Minority Stress, Self-Awareness, and Coping Strategies during the COVID-19 Pandemic among Italian Transgender Young Adults

BACKGROUND

The security measures implemented in response to the COVID-19 emergency have caused complex consequences. The aim of the present study is to examine the repercussions of the pandemic on individuals belonging to gender identity minority groups, who have experienced heightened levels of stress in comparison to the general population.

METHODS

Online interviews with 12 transgender participants who resided in Italy during the pandemic were conducted and subsequently analyzed following the thematic analysis methodology.

RESULTS

The majority of the participants reported an increase in stress levels primarily attributed to the lack of acceptance and support within their familial environments, obstacles encountered in accessing specialized healthcare services, and a lack of support from the broader LGBTQ+ community. Despite these challenges, several participants developed effective coping strategies and a subset of them also benefited from multiple resilience factors, including familial support and assistance from mental health professionals.

CONCLUSIONS

The outcomes of the present study indicate that the COVID-19 pandemic, while fostering certain protective factors within this population, has also given rise to new and critical mental health concerns. These findings hold significant implications for professionals working with transgender populations, highlighting the necessity of addressing these emerging mental health issues.

Gender minority stress in transgender people: a major role for social network

BACKGROUND

Gender minority individuals, on average, experience higher rates of mental health problems. Mounting work suggests that gender minority stress (GMS) contributes to mental health outcomes in transgender/gender-nonconforming individuals.

AIM

We assessed whether GMS decreased in transgender people after initiating gender-affirming hormone therapy (GAHT), and we identified social predictors and hormonal associations for GMS at 2 time points.

METHODS

GMS was surveyed through self-report questionnaires tapping into proximal and distal stressors and coping constructs following the minority stress framework. Eighty-five transgender persons wishing to undertake hormonal interventions were assessed prospectively at start of GAHT and after 7.7 ± 3.5 months (mean ± SD). Sixty-five cisgender persons served as a control group.

OUTCOMES

(1) Proximal stressors were surveyed by the Beck Depression Inventory II, State-Trait Anxiety Inventory, Scale for Suicide Ideation, Suicidal Thoughts/Attempts, Stigma Consciousness Questionnaire, and Perceived Stress Scale; (2) distal stressors by the Everyday Discrimination Scale; and (3) coping constructs by the Resilience Scale, social network, social standing, and Marlowe Crowne Social Desirability Scale.

RESULTS

Transgender people experienced higher rates of proximal stressors (Beck Depression Inventory II, State-Trait Anxiety Inventory, Scale for Suicide Ideation, Suicidal Thoughts/Attempts, Perceived Stress Scale) and had lower protective factors (social standing) prior to and during GAHT than cisgender people. Social network and resilience were lower in transgender people relative to cisgender peers only at baseline. Prospectively, decreasing trait anxiety was observed in transgender people. Social factors were adequate predictors of multiple GMS constructs. Specifically, a major role for social network emerged. As for hormonal associations, only serum estradiol levels in transgender women with GAHT were negatively associated with trait anxiety and suicidal thoughts/attempts but positively with resilience and social desirability.

CLINICAL IMPLICATIONS

Stimulating a social environment supportive of diverse identities, particularly by investing in social networks as a resource for resilience, is likely to alleviate GMS.

STRENGTHS AND LIMITATIONS

Longer duration of interventions with sex steroid treatment, with continued resilience-enhancing strategies, is needed to observe further alleviation of GMS in transgender persons. Also, objective and subjective GMS identification with heteronormative attitudes and beliefs should be surveyed for good measure when assessing GMS.

CONCLUSION

Transgender people experienced more GMS throughout study visits than cisgender people did. With a relatively short period of GAHT, some significant changes in and predictors for experienced GMS emerged.

Transgender and gender expansive emerging adults: The moderating role of thwarted belongingness on mental health

Transgender and gender expansive emerging adults experience multiple forms of gender minority stress, which affect their mental health and wellbeing. Belongingness has been identified as a factor that fosters resilience among this population, with potential protective effects. Few studies have explored the role of thwarted belongingness and its potential moderating effect on the relation between gender minority stress and mental health. This study recruited a sample of 93 transgender and gender expansive emerging adults between the ages of 18 and 21 to examine whether thwarted belongingness significantly moderates the relations between gender minority stressors and mental health symptoms. We found evidence that thwarted belongingness moderates the relation between social rejection and depressive symptoms and the interaction effect between thwarted belongingness and victimization was significantly associated with psychological stress. For both of these associations, high levels of thwarted belongingness amplified the positive relation between gender minority stress and mental health symptoms. In contrast, at low levels of thwarted belongingness, the relation between rejection and depression was negative and the association between victimization and psychological stress was no longer statistically significant. Findings suggest that factors that minimize or interrupt thwarted belongingness among transgender and gender expansive emerging adults may be points of intervention to improve mental health outcomes in this population.

