Research Article
No access
Published Online: 1 August 2022

“Being Trans Intersects with My Cultural Identity”: Social Determinants of Mental Health Among Asian Transgender People

Publication: Transgender Health
Volume 7, Issue Number 4

Abstract

Purpose: While studies on the relationship between social determinants and mental health among transgender people in Asia are increasing, there is a paucity of research on Asian transgender people living in Western countries. This study aimed to examine how social positions (gender, ethnicity, and migrant status) and social determinants of mental health were inter-related for Asian transgender people in Aotearoa/New Zealand.
Methods: We analyzed both quantitative and qualitative data from Asian participants (n=49) who responded to the 2018 Counting Ourselves: Aotearoa New Zealand Trans and Non-Binary Health Survey.
Results: Overall, 35% reported a very high psychological distress level. There were high levels of unmet needs for gender-affirming care, and participants reported a range of negative experiences at health care settings. About two-fifths had been discriminated because of their transgender (42%) or Asian (39%) identities. Fewer than half of participants felt that their family members were supportive of them being transgender (44%), and most reported they had supportive friends (73%). More than two-thirds of participants (68%) had a strong sense of belongingness to the transgender community and 35% reported this for the Asian community. Qualitative findings revealed specific challenges that participants experienced; these included barriers to accessing health care due to their migrant status and language barriers, influences of Asian cultures on mental health experiences, and rejection by family and people in Asian communities.
Conclusion: Our study provides evidence for health care providers, researchers, and policy makers to employ a culturally appropriate lens to improve knowledge about the intersectional experiences of being Asian and transgender.

Get full access to this article

View all available purchase options and get full access to this article.

