Uniwersyteckie Czasopisma NaukoweGender dysphoria and psychological distress among transgender individuals: the moderating role of resilience
Słowa kluczowe:
gender dysphoria, psychological distress, resilience, moderator, transgender individualsAbstrakt
Background:
Despite a growing body of research on transgender mental health, the role of resilience in shaping psychological outcomes associated with gender dysphoria remains underexplored. This study sought to examine the prevalence of gender dysphoria and levels of psychological distress among Vietnamese transgender individuals, and investigate the associations between these variables, with particular attention to the potential moderating role of resilience.
Participants and procedure:
A sample of 347 Vietnamese transgender individuals aged 16 to 44 (Mage = 23.87, SDage = 5.1; 53.0% assigned female at birth) completed an anonymous online questionnaire. Gender dysphoria, psychological distress, and resilience were assessed using the Utrecht Gender Dysphoria Scale – Gender Spectrum (UGDS-GS), the Kessler Psychological Distress Scale (K10), and the Connor-Davidson Resilience Scale (CD-RISC-10), respectively.
Results:
The mean scores for gender dysphoria and psychological distress were 64.96 and 25.50, respectively. Lower gender dyspho-ria was reported among younger, nonbinary, bisexual individuals and participants with no intention for gender-affirming interventions, lower income, non-disclosure, or no involvement in transgender support groups. Higher psychological distress was found in those who planned to undergo gender-affirming interventions and who had not come out. Gender dysphoria was positively correlated with psychological distress, but this relationship was attenuated among individuals with higher resilience.
Conclusions:
These findings underscore significant mental health challenges among transgender individuals in Vietnam. The moderating role of resilience suggests that enhancing resilience may buffer the negative impact of gender dysphoria on psychological well-being. Interventions promoting resilience might therefore represent a valuable approach to supporting transgender mental health.
Downloads
Bibliografia
Abreu, R. L., Sostre, J. P., Gonzalez, K. A., Lockett, G. M., Matsuno, E., & Mosley, D. V. (2022). Impact of gender-affirming care bans on transgender and gender diverse youth: Parental figures’ perspective. Journal of Family Psychology, 36, 643–652. https://doi.org/10.1037/fam0000987
Aitken, M., Steensma, T. D., Blanchard, R., Vander-Laan, D. P., Wood, H., Fuentes, A., Spegg, C., Wasserman, L., Ames, M., Fitzsimmons, C. L., Leef, J. H., Lishak, V., Reim, E., Takagi, A., Vinik, J., Wreford, J., Cohen-Kettenis, P. T., De Vries, A. L. C., Kreukels, B. P. C., & Zucker, K. J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. Journal of Sexual Medicine, 12, 756–763. https://doi.org/10.1111/jsm.12817
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). APA Publishing.
Arvind, A., Pandya, A., Amin, L., Aggarwal, M., Agrawal, D., Tiwari, K., Singh, S., Nemkul, M., & Agarwal, P. (2021). Social strain, distress, and gender dysphoria among transgender women and Hijra in Vadodara, India. International Journal of Transgender Health, 23, 149–163. https://doi.org/10.1080/26895269.2020.1845273
Austin, A., Holzworth, J., & Papciak, R. (2022). Beyond diagnosis: “Gender dysphoria feels like a living hell, a nightmare one cannot ever wake up from”. Psychology of Sexual Orientation and Gender Diversity, 9, 12–20. https://doi.org/10.1037/sgd0000460
Başar, K., & Öz, G. (2016). Resilience in individuals with gender dysphoria: Association with perceived social support and discrimination. Turkish Journal of Psychiatry, 27, 225–234. https://doi.org/10.5080/u17071
Bechard, M., VanderLaan, D. P., Wood, H., Wasserman, L., & Zucker, K. J. (2017). Psychosocial and psychological vulnerability in adolescents with gender dysphoria: a “proof of principle” study. Journal of Sex & Marital Therapy, 43, 678–688. https://doi.org/10.1080/0092623X.2016.1232325
Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the us transgender population. American Journal of Public Health, 103, 943–951. https://doi.org/10.2105/AJPH.2013.301241
Bouman, W. P., Bauer, G. R., Richards, C., & Coleman, E. (2010). World Professional Association for Transgender Health consensus statement on considerations of the role of distress (Criterion D) in the DSM diagnosis of gender identity disorder. International Journal of Transgenderism, 12, 100–106. https://doi.org/10.1080/15532739.2010.513927
Brokjøb, L. G., & Cornelissen, K. K. (2022). Internalizing minority stress: Gender dysphoria, minority stress, and psychopathology in a Norwegian transgender population. Psychology of Sexual Orientation and Gender Diversity, 9, 272–286. https://doi.org/10.1037/sgd0000480
Buchhave, H., Rana, T. R., & Rodriguez, L. A. (2023). Gender inclusive legislation in Vietnam: How to design a Gender Equality Law inclusive of sexual and gender minorities. The World Bank.
