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

Pharmacokinetics of duloxetine self-administered in overdose with quetiapine and other antipsychotic drugs in a Japanese patient admitted to hospital - Adachi, K.; Beppu, S.; Nishiyama, K.; Shimizu, M.; Yamazaki, H. (Journal of Pharmaceutical Health Care and Sciences, 2021)
Background: Combinations of antidepressant duloxetine (at doses of 40–60 mg/day) and other antipsychotics are frequently used in clinical treatment; however, several fatal and nonfatal cases of duloxetine overdose have been documented. We experienced a patient who had taken an overdose of duloxetine (780 mg) in combination with other drugs in a suicide attempt. Case presentation: The patient was a 37-year-old man (body weight, 64 kg) with a history of gender identity disorder and depression. He intentionally took an overdose of duloxetine in combination with three other antipsychotic drugs (18 mg flunitrazepam, 850 mg quetiapine, and 1100 mg trazodone) and was emergently admitted to Kyoto Medical Center. The patient’s plasma concentration of duloxetine during ambulance transport was 57 ng/ml, and the level was still as high as 126 ng/mL at 32 h after administration. Duloxetine disappeared most slowly from plasma, in contrast to quetiapine, which was the fastest to clear among the four medicines determined in this patient. The observed concentrations of duloxetine in this overdose patient were generally within the 95% confidence intervals of the plasma concentration curves predicted using a physiologically based pharmacokinetic (PBPK) model. Conclusion: Even if more than 1 h (the generally recommended period) has passed after administration of duloxetine in such overdose cases, gastric lavage and/or administration of activated charcoal may be effective in clinical practice up to 6 h because of the typically slow elimination behavior illustrated by the PBPK model. Pharmacokinetic profiles visualized using PBPK modeling can inform treatment decisions in cases of drug overdose for medicines such as duloxetine in emergency clinical practice.
Keywords: alanine aminotransferase; aspartate aminotransferase; creatinine; duloxetine; flunitrazepam; fresh frozen plasma; quetiapine; Ringer solution; trazodone; absorption rate constant; adult; area under the curve; article; blood sampling; blood-to-plasma ratio; case report; clinical article; creatinine blood level; creatinine clearance; depression; drug blood level; drug elimination; drug overdose; drug self administration; gender dysphoria; Glasgow coma scale; hepatic availability; human; intestinal availability; intrinsic clearance; Japanese (people); liquid chromatography-mass spectrometry; male; maximum concentration; priority journal; renal clearance; single drug dose; suicide attempt; systemic circulation

Factors associated with suicide attempts among Australian transgender adults - Zwickl, S.; Wong, A.F.Q.; Dowers, E.; Leemaqz, S.Y.-L.; Bretherton, I.; Cook, T.; Zajac, J.D.; Yip, P.S.F.; Cheung, A.S. (BMC Psychiatry, 2021)
Background: Transgender, including gender diverse and non-binary people, henceforth referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. We aimed to understand the risk and protective factors of a lifetime history of attempted suicide in a community sample of Australian trans adults to guide better mental health support and suicide prevention strategies. Methods: Using a non-probability snowball sampling approach, a total of 928 trans adults completed a cross-sectional online survey between September 2017 and January 2018. The survey assessed demographic data, mental health morbidity, a lifetime history of intentional self-harm and attempted suicide, experiences of discrimination, experiences of assault, access to gender affirming healthcare and access to trans peer support groups. Logistic regression was used to examine the risk or protective effect of participant characteristics on the odds of suicide. Results: Of 928 participants, 85% self-reported a lifetime diagnosis of depression, 63% reported previous self-harm, and 43% had attempted suicide. Higher odds of reporting a lifetime history of suicide attempts were found in people who were; unemployed (adjusted odds ratio (aOR) 1.55 (1.05, 2.29), p = 0.03), had a diagnosis of depression (aOR 3.70 (2.51, 5.45), p < 0.001), desired gender affirming surgery in the future (aOR 1.73 (1.14, 2.61), p = 0.01), had experienced physical assault (aOR 2.01 (1.37, 2.95), p < 0.001) or experienced institutional discrimination related to their trans status (aOR 1.59 (1.14, 2.23), p = 0.007). Conclusion: Suicidality is associated with barriers to gender affirming care, gender based victimisation and institutionalised cissexism. Interventions to increase social inclusion, reduce transphobia and enable timely access to gender affirming care, particularly surgical interventions, are potential areas of intervention.
Keywords: adult; article; assault; automutilation; community sample; controlled study; demography; depression; female; gender; human; human tissue; major clinical study; male; mental health; morbidity; peer group; prevention; social inclusion; suicide attempt; support group; transgender; unemployment

Addressing the critical need for long-term mental health data during the COVID-19 pandemic: Changes in mental health from April to September 2020 - Veldhuis, C.B.; Nesoff, E.D.; McKowen, A.L.W.; Rice, D.R.; Ghoneima, H.; Wootton, A.R.; Papautsky, E.L.; Arigo, D.; Goldberg, S.; Anderson, J.C. (Preventive Medicine, 2021)
Despite the large amounts of research currently being conducted and the high number of editorials warning about the potential mental health impacts, there is a stunning lack of longitudinal mental health data on the effects of the pandemic. Yet, the pandemic may have sizable long-term impacts on psychological distress and health behaviors—these effects may be long-lasting and may disproportionately affect some demographic groups more than others. Data came from a longitudinal international study of the impacts of the COVID-19 pandemic on adults' psychological distress and wellbeing (N = 1567). We found high rates of depression (55% were diagnosable with probable depression at baseline), anxiety (65%), and risk for PTSD (51%). More than one-third of participants who reported that they drank alcohol indicated that their drinking had increased since the start of the pandemic. Over time, depressive symptoms and suicidal thoughts and behaviors increased significantly, but acute stress symptoms decreased. Specific demographic groups (people of color and sexual and gender minorities) appeared to be at high risk of distress across analyses. Our findings suggest high rates of depression, anxiety, acute stress, and other signs of distress like isolation, hopelessness, and use of substances to cope—even at five-month follow-up. Our findings suggest a need to prioritize availability of, and access to, mental health care during both the pandemic and the recovery.
Keywords: acute stress; adult; anxiety; article; controlled study; coronavirus disease 2019; demography; depression; distress syndrome; drinking; female; follow up; hopelessness; human; major clinical study; male; mental health care; pandemic; posttraumatic stress disorder; sexual and gender minority; suicidal ideation; alcohol

Mental health difficulties among trans and gender diverse young people with an autism spectrum disorder (ASD): Findings from Trans Pathways - Strauss, P.; Cook, A.; Watson, V.; Winter, S.; Whitehouse, A.; Albrecht, N.; Wright Toussaint, D.; Lin, A. (Journal of Psychiatric Research, 2021)
Recent research highlights an overlap of gender diversity and autism spectrum disorders (ASD); however, data on individuals who are trans and also on the autism spectrum are largely from clinical samples and may not be representative of individuals who are trans with ASD in the general population. In addition, there is scant literature on the mental health of these individuals and their experiences in accessing gender-affirming care. We investigated the prevalence of ASD in trans young people, their mental health (psychiatric diagnoses and self-harm and suicidal behaviors) and experiences in accessing gender-affirming care. This is an analysis of data collected in an Australian cross-sectional mixed methods survey (N = 859) of trans young people aged 14–25 years. Overall, 22.5% of participants had ever received a diagnosis of ASD from a health professional. This group was more likely to exhibit current psychopathology, have engaged in self-harming and suicidal behaviors, and was also more likely than the non-ASD diagnosed reference group to have received a psychiatric diagnosis. The ASD-diagnosed group were also more likely to experience barriers in accessing gender-affirming care. This is the first large population-based sample of trans individuals with ASD to report on mental health outcomes and experiences in accessing gender-affirming care. We highlight the necessity for clinicians working with either trans or ASD populations to have awareness of the co-occurrence, and to cultivate skills to work with individuals who are both trans and on the autism spectrum.
Keywords: leuprorelin; progesterone; testosterone; adolescent; adult; antiandrogen therapy; anxiety disorder; article; autism; automutilation; controlled study; cross-sectional study; drug dependence; eating disorder; estrogen therapy; female; health care survey; hormone substitution; human; human tissue; LGBTQIA+ people; major clinical study; male; mental disease; mental health; personality disorder; posttraumatic stress disorder; priority journal; suicidal ideation; transsexuality

The Impact of Positive School Climate on Suicidality and Mental Health Among LGBTQ Adolescents: A Systematic Review - Ancheta, A.J.; Bruzzese, J.-M.; Hughes, T.L. (The Journal of school nursing : the official publication of the National Association of School Nurses, 2021)
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents are more likely to report suicidality and worse mental health than their heterosexual peers. We conducted a systematic review to examine the relationship between positive school climate and suicidality and mental health among LGBTQ adolescents. We searched the literature using PubMed, PsycINFO, and CINAHL. Six studies met inclusion criteria, and all had low to moderate risks of bias. Results indicate that LGBTQ students in schools with more positive school climates were at lower risk of suicidality and reported fewer depressive symptoms compared to students in less positive school climates. Being at the forefront of health in schools, school nurses have the opportunity to advocate for changes in school environments that promote positive mental health for all youth, including LGBTQ adolescents.
Keywords: adolescent; article; Cinahl; climate; controlled study; depression; female; health disparity; human; juvenile; LGBTQIA+ people; male; Medline; mental health; PsycINFO; school health nursing; suicidal behavior; systematic review

HIV Stigma, Homophobia, Sexual and Gender Minority Community Connectedness and HIV Testing Among Gay, Bisexual, and Other Men and Transgender People Who Have Sex with Men in Kazakhstan - Paine, E.A.; Lee, Y.G.; Vinogradov, V.; Zhakupova, G.; Hunt, T.; Primbetova, S.; Terlikbayeva, A.; El-Bassel, N.; Wu, E. (AIDS and behavior, 2021)
Although HIV incidence is rising among gay, bisexual, and other men (MSM) and transgender people who have sex with men (TSM) in Kazakhstan, whether stigmatizing attitudes and connectedness are associated with HIV testing in this region is not known. We analyzed data from one-time interviews with 304 adult MSM and TSM conducted 2018-2019 in three cities in Kazakhstan. Logistic regression determined whether HIV stigma, internalized homophobia, sexual and gender minority (SGM) connectedness predicted HIV testing (within the lifetime, past year, and past 6 months) before and after adjustment for sociodemographic characteristics. 80% of participants reported ever receiving an HIV test. Gay-identified participants reported less HIV stigma and internalized homophobia as well as greater connectedness relative to those with bisexual or other identities. In adjusted models, those who had ever tested reported lower HIV stigma (aOR 0.83, 95% CI 0.76-0.91, P < .001) and higher connectedness (aOR 1.17, 95% CI 1.06-1.29, P = .003) than those who had not; those who had ever tested reported lower internalized homophobia in the unadjusted model only (OR 0.95, 95% CI 0.91-0.99, P = .01). Similar differences and trends were found in models examining testing in the past year and past 6 months. Addressing stigmatizing attitudes and connectedness may improve uptake of HIV testing among MSM and TSM in Kazakhstan.
Keywords: adult; article; attitude; bisexuality; city; controlled study; demography; female; HIV test; homophobia; human; interview; Kazakhstan; male; stigma; transgender

Evaluation of an electronic consultation service for transgender care - Singh, J.; Lou, A.; Green, M.; Keely, E.; Greenaway, M.; Liddy, C. (BMC family practice, 2021)
BACKGROUND: Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to care and to explore the content of clinical questions that were asked. METHODS: This was a retrospective mixed methods analysis of 62 eConsults submitted between January 2017 and December 2018 by primary care providers to specialists in transgender care in a health region in eastern Ontario, Canada. A descriptive analysis was conducted to assess the average response time and the total time spent by the specialist for the eConsults. An inductive and deductive content analysis was carried out to identify common themes of clinical questions being asked to transgender specialists. A post-eConsult survey completed by primary care providers was assessed to gain insight into avoided face-to-face referrals and overall provider satisfaction. RESULTS: The median specialist response time was 1.2 days (range: 1 h to 5 days) and the average time spent by specialists per eConsult was 18 min (range: 10 to 40 min). The qualitative analysis identified six major themes: 1) interpretation/management of abnormal bloodwork, 2) change in management due to lack of desired effect/hormone levels not a target, 3) initiation of hormone therapy/initial work up, 4) management of adverse effects of hormone therapy, 5) transition related surgery counseling and post-op complications, and 6) management of patients with comorbidities. Approximately one-third of eConsults resulted in an avoided face-to-face referral and 95% of primary care providers rated the value of their eConsult as a 5 (excellent value) or 4. CONCLUSIONS: This study demonstrated that a transgender eConsult service has potential to significantly improve access to care for transgender patients. Given the importance that timely access has on improving mental health and reducing suicide attempts, eConsult has the potential to make a substantial clinical impact on this population. Identified themes of eConsult questions provides insight into potential gaps in knowledge amongst primary care providers that could help inform future continuing education events.
Keywords: adult; article; averaging; comorbidity; complication; content analysis; continuing education; controlled study; counseling; female; hormonal therapy; hormone determination; human; male; mental health; Ontario; patient referral; primary medical care; qualitative analysis; reaction time; retrospective study; satisfaction; suicide attempt; transgender

Response to: Goodyear et al. Re: Morgan et al., Disparities in Prescription Opioid Misuse Affecting Sexual Minority Adults Are Attenuated by Depression and Suicidal Ideation - Morgan, E.; Feinstein, B.A.; Dyar, C. (LGBT health, 2021)
Keywords: adult; human; letter; prescription; sexual and gender minority; suicidal ideation; opiate

Exposure to Suicidal Behavior and Social Support Among Sexual- and Gender-Minority Youth - Mitchell, K.J.; Banyard, V.; Goodman, K.L.; StrØm, I.F.; Ybarra, M.L. (Pediatrics, 2021)
OBJECTIVES: In this study, we examine reports of exposure to suicidal behavior by youth sexual and gender identity. We explore how exposure is related to depressed mood in the context of high social support while accounting for cumulative adversity. METHODS: Data from a large national sample of youth aged 14 to 15 years in the United States (N = 3979) were collected online in 2018-2019. RESULTS: Sexual- and gender-minority youth were more likely to know someone close to them who attempted suicide, relative to cisgender heterosexual youth. Cisgender heterosexual youth were buffered from recent depressed mood when they endorsed having high social support in the context of exposure to suicidal behavior; less social support did not provide such a buffer. For cisgender sexual-minority male and female youth, exposure to suicidal behavior was related to recent depressed mood regardless of the level of social support. For gender-minority youth assigned female at birth, the combination of exposure and high social support was significantly associated with elevated depressed mood. Cumulative adversity accounted for some but not all of these relationships, indicating the influential role of exposure to suicidal behavior on depressed mood for some youth. CONCLUSIONS: These findings illustrate the complexities of social support and raise questions about its potential to magnify stress rather than serve as a buffer for some youth. Although findings need to be replicated, suicide prevention efforts should carefully consider how to promote resilience among these suicide-exposed sexual- and gender-minority youth who may themselves be at risk for suicidal ideation and behavior.
Keywords: adolescent; article; controlled study; depression; female; gender identity; heterosexuality; human; juvenile; major clinical study; male; physiological stress; prevention; sexual and gender minority; social support; suicidal ideation; suicide attempt; United States; buffer

Trans and Gender-Diverse peoples' experiences of crisis helpline services - Lim, G.; Waling, A.; Lyons, A.; Pepping, C.A.; Brooks, A.; Bourne, A. (Health & social care in the community, 2021)
Crisis helplines are typically easily accessible and deliver interventions in a timely manner, regardless of geographical location. The efficacy and user experiences of these services are the subject of considerable interest within the field, but the experiences of trans and gender-diverse individuals remain unexplored despite high rates of mental ill health being documented in this population. A total of 134 trans and gender-diverse Australians were surveyed about their experiences of personal crises and of utilising crisis helplines. Within our sample, 84.2% (n = 113) of participants recognised at least one service - however, only 32.8% (n = 44) utilised a service to cope with a personal crisis. Participants cited poor recognition and understanding of the challenges specific to trans and gender-diverse individuals among helpline workers as a primary reason for avoiding these services, and articulated needs which were a poor fit for the one-off intervention model commonly employed by helpline services. In order for helpline services to be viable avenues of support for trans and gender-diverse individuals during a personal crisis, helpline workers must be sufficiently equipped to work with trans and gender-diverse callers and to facilitate their enrolment in 'traditional' mental health services.
Keywords: adult; article; Australian; community care; controlled study; drug efficacy; female; gender; human; human experiment; major clinical study; male; mental health service; suicide; transgender; worker

The Survey Measurement of Sexual Orientation: Configurations of Sexual Identity and Attraction and Associations with Mental Health - Garbarski, D. (LGBT health, 2021)
Purpose: This study aimed to examine how configurations of sexual identity and attraction are associated with mental health outcomes. Methods: Data came from the 2015, 2016, and 2017 waves of the National Survey on Drug Use and Health, one of the few nationally representative surveys to ask about sexual attraction. Sexual identity and attraction were combined into groups that are coincident (heterosexual-opposite gender attraction, gay/lesbian-same gender attraction, or bisexual-any multiple gender attraction) or branched (heterosexual-any same gender attraction, gay/lesbian-any opposite gender attraction, bisexual-only same or opposite gender attraction). The association between these configurations and various measures of mental health and well-being-severe psychological distress, major depressive episode, suicidal ideation, and suicide plan or attempt-was examined. Results: Heterosexual coincidence-being heterosexual and only attracted to the opposite gender-was associated with lower mental health risks than all other configurations of sexual identity and attraction. In addition, bisexual with coincident attraction was often associated with worse mental health outcomes than other configurations of identity and attraction, whereas bisexual with branched attraction did not necessarily follow this pattern. Finally, heterosexual with branched attraction was associated with worse mental health outcomes than heterosexual with coincident attraction, but better mental health outcomes than some of the other sexual identity and attraction configurations. Conclusion: Including one question on sexual attraction and its intersection with sexual identity adds nuance to our understanding of disparities in mental health and well-being among previously identified sexual minority and majority groups.
Keywords: article; bisexuality; controlled study; female; gender identity; health disparity; heterosexuality; homosexual female; human; major depression; male; mental health; mental stress; outcome assessment; suicidal ideation; wellbeing

Re: "Disparities in Prescription Opioid Misuse Affecting Sexual Minority Adults are Attenuated by Depression and Suicidal Ideation" by Morgan et al - Goodyear, T.; Lowik, A.J.; Robinson, S.; Knight, R. (LGBT health, 2021)
Keywords: adult; article; human; prescription; sexual and gender minority; suicidal ideation; opiate

The moderating role of parenting dimensions in the association between traditional or cyberbullying victimization and mental health among adolescents of different sexual orientation - Desmet, A.; Rodelli, M.; Walrave, M.; Portzky, G.; Dumon, E.; Soenens, B. (International Journal of Environmental Research and Public Health, 2021)
Cyberbullying victimization is associated with mental health problems and reported to occur more in nonheterosexual orientation youth (lesbian, gay, bisexual, and questioning (LGBQ)) than among heterosexual youth. Parental support may protect against mental health problems after being victimized, but nonsupportive parental influences may also exacerbate harm. This study investigated whether parenting dimensions (autonomy support, psychological control) moderated the associations between bullying victimization and mental health problems among heterosexual and LGBQ adolescents. An anonymous survey was completed by 1037 adolescents (M age = 15.2 ± 1.9, 50% female). Regression analyses examined associations between victimization, sexual orienta-tion, and mental health problems, and investigated the moderating role of parenting. Both forms of victimization were associated with higher mental health problems. LGBQ youth experienced more depressive symptoms and suicidal ideation than heterosexual youth. Lower levels of parental psychological control and higher levels of autonomy support were related to having fewer mental health problems. However, perceived autonomy support appeared less protective when adolescents experienced more frequent victimization. Moreover, parental psychological control was related to heightened risk for suicidal plans specifically among LGBQ youth and also exacerbated the association between cyberbullying victimization and stress among LGBQ youth. These findings un-derscore the need to address parenting in whole-school antibullying and mental health promotion programs.
Keywords: adolescent; article; child parent relation; controlled study; cyberbullying; depression; female; heterosexuality; human; juvenile; major clinical study; male; mental disease; physiological stress; suicidal ideation

How are consensual, non-consensual, and pressured sexting linked to depression and self-harm? The moderating effects of demographic variables - Wachs, S.; Wright, M.F.; Gámez-Guadix, M.; Döring, N. (International Journal of Environmental Research and Public Health, 2021)
Sexting among adolescents has triggered controversial debates among scholars and the general public. However, questions regarding the associations between different types of sexting, namely consensual, non-consensual, and pressured sexting, depressive symptoms, and non-suicidal self-harm remain. In addition, little attention has been given to whether demographic variables (i.e., gender, ethnicity, disability, sexual minority) might influence these associations. To fill these gaps in the literature, the present study was conducted. Participants were 2506 adolescents (ages 13–16 years old; Mage = 15.17; SDage = 0.89) from eight high schools located in the suburbs of a large Midwestern city in the United States. Adolescents self-identified as female (50%), Caucasian (57%), approximately 15% reported that they had a disability they received school accommodation for, and 18% self-identified as a sexual minority. They completed self-report questionnaires on their sexting behaviors, depressive symptoms, and non-suicidal self-harm. Findings revealed that non-consensual and pressured sexting were positively related to depressive symptoms and non-suicidal self-harm, whereas consensual sexting was unrelated to these outcomes. Boys engaged in more non-consensual sexting compared with girls, girls were more pressured to send sexts compared with boys, and sexual minority adolescents reported greater consensual sexting compared with non-sexual minority adolescents. Moderating effects revealed that girls, non-minority adolescents, and non-sexual minority adolescents experienced greater depressive symptoms and non-suicidal self-harm when they experienced pressured sexting. These findings underscore the importance of considering various types of sexting and adolescents’ demographic variables when examining the negative outcomes of sexting. Disentangling the relationships among different types of sexting, depressive symptoms, and self-harm aids in the development of evidence-based recommendations for sexting harm prevention and sexual education programs.
Keywords: adolescent; article; automutilation; Caucasian; child; controlled study; demography; depression; disability; female; high school; human; major clinical study; male; prevention; questionnaire; self report; sexting; sexual and gender minority; sexual education; United States

Understanding pathways to e-cigarette use across sexual identity: A multi-group structural equation model - Doxbeck, C.R.; Jaeger, J.A.; Bleasedale, J.M. (Addictive Behaviors, 2021)
This study explored the relationships between sexual violence, smoking behaviors, suicidality and past 30-day e-cigarette use under the theoretical framework of Minority Stress Theory. The 2017 National Youth Risk Behavioral Survey was utilized to study a nationally representative sample of sexual minority (lesbian, gay, bisexual, and unsure) and heterosexual high school students (N = 7882). Multi-group structural equation modeling (SEM) was employed to examine whether sexual violence and suicidality had a direct effect on e-cigarette use, after controlling for prior smoking behaviors (cigarette, cigar, and marijuana use). Suicidality and smoking behaviors were examined as mediators of the relationship between sexual violence and e-cigarette use, and suicidality was examined as a mediator of the relationship between sexual violence and smoking behaviors. This model was tested for invariance across sexual minority and heterosexual students. For both groups, smoking behaviors had significant direct effects on e-cigarette use, yet suicidality revealed no significant direct effects. Both suicidality and sexual violence had significant indirect effects on e-cigarette use through their effects on smoking behaviors. Sexual violence had a significant direct effect on e-cigarette use for sexual minority students, but not for heterosexual students. Despite this notable difference, the model was found to be invariant across the two groups. These findings suggest that students who report sexual violence may experience suicidality and victimization may lead to smoking behaviors and e-cigarette use. Students’ mental health and substance use behaviors should continue to be targeted in schools, particularly among sexual minority youths.
Keywords: electronic cigarette; article; confirmatory factor analysis; controlled study; descriptive research; female; gender identity; heterosexuality; human; mental health; Minority Stress Theory; self report; sexual violence; smoking; structural equation modeling; substance use; suicidal behavior; suicidal ideation; theory

Group mindful self-compassion training to improve mental health outcomes for LGBTQIA+ young adults: Rationale and protocol for a randomised controlled trial - Finlay-Jones, A.; Strauss, P.; Perry, Y.; Waters, Z.; Gilbey, D.; Windred, M.-A.; Murdoch, A.; Pugh, C.; Ohan, J.L.; Lin, A. (Contemporary Clinical Trials, 2021)
Background: Young adults who are lesbian, gay, bisexual, trans, queer or questioning, intersex, asexual and other diverse genders and sexualities (LGBTQIA+) are more likely to experience mental health difficulties and are at significantly elevated risk of substance abuse, self-harm and suicide, relative to their heterosexual, endosex and cisgender peers. There is a need for effective mental health interventions for LGBTQIA+ young adults. Mindful Self-Compassion training is a promising approach; among LGBTQIA+ individuals, self-compassion accounts for more variation in mental health outcomes than bullying, victimization, and adverse childhood experiences combined. Furthermore, LGBTQIA+ individuals with high self-compassion report more positive identity and happiness, less self-stigma, and lower suicidality than those with low self-compassion. Method: This paper outlines the rationale and protocol for a single-blind CONSORT-compliant randomised controlled trial, comparing group Mindful Self-Compassion to a delayed-treatment waitlist control group, for improving mental health, decreasing self-criticism and increasing self-compassion in LGBTQIA+ young adults (age 18–25 years). Mindful Self-Compassion training is an 8-week group program that focuses on cultivating self-compassion and mindfulness. While typically delivered as a face-to-face program, the proposed trial will investigate efficacy of the program when provided via videoconferencing. Discussion: Videoconference Mindful Self-Compassion training has the potential to improve the mental health of Australian LGBTQIA+ young adults and provide a possible cost-effective, scalable intervention for this population. The proposed trial will be the first to determine its efficacy for LGBTQIA+ young adults and will provide the first data on the delivery of the program via videoconferencing.
Keywords: adult; article; controlled study; drug efficacy; female; happiness; human; human experiment; juvenile; LGBTQIA+ people; male; mental health; mindfulness; program efficacy; randomized controlled trial; single blind procedure; stigma; suicidal behavior; telehealth; videoconferencing; young adult

Experiences of violence and mental health outcomes among Asian American transgender adults in the United States - Becerra, M.B.; Rodriquez, E.J.; Avina, R.M.; Becerra, B.J. (PLoS ONE, 2021)
Purpose We addressed prevalence and factors associated with mental health outcomes (suicidal behavior and psychological distress) among Asian Americans (AA), who identify as transgender, a key group among sexual and gender minorities that is overlooked and understudied. Methods We used data from 2015 United States Transgender Survey during 2019-2020 with our population as census defined AA. Outcomes included suicidal ideation, suicidal thoughts, and serious psychological distress (SPD). Independent variables included any abuse, partner abuse, bathroom-related abuse, and additional covariates. Adjusted odds ratio and 95% confidence interval (aOR; 95% CI) for each outcome are adjusted for age, marital status, citizenship status, education level, employment status, as well as poverty status. Results Nearly 67% reported experiencing any abuse, 52% reported abuse from romantic/sexual partner(s), while 29% reported harassment/abuse when trying to use bathrooms. Moreover, 82% reported suicidal thoughts, 40% reported suicidal attempts, and 39% had SPD. Results demonstrated that any abuse/violence had higher odds of suicidal thoughts (adjusted odds ratio [aOR] = 2.67, 95% confidence interval (CI):[1.98-3.58], suicidal attempts (aOR = 2.83, 95% CI:[2.18-3.68]), and SPD (aOR = 1.56, 95% CI:[1.20, 2.04]). Abuse from romantic/sexual partners had higher odds of suicidal thoughts (aOR = 2.47, 95% CI:[1.76-3.47]), suicidal attempts (aOR = 2.17, 95% CI:[1.68-2.80]), and SPD (aOR = 2.72, 95% CI:[2.03-3.63]). Experience of harassment/abuse during bathroom use had increased odds of suicidal attempts (aOR = 1.81, 95% CI:[1.41-2.31]). Conclusion Exposure to violence is common among AA transgender individuals and related to negative mental health outcomes. Initiatives to reduce exposure to abuse and providing resources for trauma-informed care are imperative to improve health outcomes.
Keywords: adult; article; Asian American; bath; citizenship; controlled study; education; employment status; exposure to violence; harassment; human; independent variable; injury; marriage; mental health; mental stress; partner violence; poverty; sexuality; suicidal ideation; suicide attempt; transgender

Minority stress, distress, and suicide attempts in three cohorts of sexual minority adults: A U.S. probability samplz - Meyer, I.H.; Russell, S.T.; Hammack, P.L.; Frost, D.M.; Wilson, B.D.M. (PLoS ONE, 2021)
During the past 50 years, there have been marked improvement in the social and legal environment of sexual minorities in the United States. Minority stress theory predicts that health of sexual minorities is predicated on the social environment. As the social environment improves, exposure to stress would decline and health outcomes would improve. We assessed how stress, identity, connectedness with the LGBT community, and psychological distress and suicide behavior varied across three distinct cohorts of sexual minority people in the United States. Using a national probability sample recruited in 2016 and 2017, we assessed three a priori defined cohorts of sexual minorities we labeled the pride (born 1956-1963), visibility (born 1974-1981), and equality (born 1990-1997) cohorts. We found significant and impressive cohort differences in coming out milestones, with members of the younger cohort coming out much earlier than members of the two older cohorts. But we found no signs that the improved social environment attenuated their exposure to minority stressors-both distal stressors, such as violence and discrimination, and proximal stressors, such as internalized homophobia and expectations of rejection. Psychological distress and suicide behavior also were not improved, and indeed were worse for the younger than the older cohorts. These findings suggest that changes in the social environment had limited impact on stress processes and mental health for sexual minority people. They speak to the endurance of cultural ideologies such as homophobia and heterosexism and accompanying rejection of and violence toward sexual minorities.
Keywords: adult; article; cohort analysis; cultural factor; distress syndrome; female; gender identity; homophobia; human; LGBT people; male; mental health; mental stress; middle aged; probability sample; sexual and gender minority; social acceptance; social environment; social rejection; suicide attempt; United States

Experience of chest dysphoria and masculinizing chest surgery in transmasculine youth - Mehringer, J.E.; Harrison, J.B.; Quain, K.M.; Shea, J.A.; Hawkins, L.A.; Dowshen, N.L. (Pediatrics, 2021)
OBJECTIVES: Transmasculine individuals, those assigned female sex at birth but who identify as masculine, have high rates of suicidal behavior and often suffer from chest dysphoria (discomfort and distress from unwanted breast development). Growing numbers of transmasculine youth are pursuing definitive treatment with masculinizing chest surgery (MCS), and adult studies reveal marked benefits of MCS, although little is known about the impact of chest dysphoria on transmasculine youth or the optimal timing of MCS. In this study, we aimed to explore youth experiences of chest dysphoria and the impact of MCS. METHODS: Transmasculine youth aged 13 to 21 were recruited from a pediatric hospital-based gender clinic. Participants completed a semistructured qualitative interview exploring the experience of chest dysphoria and thoughts about or experiences with MCS. Interview transcripts were coded by 3 investigators employing modified grounded theory, with the median interrater reliability at k = 0.92. RESULTS: Subjects (N = 30) were a mean age of 17.5 years, and 47% had undergone MCS. Youth reported that chest dysphoria triggered strong negative emotions and suicidal ideation, caused a myriad of functional limitations, and was inadequately relieved by testosterone therapy alone. All post-MCS youth reported near or total resolution of chest dysphoria, lack of regret, and improved quality of life and functioning. CONCLUSIONS: We observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth. MCS performed during adolescence, including before age 18, can alleviate suffering and improve functioning. Additional research is needed to develop patient-reported outcome measures to assess the impact of chest dysphoria and MCS.
Keywords: adolescence; adolescent; adult; androgen therapy; article; clinical article; consensus; controlled study; distress syndrome; dysphoria; emotion; female; gender; genetic transcription; grounded theory; human; interrater reliability; interview; juvenile; male; outcome assessment; patient-reported outcome; pediatric hospital; quality of life; suicidal ideation; surgery; thorax surgery

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

Electroconvulsive Therapy for Depression in Transgender Patients: Case Series and Literature Review - Mormando, C.B.; Dalke, K.; Mikoluk, C.; Garman, J.C.; Francis, A. (The journal of ECT, 2021)
ABSTRACT: There is very limited information regarding the effectiveness of electroconvulsive therapy (ECT) as a treatment for major depressive disorder in transgender patients. This population is also at risk for comorbid conditions, such as posttraumatic stress disorder and substance use that could impact the outcome of ECT. We report our experience with the use of ECT in this population. Clinical and response characteristics of 7 consecutive cases are described in this series. All patients had multiple psychiatric diagnoses and were refractory to pharmacologic intervention. Pretreatment Beck Depression Inventory-II scores were 45.5 ± 3.2 SEM and posttreatment scores were 21.2 ± 6.4 [P < 0.01]. Suicidality scores reduced by greater than 60%, whereas remission of depression was obtained for 2 of 7, and 4 of 7 showed greater than 50% reduction in depression scores. Treatments were tolerated well using conventional treatment procedures. This case series suggests that ECT can be effective for depressed transgender patients with multiple clinical comorbidities.
Keywords: adult; article; Beck Depression Inventory; case study; clinical article; comorbidity; electroconvulsive therapy; female; human; male; psychiatric diagnosis; remission; suicidal behavior; transgender

Differences in Adolescent Experiences of Polyvictimization and Suicide Risk by Sexual Minority Status - Johns, M.M.; Lowry, R.; Hipp, T.N.; Robin, L.; Shafir, S. (Journal of research on adolescence : the official journal of the Society for Research on Adolescence, 2021)
Sexual minority adolescents (SMA) report more suicide risk behaviors than heterosexual adolescents. Polyvictimization (co-occurrence of multiple types of victimization) may be an important, underresearched correlate of this disparity. With the 2017 national Youth Risk Behavior Survey (N = 13,179), national estimates of polyvictimization and suicide risk were assessed among high school students by sexual minority status (SM vs. heterosexual), and multivariate relationships between sexual minority status, polyvictimization, and suicide risk were tested. Additionally, risk profiles of those who experienced polyvictimization (2 + types of victimization; n = 1,932) were compared across sexual minority status. Results confirm that SMA are more likely to experience polyvictimization than heterosexual adolescents (31.8% v. 12.9%, respectively); however, also indicate that polyvictimization does not fully explain elevated suicide risk among SMA.
Keywords: adolescent; article; controlled study; female; heterosexuality; high school student; human; juvenile; major clinical study; male; risk assessment; sexual and gender minority; suicide

Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study - Xiao, Y.; Lindsey, M.A. (Administration and policy in mental health, 2021)
Suicide is the second leading cause of death for people aged 10-34 years old. Limited research has documented extant heterogeneities in suicide across the life course and among diverse sociodemographic groups. There is also limited research on the influences of mental health utilization on suicidal trajectories across the life course. This study aims to: (1) identify racial/ethnic, sex, sexual orientation, socioeconomic status, and intersectional differences in suicidal trajectories among adolescents transitioning to adulthood; and (2) examine influences of mental health service utilization on disparities in suicidal trajectories. The study included 9421 respondents (Mage = 14.99 [SD = 1.61]) from Waves I-IV National Longitudinal Study of Adolescent to Adult Health (1994-2008). Latent class growth analyses were used to identify trajectories of suicidal ideation and suicide attempts. Multivariate multinomial logistic regression was used to examine the influences of mental health treatment and sociodemographic characteristics on suicidal trajectories. Three suicidal ideation (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt (low-stable, moderate-decreasing) trajectories were identified. Compared with the low-stable trajectories, the risks of being in high-decreasing suicidal ideation trajectories were higher among females (AOR = 1.45, 95% CI 1.01-2.13) and sexual minorities (AOR = 1.82, 95% CI 1.21-2.74). Sexual minorities (AOR = 2.63, 95% CI 1.69-4.08) and low-SES adolescents (AOR = 1.79, 95% CI 1.08-2.98) were more likely to be in the moderate-decreasing suicide attempt group. Mental health service utilization predicted engagement in high-risk suicidal trajectories. Sociodemographic disparities in suicidal trajectories initiate early and persist over time. Individuals in high-risk trajectories received mental health treatment during adolescence. Suicide prevention should target vulnerable subpopulations and mental health service utilization in the early stage.
Keywords: adolescence; adolescent; adult; adulthood; article; cohort analysis; controlled study; demography; female; health disparity; human; human experiment; longitudinal study; major clinical study; mental health service; prevention; school child; sexual and gender minority; sexual orientation; social status; suicidal ideation; suicide attempt

Characteristics and Perceptions of Sexual and Gender Minority Youth Who Utilized a National Sexual and Gender Minority-Focused Crisis Service - Mereish, E.H.; Feinstein, B.A.; Mamey, M.R.; Goldbach, J.T. (Crisis, 2021)
Background: Sexual and gender minority youth (SGMY) have heightened risk of suicidality; yet, we know little about their experiences when utilizing crisis services. Aims: The purpose of this study was to understand the characteristics and experiences of SGMY when in contact with SGMY-specific suicide crisis services. Method: Data were from 592 SGMY who contacted the most widely utilized national US SGMY-specific crisis services provider. Results: High rates of suicide ideation (65.2%) and attempts (31.9%) were documented, with gender minority youth endorsing higher rates of suicide attempts. Participants contacted the center by phone (57.8%) more than by online chat/text (42.2%). Participants reported discussing their sexual orientation (60.6%), gender identity (43.8%), and identity disclosure stress (56.6%) with counselors. Participants rated the crisis service as helpful. The counselors were perceived as warm, compassionate, and knowledgeable about common concerns for SGMY and they were likely to contact the crisis center again. Participants reported using chat/text over phone because it provided them with more confidentiality and privacy; however, phone contacts were rated more positively than text/chat. Limitations: The sample was predominately White and was not representative of the broader population of SGMY, limiting the generalizability of the results. Conclusion: SGMY reported positive experiences with a national SGMY-specific crisis service. The findings highlight the critical need for and utility of SGMY-specific suicide prevention crisis services.
Keywords: adult; article; confidentiality; counselor; female; gender identity; human; juvenile; male; perception; physiological stress; prevention; privacy; sexual and gender minority; sexual orientation; suicidal ideation; suicide attempt

Full-Length Transcriptome Analysis of Plasmodium falciparum by Single-Molecule Long-Read Sequencing - Yang, M.; Shang, X.; Zhou, Y.; Wang, C.; Wei, G.; Tang, J.; Zhang, M.; Liu, Y.; Cao, J.; Zhang, Q. (Frontiers in Cellular and Infection Microbiology, 2021)
Malaria, an infectious disease caused by Plasmodium parasites, still accounts for amounts of deaths annually in last decades. Despite the significance of Plasmodium falciparum as a model organism of malaria parasites, our understanding of gene expression of this parasite remains largely elusive since lots of progress on its genome and transcriptome are based on assembly with short sequencing reads. Herein, we report the new version of transcriptome dataset containing all full-length transcripts over the whole asexual blood stages by adopting a full-length sequencing approach with optimized experimental conditions of cDNA library preparation. We have identified a total of 393 alternative splicing (AS) events, 3,623 long non-coding RNAs (lncRNAs), 1,555 alternative polyadenylation (APA) events, 57 transcription factors (TF), 1,721 fusion transcripts in P. falciparum. Furthermore, the shotgun proteome was performed to validate the full-length transcriptome of P. falciparum. More importantly, integration of full-length transcriptomic and proteomic data identified 160 novel small proteins in lncRNA regions. Collectively, this full-length transcriptome dataset with high quality and accuracy and the shotgun proteome analyses shed light on the complex gene expression in malaria parasites and provide a valuable resource for related functional and mechanistic researches on P. falciparum genes.
Keywords: alternative RNA splicing; article; controlled study; DNA library; gene expression; nonhuman; Plasmodium falciparum; polyadenylation; RNA sequencing; endogenous compound; long untranslated RNA; proteome; transcription factor; transcriptome

