Depression, Self-Esteem, and Resilience and its Relationship with Psychological Features of Sexuality among Transgender Men and Women from Brazil.

This cross-sectional study investigated whether depression, self-esteem, and resilience (mental health indicators) are associated with some psychological features of sexuality (sexual fear, sexual anxiety, sexual dissatisfaction, and sexual body image worries) in a sample of 462 transgender men and women from Brazil. Pearson's correlations were performed between all continuous variables in the study. Those that were significantly associated with the psychological features of sexuality in previous analyses were tested as independent variables in multiple linear regression models. Sexual fear, sexual anxiety, sexual dissatisfaction, and sexual body image worries were negatively related to self-esteem and resilience, while positively related to depression. Higher levels of depression were associated with sexual fear, while higher levels of depression and lower self-esteem were associated with sexual anxiety. In addition, higher levels of depression and lower levels of resilience were associated with sexual dissatisfaction. Depression and resilience were associated with the composite score of sexual dissatisfaction and sexual anxiety. Our results suggest that negative mental health indicators may impair the sexual life of transgender individuals. Clinical interventions should be developed and tested to address the psychological features of sexuality.

Impact of minority stress in depressive symptoms, suicide ideation and suicide attempt in trans persons / Impacto do estresse de minoria em sintomas depressivos, ideação suicida e tentativa de suicídio em pessoas trans.

Minority stress comprehends the relationship between prejudice (perceived, anticipated and internalized) and mental health in people belonging to minority groups, as well as protective factors for stressors. This study evaluated the prevalence of depressive symptoms, suicidal ideation and attempted suicide in Brazilian trans people, and it`s relationship with minority stress, passability, social support and trans identity support. 378 people participated through a questionnaire answered online and in the hospital services they attended. Of these, 67.20% had depressive symptoms, 67.72% suicidal ideation and 43.12% attempted suicide. Three Poisson regression analyzes were performed in two steps, according to the outcomes. In the three outcomes there was a positive association with internalized prejudice and a negative association with social support, which were the only associations in the suicide attempt. Depressive symptoms and suicidal ideation were also positively associated with anticipated prejudice and negatively passability and support for trans identity. The vulnerability of transgender people to negative mental health outcomes and the importance of addressing prejudice on an individual and social level, as well as promoting social support and transgender identity support are perceived.

O estresse de minoria aborda a relação entre preconceito (percebido, antecipado e internalizado) e saúde mental em pessoas pertencentes a grupos minoritários, assim como fatores de proteção aos estressores. Este trabalho avaliou a prevalência de sintomas depressivos, ideação suicida e tentativa de suicídio em pessoas trans brasileiras, e sua relação com estresse de minoria, passabilidade, apoio social e apoio à identidade trans. Participaram 378 pessoas, por meio de questionário respondidos on-line e nos serviços hospitalares a que frequentavam. Desses, 67,20% apresentaram sintomas depressivos, 67,72% ideação suicida e 43,12% tentativa de suicídio. Foram realizadas três análises de regressão de Poisson, em dois passos, conforme os desfechos. Nos três desfechos houve associação positiva com o preconceito internalizado e negativa com o apoio social, sendo essas as únicas associações na tentativa de suicídio. Nos sintomas depressivos e na ideação suicida, também se associou positivamente o preconceito antecipado e negativamente a passabilidade e o apoio à identidade trans. Percebe-se a vulnerabilidade das pessoas trans para os desfechos negativos de saúde mental e a importância de enfrentar o preconceito em nível individual e social, assim como promover o apoio social e à identidade trans.

Impacto do estresse de minoria em sintomas depressivos, ideação suicida e tentativa de suicídio em pessoas trans / Impact of minority stress in depressive symptoms, suicide idea and try suicide in trans

