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Mental health and resilience in transgender individuals: What type of support makes a difference?

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Research has generally shown the benefits of social support, such as the buffering effects on life stressors, yet there has been little empirical investigation of different types of support resources for transgender individuals. We examined family support, support from friends, and connectedness to a transgender community and how these forms of support come together to influence mental health and resilience. The sample included 695 transgender participants (mean age = 25.52 years, SD = 9.68, range = 16-73; 75.7% White) who completed an online survey. Greater than half of participants reported moderate to severe levels of anxious and depressive symptoms. Family social support had the strongest correlations with symptoms of anxiety and depression (r = -.31 and -.37, respectively, p < .01) and was the only form of support associated with resilience when controlling for other forms of support. Latent profile analyses revealed 4 groups based on levels of social support from family and friends and community connectedness. Notably, Class 1 (n = 323; 47.1%) had high levels of support from family and friends and high levels of community connectedness. This class had lower levels of depression and anxiety symptoms and higher levels of resilience compared to other classes (Class 2, n = 276, 40.3%, high friend/community, low family; Class 3, n = 47, 6.9%, low support; Class 4, n = 39, 5.7%, high family, low friend/community). This study highlights the importance of examining support from a more holistic approach and provides insight into unique associations between familial social support and resilience. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Journal of Family Psychology
Mental Health and Resilience in Transgender
Individuals: What Type of Support Makes a Difference?
Jae A. Puckett, Emmie Matsuno, Christina Dyar, Brian Mustanski, and Michael E. Newcomb
Online First Publication, July 18, 2019. http://dx.doi.org/10.1037/fam0000561
CITATION
Puckett, J. A., Matsuno, E., Dyar, C., Mustanski, B., & Newcomb, M. E. (2019, July 18). Mental Health
and Resilience in Transgender Individuals: What Type of Support Makes a Difference?. Journal of
Family Psychology. Advance online publication. http://dx.doi.org/10.1037/fam0000561
Mental Health and Resilience in Transgender Individuals: What Type of
Support Makes a Difference?
Jae A. Puckett
Michigan State University
Emmie Matsuno
University of California, Santa Barbara
Christina Dyar, Brian Mustanski, and Michael E. Newcomb
Northwestern University Feinberg School of Medicine
Research has generally shown the benefits of social support, such as the buffering effects on life stressors,
yet there has been little empirical investigation of different types of support resources for transgender
individuals. We examined family support, support from friends, and connectedness to a transgender
community and how these forms of support come together to influence mental health and resilience. The
sample included 695 transgender participants (mean age 25.52 years, SD 9.68, range 16 –73;
75.7% White) who completed an online survey. Greater than half of participants reported moderate to
severe levels of anxious and depressive symptoms. Family social support had the strongest correlations
with symptoms of anxiety and depression (r⫽⫺.31 and .37, respectively, p.01) and was the only
form of support associated with resilience when controlling for other forms of support. Latent profile
analyses revealed 4 groups based on levels of social support from family and friends and community
connectedness. Notably, Class 1 (n323; 47.1%) had high levels of support from family and friends
and high levels of community connectedness. This class had lower levels of depression and anxiety
symptoms and higher levels of resilience compared to other classes (Class 2, n276, 40.3%, high
friend/community, low family; Class 3, n47, 6.9%, low support; Class 4, n39, 5.7%, high family,
low friend/community). This study highlights the importance of examining support from a more holistic
approach and provides insight into unique associations between familial social support and resilience.
Keywords: transgender, social support, resilience, community connectedness, mental health
Supplemental materials: http://dx.doi.org/10.1037/fam0000561.supp
Transgender (or trans, also known as gender minorities) is an
umbrella term that refers to individuals who do not identify with
the gender that is typically associated with their sex assigned at
birth. This includes a diverse group (American Psychological
Association, 2015) of trans men, trans women, and other people
who do not identify with a gender (e.g., agender) or identify
outside binary notions of gender (e.g., genderqueer or nonbinary
individuals). We use the terms trans and gender diverse (TGD) and
gender minorities to capture the myriad of identities within the
broader transgender community.
TGD individuals experience striking elevations in mental health
concerns, such as depression (Bockting, Miner, Swinburne Ro-
mine, Hamilton, & Coleman, 2013; Rotondi et al., 2011), anxiety
(Bockting et al., 2013; Budge, Adelson, & Howard, 2013), and
suicidality (Goldblum et al., 2012; James et al., 2016). These
mental health concerns are partially driven by experiences of
stigmatization and marginalization, or minority stress (Hendricks
& Testa, 2012; Meyer, 2003). Although prior research has helped
elucidate processes that negatively impact mental health in TGD
individuals, very little research has focused on understanding what
Jae A. Puckett, Department of Psychology, Michigan State University;
Emmie Matsuno, Counseling Psychology, University of California, Santa
Barbara; Christina Dyar, Brian Mustanski, and Michael E. Newcomb,
Department of Medical Social Sciences, Institute for Sexual and Gender
Minority Health and Wellbeing, Northwestern University Feinberg School
of Medicine.
Jae A. Puckett presented on earlier versions of the findings reported
in this article to the Chicago Parents of Trans Individuals support group,
the Trans Health Community Advisory Board affiliated with this proj-
ect, and at the Association for Behavioral and Cognitive Therapies
Conference.
The project described herein was supported by a grant from the National
Institute on Drug Abuse (1F32DA038557).
We thank the members of the Trans Health Community Advisory Board,
who assisted with this project for their time, feedback, and dedicated involve-
ment. The authors also greatly appreciate the feedback that the Chicago
Parents of Trans Individuals support group provided related to early findings
from this study and their suggestions for ways that parents and families can
better support their trans loved ones. The authors would also like to thank the
participants who completed this study for their contributions.
Correspondence concerning this article should be addressed to Jae A.
Puckett, Department of Psychology, Michigan State University, 316 Phys-
ics Road, Room 262, East Lansing, MI 48824. E-mail: pucket26@msu.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Journal of Family Psychology
© 2019 American Psychological Association 2019, Vol. 1, No. 999, 000
0893-3200/19/$12.00 http://dx.doi.org/10.1037/fam0000561
1
types of social supports benefit the mental health of gender mi-
norities. This study sought to understand how various types of
support (family, friends, and TGD community connectedness)
collectively relate to mental health and resilience for TGD people.
Social Supports and Mental Health
Social support, which refers to interpersonal supports that help
decrease stress (Gerrig & Zimbardo, 2002), has emerged as a key
factor that is associated with resilience and may buffer the negative
outcomes of minority stress among TGD individuals (Bockting et
al., 2013; Budge et al., 2013). For TGD people coping with
stigmatization, there are three prominent domains from which they
may seek support: family, friends, and a TGD community (Mizock
& Mueser, 2014). For each of these specific types of support, the
research is limited but provides an important base from which to
ask more nuanced questions about what types of supports might be
related to better mental health and resilience.
Most of the research about social support for TGD individuals
tends to average all forms of social support into a single construct.
This research indicates that social support, in general, is associated
with less depression and less anxiety in genderqueer individuals
(Budge, Rossman, & Howard, 2014), trans men, trans women
(Budge et al., 2013; Pflum, Testa, Balsam, Goldblum, & Bongar,
2015), and TGD youth (Grossman, D’augelli, & Frank, 2011). In
addition, greater social support has been associated with less
nonsuicidal self-injury for trans men and trans women (Claes et al.,
2015). And beyond demographic variables and other known cor-
relates of depression, such as gender-related victimization, social
support may be an especially strong predictor of mental health
(Boza & Nicholson Perry, 2014).
Family social support, specifically, is associated with higher life
satisfaction, lower feelings of being a burden, and less depression
in TGD individuals (Simons, Schrager, Clark, Belzer, & Olson,
2013) as well as less psychological distress (Bockting et al., 2013;
Lefevor, Sprague, Boyd-Rogers, & Smack, 2019). Support from
family members may be particularly important in protecting TGD
individuals from mental health risks (Mustanski, Newcomb, &
Garofalo, 2011; Olson, Durwood, DeMeules, & McLaughlin,
2016; Ryan, Russell, Huebner, Diaz, & Sanchez, 2010; Weinhardt
et al., 2019). For example, one study found that 57% of TGD youth
who said their parents were not supportive had attempted suicide
compared with only 4% of TGD youth who reported their parents
were supportive (Travers, Bauer, Pyne, & Bradley, 2012). Re-
search with lesbian, gay, bisexual, and transgender (LGBT) par-
ticipants demonstrates that family social support may contribute to
better mental health above and beyond other forms of support,
such as from peers or an LGBT community (Snapp, Watson,
Russell, Diaz, & Ryan, 2015), and may be essential to better
mental health (Mcconnell, Birkett, & Mustanski, 2015).
