Ethnoracial inequities in access to gender-affirming mental health care and psychological distress among transgender adults

Purpose Transgender people face known barriers to accessing mental health care generally, and gender-affirming care in particular. However, little research has been done to evaluate the impact of systemic racism on access to gender-affirming mental health care (GAMHC) among transgender people of color (TPOC). Methods We conducted a cross-sectional, secondary analysis of data on 20,967 respondents to the 2015 United States Transgender Survey who reported a desire for GAMHC services related to their gender transition. We estimated inequities across ethnoracial groups in access to GAMHC, and measured the association between severe psychological distress and access to GAMHC among TPOC. Results We found decreased access to GAMHC across all TPOC groups. Inequities in access to GAMHC were most severe among assigned male at birth respondents in the Black/African-American group (aOR 0.51, 95% CI 0.37-0.71), Latino/a/e/Hispanic group (aOR 0.52, 95% CI 0.42-0.65), and Native American group (aOR 0.59, 95% CI 0.38-0.94). Among all respondents, severe psychological distress was highest among Native American respondents (47.4%), Latino/a/e/Hispanic (47.1%) respondents, and other/multiracial respondents (46.7%) and lowest among whites (39.9%). Further, among all TPOC, access to GAMHC was associated with decreased odds of severe psychological distress (aOR 0.74, 95% CI 0.62-0.87). Conclusion These results illustrate the need for research that explicitly addresses the intersectional experiences of transgender communities, and the structural drivers of inequities in access to gender-affirming care.