A cross-sectional study of mental health, suicidal ideation and suicide attempt among transgender women in Jiangsu province, China

Yuanfang Chen; Shi Chen; Sean Arayasirikul; Erin Wilson; Willi McFarland; Jing Lu; Yunting Chen; Hongjing Yan

doi:10.1016/j.jad.2020.09.002

A cross-sectional study of mental health, suicidal ideation and suicide attempt among transgender women in Jiangsu province, China

J Affect Disord. 2020 Dec 1:277:869-874. doi: 10.1016/j.jad.2020.09.002. Epub 2020 Sep 7.

Authors

Yuanfang Chen¹, Shi Chen², Sean Arayasirikul³, Erin Wilson⁴, Willi McFarland⁴, Jing Lu¹, Yunting Chen¹, Hongjing Yan⁵

Affiliations

¹ Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; Public Health Research Institute of Jiangsu Province, Nanjing 210009, China.
² Department of Public Health Sciences, College of Health and Human Services, University of North Carolina Charlotte, Charlotte 28262, USA.
³ Center for Public Health Research, San Francisco Department of Public Health, San Francisco 94102, USA; Department of Pediatrics, University of California San Francisco, San Francisco 94115, USA.
⁴ Center for Public Health Research, San Francisco Department of Public Health, San Francisco 94102, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco 94115, USA.
⁵ Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; Public Health Research Institute of Jiangsu Province, Nanjing 210009, China. Electronic address: yanhongjing@hotmail.com.

Abstract

Objectives: To measure prevalence and risk factors of poor mental health, suicidal ideation, and suicide attempt among transgender women in Jiangsu province, China.

Methods: We surveyed 250 transgender women with mean age of 27.9 years from July 2018 to May 2019 in Jiangsu province, China. Logistic regression analysis characterized risk factors for mental health, suicidal ideation, and suicide attempt.

Results: Many transgender women experienced discrimination, including verbal abuse (56.0%), physical abuse (32.0%), and sexual violence (32.0%) during their lifetime. Classification by the Kessler Psychological Distress Scale found 32.4%% to be in good mental health, while 24.0%, 16.8%, and 26.8% had mild, moderate, and severe psychological distress respectively. In multivariable logistic regression, severe psychological distress was correlated with bisexual orientation (vs. gay/lesbian, aOR = 2.9, 95%CI = 1.5-5.8), being unsure of sexual orientation (vs. gay/lesbian, aOR = 4.7, 95%CI = 1.8-12.8), experience of verbal abuse (aOR = 1.8, 95%CI = 1.1-3.1), and less severe with alcohol use (aOR = 0.6, 95%CI = 0.3-0.9) (P< 0.05). Many transgender women also reported suicidal ideation (22.0%) and prior suicide attempt (25.6%). Compared to no suicidal ideation, moderate (aOR = 4.9, 95%CI = 1.6-15.2) or severe psychological distress (aOR = 38.6) were associated with prior suicide attempt (P< 0.05). Residing in Jiangsu province (vs. not residing in Jiangsu, aOR = 0.3, 95%CI = 0.1-0.6) and higher income (vs. lower income, aOR = 0.6, 95%CI = 0.4-0.9) were protective factors for suicide attempt (P< 0.05).

Conclusion: Chinese transgender women experience high levels of discrimination, abuse, poor mental health, suicidal ideation, and suicide attempts in Jiangsu province. Society-wide interventions need to be developed to mitigate transphobic discrimination among transgender women in China.

Keywords: Mental health; Risk factors; Suicidal ideation; Suicide attempt; Transgender women.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
China / epidemiology
Cross-Sectional Studies
Female
Humans
Male
Mental Health
Risk Factors
Suicidal Ideation
Suicide, Attempted*
Transgender Persons*

Grants and funding

R01 MD010678/MD/NIMHD NIH HHS/United States