Although families have the capability to buffer the harmful
effects of stigma (Koken, Bimbi, & Parsons, 2009; Singh &
McKleroy, 2011), many TGD people experience rejection from
their own families (Bradford, Reisner, Honnold, & Xavier, 2013;
Koken et al., 2009; Mullen & Moane, 2013) and may instead be
more likely to turn to their friends for support (Moody & Smith,
2013; Nemoto, Bödeker, & Iwamoto, 2011). Unfortunately, very
limited research exists that separately examines the impact of
support from friends or peers on mental health among TGD
populations. Thus far, research has shown that support from
friends is associated with less psychological distress (Bockting et
al., 2013; Lefevor et al., 2019) and lower rates of suicidal ideation
(Bauer, Scheim, Pyne, Travers, & Hammond, 2015) for gender
minorities. Additionally, peer social support was found to have a
significant buffering effect on the association between stigma and
mental health for TGD individuals (Bockting et al., 2013).
TGD people also may seek a connection to a transgender com-
munity (Budge et al., 2012). This form of support can be important
for several reasons, including the ways connection with other TGD
individuals may facilitate the process of self-actualization and
self-acceptance, as well as decrease feelings of isolation when
faced with rejection from other groups (Graham et al., 2014).
Connectedness to a TGD community has been associated with
better well-being and fewer symptoms of depression and anxiety
(Barr, Budge, & Adelson, 2016; Pflum et al., 2015). Furthermore,
community involvement can significantly buffer the effects of
gender-based abuse on depression (Nuttbrock et al., 2015).
Although there are benefits to community connection, this re-
source may be limited to those willing to disclose their gender
minority identity (Hendricks et al., 2012) and to those in geo-
graphic locations that offer TGD community resources. Research
also indicates that involvement in TGD communities may be
associated with greater depression (Rotondi et al., 2011) and
greater exposure to discrimination (Bradford et al., 2013), perhaps
because this type of community connection may increase the
visibility of one’s identity. It also could be that this form of support
is more beneficial to the mental health of certain subgroups than
others. In one study, researchers found that TGD community
connectedness was significantly associated with fewer symptoms
of depression and anxiety among trans female spectrum partici-
pants but not trans male spectrum participants (Pflum et al., 2015).
Because of these mixed findings, research is still needed to assess
the associations between TGD community connection and mental
health.
Resilience and Social Support
Along with being associated with better mental health outcomes,
social support can help build resilience among TGD individuals
(Bockting et al., 2013; Matsuno & Israel, 2018; Singh, Hays, &
Watson, 2011). In this study, we conceptualized resilience as one’s
ability to overcome or bounce back from adversities (Matsuno et
al., 2018; Meyer, 2015; Smith et al., 2008). Although others have
labeled processes that may help one to be resilient, such as effec-
tive coping strategies or even social support, as resilience itself
(e.g., Bockting et al., 2013), we examined resilience as an indi-
vidual difference in how people respond and adapt to stressors
(Matsuno et al., 2018; Smith et al., 2008). According to the
minority stress model, resilience is hypothesized to moderate the
association between minority stressors and mental health outcomes
(Meyer, 2003). Therefore, higher levels of resilience among TGD
individuals may buffer the negative outcomes of minority stress,
making this an important area to study.
Although research has demonstrated the association between
social support and mental health outcomes (Budge et al., 2013;
Budge et al., 2014; Pflum et al., 2015), few quantitative studies
have examined how social support may relate to resilience for
TGD individuals. Partially, this is likely the case because social
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2PUCKETT, MATSUNO, DYAR, MUSTANSKI, AND NEWCOMB
support and resilience have been equated in some prior studies
(e.g., Bockting et al., 2013; Grossman et al., 2011), whereas social
support may more accurately be characterized as a factor that
promotes resilience (Matsuno et al., 2018). Even so, quantitative
research shows that resilience is associated with better mental
health for TGD individuals (Gonzalez, Bockting, Beckman, &
Dura, 2012; Scandurra, Amodeo, Valerio, Bochicchio, & Frost,
2017) and higher levels of resilience are associated with turning to
family for support and more contact with LGBT peers (Bariola et
al., 2015). Qualitative studies have consistently identified social
support from friends, family, and the TGD community as support-
ing resilience for gender minority adults (Moody, Fuks, Peláez, &
Smith, 2015; Singh et al., 2011), TGD youth (Singh, Meng, &
Hansen, 2014), and TGD youth of color (Singh, 2013).
Current Study
Social support is important to the well-being of TGD individu-
als, yet there has been extremely limited research examining the
role of different interpersonal supports in relation to mental health
and resilience in gender minorities. This is particularly relevant,
given that few studies have simultaneously examined the three
major forms of support that TGD individuals use to cope (social
support from family, friends, and community). Research also has
typically included trans men and trans women, whereas research
with a gender diverse sample more accurately reflects the variety
of identities in the TGD community. In this gender diverse sample,
we examined: (a) severity of mental health symptoms in a TGD
sample; (b) associations between social supports, mental health,
and resilience; (c) groupings based on social support from family,
friends, and TGD community connectedness; and (d) differences
in mental health and resilience based on the types of supports.
Method
Participants
For this online study, there were 861 people who opened the
survey. Of these individuals, there were 166 participants who
either opened the survey and did not finish or who were disqual-
ified from the study after opening the link for a variety of reasons
(e.g., not completing any of the items, incorrectly answering
consent comprehension questions). After removing these individ-
uals, there were 695 participants in the final sample. The mean age
of the final sample was 25.52 years (SD 9.68; range 16 –73
years). The majority of the sample identified as White (75.7%) and
most had an income below $10,000 a year (51.4%). About half of
the participants identified as either transgender men (30.4%) or
transgender women (16.6%), and a variety of other gender iden-
tities (e.g., genderqueer, nonbinary) were reported by the other
participants. In regard to sex assigned at birth, 76.8% (n534)
were assigned female at birth and 22.4% (n156) were
assigned male at birth. Of note in regard to sexual orientation,
the largest percentage of participants identified as queer (25%),
with the second most common sexual orientation being pan-
sexual (18.7%). A breakdown of all demographic information is
available in Table 1.
Procedures
The data presented here were part of a broader study, which
entailed two components— one was a daily diary study and the
other a brief, one-time survey for participants who did not qualify
for the daily diaries. Participants completed a brief screener to
determine which portion of the study they would be presented. To
qualify for the daily diary portion, participants had to meet all of
the following criteria: be between 16 and 40 years old; identify as
trans men, trans women, genderqueer, or nonbinary; live in the
United States; had sex in the past 30 days; and either binge drank
or used substances in the past 30 days. Participants who did not
qualify for the daily diary portion could participate in the one-time
survey if they were aged 16 years and older, identified as TGD,
Table 1
Sample Demographics
Characteristic n(%)
Age Range 16–73
Gender identity
Transgender man 211 (30.4%)
Transgender woman 115 (16.6%)
Genderqueer 87 (12.5%)
Nonbinary 132 (19%)
Agender 66 (9.5%)
Androgyne 7 (1%)
Bigender 22 (3.2%)
Sexual orientation
Queer 174 (25%)
Pansexual 130 (18.7%)
Bisexual 106 (15.3%)
Gay 62 (8.9%)
Asexual 100 (14.4%)
Heterosexual 38 (5.5%)
Lesbian 35 (5%)
Race/ethnicity
White 526 (75.7%)
Black/African American 13 (1.9%)
American Indian or Alaska native 1 (.1%)
Asian 21 (3%)
Latino/a 25 (3.6%)
Multiracial/multiethnic 98 (14.1%)
Education
Less than high school diploma 91 (13.1%)
High school graduate or equivalent 88 (12.7%)
Some college education but have not
graduated 228 (32.8%)
Associate’s degree/technical school degree 52 (7.5%)
Bachelor’s degree 160 (23%)
Master’s degree 63 (9.1%)
Doctorate or professional degree 13 (1.9%)
Income
Less than $10,000 357 (51.4%)
$10,000–19,999 112 (16.1%)
$20,000–29,999 59 (8.5%)
$30,000–39,999 49 (7.1%)
$40,000–49,999 39 (5.6%)
$50,000–69,999 36 (5.2%)
More than $70,000 40 (5.8%)
Note. There were five participants with missing data on the question
asking about sex assigned at birth and three participants with missing data
about their race/ethnicity and income. A response of not listed was chosen
for: 55 participants regarding gender identity, 50 for sexual orientation, and
eight for race/ethnicity. These participants had the option to provide written
responses.
