Estresse de minorias e saúde mental da população transgênero de Fortaleza e região metropolitana

Abstract

The Gender Minority Stress Theory assumes that transgender people are exposed throughout their lives to unique social stressors—both distal and proximal—that negatively affect their mental health. This cross-sectional study aimed to analyze minority stress, resilience, anxiety and depression symptoms, their predictors, and interrelations in the transgender population of Fortaleza and its metropolitan region. A convenience sampling strategy was used. Data were collected by trained researchers at the SERTRANS outpatient clinic and through an online self-administered form. The sample consisted of 171 transgender individuals. Data collection instruments included an adapted questionnaire addressing sociodemographic and health characteristics, sexual behavior, gender transition process, and experiences with health services, as well as validated instruments: the Gender Minority Stress and Resilience Measure (GMSRM), the Patient Health Questionnaire-9 (PHQ-9) for depression, and the General Anxiety Disorder-7 (GAD-7) for anxiety. Analyses were conducted using IBM SPSS v.28, and the study was approved by the Research Ethics Committee of the Federal University of Ceará (approval number 7.230.895). The majority of participants were White, educated, unemployed, and reported high rates of psychiatric diagnoses and psychotropic medication use. A significant proportion reported discrimination in healthcare settings. Mean scores for distal and proximal stressors were high, especially in the domains “non-affirmation of gender identity” and “negative expectations for the future.” Resilience scores were similar to those found in the literature. Alarmingly high rates of depressive (88.9%) and anxiety (77.8%) symptoms were found. Higher levels of distal stress were associated with having children, lacking health insurance, reporting psychiatric diagnoses, negative healthcare experiences, and not having completed stages of gender affirmation. Proximal stress was higher among younger individuals, asexual people, persons with disabilities, those with psychiatric diagnoses, and those who experienced discrimination in healthcare; it was lower among individuals who had undergone stages of gender affirmation and those who reported illicit substance use. Lower resilience was associated with unstable housing, asexuality, higher income, lack of government assistance, use of psychotropic medications, not having had multiple sexual partners in recent months, and negative healthcare experiences. Depression and anxiety symptoms were significantly associated with psychiatric diagnoses, use of psychotropic medications, and negative healthcare experiences. Only depressive symptoms were associated with physical inactivity and engagement in transactional sex. Regarding the correlation between stressors and mental health symptoms, proximal stressors showed the strongest associations, particularly the domains of internalized transphobia, rejection, and negative expectations. In conclusion, transgender individuals in Fortaleza face high levels of psychosocial vulnerability, with substantial impacts on mental health. The Gender Minority Stress Model proved useful in explaining risk and protective factors and is recommended for application in public policies and clinical practices aimed at this population.