Comparison of Depression and Suicidal Ideation in Individuals with Gender Dysphoria with and without Sex Reassignment Surgical Intervention

Gender dissatisfaction refers to a type of discomfort that is associated with a mismatch between a person's experienced or expressed gender and their assigned gender. Although not all people experience discomfort as a result of this mismatch, many people experience discomfort in the absence of appropriate physical therapy interventions using hormones and/or surgery. Gender dysphoria is a condition associated with marked incongruence between the expressed or experienced gender and the assigned gender that is present at birth. The feeling of what gender we are is very important and in transgender people, it causes them to continuously seek to acquire the physical and anatomical characteristics of the opposite sex. These people always consider themselves as another person, who has been captured and arrested in the prison of the body of the opposite sex. They are usually disgusted by the appearance of their genitals. The idea that they have to stay in this body for the rest of their lives makes them feel sad, frustrated, and angry, and finally, the depression of these patients becomes the basis for them to commit suicide as a way to get rid of this dissatisfaction.Major depressive disorder is one of the most common mental disorders, which has the highest lifetime prevalence (about 7%) among mental disorders. Depression can be in various physical or mental disorders as a sign or symptom that consists of symptoms and is secondary to an underlying disorder, or it can be a special mental disorder. In depression symptoms, one can witness states such as slowness of thinking, decrease in interest and pleasure, decrease in purposeful physical activity, feelings of guilt and despair, and problems in appetite and sleep. Major depression represents a classic disease in the class of depressive disorders, characterized by discrete episodes of at least two weeks, and includes clear changes in effect, cognition, neuro-vegetative functions, and inter-episode improvement. During this period, either a depressed mood or a lack of interest or pleasure is seen in almost all activities. Suicidal thoughts include mental preoccupation with nothingness and the desire to die, without having a practical aspect.Negative feelings about the transgender community and a person's fear of being identified as a convert and its impact on life are directly related to depression. Also, research showed that the prevalence rate of mood disorders in this population is 33%, this figure indicates the high prevalence of many mood problems in this group. Various pressures and experiencing behaviors such as ridicule, violence, abuse, and rejection, along with cultural problems, social, economic, and legal obstacles for these people lead to an increase in the risk of depression or suicidal thoughts and finally committing suicide. Based on the statistics available worldwide, between 40 and 60 percent of transgender people commit suicide or suffer from severe depression due to the pressure caused by the conflict between their physical and mental identities. Adolescents and adults with gender dissatisfaction before gender change are at an increasing risk of suicidal thoughts, suicide attempts, and ultimately successful suicide. But even after gender change, the level of adaptation may be different and the risk of suicide still exists. Our primary goal was to examine the effect of sex reassignment surgery on individuals with Gender Dysphoria. We recruited individuals with Gender Dysphoria who underwent or didn’t undergo sex reassignment surgery to achieve our objectives.

Convenient sampling was used to select 66 individuals with Gender Dysphoria with and without sex reassignment surgical intervention. To assess the impact of sex reassignment intervention on depressive symptoms and suicidal attitude, Beck's depression inventory questionnaire (BDI-II), Beck suicidal attitude questionnaire (BSSI), and socio-demographic questions were used.

The results show that in individuals with gender reassignment surgery, depression score was significantly lower t (64) =-6.837, P=0.001.Statistical analysis for variation in demographic characteristics demonstrated that depression score was negatively correlated with the level of education t (64) =02.58, P=0.012. There was a positive correlation between the BDI-II’s questionnaire and the BSSI’s questionnaire r=0.572, P=0.001.

Although this paper can be considered an important starting point for understanding the importance of suicide in the population of people suffering from gender dissatisfaction. But future research in this field is necessary to explain the specific characteristics and indicators related to suicide. In this research, some effective factors in suicidal thoughts and depression in people with gender dissatisfaction were investigated. It is recommended that future researchers investigate all the factors involved with an emphasis on Iranian society and culture. For example, the role of gender function, life in old age, and economic and livelihood function after surgery in Iranian society is still unknown. Research about the factors affecting the increase in the risk of suicide, along with the factors that prevent it, can lead to the creation of a reliable reference that meets the needs of the Iranian society for effective intervention in this issue. Creating a suitable and evidence-based authority can lead to identifying and explaining key ways of intervention to prevent the risk of suicide in this group, increasing resilience, informing families, and creating a successful support and service delivery mechanism. Selecting a suitable candidate for sex reassignment surgery among individuals with Gender Dysphoria reduces the risk of developing depressive symptoms. Furthermore, education positively impacts the attitude toward Gender Dysphoria and reduces depressive symptoms.