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Trivedi C, Rizvi A, Mansuri Z, Jain S. Mental health outcomes and suicidality in hospitalized transgender adolescents: A propensity score-matched Cross-sectional analysis of the National inpatient sample 2016-2018. J Psychiatr Res 2024; 172:345-350. [PMID: 38442450 DOI: 10.1016/j.jpsychires.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/17/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
Transgender adolescents have unique mental health needs. This demographic has increased rates of mood disorders, anxiety, and depression compared to their cisgender peers. Large-scale studies focused on mental health outcomes, including suicidality, in the transgender adolescent population remain unknown. This study tries to fill these gaps in the literature. Data for this study was taken from the National Inpatient Sample 2016-2018. Transgender adolescents were identified using the ICD-10 codes related to transsexualism diagnoses. These individuals were compared to adolescents without transsexualism diagnoses. To mitigate imbalances in baseline characteristics, we utilized a 1:2 nearest neighbor propensity score matching with a caliper width of 0.0001, considering variables such as age, year of hospitalization, and psychiatric disorders. Following propensity score matching, the study cohort comprised 2635 transgender and 5270 non-transgender adolescents (Mean age 15.2 years). The transgender group demonstrated a notably higher prevalence of mood disorders (91%) and anxiety disorders (65%). Furthermore, the prevalence of suicidal ideation was significantly higher in the transgender group (52.4% vs. 39.2%, p < 0.001). However, there was no significant difference in the prevalence of suicide attempts between the groups. After controlling for psychiatric comorbidities, age, and gender, the odds ratio for the composite outcome of suicidal ideation or attempt was 1.99 (95% CI 1.58-2.12, p < 0.001). Our study identifies elevated mood and anxiety disorders and suicidality rates in hospitalized transgender adolescents compared to cisgender peers. Mood disorders notably amplify the risk of suicidal attempts. These findings urgently call for targeted mental health interventions and policy changes to serve this vulnerable population in healthcare settings better.
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Affiliation(s)
- Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA.
| | - Abid Rizvi
- Department of Behavioral Medicine & Psychiatry, West Virginia University, 936 Sharpe Hospital Road, Weston, WV, 26452, USA.
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Shailesh Jain
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA.
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Li J, Jin Y, Xu S, Wilson A, Chen C, Wang Y. The influence of the severity of gender dysphoria on anxiety, depression, suicidal ideation, and non-suicidal self-injury in Chinese transgender, nonbinary, and gender-diverse youth. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:456-470. [PMID: 39055632 PMCID: PMC11268234 DOI: 10.1080/26895269.2023.2273360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: Gender dysphoria (GD) is frequently reported among transgender, nonbinary, and gender-diverse (TNG) populations, and is closely related to anxiety, depression, suicidal ideation, and non-suicidal self-injury (NSSI). This study aimed to understand how GD influences the four mental health disparities among TNG youth, and to compare these outcomes depending on the severity of GD. Methods: 96,218 College students participated in the survey, of which the analysis was run on an extracted sub-set data of 2,315 (2.40%) TNG youth, with a mean age of 19.46 (SD = 1.52). Self-reported inventories measured sociodemographic factors, the severity of GD (Utrecht Gender Dysphoria Scale-Gender Spectrum), anxiety (seven-item Generalized Anxiety Disorder Questionnaire), depression (nine-item Patient Health Questionnaire), suicidal ideation (Suicidal Behaviors Questionnaire-Revised), and NSSI (Clinician-Rated Severity of Non-Suicidal Self-Injury Scale). Binary logistic regression assessed the association between significant GD and the four psychiatric disorders. Adjusted multiple logistic regression, and directed acyclic graph (DAG) analyses were conducted to explore the activating relationship among GD, sociodemographic factors, and psychiatric disorders. Results: 1,582 (68.30%) TNG youth who experienced significant levels of GD (total scores cutoff >= 46) were entered into the analyses. Binary logistic regression displayed significantly positive associations between significant GD and anxiety, depression, suicidal ideation, and NSSI. Multiple regression models showed risk factors included poor relationship with one's father/mother, tobacco smoking, alcohol consumption, and having a lower subjective social status. While family harmony, a higher father's educational level, and partaking in exercise were protective factors that exerted distinct impacts on these four psychiatric disorders. DAG findings showed a poor relationship with one's father with significant GD via other socio-demographic characteristics, activated psychiatric disorders. Conclusions: TNG youth with higher levels of GD also exhibited more severe anxiety, depression, suicidal ideation, and NSSI. Tailored interventions should be provided to prioritize relieving those with severe GD to protect TNG youth from psychiatric outcomes further.
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Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Chang Chen
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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Hughes TL, Bochicchio L, Drabble L, Muntinga M, Jukema JS, Veldhuis CB, Bruck S, Bos H. Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands. BMC Public Health 2023; 23:2533. [PMID: 38110908 PMCID: PMC10729573 DOI: 10.1186/s12889-023-17466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality. METHODS Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. RESULTS Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. CONCLUSIONS Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.