Byne, W., Karasic, D. H., Coleman, E., Eyler, A. E., Kidd, J. D., Meyer-Bahlburg, H. F. L., Pleak, R. R., & Pula, J. (2018). Gender dysphoria in adults: an overview and primer for psychiatrists. Transgender Health, 3, 57–70. https://doi.org/10.1089/trgh.2017.0053
Campbell-Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20, 1019–1028. https://doi.org/10.1002/jts.20271
Cao, H., Zhou, N., Qiao, J., Wang, L. X., Liang, Y., Li, Y., Wu, S., Jiang, Z., & He, J. (2024). Gender minority stressors and psychological distress among Chinese transgender and gender diverse people: Variable-centered, person-centered, and psychological network approaches. Archives of Sexual Behavior, 53, 3945–3972. https://doi.org/10.1007/s10508-024-03003-3
Catelan, R. F., Saadeh, A., Lobato, M. I. R., Gagliotti, D. A. M., Nardi, H. C., & Costa, A. B. (2022). Depression, self-esteem, and resilience and its relationship with psychological features of sexuality among transgender men and women from Brazil. Archives of Sexual Behavior, 51, 1993–2002. https://doi.org/10.1007/s10508-021-02189-0
Chen, R., Feng, Y., Su, D., Wilson, A., Han, M., & Wang, Y. (2023). Utrecht Gender Dysphoria Scale-Gender Spectrum in a Chinese population: Scale validation and associations with mental health, self-harm and suicidality. BJPsych Open, 9, e17. https://doi.org/10.1192/bjo.2022.617
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Erlbaum.
Cooper, K., Russell, A., Mandy, W., & Butler, C. (2020). The phenomenology of gender dysphoria in adults: a systematic review and meta-synthesis. Clinical Psychology Review, 80, 101875. https://doi.org/10.1016/j.cpr.2020.101875
Cortes, R. (2017). Stigma and discrimination experiences in health care settings more evident among transgender people than males having sex with males (MSM) in Indonesia, Malaysia, the Philippines and Timor Leste: Key results. Sexually Transmitted Infections, 93, A202. https://doi.org/10.1136/sextrans-2017-053264.525
Davey, A., Bouman, W. P., Arcelus, J., & Meyer, C. (2014). Social support and psychological well-being in gender dysphoria: a comparison of patients with matched controls. Journal of Sexual Medicine, 11, 2976–2985. https://doi.org/10.1111/jsm.12681
Do, T. T., & Nguyen, A. T. V. (2020). ‘They know better than we doctors do’: Providers’ preparedness for transgender healthcare in Vietnam. Health Sociology Review, 29, 92–107. https://doi.org/10.1080/14461242.2020.1715814
Do, T. T., Nguyen, T. V. A., Vu, X. T., & Nguyen, T. P. T. (2018). Seeking healthcare as a transgender woman in contemporary Vietnam: Access barriers and the situation of hormone use. Regional Journal Southeast Asian Studies, 3, 30–58. https://doi.org/10.13140/RG.2.2.25027.45605/1
Drabish, K., & Theeke, L. A. (2022). Health impact of stigma, discrimination, prejudice, and bias experienced by transgender people: a systematic review of quantitative studies. Issues in Mental Health Nursing, 43, 111–118. https://doi.org/10.1080/01612840.2021.1961330
European Union Agency for Fundamental Rights (2014). Being trans in the European Union: Comparative analysis of EU LGBT survey data. Retrieved from https://data.europa.eu/doi/10.2811/92683
Falak, S., Safdar, F., & Nuzhat-ul-Ain (2020). Perceived discrimination, social support, and psychological distress in transgender individuals. PsyCh Journal, 9, 682–690. https://doi.org/10.1002/pchj.373
Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
Fontanari, A. M. V., Vilanova, F., Schneider, M. A., Chinazzo, I., Soll, B. M., Schwarz, K., Lobato, M. I. R., & Brandelli Costa, A. (2020). Gender affirmation is associated with transgender and gender nonbinary youth mental health improvement. LGBT Health, 7, 237–247. https://doi.org/10.1089/lgbt.2019.0046
Foster Skewis, L., Bretherton, I., Leemaqz, S. Y., Zajac, J. D., & Cheung, A. S. (2021). Short-term effects of gender-affirming hormone therapy on dysphoria and quality of life in transgender individuals: a prospective controlled study. Frontiers in Endocrinology, 12, 717766. https://doi.org/10.3389/fendo.2021.717766
