My current research focuses are transgender people's mental health, physical health, sexuality, and identity development. Supervisors: Anita DeLongis, Dave Clarke, and Elizabeth Saewyc
International Journal of Transgender Health and Wellbeing, 2022
Background: This article is by a group of trans and nonbinary researchers and experts in the fiel... more Background: This article is by a group of trans and nonbinary researchers and experts in the field of trans health who have conducted an analysis of trans health research needs. Aims: To highlight topics that need further research and to outline key considerations for those conducting research in our field. Methods: The first author conducted semi-structured interviews with all co-authors, and these were used to create a first draft of this manuscript. This draft was circulated to all authors, with edits made until consensus was reached among the authors. Results: More comprehensive long-term research that centers trans people's experiences is needed on the risks and benefits of gender affirming hormones and surgeries. The trans health research field also needs to have a broader focus beyond medical transition or gender affirmation, including general health and routine healthcare; trans people's lives without, before, and after medical gender affirmation; and sexuality, fertility, and reproductive healthcare needs. More research is also needed on social determinants of health, including ways to make healthcare settings and other environments safer and more supportive; social and legal gender recognition; the needs of trans people who are most marginalized; and the ways in which healing happens within trans communities. The second part of this article highlights key considerations for researchers, the foremost being acknowledging trans community expertise and centering trans community members' input into research design and interpretation of findings, in advisory and/or researcher roles. Ethical considerations include maximizing benefits and minimizing harms (beneficence) and transparency and accountability to trans communities. Finally, we note the importance of conferences, grant funding, working with students, and multidisciplinary teams. Discussion: This article outlines topics and issues needing further consideration to make the field of trans health research more responsive to the needs of trans people. This work is limited by our authorship group being mostly White, all being Anglophone, and residing in the Global North.
Introduction: International evidence has found large mental health inequities among transgender p... more Introduction: International evidence has found large mental health inequities among transgender people and demonstrates that mental health outcomes are associated with enacted stigma experiences and protective factors. This study aimed to examine the extent of associations of enacted stigma experiences specific to transgender people alongside protective factors with mental health of transgender people in Aotearoa/New Zealand. Method: The 2018 Counting Ourselves survey was a nationwide community-based study of transgender people (N = 1,178, Mage = 29.5) living in Aotearoa/New Zealand. The survey assessed a wide range of gender minority stress experiences and protective factors that comprised primary (support from friends and family) and secondary social ties (neighborhood and transgender community belongingness). We calculated the predicted probabilities that transgender people exhibit very high psychological distress level, non-suicidal self-injury, and suicidal risks with different combinations and exposure profiles of enacted stigma and protective factors. Results: Our findings demonstrated that enacted stigma was associated with negative mental health, and support of friends and family was linked to better outcomes across all mental health measures. Beyond primary social ties, sense of belongingness to neighborhood and transgender communities were linked to reduced odds of psychological distress and suicidal ideation. For those scoring high on enacted stigma and low on protective factors, our model revealed a 25% probability of attempting suicide in the last year compared to 3% for those scoring low on enacted stigma and high on protective factors. Conclusions: Echoing previous findings, this study demonstrates that transgender people across Aotearoa/New Zealand are less likely to manifest life-threatening mental health outcomes if they experience low levels of enacted stigma and high levels of access to protective factors. Our findings suggest a need to address the enacted stigma that transgender people face across interpersonal and structural settings, and also to enhance social supports that are gender affirmative for this population.
The effects of health inequities on transgender (or trans) and gender diverse populations have be... more The effects of health inequities on transgender (or trans) and gender diverse populations have been well documented internationally. Studies that compared the mental health of trans and gender diverse populations to cisgender populations found significant inequities for mental health problems. There has been very little research on this topic, however, from Aotearoa/New Zealand. We conducted database search in the PsycINFO, as well as manual searches for published grey literature in Aotearoa/New Zealand to identify theoretical and empirical literature on social determinants of health and related frameworks to explain the effects of social environments on health inequities experienced by trans and gender diverse people. We also complement international studies by considering Māori and Pacific trans and gender diverse identities and the ramifications of colonisation on the mental health and wellbeing of these populations.
