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. Author manuscript; available in PMC: 2024 Jan 1.
Published in final edited form as: Psychol Sex. 2022 Nov 16;14(2):399–415. doi: 10.1080/19419899.2022.2143276

Transgender and gender expansive emerging adults: The moderating role of thwarted belongingness on mental health

Keith J Watts 1, Angela Matijczak 2, Camie A Tomlinson 2, M Alex Wagaman 2, Jennifer L Murphy 2, Kelly O’Connor 3, Shelby E McDonald 4
PMCID: PMC10292787  NIHMSID: NIHMS1857300  PMID: 37378301

Abstract

Transgender and gender expansive emerging adults experience multiple forms of gender minority stress, which affect their mental health and wellbeing. Belongingness has been identified as a factor that fosters resilience among this population, with potential protective effects. Few studies have explored the role of thwarted belongingness and its potential moderating effect on the relation between gender minority stress and mental health. This study recruited a sample of 93 transgender and gender expansive emerging adults between the ages of 18 and 21 to examine whether thwarted belongingness significantly moderates the relations between gender minority stressors and mental health symptoms. We found evidence that thwarted belongingness moderates the relation between social rejection and depressive symptoms and the interaction effect between thwarted belongingness and victimization was significantly associated with psychological stress. For both of these associations, high levels of thwarted belongingness amplified the positive relation between gender minority stress and mental health symptoms. In contrast, at low levels of thwarted belongingness, the relation between rejection and depression was negative and the association between victimization and psychological stress was no longer statistically significant. Findings suggest that factors that minimize or interrupt thwarted belongingness among transgender and gender expansive emerging adults may be points of intervention to improve mental health outcomes in this population.

Keywords: gender minority stress, transgender, nonbinary, emerging adults, mental health

Introduction

Studies examining health and wellbeing in sexual and gender minority populations suggest that transgender and gender expansive (TGE) individuals are at increased risk for mental health problems due to exposure to unique minority stressors (e.g., societal transphobia, gender-based victimization, rejection, violence, and discrimination) compared to their cisgender peers (Grant et al., 2011; Hatchel et al., 2018; Hendricks & Testa, 2012; Lombardi, 2009; Meyer, 2003; Price-Feeney et al., 2020; Scandurra et al, 2017; Testa et al., 2015). Relative to the general U.S. population, TGE individuals report significantly higher levels of anxiety and depression (Clements-Nolle et al., 2001; Kessler et al., 2005). Researchers often use the minority stress theory (Meyer, 2003) to understand the unique and chronic stress that individuals from minoritized groups (such as TGE people) endure due to experiences of stigmatization and discrimination, as well as the subsequent potential for negative life outcomes. Specifically, minority stress theory posits that, in addition to the common stressors of life, such as the death of a family member or loss of a job, individuals from stigmatized groups (e.g., gender minorities) encounter additional forms of stress (Meyer, 1993, 2003).

Within this framework, stressors are described on a continuum from distal (objective events and conditions) to proximal personal processes (individual, subjective perceptions and appraisals). Distal stressors are independent of an individual’s identification with a particular minoritized gender identity category, such as being assumed TGE by someone who does not know how one actually identifies, and can lead to experiences of prejudice (e.g., harassment or violence). Proximal stress processes are related to one’s self-identification as TGE (Meyer, 1993, 2003). For example, TGE individuals may internalize social stigmas and develop feelings of shame, sadness, and/or anger directed at their sexual orientation and/or gender identity (Meyer, 1993, 2003).

Although often utilized in research that examines gender identity and mental health, the minority stress model was developed with a focus on cisgender individuals with minoritized sexual orientations/identities. Building on minority stress theory, the gender minority stress and resilience (GMSR) model (Hendricks & Testa, 2012; Testa et al., 2015) explores the ways that external (i.e., distal) and internal (i.e., proximal) stressors related to a TGE identity can influence the mental health and well-being of gender expansive people (Hendricks & Testa, 2012; Testa et al., 2017). The GMSR model maintains that chronic exposure to external stress processes, such as gender minority-based victimization, rejection, discrimination, and identity nonaffirmation (Hendricks & Testa, 2012; Testa et al., 2015), are associated with internal processes such as negative expectations, internalized transphobia, and nondisclosure of gender identity (Hendricks & Testa, 2012). Among TGE populations, exposure to distal stressors have also been linked to a host of negative psychosocial outcomes, such as anxiety, depression, posttraumatic stress disorder, body dissatisfaction, suicidal ideation, and global psychological distress (Hughto et al., 2021; Hunter et al., 2021; Klemmer et al., 2021; Nemoto et al. 2011; Price-Feeney et al., 2020; Trujillo et al., 2017; Wilson et al., 2016).

One potential protective factor that has emerged as a focus of recent studies is the role of perceived belongingness (i.e., feelings of personal involvement and integration within one’s community or environment) in buffering the harmful impact of gender minority stress on psychological well-being. Belongingness theory asserts that the desire to create significant and positive interpersonal relationships that endure over time, even when there is no perceptible material advantage, is an innate human motivation (Baumeister & Leary, 1995). It is understood that this need to belong is as integral to our survival as sustenance and shelter. Indeed, Maslow (1954) ranked the need to belong as third, following physiological needs (e.g., thirst) and the need for safety and security.

There is evidence that belongingness is associated with lower feelings of hopelessness and reduced suicidal ideation, as well as reduced sensitivity to minority stress in TGE populations (Budge et al., 2019; Hatchel et al., 2018). Moreover, belongingness has been found to promote self-esteem and psychological well-being in TGE populations (Barr et al., 2016). Feeling connected to a community of people that are perceived to be similar is an important part of mental health among TGE individuals (Frost & Meyer, 2012; Hunt et al., 2020; Pflum et al., 2015; Sanchez & Vilain, 2009); indeed, a recent study found that TGE youth report caring relationships as important sources of support when dealing with difficult life events (Hunt et al., 2020). Identity-based affinity groups and communities can provide group-level resources which counter distal gender-based stressors and can serve to affirm and validate the emotional experiences of TGE individuals related to discrimination (Frost & Meyer, 2012; Hendricks & Testa, 2012).

Notably, when individuals with minoritized identities lack a sense of belongingness and social support, it can reduce their ability to cope with negative experiences, whereas the presence of these factors can enhance resilience (Frost & Meyer, 2012; Folkman & Lazarus, 1980; Hagerty & Williams, 1999). Although belongingness and social support may have similar effects on one’s ability to cope with challenges, it is important to clarify what distinguishes these concepts. Social support has been described as “support accessible to an individual through social ties to other individuals, groups, and the larger community” (Lin et al., 1979). A sense of belongingness moves beyond these social ties and external sources of support to include a sustained perception of the self as an active participant in the development and/or maintenance of a group or community (Baumeister & Leary, 1995; Shotter, 1993).

