State-level structural stigma and suicide attempts among transgender individuals

OBJECTIVE:To assess whether stigmatizing social environments (i.e., structural stigma) were associated with suicide attempts among transgender adults.

METHODS:State-level structural stigma was coded using a previously established measure (Hatzenbuehler, 2011) based on a 4-item composite index: (1) density of same-sex couples; (2) proportion of Gay-Straight Alliances per public high school; (3) 5 policies related to sexual orientation discrimination (e.g., same-sex marriage, employment non-discrimination); and (4) public opinion toward homosexuality (aggregated responses from 41 national polls). The index was linked to individual-level data on suicide attempts and risk factors from an online sample, collected in 2003, of transgender adults (N=1,229; mean age=32.7, SD=11.96) representing 48 states and the District of Columbia. Multivariable logistic generalized estimating equation (GEE) models explored whether state-level structural stigma was associated with lifetime suicide attempts among transgender adults, independent of individual-level risk factors.

RESULTS:Among the analytic sample of 1,052 respondents, 355 (32.4%) reported having ever attempted suicide. Lower levels of structural stigma were significantly associated with fewer lifetime suicide attempts (AOR: 0.96, 95% CI: 0.92–0.99), controlling for sex, age, race/ethnicity, income, education, urbanicity, and depressive symptoms. The direction and magnitude of the results were similar for past 12-month suicide attempts. 

CONCLUSION: Supportive state-level environments for sexual minorities may reduce the risk of suicide attempts among transgender adults. Because there was little state-level variation in transgender-specific policies at the time the study was conducted, these policies were not included in our measure; thus, future studies should incorporate transgender-specific policies in order to replicate these results.