Background Parental stress impacts individual health and the development of the next generation, but there is a lack of comprehensive research on parental stress among transgender parents in China. This study is the first to investigate parental stress and mental health among transgender parents and identify potential influencing factors. Methods We designed a cross-sectional survey that recruited a representative sample of 647 transgender parents. A validated questionnaire was used to investigate parental stress, depression, anxiety, and their associated factors, including parent factors (gender dysphoria, time of coming out, depression, and anxiety) and situational factors (family violence, partner violence, relationship with partner, discrimination and family income). Linear regression models were used to explore the influencing factors of parental stress among transgender parents, a structural equation model (SEM) was established to explore the possible pathways between these factors and parental stress, and network analysis was conducted to determine primary symptoms and central risk factors. Results The average parental stress score was 50.4 ± 8.02. 92.7% of participants exhibited depressive tendencies and 73.7% showed anxiety tendencies. Lower family income (p < 0.001), coming out after having a child (Coefficient (Coef.) = 2.6, 95% confidential interval (CI) = 1.174 ∼ 4.027), family violence (Coef. = 3.582, 95%CI = 2.372 ∼ 4.791), partner violence (Coef. = 4.199, 95%CI = 2.998 ∼ 5.401), being discriminated during seeking of childbearing health care (Coef. = 3.29, 95%CI = 2.054 ∼ 4.526), poor relationship with partner (fair relationship: coef. = −3.205, 95%CI = −4.86∼−1.551; good relationship: coef. = −5.372, 95%CI = −6.886∼−3.858), depression (Coef. = 5.873, 95%CI = 3.557 ∼ 8.189), and anxiety (Coef. = 5.705, 95%CI = 4.368 ∼ 7.042) were significantly associated with higher parental stress. Through the pathway analysis, the direct or indirect effects of parent factors and situational factors on parental stress were observed. Additionally, network analysis revealed that gender dysphoria, family violence, psychological abuse, and various anxiety types as central risk factors, with two gender dysphoria symptoms showing the strongest direct relationship to stress. Conclusions Transgender parents experience significant parental stress influenced by mental health, sociodemographic, transgender-specific, family, and socio-environmental factors. Enhanced family support and a more inclusive social environment are crucial for reducing stress and improving the well-being of transgender parents and their children.
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