ABSTRACT
BACKGROUND: Gender-affirming and supportive relations for transgender youth are considered protective in terms of mental health. AIM: To describe how transgender youth perceived changes in their gender expression, in the course of the gender-affirming path, and the effect of social connectedness and social support on depression and anxiety during the pandemic. METHODS: In this cross-sectional study, transgender youth completed an online survey developed to evaluate the perceived changes in gender expression and affirmation path that occurred during COVID-19 and the age-stratified lockdown. Furthermore, we aimed to investigate the effect of social connectedness and social support on depression and anxiety in this population during the pandemic. The participants completed the following scales: Social Connectedness Scale Revised (SCS-R), Multidimensional Scale of Perceived Social Support (MSPSS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI). The effect of lockdown on life conditions, gender expression, social and medical gender-affirming path, social connectedness, social support, depression, and anxiety levels were examined. Linear regression analyses were performed to evaluate the relationships between BDI and STAI scores and other variables. OUTCOMES: The relationship between the levels of perceived social connectedness, and social support, the pandemic-related changes in living conditions and depression and anxiety scores were calculated. RESULTS: A total of 49 transgender youth with a mean age of 20.53 ± 1.86 years were enrolled. Participants reporting discomfort at the place they live and who had difficulties concerning gender expression and affirmation had higher depression and anxiety scores and perceived lower social support from their family. Social connectedness score was a significant negative predictor of depression severity, whereas social connectedness and social support were both significant negative predictors of anxiety severity. CLINICAL IMPLICATIONS: Our results show increased adversity for transgender youth when connectedness with supportive people is diminished. During the COVID-19 pandemic, social connectedness and social support perceived by transgender youth are associated with better mental health. STRENGTHS AND LIMITATIONS: This is one of the first studies to evaluate the changes that occurred during the COVID-19 pandemic in transgender youth with relation to social support and connectedness, during an age-stratified lockdown. The main limitations were the small study size, skewed gender ratio and that the study sample came from a single gender clinic. CONCLUSION: As social connectedness and social support are significant predictors of depression and anxiety severity, special attention is needed to increase contact and support for transgender youth during the pandemic.