http://dx.doi.org/10.24016/2020.v6n2.126
ORIGINAL ARTICLE
Perceived Social Support in
Transgender People: A Comparative Study with Cisgender People
Apoyo social percibido en personas trans: Un estudio comparativo con
personascisgénero
Nuria
Vázquez López 1 *, María Fernández Rodríguez 2, 3, 4,
Elena García Vega 4 and Patricia Guerra Mora 5
1 Advisory Center for Women of the Mancomunidad
Comarca de la Sidra, Spain.
2 Gender Identity Treatment Unit of the Principality of Asturias (UTIGPA),
Spain.
3 Adult Mental Health Center I "La Magdalena", Health Area III, Avilés, Spain.
4 University of Oviedo, Spain.
5 Isabel I University, Spain.
* Correspondence: nuriavazquezlopez92@gmail.com
Received: April 28, 2020 | Revised:
May 24, 2020 | Accepted: June 14, 2020 | Published Online: June 14,
2020.
CITE IT AS:
Vázquez López, N.,
Fernández Rodríguez, M., García Vega, E., & Guerra Mora, P. (2020). Perceived social
support in trans people: A comparative study with cisgender people. Interacciones,
6(2), e126. http://doi.org/10.24016/2020.v6n2.126
ABSTRACT
Background: Trans people may find themselves in a situation of social
discrimination, reflected in their health and in the lack of scientific
research. The minority stress theory points out the importance of social
support for the stress of sexual or gender minorities. This study aims to
explore social support and its dimensions in this population. Method: 81
people participate, of which 36 are trans and 45 non-trans (cisgender), as a
control group. The Mos Social Support
Survey is applied to measure perceived social support and a questionnaire
with sociodemographic variables. Results: The results show that there
are no differences in the perceived social support between both groups.
However, sociodemographic variables such as having a partner, age, and
employment situation show change for the trans population in some dimensions. Conclusion:
These findings promote future lines of research that expand the knowledge of
these variables in this group.
Keywords: Transsexuality;
social support; gender dysphoria; mental health.
RESUMEN
Introducción: Las personas trans pueden encontrarse
en una situación de discriminación social, reflejada en su salud y en la escasa
investigación científica. La teoría del estrés minoritario señala la
importancia del apoyo social para el estrés de las minorías sexuales o de
género. En este estudio se pretende explorar el apoyo social y sus dimensiones
en esta población. Método: Participan 81 personas, de las cuales 36 son
trans y 45 no trans (cisgénero),
como grupo control. Se aplica The Mos Social Support Survey para medir el apoyo social percibido y un
cuestionario con variables sociodemográficas. Resultados: Los resultados
muestran que no existen diferencias en el apoyo social percibido entre ambos
grupos. Sin embargo, variables sociodemográficas como tener pareja, edad y
situación laboral muestran cambios para la población trans en algunas
dimensiones. Conclusión: Estos hallazgos promueven futuras líneas de
investigación que amplíen el conocimiento de estas variables en este colectivo.
Palabras
clave: Transexualidad; apoyo social; disforia
de género; salud mental.
BACKGROUND
Trans people are those whose gender identity and / or expression does
not match the gender expectations of a normative society. Two traditional
binary poles are differentiated (masculine and feminine), but between the two,
there is a range of gender identities and expressions (transsexual,
transgender, transvestite, non-binary, gender fluid and other gender variants).
People whose identity does not fit with the normative sex / gender
dichotomy may have their physical, mental and sexual health affected, due to
the situation of discrimination in a transphobic culture (Basar,
Gökhan and Karakaya, 2016; Nuttbrok et al., 2010; Trujillo, Perrin, Sutter, Tabaac and Benotsh, 2016). These
difficulties of social adaptation would systematically occur in all areas and
areas of their life, such as education, employment, home and health (Boza and
Nicholson, 2014).
