According to Hoy Ellis and Fredriksen-Goldsen (2017), depression is the most significant chronic mental condition among the older American population. Similarly, depression continues to increase among the aging adult population, considering that the older adult population is expanding rapidly. It is projected that this chronic mental health condition will become the second major cause of disease burden within the more aging adult population globally by around 2030 (Hoy-Ellis and Fredriksen-Goldsen, 2017). Generally, the minority groups in any setting tend to experience higher rates of depression. This is true in older transgender women. Older transgender women are fundamentally a minority group in almost all geographical and demographic settings (Chakrapani et al., 2017). While the lifetime rate of depression among the general American population stands at approximately 16.5 percent, the depression rate in older transgender women is overwhelming, at about 62 percent (Bazargan and Galvan, 2012).
Therefore, the issue of depression in older transgender women is very critical and has drawn the attention of many organizations and researchers who have tried to mitigate this situation through intensive research and the implementation of different mechanisms such as counseling. Numerous research studies have published much valuable information regarding the state of the problem, causes, effects, types of depression, and specific interventions. In this line, the central aim of this research is to review a handful of the recently published peer-reviewed research and provide a piece of succinct general information regarding the issue at hand.
Background: Definition and Statistics
Nuttbrock et al. (2014) define transgender as simply referring to people who do not align or adhere to the traditional and cultural definitions of sex or gender. In the context of the essay at hand, transgender is used to referring to women with a variety of identities generally; thus, transsexual women or the women who have at some point in their lives interfered with their genitals, in the perspective of changing their gender to fit the gender they chose. According to Hoy-Ellis and Fredriksen-Goldsen (2017), transgender people often use makeup, clothing, hairstyles, hormones, and surgery to express their order. Therefore, they can easily be identified from the rest of the people. This forms the basis of understanding the issue of depression among this group of people.
Data from the US Transgender Survey (2015) indicate more serious suicidal attempts, suicidal ideation, and depression among older transgender women. It is estimated that the rate of depression among older transgender women is higher than 62 percent (US Transgender Survey, 2015). This is an overwhelmingly higher value, especially when compared to the depression rates in the general population, which is estimated to be approximately 16 percent. (Hoy-Ellis and Fredriksen-Goldsen, 2017). Therefore, after reviewing these heart-breaking statistical figures, one is fundamentally set to ask themselves why older transgender women experience the high rates of depression in their lifetime.
Factors that Lead to Depression in Older Transgender Women
According to Chumakov et al. (2021), a research study conducted in Russia, there are numerous interpersonal and intrapersonal; variables that are thought to affect depression in older transgender women. Firstly, stigma is the primary factor leading to depression among older transgender women. Stigmatization is associated with depression among almost all minority groups in any social or demographic setting. However, the study by Bazargan and Galvan (2012) directly links stigma to the higher levels of depression among the transgender women population. On the other hand, Hoy Ellis and Fredriksen-Goldsen (2017) seek to establish an elaborate definition of the causes of depression in older transgender based on the different “stressors,” as the study generally refers to these aspects. Even in the perspective of stressors, stigma opens the list as one of the major causes of depression among older transgender women. Similarly, another study on depression among the transgender population in India also points out stigma stressors as one of the significant causes of depression in this population (Chakrapani et al., 2017).
The stigma and other forms of discrimination are usually associated with numerous adverse health outcomes in older transgender women; according to (Chakrapani et al. (2017), the overall poor mental health in the transgender women population is linked to social stigmas. Similarly, Yousof et al. (2021) associate the higher rates of stigma to the prevalence of sexually transmitted infections, including HIV & AIDS, as well as drug and substance abuse among this same population. The psychological torture associated with societal stigma and discrimination (including from family and friends) adversely affects these individuals’ mental health, leading to chronic mental illnesses such as anxiety and depression (Kota et al., 2020). Stigma accounts for the majority of the cases of depression among older transgender women (Hoy Ellis and Fredriksen-Goldsen, 2017).
