Minority stressors and their associations with severe psychological distress among gender-diverse people

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Pease, M., Williams, N. D., Iwamoto, D. K., & Salerno, J. P. (2022). Minority stressors and their associations with severe psychological distress among gender-diverse people. American Journal of Orthopsychiatry. https://doi.org/10.1037/ort0000635


People whose gender does not align with assigned sex often experience negative mental health outcomes related to cisnormative societal expectations and oppression, including familial rejection, threat of harm, and identity invalidation (e.g., misgendering). This study merged two cross-sectional data sets of trans and gender-diverse people (N = 363; Mage = 22.02) investigating how various types of distal minority stress experiences impact psychological distress. We tested the associations between three minority stressors (i.e., family rejection, threat of harm, and identity invalidation) and psychological distress using unadjusted and adjusted regression models, including gender-stratified models. In the overall unadjusted model, all three stressors were significantly, positively associated with psychological distress, with identity invalidation having the highest standardized β value. In the adjusted overall model, only identity invalidation was significantly associated with distress. Results varied in gender-stratified models. Additionally, participants who experienced any of the three stressors had predicted mean distress scores at or above the cutoff for severe psychological distress, while those who did not fell below that cutoff. Results highlight the differential impact of minority stress experiences on gender-diverse young adults and provide directions for clinical competency, interventions, and future research toward understanding mental health disparities for trans people.


Invalidating the identity of gender-diverse (e.g., transgender, genderqueer, nonbinary) people is strongly associated with clinically notable levels of psychological distress. This study highlights the need for policies that increase inclusion and decrease invalidation of gender-diverse people in systems and society, as well as efforts that educate the public on trans issues to decrease interpersonal forms of harm and invalidation, which have strong potential to negatively impact mental health.