Department of Health Policy & Behavioral Science, School of Public Health, Georgia State University, PO Box 3984, Atlanta, GA, 30302-3984, USA.
Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA.
BMC Public Health. 2020 Jan 29;20(1):125. doi: 10.1186/s12889-020-8177-z.
Transgender women (TGW) in the U.S. experience high rates of stigma, depression, and elevated rates of suicide. This study examined correlates of suicidal ideation and estimated the conditional indirect effects of perceived stigma and psychosocial mediators on suicidal ideation.
Using a cross-sectional study design, TGW (N = 92) were recruited through snowball sampling in Atlanta, Georgia. Structured interviews were conducted. Suicidal ideation was assessed by combining two variables that measured suicidal thoughts. Logistic regression models were performed to identify the potential risk and protective factors for suicidal ideation. We examined hypothesized psychosocial factors, including anxiety, depression, psychosocial impact of gender minority status, and substance use behaviors as potential mediators for the relationship between perceived stigma and suicidal ideation. All models were controlled for age, race, education, and homelessness.
Suicidal ideation was reported by 33% (N = 30) of the study participants. In multivariable analysis, suicidal ideation was associated with sexual abuse (AOR = 3.17, 95% CI = 1.10-9.30), anxiety (AOR = 1.74, 95% CI = 1.10-2.73), family verbal abuse (AOR = 2.99, 95% CI = 1.10-8.40), stranger verbal abuse (AOR = 3.21, 95% CI = 1.02-10.08), and psychosocial impact of gender minority status (AOR = 3.42, 95% CI = 1.81-6.46). Partner support was found to be the protective factor for suicidal ideation (AOR = 0.34, 95% CI = 0.13-0.90). In the mediation analysis, the psychosocial impact of gender minority status mediated the relationship between perceived stigma and suicidal ideation. The estimated conditional indirect effect was 0.46, (95% CI = 0.12-1.11).
Interventions that aim to reduce suicidal behaviors among TGW should address stigma, psychosocial impact of gender minority status, and different forms of violence and abuse.
美国跨性别女性（TGW）经历着高比例的污名、抑郁和自杀率的升高。本研究调查了自杀意念的相关因素，并估计了感知污名和心理社会中介因素对自杀意念的条件间接影响。
使用横断面研究设计，通过在佐治亚州亚特兰大的雪球抽样招募 TGW（N=92）。进行了结构化访谈。自杀意念通过结合两个测量自杀想法的变量来评估。使用逻辑回归模型来确定自杀意念的潜在风险和保护因素。我们研究了假设的心理社会因素，包括焦虑、抑郁、性别少数群体地位的心理社会影响和物质使用行为，作为感知污名和自杀意念之间关系的潜在中介因素。所有模型都控制了年龄、种族、教育和无家可归状况。
研究参与者中有 33%（N=30）报告有自杀意念。在多变量分析中，自杀意念与性虐待（AOR=3.17，95%CI=1.10-9.30）、焦虑（AOR=1.74，95%CI=1.10-2.73）、家庭言语虐待（AOR=2.99，95%CI=1.10-8.40）、陌生人言语虐待（AOR=3.21，95%CI=1.02-10.08）和性别少数群体地位的心理社会影响（AOR=3.42，95%CI=1.81-6.46）相关。伴侣支持被发现是自杀意念的保护因素（AOR=0.34，95%CI=0.13-0.90）。在中介分析中，性别少数群体地位的心理社会影响中介了感知污名和自杀意念之间的关系。估计的条件间接效应为 0.46（95%CI=0.12-1.11）。
旨在减少 TGW 自杀行为的干预措施应针对污名、性别少数群体地位的心理社会影响以及不同形式的暴力和虐待。
