Inclusive Healthcare for Transgender Individuals: Addressing Mental Health Disparities

By Alex Abramovich and Nelson Pang

Based on the 2021 census, approximately 0.33% of the total Canadian population aged 15 and over, or 1 in 300 people, identify as transgender or non-binary. This is likely an underestimate due to a variety of reasons, with the most obvious being that each household completes one survey, and depending on who is responding to the questions, they may not be aware of each person’s gender identity, especially if someone in the household has not come out as transgender yet.

There has been a rise in violence and anti-transgender legislation across the globe, and transgender individuals continue to encounter barriers accessing housing, employment, and basic goods and services, leading to disproportionately high rates of homelessness and unemployment. Moreover, transgender individuals frequently experience social marginalization, including discrimination and stigma, which contribute to poor health outcomes. Recognizing these challenges, there has been an increasing awareness of the specific mental health struggles faced by the transgender population in recent years.

To gain a deeper understanding of the relationship between marginalization and mental health service use among transgender individuals, this study aimed to determine the extent to which neighborhood-level marginalization mediates mental health service utilization among transgender individuals in Ontario. A matched retrospective cohort study was conducted using administrative health data held at ICES.

Surprisingly, the study's findings revealed that neighborhood-level marginalization did not clinically mediate mental health service use among transgender individuals. However, it is important to note that transgender individuals were more likely to be exposed to various forms of neighborhood-level marginalization, including economic, ethno-racial, age-based, and social marginalization. Additionally, they exhibited higher rates of mental health-related service use, including psychiatrist visits, primary care provider visits, emergency department visits, and hospitalizations.

These research outcomes led to the conclusion that mental health service utilization among transgender individuals was not directly influenced by neighborhood-level marginalization. Nevertheless, the study serves as a crucial reminder of the need to investigate marginalization and mental health service use at the individual level in order to gain a comprehensive understanding of the mental health disparities experienced by transgender individuals.

Moreover, the study's findings emphasize the significance of creating inclusive and affirming healthcare services. Transgender individuals often face unique challenges and barriers when seeking healthcare, including disrespectful attitudes and being referred to by incorrect names and pronouns, highlighting the necessity for healthcare providers to be sensitive to these issues and proactively address them. One notable barrier is the shortage of family doctors in Ontario, particularly gender-affirming primary healthcare providers, especially outside of major city centers. By acknowledging and addressing these barriers, society can strive to ensure that transgender individuals have equal access to mental health support. By actively working towards inclusive and affirming healthcare services, we can take significant steps in reducing the mental health disparities experienced by transgender individuals and promote overall well-being.

In conclusion, the findings of this study shed light on the complex interplay between marginalization and mental health service utilization. While neighborhood-level marginalization did not directly mediate mental health service use, it is clear that transgender individuals face significant challenges and barriers in accessing inclusive and affirming healthcare. Addressing the mental health disparities experienced by transgender individuals requires a comprehensive approach that considers both systemic and individual factors. Healthcare providers must strive to create safe and welcoming environments, where transgender individuals feel respected and supported. This includes using correct names and pronouns, and addressing the unique healthcare needs of transgender individuals. Furthermore, it is essential for policymakers and healthcare organizations to invest in improving access to gender-affirming primary healthcare providers, particularly in underserved areas.

Read the article

Article details
Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada
Alex Abramovich, W. Ariel Gould, Nelson Pang, Claire De Oliveira, Tomisin Iwajomo, Myriam Vigny-Pau, Kinnon MacKinnon, June Sing Hong Lam & Paul Kurdyak
First Published: May 10, 2023
DOI: 10.1177/07067437231171541
The Canadian Journal of Psychiatry

About the author

Featured

Dr. Alex Abramovich is a Scientist at the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH) and an Assistant Professor at the Dalla Lana School of Public Health and the Department of Psychiatry, University of Toronto. Dr. Abramovich holds a Canada Research Chair in 2SLGBTQ+ Youth Homelessness and Mental Health, and is an internationally recognized leader in the area of 2SLGBTQ+ health and homelessness. The overarching aim of his program of research is to investigate the health and social inequities experienced by 2SLGBTQ+ individuals, with a focus on understanding and improving the health and service needs of 2SLGBTQ+ youth and young adults.

Nelson Pang is a Research Trainee at Institute for Mental Health Policy Research, CAMH and PhD Student at the Factor-Inwentash Faculty of Social Work.