Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people.
Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people.
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DOI：
10.1371/journal.pone.0254215
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Beckham SW
中科院分区：
文献类型：
--
作者：
Jarrett BA;Peitzmeier SM;Restar A;Adamson T;Howell S;Baral S;Beckham SW
跨性别者和非二元性别者尤其容易受到优质医疗保健结构性障碍、心理健康挑战和经济困难的影响。本研究探讨了新型冠状病毒病（COVID-19）危机以及随后的控制措施对多个国家跨性别者和非二元人群的性别肯定护理、心理健康和经济稳定的影响。我们收集了 2020 年 4 月至 2020 年 8 月 Hornet 和 Her 应用程序的 964 名跨性别和非二元性别成年用户的跨国横截面数据，以描述 COVID-19 导致的性别肯定护理、心理健康和经济稳定性的变化。我们采用泊松回归模型来评估获得性别肯定护理的机会和根据性别生活的能力是否与抑郁症状、焦虑和自杀意念的变化有关。个人居住在 76 个国家，包括土耳其（27.4%，n = 264）和泰国（20.6%，n = 205）。大多数是非二元性别（66.8%，n = 644）或跨性别女性（29.4%，n = 283）。由于新冠肺炎 (COVID-19)，55.0% (n = 320/582) 的受访者表示获得性别肯定资源的机会减少，38.0% (n = 327/860) 的受访者表示其性别的生存时间减少。大约一半的人抑郁症 (50.4%,442/877) 和焦虑症 (45.8%, n = 392/856) 筛查呈阳性。六分之一 (17.0%, n = 112/659) 的人预计会损失健康保险，77.0% (n = 724/940) 的人预计收入会减少。与获得性别肯定资源的机会减少的个体相比，抑郁症状、焦虑和自杀意念增加的患病率分别高出 1.63 (95% CI: 1.36–1.97)、1.61 (95% CI: 1.31–1.97) 和 1.74 (95% CI: 1.07–2.82) 倍。 COVID-19 危机与世界范围内跨性别者和非二元性别者获得性别肯定资源的机会减少以及根据其性别生活的能力减少有关。这些减少可能会导致该样本中报告的抑郁症状、焦虑和自杀意念增加。为了改善跨性别和非二元社区的健康，应优先通过政策（例如数字处方）、灵活的干预措施（例如远程医疗）以及对现有跨性别健康举措的支持来增加获得性别肯定资源的机会。
Transgender and nonbinary people are disproportionately affected by structural barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) crisis and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and nonbinary people in multiple countries. We collected multi-national, cross-sectional data from 964 transgender and nonbinary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of COVID-19. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one’s gender were related to depressive symptoms, anxiety, and changes in suicidal ideation. Individuals resided in 76 countries, including Turkey (27.4%, n = 264) and Thailand (20.6%, n = 205). A majority were nonbinary (66.8%, n = 644) or transfeminine (29.4%, n = 283). Due to COVID-19, 55.0% (n = 320/582) reported reduced access to gender-affirming resources, and 38.0% (n = 327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%, n = 392/856). One in six (17.0%, n = 112/659) expected losses of health insurance, and 77.0% (n = 724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36–1.97), 1.61 (95% CI: 1.31–1.97), and 1.74 (95% CI: 1.07–2.82) times higher for individuals whose access to gender-affirming resources was reduced versus not. The COVID-19 crisis is associated with reduced access to gender-affirming resources and the ability of transgender and nonbinary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve health of transgender and nonbinary communities, increased access to gender-affirming resources should be prioritized through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.
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