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ORIGINAL RESEARCH article

Front. Glob. Womens Health
Sec. Sex and Gender Differences in Disease
Volume 5 - 2024 | doi: 10.3389/fgwh.2024.1306065
This article is part of the Research Topic Data to Action – Advancing Research on Violence Against Trans Women Around the Globe View all articles

The interaction of adverse childhood experiences, sex, and transgender identity as risk factors for depression: disparities in transgender adults

Provisionally accepted
Siva Balakrishnan Siva Balakrishnan *Wei Yang Wei Yang Ann Weber Ann Weber
  • University of Nevada, Reno, Reno, United States

The final, formatted version of the article will be published soon.

    The intersectionality of sexism, transphobia, and adverse childhood experiences (ACE) on the mental health of transgender adults is poorly understood. We assessed whether the known association between ACE and depression was modified (or differed) by adult transgender identity and by assigned sex at birth, which we used as a proxy for adults' biological (e.g., hormonal changes) and social (e.g., sexism) experiences in childhood.Data from a representative sample of 519 transgender and 127,214 cisgender US adults was retrieved from the 2019 and 2020 Behavioral Risk Factor Surveillance System surveys. The sample was stratified by assigned sex at birth. Adjusted, sample-weighted Poisson regressions and relative excess risk due to interaction (RERI) were used to assess whether transgender identity modified the association between ACE and depression within strata of assigned sex at birth. We found 42.4% of transgender compared to 24.9% of cisgender adults experienced 3+ ACE.The association between ACE and depression was stronger for transgender compared to cisgender adults, regardless of assigned sex at birth. However, transgender adults assigned female at birth with 1-2 ACE had a combined risk of depression that was higher than would be expected from the sum of the two risks alone (RERI test of interaction for transgender with 1-2 ACE vs. cisgender with zero ACE: 1.91 [95% confidence interval 0.47-3.36]; p=0.009). The tests of interaction were not statistically significant (p > 0.05) for those assigned male at birth.Transgender adults may benefit more from depression interventions informed by and addressing childhood trauma than their cisgender counterparts, particularly for transgender adults who were assigned female at birth. Our findings suggest a need for greater and improved data collection of gender, experiences associated with assigned sex at birth, and ACE as these relate to the transgender community. This will allow for a better understanding of the intersecting influences of sexism, transphobia, and ACE on adult depression and for identifying particularly vulnerable sub-populations in need of support.

    Keywords: gender, Sex, Adverse childhood experiences, Depression, Interaction, Moderation, transgender

    Received: 04 Oct 2023; Accepted: 20 Nov 2024.

    Copyright: © 2024 Balakrishnan, Yang and Weber. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Siva Balakrishnan, University of Nevada, Reno, Reno, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.