|Year : 2018 | Volume
| Issue : 2 | Page : 99-107
Molestation of the Bengali Hijras of India: Case of hiatus between social support and mental depression
Department of Geography, SSM College, Keshpur, Paschim Medinipur, West Bengal; Department of Population Studies, Fakir Mohan University, Balasore, Odisha, India
|Date of Web Publication||14-Nov-2019|
R-34/2 Saratpally, Dak Bungalow Road, Midnapore, Paschim Medinipur - 721 101, West Bengal
Source of Support: None, Conflict of Interest: None
Background: The Hijra community has evolved to form a unique subculture within the Indian society. They are particularly vulnerable to adverse mental health outcomes, such as depression. They are socially excluded and deprived from social well-being. Objectives: This study examined mental health outcomes, androgyny-related molestation, perceived social support, and predictors of depression among Bengali Hijras of India. Methodology: An exploratory cum descriptive research design with a nonprobability purposive sampling was adopted including the Center for Epidemiological Studies Depression Scale and the Multidimensional Scale of Perceived Social Support to assess depression. Results: Overall, 80% of Hijras reported at least one instance of molestation; around 69% approved depressive omens. Social support emerged as the most significant predictor of depressive syndromes (P < 0.05), whereby Bengali Hijras experiencing higher levels of overall perceived social support tended to approve lower levels of depressive syndromes. Discussion: Contrary to expectations, molestation did not reach statistical significance as an independent risk factor of depression (P = 0.058), whereas some other Hijra-specific predictors were found to be statistically significantly associated with depressive symptoms (P < 0.05). The pervasiveness of molestation, depression, and suicidal attempts represents a major health concern and highlights the necessity to facilitate prosperity-sensitive, health-care dispensation. Conclusion: The study suggests that perceptions of social support among Bengali Hijras have very important implications upon one's likelihood of experiencing depressive symptoms. Therefore, this study may support the implementation of programs or actions to improve the mental health of Bengali Hijras.
Keywords: Bengali Hijra, depression, molestation, third gender, transgender
|How to cite this article:|
Mal S. Molestation of the Bengali Hijras of India: Case of hiatus between social support and mental depression. J Mental Health Hum Behav 2018;23:99-107
|How to cite this URL:|
Mal S. Molestation of the Bengali Hijras of India: Case of hiatus between social support and mental depression. J Mental Health Hum Behav [serial online] 2018 [cited 2020 Mar 30];23:99-107. Available from: http://www.jmhhb.org/text.asp?2018/23/2/99/270983
| Introduction|| |
The transgender people of India are known as Hijras who have a gender expression that differs from their assigned sex. This group of people is socially excluded from our mainstream society, in terms of the attainment of an opportunity for a socially productive life. The term “Hijra” is generally used to describe those who transgress social gender norms in India. “Hijra” is often used as an umbrella term to signify individuals who defy rigid, binary gender constructions and who express or present a breaking and blurring of culturally prevalent stereotypically gender roles., Similarly, it is used as a combined term to describe a number of diverse and distinct gender identities including transgenders, transsexuals, third gender, cross-dressers, emasculated, hermaphrodites, eunuchs, impotent, androgynies, intersexed, drag queens and kings, bi-gendered, and gender-queer persons.,,,,,,,,,, While persons who identify their gender outside of the male–female binary have been documented throughout history and across many cultures, their social status, social roles, and the degree of social acceptance have varied across time and place.,,
