Researchers currently lack a reliable and valid means of assessing minority stress and resilience factors in transgender and gender-nonconforming (TGNC) people. This study was conducted to develop and evaluate the validity of a tool to better assess these constructs in TGNC populations. The Gender Minority Stress and Resilience (GMSR) measure was developed grounded on Meyer’s minority stress model, and adjusted to reflect the experiences of TGNC populations based on TGNC literature and archival data from TGNC focus groups. The final GMSR includes scales assessing 9 constructs: gender-related discrimination, gender-related rejection, gender-related victimization, nonaffirmation of gender identity, internalized transphobia, negative expectations for future events, nondisclosure, community connectedness, and pride. In the current study, 844 participants completed the GMSR measure as well as measures related to mental health, general life stress, and social support. Results indicated good model fit, criterion validity, convergent validity, and discriminant validity for the 9 hypothesized scales. Discriminant validity for the scales were also partially supported. Overall, the current study offers preliminary evidence of the reliability and validity of the GMSR Measure for use with TGNC populations. The GMSR Measure has several uses for both research and clinical purposes, including increasing understanding of the experiences and correlates of gender minority stress and resilience factors and assessing whether specific therapies or interventions are helpful in reducing risk and supporting resilience in TGNC populations.

OBJECTIVE:The current study examined the role of internalized transphobia (IT) as a mediator between gender-related rejection and mental health, and reflective functioning (or mentalization) as a resilience factor moderating the relationship between both rejection and IT with mental health. METHOD:This online study included 203 Italian transgender and gender-nonconforming (TGNC) individuals ranged in age from 18 to 66 years old (M = 30.70; standard deviation = 10.79). Moderated-mediation analysis was performed using a structural equation modeling approach. RESULTS:Both rejection and IT were positively associated with mental health, and IT mediated the relationship between rejection and mental health. Mentalization moderated the relationship between rejection and IT with mental health. The indirect effect of rejection on mental health through IT was moderated by mentalization. CONCLUSIONS:Findings highlight psychological paths that may inform individual- and group-level mentalization-based interventions to reduce minority stress in TGNC individuals.

Transgender and gender nonconforming (TGNC) people experience high levels of minority stress and associated risk for negative mental health outcomes. Notwithstanding, TGNC people may resist the negative effects of minority stress on health through the resilience factors. As no comprehensive measures of gender minority stress and resilience exist in Italy, this study evaluated the psychometric characteristics of an Italian language version of the Gender and Minority Stress and Resilience Measure (GMSR) in an Italian sample of 203 TGNC individuals ranged from 18 to 66 years of age (M = 30.70, SD = 10.79). The GMSR, developed in the United States in 2015, assesses distal stressors (discrimination, rejection, victimization, and nonaffirmation), proximal stressors (internalized transphobia, negative expectations, and nondisclosure), and resilience factors (pride and community connectedness). Confirmatory factor analysis showed that the original 9-factor model had adequate fit to the data obtained from the Italian sample. Criterion validity was partially confirmed, as the stress scales positively correlated with anxiety and depression, and pride negatively correlated with depression, but not anxiety. On the contrary, community connectedness did not correlate with any of the mental health measures. Instead, both convergent and discriminant validity were confirmed as both distal and proximal stressors positively correlated with perceived stress, community connectedness was positively associated with perceived support from friends, and all correlations were below .60. This study offers evidence of the reliability and validity of the GMSR in the Italian context, providing Italian clinicians and researchers with a comprehensive tool to assess gender minority stress in TGNC individuals.

第１章 ジェンダー・アイデンティティを探求しよう 第２章 ジェンダー表現を探求しよう 第３章 家族との関係を探求しよう 第４章 学校や職場でのあり方を探求しよう 第５章 周りの人との関係を探求しよう 第６章 恋愛とセックスを探求しよう 第７章 さまざまなアイデンティティとジェンダーを探求しよう 第８章 つらい問題を乗り越えるヒント

Transgender and gender nonconforming (TGNC) individuals frequently confront discrimination, rejection, and violence. Such experiences may put TGNC individuals at risk for minority stress and associated psychiatric symptoms. Protective factors like social support, pride in one's gender identity, or connectedness to similar others may make TGNC individuals less vulnerable to psychiatric symptoms, and the presence of risk and protective factors may vary depending on living environment. This study examined the relationship of living environment (urban vs. suburban vs. small-town/rural) to social anxiety (SA) in a sample of 902 TGNC individuals who participated in the Trans Health Survey. Analysis of variance revealed a significant difference in SA across living environments. Those living in small-town/rural environments reported significantly higher levels of SA compared to those living in urban environments. There was a trend-level difference in SA in suburban compared to urban environments. Linear regression analyses revealed that living environment significantly moderated the relationship between social support and SA. Higher social support was more protective against elevated SA in urban and suburban than in small-town/rural environments. This study is the first to demonstrate the experience of elevated SA among TGNC individuals living in rural environments. Implications and future directions for research are discussed.