In contrast, thwarted belongingness, a component of the interpersonal psychological theory of suicide, is defined as a lack of interaction with others, lack of caring relationships that are reciprocal, and little to no social support (Joiner, 2005; Van Orden et al., 2010). Evidence suggests that feeling socially ostracized, which may impede feelings of belongingness within a community, is linked to several negative outcomes, such as lowered self-esteem, greater feelings of helplessness and psychological distress, impaired cognitive functioning, a reduced sense of control or meaningful existence, and the dehumanization of oneself and others (Bastian & Haslam, 2010; Buelow et al., 2015; O’Reilly & Robinson, 2009; Waldeck et al., 2017; Williams & Nida, 2011).

One example of how thwarted belongingness manifests is through the social isolation that TGE people often experience due to rejection from families, friends, and peers (Grossman et al., 2016; Hendricks & Testa, 2012; Testa et al., 2017). In a recent qualitative study, Hunt et al. (2020) found that TGE youth described thwarted belongingness as feelings of rejection and isolation and included experiences of lack of care or support, feelings of disconnection, rejection of one’s gender or sexual identity by others, and being forced into mental health treatment. Participants reported rejection of their gender identity or sexuality (e.g., refusal to use gender-affirming names and pronouns and belittling for failing to conform to gender expectations) as a particularly frequent occurrence. The severity of mental distress from such experiences of rejection and isolation were reported as leading to self harm, suicidal ideation, and suicide attempts (Hunt et al., 2020).

Current Study

Although the concept of thwarted belongingness has primarily been examined in research focused on suicide, it also may be useful in understanding how a lack of belongingness may operate within the context of relations between minority stressors and other mental health outcomes in TGE populations. In particular, does thwarted belongingness further compound the relations between exposure to distal stressors and mental health among TGE emerging adults? This study aimed to add to current knowledge by investigating thwarted belongingness as a moderator of the relations between gender-based distal minority stressors and mental health outcomes in a sample of emerging adults. We hypothesized that thwarted belongingness would moderate the relation between each of the three forms of distal gender minority stress (e.g., discrimination, victimization, rejection) and each form of mental health symptoms (e.g., anxiety, depressive, psychological stress). More specifically, we hypothesized that participants with high levels of thwarted belongingness would experience a stronger relation between distal gender minority stressors and mental health symptoms.

Method

The present study includes data obtained from an overarching study investigating stressors and supports experienced by sexual and gender minority youth, ages 15 to 21 years, living in or near a southeastern city in the U.S. The purpose of the overarching study was to investigate how different sources of social support (e.g., support from friends, family, companion animals) may influence the relation between minority stressors and mental health. The current study includes a subsample from this overarching study of participants who identified as TGE, as few studies have investigated the construct of thwarted belongingness within TGE-exclusive samples. Given only nine adolescents (i.e., 15–17 year olds) participated in the study, we chose to focus on a subsample of emerging adult participants between the ages of 18 and 21 years, who endorsed TGE identities. Participants were given twelve gender options to select from, including an option to self-identify and were able to choose multiple genders. Two of the options were cisgender woman and cisgender man. Participants who selected one of these and did not select another gender identity were excluded from this study. In addition, participants who only selected that they were questioning their gender identity were excluded from this study. Therefore, our study includes a sample of 93 participants (Mage = 19.45 years, SD = 1.11; 36.6% minoritized racial/ethnic identity, including those who identified as biracial or multiracial) recruited from an urban city in the Mid-Atlantic region of the U.S. A majority (97.8%) of participants also identified with a minoritized sexual orientation/identity. Nearly all participants indicated they were current students (87.1%), and more than half of our sample had completed at least some university coursework (64.5%). Table 1 provides additional participant demographics.

Table 1.

Demographic Information (N = 93)

Variable name Variable categories Frequency %
Racial/ethnic identity Asian/Asian American 2 2.2
Black/African American 8 8.6
Latina/Latino/Latinx 3 3.2
Multiracial/Mixed Race 20 21.5
White 59 63.4
Prefer to self-describe 1 1.1
Gender identity1 Agender 6 6.5
Cisgender man 2 2.2
Cisgender woman 4 4.3
Genderfluid 12 12.9
Genderqueer 20 21.5
Nonbinary 43 46.2
Transgender man 24 25.8
Transgender woman 3 3.2
Questioning 13 14.0
Prefer to self-describe 6 6.5
Sexual orientation1 Asexual 12 12.9
Bisexual 37 39.8
Demisexual 3 3.2
Gay 13 14.0
Lesbian 15 16.1
Pansexual 21 22.6
Queer 40 43.0
Straight/heterosexual 3 3.2
Questioning 9 9.7
Prefer to self-describe 2 2.2
Current student status No 12 12.9
Yes 81 87.1
Highest level of education completed High school or less 33 35.6
Some college, no degree 54 58.1
Associate degree 3 3.2
Bachelor’s degree 3 3.2
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1

Participants were able to select any identities that described their gender identity and sexual orientation. These categories are not mutually exclusive.

Procedures

Data were collected between April 2019 and November 2021. We partnered with five local, community-based organizations serving LGBTQ+ young people and their families to assist in recruitment and consult on study procedures. Participants were recruited through a variety of methods (e.g. posting flyers, advertising through social media, conducting information sessions), and recruitment materials included phone and email information that interested individuals could use to contact the study’s project coordinator. Participants completed a screening interview via phone call with the project coordinator. Eligibility criteria for the overarching study included being between 15 and 21 years of age, self-identifying as LGBTQ+, and being able to understand spoken English. Individuals who met inclusion criteria were invited to complete an in-person survey at either a local partner organization or at a designated, private location at the university; participants were able to choose which location they were most comfortable with. Surveys were conducted via Zoom (Version 7) following March 16, 2020 in order to adhere to COVID-19 public safety guidelines and to maintain the safety of both participants and the research team, with 33.3% of participants (n = 31) completing study procedures through Zoom.

Research assistants began by describing the study to participants and obtaining informed consent. Participants then completed nine survey measures either by self-administration through Red-Cap using a research team laptop or by having the research assistant administer the measures verbally. All participants in the current study elected to self-administer the survey. Each participant was compensated with either cash or check. This study received IRB approval from Virginia Commonwealth University for all procedures.

