Mental health problems and social functioning across different treatment stages in Chinese subjects with gender dysphoria in Hong Kong

Abstract

Background: This study assesses the prevalence of psychiatric comorbidities, functioning, and adjustment difficulties of patients undergoing different gender-affirming treatment stages at the centralized Gender Identity Disorder (GID) clinic in Hong Kong. Method: This cross-sectional study consecutively recruited patients with gender dysphoria according to the DSM-5 criteria in the GID clinic from Oct 2017 to Aug 2018. They were assessed with the Structured Clinical Interview for DSM Axis I disorders (SCID-I) and the Structured Clinical Interview for DSM Axis II personality disorders (SCID-II). Depressive and anxiety symptoms, self-esteem, quality of life and social functioning were measured. Results: Eighty-nine subjects were recruited. The current and lifetime prevalence of DSM-IV Axis I disorders were 12.4% and 46.1% respectively. Prevalence of personality disorder was 36%. Among the current and lifetime Axis I disorders, depressive disorders were the most common (10.1%, 39.3%). Avoidant personality disorder was the most common Axis II disorder (16.9%). In regression analyses, subjects who received gender-affirming surgery and gender-affirming hormone therapy were associated with better overall (p = 0.034) and psychological domain (p < 0.001) of quality of life and self-esteem (p = 0.033). Gender-affirming hormone therapy alone was associated with better psychological domain (p = 0.001) of quality of life and lower levels of depressive symptoms (p = 0.049). Higher perceived social support was associated with lower levels of depressive symptoms (p < 0.001), better overall (p < 0.001) and psychological domain (p<0.001) of quality of life, and self-esteem (p < 0.001). Conclusions: Lifetime comorbidity is common in Hong Kong GID Clinic patients with gender dysphoria. Gender-affirming treatments and social support are linked to a better quality of life and self-esteem. Hormone therapy and social support are associated with lower levels of depressive symptoms. Our finding preliminarily suggested better mental health and adjustment in patients with favorable social support who received gender-affirming treatments.