Trans people are more likely to experience rejection, discrimination and
violence than non-trans people. In studies such as that of Lombardi, Wilchins, Presing and Malouf (2001) it is found that 60% of transgender people
have experienced violence or rejection, 26% have suffered some violent incident
and 37% have been economically discriminated against. More than 90% of all
trans people reported experiencing harassment or discrimination, compared to
80% of cisgender women and 63% of cisgender men. Similar results are found in
other comparative studies with a non-transsexual population. Nemoto, Bödeker and Iwamoto
(2011) in a sample of 573 transsexual women with a history of prostitution, it
was found that more than half had been physically assaulted,
In addition, these situations of discrimination, social rejection and
violence can affect the mental health of trans people. Both research and the depathologization movement coincide in pointing to the
oppressive social and family environment as a variable to take into account in
psychological distress (Nuttbrok et al., 2014). It
has been found that trans people show greater psychopathology, have a lower
quality of life and well-being with life than the rest of the population. In
general, the group of Lesbians, Gays, Bisexuals and Transsexuals (LGBT) are
more likely to suffer from a mental health problem, where social support can be
essential as a buffer, especially for young boys and girls (McConell,
2015). However, Claes et al., (2015) point out the importance of studying
transsexual people separately from the collective to differentiate the effects
of discrimination based on sexual orientation. However, there is a high trans
population that does not identify as heterosexual (between 38.4% - 61.9%) and
intersectional discrimination may occur, both due to their gender identity and
sexual orientation, the effects on mental health Boza and Nicholson, 2014).
To explain the consequences on mental health of groups that are socially
minority, the minority stress theory should be highlighted (Meyer, 1995). This
theory has been used for other types of minorities, but it has been found
particularly useful in the trans population (Trujillo et al., 2016). From it,
the perceived experiences, their mental, physical and psychological well-being
in general are related to discrimination, prejudice, vigilance and fears that
they may experience due to the socially minority situation (Meyer, 1995).
Stressors that influence minorities can act on health directly through chronic
stress mechanisms, lead to psychological distress or health-related behaviors
such as substance use or use of health services (Balsam, Molina, Beadnell, Simoni and Walters,
2011). In addition, minority stress can occur at the same time as other types
of daily stressors in the non-minority population, thus adding more stress to
the individual's mental health. It is suggested that a possible buffer against
psychological stress in sexual minorities, such as trans boys and girls, could
be social support (Meyer, 2003).
Social support has been shown to be helpful in coping with stress and
controlling the effects it may have on people's health (Schmitt, Branscombe, Postmes & Garcia,
2014). There is no unanimous agreement when defining social support in the
literature. Social support could be defined as the possibility of receiving
help, comfort, assistance or information from both individuals and groups (Earnshaw, Lang, Lippitt, Jin and Chaudoir, 2015).
Authors such as Sherbourne and Stewart (1991)
studied the influence on health of social support due to its different
dimensions. First, they make a dichotomous distinction between structural
support (number of social relationships and interconnectedness of networks) and
functional support (degree to which these interpersonal relationships serve
certain functions). The support a person perceives would be more important than
the support structure itself (Sherbourne &
Stewart, 1991).
In addition, taking into account the functions of social support, they
differentiate between five categories: emotional, that is, expression of
positive affect, empathy and expression of emotions; informational, referring
to advice, advice, information, guidance or feedback; instrumental, that is,
material aid or assistance; positive social interaction, availability of other
people for leisure and fun activities and; affective, expressions of love and
affection. The importance of the dimensions of social support is highlighted
due to its effects on health and not only what are its sources, or the amount
of support perceived in general (Jensen et al., 2014).
Davey, Bouman, Arcelus
and Meyer (2014) recommend that the study of social support in trans people
explore these dimensions. However, research on trans people is not very
abundant (Ellis and Davis, 2017). On the one hand, significant differences have
been found in the perceived social support of trans people compared to the rest
of the population, being trans people who perceived less support than non-trans
/ cisgender people (Basar et al., 2016; Boza and
Nicholson, 2014; Davey et al., 2014; Tebbe and Moraldi, 2016). Factor and Rothblum
(2008) find similar results, particularly in perceived social support from the
family, which was lower in trans people. Davey et al. (2014) in addition to
significant differences in perceived social support between trans and cisgender
people, find differences between trans and non-trans women. Trans women
reported lower levels of available support than cisgender women. Also, in
comparison with other minorities, such as gays and lesbians, less perceived
social support has been found in trans people (Botcking,
Huang, Robinson and Rosser, 2005).
