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Dr. Jae Puckett and the Trans-ilience Research Team have contributed numerous publications related to transgender and gender diverse individuals' experiences with stress and resilience. Many of these projects are ongoing, so check back here to see what new publications the team has coming out. 


Sociopolitical Contexts and Wellbeing for Trans and Nonbinary People

DuBois, L. Z., Puckett, J. A., SturtzSreetharan, C., Jolly, D., Lash, B. R., Huit, T. Z., Holt, N., Ralston, A., Hope, D. A., Mocarski, R., Walker, T., Miles, M., Volk, S., Capannola, A., Tipton, C., & Juster, R. P. (in press). Mental health, coping and resilience among transgender and gender diverse people during the 2020 U.S. presidential election. Psychology of Sexual Orientation and Gender Diversity.

No abstract available.

Puckett, J. A., Huit, T. Z., Hope, D. A., Mocarski, R., Lash, B., Walker, T., Holt, N., Ralston, A. L., Miles, M., Capannola, A., Tipton, C., Juster, R. P., & DuBois, L. Z. (2024). Transgender and gender diverse people’s experiences of minority stress, mental health, and resilience in relation to perceptions of sociopolitical contexts. Transgender Health, 9, 14-23.

Abstract: Purpose: The sociopolitical context in which transgender and gender-diverse (TGD) people live has significant effects on mental health. We examined whether perceptions of context (TGD people’s perceptions of how TGD people were viewed) differed across four United States (U.S.) states and associations with mental health and identity pride, the mediational effects of minority stressors, and potential buffering effects of resilience. Methods: TGD individuals in Oregon, Michigan, Nebraska, and Tennessee (n=158; ages 19–70, mean=33.06) completed questionnaires assessing their perceptions of how TGD people were viewed in their local area and in the U.S., as well as scales assessing minority stressors, pride, resilience, and mental health. Data were collected during Fall 2019 to Spring 2020. Results: Oregon participants viewed perceptions in their state the most positively, with no state-level differences in terms of broader U.S. perceptions. Tennessee participants experienced more expectations of rejection; however, there were no differences across the states in other minority stress variables, identity pride, resilience, ormental health. Participants who viewed their area as having more negative views of TGD people reported higher levels of discrimination, expectations of negative events, internalized stigma, and anxiety, as well as less pride. The effects of perceptions of local context on mental health were partially explained by enacted stigma and internalized stigma. Resilience did not buffer the effects of perceptions of the local context on mental health or pride. Conclusion: Context is important to shaping exposure to minority stressors and mental health, potentially through increasing enacted and internalized stigma.

Hope, D. A., & Puckett, J. A. (2023). Bans on evidence-based care for transgender and gender diverse people present risks for clients and dilemmas for mental health providers. Cognitive and Behavioral Practice. Advance online publication.

Abstract: Despite efforts to improve the sociopolitical landscape for sexual and gender minorities, including legislation to ban sexual orientation and gender identity change efforts (SOGICE), new threats have arisen with a sharp increase in state legislatures enacting anti-TGD (transgender and gender diverse) legislation. Some of these laws and the accompanying hostile climate may prevent mental health providers from providing the best evidence-based care for their TGD clients. This paper briefly reviews the current sociopolitical climate, the impact of the climate on TGD people, and challenges faced by mental health providers serving TGD clients. We conclude with recommendations for supporting TGD clients in the current sociopolitical context and a call for advocacy to continue efforts to ban SOGICE and protect access to social, legal, and medical gender affirmation for youth and adults.

DuBois, L. Z., Puckett, J. A., Price, S., Kuehn, K., Lash, B., Walker, T., Holt, N., Ralston, A., Huit, T. Z., Miles, M., Volk, S., Capannola, A., Tipton, C., Hope, D. A., Mocarski, R., & Juster, R. P. (2023). The impact of sociopolitical events on transgender people in the U.S. Bulletin of Applied Transgender Studies, 2, 1-26.

Abstract: Marginalization experienced by transgender and gender diverse (trans) people exerts negative effects on health. However, few studies examine how trans people respond to events reflecting structural stigma or anti-trans sentiment and the sociopolitical contexts in which they occur. This study examined how trans people (N = 158) residing in Michigan, Nebraska, Oregon, and Tennessee responded to specific sociopolitical events and their impacts on health and well-being. Baseline data were collected Fall 2019–Spring 2020, followed by monthly surveys for a year. Current analyses include baseline data and one monthly survey. At baseline, participants reflected on their responses to the 2016 presidential election of Donald Trump and a 2018 memo leak with negative implications for trans people’s lives. Participants reported decreased positive experiences (e.g., hopefulness) and increased negative experiences (e.g., fear) after these events. Additionally, 80.2% of participants reported increased hate speech following the 2016 election. During one of the monthly surveys, we found variability in participants’ responses to the 2020 presidential election. Perhaps due to backlash, 31.3% of participants reported increased hate speech, with participants of color reporting additional negative impacts. These findings contextualize experiences of trans people, highlighting how marginalization and exposure to minority stressors are shaped by structural-level stigma.