Fuller, K. A., & Riggs, D. W. (2018). Family support and discrimination and their relationship to psychological distress and resilience amongst transgender people. International Journal of Transgenderism, 19, 379–388. https://doi.org/10.1080/15532739.2018.1500966
Galupo, M. P., Pulice-Farrow, L., & Lindley, L. (2020). “Every time I get gendered male, I feel a pain in my chest”: Understanding the social context for gender dysphoria. Stigma and Health, 5, 199–208. https://doi.org/10.1037/sah0000189
Galupo, M. P., Pulice-Farrow, L., & Pehl, E. (2021). “There is nothing to do about it”: Nonbinary individuals’ experience of gender dysphoria. Transgender Health, 6, 101–110. https://doi.org/10.1089/trgh.2020.0041
General Statistics Office of Vietnam (2023). Report on the socio-economic situation of Vietnam in the third quarter and September 2023. Retrieved from https://www.nso.gov.vn/en/data-and-statistics/2023/10/socio-economic-situation-in-the-third-quarterand-nine-months-of-2023/
Grosse, I. (2015). Gender values in Vietnam – between Confucianism, communism, and modernization. Asian Journal of Peacebuilding, 3, 253–272. https://doi.org/10.18588/201511.000045
Ha, C. T. (2019). Bức bối giới - xuất hiện, tồn tại và lưu dấu trong đời sống người chuyển giới [Research report: Gender dysphoria appears, exists and leaves its mark in the lives of transgender people]. Institute for Social, Economic and Environmental Studies. Retrieved from https://www.isee.org.vn/thu-vien/c8zk30ydi7y5ngxc99maqtpg3817r6-lt9f4?rq=b%E1%BB%A9c%20b%E1%BB%91i%20gi%E1%BB%9Bi
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach (2nd ed.). Guilford Press.
Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43, 460–467. https://doi.org/10.1037/a0029597
Hilton, M. N., Boulton, K. A., Kozlowska, K., Mc-Clure, G., & Guastella, A. J. (2022). The co-occurrence of neurodevelopmental disorders in gender dysphoria: Characteristics within a paediatric treatment-seeking cohort and factors that predict distress pertaining to gender. Journal of Psychiatric Research, 149, 281–286. https://doi.org/10.1016/j.jpsychires.2022.02.018
Hoang, A. N., Nguyen, X. H., & Bui, H. (2024). Vietnamese transgender persons in autobiography: an analysis and notes on a transgender woman’s discourse and politics.a/b: Auto/Biography Studies, 39, 287–310. https://doi.org/10.1080/08989575.2023.2286823
Huit, T. Z., Coyne, C., & Chen, D. (2024). State of the science: Gender-affirming care for transgender and gender diverse youth. Behavior Therapy, 55, 1335–1347. https://doi.org/10.1016/j.beth.2024.02.010
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 U.S. transgender survey. National Center for Transgender Equality. Retrieved from https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
Jamneankal, T., Kiatrungrit, K., Arunakul, J., Korpaisarn, S., & Auapisithwong, S. (2023). Validity and reliability of the Thai version of the Utrecht Gender Dysphoria Scale-Gender Spectrum (UGDS-GS) in Thai youths and young adults with gender dysphoria. General Psychiatry, 36(4), e100980. https://doi.org/10.1136/gpsych-2022-100980
Jarvis, S. W., Fraser, L. K., Langton, T., Hewitt, C. E., & Doran, T. (2025). Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England: Retrospective cohort study. Archives of Disease in Childhood, 110, 612–621. https://doi.org/10.1136/archdischild-2024-327992
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S.-L. T., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60, 184–189. https://doi.org/10.1001/archpsyc.60.2.184
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, 125. https://doi.org/10.1186/s12889-020-8177-z
Li, J., Feng, Y., Yu, Y., Xu, S., & Wang, Y. (2024). Effect of gender identity on the association between gender dysphoria and suicidality via appearance anxiety among transgender and gender-diverse young people: Moderated mediation study. BJPsych Open, 10, e66. https://doi.org/10.1192/bjo.2024.18
Li, Y., & Zheng, L. (2023). Validation of two measures of gender dysphoria/incongruence in transgender and cisgender populations in China. Archives of Sexual Behavior, 52, 1019–1030. https://doi.org/10.1007/s10508-022-02517-y
