nach oben

07.05.2024

Legal Gender Affirmation, Psychological Distress, and Physical Health Issues: Indirect Effects via Enacted Stigma

verfasst von: Jae A. Puckett, Sarah Price, Terra Dunn, Kelsi Kuehn, Devon Kimball, Debra A. Hope, Richard Mocarski, Robert-Paul Juster, L. Zachary DuBois

Erschienen in: Sexuality Research and Social Policy

Einloggen

Aktivieren Sie unsere intelligente Suche, um passende Fachinhalte oder Patente zu finden.

search-config

KI-gestützte Suche

Aus

Abstract

Introduction

One way that transgender and gender diverse (TGD) people may affirm their gender is through a legal name and/or gender marker change. Legal gender affirmation is associated with less psychological distress, but research has yet to expand upon the mechanisms that may help explain this association. We examined associations between legal gender affirmation, psychological distress, and physical health in TGD people, as well as the mediating effect of exposure to enacted stigma.

Methods

Data are from the baseline portion of a longitudinal mixed-methods study of how sociopolitical contexts influence marginalization, health, and resilience for TGD people. The study included 158 TGD participants from Oregon, Michigan, Nebraska, and Tennessee. Baseline data were collected September 2019–March 2020 (the overall study concluded Fall 2021).

Results

Latent variable structural equation model analyses revealed that participants who had legally affirmed their gender reported less enacted stigma, which was associated with less psychological distress and physical health issues. There was a significant indirect effect via enacted stigma, such that this variable may partially help explain why legal gender affirmation is associated with better health outcomes.

Conclusions

Legal gender affirmation is likely to influence TGD people’s health and well-being by shaping exposure to minority stress—specifically, enacted stigma. Our findings demonstrate the importance of sociopolitical factors in health outcomes for TGD people.

Policy Implications

Given the health benefits of legal gender affirmation and the potential protection from enacted stigma, policies should be revised to make legal name and/or gender marker changes more accessible for TGD people.

Sie haben noch keine Lizenz? Dann Informieren Sie sich jetzt über unsere Produkte:

Springer Professional "Wirtschaft+Technik"

Online-Abonnement

Mit Springer Professional "Wirtschaft+Technik" erhalten Sie Zugriff auf:

über 102.000 Bücher
über 537 Zeitschriften

aus folgenden Fachgebieten:

Automobil + Motoren
Bauwesen + Immobilien
Business IT + Informatik
Elektrotechnik + Elektronik
Energie + Nachhaltigkeit
Finance + Banking
Management + Führung
Marketing + Vertrieb
Maschinenbau + Werkstoffe
Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

Jetzt informieren

Springer Professional "Wirtschaft"

Online-Abonnement

Mit Springer Professional "Wirtschaft" erhalten Sie Zugriff auf:

über 67.000 Bücher
über 340 Zeitschriften

aus folgenden Fachgebieten:

Bauwesen + Immobilien
Business IT + Informatik
Finance + Banking
Management + Führung
Marketing + Vertrieb
Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

Jetzt informieren

Brooks, V. R. (1981). Minority stress and lesbian women. Lexington Books.

Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., Cook, K., DeVellis, R., DeWalt, D., Fries, J. F., Gershon, R., Hahn, E. A., Lai, J. -S., Pilkonis, P., Revicki, D., & Hays, R. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology, 63(11), 1179–1194. https://doi.org/10.1016/j.jclinepi.2010.04.011CrossRefPubMedPubMedCentral

Currah, P. (2022). Sex is as sex does: governing transgender identity. NYU Press.

DeChants, J. P., Price, M. N., Green, A. E., Davis, C. K., & Pick, C. J. (2022). Association of updating identification documents with suicidal ideation and attempts among transgender and nonbinary youth. International Journal of Environmental Research and Public Health, 19(9), 1–9. https://doi.org/10.3390/ijerph19095016CrossRef

Dolan, I. J., Strauss, P., Winter, S., & Lin, A. (2020). Misgendering and experiences of stigma in health care settings for transgender people. Medical Journal of Australia, 212(4), 150. https://doi.org/10.5694/mja2.50497CrossRefPubMed

DuBois, L. Z. (2012). Associations between transition-specific stress experience, nocturnal decline in ambulatory blood pressure, and C-reactive protein levels among transgender men. American Journal of Human Biology, 24(1), 52–61. https://doi.org/10.1002/ajhb.22203CrossRefPubMed

DuBois, L. Z., & Juster, R.-P. (2022). Lived experience and allostatic load among transmasculine people living in the United States. Psychoneuroendocrinology, 143, 105849. https://doi.org/10.1016/j.psyneuen.2022.105849CrossRefPubMed

