Depression and Attempted Suicide among LGBTQ

College Students: Fostering Resilience to the Effects

of Heterosexism and Cisgenderism on Campus
Michael R. Woodford Genevieve Weber Z Nicolazzo Renee Hunt
Alex Kulick Todd Coleman Simon Coulombe Kristen A. Renn

Little is known is about the impacts of covert According to minority stress theory, chronic
and overt discrimination and the protective stress associated with marginalization on the
factors for depression and suicide among LGBTQ basis of one’s sexual or gender identification
students. Using multivariable regression analyses underpins these disparities (Meyer, 2003).
of a national sample of cisgender lesbian, National research suggests that lesbian, gay,
gay, bisexual, and queer students and trans* bisexual, trans*, and queer (LGBTQ) students
students (n = 776), we examined the association experience heterosexism and/or cisgenderism on
between mental health and microaggressions, campus, ranging from derogatory comments to
victimization, psychological resilience, pride, violence, and tend to have negative perceptions
and outness. In models of all risk and protective of the campus climate (Rankin, Weber,
factors, interpersonal microaggressions was a risk Blumenfeld, & Frazer, 2010). It bears noting
factor for depression and attempted suicide among that LGBTQ students have historically called
cisgender LGBQ students and was also a risk their identities by many terms (for an overview,
factor among trans* students for depression. In see Marine, 2011); throughout this article
all but 1 model, resilience was a protective factor. we use the term trans*—itself contested and
Resilience moderated the microaggressions–suicide under construction (see Nicolazzo, 2017a)—to
relationship among cisgender LGBQ students, be inclusive of identities beyond transgender,
whereas pride moderated the victimization– such as genderqueer, gender nonconforming,
depression relationship among trans* students. and two-spirit (Tompkins, 2014). Heterosexism
is a cultural ideology that perpetuates sexual
Research indicates that mental health problems stigma by denying and denigrating any
and psychological distress are more prevalent nonheterosexual form of behavior, identity,
among sexual and gender minority college relationship, or community (Herek, 2004).
students than among their peers (Effrig, Similarly, cisgenderism refers to the denial and
Bieschke, & Locke, 2011; Kisch, Leino, & denigration of individuals’ gender identities
Silverman, 2005; Oswalt & Wyatt, 2011). that do not align with sex assigned at birth,

Michael R. Woodford is Associate Professor, Lyle S. Hallman Faculty of Social Work at Wilfrid Laurier University.
Genevieve Weber is Associate Professor of Counseling and Mental Health Professions at Hofstra University. Z Nicolazzo
is Assistant Professor of Higher Education and Student Affairs at Northern Illinois University. Renee Hunt is a doctoral
student of Psychology at Wilfrid Laurier University. Alex Kulick is a doctoral student of Sociology at the University
of California, Santa Barbara. Todd Coleman is Assistant Professor of Health Sciences; Simon Coulombe is Assistant
Professor of Psychology; both in Faculty of Science and Wilfrid Laurier University. Kristen A. Renn is Professor of
Higher, Adult, & Lifelong Education and Associate Dean of Undergraduate Studies for Student Success Research at
Michigan State University. Funded by the National Center for Institutional Diversity and the Curtis Center, both
at the University of Michigan; College of Education at Michigan State University; Wilfrid Laurier University; and
the Social Sciences & Humanities Research Council of Canada. Thanks to the study participants and students who
assisted with data collection.

July–August 2018 ◆ vol 59 / no 4 421

 Woodford et al.

as well as resulting behavior, expression, and pathologizing of minoritized sexualities and

community (Lennon & Mistler, 2014). These genders in society and in higher education (see
oppressive systems are inherent in cultural Dilley, 2002), while also acknowledging the
institutions, such as language and law, and are very real consequences of minority stressors
also conveyed through both subtle and blatant in the lives of LGBTQ college students.
forms of discrimination.
Minority stress theory also emphasizes Discrimination and
factors that might contribute to resilience in Well‑Being
the context of adversity. Resilience generally
refers to the quality of being able to survive Research suggests that among gender and
and potentially thrive in the face of adversity, sexual minority students, subtle discrimination,
mitigating the negative impact of stress on such as slurs and negative comments, are more
health. Assets, such as positive coping skills, and common than violence and other forms of overt
resources, like community connections, might discrimination (Rankin et al., 2010; Woodford,
buffer targeted individuals from the negative Han, Craig, Lim, & Matney, 2014; Woodford,
effects of discrimination (Meyer, 2003). Kulick, et al., 2014). Recent empirical atten­
Research on LGBTQ student experiences tion has been given to microaggressions and
continues to grow, including exploring the other forms of subtle, often unintentional,
link between heterosexism and mental health discrimination targeting sexual minorities and
(Silverchanz, Cortina, Konik, & Magley, 2008; trans* individuals (Nadal et al., 2011; Nadal,
Woodford, Kulick, Sinco, & Hong, 2014). Davidoff, Davis, & Wong, 2014; Wright
Little is known, however, about the relationship & Wegner, 2012), including among sexual
between cisgenderism and mental health among minority students (Platt & Lenzen, 2013;
trans* students. Also, minimal attention has Pryor, 2015; Woodford, Chonody, et al., 2015;
been given to consequences of subtle expres­sions Woodford, Joslin, Pitcher, & Renn, 2017).
of discrimination, such as microaggressions— Microaggressions can be expressed inter­
“everyday verbal, nonverbal, and environ­mental per­sonally, as in conversations with peers or
slights, snubs, or insults, whether intentional class discussions, or environmentally through
or unintentional, that com­mu­nicate hostile, exclu­sionary policies or a hostile institutional
derogatory, or negative messages to target climate. They include microinsults that convey
persons based solely upon their marginalized insensitivity and rudeness toward the target
group membership” (Sue, 2010, p. 3)— or demean the person’s identity (e.g., LGBQ
especially among trans* students. In addition, people are hypersexual), microinvalidations
little research has exam­ined resili­ence in the that dismiss or nullify a person’s identity
context of micro­a ggres­sions (Woodford, (e.g., being transgender or genderqueer is
Chonody, Kulick, Brennan, & Renn, 2015). only a phase), and microassaults that derogate
In this study of sexual and gender minority someone’s identity (e.g., avoiding working
students, we examined the role of discrim­ with a genderqueer student). Microinsults
ination, both subtle and blatant, on student and microinvalidations are generally subtle
depression and attempted suicide. We also and unintentional, whereas microassaults tend
explored the role of individual-level factors that to be explicit and purposeful (Sue, 2010).
may promote well-being when these minority Qualitative (Platt & Lenzen, 2013) and
students experience such stressors. In doing quantitative (Woodford, Howell, Silverschanz,
so we acknowledge and resist the historical & Yu, 2012; Woodford, Kulick, et al., 2014;