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3
SOCIAL SUPPORT FOR TRANS INDIVIDUALS
and lived in the United States. The data presented here are from
only participants in the one-time survey.
This study was informed by a transgender community advisory
board (CAB), which included local TGD individuals who met
weekly for a month prior to the beginning of the study and
periodically after the initiation of data collection for the duration of
the project. The role of the CAB was to provide feedback about the
overall focus of the project and the relevance and cultural sensi-
tivity to their own lived experiences as well as to provide com-
ments on the questions included in the study, study design, recruit-
ment materials, and retention methods. The primary researcher on
the project also shared preliminary findings with the CAB and
sought feedback about the results, including findings focused on
social support.
Participants in the study were recruited from Facebook, Twitter,
Tumblr, and other social media sites as well as through community
organizations that serve the TGD community and via flyers at
community events. The study was approved by the institutional
review board of the primary investigator’s institutions with a
waiver of parental permission for 16- to 17-year-olds under 45
CFR 46.408(c). Participants provided their consent/assent to par-
ticipate in the study, which was completed via the online survey.
Participants who completed the one-time survey received a $5
Amazon gift card, with the exception of the first 200 participants
because they completed the survey prior to funding being avail-
able.
Because this was an online survey, there were several steps
taken to ensure the quality of the data. Participants did not gain
immediate access to the surveys, and they had to complete the
screener questionnaire to be considered for the study, allowing us
to screen for duplicate contact information in the screener ques-
tionnaire. The surveys were e-mailed to participants who qualified
for the study, and all e-mail addresses were reviewed for suspi-
cious e-mail accounts or duplicated e-mail addresses. Each e-mail
included a unique link to the survey that could only be used once.
We also examined IP addresses to screen for duplicate responses.
In addition, the survey platform included survey protection options
that prevented the survey from being taken multiple times by the
same user, including the screener questionnaire. The survey soft-
ware included a CAPTCHA (completely automated public turing
test to tell computers and humans apart) to inhibit programmed
responses. Finally, once participants gained access to the survey,
they also answered a series of three questions to assess their
understanding of the consent information (consent comprehension
questions). This also served as a way to ensure that participants
were attending to the information and not being careless or ran-
domly responding.
Measures
Demographics. Participants reported their age, sex assigned
at birth, gender identity, sexual orientation, racial/ethnic identifi-
cation, income, employment status, and education level. See Table
1 for response options to these questions.
Social support from family and friends. The subscales mea-
suring family support and support from friends from the Multidi-
mensional Scale of Perceived Social Support (Zimet, Dahlem,
Zimet, & Farley, 1988) were utilized to assess support from these
groups. These subscales each included four items, with response
options on a 7-point scale from very strongly disagree (1) to very
strongly agree (7). Averages were calculated for each subscale.
This measure has been supported with factor analyses and has been
found to be reliable (Cronbach’s alphas of .90 and .94 for family
and friends subscales, respectively; Zimet et al., 1988). In the
current sample, Cronbach’s alpha was .93 for both subscales.
Community connection. The community connectedness sub-
scale of the Gender Minority Stress and Resilience Scale (Testa,
Habarth, Peta, Balsam, & Bockting, 2015) was completed to assess
participants’ feelings of being connected to a community of other
individuals with similar gender identities. This subscale consisted
of five items measured on a 5-point scale from strongly disagree
(1) to strongly agree (5). Two items were reverse scored and a total
score was calculated, with higher scores indicating a greater sense
of TGD community connectedness. In the development study, this
subscale was found to be reliable, and there was support for
criterion, convergent, and discriminant validity (Testa et al., 2015).
In the current sample, Cronbach’s alpha was .82.
Mental health. Mental health was assessed via a measure of
depression symptoms and a measure of anxiety symptoms. To
assess depression, participants completed a short form of the
Patient-Reported Outcomes Measurement Information System
(PROMIS)–Depression scale (Cella et al., 2011). This was an
eight-item scale in which participants reported how often in the
past 7 days they experienced symptoms of depression, such as
feeling worthless, hopeless, or sad. To assess anxiety symptoms,
participants completed a short form of the PROMIS–Anxiety
scale, which included seven items in which participants reported
how often in the past 7 days they experienced symptoms such as
feeling fearful, tense, or worried. Response options ranged from
never (1) to always (5) on both scales. To calculate scores on these
measures, a raw score was computed, which was a total score that
was then converted to Tscores, which standardized the scores
against national norm data. The Cronbach’s alpha in the current
sample was .95 for the depression scale and .94 for the anxiety
scale. These measures were originally developed and tested with a
large sample of more than 20,000 individuals who were represen-
tative of the general population in the United States. Previous
validation research has shown that these scales have high levels of
reliability, and the short forms correlate highly with the full scales
as well as with other measures of depression and anxiety symp-
toms (Cella et al., 2011). For descriptive purposes, scores on these
two measures were categorized into none to slight (scores less than
55), mild (55–59.9), moderate (60 –69.9), and severe (70 and
over), in line with recommended cutoffs (American Psychiatric
Association, 2013).
Resilience. The Brief Resilience Scale (Smith et al., 2008)
assessed participants’ abilities to recover easily from stressful
experiences. This scale includes six items and responses were
measured on a 5-point scale from strongly disagree (1) to strongly
agree (5), and appropriate items were reverse scored before
calculating a mean score. Higher scores on this measure repre-
sented higher levels of resilience. Research has shown this scale
to be reliable, with good test-retest reliability and internal
consistency as well as support for convergent and discriminant
validity (Smith et al., 2008). Cronbach’s alpha in the current
study was .92.
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4PUCKETT, MATSUNO, DYAR, MUSTANSKI, AND NEWCOMB
Statistical Analysis
All data were analyzed using SPSS (Armonk, NY), with the
exception of the latent profile analyses, which were conducted in
Mplus version 8.1 (Los Angeles, CA). From the analytic sample,
1.2% of data was missing, and given this small percentage, this
was handled using pairwise deletion. Descriptive statistics were
conducted to describe the sample. Next, we examined associations
between demographics and support variables (support from family,
friends, and TGD community connectedness) and outcomes of
interest (depression symptoms, anxiety symptoms, resilience)
using correlations and ANOVAs. Bivariate correlations between
support variables and outcomes were examined next, and the sizes
of these correlations were compared using dependent correlation
comparisons. To examine the unique effects of each support vari-
able, we conducted multiple linear regressions in which demo-
graphic covariates and all three support variables were entered as
simultaneous predictors of depression symptoms, anxiety symp-
toms, and resilience. To determine whether the effect of a support
variable differed based on the amount of support present from
other sources, three-way interactions among the support variables
were tested as predictors of the outcomes.
Latent profile analyses (LPA) were then conducted to identify
groups based on support from family, friends, and TGD commu-
nity connectedness. We used a model-building approach in which
we started by estimating a model with one class and added one
class at a time. Bayesian Information Criterion (BIC) values,
sample size–adjusted BIC (adjusted BIC) values, Lo-Mendell-
Rubin (LMR) likelihood ratio tests, parametric bootstrapped like-
lihood ratio tests (BLRTs), the number of individuals in the small-
est class, and class interpretability were used to select the
appropriate number of classes (Dziak, Lanza, & Tan, 2014; Lo,
Mendell, & Rubin, 2001; Nylund, Asparouhov, & Muthén, 2007;
Tofighi & Enders, 2008; Yang, 2006). Higher entropy values
indicate greater distinguishability of latent classes and precision
with which individuals are categorized into classes (Ramaswamy,
DeSarbo, Reibstein, & Robinson, 1993). The model with the
lowest BIC and adjusted BIC indicated the number of classes
preferred by these indicators, and a significant LMR or BLRT
indicated a preference for the current model over the model with
one less class. ANOVAs and Tukey’s post hoc tests were then
conducted to examine which classes differed significantly on the
three support variables to help inform class interpretation.
2
analyses and ANOVAs were then conducted to evaluate whether
the classes differed based on demographics, mental health, and
resilience.
