Exposure to anti-trans rhetoric, policies, and violence: associations with mental health outcomes in Australian trans and gender diverse communities

Exposure to anti-trans rhetoric, policies, and violence: associations with mental health outcomes in Australian trans and gender diverse communities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exposure to anti-trans rhetoric, policies, and violence: associations with mental health outcomes in Australian trans and gender diverse communities Sav Zwickl, Sasha Bailey, Rin Chan, Joel Murray, Foster Skewis, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7152164/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Despite escalations in anti-trans rhetoric, policies, and violence against trans and gender diverse (trans) people globally, little research has examined associated mental health outcomes. Methods A cross-sectional online survey of trans people aged ≥ 16 years living in Australia through May 2024, assessed frequency of seven different exposures in the previous month; anti-trans rhetoric in news media, online, and by Australian politicians and high-profile individuals, online bullying and harassment, anti-trans rallies and police violence against trans people in Australia, and international anti-trans legislation and violence. Modified Poisson logistic regression models were used to analyze associations between multiple times weekly exposure for each exposure type and mental health (anxiety, GAD-7; depression, PHQ-9; and self-reported past 12-month self-harm and suicidality). Results Amongst 807 respondents (median age 33 years), exposure multiple times weekly to all seven exposure types, were associated with significantly increased risk of anxiety and depression (adjusted prevalence ratio (aPRs) ranging 1.15 to 3.46). Six of the exposures were associated with significantly increased risk of suicide planning (aPRs ranging 1.39 to 2.42), four were associated with significantly increased risk of suicide ideation (aPRs ranging 1.47–2.02), and five were associated with significantly increased risk of self-harm ideation and/or behaviors (aPRs ranging 1.22 to 1.97). Conclusions Australian trans communities experience frequent exposure to anti-trans rhetoric, policies, and violence, with higher rates of exposure associated with higher risk of multiple adverse mental health outcomes. Urgent, multi-pronged collaborative responses are required from governments, news media outlets, and social media platforms to combat anti-trans mis/disinformation and discrimination. Epidemiology Psychology Publishing/Media transgender gender diverse media violence discrimination mental health anti-trans disinformation transphobia INTRODUCTION In recent years, there has been a marked escalation in rhetoric, policies, and acts of violence that are anti-trans , which we define as prejudice, discrimination, and hostility towards trans individuals, often aiming to dehumanize, stigmatize, or marginalize trans and gender diverse (henceforth ‘trans’) people based on their gender identity. Anti-trans rhetoric can manifest in social, political, and legal opposition, ranging from harmful stereotypes to physical and sexual violence against trans people ( 1 ). Research shows that anti-trans rhetoric, policies, and violence are strongly correlated over time, in what has been termed a “trifecta of violence” ( 2 , 3 ). While trans people have long been pathologized, recent trends show that mis/disinformation now dominates public rhetoric about trans people and their healthcare ( 4 ). This surge in anti-trans mis/disinformation has spurred policies in the United States of America (USA), United Kingdom (UK), and more recently, Australia, that harm trans individuals by restricting access to essential healthcare, sports participation, single-sex spaces, and legal gender affirmation ( 5 – 7 ). For example, provision of gender-affirming care to trans people who desire it, including trans children and adolescents, is supported by many major medical organizations (e.g., 8, 9, 10), with consistent evidence of improvements in mental health and wellbeing, and very low rates of regret ( 5 – 7 ). However, mis/disinformation about gender-affirming care has dominated social and political discourse, culminating in a national ban on puberty blockers for trans children and adolescents outside of research in the UK (though not for cisgender children, as a treatment for precocious puberty) ( 11 , 12 ). The same mis/disinformation has been utilized in the USA, and the number of bills introduced nationally aimed at restricting the healthcare, education and legal recognition of trans people has increased from 143 of which 18 passed in 2021, 174 of which 26 passed in 2022, 604 of which 87 passed in 2023, and 650 of which of which 50 passed in 2024 ( 13 ). Over 850 bills were introduced nationally in the US, of which over 60 passed, during the first three months of 2025 ( 13 ). In Australia, there has also been a notable escalation in anti-trans rhetoric, policies, and violence across a similar timeframe, including the public, media and political rhetoric surrounding LGBTIQA + content in Australian school curriculums in 2016 ( 14 ), the Australian Marriage Law Postal Survey in 2017 ( 15 ), and several bills and motions proposed to the Australian Senate (e.g., 16, 17). A 2023 national Australian survey of over 3,000 people found that 80% reported a cumulative growth of anti-trans rhetoric and violence in Australia over time, including anti-trans rallies and several publicized incidents of police violence against trans people ( 18 ). Furthermore, in early 2025, the Queensland State Government implemented a state-wide ban on puberty blockers for gender affirmation in trans children despite an independent evaluation confirming practices were safe and evidence-based, and recommending further resource allocation ( 19 , 20 ). Despite the global rise in anti-trans rhetoric, policies, and violence, relatively few studies have examined the threat these pose to trans mental health. International research indicates that exposure to anti-trans rhetoric, policies, and violence, is associated with adverse mental health outcomes in both trans adolescents and adults ( 21 , 22 ). However, to our knowledge, no research has explored the impacts of exposure to anti-trans rhetoric, policies, and violence on the mental health of trans individuals in Australia. To address this dearth of research, in an Australian trans community sample aged 16 + years, this study aimed to explore 1) frequency of recent exposure to anti-trans rhetoric, policies, and violence, and 2) associations between regular (multiple times weekly in preceding month) exposure to anti-trans rhetoric, policies, and violence, with mental ill-health outcomes. It was hypothesized that 1) a high proportion of our sample would report recent, regular exposure to anti-trans rhetoric, policies, and violence, and 2) that regular exposure would be associated with higher likelihood of mental ill-health outcomes, namely clinically significant symptoms of anxiety and depression, past 12-month self-harm ideation and behavior, and past 12-month suicidal ideation, planning, and attempt/s. METHODS Data used in this paper were collected as part of TRANSform , a larger ongoing longitudinal study launched in May 2020, open to trans people aged 16 or older living in Australia. The vast majority of TRANSform participant recruitment occurs through social media, with recruitment posts shared widely by trans organisations and support groups within Australia. As part of TRANSform , participants first complete an enrolment survey where they provide basic demographic data and an email address, which is then used to contact them with invitations to complete sub-studies annually. One of these sub-studies was an online survey that contained questions about mental health and exposure to anti-trans rhetoric, policies, and violence, and was open to the TRANSform cohort between 1 May – 31 May 2024. Data from these questions are the focus of this paper. TRANSform is a trans-led research project, and as such, survey design was led by a group of trans researchers with support from cisgender clinicians and researchers experienced in trans health. REDCap electronic data capture tools hosted at The University of Melbourne were used for survey data collection and management. This study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards, and received ethical and governance approval by the Austin Health Human Research Ethics Committee (Reference Number HREC/57155/Austin-2019), ACON Research Ethics Review Committee (Reference Number 2020/03) and the Thorne Harbor Health Community Research Endorsement Panel (Reference Number THH/CREP 20 − 006). Demographic data collected from survey respondents included age, Aboriginal and/or Torres Strait Islander identity, country of birth, highest level of education, and employment status. Although we acknowledge that gender identity is complex and fluid, for the purposes of data analysis we asked respondents to select one of the following gender categories; man/trans man, woman/trans woman, non-binary or gender diverse (including agender) (herein referred to as non-binary ), or a culturally-specific gender identity not captured by other options (herein referred to as culturally-specific gender identity ). To assess recent exposure to anti-trans rhetoric, policies, and violence (herein collectively referred to as anti-trans exposures ), survey respondents were asked about how often in the previous month they had; 1) observed anti-trans rhetoric in the news media; 2) observed anti-trans rhetoric online; 3) personally experienced anti-trans bullying, harassment or threats online; 4) thought about or observed anti-trans rallies in Australia; 5) thought about or observed police violence against trans people in Australia; 6) thought about or observed anti-trans rhetoric by Australian politicians and high-profile people; and 7) thought about or observed international anti-trans legislation and violence. Fixed response options included never, a few times a month, a few times a week, once daily, multiple times daily. Survey respondents completed the Generalized Anxiety-7 (GAD-7), a screening tool for clinically significant symptoms of anxiety (herein referred to as anxiety ) in the preceding two weeks ( 23 ). GAD-7 is a self-reported 7-item scale, whereby respondents select the severity of seven anxiety symptoms, from “0” (not experienced) to “3” (experienced nearly every day). The sum of all seven responses provides a total score. GAD-7 scores of 5–9 represent mild, 10–14 moderate, and ≥ 15 severe anxiety symptoms. GAD-7 scores ≥ 10 are 89% sensitive and 82% specific for detecting Generalized Anxiety Disorder ( 23 ). Respondents also completed the Patient Health Questionaire-9 (PHQ-9) as a measure of clinically significant symptoms of depression (herein referred to as depression ) in the preceding two weeks ( 24 , 25 ). PHQ-9 is a self-reported 9-item scale, whereby respondents select the severity of nine depressive symptoms, from “0” (not experienced) to “3” (experienced nearly every day). The sum of all nine responses provides a total score. PHQ-9 scores of 5–9 represent mild, 10–14 moderate, 15–19 moderately severe, and ≥ 20 severe depressive symptoms. PHQ-9 scores ≥ 10 are 88% sensitive and 85% specific for detecting clinically significant major depression ( 26 ). To assess history of self-harm and suicidality in the preceding 12 months, respondents were asked whether they had thought about hurting themselves on purpose in any way ( self-harm ideation ), hurt themselves on purpose in some way ( self-harm ), seriously considered attempting suicide ( suicidal ideation ), made a plan about how they would attempt suicide ( suicide planning ), or actually attempted suicide ( suicide attempt ). Analyses Descriptive statistics were reported as frequency (percentage) for categorical variables, and median (interquartile range), or mean (standard deviation) as appropriate. To analyze mental health outcomes associations with anti-trans exposures, a series of modified Poisson regression models with robust standard errors were computed. These models and accompanying prevalence ratios were chosen over traditional logistic regression models which produce odds ratio, as often odds ratio effect estimates can overestimate the relationship where the outcome is frequently occurring ( 27 ). Moreover, prevalence ratios are significantly easier to interpret accurately compared with odds ratios ( 28 ). All models included age, gender (trans man, trans woman, and non-binary; with culturally-specific gender identity excluded due to small sample size), education level (secondary and non-university tertiary vs university), and current employment (yes vs no), as covariates. For sensitivity analyses, all generalized variance inflation factors (GVIF) for generated models were inspected to detect potential multicollinearity. A conservative approach was