Addressing lgbtq student bullying in massachusetts schools: Perspectives of lgbtq students and school health professionals - Reisner, Sari L.; Sava, Lauren M.; Menino, David D.; Perrotti, Jeff; Barnes, Tia N.; Humphrey, D. Layne; Nikitin, Ruslan V.; Earnshaw, Valerie A. (Prevention Science, 2020)
AbstractLesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth face disparities in bullying victimization are associated with higher rates of physical injury, psychological distress, and even suicide. Innovative strategies to address bullying victimization are needed to prevent adverse physical and mental health outcomes, including those engaging school health professionals (SHPs; school nurses, psychologists). This mixed-methods study sought to identify factors that facilitate or impede SHPs’ reporting and responding to LGBTQ bullying in Massachusetts from the perspectives of LGBTQ students and SHPs. Between August 2017 and July 2018, asynchronous online focus group discussions and a brief survey were conducted separately for 28 LGBTQ students and 19 SHPs in Massachusetts (9–12 participants per group; n = 47 enrolled). Focus groups probed on bullying experiences. Rapid qualitative inquiry was used for thematic coding of facilitators and barriers to address LGBTQ student bullying described by youth and SHPs. Facilitators and barriers largely coalesced around the social ecological model. Youth and SHPs identified factors at multiple levels of the social ecological model: (1) individual (knowledge, skills, attitudes); (2) interpersonal (trust and follow-through, confidentiality and fear of being 'outed,' close relationships, champion SHPs); and (3) structural (school buy-in, time, reporting and protocols, staff roles, resources, and school culture of inclusivity). LGBTQ students expressed a need for an intersectional lens for SHPs when addressing LGBTQ student bullying. Interventions that help SHPs overcome multilevel barriers and leverage facilitators are needed. Consideration of intersectionality will better equip SHPs to support LGBTQ students and address disparities in LGBTQ student bullying that confer health risks. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual and gender minorities; Adolescent; Schools; Public health; Bullying; No terms assigned

Sexual orientation and suicide attempt disparities among US adolescents: 2009–2017 - Raifman, Julia; Charlton, Brittany M.; Arrington-Sanders, Renata; Chan, Philip A.; Rusley, Jack; Mayer, Kenneth H.; Stein, Michael D.; Austin, S. Bryn; McConnell, Margaret (Pediatrics, 2020)
Background: Sexual minority adolescents face mental health disparities relative to heterosexual adolescents. We evaluated temporal changes in US adolescent reported sexual orientation and suicide attempts by sexual orientation. Methods: We used Youth Risk Behavioral Surveillance data from 6 states that collected data on sexual orientation identity and 4 states that collected data on sex of sexual contacts continuously between 2009 and 2017. We estimated odds ratios using logistic regression models to evaluate changes in reported sexual orientation identity, sex of consensual sexual contacts, and suicide attempts over time and calculated marginal effects (MEs). Results: The proportion of adolescents reporting minority sexual orientation identity nearly doubled, from 7.3% in 2009 to 14.3% in 2017 (ME: 0.8 percentage points [pp] per year; 95%confidence interval [CI]: 0.6 to 0.9 pp). The proportion of adolescents reporting any same-sex sexual contact increased by 70%, from 7.7% in 2009 to 13.1% in 2017 (ME: 0.6 pp per year; 95% CI: 0.4 to 0.8 pp). Although suicide attempts declined among students identifying as sexual minorities (ME: 20.8 pp per year; 95% CI:21.4 to 20.2 pp), these students remained > 3 times more likely to attempt suicide relative to heterosexual students in 2017. Sexual minority adolescents accounted for an increasing proportion of all adolescent suicide attempts. Conclusions: The proportion of adolescents reporting sexual minority identity and same-sex sexual contacts increased between 2009 and 2017. Disparities in suicide attempts persist. Developing and implementing approaches to reducing sexual minority youth suicide is critically important. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual orientation; suicide attempt; trends; Adolescent; Female; Health Status Disparities; Humans; Male; Sexual Behavior; Suicide, Attempted; Time Factors; United States; Attempted Suicide; Risk Factors; Sexual Orientation; Trends; Sexual Minority Groups; Adolescent Development; Gender Identity; Heterosexuality

Transgender adolescents' uses of social media for social support - Selkie, Ellen; Adkins, Victoria; Masters, Ellie; Bajpai, Anita; Shumer, Daniel (Journal of Adolescent Health, 2020)
Purpose: Transgender adolescents are at higher risk for negative mental health outcomes, such as depression, anxiety, and suicidality, compared with cisgender adolescents. Social media may be an effective venue for addressing these health disparities because most adolescents have access to online information and socialization. This study used qualitative inquiry to explore transgender adolescents' uses of social media for social support. Methods: Transgender adolescents between the ages of 15 and 18 years with a social media profile were recruited from a pediatric gender clinic in the Midwestern U.S. A 30- to 60-minute semistructured interview assessed ways participants used social media to access transgender-related support. Thematic analysis was used to develop categories and code the transcripts. Coding discrepancies were resolved by two researchers following initial coding. Results: Results represent data from 25 interviews comprising 13 transmasculine, 11 transfeminine, and one nonbinary participant(s), with 68% of the sample identifying as white, non-Hispanic. Categories emerged regarding forms of support participants received from transgender-related online communities including emotional support through peers and role models, appraisal support for validating their experiences, and informational support for navigating health decisions and educating family and friends. Participants also referenced negative experiences, including harassment and exclusionary behavior online. Conclusions: Social media platforms represent hubs of community for transgender adolescents. These communities provide emotional, appraisal, and informational support that transgender youth may not otherwise be able to access. Future research should use the affordances of social media to identify approaches to addressing health disparities and improving the well-being of transgender adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Qualitative; Transgender; FTM; MTF; Social support; Mental health; Well-being; Social media; Adolescent; Youth; Internet; Mental Health; Social Support; Health Disparities; Transgender; Social Media; Cognitive Appraisal; Well Being; Adolescent Characteristics

School climate & sexual and gender minority adolescent mental health - Colvin, Sharon; Egan, James E.; Coulter, Robert W. S. (Journal of Youth and Adolescence, 2019)
Sexual/gender minority (Sexual/gender minority people are also referred to as Lesbian, Gay, Bisexual, Transgender, Queer) youth are more likely than cisgender heterosexual youth to exhibit depressive symptoms and be victimized. School climate research indicates that the presence of a Gay–Straight Alliance (a Gay–Straight Alliance or Gender-Sexuality Alliance is also referred to as a GSA and is a youth group to support sexual/gender minority youth), a supportive school climate, and seeking help from teachers are associated with more positive mental health outcomes; however, they are not typically measured together. This study uses a survey that measures all four measures of school environment with a national sample of 240 sexual/gender minority high school students ages 14–18 (mean age 15.77) where 53% of participants had a Gay–Straight Alliance in their school. The sample is 53% cisgender, 100% sexual minority and 62% white. Adjusting for demographics and presence of a Gay–Straight Alliance, fewer depressive symptoms were associated with lower help-seeking intentions for suicidal thoughts. The presence of Gay–Straight Alliance was not statistically associated with past-month help-seeking intentions or behaviors. Additionally, a more supportive school climate was associated with lower anxiety and depressive symptoms. However, the presence of a Gay–Straight Alliance was not statistically associated with anxiety or depressive symptoms. These findings suggest that a supportive school climate and supportive school personnel may be important for supporting the mental health of sexual/gender minority students. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Adolescent mental health; School climate; Health disparities; Sexual and gender minority youth; Help Seeking Behavior; Major Depression; Mental Health; School Environment; Adolescent Health; Anxiety; Intention; Lesbianism; Minority Groups; Test Construction; Health Disparities

Integrating minority stress theory and the interpersonal theory of suicide among sexual minority youth who engage crisis services - Fulginiti, Anthony; Goldbach, Jeremy T.; Mamey, Mary Rose; Rusow, Joshua; Srivastava, Ankur; Rhoades, Harmony; Schrager, Sheree M.; Bond, David W.; Marshal, Michael P. (Suicide and Life-Threatening Behavior, 2020)
Objective The present study sought to integrate minority stress theory (MST) and the interpersonal theory of suicide (ITS) to better understand high rates of suicide among sexual minority youth (SMY). To date, the ITS and MST have largely advanced independently from one another even though the research base for each theory contains gaps that the other theory may help fill. Method Using data from a national sample of 564 SMY (aged 12–24) recruited from an LGBTQ youth‐focused suicide crisis prevention provider, we examined structural equation models to understand how perceived burdensomeness and thwarted belongingness mediate the relationship between minority stress and suicidal ideation and attempt. Results Sexual minority stress was significantly associated with both perceived burdensomeness and thwarted belongingness in models predicting suicidal ideation and attempt. Moreover, minority stress had a direct effect on suicide attempt and an indirect effect on both suicidal ideation and suicide attempt through burdensomeness. Conclusions Given that minority stress is associated with greater thwarted belongingness, perceived burdensomeness, and suicide attempts, there should be greater demand for continuing education centered on sexual minority populations and population‐specific services. Identifying burdensomeness as a minority stress–suicide mechanism highlights the potential gains of piloting recently developed burdensomeness interventions among SMY. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: minority stress theory; interpersonal theory of suicide; sexual minority youth; No terms assigned

Trans adolescents’ perceptions and experiences of their parents’ supportive and rejecting behaviors - Johnson, Kelly C.; LeBlanc, Allen J.; Sterzing, Paul R.; Deardorff, Julianna; Antin, Tamar; Bockting, Walter O. (Journal of Counseling Psychology, 2020)
Transgender (trans) adolescents consistently report higher rates of adverse mental health outcomes compared to their cisgender peers. Parental support is a recognized adolescent protective factor; however, little is known about the specific parental behaviors that trans adolescents perceive as most or least supportive. To address this gap, we analyzed data from qualitative interviews conducted with an ethnically diverse, urban-based sample of trans adolescents (N = 24; 16–20 years old) to describe (a) the spectrum of specific parental behaviors across 3 categories—rejecting, supportive, and mixed (i.e., simultaneous supportive and rejecting behaviors)—and (b) the perceived psychosocial consequences across these 3 categories of parental behaviors. Qualitative data were gathered through lifeline interviews (i.e., visual representations from birth to present) and photo elicitation (i.e., photographs representing parental support and/or rejection). Supportive behaviors included instances where parents made independent efforts to learn about trans issues or help their child obtain gender-affirming health care. Rejecting behaviors included instances when parents refused to use their child’s name or pronouns or failed to show empathy when their child struggled with gender-identity-related challenges. Mixed behaviors included examples when parents expressed support of their child’s gender identity, but not of their sexual orientation (or vice versa). Overall, participants reported that rejecting and mixed parental behaviors contributed to a range of psychosocial problems (e.g., depression and suicidal ideation), while supportive behaviors increased positive wellbeing. These findings expand upon descriptions of parental support and rejection within the trans adolescent literature and can help practitioners target specific behaviors for interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: transgender; adolescents; parental support; gender nonbinary; mental health; Adolescent Attitudes; Mental Health; Parental Investment; Social Support; Transgender; Experiences (Events); Parents; Protective Factors; Social Acceptance

Group sex, suicidality and online partners: Implications for hiv and suicide prevention: A short report - Kongjareon, Yamol; Samoh, Nattharat; Lim, Sin How; Peerawaranun, Pimnara; Jonas, Kai J.; Guadamuz, Thomas E. (AIDS Care, 2020)
HIV-related factors and suicide-risk status were assessed among YMSM aged 18–24 years recruited through various MSM-related online social apps in Bangkok (N = 1394). The online survey assessed demographic characteristics, sexual behaviours and suicide-risk status. Measure of suicide risk was taken from the Suicidal Behaviors Questionnaire-Revised (cut-off score of seven or higher). Among participants, 249 (17.9%) reported suicide-risk. In multivariable logistic regression, correlates of suicide-risk status included having sometimes or often ever participated in group sex (AOR=1.58, 95% CI: 1.17–2.14), having received money or opportunities for sex (AOR=1.54, 95% CI: 1.09–2.17), often seeking partners online (AOR=1.59, 95% CI: 1.05–2.39), inconsistent condom use (AOR=1.67, 95% CI: 1.26–2.21), and self-assessed as having 'medium' or 'high' HIV risk (AOR=2.53, 95% CI: 1.61–3.98 and AOR=3.35, 95% CI: 1.92–5.82, respectively). Findings suggest that HIV risk behaviours shown by YMSM are significantly associated with higher risk of suicide. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicide-risk; sexual behaviour; HIV/AIDS; YMSM; Thailand; No terms assigned

Interpersonal psychotherapy for gender dysphoria in a transgender woman - Barbisan, Guilherme Kirsten; Moura, Daniel Heidemman; Lobato, Maria Inês Rodrigues; da Rocha, Neusa Sica (Archives of Sexual Behavior, 2020)
We present a case of a 32-year-old natal male seeking medical follow-up care, due to gender dysphoria (GD) along with other complaints (depressive symptoms, anxiety, and suicidal ideation). The attending team chose interpersonal psychotherapy (IPT), with a focus on role transition in order to help her. The patient presented a favorable trajectory throughout treatment and demonstrated personal growth one year after treatment. To our knowledge, little was found in the literature on the use of IPT in the treatment of those with GD; we also did not find any other publication or case report using IPT exclusively to treat the problems accompanying role transition. Psychotherapy was not intended to change the gender identity of this individual. However, further studies will be required to explore possible benefits of IPT for GD treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Interpersonal psychotherapy; Gender dysphoria; Role transition; Gender identity; Psychotherapy; Adult; Gender Dysphoria; Gender Identity; Humans; Interpersonal Psychotherapy; Male; Transgender Persons; Gender Identity; Interpersonal Psychotherapy; Psychotherapy; Transgender; Gender Dysphoria; Anxiety; Major Depression; Symptoms

Sexual minorities and teen suicide attempts in a southeastern state with prominent exclusionary policies - Richardson, Sonyia Copeland; Hales, Travis; Meehan, Erin; Waters, Abby (Death Studies, 2020)
This study examines differences in suicide-related behaviors between heterosexual and sexual minority youth in a southeastern state with exclusionary policies. Furthermore, it seeks to further knowledge regarding risk factors for suicide attempts among sexual minority high school students. Utilizing the 2017 Youth Risk Behavior Survey data, descriptive analysis tests, and logistic regression tests were conducted. Findings indicate that sexual minorities were three times as likely to experience suicidal thoughts and plans but four times as likely to attempt suicide. Risk factors were noted for sexual minority youth. Policy advocacy is recommended to decrease suicide-related behaviors among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

Verbal victimisation, depressive symptoms, and suicide risk among sexual minority adults in france: Results from the nationally-representative 2017 health barometer survey - El-Khoury, Fabienne; Heron, Mégane; Van der Waerden, Judith; Leon, Christophe; du Roscoat, Enguerrand; Velter, Annie; Lydié, Nathalie; Sitbon, Audrey (Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 2020)
AbstractPurposeOur study estimates rates of depressive symptoms and suicide risk according to sexual minority status, and examines the mediating effect of verbal victimisation in the association between sexual minority status and mental health outcomes.MethodAnalysis is based on data from the 2017 French Health Barometer, a general population phone survey, which recruited 25,198 adults aged 18–75 years. Data were weighted to be representative of the French adult population. Four mental health outcomes occurring in the preceding year or currently were examined in relation to sexual minority status using multivariate logistic regressions: (a) current depressive symptoms, (b) having experienced a major depressive episode, (c) suicidal ideation, and (d) suicide attempt. Further we conducted mediation analyses to evaluate the contribution that verbal victimisation experienced in the preceding year has in the association between sexual minority status and the listed outcomes. All analyses were also stratified by sex.ResultsSexual minority adults were more likely to experience verbal victimisation in the last year compared to heterosexual individuals (22% vs 11.4%). They were also more likely to have experienced each of the four mental health outcomes, even after adjusting for potential confounders. In adjusted mediation analysis, verbal victimisation in the preceding year was found to significantly mediate the association between sexual orientation and mental health outcome with mediated proportions varying between 15 and 22%.ConclusionSexual minority individuals are more at risk of depressive symptoms and suicidal ideation compared to heterosexuals, and this may be partially mediated by verbal victimisation. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual minority; Depressive symptoms; Minority stress; Suicidal ideation; Verbal victimisation; LGB; No terms assigned

The relationship between suicide-related exposure and personal history of suicidal behavior in transgender and gender-diverse veterans - Tucker, Raymond P.; Pardue-Bourgeois, Sarah; Snow, Annie; Bradstreet, Mike; Cerel, Julie (LGBT Health, 2019)
Purpose: Transgender and gender-diverse (TGD) veterans experience a high prevalence of suicidal thoughts and behaviors (STBs). Within the general U.S. population, suicide-related exposure is an identified risk factor for STBs. This study explores the impact of suicide-related exposure in TGD veterans. Methods: Self-identified TGD veterans (n = 195) completed an online cross-sectional survey that included self-report measures of suicide-related exposures, experience of past-year suicidal ideation (SI), and history of suicide attempt (SA)(s). Results: A considerable number of respondents indicated that they were close to someone who attempted suicide (40.5%) or died by suicide (32.8%). When asked about the gender identity of decedents, 6.7% indicated that at least one individual was TGD and 18.5% indicated knowing at least one close TGD individual who attempted suicide. Exposure to SA and to suicide were both independently related to a history of at least one SA. Neither type of suicide exposure was related to past year SI. Participants exposed to the SA of a close TGD individual were more likely to report past-year SI than those not exposed. Conclusion: TGD veterans may be more vulnerable to suicidal behaviors if suicide-related exposures are experienced. Public health suicide prevention initiatives, both inside and outside of the TGD community, may help to reduce suicide in these veterans. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: gender diverse; suicide; suicide exposure; transgender; veteran; Adult; Cross-Sectional Studies; Female; Gender Identity; Humans; Male; Prevalence; Risk Factors; Self Report; Sexual and Gender Minorities; Social Environment; Suicidal Ideation; Suicide, Attempted; Transgender Persons; Transsexualism; United States; Veterans; Attempted Suicide; Suicidal Ideation; Transgender; Exposure; Gender Nonconforming; Military Veterans; Suicide; Suicide Prevention

A systematic review of Unified Protocol applications with adult populations: Facilitating widespread dissemination via adaptability - Cassiello-Robbins, Clair; Southward, Matthew W.; Tirpak, Julianne Wilner; Sauer-Zavala, Shannon (Clinical Psychology Review, 2020)
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was designed to be a flexible, evidence-based intervention that could treat a wide range of emotional disorders. The purpose of this systematic review is to summarize (1) the range of presenting problems to which the UP has been applied with adult patients, and (2) the settings in which the protocol has been used, as well as any modifications made to it. Using PRISMA guidelines, we conducted a literature search of PsychInfo, PubMed, Proquest Dissertations and Theses, and Web of Science. The 77 studies included in this review indicated the UP has been applied to a wide range of presenting problems including anxiety, depressive, bipolar, traumatic-stressor, substance use, eating, borderline personality, insomnia, and physical health disorders. Additionally, the UP has been applied to non-diagnosable problems such as non-suicidal self-injury, subclinical presentations, and sexual minority stress. The strongest base of evidence for the UP is among Caucasian females in the United States with anxiety-related or depressive disorders. Numerous adaptions of the UP were present in the literature. Overall, results suggest the UP can be flexibly applied to a range of diagnostic presentations. However, many studies reviewed were preliminary and further research is needed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Unified Protocol for Transdiagnostic Treatment of Emotional Disorders; Systematic review; Treatment; Treatment Guidelines; Emotional and Behavioral Disorders

Research note on whether sexual minority individuals are over-represented among suicide's casualties - Feigelman, William; Plöderl, Martin; Rosen, Zohn; Cerel, Julie (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2020)
Background: Past studies have repeatedly shown higher suicidal thoughts and attempts among sexual minority members, yet have remained opaque on whether these groups are more prone to taking their own lives. Aims: This short report focuses on suicide deaths among sexual minority members. Method: We utilized two large-scale surveys: one, among adults, the updated Cumulative General Social Surveys, and the other, among adolescents, The National Longitudinal Study of Adolescent Health (Add Health), where respondents' data were cross-linked to National Death Index death records. Results: Results confirmed pre-existent findings showing elevated suicide rates among sexual minority females but not among sexual minority males. Limitations: The shortfall of female adolescent suicides in the Add Health sample prevented us from examining the question of female sexual minority suicides within this population. Conclusion: Although ample evidence demonstrates higher suicidal thoughts and attempts among sexual minority males, three studies presently do not confirm their greater propensity to die by suicide, compared with heterosexual males; yet, for sexual minority females the evidence is steadily mounting showing their greater suicide risks. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; sexual minority members; gay/lesbian/bisexual suicides; Death and Dying; Homosexuality; Minority Groups; Mortality Rate; Suicide; Attempted Suicide; Bisexuality; Lesbianism; Male Homosexuality; Suicidal Ideation; Adolescent Health

Predictors of suicidal ideation and attempts among LGBTQ adolescents: The roles of help-seeking beliefs, peer victimization, depressive symptoms, and drug use - Hatchel, Tyler; Ingram, Katherine M.; Mintz, Sasha; Hartley, Chelsey; Valido, Alberto; Espelage, Dorothy L.; Wyman, Peter (Journal of Child and Family Studies, 2019)
Objectives: Suicide is a leading causes of death for adolescents, and is a developmental period with the highest rates of suicide attempts. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are a high-risk population for suicidal ideations and behaviors when compared with their non-LGBTQ counterparts. However, a dearth of research exists on the protective factors for suicidal ideation and attempts specifically within the LGBTQ population. The current study proposes a model in which peer victimization, drug use, depressive symptoms, and help-seeking beliefs predict suicidal ideation and attempts among a statewide sample of LGBTQ adolescents. Methods: Among 4867 high school students in 20 schools, 713 self-identified as LGBTQ and had higher rates of attempts and ideation than their non-LBGTQ peers. Two logistic regression analyses were used to predict suicidal ideation and attempts among the 713 LGBTQ students (M = age 15 years). Results: Results indicated that intentions to use drugs, peer victimization, and elevated depressive symptoms predicted both suicidal ideation and attempts. Additionally, help-seeking beliefs predicted suicidal attempts but not ideation, while the interaction of help-seeking beliefs and depressive symptoms significantly predicted suicidal ideation. Conclusions: These findings underscore the importance of increasing access to effective treatment services for depression and promoting safe and accepting school and community cultures for LGBTQ youth in particular. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Suicidal ideation; Suicidal behaviors; LGBTQ youth; Substance use; Aggression; Help Seeking Behavior; Major Depression; Peer Relations; Suicidal Ideation; LGBTQ; Drug Usage; Victimization

AWARENESS: Development of a cognitive–behavioral intervention to address intersectional minority stress for sexual minority men living with HIV who use substances - Flentje, Annesa (Psychotherapy, 2020)
Sexual minority (i.e., nonheterosexual) individuals are at greater risk than heterosexual individuals for substance use and poor mental health attributed to exposure to minority stress (Meyer, 2003). Minority stress is stress that places an additional burden on sexual minority people over and above the stress experienced by heterosexual people. Sexual minority men may also be subject to minority stress related to intersecting identities or individual characteristics (e.g., HIV status, race). This study obtained initial feedback about the AWARENESS intervention from sexual minority men living with HIV who use substances and determined the feasibility of the intervention to address minority stress related to intersecting identities. AWARENESS is a 9-session cognitive–behavioral intervention targeting minority stress as a driver of greater substance use and poorer mental and physical health. Ten sexual minority men living with HIV who were episodic substance users (>1 episode of illicit drug use or binge drinking in the previous 3 months) began the intervention. Feedback on the intervention was obtained through open-ended interviews analyzed using thematic analysis and Likert scale questionnaires about experiences with the intervention. Therapists tracked identities discussed in relation to minority stress to evaluate feasibility of AWARENESS to address intersectional minority stress. Participants identified they gained cognitive–behavioral skills to cope with intersectional minority stress and described destigmatization and integration of identities. Participants discussed an average of 3.2 identity characteristics in addition to sexual minority status in relation to intervention content. This study lays the groundwork for additional testing of this intervention. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: cognitive– behavioral; sexual minority; minority stress; individual intervention; substance use; Awareness; HIV; Intervention; Minority Groups; Minority Stress; Bisexuality; Cognitive Behavior Therapy; Drug Usage; Gender Identity; Male Homosexuality; Sexual Minority Groups

Sexual orientation disparities in mental health and substance use among Black American young people in the USA: Effects of cyber and bias-based victimisation - Mereish, Ethan H.; Sheskier, Mikela; Hawthorne, David J.; Goldbach, Jeremy T. (Culture, Health & Sexuality, 2019)
Few studies have explored sexual orientation disparities in mental health and substance use outcomes among racial minorities. This study examined sexual orientation disparities in depression, suicidality and substance use among Black American young people in the USA, and the mediating role of cyber and bias-based victimisation in accounting for these disparities. Secondary analyses were performed on data from a probability sample of young people (N = 1,129) collected in a school district in the south-eastern USA. Participants reported socio-demographics, depressive symptoms, suicidality, substance use and experiences of bias-based and cyber victimisation. With some exceptions, Black participants who were lesbian, gay, bisexual or mostly heterosexual reported higher rates of depression, suicidal ideation, suicide planning and substance use than Black heterosexual participants. Black lesbian, gay, bisexual and mostly heterosexual participants reported more cyber and bias-based victimisation than Black heterosexual participants. Sexual orientation disparities in mental health and, to some extent, substance use were partially explained by both forms of victimisation. Further research is needed to address the role of bias-based and cyber victimisation in disparities in mental health and substance use among Black sexual minority young people. The present study carries implications for prevention and treatment efforts for racially diverse sexual minorities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: sexual minority; Black; adolescents; victimization; mental health; substance use; Blacks; Drug Usage; Mental Health; Minority Groups; Sexual Orientation; Major Depression; Racial and Ethnic Differences; Victimization; Cyberbullying; Suicidality

Documentation practices for transgender youth admitted to an inpatient psychiatric unit - Bieber, Ewa D.; Vande Voort, Jennifer L.; Croarkin, Paul E.; Von Drehle, Casey T.; Simon, Sue M.; Hopp, Brianna N.; Heil, Hollie M.; Romanowicz, Magdalena (Journal of Psychiatric Practice, 2020)
Background: Population-based surveys estimate that 0.7% of youth (13 to 17 y of age) in the United States identifies as transgender. Transgender youth are at an increased risk of anxiety, depression, and suicide attempts that often require inpatient care. Unfortunately, because of perceived insensitivity to gender identity from their providers, which includes incorrect use of names and/or pronouns, they may delay seeking necessary care. To date, there have been no specific documentation practice guidelines published by the International Association of Child and Adolescent Psychiatry and Allied Professions, American Academy of Child and Adolescent Psychiatry (AACAP), or other professional associations. The main goal of this study was to review documentation practices among multidisciplinary teams caring for hospitalized transgender youth on a child and adolescent inpatient psychiatry unit. Methods: Retrospective chart reviews were completed for 44 transgender patients who were hospitalized between 2008 and 2017. The charts were reviewed for consistency in the documentation of name and gender by the multidisciplinary team. Members included child and adolescent staff psychiatrists, residents, fellows, nurses, nurse practitioners, physician assistants, and social workers. Inconsistency was defined as at least 2 members of the team referring to a patient by a different name and/or gender pronoun in separate notes or > 2 interchanges of name and/or gender pronoun in a single note. Kappa coefficient was calculated between each team member role to estimate exact agreement statistics. Results: In 43.2% (n = 19) of cases, team members did not have a consistent approach to documenting a patient’s name and/or gender pronoun and 18% (n = 8) of discharge summaries were also inconsistent in this documentation. The greatest agreement in documentation practices was noted between the team and the staff psychiatrist (κ = 0.446). Conclusions: Findings from this study suggest that inpatient treatment teams show inconsistency in documentation practices for youth transgender inpatients. Further work is necessary to understand the implications of these findings for patient satisfaction and clinical outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: documentation practices; gender identity disorder; inpatient psychiatry; child and adolescent psychiatry; multidisciplinary care; Mental Health Personnel; Names; Pronouns; Psychiatric Hospital Admission; Transgender; Adolescent Psychiatry; Child Psychiatry; Interdisciplinary Treatment Approach; Psychiatrists; Gender Dysphoria

'I never saw a future': Childhood trauma and suicidality among sexual minority women - Creighton, Genevieve M.; Oliffe, John L.; Broom, Alex; Rossnagel, Emma; Ferlatte, Olivier; Darroch, Francine (Qualitative Health Research, 2019)
While a significant health concern for sexual minority women, there is little qualitative research investigating their experiences of childhood trauma and suicidality. In this study, we used photovoice methods and an intersectionality framework. Drawing on qualitative interviews, we inductively derived three themes (a) Traumatized and discredited, (b) Cascading marginality, estrangement, and suicidality, (c) Reconstruction and reclaiming resilience. In Traumatized and discredited, we describe the sense of abandonment flowing from childhood trauma heightened by a lack of protection and neglect on the part of parents/guardians. The lack of support to deal with childhood trauma and the layering effects of marginality characterizes the theme Cascading marginality, estrangement, and suicidality. In the third theme, we discuss strategies for reconstruction and reclaiming resilience as participants worked to overcome these challenging experiences. Our study findings offer guidance to suicide prevention counseling programs for sexual minority women and affirm actions to address health inequities. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Canada; women’s health; suicide; trauma; mental health and illness; gays and lesbians; bisexuals; qualitative methods; photography; photovoice; qualitative; Child Abuse; Mental Health; Trauma; Suicidality; Lesbianism; Resilience (Psychological); Suicide Prevention; Sexual Minority Groups

Using photovoice to understand suicidality among gay, bisexual, and two-spirit men - Ferlatte, Olivier; Oliffe, John L.; Salway, Travis; Broom, Alex; Bungay, Victoria; Rice, Simon (Archives of Sexual Behavior, 2019)
This study explored the drivers of suicidality from the perspectives of gay, bisexual, and two-spirit men (GB2SM) with a history of suicidality. Twenty-one GB2SM participated in this photovoice study taking photographs to depict and discuss their previous suicidality. Data were collected from in-depth individual interviews in which participants discussed their photographs and in turn offered verbal/narrative accounts of suicidality. Drawing on intersectionality, analyses of the photographs and interview data revealed three interconnected themes. First, adverse childhood events and negative adolescent experiences were described as the root causes of mental health struggles and suicidality. Second, violence and homophobia had disrupted these men’s education and employment opportunities and some participants detailed how their lack of capital and challenges for maintaining employment shaped their suicidality. Third, a sociality of stigma and sense of isolation compounded experiences of suicidality. The three themes overlapped and were shaped by multiple intersectional axes including sexuality, class, ethnicity, and mental health status. The findings have implications for services and health professionals working with GB2SM who need to thoughtfully consider life-course trajectories and multiple social axes when assessing and treating GB2SM experiencing suicidality. More so, because these factors relate to social inequities, structural and policy changes warrant targeted attention. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Male suicide; Intersectionality; Photovoice; Gay and bisexual men’s health; Sexual orientation; Bisexuality; Male Homosexuality; Mental Health; Sexual Orientation; Suicidality; Photographs

Characterizing the phenomenology of passive suicidal ideation: A systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation - Liu, Richard T.; Bettis, Alexandra H.; Burke, Taylor A. (Psychological Medicine, 2020)
Background: Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear. Methods: We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO. Results: A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons. Conclusions: Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Epidemiology; suicidal ideation; suicide; phenomenology; psychiatric comorbidity; passive suicidal ideation; active suicidal ideation; Comorbidity; Epidemiology; Mental Disorders; Phenomenology; Suicidal Ideation; Suicide

Suicide risk for sexual minorities in middle and older age: Evidence from the national survey on drug use and health - Capistrant, Benjamin D.; Nakash, Ora (The American Journal of Geriatric Psychiatry, 2019)
Objective: No studies have estimated the difference in suicidal ideation, plans, and attempts for lesbian, gay, or bisexual (LGB) adults aged 50+ compared with heterosexuals using nationally representative data. Methods: We used 2015–2017 National Survey on Drug Use and Health data to estimate the prevalence of self-reported suicidal ideation, plans, and attempts for LGB adults 50+ compared with heterosexuals in the preceding 12 months. Results: Over 185,000 LGB adults aged 50+ in the United States were estimated to have had suicidal ideation in the preceding year. After adjusting for sex and race/ethnicity, LGB individuals aged 50+ had a 4.5 percentage point higher prevalence of suicidal ideation compared with heterosexuals (prevalence difference [PD]: 0.045; 95% confidence interval [CI]: 0.022, 0.067). Of those with suicidal ideation, LGB individuals aged 50+ had a 17.2 percentage point higher prevalence of suicide plans compared with heterosexuals (PD: 0.172; 95% CI: 0.011, 0.332). Conclusion: LGB adults in middle and older age have higher suicidal ideation and plans than heterosexual peers. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Aged; middle-aged; sexual and gender minorities; suicide; suicidal ideation; Aged; Cross-Sectional Studies; Female; Health Surveys; Humans; Male; Middle Aged; Prevalence; Sexual and Gender Minorities; Suicidal Ideation; Suicide, Attempted; United States; Developmental Stages; Epidemiology; Suicidal Ideation; Suicide; Sexual Minority Groups; Age Differences; Aging; At Risk Populations; Human Sex Differences; Sexual Orientation; Test Construction

Creative identity (re)Construction, creative community building, and creative resistance: A qualitative analysis of queer ingroup members' tweets after the Orlando Shooting - Jenkins, Elizabeth M.; Zaher, Zulfia; Tikkanen, Stephanie A.; Ford, Jessica L. (Computers in Human Behavior, 2019)
With the proliferation of social media, a growing body of literature explores the significance of virtual grief, social support, and social capital in the construction of identity and community online. However, there is a dearth of research on how queer members use social media, particularly Twitter, as a tool to claim and re-define their identity—especially when their identity is under threat. The goal of this study is to understand how members of the queer community linguistically responded to the threat to their identity and safety that was caused by the shooting that took place on June 12, 2016, at the Pulse Nightclub in Orlando, Florida. To achieve this goal, we use Social Identity Theory (SIT) as a framework to examine how queer individuals use a creative language strategy to redefine their shared identity when it is threatened. This study used a qualitative iterative analysis of tweets posted by queer individuals to determine how this group identified as ingroup after the Orlando shooting. The study reveals that members of the queer community communicatively responded to the Pulse shooting through social creativity. Specifically, members of the queer community responded to threats through using creative language that fostered stronger ingroup collaborative identities by provoking a) creative identity (re)construction, b) creative community building and c) creative resistance. This study advances SIT by providing additional evidence that the strategy of using creative language by a minority ingroup has the ability to support simultaneously salient and threatened identity. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Social identity theory; Orlando shooting; Queer; Tweets; Social creativity; Creativity; Homosexuality; Social Identity; Social Media; Ingroup Outgroup; Threat; Online Community; Gun Violence

Suicidality among gay and bisexual men in Taiwan: Its relationships with sexuality and gender role characteristics, homophobic bullying victimization, and social support - Wang, Peng-Wei; Ko, Nai-Ying; Hsiao, Ray C.; Chen, Mu-Hong; Lin, Huang-Chi; Yen, Cheng-Fang (Suicide and Life-Threatening Behavior, 2019)
This study aimed to examine the associations of suicidality in emerging adulthood with time of coming out, gender role nonconformity, sexual orientation, traditional and cyber homophobic bullying victimization, and family and peer support during childhood in gay and bisexual men in Taiwan. The frequency of 'experiencing suicide ideation' and 'attempting suicide' in the past year among 500 gay or bisexual men was examined. The participants’ time of coming out, level of subjective masculinity, sexual orientation, experiences of traditional and cyber homophobic bullying victimization, and levels of family and peer support during childhood were also evaluated. In total, 31% (n = 155) of participants reported experiencing suicide ideation (n = 82) or attempting suicide (n = 73). Early coming out, traditional homophobic bullying victimization, and low family support during childhood increased the risk of suicidality in emerging adulthood; by contrast, family support did not moderate the association of early coming out or traditional bullying victimization with current suicidality. A high proportion of participants reported experiencing suicide ideation and attempt in emerging adulthood. Hence, effective suicide prevention is required for gay and bisexual men. Suicide prevention programs should consider time of coming out, traditional homophobic bullying victimization, and level of family support. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicidality; gay men; bisexual men; sexuality; gender role characteristics; homophobic bullying victimization; social support; emerging adulthood; suicide ideation; attempting suicide; Adult; Bisexuality; Bullying; Crime Victims; Gender Identity; Homophobia; Homosexuality, Male; Humans; Male; Sexual and Gender Minorities; Social Support; Suicidal Ideation; Suicide; Suicide, Attempted; Surveys and Questionnaires; Taiwan; Young Adult; Homosexuality (Attitudes Toward); Social Support; Victimization; Bullying; Suicidality; Attempted Suicide; Bisexuality; Male Homosexuality; Sex Roles; Sexuality; Suicidal Ideation; Emerging Adulthood

