Heterogeneity of Transgender Identity Nonaffirmation Microaggressions and Their Association With Depression Symptoms and Suicidality Among Transgender Persons

• Published in: Psychology of sexual orientation and gender diversity 2019-12, Vol.6 (4), p.461-474
• Main Authors: Parr, Nicholas J., Howe, Bethany Grace
• Format: Article
• Language: English
• Subjects: Attempted Suicide; Focus Group; Gender Identity; Human; Major Depression; Microaggression; Suicidal Ideation; Suicidality; Symptoms; Victimization
• ISSN: 2329-0382; 2329-0390
• DOI: 10.1037/sgd0000347

Transgender individuals experience disproportionate rates of depression, suicide ideation, and suicide attempt. Prior work has linked these outcomes to experiencing social stigma and gender-related victimization and discrimination, but an important need has been to quantitatively assess the relation of less overt forms of victimization, such as gender identity-related microaggressions, with occurrence of these outcomes among transgender persons. In the present research, a focus group and survey study were conducted to more fully characterize transgender identity nonaffirmation microaggressions. We investigated how nonaffirmation microaggressions vary in frequency, self-rated emotional intensity, and in the social and emotional responses they elicit, as well as the relation of nonaffirmation microaggressions with the occurrence of depression symptoms and suicidality among transgender individuals. A total of 402 participants completed an online survey questionnaire, responding to 14 situational prompts based on nonaffirmation microaggressions commonly reported in focus groups. In conventional logistic regression analyses, increasing frequency of transgender identity nonaffirmation or denial events was significantly associated with 150-240% increases (odds ratio = 2.54-3.41) in odds of past-year sadness or hopelessness, past-year withdrawal from regular activities, past-year suicide ideation, and lifetime suicide ideation or attempt among transgender respondents (n = 182). Using latent regression analyses that incorporated both frequency and emotional intensity of microaggression events, odds of outcomes were increased by 230-525% (odds ratio = 3.31-6.25). Increasing the number of nonaffirmation microaggressions that produced feelings of weariness or apathy, and nonaffirmation microaggressions that led to decreased interest in social engagement, was also significantly associated with increased odds of past-year depression symptomatology and suicide ideation. Public Significance Statement This research advances knowledge of chronic minority stressors experienced by transgender individuals, and the association of those stressors, in the form of identity nonaffirmation or denial microaggressions, with elevated risk for depression symptoms and suicide ideation and attempt. This study's findings strengthen the call to enhance the availability of gender-affirming policies, clinical and social practices, and mental health-promoting services to transgender individual