Regarding differences by gender, research in the general population has
indicated that women use social support to a greater extent than men (Pflum, Testa, Balsam, Godblum & Bongar, 2015). In
the trans population, the results are uneven. If we compare trans men and
women, Claes et al. (2015) find that men perceive more support from their
family than women. Other authors, however, do not find that there are
differences regarding gender (Basar et al., 2016).
Regarding this issue, differences by gender in both the cisgender and the LGB
(lesbian, gay, bisexual) population have related the types of support to gender
stereotypes. Ellis and Davis (2017) point out that there are greater
differences regarding social emotional support due to the association with the
female stereotype, while other types of support such as instrumental, would not
have so many differences according to gender. The association of social support
with the feminine and gender socialization would play a relevant role in the
differences (Pflum et al., 2015).
On the other hand, looking at specific variables that may influence
social support, the literature that has taken trans people into account is
scarce. Meier Sharp, Michonski, Babcock and
Fitzgerald (2013) find that there is a significant relationship between having
a partner and high rates of support, in a sample of 593 trans men. In turn,
having greater support was negatively correlated with depression. In trans
women, Yang et al. (2016) point out an association between casual couples with
higher levels of anxiety in the Chinese population. The issue of affective
relationships in trans people has been questioned regarding its stability due
to possible ruptures or crises in the event of a physical transition. Research shows
that half of the relationships were maintained after the transition process
(Brown, 2010).
Regarding the influence of age on social support, if we generalize to
the LGBT population, we find changes in support with respect to being more or
less young. Snapp, Watson, Russell, Díaz and Ryan (2015) point out that for
young people, friends are more relevant than family since they would provide
concrete support towards their sexuality. Previous literature in the general
population shares the trend for social support, where the perception of it
decreases with age (Jensen et al., 2014).
Therefore, the general objective of this study is to evaluate social
support with its different dimensions in trans people and to make a comparison
with cisgender people. In addition, possible differences in social support and
its dimensions based on sociodemographic variables will be studied.
METHOD
Participants
This is a retrospective case-control study with a cross-sectional
descriptive component. This design allows evaluating perceived social support
as well as the influence of sociodemographic variables in trans and cisgender
people. The total sample consisted of 81 people. The group of trans people is
made up of 36, of which 94.4% (n = 34) are users of the Gender Identity
Treatment Unit of the Principality of Asturias (UTIGPA) selected by consecutive
non-probability sampling and 5 , 6% (n = 2) were recruited through snowball
sampling used to gather information from the control group. Of the trans
sample, 66.6% (n = 24) are trans men and 33.4% (n = 12) are trans women. The
mean age of this sample is 27.25 (SD = 11.36), with a range from 15 to 57
years.
A control group selected by snowball sampling was used, consisting of 45
cisgender (non-trans) people, of which 73.3% (n = 33) are men and 26.7% (n =
12) are women. The mean age for the control group is 27.82 years (SD = 8.59),
with a range between 17 and 60 years. No statistically significant differences
were found regarding age and sex / gender ratio (or gender) between both
groups. The only exclusion criterion used was defining oneself as a trans
person.
Instruments
Two instruments were used: The Mos Social Support Survey by Sherbourne and Stewart (1991) and a questionnaire of
sociodemographic variables.
