The Impact of Internalized Transphobia and Community Connectedness on Psychological Distress and Suicidality Among Transgender Adults

Background and Purpose: The transgender and gender nonconforming (TGNC) community faces pervasive challenges including stigma and discrimination, leading to high rates of mental health issues, including depression, anxiety, and suicidality. More research is needed to examine both risk and protective factors for these negative mental health outcomes. Based on the minority stress theory, the current study aimed to expand existing knowledge by investigating (1) the relationships between internalized transphobia, psychological distress, and suicidality, and (2) the relationships between community connectedness, psychological distress, and suicidality. Hypotheses predicted (1) positive associations between internalized transphobia and psychological distress and suicidality, and (2) negative associations between community connectedness and psychological distress and suicidality.

Methods: A secondary data analysis was conducted using data from TransPop, a national survey of TGNC adults. Participants were recruited through Gallup, Inc., and a self-report questionnaire was administered via mail and email. Subscales of the Gender Minority Stress and Resiliency measure were used to assess the independent measures of internalized transphobia (Cronbach’s α = 0.87) and community connectedness (Cronbach’s α = 0.78). Dependent variables included psychological distress, measured using the Kessler-6 scale (Cronbach’s α = 0.91), and suicidality, assessed through a single-item question about previous attempts. Bivariate analyses were conducted to examine the relationships between independent and dependent variables. Based on the results of bivariate analyses, a multiple linear regression was used to examine the impact of internalized transphobia on psychological distress after controlling for age, race, gender identity, and income.

Results: Participants (N=274) were primarily White (68.2%) with a mean age of 39.36 (SD = 16.89). Most of the participants identified as a transwoman/woman (43.8%), followed by 28.5% identifying as a transman/man, and 27.7% identifying as gender nonbinary. Over one third (36.3%) of participants reported a previous suicide attempt. At the bivariate level, internalized transphobia was significantly associated with psychological distress (r(261) = .30, p <.001) but not with suicidality. Community connectedness was neither associated with psychological distress nor suicidality at the bivariate level. Results of the multiple linear regression were statistically significant (F(7,255) = 14.49, p< .001), explaining 31% of the variance in psychological distress. Increased psychological distress was predicted by younger age (b= -0.15, p<.001), non-binary or woman/transwoman gender identity (b= 2.75, p<.001; b=2.18, p<.01), household income less than $40,000 (b=2.82, p<.001) and higher scores of internalized transphobia (b=0.23, p<.001).

Conclusions and Implications: Results of these findings reveal that, while TGNC individuals are at increased risk of suicide attempts, such factors of internalized transphobia and community connectedness were not associated with a history of attempts. Furthermore, these findings contribute to the existing literature by highlighting the role of internalized transphobia on negative mental health outcomes and underscore the necessity for targeted interventions in social work practice, prioritizing younger individuals, nonbinary/transwoman identities, and those from lower-income backgrounds. Policy efforts should advocate for gender-affirming mental health care for the TGNC community. Future research should further explore the risk and protective factors for suicidality among this population.