This article includes discussion of mental illness and suicidality that may be challenging for some readers.
October 5, 2023
By Kristin Spiegel, Drexel University College of Medicine
Amidst anti-transgender legislation and don’t-say-gay bans, it is vital to consider the social and public health implications of attempts to minimize or even eliminate the experience of gender and sexual minorities. Transgender, or trans, individuals are those whose gender expression or identity differs from what they were assigned at birth. This covers individuals who were assigned male at birth but identify as female (i.e., transgender women), individuals who were assigned female at birth but identify as male (i.e., transgender men), as well as gender non-conforming and nonbinary individuals.
It is well known that the research shows a significantly increased risk of mental illness and suicidality in trans people compared to the general population, and this is higher still in transgender youth. The literature indicates up to 82% of transgender people have considered suicide, and 40% have attempted in their lifetime, a nine-fold higher rate than in the general population (Kota et al., 2020). Naturally, the higher rates of suicidality are thought to be connected to higher rates of major depressive disorder, substance use disorder, and post-traumatic stress disorder (Hafeez et al., 2017). However, there is also evidence of trans-specific social factors that contribute to higher rates of mental illness and suicidality. These point to potential areas of policy reform in order to lessen the burden of mental illness and suicidality on trans people and society as a whole.
In recent research regarding transgender health, minority stress theory has been tested as a potential theoretical framework to view this disparity. Minority stress theory states that minorities, in this case referring to being a part of a gender minority, leads to the occurrence of increased daily stressors (such as trans-related stigma and discrimination, rejection from relationships such as peers or family, increased rates of verbal and physical abuse) that eventually add up over time and deplete psychological functioning (Rabasco & Andover, 2021). Without proper coping skills, this leads to poorer mental health outcomes.
So, what can we do at a societal level? We must increase conversations around gender diversity and create opportunities for transgender people to speak from their own experiences. At the education level, we can visibly show flags, offer spaces for lesbian, gay, bisexual, transgender and queer (LGBTQ) youth to safely assemble, and educate on terms around gender diversity (Mintz et al., 2021). At the clinician level, we need to practice cultural competency and consider minority stress theory as a framework around which gender-diverse patients can develop internalized negative feelings (often referred to as “internalized transphobia”) that contribute to increased rates of mental illness and suicidality.
In this country, LGBTQ+ rights vary by state. The Equality Act seeks to incorporate protections against LGBTQ+ discrimination into the federal Civil Rights Act of 1964. In this political climate, we are far from a bipartisan agreement on this bill. Structural-level interventions are clearly needed to make a large dent in the landscape of suicidality in transgender individuals, but it really does start with a simple, honest question: What are your pronouns?
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Sources/Resources:
- Hafeez H, Zeshan M, Tahir M A, et al. (April 20, 2017) Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus 9(4): e1184.
- Kota KK, Salazar LF, Culbreth RE, Crosby RA, Jones J. Psychosocial mediators of perceived stigma and suicidal ideation among transgender women. BMC Public Health. 2020;20(1):125. Published 2020 Jan 29.
- Mintz S, Valido A, Rivas-Koehl M, et al. Supporting sexual minority youth: Protective factors of adverse health outcomes and implications for public health. Journal of Adolescent Health. 2021;69(6):983-990.
- Rabasco, A. and Andover, M. Suicidal ideation among transgender and gender diverse adults: A longitudinal study of risk and protective factors. Journal of affective disorders. 2021;278.