Characteristics of transgender individuals with emergency department visits and hospitalizations for mental health

Objective — Transgender individuals experience significant oppression resulting in mental health disparities. Factors associated with their need for acute mental healthcare are unknown. This study compared characteristics of transgender individuals who presented for acute mental healthcare with population-based comparison samples.

Methods — This cross-sectional study examined transgender individuals who had a mental health-related emergency department (ED) visit (N=728) or hospitalization (N=454). Transgender individuals were identified, and their data were linked with health administrative data. The transgender ED and hospitalization samples were each compared with two samples: all individuals in Ontario who had an ED visit or hospitalization (unmatched) and individuals matched on age, region of residence, and mental healthcare utilization history. Individuals' sociodemographic and clinical factors were compared.

Results — After matching, transgender individuals in the ED sample were more likely than those in the comparison group to be in the lowest neighborhood income quintile (37% versus 27%) and the highest residential instability quintile (47% versus 38%) and to be diagnosed as having a mood (26% versus 19%) or personality disorder (4% versus 1%). Transgender individuals in the hospitalization sample were more likely to be in the lowest neighborhood income quintile (36% versus 27%) and the highest residential instability quintile (45% versus 35%) and to be diagnosed as having a mood (40% versus 35%) or personality disorder (5% versus 2%).

Conclusions — Transgender individuals who accessed acute mental healthcare had unique sociodemographic and clinical factors associated with their presentation that persisted after matching. More research into the factors associated with their acute care presentation is warranted, including how experiences of marginalization play a role.