Among youth experiencing internalized transphobia, gender identity pride may influence mental health outcomes, according to results of a study published in the Journal of Adolescent Health.
A growing body of literature has reported a higher rate of mental health problems among transgender and gender-diverse (TGD) individuals. Some of the mechanisms that have been suggested to be related with poorer mental health outcomes among TGD individuals are gender identity pride and internalized transphobia. This study was designed to test the hypotheses that internalized transphobia associates with increased depression and anxiety whereas gender identity pride would moderate those associations.
Investigators conducted this ongoing, multisite, observational study. Youth (N=315) receiving gender-affirming hormones were recruited from 4 sites in the United States. Participants responded to questionnaires that included outcomes about perceived parental support, mental health, and gender minority stress and resilience.
The participants’ mean age was 16.01 (SD, 1.87) years, 60.3% identified as transmasculine or boys, 64.8% were male at birth, 58.7% were White, internalized transphobia score was 13.27 (SD, 8.48) points (range 0-32), and gender identity pride score was 17.51 (SD, 8.06) points (range 0-32).
Among the 7 outcome measures, 13 significant correlations were observed. Age was correlated with gender identity pride (ƿ, 0.130), anxiety (ƿ, 0.117), and perceived family support (ƿ, -0.252); gender identity pride was correlated with sex at birth (ƿ, -0.178); perceived family support was correlated with internalized transphobia (ƿ, -0.135), anxiety (ƿ, -0.209), and depression (ƿ, -0.259); depression was correlated with anxiety (ƿ, 0.706), internalized transphobia (ƿ, 0.436), and gender identity pride (ƿ, -0.186); anxiety was correlated with internalized transphobia (ƿ, 0.417) and gender identity pride (ƿ, -0.172); and internalized transphobia was correlated with gender identity pride (ƿ, -0.367).
In the full models, depression scores were associated with perceived parental support (β, -0.50; P <.01), internalized transphobia (β, 0.52; P <.01), and the internalized transphobia-by-gender identity pride interaction (β, -0.02; P =.03). Anxiety scores were related with perceived parental support (β, -0.38; P =.03) and internalized transphobia (β, 0.50; P <.01). These findings indicated that greater internalized transphobia associated with increased depression and anxiety.
The relationship between internalized transphobia and mental health outcomes was moderated by gender identity pride at low (β, 0.68; P <.01), average (β, 0.53; P <.01), and high (β, 0.38; P <.01) levels of pride. This relationship was strongest at the lowest level (F[1,298], 4.72; P =.03) which suggested that youth with the highest internalized transphobia and lowest gender identity pride reported the highest symptoms of depression.
This study was limited by the small sample size, in which subgroup analyses could not be performed.
The study authors concluded, “These results contribute to a dearth of literature specifically examining the role of potential protective factors, like gender identity pride, on the relationship between internalized transphobia and negative mental health. Our findings contribute to this literature and provide further support for behavioral interventions designed to bolster identity pride, a correlate of depressive symptoms in our study.”
Conn BM, Chen D, Olson-Kennedy J, et al. High internalized transphobia and low gender identity pride are associated with depression symptoms among transgender and gender-diverse youth. J Adolesc Health. 2023;S1054-139X(23)00146-5. doi:10.1016/j.jadohealth.2023.02.036