Brief Background
Suicide ideation and behavior represent significant public health problems among TGNB young people.1 According to a recent national survey of LGBTQ individuals aged 13-24, more than half (52%) of TGNB young people have seriously considered suicide, and of this group, 41% actually attempted suicide, compared to 34% and 33%, respectively, of their LGBQ, cisgender peers.2 Young adults are most likely to openly identify as TGNB and seek gender transition medical services. However, limited large-scale research exists on the mental health, including suicide ideation, of TGNB young adults. Further, within the extant literature, very little research has examined identity-specific protective factors among this population. Thus, we aim to examine the moderating effects of TGNB-specific protective factors on theoretical pathways of risk for active suicide ideation to better understand how to prevent suicide among TGNB young adults. Our hypotheses will remain the same, except we will examine gender identity-specific individual and interpersonal factors rather than sexual orientation-specific factors. Further, we aim to explore whether the hypothesized effects are equivalent or different between transmasculine (gender identity is on the masculine spectrum, but assigned female at birth) and transfeminine (gender identity is on the feminine spectrum, but assigned male at birth) subgroups.
Methods
We will administer an anonymous online survey to a national sample of 550 TGNB individuals (i.e., have a gender identity other than cisgender) aged 18 to 26, recruited from Facebook, Instagram, Snapchat, and Twitter with targeted advertisements. Researchers have used the Internet, social media in particular, as a recruitment source to recruit large samples of TGNB adolescents and young adults. To ensure participants do not complete the survey on multiple platforms, we will program the online survey in Qualtrics, which can be set to block multiple surveys from being completed from the same IP address. Likewise, during data cleaning, we will use standard online survey data cleaning techniques (e.g., highly overlapping demographic characteristics, any duplicate IP addresses that slip through) to identify potential duplicate cases and remove those that are likely to be duplicate participants. If recruitment through social media becomes slow, we will recruit through university Diversity Offices, Pride Coalitions/Commons, and LGBTQ+ Services, as well as LGBTQ+-specific community service organizations and healthcare clinics. The PI has conducted studies with TGNB young adults in Florida and has connections in the community. We believe our study design is feasible and recruitment strategy will yield a sufficient sample to address the study aim.
A latent variable moderated mediation model will test the study hypotheses using structural equation modeling techniques. Minority stress will serve as the independent
variable, entrapment and general psychopathology as mediators, and active suicide ideation as the outcome variable, with individual and interpersonal protective factors as moderators of these pathways. We will replace the sexual orientation-specific measures assessing minority stress, positive identity, and community involvement and connection, with gender identity-specific measures assessing the same constructs (e.g., gender-related discrimination, rejection, and victimization; non-affirmation of gender identity; internalized transphobia; TGNB identity concealment; TGNB pride; TGNB community connectedness). Further, measurement invariance will be tested through a series of multiple group confirmatory factor analyses across participants who identify as (1) transmasculine and (2) transfeminine. Our power analysis and sample size will not change as the methodology and analytic plan remains unchanged.
Impact
This study will address important gaps in the literature on suicide risk among TGNB young adults, a high-risk, yet understudied population. Findings from this study will provide tremendous preliminary data for a NIH grant proposal to conduct a larger longitudinal study testing the stability of the model over time, as well as additional subgroup comparisons between transgender women, transgender men, and non-binary individuals.