Resumo O estresse de minoria aborda a relação entre preconceito (percebido, antecipado e internalizado) e saúde mental em pessoas pertencentes a grupos minoritários, assim como fatores de proteção aos estressores. Este trabalho avaliou a prevalência de sintomas depressivos, ideação suicida e tentativa de suicídio em pessoas trans brasileiras, e sua relação com estresse de minoria, passabilidade, apoio social e apoio à identidade trans. Participaram 378 pessoas, por meio de questionário respondidos on-line e nos serviços hospitalares a que frequentavam. Desses, 67,20% apresentaram sintomas depressivos, 67,72% ideação suicida e 43,12% tentativa de suicídio. Foram realizadas três análises de regressão de Poisson, em dois passos, conforme os desfechos. Nos três desfechos houve associação positiva com o preconceito internalizado e negativa com o apoio social, sendo essas as únicas associações na tentativa de suicídio. Nos sintomas depressivos e na ideação suicida, também se associou positivamente o preconceito antecipado e negativamente a passabilidade e o apoio à identidade trans. Percebe-se a vulnerabilidade das pessoas trans para os desfechos negativos de saúde mental e a importância de enfrentar o preconceito em nível individual e social, assim como promover o apoio social e à identidade trans.

Abstract Minority stress comprehends the relationship between prejudice (perceived, anticipated and internalized) and mental health in people belonging to minority groups, as well as protective factors for stressors. This study evaluated the prevalence of depressive symptoms, suicidal ideation and attempted suicide in Brazilian trans people, and it`s relationship with minority stress, passability, social support and trans identity support. 378 people participated through a questionnaire answered online and in the hospital services they attended. Of these, 67.20% had depressive symptoms, 67.72% suicidal ideation and 43.12% attempted suicide. Three Poisson regression analyzes were performed in two steps, according to the outcomes. In the three outcomes there was a positive association with internalized prejudice and a negative association with social support, which were the only associations in the suicide attempt. Depressive symptoms and suicidal ideation were also positively associated with anticipated prejudice and negatively passability and support for trans identity. The vulnerability of transgender people to negative mental health outcomes and the importance of addressing prejudice on an individual and social level, as well as promoting social support and transgender identity support are perceived.

Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil.

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, "passing" concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher "passing" concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and "passing" concerns in transgender populations.

Brazilian transgender children and adolescents: Attributes associated with quality of life.

OBJECTIVE: to describe attributes associated with the Quality of Life of Brazilian transgender children and adolescents according to their own perception. METHOD: descriptive study conducted with 32 participants between eight and 18 years old, who were either interviewed or participated in focus groups. The statements were transcribed, grouped with the aid of the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software, version 0.7 alpha 2 and described according to the definition of Quality of Life by the World Health Organization concerning to the mental, physical, and social dimensions. RESULTS: it was possible to identify the family nucleus as the main social support for transgender children and adolescents. However, the experience of prejudice and discrimination were negative attributes associated with Quality of Life. CONCLUSION: the statements indicate that lives of transgender children and adolescents are impacted by social, physical, and mental factors due to the stigma and discrimination experienced. It is expected to contribute to the formulation of public policies related to transgender children and adolescents and expand the discussion on the citizens' duties and rights in relation to transsexuality.

Brazilian transgender children and adolescents: Attributes associated with quality of life / Crianças e adolescentes transgêneros brasileiros: atributos associados à qualidade de vida / Niños y adolescentes transgénero brasileños: atributos asociados a la calidad de vida

Objective: to describe attributes associated with the Quality of Life of Brazilian transgender children and adolescents according to their own perception. Method: descriptive study conducted with 32 participants between eight and 18 years old, who were either interviewed or participated in focus groups. The statements were transcribed, grouped with the aid of the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software, version 0.7 alpha 2 and described according to the definition of Quality of Life by the World Health Organization concerning to the mental, physical, and social dimensions. Results: it was possible to identify the family nucleus as the main social support for transgender children and adolescents. However, the experience of prejudice and discrimination were negative attributes associated with Quality of Life. Conclusion: the statements indicate that lives of transgender children and adolescents are impacted by social, physical, and mental factors due to the stigma and discrimination experienced. It is expected to contribute to the formulation of public policies related to transgender children and adolescents and expand the discussion on the citizens' duties and rights in relation to transsexuality.