undertaken and GVIFs falling between 1 to 4 were deemed accepted. GVIFs outside this range would be deemed indicative of potential multicollinearity thus warranting further investigation into possible model convergence issues. All analyses were conducted in SPSS and RStudio v4.2.1. RESULTS Sample Demographics Of the 807 respondents, the median age was 33 years (IQR 26, 42), 286 (35.6%) were trans women, 242 (30.1%) were trans men, 271 (33.7%) were non-binary, and 5 (0.6%) had a culturally specific gender identity. A majority of respondents were born in Australia (n = 681, 84.4%), 658 (81.5%) lived in a metropolitan area, and 33 (4.1%) were Aboriginal and/or Torres Strait Islander. Attainment of a tertiary qualification (e.g., certificate, diploma, degree) was reported by 655 (81.4%), and unemployment was reported by 119 (14.9%) respondents (Table 1 ). Table 1 Sample Demographics Demographic Variable n (%) Age (years) (n = 807) 16–25 184 (22.8) 26–35 283 (35.1) 36–45 167 (20.7) 46–55 85 (10.5) 56–65 57 (7.1) 65+ 31 (3.8) Gender Identity (n = 804) Trans man 242 (30.1) Trans woman 286 (35.6) Non-binary or gender diverse 271 (33.7) Culturally-specific identity 5 (0.6) Aboriginal and/or Torres Strait Islander Identity (n = 807) Aboriginal 30 (3.7) Torres Strait Islander 0 (0.0) Aboriginal and Torres Strait Islander 3 (0.4) Non-Indigenous 764 (94.7) Unsure 5 (0.6) Prefer not to say 5 (0.6) Country of Birth (n = 807) Australia 681 (84.4) Aotearoa New Zealand 22 (2.7) Other 104 (12.9) Location of Residence (n = 800) Capital city 509 (63.6) Other metropolitan centre (population ≥ 100,000) 149 (18.6) Large rural centre (population 25,000–99,000) 70 (8.8) Small rural centre (population 10,000–24,999) 34 (4.3) Other rural area (population < 10,000) 15 (1.9) Remote centre (population ≥ 5,000) 3 (0.4) Other remote area (population < 5,000) 20 (2.5) Highest level of education (n = 805) Never attended school 1 (0.1) Primary or below 4 (0.5) Secondary or below 145 (18.0) Non-university tertiary (e.g. TAFE) 183 (22.7) University - undergraduate 275 (34.2) University - postgraduate 197 (24.5) Employment Status (n = 800) * Working – full-time 298 (37.3) Working – part-time 159 (19.9) Working - casual 120 (15.0) Unemployed 119 (14.9) Pension 90 (11.3) House duties 39 (4.9) Volunteer 51 (6.4) Retired 31 (3.9) Student - full time 94 (11.8) Student - part time 73 (9.1) *Respondents were allowed to select more than one response, so percentages may exceed 100. Exposure to anti-trans rhetoric, policies, and violence Of the seven exposure types, multiple times weekly exposure to anti-trans rhetoric online was the most common, reported by 575 (72.1%) respondents (Table 2 ). This was followed by exposure to international anti-trans legislation and violence, reported by 553 (68.9%) respondents, anti-trans rhetoric in the news media (n = 469, 58.2%), anti-trans rhetoric by Australian politicians and other high-profile individuals (n = 300, 37.6%), police violence against trans people in Australia (n = 104, 12.9%), and anti-trans rallies in Australia (n = 104, 12.9%). Personal experience of anti-trans online bullying, harassment, or threats, multiple times weekly, was reported by 64 (8%) respondents. Completely stopping or reducing engagement with news media in the previous 12 months to avoid or reduce exposure to anti-trans content, was reported by 108 (13.5%) and 484 (60.6%) respondents, respectively. Over half of participants (n = 469, 58.7%) reported recently reducing engagement with social media, with one in ten (n = 81, 10.1%) stopping engagement with social media altogether. Table 2 Frequency of exposure to anti-trans rhetoric, policies, and violence in previous month Variable n (%) How often have you seen or heard anti-trans remarks in the news media? Never 44 (5.5) A few times a month 292 (36.3) A few times a week 252 (31.3) Once daily 68 (8.4) Multiple times daily 149 (18.5) Total participants reporting weekly exposure 469 (58.3) Total participants reporting daily exposure 217 (27.0) How often have you seen or heard anti-trans remarks online? Never 32 (4.0) A few times a month 190 (23.8) A few times a week 246 (30.9) Once daily 88 (11.0) Multiple times daily 241 (30.2) Total participants reporting weekly exposure 575 (72.2) Total participants reporting daily exposure 329 (41.3) How often have you personally experienced anti-trans bullying, harassment or threats online? Never 577 (72.4) A few times a month 156 (19.6) A few times a week 38 (4.8) Once daily 9 (1.1) Multiple times daily 17 (2.1) Total participants reporting weekly exposure 64 (8.0) Total participants reporting daily exposure 26 (3.3) How often have you thought about, seen or heard about anti-trans rallies in Australia? Never 219 (27.3) A few times a month 479 (59.7) A few times a week 83 (10.3) Once daily 10 (1.2) Multiple times daily 11 (1.4) Total participants reporting weekly exposure 104 (13.0) Total participants reporting daily exposure 21 (2.6) How often have you thought about, seen or heard about police violence against trans people in Australia? Never 321 (40.3) A few times a month 371 (46.6) A few times a week 76 (9.5) Once daily 11 (1.4) Multiple times daily 17 (2.1) Total participants reporting weekly exposure 104 (13.1) Total participants reporting daily exposure 28 (3.5) How often have you thought about, seen or heard about anti-trans rhetoric by Australian politicians and high-profile people? Never 83 (10.4) A few times a month 415 (52.0) A few times a week 217 (27.2) Once daily 45 (5.6) Multiple times daily 38 (4.8) Total participants reporting weekly exposure 300 (37.6) Total participants reporting daily exposure 83 (10.4) How often have you thought about, seen or heard about international anti-trans legislation and violence? Never 32 (4.0) A few times a month 217 (27.1) A few times a week 288 (35.9) Once daily 101 (12.6) Multiple times daily 164 (20.4) Total participants reporting weekly exposure 553 (69.0) Total participants reporting daily exposure 265 (33.0) Prevalence of anxiety, depression, self-harm and suicidality A GAD-7 score ≥ 10, indicating probable anxiety disorder was reported by 377 (47.8%) respondents, and a PHQ-9 score ≥ 10 indicating probable depression was reported by 505 (65.4%) respondents. In the past 12 months, 435 (53.9%) respondents reported self-harm ideation, 201 (24.9%) reported self-harm, 207 (25.7%) had experienced suicidal ideation, 161 (20.0%) reported suicide planning, and 25 (3.1%) had attempted suicide (Table 3 ). Table 3 Anxiety, depression, self-harm and suicidality Variable n (%) Anxiety (GAD-7 total score) (n = 789) Score 0–4: Minimal Anxiety 225 (28.8) Score 5–9: Mild Anxiety 187 (23.7) Score 10–14: Moderate Anxiety 180 (22.8) Greater than 15: Severe Anxiety 197 (25.0) Depression (PHQ-9 total score) (n = 773) Score 0–4: None 127 (16.4) Score 5–9: Mild Depression 141 (18.2) Score 10–14: Moderate Depression 145 (18.8) 15–19: Moderately Severe Depression 164 (21.2) 20–27: Severe Depression 196 (25.4) Thought about hurting self on purpose in any way in last 12 months (n = 807) Yes 435 (53.9) No 372 (46.1) Hurt self on purpose in last 12 months (n = 807) Yes 201 (24.9) No 606 (75.1) Seriously considered attempting suicide in last 12 months (n = 807) Yes 207 (25.7) No 600 (74.3) Made a plan about how would attempt suicide in last 12 months (n = 807) Yes 161 (20.0) No 646 (80.0) Attempted suicide in last 12 months (n = 807) Yes 25 (3.1) No 782 (96.9) Associations between exposure to anti-trans rhetoric, policies, and violence, and anxiety, depression, self-harm, and suicidality Respondents who reported multiple times weekly exposure to anti-trans rhetoric in the news media were at significantly higher risk of anxiety, depression, self-harm ideation, self-harm, and suicide planning, compared with respondents who did not experience this weekly (adjusted prevalence ratio (aPRs) ranging 1.22 to 1.70) (Table 4 ). Respondents who reported multiple times weekly exposure to anti-trans rhetoric online were at significantly higher risk of anxiety and depression, self-harm ideation, self-harm, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly (aPRs ranging 1.28 to 2.06). Respondents who reported multiple times weekly personal experiences of anti-trans bullying, harassment or threats online were at significantly higher risk of anxiety, depression, self-harm ideation, self-harm, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly (aPRs ranging 1.38 to 3.46). Respondents who reported multiple times weekly exposure to anti-trans rallies in Australia were at significantly higher risk of anxiety, depression, self-harm ideation, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly (aPRs ranging 1.32 to 1.82). Respondents who reported multiple times weekly exposure to police violence against trans people in Australia were at significantly higher risk of anxiety, depression, and suicide planning, compared with those who did not experience this weekly (aPRs ranging 1.15 to 1.66). Respondents who reported multiple times weekly exposure to anti-trans rhetoric by Australian politicians and high-profile people were at significantly increased risk of anxiety, depression, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly (aPRs ranging 1.39 to 1.76). Lastly, respondents who reported multiple times weekly exposure to international anti-trans legislation and violence were at significantly increased risk of anxiety, depression, and self-harm ideation, compared with respondents who did not experience this weekly (aPRs ranging 1.26 to 1.68). Table 4 Multivariate modified Poisson regression models testing associations between > weekly exposure to anti-trans rhetoric, policies and violence and mental health outcomes Exposure variable Clinically significant anxiety last 2 weeks PR (95% CI) Clinically significant depression last 2 weeks (95% CI) Self-harm ideation last 12 months PR (95% CI) Self-harm behaviour last 12 months PR (95% CI) Suicidal thoughts last 12 months PR (95% CI) Suicide plan last 12 months PR (95% CI) Suicide attempt last 12 months PR (95% CI) Anti-trans remarks in the news media 1.70 (1.30, 2.23) *** 1.69 (1.21, 2.37) ** 1.22 (1.06, 1.40) * 1.36 (1.05, 1.76) * 1.34 (1.04, 1.73) 1.41 (1.04, 1.90) * 2.03 (0.81, 5.08) Anti-trans remarks online 2.06 (1.44, 2.95) *** 2.19 (1.39, 3.48) ** 1.28 (1.08, 1.51) * 1.79 (1.27, 2.51) ** 1.62 (1.18, 2.23) ** 1.66 (1.15, 2.40) * 2.73 (0.80, 9.31) Personal experience anti-trans bullying, harassment or threats online 2.29 (1.71, 3.07) *** 3.46 (2.56, 4.69) *** 1.38 (1.16, 1.63) * 1.97 (1.44, 2.69) ** 2.02 (1.50, 2.72) *** 2.42 (1.75, 3.36) *** 1.69 (0.58, 4.92) Thought about, seen or heard about anti-trans rallies in Australia 1.52 (1.12, 2.05) * 1.82 (1.29, 2.57) ** 1.32 (1.13, 1.53) * 1.38 (1.02, 1.87) 1.52 (1.14, 2.03) * 1.74 (1.26, 2.40) ** 2.04 (0.83, 5.00) Thought about, seen or heard about police violence against trans people in Australia 1.15 (1.28, 2.23) ** 1.19 (1.29, 2.58) ** 1.20 (1.02, 1.41) 1.13 (0.81, 1.57) 1.37 (1.02, 1.86) 1.66 (1.18, 2.32) * 1.71 (0.64, 4.55) Thought about, seen or heard about anti-trans rhetoric by Australian politicians and high-profile people 1.48 (1.16, 1.88) ** 1.76 (1.31, 2.37) *** 1.15 (1.02, 1.31) 1.31 (1.03, 1.66) 1.47 (1.16, 1.86) ** 1.39 (1.05, 1.83) * 1.10 (0.50, 2.40) Thought about, seen or heard about international anti-trans legislation and violence 1.63 (1.20, 2.22) ** 1.68 (1.14, 2.46) * 1.26 (1.08, 1.47) * 1.30 (0.97, 1.73) 1.39 (1.04, 1.86) 1.38 (0.99, 1.63) 1.30 (0.49, 3.41) All models are adjusted for age, gender, highest education level completed, and current employment status. Statistically significant results are displayed in bold text with precise degree of statistical significance denoted via superscripted asterixis. Specifically, * denotes p < 0.05, ** denotes p < 0.01, and *** denotes p < 0.001. DISCUSSION This cross-sectional online survey of 807 trans people aged 16 years and older is, to our knowledge, the first study to explore the relationship between self-reported exposure to anti-trans rhetoric, policies, and violence, and adverse mental health outcomes of trans individuals in Australia. This study highlights the pervasive impact of anti-trans exposures in Australia. Consistent with our first hypothesis, this study observed markedly high proportions of respondents reporting exposure multiple times per week to all seven anti-trans exposure types assessed in this study, with exposure multiple times per week to online anti-trans rhetoric the most common (72.2%), followed by international anti-trans legislation and violence (69%), and anti-trans rhetoric in the news media (58.3%). Consistent with our second hypothesis, all seven types of anti-trans exposure measured in this study were associated with higher risk of anxiety and depression. Additionally, six of the exposures were associated with significantly increased risk of suicide planning, four were associated with significantly increased risk of suicide ideation, and five were associated with significantly increased risk of