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Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis.

Publication ,  Journal Article
Sherman, ADF; Higgins, MK; Balthazar, MS; Hill, M; Klepper, M; Schneider, JS; Adams, D; Radix, A; Mayer, KH; Cooney, EE; Poteat, TC; Wirtz, AL ...
Published in: J Nurs Scholarsh
January 2024

INTRODUCTION: Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring. DESIGN/METHODS: Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress). RESULTS: The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW. CONCLUSION: Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts. CLINICAL RELEVANCE: This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.

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Published In

J Nurs Scholarsh

DOI

EISSN

1547-5069

Publication Date

January 2024

Volume

56

Issue

1

Start / End Page

42 / 59

Location

United States

Related Subject Headings

  • United States
  • Transgender Persons
  • Stress Disorders, Post-Traumatic
  • Social Stigma
  • Nursing
  • Mental Health
  • Least-Squares Analysis
  • Humans
  • Female
  • 4205 Nursing
 

Citation

APA
Chicago
ICMJE
MLA
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Sherman, A. D. F., Higgins, M. K., Balthazar, M. S., Hill, M., Klepper, M., Schneider, J. S., … American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group, . (2024). Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis. J Nurs Scholarsh, 56(1), 42–59. https://doi.org/10.1111/jnu.12906
Sherman, Athena D. F., Melinda K. Higgins, Monique S. Balthazar, Miranda Hill, Meredith Klepper, Jason S. Schneider, Dee Adams, et al. “Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis.J Nurs Scholarsh 56, no. 1 (January 2024): 42–59. https://doi.org/10.1111/jnu.12906.
Sherman ADF, Higgins MK, Balthazar MS, Hill M, Klepper M, Schneider JS, et al. Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis. J Nurs Scholarsh. 2024 Jan;56(1):42–59.
Sherman, Athena D. F., et al. “Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis.J Nurs Scholarsh, vol. 56, no. 1, Jan. 2024, pp. 42–59. Pubmed, doi:10.1111/jnu.12906.
Sherman ADF, Higgins MK, Balthazar MS, Hill M, Klepper M, Schneider JS, Adams D, Radix A, Mayer KH, Cooney EE, Poteat TC, Wirtz AL, Reisner SL, American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group. Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis. J Nurs Scholarsh. 2024 Jan;56(1):42–59.
Journal cover image

Published In

J Nurs Scholarsh

DOI

EISSN

1547-5069

Publication Date

January 2024

Volume

56

Issue

1

Start / End Page

42 / 59

Location

United States

Related Subject Headings

  • United States
  • Transgender Persons
  • Stress Disorders, Post-Traumatic
  • Social Stigma
  • Nursing
  • Mental Health
  • Least-Squares Analysis
  • Humans
  • Female
  • 4205 Nursing