title: Stigma, mental health, and resilience in an online sample of the US transgender population.
abstract: OBJECTIVE
  We assessed the association between minority stress, mental health, and potential ameliorating factors in a large, community-based, geographically diverse sample of the US transgender population.
  
  
  METHODS
  In 2003, we recruited through the Internet a sample of 1093 male-to-female and female-to-male transgender persons, stratified by gender. Participants completed an online survey that included standardized measures of mental health. Guided by the minority stress model, we evaluated associations between stigma and mental health and tested whether indicators of resilience (family support, peer support, identity pride) moderated these associations.
  
  
  RESULTS
  Respondents had a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). Social stigma was positively associated with psychological distress. Peer support (from other transgender people) moderated this relationship. We found few differences by gender identity.
  
  
  CONCLUSIONS
  Our findings support the minority stress model. Prevention needs to confront social structures, norms, and attitudes that produce minority stress for gender-variant people; enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience.
authors.affiliation: Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, Minnesota, USA. wb2273@columbia.edu
authors.forename: Walter O
authors.initials: WO
authors.lastname: Bockting
authors.forename: Michael H
authors.initials: MH
authors.lastname: Miner
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Swinburne Romine
authors.forename: Autumn
authors.initials: A
authors.lastname: Hamilton
authors.forename: Eli
authors.initials: E
authors.lastname: Coleman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D003625:Data Collection; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D012044:Regression Analysis; D057545:Social Stigma; D012944:Social Support; D013001:Somatoform Disorders / Q000453:epidemiology / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D063106:Transgender Persons / Q000523:psychology*; D014481:United States / Q000453:epidemiology