Transgender ED Visitors Experience More Marginalization Than Cisgender

Transgender individuals who visit the emergency department for a mental health-related crisis are more likely to come from lower-income neighborhoods, have unstable housing, and have a diagnosed mood disorder than the general population, according to a recent study published in APA’s Psychiatric Services.

Previous studies have found transgender individuals to be 2 to 5 times more likely to have diagnosed depression or anxiety compared with cisgender individuals. They’re also up to 10 times more likely to commit suicide. Given the higher rates of mental illness in the transgender community, the researchers in the current study wanted to explore the characteristics of transgender individuals who visit the emergency department (ED) for an acute mental health issue.

The cross-sectional study used health care data from Ontario, Canada patients to compare characteristics of transgender individuals who had a psychiatric ED visit or a psychiatric hospitalization together with the general population of acute psychiatric care users. The study included individuals aged 16 and over who visited the ED between 2012 and 2018 for a psychiatric emergency or hospitalization. Gender identity was obtained through electronic health record data from 4 Ontario outpatient clinics. The transgender group contained 728 participants while the general population group included 581,708.

The researchers found transgender ED users were more likely than the matched comparison sample to be in the lowest neighborhood income quintile (37% versus 27%,

P<.001), highest residential instability quintile (47% versus 38%, P<.001), and highest material deprivation quintile (33% versus 26%, P < .001).

The transgender ED sample remained more likely than the matched comparison sample to be diagnosed as having a mood disorder (26% versus 19%) or personality disorder (4% versus 1%) and less likely to be diagnosed as having a substance-related disorder (14% versus 25%), the researchers reported. Characteristics among hospitalized individuals were similar to the ED groups.

Concerning limitations, the authors noted that the transgender individuals who participated in the study had visited clinics in larger cities while the general population came from a broader geographic area. And because the researchers worked with clinical data, it may not accurately reflect the population at large. Also, not all transgender individuals may have disclosed their gender identity in clinical paperwork.

“More research is warranted into the experiences of transgender individuals presenting for acute mental health care and the factors associated with their presentation, particularly in regard to how experiences of marginalization and discrimination may play a role,” the researchers concluded.