Measures

Gender Minority Stress

Exposure to gender minority stress was measured using the Gender Minority Stress and Resilience Scale (GMSR; Testa et al., 2015). This scale includes seven domains of stress (i.e., discrimination, rejection, victimization, non-affirmation, internalized transphobia, negative expectations for the future, non-disclosure of gender identity/history). In this study, we utilized the discrimination (ω = .73), rejection (ω = .53), and victimization (ω = .66) subscales as indicators of distal minority stress, or stressors that are experienced from people or environments with which the participant comes in contact. The discrimination subscale includes five items (e.g., “I have had difficulty getting medical or mental health treatment because of my gender identity or expression,” “I have had difficulty finding housing or staying in housing because of my gender identity or expression”); the rejection subscale (e.g., “I have been rejected by or made to feel unwelcome by a religious community because of my gender identity or expression,” “I have been rejected or distanced from family because of my gender identity or expression”) and the victimization subscale (e.g., “I have had my personal property damaged because of my gender identity or expression” “I have been pushed, shoved, hit, or had something thrown at me because of my gender identity or expression”) each consist of six items. For each subscale item, participants were assigned a value of ‘1’ if they indicated that they had experienced a specific form of discrimination, rejection, or victimization in their lifetime. Subscale scores were calculated by summing the item values; high scores indicate greater exposure to gender minority stress. Although the omega coefficients for the rejection and victimization subscales were below the standard cut-off score (i.e., .70), items on the GMSR subscales summarize the number of different forms of discrimination, rejection, and/or victimization experienced by participants across multiple contexts and relationships. The subscales may not, therefore, represent an underlying unidimensional construct. As McDonald’s omega is calculated based on a single latent factor model (Hayes & Coutts, 2020), we do not consider it problematic that some of the omega coefficients are below standard cut-off scores, as these variables are similar to count variables (total number of experiences). Thus, these three subscale scores represent the number of types of gender minority discrimination, rejection, and victimization experiences endorsed by participants, not the total frequency or severity of occurrence.

Anxiety, Depressive, and Psychological Stress Symptoms

The Brief Symptom Inventory (BSI; Derogatis & Savitz, 2000) is a 53-item self-report scale aimed at measuring the frequency of acute mental health symptoms experienced within the past 7 days. For these analyses, we used the 6-item anxiety (ω = .85) and depression (ω = .88) subscales, as well as the overall psychological stress (ω = .96) scale. Sample items include “feeling fearful”, “poor appetite,” and “feeling no interest in things.” Response options varied on a 5-point Likert scale, ranging from 0 (not at all) to 4 (extremely). Total scores for each scale were calculated by averaging all endorsed items for each respective scale; high scores indicate greater mental health symptoms.

Thwarted Belongingness

The 9-item thwarted belongingness subscale of the refined, 15-item Interpersonal Needs Questionnaire (INQ; Van Orden et al., 2012) was used to measure thwarted belongingness. This measure asks participants to report on how they’ve been feeling recently using a 7-point Likert scale ranging from 1 (not at all true to me) to 7 (very true to me). The thwarted belongingness scale includes items such as “These days, I often feel like an outsider in social gatherings” and “These days, I feel like I belong” (reverse scored). All nine items were averaged to yield a total thwarted belongingness (ω = .90) score, in which a high score indicates greater thwarted belongingness.

Covariates

We adjusted for six covariates in our analyses: age, race/ethnicity, gender identity, extent to which current basic needs are met, perceived social support, and participation prior to the onset of the COVID-19 pandemic. Age, race/ethnicity, basic needs, and gender identity were assessed using the demographic questionnaire. Race/ethnicity was dichotomized in which a value of 0 indicated White, non-hispanic and a value of 1 indicated minoritized racial/ethnic identity. Gender identity was also dichotomized into the following groups: a value of 0 reflected binary transgender participants (i.e. transgender man, transgender woman; n = 23) and a value of 1 reflected nonbinary/gender expansive participants (e.g. agender, genderfluid, nonbinary; n = 70). Our prior research with youth and young adults suggests that estimating household income, particularly that of one’s family of origin, is something that many young people are unsure how to do; therefore, to assess socioeconomic status, we used a proxy measure of “needs met” (e.g., housing, clothing). Perceived social support was measured using the total average score of the Multidimensional Scale of Perceived Social Support (ω = .83; Zimet et al., 1988). To adjust for additional COVID-19 related stress and the shift to virtual study procedures, a dichotomous variable was created to indicate whether participation occurred prior to (=0) or after (=1) the onset of these COVID-19 restrictions.

Analytic Plan

All statistical analyses were conducted using IBM SPSS Statistics (Version 27), and individual moderation analyses were conducted using PROCESS (Hayes, 2017). We tested nine moderation models (see Figure 1) to determine whether, and to what extent, thwarted belongingness moderated the relation between gender minority stress (i.e., discrimination, rejection, victimization) and mental health (i.e., anxiety, depression, and overall psychological stress symptoms). The effects of age (continuous), gender identity (dichotomous: transgender = 0; nonbinary, gender expansive = 1), race/ethnicity (dichotomous: White/non-Hispanic = 1, minoritized race/ethnicity or multiple racial/ethnic identities = 0), the extent to which current basic needs are met (continuous), perceived social support (continuous), and whether participation occurred prior to (=0) or after (=1) the onset of COVID-19 restrictions were adjusted for in each model.

Figure 1. Conceptual Model for Moderation Analyses.

Figure 1.

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Note. Covariates are not displayed in the figure for clarity.

Variables were standardized to reduce multicollinearity prior to the moderation analysis (Baron & Kenny, 1986). We also tested for multivariate assumptions of normality, linearity, multicollinearity, singularity, and homoscedasticity, which were all met. Mahallanobis distance scores were computed and indicated that there were no outliers. We conducted a post-hoc power analysis using G*Power software (Faul et al., 2009); the results indicated that our sample size (n = 93) was sufficient (> .80) to detect a hypothesized incremental medium effect size (f2 = .15), or large (f2 = .35) effect size (Cohen, 1977) at an alpha level of .05 and a critical F value of 3.96. However, we had less than adequate power to detect a small effect size (f2 = .02).

Results

The intercorrelations, means, and standard deviations are displayed in Table 2. The outcome variables (i.e., depressive symptoms, anxiety symptoms, psychological stress) were significantly correlated at p < .001. Similarly, correlations between discrimination, rejection, and victimization were statistically significant; however, these effects (r = 0.37–0.55) were not strong enough to violate the assumption of multicollinearity based on tolerance and VIF (Hair et al., 2010). Thwarted belongingness was positively correlated with anxiety symptoms (r = 0.21, p < .05), depressive symptoms (r = 0.56, p < .001), and psychological stress (r = 0.49, p < .001). Current basic needs was negatively correlated with psychological stress (r = −0.22, p < .05) and social support was negatively correlated with all outcome variables (anxiety symptoms: r = −0.28, p < .05; depressive symptoms: r = −0.41, p < .001; psychological stress: r = −0.42, p < .001). There were no other statistically significant associations between covariates (i.e., age, race/ethnicity, extent to which current basic needs are met, social support, gender identity, and participation pre- or during COVID-19 restrictions) and outcome variables in any of our moderation models. We retained all covariates in the moderation analyses as excluding them did not affect our power.

Table 2.

