Gender-related Stress Research Articles

Coping strategies employed by transgender youth with higher and lower quality of life.

Understanding transgender youth coping mechanisms may help create strategies that reduce the influence of stress on quality of life. Our study aims to measure the quality of life of Brazilian transgender youth and analyse the association with their coping strategies used for dealing with general and gender-related stress. The sample consisted of 185 participants (μ = 18.49 years; SD 2.42); of which 95 (46.34%) transgender boys, 45 (21.95%) transgender girls, 65 (31.71%) non-binary. Better quality of life was related to social support, whereas lower quality of life was related to the use of avoidance coping style in the context of general stress. The study found no association between coping strategies for gender-related stress and quality of life. Thus, the increase in quality of life in the context of gender distress among transgender youth should involve other mechanisms than promoting coping skills.

Development and validation of the Trans and Nonbinary Coping Measure (TNCM): A measure of trans and nonbinary specific ways of coping with gender-related stress.

Development and validation of the Trans and Nonbinary Coping Measure (TNCM): A measure of trans and nonbinary specific ways of coping with gender-related stress.

The relationship between gendered racism and binge eating symptoms among young adult U.S. Black women: Identity shifting as a mediator

Although research has illustrated that racial disparities in access to treatment for binge-eating disorder (BED) among Black women exist, little is known about the psychosocial related experiences of binge eating behaviors among Black women. Binge eating disorder is characterized by the recurrent consumption of large amounts of food within a brief period, accompanied by a loss of sense of control over the eating and distress over the eating behaviors. Past research has shown that race and gender related stressors are positively associated with emotional eating among Black young adult women and that they may engage in problem-solving coping strategies like identity shifting (conscious and unconscious alterations of thoughts, behaviors, perspective, and appearances) to manage these stressors. Considering the literature, the present study was developed to examine the mediating role of identity shifting in the relationship between gendered racism and binge eating symptoms among young adult Black women. To test this assertion, we administered an online survey to 239 Black women (Mage = 27.32). The results indicated that gender racism significantly predicted both identity shifting and binge eating and identity shifting significantly predicted binge eating. Additionally, identity shifting accounted for 34.5 % of the associations between gendered racism and binge eating symptoms. These findings highlight the importance of exploring experiences of discrimination and coping strategies when considering ways to reduce mental health concerns, such as binge eating symptoms, among young adult Black women.

A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV

Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease PTSD symptoms by enhancing resilience, self-care, engagement in care, and coping for trauma, racism, HIV-related discrimination/stigma, and gender-related stressors. A pilot randomized control trial was conducted with BWLWH and histories of trauma who were at risk for their HIV viral load remaining or becoming detectable (i.e., below 80% medication adherence, detectable viral load in the past year, and/or missed HIV-related appointments). 119 BWLWH were assessed at baseline and 70 met inclusion criteria, completed one session of Life-Steps adherence counseling, and were randomized to either nine sessions of STEP-AD (Striving Towards EmPowerment and Medication Adherence) or ETAU (enhanced treatment as usual consisting of biweekly check-ins). Women completed a post intervention follow up assessment (3 months post baseline) and 3-month post intervention follow-up (6 months post baseline). Via STATA the difference-in-difference methodology with mixed models compared STEP-AD to ETAU on changes in outcomes over time. BWLWH in STEP-AD compared to E-TAU had significantly higher ART adherence (estimate = 9.36 p = 0.045) and lower likelihood of being clinically diagnosed with PTSD (OR = .07, estimate = − 2.66, p = 0.03) as well as borderline significance on higher CD4 count (estimate = 161.26, p = 0.05). Our findings suggest preliminary efficacy of STEP-AD in improving ART adherence, mental health, and immune function.

