Perceptions of Barriers to and Facilitators of Participation in Health Research Among Transgender People

Purpose: Although transgender people may be at increased risk for a range of health problems, they have been the subject of relatively little health research. An important step toward expanding the evidence base is to understand and address the reasons for nonparticipation and dropout. The aim of this study was to explore the perceptions of barriers to and facilitators of participation in health research among a sample of transgender people in San Francisco, CA, and Atlanta, GA. Methods: Twelve in-person focus groups (FGs) were conducted; six (three with transwomen, three with transmen) were conducted in San Francisco and six FGs were conducted in Atlanta (three with transwomen and three with transmen). FGs were audiorecorded, transcribed, and uploaded to MaxQDA software for analysis. A codebook was used to code transcripts; new codes were added iteratively as they arose. All transcripts were coded by at least 2 of the 4 researchers and, after each transcript was coded, the researchers met to discuss any discrepancies, which were resolved by consensus. Results: Among 67 FG participants, 37 (55%) identified as transmen and 30 (45%) identified as transwomen. The average age of participants was ?41 years (range 18?67) and the majority (61%) were non-Hispanic Whites. Several barriers that can hinder participation in health research were identified, including logistical concerns, issues related to mistrust, a lack of awareness about participation opportunities, and psychosocial/emotional concerns related to being ?outed.? A broad range of facilitators were also identified, including the opportunity to gain knowledge, access medical services, and contribute to the transgender community. Conclusion: These findings provide insights about the perceived barriers to and facilitators of research participation and offer some guidance for researchers in our ongoing effort to engage the transgender community in health research.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140297/1/trgh.2016.0023.pd

Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study

Objective To investigate if the widely publicized warnings in 2003 from the US Food and Drug Administration about a possible increased risk of suicidality with antidepressant use in young people were associated with changes in antidepressant use, suicide attempts, and completed suicides among young people. Design Quasi-experimental study assessing changes in outcomes after the warnings, controlling for pre-existing trends. Setting Automated healthcare claims data (2000-10) derived from the virtual data warehouse of 11 health plans in the US Mental Health Research Network. Participants Study cohorts included adolescents (around 1.1 million), young adults (around 1.4 million), and adults (around 5 million). Main outcome measures Rates of antidepressant dispensings, psychotropic drug poisonings (a validated proxy for suicide attempts), and completed suicides. Results Trends in antidepressant use and poisonings changed abruptly after the warnings. In the second year after the warnings, relative changes in antidepressant use were −31.0% (95% confidence interval −33.0% to −29.0%) among adolescents, −24.3% (−25.4% to −23.2%) among young adults, and −14.5% (−16.0% to −12.9%) among adults. These reflected absolute reductions of 696, 1216, and 1621 dispensings per 100 000 people among adolescents, young adults, and adults, respectively. Simultaneously, there were significant, relative increases in psychotropic drug poisonings in adolescents (21.7%, 95% confidence interval 4.9% to 38.5%) and young adults (33.7%, 26.9% to 40.4%) but not among adults (5.2%, −6.5% to 16.9%). These reflected absolute increases of 2 and 4 poisonings per 100 000 people among adolescents and young adults, respectively (approximately 77 additional poisonings in our cohort of 2.5 million young people). Completed suicides did not change for any age group. Conclusions Safety warnings about antidepressants and widespread media coverage decreased antidepressant use, and there were simultaneous increases in suicide attempts among young people. It is essential to monitor and reduce possible unintended consequences of FDA warnings and media reporting

Suicide Attempts Among a Cohort of Transgender and Gender Diverse People

INTRODUCTION: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS: During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings

National Prevalence of Receipt of Antidepressant Prescriptions by Persons Without a Psychiatric Diagnosis

Objective: The study addressed recent concerns regarding increasing prescription of antidepressant drugs to patients with no recorded psychiatric diagnosis. Methods: Records from ten large integrated health systems in the Mental Health Research Network were used to examine diagnoses received by 1,011,946 health plan members who filled at least one antidepressant prescription in 2010. Results: Among individuals filling antidepressant prescriptions, psychiatric diagnoses recorded during the year were depressive disorders (48%), anxiety disorders (27%), bipolar disorders (3%), and attention deficit disorders (3%). The proportion of those filling prescriptions who had no psychiatric diagnosis was 39%, which fell to 27% after the analysis excluded prescriptions for antidepressants often prescribed for nonpsychiatric indications (tricyclic antidepressants, trazodone, and bupropion). Conclusions: Prescription of antidepressants to patients without an appropriate diagnosis appears to be less common than previously reported

Embedding Patients, Providers, and Community Stakeholders in Research to Improve Transgender Health