Correlations, Means, and Standard Deviations (SD) for Constructs of Interest (N = 93)

Variable M / # SD / % 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Age 19.45 1.11 -
2. Race/ethnicitya 59 63.4 .05 -
3. Gender identityb 70 75.3 .05 .03 -
4. Basic needs 3.74 .44 −0.07 −0.04 −0.05 -
5. Social support 5.12 1.02 −0.11 −0.08 −0.16 .27** -
6. Covid-19c 31 33.3 −0.10 −0.17 .09 .26* .09 -
7. Discrimination 1.92 1.48 −0.01 .17 −0.44*** −0.33** .02 −0.17 -
8. Rejection 3.02 1.55 −0.15 −0.12 .02 −0.26* −0.15 −0.11 .37*** -
9. Victimization 1.43 1.31 −0.04 .15 −0.14 −0.24* −0.14 −0.11 .51*** .55*** -
10. Thwarted belongingness 28.99 11.00 .16 .03 .11 −0.14 −0.66*** −0.03 −0.14 .04 .02 -
11. Anxiety 1.97 .72 −0.01 −0.01 .17 −0.14 −0.28** −0.15 −0.07 .14 .10 .21* -
12. Depression 1.94 .86 .06 −0.04 .18 −0.16 −0.41*** −0.04 −0.12 .08 .03 .56*** .50*** -
13. Psychological stress 1.30 .69 .04 .03 .18 −0.22* −0.42*** −0.15 −0.07 .19 .20 .49*** .72*** .77*** -
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a

0 = racial/ethnic minority (n = 34 [36.6%] and 1 = White, non-Latinx; frequency and percentage reflect White, non-Latinx.

b

0 = transgender man or woman (n = 23 [24.7%]) and 1 = nonbinary/gender expansive (i.e., agender, genderfluid, genderqueer, nonbinary, prefer to self-describe, multiple identities; n = 70 [75.3%]); frequency and percentage reflect non-binary/gender expansive.

c

0 = participated before (n = 62 (66.7%) and 1 = participated after COVID-19 restrictions were established; frequency and percentage reflect participants after COVID-19.

*

p < .05.

**

p < .01.

***

p < .001.

Anxiety Symptoms

In our model with anxiety symptoms as the dependent variable, neither discrimination, β = −0.04, t(83) = −0.28, p = .780, nor thwarted belongingness, β = 0.06, t(83) = 0.42, p = .676, were significantly associated with anxiety symptoms. Results indicate that the relation between discrimination and anxiety symptoms was not significantly moderated by thwarted belongingness, ΔR2 < .001, F(1, 83) = 0.02, β = −0.02, t(83) = −0.14, p = .890. Additionally, the overall model did not significantly account for the variance in anxiety symptoms R2 = .12, F(9, 83) = 1.30, p = .249.

We found similar results in our model with rejection as the independent variable. Specifically, rejection, β = 0.07, t(83) = 0.66, p = .513, and thwarted belongingness, β = 0.07, t(83) = 0.48, p = .629, were not significantly related to anxiety symptoms. Further, thwarted belongingness did not moderate the relation between rejection and anxiety symptoms, ΔR2 < .001, F(1, 83) = 0.03, β = 0.02, t(83) = 0.18, p = .856. The model did not explain a significant amount of the variance in anxiety symptoms, R2 = .13, F(9, 83) = 1.35, p = .227.

Results of our model examining the relation between victimization and anxiety symptoms indicated that, neither victimization, β = 0.09, t(83) = 0.83, p = .407, nor thwarted belongingness were significantly related to anxiety symptoms, β = 0.07, t(83) = 0.53, p = .595. We also did not find evidence of a moderating effect of victimization by thwarted belongingness on anxiety symptoms, ΔR2 = .002, F(1, 83) = 0.19, β = −0.05, t(83) = 0.43, p = .667. The overall model did not significantly account for the variance in anxiety symptoms, R2 = .13, F(9, 83) = 1.39, p = .207.

Depressive Symptoms

In a model testing the moderating effect of thwarted belongingness on the relation between rejection and depression, rejection was not significantly related to depressive symptoms, β = 0.05, t(83) = 0.58, p = .567. Thwarted belongingness was significantly and positively associated with depressive symptoms, β = 0.52, t(83) = 4.50, p < .001, and was a significant moderator of the relation between rejection and depressive symptoms, ΔR2 = .04, F(1, 83) = 5.14, β = 0.23, t(83) = 2.27, p = .026. The overall model explained a significant proportion of the variance, R2 = .38, F(9, 83) = 5.77, p < .001. We did not find evidence of any significant conditional effects: the effect of rejection on depressive symptoms was not significant at high, β = 0.33, t(15) = 1.98, p = .051, 95% CI [−0.002, 0.66], moderate, β = 0.03, t(61) = 0.36, p = .722, 95% CI [−0.15, 0.22], or low levels of thwarted belongingness, β = −0.22, t(17) = −1.58, p = .118, 95% CI [−0.50, 0.06]. However, the visual plot in Figure 2 reflects that the relation between rejection and depressive symptoms changes at different levels of thwarted belongingness, although not at the specific high, medium, or low values tested in the conditional effects. Specifically, there was a positive relation between rejection and depressive symptoms at high levels of thwarted belongingness; however, when participants reported low levels of thwarted belongingness, rejection was negatively related with depressive symptoms. Further probing of the moderation using the Johnson-Neyman technique (Bauer & Curran, 2005; Hayes, 2017) indicates that the region of significance for the effect of rejection on depressive symptoms occurs when values of thwarted belongingness are greater than 1.20 (12.90% of the participants). These results suggest that there is a significant association between rejection and depressive symptoms when levels of thwarted belongingness are greater than or equal to 1.20.

Figure 2. Conditional Effects of Rejection on Depressive Symptoms as a Function of Thwarted Belongingness (N = 93).

Figure 2.

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Note. All variables of interest were standardized.

In the model testing the moderating effect of thwarted belongingness on the relation between discrimination and depressive symptoms, discrimination was not significantly associated with depressive symptoms, β = −0.01, t(83) = −0.12, p = .902, whereas thwarted belongingness was positively associated with depressive symptoms, β = 0.52, t(83) = 4.36, p < .001. We did not find evidence that thwarted belongingness moderated the effect of discrimination on depressive symptoms, ΔR2 < .001, F(1, 83) = 0.02, β = 0.02, t(83) = 0.15, p = .881. Although the moderation effect was not statistically significant, the overall model explained a significant amount of the variance in depressive symptoms, R2 = 0.35, F(9, 83) = 4.89, p < .001.

Similarly, we did not find evidence that victimization was significantly associated with depressive symptoms in the model examining the interaction between victimization and thwarted belongingness on depressive symptoms, β = 0.04, t(83) = 0.41, p = .681. Thwarted belongingness was positively associated with depressive symptoms, β = 0.54, t(83) = 4.55, p < .001. However, thwarted belongingness did not significantly moderate the relation between victimization and depressive symptoms, ΔR2 = .01, F(1, 83) = 1.60, β = 0.13, t(83) = 1.26, p = .210. Nevertheless, the overall model contributed significantly to the variance in depressive symptoms, R2 = .36, F(9, 83) = 5.16, p < .001.

