Gender identity and sexual behavior stigmas, severe psychological distress, and suicidality in an online sample of transgender women in the United States

• Authors: Jessica L Maksut, Johns Hopkins Bloomberg School of Public Health; Travis Sanchez, Emory University; John M Wiginton, Johns Hopkins Bloomberg School of Public Health; Ayden I Scheim, Drexel University; Carmen H Logie, Women's College Research Institute; Maria Zlotorzynska, Rollins School of Public Health; Carrie E Lyons, Johns Hopkins Bloomberg School of Public Health; Stefan D Baral, Johns Hopkins Bloomberg School of Public Health
• Journal Title: Annals of Epidemiology
• Volume: Volume 52
• Publisher: Elsevier | 2020-12-01, Pages 15-22
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.annepidem.2020.07.020
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Gender identity stigma; Psychological distress; Sexual behavior stigma; Suicidality; Transgender women; Adolescent; Adult; Female; Gender Identity; Humans; Male; Mental Health; Prevalence; Psychological Distress; Risk Factors; Sexual Behavior; Social Stigma; Suicide; Suicide, Attempted; Surveys and Questionnaires; Transgender Persons; Transsexualism; Young Adult

Abstract

Purpose: The objective of this study is to (1) quantify burden of perceived, anticipated, and enacted gender identity (GI) and sexual behavior (SB) stigmas and (2) explore associations between GI and SB stigmas with key mental health factors among transgender women in the United States. Methods: We estimated associations between GI and SB stigmas with severe psychological distress, suicidal ideation, and suicide attempt using cross-sectional data from the Transgender Women's Internet Survey and Testing study from March to April, 2019. Modified Poisson regression produced prevalence ratios and 95% confidence intervals for severe psychological distress, suicidal ideation, and suicide attempt with GI and SB stigma items individually, as well as the GI and SB stigma items treated as two scales. Results: Of 381 transgender women, 52% experienced severe psychological distress in the past month, whereas 59.3% and 13.12% reported suicide ideation and attempt in the past year, respectively. In adjusted models, GI and SB stigma scales were significantly, positively associated with severe psychological distress, suicidal ideation, and suicide attempt. Conclusions: Continued training for providers in trans-competent mental health care and the development of newer engagement and delivery strategies for stigma mitigation interventions are needed.