Kurth, A. E., Puckett, J. A., & Anderson-Carpenter, K. D. (2021). Legislation restricting access to public restrooms and changing facilities for transgender individuals in Texas (US): A qualitative analysis of testimony. International Journal of Transgender Health, 22, 440-453.

Abstract: Background: An alarming amount of legislation in the United States has sought to restrict the rights of transgender people, often targeting access to public spaces or restrooms. One example of this legislation is the Texas Privacy Act (Senate Bill 6; 2017), which detailed “regulations and policies for entering or using a bathroom or changing facility” (Texas Legislature Online). Aims: The hearing for SB 6 included over 18 hours of public testimony, which we analyzed to better understand arguments for and against this bill. Methods: We conducted a thematic analysis of this public testimony. Results: Supporters of SB 6 frequently framed their arguments in terms of safety and security, economic impact, and privacy and dignity. Those opposing SB 6 focused on discrimination, safety and security, and the effects of transgender people being forced into the wrong facilities. Discussion: These findings can aid in understanding education that may help to combat viewpoints that lead to passing such legislation and contributes to understanding how legal policies shape views of gender.

Price, S. F., Puckett, J. A., & Mocarski, R. (2021). The impact of the 2016 presidential elections on transgender and gender diverse people. Sexuality Research and Social Policy, 18, 1094-1103.

Abstract: Introduction: With Trump’s presidency came a rise in the oppression of transgender and gender diverse (TGD) people, as the nation witnessed a removal of protections for TGD people. Methods: We examined the daily experiences of 181 TGD individuals (ages 16–40,Mage = 25.6) through their reflections about daily stressors over the course of 8 weeks (data collected fall 2015–summer 2017), some of which reflected shifts during theelection period. Results: During the 2016 presidential election, participants reported a rise in marginalization stress and the subsequent impact on safety, mental health, and well-being. There were three emergent themes: External Rejection and Stigma from Dominant Culture; Supporting the TGD Community; and Fear for the Self and Development of Proximal Stressors. Conclusions: In line with marginalization stress theory, participants vocalized the progression from exterior stigmatization to proximal stressors and their heightened sense of vigilance and fear of the dominant culture. Policy Implications: Based on the results of this study, policy makers and TGD advocates must work to ensure that political rhetoric and action do not serve to further marginalize and erase TGD communities.

Effects of Minority Stress on Trans and Nonbinary People

DuBois, L. Z., Puckett, J. A., Jolly, D., Powers, S., Walker, T., Hope, D. A., Mocarski, R., Huit, T. Z., Lash, B., Holt, N., Ralston, A. L., Miles, M., Capannola, A., Tipton, C., Eick, G., & Juster, R. P. (2024). Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States. Hormones and Behavior, 159.

Abstract: The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19–70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.

Puckett, J. A., Veldhuis, C. B., Gilbert, P. A., Anderson-Carpenter, K. D., Mustanski, B., & Newcomb, M. E. (2023). Differential associations between enacted and expected stigma with psychological distress, alcohol use, and substance use in transgender and gender diverse people. Drug and Alcohol Dependence, 248, 109921.

Abstract: Background: Transgender and gender diverse (TGD) people experience high rates of stigma and marginalization that are theorized to exacerbate substance use and psychological distress. However, little research has examined the role of various minority stressors in relation to substance use in TGD populations. Methods: In this sample of 181 TGD individuals in the U.S. who reported substance use or binge drinking over the past month (M age = 25.6; SD = 5.6), we evaluated whether enacted stigma predicted alcohol use, substance use, and psychological distress. Results: Participants endorsed a high rate of exposure to enacted stigma over the past 6 months (e.g., 52% had been verbally insulted). Furthermore, 27.8% of the sample was classified as having moderate or higher severity drug use, and 35.4% were classified as having hazardous drinking levels. We found that enacted stigma was significantly related to moderate-high drug use and psychological distress. There were no significant associations between stigma variables and hazardous levels of drinking. Enacted stigma had an indirect effect on psychological distress via increased expectations of stigma. Conclusions: This study adds to the growing literature exploring minority stressors in relation to substance use and mental health. Subsequent research is needed to examine TGD-specific factors that may more fully explain how TGD people cope with enacted stigma or that may influence substance use, particularly alcohol use.

Puckett, J. A., Dyar, C., Maroney, M. R., Mustanski, B., & Newcomb, M. E. (2023). Daily experiences of minority stress and mental health in transgender and gender-diverse individuals. Journal of Psychopathology and Clinical Science, 132, 340–350.