422 Journal of College Student Development

LGBTQ Resilience and Mental Health

Wright & Wegner, 2012) studies show heterosexism/cisgenderism, it is important

that, although often portrayed as minor to investigate both subtle and conspicuous
events, micro­aggressions can negatively affect forms. In this study we examined interpersonal
targeted individuals. and environmental microaggressions, as
Quantitative research suggests that trans* well as blatant interpersonal victimization
college students experience more dis­crim­ among sexual and gender minority students.
i­nation than their cisgender peers (Rankin Gender and sexuality are different, yet often
et al., 2010). Similarly, other research suggests overlapping, identities, which are largely
cisgender students experience more victimi­ conflated throughout research and praxis
zation and have higher rates of psychological (Renn, 2010). Thus, to bring much-needed
distress than those who identify as men or specificity to the topic, we examined the
women (Effrig et al., 2011). Rankin and col­ groups separately.
leagues (2010) also found that subtle forms of
dis­cri­mi­nation that resemble micro­aggres­sions, Resilience
such as being ignored, were more prevalent than
physical violence. These researchers, however, Resilience theory suggests that personal assets
did not examine students’ mental health. (e.g., positive coping skills, self-esteem) and
Qualitative studies suggest that trans* students external resources (e.g., social support, com­mu­
also often face structural discrimination, nity involvement) can promote strength in the
such as lack of access to gender-inclusive context of adversity (Fergus & Zimmerman,
facilities, which can contribute to anxiety and 2005). Researchers have examined resilience
concerns about engaging openly in campus among gender (Nicolazzo, 2016, 2017b) and
life (Nicolazzo, 2016, 2017b; Pryor, 2015). sexual (Woodford, Kulick, & Atteberry, 2015)
These barriers parallel systemic environmental minority students; however, more research
microaggressions (Woodford et al., 2017) and is needed, especially comparative studies
structural cisheterosexism (e.g., name change involving both groups. It is also important
policies, health insurance exclusions) that Spade to understand how such factors might have
(2015) identified as forms of administrative differential buffering effects depending on
violence that limit the life chances of trans* the type of discrimination experienced (i.e.,
people. To the best of our knowledge, Effrig covert or overt).
et al. (2011) conducted the only quantitative In this study, we adopted a protective
study of trans* students’ experiences with conceptualization of resilience in which assets
discrimination and mental health; however, and resources help to buffer targeted students
these researchers inquired only about blatant from the negative effects of heterosexism/
interpersonal victimization (“experiencing cisgenderism (Fergus & Zimmerman, 2005).
unwanted sexual contact, and experiencing We see resilience in two ways: (a) broadly as
harassing, controlling, or abusive behaviour,” the psychological capacity to bounce back
p. 149) and did not examine the relationship from stressful situations (Smith et al., 2008)
with mental health. and (b) possessing personal qualities that may
Collectively, these studies and their roots in enable this process (Fergus & Zimmerman,
minority stress theory suggest that experiencing 2005). Psychological resilience has been
heterosexism/cisgenderism can place LGBTQ studied among many groups, including trans*
students at risk for negative outcomes. To adults (Breslow et al., 2015). To the best of
better understand the impact of contemporary our knowledge, this conceptualization of

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 Woodford et al.

