Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults

• Published in: Social Psychiatry and Psychiatric Epidemiology Vol. 59; no. 2; pp. 285 - 294
• Main Authors: Price, Maggi A., Hollinsaid, Nathan L., McKetta, Sarah, Mellen, Emily J., Rakhilin, Marina
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2024; Springer Nature B.V
• Subjects: Adult; Adults; Attitudes; Demographics; Epidemiology; Factor analysis; Humans; Indicators; Legislation; Medicine; Medicine & Public Health; Mental health; Policies; Prejudice; Psychiatry; Psychological Distress; Psychological factors; Psychological stress; Sex discrimination; Suicidal Ideation; Suicide; Suicides & suicide attempts; Transgender persons; Transgender Persons - psychology; United States - epidemiology; United States; United States > US; Structural transphobia; Stigma; Suicidality; Psychological distress; Transgender adults; Mental health equity
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-023-02482-4

Purpose Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults’ psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. Methods We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18–100) residing in 45 US states and the District of Columbia (DC). Results Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. Conclusion Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia’s multifaceted nature and negative mental health consequences.