By Emma Harries
Social Connectedness Fellow 2017
In November 2017, the University of British Columbia published a study that sheds light on a dark reality: despite their heightened risk of physical and mental illness, Canadian transgender youth are not getting the care they need.
The study analyzed data from 923 youths who participated in the Canadian Trans Youth Health Survey, conducted online from 2013-2014. Researchers measured self-reported physical and mental health status, comfort discussing gender identity and health concerns with general practitioners, and reasons for foregone health care. While most transgender youth reported relatively poor health status, nearly half said they did not seek health care when they needed it. They cited being afraid of negative reactions from doctors as a major reason for not pursuing care.
And avoiding doctors’ visits was not restricted to physical care – forgone mental health care rates are even higher. The study found that 68% of transgender youth did not seek mental health care over the course of the year, despite feeling they needed it. In addition to worries about doctors’ reactions, major reasons for opting out of mental health care included negative past experiences, not wanting parents to know, and not knowing where to go.
The fact that so many transgender youth were found to be foregoing health care is alarming, especially considering they experience extremely high rates of violence. The Canadian Trans Youth Health Survey revealed that 70% of trans youth reported sexual harassment within a year, and nearly 1 in 4 said they had been physically forced to have sexual intercourse. Moreover, over a third said they had been physically threatened or injured within the year. Similarly, the Trans Pulse Project found that 20% of transgender people in Ontario had been physically or sexually assaulted for being trans; 67% feared they would die young. Sexual health is also a major concern. Young transgender women are particularly vulnerable to HIV, with the prevalence of HIV estimated to be 50 times higher among transgender women than other adults.
Barriers to health care – such as stigma, discomfort, and refusal of care by clinicians – can have devastating consequences. Without care, physical and mental health issues persist and worsen, leading to chronic pain and suffering. This pervasive pattern is epitomized by a disturbing statistic: attempted suicide rates are 22 times higher among transgender individuals compared to the general public. Even more unsettling is that this number does not account for successful attempts. In Canada, nearly two-thirds of trans youth self-harmed within the course of a year; 65% had seriously considered suicide and more than 1 in 3 attempted suicide.
But not all is lost and hope can be found between the lines of these chilling statistics. The same survey revealed that trans youth who had supportive relationships were four times more likely to report good or excellent mental health, and far less likely to have considered suicide. And while most trans youth reported low connectedness to their school and peers, those who cited high connectedness were twice as likely to report good or excellent mental health.
It is clear that social support and inclusion can substantially impact the well-being of trans youth. So, in addition to providing protection from violence and discrimination, programs and policy should focus on improving family and community support. ‘Being Safe, Being Me,’ a report based on the results of the Canadian Trans Youth Health Survey, outlines key recommendations for improving the lives of transgender youth, as education and awareness are crucial. They include knowledgeable and accessible health care services, support for families of trans youth, safer schools, and engaging trans youth and their families in the solutions for change. Notably underlying all these recommendations is the need for deeper social connectedness.
While the solution may seem clear, transgender youth continue to experience severe stigma and discrimination, as well as relationship difficulties and exclusion. This results in smaller social networks, inadequate social support, and social isolation. Social exclusion bears great consequences for trans youth. According to Divan et al., it “translates into increased vulnerability to HIV, other diseases, including mental health conditions, limited access to education and employment, and loss of opportunities for economic and social advancement.”
However, considering social isolation has such harmful consequences, it follows that social inclusion may have meaningful positive effects. Indeed, research from Ontario found that social inclusion can significantly reduce the high rates of suicide ideation and attempts among transgender individuals. And the PULSE Project estimates that if social support alone increased, the annual suicide attempt rates among trans people would decrease from 30% to 8%.
The importance of and desperate need for social connectedness is evident here. For a community that has historically been isolated, prioritizing inclusion may help save lives.
Adams, N., Hitomi, M., & Moody, C. (2017). Varied Reports of Adult Transgender Suicidality: Synthesizing and Describing the Peer-Reviewed and Gray Literature. Transgender Health, 2(1), 60-75. http://online.liebertpub.com/doi/pdf/10.1089/trgh.2016.0036.
Bauer, G. R., Scheim, A. I., for the Trans PULSE Project Team (2015). Transgender People in Ontario, Canada: Statistics to Inform Human Rights Policy. http://transpulseproject.ca/wp-content/uploads/2015/06/Trans-PULSE-Statistics-Relevant-for-Human-Rights-Policy-June-2015.pdf.
Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, 15, 525. http://doi.org/10.1186/s12889-015-1867-2.
Beth A Clark, Jaimie F Veale, Devon Greyson, Elizabeth Saewyc; Primary care access and foregone care: a survey of transgender adolescents and young adults, Family Practice, cmx112, https://doi.org/10.1093/fampra/cmx112.
Veale J, Saewyc E, Frohard-Dourlent H, Dobson S, Clark B & the Canadian Trans Youth Health Survey Research Group (2015). Being Safe, Being Me: Results of the Canadian Trans Youth Health Survey. Vancouver, BC: Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia. http://saravyc.sites.olt.ubc.ca/files/2015/05/SARAVYC_Trans-Youth-Health-Report_EN_Final_Print.pdf/
Wood, S. M., Salas-Humara, C., & Dowshen, N. L. (2016). Human Immunodeficiency Virus, Other Sexually Transmitted Infections, and Sexual and Reproductive Health in Lesbian, Gay, Bisexual, Transgender Youth. Pediatric Clinics of North America, 63(6), 1027–1055. http://doi.org/10.1016/j.pcl.2016.07.006.