Minority stress, mental health, and substance use in transgender youth: the moderating role of positive affect.

Objective: To examine the relationships between gender minority stressors and mental health outcomes among transgender and gender diverse (TGD) youth and explore the moderating role of positive affect.

Methods: Baseline data of 315 TGD youth (ages 12-20 years old) from the Trans Youth Care-United States study comprised the analytic sample. Youth completed three subscales of the Gender Minority Stress and Resilience Measure for Adolescents (GMSR-A; nondisclosure of gender identity/gender history, negative future expectations, and internalized transphobia), Beck Depression Inventory-II (BDI-II), Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2), Alcohol, Smoking and Substance Involvement Screen Test (ASSIST), and the NIH Toolbox Positive Affect survey. Regression analyses using the Hayes PROCESS macro assessed moderation effects.

Results: Gender minority stressors were associated with more symptoms of depression (r = 0.29 to 0.42) and anxiety (r = 0.32 to 0.42) and were not significantly associated with substance use (r = -0.01 to 0.10). Positive affect was negatively associated with gender minority stressors (r = -0.19 to -0.24) and mental health/substance use outcomes (r = -0.16 to -0.63). Positive affect significantly buffered the association between nondisclosure of gender identity and depressive symptoms (ΔR2 = 0.02) and protected against the impact of internalized transphobia on anxiety symptoms (ΔR2 = 0.01).

Conclusions: Positive affect is a promising modifiable protective factor that buffers the negative impact of gender minority stress on the mental well-being of TGD youth. Adapting existing positive emotion interventions for TGD youth is an indicated future direction for research and clinical practice.