Abstract
BackgroundTrans women have been shown to experience disproportionately poor outcomes in physical and mental health. Although it is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, particularly in developing countries. This study aims to investigate risk factors and associations with mental health, suicide ideation and suicide attempts among trans women in the largest metropolitan area in Brazil.MethodsTrans women living in São Paulo were recruited between May 2017 and July 2019 using the long-chain peer referral method Respondent-Driven Sampling. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic).ResultsA total of 763 trans women were included in the study. Over one quarter (26.5%) of trans women had been diagnosed with anxiety in the past, and close to one in five (19.1%) trans women had received a diagnosis of depression. More than two in five (41.9%) trans women had moderate to severe psychological distress. More than half of all participating trans women reported having previously either experienced suicidal ideation or attempted to take their own lives (25.0 and 31.2% respectively). In multivariate regression, moderate to severe psychological distress was associated with homelessness, income, current sex work, use of stimulant drugs, history of physical abuse, depression diagnosis and access to mental health treatment. Suicidal ideation and suicide attempts were associated with race/skin color, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress.ConclusionsThis study showed that there is a significant association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. Findings point to the need for a structural transformation in Brazil that enables a reduction in the social inequality and violence that impact the mental health of trans women. A number of recommendations to achieve this are provided.
Highlights
Trans women have been shown to experience disproportionately poor outcomes in physical and mental health
Apart from the low investment in mental health care, in Brazil medicalization stands out as the main form of intervention and treatment of the symptoms presented in common mental health disorders, with little acknowledgement of the particular conditions of vulnerability of patients, who often belong to population groups marked by specific types of violence, such as gender violence or racial discrimination [8, 9]
Data treatment and analysis Given the exploratory nature of this study, we considered a number of potential explanatory variables for the data analysis process: age, sex orientation, level of education, race/skin color, homelessness before age 18, homelessness after age 18, living situation, marital status, monthly income, receipt of government financial assistance, engagement in sex work, alcohol and drug use, access to treatment of mental health conditions, depression, PTSD and anxiety diagnoses, psychological distress based on K10 results, suicidal ideation in lifetime, suicide attempt in lifetime, and experiences of violence and discrimination
Summary
Trans women have been shown to experience disproportionately poor outcomes in physical and mental health. It is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, in developing countries. Despite an increasing awareness of the burden of mental health in society, investment in mental health support within public health systems is still largely inadequate This is the case in low and middle-income countries, where public investment in mental health care is low. Local studies point out a high correlation between the emergence of these disorders and socioeconomic conditions such as gender, race, poverty and low education level [10, 11] Whether such diagnoses point to clinical conditions or a medicalization of social issues is still not clear. In any case, fighting the symptom through medication is not likely to eliminate its structural determinants
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