Discrimination Leads to Mental Distress for Gender Diverse People

Researchers seek to identify adaptive coping responses to discrimination for the transgender and gender diverse community.


A new study, published in the Journal of Clinical Psychiatry, examines the interplay between discrimination and symptoms of anxiety and depression for transgender and gender diverse (TGD) individuals. The authors, led by clinical psychologist Jae Puckett from Michigan State University, also investigated the ways various coping mechanisms may diminish or prolong symptoms of anxiety and depression. Their results point to strategies for offering supports that reinforce adaptive coping strategies and demonstrate an urgent need for decreasing experiences of discrimination.

The results show a high percentage of the TGD population experiencing discrimination over the last year. Additionally, they found the higher levels of discrimination experienced, the higher the likelihood of symptoms of anxiety and depression. Regarding the types of coping mechanisms, the authors found that anxiety and depression were significantly positively associated with detachment/withdrawal-oriented coping responses (i.e., internalization and drug/alcohol use), as opposed to approach-oriented ways of coping (i.e., education and advocacy).

“We found that there were more anxiety and depression symptoms for participants who encountered higher levels of discrimination, which was partially explained by detaching and internalizing blame,” they write.

These results likely speak to the toll of adverse, discriminatory experiences as they accumulate. As discrimination increases, it may become more difficult to respond with educating others and engaging in advocacy work, possibly because the individual’s resources diminish via the increased burden of discrimination.”

Transgender and gender diverse people include “people whose gender identity differs from that typically associated with their sex assigned at birth.” Research has shown that this population is vulnerable to mental health disparities driven mainly by exposure to life stressors, such as minority stress. Minority stress is described as stress particularly experienced by minority groups that go “above and beyond the general stressors that all people may encounter and occurs across settings, such as employment, housing, and public accommodations, among others.

Since the existing research shows that exposure to life stressors can contribute to symptoms of anxiety and depression for minority groups, in this article, Puckett and colleagues aim to understand better TGD people’s lived experiences. They elaborate that their intentions will facilitate better conceptualization of psychological distress for TGD people and the development of more effective methods of alleviating distress.”

They begin by evaluating the most common forms of discrimination and account for the potential influence of demographic features, such as gender, race/ethnicity, socioeconomic status. Next, they conduct multiple mediation analyses to identify ways coping plays out in the face of discrimination and psychological distress. These coping responses are then assessed as either buffering or exacerbating the effects of discrimination.

The study includes 695 participants, with about half identifying as either transgender men or transgender women, and the other half identifying as genderqueer, non-binary, and other identifiers. Most participants were white with low income, limiting the ability to understand the intersectionality of race and income and preventing generalizability of the results for people of color who identify as gender minorities.

Puckett et al. examined medical and mental health treatment, access to public restrooms, identity documentation, housing, and employment as an index of exposure to various types of discrimination. They issued a 20-item version of the Coping with Discrimination Scale to measure ways of coping amidst discrimination. Lastly, the incorporated scales to register depression and anxiety symptoms, including the short form of the Patient-Reported Outcomes Measurement Information Systems (PROMIS)-Depression scale and the short form of the PROMIS-Anxiety scale.

A total of 76.1% of the participants were found to have experienced discrimination in the last year. Those experiencing greater discrimination were associated with more symptoms of depression and anxiety. Regarding coping mechanisms, they found that “overall, participants reported using education and advocacy the most to cope, followed by internalization, detachment, resistance, and drug and alcohol use.”

Of these forms of coping, symptoms of depression and anxiety were positively associated with coping via detachment, via drug and alcohol use, and via internalization, while there was no significant association between depression or anxiety and coping via education/advocacy and via resistance. To facilitate more effective coping, the researchers encourage more research on how these associations form and evolve.

The article offers clinical implications, naming that “although an immediate change in the sociopolitical context may be outside an individual’s control, modifying, and changing one’s responses to such stressors may be an empowering way of managing oppression.”

