Stigma and Barriers in Health Care Among a Sample of Transgender and Gender-Diverse Active Duty Service Members.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
pubmed:
3
2
2023
medline:
17
2
2023
entrez:
2
2
2023
Statut:
ppublish
Résumé
Transgender and/or gender-diverse (TGD) persons are vulnerable to stigma and health care inequities; however, data are particularly limited among TGD active duty military service members despite ongoing changes to service policies. TGD-related stressors may impede access to and utilization of health care due to fear of potential discrimination and distress, thereby adversely impacting military readiness. We examined stigma and barriers in health care and associations with physical and mental health in an online sample of 177 active duty service members who self-identified as TGD. To assess associations between stigma and barriers in health care with mental and physical health, linear regressions were conducted adjusting for age, gender identity, race, and rank. Over half (65%) of the participants reported at least 1 instance of stigma and/or barrier in health care. Stigma and barriers to health care were significantly associated with greater self-reported depressive symptoms (β=0.20, P =0.03), anxiety (β=0.21, P =0.03), stress (β=0.30, P =0.001), and poorer overall mental health (β=-0.23, P =0.007), after adjusting for covariates. Nearly one-quarter of participants had not disclosed their gender identity to their primary care clinician. Findings suggested that stigma and barriers to affirming health care were prevalent among active duty service members identifying as TGD, specifically, difficulty accessing gender-affirming care and negative assumptions from clinicians. These experiences may adversely affect mental health and impede the quality of health care received by a population already vulnerable to health inequities. Given recent changes to military policy, efforts may be warranted to improve access to timely, affirming care and clinician training.
Sections du résumé
BACKGROUND
Transgender and/or gender-diverse (TGD) persons are vulnerable to stigma and health care inequities; however, data are particularly limited among TGD active duty military service members despite ongoing changes to service policies. TGD-related stressors may impede access to and utilization of health care due to fear of potential discrimination and distress, thereby adversely impacting military readiness.
METHODS
We examined stigma and barriers in health care and associations with physical and mental health in an online sample of 177 active duty service members who self-identified as TGD. To assess associations between stigma and barriers in health care with mental and physical health, linear regressions were conducted adjusting for age, gender identity, race, and rank.
RESULTS
Over half (65%) of the participants reported at least 1 instance of stigma and/or barrier in health care. Stigma and barriers to health care were significantly associated with greater self-reported depressive symptoms (β=0.20, P =0.03), anxiety (β=0.21, P =0.03), stress (β=0.30, P =0.001), and poorer overall mental health (β=-0.23, P =0.007), after adjusting for covariates. Nearly one-quarter of participants had not disclosed their gender identity to their primary care clinician.
CONCLUSIONS
Findings suggested that stigma and barriers to affirming health care were prevalent among active duty service members identifying as TGD, specifically, difficulty accessing gender-affirming care and negative assumptions from clinicians. These experiences may adversely affect mental health and impede the quality of health care received by a population already vulnerable to health inequities. Given recent changes to military policy, efforts may be warranted to improve access to timely, affirming care and clinician training.
Identifiants
pubmed: 36728493
doi: 10.1097/MLR.0000000000001818
pii: 00005650-202303000-00005
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
145-149Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Grant JM, Mottet L, Tanis JE, et al. Injustice at every turn: A report of the national transgender discrimination survey. National Center for Transgender Equality. 2011.
Hill BJ, Bouris A, Barnett JT, et al. Fit to serve? Exploring mental and physical health and well-being among transgender active-duty service members and veterans in the US Military. Transgend Health. 2016;1:4–11.
Kosenko K, Rintamaki L, Raney S, et al. Transgender patient perceptions of stigma in health care contexts. Med Care. 2013;51:819–822.
Seelman KL, Colón-Diaz MJ, LeCroix RH, et al. Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults. Transgend Health. 2017;2:17–28.
Rossman K, Salamanca P, Macapagal K. A qualitative study examining young adults’ experiences of disclosure and nondisclosure of LGBTQ identity to health care providers. J Homosex. 2017;64:1390–1410.
Ruben MA, Fullerton M. Proportion of patients who disclose their sexual orientation to healthcare providers and its relationship to patient outcomes: a meta-analysis and review. Patient Educ Couns. 2018;101:1549–1560.
Strain JD, Shuff IM. Psychological well-being and level of outness in a population of male-to-female transsexual women attending a national transgender conference. Inter J Transgend. 2010;12:230–240.
Meyer IH, Frost DM Minority stress and the health of sexual minorities. 2013.
White BP, Fontenot HB. Transgender and non-conforming persons’ mental healthcare experiences: An integrative review. Arch Psychiatr Nurs. 2019;33:203–210.
Lefevor GT, Boyd-Rogers CC, Sprague BM, et al. Health disparities between genderqueer, transgender, and cisgender individuals: an extension of minority stress theory. J Couns Psychol. 2019;66:385.
McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin. 2016;63:1079–1090.
Wolf EC, Dew BJ. Understanding risk factors contributing to substance use among MTF transgender persons. J LGBT Issues Couns. 2012;6:237–256.
Tebbe EA, Moradi B. Suicide risk in trans populations: An application of minority stress theory. J Couns Psychol. 2016;63:520.
Streed CG, McCarthy EP, Haas JS. Association between gender minority status and self-reported physical and mental health in the United States. JAMA Intern Med. 2017;177:1210–1212.
Xavier J, Bradford J, Hendricks M, et al. Transgender Health Care Access in Virginia: A Qualitative Study. Intern J Transgend. 2013;14:3–17.
Wagner PE, Kunkel A, Asbury MB, et al. Health (trans) gressions: Identity and stigma management in trans* healthcare support seeking. Women Lang. 2016; 39:49–74.
Dietert M, Dentice D. Transgender Military Experiences: From Obama to Trump. J Homosex. 2022:1–18.
Yerke AF, Mitchell V. Transgender people in the military: Don’t ask? Don’t tell? Don’t enlist!. J Homosex. 2013;60:436–457.
Alford B, Lee SJ. Toward complete inclusion: Lesbian, gay, bisexual, and transgender military service members after repeal of Don’t Ask, Don’t Tell. Soc Work. 2016;61:257–265.
Gates GJ, Herman J. Transgender military service in the United States. 2014.
Schvey NA, Klein DA, Pearlman AT, et al. Stigma, health, and psychosocial functioning among transgender active duty service members in the US military. Stigma Health. 2020;5:188.
Schvey NA, Klein DA, Pearlman AT, et al. A Descriptive Study of Transgender Active Duty Service Members in the US Military. Transgend Health. 2020;5:149–157.
Balsam KF, Beadnell B, Molina Y. The Daily Heterosexist Experiences Questionnaire: Measuring minority stress among lesbian, gay, bisexual, and transgender adults. Meas Eval Couns Dev. 2013;46:3–25.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–483.
Ware J, Kosinski M, Keller S. Physical and Mental Health Summary Scales: A User’s Manual. Boston, MA: The Health Institute; 1994.
Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance—United States, 2015. MMWR Surveill Summ. 2016;65:1–174.
Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33:335–343.
Schvey NA, Blubaugh I, Morettini A, et al. Military Family Physicians’ Readiness for Treating Patients With Gender Dysphoria. JAMA Intern Med. 2017;177:727–729.
Korpaisarn S, Safer JD. Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons. Rev Endocr Metab Disord. 2018;19:271–275.
Defense Do. 2015 demographics: Profile of the military community. Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy; 2012.