13 Reasons Why: Viewing patterns and perceived impact among youths at risk of suicide - Hong, Victor; Ewell Foster, Cynthia J.; Magness, Christina S.; McGuire, Taylor C.; Smith, Patricia K.; King, Cheryl A. (Psychiatric Services, 2019)
Objective: The streaming series 13 Reasons Why generated controversy because of its depiction of teen suicide and concerns about its impact on vulnerable youths. This study examined exposure to and patterns of engagement with the show and the show’s perceived impact in a sample of youths presenting to a psychiatric emergency department (ED) with suicide-related concerns in the year after the series’ premiere. Methods: Participants were 87 parent-youth dyads (youths’ mean ± SD age = 14.6 ± 1.8; 71% of youths were female, 26% male, and 2% gender nonconforming) who completed a battery of questionnaires during their ED visit. Results: Half (49%) of the sample viewed at least one episode of 13 Reasons Why, season 1. Most youths (84%) viewed the show alone and were more likely to discuss their reactions with peers (80%) than with a parent (34%). Over half of youth viewers (51%) believed the series increased their suicide risk to a nonzero degree; having a stronger identification with the lead female character was significantly related to this belief (r = .63, df = 41, p < 0.001). Youths with more depressive symptoms and suicidal ideation were more likely to identify with the lead characters and report negative affect while viewing. Conclusions: To date, this is the first published study examining viewing patterns and reactions to 13 Reasons Why in a high-risk sample. Although further research is needed, the findings suggest a particular vulnerability to the show’s themes among youths at risk of suicide and the importance of prevention strategies to ameliorate risk among these viewers. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: risk; suicide; youths; television series viewing; Adolescent; Adolescent Behavior; Adult; Communication; Emergency Service, Hospital; Female; Humans; Male; Motion Pictures; Parents; Peer Group; Risk; Suicide; United States; Young Adult; At Risk Populations; Suicide; Television Viewing; Suicidal Ideation

Examining characteristics of worry in relation to depression, anxiety, and suicidal ideation and attempts - Gorday, Julia Y.; Rogers, Megan L.; Joiner, Thomas E. (Journal of Psychiatric Research, 2018)
Background: Pathological worry is defined as worry that is excessive, pervasive, and uncontrollable. Although pathological worry is related to depression, anxiety, and suicidal ideation, less is understood about what specific features of worry confer risk for these mental health conditions. The current study examined associations between four characteristics of worry—frequency, duration, controllability, and content—and self-reported symptoms of depression, anxiety, suicidal ideation, and lifetime suicide attempts. Methods: A sample of 548 community participants (53.6% female, 45.4% male, 0.5% transgender male, 0.2% transgender female, and 0.2% gender non-binary), aged 19–98 years (M = 36.54, SD = 12.33), was recruited via Amazon's MTurk and completed a battery of self-report questionnaires online. Results: Results indicated that controllability of worry was uniquely associated with depression, anxiety, and suicidal ideation above and beyond other characteristics of worry, demographic variables, negative affect, and future-oriented repetitive thinking. Lifetime suicide attempts were found non-significant to these mental health outcomes. Frequency of worry was also positively related to depression. Limitations: This study utilized a cross-sectional design with exclusive self-report measures. Conclusions: Overall, these findings suggest that controllability of one's thoughts may be a key transdiagnostic factor that confers risk for a variety of psychopathology-related concerns. Clinical relevance includes identifying potential risk factors for varying psychopathology. Future research should examine relationships between worry controllability and anxiety, depression, suicidal ideation, and attempts, within clinical samples and utilizing a variety of methodologies. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Worry; Anxiety; Depression; Suicide; Repetitive thinking; Perceived control; Adult; Aged; Aged, 80 and over; Anxiety Disorders; Comorbidity; Cross-Sectional Studies; Depressive Disorder; Female; Humans; Male; Middle Aged; Self-Control; Suicidal Ideation; Suicide, Attempted; Thinking; Young Adult; Anxiety; Attempted Suicide; Major Depression; Suicidal Ideation; Risk Factors

The association between supportive high school environments and depressive symptoms and suicidality among sexual minority students - Denny, Simon; Lucassen, Mathijs F. G.; Stuart, Jaimee; Fleming, Theresa; Bullen, Pat; Peiris-John, Roshini; Rossen, Fiona V.; Utter, Jennifer (Journal of Clinical Child and Adolescent Psychology, 2016)
The purpose of this study was to determine if sexual minority students in supportive school environments experienced fewer depressive symptoms and lower rates of suicide ideation, plans and attempts ('suicidality') than sexual minority students in less supportive school environments. In 2007, a nationally representative sample (N = 9,056) of students from 96 high schools in New Zealand used Internet tablets to complete a health and well-being survey that included questions on sexual attractions, depressive symptoms, and suicidality. Students reported their experience of supportive environments at school and gay, lesbian, bisexual, and transgender (GLBT) bullying, and these items were aggregated to the school level. Teachers (n = 2,901) from participating schools completed questionnaires on aspects of school climate, which included how supportive their schools were toward sexual minority students. Multilevel models were used to estimate school effects on depressive symptoms and suicidality controlling for background characteristics of students. Sexual minority students were more likely to report higher levels of depressive symptoms and suicidality than their opposite-sex attracted peers (p < .001). Teacher reports of more supportive school environments for GLBT students were associated with fewer depressive symptoms among male sexual minority students (p = .006) but not for female sexual minority students (p = .09). Likewise in schools where students reported a more supportive school environment, male sexual minority students reported fewer depressive symptoms (p = .006) and less suicidality (p < .001) than in schools where students reported less favorable school climates. These results suggest that schools play an important role in providing safe and supportive environments for male sexual minority students. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: school environment; depressive symptoms; high schools; sexual minority students; Adolescent; Adolescent Behavior; Bisexuality; Bullying; Depression; Female; Homosexuality; Humans; Internet; Male; Mental Health; Minority Groups; New Zealand; Peer Group; Schools; Sexual Behavior; Students; Suicide; Suicide, Attempted; Surveys and Questionnaires; Transgender Persons; High Schools; Major Depression; Minority Groups; School Environment; Suicidal Ideation; Bisexuality; Lesbianism; Male Homosexuality; Sexual Orientation; Transgender; Suicidality; Sexual Minority Groups

Improving the mental health outcomes of LGBTQ youth and young adults: A longitudinal study - Painter, Kirstin R.; Scannapieco, Maria; Blau, Gary; Andre, Amy; Kohn, Kris (Journal of Social Service Research, 2018)
The purpose of this groundbreaking study was to evaluate outcomes of 482 LGBTQ (lesbian, gay, bisexual, transgender, or questioning) youth and young adults who received services and supports through the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Program (CMHI). This study was a secondary data analysis using data from a larger study of 3208 LGBTQ and non-LGBTQ youth ages 11 through 21 who had a serious emotional disturbance (SED). This study is significant in that it evaluates functional outcomes for young people identified as LGBTQ based on a specialized service framework (i.e., system of care approach). In essence, do LGBTQ youth with SED benefit from a specific approach to intervention? In addition, a comparison at intake on suicidality, bullying and victimization was conducted between the LGBTQ and non-LGBTQ identifying youth from the larger sample. The youth and a caregiver were interviewed face-to-face separately at intake, 6-months, and 12-months. Significant improvements were found across all of the dependent variables, supporting the viability of SOC for improving outcomes for LGBTQ youth. Future research should continue to build on this study by adding to the design a control group to improve internal validity of the findings. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: LGBTQ Youth and Young Adults; Serious Mental Disturbance; Systems of Care; Community Services; Mental Health; Sexual Orientation; Bisexuality; Lesbianism; Male Homosexuality; Transgender

Supporting transgender and gender diverse youth: Protection against emotional distress and substance use - Gower, Amy L.; Rider, G. Nic; Brown, Camille; McMorris, Barbara J.; Coleman, Eli; Taliaferro, Lindsay A.; Eisenberg, Marla E. (American Journal of Preventive Medicine, 2018)
Introduction: Important mental and physical health disparities exist for transgender and gender diverse youth compared with cisgender youth (i.e., those whose birth-assigned sex and gender identity align), yet little is known about factors that protect transgender and gender diverse youth from health problems. The objective of this paper is to identify modifiable protective factors in the lives of transgender and gender diverse adolescents, with the goal of informing efforts to eliminate disparities in depression, suicidality, and substance use in this population. Methods: Secondary data analysis of the 2016 Minnesota Student Survey examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at school) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender. Logistic regressions assessed the role of each protective factor separately and simultaneously. Results: Each protective factor was associated with lower odds of emotional distress and substance use. When protective factors were examined simultaneously, parent connectedness was protective for all measures. Feeling safe at school and connected to adults in one's community protected against depression and suicidality; teacher connectedness buffered risk of substance use. Conclusions: Given that transgender and gender diverse youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender diverse–friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; gender diverse youth; emotional distress; substance use; Drug Abuse; Emotional Disturbances; Protective Factors; Transgender; Gender Nonconforming

Cultural heterosexism and silencing sexual diversity: Anoka-Hennepin School District - Grozelle, Renee S. (Journal of LGBT Youth, 2017)
In less than 2 years, nine young people within one Minnesota school district committed suicide. As such, the bullying of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth in the Anoka-Hennepin School District continues to be an example of how embedded ideologies of some individuals can substantially impact the treatment of marginalized groups. Using the theory of cultural heterosexism, this paper will look at the ways in which the Anoka-Hennepin School District in Minnesota became a breeding ground for homophobic violence and discrimination. Furthermore, attention will be directed toward how discourses of sexuality, mobilized by conservative Christian groups in the Anoka-Hennepin School District, were used in order to maintain a heteronormative social order. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Cultural heterosexism; bullying; suicide; sexuality; schools; LGBTQ rights; Bisexuality; Homosexuality (Attitudes Toward); Lesbianism; Sexuality; Bullying; Homosexuality; Suicide; LGBTQ

Exploring the temporal dynamics of the interpersonal theory of suicide constructs: A dynamic systems modeling approach - Rogers, Megan L.; Joiner, Thomas E. (Journal of Consulting and Clinical Psychology, 2019)
Objective: The interpersonal theory of suicide has contributed to advances in the understanding and prevention of suicidal behavior, with over a decade of empirical examination. Few studies, however, have used a longitudinal design with repeated short-term follow-ups to examine the temporal trajectories of perceived burdensomeness, thwarted belongingness, and suicidal ideation, nor have any studies to our knowledge investigated the propositions of the interpersonal theory of suicide using a dynamic systems theory approach. The present study examined the temporal dynamics of perceived burdensomeness, thwarted belongingness, and suicidal ideation, as moderated by capability for suicide, using dynamic systems modeling analyses in a sample of 91 adults at high risk for suicide (Mage = 27.03 years, SD = 8.64; 53.8% female, 44.0% male, 1.1% nonbinary, 1.1% transgender female). Method: Participants completed brief online self-report measures at 6 time-points, each 3 days apart. Results: Results were generally in support of the interpersonal theory of suicide: perceived burdensomeness, thwarted belongingness, and suicidal ideation exhibited patterns of temporal stability that were accentuated at high levels of capability for suicide; perceived burdensomeness and thwarted belongingness exhibited a reciprocal temporal pattern, as did perceived burdensomeness and suicidal ideation. However, thwarted belongingness did not have an incremental influence on suicidal ideation. Conclusions: Overall, these findings provide additional information about the nature of suicidal ideation and interpersonal risk factors over time and point to nonlinear dynamic systems modeling as an analytic technique that may prove useful in understanding trajectories of suicidal thoughts and behaviors. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: suicide; perceived burdensomeness; thwarted belongingness; capability for suicide; interpersonal theory of suicide; Suicidal Ideation; Suicide; Systems Theory; Suicidology; Belonging; Perception; Simulation; Suicide Prevention

Constructing and expanding suicide narratives from gay men - Salway, Travis; Gesink, Dionne (Qualitative Health Research, 2018)
In this study, we document life stories of gay men who attempted suicide as adults. Our goal is to expand the collection of narratives used to understand this persistent health inequity. We interviewed seven adult gay men, each of whom had attempted suicide two to four times, and identified five narratives. Pride narratives resist any connection between sexuality and suicide. Trauma-and-stress narratives enable coping through acknowledgment of sexual stigma as a fundamental trauma and cause of subsequent stress and suicidal thoughts. Memorial narratives prevent suicide by maintaining a strong sense of 'permanent' identity. Outing narratives demand that the listener confronts the legacy of unjust practices of homosexual surveillance and 'outing,' which historically resulted in gay suicides. Finally, postgay narratives warn of the risk of suicide among older generations of gay men who feel erased from the goals of modern gay movements. Sexual identity concealment or invisibility featured prominently in all five narratives. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: gay; mental health; suicide; narrative research; qualitative; Attempted Suicide; Life Experiences; Male Homosexuality; Narratives

Prevalence rates, reporting, and psychosocial correlates of stalking victimization: Results from a three-sample cross-sectional study - Nobles, Matt R.; Cramer, Robert J.; Zottola, Samantha A.; Desmarais, Sarah L.; Gemberling, Tess M.; Holley, Sarah R.; Wright, Susan (Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 2018)
Purpose: Public health and criminal justice stalking victimization data collection efforts are plagued by subjective definitions and lack of known psychosocial correlates. The present study assesses the question of stalking victimization prevalence among three groups. Psychosocial risk and protective factors associated with stalking victimization experiences were assessed. Methods: Archival data (n = 2159) were drawn from a three-sample (i.e., U.S. nationwide sexual diversity special interest group, college student, and general population adult) cross-sectional survey of victimization, sexuality, and health. Results: The range of endorsement of stalking-related victimization experiences was 13.0–47.9%. Reported perpetrators were both commonly known and unknown persons to the victim. Participants disclosed the victimization primarily to nobody or a family member/friend. Bivariate correlates of stalking victimization were female gender, Associates/Bachelor-level education, bisexual or other sexual orientation minority status, hypertension, diabetes, older age, higher weekly drug use, elevated trait aggression, higher cognitive reappraisal skills, lower rape myth acceptance, and elevated psychiatric symptoms. Logistic regression results showed the strongest factors in identifying elevated stalking victimization risk were: older age, elevated aggression, higher cognitive reappraisal skills, lesser low self-control, increased symptoms of suicidality and PTSD re-experiencing, and female and other gender minority status. Conclusions: Behavioral approaches to epidemiological and criminal justice stalking victimization are recommended. Victimization under reporting to healthcare and legal professionals were observed. Further research and prevention programming is needed to capitalize on data concerning personality and coping skills, sexual diversity, and trauma-related psychiatric symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Stalking; Victimization; Mental health; LGBTQ; BDSM; Personality; Adolescent; Adult; Aggression; Crime Victims; Cross-Sectional Studies; Disclosure; Female; Friends; Humans; Logistic Models; Male; Prevalence; Sexual and Gender Minorities; Stalking; Students; United States; Health Care Psychology; Mental Health; Stalking; Victimization; LGBTQ

Depression and associated factors among gay and heterosexual male university students in Nigeria - Oginni, Olakunle A.; Mosaku, Kolawole S.; Mapayi, Boladale M.; Akinsulore, Adesanmi; Afolabi, Temitope O. (Archives of Sexual Behavior, 2018)
Homosexuality is a recognized risk factor for depression in high-income countries; however, there is little research investigating the relationship between depression and sexual orientation in developing countries, especially in Africa. In this first study to investigate psychopathology in sexual minority men in Nigeria, the prevalence rates of depression in Nigerian gay and heterosexual individuals were compared as well as the explanatory power of risk and resilience factors in both groups. Eighty-one gay and 81 heterosexual male university students were, respectively, recruited from the Obafemi Awolowo University. Both groups were assessed for depression and other clinical factors, including alcohol and other substance use, suicidal ideation, and resilience. Gay students were further assessed for sexuality-related variables, including minority stress factors such as internalized homophobia and perceived stigma. The prevalence rates of depression among gay and heterosexual students were, respectively, 16 and 4.9% (OR 3.7; 95% CI 1.15–11.82), and this increased likelihood for depression was significantly attenuated by resilience. Clinical factors correlated significantly with depression in both groups, explaining 31% of the variance in depression in gay and heterosexual students, respectively. Sexuality-related variables including internalized homophobia and perceived stigma were further associated with depression in gay students—accounting for a further 14% of the variance of depression in gay students. The findings highlight the importance of minority stress factors in understanding depression among non-heterosexual individuals in a developing country, and the need for further research to investigate the mechanisms of these relationships in such settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Homosexuality; heterosexuality; prevalence rates of depression; males; risk; resilience; Nigeria; Adult; Depression; Heterosexuality; Homophobia; Homosexuality, Male; Humans; Male; Nigeria; Resilience, Psychological; Sexual and Gender Minorities; Social Stigma; Students; Substance-Related Disorders; Suicidal Ideation; Universities; Young Adult; Epidemiology; Heterosexuality; Major Depression; Male Homosexuality; College Students; Resilience (Psychological); Risk Factors

Association between risky sexual behavior and a psychosocial syndemic among Nigerian men who have sex with men - Oginni, Olakunle A.; Mapayi, Boladale M.; Afolabi, Olusegun T.; Ebuenyi, Ikenna D.; Akinsulore, Adesanmi; Mosaku, Kolawole S. (Journal of Gay & Lesbian Mental Health, 2019)
Background: The HIV epidemic among men who have sex with men (MSM) is reinforced by a psychosocial syndemic, but this has not been investigated in sub-Saharan Africa. This study investigated the psychosocial syndemic and its relationship with risky sexual behavior among Nigeria MSM. Methods: Eighty-one MSM and 81 heterosexual men were compared for risky sexual behavior and psychosocial adversity variables—childhood adversity, intimate partner violence, depressive symptoms, suicidal ideation, substance use, and a derived psychosocial syndemic score. The association between syndemic scores and risky sexual behavior was examined among MSM. Results: MSM had significantly higher rates of individual psychosocial adversities except substance use. There were significant interrelationships between the variables, and syndemic scores were associated with higher-risk sexual behavior. Conclusion: This is the first study to investigate the psychosocial syndemic and its relationship with HIV risk among African MSM. The findings highlight the role of psychosocial adversities in exacerbating the HIV epidemic among MSM in developing countries. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: MSM; Nigeria; psychosocial adversity; risky sexual behavior; syndemic; Epidemics; HIV; Psychosocial Factors; Sexual Risk Taking; Same Sex Intercourse; Adversity

Internalized heterosexism, religious coping, and psychache in LGB young adults who identify as religious - Bourn, Jamie R.; Frantell, Keri A.; Miles, Joseph R. (Psychology of Sexual Orientation and Gender Diversity, 2018)
We examined psychache, or intolerable emotional suffering, in a sample of lesbian, gay, and bisexual (LGB) young adults who identified as religious. Using a minority stress framework, we hypothesized internalized heterosexism (IH) would positively relate to psychache. We also hypothesized that positive religious coping (PRC) would moderate or lessen this association. Finally, we examined whether negative religious coping (NRC) moderated or mediated the relation between IH and psychache. A sample of 617 LGB young adults who identified as religious completed an online survey assessing IH, religious coping, and psychache. Consistent with our hypothesis, IH was significantly related to psychache. IH was also significantly, positively correlated with both PRC and NRC, suggesting that individuals use both forms of religious coping in relation to experiencing IH. Results suggested that NRC, but not PRC, was correlated with psychache. Contrary to our hypotheses, neither PRC nor NRC moderated the relation between IH and psychache. NRC did, however, mediate the relation between IH and psychache. Results suggest clinicians working with LGB individuals may want to attend psychache, in addition to other types of psychological distress, and that they may target their interventions toward reducing the use of NRC. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: psychache; sexual minority; internalized heterosexism; religious coping; Coping Behavior; Emotions; Homosexuality; Homosexuality (Attitudes Toward); Religion; Bisexuality; Lesbianism; Male Homosexuality; Minority Groups; Stress; Suffering; Test Construction; Sexual Minority Groups

The S Axis in PDM-2 Symptom patterns: The subjective experience - Mundo, Emanuela; Persano, Humberto; Moore, Kevin (Psychoanalytic Psychology, 2018)
In this paper we address the main innovations included in the Subjective Experience chapter (S Axis) of the PDM-2, that is, its conceptualization of adult symptom patterns. We include some comparison between, and discussion of, ICD-10, DSM-5, and PDM-2. A primary goal of the PDM is to consider both biological and psychological susceptibility factors in shaping specific symptom patterns in adults; we pursue this goal by considering specific sections; for example, suicidal behaviors. We discuss the core PDM-2 innovations: a better definition of the subjective experience of symptoms and symptom patterns, the inclusion of (and the assessment guidelines for) suicide and suicidal and parasuicidal behavior, the inclusion of the subjective experience of the therapist when encountering a specific subject with specific symptom patterns, and the addition of the description of some nonpathological conditions that may require clinical attention (i.e., demographic minorities, lesbian, gay, and bisexual populations, and gender incongruent populations). With respect to the gender incongruent subjects, we note as a significant step forward the depathologization of this condition, formerly termed 'gender identity disorder' and now, in DSM-5, termed 'gender dysphoria.' We make a case for the value of including a section on nonpathological conditions in a psychodynamically oriented diagnostic manual. Finally, we discuss the implications and limitations of such PDM-2 innovations with respect to clinical settings and future clinical research purposes. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: PDM-2; S Axis; adult psychopathology; symptom patterns; nonpathological conditions; Psychodiagnosis; Psychodynamics; Psychopathology; Psychotherapy; Subjectivity; Attempted Suicide; Client Characteristics; Diagnostic and Statistical Manual; International Classification of Diseases; Suicidal Ideation; Suicide; Susceptibility (Disorders); Symptoms; Therapist Characteristics

Gender dysphoria and anorexia nervosa symptoms in two adolescents - Ristori, Jiska; Fisher, Alessandra D.; Castellini, Giovanni; Sensi, Carolina; Cipriani, Agnese; Ricca, Valdo; Maggi, Mario (Archives of Sexual Behavior, 2019)
The co-occurrence of gender dysphoria and anorexia nervosa has been described in the scientific literature. This paper presents two adolescents with gender dysphoria and pathological eating behaviors and questions with longitudinal observations the clinical meaning of anorexia nervosa symptoms (e.g., restricting eating behaviors and fear of gaining weight) in adolescents with gender dysphoria. Both received psychological evaluations at different times: at first admission to the gender dysphoria clinic (T0) and 6 months after starting treatment with gonadotropin-releasing analogues (GnRHa; T1). In both cases, treatment with GnRHa not only improved psychological functioning, but also resolved pathological eating behaviors. In fact, both adolescents reported quick restoring of healthy food habits with restricting eating behaviors as well as intensive exercise no longer needed after treatment with GnRHa. Therefore, pathological eating behaviors (e.g., food avoidance and weight loss) could be assessed as a dysfunctional coping strategy adopted to gain control over a body developing in an unwanted direction and to block irreversible physical pubertal changes. This psychopathological conceptualization of pathological eating behaviors in adolescents with gender dysphoria stresses the importance of providing, in selected cases, early medical intervention such as pubertal suppression with GnRHa. Mental health professionals should therefore perform a specific and detailed assessment on gender identity within the evaluation of apparent eating disorders in adolescents. Restrictive eating behaviors as well as the intense fear of gaining weight or of becoming fat may, in fact, be considered secondary to a gender dysphoria diagnosis instead of anorexia nervosa symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Gender dysphoria; Adolescence; Anorexia nervosa; Puberty; GnRHa; Adolescent Psychopathology; Anorexia Nervosa; Coping Behavior; Gonadotropic Hormones; Gender Dysphoria; Puberty

Characteristics and correlates of lifetime suicidal thoughts and attempts among young Black men who have sex with men (MSM) and transgender women - Wilton, Leo; Chiasson, Mary Ann; Nandi, Vijay; Lelutiu-Weinberger, Corina; Frye, Victoria; Hirshfield, Sabina; Hoover, Donald R.; Downing, Martin J. Jr.; Lucy, Debbie; Usher, DaShawn; Koblin, Beryl (Journal of Black Psychology, 2018)
This study examined characteristics and correlates of lifetime suicidal thoughts and suicide attempts among HIV-negative young Black men who have sex with men (MSM) and transgender women (transwomen) between 16 and 29 years of age (N = 161). In our sample, 36.6% of young Black MSM and transwomen reported a history of lifetime suicidal thoughts, while 16.1% reported prior suicide attempts. Using multivariable analysis, a history of intimate partner violence, greater psychological distress, and higher perceived sexuality discrimination were significantly associated with lifetime suicidal thoughts. Childhood sexual abuse history, greater psychological distress, lower score for outness, and higher perceived sexuality discrimination were significantly related to suicide attempts among young Black MSM and transwomen. Efforts to identify and understand factors associated with lifetime suicidal thoughts and attempts are urgently needed to inform the development and implementation of culturally relevant mental health prevention strategies for young Black MSM and transwomen. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Blacks; men who have sex with men; Black transgender women; sexuality; suicide; mental health; Attempted Suicide; Blacks; Suicidal Ideation; Same Sex Intercourse; Transgender

'Savoring' buffers the association between negative emotions and suicidal behaviors in the GSM community - Klibert, Jeffrey J.; Luna, Amy; Miceli, Matthew (Journal of Gay & Lesbian Mental Health, 2019)
This study examined the effects of 'savoring the moment' (the ability to generate, maintain, and extend positive emotions) on the relationship between negative emotions and suicidal behavior in a sample of gender and sexual minorities (GSM). Savoring the moment moderated the associated effects of negative emotions on suicidal behavior; the relationship between negative emotions and suicidal behaviors ceased at higher levels of savoring the moment. Our finding offers preliminary evidence for savoring as a buffer to suicide among subpopulations of GSM individuals. Our findings also provide some insights into the use of positive psychological interventions in GSM suicide prevention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: gender and sexual minorities; negative emotions; positive psychology; savoring; suicidal behavior; Human Sex Differences; Minority Groups; Protective Factors; Negative Emotions; Suicidality; Energy Expenditure; Intervention; Suicide Prevention

Healthcare engagement among gay and bisexual men with recent suicide ideation or attempts - Salway, Travis; Ferlatte, Olivier; Purdie, Aaron; Shoveller, Jean; Trussler, Terry; Gilbert, Mark (American Journal of Orthopsychiatry, 2018)
Gay and bisexual men experience elevated rates of suicide ideation and attempts, as compared with heterosexual men, but face unique barriers in accessing health services. In this context, the present study sought to describe rates of health care engagement among gay and bisexual men with a recent history of suicide ideation or attempts. An anonymous online survey was conducted with 7,872 Canadian gay and bisexual men in 2014–2015. The sample was restricted to characterize patterns of mental health care engagement among respondents who reported suicide ideation or attempts in the previous 12 months. 'Engagement' was defined as having discussed mental health concerns (depression, substance use, or suicide) with a provider in the previous 12 months. Rates and correlates of engagement were estimated. Nineteen percent of men reported suicide ideation or attempts in the previous 12 months, of whom 58% had discussed mental health concerns with a provider. Older age, larger social support networks, and being out to a health care provider about one’s sexuality were all positively associated with mental health care engagement. Among those who had not engaged with the health care system, 88% had some contact with a provider in the previous 12 months. One-third of these men accessed care through a provider other than their family doctor. Drawing on lessons learned from the HIV crises, collaborations between gay and bisexual community organizations and decision-makers within the health system are needed to address elevated rates of suicide ideation and attempts affecting sexual minorities. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: suicide; gay and bisexual men; health care usage; mental health; Attempted Suicide; Bisexuality; Male Homosexuality; Mental Health Services; Suicidal Ideation; Drug Usage; Health Care Utilization; Major Depression; Mental Health; Test Construction

Transgender adolescent suicide behavior - Toomey, Russell B.; Syvertsen, Amy K.; Shramko, Maura (Pediatrics, 2018)
Objectives: Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups. Methods: Data from the Profiles of Student Life: Attitudes and Behaviors survey (N = 120 617 adolescents; ages 11–19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents’ highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior. Results: Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts. Conclusions: Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and nonbinary transgender adolescents. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: transgenders; adolescent development; suicide behavior; sexual orientation; Adolescent Development; Sexual Orientation; Suicide; Transgender

Transgender and non-conforming persons' mental healthcare experiences: An integrative review - White, Bradley Patrick; Fontenot, Holly B. (Archives of Psychiatric Nursing, 2019)
Introduction: Transgender and gender non-conforming (TGNC) people in the United States face disproportionate rates of mental health disorders, including suicidality, depression, anxiety, and substance use disorders than the general population. Patients' experiences utilizing mental healthcare is a determinant in their care-seeking behaviors and treatment success. Aim/question: The purpose of this integrative review is to better understand the firsthand mental healthcare experiences of TGNC persons. Method: The authors sought to locate recent English-language articles that described the mental healthcare experiences of TGNC persons. To do so, only articles that conducted data collection with a TGNC sample were considered for review. Results: Seven articles met criteria for review. Four themes emerged that depicted experiences of health promotion (welcoming environments, staff knowledge and response) and health prevention (enacted stigma, racial disparities and intersectional insensitivity). Discussion: Themes indicated that TGNC persons have mixed experiences (excellent to harmful/damaging) when receiving mental healthcare. There is room for healthcare provider growth in skills to increase TGNC cultural competency. Implications for practice: Mental healthcare providers and nurses would benefit from interventions to promote TGNC culturally competent care, including in-service training or continuing education for the current work force as well as incorporating TGNC content into pre-licensure educational curricula. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; gender non-conforming; firsthand mental health treatment experiences; stigma; psychiatry; nursing; mental health disorders; care-seeking behaviors; treatment success; Mental Disorders; Mental Health Services; Subjectivity; Treatment Outcomes; Transgender; Health Care Seeking Behavior; Health Promotion; Minority Groups

Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth - Russell, Stephen T.; Pollitt, Amanda M.; Li, Gu; Grossman, Arnold H. (Journal of Adolescent Health, 2018)
Purpose: This study aimed to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth. Methods: Data come from a community cohort sample of 129 transgender and gender nonconforming youth from three U.S. cities. We assessed chosen name use across multiple contexts and examined its association with depression, suicidal ideation, and suicidal behavior. Results: After adjusting for personal characteristics and social support, chosen name use in more contexts was associated with lower depression, suicidal ideation, and suicidal behavior. Depression, suicidal ideation, and suicidal behavior were lowest when chosen names could be used in all four contexts. Conclusion: For transgender youth who choose a name different from the one given at birth, use of their chosen name in multiple contexts affirms their gender identity and reduces mental health risks known to be high in this group. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender; Youth; Depression; Suicidality; chosen name; gender affirmation; mental health; Adolescent; Adult; Cohort Studies; Depression; Female; Humans; Male; Risk Factors; Social Support; Suicidal Ideation; Transgender Persons; Young Adult; Mental Health; Naming; Self-Concept; Transgender; Suicidality; Major Depression; Suicidal Ideation

Clinical presentation and requests for support of people with HIV/AIDS seeking counselling and psychotherapy in Greece - Peltekis, A.; Koulentianou, M. (Psychiatriki, 2019)
Despite the large progress during the last decades in the medical treatment of HIV/AIDS infection, people living with HIV nevertheless face multiple adversities at various levels of their lives. Mental disorders, in particular, are the most common comorbidities in HIV infection with negative consequences in adherence to antiretroviral medication, disease progress and overall quality of life. HIV-related stigma, still quite intense in Greece, is one of the most debilitating factors concerning people’s living with HIV mental health. The present study looked at the clinical presentation at intake and treatment requests of 191 (83% males) people living with HIV who addressed the psychological support service of the non-governmental organization ‘Centre for Life’ during the years 2016- 18. Data were collected through a semi-structured clinical interview and administration of adapted questionnaires (PHQ-9, BAI, CAGE), which resulted in 7 dichotomous variables related to clinical presentation and 13 dichotomous variables related to treatment requests at intake. To analyze data, we constructed frequency tables and performed chi-square tests. In the whole sample, 42.2% presented anxiety disorders, 40.3% depression, 28.8% occasional substance use, 17.5% problematic use of alcohol and 13.6% intravenous drug use. Moreover, 14% reported at least one suicide attempt in the past and 9.2% current suicidal ideation. Apart from more frequent intravenous drug use among heterosexual males and more frequent occasional/recreational drug use among men who have sex with men, no other differences related to gender, age group, sexual orientation or ethnicity were observed in the initial clinical presentation. Similarly, the most frequent treatment requests were homogenously distributed in our sample, such as depressive symptoms (58.6%), difficulties in romantic relationships (48.7%), accepting being HIV positive (42.9%), anxiety symptoms (42.4%) and issues of negative self-esteem (40.8%). The presence of clinically significant depression was found to be related to a wider range of treatment requests compared to other mental health problems. A large group of requests focused on interpersonal relationships difficulties (e.g. disclosure anxiety, social isolation, disturbed relationships with familiar persons). This indicates an important area of psychological intervention. HIV infection may affect many levels of an individual’s life, including their mental health. Respectively, HIV treatment needs to adopt a more holistic approach. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: HIV/AIDS infection; mental health problems; requests for psychological support; interpersonal relationships; AIDS; HIV; Psychotherapy; Interpersonal Relationships; Mental Disorders; Suicidal Ideation

The synergistic impact of sexual stigma and psychosocial well-being on HIV testing: A mixed-methods study among Nigerian men who have sex with men - Rodriguez-Hart, Cristina; Bradley, Cory; German, Danielle; Musci, Rashelle; Orazulike, Ifeanyi; Baral, Stefan; Liu, Hongjie; Crowell, Trevor A.; Charurat, Man; Nowak, Rebecca G. (AIDS and Behavior, 2018)
Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013–February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Men who have sex with men; Stigma; Latent class analysis; HIV testing; Suicidal ideation; Mental health; Adult; Ambulatory Care Facilities; HIV Infections; Homosexuality, Male; Humans; Latent Class Analysis; Male; Mass Screening; Mental Health; Nigeria; Prospective Studies; Qualitative Research; Sexual and Gender Minorities; Social Stigma; Suicidal Ideation; HIV Testing; Sexual Risk Taking; Same Sex Intercourse; Latent Class Analysis; Stigma

Psychotherapeutic depression interventions adapted for sexual and gender minority youth: A systematic review of an emerging literature - Sheinfil, Alan Z.; Foley, Jacklyn D.; Ramos, Jeremy; Antshel, Kevin M.; Woolf-King, Sarah E. (Journal of Gay & Lesbian Mental Health, 2019)
Sexual and gender minority youth (SGMY) are disproportionately affected by mental health problems, including depression and suicidality. Recently, there has been increased interest in developing and adapting evidence-based treatments for depressive symptoms tailored to address the unique issues facing SGMY. This is the first systematic review of interventions targeting depressive symptoms that have been adapted for SGMY populations. Findings from these studies provide evidence in support of the feasibility, acceptability, and preliminary efficacy for SGM-informed interventions for the treatment of depressive symptoms. Fully powered randomized controlled trials are needed to determine the efficacy of these adapted treatments prior to dissemination. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Depressive symptoms; intervention; sexual minority; systematic review; youth; No terms assigned

Suicide and the human service professions in the twenty-first century: Current issues and future directions - Westefeld, John S.; Rinaldi, Anthony P. (Journal of Loss and Trauma, 2018)
Five current issues of importance to human service professionals and the field of suicidology are examined, including Joiner’s theory of suicide, suicide in the LGBT population, bullying and suicide, the relationship between firearm availability and suicidal risk, and suicide in the military. Implications and recommendations for the human service professions are addressed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; human service professions; suicidology; bullying; firearm availability; suicidal risk; military; LGBT population; Human Services; Suicide; Suicidology; Firearms; Military Personnel; Risk Factors; Health Personnel; Bullying; LGBTQ

Looking beyond the lesbian: The intersectionality of death on Netflix’s Orange is the New Black - Ruderman-Looff, Ashley (Journal of Lesbian Studies, 2019)
In 2016, GLAAD’s 'Where We Are On TV' report noted a significant rise in lesbian death. This article addresses this perpetual trend as it manifests within Netflix’s Orange is the New Black by considering the deaths of Tricia Miller and Poussey Washington. I use a narrative form of intersectional analysis to argue that lesbian death initiates a powerful critique of the criminal legal system and the prison industrial complex. Specifically, lesbian death points to the way multiple modes of marginalization intersect with homophobia to buttress a system designed to administer social and premature death. My analysis of Tricia’s death demonstrates how the school-to-prison pipeline prepares children to take responsibility for their behaviors, but neglects to address how their futures in the justice system are systematically produced and beyond their control. This message corresponds to Tricia’s flashbacks and her suicide, which demonstrate how, under neoliberalism, Tricia’s failure to 'pull herself up' leads to her incarceration. In turning to Poussey, I argue that reading her death as an accident not only dismisses the 'one bad apple' myth typically used to account for police brutality, it demonstrates how 'accidental death' is systematically and deliberately produced within the prison industrial complex. I analyze flashbacks of both Poussey and her killer, Baxter Bayley, to draw attention to the fact that they have committed the same crimes. I demonstrate how power and criminalization are assigned on the basis of gender, race, sexuality, and class. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Death; intersectionality; lesbian representation; mass incarceration; Orange is the New Black; prison industrial complex; Attitude to Death; Humans; Prisoners; Prisons; Sexual and Gender Minorities; Social Justice; Television; Death and Dying; Incarceration; Lesbianism; Television; Theoretical Interpretation; Hallucinations; Narratives; Prisons; Trends; Marginalization

