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Identifying Barriers to Mental Healthcare for High-risk Transgender and Gender Non-conforming Youth

Thu, April 8, 10:00 to 11:30am EDT (10:00 to 11:30am EDT), Virtual

Abstract

It is well-established that transgender and gender non-conforming youth (TGNC) youth are at elevated risk for depression, suicidality, and self-harm compared to their cisgender peers (Connolly, Zervos, Barone, Johnson, & Joseph, 2016; Perez-Brumer, Day, Russell, & Hatzenbuehler, 2017). Yet, although an emerging body of research suggests that TGNC youth have difficulty accessing and receiving appropriate healthcare (Rider, McMorris, Gower, Coleman, & Eisenberg, 2018), little is known about mental healthcare use and specific barriers to treatment that these vulnerable youth face. Using a mixed methods approach, the current study explored the mental healthcare utilization and perceived barriers to mental healthcare in TGNC youth with a history of suicidality and self-harm. Twenty-eight youth (18 – 25 years old, mean age = 21.2; ethnicity = 78.6% White, 14.3% Bi-racial, 3.6% Black, 3.6% Latino) who self-identified as transgender or gender-nonconforming (10.7% transgender female, 53.6% transgender male, 35.7% gender non-conforming/non-binary) and endorsed a history of suicidality or self-harm participated in our study, which comprised of a self-report questionnaire followed by a focus group discussion (6 groups of 3-5 participants). Survey data was collected on their current mental health (Patient Health Questionnaire-9 [PHQ-9]; Kroenke, Spitzer, & Williams, 2001; self-reported suicide attempt in past week), treatment history, and perceived barriers to mental health services (Service Utilization Barriers Scale [SUBS]; Shipherd, Green, & Abramovitz, 2010); qualitative data on the youths’ previous experiences with mental health services was also collected as part of a semi-structured group discussion. All participants reported having previously seen a mental health provider; however, only 60.7% were currently in treatment. Of the youth who were not currently in treatment, 63.6% endorsed moderate-to-severe levels of depression (PHQ9 ≥ 10) and 36.4% endorsed attempting suicide in the past week; suggesting that most of these youth would benefit from treatment and this need was not being met. Table 1. shows the item-level endorsement for perceived mental healthcare barriers (n = 23). The most frequently endorsed barriers were related to personally having a bad experience with mental health services (87%), knowing or hearing about somebody who has had a bad experience with mental health services (87%), the cost of mental health care (82.6%), not liking to talk in groups (60.9%), and being afraid of their provider’s reaction to their sexual orientation (56.5%) and gender identity (56.5%).These findings suggest that, apart from logistical barriers to treatment (e.g., cost, dislike of group therapy format), a key barrier to mental health utilization is the perception that mental health providers lack the relevant knowledge or cultural competence to provide appropriate treatment. Figure 1 provides specific examples of the participants’ experiences from the focus group discussions (n = 21). Future research should continue to examine these issues on a larger scale, and with a more diverse population of TGNC youth; however, the current findings provide an initial step to understanding the mental healthcare experiences of TGNC youth and offers potential ideas (e.g., ensure cultural competence training include gender diversity issues) on how clinicians, policymakers, and researchers can improve treatment access for this underserved population.

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