Overall Psychological Stress

Whereas discrimination was not significantly related to psychological stress, β = −0.02, t(83) = −0.20, p = .842, thwarted belongingness was positively related to overall psychological stress, β = 0.41, t(83) = 3.32, p = .001. However, the effect of exposure to discrimination on psychological stress symptoms was not moderated by thwarted belongingness, ΔR2 = .006, F(1, 83) = 0.74, β = 0.09, t(83) = 0.86, p = .391. Regardless, the overall model accounted for 31% of the variance in psychological stress, F(9, 83) = 4.08, p < .001.

In a model examining the relation between rejection and overall psychological stress, rejection was not significantly associated with psychological stress, β = 0.15, t(83) = 1.53, p = .129. Thwarted belongingness, however, was positively associated with psychological stress, β = 0.40, t(83) = 3.37, p = .001, although there was no evidence of a significant moderating effect by thwarted belongingness, ΔR2 = .03, F(1, 83) = 3.84, β = 0.21, t(83) = 1.96, p = .054. This model explained 34% of the variance in psychological stress, F(9, 83) = 4.81, p < .001.

In our final model, the direct relation between victimization and psychological stress was not significant, β = 0.21, t(83) = 2.17, p = .033, whereas the relation between thwarted belongingness and psychological stress was significant and positive, β = 0.43, t(83) = 3.65, p = .001. We also found evidence of a moderated effect of victimization by thwarted belongingness on overall psychological stress, ΔR2 = .03, F(1, 83) = 4.12, β = 0.20, t(83) = 2.03, p = .046. As shown in Figure 3, there was a positive relation between victimization and psychological stress at moderate and high levels of thwarted belongingness (moderate: β = .19, t(61) = 2.01, p = .048; high: β = .44, t(15) = 2.71, p = .008). However, victimization was not significantly related to psychological stress for those who reported low levels of thwarted belongingness, β = −0.03, t(17) = −0.23, p = .817. Additionally, the overall model accounted for 36% of the variance in psychological stress, F(9, 83) = 5.15, p < .001.

Figure 3. Conditional Effects of Victimization on Psychological Stress Symptoms as a Function of Thwarted Belongingness (N = 93).

Figure 3.

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Note. All variables of interest were standardized.

Discussion

This study examined the potential moderating effect of thwarted belongingness on the relations between gender minority stress and mental health among TGE emerging adults. Although research evidence suggests that belongingness plays an important protective role for transgender people, few studies have explored the moderating effect of thwarted belongingness. Identifying potential risk and protective factors, such as thwarted belongingness, that can be targeted through interventions is critical to promote mental health outcomes among TGE young people. The study’s results suggest that the level of thwarted belongingness a TGE emerging adult experiences can exacerbate or amplify the relation between some forms of gender minority stress and aspects of mental health.

Our first hypothesis that gender minority stress would be positively associated with depressive symptoms, anxiety symptoms, and psychological stress was not supported. The lack of significant associations among distal gender minority stressors and mental health contradicts previous literature that has drawn clear connections between the experiences of gender minority stress and mental health and wellbeing generally (Grant et al., 2011; Hatchel et al., 2018; Hatzenbuehler & Pachankis, 2016; Hendricks & Testa, 2012; Lombardi, 2009; Meyer, 2003; Price-Feeney et al., 2020; Scandurra et al, 2017; Testa et al., 2015). It also raises important questions about the potential protective factors in the lives of the study participants that were not accounted for in the models, as well as the environments within which they are living. For example, the nature of the sample for this study may lend itself to having access to environments, social supports or other resources that promote coping in the face of discrimination or victimization. Most of the study participants attended school at the time of data collection and had some experience in a college environment, and only a small subset of the sample (n = 15) had high levels of thwarted belongingness.

Similarly, based on the specific stressors captured in the items on the GMSR that were used for this analysis, the study sample reported low levels of discrimination and victimization. All three forms of gender minority stress were assessed based on counting the forms of stress experienced as opposed to intensity or perception of the stressors. Previous research suggests that experiences of discrimination that one views as being related to external forces (i.e., lack of policy protections, ignorance of others) are less likely to be internalized as compared to those that are perceived as being related to one’s worth or individual character (i.e., rejection or exclusion by a person or community who is central to one’s identity; Major et al., 2003; Meyer, 2003). Similarly, it has been argued that “people are most likely to say that they were discriminated against when they feel they were treated unfairly because of their social identity” (Major & Dover, 2016, p. 215). Thus, the meaning one attributes to experiences of rejection, discrimination, or victimization matters and is an important factor for future research to examine.

Our second hypothesis that thwarted belongingness would moderate the relations between gender minority stress and mental health was partially supported. Specifically, in the relations found between rejection and depressive symptoms and the relations between victimization and overall psychological stress, thwarted belongingness was a significant moderator. The relations among rejection, thwarted belongingness, and depressive symptoms align with research evidence that thwarted belongingness plays a role in suicide risk (Hunt et al., 2020; Joiner, 2005; Silva, et al., 2015; Van Orden et al., 2010). As hypothesized, the relation between rejection and depression was strongest among those with high levels of thwarted belongingness. Importantly, at low levels of thwarted belongingness there was a negative relation between rejection and depressive symptoms in this sample, suggesting that there may be protective mechanisms at play when low levels of thwarted belongingness are present. The moderating effect of thwarted belongingness on the relations between victimization and overall psychological stress raises important questions about the mechanism of this relationship. Given the innate drive for humans to seek support and belonging during experiences of adversity (Hunt et al., 2020), it is possible that feeling as if one’s ability to belong has been thwarted will compound the relations between victimization and psychological stress. However, due to the cross-sectional nature of this study, we are not able to determine if the level of thwarted belongingness exacerbates the relations between victimization and psychological stress or if experiencing concurrent victimization and symptoms of psychological stress may cause individuals to become reluctant to pursue social connections and thereby exacerbate mental health symptoms over time. Future research should longitudinally explore how, under what conditions, and for whom, these relations occur in order to identify if this finding holds in other samples and may be an area of focus for intervention development.

It is important to note that although thwarted belongingness was not a significant moderator in many of the models, thwarted belongingness was significantly and positively related to depressive symptoms and psychological stress. This suggests that thwarted belongingness is an important construct relevant to the future study of TGE emerging adult mental health and wellbeing. This coincides with previous research linking thwarted belongingness and social ostracism with mental health problems (Waldeck et al., 2017; Wike et al., 2021; Williams & Nida, 2011). These findings warrant further research into direct relations between thwarted belongingness and mental health outcomes, particularly among marginalized populations.

