Barriers to Accessing and Engaging in Healthcare as Potential Modifiers in the Association Between Polyvictimization and Mental Health among Black Transgender Women

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Citation

Sherman, Athena D. F.; Balthazar, Monique S.; Daniel, Gaea; Bonds Johnson, Kalisha; Klepper, Meredith; Clark, Kristen D.; Baguso, Glenda N.; Cicero, Ethan; Allure, Kisha; & Wharton, Whitney, et al. (2022). Barriers to Accessing and Engaging in Healthcare as Potential Modifiers in the Association Between Polyvictimization and Mental Health among Black Transgender Women. PLOS ONE, 17(6), e0269776. PMCID: PMC9202936

Abstract

BACKGROUND: Black transgender women endure pervasive polyvictimization (experiencing multiple forms of violence throughout the lifespan). Polyvictimization is associated with poor mental health. Black transgender women also face barriers in access to healthcare, but the extent that such barriers modify the association between polyvictimization and poor mental health has not been described using convergent mixed-methods analysis.
METHODS: This convergent mixed-methods secondary analysis employs an intersectional lens and integrates two inter-related datasets to describe barriers to healthcare and the extent that such barriers modify the association between polyvictimization and mental health among Black transgender women. Investigators used survey data (n = 151 participants) and qualitative interview data (n = 19 participants) collected from Black transgender women (age 18 years and older) in Baltimore, MD and Washington, DC between 2016 and 2018. Analyses include thematic content analysis, bivariate analysis, joint display, and multivariate linear regression analysis examining mediation and moderation.
RESULTS: Joint display illuminated three domains to describe how barriers to healthcare present among Black transgender women-Affordability, Accessibility, and Rapport and Continuity. Independent t-tests revealed significantly higher polyvictimization, Post Traumatic Stress Disorder (PTSD), and depression scores among participants who reported at least one barrier to healthcare (BHI) compared to those who reported no barriers. BHI significantly moderated and partially mediated the association between polyvictimization and PTSD symptom severity and BHI fully mediated the association between polyvictimization and depressive symptom severity-when accounting for age and location.
DISCUSSION: Findings highlight the importance of access to healthcare in modifying the association between polyvictimization and PTSD and depression symptom severity among Black transgender women. Findings call for immediate interventions aimed at reducing barriers to healthcare and improved training for clinical providers serving Black transgender women.

URL

http://dx.doi.org/10.1371/journal.pone.0269776

Reference Type

Journal Article

Year Published

2022

Journal Title

PLOS ONE

Author(s)

Sherman, Athena D. F.
Balthazar, Monique S.
Daniel, Gaea
Bonds Johnson, Kalisha
Klepper, Meredith
Clark, Kristen D.
Baguso, Glenda N.
Cicero, Ethan
Allure, Kisha
Wharton, Whitney
Poteat, Tonia

Article Type

Regular

PMCID

PMC9202936

Data Set/Study

TransConnect Study

Continent/Country

United States of America

State

Maryland
Washington D.C.

Race/Ethnicity

Black

Sex/Gender

Transgender Women

ORCiD

Poteat - 0000-0001-6541-3787