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A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States

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Valentine, Sarah E., Shipherd, Jillian C.·2018·Clinical Psychology Review
DOI 10.1016/j.cpr.2018.03.003PMC PMC6663089
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Abstract

Transgender and gender non-conforming (TGNC) populations, including those who do not identify with gender binary constructs (man or woman) are increasingly recognized in health care settings. Research on the health of TGNC people is growing, and disparities are often noted. In this review, we examine 77 studies published between January 1, 1997 and March 22, 2017 which reported mental health outcomes in TGNC populations to (a) characterize what is known about mental health outcomes and (b) describe what gaps persist in this literature. In general, depressive symptoms, suicidality, interpersonal trauma exposure, substance use disorders, anxiety, and general distress have been consistently elevated among TGNC adults. We also used the minority stress model as a framework for summarizing existing literature. While no studies included all elements of the Minority Stress Model, this summary gives an overview of which studies have looked at each element. Findings suggest that TGNC people are exposed to a variety of social stressors, including stigma, discrimination, and bias events that contribute to mental health problems. Social support, community connectedness, and effective coping strategies appear beneficial. We argue that routine collection of gender identity data could advance our understanding mental health risk and resilience factors among TGNC populations.

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  • Cyberbullying arising from gender-based discrimination is an external stressor, leading to vigilance and self-protective behavior, such as avoiding social media, and ultimately the potential internalization of these stressors as internalized transphobia and negative self-perception.

    “Specifically, cyberbullying arising from gender-based discrimination is an external stressor, leading to vigilance and self-protective behavior, such as avoiding social media, and ultimately the potential internalization of these stressors as internalized transphobia and negative self-perception [2,30].”

    From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [30]

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  • This also seemed to be internalized as negative emotions and self-perception in this sample, with frequent reports of avoidance of social media in response to cyberbullying and the internalization of shame and self-hatred expressed in several responses.

    “This also seemed to be internalized as negative emotions and self-perception in this sample, with frequent reports of avoidance of social media in response to cyberbullying and the internalization of shame and self-hatred expressed in several responses [2,30].”

    From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [30]

    The Method section (‘Minority Stress Model as theoretical framework’; page unavailable) describes internalizing negative social attitudes, and the Results (‘Risk and resilience factors’; page unavailable) include internalized stigma. The review does not report this citing study’s sample responses, frequent social-media avoidance after cyberbullying, or expressions of shame and self-hatred. (LLM, conf=0.84)

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  • Although the prevalence of mental health problems is elevated among transgender people and distress may be present, clinically significant distress does not seem to be inherent in gender incongruence.

    “Although the prevalence of mental health problems is elevated among transgender people and distress (internally driven or as a result of outside forces) may be present, clinically significant distress does not seem to be inherent in gender incongruence [124, 125].”

    From Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies (2020) · cites this paper as [125]

    The Discussion (Methodological review; page unavailable) cautions that treatment-seeking people with potentially severe gender-related distress are a small subset of transgender and gender-nonconforming people. The Discussion (Mental health outcomes; page unavailable) also describes some distress as a possible response to discrimination, supporting the view that clinically significant distress is not necessarily inherent in gender incongruence. The passages reviewed do not establish the claim's separate comparison that mental health problems are more prevalent among transgender people. (LLM, conf=0.78)

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  • Witnessing the cyberbullying of others within your community acts as an external stressor, consistent with MSM explanations.

    “Conceptually, this is consistent with MSM explanations, whereby witnessing the cyberbullying of others within your community acts as an external stressor [29,30].”

    From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [30]

    The Method section (‘Minority Stress Model as theoretical framework’; page not provided) describes environmental exposure to discrimination and violence as an external stressor. The paper does not specifically address witnessing cyberbullying of others in one’s community, so it supports the model-based framing but not that particular example. (LLM, conf=0.85)

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  • The Minority Stress Model argues that minority populations such as TGD individuals are exposed to hostile and stressful social environments because of their minority status, leading to worse mental health outcomes than for cisgender and heteronormative populations.

    “The Minority Stress Model (MSM) argues that minority populations such as TGD individuals are exposed to hostile and stressful social environments because of their minority status, leading to worse mental health outcomes than for cisgender and heteronormative populations [29,30].”

    From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [30]

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Research works printed but not linked: 3

  1. Hathaway SR, & McKinley JC. 1943 The Minnesota Multiphasic Personality Inventory (Rev. ed., 2nd printing). Minneapolis, US: University of Minnesota Press.
  2. Shipherd JC, Maguen S, Skidmore WC, & Abramovitz SM (2011). Potentially traumatic events in a transgender sample: Frequency and associated symptoms. Traumatology, 17(2), 56– 67. 10.1177/1534765610395614 · DOI
  3. Valentine SE, Woulfe J, & Shipherd JC (in press). An evidence-based approach to conceptualizing trauma responses among transgender and gender non-conforming (TGNC) adults. In Pachankis JE, & Safren SA (Eds.), Handbook of evidence-based mental health practice with LGBT clients (). New York: Oxford University Press.

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Authors
Valentine, S. E., & Shipherd, J. C.
Affiliations
Boston University (US)
Corresponding author
Valentine, Sarah E.
ORCID
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2018-12
Volume
66
Pages
24-38
ISSN
0272-7358 (ISSN-L)
DOI
10.1016/j.cpr.2018.03.003
PMC
PMC6663089
OpenAlex
W2794981511
Cited by
699
References
106
Citations by year
2026: 61 · 2025: 92 · 2024: 102 · 2023: 114 · 2022: 100 · 2021: 128 · 2020: 56 · 2019: 34 · 2018: 11 · 2016: 1
FWCI
8.89
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Psychology Review (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K23MH117221)
Topics
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
transgender people, gender non-conforming people, mental health, social stress, minority stress model, depressive symptoms, suicidality, substance use disorders, anxiety, stigma, discrimination, social support, community ties, coping strategies, health disparities
MeSH terms
Psychological Trauma, Sexual and Gender Minorities, Adult, Anxiety, Depression, Female, Humans, Male, Middle Aged, Social Support, Stress, Psychological, United States, Substance-Related Disorders, Social Stigma

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