First Australian National Trans Mental Health Study

A Mixed-Methods Study of Mental Health and Associated Factors in Transgender and Transsexual (Trans) People

This is an Internet-based survey of transgender and transsexual (trans) people aged 18 years and older living in Australia. This population has received limited attention from public health researchers, planners, and practitioners. However, a growing body of evidence suggests that trans people experience disparities in several important areas of health compared with the population generally. In particular, trans people are more likely to experience mental health problems (notably depression and anxiety disorders), use alcohol, tobacco, and illicit drugs, and think about or attempt suicide. Additionally, trans people commonly report that their physical and mental health needs are not met, and underutilise preventive health care.

Participants were recruited using several non-probability sampling techniques, (including purposive sampling and snowball sampling), because random sampling is not possible with this population. Medical, social, support, and advocacy networks used by trans people were used to promote the study. A mixed quantitative and qualitative methodology was used. Validated quantitative instruments were used to obtain measures of health and well-being, which will be compared against population norms. Qualitative items complement these measures, providing rich experiential data.

The investigators hypothesised that:

• the prevalence of depressive and anxiety disorders will be higher than for the population generally, and that these conditions will commonly be undiagnosed and untreated;
• depressive and anxiety disorders will be associated with risky behaviours, such as tobacco, alcohol, and illicit drug use; and,
• trans people will report poor relationships with medical practitioners.

The investigators hypothesised that poor mental health is a consequence of several interrelated factors: body dysphoria (as a consequence of experiencing difficulty accessing medical treatment to alter sexual characteristics); societal discrimination and stigma (including harassment and violence); institutionalised discrimination (including difficulty changing identifying documents, and exclusion of surgical procedures and related treatments from public and private health systems); social isolation; and the belief held by many clinicians that transsexualism is a mental disorder (which may be a barrier to trans people forming trusting relationships with medical practitioners).

Study Overview

• Status: Completed
• Conditions: Transsexualism
• Intervention / Treatment: Other: questionnaire

• Study Type: Observational
• Enrollment (Actual): 946

Contacts and Locations

Study Locations

• Australia
  • Western Australia
    • Perth, Western Australia, Australia, 6102
      • Curtin University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

This is a study of trans people living in Australia aged 18 years or older. The investigators used the term trans in an inclusive way, and included people who use (or used) words like transsexual, transgender, sistergirl, brotherboy, androgynous, or genderqueer to describe themselves. All trans people, including those who just describe themselves as men or women were encouraged to participate.

Description

Inclusion Criteria:

• Live in Australia
• Self-identify as trans

Exclusion Criteria:

• Aged less than 18 years

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Transgender and Transsexual People; Transgender and transsexual (trans) people aged 18 years or older living in Australia were invited to complete a questionnaire assessing a range of mental and physical health domains.	Other: questionnaire

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of depressive and anxiety disorders	Assessed by self-report, and with the Patient Health Questionnaire (PHQ)	At time of entry into study (cross-sectional)
Perceived physical and mental health status	Assessed with the 36-item Short Form Health Survey (SF-36)	At time of entry into study (cross-sectional)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Use of alcohol, tobacco, and illicit drugs	Assessed by self-report	At time of entry into study (cross-sectional)
Patient-doctor relationship between trans people and their general practitioners, and doctors generally	Assessed with the Patient-Doctor Relationship Questionnaire (PDRQ-9) and other quantitative and qualitative questions	At time of entry into study (cross-sectional)
Body image	Assessed with the Body Image Quality of Life Inventory (BIQLI)	At time of entry into study (cross-sectional)
Factors that encourage and discourage trans people from accessing health care	Assessed with qualitative questions	At time of entry into study (cross-sectional)
Factors that protect and promote mental health in trans people	Assessed with qualitative questions	At time of entry into study (cross-sectional)
Use of hormone therapy and desire for, and uptake of transition-related surgery	Assessed with quantitative and qualitative questions	At time of entry into study (cross-sectional)
Experiences of discrimination and harassment	Assessed with quantitative and qualitative questions	At time of entry into study (cross-sectional)
Desire to, and success changing identifying documentation	Assessed with quantitative and qualitative questions	At time of entry into study (cross-sectional)

Collaborators and Investigators

• Sponsor: Curtin University
• Collaborators: Beyondblue (The National Depression Initiative)
• Investigators: Principal Investigator: Zoë Hyde, MPH PhD, Curtin University; Principal Investigator: Maryanne Doherty, MSc PhD, Curtin University; Principal Investigator: Peter Tilley, MPsych, Curtin University; Principal Investigator: Kieran A. McCaul, MPH PhD, The University of Western Australia; Principal Investigator: Rosanna Rooney, MPsych PhD, Curtin University; Principal Investigator: Jonine Jancey, PhD, Curtin University

Publications and helpful links

Helpful Links

• Study website

Study record dates

Study Major Dates

• Study Start: August 1, 2013
• Primary Completion (Actual): December 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: April 16, 2014
• First Submitted That Met QC Criteria: April 18, 2014
• First Posted (Estimate): April 21, 2014

Study Record Updates

• Last Update Posted (Estimate): May 6, 2014
• Last Update Submitted That Met QC Criteria: May 5, 2014
• Last Verified: May 1, 2014

More Information

Terms related to this study

• Keywords: transgender; transsexual; trans; sistergirl; brotherboy; androgynous; genderqueer
• Other Study ID Numbers: CB:gc:6722