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

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.