Suicide among lgbtqia+ youth: A review of the treatment literature - Russon, Jody; Washington, Regina; Machado, Ana; Smithee, Lauren; Dellinger, Jamie (Aggression and Violent Behavior, 2021)
Suicide is a serious public health problem among adolescent and young adults. Indeed, 12.1% of adolescents contemplate suicide, 4.0% make a plan, and 4.1% make an attempt (Nock et al., 2013). LGBTQIA+ youth (i.e., lesbian, gay, bisexual, transgender, questioning/queer, intersex and/or asexual adolescents and young adults) are particularly vulnerable to suicide (CDC, 2016; Liu & Mustanksi, 2012; Peters et al., 2019). While many LGBTQIA+ youth are healthy and resilient (Ream & Savin-Williams, 2005) they often report higher rates of both suicidal ideation and behavior than their heterosexual (Haas et al., 2011) and cisgender (James et al., 2016) peers. The purpose of this paper is to provide a structured review the state of suicide treatment research for LGBTQIA+ youth and offer recommendations for future directions. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Suicide treatment; LGBTQIA+ populations; Adolescents and young adults; No terms assigned

Association of sexual orientation acceptance with reduced suicide attempts among lesbian, gay, bisexual, transgender, queer, and questioning youth - Green, Amy E.; Price-Feeney, Myeshia; Dorison, Samuel H. (LGBT Health, 2020)
Purpose: This study examined the relationship between sexual orientation acceptance from others and suicide attempts among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. Methods: We analyzed data from a 2018 cross-sectional survey of LGBTQ youth between the ages of 13 and 24 years across the United States. Youth reported sexual orientation acceptance levels from parents, other relatives, school professionals, health care professionals, friends, and classmates to whom who they were 'out.' Adjusted logistic regression analyses were used to examine the association between sexual orientation acceptance and a past-year suicide attempt. Results: All forms of peer and adult acceptance were associated with reduced reports of a past-year suicide attempt, with the strongest associations found for acceptance from parents (adjusted odds ratio [aOR] = 0.52) and straight/heterosexual friends (aOR = 0.54). Youth who reported high levels of acceptance from any adult had nearly 40% (aOR = 0.61) lower odds of a past-year suicide attempt compared with LGBTQ peers with little to no acceptance. Youth with high levels of acceptance from any peer also had significantly lower odds of reporting a past-year suicide attempt (aOR = 0.55). These relationships remained significant even after controlling for the impact of each form of acceptance, suggesting unique associations with suicide risk for both peer and adult acceptance. Conclusion: Interventions aimed at increasing sexual orientation acceptance from supportive adults and peers have strong potential to address the public health burden of LGBTQ youth suicide. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: acceptance; minority stress model; sexual orientation; suicide; youth; No terms assigned

Suicidal as normal – A lesbian, gay, and bisexual youth script? - Canetto, Silvia Sara; Antonelli, Paolo; Ciccotti, Anna; Dettore, Davide; Lamis, Dorian A. (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2020)
Background: Lesbian, gay, and bisexual (LGB) youth are more likely to report suicidal thoughts and/or behavior (STB) than heterosexual youth. The elevated suicidality of LGB youth is not fully accounted for by sexual-minority stress, according to a meta-analysis. A less-tested explanation is that suicidality has become an expected idiom of LGB youth distress. This explanation is consistent with suicide script theory and evidence that suicidal behavior is most likely when it is relatively acceptable. Aims: Building on suicide script theory and evidence, two studies were designed: one of LGB youth attitudes about suicidal behavior, and the other of LGB youth attitudes about suicidal individuals. Method: Surveys of LGB and heterosexual youth (total N = 300; M age = 20; 51% female) were conducted. Results: LGB youth were more accepting of and empathic toward suicidal behavior than heterosexual youth. They also viewed suicidal individuals as more emotionally adjusted. Limitations: Attitudes were not examined by sexual-minority subgroups. Conclusion: LGB youth's understanding attitudes may translate into less judgmental behavior toward suicidal peers, but also into normalizing suicidality as a way to express distress and cope with life problems. There may be utility in evaluating LGB youth suicide attitudes in suicide prevention initiatives. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: lesbian/gay/bisexual; suicidal; youth; suicide attitudes; cultural scripts of suicide; Attitudes; Suicidality; LGBTQ; Adolescent Attitudes; Adolescent Development; Bisexuality; Distress; Lesbianism; Suicide Prevention

Hiv stigma, homophobia, sexual and gender minority community connectedness and hiv testing among gay, bisexual, and other men and transgender people who have sex with men in kazakhstan - Paine, Emily Allen; Lee, Yong Gun; Vinogradov, Vitaliy; Zhakupova, Gulnara; Hunt, Timothy; Primbetova, Sholpan; Terlikbayeva, Assel; El-Bassel, Nabila; Wu, Elwin (AIDS and Behavior, 2021)
Although HIV incidence is rising among gay, bisexual, and other men (MSM) and transgender people who have sex with men (TSM) in Kazakhstan, whether stigmatizing attitudes and connectedness are associated with HIV testing in this region is not known. We analyzed data from one-time interviews with 304 adult MSM and TSM conducted 2018–2019 in three cities in Kazakhstan. Logistic regression determined whether HIV stigma, internalized homophobia, sexual and gender minority (SGM) connectedness predicted HIV testing (within the lifetime, past year, and past 6 months) before and after adjustment for sociodemographic characteristics. 80% of participants reported ever receiving an HIV test. Gay-identified participants reported less HIV stigma and internalized homophobia as well as greater connectedness relative to those with bisexual or other identities. In adjusted models, those who had ever tested reported lower HIV stigma (aOR 0.83, 95% CI 0.76–0.91, P < .001) and higher connectedness (aOR 1.17, 95% CI 1.06–1.29, P = .003) than those who had not; those who had ever tested reported lower internalized homophobia in the unadjusted model only (OR 0.95, 95% CI 0.91–0.99, P = .01). Similar differences and trends were found in models examining testing in the past year and past 6 months. Addressing stigmatizing attitudes and connectedness may improve uptake of HIV testing among MSM and TSM in Kazakhstan. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Kazakhstan; HIV testing; MSM; Transgender populations; HIV stigma; Homophobia; Social connectedness; No terms assigned

It Gets Better videos for suicide prevention in LGBTIQ+ adolescents: Content analysis of German-language videos - Kirchner, Stefanie; Till, Benedikt; Plöderl, Martin; Niederkrotenthaler, Thomas (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2021)
Background: The It Gets Better project aims to help prevent suicide among lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) adolescents. It features personal video narratives portraying how life gets better when struggling with adversities. Research on the contents of messages is scarce. Aims: We aimed to explore the content of videos in the Austrian It Gets Better project regarding the representation of various LGBTIQ+ groups and selected content characteristics. Method: A content analysis of all German-language videos was conducted (N = 192). Messages related to coming out, stressors experienced, suicidal ideation/behavior, and on how things get better were coded. Results: Representation was strong for gay men (n = 45; 41.7%). Coming out to others was mainly positively framed (n = 31; 46.3%) and seen as a tool to make things better (n = 27; 37.5%). Social support (n = 42; 62.7%) and self-acceptance (n = 37; 55.2%) were prevalent topics. Common stressors included a conservative setting (n = 18, 26.9%), and fear of outing (n = 17; 25.4%). Suicidality (n = 9; 4.7%) and options to get professional help (n = 7; 8.2%) were rarely addressed. Limitations: Only aspects explicitly brought up in the videos were codeable. Conclusion: Videos do not fully represent gender identities and sexual orientations. Messaging on suicidality and professional help require strengthening to tailor them better for suicide prevention. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: adolescents; LGBTIQ+; suicide prevention; prevention videos; qualitative study; Messages; Stress; Suicide Prevention; Suicidality; LGBTQ; Bisexuality; Digital Video; Transgender; Adolescent Behavior; Intersex Conditions

The influence of minority stress on indicators of suicidality among lesbian, gay, bisexual and transgender adults in thailand - Kittiteerasack, Priyoth; Matthews, Alicia K.; Steffen, Alana; Corte, Colleen; McCreary, Linda L.; Bostwick, Wendy; Park, Chang; Johnson, Timothy P. (Journal of Psychiatric and Mental Health Nursing, 2020)
Accessible summary What is known on the subject? Established research from the United States and other Western countries has found that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. Suicidality among LGBT individuals is understudied in Thailand and other Asian countries, warranting additional research to better understand risk factors and to create effective treatment and suicide prevention interventions. What the paper adds to existing knowledge? The study examined rates and predictors of suicidality in Thai LGBT adults. Study findings suggest that general (e.g. stress and loneliness) and minority stressors (e.g. discrimination and victimization) played important roles in predicting lifetime and past‐year suicidal ideation, while socio‐demographic and health‐related factors (e.g. living in high poverty area and having chronic diseases) were associated with suicide attempts among LGBT individuals. What are the implications for practice? Changes in the nursing curriculum and continuing education resources are needed to improve knowledge and core competencies in the mental health and treatment needs of LGBT individuals in Thailand. Among LGBT serving practitioners, routine assessment of suicidality is needed to increase the early identification and treatment of individual at risk for suicidal behaviours. Standardized measures of sexual orientation and gender identity should be included in all patient intake forms. In conducting research on strategies to improve mental health outcomes among LGBT populations, standardized measures of sexual orientation/gender identity and minority‐specific stressors should be used. Suicide prevention interventions aimed at reducing general and minority stress among LGBT populations should be a priority in mental health nursing. Abstract Introduction A large and rigorous body of research in the United States has demonstrated that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. However, scant research aimed at understanding the rates and predictors for suicidality among Thai LGBT individuals exists. Aim To examine rates and predictors of suicidality among Thai LGBT adults (N = 411). Method Data collection was conducted via online and in‐person surveys. Guided by the Minority Stress Model, standardized measures of demographics, health‐related factors, general and minority‐specific stressors and suicidality were completed. Results Thirty‐nine per cent of participants reported lifetime suicidal ideation, 19.0% past 12‐month suicidal ideation and 13.1% lifetime suicide attempts. Lifetime suicidal ideation was associated with higher levels of social discrimination, stress, loneliness and chronic disease (OR = 1.12, 1.16, 2.75, and 1.46, p ≤ .05, R2 = 0.327). Past‐year suicidal ideation was associated with victimization, stress, loneliness and being a former smoker (OR = 1.52, 1.20, 2.34, and 4.89, p < .05, R2 = 0.345). Suicide attempts were associated with internalized homophobia, poverty, chronic disease, alcohol use and physical health (OR = 1.44, 1.06, 1.59, 1.45 and 0.95, p ≤ 0.05, R2 = 0.187). Discussion General and minority‐specific stressors negatively impacted suicidality among LGBT participants. Implication for practice Study findings have implications for nursing education, practice and research. Nursing education should include information about the influence of sexual orientation and gender identity on mental health outcomes. Further, systematic screening for suicidality should be conducted by LGBT serving psychiatric and mental health nurses. Finally, research is needed to determine best practices for interventions aimed at reducing suicidality risk among LGBT individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gender Identity; LGBT; Minority stress; Sexual Orientation; Suicidality; No terms assigned

Factors associated with suicide attempts among Australian transgender adults - Zwickl, Sav; Wong, Alex Fang Qi; Dowers, Eden; Leemaqz, Shalem Yiner-Lee; Bretherton, Ingrid; Cook, Teddy; Zajac, Jeffrey D.; Yip, Paul S. F.; Cheung, Ada S. (BMC Psychiatry, 2021)
Background: Transgender, including gender diverse and non-binary people, henceforth referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. We aimed to understand the risk and protective factors of a lifetime history of attempted suicide in a community sample of Australian trans adults to guide better mental health support and suicide prevention strategies. Methods: Using a non-probability snowball sampling approach, a total of 928 trans adults completed a crosssectional online survey between September 2017 and January 2018. The survey assessed demographic data, mental health morbidity, a lifetime history of intentional self-harm and attempted suicide, experiences of discrimination, experiences of assault, access to gender affirming healthcare and access to trans peer support groups. Logistic regression was used to examine the risk or protective effect of participant characteristics on the odds of suicide. Results: Of 928 participants, 85% self-reported a lifetime diagnosis of depression, 63% reported previous self-harm, and 43% had attempted suicide. Higher odds of reporting a lifetime history of suicide attempts were found in people who were; unemployed (adjusted odds ratio (aOR) 1.55 (1.05, 2.29), p = 0.03), had a diagnosis of depression (aOR 3.70 (2.51, 5.45), p < 0.001), desired gender affirming surgery in the future (aOR 1.73 (1.14, 2.61), p = 0.01), had experienced physical assault (aOR 2.01 (1.37, 2.95), p < 0.001) or experienced institutional discrimination related to their trans status (aOR 1.59 (1.14, 2.23), p = 0.007). Conclusion: Suicidality is associated with barriers to gender affirming care, gender based victimisation and institutionalised cissexism. Interventions to increase social inclusion, reduce transphobia and enable timely access to gender affirming care, particularly surgical interventions, are potential areas of intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: transgender; mental health; suicide; depression; anxiety; suicide attempt; risk factors; protective factors; lifetime history; mental health support; suicide prevention; suicidal behaviour; rural areas; unemployment; difficulty; gender-affirming interventions; perceived discrimination; assault experiences; adults; Australia; Attempted Suicide; Major Depression; Protective Factors; Risk Factors; Transgender; Anxiety; Discrimination; Experiences (Events); Intervention; Mental Health; Patient History; Rural Environments; Suicide; Suicide Prevention; Unemployment

Sexual minority stress, mental health symptoms, and suicidality among lgbtq youth accessing crisis services - Fulginiti, Anthony; Rhoades, Harmony; Mamey, Mary Rose; Klemmer, Cary; Srivastava, Ankur; Weskamp, Garrett; Goldbach, Jeremy T. (Journal of Youth and Adolescence, 2020)
Sexual and gender minority youth are at elevated risk for suicide. Studies have separately established the relation between minority stress and mental health symptoms, as well as minority stress and suicidality. However, no known research has simultaneously examined different mental health mechanisms whereby minority stress may be associated with different suicidal experiences (e.g., suicidal ideation, suicide attempts). The present study used data from a national sample of 572 sexual and gender minority youth aged 12 to 24 (mean age = 17.59; SD = 3.13) recruited from an LGBTQ youth-focused suicide crisis prevention provider. Nearly one-third of the sample (30.2%) identified as transgender, genderqueer, or questioning. Nearly one quarter of the sample (24.3%) identified as gay, 17.1% as pansexual, 16.8% as bisexual, and 15.2% as lesbian. Structural equation modeling was used for mediation analyses to explain suicidal ideation and suicide attempts. Serial mediation models were determined to be the best fit for both suicide-related outcomes. Minority stress was associated with depressive and PTSD symptoms, which were linked with suicidal ideation and attempt through hopelessness. The findings supported the hypotheses that minority stress would be associated with suicidality not just directly, but also indirectly through multiple mental health symptom pathways. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: LGBT; Suicidality; Crisis services; Minority stress; Depression; PTSD; No terms assigned

Sexual minorities, mental health, and religiosity at a religiously conservative university - Klundt, Jared S.; Erekson, David M.; Lynn, Austin M.; Brown, Hannah E. (Personality and Individual Differences, 2021)
With increasing mental health concerns on college campuses and the complex developmental tasks of young adulthood, sexual minority students may be at particular risk for negative mental health and well-being outcomes. This risk may be compounded at highly religious universities that are not affirming of same-sex romantic relationships. The current study examined religiosity, mental health outcomes, and sexual minority identity at a highly religious university using structural equation modeling. All undergraduates were invited to participate, and 7625 students participated, with 996 students indicating a sexual orientation other than 'strictly heterosexual.' We found that sexual minority students had significantly worse mental health outcomes and well-being than their heterosexual peers. We also found that religiosity acted as a protective factor for both the sexual minority and the heterosexual group, although the effect was weaker for the sexual minority group. Finally, we found that for sexual minority students, concerns around being accepted by others was the greatest predictor of lower quality of life and higher suicidality, depression, generalized anxiety, social anxiety, and academic distress. We discuss potential strategies to mitigate acceptance concerns for sexual minority students on college campuses. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: LGBQ; Mental health; Well-being; Religiosity; Religious university; University students; College Students; Mental Health; Religiosity; Sexual Minority Groups; LGBTQ

Depression and suicide risk at the cross-section of sexual orientation and gender identity for youth - Guz, Samantha; Kattari, Shanna K.; Atteberry-Ash, Brittanie; Klemmer, Cary L.; Call, Jarrod; Kattari, Leonardo (Journal of Adolescent Health, 2021)
Purpose: Adolescence is a developmental phase in which young people begin to explore their identity and seek to understand how their identity fits into the larger society. Although this is a developmental task for all adolescents, it is especially salient for sexual and gender minority youth. Owing to oppressive social structures and stigmatized identities, adolescents who identify as nonheterosexual or noncisgender are vulnerable to experiencing disproportionate adverse health outcomes. Methods: To further the literature on adolescent mental health among sexual and gender minority youth, this study analyzed a representative statewide sample of high school students (ages 14–18) to analyze how sexual orientation and gender identity are associated with depression and suicidality. Results: Results aligned with previous research demonstrating that sexual and gender minority youth were all at a heightened risk for depression. However, transgender youth and youth questioning their sexuality or gender were at especially heightened risk for experiencing depression and suicidality. Conclusion: The findings of this study indicate a need to target or adapt direct services and programming for sexual and gender minority adolescents. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: mental health; depression; suicidality; LGBTQ; questioning; Gender Identity; Major Depression; Sexual Orientation; Suicidality; LGBTQ; Mental Health; Risk Factors; Suicide

The survey measurement of sexual orientation: Configurations of sexual identity and attraction and associations with mental health - Garbarski, Dana (LGBT Health, 2021)
Purpose: This study aimed to examine how configurations of sexual identity and attraction are associated with mental health outcomes. Methods: Data came from the 2015, 2016, and 2017 waves of the National Survey on Drug Use and Health, one of the few nationally representative surveys to ask about sexual attraction. Sexual identity and attraction were combined into groups that are coincident (heterosexual-opposite gender attraction, gay/lesbian-same gender attraction, or bisexual-any multiple gender attraction) or branched (heterosexual-any same gender attraction, gay/lesbian-any opposite gender attraction, bisexual-only same or opposite gender attraction). The association between these configurations and various measures of mental health and well-being—severe psychological distress, major depressive episode, suicidal ideation, and suicide plan or attempt—was examined. Results: Heterosexual coincidence—being heterosexual and only attracted to the opposite gender—was associated with lower mental health risks than all other configurations of sexual identity and attraction. In addition, bisexual with coincident attraction was often associated with worse mental health outcomes than other configurations of identity and attraction, whereas bisexual with branched attraction did not necessarily follow this pattern. Finally, heterosexual with branched attraction was associated with worse mental health outcomes than heterosexual with coincident attraction, but better mental health outcomes than some of the other sexual identity and attraction configurations. Conclusion: Including one question on sexual attraction and its intersection with sexual identity adds nuance to our understanding of disparities in mental health and well-being among previously identified sexual minority and majority groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: health disparities; mental health; sexual attraction; sexual identity; sexual orientation; survey methodology; No terms assigned

Understanding pathways to e-cigarette use across sexual identity: A multi-group structural equation model - Doxbeck, Courtney R.; Jaeger, Joseph A.; Bleasedale, Jacob M. (Addictive Behaviors, 2021)
This study explored the relationships between sexual violence, smoking behaviors, suicidality and past 30-day e-cigarette use under the theoretical framework of Minority Stress Theory. The 2017 National Youth Risk Behavioral Survey was utilized to study a nationally representative sample of sexual minority (lesbian, gay, bisexual, and unsure) and heterosexual high school students (N = 7882). Multi-group structural equation modeling (SEM) was employed to examine whether sexual violence and suicidality had a direct effect on e-cigarette use, after controlling for prior smoking behaviors (cigarette, cigar, and marijuana use). Suicidality and smoking behaviors were examined as mediators of the relationship between sexual violence and e-cigarette use, and suicidality was examined as a mediator of the relationship between sexual violence and smoking behaviors. This model was tested for invariance across sexual minority and heterosexual students. For both groups, smoking behaviors had significant direct effects on e-cigarette use, yet suicidality revealed no significant direct effects. Both suicidality and sexual violence had significant indirect effects on e-cigarette use through their effects on smoking behaviors. Sexual violence had a significant direct effect on e-cigarette use for sexual minority students, but not for heterosexual students. Despite this notable difference, the model was found to be invariant across the two groups. These findings suggest that students who report sexual violence may experience suicidality and victimization may lead to smoking behaviors and e-cigarette use. Students’ mental health and substance use behaviors should continue to be targeted in schools, particularly among sexual minority youths. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: suicide; minority stress; substance use; substance abuse; mental health; sexual orientation; tobacco use; e-cigarette use; sexual violence; smoking behaviors; suicidality; Sex Offenses; Tobacco Smoking; Electronic Cigarettes; Suicidality; Minority Stress; Drug Abuse; Drug Usage; Mental Health; Models; Sexual Orientation; Suicide; Violence

Suicide attempts in association with traditional and electronic bullying among heterosexual and sexual minority uS High school students - Humphries, Kayleigh D.; Li, Li; Smith, Gary A.; Bridge, Jeffrey A.; Zhu, Motao (Journal of Adolescent Health, 2021)
PURPOSE: The aim of this study was to compare the association between bullying (traditional, electronic, and both) and suicide attempt in heterosexual and lesbian, gay, or bisexual (LGB) U.S. high school students. METHODS: Data were obtained from 2015–2017 National Youth Risk Behavior Survey. RESULTS: Nearly 25% of students reported experiencing bullying. Approximately 5.9% of heterosexual and 25.7% of LGB students attempted suicide. Heterosexual students who experienced either traditional or electronic bullying had a higher risk of attempting suicide (1.54 [95% confidence interval 1.19–1.98] and 1.64 [1.23–2.19], respectively). The associations were similar but weaker among LGB students (1.49 [1.08–2.04] and 1.43 [.90–2.27], respectively). Students who experienced both forms of bullying had the highest prevalence of suicide attempt, but the interaction was not statistically significant. CONCLUSIONS: LGB students had higher rates of both suicide attempts and experiencing bullying. Traditional and electronic bullying are not synergistic in the risk of attempting suicide, although each form increases that risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Sexual and gender Minorities; Bullying; Suicide; Attempted; Students; No terms assigned

A cross-sectional study of mental health, suicidal ideation and suicide attempt among transgender women in Jiangsu province, China - Chen, Yuanfang; Chen, Shi; Arayasirikul, Sean; Wilson, Erin; McFarland, Willi; Lu, Jing; Chen, Yunting; Yan, Hongjing (Journal of Affective Disorders, 2020)
Objectives: To measure prevalence and risk factors of poor mental health, suicidal ideation, and suicide attempt among transgender women in Jiangsu province, China. Methods: We surveyed 250 transgender women with mean age of 27.9 years from July 2018 to May 2019 in Jiangsu province, China. Logistic regression analysis characterized risk factors for mental health, suicidal ideation, and suicide attempt. Results: Many transgender women experienced discrimination, including verbal abuse (56.0%), physical abuse (32.0%), and sexual violence (32.0%) during their lifetime. Classification by the Kessler Psychological Distress Scale found 32.4%% to be in good mental health, while 24.0%, 16.8%, and 26.8% had mild, moderate, and severe psychological distress respectively. In multivariable logistic regression, severe psychological distress was correlated with bisexual orientation (vs. gay/lesbian, aOR = 2.9, 95%CI = 1.5-5.8), being unsure of sexual orientation (vs. gay/lesbian, aOR = 4.7, 95%CI = 1.8-12.8), experience of verbal abuse (aOR = 1.8, 95%CI = 1.1-3.1), and less severe with alcohol use (aOR = 0.6, 95%CI = 0.3-0.9) (P < 0.05). Many transgender women also reported suicidal ideation (22.0%) and prior suicide attempt (25.6%). Compared to no suicidal ideation, moderate (aOR = 4.9, 95%CI = 1.6-15.2) or severe psychological distress (aOR = 38.6) were associated with prior suicide attempt (P < 0.05). Residing in Jiangsu province (vs. not residing in Jiangsu, aOR = 0.3, 95%CI = 0.1-0.6) and higher income (vs. lower income, aOR = 0.6, 95%CI = 0.4-0.9) were protective factors for suicide attempt (P < 0.05). Conclusion: Chinese transgender women experience high levels of discrimination, abuse, poor mental health, suicidal ideation, and suicide attempts in Jiangsu province. Society-wide interventions need to be developed to mitigate transphobic discrimination among transgender women in China. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender women; Mental health; Suicidal ideation; Suicide attempt; Risk factors; Attempted Suicide; Mental Health; Risk Factors; Suicidal Ideation; Transgender; Distress

Characteristics and perceptions of sexual and gender minority youth who utilized a national sexual and gender minority-focused crisis service - Mereish, Ethan H.; Feinstein, Brian A.; Mamey, Mary Rose; Goldbach, Jeremy T. (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2021)
Background: Sexual and gender minority youth (SGMY) have heightened risk of suicidality; yet, we know little about their experiences when utilizing crisis services. Aims: The purpose of this study was to understand the characteristics and experiences of SGMY when in contact with SGMY-specific suicide crisis services. Method: Data were from 592 SGMY who contacted the most widely utilized national US SGMY-specific crisis services provider. Results: High rates of suicide ideation (65.2%) and attempts (31.9%) were documented, with gender minority youth endorsing higher rates of suicide attempts. Participants contacted the center by phone (57.8%) more than by online chat/text (42.2%). Participants reported discussing their sexual orientation (60.6%), gender identity (43.8%), and identity disclosure stress (56.6%) with counselors. Participants rated the crisis service as helpful. The counselors were perceived as warm, compassionate, and knowledgeable about common concerns for SGMY and they were likely to contact the crisis center again. Participants reported using chat/text over phone because it provided them with more confidentiality and privacy; however, phone contacts were rated more positively than text/chat. Limitations: The sample was predominately White and was not representative of the broader population of SGMY, limiting the generalizability of the results. Conclusion: SGMY reported positive experiences with a national SGMY-specific crisis service. The findings highlight the critical need for and utility of SGMY-specific suicide prevention crisis services. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: suicide; counselors; sexual and gender minority youth; crisis services; suicide prevention; Counselors; Crisis Intervention Services; Gender Identity; Suicide Prevention; Sexual Minority Groups; Attempted Suicide; Stress; Suicidal Ideation; Suicide

Family‐of‐origin rejection on suicidal ideation among a sexual minority sample - VanBergen, Alexandra M.; Love, Heather A. (Journal of Marital and Family Therapy, 2021)
Suicide is a leading cause of death in the United States. Among sexual minority populations, suicide risk is elevated; this can be explained by minority stress. One such source of minority stress is family‐of‐origin rejection, a known risk factor for suicide among lesbian, gay, and bisexual (LGB) adolescents; however, less is known about this association among sexual minority adults. While navigating the intersection of minority stress theory and the interpersonal theory of suicide, this study sought to evaluate the impact of family‐of‐origin rejection distress on suicidal ideation among a sample of adults with marginalized sexual orientations. Recruited for two larger studies, 325 LGB participants (64.3% cisgender, 35.7% transgender or nonbinary) completed an online survey concerning minority stressors, depressive symptoms, and suicide. Using cross‐sectional mediation analysis, family‐of‐origin rejection distress was indirectly associated with suicidal thoughts through depressive symptoms. Clinical implications and suggestions for future research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: depression; marginalized sexual orientation; minority stress; suicidal thoughts; No terms assigned

Gender diverse youth on fertility and future family: A qualitative analysis - Kerman, Hannah M.; Pham, An; Crouch, Julia M.; Albertson, Katie; Salehi, Parisa; Inwards-Breland, David J.; Ahrens, Kym R. (Journal of Adolescent Health, 2021)
PURPOSE: Gender-affirming treatment for transgender and nonbinary adolescents has been shown to decrease anxiety, depression, and suicidality, but treatments have medical consequences. Specifically, hormone replacement and pubertal blocking may impact patients' fertility and childbearing capabilities. We interviewed gender diverse adolescents regarding their thoughts on family and fertility. METHODS: We completed semistructured interviews with 23 gender diverse adolescents recruited from the Seattle Children's Gender Clinic. Interviewees included transfeminine, transmasculine, and nonbinary youth. Interviews were recorded, transcribed, and analyzed using Braun and Clarke's theory of thematic analysis, a flexible framework for qualitative analysis. RESULTS: Gender diverse adolescents have myriad views on fertility, but four main themes were identified: (1) an interest in future family, including ideas regarding adoption and biological children; (2) barriers to fertility, including cost and procedure-related dysphoria; (3) factors unique to the developmental stage of adolescents, including the age discordance of making fertility decisions as a teenager and parental influence on decision-making; and (4) suggestions for clinicians approaching fertility counseling with adolescents considering hormone therapy. CONCLUSIONS: Many gender diverse youth asserted an interest in building families, although the process of fertility preservation remains fraught. Relative to other studies, our participants were hopeful, imaginative, and interested in having children. Participants wanted to receive specific counseling on fertility, to receive help navigating the logistics of fertility preservation, and to be listened to when their hopes for children (or no children) were stated. Further research is needed to create care paradigms that address fertility of transgender youth in an affirming, developmentally appropriate manner. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Transgender; Gender diverse; Youth; Fertility; No terms assigned

Nonsuicidal self-injury, suicide ideation, and suicide attempts among sexual minority children - Blashill, Aaron J.; Fox, Kathryn; Feinstein, Brian A.; Albright, Christopher A.; Calzo, Jerel P. (Journal of Consulting and Clinical Psychology, 2021)
Objectives: Sexual minority adolescents have previously been found to experience disparities in self-injurious thoughts and behaviors (SITBs) compared to heterosexual adolescents. However, there is a paucity of data on SITBs amongst children. Thus, the aim of the current study is to assess the prevalence of SITBs in a large sample of U.S. children and to test whether rates vary by sexual orientation. Methods: Data were drawn from the 2.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study. The full sample included 11,777raw 9–10-year-old children (sexual minority n = 150raw). Children completed a computerized version of the youth Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5), including items assessing suicide ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Unadjusted and adjusted models compared the prevalence of outcomes by sexual orientation. Models also compared the co-occurrence of NSSI and suicide ideation by sexual orientation. Results: Across all outcomes, sexual minority children reported elevated prevalence rates compared to heterosexual children, with odds ratios ranging from 4.4 to 6.5. Among children who reported NSSI, a greater proportion of sexual minority versus heterosexual children reported co-occurring suicide ideation (OR = 3.8). Conclusions: In a large sample of 9–10-year-old U.S. children, sexual orientation disparities emerged across NSSI, suicide ideation, and suicide attempts. Results indicate that sexual minority children are a vulnerable population for SITBs. Inclusion of children in prevention programs is encouraged. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: suicide; self-injury; child; sexual orientation; health disparities; Attempted Suicide; Self-Injurious Behavior; Suicidal Ideation; Child Characteristics; Sexual Minority Groups; Heterosexuality; Sexual Orientation; Health Disparities

Suicidality risk among adult sexual minorities: Results from a cross-sectional population-based survey - Haney, Jolynn L. (Journal of Gay & Lesbian Social Services: The Quarterly Journal of Community & Clinical Practice, 2021)
Abstract Suicide among sexual minority adults is a serious public health issue. Data from the National Survey of Drug Use and Health (2015–2018) were analyzed to evaluate factors associated with past-year suicidality risk (thoughts, plans, or attempts) and self-reported sexual identity. Findings support previous research that sexual minority groups have a higher risk of suicidality compared to heterosexuals. Additionally, significant within-group gender differences were found for bisexuals with reported past-year suicide attempts. The risk ratio trajectory from suicidal ideation to suicidal attempt was the most striking for the gay and lesbian group compared to other populations. Implications and recommendations for future research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: NSDUH; sexual identity; sexual minority; sexual orientation; suicidality; suicide attempts; suicide plans; suicide thoughts; No terms assigned

Examination of minority stress pathways to suicidal ideation among sexual minority adults: The moderating role of LGBT community connectedness - Rogers, Megan L.; Hom, Melanie A.; Janakiraman, Roshni; Joiner, Thomas E. (Psychology of Sexual Orientation and Gender Diversity, 2020)
Individuals identifying as sexual minorities are at heightened risk for suicidal ideation and attempts. Meyer’s (1995, 2003) minority stress model proposes that external minority stressors (i.e., harassment, rejection, discrimination) result in the internalization of these negative attitudes and beliefs, which then leads to psychological distress (e.g., suicidal thoughts). However, the role of potential resiliency factors, such as connectedness to the LGBT community, remains less explored. This study aimed to (a) replicate previous work demonstrating that internalized homophobia accounts for the relationship between external minority stressors and suicidal ideation; and (b) examine whether LGBT community connectedness moderates these associations, above and beyond more general connectedness. A sample of 329 adults (58.4% cisgender male, 36.8% cisgender female, 2.4% transgender female, 1.2% transgender male, 0.9% gender nonconforming, 0.3% other gender) identifying as sexual minorities (86.3% gay/lesbian, 10.0% bisexual/pansexual, 0.3% asexual, 3.3% another sexual orientation), aged 18 to 74 years (M = 30.94, SD = 7.18), completed a battery of self-report measures online. Results of a moderated mediation model using path analysis indicated that internalized homophobia accounted for the association between greater external minority stressors and more severe suicidal ideation. Further, associations between greater external minority stressors and greater internalized homophobia, and between greater internalized homophobia and more severe suicidal ideation, were stronger at high, rather than low, levels of LGBT community connectedness. These findings contribute to a better understanding of how minority stress, community connectedness, and internalized homophobia may contribute to suicide risk among sexual minority individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; connectedness; sexual minority; minority stress; internalized homophobia; Homosexuality (Attitudes Toward); Suicidal Ideation; Sexual Minority Groups; LGBTQ; Minority Stress; Attempted Suicide; Communities; Resilience (Psychological); Suicide

Risk and protective factors for suicide among sexual minority youth seeking emergency medical services - Horwitz, Adam G.; Grupp-Phelan, Jacqueline; Brent, David; Barney, Bradley J.; Casper, T. Charles; Berona, Johnny; Chernick, Lauren S.; Shenoi, Rohit; Cwik, Mary; King, Cheryl A. (Journal of Affective Disorders, 2021)
Background: Differences in risk and protective factors (e.g., victimization, abuse, social support) have been used to explain elevated rates of suicidal ideation and suicide attempts in sexual minority youth (SMY) relative to heterosexual peers. However, little is known regarding how risk and protective factors may explain suicide risk differences among subgroups of SMY. The aims of this study were to 1) examine differences in prevalence and severity for suicide risk and protective factors among SMY, and 2) explore whether risk and protective factors are differentially associated with suicidal ideation and suicide attempts for SMY subgroups. Methods: Participants were 6,423 adolescents (ages 12–17) recruited from 14 Emergency Departments across the United States who completed an assessment of suicide risk and protective factors. SMY were 20% of the sample (n = 1,275) and categorized as bisexual (8%), gay/lesbian (2%), mostly straight (5%), or other sexual minority (5%). Results: Bisexual youth had elevated rates of suicidal ideation and attempts, more risk factors (e.g., bullying victimization, depression), and fewer protective factors (e.g., parent-family connectedness, positive affect) relative to mostly straight and other sexual minority youth. Bisexual and gay/lesbian youth only differed in parent-family connectedness (lower among bisexual youth). Depression and parent-family connectedness had weaker associations with suicidal ideation for bisexual youth. Limitations: Emergency departments were not nationally representative. Study design was cross-sectional, preventing causal inferences. Conclusions: Interventions seeking to mitigate risk factors and promote protective factors are greatly needed for SMY and may benefit from tailoring to address unique stressors for sexual minority subgroups. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Sexual minority youth; Suicidal ideation; Suicide attempts; Risk and protective factors; Emergency medical services; Attempted Suicide; Protective Factors; Risk Factors; Suicidal Ideation; Sexual Minority Groups; Emergency Services

Early adolescent gender diversity and mental health in the Adolescent Brain Cognitive Development study - Potter, Alexandra; Dube, Sarahjane; Allgaier, Nicholas; Loso, Hannah; Ivanova, Masha; Barrios, Lisa C.; Bookheimer, Susan; Chaarani, Bader; Dumas, Julie; Feldstein-Ewing, Sarah; Freedman, Edward G.; Garavan, Hugh; et al. (Journal of Child Psychology and Psychiatry, 2021)
Background: There are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health. Methods: The ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1‐year follow‐up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1‐year visit assessed felt‐gender, gender noncontentedness, and gender nonconformity using a 5‐point scale. Mental health measures included youth‐ and parent‐reports. Results: Roughly half a percent of 9/10‐year‐olds (n = 58) responded ‘yes’ or ‘maybe’ when asked, ‘Are you transgender’ at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, χ² = 16.0, p < .001). At the 1‐year visit, when asked about the three dimensions of gender on a 5‐point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed. Conclusions: Similar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt‐gender, gender noncontentedness, gender nonconformity) among 10/11‐year‐olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Gender diversity; gender expression; nonconformity; suicidality; early adolescent; transgender; Adolescent Development; Transgender; Early Adolescence; Gender Nonconforming; Cognitive Development; Mental Health; Surveys; Suicidality

