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. 2025 Jul 8.
doi: 10.1007/s11121-025-01825-8. Online ahead of print.

The Role of Policy in Preventing Discrimination-Based Suicide and Substance Use Coping Outcomes Within the Transgender Community

Patrick O'Neill  1   2 , Whitney Becker  3 , Casey A Cunningham  4   5 , Damon E Jones  5 , Ashley N Linden-Carmichael  6
Affiliations

The Role of Policy in Preventing Discrimination-Based Suicide and Substance Use Coping Outcomes Within the Transgender Community

Patrick O'Neill et al. Prev Sci. .

Abstract

Individuals who identify as transgender/gender diverse face an increased risk of discrimination, particularly in health care settings. This discrimination has been associated with higher odds of substance use coping and attempting suicide. However, risk and protective factors that can moderate this relationship remain under-evaluated. The present study examines the role of LGBTQ-friendly state policy climates in preventing discrimination-based outcomes of substance use coping and attempting suicide in the transgender/gender diverse community. Data from the 2008-2009 National Transgender Discrimination Survey were merged with state policy climate scores. Policy climate scores were derived from the tracking of legislation through the Movement Advancement Project. Participants were asked about using substances to cope, prior suicide attempts, and three types of discrimination at mental health clinics (denied equal treatment, verbal harassment/disrespect, physical assault). Being denied equal treatment or service and being verbally harassed or disrespected were both associated with increased odds of using substances to cope and attempting suicide. Residing in a more LGBTQ-friendly policy climate moderated the relationship between being denied equal treatment and a prior suicide attempt as well as the relationship between verbal harassment and both suicide attempt and use of substances to cope. Findings underscore the potential of LGBTQ-friendly policy climates to serve as a protective factor against discrimination faced by the transgender/gender diverse community. A greater understanding of the role of policies in the relationship between discrimination and adverse outcomes can help form policy-based prevention in an effort to improve the lives of individuals in the transgender/gender diverse community.

Keywords: Health care discrimination; Public policy; Substance use coping; Suicide; Transgender/gender diverse communities.

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Conflict of interest statement

Declarations. Ethics Approval: Approval for the present study was given by the institutional review board (IRB) at The Pennsylvania State University (STUDY00023566). Given the present study is secondary data analysis, it was ruled not human research by the IRB. Consent to Participate: Not applicable. Conflict of Interest: The authors declare no competing interests. Clinical Trial Registration: Not applicable.

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