Ambient Discrimination, Victimization, and Suicidality in a Non-Probability U.S. Sample of LGBTQ Adults - Peterson, A.L.; Bender, A.M.; Sullivan, B.; Karver, M.S. (Archives of sexual behavior, 2021)
Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are at a higher risk for suicidality compared to the general population. A growing body of research has investigated this risk, particularly with attention to systemic factors such as discrimination and harassment. Unfortunately, research has only examined the impact of direct discrimination on suicidality and has neglected to examine how ambient discrimination (i.e., witnessing or being made aware of discriminatory behaviors directed at someone other than yourself in your group) relates to suicidality. Additionally, although some links exist between discrimination and suicidality, the mechanisms by which these are related are understudied. This study aimed to address these gaps by exploring the effect of ambient discrimination on suicidal ideation and examining psychological pain as a mediator in this relationship. Data were collected from a sample of 200 LGBTQ-identified individuals (M age = 35 years; 53.5% female; 86% White). Results of independent t tests and a one-way multivariate ANOVA revealed greater vulnerability for ambient/direct discrimination and psychache among individuals identifying as transgender, queer, and other. Regression and mediation analyses revealed that while both ambient and direct discrimination predicted suicidal ideation, only direct discrimination accounted for unique variance in the outcome; however, both ambient and direct discrimination contributed unique variance to psychological pain, which fully mediated their relationships to suicidal ideation. Results of this study may begin to provide insight into the pathways of risk and points of intervention for suicidality in the LGBTQ community.
Keywords: adult; analysis of variance; article; female; gender identity; human; human tissue; LGBTQIA+ people; male; mediation analysis; pain; suicidal ideation

Development of a smartphone app to predict and improve rates of suicidal ideation among transgender persons (TransLife): A Qualitative study - Dubov, A.; Fraenkel, L.; Goldstein, Z.; Arroyo, H.; McKellar, D.; Shoptaw, S. (Journal of medical Internet research, 2021)
BACKGROUND: Transgender people are at high risk for suicide ideation, attempts, and deaths. Among transgender individuals, 77% and 41% engage in suicide ideation and attempts in their lifetime, which exceeds general population rates (9.2% and 2.7% respectively). Traditionally, suicide risk factors have been studied using long period of time between measurements, making it difficult to understand short-term variability in suicide risk. Mobile phone applications offer opportunity to understand the immediate precursors of suicidality through the assessment of behaviors and moods in real-time. This is the first study to use a mobile phone app (TransLife) to understand short-term suicide risk factors among transgender individuals. OBJECTIVE: This study's objective is to beta test the usability of an evidence-informed mHealth suicide prevention phone app TransLife. The primary aims were to obtain preliminary data on user engagement and satisfaction with the app and to assess the feasibility of completing EMAs (mood logs) within the app. METHODS: We used qualitative methods and an exploratory research approach that combined naturalistic app use, focus groups, and semi-structured phone interviews. Focus group informed the development of the prototype. We conducted a 3-week evaluation to determine engagement and obtain detailed user feedback about the app. Post pilot participation, phone-based, semi-structured, and audio-recorded exit interviews were conducted with research participants. RESULTS: Sixteen transgender individuals participated in the study. On average, users logged in four times a week and spent approximately five minutes on the app per login. Six major themes emerged. These themes focused on the app's functionality, satisfaction from using the app, perceived ease of use, perceived safety of providing personal data within the app, trusting the app enough to share personal feelings, and features that make this app engaging. These themes suggested that TransLife is an engaging, useful, and acceptable mHealth intervention. Participants reported that the app was easy to use and understand, supported mental self-care, promoted self-awareness, and helped them to identify triggers of negative moods. CONCLUSIONS: The results of this pilot study indicate that TransLife is an engaging, acceptable, and potentially effective mental health intervention. Transgender participants reported many advantages from using TransLife, such as being able to track their mood, connect to the community, and access local resources. This study provides initial support for the acceptability and usability of TransLife as an mHealth intervention designed for the transgender community. CLINICALTRIAL: This work was supported by the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) NIMH grant P30MH058107. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
Keywords: adult; article; awareness; behavior assessment; clinical article; controlled study; exploratory research; feasibility study; female; human; Human immunodeficiency virus; interview; male; mental health; mood; nonhuman; pilot study; preliminary data; prevention; qualitative analysis; qualitative research; responsibility; risk factor; satisfaction; self care; smartphone; suicidal ideation; transgender; usability

Suicide thought and behaviors, non-suicidal self-injury, and perceived life stress among sexual minority Mexican college students - Rentería, R.; Benjet, C.; Gutierrez-Garcia, R.A.; Ábrego Ramírez, A.; Albor, Y.; Borges, G.; Covarrubias Díaz Couder, M.A.; Durán, M.D.S.; González González, R.; Guzmán Saldaña, R.; Hermosillo De la Torre, A.E.; Martínez-Jerez, A.M.; et al. (Journal of Affective Disorders, 2021)
Background: Sexual minority college students are at a higher risk for suicidal thoughts and self-injurious behaviors compared to heterosexual students. Minority stress theory proposes sexual minority individuals experience higher stress due to stigma. Using a sample of Mexican college students, this study tested perceived life stress as a mediator of suicide and self-injury outcomes across various sexual orientation groups. Methods: The sample of college students (N=7882) was recruited from nine Mexican universities as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. Participants completed an online survey including demographic questions, measure of perceived life stress, suicide outcomes, and non-suicidal self-injury (NSSI) in the past 12 months. Results: Logistic regression analyses revealed identifying as a sexual minority significantly predicted a higher likelihood of suicide ideation (ORs 2.05-3.00), suicide attempts (ORs 2.48-8.73), and NSSI (ORs 2.92-4.18) compared to heterosexual students reporting no same-gender attraction. Significant indirect effects from mediation path analyses showed perceived life stress mediated the relationship between a sexual minority identity and suicide ideation (range of proportion mediated 10.48-31.48%), attempts (10.48-31.48%), and NSSI (7.69-20.09%) across each group except among asexual students. Limitations: The cross-sectional nature of the survey design precludes drawing causal inferences. Conclusion: Findings from this study contribute to minority stress theory by elucidating the role of perceived life stress as a mediator of suicide ideation and attempts and NSSI among sexual minority college students. Clinical interventions may benefit in focusing on experiences of stress across various life areas when supporting sexual minority college students.
Keywords: adult; article; asexual people; automutilation; college student; controlled study; demography; drawing; female; heterosexuality; human; life stress; major clinical study; male; mental health; Mexico; path analysis; sexual and gender minority; suicidal ideation; suicide attempt; theoretical study

Sexual violence victimization and suicide: Testing a coping-mental health framework - Kaniuka, A.R.; Desmarais, S.L.; Cramer, R.J.; Stoner, J.E.; Veri, S.; Wright, S.; Gemberling, T.M.; Nobles, M.R.; Holley, S.R. (Aggressive behavior, 2021)
Sexual violence victimization is a prevalent public health concern. However, little research has investigated the factors linking sexual violence victimization to suicidal thoughts and behaviors (STBs). The current study tested the applicability of the psychological mediation framework, a coping-mental health model, for the prevention of STBs among victims of sexual youviolence. Furthermore, the current study explored whether sexual orientation moderated the progression from sexual violence victimization to STBs. Data were drawn from an online survey of victimization experiences and health (N = 2175). Bootstrap mediation tested whether the association of sexual violence victimization and STBs was mediated by emotion regulation strategies (cognitive reappraisal and expressive suppression) and psychopathology (anxiety, depression, and posttraumatic stress disorder). Multiple-groups analysis tested whether links within the mediation effects varied by sexual orientation. Bivariate findings showed that: (1) sexual minority persons were more likely to report sexual violence victimization and (2) cognitive reappraisal was more meaningfully associated with mental health among sexual minority persons. Sexual violence victimization was associated with STBs via a serial mediation through emotion regulation and psychopathology. The association between psychopathology and STBs was stronger among sexual minority compared with heterosexual respondents. Physical violence victimization was associated with STBs for heterosexual but not sexual minority persons in a follow-up model. Findings support an emotion regulation-mental health framework for the prevention of suicide among victims of sexual violence. Research and training implications are discussed.
Keywords: adult; anxiety; article; bootstrapping; cognitive reappraisal; controlled study; depression; emotion regulation; female; follow up; heterosexuality; human; major clinical study; male; mental disease; physical violence; posttraumatic stress disorder; prevention; sexual and gender minority; sexual violence; suicidal ideation; victim

University housing reinforces the negative relationship between interpersonal violence, psychological distress, and suicidality in undergraduates, particularly among gender diverse students - Heller, A.T.; Berg, S.S.; Prichard, J.R. (Journal of American college health : J of ACH, 2021)
OBJECTIVE: To compare academic and mental health outcomes across diverse gender identities in the context of interpersonal violence and campus housing. PARTICIPANTS: 45,549 students from 124 self-selected post-secondary institutions. METHODS: Various academic and health measures from the National College Health Assessment Spring 2017 dataset were analyzed for differences across five gender identities (cis women, cis men, transwomen, transmen, and genderqueer students), and two housing categories (university housing and non-university housing). RESULTS: When compared to cisgender peers, gender diverse students reported greater experiences of interpersonal violence and higher levels of negative academic and mental health outcomes. Living in university housing was associated with an increase in these disparities. CONCLUSIONS: University housing, which usually reinforces fixed gender binaries, is associated with worse outcomes for gender diverse students. These data can help higher education institutions better understand and address problems that disproportionately impact transgender and gender diverse students, who represent a growing demographic.
Keywords: academic success; adult; article; controlled study; demography; female; gender identity; housing; human; major clinical study; male; male to female transgender; mental health; mental stress; spring; suicidal behavior; violence

Suicide, Homicide, and All-Cause Mortality Among Transgender and Cisgender Patients in the Veterans Health Administration - Boyer, T.L.; Youk, A.O.; Haas, A.P.; Brown, G.R.; Shipherd, J.C.; Kauth, M.R.; Jasuja, G.K.; Blosnich, J.R. (LGBT health, 2021)
Purpose: This study examines the differences in suicide, homicide, and all-cause mortality between transgender and cisgender Veterans Health Administration (VHA) patients. Methods: VHA electronic medical record data from October 1, 1999 to December 31, 2016 were used to create a sample of transgender and cisgender patients (n = 32,441). Cox proportional hazard regression was used to evaluate differences in survival time (date of birth to death date/study end). Death data were from the National Death Index. Results: Transgender patients had more than twofold greater hazard of suicide than cisgender patients (adjusted hazard ratio [aHR] = 2.77, 95% confidence interval [CI] = 1.88-4.09), especially among younger (18-39 years) (aHR = 3.35, 95% CI = 1.30-8.60) and older (≥65 years) patients (aHR = 9.48, 95% CI = 3.88-23.19). Alternatively, transgender patients had an overall lower hazard of all-cause mortality (aHR = 0.90, 95% CI = 0.84-0.97) compared with cisgender patients, which was driven by patients 40-64 years old (aHR = 0.78, 95% CI = 0.72-0.86) and reversed by those 65 years and older (aHR = 1.17, 95% CI = 1.03-1.33). Conclusion: Transgender patients' hazard of suicide mortality was significantly greater than that of cisgender VHA patients.
Keywords: adult; all cause mortality; article; controlled study; electronic medical record; female; homicide; human; major clinical study; male; suicide; survival time; transgender; veterans health

Investigation to identify individual socioeconomic and health determinants of suicidal ideation using responses to a cross-sectional, community-based public health survey - Mulholland, H.; McIntyre, J.C.; Haines-Delmont, A.; Whittington, R.; Comerford, T.; Corcoran, R. (BMJ open, 2021)
OBJECTIVES: To address a gap in knowledge by simultaneously assessing a broad spectrum of individual socioeconomic and potential health determinants of suicidal ideation (SI) using validated measures in a large UK representative community sample. DESIGN: In this cross-sectional design, participants were recruited via random area probability sampling to participate in a comprehensive public health survey. The questionnaire examined demographic, health and socioeconomic factors. Logistic regression analysis was employed to identify predictors of SI. SETTING: Community setting from high (n=20) and low (n=8) deprivation neighbourhoods across the North West of England, UK. PARTICIPANTS: 4319 people were recruited between August 2015 and January 2016. There were 809 participants from low-deprivation neighbourhoods and 3510 from high-deprivation neighbourhoods. The sample comprised 1854 (43%) men and 2465 (57%) women. PRIMARY OUTCOME MEASURES: SI was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire-9 instrument. RESULTS: 454 (11%) participants reported having SI within the last 2 weeks. Model 1 (excluding mental health variables) identified younger age, black and minority ethnic (BME) background, lower housing quality and current smoker status as key predictors of SI. Higher self-esteem, empathy and neighbourhood belonging, alcohol abstinence and having arthritis were protective against SI. Model 2 (including mental health variables) found depression and having cancer as key health predictors for SI, while identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) and BME were significant demographic predictors. Alcohol abstinence, having arthritis and higher empathy levels were protective against SI. CONCLUSIONS: This study suggests that it could be useful to increase community support and sense of belonging using a public health approach for vulnerable groups (e.g. those with cancer) and peer support for people who identify as LGBTQ and/or BME. Also, interventions aimed at increasing empathic functioning may prove effective for reducing SI.
Keywords: adult; alcohol abstinence; arthritis; article; automutilation; bisexuality; cancer model; controlled study; cross-sectional study; current smoker; demography; dependent variable; depression; empathy; England; female; homosexual female; housing; human; human tissue; major clinical study; male; mental health; neighborhood; Patient Health Questionnaire 9; peer group; psychiatry; public health; self esteem; suicidal ideation; transgender

Suicidality, Self-efficacy, and Mental Health Help-seeking in Lesbian, Gay, Bisexual and Transgender Adults in Taiwan: a Cross-sectional Study - Wu, C.Y.; Lee, M.B. (Journal of clinical nursing, 2021)
AIM AND OBJECTIVES: The study aimed to investigate the associations of suicide risk, self-efficacy, and mental health help-seeking among the lesbian, gay, bisexual, and transgender (LGBT). BACKGROUND: The LGBT individuals were found to have higher risk of suicide. However, mental health promotion and suicide prevention strategies were lacking in this population. DESIGN: A cross-sectional survey with two-group comparison. METHODS: The LGBT group was recruited through snowballing method, which was then age-matched with the comparison group as the reference. The questionnaire contained demographics, self-rated health, suicide risk assessment, and help-seeking indicators including formal (e.g., medical or psychiatric services) and informal (e.g., family or friends) help sought. Chi-square tests, t-tests, two-way ANOVA and multivariable regression were performed to test the differences between two groups. The methods followed STROBE criteria. RESULTS: The LGBT group had a significantly higher prevalence of lifetime/recent suicide ideation, prior suicide attempts, and mental distress or depressive symptoms. Their self-rated health and health-related self-efficacy were poorer than those of the comparison group and were associated with increased suicide risk levels. Among the 27.1% of LGBT who intended to seek help for depression, one in five visited psychiatric services. The LGBT were 2-4 times more likely than the comparison group to disclose their distress or seek informal help. However, psychiatric and medical service contacts were relatively low for suicide high-risk individuals in the LGBT group. CONCLUSIONS: The LGBT individuals had a lower level of self-efficacy and higher suicidal risks than the general public. Healthcare professionals and the public should be aware of their informal help-seeking signals such as disclosure of suicide ideation to friends/relatives and connect them to proper mental health resources for further assessment. RELEVANCE TO CLINICAL PRACTICE: The LGBT with suicide risks require early detection and proper referrals by first-line nurses to promote suicide prevention in this population.
Keywords: adult; analysis of variance; article; controlled study; cross-sectional study; demography; depression; distress syndrome; female; friend; help seeking behavior; human; LGBT people; male; medical service; mental health service; nurse; prevalence; prevention; questionnaire; relative; risk assessment; suicidal ideation; suicide; suicide attempt; Taiwan

Trends in the utilization of a peer-supported youth hotline - Kerner, B.; Carlson, M.; Eskin, C.K.; Tseng, C.-H.; Ho, J.-M.G.-Y.; Zima, B.; Leader, E. (Child and Adolescent Mental Health, 2021)
Background: Peer-supported youth hotlines have been in operation for many years but studies on the acceptance of this hotline model or on the demographics of the callers are lacking. This study was performed to examine the utilization of a metropolitan peer-supported youth hotline between 2010 and 2016. Method: The change in demographics, contact channels, and the reasons for contact were analyzed with standard linear regression analysis in 67,478 contacts over 7 years. Results: The data revealed a significant increase in hotline utilization from 8008 annual contacts in 2010 to 12,409 contacts in 2016 (p =.03). The majority of contacts were made by 15-year-old and 16-year-old girls, but contacts by children aged 13 years old and younger have also increased significantly over the years (p =.003). In 2016, anxiety and stress were among the leading reasons for contact (20.14%), followed by sadness and depression (17.21%), suicidal ideation (14.18%), and self-harm (8.15%). Recommendations for follow-up with outside mental health resources were made in 56.22% of contacts. More than 60% of contacts had found information about the hotline on the Internet. More than 30% used text messaging to reach out to the hotline. Conclusions: Our data indicate that adolescents increasingly utilize a peer-supported youth hotline to get help for mental health concerns. Therefore, it should be explored whether this hotline model could also be used for prevention and early intervention. Key Practitioner Message: Peer-supported youth hotlines are well accepted and frequently utilized by adolescents to get help for mental health issues. Our data indicate that peer-supported youth hotlines could be utilized to identify youth at risk for depression and suicide. Further research should evaluate whether peer-supported youth hotlines could serve in the prevention and in early mental health intervention, and how they could be effectively linked to other mental health resources in the community.
Keywords: adolescence; adult; anxiety; article; automutilation; awareness; call center; child; community mental health service; counseling; depression; early intervention; emotion; follow up; health care planning; hotline; human; Internet; mental disease; mental health; mental health care personnel; motivation; online support group; perception; physiological stress; sadness; suicidal behavior; suicidal ideation; suicide attempt; text messaging; training; transgender

Prevalence and predictors of suicidal thoughts and behaviours among Australian police and emergency services employees - Kyron, M.J.; Rikkers, W.; Page, A.C.; O’Brien, P.; Bartlett, J.; LaMontagne, A.; Lawrence, D. (Australian and New Zealand Journal of Psychiatry, 2021)
Objective: This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors. Method: A stratified random sample of personnel from 33 Australian emergency services organisations were invited to participate in a mental health and wellbeing survey. In total, 14,868 Australian ambulance, fire and rescue, police and state emergency services employees participated and self-reported any suicidal thoughts, plans and/or attempts in the 12 months prior to the survey or at any stage in their life. Logistic regressions assessed factors associated with suicidal thoughts and behaviours. Results: Employees reported notably higher rates of suicidal thoughts and plans than the general Australian adult population, but not attempts. Male, single/divorced, non-heterosexual or longer-serving employees reported higher rates of suicidal thoughts and behaviours across each sector. Perceptions of stigma regarding mental health conditions from others in the workplace, negative impact of work on one’s private life and low meaning of work were associated with suicidal thoughts, while bullying significantly differentiated who planned and attempted suicide from those who reported suicidal thoughts only. Higher resilience and social support were associated with lower suicidal thoughts, while intermittent explosive anger and illegal drug use were associated with higher rates of suicidal thoughts. Post-traumatic stress disorder symptoms significantly differentiated who planned suicide, while misuse of prescription drugs and psychological distress differentiated who attempted suicide from those who only reported suicidal thoughts. Conclusion: Amid inherently stressful occupations, it is important that workplaces function in a way that supports their personnel. Access to mental health services should be promoted and readily available to personnel.
Keywords: adult; age; anger; article; Australia; binge drinking; bullying; controlled study; distress syndrome; drug use; emergency health service; female; health care access; health care personnel; health survey; human; major clinical study; male; marriage; mental health; mental health service; middle aged; perception; police; posttraumatic stress disorder; prescription drug misuse; prevalence; psychological resilience; risk factor; risk reduction; self report; sleep quality; social support; stigma; suicidal behavior; suicidal ideation; symptom; wellbeing

Mental Health and sexual orientation in adolescents in a school environment - Lorimy, L.; Cosquer, M.; Barron, E.; Jousselme, C. (Encephale, 2021)
Introduction: Although homosexuality is a subject often addressed by the media, little is said about homosexuality in adolescents who are particularly affected by the question of sexual orientation. This work aims to study the mental health of adolescents who report being exclusively attracted to members of the same sex. We explore the evidence for an association between homosexuality and depression, suicide attempts, and consulting a psychiatrist or a psychologist. Methods: We used data from the cross-sectional study “Adolescent Portraits – A Multicenter Epidemiological Survey in Schools in 2013” (CHU Fondation Vallée, Inserm CESP U1018). Data were gathered through the use of an anonymous, self-administered questionnaire (348 questions) given to students between the “4e” and “terminale school” years (comparable to the 8th and 12th grade in the U.S. education system) in three contrasting French geographical areas. The risk of depression was measured using the Adolescent Depression Rating Scale (ADRS). Results: The results reflect the survey responses provided by 15,235 young people. Of these, 1.5 % reported only being attracted to members of the same sex (homosexual group). This group contained twice as many girls as boys. Students who did not report sexual attraction, who reported bisexual attraction, or who did not answer the question were excluded from the results (830 students). In the homosexual group, 24 % presented with depression versus 11.5 % of those attracted exclusively to members of the opposite sex (heterosexual group). There is also a significant difference between sexes: 13.2 % of boys in the homosexual group were depressed compared to 29.3 % of girls in the same group; 6.7 % of boys in the heterosexual group reported being depressed versus 16.1 % of girls in the same group. In the heterosexual group, 10.7 % of respondents reported having already made at least one suicide attempt versus 20.7 % of those in the homosexual group. There was a difference according to sex, since 6.3 % of boys in the heterosexual group had a history of attempted suicide versus 14.9 % of girls in the same group. This gap disappeared completely within the homosexual group, as 21.4 % of boys and 20.4 % of girls had already made at least one suicide attempt at the time of the survey. Depressed adolescents in the homosexual group also reported a higher number of previous suicide attempts than those in the heterosexual group (46.9 % versus 31.6 %). In terms of sex, 25.3 % of depressed boys in the heterosexual group made at least one suicide attempt versus 34.1 % of girls. In the homosexual group, 44.4 % of depressed boys reported having made at least one suicide attempt versus 47.5 % of depressed girls. Adolescents in the homosexual group were significantly more likely to report having consulted a psychiatrist or psychologist than those in the heterosexual group (14.6 % versus 6.5 %), regardless of sex (16.7 % versus 4.7 % for boys; 13.5 % versus 8.2 % for girls). This difference was also found among depressed subjects (26.0 % in the homosexual group versus 15.4 % in the heterosexual group). Sexual activity (having already had sex) was higher in the homosexual group than in the heterosexual group (53.7 % versus 37.5 %), and this difference remained significant after adjusting for age. Fifty percent of the sexually active homosexual respondents reported having engaged in sexual activity of a homosexual nature versus 0.7 % of sexually active heterosexual respondents. In the homosexual group, mental suffering appeared to be more severe among sexually active subjects, in terms of dark thoughts (64 % versus 46 %) and a prior history of attempted suicide (29.3 % versus 10 %), but not in terms of depression (27.9 % versus 18.9 %; NS). Conclusion: Young people who reported being exclusively attracted to members of the same sex presented a higher level of mental distress compared to those who reported being attracted to members of the opposite sex. This was especially the case for boys. These findings led to the identification of risk and protective factors that can inform the development of appropriate preventive measures.
Keywords: adolescent; adolescent depression; adolescent depression rating scale; article; child psychiatry; controlled study; cross-sectional study; depression assessment; female; heterosexuality; homosexuality; human; major clinical study; male; mental health; multicenter study; preventive medicine; protection; questionnaire; risk factor; school; sexual behavior; sexual orientation; suicide attempt

Depression and Suicide Risk at the Cross-Section of Sexual Orientation and Gender Identity for Youth - Guz, S.; Kattari, S.K.; Atteberry-Ash, B.; Klemmer, C.L.; Call, J.; Kattari, L. (Journal of Adolescent Health, 2021)
Purpose: Adolescence is a developmental phase in which young people begin to explore their identity and seek to understand how their identity fits into the larger society. Although this is a developmental task for all adolescents, it is especially salient for sexual and gender minority youth. Owing to oppressive social structures and stigmatized identities, adolescents who identify as nonheterosexual or noncisgender are vulnerable to experiencing disproportionate adverse health outcomes. Methods: To further the literature on adolescent mental health among sexual and gender minority youth, this study analyzed a representative statewide sample of high school students (ages 14–18) to analyze how sexual orientation and gender identity are associated with depression and suicidality. Results: Results aligned with previous research demonstrating that sexual and gender minority youth were all at a heightened risk for depression. However, transgender youth and youth questioning their sexuality or gender were at especially heightened risk for experiencing depression and suicidality. Conclusion: The findings of this study indicate a need to target or adapt direct services and programming for sexual and gender minority adolescents.
Keywords: adolescent; adolescent health; adult; article; depression; female; gender identity; heterosexuality; high school student; human; juvenile; LGBTQIA+ people; major clinical study; male; mental health; priority journal; sexual and gender minority; sexual orientation; suicidal behavior; suicide; suicide attempt; young adult

Affirmative Dialectical Behavior Therapy Skills Training With Sexual Minority Veterans - Cohen, J.M.; Norona, J.C.; Yadavia, J.E.; Borsari, B. (Cognitive and Behavioral Practice, 2021)
Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans’ experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group.
Keywords: adult; affirmative action; aged; anxiety; article; case report; clinical article; controlled study; depression; dialectical behavior therapy; emotion regulation; emotional disorder; evidence based practice; female; human; male; mental health; physiological stress; pilot study; practice guideline; priority journal; problem solving; sexual and gender minority; sexual orientation; shame; social stigma; suicidal behavior; veteran

Strange behavior in a transgender teenager - Maffei, S.R.; Dean, A. (Pediatrics in Review, 2021)
Keywords: amantadine; arsenic; benzatropine; benzodiazepine derivative; cannabis; chlorpromazine; creatine kinase; creatinine; escitalopram; haloperidol; heavy metal; immunoglobulin; lead; liver enzyme; lorazepam; methylprednisolone; paracetamol; risperidone; rituximab; salicylic acid derivative; tricyclic antidepressant agent; agitated depression; agitation; anti n methyl d aspartate receptor encephalitis; article; automutilation; case report; child; child behavior; clinical article; clinical evaluation; cognitive defect; confusion; cranial nerve; creatine kinase blood level; creatinine blood level; depression; differential diagnosis; ecchymosis; emergency ward; female; female to male transgender; forehead; gait disorder; gender dysphoria; gender identity; hospital patient; human; laboratory test; mania; medical assessment; mental deterioration; mental patient; motor dysfunction; motor performance; mucosal dryness; muscle hypertonia; muscle rigidity; mutism; neuroleptic malignant syndrome; neurorehabilitation; occupational therapy; physiotherapy; psychosis; school child; speech analysis; speech therapy; suicidal ideation; symptom; treatment duration

Early adolescent gender diversity and mental health in the Adolescent Brain Cognitive Development study - Potter, A.; Dube, S.; Allgaier, N.; Loso, H.; Ivanova, M.; Barrios, L.C.; Bookheimer, S.; Chaarani, B.; Dumas, J.; Feldstein-Ewing, S.; Freedman, E.G.; Garavan, H.; et al. (Journal of child psychology and psychiatry, and allied disciplines, 2021)
BACKGROUND: There are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health. METHODS: The ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1-year follow-up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1-year visit assessed felt-gender, gender noncontentedness, and gender nonconformity using a 5-point scale. Mental health measures included youth- and parent-reports. RESULTS: Roughly half a percent of 9/10-year-olds (n = 58) responded 'yes' or 'maybe' when asked, 'Are you transgender' at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, χ2  = 16.0, p < .001). At the 1-year visit, when asked about the three dimensions of gender on a 5-point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed. CONCLUSIONS: Similar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt-gender, gender noncontentedness, gender nonconformity) among 10/11-year-olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth.
Keywords: adolescent; adult; article; brain; cognitive development; cohort analysis; controlled study; female; follow up; gender; human; juvenile; major clinical study; male; mental disease; suicidal behavior; transgender

Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood - Salway, T.; Gesink, D.; Ferlatte, O.; Rich, A.J.; Rhodes, A.E.; Brennan, D.J.; Gilbert, M. (Social psychiatry and psychiatric epidemiology, 2021)
PURPOSE: Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985-2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities. METHODS: Age- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders. RESULTS: We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18-20 years of age for both genders) and one peak nearing mid-life (30-35 years of age for men; 35-40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity. CONCLUSION: In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course.
Keywords: adolescent; adult; Canada; cross-sectional study; epidemiology; female; heterosexuality; human; male; sexual and gender minority; sexual behavior; suicide attempt; United States; young adult

Association of Borderline Personality Disorder Criteria with Suicide Attempts: Findings from the Collaborative Longitudinal Study of Personality Disorders over 10 Years of Follow-up - Yen, S.; Peters, J.R.; Nishar, S.; Grilo, C.M.; Sanislow, C.A.; Shea, M.T.; Zanarini, M.C.; McGlashan, T.H.; Morey, L.C.; Skodol, A.E. (JAMA Psychiatry, 2021)
Importance: Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions. Objective: To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. Design, Setting, and Participants: The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020. Main Outcomes and Measures: Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up. Results: Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria. Conclusions and Relevance: In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.
Keywords: adult; alcoholism; anger; antisocial personality disorder; article; avoidant personality disorder; borderline state; Caucasian; child sexual abuse; clinical feature; cohort analysis; collaborative care team; college; comparative study; Connecticut; controlled study; dependent personality disorder; disease association; dissociative disorder; drug dependence; educational status; female; follow up; gender dysphoria; help seeking behavior; histrionic personality disorder; hospital patient; human; impulsiveness; independent variable; longitudinal study; major clinical study; major depression; male; Massachusetts; mental instability; mental patient; narcissism; naturalistic inquiry; New York; obsessive compulsive disorder; outcome assessment; outpatient department; paranoid personality disorder; personality disorder; posttraumatic stress disorder; prospective study; Rhode Island; risk factor; schizoidism; schizotypal personality disorder; self report; semi structured interview; single (marital status); suicide attempt; unemployment

The Effects of Polyvictimization on Mental and Physical Health Outcomes in an LGBTQ Sample - Kassing, F.; Casanova, T.; Griffin, J.A.; Wood, E.; Stepleman, L.M. (Journal of traumatic stress, 2021)
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are at elevated risk for violent victimization and often experience increased health disparities compared to their non-LGBTQ counterparts. The present study examined associations between polyvictimization and mental and physical health in an LGBTQ sample. Participants included 385 LGBTQ individuals involved in a larger health-needs assessment of LGBTQ individuals living in the southeastern United States. The sample primarily identified as gay/lesbian (63.4%), cisgender (78.7%), and White (66.5%), and the mean participant age was 34.82 years (SD = 13.45). A latent class analysis (LCA) was conducted on seven items assessing different types of violence exposure. The LCA identified a three-class model, with classes characterized by low trauma exposure (71.4%), nondiscriminatory violence (15.1%), and high trauma exposure (13.5%). Differences in demographic characteristics, perceptions of mental and physical health, and diagnoses of specific health conditions were assessed across classes. The high-trauma class reported poorer perceived physical and mental health compared to the other two classes, with mean differences in past-month poor health days ranging from 11.38 to 17.37. There were no differences between the classes regarding specific physical health conditions; however, the high-trauma and nondiscriminatory violence classes had significantly higher rates of anxiety, depression, drug abuse, and suicidality than the low-trauma class, ORs = 2.39-23.83. The present findings suggest that polyvictimization is an important risk factor for poor health among LGBTQ individuals. These results have implications for addressing health disparities among the broader LGBTQ community.
Keywords: adult; anxiety; article; controlled study; demography; drug abuse; exposure to violence; female; health disparity; human; injury; latent class analysis; LGBTQIA+ people; major clinical study; male; mental health; needs assessment; perception; risk factor; suicidal behavior; United States

Differences in Methods of Suicide Death Among Transgender and Nontransgender Patients in the Veterans Health Administration, 1999-2016 - Blosnich, J.R.; Boyer, T.L.; Brown, G.R.; Kauth, M.R.; Shipherd, J.C. (Medical care, 2021)
BACKGROUND: Limited research suggests that rates of suicide death among transgender people may be higher than their nontransgender peers. OBJECTIVE: The objective of this study was to compare rates of suicide deaths by different means between transgender and nontransgender patients. RESEARCH DESIGN: This secondary analysis used VHA administrative and electronic health record (EHR) data from October 1, 1999 through December 31, 2016. SUBJECTS: Transgender patients (n=8981) were categorized as such based on a set of International Classification of Disease codes, and a comparison sample was selected by randomly choosing 3 nontransgender patients (n=26,924). MEASURES AND ANALYSES: Cause and date of death data are from the National Death Index. Because of low frequencies amid different methods of suicide death, we combined categories into self-poisoning; hanging, strangulation and suffocation; discharge of firearms; and self-harm by all other and unspecified means. We conducted Cox regression analyses to model time-to-event for each method of suicide, adjusted for age, sex based on EHR, race, ethnicity, marital status, and whether patients had ever been diagnosed with depression. RESULTS: Among transgender patients, 73 died by suicide (22 female EHR-based sex, 51 male EHR-based sex), and among nontransgender patients, 71 died by suicide (4 female EHR-based sex, 67 male EHR-based sex). In adjusted models, transgender patients had significantly greater hazards of death by self-poisoning and firearms than their nontransgender peers. CONCLUSIONS: Differences in methods of suicide death suggest that firearms and self-poisoning may be specific areas of concern for transgender individuals experiencing suicidal crisis, which underscore needs for examining effective delivery of evidence-based care.
Keywords: adult; article; automutilation; controlled study; electronic health record; ethnicity; female; firearm; human; human tissue; International Classification of Diseases; major clinical study; male; marriage; race; secondary analysis; self poisoning; strangulation; suffocation; suicide; transgender; veterans health

Dispositional optimism and suicide among trans and gender diverse adults - Snooks, M.P.; McLaren, S. (Death studies, 2021)
Trans and gender diverse adults are at increased suicide risk. Optimism protects against suicide across multiple populations. Applying the Interpersonal-Psychological Theory of Suicide (IPTS), we examined both factors among 237 adults recruited via social media and online platforms, 79.3% of whom reported serious suicide ideation. Dispositional optimism predicted suicidal ideation and behaviors (SIB), but did not moderate the relationship between the IPTS components and SIB. After controlling for depressive symptoms, hormone therapy and gender-affirming surgery did not predict SIB. Promoting dispositional optimism within a therapeutic framework may reduce SIB in this vulnerable population.
Keywords: adult; article; depression; female; gender; hormonal therapy; human; major clinical study; male; optimism; psychological theory; social media; suicidal ideation; vulnerable population

Mental Health and Health Risk Behaviors of Active Duty Sexual Minority and Transgender Service Members in the United States Military - Holloway, I.W.; Green, D.; Pickering, C.; Wu, E.; Tzen, M.; Goldbach, J.T.; Castro, C.A. (LGBT health, 2021)
Purpose: The aim of this study was to examine health risk behaviors and mental health outcomes among sexual minority and transgender active duty military service members and their heterosexual and cisgender counterparts. Methods: Participants (N = 544) were recruited by using respondent-driven sampling between August 2017 and March 2018 and completed an online survey by using validated measures of cigarette smoking, alcohol use, anxiety, depression, post-traumatic stress disorder (PTSD), and suicidality. Bayesian random intercept multiple logistic regressions were used to understand differences between sexual minority participants and heterosexual participants as well as between transgender participants and both their cisgender sexual minority and cisgender heterosexual peers. Results: Cisgender sexual minority women service members were more likely to meet criteria for problematic alcohol use (adjusted odds ratio [aOR] = 10.11) and cigarette smoking (aOR = 7.12) than cisgender heterosexual women. Cisgender sexual minority men had greater odds of suicidality (aOR = 4.73) than their cisgender heterosexual counterparts. Transgender service members had greater odds of anxiety, PTSD, depression, and suicidality than their cisgender peers. Conclusion: Military researchers and policymakers who seek to improve the overall health and well-being of sexual minority and transgender service members should consider programs and policies that are tailored to specific health outcomes and unique sexual minority and transgender subgroups.
Keywords: adult; alcohol consumption; anxiety; article; cigarette smoking; controlled study; depression; female; health disparity; health hazard; heterosexual female; human; human tissue; major clinical study; male; mental health; military personnel; posttraumatic stress disorder; suicidal behavior; transgender; United States; wellbeing

Prevalence and Risk Factors for Nonsuicidal Self-Injury in Transgender and Gender-Expansive Youth at a Rural Gender Wellness Clinic - Leon, K.; O'Bryan, J.; Wolf-Gould, C.; Turell, S.C.; Gadomski, A. (Transgender Health, 2021)
Purpose: Transgender and gender-expansive (TGE) populations are at increased risk for nonsuicidal self-injury (NSSI). Rural TGE populations are understudied and underserved in terms of mental health services. The purpose of this study was to determine lifetime prevalence of NSSI among TGE youth at a rural gender wellness clinic and identify demographic and clinical characteristics associated with NSSI. Methods: The Gender Wellness Center Pediatric Patient Registry, a comprehensive database of 185 TGE youth ≤25 years of age, provided an estimate of the lifetime prevalence of NSSI. Univariate logistic regression models were utilized to test associations between patient demographic and clinical characteristics and NSSI. Variables that met the threshold for significance in the univariate analyses (p<0.05) were entered into a multivariate logistic regression model. All statistical analyses were conducted in SAS v.9.4. Results: Prevalence of NSSI in the sample was 36.8% (n=68). In unadjusted logistic regression models, risk factors for NSSI included female assigned sex at birth, transmasculine spectrum gender identity, history of mood disorder, history of suicidal ideation (SI) or attempt, and history of abuse (p<0.05). In the adjusted model, variables significantly associated with NSSI included female assigned sex at birth, history of mood disorder, and history of SI or attempt. Conclusion: NSSI was highly prevalent in this sample of rural TGE youth, confirming the need for screening and early interventions that target the unique vulnerabilities of TGE youth. The complex interplay of sex assigned at birth, mood disorders, and NSSI requires further research.
Keywords: adolescence; article; automutilation; child; clinical feature; controlled study; demography; early intervention; female; gender identity; human; human tissue; juvenile; LGBTQIA+ people; lifetime prevalence; major clinical study; male; mood disorder; pediatric patient; risk factor; suicidal ideation; univariate analysis

Differential Risks for Suicidality and Mental Health Symptoms among Transgender, Nonbinary, and Cisgender Sexual Minority Youth Accessing Crisis Services - Srivastava, A.; Rusow, J.A.; Goldbach, J.T. (Transgender Health, 2021)
Purpose: We examined whether health risks among sexual minority youth (SMY) differ by gender identity (transgender, nonbinary, and cisgender). Methods: Data were collected on suicide attempts (lifetime and someday), depression and post-traumatic stress disorder (PTSD), and minority stress among SMY accessing crisis services. Results: In the multivariate regression models, compared to their cisgender peers, transgender and nonbinary youth were at higher risk for suicide attempt (lifetime and someday), depression, and PTSD. Minority stress was a significant predictor for all the models. Conclusion: Crisis service organizations working to reduce suicidality among SMY should be sensitive to diverse experiences of gender identity.
Keywords: article; controlled study; depression; female; gender identity; health hazard; human; juvenile; male; organization; posttraumatic stress disorder; suicide attempt; transgender

Nonsuicidal self-injury, suicide ideation, and suicide attempts among sexual minority children - Blashill, A.J.; Fox, K.; Feinstein, B.A.; Albright, C.A.; Calzo, J.P. (Journal of consulting and clinical psychology, 2021)
OBJECTIVES: Sexual minority adolescents have previously been found to experience disparities in self-injurious thoughts and behaviors (SITBs) compared to heterosexual adolescents. However, there is a paucity of data on SITBs amongst children. Thus, the aim of the current study is to assess the prevalence of SITBs in a large sample of U.S. children and to test whether rates vary by sexual orientation. METHODS: Data were drawn from the 2.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study. The full sample included 11,777raw 9-10-year-old children (sexual minority n = 150raw). Children completed a computerized version of the youth Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5), including items assessing suicide ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Unadjusted and adjusted models compared the prevalence of outcomes by sexual orientation. Models also compared the co-occurrence of NSSI and suicide ideation by sexual orientation. RESULTS: Across all outcomes, sexual minority children reported elevated prevalence rates compared to heterosexual children, with odds ratios ranging from 4.4 to 6.5. Among children who reported NSSI, a greater proportion of sexual minority versus heterosexual children reported co-occurring suicide ideation (OR = 3.8). CONCLUSIONS: In a large sample of 9-10-year-old U.S. children, sexual orientation disparities emerged across NSSI, suicide ideation, and suicide attempts. Results indicate that sexual minority children are a vulnerable population for SITBs. Inclusion of children in prevention programs is encouraged. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Keywords: adolescent; article; automutilation; brain; child; cognitive development; controlled study; female; heterosexuality; human; human tissue; juvenile; major clinical study; male; prevalence; PsycINFO; Schedule for Affective Disorders and Schizophrenia; school child; sexual and gender minority; suicidal ideation; suicide attempt; vulnerable population