Disordered Eating and Body Dissatisfaction in Transgender and Gender-Expansive Adults: An Evaluation and Integration of the Gender Minority Stress and Resilience and Tripartite Influence Models

Transgender and gender-expansive (TGE) people, including transgender and nonbinary individuals, experience elevated rates of body dissatisfaction and disordered eating compared to cisgender individuals, but little is known about why. To address this research gap, we compared the ability of TGE-specific factors as proposed in the gender minority stress and resilience (GMSR) model, general psychological factors contained in the tripartite influence (TI) model, and an integration of these frameworks to explain body dissatisfaction and disordered eating among TGE individuals. Regression analyses were conducted to test the models' abilities to explain experiences reported in a survey of 93 U.S. TGE adults, including 43 transgender women respondents (46.2%) and 31 transgender men respondents (33.3%). Participants were diverse with regard to age (M = 34.19, SD = 12.02) and ethnoracial background (e.g., 29.0% Hispanic/Latinx, 17.2% Black/African American, 6.5% American Indian/Alaska Native; 5.4% multiracial). Results demonstrated both models' abilities to explain body dissatisfaction and disordered eating independently, except for the relationship between body dissatisfaction and the thinness-oriented TI model. An integration of the models better explained body dissatisfaction and disordered eating compared to either model alone. Notably, some findings did not align with the two frameworks, suggesting existing models may not adequately describe pathways through which disordered eating emerges in TGE populations. Specifically, body dissatisfaction showed no significant relationship with disordered eating and was not well explained by the TI model, and higher gender identity pride was related to greater disordered eating symptoms. Implications for clinical care and future research are discussed.

The Trans Youth Justice Project: A Political Education and Leadership Development Program

Research has demonstrated that systemic transphobia and cissexism harms transgender youth in terms of social, educational, and health outcomes. All too often, research and policy emphasizes vulnerability among trans youth in a way that denies their capabilities as agents of change or active participants in their liberation. This article analyzes the development of Trans Youth Justice Project, a political education and youth leadership development program for trans youth ages 15-22. Based in principles of gender minority stress and social justice youth development, the 6-week remote program aims to increase the capacity and resilience of trans youth, develop youth leaders, and contribute to addressing social, educational, and health inequalities. We conducted a formative program evaluation of 2 cycles of the program with a total of 25 youth. Pre- and post-test surveys indicated increased feelings of belongingness to a trans community. Follow-up interviews highlighted the impact the program had on skills for social justice, self-efficacy, and community connection. We offer suggestions for implementing the open-source program more broadly.

Assessment of Psychological Distress and Peer Relations among Trans Adolescents-An Examination of the Use of Gender Norms and Parent-Child Congruence of the YSR-R/CBCL-R among a Treatment-Seeking Sample

Among trans adolescents, increased psychological distress is reported in the literature. The goal of this study was to examine psychological distress, associated peer relations and parent report congruence among the treatment-seeking sample of the Gender Identity Special Consultation (GISC) for youth at the Charité Berlin. Further, differences between the instruments' binary gender norms were investigated. Retrospectively, we analyzed clinical data derived from the GISC. By initial interviews and using the Youth Self-Report and Child Behavior Checklist, n = 50 trans adolescents aged 12-18 years (M = 15.5) were examined for psychological problems and peer relations. Congruence between self and parent report was analyzed by correlations. Half of the sample reported suicidality, self-harm and bullying. Trans adolescents showed significantly higher internalizing and total problems than the German norm population. The congruence between self and parent report proved to be moderate to high. The level of congruence and poor peer relations were identified as predictors of internalizing problems. Significant differences between the female vs. male gender norms emerged regarding mean scores and the number of clinically significant cases. Data provide valuable implications for intervention on a peer and family level. There are limitations to the suitability of questionnaires that use binary gender norms, and further research on adequate instruments and assessment is needed.

Using a Comprehensive Proximal Stress Model to Predict Alcohol Use

Purpose: The gender minority stress model has been proposed by researchers to explain the high rates of substance use found within transgender communities, but its explanatory power has never been directly tested. Further, qualitative research has noted that premedically transitioned and nonbinary individuals are more likely to engage in avoidant coping such as drinking to cope. As such, the current study tested the relationship between proximal stress (comprised of internalized transphobia, anticipated stigma, concealment, and gender dysphoria), drinking to cope, and problematic alcohol use. Methods: Transgender and nonbinary participants over the age of 18 (N=297) completed an online survey on alcohol use. To test for differences in drinking to cope across gender identity and medical transition, analysis of variance and independent t-tests were conducted. Further, a structural equation model of proximal stress was developed to test whether drinking to cope mediated the relationship between proximal stress and alcohol use. Results: There were no significant differences across gender identity or medical transition status in severity of drinking to cope. Proximal stress was significantly related to problematic alcohol use and the relationship was explained by an indirect relationship with drinking to cope. Conclusion: Findings from this study suggest that drinking to cope is an important aspect of high rates of alcohol use found in the transgender community. Implications for clinical practice with transgender individuals are discussed.

