Minority stress, mental health, and substance use in transgender youth: the moderating role of positive affect.

OBJECTIVE

To examine the relationships between gender minority stressors and mental health outcomes among transgender and gender diverse (TGD) youth and explore the moderating role of positive affect.

METHOD

Baseline data of 315 TGD youth (ages 12-20 years old) from the Trans Youth Care-United States study comprised the analytic sample. Youth completed three subscales of the Gender Minority Stress and Resilience Measure for Adolescents (GMSR-A; nondisclosure of gender identity/gender history, negative future expectations, and internalized transphobia), Beck Depression Inventory-II (BDI-II), Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2), Alcohol, Smoking and Substance Involvement Screen Test (ASSIST), and the NIH Toolbox Positive Affect survey. Regression analyses using the Hayes PROCESS macro assessed moderation effects.

RESULTS

Gender minority stressors were associated with more symptoms of depression (r = 0.29 to 0.42) and anxiety (r = 0.32 to 0.42) and were not significantly associated with substance use (r = -0.01 to 0.10). Positive affect was negatively associated with gender minority stressors (r = -0.19 to -0.24) and mental health/substance use outcomes (r = -0.16 to -0.63). Positive affect significantly buffered the association between nondisclosure of gender identity and depressive symptoms (ΔR2 = 0.02) and protected against the impact of internalized transphobia on anxiety symptoms (ΔR2 = 0.01).

CONCLUSIONS

Positive affect is a promising modifiable protective factor that buffers the negative impact of gender minority stress on the mental well-being of TGD youth. Adapting existing positive emotion interventions for TGD youth is an indicated future direction for research and clinical practice.