Trans Mental Health Survey 2017:

A Preliminary Report

Trans Lifeline, co-launched with the National LGBTQ Task Force

Co-authors: Victoria Rodriguez-Roldan, Ph.D., Nina Chaubal, Ava Vita Cicarelli, Greta Gustava Martela, Donovan Ackley III, Ph.D.

Research Consultant: Anthony J. Weeks, A.M.F.T.

Presenters at Creating Change (January 26, 2018, Washington DC): Stella Shaffer & Jaden Prendergast

Linked Table of Contents

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Data collected

Survey dates: June - October 2017

Sample size: 8,574 individuals

  • reside in U.S. (96.24% U.S. citizen), over 18
  • 98.66% identify as transgender
    • Consider yourself transgender or otherwise do not identify with gender assigned at birth: Yes 96.98%, (7,439), No 3.02% (232 )
    • Sex assigned at birth (chart on next slide):
      • Female (57.59%), Male (41.84), Intersex (0.57%)
    • Do you feel like you are outside the gender binary?
      • Majority, yes: 60.7%

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

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Demographic overview of respondents

  • Race/ethnicity: Survey respondents disproportionately self-identified as white &/or Caucasian. Respondents could mark more than one category
  • Highest degree/level of school completed: H.S. diploma or more (91.64%) ; Bachelor’s degree (22.45%)
      • In comparison, according to the 2015 US Census, almost 9 out of 10 adults in the U.S. (88 percent) had at least a high school diploma or GED, while nearly 1 in 3 adults (33 percent) held a bachelor’s or higher degree (Ryan & Bauman, 2016).
  • Majority working: 40.69% employed full-time or more, 24.08% working one or more part-time jobs, 2.82% working in underground economy,
  • Current gross household income:
    • 22.12% less than $10,000/year
    • 37.64% less than $20,000/year (similar to 38% of Americans generally)
    • 54.97% less than $30,000/year (disproportionately more than 51% of U.S. population generally)
      • Comparison: Wage Statistics, Social Security Administration, 2015

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

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Have you been diagnosed with, treated for or have been living with any of these mental health diagnoses in the last year? (table below)

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

Trans people, mental health diagnoses & disability

Even though most respondents had been diagnosed with a mental health disorder, the majority do not identify as having a disability or as a disabled person (60.58%). The majority of trans people have never been on Social Security disability benefits.

  • 66.83% reported being diagnosed, treated for or living with an anxiety disorder, 68.8% with a depressive disorder
  • 11.74% had been on disability,
  • 88.26% had never been on disability
  • 69.54% had never applied for disability benefits
  • Only 2.28% reported having been denied disability benefits because of being trans

(Bar graph, next slide)

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

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Experiences of mental health care before and after coming out as trans: A comparison

Generally, almost half of respondents (48.2%) reported being misgendered all or most of the time in the past year

  • However, the majority (69.72%) have some community or social support for their trans identity and resources or support for trans-related medical care (69.7%)
    • Did you feel supported when you were coming out as transgender? (7,060 respondents)
      • YES 53.64%, NO 33.22%, I have not come out 13.14%
    • Do you currently feel supported in terms of your gender identity by the people in your life? (7,050 respondents)
      • YES 74.54% , NO 16.57% , I have not come out 8.89%

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

Regarding Therapists:

  • 88.68% of respondents currently had a therapist or have had one in the past

Do you feel that you have been treated better, worse or the same by therapist(s) since your transition? Only about 15% indicated improvement.

  • Much improved 6.68%
  • Somewhat improved 8.73%
  • Stayed the same 32.31%
  • Much worse 1.92%
  • In some ways better, in some ways worse 9.01%
  • Not applicable 41.36%

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Challenges accessing behavioral / mental health care

Do you feel that you can trust therapists?

  • Always 11.71%
  • Most of the time 35.15%
  • Sometimes 36.03%
  • Not most of the time 13.82%
  • Never 3.29%

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

Have you had to educate your therapist about transgender issues?

  • YES 60.93%

Would you consider your therapist past or present knowledgeable about the issues that transgender people face?

  • Very knowledgeable 17.9%
  • Mostly knowledgeable 18.92%
  • Somewhat knowledgeable 22.63%
  • Neutral 11.58%
  • Somewhat ignorant 11.5%
  • Mostly ignorant 12.74%
  • Very ignorant 4.73%

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How difficult has your search been to find an adequate psychiatric provider currently or in the past? (69.62% had difficulty)

  • 24.77% Very difficult
  • 18.99% Mostly difficult
  • 25.86% Somewhat difficult
  • 10.51% neutral
  • 19.87% Somewhat easy, easy, or very easy

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

Image description: Bar graph, answers to question 58. Have you experienced any of the following from any of your therapists, past or current, or associated staff because of your transgender identity? Choose all that apply: (text of results and data on next slide)

Most respondents did not report negative outcomes (61.53%)

  • However, 1 out of 3 reported the following:
    • Misgender, refused to use correct name or pronouns 32.95% (1 out of 3 therapists & staff misgender their trans patients)
    • Verbally harassed or disrespected 16.26%
    • Denied equal treatment or service 11.85%
    • Physically attacked or assaulted 0.75%

By comparison, outside of therapy settings, the same respondents reported the following experiences of being misgendered generally:

  • “People misgender me…”
    • Never 11.69% Occasionally 19.53%
    • Sometimes 20.58% Most of the time 33.95%
    • Always 14.25% (bar graph & data table, next slide)

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Transgender Mental Health Survey 2017: A Preliminary Report

