Gender affirming behavior experiences, LGBTQ+ community connection, and mental health: an investigation into associations and potential mediating effects.

Abstract

Background. Extant literature has connected gender affirmation and LGBTQ+ community connectedness to positive health outcomes for transgender and gender diverse (TGD) individuals. Current research, however, has only focused on external and/or interpersonal affirmation, and not direct acts taken by the individual for gender affirmation. No current research, to my knowledge, has This project adds a unique investigation of both gender-affirming behaviors and LGBTQ+ community connection, how they are related, and how they both impact mental health in TGD adults. Considering LGBTQ+ community connectedness and gender affirmation’s association with mental health, understanding how these constructs impact one another, and mental health is paramount to furthering the understanding of TGD identity and experiences.Aims. This study aims to explore TGD adults’ experiences with gender-affirming behaviors (GAB) engagement, the impact of engaging in GABs, LGBTQ+ community connection, and mental health. Further, it seeks to examine any potential differences in these experiences between gender identity groups. It also seeks to examine the role of both LGBTQ-CC and GAB Experiences, and if there is a mediating effect of one of these experiences on the others’ relationship with mental health outcomes. Methods. Utilizing cross-sectional data from 576 TGD adults, descriptive analyses, multiple one-way ANOVAs, multiple linear regression models, and mediation analyses were conducted utilizing SPSS 28.0.1.1 and R Statistical Software 4.4.1 (R Core Team, 2024), specifically the package ‘psych’ (Revelle, 2017). Measurements. Measurements include demographic variables, LGBTQ+ community connectedness (i.e., LGBT-Psychological Sense of Community Scale; Lin & Israel, 2012) difficulties in emotion regulation (i.e., Difficulties in Emotion Regulation Scale-16; Bjureberg et al., 2016), depression severity (i.e., Patient Health Questionnaire-9; Kroenke et al., 2001), and a research developed measure to assess engagement in and impact of gender-affirming behaviors (GAB Experiences Measure). Results. This study found that GAB experiences significantly differed between gender identity groups, while LGBTQ+ community connectedness and mental health outcomes did not. LGBTQ+ community connectedness was found to be more significantly associated with mental health than GAB experiences, and it was found to partially or fully mediate the relationship between all three GAB experiences and both mental health outcomes. Conclusion. This work suggests that LGBTQ+ community connectedness plays a significant role in the health of TGD adults. Further, GAB Experiences may impact LGBTQ+ community connectedness in ways not previously investigated. Future work should continue to investigate GAB Experiences holistically, while also assessing resilience factors such as LGBTQ+ community connectedness.