Prospective relationships between stigma, mental health, and resilience in a multi-city cohort of transgender and nonbinary individuals in the United States, 2016–2019

• Published in: Social Psychiatry and Psychiatric Epidemiology Vol. 57; no. 7; pp. 1445 - 1456
• Main Authors: Valente, Pablo K., Dworkin, Jordan D., Dolezal, Curtis, Singh, Anneliese A., LeBlanc, Allen J., Bockting, Walter O.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2022; Springer; Springer Nature B.V
• Subjects: Analysis; Cohort Studies; Epidemiology; Ethnicity; Female; Gender aspects; Gender Identity; Health aspects; Humans; Infant, Newborn; Male; Medicine; Medicine & Public Health; Mental Health; Metropolitan areas; Moderators; Non-binary gender; Original Paper; Prospective Studies; Psychiatry; Psychological stress; Race; Resilience; Social Stigma; Social support; Stigma; Stress (Psychology); Transgender people; Transgender persons; Transgender Persons - psychology; United States - epidemiology; United States; United States > US; Transgender; Pride; Stigma; Mental health; Social support
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-022-02270-6

Purpose Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals. Methods Between 2016 and 2017, we enrolled 330 TGNB individuals in three metropolitan areas in the U.S. in a prospective cohort study focused on gender identity development, risk, and resilience across the lifespan. Using multilevel regression, we examined prospective associations between enacted gender-based stigma and psychological distress (measured by the Global Severity Index/BSI-18), and examined transgender pride and social support as moderators, adjusting for age, sex assigned at birth, race/ethnicity, education, and income. Results Our sample was diverse in age ( M  = 34.4, range 16–87) and race/ethnicity (56.4% non-White). Over 2 years of follow-up, there was a decrease in reported gender-based stigma ( b  = − 0.61, p  < 0.001) and transgender pride ( b  = − 0.14, p  = 0.003), increase in social support ( b  = 0.21, p  < 0.001), and no change in psychological distress. In adjusted analyses, gender-based stigma was positively associated with psychological distress ( b  = 1.10, p  < 0.001) and social support was negatively associated with psychological distress ( b  = − 2.60, p  < 0.001). Transgender pride moderated the relationship between stigma and psychological distress ( p < 0.01), such that the association was stronger for lower levels of transgender pride. Conclusions Our study provides longitudinal evidence for the deleterious role of gender-based stigma among TGNB individuals. Future interventions should consider fostering transgender pride and social support to promote mental health and mitigate negative effects of gender-based stigma.