The presenting concerns of transgender and gender nonconforming clients at university counseling centers - Platt, Lisa F. (The Counseling Psychologist, 2020)
There is a paucity of research on transgender and gender nonconforming (TGNC) students who present to university counseling centers (UCCs). Using national-level data from the Center for Collegiate Mental Health (2012 to 2015), the current findings indicate that TGNC students seeking services at UCCs are presenting with high acuity and more severe concerns than their cisgender peers. This severity is in nearly every clinical domain including suicidality, history of hospitalization, trauma history, mood disorders, and family distress. Comparing the transgender and gender nonconforming (GNC) collegiate clients, GNC clients have the highest levels of distress and clinical symptoms on nearly every indicator. Overall, these findings for both transgender and GNC clients provide important information for UCCs about treatment and outreach to these high-risk populations. Our findings also mirror the mental health disparities seen in noncollegiate community TGNC samples. We discuss treatment implications, limitations, and suggestions for future research. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: transgender; gender nonconforming; TGNC; college students; university counseling centers; TGNC mental health; collegiate mental health; College Students; Counseling; Gender Identity; Mental Health; Transgender; Peers

Patterns of healthcare discrimination among transgender help-seekers - Romanelli, Meghan; Lindsey, Michael A. (American Journal of Preventive Medicine, 2020)
Introduction: Affirmative health care is imperative to address health and mental health disparities faced by transgender communities. Yet, transgender help-seekers experience discrimination that precludes their access to and participation in care. This study uses latent class analysis to examine patterns of healthcare discrimination among transgender help-seekers. Predictors of class membership are investigated to identify subpopulations at highest risk for healthcare discrimination. Methods: Data were obtained from the 2015 U.S. Transgender Survey and analyzed in 2019. Ten healthcare experiences were included as latent class indicators. Latent class analysis and regression were performed in Mplus, version 8 to identify latent subgroups and examine the relationship between respondent characteristics and the latent classes. Results: The final sample included 23,541 respondents. A 3-class model fit best: Class 1 experienced overt discrimination and interfaced with providers with limited trans-competence; Class 2 did not experience healthcare discrimination or report issues related to providers’ trans-competence; and Class 3 did not experience discrimination but had providers with low trans-competence. Transmen and respondents who were out as trans to their providers and reported psychological distress, suicidal thoughts, and disabilities were more likely to be members of Class 1 or 3 than Class 2. Conclusions: Experiences of healthcare discrimination are not homogeneous across transgender help-seekers. Predictors of the latent classes indicated that transgender help-seekers holding an additional marginalized identity may be at higher risk for healthcare discrimination or care from providers with limited trans-competence. Targeted engagement and education interventions might improve these transgender help-seekers’ access to and connections with care. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: health disparities; transgender; health service needs; intervention; Health Service Needs; Help Seeking Behavior; Mental Health; Health Disparities; Transgender; Discrimination; Risk Factors

Psychodynamics of suicide in lesbian, gay, bisexual, or transgender youth - Bojarski, Emeric; Qayyum, Zheala (Journal of Infant, Child & Adolescent Psychotherapy, 2018)
Lesbian, gay, bisexual, and transgender (LGBT) youth are a vulnerable population at high risk of suicide and, as such, benefit from an informed psychotherapeutic approach to treatment. While it is clear that sexual orientation and gender identity are independent dimensions from psychopathology, LGBT youth are frequently marginalized and may face unique challenges with self-acceptance and identification with peers, family, and society, increasing risk of social isolation, which in turn increases vulnerability to anxiety, mood disorders, substance use, and suicide. We elaborate on the common phenomenon of ambivalent repression of the sexual self in adolescents associated with intertwined themes frequently expressed in suicidal lesbian, gay, transgender, bisexual, and queer patients on the inpatient adolescent unit: anger directed toward internal and external objects; desire for self-punishment, atonement, and possibly rebirth; and desperation and desire to escape psychic pain. We enhance our discussion with case examples and practical therapeutic considerations that emerge from these themes that can be harnessed across treatment settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: suicide; psychodynamics; transgender; Adolescent Psychopathology; Child Psychopathology; Psychodynamics; Sexual Orientation; Suicide; Bisexuality; Lesbianism; Male Homosexuality; Transgender

Heterogeneity of transgender identity nonaffirmation microaggressions and their association with depression symptoms and suicidality among transgender persons - Parr, Nicholas J.; Howe, Bethany Grace (Psychology of Sexual Orientation and Gender Diversity, 2019)
Transgender individuals experience disproportionate rates of depression, suicide ideation, and suicide attempt. Prior work has linked these outcomes to experiencing social stigma and gender-related victimization and discrimination, but an important need has been to quantitatively assess the relation of less overt forms of victimization, such as gender identity-related microaggressions, with occurrence of these outcomes among transgender persons. In the present research, a focus group and survey study were conducted to more fully characterize transgender identity nonaffirmation microaggressions. We investigated how nonaffirmation microaggressions vary in frequency, self-rated emotional intensity, and in the social and emotional responses they elicit, as well as the relation of nonaffirmation microaggressions with the occurrence of depression symptoms and suicidality among transgender individuals. A total of 402 participants completed an online survey questionnaire, responding to 14 situational prompts based on nonaffirmation microaggressions commonly reported in focus groups. In conventional logistic regression analyses, increasing frequency of transgender identity nonaffirmation or denial events was significantly associated with 150–240% increases (odds ratio = 2.54–3.41) in odds of past-year sadness or hopelessness, past-year withdrawal from regular activities, past-year suicide ideation, and lifetime suicide ideation or attempt among transgender respondents (n = 182). Using latent regression analyses that incorporated both frequency and emotional intensity of microaggression events, odds of outcomes were increased by 230–525% (odds ratio = 3.31–6.25). Increasing the number of nonaffirmation microaggressions that produced feelings of weariness or apathy, and nonaffirmation microaggressions that led to decreased interest in social engagement, was also significantly associated with increased odds of past-year depression symptomatology and suicide ideation. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; microaggressions; suicide; depression; minority stress; Major Depression; Suicidal Ideation; Transgender; Microaggression; Suicidality; Attempted Suicide; Gender Identity; Symptoms; Victimization; Focus Group

Self-reported history of concussions is associated with risk factors for suicide completion among high school students - Mantey, Dale S.; Omega-Njemnobi, Onyinye; Barroso, Cristina S.; Kelder, Steven H. (Journal of Affective Disorders, 2020)
Background: Suicide is the third leading cause of death among adolescents. While research has found concussions to be a risk factor for suicide in adults, this relationship is not well studied in nationally representative samples of youth. This study examines the relationship between self-reported history of sports-related concussion and five risk factors for suicide completion. Methods: Data were obtained from the 2017 Youth Risk Behavior Surveillance Survey (n = 13,353). Multivariate logistic regression models assessed the relationship between self-reported, sports-related concussion and five risk factors for suicide completion. Analyses controlled for sex, race/ethnicity, grade, bullying victimization, and sexual orientation. Subsample analyses were conducted stratified by sex. Interaction models examined biological sex as a possible effect modifier. Results: Overall, 15.0% of high school students reported a sports-related concussion in the past 12-months. Self-reported, sports-related concussion was significantly associated with greater odds of feeling sad/hopeless (Adj OR: 1.20; 95% CI:1.02–1.42), suicidal ideations (Adj OR: 1.25; 95% CI:1.02–1.55), suicide attempt (Adj OR: 1.60; 95% CI:1.31–1.96), and suicide attempt treated by a doctor/nurse (Adj OR: 2.35; 95% CI:1.68–3.29), adjusting for covariates. Stratified analyses demonstrated differences by sex, however, no direct evidence of effect modification was observed in interaction models. Limitations: Data are cross-sectional, prohibiting causal inferences. Measures were assessed via self-report. No pre-concussion measures of mental health. Conclusion: Self-reported sports-related concussion was associated with risk factors for suicide completion. No direct evidence of effect modification was observed but stratified analyses suggest biological sex may impact the observed relationship. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: self-reported history; concussions; risk factors; suicide completion; high school students; Brain Concussion; High School Students; Risk Factors; Self-Report; Suicide; Attempted Suicide; Death and Dying; Models

Application of an intersectional framework to understanding the association of disability and sexual orientation with suicidal ideation among Oregon Teens - Tejera, César Higgins; Horner-Johnson, Willi; Andresen, Elena M. (Disability and Health Journal, 2019)
Background: Suicide is the second leading cause of death among U.S. youth. Prior research has found that disability and sexual orientation are each independently associated with suicide risk. However, most analyses regarding sexual orientation or disability in relation to teenagers’ health have isolated the effects of these identities via multiple regression models. That approach assumes there is no multiplicative or synergistic effect between the two identities. Objective: To examine the association between suicidal ideation and the intersection of disability and sexual orientation. Methods: Cross-sectional data from the 2015 Oregon Healthy Teens Survey were analyzed using Poisson regression analysis with robust variance to estimate the relationship between the intersection of disability and sexual orientation and youth reports of suicidal ideation. We calculated three measures of interaction: 1) the excess risk due to interaction (RERI); 2) the proportion attributable to interaction (AP); and 3) the synergy index (SI). Results: Sexual minority teenagers with disabilities had higher risk of suicidal ideation (adjusted relative risk [ARR] = 2.82, 95% CI: 2.47–3.21) with respect to heterosexual teenagers without disabilities. The risk was also elevated, to a lesser degree, for heterosexual youth with disabilities (ARR = 1.97, 95% CI: 1.78–2.19) and LGB youth without disabilities (ARR = 2.17, 95% CI: 1.95–2.42) with respect to the reference group. Our measures of interaction were indicative of a synergistic effect between disability and sexual orientation. Conclusions: Our findings suggest the combination of disability and minority sexual orientation may be associated with compounded negative experiences that could exacerbate the risk of suicide. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGB persons; Disabled persons; Adolescent; Suicidal ideation; Disabilities; Sexual Orientation; Suicidal Ideation; LGBTQ; Bisexuality; Heterosexuality; Lesbianism; Male Homosexuality; Sexual Risk Taking; Suicide; Test Construction

Heterosexism and suicidal ideation: Racial differences in the impact of social support among sexual minority adults - Trujillo, Michael A.; Perrin, Paul B.; Henry, Richard S.; Rabinovitch, Annie E. (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2020)
Background: Heterosexism has been identified as being a contributing factor of suicidality in sexual minority adults (SMA), and social support is believed to be important for mitigating these effects. Research evaluating racial/ethnic differences in suicidality among SMA is limited despite racial/ethnic minorities being at greater risk. Aims: We aimed to examine the associations between heterosexism, suicidal ideation, and social support in a sample of racially/ethnically diverse SMA. Method: SMA (N = 239) were recruited as part of an online survey on sexuality and health based in the United States. Results: There were significant positive main effects of heterosexism and significant negative main effects for non-White racial/ethnic identity on suicidal ideation. There were significant negative main effects for social support from family and a significant other but not from friends. A significant interaction of social support from a significant other and racial ethnic identity was qualified by a significant three-way interaction with heterosexism. Social support from a significant other buffered the effect of heterosexism on suicidal ideation among non-White but not among White SMA. All other interactions were not significant. Limitations: Within-group differences of racial/ethnic groups and other domains of social support were not examined, and the cross-sectional nature of the data precludes causal inference. Conclusion: Support from a significant other may be important for suicidality, particularly for racial/ethnic minority SMA. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: stigma; race/ethnicity; suicidal ideation; sexual orientation; social support; Homosexuality (Attitudes Toward); Racial and Ethnic Differences; Social Support; Suicidal Ideation; Suicidality; Heterosexuality; Homosexuality; Minority Groups; Significant Others; Stigma; Test Construction; Sexual Minority Groups

Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy - Kuper, Laura E.; Stewart, Sunita; Preston, Stephanie; Lau, May; Lopez, Ximena (Pediatrics, 2020)
Objectives: Our first aim was to examine baseline differences in body dissatisfaction, depression, and anxiety symptoms by gender, age, and Tanner (ie, pubertal) stage. Our second aim was to test for changes in youth symptoms over the first year of receiving gender-affirming hormone therapy. Our third aim was to examine potential differences in change over time by demographic and treatment characteristics. Youth experiences of suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) are also reported. Methods: Participants (n = 148; ages 9–18 years; mean age 14.9 years) were receiving gender-affirming hormone therapy at a multidisciplinary program in Dallas, Texas (n = 25 puberty suppression only; n = 123 feminizing or masculinizing hormone therapy). Participants completed surveys assessing body dissatisfaction (Body Image Scale), depression (Quick Inventory of Depressive Symptoms), and anxiety (Screen for Child Anxiety Related Emotional Disorders) at initial presentation to the clinic and at follow-up. Clinicians completed the Quick Inventory of Depressive Symptoms and collected information on youth experiences of suicidal ideation, suicide attempt, and NSSI. Results: Affirmed males reported greater depression and anxiety at baseline, but these differences were small (P < .01). Youth reported large improvements in body dissatisfaction (P < .001), small to moderate improvements in self-report of depressive symptoms (P < .001), and small improvements in total anxiety symptoms (P < .01). No demographic or treatment-related characteristics were associated with change over time. Lifetime and followup rates were 81% and 39% for suicidal ideation, 16% and 4% for suicide attempt, and 52% and 18% for NSSI, respectively. Conclusions: Results provide further evidence of the critical role of gender-affirming hormone therapy in reducing body dissatisfaction. Modest initial improvements in mental health were also evident. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: gender-affirming hormone therapy; mental health outcomes; body dissatisfaction; Dissatisfaction; Hormone Therapy; Mental Health; Affirmative Therapy; Body Esteem; Age Differences; Anxiety; Demographic Characteristics; Human Sex Differences; Major Depression; Puberty; Self-Injurious Behavior; Treatment

Self-reported history of concussions is associated with risk factors for suicide completion among high school students - Mantey, Dale S.; Omega-Njemnobi, Onyinye; Barroso, Cristina S.; Kelder, Steven H. (Journal of Affective Disorders, 2020)
Background: Suicide is the third leading cause of death among adolescents. While research has found concussions to be a risk factor for suicide in adults, this relationship is not well studied in nationally representative samples of youth. This study examines the relationship between self-reported history of sports-related concussion and five risk factors for suicide completion. Methods: Data were obtained from the 2017 Youth Risk Behavior Surveillance Survey (n = 13,353). Multivariate logistic regression models assessed the relationship between self-reported, sports-related concussion and five risk factors for suicide completion. Analyses controlled for sex, race/ethnicity, grade, bullying victimization, and sexual orientation. Subsample analyses were conducted stratified by sex. Interaction models examined biological sex as a possible effect modifier. Results: Overall, 15.0% of high school students reported a sports-related concussion in the past 12-months. Self-reported, sports-related concussion was significantly associated with greater odds of feeling sad/hopeless (Adj OR: 1.20; 95% CI:1.02–1.42), suicidal ideations (Adj OR: 1.25; 95% CI:1.02–1.55), suicide attempt (Adj OR: 1.60; 95% CI:1.31–1.96), and suicide attempt treated by a doctor/nurse (Adj OR: 2.35; 95% CI:1.68–3.29), adjusting for covariates. Stratified analyses demonstrated differences by sex, however, no direct evidence of effect modification was observed in interaction models. Limitations: Data are cross-sectional, prohibiting causal inferences. Measures were assessed via self-report. No pre-concussion measures of mental health. Conclusion: Self-reported sports-related concussion was associated with risk factors for suicide completion. No direct evidence of effect modification was observed but stratified analyses suggest biological sex may impact the observed relationship. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: concussions; high school students; suicide; risk factors; Brain Concussion; High School Students; Risk Factors; Suicide; Death and Dying

Predicting attitudes towards lesbians and gay men: The effects of social conservatism, religious orientation, and cultural humility - Choe, Elise; Srisarajivakul, Emily; Davis, Don E.; DeBlaere, Cirleen; Van Tongeren, Daryl R.; Hook, Joshua N. (Journal of Psychology and Theology, 2019)
This study explores the role cultural humility plays in attitudes and discrimination towards people identifying as gay or lesbian among religious individuals. Specifically, we explore cultural humility as a possible predictor of less discriminatory attitudes towards lesbians and gay men above and beyond the effects of conservatism and religious orientation. Consistent with prior work, we expected that (a) intrinsic religious orientation, extrinsic religious orientation, and conservatism would be positively related to discriminatory attitudes and (b) that quest religious orientation and cultural humility would be negatively related to discriminatory attitudes. Participants (N = 231) were recruited through MTurk after the 2016 Pulse Nightclub shooting in Orlando, Florida to understand the attitudes and experiences held by Americans. Participants completed measures of religious orientation, attitudes, and behaviors towards lesbians and gay men, and cultural humility regarding LGBT issues. Results supported the hypothesis that cultural humility predicts less discrimination towards lesbians and gay men beyond conservatism and religious orientation. Results, limitations, and future directions are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: psychology of religion; multicultural issues; positive psychology; virtues; cultural humility; gay men; lesbians; Conservatism; Homosexuality (Attitudes Toward); Religiosity; Social Discrimination; Humility; Attitudes; Lesbianism; Male Homosexuality; Sex Roles

Untethered lives: Barriers to societal integration as predictors of the sexual orientation disparity in suicidality - Bränström, Richard; Star, Arjan; Pachankis, John E. (Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 2019)
Purpose: Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration—or a lack of meaning, purpose, and belonging as derived from societal norms, goals, and attachment—have been widely theorized as determinants of suicidality for the general population, they have not been comprehensively explored to explain the sexual orientation disparity in suicidality. The aim of this study was to examine differences in suicidal ideation and attempts between LGB and heterosexual individuals in a nationally representative sample, and to examine barriers to societal integration as a potential explanation for any observed disparities over-and-above the influence of established contributors to sexual orientation disparity in suicidality.Methods: Data come from the cross-sectional Swedish National Public Health Survey, which collected data from unrestricted random samples of individuals (16–84 years of age) living in Sweden, annually from 2010 to 2015 (n = 57,840 individuals [response rates: 48.1–51.3%]; 1281 (2.2%) self-identified as LGB). Analyses examined sexual orientation differences in suicidality (i.e., past-12-month ideation and attempts), and explored the role of barriers to societal integration (i.e., not living with a partner or children, unemployment, and lack of societal trust) in explaining this disparity over-and-above more commonly explored psychological (e.g., depression, substance use) and interpersonal (e.g., discrimination, victimization, lack of social support) suicidality risk factors.Results: Compared to heterosexuals, suicidal ideation and attempts were more common among both gay men/lesbians (adjusted odds ratio [AOR] for suicide ideation: 2.69; 95% confidence intervals [CI]: 2.09, 3.47; AOR for suicide attempts: 5.50; 95% CI: 3.42, 8.83), and bisexuals (AOR for suicide ideation: 3.83; 95% CI: 3.26, 4.51; AOR suicide attempts: 6.78; 95% CI: 4.97, 9.24). Barriers to societal integration mediated the association between sexual orientation and suicidality even in models adjusting for established risk factors for suicidality.Conclusion: Our results suggest that previously under-examined factors, namely the disproportionate barriers to societal integration that LGB individuals experience, are important contributors to the substantially elevated risk of suicidality among sexual minorities. Preventive interventions should consider innovative ways to foster societal integration within sexual minority populations and to adjust hetero-centric social institutions to better include sexual minority individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Suicidality; Sexual minority; Lesbian; gay; bisexual; Minority stress; Social isolation; No terms assigned

Do anti-bullying laws reduce in-school victimization, fear-based absenteeism, and suicidality for lesbian, gay, bisexual, and questioning youth? - Seelman, Kristie L.; Walker, Mary Beth (Journal of Youth and Adolescence, 2018)
Lesbian, gay, and bisexual youth are at heightened risk for bullying and other forms of in-school victimization. Anti-bullying laws are a potential policy mechanism for addressing this issue, yet there has been little investigation of the impact of such policies for this population using generalizable samples or quasi-experimental designs. The current study explores whether the presence of state anti-bullying laws predicts lower likelihood of bullying victimization, fear-based absenteeism, in-school threats or injury with a weapon, and suicidality for lesbian, gay, bisexual, and questioning high school students in the United States. Based on Youth Risk Behavior Survey data across 22 states from 2005–2015, coupled with data about the presence of general and enumerated anti-bullying laws that include sexual orientation as a protected class, this study analyzes this topic using a quasi-experimental design (linear difference-in-difference models). The results indicate that lesbian, gay, bisexual, and questioning youth (particularly boys aged 15 or younger) experienced less bullying victimization in states with general or enumerated anti-bullying laws. There was modest evidence of a reduction in fear-based absenteeism among boys in states with such laws. However, there was little evidence of a relationship between such policies and in-school threats or injuries or suicidality. Further, lesbian, bisexual, and questioning girls’ likelihood of victimization, absenteeism, or suicidality was generally not related to the presence of anti-bullying laws. The results suggest that general and enumerated anti-bullying laws may help reduce bullying victimization for gay, bisexual, and questioning boys. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Bullying; Sexual minorities; Anti-bullying laws; High school; Absenteeism; Victimization; Absenteeism; Adolescent; Bisexuality; Bullying; Child; Crime Victims; Cross-Sectional Studies; Fear; Female; Humans; Male; Non-Randomized Controlled Trials as Topic; Schools; Sexual and Gender Minorities; Students; Suicide; United States; Crime Prevention; Criminal Law; High School Students; Homosexuality (Attitudes Toward); Bullying; Bisexuality; Fear; Lesbianism; Male Homosexuality; School Truancy; Suicide; Victimization; Suicidality

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS) - Diehl, Alessandra; Pillon, Sandra Cristina; Caetano, Raul; Madruga, Clarice Sandi; Wagstaff, Christopher; Laranjeira, Ronaldo (Archives of Psychiatric Nursing, 2020)
Objective: To describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals. Methods: The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older. Results: 3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM. Conclusion: The findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Substance use disorder; Sexual minorities; Sexual orientation; Violence; Adult survivors of child abuse; Drug Usage; Violence; Substance Use Disorder; Childhood Adversity; Sexual Minority Groups; Child Abuse; Test Construction

Is young adulthood a critical period for suicidal behavior among sexual minorities? Results from a US national sample - Fish, Jessica N.; Rice, Cara E.; Lanza, Stephanie T.; Russell, Stephen T. (Prevention Science, 2019)
The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalence and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experiences anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider range for sexual minority women (until age 30) relative to sexual minority men (until age 25). (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LBG; Sexual minority; Suicidal behavior; Suicidality; Young adulthood; Lifespan; Time-varying effect modeling; Sex Discrimination; Sexuality; Suicidal Ideation; Emerging Adulthood; LGBTQ; Behavior; Colleges; Critical Period; Life Span; Prevention; Public Health; Students; Sexual Minority Groups

It’s my safe space: The life-saving role of the internet in the lives of transgender and gender diverse youth - Austin, Ashley; Craig, Shelley L.; Navega, Nicole; McInroy, Lauren B. (International Journal of Transgender Health, 2020)
Background: Public awareness of Transgender and Gender Diverse (TGD) identities has grown significantly; however, acceptance and support remain elusive for many TGD youth. Resultant experiences of marginalization and stigmatization contribute to elevated rates of psychological distress and suicidality among TGD youth. Emergent evidence suggests that the internet may offer TGD youth safety, support, and community previously unavailable. Aim: The primary aim of this qualitative inquiry is to engage in an in-depth exploration of the online experiences and processes which help protect against psychological distress and promote well-being among TGD youth. Methods: Data were culled from a mixed-methods, online study of sexual and gender minority youth from across the United States and Canada which followed Institutional Review Board approved protocols. Participants for this study represent a sample (n = 260) of TGD participants aged 14–22 (x̄ = 17.30). Data were analyzed using Charmaz’ grounded theory strategies. Results: Data revealed that the internet offers TGD youth affirming spaces that, for the most part, do not exist in their offline lives. Online, TGD youth were able to engage meaningfully with others as their authentic selves, often for the first time. These experiences fostered well-being, healing, and growth through five processes: 1. Finding an escape from stigma and violence, 2. Experiencing belonging, 3. Building confidence, 4. Feeling hope, and 5. Giving back. Discussion: The unique and innovative ways in which participants use online spaces to foster resilience offer important insights to inform affirmative practices with TGD young people. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Gender diverse; internet; qualitative study; resilience; transgender; youth; Internet; Resilience (Psychological); Well Being; Transgender; Gender Nonconforming; Distress; Suicidality

Sexual and gender minorities' readiness and interest in supporting peers experiencing suicide-related behaviors - Ferlatte, Olivier; Salway, Travis; Oliffe, John L.; Kia, Hannah; Rice, Simon; Morgan, Jeffrey; Lowik, A. J.; Knight, Rod (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2020)
Background: Gatekeeper training is a widely recommended suicide prevention intervention that encourages the development of knowledge and the identification and support of those at risk of suicide. Yet, this strategy has not been implemented among sexual and gender minorities (SGM), a group at high risk of suicide. Aim: The aim of this study was to describe the readiness and interest of SGM in supporting peers experiencing suicide-related behaviors. Method: We analyzed data from an online cross-sectional survey of Canadian SGM (n = 2778). Results: In total, 90% of participants had ≥1 SGM peer with depression, and 73% had ≥1 SGM peer who had previously attempted suicide; 74% said they knew what to do to support a peer experiencing suicide risk, and 77% indicated they knew where to refer them. Furthermore, 94% were interested in learning how to recognize signs of suicidality, while 95% were interested in learning skills to support a peer struggling with suicidality and 81% of those indicated a preference to learn these skills online. Limitations: The study used a nonprobability sample and cross-sectional design. Conclusion: SGM are largely interested in learning suicide prevention skills and, as such, more resources are needed to implement and scale up evidence-based approaches for gatekeeper training among SGM. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; prevention; sexuality; gender; community-based interventions; LGBTQ; Attempted Suicide; Intervention; Peers; Suicide Prevention; LGBTQ; Community Involvement; Gender Identity; Learning; Minority Groups; Sexuality; Suicide; Test Construction; Training; Suicidality

Psychological assessment and treatment for LGBTQ+ patients - Hawks, Erin M.; Holster, Jessica; Cowperthwaite, Robyn; Lewis, Angela L.; Hart, Jonathan; Ostermeyer, Britta K. (Psychiatric Annals, 2019)
Mental health providers encounter and provide treatment to patients who identify as lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) in various treatment settings. Understanding this unique population is essential in delivering culturally competent, appropriate, and effective care to LGBTQ+ patients. This article begins by discussing the existing stigma and the resulting disparities in mental health problems for LGBTQ+ people compared to their cisgender heterosexual counterparts, such as the increased risk of suicide. Then, presented are practical adaptations for the psychological assessment and treatment of LGBTQ+ patients that maintain fidelity to treatment protocols while allowing for flexibility in addressing their unique values, preferences, and challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: psychological assessment; LGBTQ+ patients; mental health treatment; stigma; disparities; Mental Health Services; Psychological Assessment; Stigma; Health Disparities; LGBTQ

Sexual orientation–based depression and suicidality health disparities: The protective role of school‐based health centers - Zhang, Lei; Finan, Laura J.; Bersamin, Melina; Fisher, Deborah A. (Journal of Research on Adolescence, 2020)
This study's purpose was to examine whether school‐based health centers (SBHCs) support mental health indicators among sexual minority youth (SMY). Data came from the 2015 Oregon Healthy Teens Survey with 13,608 11th graders in 137 public high schools in Oregon. Regression results revealed significant SBHC by SMY status interactions indicating relative reductions in likelihood of depressive episodes (30%), suicidal ideation (34%), and suicide attempts (43%) among SMY in schools with SBHCs. SMY students in SBHC schools reported lower likelihood of a past‐year depressive episode, suicidal ideation, and suicide attempt versus those attending non‐SBHC schools. Conversely, no differences in these outcomes were observed for non‐SMY by SBHC status. SBHCs may help reduce mental health disparities among SMY, a marginalized, underserved population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: sexual orientation; depression; suicidality; health disparities; school‐based health centers; protective roles; Major Depression; Mental Health; Suicidal Ideation; Health Disparities; Suicidality; Attempted Suicide; Health Care Services; High Schools; Minority Groups; Test Construction

Stigma in the bereavement experiences of gay men who have lost a partner to suicide - Ferlatte, Olivier; Oliffe, John L.; Salway, Travis; Knight, Rod (Culture, Health & Sexuality, 2019)
Despite the high prevalence of suicide in gay communities, the impact of suicide on surviving male partners is poorly understood. This article presents a qualitative case study of two gay men who lost a partner to suicide and explores how stigma may shape gay men’s bereavement experiences. Data were collected using photovoice methods and analysed using a thematic approach. Five themes were inductively derived: (1) trying to prevent the inevitable; (2) guilty of keeping secrets; (3) dreams shattered by suicide; (4) abandoned and alone in grief; and (5) a lonesome road to recovery. Within each theme, the article identifies how stigma-related challenges associated with suicide, mental illness and minority sexual identity shaped gay men’s bereavement experiences. Practice and policy implications are discussed, including how the provision of tailored clinical and peer supports can assist gay men in the bereavement of a same-sex partner to suicide. The findings detailed in this study highlight the need for interventions to de-stigmatise mental illness and suicide within and outside the gay community. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gay men; suicide; bereavement; surviving partners; Adult; Bereavement; Homosexuality, Male; Humans; Male; Patient Acceptance of Health Care; Photography; Qualitative Research; Sexual Partners; Social Stigma; Suicide; Bereavement; Male Homosexuality; Stigma; Suicide; Partners; Communities; Mental Disorders; Suicide Prevention

Transgender dependent adolescents in the US military health care system: Demographics, treatments sought, and health care service utilization - Van Donge, Nela; Schvey, Natasha A.; Roberts, Timothy A.; Klein, David A. (Military Medicine, 2019)
Introduction: Transgender and gender-diverse (TGD) youth are at greater risk for mental health and medical conditions than their cisgender peers; however, poor health outcomes and identity-based discrimination can be minimized in the context of optimal support. Approximately 1.7 million youth may be eligible for care covered by the Military Health System, which includes mental health and gender-affirming medications. The purpose of the current study is to identify sociodemographic characteristics, the psychosocial and behavioral risk profile, and health care utilization patterns of TGD dependent youth cared for in the U.S. military system to inform provider training and resource allocation. Materials and Methods: We performed a retrospective chart review by searching all medical records between July 1, 2014 and July 1, 2017 for diagnoses suggesting visits for TGD-services at a regional referral-based adolescent medicine clinic which cares for dependent children of active duty, activated selected reserve, and retired military service members between the ages of 9 and 24 years for a wide range of health care needs. Results: Fifty-three participants were included in this study. Sixty-four percent reported a transmasculine identity, 21% a transfeminine identity, and 15% a non-binary or undecided identity. The mean age at first gender-related visit was 14.5 years (SD 3.2). The mean number of primary care physicians and specialists seen by a given individual in a military treatment facility for any visit type since the implementation of the medical record system in 2005 was 12 (SD 6.8) and 10.2 (SD 7.8), respectively. Thirty-three percent of all patients assigned as female at birth were on testosterone therapy and 23% of all patients assigned as male at birth were on estrogen therapy at their most recent clinic visit. Twelve patients were undergoing pubertal suppression with an injectable or implantable gonadotropin-releasing hormone agonist. Seventy percent reported a history of suicidal ideation, 42% self-harm, 21% at least one suicide attempt, and 33% psychiatric hospitalization. Having strongly supportive parents was significantly associated with recognizing, disclosing and seeking treatment for gender nonconformity at an earlier age (ps ≤ 0.03) and marginally associated with less likelihood of current suicidal ideation (p = 0.06) compared to those with less supportive parents. Conclusions: This study elucidated the sociodemographic and behavioral risk profile of a sample of TGD youth in the MHS. Military and non-military health care providers across a broad spectrum of specialties should be knowledgeable about the unique psychosocial and medical needs, requisite sensitivity, and available referral options in the care of TGD youth. Assumptions about one’s gender identity, sexual orientation, gender expression, or behaviors cannot be made based on birth-assigned sex. Further research is needed to investigate the health and wellbeing of TGD military-affiliated youth over time and to determine quality transgender-related services in support of this vulnerable and underserved population. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Transgender dependent adolescents; U.S. Military Health Care System; gender nonconforming; health care utilization patterns; provider training; At Risk Populations; Training; Health Personnel; Transgender; Military Families; Adolescent Attitudes; Health Care Utilization; Health Care Seeking Behavior; Human Sex Differences; Health Disparities

Minority stress and relational mechanisms of suicide among sexual minorities: Subgroup differences in the associations between heterosexist victimization, shame, rejection sensitivity, and suicide risk - Mereish, Ethan H.; Peters, Jessica R.; Yen, Shirley (Suicide and Life-Threatening Behavior, 2019)
Despite sexual orientation disparities in suicide, there is limited research examining factors associated with suicide risk among sexual minorities while considering subgroup differences within this group. This study identified differences between sexual minorities at risk for suicide and those not at risk. The study also examined heterosexist victimization, as one form of minority stress, and two relational mechanisms (i.e., shame and rejection sensitivity) as risk factors for suicidality. We examined a moderated-mediation model, in which we tested gender and sexual orientation differences in the mediating effects of the relational mechanisms on the association between heterosexist victimization and suicide risk. Participants were recruited online and completed an online survey. The sample included 719 sexual minority adults. Of the sample, 27.7% were at risk for suicide. Suicide risk varied by age, gender, sexual orientation, income, education, and relationship status. Heterosexist victimization, shame, and rejection sensitivity were significant risk factors for suicide. Shame and rejection sensitivity were mediators of the association between heterosexist victimization and suicide risk for subgroups of sexual minorities, mostly lesbian and gay individuals and to some extent bisexual individuals. The findings underscore minority stress, shame, and rejection sensitivity as key intervention points. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Minority stress; suicide; sexual minorities; heterosexist victimization; shame; rejection sensitivity; suicide risk; Adolescent; Adult; Aged; Bullying; Crime Victims; Female; Homophobia; Humans; Male; Middle Aged; Risk Factors; Self Concept; Self-Injurious Behavior; Sexual and Gender Minorities; Shame; Suicide; Violence; Young Adult; Suicide; Victimization; Sexual Minority Groups; Minority Stress; Homosexuality (Attitudes Toward); Risk Factors; Sensitivity (Personality); Shame; Social Acceptance

'Extra marginalisation within the community': Queer individuals’ perspectives on suicidality, discrimination and gay pride events - Schimanski, Irie David; Treharne, Gareth J. (Psychology & Sexuality, 2019)
Suicidality is more common among queer individuals. Past research has overlooked queer individuals’ own understandings of suicidality in relation to discrimination and supportive processes potentially achieved through gay pride events. This study applied the decompensation model as a framework to explore queer individuals’ perceptions of suicide, discrimination and gay pride events. Seven focus groups were held with a total of 28 queer individuals aged 18–25 years old. Participants had a range of sexualities, genders and ethnicities. Qualitative data from the focus groups were interpreted using an inductive form of thematic analysis, resulting in three themes: the invisibility of suicide; compound discrimination; and processes of normalising queer identities. Participants suggested that greater awareness of suicide is needed and proposed a trajectory from discrimination to suicide, wherein both queer identities and suicidality are discriminated against. Discrimination from within queer communities was problematised and gay pride events were understood to normalise queer identities by providing opportunities for support and fostering activism against inequalities. The results underscore nuanced perspectives on suicidality, discrimination and gay pride events among young queer individuals in Aotearoa/New Zealand and have implications for suicide prevention efforts. These findings also demonstrate the value of applying an intersectional approach to identity, ideology and discrimination in research on suicidality among queer individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Queer; LGBT; suicide; discrimination; gay pride events; decompensation; Homosexuality; Suicidal Ideation; Marginalization; Lesbianism; Male Homosexuality

Sexual orientation, suicide ideation and suicide attempt: A population-based study - Nystedt, Tanya; Rosvall, Maria; Lindström, Martin (Psychiatry Research, 2019)
The aim is to investigate associations between sexual orientation and experience of suicide thoughts and suicide attempts. The 2012 public health survey in Scania, southern Sweden, is a cross-sectional population-based study including 28,029 participants aged 18–80 with 51.7% participation. The associations between sexual orientation and experience of suicide thoughts and attempts were investigated in multiple logistic regressions. A 8.2% proportion of men and 11.3% of women reported suicide thoughts more than a year ago, and 4.0% of men 4.1% of women had experienced such thoughts during the past year. A 2.6% proportion of men and 4.6% of women reported suicide attempt more than a year ago, and 0.6% of men and 0.7% of women during the past year. In the age- and multiple adjusted models, bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide thoughts than heterosexual men and women. Bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide attempt than heterosexual men and women. After multiple adjustments these patterns largely remained. The results indicate that bisexual men and women and homosexual men have an increased risk of experience of suicide thoughts and suicide attempt. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicide thoughts; Suicide ideation; Suicide attempt; Bisexual; Homosexual; Economic stress; Sweden; Attempted Suicide; Bisexuality; Homosexuality; Sexual Orientation; Suicidal Ideation; At Risk Populations; Suicide