Cultural versus classic risk and protective factors for suicide - Chu, Joyce; Robinett, Emily N.; Ma, Johnson K. L.; Shadish, Katherine Y.; Goldblum, Peter; Bongar, Bruce (Death Studies, 2019)
The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: protective factors; suicide; minority groups; minority; hopelessness; Adult; Cross-Cultural Comparison; Ethnic Groups; Female; Humans; Male; Protective Factors; Risk Factors; Sexual and Gender Minorities; Suicidal Ideation; Suicide; Suicide, Attempted; Young Adult; Minority Groups; Sociocultural Factors; Suicide

Fighting for survival: The experiences of lesbian, gay, bisexual, transgender, and questioning students in religious colleges and universities - Craig, Shelley L.; Austin, Ashley; Rashidi, Mariam; Adams, Marc (Journal of Gay & Lesbian Social Services: The Quarterly Journal of Community & Clinical Practice, 2017)
ABSTRACTLittle is known about the experiences of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students attending religious colleges and universities. This study used grounded theory to analyze the narratives (N = 271) of LGBTQ former and current students. The central theme described by LGBTQ students was a fight for survival with five subthemes: (a) institutionalized homo/transphobia (strict school policies, enforcement of heterosexuality and gender conformity through discipline, conversion therapy); (b) a culture of fear (fear of exposure, homophobic panic and code words, seeking cover); (c) marginalization and isolation; (d) struggle (suffering and suicide, reconciling faith and LGBTQ identity); and (e) coping and resilience (surviving through critical thinking and strategic activism). Implications for practice are provided. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: gay; lesbian; bisexual; and transgender students; religious colleges and universities; hegemony; religious abuse; College Students; Life Experiences; Religious Beliefs; Sexual Orientation; Bisexuality; Lesbianism; Male Homosexuality; Transgender

Examining suicide-related presentations to the emergency department - Ceniti, Amanda K.; Heinecke, Nicole; McInerney, Shane J. (General Hospital Psychiatry, 2018)
OBJECTIVE: Although the Emergency Department (ED) is a frequent point of contact for individuals with suicide-related behaviour (SRB) or ideation, there is limited literature specifically examining presentations to the ED for SRB. This review examines the international literature published in North America, the United Kingdom and Australia relating to presentations to the ED for SRB, with focus on high-risk groups, screening tools used in the ED, and difficulties in classifying ED presentations of SRB. METHOD: The database PubMed was searched using relevant terms, and national health care administrative data were reviewed. RESULTS: Psychiatric history, substance use, and lower socioeconomic status were all found to be associated with higher rates of ED presentations for SRB. Limited research exists around ED presentations of SRB by particular high-risk groups, including lesbian, gay, bisexual, and transgender populations and Indigenous peoples. Individuals who present to EDs for SRB are often chronic users of EDs and have a high rate of repeat self-harm and death by suicide. CONCLUSION: These findings suggest that EDs could serve as a focal point for suicide treatment interventions. Deepening our understanding of ED presentations for SRB could inform further development and implementation of interventions to reduce death by suicide. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Suicide; Self-harm; Emergency department; No terms assigned

Bisexual-specific minority stressors, psychological distress, and suicidality in bisexual individuals: The mediating role of loneliness - Mereish, Ethan H.; Katz-Wise, Sabra L.; Woulfe, Julie (Prevention Science, 2017)
Bisexual individuals are at higher risk for poor mental health outcomes compared to heterosexual as well as lesbian and gay individuals and experience minority stressors, such as discrimination, from both heterosexual and sexual minority communities. However, there is little research examining the negative effects of bisexual-specific minority stressors on bisexual individuals’ mental health as well as psychological factors that might help explain minority stressors’ deleterious effects. This research examined the effects of distal minority stressors (i.e., anti-bisexual experiences from both heterosexual as well as lesbian and gay people) and proximal stressors (i.e., internalized heterosexism and sexual orientation concealment) on psychological distress and suicidality among bisexual adults (N = 503). Building on the relational framing of the minority stress model, we also tested one relational factor (i.e., loneliness) as a mediator of the associations between distal and proximal minority stressors and poor mental health (i.e., psychological distress and suicidality). Structural equation modeling analyses were used to test the mediating effects of loneliness on the associations between minority stressors and psychological distress and suicidality. Although distal and proximal minority stressors were not associated with each other, loneliness mediated the effects of distal and proximal minority stressors on psychological distress and suicidality. The results of this study underscore the importance of targeting bisexual-specific minority stressors as well as loneliness in preventive interventions to improve the mental health of bisexual individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Bisexual; Minority stress; Mental health; Psychological distress; Suicide; Loneliness; Adolescent; Adult; Bisexuality; Female; Humans; Loneliness; Male; Middle Aged; Minority Groups; Models, Psychological; Stress, Psychological; Suicidal Ideation; Young Adult; Bisexuality; Distress; Loneliness; Stress; Suicide; Mental Health; Suicidality; Minority Stress

Illicit drug use and social victimization among Thai sexual and gender minority adolescents - Guadamuz, Thomas E.; Cheung, Doug H.; Boonmongkon, Pimpawun; Ojanen, Timo T.; Damri, Thasaporn; Samoh, Nattharat; Cholratana, Mudjalin; Ratchadapunnathikul, Chet; Sass, Justine (Substance Use & Misuse, 2019)
Objectives: We examined the prevalence of lifetime illicit drug use and social victimization, and their association, among sexual and gender minority (SGM) and non-SGM Thai adolescents. Methods: In 2013, we conducted a school-based national survey among students grades 7–12 (aged 13–20 years) from 15 secondary schools (n = 2,070) around Thailand. We classified adolescents with same-sex attraction, sexual or gender non-conforming identities as SGM. Generalized estimating equations were used to estimate the odds of illicit drug use by SGM and non-SGM status. Results: Prevalence of lifetime illicit drug use was significantly higher among SGM adolescents than non-SGM adolescents (10.3 vs. 5.3%), but did not differ between those with same-sex attraction and SGM identity (10.3 vs. 10.8%). Among non-SGM adolescents, general social victimization, sexual experience and any school truancy were associated with lifetime illicit drug use (OR = 2.59, 95% CI: 1.53, 4.38; OR = 6.59, 95% CI: 4.90, 8.86; and OR = 4.93, 95% CI: 3.13, 7.75, respectively). Among SGM adolescents, SGM-based social victimization, depressive symptomology and suicidal ideation were associated with lifetime illicit drug use (OR = 3.17, 95% CI: 2.03, 4.95; OR = 5.03, 95% CI: 2.32, 10.90; and OR = 5.03, 95% CI: 2.76, 9.16, respectively). Conclusions: SGM adolescents have higher burden of illicit drug use. Moreover, illicit drug use among SGM adolescents is indicative of depressive symptomology and suicidal ideation. Tailored and comprehensive programs are needed to reduce the gap in burden of illicit drug use between SGM and non-SGM adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: prevalence; lifetime Illicit drug use; peer victimization; adolescent; Thailand; sexual and gender minorities; Adolescent Attitudes; Drug Usage; Epidemiology; Victimization; LGBTQ; Minority Groups

Coming-out experiences of irish gay fathers who have been heterosexually married: An interpretative phenomenological analysis - Daly, Siobhán C.; MacNeela, Pádraig; Sarma, Kiran M. (Journal of Homosexuality, 2019)
This study explores how Irish gay fathers, who married heterosexually in a heteronormative culture, assumed a settled gay identity in the Republic of Ireland. A purposive sample of nine men reflected on their experiences of marriage and separation, assuming a gay identity, and social and familial connectivity. Interpretative phenomenological analysis (IPA) indicated the suppression of gay sexual desires before marriage as a result of cultural homophobia. The coming-out process continued during the participants’ marriage. Extramarital same-gender sexual desires and/or transgressions co-occurred with existential conflict (remorse) and resulted in marital separation. The marital and family loss was experienced as traumatic, and suicidal ideation occurred for most. All the men assumed an openly gay identity after separating. Many established a family-orientated same-gender repartnership. Results highlight the individuality and significance of the marital and family loss for those who separate after coming out as gay. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Gay fathers; heterosexual marriage; coming out; marital separation; interpretative phenomenological analysis (IPA); Ireland; No terms assigned

Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans - Tucker, Raymond P.; Testa, Rylan J.; Simpson, Tracy L.; Shipherd, Jillian C.; Blosnich, John R.; Lehavot, Keren (Psychological Medicine, 2018)
Background: Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans. Methods: This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey. Results: Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks. Conclusions: Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Gender affirmation; hormone therapy; suicide; transgender; veteran; Hormone Therapy; Major Depression; Military Veterans; Suicidal Ideation; Surgery; Symptoms; Transgender

Mindfulness and other psycho-social resources protective against mental illness and suicidality among gay men - Wang, Jen; Häusermann, Michael; Ambresin, Anne-Emmanuelle (Frontiers in Psychiatry, 2018)
Background: There is considerable evidence of health disparities among gay men characterized by higher levels of stress and distress. Psycho-social resources have been linked to numerous positive health outcomes and shown to act as buffers in the stress-distress pathway. Methods: With data from the 3rd Geneva Gay Men's Health Survey carried out in 2011 using time-space sampling (n = 428), a relatively elaborate profile of 14 psycho-social resources—including mindfulness—is presented. Using their original scores, latent class analysis created an index variable dividing the respondents into meaningful groups. Psycho-social resources—the index variable as well as each resource individually—were then compared to two recent outcomes—i.e., serious mental illness in the past 4 weeks and short-term disability in the past 2 weeks—using a series of logistic regression models, controlling for all other psycho-social resources and socio-demographic confounders. To assess their potential role as buffers, a similar series of logistic regression models were erected using victimization and three outcomes—i.e., major depression, suicidal ideation, and suicide attempt—in the past 12 months. Results: According to the latent class analyses, (1) 5.1% of this sample had a low level of psycho-social resources (i.e., one standard deviation (SD) below the group means), (2) 25.2% a medium-low level, (3) 47.4% a medium level (i.e., at the group means), and (4) 22.2% a high level of psycho-social resources (i.e., one SD above the group means). Psycho-social resources appeared to strongly protect against recent mental morbidity and buffer against the impact of victimization on major depression and suicidality in the past 12 months, reducing the adjusted odds ratios below statistical significance. The explained variance and the individual psycho-social resources which remained independent in the models differed for each outcome. Conclusions: There may be disparities in several psycho-social resources among gay men, and as strong compensatory and protective factors, they may explain in part the well-established disparities in stress and distress in this population. While multiple psycho-social resources should be promoted in this population, gay men under 25 years should receive particular attention as all three disparities are most pronounced in this age group. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: psycho-social resources; mindfulness; depression; suicidality; victimization; homosexuality; Male Homosexuality; Mental Disorders; Protective Factors; Mindfulness; Suicidality; Major Depression; Test Construction; Victimization

To our readers - Benevedes, Jeffrey Moulton (Jung Journal: Culture & Psyche, 2018)
Pulse nightclub was founded by Barbara Poma and Ron Legler in 2004 as a community center for HIV and breast cancer awareness, immigrant rights, and, of course, as a throbbing gay nightclub scene replete with drag shows and bar dancers. Poma’s brother, John, died in 1991 from AIDS and Barbara named the club so John’s 'pulse' would live on. In May 2017, Poma created the onePulse Foundation to fund a memorial site and museum to open in 2020. The nightclub was the scene of one of the deadliest mass shootings in US history by a single gunman. It marked the deadliest violence against the LGBTQ community, leaving 49 people dead and fifty-eight wounded. This article provides summaries of articles in this journal issue. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Pulse nightclub; LGBTQ community; homicide; mass murder; violence; Bisexuality; Hate Crimes; Homosexuality; Transgender; Mass Murder; Lesbianism; Male Homosexuality; Violence

What we learn about peoples’ perspectives on mental health and illness from tweets? - Ganesh, Shiva; Chandan, Antra; Raghavan, Vijaya (Asian Journal of Psychiatry, 2019)
Presents a study aims to understand the views of people towards mental health and illness from the tweets made by creating a word cloud from the tweets on the same. For this study, we collected 500 recent tweets of the month December 2017 mentioning mental health or mental illness using Twitter Application programming interface (API). To carry out the statistical analysis, these tweets were converted into a text corpus using the R statistical package tm and all stop words, punctuations, numbers, special characters, and empty spaces were removed. The results indicate that suicide is the most common word used in relation with mental health or mental illness. Not quite surprisingly, people tweeted about lesbian, gay, bisexual, and transgender (LGBT) community in relation with mental health and illness. The major limitations of the study are the number of tweets is limited to 500 and only tweets mentioning mental health or mental illness were included. Inclusion of more of tweets, tweets made during mental health week and analysing tweets over a varied timeline would yield better results. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: mental health; mental illness; tweeter; Mental Disorders; Mental Health; Statistical Analysis; Social Media; Bisexuality; Lesbianism; Transgender

Accounting for diversity in suicide research: Sampling and sample reporting practices in the United States - Cha, Christine B.; Tezanos, Katherine M.; Peros, Olivia M.; Ng, Mei Yi; Ribeiro, Jessica D.; Nock, Matthew K.; Franklin, Joseph C. (Suicide and Life-Threatening Behavior, 2018)
Research on suicidal thoughts and behaviors (STB) has identified many risk factors, but whether these findings generalize to diverse populations remains unclear. We review longitudinal studies on STB risk factors over the past 50 years in the United States and evaluate the methodological practices of sampling and reporting sample characteristics. We found that articles frequently reported participant age and sex, less frequently reported participant race and ethnicity, and rarely reported participant veteran status or lesbian, gay, bisexual, and transgender status. Sample reporting practices modestly and inconsistently improved over time. Finally, articles predominantly featured White, non‐Hispanic, young adult samples. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: suicide; risk factors; ethnicity; diversity; Adolescent; Adult; Age Factors; Continental Population Groups; Cultural Diversity; Ethnic Groups; Female; Humans; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Research; Risk Factors; Sex Factors; Sexual and Gender Minorities; Suicide; United States; Veterans; Young Adult; Diversity; Ethnic Identity; Risk Factors; Suicide

Between the lines: Media coverage of Orlando and beyond - Hancock, Kristin A.; Haldeman, Douglas C. (Psychology of Sexual Orientation and Gender Diversity, 2017)
The relative unresponsiveness of the news media to the racism and homophobia of the Orlando shootings was deeply disturbing to the lesbian, gay, bisexual, and transgender community. The focus on terrorism and gun control (major topics in the 2016 presidential campaign) neglected the fact that this massacre was a hate crime. This article describes some of the fundamentals involved in the process of reporting the news and decision-making in the media that likely contributed to the narrow reporting of this tragedy. It also addresses heteronormativity, the impact of neglecting to highlight racism and homophobia in this shooting, and what might have been gained by more appropriate interpretation of the shooting as a hate crime. Additional suggestions are also offered regarding the roles that psychologists can play. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: LGBT hate crimes and the media; heteronormativity and the news; impact of Orlando shooting; LGBT invisibility; Orlando shooting news coverage; Hate Crimes; Homicide; Homosexuality (Attitudes Toward); Mass Media; Racism; Bisexuality; Lesbianism; Male Homosexuality; Sexual Orientation; Violence; Transgender

Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden - Björkenstam, Charlotte; Kosidou, Kyriaki; Björkenstam, Emma; Dalman, Christina; Andersson, Gunnar; Cochran, Susan (Journal of Epidemiology and Community Health, 2016)
Background: Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence. Methods: We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67 980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs. Results: Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% Cl 2.7 to 5.4) and bisexual women (IRR 5.4, 95% Cl 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% Cl 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm. Conclusions: Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: suicide ideation; suicide attempts; medical care; intentional self-harm; lesbians; gays; bisexuals; Health Care Services; Lesbianism; Male Homosexuality; Self-Injurious Behavior; Suicidal Ideation; Attempted Suicide; Bisexuality

Trends in suicidality among sexual minority and heterosexual students in a canadian population-based cohort study - Peter, Tracey; Edkins, Tamara; Watson, Ryan; Adjei, Jones; Homma, Yuko; Saewyc, Elizabeth (Psychology of Sexual Orientation and Gender Diversity, 2017)
Despite evidence from numerous studies that document disparities in suicidality for sexual minorities, few have investigated whether or not these trends have improved over time, which is the objective of the current study. Using school-based population data over a 15-year period (1998 to 2013), multivariate logistic regressions were used to calculate age-adjusted odds ratios (ORs) separately by gender. Interactions were included to test widening or narrowing disparities within orientation groups, which makes this one of the first studies to test whether gaps in disparities between heterosexual and sexual minorities have widened or narrowed over time. Results show that sexual minority youth are persistently at a greater risk for suicidal behavior, a trend that has continued particularly for bisexual youth of both sexes. Results also suggest that the gap in suicidal behavior is widening among some female sexual orientation groups, yet narrowing for other male sexual orientation groups. These findings have important public health implications, especially since we see decreases in suicidal behavior for heterosexual adolescents, but not in the same way for many sexual minority youth, despite advances in social acceptance of gay, lesbian, and bisexual issues in North America. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: heterosexual/bisexual/gay/lesbian; adolescents; sexual orientation; suicidal behavior; population surveys; Sexual Orientation; Suicidal Ideation; Trends; Adolescent Characteristics; Attempted Suicide; Bisexuality; Heterosexuality; Lesbianism; Male Homosexuality; Minority Groups; Suicidality; Sexual Minority Groups

'You can’t break…When you're already broken': The importance of school climate to suicidality among LGBTQ youth - Peter, Tracey; Taylor, Catherine; Campbell, Christopher (Journal of Gay & Lesbian Mental Health, 2016)
Suicide has been a longstanding problem among sexual and gender minority youth in Canada. The goal of the article is to examine the link between suicidality and school climate within a theoretically informed framework and a mixed methods approach. Qualitative and quantitative findings are presented using data from more than 3,700 secondary students from the National Climate Survey of Homophobia and Transphobia in Canadian Schools (Taylor & Peter, 2011a). The findings show that even modest efforts to shift the balance of heteronormative discourse on behalf of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) students can have profound effects on the experiences and perceptions of sexual and gender minority youth, which we argue would go a long way in reducing incidents of suicidality among LGBTQ youth. In many jurisdictions across Canada, LGBTQ-inclusive policies have attempted to improve school climates and reduce the effects of homophobia and transphobia in schools. These initiatives, along with the work done by Egale Canada to create a National Youth Suicide Prevention Strategy, are important steps in addressing the needs of LGBTQ youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Discrimination; suicide; youth; School Environment; Sex Discrimination; Sexual Orientation; Student Attitudes; Suicide Prevention; Bisexuality; Homosexuality; Sexuality; Transgender; Suicidality; LGBTQ

Transgender college students: Academic resilience and striving to cope in the face of marginalized health - Messman, Jenna B.; Leslie, Leigh A. (Journal of American College Health, 2019)
Objective: To examine health behavior and outcome disparities between transgender, female, and male participants in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 32,964 undergraduate and graduate students responding to the Fall 2013 American College Health Association–National College Health Assessment; 65.8% were female, 0.4% were transgender, 67.9% were white, and 90.4% were heterosexual. Results: Transgender students reported more mental health diagnoses, trauma, and suicidality; experienced more violence and less safety, reported more sex partners and sexually transmitted infections (STIs); higher rates of illicit and nonprescription substance use and binge drinking use while engaging in less harm reduction behavior; and reported more barriers to academic success. Conclusions: There is an established need for college clinicians and health educators to reduce these disparate outcomes once students arrive on campus through professional training and culturally competent campus prevention and intervention efforts to promote health equity. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: health behavior; outcome disparities; transgender; college students; mental health; violence; sexual health; substance use behavior; academic performance; College Academic Achievement; Health Behavior; Resilience (Psychological); Transgender; Academic Achievement; College Students; Drug Usage; Mental Health; Psychosexual Behavior; Violence; Health Disparities

Suicide risk behaviors among sexual minority adolescents in the United States, 2015 - Caputi, Theodore L.; Smith, Davey; Ayers, John W. (JAMA: Journal of the American Medical Association, 2017)
The study examined the suicide risk behaviors of sexual minority adolescents using nationally representative data from 2015. To assess suicide risk behaviors, participants were asked whether, in the past year, they had (1) seriously considered suicide, (2) planned suicide, or (3) attempted suicide. Suicide risk behaviors of sexual minority adolescents, including gay or lesbian, bisexual, or not sure, relative to heterosexuals were estimated using descriptive statistics and logistic regressions including plausible and commonly used controls for sex, age, race/ethnicity, English language proficiency, and grades. Sexual minority adolescents were substantially more likely to report suicide risk behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: suicide risk behaviors; sexual minority adolescents; United States; Adolescent; Female; Heterosexuality; Humans; Male; Risk-Taking; Sexual and Gender Minorities; Suicidal Ideation; Suicide; Suicide, Attempted; Surveys and Questionnaires; United States; Attempted Suicide; Minority Groups; Risk Factors; Sexual Orientation; Suicidal Ideation; Sexual Minority Groups

Association between sexual minority status and suicidal behavior among Chinese adolescents: A moderated mediation model - Huang, Yeen; Li, Pengsheng; Lai, Zhisheng; Jia, Xiaofei; Xiao, Di; Wang, Tian; Guo, Lan; Lu, Ciyong (Journal of Affective Disorders, 2018)
Background: Evidence shows sexual minority adolescents have a higher risk of suicidality than their heterosexual peers due to minority stressors or lack of social support, but it remains unclear how the combined effects of these influence factors impact suicidality in this population. In this study, we examine whether school victimization mediates association between sexual minority status and suicidal behavior of adolescents and explore whether such mediation is moderated by interpersonal relationships. Methods: We sampled a large nationally representative dataset comprising data collected from 7th to 12th graders (the 2015 School-based Chinese Adolescents Health Survey) using a multistage, stratified-cluster, random-sampling method. Our sample consisted of 123,459 students who completed questionnaires regarding their sexual minority status, suicidal ideation, suicide attempts, school victimization, classmate relations, and teacher–classmate relations. Results: Using a moderated mediation model, we found that school victimization mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.0296, 95% confidence intervals (CI) = 0.0259–0.0333) and suicide attempts (indirect effect = 0.0086, 95% CI = 0.0074–0.0100). These indirect effects were moderated by interpersonal relationships, and a greater effect was seen among sexual minority students with poor classmate or teacher–classmate relations. Limitations: Our study sample included only students attending school, and interpretation of the direction of the observed associations is limited due to the cross-sectional design. Conclusions: Interpersonal relationships moderate the indirect effects of school victimization on association between sexual minority status and suicidal behavior. Early intervention addressing school violence combined with improving the quality of relationships with school peers would help prevent suicidality in sexual minority adolescents. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Sexual minority status; Suicidal behavior; Adolescents; School victimization; Interpersonal relationships; Attempted Suicide; Minority Groups; Psychosexual Behavior; Sexual Orientation; Suicidal Ideation; Adolescent Development; Peers; Victimization; Interpersonal Relationships

Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study - Swannell, Sarah; Martin, Graham; Page, Andrew (Australian and New Zealand Journal of Psychiatry, 2016)
Objectives: This study investigated associations between sexual orientation and measures of suicidality and non-suicidal self-injury in Australian adults. Previous studies of sexual orientation and suicidality have been limited by unclear conceptualisations of suicidal intent, failure to differentiate between homosexuality and bisexuality, inattention to gender differences and use of convenience-based samples. Methods: A large (N = 10,531) representative national sample of Australian adults was used to investigate associations between sexual orientation (heterosexual, homosexual, bisexual) and (1) suicidal ideation, (2) attempted suicide and (3) non-suicidal self-injury, for males and females separately, in a series of sequentially adjusted logistic regression models. Results: Sexual minority participants were at greater risk of suicidality and self-injury than heterosexuals, after adjusting for age and other covariates, with patterns of risk differing by sexual orientation and gender. Compared with their heterosexual counterparts, gay men, but not bisexual men, were more likely to report suicidal ideation (odds ratio = 3.05, 95% confidence interval = [1.65, 5.60]) and suicide attempts (odds ratio = 4.16, confidence interval = [2.18, 7.93]). Bisexual women, but not lesbian women, were more likely to report suicidal ideation (odds ratio = 4.40, confidence interval = [3.00, 6.37]) and suicide attempts (odds ratio = 4.46, confidence interval = [2.41, 8.24]). Neither bisexual nor gay men were more likely than heterosexual men to report self-injury. However, bisexual women, but not lesbian women, were more likely than heterosexual women to report self-injury (odds ratio = 19.59, confidence interval = [9.05, 42.40]). Overall, bisexual females were at greatest risk of suicidality and self-injury. Conclusion: Clinicians working with sexual minority populations are encouraged to openly discuss suicidal and self-injurious thoughts and behaviours with their clients and may consider using therapeutic strategies to reduce internalised stigma and enhance personal and social resources. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: Homosexuality; bisexuality; sexual orientation; suicidal ideation; non-suicidal self-injury; Heterosexuality; Suicidal Ideation; Suicide; Bisexuality; Lesbianism

Religion, sexual orientation, and suicide attempts among a sample of suicidal adolescents - Shearer, Annie; Russon, Jody; Herres, Joanna; Wong, Amanda; Jacobs, Carrie; Diamond, Gary M.; Diamond, Guy S. (Suicide and Life-Threatening Behavior, 2018)
Despite condemnation of same‐sex attraction by certain religious groups, few studies have explored the relationship between religion, same‐sex attraction, and suicidality. This study examined the moderating effect of same‐sex attraction on the relationship between parent/adolescent religiosity and suicide ideation/attempts in a suicidal adolescent sample (N = 129). Linear and negative binomial regressions tested the effects of a two‐way dichotomous (same‐sex attraction, yes/no) by continuous (religiosity) interaction on ideation and attempts, respectively. The interaction was not significant for ideation. However, high religiosity was associated with more attempts in youth reporting same‐sex attraction but fewer attempts in those reporting opposite‐sex attraction only. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: religion; sexual orientation; suicide attempts; Adolescent; Female; Humans; Male; Religion and Psychology; Risk Factors; Sexual Behavior; Suicidal Ideation; Suicide, Attempted; United States; Religion; Sexual Orientation; Suicide

Nonsuicidal self‐injury among lesbian, gay, bisexual and transgender populations: An integrative review - Jackman, Kate; Honig, Judy; Bockting, Walter (Journal of Clinical Nursing, 2016)
Aims and objectives: To conduct an integrative review of nonsuicidal self‐injury among lesbian, gay, bisexual and transgender populations to better understand the prevalence; to identify the lesbian, gay, bisexual and transgender subgroups at increased risk for nonsuicidal self‐injury; and to examine the risk factors associated with nonsuicidal self‐injury among lesbian, gay, bisexual and transgender populations. Background: Nonsuicidal self‐injury, defined as intentional injury to the body's surface without intent to die, is a significant mental health concern among adolescents and adults. Mental health disparities in lesbian, gay, bisexual and transgender populations, including anxiety, depression and suicidality, have been documented in the scientific literature with little focus on findings about nonsuicidal self‐injury. Design: Integrative literature review of published quantitative and qualitative empirical research. Methods: A literature search of 11 on‐line databases was conducted of articles published through April 2015. Keywords were used to identify articles about lesbian, gay, bisexual and transgender populations and nonsuicidal self‐injury. Results: After screening by title, abstract and full text, 26 articles were included in this review. The literature synthesised demonstrates a consistent pattern of increased prevalence of nonsuicidal self‐injury among sexual and gender minority populations compared with heterosexual peers. This body of literature indicates which subgroups of the lesbian, gay, bisexual and transgender populations appear to be at increased risk for nonsuicidal self‐injury and which specific factors contributing to vulnerability to nonsuicidal self‐injury among these populations. Conclusions: Lesbian, gay, bisexual and transgender populations are at higher risk for nonsuicidal self‐injury compared with the general population. Lesbian, gay, bisexual and transgender‐specific and general risk factors appear to contribute to this heightened vulnerability. Relevance to clinical practice: Clinical nurses should screen for nonsuicidal self‐injury and for sexual and gender minority identity in all of their patients. Comprehensive assessment of lesbian, gay, bisexual and transgender patients presenting with nonsuicidal self‐injury may lead to identification of risk factors that can be addressed through nursing interventions. Nurse researchers and clinicians should take an active role in developing and implementing evidenced‐based tailored interventions to reduce the higher vulnerability to nonsuicidal self‐injury among lesbian, gay, bisexual and transgender populations. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: bisexual; gay; integrative review; lesbian; mental health; nonsuicidal self‐injury; sexual and gender minorities; transgender; Bisexuality; Lesbianism; Male Homosexuality; Self-Injurious Behavior; Transgender

Risk and protective factors for mental health morbidity in a community sample of female-to-male trans-masculine adults - McDowell, Michal J.; Hughto, Jaclyn M. W.; Reisner, Sari L. (BMC Psychiatry, 2019)
[Correction Notice: An Erratum for this article was reported in Vol 19[45] of BMC Psychiatry (see record [rid]2019-05304-001[/rid]). Following publication of the original article, errors were discovered in NSSI prevalence and Annual household income. The correct information is provided in the erratum. In addition, it is noted that the second author’s name should be written as Jaclyn M.W. Hughto. The name has been corrected in this record.] Background: Trans-masculine (TM) individuals, who are assigned female sex at birth and identify along the masculine gender spectrum, face mental health disparities relative to cisgender people. Limited research has sought to explore the multi-level risk and protective factors associated with mental health morbidity for TM populations. Methods: Between August 2015–September 2016, 150 TM adults were enrolled in a one-time biobehavioral health study. A survey assessed socio-demographics, past 12-month everyday discrimination, lifetime intimate partner violence (IPV), resilience (using the Brief Resilience Scale), and other factors. Bivariate and multivariable logistic regression analyses examined associations between participant characteristics and four mental health statuses: post-traumatic stress disorder (PTSD), depression, anxiety, and non-suicidal self-injury (NSSI). Results: In this sample (76.7% had a binary gender identity, i.e., man or transgender man; 74.7% were white, 70.0% were under age 30 years), 42.2% had PTSD based on past 30-day symptoms; 25.7% had depression based on past 7-day symptoms; 31.1% had anxiety based on past 7-day symptoms; and 31.3% had engaged in NSSI within the past 12-months. Results from multivariable models: 1) PTSD: unemployment, lifetime IPV and past 12-month discrimination were each associated with increased odds of PTSD, while having a partner was associated with the reduced odds of PTSD. 2) Depression: lower educational attainment and past 12-month discrimination were each associated with the increased odds of depression, while greater resilience was associated with the reduced odds of depression. 3) Anxiety: low annual household income and past 12-month discrimination were each associated with the increased odds of anxiety, while resilience was associated with the reduced odds of anxiety. 4) NSSI: past 12-month discrimination was associated with the increased odds of past 12-month NSSI, while higher age and greater resilience was associated with the reduced odds of NSSI (all p-values < 0.05). Conclusions: Unemployment, low income, limited education, everyday discrimination, and violence were risk factors for poor mental health, while being in a relationship, higher age, and personal resilience were protective against mental health morbidity. Findings highlight the need for interventions to address the individual, interpersonal, and societal factors that may be driving poor mental health in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: risk factors; protective factors; mental health morbidity; female-to-male trans-masculine adults; posttraumatic stress disorder; depression; anxiety; non-suicidal self-injury; Mental Health; Protective Factors; Risk Factors; Morbidity; Transgender; Anxiety; Major Depression; Masculinity; Posttraumatic Stress Disorder; Self-Injurious Behavior

Psychiatry’s ethical involvement in gender-affirming care - D'Angelo, Roberto (Australasian Psychiatry, 2018)
Objective: To reflect on the role of psychiatry in authorising physical treatments for Gender Dysphoria and to examine the quality of evidence for gender-reassignment. Method: A Medline search was performed with the subject term 'transsexualism' or 'gender dysphoria' and 'outcome' or 'follow-up' in the title. Studies published from 2005 onwards reporting psychosocial outcomes were selected for review. Results: Most available evidence indicating positive outcomes for gender reassignment is of poor quality. The few studies with robust methodology suggest that some patients have poor outcomes and may be at risk of suicide. Conclusion: The author raises questions about the implications for ethical treatment of transgender individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: transgender; gender-reassignment; gender dysphoria; ethics; Gender Dysphoria; Humans; Outcome Assessment, Health Care; Psychiatry; Sex Reassignment Surgery; Professional Ethics; Psychiatry; Transgender; Gender Dysphoria; Gender Reassignment

Examining mechanisms and moderators of the relationship between discriminatory health care encounters and attempted suicide among US transgender help-seekers - Romanelli, Meghan; Lu, Wenhua; Lindsey, Michael A. (Administration and Policy in Mental Health and Mental Health Services Research, 2018)
This study examined how experiences of service denial and discrimination in three health care settings—doctors’ offices, emergency rooms, and mental health clinics—might contribute to attempted suicide among transgender adults. Mechanisms of this relationship were examined, including treatment receipt and the use of substances to cope with mistreatment. Perceived emotional social support was also tested as a potential protective factor against the deleterious effects of service denial and discrimination on treatment receipt, substance use, and attempted suicide. The analysis included 4190 respondents from the National Transgender Discrimination Survey. Structural equation modeling was employed to test hypothesized relationships. Being denied a greater number of services and discriminated against in more settings were associated with lower levels of treatment receipt. Service denial was also correlated with increased rates of coping-motivated substance use and elevated rates of attempted suicide. Treatment receipt mediated the relationships between service denial/discrimination and substance use. Substance use mediated the relationship between treatment receipt and attempted suicide. Higher levels of support were protective to treatment receipt when denied services in one setting, but no longer retained protective effects when denied in two or three settings. Results have critical implications for service access and delivery and policies that protect transgender help-seekers in the health care system. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Transgender; Suicide; Discrimination; Health care access; Social support; Adaptation, Psychological; Adult; Emergency Service, Hospital; Female; Health Policy; Health Services; Health Services Accessibility; Help-Seeking Behavior; Humans; Male; Mental Health Services; Middle Aged; Prejudice; Protective Factors; Social Support; Substance-Related Disorders; Suicide, Attempted; Transgender Persons; United States; Young Adult; Attempted Suicide; Health Care Services; Social Discrimination; Social Support; Transgender; Drug Usage; Treatment Barriers

Out of the darkness and into the shadows: The evolution of contemporary bisexuality - Taylor, Julia (Canadian Journal of Human Sexuality, 2018)
Bisexuality, as we currently understand it, has evolved over the past 150 years both shaped by and shaping cultural change, scholarly endeavour and individual experience. To understand bisexuality in contemporary Western society it is essential to understand its past. This article explores the history of bisexuality within scholarly literature and social conversation by examining its progression from a largely silent past to a contemporary topic of scholarly investigation, a socio-political concept and a lived experience. With the growing awareness of poor mental health and suicidality among bisexual people in Western society, there has never been a more pressing time to examine bisexuality from its roots to its current existence with the aim of building a foundation from which academics, activists, health professionals and bisexual individuals can work together toward a more positive future where bisexuality can emerge from the shadows and be explored, understood, accepted and celebrated. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Bisexual history; bisexuality; bisexual theory; LGBTI; sexuality; Bisexuality; Lesbianism; Male Homosexuality; Psychosexual Behavior; Sexuality

Estimating the magnitude of the relation between bullying, e-bullying, and suicidal behaviors among United States youth, 2015 - Kuehn, Kevin S.; Wagner, Annelise; Velloza, Jennifer (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2019)
Background: Suicide is the second leading cause of death among US adolescents aged 12–19 years. Researchers would benefit from a better understanding of the direct effects of bullying and e-bullying on adolescent suicide to inform intervention work. Aims: To explore the direct and indirect effects of bullying and e-bullying on adolescent suicide attempts (SAs) and to estimate the magnitude of these effects controlling for significant covariates. Method: This study uses data from the 2015 Youth Risk Behavior Surveillance Survey (YRBS), a nationally representative sample of US high school youth. We quantified the association between bullying and the likelihood of SA, after adjusting for covariates (i.e., sexual orientation, obesity, sleep, etc.) identified with the PC algorithm. Results: Bullying and e-bullying were significantly associated with SA in logistic regression analyses. Bullying had an estimated average causal effect (ACE) of 2.46%, while e-bullying had an ACE of 4.16%. Limitations: Data are cross-sectional and temporal precedence is not known. Conclusion: These findings highlight the strong association between bullying, e-bullying, and SA. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: suicide; bullying; suicide prevention; electronic bullying; Death and Dying; Electronic Communication; Suicide; Suicide Prevention; Bullying; Attempted Suicide; Test Construction

