TY - JOUR
T1 - Stigma, social and structural vulnerability, and mental health among transgender women
T2 - A partial least square path modeling analysis
AU - American Cohort To Study HIV Acquisition Among Transgender Women (LITE) Study Group
AU - Sherman, Athena D.F.
AU - Higgins, Melinda K.
AU - Balthazar, Monique S.
AU - Hill, Miranda
AU - Klepper, Meredith
AU - Schneider, Jason S.
AU - Adams, Dee
AU - Radix, Asa
AU - Mayer, Kenneth H.
AU - Cooney, Erin E.
AU - Poteat, Tonia C.
AU - Wirtz, Andrea L.
AU - Reisner, Sari L.
AU - Reisner, Sari
AU - Wirtz, Andrea
AU - Althoff, Keri
AU - Beyrer, Chris
AU - Case, James
AU - Cooney, Erin
AU - Stevenson, Meg
AU - Laeyendecker, Oliver
AU - Gaydos, Charlotte
AU - Poteat, Tonia
AU - Mayer, Ken
AU - Cannon, Christopher
AU - Schneider, Jason
AU - Haw, J. Sonya
AU - Rodriguez, Allan
AU - Wawrzyniak, Andrew J.
AU - Meeks, Sherri
AU - Shackelford, Sydney
AU - Toussaint, Nala
AU - Wanzer, Sa Vanna
AU - Marques, Flora
N1 - Publisher Copyright:
© 2023 The Authors. Journal of Nursing Scholarship published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.
PY - 2024/1
Y1 - 2024/1
N2 - Introduction: Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring. Design/Methods: Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress). Results: The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW. Conclusion: Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts. Clinical Relevance: This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.
AB - Introduction: Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring. Design/Methods: Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress). Results: The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW. Conclusion: Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts. Clinical Relevance: This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.
KW - anxiety
KW - depression
KW - post-traumatic stress disorder
KW - psychological distress
KW - social support
KW - stigma
KW - transgender women
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U2 - 10.1111/jnu.12906
DO - 10.1111/jnu.12906
M3 - Article
C2 - 38228564
AN - SCOPUS:85159571488
SN - 1527-6546
VL - 56
SP - 42
EP - 59
JO - Journal of Nursing Scholarship
JF - Journal of Nursing Scholarship
IS - 1
ER -