Limitations

There are important limitations of the current study through which the results should be understood. First, the authors recognize the limitations of dichotomizing both gender (i.e., transgender vs. nonbinary/gender expansive) and race (i.e., White non-Hispanic vs. minoritized racial/ethnic identity) as covariates in the study, which does not allow for the broad spectrum of experiences to be reflected in the analysis and erases within group differences, particularly for people of color and nonbinary/gender expansive respondents. Second, there are limitations in the measures that may impact the results. The discrepancy between assessing gender minority stressors across a lifetime and mental health over the previous seven days may impact the ability to identify direct relations between these variables. Similarly, the GMSR has limitations in its use of scale scores given its design to count experiences of each form of stress in various sectors that may or may not be related to one another. Thus, as described in the measures section, reliability may be lower than desired when using scores that are computed from multiple variables. Further, this study was limited in using available standardized measures. There is a dearth of psychometrically tested measures that are able to represent the complexity and nuance of TGE individuals’ experiences. For example, the nuances of belonging - what it looks like, where it is found, and what is desired - among TGE emerging adults is not reflected in the measure used for this study. Additionally, we were not able to include information regarding belongingness within the TGE community or chosen families. Such limitations impact our ability to fully interpret the meaning of the findings. Finally, the sample size of the study limited our capacity to detect small effects. This should be kept in mind when interpreting the non-statistically significant findings of our study, as this may have been the result of our lack of power instead of actual lack of associations. Due to the large sample sizes required to detect small effect sizes in a moderation analysis, it is necessary for future research to continue to examine these relations with larger samples.

Future directions: Implications for practice and research

The findings of this study contribute to the existing knowledge base on the relations between gender minority stress and mental health for TGE emerging adults. Given that loneliness and social isolation have been framed as public health issues in the U.S. (Blazer, 2020; Hawkley & Cacioppo, 2003; Holt-Lunstad, 2017), and that TGE individuals are at increased risk for mental health challenges due to societal stigma and marginalization (Breslow et al., 2015; Hendricks & Testa, 2012; Hunt et al., 2020; Lombardi, 2009; Meyer, 2003; Nemoto et al., 2011; Testa et al., 2017), these findings point toward important areas for practice and future research. Specifically, this study offers insight into the role of thwarted belongingness as a factor that is associated with mental health as well as a potential risk factor that may exacerbate the relations between distal gender minority stressors and mental health. Our results highlight the need for interventions that aim to foster and facilitate belonging and decrease thwarted belongingness among TGE emerging adults to promote mental health in this population.

Practitioners should identify intervention strategies that support the reduction of individual, interpersonal, and environmental factors that thwart a TGE emerging adult’s ability to feel both connected to others and a part of something larger than themself. Previous research suggests that TGE people need connection and a perceived sense of belonging to a larger TGE community specifically. Given the measure of thwarted belongingness used in this study, we are limited in our ability to identify the extent to which thwarted belongingness was experienced in relation to other TGE people or in other contexts and relationships. Future research should explore the nature and mechanisms of thwarted belongingness that are specifically experienced by TGE populations and develop measures to adequately assess the extent to which it is experienced in relation to TGE community. Such research would support further exploration of risk and protection in the context of belonging for TGE people.

Although not hypothesized, we found that thwarted belongingness is associated with mental health among TGE emerging adults in this sample. The significant relations of thwarted belongingness with overall psychological stress and depressive symptoms suggests that thwarted belongingness - how it is developed and factors that reduce or enhance it - is important for practitioners to understand when serving TGE emerging adults. The significant association between thwarted belongingness and psychological stress, but lack of a significant interaction effect with rejection and discrimination, raises important questions about the role of thwarted belongingness in the relations between gender minority stressors and mental health, as well as other factors that may increase thwarted belongingness among TGE emerging adults.

As the cross-sectional design of this study does not lend itself to making causal claims, future research should examine the ways in which thwarted belongingness may be reciprocally related to gender minority stress and mental health symptoms (e.g., depression, anxiety) over time. Internalizing problems may make it difficult for TGE emerging adults to make meaningful connections with others as they may lead to social withdrawal or avoidance of social situations. Similarly, there may be underlying factors that foster a sense of thwarted belongingness that increase psychological stress among this population. For example, TGE university students have expressed that university environments that reinforce invisibility of TGE people in curriculum and other learning spaces make it difficult for students to find and connect with one another (Wagaman, et al, 2019). A deeper exploration of the directness of this relation, including the directionality and related factors that are not identified in the current study (e.g., proximal stressors, social anxiety, social isolation), will support the development and implementation of both individual mental health interventions as well as system-level interventions in environments and institutions with which TGE emerging adults must interact.

The authors acknowledge that there is little empirical evidence about the relation between belongingness (identified as a protective factor) and thwarted belongingness (a component of the interpersonal theory of suicide). Thus, the assumption that these are two interrelated concepts and that one gives us some indication of the other should be explored in future research, particularly for TGE youth and emerging adults. Such studies should aim to include samples of respondents that reflect a greater distribution of levels of thwarted belongingness. Future research should also consider the role of belonging within the TGE community and with chosen family using qualitative methods to explore nuances between thwarted belongingness occurring in non-TGE communities versus TGE communities. Additionally, future research may benefit from applying multiple moderation models to examine whether the relation between gender minority stress and mental health and wellbeing varies as a function of perceived social support (e.g., family, TGE community support) and thwarted belongingness, when the other is held constant.

Conclusion

TGE emerging adults face unique stressors and challenges to their wellbeing. Identifying factors, such as thwarted belongingness, that may exacerbate or mitigate the deleterious effects of gender minority stressors on mental health symptoms is valuable knowledge as we seek to design and deliver clinical interventions that promote resilience. This knowledge also offers insight into how we can shift institutions and systems in ways that reduce the barriers that TGE individuals face as they seek environments where they can be affirmed and supported in their wellness.

Acknowledgments:

Data collection for the LGBTQ+ Youth Supports study was funded by the VCU Presidential Research Quest Fund (PI: McDonald). The research reported in this publication is supported by a National Institute of Health, Health Disparities Loan Repayment Program Award through the National Institute of Child Health and Human Development (1L60HD103238-01; PI: McDonald). We would like to acknowledge the youth and young adults who participated in this research by graciously sharing their stories. We also thank the staff at Side by Side, Virginia League for Planned Parenthood, Nationz Foundation, and Health Brigade for their contribution to this work and continued investment in our project. We thank Dr. Traci Wike for her contributions to the research design and supervision of research assistants during the planning process. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Conflict of Interest Statement: The authors have no conflict of interest to declare.

