Skip to main content

Advertisement

SpringerLink
Log in

Uncertainty and Confusion Regarding Transgender Non-discrimination Policies: Implications for the Mental Health of Transgender Americans

  • Published:
Sexuality Research and Social Policy Aims and scope Submit manuscript

Abstract

Introduction

Recent policies have restricted the rights of the US transgender people; there is a need to explore transgender people’s knowledge and attitudes regarding such policies and related mental health.

Methods

In 2019, 580 transgender adults living in the Northeastern US completed a survey assessing demographics, knowledge/attitudes toward transgender-related policies, and mental health. Multivariable logistic regression models, adjusted for age, gender, race, and prior abuse, were fit to examine the association of concerns about the implementation of discriminatory policies and depression, anxiety, and post-traumatic stress disorder (PTSD).

Results

Many participants were confused about the status of federal and state protections for transgender people, and 48.4% were concerned that their state would pass policies that took away transgender rights. In adjusted models, compared to participants who were not concerned, those who were concerned about the enactment of state-level, anti-transgender policies had greater odds of depression, anxiety, and PTSD (p < 0.05).

Conclusions

Our findings highlight the uncertainty around changing policies and potential mental health implications as well as the need to ensure legal protections for transgender Americans.

Policy Implications

There are several pending lawsuits seeking to overturn Trump-era policies that restrict the rights of transgender individuals. At the same time, lawmakers in several states are pushing anti-transgender legislation. Findings from this study can be cited as part of future and ongoing legal and legislative efforts from advocates seeking to ensure equal protections for transgender people under state and federal law.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The deidentified data is available upon request. Please email the first author for access.

Code Availability

The SAS code used for this analysis is available upon request. Please email the first author for access.

References

  • Baldor, L. C. (2019). New Pentagon transgender rule sets limits for troops. Associated Press. https://apnews.com/ae07308b29c342429c3c627b7fc0b404. Published 2019. Accessed August 26, 2020.

  • Battle, S., Wheeler, T. (2017). Dear colleague letter on transgender students. US Department of Justice and US Department of Education. https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201702-title-ix.docx. Published 2017. Accessed.

  • Bockting, W., Barucco, R., LeBlanc, A., et al. (2020). Sociopolitical change and transgender people’s perceptions of vulnerability and resilience. Sexuality Research and Social Policy., 17(1), 162–174.

    Article  Google Scholar 

  • Brown, G. R., & Jones, K. T. (2016). Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the Veterans Health Administration: A case–control study. LGBT Health., 3(2), 122–131.

    Article  Google Scholar 

  • CDC. (2019). HIV and transgender communities. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS. https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-transgender-brief.pdf. Published 2019. Accessed September 6, 2020.

  • CNN. (2017). Diamond J. Trump to reinstate US military ban on transgender people. CNN. https://www.cnn.com/2017/07/26/politics/trump-military-transgender/index.html. Published 2017. Accessed.

  • Cruz, T. M. (2014). Assessing access to care for transgender and gender nonconforming people: A consideration of diversity in combating discrimination. Social Science and Medicine, 110, 65–73.

    Article  Google Scholar 

  • Department of Housing and Urban Development. (2017). Notice of proposed information collection: Notice on equal access regardless of sexual orientation, gender identity, or marital status for HUD’s community planning and development programs, Withdrawal, 82 Fed. Reg. 13359 (Mar. 10, 2017).

  • Derogatis LR. The Brief symptom inventory-18 (BSI-18): Administration, scoring and procedures manual. Minneapolis, MN: National Computer Systems; 2000.

  • Dewey, J. M. (2008). Knowledge legitimacy: How trans-patient behavior supports and challenges current medical knowledge. Qualitative Health Research, 18(10), 1345–1355.

    Article  Google Scholar 

  • Goldenberg, T., Reisner, S. L., Harper, G. W., Gamarel, K. E., & Stephenson, R. (2020). State policies and healthcare use among transgender people in the US. American Journal of Preventive Medicine, 59(2), 247–259.

    Article  Google Scholar 

  • Grant, J. M., Mottet, L. A., Tanis, L. A., Harrison, J., Herman, J. L., Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. 2011. https://www.transequality.org/sites/default/files/docs/resources/NTDS_Report.pdf.

