Discrimination keeps transgender people awake at night: A nationwide cross-sectional survey of 583 transgender adults in South Korea

Objectives: We sought to investigate the association between transgender identity discrimination and sleep problems among transgender people in South Korea (hereafter, Korea), and whether family support for transgender identity plays a protective role in the association. Design & setting: We analyzed a nationwide cross-sectional survey of 583 Korean transgender adults which was anonymously conducted through an online platform. Measurements: Transgender identity discrimination was assessed using a single-item question. Sleep problems were defined as having any of the following problems: poor sleep quality, short sleep duration, and use of alcohol or sleep medications to fall asleep. Family support for transgender identity was classified into 3 groups as follows: not supportive, supportive, and unaware of participants’ transgender identity. Results: Of 583 participants, 383 (65.7%) experienced transgender identity discrimination over the past 12 months. Participants who experienced transgender identity discrimination were 1.48 times (95% confidence intervals [95% CI] = 1.19-1.83) more likely to have any sleep problems, compared to those who never experienced transgender identity discrimination. When stratified by family support level, the associations between transgender identity discrimination and sleep problems remained statistically significant only among those with a family unsupportive (adjusted prevalence ratio [aPR] = 1.64; 95% CI = 1.16-2.31) or unaware (aPR = 1.60; 95% CI = 1.01-2.52) of participants’ transgender identity. However, the association was not statistically significant among those with a supportive family (aPR = 1.41; 95% CI = 0.96-2.07). Conclusion: Given transphobic environments in Korea, legal and institutional efforts are required to reduce transgender identity discrimination (eg, anti-discrimination laws) as well as to build trans-specific family resources.