Abstract: Transgender and gender-diverse people experience various minority stressors although minimal research has examined prospective effects on daily affect or mental health. We explored rates of marginalization for transgender and gender-diverse participants in a daily diary study and the concurrent and prospective associations with daily affect and weekly measures of depression and anxiety symptoms, as well as the mediating effects of internalized stigma, rumination, and isolation. There were 167 participants (82.2% white; M age = 25) retained in the daily surveys. Participants completed surveys for 56 days reflecting exposure to marginalization, gender nonaffirmation, internalized stigma, rumination, isolation, affect (negative, anxious, and positive affect), and mental health (anxiety and depression symptoms). Participants experienced marginalization on 25.1% of the days. Within-person analyses revealed concurrent associations between marginalization and gender nonaffirmation with increased negative and anxious affect and increased anxiety and depression symptoms, as well as associations for gender nonaffirmation and decreased positive affect. At the within-person level, there were prospective associations between marginalization and gender nonaffirmation with increased negative affect on the next day, as well as increased anxiety and depression symptoms the next week. Concurrent analyses revealed significant indirect effects with marginalization and gender nonaffirmation associated with all three affect variables and mental health via increases in internalized stigma, rumination, and isolation. However, only gender nonaffirmation was related to isolation and affect or mental health in the prospective analyses. Clinical considerations include strategies to address the immediate effects of minority stress as well as the long-term interpersonal effects.

Puckett, J. A., Aboussouan, A. B., Ralston, A. L., Mustanski, B., & Newcomb, M. E. (2023). Systems of cissexism and the daily production of stress for transgender and gender diverse people. International Journal of Transgender Health, 24, 113-126. DOI: 10.1080/26895269.2021.1937437

Abstract: Background: Transgender and gender diverse (TGD) people encounter a range of minority stressors (e.g., harassment, victimization, misgendering) that impact many areas of life. Much of the empirical literature on gender minority stress has utilized frameworks that were developed with a focus on sexual orientation and were often limited to cisgender sexual minorities (lesbian, gay, bisexual, and other non-heterosexual individuals), leaving questions about how well existing models fit the experiences of TGD people. Aims: To expand understandings of gender minority stress, we conducted a daily diary study where participants detailed the types of stressors they encountered on a daily basis for 56 days. Methods: There were 181 TGD participants recruited into the study (M age = 25.6 years; SD= 5.6), with 167 retained in the daily surveys from which these analyses were conducted. Results: The written responses revealed a variety of stressors, some of which are novel to the literature. Many participants reported instances of non-affirmation, such as misgendering, as well as vicarious stress when learning of oppressive experiences impacting other TGD people and seeing negative media portrayals of the lives of TGD individuals. Participants also reported bodily vigilance when being on alert for how others were perceiving their gender. Other stressors included rejection, political oppression, physical violence, uneasiness from others, and the enforcement of gender binarism. Discussion: These findings highlight gaps in the existing understandings of marginalization for TGD people that must be addressed to ensure that frameworks include and center the experiences of gender minorities.

Puckett, J. A., Price, S. F., Mocarski, R., Mustanski, B., & Newcomb, M. E. (2022). Transgender and gender diverse individuals’ daily experiences of rumination. American Journal of Orthopsychiatry, 92, 540-551.

Abstract: Transgender and gender diverse (TGD) people face a myriad of daily stressors because of the hegemonic gender norms embedded within U.S. society. Due to these minority stressors, TGD people report elevated anxiety, depression, stress, and suicidality, among other health issues. One mechanism through which stigma may lead to these negative mental health outcomes is through increased rumination. In this intensive daily diary study with 181 TGD individuals (ages 16–40), we gathered qualitative data on their ruminative thoughts over the course of 56 days. There were a total of 2,431 responses across participants, with individuals providing arange of 1–53 responses (M=15 responses). Using an experiential framework and an inductive approach to thematic analysis, we generated the following themes: (a) interpersonal relationships as a site of struggle, (b) fear and worry in response to contextual factors, (c) the weight of basic needs and safety, (d) gender as experienced through self and others, (e) intersections ofhealth and rumination, and (f) the occasional reprieve. Using a deductive approach, we also placed these data within the context of Bronfenbrenner’s Person–Process–Context–Time model to provide a conceptual model for future research in this area. These ruminative experiences revealed significant adversities and challenges weighing on participants’ minds that spanned many areas of life. These findings also highlight the nuanced nature of rumination for TGD individuals and areas that may be overlooked in current assessments of this construct.

Puckett, J. A., Maroney, M. R., Wadsworth, L. P., Mustanski, M., & Newcomb, M. E. (2020). Coping with discrimination: The insidious effects of gender minority stigma on depression and anxiety in transgender individuals. Journal of Clinical Psychology, 76, 176-194.

