The Burgeoning HIV/HCV Syndemic in the Urban Northeast: HCV, HIV, and HIV/HCV Coinfection in an Urban Setting - Morano, J.P.; Gibson, B.A.; Altice, F.L. (PLoS ONE, 2013)
Introduction:Despite recommendations for generation-based HCV and once lifetime HIV screening, thousands of individuals in the U.S. still remain untested and undiagnosed. This cross-sectional study examines the correlates of HCV and HIV monoinfection and HIV/HCV coinfection in an urban Northeast setting.Methods:Utilizing an electronic database from a mobile medical clinic in New Haven, CT from January 2003 to July 2011, 8,311 individuals underwent structured health assessment and screening for HIV and HCV.Results:HIV [N = 601 (8.0%)] and HCV [N = 753 (10.1%)] infection were identified, and 197 (26.1%) of the 753 with HCV were coinfected with HIV. Both monoinfection and coinfection status were independently correlated with crack cocaine use and increasing age. HIV/HCV coinfection was correlated with men having sex with men (MSM) (AOR = 38.53, p<0.0080), shooting gallery use (AOR = 3.06, p<0.0070), and not completing high school (AOR = 2.51, p<0.0370). HCV monoinfection correlated with health insurance (AOR = 2.16, p<0.0020), domestic violence (AOR = 1.99, p<0.0070), and being Hispanic (AOR = 2.63, p<0.0001), while HIV monoinfection correlated with having had syphilis (AOR = 2.66, p<0.0001) and being Black (AOR = 1.73, p = 0.0010).Conclusions:Though HIV and HCV share common transmission risk behaviors, independent correlates with viral infection status in an urban Northeast setting are distinct and have important implications for surveillance, healthcare delivery, disease prevention, and clinical care. © 2013 Morano et al.
Keywords: cocaine; virus RNA; adult; article; clinical practice; correlation analysis; cross-sectional study; domestic violence; ethnic group; female; geographic distribution; health care delivery; health insurance; health survey; hepatitis C; Hepatitis C virus; heterosexual male; Hispanic; human; Human immunodeficiency virus; Human immunodeficiency virus infection; major clinical study; male; mass screening; mixed infection; prophylaxis; syphilis; United States; urban area; virus transmission

Managing uncertainty: A grounded theory of stigma in transgender health care encounters - Poteat, T.; German, D.; Kerrigan, D. (Social Science and Medicine, 2013)
A growing body of literature supports stigma and discrimination as fundamental causes of health disparities. Stigma and discrimination experienced by transgender people have been associated with increased risk for depression, suicide, and HIV. Transgender stigma and discrimination experienced in health care influence transgender people's health care access and utilization. Thus, understanding how stigma and discrimination manifest and function in health care encounters is critical to addressing health disparities for transgender people. A qualitative, grounded theory approach was taken to this study of stigma in health care interactions. Between January and July 2011, fifty-five transgender people and twelve medical providers participated in one-time in-depth interviews about stigma, discrimination, and health care interactions between providers and transgender patients. Due to the social and institutional stigma against transgender people, their care is excluded from medical training. Therefore, providers approach medical encounters with transgender patients with ambivalence and uncertainty. Transgender people anticipate that providers will not know how to meet their needs. This uncertainty and ambivalence in the medical encounter upsets the normal balance of power in provider-patient relationships. Interpersonal stigma functions to reinforce the power and authority of the medical provider during these interactions. Functional theories of stigma posit that we hold stigmatizing attitudes because they serve specific psychological functions. However, these theories ignore how hierarchies of power in social relationships serve to maintain and reinforce inequalities. The findings of this study suggest that interpersonal stigma also functions to reinforce medical power and authority in the face of provider uncertainty. Within functional theories of stigma, it is important to acknowledge the role of power and to understand how stigmatizing attitudes function to maintain systems of inequality that contribute to health disparities. © 2013.
Keywords: adult; African American; article; female; health care access; health care disparity; health care management; health care quality; health care utilization; health personnel attitude; health service; health survey; human; interview; major clinical study; male; Black person; qualitative research; race difference; reinforcement; social interaction; stigma; theoretical study; transsexualism

A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues - Kerr, D.L.; Santurri, L.; Peters, P. (Journal of American College Health, 2013)
Objective: To investigate selected mental health characteristics of lesbians and bisexual undergraduate college women as compared with heterosexual college women. Participants: Self-identified lesbians and bisexual and heterosexual female college students who took part in the American College Health Association National College Health Assessment II (ACHA-NCHA-II) in Fall 2008, Spring 2009, and Fall 2009. Methods: A secondary analysis of the ACHA-NCHA-II data set for 3 semesters was conducted. Comparisons of lesbians and bisexual and heterosexual female college students were made. Results: Bisexual women reported the worst mental health status in all areas studied including anxiety, anger, depressive symptoms, self-injury, and suicidal ideation and attempts. Both bisexual women and lesbians had a far greater likelihood of having these mental health issues when compared with heterosexual women. Lesbians and bisexual women utilized significantly more mental health services (with the exception of clergy) than heterosexual women. Conclusions: College health professionals should recognize and address the mental health needs of bisexual and lesbian undergraduate college women. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: adolescent; adult; anger; anxiety; article; automutilation; bisexuality; comparative study; depression; female; heterosexuality; human; lesbianism; mental health; psychological aspect; race; socioeconomics; statistics; student; suicidal ideation; university; young adult

A description of common mental disorders in men who have sex with men (MSM) referred for assessment and intervention at an MSM clinic in Cape Town, South Africa. - Stoloff, K.; Joska, J.A.; Feast, D.; De Swardt, G.; Hugo, J.; Struthers, H.; McIntyre, J.; Rebe, K. (AIDS and behavior, 2013)
Men who have sex with men (MSM) have a higher prevalence of common mental disorders (CMD), as compared with heterosexual men. HIV infection is independently associated with higher rates of CMD. Given this context, and the high background community prevalence of HIV in South Africa, MSM are at even greater risk of developing CMD. The aim of this research was to investigate neuropsychiatric symptoms and disorders in MSM who were referred for assessment and management of mental health problems, in an MSM Clinic in urban Cape Town, South Africa. Twenty-five men were screened using the MINI, AUDIT, DUDIT, and IPDE Screener. Depression, suicidality, as well as alcohol and drug use disorders were highly prevalent in this group (44, 56, 48, and 56 % respectively). The personality disorder screening was suggestive of a high prevalence of personality disorders. The high prevalence of neuropsychiatric disorders in this sample supports the idea that integrated mental health services are needed to address the complex needs of this population. Adequate input into the mental health needs of this population could reduce the potential for HIV acquisition and transmission, improve adherence to treatment and care, and ensure the provision a comprehensive health service for MSM.
Keywords: addiction; adolescent; adult; aged; article; human; Human immunodeficiency virus infection; major depression; male; male homosexuality; mental disease; middle aged; patient referral; prevalence; psychologic test; psychological aspect; psychological rating scale; questionnaire; risk factor; socioeconomics; South Africa; statistics; suicide

Does the level of education influence completed suicide? A nationwide register study - Pompili, M.; Vichi, M.; Qin, P.; Innamorati, M.; De Leo, D.; Girardi, P. (Journal of Affective Disorders, 2013)
Objective: To evaluate whether education attainment was associated with completed suicide, a topic only marginally investigated in the literature. Methods: Data for the years between 2006 and 2008 were extracted from the Italian Mortality Database to include all deaths by suicide and natural causes and to obtain information on their education attainment. Results: We found significant differences in education attainment between suicide victims and individuals deceased by natural causes, stratified by sex and broken down by age bands. Of both males and females from 15 to 64 years old, suicide victims were significantly more often to have a higher education attainment compared with the same sex and age counterparts died from natural causes. Persons with higher school attainment, compared with those with a maximum primary school degree, had significantly increased odds ratios of dying from a suicide rather than a natural cause. For persons aged 65-74 years or above, however, the differences were not so much obvious. These observations remained almost the same after adjustment for marital status, region of residence and age. Conclusions: Individual with higher educational achievement may be more prone to suicide risk when facing failures, public shame, and high premorbid functioning. © 2012 Elsevier B.V. All rights reserved.
Keywords: adolescent; adult; aged; article; cause of death; controlled study; educational status; female; groups by age; human; major clinical study; male; mortality; priority journal; suicide

A place to feel secure. - Lomas, C. (Nursing standard (Royal College of Nursing (Great Britain) : 1987), 2013)
A new health and wellbeing centre has opened in Birmingham to address the health inequalities in the lesbian, gay, bisexual and trans (LGBT) community. Working alongside other service providers to target issues such as attempted suicide, depression, self-harm, smoking, drinking and sexual health, the centre will act as a'one-stop shop' providing ongoing support for LGBT people.
Keywords: article; bisexuality; female; human; lesbianism; male; male homosexuality; social justice; transsexualism; United Kingdom

Differences in Risk Factors for Suicide Attempts Among 9th and 11th Grade Youth: A Longitudinal Perspective - Fried, L.E.; Williams, S.; Cabral, H.; Hacker, K. (Journal of School Nursing, 2013)
The purpose of the study is to assess the relationship between timing of adolescent development and risk factors for suicide. Nationally representative data from the Add Health survey were used. The relationship of sociodemographic characteristics, known risk factors, and physical developmental timing and cognitive developmental style to suicide attempt was assessed. Depression was a risk factor for suicide attempts in both 9th and 11th grade. Other risk factors differed. Use of illegal drugs, homosexual orientation, using public assistance, and physical development were the important risk factors for ninth graders. For 11th graders, sexual abuse, being in counseling, and being of "other" race or ethnicity (mainly Asian or Native American) were risk factors. The cognitive development variable of using a systematic problem-solving method was protective for 11th graders. Recognizing that risk factors for adolescent suicide attempts change over time and with developmental timing of puberty is an important factor for suicide prevention strategies. © The Author(s) 2012.
Keywords: addiction; adolescent; adolescent behavior; adolescent development; age distribution; article; cohort analysis; counseling; depression; female; health survey; homosexuality; human; longitudinal study; male; methodology; problem solving; psychological aspect; puberty; race; risk factor; sexual crime; sexual maturation; socioeconomics; statistics; suicide attempt; United States

Coming together in pain and joy: A multicultural and arts-based suicide awareness project - Silverman, Y.; Smith, F.; Burns, M. (Arts in Psychotherapy, 2013)
The issue of suicide is still taboo in many cultures and the silence surrounding this problem is often destructive. Those affected by suicide have few opportunities to express their pain and their communities are left feeling helpless. The creative arts therapies have been used to address the emotions surrounding suicide, however few projects have studied the use of the arts to promote suicide awareness. Furthermore, there is a lack of multicultural research in this area. This article describes a two-day arts-based symposium that brought together members from diverse cultural communities including Inuit, Mohawk, Jewish, Christian, Baha'i, South-Asian Canadian, Senior and LGBTQ (Lesbian, Gay, Bisexual, Trans-gendered, Queer) communities. Through drama, music, art-making and writing, participants explored this difficult subject, expressed complex feelings and shared their perspectives. An instrumental case study design was employed for this research project. The objectives were to gather information on participants' experience of exploring the issue of suicide within an arts-based approach and to determine if cross-cultural themes would emerge. The findings indicate that using the arts helped to facilitate dialogue and communication and specific cross-cultural themes did emerge. © 2013 Elsevier Inc.
Keywords: anxiety; art; art therapy; article; awareness; baha'i; bisexuality; Christian; cultural factor; death; emotion; Eskimo; ethnic group; fear; forgiveness; gender identity; happiness; human; individuality; information; Jewish; homosexual female; literature; homosexual male; mohawk; music; pain; personal experience; priority journal; religious group; shame; south asian canadian; suicidal ideation; suicide; transsexualism; writing

Dating Violence, Psychological Distress, and Attempted Suicide Among Female Adolescents in the Juvenile Justice System - Buttar, A.; Clements-Nolle, K.; Haas, J.; Reese, F. (Journal of Correctional Health Care, 2013)
The prevalence of mental illness and suicide among female adolescents involved with the juvenile justice system is alarmingly high and there is a need to identify risk factors that may be amenable to intervention. This study examined the independent association between dating violence and poor mental health (psychological distress and attempted suicide) among 305 female adolescents involved with the juvenile justice system in Nevada. Overall, 28% of the sample met the criteria for clinically significant psychological distress and 18% had attempted suicide with intent to die. After controlling for well-established risk factors such as sexual orientation, childhood abuse, and substance abuse, dating violence remained independently associated with psychological distress and attempted suicide. These findings suggest that mental health programming for this population may be more effective if it includes a focus on dating violence. © The Author(s) 2013.
Keywords: adolescent; adolescent behavior; article; courtship; female; health survey; human; human relation; mental stress; prisoner; psychological aspect; risk factor; statistics; suicide attempt; United States; victim; violence

Marriage, cohabitation and mortality in denmark: National cohort study of 6.5 million persons followed for up to three decades (1982-2011) - Frisch, M.; Simonsen, J. (International Journal of Epidemiology, 2013)
Background: Living arrangements have changed markedly in recent decades, so we wanted to provide an up-to-date assessment of mortality as a function of marital status and cohabitation status in a complete population. Methods: We studied mortality in a national cohort of 6.5 million Danes followed for 122.5 million person-years during 1982-2011, using continuously updated individual-level information on living arrangements, socio-demographic covariates and causes of deaths. Hazard ratios (HRs) estimated relative mortality in categories of marital status, cohabitation status and combinations thereof. Results: HRs for overall mortality changed markedly over time, most notably for persons in same-sex marriage. In 2000-2011, opposite-sex married persons (reference, HR1/4 1) had consistently lower mortality than persons in other marital status categories in women (HRs 1.37-1.89) and men (HRs 1.37-1.66). Mortality was particularly high for same-sex married women (HR1/4 1.89), notably from suicide (HR1/4 6.40) and cancer (HR1/4 1.62), whereas rates for same-sex married men (HR1/4 1.38) were equal to or lower than those for unmarried, divorced and widowed men. Prior marriages (whether opposite-sex or same-sex) were associated with increased mortality in both women and men (HR1/4 1.16-1.45 per additional prior marriage). Conclusion: Our study provides a detailed account of living arrangements and their associations with mortality over three decades, thus yielding accurate and statistically powerful analyses of public health relevance to countries with marriage and cohabitation patterns comparable to Denmark's. Of note, mortality among same-sex married men has declined markedly since the mid-1990s and is now at or below that of unmarried, divorced and widowed men, whereas same-sex married women emerge as the group of women with highest and, in recent years, even further increasing mortality. © The Author 2013; all rights reserved.
Keywords: adult; article; cause of death; cohabitation; cohort analysis; demography; Denmark; female; hazard ratio; human; major clinical study; male; marriage; mortality; priority journal; same-sex marriage; social aspect; widowed person

Health priorities and perceived health determinants among Western Australians attending the 2011 LGBTI Perth Pride Fairday Festival. - Comfort, J.; McCausland, K. (Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals, 2013)
Although data exist demonstrating poorer health indicators on a range of health outcomes for lesbian, gay, bisexual, transsexual and intersex (LGBTI) people, there is little information as to how this group perceives the relative importance of different health issues or what the underlying reasons behind poorer health may be. A self-completed survey was administered to people attending the October 2011 LGBTI Perth Pride Fairday Festival. Three hundred and fifty-one people completed the survey, resulting in a total of 335 useable surveys. One hundred and seventy-eight participants identified as female, 145 as male, four as transgender and eight as other genders. Depression, anxiety, excessive worry or panic attacks and problems in family relationships were reported as the most important individual health issues, whereas depression, suicide and HIV/AIDS were seen as the most important health issues affecting the LGBTI community. Discrimination was rated the most important social factor impacting on the health and well being of this community. When members of the LGBTI community were asked to rank health issues of importance both individually and as a community, the results indicate that mental health issues are of prime concern. Discrimination and the stress of living as part of this minority group were seen as contributing to this. Health promotion and public health need to be responsive to these issues if real gains are to be made in reducing the health inequities affecting this group. So what? This research highlights the link between social justice, social inclusion and health outcomes. The health of LGBTI people is rarely considered by mainstream agencies, despite poorer health outcomes. Sensitive and targeted public health interventions that resonate with the community and that acknowledge the impact of being part of this marginalised group are required.
Keywords: adolescent; adult; aged; article; attitude to health; Australia; female; health care planning; health status indicator; human; lesbianism; male; male homosexuality; middle aged; psychological aspect; questionnaire

A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth. - Mustanski, B.; Liu, R.T. (Archives of sexual behavior, 2013)
This short-term prospective study examined general and lesbian, gay, bisexual, and transgender (LGBT)-specific risk and protective factors for suicide attempts in an ethnically diverse sample of LGBT youth (N = 237, 47.7 % male). A structured psychiatric interview assessed clinical depression and conduct disorder symptoms, as well as past and prospective suicide attempts over a 1-year follow-up period (91 % retention). Participants completed questionnaires measuring general risk factors for suicide attempts, including hopelessness, impulsiveness, and perceived social support. They also completed measures of LGBT-specific suicide risk factors, including gender nonconformity, age of first same-sex attraction, and LGBT victimization. Correlation and multivariate regression analyses were conducted to examine the relations between predictors and suicide attempt, and to identify mediators. Of nine variables examined, seven were related to lifetime history of attempted suicide: hopelessness, depression symptoms, conduct disorder symptoms, impulsivity, victimization, age of first same-sex attraction, and low family support. Depressive symptoms and hopelessness mediated the relation between multiple risk and resilience factors and suicide attempts. Suicide attempt history was the strongest predictor of prospective suicide attempts. Participants who previously attempted suicide (31.6 % of the sample) had more than 10 times greater odds of making another attempt in the 1-year follow-up period than were those who had made no previous attempt. These results highlight the need for suicide prevention programs for LGBT youth and suggest the importance of addressing depression and hopelessness as proximal determinants and family support and victimization, which have more distal effects.
Keywords: adolescent; adult; article; bisexuality; female; follow up; homosexuality; human; impulsiveness; longitudinal study; male; psychological aspect; questionnaire; social support; statistics; suicide attempt; transsexualism; victim

A Review of gay, lesbian, bisexual, and transgender youth issues for the pediatrician - Steever, J.B.; Cooper-Serber, E. (Pediatric Annals, 2013)
Keywords: article; bisexuality; depression; gender identity; health disparity; homophobia; homosexuality; human; Human immunodeficiency virus infection; homosexual female; homosexual male; practice guideline; prevalence; self concept; sexual behavior; sexual orientation; suicidal ideation; transsexualism

Psychosocial Health Problems Associated with Increased HIV Risk Behavior among Men Who Have Sex with Men in Nepal: A Cross-Sectional Survey - Deuba, K.; Ekström, A.M.; Shrestha, R.; Ionita, G.; Bhatta, L.; Karki, D.K. (PLoS ONE, 2013)
Background: Men who have sex with men (MSM) are marginalized, hidden, underserved and at high risk for HIV in Nepal. We examined the association between MSM sub-populations, psychosocial health problems and support, access to prevention and non-use of condoms. Methods: Between September-November of 2010, a cross-sectional survey on HIV-related risk behavior was performed across Nepal through snowball sampling facilitated by non-governmental organizations, recruiting 339 MSM, age 15 or older. The primary outcomes were: (a) non-use of condoms at least once in last three anal sex encounters with men and (b) non-use of condoms with women in the last encounter. The secondary outcome was participation in HIV prevention interventions in the past year. Results: Among the 339 MSM interviewed, 78% did not use condoms at their last anal sex with another man, 35% did not use condoms in their last sex with a woman, 70% had experienced violence in the last 12 months, 61% were experiencing depression and 47% had thought of committing suicide. After adjustment for age, religion, marital status, and MSM subpopulations (bisexual, ta, meti, gay), non-use of condoms at last anal sex with a man was significantly associated with non-participation in HIV interventions, experience of physical and sexual violence, depression, repeated suicidal thoughts, small social support network and being dissatisfied with social support. Depression was marginally associated with non-use of condoms with women. The findings suggest that among MSM who reported non-use of condoms at last anal sex, the ta subgroup and those lacking family acceptance were the least likely to have participated in any preventive interventions. Conclusions: MSM in Nepal have a prevalence of psychosocial health problems in turn associated with high risk behavior for HIV. Future HIV prevention efforts targeting MSM in Nepal should cover all MSM subpopulations and prioritize psychosocial health interventions. © 2013 Deuba et al.
Keywords: adolescent; adult; anal intercourse; article; bisexual male; cross-sectional study; depression; disease association; dissatisfaction; domestic violence; educational status; family acceptance; family attitude; health care access; heterosexual male; high risk behavior; human; Human immunodeficiency virus infection; infection prevention; interview; male; homosexual male; Nepal; physical violence; preventive health service; prostitution; psychosocial disorder; satisfaction; sex role; sexual violence; social participation; social support; suicidal ideation; unsafe sex; verbal hostility; violence

Attempted Suicide, LGBT Identity, and Heightened Scrutiny - Halady, S.W. (American Journal of Bioethics, 2013)
Keywords: article; assisted suicide; critical illness; custodial care; decision making; ethics; human; living will; long term care; mental disease; suicide attempt; terminally ill patient; treatment withdrawal

Complicated suicide versus autoeroticism?: a case involving multiple drugs and a porta-potty. - Dickerson, E.M.; Jones, P.; Wilkins, D.; Regnier, J.; Prahlow, J.A. (The American journal of forensic medicine and pathology, 2013)
In this report, a unique and bizarre case of complicated suicide is presented. The decedent was found dead in the basin of a porta-potty, wearing women's pantyhose, jewelry, and makeup. The initial investigation was suspect for homicide. Although an autoerotic accidental death cannot be excluded, the patient's medical history and autopsy results provided evidence for suicide, including several substances positive in his serum. Tramadol was quantified to be 140 mg/L, approximately 470 times the therapeutic range. Moreover, formaldehyde was also present, presumably absorbed from the contents of the chemical toilet. An exhaustive search could not reveal similar circumstances of suicide in a porta-potty or with the levels of tramadol found in the decedent.
Keywords: amphetamine; central stimulant agent; disinfectant agent; formaldehyde; narcotic analgesic agent; tramadol; adult; article; asphyxia; case report; cross-dressing; drug overdose; fever; forensic toxicology; human; male; sanitation; skin absorption; suicide

Health care utilization and health indicators among a national sample of U.S. veterans in same-sex partnerships. - Blosnich, J.; Bossarte, R.; Silver, E.; Silenzio, V. (Military medicine, 2013)
To examine health indicators of same-sex partnered veterans as compared with their opposite-sex partnered veteran and nonveteran peers. Same-sex partner status was derived by self-reported same-sex partnerships in data from the 2004 Behavioral Risk Factor Surveillance System. Outcome variables included health risk disparities associated with sexual minority status (e.g., frequent mental distress) and veteran status (e.g., firearm ownership). Stratified multiple logistic regression models were used to examine the association of same-sex partnered veteran status with health indicators. Same-sex partnered veterans had higher odds of being overweight and keeping firearms in the house compared with same-sex partnered nonveterans. Same-sex partnered veterans were less likely than opposite-sex partnered veterans to be overweight, and they were more than twice as likely to be current smokers when compared with opposite-sex partnered nonveterans. Findings suggest both that some health disparities patterns identified by same-sex partnership status among the general population also exist among veteran populations, and that some unique distinctions may exist, particularly related to BMI and firearm ownership. Collection of information about sexual minority status within Department of Veterans Affairs data sources is needed to more accurately assess the health of this minority population.
Keywords: adult; article; cross-sectional study; female; firearm; health behavior; health disparity; health service; homosexuality; human; male; obesity; spouse; statistics; utilization review; veteran

HIV-infected mental health patients: Characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients - Schadé, A.; van Grootheest, G.; Smit, J.H. (BMC Psychiatry, 2013)
Objectives: HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems. The majority of HIV-infected patients in the Netherlands (almost 60%) are homosexual men.The main objectives of this study were to describe the clinical and demographic characteristics of patients with HIV who seek treatment for their mental health symptoms in the Netherlands. Secondly, we tested whether HIV infected and non-infected homosexual patients with a lifetime depressive disorder differed on several mental health symptoms.Methods: We compared a cohort of 196 patients who visited the outpatient clinic for HIV and Mental Health with HIV-infected patients in the general population in Amsterdam (ATHENA-study) and with non-HIV infected mental health patients (NESDA-study). DSM-IV diagnoses were determined, and several self-report questionnaires were used to assess mental health symptoms. Results: Depressive disorders were the most commonly occurring diagnoses in the cohort and frequent drug use was common. HIV-infected homosexual men with a depressive disorder showed no difference in depressive symptoms or sleep disturbance, compared with non-infected depressive men. However, HIV-positive patients did express more symptoms like fear, anger and guilt. Although they showed significantly more suicidal ideation, suicide attempts were not more prevalent among HIV-infected patients. Finally, the HIV-infected depressive patients displayed a considerably higher level of drug use than the HIV-negative group. Conclusion: Habitual drug use is a risk factor for spreading HIV. It is also more often diagnosed in HIV-infected homosexual men with a lifetime depression or dysthymic disorder than in the non-infected population. Untreated mental health problems, such as depressive symptoms and use of drugs can have serious repercussions. Therefore, general practitioners and internists should be trained to recognize mental health problems in HIV-infected patients. © 2013 Schadé et al.; licensee BioMed Central Ltd.
Keywords: antiretrovirus agent; adult; aged; anger; article; cohort analysis; controlled study; depression; drug use; DSM-IV; fear; guilt; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; homosexual male; mental disease; Netherlands; questionnaire; self report; sleep disorder; suicidal ideation; suicide attempt

Victimization and suicidality among Dutch lesbian, gay, and bisexual youths. - van Bergen, D.D.; Bos, H.M.; van Lisdonk, J.; Keuzenkamp, S.; Sandfort, T.G. (American journal of public health, 2013)
We examined Netherlands Institute for Social Research data, collected between May and August 2009, on 274 Dutch lesbian, gay, and bisexual youths. The data showed that victimization at school was associated with suicidal ideation and actual suicide attempts. Homophobic rejection by parents was also associated with actual suicide attempts. Suicidality in this population could be reduced by supporting coping strategies of lesbian, gay, and bisexual youths who are confronted with stigmatization by peers and parents, and by schools actively promoting acceptance of same-sex sexuality.
Keywords: adolescent; article; bisexuality; cross-sectional study; female; homosexuality; human; homosexual female; male; Netherlands; parent; peer group; statistical model; statistics; suicidal ideation; suicide; suicide attempt; victim

A tool for the culturally competent assessment of suicide: The cultural assessment of risk for suicide (CARS) measure - Chu, J.; Floyd, R.; Diep, H.; Pardo, S.; Goldblum, P.; Bongar, B. (Psychological Assessment, 2013)
Despite important differences in suicide presentation and risk among ethnic and sexual minority groups, cultural variations have typically been left out of systematic risk assessment paradigms. A new self-report instrument for the culturally competent assessment of suicide, the Cultural Assessment of Risk for Suicide (CARS) measure, was administered to a diverse sample of 950 adults from the general population. Exploratory factor analysis yielded a 39-item, 8-factor structure subsumed under and consistent with the Cultural Theory and Model of Suicide (Chu, Goldblum, Floyd, & Bongar, 2010), which characterizes the vast majority of cultural variation in suicide risk among ethnic and sexual minority groups. Psychometric properties showed that the CARS total and subscale scores demonstrated good internal consistency, convergent validity with scores on other suicide-related measures (the Suicide Ideation Scale, the Beck Depression Inventory suicide item, and the Beck Hopelessness Scale), and an ability to discriminate between participants with versus without history of suicide attempts. Regression analyses indicated that the CARS measure can be used with a general population, providing information predictive of suicidal behavior beyond that of minority status alone. Minorities, however, reported experiencing the CARS cultural risk factors to a greater extent than nonminorities, though effect sizes were small. Overall, results show that the CARS items are reliable, and the instrument identifies cultural suicide risk factors not previously attended to in suicide assessment. The CARS is the first to operationalize a systematic model that accounts for cultural competency across multiple cultural identities in suicide risk assessment efforts. © 2013 American Psychological Association.
Keywords: adult; article; Beck Depression Inventory; Beck Hopelessness Scale; controlled study; cultural anthropology; Cultural Assessment of Risk fo Suicide; cultural competence; ethnic group; exploratory factor analysis; factor analysis; female; human; male; prediction; psychologic assessment; psychometry; rating scale; reliability; risk assessment; risk factor; scoring system; self report; sexual and gender minority; suicide; Suicide Ideation Scale; validity

If it quacks like a duck: reviewing health care providers' speech restrictions under the first prong of Central Hudson. - Fultz, S.L. (The American University law review, 2013)
The First Amendment protects the speech of health care providers. This protection can limit states' abilities to protect patients from harmful therapies involving speech, such as sexual orientation change efforts. Because providers' speech is more similar to commercial speech than traditional political discourse, it is possible to create a First Amendment review analysis that better balances states' police powers with providers' First Amendment rights. Under a "single-prong" approach, the first prong of Central Hudson can be used to identify quackery, which is analogous to false or misleading commercial speech and would therefore be outside the protection of the First Amendment. Because health care must be tailored to individual patients, restrictions on speech that survive the first prong of Central Hudson would be subject to strict scrutiny in order to leave the therapeutic decision to the provider and her patient, and maintain consistency with current jurisprudence. This Comment examines litigation from California's attempted ban on sexual orientation change therapy to illustrate the conflicts created by the current approach to First Amendment review of health care provider speech. This Comment then demonstrates the benefit of the proposed single-prong approach, including how it simultaneously protects patients from harm while protecting health care providers' speech.
Keywords: medical cannabis; article; civil rights; commercial phenomena; female; firearm; government; health care personnel; homosexuality; human; legal abortion; legal aspect; methodology; pregnancy; psychological aspect; psychotherapy; quackery; speech; United States

Influences on loneliness, depression, sexual-risk behaviour and suicidal ideation among Thai transgender youth - Yadegarfard, M.; Ho, R.; Bahramabadian, F. (Culture, health & sexuality, 2013)
This study examined the influence of age, education level and number of sex partners on levels of loneliness, depression, suicidal ideation and sexual-risk behaviour in Thai male-to-female transgender youth. A total of 190 participants filled in the study's questionnaire, designed to tap the primary variables of age, level of education, number of sex partners, loneliness, depression, suicidal ideation and sexual-risk behaviour. Results reveal that level of education has a significant influence on depression and loneliness, the number of sex partners has a significant influence on sexual-risk behaviour and suicidal ideation and age has a significant influence on sexual-risk behaviour and suicidal ideation. Participants with higher levels of education reported more loneliness than participants who did not graduate from high school. In addition, participants who did not graduate from high school reported more depression than participants with some university credit. Furthermore, participants aged 15 to 19 years, compared with those of 20 to 25 years, reported higher level of sexual-risk behaviour and higher levels of suicidal ideation.
Keywords: adolescent; age; analysis of variance; depression; education; human; loneliness; male; psychology; questionnaire; sexuality; suicidal ideation; Thailand; transgender; unsafe sex; young adult

Partner violence and health among HIV-infected jail detainees - Meyer, J.P.; Wickersham, J.A.; Fu, J.J.; Brown, S.-E.; Sullivan, T.P.; Springer, S.A.; Altice, F.L. (International journal of prisoner health, 2013)
PURPOSE: Little is known about the association of intimate partner violence (IPV) with specific HIV-treatment outcomes, especially among criminal justice (CJ) populations who are disproportionately affected by IPV, HIV, mental, and substance use disorders (SUDs) and are at high risk of poor post-release continuity of care. DESIGN/METHODOLOGY/APPROACH: Mixed methods were used to describe the prevalence, severity, and correlates of lifetime IPV exposure among HIV-infected jail detainees enrolled in a novel jail-release demonstration project in Connecticut. Additionally, the effect of IPV on HIV treatment outcomes and longitudinal healthcare utilization was examined. FINDINGS: Structured baseline surveys defined 49 percent of 84 participants as having significant IPV exposure, which was associated with female gender, longer duration since HIV diagnosis, suicidal ideation, having higher alcohol use severity, having experienced other forms of childhood and adulthood abuse, and homo/bisexual orientation. IPV was not directly correlated with HIV healthcare utilization or treatment outcomes. In-depth qualitative interviews with 20 surveyed participants, however, confirmed that IPV was associated with disengagement from HIV care especially in the context of overlapping vulnerabilities, including transitioning from CJ to community settings, having untreated mental disorders, and actively using drugs or alcohol at the time of incarceration. ORIGINALITY/VALUE: Post-release interventions for HIV-infected CJ populations should minimally integrate HIV secondary prevention with violence reduction and treatment for SUDs.
Keywords: adult; alcoholism; Connecticut; cross-sectional study; female; health service; health status; Human immunodeficiency virus infection; human; interview; male; mental disease; middle aged; partner violence; prevalence; correctional facility; prisoner; psychology; severity of illness index; sex difference; sexuality; statistics and numerical data; time factor; utilization

HIV risk, substance use, and suicidal behaviors among Asian American lesbian and bisexual women - Lee, J.; Hahm, H.C. (AIDS Education and Prevention, 2012)
The authors examined the association between lesbian/bisexual identity and three risky health behaviors (HIV risk, substance use, and suicidal behaviors) in a sample of Asian American women. This cross-sectional study was designed to investigate the prevalence of HIV risk behaviors and mental health functioning among unmarried Chinese, Korean, and Vietnamese women ages 18 to 35 who are children of immigrants (N = 701), using computer-assisted survey interviews (CASI). Approximately one out of five Asian American women in the sample identified themselves as a lesbian and bisexual woman (18%). Overall, Asian American lesbian and bisexual women reported higher proportions of risky health behaviors than did their exclusively heterosexual counterparts. The odds of engaging in HIV risk behaviors, using substances, and experiencing suicidal ideation were two to three times higher for lesbian and bisexual women than for exclusively heterosexual women. These findings suggest that rigorous screening is necessary for identifying women in this lesbian/bisexual subgroup in order to provide them with better assessment and services. © 2012 The Guilford Press.
Keywords: adult; article; Asian American; bisexual female; cross-sectional study; ethnicity; female; health survey; high risk behavior; human; Human immunodeficiency virus infection; immigrant; infection risk; interview; homosexual female; major clinical study; mental health care; mental health service; prevalence; sexual behavior; sexual orientation; substance abuse; suicidal behavior; suicide attempt

More than half a million California adults seriously thought about suicide in the past year. - Grant, D.; Caldwell, J.; Padilla-Frausto, D.I.; Aydin, M.; Aguilar-Gaxiola, S. (Policy brief (UCLA Center for Health Policy Research), 2012)
In 2009, nearly 2.4 million adults in California reported having seriously thought about suicide during their lifetimes. Among these adults, more than half a million had thought seriously about suicide sometime during the past year. Members of sexual minorities were almost three times as likely as all adults in California to have had suicidal thoughts during the past year. This policy brief, based on data from the 2009 California Health Interview Survey (CHIS), presents a comprehensive overview of risk factors associated with suicidal thoughts among adults ages 18 and older and highlights differences in suicidal ideation among demographic groups and geographic regions in California.
Keywords: adolescent; adult; American Indian; article; demography; Eskimo; health care survey; health status; human; mental health service; minority group; psychological aspect; risk factor; statistics; suicidal ideation; suicide; United States

Gender identity disorders in Iran; request for sex reassignment surgery - Aghabikloo, A.; Bahrami, M.; Saberi, S.M.; Emamhadi, M.A. (International Journal of Medical Toxicology and Forensic Medicine, 2012)
Background: Based on reports of the Tehran Legal Medicine Organization (LMO), requests for sex change operation by persons with Gender identity disorder (GID) have increased in the past few years in Iran. Due to the social and legal ramification of transsexualism, we decided to perform a study to assess the demographic status and legal aspects of Iranian Transsexuals who were applicants for sex reassignment surgery (SRS). Method: The total number of 69 cases with GID who requested sex change by surgery was assessed during a period of four years (2005-2009) in Tehran. Descriptive statistical methods and Chi square were used to analyze the data. Results: There were 44 male-to-female and 25 female-tomale Transsexuals with a mean age of 25 years. Out of 69 requests for sex change, transsexualism was confirmed in 61 cases and the remaining 8 cases had other Psychiatric disorders manifested by identity confusion. The onset of symptoms had developed in childhood (<10 y) in nearly 70% of patients. Depression was found in about 26% of cases. Eighteen cases (26%) had a history of suicide attempts. Among individuals with final diagnosis of Transsexualism, request of 93% was accepted for SRS. Conclusion: This study showed dominancy in Male to Female Transsexuals (1.7/1). Depression was the most common psychiatric disorder associated with Transsexualism. The article also showed that recently transsexualism accepted by community and country low more than before ©2012 Forensic Medicine and Toxicology Department.
Keywords: addiction; adult; anxiety disorder; article; confusion; cross-sectional study; demography; depression; DSM-IV; eating disorder; echography; educational status; employment status; female; female to male transgender; gender dysphoria; gender identity; hormonal therapy; human; Iran; karyotype 47,XXY; Klinefelter syndrome; legal aspect; major clinical study; male; male to female transgender; medical history; mood disorder; onset age; patient history of orchiectomy; personality disorder; phenotype; pseudohermaphroditism; psychologic test; schizophrenia; sex reassignment; sex transformation; sexual behavior; single parent; somatoform disorder; suicide attempt; transsexualism; transsexuality