Bisexual women’s experiences of microaggressions and microaffirmations and their relation to mental health - Salim, Selime; Robinson, Margaret; Flanders, Corey E. (Psychology of Sexual Orientation and Gender Diversity, 2019)
Bisexual women report worse mental health outcomes compared to heterosexual and lesbian women. To explore potential factors related to bisexual women’s mental health and wellbeing, we examined bisexual women’s daily experiences with sexual identity microaggressions and microaffirmations as they relate to depression, suicidality, and happiness. We used a 5-day online daily diary study design. The first day participants completed a survey with information on demographics, sexual identity, social support, depression, and self-esteem. For Days 2 through 5 participants completed daily diary entries consisting of the Bisexual Microaggression and Microaffirmation Scales, measures of depression, suicidality, and happiness. Data were analyzed using a multilevel model with two levels—repeated daily diary measures nested within each participant. We assessed the relationship between daily microaggressions and microaffirmations and mental health within individuals, and how mental health may differ between individuals based on social support, connectedness to LGBTQ community, self-esteem, and internalized binegativity (negative feelings about one’s bisexual identity). There was a significant relationship between daily microaggressions and depression, suicidality, and happiness within individuals. Between individuals, there was a relationship between some of the mental health outcomes and Day 1 depression, self-esteem, trans identity, and racialized identity. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: bisexuality; microaggressions; microaffirmations; daily diary study; Bisexuality; Mental Health; Microaggression; Gender Identity; Happiness; Human Females; Major Depression; Self-Esteem; Suicidality

Major depression among young men who have sex with men in Beirut, and its association with structural and sexual minority-related stressors, and social support - Wagner, Glenn J.; Ghosh-Dastidar, Bonnie; El Khoury, Cynthia; Ghanem, Carol Abi; Balan, Elie; Kegeles, Susan; Mutchler, Matt G.; Mokhbat, Jacques (Sexuality Research & Social Policy: A Journal of the NSRC, 2019)
Guided by the minority stress model, we assessed depression and its relationship to structural and sexual minority-related stressors and social support in a sample of 226 young (age 18–29 years) men who have sex with men in Beirut, Lebanon. The sample was recruited with long-chain peer referrals and administered a survey that included the PHQ-9 measure of depression. Sixteen percent had current major depression based on our PHQ-9 criteria, and 33% reported any lifetime history of suicidal ideation (including 8% who had made an attempt); 69% had experienced any sexual minority-related discrimination in the past year. In bivariate analysis, structural (unemployment, no legal resident status) and sexual minority-related (greater number of types of discrimination experienced, greater discomfort with one’s sexual orientation) stressors were associated with major depression, as was lower social support. Discomfort with one’s sexual orientation was the only correlate of major depression when controlling for other stressors, social support and socio-demographics. These findings highlight a high level of depression,and the potential for community building and social solidarity for mitigating the effects of stressors based in personal security, internalized stigma, and discrimination. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Depression; MENA; Lebanon; Stress; Social support; MSM; Stressors; Major Depression; Male Homosexuality; Social Stress; Same Sex Intercourse; Sexual Minority Groups; Discrimination; Health Promotion; Physical Comfort; Sex Discrimination; Sexual Orientation; Social Support

Sexual assault, sense of belonging, depression and suicidality among lgbq and heterosexual college students - Backhaus, Insa; Lipson, Sarah K.; Fisher, Lauren B.; Kawachi, Ichiro; Pedrelli, Paola (Journal of American College Health, 2019)
Objective: To compare the effect of sexual orientation, history of sexual assault and sense of belonging on depression and suicidality among lesbian, gay, bisexual, queer and questioning (LGBQ) and heterosexual students. Participants: A total of 60,194 students from 60 US campuses who participated in the 2017–2018 Healthy Minds Study. Methods: Three-way interaction effects were analyzed using PROCESS macro models in SPSS. Results: Significant three-way interaction effects were found for sexual orientation, sexual assault and sense of belonging predicting depressive symptoms (b = –0.06, p= 0.042, CI: –0.12 to –0.00), and suicidality (b = –0.10, p= 0.004, CI: –0.01 to –0.003). The effect of sexual assault on mental health differed depending on sexual orientation and sense of belonging. Particularly among LGBQ students, high sense of belonging was protective in the presence of sexual assault, and its absence had a deleterious effect on mental health. Conclusion: Enhancing sense of belonging may represent a strategy to mitigate depression and promote suicide prevention, particularly among LGBQ students. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: College students; depression; LGBQ; sexual assault; sense of belonging; suicidality; No terms assigned

The moderating role of community resiliency on suicide risk in the transgender population - Cogan, Chelsea M.; Scholl, James A.; Cole, Hannah E.; Davis, Joanne L. (Journal of LGBT Issues in Counseling, 2020)
Transgender individuals are disproportionately impacted by negative mental and physical health outcomes, including increased suicide risk. The gender minority stress theory proposes a potential pathway to suicide risk through distal and proximal stressors. However, little research has examined how resiliency impacts this relationship. The present study explored the moderating role of resiliency in the relationship between stressors, trauma exposure, and suicide risk. Stressors and trauma exposure were significantly associated with suicide risk, but community resilience was not found to moderate this relationship. The clinical implications of these findings are discussed in depth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Community resilience; minority stress; PTSD; suicide; transgender; trauma; Posttraumatic Stress Disorder; Resilience (Psychological); Suicide; Transgender; Community Health; At Risk Populations; Communities; Minority Stress

Minority status, depression and suicidality among counseling center clients - Kalibatseva, Zornitsa; Bathje, Geoff J.; Wu, Ivan H. C.; Bluestein, Brooke M.; Leong, Frederick T. L.; Collins-Eaglin, Jan (Journal of American College Health, 2020)
Objective: This study examined race/ethnicity, gender, sexual orientation, and financial stress and their association with depression and suicidality among university counseling center clients. Methods: The sample included 3,189 participants who received services at a university counseling center. Results: Asian American college students reported more depressive symptoms than European American and Hispanic students and were more likely to have a depression diagnosis than European American and African American students. Female and lesbian/gay/bisexual/questioning (LGBQ) individuals had higher depressive symptom scores, were more likely to have a depression diagnosis, and history of suicidal ideation and attempts than male and heterosexual individuals, respectively. Students with high financial stress reported higher depression scores and were more likely to have experienced past and current suicidality. More minority statuses were associated with higher risk for depression and suicidality. Conclusions: Counseling center clients who identified with one or more minority groups had higher risk for depression and suicidality. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Counseling center clients; depression; minority status; suicidality; No terms assigned

Relationship status and suicidal behavior in gay men: The role of thwarted belongingness and hope - Riley, Kym; McLaren, Suzanne (Suicide and Life-Threatening Behavior, 2019)
Objective: Levels of suicidal behavior among gay men are a significant concern. The Interpersonal Theory of Suicide proposes that being unpartnered is a risk factor for suicidal behavior due to thwarted belongingness; however, this has yet to be tested empirically. Recent studies also indicate that the two components of hope, agency and pathways, may be protective against suicidal behavior. The first aim of the current study was to investigate whether thwarted belongingness mediates the relationship between relationship status and suicidal behavior in gay men. The study also examined whether agency and pathways weaken the association between relationship status and thwarted belongingness, and whether agency weakens the relation between thwarted belongingness and suicidal behavior. Method: A sample of 370 self‐identified gay men aged from 18 to 66 years old (M = 26.13, SD = 8.02) completed the Suicidal Behaviors Questionnaire—Revised, the Interpersonal Needs Questionnaire—Revised, and the Adult Dispositional Hope Scale. Results: Results showed that thwarted belongingness mediated the relationship between relationship status and suicidal behavior. The hypothesized moderated‐mediation models were not supported. Conclusions: These findings have implications for the development of interventions that aim to reduce suicidal behaviors in gay men. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: relationship status; suicidal behavior; gay men; thwarted belongingness; hope; Adult; Female; Humans; Interpersonal Relations; Male; Risk Factors; Sexual and Gender Minorities; Social Behavior; Suicidal Ideation; Suicide; Surveys and Questionnaires; Hope; Male Homosexuality; Marital Status; Suicidology; Belonging; Models; Risk Factors; Sex Roles; Interpersonal Relationships

Norms and normalisation: Understanding lesbian, gay, bisexual, transgender and queer youth, suicidality and help-seeking - McDermott, Elizabeth; Hughes, Elizabeth; Rawlings, Victoria (Culture, Health & Sexuality, 2018)
Young people who identify as lesbian, gay, bisexual, and queer transgender have elevated rates of suicidality. Despite the increased risk, there is a paucity of research on lesbian, gay, bisexual, transgender and queer help-seeking and suicidality. We report on a UK sequential exploratory, two-stage, mixed-method study. Stage 1 involved 29 online and face-to-face semi-structured interviews with lesbian, gay, bisexual, transgender and queer youth aged 16–25 years old. Stage 2 utilised an online youth questionnaire employing a community-based sampling strategy (n = 789). Results indicated that participants only asked for help when they reached a crisis point because they were normalising their emotional distress. Those who self-harmed, had attempted or planned suicide or had experience of abuse related to their sexuality or gender were most likely to seek help. Results suggested that the reluctance to seek help was due to three interconnecting factors: negotiating sexuality, gender, mental health and age norms; being unable to talk about emotions; and coping and self-reliance. Policies aiming to prevent lesbian, gay, bisexual, transgender and queer youth suicide recognise that norms and normalising processes connected to sexual orientation and gender identity are additional difficulties that youth have accessing mental health support. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Youth; sexuality; gender; suicide; help-seeking; Homosexuality; Sexual Orientation; Sexuality; Transgender; Help Seeking Behavior; Human Sex Differences; Suicidal Ideation

Is self-compassion protective among sexual- and gender-minority adolescents across racial groups? - Vigna, Abra J.; Poehlmann-Tynan, Julie; Koenig, Brian W. (Mindfulness, 2020)
Objectives: Sexual- and/or gender-minority (SGM) youth report rates of suicidality, depression, and anxiety that are two to three times greater than those of their sexual- and gender-majority peers. Mounting evidence suggests that self-compassion can moderate the impact of stress on anxiety, depression, and suicidality. However, the potential limitations of self-compassion in overcoming adversity associated with minority status has not yet been investigated among youth with multiply marginalized identities (i.e., young people who find themselves at the intersection of more than one stigmatized group). Methods: Informed by the minority stress hypothesis and intersectionality theory and using models of moderated moderation as well as group mean and proportion comparisons, this secondary data analysis (n = 1572) compared buffering effects of self-compassion across youth experiencing varying degrees of marginalization. Results: In this study, although white sexual- and/or gender-minority adolescents reported higher rates of general peer victimization and anxiety than did counterparts of color, and to a moderate effect (Hedges’ g = .31 and .30, respectively), results of the Pearson’s chi-squared tests affirmed that sexual- and/or gender-minority students of color reported two to three times the frequency of exposure to structural discrimination. Results of the conditional process analysis suggest that the distinction across race within SGM status appeared in how self-compassion moderated the impact of identity on depressive symptoms compared with the reference group (i.e., white sexual- and gender-majority students). We did not find significant differences in how self-compassion moderated the relationship between sexual identity and depressive symptoms across racial groups. Conclusions: There is evidence to suggest that the relationship between self-compassion and mental health may differ according to degree of exposure to structural discrimination. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: gender minorities; Self-compassion; Peer victimization; Depression; suicidality; Anxiety; Major Depression; Racial and Ethnic Groups; Suicidality; Self-Compassion; Peer Relations; Victimization; Marginalization

Psychometric properties of the Psychological Strain Scales (PSS) in suicide attempters and community controls of rural China - Wei, Yan-Xin; Wang, Xin-Ting; Zhang, Jie; Yao, Zhi-Ying; Liu, Bao-Peng; Jia, Cun-Xian (Journal of Affective Disorders, 2020)
Background: Psychological Strain Scales (PSS) were developed to measure four types of strain comprising value strain, deprivation strain, aspiration strain, and coping strain. This study aimed to evaluate the psychometric properties of the Chinese version of 40-item PSS in suicide attempters and community controls of rural China. Methods: Data of this study came from the investigation of 132 suicide attempters and their paired community controls matched with the same sex, age (±3 years) and residence in five counties in rural Shandong, China. The Chinese version of PSS, the Center for Epidemiologic Studies Depression Scale (CES-D), the Trait Anxiety Inventory (TAI) and the Self-esteem Scale (SES) were administered and reliability test and validity test of the PSS were conducted. Results: Cronbach's α and Guttman Spilt-Half coefficient of PSS was 0.942 and 0.842 for suicide attempters, and 0.950 and 0.874 for community controls. For both suicide attempters and community controls, the Exploratory Factor Analysis indicated a one-factor structure of each strain scale, which accorded with the original factor structure proposed by the authors. The scores of the total PSS and four subscales were positively correlated with the scores of CES-D and TAI; and negatively correlated with the score of SES, which indicated a good performance in convergent validity. Limitations: This study was limited to its generalizability to the Chinese urban population. Conclusions: The Chinese version of the 40-item PSS has satisfactory psychometric properties in terms of reliability and validity in Chinese rural suicide attempters and community controls. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Psychological Strain Scales (PSS); Rural China; Attempted suicide; Reliability; Validity; Attempted Suicide; Stress; Test Reliability; Test Validity; Foreign Language Translation; Test Construction

Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults - Turban, Jack L.; Beckwith, Noor; Reisner, Sari L.; Keuroghlian, Alex S. (JAMA Psychiatry, 2020)
Importance: Gender identity conversion efforts (GICE) have been widely debated as potentially damaging treatment approaches for transgender persons. The association of GICE with mental health outcomes, however, remains largely unknown. Objective: To evaluate associations between recalled exposure to GICE (by a secular or religious professional) and adult mental health outcomes. Design, Setting, and Participants: In this cross-sectional study, a survey was distributed through community-based outreach to transgender adults residing in the United States, with representation from all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico, and US military bases overseas. Data collection occurred during 34 days between August 19 and September 21,2015. Data analysis was performed from June 8,2018, to January 2, 2019. Exposure: Recalled exposure to GICE. Main Outcomes and Measures: Severe psychological distress during the previous month, measured by the Kessler Psychological Distress Scale (defined as a score >13). Measures of suicidality during the previous year and lifetime, including ideation, attempts, and attempts requiring inpatient hospitalization. Results: Of 27715 transgender survey respondents (mean [SD] age, 31.2 [13.5] years), 11 857 (42.8%) were assigned male sex at birth. Among the 19 741 (71.3%) who had ever spoken to a professional about their gender identity, 3869 (19.6%; 95% CI, 18.7%-20.5%) reported exposure to GICE in their lifetime. Recalled lifetime exposure was associated with severe psychological distress during the previous month (adjusted odds ratio [aOR], 1.56; 95% CI, 1.09-2.24; P < .001) compared with non-GICE therapy. Associations were found between recalled lifetime exposure and higher odds of lifetime suicide attempts (aOR, 2.27; 95% CI, 1.60-3.24; P < .001) and recalled exposure before the age of 10 years and increased odds of lifetime suicide attempts (aOR, 4.15; 95% CI, 2.44-7.69; P < .001). No significant differences were found when comparing exposure to GICE by secular professionals vs religious advisors. Conclusions and Relevance: The findings suggest that lifetime and childhood exposure to GICE are associated with adverse mental health outcomes in adulthood. These results support policy statements from several professional organizations that have discouraged this practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: gender identity; psychological distress; suicide attempts; transgender adults; Attempted Suicide; Distress; Gender Identity; Life Span; Transgender; Mental Health

High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults - Newcomb, Michael E.; Hill, Ricky; Buehler, Kathleen; Ryan, Daniel T.; Whitton, Sarah W.; Mustanski, Brian (Archives of Sexual Behavior, 2019)
AbstractTransgender and gender diverse (TGD) people are disproportionately impacted by various health issues and associated risk factors, but little is known about differences in these outcomes between gender identities within the TGD population. This study characterized the health of a diverse sample of TGD youth and young adults. Data were taken from the baseline visit of two longitudinal studies in the Chicago area, RADAR (N = 1079, M age = 20.8 years) and FAB 400 (N = 488, M age = 19.57 years), which are cohorts of young sexual and gender minorities assigned male at birth (AMAB) and assigned female at birth (AFAB), respectively. There was a combined sample of 214 TGD (128 AFAB, 86 AMAB) individuals across cohorts. We examined differences between gender identities in self-reported health and related psychosocial variables, and compared TGD youth and their cisgender sexual minority peers from their cohort of origin on all variables. Among TGD youth, we found high rates of depression and suicidality (ideation, plan, attempt), violence (trauma, victimization, childhood sexual abuse), and substance use (cigarette, alcohol, illicit drug use). With the exception of depression, transgender women and non-binary AMAB youth reported worse health outcomes than transgender men and non-binary AFAB youth. Non-binary AMAB youth reported the highest rates of certain outcomes, including traumatic experiences and suicidal ideation. TGD youth generally reported worse outcomes than cisgender sexual minority youth; these differences were less pronounced among AFAB youth. Findings point to the diversity of experiences within the TGD population and critical needs for intervention approaches to mitigate health disparities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Transgender; Non-binary; Mental health; Violence; Substance use; Gender identity; No terms assigned

(Ir)reconcilable identities: Stories of religion and faith for sexual and gender minority refugees who fled from the Middle East, North Africa, and Asia to the European Union - Alessi, Edward J.; Greenfield, Brett; Kahn, Sarilee; Woolner, Leah (Psychology of Religion and Spirituality, 2019)
Religion can be an important aspect of identity for refugees, yet may be a complex phenomenon for lesbian, gay, bisexual, transgender, and queer (LGBTQ) refugees, as it has often been used to oppress them in their countries of origin. This qualitative study sought to understand how 34 LGBTQ refugees who fled to Austria and the Netherlands from Islamic societies described and understood experiences arising from the their religious and sexual or gender identities. Semistructured interviews were conducted to examine participants’ religious experiences before, during, and after migration. The researchers used thematic analysis to identify four themes: Internalizing religious messaging: shame, self-blame, and suicidality; rejecting organized religion; ‘I only had God’: drawing strength and solace from one’s faith; and reclaiming Islam in one’s own way. Participants grappled with conflict between their religious and LGBTQ identities in their countries of origin; however, their understandings of these identities in the host country differed. The majority out rightly rejected their religious backgrounds and identities. However, religion supported others through the difficulties of migration and resettlement, enabling them to reconcile their faith and sexual or gender identities by adapting their religious practices. Implications for clinical practice are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: identity; religion; LGBTQ refugees; thematic analysis; Gender Identity; Refugees; Religion; Faith; LGBTQ; Human Migration; Islam; Religious Experiences; Thematic Analysis

Parent-initiated sexual orientation change efforts with LGBT adolescents: Implications for young adult mental health and adjustment - Ryan, Caitlin; Toomey, Russell B.; Diaz, Rafael M.; Russell, Stephen T. (Journal of Homosexuality, 2020)
Studies of adults who experienced sexual orientation change efforts (SOCE) have documented a range of health risks. To date, there is little research on SOCE among adolescents and no known studies of parents’ role related to SOCE with adolescents. In a cross-sectional study of 245 LGBT White and Latino young adults (ages 21–25), we measured parent-initiated SOCE during adolescence and its relationship to mental health and adjustment in young adulthood. Measures include being sent to therapists and religious leaders for conversion interventions as well as parental/caregiver efforts to change their child’s sexual orientation during adolescence. Attempts by parents/caregivers and being sent to therapists and religious leaders for conversion interventions were associated with depression, suicidal thoughts, suicidal attempts, less educational attainment, and less weekly income. Associations between SOCE, health, and adjustment were much stronger and more frequent for those reporting both attempts by parents and being sent to therapists and religious leaders, underscoring the need for parental education and guidance. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual orientation; LGBT youth; reparative therapy; conversion therapy; sexual orientation change efforts; suicidality; depression; Adjustment; Mental Health; Therapists; Conversion Therapy; LGBTQ; Sexual Orientation

Associaton between violence and drug consumption with suicide in lesbians, gays, bisexuals, transvestites, and transsexuals: Cross-sectional study - Albuquerque, Grayce Alencar; dos Santos Figueiredo, Francisco Winter; da Silva Paiva, Laércio; Moura de Araújo, Márcio Flávio; da Silva Maciel, Erika; Adami, Fernando (Salud Mental, 2018)
Introduction: Lesbian, gay, bisexual, transvestite, and transgender (LGBT) people are affected by prejudice and psychological, physical, and/or sexual violence due to their sexual orientation. Objective: To analyze the association between violence, drug use, and suicide in LGBT people. Method: We interviewed 316 LGBT people from two cities of the Brazilian Northeast by means of a structured instrument. This included questions about sociodemographic data, sexual orientation, type of violence, type and quantity of drugs consumed, and suicide. Results: There was a positive association between physical violence and anabolic consumption (p = .001) and tranquilizers (p = .012). In relation to psychological and verbal violence, there was a positive association with the use of tranquilizers (p = .021) and negative with the use of amphetamines (p = .027). Suicide attempts were associated with having experienced physical (p = .03) and sexual (p = .037) violence. Drug use, especially ecstasy, cocaine, marijuana, and tranquilizers, was also associated with suicide attempts (p = .002, p = .031, p < .001, p < .001, respectively). The participants who had already attempted suicide were more vulnerable to experience violence and consume drugs within 30 days prior to the interview (p < .001). Discussion and conclusion: Psychological/verbal violence showed to be associated with the use of amphetamines, while physical violence was associated with a higher consumption of tranquilizers and anabolic steroids. Suicide attempts were more common among participants who had suffered physical violence and who were users of substances such as ecstasy, cocaine, marijuana, and tranquilizers. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Homosexuality; bisexuality; violence; psychotropic medications; Bisexuality; Prejudice; Violence

Peer victimization and suicidality among LGBTQ youth: The roles of school belonging, self-compassion, and parental support - Hatchel, Tyler; Merrin, Gabriel J.; Espelage, and Dorothy (Journal of LGBT Youth, 2019)
Research on lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth’s experiences at school has largely focused on stigma, adversity, disparities, and peer victimization. Factors like school climate, individual differences, and social support have also garnered significant attention. However, there has been a dearth of research examining how they relate to both suicidal ideation and suicide attempts. Our goal was to bolster the extant literature by examining the protective role of parental support and psychological mechanisms like school belonging and self-compassion among LGBTQ youth struggling with peer victimization and suicidality. A cross-sectional study was completed with a sample of 934 LGBTQ high school students. Structural equation modeling was employed to analyze direct and indirect effects. Peer victimization was positively associated with both forms of suicidality and negatively associated with school belonging and self-compassion. Psychological processes varied in their in prediction of suicidal ideation and attempts. Parental support did not moderate pathways between victimization and processes, but was associated with diminished suicidality and improved school belonging. Our findings illustrate the critical nature of further developing our understanding of the complexities of suicidality. School programs and interventions that are designed to cultivate belonging, self-compassion, and parental support may prove to be especially beneficial for victimized LGBTQ youth who struggle with suicidality. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: LGBTQ youth; bullying; suicide; school connectedness; mental health; social support; School Environment; Social Support; Suicide; Victimization; Bullying; Mental Health

'Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study': Correction - Bränström, Richard; Pachankis, John E. (The American Journal of Psychiatry, 2020)
Reports an error in 'Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study' by Richard Bränström and John E. Pachankis (The American Journal of Psychiatry, 2020[Aug][1], Vol 177[8], 727-734). In the original article, there were errors in some letters containing questions on the statistical methodology. Given that the study used neither a prospective cohort design nor a randomized controlled trial design, the conclusion that 'the longitudinal association between gender-affirming surgery and lower use of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them' is too strong. Although the percentage of individuals with a gender incongruence diagnosis who had received gender-affirming surgical treatments during the follow-up period is correctly reported in Table 3, (37.9%), the text incorrectly refers to this percentage as 48%. The article was reposted correcting this percentage. (The following abstract of the original article appeared in record [rid]2020-61360-008[/rid]). Objective: Despite professional recommendations to consider gender-affirming hormone and surgical interventions for transgender individuals experiencing gender incongruence, the long-term effect of such interventions on mental health is largely unknown. The aim of this study was to ascertain the prevalence of mood and anxiety disorder health care visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender incongruence diagnosis and gender-affirming hormone and surgical treatment in the entire Swedish population. Methods: This study used the Swedish Total Population Register (N = 9,747,324), linked to the National Patient Register and the Prescribed Drug Register. Among individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015 (N = 2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming hormone and surgical treatment. Outcome measures were mood and anxiety disorder health care visits, antidepressant and anxiolytic prescriptions, and hospitalization after a suicide attempt. Results: Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio =1.01, 95% CI = 0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio = 0.92, 95% CI = 0.87, 0.98). Conclusions: In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; treatment utilization; transgender; gender-affirming surgeries; mood disorder; anxiety disorder; antidepressant; anxiolytic prescriptions; gender incongruence; Antidepressant Drugs; Health Care Utilization; Mental Health; Prescription Drugs; Transgender; Diagnosis; Hormones; Surgery; Treatment

The myth of achilles: Non‐binary vulnerability and the intergenerational transmission of trauma - Lord, Susan A. (Journal of Family Therapy, 2020)
This paper offers a case study of individual family‐focused work with a non‐binary identified person who is working on identity formation, ongoing suicidality, and difficulties with intimate relationships. Using a combination of psychoanalytic and systemic models, issues of power, control and attachment are addressed as important to understanding intergenerational trauma. While M has always had difficulty identifying as female, the many layers of their struggle for control of a life separate from their family have impacted M’s development and current life circumstances. Much of our work has to do with separating out what they carry that is theirs from what they are carrying for prior generations of their family. Practitioner points Individual family‐focused work is a treatment of choice with certain clients, particularly when there has been a history of trauma Psychoanalytic and systemic models of treatment can be combined to deliver what is helpful to the client/client system Trauma is said to be transmitted intergenerationally through nature and/or nurture Power, control, narrative and attachment are significant elements of trauma. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: attachment; non‐binary; individual family‐focused therapy; intergenerational trauma; psychoanalytic/systemic models; No terms assigned

Mediators of increased self-harm and suicidal ideation in sexual minority youth: A longitudinal study - Oginni, O. A.; Robinson, E. J.; Jones, A.; Rahman, Q.; Rimes, K. A. (Psychological Medicine, 2019)
Background: Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships. Method: In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30–57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling. Results: Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43–3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex. Conclusions: Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: ALSPAC; depression; self-esteem; self-harm; suicidal ideation; sexual orientation; Major Depression; Self-Esteem; Self-Injurious Behavior; Sexual Orientation; Suicidal Ideation; Heterosexuality; Sex Roles; Sexual Minority Groups

LGBT-specific education in general psychiatry residency programs: A survey of program directors - Hirschtritt, Matthew E.; Noy, Gaddy; Haller, Ellen; Forstein, Marshall (Academic Psychiatry, 2019)
Objective: Lesbian, gay, bisexual, transgender (LGBT) and other sexual minority individuals are at higher risk than non-LGBT individuals for multiple psychiatric conditions and suicide. However, little is known regarding LGBT-specific training among psychiatric residents. The authors sought to characterize LGBT-specific training among adult psychiatry residency programs. Methods: An anonymous, cross-sectional survey was electronically distributed to U.S.-based adult psychiatry program directors between February and April 2018. Survey topics included program demographics, characteristics of LGBT-specific training, perceived barriers to implementation, and anticipated needs. Results: Seventy-two program directors (30.8%) provided complete survey responses. Over half (55.6%) of these programs had ≤ 5 h of LGBT-specific training ('lower-hour programs'). Lower- and higher-hour (> 5 h of LGBT-specific education) programs were similar on measured demographic variables, but lower-hour programs covered fewer LGBT-specific topics and program directors were more likely to report lack of interested or topic-expert faculty as a barrier to enhancing LGBT-specific training. Conclusions: Results of this survey suggest a need for the development and implementation of LGBT-specific educational curricula for use in U.S.-based adult psychiatry programs. In addition, future research may explore effective ways for programs to recruit, retain, and support teaching faculty with LGBT-specific expertise. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Residents: sexuality/sexual orientation; Minorities; Curriculum development; Faculty development; Adult; Cross-Sectional Studies; Curriculum; Female; Healthcare Disparities; Humans; Internship and Residency; Physician Executives; Psychiatry; Sexual and Gender Minorities; Surveys and Questionnaires; Medical Residency; Psychiatric Training; LGBTQ; Curriculum; Sexual Minority Groups

Suicide in transgender veterans: Prevalence, prevention, and implications of current policy - Tucker, Raymond P. (Perspectives on Psychological Science, 2019)
Transgender adults serve in the U.S. military at 2 to 3 times the rate of the general adult population. Unfortunately, transgender veterans die by suicide at twice the rate of their cisgender veteran peers and approximately 5.85 times the rate of the general population. This article reviews the literature regarding the prevalence of suicidal thoughts and behaviors in transgender veterans. Suicide risk and resilience factors are reviewed, and future areas of study are detailed that incorporate findings from the broader suicide-prevention literature and research on transgender mental-health disparities. Individual services and broader prevention considerations are discussed, including the adaptation of evidence-based suicide-specific psychological interventions, national transgender health-training resources, and relevant veteran suicide-prevention initiatives. Finally, U.S. Department of Defense and U.S. Department of Veterans Affairs policies regarding transgender service and health care are reviewed. State-level policies relevant to transgender veteran suicide such as firearm ownership and nondiscrimination laws are also reviewed, and their implications for suicide prevention are discussed. The aim of this article is to provide a broad review of research findings from multiple fields of study to assist health-care providers, researchers, and policymakers in their efforts to prevent transgender veteran suicide. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; transsexual; veteran; military; gender; suicide; suicidal ideation; Military Veterans; Policy Making; Suicide; Transgender; Peers; Risk Factors; Suicidal Ideation

A systematic review and meta-analysis of disparities in the prevalence of suicide ideation and attempt among bisexual populations - Salway, Travis; Ross, Lori E.; Fehr, Charles P.; Burley, Joseph; Asadi, Shayan; Hawkins, Blake; Tarasoff, Lesley A. (Archives of Sexual Behavior, 2019)
Sexual minorities are at increased risk of suicide; however, it is unclear whether there are within-sexual minority differences in risk across specific sexual identities—notably between bisexual and lesbian/gay subgroups. We therefore conducted a systematic review and meta-analysis to quantify associations between bisexual identity and self-reported suicide ideation and attempt and the moderation of these associations by gender/sex, age, sampling strategy, and measurement of sexuality. Abstracts and full texts were independently screened by two reviewers, resulting in a total of 46 studies that met inclusion criteria and reported 12-month or lifetime prevalence estimates for suicide ideation or attempt. A consistent gradient was observed across all four outcomes, whereby bisexual respondents reported the highest proportion of suicide ideation or attempt, lesbian/gay respondents the next highest proportion, and heterosexual respondents the lowest proportion. Random-effects meta-analysis comparing bisexual individuals with lesbian/gay individuals yielded odds ratios (ORs) ranging between 1.22–1.52 across the four outcomes examined. Between-study variability in ORs was large. Thirty-one percent of heterogeneity was explained by sample type (e.g., probability vs. non-probability) and 17% by gender/sex. ORs were consistently larger for women (range: 1.48–1.95, all statistically significant at p < .05) than for men (range: 1.00–1.48, all p > .05), suggesting that gender/sex moderates the association between bisexual identity and suicide risk. Within-sexual minority differences in suicide risk may be attributed to structural and interpersonal experiences of monosexism, bisexual erasure and invisibility, or lack of bisexual-affirming social support, each of which may be experienced differently across gender/sex identities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Suicide; Bisexual; Sexual orientation; Mental health; Meta-analysis; Attempted Suicide; Bisexuality; Mental Health; Sexual Orientation; Suicidal Ideation

LGBTQ youth-serving community-based organizations: Who participates and what difference does it make? - Fish, Jessica N.; Moody, Raymond L.; Grossman, Arnold H.; Russell, Stephen T. (Journal of Youth and Adolescence, 2019)
LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations—which provide LGBTQ-focused support and services—have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15–21; M = 18.81; n = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual and gender minority; LGBTQ; Youth; Mental health; Substance use; Community programs; Health promotion; Health Promotion; Mental Health; Organizations; Sexual Minority Groups; LGBTQ; Communities; Drug Usage

An interdisciplinary model for meeting the mental health needs of transgender adolescents and young adults: The Mount Sinai Adolescent Health Center approach - Oransky, Matthew; Burke, Elizabeth Zacher; Steever, John (Cognitive and Behavioral Practice, 2019)
Transgender and gender nonconforming (TGNC) adolescents and young adults face significant mental health disparities, including increased rates of suicidality, depression, and self-harm. These disparities are multidetermined and stem, in part, from the emotional consequences of family rejection, peer and community victimization, social isolation, and discrimination and transphobia in both daily settings (e.g., school) and society as a whole. In order to meet the mental health needs of TGNC youth, we must intervene in multiple levels of youths’ lives and provide gender-affirming evidence-based therapies. In this paper, we describe an integrated model of meeting the mental health needs of TGNC youth, with the ultimate goal of reducing mental health disparities. We provide guidance for macrolevel interventions, including efforts to implement social change; mezzo-level interventions, including structuring a health care setting to be gender-affirming; and micro-level interventions, including gender-affirming dialectical behavior therapy, cognitive behavioral therapy, family therapy and support group interventions. Throughout, we highlight our descriptions of interventions with case examples in order to provide additional practical guidance. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: interdisciplinary model; mental health needs; transgender adolescents; young adults; Cognitive Behavior Therapy; Health Service Needs; Mental Health; Group Intervention; Transgender; Adolescent Development; Discrimination; Family Intervention; Mental Models; Health Disparities; Emerging Adulthood; Adolescent Health

Family, school, and peer support are associated with rates of violence victimization and self-harm among gender minority and cisgender youth - Ross-Reed, Danielle E.; Reno, Jessica; Peñaloza, Linda; Green, Dan; FitzGerald, Courtney (Journal of Adolescent Health, 2019)
Purpose: Gender minority (GM) youth experience high rates of violence, and research on protective factors to reduce violence victimization and self-harm is lacking. The purpose of this study was to determine how family, school, peer, and community support influenced rates of violence victimization and self-harm among GM and cisgender adolescents. Methods: This research uses data from the 2017 New Mexico Youth Risk and Resiliency Survey (N = 18,451). The main independent variable was gender, dichotomized into GM and cisgender, and the secondary independent variables were family, school, community, and peer support. Dependent variables were sexual and dating violence, suicide attempts, and nonsuicidal self-injury. Logistic regression models were built for the four dependent variables, including demographics, support scores, and interaction terms between gender and support. Results: Six percent of high school students in New Mexico identified as GM are unsure of their gender. GM students experienced higher rates of violence and self-harm and lower levels of support than cisgender students. Among all students, family support was associated with lower odds of sexual violence and self-harm, while school support was associated with lower odds of dating violence and nonsuicidal self-injury. There were significant interactions between gender, violence, and support. The protective effects of support were less pronounced for GM students than for cisgender students. Conclusions: Family and school support are associated with lower rates of some forms of violence and self-harm among adolescents. Additional support may be necessary to reduce harm among GM adolescents, who are at higher risk for violence and its sequelae. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual violence; Intimate partner violence; Suicide; Self-injurious behavior; Transgender persons; Sexual and gender minorities; Protective factors; Health equity; Family; High School Students; Self-Injurious Behavior; Violence; Intimate Partner Violence; Minority Groups; Protective Factors; Social Support; Victimization; Health Disparities; Transgender

A systematic review of characteristics of nonprobability community venue samples of sexual minority individuals and associated methods for assessing selection bias - Salway, Travis J.; Morgan, Jeffrey; Ferlatte, Olivier; Hawkins, Blake; Lachowsky, Nathan J.; Gilbert, Mark (LGBT Health, 2019)
The majority of research on sexual minority individuals relies on nonprobability community venue samples. These samples are prone to selection bias; however, empirical syntheses of evidence of these biases are not available. We conducted, therefore, a systematic review of published sexual minority health research to summarize methods used to identify characteristics and health outcomes found to differ in nonprobability samples. We searched five health and social science databases to identify observational studies that included a nonprobability sexual minority community sample and applied an empirical method to infer selection bias. We extracted data regarding sociodemographic characteristics, behaviors, and health outcomes and examined whether the nonprobability sample was found to differ disproportionately (over- or underrepresenting the characteristic) based on appropriate statistical tests (p < 0.05 was considered statistically significant). A total of 21 studies were included. Nineteen studies used a cross-sample comparison, one used time/location sampling weights, and one used frequency of venue attendance adjustment to assess differences. The evidence was mostly consistent, that is, associations were in the same direction in >50% of studies examined, for nine variables. Nonprobability community venue samples tended to overrepresent sexual minority individuals with the following characteristics: higher income, current employment, lesbian/gay-identified, greater number of sex partners, past-year sexually transmitted infection diagnosis, suicidal ideation, alcohol use, and substance use; nonprobability community venue samples tended to underrepresent married/partnered sexual minority individuals. This review provides a nuanced empirical picture of aggregate differences in sample characteristics presumed to threaten the validity of nonprobability sexual minority community venue studies, and highlights feasible methods that can be applied to future studies to add specificity to researchers' description of selection biases. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: bisexual; gay; lesbian; selection bias; sexual minority; Data Interpretation, Statistical; Humans; Observational Studies as Topic; Selection Bias; Sexual and Gender Minorities; Sexuality; Biased Sampling; Minority Groups; Sexual Orientation; Statistical Samples; Health Outcomes; Empirical Methods; Social Sciences; Community Health; LGBTQ