Background: Transgender (trans) youth who identify outside the gender binary are a growing subpop... more Background: Transgender (trans) youth who identify outside the gender binary are a growing subpopulation. In this article, we document differences in access to gender-affirming health care between binary and non-binary identified trans youth and explore ways of meeting the health needs of non-binary youth within primary care settings. Methods: The Canadian Trans Youth Health Survey is a national online survey of trans youth, 14-25 years, conducted in 2013-2014. Among the 839 participants who responded to gender identity items in the survey, 41% identified as non-binary. We compared demographic, health outcome, and health care access responses between non-binary and binary (trans girls/women and trans boys/men) youth. Results: Non-binary and binary youth were similar in most demographics, including age, geographic distribution, and ethnocultural backgrounds, however a larger proportion (82%) of non-binary youth were assigned female at birth. Older non-binary youth (aged 19-25) were significantly more likely to forego needed healthcare than older binary youth; no significant differences were found between younger (14-18) non-binary and binary youth in foregoing healthcare. Overall, non-binary youth (13%) were significantly less likely than binary youth (52%) to access hormone therapy, but they were more likely than binary youth to report experiencing barriers to accessing hormone therapy when needed. Conclusions: Non-binary trans youth in Canada report challenges in accessing needed gender-affirming healthcare. Primary care providers are well-situated to integrate a broad range of gender-affirming care services into practice in order to address the unique needs of non-binary youth. Future research is warranted to explore experiences of non-binary youth related to barriers to care and to explore how services can be designed and delivered to better meet the needs of non-binary youth seeking gender-affirming primary care.
Recalled childhood gender role/identity is a construct that is related to sexual orientation, abu... more Recalled childhood gender role/identity is a construct that is related to sexual orientation, abuse, and psychological health. The purpose of this study was to assess the factorial validity of a short version of Zucker et al.'s (2006) " Recalled Childhood Gender Identity/Gender Role Questionnaire " using confirmatory factor analysis and to test the stability of the factor structure across groups (measurement invariance). Six items of the questionnaire were completed online by 1,929 participants from a variety of gender identity and sexual orientation groups. Models of the six items loading onto one factor had poor fit for the data. Items were removed for having a large proportion of error variance. Among birth-assigned females, a five item model had good fit for the data, but there was evidence for differences in scale's factor structure across gender identity, age, level of education, and country groups. Among birth-assigned males, the resulting four-item model did not account for all of the relationship between variables, and modeling for this resulted in a model that was almost saturated. This model also had evidence of measurement variance across gender identity and sexual orientation groups. The models had good reliability and factor score determinacy. These findings suggest that results of previous studies that have assessed recalled childhood gender role/identity may have been susceptible to construct bias due to measurement variance across these groups. Future studies should assess measurement invariance between groups they are comparing and if it is not found the issue can be addressed by removing variant indicators and/or applying a partial invariance model.
While little research has been conducted into the reproductive experiences of transgender people,... more While little research has been conducted into the reproductive experiences of transgender people, available evidence suggests that like cisgender people, most transgender people endorse a desire for these experiences. This study explores the pregnancy experiences and related health factors among transgender and gender-diverse 14–25 year olds using a national Canadian sample (N = 923). Results indicated that 26 (5%) transgender youth reported a pregnancy experience in the past and the prevalence among 14-18 year olds was comparable to population-based estimates using the same question in the British Columbia Adolescent Health Survey. Transgender youth with a history of pregnancy involvement reported a diverse range of gender identities, and this group did not differ from the remainder of the sample on general mental health, social supports, and living in felt gender. This group did report over six times greater likelihood of having been diagnosed with a sexually transmitted infection by a doctor (19%), but did they not differ in reported contraception use during last sexual intercourse. These findings suggest that pregnancy involvement is an issue that should not be overlooked by health professionals working with transgender youth and that this group has particular sexual health needs.
Results from the first Canadian Trans Youth Health Survey. Copy of the report in French and more ... more Results from the first Canadian Trans Youth Health Survey. Copy of the report in French and more on the SARAVYC website.
