Understanding Election-Related Distress in Trans Communities
One of the most common experiences my trans and nonbinary clients share with me after expressing distress related to politics is having someone in their life minimize current stressors/threat, suggesting they are overreacting. I want to start this essay by doing the opposite. The political landscape is scary and threatening for trans people, and we’re sitting with a lot of uncertainty with how bad it could get. Dr. AJ Restar and colleagues recently published an article in the American Journal of Public Health calling the current state of trans healthcare and politics a public health emergency. If you are a trans person or the loved one of a trans person, experiencing distress about the current sociopolitical climate is a completely reasonable response, as is concern specifically attached to the November 2024 elections. You’re also not alone.
[Note: I’ve written a lot here about the distress trans folks are feeling right now. My next post is about how to manage that distress. I think it will be helpful to read these pieces together, but it was monstrously long as a single post, so I’ve broken it up.]
Impacts of Hostile Sociopolitical Climate
We know that generally, hostile sociopolitical climates have a negative impact on trans people’s mental health (see DuBois et al, 2023 for an excellent summary; full PDF here). For starters, these climates lead to policies that harm our communities, including reduced protection against discrimination, restricted access to gender-affirming healthcare, barriers to legal affirmation like updating ID documents, and reduced capacity to engage safely and equitably in our communities (e.g., bathroom laws and sports bans). We also know that this rollback on trans rights is happening in tandem with other harmful political moves that affect members of the trans community as well, such as right-wing immigration policies and other enacted xenophobia and racism, government actions against indigenous people and lands, a general rise in fascism, restrictions on abortion and reproductive healthcare, and the lack of mitigation of climate change.
Additionally, hostile policies are associated with increased enacted stigma at the interpersonal level, including violence (Puckett et al., 2024). A recent study found that people in states with more hostile policies toward trans people endorsed more negative implicit and explicit views toward trans people (Roy et al., 2023; full PDF here). This is likely due to normalizing trans people’s marginalization while emboldening the people who hold bias and hatred toward us. This is why I use the term sociopolitical - the political realm affects the social realm and vice versa. And I suspect this functions as a cyclical relationship: people’s views are being shaped by the political machine using trans people as a wedge issue, and in turn people are supporting politicians and policies that harm trans people, and so it goes.
Relatedly, research and my own anecdotal data make clear that the even “just” the discourse/debate around trans-negative policies has a negative impact on trans people. For example, in a study conducted in 2021, perceived support for anti-trans legislation was associated with trans young adults and adolescents’ increased rumination, depressive symptoms, and fear of disclosing transness, while legislation-related news consumption alone was associated with increased rumination and somatic symptoms1 (Dhanani & Totton, 2023; full PDF here). Researchers at UMass Boston found that anxiety stemming from a proposed referendum on trans people’s access to bathrooms was associated with worsened depression among participants (Horne et al., 2022). In a recent study presented at the American Psychological Association’s 2024 convention, Alex Colson and colleagues in ASU’s Empowerment Lab found that this impact may be partially explained by an increased awareness of others’ negative attitudes toward trans people. This is perhaps the most significant shift in modern structural/societal transphobia: the visibility and volume of trans-negative attitudes. These discussions are so ubiquitous, it’s nearly impossible to get away from someone expressing anti-trans bias. As one of Colson and colleagues’ participants shared:
Being constantly reminded that there are so many people against my very existence is terrifying and depressing, and although nothing has particularly happened to me because of this, being exposed to this knowledge alone can be debilitating.
This is definitely consistent with what I’m hearing and what I’ve even experienced as a trans person in Massachusetts. So even in states or circumstances where a person feels protected from the policies being discussed or being enacted elsewhere, the discourse alone can have distressing consequences.
And something I’m seeing in clients and within my community is the fear of where things could go - “how bad will it get?” Folks who haven’t experienced any direct impacts of policies yet are fearful of the future. We are sitting a few years into a clear trend of rapid escalation with right-wing candidates, including presidential/vice-presidential candidates Trump and Vance making extreme anti-trans statements (see Imara Jones’ political podcast The Mess for more analysis), so it is easy to imagine continued escalation to some truly worst-case scenarios. For example, a participant in Colson and colleagues’ aforementioned study stated that they are kept up at night “thinking about the genocide the right is attempting to enact on trans people” and wondering “if my friends and family will live long lives.” I’ve heard deeply held fears like this emerge in psychotherapy sessions, as well.
Unsurprisingly, research clearly shows that trans and nonbinary people are struggling with their mental health in the face of this distress. In a poll of young people ages 13-24, 86% of trans youth reported that their mental health had been negatively impacted by the debates and laws restricting trans rights. Trans people in states with more hostile sociopolitical climates have greater levels of current psychological distress and both current and lifetime suicidality (Price et al., 2024; full PDF here). Another study found that searches related to suicide and depression increased in states following the passing of anti-trans legislation (Cunningham, Watanbe, & Buzuvis, 2022; full PDF here). Trans people in areas with more hostile sociopolitical climates also report higher levels of expectations of negative events, internalized stigma, and anxiety, and lower levels of pride (Puckett et al., 2024).
