Transphobic Violence in Educational Centers: Risk Factors and Consequences in the Victims’ Wellbeing and Health

School violence and bullying re worrying problems due to their growing prevalence and severe consequences for adolescent and youth health and wellbeing. Sociocultural factors can contribute to, complicate, and increase the cases of violence in classrooms and spaces related to educational centers. Transphobic violence in this article is defined as the type of violence suffered by transgender and nonbinary adolescents and youth as a manifestation of the problem of discrimination and hate against gender and sexual diversity. This work intends to study the complex sociocultural dynamics of violence detected in educational contexts affecting transgender and nonbinary adolescents and youth identified by recent highimpact studies. At the same time, we aim to fill the gap in the scientific literature on transphobic violence and articulate successful strategies to prevent and combat it. In this review, transphobic violence is defined as the violence affecting transgender adolescents and youth, continuous in time, influenced by peers, and taking place in spaces or realities related to educational centers. The reviewed studies point at the complexity of this kind of violence due to the combination of socio-personal factors and its variety in manifestations. Furthermore, we study the consequences of transphobic violence for the wellbeing and health of transgender and nonbinary adolescents and youth to deepen the knowledge of their mental health repercussions. We end by providing suggestions for how this problem can be prevented in educational environments, grounded on scientific evidence in the materialization of a transformative approach.


Introduction
"Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all" is, as stated by the United Nations [1] one of the development goals for both the reduction of inequalities and discrimination and the promotion of wellbeing and social justice. This fourth objective of the 2030 Agenda for Sustainable Development Goals (ASDG) aims to track a form of inequality that materializes in the educational system and can deeply determine the victim's future and right to quality education. Ethnicity, religion, origin, sex, gender, age, capabilities, and other sociocultural categories are subject to different forms of discrimination or violence in social institutions, as has been demonstrated by international observatories and organizations [2][3][4][5]. Intersectional [6][7][8] and ecological perspectives [9][10][11][12] are fundamental in the study of managing and preventing a complex and multidimensional field such as violence and victimization, as stated by the World Health Organization [13]. Therefore, these are relevant approaches to identify which factors are placing some vulnerable groups at a higher risk of suffering interpersonal violence. In this article, we aim to study a form of violence that has been identified in primary and secondary educational centers, affecting the lives of adolescents and youth all over the world. Attending to the ASDG, to achieve gender equality and empower all women and girls appears to be one of the biggest challenges in the fight against inequalities [1]. In this case, gender becomes a global challenge in the fight against inequalities, discrimination, and violence when this sociocultural construct becomes an extended and invisible problem all over the globe. The case of the lesbian, gay, bisexual, transgender, queer, intersexual, and asexual (LGBTQIA+) community in the educational system, specifically in educational centers, has been extendedly reported due to the high rate of violence and discrimination that affects them on the grounds of sexual orientation, gender identity, and gender expression [4,[14][15][16][17]. Moreover, the authors' academic background and research are also informed by transgender studies [18][19][20][21][22][23][24][25], a scientific discipline that has historically enhanced transgender voices and lives in the academic world by highlighting the needs on trans depathologization, non-binarism, and others. Overall, more evidence in high-impact research articles and research on transphobic violence is needed to demonstrate how the situation of inequality and vulnerability affects this community in educational institutions, and how this can be overcome. This gap affects the approach to violence, its detection, and the possibilities of combating it within educational institutions. In the present study, we try to fill this gap by providing two contributions: on one hand, a classification of the main barriers that LGBTQIA+ face in educational institutions; on the other hand, the successful strategies which have really impacted and improved their situation.
In the research carried out, the issue of transgender and nonbinary people has been a pending subject in all aspects of human wellbeing and recognition of self-determination, attending to anglophone research articles. These identities and expressions present groundbreaking positions in terms of gender and self-expression, allowing people to live their life freely as protagonists, presenting a new set of needs attached to this way of living gender [26]. Institutions and politics have not yet adapted to this new spectrum of identities, lacking strategies to ensure human rights and respectful environments in their institutions [27][28][29][30]. The case of those that do not conform to their gender assignation or to whom the binary system of gender is imposed shows a worrying position of inequality in different fields [31]. When approaching the reality of educational centers on this regard, the prevalence of violence taking place in classrooms is high [32][33][34]. Sociocultural factors can contribute to, complicate, and increase the cases of violence in classrooms, as is the case of the presence of nonbinary and transgender identities in educational centers [33,35]. Transphobic violence is a form of violence that has been identified, which affects transgender and nonbinary adolescents and youth (TNBAY) in education. It has a continuous character in time and usually involves the collaboration of other peers in the classroom [4,33,36,37]. Such a form of violence responds to an expression of denial, refusal, and hate against gender and sexual diversity which takes place in the most significant institution in charge of providing quality education in values of freedom, respect, and diversity. This same problem of daily violence against TNBAY has been identified as a threat to the lives of those who suffer transphobic violence, endangering the wellbeing and health of TNBAY. This has become an urgent sociocultural problem to fight, as it has already cost the lives of TNBAY through suicide [36,37].
This article is committed to social transformation to such extent that both shreds of evidence and policies for transformation must go hand in hand toward a more diverse, equal, and sustainable society for all [38]. The United Nations [26] set up a framework for the adoption of a legal and political framework for the effective protection of TNBAY from transphobic discrimination, exclusion, violence, and stigma. This positioning establishes a starting point in the recognition of human rights and the self-determination of TNBAY, refusing any type of violence and discrimination. Such a positioning coincides with the transgender depathologization struggle that aims to eradicate any treatment of transgender and nonbinary identities as medical conditions or illnesses [39]. This issue has been a historical problem of the transgender and nonbinary community, as it has had deep consequences for their access to and quality of health, education, professional careers, etc. Furthermore, it has been reported as a human rights violation [4,26,30,32,[39][40][41]].
An international demand for the effective defense of TNBAY and ensuring human rights are central to the construction of concrete and effective plans to fight against transphobic violence in educational centers [42]. Likewise, there is a need for developing respectful accompaniments for adolescents and youth, to tackle violence while also supporting the victims in their complex process of acceptance and overcoming such violence [43,44]. At the same time, critical pedagogies are necessary to develop affirming and recognizing felt gender identities and respectful practices in classrooms to ensure safe environments in educational centers [29,[45][46][47]. This article intends to contribute to this ongoing work by constructing a scientific framework for the prevention and intervention in cases of transphobic violence. For a complete review of precedents in the study of transphobic violence affecting TNBAY, possibilities of prevention, perspectives of intervention, and accompaniment guidelines are also needed when studying this form of violence and inequality in educational centers.
This article is structured in five sections defined in the following outline: (1) the introduction conceptualizes the problem of transphobic violence tackled by international institutions and the reports of violence along with scientific evidence; (2) the method section establishes the concrete strategy through which this literature review was implemented by detailing every step of the process, research method, and category construction method; (3) the results gather all evidence collected in the target research articles of the review under the four categories of analysis; (4) the discussion aims to connect the results with the theoretical background presented in the introduction by putting both into conversation; (5) the conclusions focus on developing new research, prevention, and intervention lines against transphobic violence in educational centers grounded on the scientific evidence discussed in this article.

