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Discrimination keeps transgender people awake at night: A nationwide cross-sectional survey of 583 transgender adults in South Korea

  • Yun-Jung Eom
    Affiliations
    Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea

    Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
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  • Hyemin Lee
    Affiliations
    Jeju Institute of Public Health & Health Policy, Jeju, South Korea
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  • Ranyeong Kim
    Affiliations
    Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea

    Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
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  • Sungsub Choo
    Affiliations
    Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea

    Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
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  • Horim Yi
    Affiliations
    Solidarity for LGBT Human Rights of Korea, Seoul, South Korea
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  • Seung-Sup Kim
    Correspondence
    Corresponding author: Seung-Sup Kim, MD, MPH, ScD, Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Daehak-dong, Gwanak-gu, Seoul, South Korea.
    Affiliations
    Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea

    Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Maryland, USA
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Published:August 29, 2022DOI:https://doi.org/10.1016/j.sleh.2022.06.012

      Abstract

      Objectives

      We sought to investigate the association between transgender identity discrimination and sleep problems among transgender people in South Korea (hereafter, Korea), and whether family support for transgender identity plays a protective role in the association.

      Design & setting

      We analyzed a nationwide cross-sectional survey of 583 Korean transgender adults which was anonymously conducted through an online platform.

      Measurements

      Transgender identity discrimination was assessed using a single-item question. Sleep problems were defined as having any of the following problems: poor sleep quality, short sleep duration, and use of alcohol or sleep medications to fall asleep. Family support for transgender identity was classified into 3 groups as follows: not supportive, supportive, and unaware of participants’ transgender identity.

      Results

      Of 583 participants, 383 (65.7%) experienced transgender identity discrimination over the past 12 months. Participants who experienced transgender identity discrimination were 1.48 times (95% confidence intervals [95% CI] = 1.19-1.83) more likely to have any sleep problems, compared to those who never experienced transgender identity discrimination. When stratified by family support level, the associations between transgender identity discrimination and sleep problems remained statistically significant only among those with a family unsupportive (adjusted prevalence ratio [aPR] = 1.64; 95% CI = 1.16-2.31) or unaware (aPR = 1.60; 95% CI = 1.01-2.52) of participants’ transgender identity. However, the association was not statistically significant among those with a supportive family (aPR = 1.41; 95% CI = 0.96-2.07).

      Conclusion

      Given transphobic environments in Korea, legal and institutional efforts are required to reduce transgender identity discrimination (eg, anti-discrimination laws) as well as to build trans-specific family resources.

      Keywords

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      References

      1. Office of Disease Prevention and Health Promotion (ODPHP). 2020. Retrieved from ODPHP website: Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/sleep. Accessed 15 July 22.