Racial/ethnic, sex, sexual orientation, and socioeconomic disparities in suicidal trajectories and mental health treatment among adolescents transitioning to young adulthood in the usa: A population-based cohort study - Xiao, Yunyu; Lindsey, Michael A. (Administration and Policy in Mental Health and Mental Health Services Research, 2021)
Suicide is the second leading cause of death for people aged 10–34 years old. Limited research has documented extant heterogeneities in suicide across the life course and among diverse sociodemographic groups. There is also limited research on the influences of mental health utilization on suicidal trajectories across the life course. This study aims to: (1) identify racial/ethnic, sex, sexual orientation, socioeconomic status, and intersectional differences in suicidal trajectories among adolescents transitioning to adulthood; and (2) examine influences of mental health service utilization on disparities in suicidal trajectories. The study included 9421 respondents (Mage = 14.99 [SD = 1.61]) from Waves I–IV National Longitudinal Study of Adolescent to Adult Health (1994–2008). Latent class growth analyses were used to identify trajectories of suicidal ideation and suicide attempts. Multivariate multinomial logistic regression was used to examine the influences of mental health treatment and sociodemographic characteristics on suicidal trajectories. Three suicidal ideation (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt (low-stable, moderate-decreasing) trajectories were identified. Compared with the low-stable trajectories, the risks of being in high-decreasing suicidal ideation trajectories were higher among females (AOR = 1.45, 95% CI 1.01–2.13) and sexual minorities (AOR = 1.82, 95% CI 1.21–2.74). Sexual minorities (AOR = 2.63, 95% CI 1.69–4.08) and low-SES adolescents (AOR = 1.79, 95% CI 1.08–2.98) were more likely to be in the moderate-decreasing suicide attempt group. Mental health service utilization predicted engagement in high-risk suicidal trajectories. Sociodemographic disparities in suicidal trajectories initiate early and persist over time. Individuals in high-risk trajectories received mental health treatment during adolescence. Suicide prevention should target vulnerable subpopulations and mental health service utilization in the early stage. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Suicidal trajectories; Suicidal ideation; Suicide attempt; Health disparities; Mental health treatment; Life course; No terms assigned

The impact of the first three months of the covid-19 pandemic on the australian trans community - Zwickl, Sav; Angus, Lachlan M.; Qi, Alex Wong Fang; Ginger, Ariel; Eshin, Kalen; Cook, Teddy; Leemaqz, Shalem Y.; Dowers, Eden; Zajac, Jeffrey D.; Cheung, Ada S. (International Journal of Transgender Health, 2021)
Abstract Background Trans and gender diverse individuals (people who identify with a gender different to what was presumed for them at birth) are one of the most medically and socially marginalized groups in our community. The COVID-19 pandemic may compound preexisting depression and thoughts of self-harm or suicide. Aim We aimed to explore the impact of the COVID-19 pandemic on the Australian trans community. Methods An online cross-sectional survey was conducted between 1st May 2020 and 30th June 2020, amidst strict Australia-wide social restrictions. Australian trans people aged ≥16 years were eligible to participate. Survey questions explored the impact of the COVID-19 pandemic on living situation, employment, financial situation, and healthcare. Logistic regression to assess negative impacts due to COVID-19 on depression and thoughts of self-harm or suicide (measured by Patient Health Questionnaire-9 (PHQ-9) are presented as odds ratios (95% confidence interval)). Results Of 1019 participants, 49.6% reported experiencing financial strain, 22% had reduced working hours, and 22.4% were unemployed (three times the national rate). Concerningly, 61.1% experienced clinically significant symptoms of depression (Patient Health Questionnaire-9 score ≥10), considerably higher than pre-COVID rates for the trans community and over twice the national rate. Moreover, 49% reported thoughts of self-harm or suicide (over three times the national rate) which was more likely if a person experienced cancelation or postponement of gender-affirming surgery (OR 1.56 (1.04, 2.35)), financial strain (OR 1.80 (1.36, 2.38)), or felt unsafe or afraid in their household (OR 1.96 (1.23, 3.08)). Discussion Given rates of clinically significant depression and thoughts of self-harm or suicide are far higher in trans people than the general population, specific strategies to improve mental health in the trans community during the COVID-19 pandemic must be made a priority for policymakers, researchers, and health service providers to prevent suicide. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1890659 (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Coronavirus; COVID-19; depression; suicidality; transgender; No terms assigned

Teen dating violence and suicide risk among bisexual adolescents - Smith, Ariel U.; Reidy, Dennis; Norris, Anne E. (Journal of Adolescent Health, 2020)
Purpose: Suicide is a public health problem that disproportionately affects bisexual youth more than heterosexual, lesbian/gay, and other sexual minority youth. Teen dating violence (TDV) consists of physically, emotionally, and/or psychologically aggressive behavior in adolescent relationships and has been linked to increased suicidality among sexual minority youth. Although biological sex differences in suicide and TDV have been noted, limited research currently exists regarding the importance of these differences in bisexual youth. Methods: This study employed a cross-sectional descriptive design to investigate the relationship between biological sex, TDV, and suicide risk among bisexual youth in grades 9–12. This study used structural equation modeling to conduct a secondary analysis of pooled 2015 and 2017 national Youth Risk Behavior Surveillance Survey data that examined whether TDV mediated the relationship between biological sex and suicide risk among bisexual youth. Results: Results indicated that TDV did not mediate the relationship between biological sex and suicide risk among bisexual youth. Biological sex was a significant predictor of suicide risk with male youth reporting lower suicide risk than female youth, when controlling for dating history, TDV, age, and race. TDV predicted suicide risk, with youth reporting TDV having higher suicide risk, when controlling for dating history, biological sex, age, and race. In addition, black and Hispanic youth reported lower suicide risk compared to white youth. Conclusion: There is a dire need for research that addresses issues of TDV and suicide among bisexual youth. Understanding factors influencing suicide risk following TDV experiences among bisexual youth will inform interventions to mitigate negative mental health outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; bisexuality; teen dating violence; Bisexuality; Intimate Partner Violence; Risk Factors; Sexual Risk Taking; Suicide; Social Dating; Suicide Prevention; Sexual Minority Groups

Intersecting identities and nonsuicidal self-injury among youth - Angoff, Harrison D.; McGraw, James S.; Docherty, Meagan (Identity: An International Journal of Theory and Research, 2020)
ABSTRACT Recent research suggests that intersecting marginalized identities may be important in explaining suicide-related mental health disparities. However, inconsistent findings have emerged regarding nonsuicidal self-injury (NSSI). Guided by an intersectionality framework, we examined relations between identity and NSSI using a representative sample of 8th through 12th graders from Utah (N = 49,425). The independent influence of sexual orientation, gender, race/ethnicity, and religious preference on NSSI were examined using bivariate and multivariate logistic regression analyses. Intersectionality analyses, using two-way interaction terms, were then conducted to examine the impact of intersecting identities on NSSI. Results indicated that gay/lesbian, bisexual, and transgender and 'other' gender youth, and non-Latter-day Saint (LDS) participants were at particularly high risk of NSSI. In intersectionality analyses, sexual minorities were more likely than heterosexual participants to endorse NSSI among cisgender, but not gender minority youth; bisexual participants of color were less likely to engage in NSSI than European American bisexual youth, but no effect for race/ethnicity was found for gay/lesbian youth; and among heterosexual participants, non-LDS youth were more likely than LDS youth to engage in NSSI, but no effect for religion was found among gay/lesbian or bisexual participants. Implications of these results and the differences in results by method are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Nonsuicidal self-injury; intersectionality; sexual minority; LGBTQ; transgender; No terms assigned

Suicidality among gender minorities in Karnataka, South India - Halli, Shiva S.; Isac, Shajy; Bhattacharjee, Parinita; Dutta, Sumit; Ramesh, B. M.; Lorway, Robert; Blanchard, James (BMC Psychiatry, 2021)
Background: It is argued that Indian gender minorities displayed differential mental health problems and suicide attempts. Hence, the study was intended to understand the prevalence of anxiety, depression and suicidality among this group, specifically those living in a metropolitan city in South India. Methods: The data was generated from a cross-sectional study that employed a structured questionnaire to collect information about experiences of anxiety, depression and suicidal behavior among gender-diverse individuals in Bangalore, the capital city of Karnataka state. The study used stratified simple random sampling of eligible individuals who were 18 years of age and older and who were enrolled in an HIV prevention program implemented for gender-diverse individuals run by the Karnataka Health Promotion Trust and the University of Manitoba at the time of the study (2012). Bivariate and multivariate analyses were used to assess the relative contribution of various factors that affect suicide ideation or actual attempts among the gender diverse participants. Results: Results showed that 62% whose main source of income was Basti (socially sanctioned practice of begging), 52% of Hijras, 56% who lived with their Gurus, 58% who were not happy with their physical appearance, 55% who consumed alcohol daily, and 63% who experienced high depression had ever thought of or attempted suicide in the month prior to the survey. However, multivariate analysis showed that respondents who were not happy with their physical appearance and thought of changing it had significantly higher odds (AOR = 2.861; CI 1.468,5.576; p = 0.002) of either having thoughts that it was better being dead or wished they died. Similarly, those who experienced high depression, their odds of either having had thoughts of or having attempted suicide increased by three times (AOR = 3.997; CI 1.976, 8.071; p < 0.000). Conclusions: It is observed that a high percentage of gender minorities had attempted suicide or thought of suicide during the month preceding the data collection. The findings bring new insights on the proximate determinant of physical appearance on the suicidality of gender minorities assigned male at birth and appropriate to account for this while addressing the mental health issues. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Suicidality; Gender minorities; Hijra and Kothi; Anxiety; Depression; Karnataka; India; Anxiety Disorders; Attempted Suicide; Major Depression; Suicidality; Sexual Minority Groups; Urban Environments; Gender Nonconforming

Sexual violence victimization and suicide: Testing a coping‐mental health framework - Kaniuka, Andrea R.; Desmarais, Sarah L.; Cramer, Robert J.; Stoner, Julie E.; Veri, Shelby; Wright, Susan; Gemberling, Tess M.; Nobles, Matt R.; Holley, Sarah R. (Aggressive Behavior, 2021)
Sexual violence victimization is a prevalent public health concern. However, little research has investigated the factors linking sexual violence victimization to suicidal thoughts and behaviors (STBs). The current study tested the applicability of the psychological mediation framework, a coping‐mental health model, for the prevention of STBs among victims of sexual youviolence. Furthermore, the current study explored whether sexual orientation moderated the progression from sexual violence victimization to STBs. Data were drawn from an online survey of victimization experiences and health (N = 2175). Bootstrap mediation tested whether the association of sexual violence victimization and STBs was mediated by emotion regulation strategies (cognitive reappraisal and expressive suppression) and psychopathology (anxiety, depression, and posttraumatic stress disorder). Multiple‐groups analysis tested whether links within the mediation effects varied by sexual orientation. Bivariate findings showed that: (1) sexual minority persons were more likely to report sexual violence victimization and (2) cognitive reappraisal was more meaningfully associated with mental health among sexual minority persons. Sexual violence victimization was associated with STBs via a serial mediation through emotion regulation and psychopathology. The association between psychopathology and STBs was stronger among sexual minority compared with heterosexual respondents. Physical violence victimization was associated with STBs for heterosexual but not sexual minority persons in a follow‐up model. Findings support an emotion regulation‐mental health framework for the prevention of suicide among victims of sexual violence. Research and training implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: emotion regulation; mental health; psychological mediation framework; sexual minority; sexual orientation; sexual violence; suicide; No terms assigned

Suicide, homicide, and all-cause mortality among transgender and cisgender patients in the veterans health administration - Boyer, Taylor L.; Youk, Ada O.; Haas, Ann P.; Brown, George R.; Shipherd, Jillian C.; Kauth, Michael R.; Jasuja, Guneet K.; Blosnich, John R. (LGBT Health, 2021)
Purpose: This study examines the differences in suicide, homicide, and all-cause mortality between transgender and cisgender Veterans Health Administration (VHA) patients. Methods: VHA electronic medical record data from October 1, 1999 to December 31, 2016 were used to create a sample of transgender and cisgender patients (n = 32,441). Cox proportional hazard regression was used to evaluate differences in survival time (date of birth to death date/study end). Death data were from the National Death Index. Results: Transgender patients had more than twofold greater hazard of suicide than cisgender patients (adjusted hazard ratio [aHR] = 2.77, 95% confidence interval [CI] = 1.88–4.09), especially among younger (18–39 years) (aHR = 3.35, 95% CI = 1.30–8.60) and older (≥65 years) patients (aHR = 9.48, 95% CI = 3.88–23.19). Alternatively, transgender patients had an overall lower hazard of all-cause mortality (aHR = 0.90, 95% CI = 0.84–0.97) compared with cisgender patients, which was driven by patients 40–64 years old (aHR = 0.78, 95% CI = 0.72–0.86) and reversed by those 65 years and older (aHR = 1.17, 95% CI = 1.03–1.33). Conclusion: Transgender patients' hazard of suicide mortality was significantly greater than that of cisgender VHA patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: homicide; mortality; suicide; transgender; veterans; No terms assigned

Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk - Dunlop, Brendan J.; Hartley, Samantha; Oladokun, Olayinka; Taylor, Peter J. (Journal of Affective Disorders, 2020)
[Correction Notice: An Erratum for this article was reported in Vol 277 of Journal of Affective Disorders (see record [rid]2020-75728-134[/rid]). The authors wish to acknowledge an additional affiliated institution for Dr Samantha Hartley: Pennine Care NHS Foundation Trust, Old Street, Ashton-Under-Lyne, Greater Manchester, United Kingdom.] Background: Bisexual people have been found to be at increased risk of non-suicidal self-injury (NSSI) when compared to heterosexual and gay or lesbian people. The purpose of this review was to update the estimated risk of NSSI for bisexual people and to examine variables that have been associated with NSSI in this population. Methods: The protocol for this paper was pre-registered (CRD42019145299). An electronic search of PsycINFO, CINAHL Plus, PubMed, Ovid Online and Web of Science was undertaken from earliest available date to October 2019. Twenty-four eligible papers were identified. Meta-analyses, including moderator analysis, were conducted to ascertain NSSI risk and a narrative synthesis was undertaken of predictors and correlates. All studies were assessed for risk of bias. Results: Bisexual people had up to six times the odds of engaging in NSSI compared to other sexualities. Mental health variables of anxiety and depression symptoms were found to be most commonly associated with NSSI for this population. The majority of studies had moderate risk of bias. This review demonstrates that bisexual people have an elevated risk of engaging in NSSI. Increased incidence of anxiety and depression and exposure to negative life events may explain this increased risk. Limitations: Studies were found to be consistently cross-sectional in design and limited to western cultures. A limitation of this review was that only English language papers were included. Conclusions: Results are clinically relevant as they suggest early identification and prevention of NSSI can be achieved. Future research should examine bisexual people independently of others. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Bisexual; Bisexuality; Non-suicidal self-injury; NSSI; Self-injury; LGBT; Bisexuality; Self-Injurious Behavior; Sexuality; LGBTQ

The link between LGBTQ-supportive communities, progressive political climate, and suicidality among sexual minority adolescents in Canada - Saewyc, Elizabeth M.; Li, Gu; Gower, Amy L.; Watson, Ryan J.; Erickson, Darin; Corliss, Heather L.; Eisenberg, Marla E. (Preventive Medicine: An International Journal Devoted to Practice and Theory, 2020)
Despite supportive structural changes to reduce stigma towards lesbian, gay, and bisexual, transgender, queer, and questioning (LGBTQ) Canadian residents, sexual minority youth still face disparities compared to heterosexual peers. We aimed to characterize LGBTQ-supportive environments and political climates, and examine their links to suicidal behavior among sexual minority adolescents in western Canada. Data were from the 2013 British Columbia Adolescent Health Survey, a cluster-stratified random cross-sectional survey of public school students in BC, Canada; We sampled 2678 self-identified LGB and mostly heterosexual students (69% girls) from 274 schools, representing an estimated provincial population of 24,624 sexual minority students in weighted models. Student reports of past-year suicidal ideation, suicidal attempts, and self-harm behaviors were merged with community-level data assessing diverse aspects of LGBTQ-supportive resources and progressive political climates in communities surrounding the schools. Adjusted multilevel models showed that for sexual minority adolescent girls, higher community LGBTQ-supportiveness predicted marginally significant lower suicidal ideation (aOR = 0.94, 95% CI [0.88, 1.01]) and suicidal attempts (aOR = 0.91, 95% CI [0.83, 1.00]) and significantly lower self-harm behaviors (aOR = 0.91, 95% CI [0.85, 0.98]). Further, progressive political climates predicted marginally significant lower suicidal ideation (aOR = 0.89, 95% CI [0.78, 1.02]) and significantly lower self-harm behaviors (aOR = 0.87, 95% CI [0.77, 0.99]). For sexual minority adolescent boys, no community-level variables were associated with suicidal behavior in adjusted models. Thus, LGBTQ-supportive communities and progressive political climates appear to be protective against suicidal behavior among sexual minority adolescent girls, but not sexual minority adolescent boys. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual minority youth; Suicide; LGBTQ-supportive environment; Structural stigma; BCAHS; Project RESPEQT; Communities; Political Issues; Self-Injurious Behavior; Suicidal Ideation; LGBTQ; Adolescent Behavior; Sexual Minority Groups

Mental health and health risk behaviors of active duty sexual minority and transgender service members in the united states military - Holloway, Ian W.; Green, Daniel; Pickering, Chad; Wu, Elizabeth; Tzen, Michael; Goldbach, Jeremy T.; Castro, Carl A. (LGBT Health, 2021)
Purpose: The aim of this study was to examine health risk behaviors and mental health outcomes among sexual minority and transgender active duty military service members and their heterosexual and cisgender counterparts. Methods: Participants (N = 544) were recruited by using respondent-driven sampling between August 2017 and March 2018 and completed an online survey by using validated measures of cigarette smoking, alcohol use, anxiety, depression, post-traumatic stress disorder (PTSD), and suicidality. Bayesian random intercept multiple logistic regressions were used to understand differences between sexual minority participants and heterosexual participants as well as between transgender participants and both their cisgender sexual minority and cisgender heterosexual peers. Results: Cisgender sexual minority women service members were more likely to meet criteria for problematic alcohol use (adjusted odds ratio [aOR] = 10.11) and cigarette smoking (aOR = 7.12) than cisgender heterosexual women. Cisgender sexual minority men had greater odds of suicidality (aOR = 4.73) than their cisgender heterosexual counterparts. Transgender service members had greater odds of anxiety, PTSD, depression, and suicidality than their cisgender peers. Conclusion: Military researchers and policymakers who seek to improve the overall health and well-being of sexual minority and transgender service members should consider programs and policies that are tailored to specific health outcomes and unique sexual minority and transgender subgroups. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: health disparities; health risk behaviors; mental health; military; No terms assigned

Identifying distinct subgroups of lesbian, gay, and bisexual youth for suicide risk: A latent profile analysis - Giano, Zachary; Currin, Joseph M.; Deboy, Kyle; Hubach, Randolph D. (Journal of Adolescent Health, 2020)
Purpose: The purpose of the study was to identify profiles of lesbian, gay, and bisexual (LGB) youth who are at risk for suicidal behavior. Method: Data were collected through the Youth Risk Behavior Surveillance System (N = 2,738). We used latent profile analysis to create identity profiles using variables associated with suicide, including bullying, alcohol use, poor grades, electronics use, and sleep hours. Results: The LPA revealed a 6-class solution. Class 6 represented the highest risk profile with the highest scores in alcohol, bullying, poor grades, electronics use, and the least sleep and were 17 times more likely to attempt suicide compared to class 2 (the lowest-risk class). Classes 1, 3, 4, and 5 had a mixture of both high and low risk mean scores across the variables, with class 3 showing the strongest relationship to suicide (7 times more likely than class 2). Conclusion: Because high-risk classes in our study had multiple factors contributing to associations to suicide, programming aimed at attenuating youth suicide among LGB youth may benefit from addressing multiple issues simultaneously (e.g., substance use and bullying). This would be a departure from more traditional programs for LGB youth which are predicated on one specific risk behavior, such as coping with bullying or substance use separately. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGB; Suicide; Risk; Youth; profiles of LGB youth at risk for suicidal behavior; lesbian; gay; bisexual; bullying; At Risk Populations; Suicide; Bullying; Adolescent Health; LGBTQ; Drug Usage; Suicidal Ideation; Suicidality

Ecological factors influencing suicidal ideation-to-action among Latinx adolescents: An exploration of sex differences - Villarreal-Otálora, Tatiana; Boyas, Javier F.; Alvarez-Hernandez, Luis R.; Fatehi, Mariam (Children and Youth Services Review, 2020)
Little is known regarding how various system-level factors influence suicidal behaviors between Latinx female and male youth in the US. Using an ideation-to-action and an ecological systems theory framework, this study stratified Latinx adolescent males and females to examine the association between various micro, mezzo, and macro level factors and three suicidality outcome measures. This cross-sectional study used a subsample of self-identified Latinx adolescents (n = 3639) from the 2017-National Youth Risk Behavioral Survey. Multiple micro factors—depressed mood, cannabis use, and sexual assault—were associated with each step of the suicidality continuum. One mezzo factor, physical violence, was unique in the prediction of suicide attempt for Latinx males. At the macro level, no statistically significant relationships were found. Results from the backward elimination logistic regression also revealed that identifying as lesbian, gay, or bisexual showed the strongest association with suicidal ideation and suicide planning for both groups. However, it was the strongest association with suicide attempt among Latinx adolescent males, but not for Latinx adolescent females. Implications for practice, policy, and research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Latinx youth; suicidal ideation; suicidality; ideation-to-action; ecological systems; sex differences; adolescents; micro factors; depressive mood; cannabis use; intimate partner violence; sexual assault; mezzo factors; bullying; physical fighting; safety; macrosystem factors; state-level immigration policy; climate; Ecological Factors; Human Sex Differences; Suicidal Ideation; Latinos/Latinas; Suicidality; Aggressive Behavior; Cannabis; Emotional States; Immigration; Intimate Partner Violence; Major Depression; Policy Making; Safety; Sex Offenses; Bullying

Nightmares as a unique predictor of suicide risk in a transgender and gender diverse sample - Andrew, Shianne J.; Cogan, Chelsea M.; Scholl, James A.; Davis, Joanne L. (Dreaming, 2020)
Transgender and gender diverse individuals are at an increased risk for suicidality. Previous research in the general population has shown that trauma exposure is linked to suicide risk and nightmares, which commonly occur following exposure to a traumatic event, have also been linked to suicidal thoughts, attempts, and death by suicide. The current study examined the relationship among trauma exposure, sleep disturbance, and suicide risk in a sample of 155 transgender individuals. Data were gathered through an online Qualtrics survey regarding participants’ trauma exposure, endorsement of posttraumatic stress disorder (PTSD) symptoms, frequency and severity of trauma-related nightmares, and suicide risk. Nightmare frequency was found to significantly predict suicide risk, whereas nightmare severity on its own did not. Multiple exploratory analyses were conducted to examine the effects of trauma exposure and PTSD symptom severity on the relationship. In the first analysis, nightmare frequency remained the only variable significantly contributing to suicide risk, above and beyond PTSD and trauma exposure. In the second analysis, PTSD symptom severity significantly contributed to suicide risk above and beyond nightmare severity and trauma exposure. Results of the study suggest that nightmare frequency may play a unique role in suicide risk beyond that of trauma exposure and PTSD within transgender and gender diverse individuals. This provides evidence of an additional risk factor within this specialized population that can be targeted and treated to reduce suicide risk. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: nightmares; suicide; transgender; trauma; gender diverse; Nightmares; Posttraumatic Stress Disorder; Severity (Disorders); Suicide; Transgender; Trauma; Gender Nonconforming

Health disparities in access to health care for hiv infection, substance abuse, and mental health among latino men who have sex with men in a uS–mexico border city - Loza, Oralia; Provencio-Vasquez, Elias; Mancera, Bibiana; De Santis, Joseph (Journal of Gay & Lesbian Social Services: The Quarterly Journal of Community & Clinical Practice, 2021)
Abstract A cross-sectional study among 150 community-dwelling Latino men who have sex with men (MSM) in a U.S.–Mexico border city was conducted to describe health disparities in access to care for HIV infection, substance use/abuse, and mental health. Data were collected in 2013 and 2014. Median age of participants was 26 years, and the majority of participants identified as a sexual minority and born in the United States. Half did not have health insurance and reported suicidal ideation. One-eighth reported living with HIV. Most common substances reported were alcohol, tobacco, and marijuana. Clinicians who provide care for Latino MSM should be aware of intersecting comorbidities. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Health disparities; HIV/AIDS; mental health; people of color; substance abuse; No terms assigned

Profiles of distress and self-harm among LGBTQ+ transitional youth in a rural state - Knutson, Douglas; Jacobs, Sue C.; Hakman, Melissa; Milton, David Cole (Journal of Rural Mental Health, 2021)
In the rural state of Oklahoma, suicide rates are nearly double the U.S. national average. Self-harm behaviors are among the risk factors for suicide and are believed to regulate negative emotions such as depression and anxiety. LGBTQ + transitional youth in rural areas are likely to experience elevated rates of depression, anxiety, and stress, relative to heterosexual, cisgender populations. In an effort to identify emotional and behavioral dynamics that may underlie self-harm in a rural state, 316 LGBTQ + transitional youth in Oklahoma were recruited. Participants completed measures of negative affect, emotion regulation, outness, and self-harm. A cluster analysis was conducted to identify distress-related trends in the data and identified clusters of high, moderate, and low distress groups. Chi-square analyses identified associations among groups based on gender expression, gender identity, sexual orientation, education, and homelessness. A regression equation identified predictors of self-harm. Cluster analysis results informed hierarchical organization of a linear regression equation in which the study team controlled for between-group differences and outness. In the final regression model [F (10, 305) = 14.20, p < .001], distress, emotion dysregulation, education variables, homelessness, and outness predicted self-harm behaviors. Implications of study findings for the distribution of resources and guidance for healthcare professionals and community advocates are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: LGBTQ+; self-harm; depression; anxiety; transitional youth; Anxiety; Distress; Rural Environments; Self-Injurious Behavior; LGBTQ; Major Depression; Suicide; Negative Emotions

Disparities in prescription opioid misuse affecting sexual minority adults are attenuated by depression and suicidal ideation - Morgan, Ethan; Feinstein, Brian A.; Dyar, Christina (LGBT Health, 2020)
Purpose: Heightened rates of prescription opioid misuse have been observed among sexual minority (SM) compared with heterosexual populations. In addition, depression and suicidal ideation are risk factors for misuse, and they are also elevated among SM populations. The purpose of this analysis was to examine whether depression and suicidal ideation attenuate disparities in prescription opioid misuse among SM adults. Methods: Data came from a publicly available, nationally representative data set, the National Survey on Drug Use and Health, 2015–2018. Among adults, survey-weighted logistic regression was used to assess the relationship between sexual orientation and past-year opioid misuse adjusting for demographics and either past-year major depressive episode or suicidal ideation. Probabilities of prescription opioid misuse were also assessed under counterfactual rates of depression and suicidal ideation. Analyses were stratified by sex. Results: Among participants in the analytic sample (N = 169,759; SM = 11,268), 9254 (5.5%) reported past-year prescription opioid misuse. The overall rate of opioid misuse decreased from 6.2% in 2015 to 4.6% in 2018. The association between sexual orientation and opioid misuse was attenuated downward for gay men, lesbian women, and bisexual individuals (men and women) after adjusting for either major depressive episode or suicidal ideation, but opioid misuse remained higher among most SM groups. In addition, rates of opioid misuse were found to be lower in counterfactual analyses with a nearly 2.5- and 4-fold decrease in depression and suicidal ideation among gay men and bisexual women, respectively. Conclusion: Efforts to reduce disparities in depression and suicidal ideation affecting SM individuals may reduce disparities in prescription opioid misuse affecting this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: depression; opioids; sexual minority populations; suicidal ideation; Major Depression; Opiates; Suicidal Ideation; Sexual Minority Groups; Prescription Drug Misuse; Sexual Orientation; Health Disparities

Sexual/gender minority-related individual differences predict likelihood of social action after a hate crime - Sheehan, Brynn E.; Maduro, Ralitsa S.; Derlega, Valerian J. (Psychology of Sexual Orientation and Gender Diversity, 2020)
This study examined how social identity predicts willingness to engage in social action following a hate crime. More specifically, we looked at this within the context of lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) identities, with a focus on 3 aspects of social identity; identity centrality, private regard, and public regard. Further, we assessed whether the association between identity and social action was mediated by identification with victims and feeling personally threatened by the attack. Data were provided by 232 LGBTQ persons via an online survey related to their reactions after the Pulse nightclub shooting. Path analysis model results revealed that both high identity centrality and high private regard were related to social action motivation by means of identification with the shooting victims and feeling more personally threatened. There also was an indirect effect between public regard and social action via identification with shooting victims; lower public regard predicted a greater willingness to engage in social action through increased identification with the shooting victims. We argue that high identity centrality, high private regard, and low public regard increase awareness and concern about anti-LGBTQ violence, thereby increasing many LGBTQ persons’ willingness to engage in social action after these catastrophic events occur. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBTQ identity; Pulse nightclub shooting; hate crime; social action; Emotions; Hate Crimes; Social Identity; Violence; LGBTQ; Social Justice; Test Construction; Transgender; Sexual Minority Groups

An intersectional analysis of LGBTQ online media coverage of the Pulse nightclub shooting victims - Meyer, Doug (Journal of Homosexuality, 2020)
This study illustrates the radical potential of intersectionality to offer a more deeply critical analysis of hierarchies in lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. The author examines how 377 reports from the five most-trafficked LGBTQ Web sites represented victims of the Pulse nightclub shooting in Orlando, FL. Findings support previous scholarship that has emphasized Latinx exclusion, as the articles generally failed to present the victims in an intersectional way, focusing on their LGBTQ status and excluding their Latinx identities. At the same time, a significant minority of the reports emphasized Latinx queer people, most frequently in a way that continued to prioritize LGBTQ identification, sometimes even advancing stereotypical representations of Latinx communities as extraordinarily focused on faith, family, or 'machismo.' Moreover, none of the articles considered xenophobia as a potential motivating factor in the shooting, and the reports typically presented policing agencies in a neutral, and sometimes even positive, way. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Pulse nightclub shooting; intersectionality theory; Latinx; racism in LGBTQ communities; anti-transgender violence; immigration; Latino; Latina; race/ethnicity; mass shootings; Communications Media; Websites; LGBTQ; Communities; Homosexuality; Values; Violence; Transgender; Latinos/Latinas

Suicide exposure in transgender and gender diverse adults - Cerel, Julie; Tucker, Raymond R.; Aboussouan, Alix; Snow, Annie (Journal of Affective Disorders, 2021)
Objective: The purpose of this study is to examine the psychological effects of suicide exposure for Transgender and Gender Diverse (TGD) adults. Method: Using data from a national online survey of 2784 self-identified TGD adults, the current study investigated the prevalence of suicide death and suicide attempt exposure and demographic and mental health correlates. Results: Nearly sixty percent of the sample (57.9%) reported they were close to at least one person who attempted suicide, and more than a quarter of the sample reported they were close to at least one person who died by suicide. Exposure to either the suicide attempt or death of another individual was related to multiple indicators of psychological distress. Conclusions: Exposure to the suicidal behavior of close others is prevalent in TGD individuals: over half of participants were close to someone who attempted suicide, more than in population-based studies of suicide exposure. Exposure appears to have a potential effect on recent indicators of psychological distress and suicide risk, which is important to consider when working in TGD communities. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Exposure; Transgender; suicide; Attempted Suicide; Suicide; Transgender; Gender Nonconforming; Death and Dying

Online self-injury activities among psychiatrically hospitalized adolescents: Prevalence, functions, and perceived consequences - Nesi, Jacqueline; Burke, Taylor A.; Lawrence, Hannah R.; MacPherson, Heather A.; Spirito, Anthony; Wolff, Jennifer C. (Research on Child and Adolescent Psychopathology, 2021)
The majority of adolescents with psychiatric disorders use social media, engaging in a range of online activities that may confer both risks and benefits. Very little work, however, has examined engagement in online activities related to self-injury among these youth, such as posting about self-injury, viewing self-injury related content, or messaging about self-injury with online or offline friends. This study examined the frequency and types of online self-injury activities in which adolescents engage, perceived functions that these activities serve, and associated risk for self-injurious thoughts and behaviors (SITBs). Participants were 589 psychiatrically-hospitalized adolescents (Mage = 14.88), who completed self-report measures assessing online self-injury activities, perceived functions and consequences of these activities, and SITBs. Results indicated that 43.3% of the sample had engaged in online self-injury activities, that the majority (74.8%) used social networking sites (e.g., Snapchat, Instagram) to do so, and that these activities were significantly more common among sexual and gender minority youth. Adolescents who talked about self-injury with friends met online were more likely to report a history of suicide attempt(s). A latent profile analysis revealed three distinct subgroups of youth based on their perceived functions of engaging in online self-injury activities. Subgroups reporting higher levels of engagement for purposes of identity exploration, self-expression, and aiding recovery were at heightened risk for negative perceived consequences of these activities and reported greater suicidal ideation severity. Findings offer new insights for identifying youth who may be at heightened risk for SITBs in the context of social media use. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Adolescents; Self-injury; Suicide; Social media; Online; Adolescent Psychiatry; Hospitalization; Risk Factors; Self-Injurious Behavior; Social Media; Messages; Profiles (Measurement); Suicide

Predicting suicidal behavior among lesbian, gay, bisexual, and transgender youth receiving psychiatric emergency services - Berona, Johnny; Horwitz, Adam G.; Czyz, Ewa K.; King, Cheryl A. (Journal of Psychiatric Research, 2020)
Lesbian, gay, bisexual, and transgender (LGBT) youth are at elevated risk for self-injurious thoughts and behaviors (SITBs). However, few studies have comprehensively examined SITBs and their longitudinal course in LGBT youth at high risk for suicide. The aims of the present study were to characterize histories of SITBs among high-risk LGBT youth and to examine prospective associations with suicidal behavior. Participants were 285 youth (41.8% LGBT) ages 13–25 years receiving psychiatric emergency department (ED) services. Post-discharge suicidal behavior was assessed via 4-month phone interviews and 12 month chart reviews. The sample was 42.1% male, 57.9% female, 2.5% gender minority, 41.8% sexual minority. LGBT participants were more likely to have prior psychiatric ED visits and hospitalizations, more frequent past week suicide ideation, and more severe nonsuicidal self-injury (NSSI). We conducted stratified survival analyses to identify predictors of time to suicidal behavior post discharge. The final model for LGBT youth included past week suicide ideation and past month NSSI episodes. Among non-LGBT youth, the final model included number of lifetime NSSI methods and use of a highly lethal suicide attempt method. Within this sample of youth receiving psychiatric emergency services, LGBT youth were overrepresented and had more severe histories of SITBs. Results suggest the importance of assessing both lifetime and recent factors (i.e., past week and month), particularly for LGBT youth. Future research should replicate these findings in larger samples to explore whether there are unique risk factors that can aid in predicting and preventing suicide among LGBT youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicidal behavior; lesbian; gay; bisexual; transgender; psychiatric emergency services; Emergency Services; Lesbianism; Risk Factors; Self-Injurious Behavior; LGBTQ; Adolescent Attitudes; Bisexuality; Homosexuality; Suicide; Transgender; Emerging Adulthood

Bullying victimization: Investigating the unique contribution of homophobic bias on adolescent non-suicidal self-injury and the buffering role of school support - Esposito, Concetta; Affuso, Gaetana; Amodeo, Anna Lisa; Dragone, Mirella; Bacchini, Dario (School Mental Health: A Multidisciplinary Research and Practice Journal, 2021)
Research on bullying victimization has expanded to specific forms of harassment based on discriminatory bias, which involve aggressive behavior targeting an individual's identity characteristics, such as sexual orientation and/or gender expression. Recent studies have documented elevated health risks associated with victimization based on homophobic bias, above and beyond general victimization. The aim of the current study was to test the unique contribution of homophobic victimization on adolescent non-suicidal self-injury (NSSI) and to analyze the buffering role of teachers and classmates support. Participants were 770 adolescents (55.5% females; Mage = 15.35, SD = 1.62) enrolled in Italian public schools in grade nine (N = 483) and 12 (N = 287). All measures were collected during Spring 2016 using self-reported questionnaires. Zero-inflated Poisson regression analyses suggested that homophobic victimization had a unique contribution on NSSI frequency of engagement once initiated, but not on the probability of engaging in NSSI at least once. High classmates support was negatively associated with adolescents’ engagement in NSSI. Furthermore, higher levels of classmates support were associated with a lower NSSI frequency only for youth who reported low levels of homophobic victimization. In contrast, the association between classmates support and NSSI frequency was nonsignificant when youth reported high levels of homophobic victimization. No significant effects were found for teachers support. Overall, our findings underscore the need to address the serious concern of homophobic victimization within schools and the importance of promoting healthy and positive identity development in adolescence. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Non-suicidal self-injury; Homophobic victimization; Bullying victimization; School support; Teachers support; Classmates support; Adolescence; No terms assigned

'straight sex is complicated enough!': The lived experiences of autistics who are gay, lesbian, bisexual, asexual, or other sexual orientations - Lewis, Laura Foran; Ward, Caroline; Jarvis, Noah; Cawley, Eleni (Journal of Autism and Developmental Disorders, 2020)
Autistics are more likely than neurotypicals to be gay, lesbian, bisexual, asexual, and other sexual orientations. Autistics and sexual minorities represent populations at high risk for depression, anxiety, and suicidality. Little is known about the experiences of individuals living at this intersection. In this phenomenology, 67 individuals who identified as autistic sexual minorities participated in online interviews to describe the meaning of their experiences. Six themes emerged, including: self-acceptance is a journey; autistic traits complicate self-identification of sexual orientation; social and sensory stressors affect sexual expression; feeling misunderstood and isolated; challenges finding mutually satisfying relationships; and difficulty recognizing and communicating sexual needs. Autistic sexual minorities experience a 'double minority' status that complicates identity formation and increases vulnerability in sexual relationships. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Phenomenology; Qualitative; LGBTQ +; Sexual relationships; Intimacy; No terms assigned

Suicidality in homeless children and adolescent: A systematic review - Flach, Yuri; Razza, Timothy S. (Aggression and Violent Behavior, 2021)
Suicide has been found to be the leading cause of death in the homeless youth population. Mortality rates due to suicide in this cohort can be 12–40 times more elevated than those observed in the general population. Therefore, a systematic review of the literature was conducted in order to investigate potential factors associated with suicidality among homeless children and adolescents. After a thorough investigation of peer-reviewed articles from main databases in this literature (ProQuest and EBSCO), a final number of 94 articles were studied to produce the contents of this systematic review. Factors associated with suicidality were divided into two main categories, namely risk factors and protective factors. The results of this review revealed significant risk factors including gender, sexual orientation, history of abuse, mental health diagnoses, negative coping styles, duration of homelessness, and survival sex. Conversely, this review identified protective factors associated with suicidality among homeless children and adolescents, such as the role of resilience, positive coping strategies, and supportive school environment. Given the impact of suicide rates in this already at-risk population, understanding these factors becomes paramount knowledge related to long-term outcomes for the homeless youth population. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Children and adolescents; Homelessness; Suicidality; No terms assigned