resilience has not been quantitatively examined malleable factors that can be enhanced through
among LGBTQ students. Qualitative research support programs.
suggests that trans* students develop various
practices of resilience, or personalized strategies Purpose
to negotiate their environments, which allow
them to successfully navigate institutional To advance knowledge of the risk and pro­
cisgenderism (Nicolazzo, 2016, 2017b). tective factors related to LGBTQ students’
Concerning personal assets, research mental health, specifically depression and
suggests that self-esteem moderates the effects attempted suicide among cisgender LGBQ
of heterosexist harassment among sexual students and trans* students (as two separate
minority students, specifically in terms of groups), we asked: What is the relationship
alcohol abuse, but not depression or anxiety between various types of heterosexism/
(Woodford, Kulick, et al., 2015). It also is cisgenderism on campus (LGBQ/trans*
possible that LGBTQ-specific assets may buffer environmental microaggressions, LGBQ/
LGBTQ students from discrimination. Though trans* interpersonal microaggressions, LGBQ/
a risk factor for poor mental health (Meyer, trans* victimization) and depression and
2003; Weber, 2008), internalized homophobia attempted suicide? What is the relationship
(i.e., internalizing anti-gay attitudes) can between protective factors (psychological
also moderate the discrimination–distress resilience, LGBTQ pride, LGBTQ outness)
relationship (Velez, Moradi, & Brewster, and these mental health outcomes? How do
2013). Affirmative identification with one’s these factors protect students from the effects
sexual identity (or gender identity), that is, a of each type of heterosexism/cisgenderism
sense of internalized pride, may perform the on campus? Specifically, we hypothesized
same function. Similarly, disclosure about that microaggressions, both environmental
one’s sexual minority identity is generally and interpersonal, and victimization would
considered to be linked to positive mental increase the risk for depression and attempted
health (Herrick, Egan, Coulter, Friedman, suicide in each group. We also hypothesized
& Stall, 2014; Meyer, 2003); thus, it may that resilience, pride, and outness would
help to buffer students from the effects of protect students from poor mental health and
heterosexism. The same relationship may also buffer them from the negative effects of
exist among trans* students. Garvey and discrimination on campus.
Rankin (2015) found a correlation between
higher levels of trans* student outness and Methods
higher use of campus resources; however, we
Participants
were unable to find any research focusing on
trans* students’ outness as a predictor for Participants consisted of 776 self-identified
mental health outcomes. Given the impact of LGBTQ students (562 identified as cisgender
mental health on college students’ personal and sexual minorities, referred to as cisgender
well-being and academic development, and the LGBQ, and 214 identified as trans*) from 37
pervasiveness of heterosexism and cisgenderism states representing all U.S. Census regions:
on college campuses, research into factors that Midwest 67.6%, Northeast 14.6%, West
promote sexual and gender minority students’ 10.2%, South 6.6%; 0.6% did not provide
resilience to subtle and blatant discrimination state or attended a school outside of the United
is needed. It is especially important to examine States. Most participants (71.4%) attended

424 Journal of College Student Development

LGBTQ Resilience and Mental Health

public schools, and most schools (56.9%) had effects of discrimination on campus among
doctoral programs. The majority of participants cisgender sexual minority students and trans*
(25.6%) attended schools with student students as two separate groups, we divided the
populations greater than 30,000, although a sample by gender identity (cisgender or trans*)
range of small and medium-sized schools were based on students’ responses to the screening
represented (2,500 students or fewer 16.6%; questions and a demographic question about
2,501–8,000 students 15.7%; 8,001–15,000 gender identity.
students 16.0%; 15,001–30,000 students
16.4%). Demographic information about the Measures
two subsamples is displayed in Table 1. We use LGBTQ for measures applicable to
sexual and gender minority students, LGBQ for
Procedures those applicable to cisgender sexual minorities,
We extracted data from an anonymous online and trans* for those applicable to trans*
survey conducted in 2013 as part of the students. After reverse-scoring appropriate
National Study of LGBTQ Student Success. items, we averaged all items comprising multi-
Eligibility for the original study was restricted item scales such that higher scores reflect more
to individuals 18 years of age or older who of the phenomenon of interest.
identified as a sexual and/or gender minority Mental Health. To determine depression,
and who were current or former (within the we used the depression module of the Patient
past year) college students (screening questions Health Questionnaire (PHQ–9; Spitzer,
assessed each criteria). Given the lack of a Kroenke, & Williams, 1999) to assess reported
national sampling frame for LGBTQ students, level of symptoms. This scale reflects nine
we recruited a convenience sample through DSM-IV diagnostic criteria, and participants
three phases. First, we recruited participants at indicate the frequency of being bothered by
the February 2013 Midwest Bisexual Lesbian particular symptoms (e.g., “feeling down,
Gay Transgender Ally College Conference in depressed, or hopeless”) over the past 2 weeks
Lansing, Michigan. Though the conference on a 4-point Likert-type scale from 0 (not at
draws participants nationwide, the majority of all) to 3 (nearly all the days); theoretical range
attendees were from the Midwest. Interested 0–27. Scale scores of 0–4, 5–9, 10–14, 15–19,
conference participants either completed the and 20 or higher indicate minimal/no, mild,
survey at the conference (laptops provided), moderate, moderately severe, and severe levels
or after the conference (postcards advertising of depression (Spitzer et al., 1999). Previous
the survey were distributed). Second, to recruit testing demonstrated the scale’s validity and
participants beyond the conference, conference reliability (Kroenke, Spitzer, & Williams,
attendees were asked to distribute study 2001). It was previously used with students,
postcards to peers on their campuses. Third, to including sexual and gender minorities, in
obtain the most geographically diverse sample the national Healthy Minds Study (http://
possible, we distributed notices about the healthymindsnetwork.org). The scale’s internal
study through LGBTQ listservs and networks. reliability was excellent in our study: cisgender
Participants who completed the survey at the LGBQ α = .88, trans* α = .92.
conference were given a coupon for a coffee We measured attempted suicide using the
at a local coffee shop. All participants had the question, “During the past 12 months, how
opportunity to join a drawing for an iPad. many times have you attempted suicide?”
Given our interest in understanding the with responses: 0 times, once, twice, 3 times, 4

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 Woodford et al.

