Minority stress in transgender people: A moderated mediation model of stigma, internalized transphobia, resilience, and health

Introduction: Transgender people often experience stigma because of their gender nonconformity, and this might negatively affect their mental health through internalized transphobia. The ability of coping with stigma depends on protective factors, such as resilience, which might reduce the detrimental effect of stigma on mental health. This study was aimed at applied, as an extension of the Minority Stress Perspective (MSP), the Psychological Mediation Framework (PMF) to a sample of Italian transgender people. Method: This study assessed different hypotheses based both on MSP and PMF. The main hypothesis concerns a moderated mediation model in which the indirect effect of anti-transgender discrimination on mental health through shame and alienation as indicators of internalized transphobia was hypothesized as being moderated by resilience. All the study’s hypotheses were tested using structural equation modeling. Results: The results suggest that alienation mediated the relationship between anti-transgender discrimination and both anxiety and depression, bs = .91 and .60, 95% C.I.s [.17, 2.28] and [.08, 1.56], respectively, whereas shame operated as a mediator of the relationship between anti-transgender discrimination and depression, b = .55, 95% C.I. [.08, 1.55]. Additionally, only one significant moderated indirect effect was found, ω = -.70, 95% C.I. [-1.60, -.14], indicating that the indirect relation of anti-transgender discrimination with anxiety through alienation was conditional on low and moderate levels of resilience, bs = 1.73 and .96, 95% C.I.s [.54, 3.60] and [.22, 2.33]. Conclusion: The moderated-mediation model sheds light on psychological processes that lead both anti-transgender discrimination to affect mental health and protective factors to alleviate the negative effect of stigma on mental health. This model has important implications for clinical practice and psycho-social interventions to reduce stigma and stress.