Nursing Researcher Examines Mental Health Disparities of LGBTQIA+ Individuals

June 23, 2022
brad white
Dr. Brad White is an Assistant Professor at the IHP

Dr. Bradley White’s analysis reveals more attention is needed within the medical community and in individual states to overcome inconsistent care and make treatment a priority.

By Carolyn Barrett
Office of Strategic Communications

Dr. Bradley White has always been interested in mental health. From the continued global pandemic to the trauma of racial injustice and mass shootings, he knows that access to mental health care has never been more important for all Americans. And yet, White’s work has honed in on one group whose need cannot be understated.  

“The average American has roughly a 5% chance of experiencing suicidal thoughts in their lifetime,” explained the Assistant Professor of Nursing at MGH Institute of Health Professions. “And yet, if you identify as transgender or gender-diverse, that number skyrockets to somewhere between 45 and 55%.” 

A mental health nurse, White focused his doctoral studies at Boston College examining the distinct and profound disparities that transgender and gender-diverse communities experience when engaging with mental health care. “About a third of transgender and gender-diverse individuals will attempt suicide in their lifetime,” he explains, “so it is really important that we have a mental health and overarching healthcare system that both understands these disparities and works proactively to be gender inclusive when treating.” 

As a part of his PhD work, White conducted an integrative review of the subjective mental health experiences of transgender and gender-diverse individuals. Through this, he has identified two distinct spaces for intervention.
One result was that that communal treatment environments – such as group therapy for substance abuse – can end up being a particularly unsafe space for transgender and gender-diverse patients. His research found many patients expressed that, while clinicians and staff work hard to be gender-inclusive themselves, they often fail to act appropriately when fellow patients do not do the same.  “Staff either didn’t know how to respond when someone was threatened or disparaged or simply did not respond,” White explained. Because of this, many of the transgender and gender-diverse patients White interviewed left their treatment programs before completion. 

The second major issue White identified was a lack of intersectionality. “It is one unique experience to be a trans,” but it is a whole other unique experience to be a black and trans in the United States,” he said, noting mental healthcare providers still have significant work to do when it comes to acknowledging those unique intersectionalities and marginalizations. “It is really an urgent mental health priority that “we need to really explore and acknowledge with our patients.”

White’s most recent focus has shifted to the overall experience of being LGBTQIA+ in the United States and the impact that it has on an individual’s mental health. The Center for Disease Control and Prevention conducts a yearly wellness survey called the Behavioral Risk Factor Surveillance Survey which includes several mental health questions. White and colleagues at Boston College conducted a data analysis on those responses to understand if the mental health of queer individuals in the United States is related to the state in which they live. It found that state policies such as whether an individual can have gender-affirming surgery or if a state covers same-sex partners on Medicaid insurance have a significant impact on individual’s mental health. He explains that researchers and clinicians working and studying in LGBTQIA+ affirming and inclusive states have a responsibility to do the work and research that others in less inclusive states may not have the support to do. “We found that individuals who lives in less-inclusive, less-progressive states are statistically significantly much more likely to report substance abuse, anxiety, depression, and other mental health conditions,” he said. “We live in two Americas – one that is affirming and one that can be quite dangerous.”

One solution he believes can make a difference is for all healthcare institutions and organizations to have LGBTQIA+ advocacy groups. For example, the American Medical Association has had an LGBTQIA+ advocacy group for several decades while the American Nurses Association does not. 

“Nurses are the most trusted healthcare providers in the United States,” he noted. “If anyone can have a true impact, it is us.”