Vulnerabilities, frustrations, and insecurities of Hijras have been historically overlooked by our society., Therefore, they are considered as a marginalized and stigmatized community., Nonetheless, as members of a gender minority, Hijra persons come across a number of experiences, including harassment, rejection, isolation, and societal and systematic discrimination, which can affect their health and emotional well-being. While it is clear that Hijra persons are particularly vulnerable to adverse mental health outcomes, such as depression, it is less clear that which factors are likely to increase or decrease the likelihood of a transgender person experiencing such mental health outcomes. Although it was historically assumed that discomfort or distress related to one's biological sex directly contributed to depression and suicidality, recent research suggests that the emotional distress experienced among Hijras or transgender persons arises in part from problems associated with living in an oppressive environment., A high proportion of Hijra persons are frequently exposed to gender-related victimization across various domains of their lives, with as many as 87% of respondents in the TranZnation survey reporting at least one instance of stigma or discrimination on the basis of their gender identity. Social isolation, rejection, and lack of overall support are commonly reported in the transgender literature. Depression and androgyny-related molestation, in turn, are associated with an increased risk of attempted suicide., Conversely, higher levels of perceived social support are associated with positive mental health outcomes among Hijra persons. Overall, it appears that reducing the instances of androgyny-based molestation and enhancing one's perceived availability and satisfaction with social support are critical factors in the promotion of positive mental health outcomes among Hijras. The study of depressive syndromes of Bengali Hijras has helped to develop accessible services that allow more social psychiatrists to get the help they need and deliver the services more efficiently and effectively. To enhance the clinical practice of psychiatrists with transgender people, it is necessary to have a clear understanding of what is understood by the concept of depression due to androgyny-related molestation and how it arises. This study may support a clear scenario for the necessity. Nonetheless, further research is required to understand the nature and impact of androgyny-related molestation and social isolation and rejection, in addition to understanding those contributors to depression among Hijra persons.
The purpose of the current analysis is to describe the prevalence of mental depression, androgyny-related molestation, and perceived social support among Bengali Hijras residing in India. In particular, the study aims at ascertaining the predictive value to which androgyny-related molestation and perceived social support contribute to current depressive symptoms. The term “androgyny-related molestation” is used within this study to refer to Bengali Hijras' experience of harassment, abuse, violence, and social and economic discrimination.
| Methodology|| |
In line with this methodological approach, research tools associated with both quantitative and qualitative approaches were combined to collect the data. These were interviews, questionnaires, field observation, and document analysis. An exploratory cum descriptive research design with a nonprobability purposive sampling including the snowball technique was adopted, to collect data from 51 Bengali Hijras having given their oral consent for the interview, in a span of 3 years from 2012 to 2015 at Kharagpur town in the state of West Bengal, India. The term “Bengali Hijras” refers to the Hijra community who primarily speak Bengali with regional dialects which is known as “Ulti vasa” (also known as “Gupti vasa”) along with their own language “Hijra Farsi” that has remained a secret customary language as the Hijra community is extremely protective of it. “Ulti vasa” is primarily spoken in West Bengal of India and in Bangladesh and has remained an esoteric language till recently.
To measure androgyny-related molestation, the participants were asked if they had ever experienced discrimination, harassment, or violence because of their status as a Hijra person. If they answered “yes” to this question, they were then asked to select from a list of 16 possible types of discrimination, harassment, and violence and any instances of androgyny-related molestation they had experienced. Social discrimination, harassment, violent incidents, and economic discrimination were assessed using the criteria included in the structured questionnaires. For the purpose of this study, an overall estimate of a person's experience of androgyny-related molestation was calculated by summing the instances of discrimination, harassment, violence, economic discrimination, health-care discrimination, and housing discrimination.