DuBois, L. Z., Powers, S., Everett, B. G., & Juster, R.-P. (2017). Stigma and diurnal cortisol among transitioning transgender men. Psychoneuroendocrinology, 82, 59–66. https://doi.org/10.1016/j.psyneuen.2017.05.008CrossRefPubMed

Factor, R., & Rothblum, E. (2008). Exploring gender identity and community among three groups of transgender individuals in the United States: MTFs, FTMs, and genderqueers. Health Sociology Review, 17(3), 235–253. https://doi.org/10.5172/hesr.451.17.3.235CrossRef

Garcia, J., & Crosby, R. A. (2020). Social determinants of discrimination and access to health care among transgender women in Oregon. Transgender Health, 5(4), 225–233. https://doi.org/10.1089/trgh.2019.0090CrossRefPubMedPubMedCentral

Goldenberg, T., Reisner, S., Harper, G. W., Gamarel, K. E., & Stephenson, R. (2020). State-level transgender-specific policies, race/ethnicity, and use of medical gender affirmation services among transgender and other gender-diverse people in the United States. The Milbank Quarterly, 98(3), 802–846. https://doi.org/10.1111/1468-0009.12467CrossRefPubMedPubMedCentral

Hill, B. J., Crosby, R., Bouris, A., Brown, R., Bak, T., Rosentel, K., VandeVusse, A., Silverman, M., & Salazar, L. (2018). Exploring transgender legal name change as a potential structural intervention for mitigating social determinants of health among transgender women of color. Sexuality Research and Social Policy, 15(1), 25–33. https://doi.org/10.1007/s13178-017-0289-6CrossRefPubMed

James, Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 US Transgender Survey. National Center for Transgender Equality.

Kenny, D. A. (2017, February). MedPower: An interactive tool for the estimation of power in tests of mediation [Computer software]. Available from https://davidakenny.shinyapps.io/MedPower/.

King, W. M., & Gamarel, K. E. (2021). A scoping review examining social and legal gender affirmation and health among transgender populations. Transgender Health, 6(1), 5–22. https://doi.org/10.1089/trgh.2020.0025CrossRefPubMedPubMedCentral

King, W. M., Hughto, J. M. W., & Operario, D. (2020). Transgender stigma: A critical scoping review of definitions, domains, and measures used in empirical research. Social Science & Medicine, 250, 112867. https://doi.org/10.1016/j.socscimed.2020.112867CrossRef

Knudson, G., Green, J., Tangpricha, V., Ettner, R., Bouman, W. P., Adrian, T., Allen, L., De Cuypere, G., Fraser, L., Hansen, T. M., Karasic, D., Kreukels, B. P. C., Rachlin, K., Schechter, L., Winter, S., & on behalf of the WPATH Executive Committee and Board of Directors. (2018). Identity recognition statement of the world professional association for transgender health (WPATH). International Journal of Transgenderism, 19(3), 355–356. https://doi.org/10.1080/15532739.2018.1470399CrossRef

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64(2), 258–266.CrossRefPubMed

Lacombe-Duncan, A., Jadwin-Cakmak, L., Trammell, R., Burks, C., Rivera, B., Reyes, L., Abad, J., Ward, L., Harris, H., Harper, G. W., & Gamarel, K. E. (2021). “…everybody else is more privileged. then it’s us…”: A qualitative study exploring community responses to social determinants of health inequities and intersectional exclusion among trans women of color in Detroit, Michigan. Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-021-00642-2

Loza, O., Beltran, O., Perez, A., & Green, J. (2021). Impact of name change and gender marker correction on identity documents to structural factors and harassment among transgender and gender diverse people in Texas. Sexuality, Gender & Policy, 4(2), 76–105. https://doi.org/10.1002/sgp2.12035CrossRef

Malta, M., LeGrand, S., Turban, J., Poteat, T., & Whetten, K. (2020). Gender-congruent government identification is crucial for gender affirmation. The Lancet Public Health, 5(4), e178–e179. https://doi.org/10.1016/S2468-2667(20)30054-2CrossRefPubMed

Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 16.