Gender-related stress factors and emotional perception in migraine: a structured online questionnaire in migraine patients and controls

BackgroundWhile migraine is markedly prevalent in women, gender-related phenotype differences were rarely assessed. For this reason, we investigated, through a multicenter observational cross-sectional study, based on an online questionnaire, gender-related differences in stress factors, emotions, and pain perception in migraine patients and controls and their impact on migraine severity.MethodsThe study was designed as an online questionnaire. The link was emailed to healthy subjects (C) and migraine patients (MIG) (age 18–75, education ≥ 13 years) recruited during the first visit in 8 Italian Headache Centers adhering to Italian Society for Headache Study (SISC). The questionnaire included personal/social/work information, the Perceived Stress Scale, the Romance Quality Scale, the Emotion Regulation Questionnaire, the Beck Anxiety Inventory, the Body Perception Questionnaire, the pain perception, and a self-assessment of migraine severity in the last 3 months.Results202 MIG and 202 C completed the survey. Independently from gender, migraine was characterized by higher pain sensitivity and more severe partner relationships. The female gender, in MIG, exhibited higher anxiety scores, body awareness, and reduced emotional suppression. Body awareness and emotional suppression were discriminating factors between genders in control and migraine groups without relevant influence on disease features. Perceived perception of migraine severity was similar between genders.ConclusionGender-related emotional and stress factors did not contribute to delineate a distinct phenotype in migraine men and women. The possible impact of emotional and stress factors characterizing genders could be considered for a single case–tailored therapeutic approach.

Relationship between COVID-related stressors and internalizing symptoms: Gendered neuroendocrine risk profiles

The COVID-19 pandemic generated significant life stress and increases in internalizing disorders. Moreover, COVID-related stressors disproportionately impacted women, consistent with outcomes showing a gender gap in stress-related disorders. Gender-related stress vulnerability emerges in adolescence alongside gender-specific changes in neuroendocrine signaling. Most research on the neuroendocrinology of stress-related disorders has focused on differences in the hypothalamic-pituitary-adrenal (HPA) axis effector hormone cortisol. More recent studies, however, emphasize dehydroepiandrosterone (DHEA), a neuroprotective and neuroactive hormone released concurrently with cortisol that balances its biobehavioral actions during stress. Notably, women show lower cortisol responses and higher DHEA responses to stress. However, lower cortisol and higher DHEA are associated with internalizing disorders in women, while those associations are opposite in men. Thus, gender-specific factors perhaps result in a neuroendocrine profile that places women at greater risk for stress-related disorders. The current study prospectively examined socially evaluated cold-pressor task (SECPT) induced neuroendocrine responses at age 15 and internalizing symptoms during the COVID-19 pandemic at age 21 in a cohort of 175 primarily Black low-socioeconomic status participants, while controlling for internalizing symptoms at age 15. The association between COVID-related stress and internalizing symptoms was not stronger in women. Lower DHEA-cortisol ratios were associated with a weaker relationship between COVID-related stress and internalizing symptoms in women, while higher ratios were associated with a weaker relationship in men. These findings suggest gender differences in the relationship between DHEA and cortisol and internalizing outcomes during a stressful period, and support differential neuroendocrine protective and risk pathways for young men and women.

How Do Fieldworkers in Poverty Craft Meaningful Roles to Achieve Social Impact? Female Teachers in Slums in India

Prior research has adopted a job-crafting perspective to explain why employees attempt to craft their roles meaningfully (Wrzesniewski & Dutton, 2001). We explore this theoretical lens in a new context that is particularly challenging for workers and where it would seem unlikely to apply: poverty. More specifically, we study female teachers in slums in India. We use a mixed-methods approach—first qualitative research, then quantitative research—to contextualize job-crafting theorizing by identifying, conceptualizing, and testing situational challenges and enablers in regard to meaningful work in this context. More specifically, we develop and corroborate new theory suggesting that poverty- and gender-related stressors deplete teachers’ energy and resources, limiting relational job crafting, but that teachers’ identification with the community helps to counteract this challenge, ultimately increasing their social impact. More fundamentally, we show how job-crafting theorizing, contextualized in a poverty setting, helps to understand how social organizations, through their fieldworkers (e.g., female teachers), create social impact.

Supplemental Material for Development and Validation of the Trans and Nonbinary Coping Measure (TNCM): A Measure of Trans and Nonbinary Specific Ways of Coping With Gender-Related Stress

Supplemental Material for Development and Validation of the Trans and Nonbinary Coping Measure (TNCM): A Measure of Trans and Nonbinary Specific Ways of Coping With Gender-Related Stress

Experiencing Burnout: John Henryism, Gender Role Conflict, and Anxiety Among Incarcerated Black Men.

