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Associations between discrimination experiences and symptoms of depression and anxiety among transgender adults: a nationwide cohort study of 269 transgender adults in South Korea

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Abstract

Purpose

Recently, there has been an increase in awareness of social stigma and mental health issues experienced by transgender individuals in South Korea. To provide quantitative evidence, we conducted a nationwide cohort study of transgender adults, first of its kind in Asia. The aim of the study is to assess the prevalence of depressive and anxiety symptoms and examine their associations with discrimination experiences among transgender adults.

Methods

We conducted a two-wave longitudinal survey of 269 Korean transgender adults, where the baseline was collected in October 2020 and the follow-up in October 2021. Experiences of discrimination in the past 12 months at follow-up were categorized accordingly: those who experienced (1) none, (2) only anti-transgender discrimination, (3) only other types of discrimination, and (4) both anti-transgender and other types of discrimination. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale at both waves and anxiety symptoms were measured using the Generalized Anxiety Disorder 7 only at follow-up. We used modified Poisson regression to examine the association between experiences of discrimination and mental health outcomes at follow-up and adjusted for sociodemographic characteristics and baseline depressive symptoms.

Results

A total of 63.9% had depressive symptoms and 47.2% had anxiety symptoms. Participants who experienced both anti-transgender and other types of discrimination had 1.38-times (95% CI 1.06–1.81) and 1.77-times (95% CI 1.16–2.70) higher prevalence of depressive and anxiety symptoms, respectively, compared to those without any experiences of discrimination.

Conclusions

Interventions to lessen discrimination towards transgender individuals are needed for the promotion of mental health among transgender individuals.

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References

  1. American Psychological Association (2012) Guidelines for psychological practice with lesbian, gay, and bisexual clients. Am Psychol 67(1):10

    Article  Google Scholar 

  2. Goldsen KIF, Romanelli M, Hoy-Ellis CP, Jung H (2022) Health, economic and social disparities among transgender women, transgender men and transgender nonbinary adults: results from a population-based study. Prev Med 156:106988

    Article  PubMed Central  Google Scholar 

  3. Meyer IH, Brown TN, Herman JL, Reisner SL (2014) Demographic characteristics and health status of transgender adults in select US regions: behavioral risk factor surveillance system. Am J Public Health 107(4):582–589

    Article  Google Scholar 

  4. Su D, Irwin JA, Fisher C, Ramos A, Kelley M, Mendoza DAR, Coleman JD (2016) Mental health disparities within the LGBT population: a comparison between transgender and nontransgender individuals. Transgender Health 1(1):12–20

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bränström R, Stormbom I, Bergendal M, Pachankis JE (2022) Transgender-based disparities in suicidality: a population-based study of key predictions from four theoretical models. Suicide Life Threat Behav 2:2

    Google Scholar 

  6. Crissman HP, Stroumsa D, Kobernik EK, Berger MB (2019) Gender and frequent mental distress: comparing transgender and non-transgender individuals’ self-rated mental health. J Womens Health 28(2):143–151

    Article  Google Scholar 

  7. Lefevor GT, Boyd-Rogers CC, Sprague BM, Janis RA (2019) Health disparities between genderqueer, transgender, and cisgender individuals: an extension of minority stress theory. J Couns Psychol 66(4):385

    Article  PubMed  Google Scholar 

  8. Lee H, Operario D, van den Berg JJ, Yi H, Choo S, Kim S-S (2020) Health disparities among transgender adults in South Korea. Asia Pac J Public Health 32(2–3):103–110

    Article  PubMed  Google Scholar 

  9. Reisner SL, Katz-Wise SL, Gordon AR, Corliss HL, Austin SB (2016) Social epidemiology of depression and anxiety by gender identity. J Adolesc Health 59(2):203–208

    Article  PubMed  PubMed Central  Google Scholar 

  10. Borgogna NC, McDermott RC, Aita SL, Kridel MM (2019) Anxiety and depression across gender and sexual minorities: Implications for transgender, gender nonconforming, pansexual, demisexual, asexual, queer, and questioning individuals. Psychol Sex Orientat Gend Divers 6(1):54

    Article  Google Scholar 

  11. Liu CH, Stevens C, Wong SH, Yasui M, Chen JA (2019) The prevalence and predictors of mental health diagnoses and suicide among US college students: implications for addressing disparities in service use. Depress Anxiety 36(1):8–17

