Transgender and Gender-Diverse Minority Stress and Substance Use Frequency and Problems: Systematic Review and Meta-Analysis

Gender Minority Stressors, Hopelessness, and Their Associations with Internalizing and Externalizing Mental Health Outcomes in a Hungarian Trans Adult Sample

Although distal (i.e., discrimination, victimization, rejection, and nonaffirmation) and proximal (i.e., internalized transphobia, negative expectations, and identity nondisclosure) gender minority stressors are associated with internalizing (i.e., depression, anxiety, suicidality) and externalizing (i.e., substance use) mental health outcomes of trans individuals, how they are related to two distinct types of outcomes differs. General psychological processes (i.e., hopelessness) could explain the mechanisms behind the minority stressors-mental health association. Accordingly, this study aimed to test the complete gender minority stress model and the direct and indirect effects of minority stressors via hopelessness on mental health outcomes in trans individuals. Data were collected online from a convenience sample of 205 trans adults (18-74 years; M = 29.49, SD = 10.24), 72 (35.1%) of whom were trans men, 52 (25.4%) were trans women, and 81 (39.5%) were non-binary individuals. Results from structural equation modeling showed that distal stressors directly predicted mental health outcomes, except for depression. Internalized transphobia and negative expectations had positive indirect effects on depression, anxiety, and past-year and lifetime suicidality via hopelessness. Identity nondisclosure had negative indirect effects on depression, anxiety, and past-year suicidality through hopelessness. For substance use, hopelessness was not a significant mediator. Still, identity nondisclosure mediated distal stressors-substance use link. Findings suggest that hopelessness is a significant contributor to internalizing symptoms of trans individuals, making it a target for interventions to improve the mental health of trans people. The ameliorative impact of identity nondisclosure on both types of mental health outcomes should be considered and examined in further studies.

Rising transphobia and disparities in drug-related harm experienced by transgender and gender-diverse people

BACKGROUND

Transgender (trans) and gender-diverse (TGD) people are a small but increasingly visible population who experience worsening marginalisation characterised by toxic political and media discourse, violent hate crimes and discriminatory laws targeting healthcare and public access. Governments in both the United Kingdom (UK) and the United States (US) have pushed anti-trans policies which threaten to further exclude TGD people. Understanding the public health impacts of transphobia is vital, especially regarding disproportionate drug-related harms.

MAIN BODY

TGD people are more likely than their cisgender counterparts to experience both acute and chronic drug-related harm. This is, in part, driven by rising transphobia and perpetuated by limited access to gender-affirming and harm reduction services. Current health data systems fail to accurately capture the scale of drug-related harms faced by TGD people due to suboptimal gender measurement. Inclusive data collection and culturally competent harm reduction services are urgently needed to address these disparities. Digital interventions, such as telehealth, and peer-led support may improve the accessibility and effectiveness of care for this group.

CONCLUSION

Evidence suggests that TGD individuals face disproportionate drug-related harm compared to cisgender people, a disparity likely to widen as government-led hostility increases in countries such as the UK and the US. Immediate action is required to ensure TGD people are fully represented in research, public health monitoring, and support services.

Using a Sober Curious Framework to Explore Barriers and Facilitators to Helping Sexual Minority Women Reduce Alcohol-Related Harms: Protocol for a Descriptive Study

BACKGROUND

Globally, women consume less alcohol than men, but alcohol consumption among women has declined less in recent years than among men. Drinking rates and alcohol-related harms vary substantially across population groups of women, and sexual minority women (eg, lesbian, bisexual, and queer) are at notably high risk. An emerging body of literature suggests that in addition to minority stress (eg, stigma, discrimination), drinking norms and drinking cultures likely influence sexual minority women's drinking. Almost no research has explored these factors as possible targets of interventions. Sober curiosity is a rapidly growing wellness movement that may be particularly salient for sexual minority women. It encourages individuals to be "curious" about the reasons they choose to drink and alcohol's effects on their life and health.

OBJECTIVE

The aims of this research are to (1) explore the perspectives of the drinking social worlds of sexual minority women, their awareness of the sober curious movement, perceptions of their own and their peers' drinking and desire to drink less, and perceived barriers and facilitations to changing their drinking behaviors and (2) identify key elements of an alcohol reduction intervention tailored for sexual minority women.

