Transgender-Specific Adolescent Mental Health Provider Availability is Substantially Lower in States with More Restrictive Policies

Abstract

Objective: Transgender adolescents experience adversity accessing mental healthcare, which is exacerbated by transgender-specific mental health provider shortages in the United States.Factors associated with variability in transgender-specific mental health provider availability across states-especially at the macro-social level-have yet to be identified, hindering efforts to address these shortages. To remedy this gap, we queried whether transgender-specific adolescent mental health provider availability varied by states' transgender-specific policy climate. Method:We quantified states' policy climate by factor-analyzing tallies of the presence/absence of 33 transgender-specific state laws/policies in six domains: parental/relationship recognition, nondiscrimination, education, healthcare, criminal justice, and identity documentation. We then tested whether states' transgender-specific policy climate was associated with rates of transgender-specific adolescent mental health providers-identified via Psychology Today-per transgender adolescent in all 50 states and the District of Columbia.Results: Transgender-specific adolescent mental health provider availability was substantially lower in states with more restrictive laws/policies for transgender people (rate ratio=0.65, 95% CI [0.52, 0.81], p=0.00017), controlling for state-level conservatism, religiosity, and urbanicity.States' transgender-specific policy climate was unrelated to rates of adolescent Attention-Deficit/Hyperactivity Disorder-specialty providers, Oppositional Defiant Disorder-specialty providers, and youth mental health provider shortages broadly, providing evidence for result specificity. Conclusions:Transgender adolescents appear to have access to considerably fewer transgenderspecific mental health providers in states with more restrictive laws/policies for transgender people, which may compound their already high mental health burden in these contexts.State Policy Climate and Trans-specific Adolescent Mental Health Provider Availability 3 Intervention and policy efforts are needed to address these shortages, particularly in states with increasingly prohibitive laws/policies targeting transgender adolescents.

Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults

“…The passage of additional transphobic laws/policies in these states may result in even higher rates of psychological distress and suicidality among transgender residents. This possibility is particularly concerning considering emerging evidence that transgender individuals’ access to supportive mental healthcare is substantially lower in states with higher levels of structural transphobia [ 46 ].…”

“…Additionally, to demonstrate that these associations were not better explained by other features of the social environment, we controlled for state-level income inequality (i.e., the Gini coefficient) [ 57 ] and religiosity (i.e., the percent of Evangelical Christians and Latter-day Saints/Mormons in each state) [ 58 ]. The religiosity measure has been used as a covariate in similar structural stigma studies [ 59 , 60 ], including a recent study with transgender youth [ 46 ], as past research indicates that members of these two religions endorse more negative attitudes toward transgender people and their rights compared to members of other religions [ 61 , 62 ].…”

“…Existing state-level transphobia measures have additional limitations. For example, they often comprise a limited range of state laws/policies and are frequently studied in connection with mental health data from relatively small samples of transgender adults living in US states with limited variability in structural transphobia exposure [ 3 , 41 , 46 ]. Moreover, scholars have rarely made efforts to provide evidence of the construct validity of these measures.…”

Future Directions in Mental Health Treatment with Stigmatized Youth

“…A. Price, Weisz, et al, 2022) and access (Hollinsaid et al, 2022;Roulston et al, 2022) for stigmatized youth (see Figure 1). The present paper provides a brief overview of the scientific literature on structural stigma and youth mental health treatment, and details three future research directions we hope readers pursue.…”

“…In a large sample of sexual minority youth of Color, found that structural homophobia and racism were strongly associated with treatment access, such that sexual minority youth of Color living in states with more homophobic and racist attitudes reported being less likely to access treatment, even when controlling for mental health provider availability. Likewise, Hollinsaid et al (2022) documented substantially lower rates of mental health providers who specialize in providing services to transgender youth in states with more transphobic laws/policies while controlling for other state-level factors, such as political and religious conservatism. Similar studies have also identified a dearth of genderaffirming assessment materials (e.g., inclusive online intake forms; Holt et al, 2019Holt et al, , 2021, fewer referrals for gender-affirming services for transgender youth (Indremo et al, 2022), and less affirming services for sexual minority and transgender young people (Campbell & Mena, 2021) in places with high levels of structural stigma.…”