Results
A substantial portion of the sample reported elevated symptoms
of anxiety and depression. In regard to anxiety symptoms, 14.8%
of participants reported none to slight anxiety, 13.2% reported
mild anxiety, 45.3% reported moderate anxiety, and 24.2% re-
ported severe anxiety. For depression symptoms, 23.7% reported
none to slight depression, 22.9% mild depression, 36.4% moderate
depression, and 14.2% severe depression. Notably, more than half
of the sample reported moderate to severe levels of anxiety and
depression symptoms.
Correlations and descriptive statistics are available in Table 2.
Bivariate correlations indicated that age, sex assigned at birth, and
income were each significantly associated with at least one support
variable and one outcome and were therefore included as covari-
ates in subsequent multivariable regressions. Given the low in-
come of the sample, we also conducted a
2
analysis to assess
whether this was associated with the inclusion of 16- to 17-year-
olds in our sample and found a significant association between
being 16 or 17 years old and earning less than $10,000 a year
(
2
[1, N692] 21.11, p.001).
Given the relatively small number of participants in certain
groups, we combined the following subgroups in our analyses:
agender, androgyne, and bigender participants were combined
with those who reported that their gender identity was not listed;
men were combined with trans men; women were combined with
trans women; bisexual and pansexual participants were combined;
lesbian and gay individuals were combined; and heterosexual
participants were combined with those who identified with an
unlisted label. ANCOVAs examining associations between educa-
tion, sexual identity, gender identity, and the outcomes indicated
that all demographic variables were associated with at least one
social support variable and one outcome (see Supplemental
Table 1) and thus were included as covariates in multivariable
regressions.
We utilized dependent variable correlations to determine
whether support from family or friends, or community connected-
Table 2
Correlations and Descriptive Statistics
Variable M(SD)12345678910
1. Age 25.52 (9.68)
2. Sex assigned at birth .33
ⴱⴱ
3. Race/ethnicity .09
.02 —
4. Income .31
ⴱⴱ
.07 .02
5. Social support–family 3.56 (1.75) .10
.02 .08
.10
6. Social support–friends 5.54 (1.30) .02 .03 .08
.03 .12
ⴱⴱ
7. Community connectedness 17.57 (4.48) .08
.10
.04 .01 .07 .28
ⴱⴱ
8. Depression symptoms 60.52 (9.69) .26
ⴱⴱ
.02 .05 .13
ⴱⴱ
.37
ⴱⴱ
.22
ⴱⴱ
.08
9. Anxiety symptoms 63.39 (10.24) .27
ⴱⴱ
.03 .002 .14
ⴱⴱ
.31
ⴱⴱ
.12
ⴱⴱ
.04 .64
ⴱⴱ
10. Resilience 2.75 (.91) .25
ⴱⴱ
.09
.05 .14
ⴱⴱ
.25
ⴱⴱ
.07 .01 .41
ⴱⴱ
.49
ⴱⴱ
Note. Sex assigned at birth (0 male;1female), race/ethnicity (0 White;1People of Color), and income (0 less than $20,000 per year;1
more than $20,000 per year) were dummy coded.
p.05.
ⴱⴱ
p.01.
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5
SOCIAL SUPPORT FOR TRANS INDIVIDUALS
ness emerged as stronger bivariate predictors of anxiety symptoms,
depression symptoms, or resilience. Family social support was a
significantly stronger predictor of anxiety and depression symp-
toms as well as resilience compared with social support from
friends or community connectedness (ps.01). Family support
had a moderate, negative correlation with anxiety, r⫽⫺.31, p
.01, and depression symptoms, r⫽⫺.37, p.01, and a small to
moderate positive association with resilience, r.25, p.01.
Social support from friends was also weakly negatively correlated
with anxiety, r⫽⫺.12, p.01, and depression symptoms,
r⫽⫺.22, p.01. Community connectedness was only weakly
negatively associated with depression symptoms, r⫽⫺.08, p
.05, and this association was significantly weaker than that be-
tween social support from friends and depression symptoms (p
.002). Social support from friends was not significantly associated
with resilience and community connectedness was not signifi-
cantly associated with anxiety symptoms or resilience.
To examine the unique effects of each support variable when
other support variables were controlled for, three multivariable
regressions were conducted in which all three social support vari-
ables were entered as simultaneous predictors of anxiety and
depression symptoms and resilience (Supplemental Table 2). In
these analyses age, sex assigned at birth, income, education, gen-
der identity, and sexual identity were included as covariates.
Results indicated that having more family support continued to
predict less depression and anxiety symptoms and more resilience,
even when support from friends and community connectedness
were controlled. Similarly, support from friends continued to pre-
dict less depression and anxiety symptoms when support from
family and community connectedness were controlled. However,
community connectedness did not predict anxiety and depression
symptoms or resilience in the multivariable models. None of the
three-way interactions of the support variables were significant,
indicating that the effects of the social support variables were
consistent across levels of the other social support variables (re-
sults not presented for brevity).
In the LPA, because of different scaling on the family/friend
support measure and the community connectedness variable,
scores were standardized prior to the analyses. Whereas BIC,
adjusted BIC, LMR, and BLRT indicated preference for a six-class
model (see Supplemental Table 3), this produced a very small class
consisting of 11 participants. Because classes smaller than 25
individuals can indicate the extraction of too many latent classes,
we examined four- and five-class solutions for interpretability.
Although the five-class model was preferred by model fit indices
over the four-class model, the four-class model was the most
interpretable (e.g., in the five-class solution, two groups were very
similar) and had adequate sample sizes for each group. See Sup-
plemental Figure 1 for a visual description of the classes that
emerged.
The (unstandardized) means for all social support variables by
class are presented in Table 3. Class 1 (n323; 47.1%; high
support) was the largest of the classes and included participants
with relatively high levels of support from all areas. Class 2 (n
276; 40.3%; high friend/community, low family) was character-
ized by high levels of support from friends and community con-
nectedness and low levels of support from family. Class 3 (n47;
6.9%; low support) included participants who had low levels of
support from family and friends as well as low community con-
nectedness. Class 4 (n39; 5.7%; high family, low friend/
community) was the smallest class that emerged and included
participants who reported low levels of support from friends, low
levels of community connectedness, and high levels of support
from family.
ANOVAs and Tukey’s post hoc tests were conducted to exam-
ine which classes differed significantly on support from friends
and family as well as community connectedness (see Table 3).
Omnibus ANOVAs were significant for all three sources of sup-
port (p.001), and post hoc tests indicated good differentiation
across classes in levels of support from each source. These results
indicated that Classes 1 (high support) and 2 (low family, high
friend/community) were characterized by higher levels of support
from friends and community connectedness than Classes 3 (low
support) and 4 (high family, low friend/community). Classes 1 and
2 differed significantly on support from family, with Class 1 (high
support) reporting more support from family than Class 2 (low
family, high friend/community). Classes 3 and 4 also differed on
family support with Class 3 (low support) reporting lower family
support than Class 4 (high family, low friend/community).
A series of
2
analyses and ANOVAs were conducted to assess
whether the classes differed on demographic characteristics. Be-
cause some expected cell sizes were below or near 5 in analyses of
associations between class membership and gender and sexual
identity, we utilized Fisher’s exact tests for these analyses. There
were no significant differences across classes in terms of gender
identity,
2
(12, N685) 12.64, p.40, sex assigned at birth,
Table 3
Analyses of Variance Examining Class Differences
Outcome ANOVA
Class means
Class 1 Class 2 Class 3 Class 4
Age F(3, 681) 1.50, p.21 26.33 24.73 24.74 26.05
Family support F(3, 673) 698.20, p.001 5.06
a
2.00
b
1.80
b
4.58
c
Friend support F(3, 673) 363.10, p.001 5.98
a
5.86
a
2.76
b
3.02
b
Community connectedness F(3, 680) 18.91, p.001 18.16
a
17.83
a
13.49
b
15.67
b
Depression symptoms F(3, 672) 26.53, p.001 57.45
a
62.60
b
67.75
c
62.00
b
Anxiety symptoms F(3, 674) 17.85, p.001 60.57
a
65.42
b
68.98
b
65.03
b
Resilience F(3, 673) 9.59, p.001 2.94
a
2.57
b
2.57
b
2.60
a,b
Note. Superscript letters (a, b, c) represent the results of Tukey’s post hoc comparisons of group means. Means with the same superscript letter are not
significantly different from one another, whereas means with different superscript letters differ significantly.