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Affiliation(s)
- Tonda L Hughes
- School of Nursing, Department of Psychiatry, Columbia University Irving Medical School, Center for Sexual and Gender Minority Health Research, 560 West 168 Street, New York, NY, USA.
| | - Lauren Bochicchio
- Columbia University School of Nursing Center for Sexual and Gender Minority Health Research, 560 West 168th Street, New York, NY, USA
| | - Laurie Drabble
- College of Health and Human Sciences, San Jose State University, One Washington Square, San Jose, CA, USA
| | - Maaike Muntinga
- Department of Ethics, Law and Humanities, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands
| | - Jan S Jukema
- School of Health, Saxion University of Applied Sciences, M. H. Tromplaan 28, Enschede, 7513 AB, Netherlands
| | - Cindy B Veldhuis
- Departments of Medical Social Sciences, Psychology, Psychiatry, and Obstetrics & Gynecology, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, USA
| | - Sunčica Bruck
- Kohnstamm Instituut, Keizer Karelplein 1, Amstelveen, 1185 HL, Netherlands
| | - Henny Bos
- Research Institute Child Development and Education, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, 1012 WX, Netherlands
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Cork A, Everson R, Naserian E, Levine M, Koschate-Reis M. Collective self-understanding: A linguistic style analysis of naturally occurring text data. Behav Res Methods 2023; 55:4455-4477. [PMID: 36443583 PMCID: PMC9707163 DOI: 10.3758/s13428-022-02027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/30/2022]
Abstract
Understanding what groups stand for is integral to a diverse array of social processes, ranging from understanding political conflicts to organisational behaviour to promoting public health behaviours. Traditionally, researchers rely on self-report methods such as interviews and surveys to assess groups' collective self-understandings. Here, we demonstrate the value of using naturally occurring online textual data to map the similarities and differences between real-world groups' collective self-understandings. We use machine learning algorithms to assess similarities between 15 diverse online groups' linguistic style, and then use multidimensional scaling to map the groups in two-dimensonal space (N=1,779,098 Reddit comments). We then use agglomerative and k-means clustering techniques to assess how the 15 groups cluster, finding there are four behaviourally distinct group types - vocational, collective action (comprising political and ethnic/religious identities), relational and stigmatised groups, with stigmatised groups having a less distinctive behavioural profile than the other group types. Study 2 is a secondary data analysis where we find strong relationships between the coordinates of each group in multidimensional space and the groups' values. In Study 3, we demonstrate how this approach can be used to track the development of groups' collective self-understandings over time. Using transgender Reddit data (N= 1,095,620 comments) as a proof-of-concept, we track the gradual politicisation of the transgender group over the past decade. The automaticity of this methodology renders it advantageous for monitoring multiple online groups simultaneously. This approach has implications for both governmental agencies and social researchers more generally. Future research avenues and applications are discussed.
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Affiliation(s)
- Alicia Cork
- Department of Psychology, University of Bath, Bath, UK.
| | - Richard Everson
- Department of Computer Science, University of Exeter, Exeter, UK
- Alan Turing Institute, London, UK
| | - Elahe Naserian
- Department of Politics, University of Exeter, Exeter, UK
| | - Mark Levine
- Department of Psychology, University of Lancaster, Lancaster, UK
| | - Miriam Koschate-Reis
- Institute for Data Science and Artificial Intelligence, University of Exeter, Exeter, UK
- Department of Psychology, University of Exeter, Exeter, UK
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Pliensak N, Suwan A, Panyakhamlerd K, Bumphenkiatikul T, Wainipitapong S. Mental Health of Transmasculine Adults Receiving Gender-Affirming Hormone Therapy in Thailand. Transgend Health 2023; 8:509-515. [PMID: 38213531 PMCID: PMC10777821 DOI: 10.1089/trgh.2021.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Many studies have shown conflicting results regarding mental health among transmasculine adults or transgender men (TM). This study aimed to identify the prevalence of depression among Thai TM receiving gender-affirming hormone therapy (GAHT). Methods All TM, over 18 years of age, who received GAHT for at least three consecutive months were invited to complete a self-report questionnaire that covered participants' demographic and clinical data. Mental health, including depression, anxiety, and quality of life (QoL), was assessed. We reported the prevalence of mental illnesses and examined the correlations between mental health scores and other associated data. Results A total of 84 TM were included in the analysis. Major depression and generalized anxiety disorder were detected in 14.3% and 3.6%, respectively. Depression severity was negatively associated with age and QoL. Depression and anxiety severity were found to be positively associated. Conclusions Compared with the general Thai population, the prevalence of mental health problems among Thai TM receiving GAHT was higher. Age of maturity may be a potential mental health protective factor, and assessment in younger individuals may benefit mental health.
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Affiliation(s)
- Napon Pliensak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Ammarin Suwan
- Division of Gender, Sexual, and Climacteric Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krasean Panyakhamlerd
- Division of Gender, Sexual, and Climacteric Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanapob Bumphenkiatikul
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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Jin JL, Baylor C, Teixeira J, Yorkston K, Nuara M. Reframing transgender communication in gender-affirming communication care: Comfort and confidence are the main goals. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-15. [PMID: 37907084 DOI: 10.1080/17549507.2023.2259124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
PURPOSE To understand the communicative participation experiences of transgender people through a qualitative inquiry, and to address similarities and differences in experiences across genders. METHOD This study was a secondary analysis of interview data gathered for modifying the Communicative Participation Item Bank for use with transgender populations. Fourteen transgender participants attended individual qualitative interviews. During the interview, participants shared their communication experiences in various situations and the availability of social supports related to communication. Qualitative content analysis was used to develop themes and subthemes from the data. RESULT Three themes emerged from the data: the participants' priorities for comfort, safety, and authenticity; the use of an internal "checklist" to optimise their communication; and changes in attitudes towards communication over time. Across themes, participants shared core communication experiences regardless of gender identities. CONCLUSION The findings support prior research on voice-related communication experiences of transgender people. A key finding is the notion that communication success is influenced by sociocultural contexts and the physical environment beyond their communication presentation. To achieve targeted comfort and satisfaction in communication, healthcare professionals need to consider the transgender client's communication contexts, and incorporate a life-participation approach to gender-affirming voice and communication training.