References

  1. Baron RM, & Kenny DA (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. 10.1037/0022-3514.51.6.1173 [DOI] [PubMed] [Google Scholar]
  2. Barr SM, Budge SL, & Adelson JL (2016). Transgender community belongingness as a mediator between strength of transgender identity and well-being. Journal of Counseling Psychology, 63(1), 87–97. 10.1037/cou0000127 [DOI] [PubMed] [Google Scholar]
  3. Bastian B, & Haslam N (2010). Excluded from humanity: The dehumanizing effects of social ostracism. Journal of experimental social psychology, 46(1), 107–113. 10.1016/j.jesp.2009.06.022 [DOI] [Google Scholar]
  4. Bauer DJ, & Curran PJ (2005). Probing interactions in fixed and multilevel regression: Inferential and graphical techniques. Multivariate Behavioral Research, 40(3), 373–400. 10.1207/s15327906mbr4003_5 [DOI] [PubMed] [Google Scholar]
  5. Baumeister R, & Leary M (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497–529. 10.1037/0033-2909.117.3.497 [DOI] [PubMed] [Google Scholar]
  6. Blazer D (2020). Social isolation and loneliness in older adults—a mental health/public health challenge. JAMA Psychiatry, 77(10), 990–991. 10.1001/jamapsychiatry.2020.1054 [DOI] [PubMed] [Google Scholar]
  7. Breslow AS, Brewster ME, Velez BL, Wong S, Geiger E, & Soderstrom B (2015). Resilience and collective action: Exploring buffers against minority stress for transgender individuals. Psychology of Sexual Orientation and Gender Diversity, 2, 253–265. 10.1037/sgd0000117 [DOI] [Google Scholar]
  8. Buelow MT, Okdie BM, Brunell AB, & Trost Z (2015). Stuck in a moment and you cannot get out of it: The lingering effects of ostracism on cognition and satisfaction of basic needs. Personality and Individual Differences, 76, 39–43. 10.1016/j.paid.2014.11.051 [DOI] [Google Scholar]
  9. Budge SL, Domínguez S Jr, & Goldberg AE (2019). Minority stress in nonbinary students in higher education: The role of campus climate and belongingness. Psychology of Sexual Orientation and Gender Diversity, 7(2), 222–229. 10.1037/sgd0000360 [DOI] [Google Scholar]
  10. Clements-Nolle K, Marx R, Guzman R, & Katz M (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91, 915–921. 10.2105/AJPH.91.6.915 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cohen J (1977). Statistical power analysis for the behavioral sciences (rev. ed.). New York: Academic Press. [Google Scholar]
  12. Davidson CL, Wingate LR, Grant DM, Judah MR, & Mills AC (2011). Interpersonal suicide risk and ideation: The influence of depression and social anxiety. Journal of Social and Clinical Psychology, 30(8), 842–855. 10.1521/jscp.2011.30.8.842 [DOI] [Google Scholar]
  13. Derogatis LR, & Savitz KL (2000). The SCL–90–R and Brief Symptom Inventory (BSI) in primary care. In Maruish ME (Ed.), Handbook of psychological assessment in primary care settings (pp. 297–334). Lawrence Erlbaum Associates Publishers. [Google Scholar]
  14. Faul F, Erdfelder E, Buchner A, & Lang AG (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. 10.3758/BRM.41.4.1149 [DOI] [PubMed] [Google Scholar]
  15. Folkman S, & Lazarus RS (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21, 219–239. 10.2307/2136617 [DOI] [PubMed] [Google Scholar]
  16. Frost DM, & Meyer IH (2012). Measuring community connectedness among diverse sexual minority populations. Journal of Sex Research, 49, 36–49. 10.1080/00224499.2011.565427 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Grant JM, Mottet LA, Tanis J, Herman JL, Harrison J, & Keisling M (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. [Google Scholar]
  18. Grossman AH, Park JY, & Russell ST (2016). Transgender youth and suicidal behaviors: Applying the interpersonal psychological theory of suicide. Journal of gay & lesbian mental health, 20(4), 329–349. 10.1080/19359705.2016.1207581 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hagerty BM, & Williams RA (1999). The effect of sense of belonging, social support, conflict, and loneliness on depression. Nursing Research, 48, 215–219. [DOI] [PubMed] [Google Scholar]
  20. Hatchel T, Espelage DL, & Huang Y (2018). Sexual harassment victimization, school belonging, and depressive symptoms among LGBTQ adolescents: Temporal insights. American Journal of Orthopsychiatry, 88(4), 422–430. 10.1037/ort0000279 [DOI] [PubMed] [Google Scholar]
  21. Hatchel T, Valido A, De Pedro KT, Huang Y, & Espelage DL (2019). Minority stress among transgender adolescents: The role of peer victimization, school belonging, and ethnicity. Journal of Child and Family Studies, 28(9), 2467–2476. 10.1007/s10826-018-1168-3 [DOI] [Google Scholar]
  22. Hatzenbuehler ML, & Pachankis JE (2016). Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: Research evidence and clinical implications. Pediatric Clinics of North America, 63, 985–997. 10.1016/j.pcl.2016.07.003 [DOI] [PubMed] [Google Scholar]
  23. Hawkley LC, & Cacioppo JT (2003). Loneliness and pathways to disease. Brain, Behavior, and Immunity, 17(1), 98–105. 10.1016/S0889-1591(02)00073-9 [DOI] [PubMed] [Google Scholar]
  24. Hayes AF (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford Press. [Google Scholar]
  25. Hayes AF, & Coutts JJ (2020). Use omega rather than Cronbach’s alpha for estimating reliability. But… Communication Methods and Measures, 14(1), 1–24. 10.1080/19312458.2020.1718629 [DOI] [Google Scholar]
  26. Hendricks ML, & Testa RJ (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460. 10.1037/a0029597 [DOI] [Google Scholar]
  27. Holt-Lunstad J (2017). The potential public health relevance of social isolation and loneliness: Prevalence, epidemiology, and risk factors. Public Policy & Aging Report, 27(4), 127–130. 10.1093/ppar/prx030 [DOI] [Google Scholar]
  28. Hughto JM, Pletta D, Gordon L, Cahill S, Mimiaga MJ, & Reisner SL (2021). Negative transgender-related media messages are associated with adverse mental health outcomes in a multistate study of transgender adults. LGBT health, 8(1), 32–41. 10.1089/lgbt.2020.0279 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Hunt QA, Morrow QJ, & McGuire JK (2020). Experiences of suicide in transgender youth: A qualitative, community-based study. Archives of Suicide Research, 24(sup2), S340–S355. 10.1080/13811118.2019.1610677 [DOI] [PubMed] [Google Scholar]
  30. Hunter J, Butler C, & Cooper K (2021). Gender minority stress in trans and gender diverse adolescents and young people. Clinical child psychology and psychiatry, 26(4), 1182–1195. 10.1177/13591045211033187 [DOI] [PubMed] [Google Scholar]
  31. Joiner T (2005). Why people die by suicide. Cambridge, MA: Harvard University Press. [Google Scholar]
  32. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, & Walters EE (2005). Lifetime prevalence and age-of-onset distributions of DSM–IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. 10.1001/archpsyc.62.6.593 [DOI] [PubMed] [Google Scholar]
