Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults
Open accessAbstract
Purpose Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity.Methods We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC).Results Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts.Conclusion Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.
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Clinician participants in our study spoke of treatment of transgender patients that aligned with previous studies.
“Similarly, clinician participants in our study spoke of treatment of transgender patients that aligned with previous studies showing that gender diverse and transgender people experience anti-transgender bias, non-affirmation, and further trauma when seeking mental healthcare [54,55].”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [55]
The Introduction describes interpersonal anti-transgender discrimination, and the Conclusions call for training mental health providers in gender-affirming care. Neither passage reports that transgender people experienced non-affirmation or further trauma while seeking mental healthcare; the paper examines state-level transphobia and mental health outcomes instead. No page numbers were available in our copy. (LLM, conf=0.81)
Experimental — accuracy not yet measuredGender-diverse and transgender people experience greater inequities in many dimensions of mental wellbeing, compounded by anti-transgender bias, non-affirmation, and further trauma when seeking mental healthcare.
“Recent research has confirmed that gender-diverse and transgender people experience greater inequities in many dimensions of mental wellbeing, which are in turn often compounded by anti-transgender bias, non-affirmation, and further trauma when seeking mental healthcare [54,55].”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [55]
The Introduction reports higher risks of psychological distress, psychiatric disorders, and suicidality among transgender adults, and links mental health inequities to interpersonal and structural transphobia. The Conclusions call for gender-affirming mental healthcare, but the paper does not establish that non-affirmation or further trauma while seeking mental healthcare compounds those inequities. (LLM, conf=0.86)
Experimental — accuracy not yet measuredGender diverse and transgender people experience anti-transgender bias, non-affirmation, and further trauma when seeking mental healthcare.
“previous studies showing that gender diverse and transgender people experience anti-transgender bias, non-affirmation, and further trauma when seeking mental healthcare [54,55]”
From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [55]
The Introduction describes discrimination and other forms of transphobia experienced by transgender adults, and the Conclusions call for training mental health providers in gender-affirming care. Neither passage establishes that people experience non-affirmation or further trauma specifically while seeking mental healthcare. (LLM, conf=0.81)
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“These analyses also represented steps in the external phase of construct validation [47, 48], as the outcomes are theoretically related to the structural transphobia measure.”
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“Recent research has confirmed that gender-diverse and transgender people experience greater inequities in many dimensions of mental wellbeing, which are in turn often compounded by anti-transgender bias, non-affirmation, and further trauma when seeking mental healthcare [54,55].”
- Authors
- Price, M. A., Hollinsaid, N. L., McKetta, S., Mellen, E. J., & Rakhilin, M.
- Affiliations
- Boston College (US)
- Harvard University (US)
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2023-05-10
- Volume
- 59
- Issue
- 2
- Pages
- 285-294
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- PMC
- PMC10171731
- OpenAlex
- W4376131392
- Cited by
- 81
- References
- 70
- Citations by year
- 2026: 20 · 2025: 24 · 2024: 24 · 2023: 11 · 2022: 2
- FWCI
- 23.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion, public-domain)
- Funders
- NIMH (K23MH124670)
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Keywords
- transgender adults, psychological distress, suicidality, social determinants of mental health, perceived discrimination, provider training
- MeSH terms
- Psychological Distress, Adult, Female, Humans, Male, Prejudice, Suicide, United States, Suicidal Ideation, Transgender Persons
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