title: Sex Partnership and Self-Efficacy Influence Depression in Chinese Transgender Women: A Cross-Sectional Study.
abstract: BACKGROUND
  Transgender women often suffer from transition-related discrimination and loss of social support due to their gender transition, which may pose considerable psychological challenges and may lead to a high prevalence of depression in this population. Increased self-efficacy may combat the adverse effects of gender transition on depression. However, few available studies have investigated the protective effect of self-efficacy on depression among transgender women, and there is a scarcity of research describing the mental health of Chinese transgender women. This study aims to describe the prevalence of depression among Chinese transgender women and to explore the associated factors.
  
  
  METHODS
  A cross-sectional study was conducted in Shenyang, Liaoning Province of China by convenience sampling from January 2014 to July 2014. Two hundred and nine Chinese transgender women were interviewed face-to-face with questionnaires that covered topics including the Zung Self-Rating Depression Scale (SDS), demographic characteristics, transition status, sex partnership, perceived transgender-related discrimination, the Multidimensional Scale of Perceived Social Support (MSPSS) and the adapted General Self-efficacy Scale (GSES). A hierarchical multiple regression analysis was performed to explore the factors associated with SDS scores.
  
  
  RESULTS
  The prevalence of depression among transgender women was 45.35%. Transgender women with regular partners or casual partners exhibited higher SDS scores than those without regular partners or casual partners. Regression analyses showed that sex partnership explained most (16.6%) of the total variance in depression scores. Self-efficacy was negatively associated with depression.
  
  
  CONCLUSIONS
  Chinese transgender women experienced high levels of depression. Depression was best predicted by whether transgender women had a regular partner or a casual partner rather than transgender-related discrimination and transition status. Moreover, self-efficacy had positive effects on attenuating depression due to gender transition. Therefore, interventions should focus on improving the sense of self-efficacy among these women to enable them to cope with depression and to determine risky sex partnership characteristics, especially for regular and casual partners.
authors.affiliation: Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
authors.forename: Xiaoshi
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
authors.forename: Lie
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, China; Takemi Program in International Health, Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Chun
authors.initials: C
authors.lastname: Hao
authors.affiliation: Department of AIDS and STD Control, Shenyang Centers for Disease Control and Prevention, Shenyang, Liaoning Province, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Department of AIDS and STD Control, Shenyang Centers for Disease Control and Prevention, Shenyang, Liaoning Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Song
authors.affiliation: Department of Clinical Laboratory, Liaoning Province Hospital of Chinese Armed Police Force, Shenyang, Liaoning Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Clinical Medicine, China Medical University, Shenyang, Liaoning Province, China.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Chang
authors.affiliation: Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Zhao
mesh_terms: D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D020377:Self Efficacy; D012725:Sexual Behavior; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male