1
|
Goldenberg T, Tanner AE, McGuire T, Alonzo J, Mann-Jackson L, Refugio Aviles L, Galindo CA, Bessler PA, Courtenay-Quirk C, Garcia M, Reboussin BA, Rhodes SD. The Role of Stigma and Resilience in Healthcare Engagement Among Transgender Latinas in the U.S. South: Baseline Findings from the ChiCAS Study. J Immigr Minor Health 2024:10.1007/s10903-024-01605-6. [PMID: 38809298 DOI: 10.1007/s10903-024-01605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
Research demonstrates that stigma and resilience influence transgender peoples' healthcare use. Less is known about transgender Latinas in the U.S. South who face multilevel barriers to healthcare access. We used baseline data from the ChiCAS intervention study. Using logistic regression, we examined how stigma (perceived discrimination related to gender identity, race/ethnicity, sexual behavior and perceived documentation status and internalized transphobia), and resilience (ethnic group pride and social support) are associated with two healthcare outcomes (use of routine medical care and medically supervised gender-affirming hormones). We also explored barriers to accessing both types of care. After removing 13 participants with missing data, our sample size was 131 transgender Latinas in the U.S. South. Most participants (74.8%, n = 98) received routine medical care in the past year and 57.3% (n = 75) had ever received medically supervised gender-affirming hormones. Reports of discrimination were highest for gender identity and documentation status. Race/ethnicity-based discrimination was positively associated with accessing routine medical care in the past year (OR = 1.94, p = 0.048). Having more social support was positively associated with care (routine care: OR = 3.48, p = 0.002 and gender-affirming hormones: OR = 2.33, p = 0.003). The most commonly reported barriers to accessing both types of care included cost, insurance, and not knowing where to go. Findings highlight the importance of social support for healthcare use among transgender Latinas. Social support may be especially important when considering the unique experiences of discrimination faced by transgender Latinas in the U.S. South.
Collapse
Affiliation(s)
- Tamar Goldenberg
- Department of Public Health Education, University of North Carolina Greensboro, 1408 Walker Avenue 437 Mary Channing Coleman Building Greensboro, Winston-Salem, NC, 27402, USA.
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, 1408 Walker Avenue 437 Mary Channing Coleman Building Greensboro, Winston-Salem, NC, 27402, USA
| | - Tucker McGuire
- Department of Public Health Education, University of North Carolina Greensboro, 1408 Walker Avenue 437 Mary Channing Coleman Building Greensboro, Winston-Salem, NC, 27402, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lucero Refugio Aviles
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Carla A Galindo
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia A Bessler
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cari Courtenay-Quirk
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Scott D Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, USA
| |
Collapse
|
2
|
Ralston AL, Holt NR, Andrews AR, Huit TZ, Puckett JA, Woodruff N, Mocarski R, Hope DA. Mental Health and Marginalization Stress in Transgender and Gender Diverse Adults: Differences between Urban and Non-Urban Experiences. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2024; 11:165-176. [PMID: 38577413 PMCID: PMC10989840 DOI: 10.1037/sgd0000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background Transgender and gender diverse (TGD) individuals face high rates of psychological distress, including depression, anxiety, and suicide risk. Further, TGD individuals living outside of urban areas experience additional disparities compared to their urban counterparts. Minority stress theory states that minority stressors (termed marginalization stressors for this paper), such as experiences of discrimination and internalized transphobia, lead to psychological distress. The current study compared marginalization stressors across rural (population less than 2,500), urban cluster (population between 2,500 and 50,000), and urban (population greater than 50,000) samples and tested the degree to which these stressors account for differences across areas of residence. Methods Participants were 225 TGD individuals who completed an online survey that included measures of depression, anxiety, suicidal ideation marginalization stress, and protective factors. Results In the first model, mental health outcomes, marginalization stressors, and protective factors differed between areas. Urban cluster participants reported experiencing higher levels of depression, anxiety, and suicidal ideation and rural participants reported experiencing higher levels of depression suicidal ideation than urban participants. Both rural and urban cluster participants reported more experiences of several marginalization stressors. In the subsequent path model, indirect effects between area and marginalization stress variables were significant, but urban cluster participants still reported higher depression, anxiety, and suicidal ideation symptoms (p-values < .05). Discussion We demonstrate that marginalization stress processes appear to account for some of the differences between TGD individuals living in urban, rural, and urban cluster areas. The differences between areas largely persist, however, after controlling for marginalization stress, especially when comparing urban with urban cluster areas.
Collapse
|
3
|
Chaudhry A, Hebert-Beirne J, Hanneke R, Alessi EJ, Mitchell U, Molina Y, Chebli P, Abboud S. The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review. LGBT Health 2024; 11:1-19. [PMID: 37540144 DOI: 10.1089/lgbt.2022.0392] [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] [Indexed: 08/05/2023] Open
Abstract
Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.
Collapse
Affiliation(s)
- Aeysha Chaudhry
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Rosie Hanneke
- Department of Information Services & Research, Library of the Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Edward J Alessi
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Uchechi Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Perla Chebli
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| |
Collapse
|
4
|
Termorshuizen F, de Vries AL, Wiepjes CM, Selten JP. The risk of psychosis for transgender individuals: a Dutch national cohort study. Psychol Med 2023; 53:7923-7932. [PMID: 37539460 PMCID: PMC10755224 DOI: 10.1017/s0033291723002088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The stressful minority position of transgender persons may result in a high risk of psychosis. Conflicting data suggest that the observed risk depends on setting of recruitment. We assessed the relative risk of non-affective psychotic disorder (NAPD) in a large, representative cohort of transgender persons. METHODS This cohort was composed using: data on legal sex change from the Dutch population registry and data on dispensing of cross-sex hormones (route 1), and a registry of insurance claims from mental health care including persons with a diagnosis of gender identity disorder (DSM-IV) or gender dysphoria (DSM-5) (route 2). They were matched by sex at birth, calendar year and country of birth to controls from the general population. Transgender persons (N = 5564) and controls (N = 27 820), aged 16-60 years at 1 January 2011, were followed until the first insurance claim for NAPD in 2011-2019. RESULTS The incidence rate ratio (IRR) of NAPD for transgender persons selected exclusively through route 1 (N = 3859, IRR = 2.00, 95%-CI 1.52-2.63) was increased, but significantly lower than the IRRs for those selected exclusively through route 2 (N = 694, IRR = 22.15, 95%-CI 13.91-35.28) and for those found by both routes (N = 1011, IRR = 5.17, 95%-CI 3.57-7.49; p value for differences in IRR < 0.001). CONCLUSIONS This study supports the social defeat-hypothesis of NAPD. The results also show the presence of a substantial number of transgender persons with severe psychiatric problems who have not (yet) taken steps to gender-affirmative care.
Collapse
Affiliation(s)
- Fabian Termorshuizen
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, the Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Annelou L.C. de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Chantal M. Wiepjes
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, the Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| |
Collapse
|
5
|
Rashid A, Afiqah SN. Depression, Anxiety, and Stress among the Malay Muslim Transgender Women in Northern Malaysia: A Mixed-Methods Study. Issues Ment Health Nurs 2023; 44:1124-1132. [PMID: 37738219 DOI: 10.1080/01612840.2023.2242488] [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] [Indexed: 09/24/2023]
Abstract
The study aimed to determine the prevalence and associated factors of depression, anxiety, and stress among the Malay Muslim transgender women in the northwestern states of Peninsular Malaysia. This mixed-method, quantitative and qualitative, study was conducted in collaboration with a nongovernmental organization that works incognito to advocate and help transgender women. Participants were recruited using a snowball method. A self-administered questionnaire was used that included information related to the demographic background of participants, and the Depression, Anxiety and Stress Scale and Oslo-3 Social Support Scale. For the qualitative part of the study, 13 in-depth interviews were conducted using a semi-structured interview guide in the Malay language. The study showed the prevalence of depression, anxiety, and stress was 33.3% (n = 47), 48.2% (n = 68), and 26.2% (n = 37), respectively. Difficulty in finding employment was significantly associated with depression, anxiety, and stress, whereas a history of physical abuse was also significantly associated with anxiety, and being ostracized by friends was significantly associated with depression. During in-depth interviews, suicidal thoughts were mentioned by several respondents and many lamented poor support from family and cisgender friends, and they complained of societal pressure. In addition to being physically and verbally abused, some also complained about cyberbullying. There is an urgent need to identify those with mental distress among transgender women in Malaysia to enable early interventions. More research is needed to identify mental health issues among transgender women and highlight these issues to sensitize the general public to their problems.
Collapse
Affiliation(s)
- Abdul Rashid
- Department of Public Health Medicine, RCSI & UCD Malaysia Campus, Penang, Malaysia
| | - Siti Nur Afiqah
- Department of Public Health Medicine, RCSI & UCD Malaysia Campus, Penang, Malaysia
- Centre for Research on Women and Gender (KANITA), University Sains Malaysia, Penang, Malaysia
| |
Collapse
|
6
|
Nolan CJ, Roepke TA, Perreault ML. Beyond the Binary: Gender Inclusivity in Schizophrenia Research. Biol Psychiatry 2023; 94:543-549. [PMID: 37003472 DOI: 10.1016/j.biopsych.2023.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Abstract
Schizophrenia is a severe neuropsychiatric disorder with significant differences in the incidence and symptomology between cisgender men and women. In recent years, considerably more attention has been on the inclusion of sex and gender in schizophrenia research. However, the majority of this research has failed to consider gender outside of the socially constructed binary of men and women. As a result, little is known about schizophrenia in transgender and gender-nonconforming populations. In this review, we present evidence showing that transgender and gender-nonconforming individuals have elevated risk of developing schizophrenia, and we discuss minority stress theory and other potential factors that may contribute to this risk. The need for inclusion of transgender and gender-nonconforming communities in schizophrenia research is emphasized, alongside a discussion on considerations and challenges associated with this type of research. Finally, we offer specific strategies to make research on schizophrenia, and research on other neuropsychiatric disorders, more inclusive of those populations that do not fall within the socially constructed gender binary. If we are to succeed in the development of more personalized therapeutic approaches for all, a better understanding of the variability of the human brain is needed.