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Affiliation(s)
- Jingyu Linna Jin
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jeffrey Teixeira
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kathryn Yorkston
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Michael Nuara
- Facial Plastic and Reconstructive Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
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Sares-Jäske L, Czimbalmos M, Majlander S, Siukola R, Klemetti R, Luopa P, Lehtonen J. Gendered Differences in Experiences of Bullying and Mental Health Among Transgender and Cisgender Youth. J Youth Adolesc 2023:10.1007/s10964-023-01786-7. [PMID: 37199852 DOI: 10.1007/s10964-023-01786-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
Even though previous studies have shown that transgender youth have poorer mental health and more experiences of being bullied than their cisgender counterparts, and that bullying associates with poorer mental health, knowledge on such associations in different gender identity groups is scarce. This study investigated how mental health problems and experiences of being bullied appear across different gender identity groups, and how bullying is associated with mental health among the groups in question. Data from the Finnish School Health Promotion 2021 study (n = 152,880, mean age 16.2 years (standard deviation 1.22)) was used and categorized into four gender identity groups: cisgender girls (n = 76,521), cisgender boys (n = 69,735), transfeminine youth (n = 1317), and transmasculine youth (n = 5307). Transgender youth experienced more bullying and reported poorer mental health than cisgender youth. While transfeminine youth faced the most bullying, transmasculine youth had the most mental health symptoms. In each group, bullying associated with poorer mental health. Compared to cisgender boys without bullying experiences, odds of poorer mental health were dozens-fold among transmasculine youth with weekly bullying experiences. In addition, compared to cisgender boys with bullying experiences, odds of poorer mental health were greater among all other gender identity groups with bullying experiences, and among transmasculine youth in particular (e.g., odds ratio of generalized anxiety = 8.36 (95% confidence interval, 6.59-10.6)). Bullying is associated with poorer mental health in all youth, but transgender youth, and especially transmasculine youth, may be in an even more vulnerable position for its implications. This suggests that there is a need for improving effective measures to decrease bullying in schools and to improve wellbeing of transgender youth.
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Affiliation(s)
- Laura Sares-Jäske
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Mercedesz Czimbalmos
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
- Åbo Akademi University, Tuomiokirkontori 3, FI-20500, Turku, Finland
| | - Satu Majlander
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Reetta Siukola
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Reija Klemetti
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Pauliina Luopa
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Jukka Lehtonen
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
- University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
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Lampis J, De Simone S, Lasio D, Serri F. The Role of Family Support and Dyadic Adjustment on the Psychological Well-being of Transgender Individuals: An Exploratory Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-17. [PMID: 37363352 PMCID: PMC10166461 DOI: 10.1007/s13178-023-00817-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/28/2023]
Abstract
Introduction This study aimed to measure dyadic adjustment, social support, and psychological well-being. Methods A research protocol composed of the Dyadic Adjustment Scale, the Outcome Questionnaire 45.2, and the Multidimensional Scale of Perceived Social Support was administered to a sample of 109 Italian transgender individuals. Results Higher levels of global psychological distress, symptom severity, and interpersonal relationship distress were associated with lower levels of family support and dyadic adjustment. In addition, transgender women and younger transgender individuals reported higher levels of interpersonal relationship distress. Conclusions The results indicate that the support and acceptance of one's partner and family of origin play a crucial role in promoting well-being. It represents an important protective factor with respect to negative psychological health outcomes. Policy Implications The findings emphasize the need to develop specific clinical and social practices for transgender individuals and their families. Building family and partner-centered policies and programs is particularly important to enable transgender individuals to avoid paying the emotional and psychological costs associated with rejection and non-acceptance.
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Affiliation(s)
- Jessica Lampis
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Silvia De Simone
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Diego Lasio
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Francesco Serri
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
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Strang JF, Anthony LG, Song A, Lai MC, Knauss M, Sadikova E, Graham E, Zaks Z, Wimms H, Willing L, Call D, Mancilla M, Shakin S, Vilain E, Kim DY, Maisashvili T, Khawaja A, Kenworthy L. In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:212-229. [PMID: 34121545 DOI: 10.1080/15374416.2021.1916940] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic-cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures. In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled. METHOD This study includes 93 adolescents aged 13-21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger "broad-ASD" grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender-related needs. RESULTS Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups. In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality. CONCLUSIONS Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents.
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Affiliation(s)
- John F Strang
- Gender Development Program, Children's National Hospital
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Laura G Anthony
- Department of Psychiatry, University of Colorado School of Medicine
- Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Amber Song
- Gender Development Program, Children's National Hospital
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health
- Department of Psychiatry, The Hospital for Sick Children
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto
- Autism Research Centre, Department of Psychiatry, University of Cambridge
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine
| | - Megan Knauss
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Alliance of Community Health Plans
| | | | | | - Zosia Zaks
- Hussman Center for Adults with Autism, Towson University
| | - Harriette Wimms
- Youth Gender Care Services, The Village Family Support Center of Baltimore
| | - Laura Willing
- Gender Development Program, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - David Call
- Gender Development Program, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Michael Mancilla
- Youth Pride Clinic, Adolescent and Young Adult Medicine, Children's National Hospital
| | - Sara Shakin
- Department of Pediatrics, Sinai Hospital of Baltimore
| | - Eric Vilain
- Center for Genetic Medicine Research, Children's National Hospital
- Department of Genomics and Precision Medicine, George Washington University
- Epigenetics, Data, & Politics at Centre National de la Recherche Scientifique
| | - Da-Young Kim
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Tekla Maisashvili
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Ayesha Khawaja
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
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10