Puckett, J. A., Aboussouan, A. B., Ralston, A. L., Mustanski, B., & Newcomb, M. E. (2021). Systems of cissexism and the daily production of stress for transgender and gender diverse people. International Journal of Transgender Health. Advanced online publication: https://doi-org.proxy1.cl.msu.edu/. https://doi.org/10.1080/26895269.2021.1937437

Puckett, J. A., Price, S. F., Mocarski, R., Mustanski, B., & Newcomb, M. E. (2022a). Transgender and gender diverse individuals’ daily experiences of rumination. American Journal of Orthopsychiatry. Advance Online Publication: https://doi.org/10.1037/ort0000636CrossRef

Puckett, J. A., Tornello, S., Mustanski, B., & Newcomb, M. E. (2022b). Gender variations, generational effects, and mental health of transgender people in relation to timing and status of gender identity milestones. Psychology of Sexual Orientation and Gender Diversity, 9(2), 165–178. https://doi.org/10.1037/sgd0000391CrossRefPubMed

Reisner, S. L., Radix, A., & Deutsch, M. B. (2016). Integrated and gender-affirming transgender clinical care and research. Journal of Acquired Immune Deficiency Syndromes, 72, S235-242. https://doi.org/10.1097/QAI.0000000000001088CrossRefPubMed

Restar, A., Jin, H., Breslow, A., Reisner, S. L., Mimiaga, M., Cahill, S., & Hughto, J. M. W. (2020). Legal gender marker and name change is associated with lower negative emotional response to gender-based mistreatment and improve mental health outcomes among trans populations. SSM - Population Health, 11, 100595. https://doi.org/10.1016/j.ssmph.2020.100595CrossRefPubMedPubMedCentral

Scheim, A. I., Perez-Brumer, A. G., & Bauer, G. R. (2020). Gender-concordant identity documents and mental health among transgender adults in the USA: A cross-sectional study. The Lancet Public Health, 5(4), e196–e203. https://doi.org/10.1016/S2468-2667(20)30032-3CrossRefPubMedPubMedCentral

Schumacker, R. E., & Lomax, R. G. (2010). A beginner’s guide to structural equation modeling, 3rd ed. Routledge/Taylor & Francis Group.

Smart, B. D., Mann-Jackson, L., Alonzo, J., Tanner, A. E., Garcia, M., Refugio Aviles, L., & Rhodes, S. D. (2020). Transgender women of color in the U.S. South: A qualitative study of social determinants of health and healthcare perspectives. International Journal of Transgender Health, 1–24. https://doi.org/10.1080/26895269.2020.1848691

Steadman, S. (2021). “That name is dead to me”: Reforming name change laws to protect transgender and nonbinary youth. University of Michigan Journal of Law Reform, 55. https://doi.org/10.36646/mjlr.55.1.that

Tan, K. K. H., Watson, R. J., Byrne, J. L., & Veale, J. F. (2022). Barriers to possessing gender-concordant identity documents are associated with transgender and nonbinary people’s mental health in Aotearoa/New Zealand. LGBT Health. https://doi.org/10.1089/lgbt.2021.0240CrossRefPubMedPubMedCentral

Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development of the gender minority stress and resilience measure. Psychology of Sexual Orientation and Gender Diversity, 2(1), 65–77. https://doi.org/10.1037/sgd0000081CrossRef

Wentling, T. (2020). Contested citizenship: Renaming processes among people of transgender experience. Journal of Homosexuality, 67(12), 1653–1674. https://doi.org/10.1080/00918369.2019.1610634CrossRefPubMed

World Health Organization. (2015). Transgender people and HIV: Policy brief. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/179517/WHO_HIV_2015.17_eng.pdf?sequence=1&isAllowed=y

Xavier, J., Bradford, J., Hendricks, M., Safford, L., McKee, R., Martin, E., & Honnold, J. A. (2013). Transgender health care acccess in Virginia: A qualitative study. International Journal of Transgenderism, 14, 3–17. https://doi.org/10.1080/15532739.2013.689513CrossRef

Yee, K., Lind, B. K., & Downing, J. (2022). Change in gender on record and transgender adults’ mental or behavioral health. American Journal of Preventive Medicine, 62(5), 696–704. https://doi.org/10.1016/j.amepre.2021.10.016CrossRefPubMed

Titel: Legal Gender Affirmation, Psychological Distress, and Physical Health Issues: Indirect Effects via Enacted Stigma
verfasst von: Jae A. Puckett
Sarah Price
Terra Dunn
Kelsi Kuehn
Devon Kimball
Debra A. Hope
Richard Mocarski
Robert-Paul Juster
L. Zachary DuBois
Publikationsdatum: 07.05.2024
Verlag: Springer US
Erschienen in: Sexuality Research and Social Policy
Print ISSN: 1868-9884
Elektronische ISSN: 1553-6610
DOI: https://doi.org/10.1007/s13178-024-00971-y