Returning to the Empowerment Lab study, Colson and colleagues found that nonbinary adults in the U.S. experienced, fear, worry, hopelessness, powerlessness, anger, and internalized stigma in response to the current political climate. Their participants described experiences of traumatic stress, loss of access to known sources of wellness (e.g., authenticity, care, safety), disconnection from society, and emerging suicidality. I am seeing all of this in my work with trans clients, including grief for a different world - or the world they thought they’d be living in in 2024.
Election-Related Distress
In addition to general sociopolitical distress, trans people and our loved ones (and many other folks, frankly) are experiencing a particular kind of distress associated with the upcoming November elections - and specifically, the presidential election. To illustrate the trends and complexities of this, I want to walk y’all through research conducted by a large team of folks led by Drs. Zachary DuBois and Jae Puckett (DuBois et al., 2024; email me for a PDF of the study). Researchers followed trans adults from Michigan, Nebraska, Oregon, and Tennessee in the period leading up to and following the November 2020 election, a period following four years of a Trump-Pence presidency and during the election that Biden-Harris ultimately won over Trump-Pence, as well as the post-election turmoil. Researchers asked participants to fill out monthly surveys on their mental health, resilience, and coping.
DuBois and colleagues found that anxiety and depression increased significantly in the months leading up to the election, with a significant drop in anxiety and depression immediately following the election being called for Biden, but then steadily increased again from December to March. There was a similar trend in the extent to which participants felt they were able to cope with their stress (worsened leading to election, then improvement following election, then continued worsening). To help explain why mental health might have continued to deteriorate after the election (even after a bit of relief that Trump wasn’t reelected) recall that during this period, Trump refused to accept the results of the election, the January 6 insurrection attempt occurred, and there was a flood of anti-trans bills at the state level.
Researchers also found that individual factors affected both baseline (April 2020) levels of anxiety and depression, as well as the rate of worsening in those symptoms approaching and following the election. For example, exposure to enacted stigma was associated with overall greater levels of anxiety and depression and a steeper increase in anxiety following the election.
Other relevant individual-level factors included age, access to local trans-positive resources, and general social support, though the relationship between these factors and depression, anxiety, and coping were complex. I highly recommend reading the article in full, but I want to briefly explain the results involving social support.
Although generally trans people with low social support had worse depressive symptoms than people with high social support (as expected), after the 2020 election, following the initial relief in depression, people with high social support had their depression scores start to worsen again while people with low social support did not. What this suggests to me is that general measures of things like social support aren’t going to capture the specific interpersonal and community experiences or needs of trans people. Social support in this study was not trans-specific and included items like “I feel a strong emotional bond to at least one other person.” A major theme for the trans people I sit with each week is that cis people who purport to love and care about them aren’t tracking how bad it’s getting for trans folks. So I see this complex finding and think about all the clients and friends who felt like their loved ones were relieved when we were on the other side of the election or on the other side of January 6th and weren’t alarmed by the 2021 escalation of attacks on trans rights. I understand this to perhaps be capturing the depressive impact of trans people feeling abandoned by the cis folks in their social support networks. (This is of course just a hypothesis.)
So what lessons are in this research for the current election and trans people’s distress? Overall, this study pretty powerful demonstrates that:
A federal election with Trump and his right-wing version of the GOP as a candidate is a major event in the psychological world of many trans people.
Distress crescendos the closer we get to this anticipated election.
Individual factors affect how distressed a given trans person is going to be.
A “good” or “better” outcome in the federal election is not a cure-all for trans people - there’s still distressing stuff going on and fear for the future.
Things that help cis people manage election-related distress may not apply or work the same way for trans folks.
These points are consistent with my impression of what’s going on for folks right now as we move toward the 2024 election.
Importantly, if the things that help cis folks with this don’t function the same way for trans folks, what does work for us? I get into all of that in my next post! We need not be resigned to being overwhelmed and unable to cope with the distress we will increasingly feel as we approach the election.
A Better World Is Possible, but for Now We Have To Live in This One
Somatic concerns are often a way that psychological distress manifests, and one pathway for this allostatic load - the physiological wear and tear on the body as a result of adrenal and inflammatory responses to stress. Dr. Zachary DuBois has led some important research looking at the associations between this somatic wear and tear and sociopolitical climate. In one such study, trans men and transmasculine people in states with less progressive geopolitical climates had higher levels of allostatic load as measured by 10 neuroendocrine, immune, cardiovascular, and metabolic biomarkers. People with socio-demographic disadvantages (e.g., racially minoritized trans people, trans people living in poverty) also had higher levels of allostatic load (DuBois & Juster, 2022; full PDF here).