Transgender and anxiety: A comparative study between transgender people and the general population

Abstract

Background:Anxiety disorders pose serious public health problems.The data available on anxiety disorders in the transgender population is limited by the small numbers, the lack of a matched controlled population and the selection of a nonhomogenous group of transgender people.Aims:The aims of the study were(1)To determine anxiety symptomatology (based on the HADS) in a non-treated transgender population and to compare them to a general population sample matched by age and gender;(2)To investigate the predictive role of specific variables, including experienced gender, self-esteem, victimization, social support, interpersonal functioning and cross-sex hormone use regarding levels of anxiety symptomatology;(3)To investigate differences in anxiety symptomatology between transgender people on cross-sex hormone treatment and those who are not.Methods:A total of 913 individuals, who self-identified as transgender attending a transgender health service during a three-year period agreed participation. For the first aim of the study 592 transgender people not on treatment were matched by age and gender with 3816 people from the general population. For the second and third aim the whole transgender population was included. Measurements:Socio-demographic variables and measures of depression and anxiety(HADS), self-esteem(RSE), victimisation(ETS), social support(MSPSS), and interpersonal functioning(IIP-32).Results:Compared with the general population transgender people had a nearly 3-fold increased risk of probable anxiety disorder(all p < .05). Low self-esteem and interpersonal functioning were found to be significant predictors of anxiety symptoms. Trans women on treatment with cross-sex hormones were found to have lower levels of anxiety disorder symptomatology.Conclusions:Transgender people (particularly trans males) have higher levels of anxiety symptoms suggestive of possible anxiety disorders, when compared to the general population. The findings that self-esteem, interpersonal functioning and hormone treatment is associated with lower levels of anxiety symptoms indicate the need for clinical interventions targeting self-esteem and interpersonal difficulties as well as the importance of quick access to transgender health services.

The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use

“…These high rates are consistent with recent studies on individuals who identify as transgender (Arcelus, Claes, Witcomb, Marshall, & Bouman, 2016; Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, 2013; Dawson, Wymbs, Gidycz, Pride, & Figueroa, 2017), with our large and diverse data set underscoring the major needs of transgender individuals during college. Psychological factors like the expectation of rejection may lead students to feel unworthy and unsafe, leaving them more susceptible to MH challenges compared to their counterparts who classify as cisgender (Bouman et al, 2017; Denton, Rostosky, & Danner, 2014). Notably, these high rates of diagnoses might reflect greater service utilization use among sexual minorities (Kerr et al, 2013; Oswalt & Wyatt, 2011).…”

Risk Factors for Eating Disorder Psychopathology within the Treatment Seeking Transgender Population: The Role of Cross‐Sex Hormone Treatment

“…Transgender people experience incongruence between their gender assigned at birth [determined from their sex characteristics (i.e., genitals)] and the gender they identify with. Transgender men are assigned female at birth but identify as male, while transgender women are assigned male at birth but identify as female (Arcelus & Bouman, ; Bouman et al ., ). Cisgender people (non‐transgender) do not experience such incongruence.…”

“…Factors associated with, and found to mediate, eating disorder psychopathology in the cisgender population may be particularly pertinent among transgender people. This is because research has consistently shown treatment seeking transgender people to report high levels of mental health problems, such as anxiety and depression (e.g., Arcelus, Claes, Witcomb, Marshall, & Bouman, ; Bouman et al ., ; Bouman, Davey, Meyer, Witcomb, & Arcelus, ; Dhejne, Van Vlerken, Heylens, & Arcelus, ; Millet, Longworth, & Arcelus, ), perfectionism (Khoosal et al ., ), and interpersonal problems (Davey, Bouman, Meyer, & Arcelus, ) in comparison to cisgender people. Therefore, these factors may be important when exploring risk factors for eating disorder psychopathology within the transgender population.…”

Transactional pathways of transgender identity development in transgender and gender-nonconforming youth and caregiver perspectives from the Trans Youth Family Study

“…Minority stress theory proposes that experiencing prejudice and discrimination related to stigma associated with holding a marginalized identity has a negative impact on health (Hendricks & Testa, 2012; Meyer, 2003). As a likely consequence to minority stress experienced as a result of stigma associated with being transgender, studies of mental health among transgender individuals, including youth, consistently show elevated rates of suicidality, anxiety, and depression (Bouman et al, 2017; Colizzi, Costa, & Todarello, 2014; Connolly, Zervos, Barone, Johnson, & Joseph, 2016; Millet, Longworth, & Arcelus, 2017; Perez-Brumer, Hatzenbuehler, Oldenburg, & Bockting, 2015; Reisner et al, 2015; Tebbe & Moradi, 2016; Warren, Bryant Smalley, & Nikki Barefoot, 2016). Mental and physical health care professionals have begun to see a substantial rise in referrals for gender nonconforming youth (Malpas, 2011; Meyer, 2012; Alegria, 2011; Olson-Kennedy, 2016).…”