Discrimination, mental health, and suicidal ideation among LGBTQ people of color - Sutter, M.; Perrin, P.B. (Journal of counseling psychology, 2016)
Discrimination based on race/ethnicity, sexual orientation, and gender identity has been linked to many negative psychological and physical health outcomes in previous research, including increased suicidal ideation. Two hundred lesbian, gay, bisexual, transgender, and queer (LGBTQ) people of color (POC) were surveyed on their experiences of LGBTQ-based discrimination, racism, mental health (depression, anxiety, satisfaction with life), and suicidal ideation in a national online study based in the United States. A structural equation model (SEM) was created and found that LGBTQ-based discrimination exerted an indirect effect on suicidal ideation through mental health. Racism exerted a direct effect on mental health but was not associated with suicidal ideation in the SEM. The effects of LGBTQ-based discrimination on mental health may be a key area for interventions to reduce suicidal ideation in LGBTQ POC. (PsycINFO Database Record
Keywords: adult; anxiety disorder; bisexuality; depression; epidemiology; ethnology; female; gender identity; human; lesbianism; male; male homosexuality; mental health; psychology; questionnaire; racism; social discrimination; suicidal ideation; transgender; United States; young adult

Lady with erotic preference for diapers - Cernovsky, Z.; Bureau, Y. (Mental Illness, 2016)
A patient in her 20s was referred to us for psychological assessment due to her depression and suicide attempts. She mentioned being anorgasmic except when diapered and emphasized her erotic preference for diapers. Her childhood included maternal deprivation in an impecunious family headed by an irritable physically disabled father on social assistance. Given the maternal deprivation in childhood, her erotic fixation on diapers parallels the emotional attachment to diapers observed by Harlow in mother deprived infant monkeys. Etiological hypotheses should also include the paradigm of avoidance learning from theories of behavior therapy. Our patient does not wish to change her sexual preference: in such cases, fetishism is not considered as an illness by DSM5. However, she needs to be treated for pathological levels of depression with suicidal ideation and low self-esteem.
Keywords: academic failure; adult; anorgasmia; article; bullying; Canadian; case report; depression; diaper; diaper fetishism; domestic violence; DSM-5; emotional deprivation; erotism; female; human; maternal deprivation; neuropsychological test; peer group; personality test; Pittsburgh Sleep Quality Index; psychologic assessment; psychosocial withdrawal; psychotherapy; self esteem; sexual fetishism; sleep disorder; social adaptation; suicide attempt; young adult

A study on adverse drug reactions to first-line antiretroviral therapy in HIV infected patients at a tertiary care hospital in Northeast India - Jain, A.; Lihite, R.J.; Lahkar, M.; Baruah, S.K. (HIV and AIDS Review, 2016)
Background Assam state of Northeast India is surrounded with the states which are very critical in terms of HIV/AIDS. The first line drugs recommended by National AIDS Control Organization for the treatment of HIV infected patients consist of zidovudine (AZT), lamivudine (3TC), nevirapine (NVP), efavirenz (EFV), tenofovir (TDF), and stavudine (d4T). It was observed that the reporting of adverse drug reactions (ADRs) due to these antiretroviral drugs from this region is very low. Aim To study and identify adverse drug reactions to first line treatment in HIV infected patients reported by the nodal centre of antiretroviral therapy (ART) at a tertiary care hospital. Method In this cross-sectional study, 100 HIV infected patients with ADR were reported within 2 months from the nodal ART Centre of Gauhati Medical College and Hospital (GMCH) situated at Guwahati, Assam, Northeast India. WHO-system organ class-body system was used to classify reported ADRs. Causality assessments to reported ADRs were performed by using WHO-UMC causality assessment system. Results In this study, most of the patients have received TDF + 3TC + EFV (83%) regimen followed by AZT + 3TC + NVP (10%), AZT + 3TC + EFV (4%), TDF + 3TC + NVP (2%), and d4T + 3TC + EFV (1%). Efavirenz was commonly implicated drug which was suspected in 81 patients. In this study, 216 ADRs were reported during study period. Of which, 87 ADRs were related to nervous system disorders and 81 ADRs were under gastrointestinal disorders as per WHO-system organ class-body system. Vertigo (22.68%) and vomiting (13.88%) were commonly reported ADR. In this study, substitution of ART regimen was done in 15 patients after detecting ADR while in 85 patients regimen was continued without any change. As per WHO-UMC causality assessment system, causality was possible in 85 patients while it was probable in 15 patients. Conclusion Vertigo and vomiting were the most commonly reported ADR and regimens containing EFV were more likely to induce ADR.
Keywords: efavirenz; lamivudine; nevirapine; stavudine; tenofovir; zidovudine; adult; adverse drug reaction; anemia; antiretroviral therapy; appetite disorder; article; backache; body weight; burning sensation; cross-sectional study; diarrhea; dizziness; drug efficacy; female; fever; hallucination; headache; heterosexuality; homosexuality; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; India; insomnia; liver toxicity; major clinical study; male; nausea; nephrotoxicity; nightmare; observational study; pruritus; rash; Stevens Johnson syndrome; suicide attempt; tertiary care center; underweight; vertigo; vomiting

