Elsevier

Social Science & Medicine

Volume 147, December 2015, Pages 222-231
Social Science & Medicine

Review article
Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions

https://doi.org/10.1016/j.socscimed.2015.11.010Get rights and content

Highlights

  • Stigma contributes to widespread health inequities in US transgender communities.

  • We review the multiple levels at which stigma towards transgender people operates.

  • The stress mechanisms through which stigma contributes to health are discussed.

  • Intervention strategies to reduce transgender stigma are outlined at each level.

  • Multi-level interventions are needed to reduce transgender stigma in the US.

Abstract

Rationale

Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma.

Objective

This critical review aims to integrate the literature on stigma towards transgender people in the US.

Results

This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations.

Conclusion

Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted.

Section snippets

Stigma at multiple levels

Stigma has the ability to affect transgender health at multiple levels. Using an applied ecological model, this section reviews transgender stigma at the structural, interpersonal, and individual levels.

Direct health effects of stigma

The negative health impact of multiple forms of stigma are summarized in the gender minority stress theory (Hendricks and Testa, 2012). Derived from minority stress theories applied to other stigmatized statuses (e.g., SES, Dohrenwend, 2000; race, Williams et al., 1997; sexual minority status, Meyer, 2003b), gender minority stress theory proposes that added stressors related to the stigma attached to one's discordant gender identity/expression adversely affect health and accounts for health

Interventions to reduce stigma and its negative health impact

To prevent the onset of adverse health outcomes in diverse transgender populations, interventionists need to reduce the factors that cause stress and intervene directly to help transgender people mitigate stress responses. Stigma interventions have been developed to change attitudes and improve coping at the individual-level, reduce the perpetration of stigma at the interpersonal-level, and change the norms, policies, and systems that perpetuate stigma at the structural-level. This section

Summary and future directions

Changing attitudes have allowed transgender people to become more visible in society. However, the increased visibility of transgender people also highlights the high prevalence of adverse health outcomes that exist in some transgender communities –- health inequities linked to the societal stigma attached to gender nonconforming identities and expressions. While recent US non-discrimination policies may reflect greater acceptance of transgender people, widespread interpersonal stigma

Acknowledgments

Jaclyn White Hughto is supported by grants T32MH020031 and P30MH062294 from the National Institute of Mental Health.

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