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Transgender and anxiety: a comparative study between transgender people and the general population

Bouman, Walter Pierre; Claes, Laurence; Brewin, Nicky; Crawford, John R.; Millet, Nessa; Fernandez-Aranda, Fernando; Arcelus, Jon


Walter Pierre Bouman

Laurence Claes

Nicky Brewin

John R. Crawford

Nessa Millet

Fernando Fernandez-Aranda

Clinical Professor in Mental Health & Transgender Health


Background: Anxiety disorders pose serious public health problems. The data available on anxiety disorders in the transgender population is limited by the small numbers, the lack of a matched controlled population and the selection of a nonhomogenous group of transgender people.

Aims: The aims of the study were (1) to determine anxiety symptomatology (based on the HADS) in a nontreated transgender population and to compare it to a general population sample matched by age and gender; (2) to investigate the predictive role of specific variables, including experienced gender, self-esteem, victimization, social support, interpersonal functioning, and cross-sex hormone use regarding levels of anxiety symptomatology; and (3) to investigate differences in anxiety symptomatology between transgender people on cross-sex hormone treatment and not on hormone treatment.

Methods: A total of 913 individuals who self-identified as transgender attending a transgender health service during a 3-year period agreed to participate. For the first aim of the study, 592 transgender people not on treatment were matched by age and gender, with 3,816 people from the general population. For the second and third aim, the whole transgender population was included.

Measurements: Sociodemographic variables and measures of depression and anxiety (HADS), self-esteem (RSE), victimization (ETS), social support (MSPSS), and interpersonal functioning (IIP-32).

Results: Compared with the general population transgender people had a nearly threefold increased risk of probable anxiety disorder (all p < .05). Low self-esteem and interpersonal functioning were found to be significant predictors of anxiety symptoms. Trans women on treatment with cross-sex hormones were found to have lower levels of anxiety disorder symptomatology.

Conclusions: Transgender people (particularly trans males) have higher levels of anxiety symptoms suggestive of possible anxiety disorders compared to the general population. The findings that self-esteem, interpersonal functioning, and hormone treatment are associated with lower levels of anxiety symptoms indicate the need for clinical interventions targeting self-esteem and interpersonal difficulties and highlight the importance of quick access to transgender health services.


Bouman, W. P., Claes, L., Brewin, N., Crawford, J. R., Millet, N., Fernandez-Aranda, F., & Arcelus, J. (in press). Transgender and anxiety: a comparative study between transgender people and the general population. International Journal of Transgenderism,

Journal Article Type Article
Acceptance Date Dec 1, 2016
Online Publication Date Dec 15, 2016
Deposit Date Jan 6, 2017
Publicly Available Date Jan 6, 2017
Journal International Journal of Transgenderism
Print ISSN 1553-2739
Electronic ISSN 1434-4599
Publisher Taylor & Francis (Routledge)
Peer Reviewed Peer Reviewed
Keywords Anxiety, cross-sex hormone treatment, gender dysphoria, HADS, interpersonal functioning, mental health, self-esteem, transgender
Public URL
Publisher URL
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
Additional Information “This is an Accepted Manuscript of an article published by Taylor & Francis in International Journal of Transgenderism on 15/12/2016, available online: http://www.tandfonline....0/15532739.2016.1258352


Transgender and Anxiety second submission.pdf (399 Kb)

Copyright Statement
Copyright information regarding this work can be found at the following address:

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