Sexual Identity and Heavy Drinking Among Adults in Canada by Racially Minoritized Status and Income, 2015-2020.

Purpose: Our objective was to estimate inequities in heavy drinking between heterosexual, gay or lesbian, and bisexual or pansexual individuals, by sex/gender, and to determine whether this association is heterogeneous across racially minoritized status and income groups in Canadians aged 15 and older. Methods: We pooled three Canadian Community Health Survey cycles (2015-2020) and used separate modified Poisson regressions to explore the sex/gender-specific association between sexual identity and heavy drinking prevalence by racially minoritized status, and income, adjusted for survey cycle, age, marital status, and region. Results: With racially minoritized status, and income categories collapsed, heavy drinking was 1.3 times higher (95% confidence interval [CI] = 1.0-1.7) among bisexual or pansexual women compared with heterosexual women, with no differences among men. Among racially minoritized women, heavy drinking was 2.9 (95% CI = 1.3-6.4) times higher among bisexual or pansexual women and 1.9 (95% CI = 0.7-5.2) times higher among gay or lesbian women compared with heterosexual women. Among racially minoritized men, heavy drinking was 1.9 (95% CI = 0.9-4.0) times higher among gay men compared with heterosexual men. No differences were observed across sexual identity in White men or women. Bisexual or pansexual women reported increased heavy drinking relative to heterosexual women across income quintiles. Conclusion: Heavy drinking is distributed heterogeneously across sexual identity, sex/gender, racially minoritized status, and income. These results encourage equity-focused interventions to reduce heavy drinking among intersecting sociodemographic groups experiencing a greater burden of heavy drinking.

The Concealment of Health Information at the Intersection of Sexual Orientation and Race.

Purpose: Sexually and racially minoritized people often have mistrust toward the healthcare system due to both perceived and actual experiences of discrimination. This may result in increased privacy concerns and a reluctance to share health-related information with health care providers. Drawing upon minority stress and an intersectionality framework, this study examines how rates of concealing health information differ between non-Hispanic White heterosexual people, non-Hispanic White lesbian, gay, and bisexual (LGB) people, racially minoritized heterosexual people, and those who are both sexually and racially minoritized. Methods: Using nationally representative cross-sectional data from the Health Information National Trends Survey from 2017 and 2018 (n = 4575), we fit logistic regression models to examine (1) whether sexually and racially minoritized people conceal health information from their providers more than their counterparts and (2) whether this tendency increases for those with multiple marginalized identities. Furthermore, we fit linear regression models to examine whether and how concealing health information from providers are linked to health outcomes. Results: Sexually and racially minoritized people had higher odds of concealing health information from providers than their counterparts. Those with multiple marginalized identities had even higher odds of withholding health information than other groups. Finally, we found a significant negative association between concealing health information and mental health. Conclusion: Our findings underscore the need to consider how the intersection of multiple marginalized identities shape health experiences and concerns over privacy in health care matters. We call for further research to better understand the complex dynamics of patient-provider relationships for marginalized populations.

"Where Are You From?"-on Separation, Belonging and Imposter Syndrome as an International Medical Graduate.

Minoritized international medical graduates (IMGs) in American graduate medical education (GME) programs face a disproportionately higher number of intersectional micro- and macroaggressions. In order to create a healthier, more equitable learning environment, GME programs must make greater efforts to understand intersectionality, provide IMG trainees with additional support systems, incorporate effective bystander training, and celebrate and acknowledge the contributions of their minoritized IMG trainees.

Mapping intersectional sociodemographic inequalities in measurement and prevalence of depressive symptoms: A Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA) using data from a population based nationwide survey in Germany.

