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Zhang H, Colonnello E, Wang F, Jannini EA. Gender Dysphoria and Transgender Care in Mainland China. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:857-858. [PMID: 36943554 DOI: 10.1007/s10508-023-02583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Hui Zhang
- Department of Systems Medicine, University of Rome Tor Vergata, Via Cracovia, 50, 00133, Rome, Italy
| | - Elena Colonnello
- Department of Systems Medicine, University of Rome Tor Vergata, Via Cracovia, 50, 00133, Rome, Italy
| | - Fu Wang
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Emmanuele A Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Via Cracovia, 50, 00133, Rome, Italy.
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2
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Liu Y, Wang R, Chang R, Wang H, Xu L, Xu C, Yu X, Liu S, Chen H, Chen Y, Jin L, Wang Y, Cai Y. Perceived Burdensomeness, Thwarted Belongingness, and Social Exclusion in Transgender Women: Psychometric Properties of the Interpersonal Needs Questionnaire. Front Psychol 2022; 13:787809. [PMID: 35222188 PMCID: PMC8868044 DOI: 10.3389/fpsyg.2022.787809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Transgender women (TGW) experience serious psychiatric problems and high suicide rates. According to the interpersonal theory of suicide, thwarted belongingness and perceived burdensomeness play major roles in suicidality and can be measured by the Interpersonal Needs Questionnaire (INQ). However, no study has validated the use of the INQ in TGW. This study aimed to examine the psychometric properties of the INQ among TGW. We recruited 198 TGW (mean age 38.47 years) from Shenyang, China, using snowball sampling. The construct validity of the INQ was assessed through factor analysis, and convergent and divergent validity were examined through a structural equation model with other psychosocial factors. The construct validation analysis supported a three-factor model (perceived burdensomeness, thwarted belongingness, and social exclusion) with satisfactory fit indices: χ2/df = 1.54, RMSEA = 0.052, CFI = 0.931, TLI = 0.916, SRMR = 0.053. The thwarted belongingness was significantly associated with self-esteem and social support, and the social exclusion was significantly associated with loneliness, depression, entrapment, and defeat, suggesting satisfactory convergent and divergent validity for the three-factor model. The present findings indicate that for TGW, high social exclusion is important in assessing perceived interpersonal needs, while the notable deviation from previous two-factor model warrants further study.
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Affiliation(s)
- Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huwen Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong, China
| | - Lulu Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyue Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingjie Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lian Jin
- Ban Song Yuan Road Community Health Service Centre, Shanghai, China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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3
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The mental health of transgender and gender non-conforming people in China: a systematic review. Lancet Public Health 2021; 6:e954-e969. [DOI: 10.1016/s2468-2667(21)00236-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
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Sha Y, Dong W, Tang W, Zheng L, Huang X, Muessig KE, Tucker JD. Gender minority stress and access to health care services among transgender women and transfeminine people: results from a cross-sectional study in China. BMC Infect Dis 2021; 21:1065. [PMID: 34649507 PMCID: PMC8514805 DOI: 10.1186/s12879-021-06782-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Transgender and gender diverse individuals often face structural barriers to health care because of their gender minority status. The aim of this study was to examine the association between gender minority stress and access to specific health care services among transgender women and transfeminine people in China. Methods This multicenter cross-sectional study recruited participants between January 1st and June 30th 2020. Eligible participants were 18 years or older, assigned male at birth, not currently identifying as male, and living in China. Gender minority stress was measured using 45 items adapted from validated subscales. We examined access to health care services and interventions relevant to transgender and gender diverse people, including gender affirming interventions (hormones, surgeries), human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) testing, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Multivariable regression was used to measure correlations between gender minority stress and access to health care service. Results Three hundred and twenty-four people completed a survey and data from 277 (85.5%) people were analyzed. The mean age was 29 years old (standard deviation [SD] = 8). Participants used hormones (118/277, 42.6%), gender affirming surgery (26/277, 9.4%), HIV testing (220/277, 79.4%), STI testing (132/277, 47.7%), PrEP (24/276, 8.7%), and PEP (29/267, 10.9%). Using gender affirming hormones was associated with higher levels of discrimination (adjusted odds ratio [aOR] 1.41, 95% confidence interval [CI] 1.17–1.70) and internalized transphobia (aOR 1.06, 95%CI 1.00–1.12). STI testing was associated with lower levels of internalized transphobia (aOR 0.91, 95%CI 0.84–0.98). Conclusions Our data suggest that gender minority stress is closely related to using health services. Stigma reduction interventions and gender-affirming medical support are needed to improve transgender health. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06782-5.
