Unveiling mental health challenges: Investigating depression, anxiety and stress among transgender individuals in Sindh, Pakistan
Authors: Mansoori Naveed , Ansarie Mahad , Mubeen Syed Muhammad , Kanwal Uzma 
Published: February 2025

Purpose
Transgender individuals are more susceptible to psychological distress and mental health issues. The purpose of this study is to determine the prevalence and associated factors of depression, anxiety and stress among individuals from the transgender community.

Design/methodology/approach
This cross-sectional study was conducted from March to December 2022 among the transgender community in Karachi and Hyderabad. A standardized, self-administered DASS-42 questionnaire was used, and a non-probability convenient sampling technique was used. The frequency and percentages of variables were calculated. The Cronbach’s alpha coefficient was used to evaluate the internal consistency of the items within the subscale. The impact of socio-demographic factors on depression, anxiety and stress levels was assessed using multivariate ordinal logistic regression.

Findings
Out of total 352 transgender individuals, the majority of them were experiencing extremely severe depression with 187 (53.1) affected. Additionally, 267 (75.9) individuals were dealing with extremely severe anxiety and 167 (47.4) facing severe stress. The mean depression score was 26.3 ± 8.6, with stress following closely at 26.2 ± 7.9 and anxiety at 23.5 ± 8.3. The scale had excellent internal consistency, as shown by a Cronbach’s alpha of 0.93. Male sex had a 3.48 (95% C.I: 1.34–9.05) fold higher likelihood of experiencing anxiety compared to females.

Research limitations/implications
One of the limitations of this study is the use of a non-probability convenient sampling technique and the collection of data exclusively from two cities of Pakistan (Karachi and Hyderabad).

Practical implications
The study identified specific mental health challenges faced by transgender individuals in Sindh, enabling mental health professionals and policymakers to develop targeted interventions and counseling services. This includes advocating for mental health programs and anti-discrimination laws that address the unique stressors experienced by transgender individuals. Community awareness and support programs aimed at educating the public, reducing stigma and fostering acceptance of transgender individuals should be implemented to achieve better outcomes.

Social implications
he research can help raise awareness about the challenges faced by transgender individuals, fostering greater empathy and understanding among the general public. This may contribute to reducing societal stigma, prejudice and discrimination against the transgender community. The study can encourage efforts to create a more inclusive society where transgender individuals feel valued and accepted in family, educational and workplace settings. Thich research can also serve as a tool for advocacy, empowering transgender individuals to voice their concerns and demand their rights, which could lead to greater self-confidence and a stronger sense of community among transgender people.

Originality/value
This study revealed a significant prevalence of depression, anxiety and stress among transgender individuals. Regular assessment and implementation of appropriate measures should be conducted to promote their mental well-being. By actively engaging with transgender individuals, we can develop more effective strategies to meet their mental health needs and foster social integration and acceptance.