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Supporting Transgender College Students: Implications for Clinical Intervention and Campus Prevention

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Title: Supporting Transgender College Students: Implications for Clinical Intervention and Campus Prevention
Language: English
Authors: Swanbrow Becker, Martin A., Nemeth Roberts, Stacey F., Ritts, Sam M., Branagan, William Tyler, Warner, Alia R., Clark, Sheri L.
Source: Journal of College Student Psychotherapy. 2017 31(2):155-176.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 22
Publication Date: 2017
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Undergraduate Students, Graduate Students, Sexual Identity, Student Experience, Coping, Anxiety, Comparative Analysis, Student Surveys, Online Surveys, Trauma, Suicide, Individual Counseling, Group Counseling, Intervention, Prevention, Racial Identification, Sexual Orientation, Statistical Analysis, Help Seeking
DOI: 10.1080/87568225.2016.1253441
ISSN: 8756-8225
Abstract: This study examines the experiences of transgender college students in coping with stress in comparison to their cisgender peers. Undergraduate and graduate students from 73 colleges, totaling 26,292 participants, of which 47 identified as transgender completed an online survey. Transgender students reported greater exposure to trauma and higher rates of suicidal experiences, as well as different precipitants to reported stressful periods and sources of support than their cisgender peers. Implications for individual and group counseling as well as outreach and prevention to better support transgender students are explored.
Abstractor: As Provided
Number of References: 40
Entry Date: 2017
Accession Number: EJ1134273
Database: ERIC
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  Value: <anid>AN0121963527;85y01apr.17;2019Feb14.13:24;v2.2.500</anid> <title id="AN0121963527-1">Supporting Transgender College Students: Implications for Clinical Intervention and Campus Prevention. </title> <p>This study examines the experiences of transgender college students in coping with stress in comparison to their cisgender peers. Undergraduate and graduate students from 73 colleges, totaling 26,292 participants, of which 47 identified as transgender completed an online survey. Transgender students reported greater exposure to trauma and higher rates of suicidal experiences, as well as different precipitants to reported stressful periods and sources of support than their cisgender peers. Implications for individual and group counseling as well as outreach and prevention to better support transgender students are explored.</p> <p>Keywords: college student; coping; suicide; transgender; trauma</p> <p>College students identifying as transgender face complex challenges as they attempt to negotiate a transition in their gender identity in addition to adjusting to adulthood, college life, and new social supports (Beemyn, [<reflink idref="bib5" id="ref1">5</reflink>]; Beemyn, Curtis, Davis, & Tubbs, [<reflink idref="bib6" id="ref2">6</reflink>]; Zubernis & Snyder, [<reflink idref="bib40" id="ref3">40</reflink>]). They likely experience the college environment differently from those who identify as cisgender and heteronormative, and so may feel excluded from and marginalized by the dominant cultures and even from the Lesbian, Gay, Bisexual, and Questioning (LGBQ) community with whom they are so often associated (Beemyn, [<reflink idref="bib5" id="ref4">5</reflink>]). Efforts to help transgender students thrive on campus are hampered by the lack of understanding of their multiple intersecting identities, their experiences coping during stressful times, their unique developmental tasks in managing bodily changes and learning new gender roles, and their perceived access to social, academic, and mental health supports (Beemyn et al., [<reflink idref="bib6" id="ref5">6</reflink>]). This article explores the experiences of coping with stress of 47 college students identifying as transgender.</p> <p>The term transgender subsumes several gender identities that exist outside of a dichotomous conceptualization of gender. The transgender umbrella includes those who are transsexual, genderqueer, bigender, drag kings and queens, and questioning (Beemyn, [<reflink idref="bib5" id="ref6">5</reflink>]; Donatone & Rachlin, [<reflink idref="bib17" id="ref7">17</reflink>]). Over the course of the past several years, there has been an uptick in the number of college students who endorse these identities and openly live as transgender (Beemyn, [<reflink idref="bib5" id="ref8">5</reflink>]).</p> <hd id="AN0121963527-2">Challenges facing transgender college students</hd> <p>Despite increasing visibility, transgender college students still report that the campus climate is a hostile one for them (Dugan, Kusel, & Simounet, [<reflink idref="bib19" id="ref9">19</reflink>]; McKinney, [<reflink idref="bib28" id="ref10">28</reflink>]). The simple acts of daily living are fraught for many transgender students. Because of the entrenched gender binary, facilities such as restrooms, locker rooms, and housing are often gender segregated (Beemyn, [<reflink idref="bib5" id="ref11">5</reflink>]). Housing stability is an ongoing issue for many transgender college students: Grant and colleagues ([<reflink idref="bib21" id="ref12">21</reflink>]) found that transgender students are either unable to locate appropriate housing or have, in some instances, been expelled from campus housing. In this regard, the basic needs of transgender students are not being met in many university settings.</p> <p>Additionally, transgender individuals are at high risk of gender-based discrimination and violence (National Coalition of Anti-Violence Programs, [<reflink idref="bib31" id="ref13">31</reflink>]). In fact, close to half of the transgender adults surveyed by Lombardi, Wilchins, Priesing, and Malouf ([<reflink idref="bib27" id="ref14">27</reflink>]) reported gender-based victimization in the form of harassment and violence. Thus, transgender college students have the additional burdens of often coping with a cold, unaccepting environment in tandem with acts of verbal and physical assault as they develop their adult identities.</p> <p>Coping with the impact of prejudice and discrimination complicates the psychological evolution from adolescent to adult (Zubernis & Snyder, [<reflink idref="bib40" id="ref15">40</reflink>]). Unfortunately, there has been a dearth of research into the factors that support coping for the transgender population (Singh, Hays, & Watson, [<reflink idref="bib36" id="ref16">36</reflink>]). This is especially true of transgender college students. In addition to this current study, to date, only two other studies have been drawn from a random sample of college students (Dugan et al., [<reflink idref="bib19" id="ref17">19</reflink>]; Effrig, Bieschke, & Locke, [<reflink idref="bib20" id="ref18">20</reflink>]) that have examined distress and coping in transgender young adults. This is a critical need area for research, as transgender young adults are vulnerable to distress and are at an elevated risk for suicidality (Effrig et al., [<reflink idref="bib20" id="ref19">20</reflink>]).</p> <hd id="AN0121963527-3">Risk and resilience</hd> <p>In addition to traditional stressors experienced by most students transitioning to college, the transgender community is likely to experience elevated levels of distress related to their identity development and resolution, as well as in acknowledgement within their community of their posttransition gender identity (Budge et al., [<reflink idref="bib13" id="ref20">13</reflink>]). Clements-Nolle, Marx, and Katz ([<reflink idref="bib14" id="ref21">14</reflink>]) explored risk factors and predictors associated with suicidality among transgender individuals. These findings confirmed the presence of individual risk factors previously recognized in LGBQ literature, including, history of sexual trauma, depression, and substance abuse, as well as suggesting a significant role of societal risk factors, including gender-based discrimination and victimization (Clements-Nolle et al., [<reflink idref="bib14" id="ref22">14</reflink>]).