM) youth are at heightened risk for psychopathology, purportedly due to their experiences of GM stressors. However, few studies have examined how GM stressors are associated with depression and anxiety among GM youth. Furthermore, no prior studies have investigated how experiences of GM stressors differ across gender identity and race/ethnicity within a diverse sample of GM youth. A nationwide online cross-sectional survey of 1,943 fourteen-to 18-year-old GM adolescents (66.91% White, 11.73% multiracial, 8.49% Latinx, 7.10% Black, 3.09% Asian, 1.49% American Indian/Alaskan Native) in the United States assessed GM stressors (prejudice events, expectations of rejection, internalized transnegativity, and concealment) and mental health. Structural equation modeling was used to examine how GM stressors and depressive and anxiety symptoms differ across gender identity and race/ethnicity. Higher levels of each GM stressor were related to higher depressive symptoms. Prejudice events, expectations of rejection, and concealment were related to higher anxiety symptoms. Transmasculine and transfeminine youth reported higher levels of GM prejudice events and expectations of rejection, and higher mental health symptoms, than nonbinary youth. Findings were relatively consistent across racial/ethnic identities, with the exception that Black GM adolescents reported fewer GM prejudice events and expectations of rejection and indirectly exhibited lower mental health symptoms as compared to White GM youth. Researchers and clinicians should be attuned to how intersectional identities are related to stress and mental health among diverse GM youth. Recommendations for individual and structural-level interventions are discussed. General Scientific SummaryGender minority youth are at heightened risk for depression and anxiety compared to cisgender peers. This study supports the theory that mental health symptoms among gender minority youth are associated with unique stressful experiences related to having a marginalized gender identity during adolescence. Risk for these stressful experiences and related mental health symptoms vary by gender identity and, to some extent, race/ethnicity.

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Section: Discussionsupporting

confidence: 81%

Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents.

Jardas¹,

Ladd²,

Maheux³

et al. 2023

Journal of Psychopathology and Clinical Science

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“…31 The use of BMI as a barrier to care can thus intensify preexisting racial health disparities within the TGNB population. [32][33][34] The present study is not without limitations. First, the significance of some of our results was not consistent across BMI categories because of the relatively low number of patients in the higher compared with the lower BMI categories.…”

Section: Discussionmentioning

confidence: 86%

“…Nonobese patients (BMI <30 kg/m 2 ) were significantly younger than patients with BMI categories 1 through 3 (30-44.9 kg/m 2 ) [median (IQR) age, 24 (21-29) vs 26 through 28 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) years; P < 0.001]. Nonobese patients had significantly shorter operating times compared with patients with BMI category 3 (40-44.9 kg/m 2 ) [median (IQR) operating time, 141 (110-183.5) vs 154 (120-198) minutes; P = 0.006].…”

Section: Resultsmentioning

confidence: 99%

“…The use of BMI to restrict access to surgery can also potentially worsen preexisting health disparities within the TGNB population, as non-Hispanic Black patients have higher BMI compared with Hispanic and non-Hispanic White patients, on average 31 . The use of BMI as a barrier to care can thus intensify preexisting racial health disparities within the TGNB population 32–34 …”

Section: Discussionmentioning

confidence: 99%

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Association of High Body Mass Index With Postoperative Complications After Chest Masculinization Surgery