Long-term cross-sex hormone treatment is safe in transsexual subjects - Meriggiola, M.C.; Berra, M. (Asian Journal of Andrology, 2012)
The European Journal of Endocrinology recently published a paper (Asscheman et al.) presenting mortality data from more than a thousand transsexuals followed for a median time of 18 years and who had undergone previous or were currently on long term cross-sex hormonal treatment. Transsexualism is a rare condition and in scientific literature there are few reports on the long-term safety of different treatment protocols and on the physical and psychological outcomes of medical treatments. The safety of long-term high doses oestrogen or testosterone in subjects of the opposite sex has been debated and data on long term effects are scant at best. The Asscherman paper therefore represents a very important and reassuring reference for professionals working in this field suggesting that mortality is increased among transsexuals although due to causes unrelated to cross sex replacement therapy. These results will benefit the care and treatment of these subjects. © 2012 AJA, SIMM & SJTU. All rights reserved.
Keywords: conjugated estrogen; ethinylestradiol; illicit drug; testosterone; acquired immune deficiency syndrome; article; cardiovascular mortality; cardiovascular risk; drug safety; evidence based medicine; female to male transgender; follow up; gender dysphoria; genetic polymorphism; genetic predisposition; hormonal therapy; human; male to female transgender; quality of life; sex reassignment; smoking; suicide; surgery; thromboembolism; thrombophilia

When Christianity and Homosexuality Collide: Understanding the Potential Intrapersonal Conflict - Subhi, N.; Geelan, D. (Journal of Homosexuality, 2012)
Reconciling sexual orientation with religious and spiritual beliefs can be challenging for Christian homosexuals, since many Christian churches teach that homosexual behavior is sinful. A qualitative study of 10 male and 10 female Christian homosexuals was conducted via semistructured interviews. This article seeks to explore the potential conflict between Christianity and homosexuality faced by the respondents. Participants' life stories and experiences varied widely. A few respondents were unaffected by the potential conflict between Christianity and homosexuality, however, the majority were affected. Effects included depression, guilt, anxiety, suicidal ideation, and alienation. Implications of the findings for support personnel are included. © 2012 Copyright Taylor & Francis Group, LLC.
Keywords: adult; article; conflict; female; homosexuality; human; interview; homosexual female; male; middle aged; psychological aspect; religion

Correlates of depressed mood among young stimulant-using homeless gay and bisexual men - Nyamathi, A.; Branson, C.; Idemundia, F.; Reback, C.; Shoptaw, S.; Marfisee, M.; Keenan, C.; Khalilifard, F.; Liu, Y.; Yadav, K. (Issues in Mental Health Nursing, 2012)
Homeless gay and bisexual (G/B) men are at risk for suicide attempts and have high risk of depressed mood, defined as elevated level of depressive symptoms. This study describes baseline socio-demographic, cognitive, psychosocial, and health- and drug-related correlates of depressed mood in 267 stimulant-using homeless G/B young men who entered a study designed to reduce drug use. G/B men without social support were 11 times more likely to experience depressed mood than their counterparts who had support; those who reported severe body pain were almost six times more likely to report depressed mood than those without pain. Other factors that increased risk of depressed mood included being homeless in the last four months, injecting drugs, reporting poor or fair health status, and high levels of internalized homophobia. This study is one of the first studies to draw a link between pain experienced and depressed mood in homeless young G/B men. Understanding the correlates of depressed mood among homeless G/B young men can help service providers design more targeted treatment plans and provide more appropriate referrals to ancillary care services. © 2012 Informa Healthcare USA, Inc.
Keywords: cocaine; methamphetamine; adolescent; adult; article; attitude to health; bisexuality; cocaine dependence; cross-sectional study; depression; drug abuse; homelessness; homosexuality; human; male; middle aged; multivariate analysis; pain; psychological aspect; risk factor; social support; statistical model; statistics; suicide; United States

Suicidal ideation and sexual orientation in college students: the roles of perceived burdensomeness, thwarted belongingness, and perceived rejection due to sexual orientation. - Hill, R.M.; Pettit, J.W. (Suicide & life-threatening behavior, 2012)
A theoretical model in which perceived burdensomeness and thwarted belongingness were hypothesized to account for the association between sexual orientation and suicidal ideation among college students was tested. Among 198 college students (mean age 21.28 years), gay, lesbian, and bisexual students (n = 50) reported significantly higher levels of perceived burdensomeness and suicidal ideation than heterosexual students. The relationship between sexual orientation and suicidal ideation was partially accounted for by perceived burdensomeness, but not thwarted belongingness. This indirect effect was stronger at higher levels of perceived or anticipated rejection due to one's sexual orientation. Implications for intervention and prevention science are discussed. © 2012 The American Association of Suicidology.
Keywords: adolescent; adult; article; attitude; bisexuality; comparative study; female; homosexuality; human; homosexual female; male; middle aged; psychological aspect; psychological model; questionnaire; sexuality; student; suicidal ideation

Mediating suicide: print journalism and the categorization of queer youth suicide discourses. - Cover, R. (Archives of sexual behavior, 2012)
This article undertakes textual analysis to examine some of the ways in which knowledge around sexuality-related youth suicide and its causes are produced and made available through news media discourses and news-making processes. Four categories of sexuality-related suicide discourses were identified in news stories and features over the past 20 years: statistical research that makes non-heterosexuality implicit as a cause of suicide; stories about deviancy,guilt, and shame; suicide survivor stories; and bullying/harassment of non-heterosexual persons by individuals in schools and other institutions as suicide cause. Through processes of news production and meaning-making, use of expert opinions of primary definers, experiential accounts, reliance on citations of quantitative data, private accounts given as entertainment, and the newsworthiness of suicide as drama, public knowledge on queer youth suicide is guided by contemporary journalism. In all cases, the underlying relationship between heteronormativity, mental health, depression, and despair were frequently excluded in news journalism on queer youth suicide.
Keywords: adolescent; adult; article; bisexuality; bullying; depression; female; guilt; homosexuality; human; male; mass medium; psychological aspect; publication; sexuality; shame; statistics; suicide

Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska natives - Evans-Campbell, T.; Walters, K.L.; Pearson, C.R.; Campbell, C.D. (American Journal of Drug and Alcohol Abuse, 2012)
Background: Systematic efforts of assimilation removed many Native children from their tribal communities and placed in non-Indian-run residential schools. Objectives: To explore substance use and mental health concerns among a community-based sample of 447 urban two-spirit American Indian/Alaska Native adults who had attended boarding school as children and/or who were raised by someone who attended boarding school. Method: Eighty-two respondents who had attended Indian boarding school as children were compared to respondents with no history of boarding school with respect to mental health and substance use. Results: Former boarding school attendees reported higher rates of current illicit drug use and living with alcohol use disorder, and were significantly more likely to have attempted suicide and experienced suicidal thoughts in their lifetime compared to non-attendees. About 39% of the sample had been raised by someone who attended boarding school. People raised by boarding school attendees were significantly more likely to have a general anxiety disorder, experience posttraumatic stress disorder symptoms, and have suicidal thoughts in their lifetime compared to others. © 2012 Informa Healthcare USA, Inc.
Keywords: illicit drug; adult; alcoholism; American Indian; article; boarding school; correlation analysis; drug abuse; female; generalized anxiety disorder; human; major clinical study; male; mental health; posttraumatic stress disorder; school; substance abuse; suicidal ideation; suicide attempt; urban population

Leave to Intervene in Cases of Gender Identity Disorder; Normative Causation; Financial Harms and Involuntary Treatment; and the Right to Be Protected From Suicide - Stewart, C.; Cockburn, T.; Madden, B.; Callaghan, S.; Ryan, C.J. (Journal of Bioethical Inquiry, 2012)
Keywords: adult; article; Australia; child; ethics; female; forensic psychiatry; human; informed consent; legal aspect; male; middle aged; patient right; suicide; transsexualism

Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity - McLaughlin, K.A.; Hatzenbuehler, M.L.; Xuan, Z.; Conron, K.J. (Child Abuse and Neglect, 2012)
Objectives: Lesbian, gay, and bisexual (LGB) populations exhibit elevated rates of psychiatric disorders compared to heterosexuals, and these disparities emerge early in the life course. We examined the role of exposure to early-life victimization and adversity-including physical and sexual abuse, homelessness, and intimate partner violence-in explaining sexual orientation disparities in mental health among adolescents and young adults. Methods: Data were drawn from the National Longitudinal Study of Adolescent Health, Wave 3 (2001-2002), a nationally representative survey of adolescents. Participants included gay/lesbian (. n=. 227), bisexual (. n=. 245), and heterosexual (. n=. 13,490) youths, ages 18-27. We examined differences in the prevalence of exposure to child physical or sexual abuse, homelessness or expulsion from one's home by caregivers, and physical and sexual intimate partner violence according to sexual orientation. Next we examined the associations of these exposures with symptoms of psychopathology including suicidal ideation and attempts, depression, binge drinking, illicit drug use, tobacco use, alcohol abuse, and drug abuse. Finally, we determined whether exposure to victimization and adversity explained the association between sexual orientation and psychopathology. Results: Gay/lesbian and bisexual respondents had higher levels of psychopathology than heterosexuals across all outcomes. Gay/lesbian respondents had higher odds of exposure to child abuse and housing adversity, and bisexual respondents had higher odds of exposure to child abuse, housing adversity, and intimate partner violence, than heterosexuals. Greater exposure to these adversities explained between 10 and 20% of the relative excess of suicidality, depression, tobacco use, and symptoms of alcohol and drug abuse among LGB youths compared to heterosexuals. Exposure to victimization and adversity experiences in childhood and adolescence significantly mediated the association of both gay/lesbian and bisexual orientation with suicidality, depressive symptoms, tobacco use, and alcohol abuse. Conclusions: Exposure to victimization in early-life family and romantic relationships explains, in part, sexual orientation disparities in a wide range of mental health and substance use outcomes, highlighting novel targets for preventive interventions aimed at reducing these disparities. © 2012 Elsevier Ltd.
Keywords: adolescent; adolescent health; adult; alcohol abuse; article; binge drinking; bisexuality; child abuse; child physical abuse; child sexual abuse; child welfare; controlled study; depression; drinking behavior; drug abuse; early life stress; female; health disparity; homelessness; human; homosexual female; longitudinal study; male; homosexual male; mental disease; mental health; partner violence; sexual orientation; suicidal ideation; suicide attempt; tobacco dependence

Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men - Greacen, T.; Friboulet, D.; Fugon, L.; Hefez, S.; Lorente, N.; Spire, B. (Sexually Transmitted Infections, 2012)
Objectives: Although not authorised in France, HIV self-tests are easily available online. The authors questioned French-speaking internet-using men who have sex with men (MSM) concerning their access to and use of such tests. Methods: Online questionnaire on sex websites and gay and HIV community websites. A multivariate logistic regression for rare events was used to identify factors associated with accessing self-tests. Results: 9169 MSM completed the questionnaire. 2748 (30%) were aware of online self-tests, but only 82 of those aware and not already HIV positive (3.5%) declared having accessed one and only 69 using it. In the multivariate model, living one's sex-life with men in absolute secrecy (odds ratio (OR)=3.90, 95% CI 1.73 to 8.76), knowing of the tests via a sex partner (OR=3.42, CI 1.39 to 8.41) or an internet search engine (OR=2.18, CI 1.26 to 3.74) but not through the general (OR=0.21, CI 0.11 to 0.42) or the gay press (OR=0.34, CI 0.16 to 0.73), having unprotected anal intercourse with a casual partner in the preceding year (OR=1.90, CI 1.17 to 3.06), using self-tests for other diseases (OR=2.66, CI 1.43 to 4.90), using poppers (OR=2.23, CI 1.35 to 3.67) and doping products (OR=3.53, CI 1.55 to 8) in the preceding year, having done a traditional HIV test but not in the preceding year (OR=1.93, CI 1.14 to 3.32), never having had suicidal thoughts (OR=0.54, CI 0.32 to 0.90) and living in the provinces (OR=1.80, CI 1.01 to 3.25) were all independently associated with accessing self-tests. Conclusions: Although readiness to admit use of unauthorised medical products may have influenced results, few MSM aware of the existence of self-tests actually declared having accessed one. Accessing the self-test was independently associated with both living one's sex-life with men in total secrecy and having had unprotected anal intercourse in the last 12 months, indicating that autonomous self-testing may reduce barriers to testing for this vulnerable population.
Keywords: adult; anal intercourse; article; awareness; bisexual male; controlled study; demography; diagnostic test accuracy study; doping; France; health care access; HIV self test; HIV test; human; Human immunodeficiency virus; Human immunodeficiency virus infection; Internet; major clinical study; male; homosexual male; multicenter study; multivariate analysis; online system; priority journal; questionnaire; rare disease; risk factor; self evaluation; sexual behavior; sexuality; suicide attempt; web browser

Smoking and behavioral health of women - Jessup, M.A.; Dibble, S.L.; Cooper, B.A. (Journal of Women's Health, 2012)
Background: Using data from a study of reliability and validity of a screening tool for co-occurring substance abuse and mental health problems, our objective was to compare behavioral health issues of female smokers and nonsmokers and explore correlates of smoking. Methods: Using a convenience sample (n=1021), we recruited participants to complete an online survey conducted in substance abuse treatment, primary care, mental health services, senior, and public settings. The survey included demographic questions, smoking status, the co-occurring disorders screening tool, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) and the Postraumatic Stress Disorder Checklist (PCL)-Civilian. Results: One third of participants self-identified as smokers, and African American, American Indian, and bisexual women reported the highest rates of smoking. Seventy-two percent of women reported at least one mental health problem in the past year; 29% had a past year substance abuse problem, and 26% reported a past year co-occurring disorder of both. Smokers had significantly higher rates of posttraumatic stress disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders. Smokers also had significantly higher rates of lifetime intimate partner violence (IPV) and childhood abuse. Conclusions: Smoking in women was associated with significantly higher rates of mental health and substance abuse problems. Substance abuse, being in a treatment setting, IPV, African American and mixed ethnicity, Medicaid insurance status, reduced income, and no home ownership were identified as predictors of smoking. Screening and evaluation of smoking status, mental health, substance use disorders, and the presence and impact of violence are essential for women's health. © 2012 Mary Ann Liebert, Inc.
Keywords: adult; African American; aged; American Indian; anxiety disorder; article; bisexuality; child abuse; cigarette smoking; controlled study; correlation analysis; demography; depression; discriminant validity; educational status; employment status; ethnicity; female; health behavior; health survey; human; income; major clinical study; medicaid; medicare; mental health service; Pacific Islander; partner violence; posttraumatic stress disorder; primary medical care; priority journal; questionnaire; rural area; scoring system; screening test; sexual abuse; sexual orientation; substance abuse; suicidal ideation; urban area; women's health

High levels of psychological distress in MSM are independent of HIV status. - Gibbie, T.M.; Mijch, A.; Hay, M. (Journal of health psychology, 2012)
This study assessed psychological distress (PD) in men who have sex with men (MSM) accessing primary health clinics in Australia. Relationships between PD, HIV status and substance use were explored. A cross-sectional convenience sample of 250 MSM completed the Personality Assessment Screener (PAS). One-third (n = 83) scored in the PAS clinically significant range, suggesting significant mental health symptoms. Negative Affect (27 per cent clinically significant), Suicidal Thinking (29 per cent clinically significant) and Amphetamine use significantly positively correlated with PD. There were no significant differences between HIV diagnostic groups on PD. A third of MSM displayed PD. Psychological screening may provide valuable information for improving the psychological well-being of MSM, regardless of their HIV status.
Keywords: addiction; adult; article; Australia; cross-sectional study; homosexuality; human; Human immunodeficiency virus infection; male; mental stress; psychological aspect; serodiagnosis; social class; suicidal ideation; United States

A study of changes in bone metabolism in cases of gender identity disorder - Miyajima, T.; Kim, Y.T.; Oda, H. (Journal of Bone and Mineral Metabolism, 2012)
The aim of this study was to determine the effect of increasing estrogen and decreasing androgen in males and increasing androgen and decreasing estrogen in females on bone metabolism in patients with gender identity disorder (GID). We measured and examined bone mineral density (BMD) and bone metabolism markers retrospectively in GID patients who were treated in our hospital. In addition, we studied the effects of treatment on those who had osteoporosis. Patients who underwent a change from male to female (MtF) showed inhibition of bone resorption and increased L2-4 BMD whereas those who underwent a change from female to male (FtM) had increased bone resorption and decreased L2-4 BMD. Six months after administration of risedronate to FtM patients with osteoporosis, L2-4 BMD increased and bone resorption markers decreased. These results indicate that estrogen is an important element with regard to bone metabolism in males. © The Japanese Society for Bone and Mineral Research and Springer 2012.
Keywords: alkaline phosphatase bone isoenzyme; amino terminal telopeptide; androgen; enarmon depot; estradiol; estrogen; ovahormon depot; pelanin depot; risedronic acid; testosterone; testosterone propionate; unclassified drug; adult; article; bone density; bone metabolism; clinical article; female; gender dysphoria; human; lumbar spine; male; male to female transgender; osteoporosis; priority journal; retrospective study; enarmon depot; ovahormon depot; pelanin depot

Psychological characteristics in high-risk MSM in China. - Chen, G.; Li, Y.; Zhang, B.; Yu, Z.; Li, X.; Wang, L.; Yu, Z. (BMC public health, 2012)
Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the behavioral, social and psychological characteristics in Chinese MSM, which makes the implementation of preventive and therapeutic strategies for this high-risk subpopulation of people extremely difficult. A total of 714 questionnaires were retrieved from the database of a Chinese government-sponsored National Key Research Project titled "Risk Analysis and Strategic Prevention of HIV Transmission from MSM to the General Population in China". The respondents were categorized into a high-risk group and a control group. Their behavioral, social and psychological characteristics were comparatively analyzed. Of the 714 MSM analyzed, 59 (8.26%) had high-risk homosexual behaviors. This sub-group of MSM had a higher in-marriage rate, a higher monthly income, heavier alcohol consumption and more serious problems with sexual abuse in childhood, intentional suicide attempts and mistaken assumption on condom's role in protecting HIV infection, as compared with the control group (P < 0.05). In contrast, the two groups did not differ significantly the sexual orientation, level of education, types of profession, drug use, condom use and experience of social stigma and discrimination (P > 0.05). A vast majority of the individuals in both behavior categories expressed support of legally protected gay clubs as well as gay marriage legislation in China. There was a strong correlation between high-risk behaviors and sexual abuse in childhood, alcohol drinking, income level and a mistaken belief in perfect HIV protection through the use of condoms. MSM with and without high-risk homosexual behaviors have different social and psychological characteristics, which should be taken into account when implementing behavioral and therapeutic interventions aimed at preventing HIV/AIDS transmission among MSM as well as from MSM to the general population in China.
Keywords: adult; article; China; comparative study; high risk behavior; homosexuality; human; Human immunodeficiency virus infection; male; psychological aspect; questionnaire

Correlates of consistent condom use among young migrant men who have sex with men (MSM) in Beijing, China - Liu, Y.; Li, X.; Zhang, L.; Li, S.; Jiang, S.; Stanton, B. (European Journal of Contraception and Reproductive Health Care, 2012)
Objectives The prevalence of sexually transmitted infections (STIs), including HIV, among men who have sex with men (MSM) has risen in China, mainly due to unprotected sexual intercourse. Migrant MSM might be more vulnerable to the risk of STIs/HIV because of their low socioeconomic status. This study aims at exploring the correlates of consistent condom use among young migrant MSM (aged 18-29 years) in Beijing. Methods Multivariate logistic regression analysis. Results The mean age of the sample was 23.7 years. Rural-to-urban migrant MSM accounted for 46% of the sample, and urban-to-urban migrant MSM for 54%. Of 307 migrant MSM, 178 (54%) reported having used a condom every time in the last three sexual episodes with both stable and casual sexual partners. Multivariate logistic regression analysis showed that MSM who had a low monthly income, had often experienced alcohol intoxication, did not use a condom at first sex, and had fewer lifetime male sexual partners were less likely to use condoms consistently. Conclusions Consistent condom use among young migrant MSM was relatively low and was associated with socioeconomic status and alcohol use. Future STIs/HIV prevention programmes should strengthen empowerment, access to condoms, and reduction of alcohol consumption within this socio-economically marginalised group. © 2012 The European Society of Contraception and Reproductive Health.
Keywords: adult; alcohol consumption; alcohol intoxication; article; China; condom; correlation analysis; depression; educational status; empowerment; health program; human; Human immunodeficiency virus infection; immigrant; lowest income group; major clinical study; male; homosexual male; multivariate logistic regression analysis; priority journal; prostitution; rural area; safe sex; sexual behavior; sexually transmitted disease; smoking; social status; suicidal ideation; unsafe sex; urban area

Antidepressant agents and suicide death among US department of veterans affairs patients in depression treatment - Valenstein, M.; Kim, H.M.; Ganoczy, D.; Eisenberg, D.; Pfeiffer, P.N.; Downing, K.; Hoggatt, K.; Ilgen, M.; Austin, K.L.; Zivin, K.; Blow, F.C.; McCarthy, J.F. (Journal of Clinical Psychopharmacology, 2012)
Background: Studies report mixed findings regarding antidepressant agents and suicide risks, and few examine suicide deaths. Studies using observational data can accrue the large sample sizes needed to examine suicide death, but selection biases must be addressed. We assessed associations between suicide death and treatment with the 7 most commonly used antidepressants in a national sample of Department of Veterans Affairs patients in depression treatment. Multiple analytic strategies were used to address potential selection biases. Methods: We identified Department of Veterans Affairs patients with depression diagnoses and new antidepressant starts between April 1, 1999, and September 30, 2004 (N = 502,179). Conventional Cox regression models, Cox models with inverse probability of treatment weighting, propensity-stratified Cox models, marginal structural models (MSM), and instrumental variable analyses were used to examine relationships between suicide and exposure to bupropion, citalopram, fluoxetine, mirtazapine, paroxetine, sertraline, and venlafaxine. Results: Crude suicide rates varied from 88 to 247 per 100,000 person-years across antidepressant agents. In multiple Cox models and MSMs, sertraline and fluoxetine had lower risks for suicide death than paroxetine. Bupropion had lower risks than several antidepressants in Cox models but not MSMs. Instrumental variable analyses did not find significant differences across antidepressants. DISCUSSION: Most antidepressants did not differ in their risk for suicide death. However, across several analytic approaches, although not instrumental variable analyses, fluoxetine and sertraline had lower risks of suicide death than paroxetine. These findings are congruent with the Food and Drug Administration meta-analysis of randomized controlled trials reporting lower risks for "suicidality" for sertraline and a trend toward lower risks with fluoxetine than for other antidepressants. Nevertheless, divergence in findings by analytic approach suggests caution when interpreting results. Copyright © 2012 by Lippincott Williams & Wilkins.
Keywords: amfebutamone; citalopram; fluoxetine; mirtazapine; paroxetine; sertraline; venlafaxine; adult; aged; article; cohort analysis; depression; female; human; major clinical study; male; priority journal; risk; suicide; systematic error

Gay children and suicidality: The importance of professional nurturance - McAndrew, S.; Warne, T. (Issues in Mental Health Nursing, 2012)
Suicidality among young people is a global concern, with international studies demonstrating an increased prevalence among young gay men. Being gay is not inevitably linked to mental illness, but growing up gay in a heterosexist society can compromise mental well being. This qualitative study, using free association narrative interviewing, offers an in-depth understanding of gay men's experience. One shared experience that emerged was "knowing and not knowing," the story of gay children growing up in a heterosexist society. This story provides valuable insights for mental health nurses becoming more attuned to the importance of providing professional nurturing of gay children. © 2012 Informa Healthcare USA, Inc.
Keywords: adult; article; attitude; awareness; heterosexuality; homosexuality; human; male; nurse patient relationship; psychoanalysis; psychoanalytic theory; psychological aspect; psychosexual development; self concept; social isolation; social psychology; social support; suicidal ideation; suicide; suicide attempt; verbal communication

A novel combination HIV prevention strategy: Post-exposure prophylaxis with contingency management for substance abuse treatment among methamphetamine- using men who have sex with men - Landovitz, R.J.; Fletcher, J.B.; Inzhakova, G.; Lake, J.E.; Shoptaw, S.; Reback, C.J. (AIDS Patient Care and STDs, 2012)
Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of contingency management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8h (range 12.5-68.0h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI +1-+3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM. © Copyright 2012, Mary Ann Liebert, Inc. 2012.
Keywords: emtricitabine plus tenofovir disoproxil; methamphetamine; adult; article; chlamydiasis; depression; drug exposure; drug safety; drug tolerability; drug withdrawal; feasibility study; follow up; gonorrhea; human; Human immunodeficiency virus infection; major clinical study; male; homosexual male; open study; outcome assessment; patient attitude; patient compliance; pilot study; post exposure prophylaxis; seroconversion; substance abuse; suicidal behavior; faintness; syphilis; treatment duration; truvada

Depression associated with antiretroviral drug therapy in HIV: Case report and overview - Kaestner, F.; Anneken, K.; Mostert, C.; Reichelt, D.; Rothermundt, M.; Evers, S.; Husstedt, I.W. (International Journal of STD and AIDS, 2012)
Summary: Depression is the main psychiatric symptom in patients living with HIV. Genetic predisposition, stress from disease as well as the antiretroviral therapy itself are discussed as pathogenic factors. We report a 35-year-old HIV-positive man suffering from bipolar disorder who developed major depression shortly after commercing combination antiretroviral therapy (cART) on three occasions. The first two times the patient ceased therapy autonomously, and the depression disappeared completely. The close connection between cART and major depression in the present case supports the depression-inducing potential of cART. Additionally, we present an overview of literature.
Keywords: abacavir; abacavir plus lamivudine plus zidovudine; amitriptyline; antiretrovirus agent; atazanavir; lamivudine; lamotrigine; mirtazapine; nelfinavir; perazine; ritonavir; venlafaxine; zidovudine; adult; anhedonia; antiretroviral therapy; antiviral therapy; article; bipolar disorder; case report; disease association; disease course; drug withdrawal; esophagus candidiasis; family history; fatigue; hiv associated colitis; hiv associated colitis; hiv associated thrombocytopenia; hiv associated thrombocytopenia; homosexuality; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major depression; male; neuropsychological test; pleura empyema; priority journal; psychosocial withdrawal; sleep disorder; suicidal ideation; treatment duration; treatment outcome

Unmet Mental Health and Substance Abuse Treatment Needs of Sexual Minority Elders - Jessup, M.A.; Dibble, S.L. (Journal of Homosexuality, 2012)
In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55-64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed. © 2012 Taylor and Francis Group, LLC.
Keywords: addiction; aged; article; bisexuality; female; health service; health survey; homosexuality; human; homosexual female; male; mental disease; mental health service; middle aged; minority group; psychologic test; psychological aspect; questionnaire; reproducibility; sexuality; utilization review; validation study

Hormone treatment of gender identity disorder in a cohort of children and adolescents - Hewitt, J.K.; Paul, C.; Kasiannan, P.; Grover, S.R.; Newman, L.K.; Warne, G.L. (Medical Journal of Australia, 2012)
Objective: To describe the experience of hormone treatment of gender identity disorder (GID) in children and adolescents within a specialist clinic. Design, patients and setting: Cohort study by medical record review of children aged 0-17 years referred during 2003-2011 for management at the GID clinic in a tertiary paediatric referral centre - the Royal Children's Hospital, Melbourne, Victoria. Main outcome measures: Clinical characteristics of the patient population, hormone treatment provided, frequency of referrals with time. Results: Thirty-nine children and adolescents were referred for gender dysphoria. Seventeen individuals were pubertal with persistent GID, and were considered eligible for hormone treatment. Seven patients, comprising three biological males and four biological females, had legally endorsed hormone treatment. In this group, gender dysphoria was first noted at 3-6 years of age. Hormone treatment with GnRH analogue to suppress pubertal progression (phase 1) was given at 10-16 years of age. Treatment with cross-sex hormones (phase 2) was given at 15.6-16 years. One patient purchased cross-sex hormone treatment overseas. One patient received oestrogen and progesterone for menstrual suppression before phase 1. The annual frequency of new referrals increased continuously over the study period. Conclusions: Hormone treatment for pubertal suppression and subsequent gender transition needs to be individualised within stringent protocols in multidisciplinary specialist units.
Keywords: estrogen; gonadorelin derivative; medroxyprogesterone acetate; progesterone; sex hormone; adolescence; adolescent; anxiety disorder; article; Asperger syndrome; child; child psychiatry; clinical article; cohort analysis; controlled study; depression; family history; female; gender dysphoria; gender dysphoria; hormonal therapy; human; infant; male; medical record review; obsession; preschool child; psychosexual development; puberty disorders; school child; suicidal ideation

Cyber and bias-based harassment: Associations with academic, substance use, and mental health problems - Sinclair, K.O.; Bauman, S.; Poteat, V.P.; Koenig, B.; Russell, S.T. (Journal of Adolescent Health, 2012)
Purpose: To examine how two forms of interstudent harassment, cyber and bias-based harassment, are associated with academic, substance use, and mental health problems. Methods: We used a population-based survey of 17,366 middle and high school students that assessed harassment due to race/ethnicity or sexual orientation, and harassment through the Internet or text messaging along with other forms of interstudent harassment. Results: Odds ratios indicated that students experiencing both cyber and bias-based harassment were at the greatest risk for adjustment problems across all indicators, with suicidal ideation and attempts having the largest risk differences. Conclusions: Assessments of adolescent health and adjustment should include questions regarding both cyber and bias-based harassment. © 2012 Society for Adolescent Health and Medicine.
Keywords: academic achievement; article; bias based harassment; Caucasian; online harassment; female; high school student; human; homosexual female; male; homosexual male; mental disease; middle school student; population research; priority journal; sex difference; sexual harassment; social problem; substance abuse; suicidal ideation; suicide attempt; transsexualism

Development stage-specific proteomic profiling uncovers small, lineage specific proteins most abundant in the Aspergillus Fumigatus conidial proteome - Suh, M.-J.; Fedorova, N.D.; Cagas, S.E.; Hastings, S.; Fleischmann, R.D.; Peterson, S.N.; Perlin, D.S.; Nierman, W.C.; Pieper, R.; Momany, M. (Proteome Science, 2012)
Background: The pathogenic mold Aspergillus fumigatus is the most frequent infectious cause of death in severely immunocompromised individuals such as leukemia and bone marrow transplant patients. Germination of inhaled conidia (asexual spores) in the host is critical for the initiation of infection, but little is known about the underlying mechanisms of this process.Results: To gain insights into early germination events and facilitate the identification of potential stage-specific biomarkers and vaccine candidates, we have used quantitative shotgun proteomics to elucidate patterns of protein abundance changes during early fungal development. Four different stages were examined: dormant conidia, isotropically expanding conidia, hyphae in which germ tube emergence has just begun, and pre-septation hyphae. To enrich for glycan-linked cell wall proteins we used an alkaline cell extraction method. Shotgun proteomic resulted in the identification of 375 unique gene products with high confidence, with no evidence for enrichment of cell wall-immobilized and secreted proteins. The most interesting discovery was the identification of 52 proteins enriched in dormant conidia including 28 proteins that have never been detected in the A. fumigatus conidial proteome such as signaling protein Pil1, chaperones BipA and calnexin, and transcription factor HapB. Additionally we found many small, Aspergillus specific proteins of unknown function including 17 hypothetical proteins. Thus, the most abundant protein, Grg1 (AFUA_5G14210), was also one of the smallest proteins detected in this study (M.W. 7,367). Among previously characterized proteins were melanin pigment and pseurotin A biosynthesis enzymes, histones H3 and H4.1, and other proteins involved in conidiation and response to oxidative or hypoxic stress. In contrast, expanding conidia, hyphae with early germ tubes, and pre-septation hyphae samples were enriched for proteins responsible for housekeeping functions, particularly translation, respiratory metabolism, amino acid and carbohydrate biosynthesis, and the tricarboxylic acid cycle.Conclusions: The observed temporal expression patterns suggest that the A. fumigatus conidia are dominated by small, lineage-specific proteins. Some of them may play key roles in host-pathogen interactions, signal transduction during conidial germination, or survival in hostile environments. © 2012 Suh et al.; licensee BioMed Central Ltd.
Keywords: amino acid; Aspergillus fumigatus protein; cell membrane protein; fungal protein; histone H3; histone H4; melanin; protein Grg1; pseurotin A; tricarboxylic acid; unclassified drug; article; carbohydrate synthesis; conidium; fungal development; fungal spore germination; fungus hyphae; hypoxia; nonhuman; oxidative stress; protein analysis; protein expression; protein function; protein secretion; proteomics; respiratory function

Mental health in violent crime victims: Does sexual orientation matter? - Cramer, R.J.; McNiel, D.E.; Holley, S.R.; Shumway, M.; Boccellari, A. (Law and human behavior, 2012)
The present study investigates victim sexual orientation in a sample of 641 violent crime victims seeking emergency medical treatment at a public-sector hospital. Victim sexual orientation was examined as it: (a) varies by type of violent crime and demographic characteristics, (b) directly relates to psychological symptoms, and (c) moderates the relationship between victim and crime characteristics (i.e., victim gender, victim trauma history, and type of crime) and psychological symptoms (i.e., symptoms of acute stress, depression, panic, and general anxiety). Results showed that lesbian, gay, bisexual, and transgender (LGBT) victims were more likely to be victims of sexual assault. Heterosexual victims were more likely to be victims of general assault and shootings. LGBT victims demonstrated significantly higher levels of acute stress and general anxiety. Moreover, victim sexual orientation moderated the association of type of crime with experience of panic symptoms. Also, victim sexual orientation moderated the relation of victim trauma history and general anxiety symptoms. Results are discussed in relation to victimization prevalence rates, sexual prejudice theory, and assessment and treatment of violent crime victims.
Keywords: adult; article; crime; female; human; interview; male; mental health; middle aged; psychological aspect; questionnaire; sexual behavior; United States; violence

Longitudinal predictors of past-year non-suicidal self-injury and motives among college students. - Wilcox, H.C.; Arria, A.M.; Caldeira, K.M.; Vincent, K.B.; Pinchevsky, G.M.; O'Grady, K.E. (Psychological medicine, 2012)
Non-suicidal self-injury (NSSI) is the deliberate and direct injuring of body tissue without suicidal intent for purposes not socially sanctioned. Few studies have examined the correlates of NSSI among young adults. This study aimed to identify predictors of lifetime and past-year NSSI, and describe motives for NSSI and disclosure of NSSI to others. Interviews were conducted annually with 1081 students enrolled in the College Life Study, a prospective longitudinal study conducted at a large public mid-Atlantic university. NSSI characteristics were assessed at Year 4. Demographic and predictor variables were assessed during Years 1 to 4. Multivariate logistic regression models were used to identify correlates of lifetime NSSI and predictors of past-year NSSI. The prevalence of past-year and lifetime NSSI was 2% and 7% respectively (>70% were female for both lifetime and past-year NSSI). Seven percent of NSSI cases self-injured once, whereas almost half self-injured six or more times. Independent predictors of past-year NSSI were maternal depression, non-heterosexual orientation, affective dysregulation and depression. Independent predictors of lifetime NSSI were depression, non-heterosexual orientation, paternal depression and female sex. One in six participants with NSSI had attempted suicide by young adulthood. The three most commonly reported motives for NSSI were mental distress, coping and situational stressors. Most (89%) told someone about their NSSI, most commonly a friend (68%). This study identified unique predictors of NSSI, which should help to elucidate its etiology and has implications for early identification and interventions.
Keywords: adolescent; adult; article; automutilation; child; family relation; female; human; male; mental disease; motivation; multivariate analysis; prospective study; psychologic test; psychological aspect; risk factor; sexual behavior; social support; statistical model; statistics; student; suicidal ideation; United States; university

Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco - Shields, J.P.; Whitaker, K.; Glassman, J.; Franks, H.M.; Howard, K. (Journal of Adolescent Health, 2012)
Purpose: This study investigated the association between sexual orientation, victimization, and suicide risk-related outcomes among youth attending public high schools in San Francisco. Methods: Data from the 2009 Youth Risk Behavior Survey were analyzed using bivariate and logistic regression methods for complex samples to examine the relationship between sexual orientation, victimization, and three suicide risk-related outcomes (sadness/depression, suicide planning, and attempting suicide) while controlling for demographics and substance use. Results: Lesbian, gay, or bisexual (LGB) youth reported significantly higher rates of substance use, victimization, and suicide risk-related outcomes than heterosexual youth. However, in the controlled regression models, victimization was a significant predictor of sadness/depression and suicide attempts, regardless of sexual orientation. There was a significant interaction effect between sexual orientation and victimization on suicide planning, with heterosexual youth more affected than LGB youth. Conclusions: Results underscore the deleterious effect of victimization on suicide risk-related outcomes, regardless of sexual orientation. As LGB youth continue to report higher rates of victimization, effective violence prevention approaches must focus on reducing violence among youth, specifically LGB youth. Additional research should focus on identification of other factors that may help further explain elevated suicide risk among LGB youth. © 2012 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: article; bisexuality; depression; emotion; female; high school student; human; homosexual female; male; homosexual male; priority journal; risk assessment; sexual orientation; substance abuse; suicidal ideation; suicide; United States; victim; violence

