Transgender and gender diverse individuals’ daily experiences of rumination.

Abstract

Transgender and gender diverse (TGD) people face a myriad of daily stressors because of the hegemonic gender norms embedded within U.S. society. Due to these minority stressors, TGD people report elevated anxiety, depression, stress, and suicidality, among other health issues. One mechanism through which stigma may lead to these negative mental health outcomes is through increased rumination. In this intensive daily diary study with 181 TGD individuals (ages 16-40), we gathered qualitative data on their ruminative thoughts over the course of 56 days. There were a total of 2,431 responses across participants, with individuals providing a range of 1-53 responses (M = 15 responses). Using an experiential framework and an inductive approach to thematic analysis, we generated the following themes: (a) interpersonal relationships as a site of struggle, (b) fear and worry in response to contextual factors, (c) the weight of basic needs and safety, (d) gender as experienced through self and others, (e) intersections of health and rumination, and (f) the occasional reprieve. Using a deductive approach, we also placed these data within the context of Bronfenbrenner's Person-Process-Context-Time model to provide a conceptual model for future research in this area. These ruminative experiences revealed significant adversities and challenges weighing on participants' minds that spanned many areas of life. These findings also highlight the nuanced nature of rumination for TGD individuals and areas that may be overlooked in current assessments of this construct. Public Policy Relevance StatementTransgender and gender diverse (TGD) people commonly report experiencing rumination. The content of this rumination can range from everyday stressors, like finances, to novel experiences related to gender affirmation, interpersonal rejection, political oppression, and fears for safety. aaa D espite growing recognition of the experiences of transgender and gender diverse (TGD) people (Crissman et al., 2017), general acceptance of TGD persons in mainstream society is still lacking (Norton & Herek, 2013). This unfortunate reality is evident in the widespread structural stigma that exists across the U.S., with TGD people lacking protections in areas such as housing discrimination and public accommodations, as well as efforts to ban TGD people from the military and the rolling back of health care access (White Hughto et al., 2015). This unwelcoming environment creates barriers to TGD people accessing basic needs This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.The authors thank the members of the Trans Health Community Advisory Board in Chicago who assisted with this project for their time, feedback, and dedicated involvement. We also would like to thank the participants who took part in this research for their time and effort.

The multifaceted role of emotion regulation in suicidality: Systematic reviews and meta-analytic evidence.

“…In particular, three studies were conducted on individuals without mental health issues (Wahid et al, 2022), transgender and gender-diverse people (Puckett et al, 2022), and patients with a history of suicide attempts and suffering from substance abuse (Conner et al, 2022). These brought different perspectives on the topic observing that ruminative flooding was one of the most frequent cognitive warning signs before suicide attempts (Conner et al, 2022), that rumination processes lead to a feeling of failure, which is in turn connected to suicide ideation (Wahid et al, 2022), or that proneness to ruminate is exacerbated by suicidal ideation (Puckett et al, 2022). Last, a case study of a woman suffering from BPD (Marks, 2022) aimed to illustrate the way the dialectical behavioral therapy model works, reporting an association between hopelessness rumination and passive suicidal ideation.…”

Evaluation of the gender minority stress model in transgender and gender diverse college students.

“…However, the results from Dworkin et al's ( 2018) study also exemplify a broader critique of the GMSR model, which argues that additional proximal stressors, such as gender dysphoria (Lindley & Galupo, 2020) and rumination (Puckett et al, 2022), need to be included in the model. Including additional proximal stressors in the GMSR measure may indeed clarify the relations between proximal stress and PTSD and anxiety symptoms.…”

Mental health, coping, and resilience among transgender and gender diverse people during the 2020 U.S. presidential election.

“…These include proximal minority stressors (e.g., internalized stigma) and distal minority stressors (e.g., discrimination). Over time, these theories have evolved to be better attuned to the unique experiences of TGD people, recognizing the socially embedded nature of minority stressors within the broader sociopolitical context as well as the unique forms of minority stress that TGD people may endure (Price et al, 2021; Puckett et al, 2022a, 2023). TGD minority stress, also referred to as marginalization stress, has also been linked to embodied stress (e.g., DuBois, 2012; DuBois et al, 2017, 2021), increased allostatic load (DuBois & Juster, 2022), and negative psychosocial outcomes (e.g., Puckett et al, 2020).…”

“…This atmosphere of explicit prejudice stigmatized TGD people at the structural, interpersonal, and individual levels, which can lead to heightened stress and negative mental and physical health effects (Hughto et al, 2015). Thus, minority stressors, including violence and stigma along with subsequent anxiety and depression, could be expected to increase leading up to the 2020 presidential election (Hughto et al, 2015; Price et al, 2021; Puckett et al, 2022a, 2023).…”