At the intersection of race and gender, Black men encounter conflicting and often stress-inducing gender norms. Research suggests Black men may utilize John Henryism Active Coping (JHAC), a culturally-relevant strategy to manage stress. However, little is known about how incarcerated Black men cope with gender role conflict (GRC) and resulting psychological distress. To better understand stressors and coping strategies among Black male prisoners, the current study examined the relationships between GRC, anxiety, and JHAC among N = 193 incarcerated Black men nearing community reentry. Hierarchical linear regression results showed length of incarceration, GRC, and anxiety were all negatively associated with JHAC. Full-time employment prior to incarceration was positively associated with JHAC. Moderation analyses indicated anxiety increased the strength of the negative association between GRC and JHAC. Implications highlight incarcerated Black men may benefit from interventions that encourage active coping strategies to manage gender-related stress and anxiety.

Coping, resilience, and social support among transgender and gender diverse individuals experiencing gender-related stress.

Coping, resilience, and social support among transgender and gender diverse individuals experiencing gender-related stress.

A Qualitative Assessment of Gender- and Race-Related Stress Among Black Women.

Background: Chronic psychological stress has been associated with several adverse health outcomes, including obesity. Black women report higher levels of psychological stress than White women and carry a disproportionate burden of chronic conditions associated with psychological stress, including obesity. Research also suggests that in addition to generic stressors, Black women also experience race- and gender-related stress. To further explore this, we conducted structured focus groups to examine Black women's perspectives about stress.Materials and Methods: Using the nominal group technique, three sessions (total, n = 33) were conducted exclusively with Black women to solicit responses to the following questions: (1) What are the top sources of stress for women? (2) What are the top stressors specifically for Black women? and (3) How do these stressors affect weight? Using a systematic method, participants ranked responses in order of importance. Responses were compiled and tabulated to identify which statements were viewed as most important by respondents.Results: Mean age and body mass index of participants were 43.0 ± 10.1 years and 35.1 ± 7.9 kg/m2, respectively. The top 3 responses for question 1 were health, family, and relationships. Safety of children and raising Black children, being the head of the family, and finances were the top responses for question 2. Emotional eating, not enough time for exercise, and eating fast food due to lack of time or money were voted as the top reasons as to how stressors influence women's weight.Discussion: Our findings are consistent with previous work reporting that, along with generic stress, race- and gender-related stress contribute to the overall experiences of Black women. This work adds qualitative depth to allow for a better understanding of the unique sources of stress for Black women. These gender- and race-related stressors should be considered when offering stress management interventions for weight loss and general health promotion among Black women.

Transgender Youth Referred to Clinics for Gender-Affirming Medical Care in Canada.

Referrals of transgender and gender-diverse (trans) youth to medical clinics for gender-affirming care have increased. We described characteristics of trans youth in Canada at first referral visit. Baseline clinical and survey data (2017-2019) were collected for Trans Youth CAN!, a 10-clinic prospective cohort of n = 174 pubertal and postpubertal youth <16 years with gender dysphoria, referred for hormonal suppression or hormone therapy, and 160 linked parent-participants. Measures assessed health, demographics, and visit outcome. Of youth, 137 were transmasculine (assigned female) and 37 transfeminine (assigned male); 69.0% were aged 14 to 15, 18.8% Indigenous, 6.6% visible minorities, 25.7% from immigrant families, and 27.1% low income. Most (66.0%) were gender-aware before age 12. Only 58.1% of transfeminine youth lived in their gender full-time versus 90.1% of transmasculine (P < .001). Although transmasculine youth were more likely than transfeminine youth to report depressive symptoms (21.2% vs 10.8%; P = .03) and anxiety (66.1% vs 33.3%; P < .001), suicidality was similarly high overall (past-year ideation: 34.5%, attempts: 16.8%). All were in school; 62.0% reported strong parental gender support, with parents the most common support persons (91.9%). Two-thirds of families reported external gender-related stressors. Youth had met with a range of providers (68.5% with a family physician). At clinic visit, 62.4% were prescribed hormonal suppression or hormone therapy, most commonly depot leuprolide acetate. Trans youth in Canada attending clinics for hormonal suppression or gender-affirming hormones were generally healthy but with depression, anxiety, and support needs.

Longitudinal effects of psychotherapy with transgender and nonbinary clients: A randomized controlled pilot trial.