Syndemic Profiles and Sexual Minority Men's HIV-Risk Behavior: A Latent Class Analysis - Scheer, J.R.; Clark, K.A.; Maiolatesi, A.J.; Pachankis, J.E. (Archives of sexual behavior, 2021)
Syndemic theory posits that "syndemic conditions" (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men's HIV-risk behavior.
Keywords: adult; alcohol abuse; article; controlled study; demography; distress syndrome; ethnicity; human; Human immunodeficiency virus; latent class analysis; major clinical study; male; multiple drug abuse; nonhuman; probability; race; risk behavior; sexual and gender minority; social status; syndemic; alcohol

Suicidal Ideation among Youths at Risk of School Dropout: Impact of Student Demographics, Stressors, and Academic Self-Concept - Szlyk, H.S. (Health & social work, 2021)
In the United States, suicidal ideation is an issue for high school-age youths. Research supports that youths who have learning difficulties and who are at risk of high school dropout are at greater risk for suicidal ideation. Although alternative high schools address both student academics and emotional health, they are underused, nonclinical settings for understanding and addressing suicidal ideation. This study aimed to examine the impact of student identity, external stressors, and academic self-concept on suicidal ideation among sexual and ethnic minority and underserved students enrolled in an alternative education public high school. The student sample (N = 103) completed a onetime survey comprised of the Suicidal Ideation Questionnaire-Junior, the Cultural Assessment of Risk of Suicide, the Coddington Life Events Scale for Adolescents, and the Piers Harris 2. Results of hierarchical linear regression indicated that identifying as nonheterosexual and experiencing discrimination were associated with greater student reporting of suicidal ideation. Identifying as Latino and other non-White was associated with lower reporting of suicidal ideation. Controlling for student demographics and external stressors, positive academic self-concept was associated with a lower reporting of suicidal ideation. Findings have future implications for health social work, suicide prevention and intervention, and education policy.
Keywords: adolescent; article; controlled study; demography; ethnic group; female; high school; Hispanic; human; human experiment; juvenile; Life Events Scale; linear regression analysis; major clinical study; male; mental health; prevention; questionnaire; risk assessment; school dropout; social work; suicidal ideation

Risk and protective factors for suicide among sexual minority youth seeking emergency medical services - Horwitz, A.G.; Grupp-Phelan, J.; Brent, D.; Barney, B.J.; Casper, T.C.; Berona, J.; Chernick, L.S.; Shenoi, R.; Cwik, M.; King, C.A. (Journal of Affective Disorders, 2021)
Background: Differences in risk and protective factors (e.g., victimization, abuse, social support) have been used to explain elevated rates of suicidal ideation and suicide attempts in sexual minority youth (SMY) relative to heterosexual peers. However, little is known regarding how risk and protective factors may explain suicide risk differences among subgroups of SMY. The aims of this study were to 1) examine differences in prevalence and severity for suicide risk and protective factors among SMY, and 2) explore whether risk and protective factors are differentially associated with suicidal ideation and suicide attempts for SMY subgroups. Methods: Participants were 6,423 adolescents (ages 12–17) recruited from 14 Emergency Departments across the United States who completed an assessment of suicide risk and protective factors. SMY were 20% of the sample (n = 1,275) and categorized as bisexual (8%), gay/lesbian (2%), mostly straight (5%), or other sexual minority (5%). Results: Bisexual youth had elevated rates of suicidal ideation and attempts, more risk factors (e.g., bullying victimization, depression), and fewer protective factors (e.g., parent-family connectedness, positive affect) relative to mostly straight and other sexual minority youth. Bisexual and gay/lesbian youth only differed in parent-family connectedness (lower among bisexual youth). Depression and parent-family connectedness had weaker associations with suicidal ideation for bisexual youth. Limitations: Emergency departments were not nationally representative. Study design was cross-sectional, preventing causal inferences. Conclusions: Interventions seeking to mitigate risk factors and promote protective factors are greatly needed for SMY and may benefit from tailoring to address unique stressors for sexual minority subgroups.
Keywords: adolescent; affect; article; bisexuality; bullying; child; child parent relation; depression; disease severity; emergency health service; family relation; female; help seeking behavior; heterosexuality; human; LGBT people; major clinical study; male; priority journal; risk factor; sexual and gender minority; suicidal ideation; suicide attempt

Religiosity, spirituality, suicide risk and remission of depressive symptoms: a 6-month prospective study of tertiary care Brazilian patients - Mosqueiro, B.P.; Caldieraro, M.A.; Messinger, M.; da Costa, F.B.P.; Peteet, J.R.; P Fleck, M. (Journal of Affective Disorders, 2021)
Religiosity and spirituality (R/S) are increasingly recognized as significant aspects in the evaluation of depressed patients. Limited research, however, has investigated the impact of R/S on outcomes of more severe or chronic depressed patients. The present study investigated the impact of different religiosity dimensions in tertiary care Brazilian depressed patients over suicide risk scores measured at baseline and remission of depressive symptoms in a 6-month prospective follow-up. In 277 individuals interviewed, 226 presented a diagnosis of depressive episode and 192 were assessed in the follow-up. Religiosity was evaluated using the Duke University Religion Index, comprising three dimensions of religiosity (organizational religiosity, non-organizational religiosity, intrinsic religiosity). Other potential predictors of outcomes included the Childhood Trauma Questionnaire (CTQ), Maudsley Staging of illness (MSM), Medical Outcomes Study Social Support Survey (MOS), World Health Organization Spirituality, Religiousness and Personal Beliefs instrument (WHOQOL-SRPB) and Hamilton Depression Scale (HAM-D). Results showed that almost half (46.1%) of the patients reported previous suicide attempts. Linear regression models identified that religious attendance (t-statistic -2.17, P=0.03), intrinsic religiosity (t-statistic -2.42, P=0.01) and WHOQOL-SRPB (t-statistic -3.67, P=0.00) were inversely correlated to suicide risk scores. In a prospective follow-up 16.7 % of patients (n=32/192) achieved remission of depressive symptoms (HAM-D scores ≤7). Religious attendance (OR 1.83, P=0.02) was identified as the main predictor of remission. Findings reinforce the importance of attending to religiosity/spirituality in order to improve outcomes and promote the recovery especially among severely depressed patients with increased suicide risk.
Keywords: adult; article; Atheist; Brazilian; Buddhism; Catholic; child neglect; childhood trauma; Childhood Trauma Questionnaire; comorbidity; controlled study; depression; disease severity; emotional abuse; employment status; family history; female; follow up; generalized anxiety disorder; Hamilton Depression Rating Scale; human; Judaism; major clinical study; male; middle aged; physical abuse; priority journal; prospective study; Protestant; psychosis; quality of life; religion; remission; sexual abuse; social phobia; social support; suicide; suicide attempt; tertiary health care

Psychological distress, self-harm and attempted suicide in UK 17-year olds: prevalence and sociodemographic inequalities - Patalay, P.; Fitzsimons, E. (The British journal of psychiatry : the journal of mental science, 2021)
In a large (n = 10 103), nationally representative sample of 17-year-olds 16.1% had experienced high psychological distress in the past 30 days, 24.1% had self-harmed in the previous 12 months and 7.4% had ever attempted suicide. Females, White adolescents, sexual minorities and those from more socioeconomically disadvantaged families had worse mental health outcomes; with the exceptions of no detected differences in attempted suicide by ethnicity and in self-harm by socioeconomic position. Findings include a narrower gender gap in self-harm at age 17 (males 20.1%, females 28.2%) compared with at age 14 (males 8.5%; females 22.8%) and 2-4 times higher prevalence in sexual minority adolescents (39.3% high distress, 55.8% self-harmed, 21.7% attempted suicide compared with 13.4%, 20.5% and 5.8%, respectively, in heterosexual adolescents).
Keywords: adolescent; article; automutilation; controlled study; demography; distress syndrome; female; heterosexuality; human; major clinical study; male; mental stress; prevalence; sexual and gender minority; social isolation; suicide attempt

Pain and transition: evaluating fibromyalgia in transgender individuals - Levit, D.; Yaish, I.; Shtrozberg, S.; Aloush, V.; Greenman, Y.; Ablin, J.N. (Clinical and experimental rheumatology, 2021)
OBJECTIVES: As members of a gender minority, transgender individuals face many challenges. Many experience distress, depression, anxiety and suicidal ideation related to gender non-conformity and transphobia. Stress and trauma may contribute to the development of fibromyalgia (FM) syndrome, characterised by widespread pain and fatigue. The prevalence of FM among transgenders is not known. METHODS: Transgender participants were recruited at a specialised clinic. Questionnaires included the Widespread Pain Index (WPI), the Symptom Severity Score (SSS) and the SF-36. Data concerning hormonal treatment protocols was retrieved from charts. The current prevalence of FM was determined, as well as the prevalence before and after testosterone treatment among TM. Pearson correlations were calculated between all measures. RESULTS: 115 participants were recruited, 62.6% transgender men (TM), 37.4% transgender women (TW). 17 individuals (14.8%) fulfilled the 2011 modified ACR FM criteria, for a rate of 19.4% among TM and 6.98% among TW. Among TM, FM was associated with younger age, smoking and SF-36 sub-scales related to physical functioning, role limitation due to physical pain, fatigue, pain and general health. Among TW, FM was associated with social status, employment, depression, existing medical treatment and substance abuse, as well as SF-36 subscales related to role limitations affected due to pain. CONCLUSIONS: Fibromyalgia symptoms are highly prevalent among Israeli transgender individuals and may be related to psychological distress and gender dysphoria. Healthcare professionals treating transgenders should remain vigilant for the occurrence of chronic pain, fatigue and other FM-related symptoms and be prepared to treat and/or refer such patients accordingly.
Keywords: adult; age; anxiety; article; chronic pain; clinical protocol; distress syndrome; fatigue; female; fibromyalgia; gender dysphoria; human; injury; major clinical study; male; mental stress; prevalence; questionnaire; Short Form 36; smoking; social status; substance abuse; suicidal ideation; transgender; testosterone

Family-of-origin rejection on suicidal ideation among a sexual minority sample - VanBergen, A.M.; Love, H.A. (Journal of marital and family therapy, 2021)
Suicide is a leading cause of death in the United States. Among sexual minority populations, suicide risk is elevated; this can be explained by minority stress. One such source of minority stress is family-of-origin rejection, a known risk factor for suicide among lesbian, gay, and bisexual (LGB) adolescents; however, less is known about this association among sexual minority adults. While navigating the intersection of minority stress theory and the interpersonal theory of suicide, this study sought to evaluate the impact of family-of-origin rejection distress on suicidal ideation among a sample of adults with marginalized sexual orientations. Recruited for two larger studies, 325 LGB participants (64.3% cisgender, 35.7% transgender or nonbinary) completed an online survey concerning minority stressors, depressive symptoms, and suicide. Using cross-sectional mediation analysis, family-of-origin rejection distress was indirectly associated with suicidal thoughts through depressive symptoms. Clinical implications and suggestions for future research are discussed.
Keywords: adolescent; adult; article; bisexuality; depression; distress syndrome; female; homosexual female; human; human tissue; male; mediation analysis; stress theory; suicidal ideation; theoretical study; transgender

Family Belongingness Attenuates Entrapment and Buffers Its Association with Suicidal Ideation in a Sample of Dutch Sexual Minority Emerging Adults - Parra, L.A.; van Bergen, D.D.; Dumon, E.; Kretschmer, T.; La Roi, C.; Portzky, G.; Frost, D.M. (Archives of sexual behavior, 2021)
Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N = 675; ages 18-29, M = 21.93 years, SD = 3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults.
Keywords: adult; article; controlled study; female; human; human experiment; human tissue; major clinical study; male; sexual and gender minority; sexual orientation; physiological stress; suicidal ideation; violence; buffer

Examining Profiles of Latinx Sexual Minority Adolescents Associated with Suicide Risk - Giano, Z.; O'Neil, A.M.; Stowe, M.; Hubach, R.D. (Journal of immigrant and minority health, 2021)
Few studies have focused on within-group heterogeneity about specific factors that make lesbian, gay, or bisexual (LGB) Latinx adolescents at greater odds than other LGB adolescents for suicide We take a unique mixture-modeling approach by creating profiles of Latinx LGB adolescents based on suicide risk factors used in previous investigations (bullying, alcohol, sleep, social media, and poor grades). We use these profiles in a logistic regression to investigate suicidality A sample of 686 LGB, Latinx adolescents were used in a latent profile analysis yielding four distinct profiles. Class 4 represented the highest risk, with high rates of bullying, alcohol, poor grades, and use of electronics, while class 3 represented the lowest risk with low rates of bullying and alcohol Results speak to the need to address suicidal ideation through multiple factors, noting the strong association that both bullying and alcohol have with suicidal ideation.
Keywords: adolescent; article; bisexuality; bullying; drug combination; electronics; female; homosexual female; human; male; suicidal ideation; alcohol

PTSD Symptoms, Suicidal Ideation, and Suicide Risk in University Students: The Role of Distress Tolerance - Kratovic, L.; Smith, L.J.; Vujanovic, A.A. (Journal of Aggression, Maltreatment and Trauma, 2021)
Posttraumatic stress disorder (PTSD) is associated with suicidal ideation and suicide attempts. Distress tolerance, or the perceived capacity to tolerate negative emotional states, is a cognitive-affective factor with clinical relevance to PTSD-suicide relations. No studies to date have examined the associations of PTSD symptoms, distress tolerance, and suicidal ideation or suicide risk among university students, a population at risk for suicidal ideation and behavior. It was hypothesized that greater PTSD symptom severity and lower perceived distress tolerance, respectively, would be associated with greater suicidal ideation and suicide risk; and that PTSD symptom severity would exert an indirect effect on suicidal ideation and risk through perceived distress tolerance. Covariates included trauma load, negative affectivity, and gender. Participants were comprised of 819 trauma-exposed university students (78.0% female; Mage = 22.0), who completed a battery of questionnaires. Mediation analyses were conducted, and results indicated that greater PTSD symptom severity and lower distress tolerance, respectively, were significantly associated with greater suicidal ideation and suicide risk. PTSD symptom severity exerted an indirect effect on suicidal ideation and suicide risk through perceived distress tolerance. Effects were demonstrated after controlling for theoretically relevant covariates. Clinical and research implications are discussed.
Keywords: SPSS Statistics; adult; affect; article; Beck Suicide Scale; coping behavior; data analysis software; disease association; disease severity; distress syndrome; Distress Tolerance Scale; female; gender; high risk population; human; Life Events Checklist for DSM 5; major clinical study; male; Positive and Negative Affect Schedule; post hoc analysis; posttraumatic stress disorder; PTSD Checklist 5; questionnaire; rating scale; risk factor; suicidal ideation; suicide; Suicide Behavior Questionnaire Revised; symptom; transgender; university student; young adult; SPSS Statistics

Characteristics of Transgender Patient Cases Managed by a Toxicologist: an Analysis of the Toxicology Investigator’s Consortium (ToxIC) Registry: January 2017–June 2019 - Surmaitis, R.M.; Greenberg, M.R.; Ebeling-Koning, N.E.; Grenz, P.M.; McWhirter, C.R.; Careyva, B.A.; Sabino, J.N.; Cook, M.D.; Cannon, R.D.; Koons, A.L.; Katz, K.D.; Kincaid, H.; et al. (Journal of Medical Toxicology, 2021)
Introduction: The Toxicology Investigators Consortium (ToxIC) database, created in 2010 by the American College of Medical Toxicology (ACMT), compiles data recorded by medical toxicologists. In January 2017, the data field for transgender (and if transgender, male-to-female or female-to-male) was added to the ToxIC form. Little is known regarding trends in poisonings among transgender patients. We sought to review consultations managed by a bedside toxicologist and provide descriptive data in trends among types of exposures within the transgender demographic. Methods: A retrospective ToxIC database evaluation of cases in which the patient identified as transgender were reviewed from January 2017–June 2019 and descriptive demographics reported. Results: The registry contained 113 cases that involved transgender patients. Of those with complete data, 41 (36.6%) were male-to-female, 68 (60.7%) were female-to-male, and 3 (2.7%) identified as gender non-conforming. Of those with complete data, the most common reason for encounter was intentional use of a pharmaceutical drug (N = 97, 85.8%), of which 85 (87.6%) were classified as intentional pharmaceutical use intended for self-harm. Analgesics were the most common class of drugs used out of those reported (N = 24, 22%). Forty-six (90.2%) patients aged 13–18 with complete data were identified as encounters due to self-harm. Attempt at self-harm was the most common reason for intentional pharmaceutical encounter among the sample of transgender patients with complete data (N = 85, 87.6%); with female-to-male patients having an N = 53 (77.9%). Conclusion: Among transgender patients in the ToxIC registry, the most common primary reason for the encounter was intentional use of a pharmaceutical drug intended for self-harm. In this small cohort, there were some age and transition differences in prevalence. These findings may inform poisoning prevention practices as well as sex- and gender-based management of patients in this vulnerable population.
Keywords: adrenergic receptor stimulating agent; alcohol; amphetamine; analgesic agent; anesthetic agent; anticoagulant agent; anticonvulsive agent; antidepressant agent; antiinfective agent; chelating agent; cholinergic receptor blocking agent; cholinergic receptor stimulating agent; fungicide; herbicide; hydrocarbon; insecticide; lithium; metal; muscle relaxant agent; neuroleptic agent; non prescription drug; opiate; photosensitizing agent; rodenticide; adolescent; adult; adverse drug reaction; article; automutilation; bradycardia; bradypnea; chemotherapy; data base; delirium; drug abuse; drug administration route; drug misuse; drug withdrawal; envenomation; ethnicity; exposure; extracorporeal oxygenation; female; fish poisoning; hospital patient; human; hyperreflexia; hyperthermia; hypotension; hypothermia; intensive care unit; intubation; long QT syndrome; male; medication error; outpatient; race; seizure; suicide attempt; tachycardia; tachypnea; toxicology; transgender

Substance use and sexual risk behavior among black men who have sex with men in New York city: Evidence for increased risk during young adulthood - Aivadyan, C.; Lee, Y.G.; El-Bassel, N.; Wu, E. (AIDS Education and Prevention, 2021)
This study evaluated whether the association between substance use and sexual risk behavior varies as a function of age among 1,009 Black men who have sex with men (BMSM) in New York City. Hierarchical linear regression was used to examine the relationship between age (18–26 vs. 27+), substance use, and number of sexual partners and acts of condomless anal sex (CAS) in the past 90 days. Age moderated the relationship between substance use and sexual risk behavior, such that positive associations among binge drinking, marijuana, cocaine, and party drug use and number of male sexual partners and cocaine use and acts of CAS were significantly stronger among young adults than adults. BMSM may engage in more sexual risk behavior during young adulthood, and those who use substances may be at increased risk for HIV transmission—particularly through multiple sex partners. HIV prevention interventions targeting BMSM may benefit from being tailored to age and addressing sexual risk behavior and substance use concurrently.
Keywords: adult; adulthood; article; binge drinking; controlled study; human; Human immunodeficiency virus; linear regression analysis; major clinical study; male; men who have sex with men; New York; nonhuman; risk behavior; sexuality; substance use; young adult; cannabis; cocaine

Gender dysphoria: Prejudice from childhood to adulthood, but no impact on inflammation. a cross-sectional controlled study - Real, A.G.; Fontanari, A.M.V.; Costa, A.B.; Soll, B.M.B.; Bristot, G.; de Oliveira, L.F.; Kamphorst, A.M.; Schneider, M.A.; Lobato, M.I.R. (Trends in Psychiatry and Psychotherapy, 2021)
Introduction: Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one’s gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5). Methods: Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay. Results: Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine. Conclusions: These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers.
Keywords: adult; adulthood; anxiety; article; case control study; child; child abuse; clinical article; controlled study; demography; DSM-5; female; gender dysphoria; gene expression; human; immune system; immunoassay; inflammation; male; mood; prejudice; protein expression; structured interview; suicidal ideation; suicide attempt; transgender; transsexuality; endogenous compound; interleukin 10; interleukin 1beta; interleukin 6; tumor necrosis factor

Curvilinear associations between sexual orientation and problematic substance use, behavioural addictions and mental health among young Swiss men - Wicki, M.; Marmet, S.; Studer, J.; Epaulard, O.; Gmel, G. (Addictive Behaviors, 2021)
Background and aims: It is well documented that individuals with a minority sexual orientation face greater risks of problematic substance use (e.g. heavy episodic drinking, alcohol use disorder) and mental health problems. Far less is known about how that risk varies within this population and their risk of behavioural addictions. This study estimated the risks of problematic substance use, behavioural addiction and poor mental health across the spectrum of sexual orientation. Sample and method: A sample of young Swiss men (N = 5294; mean age = 25.5, SD = 1.25; representative of 21 of Switzerland's 26 cantons) completed a self-reporting questionnaire on sexual orientation (attraction, 5-point scale) and criterion variables: problematic substance use (e.g. alcohol, cigarettes, cannabis and other illegal drugs), behavioural addictions (gambling, gaming, cybersex, internet, smartphone, work, exercise) and indicators of mental health (e.g. depression, stress). Curvilinear associations between sexual orientation (heterosexual, mostly-heterosexual, bisexual, mostly-homosexual or homosexual individuals) and criterion variables were explored using fractional polynomial regressions. Results: Although there were differences across criterion variables, in general, the highest risks of problematic substance use, behavioural addictions and mental health problems were estimated for mostly-heterosexual, bisexual or mostly-homosexual men, followed by homosexual men, and with heterosexual men facing the lowest risk. Discussion and conclusion: Aggregating the spectrum of sexual orientations into two or three distinct groups blurs important internal group differences. Outcome-specific explanations beyond minority stress and biphobia are necessary to understand the pathways between sexual orientation and risky behaviours. Considering sexual orientation is important to provide targeted healthcare prevention and interventions.
Keywords: cigarette; smartphone; adult; article; behavioral addiction; controlled study; criterion variable; exercise; gambling; homosexuality; human; internet addiction; internet sex; life satisfaction; major clinical study; major depression; male; mental health; psychological well-being; risk factor; self report; sexual orientation; substance use; suicidal ideation; tobacco dependence; work

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

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

Preteen Behaviors and Sexual Orientation of High School Students Who Report Depressive Symptoms, United States, 2015-2017 - D’Agati, D.; Kahn, G.D.; Swartz, K.L. (Public Health Reports, 2021)
Unhealthy preteen behaviors are associated with adolescent depression. However, little is known about preteen factors among sexual minority young people, a group at increased risk for teen depression and suicide. We completed weighted multivariate logistic regression analyses on data from the national 2015 and 2017 Youth Risk Behavior Survey of 30 389 high school students in the United States. Preteen sex, cigarette smoking, and alcohol and marijuana use were significantly more prevalent among lesbian, gay, or bisexual (LGB) and questioning students who reported depressive symptoms than among their heterosexual peers (adjusted prevalence ratio [APR] range, 1.33-2.34; all significant at P <.05). The only exception was that marijuana use among questioning students was not significantly different from use among heterosexual peers (APR = 1.34; P =.11). Assessment of preteen sex and substance use—especially among LGB and questioning young people, who are more prone to depressive symptoms and more likely to initiate risky preteen behaviors than their heterosexual counterparts—will facilitate a life course approach to sexual minority mental health that should begin by early adolescence.
Keywords: adolescent depression; alcohol consumption; article; bisexuality; cannabis use; cigarette smoking; controlled study; female; heterosexuality; high school student; homosexual female; human; major clinical study; male; mental health; prevalence; risk behavior; suicide; United States; alcohol

Associations between periods of COVID-19 quarantine and mental health in Canada - Daly, Z.; Slemon, A.; Richardson, C.G.; Salway, T.; McAuliffe, C.; Gadermann, A.M.; Thomson, K.C.; Hirani, S.; Jenkins, E.K. (Psychiatry Research, 2021)
Since the onset of the COVID-19 pandemic, many jurisdictions, including Canada, have made use of public health measures such as COVID-19 quarantine to reduce the transmission of the virus. To examine associations between these periods of quarantine and mental health, including suicidal ideation and deliberate self-harm, we examined data from a national survey of 3000 Canadian adults distributed between May 14-29, 2020. Notably, participants provided the reason(s) for quarantine. When pooling all reasons for quarantine together, this experience was associated with higher odds of suicidal ideation and deliberate self-harm in the two weeks preceding the survey. These associations remained even after controlling for age, household income, having a pre-existing mental health condition, being unemployed due to the pandemic, and living alone. However, the associations with mental health differed across reasons for quarantine; those who were self-isolating specifically due to recent travel were not found to have higher odds of suicidal ideation or deliberate self-harm. Our research suggests the importance of accounting for the reason(s) for quarantine in the implementation of this critical public health measure to reduce the mental health impacts of this experience.
Keywords: adult; age; article; automutilation; Canada; controlled study; coronavirus disease 2019; descriptive research; disease association; ethnicity; female; gender identity; health care planning; home quarantine; household income; human; LGBTQIA+ people; male; pandemic; personal experience; prevalence; priority journal; public health message; quarantine; suicidal ideation; travel; unemployment

Acceptability of dual HIV/syphilis rapid test in community- and home-based testing strategy among transgender women in Buenos Aires, Argentina - Zalazar, V.; Frola, C.E.; Gun, A.; Radusky, P.D.; Panis, N.K.; Cardozo, N.F.; Fabian, S.; Duarte, M.I.; Aristegui, I.; Cahn, P.; Sued, O. (International Journal of STD and AIDS, 2021)
Background: Little is known of acceptability and feasibility of dual HIV and syphilis rapid tests in community- and home-based provider-initiated strategies among transgender women (TGW), in Latin America. Objectives were (1) to assess the acceptability of this strategy and, (2) to determine the percentage of positive results of HIV and syphilis, analyze the correlates of HIV or syphilis positive results, and measure the rates of effective referral and treatment completion among TGW. Methods: A multidisciplinary team tested 89 TGW in Buenos Aires. An acceptability survey was administered after the HIV/syphilis Duo test was used. All confirmed cases were referred for treatment initiation. Results: We found high levels of acceptability (98.8%) of this strategy among TGW. However, only 60.7% preferred simultaneous HIV and syphilis diagnosis test. Moreover, we found 9% of positive results of HIV, 51.7% of syphilis, and 3.4% of positive results for both infections. Only not being tested before was associated with an HIV positive result, and only low level of education was associated with a positive syphilis result. Among 8 TGW who tested positive for HIV, 37.5% (n = 3) started antiretroviral therapy. Of 46 who tested positive for syphilis, only 73.9% (n = 34) were effectively referred and from 23 who started treatment, only 39.1% completed it. Conclusions: Community- and home-based dual HIV and syphilis rapid test is a feasible and highly acceptable approach for this hard-to-reach population. Implementing similar strategies could improve screening uptake and accessibility. However, these results highlight the need to improve strategies for treatment uptake, in order to reduce morbidity and risk of onward transmission.
Keywords: adult; antiretroviral therapy; Argentina; article; controlled study; education; female; human; Human immunodeficiency virus; major clinical study; morbidity; multidisciplinary team; nonhuman; patient attitude; screening test; syphilis rapid test; transgender

The Second National Canadian Homeless Youth Survey: Mental Health and Addiction Findings: La Deuxième Enquête Nationale Auprès des Jeunes Sans Abri : Résultats en Matière De Santé Mentale et de Toxicomanie - Kidd, S.A.; Gaetz, S.; O’Grady, B.; Schwan, K.; Zhao, H.; Lopes, K.; Wang, W. (Canadian Journal of Psychiatry, 2021)
Objective: Youth experiencing homelessness represent a major social problem in Canada and, as demonstrated in the first national survey of this population conducted in 2015, are experiencing significant mental health challenges. The present study examines the findings of a second national survey completed in 2019. These findings afford the opportunity to examine the reliability of the findings of the first study with another large, representative sample and to attempt to articulate the unique characteristics of youth experiencing the greatest distress among this at-risk population. Methods: This study analyzed the mental-health-related data from the 2019 Without a Home–National Youth Homelessness Survey that was administered through convenience sampling at 98 agencies serving homeless youth in 49 communities across Canada. The survey was cross-sectional and self-administered, assessing a range of demographic information, pre- and post-homelessness variables, and mental health indicators. Multinomial logistic regression and linear regression were implemented to evaluate associations with distress level. Results: Survey data were obtained from 1,375 youth accessing Canadian homeless services in 9 provinces. Thirty-five percent reported at least 1 suicide attempt, and 33.1% reported a drug overdose requiring hospitalization. The findings of this survey replicated most of the key findings from the 2015 survey. The current findings emphasized, for this high-risk population, the heightened adversity faced by young women, Lesbian, Gay, Bisexual, Transgender, Queer, Two-Spirit (LGBTQ2S), and Indigenous subpopulations, as well as the centrality of violence exposure in determining risk and distress. Sexual violence, in particular, emerged as a key factor in the identification of youth experiencing the greatest distress with risk buffered by contact with family. Conclusions: These findings can inform prevention and intervention policies and services and reinforce the importance of attending to violence exposure and trauma as central to the mental health trajectories of youth who have experienced homelessness.
Keywords: adult; article; Canada; controlled study; convenience sample; demography; distress syndrome; drug dependence; drug overdose; exposure to violence; female; high risk population; homeless youth; homelessness; hospitalization; human; injury; LGBTQIA+ people; linear regression analysis; male; mental disease; reliability; sexual violence; suicide attempt

Spatial analysis and risk factors of suicide among people living with HIV/AIDS who committed suicide - Zhang, H.; Feng, Y.; Li, Z.; Xiu, X.; Wang, L. (International Journal of STD and AIDS, 2021)
Poor mental health may confer worse health outcomes among people living with HIV/AIDS (PLWH). Suicidal behaviors are symptoms of a depressive episode. The goal was to explore characteristics for spatial distribution and risk factors for suicide among PLWH. This study was conducted in Mainland China with the annual newly reported data of PLWH from 2013 to 2018. We compared the spatial distribution differences between the HIV epidemic and suicide mortality and analyzed the global and local spatial analysis of suicide. Further, we explored the possible risk factors of suicide in PLWH by multivariate regression and a decision tree model. High suicide mortality regions in PLWH in China were inconsistent with that of the high prevalence of PLWH, which showed that there was distribution discordance between the HIV epidemic and suicide mortality. Multivariate regression showed that the possible risk factors of PLWH who committed suicide were younger age, with Han nationality, single, having a higher educational level, and homosexual infection route. The decision tree model showed that age was the primary factor. In conclusion, there was a discordance between HIV prevalence and suicide mortality; lower HIV prevalence regions might have higher mortality due to suicide. Concern is merited amongst PLWH with poor mental health.
Keywords: AIDS patient; article; China; controlled study; decision tree; epidemic; female; homosexuality; human; Human immunodeficiency virus prevalence; male; mental health; mortality; risk factor; spatial analysis; suicide

Long-Term Care Expectations and Plans of Transgender and Nonbinary Older Adults - Knochel, K.A.; Flunker, D. (Journal of Applied Gerontology, 2021)
Problem: Transgender and nonbinary (TNB) older adults endure discrimination from medical providers and expect it in institutional long-term care. Gender identity–based discrimination is connected to negative health outcomes and reluctance to access needed care. Objective: The aim of this study is to explore how gender identity affects TNB older adults’ fears, hopes, and plans for use of institutional long-term care. Method: Co-investigators conducted semi-structured interviews with 24 TNB older adults in Minnesota, collaboratively analyzed the results using reflexive thematic analysis, and member-checked emergent themes. Findings: Oppression is central to participants’ consideration of future long-term care. They fear mistreatment and loss of authentic gender expression and recognition in long-term care facilities. Fears of oppression factor into consideration of suicide and physical transition, although some participants hope societal shifts will lead to unbiased long-term care. Conclusion: Creation of anti-oppressive institutional and community-based long-term care options is critical to effectively serve TNB people as they age into dependence.
Keywords: aged; article; clinical article; controlled study; expectation; fear; female; gender identity; human; institutional care; male; Minnesota; nursing home; quality of life; semi structured interview; suicide; thematic analysis; transgender

Intersex adolescents seeking help for their depression: the case study of SPARX in New Zealand - Lucassen, M.F.G.; Perry, Y.; Frampton, C.; Fleming, T.; Merry, S.N.; Shepherd, M.; Stasiak, K. (Australasian Psychiatry, 2021)
Objective: SPARX is a computerized cognitive behavioral therapy self-help program for adolescent depression that is freely available in New Zealand. At registration, users identify themselves as either male, female, intersex, or transgender. We aimed to describe the mental health of adolescent intersex users. Method: A secondary analysis of SPARX usage data over 5 years. Results: Of the 8922 adolescents users, 0.6% (n = 50) identified as intersex. Based on Patient Health Questionnaire 9 – modified for Adolescents (PHQ-A) results, 78.3% of intersex users had high levels of depression and/or self-harm and suicidal ideation. The mean PHQ-A scores for intersex users were significantly higher than for males and females (p <.001). As only three intersex users completed SPARX Level 4 or more (of the seven-level program), we were unable to meaningfully investigate any reductions in their depressive symptoms over time. Conclusions: There is a dearth of empirical data on the mental health of intersex adolescents. These results suggest that intersex adolescents seeking help from an online resource have high mental health needs compared with other young people, possibly because they defer seeking help.
Keywords: adolescent; article; automutilation; controlled study; depression; female; human; intersex; major clinical study; male; mental health; New Zealand; Patient Health Questionnaire 9; secondary analysis; sexual characteristics; sexual development; suicidal ideation

Epidemiologic considerations on gender incongruence in adults, adolescents and children and mental health issues: A review of the literature - Di Grazia, M.; Sammartano, F.; Taverna, C.; Knowles, A.; Trombetta, C.; Barbone, F. (Sexologies, 2021)
Epidemiological research may offer a key to interpreting gender incongruence (GI) and identifying the medical needs of people with GI. Currently, it is difficult to estimate the real prevalence of GI due to the use of different definitions. The data on GI prevalence are influenced by case definition and by the different methodologies applied by researchers to assess cases. Estimations of prevalence therefore vary widely and are estimated between 0.1% and 1.1% among adults, with a male-to-female (MtF) – female-to-male (FtM) sex ratio of 1–6. For children, the literature reports a prevalence ranging from 1% to 4.7%, with a predominance of MtF for children and from 1.2% to 16.1% in adolescents, among whom FtM appears to be predominant. Studies based on access to gender clinics may underestimate GI prevalence while studies focused on self- or parent-reported data may overestimate the phenomenon. The literature describes high rates of affective and anxiety disorders (18–80%) and frequent personality disorders (20–70%), suicide attempts, suicide and self-harm among people with GI. These problems seem to improve after gender affirmation treatment. Some authors report a high prevalence of Autistic Spectrum Disorders (ASD) (6–14%) among youth with GI. Mortality rates, HIV infection and sexually transmitted diseases are high among the transgender population, probably related to lack of prevention. It is crucial to determine the true prevalence of GI in order to deliver adequate medical support. Future studies should be based on large multicenter cohorts or population-based surveys, and should adopt respondent-driven sampling while including individuals who do not seek services offered at gender clinics, to limit the selection bias.
Keywords: adolescent; adult; anxiety disorder; article; autism; automutilation; child; female; human; Human immunodeficiency virus infection; human tissue; juvenile; male; mental disease; mood disorder; mortality rate; multicenter study (topic); personality disorder; prevalence; selection bias; sex ratio; sexually transmitted disease; suicide attempt; transgender

Segmenting or Summing the Parts? A Scoping Review of Male Suicide Research in Canada - Oliffe, J.L.; Kelly, M.T.; Montaner, G.G.; Links, P.S.; Kealy, D.; Ogrodniczuk, J.S. (Canadian Journal of Psychiatry, 2021)
Objective: Suicide in Canadian men is high and rising. Research consistently indicates increased suicide risk in male subgroups including sexual minority, Indigenous, middle-aged, and military men. The current scoping review addresses the research question: Among male subgroups featured in Canadian suicide research, what are the key findings to inform suicide prevention efforts?. Method: A scoping review was undertaken in accord with PRISMA-ScR guidelines. Structured searches were conducted in CIHAHL, Medline, PsychInfo, and Web of Science to identify studies reporting suicidality (suicidal ideation, plans and/or attempts) and suicide among men in Canada. Inclusion criteria comprised primary empirical studies featuring Canadian male subgroups published in English from 2009 to 2020 inclusive. Results: Sixty-eight articles met the inclusion criteria, highlighting significant rates of male suicidality and/or suicide in 3 categories: (1) health inequities (n = 29); (2) age-specific (n = 30); and (3) occupation (n = 9). The health inequities category included sexual minority men, Indigenous, and other marginalized males (i.e., homeless, immigrant men, and men who use opiates). Age-specific men focused on adolescents and youth, and middle-aged and older males. Active military, veterans, and first responders featured in the occupation category. Studies compared at risk male subgroups to females, general male populations, and/or other marginalized groups in emphasizing mental health disparities and increased suicide risk. Some men’s suboptimal connections to existing mental health care services were also highlighted. Conclusion: While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientating clinicians to the potential for men’s mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among activate military, veterans, and first responder males.
Keywords: adolescent; adult; army; bereavement; Canada; Canadian; child; controlled study; empiricism; employer; female; human; human experiment; immigrant; juvenile; lobbying; male; masculinity; Medline; men's health; mental health service; middle aged; practice guideline; prevention; PsycINFO; retirement; review; sexual and gender minority; suicidal ideation; systematic review; veteran; Web of Science

Elevated Rates of Violence Victimization and Suicide Attempt Among Transgender and Gender Diverse Patients in an Urban, iSafety Net Health System - Progovac, A.M.; Tran, N.M.; Mullin, B.O.; De Mello Libardi Maia, J.; Creedon, T.B.; Dunham, E.; Reisner, S.L.; McDowell, A.; Bird, N.; Sánchez Román, M.J.; Dunn, M.; Telingator, C.; et al. (World Medical and Health Policy, 2021)
The extent to which violent victimization may explain higher rates of suicidality for transgender and gender diverse (TGD) populations is not well-understood. We identified likely-TGD patients using 2008–2019 electronic health record data and compared them with non-TGD patients to characterize differences in suicide attempt, ideation, and violent victimization. TGD patients (n = 916) had more suicide attempts (5.2 vs. 0.4 percent), ideation (20.5 vs. 1.8 percent), and violent victimization (5.4 vs. 1.7 percent, all p <.001) than non-TGDs (n = 511,026). Violent victimization and TGD cohort were independent predictors of suicide attempt (odds ratios [ORs], 7.23 and 10.84) and ideation (ORs, 6.83 and 11.03, all p <.001). We did not observe a differential impact of violent victimization for gender minorities. TGD patients are at higher baseline risk for suicidality, which is higher still for those experiencing violent victimization. Routine screening for both outcomes, including in primary care settings, may improve treatment.
Keywords: adult; article; controlled study; electronic health record; female; human; LGBTQIA+ people; major clinical study; male; primary medical care; suicide attempt; violence

A Cotherapy Supervision Approach using Person-Centered Theory with a Gender Fluid Client - Knutson, D.; Koch, J.M. (Clinical Case Studies, 2021)
The authors discuss their work with a young adult client who identified as gender fluid. The client was a college student in a rural, mid-south town. The authors are two faculty members who worked with the client for a period of 2 years using a cotherapy supervision approach. The counseling approach was affirmative and person-centered. By keeping a focus on the exploration of gender foremost, the clinicians saw an abatement of other symptoms (depression, suicidality, self-harm, disordered eating, low self-confidence, emotion dysregulation, dissociation, and so on) and an improvement in wellness (relationships, emotion regulation, self-concept, assertiveness, appropriate boundary-setting, and so on) over time. The authors offer specific interventions such as collaborative letter writing and the creation of a transition roadmap. They also highlight the advantages and utility of a collaborative, person-centered, consent-based, affirmative approach to therapy with rural transgender and nonbinary clients with complex presenting concerns.
Keywords: adult; article; assertiveness; automutilation; college student; counseling; depression; dissociation; eating disorder; emotion regulation; female; gender; human; male; suicidal behavior; transgender; writing; young adult

