Physician Follow-up Among Transgender and Gender Diverse Individuals after Psychiatric Emergency Department Visits and Hospitalizations: A Retrospective Population-Based Cohort Study

Purpose: The study compared physician-based outpatient mental health care follow-up between transgender and gender diverse (TGD) individuals and the general population who had a mental health-related emergency department (ED) visit or hospitalization. Methods: This retrospective population-based cohort study used linked health administrative data to examine all adult psychiatric patients discharged from an ED visit (ED cohort) or hospitalization (hospitalization cohort) between 2012 and 2018 in Ontario, Canada. TGD individuals were identified and their data linked with health administrative data. The primary outcome was the proportion of individuals with any outpatient physician visit for mental health reasons within 30 days of the index discharge. Multivariable logistic regression analyses examined follow-up outcomes, including by diagnostic category, with adjustment for sociodemographic and clinical factors. Results: There were 728 TGD and 581,708 general population individuals with a mental health-related ED visit, while 454 TGD and 217,507 general population individuals had a psychiatric hospitalization. TGD individuals had higher 30-day post-ED follow-up (adjusted risk ratio [aRR] =1.21; 95% confidence interval [CI]: 1.02–1.42), particularly with a psychiatrist (aRR = 1.27; 95% CI: 1.07–1.52) and for those with an anxiety and related disorder diagnosis (aRR = 1.63; 95% CI: 1.23–2.15). Meanwhile, TGD individuals had lower 30-day follow-up posthospitalization (aRR = 0.80; 95% CI: 0.66–0.98) after adjusting for covariates. Conclusions: TGD individuals have greater rates of post-ED mental health follow-up, particularly with a psychiatrist, but lower rates of follow-up after a hospitalization. The higher follow-up after ED visits likely reflects greater clinical need. Lower follow-up after hospitalization is concerning given the risk of adverse outcomes and requires further research.