Self-reported Rates of Abuse, Neglect, and Bullying Experienced by Transgender and Gender-Nonbinary Adolescents in China | Adolescent Medicine | JAMA Network Open | JAMA Network
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1.
Qiao  D, Chan  Y-C.  Child abuse in China: a yet-to-be-acknowledged ‘social problem’ in the Chinese mainland.  Child Fam Soc Work. 2005;10(1):21-27. doi:10.1111/j.1365-2206.2005.00347.xGoogle ScholarCrossref
2.
Kwok  SY, Chai  W, He  X.  Child abuse and suicidal ideation among adolescents in China.  Child Abuse Negl. 2013;37(11):986-996. doi:10.1016/j.chiabu.2013.06.006PubMedGoogle ScholarCrossref
3.
Liu  M, Zhang  L. Actuality, attitude and intervention: a survey report about family violence against women. In: Rong  W, ed.  Combating Family Violence Against Women: Chinese Theories and Practices. Beijing, China: China Social Sciences Press; 2002.
4.
Han  Z, Zhang  G, Zhang  H.  School bullying in urban China: prevalence and correlation with school climate.  Int J Environ Res Public Health. 2017;14(10):e1116. doi:10.3390/ijerph14101116PubMedGoogle ScholarCrossref
5.
Dinkes  R, Cataldi  EF, Lin-Kelly  W.  Indicators of School Crime and Safety: 2007. NCES 2008-021/NCJ 219553. Jessup, MD: National Center for Education Statistics; 2007.
6.
Xu  RB, Wen  B, Song  Y,  et al.  The change in mortality and major causes of death among Chinese adolescents from 1990 to 2016 [in Chinese].  Zhonghua Yu Fang Yi Xue Za Zhi. 2018;52(8):802-808. doi:10.3760/cma.j.issn.0253-9624.2018.08.006PubMedGoogle Scholar
7.
Chen  R, An  J, Ou  J.  Suicidal behaviour among children and adolescents in China.  Lancet Child Adolesc Health. 2018;2(8):551-553. doi:10.1016/S2352-4642(18)30170-6PubMedGoogle ScholarCrossref
8.
Xing  X-Y, Tao  F-B, Wan  Y-H,  et al.  Family factors associated with suicide attempts among Chinese adolescent students: a national cross-sectional survey.  J Adolesc Health. 2010;46(6):592-599. doi:10.1016/j.jadohealth.2009.12.006PubMedGoogle ScholarCrossref
9.
Hesketh  T, Ding  QJ, Jenkins  R.  Suicide ideation in Chinese adolescents.  Soc Psychiatry Psychiatr Epidemiol. 2002;37(5):230-235. doi:10.1007/s00127-002-0536-9PubMedGoogle ScholarCrossref
10.
Rigby  K, Slee  P.  Suicidal ideation among adolescent school children, involvement in bully-victim problems, and perceived social support.  Suicide Life Threat Behav. 1999;29(2):119-130.PubMedGoogle Scholar
11.
Sullivan  MK.  Homophobia, history, and homosexuality: trends for sexual minorities.  J Hum Behav Soc Environ. 2004;8(2-3):1-13. doi:10.1300/J137v08n02_01Google ScholarCrossref
12.
Kann  L, Olsen  EOM, McManus  T,  et al Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9-12: United States and selected sites, 2015.  MMWR Surveill Summ. 2016:65(SS-9):1-202. doi:10.15585/mmwr.ss6509a1PubMedGoogle Scholar
13.
American Psychological Association.  Guidelines for psychological practice with transgender and gender nonconforming people.  Am Psychol. 2015;70(9):832-864. doi:10.1037/a0039906PubMedGoogle ScholarCrossref
14.
Goldblum  P, Testa  RJ, Pflum  S, Hendricks  ML, Bradford  J, Bongar  B.  The relationship between gender-based victimization and suicide attempts in transgender people.  Prof Psychol Res Pr. 2012;43(5):468-475. doi:10.1037/a0029605Google ScholarCrossref
15.
Earnshaw  VA, Bogart  LM, Poteat  VP, Reisner  SL, Schuster  MA.  Bullying among lesbian, gay, bisexual, and transgender youth.  Pediatr Clin North Am. 2016;63(6):999-1010. doi:10.1016/j.pcl.2016.07.004PubMedGoogle ScholarCrossref
16.
Pi  J.  Transgender in China.  J LGBT Youth. 2010;7(4):346-358. doi:10.1080/19361653.2010.512518Google ScholarCrossref
17.
Parkin  S.  LGBT rights-focused legal advocacy in China: the promise, and limits, of litigation.  Fordham Int Law J.2018;41:1243.Google Scholar
18.
