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Transphobia-Based Violence, Depression, and Anxiety in Transgender Women: The Role of Body Satisfaction

Psychological processes may mediate the relationship between minority stress and mental health though limited data exist showing this pathway among trans women. Trans women’s degree of satisfaction with their body is associated with mental health outcomes. This study used a model of minority stress to explore for indirect effects on the association between transphobia-based victimization and anxiety and depression through one’s degree of body satisfaction. Analysis also explored for racial differences. Transgender women (N = 233) were recruited in 2013 using respondent-driven sampling. Sociodemographics, transphobia-based victimization experiences such as having been physically abused, body satisfaction, and mental health were measured. Analyses assessed for direct and indirect associations while controlling for gender confirmation therapies (i.e., cross-sex hormone therapy and gender confirmation surgeries) and racial identity; 57% reported depression and 42.1% reported anxiety diagnoses. Participants averaged nearly three of six assessed violence experiences. More than 20% reported low body satisfaction. Contrary to authors’ expectations, those reporting African American and Other racial identity experienced less transphobia-based violence than whites. Transphobia-based violence was significantly associated with anxiety, depression, and body satisfaction. Body satisfaction was associated with mental health diagnoses. Bootstrapping revealed significant indirect and total effects. Body satisfaction mediated the relationship between transphobia-based violence and mental health. Clinical intervention that promotes body satisfaction including access to gender confirmation therapies, especially hormone therapy, may prevent negative mental health outcomes among trans women. Individual intervention, however, is not a panacea for structural discrimination. Attention to structural interventions that reduce gender minority stressors including transphobia-based violence is necessary.