Mental Health: Gender-Based Discrimination Experienced by TGNC Individuals Olivia Russo
The transgender (i.e., gender identities that do not align with sex assigned at birth) and gender non-conforming (i.e., gender identities existing outside the binary categories of male and female) community (TGNC) is particularly vulnerable to psychiatric problems and disparities in mental health (Brennan et al., 2017; Chozden et al., 2019; Lloyd et al., 2019; Price-Feeney et al., 2020). TGNC individuals are 1.5 to 2 times more likely to experience symptoms of anxiety and depression than nongender minorities (Livingston et al., 2020). Furthermore, relative to cisgender individuals, TGNC individuals are at an increased risk of contemplating and attempting suicide; specifically, as compared to 5% of their cisgender counterparts, 40% of TGNC individuals will have attempted suicide at some point in their lifetime (McDowell et al., 2020; Price-Feeney et al., 2020). Research suggests that discrimination is a key factor that drives these mental health disparities (Gleason et al., 2016; Puckett et al., 2020). TGNC individuals disproportionately experience gender-based discrimination (i.e., prejudice, rejection, and violence based on identity or expression) due to their gender minority status, which may result in elevated levels of anxiety and depression (Brennan et al., 2017; Chodzen et al., 2019; Livingston et al., 2020; Lloyd et al., 2019; Williams & Mann, 2017). Gender-based discrimination exists in two notable forms: daily gender-based discrimination (i.e., everyday occurances of gender-based discrimination) and structural gender-based discrimination (i.e., discrimination in public realms due to lack of protection under policies; Glick et al., 2019; Livingston et al., 2020; Testa et al., 2017; Williams & Mann, 2017). The mechanism through which discrimination affects anxiety and depression is important to investigate, as interventions targeting this mechanism could be the most effective in alleviating anxious and depressed feelings in TGNC individuals. Thus, this review aimed to answer the following question: How does gender-based discrimination impact levels of anxious and depressed moods in TGNC individuals? Daily Discrimination Daily gender-based discrimination affects the TGNC community disporportionately through minority stress (i.e., discrimination based on the marginalized social status and systemic oppression of gender minority people; Brennan et al., 2017; Price-Feeney et al., 2020; Puckett et al, 2020). Minority stress exists in two forms: distal stress and proximal stress (Chozden et al., 2019; Testa et al., 2017). Distal stress, or overt gender-based discrimination, includes non-gender affirming external experiences and events, rejection due to gender, and verbal or physical attacks based on gender identity 20
(e.g., harassment, violent assault, microaggressions, social rejection, and sexual and physical violence; Brennan et al., 2017; Lloyd et al., 2019; Testa et al., 2017). Explicit and direct gender-based discrimination is categorized as victimization, which cumulatively can lead to TGNC individuals becoming hypervigilent about future minority stress experiences (Livingston et al., 2020). Hypervigilence to minority stress experiences causes TGNC individuals to be more aware of the plethora of discrimination they experience, which, in turn, furthers sensitivity to these experiences, creating a cyclical relation between stress experiences and sensitivity. The relation between distal stress and anxious and depressed moods is mediated by proximal stress, or the internalization of psychological processes based on experiences and societal messages about norms (Lloyd et al., 2019; Testa et al., 2017). In other words, when TGNC individuals are exposed to overt forms of discrimination and subtle messages about valid gender expression (i.e., distal stress), they often internalize these experiences in an attempt to process them (i.e., proximal stress; Livingston et al., 2020; Lloyd et al., 2019; Puckett et al., 2020; Testa et al., 2017). This process of internalizing negative experiences might subsequently lead to internalized homophobia/transphobia and internalized stress (Chodzen et al., 2019; Gleason et al., 2016; Lloyd et al., 2019). Research has found that internalized homophobia/transphobia is most damaging to TGNC individuals’ mental health (Lloyd et al., 2019). This internalization is associated with a need to conceal identity and negative self-worth, both of which further psychological distress, and, in turn, exacerbate anxious and depressed moods (Brennan et al., 2017; Livingston et al., 2020; Price-Feeney et al., 2020; Puckett et al., 2020; Testa et al., 2017). Structural Discrimination The experiences and effects of daily discrimination are compounded by structural discrimination, further damaging TGNC individuals’ mental health. Structural gender-based discrimination (i.e., policies and laws that do not promote equal rights or address gender identity as an area of discrimination) leaves TGNC individuals lacking legal protection from discrimination (Williams & Mann, 2017). Specifically, 33 out of 50 state nondiscrimination laws do not include gender identity as a category for which to protect against discrimination (Gleason et al., 2016; Kattari et al., 2016; Williams & Mann, 2017). As a result, TGNC individuals in unprotected states experience policy-level gender discrimination, stigma, and victimization in many social domains, including, but not limited to, housing, employment, and medical care (Brennan et al., 2017; Testa et al.,
