Transtorno depressivo maior e sofrimento social entre mulheres transexuais e travestis na região nordeste do Brasil.

Abstract

Major depressive disorder is one of the most prevalent mental disorders, and in transgender women and transvestis (TGW) it is even more prevalent than in the general population. Studies point out that interventions are needed to reduce psychosocial stressors and promote resilience among transgender people, which can prevent psychiatric symptoms. Notwithstanding the importance of approaching the issue from a health perspective in the biomedical sense, the complexity of the problem requires a deeper understanding of the issue. Within medical anthropology, there is the concept of social suffering that is closely related to the notions of injustice and vulnerability. Therefore, we aimed to investigate factors associated with symptoms of major depression disorder (SMDD) among TGW, as well as to identify experiences of social suffering according to the life stories narrated by the studied population. In order to achieve this, we used a mixed approach of quantitative and qualitative methods. For the production of the quantitative data we recruited 864 TGW from the cities of Salvador (166), Recife (350) and Fortaleza (348). The participants were recruited by the Respondent Driven Sampling (RDS) method. The outcome variable of the study - SMDD - was defined as per the Patient Health Questionnaire-9 (PHQ-9) and categorized into three groups: absence (score <5 points), mild/moderate (score 5-14 points) and moderately severe / severe depressive symptoms (score 15-27 points). Initially, an exploratory analysis was conducted followed by a confirmatory analysis with selection of the physical violence variable as the main exposure. Qualitative data were obtained through narrative interviews with 15 individuals out of the participants of the Salvador-BA site. The narratives were organized according to their points of connection and divergence, taking into account their singularities and the social context in which they were produced. In this process, we established four main axes of analysis - violence, social suffering, access to health services and strategies for (re)existing. In the exploratory analysis, mild/moderate SMDD was associated with history of sexual violence (OR= 2.06, 95%CI: 1.15-3.68), history of physical violence (OR= 2.09, 95%CI: 1.20-3.67), and negative perception of quality of life (OR= 2.14, 95%CI: 1.31-3.49). Moderately severe/severe SMDD was associated with history of sexual violence (OR=3.02, 95%CI: 1.17-7.77), history of physical violence (OR=.3.62, 95% CI:1.88-7.00), negative perceived quality of life (OR= 3.32, 95%CI:1.804-6.12), lack of current social support (OR=2.53, 95%CI: 1.31-4.88), and lack of social support in childhood (OR=2.17, 95%CI 1.16-4.05). In the confirmatory analysis The TGW who experienced physical violence were twice as likely to have mild/moderate major depressive disorder (OR=2.10, 95%CI 1.21-3.65), and almost four times as likely to have moderately severe/severe major depressive disorder (OR=3.80, 95% CI 1.99-7.25). The interviewees' narratives evidenced a heterogeneous multiplicity of realities that are permanently constituted with basis on the interaction between various human and non-human actors/actants. Following these entanglements - which constitute and are constituted every moment - allowed us to get close to forms of violence and suffering subjectivation that are not always explored in investigations involving TGW. Public policies are needed, which take into account the specificities of the population of TGW in the context of mental health and the diffuse and trivialized characteristic of social suffering. This is necessary in order to mitigate its effects, both through the weakening of unfavorable contexts and the stimulation of the possibilities of these women’s acting. Obviously, within the context of health care, by improving access to health services for TGW, but beyond that by improving access to health care within a broader perspective of health promotion and improved quality of life.