Lindley, L., & Galupo, M. P. (2020). Gender dysphoria and minority stress: Support for inclusion of gender dysphoria as a proximal stressor. Psychology of Sexual Orientation and Gender Diversity, 7, 265–275. https://doi.org/10.1037/sgd0000439
Lloyd, J., Chalklin, V., & Bond, F. W. (2019). Psychological processes underlying the impact of gender-related discrimination on psychological distress in transgender and gender nonconforming people. Journal of Counseling Psychology, 66, 550–563. https://doi.org/10.1037/cou0000371
Matsuno, E., & Israel, T. (2018). Psychological interventions promoting resilience among transgender individuals: Transgender resilience intervention model (TRIM). The Counseling Psychologist, 46, 632–655. https://doi.org/10.1177/0011000018787261
McGuire, J. K., Berg, D., Catalpa, J. M., Morrow, Q. J., Fish, J. N., Nic Rider, G., Steensma, T., Cohen- Kettenis, P. T., & Spencer, K. (2020). Utrecht Gender Dysphoria Scale-Gender Spectrum (UGDS-GS): Construct validity among transgender, nonbinary, and LGBQ samples. International Journal of Transgender Health, 21, 194–208. https://doi.org/10.1080/26895269.2020.1723460
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Minh-Uyen, V. T., & Im, S. (2020). Psychometric examination of the Connor-Davidson resilience scale (CD-RISC-10) among Vietnamese students. Journal of Applied Research in Higher Education, 13, 325–341. https://doi.org/10.1108/JARHE-05-2019-0116
Mirabella, M., Giovanardi, G., Fortunato, A., Senofonte, G., Lombardo, F., Lingiardi, V., & Speranza, A. M. (2020). The body I live in. Perceptions and meanings of body dissatisfaction in young transgender adults: a qualitative study. Journal of Clinical Medicine, 9, 3733. https://doi.org/10.3390/jcm9113733
Mitchell, H. K., Keim, G., Apple, D. E., Lett, E., Zisk, A., Dowshen, N. L., & Yehya, N. (2022). Prevalence of gender dysphoria and suicidality and self-harm in a national database of paediatric inpatients in the USA: a population-based, serial cross-sectional study. The Lancet Child & Adolescent Health, 6, 876–884. https://doi.org/10.1016/S2352-4642(22)00280-2
Murawsky, S. (2023). The struggle with transnormativity: Non-binary identity work, embodiment desires, and experience with gender dysphoria. Social Science & Medicine, 327, 115953. https://doi.org/10.1016/j.socscimed.2023.115953
Nguyen, H. T. (2019). From silicone and hormone injecting to sex reassignment surgery: The precarious road to becoming female of transgender funeral performers in Ho Chi Minh City, Vietnam. Culture, Health & Sexuality, 21, 999–1011. https://doi.org/10.1080/13691058.2018.1533144
Nguyen, L. T. T., Cu, L. N. T., Hoai Nguyen, A. L., Nguyen, G. Q., & Cu, L. C. (2025). An Exploration of transgender people’s lived experiences in addressing mental health challenges in Vietnam. Clinical Social Work Journal, 53, 3–15. https://doi.org/10.1007/s10615-024-00941-2
Oosterhoff, P., & Hoang, T. A. (2018). Transgender employment and entrepreneurialism in Vietnam. Gender & Development, 26, 33–51. https://doi.org/10.1080/13552074.2018.1429102
Osborn, M. (2022). “Nobody ever correctly recognizes me”: Nonbinary presentation, visibility, and safety across contexts. In M. T. Segal & V. Demos (Eds.), Gender visibility and erasure (pp. 51–69). Emerald Publishing. https://doi.org/10.1108/S1529-212620220000033011
Oshima, Y., Matsumoto, Y., Terada, S., & Yamada, N. (2022). Prevalence of gender dysphoria by gender and age in Japan: a population-based internet survey using the Utrecht Gender Dysphoria Scale. Journal of Sexual Medicine, 19, 1185–1195. https://doi.org/10.1016/j.jsxm.2022.03.605
Pease, M., Le, T. P., & Iwamoto, D. K. (2023). Minority stress, pandemic stress, and mental health among gender diverse young adults: Gender dysphoria and emotion dysregulation as mediators. Psychology of Sexual Orientation and Gender Diversity, 10, 650–662. https://doi.org/10.1037/sgd0000574
Pham, B. (2015). Study burden, academic stress and mental health among high school students in Vietnam. PhD thesis, Queensland University of Technology.
