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

Valente, Pablo K.; Dworkin, Jordan D.; Dolezal, Curtis; Singh, Anneliese A.; LeBlanc, Allen J.; Bockting, Walter

doi:10.1007/s00127-022-02270-6

Cited by 17 publications

(9 citation statements)

References 57 publications

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“…This finding, to some extent, keeps in line with a study conducted in Canada, which found that after adjusting for socioeconomic variables and age, compared to cisgender heterosexual people, only the transgender but no other types of LGBTQ+ had a significant additional risk of UMHN ( 7 ). Our findings on transgender also corroborate previous studies, which concluded that compared to other subtypes of LGBTQ+, transgender people faced additional minority stressors because of their potentially visible gender expression ( 28 , 31 , 32 ). Our supplement analysis ( Supplementary Table 4 ) confirms this point to some extent and indicated that those transgender people who never married had a 1.28-time likelihood of reporting UMHN (AOR = 1.28, 95% CI 1.11–1.49).…”

Section: Discussionsupporting

confidence: 91%

“…to other subtypes of LGBTQ+, transgender people faced additional minority stressors because of their potentially visible gender expression (28,31,32). Our supplement analysis (Supplementary Table 4) confirms this point to some extent and indicated that those transgender people who never married had a 1.28-time likelihood of reporting UMHN (AOR = 1.28, 95% CI 1.11-1.49).…”

Section: Possible Explanations and Comparison With Other Studiessupporting

confidence: 66%

See 1 more Smart Citation

Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022

Chen

Wang²,

She³

et al. 2022

Front. Med.

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BackgroundEvidence highlighted the likelihood of unmet mental health needs (UMHNs) among LGBTQ+ than non-LGBTQ+ populations during COVID-19. However, there lacks evidence to accurately answer to what extent the gap was in UMHN between LGBTQ+ and non-LGBTQ+ populations. We aim to evaluate the difference in UMHN between LGBTQ+ and non-LGBTQ+ during COVID-19.MethodsCross-sectional data from Household Pulse Survey between 21 July 2021 and 9 May 2022 were analyzed. LGBTQ+ was defined based on self-reported sex at birth, gender, and sexual orientation identity. UMHN was assessed by a self-reported question. Multivariable logistic regressions generated adjusted odds ratios (AODs) of UMHN, both on overall and subgroups, controlling for a variety of socio-demographic and economic-affordability confounders.Findings81267 LGBTQ+ and 722638 non-LGBTQ+ were studied. The difference in UMHN between LGBTQ+ and non-LGBTQ+ (as reference) varied from 4.9% (95% CI 1.2–8.7%) in Hawaii to 16.0% (95% CI 12.2–19.7%) in Utah. In multivariable models, compared with non-LGBTQ+ populations, LGBTQ+ had a higher likelihood to report UMHN (AOR = 2.27, 95% CI 2.18–2.39), with the highest likelihood identified in transgender (AOR = 3.63, 95% CI 2.97–4.39); compared with LGBTQ+ aged 65+, LGBTQ+ aged 18–25 had a higher likelihood to report UMHN (AOR = 1.34, 95% CI 1.03–1.75); compared with White LGBTQ+ populations, Black and Hispanic LGBTQ+ had a lower likelihood to report UMHN (AOR = 0.72, 95% CI 0.63–0.82; AOR = 0.85, 95% CI 0.75–0.97, respectively).InterpretationDuring the COVID-19, LGBTQ+ had a substantial additional risk of UMHN than non-LGBTQ+. Disparities among age groups, subtypes of LGBTQ+, and geographic variance were also identified.

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Section: Discussionsupporting

confidence: 91%

Section: Possible Explanations and Comparison With Other Studiessupporting

confidence: 66%

Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022

Chen

Wang²,

She³

et al. 2022

Front. Med.

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“…Overall, the findings did not support our second hypothesis and did not support that aspect of the GMSR model. These results are consistent with several prior studies that also failed to find support for resiliency as a moderator (e.g., Helsen et al, 2021; Kolp et al, 2020) but contradict other studies that did find support (e.g., Bockting et al, 2013; Valente et al, 2022). Again, the biggest difference between prior literature and the present study was the inclusion of all of the components of the GMSR model, which likely contributes to the discrepancies in results observed within the literature.…”

Section: Discussionsupporting

confidence: 90%

“…For example, Bockting et al (2013) found that support from others in the TNB community moderated the relationship between social stigma and mental health. Similarly, Valente et al (2022) found that pride in one's identity moderated the relationship between gender-based stigma and psychological distress. Zhang et al (2021) found that resilience moderated the relationship between discrimination and depression but did not moderate the relationship between rejection and depression.…”

mentioning

confidence: 94%

Minority stress and posttraumatic growth in the transgender and nonbinary community.