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Santos RB, Lemos C, Saraiva M. Gender-Affirming Hormone Therapy: Physical and Sociopsychological Effects, Impact and Satisfaction. Cureus 2023; 15:e36484. [PMID: 37090416 PMCID: PMC10118284 DOI: 10.7759/cureus.36484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background Gender dysphoria treatment includes gender-affirming hormone therapy (GAHT). Studies are still lacking on how to characterize its effects and impact on transgender people's lives more effectively. Aim To study the physical and psychological effects of GAHT on transgender individuals, assess its impact on their lives, and rate their overall satisfaction. Methods Participants (n = 114; ages 18-62 years; median age 24.0 (21.0 - 33.0) years) included transgender adults residing in Portugal who were undergoing or had undergone hormonal therapy for at least one uninterrupted year. Participants completed an original questionnaire. For most items, an ordinal Likert-style scale ranging from 0 (worst result) to 6 (best result) was used. Descriptive statistics and non-parametric tests, including Pearson's chi-squared test, Wilcoxon signed-rank test, and Mann-Whitney U test were used to analyze categorical and continuous variables, with a significance level set at 0.05. Outcomes The outcomes included desired physical changes rating (perception and satisfaction with changes); side effects of GAHT; the sociopsychological impact of GAHT (on self-esteem, body image, psychological wellbeing, social and family relations); overall satisfaction (with treatment results and medical follow-up). Results The changes classified as the most perceptible in those undergoing masculinizing treatment (Group M) were amenorrhea (6 (5.0-6.0) points) and clitoris enlargement (6 (5.0-6.0) points). These were also the ones rated as the most satisfactory (6 (6.0-6.0) points for amenorrhea and 6 (4.0-6.0) points for clitoris enlargement). On those undergoing feminizing therapy (Group F), the alteration voted as the most perceptible was sperm production decrease (6 (2.0-6.0) points), and the ones classified as the most satisfactory were sperm production decrease (6 (4.0-6.0) points) and spontaneous erections decrease (6 (5.0-6.0) points). Side effects were reported by 89.7% of Group M (mood swings were the most common) and 96.3% of Group F (decreased libido was the most frequent). The sociopsychological impact of hormonal treatment was significantly positive in all analyzed variables (p<0.001). Overall satisfaction with treatment results and medical follow-up were rated with 5 points and 4.5 points, respectively. Clinical implications This study provides clinicians with more evidence that GAHT may improve the physical, psychological and social health of transgender people seeking medical transition. Strengths and limitations The strengths of the current study include a high participant count relative to the target population, the acquisition of data on previously unexplored variables, and the significance of being one of the few investigations of its kind conducted in Portugal. However, the study has limitations, including differences in participant characteristics, a small sample size for some variables, potential bias due to the retrospective nature of the study, individualized treatment regimens, and the inclusion of participants from different countries, which limit the generalization of the results. Conclusions This study provides further evidence that GAHT is effective, and that its physical effects are satisfactory while resulting in mostly non-severe nor life-threatening side effects. GAHT is an important therapy in gender dysphoria and has consistent results in improving numerous sociopsychological variables.
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Affiliation(s)
- Rafael B Santos
- Endocrinology Department, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Carolina Lemos
- Population Studies, Instituto de Ciências Biomédicas Abel Salazar, Porto, PRT
| | - Miguel Saraiva
- Endocrinology Department, Centro Hospitalar Universitário do Porto, Porto, PRT
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11
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Corlett S, Stutterheim SE, Whiley LA. “I only wanted one thing and that was to be who I am now”: Being a trans young adult and (re)negotiating vocational identity. GENDER WORK AND ORGANIZATION 2023. [DOI: 10.1111/gwao.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Sara Corlett
- Department of Social Psychology Faculty of Psychology Universidad de Sevilla Sevilla Spain
- Department of Health Promotion & Care and Public Health Institute Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
| | - Sarah E. Stutterheim
- Department of Health Promotion & Care and Public Health Institute Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
| | - Lilith A. Whiley
- Department of Management University of Sussex Business School University of Sussex Brighton UK
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12
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Doğan MB, Oban V, Dikeç G. Qualitative and Artificial Intelligence-based Sentiment Analyses of Anti-LGBTI+ Hate Speech on Twitter in Turkey. Issues Ment Health Nurs 2023; 44:112-120. [PMID: 36668726 DOI: 10.1080/01612840.2022.2158407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this study was to evaluate hate speech in Turkish LGBTI+-related tweets during a one-month period of artificial intelligence-based sentiment analyses. Turkish tweets related to LGBTI+, were retrieved using Python library Tweepy and were evaluated by sentiment analysis. The researchers then performed a qualitative analysis of the most frequently liked and retweeted tweets (n = 556). Sentiment analysis revealed that 69.5% of tweets were negative, 23.3% were neutral, and 7.2% were positive. The qualitative analysis was grouped under seven themes: LGBTI+ Club; Terrorism and Terrorist Organization Membership; Perversion, Illness, Immorality; Presence in History; Religious References; Insults; and Humiliation. The results of this study show that anti-LGBTI+ hate speech in Turkey is significant in terms of both quality and quantity. As LGBTI+ individuals are at risk for excess mental distress and disorders, it is important to understand the risks and other factors that ameliorate stress and contribute to mental health in social media.
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Affiliation(s)
- M Berna Doğan
- Faculty of Health Sciences, Department of Nursing, Arel University, Istanbul, Turkey
| | | | - Gül Dikeç
- Faculty of Health Sciences, Department of Nursing, Fenerbahçe University, Istanbul, Turkey
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13
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Leyns C, Alighieri C, De Wilde J, Van Lierde K, T’Sjoen G, D’haeseleer E. Experiences of Transgender Women with Speech Feminization Training: A Qualitative Study. Healthcare (Basel) 2022; 10:2295. [PMID: 36421620 PMCID: PMC9690106 DOI: 10.3390/healthcare10112295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/20/2022] [Accepted: 11/10/2022] [Indexed: 10/18/2023] Open
Abstract
This study investigated the experiences of transgender women after following sessions for speech feminization using semi-structured face-to-face interviews. Transgender women who completed a clinical trial were invited for an interview and 12 accepted the invitation. Interviews were conducted using an interview guide and were recorded and transcribed verbatim. NVivo 12 was used for qualitative data analysis, applying an inductive thematic approach. Four main themes were identified: communication, therapy experiences, impact on mental health, and external factors associated with the outcomes. For most participants, fear of speaking in public decreased after the training and all participants mentioned improved vocal characteristics. Though, reactions ranged from needing more speech therapy to being satisfied with the results. Coping strategies during misgendering occasions differed a lot between participants. More emotive counseling during speech feminization sessions is necessary to help clients in managing possible negative emotions.
