Skip to main content
SpringerLink
Log in

The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Significant health disparities exist for transgender female (trans*female) youth. We assessed differences in mental health outcomes based on exposure to discrimination among transgender female youth in the San Francisco Bay Area aged 16–24 years. Youth were recruited using a combination of respondent driven sampling with online and social media methods. Logistic regression models were used to estimate odds ratios for the mental health outcomes, comparing levels of discrimination and levels of resiliency promoting protective factors among sexually active youth in the sample (N = 216). High transgender-based discrimination was significantly associated with greater odds of PTSD (AOR, 2.6; 95 % CI 1.4–5.0), depression (AOR, 2.6; 95 % CI 1.2–5.9), and stress related to suicidal thoughts (AOR 7.7, 95 % CI 2.3–35.2). High racial discrimination was significantly associated with greater odds of psychological stress (AOR 3.6; 95 % CI 1.2–10.8), PTSD (AOR 2.1; 95 % CI 1.1–4.2) and stress related to suicidal thoughts (AOR 4.3, 95 % CI 1.5–13.3). Parental closeness was related to significantly lower odds of all four mental health outcomes measured, and intrinsic resiliency positively reduced risk for psychological stress, PTSD, and stress related to suicidal thoughts. Transgender and racial discrimination may have deleterious effects on the mental health of trans*female youth. Interventions that address individual and intersectional discrimination and build resources for resiliency and parental closeness may have success in preventing mental health disorders in this underserved population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Brennan J, Kuhns LM, Johnson AK, et al. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Garofalo R, Deleon J, Osmer E, Doll M, Harper GW. Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. J Adoles Health Off Publ Soc Adoles Med. 2006;38(3):230–6.

    Article  Google Scholar 

  3. Reisner SL, Vetters R, Leclerc M, et al. Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adoles Health Off Publ Soc Adoles Med. 2015;56(3):274–9.

    Article  Google Scholar 

  4. Hill DB, Willoughby BLB. The development and validation of the Genderism and Transphobia Scale. Sex Roles. 2005;53:531–44.

    Article  Google Scholar 

  5. Grant JM, Mottet LA, Tanis J, Herman JL, Harrison J, Keisling M. National Transgender Discrimination Survey Report on health and health care. National Center for Transgender Equality; 2010.

  6. Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health. 2013;103(10):1820–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bockting W. The inmpact of stigma on transgender identity development and mental health. In: Kreukels BPC, Steesma TD, Vries ALCd, editors. Gender dysphoria and disorders of sex development. New York: Springer; 2014. p. 319–30.

  8. Xavier J, Honnold JA, Bradford J. The Health, health-related needs, and lifecourse experiences of transgender Virginians. Virginia Commonwealth University; 2007.

  9. Sugano E, Nemoto T, Operario D. The impact of exposure to transphobia on HIV risk behavior in a sample of transgendered women of color in San Francisco. AIDS Behav. 2006;10(2):217–25.

    Article  PubMed  Google Scholar 

  10. Wilson EC, Garofalo R, Harris RD, et al. Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS Behav. 2009;13:902–13.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lombardi EL, Wilchins RA, Priesing D, Malouf D. Gender violence: transgender experiences with violence and discrimination. J Homosex. 2001;42(1):89–101.

    Article  CAS  PubMed  Google Scholar 

  12. Ainsworth TA, Spiegel JH. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Qual Life Res Int J Qual Life Aspects Treat Care Rehabil. 2010;19(7):1019–24.

    Article  Google Scholar 

  13. Blosnich JR, Gordon AJ, Fine MJ. Associations of sexual and gender minority status with health indicators, health risk factors, and social stressors in a national sample of young adults with military experience. Ann Epidemiol. 2015;25(9):661–7.

    Article  PubMed  Google Scholar 

  14. Keuroghlian AS, Reisner SL, White JM, Weiss RD. Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend. 2015;152:139–46.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rowe C, Santos GM, McFarland W, Wilson EC. Prevalence and correlates of substance use among trans*female youth ages 16–24 years in the San Francisco Bay Area. Drug Alcohol Depend. 2014.

  16. Ertel KA, James-Todd T, Kleinman K, et al. Racial discrimination, response to unfair treatment, and depressive symptoms among pregnant black and African American women in the United States. Ann Epidemiol. 2012;22(12):840–6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Krieger N, Kosheleva A, Waterman PD, Chen JT, Koenen K. Racial discrimination, psychological distress, and self-rated health among US-born and foreign-born Black Americans. Am J Public Health. 2011;101(9):1704–13.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Berger M, Sarnyai Z. “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination. Stress. 2015;18(1):1–10.

    Article  PubMed  Google Scholar 

  19. Meyer IH, Schwartz S, Frost DM. Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources? Soc Sci Med. 2008;67(3):368–79.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Needham BL, Austin EL. Sexual orientation, parental support, and health during the transition to young adulthood. J Youth Adolesc. 2010;39(10):1189–98.

    Article  PubMed  Google Scholar 

  21. Wilson EC, Iverson E, Belzer M, the Adolescent Meicine Trials Network for HIV/AIDS Interventions. Parental support and condom use among transgender female youth. 2010.

