Transgender mental health: The role of primary care doctors
- A new study that took place in New Zealand has shown that, for transgender individuals, negative experiences with healthcare professionals are associated with an increased risk of psychological distress and suicidal thoughts.
- In contrast, positive or supportive experiences with primary care physicians (PCPs) reduced the risk of these negative mental health outcomes.
- This study highlights the importance of improving the awareness and education of PCPs about transgender healthcare.
Studies have consistently shown that transgender individuals have a higher risk of mental health issues than cisgender individuals.
A new study found that transgender individuals who reported supportive experiences with their PCP were less likely to experience symptoms of anxiety or depression or have suicidal thoughts.
However, only about half of the surveyed individuals reported a positive experience with their PCP, highlighting the importance of training healthcare professionals to improve the care of transgender individuals.
The study appears in the journal Family Practice.
Interactions with healthcare professionals
Negative interactions with healthcare professionals are prevalent among transgender individuals. A lack of awareness and education among medical staff about the healthcare needs of transgender individuals are some of the reasons for these negative healthcare experiences.
However, even small steps indicative of respect toward transgender individuals, such as the use of correct gender pronouns and current names, can contribute to a positive healthcare experience.
Previous studies have shown that the frequent negative healthcare experiences of transgender individuals are associated with a higher risk of depression and suicidal thoughts.
However, the current study is the first to assess the effects of positive or supportive healthcare experiences on mental health outcomes in transgender individuals in New Zealand.
Counting Ourselves survey
The researchers used data from the 2018 Counting Ourselves survey, which collects information on the health of transgender individuals aged 14 years or older residing in New Zealand.
The study included 948 transgender individuals who provided feedback on their negative and positive healthcare experiences and mental health.
The scientists used a standardized questionnaire to assess psychological distress levels on the basis of the anxiety and depressive symptoms that the individuals had experienced in the previous 4 weeks.
The researchers also determined the number of self-harm attempts and the frequency of suicidal thoughts or behaviors in the previous 12 months.
Negative health experiences
Part of the questionnaire assessed the most frequent negative experiences that people had had when dealing with healthcare professionals, including doctors, nurses, and administrative staff.
It revealed that 47% of participants had had to educate healthcare professionals about transgender people to receive the necessary care.
The participants also reported frequently encountering unnecessary or invasive questions from healthcare professionals. Another common experience of transgender individuals was healthcare professionals admitting a lack of adequate knowledge about gender-affirming treatments.
These negative health experiences were associated with increased psychological distress and a higher risk of self-harm or suicidality.
Supportive interactions
The questions on supportive interactions assessed the positive experiences that transgender individuals had had with their PCP.
The survey found that only 57% of individuals felt as though their PCP treated them in a similar manner to other patients when they were seeking care for reasons unrelated to gender-affirming care.
Only 48% of survey participants perceived their PCPs as supportive of their gender-affirming healthcare needs.
Less than one-quarter of PCPs had adequate knowledge about gender-affirming care, and about 43% showed a willingness to acquire the necessary knowledge about gender-affirming care.
Similarly, only 40% of PCPs used the correct gender pronouns, and 47% used the person’s current name.
The researchers found that a higher number of supportive experiences with PCPs was associated with lower psychological distress and a reduced likelihood of attempted suicide in the previous year.
Each additional positive experience with a PCP reduced the risk of attempted suicide by 11%. Similarly, each negative experience was associated with an increase of 20% in the risk of attempted suicide.
The study’s co-author, Dr. Gareth Treharne, a professor of psychology at the University of Otago in New Zealand, told Medical News Today:
“These findings demonstrate the importance of considering the protective effects of having primary care doctors who are supportive of the transgender patients they provide for. These protective effects can counteract some of the detrimental effects of negative healthcare experiences, but there is a pressing need to see improvement in the aspects of supportive care that are a matter of fundamental human rights for transgender people.”
Implications
The authors note that the medical education of primary care doctors in New Zealand does not include training on transgender healthcare.
The study’s other co-author, Dr. Rona Carroll, a senior lecturer in primary healthcare and general practice at the University of Otago, told MNT:
“Medical schools have an important role to play in ensuring our future doctors have the knowledge and confidence needed to provide supportive care to their transgender patients, and postgraduate general practice training programs should incorporate transgender healthcare as a key skill in their curriculum. The positive impact this can have on patient outcomes is significant, and the need is urgent.”
Similarly, Dr. Treharne noted, “Further training of primary care doctors is needed, and doctors need to take responsibility for their own learning about meeting the needs of transgender people.”
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