self-harm ideation and/or behaviors. Impacts of and strategies to address anti-trans rhetoric in the news media Trans people are likely to be exposed to and impacted by global incidence of anti-trans rhetoric, policies, and violence via news media and social media. Indicative of the pervasive nature of anti-trans exposures, over half of respondents in this study reported more than weekly exposure to anti-trans rhetoric in the news media, despite a majority reporting that they had stopped or reduced their news media engagement in the previous 12 months. Multiple times weekly exposure to anti-trans rhetoric in the news media was associated with significantly higher risk of probable anxiety and depression disorders, self-harm ideation, self-harm, and suicide planning. While previous literature has demonstrated negative mental health impacts associated with exposure to local news of anti-trans rhetoric and policies ( 21 , 29 ), this study provides robust evidence suggesting that anti-trans rhetoric, policies and violence overseas (e.g., in the USA and UK), and accompanying media reporting, may be associated with adverse mental health outcomes in trans people living in Australia. In response to emerging anti-trans rhetoric in the Australian news media, the Press Council of Australia released advisory guidelines for the reporting on persons with diverse sexual orientation, gender identity, and innate variations of sex characteristics in 2019 ( 30 ). These guidelines stipulate that “publications must take reasonable steps to ensure that factual material in news reports and elsewhere is accurate and not misleading” and “avoid causing or contributing materially to substantial offence, distress or prejudice”. Although the Press Council acknowledge that “the use of prejudicial and/or offensive language … can have adverse mental health outcomes and harmful implications”, these Advisory Guidelines are an initiative of and funded by the industry, and therefore considered optional guidelines only, rather than legally mandated standards ( 30 ). Without the risk of financial penalties or tangible consequences, Australia media outlets have a track-record of publishing anti-trans mis/disinformation, particularly if it is within the publisher’s commercial interests. For example, an analysis of 1319 articles about trans people published by Australian media outlets between 1 January 2019 to 31 December 2020, found that the framing of trans people and issues was overwhelmingly negative ( 31 ). To address the significant role news media play in perpetuating anti-trans mis/disinformation, Australian state, territory, and federal governments must work collaboratively to strengthen media regulations to ensure greater accountability for news outlets that promote anti-trans mis/disinformation ( 18 ). Additionally, accurate and evidence-based counter-messaging can be valuable in combating anti-trans mis/disinformation ( 2 ), with research demonstrating that positive trans media representation can reduce prejudice and improve attitudes towards trans people ( 32 – 34 ). Impacts of and strategies to address online anti-trans rhetoric, bullying, harassment, and threats Consistent with high rates of exposure to anti-trans online rhetoric reported elsewhere ( 35 , 36 ), this study found that almost three in four survey respondents had seen or heard anti-trans rhetoric online more than weekly in the previous month. Further, this exposure was associated with significantly increased risk of anxiety and depression, as well as recent self-harm ideation, self-harm behavior/s, suicidal ideation, and suicide planning. Additionally, just under one in ten respondents had personally experienced anti-trans online bullying, harassment, or threats, on a more than weekly basis, with this presenting the greatest adverse impact of any of the exposure types measured in the study, being associated with higher risk of six of the seven measured mental health outcomes. This included over five times greater risk of clinically significant depression, and over three times greater risk of suicidal ideation and suicide planning. Unsurprisingly, one in ten respondents reported stopping and almost 60% reported reducing their social media engagement in the previous 12 months. While this may reduce exposure to online anti-trans rhetoric, it may also limit or prohibit access to trans-affirming online spaces, which are known to play a key role in gender exploration with relative privacy and anonymity, positive trans representation, and trans community connection ( 37 – 39 ). These findings reflect the ways in which online spaces have changed over time, with some social media platforms that had formerly been sites of community connection and positive representation, becoming increasingly hostile to trans people ( 40 ). For example, in January 2025, the Hateful Conduct policy for Meta platforms was amended to permit abuse against LGBTIQA + people, while forbidding the same abuses against other marginalized communities ( 41 ). The issue of online anti-trans rhetoric bullying, harassment, and threats against trans adolescents may be addressed, in part, through comprehensive student-, parent- and school-focused prevention efforts ( 36 ). Additionally, to address the significant role of social media in perpetuating anti-trans mis/disinformation, governments must work collaboratively with social media platforms to strengthen policies related to online abuse, to combat the spread of anti-trans mis/disinformation, and online communications between anti-LGBTQIA + hate groups ( 18 ). Impacts of and strategies to address anti-trans political rhetoric and violence in Australia In Australia, there was a marked escalation in anti-trans rhetoric coinciding with the national tour of lobbyist Kellie-Jay Keen in early 2023, as well as several publicized incidents of police violence against trans people ( 42 ). Despite over a year having passed since Keen’s tour and the associated concentration in anti-trans violence, this study is indicative of the long-term adverse impacts of these events and experiences on Australian trans communities. More than one in ten respondents to this May 2024 survey had thought about or observed anti-trans rallies more than weekly in the previous month, and this was associated with greater risk of anxiety, depression, self-harm ideation, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly. Similarly, more than one in ten respondents had thought about or observed police violence against trans people in Australia more than weekly, and this was associated with greater risk of anxiety, depression, and recent suicide planning. Further, over the last decade, there has been an increase in Australian politicians and other high-profile individuals openly voicing anti-trans rhetoric and mis/disinformation ( 43 , 44 ), and several bills have been proposed to the Australian Senate that would restrict the rights of trans people (e.g., 16, 17). This study showed that more than one in three survey respondents were exposed to anti-trans rhetoric from Australian politicians and other high-profile individuals on a more than weekly basis, and that this exposure was associated with significantly increased risk of anxiety, depression, suicidal ideation, and suicide planning. Since the time of this survey, there has been further escalation in anti-trans political rhetoric and policies in Australia. This includes the Queensland State Government implementing a state-wide ban on puberty blockers for gender affirmation in trans children in early 2025 ( 19 ), and political advertisements by Trumpet of Patriots party stating “there are only two genders – male and female” in the lead up to the 2025 Australian Federal Election ( 45 ). Federal, state, and territory governments must work collaboratively to introduce anti-vilification laws to protect trans people from harassment, abuse, and violence. This must include holding politicians and high-profile individuals accountable for rhetoric and policies that aim to dehumanize, stigmatize, or marginalize trans people, including restrictions to healthcare access. Limitations This cross-sectional study involved an online survey using a non-probability snowball sampling method, and as such, it has inherent limitations. The sample is relatively young (median age was 33 years (IQR 26, 42)), a majority were born in Australia (84.4%) and lived in metropolitan areas (81.5%), which may limit the generalizability of the findings to older trans people, those born outside Australia and those living in regional and remote areas. No standardized definition of ‘anti-trans’ was provided to survey participants, allowing for a range of interpretations that could have impacted responses. Items that asked about whether respondents had ‘thought about, seen or heard’ a particular exposure, did not allow for distinction between rumination over the exposure, observation of the exposure, or personal experience of the exposure. Further, exposure measures asked respondents about their experiences in the previous month, while measures of self-harm ideation, self-harm, and suicidality asked respondents about their experience in the previous 12 months. As a result, it was not possible to determine whether these mental health outcomes occurred before or after the exposures, thus reported associations should be interpreted with caution. There were also several noteworthy topics and events that were not explored in this study, including rhetoric around religious anti-discrimination laws, changes in legal gender affirmation in some Australian states/territories, conversion practices, inclusion of trans people in the Australian census, high-profile court cases involving trans individuals, sporting policies, and access to gender affirming care. Further research is needed to explore the prevalence and associations of these exposures on the mental health of trans people. Conclusion Trans people in Australia are frequently exposed to anti-trans rhetoric, policies, and violence, and this exposure is associated with significantly increased risk of adverse mental health outcomes. An immediate multi-pronged response is needed to combat the global escalation in anti-trans rhetoric, policies, and violence. This must include collaborative action between governments, news media outlets, and social media platforms, and funding for research to better understand and address the drivers of anti-trans rhetoric, policies, and violence, and the impacts of such. Declarations Author contributions Conceptualization: SZ, JM, EW, JG, FS, TR, ASC; Methodology: SZ, JM, EW, JG, FS, TR, ASC; Investigation: SZ, JM, EW, JG, FS, TR, ASC; Formal analysis: SB, RC, JM, SL, FS; Writing – Original Draft Preparation: SZ, SB, RC, SL; Writing – Review & Editing: All authors; Funding Acquisition: ASC; Supervision: ASC All authors had full access to all of the data (including statistical reports and tables) in the study, approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Funding details Sav Zwickl was supported by a University of Melbourne MDHS Fellowship; Eli Ward-Smith was supported by an Australian Government Research Training Program Scholarship; Ada S Cheung was supported by a NHMRC Investigator Grant. Disclosure statement. The authors report there are no competing interests to declare. References Arayasirikul S, Turner C, Trujillo D, Sicro SL, Scheer S, McFarland W et al (2022) A global cautionary tale: discrimination and violence against trans women worsen despite investments in public resources and improvements in health insurance access and utilization of health care. Int J Equity Health 21(1):32 Brightman S, Lenning E, Lurie KJ, DeJong C (2024) Anti-Transgender Ideology, Laws, and Homicide: An Analysis of the Trifecta of Violence. Homicide Stud 28(3):251–269 Lenning E, Brightman S, Buist CL (2021) The trifecta of violence: A socio-historical comparison of lynching and violence against transgender women. Crit Criminol 29(1):151–172 Billard TJ (2024) The Politics of Transgender Health Misinformation. Political Communication 41(2):344–352 Cavve BS, Bickendorf X, Ball J, Saunders LA, Thomas CS, Strauss P et al (2024) Reidentification With Birth-Registered Sex in a Western Australian Pediatric Gender Clinic Cohort. JAMA Pediatr 178(5):446–453 Olson KR, Raber GF, Gallagher NM (2024) Levels of Satisfaction and Regret With Gender-Affirming Medical Care in Adolescence. 