    Article  PubMed  Google Scholar 

  12. Rotondi NK (2012) Depression in trans people: a review of the risk factors. Int J Transgender 13(3):104–116

    Article  Google Scholar 

  13. McCann E, Brown M (2017) Discrimination and resilience and the needs of people who identify as transgender: a narrative review of quantitative research studies. J Clin Nurs 26(23–24):4080–4093

    Article  PubMed  Google Scholar 

  14. Puckett JA, Maroney MR, Wadsworth LP, Mustanski B, Newcomb ME (2020) Coping with discrimination: the insidious effects of gender minority stigma on depression and anxiety in transgender individuals. J Clin Psychol 76(1):176–194

    Article  PubMed  Google Scholar 

  15. Klemmer CL, Arayasirikul S, Raymond HF (2021) Transphobia-based violence, depression, and anxiety in transgender women: the role of body satisfaction. J Interpers Violence 36(5–6):2633–2655

    Article  PubMed  Google Scholar 

  16. Zhang J, Lo HH, Au AM (2021) The buffer of resilience in the relations of gender-related discrimination, rejection, and victimization with depression among Chinese transgender and gender non-conforming individuals. J Affect Disord 283:335–343

    Article  PubMed  Google Scholar 

  17. Testa RJ, Habarth J, Peta J, Balsam K, Bockting W (2015) Development of the gender minority stress and resilience measure. Psychol Sex Orientat Gend Divers 2(1):65

    Article  Google Scholar 

  18. Lloyd J, Chalklin V, Bond FW (2019) Psychological processes underlying the impact of gender-related discrimination on psychological distress in transgender and gender nonconforming people. J Couns Psychol 66(5):550

    Article  PubMed  Google Scholar 

  19. Liu H, Yang T-C (2022) Examining the reciprocity between perceived discrimination and health: a longitudinal perspective. Popul Res Policy Rev 2:1–21

    CAS  Google Scholar 

  20. Reisner SL, Hughto JM, Gamarel KE, Keuroghlian AS, Mizock L, Pachankis JE (2016) Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults. J Couns Psychol 63(5):509

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jefferson K, Neilands TB, Sevelius J (2013) Transgender women of color: discrimination and depression symptoms. Ethnicity and inequalities in health and social care

  22. Hong S, Kang M, Kim S-S, Park H, Lee S, Lee H, Yi H, Chun S (2020) Factual survey on the stigma and discrimination against transgender individuals. National Human Rights Commission of Korea, Seoul

    Google Scholar 

  23. Park H (2021) Legislative suggestion on the legal gender recognition for transgender people. Hum Rights Just 498:41–60

    Google Scholar 

  24. Reisner SL, Deutsch MB, Bhasin S, Bockting W, Brown GR, Feldman J, Garofalo R, Kreukels B, Radix A, Safer JD (2016) Advancing methods for US transgender health research. Curr Opin Endocrinol Diabetes Obes 23(2):198

    Article  PubMed  PubMed Central  Google Scholar 

  25. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401

    Article  Google Scholar 

  26. Cho MJ, Kim KH (1993) Diagnostic validity of the CES-D (Korean version) in the assessment of DSM-III-R major depression. J Korean Neuropsychiatr Assoc 32(3):381–399

    Google Scholar 

  27. Spitzer RL, Kroenke K, Williams JB, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097

    Article  PubMed  Google Scholar 

  28. Ahn J-K, Kim Y, Choi K-H (2019) The psychometric properties and clinical utility of the Korean version of GAD-7 and GAD-2. Front Psych 10:127

    Article  Google Scholar 

  29. Zou G (2004) A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159(7):702–706

    Article  PubMed  Google Scholar 

  30. Mineka S, Watson D, Clark LA (1998) Comorbidity of anxiety and unipolar mood disorders. Annu Rev Psychol 49(1):377–412

    Article  CAS  PubMed  Google Scholar 

  31. VanderWeele TJ, Mathur MB, Chen Y (2020) Outcome-wide longitudinal designs for causal inference: a new template for empirical studies. Stat Sci 35(3):437–466

    Article  Google Scholar 

  32. Jeong H, Park S, Kim J, Oh K, Yim HW (2022) Mental health of Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey. Epidemiol Health 44:2