Attachment‐based family therapy for suicidal lesbian, gay, and bisexual adolescents: A case study - Levy, Suzanne A.; Russon, Jody; Diamond, Gary M. (Australian and New Zealand Journal of Family Therapy, 2016)
The majority of sexual minority adolescents are well‐adjusted and healthy, however, on average, 28% report suicidal ideation and between 15% and 40% make a suicide attempt each year. These rates are two to seven times higher than those found among heterosexual youths. Research has shown the protective function of parental support and acceptance, as well as the deleterious effects of parental criticism, invalidation, and rejection on the mental health of sexual minority adolescents. Given these risk and protective factors, these adolescents might benefit from an intervention that targets family relationships. Toward this goal, Attachment‐Based Family Therapy (ABFT) specifically aims to improve the quality of adolescent–parent relationships. In prior treatment developmental work, ABFT was adapted and pilot tested for depressed and suicidal lesbian, gay, and bisexual (LGB) adolescents. By adopting an evidence‐based case study format, this paper provides a case summary to illustrate how the therapy was conducted. The case study consists of a vignette, followed by therapy task descriptions and illustrative transcripts. Examples of key therapeutic moments in ABFT, for depressed and suicidal LGB adolescents, are discussed in the context of the case. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: adolescents; LGB; Attachment‐Based Family Therapy; case study; suicide; depression; Adolescent Psychopathology; Attachment Behavior; Family Therapy; Homosexuality; Suicidal Ideation; Bisexuality; Lesbianism; Major Depression; Parental Role; Risk Factors

'Risk and protective factors for mental health morbidity in a community sample of female-to-male trans-masculine adults': Correction - McDowell, Michal J.; Hughto, Jaclyn M. W.; Reisner, Sari L. (BMC Psychiatry, 2019)
Reports an error in 'Risk and protective factors for mental health morbidity in a community sample of female-to-male trans-masculine adults' by Michal J. McDowell, Jaclyn M. White Hughto and Sari L. Reisner (BMC Psychiatry, 2019[Jan][9], Vol 19[16]). Following publication of the original article, errors were discovered in NSSI prevalence and Annual household income. The correct information is provided. In addition, it is noted that the second author’s name should be written as Jaclyn M.W. Hughto. The name appears correctly in this record, and has been corrected in the original record. (The following abstract of the original article appeared in record [rid]2019-01660-001[/rid]). Background: Trans-masculine (TM) individuals, who are assigned female sex at birth and identify along the masculine gender spectrum, face mental health disparities relative to cisgender people. Limited research has sought to explore the multi-level risk and protective factors associated with mental health morbidity for TM populations. Methods: Between August 2015–September 2016, 150 TM adults were enrolled in a one-time biobehavioral health study. A survey assessed socio-demographics, past 12-month everyday discrimination, lifetime intimate partner violence (IPV), resilience (using the Brief Resilience Scale), and other factors. Bivariate and multivariable logistic regression analyses examined associations between participant characteristics and four mental health statuses: post-traumatic stress disorder (PTSD), depression, anxiety, and non-suicidal self-injury (NSSI). Results: In this sample (76.7% had a binary gender identity, i.e., man or transgender man; 74.7% were white, 70.0% were under age 30 years), 42.2% had PTSD based on past 30-day symptoms; 25.7% had depression based on past 7-day symptoms; 31.1% had anxiety based on past 7-day symptoms; and 31.3% had engaged in NSSI within the past 12-months. Results from multivariable models: 1) PTSD: unemployment, lifetime IPV and past 12-month discrimination were each associated with increased odds of PTSD, while having a partner was associated with the reduced odds of PTSD. 2) Depression: lower educational attainment and past 12-month discrimination were each associated with the increased odds of depression, while greater resilience was associated with the reduced odds of depression. 3) Anxiety: low annual household income and past 12-month discrimination were each associated with the increased odds of anxiety, while resilience was associated with the reduced odds of anxiety. 4) NSSI: past 12-month discrimination was associated with the increased odds of past 12-month NSSI, while higher age and greater resilience was associated with the reduced odds of NSSI (all p-values < 0.05). Conclusions: Unemployment, low income, limited education, everyday discrimination, and violence were risk factors for poor mental health, while being in a relationship, higher age, and personal resilience were protective against mental health morbidity. Findings highlight the need for interventions to address the individual, interpersonal, and societal factors that may be driving poor mental health in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender; Mental health; Discrimination; Resilience; Violence; Mental Health; Posttraumatic Stress Disorder; Protective Factors; Resilience (Psychological); Transgender; Anxiety; Major Depression; Risk Factors

A threat to Canadian national security: A lesbian soldier’s story - Gouliquer, Lynne; Poulin, Carmen; Moore, Jennifer (Qualitative Research in Psychology, 2018)
Before 1992, lesbians and gay soldiers were purged and discharged from the Canadian military for 'reasons of homosexuality.' Those caught or suspected of homosexuality were subject to lengthy, humiliating, and degrading interrogations. This short story sheds light on this painful past. It is based on findings of a nationally funded pan-Canadian longitudinal study examining how Canadian military policies and practices influenced the lives of lesbian, gay, bisexual, and transgender soldiers and their partners. In total, 126 people were interviewed. While in the military, countless soldiers were investigated, numerous interrogated, many lost their careers, some committed suicide and others survived. Personal details have been changed to ensure the anonymity of the people, but it is their voices that tell this story. An official state apology was delivered November 28, 2017. Due to an impending class action court case, an agreement for compensation was also reached. Compensation and memorials will be forthcoming to those who were affected by the LGBTQI2+ purge campaign. To this day, no evidence exits that these soldiers were 'ever' a threat to national security. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Canadian military; discharged soldiers; homosexuality; interrogations; justice; LGBT; national security; purge campaign; Homosexuality; Military Psychology; National Security

Transgender women's experiences with stigma, trauma, and attempted suicide in the Dominican Republic - Budhwani, Henna; Hearld, Kristine R.; Milner, Adrienne N.; Charow, Rebecca; McGlaughlin, Elaine M.; Rodriguez‐Lauzurique, Mayra; Rosario, Santo; Paulino‐Ramirez, Robert (Suicide and Life-Threatening Behavior, 2018)
Studies on attempted suicide in transgender populations, particularly those in resource‐limited settings, are scarce. We examined the relationships between stigma, trauma, and suicide attempts in a national sample of transgender women from the Dominican Republic. Bivariate analysis examined differences between suicide attempters and nonattempters (n = 298). Multivariate analysis reported odds ratios with attempted suicide as the outcome (n = 260). About a quarter of respondents (23.9%) experienced sexual abuse, 12.3% were tortured, and 20.3% experienced a murder attempt. More than a quarter reported using illegal drugs. Independent sample t tests found significant differences between suicide attempters and nonattempters. Attempters were more likely to have experienced sexual abuse, psychological abuse, torture, and a murder attempt (p < .001 for all). Respondents who experienced psychological abuse had over three times higher odds of attempting suicide, compared to respondents who had not (OR = 3.203, p < .01). Experience with torture and attempted murder were associated with higher odds of attempting suicide (OR = 2.967, p < .05 and OR = 2.894, p < .05, respectively). Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are often not consistently enforced. Eliminating stigmatizing policies may reduce rates of negative health outcomes and subsequently improving population health. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: trauma; stigma; attempted suicide; transgender women; Adult; Adult Survivors of Child Abuse; Dominican Republic; Female; Humans; Male; Multivariate Analysis; Needs Assessment; Odds Ratio; Social Stigma; Socioeconomic Factors; Suicide, Attempted; Torture; Transgender Persons; Attempted Suicide; Human Females; Stigma; Trauma; Transgender

Transitional age lesbian, gay, bisexual, transgender, and questioning youth: Issues of diversity, integrated identities, and mental health - Rodgers, Scott M. (Child and Adolescent Psychiatric Clinics of North America, 2017)
Although most LGBTQ youth become healthy young adults, they often face considerable stress over the course of their lives because of bullying, victimization, and overt/covert discrimination. Families, educational and religious institutions, health care professionals, and communities help shape the experience of LGBTQ transitional age youth. LGBTQ youth have higher rates of depression, suicide, anxiety, posttraumatic stress disorder, alcohol and drug use, and preventable sexually transmitted diseases. When best practice guidelines are followed and key stakeholders take action to support LGBTQ youth, health disparities begin to disappear. Much can be done to change the trajectory for LGBTQ youth through advocacy, education, culturally competent health care, and policy-making. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: Sexual orientation; Gender identity; Lesbian; Gay; Bisexual; Transgender; Questioning; Bisexuality; Diversity; Mental Health; Sexual Orientation; Transgender; Male Homosexuality

Differences in mental health symptoms across lesbian, gay, bisexual, and questioning youth in primary care settings - Shearer, Annie; Herres, Joanna; Kodish, Tamar; Squitieri, Helen; James, Kiera; Russon, Jody; Atte, Tita; Diamond, Guy S. (Journal of Adolescent Health, 2016)
Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal self-injury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14–24 years). Methods: Data were collected using the Behavioral Health Screen—a Web-based screening tool that assesses psychiatric symptoms and risk behaviors—during routine well visits. Results: Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well. Conclusions: Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: LGBQ; mental health screening; adolescence; primary care; Adolescent; Anxiety; Behavioral Symptoms; Female; Humans; Internet; Male; Physician-Patient Relations; Primary Health Care; Risk; Sex Factors; Sexual Behavior; Sexual and Gender Minorities; Substance-Related Disorders; Surveys and Questionnaires; Young Adult; Mental Health; Primary Health Care; Psychiatric Symptoms; Screening Tests; Adolescent Development; Bisexuality; Lesbianism; Male Homosexuality

Self-injurious thoughts and behaviors may be more common and severe among people identifying as a sexual minority - Fox, Kathryn R.; Hooley, Jill M.; Smith, Diana M. Y.; Ribeiro, Jessica D.; Huang, Xieyining; Nock, Matthew K.; Franklin, Joseph C. (Behavior Therapy, 2018)
Research indicates that people who identify as a sexual minority are at higher risk of numerous negative outcomes, including self-injurious thoughts and behaviors (SITBs). The minority stress model proposes that people identifying as a sexual minority are at higher risk of these behaviors due to sexual orientation-specific stressors—however, it does not clarify whether SITBs will be more severe among these individuals. The present study tested whether SITBs are more common and more severe among people identifying as a sexual minority using several metrics, including frequency of SITB engagement, age of onset of SITB, desire to discontinue SITB engagement, and likelihood of future SITBs. Four independent research samples were used to test this model. Results were then combined and tested in an internal meta-analysis. Findings converge to indicate a longer and more severe course of SITB engagement among people identifying as a sexual minority. Future research is needed to replicate these findings and to advance the understanding of why this imbalance in risk and severity might exist, and how it can be prevented. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: sexual minority; NSSI; suicide; self-injury; minority stress model; Adolescent; Adult; Female; Humans; Male; Retrospective Studies; Self-Injurious Behavior; Severity of Illness Index; Sexual Behavior; Sexual and Gender Minorities; Suicidal Ideation; Suicide, Attempted; Thinking; Young Adult; Minority Groups; Self-Injurious Behavior; Sexual Orientation; Theories; Sexual Minority Groups; Suicide

Correlates of suicide ideation and behaviors among transgender people: A systematic review guided by ideation-to-action theory - Wolford-Clevenger, Caitlin; Frantell, Keri; Smith, Phillip N.; Flores, Leticia Y.; Stuart, Gregory L. (Clinical Psychology Review, 2018)
Transgender people are at high risk for suicide ideation, attempts, and deaths compared to the general population. Several correlates of suicide ideation and attempts have been identified empirically to understand this increased risk. However, few attempts have been made to systematically review this literature. Further, a theory to understand and identify targetable factors for intervention has rarely been applied to this population. In the first systematic review guided by ideation-to-action frameworks of suicide, we systematically reviewed the literature from January 1991 to July 2017 regarding correlates of suicide ideation, attempts, and deaths among transgender people. To be included in the review, articles must have been reported in English, reported on empirical data, included a sample or subsample of transgender people, and reported separately on correlates of suicide ideation, attempts, or deaths. Two independent reviewers searched three major databases, references of included articles, and unpublished literature, which produced 45 articles for review. The review suggested that ideation-to-action frameworks would be worth investigating within this population, with attention to sources of psychological pain, social connectedness, and capacity/capability for suicide unique to this population. Additionally, other aspects of cultural identity were often studied (e.g., race, religion), suggesting the need to understand intersectionality of identities among transgender people and their effects on suicide risk. Finally, the review highlighted important limitations of the literature, namely measurement of suicide ideation and attempts and sampling method, which future work should seek to improve. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicidal ideation; Attempts; Transgender; Gender diverse; Humans; Psychological Theory; Suicidal Ideation; Suicide, Attempted; Transgender Persons; Risk Taking; Suicidal Ideation; Transgender; Attempted Suicide

Stigma and suicide among gay and bisexual men living with HIV - Ferlatte, Olivier; Salway, Travis; Oliffe, John L.; Trussler, Terry (AIDS Care, 2017)
HIV positive gay and bisexual men (GBM) continue to struggle with the pervasiveness of HIV stigma, but little is known about the health effects of stigma. In this article, suicidal ideation and attempts are measured among GBM living with HIV, evaluating the extent to which these experiences are associated with stigma and suicide. Drawing from an online national survey of Canadian GBM completed by 7995 respondents, a sub-set of data provided by respondents self-reporting HIV-positive status was used for the current study. The associations between suicidal ideation (SI) and attempts (SA) and four measures of HIV stigma were measured: social exclusion, sexual rejection, verbal abuse and physical abuse. A total of 673 HIV-positive men completed the survey (8% of total sample). Among this group, 22% (n = 150) reported SI and 5% (n = 33) SA in the last 12 months. After adjusting for sociodemographic factors, SI and SA were associated with each of the four measures of HIV stigma: being excluded socially for being HIV positive (SI adjusted odds ratio, AOR 2.0 95% CI 1.4–3.1; SA AOR 3.8 95% CI 1.9–7.9), rejected as a sexual partner (SI AOR 1.6 95% CI 1.1–2.4; SA AOR 2.6 95% CI 1.1–6.0), verbally abused (SI AOR 2.9 95% CI 1.9–4.5; SA AOR 2.4 95% CI 1.1–5.1), and physically abused (SI AOR 4.5 95% CI 1.8–11.7; SA AOR 6.4 95% CI 2.0–20.1). Furthermore, experiencing multiple forms of stigma was associated with significantly increased risk of SI and SA. The authors conclude that HIV positive GBM experience significant levels of stigma that are associated with heightened risk for suicide. The findings affirm the need for targeted interventions to prevent suicide amid public health efforts to de-stigmatize HIV and mental illness. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: Suicide; HIV stigma; discrimination; gay men; bisexual men; Bisexuality; HIV; Male Homosexuality; Stigma; Suicide

Examining the role of sex in self-injurious thoughts and behaviors - Fox, Kathryn R.; Millner, Alexander J.; Mukerji, Cora E.; Nock, Matthew K. (Clinical Psychology Review, 2018)
Self-injurious thoughts and behaviors (SITBs), including nonsuicidal self-injury, suicidal thoughts, suicide attempts, and suicide death exhibit substantial sex differences. Across most countries, men die by suicide more frequently than women; yet, women think about and attempt suicide more frequently than men. Research on sex differences in nonsuicidal self-injury is less developed; however, nonsuicidal self-injury is historically understood as a primarily female phenomenon. This review describes current research on sex differences across SITBs with a focus on factors that moderate these effects, such as age, race, geographic region, and time. Additionally, this review describes factors that may help to explain why sex differences across SITBs exist, including differences in culture, access to lethal suicide methods, rates of mental illness, and utilization of health care. The role of gender, and particularly non-binary gender, is also discussed. Current understanding of these sex differences is described with an eye toward future research on this topic. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: self-injurious thoughts and behaviors; sex differences; Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Self-Injurious Behavior; Sex Factors; Suicidal Ideation; Suicide, Attempted; Young Adult; Human Sex Differences; Self-Injurious Behavior; Suicidal Ideation

Connections that moderate risk of non-suicidal self-injury among transgender and gender non-conforming youth - Taliaferro, Lindsay A.; McMorris, Barbara J.; Eisenberg, Marla E. (Psychiatry Research, 2018)
We examined associations between social connections and non-suicidal self-injury (NSSI) among transgender/gender non-conforming (TGNC) youth. Data came from the 2016 Minnesota Student Survey (N = 2168). Logistic regression analyses determined connectedness factors associated with any past-year NSSI and repetitive NSSI, as well as moderating effects of significant connectedness factors on different risk factors. Almost 55% of TGNC students engaged in NSSI, and 40% of self-injurers reported repetitive self-injury. Parent connectedness, connections to non-parental adults, and school safety emerged as robust protective factors. Strategies to prevent/reduce NSSI should focus on fostering connections with prosocial adults, and ensuring schools represent safe places. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Connectedness; Self-harm; Adolescent; Adolescent; Child; Cross-Sectional Studies; Female; Humans; Interpersonal Relations; Male; Protective Factors; Risk Factors; Schools; Self-Injurious Behavior; Social Behavior; Students; Surveys and Questionnaires; Transgender Persons; Psychosocial Development; Self-Injurious Behavior; Social Interaction; Transgender; Parent Child Relations; Peer Relations

Family acceptance and faith: Understanding the acceptance processes of parents of LGBTQ youth - McCormick, Adam; Baldridge, Stephen (Social Work & Christianity, 2019)
LGBTQ youth who are coming out today to family members and peers are experiencing more acceptance and affirmation than ever before. Family acceptance is one of the strongest predictors of the health, mental health, and well-being outcomes of LGBTQ youth. LGBTQ youth with accepting families are more than 8 times less likely to attempt suicide and nearly 6 times less likely to meet criteria for depression. This article explores the overwhelming impact that family acceptance can have on the experiences of LGBTQ youth. In addition, this article provides recommendations for Christian social workers to utilize in their attempts to work with families to create greater acceptance of their LGBTQ children. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBTQ youth; family acceptance; faith; Christianity; Parent Child Relations; Social Casework; LGBTQ; Faith

The relationship between sexual minority status and suicidal ideations among urban Hispanic adolescents - Lardier, David T. Jr.; Bermea, Autumn M.; Pinto, Stacy A.; Garcia-Reid, Pauline; Reid, Robert J. (Journal of LGBT Issues in Counseling, 2017)
Youth identifying as lesbian, gay, bisexual, transgender, and queer (LGBTQ), and more specifically Hispanic youth identifying as LGBTQ, experience suicidal ideation (SI) at disproportionate rates. Furthermore, adolescents identifying as LGBTQ are likely to experience high rates of bullying, depression, and limited social support, increasing SI. Counselors often have difficulty working with youth at the intersection of sexual and ethnic minority statuses. Using structural equation modeling techniques, the present study examined sexual minority status as a predictor of school bullying, depression, social support, and SI, among urban Hispanic youth (N = 538). The authors also tested social support as a buffering mechanism. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Bullying; Hispanic urban adolescents; sexual minorities; social support; suicidal ideation; Adolescent Development; Homosexuality; Social Support; Suicidal Ideation; Sexual Minority Groups; Bullying; Latinos/Latinas

Intimate partner violence among postsecondary students with military experience - Albright, David L.; Fletcher, Kari L.; McDaniel, Justin; Thomas, Kate H.; Godfrey, Kelli; Grohowski, Mariana; Dane, Jennifer (Traumatology, 2019)
The purpose of this study was to explore intimate partner violence (IPV) among student service members and veterans within postsecondary educational settings. Secondary data for the present cross-sectional study were retrieved from the 2011–2014 National College Health Assessment on a nationally representative sample of college students (n = 114,816). Fisher’s exact test (Upton, 1992) was used to determine differences in 3 types of IPV (emotional abuse, physical abuse, and sexual violence) between students with and without military experience (ME). Logistic regression was conducted to determine (a) risk factors for IPV and (b) associations between IPV and certain mental, physical, and behavioral health outcomes among students with ME. Although—in terms of descriptive statistics—self-reported emotional abuse (10.700% vs. 9.000%) and physical abuse (23.200% vs. 20.500%) were higher among students with ME, self-reported sexual violence was more prevalent among students with no ME (8.300% vs. 10.200%). Risk factors for IPV among students with ME included identifying as transgender, identifying as heterosexual, being a graduate student, identifying as an 'other' race, and being married. The odds of self-reported mental and physical health problems, as well as unhealthy behaviors (such as binge drinking and suicide attempts), were higher among students with ME who had experienced IPV. The emotional, behavioral, and psychological risks evident from our study substantiate the critical need for higher education professionals to place more emphasis on IPV and its consequences on students’ success. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: college; intimate partner violence; mental health; student veteran; College Students; Emotional Abuse; Intimate Partner Violence; Military Veterans; Physical Abuse; Risk Factors; Sex Offenses; Military Measures

'This is how you hetero:' Sexual minorities in heteronormative sex education - Hobaica, Steven; Kwon, Paul (American Journal of Sexuality Education, 2017)
The efficacy of sex education has been questioned, as students participate in high rates of unsafe sex after completion. Without exploring various sexual minority (SM) identities (e.g., gay, lesbian, and bisexual) and forms of sex, sex education may be especially unhelpful for SMs by perpetuating the heteronormative (i.e., assuming heterosexuality is normal) environment they typically experience. In the present qualitative study, semistructured interviews were conducted with 12 SMs regarding their experiences with sex education using a grounded theory approach. Participants described sex education as being heteronormative and exclusive of their identities, making them feel invisible, sexually unprepared, and shameful. Sex education also reportedly contributed to sexual hesitance, sexual violence, and risky sexual behaviors. Participants endorsed histories of depression, anxiety, and suicidality, often associated with their identity. To become more informed and sexually prepared, they sought information through conversations with others, online searching, college courses, and trial and error sexual experiences. Participants also advocated for inclusive sex education, which would incorporate all identities and associated safe sex practices. They concluded that inclusivity in curricula could lead to various improved outcomes for SMs, such as safe sex, a sense of community, identity confidence, healthy relationships, and resilience. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: heteronormative sex education; sexual minorities; lesbian; gay; bisexual; LGB; queer; Homosexuality (Attitudes Toward); Minority Groups; Sex Education; Sexual Orientation; Bisexuality; Lesbianism; Male Homosexuality

Determinants of transgender individuals’ well-being, mental health, and suicidality in a rural state - Smith, Adina J.; Hallum-Montes, Rachel; Nevin, Kyndra; Zenker, Roberta; Sutherland, Bree; Reagor, Shawn; Ortiz, M. Elizabeth; Woods, Catherine; Frost, Melissa; Cochran, Bryan N.; Oost, Kathryn M.; Gleason, Hillary; et al. (Journal of Rural Mental Health, 2018)
This project utilized a Community-Based Participatory Research (CBPR) approach to conduct qualitative interviews with 30 transgender adults living in a rural state. Participants’ identities spanned from trans women and men to nonbinary and Two-Spirit. The aim of this study was to better understand the experiences, needs, and priorities of the participants as well as to examine possible determinants of mental health, well-being, and suicidality for transgender individuals in Montana. These factors were investigated at individual, interpersonal, community, and societal levels using an ecological framework. Qualitative results indicate that participants experienced discrimination at all levels. Participants noted that discrimination contributed to mental health challenges and limited access to adequate general and transgender-specific health care services, both of which impacted overall well-being. This is reflected most notably in the elevated rate of past suicidal ideation attempts among the sample. Participants reported that the ability to transition, as well as other protective factors, played a role in reducing suicidality and improving mental and physical health. Our findings highlight the need to address transgender mental health through implementing changes at multiple ecological levels. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; rural; suicidality; determinants of mental health; Community-based Participatory Research; Mental Health; Suicidal Ideation; Well Being; Transgender; Suicidality; Rural Environments; Test Construction

Recent suicide attempts across multiple social identities among gay and bisexual men: An intersectionality analysis - Ferlatte, Olivier; Salway, Travis; Hankivsky, Olena; Trussler, Terry; Oliffe, John L.; Marchand, Rick (Journal of Homosexuality, 2018)
This study draws from intersectionality to describe variations in recent suicide attempts (RSA) among gay and bisexual men (GBM) across sociodemographics. Using survey data, logistic regression modeling explored RSA in two analytical stages: (1) the individual effects of each sociodemographic were measured; (2) two-way interaction terms between sociodemographics were tested and added to the models created in stage A. In stage A, only education and income achieved significance. In stage B, the study found that (a) education and income interacted significantly such that the odds of RSA increased for those with a lower income and a lower education; (b) sexual orientation and partnership status interacted, resulting in decreased odds among bisexual men in heterosexual partnerships; and (c) income and education interacted with geography; the effects of these variables were significant only among urban men. These findings suggest that GBM are at unequal risk of RSA according to intersecting sociodemographics. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; suicide attempts; risk factors; intersectionality; gay; bisexuality; homosexuality; Adolescent; Adult; Aged; Aged, 80 and over; Bisexuality; Female; Heterosexuality; Homosexuality, Male; Humans; Logistic Models; Male; Middle Aged; Sexual Behavior; Social Identification; Socioeconomic Factors; Suicide, Attempted; Surveys and Questionnaires; Young Adult; Homosexuality; Male Homosexuality; Suicide; Attempted Suicide; Risk Factors

Predictors of psychological outcomes in nonheterosexual individuals - Sanders, Emily K.; Chalk, Holly McCartney (Psi Chi Journal of Psychological Research, 2016)
Gay, lesbian, bisexual, pansexual, and queer (GLBPQ) individuals have higher rates of negative psychological outcomes, but the reasons for these trends are unclear. Gay-related stress including internalized homophobia, perceived stigma, and overt discrimination may contribute to these heightened rates, but gay identity may buffer these consequences. GLBPQ individuals (N = 1,169) completed online surveys of gay-related stress, protective factors, and outcomes including depression, anxiety, stress, nonsuicidal self-injury, and suicidality. Hierarchical regressions were used to examine predictive relationships between gay-related stress, gay identity, and negative outcomes. Among gay/lesbian participants, overt discrimination predicted all outcomes; gay identity predicted Center for Epidemiologic Studies Depression Scale (CES-D) depression, Depression Anxiety Stress Scale (DASS) depression, and DASS stress; and internalized homophobia predicted Perceived Stress Scale (PSS) stress (p < .001). Among bisexual and pansexual participants, perceived stigma predicted CES-D depression, DASS depression, and Pereceived Stress Scale (PSS) stress, and overt discrimination predicted CES-D depression (p < .001). Gay identity predicted reduced negative outcomes among gay and lesbian people, but did not affect bisexual or pansexual people. Gay identity did not interact significantly with overt discrimination, perceived stigma, or internalized homophobia, challenging the hypothesis that it would buffer their effects. These results indicated that the factors may function differently in different populations, highlighting the need for further research on the topic. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: psychological outcome predictors; gay; lesbian; bisexual; pansexual; queer; gay stress; protective factors; discrimination; Gender Identity; Homosexuality; Psychodynamics; Sex Discrimination; Stigma; Bisexuality; Lesbianism; Protective Factors; Stress

Suicide risk in trans populations: An application of minority stress theory - Tebbe, Elliot A.; Moradi, Bonnie (Journal of Counseling Psychology, 2016)
Drawing on minority stress theory, the present study tested the relations of minority stressors (i.e., experiences of prejudice and discrimination, internalized antitrans attitudes, fear of antitrans stigma), social support (i.e., friend, family, and significant other support), and substance use (i.e., drug and alcohol use) with depression and suicide risk in a sample of trans individuals. Depression was examined as a mediator of the relations of minority stressors and social support with suicide risk; drug and alcohol use were examined as direct correlates of suicide risk. Participants were 335 trans-identified individuals, diverse in gender identities (e.g., trans men, trans women, nonbinary gender identities). They were recruited using online social networks and they completed the study survey online via Qualtrics. Structural equation modeling was used to test hypothesized relations. Depression fully mediated the relations of perceived experiences of discrimination, fear of antitrans stigma, and friend support with suicide risk, and partially mediated the relation of internalized antitrans attitudes with suicide. Drug use was positively associated with suicide risk, whereas alcohol use was not linked with suicide risk. Exploratory comparisons across gender subgroups suggested that the pattern of relations among study variables was consistent across trans men, trans women, and individuals with nonbinary gender identities. These findings point to minority stressors, friend support, and drug use as potentially fruitful targets of prevention and intervention efforts to reduce depression and suicide risk in trans populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; transphobia; discrimination; substance use; social support; Adolescent; Adult; Aged; Depressive Disorder; Female; Friends; Gender Identity; Humans; Male; Middle Aged; Minority Groups; Prejudice; Psychological Theory; Risk; Social Stigma; Social Support; Stress, Psychological; Substance-Related Disorders; Suicide; Surveys and Questionnaires; Transgender Persons; Young Adult; Risk Factors; Stress; Suicidal Ideation; Theories; Transgender; Discrimination; Drug Usage; Major Depression; Prejudice; Social Support; Transgender (Attitudes Toward); Minority Stress

Are LGBT populations at a higher risk for suicidal behaviors in Australia? Research findings and implications - Skerrett, Delaney M.; Kõlves, Kairi; De Leo, Diego (Journal of Homosexuality, 2015)
The aim of this article is to review the Australian literature about suicidality in minority sexual identity and/or behavior groups in order to determine the evidence base for their reported higher vulnerability to suicidal behaviors than heterosexual and non-transgendered individuals in the Australian context, as well as to identify the factors that are predictive of suicidal behaviors in these groups in Australia. A literature search for all available years (until the end of 2012) was conducted using the databases Scopus, Medline, and Proquest for articles published in English in peer-reviewed academic journals. All peer-reviewed publications that provided empirical evidence for prevalence and predictive factors of suicidal behaviors among LGBT individuals (or a subset thereof) in Australia were included. Reference lists were also scrutinized to identify 'gray' literature for inclusion. The results revealed that there is only limited research from Australia. Nevertheless, although no population-based studies have been published, research indicates that sexual minorities are indeed at a higher risk for suicidal behaviors. In order to further the understanding of suicidal behaviors and potential prevention among LGBT groups in the Australia, further research is needed, particularly on fatal suicidal behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: gay; lesbian; bisexual; transgender; intersex; suicide; self-harm; Australia; Adolescent; Adult; Aged; Aged, 80 and over; Australia; Bisexuality; Cross-Sectional Studies; Female; Homosexuality; Homosexuality, Female; Humans; Male; Middle Aged; Risk Assessment; Social Stigma; Stereotyping; Suicidal Ideation; Suicide; Suicide, Attempted; Transgender Persons; Young Adult; Bisexuality; Lesbianism; Male Homosexuality; Suicide; Transgender; Self-Injurious Behavior; Intersex Conditions

The preference for strangulation in a sexually motivated serial killer - Pettigrew, Mark (International Journal of Offender Therapy and Comparative Criminology, 2019)
The existing literature on the killing method of choice for sexually motivated serial killers suggests strangulation as the preferable means of homicide, when the victim is female. When homicide victims are male, however, existing research suggests that firearms and blades are preferable methods of causing death. A case is presented here of a sexually motivated male serial killer who exclusively targeted males and who chose strangulation as his means of killing. Analysis suggests that not only is the psychological constitution of the killer an important factor in understanding how they kill victims but, also, the nature of the sexual act is an important determinant in the method of killing in male on male sexually motivated killing. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: strangulation; serial killing; male victims; killing method; homicide; Adult; Asphyxia; Criminal Behavior; Criminal Psychology; Drowning; Fantasy; Homicide; Homosexuality, Male; Humans; Male; Motivation; Sadism; Homicide; Sexual Partners; Serial Crime; Crime Victims; Serial Homicide

Sexual identity, adverse childhood experiences, and suicidal behaviors - Clements-Nolle, Kristen; Lensch, Taylor; Baxa, Amberlee; Gay, Christopher; Larson, Sandra; Yang, Wei (Journal of Adolescent Health, 2018)
Purpose: The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on suicidal behaviors in a population-based sample of high school students. Methods: A two-stage cluster random sampling design was used to recruit 5,108 students from 97 high schools. A total of 4,955 students (97%) provided information that allowed for classification of sexual identity into three groups: (1) lesbian, gay, or bisexual (LGB) (10%); (2) not sure (4.6%); and (3) heterosexual (85.4%). Five measures of childhood abuse and household dysfunction were summed, and the ACE score was categorized as 0, 1, 2, and 3–5 ACEs. Weighted logistic regression was used to assess the influence of sexual identity, ACEs, and their interaction on suicide ideation and attempts in the past 12 months. Results: Compared with heterosexual students, those who were LGB and were not sure had higher odds of suicide ideation and attempts. There was also a graded relationship between cumulative ACE exposure and suicidal behaviors. Although sexual identity/ACE interaction was not observed, LGB/not sure students who experienced a high number of ACEs were disproportionately affected. Compared with heterosexual students with 0 ACE, LGB/not sure students with 0 ACE (adjusted odds ratio [AOR] = 3.32, 95% confidence interval [CI] = 1.96–5.61), 1 ACE (AOR = 6.58, 95% CI = 4.05–10.71), 2 ACEs (AOR 13.50, 95% CI = 8.45–21.58), and 3–5 ACEs (AOR = 14.04, 95% CI = 8.72, 22.62) had higher odds of suicide ideation. A similar pattern was observed for suicide attempts. Conclusions: LGB and students not sure of their sexual identity with greater exposure to ACEs have disproportionately high levels of suicide ideation and attempts. Trauma-informed interventions for these populations are warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: sexual identity; adverse childhood experiences; suicidal behavior; high school students; Childhood Development; Gender Identity; High School Students; Suicide; Childhood Adversity; Suicidal Ideation

On the boundaries of framing terrorism: Guilt, victimization, and the 2016 Orlando shooting - Walter, Nathan; Billard, Thomas J.; Murphy, Sheila T. (Mass Communication & Society, 2017)
The 2016 Orlando shooting offers an intriguing lens through which to evaluate the boundaries of media frames in the interpretation of terrorism. Using an experimental design (N = 243), the current study investigated the effects of two dominant frames—the homophobic hate crime and the Islamic terrorist frame—on collective guilt, collective victimization, and pro–lesbian, gay, bisexual, transgender, and queer (LGBTQ) political action. In addition, political partisanship and social network diversity were evaluated as potential moderators. Compared to the Islamic terrorist frame, exposure to the homophobic hate crime frame increased collective guilt and decreased collective victimization, subsequently enhancing support for the LGBTQ community. Moreover, social network diversity was shown to override the framing effect, as individuals who reported high diversity were more likely to sign a petition in solidarity with the LGBTQ community, irrespective of frame condition. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: terrorism; guilt; victimization; Guilt; Terrorism; Victimization; Test Construction

Cyberbullying and LGBTQ youth: A systematic literature review and recommendations for prevention and intervention - Abreu, Roberto L.; Kenny, Maureen C. (Journal of Child & Adolescent Trauma, 2018)
Research has demonstrated that cyberbullying has adverse physical and mental health consequences for youths. Unfortunately, most studies have focused on heterosexual and cisgender individuals. The scant available research on sexual minority and gender expansive youth (i.e., LGBTQ) shows that this group is at a higher risk for cyberbullying when compared to their heterosexual counterparts. However, to date no literature review has comprehensively explored the effects of cyberbullying on LGBTQ youth. A systematic review resulted in 27 empirical studies that explore the effects of cyberbullying on LGBTQ youth. Findings revealed that the percentage of cyberbullying among LGBTQ youth ranges between 10.5% and 71.3% across studies. Common negative effects of cyberbullying of LGBTQ youth include psychological and emotional (suicidal ideation and attempt, depression, lower self-esteem), behavioral (physical aggression, body image, isolation), and academic performance (lower GPAs). Recommendations and interventions for students, schools, and parents are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: cyberbullying; LGBT youth; prevalence; correlates; effects; prevention; Homosexuality; Intervention; Prevention; Transgender; Cyberbullying; Bisexuality; Lesbianism

