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

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.

The clinical characterization of the adult patient with depression aimed at personalization of management

“…Populations with higher vulnerability to stressors include patients in long-term care 228 , caregivers, postpartum women 229,230 , individuals with a housing disadvantage 231 , immigrants and refugees 232 ; lesbian, gay, bisexual and transgender people; and other stigmatized individuals 233 . Among caregivers at particularly high risk are those taking care of children with intellectual and developmental disabilities, or family members with dementia 234 .…”

Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies

“…In the absence of distress, gender incongruence cannot be conceptualized as a mental disorder, yet people may need treatment. 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]. The ICD is a broader document than the DSM, as it encompasses mental disorders as well as other conditions needing treatment.…”

“It’s worse with fellow patients… they judge you as evil”: Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda.

“…Due to fear of violence, trans-women sex workers in our study coped by changing the dress code to the one that meets societal expectations in order to access HIV/STI prevention and care services, despite not being in conformity with their gender identity. The use of dress code to mask the gender identity of transgender persons has been reported in Malaysia and the United States (33,34). Our study also reveals that trans-women sex workers did not access services due to the lack of recognition by other key population groups such as female sex workers and MSMs.…”