Important findings were recently published from Dr. Jae Puckett and collaborators’ research on the role of rumination in transgender and gender diverse (TGD) individuals’ experiences with minority stressors and the resulting health impacts of those stressors. In this study, a large group of TGD participants were enrolled in a longitudinal study in which they completed daily surveys in order to examine more closely the types of stressors that get stuck in their minds and that may linger in their impact. Having participants provide this information daily minimized the influence of recall bias and provided a higher level of accuracy than a purely retrospective study could have done.
Rumination was defined for this study as the repetitive focus on emotions or experiences that have impacted an individual’s experiences. Some examples of rumination topics for TGD individuals include fear of identity disclosure, self-monitoring, vigilance or being on watch for mistreatment from others, and attempts to suppress thoughts about stigma. Many of these ruminations had specific impacts based on identity such as feeling burdened by political stressors related to TGD communities. Rumination can be a response/coping mechanism to minority stress/stigma, but it can also exacerbate the impact, which may add to health issues.
Puckett and collaborators found 6 main themes in the ruminations reported in this study. Difficulties in interpersonal relationships were among the most common rumination topics and included family, friends, and partners. Many participants reported ruptures and fears in personal relationships, such as misgendering, rejection, or fear of rejection. Another common theme was fear and worry in response to multiple contextual factors, which were often sociopolitical factors, such as anti-TGD laws or disparaging remarks in the media. This led to vicarious stress/trauma and worries about stressors or the future, often leaving participants feeling hopeless/helpless. A third element was concerns over basic needs and safety, both identity-related and not. For example, there were frequent worries about work and money, including the financial cost of gender-affirming care. There were also the dangers of public misgendering and identity revelation to contend with and other worries, including navigating school, travel, documentation, and bathrooms as a TGD person. The fourth topic for rumination was experience of gender, both internally and externally. This referred to individuals’ interactions with their own body, as well as others’ perceptions, which encompasses gender dysphoria, whether participants were perceived as trans, gender-affirming care, disclosure, and identity invalidation. Additionally, there was an intersection between health and rumination. Several participants reported concerns related to mental health, trauma, and loss, in addition to healthcare barriers and illnesses. Finally, there were some moments of positivity reported by participants as well, such as thinking heavily about getting into a dream school or other experiences. These positive examples were few, likely due to the question being worded as related to stressors.
These common themes translated into several important findings. First, rumination is pervasive and is experienced in conjunction with minority stress. As such, these responses about rumination revealed the varied and frequent experiences of oppression TGD people experience, with unique TGD-specific rumination topics. In addition, there are rumination topics at every level of society: personal, interpersonal, community, and societal. Finally, there are serious, pervasive impacts of stigmatization and marginalization on TGD individuals. This is an important aspect of minority stress that should be studied further in TGD populations.
To read the full article, follow this link.
For a brief summation of the key takeaways and policy implications of this study, see this interview with Dr. Puckett.
To view the interview on Twitter, click here.