Violence as mediating variable in mental health disparities associated to sexual orientation among Mexican youths - Mendoza-Pérez, Juan Carlos; Ortiz-Hernández, Luis (Journal of Homosexuality, 2019)
In this study, we explored the role of sex as an effect-modifying variable in the association between sexual orientation and mental health in Mexican youth. In addition, we tested if violent experiences in the family and the school and attitudes toward homosexuality could act as mediating variables in such association. Data from three representative surveys performed in 2007, 2009, and 2013 among Mexican high school students were analyzed. Two dimensions of sexual orientation were evaluated: romantic partnership and sexual behavior. The outcomes were negative and positive mood, suicidal ideation and intent, self-concept, and self-esteem. There were differences by gender because in males, there were more disparities in mental health associated with sexual orientation (suicidal ideation and attempt, negative and positive mood, negative self-concept, and family-related self-esteem) than in females (suicidal ideation and negative mood). Experiences of school violence were mediators in the relationship between sexual orientation and most health outcomes in males. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual orientation; teenagers; mental health; disparities; violence sexual abuse; self-esteem; mood; gender; Adolescent; Attitude; Female; Homosexuality; Humans; Male; Mental Disorders; Mental Health; Mexico; Schools; Self Concept; Sex Characteristics; Sexual Behavior; Students; Suicidal Ideation; Surveys and Questionnaires; Violence; Young Adult; Mental Health; Self-Esteem; Sexual Orientation; Violence; Health Disparities; Emotional States; Homosexuality (Attitudes Toward); Human Sex Differences; Sexual Abuse

Sexual orientation discordance and nonfatal suicidal behaviors in US high school students - Annor, Francis B.; Clayton, Heather B.; Gilbert, Leah K.; Ivey-Stephenson, Asha Z.; Irving, Shalon M.; David-Ferdon, Corinne; Kann, Laura K. (American Journal of Preventive Medicine, 2018)
Introduction: Studies among adults have documented association between sexual orientation discordance and some suicide risk factors. However, studies examining sexual orientation discordance and nonfatal suicidal behaviors in youth are rare. This study examines the association between sexual orientation discordance and suicidal ideation/suicide attempts among a nationally representative sample of U.S. high school students. Methods: Using sexual identity and sex of sexual contact measures from the 2015 national Youth Risk Behavior Survey (n = 6,790), a sexual orientation discordance variable was constructed describing concordance and discordance (agreement and disagreement, respectively, between sexual identity and sex of sexual contacts). Three suicide-related questions (seriously considered attempting suicide, making a plan about how they would attempt suicide, and attempting suicide) were combined to create a two-level nonfatal suicide risk variable. Analyses were restricted to students who identified as heterosexual or gay/lesbian, who had sexual contact, and who had no missing data for sex or suicide variables. The association between sexual orientation discordance and nonfatal suicide risk was assessed using logistic regression. Analyses were performed in 2017. Results: Approximately 4.0% of students experienced sexual orientation discordance. High suicide risk was significantly more common among discordant students compared with concordant students (46.3% vs 22.4%, p < 0.0001). In adjusted models, discordant students were 70% more likely to have had suicidal ideation/suicide attempts compared with concordant students (adjusted prevalence ratio = 1.7, 95% CI = 1.4, 2.0). Conclusions: Sexual orientation discordance was associated with increased likelihood of nonfatal suicidal behaviors. Discordant adolescents may experience unique stressors that should be considered when developing and implementing suicide prevention programs. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: sexual orientation discordance; nonfatal suicidal behaviors; high school students; suicide risk factors; sexual identity; sex of sexual contacts; High School Students; Risk Factors; Sexual Orientation; Suicidality; Gender Identity; Sexual Partners

Research review: Gender identity in youth: Treatment paradigms and controversies - Turban, Jack L.; Ehrensaft, Diane (Journal of Child Psychology and Psychiatry, 2018)
Background Pediatric gender identity has gained increased attention over the past several years in the popular media, political arena, and medical literature. This article reviews terminology in this evolving field, traditional models of gender identity development and their limitations, epidemiology and natural history of cross‐gender identification among children and adolescents, co‐occurring conditions and behaviors, research into the biological and psychosocial determinants of cross‐gender identification, and research into the options regarding and benefits of clinical approaches to gender incongruent youth. Methods Based on a critical review of the extant literature, both theoretical and empirical, that addresses the issue of pediatric gender identity, the authors synthesized what is presently known and what is in need of further research in order to elucidate the developmental trajectory and clinical needs of gender diverse youth. Results The field of pediatric gender identity has evolved substantially over the past several years. New research suggests that cross‐gender identification is prevalent (approximately 1% of youth). These youth suffer disproportionately high rates of anxiety, depression, and suicidality. Although research into the etiology of cross‐gender identification is limited, emerging data have shown that affirmative treatment protocols may improve the high rates of mental health difficulties seen among these patients. Conclusions The field of pediatric gender identity has evolved dramatically. Emerging data suggest that these patients’ high rates of anxiety, depression, and suicidality appear to be improved with affirmative protocols, although future longitudinal data are needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Gender dysphoria; gender identity; depression; anxiety; suicidal behavior; Gender Identity; Health Care Services; Treatment; Gender Dysphoria; Anxiety

Persecution experiences and mental health of LGBT asylum seekers - Hopkinson, Rebecca A.; Keatley, Eva; Glaeser, Elizabeth; Erickson-Schroth, Laura; Fattal, Omar; Nicholson Sullivan, Melba (Journal of Homosexuality, 2017)
Asylum seekers are a unique population, particularly those who have endured persecution for their sexual orientation or gender identity. Little data exist about the specific experiences and needs of asylum seekers persecuted due to lesbian, gay, bisexual, or transgender (LGBT) identity. Quantitative data were gathered regarding demographics, persecution histories, and mental health of 61 clients from a torture survivors program in New York City who reported persecution due to LGBT identity. Thirty-five clients persecuted due to their LGBT identity were matched by country of origin and sex with clients persecuted for other reasons to explore how persecution and symptoms may differ for LGBT clients. LGBT asylum seekers have a higher incidence of sexual violence, persecution occurring during childhood, persecution by family members, and suicidal ideation. Understanding the type of persecution experiences and how these influence mental health outcomes is an essential step toward designing and delivering effective treatments. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Asylum; bisexual; gay; lesbian; LGBT; posttraumatic stress disorder; refugee; survivor of torture; transgender; trauma; Adult; Case-Control Studies; Female; Gender Identity; Humans; Male; Mental Health; New York City; Prejudice; Refugees; Sexual Behavior; Sexual and Gender Minorities; Suicidal Ideation; Survivors; Torture; Transgender Persons; Violence; Posttraumatic Stress Disorder; Sexual Orientation; Torture; Asylum Seeking

Exploring anabolic-androgenic steroid use and teen dating violence among adolescent males - Ganson, Kyle T.; Cadet, Tamara J. (Substance Use & Misuse, 2019)
Background: Reports indicate that 4% of the adolescent males in 2015 had taken steroids without a doctor’s prescription. Anabolic-androgenic steroids (AAS) are illicit drugs that have commonly been used to help build muscle mass. AAS use is associated with negative biological, psychological, and social side effects including substance use, suicidal behavior, and violent behavior. Objectives: This exploratory study, guided by an integrated theoretical framework that included the General Aggression Model and the Biopsychosocial Model, examined the relationship between adolescent male AAS use and teen dating violence. Methods: This cross-sectional, secondary data analysis was conducted using the 2013 and 2015 Massachusetts Youth Health Survey (MYHS). Participants were high school-aged males with a total sample of 2,080. Primary data analysis was conducted using hierarchical logistic regression. Results: Findings suggested that adolescent males who used steroids at least once in their lifetime, compared to those who did not, had greater odds of engaging in teen dating violence. Further, males who identified as a sexual minority had greater odds of using anabolic-androgenic steroids, as were those who had at least one suicide attempt in the previous 12 months. Conclusions: Adolescent male AAS use is associated with multiple psychosocial factors that practitioners, school personnel, and parents must be aware of. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Anabolic-androgenic steroids; steroid use; adolescent males; teen dating violence; suicidal behavior; Adolescent; Adolescent Behavior; Aggression; Anabolic Agents; Cross-Sectional Studies; Humans; Intimate Partner Violence; Male; Massachusetts; Substance-Related Disorders; Testosterone Congeners; Drug Usage; Human Males; Steroids; Dating Violence; Attempted Suicide; Adolescent Behavior

Perceptions of anger and aggression in rural adolescent Australian males - Edwards, Paul; van de Mortel, Thea; Stevens, John (International Journal of Mental Health Nursing, 2019)
Problematic anger is often the outward manifestation and expression of deeper mental health issues in young men with strong links to depression, aggression, and suicide. Few studies have explored adolescent anger and aggression from the perspective of adolescent males and even fewer studies focus specifically on a rural context. This research aimed to understand the role of anger and aggression from the perspective of Australian rural adolescent males. Mental health nurses can build upon this knowledge to promote more adaptive ways of coping with anger therefore identifying specific interventions for the prevention of violence and promotion of mental health in this cohort. One hundred and eighty‐seven rural adolescent males participated in focus groups that were conducted during their participation in the Rock and Water Program (RWP). Participants identified a number of factors they felt contributed to the aggression they both witnessed and experienced with eight themes emerging in response to the research questions. Four themes related to personological factors, that is racism, homophobia, family influences, and media influence. A further four themes related to situational factors, that is alcohol, territorialism, school context, and peer pressure. The study identified that racist and homophobic attitudes and beliefs were evident and clearly contributed to aggressive scripts as did family and media messages that normalized aggressive behaviour by way of endorsing stereotypical images of an aggressive masculinity. Situational factors such as alcohol use, territorialism, school context, and peer pressure were directly linked by participants to aggressive incidents embedded within their notions of masculinity. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: aggression; anger; homophobia; peer pressure; racism; rural males; territorialism; Adolescent; Aggression; Anger; Australia; Child; Family; Focus Groups; Homophobia; Humans; Interviews as Topic; Male; Masculinity; Peer Influence; Psychology, Adolescent; Racism; Rural Population; Aggressive Behavior; Anger; High School Students; Human Males; Perception; Homosexuality (Attitudes Toward); Peer Pressure; Racism; Rural Environments; Territoriality

PTSD, depression, and substance use in relation to suicidality risk among traumatized minority lesbian, gay, and bisexual youth - Smith, Brian C.; Armelie, Aaron P.; Boarts, Jessica M.; Brazil, Miquel; Delahanty, Douglas L. (Archives of Suicide Research, 2016)
Youths who are lesbian, gay, or bisexual (LGB) are more likely than heterosexuals to commit suicide. Substance use, PTSD, and depression are independent risk factors for suicidality; however, the extent to which these factors interact to predict suicidality is unclear. The current study examined the association between substance use, PTSD symptoms (PTSS), depressive symptoms, and suicidality in a sample of 68 traumatized minority LGB youths. Participants were recruited from an LGBT community center and completed a packet of questionnaires. Substance use and depressive symptoms were positively associated with prior suicide attempts. A significant three-way interaction revealed that substance use interacted with both PTSS and depressive symptoms to increase the odds of attempted suicide. Results underscore the importance of integrating substance use components into PTSD/depression treatment to reduce suicide risk in LGB youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: depression; LGB; PTSD; suicide; substance use; Adolescent; African Americans; Depression; Ethnic Groups; Female; Hispanic Americans; Humans; Indians, North American; Logistic Models; Male; Minority Groups; Odds Ratio; Psychological Trauma; Risk Factors; Sexual and Gender Minorities; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Suicidal Ideation; Suicide; Suicide, Attempted; United States; Young Adult; Lesbianism; Male Homosexuality; Suicidal Ideation; Suicidality; Bisexuality; Drug Abuse; Major Depression; Posttraumatic Stress Disorder; Suicide

The mental health of transgender youth: Advances in understanding - Connolly, Maureen D.; Zervos, Marcus J.; Barone, Charles J. II; Johnson, Christine C.; Joseph, Christine L. M. (Journal of Adolescent Health, 2016)
This review provides an update on the growing body of research related to the mental health of transgender youth that has emerged since the 2011 publication of the Institute of Medicine report on the health of lesbian, gay, bisexual, and transgender people. The databases PubMed and Ovid Medline were searched for studies that were published from January 2011 to March 2016 in English. The following search terms were used: transgender, gender nonconforming, gender minority, gender queer, and gender dysphoria. Age limits included the terms youth, child, children, teenager, and adolescen. The combined search produced 654 articles of potential relevance. The resulting abstracts went through a tiered elimination system, and the remaining 15 articles, which presented quantitative data related to the prevalence of transgender youth and their mental health, were included in the present review. In addition to providing new estimates of the number of young people who identify as transgender (.17%–1.3%), studies since 2011 have shown that transgender youth have higher rates of depression, suicidality and self-harm, and eating disorders when compared with their peers. Gender-affirming medical therapy and supported social transition in childhood have been shown to correlate with improved psychological functioning for gender-variant children and adolescents. Recent research has demonstrated increased rates of psychiatric morbidity among transgender youth compared to their peers. Future work is needed to understand those youth who identify as gender nonbinary, improve methods to capture and understand diverse gender identities and related health disparities, and delineate the social determinants of such disparities. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: Transgender; Adolescent; Mental health; Mental Health; Transgender

Concealment of sexual minority identities in interviewer-administered government surveys and its impact on estimates of suicide ideation among bisexual and gay men - Hottes, Travis Salway; Gesink, Dionne; Ferlatte, Olivier; Brennan, David J.; Rhodes, Anne E.; Marchand, Rick; Trussler, Terry (Journal of Bisexuality, 2016)
Bisexual and gay men are at increased risk of suicide ideation. Characterizing this risk requires self-disclosure of sexual identities; however, many will conceal their identity when interviewed. The authors investigated the impact of the resulting information bias within the Canadian Community Health Survey (CCHS). Expected probabilities of disclosure were derived from a community-based survey of bisexual and gay men, stratified by sexual identity and other social characteristics. Forty percent of bisexual men and 86% of gay men were willing to disclose to CCHS interviewers. The odds of suicide ideation were higher for bisexual (odds ratio [OR] = 4.91) and gay (OR = 3.63) men compared to heterosexual men. After bias analysis these disparities remained significant but were attenuated, with greater attenuation for bisexual (adjusted OR = 3.53) than for gay (adjusted OR = 3.52) men. The authors recommend that researchers continue exploring bias in estimated sexual minority health disparities, and that population surveys be more inclusive of bisexual-identified individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGB; men; sexual identity; disclosure; research methods; sampling; Bisexuality; Gender Identity; Lesbianism; Male Homosexuality; Suicidal Ideation; Methodology; Sampling (Experimental); Sexual Minority Groups

Non-suicidal self-injury among sexual minority youth: An etiological and treatment overview - Smithee, Lauren C.; Sumner, Brock W.; Bean, Roy A. (Children and Youth Services Review, 2019)
Non-suicidal self-injury (NSSI) among sexual minority youth (SMY) is a problem that is growing in attention yet is understudied and requires an informed response from therapists who engage in clinical work with youth. This paper proposes a unique model of treatment for working with SMY who engage in NSSI, accounting for proximal, distal, and systemic factors that influence the etiology of NSSI. This model is based on a review of two bodies of clinical literature: (a) treating adolescent NSSI and (b) working with SMY and their families. As an etiological theory of self-harm, Nock (2009) is applied to SMY, factoring in the unique stressors experienced by this group that affect intervention. Reviewed treatment approaches include Dialectical Behavioral Therapy for Adolescents (DBT-A) and narrative family therapy. Treatment guidelines are conceptualized and outlined to aid therapists in providing affirmative and informed therapeutic services. While few, if any articles have studied treatment for SMY who engage in NSSI, this article contributes to the literature by proposing culturally competent interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: non-suicidal self-injury; sexual minority youth; etiology; treatment; Etiology; Self-Injurious Behavior; Treatment; Sexual Minority Groups

Preventing suicide in lesbian, gay, bisexual, and transgender prisoners: A critique of U K policy - Read, Max; McCrae, Niall (Journal of Forensic Nursing, 2016)
Suicide is a global problem in prisons. As in society generally, gay men in prison have a higher risk of attempting suicide compared with their heterosexual peers. The Howard League for Penal Reform Sex in Prison Commission 2015 reveals a pervasive culture of consensual and coercive sexual relations, with gay men more likely to be targeted for unsolicited sex. Research shows an inadequate institutional response to such abuse. Victims of sexual assault in prison have high rates of psychological problems, which can lead to self-harm and suicide. The Assessment, Care in Custody and Teamwork procedure to assess and manage risk of suicide in prisoners, however, makes no reference to the needs of the lesbian, gay, bisexual, and transgender prison population, despite national policy and best practice guidance that advocates an individualized approach to suicide risk with due consideration of vulnerable group status. This article argues that the Assessment, Care in Custody and Teamwork procedure should be tuned to the requirements of the Equality Act 2010 to ensure that lesbian, gay, bisexual, and transgender prisoners are not exposed to the double jeopardy of sexual assault and related suicidal tendencies. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Assessment; care in custody; LGBT; prison; prisoners; sexual assault; suicide; teamwork; At Risk Populations; Prisoners; Sex Offenses; Suicide; Suicide Prevention; Bisexuality; Lesbianism; Male Homosexuality; Transgender; Teamwork

Mental health of transgender and gender nonconforming youth compared with their peers - Becerra-Culqui, Tracy A.; Liu, Yuan; Nash, Rebecca; Cromwell, Lee; Flanders, W. Dana; Getahun, Darios; Giammattei, Shawn V.; Hunkeler, Enid M.; Lash, Timothy L.; Millman, Andrea; Quinn, Virginia P.; Robinson, Brandi; et al. (Pediatrics, 2018)
Background: Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. Methods: Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3–9 years old) and adolescents (10–17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date. Results: Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was several fold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4–82) to 144 (95% CI 36–1248). The corresponding range for suicidal ideation was 25 (95% CI 14–45) to 54 (95% CI 18–218). Conclusions: TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: mental health; transgender youth; gender nonconforming youth; peers; medical records; Medical Records; Mental Health; Peers; Transgender

A latent class analysis of the co-occurrence of sexual violence, substance use, and mental health in youth - Nelon, Jordan L.; De Pedro, Kris T.; Gilreath, Tamika D.; Patterson, Megan S.; Holden, Caitlin B.; Esquivel, Christi H. (Substance Use & Misuse, 2019)
Purpose: The purpose of this study was to understand co-occurrence of sexual violence, substance use, and mental health in youth and see if there are differences in experiences among sexual identities, races, and genders. Methods: The 2017 Youth Risk Behavior Survey sampled 14,638 high school students. Latent class analysis was used to understand the relationship between incidence of sexual violence, substance use, and depression and suicidality in a nationally representative sample. The model controlled for demographic and bullying covariates. Results: A four-class solution provided optimal fit. Classes were low risk (51.8%); low violence, frequent substance use, and high depression and suicidal ideation (29.7%); experienced violence and moderate mental health issues(5.1%); and some violence, high substance use, and high depression and suicidal ideation (13.4%). Youth who identified as sexual minority youth were almost 2.5–5 times more likely to be in the three higher risk classes than their heterosexual peers. Those who identified as 'I don’t know' were almost 3 times more likely to be in the three higher risk classes than heterosexual youth. Multiracial youth had higher likelihood of being in the three riskier classes compared to Caucasian youth. Females were 2.5 and 3 times more likely to be in the low violence and some violence classes compared to males. Conclusion: The study’s finding distinct classes of co-occurring behavioral and mental health outcomes fill gaps in the current literature and informs practitioners that LGB youth and bi/multiracial youth were at an elevated risk of co-occurring victimization, substance use, and mental health problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Adolescents; sexual minority youth; sexual violence; mental health; substance use; Adolescent Psychopathology; Drug Usage; Mental Health; Sex Offenses; Sexual Minority Groups; Major Depression; Violence; Suicidality

Evidence needed to understand gender identity: Commentary on Turban & Ehrensaft (2018) - Berenbaum, Sheri A. (Journal of Child Psychology and Psychiatry, 2018)
Comments on an article by J. L. Turban and D. Ehrensaft (see record [rid]2017-48423-001[/rid]). Turban and Ehrensaft have provided a thoughtful review of transgender identity in children and adolescents. They have discussed a number of issues about gender identity and have emphasized the benefits of the affirmative approach in maintaining positive psychological health in transgender individuals. The review reveals gaps in our understanding of gender identity that require evidence before we can be confident that we are providing optimal treatment for children who are gender variant. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Gender dysphoria; gender identity; depression; anxiety; suicidal behavior; Adolescent Psychiatry; Adolescent Psychology; Child Psychiatry; Child Psychology; Gender Identity; Anxiety; Health Care Services; Major Depression; Pediatrics; Treatment

Factors associated with discrimination in social-service settings among a sample of transgender and gender-nonconforming adults - Klein, Augustus; Mountz, Sarah; Bartle, Eli (Journal of the Society for Social Work and Research, 2018)
Objective: Few studies have investigated discrimination in social-service or social work settings among transgender and gender-nonconforming (TGNC) individuals. This study aims to (a) examine the prevalence and magnitude of discrimination against TGNC individuals and (b) explore the factors associated with discrimination in social-service settings. Method: We examined sociodemographic factors and psychosocial and health-related indicators (suicide attempt ever, substance misuse to cope, HIV positive serostatus, transactional sex, and marginally housed) associated with reports of social-service discrimination in a national sample of transgender adults (age 18–98, M = 36.69, SD = 13.11) from the U.S. and its territories. Data were from the National Transgender Discrimination Survey (N = 6,456). Results: Approximately 16% (n = 952) of the total sample experienced some form of discrimination related to their gender identity/expression in a social-service setting. Participants reporting social-service discrimination were more likely to be non-White, under 45 years of age, lower income, and to report negative psychosocial and/or health-related outcomes. Conclusions: Findings highlight the need for future research to examine individual-, interpersonal-, and structural-level factors associated with access to and use of social services among the transgender and gender-nonconforming community. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: transgender; discrimination; health disparities; social service; Discrimination; Social Services; Health Disparities; Transgender; Gender Nonconforming

Should gender reassignment surgery be publicly funded? - Go, Johann J. (Journal of Bioethical Inquiry, 2018)
Transgender people have among the highest rates of suicide attempts of any group in society, driven strongly by the perception that they do not belong in the sex of their physical body. Gender reassignment surgery (GRS) is a procedure that can change the transgender person’s physical body to accord with their gender identity. The procedure raises important ethical and distributive justice concerns, given the controversy of whether it is a cosmetic or medical procedure and the economic costs associated with performing the procedure. This paper argues that there is a strong case for funding GRS as a matter of clinical necessity and justice. This paper will be divided in four key sections: First, the state of transgender health will be outlined, including the role of GRS and common objections to it. Second, a number of common objections to GRS will be analysed at the outset and shown to be unconvincing. Third, a constructive argument will be advanced, arguing that publicly funded GRS is clinically necessary, cost-effective, and demanded by principles of justice. Fourth, the paper will briefly discuss moralistic biases and why we demand a higher burden of justification for funding GRS compared with other analogous procedures. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Transgender; Gender reassignment surgery; Health resource allocation; Distributive justice; Health Care Costs; Resource Allocation; Surgery; Transgender; Gender Reassignment; Distributive Justice

Life experiences of sexual minorities in Iran: Limitations, adaptations and challenges - Mohammadi, Naima (Quality & Quantity: International Journal of Methodology, 2018)
The purpose of this study is to present a description, theming, and status comparison of sexual minorities, such as transgender persons and transsexuals in the Islamic society of Iran. Cultural as well as religious sensitivities have made the living conditions of sexual minorities, as an individual and a social being, extremely challenging. Using a hermeneutic interpretation (interpretative phenomenological analysis) a number of 18 semi-structured interviews were conducted with transgender individuals; from the interviews, three main themes: self-confidence, legal respect (in terms of the self) and social esteem were revealed. These individuals were categorized into three groups: transgender individuals (pre-sex reassignment surgery), transsexuals (under hormone therapy), and transsexuals (post-sex reassignment surgery). The findings indicate that social dignity in relation to transgender individuals is a critical issue. More than other social groups, transgender individuals are under a higher level of mental stress pertaining to role conflict, disappointment in romantic relationships, high risk of suicide, being discriminated against, based on sexual orientation, and physical, verbal and sexual abuse. The interviews also introduced exclusion and the inability to adapt/adjust in socially professional situations, as the leading context condition losing social dignity in all three groups. These difficulties have also been noticed in post-surgical transsexuals, especially from those that have undergone male to female sex reassignment surgeries. These findings support the rights of sexual minorities and more specifically transgender individuals in the Civil Rights Charter which has recently been submitted to the Iranian parliament. Moreover, the establishment of transgender health training centers is proposed in order to complete the medical process of sex reassignment and to facilitate appropriate behavioral adjustment to the reassigned sex, especially for male to female sex reassignment transgender individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Bodily purgatory; Body modification; Transgender; Transsexual; Iran; Gender Identity; Minority Groups; Sexual Orientation; Sociocultural Factors; Transsexualism; Transgender

Towards bi-inclusive policies: Suggestions based on research on Dutch same-sex attracted young people - van Lisdonk, Jantine; Keuzenkamp, Saskia (Sexuality Research & Social Policy: A Journal of the NSRC, 2017)
Dutch national LGBT policies are not bi-inclusive and this study provides suggestions for improvement, based on empirical research. Attention for bisexuality in policy appears simply to pay lip service and to endorse the construction of sexual orientation as a hetero/homo binary. The outcomes of our survey (n = 1449) and in-depth interviews (n = 38) of Dutch same-sex attracted young people suggest that special attention for bisexual people is warranted. Compared to exclusively same-sex attracted participants, the equally both-sex attracted participants scored worse on openness about their sexual attraction, visibility discomfort, perceived acceptance, and suicide attempts. Unique issues for bisexual-identified young people were identified as follows: marginalization of bisexuality; difficulty expressing bisexuality, particularly in relationships; and a lack of bisexual or bi-inclusive communities. These issues were all related to the hetero/homo binary and mononormativity. Suggested implications for more bi-inclusive policies focus on awareness of marginalization and invisibility of bisexuality, biphobia, community and capacity building, and comprehensive sexuality and gender education. Furthermore, rather than policies focusing on sameness, a comprehensive diversity perspective on sexuality and gender offers more space for bisexuality. This may be particularly relevant for young people who are exploring their sexuality and developing a sense of their sexual self. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: Bisexuality; Same-sex sexuality; Sexual orientation; LGBT policy; LGBT; Youth; Equality; Diversity; Sexual diversity; Biphobia; Mononormativity; Netherlands; Diversity; Homosexuality; Policy Making; Sexual Orientation; Bisexuality; Lesbianism; Transgender

Suicide in trans populations: A systematic review of prevalence and correlates - McNeil, Jay; Ellis, Sonja J.; Eccles, Fiona J. R. (Psychology of Sexual Orientation and Gender Diversity, 2017)
Trans people experience high rates of attempted suicide and suicidal ideation. No study to date has collated the various findings concerning correlates of trans suicide. This systematic review aimed to summarize the available data and provide recommendations based on this evidence. Articles were included if they were published before November 2016, were in English, were peer reviewed, and presented data concerning trans people’s suicide attempts or ideation. Nine databases were searched, and 30 articles were selected. Discrimination emerged as strongly related to suicidal ideation and attempts, whereas positive social interactions and timely access to interventions appeared protective. Limitations included differences in how articles defined trans people or measured suicide and in their largely cross-sectional nature, making assumptions about causality in reference to lifetime ideation or attempts impossible. However, results clearly indicated a need to work at both individual and structural levels to reduce society- and service-level discrimination, enhance peer support, and ensure access to required interventions. The review highlights the need to explore suicidality in the trans population both in relation to general suicide models and in relation to models of minority stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: transgender; suicidal ideation; suicide attempts; systematic review; Attempted Suicide; Suicidal Ideation; Transgender

Does self-compassion covary with minority stress? Examining group differences at the intersection of marginalized identities - Vigna, Abra J.; Poehlmann-Tynan, Julie; Koenig, Brian W. (Self and Identity, 2018)
Informed by the minority-stress hypothesis and intersectionality theory, this study examines differences in dispositional self-compassion across diverse youth subject to varying levels of structural and interpersonal discrimination. A secondary analysis of survey data from two suburban high schools in a Midwestern state (n = 1872) found significant differences in rates of exposures to stigma processes in accordance to rates of marginalization as estimated by sexual and/or gender status and racial category (minority vs majority), with a large effect. Sexual and/or gender minority students of color (SGmin) reported the highest rates of stigma experiences including exposure to economic hardship, having an incarcerated parent, not trusting the police, assignment of an IEP and exclusionary discipline. However, white SGmin students reported the highest rates of mental health concerns. Sexual gender majority (SGmaj) students of color reported the highest rates of self-compassion while white SGmin students reported the lowest and the negative relation between bullying and self-compassion was stronger for white SGmin students than for SGmin students of color, suggesting that the latter may have developed ways of coping with multiple stigmatized identities that reflect kindness to the self. As scholars seek to understand the role of self-compassion in resilience processes, we suggest emphasizing the strengths of marginalized youth as well as protecting them from the ill effects of bullying. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: sexual & gender minorities; self-compassion; peer victimization; depression and suicidality; Human Sex Differences; Minority Groups; Psychosexual Behavior; Victimization; Depression (Emotion); Suicidal Ideation; Sympathy

Investigating the association between age at first alcohol use and suicidal ideation among high school students: Evidence from the youth risk behavior surveillance system - Baiden, Philip; Mengo, Cecilia; Boateng, Godfred O.; Small, Eusebius (Journal of Affective Disorders, 2019)
Background: Although various studies have investigated and found a significant link between age at first alcohol use and health risk behaviors, few studies have investigated the effect of age at first alcohol use on suicidal ideation among adolescents. The objective of this study was to investigate the effect of age at first alcohol use on suicidal ideation. Methods: Data for this study were obtained from the 2015 Youth Risk Behavior Surveillance system. A sample of 10,745 adolescents aged 14–18 years (50.9% males) were analyzed using logistic regression with suicidal ideation as the outcome variable and age at first alcohol use as the main explanatory variable. Results: About 17% of adolescents experienced suicidal ideation during the past 12 months and 15.6% started having alcohol before age 13. Adolescents who started having alcohol before age 13 had 1.60 times higher odds of experiencing suicidal ideation and adolescents who started having alcohol by age 13 or over had 1.47 times higher odds of experiencing suicidal ideation. Other significant factors associated with suicidal ideation include experience of forced sex, physical teen dating violence, bullying, and feeling sad or hopeless. Having sufficient sleep lowered the odds of suicidal ideation. Limitations: The use of cross-sectional data limits the extent to which we can make causal claims regarding age at first alcohol use and suicidal ideation. Conclusions: Younger age at first alcohol use was associated with increased likelihood of suicidal ideation. Public health initiatives that seek to address the co-occurring problems of alcohol use and mental health illness, sexual violence, and victimization among sexual minority youth could help in reducing suicidal ideation. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Suicidal ideation; Age at first alcohol use; Victimization; Adolescents; Alcohol Drinking Patterns; At Risk Populations; Suicidal Ideation; Risk Assessment; High School Students

Coping styles and suicide in racially and ethnically diverse lesbian, bisexual, and queer women - Rabinovitch, Annie E.; Perrin, Paul B.; Tabaac, Ariella R.; Brewster, Melanie E. (Psychology of Sexual Orientation and Gender Diversity, 2015)
The purpose of the current study was to examine whether coping strategies are associated with past suicidal ideation and history of suicide attempts among sexual minority women (SMW). Participants were 150 racially and ethnically diverse lesbian, bisexual, queer, or 'other' nonheterosexual-identified cisgender women who were recruited as part of a national online survey on the experiences of SMW. Simultaneous multiple regressions suggested that coping styles significantly explained 20.3% of the variance in past suicidal ideation and 30.4% of the variance in lifetime history of suicide attempts. Within these regressions, self-blame coping positively predicted past suicidal ideation, and religious coping and venting coping were associated with a higher lifetime history of suicide attempts. Based on these findings, directions for future research and interventions to reduce suicide risk among SMW are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: coping; race/ethnicity; religion; suicide; sexual minority women; Bisexuality; Coping Behavior; Diversity; Lesbianism; Suicide; Human Females; Suicidal Ideation; Sexual Minority Groups; Coping Style

The association between intentional overdose and same-sex sexual intercourse in a cohort of people who inject drugs in Melbourne, Australia - O'Keefe, Daniel; Bowring, Anna; Aitken, Campbell; Dietze, Paul (Substance Use & Misuse, 2018)
Background: People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID. Objectives: To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI. Methods: The sample included 529 participants, from an ongoing cohort of 757 PWID. An 'ever' SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression. Results: Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: People who inject drugs; lesbian/gay/bisexual; sexual orientation; intentional overdose; suicide; Adolescent; Adult; Australia; Drug Overdose; Drug Users; Female; Homosexuality; Humans; Male; Sexual Behavior; Substance Abuse, Intravenous; Suicide, Attempted; Young Adult; Binge Drinking; Drug Abuse; Psychosexual Behavior; Bisexuality; Drug Overdoses; Injections; Lesbianism; Male Homosexuality; Sexual Orientation; Suicide; Test Construction

Suicide ideation among southern uS Sexual minority college students - Wolford-Clevenger, Caitlin; Frantell, Keri A.; Brem, Meagan J.; Garner, Alisa; Rae Florimbio, Autumn; Grigorian, Hannah; Shorey, Ryan C.; Stuart, Gregory L. (Death Studies, 2018)
Sexual minority individuals are at higher risk for suicide ideation compared with heterosexual individuals. We tested whether the interpersonal-psychological theory of suicide explains increased suicide ideation among sexual minority college students living in the southeastern region of the United States. The cross-sectional study assessed correlates of suicide ideation in a convenience sample (n = 82) of sexual minority college students. Perceived burdensomeness and thwarted belongingness correlated with suicide ideation. However, only perceived burdensomeness correlated with suicide ideation while controlling for depressive symptoms. Pending replication, perceived burdensomeness may be a target for suicide prevention and intervention among sexual minority college students. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: No terms assigned

Mental health service delivery to sexual minority and gender non-conforming students in schools: A Winnicottian approach - Wofford, Nichole C. (Child & Adolescent Social Work Journal, 2017)
Current research highlights the increased risk factors that sexual minority (lesbian, gay, bisexual) and gender minority (transgender/gender non-conforming) students face as compared to their heterosexual and cisgender peers. These risk factors include higher rates of depression, suicide, substance use, school dropout, sexually transmitted infections, experiences with bullying on school campuses and increased risk of homelessness. Although this research has aided our understanding of the needs and risks of this population of youth, few articles have emerged from these data which offer a comprehensive theoretical approach to work clinically with these adolescents in school-based settings. This article explores how school mental health staff can address the behavioural health needs of sexual and gender minority students through the adoption of a Winnicottian theoretical approach. With an intensive focus on academic achievement, schools have historically been limited in their usage of evidence-based data to create programs which adequately address the mental health needs of student populations on their campuses. Yet, sexual and gender minority students are likely to be present in almost every school in the country. Schools can serve as gateways to mental health access and can offer innovative and culturally responsive practices across racial, ethnic, class, and geographic lines. As the single largest holders of the student population in the United States, schools have the ability to play a significant role in mental health service provision for sexual and gender minority youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Winnicottian theoretical approach; school-based mental health services; sexual minority youth; gender non-conforming youth; adolescent mental health; Mental Health Services; Minority Groups; Object Relations; School Based Intervention; Sexual Orientation; Gender Identity; Sexual Minority Groups

Retrospective cyberbullying and suicide ideation: The mediating roles of depressive symptoms, perceived burdensomeness, and thwarted belongingness - Mitchell, Sean M.; Seegan, Paige L.; Roush, Jared F.; Brown, Sarah L.; Sustaíta, Michael A.; Cukrowicz, Kelly C. (Journal of Interpersonal Violence, 2018)
Research suggests that being cyberbullied is associated with increased risk for suicide ideation; however, few studies have examined the underlying mechanisms of this relation, and fewer have examined this relation within a theory of suicide. Specifically, the interpersonal theory of suicide posits that thwarted belongingness (indicated by loneliness and a lack of reciprocal caring relationships) and perceived burdensomeness (indicated by feelings of liability and self-hatred) increase risk for suicide ideation. The current study aimed to examine depressive symptoms, thwarted belongingness, and perceived burdensomeness as mediators between intensity of being cyberbullied and suicide ideation. Participants were college students (N = 348) who completed assessments of retrospective peer victimization, thwarted interpersonal needs (i.e., thwarted belongingness and perceived burdensomeness), and suicide ideation. The results indicated that after adjusting for sexual orientation, depressive symptoms significantly mediated the relation between intensity of being cyberbullied and suicide ideation. Furthermore, depressive symptoms and perceived burdensomeness serially mediated the relation between intensity of being cyberbullied and suicide ideation; however, thwarted belongingness was not a significant mediator. Clinical and research implications, limitations, and future directions are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: cyberbullying; depressive symptoms; perceived burdensomeness; suicide ideation; belongingness; Adolescent; Crime Victims; Cyberbullying; Depression; Female; Humans; Interpersonal Relations; Loneliness; Male; Retrospective Studies; Students; Suicidal Ideation; Young Adult; Major Depression; Suicidal Ideation; Retrospective Memory; Cyberbullying; Belonging; Peer Relations; Psychiatric Symptoms; Test Construction; Victimization

