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Symposia

LGBTQ+

Session: Conceptualizing Structural Transphobia: Measurement Innovations, Research Evidence, and Multilevel Solutions

3 - (SYM 144) Healthcare Access Moderates the Association Between Transphobic State Policies and Psychological Distress Among a Population-based Sample of Transgender Adults

Sunday, November 19, 2023
10:30 AM – 12:00 PM PST
Location: Nooksack (602), Level 6

Background: Emerging research has begun to elucidate the mental health consequences of structural transphobia—i.e., discriminatory policies, prejudicial community attitudes, and other societal-level conditions that restrict the rights and opportunities of individuals with gender minority identities. Although prior studies have demonstrated that transgender adults living in US states characterized by higher (vs. lower) levels of structural transphobia experience greater psychological distress, few have examined the extent to which healthcare access may moderate this relationship.

Methods: To address this gap, we quantified structural transphobia at the state level using the Movement Advancement Project’s index of policies supporting and/or restricting transgender rights. We then linked these state-level structural transphobia scores to individual data on psychological distress and healthcare access among transgender adults from 50 US states participating in the population-based TransPop Survey.

Results: Transgender adults living in states characterized by higher (vs. lower) levels of structural transphobia reported greater psychological distress (RR=1.09, 95% CI: 1.01, 1.19); no such association was observed among a comparison group of cisgender adults. Healthcare access moderated this relationship among transgender adults: associations were exacerbated among those without insurance (RR=1.60, 95% CI: 1.04, 2.47) and without a doctor (RR=1.23, 95% CI: 1.07, 1.41). Among transgender adults who had access to either insurance or to a doctor, structural transphobia was unrelated to psychological distress.

Conclusions: Transphobic state policies may contribute to greater psychological distress among transgender (but not cisgender) adults, but access to healthcare appears to ameliorate these effects. While policies remain critical contributors to adverse health among individuals with gender minority identities, advocacy efforts to increase access to essential health services may serve as important buffers to these harmful effects.