Psychological adjustment of transgender individuals in Hong Kong : the roles of gender identity acceptance, social support and coping styles

Abstract

Aims: This dissertation presents the largest study to date to examine the sociodemographic profile of clinical transgender individuals in Hong Kong. It also represents one of the first local studies to investigate psychological adjustment of transgender individuals based on the framework of the Minority Stress Theory (MST). Rather than the most utilized cross-sectional approach, a longitudinal design was adopted to investigate the mediating roles of resilience factors (social support, facilitative coping, and avoidant coping) in the relationship between gender identity acceptance (GIA) and psychological adjustment. The Gender Congruence and Life Satisfaction Scale (GCLS) was also validated in the current study as the first local outcome measure of gender congruence and gender-related mental well-being. Method: A total of 394 treatment-seeking transgender patients at the Gender Identity Clinic (GIC) in Hong Kong were recruited to participate in this longitudinal psychometric study with two time-points, being six to eight months apart, with an attrition rate of 19.29% at Time 2. At both time-points, participants completed the same battery of questionnaires comprising of a socio-demographic questionnaire, Transgender Congruence Scale (TCS), Multidimensional Scale of Perceived Social Support (MSPSS), Brief COPE, GCLS, and Depression, Anxiety, and Stress Scale (DASS-21). Findings: The socio-demographics of the current sample suggested that the transgender population continues to be an underprivileged population in Hong Kong on certain aspects. The seven-factor Chinese GCLS exhibited some differences in factor structure in the current sample, but the scale was found to be a valid and reliable tool for use in the local clinical setting (Cronbach's α = .929). In general, participants who completed their transition scored higher on GCLS scales pertaining to gender congruence and psychological functioning, and lower on DASS-21, suggesting better psychological adjustment. Psychological adjustment was also reported to be better in transmen than transwomen, but did not appear to be related to participants’ age. When data was explored cross-sectionally, social support and both facilitative and avoidant coping fully mediated the relationship between GIA and psychological adjustment. In the longitudinal mediation analysis by structural equation modelling using latent change score model, GIA was not found to predict change in psychological adjustment between the two time-points, hence a longitudinal mediation model was not established. Nevertheless, improvement in psychological adjustment between Time 1 and Time 2 was predicted by the changes in social support and avoidant coping between the two time-points. Conclusion: The findings were discussed with relevance to the MST, according to the possible chronic and transient effects of the distal and proximal factors, as well as that of resilience factors in the MST. Aside from the timely access to medical intervention, findings provided implications on psychological treatment and public policy involvement in the management of gender dysphoria. Implications for further research included the inclusion of distal factors in future longitudinal and/or intervention studies.