Country-level structural stigma, identity concealment, and day-to-day discrimination as determinants of transgender people\u2019s life satisfaction

Richard Bränström,John E Pachankis

doi:10.1007/s00127-021-02036-6

Richard Bränström, John E Pachankis

Open Access

https://doi.org/10.1007/s00127-021-02036-6

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Abstract

PurposeDiscriminatory laws, policies, and population attitudes, surrounding transgender people vary greatly across countries, from equal protection under the law and full acceptance to lack of legal recognition and open bias. The consequences of this substantial between-country variation on transgender people’s health and well-being is poorly understood. We therefore examined the association between structural stigma and transgender people’s life satisfaction across 28 countries.MethodsData from transgender participants (n = 6771) in the 2012 EU-LGBT-survey regarding identity concealment, day-to-day discrimination, and life satisfaction were assessed. Structural stigma was measured using publicly available data regarding each country’s discriminatory laws, policies, and population attitudes towards transgender people.ResultsMultilevel models showed that country-level structural stigma was associated with lower life satisfaction, an association largely explained by higher levels of identity concealment in higher-structural-stigma countries. Yet identity concealment was also associated with lower day-to-day discrimination and therefore protected against even lower life satisfaction.ConclusionThe results emphasize the importance of changing discriminatory legislation and negative population attitudes to improve transgender people’s life satisfaction, and also highlight targets for intervention at interpersonal and individual levels.

Highlights

Studies increasingly show that transgender people, namely those who experience incongruity between their sex assigned at birth and current gender identity, are at particular risk of mental health concerns, psychological distress, and other indicators of poor life satisfaction [1, 2]
Multilevel regression models adjusted for age, ethnic minority status, education level, income, relationship status, and urbanicity and for country-level Gini coefficient and life-satisfaction showed significant associations between structural stigma and life satisfaction, as well as between structural stigma and concealment of transgender identity
We found no significant association between structural stigma and day-to-day discrimination

Summary

Introduction

Studies increasingly show that transgender people, namely those who experience incongruity between their sex assigned at birth and current gender identity, are at particular risk of mental health concerns, psychological distress, and other indicators of poor life satisfaction [1, 2]. Transgender people’s higher risk of poor mental health is believed to be a consequence of their increased exposure to stigma and minority stress compared to individuals without transgender experience, that is, cis-gender individuals [6, 7]. Stigma manifests as discrimination in social interactions, victimization, non-affirmation of gender identity, and other expressions of prejudice in interactions between individuals [7, 10, 11]. The extent to which transgender people are exposed to these types of interpersonal and individuallevel experiences is believed to be a consequence of stigma at a structural level and the degree of transgender hostility in

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