Gender identity invalidation and suicide risk among trans and nonbinary individuals

Experiences of gender identity invalidation (henceforth invalidation) occur when others do not accept one's gender identity as "real" or "valid," and can be understood as a unique minority stressor, one that we conceptualize as a distinct form of enacted stigma (discrimination). We examine the association of invalidation with other minority stressors - internalized stigma (shame) and felt stigma (expectations of rejection) - and suicide risk (ideation and attempt in the past year). Cross-sectional data are drawn from a large and diverse sample of trans and nonbinary (TNB) individuals (N = 303) surveyed in New York City, the San Francisco Bay Area, and Greater Atlanta to present a preliminary examination of how experiences of invalidation may be associated with other minority stressors and suicide risk. We propose a path analytical framework for theorizing about these relationships. A series of paths within a structural equation model, which are adjusted for sociodemographic factors (sex assigned at birth, nonbinary gender identity, race/ethnicity, education, age, and income) and a more general measure of discrimination, suggest that invalidation experiences are directly associated with feelings of shame, expectations of rejection, and past-year suicide attempt. In addition, these analyses suggest that invalidation experiences are indirectly associated with past-year suicide ideation, through their association with expectations of rejection. These cross-sectional findings suggest that invalidation, which is largely unexamined in existing research, merits greater attention as a particularly pernicious minority stressor that may directly and indirectly increase suicide risk in gender minority populations.