</p> <p>Conversely, Stieglitz ([<reflink idref="bib37" id="ref23">37</reflink>]) identified positive social support as a major source of resiliency in transgender youth. It was found that "emotional support and acceptance serve as protective factors, along with ongoing support in terms of housing, food, clothing, and education" (Stieglitz, [<reflink idref="bib37" id="ref24">37</reflink>], p. 204). An emphasis is placed on the role of medical and mental health professionals in transgender health, and, therefore, a need for providers to become more knowledgeable and culturally sensitive when working with these individuals.</p> <p>Still, this population continues to experience significant levels of mental health concerns, marked by the experience of depression, low self-esteem, and substance abuse (Stieglitz, [<reflink idref="bib37" id="ref25">37</reflink>]). These concerns, within a context where they are pressured to conform to societal gender standards, have placed the transgender population at an exceptionally high risk of suicidal ideation and attempted suicide (Stieglitz, [<reflink idref="bib37" id="ref26">37</reflink>]). Risk factors exacerbating mental health issues include lack of role models in the community and media, and discrimination and victimization in home, school, healthcare, and employment settings where they are likely to experience verbal, physical, and sexual abuse; sexual objectification; and feelings of resentment in being recognized for their gender and sexual identity rather than other personal qualities. As a result, this group is likely to experience greater rates of academic problems and dropout, isolation, unemployment and poverty, homelessness, and substance use (Stieglitz, [<reflink idref="bib37" id="ref27">37</reflink>]).</p> <hd id="AN0121963527-4">Social support seeking and campus connection</hd> <p>Humans have been theorized to have a fundamental need to belong, which affects many social phenomenon, including attachment, mental health, and physical health (Baumeister & Leary, [<reflink idref="bib4" id="ref28">4</reflink>]; Brewer, [<reflink idref="bib9" id="ref29">9</reflink>]). Similarly, social support has been found to be directly and indirectly related to lower feelings of depression and anxiety, while avoidance coping strategies negatively impact mental health (Budge, Adelson, & Howard, [<reflink idref="bib12" id="ref30">12</reflink>]). Social support appears to be especially important for transgender individuals in order to learn about medical resources, speak out about political concerns, and access social networks (Pinto, Melendez, & Spector, [<reflink idref="bib33" id="ref31">33</reflink>]). Also, lower levels of social support appear detrimental as it may result in more unprotected sexual encounters and predicts more depressive symptoms (Nemoto, Bodeker, & Iwamoto, [<reflink idref="bib32" id="ref32">32</reflink>]).</p> <p>As transgender individuals appear to experience inflated rates of psychological distress, support seeking appears to be particularly important to help these individuals cope. Unfortunately, prior research indicates that those who identify as transgender tend to seek needed support and services (e.g., homeless shelter, addiction counseling) at especially low rates, as they face many barriers to service accessibility, including societal barriers, provider-related barriers, and resource-related barriers, which may impair support seeking behaviors (Acevedo-Polakovich, Bell, Gamache, & Christian, [<reflink idref="bib1" id="ref33">1</reflink>]). Previous studies of the transgender population often use snowball samples or samples consisting of those who seek services (e.g., mental health services) to collect data, which may exclude those who are not accessing social networks or social services, therefore, limiting the amount of literature examining transgender individuals and skewing the literature regarding transgender individual's experiences (e.g., Acevedo-Polakovich et al., [<reflink idref="bib1" id="ref34">1</reflink>]; Brown, Clarke, Gortmaker, & Robinson-Keilig, [<reflink idref="bib10" id="ref35">10</reflink>]; Mustanski & Liu, [<reflink idref="bib30" id="ref36">30</reflink>]).</p> <p>College student involvement in their campus communities impacts learning and development (Beemyn et al., [<reflink idref="bib6" id="ref37">6</reflink>]). With regard to transgender students, experiences with peer interactions and student organizational involvement is suggested to be a main element in the identity development process (Bilodeau, [<reflink idref="bib8" id="ref38">8</reflink>]). Unfortunately, prior literature suggests that Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) college students experience a hostile and emotionally cold campus climate (Brown et al., [<reflink idref="bib10" id="ref39">10</reflink>]). They are more likely than cisgender college students to experience harassment, to have negative perceptions of campus climate, to experience institutional discrimination through campus policies, and to experience a fear of safety (Beemyn & Rankin, [<reflink idref="bib7" id="ref40">7</reflink>]; Dugan et al., [<reflink idref="bib19" id="ref41">19</reflink>]; McKinney, [<reflink idref="bib28" id="ref42">28</reflink>]).</p> <p>Although understanding transgender individuals' college experience with social connection appears to be of significance, limited literature has been conducted that seeks to describe transgender students' connectedness with their university, or transgender students' experiences on campus at all. Literature regarding the LGBTQ communities has mainly focused on LGBQ issues or assumed transgender individuals' experiences to be similar to LGBQ individuals (Renn, [<reflink idref="bib34" id="ref43">34</reflink>]). Therefore, examination of transgender students' experiences with regard to social support networks and connectedness is warranted.</p> <hd id="AN0121963527-5">University counseling centers and transgender clients</hd> <p>In general, counseling centers on college campuses have been found to be effective in meeting the mental health needs of the students they serve (Drum, Brownson, Burton Denmark, & Smith, [<reflink idref="bib18" id="ref44">18</reflink>]). In addition, students who receive counseling have been shown to have a higher retention rate than those who do not (Illovsky, [<reflink idref="bib24" id="ref45">24</reflink>]). However, these findings relate only to the general student population and, while they may include students who identify as transgender, one is unable to clearly identify the effectiveness of university counseling centers' services for this population.</p> <p>Many college counseling centers faced with the growing diversity of the student body and placing a greater emphasis of multicultural considerations in therapy have made great strides toward supporting students who identify as transgender, but more research is needed to understand how best to serve these students. Advocacy efforts that relate to transgender students and might be led by the LGBTQ center on campus may include: establishment of gender neutral bathrooms, student health insurance coverage for transition-related health services, and flexibility in name and gender identification by the registrar's office. The campus LGBTQ center may also provide a community focal point and establish a process for university employees to seek certification as an ally or "safe place."