Jones¹,

Wehner²,

Andrade³

et al. 2022

Psychology of Sexual Orientation and Gender Diversity

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The present study tested the gender minority stress and resilience model in a transgender and nonbinary sample. The outcome of interest was posttraumatic growth (PTG). A total of 292 people who identified as transgender and/or nonbinary completed an online survey including measures of distal stressors, proximal stressors, resilience factors, and PTG. The present study supported two primary results: (a) there were indirect associations between distal stressors and PTG via internalized transphobia and negative expectations about the future, but not nondisclosure of identity, and (b) resilience factors were related to PTG independent of distal and proximal stressors. Although the results were consistent with components of the gender minority stress and resilience model, some aspects of the model were not supported, particularly the hypothesized roles of nondisclosure of identity and resilience. Thus, further research is needed to investigate and articulate the complex relationships between distal stress, proximal stress, resilience, and growth-based outcomes. Public Significance StatementViolence, discrimination, and stigma negatively impact the mental health of individuals who identify as transgender and/or nonbinary via an increase in negative thoughts about themselves and their future. Strategies that enhance resiliency, such as community building, may be particularly promising avenues to promote posttraumatic growth within the transgender and nonbinary community.

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“…Fifth, we did not examine how the effects of invalidation might potentially be moderated by psychosocial resources and other protective factors. Previous research has found that family acceptance (Gower et al, 2018; Veale, Watson, et al, 2017), transgender pride (Valente et al, 2022), and social support from other trans people (Carter et al, 2019) can moderate the effects of distal minority stressors (such as enacted stigma and gender-based discrimination) on mental health outcomes among TNB populations. Future research should examine the relationship between such protective factors and invalidation and the subsequent effects on mental health outcomes among nonbinary populations.…”

Section: Discussionmentioning

confidence: 99%

Invalidation and mental health among nonbinary individuals.

Johnson¹,

LeBlanc²,

Dolezal³

et al. 2024

Psychology of Sexual Orientation and Gender Diversity

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This study examines the experience of a unique minority stressor, gender identity invalidation (henceforth referred to as invalidation), which is defined as the refusal to accept someone's gender identity as real or valid, among transgender and nonbinary (TNB) individuals. Data are drawn from a large and diverse sample of TNB adults who participated in a quantitative survey concerning transgender identity, minority stress, and mental health (N = 302). Invalidation was assessed using a novel 17-item scale that ascertains the extent to which respondents experienced invalidation across different social contexts. On average, TNB adults in this sample report low levels of invalidation, although a minority experience it at relatively high levels. Experiences of invalidation were significantly higher among nonbinary participants when compared with their binary-trans peers. A series of multivariate regression models that control for sociodemographic factors (sex assigned at birth, race/ethnicity, education, age, and income) and well-established indicators of minority stress (felt stigma, enacted stigma) suggest that nonbinary gender identity is independently associated with poor mental health (assessed with the Global Severity Index), and that this association is mediated by invalidation. These findings suggest that invalidation, which is largely unexamined in existing research, merits greater attention as a particularly salient minority stressor influencing mental health among gender-diverse populations, nonbinary populations in particular. Public Significance StatementThis study examined invalidation and its relationship to mental health among a diverse sample of transgender and nonbinary (TNB) adults. Experiences of invalidation were found to be significantly higher among nonbinary adults when compared with their binary-trans peers. In addition, nonbinary gender identity was found to be independently associated with poorer mental health, and this association was mediated by invalidation, suggesting that invalidation may be a particularly salient minority stressor for nonbinary individuals. Findings from our study can help clinicians and researchers assess for this minority stressor and explore it as a target of treatment with TNB people.

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

Cited by 17 publications

References 57 publications

Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022

Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022

Minority stress and posttraumatic growth in the transgender and nonbinary community.

Invalidation and mental health among nonbinary individuals.

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