The Center for Epidemiological Studies-Depression Scale (CES-D) is a self-reported screening scale which is widely used as a measure of mental depressive symptoms because it has excellent sensitivity and reliability as a tool for diagnosing depression.,, It has become a standard measure of depressive symptomatology in adult persons. It correlates well with the clinical ratings of depression., However, currently, there are no reported cases of this scale being applied to Indian transgender as well as Bengali Hijras as a screening tool for depression. The CES-D is a 20-item measure which utilizes a 4-point Likert scale whereby respondents indicate that whether the item applied to them is along the range of 0 (rarely) to 3 (most of the time) during the past week. Four positively worded items are reverse coded to give a score ranging from 0 to 60, with higher scores indicating a greater frequency of depressive symptoms. A cutoff score of 16 has been widely used as a standard threshold indicating and classifying persons with depressive symptoms., The CES-D has demonstrated high internal reliability, ranging from 0.84 to 0.90, reported across various community and patient populations. The implementation of the CES-D for the present study has the potential to yield good results as documented by previous studies.,,,,
The Multidimensional Scale of Perceived Social Support (MSPSS) is a questionnaire designed to assess the current perceptions of social support across the following three domains: friends, family, and a significant other. For the purpose of this research, the total score was used, with higher scores indicating higher levels of perceived social support. The measure consists of ten statements (e.g., I can talk about my problems with my family), and respondents indicate how they feel about each statement using a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree). Results of the evaluation of assumptions for multiple regressions were satisfactory for normality and homoscedasticity of residuals, with no evidence of collinearity or multicollinearity. As such, no transformations were conducted, and instead, bivariate correlations were conducted using Spearman's rank correlation coefficient to accommodate the violation of normality. A preliminary evaluation of relationships between participant characteristics and depression, androgyny-related molestation and depression, and social support and depression was conducted using bivariate correlations. To identify factors independently associated with depression, it was conducted in a hierarchical multiple regression analysis including predictors that were significantly associated with depression in the bivariate analyses. All analyses were conducted using SPSS software version 20.0 (IBM Crop). The significance level was set at 0.05.
| Results|| |
Most Bengali Hijras, especially youth, face great challenges in coming to terms with one's own gender identity or gender expression, which are in contrary to that of the gender identity and gender role imposed on them on the basis of their biological sex. They face several issues such as shame, fear, and internalized transphobia; disclosure and coming out; adjusting, adapting, or not adapting to social pressure to conform; fear of relationships or loss of relationships; and self-imposed limitations on expression or aspirations. Civic members of mainstream society refuse to develop social relations with the Bengali Hijras. On the other hand, they prevent access of Bengali Hijras to social institutions, resources, and services. They are dominated and abused by the members of mainstream society and are unable to exercise power or establish citizenship rights at home and neighbors or in the society. Access to social, cultural, educational, legal, and health services is extremely restricted from anyone with a Hijra identity.
The sociodemographic and other relevant characteristics of the Bengali Hijras are presented in [Table 1]. Participants were predominantly of general (60.9%) and scheduled caste (33.3%). Among all, 8.6% of the Hijras are aged above 60 years and 37.9% are economically active in the age range of 21–40 years. The mean age of the participants was 32.46 years (standard deviation [SD] = 12.85), and almost half (48.7%) reported their relationship status as single. Among all, 74.5% of Bengali Hijras were assigned as a male child at the time of their birth and childhood. The majority of the participants (80.4%) felt that they are different from gender norms before the age of 15 years. The mean age at which the Hijras felt their gender differentiation was 13.92 years. A majority of Bengali Hijras felt their gender differentiation at the age of 14 years (SD = 3.64). Surprisingly, the study revealed that 68.6% of Bengali Hijras cannot accept their gender incompatibility. As a result, their human dignity and self-esteem were diminished. They feel themselves worthless and unfit to the society, searching a place where they live peacefully. Therefore, they want to leave their family. This decision of leaving home was finalized when they became closely associated with feminine male friends with whom they felt to be fit psychologically, sexually, and socially. The majority were less educated (below secondary level), with only 13.7% having completed secondary and upper education. While just over half of the Bengali Hijras are engaged in money collection through journey by foot or trains or buses (60.7%), 33.3% were employed through child dancing. Around two-thirds were currently taking hormones or medicine (66.9%), with around more than one-tenth undergoing some form of gender affirmation surgery (13.6%).
|Table 1: Characteristics of the studied Hijras and their bivariate association with depressive symptoms (n=51)|
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The life of a Bengali Hijra is not easy at all; they are accepted neither by the society nor by their families. There are people who put Hijra community down and feel that they are not capable of anything apart from clapping and dancing on a newborn's birthday. There are many aspects of their life that are not at all fancy, and they live and die in sadness.
After completing the CES-D measurement, 68.6% of the Hijras presented with depressive symptoms above the clinical threshold (CES-D ≥16; mean = 21.43, SD = 14.32). Only half (49.6%) of the total respondents reported having previously attempted suicide. Of those who reported a previous suicidal attempt, around 68.6% reported having done so due to their gender dysphoria. Almost less than one-third (25.6%) of the participants reported having a problem with alcohol, whereas only 20.2% reported about sexual interaction by their wish.