© 2018 Trans Lifeline

Barriers to receiving care: Distrust, provider ignorance

Over half of all respondents reported avoiding a mental health institution -- inpatient, outpatient, psychiatry, psychology, or other (53.15%, bar graph on next slide)

  • Have you avoided coming out to your hospital providers or staff due to fear of mistreatment or discrimination?
    • YES 51.87% (in comparison only 41.56% reported avoiding coming out to a therapist)
  • Have you had to educate your hospital providers or staff about trans issues?
    • YES 51.43%

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

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  • Would you consider your hospital providers and staff knowledgeable about the issues transgender people face?
    • Very knowledgeable 1.23%
    • Mostly knowledgeable 3.32%
    • Somewhat knowledgeable 8.04%
    • Neutral 28.15%
    • Somewhat ignorant 12.71%
    • Mostly ignorant 21.98%
    • Very ignorant 25.56%

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Prevalence of specific forms of mistreatment during hospitalization -- from most frequent to least frequent

  • I was not mistreated in any way 42.09%
  • Repeated, purposeful misgendering 41.92%
  • Harassed by employee, fellow patient, counselor 23.69%
  • Talked about in front of other employees, fellow patients, or fellow counselors who did not have a specific or necessary reason to know about transgender status 19.58%
  • Emotionally abused by employee, fellow patient, counselor 19.19%
  • Placed in incorrect single gender facility 17.78%
  • Hospital involved unsupportive family members in recovery process either without consent or by pressuring allowing it 15.87%
  • Denied access to appropriate bathroom 11.93%

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Transgender Mental Health Survey 2017:

A Preliminary Report © 2018 Trans Lifeline

  • Asked or required to discuss or show genitals without a medically necessary reason 11.59%
  • Subjected to additional or prolonged restraints or seclusion 10.47%
  • Denied visitation by supportive family members, friends, or community members (including LGBTQ organization or program staff) 7.71%
  • Pressured to renounce transgender status by a religious worker, chaplain, or patient belonging to a specific religion, for religious-based reasons 7.03%
  • Physically assaulted by employee, fellow patient, counselor 5.57%
  • Sexually assaulted by employee, fellow patient, counselor 4%

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Prevalence of self-injury & suicidal ideation among respondents:

  • 50.62% have attempted to end their life.
  • 70.59% have intentionally self-harmed / self-injured without the explicit goal of ending their life, for example as a coping mechanism (6,634 responses)
    • 59.92% participated in reckless behavior because of thoughts of ending their life
  • 88.35% have considered ending their own life (6,611 responses).
    • This figure is consistent with the findings of Trans Lifeline’s ongoing volunteer survey, 2016-2018.
  • 58.68% have considered ending their life in the last year (6,610 responses): Bar graph, next slide
    • Frequency considered ending their life (2,486 answered)
      • More than once a year 0.56% , More than once a month 66.09%
      • More than once a week 21.87%, More than once a day 11.48%

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

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Coming out as trans can dramatically reduce suicide risk

Those who considered ending their life

  • only before coming out as trans 18.37%
  • both before they came out as trans AND after they came out as trans 66.23%
  • only after coming out as trans 4.86%

Those who have considered ending their life but have not yet come out 10.42%

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

Preliminary remarks

Although there has been progress in the treatment of transgender people by behavioral health providers, survey results indicate that there is still insufficient training and resources among providers of care, especially in mental health institutions.

  • Although coming out as trans dramatically reduces risks of suicide for many trans people, social discrimination and particularly loss of family support still disproportionately place transgender people at risk for suicide whether before or after coming out.
    • These risks coincide with “thwarted belongingness” in the interpersonal theory of suicide (Van Orden, Cukrowicz, Wilte, Joiner , 2012).

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

In spite of these risks, trans respondents overwhelmingly reported resilience factors of pride in transgender identity (78.45%) and a sense of community or social support (74.54%)

  • More research on this: Gender Minority Stress & Resilience Model central to Trans Lifeline’s peer support programs (Testa, Michaels, Bliss, Rogers, Balsam, and Joiner, 2017).

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Community feedback and next steps

  • What does this data suggest to you?
  • What follow up questions do you propose we explore?
  • What applications do you think this data has?
  • How could it be used to help our communities?

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Transgender Mental Health Survey 2017: A Preliminary Report © 2018 Trans Lifeline

Creating Change 2018: First feedback

Trans Lifeline staff presented our preliminary report at the annual conference of the National LGBTQ Task Force, Creating Change, on 2/26/18, including the follow-up questions on the previous slide. Initial response from the community suggests these possible follow-up steps should be included in our final report:

  • Publication / sharing of data for academic research, especially differences in care and final healthcare outcomes for trans and queer people in comparison to their straight counterparts
    • Anticipated publication in Journal of American Association of Suicidology, lead scholar Victoria Rodriguez-Roldan, Ph.D.
  • Community members have asked for follow-up survey(s) to expand results, specifically distributing survey to reach different communities that didn't access to the initial survey

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In our analysis of the data, we have been asked to clarify explicitly whether certain responses are weighted differently:

  • For example, learning disorders like ADHD, etc, weren't included in the presentation alongside categories like Personality Disorders and Anxiety Disorders although the category is explored more specifically in the report itself but in order to focus our presentation within the time constraints of this first national conference, we focused in this preliminary report on questions we as an org are most often asked in relation to trans suicidality (issues of mental health and access to resources traditionally associated with suicide prevention). The final report is to include data from the full survey.

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Trans Mental Health Survey 2017: Preliminary Report - Google Slides