Abstract: Objectives: We examined types of discrimination encountered by transgender and gender diverse (TGD) individuals and the associations with symptoms of depression and anxiety, as well as the mediating and moderating effects of coping responses. Method: This online study included 695 TGD individuals ages 16 years and over (M = 25.52; standard deviation = 9.68). Results: Most participants (76.1%) reported discrimination over the past year. Greater exposure to discrimination was associated with more symptoms of depression and anxiety. These associations were mediated by coping via detachment and via internalization, although a direct effect remained. Conclusions: Many TGD people will encounter discrimination and this is associated with greater psychological distress. Engagement in the internalization of blame or detachment partially explains the association between discrimination and mental health issues. These findings elucidate possible avenues for interventions to bolster adaptive coping responses for TGD people and highlight that actions to decrease discrimination are urgently needed.

Experiences of Resilience for Trans and Nonbinary People

Puckett, J. A., Domínguez, S., & Matsuno, E. (2024). Measures of resilience: Do they reflect the experiences of transgender individuals? Transgender Health, 9, 1-13.

Abstract: Resilience is often viewed as the ability to bounce back from challenges. This conceptualization tends to be individualistic and can be less fitting for marginalized communities. Research with transgender and gender-diverse (TGD) individuals has shown that resilience can manifest in various ways, such as developing pride in one’s identity, connection to a TGD community, or advocating against oppression. Given these conflicting views, we sought to (1) describe common themes in TGD people’s experience of resilience by pooling information from qualitative research; and (2) evaluate how well quantitative measures of resilience reflected the ways that TGD people define resilience in qualitative research. We reviewed articles published from January 2010 to January 2020. Our search for research on resilience in TGD samples revealed 33 quantitative articles and 17 qualitative articles. We developed a codebook from the qualitative articles by retrieving information about themes from these past studies (e.g., developing motivation and agency, pride or positive self-image). We also reviewed the quantitative studies and retrieved the measures used to assess resilience, followed by coding these scales to understand whether the themes from the qualitative data were reflected in the quantitative measures of resilience. Overall, themes related to social support were common across the measures. However, other themes were not reflected in any measures, such as self-definition of gender, hope, and self-advocacy. Our research demonstrates the discrepancy between qualitative research on TGD resilience and quantitative measurement of resilience. Measure development that more fully reflects TGD people’s experiences is key to advancing this research.

Puckett, J. A., Matsuno, E., Dyar, C., Mustanski, B., & Newcomb, M. E. (2019). Mental health and resilience in transgender individuals: What type of support makes a difference? Journal of Family Psychology, 33, 954-964.

Abstract: Research has generally shown the benefits of social support, such as the buffering effects on life stressors, yet there has been little empirical investigation of different types of support resources for transgender individuals. We examined family support, support from friends, and connectedness to a transgender community and how these forms of support come together to influence mental health and resilience. The sample included 695 transgender participants (mean age = 25.52 years, SD = 9.68, range = 16–73; 75.7% White) who completed an online survey. Greater than half of participants reported moderate to severe levels of anxious and depressive symptoms. Family social support had the strongest correlations with symptoms of anxiety and depression (r = −.31 and −.37, respectively, p

Affirming Therapy and Healthcare Practices for Trans and Nonbinary People

Puckett, J. A., Kimball, D., Glozier, W. K., Wertz, M., Dunn, T., Lash, B., Ralston, A. L., Holt, N. R, Huit, T. Z., Volk, S. A., Hope, D. A., Mocarski, R., & DuBois, L. Z. (2023). Transgender and gender diverse clients’ experiences in therapy: Responses to sociopolitical events and helpful and unhelpful experiences. Professional Psychology: Research and Practice, 54, 265–274.

Abstract: We examined transgender and gender-diverse (TGD) people’s reports of their therapy experiences over the course of a year. We explored how participants’ therapists integrated discussions about current events, as well as their more general perspectives on helpful and unhelpful experiences. A total of 107 participants provided data on these questions at least once over 12 months of surveys (M age = 33.79; 70.1% White), reflecting on their current therapy experiences. Through thematic analysis of qualitative data, the following themes were constructed regarding discussing sociopolitical events: (a) facilitating coping via bearing witness to clients’ internal experiences and implementing other therapeutic interventions; (b) moving beyond the individual by integrating identity, systems, or contexts; (c) feeling disconnected and misunderstood. We grouped participants’ helpful experiences into the following themes: (1) availability, connection, and therapeutic approaches facilitate positive experiences; (2) the necessity of knowledge, education, and affirmation of TGD identities; (3) helpful therapy means seeing the world in which clients live. We grouped participants’ unhelpful experiences into the following themes: (1) logistical issues can interfere with therapy; (2) lack of depth and disconnection results in subpar therapy; (3) insufficient understandings of TGD identities results in potentially harmful practices. These findings deepen understandings of how to integrate discussions about current events into therapy and provide competent and affirming care to TGD clients.