Assessing gender identity concerns in children and adolescents: Evaluation, treatments, and outcomes - Leibowitz, S.F.; Telingator, C. (Current Psychiatry Reports, 2012)
Child and adolescent psychiatrists are increasingly evaluating youth who present with gender-nonconforming behaviors and identities. The lack of discipline-specific guidelines has made assessment and treatment of children and adolescents presenting with these concerns more difficult. Several new guidelines have recently been published, and research efforts are advancing to broaden the scope of understanding of gender identity assessment and treatment in children and adolescents. Familiarity with the latest standards of care, recent research advances, and current knowledge gaps is important to help improve clinical competency in treating mental health issues in this population. © Springer Science+Business Media, LLC 2012.
Keywords: estrogen; gonadorelin derivative; testosterone; article; attitude; child behavior; child parent relation; child sexual abuse; clinical evaluation; clinical research; clothing; cognition; depression; desistance gender; disease association; DSM-IV; evidence based medicine; family therapy; gender; gender dysphoria; gender identity; gender dysphoria; gender identity disorder not otherwise specified; health care need; help seeking behavior; hormonal therapy; hormone synthesis; human; interview; medical information; mental disease; mental health; mental health service; outcome assessment; patient satisfaction; persistence gender; play; practice guideline; prepubertal social transition; prepuberty; prevalence; psychoeducation; psychometry; risk factor; sex reassignment; sexuality; social competence; social support; suicidal ideation; suicide attempt; surgical technique; treatment indication

Suicidal ideation among sexual minority veterans: results from the 2005-2010 Massachusetts Behavioral Risk Factor Surveillance Survey. - Blosnich, J.R.; Bossarte, R.M.; Silenzio, V.M. (American journal of public health, 2012)
Suicide is a public health problem disproportionately associated with some demographic characteristics (e.g., sexual orientation, veteran status). Analyses of the Massachusetts Behavioral Risk Factor Surveillance Survey data revealed that more lesbian, gay, and bisexual (i.e., sexual minority) veterans reported suicidal ideation compared with heterosexual veterans. Decreased social and emotional support contributed to explaining the association between sexual minority status and suicidal ideation. More research is needed about suicide risk among sexual minority veterans; they might be a population for outreach and intervention by the Veterans Health Administration.
Keywords: adolescent; adult; article; bisexuality; chi square distribution; female; health survey; homosexuality; human; male; middle aged; psychological aspect; questionnaire; risk factor; statistical model; suicidal ideation; United States; veteran

Juvenile homosexual homicide. - Myers, W.C.; Chan, H.C. (Behavioral sciences & the law, 2012)
Limited information exists on juvenile homosexual homicide (JHH), that is, youths who perpetrate sexual homicides against same-sex victims. Only a handful of cases from the United States and internationally have been described in the literature. This study, the first of its kind, examines the epidemiology, victimology, victim-offender relationship, and weapon-use patterns in JHH offenders using a large U.S. database on homicide spanning three decades. The data for this study were derived from the Federal Bureau of Investigation's Supplementary Homicide Reports (SHRs) for the years 1976 through 2005. A total of 93 cases of JHH were identified. On average, three of these crimes occurred annually in the U.S., and there was a marked decline in its incidence over the study period. Ninety-five percent were male offender-male victim cases and 5% were female offender-female victim cases. JHH offenders were over-represented amongst all juvenile sexual murderers, similar to their adult counterparts. The majority of these boys were aged 16 or 17 and killed adult victims. They were significantly more likely to kill adult victims than other age groups, to be friends or acquaintances of the victims, and to use contact/edged weapons or firearms. Most offenders killed same-race victims, although Black offenders were significantly more likely than White offenders to kill interracially. A case report is provided to illustrate JHH. Further research is needed to promote our understanding of the pathogenesis, etiology, and associated risk factors for this aberrant form of murder by children. Copyright © 2012 John Wiley & Sons, Ltd.
Keywords: adolescent; adult; aged; article; child; factual database; female; homicide; homosexuality; human; juvenile delinquency; homosexual female; male; middle aged; preschool child; statistics; United States

Help seeking and treatment use among suicidal college students - Downs, M.F.; Eisenberg, D. (Journal of American College Health, 2012)
Objectives: Many suicidal college students do not receive mental health treatment, and the reasons for this are not fully understood. This study examines how attitudes, beliefs, and social network factors relate to help seeking among suicidal students. Participants: A random sample of 8,487 undergraduate and graduate students from 15 US universities participated. Methods: A Web-based survey administered in spring 2009 examined correlates of mental health service utilization among students reporting serious thoughts of suicide in the previous year (n = 543). Results: Correlates of treatment use included perceived need, beliefs that treatment is effective, contact with service users, lower personal stigma, higher perceived stigma, fewer positive relationships, and sexual minority or Caucasian identity. Conclusions: Help seeking among suicidal students is associated with a range of personal and social network factors. Campus strategies to enhance help seeking should be tailored to address identified facilitators and barriers to treatment use among target populations. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: adolescent; adult; article; attitude to health; female; health service; human; information processing; Internet; male; mental health service; patient attitude; psychological aspect; social stigma; social support; statistics; student; suicidal ideation; United States; university; utilization review

Drivers of disparity: Differences in socially based risk factors of self-injurious and suicidal behaviors among sexual minority college students - Blosnich, J.; Bossarte, R. (Journal of American College Health, 2012)
Lesbian, gay, and bisexual (ie, sexual minority) populations have increased prevalence of both self-injurious and suicidal behaviors, but reasons for these disparities are poorly understood. Objective: To test the association between socially based stressors (eg, victimization, discrimination) and self-injurious behavior, suicide ideation, and suicide attempt. Participants: A national sample of college-attending 18- to 24-year-olds. Methods: Random or census samples from postsecondary educational institutions that administered the National College Health Assessment during the Fall 2008 and Spring 2009 semesters. Results: Sexual minorities reported more socially based stressors than heterosexuals. Bisexuals exhibited greatest prevalence of self-injurious and suicidal behaviors. In adjusted models, intimate partner violence was most consistently associated with self-injurious behaviors. Conclusions: Sexual minorities elevated risks of self-injurious and suicidal behaviors may stem from higher exposure to socially based stressors. Within-group differences among sexual minorities offer insight to specific risk factors that may contribute to elevated self-injurious and suicidal behaviors in sexual minority populations. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: adult; article; automutilation; bisexuality; female; homosexuality; human; male; mental stress; minority group; psychological aspect; sexual behavior; social psychology; statistics; student; suicide attempt; United States; university; victim; violence

Men's sexual orientation and suicide: Evidence for U.S. adolescent-specific risk - Russell, S.T.; Toomey, R.B. (Social Science and Medicine, 2012)
There is strong consensus in the research literature that adolescent and adult men who report same-sex sexual orientations, identities, and behaviors are at higher risk for suicide. Recent studies of general adolescent suicide risk have identified developmental trajectories that peak during the teenage years. Because the adolescent years are characterized by the development and heightened awareness of gender roles and sexual scripts closely tied to dominant cultural ideals of masculinity and heterosexuality, an adolescent-focused developmental trajectory for suicide risk might be particularly relevant for males with adolescent same-sex sexual orientations. We provide the first prospective examination of adolescent-specific risk for suicidality based on adolescent same-sex sexual orientation using data from the United States, the National Longitudinal Study of Adolescent Health. Tracing suicide ideation and attempts across four assessments from adolescence (Wave 1 average age 15.3 years) to young adulthood (Wave 4 average age 28.2), we documented that the risk for suicidal thoughts and attempts for adolescent same-sex attracted males is developmental in nature. Specifically, the risk for suicidal thoughts and attempts for males with same-sex attractions is largely limited to the adolescent years. These results offer new insights for suicide prevention and intervention for male adolescents and adults with same-sex sexual orientations. © 2010 Elsevier Ltd.
Keywords: adolescent; adulthood; American Indian; article; Asian; controlled study; educational status; ethnic difference; heterosexuality; Hispanic; homosexuality; human; longitudinal study; male; Black person; normal human; prospective study; risk assessment; sexual orientation; suicidal ideation; suicide; suicide attempt; United States

Substance Use and Mental Health Disparities among Sexual Minority Girls: Results from the Pittsburgh Girls Study - Marshal, M.P.; Sucato, G.; Stepp, S.D.; Hipwell, A.; Smith, H.A.; Friedman, M.S.; Chung, T.; Markovic, N. (Journal of Pediatric and Adolescent Gynecology, 2012)
Purpose: To examine substance use and mental health disparities between sexual minority girls and heterosexual girls. Methods: Data from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms. Results: Compared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD, ODD, and CD symptoms. Conclusions: Sexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit. © 2012 North American Society for Pediatric and Adolescent Gynecology.
Keywords: adolescent; anxiety; article; borderline state; conduct disorder; controlled study; depression; female; health disparity; heterosexual female; human; mental disease; mental health; mental stress; minority group; oppositional defiant disorder; prevalence; priority journal; sexual minority girl; sexual orientation; substance abuse; suicidal behavior; suicidal ideation

Sexual Attraction and Trajectories of Mental Health and Substance Use During the Transition from Adolescence to Adulthood - Needham, B.L. (Journal of Youth and Adolescence, 2012)
Previous research suggests that sexual minority youth have poorer health-related outcomes than their heterosexual peers. The purpose of this study is to determine whether sexual orientation disparities in mental health and substance use increase, decrease, or remain the same during the transition from adolescence to adulthood. Data are from Waves 1-4 of the National Longitudinal Study of Adolescent Health (n = 8,322; 55% female). Respondents were in grades 7-12 at Wave 1 and aged 24-32 at Wave 4. Latent growth curve modeling is used to compare the mental health and substance use trajectories of youth who consistently report heterosexual attraction versus those who consistently report lesbian, gay, or bisexual (LGB) attraction, those who report a transition to LGB attraction, and those who report a transition to heterosexual attraction. Among women and men, sexual orientation disparities in depressive symptoms and suicidal thoughts persist, but do not increase, during the transition from adolescence to adulthood. The same pattern is observed for disparities in smoking, heavy drinking, and marijuana use among women. Among men, disparities in substance use are only observed between those who report consistent heterosexual attraction and those who transition to heterosexual attraction. Disparities between these groups persist over time for heavy drinking and marijuana use but decrease over time for smoking. While this study finds evidence of numerous disparities in mental health and substance use outcomes during adolescence and young adulthood, particularly among young women, there is no indication that these disparities get larger over time. © 2011 Springer Science+Business Media, LLC.
Keywords: addiction; adolescent; adult; anxiety; article; attitude to health; comorbidity; depression; female; health status; health survey; human; human relation; longitudinal study; male; mental health; psychological aspect; psychosexual development; questionnaire; sex ratio; sexuality; statistics; suicide attempt; United States

Reprint of: Bullying victimisation, self harm and associated factors in Irish adolescent boys - McMahon, E.M.; Reulbach, U.; Keeley, H.; Perry, I.J.; Arensman, E. (Social Science and Medicine, 2012)
School bullying victimisation is associated with poor mental health and self harm. However, little is known about the lifestyle factors and negative life events associated with victimisation, or the factors associated with self harm among boys who experience bullying. The objectives of the study were to examine the prevalence of bullying in Irish adolescent boys, the association between bullying and a broad range of risk factors among boys, and factors associated with self harm among bullied boys and their non-bullied peers. Analyses were based on the data of the Irish centre of the Child and Adolescent Self Harm in Europe (CASE) study (boys n=1870). Information was obtained on demographic factors, school bullying, deliberate self harm and psychological and lifestyle factors including negative life events. In total 363 boys (19.4%) reported having been a victim of school bullying at some point in their lives. The odds ratio of lifetime self harm was four times higher for boys who had been bullied than those without this experience. The factors that remained in the multivariate logistic regression model for lifetime history of bullying victimisation among boys were serious physical abuse and self esteem. Factors associated with self harm among bullied boys included psychological factors, problems with schoolwork, worries about sexual orientation and physical abuse, while family support was protective against self harm. Our findings highlight the mental health problems associated with victimisation, underlining the importance of anti-bullying policies in schools. Factors associated with self harm among boys who have been bullied should be taken into account in the identification of boys at risk of self harm. © 2010 Elsevier Ltd.
Keywords: abuse; academic achievement; adolescent; anxiety; article; automutilation; bullying; depression; family relation; human; impulsiveness; Ireland; life event; lifestyle; male; peer group; physical abuse; prevalence; psychological aspect; risk factor; self esteem; self report; sexual orientation; suicidal behavior

Gender dysphoria: Recognition and assessment - Eden, K.; Wylie, K.; Watson, E. (Advances in Psychiatric Treatment, 2012)
The role of the mental health professional, and of the psychiatrist in particular, is evolving and changing. As the recognition of transsexualism and gender identity disorder expands across the transgender spectrum, it has been recommended that gender dysphoria should replace existing diagnostic terminology. Patient-focused care is evolving and this ar ticle considers the limitations of current healthcare settings and how the mental health professional can support patients undergoing the real-life experience. Differentiation from other mental health conditions that may present as gender dysphoria is outlined, as well as specific clinical situations.
Keywords: article; comorbidity; disease association; educational status; gender dysphoria; health care facility; health practitioner; human; mental disease; mental health; patient care; personal experience; prevalence; psychiatrist; sexuality; stigma; suicide attempt; transsexualism

Sexual Minority Youth Victimization and Social Support: The Intersection of Sexuality, Gender, Race, and Victimization - Button, D.M.; O'Connell, D.J.; Gealt, R. (Journal of Homosexuality, 2012)
In comparison to heterosexual youth, sexual minority youth are more likely to experience victimization. Multiple studies have connected anti-gay prejudice and anti-gay victimization to negative outcomes. Research shows that social support may protect sexual minorities from the harmful effects of anti-gay victimization. However, rates of victimization and the negative outcomes linked to sexual identity within the sexual minority community have been relatively unexplored. Using data from three years of statewide data from heterosexual and sexual minority adolescents in grades 9-12, this study examines victimization, substance use, suicidality, and access to social support by sexuality. Results indicate that sexual minority youth are at increased risk for victimization, substance use, suicidality, and social isolation compared to their heterosexual counterparts. Results also indicate that there is very little bivariate difference within the sexual minority community. Multivariate results indicate differences among sexual minorities' experiences with victimization and substance use. © 2012 Taylor and Francis Group, LLC.
Keywords: addiction; adolescent; article; child; female; heterosexuality; homosexuality; human; male; minority group; psychological aspect; race; regression analysis; risk factor; sex difference; social isolation; social support; statistics; suicidal ideation; suicide attempt; United States; victim

Children and adolescents with gender identity disorder referred to a pediatric medical center - Spack, N.P.; Edwards-Leeper, L.; Feldman, H.A.; Leibowitz, S.; Mandel, F.; Diamond, D.A.; Vance, S.R. (Pediatrics, 2012)
OBJECTIVES: To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients. METHODS: Data gathered on 97 consecutive patients <21 years, with initial visits between January 1998 and February 2010, who fulfilled the following criteria: long-standing cross-gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity. RESULTS: Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 6 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%). CONCLUSIONS: After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation. Copyright © 2012 by the American Academy of Pediatrics.
Keywords: gonadorelin; adolescent; adult; age distribution; article; automutilation; child; cohort analysis; comorbidity; controlled study; disease course; doctor patient relationship; family counseling; female; female to male transgender; gender dysphoria; hormonal therapy; human; major clinical study; male; male to female transgender; mental health care; mental health care personnel; parental behavior; preschool child; priority journal; school child; sex determination; sex difference; suicide attempt

Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings - Diamond, G.M.; Diamond, G.S.; Levy, S.; Closs, C.; Ladipo, T.; Siqueland, L. (Psychotherapy, 2012)
The objective of this paper is to adapt attachment-based family therapy (ABFT) for use with suicidal lesbian, gay, and bisexual (LGB) adolescents and to obtain preliminary data on the feasibility and efficacy of the treatment with this population. In Phase I, a treatment development team modified ABFT to meet the unique needs of LGB suicidal youth. In Phase II, 10 suicidal LGB youth were offered 12 weeks of LGB sensitive ABFT. Adolescents' report of suicidal ideation, depressive symptoms, and maternal attachment-related anxiety and avoidance were gathered at pretreatment, 6 weeks, and 12 weeks (posttreatment). In Phase I, the treatment was adapted to: (a) include more individual time working with parents in order to process their disappointments, pain, anger, and fears related to their adolescent's minority sexual orientation; (b) address the meaning, implications, and process of acceptance; and (c) heighten parents' awareness of subtle yet potent invalidating responses to their adolescents' sexual orientation. Results of Phase II suggest this population can be recruited and successfully treated with a family based therapy, evidenced by high levels of treatment retention and significant decreases in suicidal ideation, depressive symptoms, and maternal attachment-related anxiety and avoidance. This is the first family-based treatment adapted and tested specifically for suicidal LGB adolescents. Though promising, the results are preliminary and more research on larger samples is warranted. © 2011 American Psychological Association.
Keywords: adolescent; adult; anger; anxiety disorder; article; attachment based family therapy; avoidance behavior; awareness; bisexuality; controlled study; depression; family therapy; fear; feasibility study; female; human; juvenile; homosexual female; major clinical study; male; homosexual male; open study; pain; parent; patient attitude; risk factor; self report; sexual orientation; suicidal ideation; suicide; suicide attempt; symptom; therapy effect; treatment duration

Self-Castration by a Transsexual Woman: Financial and Psychological Costs: A Case Report - St. Peter, M.; Trinidad, A.; Irwig, M.S. (Journal of Sexual Medicine, 2012)
Introduction. The out-of-pocket cost for an elective orchiectomy, which is often not covered by health insurance, is a significant barrier to male-to-female transsexuals ready to proceed with their physical transition. This and other barriers (lack of access to a surgeon willing to perform the operation, waiting times, and underlying psychological and psychiatric conditions) lead a subset of transsexual women to attempt self-castration. Little information has been published on the financial costs and implications of self-castration to both patients and health care systems. Aim. We compare the financial and psychological costs of elective surgical orchiectomy vs. self-castration in the case of a transsexual woman in her 40s. Methods. We interviewed the patient and her providers and obtained financial information from local reimbursement and billing specialists. Results. After experiencing minor hemorrhage following the self-castration, our patient presented to the emergency department and underwent a bilateral inguinal exploration, ligation and removal of bilateral spermatic cords, and complicated scrotal exploration, debridement, and closure. She was admitted to the psychiatric service for a hospital stay of three days. The total bill was US $14,923, which would compare with US $4,000 for an elective outpatient orchiectomy in the patient's geographical area. Conclusions. From a financial standpoint, an elective orchiectomy could have cost the health care system significantly less than a hospital admission with its associated additional costs. From a patient safety standpoint, elective orchiectomy is preferable to self-castration which carries significant risks such as hemorrhage, disfigurement, infection, urinary fistulae, and nerve damage. Healthcare providers of transsexual women should carefully explore patient attitudes toward self-castration and work toward improving access to elective orchiectomy to reduce the number of self-castrations and costs to the overall health care system. Further research on the financial implications of self-castration from different health care systems and from a series of patients is needed. © 2012 International Society for Sexual Medicine.
Keywords: benzodiazepine derivative; estradiol; lorazepam; ramelteon; selegiline; spironolactone; adult; article; bedtime dosage; bleeding; case report; castration; debridement; elective surgery; female; financial management; gender dysphoria; gender dysphoria; health care cost; health care system; hospital billing; hospitalization; human; major depression; male to female transgender; mental health service; orchiectomy; posttraumatic stress disorder; priority journal; punishment; reimbursement; sexual abuse; social phobia; spermatic cord; suicide attempt

Suicidality and sexual orientation among men in Switzerland: Findings from 3 probability surveys - Wang, J.; Häusermann, M.; Wydler, H.; Mohler-Kuo, M.; Weiss, M.G. (Journal of Psychiatric Research, 2012)
Few population-based surveys in Europe have examined the link between suicidality and sexual orientation. The objective of this study was to assess the prevalences of and risk for suicidality by sexual orientation, especially among adolescent and young adult men. Data came from three probability-based surveys in Switzerland from 2002: 1) Geneva Gay Men's Health Survey (GGMHS) with 571 gay/bisexual men, 2) Swiss Multicenter Adolescent Survey on Health (SMASH) with 7,428 16-20 year olds, and 3) Swiss Recruit Survey (ch-x) with 22,415 new recruits. In GGMHS, suicidal ideation (12 months/lifetime) was reported by 22%/55%, suicide plans 12%/38%, and suicide attempts 4%/19%. While lifetime prevalences and ratios are similar across age groups, men under 25 years reported the highest 12-month prevalences for suicidal ideation (35.4%) and suicide attempts (11.5%) and the lowest attempt ratios (1:1.5 for attempt to plan and 1:3.1 for attempt to ideation). The lifetime prevalence of suicide attempts among homo/bisexual men aged 16-20 years varies from 5.1% in ch-x to 14.1% in SMASH to 22.0% in GGMHS. Compared to their heterosexual counterparts, significantly more homo/bisexual men reported 12-month suicidal ideation, plans, and attempts (OR = 2.09-2.26) and lifetime suicidal ideation (OR = 2.15) and suicide attempts (OR = 4.68-5.36). Prevalences and ratios vary among gay men by age and among young men by both sexual orientation and study population. Lifetime prevalences and ratios of non-fatal suicidal behaviors appear constant across age groups as is the increased risk of suicidality among young homo/bisexual men. © 2012 Elsevier Ltd.
Keywords: adolescent; adult; aged; article; bisexual male; controlled study; health survey; heterosexual male; human; major clinical study; male; homosexual male; prevalence; priority journal; probability; risk factor; sexual behavior; sexual orientation; suicidal behavior; suicidal ideation; suicide attempt; suicide plan; Switzerland

Accidental strangulation resulted from hypoxyphilia associated with multiple paraphilias and substance abuse: A psychological autopsy case report - Skugarevsky, O.; Ehrlich, E.; Sheleg, S. (Romanian Journal of Legal Medicine, 2011)
We report a case of a 34-year-old male who was found hanged by his neck in his own apartment. The deceased was dressed in women's nylon panties, bra, nylon pantyhose, and a wig. The immediate cause of his death was found to be asphyxia due to hanging but the manner of his death was initially considered to be equivocal. The psychological autopsy based on the structured interview with the deceased's parents, sexual partner, and closed friends using Beck's Suicide Intent Scale (SIS), Paykel's Interview for Recent Life Events (IRLE), Duke Social Support Index (DSSI), the Structured Clinical Interview for DSM-IV-TR (SCID-I), Hamilton Depression Rating Scale (HAM-D), and our structured suicide information questionnaire based on the pamphlet "Suicide Prevention and Psychological Autopsy" (Department of U.S. Army) and some published articles was performed and the data were analyzed. The interviews with the informants showed that the deceased was single; was engaged in homosexual behavior; was well educated with a university degree; was employed; has not been diagnosed with any chronic illnesses; never had suicidal attempts in the past; didn't have any history of alcohol and drug abuse; wasn't recently emotionally upset; didn't have any chronic and recent interpersonal problems with his family, sexual partner, and friends; had plans for the future. The deceased has not being diagnosed with any psychiatric illnesses during his life. But the scrupulous crime scene investigation was indicative that diseased was meeting the DSM-IV-TR diagnostic criteria for substance abuse, multiple paraphilias involving sexual masochism (hypoxyphilia), transvestic fetishism, and agalmatophilia (a paraphilia that involves being sexually attracted to a doll, statue or mannequin). Integration of the psychological autopsy data with the crime scene findings allowed identification of this event as an accidental death (autoerotic asphyxia). © 2011 Romanian Society of Legal Medicine.
Keywords: accidental death; accidental injury; adult; article; asphyxia; autopsy; case report; cause of death; conjunctival hemorrhage; disease association; educational status; employment status; sexual fetishism; Hamilton Depression Rating Scale; homosexuality; human; sexual asphyxia; job satisfaction; male; masochism; medical history; sexual deviation; Social Support Index; strangulation; Structured Clinical Interview for DSM Disorders; substance abuse

Perinatal and psychosocial circumstances associated with risk of attempted suicide, non-suicidal self-injury and psychiatric service use. A longitudinal study of young people. - Young, R.; Riordan, V.; Stark, C. (BMC public health, 2011)
Past studies using large population based datasets link certain perinatal circumstances (birth weight, parity, etc) with mental health outcomes such as suicide, self-harm and psychiatric problems. Problematically, population datasets omit a number of social confounds. The aim of this study is to replicate past research linking perinatal circumstances and mental health (suicidality and use of psychiatric services) and to determine if such associations remain after adjusting for social circumstances. A longitudinal school-based survey of 2157 young people (surveyed at age 11, 13, 15) followed up in early adulthood (age 19). At age 11 parents of participants provided information about perinatal circumstances (birth weight, birth complications, etc.) and psychiatric service use. Participants provided data about their mental health at age 15 (attempted suicide, suicidal thoughts) and at ages 19 (self-harm, psychiatric service use). In addition, data were collected about their social and psychosocial circumstances (gender, deprivation, religion, sexual behaviour, etc.). Predictably, social factors were linked to mental health outcomes. For example, those with same sex partners were more likely (OR 4.84) to self-harm than those without a same sex partner. With a single exception, in both unadjusted and adjusted models, perinatal circumstances were not or only marginally associated with mental health outcomes. The exception was the number of birth complications; young people with two or more complications were approximately 2-3 times more likely than those without complications to use psychiatric services. While we failed to replicate results found using large population based datasets, some of our results are compatible with prior research findings. Further, evidence from this study supports the influence of perinatal circumstances (birth complications) on later psychiatric problems, or at least higher than expected contact with psychiatric service.
Keywords: adolescent; adult; article; automutilation; child; female; human; longitudinal study; male; mental health service; pregnancy; prenatal exposure; psychological aspect; questionnaire; risk assessment; suicide attempt; United Kingdom; utilization review

Suicidal ideation among patients with gender identity disorder - Terada, S.; Matsumoto, Y.; Sato, T.; Okabe, N.; Kishimoto, Y.; Uchitomi, Y. (Psychiatry Research, 2011)
In this study, we tried to clarify the prevalence of suicidal ideation and self-mutilation including suicide attempts among patients with gender identity disorder (GID) and the relationship of those behaviors to demographic characteristics. A total of 500 consecutive Japanese GID patients without any other psychiatric comorbidity were evaluated at the outpatient GID Clinic of Okayama University Hospital. The lifetime rate of suicidal ideation was 72.0% of the total sample. There were no significant differences in the prevalence of suicidal ideation among groups divided by sex, age, age at onset or education. The lifetime prevalence of self-mutilation including suicide attempts was 31.8% of the total sample. Low level of education was significantly related to self-mutilation among both male-to-female and female-to-male GID patients. Younger age at onset was a significant factor affecting self-mutilation only among MTF GID patients. A lack of strategies to cope with severe distress among persons with lower education might induce a high frequency of self-mutilation including suicidal attempt. GID patients with a low level education might be at high risk of self-mutilation and should be watched with special attention to self-mutilation. © 2011 Elsevier Ireland Ltd.
Keywords: adult; age; article; automutilation; controlled study; coping behavior; demography; disease association; disease duration; disease severity; educational status; female; gender; gender dysphoria; human; Japanese (people); major clinical study; male; onset age; prevalence; priority journal; risk assessment; suicidal ideation

Obsessive compulsive disorder with psychosis NOS, in an asexual male: A diagnostic challenge - Smigas, T.; Nevue, J.; Gadit, A.M. (BMJ Case Reports, 2011)
A 28-year-old asexual Malaysian male presented for emergency assessment with suicidal thoughts, paranoid delusions and increasing time spent on ritualistic behaviours that included hand washing, door checking and religious chanting. His obsessions were primarily related to counting, perfectionism, contamination and chanting. The patient found himself compelled to complete numerous rituals including chanting religiously to 1000, having to restart in the event of an error during such and also described delusions of being followed by a woman who was analysing his life pattern in order to steal from him. He then started to proclaim himself to be Buddha as he believed this would keep his dead grandmother away from him, thus avoiding supposed persecution from her. Following optimisation of both escitalpram and olanzapine, a slight reduction in the patient's ritualistic behaviour and psychotic phenomenon were witnessed. Copyright 2011 BMJ Publishing Group. All rights reserved.
Keywords: escitalopram; olanzapine; adult; article; case report; delusion; drug dose increase; ethnic group; human; Malaysian; male; mental health; obsessive compulsive disorder; paranoia; priority journal; psychosis; religion; ritual; suicidal ideation

Trials for the co-expression of the merozoite surface protein-1 and circumsporozoite protein genes of Plasmodium vivax - Lee, C.; Chung, K.W.; Kim, T.-S.; Choi, K.-M.; Choi, Y.K.; Chung, N.-J.; Rhie, H.-G.; Lee, H.-S.; Lee, S.-J.; Lee, H.-W. (Experimental Parasitology, 2011)
Merozoite surface protein-1 (MSP-1), a major asexual blood stage antigen, and circumsporozoite protein (CSP), a component of sporozoites that includes a Plasmodium vivax B-cell epitope, are strong candidates for use in a malaria vaccine. A chimeric recombinant gene containing portions of both msp-1 and csp from P. vivax separated by Pro-Gly linker motif was generated. The construct gene was named mlc (msp-1, linker, and csp). The MLC chimeric recombinant protein had a molecular weight of approximately 25. kDa when expressed in Escherichia coli, as determined with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis. The purified chimeric protein reacted with the sera of patients infected with P. vivax but not with the sera of uninfected patients according to western blot analysis. The chimeric protein reacted well with sera of malaria patients (109/115, 94.78%) as assessed with enzyme-linked immunosorbent assay (ELISA). BALB/c mice that were orally immunized with the MLC chimeric recombinant protein successfully produced antigen-specific antibodies. Additionally, levels of the Th1-associated cytokines IL-12(p40), TNF-α, and IFN- γ were significantly increased in the spleens of the BALB/c mice. Therefore, the E. coli-expressed MLC chimeric recombinant protein might be used as a valuable vaccine candidate for oral immunization against vivax malaria. © 2011 Elsevier Inc.
Keywords: chimeric protein; cholera toxin B subunit; circumsporozoite protein; gamma interferon; interleukin 12p40; interleukin 2; malaria vaccine; merozoite surface protein 1; MLC chimeric recombinant protein; tumor necrosis factor; unclassified drug; animal experiment; animal tissue; antibody production; antibody titer; antigenicity; article; circumsporozoite protein gene; controlled study; cytokine production; enzyme linked immunosorbent assay; Escherichia coli; gene; gene sequence; human; merozoite surface protein 1 gene; molecular weight; mouse; nonhuman; nucleotide sequence; Plasmodium vivax; Plasmodium vivax malaria; polyacrylamide gel electrophoresis; priority journal; recombinant gene; spleen; Western blotting

The effects of general and homophobic victimization on adolescents' psychosocial and educational concerns: The importance of intersecting identities and parent support - Poteat, V.P.; Mereish, E.H.; DiGiovanni, C.D.; Koenig, B.W. (Journal of Counseling Psychology, 2011)
Many adolescents experience peer victimization, which often can be homophobic. Applying the minority stress model with attention to intersecting social identities, this study tested the effects of general and homophobic victimization on several educational outcomes through suicidality and school belonging among 15,923 adolescents in Grades 7 through 12 on account of their sexual orientation and race/ethnicity. Parent support also was tested as a moderator of these effects. Homophobic victimization had different effects on suicidality across groups, indicating the importance of considering individuals' multiple social identities. However, homophobic victimization had universal negative effects on school belonging for all groups. Nearly all indirect effects of general and homophobic victimization on reported grades, truancy, and importance of graduating were significant through suicidality and school belonging across groups. Parent support was most consistent in moderating the effects of general and homophobic victimization on suicidality for heterosexual White and racial/ethnic minority youth. In nearly all cases, it did not moderate the effects of general or homophobic victimization for lesbian, gay, bisexual, transgender, and questioning youth. Furthermore, in most cases, parent support did not moderate the effects of general or homophobic victimization on school belonging. Findings underscore the need for counseling psychologists to work with parents of all youth on ways to provide support to those who experience homophobic victimization. Furthermore, they highlight the need for counseling psychologists to be involved as social justice advocates in the passage and implementation of school policies that address homophobic bullying and other forms of bias-based bullying and harassment. © 2011 American Psychological Association.
Keywords: adolescent; article; bisexuality; bullying; child; child behavior; coping behavior; educational status; female; homosexuality; human; human relation; male; parent; peer group; psychological aspect; sexuality; social behavior; social support; suicide; transsexualism; United States; victim

Social support, exposure to violence and transphobia, and correlates of depression among male-to-female transgender women with a history of sex work. - Nemoto, T.; Bödeker, B.; Iwamoto, M. (American journal of public health, 2011)
We determined racial/ethnic differences in social support and exposure to violence and transphobia, and explored correlates of depression among male-to-female transgender women with a history of sex work (THSW). A total of 573 THSW who worked or resided in San Francisco or Oakland, California, were recruited through street outreach and referrals and completed individual interviews using a structured questionnaire. More than half of Latina and White participants were depressed on the basis of Center For Epidemiologic Studies Depression Scale scores. About three quarters of White participants reported ever having suicidal ideation, of whom 64% reported suicide attempts. Half of the participants reported being physically assaulted, and 38% reported being raped or sexually assaulted before age 18 years. White and African American participants reported transphobia experiences more frequently than did others. Social support, transphobia, suicidal ideation, and levels of income and education were significantly and independently correlated with depression. For THSW, psychological vulnerability must be addressed in counseling, support groups, and health promotion programs specifically tailored to race/ethnicity.
Keywords: adult; analysis of variance; article; chi square distribution; depression; human; male; prostitution; psychological aspect; psychological rating scale; questionnaire; race; rape; regression analysis; social psychology; social support; socioeconomics; statistics; transsexualism; United States; violence

Understanding suicide among sexual minority youth in America: An ecological systems analysis - Hong, J.S.; Espelage, D.L.; Kral, M.J. (Journal of Adolescence, 2011)
This article examines major risk factors for suicide among sexual minority youth using Bronfenbrenner's ecological systems theory. Although suicidal behavior among sexual minority youth is a major public concern in the United States, understanding of this phenomenon has been limited since the majority of empirical research studies have addressed individual level characteristics without much consideration to the larger environmental contexts. This review integrates past and current empirical findings on suicidal behaviors of sexual minority youth within the context of micro-, meso-, exo-, macro-, and chrono-systems levels. Finally, it draws implications for assessment, prevention, and intervention strategies. © 2011 The Foundation for Professionals in Services for Adolescents.
Keywords: academic achievement; article; bisexuality; child parent relation; cultural value; depression; ecological systems theory; emotional attachment; emotional stress; family relation; friendship; gender identity; heterosexuality; homophobia; human; interpersonal communication; juvenile; parental behavior; patient satisfaction; peer group; psychiatrist; psychologist; religion; sex difference; sexual and gender minority; sexual orientation; social interaction; social psychology; social support; social worker; sociological theory; substance abuse; suicidal ideation; suicide; Western Hemisphere

Psychological characteristics, stressful life events and deliberate self-harm: Findings from the child & adolescent self-harm in Europe (CASE) study - Madge, N.; Hawton, K.; McMahon, E.M.; Corcoran, P.; De Leo, D.; De Wilde, E.J.; Fekete, S.; Van Heeringen, K.; Ystgaard, M.; Arensman, E. (European Child and Adolescent Psychiatry, 2011)
There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from singleepisode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated. © Springer-Verlag 2011.
Keywords: adolescent; anxiety; article; automutilation; child behavior; child parent relation; child psychiatry; controlled study; depression; disease association; disease severity; Europe; family stress; female; geographic distribution; human; impulsiveness; life event; life history trait; life stress; male; prevalence; psychological aspect; risk assessment; risk factor; self esteem; sex difference; sexual abuse; sexual orientation

Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources. - McKay, B. (Medical reference services quarterly, 2011)
Lesbian, gay, bisexual, and transgender (LGBT) persons, while widely diverse in many ways, share health disparities related to the stigma and discrimination they experience, including disproportionate rates of psychiatric disorders, substance abuse, and suicide. Lesbians, gay men, bisexuals, and the transgender communities have additional health concerns and disparities unique to each population. This paper highlights the national recognition of these health issues and disparities and presents web-based information resources about them and their mitigation.
Keywords: access to information; article; directory; health disparity; homosexuality; human; Internet; United States

