Factors related to depression among transgender women: A systematic review
Abstract
Background & Aim: Transgender women represent a vulnerable population with a high rate of depression. This systematic review aims to identify and analyze the factors associated with depression in this population.
Methods & Materials: The research protocol was registered with PROSPERO. A systematic search was conducted using PubMed, MEDLINE, Scopus, and ProQuest for studies published between 2014 and 2024. Relevant studies focusing on depression and related factors in transgender women were selected. Data extraction focused on identified factors associated with depression. The reporting of this review adhered to PRISMA guidelines, and the quality of included studies was appraised using JBI’s critical appraisal tools. A narrative synthesis was conducted to synthesize the findings.
Results: From 2,511 records identified in the database, 14 cross-sectional studies were included in the review. The analysis revealed three primary categories of factors related to depression: demographic, psychological, and sociological factors. Key demographic factors included age and insufficient income, both of which were at increased risk of depression. Psychological factors such as self-stigma and self-esteem were associated with higher depression rates. Sociological factors, including family support, peer support, and violence, were also significant predictors of depression in transgender women.
Conclusion: Depression in transgender women is influenced by a complex interaction of demographic, psychological, and sociological factors. These findings underscore the need for tailored nursing interventions that incorporate mental health support.
1. Rimes KA, Goodship N, Ussher G, Baker D, West E. Non-binary and binary transgender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences. International Journal of Transgenderism. 2019;20(2-3):230-40.
2. Herman JL, Flores AR, O'Neill KK. How many adults and youth identify as transgender in the United States? 2022. Available at: https://escholarship.org/content/qt4xs990ws/qt4xs990ws.pdf
3. Byrne J, Radix A. Blueprint for the provision of comprehensive care for trans people and trans communities in Asia and the Pacific: Health Policy Project; 2015.
4. Flores AR, Herman J, Gates GJ, Brown TN. How many adults identify as transgender in the United States? Los Angeles, CA: Williams Institute; 2016 Jun 10.
5. Dhejne CVV, R., Heylens, G., and Arcelus, J. Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry. 2016;28(1):44-57.
6. Chaovanalikit T, Wirairat K, Sriswadpong P. Quality of life, self-esteem, and depression among Thai transgender women before and after male-to-female gender confirmation surgery: a prospective cohort observational study. Sexual medicine. 2022 Aug;10(4):100533.
7. Luz PM, Jalil EM, Castilho J, Velasque L, Ramos M, Ferreira ACG, et al. Association of discrimination, violence, and resilience with depressive symptoms among transgender women in Rio de Janeiro, Brazil: A cross-sectional analysis. Transgender Health. 2022;7(1):101-6.
8. Borgogna NC, McDermott RC, Aita SL, Kridel MM. Anxiety and depression across gender and sexual minorities: Implications for transgender, gender nonconforming, pansexual, demisexual, asexual, queer, and questioning individuals. Psychology of Sexual Orientation and Gender Diversity. 2019 Mar;6(1):54.
9. Witcomb GL, Bouman WP, Claes L, Brewin N, Crawford JR, Arcelus J. Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services. Journal of Affective Disorders. 2018;235:308-15.
10. Tantirattanakulchai P, Hounnaklang N. Perceived social support and its relationship with depression among Bangkok's trans women. Journal of Health Research. 2022;36(2):365-75.
11. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: A review. Lancet. 2016;388(10042):412-36.
12. Yang X, Wang L, Hao C, Gu Y, Song W, Wang J, et al. Sex partnership and self-efficacy influence depression in Chinese transgender women: A cross-sectional study. PLoS One. 2015;10(9):e0136975.
13. Yi S, Tuot S, Chhim S, Chhoun P, Mun P, Mburu G. Exposure to gender-based violence and depressive symptoms among transgender women in Cambodia: findings from the National Integrated Biological and Behavioral Survey 2016. International Journal of Mental Health Systems. 2018;12(1):1-11.
14. World Health Organization. Creating awareness on prevention and control of depression 2024 [Available from: https://www.who.int/thailand/activities/creating-awareness-on-prevention-and-control-of-depression.
15. National Institute of Mental Health. Depression 2024 [Available from: https://www.nimh.nih.gov/health/topics/depression.
16. Daskalopoulou M, George J, Walters K, Osborn DP, Batty GD, Stogiannis D, et al. Depression as a risk factor for the initial presentation of twelve cardiac, cerebrovascular, and peripheral arterial diseases: data linkage study of 1.9 million women and men. PloS One. 2016;11(4):e0153838.