        • Auer MK
        • Liedl A
        • Fuss J
        • et al.
        High impact of sleeping problems on quality of life in transgender individuals: a cross-sectional multicenter study.
        PLoS One. 2017; 12e0171640https://doi.org/10.1371/journal.pone.0171640
        • Duncan D
        • Schneider J
        • Radix A
        • Harry-Hernandez S
        • Callander D.
        Sleep health among transgender women of color in New York City: preliminary analyses of the TURNNT study.
        Sleep. 2020; 43 (A141-A141)https://doi.org/10.1093/sleep/zsaa056.365
        • Levenson JC
        • Thoma BC
        • Hamilton JL
        • Choukas-Bradley S
        • Salk RH.
        Sleep among gender minority adolescents.
        Sleep. 2021; 44https://doi.org/10.1093/sleep/zsaa185
        • Dai H
        • Hao J.
        Sleep deprivation and chronic health conditions among sexual minority adults.
        Behav Sleep Med. 2019; 17: 254-268https://doi.org/10.1080/15402002.2017.1342166
        • Harry-Hernandez S
        • Reisner SL
        • Schrimshaw EW
        • et al.
        Gender dysphoria, mental health, and poor sleep health among transgender and gender nonbinary individuals: a qualitative study in New York City.
        Transgend Health. 2020; 5: 59-68https://doi.org/10.1089/trgh.2019.0007
        • Hershner S
        • Jansen EC
        • Gavidia R
        • Matlen L
        • Hoban M
        • Dunietz GL.
        Associations between transgender identity, sleep, mental health and suicidality among a North American cohort of college students.
        Nat Sci Sleep. 2021; 13: 383-398https://doi.org/10.2147/NSS.S286131
        • Bowen AE
        • Staggs S
        • Kaar J
        • Nokoff N
        • Simon SL.
        Short sleep, insomnia symptoms, and evening chronotype are correlated with poorer mood and quality of life in adolescent transgender males.
        Sleep Health. 2021; 7: 445-450https://doi.org/10.1016/j.sleh.2021.03.008
        • Beatty DL
        • Hall MH
        • Kamarck TA
        • et al.
        Unfair treatment is associated with poor sleep in African American and Caucasian adults: Pittsburgh SleepSCORE project.
        Health Psychol. 2011; 30: 351-359https://doi.org/10.1037/a0022976
        • Huynh VW
        • Gillen-O'Neel C
        Discrimination and sleep: the protective role of school belonging.
        Youth Soc. 2016; 48: 649-672https://doi.org/10.1177/0044118x13506720
        • Park JB
        • Nakata A
        • Swanson NG
        • Chun H.
        Organizational factors associated with work-related sleep problems in a nationally representative sample of Korean workers.
        Int Arch OccupEnviron Health. 2013; 86: 211-222https://doi.org/10.1007/s00420-012-0759-3
        • Slopen N
        • Lewis TT
        • Williams DR.
        Discrimination and sleep: a systematic review.
        Sleep Med. 2016; 18: 88-95https://doi.org/10.1016/j.sleep.2015.01.012
        • Timmins L
        • Rimes KA
        • Rahman Q.
        Minority stressors and psychological distress in transgender individuals.
        Psychol Sex Orientat Gend Divers. 2017; 4: 328https://doi.org/10.1037/sgd0000237
        • Caceres BA
        • Jackman KB
        • Belloir J
        • et al.
        Examining the associations of gender minority stressors with sleep health in gender minority individuals.
        Sleep Health. 2022; 8: 153-160https://doi.org/10.1016/j.sleh.2021.10.006
        • Testa RJ
        • Habarth J
        • Peta J
        • Balsam K
        • Bockting W
        Development of the gender minority stress and resilience measure.
        Psychol Sex Orientat Gend Divers. 2015; 2: 65https://doi.org/10.1037/sgd0000081
        • Bockting WO
        • Miner MH
        • Swinburne Romine RE
        • Hamilton A
        • Coleman E.
        Stigma, mental health, and resilience in an online sample of the US transgender population.
        AmJ Public Health. 2013; 103: 943-951https://doi.org/10.2105/AJPH.2013.301241
        • Clements-Nolle K
        • Marx R
        • Katz M.
        Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization.
        J Homosex. 2006; 51: 53-69https://doi.org/10.1300/J082v51n03_04
        • Scandurra C
        • Amodeo AL
        • Valerio P
        • Bochicchio V
        • Frost DM.
        Minority stress, resilience, and mental health: a study of Italian transgender people.
        J Soc Issues. 2017; 73: 563-585https://doi.org/10.1111/josi.12232
        • Veale JF
        • Peter T
        • Travers R
        • Saewyc EM.
        Enacted stigma, mental health, and protective factors among transgender youth in Canada.
        Transgend Health. 2017; 2: 207-216https://doi.org/10.1089/trgh.2017.0031
        • Ailshire JA
        • Burgard SA.
        Family relationships and troubled sleep among U.S. adults: examining the influences of contact frequency and relationship quality.