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PLoS ONE 17(1):e0261039 World Health Organisation Gender incongruence and transgender health in the ICD 2025 [Available from: https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd American Medical Association AMA reinforces opposition to restrictions on transgender medical care 2021 [Available from: https://www.ama-assn.org/press-center/press-releases/ama-reinforces-opposition-restrictions-transgender-medical-care APA Policy Statement on Affirming Evidence- (2024) Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science [press release] Horton C (2024) The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children. Int J Transgender Health. :1–25 ILGA-Europe Joint Statement on the decision to ban puberty blockers for trans youth in the UK 2024 [Available from: https://www.ilga-europe.org/news/joint-statement-on-the-decision-to-ban-puberty-blockers-for-trans-youth-in-the-uk/ Trans Legislation Tracker (2025) [Available from: https://translegislation.com/ Law B (2017) Moral panic 101: equality, acceptance and the Safe Schools scandal. Black Inc, Melbourne Ecker S, b RED S, RS, Byrnes JM (2019) Impact of the Australian marriage equality postal survey and debate on psychological distress among lesbian, gay, bisexual, transgender, intersex and queer/questioning people and allies. Aust J Psychol 71(3):285–295 Hanson P (2024) In: Senate A (ed) Sex Discrimination Amendment (Acknowledging Biological Reality) Bill 2024. The Parliament of the Commonwealth of Australia, Canberra Hanson P (2020) In: Senate A (ed) Australian Education Legislation Amendment (Prohibiting the Indoctrination of Children) Bill 2020. The Parliament of the Commonwealth of Australia, Canberra Badge H, Turner J, Fabry-Jenkins A, Spirovska N (2023) Fuelling hate: Abuse, harassment, vilification and violence against trans people in Australia. Trans Justice Project, Melbourne ‘Severe limitations on the rights of children’ (2025) Human Rights Commissioner on ‘pause’ on gender affirming health care [press release] Minister for Health MHaASaMfW (2024) Independent evaluation finds Queensland paediatric gender services safe and evidence-based. Queensland Government Hughto JMW, Pletta D, Gordon L, Cahill S, Mimiaga MJ, Reisner SL (2021) Negative Transgender-Related Media Messages Are Associated with Adverse Mental Health Outcomes in a Multistate Study of Transgender Adults. LGBT Health 8(1):32–41 Flores AR, Hatzenbuehler ML, Gates GJ (2018) Identifying psychological responses of stigmatized groups to referendums. Proc Natl Acad Sci U S A 115(15):3816–3821 Spitzer RL, Kroenke K, Williams JB, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097 Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613 Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T et al (2010) Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. annals family Med 8(4):348–353 Levis B, Benedetti A, Thombs BD (2019) Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. ;365 Chen W, Qian L, Shi J, Franklin M (2018) Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification. BMC Med Res Methodol 18(1):63 Cummings P (2009) The relative merits of risk ratios and odds ratios. Arch Pediatr Adolesc Med 163(5):438–445 Dhanani LY, Totton RR (2023) Have You Heard the News? The Effects of Exposure to News About Recent Transgender Legislation on Transgender Youth and Young Adults. Sexuality Res Social Policy 20(4):1345–1359 Australian Press Council Reporting on persons with diverse sexual orientation, gender identity, and sex characteristics 2023 Garcia A, Badge J (2021) Transgender people in the Australian press: Bombarded by outright harassment: Sydney Corpus Lab; [Available from: https://sydneycorpuslab.com/transgender-people-in-the-australian-press-bombarded-by-outright-harassment/ Gillig TK, Rosenthal EL, Murphy ST, Folb KL (2018) More than a Media Moment: The Influence of Televised Storylines on Viewers’ Attitudes toward Transgender People and Policies. Sex Roles 78(7):515–527 Flores AR, Haider-Markel DP, Lewis DC, Miller PR, Taylor JK (2021) Antidiscrimination interventions, political ads on transgender rights, and public opinion: results from two survey experiments on adults in the United States. Front Psychol 12:729322 Laporte H, Eggermont S (2024) News coverage on transgender celebrities in Belgium: Parasocial contact, attitudes, and policy support. Psychol Sexuality 15(2):216–234 Powell A, Scott AJ, Henry N (2020) Digital harassment and abuse: Experiences of sexuality and gender minority adults. Eur J Criminol 17(2):199–223 Abreu RL, Kenny MC, Cyberbullying, Youth LGBTQ (2018) A Systematic Literature Review and Recommendations for Prevention and Intervention. J Child Adolesc Trauma 11(1):81–97 Austin A, Craig SL, Navega N, McInroy LB (2020) It’s my safe space: The life-saving role of the internet in the lives of transgender and gender diverse youth. Int J Transgender Health 21(1):33–44 Berger MN, Taba M, Marino JL, Lim MSC, Skinner SR (2022) Social Media Use and Health and Well-being of Lesbian, Gay, Bisexual, Transgender, and Queer Youth: Systematic Review. J Med Internet Res 24(9):e38449 Selkie E, Adkins V, Masters E, Bajpai A, Shumer D (2020) Transgender Adolescents' Uses of Social Media for Social Support. J Adolesc Health 66(3):275–280 Sánchez-Sánchez AM, Ruiz-Muñoz D, Sánchez-Sánchez FJ (2024) Mapping Homophobia and Transphobia on Social Media. Sexuality Res Social Policy 21(1):210–226 Meta's New Policies (2025) How They Endanger LGBTQ + Communities and Our Tips for Staying Safe Online [press release]. The Human Rights Campaign Melbourne Activist Legal Support Statement of Concern: Policing of opposing anti-trans & trans rights rallies 2023 [Available from: https://mals.au/2023/03/20/statement-of-concern-policing-of-opposing-anti-trans-rally-trans-rights-rallies/ McGowan M (2022) NSW Liberal candidate described campaign supporting LGBT youth as ‘grooming tactic’ used by ‘gender extremists’. The Guardian Morrison S (2018) We do not need ‘gender whisperers’ in our schools. Let kids be kids Muller D (2025) Newspapers cannot justify running Clive Palmer’s Trumpet of Patriots ads as freedom of speech. Conversation Additional Declarations The authors declare no competing interests. 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Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Ada","middleName":"S","lastName":"Cheung","suffix":""}],"badges":[],"createdAt":"2025-07-17 20:51:19","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7152164/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7152164/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87179971,"identity":"604a5f20-4080-401c-9d62-7291062ad9d5","added_by":"auto","created_at":"2025-07-21 09:34:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1500733,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7152164/v1/95d17b07-cf6b-4704-ba69-f8543e225460.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eExposure to anti-trans rhetoric, policies, and violence: associations with mental health outcomes in Australian trans and gender diverse communities\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIn recent years, there has been a marked escalation in rhetoric, policies, and acts of violence that are \u003cem\u003eanti-trans\u003c/em\u003e, which we define as prejudice, discrimination, and hostility towards trans individuals, often aiming to dehumanize, stigmatize, or marginalize trans and gender diverse (henceforth \u0026lsquo;trans\u0026rsquo;) people based on their gender identity. Anti-trans rhetoric can manifest in social, political, and legal opposition, ranging from harmful stereotypes to physical and sexual violence against trans people (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Research shows that anti-trans rhetoric, policies, and violence are strongly correlated over time, in what has been termed a \u0026ldquo;trifecta of violence\u0026rdquo; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile trans people have long been pathologized, recent trends show that mis/disinformation now dominates public rhetoric about trans people and their healthcare (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This surge in anti-trans mis/disinformation has spurred policies in the United States of America (USA), United Kingdom (UK), and more recently, Australia, that harm trans individuals by restricting access to essential healthcare, sports participation, single-sex spaces, and legal gender affirmation (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFor example, provision of gender-affirming care to trans people who desire it, including trans children and adolescents, is supported by many major medical organizations (e.g., 8, 9, 10), with consistent evidence of improvements in mental health and wellbeing, and very low rates of regret (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, mis/disinformation about gender-affirming care has dominated social and political discourse, culminating in a national ban on puberty blockers for trans children and adolescents outside of research in the UK (though not for cisgender children, as a treatment for precocious puberty) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The same mis/disinformation has been utilized in the USA, and the number of bills introduced nationally aimed at restricting the healthcare, education and legal recognition of trans people has increased from 143 of which 18 passed in 2021, 174 of which 26 passed in 2022, 604 of which 87 passed in 2023, and 650 of which of which 50 passed in 2024 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Over 850 bills were introduced nationally in the US, of which over 60 passed, during the first three months of 2025 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Australia, there has also been a notable escalation in anti-trans rhetoric, policies, and violence across a similar timeframe, including the public, media and political rhetoric surrounding LGBTIQA\u0026thinsp;+\u0026thinsp;content in Australian school curriculums in 2016 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), the Australian Marriage Law Postal Survey in 2017 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and several bills and motions proposed to the Australian Senate (e.g., 16, 17). A 2023 national Australian survey of over 3,000 people found that 80% reported a cumulative growth of anti-trans rhetoric and violence in Australia over time, including anti-trans rallies and several publicized incidents of police violence against trans people (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Furthermore, in early 2025, the Queensland State Government implemented a state-wide ban on puberty blockers for gender affirmation in trans children despite an independent evaluation confirming practices were safe and evidence-based, and recommending further resource allocation (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the global rise in anti-trans rhetoric, policies, and violence, relatively few studies have examined the threat these pose to trans mental health. International research indicates that exposure to anti-trans rhetoric, policies, and violence, is associated with adverse mental health outcomes in both trans adolescents and adults (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, to our knowledge, no research has explored the impacts of exposure to anti-trans rhetoric, policies, and violence on the mental health of trans individuals in Australia.\u003c/p\u003e\u003cp\u003eTo address this dearth of research, in an Australian trans community sample aged 16\u0026thinsp;+\u0026thinsp;years, this study aimed to explore 1) frequency of recent exposure to anti-trans rhetoric, policies, and violence, and 2) associations between regular (multiple times weekly in preceding month) exposure to anti-trans rhetoric, policies, and violence, with mental ill-health outcomes. It was hypothesized that 1) a high proportion of our sample would report recent, regular exposure to anti-trans rhetoric, policies, and violence, and 2) that regular exposure would be associated with higher likelihood of mental ill-health outcomes, namely clinically significant symptoms of anxiety and depression, past 12-month self-harm ideation and behavior, and past 12-month suicidal ideation, planning, and attempt/s.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eData used in this paper were collected as part of \u003cem\u003eTRANSform\u003c/em\u003e, a larger ongoing longitudinal study launched in May 2020, open to trans people aged 16 or older living in Australia. The vast majority of \u003cem\u003eTRANSform\u003c/em\u003e participant recruitment occurs through social media, with recruitment posts shared widely by trans organisations and support groups within Australia.\u003c/p\u003e\u003cp\u003eAs part of \u003cem\u003eTRANSform\u003c/em\u003e, participants first complete an enrolment survey where they provide basic demographic data and an email address, which is then used to contact them with invitations to complete sub-studies annually. One of these sub-studies was an online survey that contained questions about mental health and exposure to anti-trans rhetoric, policies, and violence, and was open to the \u003cem\u003eTRANSform\u003c/em\u003e cohort between 1 May \u0026ndash; 31 May 2024. Data from these questions are the focus of this paper.