They suggest the results can inform mental health professionals to take a position of validating a TGD person’s experiences of discrimination and subsequent symptoms of anxiety, worry, and fear, instead of interpreting their responses as catastrophic thinking or other pathological explanations.

They write, “therapists may then be able to help TGD people relate to their symptoms in more empowering ways that assist them in living their lives authentically and fully.”

Puckett, Maroney, Wadsmorth, Mustanki, and Newcomb confirm their study supports previous research findings on the high levels of discrimination against TGD people. They conclude:

“Our results provide novel, empirical evidence for the insidious cycle experienced by gender minorities wherein TGD people are discriminated against, engage in attempts to cope via a range of strategies, and yet still have heightened levels of anxiety and depression.”

“This should serve as a call for the development of targeted therapeutic interventions to help TGD people cope with on-going discrimination in ways that will be more sustainable and empowering, while also taking social actions to address discrimination that targets TGD people.”



Puckett, J. E., Maroney, M. R., Wadsworth, L. P., Mustanski, B., & Newcomb, M. E. (2019). Coping with Discrimination: The insidious effects of gender minority stigma on depression and anxiety in transgender individuals. Journal of Clinical Psychology, 1– 19. https://doi.org/10.1002/jclp.22865 (Link)


  1. I don’t understand the dynamics during the decades with gender. Back in the early eighties there was a transgender program and folks were evaluated and then could begin their change. St the time, there were some African Americans and others and it seemed like it was no big deal. I was not involved so I could easily missed the isdues.
    I still have a hard time comprehending the fear factor. I missed a lot when being a parent and was not in the loop with LBQT folks as I had been. This hardness never needed to happen.

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  2. “Discrimination Leads to Mental Distress for” all people, including the people who have been defamed/stigmatized with the “invalid” and “bullshit” DSM “mental illnesses.”


    I am glad the “mental health” workers are speaking out against the discrimination of LGBT people. But they shouldn’t be creating their very own groups of people to discriminate against, by stigmatizing millions with their scientific fraud based DSM stigmatizations. The “mental health” workers are very hypocritical.

    But I will say my family is a perfect example of the harm the “mental health” workers are doing to families. When they proactively attack an innocent young mom, to cover up the rape of one of her children, for the mainstream child rape covering up religions.


    That mom can get her abused child away from the child molesters. And keep her child away from the insane psychiatrists, who think the best way to help a child who’d been abused – four years prior – and was largely healed, is to drug him. And she can keep her child away from the insane school social workers, who want to drug her well behaved, intelligent child, after he’d largely healed from the child abuse. Because he’d gone from remedial reading in first grade, after the abuse, to getting 100% on his state standardized tests in eighth grade.

    But that innocent mom does end up with a gay and a trans child, due to the intentional, child rape covering up, anticholinergic toxidrome attempted murdering “mental health” workers, distracting her – which she did escape – and the attempted destruction of her entire family, by the child rape covering up “mental health” industry.


    The globalist “pedophile empire,” including all it’s child rape covering up and profiteering, highly DSM deluded, scientific fraud based “mental health” workers, needs to be taken down.


    Here’s a couple of people researching into these enormous societal problems, discussing these globalist, societal problems.


    And to this day, NO “mental health” worker may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER. Unless they first misdiagnose all child abuse survivors with the scientific fraud based, but billable, DSM disorders. So that’s what all our DSM “bible” believing “mental health” workers have been doing for decades.


    Our “mental health professionals” and mainstream religions need to get out of their multibillion dollar, iatrogenic illness creating, primarily child rape covering up business, and our society actually needs to start arresting the child rapists.

    Egregious and enormous societal problems don’t occur for no reason, they occur because the wrong people have been in charge for way too long. And “We can’t solve problems by using the same kind of thinking we used when we created them.”

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  3. The WHO took away the diagnosis, due to political pressure. It is no longer okay to think of people as weird because a boy wants to be a girl.
    Most shrinks will still diagnose them with 50 other labels.
    I think the main thing it shows is that, oh my, they are capable of removing diagnosis, IF under enough pressure.

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