The Mos Social Support Survey is a short, self-administered instrument
designed for the assessment of social support in a multidimensional way. It
consists of 20 items, the first of which reports the size of the social network
and the following 19 are answered on a Likert-type scale, from 1 (never) to 5
(always). Initially, the authors identified 5 scales in the instrument
(emotional support, informational support, instrumental support, positive
social interaction, and affective support). In subsequent validations, authors
such as Revilla, Luna, Bailón and Medina (2005) find
only 3 factors. In this study, three factors arising from the factor analysis
are taken as reference, which correspond to: Factor 1 “emotional /
informational support” (items 3, 4, 8, 9, 13, 16, 17, 19); Factor 2 “positive
social interaction and affective support” (items 6, 7, 10, 11, 14, 18, 20) and
Factor 3 “instrumental” (items 2, 5, 12, 15). The Bartlett sphericity test
(Bartlett = 1124.5; gl = 171; p = 0.00) and the
Kaiser-Meyer-Olkin coefficient (KMO = 0.885) assumed adequate values. The fit
indices of this model are: X2 / gl = 1.936; p = .00;
CFI = 0.89; NFI = 0.83; GFI = 0.99; AGFI = 0.99; SRMR = 0.0497). In our sample,
Cronbach's alpha reliability for the scale of 0.943 was found; 0.926 for factor
1, 0.890 for factor 2 and 0.853 for factor 3, values similar to other studies
carried out (Londoño et al., 2012; Revilla et al.,
2005). CFI = 0.89; NFI = 0.83; GFI = 0.99; AGFI = 0.99; SRMR = 0.0497). In our
sample, Cronbach's alpha reliability for the scale of 0.943 was found; 0.926
for factor 1, 0.890 for factor 2 and 0.853 for factor 3, values similar to
other studies carried out (Londoño et al., 2012;
Revilla et al., 2005). CFI = 0.89; NFI = 0.83; GFI = 0.99; AGFI = 0.99; SRMR =
0.0497). In our sample, Cronbach's alpha reliability for the scale of 0.943 was
found; 0.926 for factor 1, 0.890 for factor 2 and 0.853 for factor 3, values
similar to other studies carried out (Londoño et
al., 2012; Revilla et al., 2005).
The sociodemographic variables questionnaire collected the following
variables: gender, age, length of stay in the UTIGPA, current partner,
coexistence, nationality, employment status and educational status. With regard
to gender, no person was defined as an alternative gender, so two groups were
differentiated (trans men and women or cisgender). Age was subsequently divided
into two groups: 26 years or younger and older than 26. The current partner
variable was categorized dichotomously: yes or no. Coexistence was divided into
the following categories: family of origin, extended family, couple, alone and
with roommates. Nationality was divided into two dichotomous categories,
Spanish versus foreign. The employment situation was divided into three
categories: active, unemployed / retired / pensioner and student. Finally, the
educational situation variable was grouped into three categories: compulsory
education, high school or equivalent studies, and university education. The
variable length of stay in the UTIGPA for trans people was divided into two
categories: less than a year or more than a year.
Process
Data was collected in person with UTIGPA users. For this, scheduled
consultations with clinical psychology or endocrinology were used.
The control group was selected by snowball sampling. Informed consent
was applied, as well as the two instruments. It was applied mainly on paper (n
= 30) although the application was also facilitated through an online survey,
which was used in 33.3% of cases (n = 15). In this cisgender data collection
procedure, two subjects identify as trans and are included in the case sample
(trans people).
Ethical aspects
National and international ethical standards have been met.
Authorization was obtained from the Research Committee of the Health Service of
the San Agustín de Avilés
University Hospital and the informed consent of the users.
Statistical analysis
For data analysis, the statistical package SPSS version 22.0 and the
Factor 7.00 program were used. In the first place, a factor analysis was carried
out to establish the number of factors. Subsequently, internal consistency
estimates were made for the different scales with Cronbach's alpha. Descriptive
and frequency analyzes were performed for the sociodemographic data for the
sample and the control group. Comparisons of means were made using Student's t
tests for the comparison of social support and its dimensions in the sample and
control group, for various sociodemographic variables, as well as to evaluate
the differences in the size of the social network. Analysis of variance (ANOVA)
with post-hoc tests (Bonferroni) was carried out for the work situation,
coexistence, time in the UTIGPA and training situation. in the different
dimensions of social support and total social support in the sample. The effect
size was calculated using the formula of Cohen (1988).
RESULTS
Sociodemographic data for the case and control sample are included in
Table 1.
Statistically significant differences were found in nationality and
educational status. All cisgender people have Spanish nationality, unlike trans
people. Regarding the educational situation, no cisgender person has only
compulsory training and the percentage of people with a university education is
much higher (68.1%) than in transgender people (16.7%).
