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Gender-Related Victimization, Perceived Social Support, and Predictors of Depression Among Transgender Australians

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This study examined mental health outcomes, gender-related victimization, perceived social support, and predictors of depression among 243 transgender Australians (n=83 assigned female at birth, n = 160 assigned male at birth). Overall, 69% reported at least 1 instance of victimization, 59% endorsed depressive symptoms, and 44% reported a previous suicide attempt. Social support emerged as the most significant predictor of depressive symptoms (p > .05), whereby persons endorsing higher levels of overall perceived social support tended to endorse lower levels of depressive symptoms. Second to social support, persons who endorsed having had some form of gender affirmative surgery were significantly more likely to present with lower symptoms of depression. Contrary to expectations, victimization did not reach significance as an independent risk factor of depression (p = .053). The pervasiveness of victimization, depression, and attempted suicide represents a major health concern and highlights the need to facilitate culturally sensitive health care provision.
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International Journal of Transgenderism
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Gender-Related Victimization, Perceived Social
Support, and Predictors of Depression Among
Transgender Australians
Crystal Bozaa & Kathryn Nicholson Perrya
a School of Social Sciences and Psychology, University of Western Sydney, Sydney, Australia
Published online: 30 Apr 2014.
To cite this article: Crystal Boza & Kathryn Nicholson Perry (2014) Gender-Related Victimization, Perceived Social Support,
and Predictors of Depression Among Transgender Australians, International Journal of Transgenderism, 15:1, 35-52, DOI:
10.1080/15532739.2014.890558
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International Journal of Transgenderism, 15:35–52, 2014
Copyright C
Taylor & Francis Group, LLC
ISSN: 1553-2739 print / 1434-4599 online
DOI: 10.1080/15532739.2014.890558
Gender-Related Victimization, Perceived Social Support,
and Predictors of Depression Among
Transgender Australians
Crystal Boza
Kathryn Nicholson Perry
ABSTRACT. This study examined mental health outcomes, gender-related victimization, perceived
social support, and predictors of depression among 243 transgender Australians (n=83 assigned female
at birth, n=160 assigned male at birth). Overall, 69% reported at least 1 instance of victimization, 59%
endorsed depressive symptoms, and 44% reported a previous suicide attempt. Social support emerged
as the most significant predictor of depressive symptoms (p>.05), whereby persons endorsing higher
levels of overall perceived social support tended to endorse lower levels of depressive symptoms.
Second to social support, persons who endorsed having had some form of gender affirmative surgery
were significantly more likely to present with lower symptoms of depression. Contrary to expectations,
victimization did not reach significance as an independent risk factor of depression (p=.053). The
pervasiveness of victimization, depression, and attempted suicide represents a major health concern
and highlights the need to facilitate culturally sensitive health care provision.
KEYWORDS. Transgender, depression, discrimination, victimization, social support, gender
affirmative surgery, hormones
Transgender is used as an umbrella term to
describe a number of diverse and distinct gen-
der identities including transgenderists, trans-
sexuals, cross-dressers, androgynous persons,
intersex persons, drag queens and kings, and
bigendered and genderqueer persons (Couch
et al., 2007; Dean et al., 2000; Gainor, 2000;
Kuper, Nussbaum, & Mustanski, 2012). While
persons who identify their gender outside of
the male–female binary have been documented
throughout history and across many cultures,
their social status, social roles, and the degree
of social acceptance have varied across time
and place (Gainor, 2000). The study of mental
Crystal Boza and Kathryn Nicholson Perry are affiliated with the School of Social Sciences and Psychology
at the University of Western Sydney in Sydney, Australia.
Address correspondence to Kathryn Nicholson Perry, Australian College of Applied Psychology, Level 5,
York Street, Sydney NSW 2000, Australia. E-mail: kathryn.nicholsonperry@acap.edu.au
health outcomes among transgender persons is
complicated by early research, which interpreted
gender-variance and gender dysphoria to be rep-
resentative of underlying pathology (Haraldsen
& Dahl, 2000). In recent years, the view of
transgenderism has shifted from that of gender
pathology to one of gender identity (Dean et al.,
2000). This shift is founded in the movement
toward understanding the psychological legacy
of sexism and heterosexism and the pursuit of
civil rights and legal protection for sexually
diverse and gender-diverse persons. Nonethe-
less, as members of a gender minority, there
are a number of experiences that can affect the
35
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36 INTERNATIONAL JOURNAL OF TRANSGENDERISM
health and emotional well-being of transgender
persons, including harassment, rejection, isola-
tion, and societal and systematic discrimination
(Dean et al., 2000; Gainor, 2000; Lev, 2004;
Whittle, Turner, & Al-Alam, 2007).
MENTAL HEALTH OUTCOMES
AMONG TRANSGENDER PERSONS
Studies internationally have reported a high
prevalence of depressive symptoms among
transgender persons. In Australia, the Tranzna-
tion survey reported that 36% of respondents met
criteria for a current major depressive episode,
a rate that was substantially inflated compared
to a representative community sample (7%;
Couch et al., 2007). These findings are consistent
with studies using convenience samples and
reporting estimates of depressive symptoms
ranging from 26% to 66% among both transsex-
ual and transgender samples (Bockting, Huang,
Ding, Robinson, & Rosser, 2005; Clements-
Nolle, Marx, & Katz, 2006; Hepp, Kraemer,
Schnyder, Miller, & Delsignore, 2005; Nemoto,
B¨
odeker, & Iwamoto, 2011; Nemoto et al., 2004;
Nuttbrock et al., 2010; Operario & Nemoto,
2005; Rotondi, Bauer, Scanlon, et al., 2011;
Rotondi, Bauer, Travers, et al., 2011; Shipherd,
Green, & Abramovitz, 2010).
High rates of self-reported lifetime suicidal
ideation and attempts have also been reported
across studies of transgender persons, with
ideation ranging from 37% to 65% (Kenagy &
Bostwick, 2005; Mathy, 2002; Xavier, Bobbin,
Singer, & Budd, 2005; Xavier, Honnold, & Brad-
ford, 2007) and previous attempts ranging from
15% to 41% (Clements-Nolle et al., 2006; Grant
et al., 2010; Kenagy, 2005; Kenagy & Bostwick,
2005; Mathy, 2002; Nemoto et al., 2011; Nut-
tbrock et al., 2010; Operario & Nemoto, 2005;
Xavier et al., 2005, 2007). Further, high rates
of alcohol and substance abuse have also been
documented among transgender persons, with
rates of alcohol abuse ranging from 20% to
34% and substance abuse ranging from 19%
to 36% (Bockting et al., 2005; Colton Meier,
Fitzgerald, Pardo, & Babcock, 2011; Xavier,
2000; Xavier et al., 2007). While it is clear that
transgender persons are particularly vulnerable
to adverse mental health outcomes, such as
depression, it is less clear what factors are likely
to increase or decrease the likelihood of a trans-
gender person experiencing such mental health
outcomes.