Characteristics of self-identified sexual addicts in a behavioral addiction outpatient clinic - Wéry, A.; Vogelaere, K.; Challet-Bouju, G.; Poudat, F.-X.; Caillon, J.; Lever, D.; Billieux, J.; Grall-Bronnec, M. (Journal of Behavioral Addictions, 2016)
Background and aims: Research on sexual addiction flourished during the last decade, promoted by the development of an increased number of online sexual activities. Despite the accumulation of studies, however, evidence collected in clinical samples of treatment-seeking people remains scarce. The aim of this study was to describe the characteristics (socio-demographics, sexual habits, and comorbidities) of self-identified "sexual addicts." Methods: The sample was composed of 72 patients who consulted an outpatient treatment center regarding their sexual behaviors. Data were collected through a combination of structured interviewing and self-report measures. Results: Most patients were males (94.4%) aged 20-76 years (mean 40.3 ± 10.9). Endorsement of sexual addiction diagnosis varied from 56.9% to 95.8% depending on the criteria used. The sexual behaviors reported to have the highest degree of functional impairment were having multiple sexual partners (56%), having unprotected sexual intercourse (51.9%), and using cybersex (43.6%). Ninety percent of patients endorsed a comorbid psychiatric diagnosis, and 60.6% presented at least one paraphilia. Conclusions: Results showed highly different profiles in terms of sexual preferences and behaviors, as well as comorbidities involved. These findings highlight the need to develop tailored psychotherapeutic interventions by taking into account the complexity and heterogeneity of the disorder.
Keywords: adult; aged; alcoholism; article; attention deficit disorder; comorbidity; concurrent sexual partnership; demography; erectile dysfunction; female; functional disease; gender dysphoria; generalized anxiety disorder; human; internet sex; major clinical study; major depression; male; masturbation; mental disease; outpatient department; pornography use; premature ejaculation; self report; sexual addiction; sexual behavior; sexual deviation; social background; social phobia; structured interview; suicidal behavior; tobacco dependence; unprotected sex