Pham, Q. P., Vu, T. L., Do, Q. A., & Hoang, N. A., (2018). Báo cáo nghiên cứu hiện trạng trải nghiệm y tế và nhu cầu chuyển đổi giới tính của người chuyển giới Việt Nam [Current status of medical experience and gender transition needs of transgender people in Vietnam]. Institute for Social, Economic and Environmental Studies. Retrieved from https://thuvien.lgbt/documents/hien-trang-trai-nghiemy-te-va-nhu-cau-chuyen-doi-gioi-tinh-cua-nguoichuyen-gioi-o-viet-nam
Pinna, F., Paribello, P., Somaini, G., Corona, A., Ventriglio, A., Corrias, C., Frau, I., Murgia, R., El Kacemi, S., Galeazzi, G. M., Mirandola, M., Amaddeo, F., Crapanzano, A., Converti, M., Piras, P., Suprani, F., Manchia, M., Fiorillo, A., Carpiniello, B., & The Italian Working Group on LGBTQI Mental Health. (2022). Mental health in transgender individuals: a systematic review. International Review of Psychiatry, 34, 292–359. https://doi.org/10.1080/09540261.2022.2093629
Puckett, J. A., Domínguez, S., & Matsuno, E. (2024a). Measures of resilience: Do they reflect the experiences of transgender individuals? Transgender Health, 9, 1–13. https://doi.org/10.1089/trgh.2022.0015
Puckett, J. A., Kimball, D., Matsuno, E., & Galupo, M. P. (2024b). Resilience in transgender and nonbinary communities: Adapting conceptual frameworks and addressing measurement challenges. In T. Lorenz, D. Hope, & K. Holland (Eds.), Gender resilience, integration and transformation (pp. 101–120). Springer. https://doi.org/10.1007/978-3-031-61969-4_6
Rood, B. A., Maroney, M. R., Puckett, J. A., Berman, A. K., Reisner, S. L., & Pantalone, D. W. (2017). Identity concealment in transgender adults: a qualitative assessment of minority stress and gender affirmation. The American Journal of Orthopsychiatry, 87, 704–713. https://doi.org/10.1037/ort0000303
Rosenstreich, G. (2013). LGBTI people mental health and suicide. National LGBTI Health Alliance.
