Serial Mediation Analysis of the Association of Familiarity with Transgender Sports Bans and Suicidality among Sexual and Gender Minority Adults in the United States

Abstract

Background: Discriminatory laws and policies are a form of structural stigma that is associated with increased suicidality among sexual and gender minority (SGM) people. Unfortunately, in the United States, there has been an increase in state-level discriminatory laws and policies targeting SGM people in 2021 and 2022, particularly, transgender sports bans. The purpose of this study was to (1) determine if familiarity with transgender sports bans was associated with suicidality among SGM adults; and (2) determine if interpersonal stigma and/or individual stigma mediated this association. Methods: This was a cross-sectional study of data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and serial mediator models were used in this analysis. Results: The increased suicidality was associated with familiarity with state-level transgender sports bans among SGM adults (p-value = 0.0150). Even after interpersonal and individual stigma mediated this relationship, the association between suicidality and familiarity with state-level transgender sports bans remained (p-value = 0.0106). Conclusion: State-level transgender sports bans appear to exacerbate existing disparities in mental health, especially for individuals who are familiar with the bans. They directly discriminate against people who are transgender and indirectly stigmatize the broader SGM community.

Moderating Effect of Community and Individual Resilience on Structural Stigma and Suicidal Ideation among Sexual and Gender Minority Adults in the United States

“…Participants were asked about their familiarity with state-level transgender sports bans by using the following question: “How familiar are you with state-level transgender sports bans being proposed or passed in several states across the US?” [ 11 ]. Available responses were not at all familiar, somewhat familiar, familiar, and very familiar.…”

“…Stigma associated with having a sexual orientation or gender identity that falls outside the cisgender/heterosexual normative culture contributes to increased suicidality in this population [ 7 ]. One form of this stigma, structural stigma, can take the form of discriminatory laws and policies and is detrimental to the health and well-being of SGM people globally [ 8 , 9 , 10 , 11 ]. Places with higher measures of structural stigma see increased mental distress, suicidality, mortality, social isolation, and a lower quality of life for people who are SGM [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

“…Transgender sports bans, if adopted, confirm SGM adults’ concerns by creating new anti-SGM policies and depriving the rights of a subgroup of the SGM community. Our previous research revealed that SGM adults familiar with transgender sports ban legislative efforts reported higher levels of suicidality than those who were not familiar [ 11 ]. This finding may result from further anticipated structural stigma, concerns about the loss of rights, or additional anti-SGM laws and policies in the US.…”

“…Our previous research found an association between familiarity with adopted or proposed transgender sports bans and suicidality among SGM adults even after interpersonal and individual stigma mediated this relationship [ 11 ]. Other research shows that individual and community resilience can attenuate the association between stigma and mental health issues among SGM people.…”

Disparities in sport participation of transgender women: a systematic and scoping review protocol

“…In the USA, there has been a rise in legislation in many states banning transgender youth from participating in sport in the category that best aligns with their gender identity 13. There is an association between increased suicidality and familiarity with legislation banning transgender individuals among sexual and gender minority people 14…”