Background. Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans. Methods. This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey. Results. Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks. Conclusions. Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.

Transgender and gender nonconforming (TGNC) individuals are at heightened risk for psychological distress, including social anxiety (SA). The current study aimed to examine whether gender-affirming medical interventions (GAMIs) are associated with lower SA among TGNC individuals. Two hundred ninety-one transfeminine and 424 transmasculine participants completed the Trans Health Survey, which assessed SA and interest in or utilization of GAMIs (genital surgery, chest surgery, hormone use, speech therapy, tracheal shave or Adam's apple removal, hair removal). Transfeminine individuals who had completed genital surgery, chest surgery, tracheal shave or Adam's apple removal, hair removal, hormone treatment, or speech therapy reported lower SA than those planning to undergo the intervention, and those who had completed genital or chest surgery reported lower SA than those considering it. Transmasculine individuals who had completed chest surgery, a hysterectomy, or used hormones reported lower SA than those who were planning to do so, and those who had completed genital surgery had lower SA than those considering it. Among those expressing interest, utilization of GAMIs is associated with less SA. GAMIs may result in greater conformity to societal expectations regarding binary gender norms, thus decreasing discrimination, rejection, victimization, and nonaffirmation. Increased alignment of physical characteristics and gender identity may increase self-esteem. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Researchers have provided evidence for behavioral health disparities between transgender and cisgender individuals. Few studies considered the impact of possessing sex characteristics at birth that are not congruent with gender identity. In studies that examined gender-affirming medical interventions (GAMIs) and behavioral health in transgender adults, important variables and a range of behavioral health symptoms have not been considered. This study explored relationships between three GAMIs and scores on 6 symptom measures, while controlling for key variables. We hypothesized that, compared with transgender people who desire but have not yet engaged in a GAMI, those who engaged in the GAMI will report lower symptom scores on behavioral health outcomes. Using a cross-sectional design, data from 868 transgender people were analyzed through comparison of the behavioral health of those who completed a given GAMI and those who wanted to complete the intervention. GAMIs were associated with lower scores on measures of depression, social anxiety, generalized anxiety, and PTSD and higher scores on alcohol abuse for trans masculine identity spectrum (TMIS) people who completed GAMIs compared with those who desired but did not complete GAMIs. Results related to trans feminine identity spectrum (TFIS) people largely demonstrated nonsignificant differences. Results indicate that among those who desire GAMIs, the completion of GAMIs are associated with better behavioral health for TMIS people, with the exception of alcohol abuse. Nonsignificant differences in the results of TFIS people may be attributable to differences in sample size, social ramifications, GAMI satisfaction, and hormone effects.

Research suggests the prevalence of suicide ideation and suicide attempts in the transgender veteran community may be upwards of 20 times higher than nontransgender veterans, who are known to be at increased risk than the general US population. This study aimed to understand the potential influence of external and internal minority stress experienced during and after military service on past-year and recent suicide ideation in a sample of 201 transgender veterans. Nonparametric bootstrapping analyses indicated past-year transgender-specific discrimination and rejection (external minority stress) indirectly predicted frequency of both past-year and past 2-week suicide ideation through past-year shame related to gender identity (internal minority stress). This result was significant when controlling for symptoms of depression and demographics. Similar patterns emerged when examining relationships among military external and internal minority stress on suicide outcomes. These results suggest that attempts to reduce both the experience and impact of minority stressors related to gender identity during and after military service may be an important avenue for suicide prevention.

Objective: Studies indicate that transgender individuals may be at risk of developing eating disorder symptoms (EDS). Elevated risk may be attributed to body dissatisfaction and/or societal reactions to nonconforming gender expression, such as nonaffirmation of a person’s gender identity (e.g., using incorrect pronouns). Limited research suggests that gender-confirming medical interventions (GCMIs) may prevent or reduce EDS among transgender people. Method: Participants included 154 transfeminine spectrum (TFS) and 288 transmasculine spectrum (TMS) individuals who completed the Trans Health Survey. Serial multiple mediation analyses controlling for age, education, and income were used to examine whether body satisfaction and nonaffirmation mediate any found relationships between various GCMIs (genital surgery, chest surgery, hormone use, hysterectomy, and hair removal) and EDS. Results: For TFS individuals, the nonaffirmation to body satisfaction path mediated relationships between all GCMIs and EDS, although body satisfaction alone accounted for more of the indirect effects than this path for chest surgery. For TMS individuals, relationships between all GCMIs and EDS were mediated by the nonaffirmation to body satisfaction path. Conclusion: Findings support the hypothesis that GCMIs reduce experiences of nonaffirmation, which increases body satisfaction and thus decreases EDS. Among TFS participants, the relationship between chest surgery and lower levels of EDS was mediated most strongly by body satisfaction alone, suggesting that satisfaction with one’s body may result in lower EDS even if affirmation from the external world is unchanged. Implications of these findings for intervention, policy, and legal efforts are discussed, and future research recommendations are provided.