EXPERIENCES OF TRANSGENDER
PERSONS: GENDER-RELATED
VICTIMIZATION AND PERCEIVED
SOCIAL SUPPORT
Given that a high portion of transgender
samples tend to report a sexual orientation other
than heterosexual (38.4%–61.9%; Clements-
Nolle et al., 2006; Lombardi, Wilchins, Priesing,
& Malouf, 2002), it might be inferred that
inflated rates of adverse mental health outcomes
might be attributable to differences in sex-
ual orientation or adverse outcomes associated
with heterosexism. However, emerging research
tends to suggest that transgender persons experi-
ence poorer mental and general health outcomes,
higher levels of suicidal ideation and attempts,
and higher rates of harassment, discrimination,
and violence compared to nontransgender pop-
ulations including lesbian, gay, and bisexual
(LGB) persons (Bockting et al., 2005; Fac-
tor & Rothblum, 2007; Mathy, 2002; Mathy,
Lehmann, & Kerr, 2003; Pitts, Smith, Mitchell,
& Patel, 2006). As such, the extrapolation of
general population and LGB research to trans-
gender persons might not accurately reflect the
transgender experience, and instead there might
be factors specific to the transgender experience
that account for these inflated rates. Two such
factors include gender-related victimization and
social isolation and rejection.
Although it was historically assumed that
discomfort or distress related to one’s bio-
logical sex directly contributed to depression
and suicidality (Lev, 2004), recent research
suggests that the emotional distress experienced
among transgender persons arises in part from
problems associated with living in an oppressive
environment (Nuttbrock et al., 2010). A high
proportion of transgender persons are frequently
exposed to gender-related victimization across
various domains of their lives, with as many as
87% of respondents in the Tranznation survey
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Crystal Boza and Kathryn Nicholson Perry 37
reporting at least one instance of stigma or
discrimination on the basis of their gender
identity (Couch et al., 2007). These findings
are consistent with other convenience studies
reporting a high prevalence of gender-related
victimization occurring from an early age and
persisting across the lifespan at high frequencies
(Clements-Nolle et al., 2006; Couch et al.,
2007; Kenagy, 2005; Kenagy & Bostwick, 2005;
Lombardi et al., 2002; Nuttbrock et al., 2010;
Scottish Transgender Alliance, 2008; Shipherd
et al., 2010; Whittle et al., 2007; Witten, 2003;
Xavier et al., 2005). Transgender persons also
experience systematic discrimination, including
inequalities and direct exclusions in the areas
of education, employment, housing, and health
care (Dean et al., 2000; Gainor, 2000; Padilla,
del Aguila, & Parker, 2007; Whittle et al.,
2007). Research suggests that around one third
of transgender persons experience victimization
in the areas of employment and health care
service provision (Couch et al., 2007; Grant
et al., 2010; Lombardi et al., 2002; Scottish
Transgender Alliance, 2008; Whittle et al.,
2007).
Discrimination and violence can serve as a
barrier to employment (Xavier et al., 2005) and
treatment seeking (Grant et al., 2010; Shipherd
et al., 2010) and can contribute to mental
health outcomes including feelings of shame,
low self-esteem, isolation, loneliness, anxiety
and depression, and substance abuse (Dean et al.,
2000; Grant et al., 2010). Further, there is
evidence to suggest that difficulties associated
with accessing hormones and/or surgery can
put emotional and financial strain upon some
transgender persons and that these can be
associated with adverse mental health outcomes
(Scottish Transgender Alliance, 2008; Whittle
et al., 2007; Xavier et al., 2007).
Social isolation, rejection, and lack of overall
support are commonly reported within the trans-
gender literature (Factor & Rothblum, 2007;
Gapka & Raj, 2003; Maguen, Shipherd, &
Harris, 2005; Whittle et al., 2007). While
there is a paucity of research examining social
support among transgender persons, preliminary
research findings indicate that the transgender
population tends to report less peer contact and
social support relative to samples of the general
population (Colton Meier et al., 2011), their
nontransgender sisters (Factor & Rothblum,
2007), and other minority groups, including men
who have sex with men and bisexually active
women (Bockting et al., 2005).
PREDICTORS OF DEPRESSION
AMONG TRANSGENDER PERSONS
To date, several studies have demonstrated
a positive association between gender-related
victimization and depressive symptoms among
transgender persons (Nemoto et al., 2011;
Nemoto et al., 2004; Nuttbrock et al., 2010;
Pitts, Couch, Mulcare, Croy, & Mitchell, 2009;
Rotondi, Bauer, Scanlon, et al., 2011; Rotondi,
Bauer, Travers, et al., 2011; Shipherd et al.,
2010; Sugano, Nemoto, & Operario, 2006).
Depression and gender-related victimization, in
turn, are associated with an increased risk of
attempted suicide (Clements-Nolle et al., 2006;
Grant et al., 2010). Conversely, higher levels of
perceived social support are associated with pos-
itive mental health outcomes among transgender
persons (Colton Meier et al., 2011; Grossman,
D’Augelli, & Frank, 2011; Liu & Mustanski,
2012; Nemoto et al., 2011). In addition, there
is also evidence to suggest that persons un-
dertaking steps toward transitioning to their
preferred gender identity—that is, hormone ther-
apy and/or gender affirmation surgery—present
with lower levels of affective symptomology
(Cole, O’Boyle, Emory, & Meyer, 1997; Colton
Meier et al., 2011; Michel, Ansseau, Legros,
Pitchot, & Mormont, 2002; Rotondi, Bauer,
Scanlon, et al., 2011) and higher reported quality
of life (Newfield, Hart, Dibble, & Kohler,
2006).
Among the few studies using multivariate
analyses to explore unique predictors of depres-
sive symptoms, various sociodemographic and
transgender-specific risk factors have emerged
as significant contributors. These include plan-
ning to medically transition but having not
yet begun, having lower levels of transgender-
identity support, experiencing lower sexual sat-
isfaction, being unemployed, having lower levels
of income or education, living outside of the
metropolitan area, and previous suicidal ideation
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38 INTERNATIONAL JOURNAL OF TRANSGENDERISM
(Nemoto et al., 2011; Rotondi, Bauer, Scanlon,
et al., 2011; Rotondi, Bauer, Travers, et al.,
2011). While some differences were observed
between biologically assigned sexes, as well
as across bivariate and multivariate analyses,
gender-related victimization and social support
consistently emerged as risk and protective fac-
tors, respectively (Nemoto et al., 2011; Nemoto
et al., 2004; Rotondi, Bauer, Scanlon, et al.,
2011; Rotondi, Bauer, Travers, et al., 2011).
