Recovery-Oriented Education: The Impact of Visiting a Clubhouse on Psychiatry Residents.

Transgender and gender-diverse (TGD) people experience substantial mental health inequities relative to cisgender people due to discrimination and stigma toward their gender identity, leading to higher risk of depression and anxiety, with prevalence of depression reported as high as 81% and anxiety as high as 62%. The disproportionately high burden of mental health conditions among TGD people in comparison to cisgender people is widely understood through the minority stress theory, where TGD people are subject to both distal (e.g. anti-TGD rejection and targeted legislation) and proximal (e.g. anticipated stigma against TGD people) stressors compounded with general every day stressors that lead to increased psychological distress. TGD people who experience gender-based discrimination, are younger than 25, and diagnosed with depression are at an increased risk of suicidality and have a prevalence of past-year suicide ideation that is eighteen times higher than the general United States (US) population. Given the current rise in mental health conditions among the general US population, thorough research on psychiatric conditions and effective strategies for treatment and management of these conditions are urgently needed. A systematic review by Scheim et al., which characterizes disease burdens and correlates among TGD people globally, advocated for the critical need to identify individual and structural determinants of health, citing such research as an important way to develop evidence-based interventions to reduce morbidity and mortality among TGD people. One intervention relevant to the mental health of TGD people is the appropriate use of pharmacological treatments. The American Psychological Association (APA) Clinical Practice Guidelines recommend antidepressants as first-line pharmacological treatment for depression. The guidelines recommend at least 6–12 weeks of treatment with antidepressants to induce remission (the acute phase), followed by an additional 4–9 months (continuation phase) of maintenance treatment that may continue in order to prevent recurrence of symptoms. Measures of psychiatric medication dispensing are a crucial component of treatment management for people with major psychiatric disorders, as they are key indicators of effective management of chronic diseases. One study using the Swedish Total Population Register linked with dispensing data found that after adjusting for sociodemographic factors, the prevalence of antidepressant use among TGD people was more than three times higher than the general Swedish population (aOR 3.95; 95% CI 3.62, 4.31). However, shorter-term medication dispensing fills ( referred to in past literature as non-adherence) is a common phenomenon. Non-adherence is defined by the World Health Organization (WHO) as a person’s medication taking behavior that does not correspond with recommendations from their health care provider. We move away from the term “adherence” to center patient-centered language, as “adherence” suggests a patient is at fault for not taking their medication while also dichotomizing medication taking as either taking the medication or not. It is essential to understand the larger (institutional and societal) factors that support or prevent medication dispensing to reduce the stigmatization that is placed on the individual.