Stigma, mental health, and resilience in an online sample of the US transgender population.

OBJECTIVES We assessed the association between minority stress, mental health, and potential ameliorating factors in a large, community-based, geographically diverse sample of the US transgender population. METHODS In 2003, we recruited through the Internet a sample of 1093 male-to-female and female-to-male transgender persons, stratified by gender. Participants completed an online survey that included standardized measures of mental health. Guided by the minority stress model, we evaluated associations between stigma and mental health and tested whether indicators of resilience (family support, peer support, identity pride) moderated these associations. RESULTS Respondents had a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). Social stigma was positively associated with psychological distress. Peer support (from other transgender people) moderated this relationship. We found few differences by gender identity. CONCLUSIONS Our findings support the minority stress model. Prevention needs to confront social structures, norms, and attitudes that produce minority stress for gender-variant people; enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience.

[1]  D. Operario,et al.  The Impact of Exposure to Transphobia on HIV Risk Behavior in a Sample of Transgendered Women of Color in San Francisco , 2006, AIDS and Behavior.

[2]  S. Hart,et al.  Female-to-male transgender quality of life , 2006, Quality of Life Research.

[3]  R. Melendez,et al.  ‘It's really a hard life’: Love, gender and HIV risk among male‐to‐female transgender persons , 2007, Culture, health & sexuality.

[4]  R. Wilchins,et al.  Gender Violence , 2002, Journal of homosexuality.

[5]  Shelley E. Taylor,et al.  Accelerated Course of Human Immunodeficiency Virus Infection in Gay Men Who Conceal Their Homosexual Identity , 1996, Psychosomatic medicine.

[6]  P. Cohen-Kettenis,et al.  A Parent-report Gender Identity Questionnaire for Children: A Cross-national, Cross-clinic Comparative Analysis , 2006, Clinical child psychology and psychiatry.

[7]  J. Crocker,et al.  Social stigma and self-esteem: The self-protective properties of stigma. , 1989 .

[8]  D. Operario,et al.  HIV risk behaviors among male-to-female transgender persons of color in San Francisco. , 2004, American journal of public health.

[9]  M. Katz,et al.  Attempted Suicide Among Transgender Persons , 2006, Journal of homosexuality.

[10]  E. Pinel,et al.  Stigma consciousness: the psychological legacy of social stereotypes. , 1999, Journal of personality and social psychology.

[11]  M. Koslowsky USING EFFECT CODING FOR COMPARING MODELS IN SOCIAL RESEARCH , 1988 .

[12]  J. Michael Oakes,et al.  Capturing the social demographics of hidden sexual minorities: An internet study of the transgender population in the United States , 2007 .

[13]  Carol T. Miller,et al.  Coping with stigma and prejudice. , 2000 .

[14]  B. Rosser,et al.  Are Transgender Persons at Higher Risk for HIV Than Other Sexual Minorities? A Comparison of HIV Prevalence and Risks , 2005 .

[15]  R. Kessler,et al.  Social factors in psychopathology: stress, social support, and coping processes. , 1985, Annual review of psychology.

[16]  A. Verschoor,et al.  Psychosocial differences between dutch male and female transsexuals , 1988, Archives of sexual behavior.

[17]  Virginia R. Brooks Minority stress and lesbian women , 1981 .

[18]  J. Elashoff,et al.  Multiple Regression in Behavioral Research. , 1975 .

[19]  Laura J. Gurak,et al.  Conducting Internet-Based HIV/STD Prevention Survey Research: Considerations in Design and Evaluation , 2007, AIDS and Behavior.

[20]  R. Zambrana,et al.  Emerging Intersections: Race, Class, and Gender in Theory, Policy, and Practice , 2009 .

[21]  M. Katz,et al.  HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. , 2001, American journal of public health.

[22]  P. Cohen-Kettenis,et al.  Sex reassignment surgery: A study of 141 dutch transsexuals , 1988, Archives of sexual behavior.

[23]  K. Jordan,et al.  Coming out for lesbian women: its relation to anxiety, positive affectivity, self-esteem, and social support. , 1998, Journal of homosexuality.

[24]  Y. Elizur,et al.  Family support and acceptance, gay male identity formation, and psychological adjustment: a path model. , 2001, Family process.

[25]  B. Boedeker,et al.  Social support, exposure to violence and transphobia, and correlates of depression among male-to-female transgender women with a history of sex work. , 2011, American journal of public health.