Collapse
Affiliation(s)
- Caitlin J Nolan
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Troy A Roepke
- Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Melissa L Perreault
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada.
| |
Collapse
|
7
|
Xu L, Chang R, Wang H, Xu C, Yu X, Chen H, Wang R, Liu S, Liu Y, Wang Y, Cai Y. Validation of the Patient Health Questionnaire-9 for Suicide Screening in Transgender Women. Transgend Health 2023; 8:450-456. [PMID: 37810941 PMCID: PMC10551761 DOI: 10.1089/trgh.2021.0075] [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 High prevalence of depression in transgender women highlights the importance of validating the measure to assess depression. Moreover, depression is significantly associated with suicide across research studies. The aims of the current study were to validate a Chinese-language version of the Patient Health Questionnaire-9 (PHQ-9) and to assess operating characteristics of the PHQ-9 for suicide screening in transgender women. Methods With the approval of an Institutional Review Board (IRB), a total of 198 transgender women living in Shenyang, China, were recruited, and asked to complete the PHQ-9, including measures of their suicidal ideation, planning and attempt. Results A one-factor model of the PHQ-9 was supported in the current sample, showing good reliability and validity. The best cutoff point for the PHQ-9 in suicidal ideation was 17, with a sensitivity/specificity of 77.78%; the best cutoff point for PHQ-9 in suicidal planning was 17, with a sensitivity of 81.82% and a specificity of 73.26%; and the best cutoff point for PHQ-9 in suicidal attempt was 20, with a sensitivity of 75% and a specificity of 90.21%. Conclusion Findings supported the validity of the PHQ-9. With potential clinical or research application, the PHQ-9 can be an efficient instrument for suicide screening in transgender women.
Collapse
Affiliation(s)
- Lulu Xu
- Department of Student Affairs, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 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
- 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
| | - Hui Chen
- 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
| | - Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 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
| |
Collapse
|
8
|
Zamudio-Haas S, Koester K, Venegas L, Salinas A, Herrera C, Gutierrez-Mock L, Welborn L, Deutsch MB, Sevelius J. "Entre Nosotras:" a qualitative study of a peer-led PrEP project for transgender latinas. BMC Health Serv Res 2023; 23:1013. [PMID: 37730598 PMCID: PMC10510224 DOI: 10.1186/s12913-023-09707-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: 12/16/2022] [Accepted: 06/15/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV/AIDS Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx staff led intervention adaptation and activities. METHODS This paper engages qualitative methods to describe how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of ethnographic observation of intervention activities and recorded field notes. We conducted thematic analysis. RESULTS Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support "entre nosotras" ("between us women/girls"). The combination of these factors contributed to the intervention's success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcome and "en casa/ at home" in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. A gender affirming, bilingual clinician and peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. CONCLUSIONS Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.
Collapse
Affiliation(s)
- Sophia Zamudio-Haas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA.
| | - Kim Koester
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luz Venegas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Ariana Salinas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Cinthya Herrera
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luis Gutierrez-Mock
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Layla Welborn
- La Clinica de La Raza, 3451 East 12th Street, CA, 94601, Oakland, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Jae Sevelius
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| |
Collapse
|
9
|
Gadhiraju T, Jalihal S, Ankola AV, Pai Khot AJ, Tom A, K RSK. Prevalence of dental caries and periodontal disease among transgenders in Belagavi district, Karnataka, India: A cross-sectional study. SPECIAL CARE IN DENTISTRY 2023; 43:546-553. [PMID: 36435634 DOI: 10.1111/scd.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/28/2022]
Abstract
AIM To assess the oral health practices and the prevalence of dental caries, and periodontal disease among transgenders. METHODS AND RESULTS The study was conducted on a sample of 180 participants from the transgender community in Belagavi district over a course of two months. A trained and calibrated examiners recorded oral health status according to WHO dentition status and treatment needs (1997) and Community Periodontal Index (CPI) under the supervision of the subject expert. Chi-square test, spearman's rank correlation coefficient test, multiple linear regression and logistic regression were applied. The statistical significance was set at p ≤ .05 for all the tests. The prevalence of dental caries and periodontal disease among transgenders was 72.2% and 92.2%, respectively. A positive linear correlation and a significant relationship was found between the oral hygiene practices/deleterious habits and dental caries among the transgenders. Multiple linear regression model revealed that the prevalence of dental caries and periodontal disease was significantly associated with age and oral hygiene practices. CONCLUSION The prevalence of dental caries and periodontal diseases among transgenders was high. These results may be of use to promote oral health promotion and establishing a paradigm for dentists to work toward improving oral health.
Collapse
Affiliation(s)
- Tejaswi Gadhiraju
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Sagar Jalihal
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Anil V Ankola
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Atrey J Pai Khot
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Aleena Tom
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Ram Surath Kumar K
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| |
Collapse
|
10
|
Stults CB, Gao S, Brandt SA, Taber JL, Lynn SG, Kaczetow W, Lee G, Cruise A, Krause KD. Intimate Partner Violence and Mental Health Among Transgender and Gender Diverse Young Adults. JOURNAL OF FAMILY VIOLENCE 2023:1-15. [PMID: 37358980 PMCID: PMC10220337 DOI: 10.1007/s10896-023-00579-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/28/2023]
Abstract
Purpose Research indicates that multiple forms of intimate partner violence (IPV) may be prevalent among transgender and gender diverse (TGD) people, including general forms of IPV (psychological, physical, sexual), as well as identity-specific forms (transgender-related IPV (T-IPV), identity abuse (IA)). Studies also suggest that IPV is associated with negative mental health outcomes in TGD populations, including depression, anxiety, and posttraumatic stress disorder (PTSD). However, little is known about IPV and its association with mental health among TGD young adults. This is noteworthy, as this is a key developmental period for many TGD individuals. Methods Thus, the present study sought (1) to estimate the lifetime and past-year prevalence of several forms of general and identity-specific IPV among a sample of (N = 200) TGD young adults in New York City and (2) to assess the associations between IPV with recent symptoms of depression, anxiety, and PTSD. To address the study aims, a cross-sectional quantitative survey was conducted between July 2019 and March 2020. Results Regarding lifetime IPV, IA was most prevalent (57.0%), followed by sexual (40.0%), physical (38.5%), T-IPV (35.5%), and psychological IPV (32.5%). Regarding past-year IPV, psychological IPV was most common (29.0%), followed by IA (27.5%), physical (20.0%), T-IPV (14.0%), and sexual IPV (12.5%). Results of hierarchical regression models indicate that lifetime IA was related to depression, anxiety, and PTSD, while past-year T-IPV was only associated with depression. Conclusions Taken together, these findings suggest that IPV is highly prevalent among TGD young adults and that IPV - especially identity-specific forms - warrants additional attention from researchers, healthcare professionals, and policymakers, as it may place this population at risk for negative mental health outcomes.
Collapse
Affiliation(s)
- Christopher B. Stults
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
- Department of Psychology, The Graduate Center, City University of New York, New York, USA
| | - Stan Gao
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
| | | | - Jamie L. Taber
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
- Department of Psychology, The Graduate Center, City University of New York, New York, USA
| | - Savannah G. Lynn
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
| | - Walter Kaczetow
- Department of Psychology, The Graduate Center, City University of New York, New York, USA
| | - Gabin Lee
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
| | - Andrew Cruise
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
| | - Kristen D. Krause
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, USA
| |
Collapse
|
11
|
Valentine SE, Smith AM, Miller K, Hadden L, Shipherd JC. Considerations and complexities of accurate PTSD assessment among transgender and gender diverse adults. Psychol Assess 2023; 35:383-395. [PMID: 36656725 PMCID: PMC10101923 DOI: 10.1037/pas0001215] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Posttraumatic stress disorder (PTSD) assessment among transgender and gender diverse (TGD) adults is complex because the literature offers little guidance on affirming assessment that accurately captures both trauma- and discrimination-related distress. This study aimed to characterize threats to precise PTSD assessment that arose during the Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (CAPS-5). Our sample (N = 44) included trans women (38%), trans men (25%), nonbinary people (23%), and other TGD identities (14%). Participants were mostly White (75%), non-Latinx (82%), educated (91% at least some college), with a mean age of 37 years (SD = 15.5). Demographic and CAPS-5 scoring data as well as content analysis of audio-recorded CAPS-5 interviews are reported. All participants reported trauma exposure, and nearly half met PTSD diagnostic criteria (49%). Interpersonal assault was a common trauma type linked to posttraumatic symptoms (77%); 41% were sexual assaults; and 41% were discrimination-based (e.g., linked to gender identity) physical or sexual assaults. Qualitative findings suggest how and when discrimination-related experiences may threaten PTSD assessment accuracy, leading to overpathologizing or underdetection of symptoms, for example, (a) initial selection of a noncriterion A discrimination event as "worst event," (b) linking symptoms to internalized transphobia (rather than trauma), and (c) linking victimization to gender identity/expression. Threats to PTSD assessment were more common when symptoms were linked to discrimination-based traumatic events, suggesting the importance of understanding contextual factors of index events. We offer a framework for understanding unique challenges to the assessment of PTSD among TGD people and provide recommendations for improving assessment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Sarah E. Valentine
- Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA, USA
| | - Ash M. Smith
- The Graduate Center, City University of New York, New York, NY, USA
| | | | - Laura Hadden
- Boston University School of Medicine, Boston, MA, USA
| | - Jillian C. Shipherd
- Boston University School of Medicine, Boston, MA, USA
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington, DC, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| |
Collapse
|
12
|
Mayo Bs D, Le PhD B. Perceived discrimination and mental health in college students: A serial indirect effects model of mentoring support and academic self-concept. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1184-1195. [PMID: 34242542 DOI: 10.1080/07448481.2021.1924725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/28/2021] [Accepted: 04/25/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Examine the direct and indirect effects of perceived discrimination, mentoring support, and academic self-concept on college student mental health. PARTICIPANTS Three hundred fifteen undergraduates of minorized gender (72%), ethnic (57%), and sexual (37%) identities. METHODS An online survey assessed perceived discrimination, mentoring support, academic self-concept, and mental health. RESULTS Perceived discrimination was associated with mentoring support (B=-0.11, p=.019), academic self-concept (B=-0.13, p<.001), and mental health (B=-0.15, p<.001). Additionally, mentoring support (B = 0.29, p<.001) and academic self-concept (B = 0.53, p<.001) were associated with mental health, and each other (B = 0.25, p<.001). Significant indirect effects were observed such that mentoring support and academic self-concept, individually and collectively, contributed to the association between perceived discrimination and mental health. CONCLUSIONS Addressing discrimination, creating supportive relationships, and facilitating academic growth may reduce mental health concerns in undergraduate populations, thereby having implications for college transition and retention strategies.
