Direct and vicarious exposure to healthcare discrimination and erasure among transgender and gender independent individuals: Testing the indirect effect of mistrust in healthcare on utilization behaviors

Direct exposure to gender identity-related discrimination and erasure among the transgender and gender independent (TGI) population are associated with healthcare underutilization, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the...

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Bibliographic Details
Published in:Social science & medicine (1982) 2024-05, Vol.348, p.116806-116806, Article 116806
Main Authors: Mason, Kyle L., Hood, Kristina B., Perrin, Paul B., Belgrave, Faye Z., Allison, Kevin W., Coston, B. Ethan
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Female
Gender Identity
Healthcare Disparities - statistics & numerical data
Humans
Male
Middle Aged
Patient Acceptance of Health Care - psychology
Patient Acceptance of Health Care - statistics & numerical data
Transgender Persons - psychology
Transgender Persons - statistics & numerical data
Trust - psychology
United States
Young Adult
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Summary:Direct exposure to gender identity-related discrimination and erasure among the transgender and gender independent (TGI) population are associated with healthcare underutilization, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, exposure to such harm vicariously (i.e., through observation or report) is underexplored. The present study examined the relationships among direct and vicarious gender identity-related healthcare discrimination and erasure exposure and past-year healthcare utilization. Gender identity-based mistrust in healthcare was also assessed, as a mechanism through which direct and vicarious gender identity-related healthcare discrimination and erasure predict healthcare utilization behaviors among a sample (N = 385) of TGI adults in the U.S., aged 18 to 71 recruited online. Results indicated direct lifetime and vicarious healthcare discrimination and erasure exposure significantly predicted past-year healthcare underutilization when participants anticipated encountering gender identity-related healthcare discrimination. Mediational analyses indicated that higher levels of exposure to direct lifetime and vicarious healthcare discrimination and erasure were related to higher levels of mistrust in healthcare, through which past-year underutilization was significantly related. These findings are vital to informing healthcare practice and policy initiatives aimed at ensuring the barriers that deleteriously influence the accessibility of healthcare among TGI individuals are ameliorated. •TGI adults reported an average of 3.5 direct, 5 vicarious forms of healthcare discrimination.•TGI adults experience ∼4x more healthcare discrimination than general population.•29% of TGI adults report avoiding needed healthcare in the prior year.•Medical mistrust is related to direct/vicarious TGI discrimination and erasure.
ISSN:0277-9536
1873-5347
DOI:10.1016/j.socscimed.2024.116806