Latent Constructs of Economic Marginality Associated with Sexual Behavior, Healthcare Access and HIV Outcomes Among Transgender and Nonbinary People in Three U.S. Cities.

Transgender and nonbinary people (TNB) in the U.S. experience high HIV prevalence and diverse economic hardships. Yet a comprehensive understanding of how multiple, simultaneously occurring hardships-termed economic marginality-are together associated with healthcare and HIV outcomes is needed. Leveraging survey data from a sample of 330 TNB people in three U.S. cities, we conducted an exploratory mixed-source principal component analysis of latent factors of economic experience, then estimated their associations with sexual behavior, access to healthcare, HIV status, and HIV testing frequency. Two factors emerged: a traditional socioeconomic factor related to income, education, and employment (SES), and one related to housing precarity and (lack of) assets (Precarity). Higher Precarity scores were associated with sexual behavior, cost-based healthcare avoidance, discrimination-based healthcare avoidance, and more frequent HIV testing. Findings highlight the importance of understanding profiles of economic marginalization among trans and nonbinary people and can inform efforts to address upstream, structural factors shaping healthcare access and HIV outcomes in this key population.

Past Experiences and Anticipated Futures in the Lives of Transgender and Nonbinary People.

Transgender and nonbinary people's life experiences are highly heterogenous and shaped by broader structural and cultural forces. We analyze experiences identified on lifeline interviews from 87 transgender and nonbinary adults in Atlanta, New York City, and San Francisco. We find that the type, timing, and relative importance of these experiences varied across categories. For example, experiences related to "Rejection and violence" were more often identified in childhood and in the past, whereas experiences related to "Gender-affirming medical interventions" were more often in adulthood and anticipated futures. Experiences related to "Community involvement," "Extracurriculars," "Gender exploration and revelation," and "Gender-affirming medical interventions" were labeled by respondents as relatively more important compared to other experiences, whereas experiences related to "Family of origin relationships," "Place of residence," "Rejection and violence," and "Sexuality" less important. These experiences were patterned according to the respondents' gender, birth cohort, race/ethnicity, and geographic location. In analyzing these lifeline data, we advance theoretical understandings of the salience of a variety of key experiences for transgender and nonbinary people at different points in the life course. Our life course approach provides empirical analyses of intra-individual processes over time for transgender and nonbinary people and provides insight into the usefulness of a lifeline method for life course studies more generally as it draws attention to within-person assessments of the distribution and importance of events over the course of a lifetime.

Prospective relationships between stigma, mental health, and resilience in a multi-city cohort of transgender and nonbinary individuals in the United States, 2016-2019.

PURPOSE: Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals. METHODS: Between 2016 and 2017, we enrolled 330 TGNB individuals in three metropolitan areas in the U.S. in a prospective cohort study focused on gender identity development, risk, and resilience across the lifespan. Using multilevel regression, we examined prospective associations between enacted gender-based stigma and psychological distress (measured by the Global Severity Index/BSI-18), and examined transgender pride and social support as moderators, adjusting for age, sex assigned at birth, race/ethnicity, education, and income. RESULTS: Our sample was diverse in age (M = 34.4, range 16-87) and race/ethnicity (56.4% non-White). Over 2 years of follow-up, there was a decrease in reported gender-based stigma (b = - 0.61, p < 0.001) and transgender pride (b = - 0.14, p = 0.003), increase in social support (b = 0.21, p < 0.001), and no change in psychological distress. In adjusted analyses, gender-based stigma was positively associated with psychological distress (b = 1.10, p < 0.001) and social support was negatively associated with psychological distress (b = - 2.60, p < 0.001). Transgender pride moderated the relationship between stigma and psychological distress (p < 0.01), such that the association was stronger for lower levels of transgender pride. CONCLUSIONS: Our study provides longitudinal evidence for the deleterious role of gender-based stigma among TGNB individuals. Future interventions should consider fostering transgender pride and social support to promote mental health and mitigate negative effects of gender-based stigma.