Methods
Before initiating the study, we obtained permission from Rovira i Virgili University to develop it within the framework of the received funding from the Secretaria d'Universitats i Recerca del Departament d'Empresa i Coneixement de la Generalitat de Catalunya, the European Union (UE), and the European Social Fund (ESF). Furthermore, this study went under revision by the Ethical Committee of the Community of Research on Excellence for All (CREA) and was approved (Project Identification Code: 20210105) following the APA Ethics Code and the rules of the Declaration of Helsinki on research involving human subjects (1975).

Reflexive Content Analysis
Content analysis is a social sciences research method, predominantly employed for text analysis. Content analysis allows for a deep study of literature by studying both the direct content of the selected materials and the latent meaning of the literature's content by also exploring the underlying significance and implications of the existing evidence. This method may offer three different approaches depending on the researcher's expertise, previous research, and existing research in the field [48]. In this case, the literature review worked on quantitative, qualitative, and mixed-method research articles.
Conventional content analysis is commonly used to describe an existing reality, when previous theory and evidence are limited, and it is the reason why this approach was implemented in this literature review. This approach allowed the authors to avoid preconceived notions of the matter, enabling them to deepen the literature and identify emergent categories, following an inductive category development [49,50]. This allowed the category construction of this review through the study of the literature and the identification of common findings between the selected materials.