Suicidal ideation among transgender and gender diverse adults: A longitudinal study of risk and protective factors - Rabasco, Ana; Andover, Margaret (Journal of Affective Disorders, 2021)
Introduction: Transgender and gender-diverse (TGD) people experience greatly heightened levels of suicidal ideation (SI) compared to the general population. Therefore, it is imperative to understand the risk and protective factors for SI within this population. Methods: The present study explored how victimization, discrimination, community connectedness, and pride impact SI cross-sectionally and longitudinally in a sample of TGD adults (N = 180, 55% transgender women, 76.7% Caucasian, age = 26.01 years). Results: Cross-sectional results showed that experiencing more types of victimization and discrimination at baseline predicted higher SI severity at baseline, while community connectedness and pride at baseline were not predictive of SI severity at baseline. Longitudinal analyses showed that experiencing fewer types of victimization and discrimination during the 1-month follow-up period were associated with a decrease in SI severity from baseline to follow-up. Medium and high levels of community connectedness were also associated with a decrease in SI severity from baseline to follow-up. Pride was not associated with change in SI from baseline to follow-up. Limitations: Limitations include the limited racial/ethnic diversity of the sample and that frequency of experiencing victimization and discrimination was not assessed. Conclusions: These results suggest victimization and discrimination are strong predictors of SI severity within this population, and the factors of victimization, discrimination, and TGD-community connectedness impact change in SI severity across time. These findings provide evidence for the importance of anti-discrimination laws that apply to TGD people, as well as the utility of connecting TGD clients to the TGD community. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Suicide; Victimization; Discrimination; Social support; Pride; Transgender; Protective Factors; Risk Factors; Suicidal Ideation; Transgender; Pride; Social Discrimination; Victimization

A transdiagnostic minority stress intervention for gender diverse sexual minority women’s depression, anxiety, and unhealthy alcohol use: A randomized controlled trial - Pachankis, John E.; McConocha, Erin M.; Clark, Kirsty A.; Wang, Katie; Behari, Kriti; Fetzner, Benjamin K.; Brisbin, Cal D.; Scheer, Jillian R.; Lehavot, Keren (Journal of Consulting and Clinical Psychology, 2020)
Objective: To remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive–behavioral treatment intended to improve this population’s mental and behavioral health. Method: The intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive–behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n = 19) and expert providers with this population (n = 12) shaped the treatment’s development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population’s disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n = 60; M age = 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use. Results: Compared to waitlist (n = 30), participants randomized to immediately receive EQuIP (n = 30) experienced significantly reduced depression and anxiety (d = 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d = 0.29) and marginally significant. In pre- to post-intervention pooled analyses, effect sizes for minority stress processes (mean d = .25) and universal risk factors (mean d = .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction. Conclusions: This study provides initial support for a minority-stress-focused transdiagnostic cognitive–behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: lesbian; gay; bisexual; transgender; sexual minority; evidence-based treatment; LGBT-affirmative treatment; empirically supported treatment; Alcohol Drinking Patterns; Cognitive Behavior Therapy; Health Care Psychology; Sexual Minority Groups; LGBTQ; Anxiety; Bisexuality; Evidence Based Practice; Intervention; Lesbianism; Male Homosexuality; Transgender; Affirmative Therapy; Minority Stress

Trans and gender‐diverse peoples’ experiences of crisis helpline services - Lim, Gene; Waling, Andrea; Lyons, Anthony; Pepping, Christopher A.; Brooks, Anna; Bourne, Adam (Health & Social Care in the Community, 2021)
Crisis helplines are typically easily accessible and deliver interventions in a timely manner, regardless of geographical location. The efficacy and user experiences of these services are the subject of considerable interest within the field, but the experiences of trans and gender‐diverse individuals remain unexplored despite high rates of mental ill health being documented in this population. A total of 134 trans and gender‐diverse Australians were surveyed about their experiences of personal crises and of utilising crisis helplines. Within our sample, 84.2% (n = 113) of participants recognised at least one service – however, only 32.8% (n = 44) utilised a service to cope with a personal crisis. Participants cited poor recognition and understanding of the challenges specific to trans and gender‐diverse individuals among helpline workers as a primary reason for avoiding these services, and articulated needs which were a poor fit for the one‐off intervention model commonly employed by helpline services. In order for helpline services to be viable avenues of support for trans and gender‐diverse individuals during a personal crisis, helpline workers must be sufficiently equipped to work with trans and gender‐diverse callers and to facilitate their enrolment in ‘traditional’ mental health services. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: discrimination; gender and community care; mental health services; suicide; support services; transgender and gender diverse; No terms assigned

Suicide thought and behaviors, non-suicidal self-injury, and perceived life stress among sexual minority mexican college students - Rentería, Roberto; Benjet, Corina; Gutierrez-Garcia, Raúl A.; Ábrego Ramírez, Adrián; Albor, Yesica; Borges, Guilherme; Covarrubias Díaz Couder, María Anabell; Durán, María del Socorro; González González, Rogaciano; Guzmán Saldaña, Rebeca; Hermosillo De la Torre, Alicia E.; Martínez-Jerez, Ana María; et al. (Journal of Affective Disorders, 2020)
BACKGROUND: Sexual minority college students are at a higher risk for suicidal thoughts and self-injurious behaviors compared to heterosexual students. Minority stress theory proposes sexual minority individuals experience higher stress due to stigma. Using a sample of Mexican college students, this study tested perceived life stress as a mediator of suicide and self-injury outcomes across various sexual orientation groups. METHODS: The sample of college students (N=7882) was recruited from nine Mexican universities as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. Participants completed an online survey including demographic questions, measure of perceived life stress, suicide outcomes, and non-suicidal self-injury (NSSI) in the past 12 months. RESULTS: Logistic regression analyses revealed identifying as a sexual minority significantly predicted a higher likelihood of suicide ideation (ORs 2.05-3.00), suicide attempts (ORs 2.48-8.73), and NSSI (ORs 2.92-4.18) compared to heterosexual students reporting no same-gender attraction. Significant indirect effects from mediation path analyses showed perceived life stress mediated the relationship between a sexual minority identity and suicide ideation (range of proportion mediated 10.48-31.48%), attempts (10.48-31.48%), and NSSI (7.69-20.09%) across each group except among asexual students. LIMITATIONS: The cross-sectional nature of the survey design precludes drawing causal inferences. CONCLUSION: Findings from this study contribute to minority stress theory by elucidating the role of perceived life stress as a mediator of suicide ideation and attempts and NSSI among sexual minority college students. Clinical interventions may benefit in focusing on experiences of stress across various life areas when supporting sexual minority college students. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; self-injury; sexual minority; college; Mexico; No terms assigned

Suicidality among youth who are questioning, unsure of, or exploring their sexual identity - Price-Feeney, Myeshia; Green, Amy E.; Dorison, Samuel H. (Journal of Sex Research, 2020)
ABSTRACT Many studies have found that lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth are disproportionately impacted by poor mental health outcomes. However, there remains a gap in understanding factors associated with the mental health of youth who are questioning, unsure of, or exploring (QUE) their sexual identity. Using data from The Trevor Project’s 2019 National Survey on LGBTQ Youth Mental Health, a quantitative cross-sectional survey of LGBTQ youth between 13 and 24, we explored suicidality among 801 QUE youth. Significantly more QUE youth were younger, nonwhite, and transgender and nonbinary compared to other LGBTQ youth. QUE youth reported higher rates of suicidality compared to other LGBTQ youth; however, this increased risk was related to the overrepresentation of younger and transgender and nonbinary youth among QUE youth. In adjusted models, being transgender and nonbinary, hearing parents use religion to say negative things about being LGBTQ, and experiencing physical threat or harm based on sexual orientation or gender identity were significantly related to seriously considering suicide and attempting suicide among QUE youth. Given the intricate relationship between the two, researchers should assess both gender identity and sexual identity when determining the risk of suicidality among LGBTQ youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

The influence of state policies on the relationship between minority stressors and suicide attempts among transgender and gender-diverse adults - Rabasco, Ana; Andover, Margaret (LGBT Health, 2020)
Purpose: We examined whether the relationship between minority stressors (victimization and discrimination) and suicide attempts (SAs) was moderated by gender identity-specific protective state policies in a sample of transgender and gender-diverse (TGD) adults. Methods: TGD adults (n = 133) were recruited online and completed questionnaires. Results: Protective state policies moderated the relationship between minority stressors and SAs, with a significant positive association between minority stressors and SAs at low, but not medium and high, policy scores. Conclusion: A lack of protective state policies may be a risk factor in the relationship between minority stressors and SAs among TGD individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: discrimination; suicidality; transgender; victimization; Attempted Suicide; Sex Discrimination; Stress; Health Care Policy; Transgender; Health Care Psychology; Policy Making; Risk Factors; Victimization; Suicidality

The Self-Acceptance of Sexuality Inventory (SASI): Development and validation - Camp, Jake; Vitoratou, Silia; Rimes, Katharine A. (Psychology of Sexual Orientation and Gender Diversity, 2020)
Due to exposure to societal stigma, self-acceptance of sexuality can be a challenging process for individuals who identify as lesbian, gay, bisexual, queer, or with other minority sexual identities (LGBQ+). Quantitative research in this area is limited, and there is a lack of appropriately validated self-report questionnaires to assess self-acceptance of sexuality. Therefore, the aim of the current study was to develop a measure of self-acceptance of sexuality. Items for the new Self-Acceptance of Sexuality Inventory (SASI) were developed in consultation with psychologists and members of the general population identifying as LGBQ+. From a sample of participants experiencing nonheterosexual attractions (N = 1,619), dimensionality (via exploratory and confirmatory factor analyzes), measurement invariance, and reliability were assessed. Construct validity of the SASI was investigated in a subsample (n = 1,217) via hypothesized associations with alternative measures of self-acceptance, sexuality-specific processes, resilience factors, and mental health outcomes. Differences in SASI scores were also investigated between those who identified as LGBQ+ and those who were unsure/questioning. The final version of the SASI included 10 items comprising two factors. The SASI had satisfactory internal consistency and test–retest reliability, and evidence of good construct validity. Our research provides evidence of different constructions of self-acceptance across people with different sexual orientations, gender identities, sex assigned at birth, and ages. The SASI is a promising new measure of self-acceptance of sexuality. Further investigations into different understandings of self-acceptance are required. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: self-acceptance; LGBQ+; sexual orientation; minority stress; identity development; Self-Perception; Test Construction; Test Validity; LGBTQ; Minority Stress; Gender Identity; Personality Development; Sexual Orientation

The health and well-being of transgender australians: A national community survey - Bretherton, Ingrid; Thrower, Emily; Zwickl, Sav; Wong, Alex; Chetcuti, Daria; Grossmann, Mathis; Zajac, Jeffrey D.; Cheung, Ada S. (LGBT Health, 2020)
Purpose: Transgender, including gender diverse and nonbinary (trans), people experience significant health disparities. We aimed to better understand the health status and needs of Australian trans people to guide resources and health and well-being programs. Methods: This anonymous, cross-sectional online survey utilized nonprobability snowball sampling of Australian adults (18 years and over) who self-identified as trans between September 2017 and January 2018. This descriptive study assessed demographic data, community views on access to health care, health burden, access to health resources, and priorities for government funding in transgender health. Results: Of 928 participants, 37% reported female, 36% reported male, and 27% reported nonbinary gender identities. Despite 47% having tertiary qualifications, the unemployment rate was 19%, with 33% reporting discrimination in employment due to being trans. Discrimination in accessing health care was reported by 26% and verbal abuse and physical assault were reported by 63% and 22%, respectively. Lifetime diagnosis of depression was reported by 73% and anxiety by 67%. Sixty-three percent reported previous self-harm and 43% had attempted suicide. Autism spectrum disorder and attention-deficit/hyperactivity disorder were reported by 15% and 11%, respectively. The most preferred method of receiving health information was through online resources, with the most popular source being Reddit, an online peer discussion board. Better training for doctors in trans health issues was the top priority for government funding. Conclusions: Barriers, including widespread discrimination and unemployment, contribute to health inequity and prevalent mental health conditions. Better training for health professionals in the provision of safe, gender-affirming and general health care for trans people is urgently required. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: barriers to care; gender-affirming endocrine care; gender-affirming surgical care; gender dysphoria; transgender; No terms assigned

Suicide attempts among a cohort of transgender and gender diverse people - Mak, Josephine; Shires, Deirdre A.; Zhang, Qi; Prieto, Lucas R.; Ahmedani, Brian K.; Kattari, Leonardo; Becerra-Culqui, Tracy A.; Bradlyn, Andrew; Flanders, W. Dana; Getahun, Darios; Giammattei, Shawn V.; Hunkeler, Enid M.; et al. (American Journal of Preventive Medicine, 2020)
Introduction: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. Methods: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. Results: During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged < 18 years than among those aged > 45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2–5 times higher among those with 1–2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. Conclusions: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide attempts; transgender & gender diverse people; discrimination; emotional distress; Attempted Suicide; Risk Factors; Suicidal Ideation; Transgender; Transsexualism; Gender Nonconforming

Prevalence, age of initiation, and patterns of co-occurrence of digital dating abuse behaviors nationwide - Ellyson, Alice M.; Adhia, Avanti; Lyons, Vivian H.; Rivara, Frederick P. (Children and Youth Services Review, 2021)
Introduction: Little is known about the patterns of adolescent and young adult digital dating abuse (DDA) nationwide. This study characterizes (1) the lifetime prevalence, (2) the age of initiation, and (3) the patterns of co-occurrence of both using and experiencing DDA behaviors in dating relationships. Methods: A cross-sectional online survey was conducted among a sample of 696 U.S. young adults recruited from Prolific, an online research platform. The sample was 50.7% female, 43.7% male, and 5.6% gender non-binary or transgender. The average age was 18.7 years (SD = 0.63, range: 16–22). Results & Conclusions: Among those with dating experience, 76.1% (n = 530) reported either using or experiencing at least one DDA behavior in their lifetime. Overall, 42.9% of respondents reported using and 58.3% experiencing digital monitoring and control behaviors, 25.0% reported using and 49.2% experiencing digital direct aggression, and 12.4% reported using and 36.4% experiencing digital sexual coercion. The average age of initiation for most DDA behaviors was 16 years with respondents reporting experiencing these behaviors at 11 years of age at the earliest. Of those with any involvement with DDA, 59.2% report both using at least one DDA behavior and experiencing at least one DDA behavior (n = 314), 32.5% report experiencing at least one DDA behavior but not using any (n = 172), and 8.3% report using at least one DDA behavior but not experiencing any (n = 44). DDA behaviors are common, can occur at young ages. Our findings highlight crossover between those who use and those who experience DDA behaviors and suggest prevention should focus on underlying issues that drive both the use and experience of these behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Dating violence; Digital dating abuse; Intimate partner violence; Aggressive Behavior; Life Span; Motivation; Social Dating; Dating Violence; Coercion; Intimate Partner Violence

Early childhood educators' beliefs about child behavior and adult outcomes related to gender and play - McCabe, Paul C. (Psychology in the Schools, 2021)
This study explored the beliefs of early childhood educators about a child's current behavior and potential adult adjustment based on a description of the child's gender and play interests. There were 451 early childhood educators from a US sample who, after reading a brief vignette describing a child's play and behavior, responded to questions related to the child's current and future behavior. Respondents also provided demographic information as well as ratings of their gender role beliefs. Results indicated that (a) educators believe strongly masculine or feminine play in early childhood predicts similar displays of masculinity or femininity in adulthood, (b) educator ratings of externalizing problem behaviors were significantly higher in the masculine play vignettes, irrespective of the child's gender, (c) ratings of internalizing problem behaviors were higher in the feminine play vignettes, also independent of child's gender, and (d) there were few differences in ratings between gender role conforming and gender role nonconforming children. However, the gender role nonconforming boy was rated as more likely to contemplate suicide as an adult compared to the gender role nonconforming girl and the gender role conforming boy and girl. Educators' beliefs about gender‐related constructs and recommendations for future practice and research were discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: gender; LGBTQ; preschool; No terms assigned

Building a life worth living during a pandemic and beyond: Adaptations of comprehensive dbt to covid-19 - O'Hayer, C. Virginia (Cognitive and Behavioral Practice, 2021)
Our team at the Jefferson Center City Clinic for Behavioral Medicine has recently been challenged to find a synthesis between the need to adapt to circumstances associated with the COVID-19 pandemic, while at the same time retaining the spirit and essential components of comprehensive DBT. This fine balance between unwavering centeredness and compassionate flexibility is central to DBT (Linehan, 1993), and has proven essential during these times of uncertainty. This short article highlights challenges and innovations faced by our DBT Team, Skills Group, individual DBT sessions, phone coaching, and also our community at large, as we strive to help our patients and team members build a life worth living during and following a pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Dialectical Behavior Therapy; suicidality; COVID-19; behavioral medicine; transgender; No terms assigned

Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature - Rew, Lynn; Young, Cara C.; Monge, Maria; Bogucka, Roxanne (Child and Adolescent Mental Health, 2020)
Background Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking gender‐affirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin‐releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition. Methods We conducted a critical review of the literature to answer a series of questions about criteria for using puberty‐blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria. Results Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged ‘excellent’, five studies met the majority of quality criteria resulting in ‘good’ ratings, whereas three studies were judged fair and had serious risks of bias. Conclusion Given the potentially life‐saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender; adolescent; puberty blockers; critical review; No terms assigned

Social and medical gender affirmation experiences are inversely associated with mental health problems in a US non-probability sample of transgender adults - Hughto, Jaclyn M. W.; Gunn, Hamish A.; Rood, Brian A.; Pantalone, David W. (Archives of Sexual Behavior, 2020)
A dearth of research has explored concurrently the associations between multiple forms of gender affirmation (or transitioning) and the mental health of transgender adults. In 2015, 288 U.S. transgender adults completed a cross-sectional, online survey assessing demographics, gender affirmation experiences, and mental health. Adjusting for age and discrimination experiences, we used mixed-effect logistic regression analyses to examine changes in self-reported suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) before and after initiating the gender affirmation process, and linear regression analyses to examine associations between gender affirmation experiences and self-reported depressive, anxiety, and stress symptoms. Overall, 81.3% of participants identified along the female-to-male, trans masculine gender spectrum (of which 20.9% identified as non-binary) and 18.8% identified along the male-to-female, trans feminine gender spectrum (of which 7.4% identified as non-binary). Nearly all participants (98.6%) reported disclosing their gender identity to family or a coworker; 67.4% endorsed recently using hormones, and 31.3% endorsed a gender-affirming medical procedure. In multivariable models, participants were at greater odds of NSSI, contemplating suicide, and attempting suicide before initiating the gender affirmation process compared to after. In additional models, gender identity disclosure and medical procedure engagement were inversely associated with depressive and anxiety symptoms, whereas gender identity disclosure, hormone use, and medical procedure engagement were inversely associated with stress symptoms. Finally, the number of gender affirmation experiences endorsed was inversely associated with depressive, anxiety, and stress symptoms. Findings support the possibility that social and medical gender affirmation experiences may be protective against mental health problems in transgender adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender; Gender affirmation; Mental health; Suicide; Self-harm; Gender Identity; Mental Health; Stress; Transgender; Self-Injurious Behavior; Self-Report; Suicide

Depression and suicidal behavior in LGB and heterosexual populations in Serbia and their differences: Cross-sectional study - Janković, Janko; Slijepčević, Vesna; Miletić, Vladimir (PLoS ONE, 2020)
Background: Sexual identity is a significant risk factor for triggering symptoms of depression, as well as for suicide attempts in lesbian, gay and bisexual (LGB) population compared to the heterosexual population. To the best of our knowledge, data on the mental health of LGB persons in Serbia are lacking, and this is the first study to address this problem. The aim of the study was to examine the association between selected determinants and depression, and selected determinants and suicide attempts in LGB and heterosexual populations in the Republic of Serbia, as well as, their differences. Methods: We conducted a cross-sectional study in 2015 of 264 heterosexual and LGB respondents using the 'snowball sampling' method. We used linear regression analyses to investigate the relationship between socio-demographic variables and different sexual identity categories with PHQ-9 scores. We assessed associations between suicide attempts, and socio-demographic characteristics, sexual identity, depression, and suicidal thoughts using logistic regression. Results: Depression symptoms were higher in female relative to male participants, in participants who were single, divorced or widowed in comparison to currently married, among people with a middle level of education compared to highly educated, and in respondents identified as bisexual or homosexual in comparison to heterosexual. Homosexual and bisexual participants reported suicidal attempts 27 [Odds Ratio (OR) = 27.31] and six times (OR = 6.40) more often than did heterosexual respondents, respectively. Suicide attempts were less frequently reported by single, divorced or widowed participants in comparison to married (OR = 0.25) and those with middle education (OR = 0.38) compared to highly educated. Conclusions: The present study showed that LGB persons in Serbia have significantly more symptoms of depression and suicide attempts compared to heterosexuals. Public health interventions should focus on the early detection of depression and on overcoming prejudicial and discriminatory attitudes. Also, intervention should emphasize that homosexuality and bisexuality are normal, equal and morally acceptable expressions of human sexuality. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: depression; suicidal behavior; lesbians; gay; bisexual; heterosexuals; Adult; Bisexuality; Cross-Sectional Studies; Depression; Female; Heterosexuality; Homosexuality, Female; Homosexuality, Male; Humans; Logistic Models; Male; Middle Aged; Serbia; Socioeconomic Factors; Suicidal Ideation; Suicide; Attempted Suicide; Bisexuality; Heterosexuality; Major Depression; LGBTQ; Gender Identity; Homosexuality; Public Health

Trends in suicidal behaviors among US adults 2015–2018 - Yockey, R. Andrew; King, Keith; Vidourek, Rebecca (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2020)
Background: Suicide remains a major public health problem in the United States. The purpose of this study was to examine trends in suicide ideation, planning, and attempts among a national sample of US adults. Method: We used aggregated 2015–2018 data from the National Survey Drug Use and Health Survey. We utilized demographic and substance use questions with each suicide behavior. We assessed weighted absolute and relative changes in a national sample of 7,654 adults. Results: Results revealed that from 2015 to 2018, there was a 16.0% increase in suicide ideation, 18.6% increase in suicide planning, and 11.6% increase in suicide attempts. Significant increases in each behavior were found in African Americans, younger adults, sexual minorities, and individuals who reported past-year drug use. Limitations: Limitations include self-report of suicidal behaviors and desirability of answers. Conclusion: We believe our findings can inform harm reduction efforts and health messages surrounding suicide prevention. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; trends; drug use; Drug Usage; Suicidal Ideation; Suicide Prevention; Trends; Attempted Suicide; Public Health; Sexual Minority Groups

Sexual orientation differences in lethal methods used in suicide: Findings from the national violent death reporting system - Clark, Kirsty A.; Mays, Vickie M.; Arah, Onyebuchi A.; Kheifets, Leeka I.; Cochran, Susan D. (Archives of Suicide Research, 2020)
Abstract We examined sexual orientation and sex differences in seven methods of suicide among adult suicides reported in the United States National Violent Death Reporting System (2012–2015; N = 59,075). Overall, most sexual minorities (i.e., lesbians, gay men, bisexuals) identified in the dataset used hanging (38%) followed by firearm (30%) and drug or poison ingestion (20%). Sexual minorities were more likely than heterosexuals to be younger, female, and Black/African American. Multivariate sex-stratified analyses in the overall sample showed that strong sexual orientation differences in lethal methods existed among men but not among women. However, when we compared sex differences in lethal methods among sexual minorities only, we found that lesbian/bisexual women, as compared to gay/bisexual men, were more likely to use a firearm or drug or poison ingestion than hanging. Findings suggest that the higher rate of suicide mortality among sexual minorities is likely driven by hanging, a method of suicide that is not particularly amenable to lethal method restricted-access prevention approaches. Future research directions, clinical training recommendations, and intervention opportunities are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Death records; firearm; hanging; mortality; overdose; No terms assigned

Adolescence and suicide: Subjective construction of the suicidal process in young gay and lesbian chileans - Tomicic, Alemka; Martínez, Claudio; Rosenbaum, Catalina; Aguayo, Francisco; Leyton, Fanny; Rodríguez, Juliana; Galvez, Constanza; Lagazzi, Iside (Journal of Homosexuality, 2020)
ABSTRACT The association between suicide risk and sexual minority status can be understood from the perspective of the social determinants of health, an approach that requires the development of culturally sensitive knowledge. The aim of this study was to characterize young gay and lesbian people’s subjective construction of their experience of having lived and survived a suicidal process. Qualitative interviews were conducted and analyzed as products based on life events. In the participants’ accounts, we identified hostile contexts associated with suicide, trajectories associated with gay/lesbian identification processes, and milestones related to victimization experiences as part of the intentionality and rationality of suicide. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Adolescence; suicide; gay and lesbian; qualitative research; internalized homophobia; No terms assigned

LGBQ+ self-acceptance and its relationship with minority stressors and mental health: A systematic literature review - Camp, Jake; Vitoratou, Silia; Rimes, Katharine A. (Archives of Sexual Behavior, 2020)
[Correction Notice: An Erratum for this article was reported in Vol 50(1) of Archives of Sexual Behavior (see record [rid]2020-78832-001[/rid]). In the original article, the following information should be noted in regard to this article: SV was funded by the Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.] Many individuals who identify as lesbian, gay, bisexual, queer, and with other non-heterosexual orientations (LGBQ+) experience stigma, prejudice, and/or discrimination because of their sexuality. According to minority stress and identity development theories, these experiences can contribute to difficulties with self-acceptance of sexuality. Lower self-acceptance is considered a risk factor for adverse mental health outcomes. The current review aims to investigate whether self-acceptance of sexuality is associated with minority stressors or difficulties with mental health in LGBQ+ individuals, as well as whether there are differences in self-acceptance between different sexual orientations. Five bibliographic databases were searched. Thirteen studies were identified which used quantitative methodology to investigate associations between self-acceptance, minority stressors, and/or mental health within LGBQ+ samples, or differences in self-acceptance between different sexual orientations. The results from these cross-sectional studies suggested that lower self-acceptance of sexuality was associated with higher levels of self-reported minority stressors, including a lack of acceptance from friends and family, a lack of disclosure to others, and internalized heterosexism. Lower self-acceptance of sexuality was associated with poorer mental health outcomes, including greater global distress, depression symptoms, and lower psychological well-being. There was no significant relationship with suicidality. Studies also found that LGBQ+ individuals had lower general self-acceptance compared to heterosexual participants, bisexual individuals had lower sexuality self-acceptance compared to lesbian/gay individuals, and lesbian women had lower sexuality self-acceptance compared to gay men. Given the potential importance of self-acceptance for LGBQ+ populations, further research is required with more robust methodology. Self-acceptance could be a potential target in clinical interventions for LGBQ+ individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Self-acceptance; Minority stress; Mental health; Sexual orientation; Sexuality; LGBQ+; Mental Health; Self-Perception; Sexual Orientation; Sexuality; LGBTQ; Psychological Stress; Minority Stress

The moderating role of psychological inflexibility in the relationship between minority stress, substance misuse, and suicidality in LGB+ adolescents - Weeks, Sean N.; Renshaw, Tyler L.; Galliher, Renee V.; Tehee, Melissa (Journal of Contextual Behavioral Science, 2020)
Minority stress has been posited as a framework to explain the health disparities seen in sexual minority youth, including lesbian, gay, bisexual (LGB+) youth. In the present study, psychological inflexibility was investigated as a moderator in the relationship between minority stress and two harmful youth outcomes: substance misuse and suicidality. Analyses showed significant interactions indicating moderating effects in the substance misuse models but not in the suicidality models. A positive direct effect of global psychological inflexibility on suicidality was also discovered. Analyses exploring the moderating effects of psychological inflexibility's sub-processes found that cognitive fusion and obstruction of valued living had significant, positive interactions with minority stress in relation to substance misuse. No moderating effects were found within models exploring the sub-processes on suicidality; however, positive direct effects were indicated between cognitive fusion and suicidality as well as between obstruction of valued living and suicidality. Overall, results suggest that psychological inflexibility is a promising moderator variable that could potentially be targeted via intervention in LGB + adolescents and therefore warrants further study with this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: LGB; Adolescents; Psychological inflexibility; Suicidality; Substance misuse; Minority stress; Adaptability (Personality); Drug Abuse; Suicidality; LGBTQ; Minority Stress; Adolescent Psychology; Suicide; Sexual Minority Groups

Suicidality in clinic-referred transgender adolescents - de Graaf, Nastasja M.; Steensma, Thomas D.; Carmichael, Polly; VanderLaan, Doug P.; Aitken, Madison; Cohen-Kettenis, Peggy T.; de Vries, Annelou L. C.; Kreukels, Baudewijntje P. C.; Wasserman, Lori; Wood, Hayley; Zucker, Kenneth J. (European Child & Adolescent Psychiatry, 2020)
Gender and sexually diverse adolescents have been reported to be at an elevated risk for suicidal thoughts and behaviors. For transgender adolescents, there has been variation in source of ascertainment and how suicidality was measured, including the time-frame (e.g., past 6 months, lifetime). In studies of clinic-referred samples of transgender adolescents, none utilized any type of comparison or control group. The present study examined suicidality in transgender adolescents (M age, 15.99 years) seen at specialty clinics in Toronto, Canada, Amsterdam, the Netherlands, and London, UK (total N = 2771). Suicidality was measured using two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). The CBCL/YSR referred and non-referred standardization samples from both the U.S. and the Netherlands were used for comparative purposes. Multiple linear regression analyses showed that there was significant between-clinic variation in suicidality on both the CBCL and the YSR; in addition, suicidality was consistently higher among birth-assigned females and strongly associated with degree of general behavioral and emotional problems. Compared to the U.S. and Dutch CBCL/YSR standardization samples, the relative risk of suicidality was somewhat higher than referred adolescents but substantially higher than non-referred adolescents. The results were discussed in relation to both gender identity specific and more general risk factors for suicidality. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gender dysphoria; Adolescents; Transgender; Suicidality; Child Behavior Checklist; Youth Self-Report; No terms assigned

Dispositional optimism and suicide among trans and gender diverse adults - Snooks, Matthew Paul; McLaren, Suzanne (Death Studies, 2021)
Abstract Trans and gender diverse adults are at increased suicide risk. Optimism protects against suicide across multiple populations. Applying the Interpersonal-Psychological Theory of Suicide (IPTS), we examined both factors among 237 adults recruited via social media and online platforms, 79.3% of whom reported serious suicide ideation. Dispositional optimism predicted suicidal ideation and behaviors (SIB), but did not moderate the relationship between the IPTS components and SIB. After controlling for depressive symptoms, hormone therapy and gender-affirming surgery did not predict SIB. Promoting dispositional optimism within a therapeutic framework may reduce SIB in this vulnerable population. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: No terms assigned

Understanding the mental health of transgender and nonbinary youth - Price-Feeney, Myeshia; Green, Amy E.; Dorison, Samuel (Journal of Adolescent Health, 2020)
Purpose: Currently, there is a lack of nationwide data examining the mental health of transgender and nonbinary youth. Furthermore, relatively little is known about how the mental health of transgender and nonbinary youth compares to that of their cisgender lesbian, gay, bisexual, queer, and questioning peers or differences within subgroups of transgender and nonbinary youth. The goal of the present study was to better understand the mental health of transgender and nonbinary youth. Methods: We analyzed responses from a national quantitative cross-sectional survey of more than 25,000 lesbian, gay, bisexual, transgender, queer, and questioning youth, aged between 13 and 24 years, in the U.S. Results: Transgender and nonbinary youth were at increased risk of experiencing depressed mood, seriously considering suicide, and attempting suicide compared with cisgender lesbian, gay, bisexual, queer, and questioning youth. Controlling for sexual orientation–based or gender identity–based experiences of perceived discrimination and physical threats or harm reduced the disparities but did not fully account for them. Within-group analyses highlighted particularly increased risk for negative mental health outcomes among transgender males and nonbinary youth assigned female at birth. Conclusions: Findings point to the need to directly address the needs of transgender and nonbinary youth in prevention and intervention programs and to advance policies that reduce discrimination and victimization based on sexual orientation or gender identity. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender youth; Nonbinary youth; Suicide; Mental health; Gender identity; Discrimination; Mental Health; Transgender; Sexual Minority Groups; Attempted Suicide; Sex Discrimination; Test Construction; Adolescent Characteristics

Age of occurrence and severity of childhood sexual abuse: Impacts on health outcomes in men who have sex with men and transgender women - Xavier Hall, Casey D.; Moran, Kevin; Newcomb, Michael E.; Mustanski, Brian (Journal of Sex Research, 2020)
ABSTRACT Childhood sexual abuse (CSA) is associated with a wide range of health outcomes and is more prevalent among men who have sex with men (MSM) compared to men who have sex with women exclusively and among transgender women (TW) compared to cisgender peers; however, there is a lack of consensus regarding an explanatory theoretical model. This analysis examined these models across health outcomes using baseline data from a longitudinal study of MSM and TW in Chicago (n = 1,035) collected from 2015 to 2019. Severity of CSA was measured for two age ranges (prior to 13 and 13–17). Logistic regression and negative binomial regressions were estimated. Teenage experiences of CSA were associated with alcohol problems, cannabis problems, suicide ideation/attempt, depression, condomless anal sex partners, rectal STI, and HIV. Pre-teenage CSA was associated with alcohol use and depressive symptoms. Significant interactions across age of experience of CSA were found for alcohol problems, cannabis problems, and condomless anal sex partners. Consistent with previous literature, this analysis found CSA to be a significant influence on various health outcomes. No single explanatory framework emerged; however, adolescent exposures may be more closely linked to health outcomes and risk behaviors than pre-teenage or cumulative exposures. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

Sexual assault and co-occurrence of mental health outcomes among cisgender female, cisgender male, and gender minority US College students - Parr, Nicholas J. (Journal of Adolescent Health, 2020)
Purpose: The aim of this study was to examine the co-occurrence of mental health (depression, anxiety, nonsuicidal self-injury, and suicide ideation) and substance use outcomes among cisgender female, cisgender male, and gender minority college students exposed to sexual assault (SA). Methods: Data were drawn from a 2018 U.S. national survey of college student well-being (N = 50,438). Inverse propensity-weighted three-step latent class analysis was used to examine co-occurrence of outcomes while adjusting for 31 potential confounders of the relation between SA and outcome classes. Results: Four latent classes were identified for cisgender female and male participants and two for gender minority participants, reflecting a range from low to high risk of co-occurring outcomes. SA was associated with significantly and substantially increased odds (odds ratio: 2.03–3.64) of membership to the highest-risk outcome class compared with the lowest-risk class across gender identity subgroups. Conclusions: SA in the college setting is associated with substantially increased odds of co-occurring depression, anxiety, nonsuicidal self-injury, and suicide ideation, regardless of gender identity. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual assault; Mental health; Depression; Nonsuicidal self-injury; Suicide; College; Latent class analysis; Transgender; Gender minority; College Students; Mental Health; Sex Offenses; Student Attitudes; Gender Identity; Major Depression; Self-Injurious Behavior; Suicidal Ideation; Latent Class Analysis

Impact of bathroom discrimination on mental health among transgender and nonbinary youth - Price-Feeney, Myeshia; Green, Amy E.; Dorison, Samuel H. (Journal of Adolescent Health, 2020)
PURPOSE: Nascent research has found that transgender and/or nonbinary (TGNB) youths experience higher rates of poor mental health outcomes than cisgender youths. The minority stress model highlights experiences of rejection and discrimination on mental health disparities for TGNB individuals. METHODS: Using data from a quantitative cross-sectional survey of TGNB youth aged 13–24 years, we examined the association between experiencing bathroom discrimination and depressive mood, seriously considering suicide, and attempting suicide. RESULTS: Overall, 58% of TGNB youths in this sample reported being prevented or discouraged from using a bathroom that corresponds to their gender identity. Among the TGNB youth who experienced bathroom discrimination, 85% reported depressive mood and 60% seriously considered suicide. Furthermore, 1 in three TGNB youths who experienced bathroom discrimination reported a past-year suicide attempt, with 1 in five reporting multiple suicide attempts. After adjusting for demographic variables and general discrimination due to one's gender identity, bathroom discrimination significantly increased the odds of reporting depressive mood (adjusted odds ratio [aOR] = 1.34), seriously considering suicide (aOR = 1.40), a suicide attempt (aOR = 1.66), and multiple suicide attempts (aOR = 1.71). CONCLUSIONS: These findings suggest that preventing TGNB youths from accessing appropriate bathrooms is associated with harmful mental health indicators. Addressing the suicide disparities for TGNB youths requires structural change. Policies and procedures need to be in place to ensure that all youths have equal access to appropriate bathrooms. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Bathroom discrimination; Transgender youth; Nonbinary youth; Suicide; Mental health; No terms assigned

A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide - Williams, A. Jess; Jones, Christopher; Arcelus, Jon; Townsend, Ellen; Lazaridou, Aikaterini; Michail, Maria (PLoS ONE, 2021)
Background: LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations. Objectives: The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups. Data sources: MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020). Study eligibility criteria: Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12–25 years). Synthesis methods: 2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses. Results: Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences. Conclusions: Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: victimisation; mental health; self-harm; suicide; LGBTQ; prevalence; Epidemiology; Mental Health; Self-Injurious Behavior; Suicide; LGBTQ

