In the United States, it is difficult to be a transgender woman.
Researchers who looked at the impact of discrimination, poverty and stigma on the mental health and relationship quality of transgender women and their male romantic partners found that social and economic marginalization not only takes a psychological toll on each person individually but also appears to undermine them as a couple.
Prior research has shown that they generally face high risks of depression, financial hardship, and discrimination, said study lead author Kristi Gamarel, a postdoctoral scholar in the Alpert Medical School's Department of Psychiatry and Human Behavior. What's more, their romantic relationships are not widely accepted. Her study in the August issue of the Journal of Family Psychology
quantifies how that relationship stigma uniquely reduced the mutual sense of harmony in their relationships.
"To our knowledge this is the first study that looks at both partners experiences of discrimination and how that influences their own individual reports of depression as well as their relationship quality," said Gamarel who performed the work while a graduate student at the City University of New York.
In addition to the study's implications for mental health, the findings point to concerns about the spread of HIV, said senior author Don Operario, a professor in the Brown University School of Public Health. HIV is concentrated in marginalized communities such as these couples, he said, and research indicates that high degrees of depression and discrimination, and a dearth of resources to cope with them, often drive people to engage in HIV risk behaviors such as unprotected sex, drug and alcohol use and having sex for pay.
Focusing on intimate relationships is important in this context, he said, because that's where HIV transmission often happens.
"HIV is frequently transmitted in the context of relationships between two primary partners," Operario said. "This must not be understated. We as public health researchers need to better understand and try to improve the health of people in primary relationships. This study represents an effort to understand the factors that promote communication and wellness among partners, in order to inform interventions to affirm individuals and relationships that have traditionally been excluded and marginalized."
A Survey of Stresses
For the study Gamarel, Operario and their co-authors analyzed responses to an extensive survey of 191 couples of transgender women and "cisgender" men (i.e. men who continue to identify with their birth gender). The volunteers from the San Francisco Bay Area were racially diverse (79.1 percent were nonwhite) and generally very poor (61.3 percent earned $500 a month or less). Couples had to be together for at least three months to participate.
Each member of the couple used standardized scales to numerically rate their degrees of depression, the discrimination they face, the stigma they perceive about their relationship (e.g. how often they feel they had to hide their relationship from others) and the quality of their relationship (e.g. degree of agreement with their partner in major life decisions).
HIV was indeed prevalent in the sample, with 18.3 percent of transgender women and 39.5 percent of their male partners reporting that they were positive. More than 40 percent in each group reported high scores of depressive distress as well.
The researchers analyzed the responses to look for statistical connections among them. All the measured stressors contributed to depression. Financial hardship also took a toll each person's view of the relationship.
"For both transgender women and their male partners one's own report of financial hardship was associated with their own perceptions of poorer relationship quality," they wrote.
But the analysis also showed that if one partner felt the sting of relationship stigma the other would likely feel that the relationship was more troubled: "There was a partner effect for both partners such at their partners' higher reports of relationship stigma scores were associated with their own perceptions of lower relationship quality."
In other words, with little money or social acceptance, couples also struggled to find refuge in their besieged relationships.
Based on the findings, the authors wrote, clinicians working with transgender women, or the men in relationships with them, should account for the health of the couple, not just the individual.
"Couples-based interventions and treatment approaches to help transgender women and their male partners cope with minority stressors are warranted to improve the health and well-being of both partners," they wrote.