Teaching and Curriculum

How can we provide better healthcare to transgender people? In our society transgender individuals face stigma and discrimination, which are often connected to problems with physical and mental health. Despite this, research on transgender demographics and health is limited.

Dr. Alex Abramovich and his team are working to develop a greater understanding of what health problems impact transgender people and how, with a particular focus on coexisting mental and physical health problems. Their new study examines demographics, health conditions, and health care experiences among transgender individuals, while comparing them to the cisgender population.

What motivated this research?

AA:The lack of data on gender identity and limited information on transgender health, including health conditions that impact the transgender population, and how transgender people are being served by the health care system, presents a challenge to healthcare providers as we try to determine how to provide transgender people with the best possible care.

The available data are primarily from self-reported surveys, making it difficult to understand health care utilization patterns and health outcomes among transgender individuals.

Overall, the knowledge that transgender individuals experience high rates of discrimination, stigma, and socioeconomic disadvantages, all of which lead to poor health outcomes and the need for high quality data motived this research.

What was the most important finding of this study, in your opinion?

AA: We found that transgender individuals were more likely to live in lower-income neighborhoods, experience chronic physical and mental health conditions, and have higher health service use compared with the general population.

In my opinion, the most important finding was that chronic physical and psychiatric illnesses occurring alongside one another was significantly more common among transgender individuals compared with the general population. The presence of multiple conditions occurring alongside each other is referred to as comorbidity in medicine, and can have serious implications for health and wellbeing.

Transgender individuals had higher rates of a number of illnesses compared with cisgender control groups.

Psychiatric comorbidities were reported in 22.9% of cisgender control groups compared with 76.3% of transgender individuals.

There are a variety of factors underlying the health disparities and high rates of mental health comorbidities experienced by transgender individuals, including stigma and socioeconomic disadvantages. Further research is needed to understand the reasons for these findings.

How does this change treatment and health services for transgender individuals?

AA: This study demonstrates the importance and need for health services to collect gender identity information and for patients to be asked what name and pronoun they go by.

Clinicians caring for transgender individuals need to be aware of the high potential for mental health issues and self-harm and ask their transgender patients about their mental health, including suicidality.

Medical guidelines on providing care for transgender individuals have been published and are available online as a helpful tool for primary care physicians. Primary care physicians can deliver the majority of health care needs for transgender individuals, including medical transition related needs, such as prescribing hormones, assessing for gender dysphoria, and making referrals for transition-related surgeries.

It is important to note that gender affirming health care leads to better mental health and improved quality of life.

Any next steps?

AA: Our next steps will be to developing a better understanding of the factors underlying the health disparities and high rates of mental health comorbidities experienced by transgender individuals and to examine how marginalization and gender identity intersect.

Future efforts should be made to improve identification of older transgender individuals and transgender individuals living in small town and rural settings.

What is the major take home message for the public?

AA: Transgender individuals face multiple barriers to accessing health care, housing, employment and education, as a result of stigma, discrimination and structural violence.

Stigma, transphobia, and structural violence have very serious consequences on the health and lives of transgender individuals and lead to poor mental health outcomes, including depression and suicidality.

Impact: Important Psychiatry Articles that Change Treatment
ImPACT Committee includes Krista Lanctôt, Alastair Flint, Meng-Chuan Lai and Simone Vigod.

Abramovich, A., Oliveira, C. D., Kiran, T., Iwajomo, T., Ross, L. E., & Kurdyak, P. (2020). Assessment of Health Conditions and Health Service Use Among Transgender Patients in Canada. JAMA Network Open, 3(8). doi:10.1001/jamanetworkopen.2020.15036

 

 

Our faculty members frequently make appearences in the media as expert consultants or authors. Each month, we summarize some of the most recent media appearences and contributions our faculty have made.

 

Canadians reporting higher levels of anxiety, depression amid the pandemic

Global News. October 10, 2020. Featuring John Trainor.

John Trainor emphasizes the growing concern in higher trends of Anxiety and Depression experienced by Canadians amid the pandemic.

 

Ontario doctor says a COVID-19 winter is going to be especially hard on women

Narcity. October 10, 2020. Featuring Dr. Karen Abrams.

Dr. Karen Abrams brings awareness to how the upcoming cold season may have a greater effect on women’s wellbeing and suggestions on how to practice self-care.

 

Pandemic’s impact on mental health must not be overlooked

OurWindsor. October 9, 2020. Featuring Dr. David Gratzer.

Dr. David Gratzer recounts his experience with the 2003 SARS outbreak on mental health and emphasizes the importance of continued focus on mental and physical health awareness during these unsettling times.

 

Inside the mental health crisis at Canadian universities

Macleans. October 8, 2020. Featuring Dr. Joanna Henderson.

Dr. Joanna Henderson discusses how COVID-19 management has exacerbated the mental health crisis of young Canadians and addresses concerns about accessibility of mental health resources amid inadequate funding.

 

長者在疫情下面對的心理健康困擾 (Mental health issues faced by seniors during COVID19 pandemic)

OMNI Television. October 2, 2020. Featuring Dr. Alan Fung.

Dr. Alan Fung speaks with OMNI to bring awareness of the drastic effects of COVID-19 on the elderly community and highlights his participation in mental health talks to help deal with these struggles.

 

Autism shares brain structure changes with other psychiatric conditions

Spectrum. October 1, 2020. Featuring Dr. Tomas Paus.

Dr. Tomas Paus shares his findings on a potential correlation between psychiatric conditions and cortical thickness.

 

For U of T students, mental health support is available when you need it

UofT News. September 14, 2020. Featuring Dr. Andrea Levinson.

Dr. Andrea Levinson discusses mental health services available across the three campuses, how COVID-19 may affect post-secondary young adults’ mental health differently than other age groups, how the pandemic has changed the delivery of services, and a few coping suggestions to feel more grounded.

 

Social media harms students’ mental health

The Daily Orange. September 14, 2020. Featuring Dr. Roger McIntyre.

Dr. Roger McIntyre speaks on the  growth in social media usage coinciding with the increase in mental illness in adults. He discusses his previous research of worsening mental health and social media; how it can partially be attributed to anonymity and unsafe or negative interactions on social media platforms.

A portrait photo of Dr. Vivian Rakoff

Dr. Vivian Rakoff, former Chair of the Department of Psychiatry, passed away on October 1, 2020, at the age of 92. A renown educator and researcher, Dr. Rakoff made many ground-breaking contributions to the field of psychiatry and the mental health of Canadians.

In June 2006, Dr. Pier Bryden and Dr. David Goldbloom interviewed Dr. Rakoff for a planned book about the perspectives of psychiatrists and the intersection between their personal and professional lives. Although their resulting book, “How Can I Help? A Week in My Life as a Psychiatrist”, ultimately took a different form, their journey began with an enriching encounter with Vivian at a time when he was past the peak of his career but still a dazzling, eloquent speaker whose reflections exuded personal warmth and boundless intellectual curiosity.

In the course of their conversation, Dr. Rakoff discussed everything from his decision to pursue medicine, the division between psychotherpy and psychopharmocology, and the promising future of psychiatrry.

In light of his passing, Dr. Bryden and Dr. Goldbloom have shared the results of this interview for the first time. You can now read the full conversation with Dr. Rakoff.