Collapse
Affiliation(s)
- Daniel Mayo Bs
- Department of Psychology, Haverford College, Haverford, Pennsylvania, USA
| | - Benjamin Le PhD
- Department of Psychology, Haverford College, Haverford, Pennsylvania, USA
| |
Collapse
|
13
|
Reyes ME, Simpson L, Sullivan TP, Contractor AA, Weiss NH. Intimate Partner Violence and Mental Health Outcomes Among Hispanic Women in the United States: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:809-827. [PMID: 34779327 DOI: 10.1177/15248380211043815] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Hispanic women in the United States experience disproportionate mental health impacts of intimate partner violence (IPV). Following the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines, we synthesized the existing knowledge based on IPV and mental health outcomes among Hispanic women in the United States. In May 2020, we searched five electronic databases (i.e., MEDLINE, PILOTS, PSYCInfo, PSYCArticles, and EMBASE). From the initial 1,180 results, 13 articles met inclusion criteria for this review (written in English, empirical study, focus on the experiences of victimization from an intimate partner, focus on mental health outcomes occurring in the person experiencing IPV, included women who identify as Hispanic, and included participants residing in the United States), representing 4,060 women. Findings highlighted significant positive associations between IPV (n = 13; 4,060 women) and general mental health outcomes (n = 4; 759 women) as well as the specific outcomes of depression (n = 12; 2,661 women), anxiety (n = 1; 274 women), post-traumatic stress disorder (n = 3; 515 women), and substance misuse (n = 2; 1,673 women) among Hispanic women in the United States. Limitations included heterogeneity across Hispanic populations and methodological differences between studies. Key avenues for future research were identified, including the need to examine mental health outcomes understudied in relation to IPV among Hispanic women (e.g., personality, obsessive-compulsive, and eating disorders) and to identify cultural and demographic factors (e.g., nativity status, level of acculturation) that may influence relations between IPV and mental health outcomes among Hispanic women. Such research can inform prevention and intervention efforts aimed at improving mental health among Hispanic women in the Untied States experiencing IPV.
Collapse
|
14
|
Hajek A, König HH, Buczak-Stec E, Blessmann M, Grupp K. Prevalence and Determinants of Depressive and Anxiety Symptoms among Transgender People: Results of a Survey. Healthcare (Basel) 2023; 11:healthcare11050705. [PMID: 36900710 PMCID: PMC10000997 DOI: 10.3390/healthcare11050705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVES The aim was to investigate the prevalence of probable depression and probable anxiety and to investigate the determinants of depressive symptoms and anxiety symptoms among transgender people. METHODS In this "Transgender Survey" (n = 104) we included transgender people who had joined self-help groups to obtain and share information about the gender-affirming surgeries performed at the Division of Plastic, Reconstructive and Aesthetic Surgery at the University Medical Center Hamburg-Eppendorf. Data collection took place between April and October 2022. To measure probable depression, the patient health questionnaire-9 was used. The generalized anxiety disorder-7 was used to quantify probable anxiety. RESULTS The prevalence of probable depression was 33.3% and it was 29.6% for probable anxiety. Multiple linear regressions showed that both more depressive symptoms and anxiety symptoms were significantly associated with younger age (β = -0.16, p < 0.01; β = -0.14, p < 0.01), being unemployed (e.g., full-time employed compared to unemployment: β = -3.05, p < 0.05; β = -2.69, p < 0.05), worse self-rated health (β = -3.31, p < 0.001; β = -1.88, p < 0.05), and having at least one chronic disease (β = 3.71, p < 0.01; β = 2.61, p < 0.05). CONCLUSIONS Remarkably high prevalence rates were identified among transgender people. Furthermore, risk factors of poor mental health (e.g., unemployment or younger age) were identified-which can help to address transgender people at risk for poor mental health.
Collapse
Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
- Correspondence:
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Elzbieta Buczak-Stec
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Marco Blessmann
- Division of Plastic, Reconstructive and Aesthetic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Katharina Grupp
- Division of Plastic, Reconstructive and Aesthetic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| |
Collapse
|
15
|
Parrott DJ, Leone RM, Schipani-McLaughlin AM, Salazar LF, Nizam Z, Gilmore A. Alcohol-Related Sexual Violence Perpetration Toward Sexual and Gender Minority Populations: A Critical Review and Call to Action. NEBRASKA SYMPOSIUM ON MOTIVATION 2023. [DOI: 10.1007/978-3-031-24426-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
|
16
|
Pandey AK, Seelman K. History of Sex Work Is Associated with Increased Risk of Adverse Mental Health and Substance Use Outcomes in Transgender Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15908. [PMID: 36497981 PMCID: PMC9735961 DOI: 10.3390/ijerph192315908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Understanding factors influencing mental health and substance use in transgender and gender diverse people is critical to reducing disparities in this population. We sought to investigate whether a history of sex work was associated with increased prevalence of poor mental health, substance use, and a negative experience within drug and alcohol treatment facilities. We conducted a secondary analysis of the data of 25,204 transgender respondents of the 2015 United States Transgender Survey. We estimated multiple logistic regressions to assess the association between a history of sex work and adverse mental health and substance use outcomes. We then estimated mean prevalence of adverse outcomes by type of sex work. Finally, we performed chi-square analysis to explore differences in mistreatment at drug and alcohol treatment facilities. Respondents with a history of sex work were significantly more likely to have poorer psychological health, suicidality, and substance use after adjusting for covariates. Among those who visited drug and alcohol treatment facilities, those with a history of sex work were significantly more likely to report adverse experiences (26.34% vs. 11.63%). Our findings highlight the increased risk of adverse outcomes in transgender sex workers and emphasize the need for interventions targeting this subgroup of transgender people.
Collapse
Affiliation(s)
- Ajay Keshav Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA 30912, USA
| | - Kristie Seelman
- School of Social Work, Georgia State University, Atlanta, GA 30302, USA
| |
Collapse
|
17
|
Messinger AM, Guadalupe-Diaz XL, Kurdyla V. Transgender Polyvictimization in the U.S. Transgender Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18810-NP18836. [PMID: 34463599 DOI: 10.1177/08862605211039250] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Relative to cisgender people, transgender individuals not only are at an elevated risk of experiencing at least one form of physical or sexual violence, but also at an increased risk of polyvictimization: that is, exposure to multiple types of violence over the life course. Given that polyvictimization increases vulnerability to adverse mental and physical health sequelae, there is a pressing need to identify which sociodemographic subgroups of transgender people are at greater risk of polyvictimization. Understanding these risk profiles will have important implications for developing transgender-specific models for violence prevention, screening, and intervention. Responding to this need in the literature, the present article offers secondary data analyses of the 2015 U.S. Transgender Survey, the largest study to-date of transgender people in the United States (N = 27,715 transgender adults), with participants selected from all 50 states and Washington, D.C., as well as several U.S. territories and overseas military bases. Multiple variable regressions examine sociodemographic predictors of five distinct forms of violence, as well as how many of these five violence types were experienced. The examined sociodemographic predictors included gender, sexual orientation, race-ethnicity, citizenship status, ever been homeless, has a disability, transgender outness, gender visual conformity, household income, and age. The five assessed violence victimization types included intimate partner violence, nonpartner sexual assault, antitransgender family violence, antitransgender physical violence during Kindergarten through 12th grade, and past-year antitransgender physical violence. With some exceptions, results indicate that more marginalized segments of transgender communities have a greater likelihood of experiencing polyvictimization. Recommendations are discussed for future research and service provision.
