在黑人跨性别女性中，遭受多种创伤与心理健康之间的关联中，获得和参与医疗保健的障碍是潜在的调节因素。
Barriers to accessing and engaging in healthcare as potential modifiers in the association between polyvictimization and mental health among Black transgender women.
机构信息
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America.
Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, United States of America.
出版信息
PLoS One. 2022 Jun 16;17(6):e0269776. doi: 10.1371/journal.pone.0269776. eCollection 2022.
BACKGROUND
Black transgender women endure pervasive polyvictimization (experiencing multiple forms of violence throughout the lifespan). Polyvictimization is associated with poor mental health. Black transgender women also face barriers in access to healthcare, but the extent that such barriers modify the association between polyvictimization and poor mental health has not been described using convergent mixed-methods analysis.
METHODS
This convergent mixed-methods secondary analysis employs an intersectional lens and integrates two inter-related datasets to describe barriers to healthcare and the extent that such barriers modify the association between polyvictimization and mental health among Black transgender women. Investigators used survey data (n = 151 participants) and qualitative interview data (n = 19 participants) collected from Black transgender women (age 18 years and older) in Baltimore, MD and Washington, DC between 2016 and 2018. Analyses include thematic content analysis, bivariate analysis, joint display, and multivariate linear regression analysis examining mediation and moderation.
RESULTS
Joint display illuminated three domains to describe how barriers to healthcare present among Black transgender women-Affordability, Accessibility, and Rapport and Continuity. Independent t-tests revealed significantly higher polyvictimization, Post Traumatic Stress Disorder (PTSD), and depression scores among participants who reported at least one barrier to healthcare (BHI) compared to those who reported no barriers. BHI significantly moderated and partially mediated the association between polyvictimization and PTSD symptom severity and BHI fully mediated the association between polyvictimization and depressive symptom severity-when accounting for age and location.
DISCUSSION
Findings highlight the importance of access to healthcare in modifying the association between polyvictimization and PTSD and depression symptom severity among Black transgender women. Findings call for immediate interventions aimed at reducing barriers to healthcare and improved training for clinical providers serving Black transgender women.
背景
黑人跨性别女性经历着普遍的多重受害（在整个生命周期中经历多种形式的暴力）。多重受害与心理健康不良有关。黑人跨性别女性在获得医疗保健方面也面临障碍，但这种障碍在多大程度上改变了多重受害与心理健康不良之间的关联，尚未通过收敛性混合方法分析来描述。
方法
本收敛性混合方法二次分析采用交叉视角，整合了两个相互关联的数据集，描述了医疗保健障碍以及这些障碍在多大程度上改变了巴尔的摩和华盛顿特区的黑人跨性别女性（18 岁及以上）中多重受害与心理健康之间的关联。调查人员使用了 2016 年至 2018 年间从黑人跨性别女性（年龄在 18 岁及以上）收集的调查数据（n = 151 名参与者）和定性访谈数据（n = 19 名参与者）。分析包括主题内容分析、双变量分析、联合展示和多元线性回归分析，以检验中介和调节作用。
结果
联合展示揭示了三个领域，描述了黑人跨性别女性中医疗保健障碍的表现方式——负担能力、可及性和融洽度与连续性。独立样本 t 检验显示，与没有医疗保健障碍的参与者相比，报告至少有一种医疗保健障碍（BHI）的参与者的多重受害、创伤后应激障碍（PTSD）和抑郁评分显著更高。BHI 显著调节和部分中介了多重受害与 PTSD 症状严重程度之间的关联，并且当考虑到年龄和地点时，BHI 完全中介了多重受害与抑郁症状严重程度之间的关联。
讨论
研究结果强调了获得医疗保健对于改变黑人跨性别女性中多重受害与 PTSD 和抑郁症状严重程度之间关联的重要性。研究结果呼吁立即采取干预措施，减少医疗保健障碍，并为服务黑人跨性别女性的临床医生提供更好的培训。
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