Baseline assessment of campus-wide general health status and mental health: Opportunity for tailored suicide prevention and mental health awareness programming - Hawley, L.D.; MacDonald, M.G.; Wallace, E.H.; Smith, J.; Wummel, B.; Wren, P.A. (Journal of American college health : J of ACH, 2016)
OBJECTIVE: A campus-wide assessment examined the physical and mental health status of a midsize midwestern public university. PARTICIPANTS: Two thousand and forty-nine students, faculty, and staff on a single college campus were assessed in March-April 2013. METHODS: Participants completed an online survey with sections devoted to demographics, physical and mental health status, and suicide knowledge and experiences. RESULTS: This study captured broad physical and mental health indicators. Students, faculty, and staff in certain demographic groups were more likely to report significant problems associated with mental and physical health. Specifically, women, faculty and staff of color, and nonheterosexual persons reported worse health outcomes. Across 8 mental health indicators, students reported consistently worse mental health than their faculty/staff counterparts. CONCLUSIONS: This paper presents findings from a significant campus-wide physical and mental health surveillance initiative. Results indicate the need for targeted physical and mental health support and intervention among these demographic groups.
Keywords: awareness; comparative study; female; health education; health status; human; male; mental health; organization and management; predictive value; primary prevention; program evaluation; psychology; questionnaire; suicide; United States; university; young adult

The Association Between Supportive High School Environments and Depressive Symptoms and Suicidality Among Sexual Minority Students - Denny, S.; Lucassen, M.F.; Stuart, J.; Fleming, T.; Bullen, P.; Peiris-John, R.; Rossen, F.V.; Utter, J. (Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 2016)
The purpose of this study was to determine if sexual minority students in supportive school environments experienced fewer depressive symptoms and lower rates of suicide ideation, plans and attempts ("suicidality") than sexual minority students in less supportive school environments. In 2007, a nationally representative sample (N = 9,056) of students from 96 high schools in New Zealand used Internet tablets to complete a health and well-being survey that included questions on sexual attractions, depressive symptoms, and suicidality. Students reported their experience of supportive environments at school and gay, lesbian, bisexual, and transgender (GLBT) bullying, and these items were aggregated to the school level. Teachers (n = 2,901) from participating schools completed questionnaires on aspects of school climate, which included how supportive their schools were toward sexual minority students. Multilevel models were used to estimate school effects on depressive symptoms and suicidality controlling for background characteristics of students. Sexual minority students were more likely to report higher levels of depressive symptoms and suicidality than their opposite-sex attracted peers (p < .001). Teacher reports of more supportive school environments for GLBT students were associated with fewer depressive symptoms among male sexual minority students (p = .006) but not for female sexual minority students (p = .09). Likewise in schools where students reported a more supportive school environment, male sexual minority students reported fewer depressive symptoms (p = .006) and less suicidality (p < .001) than in schools where students reported less favorable school climates. These results suggest that schools play an important role in providing safe and supportive environments for male sexual minority students.
Keywords: adolescent; adolescent behavior; bisexuality; bullying; depression; female; homosexuality; human; Internet; male; mental health; minority group; New Zealand; peer group; psychology; questionnaire; school; sexual behavior; statistics and numerical data; student; suicide; suicide attempt; transgender

Implicit Measure of Life/Death Orientation Predicts Response of Suicidal Ideation to Treatment in Psychiatric Inpatients - Ellis, T.E.; Rufino, K.A.; Green, K.L. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2016)
In this study, we set out to extend empirical research on the Life-Death Implicit Association Test (IAT) by administering the measure to an adult psychiatric inpatient population with suicidal ideation. We sought to examine its association with other suicide-relevant measures and to determine whether it adds predictive utility beyond that offered by other measures of suicide risk. The IAT was administered (N = 124) at biweekly intervals as part of an assessment battery at an inpatient facility for complex, treatment resistant psychiatric disorders (average length of stay: approximately 6 weeks). Multiple regression procedures were utilized to examine relationships among the measures and their predictive utility with respect to suicidal ideation at discharge. Consistent with prior research with other populations, significant associations were found between IAT performance and explicit (self-report and interview) measures of suicide risk. Moreover, the IAT was found to predict suicidal ideation at discharge above and beyond number of prior suicide attempts and admission scores on measures of depression, suicidal ideation, and hopelessness. Change in IAT performance over the course of treatment was observed. The IAT shows promise as an addition to explicit measures conventionally used to estimate suicide risk in psychiatric patients. These findings are consistent with a cognitive vulnerability model of suicide risk.
Keywords: adolescent; adult; aged; anxiety disorder; association; attitude to death; bipolar disorder; cognition; major depression; female; hospital patient; human; life; male; mental disease; middle aged; personality disorder; psychology; regression analysis; risk assessment; self report; suicidal ideation; suicide attempt; transgender; treatment outcome; young adult

