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Mental health and substance use risks and resiliencies in a U.S. sample of transgender and gender diverse adults

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Abstract

Purpose

Victimization contributes to mental and behavioral health inequities among transgender and gender diverse (TGD) people, but few studies have simultaneously examined health-promoting resiliencies. We sought to identify classes of risk and resilience among TGD adults, assess characteristics associated with these classes, and examine their relationship with mental health and substance use outcomes.

Methods

Cross-sectional data were from the 2015 US Transgender Survey, a non-probability study including 26,957 TGD adults. Using latent class analysis, we classified patterns of vulnerability and resilience based on risk (past-year denial of equal treatment, verbal harassment, physical attack, bathroom-related discrimination; lifetime sexual assault, intimate partner violence) and protective (activism; family, work, classmate support) factors. Regression models were fit to (1) determine the association between sociodemographic and gender affirmation characteristics and latent classes; (2) model associations between latent classes and mental health (current serious psychological distress, past-year and lifetime suicidal thoughts and attempts, and lifetime gender identity/transition-related counseling) and substance use (current binge alcohol use, smoking, illicit drug use; past-year drug/alcohol treatment) outcomes.

Results

Three latent classes were identified: high risks, with activism involvement (“risk-activism,” 35%); low risks, with not being out about one’s TGD identity (“not-out,” 25%); and low risks, with high family support (“family-support,” 40%). Gender affirmation and sociodemographic characteristics, such as race/ethnicity and sexual orientation, were associated with latent classes. Risk-activism class membership was associated with higher odds of negative mental health and substance use outcomes, while the family-support class had lower odds of these outcomes.

Conclusions

Interventions leveraging family support, and policy protections from discrimination and victimization, may promote TGD mental and behavioral health.

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Authors and Affiliations

  1. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Kresge Building 9th Floor-Student Mail, 677 Huntington Ave, MA, 02115, Boston, USA

    Mai-Han Trinh & Sari L. Reisner

  2. Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA

    Rodrigo Aguayo-Romero & Sari L. Reisner

  3. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Rodrigo Aguayo-Romero & Sari L. Reisner

  4. The Fenway Institute, Fenway Health, Boston, MA, USA

    Rodrigo Aguayo-Romero & Sari L. Reisner

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  1. Mai-Han Trinh
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Contributions

Conceptualization: SLR; methodology: SLR, RA, and MT; formal analysis and investigation: MT; writing—original draft preparation: MT; writing—review and editing: SLR and RA; funding acquisition: SLR; resources: SLR; supervision: SLR.

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Correspondence to Mai-Han Trinh.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the University of California—Los Angeles North General Institutional Review Board.

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Trinh, MH., Aguayo-Romero, R. & Reisner, S.L. Mental health and substance use risks and resiliencies in a U.S. sample of transgender and gender diverse adults. Soc Psychiatry Psychiatr Epidemiol 57, 2305–2318 (2022). https://doi.org/10.1007/s00127-022-02359-y

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