Tesis

Faktor-Faktor yang Memengaruhi Terjadinya Gangguan Depresi dan Ansietas serta Aksesibilitas Layanan Kesehatan Jiwa pada Populasi Transgender Di Indonesia = Factors Associated With Depression, Anxiety and Accessibility for Mental Health Services in Transgender Population in Indonesia.

Latar Belakang: Jumlah transgender di Indonesia diperkirakan terus meningkat hingga mencapai sekitar 3% populasi atau 7,5 juta individu. Survei menunjukkan bahwa populasi LGBT adalah salah satu yang paling tidak disukai di Indonesia dan rentan mengalami eksklusi sosial. Dibandingkan dengan populasi umum, populasi transgender memiliki risiko lebih tinggi mengalami gangguan jiwa seperti depresi berat (hampir 4 kali lipat) dan kecemasan (hampir 3 kali lipat) sedangkan risiko kebutuhan layanan kesehatan jiwa yang tidak terpenuhi meningkat 2,4 kali lipat pada populasi transgender. Hambatan akses layanan kesehatan jiwa, termasuk diskriminasi dari penyedia layanan, masalah biaya, dan ketidaknyamanan membicarakan emosi dapat memicu risiko swamedikasi, munculnya komorbid psikiatri, timbulnya gejala serta hendaya fungsi yang lebih berat, penurunan kualitas hidup dan produktivitas populasi. Penelitian ini bertujuan untuk memahami faktor-faktor yang memengaruhi kebutuhan serta persentase aksesibilitas layanan kesehatan jiwa pada populasi transgender di Indonesia. Metode: Penelitian dilakukan dengan desain potong lintang dari Oktober 2023-Januari 2024. Kuesioner disebarkan secara daring pada individu transgender yang tergabung dalam komunitas transpuan dan transpria. Subjek mengisi kuesioner demografis, Rosenberg SelfEsteem Scale (RSES) untuk menilai self-esteem, Brief COPE untuk menilai koping, pengukuran depresi dan ansietas dengan instrumen Kuesioner Kesehatan Pasien-9 dan Generalized Anxiety Disorder-7 dan pertanyaan terbuka terkait aksesibilitas layanan kesehatan jiwa diberikan kepada subjek. Hasil: Dari 155 subjek, mayoritas merupakan transpuan, tingkat pendidikan tinggi dan pendapatan rendah, belum melakukan transisi. Diperoleh proporsi gangguan depresi dan ansietas pada populasi transgender di Indonesia sebesar 25,8% dan 52,3%. Faktor self-esteem (p < 0,001), koping (p < 0,001), dan dukungan keluarga (p = 0,03) berhubungan dengan gangguan depresi. Untuk gangguan ansietas, faktor riwayat transisi gender (p = 0,01), asuransi kesehatan (p = 0,04), self-esteem (p < 0,001) dan koping (nilai p < 0,001) berhubungan secara statistik. Dari seluruh subjek yang mengalami gangguan depresi dan ansietas, hanya 40% dan 32,1% subjek yang mengakses layanan kesehatan jiwa. Tidak terdapat faktor internal maupun eksternal individu yang berhubungan dengan aksebilitas layanan kesehatan jiwa. Dari data tambahan penelitian, didapatkan pengalaman negatif, kekhawatiran akan stigma dari tenaga kesehatan dan masalah biaya yang disebutkan subjek sebagai tantangan dalam mengakses layanan kesehatan jiwa. Pembahasan: Prevalensi gejala ansietas dan depresi relatif tinggi, sedangkan aksesibilitas layanan kesehatan jiwa relatif rendah pada populasi transgender di Indonesia. Intervensi kesehatan jiwa dapat ditujukan untuk memodifikasi faktor internal dan eksternal yang berhubungan dengan gangguan depresi dan ansietas serta meningkatkan layanan kesehatan jiwa yang ramah transgender.
Kata Kunci: ansietas, aksesibilitas, depresi, layanan kesehatan jiwa, transgender.


Background: The number of transgender individuals in Indonesia is estimated to be steadily increasing, reaching about 3% of the population or approximately 7.5 million individuals. Surveys indicated that the LGBT population is one of the most disliked groups in Indonesia and is vulnerable to social exclusion. Compared to the general population, transgender individuals are at a higher risk of experiencing mental disorders such as major depression (almost 4 times higher) and anxiety (almost 3 times higher), while the unmet need for mental health services is 2.4 times higher among the transgender population. Barriers to accessing mental health services, including discrimination from service providers, cost issues, and discomfort in discussing emotions, may cause self-medication, the emergence of psychiatric comorbidities, more severe symptoms and functional impairment, and a decline in quality of life and productivity. This study aims to understand the factors affecting the need and accessibility of mental health services among the transgender population in Indonesia. Methods: The study was conducted with a cross-sectional design from October 2023 to January 2024. Questionnaires were distributed online to transgender individuals who are part of the trans women and trans men communities. Subjects completed demographic questionnaires, the Rosenberg Self-Esteem Scale (RSES) to assess self-esteem, the Brief COPE to assess coping, measurements of depression and anxiety using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, and open-ended questions regarding mental health service accessibility. Results: Of the 155 subjects, the majority were trans women, with high educational levels and low incomes, and had not undergone transition. The proportions of depression and anxiety disorders among the transgender population in Indonesia were found to be 25.8% and 52.3%, respectively. Factors such as self-esteem (p < 0.001), coping (p < 0.001), and family support (p = 0.03) were associated with depression. For anxiety disorders, factors such as gender transition history (p = 0.01), health insurance (p = 0.04), selfesteem (p < 0.001), and coping (p < 0.001) were statistically significant. Among all subjects with depression and anxiety disorders, only 40% and 32.1% accessed mental health services. There were no internal or external factors associated with the accessibility of mental health services. Additional research data revealed that negative experiences, concerns about stigma from healthcare providers, and cost issues were mentioned by subjects as challenges in accessing mental health services. Discussion: The prevalence of anxiety and depression symptoms is relatively high, while the accessibility of mental health services is relatively low among the transgender population in Indonesia. Mental health interventions should aim to modify the internal and external factors associated with depression and anxiety and enhance transgender-friendly mental health services.
Keywords: anxiety, accessibility, depression, mental health services, transgender.