Table 1.
Descriptive Statistics for Study Variables
Cisgender LGBQ Trans*
Students Students
Categorical Variables n % n %
Attempted Suicide
No 442 78.6 147 68.7
1 or more attempts 27 4.8 20 9.3
Missing 93 16.5 47 22.0
Race
White 395 70.3 155 72.4
People of Color 139 24.7 40 18.7
Missing 28 5.0 19 8.9
Conference Attendee
No 267 47.5 99 46.3
Yes 287 51.1 113 52.8
Missing 8 1.4 2 0.9
Gender Identity
Man 247 44.0 29 13.6
Woman 315 55.0 29 13.6
Genderqueer 0 0.0 81 37.9
Two-Spirit 0 0.0 8 3.7
Transgender 0 0.0 30 14.0
Other identity 0 0.0 14 6.5
Missing 0 0.0 23 10.7
Sexual Orientation
Gay: man-loving-man 203 36.1 19 8.9
Lesbian: woman-loving-woman 116 20.7 26 12.1
Bisexual/Other 218 38.7 146 68.2
Missing 25 4.4 23 10.7
Continuous Variables (% missing: cisgender / trans*) M SD M SD
Depression (17.1% / 22.4%) 7.68 5.78 9.20 6.94
Age (0.0% / 0.0%) 22.68 5.46 22.83 5.37
LGBQ/Trans* environmental microaggressions 2.37 1.29 2.30 1.22
(7.1% / 12.6%)
LGBQ/Trans* interpersonal microaggressions 1.40 1.19 1.38 1.22
(7.5% / 16.8%)
LGBQ/Trans* victimization (5.7% / 5.6%) 0.24 0.53 0.32 0.63
Resilience (16.5% / 22.0%) 3.28 0.81 3.02 0.88
LGBTQ pride (15.8% / 22.0%) 3.54 0.58 3.64 0.59
LGBTQ outness (0.0% / 0.0%) 2.53 1.13 2.57 1.10

426 Journal of College Student Development

LGBTQ Resilience and Mental Health

times, 5 times, more than 5 times.). We divided and .95 for interpersonal micro­aggressions.
responses into “no attempt” and “at least one We assessed victimization (e.g., verbal
attempt,” given concerns about skewness with and physical threats and assaults) for both
the original distribution. the subsamples using parallel scales (LGBQ/
Heterosexism and Cisgenderism on Campus. trans*) adapted from the Sexual Orientation
We examined the prevalence of LGBQ/ trans* Victimization Questionnaire (Herek, 1993).
environmental microaggressions, LGBQ/ The original scale was used with gay, lesbian,
trans* interpersonal microaggressions, and and bisexual students (D’Augelli, 1992; Herek,
LGBQ/trans* victimization. For each measure, 1993) and later adapted for use with LGBT
participants reported the frequency of specific youth with a Cronbach’s alpha of .87 (Lui &
incidents on campus within the past year (or Mustanski, 2012). We adapted the scale to be
since coming to campus if less than one year) inclusive of queer and gender queer identities:
using a 6-point scale from 0 (never) to 5­(very “Someone physically assaulted (e.g., punched,
frequently). Among cisgender LGBQ students, kicked, or beat) me because they knew or
the environmental (sample item: “I received assumed I was lesbian, gay, bisexual, or queer
information about sexual health that was limited [transgender or gender queer].” The scale
to heterosexual sex”) and interpersonal (“I was demonstrated excellent internal reliability in
told that being lesbian, gay, bisexual, or queer is our study; cisgender LGBQ α = .90, trans*
‘just a phase’”) microaggressions were measured α = .88. Exploratory factor analysis with
using the respective 5-item and 15-item Oblimin rotation produced single-factor
subscales from the LGBQ Microaggressions solutions (loadings: cisgender LGBQ .629 to
on Campus Scale (Woodford, Chonody, .837; trans* .529 to .897).
et al., 2015). Earlier psychometric testing Protective/Buffering Factors. We measured
that utilized data from another sample and psychological resilience through the Brief
the current one established the scale’s validity, Resilience Scale, which is a reliable and valid
including factorial (EFA and CFA), convergent, measure of one’s ability to bounce back in
discriminant, and predictive, and found it to stressful situations (Smith et al., 2008).
be internally reliable (Woodford, Chonody, Participants indicated their agreement to
et al., 2015). In our sample, Cronbach’s alphas items such as “I tend to bounce back quickly
were .81 and .94 for the environmental and after hard times” on a 5-point Likert scale.
interpersonal subscales, respectively. Cronbach’s alphas were .89 for our cisgender
For trans* students, we used seven items LGBQ sample and .91 for our trans* sample.
to assess environmental microaggressions Because we could not locate a brief scale to
(“I did not have access to bathrooms where assess internalized views about being a sexual/
I felt comfortable as a trans* person”) and gender minority individual, using adapted
18 items for interpersonal microaggressions items from Mayfield’s (2001) Internalized
(“People said or implied that my birth sex is Homonegativity Inventory for Gay Men, we
my ‘real’ sex/gender”). Earlier psychometric developed a 2-item scale assessing LGBTQ
testing using data from this study and another pride: “I’m proud to be LGBTQ” and “I
one demonstrated the scale’s factorial (EFA), believe being LGBTQ is an important part of
convergent, discriminant, and predictive me”; participants responded using a 5-point
validity, and internal reliability (Woodford et al., Likert scale. Internal consistency for our
2018). Cronbach’s alpha in the current sample sample was acceptable: cisgender LGBQ
was .80 for environmental micro­aggressions α = .74, trans* α = 82. Informed by previous

July–August 2018 ◆ vol 59 / no 4 427

 Woodford et al.

