Social Support as a Buffer of the Association between Sexual Assault and Trauma Symptoms Among Transgender and Gender Diverse Individuals

Abstract

The prevalence of experiencing sexual assault is alarmingly high among Transgender and Gender Diverse people (TGD; people whose gender identities and/or expressions are not traditionally associated with their sex assigned at birth) and is associated with various mental health sequalae. Perceived social support has been shown to abate the negative outcomes of sexual assault among cisgender individuals, yet little is known about this association among TGD people, especially which provider of support (i.e., family, friends, or significant others) may be most beneficial. To that end, 191 TGD adults were recruited through Amazon’s Mechanical Turk to examine perceived social support as a potential moderator of the association between sexual assault victimization and post-sexual assault trauma symptomology. Results showed an interaction trending toward significance between sexual assault and support from a significant other. Decomposition of this interaction demonstrated that sexual assault was associated with post-assault trauma symptoms when support from a significant other was low (ß = .25, p < .05) but not high (ß = .10, p = .089). The interaction between sexual assault and perceived social support was not significant for perceived support from friends (p = .133) or family (p = .954). Findings highlight the need for additional research on perceived social support as a potential buffering mechanism between sexual assault and post-assault symptomology in TGD people.

Keywords

transgender and gender diverse sexual assault social support

Previous research has found that the prevalence of sexual assault is alarmingly high, with research indicating between 5% and 25% of the U.S. general population report an experience of sexual assault in their lifetime (Black et al., 2011; Breiding et al., 2014; Elliott et al., 2004; Smith et al., 2018) with certain populations, including Transgender or Gender Diverse (TGD) individuals experiencing even higher rates. TGD is a term used presently to describe people whose gender identities and/or expressions are not traditionally associated with their sex assigned at birth in Western culture (Mayer et al., 2008). Given that much of the existing sexual assault literature focuses on the experiences of cisgender women (i.e., individuals whose gender identity and sex assigned at birth match), recent research has paid increasing attention to the experiences of sexual assault among TGD individuals. Early studies addressing this gap found TGD populations are at higher risk for violence, particularly for sexual violence, relative to cisgender populations (Langenderfer-Magruder et al., 2016; Stotzer, 2009). Indeed, subsequent research found almost half of TGD participants reported lifetime victimization of physical and/or sexual violence, and that experiences of violence remained consistent across other demographic characteristics such as socioeconomic status, gender identity (i.e., transgender men vs. transgender women), and age (Testa et al., 2012). Replicating these alarming rates, the 2015 U.S. Transgender Survey found that 47% of respondents reported experiencing sexual assault in their lifetime, and 10% reported experiencing sexual assault in the last year (James et al., 2016). More recent studies have suggested the rate of lifetime sexual assault may be even higher than first reported for TGD individuals, ranging between 63%-87% (Kolp et al., 2020; Sterzing et al., 2019). This range in prevalence of sexual assault is likely due to differences in sample demographics (i.e., ages 18–71 vs. 14–19) and how sexual victimization was assessed (e.g., whether measure included sexual harassment or flashing/exposure; Kolp et al., 2020; Sterzing et al., 2019). Additionally, previous research has found that TGD individuals from racially minoritized backgrounds are at increased risk for sexual assault, likely due to the intersection of multiple marginalized identities (Coulter et al., 2017; Grant et al., 2011; Staples & Fuller, 2021).

Adverse mental health outcomes following experiences of sexual assault among cisgender populations have been well-researched (see Dworkin et al., 2017 for review), but these outcomes among TGD individuals are understudied. The limited research available has shown that experiences of sexual assault among TGD individuals is associated with reported increased rates of anxiety (Henry et al., 2018), depression, PTSD, non-suicidal self-injury, suicide attempts (Beckman et al., 2018; Lindsay et al., 2016; Parr, 2020; Testa et al., 2012), as well as sleep disturbances (Kolp et al., 2020) and substance abuse (Testa et al., 2012). A similar pattern of psychological outcomes has been found among studies utilizing samples of individuals with minoritized sexual orientations, or combined those with minoritized sexual orientations and gender identities (Gilmore et al., 2014; Kiekens et al., 2021; Lucas et al., 2018; Ratner et al., 2003; Rhew et al., 2017; Smith et al., 2016).

