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Transgender and Gender-Diverse Minority Stress and Substance Use Frequency and Problems: Systematic Review and
Michael J Pellicane1, Madison E Quinn1, Jeffrey A Ciesla1
1Department of Psychological Sciences, Kent State University, Kent, Ohio, USA.
Transgender Health
|March 28, 2025
Summary
Distal minority stress, experienced by transgender and gender-diverse (TGD) individuals, is linked to increased alcohol and drug use. Proximal minority stress showed no significant association with substance use in this meta-analysis.
Area of Science:
- Psychology
- Public Health
- Sociology
Background:
- Minority stress is a significant factor impacting the health of transgender and gender-diverse (TGD) populations.
- Previous research suggests a link between minority stress and substance use, but a comprehensive synthesis is lacking.
Purpose of the Study:
- To systematically review and meta-analyze quantitative research on the associations between minority stress and substance use in TGD samples.
- To examine specific types of minority stress (distal and proximal) and their relationship with alcohol and drug use frequency and problems.
Main Methods:
- Systematic literature search of PsycInfo, MEDLINE, Gender Studies, and LGBTQ+ Source databases.
- Random-effects meta-analyses were conducted on 76 effect sizes from 36 quantitative studies.
- Moderator analyses explored the influence of publication year and sample demographics (assigned sex at birth, race/ethnicity, sexual minority status).
Main Results:
- Significant positive correlations were found between distal minority stress and alcohol use frequency (r=0.13) and problems (r=0.09).
- Distal minority stress was also significantly correlated with drug use frequency (r=0.16) and problems (r=0.14).
- No significant associations were observed for proximal minority stress and substance use outcomes. Effect sizes for distal stress and alcohol use were higher in samples with more BIPOC participants.
Conclusions:
- Distal minority stress is a significant predictor of increased alcohol and drug use frequency and problems among TGD individuals.
- Proximal minority stress was not significantly associated with substance use in this meta-analysis.
- Findings highlight the importance of addressing external stressors in interventions aimed at reducing substance use in TGD populations.
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