Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field's current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21-32%), and among GM was 46% (95% CI 36-56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges' g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.

Photo ID 280792184 © Jj Gouin| Dreamstime.com Abstract Healthcare providers should advocate for human and civil rights. They ought to recognize injustices that unfairly disadvantage certain groups of people and work to improve broader conditions that affect health. Healthcare systems have historically undervalued and even excluded certain voices from the creation of an evidence base for care, furthering health disparities for members of these groups. This is a form of testimonial injustice. Trans people experience a particular form of testimonial injustice in healthcare settings when evidence and expertise related to their lived experience are excluded from consideration, as was the case with the 2024 Cass Review. Such exclusion can lead to mistreatment and harm. Providers must be vigilant in recognizing and addressing testimonial injustice against trans patients and the health disparities it can cause. Introduction Trans individuals (people who identify as transgender, transsexual, or whose gender identity is different from the sex they were assigned at birth) face many barriers to health care. The lack of competent, knowledgeable providers poses a significant barrier to gender-affirming care, as well as other forms of everyday health care for trans people.[1] Addressing this challenge requires health professionals to actively oppose structures that perpetuate epistemic injustice, which Miranda Fricker defines as “wrong done to someone specifically in their capacity as a knower.” Testimonial injustice (a kind of epistemic injustice) undermines collective understanding of marginalized perspectives through systemic misrepresentation or dismissal of marginalized individuals’ experiences or contributions.[2] Testimonial injustice contributes to unjust conditions for accessing care and results in poorer health outcomes for transgender individuals. As professionals committed to ethical and equitable patient treatment, we believe it is imperative that healthcare providers recognize and carefully consider the experiences and expertise of trans people in order to address injustices experienced by trans people in healthcare settings. Through an analysis of the Cass Review, we demonstrate how a flawed interpretation of available evidence and the dismissal of trans testimonies generates an injustice that results in significant and unwarranted restrictions on gender-affirming care.  Testimonial Injustice Trans people regularly experience testimonial injustice in health care. It occurs when providers inappropriately discount their patients’ accounts — for example, by refusing to believe patients when they say that they are trans or gender non-conforming. This results in prejudiced assumptions about health behaviors or needs, bias and stereotyping that influence clinical judgment, and harm in the form of worse physical and mental health outcomes.[3]  Testimonial injustice takes several pernicious forms. For example, a Black woman whose reports of high postpartum pain are disregarded by her providers because of her Blackness has suffered testimonial injustice when she receives lower doses of pain medication compared to other postpartum patients at the same hospital.[4] Her attestation of pain, an experience at once personal and universal, has been inappropriately regarded as insufficiently credible, resulting in harmful and unequal postpartum pain management. Testimonial injustice harms the physical, mental, and social well-being of trans people, worsening health outcomes caused by systemic barriers and discriminatory practices. Negative healthcare experiences, along with mistreatment from providers, lead to disproportionately high rates of depression, psychological distress, and suicidal ideation among trans patients.[5] These harmful interactions lead to lower healthcare utilization and delayed treatment. Trans people are also less likely to receive preventative cancer screenings, including for cervical, breast, and colorectal cancers.[6]