research (Woodford & Kulick, 2015), we (totally masculine). Some trans* students may
measured outness by asking participants to reject this continuum, whereas others may be
report on a 5-point scale from 0 (not out to unsure how they identify, resulting in a high
anyone in this group) to 4 (out to all) “How degree of missingness. Because missingness
out are you as an LGBTQ person to members patterns were different across subsamples, the
of [the group]?” with six groups listed (e.g., issue of missing data was addressed through
friends who are not LGBTQ). Cronbach the use of Monte Carlo multiple imputation
alphas in our study were .89 for the cisgender (20 imputations) in SPSS (version 22.0),
LGBQ and .88 for trans*. Exploratory factor with separate imputations conducted for each
analysis using Oblimin rotation conducted sample. All presented analyses were conducted
with each group produced single-factor using the imputed data.
solutions (loadings: cisgender LGBQ .706 to For each group, we generated descriptive
.862; trans* .689 to .874). statistics and bivariate correlations, and
Controls. Controls included age, confer­ence ran multivariable regression models for
attendee, gender identity, sexual orienta­tion, hypothesis testing (linear for depression and
and race. Measures from Rankin and colleagues binary logistic regression for suicide). To
(2010) were used to assess gender identity (6 understand the unique effects of each type
categories) and sexual orientation (11 categories); of discrimination, separate models were run
race was assessed using 8 categories. These for each heterosexism/cisgenderism variable,
variables included “another category (please followed by a model inclusive of all types. All
specify).” Because of the low number of students models included protective factors. To examine
in particular categories, we dichotomized gender the potential buffering effects, we then tested
identity and race, and created two dummy interactions using the product of mean-
variables for sexual orientation. centered versions of each protective factors and
discrimination variable. Due to shared variance
Data Analysis explained by the discrimination variables,
The overall analytical sample consisted of we investigated the moderation effects using
776 participants (of the 952 who took the separate models for each discrimination
survey) who remained after data cleaning type. For brevity, we do not show interaction
and who reported less than 50% missing data models. For post hoc analysis, we evaluated
on all variables in the survey (no significant regression slopes at low and high values (i.e.,
differences were found on any key variables 1 standard deviation below/above the mean).
based on removing those with more than Multicollinearity was explored using tolerance
50% missing data). We examined patterns of and variance inflation factor (VIF) values
missingness among the two analytical samples. for the first imputed dataset (highest values:
For cisgender students, the most common tolerance 0.98; VIF 3.99); no concerns existed.
pattern of missingness observed across all cases
was no missing data, suggesting that data were Results
missing at random. For trans* students, the
most common pattern of missingness suggested Table 1 displays the descriptive statistics for the
that trans* students were likely missing data study variables. Among the cisgender LGBQ
for gender expression. This variable assesses sample, the overall mean depression score was
one’s self-perceived gender expression on a 7.68 (SD = 5.78). Nearly 5% of these students
continuum from 1 (totally feminine) to 9 reported attempting suicide in the past year.

428 Journal of College Student Development

 Table 2. Multivariable Linear Regressions Examining Depression Among Cisgender LGBQ and Trans* Students
Model 1 Model 2 Model 3 Model 4
B SE B SE B SE B SE
Cisgender LGBQ Students (n = 562)

July–August 2018
Heterosexism variables

◆
LGBQ environmental 0.85††† .21 0.15 .31
microaggressions
LGBQ interpersonal 1.10††† .23 0.80† .36
microaggressions
LGBTQ Resilience and Mental Health

vol 59 / no 4
LGBQ victimization 1.81†† .52 0.79 .56
Protective variables
Resilience –2.79††† .31 –2.76††† .31 –2.94††† .31 –2.75††† .31
LGBTQ pride 0.03 .48 0.01 .47 0.42 .48 0.09 .47
LGBTQ outness 0.18 .27 0.07 .27 –0.04 .28 0.05 .27
2
R .26 .27 .26 .28

Trans* Students (n = 214)

Cisgenderism variables
Trans* environmental 0.97† .41 –0.77 .71
microaggressions
Trans* interpersonal 1.58††† .40 1.91† .82
microaggressions
Trans* victimization 2.45†† .75 0.91 1.02
Protective variables
Resilience –3.61††† .59 –3.61††† .56 –3.59††† .58 –3.60††† .55
LGBTQ pride –0.05 .94 0.31 .93 0.31 .90 0.48 .94
LGBTQ outness –0.43 .54 –0.55 .54 –0.25 .54 –0.50 .55
2
R .30 .34 .31 .35
Notes. Controls: race, age, gender, sexual orientation, and conference attendee. R2 calculated with the first imputed dataset.
† †† †††

429
p < .05. p < .01. p < .001.
 Woodford et al.

figure 1. Interaction of LGBTQ Pride × Victimization on Depression

Among Trans* Students
Note. Higher depression scroes indicate greater presence/severity of depression symptoms.

LGBQ environmental microaggressions were depressive symptoms in each model. In Model

the most common, followed by interpersonal 4 (inclusive of all heterosexism variables),
microaggressions and then victimization. The LGBQ interpersonal microaggressions and
prevalence of each discrimination type among resilience remained significant. In this model,
trans* students was similar to the cisgender for every one-unit increase in the frequency of
LGBQ sample; however, trans* students encountering interpersonal microaggressions,
reported a significantly higher depression score, one’s depres­sion score is predicted to increase by
M = 9.20, SD = 6.94, t(635) = 2.75, p = .006. 0.80 points. In contrast, every one-unit increase
Reports of attempted suicide also differed in resilience is predicted to decrease depression
significantly, χ2(1) = 7.17, p = .007, with 9.3% symp­toms score by 2.75 points. No interactions
of trans* students reporting attempted suicide. were significant.
Trans* Students. In Models 1, 2, and 3
Depression (Table 2), trans* environmental micro­aggres­
Cisgender LGBQ Students. As displayed in sions, trans* interpersonal micro­aggressions,
Table 2 (Models 1, 2, and 3), LGBQ environ­ and trans* victimization, respectively, were
mental microaggressions, LGBQ interpersonal significantly related to increased depressive
microaggressions, and LGBQ victimization were symptoms, and resilience was associated with
significantly associated with increased reports decreased depressive symptoms. Both trans*
of depressive symptoms, whereas resilience was interpersonal microaggressions and resilience
significantly associated with reports of lower remained significant in Model 4, with results