Overall, it appears that reducing instances of
gender-based victimization and enhancing one’s
perceived availability and satisfaction with so-
cial support are critical factors in the promotion
of positive mental health outcomes among trans-
gender persons. Nonetheless, further research is
required to understand the nature and impact of
gender-related victimization and social isolation
and rejection, in addition to understanding those
contributors to depression among transgender
persons.
CURRENT STUDY
The purpose of the current analysis is to de-
scribe the prevalence of mental health outcomes,
gender-related victimization, and perceived so-
cial support among transgender persons residing
in Australia. In particular, we are interested in as-
certaining the predictive value to which gender-
related victimization and perceived social sup-
port contribute to current depressive symptoms.
The term gender-related victimization is used
within this study to refer to a person’s experience
of harassment, abuse, violence, and/or social
and systematic discrimination that have been
perceived to occur based on one’s transgender
status.
It is hypothesized that higher reported in-
stances of gender-related victimization will be
associated with greater symptoms of depression
and that perceived social support will be nega-
tively associated with depressive symptoms in
both bivariate and multivariate analyses. This
study will also seek to explore the role in which
two transgender-specific variables, hormone
therapy and gender-affirmative surgery, con-
tribute to depressive outcomes over and above
that of non–transgender-specific variables.
METHOD
Participants
A total of 328 participants responded to the
survey. To be eligible to participate, respondents
had to identify within the umbrella of transgen-
der, be 18 years or over and currently reside
in Australia. Seventy-three participants were ex-
cluded from the analysis because of incomplete
surveys. The remaining sample consisted of 255
respondents (n=87 assigned female at birth, n
=168 assigned male at birth) with a mean age
of 38.15 years (SD =13.56, range =18–73).
Procedure
Participants were recruited to participate in an
online survey announced as a study of transgen-
der people living in Australia. The anonymous
survey was hosted by survey monkey, a secure
survey provider, and took 10 to 15 min to
complete. Data were collected over a period of
3 months during 2012.
Participants were recruited using purposive
sampling procedures. E-mail and advertisement
invitations to participate in the study detailing
the nature of the survey, eligibility criteria, and
how to access the survey online were distributed
nationwide to transgender-related support ser-
vices for distribution to potential participants.
E-mail invitations were also distributed to es-
tablished social contacts who have close con-
tact with, or are a part of, the transgender
community for snowball recruitment. Research
advertisements were posted on online group sites
and discussion forums that were dedicated to
transgender persons, as well as through flyer
distribution to nationwide transgender-related
services.
To enroll in the study, participants were
directed to a URL link. Upon arriving at the
survey site, participants were provided with a
consent form detailing the nature of the survey
and the potential for distress. Agreement to
participate was provided by clicking “yes” to
the question “Do you consent to participating
in this research?” Only questions relating to
one’s preferred gender identity and biologically
assigned sex at birth involved forced choice,
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Crystal Boza and Kathryn Nicholson Perry 39
thereby providing participants with the option
of skipping subsequent questions or sections of
the survey. An exit button was also featured on
each page of the survey allowing the participant
to withdraw at any time without penalty.
Upon completion of the survey, participants
were presented with a debriefing form that in-
cluded contact details of the principal researcher,
nationwide transgender support services, and a
crisis support telephone number. All study pro-
cedures and questionnaires were approved by the
University of Western Sydney Human Research
and Ethics Committee, and respondents were not
paid for their participation.
Measures
The questionnaire was available as an online
survey, which included the following four sec-
tions.
Participant Characteristics
Participants were asked to report on a number
of sociodemographics including their age, bio-
logically assigned sex, preferred gender identity,
sexual orientation, relationship status, education
level, employment status, state of residence,
and ethnicity. Participants were also asked to
report additional information regarding current
hormone use, history of gender affirmation
surgery, current housing status, and history of
incarceration.
Mental Health Outcomes
The Center for Epidemiological Studies De-
pression Scale (CES-D) was used as a measure
of depressive symptoms (Radloff, 1977). The
CES-D is a 20-item measure which utilizes a
4-point Likert scale whereby respondents indi-
cate whether the item applied to them along the
range of rarely (0) to most of the time (3) during
the past week. Four positively worded items are
reverse coded to give a score ranging from 0
to 60, with higher scores indicating a greater
frequency of depressive symptoms. A cutoff
score of 16 has been widely used as a standard
threshold indicating possible clinical depression
and was employed in this study (Radloff, 1977;
Weissman, Sholomskas, Pottenger, Prusoff, &
Locke, 1977). The CES-D has demonstrated
high internal reliability, ranging from .84 to
.90 reported across various community and
patient populations (Radloff, 1977), with similar
reliability being demonstrated among male-to-
female (MtF) transgender respondents (α=.84;
Shipherd et al., 2010) and the current sample (α
=.81).
Using criteria included in Colton Meier et al.’s
(2011) research, participant’s history of suicide
attempt and history of alcohol and/or substance
abuse was assessed by choosing “yes” or “no”
to the following questions: “Have you ever
attempted suicide?” “Did you attempt suicide
because of your transgender status?” “Have you
or anyone else felt that you have/had a problem
with alcohol?” and “Have you or anyone else felt
that you have/had a problem with a substance
(other than alcohol)?”
Gender-Related Victimization
Participants were asked if they had ever expe-
rienced discrimination, harassment, or violence
because of their status as a transgender person.
If they answered “yes” to this question, partic-
ipants were then asked to select from a list of
19 possible types of discrimination, harassment,
and violence any instances of gender-related
victimization they had experienced. Participants
were also asked to select from a list of five
possible types of economic discrimination they
may have experienced. Participants were then
asked to respond “yes” or “no” to the following
questions: “Have you ever experienced problems
getting health or medical services because of
your status as a transgendered person?” and
“Have you ever experienced problems accessing
housing services (e.g. denied housing or evicted)
because of your status as a transgendered
person?”