Given these negative outcomes, previous research has consistently indicated the importance of protective factors to help alleviate psychological distress associated with sexual assault, with social support receiving ample attention primarily among cisgender populations. Two types of social support have been outlined in the literature, whereby individuals receive (i.e., received support), or judge they will receive (i.e., perceived support), quality assistance from support providers in a time of stress (e.g., family, friends, romantic partners; Lakey & Scoboria, 2005). The ability for social support to buffer and alleviate the association between negative events and negative outcomes is the basis for the stress-buffering hypothesis of social support (Cohen & Wills, 1985). Among TGD populations, receiving social support and connecting with broader support networks can be a mechanism for identifying and learning about available resources (Pinto et al., 2008). In addition, social support can be a catalyst for TGD individuals to use healthy coping mechanisms (Budge et al., 2013a; Sánchez & Vilain, 2009). Importantly, alongside the beneficial impact of receiving support, the mere belief or expectation that one will receive support (i.e., perceived support) has been shown to buffer mental health symptoms. In fact, previous research has identified the potential for perceived social support to buffer depressive symptoms (Boza & Perry, 2014; Budge et al., 2013a; Nemoto et al., 2011), anxiety (Pflum et al., 2015), alcohol use (Johnson et al., 2021), non-suicidal self-injury (Claes et al., 2015; Davey et al., 2016), and suicidal ideation and attempt risk (Bauer et al., 2015) within TGD samples. However, these studies did not examine perceived social support in the context of TGD individuals with a previous experience of sexual assault.

Among primarily cisgender samples, the stress-buffering effect of social support has been consistently supported by literature examining outcomes of trauma (Brewin et al., 2000; Ozer et al., 2003; Prati & Pietrantoni, 2009), including sexual assault (Borja et al., 2006; Dworkin, Ojalehto, et al., 2018; Frazier et al., 2004; Littleton, 2010). Meta-analyses examining risk factors for trauma symptoms concluded that a lack of either received or perceived social support conveyed one of the strongest risks for the development of PTSD (Brewin et al., 2000; Ozer et al., 2003; Wagner et al., 2016). Despite the evidence supporting the positive effects of social support in the context of sexual assault, no research has examined the stress-buffering potential of social support between sexual assault and adverse mental health outcomes in TGD people, nor examined whether the stress-buffering effects of social support varies across sources (i.e., friends, family, significant others).

Given the strong empirical evidence for the benefits of perceived social support, it is essential that investigations among TGD individuals consider unique aspects affecting the social networks of this population. Most social support research among TGD individuals has focused on family support, and shows that support from family is associated with better quality of life (Başar et al., 2016) and reduced psychological distress (Bariola et al., 2015; Bockting et al., 2013). However, TGD individuals often report less perceived social support from their family than their non-TGD family members as well as other non-TGD peers (Davey et al., 2014; Factor & Rothblum, 2007a, 2007b). Moreover, little research has examined support from significant others and friends among TGD individuals. Existing research has shown the benefit (e.g., greater well-being) of having support from romantic partners and other TGD individuals, especially in the absence of support from other sources (Budge et al., 2013b). Nonetheless, a national representative survey found 58% of respondents experienced loss of friendships due to their gender identity and/or gender expression, and 45% reported romantic relationships ended after disclosing their gender identity to their partners (Grant et al., 2011). This loss of social support on the basis of gender identity and/or expression plays a significant role in TGD individuals’ coping styles and future mental health (Budge et al., 2013a). Overall, limited existing evidence suggests a beneficial impact of social support from various sources, but additional research is needed to examine these sources further given the challenges TGD individuals often face (e.g., rejection). Given these interpersonal challenges and discrimination experiences, it is reasonable to expect social support may vary depending on the source (i.e., friends, family, significant others). Therefore, research examining whether the stress-buffering effects of social support varies across sources of support would provide a richer and more nuanced understanding of social support for TGD individuals, which in turn will inform targeted intervention work.

Given the prevalence of sexual assault experienced by TGD individuals, and the unique situations that may influence their support networks during recovery, it is imperative to better examine whether social support buffers the association between sexual assault and negative post-assault symptomology for this population. The present study therefore sought to examine perceived social support from different sources (i.e., significant others, family, and friends) as a potential moderator between experiences of sexual assault and associated symptomology among TGD adults. It was hypothesized that support from significant others, family, and friends would each moderate the relationship between sexual assault and post-assault symptomology, such that the relationship between sexual assault and trauma symptoms would be reduced at high, relative to low, levels of support.

