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. Supplementary Information The online version contains supplementary material available at 10.1007/s00127-023-02482-4.

Background: Relative to cisgender adolescents, transgender adolescents experience greater interpersonal trauma, depression, and suicidality. Structural transphobia (societal conditions constraining transgender people’s rights/wellbeing) may exacerbate associations between trauma and poor mental health for this group. Indeed, a recent study found more severe suicidality in trauma-exposed transgender adults from states with more transphobic policies. To date, this line of research has rarely examined transgender adolescents nor considered structural anti-transgender attitudes.Method: We used national survey data (5,188 transgender adolescents; 22 states) to explore the interaction of trauma and state-level transphobia (explicit anti-transgender attitudes) on mental health. Factor analysis was used to create a state-level transphobia measure. Latent class analysis identified transgender adolescents exposed to low (0-2; mostly bullying; 70%) vs. high (>2; mostly physical assault; 30%) numbers of traumas. To explore interaction effects, we created categories representing trauma class and low vs. high transphobia representing 4 groups: 31% low trauma/low transphobia, 16% low trauma/high transphobia, 37% high trauma/low transphobia, and 16% high trauma/high transphobia. Regressions examined associations between group membership and depression and suicidality.Results/Discussion: Relative to the low trauma/low transphobia group, transgender adolescents in high trauma groups were more likely to consider (ORs=2.8 & 2.4) or plan (ORs=2.9 & 3.4) suicide (ps<.001), and those in all other groups were more likely to report depression (ORs=1.3-2.8, ps<.001). The highest odds for depression and suicidality were found in the high trauma/high transphobia group. Results suggest that structural transphobia confers additional risk for trauma-exposed transgender adolescents, who may benefit from multilevel interventions addressing both interpersonal and structural stigma.

As the proportion of older adults increase, there is a need to investigate ways to promote healthy cognitive aging. There is growing interest in longitudinal studies examining the impact of regular musical activity on nonmusical cognitive functions, but the financial and logistical challenges of such studies greatly limits the amount of research on this topic, especially in older adults. To surmount these challenges and stimulate the pace of research in this area we present a novel technology-based method for conducting longitudinal studies of regular singing and song learning in older adults. This method uses a tablet based app (SingFit-R) that is given to participants to take home and used for singing a specified number of songs per day. Participants choose the songs they will sing and then follow a singing schedule created by the experimenter. The app records a variety of data each time a song is sung, including song name, date and time of singing, an audio recording of the singer’s voice, and the user-set volume levels of 2 mnemonic aids that facilitate song learning: a “guide singer” and “lyric coach” (the user reduces the volumes of these aids as a song is learned). By analyzing these data researchers can verify compliance and track song learning over the course of the study. We tested the feasibility of longitudinal research with SingFit-R in a 5-week study in which older adults sang 6 songs per day for 5 days per week. We examined measures of working memory and emotion regulation in this group before and after this intervention, and compared them to control groups that listened to music or had no musical activity. Based on measures of attrition, compliance, and enjoyment among users of the app, we conclude that this method is suitable for larger-scale studies on the cognitive impact of regular singing and song learning in older adults.

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