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6PUCKETT, MATSUNO, DYAR, MUSTANSKI, AND NEWCOMB
2
(3, N680) 1.42, p.70, race/ethnicity (white participants
compared with people of color;
2
[3, N682] 6.34, p.10),
sexual orientation,
2
(12, N685) 6.95, p.86, education,
2
(6, N685) 7.77, p.25, or age, F(3, 681) 1.50, p.21.
Classes did differ significantly on income,
2
(3, N682) 3.19,
p.04, but the proportions of individuals who reported more than
$20,000 per year and less than $20,000 per year was similar within
each class. Given the lack of differences in class membership
based on demographics, no covariates were controlled for in sub-
sequent analyses of class membership.
ANOVAs were conducted to compare the classes on levels of
anxiety and depression symptoms and resilience. Means for the
classes on these variables are provided in Table 3. There were
significant differences between the classes on anxiety and depres-
sion symptoms and resilience, and Tukey post hoc tests revealed
several significant between-group differences. Participants in the
high support class (Class 1) reported significantly lower levels of
anxiety and depression symptoms compared with all other groups.
Those in the low support class (Class 3) reported significantly
higher levels of depression symptoms compared with all other
groups. Additionally, the high support class reported significantly
higher levels of resilience compared with the high friend support/
community connectedness, low family support class (Class 2) and
the low support class (Class 3) but did not differ significantly from
the high family support, low friend support/community connect-
edness class (Class 4). For further insight into differences in
anxious and depressive symptoms, pairwise comparisons of pro-
portions were conducted utilizing categorical anxiety and depres-
sion variables based on the prevalence of symptomology (none to
slight, mild, moderate, or severe; Table 4). Individuals with high
support were more likely to have no/slight or mild anxious or
depressive symptomology and less likely to have severe anxious or
depressive symptomology compared with other groups.
Discussion
Our findings align with prior research demonstrating the notable
elevations in anxiety and depression symptoms experienced by
TGD individuals (Bockting et al., 2013; Budge et al., 2013; Ro-
tondi et al., 2011). In this study, more than half of the participants
indicated that they experienced moderate to severe levels of anx-
iety and depression symptoms. Although not examined in these
analyses, it is important to understand that there are a variety of
stressors that are likely influencing these elevated levels of psy-
chological distress, such as rejection, discrimination, and violence
(Goldblum et al., 2012; Lombardi, 2009; Rotondi et al., 2011;
Testa et al., 2012). Additionally, the low income of our sample
may contribute to the elevated symptoms of anxiety and depres-
sion (Murali & Oyebode, 2004) because of many participants
likely experiencing financial stressors. Other studies have indi-
cated that transgender populations are at higher risk for poverty
because of workplace discrimination and harassment (James et al.,
2016). More than half of participants reported an income of less
than $10,000 per year, which is high in comparison with a large
national study with transgender adults that found 28% of trans-
gender individuals reported an income of less than $10,000 per
year (James et al., 2016). This discrepancy may result from a
portion of this sample being youth or young adults who may have
lower income, given their age or student status or from being
employed in entry-level positions.
In the LPA, it was noteworthy and encouraging that almost half
of the sample (47.1%) reported high levels of support from all
areas and that only 6.7% of the sample reported low support in all
three areas. The make-up of the classes indicated that it was more
common for TGD people to have low family support and high
friend support/community connectedness (40.3%) than to have
high family support and low friend support/community connect-
edness (5.7%). Additionally, levels of support from friends and
community connectedness stayed consistent in the class groupings
(i.e., no class that had high friend support, low community con-
nectedness or vice versa emerged). Together these results may
indicate that it is more common for TGD individuals to have some
form of support than none at all and that, when there is low familial
support, they may turn to their friends and community instead.
The LPA confirmed the importance of social support in relation
to mental health and demonstrated that it is the most beneficial to
have all three types of support. Notably, among participants in the
high support class only 5.1% reported severe depression symp-
toms. This rate was greater than 8 times higher when participants
Table 4
Categories of Depressive and Anxious Symptoms by Cluster
Outcome Severity
Class 1 Class 2 Class 3 Class 4
n%n%n%n%
Anxiety symptoms
None to slight 72
a
22.8 26
b
9.4 3
b
6.4 2
b
5.1
Mild 53
a
16.8 31
a,b
11.2 2
b
4.3 6
a,b
15.4
Moderate 143
a
45.3 128
a
46.4 21
a
44.7 23
a
59.0
Severe 48
a
15.2 91
b,c
33.0 21
c
44.7 8
a,b
20.5
Depression symptoms
None to slight 114
a
36.2 46
b
16.7 0
c
.0 5
b
12.8
Mild 84
a
26.7 54
b
19.6 10
a,b
21.3 11
a,b
28.2
Moderate 101
a
32.1 118
b
42.9 17
a,b
36.2 17
a,b
43.6
Severe 16
a
5.1 57
b
20.7 20
c
42.6 6
b
15.4
Note. Superscript letters (a, b, c) represent the results of pairwise z tests of group proportions. Groups with the
same superscript letter are not significantly different from one another, whereas groups with different superscript
letters differ significantly.
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7
SOCIAL SUPPORT FOR TRANS INDIVIDUALS
had low support from all areas, with close to half of the individuals
in this low support class (42.6%) reporting severe symptoms of
depression. Additionally, most TGD individuals (89.4%) who
lacked support in all areas reported moderate to severe anxiety
symptoms and were 3 times more likely to report severe anxiety
symptoms compared with the high support class. However, in all
four classes, a large portion of TGD participants endorsed mod-
erate anxiety symptoms (44.7% - 59%) including 45.3% of par-
ticipants in the high-support class.
Although all types of social supports were important to the
mental health of TGD people in our sample, there are nuances to
this that must be considered. Overall, familial support had the
strongest association with fewer symptoms of depression and
anxiety and greater resilience. Additionally, family support signif-
icantly predicted depression and anxiety symptoms and resilience
above and beyond the variance accounted for by the other forms of
support. Family support seems to be particularly important in
relation to resilience because it was the only form of support that
significantly predicted resilience when controlling for the other
support variables. Additionally, Class 1 (high support) and Class 4
(high family/low friend-community) did not differ in levels of
resilience, whereas Class 2 (low family/high friend-community)
and Class 3 (low support) had lower levels of resilience. Other
work has indicated an association between family support and
resilience (Matsuno et al., 2018), and therefore, it could be that
family support helps TGD people bounce back from adversities by
providing a safe and supportive home base. However, our analyses
were cross-sectional, and longitudinal research is needed to deter-
mine whether family support increases resilience or whether there
is an alternative explanation.
Similar to social support from family, social support from
friends was associated with fewer symptoms of depression and
anxiety. However, unlike family support, support from friends was
not significantly associated with resilience when controlling for
other forms of support. In the latent class analysis, Class 2 (low
family/high friend-community) and Class 4 (high family/low
friend-community) showed similar symptoms of depression and
anxiety, indicating that having support from either family or
friends and community connectedness can potentially counteract
some of the negative impact of lack of support in the other area.
Both classes 2 and 4 showed lower rates of depression symptoms
compared with class 3 (low support) but did not differ in anxiety
symptoms or resilience. This finding demonstrates the importance
of having support in all three areas and indicates that having some
social support may impact symptoms of depression more than
symptoms of anxiety. Again, our results cannot conclude causality,
and there could be alternative explanations for these associations,
such as those with fewer depressive symptoms being better
equipped to seek and develop social support networks. Ultimately,
longitudinal research is needed to answer such a question.
In contrast to previous literature, community connectedness was
not significantly correlated with anxiety symptoms or resilience,
and the negative correlation with depression symptoms was weak.
Community connectedness did not significantly predict depression
or anxiety symptoms or resilience when controlling for other forms
of support. There are a few possible explanations for these find-
ings. One is that there may be overlap or conflation between
support from friends and community connectedness as it is possi-
ble that friends in a person’s network are also part of the TGD
community. Our results indicated that social support from friends
was significantly correlated with community connectedness, and
therefore, TGD community spaces may be areas in which individ-
uals cultivate new friendships with supportive others or it could be
that friends help establish connection to TGD communities.