Collapse
|
18
|
Factors that drive mental health disparities and promote well-being in transgender and nonbinary people. NATURE REVIEWS PSYCHOLOGY 2022; 1:694-707. [PMID: 36187743 PMCID: PMC9513020 DOI: 10.1038/s44159-022-00109-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/09/2023]
Abstract
Transgender (or trans) is an umbrella term for individuals who experience their gender differently from what is associated with the sex they were assigned at birth. Individuals who are nonbinary experience their gender outside binary conceptions of gender. Although research has predominantly focused on negative mental health outcomes for transgender and non-binary (TNB) individuals, an emergent literature has begun to explore protective and health-promoting factors and dimensions of psychological well-being. In this Review, we discuss the sociocultural context for TNB people, beginning with a brief history of TNB identity before highlighting frameworks for understanding the higher prevalence of certain mental health concerns among TNB individuals. Next, we summarize the predictive factors associated with higher rates of depression, anxiety, suicidality, trauma-related concerns, disordered eating behaviours and substance use. We also review TNB coping, resilience and resistance to anti-trans stigma, as well as psychological well-being, flourishing and gender euphoria. Tying these topics together, we discuss affirming interventions for reducing mental health disparities and promoting psychological health in TNB individuals and communities. We conclude by discussing future research directions. Individuals who are transgender or nonbinary experience a higher prevalence of certain mental health concerns, including depression, anxiety and disordered eating behaviours. In this Review, Tebbe and Budge discuss these disparities along with factors that protect these individuals from negative outcomes and promote well-being.
Collapse
|
19
|
Clark KD, Lunn MR, Lev EM, Trujillo MA, Lubensky ME, Capriotti MR, Hoffmann TJ, Obedin-Maliver J, Flentje A. State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9916. [PMID: 36011548 PMCID: PMC9407724 DOI: 10.3390/ijerph19169916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018−2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.
Collapse
Affiliation(s)
- Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH 03824, USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Eliot M. Lev
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
| | - Michael A. Trujillo
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
| | | | - Thomas J. Hoffmann
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine San Francisco, San Francisco, CA 94143, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
- Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, CA 94143, USA
| |
Collapse
|
20
|
Clark KD, Sherman AD, Flentje A. Health Insurance Prevalence Among Gender Minority People: A Systematic Review and Meta-Analysis. Transgend Health 2022; 7:292-302. [PMID: 36033215 PMCID: PMC9398476 DOI: 10.1089/trgh.2020.0182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose Gender minority (GM) (people whose gender does not align with the sex assigned at birth) people have historically been insured at lower rates than the general population. The purpose of this review is to (1) assess the prevalence of health insurance among GM adults in the United States, (2) examine prevalence by gender, and (3) examine trends in prevalence before and after implementation of the Affordable Care Act. Methods Published articles from PubMed, EMBASE, and Web of Science databases before April 26th, 2019, were included. This review is registered on PROSPERO (CRD42019133627). Analysis was guided by a random-effects model to obtain a meta-prevalence estimate for all GM people and stratified by gender subgroup. Heterogeneity was assessed using a Q-test and I 2 measure. Results Of 55 included articles, a random pooled estimate showed that 75% GM people were insured (95% confidence interval [CI]: 0.71-0.79; p<0.001). Subgroup analysis by gender determined 70% of transgender women (95% CI: 0.64-0.76; p<0.001; I 2=97.16%) and 80% of transgender men (95% CI: 0.77-0.83; p=0.01; I 2=54.51%) were insured. Too few studies provided health insurance prevalence data for gender-expansive participants (GM people who do not identify as solely man or woman) to conduct analysis. Conclusion The pooled prevalence of health insurance among GM people found in this review is considerably lower than the general population. Standardized collection of gender across research and health care will improve identification of vulnerable individuals who experience this barrier to preventative and acute care services.
Collapse
Affiliation(s)
- Kristen D. Clark
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Athena D.F. Sherman
- Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, Georgia, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, UCSF, San Francisco, California, USA
| |
Collapse
|
21
|
Uyar B, Yucel I, Uyar E, Ateş Budak E, Kelle I, Bulbuloglu S. A case-control study on depression, anxiety, and belief in sexual myths in trans women. Front Psychiatry 2022; 13:955577. [PMID: 36699487 PMCID: PMC9868723 DOI: 10.3389/fpsyt.2022.955577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The purpose of our study was to investigate depression, anxiety, and belief in sexual myths in trans women. METHODS This is a prospective case-control study. The case group included 60 trans women who were referred to the Medical Biology and Genetics Department from various clinics of the research and training hospital where this study was conducted. The control group consisted of 60 healthy male individuals who presented to the same hospital for routine health follow-ups and collecting documents showing their health. In data collection, we used a Personal Information Form, the Sexual Myths Scale, and the Beck Depression and Anxiety Inventories. The IBM Statistical Package for the Social Sciences 25.0 was used to analyze the data. RESULTS In the case group, 26.7% of the participants were sex workers, and all were single. While 46.7% of the participants in the case group were living with their families, 66.7% were smokers, and 13.3% were receiving hormone treatment. All 60 participants in the control group were also single. The participants in the control group had higher levels of believing sexual myths and lower levels of anxiety and depression than those in the case group (p = 0.000). The mean scores of the participants in the control group in the Sexual Orientation and Sexual Violence subscales of the Sexual Myths Scale were higher than the mean scores of those in the case group (p < 0.05). CONCLUSION The trans women who participated in this study had higher levels of anxiety and depression and lower levels of believing sexual myths than the control group. The mental health of trans women can be disrupted due to various treatments they are exposed to in society such as stigma, discrimination, and violence. Their higher anxiety and depression levels in this study could be explained by this exposure. This exposure could also have led to their lower total scores in the Sexual Myths Scale, as well as lower scores in the Sexual Violence and Sexual Orientation subscales.
Collapse
Affiliation(s)
- Betul Uyar
- Department of Psychiatry, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Ilyas Yucel
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Emre Uyar
- Department of Pharmacology, Faculty of Pharmacy, Inonu University, Malatya, Turkey
| | - Elif Ateş Budak
- Department of Psychiatry, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Ilker Kelle
- Department of Medical Pharmacology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Semra Bulbuloglu
- Division of Surgical Nursing, Nursing Department, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| |
Collapse
|
22
|
Testing whether implicit emotion regulation mediates the association between discrimination and symptoms of psychopathology in late childhood: An RDoC perspective. Dev Psychopathol 2021; 33:1634-1647. [PMID: 34323206 DOI: 10.1017/s0954579421000638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Discrimination has been associated with adverse mental health outcomes, though it is unclear how early in life this association becomes apparent. Implicit emotion regulation, developing during childhood, is a foundational skill tied to a range of outcomes. Implicit emotion regulation has yet to be tested as an associated process for mental illness symptoms that can often emerge during this sensitive developmental period. Youth aged 9-11 were recruited for the Adolescent Brain Cognitive Development (ABCD) study. Associations between psychotic-like experiences, depressive symptoms, and total discrimination (due to race, ethnicity, nationality, weight, or sexual minority status) were tested, as well as associations with implicit emotion regulation measures (emotional updating working memory and inhibitory control). Analyses examined whether associations with symptoms were mediated by implicit emotion regulation. Discrimination related to decreased implicit emotion regulation performance, and increased endorsement of depressive symptoms and psychotic-like experiences. Emotional updating working memory performance partially mediated the association between discrimination and psychotic-like experiences, while emotional inhibitory control did not. Discrimination and implicit emotion regulation could serve as putative transdiagnostic markers of vulnerability. Results support the utility of using multiple units of analysis to improve understanding of complex emerging neurocognitive functions and developmentally sensitive periods.
Collapse
|
23
|
Manpreet K, Ajmal MB, Raheel SA, Saleem MC, Mubeen K, Gaballah K, Faden A, Kujan O. Oral health status among transgender young adults: a cross-sectional study. BMC Oral Health 2021; 21:575. [PMID: 34772385 PMCID: PMC8588739 DOI: 10.1186/s12903-021-01945-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transgender and gender nonconforming (TGNC) people are a marginalized set of the population that continues to experience health care inequalities. This study aimed to assess oral health parameters including Candida growth and intensity among TGNC adults. METHODS This cross-sectional study recruited two subgroups: 40 transgender and 40 control adults. Consented participants were interviewed and clinically examined. Data using the WHO oral health assessment forms were obtained. Samples for Candida growth and intensity analysis were collected from the dorsum surface of the tongue. RESULTS 27.5% of the transgender group was HIV seropositive. Oral nicotine stomatitis and leukoplakia are reported to be the most prevalent intra-oral lesions showing a prevalence of 27.5% and 20%, respectively. The dental and periodontal health parameters of the transgender group were worse than those of the control group. The intensity of Candida colonies was significantly higher in the test group (p = 0.014). CONCLUSION Poor oral health and significant oral mucosal disorders were reported in transgender adults that have shown a higher rate of behavioral risk factors such as tobacco and alcohol consumption. Further longitudinal studies in different world regions are warranted to understand the barriers to good oral health in transgender adults and how to implement effective prevention and management strategies.