</p> <p>While outreach efforts may prove to be effective in increasing the help-seeking behaviors of transgender students and in improving the campus environment, many universities may not clearly identify their support for these students. One study examining university counseling center websites for content related to LGBTQ students found that only 30% mentioned individual counseling services for LGBTQ students, 11% identified group services, and 10% described outreach services (Wright & McKinley, [<reflink idref="bib39" id="ref46">39</reflink>]). The authors concluded that such low rates of communication of available services limited the needed visibility of the LGBTQ services. While in the Wright and McKinley study, all sexual minority students were grouped together, one would expect that services designed specifically for transgender students, a gender minority population with very different needs than LGBQ students, would be significantly lower.</p> <p>While universities would benefit from research exploring how transgender students cope with stress in order to better meet their needs, significant challenges persist. Transgender students often respond to surveys in low numbers, such as in a survey by Student Affairs Administrators in Higher Education where only.3% of students identified as transgender (Effrig et al., [<reflink idref="bib20" id="ref47">20</reflink>]). Trans-identified students are also not easily identified on campus as they may not always participate in the LGBTQ center and may not wish to "out" themselves on campus. To address these constraints, a large scale, anonymous, national survey would help provide a forum to uncover the experiences of trans-students across the county.</p> <hd id="AN0121963527-6">Current study</hd> <p>This article seeks to address whether transgender students differ in the level of distress experienced during a stressful time as compared to their cisgender LGBQ and heterosexual peers and what factors impact any differences. We hypothesized that transgender students will experience more distress as compared to their peers during a difficult time. We anticipate that they will tend to identify with multiple intersecting identities and self-identify along more continuous or fluid lines across identities than dichotomous categories. It is further hypothesized that transgender students will have experienced a greater incidence of trauma, will identify different stressors impacting them than cisgender students, and report greater levels of distress, including suicidal experiences. Lastly, it is expected that transgender students will access fewer sources of support to turn to for help than other students.</p> <p>To answer these questions, this study explores the various demographic identities endorsed by transgender college students, the prevalence of trauma within this population, as well as how these students cope with distress. We will present findings regarding transgender students' reported sexual orientation, race/ethnicity, history of trauma, suicidal experiences and their sources of support when accessing mental health services. We will then explore precipitants to stressful experiences and how they cope during such times. Clinical experience will be woven into the research findings to create a richer portrait of student needs. This discussion will inform outreach and clinical change strategies to provide a more supportive and inclusive environment on college campuses.</p> <hd id="AN0121963527-7">Method</hd> <p></p> <hd id="AN0121963527-8">Participants</hd> <p>In order to better understand how college students cope with stress, The National Research Consortium of Counseling Centers in Higher Education distributed an electronic survey to a random selection of 100,493 college students across 73 participating institutions. Students completed the 79-item survey in the Spring of 2011 and responses were collected anonymously. Institutional Review Boards at The University of Texas at Austin, the location of the Director of the Research Consortium, as well as those at all participating institutions approved the study.</p> <p>Surveys were distributed in a stratified manner according to the size of the institution: 1,000 students were randomly selected for contact from colleges and universities with 5,000 or more undergraduates; a random selection of 500 students received surveys at academic institutions with 500 to 4,999 students; and each student was contacted at colleges with fewer than 500 students. This approach was employed to draw as representative of a sample as possible by having similar numbers of respondents at each university and also allowing for additional respondents at larger schools. The same strategy was used to contact graduate students.</p> <p>The survey yielded 26,292 respondents, a 26% response rate, comprised of 13,961 undergraduates, 12,080 graduate students, 178 nondegree seeking students, and 73 who reported themselves to be unclassified.</p> <hd id="AN0121963527-9">Sample size</hd> <p>Subjects were grouped during analysis by their self-reported gender identification. They were first asked, "How do you identify?" with response options including: Female, Male, Transgender. Participants were then asked, "How would you describe your sexual orientation?" with response options including: bisexual, gay or lesbian, heterosexual, questioning, other. Participants were then placed into one of three groups: students who identified as transgender, students who identified as cisgender and LGBQ, and students who identified as cisgender and heterosexual. The transgender group was composed of 47 students (0.2%). Students who identified as cisgender and LGBQ (n = 1,759) comprised 6.8% of the total sample, while students who identified as cisgender and heterosexual (n = 23,987) comprised 93.0% of the total sample. These reported identities appear similar to other large national surveys of college students conducted in the same year, such as the ACHA-NCHA ([<reflink idref="bib2" id="ref48">2</reflink>]) survey of 105,781 college students that found 0.2% of students responding to the survey identified as transgender, 8.4% as GLBQ and 91.7% as heterosexual. Subjects who did not provide information regarding gender or sexual identity were excluded from the study.</p> <hd id="AN0121963527-10">Measures</hd> <p>The survey items were generated and reviewed by researchers in college student coping and stress. They were then subsequently analyzed by a delegate from each college or university at which the survey was distributed. The variables examined in this study are gender identity and sexual orientation, trauma history, precipitants to their stressful period, access to mental health services, as well as suicidality. During the spring of 2011, participants were first asked to respond to how they function at their day-to-day baseline levels. To explore how students' coping shifted from baseline to times of stress, they were then asked to think about the most stressful period over the last year and respond to how they experienced and coped with the stress they encountered through the prompt:</p> <p>Please reflect on the most stressful period of time that you have experienced in the past 12 months, including the present day. While it may be difficult to choose just one time, please think back on your experiences over the past 12 months and identify a single period when you were most upset, distressed or overwhelmed.</p> <p>To assess for a history of trauma, participants were asked, "in your lifetime, have you been a victim of abuse or violence (e.g., sexual abuse, physical abuse, emotional abuse, assault)?" Response options were "<emph>yes</emph>" and "<emph>no</emph>." To examine the prevalence of suicidal ideation and attempts, participants were asked to respond to questions related to their suicidal experiences. Lifetime history was assessed through asking, "have you ever seriously considered attempting suicide at some point in your life?" (responses of "<emph>yes</emph>" and "<emph>no</emph>") and "how many times in your life have you attempted suicide?" (responses of "<emph>0</emph>" were recoded as "<emph>no</emph>," and "<emph>1</emph>" or more were recoded as "yes"). Recent history of suicidal experiences were measured through asking, "during this stressful period, did you seriously consider attempting suicide?" and "during the stressful period, did you attempt suicide?" Response options were "<emph>yes</emph>" and "<emph>no</emph>" for these questions, as well. Participants were asked to select stressors that contributed to their stressful period by responding to the prompt: "Of the following categories, which best describes the contributors to this stressful period (select all that apply)." See Table 1 for the list of stressors. Respondents were asked to respond to the question: "from which of the following have you ever received counseling or mental health services (select all that apply)." See Figure 2 for the list of sources.