Raghuram Harikeerthan, Parakh Sana, Chidambaranathan Supraja, Tugnawat Deepak, Pillai Venu, Singh Sanjana, Singh Satendra, Shaikh Aqsa, Bhan Anant
Bhopal Hub, Sangath, Bhopal, India.
Department of Physiology, University College of Medical Sciences, University of Delhi, New Delhi, India.
Front Glob Womens Health. 2023 Mar 15;4:1126946. doi: 10.3389/fgwh.2023.1126946. eCollection 2023.
Transgender persons in India, who are one of the most vulnerable groups, were particularly impacted by the COVID-19 pandemic. Increased risk of COVID-19, challenges with continuing livelihood, uncertainty, and anxiety around the pandemic over pre-existing social discrimination and exclusion pose risk of a mental health impact as well. To investigate this further, this component of a larger study on experiences in healthcare of transgender persons in India during COVID-19 and looks into the question "How did the COVID-19 pandemic impact the mental health of transgender persons in India".
22 In-depth interviews (IDI) and 6 focus group discussions (FGD) were conducted virtually and in-person with persons self-identifying as transgender or belonging to ethnocultural transgender communities from different parts of India. Community based participatory research approach was used by ensuring representation from the community in the research team and through a series of consultative workshops. Purposive sampling with snowballing was used. The IDIs and FGDs were recorded, transcribed verbatim and analyzed using an inductive thematic analysis.
Mental health of transgender persons were affected in the following ways. Firstly, COVID-19, its associated fear and suffering combined with pre-existing inaccessibility of healthcare and reduced access to mental health care affected their mental health. Secondly, unique social support needs of transgender persons were disrupted by pandemic linked restrictions. Thirdly, pre-existing vulnerabilities such as precarious employment and underlying stigma were exacerbated. Finally, gender dysphoria was a key mediating factor in the impact of COVID-19 on mental health with a negative and positive impact.
The study reiterates the need to make systemic changes to make mental healthcare and general healthcare services trans-inclusive while also recognizing the essential nature of gender affirmative services and the need to continue them even during emergencies and disaster situations. While this brings out how public health emergencies can exacerbate vulnerabilities, it also shows how the lived mental health experience of transgender person is intricately linked to the way work, travel and housing is structured in our society and therefore points to the structural nature of the linkage between mental health and gender.
印度的跨性别者是最脆弱的群体之一，尤其受到了新冠疫情的影响。新冠病毒感染风险增加、生计维持面临挑战、不确定性以及围绕疫情的焦虑，再加上原有的社会歧视和排斥，也构成了对心理健康产生影响的风险。为了进一步调查这一情况，本研究是关于印度跨性别者在新冠疫情期间医疗保健经历的一项更大规模研究的组成部分，探讨了“新冠疫情如何影响印度跨性别者的心理健康”这一问题。
对来自印度不同地区、自我认同为跨性别者或属于民族文化跨性别群体的人员进行了22次深度访谈（IDI）和6次焦点小组讨论（FGD），访谈和讨论以线上和线下相结合的方式进行。采用基于社区的参与式研究方法，确保研究团队中有社区代表，并通过一系列协商研讨会来实现。使用了目的抽样和滚雪球抽样方法。对深度访谈和焦点小组讨论进行了录音、逐字转录，并采用归纳主题分析法进行分析。
跨性别者的心理健康受到了以下几方面的影响。首先，新冠疫情及其相关的恐惧和痛苦，再加上原有的医疗保健不可及以及心理健康护理可及性降低，影响了他们的心理健康。其次，跨性别者独特的社会支持需求因疫情相关限制而受到干扰。第三，原有的脆弱性，如不稳定的就业和潜在的污名化现象加剧。最后，性别焦虑是新冠疫情对心理健康产生影响的一个关键中介因素，既有负面影响，也有正面影响。
该研究重申了进行系统性变革的必要性，以使心理健康护理和一般医疗服务具有跨性别包容性，同时也要认识到性别肯定服务的本质以及即使在紧急情况和灾难时期也需要继续提供此类服务的必要性。虽然这揭示了公共卫生紧急情况如何加剧脆弱性，但也表明跨性别者的实际心理健康体验与我们社会中工作、出行和住房的结构方式有着复杂的联系，因此指出了心理健康与性别的联系具有结构性。