OBJECTIVE: Understanding how social categories like gender, migration background, LGBT status (lesbian/gay/bisexual/transgender), education and their intersections affect health outcomes is crucial. Challenges include avoiding stereotypes and fairly assessing health outcomes. This paper aims to demonstrate how to analyse these aspects. STUDY DESIGN AND SETTING: The study used data from N=19,994 respondents from the German Socio-Economic Panel (SOEP) 2021 data collection. Variations between and within intersectional social categories regarding depressive symptoms and self-reported depression diagnosis were analyzed. We employed Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA) to assess the impact of gender, LGBT status, migration, education and their interconnectedness. A Configuration-Frequency Analysis (CFA) assessed typicality of intersections. Differential Item Functioning (DIF) analysis was conducted to check for biases in questionnaire items. RESULTS: I-MAIHDA analysis revealed significant interactions between these categories for depressive symptoms and depression diagnosis. The CFA showed that certain combinations of social categories occurred less frequently compared to their expected distribution. The DIF analysis showed no significant bias in a depression short scale across social categories. CONCLUSION: Results reveal interconnectedness between the social categories, affecting depressive symptoms and depression probabilities. More privileged groups had significant protective effects while those with less societal privileges showed significant hazardous effects. Although statistical significance was found in interactions between categories, the variance within categories outweighs that between them, cautioning against individual-level conclusions.

Intersectional inequalities in health anxiety: multilevel analysis of individual heterogeneity and discriminatory accuracy in the SOMA.SOC study.

Background: Intersectional approaches are needed to disaggregate the complex interaction of social identities contributing to (mental) health disparities. Health anxiety represents an overlooked public mental health issue. Therefore, intersectional inequalities in health anxiety were examined using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Methods: Analyses are based on cross-sectional data of the adult population living in Germany (N = 2,413). Health anxiety was assessed with the Whiteley Index-7. Applying intersectional MAIHDA, health anxiety in the intersectional strata of gender, history of migration, and income was predicted. Discriminatory accuracy was assessed via the intra-class correlation and the proportional change in variance. Results: Analyses revealed additive social inequalities in health anxiety with greatest impact of low income but no clear intersectional gradient. Most affected by health anxiety were females who immigrated themselves with low income, males whose parent(s) immigrated with low income, and males who immigrated themselves with medium income. Conclusion: Intersectional approaches contribute to a more comprehensive understanding of (mental) health disparities. In addition to general efforts to counteract health inequalities, combining universal screening and targeted psychotherapeutic treatment seems promising to specifically reduce inequalities in health anxiety.

Multiple chronic diseases and psychological distress among adults in the United States: the intersectionality of chronic diseases, race/ethnicity, immigration, sex, and insurance coverage.

PURPOSE: Psychological distress significantly contributes to the burdens of morbidity and mortality in the United States (U.S.), but our understanding is limited with regards to the risk factors associated with psychological distress. We used nationally representative data to examine (1) the comorbidities of chronic diseases and their risks for psychological distress and (2) the ways in which chronic diseases combine with demographic factors such as sex, race/ethnicity, immigration status, and health insurance coverage to affect the patterning of psychological distress. METHODS: We analyzed the 2005-2018 National Health Survey Interview cross-sectional data on U.S. adults aged ≥ 18 years (n = 351,457). We fitted sequential multivariable logistic regression models. RESULTS: There was a dose-response relationship between the number of chronic diseases and psychological distress, with increased number of chronic diseases associated with increased psychological distress risk. Females (vs. males) and those without health insurance (vs. insured) were more likely to experience psychological distress. Immigrants (vs. non-immigrants) and racial/ethnic minorities (vs. White individuals) were less likely to experience psychological distress. There were significant interactions between chronic diseases and insurance coverage, immigration status, and race/ethnicity, but the three-way interactions were not statistically significant with psychological distress: chronic disease status vs. immigration status vs. health insurance coverage, and chronic disease vs. race/ethnicity vs. immigration status. CONCLUSION: The findings suggest a critical need to consider the complex ways in which chronic diseases and psychosocial factors combine to affect psychological distress and their implications for tailoring mental health screening, initiatives to reduce distress, and prevention strategies for effectively addressing health-related disparities in the general population.

Immigrant and Racialized Populations' Cumulative Exposure to Discrimination and Associations with Long-Term Conditions During COVID-19: A Nationwide Large-Scale Study in Canada.