Hassan,

Schuster,

Ascha

et al. 2023

Ann Plast Surg

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Purpose Body mass index (BMI) requirements for transgender and nonbinary patients undergoing chest masculinization surgery (CMS) are not standardized and based on small sample sizes. This is the largest and first national retrospective study to determine the association between BMI and postoperative complications. Methods The National Surgical Quality Improvement Program 2012–2020 was queried for CMS patients. The primary outcome was incidence of at least one complication within 30 days. Secondary outcomes were incidence of major and minor complications. Body mass index (in kilograms per square meter) was categorized as category 0 (<30), 1 (30–34.9), 2 (35–39.9), 3 (40–44.9), 4 (45–49.9), and 5 (≥50). Logistic regression was used to evaluate the association between BMI and outcomes. Results Of 2317 patients, median BMI was 27.4 kg/m2 (interquartile range, 23.4–32.2 kg/m2). Body mass index range was 15.6 to 64.9 kg/m2. While increasing BMI was significantly associated with greater odds of at least one complication, no patients experienced severe morbidity, regardless of BMI. Patients with BMI ≥50 kg/m2 had an adjusted odds ratio [aOR, 95% confidence interval (CI)] of 3.63 (1.02–12.85) and 36.62 (2.96–>100) greater odds of at least one complication and urinary tract infection compared with nonobese patients, respectively. Patients with BMI ≥35 kg/m2 had an adjusted odds ratio (95% CI) of 5.06 (1.5–17.04) and 5.13 (1.89–13.95) greater odds of readmission and surgical site infection compared with nonobese patients, respectively. Conclusions Chest masculinization surgery in higher BMI patients is associated with greater odds of unplanned readmission. Given the low risk for severe complications in higher BMI individuals, we recommend re-evaluation of BMI cutoffs for CMS patients.

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“…From the perspective of KCI and Wilmot researchers, the science of intersectionality emphasizes that interventions for LGBTQIA persons should also consider other identities that have been historically marginalized, such as racial and ethnic minorities, acknowledge the impact of multiple marginalization ( 43 ), and better understand intersectional minority stress experiences ( 44 ). This is especially true for interventions like FOCUS that are designed to address psychological distress, as differences in mental distress have also been documented across racial-ethnic minority groups of SGM individuals ( 45 , 46 ). LGBTQIA disparities research has also underscored differences in distress based on specific LGBTQIA identity; for example, bisexual adults disclose their identities less often ( 47 ) and report more mental distress than lesbian and gay adults ( 48 ), due in part to bisexual-specific forms of minority stress ( 49 ).…”

Section: Discussionmentioning

confidence: 99%

Community-Driven Identification and Adaptation of a Cancer Caregiving Intervention for LGBTQIA Populations

et al. 2022

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BackgroundLesbian, gay, bisexual, transgender, and other LGBTQIA cancer patients experience significant disparities in cancer-related outcomes. Their relationships may not be acknowledged in care systems designed to serve primarily heterosexual and cisgender (H/C) patients, and resources for partners and caregivers of H/C patients may not address the needs of LGBTQIA caregivers. Tailored interventions are needed to address disparities in LGBTQIA patients and caregivers.MethodsTo address this gap, researchers from Karmanos Cancer Institute in Detroit, MI and Wilmot Cancer Institute in Rochester, NY worked with a cancer action council (CAC) of LGBTQIA stakeholders with lived experience of cancer in a community-academic partnership. This group used the ADAPT-ITT model to guide their process of assessing needs in this community, identifying evidence-based interventions that could be adapted to meet those needs, and beginning the process of adapting an existing intervention to meet the needs of a new population.ResultsIn the Assessment phase of the model, CAC members shared their own experiences and concerns related to cancer and identified cancer caregiving as a priority area for intervention. In the Decision-Making phase of the model, researchers and CAC members performed a review of the literature on interventions that reported outcomes for cancer caregiver, identifying 13 promising interventions. Each of these interventions was evaluated over a series of meetings using a scoring rubric. Based on this rubric, the FOCUS intervention was established as an appropriate target for adaptation to the LGBTQIA population. In the first stage of the Adaptation phase, CAC members reacted to the intervention content and identified principal components for adaptation.ConclusionWhile the FOCUS intervention adaptation is still in process, this manuscript can serve as a guide for others establishing community-academic partnerships to adapt interventions, as well as those developing interventions and resources for LGBTQIA persons coping with cancer.

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Mental Health Disparities at the Intersections of Gender Identity, Race, and Ethnicity

Cited by 23 publications

References 39 publications

Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents.

Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents.

Association of High Body Mass Index With Postoperative Complications After Chest Masculinization Surgery

Community-Driven Identification and Adaptation of a Cancer Caregiving Intervention for LGBTQIA Populations

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