Despite Higher Rates of Minimally Recommended Depression Treatment, Transgender and Gender Diverse Medicare Beneficiaries with Depression Have Poorer Mental Health Outcomes
A new study led by researchers from the Health Equity Research Lab at Cambridge Health Alliance finds that transgender and gender diverse (TGD) Medicare beneficiaries who had depression diagnoses had higher mental health treatment rates than a comparison group of beneficiaries with depression in 2009-2016, but they still experienced higher rates of poor mental health outcomes.
CAMBRIDGE, Mass. — A new study by Cambridge Health Alliance (CHA)/Harvard Medical School’s (HMS) Health Equity Research Lab and collaborators found that likely-transgender or gender diverse ("TGD") Medicare beneficiaries with depression were more likely to receive minimally recommended depression treatment than other Medicare beneficiaries with depression, but still had poorer mental health outcomes. The findings suggest remaining unmet mental health needs.
This work was recently published in Transgender Health and led by Dr. Ana M. Progovac (she/her), a senior scientist at CHA and an assistant professor at Harvard Medical School. This work includes collaborators from CHA, HMS, Massachusetts General Hospital, and Kaiser Permanente’s Bernard J. Tyson School of Medicine.
The team analyzed Medicare claims from 2009-2016 to compare TGD Medicare beneficiaries with depression to other beneficiaries with depression on: (a) rates of minimally recommended mental health treatment, (b) inpatient mental health hospitalizations, (c) psychiatric medication fills, and (d) and suicide attempts. They found that despite higher mental health treatment rates, TGD beneficiaries with depression had more adverse mental health outcomes. These findings add important data and discussion to the mental health disparities literature focusing on the mental health needs and treatment for TGD older adults and those with disabilities.
Prior studies show that experiences such as marginalization and gender-based and healthcare discrimination are common among TGD people, and that greater adverse social conditions also contribute to mental health need and suicidality in this population. The recent study by Progovac et al. suggests that previous notions of "adequate" or "minimally recommended" mental health treatment for people who have depression (developed based on studies in the general population) do not account for high reported rates of discrimination in health care settings and may not capture complex mental health needs of specific marginalized populations.
Public health efforts to close these t mental health disparities likely need to go above and beyond increasing access to general medical and mental health care. Within health systems, targeted efforts to improve healthcare experiences for TGD populations should be of high priority, and could include: increasing the supply of mental health care providers with TGD-specific training and/or who themselves identify as LGBTQ, increasing access to peer support and community supports for TGD patients, efforts to systematically record gender identity and social needs (like family or social supports, access to safe housing, and financial security), implementing transgender-friendly clinic and hospital policies (e.g., non-discrimination policies), and staff-wide trainings in gender affirming policies and procedures.
The authors also emphasize that state and national efforts that ensure TGD people can live without discrimination are critical to ensuring the economic, psychological, and physical safety of TGD individuals across the lifespan. They note that the first part of 2023 has seen the largest number of bills which target transgender people of any year to date that specifically restrict rights or access to care for transgender people, and in particular transgender youth (HRC, February 2023). Unfortunately, the authors believe the likely outcome of these legislative efforts for transgender adults and youth is increased stress and reduced feelings of safety, which can worsen mental health.