Collapse
Affiliation(s)
- Kaur Manpreet
- Kodagu District Hospital, Madikeri, Karnataka, India
| | | | - Syed Ahmed Raheel
- Department of Oral Medicine and Radiology, KGF College of Dental Sciences, Kolar, Karnataka, India
| | | | | | - Kamis Gaballah
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Asmaa Faden
- Department of Oral Medicine, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Omar Kujan
- Oral Diagnostic and Surgical Sciences Division, UWA Dental School, The University of Western Australia, 17 Monash Avenue, Nedlands, WA, 6009, Australia.
| |
Collapse
|
24
|
Gailits N, Pastor-Bravo MM, Gastaldo D, Bajwa U, Bilbao-Joseph C, Castro C, Godoy S. Fighting for inclusion across borders: Latin American Trans women's health in Canada. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 23:5-23. [PMID: 35403120 PMCID: PMC8986298 DOI: 10.1080/26895269.2021.1988877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Worldwide, Trans women from Latin America experience some of the highest rates of violence, which has led many to emigrate. There is limited research exploring the experiences of Trans migrants, and most LGBTQI2S + migrant research focuses on immigrant gay men. This study uses the frameworks of Intersectionality and the Social Determinants of Health (SDoH) to examine the impact of migration on the health and wellbeing of Latin American Trans women living in Toronto, Canada. METHODOLOGY This qualitative arts-based study included nine participants and used hand mapping, a sociodemographic questionnaire, and focus groups to generate data. Data analysis encompassed inductive and deductive approaches and rigor was maintained through reflexivity and several verification strategies. RESULTS While migration was used as a safety strategy, participants' multiple identities as immigrants, Trans women, and Latinas, produced compounded experiences of oppression post-migration. Facing transphobia and xenophobia simultaneously, participants were forced to navigate precarious housing and employment, minimal social capital, and low social position. This limited their ability to exercise power and ultimately caused poor health and wellbeing post-migration; however, participants used sophisticated strategies to resist asymmetrical power relations, actively searching for safety and community participation, and caring for themselves and each other. CONCLUSION The participants fought for inclusion across borders of economic exclusion and gender identity, borders of power and social position, as well as geopolitical borders. Their intersectional experiences across these "borders" should be understood in the context of migration without liberation, consumption without income, compounding oppressions, as well as positive intersectionality. While the women's resistance and strength are positive by-products of fighting oppression, they cannot be the solution. Access to health and wellbeing should not be a privilege for some; it must be a right for all.
Collapse
Affiliation(s)
- Nicola Gailits
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
| | - M. M. Pastor-Bravo
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
- Nursing School of Cartagena, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - D. Gastaldo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - U. Bajwa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
| | - C. Bilbao-Joseph
- Global Migration & Health Initiative, University of Toronto, Toronto, Canada
- The Centre for Spanish Speaking Peoples, Toronto, Canada
| | - C. Castro
- Family Service Association, Toronto, Canada
- Ryerson School of Social Work, Ryerson University, Toronto, Canada
| | - S. Godoy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| |
Collapse
|
25
|
Tsang EYH. "Be the Dream Queen": Gender Performativity, Femininity, and Transgender Sex Workers in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11168. [PMID: 34769687 PMCID: PMC8583125 DOI: 10.3390/ijerph182111168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
An under-researched aspect of transgender sex workers in China pertains to their desires and expressions of femininity. Male-to-Female (MTF) transgender sex workers are a high-risk population prone to depression and stress regarding body image, intimate relationships marked by violence, and social stigma, rendering them vulnerable to hate crimes and discrimination. Ethnographic data from in-depth interviews with 49 MTF transgender sex workers indicate that sex, gender and feminine desire are mutable in the construction of self and subjectivity. This study uses the conceptual framework of gender performativity, that is, gender is performative and distinct from physical bodies and binary classifications. It is not only an individual's normative gender expressions which are based on the sex assigned at birth, but it also reinforces the normative gender performances of the gender binary. This article argues that the 49 MTF transgender sex workers are embodiments of gendered performances, displaying femininity to ameliorate hate crimes and discrimination as well as reinforce the masculinity and sexuality of their clients and intimate sex partners. Embracing their femininity constitutes a self-help program, enabling them to build self-confidence and develop a positive self-image in the face of overwhelming social disapproval.
Collapse
Affiliation(s)
- Eileen Y H Tsang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong 852, China
| |
Collapse
|
26
|
Kearns S, Kroll T, O‘Shea D, Neff K. Experiences of transgender and non-binary youth accessing gender-affirming care: A systematic review and meta-ethnography. PLoS One 2021; 16:e0257194. [PMID: 34506559 PMCID: PMC8432766 DOI: 10.1371/journal.pone.0257194] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Transgender and non-binary individuals frequently engage with healthcare services to obtain gender-affirming care. Little data exist on the experiences of young people accessing gender care. This systematic review and meta-ethnography aimed to identify and synthesise data on youths’ experiences accessing gender-affirming healthcare. Method A systematic review and meta-ethnography focusing on qualitative research on the experiences of transgender and non-binary youth accessing gender care was completed between April-December 2020. The following databases were used: PsychINFO, MEDLINE, EMBASE, and CINAHL. The protocol was registered on PROSPERO, international prospective register of Systematic Reviews (CRD42020139908). Results Ten studies were included in the final review. The sample included participants with diverse gender identities and included the perspective of parents/caregivers. Five dimensions (third-order constructs) were identified and contextualized into the following themes: 1.) Disclosure of gender identity. 2.) The pursuit of care. 3.) The cost of care. 4.) Complex family/caregiver dynamics. 5.) Patient-provider relationships. Each dimension details a complicated set of factors that can impact healthcare navigation and are explained through a new conceptual model titled “The Rainbow Brick Road”. Conclusion This synthesis expands understanding into the experience of transgender and non-binary youth accessing gender-affirming healthcare. Ryvicker’s behavioural-ecological model of healthcare navigation is discussed in relation to the findings and compared to the authors’ conceptual model. This detailed analysis reveals unique insights on healthcare navigation challenges and the traits, resources, and infrastructure needed to overcome these. Importantly, this paper reveals the critical need for more research with non-binary youth and research which includes the population in the design.
Collapse
Affiliation(s)
- Seán Kearns
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
- * E-mail: ,
| | - Thilo Kroll
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Donal O‘Shea
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
- Department of Endocrinology and Diabetes Mellitus, St Vincent’s University Hospital, Dublin, Ireland
| | - Karl Neff
- School of Medicine, University College Dublin, Dublin, Ireland
- National Gender Service, St Columcille’s Hospital, Dublin, Ireland
| |
Collapse
|
27
|
Farvid P, Vance TA, Klein SL, Nikiforova Y, Rubin LR, Lopez FG. The health and wellbeing of transgender and gender
non‐conforming
people of colour in the United States: A systematic literature search and review. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Panteá Farvid
- Psychology, Schools of Public Engagement The New School New York New York USA
| | - Thomas A. Vance
- Psychology, Schools of Public Engagement The New School New York New York USA
- Boys and Girls Clubs of America Atlanta Georgia USA
| | - Samantha L. Klein
- Psychology, School for Social Research The New School New York New York USA
| | | | - Lisa R. Rubin
- Psychology, School for Social Research The New School New York New York USA
| | - Felix G. Lopez
- Psychology, School for Social Research The New School New York New York USA
| |
Collapse
|
28
|
Ouma S, Tumwesigye NM, Ndejjo R, Abbo C. Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district: a cross-sectional study. BMC Public Health 2021; 21:1134. [PMID: 34120613 PMCID: PMC8201688 DOI: 10.1186/s12889-021-11207-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background Female sex workers operating in conflict-affected settings could be at a much greater risk of major depression. However, the epidemiology of major depression in this population remains understudied. We aimed to determine the prevalence and the factors associated with major depression among FSWs in the post-conflict Gulu district in Northern Uganda. Methods We conducted a cross-sectional study among 300 randomly selected adult female sex workers in Gulu. We utilized a pre-tested semi-structured questionnaire, embedded with MINI 7.0.0, to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex-work-related characteristics, alcohol and drug use, HIV status, and major depression. Then, data were entered into EPI INFO 7 and analyzed using logistic regression with the aid of STATA 14.0. Results The mean age (SD) of the study participants was 26.4 (± 6) years, 57.7% attained primary education, 51.7% never married, and 42.1% were living with HIV. The prevalence of major depression among FSWs in the district was 47.7%. In addition, the majority of the FSWs with major depression (91.0%) had either severe (50.4%) or moderate (40.6%) depressive symptoms. Independently, life stress (adjusted OR = 10.8, 95%CI: 5.67–20.57), living with HIV (adjusted OR = 2.25, 95%CI: 1.25–4.05), verbal abuse (adjusted OR = 2.27, 95%CI: 1.27–4.08), and older age (adjusted OR = 1.06, 95%CI: 1.01–1.12) all showed positive associations with major depression. Conversely, provision of sexual services from clients’ homes (adjusted OR = 0.50, 95%CI: 0.25–0.97), use of a non-barrier modern family planning method (adjusted OR = 0.44, 95%CI: 0.24–0.82), and daily intake of alcohol (adjusted OR = 0.50, 95%CI: 0.28–0.88) all showed negative associations with major depression. Conclusions There is a high prevalence of major depression among female sex workers in post-conflict Gulu. The high prevalence of major depression underscores the need for government and development partners to urgently and adequately address the mental health needs of female sex workers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11207-8.
Collapse
Affiliation(s)
- Simple Ouma
- Department of Research, The AIDS Support Organization (TASO), Kampala, Uganda. .,Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Nazarius Mbona Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
29
|
She R, Mo PKH, Ma T, Liu Y, Lau JTF. Impact of Minority Stress and Poor Mental Health on Sexual Risk Behaviors among Transgender Women Sex Workers in Shenyang, China. AIDS Behav 2021; 25:1790-1799. [PMID: 33438152 DOI: 10.1007/s10461-020-03108-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
This study examined the associations between minority stressors, poor mental health, and sexual risk behaviors, and whether there were interactive effects of minority stress and mental health factors in their associations with sexual risk behaviors in a sample of Chinese transgender women sex workers (TGSW). A cross-sectional study was conducted in 204 TGSW in Shenyang, China (mean age 33.4 years and 18.1% self-reported as HIV positive). We found a high prevalence of condomless anal intercourse (CAI) with male clients (27.9%) and CAI with male regular partners (49.5%) in the past three months among TGSW. Multivariate logistic regression analysis showed that discrimination, victimization, and life dissatisfaction were significantly associated with higher odds of CAI with male clients (AOR range: 1.05-1.42, all p < 0.05). Likewise, CAI with male regular partners was more frequently reported by participants who experienced higher levels of victimization, rejection, and anxiety (AOR range: 1.37-2.88, all p < 0.05). No significant interaction effects of gender minority stress and mental health on sexual behaviors were observed. Interventions addressing the multiple psychosocial risks are warranted to prevent behavioral risks of TGSW.