</p> <hd id="AN0121963527-11">Results</hd> <p></p> <hd id="AN0121963527-12">Racial identity and sexual orientation</hd> <p>More than half of the transgender student participants (53%) identified as Caucasian, 28% as multiracial, 0% as African American or Black, 9% as Asian or Asian American, 4% as Hispanic or Latino/a, 2% identified as Middle Eastern or East Indian, 2% as Native American or Alaskan, and 2% as "other." Among cisgender respondents, 70% identified as Caucasian, 5% identified with more one race/ethnicity, 4% as African American or Black; 10% as Asian or Asian American, 6% as Hispanic or Latino/a, 2% as Middle Eastern or East Indian, less than 1% as Native American or Alaskan, and 2% as "other." Regarding sexual orientation, 28% of transgender students identified as heterosexual, with the remainder identifying as bisexual (15%), gay or lesbian (15%), questioning (9%), and "other" (33%). LGBQ students self-identified as bisexual (49%), gay or lesbian (36%), questioning (14%), and "other" (0%).</p> <hd id="AN0121963527-13">History of trauma</hd> <p>We performed a chi-square test to examine the prevalence of a trauma history in three different groupings of students based on gender identity and sexual orientation: cisgender and LGBQ, cisgender and heterosexual, and transgender. Cisgender and LGBQ students were separated from the cisgender and heterosexual students as LGBQ students have been shown to have an increased vulnerability to victimization as a result of their sexual minority status and/or gender nonconforming behavior (D'Augelli, Grossman, & Starks, [<reflink idref="bib15" id="ref49">15</reflink>]; Waldo, Hesson-McInnis, & D'Augelli, [<reflink idref="bib38" id="ref50">38</reflink>]). A chi-square analysis was selected because the gender identity variable constructed a categorical nominal variable, and trauma history is a dichotomous categorical variable. The assumptions of a chi-square test were met, as there were no cells with fewer than five observations and all observations were independent of one another.</p> <p>There was a significant association between gender and sexual identity and trauma history (χ<sups>2</sups>[<reflink idref="bib2" id="ref51">2</reflink>] = 291.19, <emph>p </emph>< .001) (see Figure 1) where all three groups were significantly different from one another, with transgender students reporting the highest rate of trauma history, followed by cisgender and LGBQ and then cisgender and heterosexual students.</p> <p>Graph: Figure 1. Percentage endorsing a lifetime history of trauma and suicidal experiences. LGBQ = lesbian, gay, bisexual, and questioning.</p> <hd id="AN0121963527-14">Suicidal ideation and attempts</hd> <p>A chi-square test comparing the prevalence of suicidal ideation and attempts found a significant association between the three groups for lifetime consideration, lifetime attempts, consideration during a stressful period, and attempts during a stressful period (χ<sups>2</sups>[<reflink idref="bib2" id="ref52">2</reflink>] = 710.34, 528.96, 269.46, and 117.22, respectively, <emph>p</emph> < .001 for all comparisions). Results show significant associations between the gender and sexual identity groups and each of the suicidal experiences investigated with transgender students consistently indicating the highest rates of suicidal experiences (see Figure 1).</p> <p>While the cisgender and LGBQ group indicated much higher frequency of suicide attempts and consideration than the cisgender and heterosexual group in both lifetime attempts and during a stressful period, the transgender group reported a greater incidence of suicidal history than both groups. The transgender group also indicated that they had seriously considered suicide in their lifetime at nearly three times the rate as the cisgender heterosexual group (55% transgender, 44% cisgender and LGBQ, 19% cisgender and heterosexual); nearly seven times with regard to having attempted in their lifetime (34% transgender, 18% cisgender and LGBQ, 5% cisgender and heterosexual); six times when asked about seriously considering suicide during a stressful period (24% transgender, 12% cisgender and LGBQ, 4% cisgender and heterosexual); and seven times with respect to attempting suicide during a stressful period (4.3% transgender, 2.8% cisgender and LGBQ, 0.6% cisgender and heterosexual).</p> <hd id="AN0121963527-15">Precipitants to the stressful period</hd> <p>A chi-square analysis of 20 identified possible individual stressors was run to examine which different life stressors impact the three student populations (see Table 1). "Academics" was identified as the greatest stressor for transgender college students, endorsed by 72%, which compared similarly to the hetero and LGBQ groups as a primary contributor to stress (73% and 73%, respectively). The next greatest identified stressor among the transgender student group was "Gender Identity Concerns" (53%), which presented a greater area of concern compared to the LGBQ (4%) and heterosexual (0.2%) groups. As well, the transgender group reported a higher prevalence of "Emotional Health Problems" (43%) than the LGBQ (25%) and heterosexual (14%) groups.</p> <p>Table 1. Identified Contributors to the Stressful Period in Transgender, LGBQ Cisgender, and Heterosexual Cisgender College Students.</p> <p> <ephtml> <table><thead><tr><td /><td>Transgender</td><td>Cisgender LGBQ</td><td>Cisgender Heterosexual</td><td>χ<sup>2</sup></td><td><italic>p</italic></td></tr></thead><tbody><tr><td>Academics</td><td>72% (0.0)</td><td>73% (0.2)</td><td>73% (0.0)</td><td>0.11</td><td>.946</td></tr><tr><td>Gender identity concerns</td><td>53% (48.6)</td><td>4% (21.6)</td><td>0.2% (−8.0)</td><td>2913.85</td><td><.001</td></tr><tr><td>Emotional health problems</td><td>43% (4.9)</td><td>25% (11.0)</td><td>14% (−3.2)</td><td>183.84</td><td><.001</td></tr><tr><td>Financial Pproblems</td><td>38% (0.9)</td><td>35% (3.2)</td><td>30% (−0.9)</td><td>17.64</td><td><.001</td></tr><tr><td>Life transition</td><td>34% (0.9)</td><td>29% (1.6)</td><td>27% (−0.5)</td><td>4.83</td><td>.090</td></tr><tr><td>Family problems</td><td>32% (1.8)</td><td>26% (4.8)</td><td>20% (−1.4)</td><td>35.70</td><td><.001</td></tr><tr><td>Friendship problems</td><td>28% (1.5)</td><td>24% (5.0)</td><td>18% (−1.4)</td><td>35.70</td><td><.001</td></tr><tr><td>Physical health problems</td><td>23% (2.1)</td><td>16% (4.5)</td><td>12% (−1.3)</td><td>29.95</td><td><.001</td></tr><tr><td>Discrimination</td><td>23% (8.9)</td><td>7% (10.3)</td><td>2% (−3.2)</td><td>198.66</td><td><.001</td></tr><tr><td>Sexual orientation concerns</td><td>23% (12.5)</td><td>17% (53.6)</td><td>0.30% (−15.1)</td><td>3299.46</td><td><.001</td></tr><tr><td>Romantic relationship problems</td><td>19% (−1.1)</td><td>31% (3.0)</td><td>27% (−0.8)</td><td>15.16</td><td>.001</td></tr><tr><td>Problems at work</td><td>15% (0.4)</td><td>13% (0.2)</td><td>13% (−0.1)</td><td>0.26</td><td>.879</td></tr><tr><td>Death of a close family member or friend (excluding suicide)</td><td>13% (1.0)</td><td>10% (2.0)</td><td>8% (−0.6)</td><td>5.83</td><td>.054</td></tr><tr><td>Drugs or alcohol</td><td>13% (3.3)</td><td>7% (8.3)</td><td>3% (−2.4)</td><td>88.85</td><td><.001</td></tr><tr><td>Problems of a close person</td><td>11% (0.3)</td><td>12% (3.2)</td><td>9% (−0.9)</td><td>12.43</td><td>.002</td></tr><tr><td>Suicide of a close family member or friend</td><td>9% (4.9)</td><td>2% (2.8)</td><td>1% (−1.0)</td><td>33.51</td><td><.001</td></tr><tr><td>Other traumatic experience</td><td>6% (1.8)</td><td>3% (1.7)</td><td>2% (−0.5)</td><td>6.63</td><td>0.36</td></tr><tr><td>Legal trouble</td><td>4% (1.1)</td><td>3% (2.5)</td><td>2% (−0.7)</td><td>8.19</td><td>.017</td></tr><tr><td>Relationship violence</td><td>4% (2.0)</td><td>3% (5.4)</td><td>1% (−1.6)</td><td>36.00</td><td><.001</td></tr><tr><td>Sexual assault</td><td>2% (0.9)</td><td>2% (5.4)</td><td>1% (−1.5)</td><td>33.00</td><td><.001</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. Numbers in parenthesis represent standardized residuals. LGBQ = lesbian, gay, bisexual, and questioning.