Minority Stress and Posttraumatic Growth in the TGNC Community

Psychology of Sexual Orientation and Gender Diversity | 2024, Vol. 11, No. 3, p. 488-497

Minority Stress and Posttraumatic Growth in the Transgender and Nonbinary Community

Allison K. Jones; Department of Psychological Science, University of Mary Washington 

Christine L. Wehner; Department of Psychological Science, University of Mary Washington

Irene M. Andrade; Department of Psychological Science, University of Mary Washington

Elizabeth M. Jones; Department of Psychological Science, University of Mary Washington

Liz H. Wooten; Department of Psychological Science, University of Mary Washington

Laura C. Wilson; Department of Psychological Science, University of Mary Washington

The present study tested the gender minority stress and resilience model in a transgender and nonbinary sample. The outcome of interest was posttraumatic growth (PTG). A total of 292 people who identified as transgender and/or nonbinary completed an online survey, including measures of distal stressors, proximal stressors, resilience factors, and PTG. The present study supported two primary results: (a) there were indirect associations between distal stressors and PTG via internalized transphobia and negative expectations about the future, but not nondisclosure of identity, and (b) resilience factors were related to PTG independent of distal and proximal stressors. Although the results were consistent with components of the gender minority stress and resilience model, some aspects of the model were not supported, particularly the hypothesized roles of nondisclosure of identity and resilience. Thus, further research is needed to investigate and articulate the complex relationships between distal stress, proximal stress, resilience, and growth-based outcomes.

Gender minority; minority stress; resilience, gender identity; post-traumatic growth

"The transgender and nonbinary (TNB) community has historically faced marginalization through disproportionately high rates of unequal treatment, harassment, discrimination, and violence. Specifically, the U.S. Transgender Survey found that approximately half of TNB participants reported verbal harassment, sexual assault, and/or intimate partner violence… To inform the field’s understanding of how gender-related discrimination and violence may impact mental health, the minority stress model was adapted to reflect the unique experiences of the TNB community through the development of the gender minority stress and resilience (GMSR) model… The goal of the present study was to test the gender-specific minority stress model in relation to PTG in order to better understand the mechanisms by which and conditions under which the TNB community experiences growth-based outcomes in relation to distal stressors” (p. 488 - 490).

“A total of 293 participants completed the online survey, but one person was removed from the data because they requested to have their data deleted… Participants were recruited through the online paid data collection platform Prolific… These data were collected as part of a larger survey on mental health within the TNB community. Participants completed the Posttraumatic Growth Inventory-Short prior to completing the Gender Minority Stress and Resilience Measure” (p. 491). 

“Consistent with the GMSR model, we found support for the importance of considering external stressors, internal processes, and resilience factors in understanding the mental health of the TNB community” (p. 492).

In the present study, we partially supported our first hypothesis by demonstrating simple indirect associations between distal. In the present study, we partially supported our first hypothesis by demonstrating simple indirect associations between distal… When examining simple mediation, the present study did not demonstrate an indirect association via nondisclosure of identity. Specifically, distal stress was significantly, positively associated with nondisclosure of identity; however, nondisclosure was not associated with PTG in the simple mediation model” (p. 494). 

“When testing the full GMSR model, we found that pride and community connectedness did not moderate the indirect association nor the direct association. This means that the impact of distal stressors and proximal stressors on PTG was not conditional on levels of resiliency and highlights the deleterious and harmful impact of discrimination, violence, and rejection within the TNB community. Overall, the findings did not support our second hypothesis and did not support that aspect of the GMSR model. These results are consistent with several prior studies that also failed to find support for resiliency as a moderator” (p. 494). 