Variation in suicide risk among subgroups of sexual and gender minority college students - Horwitz, Adam G.; Berona, Johnny; Busby, Danielle R.; Eisenberg, Daniel; Zheng, Kai; Pistorello, Jacqueline; Albucher, Ronald; Coryell, William; Favorite, Todd; Walloch, Joseph C.; King, Cheryl A. (Suicide and Life-Threatening Behavior, 2020)
Objective Sexual and gender minorities are at elevated risk for suicide, yet few studies have examined differences in risk within many sexual and gender minority subgroups. The purpose of this study was to examine differences in prevalence for suicide risk factors among a wide range of sexual orientations and gender identities. Method Forty‐one thousand four hundred and twelve college students (62% cis‐female, 37% cis‐male, 1% transgender/genderqueer) completed a wellness screen that included four suicide risk factors (depression, heavy alcohol use, suicide ideation, suicide attempt). Results Gender minority students (i.e., transgender, genderqueer/non‐binary) had significantly higher rates of depression, suicide ideation, and suicide attempts relative to cisgender peers, although there were no within‐group differences among gender minority students. Adjusted odds ratios for endorsing two or more (2+) suicide risk factors were substantially higher for all sexual minority subgroups relative to heterosexuals. Among sexual minorities, those identifying as pansexual, bisexual, queer, or mostly gay/lesbian had greater odds of endorsing 2+ suicide risk factors relative to students identifying as mostly heterosexual, gay/lesbian, asexual, or ‘other sexual minority’. Pansexual students had 33% greater odds of endorsing 2+ suicide risk factors relative to bisexual students. Conclusions These findings highlight significant variation in suicide risk among sexual minority subgroups and the need for targeted interventions for subgroups at highest risk. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

The effects of polyvictimization on mental and physical health outcomes in an lgbtq sample - Kassing, Francesca; Casanova, Tracy; Griffin, James A.; Wood, Elizabeth; Stepleman, Lara M. (Journal of Traumatic Stress, 2020)
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are at elevated risk for violent victimization and often experience increased health disparities compared to their non‐LGBTQ counterparts. The present study examined associations between polyvictimization and mental and physical health in an LGBTQ sample. Participants included 385 LGBTQ individuals involved in a larger health‐needs assessment of LGBTQ individuals living in the southeastern United States. The sample primarily identified as gay/lesbian (63.4%), cisgender (78.7%), and White (66.5%), and the mean participant age was 34.82 years (SD = 13.45). A latent class analysis (LCA) was conducted on seven items assessing different types of violence exposure. The LCA identified a three‐class model, with classes characterized by low trauma exposure (71.4%), nondiscriminatory violence (15.1%), and high trauma exposure (13.5%). Differences in demographic characteristics, perceptions of mental and physical health, and diagnoses of specific health conditions were assessed across classes. The high‐trauma class reported poorer perceived physical and mental health compared to the other two classes, with mean differences in past‐month poor health days ranging from 11.38 to 17.37. There were no differences between the classes regarding specific physical health conditions; however, the high‐trauma and nondiscriminatory violence classes had significantly higher rates of anxiety, depression, drug abuse, and suicidality than the low‐trauma class, ORs = 2.39–23.83. The present findings suggest that polyvictimization is an important risk factor for poor health among LGBTQ individuals. These results have implications for addressing health disparities among the broader LGBTQ community. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

Connecting the dots: A comparison of network analysis and exploratory factor analysis to examine psychosocial syndemic indicators among HIV-negative sexual minority men - Lee, J. S.; Bainter, S. A.; Carrico, A. W.; Glynn, T. R.; Rogers, B. G.; Albright, C.; O'Cleirigh, C.; Mayer, K. H.; Safren, S. A. (Journal of Behavioral Medicine, 2020)
Syndemics, or comorbid and mutually reinforcing psychosocial problems, are associated with increased HIV risk among men who have sex with men (MSM). Although the dynamic interplay among syndemic indicators is theorized to be crucial for increasing risk of HIV acquisition, novel approaches are needed to understand how these syndemic problems interrelate. This study examined the associations between nine self-reported syndemic indicators in 194 MSM at high risk of HIV acquisition. We compared exploratory factor analyses (EFA) to a network analysis. In the present study, network analysis consisted of edges representing bidirectional partial polychoric correlations between nodes, which represent psychosocial syndemic indicators. EFA yielded a 1-factor solution including suicidal ideation (SI), injection drug use (IDU), depression, social anxiety, intimate partner violence, substance use, and sexual compulsivity, and excluded heavy drinking and childhood sexual abuse. Network analysis yielded a pattern of interconnectedness with the most central nodes being SI, IDU, substance use, and depression. Statistically significant relationships (absolute edge weights) were found between SI and depression, social anxiety, and IDU, and IDU and substance use. These results suggest that depression and substance use, especially more severe presentations of these conditions such as SI and IDU, are prominent interconnected components of the HIV syndemic among MSM at high risk for HIV acquisition. SI, IDU, substance use, and depression may indeed be prudent targets of intervention. Future research on the inclusion of these syndemic indicators in analytical models involving interaction terms may be warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Network analysis; Exploratory factor analysis; HIV; Syndemics; Men who have sex with men; Drug Usage; HIV; Major Depression; Same Sex Intercourse; Index (Testing); Comorbidity; Social Anxiety; Suicidal Ideation; Exploratory Factor Analysis; Social Network Analysis

Brief report: Differences in self-injurious thoughts and behaviors between sexual minority and heterosexual adolescent girls - Delcourt, Meaghan L.; Tung, Irene; Northrup, Jessie B.; Berona, Johnny; Stepp, Stephanie D.; Hipwell, Alison E.; Keenan, Kate (Journal of Gay & Lesbian Mental Health, 2021)
Abstract Purpose: Adolescent suicidal ideation (SI) and nonsuicidal self-injury (NSSI) are associated with depression, but few studies adequately represent sexual minorities. This study investigated whether the association between SI/NSSI and depression varies by sexual orientation. Method: SI, NSSI, sexual orientation, and depressive symptoms were measured in a community sample of adolescent girls (n = 1,803). Results: Sexual orientation and depression accounted for unique risk for SI and NSSI in logistic regressions. Sexual orientation moderated the association between depression and NSSI. Conclusions: Results indicate that depression is a less specific predictor of NSSI among sexual minority adolescents compared to their heterosexual peers and indicate a need for future research to delineate which psychosocial factors better account for NSSI risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Adolescence; Mental Health; depression; sexual minority; suicide; No terms assigned

The rejection sensitivity model as a framework for understanding sexual minority mental health - Feinstein, Brian A. (Archives of Sexual Behavior, 2020)
Sexual minorities are disproportionately affected by mental health problems (e.g., depression, anxiety, substance use disorders, suicidality). Minority stress theory and the psychological mediation framework have become the predominant conceptual models used to explain these disparities, and they have led to substantial advances in research on stigma-related stress and mental health. However, the field’s reliance on these models has limited the extent to which other theories have been considered as potential frameworks for further advancing our understanding of sexual minority mental health. In this article, I discuss how the rejection sensitivity (RS) model can be used to complement and extend minority stress theory and the psychological mediation framework by: (1) emphasizing the role of perception in stigma-related experiences; (2) acknowledging the unique consequences of different anticipatory emotions; (3) describing additional mechanisms linking proximal minority stressors to mental health; and (4) further specifying the temporal order of these processes. I conclude by discussing the importance of attending to developmental processes in research on sexual orientation-related RS and describing important directions for future research. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Rejection sensitivity; Minority stress; Sexual minority; Gay; lesbian; bisexual; Sexual orientation; Mental Health; Mental Models; Sensitivity (Personality); Social Acceptance; Sexual Minority Groups; Bisexuality; Lesbianism; Male Homosexuality; Minority Groups; Psychological Theories; Role Perception; Sexual Orientation; Minority Stress

Learning to endure: A qualitative examination of the protective factors of homeless transgender and gender expansive youth engaged in survival sex - Greenfield, Brett; Alessi, Edward J.; Manning, Dean; Dato, Caroline; Dank, Meredith (International Journal of Transgender Health, 2020)
Abstract Background: Transgender and gender expansive (TGE) youth face a number of adversities that are associated with deleterious consequences, including mental health problems, substance misuse, suicide, and homelessness. However, there is evidence that TGE youth still demonstrate resilience under extraordinary conditions. Aims: Therefore, this study examined how TGE youth who are homeless and engaging in survival sex describe and understand the protective factors present in their lives. Methods: In-depth qualitative interviews were conducted with 57 TGE youth living in a large U.S. city. Participants were 17-26 years old (M = 19.88, SD = 1.55), and identified as transgender woman (53%), transgender man (16%), and other (32%; gender-queer, gender-fluid, androgynous, or non-binary). Youth identified as Black (40%), multiracial (35%), Latinx (16%), White (5%), and as another race (3%). Researchers conducted a secondary analysis of qualitative data using thematic analysis. Results: We identified three themes to capture youth’s understanding of their protective factors: relying on oneself and others to avoid violence, accessing gender-affirming health and mental health care, and proactively maintaining sexual health. Participants described strategies for mitigating risk of harm while attempting to meet their basic needs. Additionally, they discussed the importance of having gender-affirming health and mental health services. Participants also expressed keen awareness of their sexual health risks and making calculated, often proactive decisions about their sexual health. Conclusion: The protective factors described by TGE youth reflect the unique ways in which hyper-marginalized youth must navigate their own survival and well-being, and align with literature suggesting resilience is not mutually exclusive from risk. By focusing on TGE youth, this research privileges the experiences of individuals historically underrepresented in research and encourages future research to incorporate these perspectives into policies and programs. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: homeless youth; protective factors; resilience; survival sex; transgender youth; No terms assigned

Gratitude and lower suicidal ideation among sexual minority individuals: Theoretical mechanisms of the protective role of attention to the positive - Kaniuka, Andrea R.; Job, Sarah A.; Brooks, Byron D.; Williams, Stacey L. (The Journal of Positive Psychology, 2020)
ABSTRACT Gratitude, or attention to and appreciation of the positive, is related to psychological well-being and less psychopathology, including suicidal thoughts and behaviors (STBs). However, to date, no published research has examined the gratitude-suicide relation among sexual minority (SM) adults (e.g., lesbian, gay, bisexual), a population at markedly greater risk for STBs. Further, the theoretical mechanisms underlying the impact of gratitude are understudied. The current study examined potential mechanisms that represent the four hypotheses (positive affect, schematic, coping, and broaden-and-build) that might explain the benefit of gratitude in relation to suicidal ideation (SI) among a sample of SM adults (N = 651). Less depressive symptoms (positive affect) and anticipated discrimination (schematic) and greater self-compassion (coping) and psychological flourishing (broaden-and-build) mediated the relation between gratitude and less SI. Therapeutic activities aimed at bolstering gratitude among SM individuals may have a beneficial effect on SI due to impact on psychopathology and psychological well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gratitude; suicide; LGB; sexual minority; positive psychology; No terms assigned

Questions of faith: Religious affiliations and suicidal ideation among sexual minority young adults - Blosnich, John R.; De Luca, Susan; Lytle, Megan C.; Brownson, Chris (Suicide and Life-Threatening Behavior, 2020)
Objective To examine how the associations of specific religious affiliations with recent suicidal ideation vary by sexual orientation among young adults. Method This project was a cross‐sectional secondary analysis of data from the 2006 and 2011 surveys of the National Research Consortium of Counseling Centers in Higher Education. The analytic sample was restricted to persons between the ages of 18–29 (n = 40,150). Multiple logistic regression analyses were used to examine associations of religious affiliations with recent suicidal ideation between heterosexual and sexual minority (e.g., gay, lesbian, bisexual, questioning) young adults. Results Approximately 6.7% of the sample self‐identified as sexual minority. Compared to heterosexuals, sexual minorities were more likely to report recent suicidal ideation (aOR = 4.52, 95% CI = 3.97–5.16). Among heterosexuals, Unspecified Christian and Catholic denominations were associated with 24% and 37% reduced odds of recent suicidal ideation compared to agnostic/atheist heterosexuals. However, among sexual minorities, Unspecified Christian and Catholic denominations were associated with 68% and 77% increased odds of recent suicidal ideation compared to agnostic/atheist sexual minorities. Unspecified Christian and Catholic sexual minorities had 184% and 198% increased odds of recent suicidal ideation compared to Unitarian/Universalist sexual minorities. Conclusions Although protective for heterosexuals, religious affiliation may not be globally protective against suicidal ideation among sexual minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicidal ideation; sexual orientation; religion; No terms assigned

Is being gender nonconforming distressing? It depends where you live: Gender equality across 15 nations predicts how much gender nonconformity is related to self-esteem - Zentner, Marcel; von Aufsess, Christian (Psychological Medicine, 2020)
Background Individuals exhibiting gender nonconforming behaviors experience low self-esteem and a number of other mental health conditions, including elevated suicide risk. Most of the relevant evidence is confined to US studies, however. Adopting a cross-national approach, we examined the pervasiveness of the psychological burden associated with gender nonconformity. Because self-esteem is sensitive to the fulfillment of societal expectations for gender conformity, we reasoned that the relationship between gender conformity and self-esteem ought to decrease as societies become less restrictive in their gender norms. Methods To test this proposition, we conducted two studies including 18 national samples from 15 countries varying in gender equality. Participants responded to an online survey that included measures of gender conformity and self-esteem (N = 4486). Results Using multilevel analyses and meta-analytic statistics over the samples of both studies, we found that as gender equality increased, the association between gender conformity and self-esteem decreased. Conclusions The results suggest that rather than being inherently noxious, gender non-conformity becomes detrimental to self-esteem when it clashes with restrictive gender role norms that are enacted by the macrosocial context. We suggest that previous findings on psychological problems related to gender nonconformity be considered within a broader macrosocial context that may constrain people's freedom to move against gender role norms. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Cross-cultural; gender inequality; gender nonconformity; gender roles; self-esteem; No terms assigned

Improving our understanding of the Death/Life Implicit Association Test - Podlogar, Matthew C.; Gutierrez, Peter M.; Joiner, Thomas E. (Journal of Personality Assessment, 2020)
The 'Death/Life' Implicit Association Test (d-IAT) is a reaction-time task which has been associated with past and future suicidal behavior; in some work, the association has been incremental to explicit self-report of suicide risk. Proposed mechanisms for this association relate to one’s unwillingness or inability to completely disclose or be introspectively aware of implicit risk. This study investigated moderators of implicit-explicit concordance as well as predictors of d-IAT score unexplained by self-reported suicidal thoughts and behaviors among an online sample of 382 adults with higher demographic suicide risk (i.e., military service members and veterans, men over age 50, and LGBTQ young adults). Before and after controlling for current explicit report, results replicated the finding of a significant relationship between d-IAT score and severity of past suicidal behavior, and additionally indicated that suicide attempt history and wish to live moderated the association between d-IAT score and explicit report. Furthermore, results suggest that poor introspective awareness, rather than deception, may account for differences between implicit and explicit risk assessment. Continuing investigation of moderators and mechanisms of the d-IAT is needed to improve the utility and validity of using implicit suicide risk assessment as a clinical tool. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Death/Life Implicit Association Test; reaction-time task; implicit-explicit concordance; test validity; test reliability; suicide risk; military service members; Military Personnel; Suicidal Ideation; Test Validity; Risk Assessment; Task; Military Veterans; Reaction Time; Risk Taking; Self-Report; Test Reliability

Internalized homophobia, self‐esteem, social support and depressive symptoms among sexual and gender minority women in taiwan: An online survey - Wang, Ya‐Ching; Miao, Nae‐Fang; Chang, Shiow‐Ru (Journal of Psychiatric and Mental Health Nursing, 2020)
Accessible summary What is known on the subject? Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals. Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non‐western countries. What the paper adds to existing knowledge? To the best our knowledge, this is the first study examining internalized homophobia, self‐esteem, social support and depressive symptoms among sexual minority women in Taiwan. Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self‐esteem and fewer support from partners, friends, and families. Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. What are the implications for practice? Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self‐esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation. LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. Abstract Introduction Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non‐western countries. Aim This study examined internalized homophobia, self‐esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method A total of 581 Taiwanese sexual minority women (Age range 20–48 years old, Mean 26.96, SD 5.718) completed an online survey. Results Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self‐esteem. Perceived support from participants’ partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion Mental health interventions are essential for sexual minority women with internalized homophobia and low self‐esteem. Implications for Practice Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: depressive symptoms; online surveys; self‐esteem; self‐stigma; sexual minorities; social support; No terms assigned

Family belongingness attenuates entrapment and buffers its association with suicidal ideation in a sample of dutch sexual minority emerging adults - Parra, Luis A.; van Bergen, Diana D.; Dumon, Eva; Kretschmer, Tina; La Roi, Chaïm; Portzky, Gwendolyn; Frost, David M. (Archives of Sexual Behavior, 2021)
Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N = 675; ages 18–29, M = 21.93 years, SD = 3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Homophobic violence; Entrapment; Social belongingness; Suicidal ideation; Sexual orientation; Minority stress; No terms assigned

Correlates of depressive symptoms in transgender women initiating hiv treatment in argentina - Aristegui, Ines; Radusky, Pablo D.; Zalazar, Virginia; Cardozo, Nadir; Fabian, Solange; Duarte, Mariana; Frola, Claudia; Cahn, Pedro; Sued, Omar (Journal of Gay & Lesbian Mental Health, 2021)
Abstract Introduction Transgender women (TGW) experience high prevalence of depression worldwide. Methods This study analyzed the prevalence and correlates of depressive symptoms among 61 HIV + TGW (age: M = 29.87 years, SD = 6.51) from Argentina; through questionnaires assessing psychosocial vulnerability, gender identity stigma (GIS) and violence, mental health, substance use, and protective factors. Results Half of the respondents showed significant depressive symptoms. In the multivariable logistic regression model, unstable housing, GIS from police, anxiety, and lifetime suicide attempts predicted increased odds of depressive symptoms. Conclusion The role of institutional GIS and psychosocial vulnerability in the development of depression should be considered in HIV and mental health care for TGW. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Transgender women; depression; gender identity stigma; CES-D; HIV; No terms assigned

Psychosocial characteristics of transgender youth seeking gender-affirming medical treatment: Baseline findings from the trans youth care study - Chen, Diane; Abrams, Mere; Clark, Leslie; Ehrensaft, Diane; Tishelman, Amy C.; Chan, Yee-Ming; Garofalo, Robert; Olson-Kennedy, Johanna; Rosenthal, Stephen M.; Hidalgo, Marco A. (Journal of Adolescent Health, 2020)
PURPOSE: This study aimed to characterize two developmental cohorts of transgender and nonbinary youth enrolled in the Trans Youth Care Network Study and describe their gender identity–related milestones and baseline mental health and psychosocial functioning. METHODS: Trans Youth Care participants were recruited from four pediatric academic medical centers in the U.S. before initiating medical treatment for gender dysphoria either with gonadotropin-releasing hormone agonists (GnRHa) or gender-affirming hormones (GAH). GnRHa cohort data were collected from youth and a parent; GAH cohort data were collected from youth only. RESULTS: A total of 95 youth were enrolled in the GnRHa cohort. Mean age was 11.22 years (standard deviation = 1.46), and the majority were white (52.6%) and designated male at birth (51.6%). Elevated depression symptoms were endorsed by 28.6% of GnRHa cohort youth, and 22.1% endorsed clinically significant anxiety. Approximately one fourth (23.6%) endorsed lifetime suicidal ideation, with 7.9% reporting a past suicide attempt. A total of 316 youth were enrolled in the GAH cohort. The mean age was 16.0 years (standard deviation = 1.88), and the majority were white (62%) and designated female at birth (64.9%). Elevated depression symptoms were endorsed by 51.3% of the GAH cohort, and 57.3% endorsed clinically significant anxiety. Two-thirds (66.6%) endorsed lifetime suicidal ideation, with 24.6% reporting a past suicide attempt. Life satisfaction was lower among both cohorts compared with population-based norms. CONCLUSIONS: GnRHa cohort youth appear to be functioning better from a psychosocial standpoint than GAH cohort youth, pointing to possible benefits of accessing gender-affirming treatment earlier in life. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gender dysphoria; Gender diversity; Gender expansive adolescents; Gender-affirming hormones; Pubertal suppression; Gender-affirming care; No terms assigned

Clinical characteristics of 172 children and adolescents with body dysmorphic disorder - Rautio, Daniel; Jassi, Amita; Krebs, Georgina; Andrén, Per; Monzani, Benedetta; Gumpert, Martina; Lewis, Angela; Peile, Lauren; Sevilla-Cermeño, Laura; Jansson-Fröjmark, Markus; Lundgren, Tobias; Hillborg, Maria; et al. (European Child & Adolescent Psychiatry, 2020)
Body dysmorphic disorder (BDD) often starts in childhood, with most cases developing symptoms before age 18. Yet, BDD research has primarily focused on adults. We report the clinical characteristics of the world’s largest cohort of carefully diagnosed youths with BDD and focus on previously unexplored sex and age differences. We systematically collected clinical data from 172 young people with BDD consecutively referred to 2 specialist pediatric obsessive–compulsive and related disorders outpatient clinics in Stockholm, Sweden and in London, England. A series of clinician-, self-, and parent-reported measures were administered. The cohort consisted of 136 girls, 32 boys, and 4 transgender individuals (age range 10–19 years). The mean severity of BDD symptoms was in the moderate to severe range, with more than one third presenting with severe symptoms and more than half showing poor or absent insight/delusional beliefs. We observed high rates of current psychiatric comorbidity (71.5%), past or current self-harm (52.1%), suicide attempts (11.0%), current desire for cosmetic procedures (53.7%), and complete school dropout (32.4%). Compared to boys, girls had significantly more severe self-reported BDD symptoms, depression, suicidal thoughts, and self-harm. Compared to the younger participants (14 or younger), older participants had significantly more severe compulsions and were more likely to report a desire for conducting cosmetic procedures. Adolescent BDD can be a severe and disabling disorder associated with significant risks and substantial functional impairment. The clinical presentation of the disorder is largely similar across sexes and age groups, indicating the importance of early detection and treatment. More research is needed specifically focusing on boys and pre-pubertal individuals with BDD. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Body dysmorphic disorder; Dysmorphophobia; Children; Adolescents; No terms assigned

Comparison of lifetime suicide attempts and recent suicidal/self-harming thoughts among sexual minority and heterosexual utahns: Results from a population-based survey - McGraw, James S.; Peer, Samuel O.; McManimen, Stephanie; Chinn, Jessica; Mahoney, Annette (Archives of Suicide Research, 2020)
Abstract Objective We sought to be the first published article to report differences in population-representative prevalence of suicidal thoughts and attempts by sexual orientation. Method Data from Utah’s Behavioral Risk Factor Surveillance System (BRFSS) collected for 2016 (N = 10,988) and 2017 (N = 10,251) were examined to determine differences in the prevalence of suicidal thoughts in the past 2 weeks and the lifetime prevalence of suicide attempts (i.e., any, single, and multiple) by sexual orientation. Results 3.5% of heterosexuals Utahns reported recent suicidal/self-harming thoughts in the last 2 weeks compared to 14.7% of LGB Utahns (OR = 4.73 95% CI [2.67, 8.36]). 5.8% of heterosexuals reported a lifetime prevalence of any suicidal attempts compared to 37.2% of LGB folx (OR = 9.58 95% CI [7.16, 12.81]) with similar differences occurring for single and multiple attempts. Comparing LG versus B, there was no difference in ideation or prevalence of any attempt, but bisexuals reported higher rates of multiple suicide attempts. Conclusion LGB folx in Utah are drastically more likely to have thought about suicide/self-harming in the last 2 weeks and to have attempted suicide in their lifetime when compared to heterosexuals in Utah. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: BRFSS; LGBT; Utah; No terms assigned

Puberty blockers and suicidality in adolescents suffering from gender dysphoria - Biggs, Michael (Archives of Sexual Behavior, 2020)
Comments on an article by Jack L. Turban et al. (see record [rid]2020-08381-001[/rid]). Turban et al. (2020) tested six measures of suicidality and three other measures of mental health and substance abuse. With multivariate analysis, only one of these nine measures yielded a statistically significant association: the respondents who reported taking puberty blockers were less likely to have thought about killing themselves than were the respondents who reported wanting blockers but not obtaining them. Most seriously, Turban et al. (2020) barely acknowledged the fact that adolescents with severe psychological problems would have been less eligible for drug treatment, which confounds the association between treatment and suicidal ideation. In sum, then, Turban et al. (2020) contributed nothing to our knowledge of the effects of suppressing puberty in adolescents. One study did demonstrate positive psychological effects, based on measures taken from between 41 and 57 individuals, with no control group. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: suicidality; gender dysphoria; puberty; adolescent psychopathology; Adolescent; Gender Dysphoria; Humans; Puberty; Suicidal Ideation; Suicide; Transgender Persons; Adolescent Psychopathology; Puberty; Gender Dysphoria; Suicidality

APA/Psi Chi Edwin B Newman Graduate Research Award: Andrew Young Choi (American Psychologist, 2020)
The Edwin B. Newman Graduate Research Award is sponsored jointly by Psi Chi, the national honor society in psychology, and the APA. The award is presented annually to the psychology graduate student who submits the best research paper that was published or presented at a national, regional, or state psychological association conference during the past calendar year. The Edwin B. Newman Graduate Research Award was established in 1979. The award was established to recognize young researchers at the beginning of their professional lives and to commemorate both the 50th anniversary of Psi Chi and the 100th anniversary of psychology as a science (dating from the founding of Wundt’s laboratory). It was named for Dr. Edwin B. Newman, the first national president of Psi Chi (1929) and one of its founders. He was a prolific researcher and a long-time chair of the Department of Psychology at Harvard University. Newman was a member of APA’s Board of Directors, served as recording secretary of the board from 1962 to 1967, and was parliamentarian for the APA Council of Representatives for many years. He served both Psi Chi and APA in a distinguished manner for half a century. The APA/Psi Chi Edwin B. Newman Graduate Research Award is given jointly by APA and Psi Chi. For an outstanding research paper examining the syndemic theory of health disparities among bisexual adolescents, using national data to model patterns of co-occurrence across sexual risk, substance use, and victimization. Results identified six distinctive subpopulations—Low Risk, Alcohol Use, Peer-Victimization, Sexually Active, Syndemic, and Risk-taking— which covaried differentially with demographics and suicidality. His paper, titled ‘Syndemic Behavioral Risk and Suicidality Among Bisexual Adolescents: A Latent Class Analysis,’ and coauthored by Drs. Tania Israel and Karen Nylund-Gibson, was the basis for Dr. Andrew (Andy) Young Choi’s selection as the recipient of this research award. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: American Psychological Association; Psi Chi/Edwin B. Newman Graduate Research Award; National Honor Society in Psychology; 2020 award winner; Andrew Young Choi; health disparities; bisexual adolescents; sexual risk; substance use; victimization; suicidality; latent class analysis; American Psychological Association; Awards (Merit); Professional Recognition; Bisexuality; Drug Usage; Psychologists; Sexual Risk Taking; Victimization; Health Disparities; Adolescent Characteristics; Latent Class Analysis; Suicidality

Extending a rejection sensitivity model to suicidal thoughts and behaviors in sexual minority groups and to transgender mental health - Wells, Tony T.; Tucker, Raymond P.; Kraines, Morganne A. (Archives of Sexual Behavior, 2020)
Comments on an article by Brian A. Feinstein (see record [rid]2019-39080-001[/rid]). The Target Article by Feinstein articulates how a rejection sensitivity (RS) model contributes to the understanding of the etiology and maintenance of mental health issues in sexual minority individuals. This is a compelling and timely account that complements and extends existing minority stress models of sexual minority mental health. While the commentators commend this contribution, they also identify two specific areas deserving of additional consideration in the context of developing this RS model, namely application of this model to (1) suicidal thoughts and behavior, and (2) transgender and gender diverse (TGD) individuals. The commentators are optimistic about the potential for the RS model proposed by Feinstein to contribute to a better understanding of sexual minority mental health. The commentators hope that the RS model will spur additional, innovative models and approaches to the conceptualization and promotion of sexual minority mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: sexual minority groups; suicidal thoughts; transgender; mental health; rejection sensitivity models; Humans; Mental Health; Minority Groups; Sexual and Gender Minorities; Suicidal Ideation; Transgender Persons; Mental Health; Mental Models; Suicidal Ideation; Transgender; Sexual Minority Groups; Sensitivity (Personality); Social Acceptance

Correction to: Social correlates of recent suicidal ideation among men who have sex with men in greater tokyo - Hill, Adam O.; Distefano, Anthony; Gilmour, Stuart; Bavinton, Benjamin R.; Hidaka, Yasuharu; Bourne, Adam; Armstrong, Gregory (Sexuality Research & Social Policy: A Journal of the NSRC, 2020)
The original version of this article unfortunately contained a mistake. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

Suicide attempt rates and associations with discrimination are greatest in early adulthood for sexual minority adults across diverse racial and ethnic groups - Layland, Eric K.; Exten, Cara; Mallory, Allen B.; Williams, Natasha D.; Fish, Jessica N. (LGBT Health, 2020)
Purpose: The study purpose was to investigate differences in past 5-year suicide attempts among racially/ethnically diverse sexual minority (SM) and heterosexual adults across the life course and examine the association of discrimination with past 5-year suicide attempts among SM adults. Methods: Using nationally representative data collected from 2012 to 2013, we assessed differences in age-varying prevalence of past 5-year suicide attempts among Black, Hispanic, and White SM and heterosexual adults (ages 18–60). We tested whether the association between discrimination and suicide attempts differed by race/ethnicity among SM adults. All secondary data analyses were approved by the Institutional Review Boards of The Pennsylvania State University and University of Maryland. Results: Compared with heterosexual adults of any race/ethnicity, SM adults exhibited elevated suicide attempt rates until the late twenties when prevalence for Black and Hispanic SM adults declined. Disparities persisted into the mid-40s for White SM adults. Among SM adults of all races/ethnicities, the relationship between SM discrimination and suicide attempts was strongest between ages 18 and 25. For SM adults reporting SM discrimination, odds of suicide attempts were 3.6 times higher for White SM adults and 4.5 times higher for Black and Hispanic SM adults, relative to same-race/ethnicity SM adults who did not report SM discrimination. The effect of SM discrimination was robust among Black and Hispanic SM young adults even when accounting for racial/ethnic discrimination. Conclusions: SM adults of all racial/ethnic groups demonstrated disparities when contrasted with heterosexual adults of any race/ethnicity, although ages characterized by heightened prevalence rates of suicide attempts differed by race/ethnicity. Early adulthood is a critical period for intervention seeking to disrupt the association between SM discrimination and suicide attempts. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: discrimination; life course; race/ethnicity; sexual minority; suicide attempt; time-varying effect modeling; Attempted Suicide; Discrimination; Heterosexuality; Racial and Ethnic Groups; Sexual Minority Groups; Racial and Ethnic Differences

Sexual orientation differences in non-suicidal self-injury, suicidality, and psychosocial factors among an inpatient psychiatric sample of adolescents - Peters, Jessica R.; Mereish, Ethan H.; Krek, Maya A.; Chuong, Adam; Ranney, Megan L.; Solomon, Joel; Spirito, Anthony; Yen, Shirley (Psychiatry Research, 2020)
Within broader community samples, sexual minority adolescents (SMA, e.g., lesbian, gay, bisexual, queer) are at greater risk than their heterosexual counterparts for nonsuicidal self-injury (NSSI) and suicidal thoughts and behaviors. The present study investigated whether sexual minority orientation continues to confer additional risk for these behaviors in an already higher-risk sample of youth. Frequency and function of NSSI, suicidal behavior, and psychosocial factors were assessed in a sample of 52 adolescents (aged 12–18 years) admitted to an inpatient psychiatric unit due to suicide risk; 27 of them identified as SMA, and 25 as heterosexual (HA). Greater proportions of SMA reported engaging in lifetime NSSI, compared to HA, with a greater variety and frequency of NSSI behaviors and greater endorsement of intrapersonal NSSI functions. SMA reported higher levels of suicide ideation than HA, but not suicidal behavior. Group differences in NSSI and SI persisted when controlling for the greater prevalence of abuse and levels of peer-victimization reported by SMA. In inpatient clinical settings, SMA may be more likely than heterosexual youth to engage in NSSI, including more severe forms, and to experience suicide ideation. Providing alternative coping mechanisms may serve as treatment goals for reducing NSSI in SMA. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBT; LGBTQ; Suicide; Emotion regulation; Deliberate self-harm; Gay; Bisexual; Adolescent Psychiatry; Heterosexuality; Psychosocial Factors; Self-Injurious Behavior; Suicidal Ideation; Bisexuality; Adolescent Behavior; Sexual Minority Groups

Religiosity, spirituality, suicide risk and remission of depressive symptoms: a 6-month prospective study of tertiary care Brazilian patients - Mosqueiro, Bruno Paz; Caldieraro, Marco Antônio; Messinger, Mateus; da Costa, Felipe Bauer Pinto; Peteet, John R.; Fleck, Marcelo P. (Journal of Affective Disorders, 2021)
Religiosity and spirituality (R/S) are increasingly recognized as significant aspects in the evaluation of depressed patients. Limited research, however, has investigated the impact of R/S on outcomes of more severe or chronic depressed patients. The present study investigated the impact of different religiosity dimensions in tertiary care Brazilian depressed patients over suicide risk scores measured at baseline and remission of depressive symptoms in a 6-month prospective follow-up. In 277 individuals interviewed, 226 presented a diagnosis of depressive episode and 192 were assessed in the follow-up. Religiosity was evaluated using the Duke University Religion Index, comprising three dimensions of religiosity (organizational religiosity, non-organizational religiosity, intrinsic religiosity). Other potential predictors of outcomes included the Childhood Trauma Questionnaire (CTQ), Maudsley Staging of illness (MSM), Medical Outcomes Study Social Support Survey (MOS), World Health Organization Spirituality, Religiousness and Personal Beliefs instrument (WHOQOL-SRPB) and Hamilton Depression Scale (HAM-D). Results showed that almost half (46.1%) of the patients reported previous suicide attempts. Linear regression models identified that religious attendance (t-statistic -2.17, P = 0.03), intrinsic religiosity (t-statistic -2.42, P = 0.01) and WHOQOL-SRPB (t-statistic -3.67, P = 0.00) were inversely correlated to suicide risk scores. In a prospective follow-up 16.7 % of patients (n = 32/192) achieved remission of depressive symptoms (HAM-D scores ≤ 7). Religious attendance (OR 1.83, P = 0.02) was identified as the main predictor of remission. Findings reinforce the importance of attending to religiosity/spirituality in order to improve outcomes and promote the recovery especially among severely depressed patients with increased suicide risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Religiosity; Spirituality; Depression; Suicide; Remission; Social Support; Major Depression; Religiosity; Spirituality; Suicide; Symptom Remission; Social Support; Symptoms

Differences in adolescent experiences of polyvictimization and suicide risk by sexual minority status - Johns, Michelle M.; Lowry, Richard; Hipp, Tracy N.; Robin, Leah; Shafir, Shira (Journal of Research on Adolescence, 2020)
Sexual minority adolescents (SMA) report more suicide risk behaviors than heterosexual adolescents. Polyvictimization (co‐occurrence of multiple types of victimization) may be an important, underresearched correlate of this disparity. With the 2017 national Youth Risk Behavior Survey (N = 13,179), national estimates of polyvictimization and suicide risk were assessed among high school students by sexual minority status (SM vs. heterosexual), and multivariate relationships between sexual minority status, polyvictimization, and suicide risk were tested. Additionally, risk profiles of those who experienced polyvictimization (2 + types of victimization; n = 1,932) were compared across sexual minority status. Results confirm that SMA are more likely to experience polyvictimization than heterosexual adolescents (31.8% v. 12.9%, respectively); however, also indicate that polyvictimization does not fully explain elevated suicide risk among SMA. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

Alcohol use and suicidality by sexual orientation among US youth, 2009–2017 - Phillips, Gregory L. II; Turner, Blair C.; Felt, Dylan; Marro, Rachel L.; Wang, Xinzi; Ruprecht, Megan M.; Broschart, Jacob; Beach, Lauren B. (American Journal of Preventive Medicine, 2020)
Introduction: Alcohol use and suicidality remain serious risks for U.S. youth. Research has established that disparities exist in these outcomes between heterosexual and sexual minority youth. However, research into the associations between alcohol use and suicidality has yet to consider the differential role of sexual orientation. Methods: Using a pooled, diverse sample from the 2009–2017 Youth Risk Behavior Survey, associations of alcohol use and suicidality by sex and sexual orientation, and changes in these outcomes over time, were investigated. Analyses were conducted in 2019. Results: Suicidality was highest among nonheterosexuals, who ranged from twofold to sevenfold higher odds to report suicidality across all time points, with the most striking disparities among male sexual minority youth. Rates among all students remained stable or increased over time; notable exceptions included a decrease in suicide attempts among bisexual students. Among all students, current alcohol use was associated with elevated levels of suicidality. For female students, the association between drinking and suicidality did not significantly differ by sexual identity; for male students, it was significant regardless of sexual identity and most pronounced among not sure youth. Conclusions: These results emphasize the need for additional research into the relationship between contemporaneous alcohol use and suicidality, with attention to differences based on sex, sexual orientation, and other factors that may impact these relationships. There is a particular need for research to examine the temporal nature of the association such that evidence-informed, high-impact interventions can be developed to improve suicidality outcomes among sexual minority youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: alcohol use; suicidality; sexual orientation; youth; Alcohol Drinking Patterns; Sexual Orientation; Suicidality; Sexual Minority Groups; Gender Identity; Risk Factors

The views and experiences of bisexual people regarding their psychosocial support needs: A qualitative evidence synthesis - McCann, Edward; Brown, Michael J.; Taylor, Julia (Journal of Psychiatric and Mental Health Nursing, 2020)
Accessible Summary What is known on the subject? Bisexual people experience significantly poorer mental health and higher rates of self‐harm and suicidality than their gay, lesbian or heterosexual counterparts. Although little is understood about why these disparities exist, bisexual people have been found to have unique life experiences that separate them from other sexual minority groups. Despite these health disparities and unique experiences, in research and in clinical settings, bisexual people are often incorporated under the LGBTQI+ umbrella and their needs are not seen as being different to those of other sub‐groups. What the paper adds to existing knowledge? This paper brings together the findings of the small but growing body of literature reporting on the psychosocial support needs of bisexual people. The findings reported on herein provide novel insights, collated and synthesized that will prove valuable to policy makers, service providers and researchers. What are the implications for practice? This paper clearly illustrates that bisexual people experience significant barriers to accessing the support services they need and that current competent service provision for this population is severely limited. The findings presented in this paper shed light on the unique psychosocial needs of bisexual people and highlight the need for practice change to reduce barriers to service access and ensure inclusive and culturally competent care for this community. Abstract Introduction Despite consistent evidence of poor mental health among what is a relatively large population group, research examining bisexual mental health remains sparse. Aim To identify the psychosocial needs of people who are bisexual and establish factors that may support or inhibit access to appropriate psychosocial interventions and supports. Method A qualitative evidence syntheses of the empirical evidence. Results A total of 15 papers were included in the review. The PRISMA process was used. Following data analysis, four main themes emerged that were (a) experiences of being bisexual, (b) mental health experiences and concerns, (c) service access and responses and (iv) communities and supports. Discussion Bisexual people have unique and specific psychosocial support needs that relate to, but are also different from, the needs of the broader LGBTIQ+ community. This study provides valuable insights into how future policy, practice, education and training and research can better address the needs of this highly vulnerable group. Implications for Practice This study highlights the psychosocial complexities associated with bisexuality and provides evidence for the need for improvement in current support services to ensure inclusivity and culturally competent care. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: bisexual; experiences; mental health; psychosocial; qualitative evidence syntheses; supports; No terms assigned