Scandurra, C., Amodeo, A. L., Bochicchio, V., Valerio, P., & Frost, D. M. (2017). Psychometric characteristics of the Transgender Identity Survey in an Italian sample: a measure to assess positive and negative feelings towards transgender identity. International Journal of Transgenderism, 18, 53–65. https://doi.org/10.1080/15532739.2016.1241975
Scandurra, C., Bochicchio, V., Amodeo, A. L., Esposito, C., Valerio, P., Maldonato, N. M., Bacchini, D., & Vitelli, R. (2018). Internalized transphobia, resilience, and mental health: Applying the psychological mediation framework to Italian transgender individuals. International Journal of Environmental Research and Public Health, 15, 3. https://doi.org/10.3390/ijerph15030508
Schneider, C., Cerwenka, S., Nieder, T. O., Briken, P., Cohen-Kettenis, P. T., De Cuypere, G., Haraldsen, I. R., Kreukels, B. P. C., & Richter-Appelt, H. (2016). Measuring gender dysphoria: a multicenter examination and comparison of the Utrecht Gender Dysphoria Scale and the Gender Identity/ Gender Dysphoria Questionnaire for adolescents and adults. Archives of Sexual Behavior, 45, 551–558. https://doi.org/10.1007/s10508-016-0702-x
Silva, D. C., Salati, L. R., Fontanari, A. M. V., Schwarz, K., Schneider, M. A., Soll, B. B. M., Costa, A. B., Guadagnin, F., Hirakata, V. N., & Lobato, M. I. R. (2021). Prevalence of gender dysphoria in Southern Brazil: a retrospective study. Archives of Sexual Behavior, 50, 3517–3526. https://doi.org/10.1007/s10508-021-02036-2
Singh, A. A., Meng, S. E., & Hansen, A. W. (2014). “I am my own gender”: Resilience strategies of trans youth. Journal of Counseling & Development, 92, 208–218. https://doi.org/10.1002/j.1556-6676.2014.00150.x
Slade, T., Grove, R., & Burgess, P. (2011). Kessler Psychological Distress Scale: Normative data from the 2007 Australian National Survey of Mental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry, 45, 308–316. https://doi.org/10.3109/00048674.2010.543653
Stocks, T. (2015). To what extent have the rights of transgender people been underrealized in comparison to the rights of lesbian, gay, bisexual, and queer/questioning people in the United Kingdom? International Journal of Transgenderism, 16, 1–35. https://doi.org/10.1080/15532739.2015.1007198
Su, D., Irwin, J. A., Fisher, C., Ramos, A., Kelley, M., Mendoza, D. A. R., & Coleman, J. D. (2016). Mental health disparities within the LGBT Population: a comparison between transgender and nontransgender individuals. Transgender Health, 1, 12–20. https://doi.org/10.1089/trgh.2015.0001
Sun, C. F., Xie, H., Metsutnan, V., Draeger, J. H., Lin, Y., Hankey, M. S., & Kablinger, A. S. (2023). The mean age of gender dysphoria diagnosis is decreasing. General Psychiatry, 36, e100972. https://doi.org/10.1136%2Fgpsych-2022-100972
Tankersley, A. P., Grafsky, E. L., Dike, J., & Jones, R. T. (2021). Risk and resilience factors for mental health among transgender and gender nonconforming (TGNC) youth: a systematic review. Clinical Child and Family Psychology Review, 24, 183–206. https://doi.org/10.1007/s10567-021-00344-6
Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development of the Gender Minority Stress and Resilience Measure. Psychology of Sexual Orientation and Gender Diversity, 2, 65–77. https://doi.org/10.1037/sgd0000081
Tomita, K. K., Testa, R. J., & Balsam, K. F. (2019). Gender-affirming medical interventions and mental health in transgender adults. Psychology of Sexual Orientation and Gender Diversity, 6, 182–193. https://doi.org/10.1037/sgd0000316
van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The effect of gender-affirming hormones on gender dysphoria, quality of life, and psychological functioning in transgender individuals: a systematic review. Transgender Health, 8, 6–21. https://doi.org/10.1089/trgh.2020.0094
VandenBos, G. R. (Ed.). (2015). APA dictionary of psychology (2nd ed.). American Psychological Association. https://doi.org/10.1037/14646-000
White Hughto, J. M., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine, 147, 222–231. https://doi.org/10.1016/j.socscimed.2015.11.010
Wiepjes, C. M., Nota, N. M., De Blok, C. J. M., Klaver, M., De Vries, A. L. C., Wensing-Kruger, S. A., De Jongh, R. T., Bouman, M.-B., Steensma, T. D., Cohen-Kettenis, P., Gooren, L. J. G., Kreukels, B. P. C., & Den Heijer, M. (2018). The Amsterdam cohort of gender dysphoria study (1972-2015): Trends in prevalence, treatment, and regrets. Journal of Sexual Medicine, 15, 582–590. https://doi.org/10.1016/j.jsxm.2018.01.016
Zhang, J., Lo, H. H., & Au, A. M. (2021). The buffer of resilience in the relations of gender-related discrimination, rejection, and victimization with depression among Chinese transgender and gender non-conforming individuals. Journal of Affective Disorders, 283, 335–343. https://doi.org/10.1016/j.jad.2021.01.059
Zimmerman, M. A. (2013). Resiliency theory: a strengths-based approach to research and practice for adolescent health. Health Education & Behavior, 40, 381–383. https://doi.org/10.1177/1090198113493782
