The Importance of Negative Expectations of the Future and Social Well-Being for Transgender Individuals' Mental Health

Background & Purpose: Marginalized and vulnerable populations experience negative health effects ranging from not seeking services when in need to actively being the target of harm. Past studies have examined the health disparities (both physical and mental) and social discrimination of transgender individuals. The purpose of this study was to add to existing literature by examining how negative expectations of the future potentially moderate the effects of social well-being and mental health for transgender individuals.

Methods: This study was a secondary analysis of data collected for the TransPop study, the first national probability sample of transgender individuals in the U.S. Recruitment occurred during two periods: between April 2016 and August 2016 and between June 2017 and December 2018. Using data consolidated from both recruitment periods, we obtained an analytic sample (N=1,436) that included 274 transgender participants.

We assessed the dependent variable of mental health using the Kessler-6, a 6-item scale that assesses the frequency of symptoms of serious psychological distress experience in the past 30 days with summed item scores ranging from 0 to 24. The primary independent variable was social well-being, measured by how participants saw their circumstances and functioning in society with scores ranging from 1 to 7. The moderating variable, negative expectations was assessed by a 9-item scale measuring the degree to which participants believed they will be misunderstood or not accepted because of their gender. Additional model covariates included healthcare threat (a 4-item scale that measured the degree to which participants worried about being negatively judged by/or confirming stereotypes about LGBTQA+ people with healthcare providers), age, race, gender, sexual orientation, and education. We used ordinary least squares (OLS) regression with robust standard errors to account for residual heteroscedasticity to estimate the model.

Results: The predictor set accounted for a significant portion (R²=.60) of the variation in psychological distress scores (F=26.69 p<.001). Negative future expectations were significant and also associated with more severe mental distress (b=2.79, p<.05). While the main effect of social well-being was nonsignificant (b=.69, p=.421), the interaction between social well-being and negative expectations was significant (b= -.57, p<.05). This suggests social well-being might serve as a protective factor by moderating and lessening the effects of negative future expectations on mental health. Perceived healthcare threat was statistically significant (b=.87, p<.005) with increasing perceived threat associated with more severe mental distress.

Conclusion & Implications: The study shows that negative expectations of the future, perceived healthcare threat can adversely impact transgender persons’ mental health while social well-being can serve as a protective factor. In past studies, transgender individuals articulated that they usually had to educate their service providers on transgender issues and guidelines putting additional stress on themselves that could be reinforcing negative expectations of the future and contributing to a negative confirmation bias. There are practice implications as these results support existing literature that finds that medical professionals need more training and education on best practices for engaging with the LGBTQA+ population to decrease mental illness and increase social well-being and expectations for the future.