'this could mean death for my child': Parent perspectives on laws banning gender-affirming care for transgender adolescents - Kidd, Kacie M.; Sequeira, Gina M.; Paglisotti, Taylor; Katz-Wise, Sabra L.; Kazmerski, Traci M.; Hillier, Amy; Miller, Elizabeth; Dowshen, Nadia (Journal of Adolescent Health, 2020)
OBJECTIVES: Numerous U.S. state legislatures have proposed bills to ban gender-affirming medical interventions for minors. Parents and caregivers play a critical role in advocating for and supporting their transgender and gender-diverse youth (TGDY). We aimed to understand parent and caregiver perspectives about this potential legislation and perceived effects on their TGDY’s mental health. METHODS: We developed and launched a social-media based, anonymous online survey in February 2020 to assess parent and caregiver perspectives on proposed laws to ban gender-affirming medical interventions for minors. Participants were asked to respond to two open-ended questions about these laws; responses were coded to identify key themes. RESULTS: We analyzed responses from 273 participants from 43 states. Most identified as white (86.4%) female (90.0%) mothers (93.8%), and 83.6% of their TGDY had received gender-affirming medical interventions before age 18 years. The most salient theme, which appeared in the majority of responses, described parent and caregiver fears that these laws would lead to worsening mental health and suicide for their TGDY. Additional themes included a fear that their TGDY would face increased discrimination, lose access to gender-affirming medical interventions, and lose autonomy over medical decision-making due to government overreach. CONCLUSIONS: In this convenience sample, parents and caregivers overwhelmingly expressed fear that the proposed legislation will lead to worsening mental health and increased suicidal ideation for their TGDY. They implored lawmakers to hear their stories and to leave critical decisions about gender-affirming medical interventions to families and their medical providers. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender; Gender diverse; Youth; Parents; Laws; Access; Gender-affirming care; Mental health; Suicidal ideation; No terms assigned

'it’s not okay for you to call me that': How sexual and gender minority youth cope with bullying victimization - Sang, Jordan M.; Louth-Marquez, William; Henderson, Emmett R.; Egan, James E.; Chugani, Carla D.; Hunter, Simon C.; Espelage, Dorothy; Friedman, Mark S.; Coulter, Robert W. S. (Journal of Homosexuality, 2020)
ABSTRACT Sexual and gender minority youth (SGMY) have higher rates of bullying than their heterosexual peers and must disproportionately cope with bullying victimization. The purpose of this research is to highlight various coping strategies employed by SGMY. We conducted 20 cross-sectional, semi-structured online interviews with SGMY about their bullying experiences and coping strategies. We coded interviews with descriptive qualitative research to illustrate a comprehensive summary of bullying-related coping methods. We found SGMY engage in multiple coping strategies that include (1) emotion-focused coping—rumination; self-harm and considering or attempting suicide; seeking social and emotional support; engaging in creative endeavors; self-acceptance and community connectedness—and (2) problem-focused coping—reporting the bully; confronting the bully; conceal orientation; ignoring the bullying; and changing environment. Additionally, most SGMY reported using multiple coping techniques or changing how they coped over time (i.e., coping flexibility). These findings can inform future interventions to promote positive coping mechanisms among SGMY. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: SGMY; sexual minority; gender minority; bullying; coping; qualitative; No terms assigned

Past-year suicidal ideation among transgender individuals in the united states - Yockey, Andrew; King, Keith; Vidourek, Rebecca (Archives of Suicide Research, 2020)
Abstract This study assessed potential correlates to past-year suicide ideation among a national sample of transgender adults in the United States. A secondary analysis of the 2015 Transgender Survey was conducted. The 2015 Transgender Survey is the first and largest survey assessing health behaviors among transgender individuals living in the United States. Participants were recruited by several methods (e.g., social media, random sampling, photobooth campaigns. Weighted logistic regression analyses adjusting for covariates were conducted to investigate potential associations to whether or not an individual thought about suicide. A total of 27,795 individuals who self-identified as transgender participated in the study. Of the sample, 34.0% identified as a man, 29.8% identified as a woman, 20.6% identified as non-binary, and 15.5% identified as part time one gender/part time another. Nearly half of participants (48.5%) reported past year suicide ideation. Significant predictors included gender identity, age, income, race, low family support, and self-reported physical and sexual assault. This is one of the first studies that we are aware of examining past-year suicidal ideation among a large, nationally representative sample of transgender individuals. Interventions (e.g., acceptance therapy, evaluation, focus groups) are desperately needed to address this burgeoning problem among transgender individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicide; transgender; violence; No terms assigned

Gender conformity and suicide: A case study integrating structural family therapy and satir experiential therapy - Romney, Justin S.; Hawkins, Lindsey G.; Soloski, Kristy L. (Clinical Case Studies, 2020)
Recent studies have shown that suicidality among transgender youth are 3.6 times more likely to report suicidal ideation and 3.2 times more likely to attempt suicide compared with cisgender youth. To alleviate the suicide rates among transgender youth, research suggests the need for family-based interventions. This case study explores the integration of structural family therapy and the Satir growth model to increase connection and support within the family, while also creating clear boundaries that are protective and growth-enhancing. This study provides a session by session overview of how the therapist integrated the models while working with the entire family unit. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: suicidality; transgender; family therapy; family-based intervention; Transgender; Structural Family Therapy; Suicidality

Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis - Liu, Richard T.; Sheehan, Ana E.; Walsh, Rachel F. L.; Sanzari, Christina M.; Cheek, Shayna M.; Hernandez, Evelyn M. (Clinical Psychology Review, 2019)
The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n = 51) were identified through a systematic search of PsycINFO, MEDLINE, and Embase, supplemented by a search of references of prior reviews on this topic. NSSI prevalence rates were quite elevated among sexual (29.68% lifetime) and gender (46.65% lifetime) minority individuals compared to heterosexual and/or cisgender peers (14.57% lifetime), with transgender (46.65% lifetime) and bisexual (41.47% lifetime) individuals being at greatest risk. Even among these group findings, sexual minority youth emerged as an especially vulnerable population. Moreover, current evidence suggests these rates and differences between LGBT and heterosexual and/or cisgender peers have not declined over time. These findings may in some measure be due to the existence of LGBT-specific risk correlates combined with general risk correlates being more severe among sexual and gender minority populations. Additional research, particularly employing a longitudinal design, is needed in this area to advance efforts to reduce risk for NSSI among sexual and gender minority individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBT; Non-suicidal self-injury; Self-harm; Sexual minority; Self-Injurious Behavior; LGBTQ; Bisexuality; Heterosexuality; Lesbianism; Life Span; Sexual Risk Taking; Transgender

Examining the intersection of race/ethnicity and sexual orientation on suicidal ideation and suicide attempt among adolescents: Findings from the 2017 Youth Risk Behavior Survey - Baiden, Philip; LaBrenz, Catherine A.; Asiedua-Baiden, Gladys; Muehlenkamp, Jennifer J. (Journal of Psychiatric Research, 2020)
Although some studies have examined factors associated with suicidal behaviors, few studies have examined the intersection of sexual orientation and race/ethnicity on suicidal behaviors among adolescents. The objective of this study is to examine the intersection of sexual orientation and race/ethnicity on suicidal ideation and suicide attempt. We hypothesized that controlling for the effects of known risk factors for suicidal behaviors, there will be an interaction effect between sexual orientation and race/ethnicity on suicidal behaviors. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,697 adolescents aged 14–18 years (51.8% female) was analyzed using binary logistic regression. Of the 13,697 adolescents, 17.7% reported suicidal ideation and 7.7% made at least one suicide attempt during the past 12 months. In the multivariate logistic regression models, non-White sexual minority adolescents are less likely to report suicidal ideation. However, Hispanic lesbian/gay adolescents had 1.71 times higher odds of making a suicide attempt. Odds of suicide attempt are 1.2 times higher for Black or African American bisexual adolescents and American Indian/Native Hawaiian/Pacific Islander bisexual adolescents had 2.44 times higher odds of making a suicide attempt. Other significant predictors of suicidal behaviors include a history of sexual assault, a victim of bullying, depression, cigarette smoking, misuse of prescription pain medication, and illicit drug use. The findings of the present study extend past research on the intersection of sexual orientation and race/ethnicity on mental health problems among adolescents including suicidal behaviors. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: race; ethnicity; sexual orientation; suicidal ideation; suicide attempt; adolescents; Attempted Suicide; Racial and Ethnic Differences; Sexual Orientation; Suicidal Ideation; Adolescent Behavior; Risk Factors

Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study - Bränström, Richard; Pachankis, John E. (The American Journal of Psychiatry, 2020)
[Correction Notice: An Erratum for this article was reported in Vol 177(8) of The American Journal of Psychiatry (see record [rid]2020-61360-021[/rid]). In the original article, there were errors in some letters containing questions on the statistical methodology. Given that the study used neither a prospective cohort design nor a randomized controlled trial design, the conclusion that 'the longitudinal association between gender-affirming surgery and lower use of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them' is too strong. Although the percentage of individuals with a gender incongruence diagnosis who had received gender-affirming surgical treatments during the follow-up period is correctly reported in Table 3, (37.9%), the text incorrectly refers to this percentage as 48%. The article was reposted correcting this percentage.] Objective: Despite professional recommendations to consider gender-affirming hormone and surgical interventions for transgender individuals experiencing gender incongruence, the long-term effect of such interventions on mental health is largely unknown. The aim of this study was to ascertain the prevalence of mood and anxiety disorder health care visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender incongruence diagnosis and gender-affirming hormone and surgical treatment in the entire Swedish population. Methods: This study used the Swedish Total Population Register (N = 9,747,324), linked to the National Patient Register and the Prescribed Drug Register. Among individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015 (N = 2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming hormone and surgical treatment. Outcome measures were mood and anxiety disorder health care visits, antidepressant and anxiolytic prescriptions, and hospitalization after a suicide attempt. Results: Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio =1.01, 95% CI = 0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio = 0.92, 95% CI = 0.87, 0.98). Conclusions: In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; treatment utilization; transgender; gender-affirming surgeries; mood disorder; anxiety disorder; antidepressant; anxiolytic prescriptions; gender incongruence; Antidepressant Drugs; Health Care Utilization; Mental Health; Prescription Drugs; Transgender; Diagnosis; Hormones; Surgery; Treatment

Parents matter: Considering evidence-based relationship variables within families when working with gender expansive youth - Olezeski, Christy L.; Kamody, Rebecca C. (Practice Innovations, 2020)
Transgender and gender expansive (TGE) youth represent a very vulnerable population. Research suggests high levels of anxiety, depression, disordered eating, substance abuse, self-injurious behaviors, and suicidal ideation and attempts in TGE youth. One of the most important protective factors for TGE youth is family support. In the current article, we discuss the evidence-based relationship variables such as alliance, cohesion, and empathy that can impact treatment. We then underscore how each of these evidence-based relationship variables play a role in family based treatment for TGE youth. We conclude with a discussion of how evidence-based relationship variables are extremely important to be aware of when working with transgender and gender expansive youth and families, and how researchers and clinicians can focus on the inclusion of these variables to optimize clinical care and assess clinical change, given the lack of evidence-based treatments for this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: transgender youth; gender expansive; family therapy; family support; Evidence Based Practice; Family Therapy; Protective Factors; Social Support; Transgender; Adolescent Psychotherapy; Attempted Suicide; Child Psychotherapy; Drug Abuse; Eating Disorders; Major Depression; Self-Injurious Behavior; Suicidal Ideation; Treatment

The Australian marriage equality debate: A qualitative analysis of the self-reported lived experience of lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) people - Ecker, Saan; Rostosky, Sharon S.; Riggle, Ellen D. B.; Riley, Elizabeth Anne; Byrnes, Joanne M. (International Perspectives in Psychology: Research, Practice, Consultation, 2019)
This study explored the lived experiences of a sample of lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) people during the Australian Government postal survey on legal recognition of same-sex marriage (August to November 2017). Negative impacts of public voting and debates on marriage equality for LGBTIQ people have been previously documented in United States, but less so in other national contexts. Thematic analysis was conducted using written responses of LGBTIQ participants (N = 5,313) to open-ended questions on a larger survey. Findings revealed that LGBTIQ participants experienced the Australian Marriage Law Postal Survey debate as a pervasive and predominantly negative event. Participants reported experiences of prejudice and discrimination and increased fear, anxiety, anger, and depression. They also described the harm and hurt caused by widespread negative images of and messages about LGBTIQ people. Some participants felt their lives were under threat and reported psychological distress, including thoughts of suicide. Although a few participants noted positive support that helped them cope, most participants perceived the debate and vote as a highly stressful, socially fracturing process that threatened interpersonal relationships with family members, workmates, and communities. Many participants described feeling betrayed by the government, country, and Church. These findings extend previous studies that document the public health impacts of political processes that publicly debate the human rights of LGBTIQ individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBTIQ; discrimination; stress; same-sex marriage; mental health; Mental Health; Same Sex Marriage; Sexual Orientation; Stress; Transgender; Bisexuality; Discrimination; Homosexuality; Lesbianism; Life Experiences; Male Homosexuality; Intersex Conditions

Mental health and timing of gender-affirming care - Sorbara, Julia C.; Chiniara, Lyne N.; Thompson, Shelby; Palmert, Mark R. (Pediatrics, 2020)
Background: Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. Methods: A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (< 15 years of age at presentation) or older presenting youth (OPY) (≥ 15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. Results: Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14-26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22-14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05-1.63]). Conclusions: Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; gender-affirming care; pubertal stage; mental disorders; Adolescent; Age Factors; Antipsychotic Agents; Anxiety Disorders; Child; Cross-Sectional Studies; Depression; Depressive Disorder; Disclosure; Gender Dysphoria; Humans; Logistic Models; Mental Disorders; Mental Health; Puberty; Self-Injurious Behavior; Sex Factors; Suicidal Ideation; Suicide, Attempted; Transsexualism; Gender Identity; Health Service Needs; Mental Health; Puberty; Gender Dysphoria

Greater minority stress is associated with lower intentions to disclose suicidal thoughts among lgbtq + youth - Chang, Cindy J.; Kellerman, John; Feinstein, Brian A.; Selby, Edward A.; Goldbach, Jeremy T. (Archives of Suicide Research, 2020)
Abstract Objective The current study examined suicide-related disclosure intentions in LGBTQ + youth, and the associations between reporting of lifetime experiences of minority stress and intentions to disclose suicidal thoughts. Method A sample of 592 LGBTQ + youth ages 12–24 (22.3% cisgender men, 33.1% cisgender women, 44.6% gender diverse, 75.3% white) who contacted an LGBTQ-specific crisis service, completed a survey. Results Youth reported highest intentions to disclose future suicidal ideation to LGBTQ-specific crisis services, a mental health professional, and someone they know who also identifies as LGBTQ. They reported lowest suicide-related disclosure intentions to family, spiritual counselors, and emergency room personnel. Greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions. When specific domains of minority stress were examined separately, five domains were significantly associated with lower suicide-related disclosure intentions: identity management, family rejection, homonegative communication, negative expectancies, and internalized homonegativity. However, only internalized homonegativity remained significant when they were examined simultaneously. In addition, greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions to some groups (e.g., family, friends), but not others (e.g., others who have thought about or attempted suicide, others who identify as LGBT). Conclusions Minority stress may play an important role in LGBTQ + youth’s suicide-related disclosure intentions. As such, reducing minority stress and its effects may be an important target to promote disclosure of suicidal thoughts and access to treatment among LGBTQ + youth. HIGHLIGHTS Minority stress was associated with lower suicide-related disclosure intentions. Internalized homonegativity was uniquely associated with disclosure intentions. Reducing minority stress may promote disclosure of suicidal thoughts. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Disclosure; LGBT; minority stress; suicide; No terms assigned

Syndemic profiles and sexual minority men’s hiv-risk behavior: A latent class analysis - Scheer, Jillian R.; Clark, Kirsty A.; Maiolatesi, Anthony J.; Pachankis, John E. (Archives of Sexual Behavior, 2021)
Syndemic theory posits that 'syndemic conditions' (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men’s HIV-risk behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Sexual minority men; Syndemic; HIV-risk behavior; Latent class analysis; No terms assigned

Omar Mateen as US citizen, not foreign threat: Homonationalism and LGBTQ online representations of the Pulse nightclub shooting - Meyer, Doug (Sexualities, 2020)
This article focuses on how 377 reports from popular lesbian, gay, bisexual, transgender, and queer (LGBTQ) websites represented Omar Mateen, the shooter of the 2016 Pulse nightclub shooting in Orlando, Florida, drawing particular attention to the exclusion of Mateen's native-born status. Based on a grounded theory analysis of the five most-trafficked LGBTQ websites, results demonstrate that the reports generally decontextualized Mateen from his country of birth, the USA, and excluded any emphasis on xenophobia or anti-Latinx prejudice as a potential motivating factor in the shooting. Instead, Mateen was usually associated with 'terrorism' and sometimes implicitly positioned as a 'foreign threat.' These results, building on Jasbir Puar's concept of homonationalism, have implications for LGBTQ positions on the US political left, as the reports typically constructed themselves as anti-Republican and opposed to Islamophobia, while simultaneously reinforcing homonationalist, and relatively conservative, positions. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Homonationalism; Islamophobia; mass shootings; Muslims; Pulse nightclub; LGBTQ; foreign threat; Phobias; Terrorism; Threat; Websites; LGBTQ; Homosexuality (Attitudes Toward); Islam; Muslims; Nationalism; Gun Violence

Image-based sexual abuse in a culturally conservative nigerian society: Female victims’ narratives of psychosocial costs - Aborisade, Richard Abayomi (Sexuality Research & Social Policy: A Journal of the NSRC, 2021)
BackgroundIn the last few years, many countries have introduced laws combating image-based sexual abuse (IBSA), colloquially known as 'revenge pornography.' However, the significant growth in the body of literature on the legal perspectives on IBSA, and the media coverage of high profile cases have not been equally met with appreciable victimization studies. Meanwhile, the need for a victim-centered approach in studying IBSA in Nigeria is underscored by the pervasiveness and normalization of sexual violence as a result of societal attitudes about gender and sexuality in the country. Therefore, this study explored the social and psychological implications of IBSA victimization.MethodsUsing qualitative methods, 27 adult women whose sexual images have been non-consensually shared publicly through online channels were purposively selected and interviewed for the study, between September 2019 and April 2020, and a thematic analysis of the participants’ narratives carried out.ResultsVictims of IBSA were found to be subjected to higher social condemnation, stigmatization, and isolation based on greater attribution of blames to them by their social network. Evidences of institutional re-victimization were documented. Victims also reported self-blame, paranoia, anger, guilt, depression, suicidal ideation and attempt in dealing with the abuse, secondary victimization, and social isolation.ConclusionIBSA victims are faced with peculiar social and psychological consequences which separate them from victims of other forms of sexual abuse. The study suggests a review of appropriate laws and social policies to prevent IBSA, deploy more victim support services and perpetrator programs, and protect victims from secondary victimization. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Conservatism; Image-based sexual abuse; Rape culture; Revenge porn; Victimization; No terms assigned

Correlates to lifetime suicide attempts, thoughts, and planning behaviors among african american transgender individuals - Andrew Yockey, R.; King, Keith A.; Vidourek, Rebecca A. (The Journal of Primary Prevention, 2020)
Transgender individuals are at increased risk for suicidal behaviors. We estimated lifetime suicidal ideation, planning, and attempts within a national sample of African American transgender individuals (n = 790). Using data from the 2015 US Transgender Survey, we found that 33.5% of these individuals had thought about attempting suicide at least once, 20.0% had planned to attempt suicide, and 38.0% had attempted suicide. Significant differences were found in regard to demographics and lifetime substance use; individuals who experienced intimate partner violence and used alcohol, marijuana, or other drugs were at the highest risk for attempting suicide. Our findings may assist health professionals in creating interventions designed to prevent suicide in this underserved and vulnerable population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender health; Suicide; Behavioral health; No terms assigned

Enacted stigma experiences and protective factors are strongly associated with mental health outcomes of transgender people in aotearoa/new zealand - Tan, Kyle K. H.; Treharne, Gareth J.; Ellis, Sonja J.; Schmidt, Johanna M.; Veale, Jaimie F. (International Journal of Transgender Health, 2020)
Abstract Introduction International evidence has found large mental health inequities among transgender people and demonstrates that mental health outcomes are associated with enacted stigma experiences and protective factors. This study aimed to examine the extent of associations of enacted stigma experiences specific to transgender people alongside protective factors with mental health of transgender people in Aotearoa/New Zealand. Methods The 2018 Counting Ourselves survey was a nationwide community-based study of transgender people (N = 1178, Mage = 29.5) living in Aotearoa/New Zealand. The survey assessed a wide range of gender minority stress experiences and protective factors that comprised primary (support from friends and family) and secondary social ties (neighborhood and transgender community belongingness). We calculated the predicted probabilities that transgender people exhibit very high psychological distress level, non-suicidal self-injury, and suicidal risks with different combinations and exposure profiles of enacted stigma and protective factors. Results Our findings demonstrated that enacted stigma was associated with negative mental health, and support of friends and family was linked to better outcomes across all mental health measures. Beyond primary social ties, sense of belongingness to neighborhood and transgender communities were linked to reduced odds of psychological distress and suicidal ideation. For those scoring high on enacted stigma and low on protective factors, our model revealed a 25% probability of attempting suicide in the last year compared to 3% for those scoring low on enacted stigma and high on protective factors. Conclusions Echoing previous findings, this study demonstrates that transgender people across Aotearoa/New Zealand are less likely to manifest life-threatening mental health outcomes if they experience low levels of enacted stigma and high levels of access to protective factors. Our findings suggest a need to address the enacted stigma that transgender people face across interpersonal and structural settings, and also to enhance social supports that are gender affirmative for this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Transgender; minority stress; enacted stigma; protective factors; mental health; No terms assigned

Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context - Pachankis, John E.; Williams, Stacey L.; Behari, Kriti; Job, Sarah; McConocha, Erin M.; Chaudoir, Stephenie R. (Journal of Consulting and Clinical Psychology, 2020)
Objective: To identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions—expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee. Method: In consultation with sexual minority young adults (n = 10) and stakeholders (n = 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (Mage = 23.68, SD = 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up. Results: Compared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d = 0.48) and general psychological distress (d = 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d = 0.62) and drug abuse (d = 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control. Conclusion: Brief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: rural; sexual minority; lesbian; gay; bisexual; transgender; evidence-based treatment; empirically supported treatment; Evidence Based Practice; Health Behavior; Intervention; Mental Health; LGBTQ; Discrimination; Distress; Major Depression; Rural Environments; Stigma; Suicidal Ideation; Test Construction; Written Communication; Digital Interventions; Sexual Minority Groups

Associations of discrimination, suicide ideation severity and attempts, and depressive symptoms among sexual and gender minority youth - Wyman Battalen, Adeline; Mereish, Ethan; Putney, Jennifer; Sellers, Christina M.; Gushwa, Melinda; McManama O'Brien, Kimberly H. (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2020)
We examined the unique associations among discrimination, suicidal thoughts, suicide attempts, and depressive symptoms in a sample of sexual and gender minority (SGM) youth as well as interpersonal mediators of these associations. Participants included 94 SGM youth (Mage = 18; SD = 2.88) recruited from SGM-specific drop-in centers. We used mediation analyses to test the mediating effects of perceived burdensomeness and thwarted belongingness on the associations between discrimination and suicidal ideation, suicide attempts, and depressive symptoms, accounting for childhood trauma and sociodemographic variables (age, gender identity, race, and sexual orientation). Within our nonclinical community sample of SGM youth, 49% reported a lifetime suicide attempt, 84% reported current suicide ideation, and 82% reported current depressive symptoms. Experiencing discrimination was associated with greater likelihood of suicide attempts and depressive symptoms, and greater perceived burdensomeness and thwarted belongingness, over and above the effects of childhood trauma and sociodemographic variables. Discrimination was indirectly associated with greater depressive symptoms through perceived burdensomeness and thwarted belongingness, and with greater severity of suicidal ideation through perceived burdensomeness. Findings suggest clinicians should assess for discrimination and include a focus on perceived burdensomeness and thwarted belongingness as targets of intervention for suicide and depression. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; discrimination; minority stress; child maltreatment; sexual and gender minority youth; Major Depression; Sex Discrimination; Suicidal Ideation; Symptoms; Belonging; Attempted Suicide; Child Abuse; Suicide Prevention; Trauma

Clergy attitudes about ways to support the mental health of sexual and gender minorities - Raedel, Daniel B.; Wolff, Joshua R.; Davis, Edward B.; Ji, Peter (Journal of Religion and Health, 2020)
AbstractThis pilot study explored clergy members’ attitudes about ways to support the mental health needs of sexual and gender minorities (SGM; e.g., lesbian, gay, bisexual, and transgender people). Participants (N = 86, 46% female, 26% SGMs) were US clergy members from a variety of religious faiths but mostly were leaders in Christian faith communities in the greater Chicago area. Clergy participants completed quantitative and qualitative items asking what types of resources (e.g., workshops, websites, consultations, or testimonies) and delivery format (online or in-person) they perceived as most helpful in supporting the mental health of SGM members in their faith communities. The results demonstrated that clergy members found all listed resources to be helpful to varying degrees, although suicide and homelessness prevention were prioritized above other resources. Clergy members also prioritized resources related to supporting gender minorities to be more informative, relative to resources for supporting sexual minorities. Finally, clergy member preferred information to be delivered in-person instead of online. The degree of openness to LGBTQ health promotion resources did not vary by clergy religious denomination. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Religion; Community health; Prevention; Transgender; Gay & lesbian; No terms assigned

The mediating role of emotion regulation strategies on psychopathology and suicidal behaviour following negative childhood experiences - McLafferty, M.; Bunting, B. P.; Armour, C.; Lapsley, C.; Ennis, E.; Murray, E.; O'Neill, S. M. (Children and Youth Services Review, 2020)
Background: Childhood adversities and maladaptive parenting practices, such as parental over-control, over-protection or over-indulgence can be significant risk factors for psychopathology and suicidal behaviour. Adaptive emotion regulation strategies can be protective. However, individuals may develop maladaptive emotion regulation strategies as a result of these early life experiences. Objective: This study aims to determine if emotion regulation strategies (reappraisal and suppression) mediate the impact of negative childhood experiences on psychological health, and to identify predictors of such strategies. Participants and setting: The study utilizes data from the Ulster University Student Wellbeing Study, conducted in Northern Ireland (NI) as part of the WHO World Mental Health (WMH) International College Student Initiative (n = 739). The average age of participants was 21 (462 females, 274 males). Method: Mediation analyses examined the role of emotion regulation strategies on psychopathology and suicidality following negative childhood experiences. Results: Mediation analyses revealed that individuals with adaptive emotion regulation strategies were less likely to have psychological problems following negative childhood experiences. The reduced use of suppression was particularly important. However, males and individuals who reported parental over-control were more likely to use suppression. Non-heterosexual students were less likely to use reappraisal which can be adaptive. Conclusions: The study highlights the importance of developing adaptive emotion regulation strategies following negative childhood experiences since such strategies may reduce psychological problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: Emotion regulation; Childhood adversities; Parental over-control; Psychopathology; Suicidal behavior; Emotional Adjustment; Emotional Regulation; Mental Health; Psychopathology; Negative Emotions; Behavior; Child Psychopathology; Cognitive Appraisal; College Students; Emotional Development; Strategies; Suicide

Resilience among trans and gender-diverse adults: The protective role of dispositional hope in the perceived burdensomeness-suicide relationship - Snooks, Matthew Paul; McLaren, Suzanne (Psychology of Sexual Orientation and Gender Diversity, 2020)
Trans and gender-diverse (TGD) adults are at increased risk for suicide. A wealth of evidence supports perceived burdensomeness as an independent key risk factor for suicide. Few studies have investigated dispositional hope or its components (agency and pathways) as a psychological resilience factor within the TGD population. The present study investigated the role of dispositional hope as a moderator in the relationship between perceived burdensomeness and suicidal ideation and behaviors among TGD adults. An international sample of 848 TGD adults aged 18 to 80 years (Mage= 26.27, SD = 7.70), who identified as male (n = 197), female (n = 614), or gender nonbinary (n = 37), completed the online questionnaires. Results demonstrated that dispositional hope, agency, and pathways were significant moderators, strengthening the perceived burdensomeness-suicidal ideation and behaviors relationship. Closer examination of the moderation effects suggests that higher levels of dispositional hope and its components may be protective against suicidal ideation and behaviors among TGD adults experiencing lower, but not higher, levels of perceived burdensomeness. Future research is urgently warranted within this population to help inform specialized interventions that may protect TGD adults who experience higher levels of perceived burdensomeness and are at high risk for suicidal ideation and behaviors. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: trans and gender diverse; perceived burdensomeness; dispositional hope; interpersonal–psychological theory of suicide; Hope; Resilience (Psychological); Suicidal Ideation; Transgender; Gender Nonconforming; At Risk Populations; Protective Factors; Psychological Theories; Suicide

Social correlates of recent suicidal ideation among men who have sex with men in greater tokyo - Hill, Adam O.; Distefano, Anthony; Gilmour, Stuart; Bavinton, Benjamin R.; Hidaka, Yasuharu; Bourne, Adam; Armstrong, Gregory (Sexuality Research & Social Policy: A Journal of the NSRC, 2020)
AbstractIntroductionSuicide is a major public health problem in Japan, where mortality rates are among the highest in the world. Globally, men who have sex with men (MSM) report elevated rates of suicidal ideation and attempts compared to their heterosexual peers. However, there is a paucity of research on suicidal ideation among MSM in Japan, where MSM continue to experience significant stigma and discrimination, and where resources are limited for MSM-specific mental health support.MethodsThis study examined the prevalence and correlates of recent suicidal ideation among MSM in Greater Tokyo. We recruited 1,657 MSM for an anonymous, online, cross-sectional survey posted on social mobile applications popular with MSM in Japan (e.g., Grindr, 9Monsters) from November 2015 through January 2016.ResultsRecent suicidal ideation, measured as suicidal thoughts in the preceding two weeks, was reported by almost one-third (31%) of participants. Participants who reported unemployment or part-time employment (compared to full-time employment) and knowing a heterosexual person who restricted their freedom or excluded them from a group had higher odds of suicidal ideation. Being aged 46 years or older, reporting good health, and having a medium or high level of access to social capital networks with other MSM were associated with reduced odds of suicidal ideation.Conclusions and Policy ImplicationsOur findings indicate that suicide prevention interventions with MSM in Greater Tokyo and similar urban settings in Japan should work to enhance MSM social networks as a protective factor; attend to employment concerns, particularly in younger MSM; and augment current efforts to address stigma and discrimination in the community. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Japan; MSM; Suicide; Social capital; Geo-social networking applications; No terms assigned

Risk and protective factors to lgbtq+ youth suicide: A review of the literature - Gorse, Michael (Child & Adolescent Social Work Journal, 2020)
LGBTQ+ youth experience higher rates of suicidal ideation and behavior than their cisgender, heterosexual peers, and these disparities have created a need for academic exploration of the risk factors and protective factors surrounding LGBTQ+ youth suicide (Taliaferro and Muehlenkamp in Acad Pediatr 17:715–722; Toomey et al. in J Youth Adolesc 48:788–801; Ybarra et al. in: Espelage et al. (eds) Youth suicide and bullying: challenges and strategies for prevention and intervention, Oxford University Press, Oxford, 2014). This paper reviews the research that has been completed on these topics in the last 10 years. A variety of risk factors have contributed to higher rates of suicidal ideation, attempts, and completion: minority stress, interpersonal constructs, race, transgender identity, partner violence, homelessness, school victimization, and a lack of school support (Joiner in Why people die by suicide, Harvard University Press, Cambridge, 2005; Meyer in Psychol Bull 129:674–697; Mustanski and Liu in Arch Sex Behav 42:437–448; Van Orden et al. in Psychol Rev 117:575–600). Furthermore, a range of protective factors have been connected with lower rates of suicidal ideation and behavior: gender and sexuality alliances, LGBTQ+ inclusive curriculum, LGBTQ+ affirming school policies, familial support, peer support, and mental health interventions (Poteat and Rivers in Youth suicide and bullying: challenges and strategies for prevention and intervention, Oxford University Press, Oxford, 2014; Stone et al. in Suicide Life Threat Behav 45:415–430; Whitaker et al. in J Adolesc Health 58:63–68). Areas for future research are recommended, including examining diverse LGBTQ+ subpopulations and developing standard measurements for LGBTQ+ identities. The paper concludes with highlights from the past 10 years of research. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBT; LGBT youth; LGBT suicide; Mental health; Education; Youth suicide; No terms assigned

Association of nondiscrimination policies with mental health among gender minority individuals - McDowell, Alex; Raifman, Julia; Progovac, Ana M.; Rose, Sherri (JAMA Psychiatry, 2020)
Importance: In the past decade, many states have implemented policies prohibiting private health insurers from discriminating based on gender identity. Policies banning discrimination have the potential to improve access to care and health outcomes among gender minority (ie, transgender and gender diverse) populations. Objective: To evaluate whether state-level nondiscrimination policies are associated with suicidality and inpatient mental health hospitalizations among privately insured gender minority individuals. Design, Setting, and Participants: In this cohort study, difference-in-differences analysis comparing changes in mental health outcomes among gender minority enrollees before and after states implemented nondiscrimination policies in 2009-2017 was conducted. A sample of gender minority children and adults was identified using gender minority–related diagnosis codes obtained from private health insurance claims. The present study was conducted from August 1, 2018, to September 1, 2019. Exposure: Living in states that implemented policies banning discrimination based on gender identity in 2013, 2014, 2015, and 2016. Main Outcomes and Measures: The primary outcome was suicidality. The secondary outcome was inpatient mental health hospitalization. Results: The study population included 28 980 unique gender minority enrollees (mean [SD] age, 26.5 [15] years) from 2009 to 2017. Relative to comparison states, suicidality decreased in the first year after policy implementation in the 2014 policy cohort (odds ratio [OR], 0.72; 95%CI, 0.58-0.90; P = .005), the 2015 policy cohort (OR, 0.50; 95%CI, 0.39-0.64; P < .001), and the 2016 policy cohort (OR, 0.61; 95%CI, 0.44-0.85; P = .004). This decrease persisted to the second postimplementation year for the 2014 policy cohort (OR, 0.48; 95%CI, 0.41-0.57; P < .001) but not for the 2015 policy cohort (OR, 0.81; 95%CI, 0.47-1.38; P = .43). The 2013 policy cohort experienced no significant change in suicidality after policy implementation in all 4 postimplementation years (2014: OR, 1.19; 95%CI, 0.85-1.67; P = .31; 2015: OR, 0.94; 95%CI, 0.73-1.20; P = .61; 2016: OR, 0.82; 95%CI, 0.65-1.03; P = .10; and 2017: OR, 1.29; 95%CI, 0.90-1.88; P = .18). Mental health hospitalization rates generally decreased or stayed the same for individuals living in policy states vs the comparison group. Conclusions and Relevance: Implementation of a state-level nondiscrimination policy appears to be associated with decreased or no changes in suicidality among gender minority individuals living in states that implemented these policies from 2013 to 2016. Given high rates of suicidality among gender minority individuals in the US, health insurance nondiscrimination policies may offer a mechanism for reducing barriers to care and mitigating discrimination. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: non-discrimination policies; mental health; gender minority; suicidality; Gender Identity; Mental Health; Policy Making; Discrimination Laws; Sexual Minority Groups; Health Care Policy; Transgender; Suicidality

Did the orlando shooting at pulse nightclub affect sexual minority mental health? Results and challenges using population-based data - Gavulic, Kyle A.; Gonzales, Gilbert (Journal of Gay & Lesbian Mental Health, 2020)
Abstract Purpose of the study Forty-nine people were killed in the Orlando shooting at Pulse nightclub on June 12, 2016. The objective of this study was to examine the association between the Orlando shooting and sexual minority mental health. Materials and methods We used data from the 2013–2018 National Health Interview Survey and a difference-in-differences approach to compare changes in severe psychological distress (SPD) between sexual minorities and their heterosexual peers. Results Compared to heterosexual men, the Orlando shooting was associated with a 25.6 percentage point (p < 0.05) increase in SPD for sexual minority men in June 2016. We did not observe a similar pattern of heightened SPD for sexual minority women following the Orlando shooting. Conclusion This study suggests that the Orlando shooting was detrimental to the mental health of sexual minority men. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Mental health; Orlando; mass shootings; gun violence; No terms assigned

The effect of COVID-19 on hijra (third gender) people in Bangladesh - Sifat, Ridwan Islam (The Lancet Psychiatry, 2020)
In South Asia, the hijra are referred to as a third gender, as a group of transgender women and nonbinary and intersex people who were assigned male at birth. Some estimates suggest that more than 10 000 hijras live in Bangladesh, whereas others indicate there are more than 100 000. However, they are deprived of basic human rights in Bangladesh, such as access to primary health-care services, housing facilities, food, and employment opportunities. Hijras in Bangladesh have been adversely affected by the pandemic, particularly during the national lockdown. Mental health problems, such as anxiety, depressive symptoms, discrimination, suicide, and domestic violence increased during the lockdown around the world, including in Bangladesh. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: COVID-19; transgender; primary health-care services; mental health; Bangladesh; Health Care Services; Mental Health; Primary Health Care; Transgender; Coronavirus

