Does Structural Transphobia Exacerbate the Relationship Between Interpersonal Trauma and Mental Health in Transgender Adolescents?

Abstract

Background: Relative to cisgender adolescents, transgender adolescents experience greater interpersonal trauma, depression, and suicidality. Structural transphobia (societal conditions constraining transgender people’s rights/wellbeing) may exacerbate associations between trauma and poor mental health for this group. Indeed, a recent study found more severe suicidality in trauma-exposed transgender adults from states with more transphobic policies. To date, this line of research has rarely examined transgender adolescents nor considered structural anti-transgender attitudes.Method: We used national survey data (5,188 transgender adolescents; 22 states) to explore the interaction of trauma and state-level transphobia (explicit anti-transgender attitudes) on mental health. Factor analysis was used to create a state-level transphobia measure. Latent class analysis identified transgender adolescents exposed to low (0-2; mostly bullying; 70%) vs. high (>2; mostly physical assault; 30%) numbers of traumas. To explore interaction effects, we created categories representing trauma class and low vs. high transphobia representing 4 groups: 31% low trauma/low transphobia, 16% low trauma/high transphobia, 37% high trauma/low transphobia, and 16% high trauma/high transphobia. Regressions examined associations between group membership and depression and suicidality.Results/Discussion: Relative to the low trauma/low transphobia group, transgender adolescents in high trauma groups were more likely to consider (ORs=2.8 & 2.4) or plan (ORs=2.9 & 3.4) suicide (ps<.001), and those in all other groups were more likely to report depression (ORs=1.3-2.8, ps<.001). The highest odds for depression and suicidality were found in the high trauma/high transphobia group. Results suggest that structural transphobia confers additional risk for trauma-exposed transgender adolescents, who may benefit from multilevel interventions addressing both interpersonal and structural stigma.