Exposure to androgyny-related molestation and perceived social support
Within the present study, it was found that only 19.6% of the studied Bengali Hijras reported no instances of androgyny-related molestation, and 80.4% reported at least one instance of androgyny-related molestation (mean = 3.42, SD = 3.64). A majority of Bengali Hijras were harassed by the public, where 19.6% besides them never got harassment positively. Of those who reported some form of androgyny-related public behavior, 41.2% reported an insulting instance of molestation; 56.9% reported that got harassment rarely; 15.7% reported being harassed sometimes; and 7.8% reported frequent instances of harassment. The most widely reported types of androgyny-related molestation included direct touching of body parts (39.2%) and dirty comments (94.1%), followed by health-care discrimination (88.2%). On the other hand, according to 90.2% of Bengali Hijras, people do not accept their appearance in front of them. All Bengali Hijras had the experience of receiving slang command by the public. It is too unfortunate that 27.5% of Bengali Hijras had come across the experience of fighting with the public as an instance of molestation. Over the last 7 days, 56.9% of the respondents were verbally abused and insulted by the public and over the last 12 months, 45.1% got sexual harassment. Within their sexual assault, 39.2% of Bengali Hijras considered that they were never forced by anyone to undergo sexual harassment against their will.
Bengali Hijras face multiple forms of oppression which are associated with their androgyny-related appearances. The various harassments faced by Bengali Hijras are related to their daily spatial mobility due to their livelihood. Overall, [Table 2] shows the magnitude of perceived molestations in daily spatial mobility by the studied Bengali Hijras. Besides other instances of molestation, toilet and latrine problem, officious attitude by the public, slang command by public, and police problem are more dominant.
|Table 2: Percentage distribution of the studied Hijras according to the various perceived molestations in daily spatial mobility practices (n=51)|
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Predictors of depression
Bivariate correlations explored associations between depression and participant characteristics, as outlined in [Table 1]. It is found that Bengali Hijras who were biologically assigned as female at birth, who accept gender differentiation, who left family at an earlier age, who are in a committed relationships, who have completed higher levels of education, who have stable housing, who are currently taking hormones, who have had some form of gender affirmation surgery, who did not have a previous suicidal attempt, who have sexual interaction positively, and who have no problem regarding alcohol are significantly more likely to endorse lower levels of depressive symptoms. Further bivariate analyses revealed that depression was positively correlated with the instances of androgyny-related molestation, r = 0.73, P < 0.001, and negatively correlated with perceived social support, r = −0.57, P < 0.001.
Hierarchical multiple regression was performed using depression as the criterion [Table 3]. At step 1, non-Hijra-specific sociodemographic and participant characteristics with significant bivariate relationships with depression were entered first as control variables (block 1), including assigned sex, relationship status, education, occupation, previous suicidal attempt, and alcohol problem. While housing status was identified as having a significant bivariate relationship with depression, due to its small cell size and the presence of multivariate outliers, this variable was not included in the model. At step 2, Hijra-specific predictors being found to be associated with depressive symptoms, hormonal therapy, acceptance of gender differentiation, and the age at which they left their family and underwent surgery were included to control for any additional variance. At step 3, variables of interest, androgyny-related molestation, and social support were included to ascertain whether they provided any additional unique contribution. Control variables entered at step 1 collectively explained 21.40% of the variance in depressive symptoms, F = 7.1, P < 0.001. Hijra-specific predictors, hormonal therapy, acceptance of gender differentiation, age at which they left their family and underwent surgery were entered at step 2, increasing the total variance explained by the model as a whole to 27.8%, adding an additional 7.3% of variance when controlling for variables entered in step 1, F = 8.7, P < 0.001. At step 3, predictors of interest, androgyny-related molestation, and perceived social support added an additional 9.5% of the variance in depressive symptoms, increasing the total variance explained by the model as a whole to 38.1%, F = 15.1, P < 0.001. In the final model, age at leaving the family, previous suicidal attempt, problems with alcohol and surgery, and perceived social support (MSPSS) were statistically significant. Perceived social support provided the strongest unique contribution to the model (β = −0.39, P < 0.001), surgery provided the second strongest unique contribution (β = −0.18, P < 0.004), and suicidal attempt was the third unique contribution (β = 0.16, P < 0.02). Androgyny-related molestation failed to reach statistical significance within the model (P = 0.058).