</p> <p>Overall, the transgender group identified 10 total stressors, where at least 20% of the population attributed the stressors to leading to their most stressful period, compared to 7 and 5 total stressors for the LGBQ and heterosexual students, respectively. In addition to those previously mentioned, the stressors endorsed by at least 20% of the groups included "Financial Problems" (transgender 38%, LGBQ 35%, heterosexual 30%); "Life Transition" (transgender 34%, LGBQ 29%, heterosexual 27%); "Family Problems" (transgender 32%, LGBQ 26%, heterosexual 20%); "Friendship Problems" (transgender 28%, LGBQ 24%); "Physical Health Problems" (transgender 23%); "Discrimination" (transgender 23%); and "Sexual Orientation Concerns" (transgender 23%). It is interesting to note that the LGBQ and heterosexual groups identified "Romantic Relationship Problems" as a stressor occurring in at least 20% of their populations (LGBQ 31%, hetero 27%), while only 19% of the transgender population identified this as a contributor of stress. Also of note is the finding that a considerably greater percentage of transgender students reported that a precipitant to their stressful period was the suicide of a close family member or friend (transgender 9%, LGBQ 2%, heterosexual 1%).</p> <hd id="AN0121963527-16">Help-seeking of transgender college students</hd> <p>A chi-square analysis examined the differences between the three groups of students on the sources of their professional help-seeking for counseling or mental health services over their lifetime (see Figure 2). Transgender students were significantly more likely than heterosexual/cisgender and LGBQ/cisgender students to seek help from counselors (χ<sups>2</sups>[<reflink idref="bib2" id="ref53">2</reflink>] = 318.29, <emph>p</emph> < .001), psychiatrists (χ<sups>2</sups>[<reflink idref="bib2" id="ref54">2</reflink>] = 307.14, <emph>p</emph> < .001), other medical providers (χ<sups>2</sups> [<reflink idref="bib2" id="ref55">2</reflink>] = 63.83, <emph>p</emph> < .001), and alternative medical providers (χ<sups>2</sups>[<reflink idref="bib2" id="ref56">2</reflink>] = 57.18, <emph>p</emph> < .001). Additionally, transgender college students were more likely to seek services from their university counseling center (χ<sups>2</sups>[<reflink idref="bib2" id="ref57">2</reflink>] = 231.40, <emph>p</emph> < .001).</p> <p>Graph: Figure 2. Lifetime prevalence of seeking help from professional resources. LGBQ = lesbian, gay, bisexual, and questioning.</p> <p>When asked about the sources of help students sought when dealing with their recent stressful period, the most common answer among transgender college students was that they turned to informal sources of support such as family and friends. They did so, however, at lower rates than other students. Transgender college students were significantly less likely than other students to seek help from a family member (χ<sups>2</sups>[<reflink idref="bib2" id="ref58">2</reflink>] = 59.37, <emph>p</emph> < .001), romantic partner (χ<sups>2</sups>[<reflink idref="bib2" id="ref59">2</reflink>] = 31.75, <emph>p</emph> < .001), and/or friend, peer, or roommate (χ<sups>2</sups>[<reflink idref="bib2" id="ref60">2</reflink>] = 9.01, <emph>p</emph> < .05). Conversely, transgender college students were significantly more likely than other students to reach out to an academic advisor (χ<sups>2</sups>[<reflink idref="bib2" id="ref61">2</reflink>] = 12.07, <emph>p</emph> < .01), clergy (χ<sups>2</sups>[<reflink idref="bib2" id="ref62">2</reflink>] = 8.9, <emph>p</emph> = .012), instructor (χ<sups>2</sups>[<reflink idref="bib2" id="ref63">2</reflink>] = 18.93, <emph>p</emph> < .001), medical provider (χ<sups>2</sups>[<reflink idref="bib2" id="ref64">2</reflink>] = 10.79, <emph>p</emph> = .005), psychiatrist (χ<sups>2</sups>[<reflink idref="bib2" id="ref65">2</reflink>] = 135.84, <emph>p</emph> < .001), and/or a psychologist, counsellor, or social worker (χ<sups>2</sups>[<reflink idref="bib2" id="ref66">2</reflink>] = 162.89, <emph>p</emph> < .001) (see Figure 3).</p> <p>Graph: Figure 3. Prevalence of sources of help-seeking during their stressful period. LGBQ = lesbian, gay, bisexual, and questioning.</p> <hd id="AN0121963527-17">Discussion</hd> <p></p> <hd id="AN0121963527-18">Gender, sexual, and racial/ethnic identity</hd> <p>A transgender student exists outside of the traditional gender binary. However, an individual who is a gender identity minority may not necessarily identify as a member of a sexual minority. For instance, nearly a third of the transgender students surveyed identified as heterosexual. Transgender students also appeared more fluid in their endorsement of sexual orientation than other students, with 32% indicating "other" as a sexual orientation category, 28% identifying as heterosexual, and 39% identifying as bisexual, gay, lesbian, or questioning as compared to 93% of the cisgender sample identifying as heterosexual. Thus, the social, romantic, and political concerns of a transgender student may not always align with those of the LGBQ community at large, particularly for those transgender students identifying as heterosexual.</p> <p>Transgender students also appear to self-identify as more racially diverse than their cisgender peers, as 28% of trans students in this study identified with more than one race/ethnicity as compared to 5% among cisgender students. These findings suggest that this sample of transgender students was somewhat more diverse than a sample of 91 transgender college students reported on by Dugan and colleagues ([<reflink idref="bib19" id="ref67">19</reflink>]), but as so few studies of this population exist, it is difficult to conclude whether this sample reflects the racial/ethnic make-up of the transgender population at large. Despite the fact that these results appeared to support our hypothesis that transgender students identify with greater multiple intersecting identities as compared to their cisgender peers, further research is needed.</p> <p>Their endorsement of multiple racial/ethnic identities as well as their range of sexual identities may indicate a mutability in their sense of identity that, while socially progressive and potentially protective at times (see, Hayes, Chun-Kennedy, Edens, & Locke, [<reflink idref="bib22" id="ref68">22</reflink>]), also comes with challenges as students cope with multiple minority stressors. Students in the process of transitioning must learn to manage their multiple identities in the shifting context of intersections between identities (i.e., gender, race, sexuality) and against a backdrop of cultural expectations (de Vries, [<reflink idref="bib16" id="ref69">16</reflink>]). People draw upon cultural narratives regarding their identities as they interact with others and as they develop their self-concept. For clinicians working with transgender students, this suggests a complicated process of helping students learn to understand themselves in the context of cultural narratives and internal attributions related to their individual identities as well as the intersection of those identities (de Vries, [<reflink idref="bib16" id="ref70">16</reflink>]).