Stigma shapes lesbian, gay, bisexual, transgender, and queer person's mental health and experiences with mental health services in North Macedonia

Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022

“…This finding, to some extent, keeps in line with a study conducted in Canada, which found that after adjusting for socioeconomic variables and age, compared to cisgender heterosexual people, only the transgender but no other types of LGBTQ+ had a significant additional risk of UMHN ( 7 ). Our findings on transgender also corroborate previous studies, which concluded that compared to other subtypes of LGBTQ+, transgender people faced additional minority stressors because of their potentially visible gender expression ( 28 , 31 , 32 ). Our supplement analysis ( Supplementary Table 4 ) confirms this point to some extent and indicated that those transgender people who never married had a 1.28-time likelihood of reporting UMHN (AOR = 1.28, 95% CI 1.11–1.49).…”

“…to other subtypes of LGBTQ+, transgender people faced additional minority stressors because of their potentially visible gender expression (28,31,32). Our supplement analysis (Supplementary Table 4) confirms this point to some extent and indicated that those transgender people who never married had a 1.28-time likelihood of reporting UMHN (AOR = 1.28, 95% CI 1.11-1.49).…”

“…Our Supplementary Table 4 also highlights that the impact of job loss and wage reduction was stronger among LGBTQ+ who were relatively rich, as compared to LGBTQ+ with total household income $0–$34999, LGBTQ+ with total household income $50,000–$74,999 or $100,000+ had a higher likelihood of reporting UMHN (AOR = 1.16, 95% CI 1.04–1.28; AOR = 1.19, 95% CI 1.07–1.32, respectively). The long-lasting societal stigmatization, institutional discrimination, lack of identity-affirming mental health services, and negative personal experiences with mental health services could also contribute to the additional risk of UMHN among LGBTQ+ we found ( 3 , 4 , 11 , 28 – 30 ). The identified additional risk of UMHN among LGBTQ+ during the COVID-19 crisis also keeps in line with the evidence in medical care overall.…”

“…The difference in UMHN between LGBTQ+ and non-LGBTQ+ had a wide variation across states. This geographic variation may to some extent be because of unevenly distributed LGBTQ-specific mental health services ( 24 , 28 ) and different COVID-19 containment policies (like social distance rules and vaccination mandates) adopted by states ( 36 , 37 ). Our state-level analysis indicated that for bisexual, states have a higher proportion of facility providing mental health treatment in a partial hospitalization/day treatment setting, offering dedicated mental health treatment program for persons with HIV or AIDS, offering vocational rehabilitation services, offering nicotine replacement therapy, offering non-nicotine smoking/tobacco cessation medications, or offering antipsychotics for the treatment of serious mental illness (SMI), was associated with a lower risk difference in reporting UMHN between bisexual and non-LGBTQ+ ( Supplementary Table 8 ); for gay, states have a higher proportion of facility providing administrative or operational services for mental health treatment, offering vocational rehabilitation services, offering dedicated mental health treatment program for persons aged 18 years and older with SMI, or offering illness management and recovery (IMR) services, was associated with a lower risk difference in reporting UMHN between gay and non-LGBTQ+ ( Supplementary Table 8 ); for queer, states have higher proportion of facility providing group therapy, offering mobile/off-site psychiatric crisis services, or offering antipsychotics for the treatment of SMI, was associated with a lower risk difference in reporting UMHN between queer and non-LGBTQ+ ( Supplementary Table 8 ).…”

Caring for Transgender People in Healthcare: A Qualitative Study with Hospital Staff in Croatia

“…They also mentioned their perception of transgender patients in terms of shame related to sexual health and an increased possibility of mental disorders in general. In a qualitative study by Stojanovski et al [ 35 ] conducted in North Macedonia in 2021, those participants with transgender identities stated the presence of mental health problems, as well as the effect of minority stress on their identity and health. In the context of these health problems, the participants emphasized both their need for mental health services and concerns about the availability and quality of such services.…”