Discrimination in Workplace, Health Care, Family Settings and Mental Health among Transgender People in Sri Lanka

Despite numerous studies demonstrating high rates of discrimination and poor mental health among transgender people in Western countries, little research has been conducted on this population in Sri Lanka. As such, the primary objective of this study was to assess the prevalence of discrimination experienced by transgender people in the workplace, health care, and family settings. Additionally, we investigated the potential association between discrimination and adverse mental health outcomes, including current depression, anxiety disorders, and low self-esteem. In Galle, 100 transgender participants were recruited through snowball sampling and then completed the survey through face-to-face interviews. The survey consisted of five sections: sociodemographic information, mental health scales, and discrimination experience in the workplace, health care, and family settings. We reported the prevalence of discrimination and adverse mental health outcomes. We also estimated the prevalence ratios of current depression and anxiety disorder, which are associated with work inaccessibility and workplace discrimination, adjusting for age, education, and gender identity in separate Poisson regression models. The study found that school harassment (67%), workplace insults (63.5%), and work inaccessibility (47.4%) were the most commonly reported types of discrimination among transgender participants. Among them, the prevalence of current depression, anxiety disorder, and low self-esteem were 44%, 38%, and 81%, respectively. Furthermore, work inaccessibility was associated with a 16% increase in the prevalence of depression. Workplace discrimination, as measured by two categories (1 or 2 types of discrimination, ≥3 types of discrimination) was associated with greater prevalence (41%-56%) of depression and anxiety (22% - 46%) than non-discrimination, although all of those associations were not statistically significant. The high prevalence of discrimination against transgender people presented in the study highlights the urgent need for legislative changes to protect their rights. Future studies should aim to identify coping resources and develop evidence-based interventions to minimize the adverse mental health consequences of discrimination. It is expected that the researchers and transgender voluntary groups who had been involved in the study may transform the study results into meaningful real-world interventions.