Structural stigma, gender-affirming interventions, and identity concealment as determinants of depression and life satisfaction among trans adults in 28 European countries.

Background: Although medical gender-affirming interventions (GAIs) are vital for most transgender individuals, previous evidence regarding their impacts on psychological well-being is mixed. While some studies reported improvements, others failed to find such effects. Using a large-scale dataset of trans adults from 28 European countries, we aimed to understand how structural stigma and identity concealment might explain this inconsistency. Method: 15,845 trans adults who participated in the EU-LGBTI-II survey, including measures of gender-affirming interventions, identity concealment, and life satisfaction and depression, were included in the analyses. Structural stigma was measured as the discriminatory laws, social policies, and public attitudes. The data was analyzed with multilevel moderated mediation analyses. Results: Results demonstrated that structural stigma was associated with lower levels of undergoing GAIs. Also, GAIs were indirectly associated with higher levels of life satisfaction and lower levels of depression through increased identity concealment. Structural stigma moderated this association such that these indirect effects were amplified for trans adults living in countries with lower structural stigma. Conclusions: Results suggest that identity concealment might protect the mental health of trans adults undergoing GAIs, especially in low-stigma contexts,