Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study

doi:10.1186/s12939-023-01975-7

. 2023 Aug 24;22(1):162.

doi: 10.1186/s12939-023-01975-7.

Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study

Kristen D Clark¹, Mitchell R Lunn^{2

3

4}, Jordon D Bosse⁵, Jae M Sevelius^{6

7}, Carol Dawson-Rose⁸, Sandra J Weiss⁹, Micah E Lubensky^{2

8}, Juno Obedin-Maliver^{2

4

10}, Annesa Flentje^{2

8

11}

Affiliations

¹ Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden. Kristen.Clark@uu.se.
² The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
³ Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
⁴ Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
⁵ School of Nursing, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, USA.
⁶ Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, USA.
⁷ Center of Excellence for Transgender Health, Department of Medicine, University of California, 513 Parnassus Avenue, San Francisco, San Francisco, CA, USA.
⁸ Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, USA.
⁹ Department of Community Health Systems, UCSF Depression Center, University of California, San Francisco, 2 Koret Way, San Francisco, CA, USA.
¹⁰ Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
¹¹ Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, 1930 Market Street, San Francisco, CA, USA.

PMID: 37620832
PMCID: PMC10463432
DOI: 10.1186/s12939-023-01975-7

Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study

Kristen D Clark et al. Int J Equity Health. 2023.

. 2023 Aug 24;22(1):162.

doi: 10.1186/s12939-023-01975-7.

Authors

Affiliations

¹ Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden. Kristen.Clark@uu.se.
² The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
³ Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
⁴ Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
⁵ School of Nursing, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, USA.
⁶ Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, USA.
⁷ Center of Excellence for Transgender Health, Department of Medicine, University of California, 513 Parnassus Avenue, San Francisco, San Francisco, CA, USA.
⁸ Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, USA.
⁹ Department of Community Health Systems, UCSF Depression Center, University of California, San Francisco, 2 Koret Way, San Francisco, CA, USA.
¹⁰ Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
¹¹ Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, 1930 Market Street, San Francisco, CA, USA.

PMID: 37620832
PMCID: PMC10463432
DOI: 10.1186/s12939-023-01975-7

Abstract

Background: Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely reported mistreatment in healthcare settings. Mistreatment is enacted by individuals within society who hold stigmatizing beliefs. However, the relationship between healthcare mistreatment and societal stigma (i.e., the degree to which society disapproves of GM people) is unclear and not measured consistently.

Methods: We analyzed data from 2,031 GM participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study's 2019 Annual Questionnaire to determine whether societal stigma was associated with participants' past-year reports of mistreatment (defined as denial of healthcare services and/or lower quality care) in medical or mental healthcare settings. We created a proxy measure of societal stigma by incorporating variables validated in existing literature. Participants reported whether they had experienced mistreatment in medical and mental health settings independently.

Results: Healthcare denial and/or lower quality care during the past year was reported by 18.8% of our sample for medical settings and 12.5% for mental health settings. We found no associations between the societal stigma variables and past-year reports of healthcare denial and/or lower quality care in medical or mental healthcare settings.

Conclusions: Although a high proportion of GM people reported past-year healthcare mistreatment in both medical and mental health settings, mistreatment had no relationship with societal stigma. Factors other than societal stigma may be more important predictors of healthcare mistreatment, such as healthcare workers' knowledge of and attitudes toward GM people. However, other measures of societal stigma, or different types of mistreatment, may show stronger associations. Identifying key factors that contribute to mistreatment can serve as targets for intervention in communities and healthcare settings.

Keywords: Discrimination; Gender minority; Health disparity; Healthcare access; Stigma.

PubMed Disclaimer

Conflict of interest statement

JOM has consulted for Sage Therapeutics (5/2017) in a one-day advisory board, Ibis Reproductive Health (a non-for-profit research group; 3/2017-5/2018, 2020-present), Hims Inc. (2019 - present), and Folx Inc (2020-present). MRL has consulted for Hims Inc. (2019 - present) and Folx, Inc. (2020). The remaining authors have no conflicts to disclose.

Figures

**Fig. 1**
Societal Stigma and Stigma Conceptual Model (adapted from Hughto White et al., 2015)

See this image and copyright information in PMC

Cited by

Cultural humility training interventions for healthcare students to improve care for gender and sexual minority groups: Protocol for a systematic review and a proposed meta-analysis.
Lambor PD, Bhageerathy R, Devi ES, Gudi N, R VL. Lambor PD, et al. MethodsX. 2024 Sep 14;13:102963. doi: 10.1016/j.mex.2024.102963. eCollection 2024 Dec. MethodsX. 2024. PMID: 39385938 Free PMC article.
Relationships between structural stigma, societal stigma, and minority stress among gender minority people.
Clark KD, Lunn MR, Sevelius JM, Dawson-Rose C, Weiss SJ, Neilands TB, Lubensky ME, Obedin-Maliver J, Flentje A. Clark KD, et al. Sci Rep. 2025 Jan 23;15(1):2996. doi: 10.1038/s41598-024-85013-8. Sci Rep. 2025. PMID: 39848993 Free PMC article.
A qualitative description of HIV testing and healthcare experiences among trans women in Ghanaian urban slums BSGH-012.
Dakpui HD, Shamrock OW, Aidoo-Frimpong G, Zigah EY, Kofi Agbemedu GR, Ahmed A, Osman U, Haruna A, Abu-Ba'are GR. Dakpui HD, et al. PLOS Glob Public Health. 2024 Dec 2;4(12):e0003980. doi: 10.1371/journal.pgph.0003980. eCollection 2024. PLOS Glob Public Health. 2024. PMID: 39621619 Free PMC article.