The prevalence and predictors of mental health diagnoses and suicide among US College students: Implications for addressing disparities in service use - Liu, Cindy H.; Stevens, Courtney; Wong, Sylvia H. M.; Yasui, Miwa; Chen, Justin A. (Depression and Anxiety, 2019)
Background: The college years represent a period of increased vulnerability for a wide range of mental health (MH) challenges. The onset of common psychiatric conditions occurs during this period of development. Increases in depression, anxiety, and suicidality among U.S. college students have been observed. This study identified prevalence and correlates of MH diagnoses and suicidality in a recent sample of U.S. college students. Methods: The Spring 2015 American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed MH diagnoses and suicidality from U.S. undergraduate students (n = 67,308) across 108 institutions. Results: Stress was strongly associated with a greater likelihood of suicide attempts and MH diagnoses, even among students reporting 1–2 stressful events (OR [odds ratio] range 1.6–2.6, CI [confidence interval] = 1.2–3.2). Bisexual students were more likely to report MH diagnoses and suicidality, compared to heterosexual and gay/lesbian students (OR range 1.5–3.9, CI = 1.8–4.3), with over half engaging in suicidal ideation and self-harm, and over a quarter reporting suicide attempts. Transgender students reported a higher rate of MH diagnoses and suicidality relative to females (OR range 1.9–2.4, CI = 1.1–3.4). Racial/ethnic minority students were generally less likely to report MH diagnoses relative to Whites, although the likelihood for suicidality was mixed. Conclusions: The high rate of multiple stress exposures among the U.S. college population and the high impacts of stress on MH and suicidality point to an urgent need for service utilization strategies, especially among racial/ethnic, sexual, or gender minorities. Campuses must consider student experiences to mitigate stress during this developmental period. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; minority groups; sexual and gender minorities; suicidal ideation; attempted suicide; universities; Adolescent; Adult; Anxiety; Continental Population Groups; Depression; Ethnic Groups; Female; Health Surveys; Healthcare Disparities; Humans; Male; Mental Disorders; Mental Health; Minority Groups; Odds Ratio; Prevalence; Self-Injurious Behavior; Sexuality; Stress, Psychological; Students; Suicidal Ideation; Suicide, Attempted; United States; Universities; Young Adult; College Students; Mental Disorders; Stress; Suicidality; Mental Health; Minority Groups; Suicidal Ideation; Sexual Minority Groups

Introduction to the special section on bisexual health: Can you see us now? - Bostwick, Wendy B.; Dodge, Brian (Archives of Sexual Behavior, 2019)
Despite comprising the largest proportion of the 'lesbian, gay, and bisexual' population, research focusing on the unique health concerns and needs of bisexual individuals is relatively scarce. While health disparities are increasingly well documented among lesbian, gay, bisexual, and transgender individuals relative to their heterosexual and cisgender counterparts, gaps remain in our basic understanding of how health status, behaviors, and outcomes vary within these groups, especially bisexual individuals. The lack of specified research on bisexual health is even more curious given that, when separated from both heterosexual and gay/lesbian individuals, bisexual individuals consistently report higher rates of a wide range of negative health outcomes, including mood and anxiety disorders, substance use, suicidality, as well as disparities related to healthcare access and utilization. Indeed, in scientific research, mass media, and in public health interventions, bisexual individuals remain relatively invisible. This Special Section represents an effort to shed light on a new generation of quantitative, qualitative, and mixed methods research studies that examine health-related concerns, outcomes, and intervention opportunities specifically among diverse samples of bisexual individuals from a variety of social and cultural contexts. The research herein focuses on intersections of multiple identities, the development of new measures, the use of large national data sets, and diverse groups of self-identified bisexual men (who tend to be least visible in health research). Findings from these studies will significantly advance our knowledge of factors associated with health disparities, as well as health and well-being more generally, among bisexual individuals and will help to inform directions for future health promotion research and intervention efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Bisexuality; Bisexual health; Sexual orientation; Sexual identity; LGBT; Sexual and gender minority (SGM); Bisexuality; Health; Lesbianism; Sexual Orientation; LGBTQ; Minority Groups

Sexual and gender minoritized youth in christian home schools: Perceptions of climate and support - Anderson, Sloan Okrey; Lough, Benjamin J. (Journal of LGBT Youth, 2019)
In 2014, Leelah Alcorn, a homeschooled transgender teenager in the United States, died by suicide after enduring months of social isolation and her parent’s repeated efforts to change her gender identity. Sexual and gender minoritized (SGM) youth who are, like Leelah, homeschooled in the U.S. do not have access to the institutional and relational supports afforded to SGM youth in public schools. This study examines how variations in educational setting, family support, internet access, and peer relationships influence mental health outcomes in a sample of 651 sexual and gender minoritized (SGM) young adults who were primarily homeschooled in Christian homes. Participants reported extremely high rates of mental illness (87%) suicidal ideation (72%), suicide attempts (22%) self-harm (66%), and substance abuse (29%). Regression analysis revealed that a positive family attitude toward SGM people (although rare) and access to the internet were the most significant protective factors against negative mental health outcomes in this sample. This study explores the unique vulnerabilities of SGM youth in Christian homeschool settings and has implications for educators, policy makers, health care providers, and mental health and social service professionals. To our knowledge, this is the first study to explore the experiences of homeschooled SGM youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGBT youth; adolescents; educational policy; family; religion; homophobia; suicide; mental health; No terms assigned

Resilience and non-suicidal self-injury in lgbtqia+ people: Targets for prevention and intervention - Watson, Caroline; Tatnell, Ruth (Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues, 2019)
AbstractIdentifying as LGBTQIA+ is associated with greater risk of non-suicidal self-injury (NSSI); understanding why may aid in decreasing NSSI and associated risks in this vulnerable population. We examined discrimination, psychological distress, ‘outness’, resilience, and NSSI in 330 young adults (18–30) from the Australian LGBTQIA+ community. Individuals reporting NSSI reported more depression, anxiety and stress, and less resilience than those who had not engaged in NSSI. Perceived discrimination was not associated with NSSI engagement, however people identifying as queer reported more discrimination than other LGBTQIA+ participants. Additionally, not being ‘out’ in the workplace was associated with NSSI. Building resilience and social support within and for the LGBTQIA+ community may be beneficial in addressing LGBTQIA+ mental health and NSSI. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Non-suicidal self-injury; NSSI; Sexual orientation; LGBT; Resilience; No terms assigned

Increased mental health and psychosocial risks in lgbq youth accessing australian youth aod services - Wishart, Madeline; Davis, Cassandra; Pavlis, Alexia; Hallam, Karen T (Journal of LGBT Youth, 2019)
Research has consistently demonstrated that young people who identify as lesbian, gay, bisexual, or queer (LGBQ) show greater levels of psychosocial risk than general cohorts of young people. Young people engaged with youth alcohol and other drug (AOD) services are some of the most marginalized of all young people. Hitherto research is yet to investigate if young people identifying as LGBQ fare worse in these psychosocial domains than their non-LGBQ co-clients within AOD services. This study compared outcomes for 103 matched pairs of LGBQ identified and non-LGBQ identified young people (N = 206) using youth AOD services in Australia from a youth needs census. The results indicated that youth identifying as LGBQ reported more family dysfunction; and had experienced more violent crime, sexual, physical, and emotional abuse; and accumulated trauma than the non-LGBQ group. They had significantly more substance related harms, greater polysubstance use, and greater severity in their substance use. The LGBQ group also demonstrated poorer psychological health, quality of life, and were more likely to report a history of mental illness, and non-suicidal self-injury according to their youth worker. Overall these data indicate a need to direct more support to this particularly at risk group of young people. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Alcohol and other drug; services; adolescence; mental health; substance use; LGBQ; No terms assigned

Are developmental assets protective against suicidal behavior? Differential associations by sexual orientation - Toomey, Russell B.; Syvertsen, Amy K.; Flores, Melissa (Journal of Youth and Adolescence, 2019)
Sexual orientation disparities in suicide behavior are well-documented. Yet, few studies have examined how developmental assets—key values, self-perceptions, skills, relationships, and opportunities that have been identified as the building blocks of positive youth development—are associated with suicide behaviors, particularly among sexual minority youth. This study examined concurrent associations between young people’s developmental assets and suicidal behavior by sexual orientation using a large sample of 116,925 in-school U.S. adolescents (ages 11 to 19, M = 14.74, SD = 1.78). Most of the sample identified as only heterosexual (90.2%); 5% identified as mostly heterosexual, 3.5% as bisexual, 0.6% as mostly lesbian/gay, and 0.7% as only lesbian/gay. Most participants identified as White, non-Latina/o (62.6%) and as cisgender female (50.3%) or cisgender male (47.8%). Compared to only heterosexual adolescents, youth with all other sexual orientations reported lower levels of internal and external developmental assets except for non-sports extracurricular activity participation and social justice values. Identifying as a racial/ethnic minority, particularly for only heterosexual adolescents, and specifically as Latina/o for sexual minority adolescents was associated with greater risk for suicidal behavior. Further, identifying as a gender minority exacerbated risk for suicidal behavior. Relatedly, when youth reported feeling unsafe with their family, or in their school or neighborhood, they were at greater risk for suicidal behavior, regardless of sexual orientation. Feeling hopeful was associated with lower risk for suicidal behavior for all youth. Regardless of sexual orientation, planning and decision-making skills were associated with lower risk and social-emotional skills were associated with heightened risk for suicidal behavior. School boundaries and social justice values were associated with lower risk for suicidal behavior among bisexual adolescents; there were no additional protective assets for mostly/only lesbian/gay adolescents. In conclusion, sexual orientation disparities exist in the lives of adolescents for several internal and external developmental assets. Disparities in suicidal behavior by sexual orientation, however, were largely unexplained by differential associations between developmental assets and suicidal behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Developmental assets; Positive youth development; Sexual orientation; Suicidal behavior; Behavior; Heterosexuality; Risk Factors; Risk Taking; Sexual Orientation; Ability; Adolescent Development; Minority Groups

Health disparities between genderqueer, transgender, and cisgender individuals: An extension of minority stress theory - Lefevor, G. Tyler; Boyd-Rogers, Caroline C.; Sprague, Brianna M.; Janis, Rebecca A. (Journal of Counseling Psychology, 2019)
Interpersonal, social, and structural stressors have been identified as key elements that explain health disparities between transgender and cisgender individuals. However, most of this research has focused on binary transgender individuals or has not differentiated between binary and nonbinary individuals; little research has examined the experiences of minority stress or health of those identifying outside the gender binary. Guided by intersectionality and drawing on a sample of 3,568 college students from the Center for Collegiate Mental Health’s 2012−2016 database—of whom 892 identified outside the gender binary—we conducted analyses of demographic and outcome measures administered in participants’ 1st counseling appointment, examining differences between cisgender, transgender, and genderqueer individuals. We found that genderqueer individuals were harassed, sexually abused, and subjected to traumatic events at higher rates than were either cisgender or binary transgender individuals, with approximately 50% of genderqueer individuals reporting one of these experiences. We found that genderqueer individuals experienced more anxiety, depression, psychological distress, and eating concerns than did binary transgender and cisgender individuals and more social anxiety than did cisgender individuals. Genderqueer individuals more frequently reported self-harm and suicidality than did any other group, with approximately 2/3 of participants’ having contemplated and nearly 50% making a suicide attempt. We extend current theorizing about minority stress (Hendricks & Testa, 2012; Meyer, 2003) to include genderqueer individuals and delineate several structural aspects of genderqueer experiences that may be responsible for these trends, including others’ lack of knowledge about genderqueer experiences and pronouns, poor access to legal and medical resources, and systemic discrimination. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: genderqueer; transgender; gender nonconforming; gender nonbinary; minority stress; Adult; Anxiety; Depression; Female; Gender Identity; Health Status; Humans; Male; Minority Groups; Sex Offenses; Sexual Harassment; Stress, Psychological; Transgender Persons; Transsexualism; School Counseling; Health Disparities; Gender Nonconforming; Minority Stress; College Students; Demographic Characteristics; Homosexuality; Human Sex Differences; Transgender

Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): Data from the U-SEX GESIDA 9416 Study - Dolengevich-Segal, Helen; Gonzalez-Baeza, Alicia; Valencia, Jorge; Valencia-Ortega, Eulalia; Cabello, Alfonso; Tellez-Molina, Maria Jesus; Perez-Elias, Maria Jesus; Serrano, Regino; Perez-Latorre, Leire; Martin-Carbonero, Luz; Arponen, Sari; Sanz-Moreno, Jose; et al. (PLoS ONE, 2019)
Objectives: Sexualized intravenous drug use, also known as slamsex, seems to be increasing among HIV-positive men who have sex with men (MSM). Physical and psychopathological symptoms have previously been reported in this population, although research on the subject of slamsex is scarce. The objectives of our study were to describe the psychopathological background of a sample of HIV-positive MSM who engaged in slamsex during the previous year and to compare physical, psychopathological, and drug-related symptoms between these participants and those who engaged in non-injecting sexualized drug use. Design and methods: Participants (HIV-positive MSM) were recruited from the U-Sex study in 22 HIV clinics in Madrid during 2016–17. All participants completed an anonymous cross-sectional online survey on sexual behavior and recreational drug use. When participants met the inclusion criteria, physicians offered them the opportunity to participate and gave them a card with a unique code and a link to access the online survey. The present analysis is based on HIV-positive MSM who had engaged in slamsex and non-injecting sexualized drug use. Results: The survey sample comprised 742 participants. Of all the participants who completed the survey, 216 (29.1%) had engaged in chemsex, and of these, 34 (15.7%) had engaged in slamsex. Participants who engaged in slamsex were more likely to have current psychopathology (depression, anxiety, and drug-related disorders) than participants who engaged in non-injecting sexualized drug use. In addition, participants who engaged in slamsex more frequently reported high-risk sexual behaviors and polydrug use and were more often diagnosed with sexually transmitted infections (STIs) and hepatitis C than those who did not inject drugs. Compared with participants who did not inject drugs, participants who engaged in slamsex experienced more severe drug-related symptoms (withdrawal and dependence), symptoms of severe intoxication (loss of consciousness), and severe psychopathological symptoms during or after slamsex (eg, paranoid thoughts and suicidal behaviors). Conclusion: Slamsex is closely associated with current psychiatric disorders and severe drug-related and psychiatric symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: drug-related & psychopathological symptoms; HIV; men who have sex with men; slamsex; sexualized intravenous drug use; Adult; Cross-Sectional Studies; HIV; HIV Infections; Homosexuality, Male; Humans; Male; Psychopathology; Risk-Taking; Sexual Behavior; Substance Abuse, Intravenous; HIV; Intravenous Drug Usage; Psychopathology; Same Sex Intercourse; Sexualization; Psychiatric Symptoms

Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: Three US Cities, 2015 - Agnew-Brune, Christine B.; Balaji, Alexandra B.; Mustanski, Brian; Newcomb, Michael E.; Prachand, Nik; Braunstein, Sarah L.; Brady, Kathleen A.; Hoots, Brooke E.; Smith, Justin S.; Paz-Bailey, Gabriela; Broz, Dita (AIDS and Behavior, 2019)
We examined the association between mental health issues, social support, and HIV among adolescent sexual minority males (SMM), who are disproportionally affected by HIV. National HIV Behavioral Surveillance among Young Men Who Have Sex with Men (NHBS-YMSM) data among SMM aged 13–18 years were collected in three cities (Chicago, New York City, and Philadelphia). Separate log-linked Poisson regression models were used to estimate associations between mental health issues and social support (general and family), and 3 HIV-related sexual risk behavior outcomes: past-year condomless anal intercourse (CAI) with a male partner, past-year sex with ≥ 4 partners, and first vaginal or anal sex before age 13. Of 547 adolescent SMM, 22% reported ever attempting suicide and 10% reported past-month suicidal ideation. The majority (52%) reported depression and anxiety. Thirty-nine percent reported CAI, 29% reported ≥ 4 sex partners and 22% reported first sex before age 13. Ever attempting suicide, suicidal ideation, and depression and anxiety were associated with CAI. Separately, ever attempting suicide and lack of family support were associated with ≥ 4 sex partners. None of the mental health or support measures were associated with having sex before age 13. General social support was not associated with any sexual risk behaviors. Mental health issues are common among adolescent SMM and associated with sexual risk behaviors. Including mental health support in comprehensive HIV prevention for adolescent SMM could potentially reduce HIV risk in this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: mental health; social support; HIV-related sexual risk behaviors; sexual minority males; U.S. cities; HIV; Mental Health; Sexual Risk Taking; Social Support; Sexual Minority Groups; Urban Environments

Sex education inclusivity and sexual minority health: The Perceived Inclusivity of Sex Education Scale - Keiser, Gregory H.; Kwon, Paul; Hobaica, Steven (American Journal of Sexuality Education, 2019)
Minority stress research has demonstrated negative health outcomes in sexual minority populations. However, the influence of sex education on these outcomes remains unclear. In the current study, the Perceived Inclusivity of Sex Education Scale (PISES) was developed and administered to sexual minorities (N = 263) to assess the associations between sex education climate and health outcomes. Greater perceived inclusivity was associated with lower anxiety, depression, and suicidality, but was not associated with sexual risk-taking and substance use. We hypothesized that a number of resilience factors would moderate these relationships, but no interactions were found. These findings may help guide further research on sex education among sexual minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sex education; inclusivity; health outcomes; LGB; Bisexuality; Health Education; Lesbianism; Male Homosexuality; Sex Education; Anxiety; Curriculum; Depression (Emotion); Suicidal Ideation; Sexual Minority Groups; LGBTQ; Inclusion

Suicidal and help-seeking behaviors among youth in an online lesbian, gay, bisexual, transgender, queer, and questioning social network - Lytle, Megan C.; Silenzio, Vincent M. B.; Homan, Christopher M.; Schneider, Phoenix; Caine, Eric D. (Journal of Homosexuality, 2018)
LGBTQ youth have a great burden for suicidal ideation/behavior compared to their non-LGBTQ peers. While scholars have explored risk factors for suicidal behaviors, little is known about protective factors among LGBTQ youth, let alone within group differences in terms of help-seeking. Data were collected from 203 TrevorSpace (e.g., a social network for LGBTQ youth) users via online survey to examine suicidal and help-seeking behaviors among LGBTQ individuals. Among participants who reported suicidal ideation/behavior, a large proportion did not seek help (73.1% of gay men, 33.3% of bisexual men, 42.9% of bisexual women, 14.3% of lesbian women, 41.2% of queer individuals) when they considered or attempted suicide. Among those who sought support, reaching out to a friend was most common. However, family support was associated with fewer suicidal behaviors. Our findings underscore the need to examine the effectiveness of specific sources of help and the impact of exposure to social connectedness. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: risk factors; protective factors; suicidal ideation; suicide attempt; help-seeking behavior; online social network; LGBTQ youth; Attempted Suicide; Help Seeking Behavior; Sexual Orientation; Suicidal Ideation; Online Social Networks; Protective Factors; Risk Factors; Test Construction

Differences in prevalence rates of hopelessness and suicidal ideation among adolescents by gang membership and latinx identity - Whaling, Kelly M.; Sharkey, Jill (Child & Adolescent Social Work Journal, 2019)
AbstractDespite the ongoing challenge of preventing youth gang membership in diverse communities across the United States, and increasing recognition of associations between trauma and gang involvement, the nexus between hopelessness, suicide, and gang membership has largely been ignored. We created two random samples of 1000 participants, with 50% identifying as non-Latinx White, and 50% identifying as Latinx of any race from 91,265 participants of the 2014–2015 California Healthy Kids Survey. Four Chi square tests of independence tested differences in prevalence rates of chronic hopelessness and suicidal ideation for self-identified Latinx and non-Latinx White gang and non-gang member youth. Grounded in a systems responsiveness framework, we predicted that hopelessness and suicidal ideation would be higher for groups that are more marginalized, which was supported by our findings. Specifically, gang membership and ethnicity were both associated with suicide and hopelessness. An unexpected finding, not related to the research questions, was the high prevalence of gender and sexual minority (GSM) youth who identified as gang members. This study represents a unique contribution to the adolescent suicidal ideation literature base, as most studies focus on race or ethnicity and neglect gang membership when identifying disproportionalities in suicidal ideation. Implications for practitioners, researchers, and schools and communities are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Adolescence; Gang membership; Suicide; Racial and ethnic mental health disparities; Juvenile justice; No terms assigned

Coming out in Mainland China: A national survey of LGBTQ students - Wei, Chongzheng; Liu, Wenli (Journal of LGBT Youth, 2019)
This study examined the school experience and its association with the mental health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students in Mainland China. From 29 Chinese provinces/municipalities, 732 LGBTQ students (Mage = 20.7 ± 2.5) completed an online survey based on the Supporting LGBT Lives study. The findings revealed that most Chinese schools were not inclusive for LGBTQ students. Despite the lack of support of very few LGBTQ-specific school policy, teacher training, and curriculum reported by students, the majority of LGBTQ youth felt safe living and learning at school. As well, most LGBTQ students felt comfortable about their sexual orientation and had come out to someone; however, the majority remained closeted with their siblings, parents, or teachers. Furthermore, Chinese LGBTQ students were at great risk for psychological distresses—about 85% of them felt depressed and around 40% had suicidal thoughts. Having a more inclusive school climate and more school resources, especially a positive LGBTQ role model, were significantly associated with the reduction of LGBTQ students’ suicidal ideation. Given these findings, the authors strongly recommend further research, development, and implementation of robust LGBTQ-specific policy, training, and counseling be implemented immediately to improve the lives of Chinese LGBTQ youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: School climate; LGBTQ students; coming out; mental health; Mainland China; Mental Health; School Environment; Self-Disclosure; Students; LGBTQ

'i don’t think they thought I was ready': How pre-transition assessments create care inequities for trans people with complex mental health in canada - MacKinnon, Kinnon R.; Grace, Daniel; Ng, Stella L.; Sicchia, Suzanne R.; Ross, Lori E. (International Journal of Mental Health, 2020)
Transgender (trans) people experience high rates of mental health issues including depression and suicidality. Improving access to transition-related medicine such as hormones and surgeries is suggested as an important mechanism to address these mental health issues. Yet clinicians experience challenges assessing and referring trans people for transition-related medicine. Standardized assessment protocols have been therefore recommended to optimize care. Although standardized protocols are purported to expand access to hormones and surgeries for trans people, it is unclear whether these tools achieve this goal. We therefore conducted an institutional ethnography to explicate how standardized readiness assessments coordinate access to hormones and surgeries in Canada. We analyzed key texts, talked with trans people, clinicians, clinician-educators, and administrators (total n = 22), and observed clinician-education workshops. In the context of determining transition readiness, standardized protocols direct clinicians to explore alternative diagnoses and assess the degree to which any complex mental health condition is 'managed' prior to initiating hormones or surgeries. In response, we found that trans patients downplay or withhold mental health concerns from clinicians, or otherwise do additional work (e.g., take up unwanted psychiatric interventions) to convince providers they are 'mentally ready' to transition. This phenomenon is paradoxical in that transition-related medicine is recommended to mitigate trans people’s psychosocial distress, but when patients reveal symptoms of distress they encounter significant barriers to treatment. We conclude that the logic underpinning pre-transition 'mental readiness' assessments discredits the claim that standardized protocols optimize access to hormones and surgeries. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Canada; institutional ethnography; mental health; sex reassignment surgery; sociology of medicine; transgender; transition-related surgery; No terms assigned

Comparing sexual satisfaction and function in operated vs non-operated patients of gender identity disorder - Asadpour, Elahe; Behzadipuor, Sare; Zarenejad, Mohammad (Journal of Practice in Clinical Psychology, 2019)
Objective: Gender Dysphoria is one of the most important psychiatric disorders whose complications include the problems occurring after sex reassignment surgery. Methods: This study investigates sexual function and satisfaction in patients with Gender Dysphoria, both operated and non-operated patients, from 2011 to 2013. We used a cross-sectional analysis, and by referring to the Legal Medicine Center in the province of Fars, 70 patients with Gender Dysphoria (including 35-operated male to female and 35 non-operated male to female) were selected using the non-probability sampling method. The study data were collected by sexual satisfaction standard questionnaires, sexual function index, and Beck scale for suicidal ideation were used. The results were analyzed using SPSS V. 22. Results: According to the results, no significant difference was observed between the operated and non-operated groups in terms of sexual satisfaction. However, there was a significant difference in terms of sexual function among operated group compared to the non-operated group, at the significance level of 0.05. Conclusion: Based on our finding, the patients with sex reassignment surgery have found their identity, mental relaxation, and coordinated behavior with their genders. New sexual identity heals patients’ relationship with society, presents individual in community with suitable social status and reasonable sexual function for achieving normal life. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Sexual function; Sexual satisfaction; Operated and non-operated patients; Gender Dysphoria; Gender Identity; Sexual Satisfaction; Side Effects (Treatment); Gender Dysphoria; Gender Reassignment; Client Satisfaction; Surgery

LGBT youth, mental health, and spiritual care: Psychiatric collaboration with health care chaplains - Adelson, Stewart L.; Walker-Cornetta, Emilee; Kalish, Naomi (Journal of the American Academy of Child & Adolescent Psychiatry, 2019)
Lesbian, gay, bisexual, and transgender (LGBT) youth have unique medical and mental health needs. Exposure to stigma such as family non-acceptance is associated with adverse mental health outcomes that are important sources of morbidity and mortality in this population. These include depression, anxiety, substance abuse, suicidality, and risk behaviors that mediate exposure to human immunodeficiency virus and sexually transmitted infections. Different religious and/or spiritual traditions hold various beliefs and attitudes about LGBT people. These can be a factor influencing a youth's risk of experiencing stigma. Other unique developmental challenges of LGBT youth, such as conflicts over identity integration and disclosure, also can be influenced by religious/spiritual factors. Health care chaplains could collaborate with clinicians to support mental health by helping LGBT youth and families integrate religious with other aspects of identity, decreasing religiously based stigma, and supporting family connectedness. This article discusses professional aspects of health care chaplaincy and ways in which health care chaplains can work with psychiatrists and other clinicians to support LGBT youth mental health, including case vignettes. It was developed from a conference at the Pediatric Ethics Committee of the Columbia University Medical Center addressing chaplaincy for LGBT youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGBT youth; mental health; spiritual care; psychiatric collaboration; health care chaplains; Chaplains; Family; Mental Health; Stigma; LGBTQ; Adolescent Psychiatry; Clinicians; Collaboration; Mental Health Services; Spiritual Care

Well-being and suicidality among transgender youth after gender-affirming hormones - Allen, Luke R.; Watson, Laurel B.; Egan, Anna M.; Moser, Christine N. (Clinical Practice in Pediatric Psychology, 2019)
Objective: This study is a longitudinal evaluation of the effectiveness of gender-affirming hormones for improving psychological well-being and decreasing suicidality among transgender youth referred to a transgender health specialty clinic at a large Midwest children’s hospital. Method: Forty-seven youth (13.73–19.04 years; M = 16.59, SD = 1.19) who received gender-affirming hormones were assessed at least 2 times: before the start of treatment and at least 3 months after treatment. Results: After gender-affirming hormones, a significant increase in levels of general well-being and a significant decrease in levels of suicidality were observed. Conclusion: These findings suggest that gender-affirming hormones are a valuable medical intervention with promising psychosocial outcomes for transgender youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; suicidality; well-being; youth; gender-affirming hormones; Hormone Therapy; Hormones; Well Being; Transgender; Suicidality; Intervention; Psychosocial Outcomes

Who attempts suicide among medical students? - Marcon, G.; Massaro Carneiro Monteiro, G.; Ballester, P.; Cassidy, R. M.; Zimerman, A.; Brunoni, A. R.; Diemen, L.; Hauck, S.; Passos, I. C. (Acta Psychiatrica Scandinavica, 2019)
Objective To identify factors associated with a history of suicide attempt in medical students. Methods A Web‐based survey was sent out to a sample of medical students. A multi‐predictor Poisson regression was performed to identify factors associated with a history of suicide attempt. In addition, an elastic net regularization was used to build a risk calculator to identify students at risk for attempted suicide. Results A total of 4,840 participants were included in the study. Prevalence of suicide attempts in the sample was 8.94%. Risk factors associated with past suicide attempt in the multi‐predictor Poisson regression were as follows: female gender (P < 0.001); homosexuality (P < 0.001); low income (P = 0.026); bullying by university peers (P = 0.006); childhood (P = 0.001) or adult (P = 0.001) trauma; family history of suicide (P = 0.005); suicidal ideation within the last month (P < 0.001); daily tobacco use (P = 0.037); and being at severe risk for alcohol abuse (P = 0.023). Our elastic net model performed well with an AUC of 0.83. Conclusions This study identifies a number of key factors associated with a history of suicide attempts among medical students. Future longitudinal studies should assess the causal relationship between these factors and suicide attempts. Additionally, these results demonstrate that current available data on suicide attempts among medical students can be used to develop an accurate risk algorithm. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: suicide; risk factors; self‐report; No terms assigned

Non-binary and binary transgender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences - Rimes, Katharine A.; Goodship, Nicola; Ussher, Greg; Baker, Dan; West, Elizabeth (International Journal of Transgenderism, 2019)
Background: Little research has compared the mental health and victimization experiences of non-binary youth depending on their sex assigned at birth (SAAB), or compared these two groups with binary transgender youth. Aims: To compare mental health, self-harm and suicidality, substance use and victimization experiences between non-binary and binary transgender young adults, both male assigned at birth (MAAB) and female assigned at birth (FAAB). Methods: Online survey data from 677 participants from the 'Youth Chances' community study of 16 to 25 year olds in the United Kingdom was analyzed, comparing across binary participants (transgender females (n = 105) and transgender males (n = 210)) and non-binary participants (MAAB (n = 93) and FAAB (n = 269)). Results: Female SAAB participants (binary and non-binary) were more likely to report a current mental health condition and history of self-harm than male SAAB participants (binary and non-binary). Similarly, female SAAB participants (binary and non-binary) were more likely to report childhood sexual abuse than male SAAB participants (binary and non-binary); the reverse pattern was found for lifetime physical assault relating to being LGBTQ. Non-binary MAAB participants were less likely than the other groups to report past suicide attempts and previous help-seeking for depression/anxiety. Binary participants reported lower life satisfaction than non-binary participants. For all four groups, mental health problems, self-harm, suicidality, alcohol use and victimization experiences were generally higher than that of youth in general population studies. Conclusions: These findings highlight the importance of considering both non-binary versus binary gender identity and SAAB in relation to mental health problems, self-harm, suicidality and substance use in transgender youth. The roles of sexual abuse, other abuse and discrimination in contributing to increased rates of mental illness and self-harm in non-binary and binary transgender individuals, particularly those who were assigned female at birth, relative to those assigned male, require investigation. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Abuse; discrimination; gender identity; gender-nonconformity; genderqueer; mental illness; Mental Health; Self-Injurious Behavior; Victimization; Transgender; Suicidality; Drug Usage; Gender Identity; Human Sex Differences; Mental Disorders; Sexual Abuse; Violence; LGBTQ

Cyberbullying and health: A preliminary investigation of the experiences of Canadian gay and bisexual adult men - Lam, Simon; Ferlatte, Olivier; Salway, Travis (Journal of Gay & Lesbian Social Services: The Quarterly Journal of Community & Clinical Practice, 2019)
The majority of cyberbullying studies are within the school environment. This quantitative study investigates cyberbullying among Canadian gay and bisexual men outside of the educational setting through a cross-sectional survey. Of the 7,430 respondents, 4.6% reported cyberbullying in the past year, with younger, Aboriginal, lower-educated, lower-income respondents reporting higher odds of experiencing cyberbullying. Victimization from cyberbullying was significantly associated with experiences of antigay discrimination as well as worry about antigay prejudice. A variety of negative health outcomes were also associated with cyberbullying, including intimate partner violence and suicidality. Implications for social service providers and future research are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: cyberbullying; homophobia; gay men; bisexual men; Bisexuality; Homosexuality (Attitudes Toward); Social Discrimination; Victimization; Cyberbullying

Boys don’t cry? Critical phenomenology, self-harm and suicide - Chandler, Amy (The Sociological Review, 2019)
In this article I argue that critical phenomenology, informed by critical race and intersectional scholarship, offers a useful lens through which to consider suicide and self-harm among men. To illustrate this, I draw on a narrative informed analysis of the accounts of 10 men who had experienced self-harm, read through Sara Ahmed’s queer phenomenology. Two themes are emphasised: gendered, raced, classed bodies that are (unexpectedly) stopped; and bodies that, despite being stopped, still ‘do’—enacting violence and control against self and other. Critical phenomenology can support much needed examination of the complex ways in which socioeconomic class, race, gender and age structure experiences of distress among different social groups. This approach enables a simultaneous examination of the way that privilege and oppression may shape both the experience of distress, and the way it is responded to—including through violence against the self, and against others. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: gender; phenomenology; self-harm; suicide; whiteness; Self-Injurious Behavior; Suicide; Phenomenology

The Trump military trans ban must go - McIntosh, Christopher A.; Hellman, Ronald (Journal of Gay & Lesbian Mental Health, 2019)
This article introduces the research presented in this issue of the Journal of Gay & Lesbian Mental Health. McIntosh and Hellman note that this issue introduces the Perspectives series of articles. The Perspectives series will consist of pieces that come at issues of LGBTQ mental health from a personal perspective. In this issue, Dr. Joseph Wise argues against the ban of trans personnel in the US military. This issue also presents articles on teachers' views on gender non-conforming children, the intersectionality of LGBTQ mental health with the experiences of ethnic and radicalized groups, anxiety and depression in the LGBTQ community, and statistical methods used in a research article on stigma and suicide risk among the LGBTQ population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: military personnel; transgender; LGBTQ; teacher views; gender non-conforming; students; mental health; ethnic groups; radicalized groups; anxiety; depression; statistical methods; stigma; suicide risk; LGBTQ; Anxiety; At Risk Populations; Major Depression; Mental Health; Military Personnel; Racial and Ethnic Groups; Statistical Measurement; Stigma; Suicide; Teacher Attitudes; Transgender; Gender Nonconforming

Sexual orientation, gender, and attempted suicide among adolescent psychiatric inpatients - DeCou, Christopher R.; Lynch, Shannon M. (Psychological Services, 2018)
Lesbian, gay, bisexual, and queer (LGBQ) and female youth report disproportionately high rates of attempted suicide. Previous studies have not addressed the association between sexual orientation, gender, and attempted suicide among adolescent psychiatric inpatients. This study examined LGBQ orientation as a correlate of attempted suicide above and beyond other risk factors (e.g., age, rurality, trauma exposure, psychopathology), and also examined the interaction between gender and sexual orientation with regard to attempted suicide. We conducted a chart review study that included 550 adolescent psychiatric inpatients admitted to a public psychiatric hospital. Adolescents completed standardized intake assessments and self-report measures of sociodemographics, history of attempted suicide, psychopathology, and trauma history. Sexual orientation, gender, and their interaction were evaluated as predictors of attempted suicide using sequential logistic regression. LGBQ youth were more than 3 times more likely (odds ratio [OR] = 3.08) than non-LGBQ peers to have attempted suicide, and female youth were more than twice as likely to have attempted suicide compared with male patients (OR = 2.44). There was not a significant LGBQ orientation by gender interaction. These findings demonstrate the importance of LGBQ orientation and female gender as risk factors for suicidal behavior in a sample of adolescent psychiatric inpatients. Although limited by the self-report and retrospective nature of the data collected, these findings suggest the importance of initial and ongoing assessment of gender, sexual orientation, and suicidality in inpatient youth and the need for additional research to inform effective intervention efforts in this high-risk population. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: adolescents; gender; psychiatric inpatients; LGBQ/sexual orientation; attempted suicide; Adolescent Psychopathology; Attempted Suicide; Human Sex Differences; Psychiatric Patients; Sexual Orientation; Age Differences; Bisexuality; Homosexuality; Lesbianism; Male Homosexuality; Risk Factors; Rural Environments; Trauma

LGBT people and suicidality in youth: A qualitative study of perceptions of risk and protective circumstances - Rivers, Ian; Gonzalez, Cesar; Nodin, Nuno; Peel, Elizabeth; Tyler, Allan (Social Science & Medicine, 2018)
Evidence suggests that lesbian, gay, bisexual and trans (LGBT) people are more likely to attempt to take their own lives in their youth when compared to heterosexual and/or cisgender people. This study draws on in-depth interviews with 17 LGBT individuals living in England, and explores the narratives used by participants to better understand their perceptions of risk and protective circumstances to explain suicide attempts in youth. Using a Goffman-informed thematic analysis, results identified three key themes that were linked to attempts to end life in youth. The first theme considers the conflicts resulting from first disclosure of sexual orientation and/or gender identity/trans status and being ‘out’ to others. The second theme explores participants' accounts of their concurrent mental health issues and how diagnoses of the mental health issues helped them make sense of their own experiences of attempted suicide. The final theme explores the experience of grieving over lost relationships and how that grief is received by others, including health professionals. Our results indicate that some LGBT individuals have effectively, although often arduously, navigated suicidal crises by utilising various approaches to coping. We provide a rich and layered picture of LGBT suicide risk in youth and potential resilience scenarios, although these are a reflection of our specific group of participants' experiences and realities. We argue that it is important to understand how LGBT individuals with a history of suicide attempts narrate and make sense of their experiences in early life and we suggest that the early negative experiences continue to have an effect on LGBT adults today. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGBT; Suicide; Risk factors; Protective factors; Perception; Qualitative; Youth; Bisexuality; Health Care Psychology; Male Homosexuality; Protective Factors; Suicide; Lesbianism; Risk Factors; Qualitative Methods; Suicidality