International Journal of Transgender Health and Wellbeing, 2022
Background: This article is by a group of trans and nonbinary researchers and experts in the fiel... more Background: This article is by a group of trans and nonbinary researchers and experts in the field of trans health who have conducted an analysis of trans health research needs. Aims: To highlight topics that need further research and to outline key considerations for those conducting research in our field. Methods: The first author conducted semi-structured interviews with all co-authors, and these were used to create a first draft of this manuscript. This draft was circulated to all authors, with edits made until consensus was reached among the authors. Results: More comprehensive long-term research that centers trans people's experiences is needed on the risks and benefits of gender affirming hormones and surgeries. The trans health research field also needs to have a broader focus beyond medical transition or gender affirmation, including general health and routine healthcare; trans people's lives without, before, and after medical gender affirmation; and sexuality, fertility, and reproductive healthcare needs. More research is also needed on social determinants of health, including ways to make healthcare settings and other environments safer and more supportive; social and legal gender recognition; the needs of trans people who are most marginalized; and the ways in which healing happens within trans communities. The second part of this article highlights key considerations for researchers, the foremost being acknowledging trans community expertise and centering trans community members' input into research design and interpretation of findings, in advisory and/or researcher roles. Ethical considerations include maximizing benefits and minimizing harms (beneficence) and transparency and accountability to trans communities. Finally, we note the importance of conferences, grant funding, working with students, and multidisciplinary teams. Discussion: This article outlines topics and issues needing further consideration to make the field of trans health research more responsive to the needs of trans people. This work is limited by our authorship group being mostly White, all being Anglophone, and residing in the Global North.
Introduction: International evidence has found large mental health inequities among transgender p... more Introduction: International evidence has found large mental health inequities among transgender people and demonstrates that mental health outcomes are associated with enacted stigma experiences and protective factors. This study aimed to examine the extent of associations of enacted stigma experiences specific to transgender people alongside protective factors with mental health of transgender people in Aotearoa/New Zealand. Method: The 2018 Counting Ourselves survey was a nationwide community-based study of transgender people (N = 1,178, Mage = 29.5) living in Aotearoa/New Zealand. The survey assessed a wide range of gender minority stress experiences and protective factors that comprised primary (support from friends and family) and secondary social ties (neighborhood and transgender community belongingness). We calculated the predicted probabilities that transgender people exhibit very high psychological distress level, non-suicidal self-injury, and suicidal risks with different combinations and exposure profiles of enacted stigma and protective factors. Results: Our findings demonstrated that enacted stigma was associated with negative mental health, and support of friends and family was linked to better outcomes across all mental health measures. Beyond primary social ties, sense of belongingness to neighborhood and transgender communities were linked to reduced odds of psychological distress and suicidal ideation. For those scoring high on enacted stigma and low on protective factors, our model revealed a 25% probability of attempting suicide in the last year compared to 3% for those scoring low on enacted stigma and high on protective factors. Conclusions: Echoing previous findings, this study demonstrates that transgender people across Aotearoa/New Zealand are less likely to manifest life-threatening mental health outcomes if they experience low levels of enacted stigma and high levels of access to protective factors. Our findings suggest a need to address the enacted stigma that transgender people face across interpersonal and structural settings, and also to enhance social supports that are gender affirmative for this population.
The effects of health inequities on transgender (or trans) and gender diverse populations have be... more The effects of health inequities on transgender (or trans) and gender diverse populations have been well documented internationally. Studies that compared the mental health of trans and gender diverse populations to cisgender populations found significant inequities for mental health problems. There has been very little research on this topic, however, from Aotearoa/New Zealand. We conducted database search in the PsycINFO, as well as manual searches for published grey literature in Aotearoa/New Zealand to identify theoretical and empirical literature on social determinants of health and related frameworks to explain the effects of social environments on health inequities experienced by trans and gender diverse people. We also complement international studies by considering Māori and Pacific trans and gender diverse identities and the ramifications of colonisation on the mental health and wellbeing of these populations.
Background: Transgender (trans) youth who identify outside the gender binary are a growing subpop... more Background: Transgender (trans) youth who identify outside the gender binary are a growing subpopulation. In this article, we document differences in access to gender-affirming health care between binary and non-binary identified trans youth and explore ways of meeting the health needs of non-binary youth within primary care settings. Methods: The Canadian Trans Youth Health Survey is a national online survey of trans youth, 14-25 years, conducted in 2013-2014. Among the 839 participants who responded to gender identity items in the survey, 41% identified as non-binary. We compared demographic, health outcome, and health care access responses between non-binary and binary (trans girls/women and trans boys/men) youth. Results: Non-binary and binary youth were similar in most demographics, including age, geographic distribution, and ethnocultural backgrounds, however a larger proportion (82%) of non-binary youth were assigned female at birth. Older non-binary youth (aged 19-25) were significantly more likely to forego needed healthcare than older binary youth; no significant differences were found between younger (14-18) non-binary and binary youth in foregoing healthcare. Overall, non-binary youth (13%) were significantly less likely than binary youth (52%) to access hormone therapy, but they were more likely than binary youth to report experiencing barriers to accessing hormone therapy when needed. Conclusions: Non-binary trans youth in Canada report challenges in accessing needed gender-affirming healthcare. Primary care providers are well-situated to integrate a broad range of gender-affirming care services into practice in order to address the unique needs of non-binary youth. Future research is warranted to explore experiences of non-binary youth related to barriers to care and to explore how services can be designed and delivered to better meet the needs of non-binary youth seeking gender-affirming primary care.
