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Administration and Policy in Mental Health and Mental Health Services Research
Published in: Administration and Policy in Mental Health and Mental Health Services Research 6/2018

01-11-2018 | Original Article

Examining Mechanisms and Moderators of the Relationship Between Discriminatory Health Care Encounters and Attempted Suicide Among U.S. Transgender Help-Seekers

Authors: Meghan Romanelli, Wenhua Lu, Michael A. Lindsey

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 6/2018

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Abstract

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.
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Metadata
Title
Examining Mechanisms and Moderators of the Relationship Between Discriminatory Health Care Encounters and Attempted Suicide Among U.S. Transgender Help-Seekers
Authors
Meghan Romanelli
Wenhua Lu
Michael A. Lindsey
Publication date
01-11-2018
Publisher
Springer US
Published in
Administration and Policy in Mental Health and Mental Health Services Research / Issue 6/2018
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-018-0868-8

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