[26]  Richard Tewksbury,et al.  COMING OUT AND CROSSING OVER , 1997 .

[27]  Eric Vilain,et al.  Collective Self-Esteem as a Coping Resource for Male-to-Female Transsexuals. , 2009, Journal of counseling psychology.

[29]  J. Parsons,et al.  Stigma, Concealment and Symptoms of Depression as Explanations for Sexually Transmitted Infections among Gay Men , 2007, Journal of health psychology.

[30]  A. Barsky,et al.  Do women somatize more than men? Gender differences in somatization. , 1994, Psychosomatics.

[31]  D. Operario,et al.  Need for HIV/AIDS Education and Intervention for MTF Transgenders , 2006, Journal of homosexuality.

[32]  E. Coleman,et al.  Developmental Stages of the Transgender Coming-Out Process: Toward an Integrated Identity , 2013 .

[33]  B. Rosser,et al.  Transgender HIV prevention: a qualitative needs assessment. , 1998, AIDS care.

[34]  I. Meyer Minority stress and mental health in gay men. , 1995, Journal of health and social behavior.

[35]  A. Rosenblum,et al.  Transgender Identity Affirmation and Mental Health. , 2002 .

[36]  D M Wegner,et al.  Covering up what can't be seen: concealable stigma and mental control. , 1999, Journal of personality and social psychology.

[37]  S. Hershberger,et al.  The impact of victimization on the mental health and suicidality of lesbian, gay, and bisexual youths. , 1995 .

[38]  J. Henne,et al.  The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. , 2001, American journal of public health.

[39]  Schmitt Jp,et al.  Personality Correlates of Positive Identity and Relationship Involvement in Gay Men , 1987 .

[40]  I. Meyer Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. , 2003, Psychological bulletin.

[41]  E. Rothblum,et al.  A model of predictors and outcomes of outness among lesbian and bisexual women. , 2001, The American journal of orthopsychiatry.

[42]  D. E. Frable,et al.  Predicting self-esteem, well-being, and distress in a cohort of gay men: the importance of cultural stigma, personal visibility, community networks, and positive identity. , 1997, Journal of personality.

[43]  C. Waldo Working in a Majority Context: A Structural Model of Heterosexism as Minority Stress in the Workplace. , 1999 .

[44]  J. DiPlacido Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. , 1998 .

[45]  W. Bockting,et al.  Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community , 2005, AIDS care.

[46]  B. Perry,et al.  Sexual Identity Distress, Social Support, and the Health of Gay, Lesbian, and Bisexual Youth , 2006, Journal of homosexuality.

[47]  M. Salamero,et al.  Sociodemographic, Clinical, and Psychiatric Characteristics of Transsexuals from Spain , 2009, Archives of sexual behavior.

[48]  B. Kreukels,et al.  Peer Group Status of Gender Dysphoric Children: A Sociometric Study , 2009, Archives of sexual behavior.

[49]  W. Bockting,et al.  Transgender Health and Social Service Needs in the Context of HIV Risk , 2014 .

[50]  A. Rosenblum,et al.  Psychiatric Impact of Gender-Related Abuse Across the Life Course of Male-to-Female Transgender Persons , 2010, Journal of sex research.

[51]  Graham Scambler,et al.  Being epileptic: coming to terms with stigma , 1986 .

[52]  J. Crocker,et al.  The Self-Protective Properties of Stigma: Evolution of a Modern Classic , 2003 .

[53]  E. E. Jones Social stigma: The psychology of marked relationships , 1984 .

[54]  G. Bauer,et al.  Depression in Male-to-Female Transgender Ontarians: Results from the Trans PULSE Project , 2011 .

[55]  W. Bockting,et al.  Conducting Internet Research With the Transgender Population: Reaching Broad Samples and Collecting Valid Data , 2012, Social science computer review.

[56]  R. Mathy Transgender Identity and Suicidality in a Nonclinical Sample , 2003 .

[57]  R. Mathy A Nonclinical Comparison of Transgender Identity and Sexual Orientation , 2002 .

[58]  Patrick W. Corrigan,et al.  Stigma and disclosure: Implications for coming out of the closet , 2003 .

[59]  Lynn Weber,et al.  Understanding Race, Class, Gender, and Sexuality: A Conceptual Framework , 2000 .