Socially-based discrimination was assessed
using criteria included in the Tranznation sur-
vey (Couch et al., 2007), and harassment,
violent incident, and economic discrimination
were assessed using criteria included in the
GenderPAC survey of transgender violence
(Wilchins, Lombardi, Priesing, & Malouf, 1997;
see Table 1). For the purpose of this study,
an overall estimate of a persons’ experience
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40 INTERNATIONAL JOURNAL OF TRANSGENDERISM
TABLE 1. Instances of Gender-Related Victimization (
N
=243)
N
%
Socially-based discrimination (at least one instance) 134 55.1
Direct personal insult/verbal abuse 110 45.3
Excluded socially or ignored 100 41.2
Rumors spread about you 89 36.6
Harassment (at least one instance) 105 43.2
Verbal harassment 79 32.5
Street harassment 72 29.6
Sexual harassment 29 11.9
Telephone harassment 21 8.6
Violent incident (at least one instance) 42 17.3
Assault without a weapon 25 10.3
Assault with a weapon 7 2.9
Attempted assault with a weapon 5 2.1
Sexual assault 17 7.0
Attempted rape 4 1.6
Rape 83.3
Being followed or stalked 16 6.6
Robbery by one person 5 2.1
Robbery by a group of people 3 1.2
Objects thrown at you 18 7.4
Attempted assault without a weapon 10 4.1
Unjustified arrest 3 1.2
Economic discrimination (at least one instance) 82 33.7
Not hired 63 25.9
Loss of job 27 11.1
Unfairly disciplined 27 11.1
Loss of promotion 13 5.3
Demotion 8 3.3
Health care discrimination 61 25.1
Housing discriminationϕ19 7.9
Total victimization (at least one instance)ϕ164 68.6
φ
N
=239.
of gender-related victimization was calculated
by summing instances of discrimination, harass-
ment, violence, economic discrimination, health
care discrimination, and housing discrimination
(range =0–26).
Perceived Social Support
The Multidimensional Scale of Perceived
Social Support (MSPSS) is a questionnaire
designed to assess current perceptions of social
support across three domains: friends, family,
and a significant other (Zimet, 1988). For the
purpose of this research, the total score was used,
with higher scores indicating higher levels of
perceived social support. The measure consists
of 12 statements (e.g., “I can talk about my
problems with my friends”), and respondents
indicate how they feel about each statement
using a 7-point Likert scale ranging from 1
(very strongly disagree)to7(very strongly
agree). Previously reported Cronbach’s alpha for
the total scale indicate good reliability (α=
.84–.92; Zimet, Powell, Farley, Werkman, &
Berkoff, 1990), with similar reliability being
demonstrated among a sample of transgender
youth (α=.80; Grossman et al., 2011) and in
the current sample (α=.94).
Analysis
Preliminary screening of the data revealed
small numbers (<5%) of missing data across
most variables and these were excluded case-
wise. Twelve univariate outliers were removed
from the data set, resulting in a final sample
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Crystal Boza and Kathryn Nicholson Perry 41
size of 243 respondents. The assumption of
normality was violated for MSPSS, which was
negatively skewed, and CES-D and gender-
related victimization, which were positively
skewed. Given that the clinical cutoff for depres-
sivesymptomsontheCES-Dis16ormoreand
its wide range of variability in total score (0–60),
some degree of positive skew would be expected
for this measure. Results of the evaluation
of assumptions for multiple regression were
satisfactory for normality and homoscedacity
of residuals, with no evidence of colinearity
or multicolinearity. As such, no transforma-
tions were conducted, and instead bivariate
correlations were conducted using Spearman’s
rank correlation coefficient to accommodate the
violation of normality.
Preliminary evaluation of relationships be-
tween participant characteristics and depression,
gender-related victimization and depression, and
social support and depression were conducted
using bivariate correlations. To identify factors
independently associated with depression, we
conducted a hierarchical multiple regression
analysis including predictors that were signifi-
cantly associated with depression in the bivariate
analyses. All analyses were conducted using
SPSS version 17.0. The significance level was
set at .05.
RESULTS
Sample Characteristics
The demographic and other relevant char-
acteristics of the final sample (N=243) are
presented in Table 2. Participants were predomi-
nantly of Oceanic (60.9%) or European (33.3%)
ethnicity. The mean age of the participants
was 37.89 years (SD =13.65), and almost
half (45.7%) reported their relationship status
as single. The majority were highly educated,
with 74.0% having engaged in some form of
tertiary education. While just over half of the
participants had either full-time or part-time
employment (52.3%), 19.3% were currently
unemployed or on benefits. Around two thirds
were currently taking hormones (65.4%), with
around one third having had some form of gender
affirmation surgery (33.7%).
Mental Health Outcomes
Of the 231 respondents who completed the
CES-D, 59.3% presented with depressive symp-
toms above the clinical threshold (CES-D
16; M=20.93, SD =14.61). Just under half
(43.6%) of the 243 respondents reported having
previously attempted suicide. Of those who re-
ported a previous suicide attempt, around 62.3%
reported having done so on the basis of their
transgender status. Almost one third (29.6%)
of participants reported having a problem with
alcohol, with 18.5% reporting a problem with
other substances.
Exposure to Gender-Related Victimization
and Perceived Social Support
As seen in Table 1, 31.4% of respondents
reported no instances of gender-related vic-
timization, and over two thirds (68.6%) re-
ported at least one instance of gender-related
victimization (M=3.41, SD =3.64). Of
those who reported some form of gender-related
victimization, 10.9% reported a single instance
of victimization; 25.1% reported between 2 and
4; 18.8%, between 5 and 7; 7.6%, between 8 and
10; and 6.3%, between 11 and 15 instances of
victimization. The most widely reported types
of gender-related victimization included direct
personal insult/verbal abuse (45.3%) and being
excluded socially/ignored (41.2%), whereas the
least reported types included robbery by a group
of people (1.2%), unjustified arrest (1.2%), and
attempted rape (1.6%).
Of the 229 respondents that completed the
MSPSS, the mean score of perceived social
support was 4.68 (SD =1.47). The average
social support reported among this sample was
significantly lower than in the general pop-
ulation, t(228) =−11.50, p<.001, (M=
5.8, SD =0.86; Zimet, 1988). A small but
significant negative association between gender-
related victimization and social support was
observed, rs(202) =−.21, p<.001.
