Impact of minority stress in depressive symptoms, suicide ideation and suicide attempt in trans persons

Chinazzo, Ítala Raymundo; Lobato, Maria Inês Rodrigues; Nardi, Henrique Caetano; Koller, Silvia Helena; Saadeh, Alexandre; Costa, Angelo Brandelli

doi:10.1590/1413-812320212611.3.28532019

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VIOLENCE AND PREVENTION • Ciênc. saúde coletiva 26 (suppl 3) • 2021 • https://doi.org/10.1590/1413-812320212611.3.28532019 copy

Impact of minority stress in depressive symptoms, suicide ideation and suicide attempt in trans persons

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Key words:
Prejudice; Trans people; Depressive symptoms; Suicide ideation; Suicide attempts

Variable	n	%
Gender identity
Trans woman	232	61.38
Trans man	114	30.16
Other	32	8.47
In which state do you live?
São Paulo	121	32.01
Rio Grande do Sul	257	67.99
Number of inhabitants
Up to 5,000	6	1.59
5,000 to 10,000	16	4.23
10,000 to 20,000	19	5.03
20,000 to 50,000	36	9.52
50,000 to100,000	35	9.26
100,000 to 500,000	99	26.19
Over 500,000	167	44.18
Race/color/ethnic group
Black	20	5.29
White	285	75.4
Brown	61	16.14
Indigenous	2	0.53
Yellow	10	2.65
Education
Up to primary school	5	1.32
Primary school	34	8.99
Secondary school	240	63.49
Degree	75	19.84
Post-graduation	24	6.35

Variable	n	%
Minority stress
Anticipated prejudice	255	67.50
Internalized prejudice
Extreme	124	32.80
High	94	24.87
Medium	57	15.08
Low	103	27.25
Perceived prejudice
Extreme	59	15.61
High	122	32.28
Medium	83	21.96
Low	114	30.16
Passability
Always or often (low passability)	112	29.63
Half the time	70	18.52
Rarely or never (high passability)	196	51.85
Support for trans identity
Extreme	101	26.72
High	88	23.28
Medium	95	25.13
Low	94	24.87
Social support
Material support
Extreme	93	24.60
High	82	21.69
Medium	109	28.84
Low	94	24.87
Emotional support + information
Extreme	93	24.60
High	95	25.13
Medium	88	23.28
Low	102	26.98
Affectionate support + positive social interaction
Extreme	82	21.69
High	106	28.04
Medium	94	24.87
Low	96	25.40

		Stage 1		Stage 2
		PR (95% CI)	p	PR (95% CI)	p
Anticipated prejudice	No	-	-	-	-
	Yes	2.90 (1.78; 4.74)	< 0.00*	1.39 (1.15; 1.68)	< 0.00*
Internalized prejudice	Low	-	-	-	-
	Medium	1.32 (0.67; 2.62)	0.42	1.09 (0.81; 1.45)	0.58
	High	2.97 (1.48; 5.97)	< 0.00*	1.35 (1.07; 1.70)	0.01*
	Extreme	3.98 (1.93; 8.21)	< 0.00*	1.41 (1.11; 1.78)	0.01*
Perceived prejudice	Low	-	-	-	-
	Medium	0.85 (0.44; 1.65)	0.62	0.98 (0.79; 1.22)	0.84
	High	0.85 (0.44; 1.64)	0.63	0.95 (0.78; 1.16)	0.62
	Extreme	1.03 (0.40; 2.66)	0.95	0.94 (0.76; 1.18)	0.61
Passability	Always/often			-	-
	Half the time			1.38 (1.15; 1.66)	< 0.00*
	Rarely/never			1.29 (1.10; 1.51)	< 0.00*
Support for trans identity	Low			-	-
	Medium			0.82 (071; 0.94)	0.01*
	High			0.71 (0.58; 0.87)	< 0.00*
	Extreme			0.72 (0.60; 0.87)	< 0.00*
Material support	Low			-	-
	Medium			1.07 (0.88; 1.29)	0.51
	High			1.03 (0.80; 1.34)	0.82
	Extreme			0.89 (0.64; 1.24)	0.50
Emotional support + information	Low			-	-
	Medium			0.88 (0.71; 1.09)	0.25
	High			0.94 (0.70; 1. 26)	0.69
	Extreme			1.19 (0.81; 1.75)	0.37
Affectionate support + positive social interaction	Low			-	-
	Medium			0.83 (0.70; 0.99)	0.04**
	High			0.84 (0.67; 1.04)	0.10
	Extreme			0.57 (0.42; 0.79)	< 0.00*