The prevalent cause of mental health inequalities (including depression) among minority populations globally is stigma, its constituent components, and consequences. The minority stress model explains how external and internal minority stress processes (such as stigma) interact with other minority statuses (such as gender) to influence mental health outcomes in sexual and gender minorities (Kota et al., 2020). While external minority stressors (such as discrimination and persecution) can affect anyone who is “considered” to be a member of a minority group, only individuals who self-identify as a member of that group are exposed to internal minority stress (Hoy Ellis and Fredriksen-Goldsen, 2017). Long-term concealment of minority identity, including gender identity, and internalization of stigma attached to given minority status, including transgender, are the most internal minority stressors (Chakrapani et al., 2017).
Violence toward the transgender population is prevalent worldwide. While stigma could be classified as a form of violence, it needs to be discussed separately as stigma and discrimination are significant issues when discussing any minority group. Therefore, while it may be classified as verbal harassment and violence against these groups, it is a major issue that needs more attention. According to Bazargan and Galvan (2012), the probability of a transgender woman experiencing violence is approximately three times more compared to that of the rest of the people. The mental torture that results from these forms of violence is enormous. Firstly, violence against transgender women damages the sense of self-worth and being of these women, therefore ultimately lowering their self-awareness self-confidence and thus increasing their vulnerability to chronic mental conditions such as depression and anxiety (Chumakov et al., 2021). A study conducted by Nuttbroak et al. (2014) found a very elaborate association between physical and verbal abuse with increased rates of depression among transgender women in the United States.
Therefore, another major factor leading to depression among older transgender women is physical and verbal abuse. According to Nuttbrock et al. (2017), physical violence against low-income transgender women increases suicidal attempts and ideation. Similarly, the study indicates that the relationship between the transgender women and the perpetrator of the physical and verbal violence highly determines the impact of the action on the victim’s mental health. While any form of physical and verbal abuse from any person is associated with increased risks of depression among transgender women, that from family, peers and spouses have a relatively higher negative impact than that from strangers and colleagues (Nuttbrock et al. 2014). Sexual violence also has a similar trend as physical and verbal abuse, with the perpetrator of the act influencing the extent of the action’s negative effect on the victim’s mental health (Hoy Ellis and Fredriksen-Goldsen, 2017).
Additionally, social support is critical in determining a person’s mental well-being. It encompasses family and peers support (Nuttbroak et al., 2014). Family support is often key to the mental stability and well-being of people. Similarly, peer support or support from friends and colleagues is usually crucial in mental health. While lack of social support is a factor that causes chronic mental illnesses such as depression in the transgender population of all ages, older transgender women are highly susceptible to depression due to the lack of family and peer support (Tantirattanakulchai and Hounnaklang, 2022). Often, transgender women experience deprivation of mental family and peer support from a young age when they open up to family and friends. However, as they age, they encounter many other circumstances that need social support, especially family support. Since family rarely accepts them even as they age, the flashbacks of their “family moments” often haunt and torment them. The rejection by family and peers makes most older transgender women vulnerable to depression since with increased age comes increased need and desire for family and family support (Chumakov et al., 2021). Most transgender women also open up later in life during old ages, thus increasing their vulnerability to depression from family and peer rejection pressures (Hoy Ellis and Fredriksen-Goldsen, 2017).
Nevertheless, there is an identity crisis regarding gender identity among older transgender women in society (Nuttbrock et al., 2014). Having a solid gender identity is an essential aspect of mental health. Therefore, the “trans” gender identities that often last for several years are often detrimental to the mental health of older women. Chomakov et al. (2021) elucidate that the crossing or transition of gender often takes place over a considerable period that usually lasts into the “older” segment of the subjects’ lives. The transitioning process is also affected by social and economic aspects, which often suffer conflict along the way, thus altering the presentation of the desired identity. As per Hoy Ellis and Fredriksen-Goldsen (2017), the fear associated with this span of identity crisis during the transition is associated with increased risks of anxiety, depression, and other chronic mental conditions among transgender populations, especially adult transgender women.