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42 INTERNATIONAL JOURNAL OF TRANSGENDERISM
TABLE 2. Characteristics of Study Participants (
N
=243) and Their Bivariate Association
with Depressive Symptoms
Total Depression
Characteristic
N
%
MSDrs
Assigned gender at birth .14
Female 83 34.218.09 14.05
Male 160 65.822.43 14.72
Preferred gender identity .05
Female 100 41.221.08 14.15
Male 47 19.316.04 14.07
Transgender 28 11.523.04 16.01
Transsexual 16 6.628.79 13.27
Gender queer 19 7.823.28 12.66
Bigender 4 1.626.25 20.04
Cross dresser 13 5.321.00 16.32
Other 16 6.620.06 15.08
Sexual orientation .10
Heterosexual 46 18.918.78 13.80
Homosexual 63 25.918.26 12.93
Bisexual 50 20.624.58 15.94
Asexual 16 6.623.50 17.12
Other 68 28.021.45 14.64
Relationship status .18∗∗
Married 37 15.215.46 12.82
Committed relationship 69 28.419.80 14.57
Single 111 45.722.97 14.40
Widowed, separated, divorced 21 8.624.05 17.88
Ethnicity .02
Oceanic, including Australia 148 60.920.96 14.61
European 81 33.321.71 14.34
Asian 5 2.116.60 17.84
Other 9 3.714.57 16.69
State of residence (Australia) .05
New South Wales 54 22.219.94 15.10
Australian Capital Territory 20 8.220.11 16.13
Victoria 84 34.621.23 13.00
Western Australia 21 8.621.76 18.03
Queensland 41 16.919.22 14.40
South Australia 13 5.326.92 19.61
Tasmania 8 3.323.38 11.29
Northern Territory 1 0.4— —
Current housing status .25∗∗
Stable 230 94.720.08 14.24
Unstable 12 4.938.45 11.34
Age .052
>25 48 19.822.89 13.29
25-39 92 37.920.30 14.18
40-59 77 31.720.89 15.55
60 +21 8.621.21 17.11
Education .20∗∗
>Higher school certificate 17 7.025.33 13.30
Higher school certificate 44 18.123.79 14.06
Technical/Trade qualification 65 26.722.15 15.55
Undergraduate degree 80 32.919.53 14.44
Postgraduate degree 35 14.416.00 12.99
Employment .30∗∗
Part-time employment 32 13.219.00 14.67
(Continued on next page)
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Crystal Boza and Kathryn Nicholson Perry 43
TABLE 2. Characteristics of Study Participants (
N
=243) and Their Bivariate
Association with Depressive Symptoms
(Continued)
Total Depression
Characteristic
N
%
MSDrs
Full-time employment 95 39.115.98 13.65
Student 38 15.621.28 12.13
Retired 19 7.821.05 15.62
Unemployed 21 8.628.43 11.52
Disabled or on benefits 26 10.734.04 13.99
Other 12 4.920.33 13.45
Taking hormones (current) .17∗∗
Yes 159 65.419.34 14.61
No 83 34.224.19 14.11
Reassignment surgery (ever) .23∗∗
Ye s 8 2 33 .716.55 14.28
No 157 64.623.10 14.26
Incarceration (ever) .03
Ye s 1 2 4 .922.67 15.61
No 229 94.220.65 14.50
Problems with alcohol .21∗∗
Ye s 7 2 29 .6% 25.72 15.17
No 171 70.4% 18.93 13.93
Problems with other substances .11
Ye s 4 5 18 .524.23 15.71
No 197 81.120.17 14.29
Suicide attempt (ever) .28∗∗
Yes 106 43.625.72 15.29
No 137 56.017.33 13.08
Suicide attempt attributed to gender .03
Ye s 6 6 62 .225.29 15.04
No 37 34.926.79 16.45
p
<.05. ∗∗
p
<.01.
Predictors of Depression
Using bivariate correlations, we explored
associations between depression and participant
characteristics, as outlined in Table 2. We found
that individuals who are biologically assigned
female, are in committed relationships, have
engaged in higher levels of education, are
currently employed, have stable housing, are
currently taking hormones, have had some form
of gender affirmation surgery, have not had a
previous suicide attempt, and report no history of
alcohol problems are all significantly more likely
to endorse lower levels of depressive symptoms.
Further bivariate analyses revealed that depres-
sion was positively correlated with instances of
gender-related victimization, rs(202) =.23, p<
.001, and negatively correlated with perceived
social support, rs(202) =−.45, p<.001.
Hierarchical multiple regression was per-
formed using depression as the criterion (see
Table 3). At Step 1, non–transgender-specific
sociodemographics and participant characteris-
tics with significant bivariate relationships with
depression were entered first as control variables
(Block 1), including assigned sex, relationship
status, education, employment, previous suicide
attempt, and alcohol problem. While housing
status was identified as having a significant
bivariate relationship with depression, due to its
small cell size and the presence of multivariate
outliers, this variable was not included in the
model. At Step 2, transgender-specific predictors
previously identified in the literature as being
associated with depressive symptoms, hormone
therapy and surgery, were included to control
for any additional variance. At Step 3, vari-
ables of interest, gender-related victimization
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44 INTERNATIONAL JOURNAL OF TRANSGENDERISM
TABLE 3. Predictors of Depressive Symptoms Using Hierarchical Multiple Regression (
N
=204)
Sig. of change
Step Variables entered
R
2change (%)
R
2(%)
Fp
1 Control variables 20.30 20.30 8.3<0.001
2 Surgery, hormone
therapy
6.526.70 8.6<0.001
3 Total victimization,
MSPSS
9.336.10 14.1<0.001
Variables in the equation at Step 3
Var i able
M
(
SD
)
BSEB
β
tp
Constant 29.34 5.92 5.0<0.001
Assigned sex 1.63 (0.48) 2.71 1.78 .09 1.50.13
Relationship 1.46 (0.50) 1.17 1.92 .04 0.60.54
Education 3.35 (1.14) 1.32 0.78 .10 1.70.09
Employment 3.13 (1.74) 0.99 0.54 .12 1.80.07
Alcohol problem 0.27 (0.45) 4.44 2.00 .14 2.20.03
Suicide attempt 0.43 (0.50) 4.52 1.82 .15 2.50.01
Hormone therapy 0.65 (0.48) 1.52 2.11 .05 0.70.47
Surgery 0.35 (0.48) 6.25 2.08 .21 3.00.003
MSPSS 4.76 (1.44) 3.24 0.72 .32 4.5<0.001
Total victimization 3.28 (3.48) 0.51 0.26 .12 2.00.053
Note
. Control variables =assigned sex, relationship, education, employment, suicide attempt, alcohol problem. MSPSS =Multidimensional
Scale of Perceived Social Support. Assigned sex: 1 =biologically assigned female; 2 =biologically assigned male. Relationship: 0 =single;
divorced, separated, widowed; 1 =married, committed relationship. Alcohol problem/suicide attempt/hormone therapy/ surgery: 0 =No;
1=Ye s .
and social support, were included to ascertain
whether they provided any additional unique
contribution.
Control variables entered at Step 1 col-
lectively explained 20.3% of the variance in
depressive symptoms, F(6,197) =8.35, p<
.001. Transgender-specific predictors, hormone
therapy and surgery, were entered at Step 2,
increasing the total variance explained by the
model as a whole to 26.7%, adding an additional
6.5% of variance when controlling for variables
entered in Step 1, F(8,195) =8.90, p<
.001. At Step 3, predictors of interest, gender-
related victimization and perceived social sup-
port, added an additional 9.3% of variance
in depressive symptoms, increasing the total
variance explained by the model as a whole to
32.8%, F(10,193) =10.90, p<.001. In the final
model, only perceived social support, previous
suicide attempt, problem with alcohol, surgery,
and perceived social support were statistically
significant. Perceived social support provided
the strongest unique contribution to the model
(β=−.32, p<.001) and explained 6.6%
of total variance in depressive symptoms, with
surgery providing the second strongest unique
contribution (β=−.21, p<.003). Gender-
related victimization failed to reach statistical
significance within the model (p=.053).