“Given that distal stressors contribute to the hostile sociocultural context in which TNB individuals exist, interventions at the systemic level are essential to effectively combat minority stress. First, many clients who identify as TNB experience discrimination, bias, and nonaffirmation while seeking mental health services. Therefore, the work to promote positive psychological change in the TNB community begins with mental health professionals providing more affirming and validating care. To do so, we recommend that clinicians seek appropriate training, supervision, and consultation to ensure they are engaging in competent and informed practice with this community. Clinicians are also encouraged to read and follow best practices for working with the TNB community, such as the guidelines offered by the American Psychological Association (2015) and the Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (2009). Second, we are all responsible for taking steps to ensure that the institutions and organizations we associate with engage in TNB-inclusive practices. This includes places of employment but also extends to other formal (e.g., professional organizations) and informal (e.g., church) groups we may be affiliated with. Examples of inclusive policies and practices include the creation of and funding of affinity groups, writing or revising nondiscrimination statements to include gender identity and expression, ensuring adequate access to gender-inclusive restrooms, and affirming the use of pronouns and names. One particularly relevant example is that mental health professionals should be advocating to make the language and content of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) more affirming and inclusive of the TNB community. Last, in terms of building resiliency, the concept of community resilience or minority coping is relevant because it captures how both tangible (e.g., access to resource centers) and intangible (e.g., reframing of negative societal messaging) resources may contribute to an individual’s ability to cope with stress. Historically, sexual minority spaces have excluded individuals who identify as TNB, particularly TNB individuals of color. Given that TNB individuals rarely have access to TNB-specific resources and spaces, a vital pathway to community resilience is through the broader LGBTQþ community, which has substantial work to do in order to be more inclusive and affirming. 

Because the present study found that greater resilience was associated with greater PTG outside of the impact of distal and proximal stressors, positive psychology approaches geared toward resilience may be appropriate when working with the TNB community. Examples of interventions include those that enhance hope and self-compassion. Again, clinicians should receive adequate training prior to engaging in these interventions, with particular emphasis on the impact of minority stressors on mental health. Another option is self-guided workbooks, including The Gender Quest Workbook: A Guide for Teens and Young Adults Exploring Gender Identity and The Queer and Transgender Resilience Workbook: Skills for Navigating Sexual Orientation and Gender Expression. These resources may feel safer for TNB individuals who are concealing their gender identity or have had negative experiences with the mental health field. In sum, competent practice should be guided by minority stress theory to develop a more informed treatment plan that is reflective of the client’s lived experiences” (p. 495).

“Although the present study contributed to a gap in the literature, the findings should be interpreted within the context of several limitations. First, the methodology of this study was cross-sectional, and therefore we cannot make any conclusions regarding causation. Second, we did not consider the potential influence of other aspects of identity, such as sexual orientation, race, or ethnicity. Additionally, our sample predominantly identified as nonbinary and White or Caucasian. We also did not assess for other potentially relevant aspects of identity or lived experiences, such as socioeconomic status or ability. This is problematic because prior research has suggested that experiences with distal and proximal stressors, as well as levels of PTG, may differ as a function of multiple aspects of identity (e.g., race) or lived experiences (e.g., socioeconomic status). Third, we recruited our sample through Prolific, required that participants be at least 18 years old and be a resident of the United States, and disclosed in the informed consent that the survey would ask about identity, discrimination, sexual assault, and mental and physical health. Therefore, our findings may not generalize to participants outside of these demographics, people who do not participate in research on Prolific, or individuals who did not feel comfortable with the content of our survey. Furthermore, it is possible that the gender identity inclusion criteria we used may have missed eligible TNB participants if they did not select trans man, trans woman, genderqueer, and/or gender nonconforming from the screening options. Fourth, we did not use attention checks in our survey, and therefore there was no mechanism in place to identify random responding. Finally, in the present study, we included the distal stressor factor in the analyses rather than the specific distal stressor subscales. Future research should be conducted to further confirm the psychometric properties of the Gender Minority Stress and Resilience Measure, as well as consider the reliability and validity of using the broader factors in research in lieu of using the subscales” (p. 494 - 495).