Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults

Purpose: We examined associations between family rejection and risk of suicide attempts and substance misuse among a national sample of transgender and gender nonconforming adults. Methods: Data were drawn from the National Transgender Discrimination Survey (N = 6456). This secondary analysis was restricted to 3458 individuals who self-identified as transgender or gender nonconforming and pro- vided complete data on study variables. We used multivariable logistic regression to examine health risks by level of reported family rejection (low/moderate/high), controlling for relevant sociodemographic characteris- tics. Results: Overall, 42.3% of the sample reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination. After controlling for age, race/ethnicity, sex assigned at birth, binary gender identity, income, education, and employment status, family rejection was associated with in- creased odds of both behaviors. Odds increased significantly with increasing levels of family rejection. Conclusions: Family rejection related to gender identity is an understudied interpersonal stressor that may neg- atively affect health outcomes for transgender and gender nonconforming individuals. A better understanding of the role of close relationships in both risk and resilience for transgender individuals is critical in the development of effective public health interventions for this community.