\u003c/p\u003e\u003cp\u003e\u003cem\u003eTRANSform\u003c/em\u003e is a trans-led research project, and as such, survey design was led by a group of trans researchers with support from cisgender clinicians and researchers experienced in trans health. REDCap electronic data capture tools hosted at The University of Melbourne were used for survey data collection and management. This study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards, and received ethical and governance approval by the Austin Health Human Research Ethics Committee (Reference Number HREC/57155/Austin-2019), ACON Research Ethics Review Committee (Reference Number 2020/03) and the Thorne Harbor Health Community Research Endorsement Panel (Reference Number THH/CREP 20\u0026thinsp;\u0026minus;\u0026thinsp;006).\u003c/p\u003e\u003cp\u003eDemographic data collected from survey respondents included age, Aboriginal and/or Torres Strait Islander identity, country of birth, highest level of education, and employment status. Although we acknowledge that gender identity is complex and fluid, for the purposes of data analysis we asked respondents to select one of the following gender categories; man/trans man, woman/trans woman, non-binary or gender diverse (including agender) (herein referred to as \u003cem\u003enon-binary\u003c/em\u003e), or a culturally-specific gender identity not captured by other options (herein referred to as \u003cem\u003eculturally-specific gender identity\u003c/em\u003e).\u003c/p\u003e\u003cp\u003eTo assess recent exposure to anti-trans rhetoric, policies, and violence (herein collectively referred to as \u003cem\u003eanti-trans exposures\u003c/em\u003e), survey respondents were asked about how often in the previous month they had; 1) observed anti-trans rhetoric in the news media; 2) observed anti-trans rhetoric online; 3) personally experienced anti-trans bullying, harassment or threats online; 4) thought about or observed anti-trans rallies in Australia; 5) thought about or observed police violence against trans people in Australia; 6) thought about or observed anti-trans rhetoric by Australian politicians and high-profile people; and 7) thought about or observed international anti-trans legislation and violence. Fixed response options included never, a few times a month, a few times a week, once daily, multiple times daily.\u003c/p\u003e\u003cp\u003eSurvey respondents completed the Generalized Anxiety-7 (GAD-7), a screening tool for clinically significant symptoms of anxiety (herein referred to as \u003cem\u003eanxiety\u003c/em\u003e) in the preceding two weeks (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). GAD-7 is a self-reported 7-item scale, whereby respondents select the severity of seven anxiety symptoms, from \u0026ldquo;0\u0026rdquo; (not experienced) to \u0026ldquo;3\u0026rdquo; (experienced nearly every day). The sum of all seven responses provides a total score. GAD-7 scores of 5\u0026ndash;9 represent mild, 10\u0026ndash;14 moderate, and \u0026ge;\u0026thinsp;15 severe anxiety symptoms. GAD-7 scores\u0026thinsp;\u0026ge;\u0026thinsp;10 are 89% sensitive and 82% specific for detecting Generalized Anxiety Disorder (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRespondents also completed the Patient Health Questionaire-9 (PHQ-9) as a measure of clinically significant symptoms of depression (herein referred to as \u003cem\u003edepression\u003c/em\u003e) in the preceding two weeks (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). PHQ-9 is a self-reported 9-item scale, whereby respondents select the severity of nine depressive symptoms, from \u0026ldquo;0\u0026rdquo; (not experienced) to \u0026ldquo;3\u0026rdquo; (experienced nearly every day). The sum of all nine responses provides a total score. PHQ-9 scores of 5\u0026ndash;9 represent mild, 10\u0026ndash;14 moderate, 15\u0026ndash;19 moderately severe, and \u0026ge;\u0026thinsp;20 severe depressive symptoms. PHQ-9 scores\u0026thinsp;\u0026ge;\u0026thinsp;10 are 88% sensitive and 85% specific for detecting clinically significant major depression (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo assess history of self-harm and suicidality in the preceding 12 months, respondents were asked whether they had thought about hurting themselves on purpose in any way (\u003cem\u003eself-harm ideation\u003c/em\u003e), hurt themselves on purpose in some way (\u003cem\u003eself-harm\u003c/em\u003e), seriously considered attempting suicide (\u003cem\u003esuicidal ideation\u003c/em\u003e), made a plan about how they would attempt suicide (\u003cem\u003esuicide planning\u003c/em\u003e), or actually attempted suicide (\u003cem\u003esuicide attempt\u003c/em\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDescriptive statistics were reported as frequency (percentage) for categorical variables, and median (interquartile range), or mean (standard deviation) as appropriate. To analyze mental health outcomes associations with anti-trans exposures, a series of modified Poisson regression models with robust standard errors were computed. These models and accompanying prevalence ratios were chosen over traditional logistic regression models which produce odds ratio, as often odds ratio effect estimates can overestimate the relationship where the outcome is frequently occurring (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Moreover, prevalence ratios are significantly easier to interpret accurately compared with odds ratios (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAll models included age, gender (trans man, trans woman, and non-binary; with culturally-specific gender identity excluded due to small sample size), education level (secondary and non-university tertiary vs university), and current employment (yes vs no), as covariates. For sensitivity analyses, all generalized variance inflation factors (GVIF) for generated models were inspected to detect potential multicollinearity. A conservative approach was undertaken and GVIFs falling between 1 to 4 were deemed accepted. GVIFs outside this range would be deemed indicative of potential multicollinearity thus warranting further investigation into possible model convergence issues. All analyses were conducted in SPSS and RStudio v4.2.1.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cb\u003eSample Demographics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the 807 respondents, the median age was 33 years (IQR 26, 42), 286 (35.6%) were trans women, 242 (30.1%) were trans men, 271 (33.7%) were non-binary, and 5 (0.6%) had a culturally specific gender identity. A majority of respondents were born in Australia (n\u0026thinsp;=\u0026thinsp;681, 84.4%), 658 (81.5%) lived in a metropolitan area, and 33 (4.1%) were Aboriginal and/or Torres Strait Islander. Attainment of a tertiary qualification (e.g., certificate, diploma, degree) was reported by 655 (81.4%), and unemployment was reported by 119 (14.9%) respondents (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSample Demographics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographic Variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years) (n\u0026thinsp;=\u0026thinsp;807)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e184 (22.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e283 (35.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e167 (20.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e46\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e85 (10.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e56\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57 (7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e65+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (3.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender Identity (n\u0026thinsp;=\u0026thinsp;804)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrans man\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e242 (30.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrans woman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e286 (35.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-binary or gender diverse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e271 (33.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCulturally-specific identity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAboriginal and/or Torres Strait Islander Identity (n\u0026thinsp;=\u0026thinsp;807)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAboriginal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30 (3.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTorres Strait Islander\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAboriginal and Torres Strait Islander\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Indigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e764 (94.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnsure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrefer not to say\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCountry of Birth (n\u0026thinsp;=\u0026thinsp;807)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAustralia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e681 (84.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAotearoa New Zealand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (2.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104 (12.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation of Residence (n\u0026thinsp;=\u0026thinsp;800)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCapital city\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e509 (63.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther metropolitan centre (population\u0026thinsp;\u0026ge;\u0026thinsp;100,000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149 (18.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge rural centre (population 25,000\u0026ndash;99,000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70 (8.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall rural centre (population 10,000\u0026ndash;24,999)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34 (4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther rural area (population\u0026thinsp;\u0026lt;\u0026thinsp;10,000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRemote centre (population\u0026thinsp;\u0026ge;\u0026thinsp;5,000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther remote area (population\u0026thinsp;\u0026lt;\u0026thinsp;5,000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (2.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighest level of education (n\u0026thinsp;=\u0026thinsp;805)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever attended school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (0.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary or below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (0.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary or below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e145 (18.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-university tertiary (e.g. TAFE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e183 (22.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity - undergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e275 (34.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity - postgraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e197 (24.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployment Status (n\u0026thinsp;=\u0026thinsp;800) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking \u0026ndash; full-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e298 (37.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking \u0026ndash; part-time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e159 (19.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking - casual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120 (15.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119 (14.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e90 (11.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHouse duties\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39 (4.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVolunteer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51 (6.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (3.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent - full time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e94 (11.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent - part time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73 (9.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e*Respondents were allowed to select more than one response, so percentages may exceed 100.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExposure to anti-trans rhetoric, policies, and violence\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the seven exposure types, multiple times weekly exposure to anti-trans rhetoric online was the most common, reported by 575 (72.1%) respondents (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This was followed by exposure to international anti-trans legislation and violence, reported by 553 (68.9%) respondents, anti-trans rhetoric in the news media (n\u0026thinsp;=\u0026thinsp;469, 58.2%), anti-trans rhetoric by Australian politicians and other high-profile individuals (n\u0026thinsp;=\u0026thinsp;300, 37.6%), police violence against trans people in Australia (n\u0026thinsp;=\u0026thinsp;104, 12.9%), and anti-trans rallies in Australia (n\u0026thinsp;=\u0026thinsp;104, 12.9%). Personal experience of anti-trans online bullying, harassment, or threats, multiple times weekly, was reported by 64 (8%) respondents.