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 Table of Contents  
BRIEF RESEARCH ARTICLE
Year : 2017  |  Volume : 1  |  Issue : 2  |  Page : 114-117

Psychiatric morbidity in a selective sample of transgenders in Imphal, Manipur: Adescriptive study


Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication8-Dec-2017

Correspondence Address:
Y R Niranjan Hebbar
Department of Psychiatry, Rims, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_24_17

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  Abstract 


Aim: Psychiatric morbidities seem to be one of the biggest hurdles in the stigmatized people of transgender. Lack of knowledge and ignorance with ever-growing abuse over this population make them vulnerable for mental instability. This study is an attempt to identify and access the psychiatric morbidities of gender dysphoric people of Imphal, Manipur. Materials and Methods: Using DSM-5 all qualified, consenting gender dysphoric people were assessed for psychiatric morbidities using Mini-International Neuropsychiatry Interview-Plus scale at Imphal, Manipur, and the results were compared using Chi-square test. Results: Substance use disorders were found in the majority of them. Twenty(62.5%) of them had current alcohol abuse, and 10(31.2%) of them were dependent of alcohol. Fifteen(46.8%) of them were abusing other nonalcoholic psychotropic drugs. Twelve(37.5%) were suffering from generalized anxiety disorder(GAD) followed by 10(31.2%) with current depressive disorder. Past suicidal attempts were found among 10(31.2%) of them with 14(41.2%) out of them for having current suicidal risk. Six(18.7%) of them were having dysthymia, 2(6.2%) had panic disorder, 3(9.4%) had agoraphobia and posttraumatic stress disorder, respectively, 8(25%) suffered from social phobia, and 1(3.2%) from specific phobia for spiders. Conclusions: This study found high prevalence of comorbid psychiatric disorders of which alcohol use disorder was the prominent one. Other psychiatric disorders such as GAD, depression, and suicidal risk were also found to be higher among these people. As this population is at higher risk of developing other psychiatric problems, regular screening and timely intervention is needed to prevent or treat psychiatric comorbidities.

Keywords: Depression, DSM-5, gender dysphoria, generalized anxiety disorder, substance use disorder, suicidal risk


How to cite this article:
Hebbar Y R, Singh B. Psychiatric morbidity in a selective sample of transgenders in Imphal, Manipur: Adescriptive study. Ann Indian Psychiatry 2017;1:114-7

How to cite this URL:
Hebbar Y R, Singh B. Psychiatric morbidity in a selective sample of transgenders in Imphal, Manipur: Adescriptive study. Ann Indian Psychiatry [serial online] 2017 [cited 2019 Sep 17];1:114-7. Available from: http://www.anip.co.in/text.asp?2017/1/2/114/220245




  Introduction Top


Being a transgender is a rare condition where there is a constant discrepancy between the biologically assigned sex and the identity of gender which is associated with significant impairment in social, occupational, interpersonal, and the other areas of functioning. Transgender is been included under the spectrum of gender dysphoria in DSM-5 and under gender identity disorder(GID) according to ICD-10. DSM 5 prevalence of gender dysphoria in adults from the United States was 1 in 30,000 in men and 1 in 100,000 in women.[1] 2011 census in India accounted for around 4.9 lakhs of transgender in India.[2] Although exact prevalence of this population is unavailable, trends across different studies suggest that gender dysphoria is more common in natal males than natal females with a prevalence ratio of 3:1.[3],[4] The worldwide lifetime prevalence is estimated to be 0.001–0.002.[5]

Controversies raged post Supreme Court judgment in 2013 which rejected the earlier Delhi High Court judgment on Article 377. However, a recent landmark judgment by Supreme Court of India on April 15, 2014 has identified transgender people as the third gender and has ordered the government to provide transgenders with quotas in jobs and education in line with other minorities, as well as key amenities.

Though Indian data is sparse, review of literature regarding persons with gender dysphoria shows higher rates of psychological problems and psychiatric disorders, such as negative self-image, low self-esteem, adjustment disorders, depression, suicidality, and personality disorders compared to normal controls.[6],[7],[8],[9]

”Stress minority model” suggests that the stress associated with stigma, preoccupied negative image of self, and discrimination will have direct impact on the psychological well-being of the transgender population.[10],[11]

This is one such study focused on determining the existing psychiatric problems in these sexual minority people of Imphal, Manipur.


