Violence linked to higher odds of depression among gender-diverse people in four Southeast Asian countries

A cross-sectional online survey of transgender and gender-diverse individuals in Thailand, Indonesia, the Philippines and Singapore has found that exposure to violence was consistently associated with higher odds of probable depression in every country studied, with adjusted odds ratios ranging from 1.87 in the Philippines to 4.39 in Thailand. The study, published in Discover Mental Health as an open-access research article, was conducted between November 2023 and January 2024 and is being shared as an early, citable version of record subject to further edits.

The researchers used the Patient Health Questionnaire-9, a nine-item screening instrument, to assess the severity of depressive symptoms and the likelihood of depression. The measure showed strong internal consistency across the four countries, with a Cronbach’s alpha of 0.90. Alongside depressive symptoms, the survey examined relationships with sociodemographic characteristics, openness about gender identity, experiences of violence, living conditions, educational or occupational status, relationship status, and gender-related identities.

The study’s stated aim was to identify both universal and context-specific factors associated with depression through country-specific analyses, in order to offer comparative insights that could inform mental health strategies and policy measures for transgender and gender-diverse populations in the region. The authors note in the background that the prevalence of depression among gender-diverse individuals in Asia is notably high, and that contributing factors differ across locations and subgroups within the gender-diverse community.

In multivariable models that accounted for demographic, identity and social factors, exposure to violence was associated with higher odds of probable depression across all four countries. The adjusted odds ratios were 4.39 in Thailand, 2.82 in Indonesia, 1.87 in the Philippines and 1.91 in Singapore. Because the analysis is cross-sectional, the data show an association rather than a demonstrated causal effect of violence on depression.

Several country-specific patterns emerged from the models. In Indonesia, participants who were reluctant to disclose their sex assigned at birth faced significantly higher odds of probable depression, with an adjusted odds ratio of 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 of probable depression.

In Singapore, trans women had higher odds of probable depression compared with women, with an adjusted odds ratio of 3.48 (p = .040). The authors report that depressive symptom scores varied significantly across social and structural factors, underscoring that the correlates of depression were not uniform across the four countries or across subgroups within the gender-diverse community.

In their conclusion, the researchers describe the work as offering cross-national evidence of significant mental health disparities among sexual and gender minority groups in Southeast Asia. They emphasize that the consistent association between violence and probable depression across Thailand, Indonesia, the Philippines and Singapore highlights the role of structural stigma and victimization as factors associated with psychological outcomes in these populations.

The authors caution against generalized assumptions about gender-diverse mental health in the region, arguing that the country-specific findings demonstrate the need for approaches tailored to local contexts and subgroups. The survey was conducted as an online study, which is a limitation worth noting when considering how representative the sample is of transgender and gender-diverse populations more broadly, and the reported associations are drawn from a single survey period rather than longitudinal follow-up.

As an early-shared, peer-reviewed accepted article, the findings are citable and carry a permanent DOI, but the publisher notes that this version is subject to further edits and will be replaced automatically by the final Version of Record. The study did not include a clinical trial component; the clinical trial number is listed as not applicable.

Subject of Research: Depression and its associated factors among transgender and gender-diverse individuals in Thailand, Indonesia, the Philippines and Singapore

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

Article References: Phuengsamran, D., Darawuttimaprakorn, N., Krutthai, N., Yangfa, L., Buenviaje, F. V., Phromsombat, S., Riyansyah, R., Eiamcharoen, C., & Ford, K. (2026). Depression and associated factors among gender-diverse individuals in four Southeast Asian countries. Discover Mental Health. https://doi.org/10.1007/s44192-026-00633-y

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00633-y

Keywords: depression, gender-diverse individuals, transgender health, Southeast Asia, PHQ-9, violence exposure, cross-sectional survey, mental health disparities, structural stigma, Thailand, Indonesia, Singapore