Psychological Distress and Suicidality Among Transgender Young Adults in the United States

Yu-Chi Wang; Tabor Hoatson; Catherine Stamoulis; Jody Herman; Sari L Reisner; Ilan H Meyer; Sabra L Katz-Wise

doi:10.1016/j.jadohealth.2023.11.004

Psychological Distress and Suicidality Among Transgender Young Adults in the United States

J Adolesc Health. 2024 Feb 4:S1054-139X(23)00585-2. doi: 10.1016/j.jadohealth.2023.11.004. Online ahead of print.

Authors

Yu-Chi Wang¹, Tabor Hoatson², Catherine Stamoulis³, Jody Herman⁴, Sari L Reisner⁵, Ilan H Meyer⁴, Sabra L Katz-Wise⁶

Affiliations

¹ Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Research and Best Practices, GLSEN, New York, New York. Electronic address: ycwang.phd@gmail.com.
² Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts.
³ Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
⁴ The Williams Institute, UCLA School of Law, Los Angeles, California.
⁵ Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.
⁶ Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.

PMID: 38310507
DOI: 10.1016/j.jadohealth.2023.11.004

Abstract

Purpose: Transgender young adults (TYA) are burdened by adverse mental health outcomes. Guided by intersectionality and minority stress frameworks, we compared prevalence of psychological distress and suicidality among TYA of different social identities to inform future interventions.

Methods: In this secondary data analysis of 12,738 TYA, ages 18-25 years, from the 2015 United States Transgender Survey, we developed multivariable regression models examining associations between social identities and psychological distress and suicidality, adjusting for relevant covariates. Self-reported identities were used as proxies for minority stress resulting from structural oppressions related to gender binarism, transmisogyny, heterosexism, and racism.

Results: Overall, 53% met criteria for serious psychological distress, and 66% reported suicidal ideation. Statistically higher odds of serious psychological distress and suicidal ideation and plan were found for TYA assigned male compared to assigned female at birth (adjusted odds ratios [aORs] = 1.14-1.50). Nonbinary TYA assigned male at birth also had lower odds of all outcomes compared to all other TYA (aORs = 0.6-0.7). Compared to White TYA, Latiné/x TYA were more likely to experience serious psychological distress (aOR = 1.19, 95% confidence interval: 1.02, 1.39) and multiracial TYA were more likely to report suicide plan(s) and attempt(s) (aORs = 1.25-1.30). Finally, compared to heterosexual TYA, bisexual/pansexual TYA were more likely to report suicide plan(s) (aOR = 1.28, 95% confidence intervals: 1.04, 1.52), and all sexual minority TYA were more likely to report serious psychological distress and suicidal ideation (aORs = 1.31-2.00).

Discussion: Results highlight complex associations between intersectional minority stress and mental health outcomes among TYA. Associations between identities and mental health morbidity highlight an urgent need for targeted mental health interventions.

Keywords: Intersectionality; Mental health; Minority stress; Nonbinary; Psychological distress; Suicidality; Transgender.