Significant Factors that Helps in Mitigating Depression among Older Transgender Women
Since studying the problem and the major causes is never the ultimate objective of the research, Yousuf et al. (2021) sought to provide insight into how the prevailing depression rates in older transgender women can be mitigated and prevented. While there are several factors such as the provision of social support education among others that can serve as interventions in the situation at hand, the issue of acceptance remains core in ensuring reduced risks of depression and depression rates among transgender women, including those suffering from sexually transmitted infections such as HIV and AIDS (Yousuf et al., 2021).
Both self-acceptance and acceptance by society are associated with decreased levels of depression among transgender women. Just as with all other minorities, self-awareness and acceptance is core in leading every day and happy lives. Self-acceptance originates from education, awareness, and approval by the community. As elucidated by Yousuf et al. (2021), one must realize where one feels that their body is perfectly matched with their new gender and are proud of this state to set a ground for mitigating risks of depression. In order to achieve this, societal acceptance is often necessary. A transgender surrounded by highly supportive and loving individuals has a remarkably increased self-acceptance and reduced depression, among other chronic mental conditions (Yousuf et al., 2021).
To conclude, the eight scholarly sources reviewed by this paper elucidate a relatively higher rate of depression among older transgender women than any other group of minorities and the general population. The primary cause of this situation is the high rates of stigma, discrimination, and the lack of social support from family and friends, especially during the challenging and complex transitioning process (Kota et al., 2020). Therefore, self-acceptance needs to be enhanced, primarily through societal acceptance and social support, to ensure reduced rates of depression among the population in context.
Existing Information Gap
Though numerous research studies have been conducted regarding the topic at hand, it is evident that there is still a significant piece of information that has not been provided by almost all the studies currently published. Future studies need to focus on the clinical depression experienced during the complex transition process. The process of gender transitioning is very complex and challenging, especially when the subject is an older woman. Therefore, understanding the rate of clinical depression during this process is imperative in ensuring that appropriate intimations are put in place to reduce this depression rate and increase the efficiency and success of clinical transitioning processes among older transgender women.
Bazargan, M., & Galvan, F. (2012). Perceived discrimination and depression among low-income Latina male-to-female transgender women. BMC public health, 12(1), 1-8.
Chakrapani, V., Vijin, P. P., Logie, C. H., Newman, P. A., Shunmugam, M., Sivasubramanian, M., & Samuel, M. (2017). Understanding how sexual and gender minority stigmas influence depression among older transgender women and men who have sex with men in India. LGBT health, 4(3), 217-226.
Chumakov, E. M., Ashenbrenner, Y. V., Petrova, N. N., Zastrozhin, M. S., Azarova, L. A., & Limankin, O. V. (2021). Anxiety and Depression among Transgender People: Findings from a Cross-Sectional Online Survey in Russia. LGBT health, 8(6), 412–419. https://doi.org/10.1089/lgbt.2020.0464
Hoy-Ellis, C. P., & Fredriksen-Goldsen, K. I. (2017). Depression among Transgender Older Adults: General and Minority Stress. American journal of community psychology, 59(3-4), 295–305. https://doi.org/10.1002/ajcp.12138
Kota, K. K., Salazar, L. F., Culbreth, R. E., Crosby, R. A., & Jones, J. (2020). Psychosocial mediators of perceived stigma and suicidal ideation among transgender women. BMC public health, 20(1), 1-10.
Nuttbrock, L., Bockting, W., Rosenblum, A., Hwahng, S., Mason, M., Macri, M., & Becker, J. (2014). Gender abuse and major depression among transgender women: a prospective study of vulnerability and resilience. American journal of public health, 104(11), 2191-2198.
Tantirattanakulchai, P., & Hounnaklang, N. (2022). Associations between clusters of perceived social support level, depression, and suicidal ideation among transgender women: a latent class analysis. Journal of public health research.
Yousuf, T., Naz, M., Roberson, C. B., Wise, S. M., & Rowland, D. L. (2021). Depression as a Function of Social Support in Transgender and Cisgender Individuals with Sexually Transmitted Diseases. International Journal of Environmental Research and Public Health, 18(5), 2462.