430 Journal of College Student Development

 Table 3.
Multivariable Logistic Regression Examining Attempted Suicide Among Cisgender LGBQ and Trans* Students
Model 1 Model 2 Model 3 Model 4
AOR 95% CI AOR 95% CI AOR 95% CI AOR 95% CI

July–August 2018
◆
Cisgender LGBQ Students (n = 562)
Heterosexism variables
LGBQ environmental microaggressions 1.74† [1.09, 2.78] 0.80 [0.41, 1.56]
†† †
LGBQ interpersonal microaggressions 2.12 [1.37, 3.28] 2.08 [1.05, 4.14]
LGBTQ Resilience and Mental Health

vol 59 / no 4
LGBQ victimization 2.91†† [1.54, 5.47] 1.78 [0.92, 3.42]
Protective variables
Resilience 0.30††† [0.16, 0.56] 0.28††† [0.15, 0.53] 0.24††† [0.12, 0.46] 0.25††† [0.13, 0.50]
LGBTQ pride 0.68 [0.30, 1.52] 0.60 [0.27, 1.36] 0.97 [0.42, 2.22] 0.74 [0.31, 1.79]
LGBTQ outness 0.85 [0.53, 1.37] 0.81 [0.49, 1.34] 0.70 [0.43, 1.14] 0.72 [.042, 1.23]
2
R .43 .45 .40 .46

Trans* Students (n = 214)

Cisgenderism Variables
Trans* environmental microaggressions 1.13 [0.66, 1.91] 0.55 [0.22, 1.39]
Trans* interpersonal microaggressions 1.53 [0.96, 2.44] 1.81 [0.72, 4.53]
Trans* victimization 2.93† [1.20, 7.17] 2.59 [0.80, 8.36]
Protective Variables
Resilience 0.50† [0.26, .95] 0.50† [0.26, .96] 0.53 [0.27, 1.04] 0.51 [0.26, 1.01]
LGBTQ pride 0.93 [0.33, 2.66] 0.95 [0.35, 2.60] 1.04 [0.36, 2.99] 1.18 [0.37, 3.72]
LGBTQ outness 0.86 [0.48, 1.53] 0.85 [0.46, 1.56] 0.91 [0.48, 1.71] 0.89 [0.47, 1.71]
2
R .21 .23 .26 .27
Notes. Controls: race, age, gender, sexual orientation, and conference attendee. R2 = Nagelkerke pseudo R 2, calculated with the first imputed dataset. AOR = adjusted
odds ratio.
† p < .05. †† p < .01. ††† p < .001.

431
 Woodford et al.

figure 2. Interaction of Resilience × Interpersonal Microaggressions on

Attempted Suicide Among Cisgender LGBQ Students
Note. Attempted suicide in the past year.

suggesting that depressive symptoms scores will interpersonal microaggressions and resili­ence
increase by 1.91 points with every unit increase remained significant. In this model, inter­
in reported interpersonal microaggressions, personal microaggressions was associated
and decrease by 3.60 points with each unit with a 108% increase in the adjusted odds of
increase in resilience. reporting attempted suicide, whereas resilience
We found a statistically significant inter­ was associated with 75% decrease in the
action between trans* victimization and pride adjusted odds of reporting attempted suicide.
(B = 3.40, SE = 1.29, p = .009; model not A statistically significant interaction was
shown). In Figure 1, the line representing found for LGBQ interpersonal micro­aggres­
participants with high pride shows a sharp sions and resilience (AOR = 0.54, 95% CI
and statistically significant incline when going [0.33, 0.89], p = .02). In Figure 2, the slope
from low to high victimization (B = 3.75, for the line capturing participants with high
SE = 0.99, p < .001). The line for those resilience is not statistically significant when
with low pride has a nonsignificant slope going from low to high microaggressions
(B = –0.20, SE = 1.25, p = .87). No other (B = 0.32, SE = .43, p = .47). In contrast, the
significant interactions were found. slope for the line representing students with low
resilience is significant (B = 0.84, SE = 0.25,
Attempted Suicide p = .001). No other significant interactions
Cisgender LGBQ Students. In Models 1, 2, were observed (models not shown).
and, 3 (Table 3), each heterosexism variable Trans* Students. Among each of the
was significantly associated with increased cisgenderism variables in Models 1, 2, and 3
adjusted odds of reporting attempted suicide, (Table 3), only victimization was statistically
and resilience was significantly associated significantly, with results indicating that
with decreased adjusted odds. In Model 4, greater victimization was associated with

432 Journal of College Student Development

LGBTQ Resilience and Mental Health

increased adjusted odds of reporting attempted Hunt, & Speer, 2013). Mean depression
suicide. Resilience was significantly associated scores among both subsamples (cisgender
with decreased adjusted odds of reporting LGBQ M = 7.68, trans* M = 9.20) are also
attempted suicide in Models 1 and 2. In Model considerably higher than those found in
4, none of the risk or protective variables were earlier research (Eisenberg, Golberstein, &
significant. None of the interactions attained Hunt, 2009; Lamis, Malone, Langhinrichsen-
significance (models not shown). Rohling, & Ellis, 2010; exception: Garlow
et al., 2008). These disparities, coupled with
Discussion various negative outcomes associated with
depression and attempted suicide, especially
Mental health among college students is a death, reinforce the contributions of this study.
national concern, and sexual minority and To the best of our knowledge, this is the first
trans* students are considered high-risk groups; study to investigate the risk, protective, and
however, little is known about risk, protective, buffering factors associated with depression
and buffering factors among LGBTQ students. and behavioral suicide among sexual and
In this study, we hypothesized that interpersonal gender minority college students.
and environmental microaggressions and In terms of our hypotheses related to
interpersonal victimization would increase the heterosexism and cisgenderism, important
risk for depressive symptoms and attempted differences emerged across the groups. Among
suicide among cisgender LGBQ students and cisgender LGBQ participants, when control­
trans* students. We also hypothesized that ling for only one type of heterosexism at a
psychological resilience and LGBTQ pride time, the results indicate that experiences of
and outness would foster students’ mental blatant and subtle heterosexism were each
health and buffer them from the negative associated with increased risk for depression
effects of discrimination. Among our racially and attempted suicide, and these models
and institutionally diverse national sample, we suggested that blatant victimization might
found partial support for our hypotheses. The have the most dramatic impact on both mental
findings illuminate important commonalities health indicators. When simultaneously
and differences in the nature of mental health controlling for each form of heterosexism,
among cisgender LGBQ and trans* students, interpersonal microaggressions maintained
and noteworthy differences among trans* statistical significance for each outcome. For
students in terms of risk factors across outcomes trans* students, when controlling for each
when adjusting for each form of cisgenderism. type of discrimination separately, each was
The results advance minority stress research and significantly associated with increased risk for
can inform interventions tailored to the needs depression, with interpersonal microaggres­
of sexual and gender minority students. sions maintaining statistical significance in the
Nearly 10.0% of the trans* students full model. In contrast, in terms of suicide,
and 5.0% of cisgender LGBQ students in victimization was significant when adjusting
this study reported attempting suicide in for only this form of cisgenderism.
the past year. These rates are considerably Social stress theory, racial discrimination
higher than those documented in national research, and existing LGBTQ microaggression
studies of college students, with prevalence research may be helpful in understanding these
rates between 0.6% and 1.3% (American results. Stress researchers posit that minoritized
College Health Association, 2014; Eisenberg, groups face unique stressors in society due to

July–August 2018 ◆ vol 59 / no 4 433

 Woodford et al.

a “mismatch” between the person and their perpetrated by acquaintances or friends (Sue,
social environment (Lazarus & Folkman, 2010), may be perceived as negative and have
1984, p. 234). This mismatch is at the core of a negative effect as everyday reminders of one’s
minority stress and, in the case of sexual and marginalized status (Meyer, 2003; Woodford,
gender minority students, can be experienced Kulick et al., 2014). That is, despite their
as microaggressions and victimization. Such everyday nature, parallel to victimization,
stressors can lead to cognitive, emotional, and microaggressions can contribute to chronic
biological reactions that could negatively affect stress and have a cumulative effect contributing
mental health (Cohen, Kessler, & Gordon, to increased risk for both depression and
1995). Qualitative studies have documented suicide among cisgender LGBQ students
such reactions when LGBQ (Nadal et al., and for depression among trans* students.
2011; Platt & Lenzen, 2013) and trans* (Nadal Previous research suggests that heterosexist
et al., 2014) individuals face microaggressions. microaggressions, rather than victimization, is
Some argue that racial discrimination, a driving force for psychological distress among
when understood as oppression that manifests LGBQ students (Woodford, Kulick, et al.,
through daily assaults on one’s sense of self and 2014). Further, qualitative research suggests
violence, is stressful and possibly traumatizing that interpersonal microaggressions may be
(Carter, 2007; Carter, Forsyth, Mazzeula, more likely to be internalized than overt
& Williams, 2005). Racist events that are discrimination and indirect environmental
emotionally and psychologically threatening, microaggressions (Nadal et al., 2011), which
similar to other traumatic experiences, can is supported by our full-model results for
lead to traumatic stress (Carlson, 1997). depression across both groups and for suicide
Carlson suggested that such stress can occur among cisgender LGBQ students.
if one perceives the incident as negative, if it is Qualitative studies have documented
experienced as sudden, and if one lacks control similar negative reactions to trans* micro­
during the incident. Verbal and physical threats aggres­sions, including feelings of distress and
and assaults and other forms of victimization strain (Nicolazzo, 2016; 2017b), which could
likely reflect each of these qualities. Thus, contribute to increased risk for depression, but
understanding victimization as a traumatic not necessarily attempted suicide, as our results
event can help to explain why victimization is a suggest. This is intriguing, as is finding no
risk factor for depression and attempted suicide significant risk or protective variables in the full
among trans* students and cisgender LGBQ model for this group, which could be due to
students in the victimization-only models. statistical issues related to sample size and issues
It is interesting and somewhat surprising related to shared variance in the full model.
to find microaggressions to be statistically In terms of protective/buffering variables,
significant among cisgender LGBQ students psychological resilience was negatively associ­
for both outcomes, but significant only for ated with depression scores for both groups.
depression among trans* students. In both Likewise, resilience was associated with lower
subsamples, interpersonal microaggressions odds for suicide in all models among cisgender
retained statistical significance in the full LGBQ students and select models among trans*
models for depression, and the same occurred students. Furthermore, resilience demonstrated
for suicide among the cisgender LGBQ a significant interaction with interpersonal
sample. It is possible that microaggressions, microaggressions on attempted suicide among
especially interpersonal ones that may be cisgender LGBQ students. Specifically, the