Comparison of the antibody responses to Plasmodium vivax and Plasmodium falciparum antigens in residents of Mandalay, Myanmar - Kim, T.-S.; Kim, H.-H.; Kim, J.-Y.; Kong, Y.; Na, B.-K.; Lin, K.; Moon, S.-U.; Kim, Y.-J.; Kwon, M.-H.; Sohn, Y.; Kim, H.; Lee, H.-W. (Malaria Journal, 2011)
Background: The aim of this study was to investigate the profile of antibodies against several antigens of Plasmodium vivax and Plasmodium falciparum in Mandalay, Myanmar. Methods. Malaria parasites were identified by microscopic examination. To test the antibodies against P. vivax and P. falciparum in sera, an indirect immunofluorescence antibody test (IFAT) was performed using asexual blood parasite antigens. An enzyme-linked immunosorbent assay (ELISA) was performed with circumsporozoite protein (CSP), Pvs25 and Pvs28 recombinant proteins of transmission-blocking vaccine candidates for P. vivax, and liver stage specific antigen-1 and -3 (PfLSA-1, PfLSA-3) for P. falciparum. Results: Fourteen patients among 112 were found to be infected with P. vivax and 26 with P. falciparum by thick smear examination. Twenty-three patients were found to be infected with P. vivax, 19 with P. falciparum and five with both by thin smear examination. Blood samples were divided into two groups: Group I consisted of patients who were positive for infection by microscopic examination, and Group II consisted of those who showed symptoms, but were negative in microscopic examination. In P. falciparum, IgG against the blood stage antigen in Group I (80.8%) was higher than in Group II (70.0%). In P. vivax, IgG against the blood stage antigen in Group I (53.8%) was higher than in Group II (41.7%). However, the positivity rate of the PvCSP VK210 subtype in Group II (40.0%) was higher than in Group I (23.1%). Similarly for the PvCSP VK247 subtype, Group II (21.7%) was higher than that for Group I (9.6%). A similar pattern was observed in the ELISA using Pvs25 and Pvs28: positive rates of Group II were higher than those for Group I. However, those differences were not shown significant in statistics. Conclusions: The positive rates for blood stage antigens of P. falciparum were higher in Group I than in Group II, but the positive rates for antigens of other stages (PfLSA-1 and -3) showed opposite results. Similar to P. falciparum, the positive rate of pre-blood stage (CSP VK210 and 247 subtype) and post-blood stage (Pvs25 and 28) antigens of P. vivax were higher in Group II than in Group I. Therefore, sero-diagnosis is not helpful to discriminate between malaria patients and symptomatic individuals during the epidemic season in Myanmar. © 2011 Kim et al; licensee BioMed Central Ltd.
Keywords: antigen; circumsporozoite protein; immunoglobulin G; immunoglobulin M; pflsa 1 antigen; pflsa 3 antigen; protozoon antibody; Pvs25 antigen; Pvs28 antigen; unclassified drug; adult; antibody response; article; blood analysis; blood smear; clinical article; comparative study; controlled study; enzyme linked immunosorbent assay; female; human; immunoassay; immunofluorescence test; malaria falciparum; male; microscopy; Myanmar; nonhuman; Plasmodium falciparum; Plasmodium vivax; Plasmodium vivax malaria

Male street prostitution in Dublin: A psychological analysis - McCabe, I.; Acree, M.; O'Mahony, F.; McCabe, J.; Kenny, J.; Twyford, J.; Quigley, K.; McGlanaghy, E. (Journal of Homosexuality, 2011)
This study assessed the mental health characteristics of 12 male street prostitutes (MSPs) in Dublin, with particular regard to issues of homelessness, substance abuse, depression, suicidal ideation, and self-esteem. Participants completed five psychometric tests, which indicated that all of the participants had above average levels of depression and suicidal ideation and low levels of selfesteem. This study found that candidates likely to become MSPs are young males with a combination of factors, including a background of childhood sexual or physical abuse, leaving school early, running away from home, and a dependence on heroin. © Taylor & Francis Group, LLC.
Keywords: addiction; adolescent; adult; article; child; child sexual abuse; depression; homelessness; homosexuality; human; Human immunodeficiency virus infection; Ireland; male; prostitution; psychologic test; psychological aspect; self concept; suicidal ideation

Correlates of engaging in survival sex among homeless youth and young adults. - Walls, N.E.; Bell, S. (Journal of sex research, 2011)
Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium™, crack cocaine, alcohol, Coricidin™, and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed.
Keywords: addiction; adolescent; adult; article; child; female; health behavior; homelessness; human; male; mental health; pilot study; psychological aspect; questionnaire; risk factor; sexual behavior; statistical model; United States

Racial and sexual identity-related maltreatment among minority YMSM: Prevalence, perceptions, and the association with emotional distress - Hightow-Weidman, L.B.; Phillips, G.; Jones, K.C.; Outlaw, A.Y.; Fields, S.D.; Smith, J.C. (AIDS Patient Care and STDs, 2011)
Bullying is a form of violence characterized as an aggressive behavior that is unprovoked and intended to cause harm. Prior studies have found that lesbian, gay, bisexual, and transgender (LGBT) youth experience high levels of bullying related to their sexuality and this harassment can lead to engagement in risk behaviors, depression, and suicide. Ethnic/racial minority young men who have sex with men (YMSM) may experience dual levels of stigma and maltreatment due to both their sexuality and their race. The aim of the current study was to assess the prevalence and perceptions of racial and sexual identity-based abuse among a sample of minority YMSM, and whether this maltreatment plays a role in the emotional distress of these youth. We found that overall 36% and 85% of participants experienced racial and sexuality-related bullying, respectively. There was a significant association between experiencing a high level of sexuality-related bullying and depressive symptomatology (p=0.03), having attempted suicide (p=0.03), and reporting parental abuse (p=0.05). We found no association between racial bullying and suicide attempts. In a multivariable logistic regression model, experiencing any racial bullying and high sexuality-related bullying were significant predictors of having a CES-D score ≥16; adjusted odds ratio (OR) 1.83 and 2.29, respectively. These findings contribute to the existing literature regarding the negative experiences and daily stressors facing LGBT youth with regard to both their minority status and LGBT identities. Future interventions for racial/ethnic minority YMSM should provide assistance to achieve a positive view of self that encompasses both their racial and sexual identities. © Copyright 2011, Mary Ann Liebert, Inc.
Keywords: adult; African American; article; bullying; child abuse; depression; emotional stress; gender identity; Hispanic; human; homosexual female; major clinical study; male; homosexual male; minority group; perception; predictor variable; prevalence; racism; sexism; suicide attempt; transsexualism

Age of MSM sexual debut and risk factors: Results from a multisite study of racial/ethnic minority YMSM living with HIV - Outlaw, A.Y.; Phillips, G.; Hightow-Weidman, L.B.; Fields, S.D.; Hidalgo, J.; Halpern-Felsher, B.; Green-Jones, M. (AIDS Patient Care and STDs, 2011)
The average reported age of sexual debut for youth in the United States is 14.4 years, with approximately 7% reporting their sexual debut prior to age 13. While the research literature on sexual debut for youth addresses gender and ethnic differences (with males and African-American youth experiencing earlier sexual debut), there is limited data regarding factors associated with sexual debut for young men who have sex with men (YMSM). Early sexual debut poses potential health risks, such as contracting HIV with an increased risk of unprotected intercourse. Given current high HIV infection rates for racial/ethnic minority YMSM, learning more about their sexual debuts and associated risk factors of this population is of great importance. This study investigated risk behaviors and emotional distress, and their association with MSM sexual debut for a multisite cohort of racial/ethnic minority YMSM living with HIV. We hypothesized that a MSM sexual debut younger than age 16 would be associated with engagement in more high-risk sexual behaviors (unprotected sex and exchange sex), substance use, and emotional distress than a MSM sexual debut at age 16 or older. Results indicated that participants having a MSM sexual debut before the age of 16 reported more exchange sex; drug use (specifically marijuana); emotional/psychological problems related to substance use; and a history of suicide attempts, compared to participants with later MSM sexual debuts. Comprehensive interventions that are racially/ethnically sensitive, inquire about initial sexual experiences, and focus on sexual health and healthy relationships are needed to improve health outcomes for this population. © Copyright 2011, Mary Ann Liebert, Inc.
Keywords: adolescent; adult; African American; age; article; emotional stress; high risk behavior; Hispanic; human; Human immunodeficiency virus infection; major clinical study; male; homosexual male; mental disease; minority group; prostitution; risk factor; sexual behavior; substance abuse; suicide attempt; unsafe sex

Bisexual people's experiences with mental health services: a qualitative investigation. - Eady, A.; Dobinson, C.; Ross, L.E. (Community mental health journal, 2011)
Bisexual people experience minority stress and social isolation as a result of their marginalized sexual identities, and likely due to this stigmatization, previous research has identified high rates of psychological distress, anxiety, depression, suicidality, alcohol misuse, and self-harming behaviour among bisexual populations. It is therefore important that mental health service providers are able to provide culturally competent care to bisexual people. This study used focus groups and interviews with 55 bisexual participants across the province of Ontario, Canada, to investigate their experiences with mental health care. Results suggest that bisexual people have both positive and negative experiences with mental health service providers. Specific provider practices which contribute to the perception of positive and negative experiences with mental heath services are described, and the implications for clinical practice discussed.
Keywords: adolescent; adult; aged; article; attitude to health; bisexuality; Canada; female; health personnel attitude; health service; human; information processing; interview; male; mental health; mental health service; mental stress; middle aged; participatory research; psychological aspect; qualitative research; social psychology; utilization review

Comparing health and mental health needs, service use, and barriers to services among sexual minority youths and their peers - Williams, K.A.; Chapman, M.V. (Health and Social Work, 2011)
Using a representative national sample (N = 20,745), this article explores health and mental health needs, service use, and barriers to services among sexual minority youths (SMYs) and heterosexual peers. SMYs were defined by ever having a same-sex romantic attraction or having a recent same-sex romantic relationship or sexual partner. SMYs accounted for 7.5 percent of the sample. Data were analyzed to ascertain prevalence of risks and explore group differences. Compared with peers, SMY self-reports indicated higher prevalence rates on all indicators of health and mental health need. SMYs reported more sexual activity, more sexually transmitted disease diagnoses, a higher perceived risk for HIV/AIDS, and more forgone medical care than peers. Also compared with peers, SMYs reported higher levels of anxiety, depression, suicidality, and physical and sexual victimization and higher rates of unmet mental health need. SMYs also reported greater concerns about confidentiality and were less likely to use school-based services. The majority of SMYs reported same-sex attraction only. Social work and other helping professionals should incorporate same-sex attraction questions into assessment protocols to target services for this population. School-and office-based providers must consider whether their services are welcoming and offer sufficient assurances of confidentiality to facilitate access by SMYs.
Keywords: adolescent; adult; article; child; comparative study; ethnology; female; health care delivery; health service; homosexuality; human; interview; homosexual female; longitudinal study; male; mental health service; minority group; peer group; utilization review

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample. - Sivasubramanian, M.; Mimiaga, M.J.; Mayer, K.H.; Anand, V.R.; Johnson, C.V.; Prabhugate, P.; Safren, S.A. (Psychology, health & medicine, 2011)
In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD = 5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR = 0.85, 95% CI: 0.78-0.93; social support AOR = 0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR = 0.79, 95% CI: 0.71-0.89; social support AOR = 0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR = 0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.
Keywords: adult; anxiety disorder; article; homosexuality; human; India; major depression; male; psychologic test; psychological aspect; self concept; social support; statistical model; suicidal ideation

Health care and social service providers' observations on the intersection of HIV/AIDS and violence among their clients and patients. - DiStefano, A.S.; Cayetano, R.T. (Qualitative health research, 2011)
Associations between HIV/AIDS and several forms of violence have been demonstrated in recent research. We conducted qualitative interviews with 30 providers who offered services related to HIV/AIDS or violence to identify specific manifestations of HIV/AIDS-violence intersections, factors that explain why HIV/AIDS and violence intersect in client/patient populations, and the theoretical salience of providers' narratives. Providers confirmed links between HIV/AIDS and violent victimization, and yielded new insights into crossover risk between HIV/AIDS and suicidality, nonsuicidal self-harm, and witnessing and perpetrating violence. We also isolated 20 explanatory factors, including substance use, poor mental health, sex work/trading sex, and sexual orientation/gender identity. Narratives were consistent with syndemics theory, indicating that HIV/AIDS and violence fueled each other's occurrence and magnified the health-related burden on affected client/patient populations, often under conditions of health and social disparity. Providers contribute a novel perspective on our understanding of HIV/AIDS-violence syndemics that shows promise in informing future interventions and practice.
Keywords: acquired immune deficiency syndrome; adult; article; female; human; Human immunodeficiency virus infection; male; psychological aspect; statistics; suicide; United States; violence

Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12 - Youth risk behavior surveillance, selected sites, United States, 2001-2009 - Kann, L.; Olsen, E.O.; McManus, T.; Kinchen, S.; Chyen, D.; Harris, W.A.; Wechsler, H. (Morbidity and Mortality Weekly Report, 2011)
Problem: Sexual minority youths are youths who identify themselves as gay or lesbian, bisexual, or unsure of their sexual identity or youths who have only had sexual contact with persons of the same sex or with both sexes. Population-based data on the health-risk behaviors practiced by sexual minority youths are needed at the state and local levels to most effectively monitor and ensure the effectiveness of public health interventions designed to address the needs of this population. Reporting Period Covered: January 2001-June 2009 Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, dietary behaviors, physical activity and sedentary behaviors, and weight management) and the prevalence of obesity and asthma among youths and young adults. YRBSS includes state and local school-based Youth Risk Behavior Surveys (YRBSs) conducted by state and local education and health agencies. This report summarizes results from YRBSs conducted during 2001-2009 in seven states and six large urban school districts that included questions on sexual identity (i.e., heterosexual, gay or lesbian, bisexual, or unsure), sex of sexual contacts (i.e., same sex only, opposite sex only, or both sexes), or both of these variables. The surveys were conducted among large population-based samples of public school students in grades 9-12. Results: Across the nine sites that assessed sexual identity, the prevalence among gay or lesbian students was higher than the prevalence among heterosexual students for a median of 63.8% of all the risk behaviors measured, and the prevalence among bisexual students was higher than the prevalence among heterosexual students for a median of 76.0% of all the risk behaviors measured. In addition, the prevalence among gay or lesbian students was more likely to be higher than (rather than equal to or lower than) the prevalence among heterosexual students for behaviors in seven of the 10 risk behavior categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management). Similarly, the prevalence among bisexual students was more likely to be higher than (rather than equal to or lower than) the prevalence among heterosexual students for behaviors in eight of the 10 risk behavior categories (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management). Across the 12 sites that assessed sex of sexual contacts, the prevalence among students who had sexual contact with both sexes was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 71.1% of all the risk behaviors measured, and the prevalence among students who only had sexual contact with the same sex was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 29.7% of all the risk behaviors measured. Furthermore, the prevalence among students who had sexual contact with both sexes was more likely to be higher than (rather than equal to or lower than) the prevalence among students who only had sexual contact with the opposite sex for behaviors in six of the 10 risk behavior categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, and weight management). The prevalence among students who only had sexual contact with the same sex was more likely to be higher than (rather than equal to or lower than) the prevalence among students who only had sexual contact with the opposite sex for behaviors in two risk behavior categories (behaviors related to attempted suicide and weight management). Interpretation: Sexual minority students, particularly gay, lesbian, and bisexual students and students who had sexual contact with both sexes, are more likely to engage in health-risk behaviors than other students. Public Health Action: Effective state and local public health and school health policies and practices should be developed to help reduce the prevalence of health-risk behaviors and improve health outcomes among sexual minority youths. In addition, more state and local surveys designed to monitor health-risk behaviors and selected health outcomes among population-based samples of students in grades 9-12 should include questions on sexual identity and sex of sexual contacts.
Keywords: addiction; adolescent; adult; article; behavioral risk factor surveillance system; bisexuality; body weight; female; health behavior; high risk behavior; homosexuality; human; injury; homosexual female; male; prevalence; public health; statistics; student; suicide attempt; United States; violence

Sexual revictimization and mental health: A comparison of lesbians, gay men, and heterosexual women - Balsam, K.F.; Lehavot, K.; Beadnell, B. (Journal of Interpersonal Violence, 2011)
Childhood sexual abuse (CSA) has several deleterious effects on health and well-being, including increased risk for rape in adulthood. Such revictimization experiences are linked to negative mental health outcomes. The vast majority of literature on prevalence and impact of sexual revictimization has focused on heterosexual women. In an effort to extend this research to lesbians and gay men, who are known to face higher rates of both CSA and adult rape, we conducted a study (N = 871) comparing adult lesbians, gay men, and heterosexual women on prevalence and mental health correlates of sexual revictimization. Results indicated that CSA is associated with elevated rates of adult rape for all three groups. In addition, revictimization showed comparable associations with mental health variables for all three groups. Participants with both CSA and adult rape had higher levels of psychological distress, suicidality, alcohol use, and self-harm behaviors relative to those with only one type of victimization and those with no victimization, and those with any victimization were more likely to report recent use of drugs compared to those with no victimization. © The Author(s) 2011.
Keywords: adult; article; child; child abuse; child sexual abuse; comparative study; female; heterosexuality; homosexuality; human; homosexual female; male; mental health; middle aged; psychological aspect; questionnaire; rape; risk factor; sexuality; statistics; United States

Increased risk of suicide attempts among Black and Latino lesbians, gay men, and bisexuals. - O'Donnell, S.; Meyer, I.H.; Schwartz, S. (American journal of public health, 2011)
Members of racial/ethnic minority groups have a lower lifetime prevalence than have Whites of mental disorders, a risk factor for suicide attempts; paradoxically, however, lesbian, gay, and bisexual (LGB) ethnic minority youths may be at increased risk for suicide attempts relative to White LGB youths. We found that the increased risk of suicide attempts among racial/ethnic minority LGB respondents in our sample relative to White respondents was not explained by excess youth onset of depression and substance abuse or by a higher susceptibility to suicide in the racial/ethnic minority LGB group.
Keywords: addiction; adolescent; adult; article; bisexuality; Caucasian; ethnology; female; health disparity; Hispanic; homosexuality; human; homosexual female; major depression; male; middle aged; minority group; Black person; psychological aspect; risk factor; statistics; suicide attempt; United States

Sexual orientation and mortality among US men aged 17 to 59 years: results from the National Health and Nutrition Examination Survey III. - Cochran, S.D.; Mays, V.M. (American journal of public health, 2011)
We investigated associations between minority sexual orientation and mortality among US men. We used data from a retrospective cohort of 5574 men aged 17 to 59 years, first interviewed in the National Health and Nutrition Examination Survey III (NHANES III; 1988-1994) and then followed for mortality status up to 18 years later. We classified men into 3 groups: those reporting (1) any same-sex sexual partners (men who have sex with men [MSM]; n = 85), (2) only female sexual partners (n = 5292), and (3) no sexual partners (n = 197). Groups were then compared for all-cause mortality, HIV-related mortality, suicide-related mortality, and non-HIV-related mortality. Compared with heterosexual men, MSM evidenced greater all-cause mortality. Approximately 13% of MSM died from HIV-related causes compared with 0.1% of men reporting only female partners. However, mortality risk from non-HIV-related causes, including suicide, was not elevated among MSM. In the United States, the HIV epidemic continues to be the major contributing factor for premature death rates among MSM. Cohorts such as the NHANES III offer a unique opportunity to track the effects of the HIV epidemic on this population.
Keywords: adolescent; adult; article; cause of death; comparative study; female; follow up; health disparity; health survey; heterosexuality; homosexuality; human; Human immunodeficiency virus infection; male; middle aged; minority health; mortality; nutrition; retrospective study; statistics; suicide; United States

Murine immune responses to a Plasmodium vivax-derived chimeric recombinant protein expressed in Brassica napus - Lee, C.; Kim, H.-H.; Mi Choi, K.; Won Chung, K.; Choi, Y.K.; Jang, M.J.; Kim, T.-S.; Chung, N.-J.; Rhie, H.-G.; Lee, H.-S.; Sohn, Y.; Kim, H.; et al. (Malaria Journal, 2011)
Background: To develop a plant-based vaccine against Plasmodium vivax, two P. vivax candidate proteins were chosen. First, the merozoite surface protein-1 (MSP-1), a major asexual blood stage antigen that is currently considered a strong vaccine candidate. Second, the circumsporozoite protein (CSP), a component of sporozoites that contains a B-cell epitope. Methods. A synthetic chimeric recombinant 516 bp gene encoding containing PvMSP-1, a Pro-Gly linker motif, and PvCSP was synthesized; the gene, named MLC, encoded a total of 172 amino acids. The recombinant gene was modified with regard to codon usage to optimize gene expression in Brassica napus. The Ti plasmid inducible gene transfer system was used for MLC chimeric recombinant gene expression in B. napus. Gene expression was confirmed by polymerase chain reaction (PCR), beta-glucuronidase reporter gene (GUS) assay, and Western blot. Results: The MLC chimeric recombinant protein expressed in B. napus had a molecular weight of approximately 25 kDa. It exhibited a clinical sensitivity of 84.21% (n = 38) and a clinical specificity of 100% (n = 24) as assessed by enzyme-linked immunosorbent assay (ELISA). Oral immunization of BALB/c mice with MLC chimeric recombinant protein successfully induced antigen-specific IgG1 production. Additionally, the Th1-related cytokines IL-12 (p40), TNF, and IFN- were significantly increased in the spleens of the BALB/c mice. Conclusions: The chimeric MLC recombinant protein produced in B. napus has potential as both as an antigen for diagnosis and as a valuable vaccine candidate for oral immunization against vivax malaria. © 2011 Lee et al; licensee BioMed Central Ltd.
Keywords: amino acid; beta glucuronidase; gamma interferon; interleukin 12p40; malaria vaccine; recombinant protein; tumor necrosis factor; animal experiment; antigen specificity; article; chimera; codon; controlled study; drug synthesis; enzyme linked immunosorbent assay; gene; gene expression; gene transfer; immune response; immunization; male; molecular weight; mouse; nonhuman; nucleotide sequence; plasmid; Plasmodium vivax malaria; protein motif; rapeseed; recombinant gene; sensitivity analysis; spleen; synthesis; Th1 cell; Western blotting

Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in New Zealand secondary school students - Lucassen, M.F.G.; Merry, S.N.; Robinson, E.M.; Denny, S.; Clark, T.; Ameratunga, S.; Crengle, S.; Rossen, F.V. (Australian and New Zealand Journal of Psychiatry, 2011)
Objective: To describe the sexual attractions of New Zealand secondary school students and investigate the associations between sexual attraction and self-reported depression, self-harm, suicidality and help-seeking behaviour. Method: Multiple logistic regression was used to examine the associations between sexual attraction and depressive symptoms, suicidality, self-harming and help-seeking behaviours in a nationally representative secondary school health and well-being survey, undertaken in 2007. Results: Of the students surveyed, 92% were attracted to the opposite sex, 1% to the same sex, 3% to both sexes, 2% were not sure and 2% were attracted to neither sex. Students who were attracted to the same or to both sexes consistently had higher prevalence estimates of depression (p = < 0.0001), suicidality (p = < 0.0001) and self-harming (p = < 0.0001). Odds ratios were highest for students who reported they were attracted to both sexes for depressive symptoms (OR 3.7, 95%CI 2.84.7), self-harm (OR 5.8, 95%CI 4.47.6) and attempted suicide (OR 7.0, 95%CI 5.29.4). Students not exclusively attracted to the opposite sex were more likely to report having seen a health professional for an emotional worry and were more likely to have difficulty accessing help for emotional concerns. Conclusions: The study findings highlight significant mental health disparities faced by students attracted to the same or both sexes, with those attracted to both sexes appearing particularly vulnerable. There is a vital need to ensure primary care and mental health services have the capacity and capability to screen and provide appropriate responsive care for youth who are attracted to the same or both sexes. © 2011 The Royal Australian and New Zealand College of Psychiatrists.
Keywords: adolescent; article; automutilation; depression; emotion; female; health care personnel; health disparity; help seeking behavior; high school student; human; major clinical study; male; mental health; New Zealand; primary medical care; self report; sexual behavior; sexual orientation; sexuality; suicidal ideation; suicide attempt; wellbeing

Lesbian, Gay, Bisexual, and Transgender Adolescent School Victimization: Implications for Young Adult Health and Adjustment - Russell, S.T.; Ryan, C.; Toomey, R.B.; Diaz, R.M.; Sanchez, J. (Journal of School Health, 2011)
BACKGROUND: Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long-term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school victimization and young adult psychosocial health and risk behavior. METHODS: The young adult survey from the Family Acceptance Project included 245 LGBT young adults between the ages of 21 and 25 years, with an equal proportion of Latino and non-Latino White respondents. A 10-item retrospective scale assessed school victimization due to actual or perceived LGBT identity between the ages of 13 and 19 years. Multiple regression was used to test the association between LGBT school victimization and young adult depression, suicidal ideation, life satisfaction, self-esteem, and social integration, while controlling for background characteristics. Logistic regression was used to examine young adult suicide attempts, clinical levels of depression, heavy drinking and substance use problems, sexually transmitted disease (STD) diagnoses, and self-reported HIV risk. RESULTS: Lesbian, gay, bisexual, and transgender-related school victimization is strongly linked to young adult mental health and risk for STDs and HIV; there is no strong association with substance use or abuse. Elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization. CONCLUSIONS: Reducing LGBT-related school victimization will likely result in significant long-term health gains and will reduce health disparities for LGBT people. Reducing the dramatic disparities for LGBT youth should be educational and public health priorities. © 2011, American School Health Association.
Keywords: addiction; adolescent; adult; article; bullying; child behavior; depression; female; health survey; high risk behavior; human; Human immunodeficiency virus infection; male; mental disease; psychological aspect; risk factor; school; sexuality; statistical model; suicidal ideation; cross-dressing; United States; victim

The social environment and suicide attempts in lesbian, gay, and bisexual youth - Hatzenbuehler, M.L. (Pediatrics, 2011)
OBJECTIVE: To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors. METHODS: A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006 -2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students. RESULTS: Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96-0.99]). CONCLUSIONS: This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation-related disparities in suicide attempts. Copyright © 2011 by the American Academy of Pediatrics.
Keywords: adolescent; alcoholism; article; bisexuality; child; child abuse; controlled study; depression; female; heterosexuality; high school student; homosexuality; human; homosexual female; male; peer group; policy; priority journal; risk assessment; school child; social environment; suicide attempt; United States; victim

Sexual minority youth, social connection and resilience: From personal struggle to collective identity - DiFulvio, G.T. (Social Science and Medicine, 2011)
Sexual minority youth are at increased risk for negative health outcomes including substance abuse, depression, anxiety, and suicide. Researchers suggest that sexual orientation victimization is a predictor of such outcomes. Social connectedness-or the importance of belonging where youth perceive they are cared for and empowered within a given context-has been associated with positive youth outcomes. This qualitative study utilized life story methodology. Life stories are considered to be important expressions of one's identity and are shaped by personal, social, and cultural contexts. Twenty-two interviews were conducted with 15 young people ranging in age from 14 to 22 years. Two focus groups with youth were also conducted. Youth were recruited from rural and urban communities in Massachusetts. This study contributes to the literature on resilience by including the voices of sexual minority youth and explores the meaning of social connection in their lives. Youth discuss the ways in which individual connection and group affiliation served to affirm one's identity, and provided a forum for moving personal struggle to collective action. The findings suggest the need to reconceptualize consequences of disconnection (such as depression or suicide) from individual pathology and attend to these consequences as a response to discrimination and stigma. Implications for these findings and areas for future research are discussed. © 2011 Elsevier Ltd.
Keywords: adolescent; adult; article; cultural factor; female; human; interview; juvenile; life event; male; personal experience; qualitative research; rural population; sexism; sexual and gender minority; social adaptation; social interaction; stigma; transsexualism; United States; urban population

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones - Asscheman, H.; Giltay, E.J.; Megens, J.A.J.; De Ronde, W.; Van Trotsenburg, M.A.A.; Gooren, L.J.G. (European Journal of Endocrinology, 2011)
Objective: Adverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. Design: A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods: Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses. Results: In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population. Conclusions: The increased mortality in hormone-treated MtF transsexuals was mainly due to nonhormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death. In the FtM transsexuals, use of testosterone in doses used for hypogonadal men seemed safe. © 2011 European Society of Endocrinology.
Keywords: cyproterone acetate; estrogen; sex hormone; testosterone ester; adolescent; adult; aged; article; cardiovascular disease; cause of death; clinical assessment; drug abuse; drug megadose; female; female to male transgender; hormonal therapy; hormone response; human; immune deficiency; long term care; major clinical study; male; male to female transgender; mortality; priority journal; suicide; treatment duration

Adolescent health screening practices by physicians in Jamaica - Harrison, A.; Pierre, R.; Gordon-Strachan, G.; Campbell-Forrester, S.; Leslie, K. (Revista Panamericana de Salud Publica/Pan American Journal of Public Health, 2011)
Objective. To review Jamaican physicians' adolescent health screening practices by determining their frequency in areas of biomedical, psychological, social, and educational health; the factors that influence these practices; and physicians' perceived level of self-efficacy and their awareness of screening tools and guidelines. Methods. A questionnaire was mailed to general practitioners, family medicine specialists, and pediatricians in Jamaica. The primary outcome variable was the frequency of physician screening for a range of biomedical, psychosocial, and educational developmental issues in the majority (≥ 50%) of adolescent patients. Bivariate analyses were performed to determine differences between professional groups. Results. The response rate was 32.3% (n = 213), with 209 responders being suitable for further analysis. The sample comprised 48.8% general practitioners, 33.0% family medicine specialists, and 18.2% pediatricians. Physicians more often screened for biomedical risks than for psychosocial risks, with very low frequencies of screening for psychosocial issues such as mood, suicidal ideation, sexual orientation, and safety concerns. Physicians reported high levels of confidence in discussing most psychosocial issues with adolescent patients. Time limitation and an insufficient knowledge base were the main factors identified as influencing screening practices. Conclusions. The data suggest unsatisfactory frequency of adolescent health screening by Jamaican physicians, in particular for psychosocial factors. The primary factors identified by physicians as influencing their screening practices have potential for improvement through continued medical education.
Keywords: adolescent; article; child health care; clinical practice; health status; human; Jamaica

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones - Asscheman, H.; Giltay, E.J.; Megens, J.A.J.; de Ronde, W.; van Trotsenburg, M.A.A.; Gooren, L.J.G. (European Journal of Endocrinology, Supplement, 2011)
Objective: Adverse effects of long-term cross-sex hormone administration to transsexuals are not well documented. We assessed mortality rates in transsexual subjects receiving long-term cross-sex hormones. Design: A cohort study with a median follow-up of 18.5 years at a university gender clinic. Methods: Mortality data and the standardized mortality rate were compared with the general population in 966 male-to-female (MtF) and 365 female-to-male (FtM) transsexuals, who started cross-sex hormones before July 1, 1997. Follow-up was at least 1 year. MtF transsexuals received treatment with different high-dose estrogen regimens and cyproterone acetate 100 mg/day. FtM transsexuals received parenteral/oral testosterone esters or testosterone gel. After surgical sex reassignment, hormonal treatment was continued with lower doses. Results: In the MtF group, total mortality was 51% higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome, cardiovascular disease, drug abuse, and unknown cause. No increase was observed in total cancer mortality, but lung and hematological cancer mortality rates were elevated. Current, but not past ethinyl estradiol use was associated with an independent threefold increased risk of cardiovascular death. In FtM transsexuals, total mortality and cause-specific mortality were not significantly different from those of the general population. Conclusions: The increased mortality in hormone-treated MtF transsexuals was mainly due to non-hormone-related causes, but ethinyl estradiol may increase the risk of cardiovascular death. In the FtM transsexuals, use of testosterone in doses used for hypogonadal men seemed safe. © 2011 European Society of Endocrinology.
Keywords: antiandrogen; cyproterone acetate; estradiol valerate; estrogen; ethinylestradiol; spironolactone; testosterone; testosterone ester; testosterone undecanoate; acquired immune deficiency syndrome; adolescent; adult; aged; aging; article; cancer mortality; cardiovascular disease; cause of death; clinical assessment; comorbidity; controlled study; dose response; drug abuse; drug megadose; drug safety; female; female to male transgender; follow up; gel; hematologic malignancy; hormone substitution; human; idiopathic disease; lung cancer; male; male to female transgender; risk assessment; sex reassignment; suicide; transsexualism; treatment duration; andriol

Role of gender in sexual behaviours and response to education in sexually transmitted infections in 17-year-old adolescents - Rembeck, G.I.; Gunnarsson, R.K. (Midwifery, 2011)
Objective: to investigate gender differences in high school students with respect to sexual risk behaviours, and their perceptions of the effect of an educational programme on sexually transmitted infections (STIs). In addition, this study aimed to investigate differences between students in programmes preparing for university compared with vocational programmes. Participants, setting and design: second-year high school adolescents from two communities in south-west Sweden were invited to participate in the study, and completed a questionnaire on sexual experience, sexual risk behaviours and the impact of the educational programme on STIs. Findings: males took less responsibility for STI prevention than females. Furthermore, males perceived themselves to be less influenced by the STI education than females. Females had more experience of same-sex sexuality than males. Conclusions and implications for practice: males take less responsibility for STI prevention than females. When planning STI education, it is important to consider gender, traditions and various learning styles. If STI education fails to reach males, the prevalence of these infections will continue to increase. © 2009 Elsevier Ltd.
Keywords: adolescent; article; attitude to health; child behavior; female; human; male; methodology; prevalence; psychological aspect; safe sex; sex difference; sexual education; sexuality; sexually transmitted disease; socioeconomics; standard; Sweden; unsafe sex

Is there a right not to know one's sex? The ethics of 'gender verification' in women's sports competition - Wiesemann, C. (Journal of Medical Ethics, 2011)
The paper discusses the current medical practice of 'gender verification' in sports from an ethical point of view. It takes the recent public discussion about 800 m runner Caster Semenya as a starting point. At the World Championships in Athletics 2009 in Berlin, Germany, Semenya was challenged by competitors as being a so called 'sex impostor'. A medical examination to verify her sex ensued. The author analyses whether athletes like Semenya could claim a right not to know that is generally acknowledged in human genetics and enforced by international and national genetic privacy laws. The relevance of this right for genetic diagnosis in sports is discussed. To this end, the interests of the athlete concerned and of third parties are balanced according to the expected benefits and harms.Harm is documented in a number of cases and includes unjustified disqualification, severe sex and gender identity crisis, demeaning reactions, social isolation, depression and suicide. Benefits are dubious as most cases of intersex are considered irrelevant for sports competition. It has to be concluded that the benefits to be gained from 'gender verification' in sports via genetic testing do not outweigh the grave individual disadvantages. The current practice of athletic associations to largely ignore the right of competitors not to know does not comply with prevailing ethical provisions on the protection of sensitive personal data. Therefore, genetic 'gender verification' in sports should be abolished.
Keywords: article; ethics; female; genetic counseling; human; interpersonal communication; legal aspect; male; psychological aspect; sex determination; disorder of sex development; sexual development; sport

Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden - Dhejne, C.; Lichtenstein, P.; Boman, M.; Johansson, A.L.V.; Långström, N.; Landén, M. (PLoS ONE, 2011)
Context: The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment. Objective: To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons. Design: A population-based matched cohort study. Setting: Sweden, 1973-2003. Participants: All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973-2003. Random population controls (10:1) were matched by birth year and birth sex or reassigned (final) sex, respectively. Main Outcome Measures: Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]). Results: The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8-4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8-62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls. Conclusions: Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group. © 2011 Dhejne et al.
Keywords: adult; article; cohort analysis; controlled study; female; female to male transgender; follow up; gender dysphoria; human; immigrant; major clinical study; male; male to female transgender; mental patient; morbidity; mortality; patient care; population research; sex transformation; suicide; Sweden

Context of sexual risk behaviour among abused ethnic minority adolescent women - Champion, J.D. (International Nursing Review, 2011)
Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14-18 years (n=562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self-report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self-reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported 'getting high' and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae. © 2011 The Author. International Nursing Review © 2011 International Council of Nurses.
Keywords: adolescent; African American; article; chi square distribution; child behavior; ethnology; female; high risk behavior; Hispanic; human; interview; psychological aspect; risk factor; sexual behavior; sexual crime