The protective role of gay–straight alliances for lesbian, gay, bisexual, and questioning students: A prospective analysis - Ioverno, Salvatore; Belser, Alexander B.; Baiocco, Roberto; Grossman, Arnold H.; Russell, Stephen T. (Psychology of Sexual Orientation and Gender Diversity, 2016)
Prior studies show a strong association between gay–straight alliances (GSAs) and the well-being and safety of sexual minority students at school. However, nearly all existing literature has relied on cross-sectional data. Using data from the first 2 panels of a multisite longitudinal study on risk and protective factors for suicide among lesbian, gay, bisexual, and questioning (LGBQ) youth in 3 U.S. cities, we examined the influence of presence of and participation in a GSA on perceptions of safety at school, homophobic bullying experiences, and psychosocial adjustment (depression and self-esteem) in 327 LGBQ students across 2 school years. LGBQ students who had GSAs in their schools or were members of GSAs in the prior year showed no differences in psychological adjustment, but they reported perceptions of more school safety and less homophobic bullying in the following school year. Further, changes in GSA presence (gaining a GSA) and changes in participation (from nonparticipation to participation) were independently associated with stronger perceived safety in the subsequent school year. This study provides the first prospective evidence of the lasting positive role of GSAs for high school students, and documents that changes in GSA presence and participation are associated with safety at school. Education policy and practice implications are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: bullying; depression; self-esteem; gay–straight alliance; school safety; High Schools; Homosexuality; Protective Factors; Safety; Bullying; Bisexuality; Heterosexuality; High School Students; Lesbianism; Major Depression; Male Homosexuality; Risk Factors; Self-Esteem; School Safety

Asking for help online: Lesbian, gay, bisexual and trans youth, self-harm and articulating the ‘failed’ self - McDermott, Elizabeth (Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 2015)
International evidence suggests that young people are less likely to seek help for mental health problems in comparison with adults. This study focused on lesbian, gay, bisexual and trans young people who are a population group with an elevated risk of suicide and self-harm, and little is known about their help-seeking behaviour. Utilising qualitative virtual methods, lesbian, gay, bisexual and trans youth web-based discussions about seeking help for suicidal feelings and self-harming were investigated. Findings from a thematic analysis indicate that these young people wanted assistance but found it difficult to (1) ask for help, (2) articulate emotional distress and (3) ‘tell’ their selves as ‘failed’. This analysis suggests that key to understanding these problems are emotions such as shame which arise from negotiating norms connected to heterosexuality, adolescence and rationality. I argue that these norms act to regulate what emotions it is possible to feel, what emotions it is possible to articulate and what type of young lives that can be told. The future development of health and social care interventions which aim to reduce lesbian, gay, bisexual and trans youth suicide and self-harm need to work with a nuanced understanding of the emotional life of young people if they are to be effective. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: help-seeking; LGBT; online; suicide; youth; Bisexuality; Help Seeking Behavior; Homosexuality; Self-Injurious Behavior; Transgender; Lesbianism; Male Homosexuality; Sexual Orientation

Predictors of sexual minority youth’s reported suicide attempts and mental health - Puckett, Jae A.; Horne, Sharon G.; Surace, Francisco; Carter, Alice; Noffsinger-Frazier, Nicole; Shulman, Julie; Detrie, Pam; Ervin, Audrey; Mosher, Chad (Journal of Homosexuality, 2017)
Lesbian, gay, and bisexual youth (LGBY) report higher rates of mental health concerns compared to heterosexual youth due to minority stressors. This study examined the interpersonal and intrapersonal variables that predict psychological distress and self-reported suicide attempts in a sample of 61 LGBY in the Mid-South, which is a highly overlooked regional area for LGBY research. Youth who lost friends when coming out were 29 times more likely to report suicide attempts, and those who experienced psychological maltreatment from caregivers were 9.5 times more likely to report a suicide attempt. Internalized heterosexism, feelings of guilt or shame, and psychological maltreatment from caregivers were significant predictors of depression and anxiety symptoms. This study highlights the importance of creating affirming spaces for LGBY, particularly in areas of the country that experience greater political oppression of sexual minorities, such as the Mid-South. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Anxiety; depression; harassment; internalized heterosexism; LGB youth; sexual minority youth; suicide; Adolescent; Anxiety; Bisexuality; Defense Mechanisms; Depression; Female; Heterosexuality; Homosexuality, Female; Homosexuality, Male; Humans; Male; Mental Disorders; Mental Health; Sexual Minorities; Shame; Suicide, Attempted; Young Adult; Anxiety; Attempted Suicide; Homosexuality (Attitudes Toward); Major Depression; Sexual Orientation; Adolescent Psychopathology; Harassment; Minority Groups; Sexual Minority Groups

A comparison of LGBTQ youth and heterosexual youth in the child welfare system: Mental health and substance abuse occurrence and outcomes - Scannapieco, Maria; Painter, Kirstin R.; Blau, Gary (Children and Youth Services Review, 2018)
Purpose: LGBTQ youth enter the child welfare system often because they are at higher risk of experiencing child maltreatment compared to youth who are heterosexual (Friedman, Marshal, Guadamuz, Wei, Wong, Saewye, & Stall, 2011), and due to family rejection, which places them at higher risk of suicide, higher levels of depression and are more likely to use substances (Ryan, Huebner, Dias & Sanchez, 2009). Using national data from the Substance Abuse and Mental Health Services Administration (SAMHSA), this study had two purposes; first to examine mental health disparities among LGBTQ youth and their heterosexual peers who are involved in the child welfare system, and second to observe the effectiveness of systems of care with youth in child welfare and if any differences exist between LGBTQ youth and heterosexual youth. Methods: Chi-square and logistic regression were used to analyze differences at intake between youth who identified as LGBT or Q and their heterosexual counterparts. Repeated linear mixed modeling was used to evaluate the outcomes and to compare the groups at fixed time points (intake, 6-months, and 12-months). Findings: The study found LGBTQ youth had higher levels of suicidal ideation, suicide attempts, depression, and gender identity related problems compared to the heterosexual youth in child welfare. All youth in the study experienced significant improvement, further supporting the effectiveness of system of care approaches. Recommendations are also discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBTQ; Child welfare; System of care; Mental health disparities; mental health outcomes; Child Welfare; Drug Abuse; Mental Health; Quality of Care; LGBTQ; At Risk Populations; Heterosexuality; Health Disparities

Mostly heterosexual and lesbian/gay young adults: Differences in mental health and substance use and the role of minority stress - Kuyper, Lisette; Bos, Henny (Journal of Sex Research, 2016)
Individuals mostly attracted to other-sex but also to same-sex partners are a distinct and common sexual orientation group with possibly increased levels of health problems. The current study examined whether mostly heterosexual individuals differed in mental health and substance use from lesbian/gay individuals and whether sexual minority risk and protective factors offer an explanation in a sample of 528 Dutch young adults (16 to 25 years old, M = 21.2 years). Mostly heterosexual participants reported higher levels of psychological distress, suicidality, drug use, and smoking than lesbian/gay participants and equal levels of binge drinking. They also reported higher levels of internalized negativity to same-sex attractions, less openness to family members and others, less community involvement, and lower numbers of lesbian/gay/bisexual friends. However, bootstrapped mediation analysis showed that the differences in minority stress risk and protective factors did not mediate most of the differences in mental health and substance use with one exception: higher levels of psychological distress were mediated by the higher levels of internalized negativity to same-sex attractions. The limited explanatory power of the minority stress factors combined with the elevated level of problems of mostly heterosexual individuals call for future studies examining other risk and protective factors. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: lesbian/gay young adults; mental health; substance use; minority stress; Adolescent; Adult; Bisexuality; Female; Homosexuality; Humans; Interpersonal Relations; Male; Sexual and Gender Minorities; Stress, Psychological; Substance-Related Disorders; Suicidal Ideation; Young Adult; Lesbianism; Male Homosexuality; Mental Health; Minority Stress; Drug Abuse; Stress

Childhood maltreatment and age effects on depression and suicide risk among Canadian men - Rice, Simon M.; Kealy, David; Oliffe, John L.; Seidler, Zac E.; Ogrodniczuk, John S. (Psychiatry Research, 2018)
The current findings suggest that the mood-related impact of childhood maltreatment is greatest during men's younger years. These results held after controlling for history of mental health treatment, inability to work (due to disability), and sexual minority status – each of which were associated with higher depression and suicide risk scores. Future research exploring the impacts of minority stress (e.g., associated social identities) is warranted, given that these factors may influence depression and suicide risk among men with a history of childhood maltreatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Childhood maltreatment; age effects; depression; suicide risk; Adult; Adult Survivors of Child Abuse; Age Factors; Aged; Aged, 80 and over; Canada; Depression; Humans; Male; Middle Aged; Risk Factors; Suicide, Attempted; Young Adult; Attempted Suicide; Child Abuse; Childhood Development; Major Depression; Suicide; Aging; At Risk Populations

Victimization of lesbian, gay, and bisexual people in childhood: Associations with attempted suicide - Flynn, Anna B.; Johnson, Renee M.; Bolton, Shay‐Lee; Mojtabai, Ramin (Suicide and Life-Threatening Behavior, 2016)
Higher rates of attempted suicide have been documented among people who identify themselves as gay, lesbian, and bisexual (LGB) compared with heterosexuals. This study sought to ascertain the association between childhood abuse and neglect and attempted suicide, comparing LGBs and heterosexuals. Childhood sexual abuse among men and childhood sexual and physical abuse among women were found to mediate the association between LGB identity and attempted suicide. The experience of childhood abuse likely plays a significant role in the relationship between LGB identity and attempted suicide, but other factors such as experience of discrimination are also important. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: victimization; lesbian; gay; bisexual; attempted suicide; Attempted Suicide; Bisexuality; Lesbianism; Male Homosexuality; Victimization

Suicidality in young men who have sex with men: A systematic review of the literature - Luong, Casey T.; Rew, Lynn; Banner, Matthew (Issues in Mental Health Nursing, 2018)
This systematic literature review addresses risk and protective factors associated with suicidal ideation and attempts in young men who have sex with men (YMSM). The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsychArticles, and PsychInfo yielded 14 articles. Risk factors included (1) not being enrolled in school, (2) earlier sexual debut, (3) substance use/abuse, (4) homelessness, (5) bullying and victimization, (6) fear of community violence, (7) and parental abuse. Protective factors included (1) positive sexual minority LGBT stereotypes, (2) family acceptance, (3) school and peer support, (4) high self-esteem, and (5) adaptive coping mechanisms. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: men who have sex with men; suicidality; protective factors; Homosexuality, Male; Humans; Male; Risk Factors; Suicide; Suicidal Ideation; Same Sex Intercourse; Suicidality; Protective Factors

Validation of the Minority Stress Scale among Italian gay and bisexual men - Norcini Pala, Andrea; Dell'Amore, Francesca; Steca, Patrizia; Clinton, Lauren; Sandfort, Theodorus; Rael, Christine (Psychology of Sexual Orientation and Gender Diversity, 2017)
The experience of sexual orientation stigma (e.g., homophobic discrimination and physical aggression) generates minority stress, a chronic form of psychosocial stress. Minority stress has been shown to have a negative effect on gay and bisexual men’s (GBM’s) mental and physical health, increasing the rates of depression, suicidal ideation, and HIV risk behaviors. In conservative religious settings, such as Italy, sexual orientation stigma can be more frequently and/or more intensively experienced. However, minority stress among Italian GBM remains understudied. The aim of this study was to explore the dimensionality, internal reliability, and convergent validity of the Minority Stress Scale (MSS), a comprehensive instrument designed to assess the manifestations of sexual orientation stigma. The MSS consists of 50 items assessing (a) Structural Stigma, (b) Enacted Stigma, (c) Expectations of Discrimination, (d) Sexual Orientation Concealment, (e) Internalized Homophobia Toward Others, (f) Internalized Homophobia toward Oneself, and (g) Stigma Awareness. We recruited an online sample of 451 Italian GBM to take the MSS. We tested convergent validity using the Perceived Stress Questionnaire. Through exploratory factor analysis, we extracted the 7 theoretical factors and an additional 3-item factor assessing Expectations of Discrimination From Family Members. The MSS factors showed good internal reliability (ordinal α > .81) and good convergent validity. Our scale can be suitable for applications in research settings, psychosocial interventions, and, potentially, in clinical practice. Future studies will be conducted to further investigate the properties of the MSS, exploring the association with additional health-related measures (e.g., depressive symptoms and anxiety). (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: gay; minority stress; bisexual men; sexual orientation stigma; perceived stress; Sexual Orientation; Stigma; Stress; Test Reliability; Test Validity; Bisexuality; Homosexuality (Attitudes Toward); Male Homosexuality; Minority Groups; Minority Stress

Harassment and mental distress among adolescent female students by sexual identity and BMI or perceived weight status - Johns, Michelle Marie; Lowry, Richard; Demissie, Zewditu; Robin, Leah (Obesity, 2017)
Objective: Sexual minority girls (lesbian/bisexual) and girls with overweight/obesity experience high rates of discrimination and mental distress. This study explored whether BMI or perceived weight status might compound sexual minority girls’ risk for harassment and mental distress. Methods: Data on female students from the national 2015 Youth Risk Behavior Survey (n = 7,006) were analyzed. Logistic regression was used to examine differences in bullying, harassment, and mental distress across sexual identity/BMI groups: heterosexual/normal-weight, heterosexual/overweight, sexual minority/normal-weight, and sexual minority/overweight. Procedures were repeated with four analogous groups created from sexual identity and perceived weight. Results: Across sexual identity/BMI groups, being overweight increased heterosexual females’ odds of being bullied or experiencing suicidal thoughts and behaviors. Regardless of weight status, sexual minority females had greater odds for each outcome than heterosexual females. Sexual minority females who perceived themselves as overweight had greater odds of suicidality than all other sexual minority/perceived weight groups. Conclusions: Double jeopardy may exist for sexual minority female students who perceive themselves as overweight. Professional development with school staff on how to create a positive climate for sexual minorities and those with overweight/obesity and addressing positive identity and body image within school-based suicide prevention efforts may be important to the well-being of adolescent girls. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: harassment; mental distress; adolescent female students; sexual identity; Adolescent; Adolescent Behavior; Behavioral Risk Factor Surveillance System; Bisexuality; Body Image; Body Mass Index; Body Weight; Bullying; Cluster Analysis; Female; Health Behavior; Homosexuality, Female; Humans; Mental Disorders; Minority Groups; Obesity; Overweight; Prevalence; Students; Suicidal Ideation; Suicide; Surveys and Questionnaires; Distress; Harassment; Psychosexual Behavior

Systematic review of the psychometric properties of transphobia scales - Morrison, Melanie A.; Bishop, C. J.; Gazzola, Stephanie B.; McCutcheon, Jessica M.; Parker, Kandice; Morrison, Todd G. (International Journal of Transgenderism, 2017)
Introduction: Prejudice and discrimination against transgender individuals (i.e., transphobia) is pervasive and has been shown to have pernicious effects on the physical (e.g., substance abuse and other self-harm behaviors) and psychological (e.g., depression and suicidal ideation) well-being of those targeted. Aims: To date, a review of the psychometric properties of scales assessing transphobia has not been conducted; this gap compromises researchers' ability to make informed measurement decisions. Methods: In the current study, 61 articles that contained 83 scales were identified, and their adherence to best practices in psychometric testing was evaluated. Results: Most of the transphobia scales included in the current review did not provide sufficient information about item generation and refinement, scale dimensionality, scale score reliability, or validity. Each scale was entered into a table and was ranked on the basis of its total score. A score of 1 was issued for each psychometric feature that adhered to best practice guidelines, with total scores ranging from 0 to 5 (i.e., higher scores denote greater psychometric soundness). Discussion: Properties of the reviewed scales are summarized and recommendations are made for future transphobia scale development and validation. The measures that emerged as possessing the highest scores and, subsequently, the greatest utility are identified. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Psychometric; trans; transgender; transnegativity; transphobia; transprejudice; validity; Discrimination; Prejudice; Psychometrics; Transgender; Transgender (Attitudes Toward); Test Reliability; Test Validity

Young Black gay/bisexual and other men who have sex with men: A review and content analysis of health-focused research between 1988 and 2013 - Wade, Ryan M.; Harper, Gary W. (American Journal of Men's Health, 2017)
Black young gay, bisexual, and other men who have sex with men (YGBMSM) are at high risk for negative health outcomes, though this population is underrepresented in the health literature. An extensive literature review and content analysis of health-related peer-reviewed articles (1988-2013) was conducted that targeted Black YGBMSM, examining five content areas: sexual health, health care, substance use, psychosocial functioning, and sociostructural factors. A coding sheet was created to collect information on all content areas and related subtopics and computed descriptive statistics. Out of 54 articles, most were published after 2004 (N = 49; 90.7%) and addressed some aspect of sexual health (N = 50; 92.6%). Few articles included content on psychosocial functioning, including bullying/harassment, suicide, and racial/ethnic identity. Data on health care delivery/receipt and health insurance were underrepresented; tobacco use and substance abuse were seldom addressed. Important sociostructural factors, including sexual networks and race-based discrimination, were poorly represented. Last, there was a noteworthy deficit of qualitative studies and research exploring intersectional identity and health. This review concludes that studies on Black YGBMSM health places sex at the forefront to the neglect of other critical health domains. More research is needed on the diverse health issues of a vulnerable and underexamined population. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: gay health issues; adolescence; men of color; psychosocial and cultural issues; behavioral issues; Bisexuality; Blacks; Male Homosexuality; Same Sex Intercourse

Developing resilience: Gay men’s response to systemic discrimination - Handlovsky, Ingrid; Bungay, Vicky; Oliffe, John; Johnson, Joy (American Journal of Men's Health, 2018)
Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men’s resilience in actively resisting discrimination. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: gay men; resilience; health; homophobia; sexual orientation; health promotion; prevention; social determinants; psychosocial factors; cultural effects; Health; Health Attitudes; Male Homosexuality; Resilience (Psychological); Social Discrimination; Aging; Geriatrics; Psychosocial Factors; Sociocultural Factors; Stigma; Test Construction

Distinct coping profiles are associated with mental health differences in transgender and gender nonconforming adults - Freese, Rebecca; Ott, Miles Q.; Rood, Brian A.; Reisner, Sari L.; Pantalone, David W. (Journal of Clinical Psychology, 2018)
Objective: This study assessed the unique coping strategies of transgender and gender nonconforming (TGNC) individuals in the United States used to manage gender-related stress, and examined associations between specific coping profiles and mental health. Methods: Data were from 316 participants in the 2014–2015 Transgender Stress and Health Study, an online study of TGNC mental and sexual health. A factor analysis of the coping measure (Brief COPE) was followed by a k-means cluster analysis to evaluate distinct profiles of coping with gender-related stress. Proportional odds models and logistic regression models indicated how coping profiles related to levels of self-reported depressive symptoms and suicidality. Results: A 4-factor structure was identified with three distinct profiles of coping with gender-related stress, each representative of the frequency (high or low) in which participants used functional and dysfunctional coping strategies: (a) high-functional/low-dysfunctional, (b) high-functional/high-dysfunctional, and (c) low-functional/low-dysfunctional. There were significant differences in depressive symptoms and suicidality based on distinct gender-related coping profiles. The high-functional/high-dysfunctional group reported significantly poorer mental health compared with the high-functional/low-dysfunctional group. Conclusion: To improve mental health outcomes in TGNC individuals, health providers and researchers should strive to not only promote functional coping strategies for managing gender-related stress but also decrease dysfunctional coping strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: coping; depression; mental health; suicide; transgender; Adaptation, Psychological; Adolescent; Adult; Aged; Cluster Analysis; Depression; Factor Analysis, Statistical; Female; Humans; Male; Middle Aged; Stress, Psychological; Suicidal Ideation; Transgender Persons; United States; Young Adult; Coping Behavior; Major Depression; Mental Health; Suicide; Transgender; Gender Nonconforming

The role of distal minority stress and internalized transnegativity in suicidal ideation and nonsuicidal self-injury among transgender adults - Staples, Jennifer M.; Neilson, Elizabeth C.; Bryan, Amanda E. B.; George, William H. (Journal of Sex Research, 2018)
Transgender people are at elevated risk for nonsuicidal self-injury (NSSI) and suicidal ideation compared to the general population. Transgender (trans) refers to a diverse group of people who experience incongruence between their gender identity and sex assigned at birth. The present study is guided by the minority stress model and the psychological mediation framework, which postulate that sexual minority groups experience elevated stress as a result of anti-minority prejudice, contributing to negative mental health outcomes. This study utilized these theories to investigate the role of internalized transnegativity—internalization of negative societal attitudes about one’s trans identity—in the relationships of distal trans stress to suicidal ideation and NSSI. A U.S. national sample of trans adults (N = 237) completed a battery of online measures. Structural equation modeling (SEM) was used to compare models with mediation and moderation effects. Results suggested that internalized transnegativity acts as both a mediator and a moderator in the relationship between distal trans stress and suicidal ideation. Log likelihood comparisons suggested moderation models had the superior fit for these data. Results suggest that clinical interventions should directly target individuals’ internalized transnegativity as well as societal-level transnegativity. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: distal minority stress; internalized transnegativity; suicidal ideation; nonsuicidal self-injury; transgender; Self-Injurious Behavior; Suicidal Ideation; Transgender; Minority Stress; Minority Groups

Relationship between illness representations and mental health among HIV-positive men who have sex with men - Mo, Phoenix Kit-han; Lau, Joseph Tak-fai; Wu, Xiaobing (AIDS Care, 2018)
Illness representations play a significant role on mental health across various health conditions. The present study explores the associations between illness representations of HIV and mental health (suicidal ideation and depression), and the mediation effects of emotional representations on the associations between cognitive representations and mental health among men who have sex with men who were newly diagnosed with HIV (ND-MSM) in China. A total of 225 ND-MSM were recruited from a non-governmental organisation and were invited to complete a cross-sectional survey. Results showed that 48.0% had suicidal ideation since HIV diagnosis and 48.4% scored higher than the cut-off for mild depression or above. Stepwise regression analyses showed that higher levels of emotional representations of HIV and lower levels of treatment control were associated with both suicidal ideation and depression. Emotional representations were shown to mediate the associations between some cognitive representations variables and mental health. Findings suggest that both cognitive and emotional representations of HIV were important factors of mental health among ND-MSM. Interventions to promote the mental health of ND-MSM are warranted and should seek to improve their cognitive and emotional representations of HIV. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: HIV; men who have sex with men; illness representations; depression; suicidal ideation; HIV; Major Depression; Suicidal Ideation; Same Sex Intercourse

Depression and suicidality among bisexual youth: A nationally representative sample - Taliaferro, Lindsay A.; Gloppen, Kari M.; Muehlenkamp, Jennifer J.; Eisenberg, Marla E. (Journal of LGBT Youth, 2018)
To address gaps in the literature on bisexual youth, we used the first nationally representative sample of high school students from the United States to determine profiles of behaviors related to depressive symptoms, a suicide attempt, and a medically-serious attempt. We examined the data from 922 bisexual students in grades 9–12 who completed the Centers for Disease Control and Prevention's 2015 National Youth Risk Behavior Survey. Latent class analysis derived three classes reflecting unique patterns of 10 risk and protective behaviors. For both the sexes: one group was high on all the risk behaviors and demonstrated the greatest risk of depression, a suicide attempt, and a medically-serious attempt; another was below average on all the risk and protective behaviors and demonstrated average/moderate risk of the outcomes; and the last demonstrated the highest levels of protective behaviors and the lowest risk of depression and suicidal behavior. Bisexual students are not homogenous with regard to the risk of mental health problems. Greater involvement in several risk behaviors and less involvement in protective behaviors, rather than merely a bisexual identity, might contribute to bisexual adolescents' increased risk of depression and suicidal behavior. Findings have implications for prevention programming, clinical interventions, and future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Adolescents; bisexual; depression; suicide; Attempted Suicide; Bisexuality; Major Depression; Suicide; Suicidality; Adolescent Attitudes; High School Students; Protective Factors; Risk Factors

Socio-demographic, mental health and childhood adversity risk factors for self-harm and suicidal behaviour in College students in Northern Ireland - O'Neill, Siobhan; McLafferty, Margaret; Ennis, Edel; Lapsley, Coral; Bjourson, Tony; Armour, Cherie; Murphy, Sam; Bunting, Brendan; Murray, Elaine (Journal of Affective Disorders, 2018)
Background: Prevalence estimates of suicidal behaviour in the college student population are consistently higher than rates for the general adult population. This study examines mental health disorders and childhood adversities as predictors of self-harm and suicidal behaviours. Methods: The Ulster University Student Wellbeing study commenced in September 2015 as part of the WHO World Mental Health Surveys International College Student Project. In Northern Ireland (NI) 739 students participated (462 female, 274 male and 3 other specified), with the WMH-CIDI used to examine psychopathology. Mean age was 21 years old. Results: Thirty-one percent endorsed suicidal ideation (24.3% of males and 36.9% of females) with almost 1 in 5 students having made a plan for suicide in the 12 months prior to the survey. Latent profile analysis revealed three profiles of childhood adversity (high, moderate, and low risk). Logistic regression analyses showed that there was an increased likelihood of all queried self-harm and suicidal behaviours in those who were not heterosexual orientation, and among those with either moderate or high levels of childhood adversities. Probable alcohol dependence was associated with a significantly increased likelihood of suicide attempt or self-harm with either a suicide plan or a suicide attempt. Limitations: Influences of self-report measures and the generalizability of the sample are discussed. Conclusions: Policies and strategies for early identification of those with mental illnesses or adversities that increase their risk, should be prioritised. It would also be useful to identify individuals at risk in secondary schools to allow for additional support to be offered to them during the key time of transitioning into higher education. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: College students; Suicidal behaviour; Mental health; Childhood adversities; LGBT; College Students; Mental Health; Risk Factors; Self-Injurious Behavior; Suicidal Ideation

Hospitalization for suicide ideation or attempt: 2008–2015 - Plemmons, Gregory; Hall, Matthew; Doupnik, Stephanie; Gay, James; Brown, Charlotte; Browning, Whitney; Casey, Robert; Freundlich, Katherine; Johnson, David P.; Lind, Carrie; Rehm, Kris; Thomas, Susan; et al. (Pediatrics, 2018)
Objectives: Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US children’s hospitals from 2008 to 2015. Methods: We used retrospective analysis of administrative billing data from the Pediatric Health Information System database. Results: There were 115 856 SI and SA encounters during the study period. Annual percentage of all visits for SI and SA almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points [95% confidence intervals (CIs) 0.15 to 0.17]). Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 percentage points [95% CI 0.23 to 0.30]) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points [95% CI 0.21 to 0.27]). Increases were noted in girls (average annual increase 0.14 percentage points [95% CI 0.13 to 0.15]) and boys (average annual increase 0.10 percentage points [95% CI 0.09 to 0.11]), but were higher for girls. Seasonal variation was also observed, with the lowest percentage of cases occurring during the summer and the highest during spring and fall. Conclusions: Encounters for SI and SA at US children’s hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children’s hospitals and health care delivery systems. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: hospitalization; suicide ideation; suicide attempt; children; adolescents; US; Attempted Suicide; Emergency Services; Epidemiology; Hospitalization; Suicidal Ideation; Pediatrics; Trends

Minority sexual orientation, gender identity status and suicidal behavior: Serial indirect effects of hope, hopelessness and depressive symptoms - Hirsch, Jameson K.; Cohn, Tracy J.; Rowe, Catherine A.; Rimmer, Sarah E. (International Journal of Mental Health and Addiction, 2017)
Death by suicide, and suicidal behaviors, are a significant public mental health problem, and individuals who are lesbian, gay, bisexual, transgendered and questioning (LGBTQ), may be at increased risk. Potential underlying mechanisms of this association are unknown, but may involve the impact of LGBTQ status on future orientation and mood. Our purpose was to determine the influence of sexual identity, sequentially, on cognitive and emotional functioning, and consequent relation to suicidal behavior. In a sample of 349 college students, we used serial mediation models to investigate the relation between self-identification as LGBTQ and suicidal behavior, with hope and hopelessness as first-order mediators and depression as a second order mediator. Supporting hypotheses, we found that LGBTQ status was related to less hope and greater hopelessness and, in serial fashion, to depressive symptoms and consequent suicidal behavior. Our findings may have clinical implications. Resolution of hopelessness and depression, and promotion of hopefulness, perhaps via Motivational Interviewing and Cognitive Behavioral Therapy strategies, such as goal-setting, may reduce suicidal risk in LGBTQ young adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Sexual minority; Gender identity; Trait hope; Depression; Suicidal behavior; College students; LGBTQ; College Students; Major Depression; Sexual Orientation; Suicidal Ideation; Suicide; Gender Identity; Hope; Personality Traits; Symptoms; Sexual Minority Groups; LGBTQ

'It's how we deal': Perceptions of LGB peers' use of alcohol and other drugs to cope and sexual minority adults' own coping motivated substance use following the Pulse nightclub shooting - Boyle, Sarah C.; LaBrie, Joseph W.; Costine, Lauren D.; Witkovic, Yong D. (Addictive Behaviors, 2017)
Sexual minority stress experiences (e.g. prejudice, victimization, etc.) and peer substance use norms (e.g. peers' frequency of use and quantity consumed) are important correlates of alcohol and drug use in sexual minority populations. The current study incorporates both of these by examining LGB individuals' perceptions of peers' use of alcohol and other drugs to cope with a sexual minority stressor, and whether perceptions of peer coping norms relate to one's own coping-motivated substance use in response to the stressor. Three-hundred and seven sexual minority males and females who identified as gay, lesbian, or bisexual completed an online survey approximately 1month following the Pulse Nightclub Shooting, the deadliest incident of violence against LGBT people in U.S. history, and a stressor experienced within LGB communities throughout the U.S. Results revealed that LGB peers were widely perceived as likely to have coped with alcohol (68%) and drugs (41%) following the Pulse Shooting; however only small proportions of participants themselves reported coping with alcohol (26%) and drugs (7%). Further, multivariate models revealed that even after controlling for other factors including the stress impact of the Pulse shooting, the odds of using alcohol to cope with this event were 15 times greater among participants who held the perception that LGB peers likely used alcohol to cope relative to those who did not share this perception. Similarly, the odds of using drugs to cope with this event were 9 times greater among participants who perceived LGB peers likely to use drugs to cope with Pulse compared to those who did not. Importantly, these findings suggest that personalized normative feedback designed to correct perceptions of peers' coping motivated substance use may have utility as a motivational component in larger interventions seeking to reduce LGBs' substance use. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Alcohol use; Social norms; Drinking motives; Sexual minorities; Adaptation, Psychological; Adolescent; Adult; Bisexuality; Female; Homosexuality; Humans; Male; Middle Aged; Motivation; Peer Group; Sexual and Gender Minorities; Social Perception; Stress, Psychological; Substance-Related Disorders; Transsexualism; Violence; Young Adult; Alcohol Abuse; Minority Groups; Social Norms; Sexual Minority Groups

Targeted victimization and suicidality among trans people: A web-based survey - Zeluf, Galit; Dhejne, Cecilia; Orre, Carolina; Mannheimer, Louise Nilunger; Deogan, Charlotte; Höijer, Jonas; Winzer, Regina; Thorson, Anna Ekéus (LGBT Health, 2018)
Purpose: The aim of this study was to investigate the associations between a series of empirically known risk and protective factors and suicidality among trans people in Sweden. Methods: Participants were self-selected anonymously to a web-based survey conducted in 2014. Univariable and multivariable logistic regression analyses were performed to assess associations between contributing factors and suicide ideation in the past 12 months and lifetime suicide attempts. Results: The analysis included 796 trans individuals, between 15 and 94 years of age, who live in Sweden. A total of 37% of respondents reported that they have seriously considered suicide during the past 12 months and 32% had ever attempted a suicide. Offensive treatment during the past three months and lifetime exposure to trans-related violence were significantly associated with suicidality. Less satisfaction with contacts with friends and acquaintances and with one's own psychological wellbeing were associated with suicide ideation in the past 12 months. Lack of practical support was associated with lifetime suicide attempts. Conclusions: Our findings show that suicidality is directly correlated with trans-related victimization. Preventing targeted victimization is, therefore, a key preventive intervention against this elevated suicidality. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: life satisfaction; suicide; transgender; victimization; Adolescent; Adult; Aged; Aged, 80 and over; Crime Victims; Female; Humans; Internet; Male; Middle Aged; Suicide; Surveys and Questionnaires; Sweden; Transgender Persons; Young Adult; Health Care Services; Life Satisfaction; Victimization; Suicide; Transgender

Sexual identity and risk behaviors among adolescents in rural Appalachia - Ballard, Mary E.; Jameson, John Paul; Martz, Denise M. (Journal of Rural Mental Health, 2017)
Previous research suggests that rural youth and youth who are lesbian, gay, bisexual, and questioning (LGBQ) have higher risk of multiple psychological and behavioral risk factors compared with their heterosexual counterparts. This study compared risk for bullying victimization, suicide risk, school violence, drug use, and sexual risk behavior between rural LGBQ youth and heterosexual youth. The Youth Risk Behavior Survey (YRBS), developed by the Centers for Disease Control and Prevention (CDC), was administered by the local health department in 2 high schools in rural Appalachia. Findings indicate that rural LGBQ youth are at much higher risk than rural heterosexual youth for suicide risk, bullying victimization, school violence, drug use, and sexual risk behavior. Risk was particularly high for LGBQ youth in regard to bullying victimization and for suicide risks. Further, bullying victimization resulting from the perception of LGBQ status partially mediated drug use, but not suicide risk or school violence. Our results have particular implications for possible interventions targeting LGBQ youth by high school system personnel in rural Appalachia. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: bullying; victimization; risk; LGBTQ; rural youth; Gender Identity; Risk Factors; Rural Environments; Bullying; Adolescent Characteristics; Bisexuality; Lesbianism; Male Homosexuality; Sexual Orientation; Suicide; Victimization; Transgender; LGBTQ

Discrimination, mental health, and suicidal ideation among LGBTQ people of color - Sutter, Megan; Perrin, Paul B. (Journal of Counseling Psychology, 2016)
Discrimination based on race/ethnicity, sexual orientation, and gender identity has been linked to many negative psychological and physical health outcomes in previous research, including increased suicidal ideation. Two hundred lesbian, gay, bisexual, transgender, and queer (LGBTQ) people of color (POC) were surveyed on their experiences of LGBTQ-based discrimination, racism, mental health (depression, anxiety, satisfaction with life), and suicidal ideation in a national online study based in the United States. A structural equation model (SEM) was created and found that LGBTQ-based discrimination exerted an indirect effect on suicidal ideation through mental health. Racism exerted a direct effect on mental health but was not associated with suicidal ideation in the SEM. The effects of LGBTQ-based discrimination on mental health may be a key area for interventions to reduce suicidal ideation in LGBTQ POC. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: discrimination; LGBTQ; mental health; suicidal ideation; racial/ethnic minorities; Adult; Anxiety Disorders; Bisexuality; Depressive Disorder; Female; Gender Identity; Homosexuality, Female; Homosexuality, Male; Humans; Male; Mental Health; Racism; Social Discrimination; Suicidal Ideation; Surveys and Questionnaires; Transgender Persons; United States; Young Adult; Mental Health; Minority Groups; Racism; Sexual Orientation; Suicidal Ideation; Anxiety Disorders; Bisexuality; Discrimination; Lesbianism; Life Satisfaction; Major Depression; Male Homosexuality; Transgender; LGBTQ

