Abstract
This study aimed to examine psychosocial factors and medical history as well as symptoms of depression, anxiety, and stress associated with ruminative thinking in transgender people with gender dysphoria (GD) before undergoing gender affirmation surgery (GAS). This study evaluated 189 participants with GD (111 trans women and 78 trans men) from a specialized service for GAS in southern Brazil. Semi-structured interviews were conducted, and participants were asked to complete self-report questionnaires. We recovered participants' sociodemographic and psychosocial data (e.g., history of sexual abuse, expulsion from home, and history of drug use) and data regarding their clinical history (e.g., medication, history of suicidal ideation and attempted suicide, and HIV status). Further, we implemented the Depression, Anxiety and Stress Scale (DASS-21) to examine participants' psychological state, as well as the Ruminative Response Scale (RRS) to assess ruminative thinking, which includes brooding and reflection. The predictor variables were those that exhibited a minimum level of significance of p ≤ 0.05 in multivariate linear regression. The ruminative thinking scores for trans women were higher than those of trans men (Brooding p = 0.014; Reflection p = 0.052).In the multivariate model, suicidal ideation, moderate depression, and severe/very severe anxiety were associated with both brooding and reflection. Feminine gender identity and stress symptoms moderated only brooding, while anxiety symptoms moderated only reflection. Our findings show that trans women had the highest ruminative thinking scores, and that depression, anxiety, stress, and suicidal ideation were associated with ruminative thinking in total sample. Psychological symptoms should be examined in the context of gender affirmation surgery to minimize the possibility of adverse mental health outcomes. Follow-up studies are required to measure ruminative thinking levels more accurately and to identify its predictors.
Highlights
Ruminative thinking (RT) is defined as a repetitive thinking pattern causing adverse emotional responses that impair the individual’s use of psychological coping strategies [1]
Our study is the first to analyze the psychosocial, sociodemographic, and clinical factors associated with RT in a transgender population with Gender dysphoria (GD) participating in a specialized hospital program for gender affirmation surgery (GAS)
The mechanisms underlying RT are important indicators to be taken into consideration during clinical evaluation and in the development of preventive strategies to improve trans individuals’ mental health regarding GD
Summary
Ruminative thinking (RT) is defined as a repetitive thinking pattern causing adverse emotional responses that impair the individual’s use of psychological coping strategies [1]. It can be described as the persistent tendency to harbor selfcentered thoughts, intrinsic in people in general, but which can become dangerous to psychological health and can accompany different clinical conditions [2, 3]. Silveira et al [15], analyzed RT patterns in individuals diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, depressive disorder and anxiety disorder and showed rumination as a poorly adaptable coping style associated with worry, distress, disease severity and status socioeconomic. We tried to expand the sample of participants and test another hypothesis of association
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