Subtype-discordant pancreatic ductal adenocarcinoma tumors show intermediate clinical and molecular characteristics - Topham, J.T.; Karasinska, J.M.; Lee, M.K.C.; Csizmok, V.; Williamson, L.M.; Jang, G.H.; Denroche, R.E.; Tsang, E.S.; Kalloger, S.E.; Wong, H.-L.; O’Kane, G.M.; Moore, R.A.; et al. (Clinical Cancer Research, 2021)
Purpose: RNA-sequencing–based subtyping of pancreatic ductal adenocarcinoma (PDAC) has been reported by multiple research groups, each using different methodologies and patient cohorts. “Classical” and “basal-like” PDAC subtypes are associated with survival differences, with basal-like tumors associated with worse prognosis. We amalgamated various PDAC subtyping tools to evaluate the potential of such tools to be reliable in clinical practice. Experimental Design: Sequencing data for 574 PDAC tumors was obtained from prospective trials and retrospective public databases. Six published PDAC subtyping strategies (Moffitt regression tools, clustering-based Moffitt, Collisson, Bailey, and Karasinska subtypes) were used on each sample, and results were tested for subtype call consistency and association with survival. Results: Basal-like and classical subtype calls were concordant in 88% of patient samples, and survival outcomes were significantly different (P < 0.05) between prognostic subtypes. Twelve percent of tumors had subtype-discordant calls across the different methods, showing intermediate survival in univariate and multivariate survival analyses. Transcriptional profiles compatible with that of a hybrid subtype signature were observed for subtype-discordant tumors, in which classical and basal-like genes were concomitantly expressed. Subtype-discordant tumors showed intermediate molecular characteristics, including subtyping gene expression (P < 0.0001) and mutant KRAS allelic imbalance (P < 0.001). Conclusions: Nearly 1 in 6 patients with PDAC have tumors that fail to reliably fall into the classical or basal-like PDAC subtype categories, based on two regression tools aimed toward clinical practice. Rather, these patient tumors show intermediate prognostic and molecular traits. We propose close consideration of the non-binary nature of PDAC subtypes for future incorporation of subtyping into clinical practice.
Keywords: NCT02155621; NCT02750657; adult; allelic imbalance; article; cancer prognosis; cancer survival; clinical practice; cohort analysis; female; gene expression; gene sequence; genetic transcription; human; human cell; human tissue; major clinical study; male; middle aged; molecular genetics; oncogene K ras; pancreas adenocarcinoma; priority journal; prospective study; retrospective study

Suicide Attempts in Association With Traditional and Electronic Bullying Among Heterosexual and Sexual Minority U.S. High School Students - Humphries, K.D.; Li, L.; Smith, G.A.; Bridge, J.A.; Zhu, M. (Journal of Adolescent Health, 2021)
Purpose: The aim of this study was to compare the association between bullying (traditional, electronic, and both) and suicide attempt in heterosexual and lesbian, gay, or bisexual (LGB) U.S. high school students. Methods: Data were obtained from 2015–2017 National Youth Risk Behavior Survey. Results: Nearly 25% of students reported experiencing bullying. Approximately 5.9% of heterosexual and 25.7% of LGB students attempted suicide. Heterosexual students who experienced either traditional or electronic bullying had a higher risk of attempting suicide (1.54 [95% confidence interval 1.19–1.98] and 1.64 [1.23–2.19], respectively). The associations were similar but weaker among LGB students (1.49 [1.08–2.04] and 1.43 [.90–2.27], respectively). Students who experienced both forms of bullying had the highest prevalence of suicide attempt, but the interaction was not statistically significant. Conclusions: LGB students had higher rates of both suicide attempts and experiencing bullying. Traditional and electronic bullying are not synergistic in the risk of attempting suicide, although each form increases that risk.
Keywords: article; bisexuality; controlled study; cyberbullying; female; heterosexuality; high school student; homosexual female; human; human experiment; juvenile; male; prevalence; risk behavior; suicide attempt

Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19 - O'Hayer, C.V. (Cognitive and Behavioral Practice, 2021)
Our team at the Jefferson Center City Clinic for Behavioral Medicine has recently been challenged to find a synthesis between the need to adapt to circumstances associated with the COVID-19 pandemic, while at the same time retaining the spirit and essential components of comprehensive DBT. This fine balance between unwavering centeredness and compassionate flexibility is central to DBT (Linehan, 1993), and has proven essential during these times of uncertainty. This short article highlights challenges and innovations faced by our DBT Team, Skills Group, individual DBT sessions, phone coaching, and also our community at large, as we strive to help our patients and team members build a life worth living during and following a pandemic.
Keywords: adult; article; behavioral medicine; controlled study; coronavirus disease 2019; dialectical behavior therapy; human; pandemic; skill; suicidal behavior; synthesis; transgender; uncertainty

Intersectionality and syndemics: A commentary - Sangaramoorthy, T.; Benton, A. (Social Science and Medicine, 2021)
This commentary addresses the possibilities and pitfalls of putting intersectionality and syndemics into conversation with each other. We engage with two studies published in this issue: the first on the health-related vulnerabilities among LGBTQ + Latinx men in Orlando after the Pulse nightclub shooting, and the other on syndemic health issues brought about by social and structural inequities among young Black gay, bisexual, and other men who have sex with men (GBM). Both manuscripts suggest that intersectionality and sydemics can be integrated or possibly merged to build effective health equity focused interventions for marginalized populations. We, however, argue that there are several methodological, ontological, and epistemological challenges in bringing together intersectionality and syndemics. Our argument coalesces around three key points. First, we contend that while it is feasible to think of their integration as useful to the study of health disparities, syndemics offers no added benefit to health scholarship grounded in intersectional analysis. Second, we argue that assumptions of common ground between intersectionality and syndemics rest on equating theories of interaction and additivity with critiques of mutual configurations of ideology, power structures, and social categories. Finally, we maintain that if intersectionality and syndemics are to be in conversation with each other, it must be done with the recognition and examination of where each framework situates itself relative to methodology, praxis, and power. Using our own work and those of intersectional feminist scholars, we demonstrate how the stakes of intersectionality diverge radically from those of syndemics, and how syndemics has the potential to undermine the significance of intersectionality for addressing issues of health equity.
Keywords: article; conversation; feminism; health disparity; health equity; human; Human immunodeficiency virus; ideology; nonhuman; race

Suicidality in homeless children and adolescent: A systematic review - Flach, Y.; Razza, T.S. (Aggression and Violent Behavior, 2021)
Suicide has been found to be the leading cause of death in the homeless youth population. Mortality rates due to suicide in this cohort can be 12–40 times more elevated than those observed in the general population. Therefore, a systematic review of the literature was conducted in order to investigate potential factors associated with suicidality among homeless children and adolescents. After a thorough investigation of peer-reviewed articles from main databases in this literature (ProQuest and EBSCO), a final number of 94 articles were studied to produce the contents of this systematic review. Factors associated with suicidality were divided into two main categories, namely risk factors and protective factors. The results of this review revealed significant risk factors including gender, sexual orientation, history of abuse, mental health diagnoses, negative coping styles, duration of homelessness, and survival sex. Conversely, this review identified protective factors associated with suicidality among homeless children and adolescents, such as the role of resilience, positive coping strategies, and supportive school environment. Given the impact of suicide rates in this already at-risk population, understanding these factors becomes paramount knowledge related to long-term outcomes for the homeless youth population.
Keywords: adolescent; child; cohort analysis; coping behavior; female; gender; homeless youth; homelessness; human; human experiment; male; mental health; review; risk factor; sexual orientation; suicide; systematic review

Gender Diverse Youth on Fertility and Future Family: A Qualitative Analysis - Kerman, H.M.; Pham, A.; Crouch, J.M.; Albertson, K.; Salehi, P.; Inwards-Breland, D.J.; Ahrens, K.R. (Journal of Adolescent Health, 2021)
Purpose: Gender-affirming treatment for transgender and nonbinary adolescents has been shown to decrease anxiety, depression, and suicidality, but treatments have medical consequences. Specifically, hormone replacement and pubertal blocking may impact patients' fertility and childbearing capabilities. We interviewed gender diverse adolescents regarding their thoughts on family and fertility. Methods: We completed semistructured interviews with 23 gender diverse adolescents recruited from the Seattle Children's Gender Clinic. Interviewees included transfeminine, transmasculine, and nonbinary youth. Interviews were recorded, transcribed, and analyzed using Braun and Clarke's theory of thematic analysis, a flexible framework for qualitative analysis. Results: Gender diverse adolescents have myriad views on fertility, but four main themes were identified: (1) an interest in future family, including ideas regarding adoption and biological children; (2) barriers to fertility, including cost and procedure-related dysphoria; (3) factors unique to the developmental stage of adolescents, including the age discordance of making fertility decisions as a teenager and parental influence on decision-making; and (4) suggestions for clinicians approaching fertility counseling with adolescents considering hormone therapy. Conclusions: Many gender diverse youth asserted an interest in building families, although the process of fertility preservation remains fraught. Relative to other studies, our participants were hopeful, imaginative, and interested in having children. Participants wanted to receive specific counseling on fertility, to receive help navigating the logistics of fertility preservation, and to be listened to when their hopes for children (or no children) were stated. Further research is needed to create care paradigms that address fertility of transgender youth in an affirming, developmentally appropriate manner.
Keywords: adolescent; adoption; article; child; clinical article; counseling; decision making; developmental stage; dysphoria; female; fertility preservation; gender; genetic transcription; hormonal therapy; human; juvenile; male; qualitative analysis; semi structured interview; thematic analysis; transgender

Differences in Tobacco Product Use by Sexual Orientation and Violence Factors Among United States Youth - Tabaac, A.R.; Charlton, B.M.; Tan, A.S.L.; Cobb, C.O.; Sutter, M.E. (Journal of Pediatrics, 2021)
Objective: To assess differences in the relationship between violence factor exposure and tobacco product pattern use (exclusive and poly), we hypothesized that compared with heterosexuals, sexual minority youth would be more likely to report exclusive-tobacco and poly-tobacco use patterns, and controlling for violence factors would attenuate these associations. Study design: Data from 27 513 US high-school youth were analyzed from the Centers for Disease Control and Prevention's Youth Risk Factor Surveillance System from 2015 and 2017. We fit sex-stratified, weighted, adjusted log-Poisson models to compare past 30-day exclusive combustible, exclusive e-cigarette, and poly-tobacco use in across sexual orientation. Then, models were adjusted for past-year experiences of physical fighting, bullying, attempting suicide, and physical and sexual dating violence. Results: Compared with heterosexual girls with other-sex partners, sexual minority girls were more likely to use exclusive combustible, exclusive e-cigarette, or poly-tobacco products. When adjusting for violence factors, most tobacco use associations were partially attenuated for all sexual minority girls, and completely attenuated for exclusive e-cigarette use among all sexual minority girls. Conclusions: Sexual minority girls have greater exclusive- and poly-tobacco use compared with heterosexual girls. Tobacco interventions for sexual minority youth should address the risks of poly-tobacco use as well as violence-based risk factors.
Keywords: article; bullying; child; controlled study; dating violence; disease control; electronic cigarette; exposure to violence; female; heterosexuality; high school; human; male; risk factor; sexual and gender minority; suicide; tobacco use; United States

Suicide among LGBTQIA+ youth: A review of the treatment literature - Russon, J.; Washington, R.; Machado, A.; Smithee, L.; Dellinger, J. (Aggression and Violent Behavior, 2021)
Suicide is a serious public health problem among adolescent and young adults. Indeed, 12.1% of adolescents contemplate suicide, 4.0% make a plan, and 4.1% make an attempt (Nock et al., 2013). LGBTQIA+ youth (i.e., lesbian, gay, bisexual, transgender, questioning/queer, intersex and/or asexual adolescents and young adults) are particularly vulnerable to suicide (CDC, 2016; Liu & Mustanksi, 2012; Peters et al., 2019). While many LGBTQIA+ youth are healthy and resilient (Ream & Savin-Williams, 2005) they often report higher rates of both suicidal ideation and behavior than their heterosexual (Haas et al., 2011) and cisgender (James et al., 2016) peers. The purpose of this paper is to provide a structured review the state of suicide treatment research for LGBTQIA+ youth and offer recommendations for future directions.
Keywords: adolescent; female; heterosexuality; human; juvenile; LGBTQIA+ people; male; review; suicidal ideation; young adult

A review of gender affirmation surgery: What we know, and what we need to know - Akhavan, A.A.; Sandhu, S.; Ndem, I.; Ogunleye, A.A. (Surgery (United States), 2021)
Background: Gender-affirmation surgery is a rapidly growing field in plastic surgery, urologic surgery, and gynecologic surgery. These procedures offer significant benefit to patients in reducing gender dysphoria and improving well-being. However, the details of gender-affirmation surgery are less well-known to other surgical subspecialties and other medical subspecialties. The data behind gender-affirmation surgery are comparatively sparse, and due to the recency of the field, large gaps exist in the literature. Methods: PubMed searches were carried out specific to gender-affirming mastectomies, vaginoplasty, vulvaplasty, mastectomy, metoidioplasty, and phalloplasty. Combinations and variants of “gender affirming,” “gender confirming,” “transgender,” and other variants were used to ensure broad capture. Historical articles were also reviewed. The data gathered were collated and summarized. Results: Gender-affirmation surgery is generally safe. Complication rates for gender-affirming mastectomy and breast augmentation are very low, and complication rates for genital surgeries are also reasonably low. Gender-affirmation surgery decreases rates of gender dysphoria, depression, and suicidality, and significantly improves quality-of-life measures. Data regarding facial gender-affirming surgery are limited. There are very few patient-reported outcome measures specific to gender-affirmation surgery. Conclusion: Although the data behind male-to-female gender-affirming surgery are more robust, there are significant gaps in the literature with respect to female-to-male surgery, surgical complication rates for genital surgery, facial masculinization and feminization, and patient-reported outcomes. We therefore present recommendations for further study.
Keywords: adult; article; breast augmentation; complication; face; female; feminization; gender dysphoria; human; male; mastectomy; Medline; outcome assessment; patient-reported outcome; peroperative complication; quality of life; suicidal behavior; surgery; systematic review; transgender; vagina reconstruction; virilization

Suicidal Thoughts and Behaviors Among LGBTQ Youth: Meta-Analyses and a Systematic Review - Hatchel, T.; Polanin, J.R.; Espelage, D.L. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2021)
Suicide continues to be the second-leading cause of death for all youths aged 15-24. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are at a significantly higher risk for suicidal thoughts or behaviors (STB). Establishing and understanding correlates of STB among LGBTQ youth is one important step toward enhancing prevention, intervention, and research efforts. To synthesize current knowledge on suicide among LGBTQ youth, the present meta-analyses offer results from 44 studies over the past 20 years. Two-hundred and thirty-four correlation coefficient effect sizes were calculated and categorized. To be included, the study had to quantitatively examine correlates of STB among LGBTQ youth. A number of social-science databases were used to examine the existing published research. Results illustrated the variability among correlates of STB as well as substantial limitations in the extant literature. There was a heterogeneity of effect sizes, a lack of novel correlates, a focus on risk, a dearth of theoretically driven designs, moderate publication bias, a paucity of developmentally driven analyses, and a dearth of research with transgender youth.
Keywords: adolescent; article; bisexuality; correlation coefficient; effect size; female; homosexual female; human; juvenile; male; meta analysis; publication bias; risk factor; sociology; suicidal ideation; systematic review; theoretical study; transgender

Non-Heterosexual Medical Students Are Critically Vulnerable to Mental Health Risks: The Need to Account for Sexual Diversity in Wellness Initiatives - Suárez, D.E.; Cardozo, A.C.; Villarreal, M.E.; Trujillo, E.M. (Teaching and learning in medicine, 2021)
Phenomenon: Mental health problems among medical students are a worrisome issue; recent studies have shown that one-third may be suffering major depressive disorder and one out of ten had suicidal ideation. Few studies have evaluated the association of medical students' mental health and their sexual orientation. This study aimed to evaluate differences in mental health indicators among medical students with diverse sexual orientations at a South American medical school. Approach: This study is a secondary analysis of cross-sectional data obtained through an electronic survey. The survey assessed demographics, academic variables, and several mental health scales and indexes, including: World Health Organization Well-being Index, Satisfaction With Life Scale, Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve), Self-Reporting Questionnaire, Athens Insomnia Scale, Eating Attitudes Test, and Alcohol Use Disorders Identification Test. Sexual orientation was assessed using self-identification and responses dichotomized as heterosexual and non-heterosexual. Findings: 554 students completed the survey (response rate: 70%). Mean age was 20.6 years, and the sample was 58.7% women. Eighty-two participants (14.8%) self-identified as non-heterosexual; this group comprised mostly males, fewer of whom lived with their family, and more of whom used loans or scholarships to pay university tuition fees. After adjustment for sex and tuition fee payment, non-heterosexual orientation was significantly associated (adjusted Odds Ratios [aOR] above 3.00) with rating mental health as bad, self-perceiving a need for mental health evaluation/treatment, and reporting last-year use of psychiatric medication. Lastly, non-heterosexual respondents reported more frequent psychiatric symptoms (depression/anxiety scores, suicidal ideation, eating disorder symptoms and substance use) with an aOR between 2.17 and 2.51. Insights: This study suggests that self-identified non-heterosexual medical students exhibit worse mental health outcomes evaluated through validated self-report scales and subjective perception of mental health status. This report specifically indicates that non-heterosexual medical students report family dysfunction more often and have less social support, which serve as additional risk factors. Future studies must assess social support, clarify the impact of family and peer support in mental health problems, and explore students' views on their sexual identity and the burden imposed by experiences of discrimination.
Keywords: adult; Alcohol Use Disorders Identification Test; anxiety; article; clinical assessment; controlled study; demography; depression; Eating Attitudes Test; eating disorder; female; gender identity; heterosexuality; human; human tissue; insomnia; major clinical study; male; medical school; medical student; mental disease; peer group; perception; questionnaire; risk factor; Satisfaction with Life Scale; secondary analysis; self report; social support; substance use; suicidal ideation; wellbeing; World Health Organization; young adult

Association of Sexual Orientation Acceptance with Reduced Suicide Attempts Among Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth - Green, A.E.; Price-Feeney, M.; Dorison, S.H. (LGBT health, 2021)
Purpose: This study examined the relationship between sexual orientation acceptance from others and suicide attempts among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. Methods: We analyzed data from a 2018 cross-sectional survey of LGBTQ youth between the ages of 13 and 24 years across the United States. Youth reported sexual orientation acceptance levels from parents, other relatives, school professionals, health care professionals, friends, and classmates to whom who they were "out." Adjusted logistic regression analyses were used to examine the association between sexual orientation acceptance and a past-year suicide attempt. Results: All forms of peer and adult acceptance were associated with reduced reports of a past-year suicide attempt, with the strongest associations found for acceptance from parents (adjusted odds ratio [aOR] = 0.52) and straight/heterosexual friends (aOR = 0.54). Youth who reported high levels of acceptance from any adult had nearly 40% (aOR = 0.61) lower odds of a past-year suicide attempt compared with LGBTQ peers with little to no acceptance. Youth with high levels of acceptance from any peer also had significantly lower odds of reporting a past-year suicide attempt (aOR = 0.55). These relationships remained significant even after controlling for the impact of each form of acceptance, suggesting unique associations with suicide risk for both peer and adult acceptance. Conclusion: Interventions aimed at increasing sexual orientation acceptance from supportive adults and peers have strong potential to address the public health burden of LGBTQ youth suicide.
Keywords: adult; article; controlled study; female; friend; heterosexuality; human; juvenile; LGBTQIA+ people; male; public health; relative; physiological stress; suicide attempt; United States

The Health and Well-Being of Transgender Australians: A National Community Survey - Bretherton, I.; Thrower, E.; Zwickl, S.; Wong, A.; Chetcuti, D.; Grossmann, M.; Zajac, J.D.; Cheung, A.S. (LGBT health, 2021)
Purpose: Transgender, including gender diverse and nonbinary (trans), people experience significant health disparities. We aimed to better understand the health status and needs of Australian trans people to guide resources and health and well-being programs. Methods: This anonymous, cross-sectional online survey utilized nonprobability snowball sampling of Australian adults (18 years and over) who self-identified as trans between September 2017 and January 2018. This descriptive study assessed demographic data, community views on access to health care, health burden, access to health resources, and priorities for government funding in transgender health. Results: Of 928 participants, 37% reported female, 36% reported male, and 27% reported nonbinary gender identities. Despite 47% having tertiary qualifications, the unemployment rate was 19%, with 33% reporting discrimination in employment due to being trans. Discrimination in accessing health care was reported by 26% and verbal abuse and physical assault were reported by 63% and 22%, respectively. Lifetime diagnosis of depression was reported by 73% and anxiety by 67%. Sixty-three percent reported previous self-harm and 43% had attempted suicide. Autism spectrum disorder and attention-deficit/hyperactivity disorder were reported by 15% and 11%, respectively. The most preferred method of receiving health information was through online resources, with the most popular source being Reddit, an online peer discussion board. Better training for doctors in trans health issues was the top priority for government funding. Conclusions: Barriers, including widespread discrimination and unemployment, contribute to health inequity and prevalent mental health conditions. Better training for health professionals in the provision of safe, gender-affirming and general health care for trans people is urgently required.
Keywords: adult; anxiety; article; assault; attention deficit disorder; Australian; autism; automutilation; demography; endocrine system; female; funding; gender dysphoria; government; health care access; health care planning; human; human tissue; major clinical study; male; suicide attempt; transgender; unemployment; verbal hostility; wellbeing

Gender dysphoria: prejudice from childhood to adulthood, but no impact on inflammation. A cross-sectional controlled study - Real, A.G.; Fontanari, A.M.V.; Costa, A.B.; Soll, B.M.B.; Bristot, G.; de Oliveira, L.F.; Kamphorst, A.M.; Schneider, M.A.; Lobato, M.I.R. (Trends in psychiatry and psychotherapy, 2021)
INTRODUCTION: Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one's gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5). METHODS: Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay. RESULTS: Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine. CONCLUSIONS: These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers.
Keywords: adult; adulthood; anxiety; article; child; child abuse; clinical article; controlled study; demography; DSM-5; female; gender dysphoria; gene expression; human; immune system; immunoassay; inflammation; male; mood; prejudice; protein expression; structured interview; suicidal ideation; suicide attempt; transgender; endogenous compound; interleukin 10; interleukin 1beta; interleukin 6; tumor necrosis factor

The role of work in gender identity, stress and health in low-income, middle-aged African-American men - Robinson, D.; Valdez, L.; Scott, L.; Buchanan, D. (Health promotion international, 2020)
Although progress has been made in reducing disparities in life expectancy, addressing the persistence of health inequities by race remains a high priority for public health professionals. The purpose of this research was to refine a minority stress model (MSM) by identifying previously unrecognized factors contributing to stress and chronic disease health disparities among low-income middle-aged African-American men. Using a Community-Based Participatory Research approach, we conducted semi-structured individual health interviews with 42 low-income middle-aged African-American men in a mid-size New England city. The interviews focused on the participants' perceptions of the causes of health disparities. Four major themes emerged from the analysis: the positive aspects of work, both financial and symbolic; and the negative repercussions of not working, both financial and symbolic in terms of a sense of self-respect. On an instrumental level, working men can support their family, be physically active and find social support. Symbolically, work provides a positive sense of identity as a man; it offers both social- and self-respect; it provides discipline and a sense of gratitude. Conversely, the lack of work is a significant source of stress, stemming both from the inability to support one's family and from having nothing to do, which lead to depression, low self-esteem, suicidal ideation and anger. With no perceived viable routes to socially approved roles, many low-income men of color succumb to internalizing a negative identity. This research demonstrates a clear link between structural problems with the US economy and harms to sense of identity among low-income, middle-aged African-American men.
Keywords: adult; African American; anger; article; chronic disease; employment; female; gender identity; health disparity; human; interview; lowest income group; male; middle aged; participatory research; perception; self esteem; social support; physiological stress; suicidal ideation; United States

Experiences and Correlates of Violence Among American Indian and Alaska Native Youth: A Brief Report - Edwards, K.M.; Banyard, V.L.; Charge, L.L.; Kollar, L.M.M.; Fortson, B. (Journal of interpersonal violence, 2020)
The purpose of this paper is to document the scope and correlates of past 6-month victimization among American Indian (AI) and Alaska Native (AN) youth. Types of victimization under investigation included sexual assault, dating violence, bullying, sharing of nude photos, sexual harassment, homophobic teasing, and racism. Participants were 400 AI and AN youth in grades 7-10 who completed a survey in school. Results documented concerning rates of all forms of victimization among AI and AN youth during the past 6 months. Although most forms of victimization were related, bullying (at school and electronically), racism, and sexual harassment occurred more often than sexual assault and dating violence. Older youth, girls, and sexual minorities were more likely to report some forms of violence than younger youth, boys, and heterosexual youth respectively. Compared to nonvictims, victim status was consistently related to depressive symptoms, suicidal ideation, and alcohol use and was less consistently correlated with feelings of school mattering. Evidence-based, culturally grounded prevention and response efforts are needed for AI and AN youth, as well as broader initiatives that seek to reduce health disparities among AI and AN youth.
Keywords: Alaska Native; alcohol consumption; American Indian; article; bullying; child; child abuse; controlled study; dating violence; depression; female; health disparity; heterosexuality; human; male; racism; sexual and gender minority; sexual harassment; suicidal ideation; victim

Comparing the Impact of COVID-19-Related Social Distancing on Mood and Psychiatric Indicators in Sexual and Gender Minority (SGM) and Non-SGM Individuals - Rodriguez-Seijas, C.; Fields, E.C.; Bottary, R.; Kark, S.M.; Goldstein, M.R.; Kensinger, E.A.; Payne, J.D.; Cunningham, T.J. (Frontiers in Psychiatry, 2020)
Empirical evidence demonstrates mental health disparities between sexual and gender minority individuals (SGM) compared with cisgender heterosexual individuals. SGM individuals report elevated rates of emotional distress, symptoms related to mood and anxiety disorders, self-harm, and suicidal ideation and behavior. Social support is inversely related to psychiatric symptoms, regardless of SGM status. The COVID-19 pandemic—with its associated limited social interactions—represents an unprecedented period of acute distress with potential reductions in accessibility of social support, which might be of particular concern for SGM individuals' mental well-being. In the present study, we explored the extent to which potential changes in mental health outcomes (depressive symptoms, worry, perceived stress, positive and negative affect) throughout the duration of the pandemic were related to differences in perceptions of social support and engagement in virtual social activity, as a function of SGM status. Utilizing a large sample of US adults (N = 1,014; 18% reported SGM status), we assessed psychiatric symptoms, perceptions of social isolation, and amount of time spent socializing virtually at 3 time windows during the pandemic (between March 21 and May 21). Although SGM individuals reported greater levels of depression compared with non-SGM individuals at all 3 time points, there was no interaction between time and SGM status. Across all participants, mental health outcomes improved across time. Perceived social isolation was associated with poorer mental health outcomes. Further, time spent engaging in virtual socialization was associated with reduced depression, but only for those in self-reported quarantine. We discuss these results in terms of the nature of our sample and its impact on the generalizability of these findings to other SGM samples as well as directions for future research aimed at understanding potential health disparities in the face of the COVID-19 pandemic.
Keywords: adult; article; controlled study; coronavirus disease 2019; depression; distress syndrome; female; health disparity; human; human tissue; major clinical study; male; mood; pandemic; perception; psychological well-being; quarantine; sexual and gender minority; sexual orientation; social distancing; social interaction; social isolation; social support; socialization

Trans Men's Access to Knowledgeable Providers and Their Experiences in Health Care Settings: Differences by Demographics, Mental Health, and Degree of Being "Out" to Providers - Seelman, K.L.; Kattari, S.K.; Harvey, P.; Bakko, M. (Health & social work, 2020)
Transgender adults face a health care system rife with stigma, including a lack of culturally responsive providers and high likelihood of discrimination and mistreatment. However, there is a gap in knowledge about trans men-those assigned a female sex at birth who identify as men or as transmasculine-including subgroups, such as trans men of color. Using data from the U.S. Transgender Survey, the largest transgender survey conducted in the United States, this study analyzes whether trans men's access to knowledgeable providers and their experiences of mistreatment in health care were related to demographic and mental health characteristics and degree of being "out" to providers. Among 7,950 trans men, respondent race and ethnicity, education level, disability status, psychological distress, suicidality, and being less "out" were associated with assessing one's health care provider as not knowledgeable about trans-related care. Mistreatment in health care was more common among Alaska Native/American Indian trans men; those who lived in or near poverty; those who were queer, pansexual, bisexual, or an orientation not listed; those with a disability; those experiencing distress or suicidality; and those who were more "out." This article discusses how findings can inform culturally responsive health care interventions with trans men.
Keywords: adult; Alaska Native; American Indian; article; bisexuality; demography; disability; distress syndrome; education; ethnicity; female; female to male transgender; health care personnel; human; major clinical study; male; mental health; mental stress; poverty; race; suicidal behavior; United States

Health Behavior Differences Between Male and Female U.S. Military Personnel by Sexual Orientation: The Importance of Disaggregating Lesbian, Gay, and Bisexual Groups - Jeffery, D.D.; Beymer, M.R.; Mattiko, M.J.; Shell, D. (Military medicine, 2020)
INTRODUCTION: The aims of the study are to identify health-related behaviors associated with sexual orientation among active duty military personnel and to compare those behaviors when lesbian, gay, and bisexual (LGB) groups are aggregated and disaggregated. MATERIALS AND METHODS: We used public data from the 2015 Health-Related Behavior Survey of Active Duty Military Personnel. Binomial logistic regression analyses were used to examine differences between and within heterosexual, same-sex, and bisexual groups as predicted by the following correlates: demographic characteristics, physical activity, substance use, probable mood disorders, unwanted sexual contact, physical abuse, suicidal behaviors, and sexually transmitted infection (STI). RESULTS: In univariate analyses, rates of lifetime unwanted sexual contact and lifetime suicidal ideation were significantly higher for bisexual females compared to other groups. The results of regression analyses differed depending on whether LGB groups were aggregated or disaggregated. Aggregated LGB versus heterosexual model found significant differences with respect to unwanted sexual contact, lifetime suicide attempt, STI, smoking, and marijuana use. Disaggregated models found different patterns of significant correlates, e.g., correlates comparing gays to heterosexual males were STI, sexual contact, lifetime suicide attempt, and age; correlates comparing lesbians to heterosexual females were heavy drinking, probable post-traumatic stress disorder, ever used marijuana, lifetime suicide attempt, lifetime physical abuse, and smoking. CONCLUSION: The findings are consistent with those of previous research showing highest risk for suicidal behaviors and substance abuse among bisexual individuals. We recommend that future studies and clinical care consider LGB sexual identities as heterogeneous groups; otherwise, risks for adverse health behaviors may be overlooked.
Keywords: adult; article; bisexual female; cannabis use; controlled study; demography; female; gender identity; health behavior; heavy drinking; heterosexual female; heterosexual male; homosexual female; homosexual male; human; male; military personnel; mood disorder; physical abuse; physical activity; posttraumatic stress disorder; sexually transmitted disease; smoking; substance abuse; suicidal ideation; suicide attempt; univariate analysis; cannabis

Safety and Predictors of Sexual Minority Youth Carrying Weapons - Streed, C.G.; Turner, B.; Beach, L.B.; Marro, R.; Felt, D.; Wang, X.; Phillips, G. (Journal of interpersonal violence, 2020)
Prior research has revealed sexual minority youth are more likely to carry weapons both outside of and within school. However, to date, no study has examined the degree to which bullying and harassment is associated with weapon carrying among sexual minority youth. We utilized the Youth Risk Behavior Survey to examine the prevalence and likelihood of carrying weapons by sexual identity, adjusting for adverse experiences. From the Youth Risk Behavior Survey 2009-2015, we examined self-report of adverse experiences (e.g., being bullied, skipping school due to fear for personal safety) and performed Logistic regressions to estimate the odds of carrying a weapon and were adjusted to include demographics and adverse experiences. When surveyed by sexual identity, 14.0% of heterosexual, 21.8% of gay/lesbian, 18.5% of bisexual, and 17.4% of "not sure" students reported carrying a weapon in the past 30 days. Odds of carrying a weapon were significantly increased for youth who skipped school due to feeling unsafe at school, had ever been threatened with a weapon in the past year, and had ever been in a physical fight. Compared to heterosexual female peers, sexual minority women had increased odds of carrying a weapon. Pediatricians should recognize that experiencing bullying and feeling unsafe are associated with weapon carrying, particularly among sexual minorities. Pediatricians and professionals who work with youth should recognize that reported experiences of bullying may not be the most salient indicator of risk for weapon carrying among all youth, and that other fears of or experiences with bullying are crucial to screen for among sexual minorities in particular.
Keywords: adult; article; bisexuality; bullying; controlled study; demography; drug safety; fear; female; gender identity; heterosexual female; homosexual female; human; juvenile; male; pediatrician; self report; weapon

Perceptions of LGBQ+ youth and experts of suicide prevention video messages targeting LGBQ+ youth: qualitative study - Kirchner, S.; Till, B.; Plöderl, M.; Niederkrotenthaler, T. (BMC public health, 2020)
BACKGROUND: Young lesbian, gay, bisexual, transgender, queer as well as other sexual/gender minorities (LGBTQ+) persons have higher rates of suicidal ideation and behavior compared to their non-LGBTQ+ peers, particularly during their coming out. The "It Gets Better" project is a multi-national media campaign that aims to reduce suicide among LGBTQ+ adolescents by providing personal narratives of hope delivered by mainly adult LGBTQ+ persons. There is only little knowledge so far on how young LGBTQ+ people as well as experts in suicide prevention and counseling perceive these videos, and how to potentially improve the videos based on their perceptions. METHODS: A total of n = 19 LGBQ+ adolescents and young adults and n = 9 experts participated in focus groups to discuss perceptions of a selection of "It Gets Better" videos. Eight focus groups were conducted to assess perceptions on the process of watching the videos, possible effects on young LGBQ+ viewers in general, and suicidal LGBQ+ youth in particular, as well as factors that were relevant to their perceptions. RESULTS: Messages were found to be helpful in terms of promoting hope. LGBQ+ youth identified several key strategies to increase identification with messages, which they considered crucial for their effectiveness. Criticism emerged from a perceived lack of diversity in terms of portrayed sexual identities, and some shallowness in the portrayal of suicidal ideation and how things can get better. The experts' perceptions of the videos were largely consistent with LGBQ+ youth, highlighting a positive potential of videos to support coming out and identity building processes. CONCLUSIONS: Young people and experts view the videos as helpful and relevant, but identified several strategies to better tailor them to the needs of LGBTQ+ adolescents, including suicidal peers. The insights gained are useful to the increasing number of suicide prevention projects using personal narratives of coping delivered via media to help prevent suicide.
Keywords: adolescent; adult; bisexuality; coping behavior; female; gender identity; health education; homosexuality; human; information processing; lesbianism; male; mass medium; peer group; perception; physiology; psychology; qualitative research; sexual and gender minority; sexual behavior; suicidal ideation; suicide; transgender; transsexualism; young adult

Is Emotional Abuse As Harmful as Physical and/or Sexual Abuse? - Dye, H.L. (Journal of Child and Adolescent Trauma, 2020)
This article discusses risk factors for adults who have suffered early childhood trauma, specifically focusing on emotional abuse, and discusses the negative long-term consequences from childhood trauma such as depression, anxiety, stress, and neuroticism personality. This research study predicts that those who report emotional abuse will have higher sores for depression, anxiety, stress, and neuroticism personality compared to those who reported only physical, only sexual, or combined physical and sexual abuse. Using the NEO Five-Factor Inventory, Depression Anxiety and Stress Scale, and Childhood Trauma Questionnaire, 748 college students participated in an on-line survey at a Southeastern university. As predicted, this study found those who reported emotional abuse had higher scores for depression, anxiety, stress, and neuroticism personality compared to those who reported only physical, only sexual, or combined physical and sexual abuse. Studies show emotional abuse may be the most damaging form of maltreatment causing adverse developmental consequences equivalent to, or more severe than, those of other forms of abuse (Hart et al. 1996). Therefore, this article discusses the need for public awareness campaigns to raise public and community awareness and evidenced based treatments that help with the psychological consequences resulting from emotional abuse.
Keywords: anxiety; article; awareness; caregiver; child abuse; Childhood Trauma Questionnaire; college student; depression; Depression Anxiety Stress Scale; DSM-5; DSM-IV; education; emotional abuse; human; internal consistency; mental health; NEO Five Factor Inventory; neurosis; personality; physical abuse; quality of life; self esteem; sexual abuse; sexual orientation; social support; suicidal behavior; verbal hostility; World Health Organization

The relationship of the UPPS model of impulsivity on bulimic symptoms and non-suicidal self-injury in transgender youth - Peterson, C.M.; Mara, C.A.; Conard, L.A.E.; Grossoehme, D. (Eating Behaviors, 2020)
Objective: This brief report examined the relationship of negative urgency (the tendency to act rashly in response to negative emotional states), (lack of) perseverance, (lack of) premeditation, and sensation seeking in association with non-suicidal self-injury (NSSI) and symptoms of bulimia nervosa (BN) in a sample of treatment-seeking transgender (TG) youth. Method: Eighty-six TG youth with a mean age of 17 (sd = 3.2) agreed to participate in the study. The majority of our sample identified as TG male (n = 60) with 20 participants identifying as TG female and 6 identifying as non-binary. The racial ethnic breakdown of our sample was 8.2% Black, 8.2% Multi-racial, 1.2% Native American, and 82.4% White. Over ¼ of our sample endorsed at least one episode of objective binge eating in the last 28 days and 62% endorsed a history of NSSI. Results: Negative urgency was significantly associated with the odds of NSSI, objective binge eating, and general eating disorder symptoms. Lack of premeditation was significantly related to the odds of NSSI only. No other factors were significantly associated with NSSI or symptoms of BN. Conclusions: Negative urgency appears to be an important personality construct in understanding increased risk for NSSI and BN symptoms in transgender youth.
Keywords: adolescent; adult; American Indian; article; automutilation; binge eating disorder; bulimia; Caucasian; demography; disease association; emotionality; ethnicity; female; human; impulsiveness; major clinical study; male; medical history; multiracial person; priority journal; suicidal behavior; transgender

Association between aggressive and non-fatal suicidal behaviors among U.S. high school students - Chen, C.M.; Harford, T.C.; Grant, B.F.; Chou, S.P. (Journal of Affective Disorders, 2020)
Objective: This study quantified the association between aggressive and non-fatal suicidal behaviors (NFSB) among U.S. high school students and examined whether the association could be explained by substance use, bullying and sexual/dating violence victimization, and other potential risk factors. Method: Data were based on self-reports from 14,765 students who responded to the 2017 National Youth Risk Behavior Survey. Confirmatory latent class analysis (LCA) identified two distinct, dichotomous latent class variables manifested by indicators of past-year NFSB (i.e., ideation, plan, and attempt) and aggressive behavior (i.e., physical fighting in general and on school property). The structural model estimated the odds ratios between NFSB, aggressive behavior, and their potential risk factors. Results: Without adjusting for covariates, the confirmatory LCA estimated an odds ratio (OR) of 2.55 (95% confidence interval [CI]: 1.93, 3.37) between two latent class variables for violence against self (NFSB) and others (physical fighting). The net association, however, was rendered nonsignificant (OR = 1.08 [95% CI: 0.88, 1.31]) when adjusted for covariates. Significant common risk factors included exposure to physical dating violence, being bullied on school property and/or electronically, being threatened or injured by someone with a weapon on school property, and lifetime illegal drug use and prescription opioid misuse. Limitations: Cross-sectional data do not allow assessment of causal relationships. Conclusions: Findings elucidated the association between NFSB and aggressive behavior, with serious implications for prevention and intervention. Targeting substance use, bullying, and sexual and dating violence will protect students from engaging in both types of violent behaviors.
Keywords: illicit drug; opiate; academic achievement; adolescent; adult; aggression; alcohol consumption; article; bullying; cannabis use; child; cigarette smoking; dating violence; disease association; drug abuse; drug misuse; emotional disorder; female; fighting; gender identity; high school student; hopelessness; human; latent class analysis; major clinical study; male; mental disease; non fatal suicidal behavior; obesity; physical disease; prescription; priority journal; risk factor; sadness; self report; sexual and gender minority; sexual violence; substance use; suicidal behavior; suicide attempt; United States