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Affiliation(s)
- Clara Leyns
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Cassandra Alighieri
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Jana De Wilde
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Kristiane Van Lierde
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria 0028, South Africa
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, 9000 Ghent, Belgium
| | - Evelien D’haeseleer
- Center for Speech and Language Sciences (CESLAS), Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
- Musical Department, School of Arts, Royal Conservatory Brussels, 1000 Brussels, Belgium
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14
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Trans* Jugendliche und junge Erwachsene im Gesundheitswesen: Eine qualitative Interviewstudie über Erfahrungen, Herausforderungen undWünsche. Prax Kinderpsychol Kinderpsychiatr 2022; 71:576-596. [DOI: 10.13109/prkk.2022.71.7.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Czimbalmos M, Rask S. (Dis)advantaged positions in accessing gender-affirming healthcare in Finland: an intersectional qualitative study of foreign-origin transgender people. BMC Health Serv Res 2022; 22:1287. [PMID: 36284312 PMCID: PMC9597978 DOI: 10.1186/s12913-022-08654-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An increasing body of scholarship focuses on transgender individuals' experiences when accessing gender-affirming healthcare. However, the experiences of transgender individuals who identify as being of foreign-origin in Finland have rarely been studied. This study aims to fill the gap in research and contribute to the understanding of the experiences of transgender individuals who also identify as belonging to the foreign-origin populations in Finland. METHODS Fourteen semi-structured qualitative interviews were conducted and analyzed with reflexive thematic analysis (RTA), through the framework of intersectionality. The interviews were part of a broader sample of qualitative data, collected about the experiences of sexual and gender minorities among the foreign-origin populations in Finland. RESULTS The analysis showed two main interconnected themes. Firstly, perceived barriers when accessing gender-affirming care. In this theme, the intersections of transgender identity, foreign background, class, and age affected the experiences of the individuals. Secondly, the necessity of "performing identities:" the intersections of class, transgender identity, nativity, and race affected those. CONCLUSION The findings of the current study suggest that the intersectional aspects of individual identities create structural inequalities in the Finnish gender-affirming healthcare system. To tackle these inequalities, further research is needed on the healthcare experiences of gender minorities in Finland both within and outside the scope of transgender-specific healthcare.
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Affiliation(s)
| | - Shadia Rask
- The Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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16
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de Vries JMA, Downes C, Sharek D, Doyle L, Murphy R, Begley T, McCann E, Sheerin F, Smyth S, Higgins A. An exploration of mental distress in transgender people in Ireland with reference to minority stress and dissonance theory. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:469-486. [PMID: 37901058 PMCID: PMC10601524 DOI: 10.1080/26895269.2022.2105772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Introduction: Internationally mental distress is more prominent in the LGBTI community than the general population. The LGBTIreland study was set up to take stock of this in the Republic of Ireland. This paper reports on the analysis of the transgender group with reference to minority stress theory and cognitive dissonance theory. Method: An online survey was conducted addressing several aspects of mental health and distress that received responses from all groupings (n = 2,264) among which 12.3% (n = 279) identified as transgender. The survey consisted of several validated tools to measure depression, anxiety, stress (DASS-21), coping (CSES), self-esteem (RSES), alcohol and drugs misuse (AUDIT) and a variety of questions addressing demographics, experiential aspects, coping and self-related factors. Data analysis focused on predicting mental distress using DASS-general (composite of depression, anxiety and stress). Results: Transgender participants reported higher levels of mental distress, self-harm, suicidal ideation and attempts, and lower levels of self-esteem in comparison with the LGB groups, as well as the general population. Hierarchical multiple regression showed that 53% of variance in mental distress could be predicted from reduced self-esteem, the experience of harassment and not belonging in school. Furthermore, mental distress was highest among younger participants, those who were 'not out', those who had self-harmed and used avoidant coping. There was no significant difference in distress levels among those who had sought mental health support and those who had not. Conclusions: To understand mental distress in transgender people, the minority stress model is useful when taking into account both adverse external (environmental) and internal (cognitive/emotional) factors. The cognitive dissonance mechanism is essential in outlining the mechanism whereby gender incongruence is associated with psychological discomfort, low self-esteem and high mental distress.
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Affiliation(s)
- Jan M. A. de Vries
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Danika Sharek
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Murphy
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Thelma Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Edward McCann
- Division of Nursing, City University of London, London, UK
| | - Fintan Sheerin
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Siobhán Smyth
- School of Nursing and Midwifery, National University Galway, Galway, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Giacomozzi M, Health MSG, Aubin SG, Brancaccio MT. Mapping Accessibility to Fertility Preservation for Trans Masculine Individuals in the Netherlands. LGBT Health 2022; 9:369-383. [PMID: 35533011 DOI: 10.1089/lgbt.2021.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Since 2014 in the Netherlands, sterilization is no longer required for legal gender affirmation. Access to fertility preservation (FP) options is indispensable to grant equal reproductive rights to this population. This study aims to map existing literature on barriers and enabling factors for trans masculine individuals to access FP in the Netherlands after 2014. Methods: A scoping review method was conducted, including a database and a hand search complemented with informal consultations. Literature between 2014 and 2021 was searched. Results: A total of 38 peer-reviewed articles and 22 complementary gray literature sources were retrieved. Thematic analysis identified seven common themes: biological, psychological, training, language, law and legislation, economic, and sociocultural. The themes were clustered as patient-, health care provider (HCP)- and environment-related. Conclusion: The Netherlands offers progressive legislation and accommodating insurance agreements that favor FP for trans masculine individuals. However, the current readiness of HCPs to provide adapted and tailored care is arguable, and the capacity to access appropriate health services for trans masculine individuals is largely nonexistent outside of highly specialized health institutions. The implementation of both formal and informal education training programs for HCPs on transgender and gender diverse health needs-as well as inclusive language use-could benefit this community at large.
