(PS6-2) A Qualitative Study of Behavioral Health Experiences Reported by Transgender and Gender Diverse People During Inpatient Treatment

Abstract Text: Transgender and gender diverse (TGD) people are at increased risk for psychiatric disorders and suicidality compared to cisgender individuals. In addition, TGD people face unique barriers to accessing behavioral health care (BHC). It is important to directly assess the BHC experiences of TGD people to make improvements; however, to date most of this research has been conducted in medical or community settings. The aim of the current study was to describe and quantify the lived experiences of TGD people receiving inpatient psychiatric treatment. This perspective is critical to obtain given the unique features of the inpatient setting (e.g., sharing intimate spaces with others, legal requirements of legal name use) which may create gender minority stress. Participants were 50 self-identified TGD adult psychiatric inpatients (M = 24 years old, SD = 7.319, range 18-57). About a third of participants identified as transgender male or female (n = 18), and the remaining as non-binary (n = 32; e.g., agender, gender fluid, or gender-nonconforming). All participants were diagnosed with mood disorders and/or suicidal ideation or attempt at admission. Participants were interviewed regarding their experiences accessing/receiving BHC both historically and during the current inpatient stay. Interviews were audio-recorded and transcribed. Content analysis was utilized to identify and quantify themes related to barriers in BHC access as well as their inpatient positive and negative experiences. Out of the 50 participants, over half reported gender identity-related barriers to accessing BHC services (n = 27, 54%; 65 examples). The most common theme of historical difficulties to access was services being grouped within binary gender categories (n = 15, 55.56%; 17 examples). Other themes included difficulty finding LGBTQ-friendly BHC (n = 12, 44.44%; 12 examples), working with uninformed providers (n = 10, 37.04%; 12 examples), and experiencing aggression/discrimination from BHC (n = 10, 37.04%; 12 examples). In relation to their current inpatient stay, the majority reported at least one negative gender identity-related experience (n = 37, 74%; 136 examples). The most common of these was feeling disrespected or unsafe due to name/pronoun misuse (n = 27, 72.97%; 48 examples). Other themes included modifying behaviors due to fear of prejudice (n = 13, 35.14%; 15 examples), incorrect name/pronouns on labels (n = 10, 27.03%; 14 examples), and staff/patients making rude gender identity-related comments (n = 7, 18.92%; 13 examples). Positive gender identity-related experiences were reported by nearly all participants (n = 45, 90%; 138 examples). The most frequent was name/pronouns being asked/used/corrected (n = 36, 80%; 46 examples). Some other themes included being assigned their preferred room type (n = 14, 31.11%; 14 examples), receiving affirming care (n = 12, 26.67%; 26 examples), and having access to the LGBTQ community (n = 6, 13.33%; 7 examples). Results of the current study highlight the frequency and nature of BHC disparities experienced by TGD people and also outline the types of interactions that TGD individuals perceive as positive. These findings may be used to educate providers as well as inform system policies to improve BHC for TGD people.