Differences in physical activity and perceived benefits and barriers to physical activity between LGBTQ + and non-LGBTQ + college students.

ObjectiveTo compare physical activity (PA) behaviors and perceived benefits and barriers among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) and non-LGBTQ + college students. Participants: Participants were 406 college students. Methods: Surveys assessed PA behaviors and perceptions of PA among college students. Multivariate ANOVA assessed differences in PA behaviors and perceptions of PA. Results: LGBTQ + students (n = 71) engaged in 17% less aerobic PA and 42% less resistance training than their counterparts (n = 335; both p < .05). LGBTQ + students reported 6.5% lower total Exercise Benefits and Barriers Scale scores and 13.3% higher Barriers Scale scores (both p < .05). Conclusions: LGBTQ + college students are at higher risk of not meeting PA guidelines than non-LGBTQ + students. More perceived barriers and fewer perceived benefits to PA may contribute to this disparity. Identification of LGBTQ+-specific barriers to PA among college students is needed to inform programming to increase PA among this at-risk community.

The Discrimination Experiences and Coping Responses of Non-binary and Trans People.

Trans and non-binary (TNB) people face mental health disparities, likely due to discrimination. This study aims to explore the types of discrimination that TNB people report and the corresponding coping strategies. A sample of 85 TNB adults between the ages of 18 and 46 years old completed two surveys a day for 30 days reporting discrimination, coping, and emotional state. The types of discriminatory events were grouped into four categories: rejection, active transphobia, microaggressions, and community-level transphobia. A total of 3240 discriminatory events were reported, with the most frequent types reported being misgendering and other microaggressions. Results from linear regressions found individuals who experienced rejection were less likely to use support-based coping strategies, while individuals who experienced multiple events were more likely to report marijuana use. These findings should encourage researchers and practitioners to pay attention to discrimination when intervening on mental health with people who identify as TNB.

Narratives of Generativity and Resilience among LGBT Older Adults: Leaving Positive Legacies despite Social Stigma and Collective Trauma.

The aim of many adults in middle to old age is to be generative. Generativity is the concern older adults direct toward the wellbeing of future generations. Being generative results in positive well-being during later life and is especially important to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults who have experienced lifelong discrimination. In this study, we identified stigmatizing social influences that both negatively and positively acted to inform understandings of generativity and the ability to leave a legacy for future generations. Using a narrative analysis methodology, we identified three overarching redemptive narratives from study participants: (1) experiences during the HIV/AIDS pandemic, (2) absence of positive role models, and (3) religious conviction. These life story narratives inform how generative contributions can contribute toward a legacy of resilience, despite social stigma and collective trauma.

Sociopolitical change and transgender people's perceptions of vulnerability and resilience.

BACKGROUND: Transgender and gender nonconforming (TGNC) people have gained visibility in public discourse leading to greater awareness, understanding, and social change. However, progress made in policies to combat stigma and improve public accommodation and healthcare for this minority population have been targeted for reversal, particularly since the 2016 presidential election. This study investigated the impact of changes in sociopolitical climate on perceptions of vulnerability and resilience among participants of a longitudinal study of transgender identity development. METHODS: We randomly selected 19 TGNC participants in New York, San Francisco, and Atlanta, and conducted in-depth interviews about their perceptions of societal progress and setbacks, community engagement, and desired future change. Participants ranged in age from 18 to 68; half (47.4%) identified their gender identity along the feminine spectrum (male assigned at birth) and the other half (52.6%) along the masculine spectrum (female assigned at birth). RESULTS: Content analysis revealed that greater media visibility was perceived as both positive (improved awareness of needs) and negative (increased vulnerability to stigma). Setbacks included concerns about personal safety, the safety of others (particularly those with multiple stigmatized identities), healthcare access, and policies regarding public accommodation and nondiscrimination protections. Coping strategies included social support, activism and resistance, and an enduring sense of optimism about the future. CONCLUSION: TGNC Americans, in spite of a long history of adversity, are resilient. Participants demonstrated unwavering motivation to create a better future for themselves, other minorities, and society. Research is needed to quantify the impact of policy changes on health and wellbeing, and identify moderators of resilience amenable to intervention.

