by Lukas Romano, Emanuele Tomasini, Nicolaja Girone, Niccolò Cassina, Tiziano Prodi, Matteo Vismara, Phil Reed, Roberto Truzoli

Abstract

Objective: this study compared cisgender and transgender and nonbinary (TGNB) adults living in Italy on state and trait anxiety, depressive symptoms, perceived stress, and suicidality-related protective cognitions, and examined whether age moderated these associations.
Method: a cross-sectional online survey was conducted in Italy between May and December 2023 and administered to 400 adults aged 18 years or older (201 cisgender; 199 TGNB). Validated self-report measures assessed state and trait anxiety using the State-Trait Anxiety Inventory, Form Y, depressive symptoms using the Beck Depression Inventory-II, perceived stress using the Perceived Stress Scale, and protective cognitions using the Reasons for Living Inventory (RFLI). Group differences were examined using Mann–Whitney tests and multivariable linear models including gender modality, age group, and their interaction.
Results: TGNB participants reported significantly higher anxiety, depressive symptoms, and perceived stress, together with lower RFLI scores, than cisgender participants. TGNB status was independently associated with greater anxiety and perceived stress, with effects more pronounced in younger age groups. For depressive symptoms, a similar but less consistent age-related pattern emerged. Lower RFLI scores were primarily associated with bisexual and homosexual orientation, whereas gender modality was not independently associated after adjustment.
Conclusions: TGNB adults exhibited greater psychological distress than cisgender participants, with younger gender-diverse adults showing greater vulnerability. Sexual orientation showed a stronger association with lower RFLI than gender modality, suggesting that protective cognitions may reflect intersecting minority identities. These findings support developmentally informed and minority stress-sensitive mental health strategies targeting both symptom burden and protective psychological resources.

Key words: clinical research, gender variance, minority stress, nonbinary; transgender