\u003c/p\u003e\u003cp\u003eCompletely stopping or reducing engagement with news media in the previous 12 months to avoid or reduce exposure to anti-trans content, was reported by 108 (13.5%) and 484 (60.6%) respondents, respectively. Over half of participants (n\u0026thinsp;=\u0026thinsp;469, 58.7%) reported recently reducing engagement with social media, with one in ten (n\u0026thinsp;=\u0026thinsp;81, 10.1%) stopping engagement with social media altogether.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of exposure to anti-trans rhetoric, policies, and violence in previous month\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHow often have you seen or heard anti-trans remarks in the news media?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44 (5.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e292 (36.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e252 (31.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68 (8.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple times daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149 (18.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003eweekly\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e469 (58.3)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003edaily\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e217 (27.0)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHow often have you seen or heard anti-trans remarks online?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32 (4.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e190 (23.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e246 (30.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88 (11.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple times daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e241 (30.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003eweekly\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e575 (72.2)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003edaily\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e329 (41.3)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHow often have you personally experienced anti-trans bullying, harassment or threats online?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e577 (72.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e156 (19.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (4.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (1.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple times daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003eweekly\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e64 (8.0)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003edaily\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e26 (3.3)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHow often have you thought about, seen or heard about anti-trans rallies in Australia?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e219 (27.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e479 (59.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e83 (10.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple times daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003eweekly\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e104 (13.0)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003edaily\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e21 (2.6)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHow often have you thought about, seen or heard about police violence against trans people in Australia?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e321 (40.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e371 (46.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76 (9.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple times daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003eweekly\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e104 (13.1)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003edaily\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e28 (3.5)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHow often have you thought about, seen or heard about anti-trans rhetoric by Australian politicians and high-profile people?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e83 (10.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e415 (52.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e217 (27.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45 (5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple times daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (4.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003eweekly\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e300 (37.6)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003edaily\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e83 (10.4)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHow often have you thought about, seen or heard about international anti-trans legislation and violence?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32 (4.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e217 (27.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA few times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e288 (35.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e101 (12.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple times daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e164 (20.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003eweekly\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e553 (69.0)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal participants reporting \u003cb\u003edaily\u003c/b\u003e exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e265 (33.0)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrevalence of anxiety, depression, self-harm and suicidality\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA GAD-7 score\u0026thinsp;\u0026ge;\u0026thinsp;10, indicating probable anxiety disorder was reported by 377 (47.8%) respondents, and a PHQ-9 score\u0026thinsp;\u0026ge;\u0026thinsp;10 indicating probable depression was reported by 505 (65.4%) respondents. In the past 12 months, 435 (53.9%) respondents reported self-harm ideation, 201 (24.9%) reported self-harm, 207 (25.7%) had experienced suicidal ideation, 161 (20.0%) reported suicide planning, and 25 (3.1%) had attempted suicide (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnxiety, depression, self-harm and suicidality\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnxiety (GAD-7 total score)\u0026nbsp;(n\u0026thinsp;=\u0026thinsp;789)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore 0\u0026ndash;4: Minimal Anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e225 (28.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore 5\u0026ndash;9: Mild Anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e187 (23.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore 10\u0026ndash;14: Moderate Anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e180 (22.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGreater than 15: Severe Anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e197 (25.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression (PHQ-9 total score)\u0026nbsp;(n\u0026thinsp;=\u0026thinsp;773)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore 0\u0026ndash;4: None\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e127 (16.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore 5\u0026ndash;9: Mild Depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e141 (18.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore 10\u0026ndash;14: Moderate Depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e145 (18.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;19: Moderately Severe Depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e164 (21.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;27: Severe Depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e196 (25.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThought about hurting self on purpose in any way in last 12 months (n\u0026thinsp;=\u0026thinsp;807)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e435 (53.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e372 (46.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHurt self on purpose in last 12 months (n\u0026thinsp;=\u0026thinsp;807)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e201 (24.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e606 (75.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeriously considered attempting suicide in last 12 months (n\u0026thinsp;=\u0026thinsp;807)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e207 (25.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e600 (74.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMade a plan about how would attempt suicide in last 12 months (n\u0026thinsp;=\u0026thinsp;807)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e161 (20.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e646 (80.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttempted suicide in last 12 months (n\u0026thinsp;=\u0026thinsp;807)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e782 (96.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAssociations between exposure to anti-trans rhetoric, policies, and violence, and anxiety, depression, self-harm, and suicidality\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRespondents who reported multiple times weekly exposure to anti-trans rhetoric in the news media were at significantly higher risk of anxiety, depression, self-harm ideation, self-harm, and suicide planning, compared with respondents who did not experience this weekly (adjusted prevalence ratio (aPRs) ranging 1.22 to 1.70) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRespondents who reported multiple times weekly exposure to anti-trans rhetoric online were at significantly higher risk of anxiety and depression, self-harm ideation, self-harm, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly (aPRs ranging 1.28 to 2.06).\u003c/p\u003e\u003cp\u003eRespondents who reported multiple times weekly personal experiences of anti-trans bullying, harassment or threats online were at significantly higher risk of anxiety, depression, self-harm ideation, self-harm, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly (aPRs ranging 1.38 to 3.46).\u003c/p\u003e\u003cp\u003eRespondents who reported multiple times weekly exposure to anti-trans rallies in Australia were at significantly higher risk of anxiety, depression, self-harm ideation, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly (aPRs ranging 1.32 to 1.82).\u003c/p\u003e\u003cp\u003eRespondents who reported multiple times weekly exposure to police violence against trans people in Australia were at significantly higher risk of anxiety, depression, and suicide planning, compared with those who did not experience this weekly (aPRs ranging 1.15 to 1.66).\u003c/p\u003e\u003cp\u003eRespondents who reported multiple times weekly exposure to anti-trans rhetoric by Australian politicians and high-profile people were at significantly increased risk of anxiety, depression, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly (aPRs ranging 1.39 to 1.76).\u003c/p\u003e\u003cp\u003eLastly, respondents who reported multiple times weekly exposure to international anti-trans legislation and violence were at significantly increased risk of anxiety, depression, and self-harm ideation, compared with respondents who did not experience this weekly (aPRs ranging 1.26 to 1.68).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate modified Poisson regression models testing associations between \u0026gt;\u0026thinsp;weekly exposure to anti-trans rhetoric, policies and violence and mental health outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExposure variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinically significant anxiety last 2 weeks\u003c/p\u003e\u003cp\u003ePR\u0026nbsp;(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinically significant depression last 2 weeks\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSelf-harm ideation last 12 months PR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSelf-harm behaviour last 12 months\u003c/p\u003e\u003cp\u003ePR\u0026nbsp;(95% CI)\u0026nbsp;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSuicidal thoughts last 12 months PR\u0026nbsp;(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSuicide plan last 12 months PR\u0026nbsp;(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSuicide attempt last 12 months PR\u0026nbsp;(95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnti-trans remarks in the news media\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.70 (1.30, 2.23)\u003c/b\u003e\u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.69 (1.21, 2.37)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.22 (1.06, 1.40)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.36 (1.05, 1.76)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.34 (1.04, 1.