|Table 3: Predictors of depressive symptoms using hierarchical multiple regression (n=51)|
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| Discussion|| |
Overall, majority of the Bengali Hijras endorsed symptoms consistent with depression, with 49.6% reporting a previous suicidal attempt and 80.4% reporting at least one instance of androgyny-related molestation. Consistent with our hypothesis, lower levels of perceived social support were significantly associated with higher levels of depression at both bivariate and multivariate levels. Further, greater instances of molestation were significantly associated with higher levels of current depressive symptoms at a bivariate level, although molestation did not reach significance in the multivariate analysis. The combination of currently using hormone and having some form of gender affirmative surgery provided a significant contribution to lowering depressive symptoms over and above the control variables. Interestingly, surgery emerged as the second most important unique predictor of lower depression, whereby having had some form of gender affirmative surgery was associated with lower depressive symptoms.
Prevalence of mental depression
Almost 69% of the respondents were identified as having current symptoms consistent with depression, an estimate which falls within the upper range of those reported in previous studies examining depression among transgender persons.,,, Just under half of the respondents in this study had previously attempted suicide. Of those who had reported a previous suicidal attempt, around 70% reported having done so due to their transgender status. These rates of mental health outcome are well in excess of what would be expected on the basis of broader lifetime estimates.
Perceived social support
The overall levels of perceived social support among this sample (mean = 4.98) were substantially lower than those rates observed across samples of the general population. This finding is not surprising given that transgender persons are particularly vulnerable to isolation and loneliness,,,,,, including rejection of familial and intimate relationships. Perceived social support emerged as the single-most important predictor of depressive symptoms, providing a small but unique significant contribution to current depressive symptoms. Those higher levels of perceived support are significantly predictive of lower levels of depressive symptoms, which had also been demonstrated in previous studies among transgender populations. While social support was directly and significantly associated with the mental health of people within this study, it is also possible that social support exerts indirect effects. For instance, there is evidence to suggest that Bengali Hijras experience richer and more extensive social relations. However, as this research is a purposive study of correlations, a causal relationship between social support and depression cannot be established, and it could be that those who are more depressed withdraw from social supports that are available. Regardless of its mechanisms, it is clear that enhancing satisfaction with, and availability of, social support plays a significant protective role against the likelihood of having depressive symptoms. Given that Bengali Hijras tend to report less peer contact and social support relative to samples of the general population, interventions and policy aimed at encouraging social support among Bengali Hijras may have merit in the promotion of positive mental health outcomes. Interventions should include public funding of Hijra social spaces and support services that promote peer support and contact; increasing the opportunities for Bengali Hijras to access sports and leisure centers; promoting social activism and providing opportunities for Bengali Hijras and supportive others to educate the public about transgenderism; and rolling out educational training packages and resources for schools, workplaces, and medical settings. Further, given that Bengali Hijras are vulnerable to rejection within their family and among intimate partners and that there is clear evidence to suggest that discord in the family environment and lack of intimate partnership can contribute to depression, extending support services to family and loved ones might be beneficial in encouraging the retention of supportive networks.
