Gender-Affirming Mental Health Care Access and Utilization Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States

• Published in: Transgender health Vol. 7; no. 3; pp. 219 - 229
• Main Authors: Reisner, Sari L, Benyishay, Matan, Stott, Brooke, Vedilago, Virginia, Almazan, Anthony, Keuroghlian, Alex S
• Format: Journal Article
• Language: English
• Published: United States Mary Ann Liebert, Inc., publishers 01-06-2022; Mary Ann Liebert, Inc
• Subjects: Alcohol use; Community; Domestic violence; Drug use; Gender identity; Gender-affirming care; Health care access; Health insurance; Health services; Low income groups; Mental disorders; Mental health care; Minority & ethnic groups; Non-binary gender; Original; Original Articles; Population density; Post traumatic stress disorder; Psychopharmacology; Psychotherapy; Rural areas; Sex crimes; Sociodemographics; Stigma; Transgender persons; Victimization; Victims of crime; Vermont; New York; United States > US; Massachusetts; New Hampshire; Connecticut; gender-affirming; transgender and gender diverse; mental health; adults; rural; northeastern U.S
• ISSN: 2688-4887; 2380-193X
• DOI: 10.1089/trgh.2021.0010

Purpose:
Transgender and gender diverse (TGD) populations are burdened by substantial mental health disparities. The mental health needs of TGD people in rural areas remain largely unknown. This study sought to characterize gender-affirming mental health service access and utilization in a sample of TGD adults from predominantly rural areas in the northeastern United States.
Methods:
A nonprobability sample of 241 TGD adults was recruited from 25 counties across Connecticut, Massachusetts, New Hampshire, New York, and Vermont. Participants completed a cross-sectional computer-administered survey, including self-reported mental health and mental health care needs. Bivariate and multivariable models were fit to examine the association of mental health service utilization with: sociodemographics; health insurance coverage; name and gender marker change; mental health symptoms; perceived stigma; mental health, substance use disorder, and somatic diagnoses; and violence victimization. Primary outcomes were utilizing either psychotherapy or psychopharmacology, both, or neither service.
Results:
Around 68.9% of the sample resided in rural areas. Fifty-one percent of respondents currently utilized at least one gender-affirming mental health service (48.5% psychotherapy, 18.7% psychopharmacology, 16.2% both services). Common barriers to gender-affirming mental health services were lack of trained providers, lack of mental health integration with primary care, financial costs, difficulty scheduling, distances that were too far, and transportation issues. Factors most important in choosing a mental health care provider were health insurance, gender-affirming care, rapport, and availability.
Conclusion:
Access to and utilization of gender-affirming mental health services was suboptimal in this sample. Achieving mental health equity will require addressing barriers experienced by TGD people in rural areas.