</p> <p>Based on the prevalence of trauma, suicidal experiences and multiple sources of minority stress among transgender students, they may exhibit higher potential for encountering multiple sources of stigma, which may present additional complexity in working with transgender students. Also, since transgender students identify with minority characteristics in multiple domains, they may experience feelings of not belonging to social groups, which may in turn contribute to exacerbated distress or suicidal ideation (see Joiner, [<reflink idref="bib25" id="ref71">25</reflink>] for a discussion of the impact of thwarted belongingness on suicidal experiences).</p> <hd id="AN0121963527-19">Trauma history</hd> <p>The hypothesis that transgender college students have experienced trauma at a higher rate than cisgender college students was supported by the data. A chi-square analysis revealed that transgender college students have survived a significantly greater rate of trauma than LGBQ cisgender and heterosexual cisgender students. The prevalence of a trauma history was also significantly greater in LGBQ college students as compared to heterosexual students. While the difference between trauma incidence in LGBQ cisgender and transgender college students was significant, both showed rates of trauma prevalence that were far greater than that of heterosexual cisgender college students: A history of trauma was reported among 57% of transgender students, 42% of LGBQ cisgender students, and 23% of heterosexual cisgender students. This suggests that gender minorities may share a vulnerability to victimization with sexual identity minorities. However, the threat of violence, victimization, and harassment posed to members of a gender identity minority group appears to be even greater than that faced by individuals who identify as sexual identity minorities. Based on these findings, trauma informed care may often be necessary when working with transgender college students given the increased likelihood of a trauma history.</p> <hd id="AN0121963527-20">Precipitants to distress</hd> <p>Consistent with our hypothesis, the transgender students identified different stressors compared to the cisgender LGBQ and cisgender heterosexual groups. While transgender students endorsed some of the same stressors as their cisgender peers that seem typical of college students, such as academics, life transition, and financial problems, they also reported more stressors that appear related to their special circumstances. For instance, they noted as precipitants to their most stressful period issues such as gender identity concerns, physical health problems, discrimination, and sexual orientation concerns. Within the cisgender LGBQ and heterosexual cisgender groups, Romantic Relationship Problems were identified as a stressor at rates of 31% for cisgender LGBQ and 27% for cisgender heterosexual, while the transgender group indicated it as a stressor at a lesser prevalence of 19%. The relatively lower endorsement of romantic relationship problems by transgender students may be indicative of a lack of romantic relationships or different ideas and expectations regarding what romantic relationships can be for them, especially during a period of gender transition, rather than the absence of a problem within romantic relationships. These additional and differential stressors likely impact transgender students' ability to cope and may limit their ability to find peers who can relate to their unique circumstances. A greater understanding of these particular concerns can inform campus outreach and prevention efforts.</p> <p>While universities may aspire to welcome transgender students to their campus, the ability of these students to thrive on campus may be inhibited by a campus ecology and culture that either allows for the presence of stressors, such as a culture of discrimination and unequal treatment, or fails to provide adequate resources to help students cope with their stressors. Universities may help reduce these sources of stress for transgender students by promoting a culture of inclusion, recognizing the unique needs of these students to facilitate their transition to adulthood, as well as with their gender identity, and providing resources to help them meet their physical and mental health needs. For instance, university counseling centers could offer a transgender therapy group, such as one offered at the Appalachian State University Counseling Center (Appalachian State University, Counseling and Psychological Services, [<reflink idref="bib3" id="ref72">3</reflink>]), to help students find support among professionals and peers as they navigate their transitions. Such a group could offer social supports, tools to improve communication skills and problem solving, and psychoeducation to facilitate their development.</p> <hd id="AN0121963527-21">Suicidal experiences</hd> <p>In addition to a more extensive trauma history and increased stressors, the transgender group also reported a higher prevalence of suicidal thoughts and attempts across their lifetime and during the stressful period than the cisgender LGBQ and heterosexual cisgender groups. Alarmingly, the transgender group endorsed almost three times as frequently that they had seriously considered suicide over their lifetime and nearly six times as often that they had seriously considered suicide during the recent stressful period as compared to the heterosexual cisgender group. With respect to lifetime attempts, the transgender group endorsed almost seven times more often than their heterosexual peers to have attempted, and nearly twice as often as the LGBQ group. Similarly, during a stressful period, transgender students endorsed attempting suicide at over seven times the rate of their heterosexual peers and at one and a half times the rate of the LGBQ group.</p> <p>While prior research has shown that LGBTQ students report suicidal experiences at higher rates than heterosexual students (Liu & Mustanski, [<reflink idref="bib26" id="ref73">26</reflink>]; Savin-Williams, [<reflink idref="bib35" id="ref74">35</reflink>]), these findings highlight that transgender students report these experiences well in excess of their LGBQ peers. These findings should alert campuses to the high levels of distress experienced by many transgender students. In fact, the level of suicidal distress reported by transgender students in this study far exceeds those of other groups traditionally considered high-risk groups. For example, in a national study of over 25,000 college students Brownson, Swanbrow Becker, Shadick, Jaggars, and Nitkin-Kaner ([<reflink idref="bib11" id="ref75">11</reflink>]) found that among those students identifying as Alaska Native or American Indian, traditionally considered groups with high rates of suicidal experiences, 13% endorsed seriously considering suicide over the past year, 27% endorsed seriously considering suicide in their lifetime, and 17% attempted suicide in their lifetime. These figures are roughly one-half the rates of those reported by the current sample of transgender students where 24% seriously considered suicide during their most stressful time over the past year, 55% seriously considered suicide in their lifetime, and 34% attempted suicide during their lifetime. These results illuminate the vulnerabilities transgender students may present with on college campuses and may be related to the increased amount of stressors they encounter and lack of traditional sources of support to cope.