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.41 (1.04, 1.90)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.03 (0.81, 5.08)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnti-trans remarks online\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e2.06 (1.44, 2.95)\u003c/b\u003e\u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.19 (1.39, 3.48)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.28 (1.08, 1.51)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.79 (1.27, 2.51)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.62 (1.18, 2.23)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.66 (1.15, 2.40)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.73 (0.80, 9.31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonal experience anti-trans bullying, harassment or threats online\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e2.29 (1.71, 3.07)\u003c/b\u003e\u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e3.46 (2.56, 4.69)\u003c/b\u003e\u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.38 (1.16, 1.63)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.97 (1.44, 2.69)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.02 (1.50, 2.72)\u003c/b\u003e\u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e2.42 (1.75, 3.36)\u003c/b\u003e\u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.69 (0.58, 4.92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThought about, seen or heard about anti-trans rallies in Australia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.52 (1.12, 2.05)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.82 (1.29, 2.57)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.32 (1.13, 1.53)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.38 (1.02, 1.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.52 (1.14, 2.03)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.74 (1.26, 2.40)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.04 (0.83, 5.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThought about, seen or heard about police violence against trans people in Australia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.15 (1.28, 2.23)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.19 (1.29, 2.58)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.20 (1.02, 1.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.13 (0.81, 1.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.37 (1.02, 1.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.66 (1.18, 2.32)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.71 (0.64, 4.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThought about, seen or heard about anti-trans rhetoric by Australian politicians and high-profile people\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.48 (1.16, 1.88)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.76 (1.31, 2.37)\u003c/b\u003e\u003csup\u003e\u003cb\u003e***\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.15 (1.02, 1.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.31 (1.03, 1.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.47 (1.16, 1.86)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.39 (1.05, 1.83)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.10 (0.50, 2.40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThought about, seen or heard about international anti-trans legislation and violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.63 (1.20, 2.22)\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.68 (1.14, 2.46)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.26 (1.08, 1.47)\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.30 (0.97, 1.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.39 (1.04, 1.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.38 (0.99, 1.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.30 (0.49, 3.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAll models are adjusted for age, gender, highest education level completed, and current employment status. Statistically significant results are displayed in bold text with precise degree of statistical significance denoted via superscripted asterixis. Specifically, \u003csup\u003e*\u003c/sup\u003e denotes p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e**\u003c/sup\u003e denotes p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, and \u003csup\u003e***\u003c/sup\u003e denotes p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis cross-sectional online survey of 807 trans people aged 16 years and older is, to our knowledge, the first study to explore the relationship between self-reported exposure to anti-trans rhetoric, policies, and violence, and adverse mental health outcomes of trans individuals in Australia. This study highlights the pervasive impact of anti-trans exposures in Australia. Consistent with our first hypothesis, this study observed markedly high proportions of respondents reporting exposure multiple times per week to all seven anti-trans exposure types assessed in this study, with exposure multiple times per week to online anti-trans rhetoric the most common (72.2%), followed by international anti-trans legislation and violence (69%), and anti-trans rhetoric in the news media (58.3%). Consistent with our second hypothesis, all seven types of anti-trans exposure measured in this study were associated with higher risk of anxiety and depression. Additionally, six of the exposures were associated with significantly increased risk of suicide planning, four were associated with significantly increased risk of suicide ideation, and five were associated with significantly increased risk of self-harm ideation and/or behaviors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpacts of and strategies to address anti-trans rhetoric in the news media\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTrans people are likely to be exposed to and impacted by global incidence of anti-trans rhetoric, policies, and violence via news media and social media. Indicative of the pervasive nature of anti-trans exposures, over half of respondents in this study reported more than weekly exposure to anti-trans rhetoric in the news media, despite a majority reporting that they had stopped or reduced their news media engagement in the previous 12 months. Multiple times weekly exposure to anti-trans rhetoric in the news media was associated with significantly higher risk of probable anxiety and depression disorders, self-harm ideation, self-harm, and suicide planning. While previous literature has demonstrated negative mental health impacts associated with exposure to local news of anti-trans rhetoric and policies (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), this study provides robust evidence suggesting that anti-trans rhetoric, policies and violence overseas (e.g., in the USA and UK), and accompanying media reporting, may be associated with adverse mental health outcomes in trans people living in Australia.\u003c/p\u003e\u003cp\u003eIn response to emerging anti-trans rhetoric in the Australian news media, the Press Council of Australia released advisory guidelines for the reporting on persons with diverse sexual orientation, gender identity, and innate variations of sex characteristics in 2019 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). These guidelines stipulate that \u0026ldquo;publications must take reasonable steps to ensure that factual material in news reports and elsewhere is accurate and not misleading\u0026rdquo; and \u0026ldquo;avoid causing or contributing materially to substantial offence, distress or prejudice\u0026rdquo;. Although the Press Council acknowledge that \u0026ldquo;the use of prejudicial and/or offensive language \u0026hellip; can have adverse mental health outcomes and harmful implications\u0026rdquo;, these Advisory Guidelines are an initiative of and funded by the industry, and therefore considered optional guidelines only, rather than legally mandated standards (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Without the risk of financial penalties or tangible consequences, Australia media outlets have a track-record of publishing anti-trans mis/disinformation, particularly if it is within the publisher\u0026rsquo;s commercial interests. For example, an analysis of 1319 articles about trans people published by Australian media outlets between 1 January 2019 to 31 December 2020, found that the framing of trans people and issues was overwhelmingly negative (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo address the significant role news media play in perpetuating anti-trans mis/disinformation, Australian state, territory, and federal governments must work collaboratively to strengthen media regulations to ensure greater accountability for news outlets that promote anti-trans mis/disinformation (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Additionally, accurate and evidence-based counter-messaging can be valuable in combating anti-trans mis/disinformation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), with research demonstrating that positive trans media representation can reduce prejudice and improve attitudes towards trans people (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpacts of and strategies to address online anti-trans rhetoric, bullying, harassment, and threats\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConsistent with high rates of exposure to anti-trans online rhetoric reported elsewhere (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), this study found that almost three in four survey respondents had seen or heard anti-trans rhetoric online more than weekly in the previous month. Further, this exposure was associated with significantly increased risk of anxiety and depression, as well as recent self-harm ideation, self-harm behavior/s, suicidal ideation, and suicide planning. Additionally, just under one in ten respondents had personally experienced anti-trans online bullying, harassment, or threats, on a more than weekly basis, with this presenting the greatest adverse impact of any of the exposure types measured in the study, being associated with higher risk of six of the seven measured mental health outcomes. This included over five times greater risk of clinically significant depression, and over three times greater risk of suicidal ideation and suicide planning.\u003c/p\u003e\u003cp\u003eUnsurprisingly, one in ten respondents reported stopping and almost 60% reported reducing their social media engagement in the previous 12 months. While this may reduce exposure to online anti-trans rhetoric, it may also limit or prohibit access to trans-affirming online spaces, which are known to play a key role in gender exploration with relative privacy and anonymity, positive trans representation, and trans community connection (\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese findings reflect the ways in which online spaces have changed over time, with some social media platforms that had formerly been sites of community connection and positive representation, becoming increasingly hostile to trans people (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). For example, in January 2025, the \u003cem\u003eHateful Conduct\u003c/em\u003e policy for Meta platforms was amended to permit abuse against LGBTIQA\u0026thinsp;+\u0026thinsp;people, while forbidding the same abuses against other marginalized communities (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe issue of online anti-trans rhetoric bullying, harassment, and threats against trans adolescents may be addressed, in part, through comprehensive student-, parent- and school-focused prevention efforts (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Additionally, to address the significant role of social media in perpetuating anti-trans mis/disinformation, governments must work collaboratively with social media platforms to strengthen policies related to online abuse, to combat the spread of anti-trans mis/disinformation, and online communications between anti-LGBTQIA\u0026thinsp;+\u0026thinsp;hate groups (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpacts of and strategies to address anti-trans political rhetoric and violence in Australia\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn Australia, there was a marked escalation in anti-trans rhetoric coinciding with the national tour of lobbyist Kellie-Jay Keen in early 2023, as well as several publicized incidents of police violence against trans people (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Despite over a year having passed since Keen\u0026rsquo;s tour and the associated concentration in anti-trans violence, this study is indicative of the long-term adverse impacts of these events and experiences on Australian trans communities. More than one in ten respondents to this May 2024 survey had thought about or observed anti-trans rallies more than weekly in the previous month, and this was associated with greater risk of anxiety, depression, self-harm ideation, suicidal ideation, and suicide planning, compared with respondents who did not experience this weekly. Similarly, more than one in ten respondents had thought about or observed police violence against trans people in Australia more than weekly, and this was associated with greater risk of anxiety, depression, and recent suicide planning.