Research Process
The literature search workflow involved multiple steps. First, we entered the search themes into the ISI Web of Science and SCOPUS databases to find suitable papers and research articles for the review. We implemented several searches with the combination of the keywords "transphobia", "violence", "school", "gender identity", "transgender", and "educational centers", all of them in English; the search was made between September and October of 2020. The main results came from the most relevant journals publishing articles on the intersection among education, youth, and LGBT studies: The Journal of Adolescent Health and The Journal of LGBT Youth. A second phase of the literature search was completed by the inclusion of additional papers and research articles from our reference lists fitting the same criteria.
We designed criteria in terms of theme, period of data collection and publication, type of paper, and level of assessment of the papers by the journal. We selected only peerreviewed research articles published from 2010 which targeted the dynamics of violence and discrimination on the grounds of gender identity and gender expression taking place in educational centers and affecting adolescents or youth. To limit our review more strictly to studies on the experience of this sociocultural dynamics of violence, we only accepted studies that explicitly collected the experiences of TNBAY, who are the main protagonists of this reality as victims of the violence.
After a first search, we identified more than 100 articles. After applying the criteria, we ended up with 12 articles, which were deeply studied. After this deep study, three target categories emerged from the literature: the variety of manifestations of transphobic violence, sociocultural factors that interfere with the violence, and consequences for the victims' health and wellbeing. Most of the results shared a mixed-method methodology and belonged to the psychological or medical fields, mainly studying how this form of violence affects the health and wellbeing of the subjects. Additionally, several articles also targeted risk factors, i.e., personal and sociocultural categories that can affect how transphobia takes place in educational centers or a familiar context.
The findings of this literature review allow us to deepen our knowledge on the following relevant issues: (1) an analysis was carried out of the various forms of manifestations that transphobic violence can have when taking place in educational centers affecting TNBAY; (2) a review was implemented of the current evidence on personal and sociocultural factors that can configure the sociocultural dynamics of violence and discrimination toward TNBAY; (3) an approach was given toward possible consequences of this form of violence for the subjects' wellbeing and health.

Results
All findings point to the existence of transphobic violence in educational centers which affects TNBAY in different spaces and forms, and which can be performed by different subjects of their surroundings. In the subsections below, we explore the most important findings of the literature review. This allows us to picture transphobic violence affecting youth and adolescents worldwide. This section is organized in four subsections where different issues regarding TNBAY are approached. The outline is as follows:

1.
Risk factors: felt identity, sexuality, and self-perception; external circumstances and judgments.

2.
Manifestations of transphobic violence: caregivers and the family context; peers and school personnel and educational centers.

3.
Consequences for the health and wellbeing of victims: confidence and trust in the people around them when facing violence at educational centers; coping with distress after suffering transphobic violence; suicidal thoughts, planned or attempted.

4.
Possibilities to prevent and intervene in cases of transphobic violence.

Risk Factors
Findings point to a range of factors that can influence transphobic violence, as well as its intensity and consequences due to sociocultural factors [37,[51][52][53][54][55][56][57][58][59]. This subsection is divided into two given the pertinence of these factors: internal factors, such as felt gender identity, sexuality, and self-perception, and external factors, such as circumstances and judgments.

Felt Identity, Sexuality, and Self-Perception
Findings show that transgender and gender-questioning subjects present a higher vulnerability to violence in comparison to their peers, and they are also the most likely to suffer deeply because of it [37]. As argued in other evidence, transgender female identities are more highly susceptible to any form of transphobic violence [57]. A combination of being part of both a sexual and a gender minority, such as being transgender and lesbian or gay, is also a heightened risk for suffering different forms of distress due to transphobic violence [37]. Lastly, transgender and nonbinary subjects show high risks of suffering transphobic violence through physical attacks, cyberbullying, and unsupportive environments, as well as experiencing low personal safety in educational centers; all this worsens the chances of overcoming violence in educational centers [52].
After suffering transphobic violence, certain sociocultural factors can impact how violence is internalized by victims, which is a common reaction to violence by TNBAY [53,59]. Enacted stigma has shown a higher risk of suffering eating disorders and engaging in unhealthy eating behaviors; supportive environments, caring friends, and family protection could act in such situations as protective factors [59]. Moreover, internalization is strongly related to and statistically significant for suicidality in the past 6 months, which demonstrates the great suffering to which TNBAY are exposed and the few tools that they can display to overcome the violence [53]. What can be truly transformative in this complex situation is the power of reporting and being heard by school personnel and relatives when transphobic violence takes place. Higher intentions to seek help for suicidal thoughts are associated with lower chances of suffering distress in different forms, which can be highly preventive for suffering diverse forms of distress and suicidal thoughts, plans, and attempts [54].

