Gender Minority Stress: A Critical Review

Tan, Kyle K. H.; Treharne, Gareth J.; Ellis, Sonja J.; Schmidt, Johanna; Veale, Jaimie F.

doi:10.1080/00918369.2019.1591789

Cited by 244 publications

(180 citation statements)

References 45 publications

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“…The discrepancy in prevalence could be due to the older average age of transgender participants in the other studies; these warrant further investigation. The mental health inequities between transgender and cisgender participants found in this study are consistent with and add to the body of evidence confirming the deleterious impacts of gender minority stress [16][17][18]. Our questions on depression and anxiety asked about the lifetime prevalences of these diagnoses; we are aware that these might be prone to recall bias, and that we cannot necessarily infer one's current mental health status from these particular questions in the way that we can from our psychological distress questions.…”

Section: Population-based Comparisonssupporting

confidence: 72%

“…The term health inequities reflects a social justice lens and foregrounds the impacts of unjust social norms that prevent a population from attaining their full health potential [13,14]. In this instance, the systemic difference in health status between transgender and cisgender populations are affected by cisgenderism, a prejudicial norm that asserts that there are only two valid genders (i.e., man and woman) which correspond to one's assigned sex at birth [15,16]. The Gender Minority Stress Theory posits that cisgenderism leads to a form of stress that is specific to transgender people, and that elevated mental health concerns among this population are due to their experiences of distal (e.g., external discrimination) and proximal (e.g., internalised transphobia) stressors [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Mental Health Inequities among Transgender People in Aotearoa New Zealand: Findings from the Counting Ourselves Survey

Tan

Ellis

Schmidt

et al. 2020

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There has been little international research looking at differences in mental health across different age groups. This study examines mental health inequities between transgender people and the Aotearoa/New Zealand general population from youth to older adulthood. The 2018 Counting Ourselves survey (N = 1178) assessed participants’ mental health using the Kessler Psychological Distress Scale (K10) and diagnoses of depression and anxiety disorders, questions that were the same as those used in the New Zealand Health Survey. Our results showed significant mean score differences for transgender people on K10, and these differences were almost two standard deviations higher than the general population (Cohen’s d = 1.87). The effect size differences, however, decreased from youth to older adults. Regression analyses indicated trans women were less likely to report psychological distress than trans men and non-binary participants. There was an interaction effect for age and gender, with lower psychological distress scores found for younger trans women but higher scores for older trans women. The stark mental health inequities faced by transgender people, especially youth, demonstrate an urgent need to improve the mental health and wellbeing of this population by implementing inclusive institutional practices to protect them from gender minority stress.

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Section: Population-based Comparisonssupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Mental Health Inequities among Transgender People in Aotearoa New Zealand: Findings from the Counting Ourselves Survey

Tan

Ellis

Schmidt

et al. 2020

IJERPH

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“…Developing this understanding is important as the population of gender-expansive individuals is highly understudied, and their health outcomes have seldom been studied as distinct from other gender minorities [33]. Although it has been previously proposed that all gender minority people may be at an elevated risk of eating pathology [6,8], the gender-expansive population faces distinct psychosocial stressors, which may contribute to maladaptive eating attitudes and behaviors [1,34]. Understanding the manifestations of eating disorders in this population is important for developing targeted risk assessments and treatment approaches.…”

Section: Discussionmentioning

confidence: 99%

“…However, transgender women had higher Restraint and Shape Concern subscale scores than gender-expansive individuals. This may be due to gender-expansive and transgender individuals experiencing eating disorders as a result of discrimination, stigma, and prejudice that they encounter secondary to their gender identity, termed the Gender Minority Stress Theory [15,34]. Specifically, gender-expansive individuals may face psychological distress due to identity invalidation, decreased social support, and increased discrimination [1,2,17].…”