Collapse
Affiliation(s)
- Rui She
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix Kit-Han Mo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Tiecheng Ma
- Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, China
| | - Yan Liu
- Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, China
| | - Joseph Tak-Fai Lau
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
30
|
Sartaj D, Krishnan V, Rao R, Ambekar A, Dhingra N, Sharan P. Mental illnesses and related vulnerabilities in the Hijra community: A cross-sectional study from India. Int J Soc Psychiatry 2021; 67:290-297. [PMID: 32815441 DOI: 10.1177/0020764020950775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The Hijra community is a cultural and gender grouping in South Asia broadly similar to western transgender communities, but with literature suggesting some differences in gender experience and patterns of psychosocial adversity. The present study aims to describe patterns of mental illness and psychoactive substance use in Hijra subjects and study their association with gender experience and psychosocial adversity. METHODS Fifty self-identified Hijras availing HIV-prevention services in New Delhi, India, were interviewed. Data on mental disorders, psychoactive substance use, quality of life, discrimination, empowerment, violence and gender identity were assessed using structured instruments. RESULTS Subjects were mostly in their mid-twenties, and had joined the Hijra community in their mid-teens. More subjects (46%) were involved in begging than in traditional Hijra roles (38%). Sex work was reported by 28% subjects. The rates of lifetime mental illness was 38%, most commonly alcohol abuse (26%); others had anxiety or depressive disorders (8% each), somatoform disorders (6%) and bulimia nervosa (n = 1). Disempowerment was mostly experienced in domains of autonomy and community participation; 52% had experienced sexual or psychological violence. Discrimination was attributed to gender (100%), appearance (28%) or sexual orientation (28%). There were negative correlations between the physical domain of WHO-QOL and physical violence and depression scores; and between discrimination and WHO-QOL environmental, physical and psychological domains. CONCLUSIONS This Hijra group showed high rates of mental disorder and substance involvement, related to QOL domains and experiences of discrimination and disempowerment.
Collapse
Affiliation(s)
- Deepak Sartaj
- Department of Psychiatry, AIIMS New Delhi, New Delhi, India
| | - Vijay Krishnan
- Department of Psychiatry, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Ravindra Rao
- Department of Psychiatry, AIIMS New Delhi, New Delhi, India
| | - Atul Ambekar
- Department of Psychiatry, AIIMS New Delhi, New Delhi, India
| | | | - Pratap Sharan
- Department of Psychiatry, AIIMS New Delhi, New Delhi, India
| |
Collapse
|
31
|
Tantirattanakulchai P, Hounnaklang N. Perceived social support and its relationship with depression among Bangkok's trans women. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-05-2020-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe purpose of this paper is to evaluate the prevalence of depression and to determine the association between social support and depression among transgender women in Bangkok, Thailand.Design/methodology/approachA cross-sectional study was conducted among 280 transgender women in Bangkok, Thailand between March 2019 and May 2019 using the snowball sampling method. Data were collected through a self-administered questionnaire. The questionnaire included demographic questions and measures of social support (MSPSS) and depression (CES-D). Multivariable logistic regression analysis was employed to explore the association between social support and depression.FindingsThe prevalence of depression among transgender women was 58.2%. Multivariable logistic regression analysis indicated that depression was significantly associated with perceived low social support (OR: 9.55, 95%CI: 2.10–43.39) and moderate social support (OR: 2.03, 95%CI: 1.19–3.46) after being adjusted for religion, sufficient income and alcohol drinking.Originality/valueTransgender women were prone to experience a higher prevalence of depression than the general population. Social support would reduce the risk of depression among transgender women. Therefore, social support service systems for transgender women should be embedded into organizations concerned.
Collapse
|
32
|
Restar AJ, Jin H, Jarrett B, Adamson T, Baral SD, Howell S, Beckham SW. Characterising the impact of COVID-19 environment on mental health, gender affirming services and socioeconomic loss in a global sample of transgender and non-binary people: a structural equation modelling. BMJ Glob Health 2021; 6:e004424. [PMID: 33753401 PMCID: PMC7985976 DOI: 10.1136/bmjgh-2020-004424] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We characterised the impact of COVID-19 on the socioeconomic conditions, access to gender affirmation services and mental health outcomes in a sample of global transgender (trans) and non-binary populations. METHODS Between 16 April 2020 and 3 August 2020, we conducted a cross-sectional survey with a global sample of trans and non-binary people (n=849) through an online social networking app. We conducted structural equational modelling procedures to determine direct, indirect and overall effects between poor mental health (ie, depression and anxiety) and latent variables across socioecological levels: social (ie, reduction in gender affirming services, socioeconomic loss impact) and environmental factors (ie, COVID-19 pandemic environment). RESULTS Anxiety (45.82%) and depression (50.88%) in this sample were prevalent and directly linked to COVID-19 pandemic environment. Adjusted for gender identity, age, migrant status, region, education and level of socioeconomic status, our final model showed significant positive associations between relationships of (1) COVID-19 pandemic environment and socioeconomic loss impact (β=0.62, p<0.001), (2) socioeconomic loss impact and reduction in gender affirming services (β=0.24, p<0.05) and (3) reduction in gender affirming services and poor mental health (β=0.19, p<0.05). Moreover, socioeconomic loss impact and reduction in gender affirming services were found to be partial mediators in this model. CONCLUSION The study results supported the importance of bolstering access to gender affirming services and strengthening socioeconomic opportunities and programmatic support to buffer the impact of COVID-19 pandemic environment on poor mental health among trans and non-binary communities globally.
Collapse
Affiliation(s)
- Arjee Javellana Restar
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Harry Jin
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brooke Jarrett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tyler Adamson
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan David Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - S Wilson Beckham
- Department of Health Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
33
|
Marx RA, Hatchel T, Mehring CB, Espelage DL. Predictors of sexual victimisation and suicidal ideation among transgender and gender-nonconforming adolescents. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2019.1690034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Robert A. Marx
- Department of Child and Adolescent Development, San José State University, San Jose, CA, USA
| | - Tyler Hatchel
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Cole B. Mehring
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Dorothy L. Espelage
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
34
|
Gonzalez KA, Abreu RL, Rosario CC, Koech JM, Lockett GM, Lindley L. "A center for trans women where they help you": Resource needs of the immigrant Latinx transgender community. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 23:60-78. [PMID: 35403119 PMCID: PMC8986257 DOI: 10.1080/26895269.2020.1830222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Immigrant Latinx transgender people often migrate to the United States because of a desire for increased safety and more opportunities. However, after migrating to the United States, immigrant Latinx transgender people often struggle to access basic needs, including health care, jobs, and stable finances. These struggles are exacerbated for undocumented immigrant Latinx transgender people. There is a gap in the literature regarding needed resources for immigrant Latinx transgender community members living in the United States. AIMS Utilizing a critical intersectionality framework, the aim of the present study was to investigate the resource needs of immigrant Latinx transgender community members living in the United States. METHODS A community sample of 18 immigrant Latinx transgender people living in a large metropolitan city in Florida participated in individual semi-structured interviews to explore their community resource needs. RESULTS Thematic analysis revealed five themes related to resources that participants needed including: 1) Transgender healthcare/resources, 2) Public education, 3) Financial aid resources, 4) Homelessness resources, and 5) Addictions care. Two resource need-related themes were identified that pertain specifically to undocumented immigrant Latinx transgender people, including: 1) Documentation papers for access, and 2) Legal aid. CONCLUSIONS Findings suggest that immigrant Latinx transgender community members in this study provided guidance about broad resources needed to enhance their wellness and safety, and promote liberation of community members. Participants' resource needs suggest the importance of policy and structural level changes from institutions with power that consider and enhance the wellness of immigrant Latinx transgender people. Findings also suggest the need for more tailored interventions and case work to better support immigrant Latinx transgender people.
Collapse
Affiliation(s)
- Kirsten A. Gonzalez
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Roberto L. Abreu
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | | | - Jasmine M. Koech
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Gabriel M. Lockett
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Louis Lindley
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
35
|
Domínguez-Martínez T, Rebeca RG, Fresán A, Cruz J, Vega H, Reed GM. Risk factors for violence in transgender people: a retrospective study of experiences during adolescence. PSYCHOLOGY & SEXUALITY 2020. [DOI: 10.1080/19419899.2020.1802772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tecelli Domínguez-Martínez
- Global Mental Health Research Center, Directorate of Epidemiological and Psychosocial Research, ‘Ramón de la Fuente Muñiz’ National Institute of Psychiatry, Ministry of Health, Mexico
| | - Robles García Rebeca
- Global Mental Health Research Center, Directorate of Epidemiological and Psychosocial Research, ‘Ramón de la Fuente Muñiz’ National Institute of Psychiatry, Ministry of Health, Mexico
| | - Ana Fresán
- Sub Directorate of Clinical Research, “Ramón De La Fuente Muñiz” National Institute of Psychiatry, Ministry of Health, Mexico City, Mexico
| | - Jeremy Cruz
- Comprehensive Transgender Care Center, Mexico City, Mexico
| | - Hamid Vega
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Geoffrey M. Reed
- Global Mental Health Program, Columbia University, College of Physicians and Surgeons and Research Foundation for Mental Hygiene, New York, NY, USA
| |
Collapse
|
36
|
Gender identity and sexual behavior stigmas, severe psychological distress, and suicidality in an online sample of transgender women in the United States. Ann Epidemiol 2020; 52:15-22. [PMID: 32768521 DOI: 10.1016/j.annepidem.2020.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/10/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE The objective of this study is to (1) quantify burden of perceived, anticipated, and enacted gender identity (GI) and sexual behavior (SB) stigmas and (2) explore associations between GI and SB stigmas with key mental health factors among transgender women in the United States. METHODS We estimated associations between GI and SB stigmas with severe psychological distress, suicidal ideation, and suicide attempt using cross-sectional data from the Transgender Women's Internet Survey and Testing study from March to April, 2019. Modified Poisson regression produced prevalence ratios and 95% confidence intervals for severe psychological distress, suicidal ideation, and suicide attempt with GI and SB stigma items individually, as well as the GI and SB stigma items treated as two scales. RESULTS Of 381 transgender women, 52% experienced severe psychological distress in the past month, whereas 59.3% and 13.12% reported suicide ideation and attempt in the past year, respectively. In adjusted models, GI and SB stigma scales were significantly, positively associated with severe psychological distress, suicidal ideation, and suicide attempt. CONCLUSIONS Continued training for providers in trans-competent mental health care and the development of newer engagement and delivery strategies for stigma mitigation interventions are needed.
