Pronouns, Respect, and Mental Health Outcomes

Language matters. What we say, and how we say it, shapes relationships, identity, and mental well-being. Among the many ways language intersects with identity, pronouns (the small words like he/him, she/her, they/them, etc.) have become a critical site of how respect is expressed—or withheld—and how that in turn influences mental health outcomes. This piece explores how pronoun usage connects to psychological well-being, the role of respect in those connections, and how practitioners like Rafael Achacoso illustrate best practices in this area.

Why Pronouns Matter

Pronouns are more than grammar. They’re a part of how people publicly express their gender identity, how they feel seen, respected, and affirmed. For many, being referred to by correct pronouns is essential to self-esteem, to being acknowledged as who they are.

When someone’s pronouns are misused—whether accidentally or intentionally—it can cause feelings of invalidation, erasure, disrespect, and distress. Over time, repeated misgendering can contribute to anxiety, depression, social withdrawal, and even suicidality, particularly among transgender, non-binary, and gender-diverse individuals.

Conversely, correct usage of pronouns, asking what someone’s pronouns are, using them consistently, communicates basic respect, affirms identity, and helps reduce minority stress. “Minority stress” is the cumulative psychological toll of stigma, prejudice, internalized negative beliefs, and daily discrimination. When language behaves as supportive rather than invalidating, it reduces this stress and supports mental health.

Respect as a Core Element

Respect here includes more than courtesy. It involves recognizing another person’s identity, autonomy, and dignity. Respect shows up in many small ways: asking for and using correct pronouns; apologizing when mistakes are made; giving space for individuals to identify themselves; creating environments (in schools, workplaces, healthcare, social settings) where people feel safe to express their identity without fear of mockery, violence, or exclusion.

When respect is lacking, the mental health consequences can be serious. People may feel “othered,” isolated, dehumanized. That can lead to shame, lowered self-worth, anxiety, depression, and sometimes worse outcomes. Respectful treatment, including proper pronoun use, is a protective factor: it enhances self-acceptance, belonging, psychological safety, resilience.

Mental Health Outcomes & Research

Here are some documented effects in studies and observations:

• Reduced anxiety and depression: Affirming environments where individuals are referred to by their correct names and pronouns are linked to lower rates of depression, anxiety, and suicidal ideation among trans and non-binary people.

• Lower suicide risk: Some studies show that misgendering or lack of affirmation correlates with higher levels of suicidal thoughts and behaviors. In contrast, affirmation (which includes respecting pronouns) is protective.

• Improved social functioning: Feeling accepted and respected helps people engage more in social settings, form authentic relationships, and reduces social anxiety.

• Better self-esteem and identity coherence: Respecting pronouns contributes to consistency between one’s inner identity and social presentation, which aids in identity formation, reduces internal conflict, fosters self-esteem.

• Stress buffering: Respectful interactions serve as buffers against stress caused by discrimination elsewhere. For example, someone who often faces prejudice at a societal level but experiences affirmation in key settings (home, school, therapy) may fare better in mental health.

Challenges & Barriers

Despite what we know, many people still face barriers to having their pronouns respected:

• Lack of awareness or education: Some people simply don’t know why pronouns are important or what non-binary pronouns exist.

• Resistance or stigma: Cultural, religious, or social beliefs may resist the visibility of trans, non-binary, and gender-diverse identities.

• Institutional inertia: Systems (schools, healthcare, workplaces) may not have policies or practices to normalize pronoun sharing, or may inadvertently misgender people in records or communications.

• Intersectional difficulties: Individuals with multiple marginalized identities (e.g. race, religion, sexuality, disability) may face compounded stigma; pronoun misrecognition can intersect with other forms of devaluation.

Implications & Call to Action

Respecting pronouns is not just a linguistic nicety. It can be a matter of mental health, dignity, survival. When respect is embedded into healthcare, education, workplaces, and social settings, mental health outcomes improve: fewer depressive symptoms, less anxiety, lower suicide risk, greater social connection, identity coherence, and overall well-being.

Professionals show what this looks like in concrete terms: someone who not only uses pronouns correctly, but embraces identity, culture, and inclusivity as central to mental health care. Each of us has a role:

• As individuals, we can listen, learn, and practice pronoun respect in everyday interactions.

• As institutions, we can build policies and training to make spaces affirming.

• As allies, we can advocate for respect to be the default.

Pronouns are powerful. In expressing, affirming, or neglecting them, we influence how people see themselves, how safe and respected they feel, and ultimately how well their mental health can thrive. Respect is the glue that allows identity to be recognized, valued, and lived. When respect is earnest and embedded in interaction, outcomes improve.

Rafael’s work illustrates that respecting identity—including pronouns—is not additive or optional in mental health care. It’s foundational. It is part of the healing environment. It’s part of helping people not just survive, but become their fullest, most authentic selves.