Depression and associated factors among gender-diverse individuals in four Southeast Asian countries

The prevalence of depression among gender-diverse individuals in Asia is notably high, with contributing factors differing across various locations and subgroups within the gender-diverse community. This research aimed to identify both universal and context-specific factors associated with depression through country-specific analyses, offering comparative insights to inform mental health strategies and policy measures for transgender and gender-diverse populations in this region. We conducted a cross-sectional , online survey of transgender and gender-diverse individuals in Thailand, Indonesia, the Philippines, and Singapore between November 2023 and January 2024. The study utilized the Patient Health Questionnaire-9 (PHQ-9) to assess the severity of depressive symptoms and the likelihood of depression. We also examined the relationship of these factors with sociodemographic characteristics, openness about gender identity, experiences of violence, living conditions, educational or occupational status, relationship status, and gender-related identities. The PHQ-9 showed strong internal consistency (α = 0.90) across countries, with depressive symptoms scores varying significantly across social and structural factors. In multivariable models accounting for demographic, identity, and social factors, exposure to violence consistently was associated with higher odds of probable depression across all four countries (Thailand aOR = 4.39; Indonesia aOR = 2.82; Philippines aOR = 1.87; Singapore aOR = 1.91). Indonesians reluctant to disclose their sex assigned at birth faced a significantly higher risk (aOR = 7.81, P = .008). In the Philippines, non-binary identity (aOR = 19.96, p = .001), unspecified gender identity (aOR = 13.18, p = .003), and unspecified sexual orientation (aOR = 2.52, p = .032) were linked to increased odds, while in Singapore, trans women had higher odds of probable depression compared to women (aOR = 3.48, p = .040). This study offers cross-national evidence of significant mental health disparities among sexual and gender minority groups in Southeast Asia. Violence was was associated with higher odds of probable depression across Thailand, Indonesia, the Philippines, and Singapore, highlighting the important role of structural stigma and victimization as factors associated with psychological outcomes. These findings emphasize the need to move beyond generalized assumptions about gender-diverse mental health in the region. not applicable.