title: LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People.
abstract: Previous studies have found that transgender, lesbian, and bisexual people report poorer mental health relative to heterosexuals. However, available research provides little information about mental health service access among the highest need groups within these communities: bisexual women and transgender people. This study compared past year unmet need for mental health care and untreated depression between four groups: heterosexual cisgender (i.e., not transgender) women, cisgender lesbians, cisgender bisexual women, and transgender people.
  
  
  
  This was a cross-sectional Internet survey. We used targeted sampling to recruit 704 sexual and gender minority people and heterosexual cisgendered adult women across Ontario, Canada. To ensure adequate representation of vulnerable groups, we oversampled racialized and low socioeconomic status (SES) women.
  
  
  
  Trans participants were 2.4 times (95% confidence intervals [CI] = 1.6-3.8, p < 0.01) and bisexual people 1.8 times (95% CI = 1.1-2.9, p = 0.02) as likely to report an unmet need for mental healthcare as cisgender heterosexual women. Trans participants were also 1.6 times (95% CI = 1.0-27, p = 0.04) more likely to report untreated depression. These differences were not seen after adjustment for social context factors such as discrimination and social support.
  
  
  
  We conclude that there are higher rates of unmet need and untreated depression in trans and bisexual participants that are partly explained by differences in social factors, including experiences of discrimination, lower levels of social support, and systemic exclusion from healthcare. Our findings suggest that the mental health system in Ontario is not currently meeting the needs of many sexual and gender minority people.
authors.affiliation: 1 Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto , Toronto, Canada .
authors.forename: Leah S
authors.initials: LS
authors.lastname: Steele
authors.affiliation: 2 School of Social Work, York University , School of Social Work, Toronto, Canada .
authors.forename: Andrea
authors.initials: A
authors.lastname: Daley
authors.affiliation: 3 Women's Health In Women's Hands , Toronto, Canada .
authors.forename: Deone
authors.initials: D
authors.lastname: Curling
authors.affiliation: 2 School of Social Work, York University , School of Social Work, Toronto, Canada .
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Gibson
authors.affiliation: 4 Independent Scholar , Toronto, Canada .
authors.forename: Datejie C
authors.initials: DC
authors.lastname: Green
authors.affiliation: 5 Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Canada .
authors.forename: Charmaine C
authors.initials: CC
authors.lastname: Williams
authors.affiliation: 6 Centre for Addiction and Mental Health & Dalla Lana School of Public Health, University of Toronto , Toronto, Canada .
authors.forename: Lori E
authors.initials: LE
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D009864:Ontario; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D012923:Social Class; D011795:Surveys and Questionnaires; D063106:Transgender Persons / Q000523:psychology*; D055815:Young Adult
keywords: depression; gender identity; mental health treatment; sexual orientation; unmet need