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Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada.

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Title: Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada.
Authors: Abramovich, Alex (AUTHOR), Gould, W. Ariel (AUTHOR), Pang, Nelson (AUTHOR), de Oliveira, Claire (AUTHOR), Iwajomo, Tomisin (AUTHOR), Vigny-Pau, Myriam (AUTHOR), MacKinnon, Kinnon (AUTHOR), Lam, June Sing Hong (AUTHOR), Kurdyak, Paul (AUTHOR)
Source: Canadian Journal of Psychiatry. Dec2023, Vol. 68 Issue 12, p933-948. 16p.
Subjects: Medical care use, Transgender people, Mental health services, Health equity, Mental health personnel
Geographic Terms: Ontario
Abstract (English): Objectives: To determine if and to what degree neighbourhood-level marginalization mediates mental health service use among transgender individuals. Methods: This retrospective cohort study identified 2,085 transgender individuals through data obtained from 4 outpatient community and hospital clinics in 3 large cities in Ontario, which were linked with administrative health data between January 2015 and December 2019. An age-matched 1:5 comparison cohort was created from the general population of Ontario. Outcome measures were analysed from March 2020 to May 2022. The primary outcome was mental health service utilization, which included mental health-related visits to primary care providers, psychiatrists, mental health- and self-harm-related emergency department visits, and mental health hospitalizations. Mediation variables included ethnic concentration, residential instability, dependency, and material deprivation at the neighbourhood level and were derived from the Ontario Marginalization Index. Results: This study identified 2,085 transgender individuals from participating outpatient community and hospital clinics, who were matched to the general population (n = 10,425). Overall, neighbourhood-level marginalization did not clinically mediate mental health service use. However, transgender individuals were more likely to be exposed to all forms of neighbourhood-level marginalization, as well as having higher rates of health service use across all outcome measures. Conclusions: In this study, mental health service use among transgender individuals was not clinically mediated by marginalization at the neighbourhood level. This study highlights the need to explore marginalization and mental health service use at the individual level to better understand the mental health disparities experienced by transgender individuals and to ensure that health-care services are inclusive and affirming. [ABSTRACT FROM AUTHOR]
Abstract (French): Déterminer si la marginalisation au niveau du quartier est médiatrice, et dans quelle mesure, de l'utilisation des services de santé mentale chez les personnes transgenres. La présente étude de cohorte rétrospective a identifié 2 085 personnes transgenres à l'aide de données obtenues de quatre cliniques ambulatoires communautaires et d'un hôpital de trois grandes villes de l'Ontario qui étaient reliées par des données de santé administratives entre janvier 2015 et décembre 2019. Une cohorte de comparaison 1:5 appariée selon l'âge a été créée dans la population générale de l'Ontario. Les mesures des résultats ont été analysées de mars 2020 à mai 2022. Le principal résultat était l'utilisation des services de santé mentale, qui comprenait les visites liées à la santé mentale aux fournisseurs de soins de première ligne, aux psychiatres, aux services d'urgence liés à l'autodestruction et à la santé, et aux hospitalisations de santé mentale. Les variables de la médiation, qui provenaient de l'Indice de marginalisation de l'Ontario, étaient notamment la concentration ethnique, l'instabilité résidentielle, la dépendance, et la privation matérielle au niveau du quartier. La présente étude a identifié 2 085 personnes transgenres d'une communauté ambulatoire participante et de cliniques d'hôpital qui ont été appariées à la population générale (n = 10 425). En général, la marginalisation au niveau du quartier n'était pas cliniquement médiatrice de l'utilisation des services de santé mentale. Cependant, les personnes transgenres étaient plus susceptibles d'être exposées à toutes formes de marginalisation au niveau du quartier, ainsi que d'avoir des taux plus élevés d'utilisation des services de santé dans toutes les mesures des résultats. Dans cette étude, la médiation clinique de l'utilisation des services de santé mentale chez les personnes transgenres ne se faisait pas par la marginalisation au niveau du quartier. Cette étude souligne le besoin d'explorer la marginalisation et l'utilisation des services de santé mentale au niveau individuel pour mieux comprendre les disparités de santé mentale que connaissent les personnes transgenres et afin d'assurer que les services de santé soient inclusifs et affirmatifs. [ABSTRACT FROM AUTHOR]
Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada.