DISCUSSION
Overall, 59% of respondents endorsed symp-
toms consistent with depression, with 44%
reporting a previous suicide attempt and 69%
reporting at least one instance of gender-related
victimization. Consistent with our hypothesis,
lower levels of perceived social support were
significantly associated with higher levels of
depression at both bivariate and multivariate
levels. Further, greater instances of victimization
were significantly associated with higher levels
of current depressive symptoms at a bivariate
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Crystal Boza and Kathryn Nicholson Perry 45
level, although victimization did not reach
significance in the multivariate analysis. The
combination of current hormone use and having
had some form of gender affirmative surgery
provided a significant contribution to lower
depressive symptoms over and above control
variables. Interestingly, surgery emerged as the
second most important unique predictor of lower
depression, whereby having had some form of
gender affirmative surgery was associated with
lower depressive symptoms.
Prevalence of Mental Health Outcomes
Almost 60% of respondents were identified
as having current symptoms consistent
with depression, an estimate which falls
within the upper range of those reported in
previous studies examining depression among
transgender persons (Bockting et al., 2005;
Clements-Nolle et al., 2006; Couch et al., 2007;
Nemoto et al., 2011; Nemoto et al., 2004;
Nuttbrock et al., 2010; Operario & Nemoto,
2005; Rotondi, Bauer, Scanlon, et al., 2011;
Rotondi, Bauer, Travers, et al., 2011; Shipherd
et al., 2010). Just under half of respondents in
this study had previously attempted suicide,
with this rate falling above the upper range
of prevalence rates observed across previous
studies (Clements-Nolle et al., 2006; Grant et al.,
2010; Kenagy, 2005; Kenagy & Bostwick, 2005;
Mathy, 2002; Nemoto et al., 2011; Nuttbrock
et al., 2010; Operario & Nemoto, 2005; Xavier
et al., 2005; Xavier et al., 2007). Of those who
had reported a previous suicide attempt, over
60% reported having done so on the basis of
their transgender status. These rates of mental
health outcome are well in excess of what would
be expected on the basis of broader lifetime
estimates, with depressive episodes estimated
to affect 4.1% and suicide attempt estimated to
occurin3.3%ofAustraliansaged16to85years
(Slade et al., 2009). Finally, 30% of respondents
within this study reported problematic alcohol
consumption and 19% reported a problem with
other substances, with these rates falling within
the expected range of substance misuse based on
previous research findings among transgender
persons (Bockting et al., 2005; Colton Meier
et al., 2011; Xavier, 2000; Xavier et al., 2007).
Perceived Social Support
The overall levels of perceived social sup-
port among this sample (M=4.6) was
substantially lower than those rates observed
across samples of the general population (M
=5.58–6.01; Zimet, 1988; Zimet et al.,
1990). This finding is not surprising given
that transgender persons are particularly vul-
nerable to isolation and loneliness (Gapka &
Raj, 2003; Maguen et al., 2005), including
rejection within familial and intimate relation-
ships (Factor & Rothblum, 2007; Whittle et al.,
2007).
Perceived social support emerged as the sin-
gle most important predictor of depressive symp-
toms, providing a small but unique significant
contribution to current depressive symptoms.
That higher levels of perceived support are
significantly predictive of lower levels of depres-
sive symptoms has also been demonstrated in
previous studies among transgender populations
(Nemoto et al., 2011; Rotondi, Bauer, Scanlon,
et al., 2011; Rotondi, Bauer, Travers, et al.,
2011) and is consistent with previous research
indicating that enhancing one’s social support
is a critical factor in the alleviation of depres-
sive symptoms among samples of the general
population (Aro, 1994; Grav, Hellz`
en, Romild,
& Stordal, 2012; Mead, Lester, Chew-Graham,
Gask, & Bower, 2010). While social support
was directly and significantly associated with
the mental health of people within this study, it
is also possible that social support exerts indirect
effects. For instance, there is evidence to suggest
that transgender persons experience richer and
more extensive social relations (Michel et al.,
2002) and greater satisfaction with social rela-
tionships (De Cuypere et al., 2006) after surgery.
However, as this research is a cross-sectional
study of correlations, a causal relationship be-
tween social support and depression cannot be
established, and it could be that those who are
more depressed withdraw from social supports
that are available.
Regardless of its mechanisms, it is clear that
enhancing satisfaction with, and availability of,
social supports plays a significant protective
role against the likelihood of having depressive
symptoms. Given that transgender persons tend
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46 INTERNATIONAL JOURNAL OF TRANSGENDERISM
to report less peer contact and social support
relative to samples of the general population
(Bockting et al., 2005; Colton Meier et al.,
2011), interventions and policy aimed at encour-
aging social support among transgender persons
may have merit in the promotion of positive
mental health outcomes. Interventions should
include public funding of transgender social
spaces and support services that promote peer
support and contact; increasing opportunities
for transgender persons to access sports and
leisure centers; promoting social activism and
providing opportunities for transgender persons
and supportive others to educate the public about
transgenderism; and rolling out educational
training packages and resources for schools,
workplaces, and medical settings. Further, given
that transgender persons are vulnerable to re-
jection within their family and among intimate
partners (Factor & Rothblum, 2007; Whittle
et al., 2007) and that there is clear evidence to
suggest that discord in the family environment
and lack of intimate partnership can contribute
to depression (Aro, 1994), extending support
services to family and loved ones might be bene-
ficial in encouraging the retention of supportive
networks.
Gender-Related Victimization
This study supports findings from previous
studies that a disproportionately high number
of transgender persons have been exposed to
harassment, abuse, violence, and systemic dis-
crimination (Clements-Nolle et al., 2006; Couch
et al., 2007; Kenagy, 2005; Kenagy & Bostwick,
2005; Lombardi et al., 2002; Nuttbrock et al.,
2010; Scottish Transgender Alliance, 2008;
Shipherd et al., 2010; Whittle et al., 2007;
Witten, 2003; Xavier et al., 2005). Almost 70%
of the respondents in this survey reported at least
one instance of gender-related victimization,
with around one third experiencing some form of
economic discrimination, one quarter reporting
experiencing health care discrimination, and 8%
reporting experiencing housing discrimination
on the basis of their transgender status. Consis-
tent with previous findings, greater instances of
victimization were significantly associated with
higher levels of current depressive symptoms
(Nemoto et al., 2011; Nemoto et al., 2004;
Nuttbrock et al., 2010; Pitts et al., 2009; Rotondi,
Bauer, Scanlon, et al., 2011; Rotondi, Bauer,
Travers, et al., 2011; Shipherd et al., 2010;
Sugano et al., 2006).
