Exploring Mediators of LGBTQ+ Psychological Distress

Background and Purpose: The LGBTQ+ community experiences discrimination and stigma at disproportionately higher rates than their cisgender counterparts. These experiences potentially put them at higher risk of experiencing greater psychological distress evidenced by higher levels of depression, anxiety, and suicidal ideation. Aside from discrimination and stigma, other factors that might underly transgender persons’ greater psychological distress are less well understood. We hypothesized that selected life stressors could mediate the observed differences in psychological distress symptoms between transgender and cisgender individuals.

Methods: We used secondary data from the 2016-2018 TransPop cross-sectional national survey. The sample included 1,162 self-identified cisgender and 274 transgender adults (ages 18 or above). Gender identity aggregated to cisgender or transgender was the primary independent variable. The dependent variable was psychological distress, measured using the Kessler-6 scale, with scores ranging from 0-24 with higher scores indicating more frequent experiences of symptoms of psychological distress such as depression and anxiety. Selected potential mediators representing life stressors included: adverse childhood experiences (ACE) created using the CDC-Kaiser Permanente ACE guide; social support based on the Multidimensional Scale of Perceived Social Support; and experiences of everyday discrimination created by summing nine 4-point Likert-like scale questions. We included sexual identity, measured dichotomously (heterosexual, non-heterosexual) as a moderating variable of the direct path between gender identity and psychological distress. Covariates included age, race, and income. Path analysis was done using Hayes PROCESS macro (V.40) running under SPSS (v28). The conditional process model estimated three parallel mediated indirect effects of life stressors on psychological distress and the direct effects of transgender status moderated by sexual minority identification. We used bootstrapping with 95% CIs to estimate the significance of the indirect effect pathways.

Results: The final path model accounted for 47% of the variance in psychological distress scores (F=136.93, p=.00). The direct effect of gender identity were nonsignificant for persons who also identified as heterosexual (b=.70, p=.01); however, when identified as a sexual minority, the direct effect of gender identity was statistically significant (b=1.12, p=.01). All three indirect mediated pathways between the life stressors and psychological distress were also significant, collectively accounting for an additional increase of .73 in psychological distress scores among transgender persons (b-.73, p <.05). Individual mediation effects were as follows: decreased social support (b = .46, p<.001), greater experience of everyday discrimination (b=.37, p < .01) and experiencing more ACEs (b=2.28, p < .01) were all associated with higher levels of psychological distress.

Conclusion and Implications: Lack of social support, experiencing more ACEs, and more everyday discrimination all appear to account for some of the increased psychological distress reported by transgender relative to cisgender persons. Additionally, transgender persons who identify as sexual minority are also at greater risk for more severe psychological distress, reflecting the intersectional mental health effects of identifying as both a gender and sexual minority. Policies and programs that seek to address the mental health of transgender persons might be designed to increase social support, help transgender persons manage everyday discrimination, and provide counseling resources to address ACEs.