Beyond the Binary: A Cross-Sectional Online Survey of Gender Dysphoria, Mental Health, and Well-being Among Transgender and Gender-Diverse Adults in South Africa
1
Department of Public Health, Health Economics Unit, University of Cape Town, Cape Town, South Africa
2
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Transgender and gender-diverse (TGD) adults face major mental health and well-being inequities, but evidence from South Africa remains limited1–4. This study addresses this gap by describing gender dysphoria, mental health, well-being, substance use, and socioeconomic conditions, and assessing factors associated with depression and suicidality.
METHODS:
A cross-sectional anonymous online survey was conducted with 298 TGD adults living in South Africa. Validated instruments assessed anxiety (Generalized Anxiety Disorder 7)5, depression (Center for Epidemiologic Studies Depression Scale 10)6, suicidality, gender dysphoria (Utrecht Gender Dysphoria Scale–Gender Spectrum [UGDS-GS])7, substance use, and transgender-specific well-being, including perceptions of body image, appearance, and sexual functioning (World Health Organization Quality of Life 100 items [WHOQOL-100 items])8. Group differences were assessed using chi-square/Fisher tests for categorical variables and Kruskal–Wallis tests for continuous variables. We fitted adjusted logistic models for depression and suicidality and linear models for UGDS-GS. Missing data were multiply imputed using predictive mean matching (m=30).
RESULTS:
Among 298 participants (median age 25), UGDS-GS scores differed by gender identity (median 78, interquartile range (IQR) 72–85; p<0.001). Depressive symptoms affected 76.1% (159/209) and anxiety 63.1% (135/214). Lifetime suicidal ideation was 83.4% (181/217) and suicide attempt 46.1% (100/217). About one in five exceeded Drug Use Disorders Identification Test (DUDIT)9 (21.0%) or Alcohol Use Disorders Identification Test (AUDIT)10 (20.8%) thresholds. Higher depression scores were associated with higher odds of suicidality; sufficient funds were associated with lower odds of suicide attempts; and higher UGDS-GS scores were associated with higher odds of attempts after adjustment.
CONCLUSIONS:
This sample reported a high burden of distress and suicidality. Findings show the need to improve access to gender-affirming, integrated mental health care and to address financial stress to advance equity and inclusion.
Transgender and gender-diverse (TGD) adults face major mental health and well-being inequities, but evidence from South Africa remains limited1–4. This study addresses this gap by describing gender dysphoria, mental health, well-being, substance use, and socioeconomic conditions, and assessing factors associated with depression and suicidality.
METHODS:
A cross-sectional anonymous online survey was conducted with 298 TGD adults living in South Africa. Validated instruments assessed anxiety (Generalized Anxiety Disorder 7)5, depression (Center for Epidemiologic Studies Depression Scale 10)6, suicidality, gender dysphoria (Utrecht Gender Dysphoria Scale–Gender Spectrum [UGDS-GS])7, substance use, and transgender-specific well-being, including perceptions of body image, appearance, and sexual functioning (World Health Organization Quality of Life 100 items [WHOQOL-100 items])8. Group differences were assessed using chi-square/Fisher tests for categorical variables and Kruskal–Wallis tests for continuous variables. We fitted adjusted logistic models for depression and suicidality and linear models for UGDS-GS. Missing data were multiply imputed using predictive mean matching (m=30).
RESULTS:
Among 298 participants (median age 25), UGDS-GS scores differed by gender identity (median 78, interquartile range (IQR) 72–85; p<0.001). Depressive symptoms affected 76.1% (159/209) and anxiety 63.1% (135/214). Lifetime suicidal ideation was 83.4% (181/217) and suicide attempt 46.1% (100/217). About one in five exceeded Drug Use Disorders Identification Test (DUDIT)9 (21.0%) or Alcohol Use Disorders Identification Test (AUDIT)10 (20.8%) thresholds. Higher depression scores were associated with higher odds of suicidality; sufficient funds were associated with lower odds of suicide attempts; and higher UGDS-GS scores were associated with higher odds of attempts after adjustment.
CONCLUSIONS:
This sample reported a high burden of distress and suicidality. Findings show the need to improve access to gender-affirming, integrated mental health care and to address financial stress to advance equity and inclusion.
| eISSN: | 2654-1459 |
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