Mental health of the non-heterosexual population of England - Chakraborty, A.; McManus, S.; Brugha, T.S.; Bebbington, P.; King, M. (British Journal of Psychiatry, 2011)
Background: There has been little research into the prevalence of mental health problems in lesbian, gay and bisexual (LGB) people in the UK with most work conducted in the USA. Aims: To relate the prevalence of mental disorder, self-harm and suicide attempts to sexual orientation in England, and to test whether psychiatric problems were associated with discrimination on grounds of sexuality. Method: The Adult Psychiatric Morbidity Survey 2007 (n = 7403) was representative of the population living in private UK households. Standardised questions provided demographic information. Neurotic symptoms, common mental disorders, probable psychosis, suicidality, alcohol and drug dependence and service utilisation were assessed. In addition, detailed information was obtained about aspects of sexual identity and perceived discrimination on these grounds. Results: Self-reported identification as non-heterosexual (determined by both orientation and sexual partnership, separately) was associated with unhappiness, neurotic disorders overall, depressive episodes, generalised anxiety disorder, obsessive-compulsive disorder, phobic disorder, probable psychosis, suicidal thoughts and acts, self-harm and alcohol and drug dependence. Mental health-related general practitioner consultations and community care service use over the previous year were also elevated. In the non-heterosexual group, discrimination on the grounds of sexual orientation predicted certain neurotic disorder outcomes, even after adjustment for potentially confounding demographic variables. Conclusions: This study corroborates international findings that people of non-heterosexual orientation report elevated levels of mental health problems and service usage, and it lends further support to the suggestion that perceived discrimination may act as a social stressor in the genesis of mental health problems in this population.
Keywords: alcoholism; article; automutilation; bisexuality; community care; consultation; demography; depression; disease association; drug dependence; female; gender identity; general practitioner; generalized anxiety disorder; health care utilization; household; human; homosexual female; major clinical study; male; homosexual male; mental health; neurosis; obsessive compulsive disorder; phobia; population; prediction; prevalence; psychosis; self report; sexual orientation; sexuality; social stress; suicidal ideation; suicide attempt; United Kingdom

The association between relationship markers of sexual orientation and suicide: Denmark, 1990-2001. - Mathy, R.M.; Cochran, S.D.; Olsen, J.; Mays, V.M. (Social psychiatry and psychiatric epidemiology, 2011)
Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12-year period following legalization of same-sex registered domestic partnerships (RDPs). Using data from death certificates issued between 1990 and 2001 and population estimates from the Danish census, we estimated suicide mortality risk among individuals classified into one of three marital/cohabitation statuses: current/formerly in same-sex RDPs; current/formerly heterosexually married; or never married/registered. Risk for suicide mortality was associated with this proxy indicator of sexual orientation, but only significantly among men. The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married. Suicide risk appears greatly elevated for men in same-sex partnerships in Denmark. To what extent this is true for similar gay and bisexual men who are not in such relationships is unknown, but these findings call for targeted suicide prevention programs aimed at reducing suicide risk among gay and bisexual men.
Keywords: adolescent; adult; age distribution; aged; article; bisexuality; cause of death; comparative study; Denmark; female; homosexuality; human; homosexual female; male; middle aged; minority group; psychological aspect; risk factor; sex ratio; sexual behavior; statistics; suicide; suicide attempt

Introduction to special issue on suicide, mental health, and youth development - Eliason, M. (Journal of Homosexuality, 2011)
Keywords: adolescent; article; bisexuality; bullying; female; homosexuality; human; human development; male; mental health; psychological aspect; social psychology; suicide; transsexualism; United States

Sexual attraction status and adolescent suicide proneness: The roles of hopelessness, depression, and social support - Langhinrichsen-Rohling, J.; Lamis, D.A.; Malone, P.S. (Journal of Homosexuality, 2011)
This study explored the relationship between sexual attraction status (same-sex, both-sex, and opposite-sex) and suicidal behavior in a diverse sample of adolescents (N = 1,533 youth). Adolescents with attractions to both sexes reported greater suicide proneness, recent and lifetime suicidal ideation, and past suicide attempts than those with exclusively opposite-sex attractions; individuals reporting same-sex attractions generally demonstrated moderate elevations on these variables. As hypothesized, both hopelessness and depression mediated the relationship between sexual attraction status and suicide proneness. Social support moderated the mediating effect of depression but not hopelessness in the sexual attraction status-suicide proneness link. Targeting the distress that can be associated with experiencing same-sex or both-sex attractions may enhance suicide prevention efforts, particularly in U.S. youth with reduced social support. © Taylor & Francis Group, LLC.
Keywords: adolescent; article; bisexuality; clinical trial; depression; female; homosexuality; human; male; multicenter study; psychological aspect; psychological model; regression analysis; risk factor; social support; suicide; transsexualism; United States

Transgender patients sidelined by attitudes and labelling - Bateman, C. (South African Medical Journal, 2011)
Keywords: acquired immune deficiency syndrome; article; depression; drug abuse; empathy; female to male transgender; gender; gender identity; general practitioner; health care access; health care cost; hormonal therapy; human; Human immunodeficiency virus infection; infection risk; law; lifestyle; male to female transgender; parental behavior; patient care; patient referral; patient right; prevalence; psychiatrist; psychologist; quality of life; sex transformation; sexual orientation; social worker; South Africa; suicide; surgeon; transsexualism

Sexual orientation and its relation to mental disorders and suicide attempts: Findings from a nationally representative sample - Bolton, S.-L.; Sareen, J. (Canadian Journal of Psychiatry, 2011)
Objective: To compare the rates of all Axis I and II mental disorders and suicide attempts in sexual orientation minorities with rates in heterosexuals using a nationally representative sample. Method: Data used were from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (n = 34 653, response rate = 70.2%). Cross-tabulations and multivariate logistic regression analyses were performed to determine differences in rates of mental disorders and suicide attempts by sexual orientation. All analyses were stratified by sex. Results: Compared with their heterosexual counterparts, lesbians and bisexual women demonstrated a 3-fold increased likelihood of substance use disorders, and gay and bisexual men showed twice the rate of anxiety disorders and schizophrenia and (or) psychotic illness, even after accounting for mental disorder comorbidity. Suicide attempts were independently associated with bisexuality, with odds 3 times higher than in heterosexuals. Conclusion: Findings from our study emphasize the fact that sexual orientation minorities are vulnerable to poor mental health outcomes, including suicide attempts. Clinicians need to be aware of these specific negative mental health consequences when assessing sexual orientation minorities.
Keywords: anxiety disorder; article; bisexual female; bisexual male; female; heterosexuality; human; homosexual female; major clinical study; male; homosexual male; mental disease; multivariate logistic regression analysis; psychosis; schizophrenia; sexual orientation; suicide attempt

Preventing bullycides: the school nurse's role in breaking the link between victimization of sexual minority youth and suicide. - Reynolds, D.V. (NASN school nurse (Print), 2011)
Keywords: adolescent; adult; article; bullying; child; female; homosexuality; human; male; nurse attitude; psychological aspect; school health nursing; social psychology; student; suicide; United States

The contribution of school to the feeling of acceptance and the risk of suicide attempts among Austrian gay and bisexual males - Plöderl, M.; Faistauer, G.; Fartacek, R. (Journal of Homosexuality, 2010)
School-related factors contributing to the suicidality of lesbian, gay, and bisexual individuals are understudied, especially in Germanspeaking Europe. Among our Web-based sample of 468 Austrian gay or bisexual adults, 18% attempted suicide and about one half of them reported that hard times at school related to one's homosexuality partly or mainly caused the attempt. Such suicide attempts were associated with a lack of acceptance at school and harassment experiences. In contrast to suicide attempts, acceptance at school was significantly associated with protective factors such as teachers intervening against homophobia or presence of openly homosexual teachers or peers. These findings may be important for consideration in school-based suicide prevention programs. © Taylor & Francis Group, LLC.
Keywords: adult; article; Austria; bisexuality; emotion; homosexuality; human; male; middle aged; psychological aspect; risk factor; school; social distance; social environment; suicide attempt; university

The cause of P. I. Tchaikovsky's (1840 - 1893) death: Cholera, suicide, or both? - Kornhauser, P. (AMHA - Acta Medico-Historica Adriatica, 2010)
The death of P. I. Tchaikovsky (1840-1893) excites imagination even today. According to the »official scenario«, Tchaikovsky had suffered from abdominal colic before being infected with cholera. On 2 November 1893, he drank a glass of unboiled water. A few hours later, he had diarrhoea and started vomiting. The following day anuria occured. He lost consciousness and died on 6 November (or on 25 Oktober according to the Russian Julian calendar). Soon after composer's death, rumors of forced suicide began to circulate. Based on the opinion of the musicologist Alexandra Orlova, the main reason for the composer's tragic fate lies in his homosexual inclination. The author of this article, after examining various sources and arguments, concludes that P. I. Tchaikovsky died of cholera.
Keywords: article; cholera; history; music; public figure; Russian Federation; suicide

Domestic violence screening: Prevalence and outcomes in a canadian HIV population - Siemieniuk, R.A.C.; Krentz, H.B.; Gish, J.A.; Gill, M.J. (AIDS Patient Care and STDs, 2010)
There is a strong association between domestic violence victimization and HIV infection. This may lead to poor health outcomes including mental health disorders and reduced access to care. A standardized domestic violence screening interview was incorporated into ongoing care in the large and diverse population living with HIV in Southern Alberta, Canada. Results from May through December 2009 are reported, including the prevalence and outcomes of abuse. Thirty-four percent of 853 patients screened reported abuse. Of these, 16% reported abuse in their current relationship, 58% in a previous relationship, and 57% reported a history of childhood abuse. High-risk groups for abuse included females (43%), gay/bisexual males (35%), and Aboriginals (61%). We found an association between a history of domestic violence and delayed access to care (p<0.05), missed appointments (p<0.001), and an increased use of clinic resources such as social work (p<0.0001) and psychiatry (p<0.001). Mental health conditions prior to HIV diagnosis, including depression (p<0.0001), suicidal ideation (p<0.0001), and anxiety disorder (p<0.0001) were associated with abuse at any time, while a history of adjustment disorder was associated with childhood abuse (p<0.05). A simple domestic violence screening tool was helpful for identifying patients experiencing abuse in our diverse HIV-infected population. This high prevalence of domestic violence among our HIV patients was associated with poor outcomes and an increased use of medical resources. HIV caregivers should be aware of domestic violence in order to optimize care and refer patients to appropriate support professionals as needed. © Copyright 2010, Mary Ann Liebert, Inc.
Keywords: indigenous people; adult; anxiety disorder; article; bisexual female; bisexual male; Canada; caregiver; child abuse; depression; disease association; domestic violence; female; health care access; high risk behavior; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; interview; major clinical study; male; medical history; mental health; outcome assessment; patient care; population research; prevalence; psychiatry; screening test; social work; suicidal ideation

Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. - Mustanski, B.S.; Garofalo, R.; Emerson, E.M. (American journal of public health, 2010)
We examined associations of race/ethnicity, gender, and sexual orientation with mental disorders among lesbian, gay, bisexual, and transgender (LGBT) youths. We assessed mental disorders by administering a structured diagnostic interview to a community sample of 246 LGBT youths aged 16 to 20 years. Participants also completed the Brief Symptom Inventory 18 (BSI 18). One third of participants met criteria for any mental disorder, 17% for conduct disorder, 15% for major depression, and 9% for posttraumatic stress disorder. Anorexia and bulimia were rare. Lifetime suicide attempts were frequent (31%) but less so in the prior 12 months (7%). Few racial/ethnic and gender differences were statistically significant. Bisexually identified youths had lower prevalences of every diagnosis. The BSI 18 had high negative predictive power (90%) and low positive predictive power (25%) for major depression. LGBT youths had higher prevalences of mental disorder diagnoses than youths in national samples, but were similar to representative samples of urban, racial/ethnic minority youths. Suicide behaviors were similar to those among representative youth samples in the same geographic area. Questionnaires measuring psychological distress may overestimate depression prevalence among this population.
Keywords: adolescent; adult; article; bisexuality; ethnic group; female; homosexuality; human; homosexual female; male; mental disease; mental stress; psychologic test; psychological aspect; race; statistics; suicidal ideation; suicide attempt; transsexualism; United States

Group differences in risk across three domains using an expanded measure of sexual orientation. - Loosier, P.S.; Dittus, P.J. (The journal of primary prevention, 2010)
The purpose of this study was to highlight associations between sexual orientation and risk outcomes in late adolescence and early adulthood using an expanded measure of sexual orientation. Recent data indicate higher levels of risk behavior in a newly identified population, mostly heterosexuals, as compared to heterosexuals. Comparisons among groups using an expanded measure of sexual orientation such as this, however, often do not include all possible groups or may restrict comparisons between groups. Data were derived from the National Longitudinal Study of Adolescent Health (Add Health); participants identified as heterosexual, mostly heterosexual, bisexual, mostly gay, or gay. Main risk outcomes were parental mistreatment, home displacement, thoughts of suicide, depressive symptoms, frequency of drinking, and delinquency. A priori planned comparisons examined differences between: (a) heterosexual vs. mostly heterosexual, (b) gay vs. mostly gay, (c) mostly heterosexual vs. bisexual, (d) mostly gay vs. bisexual, (e) mostly heterosexual vs. mostly gay, (f) heterosexual vs. gay, (g) heterosexual vs. bisexual, and (h) gay vs. bisexual. Mostly heterosexual youth were at significantly greater risk than heterosexual youth on all outcomes but did not differ from bisexual or mostly gay youth. Heterosexuals were at lower risk as compared to mostly heterosexuals and bisexuals. This study provides further evidence of differential risk associations for sexual minorities.
Keywords: adolescent; adult; article; depression; female; group process; homosexuality; human; information processing; male; methodology; minority group; psychological aspect; psychometry; risk assessment; sexual behavior; statistical model; statistics; United States

Sexual Orientation, Parental Support, and Health During the Transition to Young Adulthood - Needham, B.L.; Austin, E.L. (Journal of Youth and Adolescence, 2010)
Some recent studies suggest that sexual minorities may have worse health-related outcomes during adolescence because they report lower levels of family connectedness, a key protective resource. Using data from wave 3 of the National Longitudinal Study of Adolescent Health (n = 11,153; 50.6% female; mean age = 21.8 years), this study extends prior research on adolescents to young adults. We examine whether lesbian, gay, and bisexual (LGB) young adults report lower levels of parental support than their heterosexual peers and whether differences in parental support help explain why LGB young adults tend to have worse health-related outcomes. We find that lesbian and bisexual women report lower levels of parental support than heterosexual women and that gay men report lower levels of parental support than bisexual and heterosexual men. Compared to heterosexual women, lesbian and bisexual women have higher odds of suicidal thoughts and recent drug use; bisexual women also have higher odds of elevated depressive symptomatology and heavy drinking. Gay men have higher odds of suicidal thoughts than heterosexual men. With the exception of heavy drinking, parental support either partially or fully mediates each of the observed associations. Even though the transition from adolescence to young adulthood is characterized by increased independence from parents, parental support remains an important correlate of health-related outcomes during this stage of life. Sexual minorities report lower levels of parental support during young adulthood, which helps explain why they have worse health-related outcomes. Interventions designed to strengthen relationships between LGB young adults and their parents could lead to a reduction in health disparities related to sexual orientation. © 2010 Springer Science+Business Media, LLC.
Keywords: addiction; adolescent; adult; anxiety disorder; article; bisexuality; child behavior; child parent relation; comorbidity; female; health status; homosexuality; human; human relation; homosexual female; male; psychological aspect; psychosexual development; sex ratio; sexuality; social psychology; social support; statistics; suicide attempt

Self-reported premature ejaculation prevalence and characteristics in Korean young males: Community-based data from an internet survey - Son, H.; Song, S.H.; Kim, S.W.; Paick, J.-S. (Journal of Andrology, 2010)
Premature ejaculation (PE) is suspected to be the most prevalent male sexual complaint, and the prevalence of PE is considerably high also in the younger generation. We investigated the PE prevalence based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed text revision; DSM-IV-TR) definition and the risk factors of PE in Korean young men via Internet survey. Subjects (n = 3980) aged from 20 to 59, who performed sexual intercourse more than once a month during the past 6 months were asked to participate in this study. Participants were asked to complete a questionnaire that consisted of questions on general, medical, and sexual history related to ejaculation. A total of 600 subjects were included in this study. PE prevalence was found to be 18.3%. Prevalences were not significantly different across age groups, after excluding subjects with erectile dysfunction (ED). Educational level, marital status and duration, average income, sexual orientation, smoking, alcohol consumption, and circumcision status showed no difference in the PE and non-PE groups. Partners perceived satisfaction rates were 45.0% in the PE group and 63.9% in the non-PE group. Significant differences were found between the PE and non-PE groups in terms of ED, obesity, and depression prevalence. However, multiple logistic regression analysis revealed that the significant risk factors of PE were age and the frequency of conversations with partners about sexual intercourse. This Internet-based study is limited because participants probably represent a selected population of Internet users with non-representative educational and socioeconomic profiles. This study is the first to report the prevalence of both self-reported PE and PE on the basis of the DSM-IV-TR definition in the Korean population. This study demonstrates that PE in Korea is as prevalent as it is in European countries and the United States. Copyright © American Society of Andrology.
Keywords: academic achievement; adult; age distribution; alcohol consumption; article; circumcision; depression; Diagnostic and Statistical Manual of Mental Disorders; erectile dysfunction; health survey; human; income; Internet; major clinical study; male; marriage; obesity; premature ejaculation; prevalence; priority journal; questionnaire; self report; sexual intercourse; sexual orientation; sexual satisfaction; smoking; South Korea

Family acceptance in adolescence and the health of LGBT young adults. - Ryan, C.; Russell, S.T.; Huebner, D.; Diaz, R.; Sanchez, J. (Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 2010)
the role of family acceptance as a protective factor for lesbian, gay, bisexual, and transgender (LGBT) adolescents and young adults has not been established. a quantitative measure with items derived from prior qualitative work retrospectively assessed family accepting behaviors in response to LGBT adolescents' sexual orientation and gender expression and their relationship to mental health, substance abuse, and sexual risk in young adults (N= 245). family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors. family acceptance of LGBT adolescents is associated with positive young adult mental and physical health. Interventions that promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities.
Keywords: adaptive behavior; adolescent; adult; article; bisexuality; family relation; female; health behavior; homosexuality; human; homosexual female; male; psychological aspect; retrospective study; social support; transsexualism

A population-based study of sexual orientation identity and gender differences in adult health. - Conron, K.J.; Mimiaga, M.J.; Landers, S.J. (American journal of public health, 2010)
OBJECTIVES: We provide estimates of several leading US adult health indicators by sexual orientation identity and gender to fill gaps in the current literature. METHODS: We aggregated data from the 2001-2008 Massachusetts Behavioral Risk Factor Surveillance surveys (N = 67,359) to examine patterns in self-reported health by sexual orientation identity and gender, using multivariable logistic regression. RESULTS: Compared with heterosexuals, sexual minorities (i.e., gays/lesbians, 2% of sample; bisexuals, 1%) were more likely to report activity limitation, tension or worry, smoking, drug use, asthma, lifetime sexual victimization, and HIV testing, but did not differ on 3-year Papanicolaou tests, lifetime mammography, diabetes, or heart disease. Compared with heterosexuals, bisexuals reported more barriers to health care, current sadness, past-year suicidal ideation, and cardiovascular disease risk. Gay men were less likely to be overweight or obese and to obtain prostate-specific antigen tests, and lesbians were more likely to be obese and to report multiple risks for cardiovascular disease. Binge drinking and lifetime physical intimate partner victimization were more common among bisexual women. CONCLUSIONS: Sexual orientation disparities in chronic disease risk, victimization, health care access, mental health, and smoking merit increased attention. More research on heterogeneity in health and health determinants among sexual minorities is needed.
Keywords: addiction; adolescent; adult; alcohol intoxication; article; behavioral risk factor surveillance system; bisexuality; domestic violence; female; gender identity; health disparity; homosexuality; human; incidence; homosexual female; male; middle aged; mood disorder; obesity; risk; sex ratio; smoking; statistics; United States

Psychiatric comorbidity among patients with gender identity disorder - Hoshiai, M.; Matsumoto, Y.; Sato, T.; Ohnishi, M.; Okabe, N.; Kishimoto, Y.; Terada, S.; Kuroda, S. (Psychiatry and Clinical Neurosciences, 2010)
Aims: Psychiatric comorbidity and mental instability seem to be important unfavorable prognostic factors for long-term psychosocial adjustment in gender identity disorder (GID). However, psychiatric comorbidity in patients with GID has rarely been assessed. In this study, we investigated the psychiatric comorbidity and life events of patients with GID in Japan. Methods: A total of 603 consecutive patients were evaluated independently by at least two senior psychiatrists at the GID clinic using clinical information and results of examinations. Results: Using DSM-IV criteria, 579 patients (96.0%) were diagnosed with GID. Among the GID patients, 349 (60.3%) were the female-to-male (FTM) type, and 230 (39.7%) were the male-to-female (MTF) type. Current psychiatric comorbidity was 19.1% (44/230) among MTF patients and 12.0% (42/349) among FTM patients. The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients. Among current psychiatric diagnoses, adjustment disorder (6.7%, 38/579) and anxiety disorder (3.6%, 21/579) were relatively frequent. Mood disorder was the third most frequent (1.4%, 8/579). Conclusions: Comparison with previous reports on the psychiatric comorbidity among GID patients revealed that the majority of GID patients had no psychiatric comorbidity. GID is a diagnostic entity in its own right, not necessarily associated with severe comorbid psychological findings. © 2010 Japanese Society of Psychiatry and Neurology.
Keywords: adjustment disorder; anxiety disorder; article; Asperger syndrome; automutilation; bipolar I disorder; comorbidity; Diagnostic and Statistical Manual of Mental Disorders; dissociative amnesia; female; female to male transgender; gender dysphoria; generalized anxiety disorder; human; Japan; life event; major clinical study; major depression; male; male to female transgender; mood disorder; obsessive compulsive disorder; panic; pervasive developmental disorder not otherwise specified; psychiatrist; schizophrenia; social phobia; somatization; somatoform disorder; suicidal ideation

Harmful alcohol consumption and patterns of substance use in HIV-infected patients receiving antiretrovirals (ANRS-EN12-VESPA Study): Relevance for clinical management and intervention - Michel, L.; Carrieri, M.P.; Fugon, L.; Roux, P.; Aubin, H.-J.; Lert, F.; Obadia, Y.; Spire, B. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2010)
Alcohol abuse affects secondary prevention and disease progression in HIV-infected patients, and adherence and response to treatment in those chronically treated. The objective of this study was to estimate the prevalence of harmful alcohol consumption (HAC) using various indicators and identify which groups of patients may require specific targeted interventions for HAC risk reduction. A cross-sectional survey, based on a random sample representative of people living with HIV/AIDS (PLWHA) was carried out in 102 French hospital departments delivering HIV care. As alcohol abuse is particularly detrimental to patients receiving highly active antiretroviral therapy (HAART), we focused only on those individuals receiving HAART with complete alcohol assessment (CAGE, AUDIT-C, regular binge drinking, N=2340). Collected information included medical and socio-demographic data, HIV risk behaviors, adherence to treatment and substance and alcohol use, together with depression, anxiety, and experience of attempted suicide or sex work. HAC prevalence was evaluated as follows: 12% (CAGE score 2), 27% (AUDIT-C), and 9% (regular binge drinking). Three groups were at higher risk of HAC: men who have sex with men using stimulants, polydrug users, and to a lesser degree, ex-drug users. Innovative intervention strategies to reduce HAC and improve HIV prevention and HAART adherence in various PLWHA populations need urgent testing and implementation. Such interventions for alcohol risk reduction remain central to promoting improved HIV prevention and assuring HAART effectiveness in these populations. © 2010 Taylor and Francis.
Keywords: antiretrovirus agent; adult; alcohol consumption; alcoholism; anxiety; article; depression; drinking behavior; educational status; female; health survey; high risk behavior; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; homosexual male; patient care; priority journal; prostitution; substance abuse; suicide attempt

Suicide patterns and association with predictors among Rhode Island public high school students: a latent class analysis. - Jiang, Y.; Perry, D.K.; Hesser, J.E. (American journal of public health, 2010)
OBJECTIVES: We analyzed Rhode Island's 2007 Youth Risk Behavior Survey (YRBS) data to investigate suicide patterns and their association with suicide risk predictors among public high school students. METHODS: We used latent class regression analysis of Rhode Island's 2007 YRBS data (from a random sample of 2210 public high school students) to model latent classes of suicide risk and identify predictors of latent class membership. RESULTS: Four latent classes of suicide risk were modeled and predictors were associated with each: class 1 (emotionally healthy, 74%); class 2 (considered and planned suicide, 14%) was associated with being female, having low grades, being gay/lesbian/bisexual/unsure, feeling unsafe at school, having experienced forced sexual intercourse, and self-perceived overweight; class 3 (attempted suicide, 6%) was associated with speaking a language other than English at home, being gay/lesbian/bisexual/unsure, feeling unsafe at school, and forced sexual intercourse; and class 4 (planned and attempted suicide, 6%) was associated with the previously mentioned predictors and with being in 9th or 10th grade and currently smoking. CONCLUSIONS: A single model characterized and quantified 4 patterns of suicide risk among adolescents and identified predictors for 3 at-risk classes. Interventions for high-risk youths may help prevent adolescent suicides.
Keywords: adolescent; article; child behavior; child psychology; female; high risk behavior; human; male; prediction and forecasting; psychological aspect; questionnaire; regression analysis; risk assessment; suicide; United States

Chronic oral treatment with isotretinoin alters measures of activity but not anxiety in male and female rats - Ferguson, S.A.; Berry, K.J. (Neurotoxicology and Teratology, 2010)
Use of the anti-acne drug, Accutane® (ACC) (isotretinoin, 13-cis-retinoic acid), has been associated with neuropsychiatric events ranging from depression in animal models to depression and suicide ideation in humans. Our studies, however, have consistently indicated few effects on measures of depression in male and female rats. Still, the comorbidity of depression and anxiety suggests that anxiety assessments in ACC-treated rats could be informative. Such assessments must be balanced with measures of activity since drug-induced activity alterations may impact the expression of anxiety-like behaviors. Here, Sprague-Dawley rats (n=15/sex/dose) were gavaged daily with 0 (soy oil), 7.5, or 30. mg/kg/day ACC beginning on postnatal day (PND) 59. Blood ACC levels similar to humans taking recommended ACC doses are produced by 7.5. mg/kg/day. Short-term activity was assessed in open fields prior to ACC treatment (PND 51) and again at PNDs 129 and 164 and in a complex environment at PNDs 66 and PND 184. Long-term residential activity was measured in running wheels (PNDs 85-92) and figure 8 mazes (PNDs 99-106). Anxiety-like behavior was assessed via elevated plus maze (EPM) activity on PND 98 and in a black/white apparatus on PND 125. The typical sex differences in most behaviors were exhibited (i.e., increased EPM open arm entries and overall activity in most measures in females); however, there were no significant effects of ACC treatment on open field activity, complex environment activity, residential running wheel activity, or EPM activity. Residential figure 8 maze activity indicated that male and female rats treated with 30. mg/kg/day were less active on all nights (p<0.05) and females treated with 7.5 or 30. mg/kg/day were less active than same-sex controls on most days (p<0.05). Similarly, rats of both sexes treated with 30. mg/kg/day were significantly less active in the black/white apparatus (p<0.05), entering the darkened area less frequently (p<0.05), although duration in the darkened area did not differ. These data indicate that at blood levels typically achieved by humans (i.e., the 7.5. mg/kg group), there are no significant anxiogenic effects associated with ACC treatment. At higher ACC levels, there are mild effects on activity but these appear to be apparatus- and/or age-specific. © 2010.
Keywords: isotretinoin; animal experiment; anxiety; article; chronic drug administration; comorbidity; controlled study; depression; dose response; drug blood level; drug exposure; environmental factor; feeding behavior; female; light dark cycle; male; maze test; nonhuman; open field test; perinatal period; priority journal; psychologic test; rat; recommended drug dose; sex difference; accutane

Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients - Kitts, R.L. (Journal of Homosexuality, 2010)
The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.
Keywords: adolescent; anamnesis; article; attitude to health; bisexuality; doctor patient relationship; female; homosexuality; human; information processing; homosexual female; male; medicine; transsexualism

Parental acceptance and illegal drug use among Gay, Lesbian, and Bisexual adolescents: Results from a national survey - Padilla, Y.C.; Crisp, C.; Rew, D.L. (Social Work, 2010)
Although gay, lesbian, and bisexual (GLB) adolescents face many of the same developmental challenges as do heterosexual adolescents, they must also deal with the stress of being part of a stigmatized group. The purpose of this study was to examine the extent to which family support and involvement with the queer community may buffer the effects of life stress on substance use among GLB youths. Drawing on a large national online survey, the authors examined drug use in 1,906 GLB youths 12 to 17 years of age. Overall, 20 percent of the youths reported using illegal substances in the past 30 days. Results from multivariate analyses revealed that stress, as measured by suicidal ideation, significantly increased the risk of drug use. A positive reaction from the mother to the youth's coming out served as a significant protective factor, whereas involvement in a queer youth group had no effect. The authors found evidence that, for GLB adolescents, parental acceptance of sexual identity is an important aspect of a strong family relationship and, thus, has important ramifications for their healthy development. Implications of the findings for social work practice are discussed. © 2010 National Association of Social Workers.
Keywords: addiction; adolescent; adult; article; bisexuality; child; child parent relation; female; homosexuality; human; information processing; homosexual female; male; United States

Exploration of the resilience construct in posttraumatic stress disorder severity and functional correlates in military combat veterans who have served since September 11, 2001 - Green, K.T.; Calhoun, P.S.; Dennis, M.F.; Beckham, J.C.; Miller-Mumford, M.; Fernandez, A.; Taber, K.H.; Yoash-Gantz, R.E.; Moore, S.D.; Tupler, L.A. (Journal of Clinical Psychiatry, 2010)
Objective: This study evaluated the relationship between resilience and psychological functioning in military veterans deployed to a region of military conflict in support of Operation Enduring Freedom or Operation Iraqi Freedom. Method: 497 military veterans completed a structured psychiatric interview and questionnaires measuring psychological symptoms, resiliency, and trauma exposure. The study had 2 primary aims: (1) to examine whether the association between trauma exposure and PTSD was moderated by resilience and (2) to examine whether resilience was uniquely associated with functional outcomes after accounting for PTSD. Measures included the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (for PTSD diagnosis), the Connor-Davidson Resilience Scale, and the Traumatic Life Events Questionnaire. Data were collected between June 2005 and February 2009. Results: Evaluating the association of resilience and trauma exposure with PTSD revealed main effects for combat exposure, lifetime trauma exposure, and resilience. Additionally, there was a significant (P < .05) interaction between combat exposure and resilience such that higher levels of resilience were particularly protective among individuals with high combat exposure. After controlling for age, gender, minority status, trauma exposure, and PTSD diagnosis, resilience was uniquely associated with decreased suicidality, reduced alcohol problems, lower depressive symptom severity, and fewer current health complaints and lifetime and past-year medical problems. Conclusions: These results suggest that resilience is a construct that may play a unique role in the occurrence of PTSD and severity of other functional correlates among deployed veterans. Future studies in this area would benefit from a prospective design, the evaluation of other possible protective processes (eg, social support), and specific examination of particular aspects of resilience and how resilience may be increased. © Copyright 2010 Physicians Postgraduate Press, Inc.
Keywords: accident; adult; anxiety disorder; army; article; assault; battle injury; Beck Depression Inventory; cigarette smoking; controlled study; depression; Diagnostic and Statistical Manual of Mental Disorders; disaster; disease severity; female; health status; human; Iraq; life event; major clinical study; major depression; male; multivariate logistic regression analysis; occupational exposure; outcome assessment; posttraumatic stress disorder; prevalence; priority journal; psychiatric diagnosis; questionnaire; self report; sexual abuse; social support; military personnel; structured interview; substance abuse; symptom; Symptom Checklist 90; Traumatic Life Events Questionnaire; war

Transcriptome sequencing and comparative analysis of cucumber flowers with different sex types - Guo, S.; Zheng, Y.; Joung, J.-G.; Liu, S.; Zhang, Z.; Crasta, O.R.; Sobral, B.W.; Xu, Y.; Huang, S.; Fei, Z. (BMC Genomics, 2010)
Background: Cucumber, Cucumis sativus L., is an economically and nutritionally important crop of the Cucurbitaceae family and has long served as a primary model system for sex determination studies. Recently, the sequencing of its whole genome has been completed. However, transcriptome information of this species is still scarce, with a total of around 8,000 Expressed Sequence Tag (EST) and mRNA sequences currently available in GenBank. In order to gain more insights into molecular mechanisms of plant sex determination and provide the community a functional genomics resource that will facilitate cucurbit research and breeding, we performed transcriptome sequencing of cucumber flower buds of two near-isogenic lines, WI1983G, a gynoecious plant which bears only pistillate flowers, and WI1983H, a hermaphroditic plant which bears only bisexual flowers.Result: Using Roche-454 massive parallel pyrosequencing technology, we generated a total of 353,941 high quality EST sequences with an average length of 175bp, among which 188,255 were from gynoecious flowers and 165,686 from hermaphroditic flowers. These EST sequences, together with ~5,600 high quality cucumber EST and mRNA sequences available in GenBank, were clustered and assembled into 81,401 unigenes, of which 28,452 were contigs and 52,949 were singletons. The unigenes and ESTs were further mapped to the cucumber genome and more than 500 alternative splicing events were identified in 443 cucumber genes. The unigenes were further functionally annotated by comparing their sequences to different protein and functional domain databases and assigned with Gene Ontology (GO) terms. A biochemical pathway database containing 343 predicted pathways was also created based on the annotations of the unigenes. Digital expression analysis identified ~200 differentially expressed genes between flowers of WI1983G and WI1983H and provided novel insights into molecular mechanisms of plant sex determination process. Furthermore, a set of SSR motifs and high confidence SNPs between WI1983G and WI1983H were identified from the ESTs, which provided the material basis for future genetic linkage and QTL analysis.Conclusion: A large set of EST sequences were generated from cucumber flower buds of two different sex types. Differentially expressed genes between these two different sex-type flowers, as well as putative SSR and SNP markers, were identified. These EST sequences provide valuable information to further understand molecular mechanisms of plant sex determination process and forms a rich resource for future functional genomics analysis, marker development and cucumber breeding. © 2010 Guo et al; licensee BioMed Central Ltd.
Keywords: messenger RNA; plant RNA; transcriptome; article; bisexuality; computer prediction; controlled study; cucumber; expressed sequence tag; gene cluster; gene expression profiling; gene mapping; genetic database; near isogenic line; nonhuman; pistil; plant genome; pyrosequencing; RNA sequence; sex determination; single nucleotide polymorphism

Mental Health Pathways From Interpersonal Violence to Health-Related Outcomes in HIV-Positive Sexual Minority Men - Pantalone, D.W.; Hessler, D.M.; Simoni, J.M. (Journal of Consulting and Clinical Psychology, 2010)
Objective: We examined mental health pathways between interpersonal violence (IPV) and health-related outcomes in HIV-positive sexual minority men engaged with medical care. Method: HIV-positive gay and bisexual men (N = 178) were recruited for this cross-sectional study from 2 public HIV primary care clinics that treated outpatients in an urban setting. Participants (M age = 44.1 years, 36% non-White) filled out a computer-assisted survey and had health-related data extracted from their electronic medical records. We used structural equation modeling to test associations among the latent factors of adult abuse and partner violence (each comprising indicators of physical, sexual, and psychological abuse) and the measured variables: viral load, health-related quality of life (HRQOL), HIV medication adherence, and emergency room (ER) visits. Mediation was tested for the latent construct mental health problems, comprising depression, anxiety, symptomatology of posttraumatic stress disorder, and suicidal ideation. Results: The final model demonstrated acceptable fit, χ2 (123) = 157.05, p = .02, CFI = .95, TLI = .94, RMSEA = .04, SRMR = .06, accounting for significant portions of the variance in viral load (13%), HRQOL (41%), adherence (7%), and ER visits (9%), as well as the latent variable mental health problems (24%). Only 1 direct link emerged: a positive association between adult abuse and ER visits. Conclusions: Findings indicate a significant role of IPV and mental health problems in the health of people living with HIV/AIDS. HIV care providers should assess for IPV history and mental health problems in all patients and refer for evidence-based psychosocial treatments that include a focus on health behaviors. © 2010 American Psychological Association.
Keywords: adult; aged; anxiety disorder; article; depression; electronic medical record; health care survey; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; outcome assessment; partner violence; posttraumatic stress disorder; quality of life; sexual and gender minority; suicidal ideation; violence; virus load