External Circumstances and Judgments
Findings point to how external judgments also configure the odds of suffering transphobic violence, as well as its manifestation and intensities. Gender expression is a very important factor due to its external weight, which comprises the display of gender and its external perception. Following Alessi, Kahn, and Chatterji's results [51], manifesting behaviors, dressing, or recreational activities socially assigned to another gender than that assigned at birth can contribute to suffering more violence. Additionally, gender expressions perceived as less masculine or feminine, which differ from the one assigned at birth, can also be more likely associated with experiencing violence [55]. Beyond gender identity, being categorized or perceived as lesbian, gay, bisexual, and/or transgender is also a risk factor as it may present more odds of experiencing at least one form of transphobic violence [51,55]. Additionally, migration and asylum-seeking circumstances might be strong factors for victims suffering more distress when exposed to transphobic violence [51].
Some of the research articles showed other factors regarding the educational centers and a familiar context as important markers of this kind of violence [53,54,58,59]. Emotional neglect and unsupportive family and caregivers have a significant weight, as they can add more distress to victims to such an extent that it can contribute to higher odds of lifetime suicidal attempts [53]. Emotional neglect, school belonging, and internalized self-stigma have a unique connection to a high level of distress to such a degree that it can contribute to suicidality in the past 6 months [53]. Additionally, social support given to victims is statistically significant for the prevention of or contribution to unhealthy weight and eating behaviors as a form of leading with distress [59]. Unsafe feelings in schools and the lack of LGBTQI+ representation among the school staff are also relevant factors that hinder TNBAY from freely expressing themselves [58]. Limited time, staff, and resources, along with school staff unawareness on how to report transphobic violence, do not help in building more friendly atmospheres in educational centers and possibilities to successfully tackle transphobic violence [58]. These and other manifestations of non-LGBTQI+ supportiveness and safety at educational centers can be countered with gay-straight alliances in the educational centers, which can prevent and lower distress in victims [54]. Likewise, deeper alliances with students and LGBTQI+ supportiveness can prevent and improve the situation of TNBAY in educational centers by, for example, establishing trust relationships with them, working on LGBTQI+ youth awareness and resources, and working on the school staff knowledge on LGBTQI+ topics [58,60].

Manifestations of Transphobic Violence
When approaching transphobic violence in educational centers, it is necessary to study how it can be detected and identified, as this configures the possibilities of understanding the real damage, impact, and consequences of this problem. Evidence points to people who perform and execute transphobic violence as the most relevant when mapping this type of violence and developing successful strategies to detect and intervene [51,52,57,58,61].

Caregivers and the Family Context
Caregivers and close relatives are pointed out as overriding, as their power over the adolescents' lives is unquestionable given their right to decide on their good [51,52]. They are the most immediate and tight circle to the subjects, taking full part in their life and having a very big impact on the life of adolescents and youth. In the case of TNBAY family contexts and caregivers, they seem to have an indisputable role in their exploration of gender for this same reason. The importance of caregivers and the family context in the study of transphobic violence in educational centers is due to their importance and decisive role in approving, supporting, and/or accompanying TNBAY and their gender identity and gender expression path [51,52]. Various forms of transphobic violence have been found to take place at home or be exerted by caregivers against TNBAY, such as suppression attitudes, verbal and physical violence, and unsupportive behaviors. Alessi, Kahn, and Chatterji [51] detected different forms of violence at a very early stage (at the age of 5 years old) exerted by parents, relatives, or tutors of TNBAY, as these youth presented behaviors, manners of speaking, dressing, and other recreational activities which defied their gender expectations. Additionally, they found cases of severe verbal and physical abuse that began in childhood and continued into young adulthood, marking their gender and life quality, acceptance, and possibilities to freely live their felt gender.
When physical and verbal abuse fails in achieving the results of containing or pausing the victims' gender expression at a very early stage, findings point to other strategies developed by caregivers and relatives to coerce TNBAY. As Alessi, Kahn, and Chatterji [51] identified, at this point, the family context and/or caregivers have appealed to other relatives to support their thoughts against transgender or nonbinary gender expressions. Furthermore, nonbinary adolescents and youth seem to be the most affected by their closest environment, as they are the least supported by family and friends; thus, they end up being the most socially isolated group, both at home and school [52].

Peers and School Personnel and Educational Centers
Beyond the family context, the environments and the people that have been characterized as the most influential and with a higher impact on the life of TNBAY are those sharing the educational centers: school staff and peers [51,52,57,58,61]. A very wide range of abuse and violence has been found in educational centers against TNBAY exerted by peers, teachers, and school administrators while growing up [51,57], of which the perpetrators were classmates in most cases [57]. The reason for this kind of violence in most cases was TNBAY displaying gender nonconforming behaviors or being perceived as lesbian or gay, linking the abuse against nonconforming gender expressions and sexual orientation as very close problems: transphobic and homophobic violence [51]. Concerning violence exerted by teachers and school personnel, discriminatory treatments and becoming allies of violence exerted by classmates are usual forms of transphobic violence [51]. In the following quotation, we can picture a materialization of this violence through an alliance between perpetrators and teachers manifested in classrooms [51] (p. 7): "Chris: I used to remember that we have these tests where, it's sort of like a [physical education] test, but we have to dunk basketballs. [ . . . ] Like ten dunks to get a pass or what not. I couldn't get a single dunk, and I'd always get hit in the face by a ball for whatever reason and kids would laugh. Even the teacher would join in, by using, by shouting at me saying, you know, like um, 'Why are you such a . . . '. [ . . . ] It means tranny or sissy." Verbal abuse is the most common transphobic violence against TNBAY reported in educational centers [51,52,57]. TNBAY are at heightened risk of suffering violence both inside and outside of their school by peers [52]. Violence against TNBAY is manifested in various forms, such as being sent home from school, receiving failing grades, being suspended or expelled, or being threatened because of a nonconforming gender expression display. They experience a range of forms of violence from schoolteachers, such as not wanting to touch them, not grading their assignment, and forcing school faculty to retract from passing grades on TNBAY students [57]. These and other forms of verbal abuse impact the victims through very deep victimization, which results in a transfer to other educational centers or dropping out to avoid the violence [51]. Overall, the feelings of TNBAY victims include not feeling accepted, being excluded from group activities, being socially isolated, and not feeling free to be themselves in educational centers [57].
Physical abuse is another common form of transphobic violence in educational centers against TNBAY [51]. Physical violence is manifested as kicks, pushes, punches, beatings, and other brutalities, such as throwing stones and water on them, which is commonly linked to threats of physical violence [51,57]. In most cases, physical abuse is accompanied by verbal abuse, reported by victims as being teased or insulted with the intention of starting a physical fight [57]. Sexual abuse, cyberbullying, and social violence are other notso-common manifestations of violence, but which strongly affect TNBAY in educational centers. Sexual violence manifests in diverse forms while using the restroom or other educational centers' spaces, such as peers insulting and sexually harassing TNBAY, because the victims are perceived as lesbian, gay, and/or transgender [51,57]. When approaching more invisible forms of violence, such as cyberbullying and social violence, nonbinary adolescents and youth seem to be at higher risk of suffering them [52].
To prevent these complex and unsuccessful practices in educational centers, TNBAY students have developed diverse strategies [61]. Some of them started seeking support from peers, older LGBTQI-identified students, and school staff, and they discovered that transgender friends provided a special source of support. Additionally, others described proactive forms of communication with teachers and administrators about their gender identity, chosen name, and pronouns; this seemed to be more challenging for nonbinary students that faced challenges with teachers on their reality. When avoiding people or conflicts was not possible, victims chose to ignore them or to stop correcting adults and asserting themselves, hiding their chosen name, pronoun, and gender identity. This can be seen in the following quotation: "I'm like deliberately misgendering myself because I don't wanna correct my gym teacher, who frankly kind of scared me" [61] (p. 10).
When the environments of educational centers were too negative and unfriendly for victims, they chose to stop attending school to avoid conflicts and start taking care of themselves, which in some cases resulted in transferring or dropping out of school. This had great consequences with regard to configuring their future, due to their lack of quality education [60,61].

Consequences for the Health and Wellbeing of Victims
All these different manifestations and types of violence have a strong impact on the life of TNBAY in educational centers. Research shows how, in the first place, it may affect their confidence and trust in their surroundings [51,52]; secondly, it might be manifested in the victims in various forms of distress [37,51,52,57,59]; lastly, it could provoke thoughts and desires of ending their life to escape the anguish [37,[51][52][53]57].

Confidence and Trust in the People around Them When Facing Violence at Educational Centers
Results of the review indicated a lack of confidence in the people around TNBAY as one of the most visible and common impacts of transphobic violence in their wellbeing [51]. When teachers and peers get involved in any form of transphobic violence in educational centers, victimization and self-stigma start to develop. Therefore, victims might start losing their trust and stop relying on their parents to protect them. This reaction is based on the internalized fear of continuing to suffer more violence when explaining this situation, fearing for deeper abuse at home. This may lead them to keep this situation in silence and not rely on their parents to find protection or acceptance. In addition to this, when transphobic violence occurs in a family context, the situation is quite complicated because TNBAY have no one to turn for support since it is within their closest social circle that the abuse was perpetrated, resulting in suffering the violence in silence. Nonbinary adolescents and youth seem to receive the least support from family and friends, ending up being the most socially isolated and unsupported group in the LGBTQI+ community [52]. Denial and blaming reactions to the violence by close relatives are embodied in the following fragments of interviews on Alessi, Kahn, and Chatterji's research [52] (p. 8): "I came home, and I started to cry at dinner. I got yelled at because, you know, I get yelled at by my asking me to just deal with it: you're a boy." Parents replying when they turn for support because they were victims of abuse like: "It is your problem. Why you, why you appear like, why your appearance looks like alien or Martian?" In cases where TNBAY had the chance to turn for support to intervene against transphobic violence in educational centers and they mediated with school officials, the reactions focused on dismissing the family intervention [51]. School staff responded to this protection in different ways, such as minimizing the violence or overlooking any kind of complaints or reports of suffering abuse in the institution, thus conducting a serious reproduction of the violence. In the case where TNBAY and their families turned to religious institutions where they belonged for support, these groups reinforced homophobia and transphobia at the family and social level, since any form of gender or sexual diversity was pictured as abominations or sins to be eradicated. Searching for support and protection in the family and in religious groups after suffering transphobic violence in educational centers is not an option, as they might not act or may even worsen the situation by reinforcing the violence. Losing trust and confidence in the surroundings seems to be a natural reaction for self-protection when no one seems to be able to stop the violence [51,52].