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Affiliation(s)
- Yongjie Sha
- University of North Carolina Project - China, 7 Lujing Road, Guangzhou, 510091, Guangdong, China
| | - Willa Dong
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weiming Tang
- University of North Carolina Project - China, 7 Lujing Road, Guangzhou, 510091, Guangdong, China. .,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lingling Zheng
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xi Huang
- Trans Well-being Team, Guangzhou, China
| | - Kathryn E Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- University of North Carolina Project - China, 7 Lujing Road, Guangzhou, 510091, Guangdong, China. .,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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Wu Q, Ji Y, Lin X, Yang H, Chi P. Gender congruence and mental health problems among Chinese transgender and gender non-conforming individuals: A process model involving rumination and stigma consciousness. J Clin Psychol 2021; 78:622-636. [PMID: 34530497 DOI: 10.1002/jclp.23248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 05/26/2021] [Accepted: 08/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The present study examined the roles of gender identity rumination and stigma consciousness in the relationship between gender congruence (comfort with one's gender identity and external appearance) and mental health problems (anxiety and depression). METHODS Three hundred and fourteen Chinese individuals identified as transgender and gender non-conforming (TGNC) individuals were recruited through the Internet and answered an online questionnaire (Mage = 24.34 years, standard deviation = 5.80). RESULTS Gender congruence was associated with anxiety and depression through three indirect pathways: rumination, stigma consciousness, and sequentially through rumination and stigma consciousness. CONCLUSION Gender congruence is an intrapersonal resource that reduces mental health problems through its positive impacts on the TGNC identity process. A more consistent feeling of gender, a lower level of rumination, and a reduced level of consciousness about stigma could be potential working points for interventions in the TGNC community to help alleviate their mental health problems.
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Affiliation(s)
- Qinglu Wu
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Yuan Ji
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Xiuyun Lin
- Institute of Developmental Psychology, School of Psychology, Beijing Normal University, Beijing, China
| | - Hengyu Yang
- Department of Applied Psychology, School of Psychology and Cognitive Sciences, East China Normal University, Shanghai, China
| | - Peilian Chi
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
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Tsang EYH. A Sisterhood of Hope: How China's Transgender Sex Workers Cope with Intimate Partner Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7959. [PMID: 33138225 PMCID: PMC7672577 DOI: 10.3390/ijerph17217959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
Transgender sex workers (TSWs/TSW) face considerable challenges that affect their mental health and make their situations more vulnerable and precarious. TSWs often experience violence from clients, police, and others, but it is estimated that 50% of these acts of violence are at the hands of their intimate partners. The marginalization of TSWs is fueled by abuse through isolation and shaming which prevents them from seeking help through formal channels like police or counselling services. There is limited research on intimate partner violence (IPV) involving transgender sex workers (biologically male at birth who transition to women) and their partners who are typically heterosexual/bisexual men. In China, stigmatization, homophobia, heterosexism, and transphobia structurally disadvantage TSWs and this power structure tacitly supports violence and abuse against them. To survive, TSWs rely on informal networks with their 'sisters' for advice and emotional support which is more effective at combatting IPV than criminal justice or social policy efforts. Ethnographic data from in-depth interviews with 25 TSWs provide insight about IPV and how informal social support is a protective factor that helps them cope with routine acts of violence. The findings identify the importance of the 'sisterhood' and how it protects and helps TSWs manage their physical and mental health.