References

1. Ayhan CHB, Bilgin H, Uluman OT, Sukut O, Yilmaz S, Buzlu S. A systematic review of the discrimination against sexual and gender minority in Health Care settings. Int J Health Serv. 2019;50(1):44–61. doi: 10.1177/0020731419885093. - DOI - PubMed
1. Cicero EC, Reisner SL, Silva SG, Merwin EI, Humphreys JC. Health Care Experiences of Transgender adults: an Integrated mixed Research Literature Review. Adv Nurs Sci. 2019;42(2):123–38. doi: 10.1097/ANS.0000000000000256. - DOI - PMC - PubMed
1. Zeeman L, Sherriff N, Browne K, McGlynn N, Mirandola M, Gios L, et al. A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. Eur J Public Health. 2019;29(5):974–80. doi: 10.1093/eurpub/cky226. - DOI - PMC - PubMed
1. Markovic L, McDermott DT, Stefanac S, Seiler-Ramadas R, Iabloncsik D, Smith L, et al. Experiences and interactions with the healthcare system in transgender and non-binary patients in Austria: an exploratory cross-sectional study. Int J Environ Res Public Health. 2021;18(13):6895. doi: 10.3390/ijerph18136895. - DOI - PMC - PubMed
1. Snow A, Cerel J, Loeffler DN, Flaherty C. Barriers to mental health care for transgender and gender-nonconforming adults: a systematic literature review. Health Soc Work. 2019;44(3):149–55. doi: 10.1093/hsw/hlz016. - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

[1] Ayhan CHB, Bilgin H, Uluman OT, Sukut O, Yilmaz S, Buzlu S. A systematic review of the discrimination against sexual and gender minority in Health Care settings. Int J Health Serv. 2019;50(1):44–61. doi: 10.1177/0020731419885093. - DOI - PubMed

[2] Ayhan CHB, Bilgin H, Uluman OT, Sukut O, Yilmaz S, Buzlu S. A systematic review of the discrimination against sexual and gender minority in Health Care settings. Int J Health Serv. 2019;50(1):44–61. doi: 10.1177/0020731419885093. - DOI - PubMed

[3] Cicero EC, Reisner SL, Silva SG, Merwin EI, Humphreys JC. Health Care Experiences of Transgender adults: an Integrated mixed Research Literature Review. Adv Nurs Sci. 2019;42(2):123–38. doi: 10.1097/ANS.0000000000000256. - DOI - PMC - PubMed

[4] Cicero EC, Reisner SL, Silva SG, Merwin EI, Humphreys JC. Health Care Experiences of Transgender adults: an Integrated mixed Research Literature Review. Adv Nurs Sci. 2019;42(2):123–38. doi: 10.1097/ANS.0000000000000256. - DOI - PMC - PubMed

[5] Zeeman L, Sherriff N, Browne K, McGlynn N, Mirandola M, Gios L, et al. A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. Eur J Public Health. 2019;29(5):974–80. doi: 10.1093/eurpub/cky226. - DOI - PMC - PubMed

[6] Zeeman L, Sherriff N, Browne K, McGlynn N, Mirandola M, Gios L, et al. A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. Eur J Public Health. 2019;29(5):974–80. doi: 10.1093/eurpub/cky226. - DOI - PMC - PubMed

[7] Markovic L, McDermott DT, Stefanac S, Seiler-Ramadas R, Iabloncsik D, Smith L, et al. Experiences and interactions with the healthcare system in transgender and non-binary patients in Austria: an exploratory cross-sectional study. Int J Environ Res Public Health. 2021;18(13):6895. doi: 10.3390/ijerph18136895. - DOI - PMC - PubMed

[8] Markovic L, McDermott DT, Stefanac S, Seiler-Ramadas R, Iabloncsik D, Smith L, et al. Experiences and interactions with the healthcare system in transgender and non-binary patients in Austria: an exploratory cross-sectional study. Int J Environ Res Public Health. 2021;18(13):6895. doi: 10.3390/ijerph18136895. - DOI - PMC - PubMed

[9] Snow A, Cerel J, Loeffler DN, Flaherty C. Barriers to mental health care for transgender and gender-nonconforming adults: a systematic literature review. Health Soc Work. 2019;44(3):149–55. doi: 10.1093/hsw/hlz016. - DOI - PubMed

[10] Snow A, Cerel J, Loeffler DN, Flaherty C. Barriers to mental health care for transgender and gender-nonconforming adults: a systematic literature review. Health Soc Work. 2019;44(3):149–55. doi: 10.1093/hsw/hlz016. - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study

Affiliations

Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous