Investigating the factors that contribute to psychosis risk and severity among TGNC individuals: a scoping review

Robert Sawdey (1,2), Francesca de Marneffe (1,2), Gili Grunfeld (1,2), Joseph Maimone (1,2), Daniel Fulford, Jasmine Mote (1,2)
1. Boston University
2. Sargent College of Health and Rehabilitation Sciences

Background: Transgender and gender nonconforming (TGNC) individuals are more likely than their cisgender peers (i.e., people whose gender identity aligns with their sex assigned at birth) to be diagnosed with a psychotic disorder (Barr et al., 2021). It remains unclear which risk factors may be specific to TGNC individuals and which may be more broadly applicable to sexual and gender minority individuals as a whole.

Methods: To better understand psychosis risk and severity in this population, we conducted the first scoping review on these topics. Using Arksey and O’Malley’s methodological framework for scoping reviews, we found seven empirical studies examining psychosis or psychosis risk in TGNC individuals. Additionally, due to the lack of studies on risk factors specific to the development or exacerbation of psychosis in TGNC individuals, we conducted a targeted search on two risk factors for psychosis that are prevalent in this population: substance use and houselessness.

Results: Psychosis appears to be more prevalent in TGNC individuals compared to cisgender sexual minority populations. Other studies qualitatively examined the experiences of TGNC individuals at risk for or experiencing psychosis, with themes related to stigma and healthcare access based on both mental health status and gender identity emerging from this work.

Conclusions: Through summarizing what we know about these risk factors in TGNC individuals as a whole, we argue for future studies to better characterize how substance use and houselessness directly contribute to psychosis risk and severity in this population. Additionally, we identify further gaps in the literature and discuss the potential of structural interventions and inclusivity/sensitivity trainings using an intersectional lens within healthcare settings as a means of mitigating psychosis risk for this vulnerable population.