\u003c/p\u003e\u003cp\u003eFurther, over the last decade, there has been an increase in Australian politicians and other high-profile individuals openly voicing anti-trans rhetoric and mis/disinformation (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), and several bills have been proposed to the Australian Senate that would restrict the rights of trans people (e.g., 16, 17). This study showed that more than one in three survey respondents were exposed to anti-trans rhetoric from Australian politicians and other high-profile individuals on a more than weekly basis, and that this exposure was associated with significantly increased risk of anxiety, depression, suicidal ideation, and suicide planning.\u003c/p\u003e\u003cp\u003eSince the time of this survey, there has been further escalation in anti-trans political rhetoric and policies in Australia. This includes the Queensland State Government implementing a state-wide ban on puberty blockers for gender affirmation in trans children in early 2025 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and political advertisements by Trumpet of Patriots party stating \u0026ldquo;there are only two genders \u0026ndash; male and female\u0026rdquo; in the lead up to the 2025 Australian Federal Election (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Federal, state, and territory governments must work collaboratively to introduce anti-vilification laws to protect trans people from harassment, abuse, and violence. This must include holding politicians and high-profile individuals accountable for rhetoric and policies that aim to dehumanize, stigmatize, or marginalize trans people, including restrictions to healthcare access.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis cross-sectional study involved an online survey using a non-probability snowball sampling method, and as such, it has inherent limitations. The sample is relatively young (median age was 33 years (IQR 26, 42)), a majority were born in Australia (84.4%) and lived in metropolitan areas (81.5%), which may limit the generalizability of the findings to older trans people, those born outside Australia and those living in regional and remote areas. No standardized definition of \u0026lsquo;anti-trans\u0026rsquo; was provided to survey participants, allowing for a range of interpretations that could have impacted responses. Items that asked about whether respondents had \u0026lsquo;thought about, seen or heard\u0026rsquo; a particular exposure, did not allow for distinction between rumination over the exposure, observation of the exposure, or personal experience of the exposure. Further, exposure measures asked respondents about their experiences in the previous month, while measures of self-harm ideation, self-harm, and suicidality asked respondents about their experience in the previous 12 months. As a result, it was not possible to determine whether these mental health outcomes occurred before or after the exposures, thus reported associations should be interpreted with caution.\u003c/p\u003e\u003cp\u003eThere were also several noteworthy topics and events that were not explored in this study, including rhetoric around religious anti-discrimination laws, changes in legal gender affirmation in some Australian states/territories, conversion practices, inclusion of trans people in the Australian census, high-profile court cases involving trans individuals, sporting policies, and access to gender affirming care. Further research is needed to explore the prevalence and associations of these exposures on the mental health of trans people.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTrans people in Australia are frequently exposed to anti-trans rhetoric, policies, and violence, and this exposure is associated with significantly increased risk of adverse mental health outcomes. An immediate multi-pronged response is needed to combat the global escalation in anti-trans rhetoric, policies, and violence. This must include collaborative action between governments, news media outlets, and social media platforms, and funding for research to better understand and address the drivers of anti-trans rhetoric, policies, and violence, and the impacts of such.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: SZ, JM, EW, JG, FS, TR, ASC; Methodology: SZ, JM, EW, JG, FS, TR, ASC; Investigation: SZ, JM, EW, JG, FS, TR, ASC; Formal analysis: SB, RC, JM, SL, FS; Writing \u0026ndash; Original Draft Preparation: SZ, SB, RC, SL; Writing \u0026ndash; Review \u0026amp; Editing: All authors; Funding Acquisition: ASC; Supervision: ASC\u003c/p\u003e\n\u003cp\u003eAll authors had full access to all of the data (including statistical reports and tables) in the study, approved the final manuscript as submitted and agree to be accountable for all aspects of the work. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSav Zwickl was supported by a University of Melbourne MDHS Fellowship; Eli Ward-Smith was supported by an Australian Government Research Training Program Scholarship; Ada S Cheung was supported by a NHMRC Investigator Grant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report there are no competing interests to declare.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArayasirikul S, Turner C, Trujillo D, Sicro SL, Scheer S, McFarland W et al (2022) A global cautionary tale: discrimination and violence against trans women worsen despite investments in public resources and improvements in health insurance access and utilization of health care. 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Sex Roles 78(7):515\u0026ndash;527\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFlores AR, Haider-Markel DP, Lewis DC, Miller PR, Taylor JK (2021) Antidiscrimination interventions, political ads on transgender rights, and public opinion: results from two survey experiments on adults in the United States. Front Psychol 12:729322\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaporte H, Eggermont S (2024) News coverage on transgender celebrities in Belgium: Parasocial contact, attitudes, and policy support. Psychol Sexuality 15(2):216\u0026ndash;234\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePowell A, Scott AJ, Henry N (2020) Digital harassment and abuse: Experiences of sexuality and gender minority adults. Eur J Criminol 17(2):199\u0026ndash;223\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbreu RL, Kenny MC, Cyberbullying, Youth LGBTQ (2018) A Systematic Literature Review and Recommendations for Prevention and Intervention. J Child Adolesc Trauma 11(1):81\u0026ndash;97\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustin A, Craig SL, Navega N, McInroy LB (2020) It\u0026rsquo;s my safe space: The life-saving role of the internet in the lives of transgender and gender diverse youth. Int J Transgender Health 21(1):33\u0026ndash;44\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerger MN, Taba M, Marino JL, Lim MSC, Skinner SR (2022) Social Media Use and Health and Well-being of Lesbian, Gay, Bisexual, Transgender, and Queer Youth: Systematic Review. J Med Internet Res 24(9):e38449\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSelkie E, Adkins V, Masters E, Bajpai A, Shumer D (2020) Transgender Adolescents' Uses of Social Media for Social Support. J Adolesc Health 66(3):275\u0026ndash;280\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eS\u0026aacute;nchez-S\u0026aacute;nchez AM, Ruiz-Mu\u0026ntilde;oz D, S\u0026aacute;nchez-S\u0026aacute;nchez FJ (2024) Mapping Homophobia and Transphobia on Social Media. Sexuality Res Social Policy 21(1):210\u0026ndash;226\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMeta's New Policies (2025) How They Endanger LGBTQ\u0026thinsp;+\u0026thinsp;Communities and Our Tips for Staying Safe Online [press release]. The Human Rights Campaign\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMelbourne Activist Legal Support Statement of Concern: Policing of opposing anti-trans \u0026amp; trans rights rallies 2023 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://mals.au/2023/03/20/statement-of-concern-policing-of-opposing-anti-trans-rally-trans-rights-rallies/\u003c/span\u003e\u003cspan address=\"https://mals.au/2023/03/20/statement-of-concern-policing-of-opposing-anti-trans-rally-trans-rights-rallies/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcGowan M (2022) NSW Liberal candidate described campaign supporting LGBT youth as \u0026lsquo;grooming tactic\u0026rsquo; used by \u0026lsquo;gender extremists\u0026rsquo;. The Guardian\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorrison S (2018) We do not need \u0026lsquo;gender whisperers\u0026rsquo; in our schools. Let kids be kids\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuller D (2025) Newspapers cannot justify running Clive Palmer\u0026rsquo;s Trumpet of Patriots ads as freedom of speech. Conversation\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Melbourne","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"transgender, gender diverse, media, violence, discrimination, mental health, anti-trans, disinformation, transphobia","lastPublishedDoi":"10.21203/rs.3.rs-7152164/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7152164/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDespite escalations in anti-trans rhetoric, policies, and violence against trans and gender diverse (trans) people globally, little research has examined associated mental health outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional online survey of trans people aged\u0026thinsp;\u0026ge;\u0026thinsp;16 years living in Australia through May 2024, assessed frequency of seven different exposures in the previous month; anti-trans rhetoric in news media, online, and by Australian politicians and high-profile individuals, online bullying and harassment, anti-trans rallies and police violence against trans people in Australia, and international anti-trans legislation and violence. Modified Poisson logistic regression models were used to analyze associations between multiple times weekly exposure for each exposure type and mental health (anxiety, GAD-7; depression, PHQ-9; and self-reported past 12-month self-harm and suicidality).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmongst 807 respondents (median age 33 years), exposure multiple times weekly to all seven exposure types, were associated with significantly increased risk of anxiety and depression (adjusted prevalence ratio (aPRs) ranging 1.15 to 3.46). Six of the exposures were associated with significantly increased risk of suicide planning (aPRs ranging 1.39 to 2.42), four were associated with significantly increased risk of suicide ideation (aPRs ranging 1.47\u0026ndash;2.02), and five were associated with significantly increased risk of self-harm ideation and/or behaviors (aPRs ranging 1.22 to 1.97).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eAustralian trans communities experience frequent exposure to anti-trans rhetoric, policies, and violence, with higher rates of exposure associated with higher risk of multiple adverse mental health outcomes. Urgent, multi-pronged collaborative responses are required from governments, news media outlets, and social media platforms to combat anti-trans mis/disinformation and discrimination.\u003c/p\u003e","manuscriptTitle":"Exposure to anti-trans rhetoric, policies, and violence: associations with mental health outcomes in Australian trans and gender diverse communities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-21 09:26:40","doi":"10.21203/rs.3.rs-7152164/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f4334b2-f890-4de4-ae43-d8222f6ad34a","owner":[],"postedDate":"July 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":51715769,"name":"Epidemiology"},{"id":51715770,"name":"Psychology"},{"id":51715771,"name":"Publishing/Media"}],"tags":[],"updatedAt":"2025-07-21T09:26:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-21 09:26:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7152164","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7152164","identity":"rs-7152164","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}