Predicting NSSI among Chinese transgender and gender diverse people: the role of social connectedness, internalized stigma, and self-esteem.

BACKGROUND

Non-suicidal self-injury (NSSI) is highly prevalent among transgender and gender diverse (TGD) individuals. However, the mechanisms underlying the influence of psychosocial factors on NSSI remain unclear. This study aims to explore the relationship between social connectedness, internalized stigma, self-esteem, and NSSI in TGD population.

METHODS

The study was conducted from September 2024 to April 2025 among 770 TGD individuals in China (Mage = 25.55). First, we developed and validated an internalized stigma scale for TGD individuals (ISS-TGD) in the Chinese context. Second, a cross-sectional survey was conducted to investigate the relationship between social connectedness, internalized stigma, self-esteem, and NSSI.

RESULTS

The developed 24-item ISS-TGD demonstrates excellent psychometric properties. The prevalence rate of NSSI among TGD individuals was 36.36%. Social connectedness (OR = 0.70, 95% CI [0.51, 0.97]), self-esteem (OR = 0.33, 95% CI [0.20, 0.55]) were significantly associated with NSSI. In addition, the relationship between social connectedness and NSSI was mediated by internalized stigma (manifested as stereotype endorsement, β = -0.119, 95% CI [-0.245, -0.019], p = 0.036; and stigma resistance, β = -0.143, 95% CI [-0.305, -0.021], p = 0.046) and self-esteem. Network analysis revealed that "scratching self intentionally" and "pinching self deliberately" were the primary NSSI methods.

CONCLUSION

NSSI of TGD individuals is influenced by social connectedness, internalized stigma, and self-esteem. Enhancing social connectedness and self-esteem, and reducing internalized stigma are important for reducing NSSI, thereby improving mental health among TGD individuals.