Stigma, strengths, and mental health among Chinese transgender and gender non-conforming individuals

Abstract

Introduction: Transgender and gender non-conforming (TGNC) people refer to individuals who consider that their gender does not conform to their sex assigned at birth or the binary gender classification imposed by culturally defined norms. TGNC people are often confronted with widespread stigma, which is a reportedly critical factor contributing to their adverse mental health outcomes such as psychological distress and depression. The stigma manifests itself in multiple forms, which remain understudied. In addition, few studies consider the positive resources of TGNC individuals in an unfavorable environment. Thus, this study focused on enacted, anticipated, and internalized stigma simultaneously and their associations with mental health status among TGNC people in the context of mainland China, and also explored the roles of their strengths in affecting the mental health status in the adversity. Methodology: This research adopted explanatory sequential mixed methods, aiming to assess the relationships among stigma, strengths, and mental health status among Chinese TGNC people in the quantitative research, and understand more details about how the stigma and strengths of Chinese TGNC individuals affected their mental health status in the complemented qualitative research. In study 1 of the quantitative research, I used a questionnaire survey to measure the enacted stigma, anticipated stigma, internalized stigma, community consciousness, social support, identity pride, self-esteem, resilience, and mental health status in Chinese TGNC people. Hierarchical multiple regression was used to examine the relationships among stigma, strengths, and mental health status, and moderation analysis was further performed to see the moderating effects of strengths. Study 2 of qualitative research conducted follow-up semi-structured interviews with TGNC individuals to gain more understanding of the impacts of stigma and strengths on their mental health status, aiming to elaborate and validate the results in study 1. Results: There were a total of 399 Chinese TGNC people in study 1. High rates of stigma were reported by the participants, and poor mental health outcomes were also showed in TGNC people that almost a half of the TGNC individuals showed symptoms of negative mental health outcomes and low level of well-being status. As I hypothesized, the enacted stigma, anticipated stigma, and internalized stigma were significantly associated with the variance of mental health outcomes among TGNC people. The TGNC individuals with a higher level of stigma were at higher risks of negative mental health outcomes. Among their psychological strengths, social support, identity pride, and resilience were found to play buffering effects in negative mental health status, but their community consciousness and self-esteem were likely to aggravate the detrimental relationships between stigma and mental health status. In study 2, ten themes were identified in the follow-up interviews, including experiences of pervasive adversity, negative feelings of adversity, concealment and negative expectations of anticipated stigma, internalized stigma – "I had a transphobia of myself", support from family and partner, support from people around and community members, identity pride for being special, self-esteem – both a weakness and a protection, and resilience for bouncing back. Study 2 validated the detrimental influence of stigma on mental health status and that some strengths helped them recover from the adversity. It also elaborated more details about the mixed effects of community consciousness and self-esteem of TGNC individuals in affecting their mental health status. Conclusions: Overall, the findings of this study advanced our understanding of the stigma, strengths, and mental health status of Chinese TGNC people and shed light on their psychological needs, which also provided some clinical and policy implications for improving their psychological status and living conditions.