Study finds better mental health among transgender patients with supportive PCPs

Transgender individuals who said they received supportive primary care were more likely to report better mental health, according to survey results published in Family Practice.

However, only about half of transgender individuals who participated in the survey said they had supportive primary care physicians.

“The findings of this study reinforce the urgent need to provide high-quality gender-affirming and routine primary care for transgender people,” Rona Carroll, FRNZCGP, a general practitioner and senior lecturer at the University of Otago in New Zealand, and colleagues wrote.

The study included 948 transgender individuals aged 14 to 83 years in New Zealand who completed the 2018 Counting Ourselves survey. The participants were recruited through connections made with transgender community groups and social media advertisements. They were asked two sets of questions about their health care experiences — one about negative health care experiences and the other about experiences with supportive PCPs — as well as questions about nonsuicidal self-injury and suicidal ideation.

Only about 57% of participants reported feeling they were treated the same as other patients when they consulted with PCPs for needs unrelated to transgender health care, according to the results. A lower proportion — 48.2% — said their PCPs were supportive of their needs regarding gender-affirming care.

Negative health care experiences were associated with higher rates of psychological distress, nonsuicidal self-injury and suicidality, while positive experiences were associated with lower psychological distress and nonsuicidal self-injury, according to Carroll and colleagues. Every additional supportive experience with a PCP resulted in an 11% reduction in the likelihood of a suicide attempt, while each negative health care experience was associated with a 20% increase in the likelihood of a suicide attempt.

In addition, 47% of participants reported having to educate a health care provider to get appropriate care, and about 43% said their PCP was willing to educate themselves about gender-affirming care. Less than one-quarter of participants said their PCPs knew a lot about gender-affirming care.

Carroll said that PCPs do not need to be experts in transgender health care, but they “need to understand some basics and then be respectful.”

“If you don’t know something, say to the patient, ‘I’m not very familiar with that but I’ll find out’,” she told Healio.

The findings in this study confirm the need for PCPs to be supportive of transgender health care, according to Carroll.

“If we can try to create positive and supportive experiences, even if we don’t know all the answers, that looks like it will be beneficial for people’s mental health,” she said.

Transgender health care is not routinely taught in general practice training in New Zealand, and the level of training and education that PCPs get may fall behind that of other countries, Carroll said. She suggests having transgender individuals work alongside PCPs as teachers.

“Have community members help with some of the more lived experiences,” Carroll said. – by Allison Flynn Becker

References:

Only half of transgender people report supportive care from doctors. https://www.eurekalert.org/news-releases/945276. Published March 9, 2022. Accessed May 25, 2022.

Treharne GJ, et al. Family Practice. 2022;doi:10.1093/fampra/cmac005.