This study examined the association between perceived discrimination and depression in low-income, Latina, male-to-female transgender women. Similar to previous studies, a large number of transgender participants in this study suffered from depression [2
]. Thirty-five percent of the participants met the criteria for depression, compared to the 6.4% of the general US population diagnosed as having depressive disorder [40
]. The alarm is raised because these results are derived primarily from a sample drawn from people in the community who might have been benefiting from increased and higher levels of social support and services from CBOs, a feature that might distinguish them from the general community of Latina transgender individuals. This could imply that rates of depression in the general population of Latina transgender women may in fact be higher than those in our sample.
Additionally, 32% of our participants indicated that in the two weeks prior to the interviews, they either thought that they would be better off dead or thought of hurting themselves in some way nearly every day or at least on several days. A recent report of the National Transgender Discrimination Survey conducted by the National Center for Transgender Equality and National Gay and Lesbian Task Force indicated that 41% of their transgender respondents reported having attempted suicide compared to 1.6% of the general population [28
]. The present sample of Latina male-to-female transgender women who reported more frequent perceived discrimination were more likely to present with severe depression.
Our data show that a large number of the participants experienced discrimination on regular basis. These incidents of discrimination commonly include being accused of being a sex worker and HIV positive; being called names or insulted; being made fun of and treated disrespectfully; and being threatened or harassed. Additionally, being denied employment, housing, and access to public restrooms; being rejected by family members; and being stopped by law enforcement without violating any law were all common examples of discrimination that were mentioned by at least 50% of the participants. These kinds of discrimination can have a profound impact on transgender peoples’ lives [28
A recent meta-analysis of available empirical evidence from studies of other populations shows that discrimination is associated with poorer mental health status in minority populations [42
]. Homosexual and bisexual individuals report more lifetime and day-to-day experiences with discrimination than heterosexual individuals and 42% attribute this discrimination to their sexual orientation [29
]. Transgender people are significantly more likely than gay men, lesbians, and bisexuals to experience discrimination [18
]. Transgender individuals who often feel increasingly isolated, helpless, misunderstood, and discriminated against may become depressed [28
]. More research is needed on the social discrimination and isolation specific to Latina transgender women and a closer examination of perceived discrimination and levels of depression. Additionally, research is needed to explore the social network and social support of Latina transgender individuals and investigate whether lack of social support among this segment of our population exacerbates depressive symptoms.
Indeed, a recent study by Nemoto and colleagues [12
] assessed the racial/ethnic differences in social support and exposure to violence and transphobia among male-to-female transgender women with a history of sex work and showed that depression was significantly correlated with transphobia, social support and Latina ethnicity. Nemoto and colleagues argue that these findings among Latina transgender individuals need additional study to examine why Latina ethnicity contributed to higher levels of depression. Longitudinal studies that assess the role of social support and the effects of exposure to discrimination and transphobia and its impact on mental health from childhood to adulthood are needed [12
There was a notable association between self-reported history of sexual partner violence and mistreatment by main partners/spouse/casual partners and severity of depression, even after other related variables (including demographic variables and sex work) were held constant. Almost six out of 10 participants in present study admitted that they had been a victim of violence by a sexual partner. It is not a surprise then that those who were mistreated or victimized by their partners/spouse were almost two times more likely than their counterparts who were not victimized to report severe depression. For transgender people who are abused by their sexual partners, finding help can be very difficult. Undoubtedly, there are not enough appropriate agencies that can provide suitable help. Latina male-to-female transgender women who are victims of sexual partner violence may be particularly reluctant to file complaints because of the discrimination they may face [30
]. Although anyone experiencing sexual partner violence may report depressive symptoms [43
], sexual partner violence within the transgender population calls for further study for the following reasons:
1. Discrimination by law enforcement - Many transgender people have reported being harassed and discriminated against by law enforcement [28
]. The National Transgender Discrimination Survey indicates that one-fifth of transgender individuals who have interacted with law enforcement reported harassment by police [28
]. Moreover, with the Latina transgender population, immigration status may influence whether they seek legal help.
2. Social isolation and rejection - Cases of sexual partner violence are typically characterized by the perpetrator isolating his victim from family and friends despite their efforts to reach out. Given that almost 60% of the sample reported having been a victim of violence by their sexual partner, spouses or casual partners, and 66% of the participants reported that they had been rejected by their families, it is plausible to assume that the degree of isolation experienced by transgender individuals in cases of sexual partner violence may be worse than the level of isolation experienced by other victims of partner violence.
3. Providers - There are not enough providers adequately trained and equipped to meet the needs of the transgender population. The majority of transgender individuals in this study were exposed to sexual violence, and providers need to receive training specifically regarding the signs and symptoms of sexual partner violence in this population. Providers also need to receive training on the specific mental health needs of transgender patients – including addressing depression - in order to comprehensively address their needs.
This study had three main limitations. First, an interpretation of the findings was limited by the cross-sectional nature of the study and an inability to address causation. Second, the data generated were from a non-probability sample, which limits our ability to generalize the findings. Additionally, we used only two items to measure sexual partner violence.