Background: Nurses and primary care practitioners are more likely to encounter and care for the substance use and mental health care needs of minority transgender youth (MTY) in the acute care and outpatient settings These settings may be the first resource MTY use for identification, treatment, education, and support. Many providers may be unfamiliar with the challenges faced by this population, particularly the cultural care considerations of these individuals
Purpose: The purpose of this integrative review is to examine the U.S. based literature on substance use, mental health disorders and associated health disparities for MTY and to outline implications for nurses and primary care practitioners.
Methods: Integrative review that included studies, published since 2010 – within the Cumulative Index for Nursing and Allied Health (CINAHL), PsycInfo, PubMed and Google Scholar databases.
Results: Heavy drug use/drug abuse of methamphetamine, alcohol, inhalants, marijuana, nicotine, and prescription drug abuse was significantly higher in MTY.Suicidal ideation, self-harm, depression, anxiety, victimization, and risky sexual behaviors were significantly higher for MTY compared to cisgender adolescents or adolescent sexual minority groups.May seek mental health care related to or resulting from their gender identity, mood disorders and other comorbid psychiatric conditions. Risky health behaviors including unprotected anal/vaginal sex, commercial sex work, drug use/abuse, and sharing needles and other drug paraphernalia was significantly higher in MTY.Most of the studies identified socioeconomic vulnerability for MTY that contribute significantly to risky health behaviors or mental health conditions.
Conclusions: MTY experience stigma, discrimination, homophobia from healthcare providers as well as fear disclosing their sexuality or gender identity. MTY need to receive appropriate culturally congruent evidence-based screening for substance use, mental health conditions, HIV and sexually-transmitted infections. Gender affirming health care training for nurses and primary care providers, including using the correct pronouns, preferred name, and having transgender specific medical services such as cross-sex hormone therapy and surgical interventions to improve quality of life and psychological well-being. Providing resource support to help families support their transgender youth, including accurate information on sexual orientation and gender identity and expression. Focused policy agenda needs to support education and training for PCPs to care for and be inclusive of all transgender individuals.