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Affiliation(s)
- Eileen Yuk-Ha Tsang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong, China
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Liu Y, Xin Y, Qi J, Wang H, Hong T, Yang X, Li B, Chang X, Knudson G, Zhao Z, Pan B. The Desire and Status of Gender-Affirming Hormone Therapy and Surgery in Transgender Men and Women in China: A National Population Study. J Sex Med 2020; 17:2291-2298. [PMID: 32868262 DOI: 10.1016/j.jsxm.2020.07.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Gender-affirming hormone therapy and surgery are important medically necessary approaches to transgender care. However, few related data exist in China. AIM To understand the desire and access of transgender cares in the Chinese transgender men and women population. METHODS A cross-sectional self-selecting survey targeting the Chinese transgender population was conducted in 2017 using a snowball sampling method. Participants completed an online questionnaire anonymously. Gender identity was verified by specifically designed questions. Data analysis of this study was performed in 2019. OUTCOMES The main outcome was the status of receiving transgender medical care, including the desire vs actual state of receiving gender-affirming hormone treatment and gender-affirmation surgery, methods of accessing hormonal therapy and surgery, and risky behaviors associated with obtaining treatments. RESULTS Of the total 2060 valid questionnaires, there were 1,304 transgender individuals (626 transgender men and 678 transgender women), with a median age of 22 (interquartile range, 19-26) years. Among them, 1,036 (79.4%) expressed desires for hormonal therapy, but of 1,036, 741 (71.5%) considered it difficult to obtain medications from doctors. Of 1,036 individuals, 275 (26.5%) and 172 (16.6%) had thoughts or behaviors of self-injury, respectively, when lacking access to hormone therapy. Of 1,036 individuals, 602 (58.1%) had used hormones. Of those 602 hormone users, 407 (67.6%) had ever obtained medications from informal drug dealers, and 372 (61.8%) of them did not perform regular monitoring. 868 of 1,303 (66.6%) participants had received or wanted to undergo gender-affirming surgeries, but 710 of 868 (81.8%) considered the surgery resources not adequate or very scarce. CLINICAL IMPLICATIONS The transgender medical resources in China are scarce, and many transgender individuals have engaged in high-risk activities to access care. STRENGTHS & LIMITATIONS This is the first study to focus on the current status of gender-affirming hormone therapy and surgery in the Chinese transgender population, providing valuable and real-world data for understanding the need for transgender health care in China. But, the online questionnaire could not provide the prevalence and other epidemiologic information about transgender individuals in China, and the survey did not address specific medication regimens, dosages, sex hormone levels, and specific hormone therapy-related or surgery-related adverse events. CONCLUSION Significant improvement in access to gender-affirming medical and surgery care is needed in China. Liu Y, Xin Y, Qi J, et al. The Desire and Status of Gender-Affirming Hormone Therapy and Surgery in Transgender Men and Women in China: A National Population Study. J Sex Med 2020;17:2291-2298.
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Affiliation(s)
- Ye Liu
- Department of Endocrinology and Metabolism, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Ying Xin
- Transgender Division, Beijing LGBT Center, Beijing, China
| | - Ji Qi
- Transgender Division, Beijing LGBT Center, Beijing, China
| | - Haining Wang
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | - Tianpei Hong
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Bi Li
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Xu Chang
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Gail Knudson
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Zhenmin Zhao
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Bailin Pan
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China.
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Yan ZH, Lin J, Xiao WJ, Lin KM, McFarland W, Yan HJ, Wilson E. Identity, stigma, and HIV risk among transgender women: a qualitative study in Jiangsu Province, China. Infect Dis Poverty 2019; 8:94. [PMID: 31785621 PMCID: PMC6885322 DOI: 10.1186/s40249-019-0606-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Transgender women have multiple disparities globally, including social rejection and stigma, HIV infection and untreated mental health problems. However, few data on transgender women are available in China. Therefore, this study aimed to explore transgender women's experiences on gender identity, disclosure, discrimination, transgender-specific medical care, and perceptions of HIV and sexually transmitted infections (STI) risk in China. METHODS A qualitative study was conducted in Nanjing and Suzhou city, China in 2018. Key informant interviews (n = 14) and focus group discussions (n = 2) with diverse transgender women were implemented. Text was transcribed and translated, and Dedoose™ software was used for coding, analysis and interpretation by the research team. RESULTS Chinese transgender women share experiences with transgender women worldwide, including a long and challenging identity search, stigma and discrimination, poor access to trans-specific services and unmet needs for mental health care. Features unique to them include terms used for self-identification, culturally-shaped expectations for reproduction, and ideals of placing the familial and societal welfare over personal fulfillment. Social networks of this population appear sparse, scattered, and underground. Familial rejection was experienced by nearly all respondents. Perceptions of HIV and STI risk and history of HIV testing were notably low. CONCLUSIONS Transgender women in China face high social rejection and discrimination along with unmet need for various types of healthcare. Scaling up transgender-specific services including gender-affirming medical care, mental health care and HIV/STI prevention are warranted to address the social, medical and mental health of transgender women in China.