It also is possible that the findings would be different if we had
assessed feeling supported by a TGD community as opposed to
community connectedness. It is likely that differences exist be-
tween those who feel simply connected versus those who feel
supported by other TGD individuals. Additionally, other research
has shown that community connection can both benefit and place
individuals at risk for harm. Community connection often in-
creases one’s visibility as a gender minority and may place TGD
individuals at greater risk for encountering minority stressors
(Bradford et al., 2013). Additionally, it is possible that connection
to a TGD community could create more awareness of negative
events experienced by other TGD individuals, which may increase
anxiety, anticipated rejection, or depressive symptoms like feel-
ings of hopelessness. Future research is needed to establish the
routes through which this form of support may exert positive
influences on the lives of TGD individuals. And finally, it is
possible that there are other factors that may impact TGD individ-
uals’ connectedness to a community, including location, lack of
desire to be connected to a TGD community, not yet being out
about one’s identity, or lack of visibility of a TGD community.
This study had several strengths. First, we were able to recruit a
diverse sample in regard to gender, in which more than half of the
sample identified as a nonbinary identity (e.g., genderqueer, big-
ender). Also, this study is the first to our knowledge to utilize the
widely used PROMIS measures for anxiety and depression symp-
toms with a sample of TGD individuals. These measures have been
recommended for use by the American Psychiatric Association
and this study shows initial support for their use with TGD
samples, given the high levels of reliability. In addition, this is one
of few studies to examine simultaneously the three areas of support
that people who are TGD have reported relying on in previous
research (Mizock & Mueser, 2014). Our study did not conflate
different forms of support and instead conducted analyses that
described combinations of the types of support. Lastly, this study
contributes to the extremely limited empirical investigation of
resilience for TGD individuals.
In terms of limitations, our study had limited racial and ethnic
diversity. Other studies with online recruitment of TGD samples
have also had limited racial and ethnic diversity (Bockting et al.,
2013; Kuper, Nussbaum, & Mustanski, 2012). It may be necessary
to conduct more in-person recruitment to reach TGD people of
color. Furthermore, intentionally creating partnerships with orga-
nizations and communities that serve TGD people of color and
having researchers who identify as TGD people of color may build
greater trust among this population and increase research partici-
pation. Additionally, this was a cross-sectional study that pre-
cludes any causal interpretations of the data and longitudinal work
would help to further establish how changes in social support
relates to mental health and resilience. It is possible that our
sample will differ from other TGD samples, given that these were
participants who did not qualify for the daily diary study. Even so,
the subsample of participants who completed this one-time study
were largely sexually active (only 29.3% reported never having
had sex), and their rates of alcohol use and drug/substance use
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8PUCKETT, MATSUNO, DYAR, MUSTANSKI, AND NEWCOMB
were similar to that found in the U.S. Trans Survey (James et al.,
2016), providing some evidence that our sample may not differ
substantially from others. Finally, although our inclusion of a
resilience measure is novel and a strength, given the state of
quantitative investigations of this construct with TGD samples, it
is worth noting that there may be aspects of resilience for TGD
individuals that are not captured in such a measure. For TGD
people, resilience may include a general ability to bounce back
from stressors, but it also might include the act and perseverance
of affirming one’s gender in a society in which TGD people face
many oppressive individuals and social systems.
Interpersonal relationships are one way of managing stressors,
and, as we found, social support from family and friends is related
to better mental health for TGD individuals. TGD people with high
levels of support from family and friends as well as TGD com-
munity connection showed the best mental health outcomes and
reported strikingly lower levels of depression and anxiety com-
pared with TGD who reported low levels of support in these areas.
Familial social support emerged as an important form of support in
relation to resilience. Through bolstering these core relationships
across these various sources of support, there may be improved
outcomes for TGD individuals who are likely facing great
amounts of oppression at the systemic, institutional, and inter-
personal levels.
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SOCIAL SUPPORT FOR TRANS INDIVIDUALS
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10 PUCKETT, MATSUNO, DYAR, MUSTANSKI, AND NEWCOMB
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Received October 9, 2018
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Accepted May 16, 2019
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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... Gender affirmation (social, legal, medical) has also been found to be a powerful promoter of mental health (Fontanari et al. 2020;Reardon 2019), as engaging in gender affirmation processes has been found to help youth and young adults in developing a sense of pride and positivity about their identities. Robust evidence has been found for the role of social connectedness, peer support (Puckett et al. 2019) and trans community connection (Inderbinen et al. 2021;Sherman et al. 2020) in well-being and its predictors (Puckett et al. 2019). ...
... Gender affirmation (social, legal, medical) has also been found to be a powerful promoter of mental health (Fontanari et al. 2020;Reardon 2019), as engaging in gender affirmation processes has been found to help youth and young adults in developing a sense of pride and positivity about their identities. Robust evidence has been found for the role of social connectedness, peer support (Puckett et al. 2019) and trans community connection (Inderbinen et al. 2021;Sherman et al. 2020) in well-being and its predictors (Puckett et al. 2019). ...
Article
Full-text available
The transgender and gender diverse (TGGD) population is highly diverse. To date, research on the association of the various family–parenthood aspirations of TGGD people with distinct affirming paths and identities remains scarce. A survey was conducted aiming to characterize the TGGD population’s diversity and socio-demographic profile. A community-based convenience sample of 115 self-identified TGGD adults living in Portugal was collected. Most of the participants (69%) did not have any children, 10% had children of their own, and about 20% did not have children in the present but reported their intensions to have children in the future. The results were discussed, highlighting the heterogeneity found in terms of sociodemographic characteristics, gender identification, and gender affirmation pathways (social, legal, and medical), with a focus on the participants’ parenthood aspirations. The under- or non-representation of transgender individuals in population surveys, such as demographic and health surveys, is a barrier to understanding the social determinants and health disparities faced by this population.
... 5 Social support includes perceiving and receiving various forms of support and resources from a network of people, including friends, family, and significant others. 41 For TGD people, having social support is a critically important factor that facilitates resilience, 36,40,42,43 particularly from family, 44 and has been found to reduce psychological distress. 43 In addition, a sense of community belonging has been found to support resilience for TGD people in some studies. ...
... [29][30][31][32][33][34][35][36][37][38][39][47][48][49][50][51][52] There were 33 quantitative studies that utilized a measure conceptualized as resilience and we retrieved the items from these scales for coding in our analyses (Table 2). 21,42,44,46, We excluded other articles that were literature reviews, perspective pieces, or articles that used resilience frameworks in their analyses but lacked a specific measure that was described as assessing resilience. ...
Article
Resilience is often viewed as the ability to bounce back from challenges. This conceptualization tends to be individualistic and can be less fitting for marginalized communities. Research with transgender and gender diverse(TGD) individuals has shown that resilience can manifest in various ways, such as developing pride in one’s identity, connection to a TGD community, or advocating against oppression. Given these conflicting views, we sought to (1) describe common themes in TGD people’s experience of resilience by pooling information from qualitative research; and (2) evaluate how well quantitative measures of resilience reflected the ways that TGD people define resilience in qualitative research. We reviewed articles published from January 2010 to January 2020. Our search for research on resilience in TGD samples revealed 33 quantitative articles and 17 qualitative articles. We developed a codebook from the qualitative articles by retrieving information about themes from these past studies (e.g., developing motivation and agency, pride or positive self-image). We also reviewed the quantitative studies and retrieved the measures used to assess resilience, followed by coding these scales to understand whether the themes from the qualitative data were reflected in the quantitative measures of resilience. Overall, themes related to social support were common across the measures. However, other themes were not reflected in any measures, such as self-definition of gender, hope, and self-advocacy. Our research demonstrates the discrepancy between qualitative research on TGD resilience and quantitative measurement of resilience. Measure development that more fully reflects TGD people’s experiences is key to advancing this research.
... More recently, research has also investigated protective factors that ameliorate risk for adverse mental health in the context of identity-based stigma. Resilience, or the degree to which an individual feels able to overcome adversities, has been found to buffer the harmful effects of minority stress on TGD mental health and to contribute to psychological well-being (Matsuno & Israel, 2018;Puckett et al., 2019). ...