References

1. Dickey LM, Budge SL. Suicide and the transgender experience: a public health crisis. Am Psychol. 2020;75:380–390.
2. Puckett JA, Matsuno E, Dyar C, et al. Mental health and resilience in transgender individuals: what type of support makes a difference? J Fam Psychol. 2019;33:954–964.
3. James SE, Herman JL, Rankin S, et al. The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality, 2016.
4. Bailey L, Ellis SJ, McNeil J. Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt. Ment Health Rev. 2014;19:209–220.
5. Clark TC, Lucassen MFG, Bullen P, et al. The health and well-being of transgender high school students: results from the New Zealand Adolescent Health Survey (Youth’12). J Adolesc Health. 2014;55:93–99.
6. Fredriksen-Goldsen KI, Simoni JM, et al. The health equity promotion model: reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. Am J Orthopsychiatry. 2014;84:653–663.
7. Kattari SK, Bakko M, Hecht HK, Kattari L. Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health. 2020;10:100525.
8. Testa RJ, Habarth J, Peta J, et al. Development of the gender minority stress and resilience measure. Psychol Sex Orientat Gend Divers. 2015;2:65–77.
9. Chen R, Zhu X, Wright L, et al. Suicidal ideation and attempted suicide amongst Chinese transgender persons: national population study. J Affect Disord. 2019;245:1126–1134.
10. Fraser G, Shields JK, Brady A, Wilson MS. The postcode lottery: gender-affirming healthcare provision across New Zealand's district health boards. 2019. Available at https://osf.io/f2qkr/ Accessed March 25, 2021.
11. Tan KKH, Schmidt JM, Ellis SJ, et al. ‘It's how the world around you treats you for being trans’: mental health and wellbeing of transgender people in Aotearoa New Zealand. Psychol Sex. (In Press);
12. Ker A, Fraser G, Lyons A, et al. Providing gender-affirming hormone therapy through primary care: Service users' and health professionals' experiences of a pilot clinic. J Prim Health Care. 2020;12:72–78.
13. Howard SD, Lee KL, Nathan AG, et al. Healthcare experiences of transgender people of color. J Gen Intern Med. 2019;34:2068–2074.
14. Singh AA. Transgender youth of color and resilience: negotiating oppression and finding support. Sex Roles. 2013;68:690–702.
15. Lytle MC, Blosnich JR, Kamen C. The association of multiple identities with self-directed violence and depression among transgender individuals. Suicide Life Threat Behav. 2016;46:535–544.
16. Becerra MB, Rodriquez EJ, Avina RM, Becerra BJ. Experiences of violence and mental health outcomes among Asian American transgender adults in the United States. PLoS One. 2021;16:e0247812.
17. Gibson BA, Brown S-E, Rutledge R, et al. Gender identity, healthcare access, and risk reduction among Malaysia's mak nyah community. Glob Public Health. 2016;11:1010–1025.
18. Suen YT, Chan RCH, Wong EMY. Mental health of transgender people in Hong Kong: a community-driven, large-scale quantitative study documenting demographics and correlates of quality of life and suicidality. J Homosex. 2018;65:1093–1113.
19. Anderson I, Crengle S, Leialoha Kamaka M, et al. Indigenous health in Australia, New Zealand, and the Pacific. Lancet. 2006;367:1775–1785.
20. Ho E. The changing face of Asian peoples in New Zealand. NZ Popul Rev. 2015;41:95–118.
21. Ward C, Masgoret A-M. Attitudes toward immigrants, immigration, and multiculturalism in New Zealand: a social psychological analysis. Int Migr Rev. 2008;42:227–248.
22. Statistics New Zealand. New Zealand's population reflects growing diversity. Available at https://www.stats.govt.nz/news/new-zealands-population-reflects-growing-diversity Accessed January 10, 2021.
23. Chiang S-Y, Fleming T, Lucassen M, et al. Mental health status of double minority adolescents: findings from national cross-sectional health surveys. J Immigr Minor Health. 2017;19:499–510.
24. Veale JF, Byrne J, Tan KKH, et al. Counting Ourselves: The Health and Wellbeing of Trans and Non-binary People in Aotearoa New Zealand. Hamilton, New Zealand: Transgender Health Research Lab, University of Waikato, 2019.
25. Ministry of Health. Tier 1 Statistics 2019/20: New Zealand Health Survey. Available at https://minhealthnz.shinyapps.io/nz-health-survey-2019-20-annual-data-explorer/ Accessed January 10, 2021.
26. Ministry of Health. Methodology Report 2016/17: New Zealand Health Survey. Wellington, New Zealand: Ministry of Health, 2017.
27. Tan KKH, Ellis SJ, Schmidt JM, et al. Mental health inequities among transgender people in Aotearoa New Zealand: findings from the Counting Ourselves survey. Int J Environ Res Public Health. 2020;17:2862.
28. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–1288.
29. Pega F, Veale JF. The case for the World Health Organization's commission on social determinants of health to address gender identity. Am J Public Health. 2015;105:58–62.
30. Oliphant J, Veale JF, Macdonald J, et al. Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealand. Report. Hamilton, New Zealand: Transgender Health Research Lab, University of Waikato, 2018.
31. Gonzales G, Henning-Smith C. Barriers to care among transgender and gender nonconforming adults. Milbank Q. 2017;95:726–748.
32. Taylor O, Rapsey CM, Treharne GJ. Sexuality and gender identity teaching within preclinical medical training in New Zealand: content, attitudes and barriers. N Z Med J. 2018;131:35–44.
33. Statistics New Zealand. Wellbeing statistics: 2018. Available at https://www.stats.govt.nz/information-releases/wellbeing-statistics-2018 Accessed March 25, 2021.
34. Parent M, DeBlaere C, Moradi B. Approaches to research on intersectionality: perspectives on gender, LGBT, and racial/ethnic identities. Sex Roles. 2013;68:639–645.
35. Human Rights Commission. Prism: Human Rights Issues Relating to Sexual Orientation, Gender Identity and Expression, and Sex Characteristics (SOGIESC) in Aotearoa New Zealand. Auckland, New Zealand: New Zealand Human Rights Commission, 2020.
36. King ME, Winter S, Webster B. Contact reduces transprejudice: a study on attitudes towards transgenderism and transgender civil rights in Hong Kong. Int J Sex Health. 2009;21:17–34.
37. Braun V, Clarke V, Boulton E, et al. The online survey as a qualitative research tool. Int J Soc Res Methodol. (In Press);
Cite this article as: Tan KKH, Yee A, Veale JF (2022) “Being trans intersects with my cultural identity”: social determinants of mental health among Asian transgender people, Transgender Health 7:4, 329–339, DOI: 10.1089/trgh.2021.0007.

Information & Authors

Information

Published In

cover image Transgender Health
Transgender Health
Volume 7Issue Number 4August 2022
Pages: 329 - 339

History

Published in print: August 2022
Published online: 1 August 2022
Published ahead of print: 12 May 2021

Permissions

Request permissions for this article.

Topics

Authors

Affiliations

Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand.
Ashe Yee
Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand.
Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand.

Notes

*
Address correspondence to: Kyle K.H. Tan, PhD, Transgender Health Research Lab, School of Psychology, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand, [email protected]

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This work was supported by the Health Research Council of New Zealand (J.F.V., 17/587), the Rule Foundation; and the University of Waikato. The first author acknowledges the financial support received through a University of Waikato Doctoral Scholarship.

Metrics & Citations

Metrics

Citations

Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF/EPUB

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media

Back to Top