Current and military-specific gender minority stress factors and their relationship with suicide ideation in transgender veterans - Tucker, Raymond P.; Testa, Rylan J.; Reger, Mark A.; Simpson, Tracy L.; Shipherd, Jillian C.; Lehavot, Keren (Suicide and Life-Threatening Behavior, 2019)
Research suggests the prevalence of suicide ideation and suicide attempts in the transgender veteran community may be upwards of 20 times higher than nontransgender veterans, who are known to be at increased risk than the general US population. This study aimed to understand the potential influence of external and internal minority stress experienced during and after military service on past-year and recent suicide ideation in a sample of 201 transgender veterans. Nonparametric bootstrapping analyses indicated past-year transgender- specific discrimination and rejection (external minority stress) indirectly predicted frequency. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: military-specific gender minority stress factors; suicide ideation; transgender; Adult; Depression; Female; Gender Identity; Humans; Male; Middle Aged; Sexual and Gender Minorities; Shame; Stress, Psychological; Suicidal Ideation; Suicide, Attempted; Transgender Persons; Veterans; Military Veterans; Minority Groups; Stress; Suicidal Ideation; Transgender

Late-onset transgender identity development of adolescents in psychotherapy for mood and anxiety problems: Approach to assessment and treatment - Sevlever, Melina; Meyer-Bahlburg, Heino F. L. (Archives of Sexual Behavior, 2019)
The rate of adolescents with gender-nonconforming behavior and/or gender dysphoria seeking mental health care has dramatically increased in the past decade. Many of these youths also present with co-occurring psychiatric problems, including depression, anxiety, suicidality, substance use, and others. This combination may generate a complex clinical picture that challenges the ability of clinicians to accurately diagnose gender distress and develop suitable treatment recommendations. This article illustrates those challenges with two adolescent patients who developed late-onset gender dysphoria in the course of long-term mental health care for diverse psychiatric problems preceding the emergence of gender dysphoria. One underwent full progression from gender dysphoria as a male through social and medical transition to female, the other a less definitive progression from gender dysphoria as female through social transition to male without deciding for any medical treatment. The report provides details on the assessment procedures and the resulting findings, the rationale for treatment recommendations, and short-term follow-up information. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Gender dysphoria; Transgender; Adolescence; Adolescent Development; Adolescent Psychotherapy; Onset (Disorders); Transgender; Gender Dysphoria; Affective Disorders; Anxiety; Mental Health

Sounding the alarm: Perinatally HIV-infected youth more likely to attempt suicide than their uninfected cohort peers - Kreniske, Philip; Mellins, Claude Ann; Dolezal, Curtis; Korich, Rehema; Leu, Cheng-Shiun; Wiznia, Andrew; Abrams, Elaine J. (Journal of Adolescent Health, 2019)
Purpose: Suicide is the second leading cause of death among youth in the U.S., yet there are few studies on suicide among youth with perinatally acquired HIV infection (YPHIV). Our aim was to determine if suicide attempts differed for YPHIV compared with perinatally HIV-exposed but uninfected peers (YPHEU). Methods: Data come from a longitudinal behavioral health cohort (N = 340) of YPHIV (n = 206) and YPHEU (n = 134) recruited between ages 9 and 16 years and interviewed with psychosocial batteries every 12–18 months. Logistic regression analyses were conducted to assess the association between reported suicide attempt and participants' HIV status. We assessed whether baseline demographic characteristics and sexual orientation were potential confounding factors. Fisher's exact tests were used to evaluate the association between first attempted suicide and HIV status within age groups. Results: YPHIV were more likely to make a suicide attempt than YPHEU (odds ratio = 2.35, 95% confidence interval = 1.28–4.34). Youth most often reported their first attempt between the ages of 14–18 years. Demographic characteristics and sexual orientation were not associated with attempted suicide. Conclusions: YPHIV compared with YPHEU were more likely to report a suicide attempt, and this difference emerged during late adolescence and persisted through young adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicide; HIV; Adolescence; Continuum of care; YPHIV; perinatal HIV; attempted suicide; Attempted Suicide; HIV; Peers; Perinatal Period; Adolescent Development; Death and Dying; Demographic Characteristics; HIV Testing; Sexual Orientation

Does it get better? Exploring 'it gets better' videos using visual sociology - Brandon-Friedman, Richard A.; Kinney, Mx M. Killian (Journal of LGBT Youth, 2019)
In 2010, the It Gets Better (IGB) project website was launched to house videos containing messages of support for youth who identify as sexual and/or gender minorities (SGMs). Despite success as a virtual social movement, scholars have suggested that the imagery portrayed may unintentionally exclude those who are most marginalized and that the videos often implore individuals to endure suffering now to gain happiness later. Using visual sociology methodology, the visual messaging and demographics of IGB video producers were examined and compared against criticisms of the project. Imagery portrayed was consistent with common concerns about exclusions of minorities, those who do not fit social standards of physical attractiveness, and those who challenge heteronormativity and adherence to gender norms. Despite IGB videos’ intentions to promote hope, the tales of struggle and hardship relayed often resulted in the depiction of negative emotions. Expressions of confidence, defiance, and empathy were visible, but the most prevalent emotion was sadness. Negative visual presentations and exclusion of significant demographics within the SGM community suggest IGB videos project more complex visual signals and different messaging than would be expected from videos designed to be supportive. Professionals should be attuned to these concerns when working with SGM youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: It Gets Better; visual sociology; sexual orientation; Social support; youth lgbt < youth; suicide; LGBTQ Media; No terms assigned

'Invisible during my own crisis': Responses of LGBT people of color to the Orlando shooting - Ramirez, Johanna L.; Gonzalez, Kirsten A.; Galupo, M. Paz (Journal of Homosexuality, 2018)
On June 12, 2016, the Pulse nightclub in Orlando, Florida was the target of one of the country’s deadliest mass shootings. Pulse, a gay nightclub, was hosting a Latin Pride Night the evening of the tragedy, which resulted in the death of 49 victims and 53 casualties, over 90% of whom were lesbian, gay, bisexual, and transgender (LGBT) Latinx people, specifically. The present research investigates the narrative responses from LGBT people of color (LGBT-POC) following the tragedy. Results included an analysis of 94 participant narrative responses. Results were collected online from a sample of LGBT-POC with varying sexual, gender, and racial identities. Thematic analysis revealed four major themes: (1) Violence is Not New for LGBT-POC; (2) Personal Identification with Victims; (3) Lack of Intersectionality in Others’ Responses to Orlando; and (4) Acknowledgment of Intersectionality across LGBT-POC. Discussion focuses on describing the ways in which LGBT-POC responded to the shooting regarding their multiple minority identities. Implications of this research reinforce the need for continued intersectional research with LGBT-POC. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Hate crime; intersectionality; Latinx; LGBT-POC; minority stress; Orlando; Adolescent; Adult; Aged; Continental Population Groups; Ethnic Groups; Female; Florida; Humans; Male; Middle Aged; Sexual and Gender Minorities; Transgender Persons; Violence; Young Adult; Hate Crimes; Narratives; Sexual Orientation; Latinos/Latinas; Exposure to Violence; Firearms; Gender Identity; Lesbianism; Male Homosexuality; Racial and Ethnic Differences; Stress; Stress Reactions; Violence; Transgender; Minority Stress

Psychiatric epidemiology of transgender and nonbinary adult patients at an urban health center - Beckwith, Noor; McDowell, Michal J.; Reisner, Sari L.; Zaslow, Shayne; Weiss, Roger D.; Mayer, Kenneth H.; Keuroghlian, Alex S. (LGBT Health, 2019)
Purpose: Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults. Methods: We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement. Results: Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20–0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01–1.08) and suicide attempt (OR 5.79, 95% CI: 2.08–16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73–173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62–125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72–25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26–16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32–87.53), anxiety disorders (OR 15.84, 95% CI: 2.00–125.72), and MDD (OR 10.45, 95% CI: 2.28–47.98). Conclusion: Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; minority stress; nonbinary; substance use disorders; suicide; transgender; Adult; Alcoholism; Ambulatory Care; Anxiety Disorders; Case Management; Delivery of Health Care; Depressive Disorder, Major; Female; Gonadal Steroid Hormones; Humans; Male; Mental Disorders; Mental Health Services; Middle Aged; Odds Ratio; Prevalence; Primary Health Care; Risk Factors; Sex Reassignment Procedures; Sexual and Gender Minorities; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Suicide, Attempted; Transgender Persons; United States; Urban Population; Young Adult; Epidemiology; Mental Disorders; Transgender; Gender Nonconforming; Attempted Suicide; Mental Health; Outpatient Treatment; Urban Environments; Substance Use Disorder; Minority Stress

Comparing treatment response between LGBQ and heterosexual individuals attending a CBT- and DBT-skills-based partial hospital - Beard, Courtney; Kirakosian, Norik; Silverman, Alexandra L.; Winer, Jeffrey P.; Wadsworth, Lauren P.; Björgvinsson, Thröstur (Journal of Consulting and Clinical Psychology, 2017)
Objective: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ+), no prior study has examined mental health treatment outcomes for LGBQ+ populations receiving standard care. We compared individuals identifying as LGBQ+ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Method: A total of 441 participants (19% LGBQ+; mean age = 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ+ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment. Results: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ+ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities. Conclusions: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ+ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ+ affirmative treatments for specific LGBQ+ subgroups are superior to traditional treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGBTQ; treatment; CBT; disparities; sexual minority; Adult; Behavior Therapy; Female; Gender Identity; Heterosexuality; Humans; Male; Mental Disorders; Middle Aged; Self-Injurious Behavior; Sexual and Gender Minorities; Suicidal Ideation; Treatment Outcome; Cognitive Behavior Therapy; Sexual Orientation; Treatment Outcomes; Health Disparities; Dialectical Behavior Therapy; Bisexuality; Lesbianism; Male Homosexuality; Transgender; Sexual Minority Groups; LGBTQ

Supporting sexual and gender minority health: Research priorities from mental health professionals - Clark, Kristen D.; Capriotti, Matthew R.; Obedin-Maliver, Juno; Lunn, Mitchell R.; Lubensky, Micah E.; Flentje, Annesa (Journal of Gay & Lesbian Mental Health, 2019)
Sexual and gender minority (SGM) people experience significant disparities in mental health and substances use disorders. This study reached out to mental health professionals (MHPs) who treat SGM people to determine mental health priorities for research that would better inform their clinical practice. MHPs were surveyed and asked to rate items based on a likert-type scale. Open-ended questions were also queried and analyzed qualitatively. Five items had the highest mean scores: 'stressors related to SGM status,' 'lifestyle factors that support emotional resilience and wellbeing,' 'depression,' 'intimate relationships,' and 'suicide.' Intersecting identities and sexual relationships emerged as qualitative themes. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Mental health; disparities; LGBTQ; family therapy; No terms assigned

Rethinking queer failure: Trans youth embodiments of distress - Roen, Katrina (Sexualities, 2019)
This article examines trans youth embodied distress in relation to the workings of normativity. I consider the normative cruelties that structure the embodied and gendered experiences of trans youth, and I locate trans youth embodied distress in relation to a notion of queer failure. Central to this analysis is the way emotion is implicated in normativity. I focus on the idea that happiness norms are implicated in keeping gendered subjects in line, and I consider the specific emotions that are bound up in queer failure and embodied distress, such as shame, hatred, and fear. Trans youth frequently respond to the challenges of embodied distress by embarking on a significant emotional, relational project that can involve reworking the relationship to the body and reworking the relationship to norms. In the context of this emotional, relational project, some trans youth self-harm and/or become suicidal. I work with empirical data from trans and gender questioning youth who write online about their self-harming and suicidal feelings, and I use this analysis to locate self-harm in relation to the ways in which some trans youth are crafting embodied and gendered ways of being that break with norms. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: emotion; gender queer; normativity; self-harm; transgender youth; Distress; Emotions; Homosexuality; Self-Injurious Behavior; Transgender; Cruelty; Happiness; Human Sex Differences; Social Norms

Sexual minority children: Mood disorders and suicidality disparities - Blashill, Aaron J.; Calzo, Jerel P. (Journal of Affective Disorders, 2019)
Background: Sexual minority (gay, lesbian, and bisexual) individuals experience elevated mood disorders and suicidality compared to their heterosexual counterparts. However, to date, these sexual orientation disparities have yet to be examined among middle childhood-aged participants. Methods: Data were employed from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study, a U.S. representative sample. Population-level weighting was utilized, resulting in an analytic sample of N = 8,204,013 (nunweighted = 4519) children between the ages of 9 and 10 years: with 70,952 (nunweighted = 43) identifying as sexual minories (0.9% of the population). Structured clinical interviews were used to assess mood disorders (i.e., depressive and bipolar disorders) and suicidality. Sexual orientation (sexual minority vs. heterosexual) was examined as the focal independent variable. Results: The overall prevalence of mood disorders was 7.1%. Sexual minority children (22.5%) possessed a higher rate than heterosexual children (6.9%). The overall prevalence of suicidality was 4.8%; sexual minority children (19.1%) possessed a higher rate than heterosexual children (4.6%). Limitations: Sexual orientation assessment did not include attraction, and thus, results may represent a lower bound estimate of sexual minorities. Conclusions: Sexual orientation disparities in mood disorders and suicidality appear to develop as early as middle childhood. Clinicians are encouraged to assess sexual orientation among children as young as 9–10 years old, and provide appropriate normalization of sexual orientation, and referrals for mental health treatment, as indicated. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Sexual orientation; Children; Mood disorders; Suicide; Sexual minority; Affective Disorders; Child Psychopathology; Sexual Orientation; Suicidality; Sexual Minority Groups

Identity affirmation and mental health among sexual minorities: A raised-mormon sample - Bridges, James G.; Tyler Lefevor, G.; Schow, Ronald L.; Rosik, Christopher H. (Journal of GLBT Family Studies, 2019)
How can someone successfully integrate a lesbian, gay, or bisexual (LGB) identity and a Mormon identity? Using a sample of 530 LGB-identified individuals raised in the Later-Day Saints (LDS) church, this study asks how factors of empowerment are associated with sexual identity affirmation and mental health outcomes. We found that sexual identity support, connection needs support, LGBT community support, and educational attainment were significantly associated with more positive mental health outcomes. LGB women who were raised Mormon appear to fair worse than men, on average. We also found that those raised Mormon who had disaffiliated with the LDS church reported significantly lower levels of internalized homonegativity than those still affiliated. Clinicians working with LGB Mormons and post-Mormons should consider the effect that affirming sources of support may have on positive mental health outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Sexual minority; mental health; empowerment; Mormon; LDS; suicidality; No terms assigned

God bless you? The association of religion and spirituality with reduction of suicide ideation and length of hospital stay among psychiatric patients at risk for suicide - Plöderl, Martin; Kunrath, Sabine; Fartacek, Clemens (Suicide and Life-Threatening Behavior, 2019)
Objective Religion and spirituality (R&S) were protective against suicidal behavior in the majority of studies. In prospective studies, R&S were associated with improved outcome for patients with depression, a main risk factor for suicide. Thus, R&S may also improve recovery from suicidal crisis, but related data is lacking. Method We explored how aspects of R&S were associated with reduction of suicide ideation and length of hospital stay among 351 patients admitted to a psychiatric crisis intervention ward specialized in suicide prevention. We analyzed the results separately by gender and sexual orientation due to the known specific effects of R&S in these groups. Results Overall, there were only small and non‐significant associations between R&S and reduction of suicide ideation and length of hospital stay. For heterosexual men, some R&S variables were associated with less optimal outcome. Contrary to our hypothesis, R&S were not less or even more beneficial for sexual minority than heterosexual patients. Conclusions Religion and spirituality were not or only weakly associated with improvement of suicide ideation and shorter hospital stay. Further studies are needed to account for selection biases and other limitations in our study. Based on our findings, R&S may not be major sources to recover from suicidal crisis in a psychiatric setting. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: No terms assigned

Homelessness, mental health and suicidality among LGBTQ youth accessing crisis services - Rhoades, Harmony; Rusow, Joshua A.; Bond, David; Lanteigne, Amy; Fulginiti, Anthony; Goldbach, Jeremy T. (Child Psychiatry and Human Development, 2018)
LGBTQ youth experience increased risks of homelessness, mental health disorder symptoms, and suicidality. Utilizing data from LGBTQ youth contacting a suicide crisis services organization, this study examined: (a) rates of homelessness among crisis services users, (b) the relationship between disclosure of LGBTQ identity to parents and parental rejection and homelessness, and (c) the relationship between homelessness and mental health disorder outcomes and suicidality. A nationwide sample of LGBTQ youth was recruited for a confidential online survey from an LGBTQ-focused crisis services hotline. Overall, nearly one-third of youth contacting the crisis services hotline had experienced lifetime homelessness, and those who had disclosed their LGBTQ identity to parents or experienced parental rejection because of LGBTQ status experienced higher rates of homelessness. Youth with homelessness experiences reported more symptoms of several mental health disorders and higher rates of suicidality. Suggestions for service providers are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGBTQ youth; Homelessness; Suicidality; Mental health; Crisis services; Adolescent; Child; Female; Homeless Persons; Hotlines; Humans; Male; Mental Disorders; Mental Health; Sexual and Gender Minorities; Suicidal Ideation; Suicide; Surveys and Questionnaires; Young Adult; Client Characteristics; Crisis Intervention Services; Homeless; Sexual Orientation; Suicide; Bisexuality; Lesbianism; Male Homosexuality; Mental Health; Mental Health Services; Transgender; Suicidality; LGBTQ

Bias from potentially mischievous responders on large-scale estimates of lesbian, gay, bisexual, or questioning (LGBQ)—Heterosexual youth health disparities - Cimpian, Joseph R.; Timmer, Jennifer D.; Birkett, Michelle A.; Marro, Rachel L.; Turner, Blair C.; Phillips, Gregory L. II (American Journal of Public Health, 2018)
Objectives: To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)–heterosexual youth health disparities are to the presence of potentially mischievous responders. Methods: We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness. We estimated LGBQ– heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. Results: Accounting for suspected mischievousness reduced estimates of the average LGBQ–heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. Conclusions: Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: bias; mischievous responders; large-scale estimates; lesbian; gay; bisexual; questioning; LGBTQ; health disparities; sexual orientation; Deception; Sexual Orientation; Testing; Health Disparities; LGBTQ; Epidemiology; Estimation; Responses; Test Bias; Test Construction

Resilience factors and suicide risk for a sample of transgender clients - Edwards, Lindsay L.; Torres Bernal, Aníbal; Hanley, Scotty M.; Martin, Shannon (Family Process, 2019)
This study explored how individual‐ and community‐based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross‐sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens by way of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Family Therapy; Minority Stress; Minority Stress Model; Resilience; Transgender; terapia familiar; transgénero; resiliencia; modelo de estrés de minorías; estrés de minorías; 家 庭 治 疗 跨 性 别 抗 挫 力 少 数 族 裔 压 力 模 型 少 数 族 裔 压 力; No terms assigned

Posting sexually explicit images or videos of oneself online is associated with impulsivity and hypersexuality but not measures of psychopathology in a sample of US veterans - Turban, Jack L.; Shirk, Steven D.; Potenza, Marc N.; Hoff, Rani A.; Kraus, Shane W. (Journal of Sexual Medicine, 2020)
Introduction: Sending sexually explicit text messages ('sexting') is prevalent among US adults; however, the mental health correlates of this behavior among adults have not been studied adequately. Furthermore, there are few studies examining the related but distinct behavior of posting sexually explicit photos or videos of oneself online (posting sexual images [PSI]) and the mental health correlates of this behavior. Aim: To examine associations between sexting, PSI, impulsivity, hypersexuality, and measures of psychopathology. Methods: Using a national convenience sample of 283 US post-deployment, post-9/11 military veterans, we evaluated the prevalence of 2 behaviors: sexting and PSI and the associations of these behaviors with psychopathology, suicidal ideation, sexual behaviors, hypersexuality, sexually transmitted infections, trauma history, and measures of impulsivity. Main Outcome Measure: Measures of psychopathology including depression, anxiety, post-traumatic stress disorder, insomnia, substance dependence, hypersexuality, and suicidal ideation, as well as measures of impulsivity, sexual behavior, and trauma. Results: Sexting was found to be common among post-9/11 veterans (68.9%). A smaller number of veterans engaged in PSI (16.3%). PSI veterans were more likely to be younger, male, less educated, and unemployed. After adjusting for covariates, no associations were detected between PSI or sexting and the examined measures of psychopathology. However, PSI was associated with higher levels of impulsivity and hypersexuality, whereas sexting was not associated with these measures. Clinical Implications: Results from this study suggest that not all digital sexual behaviors are associated with psychopathology. However, PSI was associated with hypersexuality and impulsivity. Those who engage with PSI may benefit from guidance on how to manage their impulsivity to prevent ego-dystonic sexual behaviors. Strengths & Limitations: The strengths of this study include differentiating PSI from sexting broadly, highlighting that digital sexual behaviors are heterogeneous. Limitations include the study's cross-sectional design, which limits causal interpretations. More research is also needed in civilian populations. Conclusion: PSI was less prevalent than sexting in our sample. This behavior was associated with impulsivity and hypersexuality but not with elevated levels of psychopathology. Sexting was not associated with any of these measures. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: sexting; veterans; psychiatric disorders; sexual partners; risky sexual behavior; Hypersexuality; Impulsiveness; Psychopathology; Sexting; Mental Health; Military Veterans; Psychosexual Behavior; Suicidal Ideation

Gender identity, sexual orientation, mental health, and bullying as predictors of partner violence in a representative sample of youth - Walls, N. Eugene; Atteberry-Ash, Brittanie; Kattari, Shanna K.; Peitzmeier, Sarah; Kattari, Leo; Langenderfer-Magruder, Lisa (Journal of Adolescent Health, 2019)
Purpose: Partner violence (PV) is prevalent among US adolescents, though little is known about its prevalence and correlates across gender identities and sexual orientations. Existing research has frequently placed lesbian, gay, bisexual (LGB), questioning, and transgender adolescents in the same category, obscuring potential differences in risk of PV. Methods: This study (N = 9,352) uses the 2015 Healthy Kids Colorado Study, a statewide representative survey, to explore how sexual orientation and gender identity are associated with PV victimization among high-school youth, and whether there is a relationship between mental health and bullying victimization and PV. Results: Out of all youth who dated in the past year, 9.4% reported experiencing past-year PV. Compared to their cisgender heterosexual peers, cisgender LGB youth (AOR = 1.48 [1.17, 1.86]) and cisgender questioning youth (AOR = 1.68 [1.13, 2.48]) had elevated risk of experiencing PV. Transgender youth, particularly those who are both transgender and LGB (AOR = 3.25 [2.02, 5.22]) or transgender and questioning their sexual orientation (AOR = 8.57 [4.28, 17.16]), had the highest risk of PV. Depressive symptoms (AOR = 1.99 [1.67, 2.37]), suicidality (AOR = 1.83 [1.62, 2.06]), bullying victimization (AOR = 1.58 [1.31, 1.91]), and online bullying victimization (AOR = 1.98 [1.62, 2.06]) were associated with PV. Conclusions: LGB, questioning and transgender high school students are at elevated risk of PV, with the highest risk among those who are both LGB and transgender. Adolescents who report PV are also more likely to be struggling with bullying, depression, and suicidality. PV prevention and response interventions should use intersectional approaches responsive to the unique needs of LGBT youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Partner violence; Sexual orientation; Gender identity; Bullying; Depression; Suicide; LGBTQ; Intimate Partner Violence; Sexual Orientation; LGBTQ; Sexual Risk Taking; Bullying

Exploring cross-sectional predictors of suicide ideation, attempt, and risk in a large online sample of transgender and gender nonconforming youth and young adults - Kuper, Laura E.; Adams, Noah; Mustanski, Brian S. (LGBT Health, 2018)
Purpose: Rates of suicide ideation and attempt appear to be particularly high in the transgender and gender nonconforming (TGNC) population, yet little is known about which factors are the most salient contributors for TGNC young people and how these contributors vary across suicide-related outcomes. Methods: Within the largest sample of TGNC young people to date (N = 1896; ages 14–30), we examined the contribution of demographics (age, assigned sex, gender identity, sexual orientation identity, race/ethnicity, and socioeconomic status), minority stress (gender-related affirmation, gender-related self-concept, victimization, and gender-affirming medical treatment desire/access), social support (from family and friends), and depressive symptoms in the cross-sectional prediction of three suicide-related outcomes: past-year attempt, past-year ideation, and a composite measure of suicide risk. Results: Each set of factors explained significant variance in each outcome; however, only several predictors remained significant in each of the full models. Gender-related victimization and depressive symptoms were independent predictors for all three outcomes. Additional predictors varied across outcome. Age, male identity, sexual orientation-based victimization, and friend support were associated with suicide attempt. Age, queer identity, gender-related self-concept negativity, and family support were associated with suicide ideation, and pansexual identity and gender-related self-concept negativity were associated with positive suicide risk screen. Conclusion: Prevention and intervention efforts aimed at building support and positive self-concept, decreasing victimization, and treating depression are likely to partially reduce suicide ideation and attempt in TGNC adolescents and young adults. Comprehensive interventions with younger adolescents are particularly critical. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide ideation; suicide attempt; risk factors; transgender; age differences; Adolescent; Adult; Cross-Sectional Studies; Female; Humans; Internet; Male; Risk Factors; Suicidal Ideation; Suicide, Attempted; Transgender Persons; Young Adult; Age Differences; Attempted Suicide; Risk Factors; Suicidal Ideation; Transgender

Gender-affirming medical interventions and mental health in transgender adults - Tomita, Kevin K.; Testa, Rylan J.; Balsam, Kimberly F. (Psychology of Sexual Orientation and Gender Diversity, 2019)
Purpose: Researchers have provided evidence for behavioral health disparities between transgender and cisgender individuals. Few studies considered the impact of possessing sex characteristics at birth that are not congruent with gender identity. In studies that examined gender-affirming medical interventions (GAMIs) and behavioral health in transgender adults, important variables and a range of behavioral health symptoms have not been considered. This study explored relationships between three GAMIs and scores on 6 symptom measures, while controlling for key variables. We hypothesized that, compared with transgender people who desire but have not yet engaged in a GAMI, those who engaged in the GAMI will report lower symptom scores on behavioral health outcomes. Method: Using a cross-sectional design, data from 868 transgender people were analyzed through comparison of the behavioral health of those who completed a given GAMI and those who wanted to complete the intervention. Results: GAMIs were associated with lower scores on measures of depression, social anxiety, generalized anxiety, and PTSD and higher scores on alcohol abuse for trans masculine identity spectrum (TMIS) people who completed GAMIs compared with those who desired but did not complete GAMIs. Results related to trans feminine identity spectrum (TFIS) people largely demonstrated nonsignificant differences. Discussion: Results indicate that among those who desire GAMIs, the completion of GAMIs are associated with better behavioral health for TMIS people, with the exception of alcohol abuse. Nonsignificant differences in the results of TFIS people may be attributable to differences in sample size, social ramifications, GAMI satisfaction, and hormone effects. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; transgender health; mental health; Intervention; Mental Health Services; Transgender; Alcohol Abuse; Gender Identity; Health Care Psychology; Major Depression; Mental Health

Sexual orientation and mental health among adults in four US cities - Nam, Boyoung; Jun, Hyun-Jin; Fedina, Lisa; Shah, Roma; DeVylder, Jordan E. (Psychiatry Research, 2019)
Sexual minorities have higher risk for psychological distress than heterosexual populations. However, this disparity remains under-studied in urban settings, and there likewise has been minimal prior research of potential interactions with gender and race/ethnicity. The present study aimed to examine mental health correlates of sexual minority identification in conjunction with gender and race/ethnicity. A community sample of 1,615 adults from four eastern cities in the United States was used. A series of regression analyses were conducted to examine differences in psychological distress and suicidal ideation across different sexual orientation populations. The results showed that only bisexual individuals had significantly higher psychological distress and risk for suicidal ideation than heterosexual individuals even after adjusting for age and income. The associations were consistent across gender and race/ethnicity. No significant differences between homosexual and heterosexual individuals were found. Health professionals working with people of bisexual orientation in urban settings should attend to potential psychological distress and recent suicidal ideation. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual minorities; Bisexual; Minority stress model; Mental health; Race/ethnicity; Mental Health; Minority Groups; Racial and Ethnic Differences; Sexual Orientation; At Risk Populations; Bisexuality; Distress; Heterosexuality; Suicidal Ideation; Urban Environments

Racial/ethnic differences in mental health, substance use, and bullying victimization among self-identified bisexual high school-aged youth - Feinstein, Brian A.; Turner, Blair C.; Beach, Lauren B.; Korpak, Aaron K.; Phillips, Gregory II (LGBT Health, 2019)
Purpose: Sexual minority youth are at increased risk for mental health problems and substance use, and accumulating evidence indicates that bisexual youth are at greatest risk. However, bisexual youth are not a homogenous group and scholars have called for greater attention to the intersections of multiple marginalized identities. As such, we examined racial/ethnic differences in mental health (sadness/hopelessness and suicidal ideation), substance use (cigarette use, binge drinking, marijuana use, and other illicit drug use), and bullying (in-person and electronic) among self-identified bisexual high school-aged youth (overall and by sex). Method: Data from the local versions of the Youth Risk Behavior Survey were pooled across jurisdictions and years (2011–2015), resulting in an analytic sample of 18,515 bisexual youth who were racially/ethnically diverse. Results: Black and Hispanic bisexual youth were less likely to report in-person and electronic bullying than White bisexual youth. In addition, Black bisexual youth were less likely to report sadness/hopelessness and suicidal ideation than White, Hispanic, and Other race/ethnicity bisexual youth. Black bisexual female youth were also less likely to report cigarette use, binge drinking, and other illicit drug use than White bisexual female youth. In contrast to most of our findings, Black bisexual youth were more likely to report marijuana use than White bisexual youth. Most of the significant racial/ethnic differences in mental health and substance use remained significant after controlling for bullying. Conclusion: These findings highlight the heterogeneity of bisexual youth and the need to consider multiple marginalized identities to understand the health disparities affecting this diverse population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: bisexual; bullying; ethnicity; mental health; race; substance use; marginalization; Adolescent; Bullying; Continental Population Groups; Ethnic Groups; Female; Humans; Male; Mental Health; Schools; Sexual and Gender Minorities; Substance-Related Disorders; Surveys and Questionnaires; Bisexuality; Drug Usage; Mental Health; Racial and Ethnic Differences; Bullying; Marginalization

What is the relationship between rejection and self-harm or suicidality in adulthood? - Cawley, Rosanne; Pontin, Eleanor E.; Touhey, Jade; Sheehy, Kate; Taylor, Peter James (Journal of Affective Disorders, 2019)
Background: Rejection is an adverse experience that may help explain the heightened risk of self-harm and suicide amongst many societal groups. The aim of this systematic review was to determine the relationship between rejection experiences and self-harm and suicidal ideation. Method: The databases PsychINFO, CINAHL, Medline and Web of Science were searched from inception until May 2017 using key search terms. Quantitative studies were included if they were; (i) mean sample age over 18; (ii) in the English language; (iii) and had a measure of self-harm or suicidal behaviour and a measure of rejection. The results were synthesised narratively. Results: Eighteen studies were identified for the review. Fifteen out of the eighteen studies found a significant positive association between rejection and self-harm. This association was identified within several marginalised groups known to be at risk of self-harm, including those from lesbian, gay or bisexual sexuality or those who identify as transgender. Limitations: Heterogeneity between the measures of self-harm, suicidal behaviour and rejection, as well as the lack of longitudinal analyses made it difficult to draw firm conclusions. Conclusion: Perceived rejection may leave some individuals at risk of self-harm and might account for the elevated risk in marginalised societal groups. Interventions focused on modifying rejection experiences may help reduce the risk of self-harm in this population. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Rejection; Self-harm; Suicidal ideation; Adult; Comorbidity; Self-Injurious Behavior; Social Acceptance; Suicide

A preliminary examination of the association between adolescent gender nonconformity and suicidal thoughts and behaviors - Spivey, Leigh A.; Prinstein, Mitchell J. (Journal of Abnormal Child Psychology, 2019)
Suicidal thoughts and behaviors are a significant health concern for adolescents. Extant research suggests that sexual and gender minority adolescents are a vulnerable population at elevated risk for suicidal thoughts and behaviors, yet to date few studies have examined the unique associations between adolescent gender nonconformity and suicide risk. This study examined data from the Youth Risk Behavior Surveillance Survey (n = 7730) to estimate the association between gender nonconformity and high school-aged adolescents’ likelihood of endorsing four distinct suicide outcomes: suicidal ideation, suicide plans, any suicide attempts, and single vs. multiple suicide attempts. Multivariate logistic regression analyses were utilized to control for other known risk factors for suicidal thoughts and behaviors, including age, sex, sexual minority status, depression symptoms, and suicidal ideation. Results revealed that gender nonconformity was significantly associated with higher odds of reporting suicidal ideation, suicide plans, and multiple suicide attempts in the past year above and beyond other known risk factors. Gender nonconformity is an understudied vulnerability factor that should be taken into consideration by researchers and clinicians seeking to understand adolescents’ risk for suicidal thoughts and behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Suicide; Suicidal thoughts and behaviors; Gender nonconformity; Adolescence; Attempted Suicide; Risk Factors; Suicidal Ideation; Adolescent Behavior; Gender Nonconforming; Gender Identity; Risk Taking; Sexual Risk Taking; Suicide

Suicidal ideation and attempted suicide amongst Chinese transgender persons: National population study - Chen, Runsen; Zhu, Xuequan; Wright, Lucy; Drescher, Jack; Gao, Yue; Wu, Lijuan; Ying, Xin; Qi, Ji; Chen, Chen; Xi, Yingjun; Ji, Lanxin; Zhao, Huichun; et al. (Journal of Affective Disorders, 2019)
Background: This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China. Methods: Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants' demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China. Results: A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models. Limitations: The cross-sectional study design and lack of follow-up data are limitations of this study. Conclusions: This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Transgender; Suicidal ideation; Suicide attempts; Chinese; Attempted Suicide; Chinese Cultural Groups; Suicidal Ideation; Transgender; Mental Health

Parental reactions to transgender and gender diverse children: A literature review - Abreu, Roberto L.; Rosenkrantz, Dani E.; Ryser-Oatman, Jonathan T.; Rostosky, Sharon S.; Riggle, Ellen D. B. (Journal of GLBT Family Studies, 2019)
Transgender and gender diverse (TGD) individuals face stigmatization from family members and peers, placing this group at high risk of adverse outcomes including suicidality, substance abuse, and compromised mental health. This article uses a literature review approach to explore the common experiences of parents of TGD individuals as they navigate their relationship with their TGD children. Across 32 identified studies, the experiences of parental reactions include: (a) initial experiences (including noticing gender atypical behavior, diverse emotional reactions, cognitive dissonance and behavioral avoidance, and lack of knowledge); (b) transformation processes (including seeking informative resources and developing cognitive flexibility, seeking support and making TGD connections, facing barriers and isolation, developing awareness of discrimination and building empathy, and acknowledging the toll on mental health); (c) positive outcomes (including relational benefits, affirmation of values and activism, and new personal narratives); and (d) influences on the process (including time, gender, and attribution of the cause of TGD identity). Recommendations for health service providers include acknowledging diverse emotional reactions and cognitive dissonance, cultivating hope, honoring systemic barriers, and helping parents of TGD individuals create new positive narratives. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Parental figures; parental reactions; TGD children; literature review; No terms assigned

Comparison of perceived burdensomeness, thwarted belongingness, capability for suicide, and suicidal ideation among heterosexual and sexual minority individuals in mississippi - Pate, Ashley R.; Anestis, Michael D. (Archives of Suicide Research, 2019)
This study sought to compare risk factors for suicidal ideation among heterosexual and sexual minority college students from a previously understudied conservative region of the United States. Suicidal ideation, thwarted belongingness (TB), perceived burdensomeness (PB), and capability for suicide were examined. It was found that PB was significantly higher among sexual minorities than heterosexual individuals, TB and capability were not significantly different, and suicidal ideation was not significantly different when controlling for depression but was significant when depression was not a covariate. Additionally, among sexual minorities and heterosexuals, TB and PB were correlated with ideation and that the strength of the relationship between PB and ideation was dependent on how much TB the individual is experiencing. Sexual minorities, when compared to heterosexual individuals, do not have higher TB or capability, but do have higher levels of PB and suicidal ideation. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: capability for suicide; perceived burdensomeness; sexual minorities; suicidal ideation; thwarted belongingness; No terms assigned

Association between insufficient sleep and suicidal ideation among adolescents - Baiden, Philip; Tadeo, Savarra K.; Tonui, Betty C.; Seastrunk, Jaylon D.; Boateng, Godfred O. (Psychiatry Research, 2019)
The objective of this study was to examine the association between insufficient sleep and suicidal ideation among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,659 adolescents aged 14–18 years (51.8% female) were analyzed using logistic regression with suicidal ideation as the outcome variable and insufficient sleep as the main explanatory variable. Of the 13,659 adolescents, 2,409 representing 17.6% experienced suicidal ideation during the past 12 months and three out of four adolescents (75.2%) had insufficient sleep on an average school night. Controlling for all other predictors, the odds of experiencing suicidal ideation were 1.35 times higher for adolescents who had insufficient sleep relative to those who had sufficient sleep on an average school night (AOR = 1.35, 95% CI = 1.16–1.58). Other factors associated with suicidal ideation include female gender, sexual minority, history of traditional bullying and cyberbullying victimization, feeling sad or hopeless, being slightly or very overweight, and substance use. Physical activity was inversely associated with suicidal ideation. School counselors, clinicians, and practitioners should consider adequate sleep as an important intervention in suicide prevention. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Adolescents; Insufficient sleep; Risk behaviors; Suicidal ideation; No terms assigned