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Affiliation(s)
| | - MSc Global Health
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Maria Teresa Brancaccio
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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18
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Wainipitapong S, Burakitpachai S, Bumphenkiatikul T. Complex psychiatric comorbidities in Thai trans women: A case series. F1000Res 2022; 11:74. [PMID: 36751305 PMCID: PMC9877471 DOI: 10.12688/f1000research.75144.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/20/2022] Open
Abstract
Trans women (TW) have a high prevalence of poor mental health. Gender-affirming treatments could reduce distress regarding their gender incongruity. However, psychiatric comorbidities might complicate the management or even confirmation of being transgender. We reported three TW with complex mental illnesses, including anxiety disorder with cultural explanation, neurodevelopmental disorders with cross-dressing, and severe personality disorder accompanied by major depression. All cases received both psychiatric and gender-affirming treatments, which demonstrated promising outcomes. Along with gender dysphoria (GD), psychiatric comorbidities also altered these TW's identity and manifestations. Recognition of such conditions would be beneficial in providing care for all TW, both with and without GD.
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Affiliation(s)
- Sorawit Wainipitapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Pathumwan, Bangkok, 10330, Thailand,Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, 10330, Thailand
| | | | - Thanapob Bumphenkiatikul
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, 10330, Thailand,Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, 10330, Thailand,
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Pereira-García S, Devís-Devís J, López-Cañada E, Fuentes-Miguel J, Sparkes AC, Pérez-Samaniego V. Exploring Trans People's Narratives of Transition: Negotiation of Gendered Bodies in Physical Activity and Sport. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9854. [PMID: 34574781 PMCID: PMC8471943 DOI: 10.3390/ijerph18189854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
This paper explores how trans people who make transitions negotiate their gendered bodies in different moments of this process, and how their narrative storylines are emplotted in physical activity and (non)organized sports (PAS) participation. A qualitative semi-structured interview-based study was developed to analyze the stories of eight trans people (three trans women, two trans men, and three nonbinary persons) who participated in PAS before and during their gender disclosure. A thematic analysis was conducted to identify the patterns in the transition process and the structural analysis of the stories from the interviews. Three transition moments (the closet, opening up, and reassuring) were identified from the thematic analysis. Most participants showed difficulties in achieving their PAS participation during the two earlier moments. The predominance of failure storylines was found particularly in men, while success was more likely to appear in women because their bodies and choices fitted better with their PAS gender ideals. The nonbinary trans persons present alternative storylines in which corporeality has less influence on their PAS experiences. The knowledge provided on the moments and the stories of transition help to explain trans people's (non)involvement in PAS and to guide policymaking and professional action in PAS fields.
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Affiliation(s)
- Sofía Pereira-García
- AFES Research Group, Department of Social Work and Social Services, Universitat de Valencia, Avda Tarongers 6, 46022 Valencia, Spain;
| | - José Devís-Devís
- AFES Research Group, Department of Physical Education and Sport, Universitat de Valencia, C/Gascó Oliag, 3, 46010 Valencia, Spain;
| | - Elena López-Cañada
- AFES Research Group, Department of Body Expression Didactics, Universitat de Valencia, Avda Tarongers 4, 46022 Valencia, Spain; (E.L.-C.); (J.F.-M.)
| | - Jorge Fuentes-Miguel
- AFES Research Group, Department of Body Expression Didactics, Universitat de Valencia, Avda Tarongers 4, 46022 Valencia, Spain; (E.L.-C.); (J.F.-M.)
| | - Andrew C. Sparkes
- Carnegie School of Sport, Cavendish 101, Headingley Campus, Leeds Beckett University, Leeds LS6 3QU, UK;
| | - Víctor Pérez-Samaniego
- AFES Research Group, Department of Physical Education and Sport, Universitat de Valencia, C/Gascó Oliag, 3, 46010 Valencia, Spain;
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20
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Ussher JM, Hawkey A, Perz J, Liamputtong P, Sekar J, Marjadi B, Schmied V, Dune T, Brook E. Gender affirmation and social exclusion amongst trans women of color in Australia. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 23:79-96. [PMID: 35403115 PMCID: PMC8986236 DOI: 10.1080/26895269.2021.1947432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Transgender (trans) women of color navigate the intersected identity frames of gender, race, social class and sexuality, whilst facing multiple layers of stigma, discrimination and violence during and following gender affirmation. However, little is known about the ways in which trans women of color negotiate gender affirmation, in the context of the risk of social exclusion and violence. AIM This article discusses the experience and construction of gender transitioning and gender affirmation for trans women of color living in Australia, associated with the risk of social exclusion or violence. METHOD In-depth interviews and photovoice were conducted with 31 trans women of color, analyzed through theoretical thematic analysis informed by intersectionality theory. RESULTS The following themes were identifed: 1) 'Gender affirmation: A bittersweet experience', with three subthemes: 'Self-empowerment is tempered by family rejection', 'Migration facilitates gender affirmation' and 'Gender affirmation and social support'; 2) 'Being a trans woman of color', subthemes: 'Bodily agency and passing', 'Femininity as pleasure and cultural self-expression', and 'Resisting archetypal White hetero-femininity'; 3) 'Hormones, surgical intervention and navigating the health system'. CONCLUSION Gender transitioning and gender affirmation involved the intersection of gender, cultural, social class and sexual identities, accomplished through personal agency and with the support of significant others. To ensure that policy and support services meet the needs of trans women of color, it is critical that the voices of such multiply-marginalized women are at the center of leadership, program and policy development.