</p> <hd id="AN0121963527-22">Support seeking</hd> <p>The results from this study begin to elucidate several factors related to the help-seeking patterns of transgender college students and how they may differ from heterosexual cisgender and LGBQ cisgender students. First, results from this study found that transgender college students are more likely than heterosexual and LGBQ cisgender students to seek help from professionals such as counselors and medical providers over their lifetime. Additionally, despite the findings of Wright and McKinley ([<reflink idref="bib39" id="ref76">39</reflink>]) indicating low rates of communication and the potential for low visibility regarding LGBT counseling services on campus, transgender students are more likely to seek these professional services from their university counseling center than cisgender students. Still, when transgender college students faced their most stressful times, they tend to turn to informal sources of support, such as family, friends, or romantic partners more often than professionals in helping positions. While family and peers serve as a primary source of support for transgender students during times of stress, they seek help from these sources at lower rates, yet turn to professional sources more frequently, when compared to their cisgender peers. This indicates that the social support network available to transgender students may be more limited than those of other students. This limitation may be derived from a relative lack of friends, peers, and family members who are connected to and can empathize with the transgender student. A fear of discrimination and expectation of rejection may also inhibit the individual from reaching out (Meyer, [<reflink idref="bib29" id="ref77">29</reflink>]).</p> <p>These findings emphasize the importance of mental health providers to pursue and maintain clinical competence in working with transgender individuals. Transgender students may seek help from professionals at proportionally higher rates than do cisgender students, as professionals may be less likely to make condemning comments or judgments about the student's gender identity. Further, medical providers and counselors are gatekeepers to the treatments often sought by transgender people. In addition, transgender students may not turn to romantic partners as they appear less likely to be in romantic relationships than their peers. They also may not find as much support from friends and/or family members because of isolation, stigma, or past rejection from these groups due to their gender identity. Thus, mental health care providers may be one of few sources of help the student has to turn to. Mental health providers who acquire training and supervision from those experienced in working with transgender individuals will be more prepared to be an effective source of help.</p> <p>In order to reach out to the broader campus community, university counseling centers may collaborate with campus LGBTQ+ centers or develop their own outreach programming, including those addressing social justice issues, adapting the environment to better meet their needs, and encouraging social supports in order to make the campus environment more inviting to transgender students. In providing outreach, counseling centers may inform students of the available resources offered on campus and through the counseling center, such as individual therapy and group therapy, which may relate specifically to transgender topics.</p> <hd id="AN0121963527-23">Insight from individual and group counseling</hd> <p>Transgender students often negotiate multiple identities and can have difficulty fitting into established social groups. As such, their access to helping resources may be limited. College counseling centers can be very effective in helping students navigate issues surrounding transitions and identity development. This task is, however, complicated with transgender students, as counseling center staff find themselves supporting students seeking to transform their sense of who they are, their physical bodies, and their established peer groups. In addition, transgender students often experience significant resistance to their transition from their family of origin and friends. Such resistance can leave transgender students feeling alone when facing the seemingly high obstacles to finding peace in who they are.</p> <p>Integration of research and practice highlights the importance of social connection for managing stress. Two of the authors have experience facilitating a transgender therapy group through our university counseling center (see Appalachian State University Counseling and Psychological Services, [<reflink idref="bib3" id="ref78">3</reflink>] for a description of the group) and have found it to be a much needed social support, safe environment for coming out to others, a forum to provide information about transitioning, and a setting in which to help provide structure for students. We have a relatively high proportion of transgender students attending our university and created a unique counseling group focusing specifically on their needs and providing a safe space for them to explore their identity and receive support in their transition. Feedback provided by students in our therapy groups reinforce the study findings that they often experience a deep sense of isolation on campus and in their personal lives. In particular, trans students we have worked with often complain that they do not find their campus LBGTQ+ center a safe or supportive place for them as they see their needs as different than LGBQ students and often feel discriminated against. In addition, these research results and clinical material highlight the importance of building of a community among transgender students and ways to help them connect with the broader campus. The results pointing to increased suicidality and distress among transgender students but fewer social supports also informs the need to create a more supportive and inclusive environment for transgender students on campus to reduce their exposure to trauma and discrimination while increasing their connection to the community.</p> <hd id="AN0121963527-24">Limitations</hd> <p>A limitation of this study was that the question posed regarding the presence of trauma history requested a "yes" or "no" answer in order to indicate its presence or absence, preventing us from understanding the source and extent of the traumatic experiences. Further questions clarifying the type of trauma experienced (e.g., sexual, physical, or emotional) as well as whether that trauma was associated with gender- or sexual-orientation-based violence would have offered a more detailed view as to the nature of challenges faced by this population and the impact of different sources of trauma on individuals.</p> <p>Another limitation of this study is that issues pertinent to LGBTQ students, such as the prevalence of discrimination based on sexual and gender identity minority status, internalized transphobia and homophobia, "outness," and stage of transition were not explored. Also unknown was the stage of transition that each transgender identified student was going through. Additionally, although the survey received a respectable response rate, information regarding those who did not respond is unknown. There were likely transgender college students who chose not to participate in the study. The demographic factors of these students and how they differed from those who responded would have added to awareness as to how to sensitively pose questions that would have yielded useful data. Students may have failed to identify as transgender, as the gender identity categories of male, female, or transgender may have been too limiting for some and did not adequately describe their gender identity. For example, a student may identify as bigender or genderqueer, but those options were not offered.</p> <p>The 47 transgender students that responded hailed from 30 different colleges and universities. Similar numbers of transgender students had been found by Dugan and colleagues ([<reflink idref="bib19" id="ref79">19</reflink>], p. 91) transgender-identified students at 101 colleges and universities as well as by Effrig and colleagues ([<reflink idref="bib20" id="ref80">20</reflink>], p. 29) transgender students at 66 postsecondary educational institutions. Nonetheless, the small sample size of transgender students (<emph>n</emph> = 47) was a limitation of this study and is a threat to generalizability. Additionally, as there is a lack of literature on this subject, it is impossible to know if our sample was representative of the demographic makeup of transgender students at large. However, studies of transgender subpopulations are generally conducted on convenience or snowball samples. Thus, the fact that this subsample was drawn from a stratified, random sample of college students improves the internal validity of this study and creates an important addition to the extant literature.