Mental health of transgender people in prison: a systematic review and meta-analysis

Abstract

This systematic review aims to explore the condition of Transgender Inmates (TGI) in correctional facilities (CF), focusing on their mental health, their access to Gender-affirming Treatments (GAT), and their placement within the CF. Medline, Embase, Scopus, PsychInfo, and CINAHL were searched for studies on TGI in CF. Pooled Odds Ratios (ORs) with 95% confidence interval (95%CI) were estimated through inverse variance models with random-effects. A narrative synthesis of each study’s findings was also performed since only a few studies included a control group. Thirteen studies were selected and four considered in the meta-analysis, corresponding to 1,255 TGI and 174,314 controls. Although limited by the small number of studies, the meta-analysis showed that TGI have a higher risk of depression, post-traumatic stress disorder, and suicide attempts during detention than the controls (OR = 3.07, 95% CI = 1.33–7.06; OR = 2.23, 95% CI = 1.46–3.43; OR = 2.25, 95% CI = 1.46–3.49, respectively). Limited access to GAT and housing based on sex assigned at birth rather than gender identity were additional challenges for TGI, threatening their safety and self-affirmation. Our findings highlight the critical role of incarceration as a social determinant of health for TGI. A comprehensive policy reform and staff education should be promoted to foster inclusive and supportive correctional environments and improve safety and health of TGI.

Keywords:

• Transgender people
• inmates
• correctional facilities
• sexual and gender minority
• mental health
• gender-affirming treatment

Disclosure statement

The authors report there are no competing interests to declare.

Statement of ethics

This systematic review is exempt from ethics approval because we are collecting and synthesizing data from previous studies in which ethical approval has already been obtained by the trial investigators in their respective local sites.

Data availability statement

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.