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. 2021 Sep;56(9):1537-1545.
doi: 10.1007/s00127-021-02036-6. Epub 2021 Feb 13.

Country-level structural stigma, identity concealment, and day-to-day discrimination as determinants of transgender people's life satisfaction

Richard Bränström  1 , John E Pachankis  2
Affiliations

Country-level structural stigma, identity concealment, and day-to-day discrimination as determinants of transgender people's life satisfaction

Richard Bränström et al. Soc Psychiatry Psychiatr Epidemiol. 2021 Sep.

Abstract

Purpose: Discriminatory laws, policies, and population attitudes, surrounding transgender people vary greatly across countries, from equal protection under the law and full acceptance to lack of legal recognition and open bias. The consequences of this substantial between-country variation on transgender people's health and well-being is poorly understood. We therefore examined the association between structural stigma and transgender people's life satisfaction across 28 countries.

Methods: Data from transgender participants (n = 6771) in the 2012 EU-LGBT-survey regarding identity concealment, day-to-day discrimination, and life satisfaction were assessed. Structural stigma was measured using publicly available data regarding each country's discriminatory laws, policies, and population attitudes towards transgender people.

Results: Multilevel models showed that country-level structural stigma was associated with lower life satisfaction, an association largely explained by higher levels of identity concealment in higher-structural-stigma countries. Yet identity concealment was also associated with lower day-to-day discrimination and therefore protected against even lower life satisfaction.

Conclusion: The results emphasize the importance of changing discriminatory legislation and negative population attitudes to improve transgender people's life satisfaction, and also highlight targets for intervention at interpersonal and individual levels.

Keywords: Concealment; LGBT; Life-satisfaction; Minority stress; Structural stigma; Transgender.

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Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
a, b Conceptual model of associations among structural, interpersonal, and individual levels of stigma predicting life-satisfaction among transgender people
Fig. 2
Fig. 2
a, b Mean country-level self-reported life-satisfaction (a) and mean proportion of transgender people reporting high level of concealment of their transgender identity (b) among transgender people across Europe by country-level structural stigma
Fig. 3
Fig. 3
Multilevel mediation model of the association of country level structural stigma with life-satisfaction among transgender people across Europe mediated through transgender identity concealment and experiences of day-to-day discrimination
See this image and copyright information in PMC

References

    1. Dhejne C, Van Vlerken R, Heylens G, Arcelus J. Mental health and gender dysphoria: a review of the literature. Int Rev Psychiatry. 2016;28(1):44–57. doi: 10.3109/09540261.2015.1115753. - DOI - PubMed
    1. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, Holland CE, Max R, Baral SD. Global health burden and needs of transgender populations: a review. Lancet. 2016;388(10042):412–436. doi: 10.1016/S0140-6736(16)00684-X. - DOI - PMC - PubMed
    1. Bränström R, Pachankis JE. Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: a total population study. Am J Psychiatry. 2020;177(8):727–734. doi: 10.1176/appi.ajp.2019.19010080. - DOI - PubMed
    1. Connolly MD, Zervos MJ, Barone CJ, II, Johnson CC, Joseph CL. The mental health of transgender youth: advances in understanding. J Adolesc Health. 2016;59(5):489–495. doi: 10.1016/j.jadohealth.2016.06.012. - DOI - PubMed
    1. Perez-Brumer A, Hatzenbuehler ML, Oldenburg CE, Bockting W. Individual-and structural-level risk factors for suicide attempts among transgender adults. Behav Med. 2015;41(3):164–171. doi: 10.1080/08964289.2015.1028322. - DOI - PMC - PubMed

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