BACKGROUND: This cross-sectional study examines associations between the race-migration nexus, cumulative exposure to intersectional discrimination (2 years before and during the COVID-19 pandemic), and long-term conditions. METHODS: A nationwide self-selected sample (n = 32,605) was obtained from a Statistics Canada's Crowdsourcing online survey from August 4 to 24, 2020. Binary and multinomial logistic regression models were used to examine disparities by the race-migration nexus in accumulative experiences of multiple situations- and identity-based discrimination and their relations with long-term conditions, after controlling for sociodemographic covariates. RESULTS: During the pandemic, discrimination stemming from racialization - such as race/skin color (24.4% vs 20.1%) and ethnicity/culture (18.5% vs 16.5%) - and cyberspace (34.1% vs 29.8%) exaggerated relative to pre-pandemic period; compared to Canadian-born (CB) whites, the likelihood of experiencing multiple discrimination increased alongside the domains of discrimination being additively intersected (e.g., identity-based, all p's < 0.001) among CB racialized minorities (ORs 2.08 to 11.78), foreign-born (FB) racialized minorities (ORs 1.99 to 12.72), and Indigenous populations (ORs 1.62 to 8.17), except for FB whites (p > 0.01); dose-response relationships were found between cumulative exposure to multiple discrimination and odds of reporting long-term conditions (p's < 0.001), including seeing (ORs 1.63 to 2.99), hearing (ORs 1.83 to 4.45), physical (ORs 1.66 to 3.87), cognitive (ORs 1.81 to 3.79), and mental health-related impairments (ORs 1.82 to 3.41). CONCLUSIONS: Despite a universal health system, Canadians who are CB/FB racialized and Indigenous populations, have a higher prevalence of cumulative exposure to different aspects of discrimination that are associated with multiple long-term conditions during the COVID-19 pandemic. Equity-driven solutions are needed to tackle upstream determinants of health inequalities through uprooting intersectional discrimination faced by racialized and immigrant communities.

Intersectionality and Gender-Based Violence: An Empirical Multi-Level Examination of Prevalence and Frequency in Universities and Research Organizations.

This article provides a multilevel intersectional analysis of the prevalence and frequency of gender-based violence within universities and other research organizations in Europe. Results show not only the high prevalence of gender-based violence in this context, but also that in contrast to the prevailing discourse, that gender-based violence is not solely a "women's problem", but also a structural issue impacting diverse identities. Data on frequency show that physical and sexual violence usually occurs as isolated incidents, whereas psychological violence and harassment are often repeated.

Parkinson's Disease Inequities in Daily Cognitive Activities: An Intersectional Approach.

Objective: Intersectionality approaches to examining differences in Parkinson's disease (PD) based on racialized group, gender identity, and socioeconomic status (SES) are not well covered in the literature. Additionally, the differences in daily cognitive activities for persons diagnosed with PD by racialized group, gender, and SES are undetermined. This study was conducted to explore the differences in PD daily cognitive activities for diverse racialized groups by gender and SES. Methods: This study was a secondary analysis of the Michael J. Fox Foundation's Fox Insight online clinical dataset. Persons with PD were partitioned into 16 racialized by gender groups (Black women, Indigenous men, Latina/x women, Asian men, etc.) that were used in within-group comparisons of low-, middle-, and high-SES-a new variable comprising education and income. Results: Intersectional analyses revealed most items differed between low-SES and high-SES except for items associated with Black and Indigenous men, for whom significant differential item functioning was found between mid-SES and high-SES. Conclusions: These findings revealed that within-group differences exist and may be missed in research in which social factors are adjusted for instead of included in the model.

Transgender Health Dilemmas: An Intersectional Analysis of the Therapeutic Itineraries of Transgender Communities in the Philippines.

This study leverages an intersectional lens to characterize the therapeutic itineraries of local transgender (trans) communities vis-à-vis salient cisnormative and capitalist structures in Philippine society that produce trans health inequities. Interpretative phenomenological analysis of online interviews with thirteen (13) self-identified trans Filipinos reveals how the inaccessibility of trans-responsive care in the Philippines fosters trans health dilemmas, or the dilemmatic decision-making circumstances and processes that force trans Filipinos to choose between their trans-specific health needs and other needs. Such dilemmas valorize the deprioritization of trans health, disengagement with the health system, and the pursuit of alternative pathways to care oftentimes at the expense of their overall well-being. Addressing these dilemmas entails research, policy, and advocacy work that contend with the implicated structures of domination through systemic interventions initiated in partnership with local trans communities.