  22. Rutter M. Psychosocial resilience and protective mechanisms. In: Cichheti D, Nuechterlien K, Weintraub S, editors. Risk and protective factors in the development of psychopathology. New York, NY: Cambridge University Press; 1991. p. 331–74.

    Google Scholar 

  23. Rotondi NK, Bauer GR, Scanlon K, Kaay M, Travers R, Travers A. Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. Am J Public Health. 2013;103(10):1830–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gorin-Lazard A, Baumstarck K, Boyer L, et al. Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study. J Sexual Med. 2012;9(2):531–41.

    Article  Google Scholar 

  25. Robinson JP, Espelage DL. Peer victimization and sexual risk differences between lesbian, gay, bisexual, transgender, or questioning and nontransgender heterosexual youths in grades 7–12. Am J Public Health. 2013;103(10):1810–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sausa LA, Keatley J, Operario D. Perceived risks and benefits of sex work among transgender women of color in San Francisco. Arch Sex Behav. 2007;36(6):768–77.

    Article  PubMed  Google Scholar 

  27. Truong HM, Grasso M, Chen YH, et al. Balancing theory and practice in respondent-driven sampling: a case study of innovations developed to overcome recruitment challenges. PLoS ONE. 2013;8(8):e70344.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Arayasirikul S, Chen YH, Jin H, Wilson E. A Web 2.0 and Epidemiology Mash-Up: Using Respondent-Driven Sampling in Combination with Social Network Site Recruitment to Reach Young Transwomen. AIDS Behav. 2015; 26.

  29. Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61(7):1576–96.

    Article  PubMed  Google Scholar 

  30. Derogatis LR. BSI-18: administration, scoring and procedures manual. Minneapolis, MN: National Computer Systems; 2000.

    Google Scholar 

  31. Mustanski B, Newcomb M, Garofalo R. Mental health of lesbian, gay, and bisexual youth: a developmental resiliency perspective. J Gay Lesbian Soc Serv. 2011;23(2):204–25.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Asner-Self KK, Schreiber JB, Marotta SA. A cross-cultural analysis of the Brief Symptom Inventory-18. Cult Diver Ethnic Minor Psychol. 2006;12(2):367–75.

    Article  Google Scholar 

  33. Radloff L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  34. Boscarino JA, Kirchner HL, Hoffman SN, Sartorius J, Adams RE, Figley CR. A brief screening tool for assessing psychological trauma in clinical practice: development and validation of the New York PTSD Risk Score. Gen Hosp Psychiatry. 2011;33(5):489–500.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82.

    Article  PubMed  Google Scholar 

  36. Wilson EC, Garofalo R, Harris RD, et al. Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS Behav. 2009;13(5):902–13.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the multidimensional scale of perceived social support. J Person Assess. 1990;55(3–4):610–7.

    Article  CAS  Google Scholar 

  38. Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Family acceptance in adolescence and the health of LGBT young adults. J Child Adoles Psychiatr Nurs Off Publ Assoc Child Adoles Psychiatr Nurs 2010;23(4):205–13.

  39. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex. 2006;51(3):53–69.

    Article  PubMed  Google Scholar 

  40. Testa RJ, Sciacca LM, Wang F, et al. Effects of violence on transgender people. Prof Psychol Res Pract. 2012;43(5):452–9.

    Article  Google Scholar 

  41. Nuttbrock L, Bockting W, Rosenblum A, et al. Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study. Am J Public Health. 2013;103(2):300–7.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hoffman B. An overview of depression among transgender women. Depress Res Treat. 2014;2014:394283.

    PubMed  PubMed Central  Google Scholar 

  43. Cochran SD, Mays VM, Alegria M, Ortega AN, Takeuchi D. Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults. J Consult Clin Psychol. 2007;75(5):785–94.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Rosario M, Hunter J, Maguen S, Gwadz M, Smith R. The coming-out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths: stipulation and exploration of a model. Am J Commun Psychol. 2001;29(1):133–60.

    Article  CAS  Google Scholar 

  45. Poteat VP, Scheer JR, Mereish EH. Role of gender in educational contexts and outcomes. In: Liben LB, Bigler RS, editors Advances in child development and behavior, Vol 47. San Diego, CA: Elsevier Academic Press; 2014. p. 261–300.

Download references

Acknowledgments

The grant was completed with funding from the National Institutes of Mental Health, Grant # R01MH095598. Most importantly, we want to acknowledge and thank the trans*female youth community in the San Francisco Bay Area who contributed their time and expertise to provide a better understanding of factors affecting their health.

Author information

Authors and Affiliations

  1. Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA

    Erin C. Wilson, Yea-Hung Chen, Sean Arayasirikul, H. Fisher Raymond & Willi McFarland

Authors
  1. Erin C. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yea-Hung Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean Arayasirikul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Fisher Raymond
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Willi McFarland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erin C. Wilson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wilson, E.C., Chen, YH., Arayasirikul, S. et al. The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support. AIDS Behav 20, 2203–2211 (2016). https://doi.org/10.1007/s10461-016-1409-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-016-1409-7

Keywords

Search

Navigation