Minority stress and mental health in transgender and gender-diverse individuals

I am presenting two recent studies of stress in transgender and gender-diverse individuals. First, Puckett, Dyar, Maroney, Mustanski & Newcomb (2023) published “Daily Experiences of Minority Stress and Mental Health in Transgender and Gender-Diverse Individuals” in Journal of Psychopathology and Clinical Science.  Here’s an edited version of the abstract and impact statement with some information in bold:

Transgender and gender-diverse people experience various minority stressors although minimal research has examined prospective effects on daily affect or mental health. We explored rates of marginalization for transgender and gender-diverse participants in a daily diary study and the concurrent and prospective associations with daily affect and weekly measures of depression and anxiety symptoms, as well as the mediating effects of internalized stigma, rumination, and isolation. There were 167 participants (82.2% white; M age = 25) retained in the daily surveys. Participants completed surveys for 56 days reflecting exposure to marginalization, gender nonaffirmation, internalized stigma, rumination, isolation, affect (negative, anxious, and positive affect), and mental health (anxiety and depression symptoms). Participants experienced marginalization on 25.1% of the days. Within-person analyses revealed concurrent associations between marginalization and gender nonaffirmation with increased negative and anxious affect and increased anxiety and depression symptoms, as well as associations for gender nonaffirmation and decreased positive affect. At the within-person level, there were prospective associations between marginalization and gender nonaffirmation with increased negative affect on the next day, as well as increased anxiety and depression symptoms the next week. Concurrent analyses revealed significant indirect effects with marginalization and gender nonaffirmation associated with all three affect variables and mental health via increases in internalized stigma, rumination, and isolation. However, only gender nonaffirmation was related to isolation and affect or mental health in the prospective analyses. Clinical considerations include strategies to address the immediate effects of minority stress as well as the long-term interpersonal effects. Transgender and gender-diverse people encounter marginalization, on average, every 1 of 4 days. These stressors are related to daily fluctuations in mood with implications for overall mental health. Furthermore, there are likely longer term impacts on interpersonal relationships and isolation. 

The second study extends the first in examining substance use. Dyar, Lee, Rhew & Kaysen (2023) published “Sexual Minority Stress and Substance Use: An investigation of when and under what circumstances minority stress predicts alcohol and cannabis use at the event-level” in Journal of Psychopathology and Clinical Science. Here are the edited abstract and impact statement with information in bold.

Sexual minority women and gender diverse (SMWGD) individuals are at elevated risk for alcohol and cannabis use disorders compared with cisgender, heterosexual women. This has been attributed to the unique stressors that SMWGD experience (i.e., sexual minority stress); however, recent studies have found mixed evidence for a link between sexual minority stress and substance use. The current manuscript introduces and tests a novel theoretical model derived from integrating minority stress theory and the multistage model of drug addiction to explain these mixed findings. We used data from a 30-day ecological momentary assessment (EMA) study of substance use among SMWGD to determine whether event-level associations between enacted stigma (bias from others) and same-/next-day alcohol and cannabis use are dependent on an individual’s typical pattern of substance use (e.g., frequency, quantity, motives, and substance use disorder [SUD] symptoms). Findings indicate that enacted stigma predicted an increased likelihood of alcohol and cannabis use among those who used frequently and those who had a probable alcohol or cannabis use disorder and predicted a decreased likelihood of use among those who used less frequently. Enacted stigma also predicted cannabis (but not alcohol) use among those who reported high coping motives for use. Findings provide initial evidence in support of an integrated model of minority stress theory and the multistage model of drug addiction. Findings suggest that alcohol and cannabis use disorder interventions for SMWGD would benefit from addressing sexual minority stress and coping skill-building. 

The results of this study suggest that discrimination and microaggressions are risk factors for same/next-day alcohol and cannabis use among LGBTQ + individuals who use alcohol and/or cannabis frequently or have an SUD. However, discrimination and microaggressions do not appear to be risk factors for same/next-day alcohol and cannabis use among LGBTQ + individuals who use alcohol or cannabis less frequently or do not have an SUD. 

These studies are important in both identifying stressors and their consequences for LGBTQ+ individuals.