A Multilevel Investigation of Transgender and Nonbinary Adolescent and Young Adult Mental Health: Classification and Assessment of Structural and Interpersonal Determinants

Abstract

Mental health disparities, including depression and suicidality, among transgender and/or nonbinary (TNB) youth and college students are of high public health concern. Understanding the risk factors and population patterning of mental health disparities can shape intervention efforts at various levels to improve the mental health of TNB individuals. Caregivers of TNB youth have the ability to provide emotional support and access resources that are key to reducing disparities in TNB mental health. Colleges too have the ability to provide unique forms of institutional support to TNB students to facilitate reductions in mental health outcomes. Despite this, little is known about caregiver experiences of parenting TNB youth, the policy environments experienced by TNB college students, or the intersectional disparities in TNB college student mental health outcomes. This dissertation explores these key risk factors and disparities with the goal of informing intervention development for TNB youth and college students. The first study (Chapter 2) utilizes the social ecological model to contextualize experiences of 48 caregivers of TNB youth in semi-structured interviews using thematic analysis and immersion crystallization. Chapter 3 utilizes quantitative intersectional modeling to characterize the population patterning of mental health outcomes among US college students across intersections of gender identity, race/ethnicity, and socioeconomic status. Finally, Chapter 4 empirically classifies the distribution of 12 TNB-supportive policies across 311 US colleges using latent class analysis. Among caregivers, we found opportunities for gender affirmation and social connections, stressors between youth and caregivers, and associations between caregiver labor and stress. Among college students, we found first generation biracial Black and Indigenous TNB students had the poorest predicted mental health outcomes. Lastly, in examining college campus policy environments, we found associations between the probability of having a more supportive policy environment for TNB students and indicators of a college’s access to resources. This dissertation discusses opportunities and recommendations for intersectional interventions across levels of the social ecological model, especially interventions at the community, organizational, and societal levels.