Objetivo: descrever atributos associados à Qualidade de Vida de crianças e adolescentes transgêneros brasileiros segundo sua própria percepção. Método: estudo descritivo, realizado com 32 participantes entre oito e 18 anos, entrevistados ou que participaram de grupos focais. Os depoimentos foram transcritos, agrupados com auxílio do software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires, versão 0.7 alpha 2 e descritos segundo a definição da Qualidade de Vida pela Organização Mundial da Saúde no que concerne às dimensões mental, física e social. Resultados: foi possível identificar o núcleo familiar como o principal meio de suporte social das crianças e adolescentes transgêneros. Entretanto, a vivência de preconceito e discriminação foram atributos negativos associados à Qualidade de Vida. Conclusão: Los depoimentos indicam que a vida das crianças e adolescentes transgêneros é impactada por fatores sociais, físicos e mentais em virtude do estigma e discriminação vivenciados. Espera-se com esse estudo contribuir para a formulação de políticas públicas relacionadas às crianças e adolescentes transgêneros e ampliar a discussão sobre deveres e direitos dos cidadãos frente à transexualidade.

Objetivo: describir los atributos asociados a la Calidad de Vida de niños y adolescentes transgénero brasileños, de acuerdo con su percepción. Método: estudio descriptivo, realizado con 32 participantes entre 8 y 18 años, entrevistados o que participaron en grupos focales. Los testimonios se transcribieron y clasificaron con el soporte del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires, versão 0.7 alpha 2 y fueron descriptos de acuerdo con la definición de Calidad de Vida de la Organización Mundial de la Salud en lo concerniente a las dimensiones mental, física y social. Resultados: fue posible identificar al núcleo familiar como el principal medio de soporte social para niños y adolescentes transgénero. Sin embargo, haber vivido experiencias de prejuicio y discriminación fueron atributos negativos asociados con la Calidad de Vida. Conclusión: los testimonios indican que la vida de los niños y adolescentes transgénero se ve afectada por factores sociales, físicos y mentales debido al estigma y la discriminación que experimentan. Se espera que este estudio contribuya a la formulación de políticas públicas relacionadas con los niños y adolescentes transgénero y amplíe la discusión sobre los deberes y derechos de los ciudadanos en relación a la transexualidad.

Psychological distress among transgender people in Brazil: frequency, intensity and social causation - an ICD-11 field study

Objective: To describe self-reported experiences of gender incongruence related to discomfort and body changes to be more congruent to the desired gender, and to examine whether experiences of psychological distress related to gender identity were more strongly related to the experience of gender incongruence per se or to experiences of social rejection. Methods: This field study used a structured interview design in a purposive sample of transgender adults (aged >18 years or older) receiving health-care services in two main reference centers in Brazil. Results: A high proportion of participants (90.3%, n=93) reported experiencing psychological distress related to their gender identity and report having experienced social rejection related to their gender identity during the interview index period and that rejection by friends was the only significant predictor for psychological distress. Conclusions: Gender incongruence variables were not significant predictors of distress. This result supports the recent changes proposed by the Word Health Organization in ICD-11 to move transgender conditions from the Mental and Behavioral Disorders chapter to a new chapter on Sexual Disorders and Conditions Related to Sexual Health.

Psychological distress among transgender people in Brazil: frequency, intensity and social causation - an ICD-11 field study.

OBJECTIVE: To describe self-reported experiences of gender incongruence related to discomfort and body changes to be more congruent to the desired gender, and to examine whether experiences of psychological distress related to gender identity were more strongly related to the experience of gender incongruence per se or to experiences of social rejection. METHODS: This field study used a structured interview design in a purposive sample of transgender adults (aged >18 years or older) receiving health-care services in two main reference centers in Brazil. RESULTS: A high proportion of participants (90.3%, n=93) reported experiencing psychological distress related to their gender identity and report having experienced social rejection related to their gender identity during the interview index period and that rejection by friends was the only significant predictor for psychological distress. CONCLUSIONS: Gender incongruence variables were not significant predictors of distress. This result supports the recent changes proposed by the Word Health Organization in ICD-11 to move transgender conditions from the Mental and Behavioral Disorders chapter to a new chapter on Sexual Disorders and Conditions Related to Sexual Health.