Discrimination and risky sexual behavior, substance use, and suicidality among transgender individuals - Schweizer, Valerie J.; Mowen, Thomas J. (Deviant Behavior, 2020)
ABSTRACT Transgender identities are becoming increasingly common in the United States, and existing research provides ample evidence that risky sexual behaviors, substance use, and suicidality are prevalent experiences among transgender persons. Yet, prior research provides little insight into understanding the specific mechanisms that may promote deviant outcomes among transgender persons. Drawing from an aspect of general strain theory, the goal of this study is to examine the extent to which transwomen and transmen vary in risky sexual behaviors, substance use, and suicidality, and to explore the degree to which discrimination – as a source of strain – plays a role within this process. An analysis of data from transgender individuals from the Virginia Transgender Health Initiative Study (THIS) demonstrates that transwomen and transmen significantly diverge in self-reported risky sexual behaviors, substance use, and suicidality. Greater discrimination based on transgender identity relates to significantly increased odds of suicidality and elevated levels of substance use, but does not relate to risky sexual behavior. Overall, effects of discrimination on each outcome are similar for both transwomen and transmen. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

An investigation of the LGBTQ + youth suicide disparity using national violent death reporting system narrative data - Ream, Geoffrey L. (Journal of Adolescent Health, 2020)
Purpose: This study explored law enforcement and medical examiner reports about adolescent and young adult deaths by suicide for novel and understudied risk factors and described variability by sexual orientation and gender identity in those risk factors' prevalence. It also sought to explain why the suicide disparity between lesbian, gay, bisexual, transgender, queer/questioning, and other sexual/gender minority (LGBTQ+) youth and non-LGBTQ+ youth is wider in adolescence than in young adulthood. Methods: This study involved coding of law enforcement and medical examiner reports from the National Violent Death Reporting System (NVDRS) for all 394 LGBTQ+ youth who died by suicide in NVDRS participating states between 2013 (the year that NVDRS began coding for sexual orientation and transgender status) and 2016 (the latest year of NVDRS available), along with 394 non-LGBTQ+ cases matched with them on dimensions of sex, urbanicity, race, and military service. Results: Fifty-nine percent of 12- to 17-year-old LGBTQ+'s cases mentioned an LGBTQ+-specific contributing circumstance, whereas only 30% of 18- to 29-year-old LGBTQ+'s cases mentioned an LGBTQ+-specific contributing circumstance. However, there were 3.6 times as many cases of LGBTQ+ 18- to 29-year-olds as there were of LGBTQ+ 12- to 17-year-olds. Cases of gay males, bisexual males, and bisexual females were particularly likely to include family/peer rejection and bullying as contributing circumstances, while lesbians' cases more often mentioned romantic breakups. Conclusions: The LGBTQ+/non-LGBTQ+ suicide disparity may be greater for adolescents because LGBTQ+-specific contributing circumstances are more prevalent among adolescents. Prevention efforts should be tailored to clients' age and specific LGBTQ+ subgroup. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBTQ+; Suicide; NVDRS; Adolescent; Young adult; Death and Dying; Suicide; Violence; Adolescent Characteristics; LGBTQ; Risk Factors

Maternal support is protective against suicidal ideation among a diverse cohort of young transgender women - Jin, Harry; Restar, Arjee; Goedel, William C.; Ogunbajo, Adedotun; Biello, Katie; Operario, Don; Kuhns, Lisa; Reisner, Sari L.; Garofalo, Robert; Mimiaga, Matthew J. (LGBT Health, 2020)
Purpose: We assessed if young transgender women (YTW) with parents who are supportive of their transgender identity had lower odds of having suicidal ideation compared with YTW with unsupportive parents. Methods: This study analyzed baseline findings from a diverse sample of 297 sexually active, YTW 16–29 years of age who were enrolled in Project LifeSkills, a randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. Bivariate and multivariable logistic regression were used to assess if parental support was associated with a decreased odds of suicidal ideation. Results: Nearly one-fifth (18.9%) of YTW reported suicidal ideation at baseline. In our adjusted multivariable model, YTW with supportive mothers had 0.37 (95% confidence interval = 0.15–0.90) times the odds of having suicidal ideation compared with YTW with unsupportive mothers. Conclusion: This study found that the odds of suicidal ideation were lower among YTW who had mothers who were supportive of their transgender identity. Our results suggest that parent-focused interventions to improve the relationships between YTW and their parents may lower the odds of YTW having suicidal ideation. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Keywords: young transgender women; parental support; suicidal ideation; mental health; Mental Health; Mothers; Parental Investment; Suicidal Ideation; Transgender; Intervention; Parent Child Relations; Parents

Suicidal ideation in gender and sexual minority students in the largest brazilian university - Ramírez, Erika Gisseth Leon; Delgado, Yuly Katherine; Volpato, Rosa Jacinto; de Claudio, João Carlos M.; Pinho, Paula Hayashi; de Vargas, Divane (Archives of Psychiatric Nursing, 2020)
OBJECTIVE: Identifying the presence of suicidal ideation and associated factors among university students from a public university in Brazil. METHODS: A cross-sectional study was performed with 72 university students between 18 and 29 years old. Were used a sociodemographic data questionnaire and the Beck's Suicidal Ideation Scale. RESULTS: The suicidal ideation was significantly in the participants, as well as the association of gender, gender identity, sexual orientation and housing with it. CONCLUSIONS: The suicidal ideation in this population is important, and there is a need to explore the factors related, such as gender, sexual orientation, gender identity and housing. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicidal ideation; LGBT; Sex and gender minorities; University students; No terms assigned

Gender and sexual orientation bullying victimization are associated with gun carrying among adolescent boys - Ganson, Kyle T.; Nagata, Jason M. (Child & Adolescent Social Work Journal, 2020)
AbstractGun carrying and bullying victimization are associated among adolescent boys, however the type of the bullying remains relatively unknown. This study aimed to identify whether experiencing bullying victimization based on gender and sexual orientation is associated with carrying a gun to school among adolescent boys. A cross-sectional analysis among a representative sample of high school boys (n = 3672) from the 2015 Maine Integrated Youth Health Survey was conducted. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using logistic regression analyses while controlling for grade level, race/ethnicity, sexual orientation, suicidal ideation, alcohol and marijuana use, and gun access. Among the sample, 3.3% reported carrying a gun to school at least one time in the previous 12-months, 9.5% reported experiencing gender-based bullying victimization, and 7% reported experiencing sexual orientation-based bullying victimization. Regression analyses indicated that adolescent boys who experienced gender-based bullying victimization (OR 3.40, 95% CI 1.64, 5.62, p < .001) or sexual orientation-based bullying victimization (OR 3.57, 95% CI 1.91, 6.67, p < .001) had greater odds of reporting they carried a gun to school while controlling for grade level, race/ethnicity, sexual orientation, suicidal ideation, alcohol and marijuana use, and gun access. These results expand upon previous gun carrying and bullying research by identifying the specific type of the bullying experienced and have important implications for social workers and school personnel. Importantly, these results emphasize the need to address two of the Grand Challenges for Social Work: building healthy relationships to end violence and ensuring the healthy development for all youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Adolescent boys; Gun carrying; High school; Bullying; Sexual orientation; Gender norms; No terms assigned

Reducing internalized transnegativity: Randomized controlled trial of an online intervention - Israel, Tania; Matsuno, Em; Choi, Andrew Young; Goodman, Joshua A.; Lin, Yen-Jui; Kary, Krishna G.; Merrill, Caitlin R. S. (Psychology of Sexual Orientation and Gender Diversity, 2020)
Given the degree of hostility toward transgender people and the pervasiveness of societal messages regarding gender roles, transgender people may internalize negative attitudes and beliefs about being transgender in the form of internalized transnegativity (IT). IT has been shown to contribute to negative behavioral health outcomes including suicide among transgender people (Breslow et al., 2015; Staples, Neilson, Bryan, & George, 2018). In this study, we developed an online intervention designed to reduce IT among transgender people and evaluated its efficacy using a randomized controlled trial. The IT intervention consisted of 4 modules aimed at (a) combatting stereotypes, (b) identifying and rejecting negative messages, (c) reinforcing the rejection of negative messages, and (d) enhancing identity affirmation. We analyzed data from 639 participants recruited with Amazon Mechanical Turk (Mturk) and randomly assigned to the intervention (n = 294) or a control (n = 345) addressing stress management. We measured IT using 2 subscales from the Transgender Identity Survey (TIS; Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, 2013): shame and pride. At posttest, those who received the IT intervention reported significantly lower levels of shame and higher levels of pride when compared to control. The intervention conferred small to medium effects for reducing shame (d = .43) and increasing pride (d = .43). As IT represents a transdiagnostic risk factor for many behavioral health problems among transgender people, our brief online intervention offers a highly promising and accessible means of addressing public health issues in this population. Future research directions include dismantling studies and enhancing generalizability to transgender subpopulations. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: nonbinary; transgender; internalized transnegativity; minority stress; online intervention; Internalization; Intervention; Online Therapy; Transgender; Gender Identity; Hostility; Sex Role Attitudes; LGBTQ; Minority Stress

Allowing for nondisclosure in high suicide risk groups - Podlogar, Matthew C.; Joiner, Thomas E. (Assessment, 2020)
Inaccurate disclosure of information is a significant limitation when relying on self-report for suicide risk screening. However, allowing for an explicit nondisclosure response option in screening items (e.g., 'prefer not to disclose') may ultimately improve follow-up assessment validity. This study investigated explicit nondisclosure in suicide risk screening among military service members and veterans (n = 135), men older than 50 years, (n = 187), and LGBTQ (lesbian, gay, bisexual, transgender, or queer) young adults (n = 140); all higher risk and lower help-seeking populations. Results indicated that allowing for explicit nondisclosure minimally affected screening sensitivity and specificity. However, its selection was prevalent among higher risk participants, and was associated with experience of past unhelpful reactions and 'avoidance of stigmatized consequences.' Allowing for nondisclosure creates potential psychometric and classification advantages, and may be a safe and effective way to encourage discussion of barriers, build trust, maximize patient autonomy, and ultimately facilitate accurate risk disclosure to improve assessment validity. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: selective disclosure; risk assessment; help seeking; BSS; mixed methods; Help Seeking Behavior; Self-Report; Suicidal Ideation; Risk Assessment; Military Personnel; Military Veterans; Screening Tests; Self-Disclosure; Suicide; LGBTQ

Suicidal ideation and behavior among sexual minority and heterosexual youth: 1995–2017 - Liu, Richard T.; Walsh, Rachel F. L.; Sheehan, Ana E.; Cheek, Shayna M.; Carter, Sarina M. (Pediatrics, 2020)
Objectives: In this study, we determined trends in prevalence of suicidal thoughts and behaviors among lesbian, gay, bisexual, and heterosexual youth from 1995 to 2017 using population-based surveillance data. Methods: Data were drawn from the Massachusetts Youth Risk Behavior Survey from 1995 to 2017 (unweighted N = 41 636). The annual percent change (APC) in prevalence of suicidal ideation, plans, and attempts was stratified by sexual orientation as indexed by sexual identity and sexual behavior. Results: Among sexual minority youth, prevalence rates declined over the entire study period for suicidal ideation (APCsexual identity = −1.25; APCsexual behavior = −1.83), plans (APCsexual identity = −1.88; APCsexual behavior = −1.95), and attempts (APCsexual identity = −2.64; APCsexual behavior = −2.47). Among heterosexual youth, prevalence rates declined from 1995 to 2007 for suicidal ideation (APCsexual identity = −6.67; APCsexual behavior = −6.77) and plans (APCsexual identity = −5.73; APCsexual behavior = −6.25). These declines in ideation and plans were steeper than those for sexual minority youth. Prevalence of suicide attempts declined across the entire study period among heterosexual youth (APCsexual identity = −3.66; APCsexual behavior = −4.01). Prevalence of all 3 outcomes remained markedly high among sexual minority youth across the 23-year study period. Conclusions: Although suicidal thoughts and behavior have generally declined among sexual minority and heterosexual youth, disparities in these outcomes persist, and their prevalence among sexual minority youth has remained consistently elevated. Prioritized screening for risk for suicidal thoughts and behaviors in this vulnerable population is imperative to reduce disparities and prevalence of these outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicidal ideation; suicidal behavior; sexual minorities; heterosexuality; risk factors; Sexual Orientation; Suicidal Ideation; Trends; Suicidality; Sexual Minority Groups; Gender Identity; Heterosexuality; Homosexuality; Risk Factors; Risk Taking

Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the united states and canada: Detection of a second peak in middle adulthood - Salway, Travis; Gesink, Dionne; Ferlatte, Olivier; Rich, Ashleigh J.; Rhodes, Anne E.; Brennan, David J.; Gilbert, Mark (Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 2020)
AbstractPurposeSexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985–2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities.MethodsAge- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders.ResultsWe identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18–20 years of age for both genders) and one peak nearing mid-life (30–35 years of age for men; 35–40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity.ConclusionIn the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual minorities; Age-period-cohort models; Suicide; Social epidemiology; No terms assigned

Sexual orientation and mental health over the life course in a birth cohort - Spittlehouse, J. K.; Boden, J. M.; Horwood, L. J. (Psychological Medicine, 2020)
Background: Sexual minority individuals consistently report higher rates of mental disorder than heterosexuals. However, much of the research has methodological limitations related to the classification of sexuality, the use of cross-sectional data and problematic sampling procedures such as using convenience samples. Methods: We used longitudinal data from a birth cohort enrolled in the Christchurch Health and Development Study (n = 1040). Latent class analysis was used to classify participants sexuality based on self-report data of sexual behaviour, attraction, identity and fantasy, gathered over five assessments between the ages of 18 and 35 years. Mental health and substance use outcome data were gathered at four assessments between the ages of 21 and 35 years. Potential covariate variables were collected during childhood. Results: The latent class analysis identified four groups interpreted as: ‘heterosexual’ 82%, ‘mostly heterosexual’ 12.6%, ‘bisexual’ 3.5% and ‘gay/lesbian’ 1.9%. In the sexual minority groups, women outnumbered men by at least 2:1. Pooled rates for mental health disorders of depression, anxiety disorders, suicidal ideation, cannabis abuse and total disorders, after adjustment for childhood covariate variables, were significantly higher in the sexual minority groups (p < 0.01). The strength of association between sexuality group and mental health outcomes did not differ according to sex. Fluidity in sexuality reports appeared unrelated to risk of mental health outcomes. Conclusions: Over the life course, membership of a sexual minority group is clearly associated with mental health problems of depression, anxiety and suicidal ideation regardless of the age when same-sex attraction, behaviour, identity or fantasy is expressed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Birth cohort; sexual minorities; sexual orientation; mental health disorders; substance use disorders; social factors; family; childhood; fluidity; Mental Disorders; Sexual Orientation; Substance Use Disorder; Sexual Minority Groups; Early Experience; Family; Psychosocial Factors

Mental health among sexual and gender minority adolescents: Examining interactions with race and ethnicity - Fox, Kathryn R.; Choukas-Bradley, Sophia; Salk, Rachel H.; Marshal, Michael P.; Thoma, Brian C. (Journal of Consulting and Clinical Psychology, 2020)
Objective: Sexual and gender minority (SGM) adolescents report elevated risk for psychopathology. Identifying as a racial/ethnic minority and sexual minority (SM) or gender minority (GM) may lead to greater stress/discrimination and psychopathology. We examined nonsuicidal self-injury, suicide ideation, and suicide attempts (i.e., self-injurious thoughts and behaviors [SITBs]) and depressive symptoms across intersections of sexual orientation, gender, and race/ethnicity. Method: Study participants consisted of a large (n = 2,948; 59% GM) sample of adolescents aged 14–18 who were recruited online to complete a cross-sectional survey. SGM status, race/ethnicity, and their interactions were used to predict depressive symptoms and SITBs. Associations among race/ethnicity and GM-specific psychosocial factors were assessed. Results: SM (B = 3.75) and GM (B = 8.81) participants reported higher depressive symptoms and SITB histories (odds ratios [ORs] from 1.92 to 2.43 and 2.87 to 5.44, respectively). Asian participants were less likely to report nonsuicidal self-injury (OR = 0.45), and Latinx participants were more likely to report suicide attempts (OR = 1.50). Although omnibus tests of interactions were largely insignificant, exploratory analyses revealed fewer depressive symptoms (B = −8.40) and SITBs (ORs from −0.95 to −2.05) among Black SM participants and, at times, Black GM participants. This protective effect may relate to lower self-reported expectations of rejection due to gender. Conclusions: GM participants reported the highest risk for depressive symptoms and SITBs. Contrary to hypotheses, multiple minority identification was not associated with greater psychopathology. Future research, assessing specific sexual and gender identities across diverse samples, is needed to highlight how race affects psychopathology risk across these identities. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: adolescence; sexual minority; gender minority; nonsuicidal self-injury; suicidal self-injury; Adolescent Psychopathology; At Risk Populations; Minority Groups; Self-Injurious Behavior; Sexual Orientation; Attempted Suicide; Ethnic Identity; Major Depression; Suicidal Ideation; Symptoms; Test Construction; Sexual Minority Groups

Internalized homophobia, depressive symptoms, and suicidal ideation among lesbian, gay, and bisexual adults in South Korea: An age-stratified analysis - Lee, Hyemin; Operario, Don; Yi, Horim; Choo, Sungsub; Kim, Seung-Sup (LGBT Health, 2019)
Purpose: Little research on internalized homophobia (IHP) and mental health among lesbian, gay, and bisexual (LGB) individuals has been done in South Korea, a context in which LGB populations widely experience societal stigma. This study examined the association between IHP and depressive symptoms and suicidal ideation among Korean LGB adults and investigated whether the association differed by participants' age. Methods: Cross-sectional data from the 'Rainbow Connection Project I—Korean Lesbian, Gay, & Bisexual Adults' Health Study' were used for this study (N = 2178). Descriptive analyses were conducted to explore the distribution of IHP, depressive symptoms, and suicidal ideation across all covariates. Multivariate analyses were also used to investigate the overall and age-stratified associations between IHP and depressive symptoms and suicidal ideation. Results: The prevalence of high IHP was greater among older LGB adults, whereas the prevalence of depressive symptoms and suicidal ideation was higher among younger LGB adults. LGB individuals with high IHP levels had significantly greater risk of depressive symptoms than those with low IHP levels. In the age-stratified analyses, the associations between IHP and depressive symptoms were statistically significant only among older LGB adults with high IHP levels. Regarding suicidal ideation, the overall association was statistically significant in the full sample, but not in the age-stratified analyses. Conclusion: These findings suggest that mental health interventions are needed for LGB adults who have high IHP levels, especially among older generations. Furthermore, greater efforts are needed to enact protective legislation for sexual minority individuals in South Korea. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: depressive symptoms; internalized homophobia; LGB; sexual minority; South Korea; suicidal ideation; Adult; Age Factors; Aged; Cross-Sectional Studies; Depression; Female; Homophobia; Humans; Male; Mental Health; Middle Aged; Republic of Korea; Risk Factors; Sexual and Gender Minorities; Social Stigma; Socioeconomic Factors; Suicidal Ideation; Young Adult; Bisexuality; Internalization; Lesbianism; Male Homosexuality; Suicidal Ideation; Aging; Foreign Language Translation; Homosexuality (Attitudes Toward); Major Depression; Mental Health; Symptoms; Test Construction

Acceptance towards lgb persons is an independent protective factor against suicide on a country level - Stuke, Heiner; Heinz, Andreas; Bermpohl, Felix (Sexuality Research & Social Policy: A Journal of the NSRC, 2020)
AbstractBackgroundSexual minorities such as lesbian, gay, and bisexual (LGB) people have an increased risk for suicide, whose reasons are not sufficiently understood. We aimed to test if differences in LGB acceptance explain variations in general suicide rates on a country level.MethodsWe used linear regression models to explain the variation in age-standardized suicide rates in 34 OECD countries based on LGB acceptance, which was recently assessed in large international surveys polling the general population about their attitude towards homosexuality. We included economic and sociological variables, which have been shown to be related to suicide rates in previous work, as covariates. We then used backward elimination, leave-one-out cross-validation, and the Bayesian information criterion to identify best-fitting models (i.e., to select relevant predictors).ResultsAll employed model selection methods favored a 4-predictor model, where higher LGB acceptance, fertility rate, religiosity, and unemployment rate were significantly related to lower suicide rates. Suicide rates were well explained by this sparse model (R2 adjusted = 0.442). In the full model with all predictors, as well as in the selected four-predictor model, higher LGB acceptance was significantly related to lower suicide rates.ConclusionsOur findings suggest that low LGB acceptance, as measured by international surveys, might be a risk factor for suicide. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicide; Homosexuality; Discrimination; Public mental health; Prevention; No terms assigned

A critical review of current evidence on multiple types of discrimination and mental health - Vargas, Sylvanna M.; Huey, Stanley J. Jr.; Miranda, Jeanne (American Journal of Orthopsychiatry, 2020)
Little is known about people who experience multiple types of discrimination (e.g., racism and heterosexism). While some work suggests that multiply discriminated groups are at higher risk for poor mental health, other studies propose that they may develop resilience against additional kinds of discrimination. We conducted a review of published studies on the relationship between multiple types of discrimination and mental health to critically examine evidence in support of broad risk and resilience models. Using PRISMA guidelines, we identified 40 studies that met our inclusion criteria. Typically, studies examined either whether experiencing multiple discrimination was related to poorer mental health, or whether one kind of discrimination was more predictive of poor mental health. Studies generally showed support for the risk model, with multiple forms of discrimination associated with higher risk for depression symptoms. Furthermore, both racism and heterosexism uniquely predicted symptoms of depression, although initial evidence suggested that only heterosexism predicted suicidality among lesbian, gay, bisexual, transgender, and queer (LGBTQ) racial/ethnic minorities. Findings on multiple discrimination and other mental health problems (e.g., anxiety, posttraumatic stress disorder [PTSD], distress, and substance use) were mixed. The current evidence suggests that multiply discriminated groups exhibit higher risk for some mental health problems, particularly depression symptoms. However, methodological problems abound in this literature (e.g., correspondence between study sample and types of discrimination assessed), which limits our ability to draw clear conclusions about multiple discrimination. We propose that to further our understanding of how multiple kinds of discrimination may affect mental health, studies must remedy these and other issues. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: depression; intersectionality; multiple discrimination; perceived discrimination; multiple marginalization; Discrimination; Homosexuality (Attitudes Toward); Major Depression; Mental Health; Risk Factors; At Risk Populations; Models; Racism; Resilience (Psychological); Marginalization; Suicidality

An affirmative mindfulness approach for lesbian, gay, bisexual, transgender, and queer youth mental health - Iacono, Gio (Clinical Social Work Journal, 2019)
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth (ages 14–18), commonly referred as sexual and gender minority youth (SGMY) in the literature, experience elevated mental health risks and vulnerabilities (Almeida et al., J Youth Adolesc 38(7):1001–1014, 2009), including: depression (Martin-Storey and Crosnoe, J Adolesc 35(4):1001–1011, 2012; King et al., BMC Psychiatry 8:70, 2008), substance misuse (Mustanski et al., Am J Public Health 104(2):287–294, 2014), and increased suicidality (Marshal et al., J Adolesc Health 49:115–123, 2011; Marshal et al., J Youth Adolesc 42(8):1243–1256, 2013). Furthermore, there is a notable gap in the study of empirically supported mental health interventions for SGMY (Craig and Austin, Children Youth Serv Rev 64:136–144, 2016). This conceptual paper will explore the feasibility of mindfulness-based interventions as a mental health approach for SGMY. In light of the promising research evidence for mindfulness-based interventions (Tan, Clin Child Psychol Psychiatry 21(2):193–207, 2016), this paper proposes the use of mindfulness to help address mental health vulnerabilities experienced by SGMY. A brief review of the mindfulness-based intervention literature for youth will be provided. Finally, utilizing minority stress theory (Meyer, in Minority stress and mental health in gay men, Columbia University Press, New York, NY, 2003) and an affirmative-based practice conceptualization, adapting mindfulness-based interventions to address mental health issues among SGMY will be explored. Drawing on the author’s clinical and community based experience working with SGMY, this paper will build a case for the systematic investigation of culturally-appropriate affirmative mindfulness-based interventions for SGMY. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Mindfulness; LGBTQ youth; Clinical interventions; Affirmative practice; Clinical social worK; Mental health; Bisexuality; Lesbianism; Mental Health; Mindfulness-Based Interventions; LGBTQ; Homosexuality; Transgender; Mind Body Therapy

Suicidality, self-harm, and their correlates among transgender and cisgender people living in aotearoa/new zealand or australia - Treharne, Gareth J.; Riggs, Damien W.; Ellis, Sonja J.; Flett, Jayde A. M.; Bartholomaeus, Clare (International Journal of Transgender Health, 2020)
Abstract Background Transgender people experience high rates of suicidality and self-harm. Past research has established a range of correlates of suicidality/self-harm among transgender people but little is known about whether these correlates are similar for transgender and cisgender people. Aims The aim of this study was to test whether a range of potential demographic and psychosocial correlates of suicidality/self-harm hold for both transgender and cisgender people living in Aotearoa/New Zealand and Australia. Methods An online survey was completed by 700 adults living in Aotearoa/New Zealand (n = 328) or Australia (n = 372). Targeted advertising was used to recruit transgender respondents (n = 392) and cisgender respondents (n = 308). Participants completed questions about demographics, discrimination (the Everyday Discrimination Scale), distress (the Kessler-10 scale), social support (the Multi-Dimensional Scale of Perceived Social Support), resilience (the Brief Resilience Scale), suicidality (the Suicidal Ideation Attributes Scale and other questions about ideation/attempts), and self-harm (the Deliberate Self-Harm Inventory). Results Lifetime suicidal ideation, lifetime suicide attempts, and lifetime self-harm were more common among transgender participants. Discrimination was associated with lifetime suicide attempts and lifetime self-harm, particularly for transgender participants. Distress was consistently associated with recent suicidality and self-harm for transgender participants. Younger cisgender participants were more likely to report lifetime self-harm. Recent suicidal ideation was associated with lower social support among transgender participants but with lower resilience among cisgender participants. Discussion These findings reaffirm and expand on past research on suicidality/self-harm among transgender or cisgender people and demonstrate the relevance of tackling discrimination and distress experienced by transgender people. In addition, the findings highlight the importance of meeting additional social support needs among transgender people to help prevent suicide and self-harm. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Cisgender; discrimination; non-suicidal self-harm; psychological distress; resilience; social support; suicide; transgender; No terms assigned

Gender and sexual identities predicting patterns of co-occurring health risks among sexual minority youth: A latent class analysis approach - Srivastava, Ankur; Davis, Jordan P.; Goldbach, Jeremy T. (Prevention Science, 2020)
AbstractBehavioral health disparities (e.g., substance use, mental health) exist for gender nonconforming (GNC) and sexual minority youth; however, there is limited knowledge on disparities that may be unique among youth who identify as both a sexual and gender minority. This study utilized a diverse sample of GNC and cisgender sexual minority youth seeking crisis services to examine co-occurrence of behavioral health outcomes. Surveys were administered with youth (aged 12–24, N = 592), and latent class analyses were applied. Two latent class regression models were conducted to examine how gender and sexual identity separately (independent effect; Model 1) and configurations of gender and sexual identity (Model 2) predicted class membership. Analyses resulted in a four-class solution: High All (17.6%), High Substance Use and Moderate Mental Health (10.6%), Low All (20.1%), and High Suicide and High Mental Health (51.7%). In our first model, youth who identified as GNC had 2.11 higher odds of being in the High Suicide and High Mental Health class compared to the Low All class; however, sexual identity was not a significant predictor. In the second model, individuals identifying as GNC gay or lesbian or GNC pansexual had 1.95 and 2.57 higher odds, respectively, of being in the High Suicide and High Mental Health class compared to the Low All class. Our study suggests the information on gender and sexual identities together are more helpful in identifying youth at risk for co-occurring negative health outcomes. Implications for prevention approaches are described. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual identity; Gender identity; Co-occurring behavioral health risks; No terms assigned

What's unique about lesbian, gay, bisexual, and transgender (LGBT) youth and young adult suicides? Findings from the National Violent Death Reporting System - Ream, Geoffrey L. (Journal of Adolescent Health, 2019)
Purpose: The purpose of the study was to explore variability in circumstances around suicide deaths among youth and young adults by sexual/gender identity category (gay male, lesbian/gay female, bisexual male, bisexual female, transgender male, transgender female, non–LGBT [lesbian, gay, bisexual, and transgender] male, and non-LGBT female). Methods: Secondary analysis of National Violent Death Reporting System (NVDRS) data for all 12- to 29-year-olds who died by suicide in NVDRS participating states. Coverage begins in 2013, the year that NVDRS began coding for sexual orientation and transgender status, and ends in 2015, the latest year of NVDRS data available. The valid sample was limited to cases in which sexual orientation or transgender status could be determined postmortem, n = 2,209. Results: Almost one quarter (24%) of 12- to 14-year-olds who died by suicide were LGBT, whereas only 8% of 25- to 29-year-olds who died by suicide were LGBT. Most non-LGBT males and bisexual males died by firearm and had intimate partner problems contribute to their deaths. Non-LGBT females and LGBT persons other than bisexual males were generally less likely to use firearms. They were also more likely to have psychiatric diagnoses, prior suicidality, and family problems contributing to their deaths. Rates of many circumstances varied widely among LGBT subgroups. Conclusions: The LGBT versus non-LGBT suicide disparity is greatest at younger ages, and each LGBT subgroup has its own specific risk profile for suicide. Suicide prevention and intervention efforts targeted at LGBT youth may increase their effectiveness by attending to these distinct risk profiles. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: LGBT; Suicide; NVDRS; Adolescent; Young adult; Death and Dying; Sexual Orientation; Suicide; LGBTQ

Using latent profile analysis and related approaches in adolescent health research - Hensel, Devon J. (Journal of Adolescent Health, 2020)
Comments on an article by Z. Giano et al. (see record [rid]2020-32528-001[/rid]). Giano et al. use latent profile analysis (LPA) to examine how risk factors differentially combine to impact suicide risk among lesbian, gay, and bisexual youth. This article joins a fast-growing body of literature using statistical approaches to understand variability in adolescent health experiences. This editorial will focus on providing a brief review of how and when health professions researchers might use LPA or related methods in their own work. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: adolescent health research; suicide risk; lesbian; gay; bisexual youth; Lesbianism; Profiles (Measurement); Risk Factors; Suicide; Adolescent Health; Bisexuality

Suicide risk among gender and sexual minority college students: The roles of victimization, discrimination, connectedness, and identity affirmation - Busby, Danielle R.; Horwitz, Adam G.; Zheng, Kai; Eisenberg, Daniel; Harper, Gary W.; Albucher, Ronald C.; Roberts, Laura Weiss; Coryell, William; Pistorello, Jacqueline; King, Cheryl A. (Journal of Psychiatric Research, 2020)
Background: Little is known about how victimization and discrimination relate to suicide risk among sexual and gender minority (SGM) college students, or what is protective for these students. The current study will: 1.) determine the extent to which interpersonal victimization, discrimination, identity affirmation, and social connectedness are associated with suicide risk characteristics, and if race and/or ethnicity moderates this association; 2.) examine whether identity affirmation and social connectedness are protective against associations between victimization or discrimination and suicide risk characteristics. Method: Participants were 868 students (63.6% female) from four United States universities who completed an online screening survey and met the following study inclusion criteria: self-identification as gender and/or sexual minority, endorsement of at least one suicide risk characteristic and no current use of mental health services. Participants also completed measures that assessed demographics, non-suicidal self-injury (NSSI), victimization, discrimination, connectedness, and LGBTQ identity affirmation. Results: Victimization was positively associated with depression severity, suicidal ideation, alcohol misuse, suicide attempt history, and NSSI. Discrimination was positively associated with depression severity, suicide attempt history, and NSSI. Connectedness was inversely associated with depression severity, suicidal ideation severity, suicide attempt history, and NSSI, and moderated the association between victimization and suicide attempt history. LGBTQ identity affirmation moderated the link between victimization and depression. Conclusions: Results suggest efforts to decrease victimization and discrimination and increase connectedness may decrease depressive morbidity and risks for self-harm among SGM college students. Further, increasing LGBTQ identity affirmation may buffer the impact of victimization on depression. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Sexual minority; Gender minority; College students; Suicide risk; Victimization; Discrimination; Gender Identity; Social Discrimination; Suicide; Victimization; Sexual Minority Groups; College Students; Protective Factors; Risk Factors; Social Interaction; Test Construction

'Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk': Corrigendum - Dunlop, Brendan J.; Hartley, Samantha; Oladokun, Olayinka; Taylor, Peter J. (Journal of Affective Disorders, 2020)
Reports an error in 'Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk' by Brendan J. Dunlop, Samantha Hartley, Olayinka Oladokun and Peter J. Taylor (Journal of Affective Disorders, 2020[Nov][1], Vol 276, 1159-1172). The authors wish to acknowledge an additional affiliated institution for Dr Samantha Hartley: Pennine Care NHS Foundation Trust, Old Street, Ashton-Under-Lyne, Greater Manchester, United Kingdom. (The following abstract of the original article appeared in record [rid]2020-64969-140[/rid]). Background: Bisexual people have been found to be at increased risk of non-suicidal self-injury (NSSI) when compared to heterosexual and gay or lesbian people. The purpose of this review was to update the estimated risk of NSSI for bisexual people and to examine variables that have been associated with NSSI in this population. Methods: The protocol for this paper was pre-registered (CRD42019145299). An electronic search of PsycINFO, CINAHL Plus, PubMed, Ovid Online and Web of Science was undertaken from earliest available date to October 2019. Twenty-four eligible papers were identified. Meta-analyses, including moderator analysis, were conducted to ascertain NSSI risk and a narrative synthesis was undertaken of predictors and correlates. All studies were assessed for risk of bias. Results: Bisexual people had up to six times the odds of engaging in NSSI compared to other sexualities. Mental health variables of anxiety and depression symptoms were found to be most commonly associated with NSSI for this population. The majority of studies had moderate risk of bias. This review demonstrates that bisexual people have an elevated risk of engaging in NSSI. Increased incidence of anxiety and depression and exposure to negative life events may explain this increased risk. Limitations: Studies were found to be consistently cross-sectional in design and limited to western cultures. A limitation of this review was that only English language papers were included. Conclusions: Results are clinically relevant as they suggest early identification and prevention of NSSI can be achieved. Future research should examine bisexual people independently of others. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Bisexual; Bisexuality; Non-suicidal self-injury; NSSI; Self-injury; LGBT; Bisexuality; Self-Injurious Behavior; Sexuality; LGBTQ

Sexual identity–behavior profiles and suicide outcomes among heterosexual, lesbian, and gay sexually active adolescents - Romanelli, Meghan; Xiao, Yunyu; Lindsey, Michael A. (Suicide and Life-Threatening Behavior, 2020)
Objective Adolescents’ sexual behaviors can be incongruent with those assumed to align with their sexual identity. Identity–behavior profiles permit the characterization of youth who might remain undetected using a single‐dimensional assessment of sexual orientation. This study examined suicide risks among four distinct sexual identity–behavior profiles of youth: heterosexual with other‐sex partners only, heterosexual with any same‐sex partners, lesbian or gay (LG) with same‐sex partners only, and LG with any other‐sex partners. Method Data were analyzed from the 2017 National Youth Risk Behavior Survey. Participants’ reported sex, sexual identity, and the sex of their sexual contacts were used to construct the identity–behavior profiles. Multivariate logistic regression was used to examine the relationship between identity–behavior profiles and suicide outcomes. Results Compared to heterosexual respondents with other‐sex partners only, heterosexual respondents with any same‐sex partners and LG respondents with same‐sex partners only had greater odds of having a suicide plan; LG respondents with any other‐sex partners were over seven times more likely to have suicidal thoughts and attempt suicide and 14 times more likely to have a suicide plan. Conclusions Health and mental health providers can expand the identification of youth at risk for suicide by assessing both sexual identity and behavior. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: No terms assigned

Cultural pathways for suicidal ideation and behaviors - Chu, Joyce; Maruyama, Brian; Batchelder, Holly; Goldblum, Peter; Bongar, Bruce; Wickham, Robert E. (Cultural Diversity and Ethnic Minority Psychology, 2020)
Objective: Goals were to empirically examine cultural suicide pathways initially theorized by the cultural theory and model of suicide, by examining relationships between cultural (family conflict, minority stress, cultural suicide sanctions), general distress (depression, hopelessness), and cultural idioms of distress factors as predictors of suicidal ideation and attempts. Method: Path analysis examined a moderated mediation model with a community sample of 1,077 ethnic minority and/or LGBTQ adults (average age of 24.32 (SD = 10.23) ranging from 18 to 88, 299 LGBTQ, 447 Asian American, 196 Latino/a, 60 Black or African American, 8 Hawaiian or Pacific Islander, 6 Arab American, 2 Native American, 187 mixed race). Results: Multiple pathways of statistical significance emerged. First, cultural life events (family conflict and minority stress) showed direct paths to ideation and attempts and indirect paths through general (depression and hopelessness) and cultural idioms of distress to ideation and attempts. The path from minority stress to ideation was entirely explained by general/cultural distress. Second, cultural suicide sanctions moderated the relationship between family conflict and ideation. Third, cultural idioms of distress was an important component of overall distress, alongside depression and hopelessness, predicting attempts and ideation. Conclusions: Findings elucidated pathways involving both general distress and cultural factors, and pathways from cultural life events to suicide constructs independent of mental illness-related factors. Findings question utilizing mental illness as a primary suicide driver, make theoretical contributions in refining the cultural theory and model of suicide, and advance understandings of roles of cultural factors in suicide research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; culture; LGBTQ; ethnic minority; path analysis; Distress; Suicidal Ideation; Suicide; LGBTQ; Minority Stress; Attempted Suicide; Family Conflict; Hopelessness; Ideation; Major Depression; Path Analysis; Sociocultural Factors; Test Construction