What Does It Mean to Be White in Veterinary Medicine?

Race is a pseudo-scientific system that was invented to sort people by skin color into different categories. Race has no biologic basis, meaning the phenotype of skin color cannot accurately separate humans into distinct categories. Contemporary Western veterinary medicine was founded by white European men to treat livestock and working horses; 150+ years later, the majority of veterinary graduates are white women working on domesticated family pets. The history of veterinary medicine informs our current reality.

Analysis of Faculty Gender and Race in Scholarly Achievements in Academic Neurology.

Background: Intersection of gender and race and/or ethnicity in academic medicine is understudied; we aim to understand these factors in relation to scholarly achievements for neurology faculty. Methods: Faculty from 19 US neurology departments completed a survey (2021-2022) to report rank, leadership positions, publications, funded projects, awards, and speaker invitations. Regression analyses examined effects of gender, race, and their intersectionality on these achievements. Women, Black/Indigenous/People of Color (BIPOC), and BIPOC women were comparator groups. Results: Four hundred sixty-two faculty responded: 55% women, 43% men; 31% BIPOC, 63% White; 21% BIPOC women, 12% BIPOC men, 36% White women, 31% White men. Men and White faculty are more likely to be full professors than women and BIPOC faculty. The number of leadership positions, funded projects, awards, and speaker invitations are significantly greater in White compared to BIPOC faculty. Relative to BIPOC women, the number of leadership positions is significantly higher among BIPOC men, White women, and White men. Publication numbers for BIPOC men are lower, number of funded projects and speaker invitations for White women are higher, and number of awards among White men and White women is higher compared to BIPOC women. Discussion: Our study highlights that inequities in academic rank, award number, funded projects, speakership invitations, and leadership roles disproportionately impacted BIPOC women. More studies are needed to evaluate gender and race and/or ethnicity intersectionality effects on faculty achievements, reasons for inequities, recognition, and potential solutions.

Gender and race in radiology: An intersectional analysis of the American Association of Medical Colleges (AAMC) database from 1966 to 2021.

PURPOSE: To describe trends in gender and racial representation within academic radiology in the United States over a 55-year period from 1966 to 2021. METHODS: A retrospective analysis of the American Association of Medical Colleges database of radiology faculty members from 1966 to 2021 was conducted. Trends in academic rank and tenure status for five different ethnoracial groups (White, Asian, Black, Hispanic, and Native American) each subdivided into two gender identities (men and women) were analyzed. The proportional change over time of each demographic group per outcome was analyzed with linear regression models. RESULTS: Between 1966 and 2021, White men comprised the largest demographic in academic radiology each year. A significant decrease in both White individuals (-0.51 % per year) and men (-0.30 % per year) were observed over the study period. Additionally, the only demographic groups with meaningful changes in representation were White women (+0.20 % per year) and Asian men (+0.23 % per year), followed by Asian women in later years. Underrepresented minority groups (Black, Hispanic and Native American) collectively comprised less than 5 % of all academic radiologists. Finally, within each demographic group, the representation of women consistently lagged behind men. Despite these relative increases, in 2021, the majority of US academic radiologists were White (59.1 %) and male (70.1 %). CONCLUSION: Historically underrepresented minorities, especially women within these groups, continue to face discrimination and are consistently the least represented in radiology. Initiatives that incorporate the intersectionality framework are imperative to break this cycle.

"I didn't come here for your judgement" alongside "they understand you and encourage you": Exploring the narratives of young black and mixed-race LGBTQ+ people who have a physical health condition and their experiences within physical health services.