The results found for social support are included in Table 2. No
statistically significant differences were found either in the three dimensions
or in social support considered globally.
Nor are statistically significant differences found in the size of the
social network, that is, in structural social support (t (79) = -. 346; p =
.730), among trans people (M = 7.14; SD = 5.478) and cisgender people (M =
7.51; SD = 4.203). Nor were there significant differences regarding the size of
the social network in cisgender men (M = 6.89; SD = 3.98) and cisgender women
(M: 8.42; SD = 6.27). The different types of social support and total social
support in trans people were analyzed in relation to the sociodemographic
variables.
No differences were found in total social support (t (34.67) = .342; p =
7.34) between trans men (M = 4.034; SD = .675) and trans women (M = 3.97; SD =,
889) or in its dimensions. The results according to age groups are included in
Table 3. Differences were only found in the instrumental support dimension
between young people and those over 26 years of age. The effect size was medium
(r = 0.577). The same t-tests are carried out to check if the results by age
groups also occur in structural social support. No significant differences [t
(16.204) = -. 117; p = .908] were found between the social network of young
people (M = 7.04; SD = 4.13) and older people (M = 7.31; SD = 7.50).
The analyzes of variance for the variables works
situation, training and time spent in the UTIGPA are included in Table 4.
Statistically significant differences were found in
terms of employment status in instrumental social support (F (2) = 4.190; p = .024).
Post-hoc comparisons showed that there were significant differences in
instrumental social support between active people (M = 4.38; SD =. 625) and
unemployed or retired and pensioners (M = 3.25; SD = 1.587); p = 0.34) and
between the unemployed and students (M = 4.312, SD = .6800) with a p = 0.41.
The results for the couple variable are included in Table 5.
Regarding the partner, statistically significant
differences have been found in social support and in several of its dimensions.
Specifically, in emotional-informational support and in positive social
interaction-affective support, both dimensions with a medium effect size.
To know if the statistically significant results are replicated in the
control group, the same tests are performed. No differences were found in
instrumental support by age group of young people (M = 4.22; SD: .595) and
older [M = 4.07, SD = .972; t (40.52) = .658; p = .51]. In the analysis of
variance, no significant differences were found with respect to the employment
situation in instrumental social support [F (2) = 1.36; p = .269] or in total
social support [F (2) = .37; p = .964]. Regarding having or not having a
partner in relation to the dimensions of social support, there are significant
differences in the dimension of positive social interaction-affective support
between people who have a partner (M = 4.30; SD = .697) and people who do not
have a partner (M = 3.85; SD = .715, t (42.98) = 2.157; p = .037). The effect
size in this case is r = 0.30.
DISCUSSION
The first objective of this study was to evaluate social support and its
dimensions in trans people and to make a comparison with the results in
cisgender people. No significant differences were found between the perceived
social support between both groups. The scarce previous literature did establish
differences between social support between trans and cis, where transsexual
people perceived lower levels of social support than the rest of the population
(Basar et al., 2016; Boza and Nicholson, 2014; Davey
et al. , 2014; Tebbe and Moraldi,
2016). Possible explanations for these results could be related to
characteristics of the sample. While in other investigations the surveys of the
broadest and most heterogeneous transsexual population are carried out (Budge,
Adelson and Howard, 2013), the present study is limited, almost entirely, to
people who attend a specific gender identity unit. Trans people who already
have health care probably have greater social support and other living
conditions than those who do not attend (Arcelus, Claes, Witcomb, Marshall and Bouman, 2016). Another possible explanation is that their
perception of support from their environment has increased based on less
discrimination in it. Improvements in visibility have been found in the period
from 2009 to 2012 in countries such as the United States (James et al., 2016).
Also, the fact that there are no differences between the perception of support
between people who attend a specialized unit and cisgender people, could
rethink the supportive role that this type of unit has in trans people.
