(PS7-A22) Transgender and Gender-diverse Minority Stress and Substance Use: Systematic Review and Meta-analysis

Introduction: Transgender and gender-diverse (TGD) individuals experience unique stressors related to their TGD status, leading to increased rates of mental health problems. While research has found associations between TGD minority stress and substance use, it’s unclear whether this relationship differs by the type of minority stress, the type of substance used, or whether minority stress is more associated with substance use frequency vs. use problems. 

Methods: We conducted a pre-registered systematic review and meta-analysis of quantitative research studies examining the relationship between TGD minority stress and drug and alcohol use frequency and problems. Moderator analyses were conducted to determine if effect sizes varied by the sample’s location, mean age, and the proportion of the sample identified as non-White, assigned female at birth, or sexual minority. 

Results: Thirty-six studies comprising 76 effect sizes were included in meta-analyses. Results indicate that distal stress was associated with alcohol and drug use frequency and problems. No significant associations between proximal stress and substance use were observed. Effect sizes for the relationship between distal stress and alcohol use frequency were larger in samples with more non-White subjects.

Discussion: These findings provide additional support for minority stress theory, finding that distal stress is associated with substance use frequency and problems. Significant moderation demonstrates the importance of an intersectional analysis of substance use disparities within TGD populations. Future research on minority stress and substance use would benefit from using longitudinal designs and more diverse samples.