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

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.

Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans

“…Among transgender adults, these estimates are even higher. This is particularly worrisome and merits further education and antidiscriminatory policies and training in health care, as avoiding health care can further exacerbate health disparities between LGBTQ and non‐LGBTQ adults …”

“…Experiencing discrimination persistently leads to negative health effects for LGBTQ people, and it limits their opportunities and access to critical resources in areas such as health care, employment, and public safety . It also leads to avoidance of care, further amplifying these negative health consequences . For example, transgender people who have experienced discrimination in health care are more likely than those who have not experienced discrimination to subsequently avoid both preventative and urgent health care services, including needed care due to illness or injury .…”

“…Even the anticipation of or mental preparation for discrimination, whether discrimination actually occurs (ie, felt stigma), has significantly harmful effects on health. [12][13][14] While much related research has focused on the effects of racism 10,15,16 and sexism on health, 16,17 these same effects have also been observed in the context of discrimination, harassment, and assault against nonrepresentative samples of LGBTQ people. [18][19][20][21] In some cases, these effects persist even after basic protection policies have been implemented.…”

“…21,22 It also leads to avoidance of care, further amplifying these negative health consequences. 14 For example, transgender people who have experienced discrimination in health care are more likely than those who have not experienced discrimination to subsequently avoid both preventative and urgent health care services, including needed care due to illness or injury. 22 This leads to worse health outcomes, including higher likelihood of depression and suicidal ideation or attempts.…”

“…22 This leads to worse health outcomes, including higher likelihood of depression and suicidal ideation or attempts. 14 Further, these negative consequences for health are likely to be compounded for individuals from multiple minority backgrounds, such as LGBTQ racial/ethnic minorities or LGBTQ women. 18,[25][26][27][28][29][30] Transgender people, with their unique health concerns, may also face special health-related vulnerabilities as a result of discrimination, including social and economic vulnerabilities that increase health risks.…”