Factors Associated With Ruminative Thinking in Individuals With Gender Dysphoria

Abstract

This study aimed to examine psychosocial factors and medical history as well as symptoms of depression, anxiety, and stress associated with ruminative thinking in transgender people with gender dysphoria (GD) before undergoing gender affirmation surgery (GAS). This study evaluated 189 participants with GD (111 trans women and 78 trans men) from a specialized service for GAS in southern Brazil. Semi-structured interviews were conducted, and participants were asked to complete self-report questionnaires. We recovered participants' sociodemographic and psychosocial data (e.g., history of sexual abuse, expulsion from home, and history of drug use) and data regarding their clinical history (e.g., medication, history of suicidal ideation and attempted suicide, and HIV status). Further, we implemented the Depression, Anxiety and Stress Scale (DASS-21) to examine participants' psychological state, as well as the Ruminative Response Scale (RRS) to assess ruminative thinking, which includes brooding and reflection. The predictor variables were those that exhibited a minimum level of significance of p ≤ 0.05 in multivariate linear regression. The ruminative thinking scores for trans women were higher than those of trans men (Brooding p = 0.014; Reflection p = 0.052).In the multivariate model, suicidal ideation, moderate depression, and severe/very severe anxiety were associated with both brooding and reflection. Feminine gender identity and stress symptoms moderated only brooding, while anxiety symptoms moderated only reflection. Our findings show that trans women had the highest ruminative thinking scores, and that depression, anxiety, stress, and suicidal ideation were associated with ruminative thinking in total sample. Psychological symptoms should be examined in the context of gender affirmation surgery to minimize the possibility of adverse mental health outcomes. Follow-up studies are required to measure ruminative thinking levels more accurately and to identify its predictors.

Gender affirming hormone therapy dosing behaviors among transgender and nonbinary adults

“…While not all trans individuals will seek out hormones, access to and use of hormones can be lifechanging among those who do, particularly those with gender dysphoria. Individuals with gender dysphoria experience distress related to differences between their sex assigned at birth and gender identity (Ashley, 2021) and may experience episodes of distress, ruminative thinking, anxiety, and depression (Bouman et al, 2017;Chodzen et al, 2019;Klemmer et al, 2021;Silva et al, 2021). As gender-affirming hormones are highly effective in developing secondary sex characteristics and are less costly and more accessible than gender-affirming surgeries, hormones are most often the first or only form of gender-affirming care trans patients will seek out (Restar et al, 2019;White Hughto & Reisner, 2016).…”

Daily experiences of minority stress and mental health in transgender and gender-diverse individuals.

“…Rumination is another general factor that may underlie the mental health impacts of minority stressors. Rumination is associated with higher levels of suicidal ideation, depression, and anxiety in transgender individuals (Silva et al, 2021). Furthermore, in their cross-sectional study, Timmins et al (2017) found that distal and proximal stressors were related to distress for transgender people and that rumination partially accounted for these associations.…”

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

“…A total of 17 380 records were identified from the search, with 286 studies 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 ...…”