  33. Klemmer CL, Arayasirikul S, & Raymond HF (2021). Transphobia-based violence, depression, and anxiety in transgender women: The role of body satisfaction. Journal of Interpersonal Violence, 36(5–6), 2633–2655. 10.1177/0886260518760015 [DOI] [PubMed] [Google Scholar]
  34. Lombardi E (2009). Varieties of transgender/transsexual lives and their relationship with transphobia. Journal of Homosexuality, 56, 977–992. 10.1080/00918360903275393 [DOI] [PubMed] [Google Scholar]
  35. Lin N, Ensel WM, Simeone RS, & Kuo W (1979). Social support, stressful life events, and illness: A model and an empirical test. Journal of Health and Social Behavior, 108–119. [PubMed] [Google Scholar]
  36. Major B, & Dover TL (2016). Attributions to discrimination: Antecedents and consequences. In Nelson TD (Ed.), Handbook of prejudice, stereotyping, and discrimination (p. 213–239). Psychology Press. 10.4324/9780203361993 [DOI] [Google Scholar]
  37. Major B, Quinton WJ, & Schmader T (2003). Attributions to discrimination and self-esteem: Impact of group identification and situational ambiguity. Journal of Experimental Social Psychology, 39(3), 220–231. 10.1016/S0022-1031(02)00547-4 [DOI] [Google Scholar]
  38. Maslow AH (1954). The instinctoid nature of basic needs. Journal of Personality, 22, 326–347. 10.1111/j.1467-6494.1954.tb01136.x [DOI] [PubMed] [Google Scholar]
  39. Meyer IH (1993). Prejudice and pride: Minority stress and mental health in gay men (Doctoral dissertation, Columbia University). [Google Scholar]
  40. Meyer IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. 10.1037/0033-2909.129.5.674 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Nemoto T, Bödeker B, & Iwamoto M (2011). Social support, exposure to violence and transphobia, and correlates of depression among male- to-female transgender women with a history of sex work. American Journal of Public Health, 101, 1980–1988. 10.2105/AJPH.2010.197285 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. O’Reilly J, & Robinson SL (2009). The negative impact of ostracism on thwarted belongingness and workplace contributions. In Academy of management proceedings (Vol. 2009, No. 1, pp. 1–7). Briarcliff Manor, NY 10510: Academy of Management. 10.5465/AMBPP.2009.44243707 [DOI] [Google Scholar]
  43. Pflum SR, Testa RJ, Balsam KF, Goldblum PB, & Bongar B (2015). Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 2(3), 281. 10.1037/sgd0000122. [DOI] [Google Scholar]
  44. Price-Feeney M, Green AE, & Dorison SH (2020a). Impact of bathroom discrimination on mental health among transgender and nonbinary youth. Journal of Adolescent Health. 10.1016/j.jadohealth.2020.11.001 [DOI] [PubMed] [Google Scholar]
  45. Price-Feeney M, Green AE, & Dorison S (2020b). Understanding the mental health of transgender and nonbinary youth. Journal of Adolescent Health, 66(6), 684–690. 10.1016/j.jadohealth.2019.11.314 [DOI] [PubMed] [Google Scholar]
  46. Sánchez FJ, & Vilain E (2009). Collective self-esteem as a coping resource for male-to-female transsexuals. Journal of Counseling Psychology, 56, 202–209. 10.1037/a0014573 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Scandurra C, Amodeo AL, Valerio P, Bochicchio V, & Frost DM (2017). Minority stress, resilience, and mental health: A study of Italian transgender people. Journal of Social Issues, 73(3), 563–585. 10.1111/josi.12232 [DOI] [Google Scholar]
  48. Shotter J (1993). Becoming someone: Identity and belonging. In Coupland N & Nussbaum JF (Eds.), Discourse and lifespan identity. (pp. 5–27). Sage Publications, Inc. [Google Scholar]
  49. Silva C, Ribeiro JD, & Joiner TE (2015). Mental disorders and thwarted belongingness, perceived burdensomeness, and acquired capability for suicide. Psychiatry Research, 226(1), 316–327. 10.1016/j.psychres.2015.01.008 [DOI] [PubMed] [Google Scholar]
  50. Testa RJ, Habarth J, Peta J, Balsam K, & Bockting W (2015). Development of the gender minority stress and resilience measure. Psychology of Sexual Orientation and Gender Diversity, 2(1), 65. 10.1037/sgd0000081 [DOI] [Google Scholar]
  51. Testa Rylan J, Michaels Matthew S, Bliss Whitney, Rogers Megan L, Balsam Kimberly F, & Joiner Thomas. (2017). Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors. Journal of Abnormal Psychology (1965), 126(1), 125–136. 10.1037/abn0000234 [DOI] [PubMed] [Google Scholar]
  52. Trujillo MA, Perrin PB, Sutter M, Tabaac A, & Benotsch EG (2017). The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample. International Journal of Transgenderism, 18(1), 39–52. 10.1080/15532739.2016.1247405 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Van Orden KA, Cukrowicz KC, Witte TK, & Joiner TEJ (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the interpersonal needs questionnaire. Psychological Assessment, 24(1), 197–215. 10.1037/a0025358 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, & Joiner TE Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. 10.1037/a0018697 [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Wagaman MA, Alessi EJ, Goffnett J, Watts KJ, Iacono G, Thomas D, Paceley M, & Craig SL (2019). Interrupting hetero- and cisnormativity in social work programs: LGBTQ+ student strategies for increasing inclusion. Journal of Social Work Education. 10.1080/10437797.2019.1671261 [DOI] [Google Scholar]
  56. Waldeck D, Tyndall I, Riva P, & Chmiel N (2017). How do we cope with ostracism? Psychological flexibility moderates the relationship between everyday ostracism experiences and psychological distress. Journal of Contextual Behavioral Science, 6(4), 425–432. 10.1016/j.jcbs.2017.09.001 [DOI] [Google Scholar]
  57. Wike T, Tomlinson CA, Wagaman A, Matijczak A, Murphy J, Watts K, … & McDonald S (2021). The role of thwarted belongingness on the relationship between microaggressions and mental health for LGBTQ+ emerging adults. Journal of Youth Studies, 1–18. 10.1080/13676261.2021.2010687 [DOI] [Google Scholar]
  58. Williams KD, & Nida SA (2011). Ostracism: Consequences and coping. Current Directions in Psychological Science, 20(2), 71–75. 10.1177/0963721411402480 [DOI] [Google Scholar]
  59. Wilson EC, Chen YH, Arayasirikul S, Raymond HF, & McFarland W (2016). The impact of discrimination on the mental health of trans* female youth and the protective effect of parental support. AIDS and Behavior, 20(10), 2203–2211. 10.1007/s10461-016-1409-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Zimet GD, Dahlem NW, Zimet SG, & Farley GK (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30–41. 10.1207/s15327752jpa5201_2 [DOI] [PubMed] [Google Scholar]

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