Puckett, J. A., Wiklund, L. O., Louis, C. C., Gallik, C., Brown-Wren, L., Chu, H., Rodriguez, J., Langeni, N. S., & Strong, E. (2023). Clinical practice with transgender and gender diverse clients: Setting up an inclusive practice and training considerations. Practice Innovations, 8, 265-276.

Abstract: Transgender and gender diverse (TGD) people experience various minority stressors that drive health disparities. In the face of this marginalization, therapy may be helpful to manage these stressors and promote well-being. For some TGD people, they also may need to interact with mental health providers in order to gain access to gender-affirming medical procedures. As such, it is not unusual for mental health providers to have TGD clients at some point in their careers. Even so, there is little graduate training about working with TGD clients, which can result in providers being underprepared to work with TGD communities in affirming ways. Many TGD people report experiencing microaggressions or worse on the part of providers and even those who claim to be affirming may not be taking the steps needed to create a safe clinical context for care. This presents an important training point for graduate programs as well given that many of the professors or clinic staff may not have received the necessary training either. In this manuscript, we detail a summary of existing best practices for affirming mental health services with TGD clients that were informed by existing literature, community input, and clinical practice. These specific actions span from paperwork, to the clinical space, and specifics of interactions with clients. By carrying out these actions, providers will be able to live out their commitment to affirmation of TGD people. We also provide guidance for graduate programs to ensure that future generations of therapists are better trained in these areas.

Puckett, J. A., Holt, N. R., Lash, B., Huit, T. Z., Ralston, A. L., Hope, D. A., Mocarski, R., & DuBois, L. Z. (2023). Transgender and gender diverse adults’ self-reported mental health diagnoses, engagement in mental health services, and perceptions of therapists. Psychotherapy Research, 33, 84-94. doi: 10.1080/10503307.2022.2091961

Abstract: Objective: Transgender and gender diverse (TGD) people face various challenges when seeking therapy. Given this, we wanted to understand more about TGD people’s perceptions of providers and how these compare to researcher ratings of providers on metrics of affirming practice. Method: The sample included 158 TGD adults (Mage= 33.06); 57.6% were in therapy. Participants completed measures about mental health, resilience, and therapy. We systematically coded provider websites and intake forms. Results: Participants in therapy were older, had higher depression, and lower resilience than participants not in therapy. Non-binary/genderqueer participants rated providers as less knowledgeable compared to trans feminine participants. Overall, participants appeared satisfied (71.4% extremely satisfied) and viewed providers as at least moderately knowledgeable (89.1%). Provider coding revealed variation across the markers ofaffirmation; 66.04% identified a TGD-specialty and only 26.42% shared provider pronouns. Higher frequency ofinclusivity (via coding) was related to higher ratings of provider knowledge and more of a focus on gender, however, there was not a significant association with satisfaction. Conclusions: Providers who engaged in more affirming practiceswere more knowledgeable compared to those who engaged in fewer affirming practices. This may influence the content of therapy and whether clients feel comfortable discussing gender.

Puckett, J. A., Giffel, R., Brown, F., Gallik, C., Kimball, D., Chu, H., Mustanski, B., & Newcomb, M. E. (2022). Suggestions for improving healthcare for transgender and gender diverse people in the United States. International Journal of Transgender Health. Advance online publication.

Abstract: Introduction: Transgender and gender diverse (TGD) individuals face disproportionate barriers to accessing affirming healthcare, ranging from individual practitioners’ biases to financial constraints and societal-level cisnormativity. Method: This study identified suggestions for improving healthcare from 420 TGD individuals in the United States. Participants responded to an open-ended question about their suggestions for improving healthcare for TGD people. These responses were then coded using thematic analysis, resulting in 22 specific codes under 6 themes. Results: Results indicated a need for eliminating cisnormativity, taking a holistic approach with clients, adjusting conceptual frameworks for care, eliminating accessibility barriers, promoting affirmative interactions with TGD clients, and providing TGD-affirmative training for providers. Notably, these suggestions spanned from the broader, cultural level regarding general understandings of TGD people and gender to micro-level interactions. Conclusions: This study provides important tools for improving TGD care via a reduction of barriers and an increase in competency and affirmation.

Puckett, J. A., & Matsuno, E. (2021). Research on evidence based practice with transgender adults: A commentary on “A Systematic Review of Recommendations for Behavioral Health Services for Transgender and Gender Diverse Adults.” Clinical Psychology: Science and Practice, 28, 202-205.

No abstract available

Feinstein, B. A., & Puckett, J. A. (2020). Introduction to the special issue: Psychologists’ role in advocacy to support the health of marginalized populations. the Behavior Therapist, 43, 234-235.

No abstract available

Puckett, J. A. (2019; invited submission). An ecological approach to therapy with gender minorities: Special issue commentary. Cognitive and Behavioral Practice, 26, 254-269.

