Nonbinary people make up approximately one third of the broader trans community, yet most research on trans populations focuses on the experiences of binary trans people (i.e., trans men and trans women). Research has begun to indicate that mental health disparities may differ between binary and nonbinary trans populations and that nonbinary people may be at even greater risk for some mental health disparities compared to binary trans populations. Minority stress theory provides a framework for understanding the mental health disparities among LGBTQþ populations. However, research has yet to examine the unique minority stress experiences among nonbinary people. This qualitative study conducted by an all nonbinary team of researchers aimed to comprehensively identify the minority stress experiences of nonbinary people. Data were collected from five focus groups and six individual interviews with a diverse sample of nonbinary adults living in geographic areas across the United States (N = 29). Thematic analysis was applied with a deductive approach using the gender minority stress model (Testa et al., 2015) as a framework for identifying themes. Similar to the gender minority stress model, which focused on binary trans populations, nonbinary participants in this study reported experiencing discrimination, rejection, harassment/violence, misgendering, internalized stigma, anticipated minority stress, and concealment, but in unique ways. Newly identified minority stressors were binary normativity, interpersonal invalidation, burdening, gender dysphoria, and mental/emotional labor. Results advance minority stress theory as it applies to nonbinary populations and provide important implications for clinical interventions, policy, and future research. Public Significance StatementResults from this qualitative study showed that nonbinary people have unique experiences of stress compared with other trans populations due to structures, systems, and cultures being organized by the gender binary. As a result, nonbinary people experience invalidation and misgendering on a daily basis and expend undue mental and emotional labor explaining their identity to others.

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Research has documented that parental figures of trans and gender diverse (TGD) youth often struggle with fear, grief, and stress as a result of antitransgender oppression. However, there is a dearth of research about how parental figures of TGD youth are impacted by antitransgender state and federal laws and bills. The present study aimed to explore parental figures' reactions and coping strategies with recent proposed and enacted laws and bills in the United States restricting access to gender-affirming healthcare for TGD youth. A sample of 138 parental figures of TGD youth who currently or previously lived in the United States participated in an online survey where they shared their reactions and coping strategies as a result of current antitransgender laws and bills. Thematic analysis revealed four themes depicting participants' cognitive reactions, including: (a) violation of rights, (b) increased stigma, (c) decreased quality of healthcare, and (d) support for child's journey. Also, three themes emerged about participants' emotional reactions, including: (a) fear and anxiety, (b) anger, and (c) relief. Additionally, participants shared narratives about how they are coping with these antitransgender laws and bills, including: (a) activism and advocacy, (b) educating others, (c) seeking support from communities/ groups, and (d) relocation and avoidance. Recommendations for practitioners such as debunking incorrect information about trans healthcare when working with parental figures are discussed. Public Significance StatementNo research to date has explored how parental figures of trans and gender diverse (TGD) youth are impacted by current antitransgender policies. The current study found that parental figures of TGD youth are experiencing intense cognitive and emotional reactions and also actively using coping skills to navigate the effects of these oppressive laws and bills.

The effectiveness of training for mental health professionals to increase queer-affirming (e.g., lesbian, gay, bisexual, pansexual) cultural competencies has not been well established. Though there is an assumption that training generally works to increase or improve knowledge, attitudes, and skills, it is unclear what training format, content, and pedagogical approaches are effective. To explore the effectiveness of cultural competency training interventions for mental health professionals, a systematic review of peer-reviewed empirical articles in English published between 2000 and 2020 was conducted. Studies were selected for inclusion if the article was empirical, evaluated a training or education related to working with queer clients, and participants were mental health providers or graduate level trainees. Independent data extraction was conducted by using predefined thematic content areas, including information about the research method, training content, training format, measures, outcomes, and recommendations. Data was reviewed for 13 studies and training duration varied from 1 hr to 1 year. Most studies measured knowledge, and some measured attitudes, skills, and self-efficacy. There is some evidence that queer cultural competency training helps to improve self-reported knowledge, attitudes, and skills for mental health professionals. However, given several limitations, including a lack of studies and various methodological challenges, clear conclusions cannot be made about the effectiveness of queer cultural competency training for mental health professionals, more broadly. Public Significance StatementEvidence-based queer-affirming training for mental health professionals is needed and a systematic review of this literature provides an overview of the current research. Training in this area tends to increase self-reported cultural competency, however, more research and rigorous methods are needed to continue testing the effectiveness of such training.

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