The Interrelations Between Internalized Homophobia, Depressive Symptoms, and Suicidal Ideation Among Australian Gay Men, Lesbians, and Bisexual Women - McLaren, S. (Journal of homosexuality, 2016)
Internalized homophobia has been linked to depression among gay men, lesbians, and bisexuals. Relatively little research has investigated the link between internalized homophobia and suicidal thoughts and behaviors. The current research investigated the interrelations among internalized homophobia, depressive symptoms, and suicidal ideation by testing additive, mediation, and moderation models. Self-identified Australian gay men (n = 360), lesbians (n = 444), and bisexual women (n = 114) completed the Internalized Homophobia Scale, the Center for Epidemiological Studies Depression Scale, and the suicide subscale of the General Health Questionnaire. Results supported the additive and partial mediation models for gay men and the mediation and moderation models for lesbians. None of the models were supported for bisexual women. The findings imply that clinicians should focus on reducing internalized homophobia and depressive symptoms among gay men and lesbians, and depressive symptoms among bisexual women, to reduce suicidal ideation.
Keywords: adult; aged; Australia; bisexuality; defense mechanism; depression; female; homophobia; human; lesbianism; male; male homosexuality; middle aged; psychology; suicidal ideation; very elderly; young adult

A pilot study to assess emotional distress and quality of life among transgenders in South India - Poguri, M.; Sarkar, S.; Nambi, S. (Neuropsychiatry, 2016)
Background and aims: Transgenders face several social disadvantages in the Indian cultural context, and often live on the fringe of the society. Presence of adverse life circumstances predisposes them to have psychological morbidity. In the absence of previous systematic evidence, this pilot study aimed to assess emotional distress and quality of life among transgenders attending a clinic in south India. Methods: This hospital based cross-sectional study assessed transgenders attending a specialized multi-speciality clinic. Participants were assessed for relevant demographic and clinical information. Anxiety and depression were assessed using Hospital Anxiety and Depression Scale (HADS), while General Health Questionnaire (GHQ) was used to assess for general emotional distress. WHOQOL Bref was used to assess quality of life. Results: The pilot study included 15 transgenders with a median age of 30 years. All the participants had experienced sexual abuse in childhood, and 11/15 (73.3%) had a lifetime suicide attempt. The median HADS anxiety, HADS depression and GHQ scores were 9, 14 and 8 respectively. About 66.7% of the sample had significant anxiety symptoms while 100% had significant depressive symptoms as per HADS cut-off. The quality of life scores were particularly low for the 'social' domain. Conclusion: Transgenders experience considerable emotional distress and have poor social quality of life. Medical professionals need to be sensitive to the health-care needs of transgenders to improve their psychological wellbeing.
Keywords: adult; anxiety disorder; article; child sexual abuse; clinical article; cross-sectional study; depression; descriptive research; emotional stress; female; female to male transgender; General Health Questionnaire; Hospital Anxiety and Depression Scale; human; India; male; male to female transgender; pilot study; priority journal; quality of life; suicide attempt; transgender