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Affiliation(s)
- Jane M. Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Pranee Liamputtong
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Jessica Sekar
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Brahmaputra Marjadi
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Virginia Schmied
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
| | - Tinashe Dune
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, Australia
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21
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Ross MB, van de Grift TC, Elaut E, Nieder TO, Becker-Hebly I, Heylens G, Kreukels BPC. Experienced barriers of care within European treatment seeking transgender individuals: A multicenter ENIGI follow-up study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:26-37. [PMID: 36713146 PMCID: PMC9879197 DOI: 10.1080/26895269.2021.1964409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objectives: To evaluate the experienced barriers of care for treatment-seeking trans individuals (TSTG) in three large European clinics. Methods: An online follow-up questionnaire was filled out by 307 TSTG individuals as part of the research protocol of the European Network for the Investigation of Gender Incongruence (ENIGI). Data was collected during follow-up in 2017/2018, around 5 years after participants had their initial clinical appointments in Ghent (Belgium), Amsterdam (the Netherlands), or Hamburg (Germany). Background characteristics, country, treatment characteristics and mental health were analyzed in relation to experienced barriers of care (EBOC, measured though agreement with statements). Results: The majority of participants reported various EBOC, oftentimes more than one. The most-frequently reported EBOCs pertained to the lack of family and friends' support (28.7%, n = 88) and travel time and costs (27.7%, n = 85), whereas around one-fifth felt hindered by treatment protocols. Also, a significant share expressed the feeling that they had to convince their provider they needed care and/or express their wish in such way to increase their likelihood of receiving care. A higher number of EBOCs reported was associated with more mental health problems, lower income and female gender. Conclusions: A substantial number of TSTG individuals within three European health care systems experiences EBOCs. EBOCs relate to both personal and systemic characteristics. These findings can help health care providers and centers to improve care. More research must be done to better understand the diversity among TSTG individuals and the corresponding barriers experienced. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1964409.
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Affiliation(s)
- Maeghan B. Ross
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Tim C. van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Els Elaut
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Timo O. Nieder
- Interdisciplinary Transgender Health Care Center, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Becker-Hebly
- Interdisciplinary Transgender Health Care Center, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunter Heylens
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Baudewijntje P. C. Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Guethlein N, Grahlow M, Lewis CA, Bork S, Habel U, Derntl B. Healthcare for Trans*gender People in Germany: Gaps, Challenges, and Perspectives. Front Neurosci 2021; 15:718335. [PMID: 34557067 PMCID: PMC8452951 DOI: 10.3389/fnins.2021.718335] [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: 05/31/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
People whose gender does not correspond to the binary gender system, i.e., trans∗gender people, face two main problems when it comes to healthcare in Germany: (1) They often suffer from general psychiatric comorbidities as well as specific and significant mental distress due to gender dysphoria, and (2) the German healthcare system lacks sufficiently educated and clinically experienced medical personnel who are able to provide specialized healthcare. Aside from transition, it often is extremely difficult for trans∗gender people to get access to and be integrated into the medical system. Stigmatization and pathologization in treatment are widespread, as are long waiting times for specialized healthcare providers who are often only accessible to those trans∗gender people willing to travel long distances. Frequently, trans∗gender people face further difficulties and barriers after transition, as some healthcare professionals fail to provide suitable care (e.g., gynecological consultation for transmen). The ICD-11 German Modification (ICD-11-GM), which should be routinely used by 2022, implements a depathologization of trans∗gender people in the medical system. This paper compares the issues related to health and healthcare of trans∗gender people in Germany with those in other European countries. We review the care offered by specialized centers with regard to treatment of and support for trans∗gender people. We conclude with specific proposals that may contribute to establish an improved, up-to-date, gender-sensitive healthcare system.
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Affiliation(s)
- Nora Guethlein
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Melina Grahlow
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Graduate Training Centre of Neuroscience, University of Tübingen, Tübingen, Germany
| | - Carolin A. Lewis
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Emotion Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- International Max Planck Research School on Neuroscience of Communication: Function, Structure, and Plasticity, Leipzig, Germany
| | - Stephan Bork
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- LEAD Graduate School and Research Network, University of Tübingen, Tübingen, Germany
- International Max Planck Research School for Cognitive and Systems Neuroscience, University of Tübingen, Tübingen, Germany
- TübingenNeuroCampus, University of Tübingen, Tübingen, Germany
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23
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Nuyen B, Kandathil C, McDonald D, Thomas J, Most SP. The impact of living with transfeminine vocal gender dysphoria: Health utility outcomes assessment. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:99-107. [PMID: 36713148 PMCID: PMC9879186 DOI: 10.1080/26895269.2021.1919277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background: The voice signals a tremendous amount of gender cues. Transfeminine individuals report debilitating quality-of-life deficits as a result of their vocal gender dysphoria.Aims: We aimed to quantify the potential impact of this dysphoria experienced with quality-adjusted life years (QALYs), as well as associated treatments, through validated health utility measures. Methods: Peri-operative phonometric audio recordings of a consented transfeminine patient volunteer with a history of vocal gender dysphoria aided in the description of two transfeminine health states, pre- and post-vocal feminization gender dysphoria; monocular and binocular blindness were health state controls. Survey responses from general population adults rate these four health states via visual analogue scale (VAS), standard gamble (SG), and time tradeoff (TTO). Results: Survey respondents totaled 206 with a mean age of 35.8 years. Through VAS measures, these general adult respondents on average perceived a year of life with transfeminine vocal gender dysphoria as approximately three-quarters of a life-year of perfect health. Respondents also on average would have risked a 15%-20% chance of death on SG analysis and would have sacrificed 10 years of their remaining life on TTO measures to cure the condition. The QALY scores for the post-gender affirming treatments for vocal gender dysphoria (+0.09 VAS, p < 0.01) were significantly higher compared to the pretreatment state. There were no differences in the severity of these QALY scores by survey respondent's political affiliation or gender identity. Conclusions: To our knowledge, this study is the first to quantify how the general population perceives the health burden of vocal gender dysphoria experienced by transfeminine patients. Feminization treatments including voice therapy with feminization laryngoplasty appear to significantly increase health utility scores.