        J HealthSoc Behav. 2012; 53: 248-262https://doi.org/10.1177/0022146512446642
        • Tsai KM
        • Dahl RE
        • Irwin MR
        • et al.
        The roles of parental support and family stress in adolescent sleep.
        Child Dev. 2018; 89: 1577-1588https://doi.org/10.1111/cdev.12917
        • Yi H
        • Luhur W.
        • Brown T.N.
        Public Opinion of Transgender Rights in South Korea.
        The Williams Institute, Los Angeles, CA2019
        • Luhur W
        • Brown T.N.
        • Flores A.R.
        Public Opinion of Transgender Rights in the United States.
        The Williams Institute, Los Angeles, CA2019
        • Lee H
        • Park J
        • Choi B
        • Yi H
        • Kim S-S.
        Experiences of and barriers to transition-related healthcare among Korean transgender adults: focus on gender identity disorder diagnosis, hormone therapy, and sex reassignment surgery.
        Epidemiol Health. 2018; 40e2018005https://doi.org/10.4178/epih.e2018005
        • Yi H
        • Lee H
        • Yoon J
        • Park J
        • Kim S.
        Transgender people's access to health care in Korea.
        Health Soc Welf Rev. 2015; 35: 64-94
        • Lee H
        • Operario D
        • van den Berg JJ
        • Yi H
        • Choo S
        • Kim S-S.
        Health disparities among transgender adults in South Korea.
        Asia Pac J Public Health. 2020; 32: 103-110https://doi.org/10.1177/1010539520912594
        • Tate CC
        • Ledbetter JN
        • Youssef CP.
        A two-question method for assessing gender categories in the social and medical sciences.
        J Sex Res. 2013; 50: 767-776https://doi.org/10.1080/00224499.2012.690110
        • Zou G.
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706https://doi.org/10.1093/aje/kwh090
        • Bradford J
        • Reisner SL
        • Honnold JA
        • Xavier J.
        Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.
        Am J Public Health. 2012; 103: 1820-1829https://doi.org/10.2105/AJPH.2012.300796
        • Grant JM
        • Mottet LA
        • Tanis J
        • Min D
        Transgender Discrimination Survey. National Center for Transgender Equality and National Gay and Lesbian Task Force, Washington, DC, USA2011
        • James S
        • Herman J
        • Rankin S
        • Keisling M
        • Mottet L
        • Anafi Ma
        The report of the 2015 US transgender survey. National Center for Transgender Equality, Washington, DC, USA2016
        • Lefevor GT
        • Boyd-Rogers CC
        • Sprague BM
        • Janis RA.
        Health disparities between genderqueer, transgender, and cisgender individuals: an extension of minority stress theory.
        J Couns Psychol. 2019; 66: 385-395https://doi.org/10.1037/cou0000339
        • Butler ES
        • McGlinchey E
        • Juster R-P.
        Sexual and gender minority sleep: a narrative review and suggestions for future research.
        J Sleep Res. 2020; 29: e12928https://doi.org/10.1111/jsr.12928
        • Garrison SM
        • Doane M
        • Elliott M.
        Gay and lesbian experiences of discrimination, health, and well-being: surrounding the presidential election.
        Soc Psychol Personal Sci. 2017; 9: 131-142https://doi.org/10.1177/1948550617732391
        • Bauerband LA
        • Galupo MP.
        The gender identity reflection and rumination scale: development and psychometric evaluation.
        J Couns Dev. 2014; 92: 219-231https://doi.org/10.1002/j.1556-6676.2014.00151.x
        • Krieger N
        • Smith K
        • Naishadham D
        • Hartman C
        • Barbeau EM.
        Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health.
        Soc Sci Med. 2005; 61: 1576-1596https://doi.org/10.1016/j.socscimed.2005.03.006
        • Lee H
        • Operario D
        • Yi H
        • Choo S
        • Kim J-H
        • Kim S-S.
        Does discrimination affect whether transgender people avoid or delay healthcare?: a nationwide cross-sectional survey in South Korea.
        J ImmigrMinor Health. 2021; 24: 170-177https://doi.org/10.1007/s10903-021-01193-9
        • Lee H
        • Tomita KK
        • Habarth JM
        • et al.
        Internalized transphobia and mental health among transgender adults: a nationwide cross-sectional survey in South Korea.
        Int J Transgen Health. 2020; 21: 182-193https://doi.org/10.1080/26895269.2020.1745113
        • Cappuccio FP
        • D'Elia L
        • Strazzullo P
        • Miller MA
        Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies.
        Sleep. 2010; 33: 585-592https://doi.org/10.1093/sleep/33.5.585
        • Itani O
        • Jike M
        • Watanabe N
        • Kaneita Y.
        Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression.
        Sleep Med. 2017; 32: 246-256https://doi.org/10.1016/j.sleep.2016.08.006