A cross-sectional study of mental health, suicidal ideation and suicide attempt among transgender women in Jiangsu province, China - Chen, Y.; Chen, S.; Arayasirikul, S.; Wilson, E.; McFarland, W.; Lu, J.; Chen, Y.; Yan, H. (Journal of Affective Disorders, 2020)
Objectives: To measure prevalence and risk factors of poor mental health, suicidal ideation, and suicide attempt among transgender women in Jiangsu province, China. Methods: We surveyed 250 transgender women with mean age of 27.9 years from July 2018 to May 2019 in Jiangsu province, China. Logistic regression analysis characterized risk factors for mental health, suicidal ideation, and suicide attempt. Results: Many transgender women experienced discrimination, including verbal abuse (56.0%), physical abuse (32.0%), and sexual violence (32.0%) during their lifetime. Classification by the Kessler Psychological Distress Scale found 32.4%% to be in good mental health, while 24.0%, 16.8%, and 26.8% had mild, moderate, and severe psychological distress respectively. In multivariable logistic regression, severe psychological distress was correlated with bisexual orientation (vs. gay/lesbian, aOR = 2.9, 95%CI = 1.5-5.8), being unsure of sexual orientation (vs. gay/lesbian, aOR = 4.7, 95%CI = 1.8-12.8), experience of verbal abuse (aOR = 1.8, 95%CI = 1.1-3.1), and less severe with alcohol use (aOR = 0.6, 95%CI = 0.3-0.9) (P< 0.05). Many transgender women also reported suicidal ideation (22.0%) and prior suicide attempt (25.6%). Compared to no suicidal ideation, moderate (aOR = 4.9, 95%CI = 1.6-15.2) or severe psychological distress (aOR = 38.6) were associated with prior suicide attempt (P< 0.05). Residing in Jiangsu province (vs. not residing in Jiangsu, aOR = 0.3, 95%CI = 0.1-0.6) and higher income (vs. lower income, aOR = 0.6, 95%CI = 0.4-0.9) were protective factors for suicide attempt (P< 0.05). Conclusion: Chinese transgender women experience high levels of discrimination, abuse, poor mental health, suicidal ideation, and suicide attempts in Jiangsu province. Society-wide interventions need to be developed to mitigate transphobic discrimination among transgender women in China.
Keywords: alcohol; adult; alcohol consumption; article; bisexuality; China; cross-sectional study; distress syndrome; female; human; income; major clinical study; mental health; personal experience; physical abuse; prevalence; priority journal; rating scale; risk factor; sexual orientation; sexual violence; social discrimination; suicidal ideation; suicide attempt; transgender; verbal hostility

Gender identity and sexual behavior stigmas, severe psychological distress, and suicidality in an online sample of transgender women in the United States - Maksut, J.L.; Sanchez, T.H.; Wiginton, J.M.; Scheim, A.I.; Logie, C.H.; Zlotorzynska, M.; Lyons, C.E.; Baral, S.D. (Annals of Epidemiology, 2020)
Purpose: The objective of this study is to (1) quantify burden of perceived, anticipated, and enacted gender identity (GI) and sexual behavior (SB) stigmas and (2) explore associations between GI and SB stigmas with key mental health factors among transgender women in the United States. Methods: We estimated associations between GI and SB stigmas with severe psychological distress, suicidal ideation, and suicide attempt using cross-sectional data from the Transgender Women's Internet Survey and Testing study from March to April, 2019. Modified Poisson regression produced prevalence ratios and 95% confidence intervals for severe psychological distress, suicidal ideation, and suicide attempt with GI and SB stigma items individually, as well as the GI and SB stigma items treated as two scales. Results: Of 381 transgender women, 52% experienced severe psychological distress in the past month, whereas 59.3% and 13.12% reported suicide ideation and attempt in the past year, respectively. In adjusted models, GI and SB stigma scales were significantly, positively associated with severe psychological distress, suicidal ideation, and suicide attempt. Conclusions: Continued training for providers in trans-competent mental health care and the development of newer engagement and delivery strategies for stigma mitigation interventions are needed.
Keywords: adolescent; adult; article; asexual people; bisexuality; cross-sectional study; disease severity; distress syndrome; female; gender identity; heterosexuality; homosexuality; human; LGBTQIA+ people; major clinical study; mental health; mental health care; personal experience; prevalence; priority journal; sexual behavior; stigma; suicidal ideation; suicide attempt; transgender; United States

Clergy Attitudes About Ways to Support the Mental Health of Sexual and Gender Minorities - Raedel, D.B.; Wolff, J.R.; Davis, E.B.; Ji, P. (Journal of religion and health, 2020)
This pilot study explored clergy members' attitudes about ways to support the mental health needs of sexual and gender minorities (SGM; e.g., lesbian, gay, bisexual, and transgender people). Participants (N = 86, 46% female, 26% SGMs) were US clergy members from a variety of religious faiths but mostly were leaders in Christian faith communities in the greater Chicago area. Clergy participants completed quantitative and qualitative items asking what types of resources (e.g., workshops, websites, consultations, or testimonies) and delivery format (online or in-person) they perceived as most helpful in supporting the mental health of SGM members in their faith communities. The results demonstrated that clergy members found all listed resources to be helpful to varying degrees, although suicide and homelessness prevention were prioritized above other resources. Clergy members also prioritized resources related to supporting gender minorities to be more informative, relative to resources for supporting sexual minorities. Finally, clergy member preferred information to be delivered in-person instead of online. The degree of openness to LGBTQ health promotion resources did not vary by clergy religious denomination.
Keywords: adult; attitude; clergy; female; human; Illinois; male; mental health; middle aged; pilot study; psychology; religion; sexual and gender minority

Questions of faith: Religious affiliations and suicidal ideation among sexual minority young adults - Blosnich, J.R.; De Luca, S.; Lytle, M.C.; Brownson, C. (Suicide & life-threatening behavior, 2020)
OBJECTIVE: To examine how the associations of specific religious affiliations with recent suicidal ideation vary by sexual orientation among young adults. METHOD: This project was a cross-sectional secondary analysis of data from the 2006 and 2011 surveys of the National Research Consortium of Counseling Centers in Higher Education. The analytic sample was restricted to persons between the ages of 18-29 (n = 40,150). Multiple logistic regression analyses were used to examine associations of religious affiliations with recent suicidal ideation between heterosexual and sexual minority (e.g., gay, lesbian, bisexual, questioning) young adults. RESULTS: Approximately 6.7% of the sample self-identified as sexual minority. Compared to heterosexuals, sexual minorities were more likely to report recent suicidal ideation (aOR = 4.52, 95% CI = 3.97-5.16). Among heterosexuals, Unspecified Christian and Catholic denominations were associated with 24% and 37% reduced odds of recent suicidal ideation compared to agnostic/atheist heterosexuals. However, among sexual minorities, Unspecified Christian and Catholic denominations were associated with 68% and 77% increased odds of recent suicidal ideation compared to agnostic/atheist sexual minorities. Unspecified Christian and Catholic sexual minorities had 184% and 198% increased odds of recent suicidal ideation compared to Unitarian/Universalist sexual minorities. CONCLUSIONS: Although protective for heterosexuals, religious affiliation may not be globally protective against suicidal ideation among sexual minorities.
Keywords: adult; Agnostic; article; Atheist; bisexuality; Catholic; controlled study; counseling; education; female; heterosexuality; homosexual female; human; human experiment; major clinical study; male; religion; secondary analysis; suicidal ideation; young adult

Correlates to Lifetime Suicide Attempts, Thoughts, and Planning Behaviors Among African American Transgender Individuals - Andrew Yockey, R.; King, K.A.; Vidourek, R.A. (The journal of primary prevention, 2020)
Transgender individuals are at increased risk for suicidal behaviors. We estimated lifetime suicidal ideation, planning, and attempts within a national sample of African American transgender individuals (n = 790). Using data from the 2015 US Transgender Survey, we found that 33.5% of these individuals had thought about attempting suicide at least once, 20.0% had planned to attempt suicide, and 38.0% had attempted suicide. Significant differences were found in regard to demographics and lifetime substance use; individuals who experienced intimate partner violence and used alcohol, marijuana, or other drugs were at the highest risk for attempting suicide. Our findings may assist health professionals in creating interventions designed to prevent suicide in this underserved and vulnerable population.
Keywords: adult; African American; article; controlled study; demography; female; human; human tissue; major clinical study; male; partner violence; prevention; substance use; suicidal ideation; suicide attempt; transgender; vulnerable population; alcohol; cannabis

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

Suicidal ideation in gender and sexual minority students in the largest Brazilian University - Ramírez, E.G.L.; Delgado, Y.K.; Volpato, R.J.; de Claudio, J.C.M.; Pinho, P.H.; de Vargas, D. (Archives of psychiatric nursing, 2020)
OBJECTIVE: Identifying the presence of suicidal ideation and associated factors among university students from a public university in Brazil. METHODS: A cross-sectional study was performed with 72 university students between 18 and 29 years old. Were used a sociodemographic data questionnaire and the Beck's Suicidal Ideation Scale. RESULTS: The suicidal ideation was significantly in the participants, as well as the association of gender, gender identity, sexual orientation and housing with it. CONCLUSIONS: The suicidal ideation in this population is important, and there is a need to explore the factors related, such as gender, sexual orientation, gender identity and housing.
Keywords: adult; article; cross-sectional study; demography; female; gender identity; housing; human; human experiment; major clinical study; male; questionnaire; sexual and gender minority; sexual orientation; suicidal ideation; university student

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

Age of Occurrence and Severity of Childhood Sexual Abuse: Impacts on Health Outcomes in Men Who Have Sex with Men and Transgender Women - Xavier Hall, C.D.; Moran, K.; Newcomb, M.E.; Mustanski, B. (Journal of sex research, 2020)
Childhood sexual abuse (CSA) is associated with a wide range of health outcomes and is more prevalent among men who have sex with men (MSM) compared to men who have sex with women exclusively and among transgender women (TW) compared to cisgender peers; however, there is a lack of consensus regarding an explanatory theoretical model. This analysis examined these models across health outcomes using baseline data from a longitudinal study of MSM and TW in Chicago (n = 1,035) collected from 2015 to 2019. Severity of CSA was measured for two age ranges (prior to 13 and 13-17). Logistic regression and negative binomial regressions were estimated. Teenage experiences of CSA were associated with alcohol problems, cannabis problems, suicide ideation/attempt, depression, condomless anal sex partners, rectal STI, and HIV. Pre-teenage CSA was associated with alcohol use and depressive symptoms. Significant interactions across age of experience of CSA were found for alcohol problems, cannabis problems, and condomless anal sex partners. Consistent with previous literature, this analysis found CSA to be a significant influence on various health outcomes. No single explanatory framework emerged; however, adolescent exposures may be more closely linked to health outcomes and risk behaviors than pre-teenage or cumulative exposures.
Keywords: adolescence; adolescent; alcohol consumption; article; child; child sexual abuse; controlled study; depression; female; human; Human immunodeficiency virus; Illinois; longitudinal study; major clinical study; male; men who have sex with men; nonhuman; suicidal ideation; transgender; alcohol; cannabis

Sexual Minority Stress, Mental Health Symptoms, and Suicidality among LGBTQ Youth Accessing Crisis Services - Fulginiti, A.; Rhoades, H.; Mamey, M.R.; Klemmer, C.; Srivastava, A.; Weskamp, G.; Goldbach, J.T. (Journal of youth and adolescence, 2020)
Sexual and gender minority youth are at elevated risk for suicide. Studies have separately established the relation between minority stress and mental health symptoms, as well as minority stress and suicidality. However, no known research has simultaneously examined different mental health mechanisms whereby minority stress may be associated with different suicidal experiences (e.g., suicidal ideation, suicide attempts). The present study used data from a national sample of 572 sexual and gender minority youth aged 12 to 24 (mean age = 17.59; SD = 3.13) recruited from an LGBTQ youth-focused suicide crisis prevention provider. Nearly one-third of the sample (30.2%) identified as transgender, genderqueer, or questioning. Nearly one quarter of the sample (24.3%) identified as gay, 17.1% as pansexual, 16.8% as bisexual, and 15.2% as lesbian. Structural equation modeling was used for mediation analyses to explain suicidal ideation and suicide attempts. Serial mediation models were determined to be the best fit for both suicide-related outcomes. Minority stress was associated with depressive and PTSD symptoms, which were linked with suicidal ideation and attempt through hopelessness. The findings supported the hypotheses that minority stress would be associated with suicidality not just directly, but also indirectly through multiple mental health symptom pathways.
Keywords: adolescent; adult; article; child; controlled study; female; hopelessness; human; juvenile; LGBTQIA+ people; male; posttraumatic stress disorder; prevention; structural equation modeling; suicidal ideation; suicide attempt

Is being gender nonconforming distressing? It depends where you live: gender equality across 15 nations predicts how much gender nonconformity is related to self-esteem - Zentner, M.; von Aufsess, C. (Psychological medicine, 2020)
BACKGROUND: Individuals exhibiting gender nonconforming behaviors experience low self-esteem and a number of other mental health conditions, including elevated suicide risk. Most of the relevant evidence is confined to US studies, however. Adopting a cross-national approach, we examined the pervasiveness of the psychological burden associated with gender nonconformity. Because self-esteem is sensitive to the fulfillment of societal expectations for gender conformity, we reasoned that the relationship between gender conformity and self-esteem ought to decrease as societies become less restrictive in their gender norms. METHODS: To test this proposition, we conducted two studies including 18 national samples from 15 countries varying in gender equality. Participants responded to an online survey that included measures of gender conformity and self-esteem (N = 4486). RESULTS: Using multilevel analyses and meta-analytic statistics over the samples of both studies, we found that as gender equality increased, the association between gender conformity and self-esteem decreased. CONCLUSIONS: The results suggest that rather than being inherently noxious, gender non-conformity becomes detrimental to self-esteem when it clashes with restrictive gender role norms that are enacted by the macrosocial context. We suggest that previous findings on psychological problems related to gender nonconformity be considered within a broader macrosocial context that may constrain people's freedom to move against gender role norms.
Keywords: adult; article; controlled study; distress syndrome; expectation; female; human; human experiment; major clinical study; male; multilevel analysis; organization; self esteem; sex role

The Influence of Minority Stress on Indicators of Suicidality among Lesbian, Gay, Bisexual, and Transgender Adults in Thailand - Kittiteerasack, P.; Matthews, A.K.; Steffen, A.; Corte, C.; McCreary, L.; Bostwick, W.; Park, C.; Johnson, T.P. (Journal of psychiatric and mental health nursing, 2020)
INTRODUCTION: A large and rigorous body of research in the United States has demonstrated that lesbian, gay, bisexual, and transgender (LGBT) populations are at an elevated risk for suicide. However, scant research aimed at understanding the rates and predictors for suicidality among Thai LGBT individuals exists. AIM: To examine rates and predictors of suicidality among Thai LGBT adults (N = 411). METHOD: Data collection was conducted via online and in-person surveys. Guided by the Minority Stress Model, standardized measures of demographics, health-related factors, general and minority specific stressors, and suicidality were completed. RESULTS: Thirty-nine percent of participants reported lifetime suicidal ideation, 19.0% past 12-month suicidal ideation, and 13.1% lifetime suicide attempts. Lifetime suicidal ideation was associated with higher levels of social discrimination, stress, loneliness, and chronic disease (OR = 1.12, 1.16, 2.75, and 1.46, P ≤ .05, R2 = .327). Past year suicidal ideation was associated with victimization, stress, loneliness, and being a former smoker (OR = 1.52, 1.20, 2.34, and 4.89, p < .05, R2 = .345). Suicide attempts were associated with internalized homophobia, poverty, chronic disease, alcohol use, and physical health (OR = 1.44, 1.06, 1.59, 1.45, and .95, p =< .05, R2 = .187). DISCUSSION: General and minority specific stressors negatively impacted suicidality among LGBT participants. IMPLICATION FOR PRACTICE: Study findings have implications for nursing education, practice and research. Nursing education should include information about the influence of sexual orientation and gender identity on mental health outcomes. Further, systematic screening for suicidality should be conducted by LGBT serving psychiatric and mental health nurses. Finally, research is needed to determine best practices for interventions aimed at reducing suicidality risk among LGBT individuals.
Keywords: adult; alcohol consumption; article; chronic disease; controlled study; demography; ex-smoker; female; gender identity; homophobia; human; LGBT people; loneliness; major clinical study; male; mental health; nursing education; poverty; sexual orientation; physiological stress; suicidal ideation; suicide attempt; Thailand

"It's Not Okay for You to Call Me That": How Sexual and Gender Minority Youth Cope with Bullying Victimization - Sang, J.M.; Louth-Marquez, W.; Henderson, E.R.; Egan, J.E.; Chugani, C.D.; Hunter, S.C.; Espelage, D.; Friedman, M.S.; Coulter, R.W.S. (Journal of homosexuality, 2020)
Sexual and gender minority youth (SGMY) have higher rates of bullying than their heterosexual peers and must disproportionately cope with bullying victimization. The purpose of this research is to highlight various coping strategies employed by SGMY. We conducted 20 cross-sectional, semi-structured online interviews with SGMY about their bullying experiences and coping strategies. We coded interviews with descriptive qualitative research to illustrate a comprehensive summary of bullying-related coping methods. We found SGMY engage in multiple coping strategies that include (1) emotion-focused coping-rumination; self-harm and considering or attempting suicide; seeking social and emotional support; engaging in creative endeavors; self-acceptance and community connectedness-and (2) problem-focused coping-reporting the bully; confronting the bully; conceal orientation; ignoring the bullying; and changing environment. Additionally, most SGMY reported using multiple coping techniques or changing how they coped over time (i.e., coping flexibility). These findings can inform future interventions to promote positive coping mechanisms among SGMY.
Keywords: article; automutilation; bullying; coping behavior; female; human; interview; juvenile; male; qualitative research; rumination; sexual and gender minority; suicide

Suicidal as Normal - A Lesbian, Gay, and Bisexual Youth Script? - Canetto, S.S.; Antonelli, P.; Ciccotti, A.; Dettore, D.; Lamis, D.A. (Crisis, 2020)
Background: Lesbian, gay, and bisexual (LGB) youth are more likely to report suicidal thoughts and/or behavior (STB) than heterosexual youth. The elevated suicidality of LGB youth is not fully accounted for by sexual-minority stress, according to a meta-analysis. A less-tested explanation is that suicidality has become an expected idiom of LGB youth distress. This explanation is consistent with suicide script theory and evidence that suicidal behavior is most likely when it is relatively acceptable. Aims: Building on suicide script theory and evidence, two studies were designed: one of LGB youth attitudes about suicidal behavior, and the other of LGB youth attitudes about suicidal individuals. Method: Surveys of LGB and heterosexual youth (total N = 300; M age = 20; 51% female) were conducted. Results: LGB youth were more accepting of and empathic toward suicidal behavior than heterosexual youth. They also viewed suicidal individuals as more emotionally adjusted. Limitations: Attitudes were not examined by sexual-minority subgroups. Conclusion: LGB youth's understanding attitudes may translate into less judgmental behavior toward suicidal peers, but also into normalizing suicidality as a way to express distress and cope with life problems. There may be utility in evaluating LGB youth suicide attitudes in suicide prevention initiatives.
Keywords: adult; article; attitude; bisexuality; distress syndrome; female; heterosexuality; homosexual female; human; juvenile; male; meta analysis; prevention; physiological stress; suicide; theoretical study

Trends in Suicidal Behaviors Among US Adults 2015-2018 - Yockey, R.A.; King, K.; Vidourek, R. (Crisis, 2020)
Background: Suicide remains a major public health problem in the United States. The purpose of this study was to examine trends in suicide ideation, planning, and attempts among a national sample of US adults. Method: We used aggregated 2015-2018 data from the National Survey Drug Use and Health Survey. We utilized demographic and substance use questions with each suicide behavior. We assessed weighted absolute and relative changes in a national sample of 7,654 adults. Results: Results revealed that from 2015 to 2018, there was a 16.0% increase in suicide ideation, 18.6% increase in suicide planning, and 11.6% increase in suicide attempts. Significant increases in each behavior were found in African Americans, younger adults, sexual minorities, and individuals who reported past-year drug use. Limitations: Limitations include self-report of suicidal behaviors and desirability of answers. Conclusion: We believe our findings can inform harm reduction efforts and health messages surrounding suicide prevention.
Keywords: adult; African American; article; demography; female; harm reduction; health survey; human; human experiment; human tissue; major clinical study; male; prevention; self report; sexual and gender minority; substance use; suicidal ideation; suicide attempt

Sexual Assault and Co-Occurrence of Mental Health Outcomes Among Cisgender Female, Cisgender Male, and Gender Minority U.S. College Students - Parr, N.J. (Journal of Adolescent Health, 2020)
Purpose: The aim of this study was to examine the co-occurrence of mental health (depression, anxiety, nonsuicidal self-injury, and suicide ideation) and substance use outcomes among cisgender female, cisgender male, and gender minority college students exposed to sexual assault (SA). Methods: Data were drawn from a 2018 U.S. national survey of college student well-being (N = 50,438). Inverse propensity-weighted three-step latent class analysis was used to examine co-occurrence of outcomes while adjusting for 31 potential confounders of the relation between SA and outcome classes. Results: Four latent classes were identified for cisgender female and male participants and two for gender minority participants, reflecting a range from low to high risk of co-occurring outcomes. SA was associated with significantly and substantially increased odds (odds ratio: 2.03–3.64) of membership to the highest-risk outcome class compared with the lowest-risk class across gender identity subgroups. Conclusions: SA in the college setting is associated with substantially increased odds of co-occurring depression, anxiety, nonsuicidal self-injury, and suicide ideation, regardless of gender identity.
Keywords: adult; anxiety; article; automutilation; college student; depression; female; high risk population; human; low risk population; major clinical study; male; mental health; outcome assessment; priority journal; sexual and gender minority; sexual assault; substance use; suicidal ideation; young adult

Teen Dating Violence and Suicide Risk Among Bisexual Adolescents - Smith, A.U.; Reidy, D.; Norris, A.E. (Journal of Adolescent Health, 2020)
Purpose: Suicide is a public health problem that disproportionately affects bisexual youth more than heterosexual, lesbian/gay, and other sexual minority youth. Teen dating violence (TDV) consists of physically, emotionally, and/or psychologically aggressive behavior in adolescent relationships and has been linked to increased suicidality among sexual minority youth. Although biological sex differences in suicide and TDV have been noted, limited research currently exists regarding the importance of these differences in bisexual youth. Methods: This study employed a cross-sectional descriptive design to investigate the relationship between biological sex, TDV, and suicide risk among bisexual youth in grades 9–12. This study used structural equation modeling to conduct a secondary analysis of pooled 2015 and 2017 national Youth Risk Behavior Surveillance Survey data that examined whether TDV mediated the relationship between biological sex and suicide risk among bisexual youth. Results: Results indicated that TDV did not mediate the relationship between biological sex and suicide risk among bisexual youth. Biological sex was a significant predictor of suicide risk with male youth reporting lower suicide risk than female youth, when controlling for dating history, TDV, age, and race. TDV predicted suicide risk, with youth reporting TDV having higher suicide risk, when controlling for dating history, biological sex, age, and race. In addition, black and Hispanic youth reported lower suicide risk compared to white youth. Conclusion: There is a dire need for research that addresses issues of TDV and suicide among bisexual youth. Understanding factors influencing suicide risk following TDV experiences among bisexual youth will inform interventions to mitigate negative mental health outcomes.
Keywords: adolescent; article; bisexual female; bisexual male; bisexuality; comparative study; construct validity; controlled study; cross-sectional study; dating violence; ethnic group; female; heterosexuality; hopelessness; human; major clinical study; male; priority journal; risk factor; secondary analysis; sex difference; sexual and gender minority; structural equation modeling; suicidal ideation; suicide

Sexual and Gender Minority Status and Firearms in the Household: Findings From the 2017 Behavioral Risk Factor Surveillance System Surveys, California and Texas - Blosnich, J.R.; Clark, K.A.; Mays, V.M.; Cochran, S.D. (Public Health Reports, 2020)
Objectives: Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with firearms in the home, the storage of firearms as stored unloaded, stored as loaded and locked, or stored as loaded and unlocked. Methods: We used data from the 2017 Behavioral Risk Factor Surveillance System surveys from California and Texas (N = 11 694), which were the only states to include items about both sexual orientation and gender identity and the status of firearms in the home. We used logistic regression analysis to assess the association of sexual orientation and gender identity with having firearms in the home while accounting for sociodemographic characteristics and survey state. All analyses were weighted to account for the complex sampling design. Results: Approximately 4.2% of the sample identified as lesbian, gay, and bisexual (LGB). About 18.2% of LGB people reported firearms in the home compared with 29.9% of their heterosexual peers. After adjusting for sex, age, race/ethnicity, educational attainment, and military veteran status, LGB respondents had significantly lower odds of reporting firearms in the home than their heterosexual peers (adjusted odds ratio = 0.47; 95% CI, 0.27-0.84). Among respondents with firearms in the home, firearm storage did not differ by sexual orientation. Conclusions: Further research is needed to examine whether lower odds of firearms in the home are protective against suicide deaths among LGB populations.
Keywords: adult; aged; article; behavior; California; demography; disease surveillance; educational status; ethnicity; female; firearm; gender identity; groups by age; health care system; heterosexuality; human; LGBT people; male; middle aged; priority journal; race; risk factor; sex; sexual and gender minority; sexual orientation; social status; Texas; veterans health

Prevalence and clinical indices of risk for sexual and gender minority youth in an adolescent inpatient sample - Bettis, A.H.; Thompson, E.C.; Burke, T.A.; Nesi, J.; Kudinova, A.Y.; Hunt, J.I.; Liu, R.T.; Wolff, J.C. (Journal of Psychiatric Research, 2020)
Objective: Rates of self-injurious thoughts and behaviors have increased in adolescents over the past two decades. Sexual and gender minority (SGM) youth report elevated rates of self-injurious thoughts and behaviors compared to heterosexual and cisgender youth. Studies of factors influencing suicide risk in SGM youth remain limited, however, and have largely been conducted in community or epidemiological samples. Method: The present study aimed to address these limitations by examining the prevalence and clinical characteristics of sexual and gender minority youth in a sample of 515 youth admitted to an adolescent inpatient unit. In addition, the present study aimed to compare rates of self-reported self-injurious thoughts and behaviors, adverse early childhood experiences, and rates of rehospitalization in sexual and gender minority compared to non-sexual and gender minority youth. Results: Results show that nearly 40% of the sample identified as sexual and/or gender minority. Sexual minority youth reported higher rates of suicidal ideation (t = −6.19, p <.001), higher rates of prior suicidal behavior (Chi2 = 27.44, p <.001) and non-suicidal self-injury (Chi2 = 48.09, p <.001), and greater numbers of adverse childhood experiences (t = −3.99, p <.001); gender minority youth reported higher rates of suicidal ideation (t = −3.91 p =.001). There were no group differences for SGM youth in rates of rehospitalization in the 6-months following initial admission. These results held when controlling for sex assigned at birth and current depression status in multi-variate analyses. Conclusions: The study illuminates the importance of assessing SGM status in clinical care and highlights the need to evaluate sexual and gender minority specific risk factors for self-injurious thoughts and behaviors in youth.
Keywords: adolescent; article; automutilation; childhood adversity; controlled study; female; generalized anxiety disorder; heterosexuality; hospital admission; hospital readmission; human; length of stay; major clinical study; major depression; male; posttraumatic stress disorder; prevalence; priority journal; risk; sexual and gender minority; sexual orientation; social phobia; suicidal behavior; suicidal ideation; suicide attempt

The hidden pandemic of family violence during COVID-19: Unsupervised learning of tweets - Xue, J.; Chen, J.; Chen, C.; Hu, R.; Zhu, T. (Journal of Medical Internet Research, 2020)
Background: Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time. Objective: This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter. Methods: We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets. Results: We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence–related news (eg, Tara Reade, Melissa DeRosa). Conclusions: This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks.
Keywords: aggression; alcohol abuse; article; awareness; child abuse; coercion; confidentiality; coronavirus disease 2019; domestic violence; family violence; financial crisis; funding; gun violence; homicide; hotline; human; law enforcement; LGBTQIA+ people; machine learning; pandemic; police; quarantine; risk factor; sexual abuse; sexual violence; social media; social support; social work; social worker; survivor; unsupervised machine learning; vulnerable population

Suicidal ideation in patients with gender identity disorder in western iran from march 2019 to march 2020 - Mohajer, M.A.; Adibi, A.; Mozafari, A.A.; Sahebi, A.; Bakhtiyari, A. (International Journal of Medical Toxicology and Forensic Medicine, 2020)
Background: In recent years, the number of patients with gender identity disorder (GID) has rapidly increased. These people are at risk of adverse life events that influence their health and wellbeing. Research studies have also shown a significant rate of suicide in these individuals. This study aims to determine the prevalence of suicidal ideation in patients with GID referred to Legal Medicine Office in Ilam Province. Methods: In study sample comprised 21 patients without psychiatric comorbidity visited the Legal Medicine Office in Ilam Province for confirmation of transsexuals from March 2019 to March 2020. GID disorder was diagnosed through a Gender Identity/Gender Dysphoria Questionnaire for adulescents and Adults (GIDYQ) (A-A) questionnaire and clinical interview. The Beck scale for suicide ideation was used to clarify and measure the intensity of attitudes, behaviors, and planning for a suicide attempt. Results: In 21 patients with GID, the average score for suicide ideation was 11.6. The average age of patients was 19 years, and all of them were single. In this sample, 19.1% had low risks, 71.5% high risks, 9.5% had very high-risk suicide ideation. Linear regression analysis showed that higher education and higher age were risk factors for suicide ideation in patients with GID. Conclusion: The high rate of suicidal ideation in patients with gender identity disorder makes it essential to pay attention to their mental health. It should be noted that suicidal thoughts can be a basis for suicide attempts.
Keywords: adult; article; attention; attitude; clinical article; comorbidity; education; female; forensic medicine; gender dysphoria; human; human tissue; interview; linear regression analysis; male; mental health; prevalence; questionnaire; risk factor; suicidal ideation; suicide attempt; transgender; young adult

Improving Our Understanding of the Death/Life Implicit Association Test - Podlogar, M.C.; Gutierrez, P.M.; Joiner, T.E. (Journal of personality assessment, 2020)
The "Death/Life" Implicit Association Test (d-IAT) is a reaction-time task which has been associated with past and future suicidal behavior; in some work, the association has been incremental to explicit self-report of suicide risk. Proposed mechanisms for this association relate to one's unwillingness or inability to completely disclose or be introspectively aware of implicit risk. This study investigated moderators of implicit-explicit concordance as well as predictors of d-IAT score unexplained by self-reported suicidal thoughts and behaviors among an online sample of 382 adults with higher demographic suicide risk (i.e., military service members and veterans, men over age 50, and LGBTQ young adults). Before and after controlling for current explicit report, results replicated the finding of a significant relationship between d-IAT score and severity of past suicidal behavior, and additionally indicated that suicide attempt history and wish to live moderated the association between d-IAT score and explicit report. Furthermore, results suggest that poor introspective awareness, rather than deception, may account for differences between implicit and explicit risk assessment. Continuing investigation of moderators and mechanisms of the d-IAT is needed to improve the utility and validity of using implicit suicide risk assessment as a clinical tool.
Keywords: adult; article; awareness; deception; human; human tissue; major clinical study; male; military service; risk assessment; suicidal ideation; suicide attempt; validity; veteran; young adult

Heterosexism and Suicidal Ideation - Trujillo, M.A.; Perrin, P.B.; Henry, R.S.; Rabinovitch, A.E. (Crisis, 2020)
Background: Heterosexism has been identified as being a contributing factor of suicidality in sexual minority adults (SMA), and social support is believed to be important for mitigating these effects. Research evaluating racial/ethnic differences in suicidality among SMA is limited despite racial/ethnic minorities being at greater risk. Aims: We aimed to examine the associations between heterosexism, suicidal ideation, and social support in a sample of racially/ethnically diverse SMA. Method: SMA (N = 239) were recruited as part of an online survey on sexuality and health based in the United States. Results: There were significant positive main effects of heterosexism and significant negative main effects for non-White racial/ethnic identity on suicidal ideation. There were significant negative main effects for social support from family and a significant other but not from friends. A significant interaction of social support from a significant other and racial ethnic identity was qualified by a significant three-way interaction with heterosexism. Social support from a significant other buffered the effect of heterosexism on suicidal ideation among non-White but not among White SMA. All other interactions were not significant. Limitations: Within-group differences of racial/ethnic groups and other domains of social support were not examined, and the cross-sectional nature of the data precludes causal inference. Conclusion: Support from a significant other may be important for suicidality, particularly for racial/ethnic minority SMA.
Keywords: adult; article; controlled study; ethnic group; ethnicity; female; friend; human; human experiment; human tissue; major clinical study; male; race; sexual and gender minority; sexual orientation; social support; stigma; suicidal ideation; United States

Tobacco Use and Cessation Among a National Online Sample of Men Who Have Sex With Men in Malaysia - Lim, S.H.; Daghar, L.; Bullen, C.; Faiz, H.M.; Akbar, M.; Amer Nordin, A.S.; Yee, A. (Asia-Pacific journal of public health, 2020)
Previous studies documented the health disparities in smoking among sexual minority populations, including men who have sex with men (MSM). However, smoking behaviors have never been examined among Malaysian MSM, a sexual minority group in a predominantly Muslim country. A total of 622 Malaysian MSM completed an anonymous online survey in 2017. Data on the demographics, smoking and substance use behaviors, psychosocial factors, and attitudes toward smoking cessation were collected and analyzed. The mean age was 28 years and 67% of participants were of Malay ethnicity. The prevalence of current smoking was 23% (n = 143), while former smokers were 9% (n = 59). Current smoking status was associated with HIV-positive status and risk behaviors, such as suicidality, alcohol use, and illicit drug use (P = .001). Almost two thirds of current smokers had attempted to quit in the past year. Hence, comprehensive smoking cessation interventions addressing the psychosocial needs of MSM should be prioritized.
Keywords: adult; epidemiology; health survey; human; Internet; Malaysia; male; male homosexuality; prevalence; psychology; smoking cessation; tobacco use

The Influence of State Policies on the Relationship Between Minority Stressors and Suicide Attempts Among Transgender and Gender-Diverse Adults - Rabasco, A.; Andover, M. (LGBT health, 2020)
Purpose: We examined whether the relationship between minority stressors (victimization and discrimination) and suicide attempts (SAs) was moderated by gender identity-specific protective state policies in a sample of transgender and gender-diverse (TGD) adults. Methods: TGD adults (n = 133) were recruited online and completed questionnaires. Results: Protective state policies moderated the relationship between minority stressors and SAs, with a significant positive association between minority stressors and SAs at low, but not medium and high, policy scores. Conclusion: A lack of protective state policies may be a risk factor in the relationship between minority stressors and SAs among TGD individuals.
Keywords: adult; article; female; gender identity; human; major clinical study; male; questionnaire; risk factor; suicide attempt; transgender

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

Suicide Attempt Rates and Associations with Discrimination Are Greatest in Early Adulthood for Sexual Minority Adults Across Diverse Racial and Ethnic Groups - Layland, E.K.; Exten, C.; Mallory, A.B.; Williams, N.D.; Fish, J.N. (LGBT health, 2020)
Purpose: The study purpose was to investigate differences in past 5-year suicide attempts among racially/ethnically diverse sexual minority (SM) and heterosexual adults across the life course and examine the association of discrimination with past 5-year suicide attempts among SM adults. Methods: Using nationally representative data collected from 2012 to 2013, we assessed differences in age-varying prevalence of past 5-year suicide attempts among Black, Hispanic, and White SM and heterosexual adults (ages 18-60). We tested whether the association between discrimination and suicide attempts differed by race/ethnicity among SM adults. All secondary data analyses were approved by the Institutional Review Boards of The Pennsylvania State University and University of Maryland. Results: Compared with heterosexual adults of any race/ethnicity, SM adults exhibited elevated suicide attempt rates until the late twenties when prevalence for Black and Hispanic SM adults declined. Disparities persisted into the mid-40s for White SM adults. Among SM adults of all races/ethnicities, the relationship between SM discrimination and suicide attempts was strongest between ages 18 and 25. For SM adults reporting SM discrimination, odds of suicide attempts were 3.6 times higher for White SM adults and 4.5 times higher for Black and Hispanic SM adults, relative to same-race/ethnicity SM adults who did not report SM discrimination. The effect of SM discrimination was robust among Black and Hispanic SM young adults even when accounting for racial/ethnic discrimination. Conclusions: SM adults of all racial/ethnic groups demonstrated disparities when contrasted with heterosexual adults of any race/ethnicity, although ages characterized by heightened prevalence rates of suicide attempts differed by race/ethnicity. Early adulthood is a critical period for intervention seeking to disrupt the association between SM discrimination and suicide attempts.
Keywords: adult; adulthood; article; clinical article; controlled study; data analysis; ethnic group; female; heterosexuality; Hispanic; human; institutional review; male; Maryland; Pennsylvania; prevalence; racism; sexual and gender minority; suicide attempt; young adult

Health and Service-related Impact of Sexual and Stalking Victimization During United States Military Service on LGBT Service Members - Klemmer, C.L.; Schuyler, A.C.; Mamey, M.R.; Schrager, S.M.; Castro, C.A.; Goldbach, J.; Holloway, I.W. (Journal of interpersonal violence, 2020)
Prior research among military personnel has indicated that sexual harassment, stalking, and sexual assault during military service are related to negative health sequelae. However, research specific to LGBT U.S. service members is limited. The current study aimed to explore the health, service utilization, and service-related impact of stalking and sexual victimization experiences in a sample of active-duty LGBT U.S. service members (N = 248). Respondent-driven sampling was used to recruit study participants. U.S. service members were eligible to participate if they were 18 years or older and active-duty members of the U.S. Army, U.S. Navy, U.S. Marine Corps, or U.S. Air Force. This study included a sizeable portion of transgender service members (N = 58, 23.4%). Sociodemographic characteristics, characteristics of military service, health, and sexual and stalking victimization in the military were assessed. Regression was used to examine relationships between health and service outcomes and sexual and stalking victimization during military service. Final adjusted models showed that experiencing multiple forms of victimization in the military increased the odds of visiting a mental health clinician and having elevated somatic symptoms, posttraumatic stress disorder symptomatology, anxiety, and suicidality. Sexual and stalking victimization during U.S. military service was statistically significantly related to the mental and physical health of LGBT U.S. service members. Interventions to reduce victimization experiences and support LGBT U.S. service members who experience these types of violence are indicated. Research that examines the role of LGBT individuals' experiences and organizational and peer factors, including social support, leadership characteristics, and institutional policies in the United States military is needed.
Keywords: adult; air force; anxiety; article; controlled study; demography; female; health care utilization; human; human tissue; leadership; LGBT people; major clinical study; male; mental health; military health; navy; organizational policy; posttraumatic stress disorder; sexual harassment; social support; stalking; suicidal behavior; United States

Experiencing Intimate Partner Violence (IPV) Is Associated with Psychosocial Health Problems Among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Nigeria, Africa - Ogunbajo, A.; Oginni, O.A.; Iwuagwu, S.; Williams, R.; Biello, K.; Mimiaga, M.J. (Journal of interpersonal violence, 2020)
Previous research has shown high rates of intimate partner violence (IPV) among gay, bisexual, and other men who have sex with men (GBMSM). Experiencing IPV may predispose GBMSM to psychosocial health problems. A vast majority of the research on IPV among GBMSM have been conducted in North America and Europe. To date, no published studies that we are aware of have investigated the prevalence and correlates of IPV among GBMSM in West Africa. To fill this gap in research, the present study investigated the prevalence of IPV and its' association with psychosocial health problems in a large multicity sample of community-recruited GBMSM in Nigeria. Bivariate and multivariable logistic regression analyses were utilized to examine associations between sociodemographic characteristics, psychosocial health problems, sexual risk, and experiences of IPV (N = 389). The prevalence of experiencing emotional, physical, sexual, monitoring behaviors, and controlling behavior were 45%, 31%, 20%, 55%, and 22% respectively. Experiencing all types of IPV, except physical violence, was significantly associated with increased odds of having depressive symptoms (Adjusted OR [AOR] 1.79-2.63; 95% confidence interval [CI]: 1.08-4.60) and anxiety (AOR 1.63-2.63; 95% CI: 1.01-4.18). Experiencing emotional violence (standardized beta [β] = 0.21; standard error [SE] SE = 0.44), physical violence (β = 0.14; SE = 0.48), and controlling behaviors (β = 0.11; SE = 0.54) was associated with increased odds of loneliness. Experiencing all types of IPV was associated with history of suicide thoughts (AOR 2.20-3.68; 95% CI: 1.28-6.32) and suicide attempt (AOR 2.36-3.42; 95% CI: 1.20-6.75). Additionally, we observed a dose-response relationship, whereby increasing number of IPV was associated with a higher likelihood of reporting psychosocial health problems. Lastly, after adjusting for other psychosocial health problems and demographic characteristics, there remained a significant association between experiencing IPV and reporting a history of suicide thoughts and suicide attempt. Consequently, it is imperative that health interventions aimed at improving psychosocial health of GBMSM explore experience and perpetration of IPV.
Keywords: adult; anxiety; article; bisexuality; controlled study; demography; depression; dose response; emotional abuse; female; human; loneliness; major clinical study; male; men who have sex with men; Nigeria; partner violence; physical violence; prevalence; suicide attempt