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Affiliation(s)
- Zi-Han Yan
- 0000 0001 2181 7878grid.47840.3fUniversity of California, Berkeley, USA
| | - Jessica Lin
- 0000 0004 0461 9142grid.410359.aSan Francisco Department of Public Health, 25 Van Ness Avenue, Suite 710, San Francisco, CA 94102-6033 USA
| | - Wen-Jing Xiao
- 0000 0000 8803 2373grid.198530.6Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Gulou District, Nanjing, 210009 Jiangsu China ,0000 0000 9255 8984grid.89957.3aNanjing Medical University, Nanjing, China
| | - Keh-Ming Lin
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, USA
| | - Willi McFarland
- 0000 0004 0461 9142grid.410359.aSan Francisco Department of Public Health, 25 Van Ness Avenue, Suite 710, San Francisco, CA 94102-6033 USA ,0000 0001 2297 6811grid.266102.1University of California, San Francisco, USA
| | - Hong-Jing Yan
- Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Gulou District, Nanjing, 210009, Jiangsu, China.
| | - Erin Wilson
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA. .,University of California, San Francisco, USA.
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Zhu X, Gao Y, Gillespie A, Xin Y, Qi J, Ou J, Zhong S, Peng K, Tan T, Wang C, Chen R. Health care and mental wellbeing in the transgender and gender-diverse Chinese population. Lancet Diabetes Endocrinol 2019; 7:339-341. [PMID: 30902476 DOI: 10.1016/s2213-8587(19)30079-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Xuequan Zhu
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Yue Gao
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Amy Gillespie
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ying Xin
- Beijing LGBT Center, Chaoyang District, Beijing, China
| | - Ji Qi
- Beijing LGBT Center, Chaoyang District, Beijing, China
| | - Jianjun Ou
- Hunan Key Laboratory of Psychiatry and Mental Health, Chinese National Technology Institute on Mental Disorders, Changsha, China; Department of Psychiatry and Mental Health Institute, Second Xiangya Hospital, Central South University, Chinese National Clinical Research Centre on Mental Disorders, Changsha, Hunan, China
| | - Shaoling Zhong
- Hunan Key Laboratory of Psychiatry and Mental Health, Chinese National Technology Institute on Mental Disorders, Changsha, China; Department of Psychiatry and Mental Health Institute, Second Xiangya Hospital, Central South University, Chinese National Clinical Research Centre on Mental Disorders, Changsha, Hunan, China
| | - Ke Peng
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia; School of Public Health, The University of Sydney, Sydney, Australia
| | - Tingting Tan
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Hunan, China; National Clinical Research Centre for Metabolic Diseases, Changsha, China
| | - Chaoyue Wang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Runsen Chen
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Department of Psychiatry, University of Oxford, Oxford, UK.
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Suicidal ideation and attempted suicide amongst Chinese transgender persons: National population study. J Affect Disord 2019; 245:1126-1134. [PMID: 30699856 DOI: 10.1016/j.jad.2018.12.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/18/2018] [Accepted: 12/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China. METHODS Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants' demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China. RESULTS A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models. LIMITATIONS The cross-sectional study design and lack of follow-up data are limitations of this study. CONCLUSIONS This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population.