Minority stress has been determined to contribute to some mental health concerns for transgender, nonbinary, and gender nonconforming individuals, yet little is known regarding interventions to decrease the effects of minority stress. The purpose of this pilot study was to assess the feasibility and relative effectiveness of two interventions developed for work with transgender clients. Transgender individuals (N = 20) were recruited to participate in a randomized controlled trial comparing two psychotherapy interventions for transgender adults seeking psychotherapy for a variety of concerns: (a) transgender affirmative psychotherapy (TA) and (b) Building Awareness of Minority Stressors + Transgender Affirmative psychotherapy. Gender-related stress and resilience were assessed before, immediately after, and 6 months following the intervention; psychological distress and working alliance were assessed at these three time points as well as weekly during the intervention. Feasibility and acceptability of the study and psychotherapy interventions were supported. Exploratory analyses indicate improvement in both groups based on general outcome measures; targeted outcome measures indicate a trend of improvement for internalized stigma and nonaffirmation experiences. Results from this study support further evaluation of both treatment arms in a larger randomized controlled trial. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Disparities in disordered eating between gender minority and cisgender adolescents.

Adolescence is a developmental period of increased risk for disordered eating. Gender minority adolescents (GMAs), or those whose gender identity does not align with their sex assigned at birth, may experience body image concerns related to unique gender-related stressors. GMAs may use disordered eating to affirm a feminine, masculine, or nonbinary gender identity. However, little is known about differences in disordered eating between GMAs and cisgender adolescents. Therefore, this study had two primary goals: (a) to compare disordered eating between GMAs and cisgender adolescents by examining the role of gender identity and sex assigned at birth; and (b) within GMAs, to examine associations between gender identity congruence and disordered eating. A large U.S. sample of GMAs and cisgender adolescents (n = 1,191 GMAs; 919 cisgender; Mage = 15.93 years) reported their disordered eating on an anonymous online survey. A MANOVA revealed a significant interaction between gender identity and sex assigned at birth. Follow-up ANOVAs demonstrated that purging, caloric restriction, excessive exercise, and muscle building differed as a function of gender identity and sex assigned at birth. Among GMAs, a multiple multivariate regression model demonstrated that disordered eating was lower among participants who reported greater gender identity congruence. GMAs should not be considered a homogenous group, as differences in gender identity may lead to the internalization of different appearance ideals and disparate eating disorder symptomatology. Results suggest that clinicians working with GMAs consider the unique body image concerns that could accompany a specific gender identity.

"A woman's life is tension": A gendered analysis of women's distress in poor urban India.

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women’s perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression “tension” to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women’s distress and the need for scholarship on women’s mental health in low-income settings to be more attuned to gendered forms of marginalization.

Dealing with gender-related and general stress: Substance use among Brazilian transgender youth

IntroductionAdolescent substance use is a major public health concern since it enhances adolescent morbidity and mortality, affecting adulthood health and well-being. Although current evidence shows a high risk for substance use among transgender populations, to date, few studies evaluate substance use among transgender youth. MethodBrazilian transgender youth (ages between 16 and 25 years old) answered an online questionnaire measuring demographics, substance use and modifiable factors associated with drug use to deal with general stress, gender-related stress, and recreational use. ResultsCannabis was the most frequent substance used among transgender youth (20.88%; CI 95% 23.71–36.19), whereas 11.45% (CI 95% 11.38–21.47) of volunteers disclosed use of pain medication, such as codeine, and 5.05% (CI 95% 3.71–10.78) revealed use of sedatives and tranquilizers in the last 30 days. ADH medication (not prescribed), as well as cocaine and other drugs (such as antihistamines and Hookah), was also reported by 2.36% (CI 95% 0.92–5.84), 2.69% (CI 95% 1.24–6.49) and 4.04% (CI 95% 2.61–8.98) of transgender youth. ConclusionA logistic regression model showed that discrimination and home instability were the primary determinants of vulnerable to substance use among youth. Therefore, the harm reduction strategies must affect the social and physical aspects of transgender youth lives.

Trans Students Who Leave College: An Exploratory Study of Their Experiences of Gender Minority Stress

This article reports findings from an exploratory study of 14 trans college students who had taken leave, dropped out, and/or transferred institutions. Participants shared complex reasons for leaving college, including institutional and interpersonal experiences of gender-related stress, namely unwelcoming or insensitive campus and classroom climates, as well as a lack of trans-affirming supports and services, which made gender transitions difficult and stressful. Lack of family support and financial and academic concerns, were often intertwined with gender minority stress and contributed to some participants' leaving.