Suicidality Among Youth Who are Questioning, Unsure of, or Exploring Their Sexual Identity - Price-Feeney, M.; Green, A.E.; Dorison, S.H. (Journal of sex research, 2020)
Many studies have found that lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth are disproportionately impacted by poor mental health outcomes. However, there remains a gap in understanding factors associated with the mental health of youth who are questioning, unsure of, or exploring (QUE) their sexual identity. Using data from The Trevor Project's 2019 National Survey on LGBTQ Youth Mental Health, a quantitative cross-sectional survey of LGBTQ youth between 13 and 24, we explored suicidality among 801 QUE youth. Significantly more QUE youth were younger, nonwhite, and transgender and nonbinary compared to other LGBTQ youth. QUE youth reported higher rates of suicidality compared to other LGBTQ youth; however, this increased risk was related to the overrepresentation of younger and transgender and nonbinary youth among QUE youth. In adjusted models, being transgender and nonbinary, hearing parents use religion to say negative things about being LGBTQ, and experiencing physical threat or harm based on sexual orientation or gender identity were significantly related to seriously considering suicide and attempting suicide among QUE youth. Given the intricate relationship between the two, researchers should assess both gender identity and sexual identity when determining the risk of suicidality among LGBTQ youth.
Keywords: article; controlled study; female; gender identity; hearing; human; juvenile; LGBTQIA+ people; male; mental health; religion; risk assessment; sexual orientation; suicide

Factors Associated with Mental Health Disorders among University Students in France Confined during the COVID-19 Pandemic - D'Hondt, F.; Wathelet, M.; Duhem, S.; Vaiva, G.; Baubet, T.; Habran, E.; Veerapa, E.; Debien, C.; Molenda, S.; Horn, M.; Grandgenèvre, P.; Notredame, C.-E.; et al. (JAMA Network Open, 2020)
Importance: The coronavirus disease 2019 (COVID-19) pandemic and quarantine measures have raised concerns regarding their psychological effects on populations. Among the general population, university students appear to be particularly susceptible to experiencing mental health problems. Objectives: To measure the prevalence of self-reported mental health symptoms, to identify associated factors, and to assess care seeking among university students who experienced the COVID-19 quarantine in France. Design, Setting, and Participants: This survey study collected data from April 17 to May 4, 2020, from 69054 students living in France during the COVID-19 quarantine. All French universities were asked to send an email to their students asking them to complete an online questionnaire. The targeted population was approximately 1600000 students. Exposure: Living in France during the COVID-19 quarantine. Main Outcomes and Measures: The rates of self-reported suicidal thoughts, severe distress, stress, anxiety, and depression were assessed using the 22-item Impact of Events Scale-Revised, the 10-item Perceived Stress Scale, the 20-item State-Trait Anxiety Inventory (State subscale), and the 13-item Beck Depression Inventory, respectively. Covariates were sociodemographic characteristics, precariousness indicators (ie, loss of income or poor quality housing), health-related data, information on the social environment, and media consumption. Data pertaining to care seeking were also collected. Multivariable logistic regression analyses were performed to identify risk factors. Results: A total of 69054 students completed the survey (response rate, 4.3%). The median (interquartile range) age was 20 (18-22) years. The sample was mainly composed of women (50251 [72.8%]) and first-year students (32424 [47.0%]). The prevalence of suicidal thoughts, severe distress, high level of perceived stress, severe depression, and high level of anxiety were 11.4% (7891 students), 22.4% (15463 students), 24.7% (17093 students), 16.1% (11133 students), and 27.5% (18970 students), respectively, with 29564 students (42.8%) reporting at least 1 outcome, among whom 3675 (12.4%) reported seeing a health professional. Among risk factors identified, reporting at least 1 mental health outcome was associated with female gender (odds ratio [OR], 2.10; 95% CI, 2.02-2.19; P <.001) or nonbinary gender (OR, 3.57; 95% CI, 2.99-4.27; P <.001), precariousness (loss of income: OR, 1.28; 95% CI, 1.22-1.33; P <.001; low-quality housing: OR, 2.30; 95% CI, 2.06-2.57; P <.001), history of psychiatric follow-up (OR, 3.28; 95% CI, 3.09-3.48; P <.001), symptoms compatible with COVID-19 (OR, 1.55; 95% CI, 1.49-1.61; P <.001), social isolation (weak sense of integration: OR, 3.63; 95% CI, 3.35-3.92; P <.001; low quality of social relations: OR, 2.62; 95% CI, 2.49-2.75; P <.001), and low quality of the information received (OR, 1.56; 95% CI, 1.49-1.64; P <.001). Conclusions and Relevance: The results of this survey study suggest a high prevalence of mental health issues among students who experienced quarantine, underlining the need to reinforce prevention, surveillance, and access to care..
Keywords: adult; anxiety; article; Beck Depression Inventory; controlled study; coronavirus disease 2019; depression; distress syndrome; e-mail; female; follow up; France; gender; health survey; housing; human; Impact of Events Scale; integration; major clinical study; male; mental disease; mental stress; pandemic; Perceived Stress Scale; prevalence; priority journal; quarantine; questionnaire; risk factor; self report; social environment; social interaction; social isolation; social media; State Trait Anxiety Inventory; suicidal ideation; university student

Associations of Discrimination, Suicide Ideation Severity and Attempts, and Depressive Symptoms Among Sexual and Gender Minority Youth - Wyman Battalen, A.; Mereish, E.; Putney, J.; Sellers, C.M.; Gushwa, M.; McManama O'Brien, K.H. (Crisis, 2020)
We examined the unique associations among discrimination, suicidal thoughts, suicide attempts, and depressive symptoms in a sample of sexual and gender minority (SGM) youth as well as interpersonal mediators of these associations. Participants included 94 SGM youth (Mage = 18; SD = 2.88) recruited from SGM-specific drop-in centers. We used mediation analyses to test the mediating effects of perceived burdensomeness and thwarted belongingness on the associations between discrimination and suicidal ideation, suicide attempts, and depressive symptoms, accounting for childhood trauma and sociodemographic variables (age, gender identity, race, and sexual orientation). Within our nonclinical community sample of SGM youth, 49% reported a lifetime suicide attempt, 84% reported current suicide ideation, and 82% reported current depressive symptoms. Experiencing discrimination was associated with greater likelihood of suicide attempts and depressive symptoms, and greater perceived burdensomeness and thwarted belongingness, over and above the effects of childhood trauma and sociodemographic variables. Discrimination was indirectly associated with greater depressive symptoms through perceived burdensomeness and thwarted belongingness, and with greater severity of suicidal ideation through perceived burdensomeness. Findings suggest clinicians should assess for discrimination and include a focus on perceived burdensomeness and thwarted belongingness as targets of intervention for suicide and depression.
Keywords: adult; article; child abuse; childhood trauma; community sample; controlled study; demography; depression; female; gender identity; human; human tissue; juvenile; male; race; sexual and gender minority; sexual orientation; suicidal ideation; suicide attempt

A community-based study of demographics, medical and psychiatric conditions, and gender dysphoria/incongruence treatment in transgender/gender diverse individuals - James, H.A.; Chang, A.Y.; Imhof, R.L.; Sahoo, A.; Montenegro, M.M.; Imhof, N.R.; Gonzalez, C.A.; Lteif, A.N.; Nippoldt, T.B.; Davidge-Pitts, C.J. (Biology of sex differences, 2020)
BACKGROUND: Current understanding about health care in the gender diverse population is limited by the lack of community-based, longitudinal data, especially in the USA. We sought to characterize a community-based cohort of transgender individuals including demographics, gender identities, social characteristics, psychiatric and medical conditions, and medical therapy for gender dysphoria/incongruence. PATIENTS AND METHODS: We performed a retrospective chart review of gender diverse residents of Olmsted County, Minnesota, who sought gender-specific healthcare from January 1, 1974, through December 31, 2015, using an infrastructure that links medical records of Olmsted County residents from multiple institutions. RESULTS: The number of patients seeking gender-specific healthcare increased from 1 to 2 per 5-year interval during the 1970s-1990s to 41 from 2011 to 2015 (n = 82). Forty-nine (59.8%) were assigned male sex at birth (AMAB), 31 (37.8%) were assigned female (AFAB), and 2 (2.4%) were intersex. Gender identities evolved over time in 16.3% and 16.1% of patients AMAB and AFAB, respectively, and at most recent follow-up, 8.2% and 12.9% of patients AMAB and AFAB, respectively, were non-binary. Depression affected 78%, followed by anxiety (62.2%), personality disorder (22%), and post-traumatic stress disorder (14.6%). 58.5% experienced suicidal ideation, 22% attempted suicide, and 36.6% were victims of abuse. The most prevalent medical conditions and cardiovascular (CV) risk factors included obesity (42.7%), tobacco use (40.2%), fracture [34.1% (86.2% traumatic)], hypertension (25.6%), hyperlipidemia (25.6%), and hypertriglyceridemia (15.9%). 67.3% of patients AMAB used feminizing and 48.4% of patients AFAB used masculinizing hormone therapy. When compared to US CDC National Health Statistics, there was a significantly greater prevalence of depression and anxiety but no difference in the prevalence of obesity, hypertension, hypercholesterolemia, type 2 diabetes, or stroke. CONCLUSION: Transgender and gender diverse individuals represent a population who express various gender identities and are seeking gender-specific healthcare at increasing rates. Psychiatric illness is highly prevalent compared to the US population but there is no difference in the prevalence of CV risk factors including obesity, type 2 diabetes, hypertension, and dyslipidemia.
Keywords: adult; anxiety; article; cardiovascular risk; cerebrovascular accident; controlled study; demography; depression; dyslipidemia; female; follow up; fracture; gender dysphoria; hormonal therapy; human; hypercholesterolemia; hypertension; hypertriglyceridemia; intersex; major clinical study; male; medical record review; Minnesota; non insulin dependent diabetes mellitus; obesity; posttraumatic stress disorder; prevalence; public health; resident; retrospective study; suicidal ideation; suicide attempt; tobacco use; transgender; victim

Self-harm and suicidal behaviour among LGBTQ+ young people: An overlooked public mental health issue in Africa - Quarshie, E.N.-B. (The International journal of social psychiatry, 2020)
Keywords: Africa; automutilation; human; letter; LGBTQIA+ people; mental health; suicidal behavior

‘Our life is pointless … ’: Exploring discrimination, violence and mental health challenges among sexual and gender minorities from Brazil - Malta, M.; Gomes de Jesus, J.; LeGrand, S.; Seixas, M.; Benevides, B.; Silva, M.D.D.; Lana, J.S.; Huynh, H.V.; Belden, C.M.; Whetten, K. (Global Public Health, 2020)
Worldwide, Brazil has the highest prevalence of violence and hate crimes against sexual and gender minorities (SGMs) among countries with available data. To explore the impact of this scenario, we conducted a qualitative study with 50 SGMs from Rio de Janeiro, Brazil. Among the participants, 66% screened positive for generalised anxiety disorder, 46% for major depressive disorder and 39% for PTSD. A third reported low self-esteem (32%) and one quarter low social support (26%). Experiences of interpersonal discrimination were highly prevalent ('60%), while institutional discrimination related to employment or healthcare was reported by 46% of participants. Verbal abuse is very common (80%), followed by physical assault (40%). Sexual violence is highly frequent among women. Focus groups analysis highlighted three major domains: (1) stigma and discrimination (family, friends and partners, in schools and health services, influencing social isolation); (2) violence (bullying, harassment, physical and sexual violence); and (3) mental suffering (alcohol and drug abuse, depression, suicidality, anxiety). Our findings suggest a close synergy between experiences of discrimination and violence with selected mental disorders. This complex synergy might be better addressed by longer-term individual and group-level interventions that could foster social solidarity among the different groups that comprise SGMs.
Keywords: adolescent; adult; alcohol abuse; article; Brazil; bullying; conceptual framework; depression; drug abuse; employment; family; female; friend; generalized anxiety disorder; harassment; human; major clinical study; major depression; male; mental disease; partner violence; physical violence; posttraumatic stress disorder; priority journal; qualitative research; Rosenberg Self-Esteem Scale; self esteem; sex worker; sexism; sexual and gender minority; sexual assault; sexual violence; social stigma; social support; suicidal behavior; suicidal ideation; verbal hostility

Increased risk of suicidal ideation among French women: the mediating effect of lifetime sexual victimisation. Results from the nationally representative 2017 Health Barometer survey - El-Khoury, F.; Puget, M.; Leon, C.; du Roscoat, E.; Velter, A.; Lydié, N.; Sitbon, A. (Archives of Women's Mental Health, 2020)
Sexual victimisation has been associated with suicidal ideation, especially among women; however data on this association from a large sample of general population is surprisingly limited. Also, no study quantifies sex differences in the effect of sexual victimisation on suicide risk. We used data from the French Health Barometer, a general population phone survey, which recruited 25,319 adults aged 18 to 75 years in 2017. Data were weighted to be representative of the French adult population. Three outcomes were examined: (a) suicidal ideation in the preceding year, (b) suicidal imagery (having thought about how to commit suicide), and (c) suicide attempt in the preceding year. We conducted adjusted mediation analyses, using the counterfactual approach, to evaluate the contribution that lifetime sexual victimisation has in the association between sex and suicide risk. Women were around five times more likely to report lifetime sexual violence (9.1% vs 1.9%) and were more at risk of any suicidal ideation (Ora = 1.20 (95%CI: 1.07–1.36)) and suicidal imagery (Ora = 1.39 (95%CI: 1.20–1.61)), but not suicide attempt compared to men in adjusted analysis. In mediation analysis, sexual victimisation explained 49 and 40% of the increased risk women have compared to men in suicidal ideation and suicidal imagery, respectively. Sexual violence is more prevalent among women and explains a substantial share of sex difference in suicide risk. Our findings reiterate the importance of the prevention of sexual violence and an adequate care for victims, especially women, in public health and mental health policies and initiatives.
Keywords: adult; aged; article; comparative study; cross-sectional study; demography; female; France; human; imagery; lifespan; major clinical study; male; priority journal; risk factor; sex difference; sexual and gender minority; sexual violence; social status; suicidal behavior; suicidal ideation; suicide attempt; telephone interview; victim

Kidney transplantation and donation in the transgender population: A single-institution case series - Ramadan, O.I.; Naji, A.; Levine, M.H.; Porrett, P.M.; Dunn, T.B.; Nazarian, S.M.; Weinrieb, R.M.; Kaminski, M.; Johnson, D.; Trofe-Clark, J.; Lorincz, I.S.; Blumberg, E.A.; et al. (American Journal of Transplantation, 2020)
The medical needs of the transgender population are increasingly recognized within the US health care system. Hormone therapy and gender-affirming surgery present distinct anatomic, hormonal, infectious, and psychosocial issues among transgender kidney transplant donors and recipients. We present the first reported experience with kidney transplantation and donation in transgender patients. A single-center case series (January 2014-December 2018) comprising 4 transgender kidney transplant recipients and 2 transgender living donors was constructed and analyzed. Experts in transplant surgery, transplant psychiatry, transplant infectious disease, pharmacy, and endocrinology were consulted to discuss aspects of care for these patients. Four transgender patients identified as male-to-female and 2 as female-to-male. Three of 6 had gender-affirming surgeries prior to transplant surgery, 1 of whom had further procedures posttransplant. Additionally, 4 patients were on hormone therapy. All 6 had psychiatric comorbidities. The 4 grafts have done well, with an average serum creatinine of 1.45 mg/dL at 2 years (range 1.01-1.85 mg/dL). However, patients encountered various postoperative complications, 1 of which was attributable to modified anatomy. Thus, transgender kidney transplant patients can present novel challenges in regard to surgical considerations as well as pre- and posttransplant care. Dedicated expertise is needed to optimize outcomes for this population.
Keywords: suprapubic catheter; acetylsalicylic acid; antibiotic agent; atypical antipsychotic agent; creatinine; estradiol; finasteride; gestagen; leuprorelin; mycophenolate mofetil; prednisone; serotonin uptake inhibitor; tacrolimus; testosterone; thymocyte antibody; warfarin; acute kidney failure; adult; anemia; anxiety; article; bipolar I disorder; clinical article; clinical decision making; clinical research; comorbidity; coronary artery aneurysm; creatinine blood level; delayed graft function; drug dependence; end stage renal disease; female; gender dysphoria; gender identity; generalized anxiety disorder; graft recipient; gynecomastia; health disparity; hemodialysis; hormonal therapy; hospital readmission; hot flush; human; Human immunodeficiency virus infection; hypertension; immunosuppressive treatment; intermittent catheterization; kidney donor; kidney graft; kidney transplantation; length of stay; living donor; lymphocele; major depression; male; mental health; middle aged; military service; mucocutaneous lymph node syndrome; nephrectomy; percutaneous nephrostomy; physical abuse; postoperative care; postoperative complication; posttraumatic stress disorder; priority journal; psychotherapy; sex reassignment; suicide attempt; transgender; treatment refusal; ureteroneocystostomy; urethra stenosis; urethrotomy; urinary tract infection; vagina bleeding

Informed consent and childhood gender dysphoria: emerging complexities in diagnosis and treatment - d’Abrera, J.C.; D’Angelo, R.; Halasz, G.; Prager, S.; Morris, P. (Australasian Psychiatry, 2020)
Objective: To explore some of the emerging complexities in the management of childhood gender dysphoria. Conclusion: The authors raise questions about the gender-affirmation approach and highlight concerns about informed consent and research ethics.
Keywords: sex hormone; article; childhood disease; cognition; cohort analysis; DSM-5; DSM-IV; emotion; female; gender dysphoria; human; maturity; morbidity; mortality; prescription; psychiatry; psychosocial care; psychotherapy; puberty; sex reassignment; social psychology; suicide

The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US - Lelutiu-Weinberger, C.; English, D.; Sandanapitchai, P. (Behavioral Medicine, 2020)
Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one’s gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.
Keywords: HIV test; adult; aged; article; controlled study; distress syndrome; female; health care policy; health care system; health care utilization; hormonal therapy; human; immigration; major clinical study; mental health; middle aged; outcome assessment; outcome variable; practice guideline; psychological resilience; race difference; sexism; sexual assault; sexual orientation; social network; social support; structural equation modeling; substance use; suicidal ideation; transgender

The Moderating Effect of Resilience on the Relationship between Adverse Childhood Experiences (ACEs) and Quality of Physical and Mental Health among Adult Sexual and Gender Minorities - Schnarrs, P.W.; Stone, A.L.; Salcido, R.; Georgiou, C.; Zhou, X.; Nemeroff, C.B. (Behavioral Medicine, 2020)
Sexual and gender minority (SGM) individuals experience a greater burden of poor mental health compared to heterosexual individuals. One factor that helps to explain this disparity is trauma experienced during childhood. SGM are more likely to report traumatic experiences during childhood contributing to this disparity. Previous research has shown that resilience moderates the relationship between childhood trauma and adults mental health outcomes. As part of the Strengthening Colors of Pride project, data on 463 SGM adults living in San Antonio were collected using surveys. A diverse recruitment strategy was used in conjunction with a community advisory board. The brief resilience scale (BRS) was used to assess intrapersonal level resilience to determine if there was an effect on the relationship between ACEs and quality of mental and physical health. Differences were noted for some items across low, normal, and high levels of resilience. Both ACEs and BRS significantly predicted quality of mental and physical health. We also noted a significant interaction between ACEs and BRS with regard to quality of mental health. Findings suggest there is a relationship between intrapersonal level resilience, ACEs, and quality of mental health.
Keywords: adult; aged; article; behavioral risk factor surveillance system; Brief Resilience Scale; child abuse; child neglect; childhood adversity; childhood trauma; divorce; domestic violence; emotional abuse; emotional neglect; female; gender identity; health care disparity; human; major clinical study; male; mental disease; mental health; middle aged; participatory research; physical abuse; psychological resilience; psychological resilience scale; sexual abuse; sexual and gender minority; sexual orientation; substance abuse; suicide attempt; transgender; young adult

Dysmenorrhea and Endometriosis in Transgender Adolescents - Shim, J.Y.; Laufer, M.R.; Grimstad, F.W. (Journal of Pediatric and Adolescent Gynecology, 2020)
Study Objective: To study the presentation of dysmenorrhea and endometriosis in transmasculine adolescents and review their treatment outcomes. Design: A retrospective review. Setting: Boston Children's Hospital. Participants: Transmasculine persons younger than 26 years old who were diagnosed with dysmenorrhea and treated between January 1, 2000 and March 1, 2020. Interventions: Not applicable. Main Outcome Measures: An electronic medical record review of the clinical characteristics, transition-related care, and treatment outcomes. Results: Dysmenorrhea was diagnosed in 35 transmasculine persons. Mean age was 14.9 years ± 1.9 years. Twenty-nine (82.9%) were diagnosed after social transition. Twenty-three of 35 (65.7%) were first treated with combined oral contraceptives, but 14/23 (61%) discontinued or transitioned to alternative therapy. Twelve patients with dysmenorrhea alone initiated testosterone treatment, and 4/12 (33.3%) experienced persistent symptoms. Seven of 35 patients with dysmenorrhea (20.0%) were laparoscopically evaluated for endometriosis, and it was confirmed in all seven. Six had stage I disease, and one had stage II. Three of the 7 (42.9%) were diagnosed after social transition, with one diagnosed 20 months after initiating testosterone treatment. Their endometriosis was treated with combined oral contraceptives, danazol, or progestins; four experienced suboptimal response during treatment with these therapies alone. Two of those with suboptimal response subsequently resolved their dysmenorrhea when using testosterone. Five patients with endometriosis initiated testosterone treatment, and of the 5 (40%) experienced persistent symptomatology with combined testosterone and progestin therapies. Conclusion: To our knowledge, this is the first study to characterize endometriosis in transmasculine persons. Evaluation for endometriosis was underutilized in transmasculine persons with dysmenorrhea, despite those who underwent laparoscopic evaluation and had disease confirmation. Although testosterone treatment can resolve symptoms in some, others might require additional suppression. Endometriosis should be considered in transmasculine persons with symptoms even when they are using testosterone.
Keywords: levonorgestrel releasing intrauterine system; danazol; gestagen; levonorgestrel; norethisterone acetate; oral contraceptive agent; testosterone; adolescent; alternative medicine; androgen therapy; article; bleeding; breast tenderness; clinical article; drug substitution; drug withdrawal; dysmenorrhea; endometriosis; female to male transgender; human; laparoscopic surgery; male; menarche; pain; priority journal; retrospective study; social adaptation; social transition; suicidal ideation; symptomatology; treatment outcome; treatment response; unspecified side effect

The link between LGBTQ-supportive communities, progressive political climate, and suicidality among sexual minority adolescents in Canada - Saewyc, E.M.; Li, G.; Gower, A.L.; Watson, R.J.; Erickson, D.; Corliss, H.L.; Eisenberg, M.E. (Preventive Medicine, 2020)
Despite supportive structural changes to reduce stigma towards lesbian, gay, and bisexual, transgender, queer, and questioning (LGBTQ) Canadian residents, sexual minority youth still face disparities compared to heterosexual peers. We aimed to characterize LGBTQ-supportive environments and political climates, and examine their links to suicidal behavior among sexual minority adolescents in western Canada. Data were from the 2013 British Columbia Adolescent Health Survey, a cluster-stratified random cross-sectional survey of public school students in BC, Canada; We sampled 2678 self-identified LGB and mostly heterosexual students (69% girls) from 274 schools, representing an estimated provincial population of 24,624 sexual minority students in weighted models. Student reports of past-year suicidal ideation, suicidal attempts, and self-harm behaviors were merged with community-level data assessing diverse aspects of LGBTQ-supportive resources and progressive political climates in communities surrounding the schools. Adjusted multilevel models showed that for sexual minority adolescent girls, higher community LGBTQ-supportiveness predicted marginally significant lower suicidal ideation (aOR = 0.94, 95% CI [0.88, 1.01]) and suicidal attempts (aOR = 0.91, 95% CI [0.83, 1.00]) and significantly lower self-harm behaviors (aOR = 0.91, 95% CI [0.85, 0.98]). Further, progressive political climates predicted marginally significant lower suicidal ideation (aOR = 0.89, 95% CI [0.78, 1.02]) and significantly lower self-harm behaviors (aOR = 0.87, 95% CI [0.77, 0.99]). For sexual minority adolescent boys, no community-level variables were associated with suicidal behavior in adjusted models. Thus, LGBTQ-supportive communities and progressive political climates appear to be protective against suicidal behavior among sexual minority adolescent girls, but not sexual minority adolescent boys.
Keywords: adolescent; adult; article; automutilation; Canada; child; community care; controlled study; ethnicity; female; health care access; health care disparity; human; LGBTQIA+ people; major clinical study; male; politics; prediction; priority journal; risk assessment; sex difference; sexual and gender minority; sexual orientation; suicidal behavior; suicidal ideation; suicide attempt

Suicide Attempts Among a Cohort of Transgender and Gender Diverse People - Mak, J.; Shires, D.A.; Zhang, Q.; Prieto, L.R.; Ahmedani, B.K.; Kattari, L.; Becerra-Culqui, T.A.; Bradlyn, A.; Flanders, W.D.; Getahun, D.; Giammattei, S.V.; Hunkeler, E.M.; et al. (American Journal of Preventive Medicine, 2020)
Introduction: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. Methods: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. Results: During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged <18 years than among those aged >45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2–5 times higher among those with 1–2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. Conclusions: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings.
Keywords: adolescent; adult; age; article; automutilation; child; cohort analysis; ethnic difference; female; human; incidence; major clinical study; male; medical history; mental health; race difference; suicidal ideation; suicide attempt; transgender

Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: An open-label safety and feasibility pilot study - Anderson, B.T.; Danforth, A.; Daroff, P.R.; Stauffer, C.; Ekman, E.; Agin-Liebes, G.; Trope, A.; Boden, M.T.; Dilley, P.J.; Mitchell, J.; Woolley, J. (EClinicalMedicine, 2020)
Background: Psilocybin therapy has shown promise as a rapid-acting treatment for depression, anxiety, and demoralization in patients with serious medical illness (e.g., cancer) when paired with individual psychotherapy. This study assessed the safety and feasibility of psilocybin-assisted group therapy for demoralization in older long-term AIDS survivor (OLTAS) men, a population with a high degree of demoralization and traumatic loss. Methods: Self-identified gay men OLTAS with moderate-to-severe demoralization (Demoralization Scale-II ≥8) were recruited from the community of a major US city for a single-site open-label study of psilocybin-assisted group therapy comprising 8–10 group therapy visits and one psilocybin administration visit (0·3–0·36 mg/kg po). Primary outcomes were rate and severity of adverse events, and participant recruitment and retention. The primary clinical outcome was change in mean demoralization from baseline to end-of-treatment and to 3-month follow-up assessed with a two-way repeated measures ANOVA. Trial registration: Clinicaltrials.gov (NCT02950467) Findings: From 17 July 2017 to 16 January 2019, 18 participants (mean age 59·2 years (SD 4·4)) were enrolled, administered group therapy and psilocybin, and included in intent-to-treat analyses. We detected zero serious adverse reactions and two unexpected adverse reactions to psilocybin; seven participants experienced self-limited, severe expected adverse reactions. We detected a clinically meaningful change in demoralization from baseline to 3-month follow-up (mean difference -5·78 [SD 6·01], ηp2 = 0·47, 90% CI 0·21–0·60). Interpretation: We demonstrated the feasibility, relative safety, and potential efficacy of psilocybin-assisted group therapy for demoralization in OLTAS. Groups may be an effective and efficient means of delivering psychotherapy pre- and post-psilocybin to patients with complex medical and psychiatric needs. Funding: Carey Turnbull, Heffter Research Institute, NIMH R25 MH060482, NIH UL1 TR001872, River Styx Foundation, Saisei Foundation, Sarlo Foundation, Stupski Foundation, Usona Institute, US Department of Veterans Affairs (Advanced Neurosciences Fellowship and IK2CX001495).
Keywords: NCT02950467; biomedical software; Microsoft Excel v.2016; Stata v.16; psilocybine; acquired immune deficiency syndrome; adult; anamnesis; anxiety disorder; article; ataxia; borderline state; checklist; cholecystitis; clinical article; clinical protocol; cohort analysis; Columbia Suicidality Severity Rating Scale; controlled study; data analysis software; demoralization; depression; disease severity; drug efficacy; drug safety; drug tolerability; experimental psychosis; exploratory research; fatigue; feasibility study; funding; gait disorder; generalized anxiety disorder; good clinical practice; group therapy; headache; human; hypertension; insomnia; intention to treat analysis; major depression; male; middle aged; Montreal cognitive assessment; nausea; outcome assessment; panic; paranoia; pilot study; pneumothorax; psychotherapy; rating scale; renal cell carcinoma; restlessness; suicide attempt; survival time; tachycardia; thought disorder; tinnitus; urine incontinence; Microsoft Excel v.2016; Stata v.16

Serious and persistent suicidality among European sexual minority youth - Gambadauro, P.; Carli, V.; Wasserman, D.; Balazs, J.; Sarchiapone, M.; Hadlaczky, G. (PLoS ONE, 2020)
Background Suicide is a leading cause of death among adolescents and more knowledge from high risk groups is needed in order to develop effective preventive strategies. The aim of this study was to evaluate the association between sexual minority status and suicidality in a multinational sample of European school pupils. Methods A self-report questionnaire was delivered to 2046 adolescents (mean age 15.34±1.01; 56.3% females) recruited from 27 randomly selected schools in 6 European countries. Suicidal ideation, measured with the Paykel Suicide Scale (PSS), and lifetime suicide attempts were compared between heterosexual and sexual minority (i.e. those with a non-heterosexual orientation) youth. Poisson regression analyses studied the longitudinal association between sexual minority status and the rate of serious suicidal ideation, measured at three time-points during a 4-month period. Several variables, including alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity, were included in multivariable analysis. Sex-stratified analyses evaluated the association respectively among females and males. Results Of 1958 pupils included in analysis (mean age 15.35±1.00; females 56.8%), 214 (10.9%) were categorized as sexual minority youth (SMY). When compared to heterosexual youth (HSY), SMY were significantly more exposed to substance abuse, bullying, school-related stress, and lower economic status. SMY pupils had significantly higher suicidal ideation scores (p<0.001; r 0.145) as well as higher prevalence of serious suicidal ideation (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.83-3.79) and previous suicide attempts (OR 2.72, 95%CI 1.77-4.18), compared to their HSY peers. The rate of serious suicidal ideation reports during the study was significantly higher among SMY compared to HSY (rate ratio [RR] 2.55, 95%CI 1.90-3.43). A significant difference was found even when controlling for the pupils' country as well as after adjustment for alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity (adjusted RR 1.73, 95%CI 1.23-2.48). Stratified analyses showed significant associations between SMY status and persistent serious suicidal ideation for both sexes, with a notably strong association among male pupils (females aRR 1.51, 95%CI 1.01-2.24; males aRR 3.84, 95%CI 1.94- 7.59). Conclusions European sexual minority youth are a high-risk group for suicidality, independently from objective factors such as victimization or substance abuse. There is a need to develop primary and secondary preventive measures for sexual minority youth, including the management of context vulnerabilities and related distal stressors, before the establishment of proximal stressors. Context-targeting interventions may effectively focus on social and economic factors, as well as on the potentially different risk profile of female and male sexual minority youth.
Keywords: illicit drug; adolescent; alcohol consumption; article; bullying; cohort analysis; controlled study; economic status; European; family interaction; female; heterosexuality; high risk population; human; juvenile; longitudinal study; major clinical study; male; mental disease assessment; Paykel Suicide Scale; prevalence; questionnaire; religion; school stress; sexual and gender minority; social interaction; substance abuse; suicidal behavior; suicidal ideation; suicide attempt

The Rejection Sensitivity Model as a Framework for Understanding Sexual Minority Mental Health - Feinstein, B.A. (Archives of sexual behavior, 2020)
Sexual minorities are disproportionately affected by mental health problems (e.g., depression, anxiety, substance use disorders, suicidality). Minority stress theory and the psychological mediation framework have become the predominant conceptual models used to explain these disparities, and they have led to substantial advances in research on stigma-related stress and mental health. However, the field's reliance on these models has limited the extent to which other theories have been considered as potential frameworks for further advancing our understanding of sexual minority mental health. In this article, I discuss how the rejection sensitivity (RS) model can be used to complement and extend minority stress theory and the psychological mediation framework by: (1) emphasizing the role of perception in stigma-related experiences; (2) acknowledging the unique consequences of different anticipatory emotions; (3) describing additional mechanisms linking proximal minority stressors to mental health; and (4) further specifying the temporal order of these processes. I conclude by discussing the importance of attending to developmental processes in research on sexual orientation-related RS and describing important directions for future research.
Keywords: female; human; male; mental health; mental stress; psychology; sexual and gender minority

Social and Medical Gender Affirmation Experiences Are Inversely Associated with Mental Health Problems in a U.S. Non-Probability Sample of Transgender Adults - Hughto, J.M.W.; Gunn, H.A.; Rood, B.A.; Pantalone, D.W. (Archives of sexual behavior, 2020)
A dearth of research has explored concurrently the associations between multiple forms of gender affirmation (or transitioning) and the mental health of transgender adults. In 2015, 288 U.S. transgender adults completed a cross-sectional, online survey assessing demographics, gender affirmation experiences, and mental health. Adjusting for age and discrimination experiences, we used mixed-effect logistic regression analyses to examine changes in self-reported suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) before and after initiating the gender affirmation process, and linear regression analyses to examine associations between gender affirmation experiences and self-reported depressive, anxiety, and stress symptoms. Overall, 81.3% of participants identified along the female-to-male, trans masculine gender spectrum (of which 20.9% identified as non-binary) and 18.8% identified along the male-to-female, trans feminine gender spectrum (of which 7.4% identified as non-binary). Nearly all participants (98.6%) reported disclosing their gender identity to family or a coworker; 67.4% endorsed recently using hormones, and 31.3% endorsed a gender-affirming medical procedure. In multivariable models, participants were at greater odds of NSSI, contemplating suicide, and attempting suicide before initiating the gender affirmation process compared to after. In additional models, gender identity disclosure and medical procedure engagement were inversely associated with depressive and anxiety symptoms, whereas gender identity disclosure, hormone use, and medical procedure engagement were inversely associated with stress symptoms. Finally, the number of gender affirmation experiences endorsed was inversely associated with depressive, anxiety, and stress symptoms. Findings support the possibility that social and medical gender affirmation experiences may be protective against mental health problems in transgender adults.
Keywords: adult; cross-sectional study; female; human; male; mental disease; psychology; transgender; United States

Variation in Suicide Risk among Subgroups of Sexual and Gender Minority College Students - Horwitz, A.G.; Berona, J.; Busby, D.R.; Eisenberg, D.; Zheng, K.; Pistorello, J.; Albucher, R.; Coryell, W.; Favorite, T.; Walloch, J.C.; King, C.A. (Suicide & life-threatening behavior, 2020)
OBJECTIVE: Sexual and gender minorities are at elevated risk for suicide, yet few studies have examined differences in risk within many sexual and gender minority subgroups. The purpose of this study was to examine differences in prevalence for suicide risk factors among a wide range of sexual orientations and gender identities. METHOD: Forty-one thousand four hundred and twelve college students (62% cis-female, 37% cis-male, 1% transgender/genderqueer) completed a wellness screen that included four suicide risk factors (depression, heavy alcohol use, suicide ideation, suicide attempt). RESULTS: Gender minority students (i.e., transgender, genderqueer/non-binary) had significantly higher rates of depression, suicide ideation, and suicide attempts relative to cisgender peers, although there were no within-group differences among gender minority students. Adjusted odds ratios for endorsing two or more (2+) suicide risk factors were substantially higher for all sexual minority subgroups relative to heterosexuals. Among sexual minorities, those identifying as pansexual, bisexual, queer, or mostly gay/lesbian had greater odds of endorsing 2+ suicide risk factors relative to students identifying as mostly heterosexual, gay/lesbian, asexual, or 'other sexual minority'. Pansexual students had 33% greater odds of endorsing 2+ suicide risk factors relative to bisexual students. CONCLUSIONS: These findings highlight significant variation in suicide risk among sexual minority subgroups and the need for targeted interventions for subgroups at highest risk.
Keywords: adult; alcohol consumption; article; bisexuality; college student; controlled study; female; gender identity; heterosexuality; homosexual female; human; major clinical study; male; prevalence; risk factor; suicidal ideation; suicide attempt; transgender

LGBQ+ Self-Acceptance and Its Relationship with Minority Stressors and Mental Health: A Systematic Literature Review - Camp, J.; Vitoratou, S.; Rimes, K.A. (Archives of sexual behavior, 2020)
Many individuals who identify as lesbian, gay, bisexual, queer, and with other non-heterosexual orientations (LGBQ+) experience stigma, prejudice, and/or discrimination because of their sexuality. According to minority stress and identity development theories, these experiences can contribute to difficulties with self-acceptance of sexuality. Lower self-acceptance is considered a risk factor for adverse mental health outcomes. The current review aims to investigate whether self-acceptance of sexuality is associated with minority stressors or difficulties with mental health in LGBQ+ individuals, as well as whether there are differences in self-acceptance between different sexual orientations. Five bibliographic databases were searched. Thirteen studies were identified which used quantitative methodology to investigate associations between self-acceptance, minority stressors, and/or mental health within LGBQ+ samples, or differences in self-acceptance between different sexual orientations. The results from these cross-sectional studies suggested that lower self-acceptance of sexuality was associated with higher levels of self-reported minority stressors, including a lack of acceptance from friends and family, a lack of disclosure to others, and internalized heterosexism. Lower self-acceptance of sexuality was associated with poorer mental health outcomes, including greater global distress, depression symptoms, and lower psychological well-being. There was no significant relationship with suicidality. Studies also found that LGBQ+ individuals had lower general self-acceptance compared to heterosexual participants, bisexual individuals had lower sexuality self-acceptance compared to lesbian/gay individuals, and lesbian women had lower sexuality self-acceptance compared to gay men. Given the potential importance of self-acceptance for LGBQ+ populations, further research is required with more robust methodology. Self-acceptance could be a potential target in clinical interventions for LGBQ+ individuals.
Keywords: adult; article; bibliographic database; bisexuality; controlled study; cross-sectional study; depression; distress syndrome; female; friend; heterosexuality; homosexual female; homosexual male; human; male; psychological well-being; quantitative analysis; physiological stress; suicidal behavior; systematic review

