Dataset Information

Documenting Research with Transgender, Nonbinary, and Other Gender Diverse (Trans) Individuals and Communities: Introducing the Global Trans Research Evidence Map.

ABSTRACT: There is limited information about how transgender, nonbinary, and other gender diverse (trans) people have been studied and represented by researchers. The objectives of this study were to: (1) increase access to trans research; (2) map and describe trans research across subject fields; and (3) identify evidence gaps and opportunities for more responsible research. Eligibility criteria were established to include empirical research of any design, which included trans participants or their personal information and that was published in English in peer-reviewed journals. A search of 15 academic databases resulted in 25,230 references; data presented include 690 trans-focused articles that met the screening criteria and were published between 2010 and 2014. The 10 topics studied most frequently were: (1) therapeutics and surgeries; (2) gender identity and expression; (3) mental health; (4) biology and physiology; (5) discrimination and marginalization; (6) physical health; (7) sexual health, HIV, and sexually transmitted infections; (8) health and mental health services; (9) social support, relationships, and families; and (10) resilience, well-being, and quality of life. This map also highlights the relatively minor attention that has been paid to a number of study topics, including ethnicity, culture, race, and racialization; housing; income; employment; and space and place. Results of this review have the potential to increase awareness of existing trans research, to characterize evidence gaps, and to inform strategic research prioritization. With this information, it is more likely that trans communities and allies will be in a position to benefit from existing research and to hold researchers accountable.

SUBMITTER: Marshall Z

PROVIDER: S-EPMC6400230 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Documenting Research with Transgender, Nonbinary, and Other Gender Diverse (Trans) Individuals and Communities: Introducing the Global Trans Research Evidence Map.

Marshall Zack Z Welch Vivian V Minichiello Alexa A Swab Michelle M Brunger Fern F Kaposy Chris C

Transgender health 20190301 1

There is limited information about how transgender, nonbinary, and other gender diverse (trans) people have been studied and represented by researchers. The objectives of this study were to: (1) increase access to trans research; (2) map and describe trans research across subject fields; and (3) identify evidence gaps and opportunities for more responsible research. Eligibility criteria were established to include empirical research of any design, which included trans participants or their perso ...[more]

PMID: 30842978

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Project description:ImportanceTransgender and nonbinary (TNB) youths are disproportionately burdened by poor mental health outcomes owing to decreased social support and increased stigma and discrimination. Although gender-affirming care is associated with decreased long-term adverse mental health outcomes among these youths, less is known about its association with mental health immediately after initiation of care.ObjectiveTo investigate changes in mental health over the first year of receiving gender-affirming care and whether initiation of puberty blockers (PBs) and gender-affirming hormones (GAHs) was associated with changes in depression, anxiety, and suicidality.Design, setting, and participantsThis prospective observational cohort study was conducted at an urban multidisciplinary gender clinic among TNB adolescents and young adults seeking gender-affirming care from August 2017 to June 2018. Data were analyzed from August 2020 through November 2021.ExposuresTime since enrollment and receipt of PBs or GAHs.Main outcomes and measuresMental health outcomes of interest were assessed via the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales, which were dichotomized into measures of moderate or severe depression and anxiety (ie, scores ≥10), respectively. Any self-report of self-harm or suicidal thoughts over the previous 2 weeks was assessed using PHQ-9 question 9. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up. Bivariate and multivariable logistic models were estimated to examine temporal trends and investigate associations between receipt of PBs or GAHs and each outcome.ResultsAmong 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded "I don't know" or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not. There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51).Conclusions and relevanceThis study found that gender-affirming medical interventions were associated with lower odds of depression and suicidality over 12 months. These data add to existing evidence suggesting that gender-affirming care may be associated with improved well-being among TNB youths over a short period, which is important given mental health disparities experienced by this population, particularly the high levels of self-harm and suicide.

Project description:BackgroundThe purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers.MethodBetween September-November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N = 28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software.ResultsParticipants were a mean age of 33.9 years (SD 12.3; Range 18-66). Participants varied in gender identity with 4 (14.3%) men, 3 (10.7%) women, 8 (28.6%) transgender men, 10 (35.7%) transgender women, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a 'cisgender lens", distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative.ConclusionThough similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them.

Project description:ImportanceThis is the first comprehensive national study reporting the rates of abuse, neglect, and bullying from family and classmates or teachers among Chinese transgender and gender-nonbinary adolescents and identifying risk factors associated with poor mental health in this population.ObjectiveTo assess the rates of abuse, neglect, and bullying and their association with poor mental health among Chinese transgender and gender nonbinary adolescents.Design, setting, and participantsThis national survey study used an online self-selecting survey conducted between January 1, 2017, and September 29, 2017, in China. Eligibility criteria included reporting being aged 12 to 18 years and being transgender or gender nonbinary. Data analysis was performed from March 25 to 28, 2019.Main outcomes and measuresThe main outcome was self-reported poor mental health, including depressive symptoms, anxiety symptoms, and suicidal ideation. Depressive symptoms were measured using the Center for Epidemiological Studies Depression 9-item scale. Anxiety symptoms were measured using the 7-item General Anxiety Disorder scale. Suicidal ideation was measured using standardized questions adapted from previous Chinese studies. Abuse, neglect, and bullying were measured using specifically designed questions.ResultsOf 564 responses collected, 385 respondents (mean [SD] age, 16.7 [1.2] years) met inclusion criteria, including 109 (28.3%) transgender adolescent boys, 167 (43.4%) transgender adolescent girls, and 109 (28.3%) gender-nonbinary adolescents. Among 319 respondents who reported that their parents were aware of their gender identity, 296 (92.8%) reported having experienced parental abuse or neglect. Among the full cohort, 295 respondents (76.6%) reported having experienced abuse or bullying owing to being transgender or gender nonbinary in school from classmates or teachers. There were 173 respondents (44.9%) with Center for Epidemiological Studies Depression 9-item scale scores indicating they were at risk of major depressive disorder, and 148 respondents (38.4%) had 7-item General Anxiety Disorder scale scores indicating they were at risk of an anxiety disorder. In univariate analysis, reporting experiences of bullying from a classmate or teacher was significantly associated with suicidal ideation (odds ratio, 1.68 [95% CI, 1.04-2.70]; P = .03), but the association was no longer statistically significant after controlling for level of educational attainment, aversion to assigned sex, and depressed mood at the onset of puberty (odds ratio, 1.63 [95% CI, 0.97-2.73]; P = .06).Conclusions and relevanceIn this survey study, transgender and gender-nonbinary adolescents in China reported high rates of abuse, neglect, and bullying at home and in school and high rates of symptoms associated with poor mental health. This study highlights the importance of reducing home- and school-based abuse, neglect, and bullying of transgender and gender-nonbinary adolescents in China to improve mental health outcomes; however, broader change in the social environment may be required to address the prejudice and stigma aimed at gender minorities.

Dataset Information

Documenting Research with Transgender, Nonbinary, and Other Gender Diverse (Trans) Individuals and Communities: Introducing the Global Trans Research Evidence Map.

Publications

Documenting Research with Transgender, Nonbinary, and Other Gender Diverse (Trans) Individuals and Communities: Introducing the Global Trans Research Evidence Map.

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