Romanelli Meghan, Lu Wenhua, Lindsey Michael A
New York University, Silver School of Social Work, 41 East 11th Street, Seventh Floor, New York, NY, 10003, USA.
McSilver Institute for Poverty Policy and Research, New York University, Silver School of Social Work, New York, NY, USA.
Adm Policy Ment Health. 2018 Nov;45(6):831-849. doi: 10.1007/s10488-018-0868-8.
This study examined how experiences of service denial and discrimination in three health care settings-doctors' offices, emergency rooms, and mental health clinics-might contribute to attempted suicide among transgender adults. Mechanisms of this relationship were examined, including treatment receipt and the use of substances to cope with mistreatment. Perceived emotional social support was also tested as a potential protective factor against the deleterious effects of service denial and discrimination on treatment receipt, substance use, and attempted suicide. The analysis included 4190 respondents from the National Transgender Discrimination Survey. Structural equation modeling was employed to test hypothesized relationships. Being denied a greater number of services and discriminated against in more settings were associated with lower levels of treatment receipt. Service denial was also correlated with increased rates of coping-motivated substance use and elevated rates of attempted suicide. Treatment receipt mediated the relationships between service denial/discrimination and substance use. Substance use mediated the relationship between treatment receipt and attempted suicide. Higher levels of support were protective to treatment receipt when denied services in one setting, but no longer retained protective effects when denied in two or three settings. Results have critical implications for service access and delivery and policies that protect transgender help-seekers in the health care system.
本研究考察了在医生办公室、急诊室和心理健康诊所这三种医疗环境中被拒绝服务和遭受歧视的经历如何可能导致跨性别成年人自杀未遂。研究了这种关系的机制，包括接受治疗以及使用药物来应对虐待。感知到的情感社会支持也作为一种潜在的保护因素进行了测试，以抵御拒绝服务和歧视对接受治疗、药物使用及自杀未遂所产生的有害影响。分析纳入了来自全国跨性别歧视调查的4190名受访者。采用结构方程模型来检验假设的关系。被拒绝的服务数量越多以及在更多环境中遭受歧视，与接受治疗的水平越低相关。拒绝服务还与因应对而使用药物的比率增加以及自杀未遂率升高相关。接受治疗在拒绝服务/歧视与药物使用之间起中介作用。药物使用在接受治疗与自杀未遂之间起中介作用。当在一种环境中被拒绝服务时，较高水平的支持对接受治疗具有保护作用，但当在两种或三种环境中被拒绝服务时，这种保护作用不再存在。研究结果对医疗服务的获取与提供以及保护医疗系统中寻求帮助的跨性别者的政策具有关键意义。