Relationship among gender-related stress, resilience factors, and mental health in a Midwestern US transgender and gender-nonconforming population - Brennan, Stephanie L.; Irwin, Jay; Drincic, Andjela; Amoura, N. Jean; Randall, Amanda; Smith-Sallans, Megan (International Journal of Transgenderism, 2017)
Background: Transgender and gender-nonconforming individuals experience more discrimination than their cisgender peers, and this discrimination can be associated with poorer mental health. This study used the gender minority stress model as a framework to examine the relationship among gender-related stressors and resilience factors and mental health outcomes. The study particularly aimed to increase knowledge of the gender-nonconforming population. Methods: A community sample of 83 individuals that identify as a gender different than the sex assigned to them at birth completed an online survey. Depression and anxiety were assessed using the Center for Epidemiological Studies Depression Scale (CES-D) and Beck Anxiety Inventory (BAI), respectively. The Gender Minority Stress and Resilience measure was used to assess distal and proximal stressors and resilience factors. Results: The median CES-D and BAI scores were 16 and 13, respectively. Forty percent had a history of non-suicidal self-injury (NSSI), 75% had experienced suicidal ideation, and 45% had attempted suicide. Proximal stress was found to be a positive predictor of depressive symptoms. Resilience was a weak negative predictor of anxiety symptoms. Distal stress was a positive predictor of suicide attempts, and resilience factors and hormone use were marginal negative predictors of suicide attempt. Trans women were significantly less likely to have engaged in NSSI, but had a significantly higher proximal stress score than trans men and gender-nonconforming individuals. Conclusion: Our study found high rates of mental health problems in the trans and gender-nonconforming sample. Our findings in part support the gender minority stress model, with gender-related stress predicting certain mental health problems and resilience being a negative predictor. Overall, gender-nonconforming individuals have had similar experiences and mental health findings as transgender individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Gender-nonconforming; gender-related stress; mental health; non-suicidal self-injury; resilience; transgender; Discrimination; Mental Health; Resilience (Psychological); Stress; Transgender; Anxiety; Depression (Emotion); Nonconformity (Personality); Gender Nonconforming

Pathways to suicide in lesbian and gay populations in Australia: A life chart analysis - Skerrett, Delaney M.; Kõlves, Kairi; Leo, Diego (Archives of Sexual Behavior, 2017)
Given the continued paucity of research into suicide in lesbian and gay (LG) people, there is a need to investigate the characteristics of those LG suicides that are able to be identified. The aim of this article was to analyze pathways to suicide in lesbian and gay individuals by way of life charts. Data were gathered through of 24 psychological autopsy interviews with next-of-kin of an LG person who had died by suicide. The female (n = 5) and male (n = 19) cases in this study clustered into younger and older suicides. The defining feature of the younger suicides was lack of acceptance by family and, to a lesser extent, self, and that of the older suicides was romantic relationship conflict, although this was also common in younger suicides. There appears to have been, furthermore, an accumulation of risk factors, particularly in the period prior to death where these specific risk factors combined with other life stressors, such as work problems. Initiatives to reduce stigma around diversity in sexuality and to support families and young people through the 'coming out' process as well as services designed to assist those experiencing problems in same-sex relationships, in particular, would appear to be the most relevant within the trajectories presented. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: lesbian; gay; suicide; risk factors; psychological autopsy; sexual orientation; Lesbianism; Male Homosexuality; Psychological Autopsy; Sexual Orientation; Suicide

A tailored compassion-focused therapy program for sexual minority young adults with depressive symotomatology: Study protocol for a randomized controlled trial - Pepping, Christopher A.; Lyons, Anthony; McNair, Ruth; Kirby, James N.; Petrocchi, Nicola; Gilbert, Paul (BMC Psychology, 2017)
Background: Lesbian, gay, and bisexual (LGB) men and women represent one of the highest-risk populations for depressive symptomatology and disorders, with young LGB adults being at greatest risk. To date, there have been no randomized controlled trials (RCT) to specifically target depressive symptoms in young LGB adults. This is despite research highlighting unique predictors of depressive symptomatology in this population. Here we outline a protocol for an RCT that will test the preliminary efficacy of a tailored compassion-focused therapy (CFT) intervention for young LGB adults compared with a self-directed cognitive behavioral therapy (CBT) program with no specific tailoring for LGB individuals. Methods: The CFT intervention consists of 8 units with self-directed reading and activities tailored to LGB young adults, and 8 x weekly 1-hour consultations with a therapist. The CBT intervention consists of 8 units with self-guided reading and activities, with 1 x 1-hour session with a therapist at the mid-point of therapy. Fifty LGB individuals with scores of 13 or above on the Beck Depression Inventory-II will be randomized to either the CFT or CBT condition. The primary outcome measure is depressive symptomatology. Secondary outcome measures are symptoms of anxiety, suicidal ideation, internalized homophobia, self-compassion, and shame and guilt proneness. Assessments will occur at pre-intervention, post-intervention, and at 3-month post-intervention. Discussion: This study is an RCT to test the preliminary efficacy of an LGB-tailored compassion-focused intervention for young LGB adults with depressive symptomatology. If this intervention is efficacious, this could begin to address the substantial mental health disparities amongst sexual minorities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Lesbian; Gay; Bisexual; Depression; Compassion; Sexual minority; Adolescent; Adult; Clinical Protocols; Cognitive Therapy; Depression; Empathy; Female; Humans; Male; Psychotherapy; Quality of Life; Research Design; Sexual Behavior; Sexual Minorities; Shame; Stress, Psychological; Suicidal Ideation; Young Adult; Cognitive Behavior Therapy; Homosexuality; Major Depression; Sympathy; Treatment Effectiveness Evaluation; Bisexuality; Lesbianism; Male Homosexuality; Minority Groups; Sexual Minority Groups

Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth - Baams, Laura; Grossman, Arnold H.; Russell, Stephen T. (Developmental Psychology, 2015)
The experience of minority stress is often named as a cause for mental health disparities among lesbian, gay, and bisexual (LGB) youth, including higher levels of depression and suicidal ideation. The processes or mechanisms through which these disparities occur are understudied. The interpersonal-psychological theory of suicide posits 2 key mechanisms for suicidal ideation: perceived burdensomeness and thwarted belongingness (Joiner et al., 2009). The aim of the current study is to assess the mental health and adjustment among LGB youth emphasizing the minority stress model (Meyer, 2003) and the interpersonal-psychological theory of suicide (Joiner et al., 2009). With a survey of 876 LGB self-identified youth, levels of coming-out stress, sexual orientation victimization, perceived burdensomeness, thwarted belongingness, depression, and suicidal ideation were examined. The results of a multigroup mediation model show that for all gender and sexual identity groups, the association of sexual orientation victimization with depression and suicidal ideation was mediated by perceived burdensomeness. For gay, lesbian, and bisexual girls coming-out stress was also found to be related to depression and suicidal ideation, mediated by perceived burdensomeness. The results suggest that feeling like a burden to 'people in their lives' is a critical mechanism in explaining higher levels of depression and suicidal ideation among LGB youth. These results have implications for community and social support groups, many of which base their interventions on decreasing social isolation rather than addressing youths’ beliefs of burdensomeness. Implications for future research, clinical and community settings are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: depression; LGB youth; minority stress; interpersonal-psychological theory of suicide; suicidal ideation; Adolescent; Bisexuality; Crime Victims; Depression; Female; Homosexuality, Female; Homosexuality, Male; Humans; Interpersonal Relations; Male; Minority Groups; Psychological Theory; Risk Factors; Stress, Psychological; Suicidal Ideation; Young Adult; Bisexuality; Lesbianism; Male Homosexuality; Stress; Suicidal Ideation; Major Depression; Minority Groups; Sexual Orientation; Suicide; Theories; Victimization; Health Disparities; Minority Stress

Editorial: Minding the gap—Research on sexual minority and gender nonconforming children and adolescents - Zeanah, Charles H.; Myint, Myo Thwin (Journal of Child Psychology and Psychiatry, 2017)
This editorial highlights the gap in research on sexual minority and gender nonconforming children and adolescents. With changing cultural norms, research on sexual minority and gender nonconforming children has been increasing, both in clinical and community samples. One of the reasonably consistent findings has been that these children and adolescents are at increased risk not only for anxiety disorders but also for depression, self-harm, and suicidality. As we mind the gap between future research findings about the development and management of gender nonconformity and the political/cultural assumptions and conflicts surrounding it, we must think carefully about how best to educate and support sexual minority and gender non-conforming youth and their families on an individualized basis, with their well-being and safety in mind. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: research gap; sexual minority; gender nonconforming; children; adolescents; Adolescent; Child; Gender Dysphoria; Humans; Transgender Persons; Adolescent Psychology; Child Psychology; Minority Groups; Sexual Orientation; Sexual Minority Groups; Gender Nonconforming

Suicidality, self‐harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria - Peterson, Claire M.; Matthews, Abigail; Copps‐Smith, Emily; Conard, Lee Ann (Suicide and Life-Threatening Behavior, 2017)
Prevalence of suicide attempts, self-injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty-seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self-injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female-to- male youth reported a history of suicide attempts and self-harm behaviors than male-to-female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life-threatening behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: dysphoria; symptoms; severity; Adolescent; Body Image; Emotions; Female; Gender Dysphoria; Humans; Male; Medical Audit; Prevalence; Retrospective Studies; Self-Injurious Behavior; Suicidal Ideation; Suicide; Suicide, Attempted; Transgender Persons; Young Adult; Attempted Suicide; Body Image Disturbances; Self-Injurious Behavior; Transgender; Emerging Adulthood; Suicidal Ideation; Gender Dysphoria; Suicidality

'It gets better': Internet memes and the construction of collective identity - Gal, Noam; Shifman, Limor; Kampf, Zohar (New Media & Society, 2016)
In September 2010, a video titled 'It Gets Better' was uploaded to YouTube, responding to suicides of gay teens who had suffered from homophobic bullying. Before long, thousands of Internet users added their own versions of the clip, creating a mass appeal to young people while simultaneously negotiating the norms of lesbian, gay, bisexual, transgender and queer (LGBTQ) collective identity. Conceptualizing this body of videos as an Internet meme, we examine the extent to which participants imitate or alter textual components presented in previous videos. A combined quantitative and qualitative analysis of 200 clips shows that in an arena ostensibly free of formal gatekeepers, participants tend to police themselves, toeing the line with conformist norms. We also identify domains of potential subversion, related not only to the content of the videos but mainly to the forms facilitated by digital media. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Collective identity; It Gets Better; LGBTQ; memes; participation; representation; Collective Behavior; Communication; Homosexuality; Internet; Suicide Prevention; Lesbianism; Technology; Social Media; LGBTQ

Associations of outside- and within-school adult support on suicidality: Moderating effects of sexual orientation - Coulter, Robert W. S.; Kessel Schneider, Shari; Beadnell, Blair; O'Donnell, Lydia (American Journal of Orthopsychiatry, 2017)
This study examined sexual-orientation differences in reports of outside- and within-school adult support, and whether sexual orientation moderates the associations between adult support and suicidality (i.e., thoughts, plans, and attempts). At 26 high schools across MetroWest Boston, 22,834 students completed surveys assessing: sexual orientation (heterosexual, gay/lesbian, bisexual, or questioning); presence of outside- and within-school adult support; and past-year suicidality. Multivariable regression analyses with General Estimating Equations (adjusting for gender, grade, and race/ethnicity) examined sexual-orientation subgroup differences in adult support, and how sexual orientation and adult support were associated with suicidality. Interaction terms tested whether relationships between adult support and suicidality were moderated by sexual orientation. Gay/lesbian, bisexual, and questioning youth were each less likely than heterosexuals to report having outside-school adult support (risk ratios range: 0.85–0.89). Each group also had greater odds than heterosexuals for suicidal thoughts (odds ratios [ORs] range: 1.86–5.33), plans (ORs range: 2.15–5.22), and attempts (ORs range: 1.98–7.90). Averaged across sexual-orientation subgroups, outside-school support was more protective against suicidality (ORs range: 0.34–0.35) than within-school support (ORs range: 0.78–0.82). However, sexual orientation moderated the protective effects of outside-school adult support, with support being less protective for bisexual and questioning youth than for heterosexuals. Adult support, and particularly outside-school adult support, is associated with lower suicidality. However, fewer gay/lesbian, bisexual, and questioning youth can rely on outside-school support and, even if present, it may be less protective against suicidality. Interventions are needed to help adults support gay/lesbian, bisexual, and questioning youth and reduce suicidality disparities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: suicidality; adult support; mental health; sexual orientation; Adolescent; Adult; Female; Health Surveys; Heterosexuality; Humans; Male; Schools; Sexual Behavior; Sexual and Gender Minorities; Social Support; Suicidal Ideation; Suicide, Attempted; Mental Health; Sexual Orientation; Social Support; Suicidal Ideation; Suicidality; High School Students

Religious conflict, sexual identity, and suicidal behaviors among LGBT young adults - Gibbs, Jeremy J.; Goldbach, Jeremy (Archives of Suicide Research, 2015)
This is the first known study to explore how religious identity conflict impacts suicidal behaviors among lesbian, gay, bisexual, and transgender (LGBT) young adults and to test internalized homophobia as a mediator. A secondary analysis of 2,949 youth was conducted using a national dataset collected by OutProud in 2000. Three indicators of identity conflict and an internalized-homophobia scale (mediator), were included in logistic regressions with three different suicide variable outcomes. Internalized homophobia fully mediates one conflict indicator and partially mediates the other two indicators’ relationship with suicidal thoughts. Internalized homophobia also fully mediates the relationship between one conflict indicator and chronic suicidal thoughts. Two indicators were associated with twice the odds of a suicide attempt. LGBT young adults who mature in religious contexts have higher odds of suicidal thoughts, and more specifically chronic suicidal thoughts, as well as suicide attempt compared to other LGBT young adults. Internalized homophobia only accounts for portions of this conflict. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: identity; LGBT; religion; suicide; young adults; Gender Identity; Homosexuality (Attitudes Toward); Religious Beliefs; Sexual Orientation; Suicide; Attempted Suicide; Bisexuality; Lesbianism; Male Homosexuality; Religion; Transgender

The 2015 national Canadian homeless youth survey: Mental health and addiction findings - Kidd, Sean A.; Gaetz, Stephen; O'Grady, Bill (The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 2017)
Objective: This study was designed to provide a representative description of the mental health of youth accessing homelessness services in Canada. It is the most extensive survey in this area to date and is intended to inform the development of mental health and addiction service and policy for this marginalized population. Methods: This study reports mental health–related data from the 2015 'Leaving Home' national youth homelessness survey, which was administered through 57 agencies serving homeless youth in 42 communities across the country. This self-reported, point-in-time survey assessed a broad range of demographic information, pre-homelessness and homelessness variables, and mental health indicators. Results: Survey data were obtained from 1103 youth accessing Canadian homelessness services in the Nunavut territory and all Canadian provinces except for Prince Edward Island. Forty-two per cent of participants reported 1 or more suicide attempts, 85.4% fell in a high range of psychological distress, and key indicators of risk included an earlier age of the first episode of homelessness, female gender, and identifying as a sexual and/or gender minority (lesbian, gay, bisexual, transgender, queer, and 2 spirit [LGBTQ2S]). Conclusions: This study provides clear and compelling evidence of a need for mental health support for these youth, particularly LGBTQ2S youth and female youth. The mental health concerns observed here, however, must be considered in the light of the tremendous adversity in all social determinants faced by these youth, with population-level interventions best leveraged in prevention and rapid response. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: homeless youth; street youth; homeless adolescent; mental illness; addictions; mental health; Canada; national; Drug Addiction; Homeless; Mental Disorders; Mental Health

Muslim mass shooters are perceived as less mentally ill and more motivated by religion - Mercier, Brett; Norris, Adam; Shariff, Azim F. (Psychology of Violence, 2018)
Objective: We test whether prejudice can influence lay attributions of mental illness to perpetrators of violence. Specifically, we examine whether people with negative attitudes toward Muslims perceive Muslim mass shooters as less mentally ill than non-Muslim shooters. Method: Study 1 compares attributions of mental illness to Muslim and non-Muslim perpetrators of recent mass shootings. Studies 2 and 3 experimentally test whether a mass shooter described in a news article is seen as less mentally ill when described as being a Muslim, compared with when described as a Christian (Study 2) and when religion is not mentioned (Study 3). Study 4 tests whether a Muslim shooter is seen as less mentally ill than a Christian shooter, even when both shooters have symptoms of mental illness. Results: In all studies, Muslim shooters were seen as less mentally ill than non-Muslim shooters, but only by those with negative views toward Muslims. Conclusion: Those with anti-Muslim prejudices perceive Muslim mass shooters as less mentally ill, likely to maintain culpability and fit narratives about terrorism. This may reinforce anti-Muslim attitudes by leading those with anti-Muslim prejudice to overestimate the amount of violence inspired by groups like the Islamic State of Iraq and Syria (ISIS) relative to extremist groups from other ideologies. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: prejudice; Muslims; terrorism; mental illness; mass shootings; Motivation; Prejudice; Religious Beliefs; Terrorism; Mass Murder; Perpetrators; Test Construction; Violence

Clinical barriers to effective treatment of eating disorders and co-occurring psychiatric disorders in transgendered individuals - Wagner, Rebecca; Stevens, Jonathan R. (Journal of Psychiatric Practice, 2017)
Eating disorders (EDs) are complex and difficult to treat illnesses that are often chronic and disabling on their own accord or due to comorbidity with other psychiatric conditions. Historically, EDs have been viewed as illnesses of heterosexual, affluent white females. This stereotype increases the likelihood that these disorders will be underrecognized in the lesbian, gay, bisexual, and transgender community, as well as in different gender, socioeconomic, and ethnic populations. Our case report illustrates the clinical difficulties of managing a patient who presented to inpatient treatment with complaints of depression and suicidality, but who also had an active ED and was transgender. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: eating disorders; transgender; comorbidity; shame; suicide; Comorbidity; Eating Disorders; Shame; Suicide; Transgender

Sexual orientation and suicidal behaviour in adolescents and young adults: Systematic review and meta-analysis - Miranda-Mendizábal, A.; Castellví, P.; Parés-Badell, O.; Almenara, J.; Alonso, l.; Blasco, M. J.; Cebrià, A.; Gabilondo, A.; Gili, M.; Lagares, C.; Piqueras, J. A.; Roca, M.; et al. (The British Journal of Psychiatry, 2017)
Background: Research suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors. Aims: To assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults. Method: A systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis. Results: Sexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups. Conclusions: Sexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: sexual orientation; suicidal behavior; risk factors; age differences; Age Differences; Risk Factors; Sexual Orientation; Suicidal Ideation; Adolescent Development

Liberals possess more national consensus on political attitudes in the United States: An examination across 40 years - Ondish, Peter; Stern, Chadly (Social Psychological and Personality Science, 2018)
Do liberals or conservatives have more agreement in their political attitudes? Recent research indicates that conservatives may have more like-minded social groups than do liberals, but whether conservatives have more consensus on a broad, national level remains an open question. Using two nationally representative data sets (the General Social Survey and the American National Election Studies), we examined the attitudes of over 80,000 people on more than 400 political issues (e.g., attitudes toward welfare, gun control, same-sex marriage) across approximately 40 years. In both data sets, we found that liberals possessed a larger degree of agreement in their political attitudes than did conservatives. Additionally, both liberals and conservatives possessed more consensus than did political moderates. These results indicate that social–cognitive motivations for building similarity and consensus within one’s self-created social groups may also yield less consensus on a broad, national level. We discuss implications for effective political mobilization and social change. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: political ideology; consensus; political attitudes; Political Attitudes; Politics; Social Psychology

LGBTQ adolescents of color: Considerations for working with youth and their families - Murphy, James; Hardaway, Rashad (Journal of Gay & Lesbian Mental Health, 2017)
Adolescence is a period during which youth are tasked with self-discovery and formation of their identity. This may be more challenging for youths of minority backgrounds. LGBTQ individuals have the additional task of understanding who they are in comparison to heterosexual peers. For LGBTQ youth of color, however, a multiple minority status can lead to particular psychosocial vulnerabilities. These vulnerabilities are noted in family and social life, and may occur in both online and in-person settings. A review of literature as it pertains to a clinical vignette was performed, highlighting risk factors and protective factors for LGBTQ youth of color during adolescence. Cross-sectional data and longitudinal studies have been noted to show that sexual minority youth of color are at increased risk of relationships with adult individuals, substance use, suicidal ideation and suicide attempts, and trauma. In light of this, minority status may be a protective factor in these youths' lives. It is important for clinicians to be aware of the intersectionality of LGBTQ status and racial/ethnic identity, as this may yield to increased risk for psychosocial stressors and comorbidities. Furthermore, clinicians should be aware of resources for patient referral to mitigate these factors. Further research is needed to understand the complex dynamics that occur in the lives of LGBTQ youth of color. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Adolescent; intersectionality; LGBTQ; racial minority; sexual minority; Bisexuality; Lesbianism; Male Homosexuality; Transgender; Adolescent Characteristics; Family Members; Health; Homosexuality; Sexual Minority Groups; LGBTQ

Religion-related stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a South African rural-based university - Mavhandu-Mudzusi, Azwihangwisi Helen; Sandy, Peter Thomas (Culture, Health & Sexuality, 2015)
This paper reports on the stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a rural university in South Africa. Twenty lesbian, gay, bisexual and transgender students recruited through snowball sampling participated in this study. Interpretative Phenomenological Analysis was used as a framework for data analysis. Findings indicate that religion-related stigma and discrimination are common at a rural-based university in South Africa. Lesbian, gay, bisexual and transgender students are typically ascribed a range of labels, including ‘sinners’, ‘devils’ and ‘demon possessed’. They are also exposed to a number of discriminatory acts, such as the denial of financial and healthcare services and threats of and/or actual rape. Study participants reported attempts to convert lesbian, gay, bisexual and transgender students' sexual orientation which involved the use of intervention in the form of prayers. Derogatory labelling and associated discriminatory acts, for example the threat of rape, led many students to conceal their sexual identity, not attend specific classes, terminate their studies and even attempt suicide. Universities should develop policies to promote greater social inclusion and the acceptance of lesbian, gay, bisexual and transgender students. Policies should also specify the steps or approaches to be taken in addressing discriminatory practices. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: homophobia; lesbian; gay; bisexual and transgender students; religion; rural-based university; South Africa; Adult; Bisexuality; Female; Homophobia; Homosexuality; Humans; Male; Religion and Psychology; Rural Population; Social Stigma; South Africa; Stereotyping; Students; Transgender Persons; Universities; Young Adult; College Students; Psychosexual Behavior; Religion; Sexual Orientation; Stigma; Bisexuality; Homosexuality; Homosexuality (Attitudes Toward); Lesbianism; Transgender

Emotional health of lesbian, gay, bisexual and questioning bullies: Does it differ from straight bullies? - Eisenberg, Marla E.; Gower, Amy L.; McMorris, Barbara J. (Journal of Youth and Adolescence, 2016)
Research demonstrates that young people involved in bullying are at greater risk for poor emotional health outcomes, but this association may not be consistent for youth of different sexual orientations. Understanding the unique needs of lesbian, gay, bisexual and questioning (LGBQ) youth may suggest important opportunities for intervention and prevention. This study, therefore, examines whether involvement with bullying is differentially associated with emotional well-being across sexual orientation. Survey data were collected from a large statewide sample of 9th and 11th grade students in 2013 (N = 79,039, 49.8 % female, 74.6 % white). Logistic regression tested associations between sexual orientation, physical or relational bullying perpetration and five measures of emotional health. In the full sample, those reporting bullying perpetration had significantly elevated odds of emotional health problems. However, interaction terms and stratified models indicated that in nine out of ten physical bullying models and two out of ten relational bullying models, perpetration was not as strongly associated with poor emotional health among LGBQ adolescents as it was among heterosexual youth. Possible explanations for this finding include unhealthy coping strategies or masking one’s own vulnerable status as LGBQ. Continued efforts to prevent bullying are needed for all youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Bullying; Emotional health; Suicide; Sexual orientation; Adolescent; Adolescent Behavior; Bisexuality; Bullying; Crime Victims; Female; Heterosexuality; Homosexuality; Humans; Male; Mental Health; Minnesota; Peer Group; Surveys and Questionnaires; Homosexuality (Attitudes Toward); Mental Disorders; Sexual Orientation; Well Being; Bullying; Attempted Suicide; Bisexuality; Lesbianism; Male Homosexuality; Self-Injurious Behavior; Social Discrimination; Suicidal Ideation; Adolescent Characteristics; Emotional Health

Family functioning and mental health of transgender and gender-nonconforming youth in the trans teen and family narratives project - Katz-Wise, Sabra L.; Ehrensaft, Diane; Vetters, Ralph; Forcier, Michelle; Austin, S. Bryn (Journal of Sex Research, 2018)
Transgender and gender-nonconforming (TGN) youth are at increased risk for adverse mental health outcomes, but better family functioning may be protective. This study describes TGN youth’s mental health and associations with family functioning in a community-based sample. Participants were from 33 families (96 family members) and included 33 TGN youth, ages 13 to 17 years; 48 cisgender (non-transgender) caregivers; and 15 cisgender siblings. Participants completed a survey with measures of family functioning (family communication, family satisfaction) and mental health of TGN youth (suicidality, self-harm, depression, anxiety, self-esteem, resilience). TGN youth reported a high risk of mental health concerns: suicidality (15% to 30%), self-harm (49%), clinically significant depressive symptoms (61%); and moderate self-esteem (M = 27.55, SD = 7.15) and resiliency (M = 3.67, SD = 0.53). In adjusted models, better family functioning from the TGN youth’s perspective was associated with better mental health outcomes among TGN youth (β ranged from −0.40 to −0.65 for self-harm, depressive symptoms, and anxious symptoms, and 0.58 to 0.70 for self-esteem and resiliency). Findings from this study highlight the importance of considering TGN youth’s perspectives on the family to inform interventions to improve family functioning in families with TGN youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: family functioning; mental health; transgender; gender-nonconforming youth; trans teen; family narratives; Adolescent Development; Family Relations; Mental Health; Narratives; Transgender; Gender Nonconforming

The lifetime prevalence of psychiatric diagnoses in an academic gender reassignment service - Grobler, Gerhard P. (Current Opinion in Psychiatry, 2017)
Purpose of review: To review the literature regarding the prevalence of mental health concerns, including psychiatric diagnoses in the TGNC community. Recent findings: Gender dysphoria is not the only mental health concern experienced by some members of TGNC people. Stigma and discrimination play a role in the development of mental health concerns. Even after reassignment surgery some members of the TGNC community is almost five times more likely to attempt suicide. Using a structured clinical psychiatric interview improves the likelihood of recognizing the presence of psychiatric diagnoses. Nonaffirming attitudes and behavior seem to predispose to psychiatric symptoms in some members of the TGNC community and impacts on family and peer relationships. Psychiatric symptoms are often hidden for fear of further discrimination. Summary: A significant proportion of the TGNC community present with mental health concerns. Clinicians should screen appropriately for these concerns. Gender affirming interventions generally have an efficacious effect. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: gender affirming interventions; mental health concerns; psychiatric diagnoses; transgender and gender nonconforming community; Gender Dysphoria; Humans; Mental Health; Prevalence; Psychological Techniques; Sex Reassignment Surgery; Suicide; Gender Identity; Medical Diagnosis; Mental Health; Psychiatric Evaluation; Transgender; Gender Dysphoria; Gender Nonconforming

Conflating sexual orientation and gender identity - White, Margaret I. (The British Journal of Psychiatry, 2017)
Comments on an article, Sexual Orientation and Suicidal Behaviour in Young People by Nick Meader and Melissa K. Y. Chan (2017). It is ironic that an editorial which highlights the lack of knowledge of lesbian, gay, bisexual and transgender (LGBT) issues among healthcare professionals should open with a sentence that conflates sexual orientation with gender identity. Using ‘heterosexual’ as a contrast to LGBT is inaccurate, as any number of trans heterosexual individuals could attest to. In their discussion of Miranda-Mendizábal et al.'s paper, Meader & Chan make it clear that the paper only covers LGB youth, and that differing sexual orientations within this group may lead to differing experiences; however, in the rest of their editorial ‘LGBT youth’ is treated as a monolithic entity. It is also perhaps disappointing that the first suggestion of why transgender young people have a greater risk of suicidality is ‘higher rates of stigma’. Although this is undoubtedly important, there is increasing evidence that supporting transgender young people to live and present as their gender identity improves mental health outcomes. Psychiatry and psychiatrists often have a poor reputation among sexual minority groups, for very understandable historical reasons. To overcome this, we need to provide genuinely inclusive care - which starts with knowledge and understanding. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: sexual orientation; LGBT; suicidal ideation; sexuality; gender identity; Gender Identity; Sexual Orientation; Sexuality; Bisexuality; Lesbianism; Male Homosexuality; Suicidal Ideation; Transgender

Intimate partner violence against women in northwestern Botswana: The Maun women’s study - Barchi, Francis; Winter, Samantha; Dougherty, Danielle; Ramaphane, Peggie (Violence Against Women, 2018)
Factors characterizing intimate partner violence (IPV) against women vary according to setting and must be understood in localized environments if effective interventions are to be identified. This 2009-2010 exploratory study in Maun, Botswana, used semistructured interviews to elicit information from 469 women about their experiences with IPV. Characteristics found to be important included suicide attempts, childhood exposure to familial violence, access to and control over certain tangible assets, number of children, household location and monthly income, controlling behavior by a partner, and alcohol consumption. Controlling behavior by a partner was the single greatest predictor of physical or psychological IPV. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Botswana; intimate partner violence; women’s health; gender-based violence; Adolescent; Adult; Aged; Botswana; Cross-Sectional Studies; Female; Humans; Interpersonal Relations; Interviews as Topic; Intimate Partner Violence; Middle Aged; Prospective Studies; Risk Factors; Surveys and Questionnaires; African Cultural Groups; Human Females; Intimate Partner Violence; Sexual Abuse; Health Outcomes; Domestic Violence; Human Sex Differences; Risk Factors; Test Construction

Applying a general strain theory framework to understand school weapon carrying among LGBQ and heterosexual youth - Button, Deeanna M.; Worthen, Meredith G. F. (Criminology: An Interdisciplinary Journal, 2017)
Lesbian, gay, bisexual, and questioning (LGBQ) youth are at a higher risk for school victimization, social isolation, and school weapon carrying compared with their heterosexual peers, yet few studies have been conducted to investigate their experiences. By using a general strain theory (GST) framework, data from the Youth Risk Behavior Survey (YRBS) statewide probability sample of Delaware heterosexual (n = 7,688) and LGBQ (n = 484) youth in grades 9–12 show that there are both similarities and differences in the factors associated with school weapon carrying among LGBQ and heterosexual youth. LGBQ and heterosexual youth's weapon carrying is related to school victimization, but social support does not moderate the relationship between school victimization and school weapon carrying as suggested by GST. Furthermore, being male is significantly related to heterosexual youth's weapon carrying, but sex is not related to weapon carrying among LGBQ youth. Overall, the results highlight a need to reconceptualize GST to help center the experiences of LGBQ youth, a historically marginalized group, within mainstream criminological literature. Theoretical and policy implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: school weapon carrying; LGBQ; lesbian; gay; bisexual; social support; social isolation; victimization; general strain theory; school violence; Firearms; Group Differences; School Violence; Sexual Orientation; Victimization; Conflict; Social Isolation; Social Support

Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital - Plöderl, Martin; Kunrath, Sabine; Cramer, Robert J.; Wang, Jen; Hauer, Larissa; Fartacek, Clemens (BMC Psychiatry, 2017)
Background: Sexual minority (SM) individuals (gay, lesbian, bisexual, or otherwise nonheterosexual) are at increased risk for mental disorders and suicide and adequate mental healthcare may be life-saving. However, SM patients experience barriers in mental healthcare that have been attributed to the lack of SM-specific competencies and heterosexist attitudes and behaviors on the part of mental health professionals. Such barriers could have a negative impact on common treatment factors such as treatment expectancy or therapeutic alliance, culminating in poorer treatment outcomes for SM versus heterosexual patients. Actual empirical data from general psychiatric settings is lacking, however. Thus, comparing the treatment outcome of heterosexual and SM patients at risk for suicide was the primary aim of this study. The secondary aim was to compare treatment expectation and working alliance as two common factors. Methods: We report on 633 patients from a suicide prevention inpatient department within a public psychiatric hospital. Most patients were at risk for suicide due to a recent suicide attempt or warning signs for suicide, usually in the context of a severe psychiatric disorder. At least one indicator of SM status was reported by 21% of patients. We assessed the treatment outcome by calculating the quantitative change in suicide ideation, hopelessness, and depression. We also ran related treatment responder analyses. Treatment expectation and working alliance were the assessed common factors. Results: Contrary to the primary hypothesis, SM and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis. Contrary to the secondary hypothesis, there were no significant sexual orientation differences in treatment expectation and working alliance. When adjusting for sociodemographics, diagnosis, and length of stay, some sexual orientation differences became significant, indicating that SM patients have better outcomes. Conclusions: These unexpected but positive findings may be due to common factors of therapy compensating for SM-specific competencies. It may also be due to actual presence of SM competencies—though unmeasured—in the department. Replication in other treatment settings and assessment of SM-specific competencies are needed, especially in the field of suicide prevention, before these findings can be generalized. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: Gay; Lesbian; Suicide; Treatment; Common factors; Client Attitudes; Minority Groups; Psychiatric Hospitalization; Sexual Orientation; Treatment Outcomes; At Risk Populations; Expectations; Suicide; Suicide Prevention; Therapeutic Alliance

Mental health of transgender people in Hong Kong: A community-driven, large-scale quantitative study documenting demographics and correlates of quality of life and suicidality - Suen, Yiu Tung; Chan, Randolph Chun Ho; Wong, Eliz Miu Yin (Journal of Homosexuality, 2018)
A community-driven survey of 106 transgender people (the first such survey in Hong Kong) showed that: (1) more than half the sample (50.9%) had a university degree or higher qualification; (2) despite this, 43.4% had a monthly income below HK$6,000 (about USD$775); (3) 66% reported 'fair' or 'poor' quality of life; (4) 67% of the sample (87.1% of respondents aged 15–24 years) had contemplated suicide; and (5) 20.8% of the sample (35.5% of respondents aged 15–24 years) had attempted suicide. It was found that (1) those who were single, had a lower monthly income, and identified as transgender women reported lower quality of life; and (2) those who were younger and on a lower income expressed higher suicidality. The findings suggest that service providers and policy makers urgently need to address the mental health needs of transgender people, particular younger transgender people. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Hong Kong; LGBT; mental health; quality of life; suicide attempt; suicide ideation; transgender; Adolescent; Adult; Demography; Female; Hong Kong; Humans; Income; Male; Mental Health; Middle Aged; Quality of Life; Suicide, Attempted; Surveys and Questionnaires; Transgender Persons; Transsexualism; Demographic Characteristics; Mental Health; Quality of Life; Suicide; Transgender

Considerations when providing mental health first aid to an LGBTIQ person: A Delphi study - Bond, K. S.; Jorm, A. F.; Kelly, C. M.; Kitchener, B. A.; Morris, S. L.; Mason, R. J. (Advances in Mental Health, 2017)
Objective: A Delphi study was conducted to develop guidelines on considerations when providing sensitive and appropriate mental health first aid to a lesbian, gay, bisexual, transgender, intersex and queer or questioning (LGBTIQ) person. These can be used in conjunction with existing guidelines when assisting a person who might be experiencing a mental health problem or crisis. Methods: A systematic search of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions needed for assisting an LGBTIQ person who is experiencing mental health problems. These items were rated over three survey rounds by an expert panel according to whether they should be included in the guidelines. Results: Seventy-five mental health professionals who were part of the LGBTIQ community or who treated people from the LGBTIQ community participated in the study. Of the 209 items that were rated over the 3 rounds, 164 items were endorsed by at least 80% of panel members. These items formed the basis of the guidelines document that outlines what a person needs to consider when providing mental health first aid to an LGBTIQ person with mental health problems. Conclusion: This research highlighted the complexity of supporting an LGBTIQ person with mental health problems, but also provided specific advice on how to address these complexities. It is hoped that these guidelines will increase support, and decrease stigma and discrimination towards LGBTIQ people who are experiencing mental health problems. More specifically, the guidelines will be used to supplement the content of Mental Health First Aid training courses. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: Mental health problems; LGBTIQ; mental health first aid; Delphi; Lesbianism; Male Homosexuality; Mental Health; Mental Health Services; Mental Disorders

