WITHDRAWN: Exploring Housing As a Social Determinant of Mental Health and Substance Use Among a National Sample of Transgender and Gender Expansive Youth

Background/Purpose:

An estimated 48% of trans people have ever attempted suicide, approximately 10 times the rate in the general US population. Emerging research has drawn attention to the significant association between housing insecurity and suicidal behavior. Youth homelessness – a significant public health threat -- is associated with dire effects on both physical and mental health. Approximately 30% of transgender and genderqueer (we refer to as trans*) people have experienced homelessness. Unaccompanied homeless trans* youth experience disproportionate rates of homelessness as compared to unaccompanied cis-gender youth and adult trans* people. Homelessness among youth is associated with increased exposure to violence, contributing to increased psychological distress, risky substance use, and increased premature mortality risk. Despite limited descriptive research among trans* veterans, few studies examine the scope of housing as a social determinant of mental health among trans* youth or inquire into other available supportive resources, such as family support.

Methods:

Data and Sample: This secondary data analysis used a subsample of young adults ages 18-25 (n= 11,640) from the 2015 United States Trans*gender Survey (USTS) (N=27,715) conducted by the National Institute of Trans*gender Equality.

Measures: Housing was measured as past year homelessness or couch-surfing, housing instability (e.g. housing discrimination or eviction). Mental health was measured by the Kessler psychological distress scale, past-year suicidal ideation, plans, and attempts, and illicit substance use. Family support was measured by the endorsement of at least one item of family support (e.g., use correct pronouns, financially support gender transition).

Analysis: Data were analyzed using a binomial logistic regression to describe the association between past 12-month housing experiences with past 12-month substance use, risky alcohol use, and suicidal ideation, plans, and attempts. OLS linear regression was run to examine the association between housing status and psychological distress.

Results:

A greater proportion of trans* youth who experienced any housing insecurity, homelessness, or couch-surfing in the past year were significantly more likely to report binge drinking, illicit drug use, ideation and suicidal behavior, and current psychological distress than their securely housed peers. Over 70% of youth who experienced homelessness or couch surfing reported past-year suicidal ideation, 50% report making plans to die by suicide, and 31% report an attempt in the past year. Preliminary logistic regressions indicate that youth experiencing homelessness or couch surfing have over twice the odds of suicidal ideation, plans, or attempts when controlling for family support, illicit substance use, and psychological distress. Homelessness and housing insecurity did increase the odds of a higher score on the Kessler psychological distress scale and illicit substance use. However, preliminary model fit statistics indicate a poor fit.

Conclusion and Implications:

Examination of housing as a social determinant of mental health among trans* youth as an urgent need. Our findings also echo previous statements calling suicide among trans* people a public health emergency. Future research should not only focus on individual risk factors but also how existing resilience strategies and systemic interventions in the housing system can provide appropriate and effective support protecting the well-being of trans* youth.