The Effect of Hybrid Cognitive Behavioural Therapy-Based and Peer Support Programme on Depression Among Transgender Women.

Abstract

Transgender women (TGWs) experience high rates of depression due to stigma, discrimination and limited access to inclusive healthcare. This study aimed to examine the effect of a hybrid Cognitive Behavioural Therapy (CBT)-based and peer support programme on depression among TGWs and to examine whether intervention effects differed by transitional process (gender-affirming surgery [GAS] vs. gender-affirming hormone therapy [GAHT]). A randomized controlled trial with repeated measures ANCOVA was conducted. Participants were assigned to either an experimental group receiving the hybrid programme or a control group receiving usual care. Depression was assessed at posttest and 1-month follow-up, with baseline depression included as a covariate. Subgroup analyses were performed based on transitional process. After adjusting for baseline scores, the experimental group demonstrated significantly lower depression compared to the control group. A significant time-by-group interaction suggested divergent trajectories, with depression remaining stable in the experimental group but worsening in the control group. Exploratory subgroup analyses suggested potentially stronger effects among participants undergoing GAS. However, formal moderation analyses were not statistically significant. Additionally, participants in the experimental group exhibited reduced internalized sexual stigma and increased self-esteem and self-efficacy. Overall, the findings suggest that integrating peer support into CBT-based approaches may be associated with improved outcomes. Future research is needed to examine long-term effects and to further investigate mechanisms underlying differential responses across transitional pathways.