Background/Aims: The Institute of Medicine in its 2011 report highlights unique health challenges facing the transgender community. Evaluations of outcomes for medical gender reassignment (more appropriately termed “gender confirmation”) are rare and of low quality. The literature on treatment-related quality of life is limited and little is known about the long-term effects of contra-sex hormones on the risk of age-related chronic conditions. The Study of Transition, Outcomes & Gender (STRONG) research program will provide critical information about morbidity and mortality following gender confirmation treatments. It will also assess the comparative effectiveness of gender confirmation therapies for improving quality of life and alleviating gender dysphoria. The multidisciplinary STRONG research team includes investigators from five institutions. Members of the transgender community and health professionals who care for transgender individuals are an integral part of the team and are directly involved in all aspects of this research program including refinement of research questions, development of methods and content for data collection, and evaluation and dissemination of results. Methods: We identified the population of transgender individuals enrolled in the Veterans Administration and Kaiser Permanente health plans in Georgia and Northern and Southern California with a combination of validated ICD codes and keyword string searches. To evaluate mortality and morbidity, we will conduct an electronic medical record-based retrospective cohort study. To assess quality of life and other patient reported outcomes, we will conduct an online cross-sectional survey. Online and in-person focus groups with transgender stakeholders will guide data collection and interpretation of results. Results: ICD codes and keywords identified nearly 15,000 individuals. These preliminary findings indicate the STRONG program will represent the largest cohort of transgender individuals to date and the first such research effort in the United States. Six in-person focus groups have been completed with six more in progress. The study survey has been developed, programmed and pretested via online focus groups. Discussion: The STRONG research program will help close the health disparities gap for the transgender community through increasing scientific knowledge. The research findings will provide guidance to clinicians and policy makers in the care they provide to this sizeable, but underserved, community

Embedding Patients, Providers, and Community Stakeholders in Research to Improve Transgender Health

Background/Aims: The Institute of Medicine in its 2011 report highlights unique health challenges facing the transgender community. Evaluations of outcomes for medical gender reassignment (more appropriately termed “gender confirmation”) are rare and of low quality. The literature on treatment-related quality of life is limited and little is known about the long-term effects of contra-sex hormones on the risk of age-related chronic conditions. The Study of Transition, Outcomes & Gender (STRONG) research program will provide critical information about morbidity and mortality following gender confirmation treatments. It will also assess the comparative effectiveness of gender confirmation therapies for improving quality of life and alleviating gender dysphoria. The multidisciplinary STRONG research team includes investigators from five institutions. Members of the transgender community and health professionals who care for transgender individuals are an integral part of the team and are directly involved in all aspects of this research program including refinement of research questions, development of methods and content for data collection, and evaluation and dissemination of results. Methods: We identified the population of transgender individuals enrolled in the Veterans Administration and Kaiser Permanente health plans in Georgia and Northern and Southern California with a combination of validated ICD codes and keyword string searches. To evaluate mortality and morbidity, we will conduct an electronic medical record-based retrospective cohort study. To assess quality of life and other patient reported outcomes, we will conduct an online cross-sectional survey. Online and in-person focus groups with transgender stakeholders will guide data collection and interpretation of results. Results: ICD codes and keywords identified nearly 15,000 individuals. These preliminary findings indicate the STRONG program will represent the largest cohort of transgender individuals to date and the first such research effort in the United States. Six in-person focus groups have been completed with six more in progress. The study survey has been developed, programmed and pretested via online focus groups. Discussion: The STRONG research program will help close the health disparities gap for the transgender community through increasing scientific knowledge. The research findings will provide guidance to clinicians and policy makers in the care they provide to this sizeable, but underserved, community

Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care

Objective To determine the long term effectiveness of collaborative care management for depression in late life. Design Two arm, randomised, clinical trial; intervention one year and follow-up two years. Setting 18 primary care clinics in eight US healthcare organisations. Patients 1801 primary care patients aged 60 and older with major depression, dysthymia, or both. Intervention Patients were randomly assigned to a 12 month collaborative care intervention (IMPACT) or usual care for depression. Teams including a depression care manager, primary care doctor, and psychiatrist offered education, behavioural activation, antidepressants, a brief, behaviour based psychotherapy (problem solving treatment), and relapse prevention geared to each patient's needs and preferences. Main outcome measures Interviewers, blinded to treatment assignment, conducted interviews in person at baseline and by telephone at each subsequent follow up. They measured depression (SCL-20), overall functional impairment and quality of life (SF-12), physical functioning (PCS-12), depression treatment, and satisfaction with care. Results IMPACT patients fared significantly (P < 0.05) better than controls regarding continuation of antidepressant treatment, depressive symptoms, remission of depression, physical functioning, quality of life, self efficacy, and satisfaction with care at 18 and 24 months. One year after IMPACT resources were withdrawn, a significant difference in SCL-20 scores (0.23, P < 0.0001) favouring IMPACT patients remained. Conclusions Tailored collaborative care actively engages older adults in treatment for depression and delivers substantial and persistent long term benefits. Benefits include less depression, better physical functioning, and an enhanced quality of life. The IMPACT model may show the way to less depression and healthier lives for older adults