Collapse
|
37
|
Taube LN, Mussap AJ. Evaluating the transgender positive identity measure (T-PIM) across intersecting identities. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2020. [DOI: 10.1080/19359705.2020.1789019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Lee N. Taube
- School of Psychology, Deakin University, Melbourne, Australia
| | | |
Collapse
|
38
|
Peitzmeier SM, Malik M, Kattari SK, Marrow E, Stephenson R, Agénor M, Reisner SL. Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates. Am J Public Health 2020; 110:e1-e14. [PMID: 32673114 DOI: 10.2105/ajph.2020.305774] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals.Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations.Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population.Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location.Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups.Main Results: We identified 85 articles from 74 unique data sets (ntotal = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations.Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed.Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.
Collapse
Affiliation(s)
- Sarah M Peitzmeier
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Mannat Malik
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Shanna K Kattari
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Elliot Marrow
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Rob Stephenson
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Madina Agénor
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Sari L Reisner
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| |
Collapse
|
39
|
Falak S, Safdar F, Nuzhat-Ul-Ain. Perceived discrimination, social support, and psychological distress in transgender individuals. Psych J 2020; 9:682-690. [PMID: 32618064 DOI: 10.1002/pchj.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 11/06/2022]
Abstract
The present study aimed to find the relationship among perceived discrimination, social support, and psychological distress in transgender individuals (TIs) and the predictors of psychological distress in TIs. A correlational research design was used in the present study. It was hypothesized that there would likely to be a positive relationship between perceived discrimination and psychological distress and that there would likely be a negative relationship between social support and psychological distress. It was also hypothesized that perceived discrimination would predict psychological distress. Permission for using the questionnaires was taken from the authors of the original tools and the authors of the Urdu translated versions of the tools. The sample of 111 participants with an age range of 20-65 years was recruited by using purposive and non-probability snowball sampling techniques. The Everyday Perceived Discrimination Scale, the Multidimensional Scale of Perceived Social Support, and the Kessler Psychological Distress Scale were used to determine perceived discrimination, social support, and psychological distress, respectively, in TIs. Results revealed that there was a significant positive relationship between perceived discrimination and psychological distress, a significant negative relationship between social support and psychological distress, and there was also a significant negative relationship between perceived discrimination and social support. Additional findings revealed that perceived discrimination was found more in younger TIs than older TIs while social support from significant others was greater for younger TIs than for their older counterparts.
Collapse
Affiliation(s)
- Sobia Falak
- Centre for Clinical Psychology, University of the Punjab, Lahore, Pakistan
| | - Faiza Safdar
- Centre for Clinical Psychology, University of the Punjab, Lahore, Pakistan
| | - Nuzhat-Ul-Ain
- Centre for Clinical Psychology, University of the Punjab, Lahore, Pakistan
| |
Collapse
|
40
|
Taube LN, Mussap AJ. Growth from adversity in trans and gender diverse people of color. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 23:194-213. [PMID: 35403108 PMCID: PMC8986204 DOI: 10.1080/26895269.2020.1777615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Trans-negativity and gender-based discrimination negatively impact on the wellbeing and mental health in transgender (trans) and gender diverse people (TGD). There is limited research on TGD people thriving under adversity, and no research to date has considered TGD people of color in this context. METHOD We used the Post-Traumatic Growth Inventory (PTGI-X) to survey 125 TGD people of color and 625 white TGD adults (18 to 68 years old, M = 26.0, SD = 9.2) about their experiences of growth from adversity. Confirmatory factor analysis (CFA), using sub-sampling to compensate for our unequal sample sizes, supported a five-factor structure of the PTGI-X consisting of growth in relating to others, finding new possibilities, personal strength, greater appreciation of life, and spiritual/existential change. Measurement invariance tests confirmed configural, metric, and scalar invariance of this structure across the two TGD subgroups. RESULTS A MANOVA revealed that growth from adversity in TGD participants was generally greater than that reported by people who have recently been exposed to a traumatic event. T-tests revealed that TGD people of color experienced more growth in terms of relating to others and more personal strength than white TGD participants. Subsequent hierarchical regressions revealed that race moderated associations between PTGI-X scores and personal well-being, with TGD people of color reporting more benefits (more well-being) at high levels of growth but also more deficits (less well-being) at low levels of growth than the white TGD subgroup. CONCLUSION The results support the use of the PTGI-X with TGD populations and across racial TGD subgroups and indicate that growth from adversity is not only prevalent in TGD people but also relevant to positive outcomes, particularly in TGD people of color.
Collapse
Affiliation(s)
- Lee N. Taube
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | | |
Collapse
|
41
|
Abreu RL, Gonzalez KA, Mosley DV, Pulice-Farrow L, Adam A, Duberli F. "They feel empowered to discriminate against las chicas": Latina transgender women's experiences navigating the healthcare system. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 23:178-193. [PMID: 35403109 PMCID: PMC8986233 DOI: 10.1080/26895269.2020.1767752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Transgender Women of Color are more likely to experience oppression at the hands of healthcare providers than their transgender White counterparts. However, there is a paucity of research on the experiences of Latina transgender women in the United States. AIMS Using an intersectionality theory framework, the present study aimed to investigate the factors that contribute to Latina transgender women's decision to seek or refuse healthcare services and Latina transgender women's experiences with healthcare providers in the United States. METHODS A community sample of 15 Latina transgender women at a large metropolitan city in Florida participated in a focus group to explore their experiences with seeking out and accessing healthcare services. RESULTS Thematic analysis revealed five themes: 1) experiences in seeking healthcare, 2) the effects of hormones on mental health, 3) resistance, 4) imparting collective knowledge, and 5) recommendations to healthcare providers. CONCLUSIONS Through collective dialog these women gave voice to their needs and pains in the context of healthcare while also positioning themselves as agentic, resistant, and aware of the power of collectivism in the process of healing. The current findings support and extend calls for training improvements related to transgender populations, giving voice not only to the need for training but specifying immigrant Latina transgender women's desire for such training. Also, elements related to Latinx cultural values (e.g., convivencia, familismo) must be considered when working with Latina transgender women.
Collapse
Affiliation(s)
- Roberto L. Abreu
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Kirsten A. Gonzalez
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Della V. Mosley
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Lex Pulice-Farrow
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Alissa Adam
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | | |
Collapse
|
42
|
Martínez-Guzmán A, Johnson K. Narratives of transphobic violence in the Mexican province of Colima: A psychosocial analysis. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 22:253-268. [PMID: 34240069 PMCID: PMC8118226 DOI: 10.1080/26895269.2020.1760164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mexico has the second-highest index of crimes motivated by transphobia in the world. Transphobic violence manifests in a pervasive and complex manner in a country where violence permeates all aspects of social life. Some progress has been made to improve transgender rights and fight discrimination, but this has had an unequal impact in different geopolitical and cultural contexts within the country, particularly outside of metropolitan centers. AIM The study explores how transphobia is experienced in the conservative province of Colima and how transphobic practices play a part in shaping transgender subjective experience and identity construction. A psychosocial theoretical framework is adopted to attend to the relationship between cultural, institutional and interpersonal practices in this process. METHODS A qualitative approach is used to explore how different forms of transphobic violence are experienced by trans women in Colima. A purposive sample of 12 trans women, aged 22-38 years took part in narrative interviews which were analyzed thematically. Findings: The analysis is organized into three themes: (a) narratives of gender identity construction (b) gender expression and experiences of transphobic violence in Colima (c) sites for social support and change. DISCUSSION We argue that the psychosocial processes related to transphobia are context-specific shaping transgender identities and limiting and regulating gender expression. Family, education, LGBT community and the police were identified as key sites for support against or source of transphobic violence. CONCLUSION Despite the challenging socio-political context interventions are needed in policy and institutional practices to tackle stigma, transphobia and, trans-misogyny and improve the lives of transgender people living in regional areas in the global south.