Abstract: This special series includes four articles that review important considerations for clinical work with gender minorities, including youth and young adults, individuals who are nonbinary, transgender individuals in inpatient or residential care, and transgender individuals recovering from trauma. These articles provide important insights and concrete suggestions for how to enact affirming practice, spanning across macro, mezzo, and micro levels. Ultimately, a multilevel approach to working with transgender and gender diverse individuals is essential to addressing health disparities in this population, as the work of an affirming provider goes beyond the therapy hour and the therapy office or treatment unit. In this commentary, I review the major themes from these contributions, provide a perspective on how they fit within the existing literature, and provide an overview of pressing future directions in gender minority research.

Puckett, J. A., Barr, S. M., Wadsworth, L. P., & Thai, J. (2018). Considerations for clinical work and research with transgender and gender diverse individuals. the Behavior Therapist, 41, 253-262.

Abstract: The aim of the present article is to provide psychologists, other mental health professionals, and individuals in training with a selection of clinical and research recommendations for working with people who are transgender (or trans) and gender diverse. Within clinical work, there are many considerations for how to create an affirming atmosphere and engage in culturally competent care with trans and gender diverse clients. It is important to remember that it is simply not possible in the current sociopolitical climate for a trans or gender diverse person to avoid exposure to anti-trans stigma and for trans people of color to avoid this in combination with exposure to racism, xenophobia, and White supremacy. The author hopes that this article opens up conversations about how to engage in affirming clinical work and research with trans and gender diverse communities and that it encourages you to think critically about practices in your organization, graduate program, or research lab.

Puckett, J. A., Cleary, P., Rossman, K., Mustanski, B., & Newcomb. M. (2018). Barriers to gender-affirming care for transgender and gender nonconforming individuals. Sexuality Research and Social Policy, 15, 48-59.

Abstract: Gender-affirming care, including hormone therapy, "top" (e.g., chest reconstruction surgery) and "bottom" (e.g., vaginoplasty, phalloplasty, metoidioplasty, etc.) surgeries, and puberty blockers, is an efficacious treatment of gender dysphoria for transgender and gender nonconforming (TGNC) individuals. However, many TGNC people encounter significant barriers in accessing gender-affirming care, which we detail via results from on online study. Participants included 256 TGNC individuals (78.9% White, ages 16–73,Mage= 28.4). Among participants, 61.3% were receiving hormone therapy, 22.7% had undergone top surgery, and 5.5% had undergone bottom surgery. Open-ended responses (n= 201) were thematically analyzed and common barriers included finances and insurance issues, a lack of service availability, and fears or worries. Participants reported various systemic issues and incidents of bias within medical and mental health fields, as well as a lack of medical provider awareness and education. Other themes were interpersonal barriers (e.g., fears of rejection); age and need of parental consent for minors; other medical issues; and a lack of information about how to acquire care. These findings can be utilized to educate professionals in medical and mental health fields about barriers their TGNC patients may encounter in receiving affirming care and suggest a num-ber of ways to improve access to these services.

Prejudice Against Trans and Nonbinary People

Puckett, J. A., Hanson, C., Dunn, T., Kuehn, K., & DuBois, L. Z. (2024). An examination of predictors of prejudice against transgender individuals. Journal of Homosexuality, 71, 645-665.

Abstract: We examined associations between prejudice toward transgender people, aggression proneness, history of family violence, contact and closeness with transgender people, and education about issues that impact transgender individuals. We also examined the moderating effects of contact, education, and closeness on the relations between aggression and history of family violence with prejudice. There were 360 participants (M age = 31.34, SD = 12.47, range 18–75) who completed the survey online. Participants were recruited through social media, web-sites, and MTurk. Higher levels of aggression proneness were related to higher levels of prejudice. Higher levels of education about issues that impact transgender people and prior contact with a transgender person were associated with less prejudice. In a multiple regression analysis, the strongest predictor of prejudice was education about transgender people and topics. Moderation analyses revealed that prior contact may buffer the effects of aggression proneness on prejudiced beliefs.

Puckett, J. A., DuBois, L. Z., McNeill, J. N., & Hanson, C. L. (2020). The association between social dominance orientation, critical consciousness, and gender minority stigma. Journal of Homosexuality, 67, 1081-1096. doi: 10.1080/00918369.2019.1603493

Abstract: Transgender people are exposed to great amounts of discrimination and violence, but research has yet to fully understand what drives stigma towards this community. In this study, we hypothesized that social dominance orientation would be associated with greater gender minority stigma (i.e., stigmatizing views of transgender people), with this association mediated by higher levels of trait aggression and lower levels of critical consciousness. Data were collected online from 254 cisgender individuals (158 women, 96 men; Mage=30.81 years). Social dominance orientation was associated with higher levels of gender minority stigma. Trait aggression was not a significant mediator of this association. However, there was a significant indirect effect via lowered critical consciousness (B= 0.10, SE = 0.04, 95% CI: 0.02, 0.17). Approaches that increase awareness about social hierarchies and systems of privilege will likely prove fruitful in facilitating social change in attitudes towards transgender people.

