A Cross-Sectional Study of Mental Health and Suicidality Among Trans Women in São Paulo, Brazil

Abstract

Background Trans women have also 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. Methods We surveyed 763 adult trans women living in São Paulo between May 2017 and July 2019. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic). Results Over one quarter of trans women had been diagnosed with anxiety in the past, and close to one in five trans women had received a diagnosis of depression. More than two in five 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. In multivariate regression, moderate to severe psychological distress was correlated 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 correlated with race, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress. Conclusions This study showed that there is a clear association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. This is the largest published empirical study of trans women’s mental health outcomes and related socioeconomic risk factors in Brazil and, to our knowledge, one of the largest worldwide.