A systematic review and meta-analysis of the associations between structural, interpersonal, and individual stigma and health outcomes for transgender and nonbinary people.
Meta-analysis reveals negative health impacts of multilevel stigma in transgender and nonbinary people, indicating a need for systemic interventions.
Key Points
To assess how structural, interpersonal, and individual gender-related stigma correlate with diverse health outcomes in transgender and nonbinary individuals, including potential mediators and moderators.
Conducted a systematic review and multilevel meta-analysis synthesizing 1,871 effect sizes from 225 reports representing N=121,240 participants.
Evaluated publication bias using Egger's regression test, funnel plots, and the fail-safe N procedure.
Applied meta-analytic structural equation modeling to analyze direct and indirect pathways connecting stigma levels to health outcomes.
All stigma types correlated with poorer health outcomes: structural (r = -.18), interpersonal (r = -.20), and individual (r = -.28).
Overall stigma was associated with poorer mental health (r = -.25), suicidality (r = -.25), lower well-being (r = -.23), poorer physical health (r = -.19), substance use (r = -.14), and poorer sexual health (r = -.12).
Structural equation modeling demonstrated a trickle-down effect where structural stigma directly and indirectly shaped interpersonal and individual stigma to impair overall health, with resilience factors failing to moderate these negative associations.