Publishing in academic journal articles is an important part of academic research because these have been reviewed by independent experts, and usually this means that we have had to make changes to these articles based on these reviewers’ feedback. Academic journal articles are a good place to go into more in-depth analysis of our data than we could do in a community report or a fact sheet. These are also a good way for our findings to reach other academic researchers and health professionals.
Our aim is to make as many of these freely available to the general public as possible. However, there is a cost to making these open access, and we only received a limited amount of funding to do so.
Gender identity change efforts faced by trans and non-binary people in New Zealand: Associations with demographics, family rejection, internalized transphobia, and mental health
Based on their transphobic assumption that being transgender or non-binary (TNB) is pathological or otherwise undesirable, gender identity change efforts (GICE) attempt to make a person’s gender conform with their sex assigned at birth. While many professional bodies have noted that GICE practices are unethical, there has been little empirical research into the prevalence and correlates of GICE exposure. Counting Ourselves: the Aotearoa New Zealand Trans and Non-binary Health Survey is a community-based study, which participants completed mostly online. Out of 610 participants who had ever spoken to a health professional about their gender, 19.7% [16.6%, 23.1%] reported GICE exposure and a further 9.3% [7.2%, 11.9%] did not know. GICE exposure was higher among younger participants. Participants with GICE exposure were more likely than those without such exposure to report psychological distress, non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts (e.g., suicidal ideation OR = 2.39). GICE partially mediated the effect of family rejection on mental health and Internalized Transphobia partially mediated the effect of GICE on mental health. These correlates between GICE and mental health replicate recent findings from the US Trans Survey, and the mediation analyses help to understand potential causal mechanisms underlying these correlations. Although our findings are limited by being a convenience sample, they are consistent with the hypothesis that GICE exposure is harmful to TNB people’s mental health. Moreover, these findings support moves by many professional bodies to emphasize that GICE is unethical and the legal steps taken by a growing number of jurisdictions to ban such practices.
Reference: Veale, J.F., Tan, K.K.H. & Byrne, J.L (2021) Gender identity change efforts faced by trans and non-binary people in New Zealand: Associations with demographics, family rejection, internalized transphobia, and mental health, Psychology of Sexual Orientation and Gender Diversity. Advanced online publication. DOI: 10.1037/sgd0000537
Access to fertility preservation for trans and non-binary people in Aotearoa New Zealand
There is a growing need for healthcare professionals to discuss fertility preservation options with trans and non-binary people before commencing medical transition as part of informed consent-based models of care. In this article, we adapt the Five-A framework of healthcare access to examine fertility preservation information and services. To do so, we present an analysis of data from Counting Ourselves, the first comprehensive national survey in Aotearoa New Zealand of trans and non-binary people’s health and the first study exploring their access to cryopreservation information and services. Among 419 participants who had received gender-affirming hormones or surgery, 33.7% received information about options for fertility preservation and 15.8% accessed fertility preservation services. Findings from the study indicate the need for greater understanding of trans and non-binary people’s desire for genetically related children, and what type of information and form of delivery would be most helpful to ensure equitable outcomes in relation to decision-making around fertility and future family-building.
Reference: Ker, A., Shaw, R.M., Byrne, J.L., & Veale, J.F. (2021) Access to fertility preservation for trans and non-binary people in Aotearoa New Zealand, Culture, Health & Sexuality. Advanced online publication. DOI: 10.1080/13691058.2021.1944670
“Being trans intersects with my cultural identity”: Social determinants of mental health among Asian transgender people
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.
Reference: Tan, K.K.H., Yee, A., & Veale, J.F. (2021) “Being trans intersects with my cultural identity”: Social determinants of mental health among Asian transgender people, Transgender Health. Advanced online publication. DOI:10.1089/trgh.2021.0007
“It’s how the world around you treats you for being trans”: Mental health and wellbeing of transgender people in Aotearoa New Zealand
Globally, transgender people have been described as a highly marginalised population due to cisgenderism that delegitimises their gender identities and expressions. Despite robust evidence from many countries noting the association of discrimination and stigma for being transgender with heightened mental health risks, qualitative research that examines the nuances of mental health indicators using health equity frameworks has been scant both in Aotearoa/New Zealand and overseas. Using an inductive thematic approach, this paper analysed 222 open-text responses in the mental health section of the 2018 Counting Ourselves: Aotearoa New Zealand, Trans and Non-binary Health Survey. Our findings showed four overarching themes: gender-affirming healthcare, mental healthcare services and accessibility, gender minority stress, and self-affirmation and social support. Participants’ narratives described pervasive gender minority stress experiences in gender-affirming and mental healthcare services, including unmet healthcare needs, lack of competency in healthcare delivery, and pathologisation of their genders. In social settings, our participants commonly reported discrimination and violence, although they also reported that self-affirmation strategies and social support offset the impacts of gender minority stress on their mental health. The current findings indicate the importance of exploring mental health outcomes for transgender people in relation to cisgenderism and resultant gender minority stress.