Coping with Distress after Suffering Transphobic Violence
Apart from losing trust for support, suffering violence has direct consequences on the health of TNBAY. Victims of transphobic violence have reported experiences of psychological distress in childhood, which extended into adulthood, as well as beliefs of being defective, sick, or demonically possessed, caused by the internalization of negative messages in educational centers. Aside from this, when peers, family members, and other community members alienate TNBAY, they provoke feelings of desperation in them as they feel no one is understanding and supporting them [51].
Adolescents and youth who are both transgender and female face transphobic violence in educational centers differently than others; they experience more feelings of humiliation, embarrassment, and anger when being treated unfairly, since they suffer discrimination for being both transgender and women [57], leading to transmisogynist forms of violence. Likewise, youth in educational centers who belong to a gender minority and to a sexual minority group are more vulnerable to depression or past-year depression [37]. Furthermore, nonbinary and youth who do not have a clear gender identity also have a heightened risk of depression in comparison with their peers, which highlights the social risk of suffering violence for those who do not fit into the binary system of gender identities. It has been proven that, when TNBAY suffer transphobic violence in educational centers, their psychological health and wellbeing needs raise, they develop feelings of being socially isolated and unhappy, and they show more psychological health problems [52]. In Watson's study [59], the risk of suffering from unhealthy and dangerous eating or weighing behaviors, such as binge eating and losing weight, seems to be very high for TNBAY, risking their health, wellbeing, self-esteem, and acceptance.
All these forms of health and wellbeing adversities can also have consequences for their lives and their performance in educational centers. Some of the victims of transphobic violence start experiencing a worsening of their grades or even not passing or graduating as a result of the discrimination and suffering they face. Others decide to switch schools, drop out, or try to avoid the violence and discrimination in their school [57]. Eventually, these psychological struggles also impact their social environment through loss of relationships and increasing isolation due to the violence and the pressure caused by transphobic violence [51].

Suicidal Thoughts, Planned or Attempted
Suicide seems to be a harsh but very common circumstance that affects TNBAY suffering transphobic violence. Transgender youth are at a particularly high risk of having suicide plans as a reaction to the violence [37]. Nonbinary and nondecisive gender identities also experience the risk of having past-year suicidal plans.
By studying suicide and its presence in the life of TNBAY due to the severity of transphobic violence, we describe how it might appear according to its intensity and form. On the one hand, suicidal thoughts are the most common manifestation of distress in the form of speculation of wanting to end life after years of cumulative abuses of transphobic violence [51,52,57]. These ideas of ending with the suffering become touchable when suicide seems to be the only option to escape transphobic violence. Their feelings of isolation, deep suffering, and lack of support are manifested as "wanting to disappear" and being "broken inside" [51]. On the other hand, some circumstances can worsen and deteriorate their wellbeing and escalate suicidal thoughts to another stage. Familiar emotional neglect and lack of school belonging can contribute to chronic suicidal attempts, as well as internalized self-stigma that can significantly contribute to suicidality of TNBAY victims in the past 6 months [53]. Transgender youth vulnerability is manifested as a high risk of suicidal attempts and reported past-year suicides [37], as a reaction to the cumulative abuse of transphobic violence in educational centers.

