Department of Epidemiology, Harvard T. H. Chan School of Public Health, Kresge Building 9th Floor-Student Mail, 677 Huntington Ave, MA, 02115, Boston, USA.
Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA.
Soc Psychiatry Psychiatr Epidemiol. 2022 Nov;57(11):2305-2318. doi: 10.1007/s00127-022-02359-y. Epub 2022 Sep 16.
Victimization contributes to mental and behavioral health inequities among transgender and gender diverse (TGD) people, but few studies have simultaneously examined health-promoting resiliencies. We sought to identify classes of risk and resilience among TGD adults, assess characteristics associated with these classes, and examine their relationship with mental health and substance use outcomes.
Cross-sectional data were from the 2015 US Transgender Survey, a non-probability study including 26,957 TGD adults. Using latent class analysis, we classified patterns of vulnerability and resilience based on risk (past-year denial of equal treatment, verbal harassment, physical attack, bathroom-related discrimination; lifetime sexual assault, intimate partner violence) and protective (activism; family, work, classmate support) factors. Regression models were fit to (1) determine the association between sociodemographic and gender affirmation characteristics and latent classes; (2) model associations between latent classes and mental health (current serious psychological distress, past-year and lifetime suicidal thoughts and attempts, and lifetime gender identity/transition-related counseling) and substance use (current binge alcohol use, smoking, illicit drug use; past-year drug/alcohol treatment) outcomes.
Three latent classes were identified: high risks, with activism involvement ("risk-activism," 35%); low risks, with not being out about one's TGD identity ("not-out," 25%); and low risks, with high family support ("family-support," 40%). Gender affirmation and sociodemographic characteristics, such as race/ethnicity and sexual orientation, were associated with latent classes. Risk-activism class membership was associated with higher odds of negative mental health and substance use outcomes, while the family-support class had lower odds of these outcomes.
Interventions leveraging family support, and policy protections from discrimination and victimization, may promote TGD mental and behavioral health.
在跨性别和性别多样化（TGD）人群中，受害经历导致了心理健康和行为健康的不平等，但很少有研究同时检查促进健康的恢复力。我们试图确定 TGD 成年人的风险和恢复力类别，评估与这些类别相关的特征，并研究它们与心理健康和物质使用结果的关系。
横断面数据来自 2015 年美国跨性别调查，这是一项非概率研究，包括 26957 名 TGD 成年人。我们使用潜在类别分析，根据风险（过去一年被拒绝平等对待、言语骚扰、人身攻击、与浴室相关的歧视；终生性侵犯、亲密伴侣暴力）和保护因素（激进主义；家庭、工作、同学支持）来对脆弱性和恢复力模式进行分类。回归模型用于：（1）确定社会人口统计学和性别认同特征与潜在类别之间的关联；（2）模拟潜在类别与心理健康（当前严重心理困扰、过去一年和终生自杀念头和尝试以及终生性别认同/过渡相关咨询）和物质使用（当前酗酒、吸烟、非法药物使用；过去一年药物/酒精治疗）结果之间的关系。
确定了三个潜在类别：高风险，有激进主义参与（“风险激进主义”，35%）；低风险，不公开自己的 TGD 身份（“不出柜”，25%）；低风险，家庭支持度高（“家庭支持”，40%）。性别认同和社会人口统计学特征，如种族/民族和性取向，与潜在类别相关。“风险激进主义”类别成员与负面心理健康和物质使用结果的可能性更高相关，而“家庭支持”类别与这些结果的可能性更低相关。
利用家庭支持的干预措施，以及免受歧视和受害的政策保护，可能会促进 TGD 的心理健康和行为健康。