Recalled childhood gender role/identity is a construct that is related to sexual orientation, abu... more Recalled childhood gender role/identity is a construct that is related to sexual orientation, abuse, and psychological health. The purpose of this study was to assess the factorial validity of a short version of Zucker et al.'s (2006) " Recalled Childhood Gender Identity/Gender Role Questionnaire " using confirmatory factor analysis and to test the stability of the factor structure across groups (measurement invariance). Six items of the questionnaire were completed online by 1,929 participants from a variety of gender identity and sexual orientation groups. Models of the six items loading onto one factor had poor fit for the data. Items were removed for having a large proportion of error variance. Among birth-assigned females, a five item model had good fit for the data, but there was evidence for differences in scale's factor structure across gender identity, age, level of education, and country groups. Among birth-assigned males, the resulting four-item model did not account for all of the relationship between variables, and modeling for this resulted in a model that was almost saturated. This model also had evidence of measurement variance across gender identity and sexual orientation groups. The models had good reliability and factor score determinacy. These findings suggest that results of previous studies that have assessed recalled childhood gender role/identity may have been susceptible to construct bias due to measurement variance across these groups. Future studies should assess measurement invariance between groups they are comparing and if it is not found the issue can be addressed by removing variant indicators and/or applying a partial invariance model.
While little research has been conducted into the reproductive experiences of transgender people,... more While little research has been conducted into the reproductive experiences of transgender people, available evidence suggests that like cisgender people, most transgender people endorse a desire for these experiences. This study explores the pregnancy experiences and related health factors among transgender and gender-diverse 14–25 year olds using a national Canadian sample (N = 923). Results indicated that 26 (5%) transgender youth reported a pregnancy experience in the past and the prevalence among 14-18 year olds was comparable to population-based estimates using the same question in the British Columbia Adolescent Health Survey. Transgender youth with a history of pregnancy involvement reported a diverse range of gender identities, and this group did not differ from the remainder of the sample on general mental health, social supports, and living in felt gender. This group did report over six times greater likelihood of having been diagnosed with a sexually transmitted infection by a doctor (19%), but did they not differ in reported contraception use during last sexual intercourse. These findings suggest that pregnancy involvement is an issue that should not be overlooked by health professionals working with transgender youth and that this group has particular sexual health needs.
Results from the first Canadian Trans Youth Health Survey. Copy of the report in French and more ... more Results from the first Canadian Trans Youth Health Survey. Copy of the report in French and more on the SARAVYC website.
Counting Ourselves is the first comprehensive national survey of the health and wellbeing of tran... more Counting Ourselves is the first comprehensive national survey of the health and wellbeing of trans and non-binary people living in Aotearoa New Zealand and was conducted from 21June till 30 September 2018. We worked with a diverse community advisory group to design the questions. Our team is based at the University of Waikato and we also collaborated with other academics, health professionals, community organisations and policymakers with an interest in the wellbeing of trans and non-binary people. We had 1,178 survey participants, with 99% of them completing the survey online. The survey had participants from all regions in the country, who ranged in age from 14 to 83. Most were either youth aged 14–24 (46%) or adults aged 25–54 (47%). Almost half (45%) of participants were non-binary, and we had slightly more trans men (29%) than trans women (26%). The survey had a higher proportion of European participants and a lower proportion of Asian participants than the general population. A quarter of participants had a disability.
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New Zealand and was conducted from 21June till 30 September 2018. We worked with a diverse community advisory group to design the
questions. Our team is based at the University of Waikato and we also collaborated with other academics, health professionals, community
organisations and policymakers with an interest in the wellbeing of trans and non-binary people. We had 1,178 survey participants, with 99% of them completing the survey online.
The survey had participants from all regions in the country, who ranged in age from 14 to 83. Most were either youth aged 14–24 (46%) or adults aged 25–54 (47%). Almost half (45%) of participants were non-binary, and we had slightly more trans men (29%) than trans women (26%). The survey had a higher proportion of European participants and a lower proportion of Asian participants than the general population. A quarter of participants had a disability.