Almost 80% of the respondents in this survey reported at least one instance of androgyny-related molestation, with around one-third experiencing some form of economic discrimination, one-quarter experiencing health-care discrimination, and 18% experiencing housing discrimination on the basis of their Hijra identity. Consistent with previous findings, greater instances of molestation were significantly associated with higher levels of current depressive symptoms. Androgyny-related molestation has emerged as a significant independent predictor of depression in several previous studies;, however, it failed to emerge as a significant unique predictor of depression within this study. For instance, access to hormonal therapy or surgery may increase or decrease the likelihood of molestation by the way of disclosure of one's preferred gender identity, or similarly by the way of “passing,” that is, not being perceived to be Hijra by others, an area which could be further investigated in future research. Similarly, given the small but significant negative correlation between social support and androgyny-related molestation, it is also likely that having greater perceptions of social support may also be protective against molestation. That androgyny-related molestation failed to reach significance at a multivariate level within this study, which may also be a function of differences in the measurement of androgyny-related molestation across studies and the application of a nonstandardized measure of molestation within this study. Further, caution in interpreting these results is required given the violation of normality across measures used in this study in addition to the large variance in molestation scores, both of which may compromise the representativeness of this data set of the broader population of transgender persons. Nevertheless, androgyny-related molestation creates an undue stressful social environment that can contribute to adverse mental health outcomes among Bengali Hijras, and thus constitutes a significant health concern. Interventions are required to reduce instances of molestation such as violence prevention programs, more pervasive and accessible public policies and legislation concerning antidiscrimination, and promotion of safe reporting of instances of molestation in addition to services to educate and support persons who are vulnerable to or have experienced androgyny-related molestation, such as mentoring programs.
| Conclusion|| |
Results of this study indicate that depression symptomology, suicidal tendency, and dysphonia-related victimization are widespread among the Bengali Hijras of India, and represent a major health concern. Clinically, these findings suggest that perceptions of social support among some Hijra persons have very important implications upon one's likelihood of experiencing depressive symptoms and upon persons seeking medical interventions to transform into their preferred gender, not being able to access hormones and surgery may compromise their mental health.
Other researches on Indian transgender do not offer an understanding of how psychiatrists specifically understand the formulation of mental depression associated with perceived molestation and social difficulties of transgender. This is in keeping with recommendations to continue to share a dialog with other disciplines within the field of mental health practice of the transgender community in India. This study may support the implementation of more research into interventions correlating social support and mental depression of Hijras that help to solve the issues of Bengali Hijras in our civic society, and how systems of mental health care promote or obstruct their social outcomes. The findings of the study will be also useful for policymakers for the formulation of effective programs or actions for improving the functioning of health-care program running in the different states of India for Hijra communities.
We are driven by certain myths related to Hijras, but very few have tried to know them. Bengali Hijras are suffering from various problems of mental depression, a psychological problem or genuine handicap, beyond their control. We should understand them and abridge the prevailing state of doubt and mistrust. This will help in solving their psychological depression and financial problems and make their life comfortable and productive for the society at large.
This study is based on data from a research by the author from the Department of Population Studies, Fakir Mohan University, Odisha, India. The author would like to thank Dr. Pralip Kumar Narzary (assistant professor) for his encouragement and supportive role throughout the research period, which made implementation of this kind of study possible with marginalized people in the Indian context. Finally, the author expresses his gratefulness to the members of the Hijra community who kindly volunteered to participate in this study and provided their valuable time by sharing intimate and secret issues in their lives.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nanda S. Neither Man nor Woman: The Hijras of India. Belmont, CA: Wadsworth Publishing Company; 1999.
Reddy, G. Geographies of contagion: Hijras, Kothis, and the politics of sexual marginality in Hyderabad. Anthropol Med 2005;12:255-70.
Couch M, Pitts MK, Mulcare H, Croy S, Mitchell A, Patel S. TranZnation: A Report on the Health and Wellbeing of Transgender People in Australia and New Zealand 2007. Available from: http://glhv.org.au/files/Tranznation Report.pdf
. [Last accessed on 2017 July 23].
Dean L, Meyer IH, Robinson K, Sell RL, Sember R, Silenzio VM, et al
. Lesbian, gay, bisexual, and transgender health: Findings and concerns. J Gay Lesbian Medl Assoc 2000;4:102-51.
Gainor KA. Including transgender issues in lesbian, gay and bisexual psychology. In: Greene B, Croom GL, editors. Education, Research and Practice in Lesbian, Gay, Bisexual and Transgendered Psychology: A Resource Manual. Vol. 5. Thousand Oaks, CA: Sage; 2000. p. 131-60.
