A Structural Analysis of Gender-Based Violence and Depression in the Lives of Sexual Minority Women and Trans People.

This article explores structural mechanisms that are the context for violence and depression in the lives of sexual minority women and trans people in Ontario, Canada. The article draws on interviews with 14 people who reported experiences of depression in the previous year, foregrounding three representative narratives. Narrative and case study analysis reveal that violence is a repeated and cumulative experience over lifetimes, occurring across different interpersonal contexts and institutional encounters. A common theme across the narratives is that experiences of violence are connected to a broader context in which structural arrangements, cultural norms, and institutional processes create conditions where marginalized people are put in harm's way, perpetrators are empowered, and justice and access to help are elusive. As the violence experienced by these sexual minority women and trans people is rooted in structural and cultural oppression represented in poverty, racism, misogyny, homophobia, and transphobia, the prevention of violence and its consequences for these and other marginalized populations requires systemic transformation of the structures and systems that currently allow and perpetuate harm.

Depression and discrimination in the lives of women, transgender and gender liminal people in Ontario, Canada.

This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ-9 Questionnaire for Depression was completed by 704 people via Internet or pen-and-paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction terms to model intersecting identities and exclusion contributed to explained variance in both outcome variables. Everyday discrimination was the strongest predictor of both depression and unmet need for mental healthcare. The results suggest lower income and intersections of race with other marginalised identities are associated with more depression and unmet need for mental healthcare; however, discrimination is the factor that contributes the most to those vulnerabilities. Future research can build on intersectionality theory by foregrounding the role of structural inequities and discrimination in promoting poor mental health and barriers to healthcare.

LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People.

BACKGROUND: Previous studies have found that transgender, lesbian, and bisexual people report poorer mental health relative to heterosexuals. However, available research provides little information about mental health service access among the highest need groups within these communities: bisexual women and transgender people. This study compared past year unmet need for mental health care and untreated depression between four groups: heterosexual cisgender (i.e., not transgender) women, cisgender lesbians, cisgender bisexual women, and transgender people. MATERIALS AND METHODS: This was a cross-sectional Internet survey. We used targeted sampling to recruit 704 sexual and gender minority people and heterosexual cisgendered adult women across Ontario, Canada. To ensure adequate representation of vulnerable groups, we oversampled racialized and low socioeconomic status (SES) women. RESULTS: Trans participants were 2.4 times (95% confidence intervals [CI] = 1.6-3.8, p < 0.01) and bisexual people 1.8 times (95% CI = 1.1-2.9, p = 0.02) as likely to report an unmet need for mental healthcare as cisgender heterosexual women. Trans participants were also 1.6 times (95% CI = 1.0-27, p = 0.04) more likely to report untreated depression. These differences were not seen after adjustment for social context factors such as discrimination and social support. CONCLUSION: We conclude that there are higher rates of unmet need and untreated depression in trans and bisexual participants that are partly explained by differences in social factors, including experiences of discrimination, lower levels of social support, and systemic exclusion from healthcare. Our findings suggest that the mental health system in Ontario is not currently meeting the needs of many sexual and gender minority people.

Using interactive theatre to help fertility providers better understand sexual and gender minority patients.

