Integrating Psychiatric Care With Gender-Affirming Primary Care to Meet Transgender, Non-Binary, and Gender Expansive Mental Health Needs: A Pilot Study

Objective: Transgender, non-binary, and gender expansive individuals experience disproportionately high rates of mental health symptomatology and face unique barriers to accessing care (eg, concerns about experiencing non-affirming care). This project aimed to address these demonstrated barriers by integrating gender-affirming psychiatric care within primary care. Methods: We established an embedded gender-affirming psychiatric care clinic within a large, urban, academic family medicine practice. Transgender, non-binary, and gender expansive adults were referred by their primary care provider for psychiatry evaluation and, if appropriate, psychotropic medication management and support connecting to outpatient psychotherapy. Patients (n = 17) completed validated measures of depression, anxiety, and working alliance at pre-treatment, each session, and post-treatment. Primary care providers (n = 6) completed measures of feasibility, acceptability, and appropriateness. We computed descriptive statistics and used Wilcoxon Signed Ranks Tests to explore changes in symptoms from pre- to post-treatment. Results: Patient depression and anxiety symptoms significantly improved from pre- to post-treatment. Patients utilized telehealth more often than in-person appointments. Primary care providers approved of the pilot clinic model and desired expanded offerings, particularly in-house psychotherapy. Conclusions: This pilot study supports the acceptability, feasibility, and preliminary effectiveness of integrating gender-affirming psychiatric care within primary care. Further research that is sufficiently powered to detect effects is needed.