Reducing the treatment gap for lgbt mental health needs: The potential of telepsychiatry - Whaibeh, Emile; Mahmoud, Hossam; Vogt, Emily L. (The Journal of Behavioral Health Services & Research, 2019)
AbstractThe high prevalence of psychiatric conditions and the concomitant increase in need for mental illness have posed a challenge across the USA. Patients continue to encounter many barriers to accessing care with only 43% receiving treatment. This situation is even more challenging for LGBT individuals, who experience higher rates of some mental health conditions, with an increased risk of suicidality, due to stressors such as discrimination and trauma. Simultaneously, LGBT individuals face specific barriers at the individual level, clinician level, and systemic level. Telepsychiatry has emerged as an approach that can help overcome some of the challenges faced by LGBT individuals when it comes to healthcare access. This paper examines the ways in which telepsychiatry can overcome the aforementioned barriers and provides recommendations to enhance the quality of telepsychiatry services for LGBT patients. Recommendations include improving medical education, enhancing health-force training on cultural competency, and expanding culturally affirming telehealth programs. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: No terms assigned

'Fear runs deep:' The anticipated needs of LGBT older adults in long-term care - Putney, Jennifer M.; Keary, Sara; Hebert, Nicholas; Krinsky, Lisa; Halmo, Rebekah (Journal of Gerontological Social Work, 2018)
Objectives: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. Discussion: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: fear; LGBT; older adults; long-term care; nursing homes; assisted living; Aged; Aged, 80 and over; Cultural Competency; Fear; Female; Focus Groups; Humans; Long-Term Care; Male; Middle Aged; Needs Assessment; Qualitative Research; Sexual and Gender Minorities; Aging; Fear; Long Term Care; LGBTQ; Assisted Living; Nursing Homes

Discrimination and suicidal ideation among transgender veterans: The role of social support and connection - Carter, Sarah P.; Allred, Kelly M.; Tucker, Raymond P.; Simpson, Tracy L.; Shipherd, Jillian C.; Lehavot, Keren (LGBT Health, 2019)
Purpose: The aim was to examine social support and community connection as moderators of the relationship between discrimination and suicidal ideation (SI) in transgender veterans. Methods: A national convenience sample of 298 transgender veterans completed an online cross-sectional survey from February to May 2014. Hierarchical regressions using nonparametric bootstrapping assessed associations among gender-related discrimination within the past year, two aspects of social support (social support, social connection) from four sources (family, friends, transgender/LGBT friends, and veterans), and SI in the past 2 weeks. Results: Discrimination was positively associated with SI. Social support from transgender friends and social connection with LGBT and veteran communities moderated the relationship between discrimination and SI. At high and average levels of social support and connection, discrimination was associated with greater SI, whereas at low levels of these variables, SI was consistently elevated and unrelated to discrimination. Conclusion: Given that SI was consistently elevated when discrimination was high, these findings emphasize the need for additional research on how to mitigate the detrimental effects of discrimination, with consideration given to interventions targeting discrimination or responses to discrimination. In addition, given that high and average transgender social support and LGBT social connection were associated with reduced SI when discrimination was low, research would benefit from continued exploration of the potential protective elements of social support from a shared stigmatized community. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: discrimination; minority stress; social support; suicide ideation; transgender; veterans; Adult; Family; Female; Friends; Humans; Male; Middle Aged; Sexual and Gender Minorities; Social Discrimination; Social Participation; Social Support; Suicidal Ideation; Transgender Persons; Veterans; Military Veterans; Social Discrimination; Social Support; Suicidal Ideation; Transgender; Interpersonal Interaction; Test Construction; Minority Stress

Higher educational attainment is associated with lower risk of a future suicide attempt among non-Hispanic whites but not non-Hispanic Blacks - Assari, Shervin; Schatten, Heather T.; Arias, Sarah A.; Miller, Ivan W.; Camargo, Carlos A.; Boudreaux, Edwin D. (Journal of Racial and Ethnic Health Disparities, 2019)
Purpose: In a sample of patients presenting to the emergency department (ED), the current study was conducted with two aims: (1) to investigate the protective effects of educational attainment (i.e., completing college) on subsequent risk of suicide attempt/death among patients presenting to the ED and (2) to compare this effect between non-Hispanic Black and non-Hispanic White ED patients. Methods: The current study analyzed data from the Emergency Department Safety Assessment and Follow-Up Evaluation (ED-SAFE) study, a quasi-experimental, eight-center study of universal suicide screening and follow-up of ED patients presenting for suicidal ideation and behavior. Our sample included 937 non-Hispanic White and 211 non-Hispanic Blacks. The dependent variable was suicide attempt/death during the 52-week follow-up. The independent variable was completing college. Age, gender, lesbian/gay/bisexual status, psychiatric history, and previous suicide attempts at baseline were covariates. Race/ethnicity was the focal effect modifier. Logistic regression models were used to test the protective effects of educational attainment on suicide risk in the overall sample and by race/ethnicity. Results: In the overall sample, educational attainment was not associated with suicide risk over the follow-up period. A significant interaction was found between race/ethnicity and educational attainment on suicide risk, suggesting a larger protective effect for non-Hispanic Whites compared with non-Hispanic Blacks. In race/ethnicity-specific models, completing college was associated with decreased future suicide risk for non-Hispanic Whites but not Blacks. Conclusions: Consistent with the Minorities’ Diminished Return theory, educational attainment better protected non-Hispanic White than non-Hispanic Blacks against future suicide attempt/death. While Whites who have not completed college may be at an increased risk of suicide, risk of suicide seems to be independent of educational attainment for non-Hispanic Blacks. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Socioeconomic status; Ethnic health disparities; Race; Ethnicity; Blacks; Suicide; At Risk Populations; Attempted Suicide; Blacks; Educational Attainment Level; Suicide; Emergency Services; Protective Factors; Whites; Latinos/Latinas

The relationship between family acceptance-rejection and transgender youth psychosocial functioning - Pariseau, Emily M.; Chevalier, Lydia; Long, Kristin A.; Clapham, Rebekah; Edwards-Leeper, Laura; Tishelman, Amy C. (Clinical Practice in Pediatric Psychology, 2019)
Objective: Transgender youth have a high risk of adverse mental health outcomes. Family acceptance may play a protective role in transgender youth’s psychosocial adjustment; however, studies have largely examined acceptance independent from gender identity, averaged across family members, and in extreme examples (i.e., high acceptance or high rejection). Grounded in interpersonal acceptance-rejection theory, this study documents transgender youth’s experiences of family acceptance-rejection across family members, including siblings, and investigates the relationship between family acceptance-rejection and youth psychosocial functioning. Method: Fifty-four youth completed psychosocial questionnaires, and youth and caregivers completed semistructured clinical interviews, which were coded for family acceptance-rejection. Analyses examined associations between acceptance-rejection and psychosocial variables. Results: Lower primary caregiver past acceptance predicted increased youth depressive/anxiety symptoms/internalizing problems. Higher secondary caregiver indifference predicted increased youth depressive symptoms. Lower sibling acceptance predicted increased youth suicidal ideation. Conclusions: Findings demonstrate that family acceptance-rejection plays an important role in the psychosocial adjustment of transgender youth. New to the existing literature are the findings that caregiver indifference and sibling acceptance are associated with mental health outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: acceptance; rejection; family; siblings; transgender youth; Family; Psychosocial Factors; Social Acceptance; Transgender; Social Functioning; At Risk Populations; Caregivers; Family Relations; Internalization; Major Depression; Mental Health; Protective Factors; Psychosocial Readjustment; Siblings

Suicide acceptability and sexual orientation: Results from the general social survey 2008–2014 - Blosnich, John R.; Lytle, Megan C.; Coulter, Robert W. S.; Whitfield, Darren L. (Archives of Suicide Research, 2018)
Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n = 5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR = 1.92; 95% CI: 1.06, 3.46), dishonors family (OR = 1.83; 95% CI: 1.01, 3.28), or is tired of living (OR = 2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: general social survey; sexual minority; sexual orientation; suicide acceptability; Adolescent Attitudes; Health Attitudes; Sexual Orientation; Suicide; Suicidology; Bisexuality; Lesbianism; Male Homosexuality; Sexual Minority Groups

Disability, sexual orientation, and the mental health outcomes of intimate partner violence: A comparative study of women in the US - Coston, Bethany M. (Disability and Health Journal, 2019)
Background: Research on disabled non-heterosexual women's post-intimate partner violence mental health outcomes—such as anxiety, depression, suicidal ideation, and alcohol use—is lacking. Objective: To examine the impact of the intersection of disability and sexual orientation on women's post-intimate partner violence mental health outcomes: including difficulty sleeping, missing school or work, or reporting some post-traumatic stress disorder symptomology and a self-reported subjective measure of overall wellbeing. Methods: Data come from the National Intimate Partner and Sexual Violence Survey (2010). A series of chi-square analyses were conducted (applying standardized sample weights and adjusting standard errors for both clustering and stratification for survey data). Results: Bisexual women are significantly more likely than straight women to report being disabled prior to victimization, but all disabled women—regardless of sexual orientation—are equivalently likely to rate their mental health as poor and/or actively experience difficulty sleeping, difficulty going to work or school, and/or PTSD. Conclusions: Aligned with previous work, this study finds that bisexual women are significantly more likely than straight women to be disabled prior to experiencing all forms of intimate partner violence; and that disabled women, generally, are significantly more likely than not-disabled women to experience the negative mental health consequences of that violence. However, contrary to previous work, there are no sexual orientation disparities in said mental health outcomes among disabled women. Clinically, it is important for health care providers to be aware of the significant impact of intimate partner violence on the disabled women they regularly provide care to. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGBT; Mental health; Bisexual; Intimate partner violence; Domestic violence; Disabilities; Human Females; Intimate Partner Violence; Mental Health; Sexual Orientation; Bisexuality; Test Construction; Violence; Partners; LGBTQ

Gender minority mental health in the US: Results of a national survey on college campuses - Lipson, Sarah Ketchen; Raifman, Julia; Abelson, Sara; Reisner, Sari L. (American Journal of Preventive Medicine, 2019)
Introduction: The purpose of this study was to examine mental health status by gender identity among undergraduate and graduate students. Methods: Data came from the 2015–2017 Healthy Minds Study, a mobile survey of randomly selected students (N = 65,213 at 71 U.S. campuses, including 1,237 gender minority [GM] students); data were analyzed in 2018. Outcomes were symptoms of depression, anxiety, eating disorders, self-injury, and suicidality based on widely used, clinically validated screening instruments. Bivariable and multivariable analyses explored differences between GM and cisgender (non-GM) students as well as by assigned sex at birth. Results: Across mental health measures, a significantly higher prevalence of symptoms was observed in GM students than cisgender students. Compared with 45% of cisgender students, 78% of GM students met the criteria for 1 or more of the aforementioned mental health outcomes. GM status was associated with 4.3 times higher odds of having at least 1 mental health problem (95% CI = 3.61, 5.12). Conclusions: Findings from this largest campus-based study of its kind using representative data with both gender identity and mental health measures underscore the importance of recognizing and addressing GM mental health burdens, such as by screening for mental health and providing gender-affirming services. There is broad urgency to identify protective factors and reduce mental health inequities for this vulnerable population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gender minority; mental health; college campuses; protective factors; Campuses; College Students; Gender Identity; Mental Health; Sexual Minority Groups; Anxiety; Eating Disorders; Graduate Students; Major Depression; Self-Injurious Behavior; Symptoms; Suicidality

Evaluating a tool to support the integration of gender in programs to promote men’s health - Struik, Laura L.; Abramowicz, Aneta; Riley, Barbara; Oliffe, John L.; Bottorff, Joan L.; Stockton, Lisa D. (American Journal of Men's Health, 2019)
Men’s disproportionate rate of suicide and substance use has been linked to problematic conformity to traditional masculine ideals. Mental health promotion interventions directed toward men should address the gender-specific needs of men; yet, no tools exist to provide such guidance. To address this need, the Check-Mate tool was developed as part of a global evaluation of the Movember Foundation’s Social Innovators Challenge (SIC). The tool provides an initial set of evidence-based guidelines for incorporating gender-related influences in men’s mental health promotion programs. This article describes the development of Check-Mate and an evaluation of its usability and usefulness. Using a qualitative descriptive approach, semistructured interviews were conducted with the leads for eight of the SIC projects; they used the tool for these. Data were analyzed using conventional content analysis. Overall, project leads found the tool user-friendly. Identified strengths of Check-Mate included its practicality, adaptability, usefulness for priming thinking on gender sensitization, and value in guiding program planning and implementation. With respect to limitations, project leads explained that the complexity of men’s mental health promotion programming may limit applicability of some or all approaches included in Check-Mate. They also expressed concern about how using Check-Mate might reinforce hegemonic masculine ideals. It was suggested that examples illustrating the use of Check-Mate would be a helpful accompaniment to the tool. Findings indicate that Check-Mate is a useful guide in men’s mental health promotion programming. In addition to future testing of the tool in different settings, links between the tool’s approaches and program outcomes should be explored. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: masculinity; gender issues; sexual orientation; health promotion; disease prevention; health care issues; health programs; men’s health interventions; mental health; Educational Measurement; Health Education; Health Promotion; Human Males; Sex and Gender Measures; Curriculum Development; Educational Objectives; Educational Program Planning; Educational Programs; Evaluation Criteria; Masculinity; School Based Intervention; Test Construction

Risk factors and correlates of self-injurious behavior and suicidal ideation among college students - Bakken, Nicholas W. (Deviant Behavior, 2019)
This research examines psychosocial risk factors of non-suicidal self injury (NSSI) and suicidal ideation among a sample of college students. Data were collected from a random sample of 1,153 undergraduate students attending a Midwestern public university. Logistic regression was used to investigate various risk factors of NSSI and suicidal ideation, including respondent demographic characteristics, mental health, sexual victimization, substance use, and academic anxiety. Overall, 7% of the college students reported engaging in NSSI in the past year, while 8% reported suicidal ideation in the past year. Factors associated with significantly higher likelihood of NSSI and suicidal ideation include non-heterosexual orientation, sexual victimization, substance use, depression, and low self-esteem and self-efficacy. Students experiencing psychosocial and health related factors were found to be at an increased risk for NSSI and suicidal ideation. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: No terms assigned

Perceptions of safety among LGBTQ people following the 2016 Pulse nightclub shooting - Stults, Christopher B.; Kupprat, Sandra A.; Krause, Kristen D.; Kapadia, Farzana; Halkitis, Perry N. (Psychology of Sexual Orientation and Gender Diversity, 2017)
The goals of this manuscript are twofold. First, we provide a brief reaction to this journal’s 'Special Section: Reflections on the Orlando Massacre on its First Anniversary.' Second, we present findings from a study on perceptions of safety among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals following the Pulse shooting. These issues are discussed within the historical context of hate crimes experienced by the LGBTQ population (Herek), media coverage following the shooting (Hancock and Halderman), and the immediate reaction of LGBTQ graduate students to the event (Jackson). Our study sought to examine differences in perceptions of personal and peer safety by race/ethnicity, gender identity, and sexual orientation among a large, diverse sample of LGBTQ people. Findings from our study indicate that there were differences in perceptions of personal safety by gender identity, and differences in perceptions of peer safety by gender identity and sexual orientation. These findings also suggest that subgroups of the LGBTQ community with more marginalized gender and sexual identities (e.g., female, transgender, genderqueer, bisexual, queer respondents) perceived more concerns related to safety, on average, than subgroups with relatively more privilege (e.g., gay, male). Elevated safety concern may exacerbate multiple minority stress burden, a known driver of poor health outcomes among LGBTQ people. These findings are a call to action to health care providers to be well informed and trained to provide the appropriate care and counseling referrals that can address the safety-related concerns of LGBTQ individuals in the aftermath of identity-related attacks. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Pulse nightclub; mass shooting; LGBTQ people; collective trauma; perceptions of safety; Hate Crimes; Homosexuality; Safety; Sexual Orientation; Violence; Adult Attitudes; Bisexuality; Lesbianism; Male Homosexuality; Trauma; Transgender; LGBTQ

Counselling transgender individuals: Issues and considerations - Weir, Cassandra; Piquette, Noëlla (Canadian Psychology/Psychologie canadienne, 2018)
Transgender individuals represent a unique population whose voices are often lost within the Lesbian, Gay, Bisexual, and Transgender (LGBT) population. Being transgender challenges the assumptions that people may make regarding sex and gender as they do not adhere to a gender binary. Transgender individuals experience unique life challenges and are at risk for violence as well as mental health concerns, including suicide. With an increase in awareness regarding transgender individuals, as well as recent changes to policies and treatment, it is important that counsellors are aware of this population and the challenges they face. Transgender individuals are often combined with other sexual minorities; however, although they may identify as homosexual and experience homophobia, they also experience transphobia because of their gender identity. The potential for multiple forms of violence, combined with a lack of safe and appropriate supports, can lead to the potential for serious harm and damage among this population. Therefore, counsellors should work toward developing competencies and awareness in how to best serve this population. This article addresses many of the key issues and counselling recommendations. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: transgender; violence; counselling support; at risk; counselling competencies; Counseling; Violence; Transgender; At Risk Populations; Mental Health; Professional Competence; Social Support; Suicide

Mental health staff perceptions and practice regarding self-harm, suicidality and help-seeking in LGBTQ youth: Findings from a cross-sectional survey in the UK - Hughes, Elizabeth; Rawlings, Victoria; McDermott, Elizabeth (Issues in Mental Health Nursing, 2018)
Young people who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) experience higher levels of suicidality compared to heterosexual or cisgender peers, and face significant barriers accessing mental health services including prejudice from staff. In a cross-sectional survey, mental health staff who reported receiving LGBT awareness training were significantly more likely to report in relation to working with LGBT youth that they routinely discussed issues of sexuality and gender (χ² = 8.782, df = 2, p < 0.05); to feel that their organisation supported them to work with this group (χ² = 14.401, df = 2, p < 0.001); and report that they had access to adequate skills training that supported their work with suicidality and self-harm with this group (χ² = 21.911, df = 2, p < 0.001). There is a need to enhance the mental health workforce in LGBTQ awareness, and these findings indicate that awareness training could impact positively on practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: mental health personnel attitudes; self-harm; suicidality; LGBTQ youth; Adolescent; Adult; Attitude of Health Personnel; Cross-Sectional Studies; Female; Health Services Accessibility; Humans; Male; Mental Health Services; Middle Aged; Patient Acceptance of Health Care; Self-Injurious Behavior; Sexual and Gender Minorities; Sexuality; Suicide; Surveys and Questionnaires; United Kingdom; Health Personnel Attitudes; Mental Health Personnel; Personnel Training; Sexuality; Suicidal Ideation; Awareness; Help Seeking Behavior; Test Construction; Treatment Barriers; Suicidality; LGBTQ

Relation between sexual and gender minority status and suicide attempts among veterans seeking treatment for military sexual trauma - Sexton, Minden B.; Davis, Margaret T.; Anderson, RaeAnn E.; Bennett, Diana C.; Sparapani, Erin; Porter, Katherine E. (Psychological Services, 2018)
There is limited study of suicidal behaviors among veterans identifying as sexual and gender minorities (SGMs), despite previous research indicating rates of suicide attempts are high within civilian SGM populations. Further, some research incorporating military service members suggests those identifying as SGMs are disproportionately exposed to military sexual trauma (MST), an additional risk factor for negative psychiatric sequelae. To address health care research disparities among minority veterans (i.e., women, those endorsing MST, SGMs), we examined presentations of veterans (N = 277) who attended initial consultation appointments for MST-related treatment and completed a semistructured clinical interview including demographic characteristics, history of suicide attempts (HSA), and a diagnostic evaluation. Twenty-eight (10.1%) veterans identified as SGMs. SGM/non-SGM groups were contrasted on suicidal and psychiatric morbidity outcomes. Overall, endorsement of HSA was high (30.7%). Despite similar clinical profiles, 53.6% of veterans who identified as SGM endorsed HSA in contrast with 28.1% of peers identifying as heterosexual and nontransgender, a significant effect of small-to-moderate size. Findings suggest assessment and clinical management of suicidality is of critical importance for clinicians providing services to veterans pursuing recovery from MST, generally, and may be especially so when delivering care to SGM. Further, results underscore the need for culturally competent delivery of trauma-focused interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: veterans; suicide attempts; military sexual trauma; sexual minorities; gender minorities; Attempted Suicide; Health Care Seeking Behavior; Military Veterans; Minority Groups; Sexual Orientation; Lesbianism; Male Homosexuality; Risk Factors; Sex Offenses; Transgender

The Gender Affirmative Lifespan Approach (GALA): A framework for competent clinical care with nonbinary clients - Rider, G. Nic; Vencill, Jennifer A.; Berg, Dianne R.; Becker-Warner, Rachel; Candelario-Pérez, Leonardo; Spencer, Katherine G. (International Journal of Transgenderism, 2019)
Background: The limited research on nonbinary individuals suggests that this community experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals. Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA’s therapeutic interventions are designed to promote positive gender identity development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired). Results: The core components of the GALA model are individualized to each client’s unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals. Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: nonbinary; transgender; transgender health; LGBT health; psychotherapy; Life Span; Mental Health; Clinical Models; LGBTQ; Gender Nonconforming; Clients; Intervention; Psychotherapy; Health Disparities

Association of religiosity with sexual minority suicide ideation and attempt - Lytle, Megan C.; Blosnich, John R.; De Luca, Susan M.; Brownson, Chris (American Journal of Preventive Medicine, 2018)
Introduction: The purpose of this study is to explore how the associations between importance of religion and recent suicide ideation, recent suicide attempt, and lifetime suicide attempt vary by sexual orientation. Methods: Survey data were collected from the 2011 University of Texas at Austin’s Research Consortium data from 21,247 college-enrolled young adults aged 18–30 years. Respondents reported sexual identity as heterosexual, gay/lesbian, bisexual, or questioning. Two sets of multivariable models were conducted to explore the relations of religious importance and sexual orientation with the prevalence of suicidal behavior. The first model was stratified by sexual orientation and the second model was stratified by importance of religion. To explore potential gender differences in self-directed violence, the models were also stratified by gender identity. The main outcome measures were recent suicidal ideation, recent suicide attempt, and lifetime suicide attempt. Results: Overall, increased importance of religion was associated with higher odds of recent suicide ideation for both gay/lesbian and questioning students. The association between sexual orientation and self-directed violence were mixed and varied by strata. Lesbian/gay students who viewed religion as very important had greater odds for recent suicidal ideation and lifetime suicide attempt compared with heterosexual individuals. Bisexual and questioning sexual orientations were significantly associated with recent suicide ideation, recent attempt, and lifetime attempt across all strata of religious importance, but the strongest effects were among those who reported that religion was very important. Conclusions: Religion-based services for mental health and suicide prevention may not benefit gay/lesbian, bisexual, or questioning individuals. Religion-based service providers should actively assure their services are open and supportive of gay/lesbian, bisexual, or questioning individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: suicide ideation; suicide attempt; religiosity; sexual minority; Adult; Female; Humans; Male; Religion and Psychology; Sexual and Gender Minorities; Social Stigma; Suicidal Ideation; Suicide, Attempted; Texas; Young Adult; Attempted Suicide; Religiosity; Sexual Orientation; Suicidal Ideation; Sexual Minority Groups; Gender Identity

Experiences of sexual and gender minorities in an urban enclave of haiti: Despised, beaten, stoned, stabbed, shot and raped - Rahill, Guitele J.; Joshi, Manisha; Galea, Jerome; Ollis, Jenifer (Culture, Health & Sexuality, 2019)
Studies of sexual and gender minorities in Haiti and globally typically involve HIV research and programming with men who have sex with men. We conducted focus groups with individuals in Haiti’s Cité Soleil slum whose assigned gender at birth matched neither their gender identity nor contextual heteronormative constructions of gender roles, i.e. transwomen and transmen. The Yogyakarta Principles provided the study framework. Focus group participants offered emic perspectives on overall well-being, identities, biopsychosocial strengths and HIV-protective and risk factors. We found that gender expression that conflicts with contextual norms evoked recurring, humiliating and intentionally injurious sexual assaults against participants, heightening their HIV risk; participants endured beatings, shootings, stabbings, stonings and socio-political violence. Lack of confidentiality and stigma hinder participants’ access to scarce HIV resources. Indistinct boundaries between sexuality, gender identity and gender expression merged with traditional gender-based roles to perpetuate sexual violence towards transwomen by cisgender heterosexual men and by transmen towards cisgender heterosexual women. Despite resignation to omnipresent violence, participants showed resilience regarding gender identity. Needed are integrated socio-behavioural and health programmes to challenge existing gender inequities while providing training on human rights and HIV risk reduction for Haitian sexual and gender minorities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Sexual violence; sexual and gender minorities; gender-based violence; HIV; Haiti; No terms assigned

'Mental health among UK inner city non-heterosexuals: The role of risk factors, protective factors and place': Corrigendum - Woodhead, C.; Gazard, B.; Hotopf, M.; Rahman, Q.; Rimes, K. A.; Hatch, S. L. (Epidemiology and Psychiatric Sciences, 2019)
Reports an error in 'Mental health among UK inner city non-heterosexuals: The role of risk factors, protective factors and place' by C. Woodhead, B. Gazard, M. Hotopf, Q. Rahman, K. A. Rimes and S. L. Hatch (Epidemiology and Psychiatric Sciences, 2016[Oct], Vol 25[5], 450-461). In the original article, there are errors in the tables. The correct versions of the tables and details of the corrections are given in the erratum. (The following abstract of the original article appeared in record [rid]2016-47001-010[/rid]). Background: Sexual minorities experience excess psychological ill health globally, yet the UK data exploring reasons for poor mental health among sexual minorities is lacking. This study compares the prevalence of a measure of well-being, symptoms of common mental disorder (CMD), lifetime suicidal ideation, harmful alcohol and drug use among inner city non-heterosexual and heterosexual individuals. It is the first UK study which aims to quantify how much major, everyday and anticipated discrimination; lifetime and childhood trauma; and coping strategies for dealing with unfair treatment, predict excess mental ill health among non-heterosexuals. Further, inner city and national outcomes are compared. Methods: Self-report survey data came from the South East London Community Health study (N = 1052) and the Adult Psychiatric Morbidity Survey (N = 7403). Results: Adjustments for greater exposure to measured experiences of discrimination and lifetime and childhood trauma had a small to moderate impact on effect sizes for adverse health outcomes though in fully adjusted models, non-heterosexual orientation remained strongly associated with CMD, lifetime suicidal ideation, harmful alcohol and drug use. There was limited support for the hypothesis that measured coping strategies might mediate some of these associations. The inner city sample had poorer mental health overall compared with the national sample and the discrepancy was larger for non-heterosexuals than heterosexuals. Conclusions: Childhood and adult adversity substantially influence but do not account for sexual orientation-related mental health disparities. Longitudinal work taking a life course approach with more specific measures of discrimination and coping is required to further understand these associations. Sexual minorities should be considered as a priority in the design and delivery of health and social services. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Cross cultural psychiatry; discrimination; epidemiology; mental health; minority issues; Mental Disorders; Protective Factors; Risk Factors; Sexual Orientation; Well Being; Epidemiology; Minority Groups; Psychiatry; Suicidal Ideation

Minority stress and mental health among LGBT populations: An update on the evidence - Mongelli, Francesca; Perrone, Daniela; Balducci, Jessica; Sacchetti, Andrea; Ferrari, Silvia; Mattei, Giorgio; Galeazzi, Gian M. (Minerva Psichiatrica, 2019)
Introduction: In the past five years, researchers have increasingly turned to the study of mental health outcomes in LGBT populations. The present paper summarizes recent literature on the relationship between minority stress experienced by sexual minorities and mental health. Evidence Acquisition: PsycINFO, PubMed, and the EBSCO Psychology and Behavioral Science Collection were searched for papers concerning minority stress and mental health disparities in LGBT populations, published between 1 January 2014 and 30 June 2018. All collected papers were screened using the following criteria: study involving >50 individuals; written in English; focusing on clinical outcomes of depression, suicidality, and substance use in relation to experienced minority stress. Evidence Synthesis: Sixty-two papers were included in this review. Findings are reported under three main headings: studies primarily focused on depression, studies concerning suicidality and suicide attempts, and papers analyzing the correlation between substance use and minority stress in LGBT populations. The included studies supported the minority stress model as a framework to better explain disparities in mental health outcomes in sexual minority populations. Higher rates of depression, suicidality, and substance use are reported in LGBT populations, as are the related minority stressors analyzed. Conclusions: Sexual minorities still face numerous mental health disparities. Research indicates that the levels of minority stressors positively predict mental health outcomes. Specific policies designed to support the civil rights of sexual minorities may help to overcome such inequalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Minority health; Mental health; Sexual and gender minorities; Depression; Suicide; Substance-related disorders.; Mental Health; Health Disparities; Sexual Minority Groups; LGBTQ; Minority Stress; Major Depression; Substance Use Disorder; Suicidality

The link between discrimination and worst point suicidal ideation among sexual and gender minority adults - Salentine, Cassidy M.; Hilt, Lori M.; Muehlenkamp, Jennifer J.; Ehlinger, Peter P. (Suicide and Life-Threatening Behavior, 2019)
Objective Sexual and gender minority (SGM) adults often report a disproportionately high rate of suicidal ideation compared to their heterosexual and cisgender counterparts. The current study aimed to understand the relationship between discrimination for one's sexual orientation or gender identity and suicidal ideation. We hypothesized that discrimination would be associated with suicidal ideation at one's worst point through the indirect effects of hopelessness regarding thwarted belongingness and perceived burdensomeness. Method A sample of 178 SGM adults (M age = 30.34, range 18–69; 76% white) completed an online questionnaire assessing minority‐specific stressors and suicide‐related thoughts and behaviors. Results A mediation model with bootstrapping indicated that greater discrimination was associated with more frequent suicidal ideation at one's worst point through the indirect effect of hopelessness regarding thwarted belongingness. Conclusions The current study provides evidence that the pathway between discrimination and worst point suicidal ideation may be partially explained by the perception that one will never belong. These findings support the utility of an understudied Interpersonal Theory of Suicide hypothesis for research among SGM adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: No terms assigned

Treatment-resistant depression in an adolescent treated with clozapine: Weighing the options in a young suicidal patient - Whitlock, Kevin; Smith, Noah; Poulsen, Raul J.; Coffey, Barbara J. (Journal of Child and Adolescent Psychopharmacology, 2020)
Presents a case report of a 13-year-old Hispanic biological female to a male transgender adolescent, A, with a psychiatric history of major depression, anxiety, and trauma who was involuntarily admitted to an inpatient child and adolescent psychiatry unit for recent and recurrent suicide attempts and self-harming behaviors. A summary of the patient's present illness, along with his psychiatric, developmental, educational, social, family, medical and medication history are provided. Hospital course, a brief formulation, and multiaxial diagnoses are presented. This case illustrates a not rare clinical problem for child and adolescent psychiatrists in which there is little evidence base for treatment. Although clozapine was shown to be both safe and effective for this patient in acute treatment, more data are needed to demonstrate its utility in management of treatment-resistant depression and BPD in the adolescent population. The need for more research is highlighted by the fact that there are many potential treatment options for these patients—such as ECT, and various medication augmentation strategies—but no proven superiority of any modality in youth. This case suggests that more research is needed to determine whether clozapine can improve outcomes in this high risk population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: case report; transgender adolescent; clozapine treatment; treatment-resistant depression; attempted suicide; major depressive disorder; borderline personality disorder; clozapine; Attempted Suicide; Borderline Personality Disorder; Clozapine; Drug Therapy; Treatment Resistant Depression; Adolescent Psychiatry; Comorbidity; Major Depression; Transgender

Thwarted belongingness and perceived burdensomeness explain the relationship between sleep problems and suicide risk among adults identifying as sexual and/or gender minorities - Chu, Carol; Hom, Melanie A.; Hirsch, Jameson K.; Joiner, Thomas E. (Psychology of Sexual Orientation and Gender Diversity, 2019)
Sleep problems are robust suicide risk correlates. According to the interpersonal theory of suicide, thwarted belongingness (TB) and perceived burdensomeness (PB) may explain the link between sleep problems and suicide risk. This study examined these relationships among 331 community-dwelling adults identifying as sexual and/or gender minorities. Self-report measures of sleep problems, TB, PB, suicide risk, and anxiety were completed. Bootstrap mediation analyses were conducted to test TB and PB as interacting, individual, and parallel explanatory factors linking sleep problems and suicide risk. Sleep problems were associated with greater TB, PB, and suicide risk. TB and PB, in parallel and individually, accounted for the relationship between sleep problems and suicide risk, beyond age and anxiety. In contrast to the interpersonal theory, the indirect effect of PB was stronger at lower levels of TB and the indirect effect of TB was stronger at lower levels of PB. Exploratory analyses indicated significant differences between sexual minorities, gender minorities, and individuals identifying as both sexual and gender minorities: the indirect effect of sleep problems on suicide risk through PB was descriptively strongest among sexual minorities, and the indirect effect through TB was descriptively stronger among gender minorities and individuals identifying with both minority groups. Findings suggest that intervening upon TB and PB may thwart the trajectory from sleep problems to suicide risk among sexual and gender minorities. Further work is needed to determine whether suicide risk pathways differ across minority groups. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: sleep; suicide; interpersonal theory of suicide; gender identity; sexual orientation; Sleep; Suicide; Belonging; Gender Identity; Interpersonal Interaction; Risk Factors; Sexual Orientation; Theories

Autoethnographic poetic inquiry: Therapeutically engaging with violence toward queers - Teman, Eric D. (Journal of Poetry Therapy, 2019)
Therapeutic applications of poetry provide a powerful means of exploring and portraying lived experiences of queer individuals. In this article, autoethnographic poetic inquiry is used to explore the author’s life. Bullying, suicide, moments of strength and weakness, othering, and stifling of voice are some of the issues explored through this poetic journey. The author reflects on each of the poems he has written and roots such explorations in methodological literature of arts-based qualitative research. The overall purpose of the article is to document parts of the author’s life as he demonstrates how poetry has begun to help him heal. Through the act of writing poetry and reflecting on the meanings of said poems, the author takes the reader on a journey through his therapeutic healing process. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Arts-based research; autoethnography; othering; poetic inquiry; queer; Ethnography; Homosexuality (Attitudes Toward); Poetry Therapy; Violence; Arts

The role of chaplaincy in LGBT veteran healthcare - Kopacz, Marek S.; Nieuwsma, Jason A.; Wortmann, Jennifer H.; Hanson, Janet L.; Meador, Keith G.; Thiel, Mary Martha (Spirituality in Clinical Practice, 2019)
For many LGBT veterans, meeting with a Department of Veterans Affairs (VA) chaplain marks the first time they are able to openly discuss their sexual and gender identity in the context of their religious/spiritual beliefs. Here we provide an overview of VA chaplaincy services, giving voice to some of the spiritual and pastoral care needs of LGBT veterans, provide a case vignette of a sexual minority veteran, and draw attention to future challenges for VA chaplaincy. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: veterans; spiritual/religious identity; religious conflict; Gender Identity; Military Veterans; Pastoral Counseling; Sex Roles; LGBTQ; Religious Beliefs; Spirituality

Risk and protective factors for self-harm in a population-based sample of transgender youth - Taliaferro, Lindsay A.; McMorris, Barbara J.; Rider, G. Nicole; Eisenberg, Marla E. (Archives of Suicide Research, 2019)
This study sought to identify factors distinguishing transgender/gender non-conforming (GNC) adolescents across three groups: no self-harm, non-suicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). Data were from the 2016 Minnesota Student Survey. The final analytic sample included 1,635 transgender/GNC students in grades 9 and 11. Logistic regression analyses determined factors that best distinguished transgender/GNC students who reported self-harm (NSSI only or NSSI + SA) from those who reported no self-harm, and transgender/GNC adolescents who reported NSSI + SA from those who reported NSSI only. Final models were developed over 3 stages of analysis that tested associations of variables within risk factor, protective factor, and health-risk behavior domains to self-harm. Over half (51.6%) of transgender/GNC adolescents reported past-year self-harm behavior. Factors that consistently distinguished transgender/GNC youth who reported self-harm from those who reported no self-harm included reports of a mental health problem, depression, running away from home, and substance use (alcohol or marijuana use). Factors that distinguished the NSSI + SA group from the NSSI only group were reports of a mental health problem, physical or sexual abuse, relationship violence, bullying victimization, less parent connectedness, lower grades, lower levels of perceived school safety, and running away from home. Clinicians and school personnel need to be prepared to address risk factors and enhance protective factors that may reduce the likelihood this population of vulnerable youth will engage in NSSI and/or attempt suicide. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: adolescent; self-harm; self-injury; suicide; transgender; Adolescent; Bullying; Child Abuse; Child Abuse, Sexual; Crime Victims; Depression; Female; Humans; Intimate Partner Violence; Logistic Models; Male; Minnesota; Parent-Child Relations; Prevalence; Protective Factors; Risk Factors; Self-Injurious Behavior; Social Environment; Suicide, Attempted; Transgender Persons; Underage Drinking; Attempted Suicide; Protective Factors; Risk Factors; Self-Injurious Behavior; Transgender

