Meredith Klepper

Introduction: Black transgender women are disproportionately exposed to chronic stigma and barriers to healthcare access, which are associated with poor mental health and delays in treatment-seeking. Due to these barriers, traditional treatment pathways are often inaccessible to this population. Thus, health self-management may be critical in promoting health among Black transgender women. The purpose of this study was to examine how chronic stigma exposure influences mental health self-management among Black transgender women. Methods: Participants were recruited between October 2021 and October 2023. Black transgender women (N=28) completed individual semi-structured interviews. Interview narratives were analyzed using thematic content analysis guided by Health Equity and Promotion Model and the Model of the Individual and Family Self-management Theory. Results: Findings identified four interrelated themes describing mental health self-management in the context of stigma: avoidant coping in response to anticipated stigma, persistence in engaging healthcare despite interpersonal and structural barriers, disengagement from providers perceived as stigmatizing, and resilience as resistance, including self-affirmation and reliance on LGBTQ+ support. Discussion: Findings suggest that interventions and health-care systems must adopt anti-cisgenderist and anti-racist approaches that address structural barriers to health self-management among Black transgender women. Steps must be taken at the systemic level to combat stigma, so that Black transgender women are able to engage with the healthcare system in a positive way.

Background: Transgender and gender expansive (TGE) people experience high rates of interpersonal victimization, which has been linked to high rates of post-traumatic stress disorder (PTSD, a highly disabling and under-studied mental illness among TGE people). This systematic review identifies, classifies, critically appraises, and synthesizes the peer-reviewed literature describing the association between interpersonal victimization and post-traumatic stress among TGE people. This review collates what is known about the associations between victimization and PTSD among TGE people and makes recommendations to guide future research and intervention development. Methods: Searches were conducted across five databases (PubMed, Embase, Web of Science, PsycInfo, and CINAHL) following PRISMA guidelines. Inclusion criteria were: English language; peer-reviewed original research; articles describing the association between victimization and PTSD among TGE youth or adults; reporting TGE-specific data. Exclusion criteria were: reviews, commentaries without original data, dissertations or theses, conference abstracts, animal studies, studies without TGE-specific findings, and case studies. Quality appraisal was completed for all studies, which included a discussion of bias. Data extraction was completed by two independent authors, and conflicts were resolved by a third. Data were stratified by gender identity, race or ethnicity, and type of violence for further synthesis. Results: 25 studies were evaluated for design, measure quality, and key findings. Findings were highly consistent across studies: multiple forms of interpersonal violence (e.g., childhood maltreatment, sexual violence, intimate partner violence, and transgender-specific victimization) were significantly associated with PTSD symptom severity or diagnosis across diverse identities and geographic contexts. All studies examining childhood sexual abuse reported significant associations with PTSD outcomes, highlighting early life as a critical period of vulnerability. Samples were disproportionately White and adult, with limited examination of intersectional experiences shaped by race, ethnicity, and socioeconomic status. Discussion: Interpersonal violence-related PTSD among TGE populations reflects a pervasive and systemic pattern of trauma rooted in structural discrimination rather than isolated individual risk. Addressing this inequity requires multilevel prevention and intervention strategies. Future research should prioritize longitudinal designs, culturally responsive measurement tools, and intersectional analyses to inform prevention, clinical care, and policy responses. The majority of studies were cross-sectional designs, so causality cannot be inferred. Additionally, the samples were disproportionately White and adult, which may bias the magnitude of associations reported and limit generalizability to racially and ethnically diverse TGE populations. Although many studies reported race and ethnicity descriptively, none disaggregated violence-related PTSD outcomes by racial or ethnic group within TGE samples, representing a critical limitation for intersectional analysis.

Black transgender women report high levels of discrimination, which is associated with poor health outcomes. Some evidence suggests that intersectional discrimination—that is, interacting forms of marginalization related to one’s real or perceived social identities or positions that contribute to unique dynamics and effects on health—is associated with worse health-related quality of life; however, little evidence explores this possible association among Black transgender women. Addressing this gap is crucial in understanding how overlapping experiences of racism and cisgenderism contribute to poor health outcomes in this population. We used cross-sectional survey data from 151 Black transgender women ages 18 to 67 (mean = 35.9 ± 11 years) to examine the associations between age, intersectional discrimination via the Day-to-Day Intersectional Discrimination Index (INDI-D), and aspects of Health-Related Quality of Life (HRQoL; i.e., self-perceived quality of general health [GenHealth] and number of health days in the past 30 days), via T-tests, Pearson’s correlations, stepwise sequential linear regression (SSLR) to test for moderation, and the PROCESS macro for SPSS to test for indirect effects. Increased INDI-D was consistently significantly associated with worse GenHealth and decreased number of healthy days across adjusted and unadjusted models. However, adjusted moderation and indirect effects analyses did not support moderation or mediation hypotheses. Future research should further investigate how discrimination and aging affect the health of Black transgender women, with attention to weathering and coping. Additional studies are needed to develop and improve interventions to support the well-being of this marginalized community.

Low health literacy is a known contributing factor to poorer patient outcomes. Health information is often presented through materials written at high reading levels and thus may be an ineffective education tool for patients of diverse socioeconomic backgrounds, age ranges, and education levels. Graphic medicine (i.e., healthcare concepts presented through illustrations, such as comics or cartoons) may be a more equitable and efficacious format for many patients. The purpose of this review was to describe the efficacy and use of graphic medicine interventions regarding health outcomes, behavior changes, and engagement with health services. Nine databases were searched for studies that were randomized controlled trials in the English language, published before 4 December 2023. The searches identified 34 research articles that met the inclusion/exclusion criteria. This review revealed four key takeaways: (1) graphic medicine interventions are used globally; (2) graphic medicine interventions may be efficacious for a wide variety of health topics; (3) graphic medicine can be equitably delivered in many formats; and (4) graphic medicine can be applied broadly across the lifespan. The findings suggest that graphic medicine enhances patient engagement, empowers individuals with knowledge, and ultimately contributes to improved health outcomes across various populations; however, more effectiveness trials are needed. Additionally, an expanded definition of graphic medicine is presented.

Introduction: Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co‐occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring.Design/Methods: Partial least square path modeling followed by response‐based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)‐based TW (N = 1418; 46.2% White non‐Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post‐traumatic stress and psychological distress).Results: The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW.Conclusion: Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co‐occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real‐world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti‐racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts.Clinical Relevance: This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post‐traumatic stress disorder and psychological distress. Specifically, interventions should take an anti‐racist approach and would benefit from incorporating social support‐building activities.