Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review.
Kristen D Clark, Jaylyn Jewell, Athena D F Sherman and 3 others
PMID 39435958WHAT IT FOUND
LGBTQ+ patients in inpatient psychiatric care reported pervasive stigma from admission to discharge, including misgendering, pathologisation of identity, and unsafe rooming.
Nurses, who provide around-the-clock care, are identified as key to implementing affirming practices and reducing this harm.
Key findings
01Patients experienced structural stigma at admission through noninclusive intake tools that failed to capture sexual orientation or gender identity, leading to misgendering and use of deadnames in records.
02During inpatient stays, patients reported interpersonal stigma including discrimination, victimisation by staff and peers, and silencing of their identities, with some experiencing conversion therapy attempts.
03Discharge planning often failed to address LGBTQ+ specific needs, with patients facing a lack of affirming community resources and being placed in housing or shelters that did not align with their gender identity.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only 14 studies, and five of these were rated as low quality. Sample sizes were generally small, ranging from 1 to 90 participants, with only one study including 633 participants. The literature was limited to English-language publications, potentially excluding relevant international perspectives. Most included studies focused on transgender and gender-diverse individuals, so findings may not fully represent the experiences of cisgender LGBQ+ people. Generalisability is limited due to the small number of studies and the predominance of US and Canadian samples.
Declared interests
The authors declare no conflicts of interest. The work was funded by the National Institute of Nursing Research, the National Center for Complementary and Integrative Health, and the National Institutes of Health.
The easy way to misread this
Do not interpret the pervasive stigma reported in this review as evidence that all inpatient psychiatric care is harmful or that individual nurses are intentionally discriminatory. The findings describe patient perceptions across a small, mostly qualitative body of literature, and some studies reported affirming experiences. The review identifies areas for improvement rather than proving a universal failure of the system.