Transgender Adults' Public Bathroom-Related Stressors and Their Association with Depressive Symptoms: A Nationwide Cross-Sectional Study in South Korea

Public Restroom Access and Mental Health Among Gender-Minoritized Individuals in China

This cross-sectional study assesses the adequacy of gender-neutral public restrooms and examines the association of public restroom–related stress with mental health among gender-diverse individuals in China.

Situational Avoidance and Its Association with Mental Health Among Transgender Adults in South Korea: A Nationwide Cohort Study

Purpose: In fear of discrimination or unwanted disclosure of their transgender identity, transgender and nonbinary (TGNB) people may commonly avoid daily activities. We assessed the prevalence of situational avoidance among TGNB people and examined its associations with mental health outcomes. Methods: We analyzed data from a longitudinal survey conducted at baseline (2020) and follow-up (2021) among 268 TGNB people in South Korea. Situational avoidance due to transgender identity within the past 12 months was assessed based on 12 kinds of daily activities (e.g., public bathroom use, job applications, and hospital visits). Past-week depressive symptoms and past 2-week anxiety symptoms were measured with the Center for Epidemiologic Studies-Depression Scale and General Anxiety Disorder Scale, respectively. Results: Of 268 participants, 135 (50.4%) have ever avoided daily activities. The most frequently reported situational avoidance was public bathroom use (32.1%), followed by job applications (24.3%) and hospital visits (12.3%). After adjusting for confounders including baseline depressive symptoms and experience of anti-transgender discrimination, participants with any situational avoidance experience were 1.30 times (95% confidence intervals [CI] = 1.01-1.69) more likely to have anxiety symptoms compared with those without situational avoidance experience. In particular, participants who avoided three or more kinds of daily activities were 1.40 times (95% CI = 1.02-1.93) more likely to have anxiety symptoms than those without any experience of situational avoidance. No association was observed with depressive symptoms. Conclusion: Multilateral interventions including anti-discrimination law enactment are necessary to reduce transphobia and provide support for TGNB people in Korea, thus reducing their fear of participating in daily activities and promoting their mental well-being.

Does discrimination prevent transgender and gender diverse people from seeking healthcare?: A nationwide cohort study in South Korea

Introduction

Using Asia's first nationwide cohort dataset, this study aimed to assess the prevalence of anti-transgender discrimination and healthcare avoidance and delay (HAD) and examine their associations among transgender and gender diverse (TGD) adults in South Korea.

Methods

We analyzed a two-wave (2020-2021) longitudinal dataset of 190 Korean TGD adults. Anti-transgender discrimination were classified accordingly: experienced at (1) neither wave, (2) baseline (2020) only, (3) follow-up (2021) only, and (4) both waves. We also asked about HAD in the past 12 months at follow-up for both transition-related and non-transition-related healthcare services. Multivariate modified Poisson regression was used to examine the associations between anti-transgender discrimination and HAD.

Results

Of 190 participants, 102 (53.7%) experienced anti-transgender discrimination at both waves, and 130 (68.4%) reported HAD at follow-up. Compared to those without any experiences of anti-transgender discrimination, those who experienced it in both waves had a 1.78-times (95% CI: 1.21-2.63) higher prevalence of non-transition-related HAD, but not among those who experienced it in either wave. In contrast, anti-transgender discrimination was not associated with transition-related HAD.

Conclusion

In order to enhance healthcare access for transgender and gender diverse (TGD) individuals, it is necessary to implement interventions, such as anti-discrimination laws, that protect them from discrimination.

Transgender-specific COVID-19-related stressors and their association with depressive symptoms among transgender adults: A nationwide cross-sectional survey in South Korea

Introduction

COVID-19 has disproportionately impacted marginalized groups, including transgender populations, reproducing and exacerbating inequalities and vulnerabilities that existed in those groups prior to the pandemic. This study aimed to assess the prevalence of transgender-specific COVID-19-related stressors and their association with depressive symptoms among South Korean transgender adults.

Methods

We conducted a nationwide cross-sectional study of 564 South Korean transgender adults (trans women, trans men, and nonbinary people) from October 7 to October 31, 2020. We measured four transgender-specific COVID-19-related stressors as follows: (A) had difficulty receiving gender-affirming healthcare due to economic hardship related to COVID-19, (B) had difficulty receiving gender-affirming healthcare due to limited access to hospitals under the COVID-19 situation, (C) had difficulty purchasing a public face mask due to gender information on an identification card, and (D) avoided getting a COVID-19 test in fear of unfair treatment and dirty looks due to gender identity, despite having COVID-19 symptoms. Past-week depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale.

Results

Of the total participants, 30.7% experienced any of the four transgender-specific COVID-19-related stressors, and 70.2% were classified as having depressive symptoms during the past week. We found statistically significant associations with depressive symptoms among participants who reported that they had difficulty receiving gender-affirming healthcare due to either economic hardship (adjusted prevalence ratio [aPR] = 1.20, 95% Confidence Interval [CI] = 1.05-1.37) or limited access to hospitals (aPR = 1.15, 95% CI = 1.00-1.32), respectively. Furthermore, those who had two or more of the four transgender-specific COVID-19-related stressors were 1.21 times (95% CI = 1.05-1.40) more likely to report depressive symptoms, compared to those who did not report any stressor.

Conclusion

Transgender-specific COVID-19-related stressors may negatively influence depressive symptoms among South Korean transgender adults. Given these findings, transgender-inclusive interventions should be implemented at the policy level during the COVID-19 pandemic in South Korea.