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals experience health inequalities. Young people living with a health condition are also more likely to experience adverse mental health outcomes. Developing positive identity can help to mitigate the impact of this. Young black LGBTQ+ people have additional barriers to developing positive identity. Current research rarely considers the intersection of these identities for young people despite the discrimination they may face, and the impact this may have on their health. A narrative approach allows these voices to be heard in research. Eight participants were interviewed using a narrative approach. Interviews were analysed using content and thematic narrative analysis. Global summaries of each interview were developed and 'plot lines' emerged from these. A central plot related to identity development, with two plots embedded in these exploring experiences of illness and of healthcare. Participants had positive experiences of healthcare despite encountering stigma. Access to positive role models and being able link in with various communities allowed participants to integrate and accept their identities. A key discussion point in this study is the ways in which healthcare staff could become role models for young LGBTQ+ people and help them to integrate and accept their identities.

Young LGBTQ+ people can experience discrimination which can impact on their health, including preexisting health conditions. Having a positive identity can help young people to be more resilient in the face of these difficulties. Current research has rarely given young black and mixed-race LGBTQ+ people with a physical health condition an opportunity to share their stories and explore their identity. Eight young people were interviewed using a narrative approach, which allowed them an opportunity to tell their whole life story. Shared plot lines emerged from the young people's life stories about identity development, experience of illness, and experiences of healthcare. The young people had all had positive experiences of healthcare staff as well as some negative experiences of discrimination. It was important to the young people to have positive role models who supported their identity and access to supportive communities. This study suggests that healthcare staff could be suited to become positive role models for the young people they care for.

Racial discrimination and mental health in the context of anti-Asian xenophobia: An intersecting approach of race, ethnicity, nativity, and socioeconomic status.

The COVID-19 pandemic, polarized politics, and heightened stigma and discrimination are salient drivers for negative mental health outcomes, particularly among marginalized racial and ethnic minoritized groups. Intersectionality of race, ethnicity, foreign-born status, and educational attainment may distinctively shape an individual's experience of discrimination and mental health during such unprecedented time. The present study examines the differential associations of racial discrimination and mental health based on an individual's race, ethnicity, foreign-born status, and educational attainment during the COVID-19 pandemic. Analyses were based on a nationally representative sample of U.S. adults collected between October and November 2021 (n = 6276). We utilized multivariable linear regressions to identify the multiplicative effects of race, ethnic, foreign-born status and self-reported racial discrimination on mental health, stratified by educational attainment. Among individuals with lower educational attainment, associations between racial discrimination and poor mental health were stronger among Asians (US-born: ß = -2.07, p = 0.03; foreign-born: ß = -3.18, p = 0.02) and US-born multiracial individuals (ß = -1.96, p = 0.02) than their White counterparts. Among individuals with higher educational attainment, foreign-born Hispanics (ß = -3.66, p < 0.001) and US-born Asians (ß = -2.07, p = 0.01) reported worst mental health when exposed to racial discrimination out of all other racial, ethnic and foreign-born groups. Our results suggest that association of racial discrimination and mental health varies across racial, ethnic, foreign-born, and education subgroups. Using an intersectional approach to address the widening inequities in racial discrimination and mental health during the COVID-19 pandemic contextualizes unique experience of discrimination and provides crucial insight on the patterns of mental health among marginalized groups.

Systemic biases promoting the under-inclusion of marginalized groups in randomized controlled trials for co-occurring alcohol use and posttraumatic stress disorder: an intersectional analysis.

Co-occurring posttraumatic stress disorder and alcohol use disorder is a major public health concern affecting millions of people. Although this disorder affects people from all groups, research shows that, when compared to White people, people of color systematically suffer worse chronicity and burden of disorder. Additionally, research shows that people of color endure a variety of barriers to accessing treatment and often require specialized or culturally appropriate care. Consequently, the array of treatments available must have been determined to be effective for people of color when they access treatment, and people of color must be well represented in research to ensure effective treatment. Therefore, randomized controlled trials testing treatments for this disorder must include racially diverse samples and ensure treatments are effective for all groups. Further, if they lack diversity, it is necessary to explore whether and how the process of conducting randomized controlled trials is biased toward the constrained inclusion of people of color. This study used a Matrix of Domination framework as an intersectional method to investigate this question. It assessed the inclusion of people by race and sex in randomized controlled trials for co-occurring posttraumatic stress disorder and alcohol use disorder. We found that people of color and White women are significantly underincluded in randomized controlled trials and that these studies are hegemonically, disciplinarily, and structurally biased in ways that facilitate the overrepresentation of White men and the underrepresentation of marginalized groups.

