Mental Health in Transgender Adults: The Role of Proximal Minority Stress, Community Connectedness, and Gender Nonconformity

The minority stress model is used to explore the development of mental health disparities experienced by transgender adults. However, research so far has focused on the harmful impact of distal minority stressors, leaving proximal minority stressors understudied. This study aimed to examine the associations between mental health difficulties of transgender adults and proximal minority stress, community connectedness, and gender nonconformity. Between December 28th, 2018 and March 1st, 2019; 143 Flemish and Dutch transgender adults (65 transgender women, 44 transgender men, 34 nonbinary adults) between the ages of 18 and 70 (M = 34.79, SD = 13.62) filled out an online survey. Using multiple linear regression analyses, results confirmed that proximal minority stress was associated with higher levels of mental health difficulties. Specifically, internalized transnegativity and expectations of rejection-but not concealment-were associated with higher levels of mental health difficulties. Community connectedness was not associated with mental health difficulties and did not act as a moderator, suggesting that it might not foster resilience in transgender adults. Finally, gender nonconformity was associated with higher levels of mental health difficulties but did not act as a moderator. These findings partially support the applicability of the minority stress model but suggest expanding it to include stigma visibility, that is, gender nonconformity, as a determinant of mental health difficulties in transgender adults. Overall, these findings highlight that prevention and treatment strategies for mental health difficulties in transgender people should take into account internalized transnegativity, expectations of rejection, and the social stigma associated with gender nonconformity. Public Significance Statement This study suggests that transgender adults with higher levels of internalized transnegativity, expectations of rejection, and/or gender nonconformity may experience higher levels of mental health difficulties.