HEALTH
127
American Journal of Public Health, 104(11), 2191, 2198;
Bockting, W. O., Miner, M. H., Swinburne Romine, R. E.,
Hamilton, A., & Coleman, E. (2013). Stigma, mental health,
and resilience in an online sample of the US transgender
population. American Journal of Public Health, 103(5), 943–
951; Institute of Medicine. (2011). The Health of Lesbian, Gay,
Bisexual, and Transgender People: Building a Foundation for
Better Understanding. DC: National Academy of Sciences.
31 The general health rating among adults in the U.S. population
was calculated by the research team using data from
the Behavioral Risk Factor Surveillance System (BRFSS).
Centers for Disease Control and Prevention. (2015). BRFSS
Prevalence & Trends Data. Available at: http://www.cdc.gov/
brfss/brfssprevalence.
32 The Kessler Psychological Distress Scale, or K6, assesses
psychological distress based on how often in the past 30
days respondents felt: so sad that nothing could cheer them
up, nervous, restless or fidgety, hopeless, that everything
was an eort, or worthless. See Q. 12.2. See the National
Health Interview Survey for additional information about
the K6 mental health screening instrument and measure of
serious psychological distress in adults (available at: http://
www.healthindicators.gov/Indicators/Serious-psychological-
distress-adults-percent_50055/Profile).
33 The K6 scale rates how often feelings are experienced on
the following scale: (0) none of the time, (1) a little of the time,
(2) some of the time, (3) most of the time, and (4) all of the
time. See Q. 12.2. A total score of 13 or above across all six
measures indicates serious psychological distress.
34 Centers for Disease Prevention and Control. (2016). 2015
National Health Interview Survey: Sample Adult File.
Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/
Dataset_Documentation/NHIS/2015/samadult_freq.pdf.
35 See note 33 for an explanation of how “serious psychological
distress” is calculated based on the K6 scale.
36 Center for Behavioral Health Statistics and Quality.
(2016).Results from the 2015 National Survey on Drug Use
and Health: Detailed Tables.Table 8.86B.Rockville, MD:
Substance Abuse and Mental Health Services Administration.
Available at: http://www.samhsa.gov/data/sites/default/files/
NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-
DetTabs-2015.pdf.
37 Serious psychological distress is related to age and
educational attainment in the U.S. general population.
(see note 33; http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm6340a13.htm). Those who are younger
and have lower educational attainment have a higher
prevalence of serious psychological distress. When the
“supplemental weight” is applied to the USTS sample’s
prevalence of serious psychological distress to adjust the
sample to reflect the age and educational attainment of the
U.S. adult population, the prevalence is reduced to 30%,
six times the national prevalence for U.S. adults. Based on
studies using population-based samples of transgender
adults, it is estimated that the transgender population is
younger and has lower educational attainment than the U.S.
adult population. Flores, A. R., Brown, T. N. T., & Herman,
J. L. (2016). Race and Ethnicity of Adults who Identify as
Transgender in the United States. Los Angeles, CA: Williams
Institute; Conron, K. J., Scott, G., Stowell, G. S., & Landers, S.
J. (2012). Transgender health in Massachusetts: Results from
a household probability sample of adults. American Journal
of Public Health, 102(1), 118–122. Therefore, the finding of
39% for prevalence of serious psychological distress is
reported here using the standard weight only.
38 Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables.Table 8.86B.See note 36.
39 Results for respondents who were sexually assaulted here
reflect those who reported that they had “experienced
unwanted sexual contact (such as oral, genital, or anal
contact or penetration, forced fondling, rape)” in the past
year (see Q. 18.3).
40 Substance Abuse and Mental Health Services Administration.
(2015). Ending Conversion Therapy: Supporting and
Arming LGBTQ Youth. Available at: http://store.samhsa.gov/
shin/content//SMA15-4928/SMA15-4928.pdf.
41 Additionally, eleven percent (11%) of respondents in the
sample said they were sent to a therapist, counselor, or
religious advisor by immediate family members to stop them
from being transgender. See the “Sent to a Professional for
Being Transgender” section of the Family Life and Faith
Communities chapter for a discussion about respondents
who were sent to a professional by their family.
42 Although 0.4% of the overall sample reported that gender
transition was not for them, these respondents did identify
as transgender, meeting all criteria for inclusion in the survey
(see Q. 1.10–1.18).
43 Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014). Suicide
Attempts Among Transgender and Gender Non-Conforming
Adults. New York, NY & Los Angeles, CA; American
Foundation for Suicide Prevention & Williams Institute;
Moody, C. & Smith, N. G. (2013). Suicide protective factors
among trans adults. Archives of Sexual Behavior 42(5),
739–752; Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J.,
Herman, J. L., & Keisling, M. (2011). Injustice at Every Turn: A
Report of the National Transgender Discrimination Survey. (p.
82). DC: National Center for Transgender Equality & National
Gay and Lesbian Task Force.
44 Lipari, R., Piscopo, K., Kroutil, L. A., & Miller, G. K. (2015).
Suicidal Thoughts and Behaviors Among Adults: Results
from the 2014 National Survey on Drug Use and Health.
Rockville, MD: Substance Abuse and Mental Health Services
Administration.
45 Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa,
S., Hiripi, E., . . . Zheng, H. (2004). The US National
Comorbidity Survey Replication (NCS-R): design and field
procedures. International Journal of Methods in Psychiatric
Research, 13(2), 69–92.