'I should have …': A photovoice study with women who have lost a man to suicide - Creighton, Genevieve; Oliffe, John L.; Bottorff, Joan; Johnson, Joy (American Journal of Men's Health, 2018)
While the gendered nature of suicide has received increased research attention, the experiences of women who have lost a man to suicide are poorly understood. Drawing on qualitative photovoice interviews with 29 women who lost a man to suicide, we completed a narrative analysis, focused on describing the ways that women constructed and accounted for their experiences. We found that women’s narratives drew upon feminine ideals of caring for men’s health, which in turn gave rise to feelings of guilt over the man’s suicide. The women resisted holding men responsible for the suicide and tended to blame themselves, especially when they perceived their efforts to support the man as inadequate. Even when women acknowledged their guilt as illogical, they were seemingly unable to entirely escape regret and self-blame. In order to reformulate and avoid reifying feminine ideals synonymous with selflessly caring for others regardless of the costs to their own well-being, women’s postsuicide bereavement support programs should integrate a critical gender approach. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; behavioral issues; women’s health; bereavement; gender role; gender issues; sexual orientation; caregiving; Adult; Depression; Emotions; Female; Guilt; Humans; Interpersonal Relations; Male; Masculinity; Men's Health; Self Concept; Socioeconomic Factors; Stress, Psychological; Suicide; Young Adult; Bereavement; Discourse Analysis; Mental Health; Narratives; Suicide; Caregivers; Sex Roles; Sexual Orientation; Survivors; Caregiving

On hate crime victimization: Rates, types, and links with suicide risk among sexual orientation minority special interest group members - Cramer, Robert J.; Wright, Susan; Long, Molly M.; Kapusta, Nestor D.; Nobles, Matt R.; Gemberling, Tess M.; Wechsler, Hayley J. (Journal of Trauma & Dissociation, 2018)
Hate crimes remain pressing traumatic events for sexual orientation minority adults. Previous literature documents patterns in which hate crime victimization is associated with elevated risk for poor mental health. The present paper held 2 aims to advance literature. First, we investigated the rates and types of hate crime victimization among sexual orientation minority adults. Second, adopting a mental health amplification risk model, we evaluated whether symptoms of depression, impulsivity, or post-traumatic stress exacerbated the hate crime victimization–suicide risk link. Participants were 521 adult sexual orientation minority-identifying members of the National Coalition for Sexual Freedom (i.e., a bondage and discipline, and sadomasochism-identifying sexuality special interest group). Participants completed demographic and mental health inventories via online administration. Results showed: (1) low rates of total lifetime hate crime victimization and (2) higher rates of interpersonal violence compared to property crime victimization within the sample. Regression results showed: (1) independent positive main effects of all 3 mental health symptom categories with suicide risk; (2) an interaction pattern in which impulsivity was positively associated with suicide risk for non-victims; and (3) an interaction pattern in which post-traumatic stress was positively associated with suicide risk for hate crime victims and non-victims. Results are discussed concerning implications for trauma-informed mental healthcare, mental health amplification models, and hate crime and suicide prevention policies. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Sexual orientation; suicide; post-traumatic stress; hate crimes; depression; Crime Victims; Cross-Sectional Studies; Depression; Disruptive, Impulse Control, and Conduct Disorders; Female; Hate; Humans; Male; Minority Groups; Risk; Sexuality; Stress Disorders, Post-Traumatic; Suicide; Crime; Sexual Orientation; Suicide; Posttraumatic Stress Disorder

Psychometric analysis of the Life Worries Scale for a new generation of sexual minority men: The P18 Cohort Study - Halkitis, Perry N.; Cook, Stephanie H.; Ristuccia, Annie; Despotoulis, James; Levy, Michael D.; Bates, Francesca C.; Kapadia, Farzana (Health Psychology, 2018)
Objective: Sexual minority men (SMM) in the United States continue to experience adverse health problems and psychosocial burdens. However, there is limited psychometric research seeking to quantify the life worries of this population. Informed by syndemic theory, the Life Worries Scale (LWS) was developed to measure the concerns of young SMM. Method: Analyses of the scale were undertaken using baseline data (n = 665) from an ongoing cohort study of emerging adult, SMM. Results: Exploratory factor analyses (EFA) of an initial set of 24 Likert-type items, followed by confirmatory factor analysis (CFA) and an exploratory structural equation model (ESEM), indicated a structure consisting of 6 domains of worries: financial stability, social stability, self esteem, loneliness, physical appearance, and physical health. These 6 subscales were highly correlated and also demonstrated high levels of internal consistency. Differences in life worries were noted across demographic states, specifically HIV serostatus, sexual attraction, housing status, and self-rated health. High levels of association were also detected between all 6 subscales with both depression and PTSD, while significant correlations were detected between suicidality and both self esteem and loneliness related worries. Conclusions: The results of our analyses provide evidence for the strong psychometric characteristics of the LWS. This newly developed instrument should be utilized in research to examine the extent to which life worries explain health outcomes and risk behaviors in sexual minority males, and may be potentially extended for use in other populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: HIV; millennial; psychometrics; emerging adulthood; gay and bisexual; Cohort Studies; Female; Humans; Male; Psychometrics; Quality of Life; Sexual and Gender Minorities; United States; Minority Groups; Psychometrics; Rating Scales; Sexuality; Emerging Adulthood; Anxiety; Bisexuality; HIV; Male Homosexuality; Sexual Minority Groups

Payback: The custom of assault and rape of sistergirls and brotherboys: Australia's trans and sex/gender diverse First Peoples - Kerry, Stephen (Violence and Gender, 2018)
To date, little research has been conducted into the lives of trans Indigenous Australians, also known as sistergirls and brotherboys. The author recently completed a 3-year research project into the lives of trans people living in Australia's remotely located Northern Territory as well as sistergirls and brotherboys. This research is groundbreaking because it analyses, for the first time, the issues impacting these populations. This article draws out the most pressing difficulties sistergirls and brotherboys experience, that is, transphobia within traditional Aboriginal communities. It has become a push factor for many sistergirls and brotherboys to leave their communities, yet, migrating to large residential areas leads to further discrimination. There may be racism within predominantly white trans communities and difficulties with language because, for example, English, for many Indigenous Australians, is their third or fourth language. Furthermore, sistergirls and brotherboys may experience a loss of identity because community and country are essential aspects of Indigenous Australian's sense of self, well-being, and spirituality. Transphobia in traditional Aboriginal communities manifests in the so-called custom of payback, through which retribution for social transgressions is brought on community members. To illustrate this custom, this article focuses on Crystal, one of the author's interviewees. Crystal is a sistergirl from the remote Tiwi Islands on the north coast of Australia and, for decades, her family and community enacted payback because she is a sistergirl. This payback took the form of verbal harassment, physical assault, and rape not only against Crystal herself but also immediate members of her family, and, as a result, several committed suicide. She rejects the notion that payback should be a protected custom; rather she demands that it is her human rights and the human rights of all sistergirls and brotherboys that need protecting. Crystal refuses to be silenced and she advocates on behalf of sistergirls and brotherboys. In 2012, Crystal was elected to the local Tiwi Island council and, in doing so, became the first sistergirl and trans woman to be elected to an Australian government office. Crystal is known as Aunty because she helps the younger generation, but because she has won the respect of her community, she is now also known as Elder. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: sistergirls; brotherboys; Indigenous; Aboriginal; Australia; transgender; sex/gender diverse; Rape; Spirituality; Transgender; Human Sex Differences; Indigenous Populations; Test Construction

Suicide risk among transgender people: A prevalent problem in critical need of empirical and theoretical research - Wolford-Clevenger, Caitlin; Cannon, Christopher J.; Flores, Leticia Y.; Smith, Phillip N.; Stuart, Gregory L. (Violence and Gender, 2017)
Transgender individuals are at increased risk for suicide relative to nontransgender people. Despite this, research on transgender people's risk for suicide mirrors their marginalization at the societal level; there is simply not enough research dedicated to understanding increased suicide risk among transgender people. This article presents a brief review of what is known regarding the prevalence and correlates of suicide-related thoughts and behaviors among transgender people and offers perspective regarding what theories of suicide may be pertinent to understanding and addressing increased suicide risk within this population. We also summarize strengths and limitations of the current body of work to provide impetus for additional and improved research on this important problem. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: transgender; gender-fluid; genderqueer; suicidal ideation; suicide attempts; suicidal behavior; Attempted Suicide; Suicidal Ideation; Suicide; Transgender

Suicidal thoughts and behaviors among first-year college students: Results from the WMH-ICS project - Mortier, Philippe; Auerbach, Randy P.; Alonso, Jordi; Bantjes, Jason; Benjet, Corina; Cuijpers, Pim; Ebert, David D.; Green, Jennifer Greif; Hasking, Penelope; Nock, Matthew K.; O'Neill, Siobhan; Pinder-Amaker, Stephanie; et al. (Journal of the American Academy of Child & Adolescent Psychiatry, 2018)
Objective: College entrance may be a strategically well-placed 'point of capture' for detecting late adolescents with suicidal thoughts and behaviors (STB). However, a clear epidemiological picture of STB among incoming college students is lacking. We present the first cross-national data on prevalence as well as socio-demographic and college-related correlates for STB among first-year college students. Method: Web-based self-report surveys were obtained from 13,984 first-year students (response rate 45.5%) across 19 colleges in 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, and the United States). Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 32.7%, 17.5%, and 4.3%, respectively. The 12-month prevalence was 17.2%, 8.8%, and 1.0%, respectively. About three-fourths of STB cases had onset before the age of 16 years (Q3 = 15.8), with persistence figures in the range of 41% to 53%. About one-half (53.4%) of lifetime ideators transitioned to a suicide plan; 22.1% of lifetime planners transitioned to an attempt. Attempts among lifetime ideators without plan were less frequent (3.1%). Significant correlates of lifetime STB were cross-nationally consistent and generally modest in effect size (median adjusted odds ratio [aOR] = 1.7). Nonheterosexual orientation (aOR range 3.3−7.9) and heterosexual orientation with some same-sex attraction (aOR range 1.9−2.3) were the strongest correlates of STB, and of transitioning from ideation to plans and/or attempts (aOR range 1.6−6.1). Conclusion: The distribution of STB in first-year students is widespread, and relatively independent of socio-demographic risk profile. Multivariate risk algorithms based on a high number of risk factors are indicated to efficiently link high-risk status with effective preventive interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: suicidal thoughts; college students; College Students; Suicidal Ideation; Test Construction

School-based protective factors related to suicide for lesbian, gay, and bisexual adolescents - Whitaker, Kelly; Shapiro, Valerie B.; Shields, John P. (Journal of Adolescent Health, 2016)
Purpose: Research indicates that lesbian, gay, and bisexual (LGB) adolescents are three times more likely to consider suicide than their heterosexual peers. Although research has identified risk factors for suicide among this population, little is known about school-level protective factors among this population, which may buffer the impact of risk. This study aims to understand whether school-based protective factors (e.g., school safety, relationships with caring adults at school, school connectedness) are associated with decreased suicidal ideation for LGB adolescents. Methods: Logistic regression analyses were conducted on the data generated by the San Francisco Unified School District's 2011 California Healthy Kids Survey to examine the influence of protective factors related to suicidal ideation for LGB adolescents (n = 356). Results: Results indicated that higher levels of school connectedness predicted less suicidal ideation (odds ratio = .59, p =. 005). Conclusions: This study provided evidence that school protective factors were related to reduced suicidal ideation for LGB adolescents, controlling for risk factors and demographic variables. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: Sexual orientation; Suicide; Protective factors; School connectedness; Adolescent; Bisexuality; Faculty; Female; Homosexuality; Humans; Logistic Models; Male; Peer Group; Protective Factors; Safety; San Francisco; Suicide; Adolescent Psychology; Protective Factors; School Based Intervention; Sexual Orientation; Suicidal Ideation; Bisexuality; Risk Factors

Practicing care: Queer vulnerability in the hospital - Horncastle, J. (Social Identities: Journal for the Study of Race, Nation and Culture, 2018)
This discussion paper addresses practicalities of queer resistance to norms about life and identity, in mainstream medical contexts. Queer agency may be compromised at times of illness and/or health-related vulnerability. Although this compromise is part of mundane politics for hardy queers who routinely negotiate mainstream institutions such as hospitals, there are side-effects that may negatively impact non-normative subjectivity. This paper highlights the necessarily contingent nature of being cared for in the clinic, the surgeon’s hands, or the psychiatric ward and reveals what may be overlooked, misunderstood or explicitly rejected in mainstream medical contexts. The salient points from my own hospital experiences are explored to highlight counter-discourses and contentious issues around caring for non-normative (queer) subjectivities. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Genderqueer-ness; care; mad studies; suicidality; agency; cancer; queer; Breast Neoplasms; Quality of Care; Sexuality; Social Identity; Suicidality; Feminism; Health Care Services; Hospitals

The impact of cannabis use disorder on suicidal and nonsuicidal self‐injury in Iraq/Afghanistan‐era veterans with and without mental health disorders - Kimbrel, Nathan A.; Meyer, Eric C.; DeBeer, Bryann B.; Gulliver, Suzy B.; Morissette, Sandra B. (Suicide and Life-Threatening Behavior, 2018)
The objective of this study was to assess the association between cannabis use disorder (CUD) and self‐injury among veterans. As expected, after adjusting for sex, age, sexual orientation, combat exposure, traumatic life events, traumatic brain injury, posttraumatic stress disorder, depression, alcohol use disorder, and noncannabis drug use disorder, CUD was significantly associated with both suicidal (OR = 3.10, p = .045) and nonsuicidal (OR = 5.12, p = .009) self‐injury. CUD was the only variable significantly associated with self‐injury in all three models examined. These findings are consistent with prior research among civilians and suggest that CUD may also increase veterans’ risk for self‐injurious behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: cannabis use disorder; nonsuicidal self‐injury; veterans; mental health disorders; suicidal self-injury; Adult; Afghan Campaign 2001-; Alcoholism; Comorbidity; Depressive Disorder; Female; Humans; Iraq War, 2003-2011; Male; Marijuana Abuse; Middle Aged; Risk Factors; Self-Injurious Behavior; Stress Disorders, Post-Traumatic; Suicidal Ideation; Suicide; Veterans; Cannabis; Drug Abuse; Self-Injurious Behavior; Suicidality; Mental Disorders; Military Veterans

Lifetime prevalence of suicidal ideation among men who have sex with men: A meta-analysis - Luo, Zhenzhou; Feng, Tiejian; Fu, Hanlin; Yang, Tubao (BMC Psychiatry, 2017)
Background: Suicide is a leading cause of death among men who have sex with men (MSM) and suicidal ideation may put individuals at higher risk of suicide. A great disparity of lifetime prevalence of suicidal ideation among MSM was observed across studies, indicating the importance of a reliable estimation of the pooled lifetime prevalence. However, the only one published meta-analysis estimating the pooled lifetime prevalence of suicidal ideation among MSM was conducted in 2008 with only 2 eligible studies. Subsequently, there was a rapid increase of publications about lifetime suicidal ideation among MSM, suggesting that an update on the pooled lifetime prevalence of suicidal ideation among MSM was necessary. Therefore, this study aimed to update the estimation of the pooled lifetime prevalence of suicidal ideation among MSM. Methods: Electronic databases of PubMed, CINAHL, Scopus (social science), Embase and PsycInfo were searched until September 2017 to identify relevant studies. Cross-sectional studies exploring the lifetime prevalence of suicidal ideation among MSM were enrolled. Heterogeneity was evaluated using the Cochran Q test and quantified using the I² statistic. The possibility of publication bias was assessed using both Begg’s rank test and Egger’s linear test, and an Egger’s funnel plot for asymmetry was presented. Subgroup analyses were performed according to the geographic area, sample source and HIV status. Results: Nineteen studies with a total of 26,667 MSM were included, of which 9374 were identified with suicidal ideation. A high degree of heterogeneity (P ≤ 0.001, I² = 99.2%) was observed among the eligible studies, with the reported prevalence ranging from 13.18 to 55.80%. The pooled lifetime prevalence of suicidal ideation among MSM by a random effects model was 34.97% (95% confidence interval: 28.35%–41.90%). Both the Begg’s rank test and Egger’s linear test indicated low possibility of publication bias. Subgroup analyses showed that the lifetime prevalence of suicidal ideation among MSM differed significantly by geographic area, sample source and HIV status (P < 0.05). Conclusions: The high pooled lifetime prevalence of suicidal ideation among MSM found in this meta-analysis significantly underscores the importance of early assessment of suicidal ideation among MSM, as well as the need for strengthening the psychological interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Suicidal ideation; Men who have sex with men; Prevalence; Meta-analysis; Epidemiology; Male Homosexuality; Meta Analysis; Suicidal Ideation; Same Sex Intercourse

Ethnic youth and sexual identity: The role of clinical and social support for ‘double minorities’ - Wong, Nicole; Menkes, David B. (Australasian Psychiatry, 2018)
Objectives: Sexual-minority youth exhibit increased rates of psychiatric morbidity, subject to various social factors. We examine the impact of ethnicity and culture on these phenomena, with particular reference to Asian youth living in Western societies. Conclusions: Youth from minority ethnic groups who do not identify with their native gender and/or who are not exclusively heterosexual are known as ‘double minorities’. Available evidence suggests that such individuals are at particularly increased risk of depression and suicide, but that this may be mitigated by social support. More research is needed to understand the challenges faced by ‘double minorities’, notably their perception of and ability to access available clinical and social supports. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: sexual minority; LGBT; depression; suicide; ethnic minority; Asian youth in western countries; Adolescent; Adult; Depressive Disorder; Humans; Minority Groups; New Zealand; Sexual and Gender Minorities; Social Support; Suicide; Young Adult; Mental Disorders; Racial and Ethnic Groups; Sexual Minority Groups; LGBTQ; Intervention; Minority Groups; Social Support; Suicide Prevention

New data on intimate partner violence and intimate relationships: Implications for gun laws and federal data collection - Sorenson, Susan B.; Spear, Devan (Preventive Medicine: An International Journal Devoted to Practice and Theory, 2018)
Age at first marriage has risen substantially and birth rates are at a record low; people are spending more time in relationships that, by comparison, have fewer emotional, financial, and legal commitments. Little research has examined intimate partner violence (IPV) prevalence in current and former adult (vs. adolescent) dating relationships. Such information is relevant to federal firearms policies that are based on the nature of an intimate relationship. We examined assaultive behaviors by the type and status of the relationship—current spouse, former spouse, current boyfriend or girlfriend, and former boyfriend or girlfriend—in 31,206 IPV incidents responded to by Philadelphia police in 2013. Over 80% of the IPV incidents involved individuals in non-marital relationships. Incidents involving current boyfriends or girlfriends had the highest percentage of violent behaviors (e.g., punch, strangle). They also were more likely than current spouses to use bodily weapons (hands, fists, or feet) or non-gun weapons (knives, bats, etc.) (AOR = 1.19 and 1.43, respectively), to injure their victims (AOR = 1.37), and to be arrested (AOR = 1.46). Former unmarried partners had the highest odds of stalking their intimate (AOR = 3.37) and violating a restraining order (AOR = 2.61). Gun use was similar across relationship type. A growing portion of the population is not protected by federal policies designed to keep guns out of the hands of abusers. Current boyfriends and girlfriends are a risk to their intimates. Federal data collection practices and firearm policies merit updating to more fully take into account dating, same-sex marriage, and other partnerships. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: Firearms; Guns; Domestic violence; Policy; Domestic Violence; Firearms; Government Policy Making; Gun Control Laws; Intimate Partner Violence; Abuse Reporting; Data Collection; Risk Management; Trends

Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course - Blosnich, John R.; Nasuti, Laura J.; Mays, Vickie M.; Cochran, Susan D. (American Journal of Orthopsychiatry, 2016)
This investigation explored suicide-related characteristics and help-seeking behavior by sexual orientation. Population-based data are from the California Quality of Life Surveys, which included 1,478 sexual minority (lesbian, gay, bisexual, and homosexually experienced individuals) and 3,465 heterosexual individuals. Bisexual women had a nearly six-fold increased risk of lifetime suicide attempts than heterosexual women (RR = 5.88, 95%CI: 3.89–8.90), and homosexually experienced men had almost 7 times higher risk of lifetime suicide attempts than heterosexual men (RR = 6.93, 95%CI: 3.65–13.15). Sexual minority men and women were more likely than heterosexual men and women to have disclosed suicide attempts to a medical professional (RR = 1.48 and RR = 1.44, respectively). Among persons who ever attempted suicide, sexual minority women had a younger age of index attempt than heterosexual women (15.9 vs. 19.6 years of age, respectively). Healthcare professionals should be aware of suicidal risk heterogeneity among sexual minority individuals, including vulnerable points of risk and evidenced-based treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: gay; lesbian; bisexual; suicide; mental disorders; sexual minority; Adolescent; Adult; Aged; California; Disclosure; Female; Humans; Male; Middle Aged; Minority Groups; Risk Factors; Self-Injurious Behavior; Sex Factors; Sexuality; Suicide, Attempted; Surveys and Questionnaires; Young Adult; Attempted Suicide; Help Seeking Behavior; Mental Disorders; Minority Groups; Sexual Orientation; Bisexuality; Lesbianism; Male Homosexuality; Self-Disclosure; Suicidal Ideation; Symptoms; Suicidality; Sexual Minority Groups

Results of Gottman Method couples therapy with gay and lesbian couples - Garanzini, Salvatore; Yee, Alapaki; Gottman, John; Gottman, Julie; Cole, Carrie; Preciado, Marisa; Jasculca, Carolyn (Journal of Marital and Family Therapy, 2017)
The results of an uncontrolled study of Gottman Method Couples Therapy in changing relationship satisfaction with 106 gay and lesbian couples is reported in this paper. Measurement of relationship satisfaction was conducted at five separate time points. The data show significant improvements in relationship satisfaction following eleven sessions of therapy for both gay male and lesbian couples. Effect sizes suggest that this therapy was highly effective, compared to the usual 0.5 standard deviation effect size in couples therapy. Initial co‐morbidities did not affect the size of the changes; in fact, some changes were significantly larger for three initial co‐morbidities. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: couples therapy; sexual orientation; relationship satisfaction; effect size; Adult; Couples Therapy; Female; Homosexuality, Female; Homosexuality, Male; Humans; Male; Marital Therapy; Sexual and Gender Minorities; Spouses; Couples Therapy; Relationship Satisfaction; Sexual Orientation

Towards a greater understanding of anxiety sensitivity across groups: The construct validity of the Anxiety Sensitivity Index-3 - Jardin, Charles; Paulus, Daniel J.; Garey, Lorra; Kauffman, Brooke; Bakhshaie, Jafar; Manning, Kara; Mayorga, Nubia A.; Zvolensky, Michael J. (Psychiatry Research, 2018)
The present study examined the factor structure, invariance properties, reliability, and validity of the Anxiety Sensitivity Index-3 (ASI-3, Taylor et al., 2007). Participants were recruited from a large, ethnically diverse southwestern university (n = 3651; 77.8% female; Mage = 22.06 years; 28% non-Hispanic White). Findings supported a bifactor structure for the ASI-3, which demonstrated measurement invariance across sex, race/ethnicity, age, and sexual minority status. Furthermore, the ASI-3 demonstrated strong reliability and validity, with the anxiety sensitivity general and specific factors (physical, cognitive, and social concerns) evidencing unique patterns of relations with symptoms of depression, suicidality, anxious arousal, and social anxiety. Clinically, these findings generally support the validity of the ASI-3 in measuring anxiety sensitivity across sex, age, race/ethnicity, and sexual minority status. Future work is needed to better understand the role anxiety sensitivity plays within specific demographic subgroups, particularly African–Americans, Asian Americans, and sexual minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Anxiety sensitivity; Measurement invariance; Gender; Race/ethnicity; Sexual orientation; Adolescent; Adult; Anxiety; Comprehension; Cross-Sectional Studies; Depression; Fear; Female; Humans; Male; Psychiatric Status Rating Scales; Psychometrics; Reproducibility of Results; Self Concept; Students; Universities; Young Adult; Anxiety; Human Sex Differences; Personality Measures; Psychometrics; Racial and Ethnic Differences; Construct Validity; Factor Structure; Sexual Orientation; Test Reliability; Test Validity

Mental health service utilization among men who have sex with men who are at risk of mental health problems in Hong Kong: Prevalence and associated factors - Mo, Phoenix K. H.; Lau, Joseph T. F.; Lau, Mason M. C.; Kim, Yoona (Psychology of Men & Masculinity, 2018)
Mental health problems are prevalent among men who have sex with men (MSM); however, underutilization of mental health services among MSM with mental health problems has been widely documented. To explore factors associated with mental health service utilization (i.e., having sought help from mental health professionals; and intention to seek mental health services if one were to have mental health problems) among 2 subsamples of MSM who were at risk of mental health problems (Subsample 1: those who scored above the cut-off for probable depression or probable anxiety, or had suicidal ideation; Subsample 2: those self-perceived to have had mental health problems in the past 12 months) in Hong Kong. A cross-sectional telephone survey was conducted among MSM (N = 175 for Subsample 1 and N = 143 for Subsample 2). Multivariate logistic regressions showed that factors for having sought help from mental health professionals included disclosure of MSM behavior to all family members and positive attitudes toward seeking professional psychological help for Subsample 1, and positive attitudes toward seeking professional psychological help, ever diagnosed for mental disorders, and enacted stigma for Subsample 2. In addition, factors associated with intention to seek help from mental health professionals included willingness to disclose MSM behavior to mental health professionals for Subsample 1, and positive attitudes toward seeking professional psychological help for both subsamples. Interventions to promote help seeking for mental health problems among MSM should promote positive attitudes toward seeking psychological help and reduce stigma. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: men who have sex with men; help seeking; mental health problems; mental health services; At Risk Populations; Health Care Utilization; Human Males; Mental Health; Same Sex Intercourse; Chinese Cultural Groups; Help Seeking Behavior; Test Construction

Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston - Duncan, Dustin T.; Hatzenbuehler, Mark L. (American Journal of Public Health, 2014)
Objectives: We examined whether past-year suicidality among sexual-minority adolescents was more common in neighborhoods with a higher prevalence of hate crimes targeting lesbian, gay, bisexual, and transgender (LGBT) individuals. Methods: Participants’ data came from a racially/ethnically diverse population-based sample of 9th- through 12th-grade public school students in Boston, Massachusetts (n = 1292). Of these, 108 (8.36%) reported a minority sexual orientation. We obtained data on LGBT hate crimes involving assaults or assaults with battery between 2005 and 2008 from the Boston Police Department and linked the data to the adolescent’s residential address. Results: Sexual-minority youths residing in neighborhoods with higher rates of LGBT assault hate crimes were significantly more likely to report suicidal ideation (P = .013) and suicide attempts (P = .006), than were those residing in neighborhoods with lower LGBT assault hate crime rates. We observed no relationships between overall neighborhood-level violent and property crimes and suicidality among sexual-minority adolescents (P > .05), providing evidence for specificity of the results to LGBT assault hate crimes. Conclusions: Neighborhood context (i.e., LGBT hate crimes) may contribute to sexual-orientation disparities in adolescent suicidality, highlighting potential targets for community-level suicide-prevention programs. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: lesbian; gay; bisexual; transgenders; hate crimes; suicidality; sexual minority adolescents; neighborhoods; Adolescent; Boston; Crime; Female; Humans; Male; Sexuality; Suicidal Ideation; Suicide, Attempted; Transgender Persons; United States; Violence; Hate Crimes; Minority Groups; Suicide; Suicidality; Sexual Minority Groups; Bisexuality; Lesbianism; Male Homosexuality; Neighborhoods; Transgender

Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals - Lytle, Megan C.; De Luca, Susan M.; Blosnich, John R.; Brownson, Chris (Journal of Affective Disorders, 2015)
Background: Our aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals. Methods: Data from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n = 24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation. Results: Across most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation. Limitations: Cross-sectional design and self-reported data. Conclusions: Results corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: Suicidal ideation; LGBT; Race/ethnicity; Religious affiliation; Adolescent; Bisexuality; Continental Population Groups; Cross-Sectional Studies; Ethnic Groups; Female; Heterosexuality; Homosexuality; Humans; Male; Middle Aged; Religion and Psychology; Self Report; Suicidal Ideation; Young Adult; Heterosexuality; Religious Affiliation; Suicidal Ideation; Bisexuality; College Students; Ethnic Identity; Lesbianism

Sexual identity development: Relationship with lifetime suicidal ideation in sexual minority women - Dirkes, Jessica; Hughes, Tonda; Ramirez‐Valles, Jesus; Johnson, Tim; Bostwick, Wendy (Journal of Clinical Nursing, 2016)
Aims and objectives: This study draws on a life course perspective to evaluate in a sample of sexual minority women: (1) the relationship between age at reaching sexual identity milestones and risk of suicidal ideation, (2) developmental stages or stages of sexual identity development that represent greatest risk and (3) the relationship between age of reaching milestones and parental support. Background: Research shows higher rates of suicidal ideation among sexual minority women than heterosexual women. Evidence suggests this is partly accounted for by risk factors including sexual identity development and parental support. However, it remains unclear whether there are stages of particularly high risk. Design: This is a cross‐sectional study. Data come from a prospective study of sexual minority women that used convenience and respondent‐driven sampling methods. Methods: Using logistic regression, we examined associations among age at sexual identity developmental milestones, parental support and suicidal ideation in a large (N = 820), ethnically diverse sample of sexual minority women. Results: Compared with women who first wondered about their sexual identity in adulthood, those who first wondered in early, middle or late adolescence had greater odds of lifetime suicidal ideation. Younger age at subsequent milestones (first decided or first disclosed) was not associated with heightened risk of suicidal ideation. Parental support was independently associated with suicidal ideation. Conclusions: Findings suggest that where one is in the process of identifying as a sexual minority may be more important than age in understanding risk of suicidal ideation in this population. As individuals come to accept and integrate their sexual minority identity risks associated with younger age diminish. Relevance to Clinical Practice: Nurses and other healthcare providers who work with youth should routinely ask about sexual orientation and suicidal ideation and be aware that youth in the earliest stages of coming out as sexual minority may be at particularly high risk of suicide. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: bisexual women; lesbian; mental health; sexual minority women; sexual minority youth; sexuality; suicidal ideation; suicide; women's health; Adolescent; Adult; Aged; Aged, 80 and over; Chicago; Cross-Sectional Studies; Female; Gender Identity; Humans; Logistic Models; Mental Disorders; Middle Aged; Minority Groups; Prospective Studies; Risk Factors; Sexual and Gender Minorities; Suicidal Ideation; Young Adult; Human Females; Minority Groups; Psychosexual Development; Sexual Orientation; Suicidal Ideation; Age Differences; Bisexuality; Gender Identity; Lesbianism; Life Span; Sexuality; Sexual Minority Groups

Correctional policy and attempted suicide among transgender individuals - Drakeford, Leah (Journal of Correctional Health Care, 2018)
Little research has examined the link between incarceration and suicide among transgender individuals. Transgender inmates face unique circumstances within the correctional setting that expose them to potentially harmful conditions, including correctional policies that limit access to proper medical care and expose them to threats of harassment and violence. Using data from the 2011 National Transgender Discrimination Survey, this article examines the link between incarceration and suicide among transgender individuals by focusing on the link between correctional policies and attempted suicide among transgender individuals who have been incarcerated. Multivariate results suggest that correctional policies regarding health care and housing may deleteriously impact transgender inmates. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: suicide; transgender; mental health; policy; incarceration; Female; Humans; Male; Policy; Prisons; Suicide, Attempted; Transgender Persons; Correctional Institutions; Suicide; Transgender; Incarceration; Mental Health

Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors - Testa, Rylan J.; Michaels, Matthew S.; Bliss, Whitney; Rogers, Megan L.; Balsam, Kimberly F.; Joiner, Thomas (Journal of Abnormal Psychology, 2017)
Research has revealed alarmingly high rates of suicidal ideation (SI) and suicide attempts among transgender and gender nonconforming (TGNC) people. This study aims to analyze the role of factors from the gender minority stress and resilience (GMSR) model (Testa, Habarth, Peta, Balsam, & Bockting, 2015), the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005; Van Orden et al., 2010), and the potential integration of these factors, in explaining SI in this population. A convenience sample of 816 TGNC adults responded to measures of current SI, gender minority stressors, and IPTS factors. Path analysis was utilized to test 2 models. Model 1 evaluated the associations between external minority stressors and SI through internal minority stressors. Model 2 examined the relationships between internal minority stressors and SI through IPTS variables (perceived burdensomeness and thwarted belongingness). All GMSR external stressors (rejection, nonaffirmation, victimization, and discrimination), internal stressors (internalized transphobia, negative expectations, and nondisclosure), and IPTS factors (thwarted belongingness and perceived burdensomeness) were related to SI. Both models demonstrated good fit. Model 1 revealed that rejection, nonaffirmation, and victimization were related to SI through experiences of internalized transphobia and negative expectations. Model 2 indicated that internalized transphobia and negative expectations were associated with SI through IPTS factors. The models demonstrate pathways through which GMSR and IPTS constructs relate to one another and confer risk for SI among TGNC individuals. These pathways and several recently proposed constructs examined here provide promising directions for future research and clinical interventions in this area. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender; suicidal ideation; minority stress; interpersonal theory of suicide; Adolescent; Adult; Aged; Female; Humans; Interpersonal Relations; Male; Middle Aged; Psychological Theory; Sexual and Gender Minorities; Stress, Psychological; Suicidal Ideation; Transgender Persons; Young Adult; Minority Groups; Stress; Suicidal Ideation; Transgender; Minority Stress; Gender Identity; Suicide; Theories

Have mischievous responders misidentified sexual minority youth disparities in the National Longitudinal Study of Adolescent to Adult Health? - Fish, Jessica N.; Russell, Stephen T. (Archives of Sexual Behavior, 2018)
The National Longitudinal Study of Adolescent to Adult Health (Add Health) has been instrumental in identifying sexual minority youth health disparities. Recent commentary suggested that some Wave 1 youth responders, especially males, intentionally mismarked same-sex attraction and, as a result, published reports of health disparities from these data may be suspect. We use two recently developed approaches to identify 'jokesters' and mischievous responding and apply them to the Add Health data. First, we show that Wave 1 same-sex attracted youth, including those who later reported completely heterosexual identities in adulthood, were no more likely than different-sex attracted youth and consistently heterosexual participants to be 'jokesters.' Second, after accounting for mischievous responses, we replicated six previously established disparities: depressive symptoms, suicidal ideation and behaviors, alcohol use, cocaine use, parental satisfaction, and school connectedness. Accounting for mischievousness resulted in the elimination of one observed disparity between heterosexual and sexual minority youth: suicidal ideation for males who reported romantic attraction to both sexes. Results also showed that accounting for mischievous responding may underestimate disparities for sexual minority youth, particularly females. Overall, results presented here support previous studies that identified health disparities among sexual minority youth using these data. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: mischievous responders; misidentification; sexual minority youth disparities; National Longitudinal Study of Adolescent to Adult Health; Credibility; Measurement; Health Disparities; Sexual Minority Groups; Sexual Orientation

The interrelations between internalized homophobia, depressive symptoms, and suicidal ideation among Australian gay men, lesbians, and bisexual women - McLaren, Suzanne (Journal of Homosexuality, 2016)
Internalized homophobia has been linked to depression among gay men, lesbians, and bisexuals. Relatively little research has investigated the link between internalized homophobia and suicidal thoughts and behaviors. The current research investigated the interrelations among internalized homophobia, depressive symptoms, and suicidal ideation by testing additive, mediation, and moderation models. Self-identified Australian gay men (n = 360), lesbians (n = 444), and bisexual women (n = 114) completed the Internalized Homophobia Scale, the Center for Epidemiological Studies Depression Scale, and the suicide subscale of the General Health Questionnaire. Results supported the additive and partial mediation models for gay men and the mediation and moderation models for lesbians. None of the models were supported for bisexual women. The findings imply that clinicians should focus on reducing internalized homophobia and depressive symptoms among gay men and lesbians, and depressive symptoms among bisexual women, to reduce suicidal ideation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: Depressive symptoms; internalized homophobia; suicidal ideation; Bisexuality; Homosexuality; Homosexuality (Attitudes Toward); Major Depression; Suicidal Ideation; Lesbianism; Male Homosexuality; Symptoms

An AFFIRMative cognitive behavioral intervention for transgender youth: Preliminary effectiveness - Austin, Ashley; Craig, Shelley L.; D'Souza, Sandra A. (Professional Psychology: Research and Practice, 2018)
Authentically expressing and navigating a transgender or gender nonconforming identity during adolescence can be a difficult and painful process. Using a transgender affirmative approach to clinical practice, psychologists and other mental health professionals can play a key role in supporting youth through this process. To date, there is a paucity of research exploring the impact of transgender affirmative interventions on well-being. The primary objective of this article is to present the results of a pilot study exploring the preliminary effectiveness and acceptability of AFFIRM, an affirmative cognitive–behavioral coping skills group intervention with transgender youth. This article will also describe transgender-specific considerations for delivering transgender affirmative interventions. The transgender subsample (N = 8) of participants in the study were between the ages of 16 and 18 and represented a diversity of intersecting racial/ethnic, sexual, and gender identities. Results indicate that AFFIRM was effective in significantly decreasing depression scores, and changes persisted through the 3-month follow-up. While changes in coping were not statistically significant, scores trended in a positive direction. Data indicate favorable responses to AFFIRM among transgender participants across a variety of dimensions of satisfaction. While findings are preliminary, they are promising, addressing a critical gap in intervention research aimed at decreasing depression and improving coping among transgender youth. Future controlled studies are needed to explore the efficacy of AFFIRM with larger samples of transgender youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: affirmative; transgender; outcomes; cognitive behavior therapy; Cognitive Behavior Therapy; Intervention; Transgender; Affirmative Therapy; Beck Depression Inventory; Client Satisfaction; Surveys; Test Construction; Adolescent Characteristics; Stress and Coping Measures; Transgender (Attitudes Toward)

