Transgender individuals are defined as those whose assigned sex at birth differs from their current gender expression or identity. It has been established that multiple physiological, social, and psychological factors have a direct negative impact on the quality of life (QoL) of transgender persons. Moreover, traumatic and victimization experiences might be associated with the frequency and severity of psychiatric symptoms in the transgender population.11. Zucchi EM, Barros CRS, Redoschi BRL, Deus LFA, Veras MASM. [Psychological well-being among transvestites and trans women in the state of São Paulo, Brazil]. Cad Saude Publica. 2019;35:e00064618.,22. Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, et al. Transgender people: health at the margins of society. Lancet. 2016;388:390-400. Few studies have examined how sociodemographic traits, victimization, and/or mental illness affect the QoL of transgender persons.
The present study consisted of a cross-sectional analysis of data collected between September and December 2021 through individual interviews during psychiatric consultations at a specialized psychiatric outpatient clinic. This study was approved by the respective Institutional Review Board, and all participants provided informed consent prior to inclusion. The respondents (70 transgender participants aged 18-75 years) completed a sociodemographic questionnaire, and the Brazilian version of the Mini International Neuropsychiatric Interview (MINI)33. Amorim P. Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Rev Bras Psiquiatr. 2000;22:106-15. was used for the assessment of mental disorders. The World Health Organization Quality of Life Abbreviated Version (WHOQOL-BREF) in Portuguese and the Questionnaire on Victimization of LGBT Individuals by Anthony D’Augelli were applied to investigate QoL and victimization experiences, respectively.44. Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. [Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref]. Rev Saude Publica. 2000;34:178-83.,55. D’Augelli AR, Hershberger SL. Lesbian, gay, and bisexual youth in community settings: personal challenges and mental health problems. Am J Community Psychol. 1993;21:421-48.
The Shapiro-Wilk test was used to assess normality of data. The Friedman test was applied to compare QoL scores between the ranges defined by the scale, followed by the Wilcoxon test for pairwise multiple comparisons. To assess which factors were associated with the presence of mental disorders, a contingency table was created and the chi-square test for independence was applied. To determine which factors significantly influenced the QoL scores of the patients studied, the mean and standard deviation of the scores were calculated and the Student’s t-test or analysis of variance (ANOVA) were used as appropriate to compare the mean QoL scores and the different sociodemographic and victimization variables. For all statistical tests, significance was accepted at a p-value of 5%.
Most patients were transgender men (97.7%), aged between 18 and 30 years (84.3%), white (60%), and single (61.4%), had at least some secondary education (62.9%), were formally or informally employed (50%), had a monthly household income of one to two times the federal minimum wage (37.1%), and were not religious (74.2%).
The group aged ≥ 31 years had higher mean QoL scores in the physical (p = 0.024), psychological (p = 0.013), and general (p = 0.002) domains (Table 1). A higher mean QoL score was observed in all domains evaluated for the group of patients who were divorced/separated/widowed; however, the mean comparison test was significant only for the general QoL score domain (p = 0.006). Living arrangements had a significant influence on the patients’ overall QoL score (p = 0.014) and in the physical (p = 0.033) and social (p = 0.004) domains, with the group of patients living alone having the highest mean QoL score. Living alone is thought to result in higher social and overall QoL scores as these individuals would be less vulnerable to intra-family violence due to their gender identities. Occupational or employment status was significantly associated with physical-domain (p = 0.015) and overall QoL scores (p = 0.015), with the highest mean scores for those participants with a job or occupation. We also observed that individuals earning three times or more the minimum wage had lower overall QoL scores when compared to the group earning only two to three times the minimum wage (p = 0.032). One possible explanation is that transgender persons in a more favorable financial situation may experience higher levels of self-demand and feelings of worthlessness, both of which are connected to self-stigmatization.
Means and standard deviations of QoL scores according to personal profile, recurrence of victimization, and number of mental disorders, followed by the distribution of mental disorders according to recurrent victimization, in a sample of transgender persons (n=70) recruited from an outpatient psychiatric clinic.
Most patients had a history of abuse in childhood (52.2%), exhibited violent behavior in the past (30%, p = 0.001), had been victims of some type of violent behavior (66.7%, p = 0.008), and had a relationship with the perpetrator thereof (93%, p < 0.001). Having experienced abuse in childhood significantly influenced QoL scores in the psychological (p = 0.028) and social (p = 0.002) domains and overall (p = 0.026), with the highest mean scores observed in the group that did not experience abuse in childhood.
Additionally, we observed that the most prevalent mental disorders in this group were generalized anxiety disorder (47.1%), major depressive episodes (35.7%), and panic disorder (30%). Although we found a high percentage of exposure to traumatic events, only 1.4% of patients formally met the diagnostic criteria for posttraumatic stress disorder (PTSD). The group of patients who did not have a psychiatric disorder had higher QoL scores in all the assessed domains. Moreover, there was a higher prevalence of mental disorders in the group of patients who had experienced recurrent victimization (87.1%). The independence test was significant (p < 0.05), indicating recurrent victimization is a determining factor that increases the risk of mental disorders.
Our findings suggest that victimization experiences affect the QoL of transgender individuals. Additional analysis of clinical, social, and psychological aspects may lead to a better understanding of QoL and mental health outcomes. For professionals working with transgender persons’ mental health, considering victimization appears important to providing tailored interventions and improving the overall QoL.
References
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1Zucchi EM, Barros CRS, Redoschi BRL, Deus LFA, Veras MASM. [Psychological well-being among transvestites and trans women in the state of São Paulo, Brazil]. Cad Saude Publica. 2019;35:e00064618.
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2Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, et al. Transgender people: health at the margins of society. Lancet. 2016;388:390-400.
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3Amorim P. Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Rev Bras Psiquiatr. 2000;22:106-15.
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4Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. [Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref]. Rev Saude Publica. 2000;34:178-83.
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5D’Augelli AR, Hershberger SL. Lesbian, gay, and bisexual youth in community settings: personal challenges and mental health problems. Am J Community Psychol. 1993;21:421-48.
Publication Dates
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Publication in this collection
15 July 2024 -
Date of issue
2024
History
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Received
25 Apr 2023 -
Accepted
02 Dec 2023
