Systematic review and conceptual framework for trans and nonbinary psychological well-being

This systematic review considered the quantitative research on transgender and nonbinary (TNB) psychological well-being (PWB) in relation to the shifting sociopolitical landscape across the past 50 years. Using an empirically informed framework to conceptualize PWB outside of cisnormativity, we reviewed 93 studies of PWB and organized them according to three socioecological levels of gender identity affirmation: (a) societal affirmation, (b) interpersonal affirmation, and (c) individual strengths. Using a critical intersectional framework, we characterized how well this literature represents the range of experiences within TNB communities, noting that intersectionality was typically incorporated at the individual level (i.e., based on intersecting identities) rather than at the societal level (i.e., systems of oppression) or interpersonal level (i.e., relational/community). Additionally, we contextualized the literature based on historical and transition-related milestones (i.e., shifts in the Diagnostic and Statistical Manual of Mental Disorders, World Professional Association for Transgender Health standards of care), noting shifts from trans-negativity to trans-positivity, and more recent studies accounting for the impact of the sociopolitical landscape. We use these findings to propose a novel framework of TNB PWB and provide recommendations for how psychological science can promote PWB and advance intersectional social justice for TNB communities through systems, community, and individual-level interventions. In the context of current sociopolitical attacks, we recommend broadening TNB research beyond the individual level of analysis, decentering cisnormativity, using intersectionality, and including TNB psychological well-being. (PsycInfo Database Record (c) 2026 APA, all rights reserved).