Another objective was to analyze social support taking into account
different sociodemographic variables. No differences by gender have been found
in this work. Previous studies indicated that there could be differences
between men and women due to differences in gender socialization, the result of
which is that men perceive or have less social support than women (Davey et
al., 2014; Ellis and Davis, 2017). However, the
results of this study do not find differences by gender or in the comparison of
the cisgender population and trans or in the
population of trans people, according to the results of other research (Basar et al., 2016). Regarding other possible
characteristics that could affect social support, no differences have been
found for variables such as coexistence, educational situation and time in the
UTIGPA.
Other sociodemographic variables have shown significant differences in
dimensions of social support. Differences have been found between age groups
(people aged 26 or younger and older than that), having a partner or not, and
by employment status. In the first place, differences taking into account age
are reflected in instrumental social support, that is, in the perception they
have about the availability of material, instrumental or assistance help. In
this study, younger people perceive a greater amount of instrumental social
support than older people, only in the case of the trans population. Previous
literature in the general population shares this trend for social support, where
the perception of it decreases with age (Jensen et al., 2014). This specific
dimension of social support has been studied for populations in situations of
discrimination, but it has not been specifically found in trans people. Studies
of the population with social stigma, such as people with HIV, found that a
greater perception of material or assistance help was associated with a
reduction in stress due to stigma (Earnshaw et al., 2015). Differences have
also been found in instrumental social support depending on the employment
situation. Higher levels of social support have been found in active people
than in unemployed people, and higher in students than in unemployed people.
These differences are not thus found in instrumental social support in cisgender
people, nor are differences found in other types of support. No specific
literature has been found on instrumental social support in transgender people
or how the employment situation or age could affect their perception. Future
research could take these characteristics into account in its studies.
The couple variable has been the one that shows the most differences in
perceived social support in trans people. Higher levels of support have been
found if one has a current partner compared to not having a partner, for two
scales of social support (emotional-informational and positive social
interaction-affective support) as well as for total social support.
Social-emotional-informational support is a factor that includes two types of
emotional support (positive expression of affection, empathic understanding and
expression of emotions) and informative (receiving advice, information and
guidance). The second factor in the questionnaire that shows significant
results is positive social interaction (people for leisure / fun) and affective
support (expression of love and affection). In cisgender people there are only
differences in positive social interaction-affective support, but not in total
social support and emotional-information support, as in trans people. Although
scarce, these results are consistent with previous research. Meier et al.
(2013) also found higher levels of social support in transgender people with a
partner than in single people. The couple has been studied in other sexual
minorities, such as same-sex couples, not so for trans couples (Ellis and
Davis, 2017; Kurdek, 2006). One possible explanation
is that having an affective partner is intrinsically related to these
dimensions of support due to their content.
Taking into account the mental health consequences proposed by the
minority stress theory and how social support can be a buffer against
psychological stress, the results of this research seem encouraging. However,
it is necessary to take into account the diverse results in social support based
on the sociodemographic variables examined in subsequent studies.
Finally, it is worth highlighting the limitations of this research for
the correct interpretation of the results. In the first place, in this study
the sample size is limited due to the difficulties of access to the population
and the conditions of this work itself. In addition, it is a very specific
population of people who attend the services of the UTIGPA. On the other hand,
the trans population is not widely represented or investigated due to its
discrimination situation or other issues in the scientific literature (Factor
and Rothblum, 2007). While other minorities of the
LGBT community, such as gays, lesbians, there are a greater number of
publications (Russell and Fish, 2016), trans people have not been included too
much so far.
As it is an exploratory study and in view of the findings, topics of
interest can be established for further research. It would be convenient to
expand studies on social support for this population group and, in particular,
on its different dimensions. Also delve into characteristics such as age,
partner and employment situation, which in this study have been revealed of
interest. Considering previous findings on the influence of social support on
mental health, it is urged to continue in this line of research.
ORCID
Nuria Vazquez Lopez https://orcid.org/0000-0001-6403-8022
Maria Fernandez Rodriguez https://orcid.org/0000-0002-1123-8220
Elena Garcia Vega https://orcid.org/0000-0002-8754-9949
Patricia
Guerra Mora https://orcid.org/0000-0003-0083-6513
FUNDING
The present study has been self-financed by the
author.
CONFLICTS OF INTEREST
This study does not present a conflict of interest.
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