Gender-related victimization has emerged as
a significant independent predictor of depression
in several previous studies (Nemoto et al., 2011;
Nemoto et al., 2004; Rotondi, Bauer, Scanlon,
et al., 2011); however, it failed to emerge as a
significant unique predictor of depression within
this study. A similar outcome was observed
among MtF Ontarians whereby gender-related
victimization was associated with a 13% in-
crease in the odds of depression but failed to
meet significance when controlling for other
variables in the model (Rotondi, Bauer, Travers,
et al., 2011). It seems likely then that the as-
sociation between victimization and depression
may be mediated by other variables entered into
the model within this study. For instance, access
to hormone therapy or surgery may increase or
decrease the likelihood of victimization by way
of disclosure of one’s preferred gender identity,
or similarly by way of “passing”—that is, not
being perceived to be transgender by others,
an area which could be further investigated in
future research. Similarly, given the small but
significant negative correlation between social
support and gender-related victimization, it is
also likely that having greater perceptions of
social support may also be protective against
victimization.
That gender-related victimization failed to
reach significance at a multivariate level within
this study may also be a function of differ-
ences in the measurement of gender-related
victimization across studies and the application
of a nonstandardized measure of victimization
within this study. Further, caution in interpreting
these results is required given the violation of
normality across measures used in this study in
addition to the large variance in victimization
scores, both of which may compromise the
representativeness of this data set of the broader
population of transgender persons. Nevertheless,
gender-related victimization creates an undue
stressful social environment that can contribute
to adverse mental health among transgender
persons and thus constitutes a significant health
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Crystal Boza and Kathryn Nicholson Perry 47
concern. Interventions are required to reduce
instances of victimization such as violence-
prevention programs, more pervasive and acces-
sible public policies and legislation concerning
antidiscrimination, and promotion of safe re-
porting of instances of victimization in addition
to services to educate and support persons
who are vulnerable to, or have experienced,
gender-related victimization, such as mentoring
programs.
Hormone Therapy and Gender
Affirmation Surgery
Over and above those contributors to depres-
sion shared with the non–transgender-specific
population, current hormone use and having
had some form of gender affirmative surgery
emerged as significant predictors of current de-
pressive symptoms within this study. Even when
variables of interest gender-related victimiza-
tion and perceived social support were entered
into the model, having undergone some form
of gender affirmative surgery emerged as the
second most important predictor of depressive
symptoms. Consistent with previous research,
the outcomes of this study suggest that those
persons who are taking steps toward affirming
their preferred gender identity, including hor-
mone therapy and/or surgery, tend to report
lower levels of depressive symptoms (Blan-
chard, Clemmensen, & Steiner, 1983; Blanchard
& Steiner, 1983; Colton Meier et al., 2011;
Michel et al., 2002; Rotondi, Bauer, Scanlon,
et al., 2011).
There are several possible mechanisms
whereby having had some form of gender
affirmative surgery might contribute to better
mental health outcomes that are supported by
the available research. Firstly, it is likely that
surgery helps to lessen the incongruence be-
tween one’s preferred gender identity and one’s
biologically assigned sex, which might decrease
psychological outcomes associated with gender
dysphoria (Colton Meier et al., 2011; Dean et al.,
2000) and improve one’s perception of their
body (Rakic, Starcevic, Maric, & Kelin, 1996).
In turn, these can contribute to improved quality
of life (Newfield et al., 2006) and improved
social and occupational functioning (Rakic et al.,
1996).
Despite clear clinical guidelines positing
that gender affirmative surgery be regarded
as an appropriate treatment option for gender
dysphoria (World Professional Association for
Transgender Health, 2012), in Australia, access
to some hormones and major surgeries are only
partially government subsidized. Further, this
subsidy is only available for surgeries carried
out within Australia, and the individual is often
left to pay upward of thousands of dollars out
of pocket. There are still a number of gender
affirmative surgeries and medical treatments that
are not covered by Medicare at all. The finding
that surgery is predictive of depression among
this sample may have emerged in part due to
the fact that those persons reporting having had
surgery would have done so at their own expense.
Given the substantial cost associated with such
surgeries, it is likely that those persons would
have greater personal and financial resources
and that this might be associated with improved
mental health. It is also important to note
that the generalization of these findings to the
broader transgender population is complicated
in that there is no single path of transition
for persons seeking to express their preferred
gender identity. Some persons may not want,
or are unable, to access the various forms of
hormone therapies and surgical interventions
that are available and thus may have differing
mental health outcomes, an area that might be
addressed in future research.
STUDY LIMITATIONS AND FUTURE
DIRECTIONS
In addition to those limitations identified
above, there are a number of methodological
limitations that may affect the generalizability
of findings drawn from the research and its
comparison to previous literature. For example,
participation in this study depended on self-
identification as transgender, and the majority
of respondents were sourced via gender-related
support services. Consequently, this sample may
not have captured those who are entirely isolated
from the transgender community or may have
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48 INTERNATIONAL JOURNAL OF TRANSGENDERISM
omitted individuals who do not identify as
transgender or those who identify themselves
as gay, lesbian, or bisexual but may fall within
the transgender spectrum (Xavier et al., 2005).
Additionally, the sample was predominantly of
Oceanic or European background (94.2%) and
may not adequately capture the racial diversity
of transgender Australians, including sistergirls,
who might also be subject to victimization
on the basis of their race (Moran & Sharpe,
2004). Further, this study failed to collect data
concerning level of drug or alcohol use, phys-
ical health conditions including HIV-positive
serostatus, HIV sexual risk behaviors, and
medication use (including antiretroviral therapy
and psychotropic medication), all of which can
impact mental health outcomes (Dean et al.,
2000; Kaestner et al., 2012; Rotondi, 2012) and
could have influenced the findings presented
here.
It is important to note that, while this study
sought to investigate predictors of depression
shared across transgender persons regardless
of their biologically assigned sex or preferred
gender identity, previous research has demon-
strated differential pathways to depression
among female-to-male (FtM) persons compared
to MtF persons (Rotondi, Bauer, Scanlon, et al.,
2011; Rotondi, Bauer, Travers, et al., 2011).
For example, not having accessed hormones or
surgery was a significant unique risk factor for
depressive symptoms among FtM Ontarians but
not MfT Ontarians.
