Changes in depression symptom profile with gender-affirming hormone use in transgender persons 81 model showed the best fit, but this model had one factor with only one item with a loading over 0.4. The next best model fit was seen in the 4-factor model (TLI=0.92 and RMSEA=0.043), which was therefore chosen for further analysis and is displayed in Supplementary Table S3.4. This model showed that items related to mood or affect loaded on the first factor (“Mood” factor), items related to anxiety or self-image loaded on the second factor (“Anxiety”), items related to lethargy loaded on the third factor (“Lethargy”) and items related to physical complaints loaded on the fourth factor (“Somatic”). A total of 12 items did not show loadings over 0.4 and were therefore not included in any of the factors. All factor loadings are shown in the Supplementary Table S3.4, and the symptom clusters and factor loadings are displayed in Figure 3.3. IDS total score and cluster scores at baseline Baseline scores in the full cohort showed that at baseline, the TM group did not report higher total IDS-SR scores compared to the TF group (TM: median 15, IQR 9 to 28 versus TF: median 11, IQR 7 to 22.5; p=0.055). At the start of GAHT, we found no significant differences in the subscale scores for mood (TM: median 2, IQR 0 to 4 versus TF: median 2, IQR 1 to 3; p=0.84), anxiety (TM: median 2, IQR 0 to 5 versus TF: median 2, IQR 1 to 4; p=0.84), lethargy (TM: median 3, IQR 1 to 5 versus TF: median 1, IQR 0 to 4; p=0.073) or somatic symptoms (TM: median 1, IQR 0 to 1 versus TF: median 0, IQR 0 to 1; p=0.059). 3.3. Depression profile changes after start of GAHT Changes in IDS total score and cluster scores after GAHT All longitudinal analyses were conducted on measurements from participants who contributed a baseline measurement and at least one follow-up measurement. Results show that the total IDS-SR score in the total cohort (i.e. TM and TF groups together) did not show any significant change after either 3 months or 12 months of GAHT. Interaction analyses comparing the groups shows that the TF group showed a significantly stronger increase in the total IDS-SR compared to the TM group after 3 months (+25.1%, 95% CI=2.9% to 52.0%, p=0.026) and 12 months (+29.1%, 95% CI=2.9% to 61.7%, p=0.029) of GAHT.
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