A systematic review and meta-analysis of the associations between structural, interpersonal, and individual stigma and health outcomes for transgender and nonbinary people.

This study examined how structural, interpersonal, and individual gender-related stigma are linked to health outcomes for transgender and nonbinary (TNB) individuals and factors that may moderate and mediate these relations. These research questions were investigated through a systematic review and meta-analysis of 1,871 effect sizes from 225 reports containing 121,240 participants. The data were analyzed using multilevel meta-analysis methods. Risk of bias was assessed using Egger's regression test, a funnel plot, and the fail-safe N procedure. Results showed that all stigma types were linked to poorer health (rstructural = -.18; rinterpersonal = -.20; rindividual = -.28). Overall stigma was linked to poorer mental health (r = -.25), well-being (r = -.23), physical health (r = -.19), and sexual health (r = -.12), suicidality (r = -.25), and substance use (r = -.14). These effects remained consistent across age, gender identity, socioeconomic status, education, and urbanicity but were lower for TNB Black, Indigenous, and other people of color than for TNB White individuals. Resilience factors-community connectedness, gender affirmation, and gender identity pride-did not moderate stigma's health impacts. Meta-analytic structural equation modeling revealed direct effects of all stigma types on health, as well as indirect effects, showing that structural stigma affects health via interpersonal and individual stigma, while interpersonal stigma affects health through individual stigma. Findings suggest a trickle-down effect, where structural stigma fosters interpersonal and individual stigma, progressively undermining health. This underscores the need for multilevel interventions to address structural, interpersonal, and individual stigma and improve health outcomes for TNB populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).