Possibilities to Prevent and Intervene in Cases of Transphobic Violence
When studying the problem of bullying in the educational system, research points to the possibility of prevention of violence or to overcome this discriminatory situation. When going further in the study of LGBTQ-phobic violence, expanding the focus by including both the study of prevalence and consequences of the violence and the transformation possibilities, we involve the entire educational community in the struggle of transforming education institutions [38,62]. In that sense, some indicators have been identified in the literature for the successful prevention and intervention of cases of distress and other forms of suffering by TNBAY. Several articles referred to the relevant role of family members, peers, school staff, and friends of the victims [52,53,56]. Their role was largely determined to be significant in the sections above, as they might be the perpetrators or passive witnesses in cases of violence against TNBAY. However, the most transformative factor attached to the social relations when studying transphobic violence in educational centers is the potentiality of these relations; in some cases, they may become supportive relationships and stop a situation of transphobic violence as shown by the bystander perspective [63][64][65].
Studies show how, from a very early age, support from parents and other family members when TNBAY start to question gender norms becomes essential in their self-acceptance and first reactions to their gender exploration experiences [51]. Similarly, peers have a very important role as classmates and partners in the prevention and intervention of this violence when witnessing and receiving experiences of suffering violence by other students [58]. Some articles demonstrate that the lack of knowledge, preparation, and skills in dealing with transphobic violence in educational centers is a major concern, especially when educational interventions may incur violence and discrimination against TNBAY [58,61]. For example, there were cases where victims reported violent episodes to school personnel and they did not receive any response, or perhaps victims were dismissed for not having proof, or adults never checked-in after transphobic violence incidents [58]. In other instances, victims suffered specific episodes of violence where their or other LGBTQ students' identity was disclosed to others without their permission (also known as "outing someone"). Due to this lack of confidence in careful and confidential interventions by school personnel, some victims decided not to talk about transphobic violence as they did not want to be "outed" to their family or peers, which could have deeper consequences in their life [58].
In this regard, TNBAY have developed significant and subtle actions against transphobic violent episodes to prevent them from happening. To maintain their self-worth and to make the educational center easier to cope with for themselves, some students decide to avoid people or situations and, when that is not possible or when the conflicts are too usual, they decide to ignore conflicts on gender issues regarding their own identity or expression. Moreover, victims decide to hide or lie regarding their gender identity, incurring invisibility of their transgender identities, another form of social violence [61]. In addition to this, results point to the importance of welcoming and supportive responses from school staff when being notified of experiences or reports of violence on the grounds of sexual orientation, gender identity, or gender expression. Intentions of seeking help and support are associated with lower levels of depressive symptoms in victims [54], and supportive and open school environments are strongly related to more positive results in transgender transitions, accompaniments, support, and acceptance in educational centers [60]. Circumstances as such need to be identified to start developing more successful strategies to identify, prevent, and intervene in cases of transphobic violence, to improve the quality of life of the victims, to make effective the right to equitable quality education, and to promote lifelong learning opportunities for all [1].
Work on the entire society is essential to ensure a better environment for future generations of TNBAY in both close social circles and educational contexts. Education on LGBTQI+ issues and gender perspective can help in the long-term prevention of a sociocultural problem that affects the life of transgender and nonbinary subjects in many spheres of their life, as demonstrated above. In this sense, education might lead to more sensitive and open environments in family contexts, in which the role of parenting and supporting the transgender and nonbinary kids seems unequivocal for a healthy gender transition in both family and school environments. It may prevent forms of violence within the family context, which have deep and strong consequences for the self-esteem and self-acceptance of TNBAY [52,53,56]. Additionally, it could provide healthy and supportive spaces for students to share and live gender and sexual orientation freely, which have a very positive influence on school climate, associated with lower psychological suffering and more help-seeking behaviors by victims [54]. Lastly, the implementation of consistent and critical and evidence-based training from a gender perspective and in the LGBTIQ+ reality for the school staff can prevent failures in the treatment of gender transitions, the reception of experiences of bullying, or the management of conflicts, some of the most common problems related to LGBTQI-phobic violence in educational centers [45,58].