Stigmatization, Resilience, and Mental Health Among a Diverse Community Sample of Transgender and Gender Nonbinary Individuals in the U.S.

Transgender and gender nonbinary (TGNB) individuals were recently designated a health disparity population by the U.S. National Institutes of Health. We examined the effect of gender-related discrimination and resilience factors on the mental health of a community sample diverse in gender identity, age, and race/ethnicity. We report on the baseline data of a longitudinal study of transgender identity development across the lifespan with 330 TGNB individuals recruited through venue-based recruitment in three major metropolitan areas in the U.S. Mean age of participants was 34.4 years (SD = 13.7). Structured interviews collected self-report data on sociodemographics, gender-related discrimination, mental health, and resilience. We used hierarchical regression to examine the association between gender-related discrimination and psychological distress (BSI-18) and tested the moderating effect of family support, transgender community connectedness, gender literacy, and transgender activism on this relationship. In adjusted analyses, gender-related discrimination was positively associated with psychological distress. Family support was negatively associated with psychological distress. Contrary to our expectations, gender literacy and transgender activism were positively associated with psychological distress, while no significant relationship was found for transgender community connectedness. Family support, transgender community connectedness, gender literacy, and transgender activism did not moderate the effect of gender-related discrimination on psychological distress. Future mental health interventions should consider leveraging family support among TGNB individuals. Longitudinal studies are needed to better understand the role of gender literacy and activism with respect to mental health and development of identity and resilience among TGNB people.

Black Lives Matter: A Call to Action for Counseling Psychology Leaders.

Police brutality and widespread systemic racism represent historical and current sources of trauma in Black communities. Both the Black Lives Matter movement and counseling psychology propose to confront these realities at multiple levels. Black Lives Matter seeks to increase awareness about systemic racism and promote resilience among Black people. Counseling psychology states values of multiculturalism, social justice, and advocacy. Executive leadership in counseling psychology may seek to promote racial justice, yet struggle with how to participate in Black Lives Matter movements and address racial discrimination within larger systems spontaneously and consistently. However, counseling psychology trainees and professionals are actively involved in the Black Lives Matter movement, leading the way forward. Through the framework of spontaneity in social movements, this manuscript highlights what counseling psychologists are currently contributing to Black Lives Matter and makes recommendations that build on the opportunity counseling psychologists have for further involvement in the movement.

Finding a Trans-Affirmative Provider: Challenges Faced by Trans and Gender Diverse Psychologists and Psychology Trainees.

This article explores some of the challenges faced by trans and gender diverse (TGD) individuals who not only are attempting to access trans-affirmative care, but who are also members of the very profession from which they are seeking services. The authors explore challenges related to finding supervision, accessing care for assessment services, and finding a provider for personal counseling. With each example, the authors unpack the challenges and also address the implications for training for all involved. Based on these challenges that TGD psychologists and trainees face in attempting to access care, the authors provide recommendations related to trans-affirmative training for psychologists.

Social Justice and Advocacy for Transgender and Gender-Diverse Clients.

This article explores the role of mental health providers and advocacy for transgender people. It begins with a history of the mental health provider's relationship with transgender and gender-diverse people. The article explores the ways that major mental health professional organizations have called for providers to serve in advocacy roles. The article ends with recommendations about how to serve in an advocacy role.

Treatment of Trauma and Nonsuicidal Self-Injury in Transgender Adults.

This article explores the presence of trauma and nonsuicidal self-injury (NSI) in transgender people. We explore the prevalence of trauma and NSI in transgender people, the ways in which these clinical concerns manifest across the lifespan, and special considerations for assessment and treatment. The article concludes by describing the importance of developing a strong rapport with clients and the concept of reasonably well-controlled cooccurring mental health concerns.