Collapse
|
43
|
Wirtz AL, Poteat TC, Malik M, Glass N. Gender-Based Violence Against Transgender People in the United States: A Call for Research and Programming. TRAUMA, VIOLENCE & ABUSE 2020; 21:227-241. [PMID: 29439615 DOI: 10.1177/1524838018757749] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Gender-based violence (GBV) is an umbrella term for any harm that is perpetrated against a person's will and that results from power inequalities based on gender roles. Most global estimates of GBV implicitly refer only to the experiences of cisgender, heterosexually identified women, which often comes at the exclusion of transgender and gender nonconforming (trans) populations. Those who perpetrate violence against trans populations often target gender nonconformity, gender expression or identity, and perceived sexual orientation and thus these forms of violence should be considered within broader discussions of GBV. Nascent epidemiologic research suggests a high burden of GBV among trans populations, with an estimated prevalence that ranges from 7% to 89% among trans populations and subpopulations. Further, 165 trans persons have been reported murdered in the United States between 2008 and 2016. GBV is associated with multiple poor health outcomes and has been broadly posited as a component of syndemics, a term used to describe an interaction of diseases with underlying social forces, concomitant with limited prevention and response programs. The interaction of social stigma, inadequate laws, and punitive policies as well as a lack of effective GBV programs limits access to and use of GBV prevention and response programs among trans populations. This commentary summarizes the current body of research on GBV among trans populations and highlights areas for future research, intervention, and policy.
Collapse
Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Tonia C Poteat
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mannat Malik
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Nancy Glass
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| |
Collapse
|
44
|
Poteat TC, Celentano DD, Mayer KH, Beyrer C, Mimiaga MJ, Friedman RK, Srithanaviboonchai K, Safren SA. Depression, sexual behavior, and HIV treatment outcomes among transgender women, cisgender women and men who have sex with men living with HIV in Brazil and Thailand: a short report. AIDS Care 2020; 32:310-315. [PMID: 31530004 PMCID: PMC6981024 DOI: 10.1080/09540121.2019.1668526] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
One in five transgender women (TW) are living with HIV, yet little has been published about their health outcomes. We analyzed data from TW (n = 37), cisgender women (CW, n = 165), and cisgender men who have sex with men (MSM, n = 151) in Thailand and Brazil. We hypothesized: (1) TW will have higher odds of depressive symptoms, lower odds of condom use and greater odds of a detectable viral load compared to MSM and CW; and (2) TW will have lower odds of condom use and higher odds of detectable viral load. We found that TW had higher odds of depression (OR 2.2, 95%CI: 1.0, 4.8, p = 0.04) and were less likely than MSM (22% v. 42%, p = 0.01) to use condoms with partners of unknown serostatus. In multivariable models, TW had lower odds than MSM of using condoms with partners with unknown serostatus (OR 0.38, 95%CI: 0.15, 0.90) and CW had lower odds than MSM of using condoms with HIV-negative partners (0.60 [0.38, 0.95], p = 0.029). We found no significant differences in detectable viral load. Disaggregating data by gender is important to understand factors that contribute to viral suppression and HIV transmission risk among people living with HIV.
Collapse
Affiliation(s)
- Tonia C. Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
| | - David D. Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
| | - Kenneth H. Mayer
- Department of Global Health and Population, Harvard T.H.
Chan School of Public Health, Boston, MA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
| | - Matthew J. Mimiaga
- Departments of Behavioral & Social Health Sciences and
Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Ruth K Friedman
- Instituto de Pesquisa Clinica Evandro Chagas, Rio de
Janeiro, Brazil
| | | | | |
Collapse
|
45
|
King WM, Hughto JMW, Operario D. Transgender stigma: A critical scoping review of definitions, domains, and measures used in empirical research. Soc Sci Med 2020; 250:112867. [PMID: 32163820 PMCID: PMC7442603 DOI: 10.1016/j.socscimed.2020.112867] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 12/23/2022]
Abstract
RATIONALE A growing body of transgender (trans) health research has explored the relationship between stigma and health; yet, studies have conceptualized and operationalized anti-trans stigma in multiple ways. OBJECTIVE This scoping review aims to critically analyze quantitative measures of anti-trans stigma in the U.S. using a socioecological framework. METHOD We organized and appraised measures from 126 included articles according to socioecological level: structural, interpersonal, or individual. RESULTS Of the identified articles, 36 measured anti-trans stigma at the structural level (i.e., institutional structures and policies), 102 measured anti-trans at the interpersonal level (i.e., community interactions), and 44 measured anti-trans stigma at the individual level (i.e., internalized or anticipated stigma). Definitions of anti-trans stigma varied substantially across articles. Most measures were adapted from measures developed for other populations (i.e., sexual minorities) and were not previously validated for trans samples. CONCLUSIONS Studies analyzing anti-trans stigma should concretely define anti-trans stigma. There is a need to develop measures of anti-trans stigma at all socioecological levels informed by the lived experiences of trans people.
Collapse
Affiliation(s)
- Wesley M King
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Jaclyn M W Hughto
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
| | - Don Operario
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
| |
Collapse
|
46
|
de Freitas LD, Léda-Rêgo G, Bezerra-Filho S, Miranda-Scippa Â. Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry Clin Neurosci 2020; 74:99-104. [PMID: 31642568 DOI: 10.1111/pcn.12947] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/20/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022]
Abstract
AIM Although there has been an increase in the social acceptance of the gender dysphoria (GD) population, these individuals still suffer a high degree of emotional stress, which highlights the importance of knowing their mental illness diagnosis. METHODS A systematic review was conducted to identify the frequency of lifetime Axis I mental disorders in this population, using the MEDLINE/PubMed, SciELO, Cochrane, EMBASE, and PsychINFO databases and manual searching, examining articles published after 1980. The search used the key words: ('transgender' OR 'gender identity disorder' OR 'gender dysphoria' OR 'transsexualism' OR 'gender dysphoric patients' OR 'gender incongruence') AND ('mental disorder' OR 'axis I' OR 'psychiatric disorders') AND ('comorbidity' OR 'comorbid' OR 'prevalence'). RESULTS From 233 papers found, five were included. The total sample comprised 577 individuals diagnosed with GD, of whom 307 (53.2%) had presented with at least one mental disorder in their lifetime. Among this high frequency of Axis I disorders, mood disorders were the most frequent (found in 243 individuals [42.1%]), followed by anxiety disorders (155 [26.8%]), and substance use/abuse disorders (85 [14.7%]). CONCLUSION This study offers important data to researchers and clinicians so they can recognize and contribute to the development of public policy on the mental health of the population diagnosed with GD. The mental health of these individuals requires special attention as it contributes to their functional impairment.
Collapse
Affiliation(s)
- Larissa Dias de Freitas
- Mood and Anxiety Disorders Program (CETHA), University Hospital, Federal University of Bahia, Salvador, Brazil
| | - Gabriela Léda-Rêgo
- Mood and Anxiety Disorders Program (CETHA), University Hospital, Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Severino Bezerra-Filho
- Mood and Anxiety Disorders Program (CETHA), University Hospital, Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), University Hospital, Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.,Department of Neurosciences and Mental Health, Medical School, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
47
|
Madera SL, Díaz NV, Padilla M, Pibernus XR, Neilands TB, Segarra ER, Velázquez CM, Bockting W. "Just Like Any Other Patient": Transgender Stigma among Physicians in Puerto Rico. J Health Care Poor Underserved 2019; 30:1518-1542. [PMID: 31680112 DOI: 10.1353/hpu.2019.0089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Transgender women (TW) in Puerto Rico (PR) face social stigmatization. Physicians' transgender stigma can have detrimental consequences for TW's health. PURPOSE The objective of this study was to document physicians' knowledge, competencies, and attitudes towards TW in PR and study their associations with stigma towards TW. METHODS We implemented an exploratory sequential mixed-methods study. We used in-depth interviews (n=30) and self-administered questionnaire (n=255). RESULTS Qualitative results illustrated lack of recognition of the needs of TW; they also evidenced the impact of stigmatizing attitudes on clinical decisions. Quantitative results showed that more willingness and knowledge to provide health services to TW were negatively associated with stigma. Participants who reported history of training in working with TW presented significantly less stigma than participants who had not received such training. CONCLUSION In order to provide stigma-free services for TW in PR, specialized training regarding the particular needs of this population is needed.
Collapse
|
48
|
Domínguez-Martínez T, Robles R. Preventing Transphobic Bullying and Promoting Inclusive Educational Environments: Literature Review and Implementing Recommendations. Arch Med Res 2019; 50:543-555. [DOI: 10.1016/j.arcmed.2019.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/28/2019] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
|
49
|
Puckett JA, Maroney MR, Wadsworth LP, Mustanski B, Newcomb ME. Coping with discrimination: The insidious effects of gender minority stigma on depression and anxiety in transgender individuals. J Clin Psychol 2019; 76:176-194. [PMID: 31517999 DOI: 10.1002/jclp.22865] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We examined types of discrimination encountered by transgender and gender diverse (TGD) individuals and the associations with symptoms of depression and anxiety, as well as the mediating and moderating effects of coping responses. METHOD This online study included 695 TGD individuals ages 16 years and over (M = 25.52; standard deviation = 9.68). RESULTS Most participants (76.1%) reported discrimination over the past year. Greater exposure to discrimination was associated with more symptoms of depression and anxiety. These associations were mediated by coping via detachment and via internalization, although a direct effect remained. CONCLUSIONS Many TGD people will encounter discrimination and this is associated with greater psychological distress. Engagement in the internalization of blame or detachment partially explains the association between discrimination and mental health issues. These findings elucidate possible avenues for interventions to bolster adaptive coping responses for TGD people and highlight that actions to decrease discrimination are urgently needed.
Collapse
Affiliation(s)
- Jae A Puckett
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Meredith R Maroney
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, Massachusetts
| | | | - Brian Mustanski
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael E Newcomb
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
50
|
Part of the Solution to Address Sexual and Gender Minority Health and Health Care Disparities: Inclusive Professional Education. Dela J Public Health 2019; 5:56-62. [PMID: 34467041 PMCID: PMC8389761 DOI: 10.32481/djph.2019.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|