Gender and Sexual Identities Predicting Patterns of Co-occurring Health Risks Among Sexual Minority Youth: a Latent Class Analysis Approach - Srivastava, A.; Davis, J.P.; Goldbach, J.T. (Prevention science : the official journal of the Society for Prevention Research, 2020)
Behavioral health disparities (e.g., substance use, mental health) exist for gender nonconforming (GNC) and sexual minority youth; however, there is limited knowledge on disparities that may be unique among youth who identify as both a sexual and gender minority. This study utilized a diverse sample of GNC and cisgender sexual minority youth seeking crisis services to examine co-occurrence of behavioral health outcomes. Surveys were administered with youth (aged 12-24, N = 592), and latent class analyses were applied. Two latent class regression models were conducted to examine how gender and sexual identity separately (independent effect; Model 1) and configurations of gender and sexual identity (Model 2) predicted class membership. Analyses resulted in a four-class solution: High All (17.6%), High Substance Use and Moderate Mental Health (10.6%), Low All (20.1%), and High Suicide and High Mental Health (51.7%). In our first model, youth who identified as GNC had 2.11 higher odds of being in the High Suicide and High Mental Health class compared to the Low All class; however, sexual identity was not a significant predictor. In the second model, individuals identifying as GNC gay or lesbian or GNC pansexual had 1.95 and 2.57 higher odds, respectively, of being in the High Suicide and High Mental Health class compared to the Low All class. Our study suggests the information on gender and sexual identities together are more helpful in identifying youth at risk for co-occurring negative health outcomes. Implications for prevention approaches are described.
Keywords: article; child; controlled study; female; gender identity; health hazard; homosexual female; human; human experiment; juvenile; latent class analysis; major clinical study; male; mental health; school child; substance use; suicide

The Healthy Young Men's Cohort: Health, Stress, and Risk Profile of Black and Latino Young Men Who Have Sex with Men (YMSM) - Kipke, M.D.; Kubicek, K.; Akinyemi, I.C.; Hawkins, W.; Belzer, M.; Bhandari, S.; Bray, B. (Journal of urban health : bulletin of the New York Academy of Medicine, 2020)
Young men who have sex with men (YMSM), especially YMSM of color, are at increased risk for a wide range of threats to their health and well-being. In this study, we recruited and surveyed an urban sample of 448 young African American/Black (Black), Hispanic/Latino (Latino), and multi-racial/ethnic YMSM, ages 16-24 years (mean = 22.3 years), about stressful life events, their health and mental health, their access to and utilization of care, and their involvement in risk-related behaviors. We found that the majority reported experiences of racism (87%) and homophobia (76%). A high percentage reported food insecurity/hunger (36%), residential instability (15%), financial hardship (63%), and conflict with family/friends (62%). The prevalence of risk behaviors was also high, including recent use of tobacco (46%), alcohol (88%), and marijuana (72%), and 41% tested positive for 1+ drugs. Furthermore, 26% tested positive for 1+ sexually transmitted infections (STIs). Over half (56%) reported being worried about their health, 33% reported having a chronic health condition and 31% a mental health condition, and 45% had wanted/needed mental health services during the past year. Further, 17% reported suicidal ideation/had planned a suicide attempt and 26% had ever engaged in self-injurious behaviors. Significant differences by race/ethnicity and HIV status included residential status/food insecurity, type of racism/homophobia, drug use, and STIs. These findings demonstrate how vulnerable this population is with respect to a wide range of structural and social determinants of health that may be important drivers of behavioral, health, mental health outcomes, and potentially long-term health disparities.
Keywords: adolescent; adult; African American; attitude to health; cohort analysis; health status; high risk behavior; Hispanic; human; male; male homosexuality; psychology; urban population; young adult

Maternal Support Is Protective Against Suicidal Ideation Among a Diverse Cohort of Young Transgender Women - Jin, H.; Restar, A.; Goedel, W.C.; Ogunbajo, A.; Biello, K.; Operario, D.; Kuhns, L.; Reisner, S.L.; Garofalo, R.; Mimiaga, M.J. (LGBT health, 2020)
Purpose: We assessed if young transgender women (YTW) with parents who are supportive of their transgender identity had lower odds of having suicidal ideation compared with YTW with unsupportive parents. Methods: This study analyzed baseline findings from a diverse sample of 297 sexually active, YTW 16-29 years of age who were enrolled in Project LifeSkills, a randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. Bivariate and multivariable logistic regression were used to assess if parental support was associated with a decreased odds of suicidal ideation. Results: Nearly one-fifth (18.9%) of YTW reported suicidal ideation at baseline. In our adjusted multivariable model, YTW with supportive mothers had 0.37 (95% confidence interval = 0.15-0.90) times the odds of having suicidal ideation compared with YTW with unsupportive mothers. Conclusion: This study found that the odds of suicidal ideation were lower among YTW who had mothers who were supportive of their transgender identity. Our results suggest that parent-focused interventions to improve the relationships between YTW and their parents may lower the odds of YTW having suicidal ideation. Clinical Trial Registration Identifier: NCT01575938.
Keywords: NCT01575938; adolescent; adult; article; cohort analysis; controlled study; female; human; Human immunodeficiency virus; Illinois; Massachusetts; mental health; mother; nonhuman; prevention; randomized controlled trial; suicidal ideation; transgender

It is time to mobilize suicide prevention for sexual and gender minorities in Canada - Ferlatte, O.; Salway, T.; Oliffe, J.L.; Saewyc, E.M.; Holmes, C.; Schick, L.; Purdie, A.; Damstrom-Albach, D.D.; Mantler, E.R.G.; Ho, D.; Knight, R. (Canadian journal of public health = Revue canadienne de sante publique, 2020)
Suicide is a significant health issue among sexual and gender minority adults (SGMA); yet, there are no tailored suicide prevention programs for these marginalized populations in Canada. We hosted two world cafés with community leaders, health professionals, policymakers, and researchers to identify recommendations for mobilizing SGMA-focused suicide prevention programs. We identified five priorities: (1) make society safer for sexual and gender minorities; (2) decrease barriers to mental health services; (3) support community-driven and community-based interventions; (4) increase suicide knowledge and reduce stigma; (5) expand the knowledge base on SGMA suicide. In the absence of a national Canadian SGMA suicide prevention policy, these priorities provide a starting point in addressing SGMA suicide inequities by advancing SGMA-tailored interventions.
Keywords: adult; article; bisexuality; Canada; female; homosexual female; human; human experiment; knowledge base; male; mental health service; prevention; stigma; suicide; transgender

Critical overview of adolescent suicides in india; a public health concern - Mathew, A.; Suja, M.K.; Priya, V. (Medico-Legal Update, 2020)
Suicide is the second most leading cause of death among the 15-29 age group (adolescent). The World Health Organization statistics indicate that 8, 00,000 people suicide annually. The National Crime Records Bureau records indicates that suicidal deaths in 2014 is 15.8% more than 2004, 17% of the suicides worldwide happens in India. Suicides is a contingency that affects the victim’s family community and nation at large and has a long lasting effect on the people left behind. The adolescents often don’t get help when needed which leads to suicides. Sustainable Development Goals 3 intents to promote healthy lives and promote wellbeing for all. Aim: To understand; 1) the percentage increase of suicide in India, difference between male and female suicides, 2) identify states with maximum number of suicides, 3) identify states with maximum number of student suicides, 4) Major Causes for suicide among adolescent male, female and trans gender and to study 5) Major means adopted for suicides in India, 6) Understand the significance promoting wellness addressing adolescent suicides. Results: there is significant increase in number of suicides form 2013 to 2016 and it affects the nation’s economy. The states with maximum number of adolescent suicides are 1) Maharastra, 2) Tamil Nadu, 3) West Bengal, 4) Madhya Pradesh and 5) Karnataka. The major Causes for suicides among adolescents male, female and trans gender were identified. The most common means adopted for suicide among adolescents have been identified and listed. Conclusion: The adolescent and student suicides in the nation are increasing rapidly causing serious economic burden to the nation. Hence a comprehensive suicide prevention plan must be developed, the policy should individually target the states with highest number of adolescent and student suicides, access to the most prominent means of suicides must be limited. A national suicide prevention help line and community based access points could be created to provide mental health first aid to the vulnerable adolescents and students.
Keywords: adolescent; adult; article; controlled study; economic aspect; female; first aid; gender; groups by age; human; Karnataka; Madhya Pradesh; major clinical study; male; mental health; public health; student; suicide; sustainable development; Tamil Nadu; transgender; victim; wellbeing; West Bengal

Greater Minority Stress is Associated with Lower Intentions to Disclose Suicidal Thoughts among LGBTQ + Youth - Chang, C.J.; Kellerman, J.; Feinstein, B.A.; Selby, E.A.; Goldbach, J.T. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2020)
OBJECTIVE: The current study examined suicide-related disclosure intentions in LGBTQ + youth, and the associations between reporting of lifetime experiences of minority stress and intentions to disclose suicidal thoughts. METHOD: A sample of 592 LGBTQ + youth ages 12-24 (22.3% cisgender men, 33.1% cisgender women, 44.6% gender diverse, 75.3% white) who contacted an LGBTQ-specific crisis service, completed a survey. RESULTS: Youth reported highest intentions to disclose future suicidal ideation to LGBTQ-specific crisis services, a mental health professional, and someone they know who also identifies as LGBTQ. They reported lowest suicide-related disclosure intentions to family, spiritual counselors, and emergency room personnel. Greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions. When specific domains of minority stress were examined separately, five domains were significantly associated with lower suicide-related disclosure intentions: identity management, family rejection, homonegative communication, negative expectancies, and internalized homonegativity. However, only internalized homonegativity remained significant when they were examined simultaneously. In addition, greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions to some groups (e.g., family, friends), but not others (e.g., others who have thought about or attempted suicide, others who identify as LGBT). CONCLUSIONS: Minority stress may play an important role in LGBTQ + youth's suicide-related disclosure intentions. As such, reducing minority stress and its effects may be an important target to promote disclosure of suicidal thoughts and access to treatment among LGBTQ + youth. HIGHLIGHTS Minority stress was associated with lower suicide-related disclosure intentions. Internalized homonegativity was uniquely associated with disclosure intentions. Reducing minority stress may promote disclosure of suicidal thoughts.
Keywords: adult; article; counselor; emergency ward; expectancy; female; friend; human; human experiment; human tissue; juvenile; LGBTQIA+ people; male; mental health care personnel; physiological stress; suicidal ideation; suicide attempt

Inequalities in Health and Care Among Lesbian, Gay, and Bisexual People Aged 50 and Older in the United Kingdom: A Systematic Review and Meta-analysis of Sources of Individual Participant Data - Kneale, D.; Thomas, J.; French, R. (The journals of gerontology. Series B, Psychological sciences and social sciences, 2020)
OBJECTIVES: Modeling the health and care trajectories of lesbian, gay, and bisexual (LGB) is essential to identify inequalities and support needs, yet because of the small sample of LGB people in any one survey, current evidence relies on studies that have poor generalizability and low power. This study assesses the magnitude of health inequalities among older LGB people across 10 outcomes, informed by evidence on the health trajectories and distinct LGB history of the United Kingdom. METHOD: A systematic review was conducted of representative data sources on older LGB and heterosexual people's health and care status in the United Kingdom. Individual Participant Data (IPD) meta-analysis was employed to synthesize data from up to 25 different sources. To account for the intricacies of individual data sets, the analysis employed a two-stage approach where an odds ratio and standard error was calculated for each data set individually, before being meta-analyzed through DerSimonian and Laird random effects models. RESULTS: Among men aged 50+, being gay, bisexual, or having another nonheterosexual orientation is associated with an increased risk of reporting long-term illness and health-related limitations. Indicators of mental health also suggest that gay and bisexual men are more likely to report low life satisfaction and to have attempted suicide over their life time. Among women, differences are apparent with regards to self-rated health as well as with engagement with risky health behaviors. DISCUSSION: The findings corroborate the minority stress theory, but they also generate new questions for researchers around when and how these inequalities emerge.
Keywords: aged; comparative study; female; health care disparity; health status; human; male; meta analysis; middle aged; sexual and gender minority; United Kingdom

Sexual orientation and adolescent suicide attempt and self-harm: a co-twin control study - O'Reilly, L.M.; Pettersson, E.; Donahue, K.; Quinn, P.D.; Klonsky, E.D.; Lundström, S.; Larsson, H.; Lichtenstein, P.; D'Onofrio, B.M. (Journal of child psychology and psychiatry, and allied disciplines, 2020)
BACKGROUND: Research has demonstrated that individuals who identify as a sexual minority (e.g., gay/lesbian, bisexual) are at increased risk for suicidality-related outcomes. However, previous research is primarily limited by the lack of adjustment for unmeasured (i.e., genetic and environmental) confounding factors and previous psychopathology. METHODS: Using the Child and Adolescent Twin Study in Sweden, we employed a co-twin control design to examine the extent to which the association between sexual orientation and adolescent suicide attempt and self-harm (SA/SH) was independent of genetic and environmental factors shared by twins, as well as measured symptoms of childhood psychopathology. RESULTS: Adolescents who identified as a sexual minority (i.e., gay/lesbian, bisexual, or other sexual orientation) were at two-fold increased odds for SA/SH (OR, 2.01 [95% confidence interval, 1.63-2.49) compared to heterosexual adolescents. When adjusting for all genetic and shared environmental factors that make twins similar and for measured childhood psychopathology, the association remained positive but attenuated to OR, 1.55 (1.11-2.16). CONCLUSIONS: Identifying as a sexual minority was associated with approximately 50% increased odds of SA/SH in adolescence after adjusting for unmeasured genetic and environmental factors shared by twins and for childhood psychopathology. The results support that environmental factors specifically associated with identifying as a sexual minority likely increase risk for SA/SH. Our findings highlight the need to monitor suicidality risk among this group.
Keywords: adolescence; adolescent; article; automutilation; bisexuality; child; controlled study; environmental factor; female; heterosexuality; homosexual female; human; mental disease; sexual behavior; suicide attempt; Sweden; twin study

Sexual Orientation Differences in Lethal Methods Used in Suicide: Findings From the National Violent Death Reporting System - Clark, K.A.; Mays, V.M.; Arah, O.A.; Kheifets, L.I.; Cochran, S.D. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2020)
We examined sexual orientation and sex differences in seven methods of suicide among adult suicides reported in the United States National Violent Death Reporting System (2012-2015; N = 59,075). Overall, most sexual minorities (i.e., lesbians, gay men, bisexuals) identified in the dataset used hanging (38%) followed by firearm (30%) and drug or poison ingestion (20%). Sexual minorities were more likely than heterosexuals to be younger, female, and Black/African American. Multivariate sex-stratified analyses in the overall sample showed that strong sexual orientation differences in lethal methods existed among men but not among women. However, when we compared sex differences in lethal methods among sexual minorities only, we found that lesbian/bisexual women, as compared to gay/bisexual men, were more likely to use a firearm or drug or poison ingestion than hanging. Findings suggest that the higher rate of suicide mortality among sexual minorities is likely driven by hanging, a method of suicide that is not particularly amenable to lethal method restricted-access prevention approaches. Future research directions, clinical training recommendations, and intervention opportunities are discussed.
Keywords: adult; African American; article; bisexual female; bisexual male; controlled study; drug overdose; female; firearm; heterosexuality; homosexual female; homosexual male; human; human tissue; ingestion; major clinical study; male; mortality; prevention; sex difference; suicide; United States; poison

Fatal comedown after taking 3-methylmethcathinone (3-MMC): A case report - Aknouche, F.; Maruejouls, C.; Kernalleguen, A.; Teston, K.; Mazoyer, C.; Gasnot, W.; Pellegrino, F.; Arbouche, N.; Gheddar, L.; Ameline, A.; Kintz, P. (Toxicologie Analytique et Clinique, 2020)
The use of cathinones is a recent phenomenon linked to the emergence of new psychoactive substances. Certain population groups, such as men who have sex with other men (MSM) while under the influence of stimulants, known as “chemsex”, may be more exposed. The authors report an original finding that seems indirectly linked to the death of a user. At 10.30 a.m., an argument broke out between a homosexual couple. One may have been a narcotics user and had taken cathinones several times in two days. To prevent an unpleasant comedown, he wanted to take some more drugs but his companion was opposed to it. At 8.35 p.m., the individual was found hanged at his workplace. The autopsy findings were consistent with hanging. A standard toxicological expertise was ordered that revealed the presence of 3-methylmethcathinone (3-MMC) at the following concentrations: femoral blood (49 ng/mL), cardiac blood (53 ng/mL), urine (310 ng/mL), stomach contents (74 ng/mL), and bile (205 ng/mL). GC/MS was essential to differentiate 3-MMC from 4-MMC (mephedrone). The pubic hair analyses revealed the following: 12 pg/mg of MDMA, 4 pg/mg of 3-MMC, and 28 pg/mg of buphedrone. The analysis of a vial found at the victim's home revealed the presence of buphedrone. Finally, 3-MMC and traces of MDMA, MDA, and buphedrone were found on the victim's clothes (T-shirt, underwear). All the 3-MMC concentrations were most probably underestimated owing to the renowned chemical instability of this molecule. The suicide appears to be related to the comedown described after taking stimulants. The circumstances seem similar to the rare cases described in the literature with a high prevalence of hanging.
Keywords: 3 methyl methcathinone; 4' methylmethcathinone; buphedrone; cathinone; narcotic agent; unclassified drug; article; autopsy; blood analysis; case report; clinical article; fatality; hair analysis; hanging; homosexuality; human; human tissue; male; mass fragmentography; men who have sex with men; prevalence; workplace

Differential experiences of mental health among trans/gender diverse adults in Michigan - Kattari, S.K.; Kattari, L.; Johnson, I.; Lacombe-Duncan, A.; Misiolek, B.A. (International Journal of Environmental Research and Public Health, 2020)
Transgender and gender diverse individuals experience high rates of health disparities, as compared with their cisgender (non-transgender) counterparts. One area in which these disparities is most grave is that of mental health, with some studies indicating transgender and gender diverse individuals as having a 40% rate of lifetime suicide attempts and similarly high rates of depression, anxiety, and suicidal ideation. These rates vary further within this population, with differential rates seen across sociodemographic factors, including race/ethnicity, gender, sexual orientation, disability status, education level, and income. This study explores mental health experiences across different social identities, using data from the 2018 Michigan Trans Health Survey (N = 659), a community-based participatory action research project collected in Michigan, United States, analyzed using chi-square tests of independence and logistic regressions. Findings indicate incredibly high rates of mental health concerns; 72.2% had been diagnosed with depression in their lifetime and 73.0% had been diagnosed with anxiety in their lifetime. In the past year, 49.9% had had non-suicidal self-injury (NSSI) thoughts, 45.4% had suicidal thoughts, 26.3% engaged in NSSI, and 7.7% had attempted suicide. Bivariate regressions showed some nuanced experiences of rates of mental health diagnoses and experiences, such as greater odds of experiencing all mental health disparities among those with disabilities, and differential odds across gender in regard to ever having a depression diagnosis, non-suicidal self-injury thoughts and engaging in non-suicidal self-injury behavior. This indicates a need for social workers, counselors, therapists, and other human services professionals to act more intentionally and with an intersectional lens when it comes to exploring the mental health of transgender and gender diverse persons.
Keywords: adult; anxiety disorder; article; automutilation; clinical outcome; controlled study; depression; descriptive research; ethnicity; experience; female; gender identity; health care access; health care disparity; health disparity; human; male; mental health; mental health service; Michigan; prevalence; psychological resilience; rural population; sexual orientation; social class; social support; suicidal ideation; suicide attempt; transgender; urban population

Age-and sex-specific risk factors for youth suicide: A mixed methods review - Kohlbeck, S.; Hargarten, S.; Cassidy, L.D. (Wisconsin Medical Journal, 2020)
Background: Suicide is the second-leading cause of death for individuals ages 10 through 34, and rates are rising. This study seeks to broaden the understanding of suicide in youths ages 10-17. Study Aims: Use a mixed-methods approach to investigate the different characteristics leading to youth suicide by 2 distinct youth age subgroups (pre-high school and high school) and by sex. Methods: A retrospective review and analysis of the Wisconsin Violent Death Reporting System data on Wisconsin resident suicides was conducted for 146 individuals ages 10 through 17 who died by suicide from 2012 through 2016. Results: A total of 20 common characteristics were extrapolated from the narratives. Among the 10-to 13-year-old age group, 4 age-specific characteristics emerged: estrangement, exposure to suicide, school issues, and adversity. Six age-specific characteristics emerged among the 14-to 17-year-old age group: history of abuse (P < 0.01), history of self-harm (P < 0.01), and history of suicide attempt (P < 0.01) were highly associated with female sex. Conclusions: This study demonstrates that there are unique age and sex-specific characteristics for teenage suicide. This information can be leveraged to plan focused prevention strategies relevant to youth in 2 distinct age groups.
Keywords: adolescent; age; alcohol abuse; article; attention deficit disorder; automutilation; cause of death; child; childhood adversity; ethnicity; exposure; female; firearm; high school; human; injury; intoxication; juvenile; legal aspect; male; pressure; psychological aspect; race; risk factor; sex; sexual and gender minority; strangulation; physiological stress; suicide attempt; Wisconsin

Alcohol Use and Suicidality by Sexual Orientation Among U.S. Youth, 2009–2017 - Phillips, G.L.; Turner, B.C.; Felt, D.; Marro, R.L.; Wang, X.; Ruprecht, M.M.; Broschart, J.; Beach, L.B. (American Journal of Preventive Medicine, 2020)
Introduction: Alcohol use and suicidality remain serious risks for U.S. youth. Research has established that disparities exist in these outcomes between heterosexual and sexual minority youth. However, research into the associations between alcohol use and suicidality has yet to consider the differential role of sexual orientation. Methods: Using a pooled, diverse sample from the 2009–2017 Youth Risk Behavior Survey, associations of alcohol use and suicidality by sex and sexual orientation, and changes in these outcomes over time, were investigated. Analyses were conducted in 2019. Results: Suicidality was highest among nonheterosexuals, who ranged from twofold to sevenfold higher odds to report suicidality across all time points, with the most striking disparities among male sexual minority youth. Rates among all students remained stable or increased over time; notable exceptions included a decrease in suicide attempts among bisexual students. Among all students, current alcohol use was associated with elevated levels of suicidality. For female students, the association between drinking and suicidality did not significantly differ by sexual identity; for male students, it was significant regardless of sexual identity and most pronounced among not sure youth. Conclusions: These results emphasize the need for additional research into the relationship between contemporaneous alcohol use and suicidality, with attention to differences based on sex, sexual orientation, and other factors that may impact these relationships. There is a particular need for research to examine the temporal nature of the association such that evidence-informed, high-impact interventions can be developed to improve suicidality outcomes among sexual minority youth.
Keywords: alcohol consumption; article; bisexuality; controlled study; current drinker; disease association; female; homosexual female; homosexual male; human; major clinical study; male; sex difference; sexual and gender minority; sexual orientation; student; suicidal behavior; suicidal ideation; suicide attempt; suicide planning; United States

Suicidal thoughts and behaviors and their associations with transitional life events in men and women: Findings from an international web-based sample - Milton, A.C.; Davenport, T.A.; Iorfino, F.; Flego, A.; Burns, J.M.; Hickie, I.B. (JMIR Mental Health, 2020)
Background: Although numerous studies have demonstrated sex differences in the prevalence of suicidal thoughts and behaviors (STB), there is a clear lack of research examining the similarities and differences between men and women in terms of the relationship between STB, transitional life events, and the coping strategies employed after experiencing such events when they are perceived as stressful. Objective: This study aims to examine the differences between men's and women's experiences of STB, sociodemographic predictors of STB, and how coping responses after experiencing a stressful transitional life event predict STB. Methods: A web-based self-report survey was used to assess the health and well-being of a voluntary community-based sample of men and women aged 16 years and older, living in Australia, Canada, New Zealand, the United Kingdom, and the United States, who were recruited using web-based social media promotion and snowballing. Results: In total, 10,765 eligible web-based respondents participated. Compared with men, a significantly greater proportion of women reported STB (P<.001) and endorsed experiencing a transitional life event as stressful (P<.001). However, there were no gender differences in reporting that the transitional life event or events was stressful for those who also reported STB. Significant sociodemographic adjusted risk factors of STB included younger age; identifying as a sexual minority; lower subjective social connectedness; lower subjective intimate bonds; experiencing a stressful transitional life event in the past 12 months; living alone (women only); not being in employment, education, or training (women only); suddenly or unexpectedly losing a job (men only); and experiencing a relationship breakdown (men only). Protective factors included starting a new job, retiring, having a language background other than English, and becoming a parent for the first time (men only). The results relating to coping after experiencing a self-reported stressful transitional life event in the past 12 months found that regardless of sex, respondents who reported STB compared with those who did not were less likely to engage in activities that promote social connections, such as talking about their feelings (P<.001). Coping strategies significantly explained 19.0% of the STB variance for men (F16,1027=14.64; P<.001) and 22.0% for women (F16,1977=36.45; P<.001). Conclusions: This research highlights multiple risk factors for STB, one of which includes experiencing at least one stressful transitional life event in the past 12 months. When individuals are experiencing such events, support from services and the community alike should consider using sex-specific or targeted strategies, as this research indicates that compared with women, more men do nothing when experiencing stress after a transitional life event and may be waiting until they experience STB to engage with their social networks for support.
Keywords: adolescent; adult; article; Australia; Canada; controlled study; coping behavior; data analysis software; demography; education; employment; employment status; female; health survey; human; independent living; language; life event; major clinical study; male; New Zealand; parent; risk factor; sex difference; sexual and gender minority; social media; social network; suicidal behavior; suicidal ideation; United Kingdom; United States; wellbeing

Study of adolescent problems and psychosocial disorders - Bhat, S.; Kumar, K.; Kumar, A. (European Journal of Molecular and Clinical Medicine, 2020)
Adolescence is referred to the 10 to 19-year age range. During their growth teenagers suffer from psycho-social disorders at one time or another. Majority of young couples are working because of industrialization and urbanization and therefore less opportunity to provide for their offspring. This age demographic has been a history of psycho-social issues and substance addiction. Most common disorders include disorders that internalize depression and anxiety, and disorders that outsource delinquency, aggression, educational difficulties, and truancy. Adolescence is mainly affected by the environments in the home and school. Support and counselling, involvement in artistic events, healthy sexual conduct, social knowledge, abstinence, usage of safeguards including contraceptives and getting married at a reasonable age are ideally the measures needed to handle teenage issues. During adolescence a gulf can emerge between the parents and their children. The explanation why all of us find it so daunting is that it's a time of accelerated physical transformation and significant emotional transition. They are thrilling but can be overwhelming and awkward for both parents and children alike. Adolescents in India face a wide variety of problems and challenges including dietary disorders, reproductive health problems, sexually transmitted infections or diseases (STD’s) and emotional and physical stress related issues. Stress also results in the abuse of tobacco and other drugs which shape habits.
Keywords: alcohol; contraceptive agent; adolescent; adolescent behavior; adolescent disease; adolescent sexual behavior; adolescent smoking; adult; aggression; alcohol abuse; alcohol consumption; anxiety disorder; article; cause of death; child; condom use; controlled study; crime; depression; diseases; domestic violence; drug abuse; dysmenorrhea; eating disorder; female; government; groups by age; human; incidence; major clinical study; male; menstruation disorder; mental disease; oligomenorrhea; onset age; peer pressure; personality disorder; premarital sex; problem behavior; psychosocial disorder; sexual education; sexual orientation; social psychology; suicide; violence; young adult

Resilience Factors and Suicide Risk for a Sample of Transgender Clients - Edwards, L.L.; Torres Bernal, A.; Hanley, S.M.; Martin, S. (Family process, 2020)
This study explored how individual- and community-based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross-sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens by way of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study.
Keywords: adult; article; emotional stability; family therapy; female; human; major clinical study; male; physiological stress; suicide; transgender

Perceived Importance of Health Concerns Among Lesbian, Gay, Bisexual, and Transgender Adults in a National, Probability-Based Phone Survey, 2017 - Boynton, M.H.; Gilbert, J.; Shook-Sa, B.E.; Lee, J.G.L. (Health promotion practice, 2020)
Perceptions of the importance of health problems can drive advocacy, policy change, resource distribution, and individual behaviors. However, little is known about how lesbian, gay, bisexual, and transgender (LGBT), that is, sexual and gender minority (SGM) adults view the health problems facing SGM populations. In a 2017 national, probability-based survey of U.S. SGM adults (N = 453), we asked respondents to identify the most serious health problem facing SGM people today. Participants also rated the seriousness of five specific health problems (HIV/AIDS, suicide, hate crimes, harmful alcohol use, tobacco use). Analyses accounted for the complex sampling design and were stratified by gender identity. One quarter of U.S. SGM adults identified the most serious health problem facing SGM people to be HIV/AIDS (95% confidence interval [20.3, 31.2]). More respondents stated there were no serious LGBT health differences compared with straight/cisgender adults (4.2%, confidence interval [2.6, 5.9]) than identified tobacco use, hate crimes, chronic diseases, cancer, or suicide as the most serious. Importance ratings differed by gender and tobacco/alcohol use were perceived as less serious compared with HIV/AIDS, suicide, and hate crimes. Attention paid to HIV/AIDS by the SGM public, while important, may hinder efforts to address chronic diseases and other health issues affecting SGM people.
Keywords: acquired immune deficiency syndrome; adult; alcohol abuse; alcohol consumption; article; attention; chronic disease; controlled study; crime; female; gender identity; human; LGBT people; major clinical study; male; malignant neoplasm; probability; questionnaire; smoking; suicide

Association of nondiscrimination policies with mental health among gender minority individuals - McDowell, A.; Raifman, J.; Progovac, A.M.; Rose, S. (JAMA Psychiatry, 2020)
Importance: In the past decade, many states have implemented policies prohibiting private health insurers from discriminating based on gender identity. Policies banning discrimination have the potential to improve access to care and health outcomes among gender minority (ie, transgender and gender diverse) populations. Objective: To evaluate whether state-level nondiscrimination policies are associated with suicidality and inpatient mental health hospitalizations among privately insured gender minority individuals. Design, Setting, and Participants: In this cohort study, difference-in-differences analysis comparing changes in mental health outcomes among gender minority enrollees before and after states implemented nondiscrimination policies in 2009-2017 was conducted. A sample of gender minority children and adults was identified using gender minority-related diagnosis codes obtained from private health insurance claims. The present study was conducted from August 1, 2018, to September 1, 2019. Exposure: Living in states that implemented policies banning discrimination based on gender identity in 2013, 2014, 2015, and 2016. Main Outcomes and Measures: The primary outcome was suicidality. The secondary outcome was inpatient mental health hospitalization. Results: The study population included 28980 unique gender minority enrollees (mean [SD] age, 26.5 [15] years) from 2009 to 2017. Relative to comparison states, suicidality decreased in the first year after policy implementation in the 2014 policy cohort (odds ratio [OR], 0.72; 95% CI, 0.58-0.90; P =.005), the 2015 policy cohort (OR, 0.50; 95% CI, 0.39-0.64; P <.001), and the 2016 policy cohort (OR, 0.61; 95% CI, 0.44-0.85; P =.004). This decrease persisted to the second postimplementation year for the 2014 policy cohort (OR, 0.48; 95% CI, 0.41-0.57; P <.001) but not for the 2015 policy cohort (OR, 0.81; 95% CI, 0.47-1.38; P =.43). The 2013 policy cohort experienced no significant change in suicidality after policy implementation in all 4 postimplementation years (2014: OR, 1.19; 95% CI, 0.85-1.67; P =.31; 2015: OR, 0.94; 95% CI, 0.73-1.20; P =.61; 2016: OR, 0.82; 95% CI, 0.65-1.03; P =.10; and 2017: OR, 1.29; 95% CI, 0.90-1.88; P =.18). Mental health hospitalization rates generally decreased or stayed the same for individuals living in policy states vs the comparison group. Conclusions and Relevance: Implementation of a state-level nondiscrimination policy appears to be associated with decreased or no changes in suicidality among gender minority individuals living in states that implemented these policies from 2013 to 2016. Given high rates of suicidality among gender minority individuals in the US, health insurance nondiscrimination policies may offer a mechanism for reducing barriers to care and mitigating discrimination..
Keywords: adult; article; cohort analysis; confidence interval; controlled study; female; hospital patient; hospitalization; human; major clinical study; male; mental disease; mental health; nondiscrimination policy; odds ratio; private health insurance; sexual and gender minority; suicidal behavior

Changes in Anxiety and Depression from Intake to First Follow-Up among Transgender Youth in a Pediatric Endocrinology Clinic - Cantu, A.L.; Moyer, D.N.; Connelly, K.J.; Holley, A.L. (Transgender Health, 2020)
Monitoring acute distress in transgender youth initiating gender-affirming care is important given their increased risk for significant mental health symptoms. The current study examined changes in anxiety, depression, and suicidality from initial appointment to first follow-up in 80 youth, ages 11-18. Average time between visits was ∼4 months but varied across participants. Results revealed no change in acute distress from intake to follow-up. Neither distance from medical center nor initiation of hormone therapy was associated with symptom changes. While research shows decreased distress with initiation of hormones, study findings suggest changes may actually take longer to occur.
Keywords: hormone; adolescent; adolescent depression; adult; anxiety assessment; anxiety disorder; article; child; endocrinology; female; follow up; generalized anxiety disorder 7; hormonal therapy; human; juvenile; major clinical study; male; medical record review; Patient Health Questionnaire 9; pediatric hospital; priority journal; retrospective study; suicidal ideation; transgender

Substance use and suicide attempts among adolescent males who are members of a sexual minority: A comparison of synthesized substance-use measures - Turpin, R.E.; Rosario, A.D.; Dyer, T.V. (American Journal of Epidemiology, 2020)
Adolescent sexual minority males (ASMM) are among the highest risk groups for suicide in the United States, with substance use as a significant risk factor. We tested for an association between substance use and suicidality among ASMM from the 2015 and 2017 Youth Risk Behavior Survey (n = 849). We compared several approaches to synthesizing measures of marijuana, cocaine, heroin, ecstasy, methamphetamines, synthetic marijuana, and prescription drug abuse, including several categorized and continuous indices, latent class analysis based on any use of each substance, and latent profile analysis based on use frequency. Using all approaches, substance use was positively associated with suicide attempts independent of covariates. A continuous cumulative index was the best fit to our data (quasi-information criterion = 853.9969) and detected the largest association, with the highest prevalence of suicide attempts among ASMM who used all substances compared with those who used none (adjusted prevalence ratio = 3.35, 95% confidence interval: 2.41, 4.66). A 3-latent-class model had the second best fit to the data (quasi-information criterion = 878.4464), with the highest prevalence of suicide attempts (adjusted prevalence ratio = 2.54, 95% confidence interval: 1.80, 3.57) among the high-substance-use class compared with the low-use class. Substance use is an especially important focal point for targeted interventions reducing suicidality among ASMM.
Keywords: cannabis; cannabis derivative; cocaine; diamorphine; methamphetamine; midomafetamine; prescription drug; adolescent; age; article; bivariate analysis; continuous cumulative index; controlled study; data analysis; disease association; human; latent class analysis; major clinical study; male; prevalence; regression analysis; sexual and gender minority; statistical analysis; substance use; suicidal behavior; suicide attempt; univariate analysis

An Intersectional Analysis of LGBTQ Online Media Coverage of the Pulse Nightclub Shooting Victims - Meyer, D. (Journal of homosexuality, 2020)
This study illustrates the radical potential of intersectionality to offer a more deeply critical analysis of hierarchies in lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. The author examines how 377 reports from the five most-trafficked LGBTQ Web sites represented victims of the Pulse nightclub shooting in Orlando, FL. Findings support previous scholarship that has emphasized Latinx exclusion, as the articles generally failed to present the victims in an intersectional way, focusing on their LGBTQ status and excluding their Latinx identities. At the same time, a significant minority of the reports emphasized Latinx queer people, most frequently in a way that continued to prioritize LGBTQ identification, sometimes even advancing stereotypical representations of Latinx communities as extraordinarily focused on faith, family, or "machismo." Moreover, none of the articles considered xenophobia as a potential motivating factor in the shooting, and the reports typically presented policing agencies in a neutral, and sometimes even positive, way.
Keywords: female; Florida; human; Internet; male; mass disaster; sexual and gender minority

Suicidal Ideation and Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019 - Ivey-Stephenson, A.Z.; Demissie, Z.; Crosby, A.E.; Stone, D.M.; Gaylor, E.; Wilkins, N.; Lowry, R.; Brown, M. (MMWR supplements, 2020)
Suicide is the second leading cause of death among high school-aged youths 14-18 years after unintentional injuries. This report summarizes data regarding suicidal ideation (i.e., seriously considered suicide) and behaviors (i.e., made a suicide plan, attempted suicide, and made a suicide attempt requiring medical treatment) from CDC's 2019 Youth Risk Behavior Survey. Results are reported overall and by sex, grade, race/ethnicity, sexual identity, and sex of sexual contacts, overall and within sex groups. Trends in suicide attempts during 2009-2019 are also reported by sex, race/ethnicity, and grade. During 2009-2019, prevalence of suicide attempts increased overall and among female, non-Hispanic white, non-Hispanic black, and 12th-grade students. Data from 2019 reflect substantial differences by demographics regarding suicidal ideation and behaviors. For example, during 2019, a total of 18.8% of students reported having seriously considered suicide, with prevalence estimates highest among females (24.1%); white non-Hispanic students (19.1%); students who reported having sex with persons of the same sex or with both sexes (54.2%); and students who identified as lesbian, gay, or bisexual (46.8%). Among all students, 8.9% reported having attempted suicide, with prevalence estimates highest among females (11.0%); black non-Hispanic students (11.8%); students who reported having sex with persons of the same sex or with both sexes (30.3%); and students who identified as lesbian, gay, or bisexual (23.4%). Comprehensive suicide prevention can address these differences and reduce prevalence of suicidal ideation and behaviors by implementing programs, practices, and policies that prevent suicide (e.g., parenting programs), supporting persons currently at risk (e.g., psychotherapy), preventing reattempts (e.g., emergency department follow-up), and attending to persons who have lost a friend or loved one to suicide.
Keywords: adolescent; female; high risk behavior; human; male; psychology; questionnaire; school; student; suicidal ideation; suicide attempt; United States

Trends in Violence Victimization and Suicide Risk by Sexual Identity Among High School Students - Youth Risk Behavior Survey, United States, 2015-2019 - Johns, M.M.; Lowry, R.; Haderxhanaj, L.T.; Rasberry, C.N.; Robin, L.; Scales, L.; Stone, D.; Suarez, N.A. (MMWR supplements, 2020)
Lesbian, gay, and bisexual (LGB) youths continue to experience more violence victimization and suicide risk than heterosexual youths; however, few studies have examined whether the proportion of LGB youths affected by these outcomes has varied over time, and no studies have assessed such trends in a nationally representative sample. This report analyzes national trends in violence victimization and suicide risk among high school students by self-reported sexual identity (LGB or heterosexual) and evaluates differences in these trends among LGB students by sex (male or female) and race/ethnicity (non-Hispanic black, non-Hispanic white, or Hispanic). Data for this analysis were derived from the 2015, 2017, and 2019 cycles of CDC's Youth Risk Behavior Survey (YRBS), a cross-sectional, school-based survey conducted biennially since 1991. Logistic regression models assessed linear trends in prevalence of violence victimization and indicators of suicide risk among LGB and heterosexual students during 2015-2019; in subsequent models, sex-stratified (controlling for race/ethnicity and grade) and race/ethnicity-stratified (controlling for sex and grade) linear trends were examined for students self-identifying as LGB during 2015-2019. Results demonstrated that LGB students experienced more violence victimization and reported more suicide risk behaviors than heterosexual youths. Among LGB youths, differences in the proportion reporting violence victimization and suicide risk by sex and race/ethnicity were found. Across analyses, very few linear trends in these outcomes were observed among LGB students. Results highlight the continued need for comprehensive intervention strategies within schools and communities with the express goal of reducing violence victimization and preventing suicide risk behaviors among LGB students.
Keywords: adolescent; crime victim; cross-sectional study; female; heterosexuality; high risk behavior; human; male; psychology; questionnaire; risk assessment; school; sexual and gender minority; student; suicide; United States; violence

Adolescence and Suicide: Subjective Construction of the Suicidal Process in Young Gay and Lesbian Chileans - Tomicic, A.; Martínez, C.; Rosenbaum, C.; Aguayo, F.; Leyton, F.; Rodríguez, J.; Galvez, C.; Lagazzi, I. (Journal of homosexuality, 2020)
The association between suicide risk and sexual minority status can be understood from the perspective of the social determinants of health, an approach that requires the development of culturally sensitive knowledge. The aim of this study was to characterize young gay and lesbian people's subjective construction of their experience of having lived and survived a suicidal process. Qualitative interviews were conducted and analyzed as products based on life events. In the participants' accounts, we identified hostile contexts associated with suicide, trajectories associated with gay/lesbian identification processes, and milestones related to victimization experiences as part of the intentionality and rationality of suicide.
Keywords: adolescence; adult; article; Chilean; female; homophobia; homosexual female; human; interview; life event; male; qualitative research; suicide

