Intersecting Inequalities: Gender Identity, Discrimination, and Mental Health Across Developing and Developed Nations

Abstract

Gender identity–based discrimination is a significant social determinant of mental health, yet comparative evidence across developing and developed nations remains limited. This study examines the relationship between gender identity, discrimination, and mental health using original cross-national data. A mixed-methods design was employed, combining an online survey (N = 642) with qualitative thematic analysis. Participants were drawn from developing (n = 327) and developed (n = 315) countries. Quantitative results indicated that 78.4% of respondents experienced gender identity–based discrimination in the previous year. Mean overall discrimination scores were significantly higher in developing countries (M = 4.04, SD = 0.68) than in developed countries (M = 3.14, SD = 0.71; p < .001). Symptoms of depression were reported by 69.2% of participants in developing nations compared to 54.6% in developed nations. Regression analysis revealed discrimination as a strong predictor of psychological distress (β = 0.48, p < .001), with national context independently contributing to distress levels (β = 0.31, p < .001). Access to gender-affirming mental health care significantly reduced symptom severity (β = −0.29, p < .001). Qualitative findings highlighted chronic discrimination, family rejection, and barriers to mental health care as key themes, with resilience emerging through community support. The study underscores the role of intersecting inequalities in shaping mental health disparities and emphasizes the need for context-sensitive, inclusive mental health policies.