跨性别者的非包容性医疗保健以及因恐惧而延迟就医：与跨性别成年人总体健康和心理健康的关联
Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults.
作者信息
Seelman Kristie L, Colón-Diaz Matthew J P, LeCroix Rebecca H, Xavier-Brier Marik, Kattari Leonardo
机构信息
School of Social Work, Georgia State University, Atlanta, Georgia.
Department of Sociology, Georgia State University, Atlanta, Georgia.
出版信息
Transgend Health. 2017 Feb 1;2(1):17-28. doi: 10.1089/trgh.2016.0024. eCollection 2017.
There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base. This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health. Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (=-0.26, <0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation (<0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health. This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare.
跨性别者获得可靠医疗保健存在诸多障碍，这些障碍常常导致他们延迟或回避所需的医疗护理。然而，很少有研究探讨非包容性的医疗保健以及因害怕受到歧视而延迟所需医疗护理是否与跨性别成年人健康状况较差有关。本研究旨在填补这一知识空白。这项研究分析了来自美国落基山地区对417名跨性别成年人进行的全州范围调查的二手数据。自变量包括初级保健提供者（PCP）提供的非包容性医疗保健以及因害怕歧视而延迟所需医疗护理。因变量评估一般健康状况和心理健康状况。因害怕歧视而延迟医疗保健的跨性别者在过去一个月的一般健康状况比未延迟或因其他原因延迟护理的人更差（=-0.26，<0.05）；他们当前患抑郁症的几率高出3.08倍，过去一年有自杀未遂行为的几率高出3.81倍，过去一年有自杀意念的几率高出2.93倍（<0.001）。在控制因害怕歧视而延迟护理的因素后，拥有非包容性的初级保健提供者与一般健康状况或心理健康状况均无显著关联。本研究表明，因害怕歧视而延迟医疗保健与跨性别成年人较差的一般健康状况和心理健康状况之间存在显著关联。即使在控制了提供者的非包容性之后，这些关系仍然显著，这表明害怕歧视以及随之而来的护理延迟是跨性别成年人健康挑战的首要因素。非包容性医疗保健缺乏统计学意义可能与所使用的测量方法有关；未来需要开展研究以开发一种改进的工具来测量跨性别者的非包容性医疗保健。
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