  • Franciscan Alliance IeavTEP, M. D., Secretary of the United States Department of Health and Human Services, et al. (2017). Defendants’ Motion for Voluntary Remand and Stay. Filed 05/02/17. https://www.transequality.org/sites/default/files/docs/releases/1557%20motion%20for%20remand.pdf.

  • Franciscan Alliance IvBUSDC, N.D. Texas, Wichita Falls Division. (2016). United States District Court, N.D. Texas, Wichita Falls Division. Dec 31, 2016. 227 F. Supp. 3d 660 (N.D. Tex. 2016).

  • Hatzenbuehler, M. L., Keyes, K. M. (2013). Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth. Journal of Adolescent Health, 53(1, Supplement):S21-S26.

  • Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health, 99(12), 2275–2281.

    Article  Google Scholar 

  • James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., Anafi, M. (2016). The report of the 2015 U.S. Transgender Survey. 2016. http://www.ustranssurvey.org/report/.

  • Janssen, A., Voss, R. (2020). Policies sanctioning discrimination against transgender patients flout scientific evidence and threaten health and safety. Transgender Health. 2020:Ahead of print.

  • Liptak, A. (2019). Supreme court revives transgender ban for military service. https://www.nytimes.com/2019/01/22/us/politics/transgender-ban-military-supreme-court.html. Published 2019. Accessed August 26, 2020.

  • MAP. (2020a). Employment nondiscrimination. Movement advancement project. https://www.lgbtmap.org/equality-maps/employment_non_discrimination_laws. Published 2020. Accessed August 26, 2020.

  • MAP. (2020b). Nondiscrimination laws. Movement advancement project. https://www.lgbtmap.org/equality-maps/non_discrimination_laws. Published 2020. Accessed August 26, 2020.

  • MAP. (2020c). Hate crime laws. Movement advancement project. https://www.lgbtmap.org/equality-maps/hate_crime_laws. Published 2020. Accessed August 26, 2020.

  • MAP. (2020d). Snapshot: LGBTQ equality by state. Movement advancement project. https://www.lgbtmap.org/equality-maps. Published 2020. Accessed August 26, 2020.

  • Massachusetts, J. M. (2018). J M. Massachusetts backs transgender rights in historic statewide referendum. NBC News. https://www.nbcnews.com/feature/nbc-out/massachusetts-backs-transgender-rights-historic-statewide-referendum-n933516. Published 2018. Accessed September 10, 2020.

  • No. 18–107. (2018). R.G. & G.R. Harris Funeral Homes, Inc., Petitioner v. Equal Employment Opportunity Commission, et al. Brief for the federal respondent in opposition: United States Court of Appeals for the Sixth Circuit. (October 24, 2018).

  • Prins, A., Ouimette, P., Kimerling, R., et al. (2004). The primary care PTSD screen (PC-PTSD): Corrigendum. Prim Psychiatry., 9, 151.

    Google Scholar 

  • Reisner, S. L., Biello, K., Rosenberger, J. G., et al. (2014b). Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain. Archives of Sexual Behavior, 43(8), 1503–1514.

    Article  Google Scholar 

  • Reisner, S. L., Hughto, J. M., Dunham, E. E., et al. (2015c). Legal protections in public accommodations settings: A critical public health issue for transgender and gender-nonconforming people. Milbank Quarterly, 93(3), 484–515.

    Article  Google Scholar 

  • Reisner, S. L., White Hughto, J., Dunham, E., et al. (2015b). Legal protections in public accommodations settings: A critical public health issue for gender minority people. Milbank Quarterly, 93(3), 1–32.

    Article  Google Scholar 

  • Reisner, S. L., White Hughto, J. M., Dunham, E. E., et al. (2015a). Legal protections in public accommodations settings: A critical public health issue for transgender and gender-nonconforming people. Milbank Quarterly, 93(3), 484–515.

    Article  Google Scholar 

  • Reisner, S. L., White Hughto, J. M., Gamarel, K. E., Keuroghlian, A. S., Mizock, L., & Pachankis, J. E. (2016). Discriminatory experiences associated with post-traumatic stress disorder symptoms among transgender adults. Journal of Counseling Psychology, 63(5), 509–519.