Research has revealed alarmingly high rates of suicidal ideation (SI) and suicide attempts among transgender and gender nonconforming (TGNC) people. This study aims to analyze the role of factors from the gender minority stress and resilience (GMSR) model (Testa, Habarth, Peta, Balsam, & Bockting, 2015), the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005; Van Orden et al., 2010), and the potential integration of these factors, in explaining SI in this population. A convenience sample of 816 TGNC adults responded to measures of current SI, gender minority stressors, and IPTS factors. Path analysis was utilized to test 2 models. Model 1 evaluated the associations between external minority stressors and SI through internal minority stressors. Model 2 examined the relationships between internal minority stressors and SI through IPTS variables (perceived burdensomeness and thwarted belongingness). All GMSR external stressors (rejection, nonaffirmation, victimization, and discrimination), internal stressors (internalized transphobia, negative expectations, and nondisclosure), and IPTS factors (thwarted belongingness and perceived burdensomeness) were related to SI. Both models demonstrated good fit. Model 1 revealed that rejection, nonaffirmation, and victimization were related to SI through experiences of internalized transphobia and negative expectations. Model 2 indicated that internalized transphobia and negative expectations were associated with SI through IPTS factors. The models demonstrate pathways through which GMSR and IPTS constructs relate to one another and confer risk for SI among TGNC individuals. These pathways and several recently proposed constructs examined here provide promising directions for future research and clinical interventions in this area. (PsycINFO Database Record

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals constitute a substantial minority of mental health clients, with a reported higher prevalence of psychological distress among this group. This disparity is generally attributed to minority stress experienced by living within communities that devalue and discriminate against them. Many LGBTQ individuals internalize these negative experiences, increasing their odds for negative mental health outcomes, (e.g., depression, anxiety, substance misuse, and suicide). Minority stress research has identified components specific to this population and has begun to develop assessment measures. In this chapter, measures such as the Cultural Assessment of Risk of Suicide Minority Stress Scale (CMSS) will be discussed and incorporated within a 5-phase model of clinical assessment. After an overview of minority stress and its mental health effects, the chapter will discuss individual factors that may increase or buffer the deleterious effects of discrimination-related stressors. This chapter will also explore ways that the clinician can establish and maintain rapport with gender and sexual minority clients to ensure accurate and sensitive assessment of minority stress and other important clinical factors.

For those identifying as transgender or gender nonconforming (TGNC), the support of others can be instrumental in mitigating the challenges associated with cross-gender transition and identification. Social support and connectedness to the TGNC community can positively impact psychological well-being, facilitate resilience, and buffer against external stigmatization, prejudice, and discrimination (Frost & Meyer, 2012; Hendricks & Testa, 2012). The present study seeks to improve understanding of relationships among general social support (GSS), trans community connectedness (TCC), depressive symptoms, and anxiety symptoms. The inclusion of 2 forms of social support allows for greater examination of the differential impact of perceived general support (i.e., from both cisgender and TGNC friends and family members) and TGNC-specific social support (i.e., feeling connected to other TGNC people). To honor the diversity within the TGNC community, the impact of social support was examined among TGNC participants differentiated by gender identity, ethnicity, and living environment. As part of the Internet-based Trans Health Survey, standardized measures of depression, generalized anxiety, and social support were administered to 865 TGNC adults. For both trans male spectrum (TMS) and trans female spectrum (TFS) participants, general social support was significantly negatively associated with symptoms of anxiety and depression. However, the negative correlation between trans community connectedness and mental health symptoms was significant only for TFS participants. Variations in perceived TCC among ethnicity and living environment groups--distinguished by gender identity--are also explored. Finally, targets for future minority stress and social support research with the TGNC population are discussed. Language: en

We examined the relationships between promotion and prevention focus and caloric consumption in reaction to a dietary lapse scenario among weight loss maintainers. Participants were 65 adult females who had attained and maintained a weight loss of 10 % or more for at least 1 month. After engaging in a dietary lapse in a feeding laboratory, participants completed a “bogus” taste test, during which they could consume as much food as they liked. It was hypothesized that promotion and prevention focus would predict caloric consumption, mediated by depressive and anxious affect. Prevention focus, but not promotion focus, was positively associated with proportion of daily calories consumed. Affect was not a mediator. Prevention focus may be deleterious for dietary maintenance following dietary lapses. Theoretical and clinical implications are discussed in light of prior research. Limitations of the study and recommendations for future research also are presented.

Research examining risk and resilience among transgender individuals suggests that connection to a transgender community may be protective. Utilizing archival survey data of 3,087 adult transgender participants collected in 2005-06, this study further evaluated how awareness and engagement with other transgender people influences risk and resilience during early gender identity development. As hypothesized, among male-to-female and female-to-male respondents, both prior awareness and prior engagement with other transgender people were independently related to less fearfulness, less suicidality, and more comfort. These relationships were not significant among male-to-different-gender or female-to-different-gender participants. Implications of these findings are discussed.