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A cross-sectional study of associations between casual partner, friend discrimination, social support and anxiety symptoms among Chinese transgender women. J Affect Disord 2016; 203:22-29. [PMID: 27267953 DOI: 10.1016/j.jad.2016.05.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/22/2016] [Indexed: 11/21/2022]
Abstract
Anxiety symptoms are the prevalent mental disorders for transgender women. However, only a few studies are available pertaining to this problem among Chinese Transgender women. Chinese Transgender women are a vulnerable population which is exposed to discrimination and loss of social support due to their gender identity and transition. This study was conducted to estimate the prevalence and factors associated with anxiety symptoms among Chinese transgender women. A cross-sectional study was performed by convenience sampling. This comprised of 209 Chinese transgender women in Shenyang, China. The Zung Self-Rating Anxiety Scale (SAS) was used to assess anxiety symptoms for these transgender women. Hierarchical multiple regression analysis was performed to explore the associated factors of SAS. The prevalence of anxiety symptoms in Chinese transgender women was found to be 34.5%. Regression analyses indicated that SAS was associated with casual partnership, friend discrimination and social support in the final model. Sexual partnership and discrimination contributed the most to the model, R-square, accounting for 19.2% and 15.5% of the total variance respectively. Chinese transgender women showed considerably high level of anxiety symptoms. It was also found that they were exposed to significant transition challenges, such as high risk sexual partnership, excessive discrimination and a reduction in social support. Furthermore, anxiety symptoms was best predicted by the absence or presence of a casual partner, friend discrimination and social support rather than the disclosure of their gender identity, knowledge of HIV prevention and health service. Improvement of social support, reduction of friend discrimination and determination of the characteristics of risky sexual partnerships especially for the casual partner can help to attenuate anxiety symptoms and increase mental well-being for transgender women.
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Prevalence and associated factors of condomless receptive anal intercourse with male clients among transgender women sex workers in Shenyang, China. J Int AIDS Soc 2016; 19:20800. [PMID: 27431471 PMCID: PMC4949316 DOI: 10.7448/ias.19.3.20800] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 05/04/2016] [Accepted: 05/13/2016] [Indexed: 11/08/2022] Open
Abstract
Introduction Globally, transgender women sex workers have a high prevalence of HIV and condomless receptive anal intercourse with male clients (CRAIMC). We investigated the prevalence of CRAIMC and factors associated with CRAIMC among transgender women sex workers in China. Methods In 2014, we anonymously interviewed 220 transgender women sex workers face to face in Shenyang, China. Those who self-reported as HIV negative or as having unknown HIV serostatus were invited to take up free, anonymous HIV rapid testing (n=183); 90 did so. Using CRAIMC in the last month as the dependent variable, three types of associated factors were investigated, in addition to background factors: feminizing medical interventions, sex work and perceptions related to condom use. Univariate and multiple logistic regression models were fitted. Results Of the participants, 16.8% self-reported as HIV positive and 9.1% were detected to be HIV positive through free HIV testing; 26.8% had had CRAIMC in the last month, 45.5% had performed sex work in other Chinese cities (last year), and 23.2% had had condomless anal intercourse with men who were non-clients. In the adjusted analysis, significant factors associated with CRAIMC (last month) included the following: 1) any feminizing medical intervention performed (adjusted odds ratio, AOR: 2.22); 2) sex-work-related factors, including recruitment of male clients most often at hotels (AOR: 5.02) and charge per episode of transactional sex (201 to 400 RMB, AOR: 0.27; reference group: ≤100 RMB); and 3) perceptions related to condom use, including perceived transgender identity's impact on condomless sex such as wearing feminine attire, concern about exposing their status as a transgender woman to male clients (AOR: 1.20) and perceived self-efficacy of consistent condom use with male clients (AOR: 0.56). Perceived self-efficacy of consistent condom use with male clients fully mediated the association between perceived transgender identity's impact on condomless sex and CRAIMC. Conclusions HIV prevalence among transgender women sex workers was high but probably underestimated. The high prevalence of condomless anal intercourse with male non-clients and high mobility in sex work among this population in China are causes for concern. Risk factors for CRAIMC were multidimensional and should be considered when designing interventions targeting transgender women sex workers. Such interventions are urgently needed.
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HIV epidemics among transgender populations: the importance of a trans-inclusive response. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.3.21259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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