Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates

Abstract

Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals.Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations.Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population.Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location.Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups.Main Results: We identified 85 articles from 74 unique data sets (n_total = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations.Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed.Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.

FIGURE 1—

Forest Plot Comparing Prevalence of Any Intimate Partner Violence Victimization Between Transgender and Cisgender Participants Across 20 Studies That Included Transgender and Cisgender Participants Note. CI = confidence interval; RR = risk ratio.

FIGURE 2—

Forest Plot Comparing Prevalence of Physical Intimate Partner Violence Victimization Between Transgender and Cisgender Participants Across 21 Studies That Included Transgender and Cisgender Participants Note. CI = confidence interval; IPV = intimate partner violence; RR = risk ratio. Whitton et al. provided transgender prevalence data, but not cisgender prevalence data, upon request. Cisgender prevalence is estimated by applying their reported adjusted odds ratio of 2.46 (95% CI = 1.24, 4.92). Reuter et al. reported comparison data, but it is not included because it was published in an earlier report with a smaller sample size from the same data set as Whitton et al. Whitfield et al. and Griner et al. used data from the same study; only Griner et al. was included in the meta-analysis. Woulfe et al. included past-year and adult IPV. The estimates for adult IPV were included because they had the greatest number of events for estimate stability. Johns et al. and Zalla et al. provided unweighted prevalence data; the raw number/total number is reported here and differs from weighted prevalence percentage reported in the original articles.

FIGURE 3—

Forest Plot Comparing Prevalence of Sexual IPV Victimization Between Transgender and Cisgender Participants Across 15 Studies That Included Transgender and Cisgender Participants Note. CI = confidence interval; IPV = intimate partner violence; RR = risk ratio. Johns et al. provided unweighted prevalence data; the raw number/total number is reported here and differs from weighted prevalence percentage reported in the original article. Smith et al. included estimates for victimization during adolescence, young adulthood, adulthood, and past year. The estimates for young adulthood were included here because they had the greatest number of events for estimate stability. Results were qualitatively similar when other time periods were used in a sensitivity analysis. Whitfield et al. and Griner et al. used data from the same study; only Griner et al. was included in the meta-analysis. Woulfe et al. included past-year and adult IPV. The estimates for adult IPV were included because they had the greatest number of events for estimate stability. Whitton et al. provided transgender prevalence data but not cisgender prevalence data when requested from the authors. Cisgender prevalence was estimated by applying their reported adjusted odds ratio of 3.42 (95% CI = 1.85, 6.33).