nd health. This is particularly surprising, given that gender theorists have posited that transgender people primarily face social penalties due to perceptions that they are not normatively “doing gender” (West and Zimmerman 1987 ). In this article, we use data from the landmark 2008 National Transgender Discrimination Survey (NTDS) to examine whether gender nonconforming transgender people face more discrimination and worse health than their gender conforming counterparts. In particular, we examine three research questions. First, is perceived gender nonconformity associated with exposure to day‐to‐day and major events of transphobic discrimination? Second, is more exposure to transphobic discrimination associated with greater likelihood of engaging in health‐harming behaviors (i.e., attempted suicide, drug/alcohol abuse, and smoking)? Finally, does self‐reported transphobic discrimination mediate the relationships between gender nonconformity and these health‐harming behaviors? In other words, does transphobic discrimination help to explain why gender nonconforming transgender people may have worse health problems? Taken together, our analyses highlight the role that gender nonconformity plays in transgender people's experiences with discrimination and poor health. Background The Lives of Transgender People We use the terms transgender people and trans people to refer to individuals whose gender identity and expression do not normatively align with their assigned sex. The term gender nonconformity is used as a way to signify that one's gender expression breaks cultural expectations for normatively “doing gender” (West and Zimmerman 1987 ). In addition, the term gender transitioning is used to signify a social process wherein modifications are made to one's appearance, style of dress, hair, body, hormones, physical anatomy, and pronoun/name usage. The decision to undergo gender transitioning is typically motivated by one's desire to affirm one's gender identity (Ma The results suggest that gender nonconforming trans people face more discrimination and, in turn, are more likely to engage in health‐harming behaviors than trans people who are gender conforming. Our findings highlight the important role of gender nonconformity in the social experiences and well‐being of transgender people. For example, transgender people frequently face subtle, day‐to‐day expressions of discrimination, including others' expressed discomfort, as well as physical threats, and harassment (Nadal, Skolnik, and Wang 2012 ). However, researchers have not examined whether gender nonconformity—as a visible and known marker of one's stigmatized status—shapes trans people's experiences with discrimination and health. This is particularly surprising, given that gender theorists have posited that transgender people primarily face social penalties due to perceptions that they are not normatively “doing gender” (West and Zimmerman 1987 ). Finally, does self‐reported transphobic discrimination mediate the relationships 2012 ; Vidal‐Ortiz 2009 ; Williams, Weinberg, and Rosenberger 2013 ). What is largely missing from this literature is an understanding of whether transgender people face more severe social consequences for being read as gender nonconforming. We thus provide an empirical investigation of this and also offer an understanding of the health consequences of these dynamics. Gender Nonconformity, Discrimination, and Health Minority Stress Model and Transgender Health Transphobic discrimination has consequences for many aspects of transgender people's lives, including their health and well‐being. That is, trans people who are more frequently read as transgender or gender nonconforming report facing more types of transphobic discrimination compared to those who are read as such less frequently. In Models 2 and 5, these patterns hold, net of medical and social transition statuses. Finally, in Models 3 and 6, gender nonconformity is still significantly and positively associated with exposure to major (IRR: 1.12; CI: 1.08–1.16) and everyday discrimination (IRR: 1.20; CI: 1.17–1.24), net of sociodemographic controls. These findings offer further evidence that the minority stress framework (Meyer 1995 ) can be used to understand the aspects of the social environment that shape and constrain the health status of the transgender population—in this case, widespread exposure to transphobic discrimination. Our second, more central finding is that gender nonconformity may heighten trans people's exposure to discrimination and health‐harming behaviors. Gender nonconforming trans adults reported more events of major and everyday transphobic discrimination than their gender conforming counterparts. 2012 ; West and Zimmerman 2009 ), including an empirical assessment of the social consequences of gender nonconformity that transgender people face (Vidal‐Ortiz 2009 ). Indeed, we find that transgender people who are read as gender nonconforming faced more discrimination than their gender conforming counterparts. In other words, our findings are consistent with assertions by West and Zimmerman ( 2009 ) that accountability structures are still in place, which serve to punish those who deviate from binary understandings of gender. Our findings suggest that gender still remains highly salient in the lives of transgender people. Our findings make major contributions to understanding the social consequences of gender nonconformity for transgender people. Our analyses suggest that gender nonconformity—as a visible and known marker of one's stigmatized status—plays an important role in trans people's experiences with discrimination and poor health. Specifically, we find that trans people who are frequently read by others as transgender and gender nonconforming faced more major and day‐to‐day events of discrimination and, in turn, were more likely to engage in health‐harming behaviors compared to more gender conforming trans people.

... transgender individuals can develop particular fears about being “outed” in public and strive to conceal their gender ... experience, though depressive symptoms can also be present. Comorbid disorders can include separation anxiety ... Abnormal and clinical psychology courses are offered in psychology programs at universities worldwide, but the most recent major encyclopedia on the topic was published many years ago. Although general psychology handbooks and encyclopedias include essays on abnormal and clinical psychology, such works do not provide students with an accessible reference for understanding the full scope of the field. The SAGE Encyclopedia of Abnormal and Clinical Psychology, a 7-volume, A-Z work (print and electronic formats), is such an authoritative work. Its more than 1,400 entries provide information on fundamental approaches and theories, various mental health disorders, assessment tools and psychotherapeutic interventions, and the social, legal, and cultural frameworks that have contributed to debate