Gender incongruence: a comparative study using ICD-10 and DSM-5 diagnostic criteria

Objective: To compare the presence of criteria listed in the DSM-5 and ICD-10 diagnostic manuals in a Brazilian sample of transgender persons seeking health services specifically for physical transition. Methods: This multicenter cross-sectional study included a sample of 103 subjects who sought services for gender identity disorder in two main reference centers in Brazil. The method involved a structured interview encompassing the diagnostic criteria in the two manuals. Results: The results revealed that despite theoretical disagreement about the criteria, the manuals overlap regarding diagnosis confirmation; the DSM-5 was more inclusive (97.1%) than the ICD-10 (93.2%) in this population. Conclusions: Although there is no consensus on diagnostic criteria on transgenderism in the diversity of social and cultural contexts, more comprehensive diagnostic criteria are evolving due to society's increasing inclusivity.

HIV-Related Healthcare Needs and Access Barriers for Brazilian Transgender and Gender Diverse People.

The aim of this study is to investigate HIV-related healthcare needs and access barriers for Brazilian transgender and gender diverse people. Data were collected from gender identity clinics and the questionnaire was also made available on the Internet. Out of the 543 participants-62.1% (n = 337) transgender women, 28.7 (n = 156) transgender men and 9.2% (n = 50) gender diverse people, 63.7% had been tested at least once in their lives. The prevalence of self-reported HIV-positive status among transgender women was 16.5%, of which 92.0% reported having a physician with whom they regularly consulted about HIV, whereas none of the transgender men or gender diverse people reported HIV-positive status. In addition, 8.2% of transgender men and 12.5% of gender diverse people did not know their serological status. Finally, 71.0% of the participants were unfamiliar with post-exposure prophylaxis. The study discusses the need for adequate behavior-oriented HIV health policies and training of healthcare professionals regarding the needs of Brazilian transgender and gender diverse people.

Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People.

Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.

Gender incongruence: a comparative study using ICD-10 and DSM-5 diagnostic criteria.

OBJECTIVE: To compare the presence of criteria listed in the DSM-5 and ICD-10 diagnostic manuals in a Brazilian sample of transgender persons seeking health services specifically for physical transition. METHODS: This multicenter cross-sectional study included a sample of 103 subjects who sought services for gender identity disorder in two main reference centers in Brazil. The method involved a structured interview encompassing the diagnostic criteria in the two manuals. RESULTS: The results revealed that despite theoretical disagreement about the criteria, the manuals overlap regarding diagnosis confirmation; the DSM-5 was more inclusive (97.1%) than the ICD-10 (93.2%) in this population. CONCLUSIONS: Although there is no consensus on diagnostic criteria on transgenderism in the diversity of social and cultural contexts, more comprehensive diagnostic criteria are evolving due to society's increasing inclusivity.

De adultos a crianças: análise retrospectiva e psicanalítica de serviço ambulatorial de população com disforia de gênero-transtorno de identidade de gênero-transexualismo / From adults to children: retrospective and psychoanalytic analysis of outpatient services of the population with gender dysphoria, gender identity disorder and transsexualism / De adultos a niños: análisis retrospectivo y psicoanalítico de servicio ambulatorio a población con disforia de género-trastorno de identidad de género-transexualismo

No Brasil, foi após 1997, com a publicação da padronização do Conselho Federal de Medicina, que o acompanhamento e o tratamento da população transexual se tornaram mais intensivos. O Ambulatório de Transtorno de Identidade de Gênero e Orientação Sexual - Amtigos, do Nufor-IPq-HCFMUSP foi criado em 2010; nele, pacientes com disforia de gênero são tratados seguindo as orientações da World Professional Association for Transgender Health (WPATH), adaptadas à realidade sociocultural brasileira. O Amtigos promove triagens multidisciplinares, atendimento médico psiquiátrico e psicoterapia para pacientes adultos e, mais recentemente, para adolescentes e crianças trazidos por familiares que buscam orientação e tratamento. Nossa proposta consiste em uma abordagem transdisciplinar com base em nossa experiência, para que seja provida adequada assistência psicológica, psiquiátrica e acompanhamento psicoterápico a esses pacientes. Não se trata de tutoria, mas sim de um desenvolvimento conjunto de responsabilidades por todo o processo.

