The stench of bathroom bills and anti-transgender legislation: Anxiety and depression among transgender, nonbinary, and cisgender LGBQ people during a state referendum.

Abstract

Informed by structural stigma theory, this article presents the results of two studies that explored mental health experiences of transgender, nonbinary, and gender-diverse (TNG) individuals and cisgender lesbian, gay, bisexual, and queer (LGBQ) individuals (N = 523) prior to and following a state referendum to remove gender-based protections. In the Preelection Study, a path model explored relationships among individual factors (i.e., TNG identity, history of gender-based victimization), interpersonal variables (i.e., Referendum familiarity, exposure to Referendum-related messages, sexual orientation, and gender identity-specific social support), and mental health factors (i.e., Referendum-related anxiety and depressive symptomatology). Referendum-related anxiety mediated the relationships between TNG identity, gender-based victimization, sexual orientation and gender identity social support, and depressive symptomatology, explaining 40% of the variance in depressive symptomatology. Postelection, a subsample of participants (N = 117) was used to test a model of differences from pre-to postelection. Neither TNG identity nor victimization predicted Postelection mental health, however, Referendum-related anxiety and depressive symptomatology were significantly lower following the ballot vote that retained gender-based rights. Clinical implications suggest sexual and gender minorities may report increased anxiety in the face of anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ) legislation, which may be associated with heightened symptoms of depression. TNG people and LGBTQ people with histories of genderbased victimization may be more at risk for mental health concerns related to anti-TNG legislation. Public Significance StatementThis study suggests that public debate over and legislative attempts to restrict protections for lesbian, gay, bisexual, transgender, and queer (LGBTQ) people present an ongoing threat to mental health for LGBTQ people, and particularly for transgender, nonbinary, and gender diverse (TNG) individuals. Even when legislative outcomes are favorable, LGBTQ people may suffer anxiety and depression, especially those who identify as TNG or who have histories of gender-based victimization.

Factors that drive mental health disparities and promote well-being in transgender and nonbinary people

“…By contrast, interpersonal-level external forms of stigma include discrimination in healthcare and workplace settings, rejection by family members, and acts of violence 52 . Finally, structural-level forms of stigma include anti-trans policies and enforcement practices 53 , 54 (such as policies restricting the use of public restrooms to sex assigned at birth 55 , 56 and legal name and gender change on identity documents 57 ), as well as barriers to accessing competent and affirming healthcare and lack of provider education and training 58 , 59 . Building on this model to identify interventions for addressing anti-trans stigma, additional structural-level factors include gatekeeping practices within psychology, the erasure of non-binary individuals in discourse related to trans health, and the tendency to limit dissemination of new knowledge to academic outlets (for example, peer-reviewed journals and academic conferences) 51 .…”

Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders

“…Consistent with intersectionality theory, belonging to multiple marginalized and minoritized groups compounds risk for unequal and disparate outcomes ( Bowleg, 2012 ) and may heighten the burden of these stressors experienced by transgender persons with intersecting marginalized identities and lead to differences in downstream health outcomes. Lastly, it must be noted that these data were collected between 2009 and 2017, and in recent years, the sociopolitical climate for transgender people has inarguably shifted toward increased anti-transgender policy and rhetoric ( Barbee, Deal, & Gonzales, 2022 ; Cahill, Miller, & Keuroghlian, 2022 ; Horne, McGinley, Yel, & Maroney, 2022 ). As such, our findings may underestimate the current prevalence of and relationships between stressors, SUDs, and disparities ( Burgess, Kauth, Klemt, Shanawani, & Shipherd, 2019 ).…”

Supporting and advocating for transgender and gender diverse youth and their families within the sociopolitical context of widespread discriminatory legislation and policies.

“…Exploring a youth and/or caregiver's past experiences of minority stressors (e.g., harassment, exposure to negative media) and resiliency factors (e.g., supportive relationships, connection to community) can help inform the provider's understanding of what may be contributing to the youth and/or caregiver's current difficulties as well as what strengths can be capitalized on (Horne et al, 2022). Providers can also help youth and caregivers explore a range of possible coping strategies and weigh the pros and cons of each, unique to their specific needs and circumstances.…”