Hu  X, Wang  Y.  LGB identity among young Chinese: the influence of traditional culture.  J Homosex. 2013;60(5):667-684. doi:10.1080/00918369.2013.773815PubMedGoogle ScholarCrossref
19.
Yang  X, Zhao  L, Wang  L,  et al.  Quality of life of transgender women from China and associated factors: a cross-sectional study.  J Sex Med. 2016;13(6):977-987. doi:10.1016/j.jsxm.2016.03.369PubMedGoogle ScholarCrossref
20.
Wei  C-z, Liu  W-l.  The association between school bullying and mental health of sexual minority students.  Chin J Clin Psychol. 2015;23(4):701-705.Google Scholar
21.
Cheng  FK.  Dilemmas of Chinese lesbian youths in contemporary mainland China.  Sex Cult. 2018;22(1):190-208. doi:10.1007/s12119-017-9460-8Google ScholarCrossref
22.
Shao  J, Chang  ES, Chen  C.  The relative importance of parent-child dynamics and minority stress on the psychological adjustment of LGBs in China.  J Couns Psychol. 2018;65(5):598-604. doi:10.1037/cou0000281PubMedGoogle ScholarCrossref
23.
Nock  MK, Green  JG, Hwang  I,  et al.  Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement.  JAMA Psychiatry. 2013;70(3):300-310. doi:10.1001/2013.jamapsychiatry.55PubMedGoogle ScholarCrossref
24.
Haas  AP, Rodgers  PL, Herman  JL.  Suicide attempts among transgender and gender non-conforming adults. https://williamsinstitute.law.ucla.edu/research/suicide-attempts-among-transgender-and-gender-non-conforming-adults/. Accessed July 30, 2019.
25.
Meyer  IH.  Minority stress and mental health in gay men.  J Health Soc Behav. 1995;36(1):38-56. doi:10.2307/2137286PubMedGoogle ScholarCrossref
26.
Meyer  IH.  Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.  Psychol Bull. 2003;129(5):674-697. doi:10.1037/0033-2909.129.5.674PubMedGoogle ScholarCrossref
27.
Allport  GW.  The Nature of Prejudice. Reading, MA: Addison-Wesley; 1954.
28.
Lehavot  K, Simoni  JM.  The impact of minority stress on mental health and substance use among sexual minority women.  J Consult Clin Psychol. 2011;79(2):159-170. doi:10.1037/a0022839PubMedGoogle ScholarCrossref
29.
Hendricks  ML, Testa  RJ.  A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model.  Prof Psychol Res Pr. 2012;43(5):460-467. doi:10.1037/a0029597Google ScholarCrossref
30.
Zhu  X, Gao  Y, Gillespie  A,  et al.  Health care and mental wellbeing in the transgender and gender-diverse Chinese population.  Lancet Diabetes Endocrinol. 2019;7(5):339-341. doi:10.1016/S2213-8587(19)30079-8PubMedGoogle ScholarCrossref
31.
Chen  R, Zhu  X, Wright  L,  et al.  Suicidal ideation and attempted suicide amongst Chinese transgender persons: national population study.  J Affect Disord. February 2019;245:1126-1134. doi:10.1016/j.jad.2018.12.011PubMedGoogle ScholarCrossref
32.
Jin  H, Chen  Z, Guo  F, Zhang  J, Yang  Y, Wang  Q.  A short Chinese version of Center For Epidemiologic Studies Depression Scale.  Chin J of Behav Med and Brain Sci. 2013;22(12):1133-1136.Google Scholar
33.
Wang  Y-Y, Dong  M, Zhang  Q,  et al.  Suicidality and clinical correlates in Chinese men who have sex with men (MSM) with HIV infection.  Psychol Health Med. 2019;24(2):137-143. doi:10.1080/13548506.2018.1515495PubMedGoogle ScholarCrossref
34.
Simons  L, Schrager  SM, Clark  LF, Belzer  M, Olson  J.  Parental support and mental health among transgender adolescents.  J Adolesc Health. 2013;53(6):791-793. doi:10.1016/j.jadohealth.2013.07.019PubMedGoogle ScholarCrossref
35.
Pedro  KT, Esqueda  MC.  Exploring school victimization and weapon carrying among military-connected lesbian, gay, bisexual, and transgender youth in California schools [published online July 25, 2017].  J Interpers Violence. doi:10.1177/0886260517719537Google Scholar
36.
Greytak  EA, Kosciw  JG, Diaz  EM.  Harsh Realities: The Experiences of Transgender Youth in Our Nation’s Schools. New York, NY: Gay, Lesbian and Straight Education Network; 2009.
37.
