Transgender Adults' Public Bathroom-Related Stressors and Their Association with Depressive Symptoms: A Nationwide Cross-Sectional Study in South Korea

Purpose: This study assessed public bathroom-related stressors and examined their association with depressive symptoms, suicidal ideation, and suicide attempts among transgender individuals in South Korea. Methods: We analyzed data from a nationwide cross-sectional survey of 557 South Korean transgender adults (age range: 19-60 years) conducted in October 2020. Participants were asked nine yes/no questions about whether they have ever experienced public bathroom-related stressors within the last 12 months. The responses were classified into three categories: "never experienced,""avoidant behaviors alone,"and "victimization experiences."Results: The proportions of participants who reported "avoidant behaviors alone"and "victimization experiences"related to public bathroom use were 47.0% and 23.0%, respectively. Past-week prevalence of depressive symptoms was 70.7%, and past 12-month prevalence of suicidal ideation and suicide attempts was 63.0% and 19.8%, respectively. Compared with participants who "never experienced"public bathroom-related stressors, the prevalence of depressive symptoms was statistically significantly higher among those who reported "avoidant behaviors alone"(adjusted prevalence ratio [aPR] = 1.22; 95% confidence interval [CI] = 1.07-1.40) and "victimization experiences"(aPR = 1.18; 95% CI = 1.01-1.38), after adjusting for covariates, including gender perception by others. In the same adjusted model, however, no significant associations of public bathroom-related stressors with suicidal ideation and suicide attempts were observed. Conclusions: Given these findings showing that public bathroom-related stressors may negatively influence transgender adults' depressive symptoms, efforts are necessary to ensure their safe access to public bathrooms in South Korea. Furthermore, policy-level interventions are needed to eliminate stigma against transgender individuals, given that public bathroom-related stressors could be considered an indicator of broader anti-transgender stigma.