		Stage 1		Stage 2
		PR (95% CI)	P	PR (95% CI)	p
Anticipated prejudice	No	-	-	-	-
	Yes	1.89 (1.13; 1.34)	0.01*	1.20 (1.00; 1.43)	0.05**
Internalized prejudice	Low	-	-	-	-
	Medium	2.85 (1.43; 5.67)	< 0.00*	1.49 (1.13; 1.97)	0.01*
	High	4.43 (2.20; 8.91)	< 0.00*	1.61 (1.24; 2.09)	< 0.00*
	Extreme	6.65 (3.17; 13.95)	< 0.00*	1.70 (1.31; 2.21)	< 0.00*
Perceived prejudice	Low	-	-	-	-
	Medium	0.91 (0.47; 1.76)	0.77	1.01 (0.82; 1.24)	0.96
	High	0.79 (0.40; 1.53)	0.48	0.97 (0.80; 1.18)	0.74
	Extreme	0.73 (0.29; 1.80)	0.49	0.96 (0.77; 1.20)	0.74
Passability	Always/often			-	-
	Half the time			1.32 (1.09; 1.60)	< 0.00*
	Rarely/never			1.28 (1.09; 1.51)	< 0.00*
Support for trans identity	Low			-	-
	Medium			1.02 (0.88; 1.19)	0.77
	High			0.90 (0.75; 1.09)	0.27
	Extreme			0.73 (0.59; 0.91)	0.01*
Material support	Low			-	-
	Medium			0.94 (0.76; 1.16)	0.55
	High			1.00 (0.76; 1.31)	0.98
	Extreme			0.95 (0.69; 1.31)	0.75
Emotional support + information	Low			-	-
	Medium			1.10 (0.87; 1.38)	0.43
	High			1.08 (0.78; 1.48)	0.66
	Extreme			1.29 (0.86; 1.92)	0.22
Affectionate support + positive social interaction	Low			-	-
	Medium			0.72 (0.60; 0.87)	< 0.00*
	High			0.76 (0.62; 0.94)	0.01*
	Extreme			0.66 (0.48; 0.91)	0.01*

		Stage 1		Stage 2
		PR (95% CI)	p	PR (95% CI)	p
Anticipated prejudice	No	-	-	-	-
	Yes	1.28 (0.95; 1.72)	0.11	1.29 (0.96; 1.73)	0.09
Internalized prejudice	Low	-	-	-	-
	Medium	1.76 (1.03; 2.98)	0.04**	1.64 (0.96; 2.79)	0.07
	High	2.64 (1.63; 4.27)	< 0.00*	2.35 (1.45; 3.80)	< 0.00*
	Extreme	2.80 (1.73; 4.53)	< 0.00*	2.50 (1.52; 4.10)	< 0.00*
Perceived prejudice	Low	-	-	-	-
	Medium	1.13 (0.80; 1.58)	0.50	1.19 (0.85; 1.67)	0.31
	High	0.77 (0.54; 1.11)	0.16	0.80 (0.55; 1.15)	0.22
	Extreme	1.11 (0.78; 1.58)	0.56	1.21 (0.83; 1.75)	0.32
Passability	Always/often			-	-
	Half the time			1.34 (0.98; 1.83)	0.07
	Rarely/never			1.19 (0.92; 1.55)	0.19
Support for trans identity	Low			-	-
	Medium			1.06 (0.80; 1.39)	0.69
	High			0.91 (0.66; 1.25)	0.56
	Extreme			0.93 (0.66; 1.31)	0.66
Material support	Low			-	-
	Medium			0.99 (0.71; 1.38)	0.94
	High			0.86 (0.54; 1.36)	0.51
	Extreme			0.61 (0.34; 1.12)	0.11
Emotional support + information	Low			-	-
	Medium			1.20 (0.86; 1.68)	0.28
	High			1.58 (0.95; 2.64)	0.08
	Extreme			2.14 (1.04; 4.39)	0.04**
Affectionate support + positive social interaction	Baixo			-	-
Affectionate support + positive social interaction	Low			-	-
	Medium			0.53 (0.37; 0.77)	< 0.00*
	High			0.62 (0.41; 0.94)	0.03**
	Extreme			0.59 (0.32; 1.06)	0.08

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

IR Chinazzo worked on data analysis and interpretation and writing. MIR Lobato, in research and methodology. HC Nardi and SH Koller, in design, methodology and critical review. AB Costa, in the design, research, data analysis and interpretation, writing and critical review. A Saadeh woeked in the study design and data collection.