Health Insurance and Mental Health Care Utilization Among Adults Who Identify as Transgender and Gender Diverse
Sarah P. Carter, Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Services, Seattle (Carter); Department of Health Services, University of Washington, Seattle (Carter); Department of Psychology, Louisiana State University, Baton Rouge (Cowan, Tucker); College of Social Work, University of Kentucky, Lexington (Snow, Cerel).
Tovah Cowan, Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Services, Seattle (Carter); Department of Health Services, University of Washington, Seattle (Carter); Department of Psychology, Louisiana State University, Baton Rouge (Cowan, Tucker); College of Social Work, University of Kentucky, Lexington (Snow, Cerel).
Annie Snow, Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Services, Seattle (Carter); Department of Health Services, University of Washington, Seattle (Carter); Department of Psychology, Louisiana State University, Baton Rouge (Cowan, Tucker); College of Social Work, University of Kentucky, Lexington (Snow, Cerel).
Julie Cerel, Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Services, Seattle (Carter); Department of Health Services, University of Washington, Seattle (Carter); Department of Psychology, Louisiana State University, Baton Rouge (Cowan, Tucker); College of Social Work, University of Kentucky, Lexington (Snow, Cerel).
Raymond Tucker, Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Services, Seattle (Carter); Department of Health Services, University of Washington, Seattle (Carter); Department of Psychology, Louisiana State University, Baton Rouge (Cowan, Tucker); College of Social Work, University of Kentucky, Lexington (Snow, Cerel).
Abstract
OBJECTIVE: Transgender people are less likely to have health insurance, which has been associated with reduced utilization of health care. In the current study, the authors sought to assess the role of health insurance in mental health care utilization among transgender individuals. METHODS: A total of 4,334 adults who self-identified as transgender or gender diverse (neither male nor female) participated in the 2017 Trans Lifeline Mental Health Survey, which included self-report measures of current insurance type and lifetime history of having seen a therapist or psychiatric provider. Logistic regression analyses assessed the association of insurance status with lifetime utilization of a mental health therapist or psychiatric provider. RESULTS: Although only 8% of the sample were uninsured, these individuals were significantly less likely to have seen a therapist or psychiatric provider in their lifetime compared with those with health insurance, even after the analyses were adjusted for sociodemographic factors. Conversely, those with insurance through the military or the Veterans Health Administration were more than twice as likely as those with employer-provided insurance to have seen a therapist or psychiatric provider. There were no significant differences in mental health care utilization between those with employer-provided insurance versus public or privately purchased insurance. CONCLUSIONS: Rates of being uninsured were lower than in earlier assessments of transgender adults and adults who identify as gender diverse. However, type of health insurance also appeared to be a notable structural factor contributing to disparities in mental health care utilization among transgender individuals.