Reference: Tan, K.K.H., Schmidt, J.M., Ellis, S.E., Veale, J.F., & Byrne, J.L. (2021) ‘It’s how the world around you treats you for being trans’: mental health and wellbeing of transgender people in Aotearoa New Zealand, Psychology & Sexuality. Advanced online publication. DOI: 10.1080/19419899.2021.1897033
Enacted stigma experiences and protective factors are strongly associated with mental health outcomes of transgender people in Aotearoa/New Zealand
Introduction: International evidence has found large mental health inequities among transgender people and demonstrates that mental health outcomes are associated with enacted stigma experiences and protective factors. This study aimed to examine the extent of associations of enacted stigma experiences specific to transgender people alongside protective factors with mental health of transgender people in Aotearoa/New Zealand.
Method: The 2018 Counting Ourselves survey was a nationwide community-based study of transgender people (N = 1,178, Mage = 29.5) living in Aotearoa/New Zealand. The survey assessed a wide range of gender minority stress experiences and protective factors that comprised primary (support from friends and family) and secondary social ties (neighborhood and transgender community belongingness). We calculated the predicted probabilities that transgender people exhibit very high psychological distress level, non-suicidal self-injury, and suicidal risks with different combinations and exposure profiles of enacted stigma and protective factors.
Results: Our findings demonstrated that enacted stigma was associated with negative mental health, and support of friends and family was linked to better outcomes across all mental health measures. Beyond primary social ties, sense of belongingness to neighborhood and transgender communities were linked to reduced odds of psychological distress and suicidal ideation. For those scoring high on enacted stigma and low on protective factors, our model revealed a 25% probability of attempting suicide in the last year compared to 3% for those scoring low on enacted stigma and high on protective factors.
Conclusions: Echoing previous findings, this study demonstrates that transgender people across Aotearoa/New Zealand are less likely to manifest life-threatening mental health outcomes if they experience low levels of enacted stigma and high levels of access to protective factors. Our findings suggest a need to address the enacted stigma that transgender people face across interpersonal and structural settings, and also to enhance social supports that are gender affirmative for this population.
Reference: Tan, K. K. H., Treharne, G. J., Ellis, S. J., Schmidt, J. M., & Veale, J. F. (2021). Enacted stigma experiences and protective factors are strongly associated with mental health outcomes of transgender people in Aotearoa/New Zealand. International Journal of Transgender Health, 22(3), 269-280. DOI: 10.1080/15532739.2020.1819504
Mental Health inequities among transgender people in Aotearoa New Zealand: Findings from the Counting Ourselves Survey
There has been little international research looking at differences in mental health across different age groups. This study examines mental health inequities between transgender people and the Aotearoa/New Zealand general population from youth to older adulthood. The 2018 Counting Ourselves survey (N = 1178) assessed participants’ mental health using the Kessler Psychological Distress Scale (K10) and diagnoses of depression and anxiety disorders, questions that were the same as those used in the New Zealand Health Survey. Our results showed significant mean score differences for transgender people on K10, and these differences were almost two standard deviations higher than the general population (Cohen’s d = 1.87). The effect size differences, however, decreased from youth to older adults. Regression analyses indicated trans women were less likely to report psychological distress than trans men and non-binary participants. There was an interaction effect for age and gender, with lower psychological distress scores found for younger trans women but higher scores for older trans women. The stark mental health inequities faced by transgender people, especially youth, demonstrate an urgent need to improve the mental health and wellbeing of this population by implementing inclusive institutional practices to protect them from gender minority stress.
Reference: Tan, K. K. H., Ellis, S. J., Schmidt, J. M., Byrne, J. L., & Veale, J. F. (2020). Mental health inequities among transgender people in Aotearoa New Zealand: Findings from the Counting Ourselves survey. International Journal of Environmental Research and Public Health, 17(8), 262. DOI: 10.3390/ijerph17082862