Toomey  RB, Ryan  C, Diaz  RM, Card  NA, Russell  ST.  Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment.  Dev Psychol. 2010;46(6):1580-1589. doi:10.1037/a0020705Google ScholarCrossref
38.
Rostosky  SS, Owens  GP, Zimmerman  RS, Riggle  ED.  Associations among sexual attraction status, school belonging, and alcohol and marijuana use in rural high school students.  J Adolesc. 2003;26(6):741-751. doi:10.1016/j.adolescence.2003.09.002PubMedGoogle ScholarCrossref
39.
Collier  KL, van Beusekom  G, Bos  HM, Sandfort  TG.  Sexual orientation and gender identity/expression related peer victimization in adolescence: a systematic review of associated psychosocial and health outcomes.  J Sex Res. 2013;50(3-4):299-317. doi:10.1080/00224499.2012.750639PubMedGoogle ScholarCrossref
40.
Murdock  TB, Bolch  MB.  Risk and protective factors for poor school adjustment in lesbian, gay, and bisexual (LGB) high school youth: variable and person-centered analyses.  Psychol Sch. 2005;42(2):159-172. doi:10.1002/pits.20054Google ScholarCrossref
41.
Goodenow  C.  Classroom belonging among early adolescent students: relationships to motivation and achievement.  J Early Adolesc. 1993;13(1):21-43. doi:10.1177/0272431693013001002Google ScholarCrossref
42.
Eisenberg  ME, Neumark-Sztainer  D, Perry  CL.  Peer harassment, school connectedness, and academic achievement.  J Sch Health. 2003;73(8):311-316. doi:10.1111/j.1746-1561.2003.tb06588.xPubMedGoogle ScholarCrossref
43.
Hatchel  T, Valido  A, De Pedro  KT, Huang  Y, Espelage  DL.  Minority stress among transgender adolescents: the role of peer victimization, school belonging, and ethnicity [published online June 25, 2018].  J Child Fam Stud. doi:10.1007/s10826-018-1168-3Google Scholar
44.
Reisner  SL, Biello  KB, White Hughto  JM,  et al.  Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: baseline findings from project LifeSkills.  JAMA Pediatr. 2016;170(5):481-486. doi:10.1001/jamapediatrics.2016.0067PubMedGoogle ScholarCrossref
45.
Toomey  RB, Syvertsen  AK, Shramko  M.  Transgender adolescent suicide behavior.  Pediatrics. 2018;142(4):e20174218. doi:10.1542/peds.2017-4218PubMedGoogle ScholarCrossref
46.
Becerra-Culqui  TA, Liu  Y, Nash  R,  et al.  Mental health of transgender and gender nonconforming youth compared with their peers.  Pediatrics. 2018;141(5):e20173845. doi:10.1542/peds.2017-3845PubMedGoogle ScholarCrossref
47.
Tebbe  EA, Moradi  B.  Suicide risk in trans populations: an application of minority stress theory.  J Couns Psychol. 2016;63(5):520-533. doi:10.1037/cou0000152PubMedGoogle ScholarCrossref
48.
Liu  XC, Ma  DD, Kurita  H, Tang  MQ.  Self-reported depressive symptoms among Chinese adolescents.  Soc Psychiatry Psychiatr Epidemiol. 1999;34(1):44-47. doi:10.1007/s001270050110PubMedGoogle ScholarCrossref
49.
Reisner  SL, Vetters  R, Leclerc  M,  et al.  Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study.  J Adolesc Health. 2015;56(3):274-279. doi:10.1016/j.jadohealth.2014.10.264PubMedGoogle ScholarCrossref
50.
Perez-Brumer  A, Day  JK, Russell  ST, Hatzenbuehler  ML.  Prevalence and correlates of suicidal ideation among transgender youth in California: findings from a representative, population-based sample of high school students.  J Am Acad Child Adolesc Psychiatry. 2017;56(9):739-746. doi:10.1016/j.jaac.2017.06.010PubMedGoogle ScholarCrossref
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    1 Comment for this article
    Bullying in other parts of the world
    Frederick Rivara, MD, MPH | University of Washingtoni=
    We know that in the West, transgender and gender-nonbinary adolescents experience greater rates of bullying than the rest of their peers. This is the first study to extend these findings to China, and the negative effects on the mental health of these youth.
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Original Investigation
    Public Health
    September 6, 2019