Other Research Areas

Rabine, S., & Puckett, J. A. (2023). “Open science: The future of psychology:” Reflections on the invited panel. the Behavior Therapist, 46, 72-78.

No abstract available.

DuBois, L. Z., SturtzSreetharan, C, MacFife, B., Puckett, J. A., Jagielski, A., Dunn, T., Anderson, T., Hope, D. A., Mocarski, R., Juster, R.P. (2023). Trans and gender diverse people’s experience wearing face masks during the COVID-19 pandemic: Findings from data across 4 states in the USA. Sexuality Research and Social Policy, 20, 1072-1080.

Abstract: Introduction: Social isolation and reduced access to public life in response to SARS-CoV-2 (COVID-19) challenges health and well-being for many. Marginalized communities, including transgender and gender diverse (TGD) people, have been dis-proportionally impacted. Experiences of TGD people should be centered in pandemic-related research to better inform policy. Methods: A diverse sample of TGD people (N = 158) were recruited from Michigan, Nebraska, Oregon, and Tennessee to participate in the Trans Resilience and Health Study. Participants ranged from 19 to 70 years old (M = 33.06; SD = 12.88) with 27.2% identifying as trans men/men, 26% identifying as trans women/women, and remaining identifying with terms like genderqueer and nonbinary. Thirty percent identified as people of color. Participants completed a monthly COVID-19-related questionnaire April 2020–March 2021 including open-ended questions to learn what contributed to resilience during this time. Thematic analyses of responses enabled identification of salient themes. Results: Analyses revealed pandemic-related changes in social experiences of marginalization and mask-wearing. Twenty-six participants mentioned face masks as contributing to resilience while also elaborating the influence of masks on experiences of misgendering. Participants identifying as trans women reported decreased misgendering while trans men and nonbinary participants reported increased misgendering. Conclusions and Policy Implications: Mask-wearing helps reduce transmission of COVID-19. For some trans women, masks also reduce the threat of misgendering and possibly other forms of enacted stigma. However, increased risk for misgendering, as noted by trans men in our study, should be considered and increased supports should be provided.

Puckett, J. A., Tornello, S., Mustanski, B., & Newcomb, M. E. (2022). Gender variations, generational effects, and mental health of transgender people in relation to timing and status of gender identity milestones. Psychology of Sexual Orientation and Gender Diversity, 9, 165-178.

Abstract: Transgender and gender diverse (TGD) people commonly report the following gender identity milestones: feeling different about their gender than expectations for their sex assigned at birth, identifying as TGD, living in their affirmed gender, and, for some, accessing gender-affirming medical care. We explored the average ages of reaching these milestones and variations across gender groups and generational cohorts. We also examined how gender groups, generational cohorts, and endorsement of reaching each of the milestones related to minority stress variables and mental health. This online study included 695 TGD individuals ages 16–73. Boomersand Generation X groups were more likely to identify as trans women compared with the younger generational cohorts, who were more varied in their identities. Trans women had later ages of starting to live in their affirmed gender and receiving gender affirming medical care compared with other gender groups. The Boomerscohort reported later ages for the milestones compared with other generational cohorts. And, finally, younger generational cohorts had higher levels of internalized stigma, anxiety, and depression, compared with the older cohorts. Gender congruence emerged as a consistent predictor of mental health in the full sample and within each generational cohort. There are important generational differences across identity milestones, minority stress, and mental health that need exploration in future longitudinal research. In addition, beyond the effects of milestone timing, reporting feelings of congruence with one’s gender identity is an important consideration for mental health.

Puckett, J. A., Glozier, W. K., Kimball, D., & Giffel, R. (2021; invited submission). A systematic review of sexuality measurement in transgender and gender diverse populations. Psychology of Sexual Orientation & Gender Diversity, 8, 276-291.

Abstract: Research related to the lives of transgender and gender diverse (TGD) people has grown substantially in recent years. One area of such growth has been research on TGD people’s sexuality. Sexuality can include sexual behaviors, sexual attraction, and sexual identity, among other domains. Historically, sexuality of TGD people was often policed by providers with expectations of heterosexuality or the conflation of sexuality and gender experiences. This resulted in a lag in understanding the lived experiences of TGD people in relation to sexuality. In this review, we examine research that has been conducted over the past 5 years with any measurement of sexuality with TGD participants. The initial search revealed 11,891 articles. After removing duplicates, there were 6,538 articles in the abstract review stage, with 1,669 retained for full text review and 179 retained for extraction. Most studies included majority white samples, and about half were conducted solely in theUnited States. Most studies measured a single dimension of sexuality, specifically sexual identity, whereas only 2.2% asked about all three dimensions of identity, behavior, and attraction. Of those that inquired about sexual identity, most samples were majority sexual minorities. Many studies had issues related to inclusivity, such as the language used in response options or questions. These findings are placed within the context of the revised 2021 guidelines for practice with sexual minorities and emphasize the importance of diversifying our field’s understandings and assessments of sexuality for TGD people.