17. World Health Organization. Depression 2024 [Available from: https://www.who.int/health-topics/depression#tab=tab_2.
18. O’Neill E. The Inside Story: The Impact of Depression on Daily Life. Depression Alliance. 2008.
19. World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates 2020 [Available from: https://www.who.int/publications/i/item/depression-global-health-estimates.
20. World Health Organization. Other common mental disorders: global health estimates. Geneva: World Health Organization. 2017;24.
21. Hall WJ. Psychosocial risk and protective factors for depression among lesbian, gay, bisexual, and queer youth: A systematic review. Journal of Homosexuality. 2018 Feb 23;65(3):263-316.
22. Tankersley AP, Grafsky EL, Dike J, Jones RT. Risk and resilience factors for mental health among transgender and gender nonconforming (TGNC) youth: A systematic review. Clinical Child and Family Psychology Review. 2021;24(2):183-206.
23. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
24. Aromataris E, Munn Z. JBI manual for evidence synthesis: JBI; 2020.
25. Pimsen A, Kao CY, Hsu ST, Shu BC. The effect of advance care planning intervention on hospitalization among nursing home residents: a systematic review and meta-analysis. Journal of the American Medical Directors Association. 2022 Sep 1;23(9):1448-60.
26. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.
27. Hajek A, Konig H-H, Buczak-Stec E, Blessmann M, Grupp K, editors. Prevalence and determinants of depressive and anxiety symptoms among transgender people: results of a survey. Healthcare; 2023: MDPI.
28. Okonkwo N, Rwema JO, Lyons C, Liestman B, Nyombayire J, Olawore O, Nsanzimana S, Mugwaneza P, Kagaba A, Sullivan P, Allen S. The relationship between sexual behavior stigma and depression among men who have sex with men and transgender women in Kigali, Rwanda: a cross-sectional study. International Journal of Mental Health and Addiction. 2022 Dec 1:1-6.
29. Boza C, Nicholson Perry K. Gender-related victimization, perceived social support, and predictors of depression among transgender Australians. International Journal of Transgenderism. 2014;15(1):35-52.
30. Silva GWdS, Meira KC, Dantas ESO, Gomes SM, Pedrosa IMB, Miranda FANd. Depressive symptoms and associated factors among travestis and transsexuals: a cross-sectional study. Revista Brasileira de Enfermagem. 2024;77(Suppl 3):e20230071.
31. Chang R, Wang H, She R, Zhang S, Tsamlag L, Shen Q, Shi Y, Wang Z, Lau JT, Wang Y, Cai Y. Feelings of entrapment and defeat mediate the association between self-esteem and depression among transgender women sex workers in China. Frontiers in Psychology. 2019 Oct 4;10:2241.
32. Yamanis T, Malik M, del Río-González AM, Wirtz AL, Cooney E, Lujan M, Corado R, Poteat T. Legal immigration status is associated with depressive symptoms among Latina transgender women in Washington, DC. International Journal of Environmental Research and Public Health. 2018 Jun;15(6):1246.
33. Almeida MMd, Silva LAVd, Bastos FI, Guimarães MDC, Coutinho C, De Brito AM, et al. Factors associated with symptoms of major depression disorder among transgender women in Northeast Brazil. Plos One. 2022;17(9):e0267795.
34. Srivastava A, Davis JP, Patel P, Daniel EE, Karkal S, Rice E. Sex work, gender transition, family rejection and depressive symptoms among transgender women in India. International Journal of Transgender Health. 2023 Jan 25;24(1):49-58.
35. Lee H, Tomita KK, Habarth JM, Operario D, Yi H, Choo S, Kim SS. Internalized transphobia and mental health among transgender adults: A nationwide cross-sectional survey in South Korea. International Journal of Transgender Health. 2020 Apr 2;21(2):182-93.
36. Leigh Ann Van der Merwe L, Nikodem C, Ewing D. The socio-economic determinants of health for transgender women in South Africa: Findings from a mixed-methods study. Agenda. 2020;34(2):41-55.
37. Degtiar I, Rose S. A review of generalizability and transportability. Annual Review of Statistics and Its Application. 2023;10(1):501-24.
38. El-Den S, Chen TF, Gan Y-L, Wong E, O’Reilly CL. The psychometric properties of depression screening tools in primary healthcare settings: A systematic review. Journal of Affective Disorders. 2018;225:503-22.
39. Safer JD, Chan KJ. Review of medical, socioeconomic, and systemic barriers to transgender care. Transgender medicine: A Multidisciplinary Approach. 2019:25-38.
40. Hoffman B. An overview of depression among transgender women. Depression Research and Treatment. 2014;2014(1):394283.