Article
Drawing on minority stress and intersectionality theory frameworks, this study used latent profile analysis to examine how distal (gender-related discrimination, gender-related rejection, neurodiverse discrimination) and proximal (internalized transphobia, stigma consciousness) stressors clustered together to form distinct patterns of identity-based stress among 190 transgender and gender-diverse (TGD) undergraduate students who are neurodiverse (ND). Variation in relative risk of profile membership based on mental health (psychological distress, resilience) and academic outcomes (college self-efficacy, grade point average [GPA]) was assessed using multinomial logistic regression. Four distinct profiles emerged: low stress (Profile 1, n = 59), high gender-related discrimination (Profile 2, n = 56), high stress (Profile 3, n = 43), and high stigma consciousness (Profile 4, n = 32). Profile membership was associated with ND diagnosis, gender identity, race, and income. Multinomial logistic regression analysis found that psychological distress, college self-efficacy, and GPA predicted profile membership. The implications of study findings for existing theory and clinical practice are discussed. Public Significance Statement: This study investigated differences in identity-based stress experiences among TGD undergraduate students who are ND, identifying distinct patterns that grouped individuals together on the basis of these experiences. Demographically, we identified differences among the groups, and largely found that the risk of membership in the high minority stress groups was higher for worse levels of psychological distress and lower for better academic outcomes.
... Parental support has consequently been posited as the strongest protective factor against negative health outcomes for trans young people (Bariola et al., 2015;Puckett et al., 2019;Veale et al., 2017). Facilitating strong parental support is therefore of the utmost importance to promote optimal developmental outcomes across trans children's life spans. ...
Article
Parental support is strongly correlated with protective factors for trans youth yet most experience parental rejection or ambivalence regarding their gender. Many parents report a desire to support their child but indicate lack of understanding and support as key barriers. We aimed to develop a nuanced understanding of the challenges and facilitators experienced by Australian parents in developing understanding, support and acceptance of their child’s gender and their needs to do so. Using data from semi-structured interviews (N = 30), the General Inductive Approach (GIA) was employed to explore primary themes within parental narratives. Participants described a range of complex emotions and exhausting mental burden as they simultaneously supported their child, searched for information, and navigated multiple systems (e.g., school, health). Good-quality information, seeing positive change in their child once affirmed and peer connections were powerful facilitators for increased support. There was strong thematic unity regarding their needs. Parents reported wanting an online ‘one-stop hub’ with evidence-based information and resources, and access to others’ lived experiences. Better understanding of the parental experience and what parents need to optimally support their child holds implications for the development of online interventions to promote parental understanding, support and acceptance of a child’s gender.
... Axt et al. (2021) found that their implicit association test had higher predictive validity in predicting gender essentialism, contacts with transgender individuals, and support for transgender policies, beyond that of self-reported explicit attitudes. Furthermore, a variety of additional factors such as biological determinism (Ching & Xu, 2018), contact apprehension and intergroup anxiety (McCullough, 2016), physical appearance (Miller & Grollman, 2015), and social dominance orientation (Puckett et al., 2019), could provide further predictive strength or act as mediators in this model and warrant further investigation in young samples. ...
Thesis
Despite the legislative progress and increased visibility of LGBTQI+ individuals in society, research continues to highlight the prejudice and victimisation that this population can face. According to the minority stress model, sexual minorities can face hostile stigma-related stressors which can compromise the mental health of LGBTQI+ individuals. Additionally, LGBTQI+ individuals face a distinct path of navigating identity development compared to nonLGBTQI+ peers. Chapter one begins by outlining the context, rationale, and scope for this research. As identity development takes place in a contemporary world of widespread social media use, chapter two presents the systematic literature review conducted to answer ‘how do LGBTQI+ individuals use social media as part of their identity development?’ The review included 16 studies and adopted a thematic synthesis methodology. LGBTQI+ individuals used social media for: gaining a sense of belonging, developing my identity, managing my identity, and broadcasting my identity. Furthermore, understanding the mechanisms which underly transprejudice has implications for the outcomes and mental health of transgender individuals. Consequently, chapter three presents the findings from an online survey with 129 young people, to investigate the factors which predict young people’s attitudes towards transgender individuals. A multiple regression analysis revealed that several previously identified factors from the adult literature formed a comprehensive model in explaining a large amount of variance in young people’s attitudes. The importance of discomfort felt with violations of heteronormativity, hostile sexism, and gender were emphasised. Implications to inform support across different ecological and contextual systems and scope for further research is discussed.
... 13,19,25 Increasingly, research is enhancing understandings of TGD resilience 26,27 and factors that protect against the negative health effects of stigma. 28 Key contributors to resilience include identity pride, 13,28 affirmation of one's gender by others, 29 social supports from family, 30,31 and community connectedness 32 to name a few. ...
... Resilience and gratitude have been found to be positively asscoiated with PA and negatively associated with NA (Dey et al., 2021;Sun & Kong, 2013). Recently, resilience and gratitude have been treated as important outcomes by studies examining profile differences of psychological and behavioral processes (e.g., support and the virtue of thrift) (Puckett et al., 2019;Ratchford et al., 2020), but few studies have examined the affective profile differences in these personal strengths. Because personal strengths are emphasized in positive psychology and are vital for psychosocial adjustment (Shoshani & Aviv, 2012), we aim to examine affective profile differences on psychosocial adjustment while considering the personal strengths of resilience and gratitude together with self-esteem, which is an important self-related personal resource and widely used indicator of psychosocial adjustment. ...
Article
Full-text available
PurposeTwo studies were conducted to explore the patterns of positive affect (PA) and negative affect (NA) while considering collectivist cultural specificity (dialecticism) and to examine the associations of affective profiles with psychosocial adjustment.Methods We used two Chinese samples, one comprising adults with adverse childhood experiences (N = 488) and one comprising ordinary adolescents (N = 635). The participants completed scales on PA, NA, and psychosocial adjustment, including mental health problems (depressive symptoms, anxiety), personal strengths (self-esteem, gratitude, resilience), and life satisfaction.ResultsThree profiles were identified through latent profile analysis: well-adjusted (high PA, low NA), low affective (low PA, low NA), and moderate affective (moderate PA, moderate NA). Participants in the well-adjusted profile had the fewest mental health problems (depressive symptoms, anxiety) and scored highest on personal strengths (self-esteem, gratitude, resilience) and life satisfaction. Participants in the low affective profile had fewer mental health problems than those in the moderate affective profile.Conclusion Individual differences and cultural variations should be considered when exploring affective profiles. Future interventions aimed at promoting affective well-being should accommodate dialecticism and individual differences in the target population.
Article
The fat body and the transgender body are expected to always be in a state of becoming. For fat bodies, becoming less fat, for transgender bodies, becoming more “congruent.” To be fat and/or transgender means coming into constant confrontation with social and cultural expectations about the fat and (trans)gendered body. It means navigating a medical system that considers one a problem to be solved with a careful and pre-determined set of solutions. It means diminished autonomy and little agency. Fat bodies and transgender bodies are often met with solutions based on gatekeeping versus informed consent. Fat bodies and trans bodies are often unwelcome and even made invisible in public spaces. When there are no chairs to fit fat bodies, and no bathrooms to include trans bodies, those bodies are erased, and the gender binary and body ideal reified. When transgender studies excludes discussion and acknowledgment of fat bodies and when fat studies excludes transgender bodies from their analysis or employs gender as a binary characteristic, fat trans bodies are disappeared, raising the question, how might thinking intersectionally reinvigorate both fields? This auto ethnographic exploration of navigating social and medical structures as a fat, trans/non-binary individual seeks to underscore the many commonalities inherent in anti-fat and (trans)gender oppression, and to highlight the ways these oppressions intersect to create unique barriers for fat, trans folks.
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Sexual and gender minority (SGM) rural adolescents are at risk for higher levels of social isolation, a well-known risk factor for depression and other negative health outcomes. We qualitatively examined how rural SGM youth seek emotional and informational support, which are protective factors for social isolation on social media (SM) regarding their SGM identity, and determined which SM platforms and tools are most effective in providing support. We conducted semistructured online interviews with rural SGM teens who screened positive for social isolation in spring 2020 and used a thematic analysis approach to analyze the data. Sixteen youths participated in interviews. Themes included seeking emotional support through SM groups and communities, seeking emotional support in designated online SGM spaces, using SM feeds for informational support, and disclosing SGM identity differentially across platforms. SM-based interventions could be leveraged to provide emotional and informational support for rural SGM youth across specific SM platforms and consider whether they are providing emotional or information support. Interventions focused on informational support may best be used on content-based platforms. Those designed to combat social isolation and connect marginalized SGM youths to similar others might benefit from community and forum-based platforms.
