2 - (SYM 9) Beyond Prejudice: The Role of Systemic and Personal Marginalization in Predicting Transgender and Gender-diverse Adults' Suicide-related Thoughts and Behaviors

Transgender and gender-diverse (TGD) individuals report higher prevalence of suicide-related thoughts and behaviors (STBs) than their cisgender peers. According to the gender minority stress theory, a combination of intra- and interpersonal factors unique to TGD individuals increase risk for mental distress and STBs. However, models inclusive of societal-level factors, such as socioeconomic status and healthcare access, are vanishingly rare in the literature. This cross-sectional study examined the combinatory role of systemic and personal factors in predicting STBs in a U.S. sample of transgender adults (n = 274). The participants were 28% trans men, 44% trans women, and 28% nonbinary or genderqueer. They were diverse in sexual orientation (21% heterosexual; 39% gay/lesbian/queer; 27% bisexual+, 4% asexual; 8% other), race/ethnicity (32% non-White; 68% White), and age (M = 39.3, range = 18-72). A structural equation model was estimated using robust maximum likelihood with the following latent variables: (1) socioeconomic status (SES), including income, education, and housing stability; (2) access to high-quality healthcare (HC), including healthcare satisfaction, presence of a primary care physician, and past 12 month access to care; (3) internalizing symptoms (INT), including symptoms of depression, anxiety, and PTSD; and (4) identity-related stressors (IS), including minority stress and everyday discrimination. The outcome variable was lifetime STBs, including suicide thoughts, planning, intent, and attempts. The model tested the relationship of SES and IS to STBs through the mediators of HC and INT. Regression analyses confirmed that SES, IS, HC, and INT were significantly related to lifetime STBs. The model demonstrated good fit (CFI = .96, TLI = .95, RMSEA = .045). However, although INT was significantly predicted by IS (β = 0.64, p = .001) and SES (β = -0.33, p = .023), when accounting for the effects of HC and INT, neither SES nor IS significantly predicted STBs (all ps > .05). The current study adds to the body of research on factors relating to internalizing symptoms and STBs in TGD adults by including both personal and systemic factors. The fact that no latent variables predicted STBs in the final model may be due to high levels of correlation between the predictors (all rs > 0.65). This study underlines the importance of studying the multiaxial impact of marginalization of TGD individuals on STBs with nuance and conducting outreach to accrue sufficiently large TGD samples for complex data analysis.