The Life History Calendar As a Tool to Examine Transgender Women's Victimization, Mental Health, and Seeking and Attaining Help: An Example of a Culturally Relevant Adaptation

Background and purpose: The life history calendar (LHC) is useful for examining trajectories of victimization and associated mental health outcomes, yet to date this method has not been used to examine transgender women’s victimization trajectories. Most studies using the LHC to examine violence among transgender women have relied on a count or frequency method to measure victimization, and typically explore only one form of victimization (e.g., IPV). While important for documenting the high rates of violence among transgender women, this research does not take into account the heterogeneity of women’s experiences, including the context or relationship in which the abuse first occurred, how these victimizations may have changed over time, the severity and longevity of the abuse, or women’s help-seeking behaviors in response to these experiences. Yet these data are important for understanding the effects of cumulative victimization on transgender women’s mental health, as cumulative victimization has been associated with more severe mental health consequences in cisgender populations. Furthermore, trajectories of victimization are likely impacted by the timing of transition-related milestones (e.g., coming out, starting to socially transition one’s gender). In this paper, we describe adapting the LHC; using the adapted LHC to examine transgender women’s experiences of victimization, adverse mental health, and seeking and attaining help (N = 103); and collecting participants’ feedback on the acceptability of the LHC as a data collection tool.

Methods: We collaborated with local organizations and community leaders to iteratively develop and adapt the LHC to ensure that it was relevant and appropriate to the experiences of transgender women, including assessing for identity development milestones and transgender-specific victimization experiences. The adapted LHC was then used in interviews with a sample of 103 transgender women. At the end of the interview, we asked participants to share what it was like for them to be interviewed using the LHC. Responses were transcribed verbatim and coded using open and thematic coding methods. Responses were coded as either positive, neutral, or challenging. Challenging responses were those in which participants indicated that they felt sad, tired, or upset. Many responses included multiple codes.

Findings: To our knowledge, this study is among the first to systematically tailor and utilize the LHC method with transgender women to examine trajectories of victimization and mental health outcomes. The majority of participants (97.8%) found the experience to be positive (73.0%) or neutral (39.3%). Just two participants’ responses were coded as only challenging. Other themes included enjoying the process of using the calendar to reflect on their life events and feeling good about using their stories to help others.

Conclusion and implications: The adaptation and findings from our study demonstrate that despite high levels of victimization and trauma and potential difficulty discussing these topics in a research context, transgender women who participated in this study found the LHC interview to be acceptable and, in many cases, positive. Findings can inform future LHC adaptations and research as well as the development of culturally relevant and effective mental health interventions for transgender women.