The factors influencing the psychological distress of transgender women in Shandong, China: a cross-sectional study

BACKGROUND: As a group at high-risk for acquired immune deficiency syndrome (AIDS) infection, the psychological distress of transgender women cannot be ignored while preventing and controlling AIDS risks. Transgender women are a vulnerable group, and their psychological distress deserves attention. The purpose of this study was to evaluate the psychological distress of transgender women and further determine the influences of factors on the psychological distress of transgender women. METHODS: From March 2021 to August 2021, a cross-sectional survey was conducted in Shandong province, China. Data were collected by a questionnaire designed for transgender women, and the GHQ-12 scale was used to measure their psychological distress. The questionnaire combined sociodemographic characteristics, HIV/AIDS cognition, related behaviors, substance abuse, social support, gender identity and other factors. Univariate logistic regression and multivariate logistic regression models were used to explore the psychological factors of transgender women. RESULTS: In this study, the rate of transgender women with psychological distress was 20.08%. Earned monthly income between 10,000–15,000 yuan (OR:0.16, 95% CI:0.06–0.45) and a monthly income greater than 15,000 yuan (OR:0.07, 95% CI:0.01–0.43) were protective factors in the psychology of transgender women. Transgender women who never disclosed sexual orientation and identity (OR: 0.19, 95% CI: 0.06–0.58), who only disclosed their sexual orientation and identity to families or friends (OR: 0.41, 95% CI: 0.18–0.93) were also less likely to have psychological distress. Additionally, transgender women who did not desire to be identified with their sexual orientation and identity (OR: 3.31, 95%CI: 1.08–10.16) and who reported that the Internet did not play an essential role in helping determine sexual orientation (OR: 5.96, 95% CI: 2.91–12.20) were more likely to have psychological distress. CONCLUSION: Transgender women were at risk of psychological distress. Earning more money can help transgender women's psychological health. When formulating measures for transgender women, we should pay attention to enhance social inclusion and social acceptance of their gender identity and sexual orientation. Strengthening the role of the internet in transgender women's confirmation of sexual orientation and improving the social acceptance of transgender women will have a positive impact on the psychological status of transgender women. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13357-9.