</p> <p>Despite the fact that this project focused on a randomly selected sample of college students, the lack of African American identified transgender students points to conclusions extrapolated from this data set as not being entirely generalizable to different racial and ethnic subgroups. Until recently, the body of literature focused on LGBTQ people of Color has been thin (Huang et al., [<reflink idref="bib23" id="ref81">23</reflink>]). Thus, continued work in the area of accessing the voices of young transgender adults of Color is still needed.</p> <hd id="AN0121963527-25">Implication and future directions</hd> <p>The results of this study inform areas where transgender students may need more support and ways to make resources more accessible to them. Given that the intersectionality between multiple minority identities is critical to understanding the whole lived experience of a transgender college student, further research is needed into the impact of race, sexual orientation, and gender identity on the prevalence of trauma history and other risk factors. This project serves as a foundation for creating understanding of the current needs and help-seeking patterns of transgender college students. A future study in which transgender students were asked to specify the resources which are currently absent and would be most beneficial to creating a supportive campus environment would help campus administrators, educators, students, and activists to create physical and social scaffolding for transgender college students.</p> <p>The knowledge of risk factors, precipitants to distress, suicidal experiences, supports, and help-seeking patterns within the transgender college student population gained in this study can be used by mental health practitioners to determine best clinical practices and develop interventions. Campuses should focus outreach and prevention efforts to reduce stressors for transgender students, for example, through reducing discrimination, and also to encourage broader help seeking by adjusting the culture as well as physical facilities to make campuses more inclusive and accepting. These results highlight the need for counseling center staff to conduct thorough suicide risk assessment with transgender clients and provide interventions that are sensitive to a high potential for trauma history. College counseling centers should further consider providing specialized group counseling experiences for transgender students to enhance their social supports. Group counseling would also provide access to professional help to facilitate their transitions to adulthood and to their new identities.</p> <hd id="AN0121963527-26">Funding</hd> <p>We wish to thank the Research Consortium of Counseling Centers in Higher Education for their support of this research.</p> <ref id="AN0121963527-27"> <title> References </title> <blist> <bibl id="bib1" idref="ref33" type="bt">1</bibl> <bibtext> Acevedo-Polakovich, I. D., Bell, B., Gamache, P., & Christian, A. S. (2011). Service accessibility for lesbian, gay, bisexual, transgender, and questioning youth. 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  Data: Supporting Transgender College Students: Implications for Clinical Intervention and Campus Prevention
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  Data: <searchLink fieldCode="AR" term="%22Swanbrow+Becker%2C+Martin+A%2E%22">Swanbrow Becker, Martin A.</searchLink><br /><searchLink fieldCode="AR" term="%22Nemeth+Roberts%2C+Stacey+F%2E%22">Nemeth Roberts, Stacey F.</searchLink><br /><searchLink fieldCode="AR" term="%22Ritts%2C+Sam+M%2E%22">Ritts, Sam M.</searchLink><br /><searchLink fieldCode="AR" term="%22Branagan%2C+William+Tyler%22">Branagan, William Tyler</searchLink><br /><searchLink fieldCode="AR" term="%22Warner%2C+Alia+R%2E%22">Warner, Alia R.</searchLink><br /><searchLink fieldCode="AR" term="%22Clark%2C+Sheri+L%2E%22">Clark, Sheri L.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+College+Student+Psychotherapy%22"><i>Journal of College Student Psychotherapy</i></searchLink>. 2017 31(2):155-176.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 22
– Name: DatePubCY
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  Data: 2017
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Graduate+Students%22">Graduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Identity%22">Sexual Identity</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Experience%22">Student Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Coping%22">Coping</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+Analysis%22">Comparative Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Surveys%22">Student Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Online+Surveys%22">Online Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Trauma%22">Trauma</searchLink><br /><searchLink fieldCode="DE" term="%22Suicide%22">Suicide</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Counseling%22">Individual Counseling</searchLink><br /><searchLink fieldCode="DE" term="%22Group+Counseling%22">Group Counseling</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+Identification%22">Racial Identification</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Orientation%22">Sexual Orientation</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+Analysis%22">Statistical Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Help+Seeking%22">Help Seeking</searchLink>
– Name: DOI
  Label: DOI
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  Data: 10.1080/87568225.2016.1253441
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 8756-8225
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study examines the experiences of transgender college students in coping with stress in comparison to their cisgender peers. Undergraduate and graduate students from 73 colleges, totaling 26,292 participants, of which 47 identified as transgender completed an online survey. Transgender students reported greater exposure to trauma and higher rates of suicidal experiences, as well as different precipitants to reported stressful periods and sources of support than their cisgender peers. Implications for individual and group counseling as well as outreach and prevention to better support transgender students are explored.
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  Data: 2017
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  Label: Accession Number
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  Data: EJ1134273
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        Value: 10.1080/87568225.2016.1253441
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 22
        StartPage: 155
    Subjects:
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Graduate Students
        Type: general
      – SubjectFull: Sexual Identity
        Type: general
      – SubjectFull: Student Experience
        Type: general
      – SubjectFull: Coping
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      – SubjectFull: Comparative Analysis
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      – SubjectFull: Student Surveys
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      – SubjectFull: Online Surveys
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      – SubjectFull: Trauma
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      – SubjectFull: Suicide
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      – SubjectFull: Individual Counseling
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      – SubjectFull: Intervention
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      – SubjectFull: Help Seeking
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      – TitleFull: Supporting Transgender College Students: Implications for Clinical Intervention and Campus Prevention
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