Suicidal ideation among young French adults: Association with occupation, family, sexual activity, personal background and drug use - Legleye, S.; Beck, F.; Peretti-Watel, P.; Chau, N.; Firdion, J.M. (Journal of Affective Disorders, 2010)
Background: To assess associations among young adults between suicidal ideation in the previous year and adverse childhood events, occupation, education, tobacco use, alcohol abuse, cannabis use in the previous month, illicit drug use, sexual orientation and activity, depression, physical violence in the previous year, and lifetime forced sexual intercourse. Methods: A subsample of 4075 French adults aged 18-30 years was drawn from a random national telephone survey in 2005. Major depressive episode and alcohol abuse were assessed using CIDI-SF and AUDIT-C (score above 4). Data were analysed with logistic regressions. Results: Suicidal ideation affected 5.7% of men and 4.9% of women. Among men depression had the highest adjusted odds ratio (ORa = 8.06, 5.07-12.79), followed by homosexual intercourse (3.37, 1.62-7.04), absence of sexual activity (2.83, 1.80-4.44); ORa between 1.6 and 2.0 were observed for living alone, daily tobacco smoking, being unemployed, serious health event concerning the father, age 26-30 and bad relationships between parents. Among women, depression had the highest ORa (7.60, 4.70-12.29), followed by lifetime experience of forced sexual intercourse (5.37, 2.89-9.96), having consumed illicit drugs other than cannabis (4.01, 1.48-10.89); ORa between 1.7 and 2.5 were observed for living alone, being unemployed, bad relationship between parents and age 26-30. Limitations: Cross-sectional survey, sexual orientation inferred from sexual activity. Conclusion: Suicide prevention should integrate the fact that besides depression, unemployment, family history, age, and sexual activity and orientation are specific risk factors among men, whereas illicit drug use, violence and forced sexual intercourse are more important among women. © 2009 Elsevier B.V. All rights reserved.
Keywords: alcohol; cannabis; adult; alcohol abuse; article; drug abuse; education; family; family history; female; France; health survey; human; human relation; major clinical study; major depression; male; occupation; priority journal; sexual behavior; sexual intercourse; sexual orientation; smoking; suicidal ideation; telephone; unemployment; violence

Adolescent Suicide and Health Risk Behaviors. Rhode Island's 2007 Youth Risk Behavior Survey - Jiang, Y.; Perry, D.K.; Hesser, J.E. (American Journal of Preventive Medicine, 2010)
Background: Suicide is the third-leading cause of death among high school students in the U.S. Purpose: This study examined the relationships among indicators of depressed mood, suicidal thoughts, suicide attempts, and demographics and risk behaviors in Rhode Island high school students. Methods: Data from Rhode Island's 2007 Youth Risk Behavior Survey were utilized for this study. The statewide sample contained 2210 randomly selected public high school students. Data were analyzed in 2008 to model for each of five depressed mood/suicide indicators using multivariable logistic regression. Results: By examining depressed mood and suicide indicators through a multivariable approach, the strongest predictors were identified, for multiple as well as specific suicide indicators. These predictors included being female, having low grades, speaking a language other than English at home, being lesbian/gay/bisexual/unsure of sexual orientation, not going to school as a result of feeling unsafe, having been a victim of forced sexual intercourse, being a current cigarette smoker, and having a self-perception of being overweight. Conclusions: The strength of associations between three factors (immigrant status, feeling unsafe, and having forced sex) and suicide indicators adds new information about potential predictors of suicidal behavior in adolescents. © 2010 American Journal of Preventive Medicine.
Keywords: article; cigarette smoking; demography; depression; female; health hazard; high risk behavior; high school student; human; juvenile; major clinical study; male; multivariate logistic regression analysis; obesity; prediction; self concept; sexual intercourse; sexual orientation; suicidal behavior; suicide; suicide attempt

Oedipus at Colonus - Harris, J.C. (Archives of General Psychiatry, 2010)
Keywords: article; bisexuality; childhood; dream; ethnology; homosexuality; household; human; infanticide; marriage; morality; neurosis; Oedipus complex; personality disorder; psychoanalysis; psychoanalytic theory; psychodynamics; psychological aspect; public figure; reproduction; sexual crime; sexuality; suicide; superego

Use of school-based health centres for mental health support in Cape Breton, Nova Scotia - Szumilas, M.; Kutcher, S.; LeBlanc, J.C.; Langille, D.B. (Canadian Journal of Psychiatry, 2010)
Objective: To determine whether students with self-reported needs for mental health support used school-based health centres (SBHCs) for this purpose. Method: A secondary analysis was conducted on self-reported data collected from 1629 high school students from Cape Breton, Nova Scotia. Descriptive statistics and logistic regression analyses were employed to determine the influence of sex, grade, sexual orientation, socioeconomic status (SES), school performance, social involvement, and health risk-taking behaviours on need for mental health support and use of SBHC for that purpose. Results: One-half of surveyed students reported needs for mental health support. Risk for depression was the most commonly reported indicator of need. Only 13% of students visited a SBHC nurse for mental health support, and 4 times as many females than males used the SBHC for this purpose (20.4%, compared with 5.3%, P < 0.001). There was a significantly increased likelihood of use of SBHC for mental health support, given the presence of a greater number of need factors. Multivariate logistic regression determined that female sex (OR 5.57, 95% CI 3.07 to 10.09), lower SES factor (OR 1.19, 95% CI 1.11 to 1.28), sexual health risk-taking behaviours (OR 1.72, 95% CI 1.28 to 2.31), and suicidal behaviour (OR 1.83, 95% CI 1.48 to 2.27) were significantly associated with the use of SBHCs for mental health support. Conclusions: Substantial need for mental health support and significant unmet need were observed. In particular, male students underused the services relative to their self-reported need. Implications for SBHCs and directions for future research are discussed.
Keywords: academic achievement; adolescent; adult; article; Canada; controlled study; depression; female; health center; health hazard; high risk behavior; high school; human; logistic regression analysis; major clinical study; male; mental health; school based health center; school health service; secondary analysis; self concept; sex difference; sexual orientation; social status; socioeconomics; suicidal behavior

Genetic and environmental influences on risk of death due to infections assessed in Danish twins, 1943-2001 - Obel, N.; Christensen, K.; Petersen, I.; Sørensen, T.I.A.; Skytthe, A. (American Journal of Epidemiology, 2010)
Genetic differences have been proposed to play a strong role in risk of death from infectious diseases. The study base of 44,005 included all same-sex twin pairs born in 1870-2001, with both twins alive on January 1, 1943, or those born thereafter. Cause of death was obtained from the Danish Cause of Death Register and was available for 18,359 deaths. The authors classified death due to infections by 3 definitions (narrow, broader, and broadest) and calculated concordance rates for same-sex monozygotic and dizygotic twin pairs. Heritability was estimated by using structural equation models. When the 3 definitions were applied, 211 (1.1%), 1,089 (5.9%), and 2,907 (15.8%) deaths, respectively, were due to infections. The probandwise concordance rates for monozygotic twin pairs were consistently higher than for dizygotic twin pairs regardless of the definition (9% vs. 0% (P = 0.04), 10% vs. 3% (P < 0.01), and 19% vs. 15% (P = 0.07), respectively). For the broader and broadest definitions, heritability was 40% (95% confidence interval: 12, 50) and 19% (95% confidence interval: 3, 35), respectively. The concordance rates were generally low, and, although a genetic influence on the risk of death from infectious diseases could be demonstrated, the absolute effect of the genetic component on mortality was small. © The Author 2010.
Keywords: accident; article; cardiovascular disease; cerebrovascular accident; congenital malformation; death; dementia; Denmark; digestive system disease; dizygotic twins; environmental factor; genetic difference; heredity; homicide; human; infection; major clinical study; malignant neoplasm; monozygotic twins; mortality; register; respiratory tract disease; risk assessment; senility; suicide; tuberculosis; twin concordance; twins; urogenital tract disease

Men's sexual orientation and health in Canada. - Brennan, D.J.; Ross, L.E.; Dobinson, C.; Veldhuizen, S.; Steele, L.S. (Canadian journal of public health. Revue canadienne de santé publique, 2010)
OBJECTIVES: Previous large-scale population studies have reported that gay and bisexual men may be at increased risk for health disparities. This study was conducted to determine whether health status and health risk behaviours of Canadian men vary based on sexual orientation identity. METHODS: Utilizing the Canadian Community Health Survey data (Cycle 2.1, 2003; n = 49,901), we conducted multivariable logistic regression to assess the independent effects of sexual orientation on health status and health risk behaviours. For all multivariate models, we calculated odds ratios, p-values, standard errors, and 95% confidence intervals (CIs) using the bootstrap re-sampling procedure recommended by Statistics Canada. RESULTS: When compared to heterosexual men, gay and bisexual men did not report more respiratory conditions; had lower rates of obesity and overweight BMI; and reported more mood/anxiety disorders, and a history of lifetime suicidality. Gay and bisexual men did not report higher rates of daily smoking or risky drinking, however, gay men reported an almost six-fold increase in STD diagnoses when compared to heterosexual men. CONCLUSION: This study represents the largest-known population-based data analysis on health risks and behaviours among men of varying sexual orientations. These findings raise important concerns regarding the impact of sexual orientation on mental and sexual health. Limitations of this data set, including those associated with measurement of sexual orientation, are discussed. Further research is required to understand the mechanisms that influence these health resiliencies and disparities.
Keywords: adult; article; bisexuality; Canada; cross-sectional study; health status; high risk behavior; homosexuality; human; interview; male; middle aged; sexual behavior; statistical model

Psychiatric adverse events in randomized, double-blind, placebo-controlled clinical trials of varenicline: A pooled analysis - Tonstad, S.; Davies, S.; Flammer, M.; Russ, C.; Hughes, J. (Drug Safety, 2010)
Background: Varenicline (Chantix®, Champix®) has shown efficacy and tolerability as an aid to smoking cessation. In postmarketing surveillance, neuropsychiatric symptoms have appeared; however, their incidence and causal relationship to varenicline is not known. Objective: We assessed the incidence and relative risk (RR) of psychiatric disorders in ten randomized, double-blind, placebo-controlled trials of varenicline for smoking cessation. Methods: All smoking cessation phase II, III and IV randomized controlled clinical trials of varenicline versus placebo completed as of 31 December 2008, on file with the manufacturer (Pfizer, Inc.), were included. All studies have been published. All 3091 participants who received at least one dose of varenicline and all 2005 participants who received placebo were included in this analysis. These were men and women smoking ≥10 cigarettes/day, aged 18-75 years and without current psychiatric disease who received varenicline or placebo for 6 (one study), 12 (eight studies) or 52 (one study) weeks. Adverse events were recorded at each study visit and classified according to standard Medical Dictionary for Regulatory Activities (MedDRA) terms (version 11.0). Results: The incidence of psychiatric disorders other than solely sleep disorders and disturbances was 10.7% in subjects treated with varenicline and 9.7% in subjects treated with placebo, with an RR of 1.02 (95% CI 0.86, 1.22). The RRs (95% CI) versus placebo of psychiatric adverse events with an incidence ≥1% in the varenicline group were 0.86 (0.67, 1.12) for anxiety disorders and symptoms, 0.76 (0.42, 1.39) for changes in physical activity, 1.42 (0.96, 2.08) for depressed mood disorders and disturbances, 1.21 (0.79, 1.83) for mood disorders and disturbances not elsewhere classified and 1.70 (1.50, 1.92) for sleep disorders and disturbances. There were no cases of suicidal ideation or behaviour in varenicline-treated subjects in the ten placebo-controlled studies analysed. However, among three trials that were excluded from the analysis because of their open-label design, two cases of suicidal ideation and one completed suicide were reported in patients who had been treated with varenicline. With the exception of sleep disorders and disturbances, there was no evidence of dose-responsivity. Conclusions: There was no significant increase in overall psychiatric disorders, other than sleep disorders and disturbances, in varenicline-treated subjects in this sample of smokers without current psychiatric disorders. Ongoing studies are testing the use of varenicline in psychiatric patients. © 2010 Adis Data Information BV. All rights reserved.
Keywords: amfebutamone; placebo; varenicline; adjustment disorder; aggression; anger; anhedonia; anxiety disorder; apathy; article; attention disturbance; automutilation; bipolar disorder; cigarette smoking; clinical trial; cognitive defect; communication disorder; confusion; controlled clinical trial; delirium; depression; disorientation; dissociative disorder; dose response; drug withdrawal; frustration; gender dysphoria; hallucination; hostility; human; incidence; mania; mental disease; perception disorder; personality disorder; priority journal; psychosis; randomized controlled trial; restlessness; risk assessment; risk factor; schizophrenia; sexual dysfunction; side effect; sleep disorder; smoking cessation; somatoform disorder; suicidal ideation; suicide attempt; thought disorder; tobacco dependence; champix; chantix

A choice between fun or health Relationships between nightlife substance use, happiness, and mental well-being - Sumnall, H.; Bellis, M.A.; Hughes, K.; Calafat, A.; Juan, M.; Mendes, F. (Journal of Substance Use, 2010)
Objective: To examine the substance use behaviours of young adults in Europe and to explore the association with self reported indices of mental well being, and the relative value of health. Method: 1341 1635-year-olds, representing youth and young adults who routinely engage in nightlife, were surveyed in nine European cities. Participants self-completed questionnaires, designed to gather demographic, social, and behavioural data on historic and current substance use, risk behaviours, and mental well being. Results: Controlling for inter-country differences, we found that early initiation and frequency of use of a range of substances was associated with poorer life satisfaction, suicidal ideation, and hopelessness. Younger, more frequent substance users placed greater value on having fun than maintaining long-term health. Bihomosexual participants were more likely to report hopelessness, suicidal thoughts, dissatisfaction with life, and preferring fun to health. Younger cocaine initiates were more likely to report considering suicide in the last 12 months than older initiates. Conclusions: These findings confirm the importance of early intervention for young substance users. Whilst our study does not make assumptions on causality, identification of substance use in nightclub attendees may be a good marker of comorbid disorders. It is important to recognize that negative mental states may also partly be a product of lifestyle and socioeconomic factors. Prevention and harm reduction interventions should recognize that the most at risk young people may discount future health gains from reducing their substance use. © 2010 Informa UK Ltd.
Keywords: midomafetamine; alcohol; cannabis; cocaine; adolescent; adult; age; article; attitude to health; Austria; behavior; bisexuality; Czech Republic; female; Germany; Greece; happiness; homosexuality; hopelessness; human; income; Italy; life satisfaction; male; night life; Portugal; priority journal; psychological well-being; self report; Slovenia; social life; Spain; substance abuse; suicidal ideation; United Kingdom

Coming out to talk about suicide: Gay men and suicidality - McAndrew, S.; Warne, T. (International Journal of Mental Health Nursing, 2010)
International studies report increased rates of mental health problems and subsequent suicidality among homosexual populations. While international health-care policy is concerned with reducing suicide among young people, important research findings relating to gay people and suicidality remain unacknowledged in the Suicide Prevention Strategy for England. This qualitative study, utilizing single case studies, was used to gain an in-depth understanding of the life experiences contributing to the suicidality of four gay men. The methodology was psychoanalytically informed, using free association narrative interviewing. The initial data analysis involved interpretation of each of the case studies and a subsequent analysis exploring the shared experiences found in each of the individual narratives. Thematically, these are described as 'knowing and not knowing', 'the centrality of the father-son relationship', 'the loneliness of outsiderness', 'leading a double life', and 'crime and punishment'. The significance of the life experiences these themes illustrate reveal why some gay men might not only experience long-term mental health problems, but also engage in suicidality. Individually and collectively, the analyses provide important insights for mental health nurses becoming more attuned to provide sensitive mental health care to those who have a gay sexual orientation. © 2010 The Authors. Journal compilation © 2010 Australian College of Mental Health Nurses Inc.
Keywords: adult; article; comorbidity; homosexuality; human; male; mental disease; methodology; psychologic test; psychological aspect; risk factor; statistics; suicide; United Kingdom

Health behaviors in the development and maintenance process of homosexual identity. - Patthum, T.; Kessomboon, P.; Sinsuphan, N.; Ratanasiri, A. (Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010)
Health behaviors of men who have sex with men (MSM) affect their health status in many aspects. Rate of HIV infection among Thai male prostitutes in 2005 was 15.4%. Among these, 28.3% were MSM. Thirty percent of youth suicides were conducted by gays and lesbians. To explore the health behaviors related to the development and maintenance process of men who have sex with men. This was a qualitative study. The study population was MSM in Mukdahan province. The subjects were recruited gradually, by snowball sampling, until the required data were saturated. In-depth interviews and participant observations were performed over a period of 17 months. A triangulation technique was applied to check reliability of the data. Data were analyzed by content analysis and compared with the Troiden's stages of development and maintenance process of homosexual identity. Eleven Thai MSM were recruited and followed up. Health behaviors of them were different according to the stages of development and maintenance process regarding Troiden's theory. Physical, psychological, social and sexual aspects of health behaviors were identified in various stages. It was found that many factors affect health behaviors of MSM. These include health promoting and undermining factors. Health behaviors of MSM varied in each stage of development and maintenance of homosexual identity. Health promotion campaigns and policies for MSM should be designed accordingly.
Keywords: adolescent; adult; article; ethnology; follow up; health behavior; health status; high risk behavior; homosexuality; human; interview; male; mental health; mental stress; middle aged; psychological aspect; qualitative research; self concept; Thailand

The Relation Between Sexual Orientation and Suicide Attempts in Austria - Plöderl, M.; Kralovec, K.; Fartacek, R. (Archives of Sexual Behavior, 2010)
Previous studies indicate that homosexual or bisexual individuals are at a higher risk of attempting suicide compared to heterosexuals. To overcome biases in these studies, more rigorous definitions of "suicide attempts" and the assessment of multiple dimensions of sexual orientation are needed. In addition, studies from the German speaking region are sparse, especially those not recruiting participants from the gay or lesbian communities. We solicited self-reported suicide attempts among 1,382 Austrian adults recruited through structured snowball sampling from students' social networks. Suicide attempts were more frequently reported by those participants with homosexual or bisexual fantasies, partner preference, behavior, and self-identification, compared to their heterosexually classified counterparts. This was true for any dimension of sexual orientation and for suicide attempts with intent to die or suicide attempts that required medical treatment. Our Austrian study confirmed existing evidence that homosexual and bisexual individuals are at an increased risk for attempting suicide. This should be considered in suicide preventive efforts. © 2010 Springer Science+Business Media, LLC.
Keywords: suicide attempt; sexual orientation; homosexuality; Austria; bisexuality; suicide; risk; heterosexuality; speech; adult; homosexual female; community; sampling; student; social network; fantasy; commercial phenomena; therapy

Suicide in HIV-infected individuals and the general population in Switzerland, 1988-2008 - Keiser, O.; Spoerri, A.; Brinkhof, M.W.G.; Hasse, B.; Gayet-Ageron, A.; Tissot, F.; Christen, A.; Battegay, M.; Schmid, P.; Bernasconi, E.; Egger, M. (American Journal of Psychiatry, 2010)
Objective: High rates of suicide have been described in HIV-infected patients, but it is unclear to what extent the introduction of highly active antiretroviral therapy (HAART) has affected suicide rates. The authors examined time trends and predictors of suicide in the pre-HAART (1988-1995) and HAART (1996-2008) eras in HIV-infected patients and the general population in Switzerland. Method: The authors analyzed data from the Swiss HIV Cohort Study and the Swiss National Cohort, a longitudinal study of mortality in the Swiss general population. The authors calculated standardized mortality ratios comparing HIV-infected patients with the general population and used Poisson regression to identify risk factors for suicide. Results: From 1988 to 2008, 15,275 patients were followed in the Swiss HIV Cohort Study for a median duration of 4.7 years. Of these, 150 died by suicide (rate 158.4 per 100,000 person-years). In men, standardized mortality ratios declined from 13.7 (95% CI=11.0-17.0) in the pre-HAART era to 3.5 (95% CI=2.5-4.8) in the late HAART era. In women, ratios declined from 11.6 (95% CI=6.4-20.9) to 5.7 (95% CI=3.2-10.3). In both periods, suicide rates tended to be higher in older patients, in men, in injection drug users, and in patients with advanced clinical stage of HIV illness. An increase in CD4 cell counts was associated with a reduced risk of suicide. Conclusions: Suicide rates decreased significantly with the introduction of HAART, but they remain above the rate observed in the general population, and risk factors for suicide remain similar. HIV-infected patients remain an important target group for suicide prevention.
Keywords: antiretrovirus agent; adult; article; CD4+ T lymphocyte; cohort analysis; controlled study; female; follow up; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; incidence; intravenous drug abuse; longitudinal study; major clinical study; male; homosexual male; mortality; Poisson distribution; priority journal; psychotherapy; risk assessment; risk factor; risk reduction; sex ratio; suicide; Switzerland

Adolescent same-sex attraction and mental health: The role of stress and support - Teasdale, B.; Bradley-Engen, M.S. (Journal of Homosexuality, 2010)
This study draws on the social stress model from the sociology of mental health to examine the impact of same-sex attraction on depressed mood and suicidal tendencies. Specifically, we hypothesize that across multiple contexts, adolescents with same-sex attractions are likely to experience more social stress and less social support than heterosexual adolescents. In turn, these experiences increase the likelihood of negative mental health outcomes. Using data from the National Longitudinal Study of Adolescent Health (n = 11,911), we find that adolescents with same-sex attraction are more likely than their heterosexual counterparts to report depressed mood and suicidal tendencies. Moreover, stress and social support were found to mediate a substantial part of the relationship between same-sex attraction and depressed mood. In addition, stress and social support mediated about one third of the relationship between same-sex attraction and suicidal tendencies. These findings give strong support for the social stress model. We conclude with a discussion of the role that alienation plays in same-sex-attracted adolescent mental health. © Taylor & Francis Group, LLC.
Keywords: adolescent; affect; article; depression; female; homosexuality; human; male; mental health; mental stress; physiology; prevalence; psychological aspect; social support; statistics; suicide

Alcohol and drug use and related consequences among gay, lesbian and bisexual college students: Role of experiencing violence, feeling safe on campus, and perceived stress - Reed, E.; Prado, G.; Matsumoto, A.; Amaro, H. (Addictive Behaviors, 2010)
Objective: To examine differences between gay, lesbian, and bisexual (GLB) and non-GLB university students in alcohol and other drug use (AOD) and related consequences as well as the relevance of violence, perceived safety, and stress to any such differences in AOD use and related concerns. Methods: A random representative sample of university students (n = 988) were recruited via email for an online survey. Linear regression models assessed associations between identifying as GLB and AOD use and related consequences. Results: Regression models (adjusted for gender) indicated that, in comparison to heterosexual students, GLB students were more likely to report recent illicit drug use (AOR = 2.0; 95% CI: 1.1-3.9), more frequent negative AOD consequences (β = 5.5, SE = 1.4, p < 0.0001), and having seriously thought about/attempted suicide due to AOD use in the past year (AOR = 6.6; 95% CI: 3.0-14.3). Study findings also suggested that violence, safety, and stress variables partially contribute to AOD use and related concerns among GLB students. Conclusions: Findings highlight the need for future efforts to investigate and address mechanisms, including aspects of campus life, which contribute to AOD related risks among GLB students. © 2009 Elsevier Ltd. All rights reserved.
Keywords: adult; alcohol consumption; article; bisexual female; bisexual male; college student; comparative study; controlled study; drug use; female; human; homosexual female; male; homosexual male; safety; school stress; social behavior; student attitude; suicide attempt; threat; violence

Suicidal Ideation and Attempt Among Adolescents Reporting "Unsure" Sexual Identity or Heterosexual Identity Plus Same-Sex Attraction or Behavior: Forgotten Groups? - Zhao, Y.; Montoro, R.; Igartua, K.; Thombs, B.D. (Journal of the American Academy of Child and Adolescent Psychiatry, 2010)
Objective: To compare risk of suicide ideation and attempts in adolescents with 1) gay, lesbian, or bisexual (GLB) identity, 2) "unsure" identity, or 3) heterosexual identity with same-sex attraction/fantasy or behavior, to heterosexual identity without same-sex attraction/fantasy or behavior. Method: A total of 1,856 students 14 years of age and older from 14 public and private high schools in Montréal, Québec, were surveyed anonymously. The survey included items assessing sexual orientation, health risk behaviors, and suicidal ideation and attempts. Multiple logistic regression models were used to assess risk factors for suicidal ideation and attempts. Results: In all, 58 (3.1%) adolescents self-identified as GLB, 59 (3.2%) as unsure, and 115 (6.2%) as heterosexual with same-sex attraction/fantasy or behavior. Compared with heterosexually identified youth without same-sex attraction/fantasy or behavior (N = 1,624; 87.5%), in multivariable analyses, 12-month suicidal ideation was significantly higher for both GLB (odds ratio [OR] = 2.31, 95% confidence interval [CI] = 1.22-4.37) and unsure youth (OR = 2.64, 95% CI = 1.38-5.08). Twelve-month suicide attempts were significantly elevated for GLB youth (OR = 2.23, 95% CI = 1.15-4.35) and high, although not statistically significant, for unsure youth (OR = 1.61, 95% CI = 0.77-3.36). Heterosexual identity with same-sex attraction/fantasy or behavior was not significantly associated with increased suicidal ideation (OR = 1.26, 95% CI = 0.76-2.08) or attempts (OR = 1.03, 95% CI = 0.55-1.91) in multivariable analyses. Conclusion: Compared with heterosexual youth without same-sex attraction/fantasy or behavior, adolescents with GLB and unsure identities were at greater risk of suicidality. However, youth who reported same-sex attraction or behavior but a heterosexual identity were not at elevated risk. © 2010 American Academy of Child and Adolescent Psychiatry.
Keywords: adolescent; adult; article; bisexuality; Canada; fantasy; female; gender dysphoria; heterosexuality; high risk behavior; high risk population; human; homosexual female; major clinical study; male; homosexual male; priority journal; risk assessment; sexual orientation; suicidal ideation; suicide attempt

Sexually transmitted disease (STD) diagnoses and mental health disparities among women who have sex with women screened at an Urban Community Health Center, Boston, MA, 2007 - Reisner, S.L.; Mimiaga, M.J.; Case, P.; Grasso, C.; O'Brien, C.T.; Harigopal, P.; Skeer, M.; Mayer, K.H. (Sexually Transmitted Diseases, 2010)
BACKGROUND: A growing body of research documents mental health disparities among women who have sex with women (WSW) compared with women who have sex with men only (WSM). However, there remains a dearth of research exploring these indicators alongside sexually transmitted diseases (STDs) and WSW sexual health. METHODS: A retrospective chart review was conducted of all female patients (n = 368) screened for STDs between July 2007 and December 2007 at an urban community health center in Boston, MA. Deidentified electronic medical record data (e.g., demographics, psychosocial, sexual health) were analyzed and linked to STD positivity. Women who did not have sexual behavior documented in their medical chart (n = 58) were excluded from this analysis. Bivariate and multivariable logistic regression procedures examined sexual and psychosocial health indicators, including sexual preference. RESULTS: Twenty-seven percent of participants were WSW (17% WSW only and 10% WSW/M). Overall, 5% of WSW were diagnosed with a new STD (human papillomavirus, anogenital warts, genital herpes, pelvic inflammatory disease) and 17% had a history of a prior STD. In multivariable models adjusting for demographics, WSW were disproportionately more likely to have mental health and psychosocial issues noted in their medical records, including: a clinical diagnosis of depression, anxiety, and posttraumatic stress disorder, history of suicide attempts, and inpatient psychiatric/mental health treatment. However, WSW were significantly less likely than WSM to engage in "high risk" HIV/STD sexual behavior. In a final multivariable model, same sex behavior was not associated with a different likelihood of being diagnosed with an STD, compared with opposite sex behavior. However, WSW diagnosed with STDs were at increased odds of having bipolar disorder and utilizing outpatient mental health counseling services compared with WSW without STDs. WSW with a history of STDs were at increased odds of having attempted suicide in the past, utilizing both outpatient and inpatient mental health treatment services, and having a history of injection drug use compared with WSW without a history of STDs. CONCLUSIONS: WSW with STDs may have presenting psychosocial problems. Further research is warranted to better understand the relationship between sexual behavior and health, as well as to guide the development of interventions to ameliorate health disparities among WSW, particularly in the psychosocial domain. Copyright © 2009 American Sexually Transmitted Diseases Association All rights reserved.
Keywords: adult; anxiety; article; bipolar disorder; bivariate analysis; condyloma acuminatum; demography; depression; drug abuse; electronic medical record; female; genital herpes; health center; health disparity; hospital patient; human; Human immunodeficiency virus; major clinical study; mass screening; medical record; medical record review; mental health; mental patient; multivariate logistic regression analysis; outpatient; pelvic inflammatory disease; posttraumatic stress disorder; psychiatric treatment; risk factor; sex; sexual behavior; sexual health; sexually transmitted disease; social psychology; substance abuse; suicide attempt; United States; urban population; Wart virus

Sexual orientation and gender identity in youth suicide victims: An exploratory study - Renaud, J.; Berlim, M.T.; Begolli, M.; McGirr, A.; Turecki, G. (Canadian Journal of Psychiatry, 2010)
Objective: Our study was designed to explore additional outcome variables of a suicide case - control study to determine the association between sexual orientation and gender identity in suicide completion in children and adolescents. Method: Fifty-five child and adolescent suicide victims and 55 community control subjects were assessed using semi-structured, proxy-based interviews and questionnaires regarding sexual orientation and gender issues, psychopathological diagnoses, and service use. Results: In our sample, no significant differences between suicide victims and control subjects were found regarding same-sex sexual orientation nor intimidation related to same-sex sexual orientation. Suicide victims with same-sex sexual orientation were more likely than suicide victims without same-sex sexual orientation, to meet criteria for anxiety disorders. Within the month preceding their deaths, these youth were more likely to have consulted a health professional, a psychiatrist, as well as having been hospitalized, and were more likely to have consulted a psychiatrist in the last year. Conclusions: In our sample, same-sex sexual orientation and gender identity issues do not appear to be more prevalent among youth who die by suicide, compared with youth recruited from the general population, nor for same-sex sexual-related intimidation. While exhibiting comparable levels of general psychopathological diagnoses associated with suicide, suicide victims with same-sex sexual orientation were more likely to meet criteria for anxiety disorders and to have consulted mental health professionals before their deaths.
Keywords: adolescent; alcohol abuse; anxiety disorder; article; bipolar disorder; case control study; child; controlled study; death; disease association; drug abuse; dysthymia; exploratory research; female; gender identity; health practitioner; hospitalization; human; major clinical study; major depression; male; outcome variable; population; psychiatrist; psychosis; questionnaire; school child; semi structured interview; sexual orientation; suicide; victim

Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. - Nuttbrock, L.; Hwahng, S.; Bockting, W.; Rosenblum, A.; Mason, M.; Macri, M.; Becker, J. (Journal of sex research, 2010)
The psychiatric impact of interpersonal abuse associated with an atypical presentation of gender was examined across the life course of 571 male-to-female (MTF) transgender persons from the New York City Metropolitan Area. Gender-related abuse (psychological and physical), suicidality, and Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) major depression were retrospectively measured across five stages of the life course using the Life Chart Interview. Among younger respondents (current age of 19-39), the impact of both types of abuse on major depression was extremely strong during adolescence and then markedly declined during later stages of life. Among older respondents (current age of 40-59), the impact of both types of abuse on major depression was strong during adolescence and then marginally declined during later stages of life. The effects of both types of abuse on suicidality were weaker but more consistently observed across the life course among both the younger and older respondents. Gender-related abuse is a major mental health problem among MTF transgender persons, particularly during adolescence. As these individuals mature, however, the consequences of this abuse appear less severe, which may represent the development of moderately effective mechanisms for coping with this abuse.
Keywords: adult; article; Diagnostic and Statistical Manual of Mental Disorders; female; gender identity; human; major depression; male; partner violence; psychological aspect; sexual crime; statistics; transsexualism

Pilots of the future: Suicide prevention and the internet - Boyce, N. (The Lancet, 2010)
Keywords: article; Australia; automutilation; awareness; bisexuality; community care; human; information processing; Internet; homosexual female; homosexual male; mental disease; online monitoring; online system; priority journal; public health; publication; sexual education; sexually transmitted disease; social isolation; social network; suicidal behavior; suicide; television; transsexualism; violence

The association between relationship markers of sexual orientation and suicide: Denmark, 1990-2001 - Mathy, R.M.; Cochran, S.D.; Olsen, J.; Mays, V.M. (Social Psychiatry and Psychiatric Epidemiology, 2009)
Objective: Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12-year period following legalization of same-sex registered domestic partnerships (RDPs). Method: Using data from death certificates issued between 1990 and 2001 and population estimates from the Danish census, we estimated suicide mortality risk among individuals classified into one of three marital/cohabitation statuses: current/formerly in same-sex RDPs; current/formerly heterosexually married; or never married/registered. Results: Risk for suicide mortality was associated with this proxy indicator of sexual orientation, but only significantly among men. The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married. Conclusions: Suicide risk appears greatly elevated for men in same-sex partnerships in Denmark. To what extent this is true for similar gay and bisexual men who are not in such relationships is unknown, but these findings call for targeted suicide prevention programs aimed at reducing suicide risk among gay and bisexual men. © 2009 The Author(s).
Keywords: marker; suicide; sexual orientation; mortality; Denmark; homosexual female; homosexuality; risk; bisexual male; custodial care; heterosexuality; suicide attempt; marriage; prevention; death certificate; population; population research

Women's sexual orientation and health: Results from a Canadian population-based survey - Steele, L.S.; Ross, L.E.; Dobinson, C.; Veldhuizen, S.; Tinmouth, J.M. (Women and Health, 2009)
The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.
Keywords: adult; article; Canada; chi square distribution; cross-sectional study; drinking behavior; female; health status; health survey; high risk behavior; human; mental health; middle aged; questionnaire; regression analysis; risk; sexuality; smoking; statistics; women's health

Desire for non-mutilative disability in a nonhomosexual, male-to-female transsexual - Kolla, N.J.; Zucker, K.J. (Archives of Sexual Behavior, 2009)
In adults, the desire for a healthy limb amputation has been reported in both the lay press and the scientific literature. While the etiology of this condition is currently unknown, prevailing theories have tended to conceptualize the phenomenon as paraphilic in origin. In this report, we present the case of a 25-year-old, nonhomosexual male-to-female transsexual who manifested an intense desire to be afflicted with a nonmutilative neurological disability (multiple sclerosis). The patient categorically denied sexual attraction towards the thought of being an amputee or physically disabled. Hypotheses are proposed for the development of this condition with special emphasis accorded to the significance of the preferred target disability. © 2009 Springer Science+Business Media, LLC.
Keywords: amfebutamone; betahistine; estrogen; salbutamol; spironolactone; adult; anxiety; apotemnophilia; article; attention deficit disorder; automutilation; behavior disorder; body dysmorphic disorder; borderline state; bulimia; case report; depression; disabled person; disease course; estrogen therapy; female; femininity; gender dysphoria; gender identity; heterosexuality; homosexuality; human; limb amputation; major depression; male to female transgender; malingering; masculinity; multiple sclerosis; neurologic disease; paresthesia; patient referral; personality test; physical disability; psychologic test; psychopharmacology; psychosexual disorder; psychosocial withdrawal; sexual behavior; sexual intercourse; sexual orientation; suicidal behavior; suicide attempt; urine incontinence; visual disorder; Wechsler intelligence scale; wheelchair

Childhood sexual abuse and the sociocultural context of sexual risk among adult Latino gay and bisexual men - Arreola, S.G.; Neilands, T.B.; Díaz, R. (American Journal of Public Health, 2009)
Objectives. We sought to examine the relationships among childhood sexual abuse, social discrimination, psychological distress, and HIV-risk among Latino gay and bisexual men in the United States. Methods. Data were from a probability sample of 912 men from Miami, FL; Los Angeles, CA; and New York, NY. We used logistic regression and path analyses to examine direct and indirect effects of childhood sexual abuse on psychological distress and sexual risk behavior. Results. We found a 15.8% (95% confidence interval=12.3%, 19.2%) prevalence of childhood sexual abuse. Not having sex before age 16 years and having consensual sex before age 16 years did not differ from each other in predicting any of the outcomes of interest. Forced sex was associated with a significantly increased risk for all outcomes. A path analyses yielded direct effects of childhood sexual abuse and exposure to homophobia during childhood and during adulthood on psychological distress and indirect effects on risky sexual behavior. Conclusions. HIV-risk patterns among Latino gay and bisexual men are related to childhood sexual abuse and a social context of discrimination, which combined lead to symptoms of psychological distress and participation in risky sexual situations that increase risky sexual behaviors associated with HIV acquisition.
Keywords: adult; adulthood; anxiety; article; bisexual male; child sexual abuse; depression; distress syndrome; high risk population; Hispanic; homophobia; human; Human immunodeficiency virus; infection risk; major clinical study; male; homosexual male; mental stress; prediction; prevalence; probability sample; risk assessment; sex; sexual behavior; sleep; social class; social discrimination; social environment; suicide; symptom; United States

