Psychological Distress among Transgender Individuals: The Impact of Gender Discrimination, Victimization, Social Support, and Knowledge of Legal Protection

Background:  Transgender individuals experience high rates of discrimination and victimization, but little is known about the impact on psychological distress or factors that may protect against psychological distress.

Methods: 205 Male-to-Female (MTF) and Female-to-Male (FTM) transgender individuals completed an anonymous online survey.   We assessed participants’ experience with discrimination (employment, housing, health care) and victimization (verbal harassment, physical abuse, problems with police) due to gender identity or expression.  Validated measures were used to measure psychological distress (BSI-18) and social support (MSPSS).  We measured participants’ awareness of state law prohibiting discrimination based on gender identity.  Logistic regression was conducted to assess the independent relationship between gender discrimination/victimization and psychological distress as well as the impact of social support and knowledge of legal protection.

Results:  Gender discrimination/victimization was common:  39.5% of participants reported 1-2 different types, 27.8% 3-4 types, and 13.2% 5-6 types.  After controlling for age, gender, race and education, increasing levels of discrimination/victimization were associated with increasing odds of psychological distress:  1-2 types [AOR=3.51 (95% CI=1.21, 10.25); p=.02], 3-4 types [AOR=4.61 (95% CI=1.53, 13.92); p=.007], and 5-6 types [AOR=23.03 (95% CI=5.80, 91.36); p<.001].  Higher levels of social support [AOR=0.97 (95% CI=0.95, 0.99); p=.006] and knowledge of state law protecting transgender individuals [AOR=0.42 (95% CI=0.19, 0.93); p=.03] decreased the odds of psychological distress.

Conclusions:  Our results suggest that decreasing gender discrimination/victimization could have a profound impact on psychological distress among transgender individuals.  In addition, building social support and increasing awareness of legal protection may promote emotional well-being in this population.