Lay Summary

In this first of its kind study in the United Kingdom, we examined the impact of microaggressions (brief, commonplace insults directed at marginalised groups) on suicidal thoughts, attempts, and self-harm in the trans and non-binary community. We found that when trans people experience more microaggressions, the more suicidal they feel, after taking into consideration education, ethnicity, age, and perceived gender identity. This matters as the current mental health burden amongst trans and non-binary people has been stable and high over the past 10 years. The social climate for trans people in the UK is rife with microaggressions. Therefore, building resilience against microaggressions, and educating the public regarding microaggressions, may help to reduce the current mental health burden of trans and non-binary people.

Background

Trans and non-binary people are at an increased risk of suicidality, with the most recent largest study of trans mental health in the UK suggesting that 53% of trans people self-harm at some point in their lives, 84% experience suicidal ideations, and 48% report a prior suicide attempt. Previous research examines discrimination and gender minority stress as putative factors underlying the suicide burden, however little is known about the epidemiology of microaggressions and their impact on trans mental health, especially suicidality.

Methods

The TRANS: Microaggressions & Mental Health survey is a cross-sectional study of trans and non-binary people in the United Kingdom. The survey comprises of 55 questions capturing depression, anxiety, suicidality, microaggressions, gender minority stress, rumination, and loneliness. This paper focuses on microaggressions and suicidality. The principal outcome of this study is suicidality which was measured using a categorical response format of "Yes, no, prefer not to say" and focused on suicidal ideation, attempts to end one's life, and self-harm. The exposure, microaggressions, was examined using the Gender Identity Microaggressions scale, and it's five subscales. The GIMS score ranges from 14 to 70 and the subscales relate to 1) denial of gender identity, 2) denial of societal transphobia, 3) behavioural discomfort, 4) misuse of pronouns, and 5) invasion of bodily privacy. Logistic regression models were employed adjusting for age, perceived gender, and education to produce effect estimates for the relationship between microaggressions (and each subtype) and suicidality. All analyses were conducted using Stata 17.0

Results

We asked the following research question: What is the association between microaggressions and suicidality in trans people? with the following hypothesis: Trans people who report higher overall microaggression scores will report higher odds of self-harm, suicidal ideation, and attempts. Results support the hypothesis that those who report higher microaggressions have a higher odds of suicidal ideation ((aOR 1.07 (95%CI 1.04 to 1.10)), self-harm ((aOR 1.05 (95%CI 1.03 to 1.06)), and suicide attempt ((aOR 1.04 (1.03 to 1.06)). Regarding each subscale, there is strong evidence associated with increased odds of suicidal ideation, attempts, and self-harm. For example, denial of societal transphobia ((aOR 1.25 (95%CI 1.12 to 1.41)), misusing someone's pronouns ((aOR 1.35 (95%CI 1.21 to 1.50)), invasion of bodily privacy ((aOR 1.18 (95%CI 1.08 to 1.29)), denial of gender identity ((aOR 1.13 (95%CI 1.06 to 1.21)), and expressing behavioural discomfort ((aOR 1.26 (95%CI 1.11 to 1.41)) were all associated with increased suicidal ideation.

Conclusion

This project shows promising implications in how we understand microaggressions as a mechanism behind the suicidality burden of trans and non-binary people. This has implications for prevention (through public education and anti-harassment policies) and intervention (coping with microaggressions, building resilience). As data collection ends on the cross-sectional study, the project will be starting its second study an ecological momentary assessment to establish temporality and dose-response, thus intending to strengthen causal inferences.