434 Journal of College Student Development

LGBTQ Resilience and Mental Health

interaction results suggested that students a cross-sectional design means we cannot

with low levels of resilience were particularly determine causation; nevertheless, the relation­
vulnerable to interpersonal microaggressions, ships we observed are consistent with minority
with greater risk when these students reported stress theory and previous research (exceptions
high levels of microaggressions. In contrast, the noted). Data were self-reported; thus some
effect of interpersonal microaggressions was not students may not have recalled details accurately
significant among those with high resilience. and may have overestimated or underestimated
Overall, these results suggest that increasing their experiences; however, self-reporting
resilience among gender and sexual minority contributes to anonymity, which is important
students may lower their risk for depression and when collecting sensitive information. The
attempted suicide; however, in the case of LGBQ sample was relatively large, included an array
interpersonal microaggressions, possessing the of institutional types, was racially diverse, and
ability to bounce back can protect cisgender was national in scope. Since most participants
LGBQ students from the negative effects of identified as White and were from the Midwest,
these minority stressors in terms of depression. the findings may not reflect the experiences
None of the LGBTQ-identity factors of all students in all regions. Further, we
exhibited a main effect with either dependent collapsed some groups (e.g., race, sexual
variable, but a significant interaction between orientation, gender), thus we are not able to
pride and victimization for depressive symptoms capture differences within these groups. Greater
was found among trans* students. Post hoc diversity in future studies will enable exploring
analysis indicated that those who report high the role of race, gender, and campus climate
pride and high victimization scores tended on LGBTQ students’ mental health. Although
to report higher depression scores, whereas recruiting students attending an LGBTQ
the level of victimization did not affect the conference or connected to LGBTQ online
victimization–depression relationship among networks produced a large and diverse national
those reporting low pride. Developing trans* sample, it is possible that students involved
pride is a milestone to healthy trans* identity in these activities may possess more strengths
(Beemyn & Rankin, 2011), but our results and assets than those who are more isolated.
suggest it can disadvantage trans* students The results may not apply to LGBTQ students
who experience high rates of victimization. who are not involved in these activities. Using
It is possible that this may have to do with Facebook and other popular social media tools
the sharp discrepancy between the positive in future research for recruitment may address
feelings associated with identity pride and this concern. Finally, some of our measures
the negative messages and threats inherent in were adapted or created for the study. We
blatant discrimination. Research is needed to judged these measures to have face validity and
examine this finding further. conducted other testing, when possible. Future
scale development is needed. Although the factor
Limitations and structure, validity, and reliability of the trans*
Future Research microaggressions measure have been examined
(Woodford et al., 2018), we recommend that
In addition to methodological strengths (e.g., it undergo additional psychometric testing,
large overall sample that enabled comparison including confirmatory factor analysis.
between cisgender LGBQ and trans* students), Research examining other risk and protec­
several noteworthy limitations exist. Using tive factors for depression and attempted

July–August 2018 ◆ vol 59 / no 4 435

 Woodford et al.

suicide is needed, especially among trans* prevention efforts also address interpersonal
students, given the significantly higher scores/ trans* microaggression.
rates we documented. We recommend that Psychological resilience had a main
attention be given to structural factors, such as effect on depression among each group
campus resources and policies. Other areas of and on suicide among cisgender LGBQ
mental health, for example anxiety, perceived students and in select models among trans*
stress, and suicidal ideation, as well as academic students. It also moderated the interpersonal
indicators, plus the nature of psychological microaggressions–suicide relationship among
resilience and other forms of resilience also cisgender students. Overall, the results suggest
need more study. that by strengthening psychological resilience
among LGBTQ students, campuses can help
Implications and to promote positive mental health among
Conclusions students. We recommend that this work be
done simultaneously with efforts to reduce the
Existing research on the mental health of prevalence of discrimination. We recommend
LGBTQ college students provides valuable that policies, including student codes of
information, yet researchers continue to seek conduct, address overt and subtle heterosexism
a clearer understanding of risk and protective and cisgenderism. We also recommend that
factors that may buffer students from the educational programs help campus members
effects of discrimination. This study extends understand the nature and consequences of
minority stress theory research by investigating contemporary heterosexism and cisgenderism,
subtle and blatant discrimination, as well as if and how they may perpetuate LGBTQ
intrapersonal assets and characteristics. The discrimination, and to share strategies for
results highlight important differences between effective bystander intervention.
cisgender LGBQ students and trans* students Finally, the moderation results indicate
in terms of risk factors, especially in regard to that reducing the prevalence of victimization
suicide, as well as moderating factors. will be particularly important in protecting
All forms of discrimination, particularly trans* students with high levels of pride from
interpersonal microaggressions (given their the negative stressors of victimization and the
enduring relationship in the full models for risk for depression. These results also direct
depression in both subsamples and suicide practitioners to explore trans* students’ level of
among cisgender LGBQ students) need to be pride in that it may shape how they are affected
addressed in clinical/support interventions by high levels of victimization. Educators,
and reduced—and ultimately eliminated—on administrators, and researchers may find our
campus to foster positive mental health among results useful as they work to foster positive
LGBTQ students. Although interpersonal mental health among LGBTQ students.
microaggressions may not be risk factors for
attempted suicide in our trans* sample, they Correspondence concerning this article should be
are positively correlated (r = .59, p < .01) addressed to Michael R. Woodford, Associate Professor,
with victimization (the only significant risk Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier
factor identified), thus they may contribute to University, 120 Duke Street West, Kitchener, ON N2H
trans* victimization; therefore, we suggest that 3W8; [email protected]

436 Journal of College Student Development

LGBTQ Resilience and Mental Health

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