Methods

Measures

Demographics

To gather information in regard to gender identity, participants completed the Gender Identity Questionnaire (Wilson, 2013). This measure comprises four questions: First, participants were instructed to briefly describe their gender identity. Second, participants were instructed to indicate all answer options that described their current gender identity, including man, woman, trans man, trans woman, and genderqueer. In addition, this question had an additional category where participants could specify how they identified, as well as a decline to state option. Third, participants were asked what sex they were assigned at birth (male, female, decline to state). Finally, the fourth question assessed whether participants were “…born with an intersex condition.”

Other demographic questions instructed participants to report their age, race, and sexual orientation. Income was assessed on a Likert scale with the following eight categories: (1) Less than $5000; (2) $5000 through $11,999; (3) $12,000 through $15,999; (4) $16,000 through $24,999; (5) $25,000 through $34,999; (6) $35,000 through $49,999; (7) $50,000 through $74,999; (8) $100,000 and greater.

Sexual victimization

The Sexual Experiences Survey-Short From Victimization (Koss et al., 2007) was used to assess experiences of sexual assault. This measure captures a range of unwanted sexual behaviors (i.e., sexual contact, attempted rape, completed rape) and assesses the tactics used by the perpetrator at the time of the assault (i.e., physical force, intoxication, and/or verbal coercion). The question assessing sexual contact states, “Someone fondled, kissed, or rubbed up against the private area of my body (lips, breast/chest, crotch, or butt) or removed some of my clothes without my consent.” This measure does not include sexual victimization that does not involve contact or attempted contact (e.g., sexual harassment or exposure). In addition, participants were asked their relationship to the perpetrator (i.e., stranger, a person they knew, an immediate family member, an extended family member, an intimate partner, or don’t know). If they had more than one incident, they were instructed to answer this question based on who most often perpetrated against them. Internal consistency for the SES in the present sample was excellent (Cronbach’s alpha = .89), which is comparable to validity research on the SES-SFV (Cronbach’s alpha = 92, Johnson et al., 2017).

First, participants were instructed to report the number of times (0–3+) they experienced nonconsensual sexual contact, attempted rape, and/or completed rape by each perpetrator tactic (i.e., verbal coercion, intoxication, physical force) since the age of 14. Then, a continuous total score was computed to account for both severity and frequency of assault experiences (Davis et al., 2014). To compute the continuous total score for each participant, we first created a seven-point ranking scheme that combines outcomes and separates the tactics used by the perpetrator (0 = No history of sexual assault, 1 = Sexual contact by verbal coercion, 2 = Sexual contact by intoxication, 3 = Sexual contact by physical force, 4 = Attempted or completed rape by verbal coercion, 5 = Attempted or completed rape by intoxication, 6 = Attempted or completed rape by physical force). This severity score (i.e., 0–6) was then multiplied by the number of times each outcome/tactic combination occurred (i.e., one, two, or three times). Then, this score (i.e., severity x frequency) for each tactic was summed to create a continuous 0–63-point scale. For example, if a participant reports three experiences of sexual contact by verbal coercion (i.e., 3 × 1 = 3), three experiences of attempted or completed rape by intoxication (3 × 5 = 15), and one experience of attempted or completed rape by physical force (1 × 6 = 6), their score would be 24 (i.e., 3+15+6). Higher numbers indicate more severe and/or frequent experiences of sexual assault, and zeros indicate the participant did not report a history of experiencing sexual assault. These scoring procedures are one of three recommended in Davis et al. (2014), and further description of the scoring procedures are outlined therein.

Social support

To assess level of perceived support, the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1988) was completed by participants. This 12-item measure instructs participants to rate their agreement with a statement on a 7-item Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree). The MSPSS has three subscales: Significant Other, Friends, and Family. Subscale scores were derived by taking the average score of items on each subscale. Items in the Significant Other subscale include, “There is a special person who is around when I am in need,” and “There is a special person in my life who cares about my feelings.” Items in the Friends subscale include, “My friends really try to help me,” and “I can count on my friends when things go wrong.” Finally, items in the Family subscale include, “My family really tries to help me,” and “I can talk about my problems with my family.” The MSPSS has demonstrated good validity of subscales and internal reliability (α = .81–.90; (Zimet et al., 1990), including in TGD samples (Thorne et al., 2018). Subscales demonstrated excellent internal consistency in the present sample (Significant other subscale, α = .90, Family subscale, α = .93, Friends subscale, α = .91).

Trauma symptoms

To assess trauma symptoms associated with sexual assault, the Sexual Abuse Trauma Index (SATI) subscale from the Trauma Symptom Checklist – 40 (TSC-40; Briere & Runtz, 1989) was used for the present analyses. Critically, the structure of TSC-40 does not aim at determining PTSD diagnosis which allows for assessment without this diagnostic structure. Though the TSC-40 assesses a range of trauma symptoms, the SATI items specifically assess trauma symptoms associated with sexual abuse, and are correlated with a history of sexual abuse (Gold et al., 1994). Specifically, the SATI subscale consists of items assessing symptoms such as “Flashbacks (sudden, vivid, distracting memories),” “Nightmares,” “Memory problems,” and “Bad thoughts or feelings during sex.” Participants were instructed to rate the frequency of experiencing each symptom over the past 2 months. Answer options fall on a 4-point Likert scale ranging from 0 (never) to 3 (often). Internal consistency of the SATI subscale was good (Cronbach’s alpha = .79), and higher than consistency scores reported in validation research (Cronbach’s alpha = .62, Elliott & Briere, 1992).

Depression

The Depression subscale of the TSC-40 was also utilized in the present analyses (TSC-40; Briere & Runtz, 1989). This subscale comprises symptoms such as, “Insomnia (trouble getting to sleep),” “Weight loss (without dieting,” and “Sadness.” Again, participants were instructed to rate the frequency of experiencing each symptom over the past 2 months and answer options fall on a 4-point Likert scale ranging from 0 (never) to 3 (often). Internal consistency of the SATI subscale was good in the current sample (Cronbach’s alpha = .87), and higher than consistency scores reported in validation research (Cronbach’s alpha = .70, Elliott & Briere, 1992).

Procedure

Participants were recruited from the United States and Canada using Amazon’s Mechanical Turk (MTurk). Despite their eligibility, no participants from Canada opted to participate. From this platform, participants could view the study advertisement which explained that “The study is investigating the feelings, behaviors, and social experiences of transgender and non-binary men and women.” Upon signing up, the participants received a link that directed them to the beginning of the study. First, participants read an online informed consent and clicked a button to indicate their consent. Then, participants completed the Gender Identity Questionnaire (Wilson, 2013), and those who did not self-identify as TGD were not permitted to complete the study. Eligible participants (i.e., those who self-identified as TGD) then completed the remaining survey questions online. Some questions in the online survey served as attention checks and were dispersed throughout. Upon completion, $2.00 was paid to participants’ MTurk account and they were directed to a debriefing form that included the contact information for study researchers as well as a list of psychological resources. All study procedures were approved by the Institutional Review Board at the university at which the study was conducted.

Participants

A full description of demographic characteristics of the present sample (N = 191) can be found in Table 1. Regarding gender identity, participants could select more than one gender identity, and most of the sample self-identified as either Trans man (n = 47, 24.6%) or Trans woman (n = 85, 44.5%). The remainder of the sample self-identified as Genderqueer (n = 21, 11.0%), woman (n = 19, 9.9%), and man (n = 11, 5.8%). In addition, six participants (3.1%) opted to write-in their gender identity (i.e., four wrote “non-binary,” one wrote “genderless,” and one wrote “gender non-conforming”). More than half of the sample reported their sex assigned at birth was male (n = 118, 61.8%; female n = 66, 34.6%), and seven participants declined to report (3.7%). In addition, 21 participants (11.0%) reported being “born with an intersex condition” and 26 participants (13.6%) declined to respond to this question. Participants in the present sample largely self-identified as White (n = 139, 72.8%), with the second largest racial representation in the sample as Black or African American (n = 36, 18.8%). The average age of the sample was 30.28 (range = 18–71, SD = 7.09). Participants were from all regions of the United States. This sample has been reported on elsewhere (CITATIONS MASKED FOR REVIEW).

Table 1.

Demographic Characteristics of Participants.

	N	%
Gender
Man	11	5.8
Woman	19	9.9
Transman	47	24.6
Transwoman	85	44.5
Genderqueer	21	11.0
Self-specify	6	3.1
Declined to state	2	1.0
Sexual orientation
Asexual	13	6.8
Heterosexual or straight	45	23.6
Gay or lesbian	36	18.8
Bisexual	65	34.0
Pansexual	20	10.5
Self-specify^a	3	1.6
Haven’t had sex in past 12 months	9	4.7
Race/Ethnicity ^b
White	139	72.8
Black or African American	36	18.8
American Indian or Alaskan native	8	4.2
Native Hawaiian	2	1.0
Mexican, Mexican American, Chicano	15	7.9
Puerto Rican	8	4.2
Other Spanish/Hispanic/Latinx^c	6	3.1
Korean	2	1.0
Asian Indian	1	0.5
Chinese	3	1.6
Biracial or Multiracial	3	1.6
Guamanian or Chamorro	1	0.5
Declined to state	5	2.6
Income ^d
Less than $5000	7	3.7
$5000 through $11,000	13	6.8
$12,000 through $15,999	6	3.2
$16,000 through $24,999	21	11.1
$25,000 through $34,999	34	17.9
$35,000 through $49,999	35	18.4
$50,000 through $74,99	52	27.4
$75,000 through $99,999	15	7.9
$100,000 and greater	7	3.7
Geographic region
Northeast	50	26.2
Southeast	31	16.2
South	30	15.7
Midwest	43	22.5
Southwest	22	11.5
Northwest	15	7.9

^aParticipants who selected this category specified Non-Binary, Genderless, and Gender Non-Conforming.

^bParticipants who selected this category specified Demisexual, Human, and “I love everyone.”

^cParticipants were instructed to select all that apply, therefore total exceeds 100%.

^dParticipants who selected this category specified Dominican and El Salvadoran.

^eOne participant did not report their income.

Data Analytic Plan

To address the hypotheses, multiple regression analyses were conducted with participant SATI scores as the dependent variable. Previous research has documented that TSC-40 scores were negatively correlated with age and income (Elliott & Briere, 1992), which suggests that individuals lower in age and income would be expected to have the highest trauma symptoms. Thus, all analyses accounted for the effects of age and income. As income was collected on an eight-point scale with corresponding salary ranges, this variable was mean centered using the average score rather than dollar equivalent (M = 5.59, SD = 1.92). Furthermore, as the TSC-40 depression subscale was highly correlated with the SATI subscale (r = .86), the depression subscale variable was also accounted for in regression analyses. All independent, covariate, and moderating variables were mean centered to reduce multicollinearity among these variables. Interaction terms were created between sexual assault and the three MSPSS subscales by multiplying the variables together (Aiken & West, 1991), and models were conducted separately for each type of social support. Significant interactions were decomposed at high (+1SD) and low (-1SD) levels of the moderator.

Missing data was handled in the following ways. For participants missing less than 20% of data on a given measure, Ipsative mean substitution was used to deal with missing data (Tabachnick & Fidell, 2007), such that their data point was replaced with the mean data point for that item of the sample. Missing data on the SES-SFV were handled in accordance to the scoring method described in Davis et al. (2014). A continuous total score was not calculated for one participant due to a missing response to a question assessing experience with unwanted sexual contact through incapacitation. This participant was retained in the present sample as they answered all other items on the SES (i.e., they scored all items as 0). A score of 0, indicating this had never happened since the age of 14, replaced the missing item for this one participant so a continuous total score could be calculated.

Results

Descriptive Statistics

Sexual victimization

As previously reported in this sample (Kolp et al., 2020), 63.9% reported experiencing sexual assault since the age of 14. Continuous total scores accounting for severity and frequency of sexual assault experiences fell along the full possible range (i.e., 0–63), with an average score of 25.77 (SD = 25.48). Regarding relationship to the perpetrator, 40 participants (20.9%) reported it was someone they knew (e.g., neighbor, friend, acquaintance, coworker), 26 participants (13.6%) reported it was a stranger, 10 participants (5.2%) reported it was an intimate partner (e.g., sexual partner, committed partner, spouse), seven participants (3.7%) reported it was an immediate family member (e.g., mother, father, sibling), and six participants (3.1%) reported it was an extended family member (e.g., aunt, uncle, cousin, grandparent). Finally, one participant (0.5%) reported they “don’t know” who the perpetrator was.

Correlations

See Table 2 for full correlation details. Results indicated a significant positive correlation between sexual assault and post-assault trauma symptomology (r = .55, p < .001). In addition, support from a significant other was significantly and negatively correlated with sexual assault (r = −.15, p < .05). Support from significant others (r = −.15, p < .05), family (r = −.14, p < .05), and friends (r = −.20, p < .01), was significantly and negatively correlated with post-assault trauma symptomology. Similarly, support from significant others (r = −.16, p < .05), family (r = −.17, p < .05), and friends (r = −.21, p < .01), was significantly and negatively correlated with depression. Scores for depression and post-assault trauma symptomology were highly correlated (r = .85, p < .01), and both were significantly correlated with sexual assault (depression, r = .47, p < .01; post-assault trauma symptomology score, r = .55, p < .01).

Table 2.

Zero-Order Correlations.

	1	2	3	4	5	6
1. Significant other support	—	.49**	.66**	−.16*	−.15*	−.15*
2. Family support		—	.46**	−.17*	−.14*	−.07
3. Friends support				−.21**	−.20**	−.13
4. Depression					.85**	.47**
5. Sexual assault trauma Index					—	.55**
6. Sexual assault						—
Mean	5.03	4.40	5.04	7.43	4.76	25.77
Standard deviation	1.64	1.73	1.37	5.99	4.91	25.48

*p < .05, **p < .01.

Moderation Results

A series of three linear regressions were conducted (Table 3). Main effect models demonstrated sexual assault victimization was positively associated with post-assault trauma symptomology (ß = .19, p < .001). Further, regression analyses demonstrated an interaction that was trending toward significance between sexual assault and perceived support from a significant other (ß = −.07, p = .057). Decomposition of this interaction indicated sexual assault was associated with post-assault trauma symptomology at low levels of perceived support from a significant other (ß = .25, p < .001), but not high levels of perceived support from a significant other (ß = .10, p = .089). The interactions between sexual assault and perceived support from friends (ß = −.06, p = .133) and family (ß = - .00, p = .954) were not significant.

Table 3.

Regression Analyses Summary of Predicting Sexual Assault Trauma Index score.

	B	ß	S.E.	t	p
Significant other support
Model 1
Age	−.02	−.02	.03	−.63	.530
Income	.06	.02	.10	.61	.543
Depression	.63	.77	.03	18.59	<.001*
Sexual assault	.04	.19	.01	4.47	<.001*
Significant other support	−.01	−.00	.11	-.12	.907
Model 2
Age	−.02	−.03	.03	−0.74	.462
Income	.06	.02	.10	0.64	.527
Depression	.63	.77	.03	18.69	<.001*
Sexual assault	.03	.18	.01	4.32	<.001*
Significant other support	−.07	−.02	.12	−0.63	.529
Sexual assault X significant other support	−.01	−.07	.01	−1.92	.057
Family support
Model 1
Age	−.02	−.02	.03	−.65	.514
Income	.07	.03	.10	.66	.510
Depression	.63	.77	.03	18.43	<.001*
Sexual assault	.04	.19	.01	4.50	<.001*
Family support	−.03	−.01	.11	−.32	.751
Model 2
Age	−.02	−.02	.03	−0.65	.514
Income	.07	.03	.10	0.659	.511
Depression	.63	.77	.03	18.36	<.001*
Sexual assault	.04	.19	.01	4.49	<.001*
Family support	−.04	−.01	.11	−0.32	.748
Sexual assault X family support	.00	−.00	.00	−0.06	.954
Friends support
Model 1
Age	−.01	−.02	.03	−.55	.583
Income	.06	.02	.10	.63	.528
Depression	.63	.77	.03	18.40	<.001*
Sexual assault	.04	.19	.01	4.49	<.001*
Friends support	−.04	−.01	.14	−.32	.747
Model 2
Age	−.02	−.02	.03	−0.66	.514
Income	.07	.03	.10	0.68	.498
Depression	.63	.77	.03	18.52	<.001*
Sexual assault	.04	.18	.01	4.35	<.001*
Friends support	−.08	−.02	.14	−0.57	.568
Sexual assault X friends support	−.01	−.06	.01	−1.51	.133

*p < .001.

Discussion

Findings showed that sexual assault was associated with trauma symptoms related to sexual assault (i.e., SATI items) among TGD adults. This is consistent with prior research examining the association between sexual assault and post-traumatic symptoms among cisgender populations (Borja et al., 2006; Dworkin, Ojalehto, et al., 2018; Frazier et al., 2004; Littleton, 2010), and replicates prior research indicative of a similar pattern among TGD individuals (Beckman et al., 2018; Lindsay et al., 2016). In addition, study hypotheses pertaining to perceived social support were marginally supported by the present analyses. Specifically, results indicated a trend for perceived support from a significant other to moderate the relationship between sexual assault and trauma symptoms associated with sexual assault. Decomposition of this interaction produced results that would be expected based on the stress-buffering hypothesis of social support, such that at high levels of support, relative to low, the relationship between sexual assault and trauma symptoms associated with sexual assault was reduced. On the other hand, support from family and friends was not found to buffer the association between sexual assault and trauma symptoms associated with sexual assault. As such, results highlight the importance of romantic partnerships among TGD individuals, especially their ability to potentially abate psychological distress for those who have experienced sexual assault.

Importantly, the present findings do not explain why support from significant others buffered symptoms. It is also important to note the present analyses did not examine whether participants had disclosed their experience with sexual assault to their significant other, nor whether participants perceived their partner would provide support when experiencing post-assault symptomology. Of concern, existing research fails to describe to whom TGD people disclose experiences of sexual assault, despite the same attention afforded to cisgender populations (Ahrens et al., 2007; Orchowski & Gidycz, 2012). In addition, research indicates that response to disclosure may play a critical role in recovery from sexual assault (Orchowski & Gidycz, 2015; Ullman & Peter-Hagene, 2014). As such, further work should be aimed at investigating who TGD individuals seek for support following experiences of sexual assault, with particular attention afforded to the responses to disclosure they receive.

As mentioned, support from family and friends was not found to buffer the association between sexual assault and trauma symptoms associated with sexual assault. When considering the unique aspects of the social networks that may surround TGD people, particularly the experience of rejection, this result may not be surprising. For example, compared to non-TGD family members, TGD individuals report less perceived support from their family (Davey et al., 2014; Factor & Rothblum, 2007a, 2007b). This is concerning, as support from one’s family has shown a positive impact on quality of life (Başar et al., 2016) and psychological distress (Bariola et al., 2015; Bockting et al., 2013) among TGD individuals. Yet, the present findings suggest this benefit may not extend to post-assault symptomology for TGD sexual assault survivors. That said, previous work has shown that experiences with family among TGD individuals varies widely. For instance, 45% of TGD individuals in a nationally representative sample reported experiencing family rejection (Grant et al., 2011). Conversely, 45% from this same sample reported their family is as strong today as it was before disclosing their TGD identity (Grant et al., 2011). Similar to family, TGD individuals have a wide array of experiences with friends, with 58% of TGD individuals reporting rejection from friends (Grant et al., 2011). Given the diverse experiences TGD individuals have with friends and family and the importance of these relationships, future research should investigate the impact of rejection on perceived support, particularly among TGD individuals with a history of trauma. Moreover, defining “family” outside the bounds of relatives is prominent among those with minoritized gender identities (Hull & Ortyl, 2019). Thus, future research in this area should examine the impact of support from one’s family-of-origin versus one’s family-of-choice.

Clinical Implications

When considering the relevant implications of the present findings, it is critical to acknowledge that the present findings are preliminary and need to be replicated. Thus, clinical implications should be considered cautiously until further research is completed. Furthermore, it is important to consider the complex and overlapping experiences of trauma and discrimination experienced by TGD individuals, in addition to sexual assault. For instance, TGD individuals experience higher rates of verbal harassment (James et al., 2016), childhood psychological, physical and sexual abuse (Thoma et al., 2021), as well as intimate partner violence (Henry et al., 2018; Langenderfer-Magruder et al., 2016; Valentine et al., 2017) compared to cisgender populations. Therefore, this line of research showing increased violence and minority stress (Hendricks & Testa, 2012) experienced by TGD individuals should inform culturally competent care of TGD sexual assault survivors.

The present findings suggest TGD individuals perceive similar levels of social support from friends and significant others, but perceived support from friends may be ineffective in abating post-assault trauma symptoms. Clinicians working with TGD people can increase awareness of peer-led support groups and community resources that may bolster the efficacy of perceived support from friends in buffering trauma symptoms (Shipherd et al., 2019). In addition, it is important clinicians understand the complex familial relationships that many TGD individuals experience. To date, there are no evidence-based interventions tailored towards increasing familial acceptance of TGD people (Strauss et al., 2020). Research aimed towards the development of such an intervention could provide clinicians with a tool for increasing familial social support in the lives of TGD people. However, many TGD individuals may choose not to pursue acceptance from their family because of the abuse or discrimination perpetrated against them by family members. Thus, clinicians must respect and validate their clients’ choices as they pertain to increasing familial social support.

Limitations

Some methodological limitations are important to note. Specifically, participants were recruited using Amazon’s MTurk. While this recruitment method has many benefits (Bartneck et al., 2015), it does not allow for the control of participants’ environments (McCoy et al., 2004). Thus, the introduction of unknown confounding variables may have been present in the environment (Kelly et al., 2008). Further, the assessment of sexual victimization only included contact offenses, neglecting the potential impact of non-contact offenses such as sexual harassment. Research suggests that approximately 81% of TGD youth experience sexual harassment, and 63–65% experience distress as a result (Mitchell et al., 2014). Research is warranted to examine the buffering role of perceived social support between additional forms of sexual victimization not assessed currently (e.g., childhood sexual abuse and sexual harassment), and distress. In addition, the current study was underpowered to examine if findings varied based on who perpetrated the sexual assault (e.g., significant other, stranger, friend, family member) and future research should examine this.

Furthermore, the sample is predominantly White (72.8%), with the second largest racial category falling to 18.8% for Black or African American. Experiences with sexual assault (Staples & Fuller, 2021) and support networks (Grant et al., 2011) vary as a function of race among TGD individuals, and thus the limited racial and ethnic diversity in the current sample is an important limitation of the present work. Further, the predominantly White sample limits the generalizability of the present findings. Additionally, the sample lacked diversity in the range of TGD identities, particularly in regard to those who reported a genderqueer identity (11.0%) or self-identified (3.1%). This is an important limitation, as previous research has documented that transgender individuals have differing experiences with family compared to gender non-conforming individuals (i.e., not identifying with a specific gender) (Grant et al., 2011). As such, it is critical that future research attempt to include increasingly diverse samples along racial and ethnic identities, as well as gender identity. Finally, the study was cross-sectional by design, thus precluding investigation and determination of causal effects.

Conclusion

The present study highlights the importance of social support among TGD individuals, particularly those who have experienced sexual assault. The current study is the first to examine the ability of social support to buffer the association between sexual assault and trauma symptoms associated with sexual assault among TGD individuals. Results suggest that support from significant others, rather than family and friends, may work to buffer negative post-assault symptomology. These data underscore the importance of critically examining the unique characteristics affecting the support networks of TGD people, and how these may impact mental health symptomology among those who have experienced sexual assault. Further research is warranted to examine the importance of perceived support from significant others, which may inform intervention work aimed at providing services to the TGD community.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Ohio University Graduate Student Competitive Research Fund in Psychology.

ORCID iD

Lauren R. Grocott

Author Biographies

Lauren R. Grocott is a Clinical Psychology PhD student at the University of Wisconsin-Milwaukee. Her research focuses on sexual assault and intimate partner violence in young adults.

Thomas E. Schlechter is a Counseling Psychology PhD student at Colorado State University. Their research focuses on Queer and Trans mental health, identities, relationships, and language.

Shannon M. J. Wilder, PhD, is a licensed psychologist at the Veterans Affairs in Topeka Kansas. She received her PhD from Ohio University.

Cayla M. O’Hair is a Clinical Psychology PhD student at the University of Wisconsin-Milwaukee. Her research focuses risk factors for intimate partner violence in young adults.

Christine A. Gidycz, PhD, is a Professor Emerita of Psychology at Ohio University. Her research focuses on sexual assault prevention and risk reduction programs.

Ryan C. Shorey, PhD, is an Associate Professor of Psychology at the University of Wisconsin-Milwaukee. His research focuses on intimate partner violence and sexual assault.

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