Barriers and stigma experienced by gay fathers and their children - Perrin, Ellen C.; Hurley, Sean M.; Mattern, Kathryn; Flavin, Lila; Pinderhughes, Ellen E. (Pediatrics, 2019)
Background: Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality. Methods: Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a 'snowball' method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts. Results: Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections. Conclusions: Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States’ legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: barriers; stigma; gay fathers; children; well being; Fathers; Homosexual Parents; Stigma; Well Being; Parenting; Child Attitudes; Test Construction

A heuristic inquiry on the role of person‐environment interaction in suicide risk among transgender youth - Chang, Brie; Delaney, Kathleen (Journal of Child and Adolescent Psychiatric Nursing, 2019)
Elevated levels of suicide risk among transgender youth have alarmed both public health officials and researchers from various disciplines. Despite nursing's robust involvement in suicide research, literature reviews indicate a lack of nursing research focused on suicide among transgender youth. Most of the existing literature pertain to predictive factors in either the individual or environmental domain. There is limited research examining how interactions with the environment in of itself might be a predictive factor. This paper treats the subject of suicide risk among transgender youth with a heuristic inquiry into person–environment interaction. The Society to Cell Resiliency Framework and Social Self Preservation Model were used to inform exploration of how person–environment interactions might be associated with suicide risk. Implications of this framework will be discussed in terms of how it may affect advancements in nursing education, practice, and research with transgender youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: minority stress; nursing; person– environment interaction; social evaluative threat; suicide risk; transgender health; Person Environment Fit; Risk Factors; Suicide; Transgender; Environment; Heuristics; Nursing; Prediction

Examining the association between prescription opioid misuse and suicidal behaviors among adolescent high school students in the United States - Baiden, Philip; Graaf, Genevieve; Zaami, Mariama; Acolatse, Charles K.; Adeku, Yvonne (Journal of Psychiatric Research, 2019)
Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few studies have examined the effects of prescription opioid misuse on suicidal behaviors among adolescents. The objective of this study was to examine the association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 8830 adolescents aged 14–18 years (50.9% female) were analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and prescription opioid misuse as the main explanatory variable. Of the 8830 adolescents, 13.3% ever misused prescription opioids; 17.7% experienced suicidal ideation, 13.3% made a suicide plan, and 6.5% attempted suicide during the past 12 months. In the multivariate logistic regression models, adolescent students who misused prescription opioids were 1.50 times more likely to have experienced suicidal ideation, 1.44 times more likely to have made a suicide plan, and 1.58 times more likely to have attempted suicide during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant predictors of suicidal behaviors include sexual minority, history of sexual assault, traditional bullying and cyberbullying victimization, feeling sad or hopeless, cigarette smoking, and illicit drug use. The findings of the present study demonstrate the harmful effects of prescription opioid misuse and its association with suicidal behaviors among adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Prescription opioid misuse; Suicidal ideation; Suicide plan; Suicide attempt; Adolescents; Attempted Suicide; High School Students; Prescription Drugs; Suicidal Ideation; Opioid Use Disorder

Caring for the transgender adolescent: It takes a village - Agana, Marisha; Apple, Roger; Alavi, Zakia; Gibb, Tyler; Soares, Neelkamal; Augustyn, Marilyn (Journal of Developmental and Behavioral Pediatrics, 2019)
CASE: Christa is a 15-year-old male-to-female (MTF) transgender patient who comes to your Developmental-Behavioral Pediatrics office for consultation on attention deficit/hyperactivity disorder (ADHD) management and concerns about worsening anxiety. Review of medical history included mild persistent asthma managed with steroid inhaler and leukotriene antagonist. She was diagnosed with ADHD at 12 years and has been placed on methylphenidate and clonidine over the years with little improvement. She struggles in school, with barely passing grades, and feels that she cannot focus on her assignments.She was diagnosed with MTF transition gender dysphoria, social anxiety disorder, and depressive disorder at 13 years by a psychiatrist and was treated with sertraline with some mood improvement. More recently, she reports having thoughts of wanting to hurt people and 'wanting to watch them wither away.' She expressed being terrified by these thoughts, which lasted for a couple of days but have since resolved. She denied any suicidal thoughts recently and gives credit to her 'best girlfriend' for her overall improved mood, improved sleep pattern, and increased energy level. She expressed having deepening feelings for this girlfriend but admitted to not having acted on these feelings as she is afraid of the consequences. She currently uses the pronouns she/her/hers.Family history is pertinent for paternal bipolar disorder. There is considerable psychosocial stress as Christa is estranged from her father, who is not supportive of her transition, although mother is. Unfortunately, she is dependent on her father for medical insurance coverage, and he is refusing to give authorization to proceed with the evaluations and diagnostic workup for the transformation. Christa has been repeatedly encouraged to seek counseling but has declined because of previous poor experiences with counselors. Her primary care clinician in Family Medicine has been administering hormonal replacement therapy because she cannot access the regional center of excellence because of above-mentioned insurance issues. She presents to you now with her mother for management suggestions and diagnostic clarification. What is your next step? (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; ADHD; diagnostic overshadowing; attention-deficit hyperactivity disorder; bipolar disorder; BPD; depressive disorder; social anxiety disorder; gender dysphoria; insurance; hormone replacement therapy; Attention Deficit Disorder with Hyperactivity; Insurance; Transgender; Adolescent Development; Bipolar Disorder; Hormone Therapy; Major Depression; Pediatrics; Social Phobia; Gender Dysphoria

Advocating for dialogue: Short and long-term outcomes of seattle-based kuow radio’s 'ask a' project - Manusov, Valerie; Stofleth, Daniel; Reynolds, Ross (Howard Journal of Communications, 2019)
In this study, we report on changes to reported attitudes, knowledge, and empathy immediately after and 3 months following a round-robin conversation between 'askers' and 'answerers' in intergroup sessions created by a local public radio station. Listeners were invited to have short one-on-one in—person conversations with people who were members of an identifiable out-group. These were 'Ask A' sessions with Muslims, transgender people, Trump supporters, police officers, formerly homeless, newcomers, immigrants, gun owners, foster parents, journalists, and Special Olympians. We found correlations among our assessed variables for askers (N = 113) going into the interactions and increases in the variables as reported after the event. Two of the expectancy variables remained high three months after the sessions. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: advocacy; dialogue; intergroup contact theory; interaction; stereotypes; No terms assigned

Prevalence of self-injurious thoughts and behaviors in transgender individuals with eating disorders: A national study - Duffy, Mary E.; Henkel, Kristin E.; Joiner, Thomas E. (Journal of Adolescent Health, 2019)
Purpose: This study examined prevalence of self-injurious thoughts and behaviors (SITBs) in transgender individuals with eating disorders, as compared to cisgender individuals with eating disorders and transgender individuals without eating disorders. Methods: Data were analyzed from 365,749 individuals (median age 21 years, 71.8% White/Caucasian, 34.9% male, 64.9% female, and 0.2% transgender) who participated in American College Health Association-National College Health Assessment, an annual national assessment of college student health, from 2008 to 2011. Results: Rates of past-year nonsuicidal self-injury, suicidal ideation, and suicide attempts were elevated in transgender participants with eating disorders (74.8%, 75.2%, and 74.8%, respectively), as compared to cisgender participants with eating disorders and transgender participants without eating disorders. Follow-up logistic regression analyses indicated these differences were statistically significant above and beyond the effects of demographic variables and depression. Conclusions: Results found extremely high rates of SITBs in transgender individuals with eating disorders. This combination of identities, each associated with SITBs, may have a compounding effect. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Suicide; Suicide attempt; Suicidal ideation; Non-suicidal self-injury; Transgender; Cisgender; Eating disorder; College students; Prevalence; Attempted Suicide; Eating Disorders; Epidemiology; Suicidal Ideation; Transgender; College Students; Self-Injurious Behavior

A comparison of mental health symptomatology and levels of social support in young treatment seeking transgender individuals who identify as binary and non-binary - Thorne, Nat; Witcomb, Gemma L.; Nieder, Timo; Nixon, Elena; Yip, Andrew; Arcelus, Jon (International Journal of Transgenderism, 2019)
Background: Previous research has consistently reported high rates of mental health symptomatology and lower social support in young treatment seeking transgender individuals. However, these studies have failed to distinguish between transgender people who identify within the gender binary and those who identify as non-binary. Aims: This study aimed to compare levels of mental health symptomatology (anxiety, depression, and non-suicidal self-injury behavior) and social support of treatment seeking non-binary transgender young individuals with those self-identified as binary transgender young individuals. All participants attended a national transgender health service in the UK during a 2-year period. Measures: Age and gender identity descriptors were collected, as well as clinical measures of anxiety and depression (Hospital Anxiety and Depression Scale), self-esteem (The Rosenberg Self-Esteem Scale), non-suicidal self-injury (Non-Suicidal Self-Injury: Treatment Related), and social support (Multidimensional Scale of Perceived Social Support). Results: A total of 388 young people, aged 16–25 years, agreed participation; 331 (85.3%) identified as binary and 57 (14.7%) as non-binary. Analysis of the data showed the non-binary group experienced significantly more anxiety and depression and had significantly lower self-esteem than the binary group. There were no significant differences between groups in the likelihood of engaging in non-suicidal self-injury behavior or levels of social support.Conclusions: Non-binary identifying treatment seeking transgender youth are at increased risk of developing anxiety, depression, and low self-esteem compared to binary transgender youth. This may reflect the even greater barriers and feelings of discrimination that may be faced by those whose identity does not fit the notion of binary gender that is pervasive in how society views both cis- and transgender populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Anxiety; depression; gender dysphoria; non-binary; non-suicidal self-injury; self-esteem; social support; transgender; Anxiety; Health Care Seeking Behavior; Self-Injurious Behavior; Social Support; Transgender; Mental Health; Self-Esteem; Symptoms

Mental health disparities and high‐risk alcohol use among non‐heterosexual high school students - Goodin, Amie; Elswick, Alex; Fallin‐Bennett, Amanda (Perspectives in Psychiatric Care, 2019)
Purpose To examine disparities in mental health and high‐risk alcohol use among high school students by sexual orientation, and the impact of having access to an adult with whom to talk. Design and Methods Cross‐sectional survey, from the 2015 Kentucky Youth Risk Behavior Survey. Logistic regression estimated the relationship between being 'non‐heterosexual' on mental health (e.g, suicidal ideation/attempt) and alcohol behaviors (e.g, binge drinking), controlling for demographics and 'having an adult to talk to.' Findings Non‐heterosexual students were more likely to report all adverse outcomes and risk was lower among students who report 'having an adult to talk to.' Practice Implications Psychiatric nurses need to assess sexual minority youth for access to positive adult relationships. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: adolescent alcohol use; adolescent mental health; LGB; sexual orientation; No terms assigned

Lessons from a community-based participatory research study with transgender and gender nonconforming youth and their families - Katz-Wise, Sabra L.; Pullen Sansfaçon, Annie; Bogart, Laura M.; Rosal, Milagros C.; Ehrensaft, Diane; Goldman, Roberta E.; Bryn Austin, S. (Action Research, 2019)
Community-based participatory research (CBPR) involves community members collaborating with academic investigators in each step of the research process. CBPR may be especially useful for research involving marginalized populations with unique perspectives and needs. In this paper, we discuss successes and challenges of using a CBPR approach for the Trans Teen and Family Narratives Project, a longitudinal mixed-methods study to examine how the family environment affects the health and well-being of transgender and gender nonconforming youth. We describe considerations for using a CBPR approach with this population, including defining the community of transgender and gender nonconforming youth and families, engaging the community in the research process, managing conflicting agendas for community partner meetings, addressing insider/outsider status of the researchers, resolving researcher/community tensions regarding data collection tools, integrating academic and community members into a cohesive research team, developing safety plans to address participant suicidality disclosures, and differentiating the role of academics as researchers vs. advocates. We conclude by sharing lessons learned, which can inform future research to address the needs of transgender and gender nonconforming youth and families. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Community-based participatory research (CBPR); family systems; gender nonconforming; transgender health; Community Services; Family; Human Sex Differences; Transgender; Action Research

Adolescents with gender dysphoria: Reflections on some contemporary clinical and research issues - Zucker, Kenneth J. (Archives of Sexual Behavior, 2019)
This article provides an overview of five contemporary clinical and research issues pertaining to adolescents with a diagnosis of gender dysphoria: (1) increased referrals to specialized gender identity clinics; (2) alteration in the sex ratio; (3) suicidality; (4) 'rapid-onset gender dysphoria' (ROGD) as a new developmental pathway; (5) and best practice clinical care for adolescents who may have ROGD. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Gender dysphoria; Gender identity; Rapid-onset gender dysphoria; Sex ratio; Suicidality; DSM-5; Adolescent Development; Gender Identity; Onset (Disorders); Gender Dysphoria; Suicidality; Human Sex Differences; Best Practices

Sexual minority status and child maltreatment: How do health outcomes among sexual minority young adults differ due to child maltreatment exposure? - Paul, June C.; Monahan, Emma Kahle (Child Abuse & Neglect, 2019)
Background: Although prior studies indicate heightened health and well-being concerns for sexual minority (SM) youth, as well as for youth exposed to child maltreatment in the general population, it is unclear whether there are differences in these outcomes among SM youth that have and have not experienced maltreatment. Objective: Our aim was to investigate the unique associations between child maltreatment and emerging health outcomes beyond the impact of SM status. Data was drawn from a nationally representative sample of 648 SM youth in the U.S. in grades 7–12 during the 1994–1995 school year. Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health, descriptive statistics and ordinary least squares regression models were used to investigate differences in SM young adult outcomes by experiences of child maltreatment. Results: Maltreatment among SM individuals showed strong associations with poor adult mental health outcomes (e.g. depression, anxiety, isolation, and suicidal ideation) and fairly strong negative associations with general health outcomes (e.g., heart and lung problems) when compared to their non-maltreated peers. Associations with maltreatment and behavioral health and socioeconomic outcomes were not as strong for this population, which suggests the effects of maltreatment for SM youth are most salient in regards to mental and physical health. Conclusions: Findings provide insight into what areas of health and well-being should be focused on when working with SM youth that have been maltreated, and offer evidence to encourage further exploration of the outcomes of SM maltreated individuals in young adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual minority status; Child maltreatment; Health outcomes; Disparities; Young adult; Child Abuse; Well Being; Sexual Minority Groups; Health Outcomes; Child Neglect; Childhood Development; Emerging Adulthood; Childhood Adversity; Adolescent Health

Evidence of multiple mediating pathways in associations between constructs of stigma and self-reported suicide attempts in a cross-sectional study of gay and bisexual men - Salway, Travis; Gesink, Dionne; Ibrahim, Selahadin; Ferlatte, Olivier; Rhodes, Anne E.; Brennan, David J.; Marchand, Rick; Trussler, Terry (Archives of Sexual Behavior, 2018)
Gay and bisexual men (GBM) are more likely to attempt suicide than heterosexual men. This disparity is commonly interpreted using minority stress theory; however, specific pathways from antigay stigma to suicidal behavior are poorly understood. We aimed to estimate associations between multiple constructs of stigma and suicide attempts among adult GBM, and to measure the proportion of these associations mediated by distinct suicide risk factors, thus identifying proximal points of intervention. Data were drawn from a Canadian community-based survey of adult GBM. Structural equation modeling was used to compare associations between three latent constructs—enacted stigma (e.g., discrimination, harassment), anticipated prejudice (worry about encountering antigay/bisexual prejudice), and sexuality concealment—and self-reported suicide attempts (last 12 months). Coefficients were estimated for direct, indirect, and total pathways and evaluated based on magnitude and statistical significance. The proportion of associations mediated by depression, drug/alcohol use, and social isolation was calculated using indirect paths. Among 7872 respondents, 3.4% reported a suicide attempt in the past 12 months. The largest total association was observed for enacted stigma, and this association was partially mediated by depression and drug/alcohol use. The total association of anticipated prejudice was relatively smaller and mediated by depression and social isolation. Concealment had an inverse association with suicide attempts as mediated by depression but was also positively associated with suicide attempts when mediated through social isolation. Multiple constructs of antigay stigma were associated with suicide attempts; however, mediating pathways differed by construct, suggesting that a combination of strategies is required to prevent suicide in adult GBM. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Suicide attempts; Gay and bisexual men; Minority stress; Sexual stigma; Mental health; Sexual orientation; Attempted Suicide; Bisexuality; Male Homosexuality; Stigma; Sexual Orientation; Minority Stress

Transgender and gender non-conforming bereavement (tgnc): A case study on complicated grief experienced and the effect of partner suicide on interpersonal relationships and subsequent partnerships of the bereaved - Nolan, Rachael D. (Death Studies, 2019)
Grief, death, bereavement, and loss do not discriminate based on gender identity or sexual orientation. Limited attention has been given to the bereaved partners of transgender and gender non-conforming persons (TGNC). Despite recent efforts to protect the rights of TGNC persons, the death of a TGNC partner is often complicated, marked by family members and friends who might never have known or refused to acknowledge the deceased in his, her, or their preferred gender. The present study adopted a single case study design to examine the death of a TGNC spouse through the unique lens of a bereaved partner. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: No terms assigned

School counseling toward an LGBTQ-inclusive school climate: Implementing the SCEARE model - Asplund, Nancy R.; Ordway, Ann M. (Journal of LGBT Issues in Counseling, 2018)
The school environment is often perceived as hostile by sexual minority youth. Lesbian, gay, bisexual, transgender, queer (LGBTQ) students experience high rates of bullying and suicidal ideation yet are often underserved by school counselors. School counselors are uniquely situated to facilitate systemic change within a school. The proposed School Counselors: Educate, Affirm, Respond, and Empower (SCEARE, pronounced SKEER) model outlines components of an LGBTQ-inclusive school climate. It is designed to be a practical tool for helping school counselors conceptualize their interventions, and a theory of how systemic change might occur. It empowers school counselors to be catalysts of change toward an LGBTQ-inclusive school climate. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: inclusive; LGBTQ; school climate; school counseling; systemic change; Mainstreaming (Educational); Models; School Counseling; School Environment; Sexual Orientation; Bisexuality; Learning Environment; Lesbianism; Male Homosexuality; School Adjustment; Transgender; LGBTQ

The association between hiv/aids and childhood sexual abuse: An exploratory case study - Diao, Xavier Y.; Albert, Madeline; Forstein, Marshall (Journal of Gay & Lesbian Mental Health, 2019)
The effects of sexual abuse in childhood are serious and far-reaching, and include a number of short- and long-term sequelae, including depression, anxiety, disordered eating, post-traumatic stress disorder (PTSD), substance abuse disorders, suicidal ideation and self-injurious behavior, sexual dysfunction, borderline personality traits, high-risk sexual behavior, and dissociative disorders. MSM (men who have sex with men) with a history of childhood sexual abuse are more likely to engage in high-risk sexual behavior, trade sex for substances and/or money, experience intimate partner violence, and report as being HIV-positive. In this case study, we aim to explore the association between sexual abuse in childhood and HIV/AIDS. We identify a HIV-positive gay man with a history of sexual abuse and review the existing literature on the subject of HIV and sexual abuse, with a focus on victims who are MSM. Early childhood traumas, especially sexual abuse, can have immense and long-lasting psychological sequelae. Here, we report a victim of childhood sexual abuse who suffers from PTSD, selective amnesia, and episodes of dissociation during sex who was diagnosed as being HIV-positive at the height of the HIV/AIDS epidemic in the United States. More research needs to be done to investigate the complex relationship between childhood trauma and HIV infection, with insights into racial, gender, and socioeconomic differences. Counseling and risk-reduction strategies need to be explored with patients with a history of sexual trauma, in tandem with long-term pharmacologic and therapeutic interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: AIDS; HIV; LGBT; sexual abuse; No terms assigned

Trauma exposure, posttraumatic overmodulation and undermodulation, and nonsuicidal self-injury in traumatized justice-involved adolescents - Modrowski, Crosby A.; Chaplo, Shannon D.; Kerig, Patricia K.; Mozley, Michaela M. (Psychological Trauma: Theory, Research, Practice, and Policy, 2019)
Objective: Previous research has established associations among childhood trauma exposure, posttraumatic stress symptoms (PTSSs), and adolescent nonsuicidal self-injury (NSSI). In fact, numerous studies have suggested that PTSSs may serve as a mechanism linking trauma exposure and NSSI. However, studies to date have not utilized newer models of PTSSs that differentiate between symptoms of overmodulation and undermodulation. This study investigated associations among interpersonal and noninterpersonal trauma exposure, posttraumatic overmodulation and undermodulation, and NSSI in a sample of justice-involved youth. Method: Participants were 566 youth (2 transgender youth, 142 girls, and 422 boys). On average, youth were 16 years old (SD = 1.27), and approximately half self-identified as an ethnic minority. Participants completed measures of lifetime trauma exposure and NSSI, and past-month PTSSs. Results: Structural equation modeling demonstrated that interpersonal trauma exposure was associated with symptoms of overmodulation (95% confidence interval [CI] [.180, .340]) and undermodulation (95% CI [.179, .338]) as well as NSSI (95% CI [.156, .572]). Additionally, symptoms of overmodulation were differentially associated with NSSI (95% CI [.158, .720]), and there was a significant indirect effect between interpersonal trauma exposure and NSSI via overmodulation (95% CI [.015, .095]). Conclusions: This study highlights the utility of conceptualizing posttraumatic stress disorder as a disorder of emotion regulation characterized by symptoms of overmodulation and undermodulation, and has clinical implications for mental health professionals who interact with youth in the justice system. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: adolescents; posttraumatic stress; nonsuicidal self-injury (NSSI); detained youth; Legal Detention; Self-Injurious Behavior; Trauma; Interpersonal Relationships; Post-Traumatic Stress; Emotional Regulation; Juvenile Delinquency; Exposure

Emotional distress, bullying victimization, and protective factors among transgender and gender diverse adolescents in city, suburban, town, and rural locations - Eisenberg, Marla E.; Gower, Amy L.; McMorris, Barbara J.; Rider, G. Nicole; Coleman, Eli (The Journal of Rural Health, 2019)
Purpose: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. Methods: Data come from a statewide school‐based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. Findings: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. Conclusions: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: adolescence; bullying; mental health; social environment; transgender; Adolescent; Analysis of Variance; Crime Victims; Female; Geographic Mapping; Humans; Male; Protective Factors; Psychological Distress; Residence Characteristics; Transgender Persons; Distress; Protective Factors; Bullying; Transgender; Gender Nonconforming; Rural Environments; Social Environments; Suburban Environments; Urban Environments; Victimization

Coping, stress, and negative childhood experiences: The link to psychopathology, self‐harm, and suicidal behavior - McLafferty, Margaret; Armour, Cherie; Bunting, Brendan; Ennis, Edel; Lapsley, Coral; Murray, Elaine; O'Neill, Siobhan (PsyCh Journal, 2019)
Early life experiences, such as childhood adversities or poor parenting practices, can impact on the ability to cope with stressors across the lifespan. Furthermore, poor coping skills can lead to the development of mental illnesses, self‐harm, and suicidal behavior. This study aimed to examine demographic differences in stress levels and to determine if those who had endured negative childhood experiences would be more likely to develop psychological problems and display suicidal behavior when current stress levels were accounted for. The study also explored the link between coping and mental health problems. Finally, it aimed to predict risk and protective factors related to good coping skills. The study utilized data obtained from the Ulster University Student Wellbeing Study, conducted across four university campuses in Northern Ireland in 2015 (n = 716) as part of the World Health Organization World Mental Health (WMH) International College Student Initiative. Mental health problems and early childhood experiences were examined using questions adapted from the WMH Composite International Diagnostic Interview, with self‐harm and suicidal behavior measured using the Self‐Injurious Thoughts and Behaviors Interview (SITBI). Females, non‐heterosexuals, and older students experienced more current stress. When current stress levels were high, childhood adversities and parental overcontrol and overindulgence were related to higher rates of mental health problems, self‐harm, and suicidal behavior. Poor coping skills were associated with negative mental health outcomes. Social support and good emotion‐regulation strategies were related to effective coping, while parental overcontrol and overindulgence, female gender, and younger age were related to poorer coping. The study highlights the importance of developing good coping skills to deal with life stressors, thereby minimizing the risk of psychological problems and suicidal behavior. The findings provide support for initiatives to help parents improve their parenting skills and other programs to help young people cope with stress, and to develop social networks and adaptive emotion‐regulation strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: childhood adversity; coping; mental health; stress; No terms assigned

Substance use, violence experiences, and mental health issues: Are these health risks associated with HIV testing among sexually experienced US high school students? - Pampati, Sanjana; Lowry, Richard; Steiner, Riley J. (AIDS Care, 2019)
HIV testing is a critical strategy for prevention of HIV yet testing among sexually experienced adolescents is sub-optimal. The purpose of this study is to examine associations between risk behaviors and experiences related to substance use, violence, and mental health and suicide and receipt of testing. We analyzed cross-sectional data from the 2017 national Youth Risk Behavior Survey, a nationally representative sample of U.S. high school students in grades 9–12. Analyses were limited to sexually experienced participants (n = 5192). Measures included nine indicators related to substance use, violence, and mental health and suicide. Unadjusted and adjusted prevalence ratios were calculated for each indicator to examine associations with testing. Adjusted models controlled for same-sex sexual behavior, sexual risk, and demographic characteristics. Prevalence of HIV testing was 17.2%. In adjusted models, forced sexual intercourse, injection drug use, other illicit drug use, and persistent feelings of sadness or hopelessness were associated with a higher likelihood of testing. Prevalence of HIV testing in this sexually experienced sample was low. Some behaviors and experiences that may be indicative of HIV risk, including sexual dating violence and prescription opioid misuse, were not associated with testing. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: HIV testing; adolescents; mental health; violence; substance use; Adolescent; Adolescent Behavior; Cross-Sectional Studies; Female; HIV Infections; Humans; Male; Mental Disorders; Patient Acceptance of Health Care; Risk Factors; Risk-Taking; Students; Substance-Related Disorders; United States; Violence; Drug Usage; HIV Testing; Mental Health; School Violence; Health Risk Behavior; High School Students; Psychosexual Behavior; Suicide

'Connection is the antidote': Psychological distress, emotional processing, and virtual community building among LGBTQ students after the Orlando shooting - Jackson, Skyler D. (Psychology of Sexual Orientation and Gender Diversity, 2017)
Scholars have called for increased research on the process by which lesbian, gay, bisexual, transgender, and queer (LGBTQ) people cope with stigma and hate-related incidents. Homophobic hate crimes, for example, may have a ripple effect within the LGBTQ community, in which individuals beyond the immediate victim experience psychological distress and, in some cases, vicarious traumatization. The present case study examines the emotional, cognitive, and behavioral responses of LGBTQ individuals to the 2016 Orlando mass shooting, an event conceptualized as an anti-LGBTQ hate crime. On the day of the Orlando shooting, a group of graduate students who were connected through a listserv related to sexual orientation and gender diversity received a prompt intended to facilitate open discussion and emotional processing regarding the Orlando shooting. Thirty-three LGBTQ psychology graduate students participated in the virtual discussion. The content within this conversation thread was reviewed and organized into six thematic categories: (1) emotional distress, (2) personal significance of the event, (3) feelings of in-group isolation and community connectedness, (4) self-care and coping strategies, (5) the need for action, and (6) expressions of gratitude for the discussion forum. Implications are discussed in light of literature on community reactions to hate-motivated violence, virtual community support, and LGBTQ coping strategies. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: sexual and gender minorities; LGBTQ hate crimes; vicarious traumatization; emotional processing; virtual community support; Emotional Responses; Hate Crimes; Homosexuality; Minority Groups; Online Community; Bisexuality; Distress; Graduate Students; Lesbianism; Male Homosexuality; Social Support; Trauma; Transgender; LGBTQ; Emotional Processing

Sexual orientation enumeration in state antibullying statutes in the United States: Associations with bullying, suicidal ideation, and suicide attempts among youth - Meyer, Ilan H.; Luo, Feijun; Wilson, Bianca D. M.; Stone, Deborah M. (LGBT Health, 2019)
Purpose: The aim was to assess the associations of antibullying U.S. state statutes that enumerate sexual orientation with exposure to bullying and other stressors and with suicidal ideation and suicide attempts in sexual minority and non sexual minority youth. Methods: We analyzed data from the 2015 national school-based Youth Risk Behavior Survey, representative of 9th through 12th grade students attending public and private schools in the United States. We reviewed each state's antibullying statutes and classified them on enumeration. Results: Antibullying state laws that enumerate sexual orientation were associated with lower risk for suicide attempts and serious attempts requiring medical attention and lower risk for forced sexual intercourse. They were also associated with feeling safe at school or on the way to or from school. Results did not differ by sexual orientation. Conclusions: Enumeration of sexual orientation was associated with reduced stressors and suicide attempts, but it is insufficient to remove significant disparities based on sexual orientation. Additional policies and practices are required to address persistent sexual orientation disparities in exposure to bullying and suicidal behavior. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: bullying; law and policy; schools; sexual minority youth; suicide attempts; Adolescent; Bullying; Female; Humans; Legislation as Topic; Male; Risk-Taking; Schools; Sexual Behavior; Sexual and Gender Minorities; Stress, Psychological; Suicidal Ideation; Suicide, Attempted; Surveys and Questionnaires; United States; Legislative Processes; Sexual Orientation; Bullying; Discrimination Laws; Sexual Minority Groups; Attempted Suicide; Hate Crimes; Suicidal Ideation

Minority stress and suicidal behavior: Investigating a protective model through resilience in a bisexual sample - Miceli, Matt; Klibert, Jeff; Yancey, C. Thresa (Journal of Bisexuality, 2019)
Suicidal behaviors are a serious public health concern in the bisexual community. Protective models are needed to guide culturally informed methods of prevention. The current study evaluated the moderating effects of resilience and mental health status on the relationship between minority stress and suicidal behaviors. Data were collected from a convenience sample of bisexuals (N = 200). Results reveal a complex pattern of findings. Resilience moderates the relationship between minority stress and suicidal behaviors for bisexual community members with a reported mental health diagnosis; at moderate levels of resilience, a score of 15 on the Brief Resilience Scale, the relationship between minority stress and suicidal behaviors is nullified. Alternatively, resilience was not revealed as a significant moderator among bisexual community members without a mental health diagnosis. These findings provide preliminary evidence for resilience as a buffer against suicide for bisexual community members with mental health difficulties. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: bisexual; resilience; minority stress; suicidal behavior; mental health status; Bisexuality; Mental Health; Resilience (Psychological); Suicidal Ideation; Minority Stress; Diagnosis; Prevention; Public Health

Alcohol and marijuana use as daily predictors of suicide ideation and attempts among adolescents prior to psychiatric hospitalization - Sellers, Christina M.; Diaz-Valdes Iriarte, Antonia; Wyman Battalen, Adeline; O'Brien, Kimberly H. McManama (Psychiatry Research, 2019)
Objective: Little research has been conducted on alcohol use, marijuana use, and suicide ideation and attempts on a daily level, and specifically among adolescents prior to inpatient hospitalization. The purpose of this study was to examine the within (over time) and between (between adolescents) effects of alcohol use and marijuana use on suicide ideation and attempts. Methods: Participants included 50 adolescents (80% female; Mage = 15.8). All participants reported drinking alcohol in the prior three months and were receiving treatment in an inpatient psychiatric hospital. Random and mixed-effect models were used to test study hypotheses. Results: Results from the random effect model indicated that alcohol use, marijuana use, hospitalization and sexual orientation were significant predictors of suicide attempts. Results from the mixed-effect model indicated that marijuana use, hospitalization, and sexual orientation were significant predictors of suicide ideation. Conclusions: Study findings extend current knowledge about the longitudinal and day-to-day relationship between alcohol and marijuana use and suicide ideation and attempts. Results underscore the importance of addressing alcohol and marijuana use in interventions with suicidal adolescents, recognizing that sexual minority youth may be at elevated risk for suicide ideation. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Substance use; Suicide ideation; Suicidal behaviors; Adolescent; Adolescent Behavior; Female; Hospitalization; Hospitals, Psychiatric; Humans; Inpatients; Male; Marijuana Abuse; Marijuana Use; Sexual Behavior; Suicidal Ideation; Suicide, Attempted; Underage Drinking; Alcohol Abuse; Attempted Suicide; Marijuana Usage; Prediction; Suicidal Ideation; Alcohol Drinking Patterns; Models; Psychiatric Hospitalization; Sexual Orientation

Estimate of lesbian, gay, bisexual, and transgender youth suicide is inflated - Clark, Kirsty A.; Blosnich, John R.; Haas, Ann P.; Cochran, Susan D. (Journal of Adolescent Health, 2019)
Comments on an article by G. L. Ream (see record [rid]2019-05735-001[/rid]). Ream’s study focuses on suicide deaths among youth and young adults where lesbian, gay, bisexual, and transgender (LGBT) and heterosexual themes emerged in the course of their investigation. In doing so, he underscores the dearth of data on this important public health issue. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: lesbian; gay; bisexual; transgender; suicide; Bisexuality; Death and Dying; Lesbianism; Suicide; Transgender; Experimentation; Heterosexuality; LGBTQ

Non-suicidal self-injury, sexuality concerns, and emotion regulation among sexually diverse adolescents: A multiple mediation analysis - Fraser, Gloria; Wilson, Marc Stewart; Garisch, Jessica Anne; Robinson, Kealagh; Brocklesby, Madeleine; Kingi, Tahlia; O'Connell, Angelique; Russell, Lynne (Archives of Suicide Research, 2018)
Despite increasing interest in the prevalence and correlates of Non-Suicidal Self-Injury (NSSI) in adolescent populations, relatively few studies have examined NSSI among lesbian, gay and bisexual (LGB) adolescents. The current study explored sexuality concerns and elevated emotion dysregulation as potential mechanisms underlying the relationship between sexual orientation and elevated non-suicidal self-injury (NSSI). A community sample of 1,799 adolescents completed a questionnaire assessing NSSI, sexual orientation, sexuality concerns, and emotion regulation. Across the study, 20.6% of adolescents reported a history of NSSI. Adolescents who identify as 'mostly heterosexual,' 'bisexual,' and 'mostly homosexual' were more likely to engage in NSSI than gay/lesbian, heterosexual, and asexual adolescents. Multiple mediation analysis showed that emotion regulation, but not sexuality concerns, mediated the relationship between sexual orientation and NSSI. The current study tested two theoretical pathways by which sexual orientation could predict NSSI engagement. Findings suggest that literature on general psychological processes, as well as group-specific minority stressors, can shed light on high rates of NSSI among LGB populations. Specifically, the challenges faced by LGB adolescents may undermine the development of emotion regulation. As such, this should be a key target of intervention with LGB adolescents engaging in NSSI. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: emotion regulation; LGBT; non-suicidal self-injury; NSSI; sexual orientation; youth; Emotional Regulation; Self-Injurious Behavior; Sexual Orientation

Psychological correlates of self-harm within gay, lesbian and bisexual uk university students - Taylor, Peter James; Dhingra, Katie; Dickson, Joanne M.; McDermott, Elizabeth (Archives of Suicide Research, 2018)
This study explores the association between lesbian, gay or bisexual (LGB) status and self-harm in UK higher education students. There is currently limited data on this association, and the role psychological variables have in potentially explaining this link, in UK students. We examine whether LGB status is associated with self-harm (both non-suicidal self-injury [NSSI] and suicide attempts [SA]), and whether 4 psychological variables (depression, anxiety, belongingness, self-esteem) mediate this association. A cross-sectional survey was used. UK university students (n = 707) completed an online survey including measures of self-harm, affective symptoms, belongingness, and self-esteem. Latent Variable Modelling (LVM) was used to test our hypotheses. LGB status remained associated with an elevated risk of NSSI and SA even after accounting for mediating factors. Self-esteem and (in the case of SA but not NSSI) thwarted belongingness, did, however, explain some of this association and were correlated with self-harm risk. The findings suggest that psychological factors may account for the association between LGB status and self-harm and, as such, prevention and intervention efforts directed at these psychological mediators may help to reduce self-harm risk in this population. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: bisexual; gay; lesbian; LGB; self-esteem; self-harm; No terms assigned

Sexual identity modifies the association between bullying and suicide planning among adolescents with same-sex sexual partners - Turpin, Rodman; Boekeloo, Bradley; Dyer, Typhanye (Journal of LGBT Youth, 2019)
Heterosexual adolescents with same-sex sexual partners may be at increased risk for psychological distress from victimization; this may lead to suicidality. We tested if sexual identity modified the association between bullying at school and suicide planning among adolescents with the same-sex sexual partners. We sampled 924 youth with same-sex sexual partners from the 2015 Youth Risk Behavior Survey, testing the association between bullying and suicide planning using log-binomial regression with sexual identity interactions. Sexual identity modified this association, with the greatest association among heterosexual participants (PR = 4.01, 95% CI 2.60–6.18). Anti-homophobia messaging and intervention programs that target these youth may be needed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Bullying; identity; LGB; sexuality; suicide; Adolescent Psychology; Gender Identity; Suicide; Sexual Partners; Bullying; Heterosexuality; Risk Factors; Sexual Risk Taking

