Gender Dysphoria and Social Anxiety: An Exploratory Study in Spain

Minority stress and mental health in European transgender and gender diverse people: A systematic review of quantitative studies

The current study aimed at systematically reviewing evidence on the relationships between gender minority stress and mental health outcomes among European transgender and gender diverse (TGD) individuals. A systematic search was conducted in PsycINFO, PubMED, Scopus, and Google Scholar. It was based on Boolean operators to combine terms related to minority stress, TGD identities, and mental health. Thirty studies were identified as eligible. The results confirmed that gender minority stress factors are significantly related with mental health problems among European TGD individuals. Distal stressors were identified as strongly associated with poorer mental health, with gender-related discrimination emerging as the most documented risk factor. The significant role of proximal stressors was also highlighted, with some mediation analyses detecting an indirect effect on mental health. However, identity concealment appeared unrelated to mental health outcomes. Resilience-promoting factors buffering the impact of stressors were also identified, including self-esteem, pride, transitioning, and social support. Conversely, data on community connectedness as a source of resilience were inconclusive. The studies reviewed have several limitations, including lack of longitudinal designs, sampling bias, variability in measurement methods, and unaccounted ethnic variables. Research and clinical recommendations in this field are reported.

The Adaptation and Validation of the Trans Attitudes and Beliefs Scale to the Spanish Context

This article examines the reliability and validity of the adaptation of the Trans Attitudes and Beliefs Scale (TABS), an instrument capable of detecting transphobic positions, to the Spanish context. A total of 829 psychology students participated in the adaptation procedure. A confirmatory factor analysis was performed to study the fit of the new scale to the factor structure of the original scale (interpersonal comfort, gender identity beliefs, and human value). Convergent validity evidence showed significant correlations and predictive levels with different constructs and sociodemographic variables. The internal consistency of the mean scores was adequate at the global level. The study showed that the TABS is a psychometrically sound instrument for the assessment of attitudes toward trans people, particularly in the context of debates over access to rights and the lack of professional training in disciplines such as psychology.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain

INTRODUCTION

Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown.

OBJECTIVE

Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment.

MATERIAL AND METHODS

We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender.

RESULTS

The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found.

CONCLUSIONS

The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain

INTRODUCTION

Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown.

OBJECTIVE

Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment.

MATERIAL AND METHODS

We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender.

RESULTS

The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found.

CONCLUSIONS

The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Non-HIV chronic disease burden among transgender populations globally: A systematic review and narrative synthesis

Chronic disease is a growing concern for research, policy and clinical care. While the global burden of HIV for transgender populations has been comprehensively covered in recent systematic reviews, the same is not true for the burden of other chronic disease. The objective of this study was to review the literature on non-HIV chronic disease burden for transgender populations worldwide. A systematic review was conducted of Medline, Embase, CINAHL, PsycINFO and LGBT Life bibliographic databases for peer-reviewed scientific studies with non-HIV chronic disease prevalence data for transgender populations published any date up to February 15, 2019 without restriction on country or study design. A total of 93 studies and 665 datapoints were included in this review, comprising 48 distinct chronic disease outcomes in seven groups (cancer, cerebro/cardiovascular conditions, chronic liver and kidney disease, mental health and substance use conditions, metabolic and endocrine disorders, musculoskeletal and brain disorders, respiratory conditions, and unspecified and other conditions). The empirical literature on chronic disease among global transgender populations focuses on mental health morbidity, demonstrating an evidence gap on chronic physical health morbidity, particularly beyond that of sexual health. This review identified important gaps including in age-related conditions, inflammation-related disease and studies designed explicitly to investigate chronic disease burden among transgender populations. There is a need for high quality evidence in this area, including longitudinal population-based studies with appropriate comparison groups, and consistent measurement of both transgender status and chronic conditions.