Patient-reported satisfaction and quality of life after trans male gender affirming surgery - McNichols, Colton H. L.; O'Brien-Coon, Devin; Fischer, Beverly (International Journal of Transgender Health, 2020)
Background: Trans male gender affirming surgery is becoming more available resulting in an increase in patients undergoing these procedures. There are few reports evaluating the outcomes of these procedures in the transgender population. This study was performed to provide patient-centric insight on self-image and other concerns that arise during surgical transition.Methods: A 22-question survey was sent to 680 trans male patients. The survey was broken down into the following sections: demographics, timing and type of surgical procedures, self-image, sex/dating life, social life, employment, co-existing psychiatric morbidity, and common issues faced during the surgical transition.Results: A total of 246 patients responded (36% response rate). Most patients (54%) waited 1–2 years after starting their transition before having a surgical procedure, and 10% waited longer than 6 years. In regard to self-image, sex/dating life, and social life there was a significant improvement (p < 0.001) after undergoing gender affirming surgery. Patients reported significantly less difficulty with employment after having gender affirming surgery (p < 0.001). If present, the following psychiatric morbidities were self-reported to have a statistically significant improvement after surgery: depression, anxiety, substance abuse, suicidal ideation, panic disorder, social phobia, and obsessive-compulsive disorder (P < 0.003).Conclusion: It is important to provide patients, surgeons, and insurance companies with expected outcomes of gender affirming surgery along with the potential risks and benefits. Post-surgical trans male patients reported a significant improvement in overall quality of life. Initial hesitations to having surgery such as regret and potential complications were found to be non-issues. Additional research should be done to include more patients with phalloplasties, trans females, and nonbinary identifying patients. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; quality of life; satisfaction; surgery outcomes; trans men; transgender; No terms assigned

Role of school health officers in mental health care for secondary school students in can tho city, vietnam - Nguyen, Dat Tan; Wright, E. Pamela; Pham, Tam Thi; Bunders, Joske (School Mental Health: A Multidisciplinary Research and Practice Journal, 2020)
AbstractThe objectives of the study were to explore the experiences of school health officers in identifying and managing mental health problems of secondary school students and to gather recommendations from the school officers for improving the effectiveness of mental health care in secondary schools in Can Tho City, Vietnam. We conducted a qualitative study based on in-depth interviews using a semi-structured guideline with 15 school health officers at 15 secondary schools in Can Tho City, Vietnam. Data were analyzed using content-driven analysis to identify recurring themes. The school health officers reported that stress, depression, suicidal ideation, and sexual orientation issues were the most commonly encountered mental health problems among their students. The officers worked with a limited range of interventions for helping these students, such as giving non-narcotic analgesics or advising students to take a short break at school or to go home. Most of them felt that their training was insufficient to deal with mental health problems in an optimal way. They recommended further training to improve their knowledge and skills in recognizing and managing mental health problems in students. They also considered a university-sponsored mental health website a good source of information on mental health care for students. School health officers reported that they did not feel well equipped to manage mental health problems because of insufficient training, lack confidence, and absence of an appropriate network for advice and referral. Updated policies and programs are needed for initial training and refresher courses, which will strengthen the role of school health officers as first line support for secondary school students with mental health problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Mental health care; Students; School nurse; School health officers; Vietnam; No terms assigned

Behavioral health concerns and eligibility factors among adolescents and young adults seeking gender-affirming masculinizing top surgery - Boskey, Elizabeth R.; Jolly, Divya; Tabaac, Ariella R.; Ganor, Oren (LGBT Health, 2020)
Purpose: We evaluated behavioral health histories and eligibility factors for patients seeking chest reconstruction. Methods: One hundred and fifty-eight consecutive transgender patients were seen for initial masculinizing top surgery consults between May 2017 and July 2019. Chart review was used to assess behavioral health and demographic factors, and eligibility factors related to the World Professional Association for Transgender Health (WPATH) Standards of Care. Univariate and age-adjusted regression models were used to examine the relationship between demographic and behavioral health factors and WPATH criteria. Results: The average age of patients at the time of their first consult was 18 (standard deviation = 3.3, range = 14–33). Eighty-five percent had at least one behavioral health diagnosis; 27% had three or more. Sixty-four percent endorsed a history of self-harm or suicidal ideation, 13% within the last 6 months. Thirty-two percent reported a history of marijuana use and 19% a history of nicotine use. For those prescribed testosterone, additional months on testosterone were significantly associated with male (vs. nonbinary) gender (β = 4.64, 95% confidence interval [CI] 0.37–8.90, p = 0.033), age (β = 0.87, 95% CI 0.41–1.34, p < 0.001), living as one's affirmed gender for over 1 year (β = 6.37, 95% CI 1.37–11.37, p = 0.013), history of marijuana use (β = 4.54, 95% CI 1.10–7.98, p = 0.010), and history of nicotine use (β = 6.23, 95% CI 2.22–10.26, p = 0.003). Conclusion: Patients seeking gender-affirming masculinizing top surgery are behaviorally complex, in ways not necessarily associated with surgical eligibility. Involving a behavioral health provider in perioperative assessment can help identify and address potential risks to recovery and outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: adolescent health; chest reconstruction; interdisciplinary care; top surgery; Health Care Psychology; Masculinity; Surgery; Transgender; Adolescent Health; Testosterone; Thorax

Suicide and the transgender experience: A public health crisis - dickey, lore m.; Budge, Stephanie L. (American Psychologist, 2020)
Given the rise in the visibility of the trans community, increasing attention has been paid to mental health disparities in trans populations. Specifically, research findings conclude that suicide is considered 1 of the major health disparities in trans populations. Across several studies it has been found that 40% or more of trans people have attempted suicide at least once in their lifetime. There are a multitude of reasons why trans people experience suicidal ideation and attempt suicide, with minority stress being theorized as a primary cause. To address minority stress-focused suicide, a psychologically adapted public health model is proposed. This model includes the following steps for preventing suicidal thoughts and behaviors: (a) defining the issue, (b) identifying causes and risk factors, (c) developing and testing psychological interventions, and (d) implementing psychological interventions. Key components discussed include the evidence and practice for supporting trans people through their social and medical transition processes, which have been demonstrated to improve mental and physical health outcomes. The implications of the prevention model indicate that psychologists play a key role in supporting trans people, regardless of the clinical concerns that bring them to therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: transgender; suicide; resilience; public health; risk and protective factors; Protective Factors; Public Health; Resilience (Psychological); Suicide; Transgender; At Risk Populations; Attempted Suicide; Intervention; Risk Factors; Suicidal Ideation; Suicide Prevention; Minority Stress

The roles of gender affirmation and discrimination in the resilience of transgender individuals in the US - Lelutiu-Weinberger, Corina; English, Devin; Sandanapitchai, Priyadharshiny (Behavioral Medicine, 2020)
Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one’s gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: discrimination; gender affirmation; mental health; physical health; behavioral health; outcomes; transgender; United States; Mental Health; Physical Health; Resilience (Psychological); Sex Discrimination; Transgender; Health Care Psychology

Depression and suicide literacy among canadian sexual and gender minorities - Ferlatte, Olivier; Salway, Travis; Oliffe, John L.; Rice, Simon M.; Gilbert, Mark; Young, Ingrid; McDaid, Lisa; Ogrodniczuk, John S.; Knight, Rod (Archives of Suicide Research, 2020)
The purpose of this study was to examine and compare depression and suicide literacy among Canadian sexual and gender minorities (SGM). Online surveys comprised of the 22-item depression literacy scale (D-LIT) and the 12-item literacy of suicide scale (LOSS) were completed by 2,778 individuals identifying as SGM. Relationships between depression and suicide literacy and demographic characteristics were evaluated using multivariable linear regression. Overall, SGM correctly answered 71.3% of the questions from the D-LIT and 76.5% of the LOSS. D-LIT scores were significantly lower among cisgender men and D-LIT and LOSS scores were lower among transgender women when compared to cisgender women. LOSS and D-LIT scores were significantly lower among SGM without a university degree (compared to those with a university degree) and among SGM from ethnic minority groups (compared to White SGM). D-LIT scores, but not LOSS scores, were significantly lower among Indigenous SGM compared to White SGM. The findings provide evidence of differences in suicide and depression literacy between SGM subgroups along multiple social axes. Interventions to increase depression and suicide literacy should be prioritized as part of a mental health promotion strategy for SGM, targeting subgroups with lower literacy levels, including cisgender men, transgender women, Indigenous people, racialized minorities, and those without a university degree. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Depression; gender identity; literacy; sexual and gender minorities; sexual orientation; suicide; No terms assigned

Mental health and challenges of transgender women: A qualitative study in brazil and india - Gomes de Jesus, Jaqueline; Belden, C. Micha; Huynh, Hy V.; Malta, Monica; LeGrand, Sara; Kaza, Venkata Gopala Krishna; Whetten, Kathryn (International Journal of Transgender Health, 2020)
Background: Transgender women from low- and middle-income countries (LMICs) are understudied, their coping strategies and struggles underrecognised.Aims: This study aimed to explore the lived experiences of transgender women from two major cities located in Brazil and India, LMICs with high rates of transphobia and gender-based violence.Methods: We conducted a mixed-methods, exploratory study, including focus group discussions (FGDs) and brief survey interviews with 23 transgender women from Hyderabad, India and 12 transgender women from Rio de Janeiro, Brazil. Herein we present the combined (qualitative and quantitative) results related to discrimination, stigma, violence, and suicidality in transgender women’s lives.Results: Three major themes emerged from FGDs: stigma and discrimination; violence, and suicidality. Lack of education and working opportunities influence high levels of poverty and engagement in survival sex work by transgender women in both cities. Study participants live in large cities with more than 6 million inhabitants, but transgender women reported chronic social isolation. Participants disclosed frequent suicide ideation and suicide attempts. Brief surveys corroborate FGD findings, identifying high prevalence of discrimination, intimate partner violence, suicidality and low social support.Discussion: Multiple layers of stigma, discrimination, violence and social isolation affect transgender women’s quality of life in Hyderabad and Rio de Janeiro. Strategies sensitive to gender and culture should be implemented to tackle entrenched prejudice and social exclusion reported by transgender women. Additional social support strategies, better access to education and employment opportunities are also urgently needed. Improving the availability of evidence-based mental health interventions addressing the high prevalence of suicidality among transgender women from Hyderabad, India and Rio de Janeiro, Brazil should be prioritized. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Brazil; discrimination; India; qualitative study; stigma; transgender women; violence; suicide; mental health; No terms assigned

Sexual orientation and the integrated motivational–volitional model of suicidal behavior: Results from a cross-sectional study of young adults in the united kingdom - Rasmussen, Susan; Cramer, Robert J.; McFadden, Claire; Haile, Caitlin R.; Sime, Victoria L.; Wilsey, Corrine N. (Archives of Suicide Research, 2019)
Sexual orientation minority (i.e., lesbian, gay, bisexual, queer, and other; LGBQ+) persons represent a vulnerable population with respect to suicide-related behavior. An emerging theory of suicide, the Integrated Motivational–Volitional Model of Suicide (IMV), is utilized in the present study to examine sexual orientation, as well as a number of other IMV-defined pre-motivational factors (i.e., demographics, psychological distress and personality), as they impact the IMV motivational factors of defeat, entrapment, and suicidal ideation/intent. The present investigation featured a cross-sectional online survey of young adults (ages 18–34 years; n = 418; 27% identified as LGBTQ+) across the United Kingdom. The key findings included: (1) high rates of 12-month suicidal ideation prevalence (54.5%) and willingness to enact a future suicide attempt (60.8%); (2) bisexual and other (e.g., pansexual)-identifying sexual minority persons reported higher levels of IMV-related outcomes (e.g., internal entrapment, defeat); (3) sexual orientation accounted for significant variance in predicting motivational constructs controlling for a number of other pre-motivational factors; (4) other sexual minority status, compared to heterosexual identity, predic all motivational outcomes, and; (5) extraversion, agreeableness, and emotional stability emerged as pre-motivational protective factors for varying motivational outcomes. Findings are discussed with respect to the suicide and sexual minority theories, as well as tailored suicide prevention efforts and future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: sexual orientation; suicide; defeat; entrapment; personality; No terms assigned

Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000–2017, USA - Durham, Marcus D.; Armon, Carl; Mahnken, Jonathan D.; Novak, Richard M.; Palella, Frank J. Jr.; Tedaldi, Ellen; Buchacz, Kate (Preventive Medicine: An International Journal Devoted to Practice and Theory, 2020)
Background: Suicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement. Methods: Using clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses. Results: Among 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4 years [IQR: 38.7–50.3], median (IQR) CD4+ cell count was 439 cells/mm3 (IQR: 237–686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50 years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36–2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29–2.38), have CD4+ cell count <350 cells/mm3 (aRR 1.32; 95%CI 1.05–1.65), have a viral load ≥50 copies/mL (aRR 1.49; 95%CI 1.12–1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10–1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67–4.52), and drug overdose (aRR 4.09; 95%CI 2.16–7.71). Conclusion: Routine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicidal ideation; HIV-infected patients; risk; outpatients; At Risk Populations; HIV; Outpatients; Suicidal Ideation

Knowledge and confidence of clinicians in irish camhs when working with transgender youth; and the factors clinicians report will assist them in this work - Hodgins, Sinéad; Byrne, Triona; Spies, Marelise; Madigan, Kevin (Irish Journal of Psychological Medicine, 2020)
Objectives:The Health Service Executive (HSE) Quality Improvement Division (2016) report states that young people who identify as transgender are one of the highest risk groups for suicidal ideation, self-harm, and completed suicides and may require significant input in Irish Child and Adolescent Mental Health Services (CAMHS). This research represents the first exploration of CAMHS staff’s capacity within an Irish mental health service to support transgender youth by considering their knowledge about and confidence in working with these youth.Method:A multi-method design was used to evaluate the knowledge and confidence levels of CAMHS clinicians in supporting transgender youth and to identify what factors would enable them to conduct this work. A questionnaire and a survey about supporting transgender youth were distributed to all clinicians in five Irish-based CAMHS services (N = 71), using an online platform. Additionally, semi-structured interviews were conducted with six clinicians. Quantitative, content, and thematic analyses were performed.Results:CAMHS staff reported limited knowledge and experience about supporting transgender youth. Findings indicated that both of these factors undermined their confidence in supporting these youths. Clinicians expressed a need for additional clinical education delivered through expert consultation, presentations, and learning from ‘experts by experience’.Conclusion:CAMHS clinicians need and want further clinical education about supporting transgender youth and their families. Recommendations are made for enhancing the knowledge, confidence, and competence of CAMHS clinicians using methods identified as acceptable by clinicians, in order to best support these youths. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: CAMHS; clinicians; confidence; knowledge; training; transgender youth; No terms assigned

Syndemic behavioral risk and suicidality among bisexual adolescents: A latent class analysis - Choi, Andrew Young; Israel, Tania; Nylund-Gibson, Karen (Journal of Consulting and Clinical Psychology, 2020)
Objective: We explored the internal structure of within-group variation in the syndemic construct among bisexual adolescents, an understudied and highly vulnerable population known to experience health disparities compared with monosexuals (those attracted to a single gender). We sought to identify patterns of co-occurrence among three domains of high priority behavioral risks—sexual risk factors, substance use, and victimization—and their implications for suicidality. Method: We used a national sample of 1,053 ethnically/racially diverse, high school age bisexual adolescents drawn from the 2015 Youth Risk Behavior Surveillance System (YRBSS). We applied latent class analysis (LCA) to 15 indicators measuring the three aforementioned domains and modeled predictors and an outcome of class membership. Results: Within-group variation in the syndemic construct appears categorical, systematic, and comprised of Low Risk (38%), Alcohol Use (20%), Peer-victimization (14%), Sexually Active (11%), Syndemic (11%), and Risk-taking (7%) classes. Classes were well-separated per classification statistics. The proportions of bisexual identification, sex, and race varied significantly across classes. Syndemic and Peer-victimization classes were equivalent and elevated in their suicidality risk, out of all classes. Conclusions: Results revealed multiple and diverging forms of conjoint behavioral risk that conferred differential health implications; illuminated the shape and functional form of the syndemic construct among bisexual adolescents; and illustrated the utility of LCA for classifying typologies of risky and normative health behavior patterns. Psychologists are recommended to carefully consider the comorbidly operant nature of behavioral risks in this population. Future directions include addressing replication, multiple-group invariance, additional auxiliary variables, and alternative mixture techniques. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: bisexual; syndemic; YRBSS; latent class analysis; risk behavior; Bisexuality; Risk Taking; Latent Class Analysis; Suicidality; Adolescent Behavior; Human Sex Differences; Sexual Attraction; Test Construction; Health Disparities

An act of terror and an act of hate: National elite and populace newspaper framing of pulse nightclub shooting - Valcore, Jace L.; Buckler, Kevin (Criminal Justice Studies: A Critical Journal of Crime, Law & Society, 2020)
ABSTRACT The Pulse nightclub mass shooting is a defining event for the LGBTQ and Latinx communities. It signified that much remains to be done to achieve true equality and equitable treatment over and above the symbolic mentions of it in law and public policy. The news media is an important mechanism for communication of meaning following tragic and painful events such as the Pulse shooting. This study examined how the Pulse nightclub shooting that occurred on 12 June 2016, was covered by influential national newspapers in the United States, The New York Times, The Washington Post, and USA Today, to determine how the event was framed, what types of sources were relied upon, and what types of social and legal solutions were emphasized. The unit of analysis was direct and indirect quotes in each news article. Content analysis revealed that the dominant framing of the attack was that of a terrorist act committed by a pathological, ideologically motivated offender. The most common control mechanism discussed were soft measures, particularly gun control. Little attention was given to the victims or the anti-LGBTQ nature of the shooting. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Media and crime; hate crime; terrorism; LGBTQ; No terms assigned

Associations of lesbian, gay, bisexual, transgender, and questioning–inclusive sex education with mental health outcomes and school-based victimization in US high school students - Proulx, Chelsea N.; Coulter, Robert W. S.; Egan, James E.; Matthews, Derrick D.; Mair, Christina (Journal of Adolescent Health, 2019)
Purpose: Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)–inclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth. Methods: Data analysis of representative data from the 2015 Youth Risk Behavior Survey and the 2014 School Health Profiles was conducted using multilevel logistic models testing whether youth in states with higher proportions of schools teaching LGBTQ-inclusive sex education had lower odds of reporting being bullied in school and experiencing adverse mental health outcomes, including depressive symptoms and suicidality. Results: After controlling for covariates, protective effects for all youth were found for suicidal thoughts (adjusted odds ratio [AOR]: .91, 95% confidence interval [CI]: .89–.93) and making a suicide plan (AOR: .79; 95% CI: .77–.80). Lesbian and gay youth had lower odds of experiencing bullying in school as the proportion of schools within a state teaching LGBTQ-inclusive sex education increased (AOR: .83; CI: .71–.97). Bisexual youth had significantly lower odds of reporting depressive symptoms (AOR: .92; 95% CI: .87–.98). Conclusions: Students in states with a greater proportion of LGBTQ-inclusive sex education have lower odds of experiencing school-based victimization and adverse mental health. These findings can be used to guide intervention development at the school and state levels. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Sexual minority youth; Mental health; Bullying; Inclusive sex education; School climate; Homosexuality (Attitudes Toward); School Environment; Sex Education; Victimization; LGBTQ; High School Students; Mental Health; Bullying

Sociodemographic differences in barriers to mental health care among college students at elevated suicide risk - Horwitz, Adam G.; McGuire, Taylor; Busby, Danielle R.; Eisenberg, Daniel; Zheng, Kai; Pistorello, Jacqueline; Albucher, Ronald; Coryell, William; King, Cheryl A. (Journal of Affective Disorders, 2020)
Background: College student mental health (MH) problems and suicide risk have steadily increased over the past decade and a significant number of students with MH problems do not seek treatment. While some barriers to mental health care service utilization (MHSU) have been identified, very little is known regarding how these barriers differ among sociodemographic subgroups of students. Method: Participants were 3,358 college students from four US universities who screened positive for elevated suicide risk (defined as 2 or more of: depression, alcohol misuse, suicidal ideation, suicide attempt) and were not actively receiving MH services. Reported barriers to MHSU were categorized into: Low perceived need, privacy/stigma concerns, questioning helpfulness of treatment, logistics, time constraints, finances, and cultural issues. Results: Adjusted odds ratios indicated that finances were a greater barrier for women, sexual and gender minority students, and Black and Hispanic students. Privacy/stigma concerns were more prominent for men and young undergraduate students. White students and older undergraduate and graduate students were more likely to report a lack of time, and cultural sensitivity issues were significant barriers for sexual and gender minority, and racial/ethnic minority, students. Limitations: Participating sites were not nationally representative. The barriers assessment did not examine the degree to which a specific barrier contributed to lack of MHSU relative to others. Conclusions: In light of the significant variation in barriers based on age, gender identity, race/ethnicity, and sexual orientation, efforts to increase MHSU should be tailored to meet the unique needs of specific sociodemographic student subgroups. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Sociodemographic differences; College students; Service utilization; Barriers to care; Health Care Utilization; Mental Health Services; Risk Factors; Suicide; Treatment Barriers; Attempted Suicide; College Students; Demographic Characteristics; Minority Groups; Test Construction

Trends in suicide death risk in transgender people: Results from the amsterdam cohort of gender dysphoria study (1972–2017) - Wiepjes, C. M.; den Heijer, M.; Bremmer, M. A.; Nota, N. M.; Blok, C. J. M.; Coumou, B. J. G.; Steensma, T. D. (Acta Psychiatrica Scandinavica, 2020)
Objective This study explored the overall suicide death rate, the incidence over time, and the stage in transition where suicide deaths were observed in transgender people. Methods A chart study, including all 8263 referrals to our clinic since 1972. Information on death occurrence, time, and cause of death was obtained from multiple sources. Results Out of 5107 trans women (median age at first visit 28 years, median follow‐up time 10 years) and 3156 trans men (median age at first visit 20 years, median follow‐up time 5 years), 41 trans women and 8 trans men died by suicide. In trans women, suicide deaths decreased over time, while it did not change in trans men. Of all suicide deaths, 14 people were no longer in treatment, 35 were in treatment in the previous two years. The mean number of suicides in the years 2013–2017 was higher in the trans population compared with the Dutch population. Conclusions We observed no increase in suicide death risk over time and even a decrease in suicide death risk in trans women. However, the suicide risk in transgender people is higher than in the general population and seems to occur during every stage of transitioning. It is important to have specific attention for suicide risk in the counseling of this population and in providing suicide prevention programs. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: gender dysphoria; transgender; suicide; No terms assigned

Queering gendered disabilities - Jones, Cara E. (Journal of Lesbian Studies, 2020)
This project defines gendered disabilities broadly, including chronic illnesses that involve the uterus, ovaries, and other body parts traditionally classified as 'female.' I interrogate the usage of language such as women’s health and gynecological using endometriosis, a common chronic illness that can cause severe pain, fatigue, system-wide effects, and infertility. It affects at least ten percent of cisgender women as well as unmeasured numbers of cisgender men and transgender and gender nonconforming people, occurring more commonly than migraines or Crohn’s disease. Endometriosis symptoms are often debilitating and can lead to un-/under-employment, reduced quality of life, and even suicide. Once nearly invisible, endometriosis has enjoyed recent public discussion, as major news outlets have reported the individual and social costs of endometriosis, and public figures have spoken out about their experiences. However, increased public spotlight has led to the proliferation of a narrative that endo is primarily a reproductive disease, a myth begun in medical literature nearly a century ago, which overlooks significant medical evidence and drives interventions that have high rates of failure and often cause further impairment. This paper examines locations where queerness meets gendered ableism, arguing that imagining endo as a gendered disability would be a first step toward decoupling compulsory heterosexuality from compulsory able-bodiedness. I also articulate gender-neutral ways to discuss endo and recommendations for more inclusive and accurate language and practices. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Women’s health; gynecology; disability; queer; crip; endometriosis; No terms assigned

Gender-affirmation surgery conclusion lacks evidence - Van Mol, Andre; Laidlaw, Michael K.; Grossman, Miriam; McHugh, Paul R. (The American Journal of Psychiatry, 2020)
Comments on an article by Richard Bränström and John E. Pachankis (see record [rid]2020-61360-008[/rid]). This study covered outcomes only for calendar year 2015 for all individuals living in Sweden on December 31, 2014. Measured outcomes were limited to 'mood and anxiety disorder health care visits, antidepressant and anxiolytic prescriptions, and hospitalization after a suicide attempt.' This selection excludes completed suicides, suicide attempts without subsequent hospitalization, health care visits and hospitalizations for other medical or psychological issues still related to gender-affirming surgeries, individuals refusing treatment, and individuals choosing self-medication with alcohol or illicit substances. The lack of control subjects, the limited 1-year time frame, and the avoidance of examining completed suicides and psychiatric hospitalizations are substantial study shortfalls. The study supports only weak conclusions about psychiatric medication usage and nothing decisive about suicidality. In overlooking so much available data, this study lacks the evidence to support its progender-affirmation surgery conclusion. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; treatment utilization; transgender; gender-affirming surgeries; mood disorder; anxiety disorder; antidepressant; anxiolytic prescriptions; gender incongruence; Antidepressant Drugs; Health Care Utilization; Mental Health; Prescription Drugs; Transgender; Diagnosis; Hormones; Surgery; Treatment

Associations between negative life experiences and the mental health of trans and gender diverse young people in Australia: Findings from Trans Pathways - Strauss, Penelope; Cook, Angus; Winter, Sam; Watson, Vanessa; Toussaint, Dani Wright; Lin, Ashleigh (Psychological Medicine, 2020)
Background: Trans and gender diverse (TGD) young people worldwide experience high rates of poor mental health; however, these rates were unknown in Australia. In addition, how negative life events affect the mental health of TGD young people has been largely unexplored. Methods: This paper reports on novel mental health findings of Trans Pathways, the largest study ever conducted in Australia with trans (transgender) and gender diverse young people (N = 859; aged 14–25 years). The study was an anonymous online cross-sectional survey undertaken in 2016. Logistic and linear regression models were used to test associations between mental health outcomes and negative life experiences. Results: TGD young people in Australia experience high levels of mental distress, including self-harming (79.7%), suicidal thoughts (82.4%), and attempting suicide (48.1%). Three in four participants had been diagnosed with depression and/or anxiety (74.6% and 72.2%, respectively). Many TGD young people had been exposed to negative experiences such as peer rejection (89.0%), precarious accommodation (22.0%), bullying (74.0%), and discrimination (68.9%). Most poor mental health outcomes were associated with negative experiences. The strongest associations were found for precarious accommodation and issues within educational settings. For example, participants with a prior suicide attempt were almost six times more likely to have experienced issues with accommodation, including homelessness. Conclusions: The current results highlight the urgent need for better mental health care and provide insight into areas for targeted mental health interventions. These findings are pertinent for clinicians working with trans young people and wider society. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gender diversity; mental health; suicide; transgender; trans & gender diverse young people; Life Experiences; Mental Health; Transgender; Gender Nonconforming; Attempted Suicide; Suicidal Ideation; Negative Emotions

Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers - van der Miesen, Anna I. R.; Steensma, Thomas D.; de Vries, Annelou L. C.; Bos, Henny; Popma, Arne (Journal of Adolescent Health, 2020)
Purpose: Transgender adolescents are at risk for internalizing and externalizing problems, along with high suicidality rates, and poor peer relations. The present study compared transgender adolescents before and after gender-affirmative care with a sample of nonclinical age-equivalent cisgender adolescents from the general population on psychological well-being and aimed to investigate the possible effect of transgender care involving puberty suppression. Methods: In this cross-sectional study, emotional and behavioral problems were assessed by the Youth Self-Report in a sample of 272 adolescents referred to a specialized gender identity clinic who did not yet receive any affirmative medical treatment and compared with 178 transgender adolescents receiving affirmative care consisting of puberty suppression and compared with 651 Dutch high school cisgender adolescents from the general population. Results: Before medical treatment, clinic-referred adolescents showed more internalizing problems and reported increased self-harm/suicidality and poorer peer relations compared with their age-equivalent peers. Transgender adolescents receiving puberty suppression had fewer emotional and behavioral problems than the group that had just been referred to transgender care and had similar or fewer problems than their same-age cisgender peers on the Youth Self-Report domains. Conclusions: Transgender adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gender dysphoria; Transgender; Gender-affirming treatment; Youth Self-Report; Mental health; Peers; Puberty; Self-Report; Transgender; Emotional Disturbances; Medical Treatment (General); Mental Health; Peer Relations; Well Being

'it feels like home': Transgender youth in the midwest and conceptualizations of community climate - Paceley, Megan S.; Sattler, Patricia; Goffnett, Jacob; Jen, Sarah (Journal of Community Psychology, 2020)
Community climate toward sexual and gender minority (SGM) youth is associated with higher rates of victimization and poorer health and wellbeing‐related outcomes such as depression and suicidal ideation. However, this field of research has underemphasized the experiences of transgender youth, particularly within the Midwestern context which is marked by vast rurality and characterized as sociopolitically conservative. Using qualitative and community‐based methods, this study identified factors that impact community climate from the perspective of transgender youth (n = 19) in the Midwest and situated them within the Ecological Systems Theory (EST). Thematic analysis of interviews revealed four themes: resources, visibility, policies, and ideologies. Themes often crossed levels within the EST, indicating the complexity and interrelated nature of climate across local, regional, and national contexts. Implications for theory, research, and practice are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: community climate; Midwest; rural; transgender; youth; No terms assigned

A systematic review of qualitative studies capturing the subjective experiences of gay and lesbian individuals’ of faith or religious affiliation - Wilkinson, Dean J.; Johnson, Amy (Mental Health, Religion & Culture, 2020)
Individuals identifying as religious tend to report better health and happiness regardless of affiliation, work and family social support or financial status. Evidence suggests that cultural factors are intertwined with these concepts. Exploration of sexual minorities' experiences has been neglected. Recently, a body of evidence is developing concerning this population, with theoretical speculation for changes of 'stressors' for future generations and implications, particularly, on mental health. Lesbian and Gay (LG) individuals of faith (or spirituality) are susceptible to unique 'stressors'; however, religion can provide a support network providing protective health benefits. This review systematically explores the existing evidence for the subjective experiences and accounts of LG people of faith. Sexual minority individuals who follow a religion or faith can experience good social support, reducing the risk of negative health outcomes, while for others, potentially serious, negative mental and physical health consequences are experienced (e.g., internalised homophobia, anxiety, rejection and suicidal ideation). (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Religion; sexuality; sexual orientation; mental health; No terms assigned

Suicide in Northern Ireland: Epidemiology, risk factors, and prevention - O'Neill, Siobhan; O'Connor, Rory C. (The Lancet Psychiatry, 2020)
The rates of suicide and self-harm in Northern Ireland are high, and have increased from 143 registered suicides in 1996 to 313 in 2010 and 318 in 2015. This Review summarises the epidemiology of suicidal behaviour, as well as the evidence from a small number of studies that have identified risk factors associated with high suicide rates in Northern Ireland. These risk factors were mental illness, trauma, exposure to the conflict known as the Troubles, deprivation, relationship problems, employment difficulties, financial difficulties, being LGBT, childhood adversities, and alcohol or drug use. We highlight the key challenges and opportunities for suicide prevention, emphasising a so-called lifespan approach. More needs to be done to address the relationship between substance misuse and suicide. Future research and prevention efforts should also focus on the transgenerational effect of the conflict, youth suicide, suicide prevention in minority groups, and the criminal justice context. The provision of and access to suicide-specific psychosocial interventions need to be prioritised, more support for people in crisis is required, as well as interventions for mental illness. Protect Life 2, the national suicide prevention strategy, needs to be implemented in full. Given the legacy of conflict in Northern Ireland, all suicide prevention efforts should be trauma informed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; epidemiology; risk factors; Northern Ireland; Epidemiology; Risk Factors; Suicide; Suicide Prevention; Mental Disorders; Trauma

Adolescent homelessness and associated features: Prevalence and risk across eight states - Cutuli, J. J.; Treglia, Dan; Herbers, Janette E. (Child Psychiatry and Human Development, 2020)
This study utilizes data from the Youth Risk Behavior Survey to estimate the prevalence of adolescent homelessness and relations to five indicators of poor functioning among students attending public high school in eight states. About 3.27% of students experienced homelessness, and nearly 7% of teens who identified as lesbian, gay, or bisexual (LGB) experienced homelessness. Homelessness was related to higher rates of sexual/dating violence as well as having been bullied and feeling unsafe at school. Homelessness and LGB identification predicted higher rates of more-severe problems with alcohol, hard drug use, poor grades, suicidality, and risky sexual behavior, controlling for other factors. There was no interaction effect between homelessness and LGB status, suggesting that these risks are additive. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Adolescent and youth homelessness; Sexual minority; Alcohol problem; Substance use; Suicidality; High School Students; Homeless; Risk Factors; Bisexuality; Drug Usage; Lesbianism; Risk Taking; Underage Drinking; Suicidality; Sexual Minority Groups

Homophobic bullying and suicidal behavior among US heterosexual youth - Parent, Mike C.; Johnson, Karen E.; Russell, Stephen; Gobble, Teresa (Journal of the American Academy of Child & Adolescent Psychiatry, 2020)
Homophobic bullying is pervasive in schools, and has been linked with suicidality among sexual minority youth. In prior studies, heterosexual adolescents have typically served as the reference group to understand disparities facing sexual minority youth. Yet, heterosexual adolescents may also face homophobic bullying. We assessed the associations between homophobic bullying and risk factors for suicide among youth who identify as heterosexual. Secondary analysis of a cross-sectional high-response survey was used. A sample of 15,234 US high school students who provided complete data on the variables were included in the analyses. Measures used in analyses included self-report of sadness/hopelessness, considering suicide, planning suicide, and attempting suicide. After accounting for the effects of general bullying and gender, heterosexual youth reporting homophobic bullying described higher self-reported sadness/hopelessness, considering suicide, planning suicide, and attempting suicide than non homophobically bullied peers. There was no gender difference in the associations between homophobic bullying and suicidality. The present findings describe the negative influence of homophobic bullying on the mental health of heterosexual adolescents, and suggest that anti-homophobic bullying campaigns should extend beyond sexual minority students as victims. The purpose of this study is to address the gap in knowledge on the associations between homophobic bullying and suicidality among heterosexual adolescents. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: homophobic bullying; suicidal behavior; heterosexual youth; Attempted Suicide; Heterosexuality; Homosexuality (Attitudes Toward); Bullying; Suicidality; Human Sex Differences; Self-Report; Sexual Minority Groups

Self-harm and suicidality in gender-nonconforming children: A Canadian community-based parent-report study - MacMullin, Laura N.; Aitken, Madison; Nabbijohn, A. Natisha; VanderLaan, Doug P. (Psychology of Sexual Orientation and Gender Diversity, 2020)
No study to date has examined self-harm/suicidality in a community sample of children who express gender nonconformity (GNC). This parent-report study (N = 1,923) examined self-harm/suicidality in a nonclinical community sample of 6- to 12-year-old children, including those who express marked GNC but do not have a gender dysphoria (GD) diagnosis. Child Behavior Checklist (CBCL) Items 18 ('Deliberately harms self or attempts suicide') and 91 ('Talks about killing self') measured self-harm/suicidality. The Gender Identity Questionnaire for Children measured GNC, the CBCL measured peer relations and behavioral and emotional challenges, and the Child-Rearing Sex-Role Attitude Scale measured parents’ gender-stereotypical attitudes toward child-rearing. Among children who expressed GNC most markedly, 9.1% had attempted suicide and/or self-harmed and 6.8% had suicidal ideation. These rates parallel those reported for children clinic-referred for GD. Across the sample, suicidal ideation, self-harm/suicide attempt, poor peer relations, and behavioral and emotional challenges were significantly positively correlated. Among children assigned female at birth, self-harm/suicide attempt was negatively correlated with gender-liberal parental attitudes. Binary logistic regressions showed some evidence that children who expressed GNC had higher suicidality/self-harm compared to children who were gender-conforming and did not have a mental health diagnosis; however, group effects were mostly accounted for when controlling for poor peer relations and behavioral and emotional challenges, with the latter being the strongest predictor of suicidal ideation and self-harm/suicide attempt. Thus, self-harm/suicidality among gender-nonconforming children is likely greater in scope than previously recognized, and parental attitudes, peer relations, and behavioral and emotional challenges are important factors to consider. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicidality; self-harm; children; gender nonconformity; mental health; Gender Identity; Parental Attitudes; Peer Relations; Self-Injurious Behavior; Suicidal Ideation; Diagnosis; Suicidality; Gender Nonconforming

Risk versus resiliency: Addressing depression in lesbian, gay, bisexual, and transgender youth - Johnson, Brandon; Leibowitz, Scott; Chavez, Alexis; Herbert, Sarah E. (Child and Adolescent Psychiatric Clinics of North America, 2019)
LGBT youth have disproportionate health disparities, including higher rates of depression, than their non-LGBT peers. Available evidence repeatedly shows that these higher rates of depression occur in the context of stigma, discrimination, and victimization. Assessment of depression in LGBT youth must take into account these additional risk factors as they have an impact on a particular youth. Treatment includes addressing these factors in addition to using other gold standard treatments for depression. Emerging evidence shows that LGBT youth who are in more supportive environments have better mental health outcomes, making the role of the mental health provider as an advocate even more important in this population. Further research is needed to better understand various aspects of working with depressed LGBT youth. This is perhaps most notable in the area of youth with GD, where complex medical decision making is currently based on limited outcome data. What seems most clear is that there is no 1-size-fits-all approach for working with LGBT youth. Forming collaborative relationships with both youth and their families allows clinicians to create an individualized treatment plan to address their unique needs. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Lesbian; Gay; Bisexual; Transgender; Depression; Suicidality; Gender dysphoria; At Risk Populations; Major Depression; Resilience (Psychological); Health Disparities; LGBTQ; Bisexuality; Lesbianism; Transgender; Suicidality

The effect of gender-affirming treatment on psychiatric morbidity is still undecided - Landén, Mikael (The American Journal of Psychiatry, 2020)
Comments on an article by Richard Bränström and John E. Pachankis (see record [rid]2020-61360-008[/rid]). Bränström and Pachankis study mental health treatment and suicide attempts in persons diagnosed with gender dysphoria in Sweden. William J. Malone and Sven Roman, argue that their claim that the study shows that gender-affirming treatment reduces the risk of mental health treatment and suicide attempts is misleading because the study design is flawed. They find no effect (odds ratio =1.0), but they do find a trend toward increased risk of suicide attempts as a function of years since starting hormonal treatment. Because Bränström and Pachankis do not present data prior to gender affirming surgery, the study is uninformative with regard to the effects on psychiatric morbidity. Moreover, they missed the one conclusion that can be drawn: that the perioperative transition period seems to be associated with high risk for suicide attempt. Future research should use properly designed observational studies to answer the important question as to whether gender-affirming treatment affects psychiatric outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; treatment utilization; transgender; gender-affirming surgeries; mood disorder; anxiety disorder; antidepressant; anxiolytic prescriptions; gender incongruence; Antidepressant Drugs; Health Care Utilization; Mental Health; Prescription Drugs; Transgender; Diagnosis; Hormones; Surgery; Treatment