Identification and characterization of integron mediated antibiotic resistance in pentachlorophenol degrading bacterium isolated from the chemostat - Sharma, A.; Thakur, I.S. (Journal of Environmental Sciences, 2009)
A bacterial consortium was developed by continuous enrichment of microbial population isolated from sediment core of pulp and paper mill effluent in mineral salts medium (MSM) supplemented with pentachlorophenol (PCP) as sole source of carbon and energy in the chemostat. The consortia contained three bacterial strains. They were identified as Escherichia coli, Pseudomonas aeruginosa and Acinetobacter sp. by 16S rRNA gene sequence analysis. Acinetobacter sp. readily degraded PCP through the formation of tetrachloro-p-hydroquinone (TecH), 2-chloro-1,4-benzenediol and products of ortho ring cleavage detected by gas chromatograph/mass spectrometer (GC-MS). Out of the three acclimated PCP degrading bacterial strains only one strain, Acinetobacter sp. showed the presence of integron gene cassette as a marker of its stability and antibiotic resistance. The strain possessed a 4.17 kb amplicon with 22 ORF's. The plasmid isolated from the Acinetobacter sp. was subjected to shotgun cloning through restriction digestion by BamHI, HindIII and SalI, ligated to pUC19 vector and transformed into E. coli XLBlue1α, and finally selected on MSM containing PCP as sole source of carbon and energy with ampicillin as antibiotic marker. DNA sequence analysis of recombinant clones indicated homology with integron gene cassette and multiple antibiotic resistance genes. © 2009 The Research Centre for Eco-Environmental Sciences, Chinese Academy of Sciences.
Keywords: pentachlorophenol; Acinetobacter; antibiotic resistance; article; bacterial count; Escherichia coli; genetics; industrial waste; integron; metabolism; pollutant; Pseudomonas aeruginosa; soil pollutant

Clinical case rounds in child and adolescent psychiatry: Erotomania in an adolescent male with concomitant gender identity issues - Ritchie, B. (Journal of the Canadian Academy of Child and Adolescent Psychiatry, 2009)
Keywords: adolescent; article; case report; cognitive therapy; denial; dysphoria; erotomania; exercise; gender dysphoria; group therapy; human; male; obsession; occupational therapy; patient decision making; patient participation; psychoeducation; psychologic assessment; stalking; suicidal ideation

Age of minority sexual orientation development and risk of childhood maltreatment and suicide attempts in women. - Corliss, H.L.; Cochran, S.D.; Mays, V.M.; Greenland, S.; Seeman, T.E. (The American journal of orthopsychiatry, 2009)
Women with minority sexual orientations (e.g., lesbian, bisexual) are more likely than heterosexual women to report histories of childhood maltreatment and attempted suicide; however, the importance of the timing of minority sexual orientation development in contributing to this increased risk is uncertain. This study investigated relationships between self-reported ages of achieving minority sexual orientation development milestones (first awareness of same-gender attractions, disclosure of a minority sexual orientation to another person, and same-gender sexual contact), and childhood maltreatment and suicide attempt experiences in a sample of 2,001 women recruited from multiple-community sources. Younger age of minority sexual orientation development milestones was positively linked to self-reported recall of childhood maltreatment experiences, and to a childhood suicide attempt. After adjusting for differences in maltreatment, the odds of suicide attempt attributable to younger age of sexual orientation development milestones was reduced by 50 to 65%, suggesting that maltreatment may account for about half of the elevated risk for childhood suicide attempts among women with early minority sexual orientation development. Implications for services, interventions, and further research to address maltreatment disparities for sexual minorities are discussed. (c) 2009 APA, all rights reserved.
Keywords: adolescent; adult; age; article; child; child abuse; female; human; mental stress; minority group; psychological aspect; risk factor; sexual behavior; sexual development; social behavior; suicide attempt

Addressing key theoretical approaches to gay male sexual identity: Issues and insights for practitioners of mental health - Casey, M. (Critical Public Health, 2009)
This article seeks to draw attention to understandings of sexual identity and practice beyond essentialist notions of sexuality for mental health professionals working with gay men. A number of key studies and articles are explored in the article, which offer both historical and contemporary discussions of sexuality in mental health research and the social sciences. Initially, the article examines the important changes in approaches to and understandings of homosexuality and gay male identity by mental health professionals. In so doing, it considers the strengths and limits of recent studies by Diaz et al. (2001) and Sandfort et al. (2006) into mental health and homosexuality. The article then goes on to highlight approaches to gay male identity within the social sciences, focusing, in particular, on the work of Richardson (1987) and the value of social constructionist approaches to sexuality for therapists and practitioners. Work by Gray (2000) is then drawn upon which he examines the worth and value of using social constructionist accounts of sexuality in therapeutic practice. The aim of the article is to draw attention to the limits of essentialist notions of sexuality and the potential value of social constructionist accounts of sexual identity for those working with gay men and their mental health needs. © 2009 Taylor & Francis.
Keywords: article; gender identity; health behavior; health care need; homophobia; homosexuality; Human immunodeficiency virus infection; homosexual male; mental health care personnel; mental health service; psychological well-being; sexual orientation; social support; stigma; suicide

Impact of Sexual Harassment Victimization by Peers on Subsequent Adolescent Victimization and Adjustment: A Longitudinal Study - Chiodo, D.; Wolfe, D.A.; Crooks, C.; Hughes, R.; Jaffe, P. (Journal of Adolescent Health, 2009)
Purpose: To examine gender differences in prevalence and types of sexual harassment victimization experienced in grade 9 and how it contributes to relationship victimization and psychological adjustment 2.5 years later. Methods: A total of 1734 students from 23 schools completed self-report surveys at entry to grade 9 and end of grade 11. Self-report data were collected on victimization experiences (sexual harassment, physical dating violence, peer violence, and relational victimization) and adjustment (emotional distress, problem substance use, self-harm, suicidal thoughts, maladaptive dieting, feeling unsafe at school, and perpetration of violent delinquency). Separate analyses by sex were prespecified. Results: Sexual harassment victimization was common among boys (42.4%) and girls (44.1%) in grade 9, with girls reporting more sexual jokes, comments, and unwanted touch than among boys, and with boys reporting more homosexual slurs or receiving unwanted sexual content. For girls, sexual harassment victimization in grade 9 was associated with elevated risk of self-harm, suicidal thoughts, maladaptive dieting, early dating, substance use, and feeling unsafe at school. A similar pattern of risk was found for boys, with the exception of dieting and self-harm behaviors. Adjusted odds ratios (AOR) indicated these students were significantly more likely than nonharassed students to report victimization by peers and dating partners 2.5 years later (AOR for boys and girls, respectively; all p < .01), including sexual harassment (AOR: 2.45; 2.9), physical dating violence (AOR: 2.02; 3.73), and physical peer violence (AOR: 2.75; 2.79). Gr 9 sexual harassment also contributed significantly to emotional distress (AOR: 2.09; 2.24), problem substance use (AOR: 1.79; 2.04), and violent delinquency perpetration (AOR: 2.1; 3.34) 2.5 years later (boys and girls, respectively; all p < .01). Conclusions: Sexual harassment at the beginning of high school is a strong predictor of future victimization by peers and dating partners for both girls and boys, and warrants greater prevention and intervention efforts. © 2009 Society for Adolescent Medicine.
Keywords: adjustment; article; child behavior; emotional stress; feeding behavior; female; human; major clinical study; male; peer group; prevalence; priority journal; psychological aspect; risk factor; self report; sex difference; sexual behavior; sexual harassment; substance abuse; suicidal ideation; victim; violence

Association of adolescent catatonia with increased mortality and morbidity: Evidence from a prospective follow-up study - Cornic, F.; Consoli, A.; Tanguy, M.-L.; Bonnot, O.; Périsse, D.; Tordjman, S.; Laurent, C.; Cohen, D. (Schizophrenia Research, 2009)
This paper examined outcomes among youth with catatonic syndrome and determined whether the characteristics suggesting the relevance of chronic catatonic schizophrenia (CCS) at index episode remained stable at follow-up. From 1993 to 2004, 35 individuals aged 12 to 18 years were prospectively admitted for management of catatonic syndrome and followed up after discharge. Mean duration from discharge to follow-up was 3.9 years (range 1-10). Four patients were lost to follow-up. Among the remaining 31 subjects (mean age = 19.5 years, range 15-26), life-time diagnosis using the Diagnostic Interview for Genetic Studies was unchanged in 28 patients, and included schizophrenia (all subtypes; N = 20), major depressive episode (N = 5), bipolar disorder type I (N = 4) and brief psychotic episode (N = 2). Mortality (all-cause Standardized Mortality Ratio = 6266; 95% CI = 1181-18,547) and morbidity were severe, with 3 deaths (including 2 suicides), 6 patients presenting with a causal organic condition and 14 subjects needing continuous psychiatric care. All males in the study (N = 8) who had chronic catatonic schizophrenia at the index episode still had chronic catatonic signs at follow-up. Catatonia is one of the most severe psychiatric syndromes in adolescents. It is associated with a 60-fold increased risk of premature death, including suicide, when compared to the general population of same sex and age. This increased risk of premature death remains higher than the one measured in former adolescent psychiatric patients (all-cause SMR = 221; 95% CI = 156-303; Engqvist and Rydelius, 2006), or in schizophrenia irrespective to age and subtype (all-cause SMR = 157; 95% CI = 153-160; Harris and Barraclough, 1998). © 2009 Elsevier B.V. All rights reserved.
Keywords: adolescent; adult; article; bipolar I disorder; brief psychotic disorder; catatonia; cause of death; child psychiatry; clinical article; female; follow up; human; major depression; male; morbidity; mortality; priority journal; prospective study; risk factor; schizophrenia; suicide

Suicide in teens and young adults in the United States - Baron, D.; Paglia, C.; Thorkelson, G.; Namdari, M. (Quaderni Italiani di Psichiatria, 2009)
Introduction: Physicians choose a career in medicine to help people live longer, healthier lives. When individuals attempt to, or succeed in, ending their lives, it is very stressful for their families, friends, and care providers. This is particularly true when adolescents choose to end their young lives. Aim of this paper: This paper will provide an overview of adolescent suicide in the United States. Special emphasis will be placed on reviewing the epidemiology of adolescent suicide, known risk factors and suggestions for early intervention. The authors review the extant literature, including the Columbia Suicide Assessment Scale (C-CASA), and highlight areas in need of additional research. © 2009 Elsevier Srl. All rights reserved.
Keywords: serotonin uptake inhibitor; adolescent; alcohol consumption; article; behavior therapy; bullying; cognitive therapy; community program; eating disorder; genetics; homosexuality; hospitalization; human; imitation; Internet; mental disease; military service; patient referral; posttraumatic stress disorder; psychotherapy; risk factor; sexual abuse; social isolation; substance abuse; suicidal behavior; suicidal ideation; suicide; United States

Predictors of non-suicidal self-injury versus attempted suicide: similar or different? - Wichstrøm, L. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2009)
A nationally representative sample of Norwegian high school students (ages 14 to 19, N = 2,924) completed self-reports in school about non-suicidal self-injury (NSSI), suicide attempt (SA), and risk and protective factors. They were re-examined 5 years later. In all 2.2% reported NSSI with no SA during the follow-up period and 3.2% reported SA. Several risk and protective factors were common to NSSI and SA: previous SA, young age, debut of sexual intercourse before the age of 15, and non-heterosexual sexual interest. However, other risk and protective factors were unique to NSSI or SA: Previous NSSI increased the risk for future NSSI whereas satisfaction with social support protected against later NSSI. Suicidal ideation increased the risk for SA whereas attachment to parents protected against it. NSSI did not increase the risk of future SA. NSSI and SA may be thus conceived of as only partly overlapping phenomena, and not necessarily just representing different degrees of suicidality.
Keywords: adolescent; adult; article; automutilation; child; child parent relation; cross-sectional study; female; follow up; human; male; prospective study; psychological aspect; questionnaire; risk factor; satisfaction; self concept; sexual behavior; social support; statistics; student; suicide attempt

Connecting the invisible dots: Reaching lesbian, gay, and bisexual adolescents and young adults at risk for suicide through online social networks - Silenzio, V.M.B.; Duberstein, P.R.; Tang, W.; Lu, N.; Tu, X.; Homan, C.M. (Social Science and Medicine, 2009)
Young lesbian, gay, and bisexual (young LGB) individuals report higher rates of suicide ideation and attempts from their late teens through early twenties. Their high rate of Internet use suggests that online social networks offer a novel opportunity to reach them. This study explores online social networks as a venue for prevention research targeting young LGB. An automated data collection program was used to map the social connections between LGB self-identified individuals between 16 and 24 years old participating in an online social network. We then completed a descriptive analysis of the structural characteristics known to affect diffusion within such networks. Finally, we conducted Monte Carlo simulations of peer-driven diffusion of a hypothetical preventive intervention within the observed network under varying starting conditions. We mapped a network of 100,014 young LGB. The mean age was 20.4 years. The mean nodal degree was 137.5, representing an exponential degree distribution ranging from 1 through 4309. Monte Carlo simulations revealed that a peer-driven preventive intervention ultimately reached final sample sizes of up to 18,409 individuals. The network's structure is consistent with other social networks in terms of the underlying degree distribution. Such networks are typically formed dynamically through a process of preferential attachment. This implies that some individuals could be more important to target to facilitate the diffusion of interventions. However, in terms of determining the success of an intervention targeting this population, our simulation results suggest that varying the number of peers that can be recruited is more important than increasing the number of randomly-selected starting individuals. This has implications for intervention design. Given the potential to access this previously isolated population, this novel approach represents a promising new frontier in suicide prevention and other research areas. © 2009 Elsevier Ltd. All rights reserved.
Keywords: adolescent; adult; article; bisexuality; child psychiatry; controlled study; female; human; homosexual female; major clinical study; male; homosexual male; online system; peer group; primary prevention; simulation; social network; suicide

Predicting deliberate self-harm in adolescents: A six month prospective study - O'Connor, R.C.; Rasmussen, S.; Hawton, K. (Suicide and Life-Threatening Behavior, 2009)
Few studies have investigated the extent to which psychosocial/ psychological factors are associated with the prediction of deliberate self-harm (DSH) among adolescents. In this study, 737 pupils aged 15-16 years completed a lifestyle and coping survey at time one and 500 were followed up six months later. Six point two percent of the respondents (n = 31) reported an act of DSH between Time 1 and Time 2. In multivariate analyses, worries about sexual orientation, history of sexual abuse, family DSH, anxiety, and self-esteem were associated with repeat DSH during the course of the study, but history of sexual abuse was the only factor predictive of first-time DSH. The findings suggest that school-based programs focused on how young people cope with psychosocial stressors may offer promise. © 2009 The American Association of Suicidology.
Keywords: adolescent; alcohol consumption; anxiety; article; automutilation; bullying; child abuse; coping behavior; depression; drug use; family relation; female; follow up; friendship; health survey; human; impulsiveness; intimacy; male; optimism; prediction; prevalence; prospective study; self esteem; self poisoning; sexual abuse; sexual orientation; smoking; social behavior; suicide attempt

Psychosocial and psychiatric factors associated with adolescent suicide: A case-control psychological autopsy study - Portzky, G.; Audenaert, K.; van Heeringen, K. (Journal of Adolescence, 2009)
This study aimed at the investigation of psychosocial and psychiatric risk factors of adolescent suicide by means of a case-control psychological autopsy study. Relatives and other informants of 19 suicide victims and 19 matched psychiatric controls were interviewed by means of a semi-structured interview schedule. Psychiatric controls included adolescents, individually matched according to gender, age and time between interview and suicide/admission, who had been admitted to a Psychiatric Department with suicidal ideation or attempted suicide at admission. Results showed that suicide victims had been exposed more frequently to suicidal behaviour by friends and through media and experienced more relational problems in the past year. Suicidal communication was less frequently reported in suicide victims than in controls and when communication did occur, it was less often directed towards parents. Treatment of psychiatric disorders was significantly less found in suicide victims. Psychiatric control patients were more likely to have comorbidity of psychiatric disorder, conduct disorder, delinquency or academic difficulties. This study showed significant differences between young suicide victims and psychiatric controls for life events, exposure, communication and treatment. These results also suggest that more symptoms and more externalizing behaviour can be observed in psychiatric control patients which could indicate more warning signals of possible psychiatric problems for the environment, which could result in more help-seeking behaviour and treatment. © 2008 The Association for Professionals in Services for Adolescents.
Keywords: academic failure; adjustment disorder; adolescent; adult; age; article; Asperger syndrome; autopsy; body dysmorphic disorder; case control study; child parent relation; child psychiatry; clinical article; comorbidity; conduct disorder; controlled study; divorce; eating disorder; educational status; family life; female; gender dysphoria; help seeking behavior; hospital admission; human; human relation; impulsiveness; interpersonal communication; juvenile delinquency; life event; male; mass medium; mental disease; mental health care; mental health service; mood disorder; panic; personality disorder; risk factor; schizoaffective psychosis; schizophrenia; semi structured interview; sex difference; social problem; social psychology; substance abuse; suicidal behavior; suicidal ideation; suicide attempt

LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes - Birkett, M.; Espelage, D.L.; Koenig, B. (Journal of Youth and Adolescence, 2009)
Lesbian, gay, and bisexual students (LGB) and those questioning their sexual orientation are often at great risk for negative outcomes like depression, suicidality, drug use, and school difficulties (Elliot and Kilpatrick, How to Stop Bullying, A KIDSCAPE Guide to Training, 1994; Mufoz-Plaza et al., High Sch J 85:52-63, 2002; Treadway and Yoakam, J School Health 62(7):352-357, 1992). This study examined how school contextual factors such as homophobic victimization and school climate influence negative outcomes in LGB and questioning middle school students. Participants were 7,376 7th and 8th grade students from a large Midwestern county (50.7% Female, 72.7% White, 7.7% Biracial, 6.9% Black, 5.2% Asian, 3.7% Hispanic, and 2.2% reported "other"). LGB and sexually questioning youth were more likely to report high levels of bullying, homophobic victimization, and various negative outcomes than heterosexual youth. Students who were questioning their sexual orientation reported the most bullying, the most homophobic victimization, the most drug use, the most feelings of depression and suicidality, and more truancy than either heterosexual or LGB students. A positive school climate and a lack of homophobic victimization moderated the differences among sexual orientation status and outcomes. Results indicate that schools have the ability to lessen negative outcomes for LGB and sexually questioning students through creating positive climates and reducing homophobic teasing. © 2009 Springer Science+Business Media, LLC.
Keywords: achievement; addiction; adolescent; article; bisexuality; depression; female; homosexuality; human; homosexual female; male; psychological aspect; questionnaire; school; sexual harassment; social environment; statistics; student; suicide attempt

Emotional distress among lgbt youth: The influence of perceived discrimination based on sexual orientation - Almeida, J.; Johnson, R.M.; Corliss, H.L.; Molnar, B.E.; Azrael, D. (Journal of Youth and Adolescence, 2009)
The authors evaluated emotional distress among 9th-12th grade students, and examined whether the association between being lesbian, gay, bisexual, and/or transgendered (i.e., "LGBT") and emotional distress was mediated by perceptions of having been treated badly or discriminated against because others thought they were gay or lesbian. Data come from a school-based survey in Boston, Massachusetts (n = 1,032); 10% were LGBT, 58% were female, and ages ranged from 13 to 19 years. About 45% were Black, 31% were Hispanic, and 14% were White. LGBT youth scored significantly higher on the scale of depressive symptomatology. They were also more likely than heterosexual, non-transgendered youth to report suicidal ideation (30% vs. 6%, p < 0.0001) and self-harm (21% vs. 6%, p < 0.0001). Mediation analyses showed that perceived discrimination accounted for increased depressive symptomatology among LGBT males and females, and accounted for an elevated risk of self-harm and suicidal ideation among LGBT males. Perceived discrimination is a likely contributor to emotional distress among LGBT youth. © 2009 Springer Science+Business Media, LLC.
Keywords: adolescent; article; attitude; bisexuality; depression; female; homosexuality; human; homosexual female; male; perception; psychological aspect; questionnaire; sexual behavior; social psychology; statistics; student; suicide attempt; transsexualism

Accidental death due to complete autoerotic asphyxia associated with transvestic fetishism and anal self-stimulation - Case report - Atanasijević, T.; Jovanović, A.A.; Nikolić, S.; Popović, V.; Jašović-Gašić, M. (Psychiatria Danubina, 2009)
A case is reported of a 36-year-old male, found dead in his locked room, lying on a bed, dressed in his mother's clothes, with a plastic bag over his head, hands tied and with a barrel wooden cork in his rectum. Two pornographic magazines were found on a chair near the bed, so that the deceased could see them well. Asphyxia was controlled with a complex apparatus which consisted of two elastic luggage rack straps, the first surrounding his waist, perineum, and buttocks, and the second the back of his body, and neck. According to the psychological autopsy based on a structured interview (SCID-I, SCID-II) with his father, the deceased was single, unemployed and with a part college education. He had grown up in a poor family with a reserved father and dominant mother, and was indicative of fulfilling DSM-IV diagnostic criteria for alcohol dependence, paraphilia involving hypoxyphilia with transvestic fetishism and anal masturbation and a borderline personality disorder. There was no evidence of previous psychiatric treatment. The Circumstances subscale of Beck's Suicidal Intent Scale (SIS-CS) pointed at the lack of final acts (thoughts or plans) in anticipation of death, and absence of a suicide note or overt communication of suicidal intent before death. Integration of the crime scene data with those of the forensic medicine and psychological autopsy enabled identification of the event as an accidental death, caused by neck strangulation, suffocation by a plastic bag, and vagal stimulation due to a foreign body in the rectum. © Medicinska naklada.
Keywords: accidental death; alcoholism; article; asphyxia; autopsy; borderline state; educational status; sexual fetishism; human; lowest income group; masturbation; self stimulation; sexual deviation; structured interview; cross-dressing; unemployment; vagus nerve stimulation

Childhood gender nonconformity and harassment as predictors of suicidality among gay, lesbian, bisexual, and heterosexual Austrians - Plöderl, M.; Fartacek, R. (Archives of Sexual Behavior, 2009)
The role of childhood gender role nonconformity (CGNC) and childhood harassment (CH) in explaining suicidality (suicide ideation, aborted suicide attempts, and suicide attempts) was examined in a sample of 142 lesbian, gay, and bisexual (LGB) adults and 148 heterosexual adults in Austria. Current and previous suicidality, CGNC, and CH were significantly greater in LGB participants compared to heterosexual participants. After controlling for CGNC, the effect of sexual orientation on CH diminished. CGNC correlated significantly with current suicidality in the LGB but not in the heterosexual group, and only non-significant correlations were found for CGNC with previous suicidality. Controlling for CH and CGNC diminished the effect of sexual orientation on current suicidality. Bayesian multivariate analysis indicated that current suicidality, but not previous suicidality, depended directly on CGNC. CH and CGNC are likely implicated in the elevated levels of current suicidality among adult LGB participants. As for previous suicidality, the negative impact of CGNC on suicidality might be overshadowed by stress issues affecting sexual minorities around coming out. The association of CGNC with current suicidality suggests an enduring effect of CGNC on the mental health and suicide risk of LGB individuals. © 2007 Springer Science+Business Media, LLC.
Keywords: adolescent; adult; article; Austria; bisexuality; child sexual abuse; controlled study; correlational study; female; heterosexuality; human; homosexual female; major clinical study; male; homosexual male; mental health; prediction; sex role; sexual harassment; sexual and gender minority; sexual orientation; suicidal behavior; suicidal ideation; suicide attempt

Sociodemographic, clinical, and psychiatric characteristics of transsexuals from Spain - Gómez-Gil, E.; Trilla, A.; Salamero, M.; Godás, T.; Valdés, M. (Archives of Sexual Behavior, 2009)
The aim of this study was to examine the characteristics of transsexuals from Spain. A total of 252 consecutive applicants for sex reassignment were evaluated using a standardized semistructured clinical interview and the Mini International Neuropsychiatric Interview (Spanish Version 5.0.0) to record demographic, clinical, and psychiatric data. Transsexualism was diagnosed in 230 patients, with a male to female (MF)/female to male (FM) ratio of 2.2:1. Transsexual patients frequently had low employment status, lived with their parents, and mainly had a sexual orientation toward same-sex partners. The most frequent psychiatric diagnoses were adjustment disorder and social phobia in both groups, and alcohol and substance-related disorders in the MF group. MF transsexuals were older than FM transexuals when requesting sex reassignment, but did not differ in age when starting hormonal therapy (often on their own); fewer MFs were in employment requiring high educational qualification, more were non-Spanish natives, and more had previous and current histories of alcohol and substance abuse or dependence. The basic characteristics of transsexuals from Spain were similar to those of other European countries, except for the higher proportion of patients living with their parents and the higher proportion of MFs who reported same-sex sexual orientation compared with previous studies. © 2008 Springer Science+Business Media, LLC.
Keywords: adjustment disorder; adult; agoraphobia; alcoholism; anorexia nervosa; anxiety disorder; article; bipolar disorder; bisexuality; bulimia; clinical evaluation; comorbidity; controlled study; dysthymia; educational status; employment; Europe; female; homosexuality; hormonal therapy; human; hypomania; major clinical study; major depression; male; mania; marriage; obsessive compulsive disorder; panic; personality disorder; posttraumatic stress disorder; progeny; psychopathy; residential area; schizophrenia; semi structured interview; sex transformation; sexual behavior; sexual orientation; sexuality; social phobia; Spain; substance abuse; suicidal behavior; transsexualism

Psychosocial Concerns of Sexual Minority Youth: Complexity and Caution in Group Differences - Poteat, V.P.; Aragon, S.R.; Espelage, D.L.; Koenig, B.W. (Journal of Consulting and Clinical Psychology, 2009)
This investigation tested a large adolescent sample (n = 14,439) for significant group differences on psychosocial concerns on the basis of intersecting identities of sexual orientation (lesbian, gay, bisexual, questioning/less certain, heterosexual), race (Whites, racial minorities), and gender (boys, girls). A significant 2-way interaction between sexual orientation and gender was identified on victimization. Boys reported higher victimization than did girls among heterosexual and questioning/less certain students. Furthermore, significant 3-way interactions between sexual orientation, race, and gender were identified for substance use and depressed/suicidal thoughts. Questioning/less certain youth generally reported the highest levels of victimization, substance abuse, and suicidal thoughts. However, results suggest that, on the basis of small effect sizes for most comparisons, significant differences should be interpreted with caution. Results indicate the need to consider the diversity of subgroups within the sexual minority youth community and that intervention efforts might be more effective if tailored to the unique needs of specific subgroups. © 2009 American Psychological Association.
Keywords: adolescent; bisexuality; boy; community; effect size; gender; girl; heterosexuality; identity; juvenile; homosexual female; sexual and gender minority; sexual orientation; student; substance abuse

Correlates of serious suicidal ideation and attempts in female adult sexual assault survivors - Ullman, S.E.; Najdowski, C.J. (Suicide and Life-Threatening Behavior, 2009)
Relations between (a) serious suicidal ideation and attempts and (b) demographics, trauma history, assault characteristics, post-assault outcomes, and psychosocial variables were examined among female adult sexual assault survivors. Younger, minority, and bisexual survivors reported greater ideation. More traumas, drug use, and assault disclosure related to greater attempts, whereas perceived control over recovery was related to fewer attempts. Child sexual abuse and some assault characteristics predicted suicidal behavior. Depression was related to suicidal behavior until psychosocial variables were accounted for. Specifically, using substances to cope and self-blame predicted greater ideation, whereas receiving aid/information support was related to less ideation. Implications for research and treatment are discussed. © 2009 The American Association of Suicidology.
Keywords: adult; article; bisexual female; child sexual abuse; controlled study; depression; drug use; female; human; injury; major clinical study; sexual crime; social psychology; suicidal ideation; suicide attempt; survivor

HIV prevalence and risk behaviour among men who have sex with men in Vientiane Capital, Lao People's Democratic Republic, 2007 - Sheridan, S.; Phimphachanh, C.; Chanlivong, N.; Manivong, S.; Khamsyvolsvong, S.; Lattanavong, P.; Sisouk, T.; Toledo, C.; Scherzer, M.; Toole, M.; Griensven, F.V. (AIDS, 2009)
Background: Men who have sex with men are at high risk for HIV infection. Here we report the results of the first assessment of HIV prevalence and risk behaviour in this group in Vientiane, Lao People's Democratic Republic. Methods: Between August and September 2007, 540 men were enrolled from venues around Vientiane, using venue-day-time sampling. Men of Lao nationality, 15 years and over, reporting oral or anal sex with a man in the previous 6 months were eligible for participation. Demographic and socio-behavioural information was self-collected using hand-held computers. Oral fluid was tested for HIV infection. Logistic regression was used to evaluate risk factors for prevalent HIV infection. Results: The median age of participants was 21 years; the HIV prevalence was 5.6%. Of participants, 39.6% reported exclusive attraction to men and 57.6% reported sex with women. Of those who reported having regular and nonregular sexual partner(s) in the past 3 months, consistent condom use with these partners was 14.4 and 24.2%, respectively. A total of 42.2% self-reported any sexually transmitted infection symptoms and 6.3% had previously been tested for HIV. Suicidal ideation was reported by 17.0%, which was the only variable significantly and independently associated with HIV infection in multivariate analysis. Conclusion: Although the HIV prevalence is low compared with neighbouring countries in the region, men who have sex with men in Lao People's Democratic Republic are at high behavioural risk for HIV infection. To prevent a larger HIV epidemic occurrence and transmission into the broader community, higher coverage of HIV prevention interventions is required. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Keywords: adult; anal intercourse; article; body fluid; condom; diagnostic test; disease transmission; epidemic; high risk behavior; human; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; Laos; logistic regression analysis; male; homosexual male; oral sex; prevention and control; priority journal; risk assessment; sexuality; sexually transmitted disease

Self-harm in adolescents: self-report survey in schools in Scotland - O'Connor, R.C.; Rasmussen, S.; Miles, J.; Hawton, K. (The British journal of psychiatry : the journal of mental science, 2009)
BACKGROUND: The suicide rate in Scotland is twice as high as that in England. However, the prevalence of self-harm is unknown. AIMS: To determine the prevalence of self-harm in adolescents in Scotland and the factors associated with it. METHOD: A total of 2008 pupils aged 15-16 years completed an anonymous lifestyle and coping survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, social influences, psychological variables and self-harm. RESULTS: Self-harm was reported by 13.8% of the respondents. The majority (71%) of those who had self-harmed had done so in the past 12 months and girls were approximately 3.4 times more likely to report self-harm than boys. In multivariate analyses, smoking, bullying, worries about sexual orientation, self-harm by family and anxiety were associated with self-harm in both genders. In addition, drug use, physical abuse, serious boy/girlfriend problems, self-harm by friends and low levels of optimism were also associated with self-harm in girls. CONCLUSIONS: Despite markedly different national suicide rates, the prevalence of self-harm in Scotland is similar to that in England with girls at least three times more likely to report self-harm than boys. The findings suggest a role for emotional literacy programmes in schools and highlight the importance of promoting positive mental health among adolescents.
Keywords: adolescent; anxiety; automutilation; clinical trial; coping behavior; diagnosis; female; human; impulsiveness; lifestyle; male; multicenter study; prevalence; psychology; regression analysis; risk factor; school; Scotland; self concept; self disclosure

Out yonder: Sexual-minority adolescents in rural communities in British Columbia - Poon, C.S.; Saewyc, E.M. (American Journal of Public Health, 2009)
Objectives. We compared sexual-minority adolescents living in rural communities with their peers in urban areas in British Columbia, exploring differences in emotional health, victimization experiences, sexual behaviors, and substance use. Methods. We analyzed a population-based sample of self-identified lesbian, gay, or bisexual respondents from the British Columbia Adolescent Health Survey of 2003 (weighted n=6905). We tested rural-urban differences separately by gender with the χ2 test and logistic regressions. Results. We found many similarities and several differences. Rural sexual-minority adolescent boys were more likely than were their urban peers to report suicidal behaviors and pregnancy involvement. Rural sexual-minority adolescents, especially girls, were more likely to report various types of substance use. Rural status was associated with a lower risk of dating violence and higher risk of early sexual debut for sexual-minority girls and a higher risk of dating violence and lower risk of early sexual debut for sexual-minority boys. Conclusions. Location should be a demographic consideration in monitoring the health of sexual-minority adolescents. Lesbian, gay, and bisexual adolescents in rural communities may need additional support and services as they navigate adolescence.
Keywords: adolescent; article; bisexuality; Canada; controlled study; emotional stability; female; health survey; human; homosexual female; male; homosexual male; risk factor; rural population; sexual behavior; sexual and gender minority; substance abuse; urban population; violence

Self-harm in adolescents: Self-report survey in schools in Scotland - O'Connor, R.C.; Rasmussen, S.; Miles, J.; Hawton, K. (British Journal of Psychiatry, 2009)
Background: The suicide rate in Scotland is twice as high as that in England. However, the prevalence of self-harm is unknown. Aims: To determine the prevalence of self-harm in adolescents in Scotland and the factors associated with it. Method: A total of 2008 pupils aged 15-16 years completed an anonymous lifestyle and coping survey, information was obtained on demographic characteristics, lifestyle, life events and problems, social influences, psychological variables and self-harm. Results: Self-harm was reported by 13.8% of the respondents. The majority (71%) of those who had self-harmed had done so in the past 12 months and girls were approximately 3.4 times more likely to report self-harm than boys. In multivariate analyses, smoking, bullying, worries about sexual orientation, self-harm by family and anxiety were associated with self-harm in both genders. In addition, drug use, physical abuse, serious boy/girlfriend problems, self-harm by friends and low levels of optimism were also associated with self-harm in girls. Conclusions: Despite markedly different national suicide rates, the prevalence of self-harm in Scotland is similar to that in England with girls at least three times more likely to report self-harm than boys. The findings suggest a role for emotional literacy programmes in schools and highlight the importance of promoting positive mental health among adolescents.
Keywords: adolescent; school; self report; United Kingdom; abuse; anxiety; boy; bullying; coping behavior; demography; drug use; friend; gender; girl; life event; lifestyle; mental health; multivariate analysis; optimism; prevalence; reading; sexual orientation; smoking; suicide

Family rejection as a predictor of negative health outcomes in white and latino lesbian, gay, and bisexual young adults - Ryan, C.; Huebner, D.; Diaz, R.M.; Sanchez, J. (Pediatrics, 2009)
OBJECTIVE. We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. METHODS. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. RESULTS.Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. CONCLUSIONS. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth. Copyright © 2009 by the American Academy of Pediatrics.
Keywords: adult; article; bisexuality; caregiver; controlled study; European American; family interaction; family rejection; female; gender identity; health survey; Hispanic; human; interview; homosexual female; male; homosexual male; mental health; normal human; priority journal; quantitative analysis; questionnaire; retrospective study; self report; sexual orientation; substance abuse

A report from a single institute's 14-year experience in treatment of male-to-female transsexuals - Imbimbo, C.; Verze, P.; Palmieri, A.; Longo, N.; Fusco, F.; Arcaniolo, D.; Mirone, V. (Journal of Sexual Medicine, 2009)
Introduction: Gender identity disorder or transsexualism is a complex clinical condition, and prevailing social context strongly impacts the form of its manifestations. Sex reassignment surgery (SRS) is the crucial step of a long and complex therapeutic process starting with preliminary psychiatric evaluation and culminating in definitive gender identity conversion. Aim: The aim of our study is to arrive at a clinical and psychosocial profile of male-to-female transsexuals in Italy through analysis of their personal and clinical experience and evaluation of their postsurgical satisfaction levels SRS. Methods: From January 1992 to September 2006, 163 male patients who had undergone gender-transforming surgery at our institution were requested to complete a patient satisfaction questionnaire. Main Outcome Measures: The questionnaire consisted of 38 questions covering nine main topics: general data, employment status, family status, personal relationships, social and cultural aspects, presurgical preparation, surgical procedure, and postsurgical sex life and overall satisfaction. Results: Average age was 31 years old. Seventy-two percent had a high educational level, and 63% were steadily employed. Half of the patients had contemplated suicide at some time in their lives before surgery and 4% had actually attempted suicide. Family and colleague emotional support levels were satisfactory. All patients had been adequately informed of surgical procedure beforehand. Eighty-nine percent engaged in postsurgical sexual activities. Seventy-five percent had a more satisfactory sex life after SRS, with main complications being pain during intercourse and lack of lubrication. Seventy-eight percent were satisfied with their neovagina's esthetic appearance, whereas only 56% were satisfied with depth. Almost all of the patients were satisfied with their new sexual status and expressed no regrets. Conclusions: Our patients' high level of satisfaction was due to a combination of a well-conducted preoperative preparation program, competent surgical skills, and consistent postoperative follow-up. © 2009 International Society for Sexual Medicine.
Keywords: adult; article; cultural factor; educational status; employment status; esthetics; human; human relation; male; male to female transgender; patient satisfaction; priority journal; questionnaire; sexual behavior; sexual satisfaction; social aspect