Development of the Trans and Gender Diverse Social Anxiety Scale

Objectives: We develop and evaluate a Trans and Gender Diverse Social Anxiety Scale (TSAS) suitable for use with trans and gender diverse (TGD) people. Methods: We evaluate the TSAS on a sample of 171 TGD adults (40 transmen, 80 transwomen, and 51 gender nonbinary). We test the TSAS's construct validity against measures of perceived and enacted anti-trans stigma, and in comparison to a generic (i.e., non-TGD-specific) measure of social anxiety, the Liebowitz Social Anxiety Scale (LSAS). Results: Factor analyses reveal a four-factor structure consisting of fear and avoidance of (i) social interactions with familiar people, (ii) public scrutiny, (iii) interactions with organizations, and (iv) interactions with religious people or religious authority. Hierarchical regressions confirm that although symptoms of social anxiety assessed by the TSAS overlap with symptoms of generic social anxiety, responses to the TSAS target social situations specifically related to anti-trans stigma. MANOVAs of TSAS score by TGD gender subgroups also reveal that transmen report more social anxiety than either gender nonbinary TGD people or transwomen. Conclusions: The TSAS is a brief instrument that can be used to measure social anxiety in TGD people in social situations in which anti-trans stigma is commonly encountered.

Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis

The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n = 51) were identified through a systematic search of PsycINFO, MEDLINE, and Embase, supplemented by a search of references of prior reviews on this topic. NSSI prevalence rates were quite elevated among sexual (29.68% lifetime) and gender (46.65% lifetime) minority individuals compared to heterosexual and/or cisgender peers (14.57% lifetime), with transgender (46.65% lifetime) and bisexual (41.47% lifetime) individuals being at greatest risk. Even among these group findings, sexual minority youth emerged as an especially vulnerable population. Moreover, current evidence suggests these rates and differences between LGBT and heterosexual and/or cisgender peers have not declined over time. These findings may in some measure be due to the existence of LGBT-specific risk correlates combined with general risk correlates being more severe among sexual and gender minority populations. Additional research, particularly employing a longitudinal design, is needed in this area to advance efforts to reduce risk for NSSI among sexual and gender minority individuals.

Rural living environment predicts social anxiety in transgender and gender nonconforming individuals across Canada and the United States

Transgender and gender nonconforming (TGNC) individuals frequently confront discrimination, rejection, and violence. Such experiences may put TGNC individuals at risk for minority stress and associated psychiatric symptoms. Protective factors like social support, pride in one's gender identity, or connectedness to similar others may make TGNC individuals less vulnerable to psychiatric symptoms, and the presence of risk and protective factors may vary depending on living environment. This study examined the relationship of living environment (urban vs. suburban vs. small-town/rural) to social anxiety (SA) in a sample of 902 TGNC individuals who participated in the Trans Health Survey. Analysis of variance revealed a significant difference in SA across living environments. Those living in small-town/rural environments reported significantly higher levels of SA compared to those living in urban environments. There was a trend-level difference in SA in suburban compared to urban environments. Linear regression analyses revealed that living environment significantly moderated the relationship between social support and SA. Higher social support was more protective against elevated SA in urban and suburban than in small-town/rural environments. This study is the first to demonstrate the experience of elevated SA among TGNC individuals living in rural environments. Implications and future directions for research are discussed.

A Review of Evidence Based Treatments for Transgender Youth Diagnosed with Social Anxiety Disorder

In addition to the high prevalence of gender dysphoria among transgender youth, this population is at greater risk of suffering from additional mental health disorders, including social anxiety disorder, compared to their cisgender peers. Cognitive behavioral therapy (CBT) has been established as an effective form of treatment for social anxiety disorder. It is recommended that therapists modify and adapt CBT when working with minority groups such as transgender youth to ensure that the treatment is efficacious and culturally sensitive. However, literature assessing the efficacy of CBT for transgender youth with mental health issues is scant. As a result, there is no empirical literature on effective treatment for transgender youth who meet criteria for social anxiety disorder alone or youth who meet criteria for social anxiety disorder and gender dysphoria. This literature review aims to identify current research related to prevalence of mental health disorders in transgender youth, the current literature on adaptations of cognitive behavioral techniques, and the need for treatment research on adaptation of CBT for transgender individuals, specifically those with social anxiety disorder and gender dysphoria.