Lal V. Not This, Not That: The Hijras of India and the Cultural Politics of Sexuality. In: Social Text No. 61. Out Front: Lesbians, Gays, and the Struggle for Workplace Rights, Winter, Duke University Press, 1999; 119-40.
Mal S. Consequences of Spatial Mobility among Hijras of Kharagpur Town, West Bengal, India (Unpublished M. Phil Dissertation). Fakir Mohan University, Odisha, India 2015.
Mal S. Let us to live: Social exclusion of Hijra community. Asian J Res Soc Sci Hum 2015;5:108-17.
Mal S. Let us Live: Social Exclusion of Hijra Community. Midnapore: Jaladarchi Publisher; 2015.
Mal S. The Hijras of India: A marginal community with paradox sexual identity. Indian J Soc Psychiatry 2018;34:79-85. [Full text]
Loh JU. Narrating identity: The employment of mythological and literary narratives in identity formation among the Hijras of India. Relig Gen 2014;4:21-39.
Kollen T. Sexual Orientation and Transgender Issues in Organizations: Global Perspectives on LGBT Workforce Diversity. Switzerland: Springer International Publishing; 2016.
Sidanius J, Pratto F. Social Dominance: An Intergroup Theory of Social Hierarchy and Oppression. New York:Cambridge University Press; 1999.
Swain S. Problems of third gender. In: Swain S, editor. Social Issues of India. New Delhi: New Vishal Publications; 2006.
Agrawal A. Gendered bodies: The case of the “third gender” in India. Contrib Indian Sociol 1997;31:273-97.
Sharma SK. Hijras: The Labelled Deviance. New Delhi: Gyan Publishing House; 2000.
Lev AI. Learning to Listen to Gender Narratives. Transgender Emergence: Therapeutic Guidelines for Working with Gender-variant People and their Families. Binghamton, NY: Haworth Clinical Practice Press 2004.
Mal S, Mundu GB. Hidden truth about ethnic lifestyle of Indian Hijras. Res J Hum Soc Sci 2018;9:621-8.
Nuttbrock L, Hwahng S, Bockting W, Rosenblum A, Mason M, Macri M, et al
. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. J Sex Res 2010;47:12-23.
Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. J Homosex 2006;51:53-69.
Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385-401.
Blank K, Gruman C, Robison JT. Case-finding for depression in elderly people: Balancing ease of administration with validity in varied treatment settings. J Gerontol A Biol Sci Med Sci 2004;59:378-84.
Moullec G, Maïano C, Morin AJ, Monthuy-Blanc J, Rosello L, Ninot G, et al
. A very short visual analog form of the center for epidemiologic studies depression scale (CES-D) for the idiographic measurement of depression. J Affect Disord 2011;128:220-34.
Bradley KL, Bagnell AL, Brannen CL. Factorial validity of the center for epidemiological studies depression 10 in adolescents. Issues Ment Health Nurs 2010;31:408-12.
Roberts RE, Vernon SW. The center for epidemiologic studies depression scale: Its use in a community sample. Am J Psychiatry 1983;140:41-6.
Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations: A validation study. Am J Epidemiol 1977;106:203-14.
Zimet G. The multidimensional scale of perceived social support. J Pers Assess 1988;52:30-41.
Boza C, Perry KN. Gender-related victimization, perceived social support, and predictors of depression among transgender Australians. Int J Transgend 2014;15:35-52.
Maguen S, Shipherd JC, Harris HN. Providing culturally sensitive care for transgender patients. Cogn Behav Pract 2005;12:479-90.
Mal S, Das PS. Assessment of nutritional status of Hijras: A study of Paschim Medinipur district, West Bengal. Int J Interdisciplinary Res Innov 2018;6:309-16.
Rotondi NK, Bauer GR, Scanlon K, Kaay M, Travers R, Travers A. Prevalence of and risk and protective factors for depression in female-to-male transgender Ontarians: Trans PULSE project. Can J Community Ment Health 2011;30:135-55.
[Table 1], [Table 2], [Table 3]