Puckett, J. A. (2021). Mental health. In A. E. Goldberg & G. Beemyn (Eds.), The SAGE Encyclopedia of Trans Studies (Vol. 2, pp. 521-528).

Many trans individuals report notable elevations in mental health concerns as a result of the social rejection and oppression that they are exposed to in their immediate and broader communities. Mental health disparities exist across a number of areas, such as depression, anxiety, and suicidality, as well as other forms of psychological distress. Drivers of these mental health disparities include exposure to adverse life events, minority stressors, gender dysphoria, and other contextual factors. Trans individuals who are supported in their identities experience benefits to their mental health and a reduction in health disparities. This entry outlines what is currently known about the mental health disparities reported by trans individuals and the factors that are driving these negative mental health outcomes. This is followed by an overview of several factors that may be associated with improvements in mental health, such as gender affirmation and coping. The entry concludes with an overview of research related to mental health services for trans individuals.

Puckett, J. A. (2021). Gender minority stress. In A. E. Goldberg & G. Beemyn (Eds.), The SAGE Encyclopedia of Trans Studies (Vol. 1, pp. 315-319).

Minority stress broadly refers to the unique stressors that minority groups experience, above and beyond the general types of stressors that anyone may endure. For instance, work may be stressful for many reasons—including navigating relationships with coworkers, job performance and advancement concerns, or other reasons. When someone holds a minority status, there are likely additional stressors that may arise, such as concerns about microaggressions or mistreatment from coworkers or one’s boss, concerns about company policies and whether there are inclusive nondiscrimination protections, or other stressors. Even the stressors that are general in nature may take on additional nuance when experienced as the member of a minority. As such, the general stressors could also be influenced by biases toward minorities, such as interpersonal relationships not only being affected by individual personality differences but also slight or overt displays of stigma. When applied to trans individuals, these unique stressors are termed gender minority stress.

Puckett, J. A., Brown, N., Dunn, T., Mustanski, B., & Newcomb, M. E. (2020). Perspectives from transgender and gender diverse people on how to ask about gender. LGBT Health, 7, 305-311. DOI: 10.1089/lgbt.2019.0295

Abstract: Purpose: When inquiring about the gender of research participants, most studies use self-generated questions about gender or questions prepared by researchers that have been evaluated for comprehension by transgender and gender diverse (TGD) and cisgender individuals. However, many gaps still exist in this area, including identifying how TGD people would like to see their gender represented in questions about gender identity. To address this issue, we explored the perspectives of TGD people regarding the construction of questions about gender. Methods: In this online study of 695 TGD people (Mage=25.52), participants provided written suggestions for how to ask about gender and these responses were analyzed thematically. Data were collected between fall 2015 and summer 2017. Results: Three broad categories of responses emerged: (1) specific identities to include in response options; (2)specific questions to ask about gender; and (3) qualifiers/nuanced considerations. Conclusion: Participants provided a variety of suggestions for how to ask about gender and future research is needed to explore the implementation of these suggestions. Recommendations are provided for options that researchers can explore for how to ask about gender. These findings highlight the ways that TGD people would like their gender to be asked about, which is necessary information to ensure that questions about gender reflect TGD people’s identities accurately.

Puckett, J. A., Mereish, E. H., Levitt, H. M., Horne, S. G., & Hayes-Skelton, S. A. (2018). Internalized heterosexism and psychological distress: The moderating effects of decentering. Stigma & Health, 3, 9-15.

Abstract: Internalized heterosexism (IH) refers to the internalization of stigma, stereotypes, and negative views of sexual minorities into one’s self concept as a product of social bias. Although substantial research has documented the negative impact of IH on mental health, there is a dearth of research examining variables buffering this association. One cognitive strategy that may help protect individuals against the negative effects of IH on health is decentering, or the ability to view thoughts and feelings as events rather than as truths about oneself. In this online study of 436 sexual minority participants (80% White, age range18–80, mean age39.31), we examined the moderating effects of decentering on the association between IH and psychological distress. Results revealed that there was a significant association between greater IH and psychological distress (B2.43,p.05). Also, higher levels of decentering were related to lower reported psychological distress (B0.31,p.001). In addition, decentering significantly moderated the association between IH and psychological distress (B0.35,p.05). For individuals who reported higher than average levels of decentering, there was not a significant association between IH and psychological distress. However, for individuals who reported average and low levels of decentering, greater IH was associated with greater psychological distress. These results suggest that decentering significantly buffered the association between IH and psychological distress, highlighting a promising avenue for future research to explore in developing empirically supported interventions to cope and manage internalized stigma.

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