"Passing": An investigation of its distribution and association with depression and anxiety in a cohort of transgender people Open Access

To, Margaret (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/jm214p99m?locale=en


Visual conformity with desired gender identity or ‘passing’ is thought to be an important, but poorly understood, determinant of well-being in transgender people. In this study we define ‘passing’ as a quantitative measure of affirmation status in two ways – social affirmation (SoA) and self-affirmation (SeA). SoA and SeA were measured as the differences between the actual and desired scores on a gender identity and expression continuum. The goal was to examine frequency and extent of SeA and SoA and their independent associations with anxiety and depression symptoms in a study of 508 transgender individuals that included 244 persons assigned male sex at birth (AMAB) and 264 persons assigned female sex at birth (AFAB). Having achieved high levels of SeA was reported in 54.1% of AMAB participants and 67.4% of AFAB participants. The corresponding proportions for SoA were 24.3% and 60.7% among AMAB and AFAB cohort members, respectively. Multivariable logistic regression models controlling for transgender congruence scale, AMAB/AFAB status, age, and receipt of gender confirmation treatment indicated that persons with high levels of either SoA or SeA had a lower likelihood of depression with odds ratios (95% confidence intervals) of 0.53 (0.36, 0.79) and 0.67 (0.46, 0.99), respectively. In the analyses for anxiety there was significant inverse association with SoA, but not SeA. These results, once confirmed by prospective studies, can help us better characterize the determinants of mental health in the transgender community and take the appropriate steps to design interventions aimed at improving the well-being of this vulnerable population.

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