The Effect of Interpersonal and Structural Gender Affirmation on Genderqueer and Non-Binary Individuals' Mental Health

Background and Purpose: Genderqueer and non-binary (i.e. gender identity differs than assumed at birth and is neither woman or man, a mix, or another gender altogether; GQNB) people make up over one-third of an estimated 1.4 million adults whose gender differs than assumed at birth. GQNB communities are often grouped with binary trans (i.e. gender identity differs than assumed at birth and is woman, man, trans woman or man; BT) communities in transgender mental health research. Given the systematic social and structural exclusion of GQNB individuals in a society dominated by binarism and restrictive gender ideas, GQNB individuals likely have different gender affirmation experiences compared to BT individuals. This study will examine the effects of interpersonal and structural gender affirmation on mental health among GQNB and BT individuals and hypothesizes:

1. GQNB individuals will report higher levels of psychological distress than BT individuals.
2. The difference in psychological distress by current gender identity is mediated by interpersonal affirmation.
3. The relationship between gender and interpersonal level affirmation will be stronger and the relationship between gender and psychological distress will be weaker with the presence of structural affirmation.

Methods: De-identified data from the 2015 US Transgender Survey (N=27,715) will be used. Data were collected using a blend of community driven and convenience sampling methods. Reflecting all 50 US states, GQNB and BT respondents' age averaged 25.64 (n=9,769) and 33.56 (n=17,188) years respectively.

A conditional process model tested the hypothesized moderated mediation. The following variables, indicators and levels of measurement were included: current gender identity (GQNB and BT; dichotomous antecedent); psychological distress (Kessler 6; continuous outcome); interpersonal affirmation (total family acts of gender affirmation; continuous mediator); and structural affirmation (no or some identification documents reflecting asserted name and gender; dichotomous moderator). Race and age were treated as covariates.

Results: Preliminary analyses revealed higher mean psychological distress scores among GQNB compared to BT respondents (t (21371) = -27.37, p<.001, two-tailed). A conditional process analysis revealed GQNB respondents reported significantly less interpersonal affirmation compared to BT respondents (b=-2.921, [-3.134:-2.709],  p<.001). For psychological distress, structural affirmation significantly moderated the mediation of gender via interpersonal affirmation (b=1.716, [1.391:2.041],  p<.001). Finally, structural affirmation was not found to significantly moderate the relationship between gender and psychological distress (b=-.596, [-.319:1.150], p=.093).

Conclusions and Implications: The findings suggest the moderation of structural gender affirmation on mental health through interpersonal affirmation. In addition, this study highlights mental health inequities among GQNB communities as a result of experiencing significantly less gender affirmation compared to BT individuals. Findings underscore the need to socially and structurally validate genders transcending the woman-man dichotomy, supporting the value of recent policy efforts which recognize more than two genders on identification documents. Correct identification documents are also necessary for addressing pervasive economic inequities among GQNB and BT communities, and in particular communities of color.