Moving from affirmation to liberation in psychological practice with transgender and gender nonconforming clients.

While affirmative approaches with transgender and gender nonconforming (TGNC) clients are gaining momentum within psychological practice (American Counseling Association, 2010; American Psychological Association, 2015), there is a simultaneous and pressing need to move beyond TGNC-affirmative to TGNC-liberatory approaches to more fully address how societal gender binaries influence both psychologist and client. Psychologists may use the lens of liberation psychology (Martín-Baró, 1996) to transform the ways they work with TGNC clients. Using this perspective, psychologists can reflect on their own gender journey and experiences, identify how cisgender privilege influences counseling and psychological practice, and advocate for TGNC people to be better served in the settings in which they work. Psychologists are then able to engage in social change on behalf of, and in collaboration with, TGNC people in ways that simultaneously liberate psychologists from their own gender oppression experiences. (PsycINFO Database Record

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults.

Despite the growing visibility and acceptance of transgender and gender nonconforming (TGNC) individuals, TGNC older adults experience many barriers in accessing competent and affirming health and social services due to anti-TGNC prejudice, discrimination, and lack of competent healthcare training on the part of healthcare workers. Clinical gerontologists and geriatricians will likely encounter TGNC adults in their practice given population aging and greater numbers of TGNC people who are living in their affirmed gender identities. The American Psychological Association recently published its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which document the unique needs of TGNC individuals and outlines approaches for competent and affirming service provision (APA, 2015). We interpret these Guidelines using a gerontological lens to elucidate specific issues faced by the TGNC older adult along with the practice and policy implications for this population.

"It's complicated": collective memories of transgender, queer, and questioning youth in high school.

Using the qualitative participatory action methodology, collective memory work, this study explored how transgender, queer, and questioning (TQQ) youth make meaning of their sexual orientation and gender identity through high school experiences. Researchers identified three major conceptual but overlapping themes from the data generated in the transgender, queer, and questioning youth focus group: a need for resilience, you should be able to be safe, and this is what action looks like! The researchers discuss how as a research product, a documentary can effectively "capture voices" of participants, making research accessible and attractive to parents, practitioners, policy makers, and participants.

Development and validation of the Internalized Racial Oppression Scale for Black individuals.

This article describes the development and validation of the Internalized Racial Oppression Scale (IROS) for Black individuals in 2 studies using a total sample of 468 Black college students. The IROS is intended to measure the degree to which racial oppression is internalized and replicated by Black individuals in the United States. An exploratory factor analysis suggested a five-factor solution: Belief in the Biased Representation of History (BRH), Devaluation of the African Worldview and Motifs (DAW), Alteration of Physical Appearance (APA), Internalization of Negative Stereotypes (INS), and Hair Change (HC). Confirmatory factory analysis supported an adequate model fit of a four-factor model: BRH, APA, INS, and HC. All factors of the IROS were positively correlated with the Pre-Encounter subscale of the Racial Identity Attitude Scale (RIAS-B; J. E. Helms & T. A. Parham, 1996), and 4 of the factors were negatively correlated with the Immersion/Emersion subscale of the RIAS-B. Four factors of the IROS were negatively correlated with all subscales and total scores of the African Self-Consciousness Scale (J. A. Baldwin & Y. R. Bell, 1985). These results provide some support of the validity of the IROS.

South asian immigrant women who have survived child sexual abuse: resilience and healing.

The current study is a phenomenological examination of the resilience strategies of South Asian immigrant women in the United States who survived child sexual abuse. Semistructured interviews (N = 5) and a focus group (N = 8) were analyzed to gain a deep structural understanding of participants' experiences of child sexual abuse and resilience. Findings included four subthemes of South Asian context (strict gender socialization, maintenance of family image, influence of ethnic identity, acculturative stressors) and five subthemes of resilience strategies (use of silence, sense of hope, South Asian social support, social advocacy, intentional self-care). Research and practice implications are discussed.