Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis.
Athena D F Sherman, Melinda K Higgins, Monique S Balthazar and 10 others
PMID 38228564WHAT IT FOUND
Discrimination and violence were strongly linked to higher PTSD and psychological distress among 1,418 transgender women.
Housing, food, and job instability added smaller links, and those facing both had the worst symptoms.
Key findings
01Stigma, including discrimination and violence, was significantly associated with PTSD and psychological distress, while social and structural instability was associated with these outcomes to a smaller degree.
02In the in-person sample, one cluster had the strongest stigma-to-mental-health link and the highest distress and PTSD symptoms, along with more discrimination, violence, food insecurity, homelessness, sex work, unemployment, and substance use.
03When variables were compared directly, discrimination had the strongest link to psychological distress, and violence exposure had the strongest link to PTSD symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis is cross-sectional, so it cannot show that stigma or social instability caused mental health symptoms. This was a secondary analysis of baseline survey data, and the specific analysis was not pre-registered. Missing data were higher among people of color and HIV-positive participants, so the analysed sample may not represent them equally. Mental health was measured with brief screeners, not clinical interviews, so scores may not equal diagnoses. The statistical models fit only moderately, and some measures of social and structural vulnerability did not fit the intended category well. The cluster analysis was exploratory and needs replication. The in-person and online samples differed substantially, so findings may not transfer between them. Other factors, including the effect of the COVID-19 pandemic, may have influenced the results.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that stigma or social instability causes PTSD or distress. The study measured these things at one time and only shows associations. Do not treat screening, inclusive intake forms, or telehealth as proven interventions; this paper did not test them.