The case of Abel: Religion as boon and bane for a Catholic gay man - Cerbone, Armand R.; Danzer, Graham (Journal of Clinical Psychology, 2017)
Conservative religions that condemn homosexual sexual orientation and acts as unnatural and sinful pose significant challenges for gay persons whose faith is a core part of their identity. The condemnation presents a serious barrier to the acceptance and integration of their sexuality, a primary task of psychosexual development. As a result, they can manifest depression, anxiety, suicidal ideation, and even suicide attempts. The ecclesiastical censure also imposes an untenable dilemma for homosexuals in that they feel pressed to reject their sexual identity or renounce their spiritual identity and heritage. Psychotherapists who treat gay persons caught in this quandary can find themselves facing a similar problem: how to help their homosexual client reconcile their proscribed sexuality with their spiritual commitments. The case presented here recounts the treatment over many years of a gay man suffering from such a conflict and his eventual accommodation of both his homosexuality and his faith. Recommendations are offered for constructive treatment with those torn between two conflicting core identities. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: gay; homosexuality; spirituality; religion; psychotherapy; Catholics; Male Homosexuality; Psychotherapy; Religious Beliefs; Gender Identity; Spirituality

‘The darkest times of my life’: Recollections of child abuse among forced migrants persecuted because of their sexual orientation and gender identity - Alessi, Edward J.; Kahn, Sarilee; Chatterji, Sangeeta (Child Abuse & Neglect, 2016)
Numerous studies demonstrate that lesbian, gay, bisexual, and transgender (LGBT) children and youth are likely to experience abuse by peers, parents, and other adults and that these experiences correlate with a host of mental health problems. However, there is little understanding of the experiences of LGBT children and youth living in countries where social and legal protections for sexual and gender minorities are limited or nonexistent. This qualitative study used thematic analysis to explore the child and adolescent abuse experiences and their impact on the pre-migration mental health of LGBT forced migrants. We analyzed 26 interviews with individuals who obtained refugee or asylee status in the United States or Canada on the basis of sexual orientation or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: abuse by parents and caregivers, abuse by peers and school personnel, having nowhere to turn, and dealing with psychological distress. Findings indicate that participants experienced severe verbal, physical, and sexual abuse throughout childhood and adolescence and that this abuse occurred at home, in school, and in the community. Furthermore, there were no resources or sources of protection available to them. Participants linked their abuse to subjective experiences of depression, anxiety, and traumatic stress, as well as suicidal ideation and suicide attempts. We conclude with implications for refugee adjudication practices, mental health care, and international policy. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBT children; LGBT youth; International child protection; Child abuse; Thematic analysis; Adult; Child Abuse; Child, Preschool; Family Relations; Female; Gender Identity; Humans; Male; Sexual Behavior; Social Discrimination; Transients and Migrants; United States; Young Adult; Child Abuse; Gender Identity; Human Migration; Mental Health; Sexual Orientation; Bisexuality; Lesbianism; Male Homosexuality; Persecution; Transgender

Suicidal ideation and suicide attempts in persons with gender dysphoria - García-Vega, Elena; Camero, Aida; Fernández, María; Villaverde, Ana (Psicothema, 2018)
Background: The little research there is about suicidal behaviour in those with gender dysphoria indicates that they are at a much higher risk of death by suicide and suicidal behaviour than the general population. The objective of this research is to analyse the prevalence of suicidal ideation and suicide attempts reported by people who attended consultations at the Gender Identity Treatment Unit between 2007 and 2017 presenting complaints related to gender dysphoria. Method: An ex-post facto study with a sample of 151 people who were clients at the unit, 97 in the male to female trans group, 54 female to male. Clinical evaluations were carried out assessing variables of suicidal ideation and attempts, along with a possible psychiatric diagnosis. Results: Almost half (48.3%) reported suicidal ideation, 23.8% had attempted suicide. Conclusions: There are higher levels of suicidal ideation and suicide attempts in people with gender dysphoria than in the general population. No differences were seen between groups in terms of gender/sex. Psychiatric morbidity was not an influential variable for suicidal behaviour. This suggests that suicidal ideation is one of the best indicators of the risk of suicidal behaviours. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: gender dysphoria; suicidal ideation; suicide attempts; Attempted Suicide; Suicidal Ideation; Gender Dysphoria

Can need for affect and sexuality differentiate suicide risk in three community samples? - Cramer, Robert J.; Mandracchia, Jon; Gemberling, Tess M.; Holley, Sarah R.; Wright, Susan; Moody, Kendall; Nobles, Matt R. (Journal of Social and Clinical Psychology, 2017)
Suicide is a pressing community mental health problem, yet remains under investigated in certain vulnerable populations such as the bondage and sadomasochism (BDSM) community. As reflected by the Need for Affect (NFA), the present paper aims to test a new approach to understanding suicide risk from a Preferences in Information Processing perspective. Adult participants (n = 2,097) drawn from community, college, and BDSM community samples completed a health survey via online administration. Bivariate tests were used to identify correlates of elevated suicide risk, and logistic regression was employed to test primary hypotheses. Results yielded the following indicators of elevated suicide risk category membership: (1) female gender, (2) BDSM community membership, (3) lesbian, gay, bisexual and other sexual orientation identity minority status, (4) elevated depressive symptoms, (5) elevated NFA approach, and (6) elevated NFA Avoidance. BDSM and NFA results are largely new, and speak to the need for further attention. Results are discussed with respect to information processing preferences, as well as the intersection of sexuality-based marginalized groups, stigma, and health disparities. Implications for community mental health and suicide prevention are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: suicide; need for affect; BDSM; sexual orientation; college students; Affection; College Students; Risk Factors; Sexuality; Suicide

Impacts of a documentary about masculinity and men’s health - King, Kylie; Schlichthorst, Marisa; Reifels, Lennart; Keogh, Louise; Spittal, Matthew J.; Phelps, Andrea; Pirkis, Jane (American Journal of Men's Health, 2018)
As part of a larger study, we developed a three-part documentary called Man Up that explored the relationship between masculinity, mental health, and suicide. In this study, we examine in detail the qualitative feedback provided by those who viewed Man Up, in order to gain a more in-depth understanding of its impact on them. A total of 169 participants provided qualitative feedback via an online survey 4 weeks after viewing Man Up. We examined their opinions about the show and whether they reported any changes in their attitudes and/or behaviors as a result of watching it. All the men who provided feedback on Man Up were overwhelmingly positive about it. The majority reported significant and profound impacts of viewing the documentary. They reported being more aware of others, more willing to help others, and more open about their emotions and problems, as well as demonstrating associated behavioral changes related to helping others and being more emotionally expressive. The data presented here demonstrate the potential for men’s health outcomes to be positively impacted by novel, media-based public health interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: documentary film; suicide; masculinity; gender; sexual orientation; public health; mental health; qualitative feedback; Films; Masculinity; Mental Health; Sexuality; Suicide; Audiences; Evaluation; Mental Disorders; Test Construction

Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men - O'Cleirigh, Conall; Pantalone, David W.; Batchelder, Abigail W.; Hatzenbuehler, Mark L.; Marquez, Samantha M.; Grasso, Chris; Safren, Steven A.; Mayer, Kenneth H. (Journal of Behavioral Medicine, 2018)
Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether sexual minority specific syndemic indicators were associated with higher health care costs, health care utilization, or the risk of being HIV-infected. Health care consumers at a community health center (N = 1211) completed a brief screening questionnaire collected over 12 months. Self-reported data were linked with participants’ clinical billing records. Adjusted logistic regression models identified that four syndemic indicators (suicidality, substance use, childhood sexual abuse, and intimate partner violence) were each significantly related to each other. Multiple syndemics significantly predicted higher medical care utilization and cost, and were associated with 2.5 times the risk of being HIV-infected (OR 2.49, 95% CI 1.45–4.25). Syndemic indicators did not significantly predict the number of mental health visits or costs per patient. These results confirm and extend earlier findings by relating syndemics to health services use and costs for sexual minority men. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Syndemic; Sexual minority; Mental health; Medical cost; Health Care Utilization; HIV; Mental Health; Primary Health Care; Psychosocial Factors; Costs and Cost Analysis; Sexual Minority Groups

Mental health and substance use disorder comorbidity among methamphetamine-using men who have sex with men - Fletcher, Jesse B.; Swendeman, Dallas; Reback, Cathy J. (Journal of Psychoactive Drugs, 2018)
Men who have sex with men (MSM) exhibit elevated rates of mental health and substance use disorder relative to their non-MSM male counterparts. Methamphetamine use in particular has been associated with both neuronal damage and mental health disorders among MSM, and this study reports on the prevalence and comorbidity of DSM-5 mental health and substance use disorders in a sample of methamphetamine-using MSM. From March 2014 through January 2015, 286 methamphetamine-using MSM enrolled in a study to reduce methamphetamine use and sexual risk behaviors. At baseline, participants demonstrated high rates of current major depressive episode (35.8%), antisocial personality disorder (23.9%), suicide risk (23.2%), obsessive-compulsive disorder (23.2%), and social phobia (20.4%), as well as methamphetamine use disorder (89.1%), marijuana use disorder (41.0%), alcohol use disorder (39.6%), cocaine use disorder (30.9%), and inhalants use disorder (15.4%). Analyses revealed significant (p < 0.05) associations between methamphetamine use disorder severity and all listed mental health disorders, as well as between alcohol use disorder and all listed mental health disorders. Mental health disorder prevalence and substance use disorder severity were both elevated, and both methamphetamine and alcohol use disorder severity were associated with increased likelihood of comorbid mental health disorder. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: DSM-5; mental health disorder; men who have sex with men; methamphetamine; substance use disorder severity; Comorbidity; Mental Health; Methamphetamine; Same Sex Intercourse; Substance Use Disorder; Drug Abuse

A comparative analysis of a community and general sample of lesbian, gay, and bisexual individuals - Kuyper, Lisette; Fernee, Henk; Keuzenkamp, Saskia (Archives of Sexual Behavior, 2016)
[Correction Notice: An Erratum for this article was reported in Vol 45(3) of Archives of Sexual Behavior (see record [rid]2016-11666-011[/rid]). In the original article, There was an error in Table 5. The correct version of Table 5 is present in the erratum.] Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues ('community sample,' N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands ('panel sample,' N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexual orientation, were more open about their sexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R 2 of the analyses (which were adjusted for sociodemographic differences) ranged from .08 (suicide plans among men) to .27 (sexual attraction among women). However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: sexual orientation; gay men; lesbians; bisexuality; homosexuality; minority stress; Adolescent; Adult; Bisexuality; Female; Homosexuality, Female; Homosexuality, Male; Humans; Male; Mental Health; Middle Aged; Minority Groups; Netherlands; Residence Characteristics; Stress, Psychological; Surveys and Questionnaires; Young Adult; Bisexuality; Lesbianism; Male Homosexuality; Sexual Orientation; Stress; Minority Groups; Minority Stress

Transgender research in the 21st century: A selective critical review from a neurocognitive perspective - Mueller, Sven C.; De Cuypere, Griet; T'Sjoen, Guy (The American Journal of Psychiatry, 2017)
Gender dysphoria describes the psychological distress caused by identifying with the sex opposite to the one assigned at birth. In recent years, much progress has been made in characterizing the needs of transgender persons wishing to transition to their preferred gender, thus helping to optimize care. This critical review of the literature examines their common mental health issues, several individual risk factors for psychiatric comorbidity, and current research on the underlying neurobiology. Prevalence rates of persons identifying as transgender and seeking help with transition have been rising steeply since 2000 across Western countries; the current U.S. estimate is 0.6%. Anxiety and depression are frequently observed both before and after transition, although there is some decrease afterward. Recent research has identified autistic traits in some transgender persons. Forty percent of transgender persons endorse suicidality, and the rate of self-injurious behavior and suicide are markedly higher than in the general population. Individual factors contributing to mental health in transgender persons include community attitudes, societal acceptance, and posttransition physical attractiveness. Neurobiologically, whereas structural MRI data are thus far inconsistent, functional MRI evidence in trans persons suggests changes in some brain areas concerned with olfaction and voice perception consistent with sexual identification, but here too, a definitive picture has yet to emerge. Mental health clinicians, together with other health specialists, have an increasing role in the assessment and treatment of gender dysphoria in transgender individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: neurocognitive perspective; gender dysphoria; mental health; transgender; psychological distress; gender; Brain; Comorbidity; Humans; Mental Disorders; Risk Factors; Transgender Persons; Transsexualism; Distress; Mental Health; Neurocognition; Transgender; Gender Dysphoria; Gender Identity

Evaluation of an avatar-based training program to promote suicide prevention awareness in a college setting - Rein, Benjamin A.; McNeil, Daniel W.; Hayes, Allison R.; Hawkins, T. Anne; Ng, H. Mei; Yura, Catherine A. (Journal of American College Health, 2018)
Objective: Training programs exist that prepare college students, faculty, and staff to identify and support students potentially at risk for suicide. Kognito is an online program that trains users through simulated interactions with virtual humans. This study evaluated Kognito's effectiveness in preparing users to intervene with at-risk students. Participants: Training was completed by 2,727 university students, faculty, and staff from April, 2014 through September, 2015. Methods: Voluntary and mandatory participants at a land-grant university completed Kognito modules designed for higher education, along with pre- and post-assessments. Results: All modules produced significant gains in reported Preparedness, Likelihood, and Self-Efficacy in intervening with troubled students. Despite initial disparities in reported abilities, after training participants reported being similarly capable of assisting at-risk students, including LGBTQ and veteran students. Conclusions: Kognito training appears to be effective, on a large scale, in educating users to act in a facilitative role for at-risk college students. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: College students; LGBTQ; mental health; suicide prevention; veterans; Adolescent; Computer-Assisted Instruction; Female; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Male; Program Evaluation; Students; Suicide; Universities; West Virginia; College Environment; Intervention; Mental Health Services; Suicide Prevention; Training; At Risk Populations; College Students; Health Promotion; Mental Health; Military Veterans; LGBTQ; Avatars

Risk and protective factors in the lives of transgender/gender nonconforming adolescents - Eisenberg, Marla E.; Gower, Amy L.; McMorris, Barbara J.; Rider, G. Nicole; Shea, Glynis; Coleman, Eli (Journal of Adolescent Health, 2017)
Purpose: Research suggests that transgender and gender nonconforming (TGNC) youth may be at greatly increased risk of high-risk health behaviors compared with cisgender youth, but existing studies are limited by convenience samples and small numbers. This study uses a large school-based sample of adolescents to describe the prevalence of TGNC identity, associations with health risk behaviors and protective factors, and differences across birth-assigned sex. Methods: This study analyzes existing surveillance data provided by 9th and 11th grade students in Minnesota in 2016 (N = 81,885). Students who were transgender, genderqueer, genderfluid, or unsure about their gender identity (TGNC) were compared with those who were not, using χ² and t-tests. Outcome measures included four domains of high-risk behaviors and experiences and four protective factors. Results: The prevalence of TGNC identity was 2.7% (n = 2,168) and varied significantly across gender, race/ethnicity, and economic indicators. Involvement in all types of risk behaviors and experiences was significantly higher, and reports of four protective factors were significantly lower among TGNC than cisgender youth. For example, almost two-thirds (61.3%) of TGNC youth reported suicidal ideation, which is over three times higher than cisgender youth (20.0%, χ² = 1959.9, p < .001). Among TGNC youth, emotional distress and bullying experience were significantly more common among birth-assigned females than males. Conclusions: This research presents the first large-scale, population-based evidence of substantial health disparities for TGNC adolescents in the United States, highlighting numerous multilevel points of intervention through established protective factors. Health care providers are advised to act as allies by creating a safe space for young people, bolstering protective factors, and supporting their healthy development. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Transgender; Gender identity; High-risk health behaviors; Protective factors; Risk factors; Adolescent; Adolescent Development; Bullying; Female; Gender Identity; Health Status Disparities; Humans; Male; Population Surveillance; Protective Factors; Risk Factors; Risk-Taking; Sexual Behavior; Stress, Psychological; Suicidal Ideation; Surveys and Questionnaires; Transgender Persons; United States; Gender Identity; Health Behavior; Protective Factors; Risk Factors; Transgender; Gender Nonconforming

A young transgender woman with fatigue, malnutrition, and a previous suicide attempt - Robitz, Rachel; Gajaria, Amy; Stoklosa, Hanni; Jones, Ebony; Baldwin, Susie B. (Psychiatric Annals, 2018)
Presents a case report of 20-year-old transgender woman presented to a psychiatrist’s office complaining of fatigue. She was accompanied by a man she described as her boyfriend, who looked approximately 20 years older. The patient indicated a desire to have him accompany her during the appointment and both were resistant to suggestions that she be interviewed alone. The next week, the patient presented to the ED with a broken jaw. In the ED, staff assessed her for human trafficking using a brief tool after separating her from a woman who had accompanied her. She screened positive for trafficking, resulting in further evaluation by the ED social worker who ultimately called the National Human Trafficking Hotline, which linked the patient to appropriate local resources. Human trafficking often goes un-recognized in psychiatric settings, so it is critical that psychiatric providers receive training in identifying and treating victims in a trauma-informed manner. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: transgender women; fatigue; malnutrition; human trafficking; Fatigue; Human Trafficking; Nutritional Deficiencies; Transgender

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth - Levine, David A. (Pediatrics, 2013)
The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. This technical report reflects the rapidly expanding medical and psychosocial literature about sexual minority youth. Pediatricians should be aware that some youth in their care may have concerns or questions about their sexual orientation or that of siblings, friends, parents, relatives, or others and should provide factual, current, nonjudgmental information in a confidential manner. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to increased mental health issues for sexual minority youth. LGBTQ and MSM/WSW (men having sex with men and women having sex with women) adolescents, in comparison with heterosexual adolescents, have higher rates of depression and suicidal ideation, higher rates of substance abuse, and more risky sexual behaviors. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. This includes having supportive, engaging office staff members who ensure that there are no barriers to care. For transgender youth, pediatricians should provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender. Referral of transgender youth to a qualified mental health professional is critical to assist with the dysphoria, to educate them, and to assess their readiness for transition. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: office based care; lesbians; gay males; bisexuality; transgender; questioning; Adaptation, Psychological; Adolescent; Ambulatory Care; Bisexuality; Cooperative Behavior; Delivery of Health Care; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Female; Gender Identity; Health Status Disparities; Homophobia; Homosexuality, Female; Homosexuality, Male; Humans; Interdisciplinary Communication; Male; Medical History Taking; Parent-Child Relations; Physician-Patient Relations; Sex Education; Sex Reassignment Procedures; Substance-Related Disorders; Suicidal Ideation; Transgender Persons; United States; Unsafe Sex; Bisexuality; Health Care Delivery; Lesbianism; Pediatrics; Transgender

Nonsuicidal self-injury among a representative sample of US adolescents, 2015 - Monto, Martin A.; McRee, Nick; Deryck, Frank S. (American Journal of Public Health, 2018)
Objectives: To provide prevalence estimates of adolescent nonsuicidal self-injury (NSSI) based on large, representative, nonclinical samples of high-school students, and to explore gender differences in health risks associated with NSSI. Methods: We used 2015 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System data to estimate the prevalence of self-injury and variables potentially associated with self-injury for high-school–age boys (n = 32 150) and girls (n = 32 521) in 11 US states. We used logistic regression analysis to consider associations between NSSI and other health risks. Results: Rates of boys reporting purposefully hurting themselves without wanting to die over the past 12 months ranged from 6.4% (Delaware) to 14.8% (Nevada). Rates for girls varied from 17.7% (Delaware) to 30.8% (Idaho). Rates declined with age and varied by race and ethnicity. Depression; suicidal thoughts, plans, and attempts; sexual minority status; being electronically bullied; smoking; and substance use were associated with NSSI. There were minor differences in associations between NSSI and health risk variables by gender. Conclusions: Nonclinical populations of adolescents are at high risk for self-injury. Nonsuicidal self-injury was higher among girls than among boys, but patterns of association with other health risks were similar. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: non-suicidal self-injury; high school adolescents; gender differences; health; risk factors; prevalence; Adolescent; Cross-Sectional Studies; Female; Humans; Male; Prevalence; Risk Factors; Risk-Taking; Self-Injurious Behavior; United States; Adolescent Psychopathology; Epidemiology; High School Students; Self-Injurious Behavior; Human Sex Differences; Motivation; Risk Factors

Minority stress and leukocyte gene expression in sexual minority men living with treated HIV infection - Flentje, Annesa; Kober, Kord M.; Carrico, Adam W.; Neilands, Torsten B.; Flowers, Elena; Heck, Nicholas C.; Aouizerat, Bradley E. (Brain, Behavior, and Immunity, 2018)
Sexual minority (i.e., non-heterosexual) individuals experience poorer mental and physical health, accounted for in part by the additional burden of sexual minority stress occurring from being situated in a culture favoring heteronormativity. Informed by previous research, the purpose of this study was to identify the relationship between sexual minority stress and leukocyte gene expression related to inflammation, cancer, immune function, and cardiovascular function. Sexual minority men living with HIV who were on anti-retroviral medication, had viral load < 200 copies/mL, and had biologically confirmed, recent methamphetamine use completed minority stress measures and submitted blood samples for RNA sequencing on leukocytes. Differential gene expression and pathway analyses were conducted comparing those with clinically elevated minority stress (n = 18) and those who did not meet the clinical cutoff (n = 20), covarying reactive urine toxicology results for very recent stimulant use. In total, 90 differentially expressed genes and 138 gene set pathways evidencing 2-directional perturbation were observed at false discovery rate (FDR) < 0.10. Of these, 41 of the differentially expressed genes and 35 of the 2-directionally perturbed pathways were identified as functionally related to hypothesized mechanisms of inflammation, cancer, immune function, and cardiovascular function. The neuroactive-ligand receptor pathway (implicated in cancer development) was identified using signaling pathway impact analysis. Our results suggest several potential biological pathways for future work investigating the relationship between sexual minority stress and health. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Gene expression; Minority stress; Sexual minority men; HIV; Stimulant use; Immune activation; Inflammation; Cancer; Cardiovascular; Gene Expression; HIV; Leucocytes; Minority Groups; Stress; Human Males; Sexual Minority Groups; Minority Stress

Importance of health and social care research into gender and sexual minority populations in Nepal - Regmi, Pramod R.; van Teijlingen, Edwin (Asia-Pacific Journal of Public Health, 2015)
Despite progressive legislative developments and increased visibility of sexual and gender minority populations in the general population, mass media often report that this population face a wide range of discrimination and inequalities. LGBT (lesbian, gay, and bisexual, and transgender) populations have not been considered as priority research populations in Nepal. Research in other geographical settings has shown an increased risk of poor mental health, violence, and suicide and higher rates of smoking, as well as alcohol and drugs use among LGBT populations. They are also risk for lifestyle-related illness such as cancer, diabetes, and heart diseases. Currently, in Nepal, there is a lack of understanding of health and well-being, social exclusion, stigma, and discrimination as experienced by these populations. Good-quality public health research can help design and implement targeted interventions to the sexual and gender minority populations of Nepal. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: gender and sexual minority; stigma; LGBT; culture; South Asia; Biomedical Research; Bisexuality; Female; Health Status Disparities; Homosexuality; Homosexuality, Female; Humans; Male; Minority Groups; Nepal; Social Work; Transgender Persons; Health Care Services; Human Sex Differences; Minority Groups; Sexual Orientation; Social Services; Bisexuality; Health Attitudes; Lesbianism; Male Homosexuality; Transgender; Sexual Minority Groups

Non-suicidal self-injury in a New Zealand student population: Demographic and self-harm characteristics - Fitzgerald, John; Curtis, Cate (New Zealand Journal of Psychology, 2017)
There is an established international literature on the prevalence of non-suicidal self-injury (NSSI). However, New Zealand information regarding prevalence, attitudes, motivation, co-morbidities, etc., is limited. In this study data were collected using an on-line survey from approximately 850 university students regarding self-injurious behaviour, risk and protective factors, mental health co-morbidity, help-seeking, and addiction. Our data revealed that 293 participants (38%) had engaged in NSSI on at least one occasion in their lifetime, elevated risk for females who were lesbian or bisexual, and different patterns of site and function of injury by gender. Given research suggesting that Māori (indigenous New Zealanders) are at elevated risk for suicide it was surprising that those identifying as Māori were at no greater risk of NSSI than those identifying as New Zealanders of European origin. Females were more likely to exhibit chronic self-injuring and more likely to engage in more ‘covert’ forms of self-injury that can be hidden or disguised (e.g., scratching and cutting on their wrists, arms or thighs) whereas males were more likely to engage in ‘overt’ forms of self-injury (e.g., banging or punching themselves or objects with their hands or head). Patterns of NSSI were similar to international comparisons, although prevalence was somewhat elevated. A number of factors differed by gender, including underlying reasons, forms, rates and increasing severity of self-injury, which add to the international literature. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: non-suicidal self-injury; university students; self-harm; risk factors; College Students; Protective Factors; Risk Factors; Self-Injurious Behavior; Demographic Characteristics; Test Construction

Mental health service use in a sample of gay, bisexual, and other men who have sex with men living in Middlesex County, Ontario, Canada: An exploratory analysis - Coleman, Todd A.; Bauer, Greta R.; Aykroyd, Gloria; Powell, Leanne; Pugh, Daniel (Canadian Journal of Community Mental Health, 2016)
Risks of mental health issues (e.g., depression, anxiety/mood disorders, and suicidality) are found to be elevated among Canadian gay, bisexual, and men who have sex with men (GB-MSM). We studied factors impacting mental health care use in a community sample of 202 GB-MSM in London-Middlesex, Ontario. Our results show that, for the entire sample, experiences of both homophobia and internalized homonegativity are associated with increased prevalence of mental health service use over the past year, and suggest that service use is lower among immigrant GB-MSM than among those born in Canada. Implications for mental health and social service providers are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: mental health service use; gay; bisexual; men who have sex with men; Bisexuality; Health Care Utilization; Male Homosexuality; Mental Health Services; Same Sex Intercourse; Human Males

Identity, relationship satisfaction, and disclosure: Predicting suicide risk among sexual minority women - Velkoff, Elizabeth A.; Forrest, Lauren N.; Dodd, Dorian R.; Smith, April R. (Psychology of Women Quarterly, 2016)
We tested the usefulness of combining the Interpersonal–Psychological Theory of Suicide and minority stress models in studying suicidality among sexual minority women. According to the Interpersonal–Psychological Theory of Suicide, perceptions of being a burden on others and feelings of failed belongingness predict suicidal ideation. In a sample of sexual minority women (n = 51), we tested first, if the interaction of perceived burdensomeness and failed belongingness predicted lifetime suicidal behavior; second, if identity affirmation was negatively related to perceived burdensomeness and if this relation was moderated by disclosure; and third, if relationship satisfaction was negatively related to failed belongingness and if this relation was moderated by acceptance concerns. The proposed interaction of perceived burdensomeness and failed belongingness predicted lifetime suicide attempts. Moreover, among sexual minority women with greater disclosure of their sexual minority identities, low identity affirmation was related to higher perceived burdensomeness. For sexual minority women with high acceptance concerns, relationship satisfaction did not relate to lower feelings of failed belongingness. These findings suggest that sexual minority related stressors moderate risk factors for suicidality—in particular, perceptions of burdensomeness and failed belongingness. We suggest clinicians and others encourage sexual minority individuals to engage in activities that promote effectiveness and interpersonal closeness. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: sexual orientation; relationship satisfaction; identity; Interpersonal–Psychological Theory of Suicide; suicide; Human Sex Differences; Interpersonal Interaction; Relationship Satisfaction; Sexual Orientation; Suicide; Minority Groups; Sexual Minority Groups

Mental health as an advocacy priority in the lesbian, gay, bisexual, and transgender communities - Pandya, Anand (Journal of Psychiatric Practice, 2014)
This column reviews the evolution of lesbian, gay, bisexual, and transgender (LGBT) mental health advocacy in relation to modern mental health advocacy efforts. In addition to developments in organized psychiatry (e.g., American Psychiatric Association’s LGBT caucus), grassroots LGBT community initiatives are playing an important role (e.g., Trevor Project providing crisis intervention/suicide prevention services to LGBT youth, face-to-face mental health services in LGBT community centers). Studies have found that LGBT individuals are at increased risk for mental health problems (e.g., depression, anxiety, substance misuse, suicidal ideation, self-harm). Mental health advocacy in the LGBT community has been slowed by the long-standing association of the concept of homosexuality with psychopathology in mainstream psychiatry (e.g., homosexuality was only removed from the DSM in 1973, ego dystonic homosexuality still appears in the ICD-10). However, positive developments in LGBT mental health advocacy have been fostered by the proposed minority stress model (i.e., that elevated risk of mental illness in LGBT individuals is a consequence of a hostile stressful environment). A particularly encouraging initiative is the It Gets Better Project, in which thousands of videos, some by prominent individuals, have been posted online to send a message of hope to LGBT youth facing harassment and low self-esteem. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: lesbian & gay & bisexual & transgender communities; mental health; advocacy; Bisexuality; Community Mental Health Services; Crisis Intervention; Female; Homosexuality, Female; Homosexuality, Male; Humans; Male; Mental Disorders; Needs Assessment; Patient Advocacy; Risk Assessment; Social Adjustment; Social Environment; Suicide; Transgender Persons; United States; Advocacy; Communities; Mental Health; Bisexuality; Homosexuality; Lesbianism; Mental Disorders; Transgender

Differences in well-being between sexual minority and heterosexual college students - Crawford, Timothy N.; Ridner, S. Lee (Journal of LGBT Youth, 2018)
This study examines differences in well-being between sexual minority and heterosexual college students and identifies factors associated with well-being among sexual minority college students. A secondary analysis of cross-sectional web-based survey data was conducted. Using propensity score matching, 43 sexual minority students were matched to 43 heterosexual students on age, race, sex, and year in school. Sexual minorities had significantly lower well-being scores compared to heterosexual college students. Among sexual minorities, physical activity, depression, thoughts of suicide, and sleep quality were all predictive of well-being. Understanding issues related to well-being among sexual minorities is important and strategies need to be developed to improve well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: sexual minority; well-being; college students; heterosexuality; College Students; Group Differences; Heterosexuality; Well Being; Sexual Minority Groups

Postacute care after pediatric hospitalizations for a primary mental health condition - Gay, James C.; Zima, Bonnie T.; Coker, Tumaini R.; Doupnik, Stephanie K.; Hall, Matthew; Rodean, Jonathan; O'Neill, Margaret; Morse, Rustin; Rehm, Kris P.; Berry, Jay G.; Bardach, Naomi S. (The Journal of Pediatrics, 2018)
Objectives: To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state. Study design: Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases. Discharge to PAC was used as a proxy for transfer to an inpatient mental health facility. We derived adjusted logistic regression models to assess the association of patient and hospital characteristics with discharge to PAC. Results: In 2012, 14.7% of hospitalized children (n = 248 359) had a primary mental health diagnosis. Among these, 72% (n = 178 214) had bipolar disorder, depression, or psychosis, of whom 4.9% (n = 8696) were discharged to PAC. The strongest predictors of PAC discharge were homicidal ideation (aOR, 24.9; 96% CI, 4.1-150.4), suicide and self-injury (aOR, 15.1; 95% CI, 11.7-19.4), and substance abuse–related medical illness (aOR, 5.0; 95% CI, 4.5-5.6). PAC use varied widely by state, ranging from 2.2% to 36.3%. Conclusions: The majority of children hospitalized primarily for a mood disorder or psychosis were not discharged to PAC, and safety-related conditions were the primary drivers of the relatively few PAC discharges. There was substantial state-to-state variation. Target areas for quality improvement include improving access to PAC for children hospitalized for mood disorders or psychosis and equitable allocation of appropriate PAC resources across states. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Keywords: suicidal ideation; depression; psychosis; mood disorders; psychiatric hospitalization; Affective Disorders; Affective Psychosis; Major Depression; Psychiatric Hospitalization; Suicidal Ideation; Pediatrics

Relationships of substance use and sexual behavior of female junior high school students in Korea: A cross-sectional Web-based survey - Lee, Gyu-Young; Song, Seung Hun; Choi, Yun-Jung (Journal of Child & Adolescent Substance Abuse, 2018)
The purpose of this study was to identify the sexual behavior and associated factors of Korean female junior high school students. This study design was cross-sectional, and used raw data from the 2013 Korea Youth Risk Behavior Web-based Survey. Among the data from 72,435 students, we analyzed those from 17,609 female junior high school students. Descriptive statistics were used to identify sexual behavior, and χ²-test and logistic regression were used to identify factors related to sexual behavior. Among the female students, 2.5% responded that they had experienced sexual intercourse, and the prevalence of sexual intercourse was higher among mixed-school students than girls’-school students. The students’ risk behaviors or mental health such as drinking, smoking, drug use, depression, and suicidal ideation or attempt showed significant associations whether they had experiences of sexual intercourse or not. Factors which significantly related to students’ likelihood of sexual intercourse were smoking, drug use, depression, suicidal attempt, perceived economic status, and part-time job experiences. Based on the results of this study, development of a sexual education program including a focus on the students’ risk behaviors and mental health is recommended to reduce the likelihood of risky sex among Korean female junior high school students. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: female student; junior high school; mental health; sexual behavior; Drug Usage; Psychosexual Behavior; Mental Health; Tobacco Smoking

Explaining self-harm: Youth cybertalk and marginalized sexualities and genders - McDermott, Elizabeth; Roen, Katrina; Piela, Anna (Youth & Society, 2015)
This study investigates self-harm among young lesbian, gay, bisexual, and trans (LGBT) people. Using qualitative virtual methods, we examined online forums to explore young LGBT people’s cybertalk about emotional distress and self-harming. We investigated how youth explained the relationship between self-harm and sexuality and gender. We found that LGBT youth may articulate contradictory, ambiguous, and multiple accounts of the relationship but there were three strong explanations: (a) self-harm was because of homophobia and transphobia; (b) self-harm was due to self-hatred, fear, and shame; (c) self-harm was emphatically not related to sexuality or gender. There was evidence of youth negotiating LGBT identities, managing homophobia, resisting pathologization, and explaining self-harm as a way of coping. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: self-harm; youth; sexuality; gender; transgender; gay; lesbian; bisexual; queer; intersex; suicide; stigma; homophobia; pathologization; Bisexuality; Lesbianism; Male Homosexuality; Self-Injurious Behavior; Transgender; Human Sex Differences; Sexuality; Cyberbullying; Intersex Conditions

Understanding the effects of victimization: Applying general strain theory to the experiences of LGBQ youth - Button, Deeanna M. (Deviant Behavior, 2016)
Using a statewide probability sample of lesbian, gay, bisexual, and queer (LGBQ) youth (N = 484), this study uses a general strain theory framework to better understand the processes that connect LGBQ youths’ experiences with victimization, negative outcomes, and social support. Results show that while victimization reliably predicts negative outcomes, including poor academic performance, substance use, and suicidality, the moderating effects of social support are unreliable and contrary to theoretical expectations. Reconceptualizing social support from a moderating variable to social isolation, an independent variable, helps elucidate the role of social support in LGBQ youths’ experiences with negative outcomes. Implications are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Keywords: victimization; strain theory; LGBQ youth; social support; Psychological Theories; Sexual Orientation; Social Isolation; Social Support; Victimization; Bisexuality; Lesbianism; Male Homosexuality; Transsexualism

Depressive symptoms and suicidal ideation among Irish undergraduate college students - Horgan, Aine; Kelly, Peter; Goodwin, John; Behan, Laura (Issues in Mental Health Nursing, 2018)
This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: depressive symptoms; suicidal ideation; Irish undergraduate; college students; Adolescent; Adult; Cross-Sectional Studies; Depression; Female; Humans; Ireland; Male; Prevalence; Students; Suicidal Ideation; Young Adult; College Students; Mental Health; Suicidal Ideation; Depression (Emotion)