Augustus Klein and Sarit Golub are professors at the City University of New York (CUNY), Klein in the Department of Social Welfare at the Graduate Center and Golub in the Department of Psychology at Hunter.

They have recent had a paper published Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults.

Data were drawn from the National Transgender Discrimination Survey (N = 6456). This secondary analysis was restricted to 3458 individuals who self-identified as transgender or gender nonconforming and provided complete data on study variables. We used multivariable logistic regression to examine health risks by level of reported family rejection (low/moderate/high), controlling for relevant sociodemographic characteristics.

Most common characteristics that led to high rejection are: being over 45 years of age, being non-hispanic black, being assigned male at birth, having a binary gender identity, having at most a high school education, having an annual income of less than $20K, and being unemployed.

A little less than half the participants (42.3%) reported having attempted suicide. In bivariate analyses, higher odds of suicide attempts were associated with a younger age, a binary gender identity, nonwhite race/ethnicity, lower education and income, and being unemployed. Reports of both moderate and high levels of family rejection were also associated with greater odds of attempted suicide.

We then ran an adjusted multivariable model, including all covariates that were significantly associated (p less than 0.05) with attempted suicide or family rejection in bivariate analyses. All variables remained significant, including family rejection. In the multivariate model, moderate levels of family rejection were associated with almost twice the odds of attempted suicide, and high levels of family rejection were associated with almost three and a half times the odds of attempted suicide.

26.3% of the sample reported misusing drugs or alcohol to cope with ani-transgender discrimination. 45+-year olds assigned male at birth were perhaps surprisingly less likely to engage in substance abuse. Higher rates of substance abuse were associated with moderate and high levels of family rejection.

After adjusting for sociodemographic factors, having experienced high levels of family rejection was associated with almost three and half times the odds of suicide attempts and two and a half times the odds of substance misuse, compared to those who experienced little or no family rejection. Having experienced only moderate levels of family rejection was associated with almost twice the odds of suicide attempts and over 1.5 times the odds of substance misuse.

Familial rejection may be a stressor in and of itself, leading to negative health outcomes. Alternatively (or synergistically), family rejection may deprive transgender individuals of the emotional or logistical social support that provides other stigmatized individuals with a buffer in the face of stressful circumstances.

In the largest study of transgender individuals, ~41% reported attempting suicide. Among individuals reporting moderate or high levels of family rejection in our sample, this percentage was significantly higher (50% and 61%, respectively); however, among those who reported low or no family rejection experiences, this percentage was significantly lower (33%).

These findings suggest that providers serving the transgender community consider the role of families when assessing a transgender person’s social, emotional, and physical health. Providing emotional and informational support to families may help make a critical difference in decreasing the risk and increasing well-being for transgender individuals.