Analysis of behavior-related adverse experiences in clinical trials of montelukast - Philip, G.; Hustad, C.M.; Malice, M.-P.; Noonan, G.; Ezekowitz, A.; Reiss, T.F.; Knorr, B. (Journal of Allergy and Clinical Immunology, 2009)
Background: Frequencies of behavior-related adverse experiences (BRAEs) in controlled clinical studies of leukotriene modifier drugs have not been summarized. Objective: We sought to compare the frequency of BRAEs in patients receiving montelukast or placebo in a retrospective analysis of Merck clinical trial data. Methods: An adverse experience database was constructed to include all double-blind, placebo-controlled trials of montelukast meeting prespecified criteria. BRAEs (described using the Medical Dictionary for Regulatory Activities controlled vocabulary dictionary) were prespecified to include any term in the Psychiatric Disorders System Organ Class, selected terms related to general disorders, and terms related to akathisia. Frequencies of BRAEs (overall, leading to study discontinuation, and/or serious) were summarized. Analyses estimated the odds ratios (ORs) for montelukast versus placebo based on the frequency of patients with BRAEs in each study. Results: In total 35 adult and 11 pediatric placebo-controlled trials were included; 11,673 patients received montelukast, 8,827 received placebo, and 4,724 received active control. The frequency of patients with 1 or more BRAEs was 2.73% and 2.27% in the montelukast and placebo groups, respectively; the OR for montelukast versus placebo was 1.12 (95% CI, 0.93-1.36). The frequency of patients with a BRAE leading to study discontinuation was 0.07% and 0.11% in the montelukast and placebo groups, respectively (OR, 0.52; 95% CI, 0.17-1.51). The frequency of patients with a BRAE considered serious was 0.03% in both treatment groups. Conclusion: Reports of BRAEs were infrequent in clinical trials of montelukast. Those leading to study discontinuation or considered serious were rare. Frequencies were similar regardless of treatment group. © 2009 American Academy of Allergy, Asthma & Immunology.
Keywords: montelukast; placebo; adolescent; adult; aged; akathisia; anxiety disorder; article; asthenia; asthma; attention disturbance; automutilation; behavior disorder; bipolar disorder; bronchiolitis; child; clinical trial; cognitive defect; comparative study; control group; controlled clinical trial; controlled study; crossover procedure; delirium; depression; double blind procedure; drug withdrawal; eating disorder; fatigue; female; gender dysphoria; pollen allergy; human; impulse control disorder; insomnia; irritability; major clinical study; malaise; male; mania; migraine; mood disorder; nervousness; nightmare; perennial rhinitis; personality disorder; physical activity; preschool child; priority journal; psychomotor disorder; psychosis; randomized controlled trial; restlessness; retrospective study; schizoaffective psychosis; schizophrenia; school child; sexual dysfunction; side effect; sleep disorder; suicidal behavior; thought disorder; treatment duration

Mental health in sexual minorities: Recent indicators, trends, and their relationships to place in North America and Europe - Lewis, N.M. (Health and Place, 2009)
This meta-analysis featuring 12 national adult studies and 16 state/regional youth studies of sexuality and mental health finds that sexual minorities-as a likely consequence of place-contingent minority stress-experience mental health outcomes such as depression, anxiety, and suicide ideation much more frequently than their heterosexual counterparts. By interrogating the geographic variations in the findings, such as high rates of poor mental health outcomes in the United Kingdom, large gay-heterosexual disparities in the Netherlands, and lower and improving rates of both outcomes and risk factors in Vermont and British Columbia, this study asserts that policy regimes, health programming, and the ways in which sexual minorities are constructed in places all contribute to their mental health. © 2009 Elsevier Ltd. All rights reserved.
Keywords: anxiety disorder; article; Canada; depression; Europe; geographic distribution; health care policy; health disparity; health hazard; health program; heterosexuality; human; juvenile; mental disease; mental health; mental stress; Netherlands; North America; outcome assessment; priority journal; sexual and gender minority; sexuality; suicidal ideation; United Kingdom; United States

Avoiding shame: Young LGBT people, homophobia and self-destructive behaviours - McDermott, E.; Roen, K.; Scourfield, J. (Culture, Health and Sexuality, 2008)
This paper reports on findings from qualitative research conducted in the UK that sought to explore the connections between sexual identities and self-destructive behaviours in young people. International evidence demonstrates that there are elevated rates of suicide and alcohol abuse amongst lesbian, gay, bisexual and transgender (LGBT) youth. Rarely included in this body of research are investigations into young LGBT people's views and experiences of self-destructive behaviours. Data from interviews and focus groups with young LGBT participants suggest a strong link between homophobia and self-destructive behaviours. Utilising a discourse analytic approach, we argue that homophobia works to punish at a deep individual level and requires young LGBT people to manage being positioned, because of their sexual desire or gendered ways of being, as abnormal, dirty and disgusting. At the centre of the complex and multiple ways in which young LGBT people negotiate homophobia are 'modalities of shame-avoidance' such as: the routinization and minimizing of homophobia; maintaining individual 'adult' responsibility; and constructing 'proud' identities. The paper argues that these strategies of shame-avoidance suggest young LGBT people manage homophobia individually, without expectation of support and, as such, may make them vulnerable to self-destructive behaviours.
Keywords: adolescent; adult; alcohol abuse; article; automutilation; bisexuality; clinical article; controlled study; female; gender identity; high risk behavior; homophobia; human; interview; juvenile; homosexual female; male; homosexual male; mental health; priority journal; qualitative research; self concept; shame; social behavior; social interaction; suicidal behavior; transsexualism; United Kingdom

Adjustment among mothers reporting same-gender sexual partners: A study of a representative population sample from Quebec province (Canada) - Julien, D.; Jouvin, E.; Jodoin, E.; L'Archevêque, A.; Chartrand, E. (Archives of Sexual Behavior, 2008)
We examined the well-being of mothers and non-mothers reporting exclusive opposite-gender sexual partners (OG), same-gender sexual partners (SG), or both (BI) in a representative sample of 20,773 participants (11,034 women) 15-years-old or older from the population of Quebec province in Canada. Participants completed a self-administered questionnaire and SG and BI women (n = 179) were matched to a sample of OG women (n = 179) based on age, income, geographical area, and children (having at least one 18-year-old or younger biological or adopted child at home). We assessed social milieu variables, risk factors for health disorders, mental health, and quality of mothers' relationship with children. The findings indicated a sexual orientation main effect: Mothers and non-mothers in the SG and BI group, as compared to their OG controls, were significantly less likely to live in a couple relationship, had significantly lower levels of social support, higher prevalence of early negative life events, substance abuse, suicide ideation, and higher levels of psychological distress. There were no Sexual Orientation X Parenthood status effects. The results further indicated that sexual orientation did not account for unique variance in women's psychological distress beyond that afforded by their social milieu, health risk factors, and parenthood status. No significant differences were found for the quality of mothers' relationship with children. SG-BI and OG mothers with low levels of social integration were significantly more likely to report problems with children than parents with high levels of social integration. We need to understand how marginal sexualities and their associated social stigma, as risk indicators for mothers, interact with other factors to impact family life, parenting skills, and children's adjustment. © 2007 Springer Science+Business Media, LLC.
Keywords: adopted child; article; Canada; controlled study; distress syndrome; family life; female; geography; homosexuality; human; income; integration; male; mental health; mother; prevalence; psychologic test; questionnaire; risk assessment; risk factor; sexual orientation; sexuality; skill; social environment; substance abuse; suicidal ideation

Adolescent sexual orientation - Baltzer, F.; Elliott, A.; Katzman, D.; Pinzon, J.; Sankaran, K.; Taddeo, D.; Findlay, S.M.; Harvey, J.; Kaufman, M. (Paediatrics and Child Health, 2008)
Keywords: 3,4 methylenedioxyamphetamine; ketamine; methamphetamine; adolescent; alcohol consumption; article; child behavior; child parent relation; conflict; depression; doctor patient relationship; drug use; gender identity; high risk behavior; homosexuality; human; homosexual female; homosexual male; medical education; risk assessment; sexual behavior; sexual orientation; sexually transmitted disease; smoking; social interaction; stigma; suicide attempt

Your teen's sexual orientation: What parents should know (Paediatrics and Child Health, 2008)
Keywords: Wart virus vaccine; adolescent; anal intercourse; article; bisexuality; depression; fantasy; heterosexual male; heterosexuality; homosexuality; human; Papanicolaou test; safe sex; sexual orientation; sexually transmitted disease; stigma; suicide; vaccination; virus infection

Childhood sexual experiences and adult health sequelae among gay and bisexual men: Defining childhood sexual abuse - Arreola, S.; Neilands, T.; Pollack, L.; Paul, J.; Catania, J. (Journal of Sex Research, 2008)
Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.
Keywords: adult; article; bisexual male; child sexual abuse; controlled study; depression; disease transmission; distress syndrome; high risk behavior; human; Human immunodeficiency virus infection; infection risk; male; homosexual male; mental health; probability; psychologic assessment; risk assessment; sexual behavior; sexual health; sexually transmitted disease; substance abuse; suicidal ideation; wellbeing

Making sense of suicide: A discourse analysis of young people's talk about suicidal subjecthood - Roen, K.; Scourfield, J.; McDermott, E. (Social Science and Medicine, 2008)
Though there is a substantial body of literature on youth suicide, relatively few studies provide a detailed analysis of young people's own understandings of suicidal behaviour. The present research pays particular attention to how young people make sense of suicide, in the understanding that suicide only becomes possible insofar as it is imaginable. Interviews and focus groups (including 69 participants in total) with people aged 16-24 years provide the empirical material for this study. Research participants were recruited across a range of ethnic groups and sexual orientations, and drawn from rural and urban areas in the North of England and South Wales. Four frameworks for understanding youth suicide are discussed in this paper. These frameworks of understanding variously (i) cast suicidal subjects as Other, (ii) highlight suicide as something that is accessible to young people, (iii) demonstrate the desire to rationalise suicidal behaviour, and (iv) define suicidal subjects in terms of their relationships with others. The interwoven meanings that run through these four frameworks, and their connection with existing literature, are discussed and the implications for suicide prevention are indicated. © 2008 Elsevier Ltd. All rights reserved.
Keywords: adolescent; adult; article; controlled study; ethnicity; human; medical research; sexual orientation; suicidal behavior; suicide; United Kingdom

Suicidality and self-harm among sexual minorities in Japan - DiStefano, A.S. (Qualitative Health Research, 2008)
In this study, I used ethnographic methods to examine suicidality and nonsuicidal self-harm among gay, lesbian, bisexual, and transgender persons in Japan. Participants (N = 84) indicated that suicidality and self-harm are serious problems among sexual minorities and tend to be driven by (a) a homophobic/transphobic environment and the negative consequences of sexual minorities either disclosing their true selves or remaining hidden and silent within such an environment; (b) various antecedents to poor mental health; and (c) factors not directly related to being a sexual minority, particularly unemployment and debt in the context of a protracted national economic decline in Japan prior to the study period of 2003-2004. Participants also perceived a potentially higher risk for suicidality and self-harm among sexual minority adolescents and persons in their early 20s; those who work in the entertainment, bar, or sex industries; and survivors of violence perpetrated by intimate partners or family members. © 2008 Sage Publications.
Keywords: adult; age distribution; article; automutilation; bisexuality; ethnography; family violence; female; homophobia; human; Japan; job stress; homosexual female; major clinical study; male; homosexual male; mental health; partner violence; priority journal; qualitative analysis; risk factor; sexual and gender minority; sexuality; social aspect; social behavior; social status; suicidal ideation; transsexualism; unemployment; vulnerable population

An early male adolescent with externalizing behaviors, school failure, and a colostomy - Sedberry, D.; Tarbell, S.; Stein, M.T. (Journal of Developmental and Behavioral Pediatrics, 2008)
CASE:: Jeff is a 14 1/2 years old ninth grader who presents with his mother, father, and step-father because he is failing in school. Jeff was born with an imperforate anus, and he had several surgical procedures in the first few years of life. He has a colostomy, but it is not clear how well he cares for it independently. Jeff's parents state that there other concern is that to prepare for school each morning or for other activities, they literally remind him of each step.Jeff has been active and disruptive since preschool, but is also described as "charming." School work and peer relations improved following a diagnosis of attention-deficit hyperactivity disorder (ADHD) in the second grade and treatment with a long-acting stimulant medication. An Independent Education Plan (IEP) in second grade included achievement tests that demonstrated above grade level scores. Jeff continued to have problems with written expression, but did quite well in verbal expression.By seventh grade, Jeff complained to his parents that he "wasn't fun to be around," and refused to take medication for ADHD. He increasingly refused to do most of his homework or class work. Grades were approaching failing levels in the eighth grade when he was suspended twice for impulsive behaviors-drawing a picture of a gun pointed at another student, and signing a petition stating that a classmate was gay. After his second suspension, he was sent to a continuation school, where he resisted doing the required work, failed each subject, and socialized with peers.Jeff is failing in ninth grade although his teachers describe him as respectful in the classroom. His parents divorced when Jeff was a preschooler, and they do not agree on how to manage Jeff. Jeff's father has not supported medication for the treatment of ADHD. The parents tried numerous strategies to help Jeff, including improving organizational skills, offering rewards and punishments and counseling; they have participated in parenting classes. The parents acknowledge that Jeff always tries to negotiate with them and they often give in. There is no known substance abuse or illegal behavior, although he has demonstrated destructiveness and stealing at home. Jeff's mother remarried a year ago, and her husband backed her in setting more strict limits for Jeff; at Jeff's request, he is currently living with his father most of the time. © 2008 Lippincott Williams & Wilkins.
Keywords: academic achievement; adolescent; anus atresia; article; attention deficit disorder; case report; child behavior; child parent relation; colostomy; counseling; education; human; impulsiveness; male; peer group; priority journal; punishment; socialization; surgical technique; suspension; theft; treatment refusal; verbal behavior

Suicide and reputation damage - Pridmore, S.; McArthur, M. (Australasian Psychiatry, 2008)
Aim: This paper uses the public record to explore the relationship between reputation damage and suicide. Method: The public record of the last 20 years was examined for examples of individuals without evidence of mental disorder who suffered actual or threatened reputation damage and suicided shortly thereafter. Results: Fifteen individual cases were identified; 18 additional cases, less comprehensively detailed, were mentioned in reports of The Wood Royal Commission and Operation Auxin. All cases were male. Of the 15 individual cases, the average age was 55 years, with a range of 40 to 76 years. The available details of the 18 additional cases were consistent with these findings. Conclusion: Middle-aged males without clear evidence of mental disorder, who suffer actual or threatened reputation damage, may be at increased risk of suicide. Naming and shaming needs to be conducted with caution.
Keywords: adult; aged; article; clinical article; crime; delinquency; homosexuality; human; human dignity; male; mental disease; pedophilia; police; correctional facility; risk assessment; sociology; suicide

Attempted suicide and associated risk factors among youth in urban Japan - Hidaka, Y.; Operario, D.; Takenaka, M.; Omori, S.; Ichikawa, S.; Shirasaka, T. (Social Psychiatry and Psychiatric Epidemiology, 2008)
Background: Suicide is a major social and health issue in Japan. We assessed prevalence of attempted suicide and explored individual, interpersonal, behavioral, and psychological risk factors associated with attempted suicide in a general community sample of youth in a metropolitan Japanese city. Method: Survey of 2,095 participants age between 15 and 24 who were recruited using street-intercept techniques. Results: Overall, 6% of males and 11% of females reported a prior suicide attempt. For males, attempted suicide was independently associated with experience of school bullying, being homosexual or bisexual, history of drug use, experience of unwanted sex, history of a diagnosed sexually transmitted infection, and low self-esteem. For females, attempted suicide was independently associated with being younger (ages 15-19 compared to 20-24), experience of school bullying, history of drug use, and history of smoking. Conclusion: Prevention intervention programs for youth in Japan are necessary to achieve national aims to reduce attempted suicides and suicide mortality. © Springer-Verlag 2008.
Keywords: adolescent; adult; article; bullying; community; drug use; experience; female; health survey; homosexuality; human; Japan; major clinical study; male; mortality; prevalence; risk factor; self esteem; sexual behavior; sexually transmitted disease; smoking; suicide attempt; urban area

Suicide attempts among people living with HIV in France - Preau, M.; Bouhnik, A.-D.; Peretti-Watel, P.; Obadia, Y.; Spire, B.; Afsa, C.; Bonnet, A.; Bouhnik, A.D.; Di Paola, V.; Dray-Spira, R.; Fagnani, J.; Fernandez, L.; et al. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2008)
This study examined the prevalence and characteristics of attempted suicide among a representative sample of French Human Immunodeficiency virus (HIV) infected individuals. In 2003, a face-to-face survey was conducted among people living with HIV/AIDS (PLWHA) selected in a random, stratified sample of French hospital departments. Among solicited individuals, 2,932 agreed to participate and were asked if they had ever AS. Among the respondents, 23% had AS. Female gender, younger age, native French citizenship, reporting household financial difficulties, having been HIV-contaminated through homosexual contact or through injection drug use and suffering from lipodystrophy-related symptoms were all independently associated with AS. HIV-discrimination and the lack of social support from family remained independently associated with AS. Our findings indicate a high level of AS among PLWHA and emphasize the multiple roles of factors associated with living with HIV, together with sociodemographic factors. The results enable the possibility for vulnerable groups to be targeted for specific future interventions in order to prevent attempted suicide. © 2008 Taylor & Francis.
Keywords: acquired immune deficiency syndrome; adult; article; controlled study; demography; disease association; drug abuse; female; France; health survey; homosexuality; human; Human immunodeficiency virus; lipodystrophy; major clinical study; male; prevalence; priority journal; questionnaire; suicide attempt

Suicidal ideation in UK HIV clinic attenders - Sherr, L.; Lampe, F.; Fisher, M.; Arthur, G.; Anderson, J.; Zetler, S.; Johnson, M.; Edwards, S.; Harding, R. (AIDS, 2008)
Background:: HIV has been associated with elevated suicidal ideation. Although new treatments have changed prognosis, they also bring new challenges. This study measured suicidal ideation in HIV clinic attenders in the United Kingdom (London/Southeast) and explored associated factors. Method:: All 1006 attenders at five HIV clinics were approached, of which 903 met inclusion criteria and 778 participated (86% response). Participants provided detailed information on suicidal ideation, demographics, treatment, adherence, symptoms (psychological and physical on Memorial Symptom Assessment Schedule), quality of life (EuroQol) information, HIV disclosure, clinical variables, sexual risk behaviour and treatment optimism. Results:: There was a 31% prevalence of suicidal ideation. Factors associated with suicidal ideation were being a heterosexual man, black ethnicity, unemployment, lack of disclosure of HIV status, having stopped antiretroviral treatment (compared to treatment or treatment naive), physical symptoms, psychological symptoms and poorer quality of life. There was no association with sexual risk behaviour. Sex/sexuality and ethnicity were independently associated with suicidal ideation: the odds of suicidal ideation increased almost two-fold for heterosexual men compared with gay men or women and for black respondents compared with White or Asian respondents. Lack of disclosure was independently associated with a two-fold increase in odds of suicidal ideation. Elevated physical and psychological symptoms were strong independent predictors of suicidal ideation. Independent predictors of suicidal ideation were very similar among the subgroup of 492 patients on antiretroviral treatment. Conclusion:: Despite advances in treatment, suicidal ideation rates among HIV-positive clinic attenders are high. Emotional support and attention to mental health provision and social context are strongly endorsed. © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Keywords: academic achievement; adult; article; Asian; CD4 lymphocyte count; demography; ethnicity; female; heterosexual male; human; Human immunodeficiency virus infected patient; major clinical study; male; homosexual male; Black person; outpatient department; patient compliance; priority journal; quality of life; risk factor; self disclosure; sexual behavior; statistical analysis; suicidal ideation; symptom; unemployment; United Kingdom; virus load

Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder? - Giordano, S. (Journal of medical ethics, 2008)
Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child's quality of life and even save his or her life, then it is indeed unethical to defer treatment.
Keywords: hormone antagonist; adolescent; article; child; drug effect; female; gender identity; health care policy; human; legal aspect; male; psychological aspect; puberty; risk assessment; self concept; sexuality; transsexualism; victim

Gynecologic Care of the Female-to-Male Transgender Man - Dutton, L.; Koenig, K.; Fennie, K. (Journal of Midwifery and Women's Health, 2008)
Transgender men are a vulnerable population whose health care needs have been difficult to identify because of limited research and an inability to identify the population. Limited evidence suggests that transgender men are at increased risk of having polycystic ovarian syndrome, contracting HIV, experiencing violence, and committing suicide. This qualitative study, conducted through face-to-face interviews of a convenient sample, was a three-part interview containing a demographic and health questionnaire, the Norbeck Social Support Questionnaire, as well as the Health Care Relationship Trust Scale. Audio recordings and written notes were reviewed and common themes were identified via content analysis. Six self-identified transgender men between the ages of 19 and 45 years were enrolled in the study. Participants were at varying degrees of social and medical transition. Four major themes were identified: 1) receiving gynecologic care was perceived to be important; 2) breasts caused the most gender identity conflict; 3) transgender men struggle with revealing their gender identity to health care providers; and 4) the male/female boxes on health intake forms, as well as pronoun usage by medical staff, were barriers to receiving health care. This gynecologic health care needs assessment of transgender men begins to characterize the barriers transgender men face when seeking health care. © 2008 American College of Nurse-Midwives.
Keywords: adult; article; breast; clinical article; content analysis; demography; doctor patient relationship; female to male transgender; gender dysphoria; gynecologic care; health care access; health care need; Health Care Relationship Trust Scale; health survey; help seeking behavior; high risk population; human; male; medical staff; needs assessment; Norbeck Social Support Questionnaire; priority journal; qualitative research; scoring system

An exploratory study of correlates, onset, and offset of non-suicidal self-injury - Deliberto, T.L.; Nock, M.K. (Archives of Suicide Research, 2008)
The study of non-suicidal self-injury (NSSI) has focused largely on identifying diagnostic correlates and the functions of this behavior; however, little is known about the broader range of factors related to NSSI. We examined a wide array of factors hypothesized to correlate with non-suicidal self-injury (NSSI) and provided a qualitative analysis of adolescents' self-reported motivations for starting and stopping this behavior. Participants were 64 adolescents with a history of NSSI and 30 comparison adolescents without such a history matched on age, sex, and ethnicity recruited from the community and assessed during one laboratory visit. The presence of NSSI was associated with a family history of suicidal ideation, violence, and drug and alcohol abuse, but not with more general forms of psychopathology. NSSI also was associated with the presence of in utero complications, the occurrence of non-injurious repetitive behaviors during childhood, and endorsement of a homosexual or bisexual orientation. Self-injurers reported getting the idea to self-injure from peers (38%) more often than any other source, and most (78%) reported at least one reason for wanting to stop self-injury. Less than half were currently receiving treatment. This exploratory study provides new information about the correlates of NSSI that has implications for research and clinical work in this area. Copyright © International Academy for Suicide Research.
Keywords: adolescent; adult; article; automutilation; ethnic group; female; homosexuality; human; male; psychological aspect; risk factor; statistics

Proteomic profile of dormant Trichophyton Rubrum conidia - Leng, W.; Liu, T.; Li, R.; Yang, J.; Wei, C.; Zhang, W.; Jin, Q. (BMC Genomics, 2008)
Background: Trichophyton rubrum is the most common dermatophyte causing fungal skin infections in humans. Asexual sporulation is an important means of propagation for T. rubrum, and conidia produced by this way are thought to be the primary cause of human infections. Despite their importance in pathogenesis, the conidia of T. rubrum remain understudied. We intend to intensively investigate the proteome of dormant T. rubrum conidia to characterize its molecular and cellular features and to enhance the development of novel therapeutic strategies. Results: The proteome of T. rubrum conidia was analyzed by combining shotgun proteomics with sample prefractionation and multiple enzyme digestion. In total, 1026 proteins were identified. All identified proteins were compared to those in the NCBI non-redundant protein database, the eukaryotic orthologous groups database, and the gene ontology database to obtain functional annotation information. Functional classification revealed that the identified proteins covered nearly all major biological processes. Some proteins were spore specific and related to the survival and dispersal of T. rubrum conidia, and many proteins were important to conidial germination and response to environmental conditions. Conclusion: Our results suggest that the proteome of T. rubrum conidia is considerably complex, and that the maintenance of conidial dormancy is an intricate and elaborate process. This data set provides the first global framework for the dormant T. rubrum conidia proteome and is a stepping stone on the way to further study of the molecular mechanisms of T. rubrum conidial germination and the maintenance of conidial dormancy. © 2008 Leng et al; licensee BioMed Central Ltd.
Keywords: 1,3 beta glucan synthase; adhesin; amino acid transfer RNA ligase; catalase; catalase 1; catalase 2; catalase 3; cell membrane protein; chitin synthase; complex v; cyclic AMP; cyclic AMP dependent protein kinase; cysteine transfer RNA ligase; cytochrome c oxidase; fungal protein; hydrophobin; mannosyltransferase; messenger RNA; mitogen activated protein kinase; oxidoreductase; protein Ecm33; proteome; Ras protein; reduced nicotinamide adenine dinucleotide dehydrogenase (ubiquinone); serine transfer RNA ligase; succinate dehydrogenase (ubiquinone); trehalose; ubiquinol cytochrome c reductase; amino acid sequence; article; conidium; controlled study; cytolysis; fractionation; functional proteomics; fungal cell culture; fungal spore germination; fungal strain; microbial morphology; molecular dynamics; molecular evolution; nonhuman; nucleotide sequence; protein analysis; protein database; protein synthesis; sequence analysis; signal transduction; Trichophyton rubrum

Clustering of adolescent dating violence, peer violence, and suicidal behavior - Bossarte, R.M.; Simon, T.R.; Swahn, M.H. (Journal of Interpersonal Violence, 2008)
To understand the co-occurrence of multiple types of violence, the authors developed a behavioral typology based on self-reports of suicidal behaviors, physical violence, and psychological abuse. Using a sample of dating adolescents from a high-risk school district, they identified five clusters of behaviors among the 1,653 students who reported being abusive or violent in the past year. Victimization and perpetration with same-sex peers and dating partners clustered together among the students who reported the highest levels of abusive (n = 357) or violent behavior (n = 146). These students also reported high levels of suicidal behavior. There were few significant demographic differences across clusters. The implications of the results for the need to design and evaluate efforts to prevent multiple types of violence are discussed. © 2008 Sage Publications.
Keywords: addiction; adolescent; aggression; article; child behavior; courtship; female; high risk behavior; human; male; peer group; psychological aspect; quality of life; questionnaire; risk factor; sexual behavior; statistics; student; suicide attempt; United States; violence

Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations - Meyer, I.H.; Dietrich, J.; Schwartz, S. (American Journal of Public Health, 2008)
Past studies have reported little about variability in mental disorders among lesbians, gay men, and bisexual individuals. We assessed the prevalence of psychiatric disorders in 388 lesbian, gay, and bisexual Black, Latino, and White individuals. Black lesbians, gay men, and bisexual individuals had lower prevalence of all disorders than did Latino and White individuals; younger cohorts had fewer mood disorders than did older cohorts; bisexual persons had more substance use disorders than did gay men and lesbians; and Latino respondents attempted suicide more often than did White respondents.
Keywords: adult; African American; anxiety disorder; article; bisexuality; drug dependence; European American; female; Hispanic; human; homosexual female; major clinical study; male; homosexual male; minority group; mood disorder; prevalence; substance abuse; suicide attempt; United States

Risk for reassault in abusive female same-sex relationships - Glass, N.; Perrin, N.; Hanson, G.; Bloom, T.; Gardner, E.; Campbell, J.C. (American Journal of Public Health, 2008)
Objectives. We revised the Danger Assessment to predict reassault in abusive female same-sex relationships. Methods. We used focus groups and interviews to evaluate the assessment tool and identify new risk factors and telephone interviews at baseline and at 1-month follow-up to evaluate the revised assessment. Results. The new assessment tool comprised 8 original and 10 new items. Predictors included increase in physical violence (relative risk ratio [RRR]=1.95; 95% confidence interval [CI]=0.84, 4.54), constant jealousy or possessiveness of abuser (RRR=4.07; 95% CI=0.61, 27.00), cohabitation (RRR=1.96; 95% CI=0.54, 7.12), threats or use of gun by abuser (RRR=1.93; 95% CI=0.79, 4.75), alcoholism or problem drinking of abuser (RRR=1.47; 95% CI=0.79, 2.71), illegal drug use or abuse of prescription medications by abuser (RRR=1.33; 95% CI=0.72, 2.46), stalking by abuser (RRR=1.39; 95% CI=0.70, 2.76), failure of individuals to take victim seriously when she sought help (RRR=1.66; 95% CI=0.90, 3.05), victim's fear of reinforcing negative stereotypes (RRR=1.42; 95% CI=0.73, 2.77), and secrecy of abuse (RRR=1.72; 95% CI=0.74, 3.99). Both unweighted (P<.005) and weighted (P<.004) versions of the revised assessment were significant predictors of reassault. Conclusions. The revised Danger Assessment accurately assesses risk of reassault in abusive female relationships.
Keywords: adult; article; assault; female; gender identity; human; interview; homosexual female; major clinical study; partner violence; recurrence risk; risk assessment; risk factor

Lesbian, gay, bisexual and transgender young people's experiences of distress: Resilience, ambivalence and self-destructive behaviour - Scourfield, J.; Roen, K.; McDermott, L. (Health and Social Care in the Community, 2008)
The research presented in this paper set out to explore the cultural context of youth suicide and more specifically any connections between sexual identity and self-destructive behaviour, in the light of international evidence about the disproportionate risk of suicidal thoughts and suicide attempts in lesbian, gay, bisexual and transgender (LGBT) young people. The empirical basis for the paper is qualitative research that was carried out in the North West of England and South Wales. Focus groups and interviews were conducted with a total of 69 young people, with a purposive sample to reflect diversity of sexual identity, social class and regional and rural-urban location. The paper presents a thematic analysis of the data specifically relating to the experiences of LGBT young people. A range of strategies that LGBT young people employ in the face of distress are described. These are categorised as resilience, ambivalence and self-destructive behaviour (including self-harm and suicide). The potential implications for health and social care of these strategies include the need for ecological approaches and for sexual cultural competence in practitioners, as well as prioritisation of LGBT risk within suicide prevention policies. © 2008 Blackwell Publishing Ltd.
Keywords: adaptive behavior; adolescent; article; automutilation; female; homosexuality; human; information processing; interview; male; psychological aspect; sexual behavior; suicide; transsexualism; United Kingdom

Correlates of substance use among homeless youths in eight cities - Salomonsen-Sautel, S.; Van Leeuwen III, J.M.; Gilroy, C.; Boyle, S.; Malberg, D.; Hopfer, C. (American Journal on Addictions, 2008)
Homeless youths (N = 684) in eight cities participated in this study to understand the rates and correlates of substance use. Rates of lifetime and recent substance use ranged from 66% to 90%. Variability in lifetime and recent substance use was partially explained by being white (ages 14-17); ever attempting suicide (ages 14-17); not being African American (lifetime substance use) or Hispanic (ages 18-24); being male (ages 18-24); identifying as lesbian, gay, or bisexual (ages 18-24); using substances with a parent; beginning substance use at a young age; and having a family history of a substance problem. Copyright © American Academy of Addiction Psychiatry.
Keywords: adolescent; adult; African American; article; bisexual male; controlled study; correlation analysis; European American; family history; female; Hispanic; homelessness; human; homosexual female; lifespan; major clinical study; male; homosexual male; substance abuse; suicide attempt

Suicidal ideation and attempts in north american school-based surveys: Are bisexual youth at increasing risk? - Saewyc, E.M.; Skay, C.L.; Hynds, P.; Pettingell, S.; Bearinger, L.H.; Resnick, M.D.; Reis, E. (Journal of LGBT Health Research, 2008)
This study explored the prevalence, disparity, and cohort trends in suicidality among bisexual teens vs. heterosexual and gay/lesbian peers in 9 population-based high school surveys in Canada and the U.S. Multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender; 95% confidence intervals tested cohort trends where surveys were repeated over multiple years. Results showed remarkable consistency: bisexual youth reported higher odds of recent suicidal ideation and attempts vs. heterosexual peers, with increasing odds in most surveys over the past decade. Results compared to gay and lesbian peers were mixed, with varying gender differences in prevalence and disparity trends in the different regions. © 2007 by The Haworth Press. All rights reserved.
Keywords: adolescent; age distribution; article; bisexuality; Canada; cause of death; cohort analysis; controlled study; female; gender; health disparity; health survey; heterosexuality; human; juvenile; homosexual female; major clinical study; male; homosexual male; North America; peer group; population based case control study; prevalence; risk; risk reduction; school; self concept; sex difference; sexual orientation; suicidal ideation; suicide attempt; trend study; United States

Sexuality in patients with spinal cord injuries due to attempted suicide - Lombardi, G.; Mondaini, N.; Iazzetta, P.; MacChiarella, A.; Popolo, G.D. (Spinal Cord, 2008)
Objective: To evaluate the specific characteristics of sexuality in spinal cord injury (SCI) patients resulting from attempted suicide pre- and post-SCI. Methods: From March 1998 to March 2005, n=27 were compared with a SCI group with similar characteristics. In March 2006, all patients completed a final sexual check-up. Using our database we reviewed their sexuality path. Results: Suicide group (SG): Examination of personal/clinical history revealed in three how sexuality represented a possible co-factor for suicidal tendencies: one female reported a history of sexual abuse, two were homosexual (one gay and one lesbian). Five reported sexual dysfunctions. Nine females consistently showed via the Female Sexual Function Index (FSFI) at least one sexual disorder in all follow-ups; six females were in a stable relationship pre-SCI, seven during the final check-up; eight males in the SG presented erectile dysfunction using the International Index of Erectile Function (IIEF5); and eight were in a stable relationship pre-SCI and seven during the final visit. Control group (CG): Pre-SCI only one male presented erectile dysfunction. Seven females consistently showed sexual disorders. 11 females and 11 males were in stable relationships pre-SCI, respectively, 10 and 11 at the final check-up. In women the overall sexual satisfaction is statistically significant, correlated to the duration of the relationship P<0.05. Nine patients showed erectile dysfunction in the final follow-up. Conclusions: The SG showed a higher percentage of sexual dysfunction pre-SCI compared with CG, and they presented constant difficulty in establishing a stable relationship causing both an obstacle in the initial sexual rehabilitation and in achieving a satisfactory overall sexual life. © 2008 International Spinal Cord Society All rights reserved.
Keywords: adult; article; erectile dysfunction; female; follow up; human; homosexual female; major clinical study; male; homosexual male; priority journal; sexual abuse; sexual behavior; sexual dysfunction; sexual satisfaction; sexuality; spinal cord injury; suicide attempt

Suicidal ideation and attempts among sexual minority youths receiving social services - Walls, N.E.; Freedenthal, S.; Wisneski, H. (Social Work, 2008)
The increased risk of suicidal ideation and attempts among sexual minority youths have been documented in studies using both convenience samples and representative community samples. However, as most youths do not access social services, these studies do not necessarily represent the sexual minority youths that community-based social workers may encounter in their day-to-day practice. As such, the present study on risk and protective factors related to suicidality surveyed 182 sexual minority youths (14 to 21 years of age) who sought assistance at a community-based social services agency in Denver. Similar to existing literature, the findings suggest that risk factors related to suicidality include hopelessness, methamphetamine use, homelessness, and in-school victimization. However, unlike studies of the general youth population, this study found that African American and male sexual minority youths were not at a lower risk of suicidality than sexual minority youths who were, respectively, white or female. In addition, our findings suggest that the presence of gay-straight alliances in schools may function as a protective resource for sexual minority youths. Implications for social work practice are discussed. © 2008 National Association of Social Workers.
Keywords: adolescent; adult; article; female; homosexuality; human; male; minority group; psychological aspect; social work; statistics; suicide attempt; cross-dressing

Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia - Saewyc, E.M.; Poon, C.S.; Homma, Y.; Skay, C.L. (Canadian Journal of Human Sexuality, 2008)
Over the past decade, several large-scale school-based studies of adolescents in Canada and the U.S. have documented health disparities for lesbian, gay and bisexual teens compared to their heterosexual peers, such as higher rates of suicide attempts, homelessness, and substance use. Many of these disparities have been linked to "enacted stigma," or the higher rates of harassment, discrimination, and sexual or physical violence that sexual minority youth experience at home, at school, and in the community. An unexpected health disparity for lesbian, gay and bisexual youth is their significantly higher risk of teen pregnancy involvement (between two and seven times the rate of their heterosexual peers), especially in light of declining trends in teen pregnancy across North America since the early 1990s. What is behind this higher risk? Is it getting better or worse? Using the province-wide cluster-stratified British Columbia Adolescent Health Surveys from 1992, 1998, and 2003, this paper explores the trends in pregnancy involvement, related sexual behaviours, and exposure to forms of enacted stigma that may help explain this particular health disparity for gay, lesbian and bisexual youth in Canada.
Keywords: bisexuality; Canada; homosexual female; pregnancy; student; adolescent; adolescent health; community; exposure; health disparity; health survey; heterosexuality; homelessness; juvenile; North America; risk; school; sexual behavior; sexual and gender minority; suicide attempt; United States; violence