METHODS

We conducted a comprehensive review of the literature on alcohol interventions with sexual minority women. The handful of studies we found paid scant attention to drinking cultures, normative beliefs, or other key elements of sober curiosity. To address the study aims, we are conducting 2 descriptive studies with adult (>18 years) sexual minority women using mixed methods. One includes focus group interviews (n=24-36) and a national survey (n=100-120) with sexual minority women in Scotland. The other includes in-depth interviews (n=18-20) with sexual minority women in the United States. Data from the 2 countries and 3 sources will be analyzed using qualitative and quantitative methods to identify patterns and relationships across data to validate or corroborate findings.

RESULTS

Each of the studies received ethics approval in August 2023 and is currently open for recruitment. We anticipate completing data collection in spring 2025. The results of qualitative analyses will be summarized as themes, and results of survey data analyses will be summarized in tables. Findings will be presented to 2 panels of international experts who will assist in identifying critical elements of an alcohol reduction intervention tailored to the unique needs of sexual minority women.

CONCLUSIONS

With the assistance of the expert panels, we will use Acceptability, Practicability, Effectiveness, Affordability, Side-Effects, and Equity criteria to inform the development of a tailored intervention building on tenants of sober curiosity to assist sexual minority women in reducing harmful drinking.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63282.

Relationships between structural stigma, societal stigma, and minority stress among gender minority people

Structural stigma towards gender minority (GM; people whose current gender does not align with sex assigned at birth) people is an important contributor to minority stress (i.e., stress experienced due to one's marginalized GM identity), although existing variables are unclear in their inclusion of social norms, or societal stigma, as a key component of the construct. We examined potential variables representing structural stigma, including variables that are inclusive of societal stigma, to identify those that most strongly relate to minority stress outcomes. We tested variables identified in the literature as measures of structural stigma inclusive of societal stigma (LGBT + Business Climate Index, state voting behaviors, and Google Trends search data), the most commonly used structural stigma variable (State Policy Environment Tally), and proxy variables (region, population density) for comparison. The relationships between structural stigma and minority stress model outcomes were tested in a sample of GM participants from The Population Research in Identity and Disparities for Equality (PRIDE) Study (N = 2,094) 2019 Annual Questionnaire using a structural equation model (SEM). Lower structural stigma (i.e., higher LGBT Business Climate Index) was associated with lower experienced stigma (β= -0.260, p < .01) and lower anticipated stigma (β= -0.433, p < .001). Greater conservative voting behavior was associated with less experienced stigma (β= -0.103, p < .01). Living in a more densely populated county was also associated with lower anticipated stigma (β=-0.108, p < .001) and greater identity outness (β = 0.053, p < .05). Two of the identified structural stigma variables that were inclusive of societal stigma (i.e., LGBT + Business Climate Index, conservative voting behaviors) and one proxy variable (population density) were associated with minority stress outcomes. However, the most commonly used variable for structural stigma (State Policy Environment Tally) was not associated with any outcomes. The State LGBT + Business Climate Index showed the most promise for use as a structural stigma variable in future research. The application of this variable should be investigated further to explore its association with health outcomes and to inform efforts to reduce health equity barriers experienced by GM people through addressing structural stigma in a manner inclusive of societal stigma.

Shortcomings of transgender identity concealment research: a scoping review of associations with mental health

Background

Empirical research indicates that high rates of mental health issues in members of marginalised population groups are predicted in part by their decisions to disclose or conceal their stigmatized identities from others-a field of study known as outness research. Transgender outness research is a nascent branch of this field. It reflects neither the multidimensional view of disclosure and concealment adopted in other branches, nor the ability to address unique aspects of trans outness, such as the practical challenges of concealment and the difference between concealing one's gender identity and concealing one's assigned sex. Consequently, prior literature may not accurately represent the effects of transgender identity disclosure and concealment.

Methods

This scoping review explores the theoretical and operational definitions of trans disclosure and concealment in 46 English-language papers, identified from extensive database searches, addressing relationships between these concepts and mental health factors.

Results

Findings indicate that the issues outlined above remain unresolved, even in the widely-used nondisclosure subscale of the Gender Minority Stress and Resilience Measure, and are rarely recognized as a potential source of error. Although small detrimental effects of concealment and beneficial effects of disclosure on mental health were reported in the reviewed studies, reliable conclusions about these relationships and their importance to health and safety in the trans community cannot be drawn while these shortcomings are overlooked.

Conclusion

We encourage researchers to address these neglected areas, reevaluate the language used in measurement questions, and conduct longitudinal research to support an accurate understanding of trans outness phenomena.