Lee Hyemin, Restar Arjee J, Operario Don, Choo Sungsub, Streed Carl G, Yi Horim, Kim Ranyeong, Eom Yun-Jung, Kim Seung-Sup
Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.
Int J Transgend Health. 2021 Nov 4;24(3):334-345. doi: 10.1080/26895269.2021.1989357. eCollection 2023.
COVID-19 has disproportionately impacted marginalized groups, including transgender populations, reproducing and exacerbating inequalities and vulnerabilities that existed in those groups prior to the pandemic. This study aimed to assess the prevalence of transgender-specific COVID-19-related stressors and their association with depressive symptoms among South Korean transgender adults.
We conducted a nationwide cross-sectional study of 564 South Korean transgender adults (trans women, trans men, and nonbinary people) from October 7 to October 31, 2020. We measured four transgender-specific COVID-19-related stressors as follows: (A) had difficulty receiving gender-affirming healthcare due to economic hardship related to COVID-19, (B) had difficulty receiving gender-affirming healthcare due to limited access to hospitals under the COVID-19 situation, (C) had difficulty purchasing a public face mask due to gender information on an identification card, and (D) avoided getting a COVID-19 test in fear of unfair treatment and dirty looks due to gender identity, despite having COVID-19 symptoms. Past-week depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale.
Of the total participants, 30.7% experienced any of the four transgender-specific COVID-19-related stressors, and 70.2% were classified as having depressive symptoms during the past week. We found statistically significant associations with depressive symptoms among participants who reported that they had difficulty receiving gender-affirming healthcare due to either economic hardship (adjusted prevalence ratio [aPR] = 1.20, 95% Confidence Interval [CI] = 1.05-1.37) or limited access to hospitals (aPR = 1.15, 95% CI = 1.00-1.32), respectively. Furthermore, those who had two or more of the four transgender-specific COVID-19-related stressors were 1.21 times (95% CI = 1.05-1.40) more likely to report depressive symptoms, compared to those who did not report any stressor.
Transgender-specific COVID-19-related stressors may negatively influence depressive symptoms among South Korean transgender adults. Given these findings, transgender-inclusive interventions should be implemented at the policy level during the COVID-19 pandemic in South Korea.
新冠疫情对包括跨性别群体在内的边缘化群体产生了尤为严重的影响，使疫情之前这些群体中就已存在的不平等和脆弱性进一步加剧。本研究旨在评估韩国成年跨性别者中与新冠疫情相关的特定跨性别应激源的发生率及其与抑郁症状的关联。
2020年10月7日至10月31日，我们对564名韩国成年跨性别者（跨性别女性、跨性别男性和非二元性别者）进行了一项全国性横断面研究。我们测量了四种与新冠疫情相关的特定跨性别应激源，具体如下：（A）由于新冠疫情导致的经济困难，在接受性别肯定医疗保健方面存在困难；（B）由于新冠疫情期间医院就诊机会有限，在接受性别肯定医疗保健方面存在困难；（C）由于身份证上的性别信息，在购买公共口罩时遇到困难；（D）尽管有新冠症状，但因担心因性别认同而受到不公平对待和异样眼光而避免进行新冠检测。使用流行病学研究中心抑郁量表评估过去一周的抑郁症状。
在所有参与者中，30.7%经历了四种与新冠疫情相关的特定跨性别应激源中的任何一种，70.2%在过去一周被归类为有抑郁症状。我们发现，报告因经济困难（调整患病率比[aPR]=1.20，95%置信区间[CI]=1.05-1.37）或医院就诊机会有限（aPR = 1.15，95% CI = 1.00-1.32）而在接受性别肯定医疗保健方面存在困难的参与者，与抑郁症状之间存在统计学上的显著关联。此外，与未报告任何应激源的参与者相比，有两种或更多种与新冠疫情相关的特定跨性别应激源的参与者报告抑郁症状的可能性高出1.21倍（95% CI = 1.05-1.40）。
与新冠疫情相关的特定跨性别应激源可能会对韩国成年跨性别者的抑郁症状产生负面影响。鉴于这些发现，韩国在新冠疫情期间应在政策层面实施包含跨性别者的干预措施。
