O'Brien Megan, Hirschtritt Matthew E, Tahir Peggy, Kalapatapu Raj K
Department of Psychiatry and Behavioral Sciences University of California San Francisco USA.
Division of Research Kaiser Permanente Northern California Oakland California USA.
J Am Coll Emerg Physicians Open. 2023 Aug 3;4(4):e13018. doi: 10.1002/emp2.13018. eCollection 2023 Aug.
This scoping review aims to characterize what is known about transgender and gender diverse (TGD) individuals in emergency psychiatric settings and identify what gaps persist in this literature.
A search of 4 electronic databases (PubMed, Web of Science, GenderWatch, and PsycINFO) was used for data collection. Included were studies that looked at TGD individuals presenting to a psychiatric emergency department (ED) or ED with a primary mental health concern. Study screening progress was documented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses flow chart. A total of 232 titles and abstracts were screened, 38 full texts were evaluated for eligibility, and 10 studies were included.
The studies reviewed identified mental health vulnerabilities unique to the TGD population, including service denial in health care settings, gender dysphoria, increased rates of non-suicidal self-injury, and in some studies an increase in suicidality. Societal inequities, including the risk of discrimination and residential instability, were also revealed. A subset of the studies identified best practices in caring for this population, including the use of non-judgmental, affirmative, and inclusive language, and on a structural level creating emergency environments that are confidential, inclusive, and therapeutic for these individuals.
There is limited information on TGD individuals in emergency psychiatric settings, and thus it is difficult to form strong conclusions. However, the current evidence available suggests possible inequities in this population. Three major themes with regards to TGD individuals in emergency psychiatric settings were identified: mental health vulnerabilities, societal inequities, and best practices in caring for this population. Overall, there is a scarcity of literature in this field, and further research on the experiences of this population is needed to inform clinical practice.
本范围综述旨在描述在急诊精神科环境中关于跨性别和性别多样化（TGD）个体的已知情况，并确定该文献中仍然存在哪些空白。
通过检索4个电子数据库（PubMed、科学网、性别观察和心理学文摘数据库）来收集数据。纳入的研究关注的是前往精神科急诊科（ED）或因主要心理健康问题就诊于急诊科的TGD个体。研究筛选过程记录在系统评价和Meta分析的首选报告项目流程图中。共筛选了232篇标题和摘要，评估了38篇全文的 eligibility，纳入了10项研究。
所综述的研究确定了TGD人群特有的心理健康脆弱性，包括医疗环境中的服务拒绝、性别焦虑、非自杀性自伤率增加，以及在一些研究中自杀倾向增加。还揭示了社会不平等现象，包括歧视风险和居住不稳定。部分研究确定了照顾该人群的最佳实践，包括使用无偏见、肯定性和包容性的语言，以及在结构层面创建对这些个体保密、包容和具有治疗性的急诊环境。
关于急诊精神科环境中TGD个体的信息有限，因此难以得出强有力的结论。然而，目前可得的证据表明该人群可能存在不平等现象。确定了关于急诊精神科环境中TGD个体的三个主要主题：心理健康脆弱性、社会不平等以及照顾该人群的最佳实践。总体而言，该领域的文献稀缺，需要进一步研究该人群的经历以为临床实践提供信息。