    Article  Google Scholar 

  • Reisner, S. L., White, J. M., Bradford, J., & Mimiaga, M. J. (2014a). Transgender health disparities: Comparing full cohort and nested matched-pair study designs in a community health center. LGBT Health., 1(3), 177–184.

    Article  Google Scholar 

  • Restar, A., Jin, H., Breslow, A., et al. (2020). Legal gender marker and name change is associated with lower negative emotional response to gender-based mistreatment and improve mental health outcomes among trans populations. SSM-Population Health. 2020:100595.

  • The Matthew Shepard and James Byrd, Jr. (2009). Hate Crimes Prevention Act of 2009. 18 U.S.C. § 249. In.

  • TransEquality.org. (2020). The discrimination administration: Trump’s record of action against transgender people. National Center for Transgender Equality. https://transequality.org/the-discrimination-administration. Published 2020. Accessed.

  • Trump, D. (2017). Presidential Memorandum for the Secretary of Defense and the Secretary of Homeland Security. https://www.whitehouse.gov/presidential-actions/presidential-memorandum-secretary-defense-secretary-homeland-security/. Published 2017. Accessed.

  • Trump, D. (2018). Presidential Memorandum for the Secretary of Defense and the Secretary of Homeland Security Regarding Military Service by Transgender Individuals. https://www.whitehouse.gov/presidential-actions/presidential-memorandum-secretary-defense-secretary-homeland-security-regarding-military-service-transgender-individuals/. Published 2018. Accessed.

  • U.S. Census. (2020a). Quick facts: Massachusetts. U.S. Census Bureau. http://www.census.gov/quickfacts/table/PST045215/25. Published 2020. Accessed May 26, 2020.

  • U.S. Census. (2020b). Quick facts: Rhode Island. U.S. Census Bureau. https://www.census.gov/quickfacts/fact/table/RI,US/PST045219. Published 2020. Accessed May 26, 2020.

  • U.S. Department of Health and Human Services. (2016). Nondiscrimination in health programs and activities. Federal Register 2016;Vol. 81: No. 96, pp 31387–31390 Web site. https://www.govinfo.gov/content/pkg/FR-2016-05-18/pdf/2016-11458.pdf. Published 2016. Accessed August 26, 2020.

  • Veldhuis, C. B., Drabble, L., Riggle, E. D., Wootton, A. R., & Hughes, T. L. (2018). “I fear for my safety, but want to show bravery for others”: Violence and discrimination concerns among transgender and gender-nonconforming individuals after the 2016 presidential election. Violence and Gender., 5(1), 26–36.

    Article  Google Scholar 

  • White Hughto, J. M., Pachankis, J., Willie, T., & Reisner, S. (2017). Victimization and depressive symptomology in transgender adults: The mediating role of avoidant coping. Journal of Counseling Psychology, 64(1), 41–51.

    Article  Google Scholar 

  • White Hughto, J. M., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science and Medicine., 147, 222–231.

    Article  Google Scholar 

  • WhiteHouse.gov. (2017). Press briefing by Press Secretary Sarah Sanders. https://www.whitehouse.gov/briefings-statements/press-briefing-press-secretary-sarah-sanders-120517/. Published 2017. Accessed August 10, 2020.

  • Xavier, J., Bradford, J., Hendricks, M., et al. (2013). Transgender health care access in Virginia: A qualitative study. International Journal of Transgenderism., 14(1), 3–17.

    Article  Google Scholar 

Download references

Acknowledgements

We wish to thank our participants and community partners: Massachusetts Transgender Political Coalition (MTPC) (Mason Dunn, Kelsey Grunstra), Boston Health Care for the Homeless (Pam Klein, Sarah Reid), Lifespan Adolescent Medicine (Michelle Forcier), Thundermist Health Center (Jaye Watts, Dreya Catozzi, Denise Crooks), Project Weber/RENEW (Coleen Daley Ndoye, Lily Rivera, Rich Holcomb), Fenway Health staff (Dana Pardee, Josibel Garcia Valles, Athena Vaughn) and board member (Bianca Robinson), and Brown University staff (Christopher Santostefano, Peter Salhaney, Jennifer Olson) and outreach consultants/alumni (Jackson McMahon, Ryan Segur, Arjee Restar).