Typologies of illicit drug use in mid-adulthood: a quasi-longitudinal latent class analysis in a community-based sample of twins - Dash, G.F.; Martin, N.G.; Agrawal, A.; Lynskey, M.T.; Slutske, W.S. (Addiction (Abingdon, England), 2020)
AIMS: To identify drug use typologies based on substances used and persistence of use over two time points, use a genetically informed design to explore twin concordance of and genetic influence on the use typologies and compare patterns of declined/discontinued ("desistant") and persistent drug use on drug use correlates. DESIGN: Latent class analysis was applied to data from a cross-sectional self-report survey on current and past drug use. Use characteristics, use disorder, and psychiatric problems were compared across classes. SETTING: Computer-assisted telephone interview in respondents' homes. PARTICIPANTS: A total of 3785 individual twins and siblings (1365 men, 2420 women; Mage = 32) from the Australian Twin Registry Cohort III. MEASUREMENTS: A comprehensive interview assessed prior to past year and past year use of cannabis, stimulants, cocaine/crack, hallucinogens, opioids, sedatives, inhalants, dissociatives, and solvents; age of first use; opportunity to use; peer drug use; attention deficit/hyperactivity, conduct, antisocial personality, depressive, and substance use disorders; and suicidality. FINDINGS: A five-class solution emerged: no/low use (50%), desistant cannabis use (23%), desistant party drug use (18%), persistent prescription drug misuse (4%), and persistent polydrug use (5%). Twin concordances were higher among monozygotic (k = 0.30-0.35) than dizygotic pairs (same-sex k = 0.19-0.20; opposite sex k = 0.07), and biometric modeling suggested that the persistent polydrug use class, in particular, was highly heritable (a2 = 0.94). Conduct disorder (OR = 2.40), antisocial personality disorder (OR = 3.27), and suicidal ideation (OR = 1.98) increased persistent polydrug use risk; depression (OR = 2.38) and lifetime suicide attempt (OR = 2.31) increased persistent prescription misuse risk. Relative to persistent prescription drug misuse, persistent polydrug use was associated with higher rates of cannabis and stimulant use disorder (OR = 6.14-28.01), younger first substance use (OR = 0.82-0.83), more drug use opportunity (OR = 10.66-66.06), and more drug-using peers (OR = 4.66-9.20). CONCLUSIONS: Unique patterns of declined/discontinued ("desistant") and persistent drug use are differentially heritable and differentially associated with risk factors, psychiatric symptoms, and substance use disorder outcomes.
Keywords: adult; adulthood; antisocial personality disorder; article; attention deficit disorder; cannabis use; cohort analysis; computer; conduct disorder; controlled study; depression; dissociation; female; human; latent class analysis; major clinical study; male; multiple drug abuse; prescription drug misuse; risk factor; self report; sibling; suicidal ideation; suicide attempt; telephone interview; twin concordance; twin study; cannabis; cocaine; illicit drug; opiate; solvent

Depressive Emotion Detection and Behavior Analysis of Men Who Have Sex With Men via Social Media - Li, Y.; Cai, M.; Qin, S.; Lu, X. (Frontiers in Psychiatry, 2020)
Background: A large amount of evidence has indicated an association between depression and HIV risk among men who have sex with men (MSM), but traditional questionnaire-based methods are limited in timely monitoring depressive emotions with large sample sizes. With the development of social media and machine learning techniques, MSM depression can be well monitored in an online and easy-to-use manner. Thereby, we adopt a machine learning algorithm for MSM depressive emotion detection and behavior analysis with online social networking data. Methods: A large-scale MSM data set including 664,335 users and over 12 million posts was collected from the most popular MSM-oriented geosocial networking mobile application named Blued. Also, a non-MSM Benchmark data set from Twitter was used. After data preprocessing and feature extraction of these two data sets, a machine learning algorithm named XGBoost was adopted for detecting depressive emotions. Results: The algorithm shows good performance in the Blued and Twitter data sets. And three extracted features significantly affecting the depressive emotion detection were found, including depressive words, LDA topic words, and post-time distribution. On the one hand, the MSM with depressive emotions published posts with more depressive words, negative words and positive words than the MSM without depressive emotions. On the other hand, in comparison with the non-MSM with depressive emotions, the MSM with depressive emotions showed more significant depressive symptoms, such as insomnia, depressive mood, and suicidal thoughts. Conclusions: The online MSM depressive emotion detection using machine learning can provide a proper and easy-to-use way in real-world applications, which help identify high-risk individuals at the early stage of depression for further diagnosis.
Keywords: laboratory software; XGBoost; article; behavioral science; controlled study; data base; depression; disease classification; human; insomnia; learning algorithm; machine learning; major clinical study; male; mathematical analysis; mathematical model; men who have sex with men; mental health; social interaction; social media; social network; suicidal ideation; XGBoost

Comparison of Lifetime Suicide Attempts and Recent Suicidal/Self-Harming Thoughts Among Sexual Minority and Heterosexual Utahns: Results from a Population-Based Survey - McGraw, J.S.; Peer, S.O.; McManimen, S.; Chinn, J.; Mahoney, A. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2020)
OBJECTIVE: We sought to be the first published article to report differences in population-representative prevalence of suicidal thoughts and attempts by sexual orientation. METHOD: Data from Utah's Behavioral Risk Factor Surveillance System (BRFSS) collected for 2016 (N = 10,988) and 2017 (N = 10,251) were examined to determine differences in the prevalence of suicidal thoughts in the past 2 weeks and the lifetime prevalence of suicide attempts (i.e., any, single, and multiple) by sexual orientation. RESULTS: 3.5% of heterosexuals Utahns reported recent suicidal/self-harming thoughts in the last 2 weeks compared to 14.7% of LGB Utahns (OR = 4.73 95% CI [2.67, 8.36]). 5.8% of heterosexuals reported a lifetime prevalence of any suicidal attempts compared to 37.2% of LGB folx (OR = 9.58 95% CI [7.16, 12.81]) with similar differences occurring for single and multiple attempts. Comparing LG versus B, there was no difference in ideation or prevalence of any attempt, but bisexuals reported higher rates of multiple suicide attempts. CONCLUSION: LGB folx in Utah are drastically more likely to have thought about suicide/self-harming in the last 2 weeks and to have attempted suicide in their lifetime when compared to heterosexuals in Utah.
Keywords: article; automutilation; behavioral risk factor surveillance system; bisexuality; female; heterosexuality; human; major clinical study; male; prevalence; sexual and gender minority; suicidal ideation; suicide attempt; Utah

Past-Year Suicidal Ideation Among Transgender Individuals in the United States - Yockey, A.; King, K.; Vidourek, R. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2020)
This study assessed potential correlates to past-year suicide ideation among a national sample of transgender adults in the United States. A secondary analysis of the 2015 Transgender Survey was conducted. The 2015 Transgender Survey is the first and largest survey assessing health behaviors among transgender individuals living in the United States. Participants were recruited by several methods (e.g., social media, random sampling, photobooth campaigns. Weighted logistic regression analyses adjusting for covariates were conducted to investigate potential associations to whether or not an individual thought about suicide. A total of 27,795 individuals who self-identified as transgender participated in the study. Of the sample, 34.0% identified as a man, 29.8% identified as a woman, 20.6% identified as non-binary, and 15.5% identified as part time one gender/part time another. Nearly half of participants (48.5%) reported past year suicide ideation. Significant predictors included gender identity, age, income, race, low family support, and self-reported physical and sexual assault. This is one of the first studies that we are aware of examining past-year suicidal ideation among a large, nationally representative sample of transgender individuals. Interventions (e.g., acceptance therapy, evaluation, focus groups) are desperately needed to address this burgeoning problem among transgender individuals.
Keywords: adult; article; gender identity; health behavior; human; human tissue; race; secondary analysis; sexual assault; social media; suicidal ideation; transgender; United States

Ensuring gender-affirming care in nephrology: Improving care for transgender and gender-expansive individuals - Mohottige, D.; Lunn, M.R. (Clinical Journal of the American Society of Nephrology, 2020)
Keywords: hemoglobin; spironolactone; testosterone; anxiety; article; blood pressure; breast development; chronic kidney failure; creatinine blood level; depression; dialysis; electronic health record; erythropoiesis; female; gender dysphoria; gender identity; gonadectomy; hair loss; hematocrit; hirsutism; hormonal therapy; hormone substitution; human; immune deficiency; immunosuppressive treatment; kidney graft; male; medical care; menstruation; mineral metabolism; nephrology; osteoporosis; patient care; potassium blood level; sexual and gender minority; sexual orientation; social change; physiological stress; suicide; transgender; urologic surgery; venous thromboembolism; violence

Pride in all Who Served: Development, Feasibility, and Initial Efficacy of a Health Education Group For LGBT Veterans - Lange, T.M.; Hilgeman, M.M.; Portz, K.J.; Intoccia, V.A.; Cramer, R.J. (Journal of Trauma and Dissociation, 2020)
Many of the more than 1 million military veterans who identify as lesbian, gay, bisexual, and/or transgender (LGBT) have encountered “rejecting experiences in the military” and stigma from prior “Don’t Ask Don’t Tell” policies. Associated minority stress and social isolation have been linked to a disproportionate risk for depression and suicide, as well as a reluctance to seek medical care at Veterans Health Administration (VHA) facilities. This paper describes feasibility and preliminary outcomes of the newly developed, Pride in All Who Served Health Education Group created to meet the unique needs of sexual and gender minority veterans. The 10-week, closed, health education group (e.g., continuums of identity, military culture) enables open dialogue, fosters social connectedness, and empowers veterans to be more effective self-advocates within the healthcare system. Feedback from formative evaluations (n = 29 LGBT veterans and n = 25 VHA stakeholders) was incorporated before conducting a small scale, non-randomized pilot. Preliminary pre-post surveys (n = 18) show promise (i.e., Cohen’s d range ± 0.40 to 1.59) on mental health symptoms (depression/anxiety, suicidal ideation), resilience indicators (identity affirmation, community involvement, problem-focused coping), and willingness to access care within the VA system (satisfaction with VA services, perception of staff competence). Results suggest that the 10-week Pride Group may be an effective tool for addressing minority-related stress in LGBT veterans. A full-scale, randomized clinical trial of this intervention is needed to determine short and long-term impacts on clinical and healthcare access-related outcomes.
Keywords: adult; anxiety; army; article; clinical competence; community; coping behavior; depression; empowerment; feasibility study; female; gender identity; health care access; health care need; health care system; health education; health survey; human; LGBT people; major clinical study; male; medical staff; mental health; mental health service; middle aged; needs assessment; patient satisfaction; pilot study; priority journal; problem solving; program evaluation; psychoeducation; psychological resilience; psychological well-being; self concept; sexual and gender minority; sexual health; sexual orientation; social support; suicidal ideation; veteran

Group sex, suicidality and online partners: implications for HIV and suicide prevention: a short report - Kongjareon, Y.; Samoh, N.; Lim, S.H.; Peerawaranun, P.; Jonas, K.J.; Guadamuz, T.E. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2020)
HIV-related factors and suicide-risk status were assessed among YMSM aged 18–24 years recruited through various MSM-related online social apps in Bangkok (N = 1394). The online survey assessed demographic characteristics, sexual behaviours and suicide-risk status. Measure of suicide risk was taken from the Suicidal Behaviors Questionnaire-Revised (cut-off score of seven or higher). Among participants, 249 (17.9%) reported suicide-risk. In multivariable logistic regression, correlates of suicide-risk status included having sometimes or often ever participated in group sex (AOR=1.58, 95% CI: 1.17–2.14), having received money or opportunities for sex (AOR=1.54, 95% CI: 1.09–2.17), often seeking partners online (AOR=1.59, 95% CI: 1.05–2.39), inconsistent condom use (AOR=1.67, 95% CI: 1.26–2.21), and self-assessed as having “medium” or “high” HIV risk (AOR=2.53, 95% CI: 1.61–3.98 and AOR=3.35, 95% CI: 1.92–5.82, respectively). Findings suggest that HIV risk behaviours shown by YMSM are significantly associated with higher risk of suicide.
Keywords: adult; article; condom use; demography; educational status; group sex; human; Human immunodeficiency virus infection; major clinical study; male; men who have sex with men; mental disease assessment; multivariate logistic regression analysis; online dating; priority journal; risk; sexual behavior; suicidal behavior; Suicidal Behaviors Questionnaire Revised; Thailand; unsafe sex

Gender Conformity and Suicide: A Case Study Integrating Structural Family Therapy and Satir Experiential Therapy - Romney, J.S.; Hawkins, L.G.; Soloski, K.L. (Clinical Case Studies, 2020)
Recent studies have shown that suicidality among transgender youth are 3.6 times more likely to report suicidal ideation and 3.2 times more likely to attempt suicide compared with cisgender youth. To alleviate the suicide rates among transgender youth, research suggests the need for family-based interventions. This case study explores the integration of structural family therapy and the Satir growth model to increase connection and support within the family, while also creating clear boundaries that are protective and growth-enhancing. This study provides a session by session overview of how the therapist integrated the models while working with the entire family unit.
Keywords: adolescent; article; assessment of humans; avoidance behavior; Brief Symptom Inventory scale; case report; child parent relation; clinical article; conformity (social behavior); coping behavior; emotional attachment; family therapy; female to male transgender; follow up; gender dysphoria; gender identity; human; integration; major depression; male; Outcome Questions Youth scale; psychosocial care; psychotherapy; satir experiential therapy; self esteem; sex difference; physiological stress; suicidal ideation; suicide attempt

Identifying Distinct Subgroups of Lesbian, Gay, and Bisexual Youth for Suicide Risk: A Latent Profile Analysis - Giano, Z.; Currin, J.M.; Deboy, K.; Hubach, R.D. (Journal of Adolescent Health, 2020)
Purpose: The purpose of the study was to identify profiles of lesbian, gay, and bisexual (LGB) youth who are at risk for suicidal behavior. Method: Data were collected through the Youth Risk Behavior Surveillance System (N = 2,738). We used latent profile analysis to create identity profiles using variables associated with suicide, including bullying, alcohol use, poor grades, electronics use, and sleep hours. Results: The LPA revealed a 6-class solution. Class 6 represented the highest risk profile with the highest scores in alcohol, bullying, poor grades, electronics use, and the least sleep and were 17 times more likely to attempt suicide compared to class 2 (the lowest-risk class). Classes 1, 3, 4, and 5 had a mixture of both high and low risk mean scores across the variables, with class 3 showing the strongest relationship to suicide (7 times more likely than class 2). Conclusion: Because high-risk classes in our study had multiple factors contributing to associations to suicide, programming aimed at attenuating youth suicide among LGB youth may benefit from addressing multiple issues simultaneously (e.g., substance use and bullying). This would be a departure from more traditional programs for LGB youth which are predicated on one specific risk behavior, such as coping with bullying or substance use separately.
Keywords: academic underachievement; adolescent; adolescent behavior; adolescent health; alcohol consumption; article; bisexuality; bullying; female; high risk population; homosexual female; homosexual male; human; latent class analysis; major clinical study; male; priority journal; risk factor; sleep time; suicidal behavior; suicide attempt; video game

The knife's edge: Masculinities and precarity in East Africa - Fast, D.; Bukusi, D.; Moyer, E. (Social Science and Medicine, 2020)
In our field sites and clinical practice in East Africa, we regularly encounter men who have become overwhelmed by “thinking too many thoughts” and “gone crazy from confusion,” brought about by the problems of life created by deepening social, economic and political precarity. Across diverse settings, many African men continue to be enmeshed in social and material obligations and expectations that position them as economic consumers and providers for those they care for and love. When these gendered obligations, expectations and fantasies are left unfulfilled, this sense of failure can be embodied to produce particular kinds of health effects. Namely, men may become plagued by troublesome and confusing thoughts, leading them in some cases to “give up on” (as our research subjects put it) pursuing work and education, to become immersed in problematic drug and alcohol use, and even to take their own lives. While these afflictions can be glossed using the language of depression, anxiety, addiction and suicide, such medicalizing frames may obscure more nuanced social, structural and affective diagnoses of what is happening to men across Africa and globally. Anthropology provides us with alternative frames through which to understand how psychological wounds are made—and healed.
Keywords: age; alcohol consumption; alcoholism; anxiety disorder; article; cannabis addiction; capital; cocaine dependence; confusion; depression; distress syndrome; drug dependence; drug use; educational status; emotional stress; employment; Ethiopia; heroin dependence; human; Kenya; leisure; masculinity; Nigeria; sexual orientation; social change; social discrimination; social exclusion; social interaction; social status; social stigma; socioeconomics; suicidal ideation; suicide; Tanzania; unemployment; work

Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study - Bränström, R.; Pachankis, J.E. (American Journal of Psychiatry, 2020)
Objective: Despite professional recommendations to consider gender-affirming hormone and surgical interventions for transgender individuals experiencing gender incongruence, the long-term effect of such interventions on mental health is largely unknown. The aim of this study was to ascertain the prevalence of mood and anxiety disorder health care visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender incongruence diagnosis and genderaffirming hormone and surgical treatment in the entire Swedish population. Methods: This study used the Swedish Total Population Register (N=9,747,324), linked to the National Patient Register and the Prescribed Drug Register. Among individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015 (N=2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming hormone and surgical treatment. Outcome measures were mood and anxiety disorder health care visits, antidepressant and anxiolytic prescriptions, and hospitalization after a suicide attempt. Results: Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98). Conclusions: In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.
Keywords: antidepressant agent; anxiolytic agent; adult; anxiety disorder; article; female; gender dysphoria; health care utilization; health service; hospitalization; human; major clinical study; male; mental health care; mood disorder; outcome assessment; prescription; prevalence; priority journal; register; sex reassignment; suicide attempt; Swedish citizen; transgender; transsexualism; urologic surgery

Evaluation of sexual minority identity as a moderator of the association between intimate partner violence and suicidal ideation and attempts among a national sample of youth - Nydegger, L.A.; Blanco, L.; Nathan Marti, C.; Kreitzberg, D.; Quinn, K. (PLoS ONE, 2020)
Sexual minority (SM) youth are at high risk for intimate partner violence (IPV) and suicidal ideation/attempts compared to their heterosexual peers. We examined whether SM identity enhanced the relationship between experiences of IPV and suicidal ideation/attempts. Weighted logistic regression models were run using the 2017 Youth Risk Behavior Survey. All main effects were significant; each SM identity and both physical and sexual IPV were significantly associated with suicidal ideation and suicide attempts. The interaction between bisexual identity and physical IPV was significant for suicidal ideation; as physical IPV experiences increased, the difference between bisexual identity and heterosexual youth was non-significant. Findings suggest exploring trauma and suicidal ideation by aggregate groups and increasing support for SM youth in schools and communities.
Keywords: adolescent; adult; article; child; community; controlled study; female; gender identity; heterosexuality; high risk behavior; human; injury; juvenile; logistic regression analysis; male; partner violence; physical violence; questionnaire; school; school child; sexual and gender minority; sexual violence; suicidal ideation; suicide attempt; young adult

Assessing Health Provider Perspectives Regarding Barriers American Indian/Alaska Native Transgender and Two-Spirit Youth Face Accessing Healthcare - Angelino, A.; Evans-Campbell, T.; Duran, B. (Journal of racial and ethnic health disparities, 2020)
BACKGROUND: American Indian/Alaska Native (AI/AN) youth disproportionately face barriers accessing healthcare compared with non-AI/AN youth. AI/AN youth who also identify as transgender or Two-Spirit (2S) face higher rates of mental health issues and suicidality, along with increased rates of disease, due to health inequity and historical trauma. OBJECTIVES: This project evaluated health provider knowledge of context surrounding gender and sexuality in AI/AN communities. It assessed provider perspectives of provider-side and patient-side barriers accessing care to develop suggestions for improvement. METHODS: Semi-structured interviews (SSI) and focus group discussions (FGD) were held among healthcare providers across four sites in the Pacific Northwest. Questions were developed using a community-based participatory research conceptual model, considering the impacts of context, partnerships, and community knowledge. A grounded theory approach was used to analyze transcripts. This project received exemption from the University of Washington IRB and approval from each tribal ethical/research committee. RESULTS: Twenty healthcare providers from varied geographic settings, provider types, and ethnic backgrounds participated in this study. Knowledge regarding contexts surrounding gender in AI/AN communities varied. Long-standing effects of settler colonialism, trauma, and systemic issues presented as overarching concepts. Participants also shared a number of patient and provider-side barriers impacting care and suggested solutions to reduce these barriers. CONCLUSIONS: Patient and provider-side barriers inhibit AI/AN transgender and 2S youth access to healthcare. Historical trauma and community resilience play a role in health for these youth. Understanding history, the intersection of identities, and community strengths can help with the development of solutions to provide high quality care to AI/AN transgender or 2S youth.
Keywords: adult; Alaska Native; American Indian; article; colonialism; conceptual model; controlled study; female; gender identity; genetic transcription; grounded theory; health care personnel; health care quality; health disparity; human; injury; juvenile; male; participatory research; semi structured interview; sexuality; transgender; Washington

Recruitment of Schools for Intervention Research to Reduce Health Disparities for Sexual and Gender Minority Students - Shattuck, D.; Hall, J.L.; Green, A.; Greenberg, C.; Peñaloza, L.; Ramos, M.; Willging, C. (The Journal of school nursing : the official publication of the National Association of School Nurses, 2020)
Recruiting schools for intervention research can be daunting. This study examined the experiences of researchers recruiting public high schools for a randomized controlled trial to reduce suicide disparities for sexual and gender minority (SGM) youth by implementing evidence-based strategies to enhance school environments. We enrolled 42 schools throughout New Mexico between August 2016 and April 2017. Based on qualitative analysis of recruitment efforts, three groups of factors affected enrollment: (1) non-SGM-specific factors, (2) SGM-specific factors, and (3) facilitating factors. Non-SGM-specific factors negatively impacted the willingness or ability to participate (e.g., demanding staff workloads and beliefs that "outsiders" should not assist with school-based interventions). Notable SGM-specific factors centered on influences in socially conservative community environments and beliefs that schools lacked SGM students. Advocacy, leveraging relationships, and persistence were facilitating factors for overcoming recruitment obstacles. Our findings have implications for researchers and school nurses interested in school-based interventions, especially those focused on SGM youth.
Keywords: article; controlled study; female; health disparity; high school; human; juvenile; male; New Mexico; qualitative analysis; qualitative research; randomized controlled trial; school health nursing; sexual and gender minority; suicide; workload

Verbal victimisation, depressive symptoms, and suicide risk among sexual minority adults in France: results from the nationally-representative 2017 Health Barometer survey - El-Khoury, F.; Heron, M.; Van der Waerden, J.; Leon, C.; du Roscoat, E.; Velter, A.; Lydié, N.; Sitbon, A. (Social psychiatry and psychiatric epidemiology, 2020)
PURPOSE: Our study estimates rates of depressive symptoms and suicide risk according to sexual minority status, and examines the mediating effect of verbal victimisation in the association between sexual minority status and mental health outcomes. METHOD: Analysis is based on data from the 2017 French Health Barometer, a general population phone survey, which recruited 25,198 adults aged 18-75 years. Data were weighted to be representative of the French adult population. Four mental health outcomes occurring in the preceding year or currently were examined in relation to sexual minority status using multivariate logistic regressions: (a) current depressive symptoms, (b) having experienced a major depressive episode, (c) suicidal ideation, and (d) suicide attempt. Further we conducted mediation analyses to evaluate the contribution that verbal victimisation experienced in the preceding year has in the association between sexual minority status and the listed outcomes. All analyses were also stratified by sex. RESULTS: Sexual minority adults were more likely to experience verbal victimisation in the last year compared to heterosexual individuals (22% vs 11.4%). They were also more likely to have experienced each of the four mental health outcomes, even after adjusting for potential confounders. In adjusted mediation analysis, verbal victimisation in the preceding year was found to significantly mediate the association between sexual orientation and mental health outcome with mediated proportions varying between 15 and 22%. CONCLUSION: Sexual minority individuals are more at risk of depressive symptoms and suicidal ideation compared to heterosexuals, and this may be partially mediated by verbal victimisation.
Keywords: adolescent; adult; aged; crime victim; depression; female; France; human; major depression; male; middle aged; sexual and gender minority; suicidal ideation; young adult

Sexual Identity-Behavior Profiles and Suicide Outcomes Among Heterosexual, Lesbian, and Gay Sexually Active Adolescents - Romanelli, M.; Xiao, Y.; Lindsey, M.A. (Suicide & life-threatening behavior, 2020)
OBJECTIVE: Adolescents' sexual behaviors can be incongruent with those assumed to align with their sexual identity. Identity-behavior profiles permit the characterization of youth who might remain undetected using a single-dimensional assessment of sexual orientation. This study examined suicide risks among four distinct sexual identity-behavior profiles of youth: heterosexual with other-sex partners only, heterosexual with any same-sex partners, lesbian or gay (LG) with same-sex partners only, and LG with any other-sex partners. METHOD: Data were analyzed from the 2017 National Youth Risk Behavior Survey. Participants' reported sex, sexual identity, and the sex of their sexual contacts were used to construct the identity-behavior profiles. Multivariate logistic regression was used to examine the relationship between identity-behavior profiles and suicide outcomes. RESULTS: Compared to heterosexual respondents with other-sex partners only, heterosexual respondents with any same-sex partners and LG respondents with same-sex partners only had greater odds of having a suicide plan; LG respondents with any other-sex partners were over seven times more likely to have suicidal thoughts and attempt suicide and 14 times more likely to have a suicide plan. CONCLUSIONS: Health and mental health providers can expand the identification of youth at risk for suicide by assessing both sexual identity and behavior.
Keywords: adolescent; article; controlled study; female; gender identity; heterosexuality; homosexual female; human; human experiment; juvenile; male; mental health; risk assessment; suicidal ideation

"It feels like home": Transgender youth in the Midwest and conceptualizations of community climate - Paceley, M.S.; Sattler, P.; Goffnett, J.; Jen, S. (Journal of community psychology, 2020)
Community climate toward sexual and gender minority (SGM) youth is associated with higher rates of victimization and poorer health and wellbeing-related outcomes such as depression and suicidal ideation. However, this field of research has underemphasized the experiences of transgender youth, particularly within the Midwestern context which is marked by vast rurality and characterized as sociopolitically conservative. Using qualitative and community-based methods, this study identified factors that impact community climate from the perspective of transgender youth (n = 19) in the Midwest and situated them within the Ecological Systems Theory (EST). Thematic analysis of interviews revealed four themes: resources, visibility, policies, and ideologies. Themes often crossed levels within the EST, indicating the complexity and interrelated nature of climate across local, regional, and national contexts. Implications for theory, research, and practice are discussed.
Keywords: article; climate; clinical article; ecosystem; human; ideology; interview; juvenile; thematic analysis; theoretical study; transgender; visibility

Self-Reported Conversion Efforts and Suicidality Among US LGBTQ Youths and Young Adults, 2018 - Green, A.E.; Price-Feeney, M.; Dorison, S.H.; Pick, C.J. (American journal of public health, 2020)
Objectives. To explore associations between undergoing sexual orientation or gender identity conversion efforts (SOGICE) and suicidality among young LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) individuals.Methods. Data were derived from a 2018 online cross-sectional study of young LGBTQ individuals (13-24 years of age) residing in the United States. Multivariate logistic regression was used to determine the relative odds of suicidality among young LGBTQ individuals who experienced SOGICE (in comparison with those who did not) after adjustment for age, race/ethnicity, geography, parents' use of religion to say negative things about being LGBTQ, sexual orientation, gender identity, discrimination because of sexual orientation or gender identity, and physical threats or harm because of sexual orientation or gender identity.Results. Relative to young people who had not experienced SOGICE, those who reported undergoing SOGICE were more than twice as likely to report having attempted suicide and having multiple suicide attempts.Conclusions. The elevated odds of suicidality observed among young LGBTQ individuals exposed to SOGICE underscore the detrimental effects of this unethical practice in a population that already experiences significantly greater risks for suicidality.
Keywords: adolescent; adult; counseling; cross-sectional study; female; gender identity; human; male; psychology; questionnaire; self report; sexual and gender minority; sexual behavior; suicide attempt; United States; young adult

Transgender and gender-expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families - Michels, S.; Kovar, C.L. (Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 2020)
TOPIC: Society's blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifically nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary. PURPOSE: To clarify the areas of potential impact in the nurse's role and to discuss ways in which they can better equip themselves to promote effective communication and culturally competent care. Thus, we envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self-harm, and suicidal ideation in our transgender and gender-expansive youth. SOURCES USED: Utilizing PubMed, nationally recognized websites, and current textbooks/pamphlets, a literature review was conducted to ascertain pertinent information related to transgender, gender-expansive youth, and nursing education. Included references were from 2012 to the present. CONCLUSIONS: Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources.
Keywords: article; automutilation; care behavior; cultural competence; depression; empowerment; female; gender identity; human; juvenile; latitude; LGBTQIA+ people; male; Medline; mental stress; microscope; nurse attitude; nursing education; suicidal ideation; transcultural care

Corrigendum to Suicidality among Transgender Youth: Elucidating the Role of Interpersonal Risk Factors (Journal of interpersonal violence, 2020)
Keywords: erratum

Coming-Out Experiences of Irish Gay Fathers Who Have Been Heterosexually Married: An Interpretative Phenomenological Analysis - Daly, S.C.; MacNeela, P.; Sarma, K.M. (Journal of homosexuality, 2020)
This study explores how Irish gay fathers, who married heterosexually in a heteronormative culture, assumed a settled gay identity in the Republic of Ireland. A purposive sample of nine men reflected on their experiences of marriage and separation, assuming a gay identity, and social and familial connectivity. Interpretative phenomenological analysis (IPA) indicated the suppression of gay sexual desires before marriage as a result of cultural homophobia. The coming-out process continued during the participants' marriage. Extramarital same-gender sexual desires and/or transgressions co-occurred with existential conflict (remorse) and resulted in marital separation. The marital and family loss was experienced as traumatic, and suicidal ideation occurred for most. All the men assumed an openly gay identity after separating. Many established a family-orientated same-gender repartnership. Results highlight the individuality and significance of the marital and family loss for those who separate after coming out as gay.
Keywords: adult; aged; father; heterosexuality; homophobia; human; Ireland; male; male homosexuality; marriage; middle aged; psychology; questionnaire; self disclosure; sexual and gender minority; suicidal ideation

Intravenous Ketamine as an Effective and Safe Treatment in a Suicidal Patient With Cancer Who Was Nil Per Os - Rajagukguk, S.; Lee, T. (Psychosomatics, 2020)
Keywords: amfebutamone; cannabis; cocaine; fentanyl; ketamine; mescaline; selegiline; sertraline; adult; antidepressant activity; artery thrombosis; article; auditory hallucination; borderline state; cancer patient; cancer staging; cannabis addiction; carcinomatous peritonitis; clinical article; depression; disease exacerbation; drowsiness; drug efficacy; drug overdose; drug safety; drug tolerability; duodenojejunal anastomosis; gastrointestinal symptom; homelessness; homosexual male; hospital discharge; hospital readmission; human; intensive care unit; intestine anastomosis; jejunum cancer; male; mother; nausea; nausea and vomiting; omentectomy; physical abuse; postoperative pain; psychotherapy; recurrent disease; self evaluation; single drug dose; small intestine resection; smoking cessation; spiritual care; substance use; suicidal ideation; suicide attempt; superior mesenteric artery; thrombectomy; treatment failure; verbal hostility

Prevalence of Exposure to Sexual Orientation Change Efforts and Associated Sociodemographic Characteristics and Psychosocial Health Outcomes among Canadian Sexual Minority Men - Salway, T.; Ferlatte, O.; Gesink, D.; Lachowsky, N.J. (Canadian Journal of Psychiatry, 2020)
Objective: Sexual orientation change efforts (SOCE), or “conversion therapy,” are pseudoscientific practices intended to suppress or deny sexual attraction to members of the same gender/sex. There are currently no data available to inform estimates of the prevalence of SOCE exposure in Canada. The objective of this study is therefore to describe the prevalence, social–demographic correlates, and health consequences of SOCE among Canadian sexual minority men. Methods: Sex Now 2011 to 2012 was a cross-sectional nonprobability survey of Canadian sexual minority men. Respondents were asked about lifetime SOCE exposure. We estimated prevalence of SOCE exposure by sociodemographic characteristics and examined psychosocial health outcomes among those exposed to SOCE. Results: Of N = 8,388 respondents, 3.5% (95% confidence interval, 3.2% to 4.1%) reported having ever been exposed to SOCE. Exposure to SOCE was higher among gay men (as compared with bisexual men), transgender respondents (as compared with cisgender respondents), those who were “out” about their sexuality (as compared with those who were not “out”), Indigenous men (as compared with White men), other racial minorities (as compared with White men), and those earning a personal income <$30,000 (as compared with those earning ≥$60,000 CAD). Exposure to SOCE was positively associated with loneliness, regular illicit drug use, suicidal ideation, and suicide attempt. Conclusions: SOCE exposure remains prevalent and associated with substantial psychosocial morbidity among sexual minority men in Canada. All levels of government in Canada should consider action to ban SOCE. SOCE survivors likely require intervention and support from the Canadian health-care system.
Keywords: illicit drug; adult; article; bisexual male; bisexuality; Canada; Caucasian; confidence interval; controlled study; conversion therapy (sexual orientation); correlation analysis; cross-sectional study; demography; drug use; health status; health survey; homosexual male; human; loneliness; major clinical study; male; mental health; middle aged; personal income; prevalence; sexual and gender minority; sexuality; social psychology; social status; suicidal ideation; suicide attempt; transgender; young adult

Advocacy and collaborative health care for Justice-involved youth - Owen, M.C.; Wallace, S.B. (Pediatrics, 2020)
Children and adolescents who become involved with the justice system often do so with complex medical, mental health, developmental, social, and legal needs. Most have been exposed to childhood trauma or adversity, which both contribute to their involvement with the justice system and negatively impact their health and well-being. Whether youth are held in confinement or in their home communities, pediatricians play a critical role in promoting the health and well-being of justice-involved youth. Having a working knowledge of the juvenile justice system and common issues facing justice-involved youth may help pediatricians enhance their clinical care and advocacy efforts. This policy statement is a revision of the 2011 policy "Health Care for Youth in the Juvenile Justice System." It provides an overview of the juvenile justice system, describes racial bias and overrepresentation of youth of color in the justice system, reviews the health and mental health status of justice-involved youth, and identifies advocacy opportunities for juvenile justice reform.
Keywords: psychotropic agent; alternative medicine; article; child advocacy; child welfare; childhood adversity; collaborative care team; community care; deinstitutionalization; empowerment; health care delivery; health care facility; health education; health status; hospital admission; human; Human immunodeficiency virus infection; human rights; immunization; infection; informed consent; juvenile; juvenile transfer law; legal aspect; LGBTQIA+ people; medical care; mental disease; mental health; mental health care; patient care; patient isolation; prevalence; priority journal; psychologic assessment; punishment; race difference; reproductive health; sex ratio; sex trafficking; sexual health; sexually transmitted disease; substance use; suicidal behavior; transgender; traumatology; treatment refusal; tuberculosis

A register-based approach to identifying treatment-resistant depression-Comparison with clinical definitions - Hägg, D.; Brenner, P.; Reutfors, J.; Li, G.; DiBernardo, A.; Bodén, R.; Brandt, L. (PLoS ONE, 2020)
Background: Several definitions of treatment-resistant depression (TRD) are used for clinical research, but no verified model for use in register data exists. We aimed to compare a novel model created for use in register data-the Karolinska Institutet Model (KIM)-to the clinical definitions regarding the proportion of patients identified with TRD, their characteristics and clinical outcomes. Methods: All patients in Sweden initiating antidepressant treatment with a diagnosis of depression in specialized healthcare 2006-2014 were identified and followed in national registers. In KIM, patients who initiated a third sequential, >28-day antidepressant treatment trial were defined as having TRD. Proportion of TRD and patient characteristics were compared with register adaptations of the European Staging Model (ESM), Massachusetts General Hospital Staging Method (MGH-s), and Maudsley Staging Model (MSM). Differences in patient characteristics were assessed with Chi-square tests and one-way ANOVAs. Hazard ratios for psychiatric hospitalization and for death from external causes were estimated by Cox proportional hazard regressions. Results: Out of 127,108 antidepressant initiators with depression, the highest proportion of TRD was found using the MGH-s (19.0%), followed by MSM (15.3%), KIM (12.9%), and ESM (9.5%). Clinical characteristics were similar across the models. Compared with TRD patients identified by KIM, those identified by ESM had a marginally higher risk for psychiatric hospitalization (adjusted hazard ratio [aHR] 1.03, 95%CI 1.00-1.05), whereas those identified by MGH-s (aHR 0.92; 0.90-0.94) and MSM (aHR 0.95; 0.94-0.97) had a slightly reduced risk. Patients identified by MGH-s showed a reduced mortality compared with KIM (aHR 0.84; 0.72-0.98). Conclusions: This study provides insight into the differing characteristics of patients captured by various TRD models when used for register research. Models yielding lower proportions of TRD seemed to identify patients with greater morbidity. The KIM may be useful for register based research in TRD.
Keywords: accident; adult; aged; article; clinical outcome; comparative study; controlled study; death; European Staging Model; female; health care; hospitalization; human; Karolinska Institutet Model; major clinical study; male; Massachusetts General Hospital Staging Method; Maudsley Staging Model; model; mortality; register; risk reduction; suicide; Sweden; treatment resistant depression

Grazoprevir/elbasvir for the immediate treatment of recently acquired HCV genotype 1 or 4 infection in MSM - Boyd, A.; Miailhes, P.; Chas, J.; Valantin, M.-A.; Yazdanpanah, Y.; Rosenthal, E.; Chevaliez, S.; Piroth, L.; Rougier, H.; Peytavin, G.; Pialoux, G.; Girard, P.-M.; et al. (Journal of Antimicrobial Chemotherapy, 2020)
Background: In Europe, increases in HCV infection have been observed over the last two decades in MSM, making them a key population for recently acquired HCV. Alternative combinations of direct-acting antiviral agents against early HCV infection need to be assessed. Patients and methods: In this pilot trial, MSM with recently acquired genotype 1 or 4 HCV infection were prospectively included and received 8 weeks of oral grazoprevir 100 mg and elbasvir 50 mg in a fixed-dose combination administered once daily. The primary endpoint was sustained virological response evaluated 12 weeks after the end of treatment (EOT) (SVR12). Secondary endpoints were the virological characterization of failures, the quality of life before, during and after treatment and the rate of reinfection. Results: In a 15 month period, 30 patients were enrolled, all of whom were MSM. Of the 29 patients completing follow-up, 28 (96%, 95% CI = 82%-99%) achieved SVR12. One patient interrupted follow-up (suicide) but had undetectable plasma HCV RNA at EOT. One patient with suboptimal adherence confirmed by plasma drug monitoring relapsed and developed NS3, NS5A and NS5B resistance-associated substitutions (V36M, M28V and S556G). The most common adverse events related to study drug were diarrhoea (n = 4, 13%), insomnia (n = 2, 7%) and fatigue (n = 2, 7%), although no patient discontinued treatment. No HIV RNA breakthrough was reported in the 28 patients with HIV coinfection. At Week 48, reinfection was diagnosed in three patients. Conclusions: Our data support the use of grazoprevir/elbasvir for immediate treatment against HCV in order to reduce HCV transmission in MSM.
Keywords: alanine aminotransferase; aspartate aminotransferase; cobicistat; dolutegravir; elbasvir; emtricitabine; grazoprevir; illicit drug; raltegravir; tenofovir disoproxil; virus RNA; abdominal distension; adult; alanine aminotransferase blood level; antiviral therapy; article; aspartate aminotransferase blood level; binge eating disorder; CD4+ T lymphocyte; clinical article; combination drug therapy; diarrhea; drug blood level; drug monitoring; dysgeusia; fatigue; female; follow up; gonorrhea; hepatitis C; Hepatitis C virus genotype 1; Hepatitis C virus genotype 4; human; Human immunodeficiency virus; Human immunodeficiency virus infected patient; hyperhidrosis; immunosuppressive treatment; infection rate; insomnia; male; mixed infection; myalgia; osteoarthritis; panic; patient compliance; pilot study; prospective study; quality of life; reinfection; sexually transmitted disease; Short Form 12; stomach spasm; suicidal ideation; suicide; sustained virologic response; syphilis; treatment failure; virus load; xerostomia