    Article  Google Scholar 

  33. Vargas SM, Huey SJ Jr, Miranda J (2020) A critical review of current evidence on multiple types of discrimination and mental health. Am J Orthopsychiatry 90(3):374

    Article  PubMed  Google Scholar 

  34. Kenny C, Patel D (2017) Norms and reform: legalizing homosexuality improves attitudes. Center for Global Development Working Paper 465 (465)

  35. Madrigal-Borloz V (2018) Protection against violence and discrimination based on sexual orientation and gender identity. United Nations, Geneva, Switzerland

  36. Matsuno E, Israel T (2018) Psychological interventions promoting resilience among transgender individuals: transgender resilience intervention model (TRIM). Couns Psychol 46(5):632–655

    Article  Google Scholar 

  37. Williams DR, Yu Y, Jackson JS, Anderson NB (1997) Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol 2(3):335–351

    Article  CAS  PubMed  Google Scholar 

  38. Watson LB, Allen LR, Flores MJ, Serpe C, Farrell M (2019) The development and psychometric evaluation of the trans discrimination scale: TDS-21. J Couns Psychol 66(1):14

    Article  PubMed  Google Scholar 

  39. Jarrett BA, Peitzmeier SM, Restar A, Adamson T, Howell S, Baral S, Beckham SW (2021) Gender-affirming care, mental health, and economic stability in the time of COVID-19: a multi-national, cross-sectional study of transgender and nonbinary people. PLoS ONE 16(7):e0254215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Lee H, Restar AJ, Operario D, Choo S, Streed CG Jr, Yi H, Kim R, Eom Y-J, Kim S-S (2021) Transgender-specific COVID-19-related stressors and their association with depressive symptoms among transgender adults: a nationwide cross-sectional survey in South Korea. Int J Transgender Health 2:1–12

    Google Scholar 

  41. Kidd JD, Jackman KB, Barucco R, Dworkin JD, Dolezal C, Navalta TV, Belloir J, Bockting WO (2021) Understanding the impact of the COVID-19 pandemic on the mental health of transgender and gender nonbinary individuals engaged in a longitudinal cohort study. J Homosex 68(4):592–611

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank research participants and the community experts of Rainbow Connection Project III—Korean Transgender Adult’s Health Panel Study for their contributions to the study.

Funding

Research reported in this publication was funded by the National Human Rights Council of Republic of Korea and the National Research Foundation of Republic of Korea, under project BK21 FOUR operated by the Center for Teaching and Learning of Korea University. The funders held no role in the development of this manuscript. The data of the study are not available.

Author information

Authors and Affiliations

  1. Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea

    Sungsub Choo, Ranyeong Kim & Yun-Jung Eom

  2. Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea

    Ranyeong Kim, Yun-Jung Eom & Rockli Kim

  3. Jeju Institute of Public Health & Health Policy, Jeju, South Korea

    Hyemin Lee

  4. Solidarity for LGBT Human Rights of Korea, Seoul, South Korea

    Horim Yi

  5. Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea

    Rockli Kim

  6. Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea

    Seung-Sup Kim

Authors
  1. Sungsub Choo
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  2. Ranyeong Kim
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  3. Hyemin Lee
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  4. Yun-Jung Eom
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  5. Horim Yi
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Contributions

SC: funding acquisition, survey development, data curation, conceptualization, methodology, formal analysis, and writing—original draft. RYK: funding acquisition, survey development, and writing—review and editing. HL: funding acquisition, survey development, and writing—review and editing. HY: funding acquisition, survey development, and writing—review and editing. YJE: survey development and writing—review and editing. RK: writing—review and editing. SSK: funding acquisition, survey development, conceptualization, supervision, and writing—review and editing.

Corresponding author

Correspondence to Seung-Sup Kim.

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Conflict of interest

The authors report no conflict of interest.

Ethical approval

Korea University Institutional Review Board reviewed and approved study procedures, which were performed in accordance with ethical standards of the 1964 Helsinki Declaration and its later amendments. All participants provided informed consent for participation and academic use of their responses via online.

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Choo, S., Kim, R., Lee, H. et al. Associations between discrimination experiences and symptoms of depression and anxiety among transgender adults: a nationwide cohort study of 269 transgender adults in South Korea. Soc Psychiatry Psychiatr Epidemiol 59, 859–869 (2024). https://doi.org/10.1007/s00127-023-02554-5

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  • DOI: https://doi.org/10.1007/s00127-023-02554-5

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