    Self-reported Rates of Abuse, Neglect, and Bullying Experienced by Transgender and Gender-Nonbinary Adolescents in China

    Author Affiliations
    • 1National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
    • 2Department of Psychiatry, University of Oxford, Oxford, United Kingdom
    • 3Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
    • 4Beijing LGBT Center, Beijing, China
    • 5Department of Psychiatry and Mental Health Institute, Second Xiangya Hospital, Central South University, Chinese National Clinical Research Centre on Mental Disorders, Changsha, China
    • 6First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
    • 7Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
    • 8Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
    JAMA Netw Open. 2019;2(9):e1911058. doi:10.1001/jamanetworkopen.2019.11058
    Key Points español 中文 (chinese)

    Question  What are the rates of abuse, neglect, and bullying and their association with poor mental health experienced by Chinese transgender and gender nonbinary adolescents?

    Findings  In this national survey study of 385 transgender and gender-nonbinary adolescents, 296 respondents reported experiencing parental abuse or neglect and 295 respondents reported experiencing abuse or bullying from classmates or teachers. Reporting experiences of bullying or abuse from classmates or teachers was significantly associated with increased risk of suicidal ideation.

    Meaning  Greater access to appropriate mental health care may be helpful to address the high rates of mental health issues and abuse, neglect, and bullying experienced by Chinese transgender and gender-nonbinary adolescents.

    Abstract

    Importance  This is the first comprehensive national study reporting the rates of abuse, neglect, and bullying from family and classmates or teachers among Chinese transgender and gender-nonbinary adolescents and identifying risk factors associated with poor mental health in this population.

    Objective  To assess the rates of abuse, neglect, and bullying and their association with poor mental health among Chinese transgender and gender nonbinary adolescents.

    Design, Setting, and Participants  This national survey study used an online self-selecting survey conducted between January 1, 2017, and September 29, 2017, in China. Eligibility criteria included reporting being aged 12 to 18 years and being transgender or gender nonbinary. Data analysis was performed from March 25 to 28, 2019.

    Main Outcomes and Measures  The main outcome was self-reported poor mental health, including depressive symptoms, anxiety symptoms, and suicidal ideation. Depressive symptoms were measured using the Center for Epidemiological Studies Depression 9-item scale. Anxiety symptoms were measured using the 7-item General Anxiety Disorder scale. Suicidal ideation was measured using standardized questions adapted from previous Chinese studies. Abuse, neglect, and bullying were measured using specifically designed questions.

    Results  Of 564 responses collected, 385 respondents (mean [SD] age, 16.7 [1.2] years) met inclusion criteria, including 109 (28.3%) transgender adolescent boys, 167 (43.4%) transgender adolescent girls, and 109 (28.3%) gender-nonbinary adolescents. Among 319 respondents who reported that their parents were aware of their gender identity, 296 (92.8%) reported having experienced parental abuse or neglect. Among the full cohort, 295 respondents (76.6%) reported having experienced abuse or bullying owing to being transgender or gender nonbinary in school from classmates or teachers. There were 173 respondents (44.9%) with Center for Epidemiological Studies Depression 9-item scale scores indicating they were at risk of major depressive disorder, and 148 respondents (38.4%) had 7-item General Anxiety Disorder scale scores indicating they were at risk of an anxiety disorder. In univariate analysis, reporting experiences of bullying from a classmate or teacher was significantly associated with suicidal ideation (odds ratio, 1.68 [95% CI, 1.04-2.70]; P = .03), but the association was no longer statistically significant after controlling for level of educational attainment, aversion to assigned sex, and depressed mood at the onset of puberty (odds ratio, 1.63 [95% CI, 0.97-2.73]; P = .06).

    Conclusions and Relevance  In this survey study, transgender and gender-nonbinary adolescents in China reported high rates of abuse, neglect, and bullying at home and in school and high rates of symptoms associated with poor mental health. This study highlights the importance of reducing home- and school-based abuse, neglect, and bullying of transgender and gender-nonbinary adolescents in China to improve mental health outcomes; however, broader change in the social environment may be required to address the prejudice and stigma aimed at gender minorities.

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