Minority Stress, Pandemic Stress, and Mental Health among Gender Diverse Young Adults: Gender Dysphoria and Emotion Dysregulation as Mediators

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Pease, M., Le, T. P., & Iwamoto, D. K. (2022). Minority stress, pandemic stress and mental health among gender diverse young adults: Gender dysphoria and emotion dysregulation as mediators. Psychology of Sexual Orientation and Gender Diversity. https://doi.org/10.1037/sgd0000574


Gender diverse people in the United States are uniquely vulnerable to deleterious health outcomes because of long-enshrined systems of oppression and marginalization in American society. Trans young adults are especially vulnerable to these deleterious outcomes owing to their unique position in the life course. However, more research is needed on the mechanisms through which this marginalization contributes to mental health disparities in trans populations. Using a minority stress framework and online cross-sectional survey design, the current study examines potential mediators of the relationship between transgender identity-related distal stress and psychological distress from late May to early July 2020 in a sample of transgender young adults (N = 239; ages 18–29). More than half the sample scored above the K6 cutoff for severe psychological distress. Distal stress had a significant direct (β = .17, SE = .04, t = 2.76, p = .006) and indirect effect on psychological distress. Distal stress was indirectly associated with psychological distress through gender dysphoria (β = .04; 95% CI [.001, .10]) and emotion dysregulation (β = .16; 95% CI [.09, .23]). COVID-19 pandemic stressors were also positively associated with psychological distress (β = .36, SE = .12, t = 5.95, p < .001). Results highlight the significant mental health burden facing the trans community especially in the COVID-19 context, support a conceptualization of gender dysphoria as connected to experiences of oppression, and affirm the relevance of emotion dysregulation within minority stress frameworks. Mental health resources cognizant of the specific challenges experienced by trans young adults as well as policy changes that seek to address underlying structural transphobia in American culture and institutions are urgently needed.


This study surveying young adults with minority gender identities found 1) high rates of psychological distress during COVID-19, 2) that pandemic stress was associated with greater psychological distress and 3) transphobic discrimination was associated with greater gender dysphoria and emotion dysregulation, which were both associated with greater psychological distress. This highlights the mechanisms underlying trans health disparities and the importance of recognizing transphobic/cisnormative experiences and systems of oppression when conducting research or providing services to support the transgender community.