  Materials and Methods Top


It was a cross-sectional, single interview study conducted after Institutional Ethical Committee approval. Thirty-two cases who fulfilled the criteria of gender dysphoria according to DSM-5 were included for the study. All consenting transgenders aged above 18years were interviewed at their workplaces/locality with the help of a NGO organization (All Manipuri Nupi Manbi Association) which works for the wellfare of transgender people of Manipur. Nonprobability convenience sampling was used for the selection of the transgenders during the study period. Those having significant neurological diseases or any comorbid medical illness were excluded along with nonwilling cases.

After written informed consent, each transgender was interviewed individually. Semi-structured pro forma was used for assessing sociodemographic profile and Mini-International Neuropsychiatry Interview(MINI)-PLUS scale for assessing psychiatric morbidities.

MINI-PLUS is a brief structured interview for assessing major axis one psychiatric disorders, which has a acceptably high validation and reliability scores and can be administered in a much shorter period of time(mean 18.7±11.6min, median 15min) was used.

The data collected was checked, entered, and processed using Statistical package for Windows, version 16.0. Chicago, SPSS Inc. Chi-square test and Fisher's exact were used to find significance. P < 0.05 was considered significant for this study.


  Results Top


The study included 20male to female transgender(MTF) and 12female to male transgender(FTM) with a mean duration of 27.13years and standard deviation of 5.8years. Maximum of 20(62.5%) were hailing from urban settings. Nineteen(59.3%) of them did not complete their secondary schooling. Although 20 (62.5%) of them were employed. Family support and acceptance were seen only in 5 (15.6%) of them. Only 2(10%) were staying in joint family and the rest were from nuclear family. Four(12.5%) of them had history of sexual abuse in their childhood[Table1].
Table 1: Sociodemographic characteristics of the study sample

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Substance abuse was on the top among psychiatric morbidities. Twenty(62.5%) of them had current alcohol abuse and 10(31.2%) of them were dependent of alcohol. Fifteen(46.8%) of them were abusing other nonalcoholic psychotropic drugs. Twelve(37.5%) were suffering from generalized anxiety disorder(GAD) followed by 10(31.2%) with current depressive disorder. Past suicidal attempts were found among 10 (31.2%) of them and 14 (41.2%) out of them have current suicidal risk. 6 (18.7%) of them had dysthymia, 2 (6.2%) had panic disorder. In our study, the prevalence of agoraphobia and social phobia were 9.4% and 25% receptively. 1(3.2%) of them also suffered from specific phobia for spiders. 3(9.4%) of them were found to be suffering from post traumatic stress disorder(PTSD). Although most of them were found in MTF transgender than in FTM, no statistical significance was found[Table2].
Table 2: Psychiatric morbidities assessed using mini-international neuropsychiatry interview plus

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  Discussion Top


George et al.[12] in 2015 studied quality of life of transgender older adults at Bangalore, Karnataka and reported only 38.3% of people completed their primary school of education and 75% of them used to beg for their living and 90% of them used to live separately away from their home. Our study found 59.3% of the cases completed their primary schooling and 62.5% of them were self-employed, mostly in saloons and beauty parlors and none used to beg for their living and only 37.5% in our study used to live with their parents. Significant differences in the sociodemographic profile may be due to cultural and social differences across the states[Table1].

Kussin-Shoptaw et al.[13] reported around 84.9% of transgender women experienced physical or sexual abuse at some point in their lifetime. In our study, sexual abuse was only found in 12.5% of them. Lower familial coherence and adaptability were found by Kim et al.[14] in 2006. In our study, we found good family support and acceptance in only 15.6% of the total[Table1].

Reisner et al.[15] found lifetime and current major depressive episode of 35.4% and 14.7%, respectively, among their study group. Similar to this, our study found past episode of depression of 34.4% and current depression of 31.2%[Table2].