In Brazil, it was after 1997, with the publication of the standardization of the Federal Council of Medicine, that the care and treatment of the transsexual population became more intensive. The Sexual Orientation and Gender Identity Disorder Outpatient Unit AMTIGOS-NUFOR-IPq-HCFMUSP was established in 2010; there, patients with gender dysphoria are treated following the orientations of the World Professional Association for Transgender Health WPATH, adapted to the Brazilian social and cultural reality. The amtigos promotes multidisciplinary selections, mental health care and psychotherapy for adults and, more recently, adolescents and children brought by family members seeking counseling and treatment. Our proposal consists of a transdisciplinary approach based on our experience in order to provide adequate psychological, psychiatric and psychotherapeutic assistance for these patients. It is not about tutoring, but a joint development of responsibilities for the entire process.

En Brasil, fue después del 1997, con la publicación de la estandarización del Consejo Federal de Medicina, que el seguimiento y el tratamiento de la población transexual se tornaron más intensivos. El Ambulatório de Transtorno de Identidade de Gênero e Orientação Sexual AMTIGOS-NUFOR-IPq-HCF-MUSP fue creado en el 2010; en él, pacientes con disforia de género son tratados siguiendo las orientaciones de la World Professional Association for Transgender Health WPATH, adaptadas a la realidad sociocultural brasileña. El amtigos promueve evaluaciones multidisciplinarias, atención médica psiquiátrica y psicoterapia a pacientes adultos y, más recientemente, a adolescentes y niños traídos por familiares que buscan orientación y tratamiento. Nuestra propuesta consiste en un abordaje transdisciplinario basado en nuestra experiencia para que se proporcione una adecuada asistencia psicológica, psiquiátrica y seguimiento psicoterápico a esos pacientes. No se trata de tutoría, sino de un desarrollo conjunto de responsabilidades por todo el proceso.

Transtorno de identidade sexual: um estudo psicopatológico de transexualismo masculino e feminino / Sexual identity disorder: a psychopathological study of male-to-female and female-to-male transsexuals

Esse estudo propôs-se avaliar presença de transtornos de eixo I, personalidade e caracterizar demograficamente 33 transexuais (masculinos e femininos). Outros objetivos foram comparar Depressão e Transtornos de Personalidade após dois anos de psicoterapia grupal e estruturar um temário específico para ela. Foram aplicados: SCID-I/P, Beck, Hamilton e Entrevista Estruturada para Distúrbios da Personalidade pelo DSM-III-R. As características demográficas gerais não variaram nos grupos. Não houve nenhum diagnóstico psiquiátrico prevalente. Houve predomínio de sintomas depressivos e não de quadros clínicos de depressão. Quanto aos transtornos e traços de personalidade, nenhum dado estatisticamente significativo foi encontrado. Temas para psicoterapia foram estabelecidos./This study aimed to evaluate the presence of personality disorders of axis I as well as to characterize demographically 33 transsexuals (male and female). Other objectives were to compare depression and personality disorders after two years of group therapy and structure a specific theme list to it. SCID-I/P, Beck, Hamilton and Structured Interview for Personality disorders by the DMS-III-R were applied...

Anxiety and depression in the first year of medical residency training.

OBJECTIVE: To perform a screening, follow-up and comparative evaluation of depression and anxiety symptoms in a group of 59 first-year internal medicine residents of a teaching hospital and evaluate the influence of their rotation, nature of rotation, subgroup, sex and the time of year on these symptoms. METHODS: We used the Spielberger State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), applied seven times, in the last week of every rotation. RESULTS AND CONCLUSION: We obtained two identical averages (P=0.98) of trait-anxiety, six months apart one from the other. There was a significant correlation (R=0.65, P < 0.001) between the indexes of state-anxiety and depression. Women had higher levels of symptoms of both anxiety and depression (P < 0.001) compared to men. A cluster of three subgroups of residents with higher trait-anxiety levels (P=0.001) also showed significantly higher levels of symptoms of state-anxiety and depression (P < 0.001). The time of the year and the nature of the rotation (emergency or not) did not interfere with the levels of depression (P=0.47). We detected rotations where there was greater frequency of residents with symptoms compatible with moderate and severe depression. There were 2.1% of residents with symptoms compatible with severe, 4.2% with moderate and 27% with mild depression. It was possible to graduate symptoms of anxiety and depression in residents, evaluate factors involved in their genesis and locate residents with moderate and severe depression.