While this report placed an emphasis on
identifying those factors associated with current
depressive symptoms, it is important to note
that the CES-D is not a diagnostic tool and
that outcomes from this study do not infer
that transgender persons are at a higher risk
of clinically relevant psychopathology. In fact,
the understanding of mental health outcomes
among some transgender persons is complicated
in that psychopathology can be etiologically
entwined with a number of precursors including
(a) normal responses to stages of gender identity
development, including distress resulting from
the mismatch of biological sex and gender
identity; (b) concerns related to, but not inherent
to or caused by, gender identity; (c) discrimi-
nation, victimization and other culturally based
stressors; (d) the process of gender reassignment,
including adverse reactions to hormones or
unsatisfactory health care experiences; and (e)
reasons unrelated to gender identity or dis-
crimination (Dean et al., 2000; Gainor, 2000;
Lev, 2004; Pitts et al., 2009; Xavier et al.,
2005).
In addition to addressing those limitations
highlighted within this article, future research
would benefit from the inclusion of a compar-
ison group of nontransgender participants to
accommodate the direct exploration of differ-
ences in depressive predictors across groups.
Furthermore, given the temporal limitations of
cross-sectional research and the CES-D and
MSPSS, future research would benefit from a
prospective study design that would allow the
differentiation between depression arising from
temporal fluctuations compared to depression
arising from victimization. Similarly, future
research might seek to explore the association
between perceptions of social support and vic-
timization by assessing levels of support at the
time of the instance of victimization. Included
in the aims of such research projects may
be the investigation of whether a transgender-
specific measure of mental health outcomes
that accommodates those unique aspects of the
transgender experience might be a more viable
alternative to general population measures of
depression.
IMPLICATIONS OF THE CURRENT
STUDY AND CONCLUSIONS
This research provides important information
concerning individual and societal predictors
of depression among transgender persons and
thereby highlights primary areas that can serve
as a focal point when developing interventions
designed to increase well-being among transgen-
der persons. This study confirms that depression
is a multifaceted condition that, for transgender
persons, includes known risk factors shared
across the non–transgender-specific community
as well as additional risk factors that are specific
to the transgender community. That risk factors
include aspects unique to the transgender expe-
rience highlights the need to facilitate ongoing
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Crystal Boza and Kathryn Nicholson Perry 49
service provider education concerning the needs
and experiences of transgender persons in order
to promote culturally sensitive health care pro-
vision.
Transgender persons are often underrepre-
sented in research and the available research
is often overlooked in the context of health
care, a phenomena referred to as “informational
erasure” (Bauer et al., 2009). As such, more
effort is required to disseminate findings of
research regarding the needs and experiences
of transgender persons, in addition to cam-
paigning for government and funding bodies
to support further research. Specifically, we
need to work toward disseminating research
findings in an effort to foster a greater awareness
and understanding of the challenges transgender
people encounter that can negatively impact their
mental health. Further, we should work toward
disseminating research findings to policy makers
to advocate for informed changes to policy and
legislation relevant to the promotion of mental
health outcomes for transgender persons.
It is extremely concerning that the rate of
attempted suicide within this study exceeds
both non–transgender-specific population esti-
mates and rates reported in previous studies of
transgender persons. Given that victimization
and depression are risk factors of attempted
suicide among transgender persons (Clements-
Nolle et al., 2006; Grant et al., 2010), ef-
fective evidence-based strategies to reduce the
persistence of depression, gender-related vic-
timization, and suicidality need to be devel-
oped and implemented. It is recommended that
those strategies include not only a bottom-up
approach to reduce the stigma associated with
transgressions of the assumed gender binary and
circumvent the pervasiveness of victimization,
but also a top-down approach whereby the
needs of transgender persons are recognized and
supported by the government.
In summary, results from this study indi-
cate that depression symptomology, suicidality,
and gender-related victimization are widespread
among transgender Australians and represent
a major health concern. Clinically, these find-
ings suggest that perceptions of social sup-
port among some transgender persons have
very important implications upon one’s like-
lihood of experiencing depressive symptoms
and that for persons seeking medical interven-
tions to physically transition to their preferred
gender, not being able to access hormones
and surgery may compromise their mental
health.
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This study examined 392 regrettable sex stories submitted by college students attending a large public university in the northeast. Stories were coded for common themes. In nearly half the sexual episodes (49%), the individuals were drinking. However, only 16% cited “I was drunk” as the primary reason for regretting the sexual experience. Other common reasons cited by students for regretting a sexual experience were: “It was a disappointing first time” (25%), “It was unprotected sex” (22%), “I was cheating on my partner” (17%), “It was a one-night stand” (17%), and “It ruined our friendship” (11%). Implications for educating college students are discussed.
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Although depression is understudied in transgender and transsexual communities, high prevalences have been reported. This paper presents original research from the Trans PULSE Project, an Ontario-wide, community-based initiative that surveyed 433 participants using respondent-driven sampling. The purpose of this analysis was to determine the prevalence of, and risk and protective factors for, depression among female-to-male (FTM) Ontarians (n = 207). We estimate that 66.4% of FTMs have symptomatology consistent with depression. In multivariable analyses, sexual satisfaction was a strong protective factor. Conversely, experiencing transphobia and being at the stage of planning but not having begun a medical transition (hormones and/or surgery) adversely affected mental health in FTMs.
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The call by transgender people for the police to take violence against them more seriously has some familiar attributes. In general it is a violence characterized as hate crime. Transgender activism has highlighted many problems, for example, under-reporting, lack of trust and confidence in policing, lack of police recognition, low detection rates, clear up rates and infrequent judicial determinations of guilt. This activism might be characterized as another instance of identity politics emerging within the field of policing and criminal justice. While we welcome its emergence some scholars have been critical of the impact of identity politics upon policing and criminal justice bodies, suggesting it promotes further social and community divisions. Although we share some of these concerns, in this article we argue that these problems are the effect of particular assumptions about the nature of identity. We offer an analysis of identity politics that seeks to challenge this position, as well as an analysis of empirical data of transgender experiences of violence and insecurity arising out of research undertaken in Sydney, Australia. Our analysis exposes the multiple and simultaneous operation of many different social and cultural divisions at work in the context of transgender identity. We explore the significance of this approach to identity for policing.
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Fifty-five transgender youth described their gender development and some of the stressful life experiences related to their gender identity and gender expression. More than two-thirds of youth reported past verbal abuse by their parents or peers related to their gender identity and nonconformity, and approximately one-fifth to one-third reported past physical abuse. The more gender non-conforming the youth were, the more abuse they reported. Four aspects of psychological resilience were examined: a sense of personal mastery, self-esteem, perceived social support, and emotion-oriented coping. A regression model of the selected aspects of resilience accounted for 40%–55% of the variance in relation to depression, trauma symptoms, mental health symptoms, and internalizing and externalizing problems. Emotion-oriented coping was a significant predictor of negative mental health as determined by each of the mental health variables.