Suicidal ideation in gay adolescents in the context of cultural stigma and criminalized homosexuality in Sri Lanka - Chandradasa, Miyuru (International Journal of Social Psychiatry, 2019)
This letter briefs the prevalence of suicidal ideation in gay adolescents in the context of cultural stigma and criminalized homosexuality in Sri Lanka. The lesbian, gay, bisexual and transgender rights remain stagnant since the colonial era and homosexuality is illegal in Sri Lanka. Culturally, virginity is highly valued for females leading to gender segregation in adolescent years. Many boys do not continue this behaviour and function as heterosexuals in adulthood. Furthermore, homosexuality is stigmatized by the mainstream culture and persons with same-sex orientation face significant abuse during their lives. Gay men and lesbians in other Asian countries have been reported to have higher suicidal ideation compared to heterosexuals. Furthermore, in neighbouring India, a landmark ruling has been issued by the Supreme Court legalizing gay sexual relationships. This ruling overturns a colonial-era law, known as Section 377, under which gay sex was illegal. The Buddhist and Hindu values were introduced to Sri Lanka from India in the ancient times. Maybe this is a golden opportunity to follow the pathway of India again on restoring legal equality in sexual expression. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicidal ideation; gay adolescents; cultural stigma; criminalized homosexuality; Adolescent; Buddhism; Homosexuality, Male; Humans; Male; Sexual and Gender Minorities; Social Stigma; Sri Lanka; Suicidal Ideation; Male Homosexuality; Stigma; Suicidal Ideation; Minority Stress; Crime

Intimate partner violence, suicide, and their overlapping risk in women veterans: A review of the literature - Iovine-Wong, Paige E.; Nichols-Hadeed, Corey; Thompson Stone, Jennifer; Gamble, Stephanie; Cross, Wendi; Cerulli, Catherine; Levandowski, Brooke A. (Military Medicine, 2019)
Introduction: Suicidal thoughts and behaviors (STB) and intimate partner violence (IPV) are both serious and prevalent problems in the Veteran population that often occur in tandem, particularly among women Veterans. Women Veterans, the fastest growing segment of the Veteran population, may have unique overlapping risks that are worth exploring. Although the intersection of IPV and STB is well documented in the civilian population, it has not been thoroughly explored in women Veterans. Materials and Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we conducted a systematic review of the STB and IPV literature specifically related to women Veterans. We only included articles that sampled women Veterans, rather than active duty/reservist/National Guard women; due to the small volume of STB research using samples of only women Veterans, we included studies that used mixed-gender samples. We extracted risk factors for STB and/or IPV involvement from 56 selected articles and placed them into tables for comparison to determine commonalities. Results: Common risk factors fell into three categories: socio-demographic risk factors (young age, unemployment, and sexual minority status) were significant across both bodies of literature; mental health risk factors (general psychopathology, post-traumatic stress disorder (PTSD), depression, sleep disturbance, and substance use/abuse) also had significant overlap; and military service-related risk factors (military sexual trauma (MST) and deployment factors) were also relevant across both bodies of literature. Mental health risk factors, particularly PTSD, were the most common. Conclusion: Frequently, the risk factors for IPV and STB are shared and it is important to consider how research, screening and intervention efforts for these serious problems might be integrated. Our exploration of the literature may be used as a basis for future research with women Veterans on the intersection of STB and IPV. Further, Veterans Health Administration clinicians should be aware of these intersecting risk factors to enhance care and improve screening for both issues in women Veteran clients. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: women; Veterans; intimate partner violence; suicide risk; Human Females; Intimate Partner Violence; Military Veterans; Social Psychology; Suicide; At Risk Populations

Depression and attempted suicide among LGBTQ college students: Fostering resilience to the effects of heterosexism and cisgenderism on campus - Woodford, Michael R.; Weber, Genevieve; Nicolazzo, Z.; Hunt, Renee; Kulick, Alex; Coleman, Todd; Coulombe, Simon; Renn, Kristen A. (Journal of College Student Development, 2018)
Little is known is about the impacts of covert and overt discrimination and the protective factors for depression and suicide among LGBTQ students. Using multivariable regression analyses of a national sample of cisgender lesbian, gay, bisexual, and queer students and trans students (n = 776), we examined the association between mental health and microaggressions, victimization, psychological resilience, pride, and outness. In models of all risk and protective factors, interpersonal microaggressions was a risk factor for depression and attempted suicide among cisgender LGBQ students and was also a risk factor among trans students for depression. In all but 1 model, resilience was a protective factor. Resilience moderated the microaggressions–suicide relationship among cisgender LGBQ students, whereas pride moderated the victimization–depression relationship among trans students. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: attempted suicide; LGBTQ college students; mental health; microaggressions; victimization; psychological resilience; pride; outness; risk & protective factors; Attempted Suicide; College Students; Homosexuality (Attitudes Toward); Resilience (Psychological); LGBTQ; Mental Health; Pride; Protective Factors; Risk Factors; Victimization; Microaggression

Exploring lived experience in gender and sexual minority suicide attempt survivors - Williams, Sara M.; Frey, Laura M.; Stage, Dese'Rae L.; Cerel, Julie (American Journal of Orthopsychiatry, 2018)
Gender and sexual minorities (GSM) are at a higher risk for victimization, discrimination, and emotional distress. GSM also face unique stressors that contribute to negative mental health outcomes, such as family and interpersonal rejection, ostracism and isolation, and internalized gender and sexual stigma. Suicide attempt survivors often experience similar stigma and isolation after an attempt. However, little is known about the specific experiences of GSM individuals who attempt suicide. Transcripts of interviews with 25 GSM attempt survivors conducted as part of the Live Through This project were analyzed using an interpretive phenomenological approach. Five themes that capture the lived experience of suicidality of the participants were identified in the interviews: (a) intersecting identities, (b) identity concealment, (c) internalized stigma and self-hate, (d) the social environment, and (e) the importance of peer support. Findings highlight the compounding stigma that occurs when individuals identify as both a GSM and a suicide attempt survivor. Implications for clinical work include the need for additional peer support for individuals who maintain the dual identity of GSM and suicide attempt survivor. Moreover, there is a need for mental health, crisis, and support resources and services tailored for GSM individuals that emphasize the importance of peer support in healing and recovery after a suicide attempt and in preventing future suicidal behavior. This important information can help us develop strategies to prevent suicide among the GSM population and to provide support for GSM suicide attempt survivors. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; LGBTQ; suicide attempt; gender and sexual minorities; lived experience; Adult; Female; Humans; Male; Middle Aged; Qualitative Research; Sexual and Gender Minorities; Social Stigma; Suicide, Attempted; Survivors; Young Adult; Attempted Suicide; Mental Health; Minority Groups; Sexual Orientation; Stigma; Bisexuality; Experiences (Events); Internalization; Lesbianism; Male Homosexuality; Peer Relations; Survivors; Transgender; Sexual Minority Groups; LGBTQ

Role of sleep quality in mediating the relationship between sexual minority status and suicidal behavior among Chinese adolescents - Huang, Yeen; Li, Pengsheng; Lai, Zhisheng; Jia, Xiaofei; Xiao, Di; Wang, Tian; Guo, Lan; Lu, Ciyong (Psychology Research and Behavior Management, 2018)
Background: Studies suggest that sexual minority adolescents experience higher rates of sleep disturbance than their heterosexual peers, and disturbed sleep is a well-known risk factor for suicidality. This study aimed to explore whether sleep quality had mediating effects on the relationship between sexual minority status and suicidal behavior in Chinese adolescents. Methods: We analyzed data collected from 7th to 12th graders from seven randomly selected provinces of People’s Republic of China in the 2015 School-Based Chinese Adolescents Health Survey. The 123,459 students who completed questionnaires regarding sexual attraction, the Pittsburgh Sleep Quality Index, past-year suicidal ideation, and past-year suicide attempts were included in our study (response rate: 95.9%). Results: After adjustment for covariates, sexual minority status was associated with suicidal ideation (adjusted odds ratio = 1.82, 95% CI = 1.69–1.95) and suicide attempts (adjusted odds ratio = 2.16, 95% CI = 1.82–2.56). Sleep quality partially mediated the effects of sexual minority status on suicidal ideation (standardized β estimate = 0.009, 95% CI = 0.007–0.012) and suicide attempts (standardized β estimate = 0.004, 95% CI = 0.003–0.005). Conclusion: Poor sleep quality partially explained the increased risk of suicidality for Chinese sexual minority adolescents. To prevent subsequent suicidality, suicide interventions targeting sexual minorities should be made, with a focus on their disparities in sleep disturbance and sleep health promotion. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: sleep quality; sexual minority status; suicidal behavior; Chinese adolescents; Adolescent Psychopathology; Attempted Suicide; Suicidal Ideation; Sleep Wake Disorders; Sexual Minority Groups; Chinese Cultural Groups; Sexual Orientation; Sleep; Test Construction; Suicidology

The nature of bias crime injuries: A comparative analysis of physical and psychological victimization effects - Fetzer, Matthew D.; Pezzella, Frank S. (Journal of Interpersonal Violence, 2019)
The core justification of bias crime statutes concerns whether bias-motivated crimes are qualitatively different from otherwise motivated crimes. We test the hypothesis that bias crimes are more detrimental than non-bias crimes by testing for multi-dimensional injuries to victims of bias and non-bias-motivated criminal conduct. Using National Crime Victimization Survey (NCVS) Extract 2013 Collection Year Incident-level Extract File, we analyzed physical injuries and psychological trauma to NCVS victims during 2013. We found a range of covariates consistent with the likelihood of physical injury and psychological trauma. These included whether the incident was bias motivated, whether weapons (firearms, knives, other or unknown type of weapons) were involved, whether the incident involved multiple offenders or strangers, or whether drugs or alcohol were involved. Our findings reinforce previous studies that detected empirical evidence of multi-dimensional physical and psychological injuries to bias crime victims. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: hate crimes; violence against; LGBTQ; vicarious trauma; violence exposure; Crime Victims; Hate Crimes; Injuries; Trauma; Victimization; Crime

Suicidality and associated factors among men who have sex with men in Estonia - Rüütel, Kristi; Valk, Anti; Lõhmus, Liilia (Journal of Homosexuality, 2017)
Many studies over the last decade provide strong evidence of elevated rates of suicidality among lesbian, gay, bisexual, and transgender populations compared to heterosexual populations. The aim of the current study was to investigate suicidal ideation and attempts and related factors among men who have sex with men (MSM) in Estonia. We conducted a nationwide Internet-based study among MSM with 265 eligible participants. Our results reveal high rates of self-reported suicidal ideation (lifetime prevalence 45%) and attempts (lifetime prevalence 11%) as well as a high rate of problem drinking (33%) and depressive symptoms (32%) among MSM. Recent suicidal ideation (14% had thought about suicide in the last 12 months) was related to depressive symptoms and lower socioeconomic situation. There is a need to develop specific interventions to address these issues among MSM and to provide gay-friendly mental health services. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Depression; HIV; internalized homonegativity; men who have sex with men; outness; problem drinking; suicide; Adolescent; Adult; Depression; Estonia; Heterosexuality; Homosexuality, Male; Humans; Male; Prevalence; Sexual Minorities; Suicidal Ideation; Surveys and Questionnaires; Young Adult; Homosexuality (Attitudes Toward); Internalization; Major Depression; Suicidal Ideation; Same Sex Intercourse; Alcohol Abuse; HIV; Self-Disclosure; Suicide; Suicidology; Suicidality

Increasing intentions to use mental health services among university students Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student initiative - Ebert, David Daniel; Franke, Marvin; Kählke, Fanny; Küchler, Ann‐Marie; Bruffaerts, Ronny; Mortier, Philippe; Karyotaki, Eirini; Alonso, Jordi; Cuijpers, Pim; Berking, Matthias; Auerbach, Randy P.; Kessler, Ronald C.; et al. (International Journal of Methods in Psychiatric Research, 2019)
Background: The majority of university students with mental health problems are untreated. Only a small empirical literature exists on strategies to increase mental health service use. Aims: To investigate the effects and moderators of a brief acceptance‐facilitating intervention on intention to use mental health services among university students. Method: Within the German site of the World Health Organization's World Mental Health International College Student (WMH‐ICS) initiative, 1,374 university students were randomized to an intervention condition (IC; n = 664) or a control condition (CC; n = 710) that was implemented in the survey itself. Both conditions received the questions assessing mental disorders and suicidality that were included in other WMH‐ICS surveys. The IC group then additionally received: Internet‐based personalized feedback based on subject symptom severity in the domains of depression, anxiety, substance use, suicidal thoughts and behaviors, and nonsuicidal self‐injury; psychoeducation tailored to the personal symptom profile; and information about available university and community mental health services. The primary outcome was reported intention to use psychological interventions in the next semester, which was the last question in the survey. A broad range of potential moderating factors was explored. Results: There was a significant main effect of the intervention with students randomized to IC, reporting significantly higher intentions to seek help in the next semester than students in the CC condition (d = 0.12, 95% CI: 0.02 to 0.23). Moderator analyses indicated that the intervention was more effective among students that fulfilled the criteria for lifetime (d = 0.34; 95% CI: −0.08 to 0.7) and 12‐month panic‐disorder (d = 0.32; 95% CI: −0.10 to 0.74) compared with those without lifetime (d = 0.11; 95% CI: 0.00 to 0.22) or 12‐month panic disorder (d = 0.11; 95% CI: 0.00 to 0.22), students with lower (d = 0.37; 95% CI: −0.77 to 1.51) than higher (d = −0.01; 95% CI: −0.36 to 0.34) self‐reported physical health, and students with nonheterosexual (d = 0.38; 95% CI: 0.08 to 0.67) compared with heterosexual (d = 0.06; 95% CI: −0.06 to 0.17) sexual orientation. The intervention had no effects among students who reported that they recognized that they had an emotional problem and 'are already working actively to change it' (Stage 4 'stages of change'). Conclusions: A simple acceptance‐facilitating intervention can increase intention to use mental health services, although effects, are on average, small. Future studies should investigate more personalized approaches with interventions tailored to barriers and clinical characteristics of students. In order to optimize intervention effects, the development and evaluation should be realized in designs that are powered to allow incremental value of different intervention components and tailoring strategies to be evaluated, such as in multiphase optimization designs. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: health behavior; psychoeducation; public mental health; risk factors; College Students; Health Care Utilization; Intention; Mental Health Services; Public Mental Health; Mental Disorders; Mental Health; Risk Factors

Peer victimization and dating violence among LGBTQ youth: The impact of school violence and crime on mental health outcomes - Espelage, Dorothy L.; Merrin, Gabriel J.; Hatchel, Tyler (Youth Violence and Juvenile Justice, 2018)
This study examined the moderating role of school violence and peer victimization on the association between sexual orientation and mental health. The sample consisted of 11,794 high school students (Mage = 16, SD = 1.23; female assigned at birth = 51%; 1.8% identified as transgender) across 23 schools. Participants completed a self-report survey that assessed sexual orientation, ethnicity, gender identity, victimization experiences (e.g., peer and dating), perceptions of school violence and crime, as well as anxiety and suicidality. Multilevel analyses indicated that lesbian, gay, bisexual, questioning, and transgender (LGBTQ) individuals with lower rates of victimization had significantly lower rates of suicidality compared to LGBTQ individuals with higher rates of victimization. LGBTQ individuals in schools with high student perceptions of school violence and crime had higher suicidality than their non-LGBTQ counterparts. LGBTQ youth in schools with lower school violence and crime levels had lower rates of suicidality than their non-LGBTQ counterparts. Interventions need to consider multiple forms of victimization and school environment as potential risk and protective factors for LGBTQ youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: victimization; teen dating violence; school violence and crime; sexual minority youth; LGBTQ youth; Crime; Mental Health; Peers; School Violence; Victimization; Bisexuality; Homosexuality; Lesbianism; Male Homosexuality; Transgender; Dating Violence; Sexual Minority Groups; LGBTQ; Health Outcomes

Stigma and suicide risk among the LGBTQ population: Are anxiety and depression to blame and can connectedness to the LGBTQ community help? - Kaniuka, Andrea; Pugh, Kelley C.; Jordan, Megan; Brooks, Byron; Dodd, Julia; Mann, Abbey K.; Williams, Stacey L.; Hirsch, Jameson K. (Journal of Gay & Lesbian Mental Health, 2019)
LGBTQ individuals may be at risk for suicidal behavior due to perceived stigma and psychopathology. However, protective factors, such as community connectedness, may reduce risk. We examined depression and anxiety as mediators of the linkage between perceived stigma and suicidal behavior, and the moderating role of LGBTQ community connectedness. Among our sample of LGBTQ persons (N = 496), psychopathology mediated the association between perceived stigma and suicidal behavior. Connectedness moderated the relation between perceived stigma and depression, and between perceived stigma and suicidal behavior in the anxiety model. Therapeutically addressing stigma and promoting LGBTQ community connectedness may reduce risk for suicidal behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Connectedness; LGBTQ; perceived stigma; psychopathology; suicide; Anxiety; Major Depression; Stigma; Suicide; LGBTQ; Communities; Protective Factors; Psychopathology; Risk Factors

Perceived barriers to mental health services among canadian sexual and gender minorities with depression and at risk of suicide - Ferlatte, Olivier; Salway, Travis; Rice, Simon; Oliffe, John L.; Rich, Ashleigh J.; Knight, Rod; Morgan, Jeffrey; Ogrodniczuk, John S. (Community Mental Health Journal, 2019)
This study examines barriers to mental health services among sexual and gender minorities (SGM) who screened positive for depression and risk of suicide. Data from an online survey of SGM (N = 2778) are analyzed. 37.5% met criteria for depression and 73.6% screened for being at risk of suicide. The most frequently cited barriers to mental health services access were inability to pay (62.3%), insufficient insurance (52.2%), a preference for ‘waiting’ for the problems to go away (51.5%), discomfort discussing emotions (45.7%), and feeling embarrassed and ashamed about mental health challenges (42.5%). Policy and practices implications of these findings are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Sexual and gender minorities; LGBTQ; Mental health; Depression; Suicide; No terms assigned

Sexual violence and safety: The narratives of transwomen in online forums - Noack-Lundberg, Kyja; Liamputtong, Pranee; Marjadi, Brahm; Ussher, Jane; Perz, Janette; Schmied, Virginia; Dune, Tinashe; Brook, Eloise (Culture, Health & Sexuality, 2019)
An online forum analysis was conducted to explore experiences of sexual violence and safety among transwomen, with a particular focus on transwomen of colour. Four online forums were chosen for the analysis. Three key themes were identified: dating and violence in intimate relationships; fear of violence and safety strategies; and coping after sexual assault. Forum posters faced heightened gender policing and scrutiny, due to not conforming to normative ideals of femininity. Femininity was also predicated on white, middle-class status, and associated with domesticity and romance. As a result, expressions of femininity from non-white backgrounds could be read as deviant or excessive. The intersection of deviation from gender norms and femininity based on whiteness meant that transwomen of colour faced disproportionate levels of violence, both in public and private spaces. Transwomen of colour also faced disadvantage due to participation in higher-risk forms of sex work, low socioeconomic status and employment, and institutional discrimination. Coping mechanisms to deal with cumulative disadvantage included seeking support from health professionals and transgender community networks. However, it also included more harmful forms of self-medicating such as heavy alcohol and drug use, self-harm and suicide attempts. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Online forums; transwomen of colour; sexual violence; physical violence; safety; No terms assigned

'Estimate of lesbian, gay, bisexual, and transgender youth suicide is inflated': Reply - Ream, Geoffrey L. (Journal of Adolescent Health, 2019)
Reply by the current author to the comments made by Kirsty A. Clark et al. (see record [rid]2019-34234-023[/rid]) on the original article (see record [rid]2019-05735-001[/rid]). 'Inflated' is the wrong complaint, directed at the wrong people. All the material facts that Clark et al. state about National Violent Death Reporting System (NVDRS) data are true. I stipulate to them in my article. The reviewers and editors of the Journal of Adolescent Health knew about them when they chose to favorably review my article and accept it for publication. One can state the 24% figure in the context of those qualifiers, as I do in my article, without going beyond the data. However, a firm statement that the 24% figure is 'inflated' would go beyond the data. Reporting the 24% figure without appropriate qualification is, arguably, intellectually dishonest. However, that happened on Twitter, not in the Journal of Adolescent Health. There is only so much responsibility that journal article authors, reviewers, and editors can accept for Twitter. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: lesbian; gay; bisexual; transgender; suicide; LGBT suicide; Bisexuality; Death and Dying; Lesbianism; Suicide; Transgender; Experimentation; Heterosexuality; LGBTQ

Suicide in sexual minority populations: A systematic review of evidence-based studies - Yıldız, Erman (Archives of Psychiatric Nursing, 2018)
Sexual minority populations are exposed to more forms of distress than heterosexual individuals, thereby increasing the risk of suicidal behavior. It therefore seems surprising that suicidal behavior in sexual minorities is not sufficiently addressed in the nursing literature. The aim of this review was to integrate evidence-based knowledge and experiences related to suicide in sexual minorities into the nursing literature. This study has been conducted according to PRISMA guidelines, which contains a basic systematic screening process. Fourteen articles met the research criteria. The evaluation encompassed 4 themes: 1) Suicide attempts; 2) Thoughts of suicide; 3) Suicide attempts and completed suicide; 4) Suicidal thoughts and suicide attempts. Most studies focused on the dimensions of attempted suicide. The key finding was that young people in sexual minority groups exhibit more suicidal ideation, more suicide attempts and are more at risk of completed suicide than heterosexual individuals. Family-centered care for young people can therefore be one of the basic principles of nursing practice. Nurses can routinely ask adolescents about their sexual orientation and identity to provide appropriate assessment and care. Additionally, nurses can use educational, counseling, case manager and therapist roles to avoid negative experiences such as homophobia, stigmatization and the discrimination of sexual minorities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGBT; nurse roles; sexual minority; suicide; systematic reviews and meta-analyses; Evidence-Based Practice; Humans; Nurse's Role; Risk Factors; Sexual and Gender Minorities; Suicidal Ideation; Suicide, Attempted; Nurses; Suicide; Professional Role; Sexual Minority Groups; LGBTQ; Meta Analysis; Systematic Review

Acting as yourself: Implementing acceptance and commitment therapy for transgender adolescents through a developmental lens - Bennett, Caitlyn McKinzie; Dillman Taylor, Dalena (Journal of Child and Adolescent Counseling, 2019)
Transgender adolescents are at an increased risk for mental health concerns including depression, anxiety, suicidal ideation, substance abuse, and truancy. Transgender youth are especially vulnerable to victimization and bullying, often exacerbating mental health symptoms. Furthermore, typical adolescent developmental milestones as well as the unique developmental experiences of transgender adolescents make growth and identity development challenging. Acceptance and commitment therapy (ACT) is a third-wave cognitive therapy that focuses on acceptance, values-driven decisions, and committed action. Practitioners’ use of ACT has demonstrated effectiveness with at-risk adolescents and allows for transgender adolescent clients to gain more skills and support throughout their personal journey. In this article, we provide a case illustration and application of ACT with a transgender adolescent and also explore the developmental needs and considerations of this population in need. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; adolescents; acceptance and commitment therapy; No terms assigned

Journal article reviews - Weitzman, Carol C.; DeVinck-Baroody, Oana; Farrell, Cristina; Nadler, Cy B.; Poon, Jennifer K. (Journal of Developmental and Behavioral Pediatrics, 2019)
This article contains multiple, brief reviews of other articles within the journal. Reviews cover topics such ADHD, autism, and family relationships. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: article review; ADHD; attention-deficit hyperactivity disorder; autism; suicide prevention; gay fathers; cognitive outcomes; family interaction; brain development; Attention Deficit Disorder with Hyperactivity; Autism Spectrum Disorders; Family Relations; Suicide Prevention; Brain Development; Fathers; Male Homosexuality

A systematic review of family victimization experiences among sexual minority youth - McGeough, Briana L.; Sterzing, Paul R. (The Journal of Primary Prevention, 2018)
Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Childhood abuse; Sibling abuse; Domestic violence; Sibling aggression; Risk factors; Health correlates; Adolescent; Child Abuse, Sexual; Crime Victims; Domestic Violence; Family; Humans; Sexual and Gender Minorities; Child Abuse; Domestic Violence; Family; Victimization; Sexual Minority Groups; Life Experiences

Suicidality and clinical correlates in Chinese men who have sex with men (MSM) with HIV infection - Wang, Yuan-Yuan; Dong, Min; Zhang, Qinge; Xu, Dan-Dan; Zhao, Jin; Ng, Chee H.; Ungvari, Gabor S.; Jia, Fu-Jun; Xiang, Yu-Tao (Psychology, Health & Medicine, 2019)
Little is known about suicidality in Chinese men who has sex with men (MSM) infected with human immunodeficiency virus (HIV). This study investigated suicidality and its clinical correlates in Chinese MSM with HIV infection. Suicidality, demographic and clinical characteristics were assessed in 410 MSM with HIV infection consecutively recruited from a public HIV clinic in China. The prevalence of suicidality was 10.7% in Chinese HIV-infected MSM. Compared with those without suicidality, MSM with suicidality were more likely to be younger, unmarried and unemployed, and have more frequent insomnia, lower CD4 lymphocyte counts, and higher GAD-7 and CSE-D total scores. Multiple logistic regression analyses revealed that suicidality was independently associated with unemployment (p = 0.03, OR = 0.3, 95% CI = 0.1–0.9), age (p < 0.01, OR = 0.9, 95% CI = 0.8–0.9), CD4 lymphocyte counts (p = 0.02, OR = 0.9, 95% CI = 0.9–1.0), and the GAD-7 total score (p < 0.001, OR = 1.3, 95% CI = 1.1–1.5). Suicidality is common in Chinese MSM with HIV infection. There is an urgent need to develop comprehensive suicide prevention program and mental health services for this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicidality; human immunodeficiency virus; men who have sex with men; China; HIV; Infectious Disorders; Same Sex Intercourse; Suicidality; Lymphocytes; Unemployment

Trajectories of suicidal ideation from adolescence to adulthood: Does the history of same-sex experience matter? - Oi, Katsuya; Wilkinson, Lindsey (Archives of Sexual Behavior, 2018)
The fluidity of same-sex experience (SSE) can be conceptualized as both a risk and a resource that impacts suicidal ideation over time. Considering whether SSE occurs in adolescence, adulthood, or both, this study suggests that SSE in both adolescence and adulthood is associated with depression and low self-esteem throughout the life course, resulting in chronic susceptibility to suicidal ideation. Yet due to variation in both accumulation of risk and resources over time, trajectories of suicidal ideation during the transition to adulthood likely vary by timing of SSE. To test these hypotheses, we fit latent growth curve models to a gender-stratified sample taken from the National Longitudinal Study of Adolescent to Adult Health (7608 men, 8070 women). We created four groups of SSE: no SSE (6322 men, 5981 women), SSE in adolescence only (634 men, 480 women), SSE in adulthood only (372 men, 1081 women), and SSE in adolescence and adulthood (280 men, 528 women). Men and women with SSE in both life stages had the greatest risk of suicidal ideation in adolescence and in adulthood. Yet women with first SSE in adulthood had less of a decline in suicidal ideation over time, relative to those with no SSE and those with SSE in adolescence only, and this was partially due to higher depression and lower self-esteem. Results suggest greater support is needed for adolescents expressing non-normative sexualities and for those with first SSE in adulthood, a group that is more difficult to identify in schools. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Suicidality; Non-heterosexuality; Adolescence; Coping; Sexual orientation; Same-sex experience; sexual minorities; Suicidal ideation; Adolescent; Adult; Depression; Depressive Disorder; Female; Homosexuality; Humans; Longitudinal Studies; Male; Psychology, Adolescent; Self Concept; Sexual Behavior; Sexuality; Suicidal Ideation; Adolescent Development; Sexual Orientation; Suicidal Ideation; Emerging Adulthood; Suicidality; At Risk Populations; Coping Behavior; Sexuality; Sexual Minority Groups

Stigma, gender dysphoria, and nonsuicidal self-injury in a community sample of transgender individuals - Jackman, Kasey B.; Dolezal, Curtis; Levin, Bruce; Honig, Judy C.; Bockting, Walter O. (Psychiatry Research, 2018)
We investigated rates of nonsuicidal self-injury (NSSI) and correlates of past-year NSSI among transgender people to better understand factors contributing to this health disparity. A community-based sample of 332 transgender people participated in quantitative in-person interviews. The mean age of participants was 34.56 years (SD=13.78, range=16–87). The sample was evenly divided between transfeminine spectrum (50.3%) and transmasculine spectrum identities (49.7%) and was diverse in race/ethnicity. We evaluated associations between sociodemographic characteristics, stigma, hypothesized resilience factors, and identity variables with past-year NSSI. 53.3% of participants reported ever having self-injured in their lifetime. Past-year NSSI was reported by 22.3% of the sample and did not significantly differ based on gender identity. In logistic regression models, past-year NSSI was associated with younger age and felt stigma (perceived or anticipated rejection), but not enacted stigma (actual experiences of discrimination), and with gender dysphoria. Efforts to address the high rates of NSSI among transgender people should aim to reduce felt stigma and gender dysphoria, and promote transgender congruence. Future research using a developmental approach to assess variations in NSSI across the life course and in relation to transgender identity development may illuminate additional processes that affect NSSI in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: stigma; gender dysphoria; non-suicidal self-injury; transgender; Adolescent; Adult; Aged; Child; Cross-Sectional Studies; Female; Gender Dysphoria; Gender Identity; Humans; Independent Living; Longitudinal Studies; Male; Middle Aged; Self-Injurious Behavior; Social Stigma; Transgender Persons; Young Adult; Self-Injurious Behavior; Stigma; Transgender; Gender Identity

Representation and erasure of bisexual people of color: A content analysis of quantitative bisexual mental health research - Ghabrial, Monica A.; Ross, Lori E. (Psychology of Sexual Orientation and Gender Diversity, 2018)
Bisexual people of color (BPOC) live with a complex intersection of identities, facing binegativity, racism, and invisibility. These issues result in a wide range of stressors that incorporate the intersecting stigmas they face in various contexts. Sexual minority research has limited applications to bisexual people, as most of the existing theories and approaches are based on research that included only lesbian and gay populations. The present study was designed to investigate the representation of BPOC in mental health research. To satisfy this objective, we extracted race/ethnicity data from a pool of quantitative studies on depression, anxiety, smoking, substance use, and suicidality that included bisexual participants, and conducted a content analysis with the resulting 324 articles. Seventy-two percent of studies reported the racial/ethnic makeup of their total sample; however, only 40% reported the number of BPOC present in the sample, and only 7% reported outcomes for BPOC separately from White participants and other sexual minority groups. Details on racial groups included, recruitment methods utilized in studies with diverse samples, and the nature of research involving racial/ethnic minority persons are presented and discussed. Results of this investigation reveal that there is marginal emphasis on people of color in bisexual research and that this representation has not seen significant progress over the last 2 decades. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: bisexuality; biphobia; intersectionality; racism; minority stress; Bisexuality; Blacks; Content Analysis; Experimentation; Mental Health; Anxiety; Drug Usage; Homosexuality (Attitudes Toward); Major Depression; Minority Groups; Racism; Suicidal Ideation; Tobacco Smoking; Latinos/Latinas; Minority Stress

The fizzling effect: A phenomenological study on suicidality among Filipino lesbian women and gay men - Bautista, Angelie D.; Pacayra, Eva E.; Sunico-Quesada, Carmen R.; Reyes, Marc Eric S.; Davis, Roger D. (Psychological Studies, 2017)
Suicide is now the second leading cause of death among the 15- to 29-year-old age group (WHO in: Preventing suicide: a global imperative, executive summary, World Health Organization, Geneva, 2014. Retrieved from www.who.int/mental_health/suicide-prevention/exe_summary_english.pdf ). Current research supports the observation that suicidality is a critical concern among lesbian, gay, bisexual, and transgender populations, who may be at greater risk than their heterosexual peers. Phenomenological methods were used to study the dynamics of lesbian women and gay men suicidality in the Philippines. A selection of five self-identified gay men and four self-identified lesbian women met the inclusion criteria of the study and, individually, went through an in-depth interview, consisting of two parts, namely the robotfoto and the semi-structured interview. Analyses went through reduction, description, and finding the essence. Three distinct but interrelated themes surfaced: effervescing dilemma, pressurizing turmoil, and fizzling explosion. These themes suggest that Filipino lesbian women and gay men may suffer from internalized stigma and heaving emotional turmoil, which contribute to suicidal ideation and self-injurious behaviors. Difficult life events may trigger an explosion of pent-up negative emotions, culminating in attempted suicide. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Suicidality; Suicide; Lesbian women; Gay men; LG suicidality model; Phenomenology; Lesbianism; Male Homosexuality; Phenomenology; Suicidal Ideation; Suicidality

Suicide etiology in youth: Differences and similarities by sexual and gender minority status - McKay, Tasseli; Berzofsky, Marcus; Landwehr, Justin; Hsieh, Patrick; Smith, Amanda (Children and Youth Services Review, 2019)
Sexual and gender minority (SGM) individuals are at steeply elevated risk for suicide, particularly in adolescence and young adulthood. Evidence on suicide risk factors specific to SGM youth is emerging, but an integrated understanding of the etiology of suicide that accounts for both commonalities and differences between SGM and non-SMG youth is lacking. Using 2018 data from a social media-based sample of SGM (n = 175) and non-SGM (n = 310) youth ages 14–21, we assess the role of constructs from the general-population-based interpersonal-psychological theory of suicide and the SGM-specific minority stress theory in suicide ideation and attempt. Parental support was a strong protective factor shared across the SGM and non-SGM youth samples. The role of other factors, such as racial/ethnic identity, differed by group. Implications for suicide prevention and intervention in schools and other settings that include both SGM- and non-SGM youth are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; etiology; gender identity; minority stress; Etiology; Human Sex Differences; Risk Factors; Suicide; Suicide Prevention; Sexual Risk Taking; Suicidology; Minority Stress

Is young adulthood a critical period for suicidal behavior among sexual minorities? Results from a us national sample - Fish, Jessica N.; Rice, Cara E.; Lanza, Stephanie T.; Russell, Stephen T. (Prevention Science, 2018)
The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalences and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experienced anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider age range for sexual minority women (until age 30) relative to sexual minority men (until age 25). (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGB; Sexual minority; Suicidal behavior; Suicidality; Young adulthood; Lifespan; Time-varying effect modeling; Suicidality; Sexual Minority Groups

A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States - Valentine, Sarah E.; Shipherd, Jillian C. (Clinical Psychology Review, 2018)
Transgender and gender non-conforming (TGNC) populations, including those who do not identify with gender binary constructs (man or woman) are increasingly recognized in health care settings. Research on the health of TGNC people is growing, and disparities are often noted. In this review, we examine 77 studies published between January 1, 1997 and March 22, 2017 which reported mental health outcomes in TGNC populations to (a) characterize what is known about mental health outcomes and (b) describe what gaps persist in this literature. In general, depressive symptoms, suicidality, interpersonal trauma exposure, substance use disorders, anxiety, and general distress have been consistently elevated among TGNC adults. We also used the minority stress model as a framework for summarizing existing literature. While no studies included all elements of the Minority Stress Model, this summary gives an overview of which studies have looked at each element. Findings suggest that TGNC people are exposed to a variety of social stressors, including stigma, discrimination, and bias events that contribute to mental health problems. Social support, community connectedness, and effective coping strategies appear beneficial. We argue that routine collection of gender identity data could advance our understanding mental health risk and resilience factors among TGNC populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender; Non-conforming; Gender; Mental health; Substance use; Social stress; Adult; Anxiety; Depression; Female; Humans; Male; Middle Aged; Psychological Trauma; Sexual and Gender Minorities; Social Stigma; Social Support; Stress, Psychological; Substance-Related Disorders; United States; Mental Health; Social Stress; Transgender; Gender Nonconforming

'The problem isn’t yourself overcoming, it’s other people overcoming you:' A decolonizing mental health DSE curricular cripstemology reading of Daniel and Luna’s intersectional dis/ability experiences - Hernández-Saca, David I.; Kahn, Laurie Gutmann (Educational Studies: Journal of the American Educational Studies Association, 2019)
This study brings together 2 case studies to interrogate the intersectional experiences of historically marginalized youth at the intersections of power and identity from a decolonizing mental health disability studies in education (DSE) cripstemology approach. Specifically, we analyzed how US schools create normalized meanings of mental health. Daniel was a 1st-generation Mexican American to the United States, bilingual in both Spanish and English, and was labeled with a learning disability and a speech and language impairment. Daniel was born in Pinole, a southwestern major urban city and was in the 8th grade. Luna, a 16-year-old 10th-grader who lived at home with his mother and his stepfather and identifies as an Arab American, was on an individual education program for his disabilities including mild cerebral palsy, apraxia, and dysarthria. Luna identified as a pansexual and transgender individual and experiences depression and suicide ideation. There were similarities and differences between Daniel and Luna’s experiences related to intersectional disability oppressions that were interpersonal and institutional, their identity processes around school contexts tied to their ethnicities, language use, sexuality, and their experiences with colonial mental health hegemony. Our framework created new knowledge for theory, research, and praxis within US schools. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; curricular cripstemology; marginalized youth; intersectional disability experiences; schools; Disabilities; Mental Health; Schools; Special Education; Marginalization