Levels of anxiety and depression in transgender people accessing services: A large matched control study

Anxiety and depression are serious disorders which significantly impact upon a person’s wellbeing and quality of life. The transgender population is reported to be at an increased risk for such disorders, with symptoms often... [ view full abstract ]

Anxiety and depression are serious disorders which significantly impact upon a person’s wellbeing and quality of life. The transgender population is reported to be at an increased risk for such disorders, with symptoms often associated with other difficulties such as discrimination in employment, abuse and harassment, and lack of gender confirming treatment. While studies that have sought to investigate the prevalence of these disorders in the transgender population have offered valuable insight, the data are often limited by small sample sizes, the lack of control for known factors that affect symptomology (age and gender), and the selection of non- homogenous groups of transgender people; that is, those at varying points in their treatment.

Given these limitations, the first aim of the study was to explore differences in anxiety and depressive symptomology between a large sample of non-treated, transgender individuals attending a national transgender health... [ view full abstract ]

Given these limitations, the first aim of the study was to explore differences in anxiety and depressive symptomology between a large sample of non-treated, transgender individuals attending a national transgender health service in the UK who were matched by age and experienced gender with a general population sample. The second aim of the study was to investigate, in the transgender individuals, the predictive role of specific variables on levels of anxiety and depressive symptomology and any differences in such symptomology between those on cross-sex hormone treatment and those not. The third and final aim was to assess the prevalence of anxiety and depressive symptomology between treated and non-treated transgender individuals.

During a three-year period, from 2012-2015, all transgender individuals (n=937) attending a transgender health service in the UK were invited to participate in the study. Of these, 24 did not agree, leaving a final sample of... [ view full abstract ]

During a three-year period, from 2012-2015, all transgender individuals (n=937) attending a transgender health service in the UK were invited to participate in the study. Of these, 24 did not agree, leaving a final sample of 913 transgender individuals to be matched with a general population sample. Anxiety and depression were measured in both the transgender and cisgender populations using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Transgender participants also completed measures of self-esteem (Rosenberg Self-Esteem Scale, RSE), victimization (Experiences of Transgenderphobia Scale, ETS), social support (Multidimensional Scale of Perceived Social Support, MSPSS), and interpersonal function (Inventory of Interpersonal Problems, IIP-32). Information regarding the use of treatment (cross-sex hormones (CHT) pre-assessment) was also collected.

The main outcome measures were anxiety and depressive symptomology. For both anxiety and depression scores, individuals were categorized as either no disorder, possible disorder, or probable disorder based on cut-offs... [ view full abstract ]

The main outcome measures were anxiety and depressive symptomology. For both anxiety and depression scores, individuals were categorized as either no disorder, possible disorder, or probable disorder based on cut-offs recommended in the literature. The additional questionnaires were scored and used as predictor variables for these two main outcome measures.

Of the 913 transgender individuals, 259 were on CHT and 640 were not. Data was missing for 14 individuals and so they were excluded from further analysis. For Aim 1, the 640 individuals not on CHT were matched with individuals... [ view full abstract ]

Of the 913 transgender individuals, 259 were on CHT and 640 were not. Data was missing for 14 individuals and so they were excluded from further analysis. For Aim 1, the 640 individuals not on CHT were matched with individuals from the general population by age and experienced gender. Due to insufficient numbers for certain age groups (n=64), only 576 individuals could be matched. Analysis revealed that transgender individuals were significantly more prevalent in the categories of possible and probable anxiety disorder and possible and probable depressive disorder compared to cisgender individuals who were more prevalent in the no disorder categories (all p<.01). This pattern of results was consistent when comparing within identified genders also, e.g. cis men compared to trans men (all p<0.01) In relation to Aim 2, within the whole transgender group (both treated and non-treated; n=889), low self-esteem and interpersonal function significantly predicted both anxiety and depressive symptoms, while less social support also predicted the latter. The analysis for Aim 3 also found that the use of cross-sex hormones was associated with lower levels of anxiety and depressive symptoms in transgender individuals. 

This large scale, matched control study confirms that non-treated transgender individuals are at an increased risk of disorders that impact upon their wellbeing. This risk is predicted by other factors indicative of reduced... [ view full abstract ]

This large scale, matched control study confirms that non-treated transgender individuals are at an increased risk of disorders that impact upon their wellbeing. This risk is predicted by other factors indicative of reduced quality of life, such as low self-esteem, poor interpersonal skills and lack of social support. Interventions aimed at developing interpersonal skills, increasing self-esteem and improving social support may prepare the individual for a more successful transition.