Association between perceived public stigma and suicidal behaviors among college students of color in the US - Goodwill, Janelle R.; Zhou, Sasha (Journal of Affective Disorders, 2020)
Background: Suicide is the 2nd leading cause of death among college students and 10 to 34-year-olds in the U.S. While rates of suicide among young people of color have increased, less is known about factors that contribute to suicidality among racial minority students who are sorely underrepresented within existing research. Thus, we sought to explore the association between perceived public stigma of receiving mental health treatment and suicidality among Black, Asian Domestic, Asian International, Latinx, Multiracial, Arab/Arab American, American Indian/Alaska Native, and White college students. Methods: We analyzed cross-sectional survey responses from racially diverse sample of 153, 635 college students who participated in the Healthy Minds Study from years 2007–2018. Multivariable logistic regression was used to examine associations between perceived public stigma and suicide ideation, suicide planning, and suicide attempt. Results: Perceived public stigma was significantly associated with greater odds of suicide ideation, planning, and attempt. Odds of having attempted suicide within the past year were significantly greater among Asian International and Black college students. Sexual minority students broadly, and bisexual students specifically, were also at elevated risk for suicidal behavior. Limitations: Cross-sectional survey responses were assessed and causality cannot be determined. Conclusions: Students who endorsed more perceived public stigma also reported significantly greater odds of having experienced suicide ideation, planning, and attempt within the past 12 months. Subsequent interventions should account for concerns surrounding public perceptions of stigma when working to prevent suicide among students of color. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Stigma; Suicide; College students; Students of color; perceived public stigma; racial minority students; mental health treatment; Blacks; College Students; Help Seeking Behavior; Suicidality; Mental Health Stigma; Attempted Suicide; Major Depression; Minority Groups; Stigma; Student Attitudes; Suicidal Ideation; Suicide; Test Construction

Mental health issues and complex experiences of abuse among trans and gender diverse young people: Findings from trans pathways - Strauss, Penelope; Cook, Angus; Winter, Sam; Watson, Vanessa; Toussaint, Dani Wright; Lin, Ashleigh (LGBT Health, 2020)
Purpose: Trans and gender diverse (TGD) young people have reported high levels of mental distress in research studies, specifically depression, anxiety, self-harming, and suicidal behaviors. Rates of abuse are also high in TGD populations, but little is known about how this relates to mental health in populations of TGD young people. This study sought to examine associations between experiences of abuse and mental health outcomes. Methods: A cross-sectional study design was used. An anonymous online questionnaire was conducted to determine rates of abuse among Australian TGD young people (N = 859) and the potential association with poor mental health. Primary outcomes of interest were self-reported psychiatric diagnoses, self-harm and suicidal behaviors, and current anxiety and depressive symptoms. Results: Exposures to six forms of abuse are reported in this article: extrafamilial physical abuse, familial physical abuse, extrafamilial sexual abuse, familial sexual abuse, abuse within an intimate relationship, and other familial abuse (including emotional or verbal abuse and neglect). All six forms of abuse measured were associated with poor mental health overall; risk estimates for some forms of abuse were much stronger than others. Conclusion: The current findings have wide-ranging implications for clinical practice. Those working in TGD health care need to be aware of the high prevalence of violence and abuse among TGD young people and the association with poor mental health outcomes. The findings also have implications for broader societal change and interventions targeting increasing parental support to reduce familial violence against TGD young people. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: abuse; LGBT; suicide; transgender; trauma; Mental Health; Physical Abuse; Transgender; Gender Nonconforming; Anxiety; Major Depression; Self-Injurious Behavior; Sexual Abuse; Test Construction; Violence

Transgender and gender‐expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families - Michels, Susan; Kovar, Cheryl L. (Journal of Child and Adolescent Psychiatric Nursing, 2020)
Topic Society's blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifical nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary. Purpose To clarify the areas of potential impact in the nurse's role and to discuss ways in which they can better equip themselves to promote effective communication and culturally competent care. Thus, we envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self‐harm, and suicidal ideation in our transgender and gender‐expansive youth. Sources Used Utilizing PubMed, nationally recognized websites, and current textbooks/pamphlets, a literature review was conducted to ascertain pertinent information related to transgender, gender‐expansive youth, and nursing education. Included references were from 2012 to the present. Conclusions Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: cultural competence; evidence‐based practice; gender identity; transgender youth; No terms assigned

Anti-LGBT victimization, fear of violence at school, and suicide risk among adolescents - Barnett, Andrew P.; Molock, Sherry Davis; Nieves-Lugo, Karen; Zea, Maria Cecilia (Psychology of Sexual Orientation and Gender Diversity, 2019)
We investigated whether strengths of the relationships between anti–lesbian, gay, bisexual, and transgender (LGBT) victimization, fear of violence at school, and suicide risk differ by sexual orientation among a predominantly ethnic minority sample of adolescents. Using the 2012 District of Columbia Youth Risk Behavior Survey high school data set, we performed a 4-stage, stepwise logistic regression for suicide attempts, suicidal ideation, and suicide planning. First, we tested the independent variables, sexual orientation and anti-LGBT victimization. Second, we added an anti-LGBT victimization by sexual orientation interaction term. Third, we tested the independent variable, fear of violence at school, in an additive model. Fourth, we added a fear of violence at school by sexual orientation interaction term. In Model 1, sexual orientation and anti-LGBT victimization were both significantly associated with each suicide risk behavior. In Model 2, the anti-LGBT victimization by sexual orientation interaction term was not significant for any of the dependent variables. In Model 3, fear of violence at school was significantly associated with each suicide risk behavior. In Model 4, the fear of violence at school by sexual orientation interaction term was not significant for suicide attempts or suicidal ideation but was significant for suicide planning in the direction opposite to our hypotheses. Anti-LGBT victimization, sexual orientation, and fear of violence at school were associated with suicidal ideation, suicide planning, and suicide attempts. The strength of the association between fear of violence at school and suicide planning was weaker for sexual minority adolescents than for heterosexual adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: suicide; bullying; sexual minorities; School Violence; Sexual Orientation; Suicide; Victimization; Violence; Attempted Suicide; Bisexuality; Fear; Lesbianism; Male Homosexuality; Suicidal Ideation; Transgender

Suicide prevention from the perspectives of gay, bisexual, and two-spirit men - Ferlatte, Olivier; Oliffe, John L.; Louie, Dennis R.; Ridge, Damien; Broom, Alex; Salway, Travis (Qualitative Health Research, 2019)
Although gay, bisexual, and two-spirit men (GBTSM) experience high rates of suicidality, there have been few empirical studies of prevention initiatives and policies that could address or reverse this major social problem. This article reports on a photovoice study of 29 GBTSM who had a history of suicidality or lost a fellow GBTSM to suicide. We focused our analysis on participants’ perspectives on suicide prevention. Participants described four key considerations for GBTSM suicide prevention: (a) recognizing and addressing enduring homophobia, biphobia, and mental illness stigma; (b) provision of low-barrier, long-term, and GBTSM-affirming counseling; (c) de-isolation through peer support and community connection; and (d) fostering creativity and cultural resilience. By engaging GBTSM affected by suicide through photographs that depict their experiences and points of view, in this study, we offer concrete recommendations to reduce suicidality among GBTSM. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide; gays and lesbians; stigma; bisexuals; sexuality; sexual health; resilience; resistance; mental health and illness; qualitative; photovoice; interview; Vancouver; Bisexuality; Male Homosexuality; Mental Health; Suicide; Suicide Prevention; Lesbianism; Mental Disorders; Resilience (Psychological); Sexuality; Sexual Health

Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans - Aboussouan, Alix; Snow, Annie; Cerel, Julie; Tucker, Raymond P. (Journal of Affective Disorders, 2019)
Background: Transgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans. Method: Data analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI. Results: Results of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals. Limitations: The limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans. Conclusion: NSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Transgender; Gender non-conforming; Non-suicidal self-injury; Suicide; Veteran; Attempted Suicide; Self-Injurious Behavior; Suicidal Ideation; Transgender; Gender Nonconforming; Human Sex Differences; Military Veterans

Suicidality disparities between transgender and cisgender adolescents - Thoma, Brian C.; Salk, Rachel H.; Choukas-Bradley, Sophia; Goldstein, Tina R.; Levine, Michele D.; Marshal, Michael P. (Pediatrics, 2019)
Background And Objectives: Emerging evidence indicates transgender adolescents (TGAs) exhibit abstract elevated rates of suicidal ideation and attempt compared with cisgender adolescents (CGAs). Less is known about risk among subgroups of TGAs because of limited measures of gender identity in previous studies. We examined disparities in suicidality across the full spectrum of suicidality between TGAs and CGAs and examined risk for suicidality within TGA subgroups. Methods: Adolescents aged 14 to 18 completed a cross-sectional online survey (N = 2020, including 1148 TGAs). Participants reported gender assigned at birth and current gender identity (categorized as cisgender males, cisgender females, transgender males, transgender females, nonbinary adolescents assigned female at birth, nonbinary adolescents assigned male at birth, and questioning gender identity). Lifetime suicidality (passive death wish, suicidal ideation, suicide plan, suicide attempt, and attempt requiring medical care) and nonsuicidal self-injury were assessed. Results: Aggregated into 1 group, TGAs had higher odds of all outcomes as compared with CGAs. Within TGA subgroups, transgender males and transgender females had higher odds of suicidal ideation and attempt than CGA groups. Conclusion: In this study, we used comprehensive measures of gender assigned at birth and current gender identity within a large nationwide survey of adolescents in the United States to examine suicidality among TGAs and CGAs. TGAs had higher odds of all suicidality outcomes, and transgender males and transgender females had high risk for suicidal ideation and attempt. Authors of future adolescent suicidality research must assess both gender assigned at birth and current gender identity to accurately identify and categorize TGAs. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicidality disparities; transgender; cisgender adolescents; risk factors; Adolescent; Cross-Sectional Studies; Female; Gender Identity; Homosexuality; Humans; Male; Self-Injurious Behavior; Suicidal Ideation; Suicide, Attempted; Surveys and Questionnaires; Transgender Persons; United States; Attempted Suicide; Gender Identity; Suicidal Ideation; Transgender; Suicidality; Risk Factors

Sexual racism, psychological symptoms, and mindfulness among ethnically/racially diverse young men who have sex with men: A moderation analysis - Hidalgo, Marco A.; Layland, Eric; Kubicek, Katrina; Kipke, Michele (Mindfulness, 2020)
Objectives: This study examined the potential moderating role of trait mindfulness on the association between perceived sexual racism and psychological symptoms among a community-based sample of ethnic/racial minority young men who have sex with men (MSM) residing in greater Los Angeles. Methods: From a cross-sectional sample of 448 participants, aged 16–24 years, survey data were analyzed to examine rates of perceived sexual racism, mindfulness, psychological symptoms, and moderation by mindfulness through various analyses, including analysis of variance and logistic regression. Results: Results indicated that Latino young MSM reported the lowest scores of sexual racism, and sexual racism was associated with higher odds of psychological symptoms, suicidal ideation with a plan in the past year, and self-injury in the past 3 months. The protective potential of mindfulness was suggested by its main effects on psychological symptoms; however, it only buffered the effects of sexual racism on suicidal ideation with a plan and self-injury, with marginal buffering effects on depression. Conclusions: Findings underscore the potential utility of assessing sexual racism among young MSM of color, as well as the potential benefit of mindfulness approaches to buffer the effects of sexual racism on symptoms of depression. Interpretation of these findings is briefly discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Gay/bisexual; Young adults; Sexual objectification; Depression; Psychiatric Symptoms; Racism; Mindfulness; Same Sex Intercourse; Major Depression; Self-Injurious Behavior; Sex Roles; Suicidal Ideation

Calling into question whether gender-affirming surgery relieves psychological distress - Malone, William J.; Roman, Sven (The American Journal of Psychiatry, 2020)
Comments on an article by Richard Bränström and John E. Pachankis (see record [rid]2020-61360-008[/rid]). The study by Bränström and Pachankis shows a reduction in mental health treatments and hospitalization after suicide attempts with increased time after masculinizing or feminizing surgeries. According to the study, mental health utilization rates were highest in the perioperative period. However, the data also could be interpreted as showing that masculinizing or feminizing surgeries were the actual cause of increased mental health utilization. It is not clear what caused the reduction in the two markers for mental health distress past the 10-year mark. Because of the limitations in the study design, it is not possible to determine the cause of the differences in mental health service utilization or whether true reductions in psychological distress actually occurred. Therefore, the authors’ conclusion that the results of their study should be interpreted to support policies that provide gender-affirming surgeries cannot be supported. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; treatment utilization; transgender; gender-affirming surgeries; mood disorder; anxiety disorder; antidepressant; anxiolytic prescriptions; gender incongruence; Antidepressant Drugs; Health Care Utilization; Mental Health; Prescription Drugs; Transgender; Diagnosis; Hormones; Surgery; Treatment

Longitudinal predictors of self-injurious thoughts and behaviors in sexual and gender minority adolescents - Smith, Diana M.; Wang, Shirley B.; Carter, Mikaela L.; Fox, Kathryn R.; Hooley, Jill M. (Journal of Abnormal Psychology, 2020)
Sexual and gender minority (SGM) populations are at increased risk for several negative psychological outcomes, including self-injury. Although correlates of self-injurious thoughts and behaviors (SITBs) have been identified, it is unclear which factors are prospective predictors of SITB engagement in SGM youth. The current study investigated an online sample of 252 SGM adolescents over a 6-month period. Participants reported attitudes based on SGM identity, depression, self-criticism, body image, family support and family strain, friend NSSI engagement, and experiences of everyday discrimination. Lasso and elastic net regularized logistic regressions were used to examine which baseline variables were associated with SITB engagement at follow-up. Models resulted in excellent predictive accuracy of nonsuicidal self-injury and suicidal ideation (mean Area Under the Receiving Operating Characteristics Curve [AUC] of 0.90 and 0.91), good predictive accuracy for suicide plans (mean AUC = 0.85), and fair predictive accuracy for suicidal behaviors (mean AUC = 0.78). Several variables emerged as prospectively related to SITB risk, with varied associations across different SITBs. Results suggest that minority-specific factors may predict SITBs in SGM adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: self-injury; adolescents; sexual minority; gender minority; minority stress; Adolescent; Female; Humans; Male; Prospective Studies; Risk Factors; Self-Injurious Behavior; Sexual and Gender Minorities; Suicidal Ideation; Suicide, Attempted; Predictability (Measurement); Risk Factors; Self-Injurious Behavior; Stress; Adolescent Behavior; Adolescent Psychopathology; Body Image; Discrimination; Major Depression; Self-Criticism; Sexual Risk Taking; Test Construction; Sexual Minority Groups

Co-occurring risk factors among US high school students at risk for suicidal thoughts and behaviors - Flores, Jean P.; Swartz, Karen L.; Stuart, Elizabeth A.; Wilcox, Holly C. (Journal of Affective Disorders, 2020)
Background: Suicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent. The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings. Method: Data are from the CDC's 2015 and 2017 National Youth Risk Behavior Survey of US high school students. Among students reporting depression symptoms, latent class analysis is used to identify subtypes at risk for STBs based on personal characteristics, risk behaviors and environments. Results: Two distinct subtypes of youth were found to be at high risk for STBs: The first, larger subtype (22%) is predominately females in early high school, many of whom identify as bisexual, experienced past-year bullying, and are likely to have experienced sexual victimization. These students have low levels of externalizing risk behaviors making them difficult to detect. The second high-risk subtype (7%) is characterized by students with significant social integration challenges, with extremely high levels of substance abuse, fighting, physical and sexual victimization and poor academic performance. Many of these students have low English fluency, and identify as sexual minority. Limitations: Due to attrition or language barriers, experiences of some students at high-risk for STBs may not have been captured by this survey. Conclusion: Universal screening in clinical settings, and universally focused suicide prevention programs in school-based settings are needed and should be introduced early on. Interventions should be tailored to reach high-risk students with language, cultural and social integration challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Suicide; Adolescence; subtypes; youth at risk; suicidal thoughts; At Risk Populations; Suicidal Ideation; Suicide; Adolescent Behavior; High School Students

Strengthening our schools to promote resilience and health among LGBTQ youth: Emerging evidence and research priorities from The State of LGBTQ Youth Health and Wellbeing symposium - Johns, Michelle M.; Poteat, V. Paul; Horn, Stacey S.; Kosciw, Joseph (LGBT Health, 2019)
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents face well-documented health disparities in suicide risk, substance use, and sexual health. These disparities are known to stem, in part, from stigma directed toward LGBTQ youth in the form of minority stressors such as violence, discrimination, and harassment. Given the proportion of time that LGBTQ students spend in school, schools provide a critical context within which protective factors may be developed and leveraged to improve the health and wellbeing of these populations. This article provides a summary of key findings from a discussion among researchers, practitioners, and community members who participated in 'The State of LGBTQ Youth Health and Wellbeing: Strengthening Schools and Families to Build Resilience,' a public symposium held in June 2017. We detail emerging science on and future priorities for school-based research with LGBTQ youth which were identified by attendees at this meeting, with a particular focus on intersectionality, supportive adults in schools, and in-school programs. We call for more school-based research on priority gaps such as how LGBTQ students' intersecting identities affect their in-school experiences, how to design professional development programs that cultivate supportive educators, and how to leverage gay–straight alliances/gender and sexuality alliances as sites of health programming for LGBTQ students. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: disparity; gender minority; resilience; schools; sexual minority; youth; Adolescent; Adolescent Health; Child Welfare; Congresses as Topic; Female; Healthcare Disparities; Humans; Male; Research; Resilience, Psychological; Schools; Sexual and Gender Minorities; Health Promotion; Resilience (Psychological); Students; Well Being; LGBTQ; Bisexuality; Family; Lesbianism; Protective Factors; School Based Intervention; Transgender

Disparities in suicidality by gender identity among Medicare beneficiaries - Progovac, Ana M.; Mullin, Brian O.; Dunham, Emilia; Reisner, Sari L.; McDowell, Alex; Sanchez Roman, Maria Jose; Dunn, Mason; Telingator, Cynthia J.; Lu, Frederick Q.; Breslow, Aaron Samuel; Forstein, Marshall; Cook, Benjamin Lê (American Journal of Preventive Medicine, 2020)
Introduction: Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities. Methods: This study used 2009–2014 Medicare claims to identify people with gender identity–related diagnosis codes (disabled, n = 6,678; older adult, n = 2,018) and compared their prevalence of suicidality with a 5% random non–gender minority beneficiary sample (disabled, n = 535,801; older adult, n = 1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019. Results: Gender minority beneficiaries had higher unadjusted suicidality than non–gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p < 0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligibility, depression or behavioral health conditions, avoidable hospitalizations, and violence victimization. In age- and mental health–adjusted logistic regression models, gender minorities had higher odds of suicidality than non–gender minority beneficiaries (disabled, OR = 1.95, p < 0.0001; older adult, OR = 2.10, p < 0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region. Conclusions: Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicidality disparities; gender identity; Medicare beneficiaries; Medicaid; Aging; Gender Identity; Medicaid; Medicare; Suicidality; Logistic Regression; Models; Racial and Ethnic Differences

Lifetime prevalence of suicidal ideation and suicidal behaviors in gender non-conforming youths: A meta-analysis - Surace, Teresa; Fusar-Poli, Laura; Vozza, Lucia; Cavone, Vito; Arcidiacono, Chiara; Mammano, Rossella; Basile, Lucia; Rodolico, Alessandro; Bisicchia, Pablo; Caponnetto, Pasquale; Signorelli, Maria Salvina; Aguglia, Eugenio (European Child & Adolescent Psychiatry, 2020)
AbstractGender identity represents a topic of growing interest in mental health research. People with non-conforming gender identity are prone to suffer from stigmatization and bullying and often present psychiatric issues, which may in turn lead to a high prevalence of suicidal ideation and behaviors. The present meta-analysis aimed to estimate the prevalence of suicidal ideation and suicidal behaviors in gender non-conforming children, adolescents and young adults. A systematic search was performed in Web of Science and PsycINFO from inception to December 2018. We selected cross-sectional and cohort studies including youths (up to 25 years) with a diagnosis confirmed by a clinician according to international classifications, or after a direct interview with a peer. A random-effects meta-analysis was computed for the following outcomes: non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts. Overall, we found a mean prevalence of NSSI of 28.2% (9 studies, 3057 participants, 95% CI 14.8–47.1). A similar prevalence (28%) was found for suicidal ideation (6 studies, 2249 participants, 95% CI 15–46.3), while the prevalence of suicide attempts was 14.8% (5 studies, 1039 participants, 95% CI 7.8–26.3). Subgroup analyses revealed no significant differences according to biological sex. Given the prevalence of suicidal behaviors in gender non-conforming youths, it appears desirable to implement therapeutic and support strategies for this population. Moreover, educational interventions directed to parents, teachers, mental health professionals and general community should be promoted to struggle against stigma and social isolation, factors that may contribute to increasing the risk of suicidal behaviors. (PsycINFO Database Record (c) 2020 APA, all rights reserved)
Keywords: Gender identity; Gender dysphoria; Gender incongruence; Children; Adolescents; Suicide; Self-injury; Minority stress; No terms assigned

Understanding the Justifiability Scale in international surveys: An exploratory study - Remizova, Alisa; Rudnev, Maksim (International Journal of Social Research Methodology: Theory & Practice, 2020)
The justifiability scale (JS) is widely used to measure individual and country differences in moral attitudes. However, the validity of the instrument has been barely assessed. The current study addressed the concurrent and content validity of four popular JS items (justifiability of homosexuality, suicide, prostitution, and euthanasia). A sample of 493 Russians completed both JS and the four validated multi-item scales. Results demonstrated that multi-item scales measuring suicide, prostitution, and euthanasia attitudes explained less than half of the variance of the corresponding JS items. The JS underestimated the justifiability of homosexuality, prostitution and suicide, and overestimated the justifiability of euthanasia. The JS homosexuality item appeared to be a precise measure of attitudes towards male but less so female homosexuality. The concurrent validity of the four items was associated with item non-differentiation. We conclude that JS items should be used either after accounting for their bias, or as indicators of more abstract latent constructs. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Justifiability Scale; international surveys; moral attitudes; concurrent validity; content validity; homosexuality; suicide; prostitution; euthanasia; Attitude Measures; Concurrent Validity; Content Validity; Morality; Test Validity; Euthanasia; Homosexuality; Suicide; Sex Work

Pubertal suppression for transgender youth and risk of suicidal ideation - Turban, Jack L.; King, Dana; Carswell, Jeremi M.; Keuroghlian, Alex S. (Pediatrics, 2020)
Background and objectives: Gonadotropin-releasing hormone analogues are commonly prescribed to suppress endogenous puberty for transgender adolescents. There are limited data regarding the mental health benefits of this treatment. Our objective for this study was to examine associations between access to pubertal suppression during adolescence and adult mental health outcomes. Methods: Using a cross-sectional survey of 20 619 transgender adults aged 18 to 36 years, we examined self-reported history of pubertal suppression during adolescence. Using multivariable logistic regression, we examined associations between access to pubertal suppression and adult mental health outcomes, including multiple measures of suicidality. Results: Of the sample, 16.9% reported that they ever wanted pubertal suppression as part of their gender-related care. Their mean age was 23.4 years, and 45.2% were assigned male sex at birth. Of them, 2.5% received pubertal suppression. After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation (adjusted odds ratio = 0.3; 95% confidence interval = 0.2-0.6). Conclusions: This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: pubertal suppression; transgender; risk factors; suicidal ideation; Hormone Therapy; Mental Health; Puberty; Suicidal Ideation; Transgender; Adjustment; Suicidality

Affirmative dialectical behavioral therapy skills training with sexual minority veterans - Cohen, Jeffrey M.; Norona, Jerika C.; Yadavia, James E.; Borsari, Brian (Cognitive and Behavioral Practice, 2020)
Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans’ experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: dialectical behavior therapy; sexual minorities; emotion regulation; depression; anxiety; No terms assigned

Psychosocial factors associated with suicide attempts, ideation, and future risk in lesbian, gay, and bisexual youth: The Youth Chances study - Rimes, Katharine A.; Shivakumar, Sandhya; Ussher, Greg; Baker, Dan; Rahman, Qazi; West, Elizabeth (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2019)
Background: Lesbian, gay, and bisexual (LGB) youth have elevated suicidality rates. Aims: To investigate LGB-related and other factors associated with suicide attempts, suicidal ideation, and future suicide risk in a large UK sample. Method: Logistic regression was used to investigate factors associated with suicidality in 3,275 LGB young adults from the Youth Chances project. Results: Suicide attempts (lifetime) were reported by 13.6% of participants; 45.2 % had suicidal ideation in the past year and 9.5% said future suicide attempts were likely. LGB stigma and discrimination experiences were significantly associated with all three aspects of suicidality. These included school stigma factors (e.g., teachers not speaking out against prejudice, lessons being negative about sexual minorities), negative reactions to coming out from family and friends, and LGB-related harassment or crime experiences. Bisexuality, not feeling accepted where one lives, younger sexual minority identification, and younger coming out were also associated with suicidality. Significant non-LGB factors included female gender, lower social support, anxiety/depression help-seeking, experiences of abuse/violence, and sexual abuse. Limitations: This study is cross-sectional and further research is needed to test out whether any of these factors have a causal relationship with suicidality. Conclusion: A wide range of LGB stigma and discrimination experiences are associated with increased suicidality in LGB youth. Health, social care, and education professionals supporting young people should address LGB-specific risk factors. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: youth; prejudice; discrimination; stigma; sexual orientation; Attempted Suicide; Psychosocial Factors; Sexual Orientation; Stigma; Suicidal Ideation; Bisexuality; Discrimination; Lesbianism; Male Homosexuality; Prejudice; Risk Factors; Test Construction; Adolescent Characteristics

Psychotherapeutic interventions for lgbtq + youth: A systematic review - Bochicchio, Lauren; Reeder, Kelsey; Ivanoff, Andre; Pope, Hunter; Stefancic, Ana (Journal of LGBT Youth, 2020)
LGBTQ + youth are at elevated risk for suicidality, substance use, and other mental health concerns. Evidence-based psychotherapeutic interventions are often the first line treatment for mental health concerns. However, there is limited research examining the effectiveness of such interventions among LGBTQ + adolescents. This systematic review synthesizes extant literature examining psychotherapeutic interventions for LGBTQ + adolescents with mental illness and/or substance use. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, studies were assessed for inclusion eligibility. Researchers consulted three electronic databases, yielding a total of 666 results. Ten studies, with interventions ranging from drug use prevention to school-counseling, met inclusion criteria. Seven studies implemented adaptations to standard intervention protocol to make intervention content more accessible to LGBTQ + clients. Outcomes included decreased depressive symptoms, substance use, and social isolation. Significant design and methodological limitations were present across most studies, with four using a case study design and only two using a randomized controlled trial design. The review highlights preliminary evidence supporting the use of mental health interventions for LGBTQ + youth. However, more rigorous research is needed to determine if adapted interventions that include population-specific concerns of minority stress are more effective than treatment as usual. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: Mental Health; LGBT Youth; review; intervention strategies; No terms assigned

Understanding suicide risk and eating disorders in college student populations: Results from a national study - Lipson, Sarah K.; Sonneville, Kendrin R. (International Journal of Eating Disorders, 2020)
Objective: To examine suicide risk by eating disorder severity and symptom presentation in a nationwide sample of college students. Method: The Healthy Minds Study is the largest mental health survey of college populations in the United States. We analyzed the most recent available data (2015–2017) with 71,712 randomly selected students from 77 campuses.We estimated associations between two measures of suicidality (ideation and attempts) and three validated measures of eating disorder symptoms (the SCOFF, weight concerns scale, and the eating disorder examination questionnaire binge and purge items). Importantly, we also controlled for co-occurring symptoms of depression and anxiety, based on validated screening tools. The large, diverse sample provided a unique opportunity to assess whether certain individual characteristics were associated with increased risk. Results: Eating disorder symptoms, even at subthreshold levels, were highly predictive of suicidality. Relative to students with no apparent eating disorder symptoms, students with the highest symptom levels (a SCOFF score of 5) had 11 times higher odds of attempting suicide, while those with subthreshold symptoms had two times higher odds. We also observed a strong association between suicide attempts and eating disorder presentations that included purging. Students from marginalized backgrounds, particularly gender and sexual minorities, were at increased risk for suicide and eating disorders. Discussion: In the largest known study to date, findings suggest that eating disorders should be a priority within broader campus suicide prevention efforts, should be assessed along a continuum of severity and symptom presentation, and should focus on reaching vulnerable students. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: suicide risk; eating disorders; college students; severity; suicidality; suicide ideation; suicide attempts; Adolescent; Adult; Feeding and Eating Disorders; Female; Humans; Male; Risk Factors; Students; Suicide, Attempted; Surveys and Questionnaires; United States; Young Adult; Eating Disorders; Risk Factors; Severity (Disorders); Suicide; Suicidality; Attempted Suicide; College Students; Suicidal Ideation

ED visits and readmissions after follow-up for mental health hospitalization - Bardach, Naomi S.; Doupnik, Stephanie K.; Rodean, Jonathan; Zima, Bonnie T.; Gay, James C.; Nash, Carol; Tanguturi, Yasas; Coker, Tumaini R. (Pediatrics, 2020)
Objectives: A national quality measure in the Child Core Set is used to assess whether pediatric patients hospitalized for a mental illness receive timely follow-up care. In this study, we examine the relationship between adherence to the quality measure and repeat use of the emergency department (ED) or repeat hospitalization for a primary mental health condition. Methods: We used the Truven MarketScan Medicaid Database 2015–2016, identifying hospitalizations with a primary diagnosis of depression, bipolar disorder, psychosis, or anxiety for patients aged 6 to 17 years. Primary predictors were outpatient follow-up visits within 7 and 30 days. The primary outcome was time to subsequent mental health–related ED visit or hospitalization. We conducted bivariate and multivariate analyses using Cox proportional hazard models to assess relationships between predictors and outcome. Results: Of 22 844 hospitalizations, 62.0% had 7-day follow-up, and 82.3% had 30-day followup. Subsequent acute use was common, with 22.4% having an ED or hospital admission within 30 days and 54.8% within 6 months. Decreased likelihood of follow-up was associated with non-Hispanic or non-Latino black race and/or ethnicity, fee-for-service insurance, having no comorbidities, discharge from a medical or surgical unit, and suicide attempt. Timely outpatient follow-up was associated with increased subsequent acute care use (hazard ratio [95% confidence interval]: 7 days: 1.20 [1.16–1.25]; 30 days: 1.31 [1.25–1.37]). These associations remained after adjusting for severity indicators. Conclusions: Although more than half of patients received follow-up within 7 days, variations across patient population suggest that care improvements are needed. The increased hazard of subsequent use indicates the complexity of treating these patients and points to potential opportunities to intervene at follow-up visits. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: mental health; pediatrics; hospitalizations; emergency services; Emergency Services; Psychiatric Hospital Admission; Psychiatric Hospitalization; Hospitalized Patients; Pediatrics

Minority stress among transgender adolescents: The role of peer victimization, school belonging, and ethnicity - Hatchel, Tyler; Valido, Alberto; De Pedro, Kris T.; Huang, Yuanhong; Espelage, Dorothy L. (Journal of Child and Family Studies, 2019)
Transgender youth peer relations is understudied when compared to lesbian, gay, and bisexual youth (LGB). Likewise, transgender youth of color (YOC) are also understudied given the difficulties associated with accessing the sample. This study examines the relations among peer victimization, school belonging, and mental health with an ethnically diverse sample of transgender adolescents (N = 4778). Invariance testing and structural equation modeling were employed to explore these relations as well as the potential moderating role of ethnic minority status. Findings demonstrate that an alarming number of transgender youth were exposed to victimization and that victimization predicted mental health issues like suicidal ideation. Furthermore, analyses showed that peer victimization was associated with diminished school belonging. School belonging was associated with better mental health and appeared to mediate the relation between victimization and mental health issues. Ethnic minority status did not moderate these associations. Implications for research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: Peer victimization; School belonging; Mental health; Ethnic minority status; Transgender adolescents; Gender nonconformity; Suicide; Suicidality; Depression; LGBT; Intersectionality; Minority stress; Mental Health; Peer Relations; Victimization; Transgender; Belonging; Major Depression; Minority Groups; Suicidal Ideation; Minority Stress

Is there a need for LGBT-specific suicide crisis services? - Goldbach, Jeremy T.; Rhoades, Harmony; Green, Daniel; Fulginiti, Anthony; Marshal, Michael P. (Crisis: The Journal of Crisis Intervention and Suicide Prevention, 2019)
Background: Lesbian, gay, bisexual, and transgender (LGBT) youth are more than twice as likely to attempt suicide than their peers. Although LGBT-specific crisis services have been developed, little is known about the need for these services beyond that of general lifeline services. Aims: The present study sought to (a) describe the primary reasons for calling a specialized provider as opposed to another and (b) examine sociodemographic differences in the primary reason by race, ethnicity, gender, age, and sexual orientation. Method: Data from 657 youth who sought crisis services from an LGBT-specific national service provider in the United States were assessed. Logistic regression models assessed demographic differences. Thematic analysis of open-ended responses regarding reasons for choosing this LGBT-specific crisis service provider followed a consensus model. Results: Most respondents indicated they either would not have contacted another helpline (26%) or were not sure (48%). Nearly half (42%) indicated they called specifically because of LGBT-affirming counselors, a reason more commonly reported by gender minority (transgender and gender nonbinary) and queer or pansexual youth than cisgender, gay, or lesbian youth. Conclusion: LGBT-specific crisis services appear to play an important role in suicide prevention. Further research is needed to understand the use of culturally tailored suicide prevention approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Keywords: crisis services; suicide prevention; LGBT youth; Crisis Intervention Services; Sexual Orientation; Suicide Prevention; Bisexuality; Lesbianism; Male Homosexuality; Test Construction; Transgender; Adolescent Characteristics

The role of perceived support and perceived prejudice in the health of lgbt soldiers - Conway, Morgan A.; Dretsch, Michael N.; Taylor, Maura R.; Quartana, Phillip J. (Sexuality Research & Social Policy: A Journal of the NSRC, 2020)
AbstractIntroductionVery little is known about factors that underlie the behavioral health status of LBGT compared with heterosexual soldiers. To address this knowledge gap, the current study explored the potential mechanistic roles of perceived prejudice and support for the LGBT community as they related to observed differences in behavioral health symptoms between LGBT and heterosexual soldiers.MethodsBetween May 10 and 12, 2016, a sample of active-duty soldiers (N = 759) completed a battery of study measures while attending an academic training institute. Latent variable models using diagonally weighted least squares (DWLS) estimation were used to test for the direct and indirect effects of LGBT identity on behavioral health symptoms when treating perceived prejudice and support as simultaneous mediators.ResultsThere is no evidence for a direct effect of LGBT identity on behavioral health symptoms after accounting for the role of perceived prejudice and support. There are indirect effects of LGBT status on these behavioral health outcomes manifested through shared associations with perceived support for and prejudice against the LBGT community.ConclusionsEven though 'Don’t Ask, Don’t Tell' is no longer an explicit guideline, there are critical differences in the experience of LGBT and heterosexual soldiers, which may explain differences in mental and behavioral health. Specifically, perceived prejudice and perceived support appear to play a mechanistic role in those differences.Policy ImplicationsThe culture of the military following the repeal of Don’t Ask Don’t Tell continues to impact both heterosexual and LGBT Soldiers. Understanding the mechanistic role culture plays in the behavioral health of LGBT Soldiers may be one means of addressing their behavioral health needs. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: LGBT; Perceived support; Suicidality; Depression; Military psychology; No terms assigned

Suicides among lesbian and gay male individuals: Findings from the national violent death reporting system - Lyons, Bridget H.; Walters, Mikel L.; Jack, Shane P. D.; Petrosky, Emiko; Blair, Janet M.; Ivey-Stephenson, Asha Z. (American Journal of Preventive Medicine, 2019)
Introduction: Information regarding the epidemiology of suicide among lesbian and gay male individuals is limited, and comprehensive information is needed. This study seeks to describe the characteristics and precipitating circumstances of suicide among lesbian and gay male decedents when compared with non-lesbian and non-gay male decedents. Methods: An analysis was conducted of National Violent Death Reporting System data from 18 U.S. states for the years 2003−2014. Sociodemographic characteristics and precipitating circumstances of suicide among lesbian and gay male decedents were compared with non-lesbian and non-gay male decedents. Logistic regression analysis was conducted to examine the association between precipitating circumstances and suicide by sexual orientation. The analysis was conducted in December 2017. Results: There were a total of 123,289 suicide decedents from 18 states participating in National Violent Death Reporting System during 2003−2014; of those, 621 (0.5%) were identified as lesbian, gay, bisexual, or transgender. The majority of lesbian, gay, bisexual, or transgender decedents were identified as gay male (53.9%), followed by lesbian (28.0%), transgender (10.4%), and bisexual (7.5%). The analysis revealed several differences by age, mechanism of injury, and precipitating circumstances, including intimate partner problems among lesbian decedents, suicide planning and intent for both lesbian and gay male decedents, and mental health problems among gay male decedents. Conclusions: Findings highlight differences in the characteristics of suicide among lesbian and gay male and non-lesbian and non-gay male decedents. It is important for suicide prevention efforts to be culturally sensitive and consider the needs of sexual minority populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Keywords: transgender; death reporting; suicide; lesbians; gay males; violent death; epidemiology; Adolescent; Adult; Age Factors; Female; Humans; Male; Mental Health; Middle Aged; Sexual and Gender Minorities; Suicide; United States; Young Adult; Risk Factors; Suicide; Transgender; Death and Dying; Epidemiology; Lesbianism; Male Homosexuality; Violence