41. Hoy-Ellis CP. Minority stress and mental health: A review of the literature. Journal of Homosexuality. 2023 Apr 16;70(5):806-30.
42. Wang Y, Lao CK, Wang Q, Zhou G. The impact of sexual minority stigma on depression: The roles of resilience and family support. Sexuality Research and Social Policy. 2022 Jun 1:1-1.
43. Taylor JK, Haider-Markel DP, Lewis DC. The remarkable rise of transgender rights. University of Michigan Press; 2018 Oct 17.
2. Herman JL, Flores AR, O'Neill KK. How many adults and youth identify as transgender in the United States? 2022. Available at: https://escholarship.org/content/qt4xs990ws/qt4xs990ws.pdf
3. Byrne J, Radix A. Blueprint for the provision of comprehensive care for trans people and trans communities in Asia and the Pacific: Health Policy Project; 2015.
4. Flores AR, Herman J, Gates GJ, Brown TN. How many adults identify as transgender in the United States? Los Angeles, CA: Williams Institute; 2016 Jun 10.
5. Dhejne CVV, R., Heylens, G., and Arcelus, J. Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry. 2016;28(1):44-57.
6. Chaovanalikit T, Wirairat K, Sriswadpong P. Quality of life, self-esteem, and depression among Thai transgender women before and after male-to-female gender confirmation surgery: a prospective cohort observational study. Sexual medicine. 2022 Aug;10(4):100533.
7. Luz PM, Jalil EM, Castilho J, Velasque L, Ramos M, Ferreira ACG, et al. Association of discrimination, violence, and resilience with depressive symptoms among transgender women in Rio de Janeiro, Brazil: A cross-sectional analysis. Transgender Health. 2022;7(1):101-6.
8. Borgogna NC, McDermott RC, Aita SL, Kridel MM. Anxiety and depression across gender and sexual minorities: Implications for transgender, gender nonconforming, pansexual, demisexual, asexual, queer, and questioning individuals. Psychology of Sexual Orientation and Gender Diversity. 2019 Mar;6(1):54.
9. Witcomb GL, Bouman WP, Claes L, Brewin N, Crawford JR, Arcelus J. Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services. Journal of Affective Disorders. 2018;235:308-15.
10. Tantirattanakulchai P, Hounnaklang N. Perceived social support and its relationship with depression among Bangkok's trans women. Journal of Health Research. 2022;36(2):365-75.
11. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: A review. Lancet. 2016;388(10042):412-36.
12. Yang X, Wang L, Hao C, Gu Y, Song W, Wang J, et al. Sex partnership and self-efficacy influence depression in Chinese transgender women: A cross-sectional study. PLoS One. 2015;10(9):e0136975.
13. Yi S, Tuot S, Chhim S, Chhoun P, Mun P, Mburu G. Exposure to gender-based violence and depressive symptoms among transgender women in Cambodia: findings from the National Integrated Biological and Behavioral Survey 2016. International Journal of Mental Health Systems. 2018;12(1):1-11.
14. World Health Organization. Creating awareness on prevention and control of depression 2024 [Available from: https://www.who.int/thailand/activities/creating-awareness-on-prevention-and-control-of-depression.
15. National Institute of Mental Health. Depression 2024 [Available from: https://www.nimh.nih.gov/health/topics/depression.
16. Daskalopoulou M, George J, Walters K, Osborn DP, Batty GD, Stogiannis D, et al. Depression as a risk factor for the initial presentation of twelve cardiac, cerebrovascular, and peripheral arterial diseases: data linkage study of 1.9 million women and men. PloS One. 2016;11(4):e0153838.
17. World Health Organization. Depression 2024 [Available from: https://www.who.int/health-topics/depression#tab=tab_2.
18. O’Neill E. The Inside Story: The Impact of Depression on Daily Life. Depression Alliance. 2008.
19. World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates 2020 [Available from: https://www.who.int/publications/i/item/depression-global-health-estimates.
20. World Health Organization. Other common mental disorders: global health estimates. Geneva: World Health Organization. 2017;24.
21. Hall WJ. Psychosocial risk and protective factors for depression among lesbian, gay, bisexual, and queer youth: A systematic review. Journal of Homosexuality. 2018 Feb 23;65(3):263-316.
22. Tankersley AP, Grafsky EL, Dike J, Jones RT. Risk and resilience factors for mental health among transgender and gender nonconforming (TGNC) youth: A systematic review. Clinical Child and Family Psychology Review. 2021;24(2):183-206.
23. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
24. Aromataris E, Munn Z. JBI manual for evidence synthesis: JBI; 2020.
25. Pimsen A, Kao CY, Hsu ST, Shu BC. The effect of advance care planning intervention on hospitalization among nursing home residents: a systematic review and meta-analysis. Journal of the American Medical Directors Association. 2022 Sep 1;23(9):1448-60.
26. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.
27. Hajek A, Konig H-H, Buczak-Stec E, Blessmann M, Grupp K, editors. Prevalence and determinants of depressive and anxiety symptoms among transgender people: results of a survey. Healthcare; 2023: MDPI.
28. Okonkwo N, Rwema JO, Lyons C, Liestman B, Nyombayire J, Olawore O, Nsanzimana S, Mugwaneza P, Kagaba A, Sullivan P, Allen S. The relationship between sexual behavior stigma and depression among men who have sex with men and transgender women in Kigali, Rwanda: a cross-sectional study. International Journal of Mental Health and Addiction. 2022 Dec 1:1-6.
29. Boza C, Nicholson Perry K. Gender-related victimization, perceived social support, and predictors of depression among transgender Australians. International Journal of Transgenderism. 2014;15(1):35-52.
30. Silva GWdS, Meira KC, Dantas ESO, Gomes SM, Pedrosa IMB, Miranda FANd. Depressive symptoms and associated factors among travestis and transsexuals: a cross-sectional study. Revista Brasileira de Enfermagem. 2024;77(Suppl 3):e20230071.
31. Chang R, Wang H, She R, Zhang S, Tsamlag L, Shen Q, Shi Y, Wang Z, Lau JT, Wang Y, Cai Y. Feelings of entrapment and defeat mediate the association between self-esteem and depression among transgender women sex workers in China. Frontiers in Psychology. 2019 Oct 4;10:2241.
32. Yamanis T, Malik M, del Río-González AM, Wirtz AL, Cooney E, Lujan M, Corado R, Poteat T. Legal immigration status is associated with depressive symptoms among Latina transgender women in Washington, DC. International Journal of Environmental Research and Public Health. 2018 Jun;15(6):1246.
33. Almeida MMd, Silva LAVd, Bastos FI, Guimarães MDC, Coutinho C, De Brito AM, et al. Factors associated with symptoms of major depression disorder among transgender women in Northeast Brazil. Plos One. 2022;17(9):e0267795.
34. Srivastava A, Davis JP, Patel P, Daniel EE, Karkal S, Rice E. Sex work, gender transition, family rejection and depressive symptoms among transgender women in India. International Journal of Transgender Health. 2023 Jan 25;24(1):49-58.
35. Lee H, Tomita KK, Habarth JM, Operario D, Yi H, Choo S, Kim SS. Internalized transphobia and mental health among transgender adults: A nationwide cross-sectional survey in South Korea. International Journal of Transgender Health. 2020 Apr 2;21(2):182-93.
36. Leigh Ann Van der Merwe L, Nikodem C, Ewing D. The socio-economic determinants of health for transgender women in South Africa: Findings from a mixed-methods study. Agenda. 2020;34(2):41-55.
37. Degtiar I, Rose S. A review of generalizability and transportability. Annual Review of Statistics and Its Application. 2023;10(1):501-24.
38. El-Den S, Chen TF, Gan Y-L, Wong E, O’Reilly CL. The psychometric properties of depression screening tools in primary healthcare settings: A systematic review. Journal of Affective Disorders. 2018;225:503-22.
39. Safer JD, Chan KJ. Review of medical, socioeconomic, and systemic barriers to transgender care. Transgender medicine: A Multidisciplinary Approach. 2019:25-38.
40. Hoffman B. An overview of depression among transgender women. Depression Research and Treatment. 2014;2014(1):394283.
41. Hoy-Ellis CP. Minority stress and mental health: A review of the literature. Journal of Homosexuality. 2023 Apr 16;70(5):806-30.
42. Wang Y, Lao CK, Wang Q, Zhou G. The impact of sexual minority stigma on depression: The roles of resilience and family support. Sexuality Research and Social Policy. 2022 Jun 1:1-1.
43. Taylor JK, Haider-Markel DP, Lewis DC. The remarkable rise of transgender rights. University of Michigan Press; 2018 Oct 17.
| Files | ||
| Issue | Vol 12 No 2 (2025): Spring | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/npt.v12i2.18335 | |
| Keywords | ||
| depression; transgender women; systematic review | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Krongtham P, Thato R, Uthis P. Factors related to depression among transgender women: A systematic review. NPT. 2025;12(2):120-131.