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  Data: <searchLink fieldCode="AR" term="%22Abramovich%2C+Alex%22">Abramovich, Alex</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gould%2C+W%2E+Ariel%22">Gould, W. Ariel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pang%2C+Nelson%22">Pang, Nelson</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22de+Oliveira%2C+Claire%22">de Oliveira, Claire</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Iwajomo%2C+Tomisin%22">Iwajomo, Tomisin</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Vigny-Pau%2C+Myriam%22">Vigny-Pau, Myriam</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22MacKinnon%2C+Kinnon%22">MacKinnon, Kinnon</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lam%2C+June+Sing+Hong%22">Lam, June Sing Hong</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kurdyak%2C+Paul%22">Kurdyak, Paul</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Canadian+Journal+of+Psychiatry%22">Canadian Journal of Psychiatry</searchLink>. Dec2023, Vol. 68 Issue 12, p933-948. 16p.
– Name: Subject
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  Data: <searchLink fieldCode="DE" term="%22Medical+care+use%22">Medical care use</searchLink><br /><searchLink fieldCode="DE" term="%22Transgender+people%22">Transgender people</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+health+services%22">Mental health services</searchLink><br /><searchLink fieldCode="DE" term="%22Health+equity%22">Health equity</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+health+personnel%22">Mental health personnel</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Ontario%22">Ontario</searchLink>
– Name: Abstract
  Label: Abstract (English)
  Group: Ab
  Data: Objectives: To determine if and to what degree neighbourhood-level marginalization mediates mental health service use among transgender individuals. Methods: This retrospective cohort study identified 2,085 transgender individuals through data obtained from 4 outpatient community and hospital clinics in 3 large cities in Ontario, which were linked with administrative health data between January 2015 and December 2019. An age-matched 1:5 comparison cohort was created from the general population of Ontario. Outcome measures were analysed from March 2020 to May 2022. The primary outcome was mental health service utilization, which included mental health-related visits to primary care providers, psychiatrists, mental health- and self-harm-related emergency department visits, and mental health hospitalizations. Mediation variables included ethnic concentration, residential instability, dependency, and material deprivation at the neighbourhood level and were derived from the Ontario Marginalization Index. Results: This study identified 2,085 transgender individuals from participating outpatient community and hospital clinics, who were matched to the general population (n = 10,425). Overall, neighbourhood-level marginalization did not clinically mediate mental health service use. However, transgender individuals were more likely to be exposed to all forms of neighbourhood-level marginalization, as well as having higher rates of health service use across all outcome measures. Conclusions: In this study, mental health service use among transgender individuals was not clinically mediated by marginalization at the neighbourhood level. This study highlights the need to explore marginalization and mental health service use at the individual level to better understand the mental health disparities experienced by transgender individuals and to ensure that health-care services are inclusive and affirming. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label: Abstract (French)
  Group: Ab
  Data: Déterminer si la marginalisation au niveau du quartier est médiatrice, et dans quelle mesure, de l'utilisation des services de santé mentale chez les personnes transgenres. La présente étude de cohorte rétrospective a identifié 2 085 personnes transgenres à l'aide de données obtenues de quatre cliniques ambulatoires communautaires et d'un hôpital de trois grandes villes de l'Ontario qui étaient reliées par des données de santé administratives entre janvier 2015 et décembre 2019. Une cohorte de comparaison 1:5 appariée selon l'âge a été créée dans la population générale de l'Ontario. Les mesures des résultats ont été analysées de mars 2020 à mai 2022. Le principal résultat était l'utilisation des services de santé mentale, qui comprenait les visites liées à la santé mentale aux fournisseurs de soins de première ligne, aux psychiatres, aux services d'urgence liés à l'autodestruction et à la santé, et aux hospitalisations de santé mentale. Les variables de la médiation, qui provenaient de l'Indice de marginalisation de l'Ontario, étaient notamment la concentration ethnique, l'instabilité résidentielle, la dépendance, et la privation matérielle au niveau du quartier. La présente étude a identifié 2 085 personnes transgenres d'une communauté ambulatoire participante et de cliniques d'hôpital qui ont été appariées à la population générale (n = 10 425). En général, la marginalisation au niveau du quartier n'était pas cliniquement médiatrice de l'utilisation des services de santé mentale. Cependant, les personnes transgenres étaient plus susceptibles d'être exposées à toutes formes de marginalisation au niveau du quartier, ainsi que d'avoir des taux plus élevés d'utilisation des services de santé dans toutes les mesures des résultats. Dans cette étude, la médiation clinique de l'utilisation des services de santé mentale chez les personnes transgenres ne se faisait pas par la marginalisation au niveau du quartier. Cette étude souligne le besoin d'explorer la marginalisation et l'utilisation des services de santé mentale au niveau individuel pour mieux comprendre les disparités de santé mentale que connaissent les personnes transgenres et afin d'assurer que les services de santé soient inclusifs et affirmatifs. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – SubjectFull: Transgender people
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      – SubjectFull: Mental health services
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      – SubjectFull: Health equity
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      – SubjectFull: Ontario
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              Text: Dec2023
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