Past studies that compare cisgender to transgender (or trans) and gender diverse people have found a higher prevalence of mental health problems among the latter groups. This paper utilises Testa's Gender Minority Stress Framework, which is an expansion of Minority Stress Theory to assess minority stressors that are specific to the experiences of trans and gender diverse people. The concept of cisnormativity, an ideology that positions cisgender identities as a norm, is used in relation to the Gender Minority Stress Framework to describe the marginalising nature of social environments for trans and gender diverse people. This paper provides a critical review that integrates and expands upon past theoretical perspectives on gender minority stressors and protective factors. Specifically, this paper demonstrates the relevance of cultural and ethnic backgrounds to complement the application of intersectionality in research on health disparities experienced by trans and gender diverse people.

There has been little international research looking at differences in mental health across different age groups. This study examines mental health inequities between transgender people and the Aotearoa/New Zealand general population from youth to older adulthood. The 2018 Counting Ourselves survey (N = 1178) assessed participants’ mental health using the Kessler Psychological Distress Scale (K10) and diagnoses of depression and anxiety disorders, questions that were the same as those used in the New Zealand Health Survey. Our results showed significant mean score differences for transgender people on K10, and these differences were almost two standard deviations higher than the general population (Cohen’s d = 1.87). The effect size differences, however, decreased from youth to older adults. Regression analyses indicated trans women were less likely to report psychological distress than trans men and non-binary participants. There was an interaction effect for age and gender, with lower psychological distress scores found for younger trans women but higher scores for older trans women. The stark mental health inequities faced by transgender people, especially youth, demonstrate an urgent need to improve the mental health and wellbeing of this population by implementing inclusive institutional practices to protect them from gender minority stress.

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Background Past research has established that transgender people experience significant disparities in mental health outcomes and healthcare dissatisfaction compared with cisgender people, but more research is needed on how supportive healthcare interactions relate to the mental health of transgender people. Objectives The 2 main aims of our analyses were: (i) to establish the most common negative experiences in healthcare and the most common supportive experiences specifically with primary care doctors for transgender people; and (ii) to examine the association of supportive experiences with mental health variables after controlling for demographic factors. Methods Data from the 2018 Counting Ourselves nationwide survey of transgender people were analysed using regression modelling. The 948 participants with a primary care doctor or general practitioner were included in analyses. Participants were aged 14–83 years old (mean 30.20). Results The most common supportive experiences involved primary care doctors treating transgender people equitably, with competence, and with respect. Participants with more negative healthcare experiences had higher psychological distress as well as higher likelihood of reporting nonsuicidal self-injury and suicidality. Conversely, participants with more experiences of supportive primary care doctors had lower psychological distress and were less likely to have attempted suicide in the past 12 months. Conclusion When transgender people receive supportive care from their primary care providers they experience better mental health, despite ongoing negative healthcare experiences. Future research is needed to confirm ways of supporting positive trajectories of mental health for transgender people but these findings demonstrate the importance of positive aspects of care.

2021) 'It's how the world around you treats you for being trans': mental health and wellbeing of transgender people in Aotearoa New Zealand, Psychology & Sexuality.