Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University, Shanghai, China; Department of Psychiatry, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Psychiatry and Behavioral Science, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Joseph J Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
Lancet Public Health. 2021 Dec;6(12):e954-e969. doi: 10.1016/S2468-2667(21)00236-X.
Transgender and gender non-conforming (TGNC) individuals are at a high risk of adverse mental health outcomes due to minority stress-the stress faced by individuals categorised as stigmatised social minority groups. This systematic review sought to summarise the key mental health findings of the research on TGNC individuals in mainland China. We also aimed to consolidate research on the topic, identify specific mental health disparities, and offer new perspectives for future research to inform both policy and clinical practice. An extensive search of the literature, published in English and Chinese, was done between Jan 1, 1990, and Aug 1, 2021, using PubMed, PsycINFO, Scopus, Wanfang (in Chinese), and CNKI (in Chinese). Overall, two qualitative and 28 quantitative articles were identified. The quantitative findings showed a high prevalence of mental health problems, such as depression, anxiety, substance use disorders, and stress-related issues, and greater disparities in psychological wellbeing. High prevalence is also reported in suicidality and self-harm behaviours in this group. Across the two qualitative studies, attributable factors included gender-related discrimination, barriers to accessing health services, low social support, decreased knowledge and awareness of HIV prevention, and demographic characteristics-such as marital status, educational level, and gender identity. This Review also found little evidence of gender-affirming care and mental health interventions in mainland China. Following from these results, the next step is to integrate multi-level, social-psychological interventions with education to reduce cultural stereotypes and transphobia in mainland China. Political and social implications are also discussed to inform a standard set of guidelines for transgender-inclusive health-care services, including advocating for funding to create these special care programmes and services.
跨性别和性别不一致（TGNC）个体由于少数群体压力（被归类为受污名化的社会少数群体的个体所面临的压力）而处于不良心理健康结果的高风险之中。本系统综述旨在总结中国大陆 TGNC 个体研究的主要心理健康发现。我们还旨在整合该主题的研究，确定特定的心理健康差异，并为未来研究提供新的视角，为政策和临床实践提供信息。从 1990 年 1 月 1 日到 2021 年 8 月 1 日，使用 PubMed、PsycINFO、Scopus、万方（中文）和中国知网（中文），对发表在英文和中文的文献进行了广泛搜索。总体上，确定了两篇定性文章和 28 篇定量文章。定量研究结果表明，该群体存在较高的心理健康问题，如抑郁、焦虑、物质使用障碍和与压力相关的问题，以及心理健康状况的更大差异。该群体也报告了较高的自杀意念和自残行为发生率。在这两项定性研究中，归因因素包括与性别相关的歧视、获得卫生服务的障碍、社会支持不足、对 HIV 预防的知识和认识减少以及人口统计学特征，如婚姻状况、教育水平和性别认同。本综述还发现，中国大陆很少有性别肯定护理和心理健康干预的证据。基于这些结果，下一步是将多层次的社会心理干预与教育相结合，以减少中国大陆的文化刻板印象和跨性别恐惧症。还讨论了政治和社会影响，以告知一套包括倡导为创建这些特殊护理计划和服务提供资金在内的跨性别包容的医疗保健服务的标准指南。