Discussion
As argued in this literature review, the case of TNBAY presents very vulnerable conditions in educational institutions, given the high presence of violence and intolerance toward the diversity of sexual orientation, gender identity, and gender expression [4,[14][15][16][17]33]. The reality at educational centers grows more complex when approaching the prevalence of violence that takes place in classrooms affecting TNBAY [33,35]. Transphobic violence is where violent episodes threaten the life of those who do not follow the binary system of gender [4,33,36,37]. Accordingly, the results of the literature review point to the relevance of those who execute, assist, or witness the violence. At the same time, all the agents involved become perpetrators of the violence, and their roles need to be accounted for to understand and develop strategies to detect and intervene in cases of transphobic violence [51,52,57,58,61]. Additionally, the literature also remarks on the possible effects that sociocultural factors of victims and perpetrators may have on transphobic violence [37,[51][52][53][54][55][56][57][58][59]66]. What these findings demonstrate is the intricacy of the reality of TNBAY, the severe consequences of transphobic violence (because of the number of people involved in the violence), and the ramifications given by the sociocultural factors that can configure these repercussions. These results demonstrate the difficulties in tasks of detection, intervention, and prevention when victims and perpetrators coexist, share relationships and classrooms, and are deeply tied up in sociocultural relations of power in the educational institution.
Research limitations are also present in the study of this reality. The subjects of the violence are subjected to power and age implications; this impacts research in the sense that not all TNBAY may appear in the studies, because their gender identity or gender expression might be silenced or overpowered by their closest circle, as stated by the literature [51,52]. Thus, both educational centers and figures of tutorship, such as parents, tutors, or institutional custodians, become the two main figures of power to take into account when approaching transphobic violence.
According to the literature review carried out in this article, more efforts should be taken to protect the whole spectrum of gender identities in all social institutions, specifically those who refuse to fit into the binary gender norms in combination with diverse sexual orientations [27][28][29][30][31]. Evidence illustrates that transphobic violence affects more harshly and silently nonbinary identities and those transgender subjects who simultaneously belong to sexual minorities, affecting even more their confidence and trust in their surroundings [39,52,53]. They are also affected by more complex forms of violence, such as cyberbullying and a wider range of sexual violence and harassment in educational centers [51,52,57]. What is even more worrying is that these subjects are also more strongly exposed to and affected by various forms of distress, consequently leading to desires to end their life upon suffering transphobic violence [37,51,52,57,59], which can influence their health, education, and future. To combat this inequality, activist organizations and feminist and queer studies have proposed more critical and diverse education practices, as well as sensitive accompaniments to ensure safer transitioning processes and an improved coexistence in educational centers for TNBAY [67][68][69][70].
Our review was able to deeply analyze high-impact research studies, including experiences of TNBAY with different belongings, beliefs, sexual orientations, gender identities, and ethnicities. Such variety and diversity are crucial in the articulation of new strategies for the prevention of transphobic violence at educational centers. Most of the difficulties of this review were related to access to research articles under the selection criteria. There is a lack of studies focusing on primary and secondary education age groups (from 12 to 18 years old), particularly those focused on identifying effective strategies with social impact that have contributed to reducing TNBAY's suffering. Such limitations explain why percentages of violence against TNBAY are still very high around the world. However, these limitations have helped authors to reflect on the need to deepen their knowledge on the protective factors which can help TNBAY to be safe in educational institutions.
After including all these findings and contributions in prevention and intervention, it is demonstrated that there are specific practices that could eradicate the form of violence that threatens the life and education of adolescents and youth merely because of their gender identity and gender expression. Such a social problem, not effectively stopped by social institutions, might implicate different forms of discrimination, such as institutional violence, which has been recognized by the United Nations on the Declaration in the Elimination of Violence against Women [71], the Organization of American States at the "Belém do Pará" Convention [72], and the European Union at the Istanbul Convention [73]. For a more diverse, equal, and sustainable society [38], social and political agents are required to review the precedents of transphobic violence and work on successful possibilities for prevention, intervention, and accompaniments of TNBAY. On one hand, it is urgent to account for the involvement of agents in transphobic violence, as their role is essential in prevention and intervention strategies, as largely claimed in transgender studies [19,24,51,52,57,58,61,74]. Perspectives such as the bystander intervention propose a positive approach to educational centers arousing the community's responsibility to take part and intervene in cases of violence [63][64][65]. On the other hand, findings have illustrated how homophobia is tightly linked to transphobic violence in educational centers. Evidence has demonstrated how the external reading and expectations of gender and sexual orientation of TNBAY by others in educational centers carry the highest risk of suffering violence. This argues how homophobia and transphobia are repeatedly interconnected when studying violence affecting TNBAY, and it highlights the need for studying gender expression along with gender identity. This multiplicity and complexity of violence under the concept of transphobic violence needs to be fought and studied under an intersectional, transversal, and gender-sensitive approach in both research and intervention practices [9][10][11][12].
New perspectives would allow researchers and professionals to investigate the detection of transphobic violence and the transformation of social institutions to ensure the quality of life and education of adolescents and youth to freely express their gender [18,19,25,73]. Further research could explore the depth of transphobic violence and how this violence can alienate victims, affecting their agency and strength when facing it and trying to overcome it. Additionally, other research lines and policies need to be expanded concerning the implications and evaluation processes in social institutions. Moreover, they must approach the most effective and impactful strategies in the prevention of and intervention in this violence, ensuring the transformation of educational centers [75]. These lines of research would assess the level of implementation, impact, and difficulties in their application, issues which may help diagnose how educational institutions are managing the problem of transphobic violence.