Suicidality, GAD and PTSD were reported among 20.2%, 7.9%, and 9.8% by Reisner et al.[15] in their study group. Our study found 43% of the study population to have current suicidal risks and 31.2% past suicidal attempts. GAD and PTSD were found in 37.5% and 9.4% in our study[Table2]. Higher prevalence of these disorders can also be explained as the overall prevalence of mental health disorders in Manipur(14.4%) itself is high, as evidenced by recent national mental health survey 2015–2016.[16]

Alcohol dependence of 11.2% and nonalcohol psychoactive substance use dependence of 15.2% were found by Reisner et al.[15] in their study group. Whereas we found 31.2% of alcohol dependence and 46.8% of nonalcoholic psychoactive substance among our group[Table2]. Higher prevalence of substance use disorder may be explained due to its geographical location, as Manipur is a part of “Golden Triangle” which is known for illicit drug trafficking.


  Conclusions Top


This study found high prevalence of comorbid psychiatric disorders of which alcohol use disorder was the prominent one. Other psychiatric disorders such as GAD, depression, and suicide risk were also higher. As this population is at higher risk of developing other psychiatric problems, regular screening and timely intervention are needed to prevent or treat psychiatric comorbidities.

Limitations

Suicidality was assessed using the MINI-Plus interview, which was also used to measure Axis I disorders; therefore, we could not investigate whether there was an association between suicide risk and having an Axis I disorder. Smaller sample size and selection bias from NGO. Hence, results cannot be generalized.

Acknowledgment

We would like to thank SAATI foundation for continuous support and help.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5thed. Washington, DC: American Psychiatric Association; 2013.  Back to cited text no. 1
    
2.
Census of India 2011. Available from: http://www.imaginmor.com/census-of-india-2011.html.[Last accessed on 2017May12].  Back to cited text no. 2
    
3.
LandenM, WalinderJ, LundstromB. Prevalence, incidence and sex ratio of transsexualism. Acta Psychiatr Scand 1996;93:221-3.  Back to cited text no. 3
    
4.
ZuckerK, LawrenceA. Epidemiology of gender identity disorder: Recommendations for the standards of care of the world professional association of transgender health. Int J Transgend 2009;11:8-18.  Back to cited text no. 4
    
5.
RobertoLG. Issues in diagnosis and treatment of transsexualism. Arch Sex Behav 1983;12:445-73.  Back to cited text no. 5
    
6.
OkabeN, SatoT, MatsumotoY, IdoY, TeradaS, KurodaS, etal. Clinical characteristics of patients with gender identity disorder at a Japanese gender identity disorder clinic. Psychiatry Res 2008;157:315-8.  Back to cited text no. 6
    
7.
HoshiaiM, MatsumotoY, SatoT, OhnishiM, OkabeN, KishimotoY, etal. Psychiatric comorbidity among patients with gender identity disorder. Psychiatry Clin Neurosci 2010;64:514-9.  Back to cited text no. 7
    
8.
WallienMS, SwaabH, Cohen-KettenisPT. Psychiatric comorbidity among children with gender identity disorder. JAm Acad Child Adolesc Psychiatry 2007;46:1307-14.  Back to cited text no. 8
    
9.
ColeCM, O'BoyleM, EmoryLE, Meyer WJ 3rd. Comorbidity of gender dysphoria and other major psychiatric diagnoses. Arch Sex Behav 1997;26:13-26.  Back to cited text no. 9
    
10.
MeyerIH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull 2003;129:674-97.  Back to cited text no. 10
    
11.
MeyerIH. Minority stress and mental health in gay men. JHealth Soc Behav 1995;36:38-56.  Back to cited text no. 11
    
12.
GeorgeA, JanardhanaN, Muralidhar D. Quality of life of transgender older adults. Int J Humanit Soc Sci Invent 2015;4:7-11.  Back to cited text no. 12
    
13.
Kussin-ShoptawAL, FletcherJB, RebackCJ. Physical and/or sexual abuse is associated with increased psychological and emotional distress among transgender women. LGBT Health 2017;4:268-74.  Back to cited text no. 13
    
14.
KimTS, CheonYH, PaeCU, KimJJ, LeeCU, LeeSJ, etal. Psychological burdens are associated with young male transsexuals in Korea. Psychiatry Clin Neurosci 2006;60:417-21.  Back to cited text no. 14
    
15.
ReisnerSL, BielloKB, HughtoJW, KuhnsL, MayerKH, GarofaloR, etal. Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: Baseline findings from project life skills. JAMA Pediatr 2016;170:481-6.  Back to cited text no. 15
    
16.
MurthyRS. National mental health survey of India 2015-2016. Indian J Psychiatry 2017;59:21-6.  Back to cited text no. 16
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