Funding

This study was supported by an award from the Providence/Boston Center for AIDS Research (CFAR) NIH/NIAID fund P30AI042853. Dr. Hughto is also supported by COBRE on Opioids and Overdose funded by the National Institute of General Medical Sciences of the National Institutes of Health under grant no. P20GM125507.

Author information

Authors and Affiliations

  1. Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA

    Jaclyn M. W. Hughto

  2. Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA

    Jaclyn M. W. Hughto

  3. Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA

    Jaclyn M. W. Hughto

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

    Jaclyn M. W. Hughto, Matthew J. Mimiaga, Sari L. Reisner & Sean Cahill

  5. Center for Gerontology and Health Services, Brown University School of Public Health, Providence, RI, USA

    David J. Meyers

  6. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA

    David J. Meyers

  7. UCLA Center for LGBTQ Advocacy, and Health (C-LARAH), ResearchLos Angeles, CA, USA

    Matthew J. Mimiaga

  8. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Matthew J. Mimiaga

  9. Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Matthew J. Mimiaga

  10. Department of General Medicine, Harvard Medical School, Boston, MA, USA

    Sari L. Reisner

  11. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Sari L. Reisner

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

    Sari L. Reisner

  13. Bouve College of Health Sciences, Northeastern University, Boston, MA, USA

    Sean Cahill

  14. Department of Health Law, Policy and Management , Boston University School of Public Health , MA, Boston, USA

    Sean Cahill

Authors
  1. Jaclyn M. W. Hughto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David J. Meyers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew J. Mimiaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sari L. Reisner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sean Cahill
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Hughto is the overall principal investigator of the parent study. She conceptualized the analysis and wrote the first draft of the manuscript. All authors contributed to the interpretation of the analysis and edited the manuscript. Drs. Reisner, Mimiaga, and Cahill are all co-investigators on the parent study.

Corresponding author

Correspondence to Jaclyn M. W. Hughto.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix 1. Policy-related Survey Items Adapted or Developed for this Study

Federal Laws

New laws and policies passed by the White House and/or the Federal Government allow transgender people to be discriminated against in…

 

True

False

Don't know

Prefer not to answer

1. Public schools

    

2. Private schools

    

3. Healthcare settings (hospitals, doctor's offices)

    

4. Employment

    

5. Housing

    

6. Public places (restaurants, parks, stores, transportation)

    

7. The military

    

Correct answer = true (1, 3, 7); false (2, 4, 5, 6)

State Hate Crime Laws

There is a transgender rights law in my state that protects people from hate crimes based on their gender identity/expression.

  1. 1.

    Yes

  2. 2.

    No

  3. 3.

    Don’t know

  4. 4.

    Prefer not to answer

Correct answer = yes

State Legal Protections

The transgender rights law in my state makes it illegal to discriminate against people based on their gender identity and expression in the following places (Check all that apply):

  1. 1.

    Employment

  2. 2.

    Housing

  3. 3.

    Public education/schools

  4. 4.

    Hospitals

  5. 5.

    Doctor’s offices and healthcare centers

  6. 6.

    Public transportation

  7. 7.

    Supermarkets

  8. 8.

    Retail stores

  9. 9.

    Credit/lending

  10. 10.

    Nursing homes

  11. 11.

    Don’t know

  12. 12.

    Prefer not to answer

Correct answers: checking yes to items 1–10

State-level Policy Concerns

I am concerned that politicians in the state where I live will pass laws that take away transgender people’s rights.

  1. 1.

    Yes

  2. 2.

    No

  3. 3.

    Unsure

  4. 4.

    Prefer not to answer

*No correct answer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hughto, J.M.W., Meyers, D.J., Mimiaga, M.J. et al. Uncertainty and Confusion Regarding Transgender Non-discrimination Policies: Implications for the Mental Health of Transgender Americans. Sex Res Soc Policy 19, 1069–1079 (2022). https://doi.org/10.1007/s13178-021-00602-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13178-021-00602-w

Keywords

Search

Navigation