Citation

Price MA, Hollinsaid NL, McKetta S, Mellen EJ, Rakhilin M. Soc. Psychiatry Psychiatr. Epidemiol. 2024; 59(2): 285-294.

Copyright

(Copyright © 2024, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00127-023-02482-4

PMID

37165214

PMCID

PMC10171731

Abstract

PURPOSE: Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity.

METHODS: We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC).

RESULTS: Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts.

CONCLUSION: Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.

Language: en

Keywords

Adult; Humans; Mental health equity; Prejudice; Psychological distress; Psychological Distress; Stigma; Structural transphobia; Suicidal Ideation; Suicidality; Suicide; Transgender adults; Transgender Persons; United States