Section: Discussionmentioning

confidence: 99%

Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations

et al. 2020

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Purpose Gender-expansive individuals (i.e., those who identify outside of the binary system of man or woman) are a marginalized group that faces discrimination and have a high burden of mental health problems, but there is a paucity of research on eating disorders in this population. This study aimed to describe the community norms for the Eating Disorder Examination Questionnaire (EDE-Q) in gender-expansive populations. Methods The participants were 988 gender-expansive individuals (defined as neither exclusively cisgender nor binary transgender) from The PRIDE study, an existing longitudinal cohort study of health outcomes in sexual and gender minority people. Results We present the mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in this group as a whole and stratified by sex assigned at birth. Gender-expansive individuals reported any occurrence (≥1/28 days) of dietary restraint (23.0%), objective binge episodes (12.9%), excessive exercise (7.4%), self-induced vomiting (1.4%), or laxative misuse (1.2%). We found no statistically significant differences by sex assigned at birth. Compared to a prior study of transgender men and women, there were no significant differences in eating attitudes or disordered eating behaviors noted between gender-expansive individuals and transgender men. Transgender women reported higher Restraint and Shape Concern subscale scores compared to gender-expansive individuals. Compared to a prior study of presumed cisgender men 18–26 years, our age-matched gender-expansive sample had higher Eating, Weight, and Shape Concern subscales and Global Score, but reported a lower frequency of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18–25 years, our age-matched gender-expansive sample had a higher Shape Concern subscale score, a lower Restraint subscale score, and lower frequencies of self-induced vomiting, laxative misuse, and excessive exercise. Conclusions Gender-expansive individuals reported lower Restraint and Shape Concern scores than transgender women; higher Eating, Weight, and Shape Concern scores than presumed cisgender men; and lower Restraint but higher Shape Concern scores than presumed cisgender women. These norms can help clinicians in treating this population and interpreting the EDE-Q scores of their gender-expansive patients.

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“…Moreover, these theories were largely non-trans-specific, and no studies drew on frameworks such as gender minority stress and gender affirmation that have been commonly used in trans health research. [78][79][80][81] Future research could be strengthened by adapting existing frameworks, and developing new frameworks, for research with trans men in LMIC.…”

Section: Overview Of Findingsmentioning

confidence: 99%

Health of transgender men in low-income and middle-income countries: a scoping review

et al. 2020

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IntroductionDespite the rapid growth of research on transgender (trans) health globally, the extent of research on trans men and other transmasculine persons assigned the female sex at birth remains unclear. We, therefore, conducted a scoping review on trans men’s health in low-income and middle-income countries (LMICs).MethodsThe review included peer-reviewed articles and conference abstracts, and grey literature published from 1 January 1999 to 5 July 2019 in English, French, Hindi or Spanish and reporting original quantitative and/or qualitative data on the health of trans men or transmasculine persons living in LMIC. Studies were excluded if they did not disaggregate data for trans men or if they only described surgical techniques or laboratory values.ResultsWe included 53 studies (42 peer-reviewed and 11 grey literature) from 19 LMIC. Most were conducted in higher-middle-income countries (n=12) and in Latin America (n=16, 30.2%), the Middle East (n=14, 26.4%) or Sub-Saharan Africa (n=12, 22.6%) and published in 2014 or later (n=44, 83.0%). Approximately half of studies used quantitative methods (52.8%, n=28), of which 64.3% (n=18) had fewer than 50 participants and 14.2% (n=4) had over 150. Across study designs, social determinants of health and gender-affirming care were the most commonly represented domains (49.1% and 47.1% of studies respectively), with common themes including gender-based violence, coercion and discrimination as well as unprescribed hormone use. Other domains represented included mental health (32.1%), sexual and reproductive health (24.5%), general healthcare access (18.9%), physical health (9.4%) and substance use (9.4%).ConclusionGreater inclusion and disaggregation of trans men and transmasculine persons in global health research is needed to support sex- and gender-based analyses of trans health. Community-based research approaches and theoretically driven research may help to increase the relevance and rigour of such research. Funders should invest in research on trans men’s health in LMIC.

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Gender Minority Stress: A Critical Review

Cited by 244 publications

References 45 publications

Mental Health Inequities among Transgender People in Aotearoa New Zealand: Findings from the Counting Ourselves Survey

Mental Health Inequities among Transgender People in Aotearoa New Zealand: Findings from the Counting Ourselves Survey

Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations

Health of transgender men in low-income and middle-income countries: a scoping review

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