OBJECTIVE: To determine the effectiveness of interactive theatre as a knowledge translation and exchange (KTE) method to educate assisted human reproduction (AHR) service providers about lesbian, gay, bisexual, trans and queer (LGBTQ) patients. DESIGN: We transformed data from the 'Creating Our Families' study, a qualitative, community-based study of LGBTQ peoples' experiences accessing AHR services, into a script for an interactive theatre workshop for AHR service providers. Based on forum theatre principles, our workshop included five scenes illustrating LGBTQ people interacting with service providers, followed by audience interventions to these scenes. Before and after the workshop, service providers completed surveys to assess their knowledge and comfort concerning LGBTQ patients, as well as the modality of the interactive theatre workshop as a KTE strategy. Wilcoxon signed-rank tests were used to determine changes in preworkshop and postworkshop knowledge and comfort scores. RESULTS: Thirty AHR service providers attended the workshop. Twenty-three service providers (76.7%) fully completed the preworkshop and postworkshop evaluation forms. Service providers' knowledge scores significantly improved after the workshop, while their comfort scores minimally decreased. Most agreed that the interactive workshop was an effective KTE method. CONCLUSIONS: In comparison with traditional forms of KTE, interactive theatre may be particularly effective in engaging service providers and addressing their attitudes towards marginalised patient populations. Although the evaluation results of our interactive workshop were mostly positive, the long-term impact of the workshop is unknown. Long-term evaluations are needed to determine the effectiveness of arts-based KTE efforts. Other considerations for developing effective arts-based KTE strategies include adequate funding, institutional support, attention to power dynamics and thoughtful collaboration with forum theatre experts.

Sexual and gender minority peoples' recommendations for assisted human reproduction services.

OBJECTIVE: To determine what recommendations lesbian, gay, bisexual, trans, and queer (LGBTQ) people have for provision of assisted human reproduction (AHR) services to their communities. METHODS: Using a semi-structured guide, we interviewed a purposeful sample of 66 LGBTQ-identified individuals from across the province of Ontario who had used or had considered using AHR services since 2007. RESULTS: Participants were predominantly cisgender (non-trans), white, same-sex partnered, urban women with relatively high levels of education and income. Participants made recommendations for changes to the following aspects of AHR service provision: (1) access to LGBTQ-relevant information, (2) adoption of patient-centred practices by AHR service providers, (3) training and education of service providers regarding LGBTQ issues and needs, (4) increased visibility of LGBTQ people in clinic environments, and (5) attention to service gaps of particular concern to LGBTQ people. CONCLUSION: Many of the recommendations made by study participants show how patient-centred models may address inequities in service delivery for LGBTQ people and for other patients who may have particular AHR service needs. Our results suggest that service providers need education to enact these patient-centred practices and to deliver equitable care to LGBTQ patients.

Objectif : Chercher à connaître les recommandations que formuleraient les personnes lesbiennes, gaies, bisexuelles, transgenres et allosexuelles (LGBTQ) en ce qui concerne l'offre de services de procréation assistée (PA) à leurs communautés. Méthodes : En utilisant un guide semi-structuré, nous avons interviewé un échantillon choisi à dessein de 66 personnes s'identifiant comme étant LGBTQ et provenant de partout dans la province de l'Ontario qui avaient utilisé ou qui avaient envisagé d'utiliser des services de PA depuis 2007. Résultats : Les participantes étaient principalement des femmes cisgenres (non transgenres), blanches, ayant une partenaire du même sexe et vivant en milieu urbain qui comptaient des niveaux relativement élevés de scolarité et de revenu. Les participantes ont formulé des recommandations visant l'apport de modifications aux aspects suivants de l'offre de services de PA : (1) accès à des renseignements pertinents pour les personnes LGBTQ, (2) adoption de pratiques axées sur la patiente par les fournisseurs de services de PA, (3) formation et éducation des fournisseurs de services à l'égard des enjeux et des besoins des personnes LGBTQ, (4) accroissement de la visibilité des personnes LGBTQ en milieu clinique et (5) octroi d'une attention aux lacunes en matière de services qui préoccupent particulièrement les personnes LGBTQ. Conclusion : Bon nombre des recommandations formulées par les participantes à l'étude illustrent la façon dont l'adoption de modèles axés sur la patiente pourrait combler les inégalités en ce qui concerne l'offre de services aux personnes LGBTQ et à d'autres patientes pouvant avoir des besoins particuliers en matière de PA. Nos résultats semblent indiquer que des ressources éducatives devraient être mises à la disposition des fournisseurs de services pour leur permettre de mettre en œuvre de telles pratiques axées sur les patientes et d'offrir des soins équitables aux patientes LGBTQ.