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Affiliation(s)
- Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cherian Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Daniella McDonald
- Medical Scientist Training Program, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - James Thomas
- Clinic for Voice Disorders, Portland, Oregon, USA
| | - Sam P. Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
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24
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Sundus A, Shahzad S, Younas A. Ethical and culturally competent care of transgender patients: A scoping review. Nurs Ethics 2021; 28:1041-1060. [PMID: 33706609 DOI: 10.1177/0969733020988307] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care. ETHICAL CONSIDERATIONS No formal ethical approval was required. AIM To synthesize the literature and identify gaps about approaches to the provision of ethical and culturally competent care to transgender populations. DESIGN A Scoping Review. LITERATURE SEARCH Literature was searched within CINAHL, Science Direct, PubMed, Google Scholar, EMBASE, and Scopus databases using indexed keywords such as "transgender," "gender non-conforming," "ethically sensitive care," and "culturally sensitive care." In total, 30 articles, which included transgender patients and their families and nurses, doctors, and health professionals who provided care to transgender patients, were selected for review. Data were extracted and synthesized using tabular and narrative summaries and thematic synthesis. FINDINGS Of 30 articles, 23 were discussion papers, 5 research articles, and 1 each case study and an integrative review. This indicates an apparent dearth of literature about ethical and culturally sensitive care of transgender individuals. The review identified that healthcare professionals should educate themselves about sensitive issues, become more self-aware, put transgender individual in charge during care interactions, and adhere to the principles of advocacy, confidentiality, autonomy, respect, and disclosure. CONCLUSIONS The review identified broad approaches for the provision of ethical and culturally competent care. The identified approaches could be used as the baseline, and further research is warranted to develop and assess organizational and individual-level approaches.
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Affiliation(s)
| | | | - Ahtisham Younas
- 7512Memorial University of Newfoundland, Canada; CareGivers, Canada; Swat College of Nursing, Pakistan
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25
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Magalhães M, Aparicio-García ME, García-Nieto I. Transition Trajectories: Contexts, Difficulties and Consequences Reported by Young Transgender and Non-Binary Spaniards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186859. [PMID: 32961787 PMCID: PMC7558185 DOI: 10.3390/ijerph17186859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 12/02/2022]
Abstract
The transition process can have a significant impact on young transgender and non-binary individuals (TNBI), especially regarding their mental health. As such, this study aimed to explore the encountered difficulties and expectations of 225 young adults, between 14 and 25 years old, who identify themselves as TNBI. Four different aspects were analyzed: difficulties related to the transition process; main current difficulties; if the current difficulties are due to the participants’ sexual orientation or gender identity; and if participants feel the need of changing something in their lives. Several obstacles either before, during or after the transition process were identified; and these obstacles have serious consequences in TBNI’s mental health. Questions regarding legislation, discrimination, transphobia, lack of social support, the pathologization of transgenderism, low self-esteem, anxiety symptomatology, among others, were pointed out by the participants. The narratives collected and analyzed in the present study appear as important inputs to the literature, which can be translated into the basis of further investigations and the improvement of professional practices in the health field.
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Affiliation(s)
- Mariana Magalhães
- Work, Social and Differential Psychology Department, Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain;
| | - Marta E. Aparicio-García
- Work, Social and Differential Psychology Department, Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain;
- Correspondence:
| | - Isidro García-Nieto
- LGBTI Service of Madrid Community; C/ Alcalá, 22, 5° dcha, 28014 Madrid, Spain;
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26
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Konrad M, Kostev K. Increased prevalence of depression, anxiety, and adjustment and somatoform disorders in transsexual individuals. J Affect Disord 2020; 274:482-485. [PMID: 32663979 DOI: 10.1016/j.jad.2020.05.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to explore rates of depression, anxiety, and adjustment and somatoform disorders in a large sample of transsexual individuals (TSI), compared with matched non-TSI cohorts from general practices in Germany. METHODS Individuals initially documented as transsexual (index date) between January 2010 and December 2018 were identified in 468 general practices (GP) from the IMS Disease Analyzer database (IQVIA). Non-transsexual women (NTSW) and men (NTSM) were matched (1:1) with transsexual individuals by age, index year, and physician. The main outcome measure was the prevalence of depression, anxiety, and adjustment and somatoform disorders among TSI compared to NTSW and NTSM. RESULTS A total of 535 TSI, 535 NTSW, and 535 NTSM were analyzed (mean age in each group was 35 years). Depression was documented in 20% of TSI versus 7.7% of NTSW and 5.5% of NTSM (p < 0.001), reaction to severe stress and adjustment disorders in 10% of TSI versus 4.3% of NTSW and 2.9% of NTSM (p < 0.001), somatoform disorders in 9.7% of TSI versus 5.8% of NTSW and 5.8% of NTSM (p 0.016), and anxiety disorders in 5.8% of TSI versus 1.9% of NTSW and 1.6% of NTSM, (p < 0.001). CONCLUSION Our findings indicate a need to promote TSI mental health. Furthermore, primary care physicians and psychiatrists should be aware of the importance of detecting and treating mental disorders in TSI and thereby improve their quality of life.
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Affiliation(s)
- Marcel Konrad
- FOM University of Applied Sciences for Economics and Management, Frankfurt, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Main Airport Center, Unterschweinstiege 2-14, 60549 Frankfurt, Germany.
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