Relationship of Internalized Transnegativity and Protective Factors With Depression, Anxiety, Non-suicidal Self-Injury and Suicidal Tendency in Trans Populations: A Systematic Review

Discrimination heavily impacts the lives of trans populations and causes adverse mental health outcomes. As stated by the Gender Minority Stress Model self-stigmatization could play an important role in this process. The aim of this systematic review is to investigate whether there is a positive association between self-stigmatization and mental health and to identify mediation factors. Studies which quantitatively investigated the association between internalized transnegativity and selected mental health outcomes (depression, anxiety, non-suicidal self-injury, suicidal tendency) in self-identified trans populations were included. Comprehensive search of 5 large databases in June 2020 and the following screening and selection procedure, performed by two researchers separately, identified 14 studies which met criteria. The relationship to be studied was reported with correlation and/or mediation analysis of cross-sectional data. IT was directly positively associated with depression, anxiety and suicidal tendency in most of the reviewed studies. Data indicates links between self-stigmatization and other general mental health stressors such as rumination and thwarted belongingness. Community connectedness showed to be the strongest protective factor for mental health impairments. These results should be considered in transition counseling. More research is needed to better understand the underlying mechanisms of the GMSM and to address unsolved operationalization and measurement issues.

Health Disparities in Transgender and Gender Expansive Adolescents: A Topical Review From a Minority Stress Framework

OBJECTIVE

To present a topical review of minority stressors contributing to psychosocial and physical health disparities in transgender and gender expansive (TGE) adolescents.

METHODS

We conducted a topical review of original research studies focused on distal stressors (e.g., discrimination; victimization; rejection; nonaffirmation), proximal stressors (e.g., expected rejection; identity concealment; internalized transphobia), and resilience factors (e.g., community connectedness; pride; parental support) and mental and physical health outcomes.

RESULTS

Extant literature suggests that TGE adolescents experience a host of gender minority stressors and are at heightened risk for negative health outcomes; however, limited research has directly applied the gender minority stress framework to the experiences of TGE adolescents. Most research to date has focused on distal minority stressors and single path models to negative health outcomes, which do not account for the complex interplay between chronic minority stress, individual resilience factors, and health outcomes. Research examining proximal stressors and resilience factors is particularly scarce.

CONCLUSIONS

The gender minority stress model is a helpful framework for understanding how minority stressors contribute to health disparities and poor health outcomes among TGE adolescents. Future research should include multiple path models that examine relations between gender minority stressors, resilience factors, and health outcomes in large, nationally representative samples of TGE adolescents. Clinically, adaptations of evidence-based interventions to account for gender minority stressors may increase effectiveness of interventions for TGE adolescents and reduce health disparities in this population of vulnerable youth.

Gender Minority Stress: A Critical Review

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 article uses 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 marginalizing nature of social environments for trans and gender diverse people. This article provides a critical review that integrates and expands on past theoretical perspectives on gender minority stressors and protective factors. Specifically, this article 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.

Gender Minority Stress and Health Perceptions Among Transgender Individuals in a Small Metropolitan Southeastern Region of the United States

Purpose: Transgender individuals continue to face wide-ranging health disparities, which may be due in part to unique and chronic gender identity-related stressors. The present study assessed the relationships between barriers to health care, proximal minority stress related to perceived community safety, and overall health perceptions of transgender individuals living in a small metropolitan region of the Southern United States.

Methods: Participants included 66 transgender individuals who took part in a larger lesbian, gay, bisexual, transgender, and queer (LGBTQ) community needs assessment study. Participants completed measures of barriers to health care, inclusive of medical access barriers, psychosocial needs barriers, and personal resource barriers, perceptions of LGBTQ safety within the region, and overall perceptions of health.

Results: Results revealed that psychosocial needs barriers, personal needs barriers, and perceived lack of community safety were correlated with poorer self-perceptions of overall health, with psychosocial needs barriers and perceived lack of community safety independently predictive of poor health perceptions.

Conclusions: The study demonstrates the need for greater health resources and access to care, as well as improved community conditions for transgender individuals, particularly those in less populated, Southern regions of the United States, to improve health quality and ultimately reduce community health disparities.