Resilience takes a village: black women utilize support from their community to foster resilience against multiple adversities

ABSTRACTBlack women living with HIV (BWLWH) represent the highest percentage of women with HIV in the U.S. and experience worse health outcomes than other women living with HIV, in part due to experiences of trauma, racism, HIV-stigma, and stressors they face as women. However, their own stories of resilience in the face of multiple adversities and insights of community stakeholders may inform our field on how to best empower this population to strive despite adversities. Thirty BWLWH in the U.S. and fifteen community stakeholders were interviewed about women’s experiences and adaptive coping strategies used to cope with trauma, racism, HIV-stigma, and gender-related stressors. Interviews were coded using thematic content analysis. A major theme that spanned across interviews with BWLWH and community stakeholders was that resilience was fostered by members of their “village”. In the midst of or following adverse experiences BWLWH used social support from their children, grandchildren, other family members, friends/peers, and caring providers in order to overcome their adversities and focus on their health and well-being. Promoting resilience among BWLWH requires an understanding of the most adaptive strategies utilized to “bounce back” following or in the face of adversities. Our findings highlight that both BWLWH and community stakeholders recognize social support from their “village” as an importance resilience resource. Research and applied efforts need to be geared at strengthening both BWLWH and their “village” in order to promote resilience and reduce health disparities.

Still I rise: The need for self-validation and self-care in the midst of adversities faced by Black women with HIV.

Psychosocial factors of trauma and abuse, racial discrimination, HIV stigma, and gender-related stressors (e.g., prioritizing others' needs) have been associated with antiretroviral treatment (ART) nonadherence and poor viral suppression among Black women living with HIV (BWLWH). To inform the development of an intervention addressing these psychosocial factors to improve ART adherence, the authors sought the insight of BWLWH. Qualitative semistructured interviews were conducted with 30 BWLWH to gather information on their experiences with trauma, racism, HIV stigma, gender-related stressors, ART adherence, and coping strategies, and their insights on the proposed intervention. Participants' interviews were audio-recorded, transcribed, and coded using thematic content analysis and grounded theory. Participants shared (a) their experiences with trauma/abuse, racism, HIV-stigma, gender-related stress, and medication adherence; (b) coping strategies they use (e.g., social support, awareness [acknowledging systemic racism], assertiveness, selective disclosure of HIV status, and prioritizing the self); (c) how each of these adversities relate to their medication adherence and how they found ways to self-validate and practice self-primacy and self-care, including medication adherence in spite of adversities; and (d) enthusiasm for the proposed intervention. Culturally adapted interventions are needed to improve the health of BWLWH by enhancing coping strategies for the multiple adversities they face and promoting self-validation, self-primacy, and self-care in spite of adversities. (PsycINFO Database Record

Relationship among gender-related stress, resilience factors, and mental health in a Midwestern U.S. transgender and gender-nonconforming population

ABSTRACT Background: Transgender and gender-nonconforming individuals experience more discrimination than their cisgender peers, and this discrimination can be associated with poorer mental health. This study used the gender minority stress model as a framework to examine the relationship among gender-related stressors and resilience factors and mental health outcomes. The study particularly aimed to increase knowledge of the gender-nonconforming population.Methods: A community sample of 83 individuals that identify as a gender different than the sex assigned to them at birth completed an online survey. Depression and anxiety were assessed using the Center for Epidemiological Studies Depression Scale (CES-D) and Beck Anxiety Inventory (BAI), respectively. The Gender Minority Stress and Resilience measure was used to assess distal and proximal stressors and resilience factors.Results: The median CES-D and BAI scores were 16 and 13, respectively. Forty percent had a history of non-suicidal self-injury (NSSI), 75% had experienced suicidal ideation, and 45% had attempted suicide. Proximal stress was found to be a positive predictor of depressive symptoms. Resilience was a weak negative predictor of anxiety symptoms. Distal stress was a positive predictor of suicide attempts, and resilience factors and hormone use were marginal negative predictors of suicide attempt. Trans women were significantly less likely to have engaged in NSSI, but had a significantly higher proximal stress score than trans men and gender-nonconforming individuals.Conclusion: Our study found high rates of mental health problems in the trans and gender-nonconforming sample. Our findings in part support the gender minority stress model, with gender-related stress predicting certain mental health problems and resilience being a negative predictor. Overall, gender-nonconforming individuals have had similar experiences and mental health findings as transgender individuals.