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.