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Transgender and nonbinary (TNB) individuals are at increased risk for depression, making it important to understand the factors that may contribute to or attenuate this disparity. Community connectedness is one such factor, but prior research regarding its effect on depression has been mixed. It is possible that these mixed findings may be because community connectedness leads to multiple types of self-focused attention (i.e., gender reflection, gender rumination, and preoccupation with others’ perceptions) which then have opposing effects on depression. To explore this possibility, the current study sought to test a mediation model in which the three types of self-focused attention would mediate the relationship between community connectedness and depression. Cross-sectional data were collected using online surveys with 309 TNB young adults aged 18–30 years old. As hypothesized, preoccupation with others’ perceptions was a significant mediator explaining 35.85% of the variance in depression. Contrary to expectations, gender reflection and gender rumination were not significant mediators. However, community connectedness significantly predicted greater gender reflection, while gender rumination predicted greater depression. The present results indicate that different types of self-focused attention have differing effects on depression in this population, suggesting that clinicians working with TNB young adults should target the ways that these clients think about their gender identity. Additionally, connection to the TNB community can have multiple effects on thought processes, and efforts should be made to maximize the benefits while minimizing the costs. Future research should test these relationships using longitudinal designs and at different ages, as well as assess whether aspects of the community connectedness itself (e.g., co-rumination in TNB spaces, online vs. in-person connection) may have different effects.
Article
Full-text available
Background: Transgender and gender nonconforming (TGNC) individuals experience an increased prevalence of many psychological disorders, leading many to reach out for support from family, friends, mental health professionals, and religious or community networks. Nonetheless, experiences seeking support are often negative, and many psychotherapists report feeling underprepared to work with TGNC clients. To better understand the experiences of TGNC individuals and better equip psychotherapists in their work with TGNC clients, we investigate which sources of support most successfully buffer psychological distress among TGNC individuals. Aims: This study aims to identify differences in levels of various types of support (social, family, religious, and living-situation) between cisgender and TGNC individuals and examine how these types of support may or may not buffer psychological distress among TGNC individuals. Method: We used a United States national sample of 3,090 students (1,030 cisgender men; 1,030 cisgender women; 349 transgender; 681 endorsing another gender identity) from the Center for Collegiate Mental Health 2012–2015 database which provided basic demographic information through the Standardized Data Set. Psychological distress was measured through the Counseling Center Assessment of Psychological Symptoms 34-item questionnaire. Results: TGNC individuals reported more distress, less family support, more social support, and less frequent religious affiliation than cisgender men and women. Family and social support emerged as the strongest predictors of distress for both TGNC and cisgender individuals. Though religious affiliation and living on-campus buffered distress among cisgender students, they did not buffer distress among TGNC students. Conclusion: Our study highlights disparities in distress and support between TGNC and cisgender individuals. We found that although religious affiliation and on-campus living are beneficial for cisgender students, neither systematically buffers distress for TGNC students. These findings illustrate the impact minority stress and systemic discrimination may have on TGNC individuals and provide suggestions for therapeutic intervention in work with TGNC individuals.
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Transgender youth have been found to experience mental health disparities, experiencing greater rates of depression and anxiety than their cisgender counterparts. This mixed-methods study examined social support and how it is related to well-being and resilience among transgender youth. A sample of 154 transgender and gender nonbinary youth (13 to 21 years) completed a survey at a Pride event in a Midwest US city. The survey assessed living as one’s affirmed gender, social support, finding meaning in life, quality of life, mental health, and resilience. A focus group (n = 8) discussed their experiences of support. Ninety-two percent reported being assigned female at birth; 27% identified as transmasculine, 38% genderqueer, and 24% more than one gender. Family support was positively associated with the likelihood of living as one’s affirmed gender. Support from friends and significant others were not significant indicators of living as one’s affirmed gender. Participants with greater family support were less likely to report that they had a mental health problem in the past year. Friend support was positively associated with connectedness and finding meaning in life. Qualitative analyses identified how transgender youth define and experience support in their lives. Future studies should examine the use of family counseling and building communication skills for transgender youth health and resilience interventions.
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Transgender people experience disproportionately high mental and physical health risks. Minority stress theory identifies distal and proximal stressors that contribute to negative mental health outcomes for transgender people, and suggests that resilience factors can buffer the negative influence of these stressors. In this article, we aim to synthesize the psychological literature on resilience strategies among transgender people and position it within the minority stress framework and introduce an adapted model called the transgender resilience intervention model (TRIM). The TRIM suggests that social support, community belonging, family acceptance, participating in activism, having positive role models, and being a positive role model are group-level resilience factors. Self-worth, self-acceptance and/or pride, self-definition, hope, and transition are individual-level factors that promote resilience. Community, group, and individual interventions and their potential influence on resilience are discussed. The model calls for the development of additional interventions aimed at increasing resilience for transgender people.
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Sexual minority and transgender status is associated with mental health disparities, which have been empirically and theoretically linked to stressors related to social stigma. Despite exposure to these unique stressors, many sexual minority and transgender individuals will not experience mental health disorders in their lifetime. Little is known about the specific processes that sexual minority and transgender youth use to maintain their wellbeing in the presence of discrimination and rejection. Semi-structured interviews were conducted with 10 sexual minority males and transgender females aged 18–22 years, who currently met criteria for an operationalized definition of resilience to depression and anxiety. Data were analyzed qualitatively, yielding information related to a wide variety of problem-solving, support-seeking, and accommodative coping strategies employed by youth in the face of social stigma. Results are discussed in light of their clinical implications.
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In 2015, the American Psychological Association adopted Guidelines for Psychological Practice with Transgender and Gender Nonconforming Clients in order to describe affirmative psychological practice with transgender and gender nonconforming (TGNC) clients. There are 16 guidelines in this document that guide TGNC-affirmative psychological practice across the lifespan, from TGNC children to older adults. The Guidelines are organized into five clusters: (a) foundational knowledge and awareness; (b) stigma, discrimination, and barriers to care; (c) lifespan development; (d) assessment, therapy, and intervention; and (e) research, education, and training. In addition, the guidelines provide attention to TGNC people across a range of gender and racial/ethnic identities. The psychological practice guidelines also attend to issues of research and how psychologists may address the many social inequities TGNC people experience.
Article
Objective: Transgender children who have socially transitioned, that is, who identify as the gender "opposite" their natal sex and are supported to live openly as that gender, are increasingly visible in society, yet we know nothing about their mental health. Previous work with children with gender identity disorder (GID; now termed gender dysphoria) has found remarkably high rates of anxiety and depression in these children. Here we examine, for the first time, mental health in a sample of socially transitioned transgender children. Methods: A community-based national sample of transgender, prepubescent children (n = 73, aged 3-12 years), along with control groups of nontransgender children in the same age range (n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures. Results: Transgender children showed no elevations in depression and slightly elevated anxiety relative to population averages. They did not differ from the control groups on depression symptoms and had only marginally higher anxiety symptoms. Conclusions: Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex.
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This study examined transgender community belongingness as a mediator between strength of transgender identity and well-being. A total of 571 transgender adults (n = 209 transgender women, n = 217 transgender men, and n = 145 nonbinary-identified individuals) completed an online survey assessing transgender community belongingness, strength of transgender identity (operationalized as the extent to which a person self-categorizes their identity as transgender and the extent to which they believe their gender transition to be important to their self-definition), and well-being (using measures of self-esteem, satisfaction with life, and psychological well-being). Structural equation modeling was used to analyze the data. When controlling for participants' income, age, and stage of gender transition, transgender community belongingness fully mediated the relationship between strength of transgender identity and well-being. Strength of transgender identity was indirectly and positively related to well-being through community belongingness, but was not directly related to well-being. Results suggest that transgender community belongingness is an important construct in the mental health of transgender people. The strength of a person's transgender identity also appears to be a significant construct in transgender people's well-being via its relationship with transgender community belongingness. Implications of the findings are discussed. (PsycINFO Database Record
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Researchers have recently begun to examine resiliency among transgender persons with a few studies suggesting that the effects of stigma on psychological distress may be moderated by aspects of involvement with transgender peers. We extended this line of inquiry with a longitudinal study of transgender community involvement as a moderator of a previously observed association between gender abuse (enacted stigma) and major depression among 230 transgender women from the New York City Area. Statistical techniques including generalized estimating equations. With potential confounders controlled, the longitudinal association between gender abuse and depression was significantly moderated by community involvement. Abuse was strongly associated with depression among those with no community involvement; abuse was only marginally associated with depression among those with high levels of involvement. Involvement in a community of peers with shared experiences of gender abuse appears to protect transgender women from the depressogenic effect of this abuse. The implications and limitations of the study are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)