Women's rugby for all: Toward an intersectional women's rugby research agenda.

Women rugby players are participating in the sport at the highest levels to date. However, despite this increase in participation, sports sciences and sports medicine/sports physiotherapy (SEMS) research output has not mirrored this increase. Females have hormonally mediated anatomical and physiological profiles, which may have implications for rugby performance, injury risk and rehabilitation outcomes. However, hormonal fluctuations and the physiological differences between the sexes are not the only contributors to sex-related differences in the rugby experience. Rugby is a highly gendered environment, which operates within a hegemonic masculine norm and marginalises female and women athletes. Further, while women players in general are underrepresented in sports sciences and SEMS research, women rugby players and experts from ethnic minorities and the Global South are near invisible in the literature as they are marginalised on multiple fronts. Sports sciences and SEMS research should take an intersectional lens to investigate the joint relationship between the various sources of inequity in rugby. Intersectional research in women rugby players would encourage the conceptualisation and analysis of the complex social inequalities that the most marginalised women players and those who simultaneously negotiate multiple identities experience. Such data can better inform federation-level interventions and policy changes to address the needs of historically marginalised player populations as our research portfolio will be more representative of the world's rugby population.

Opioid Dose Reductions by Sex and Race in a Cohort of Patients in a Family Medicine Clinic.

BACKGROUND: The 2022 Centers for Disease Control's "Clinical Practice Guidelines for Prescribing Opioids for Pain in United States" called for attention and action toward reducing disparities in untreated and undertreated pain among Black and Latino patients. There is growing evidence for controlled substance safety committees (CSSC) to change prescribing culture, but few have been examined through the lens of health equity. We examined the impact of a primary care CSSC on opioid prescribing, including by patients' race and sex. METHODS: We conducted a retrospective cohort study. Our primary outcome was a change in prescribed morphine milligram equivalents (MME) at baseline (2017) and follow-up (2021). We compared the differences in MME by race and sex. We also examined potential intersectional disparities. We used paired t test to compare changes in mean MME's and logistic regression to determine associations between patient characteristics and MME changes. RESULTS: Our cohort included 93 patients. The mean opioid dose decreased from nearly 200 MME to 136.1 MME, P < .0001. Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. Black women were prescribed 88.5 fewer MME's at baseline compared with their White men counterparts, P = .04. DISCUSSION: Our findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.

Depression disparities among sexual minority faculty of color in the United States.

This study aimed to examine potential differences in depression symptoms between sexual minority (SM) and heterosexual faculty of color (FOC). A United States (U.S.) national survey of early and mid-career faculty experiences was undertaken. A total of N = 676 participants were screened, with a total usable sample size of N = 596 (n = 80 surveys were missing sexual orientation information). Participants were U.S. born and self-identified as African American/Black, Mexican, Puerto Rican, Native American/American Indian, or other Hispanic, and held a tenure-track assistant or associate professor position at a research university. Participants were identified through network sampling techniques, such as use of academic listservs, personal contacts, respondent referrals, and university websites. The study aim was examined using multiple linear regression. In multivariable analysis, SM FOC were more likely to suffer from greater depression symptoms compared to heterosexual FOC (HFOC). Significant covariates included perceived career impact of inadequate mentoring, individual annual income, and home ownership. Study findings signify mental health threat among SM FOC compared to HFOC. There's an urgent public health need for future research to identify the underlying mechanisms driving mental health among SM FOC to inform the development of prevention programs that can mitigate these disparities, especially in higher education settings. Lastly, findings suggest a need for critical examination of mental health, socioeconomic, and mentoring resources for SM FOC in higher education institutions.

Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis.

OBJECTIVE: Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care. METHODS: The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989-December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed. RESULTS: Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices. CONCLUSIONS: Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training.