Self-injury, suicide ideation, and sexual orientation: differences in causes and correlates among high school students - DeCamp, W.; Bakken, N.W. (Journal of injury & violence research, 2016)
BACKGROUND: Research has suggested that sexual minority youth are more likely to experience a number of behavioral and health-related risk factors due to their exposure to negative attitudes and beliefs about sexual minorities. Few studies, however, have examined the prevalence of non-suicidal self-injury (NSSI) among sexual minority youth. With self-cutting and suicidal ideation common in middle and high schools, understanding the antecedents and correlates of such behavior may help identify troubled students and initiate preventative measures. METHODS: Bivariate probit regression analyses are performed using data from 7,326 high school students collected via the Delaware Youth Risk Behavior Survey. RESULTS: Results indicate that bullying victimization, fighting, substance use, sexual behavior, depression, and unhealthy dieting behaviors were generally associated with NSSI and suicidal ideation. Some effects--including those from sexual activity, substance use, and unhealthy dieting behaviors--significantly differed based on gender and orientation. CONCLUSIONS: Risk factors for suicide and NSSI vary by gender and orientation. Both prevention/intervention specialists and researchers should consider the intersection of these risk factors with sexual orientation in their efforts.
Keywords: adolescent; adolescent behavior; comparative study; Delaware; female; high risk behavior; human; male; psychology; questionnaire; automutilation; sex difference; sexual behavior; statistics and numerical data; student; suicidal ideation; suicide; suicide attempt

Preventing Suicide in Lesbian, Gay, Bisexual, and Transgender Prisoners: A Critique of U.K. Policy - Read, M.; McCrae, N. (Journal of forensic nursing, 2016)
Suicide is a global problem in prisons. As in society generally, gay men in prison have a higher risk of attempting suicide compared with their heterosexual peers. The Howard League for Penal Reform Sex in Prison Commission 2015 reveals a pervasive culture of consensual and coercive sexual relations, with gay men more likely to be targeted for unsolicited sex. Research shows an inadequate institutional response to such abuse. Victims of sexual assault in prison have high rates of psychological problems, which can lead to self-harm and suicide. The Assessment, Care in Custody and Teamwork procedure to assess and manage risk of suicide in prisoners, however, makes no reference to the needs of the lesbian, gay, bisexual, and transgender prison population, despite national policy and best practice guidance that advocates an individualized approach to suicide risk with due consideration of vulnerable group status. This article argues that the Assessment, Care in Custody and Teamwork procedure should be tuned to the requirements of the Equality Act 2010 to ensure that lesbian, gay, bisexual, and transgender prisoners are not exposed to the double jeopardy of sexual assault and related suicidal tendencies.
Keywords: bisexuality; female; health care delivery; health care policy; homosexuality; human; in service training; male; prisoner; psychology; sexual behavior; suicide; transgender; United Kingdom

PTSD, Depression, and Substance Use in Relation to Suicidality Risk among Traumatized Minority Lesbian, Gay, and Bisexual Youth - Smith, B.C.; Armelie, A.P.; Boarts, J.M.; Brazil, M.; Delahanty, D.L. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2016)
Youths who are lesbian, gay, or bisexual (LGB) are more likely than heterosexuals to commit suicide. Substance use, PTSD, and depression are independent risk factors for suicidality; however, the extent to which these factors interact to predict suicidality is unclear. The current study examined the association between substance use, PTSD symptoms (PTSS), depressive symptoms, and suicidality in a sample of 68 traumatized minority LGB youths. Participants were recruited from an LGBT community center and completed a packet of questionnaires. Substance use and depressive symptoms were positively associated with prior suicide attempts. A significant three-way interaction revealed that substance use interacted with both PTSS and depressive symptoms to increase the odds of attempted suicide. Results underscore the importance of integrating substance use components into PTSD/depression treatment to reduce suicide risk in LGB youth.
Keywords: adolescent; African American; American Indian; depression; ethnic group; female; Hispanic; human; male; minority group; odds ratio; psychotrauma; psychology; risk factor; sexual and gender minority; statistical model; statistics and numerical data; posttraumatic stress disorder; drug dependence; suicidal ideation; suicide; suicide attempt; United States; young adult

Suicide by transgender: A crisis of identity - Chouksey, V.K.; Band, R.; Rani, M.; Rani, Y. (Journal of Forensic Medicine and Toxicology, 2016)
Transgender community is socially isolated and most discriminated against group in India and world over. Black and white depiction of humans into male and female ignores the gray shades of transsexuals. Present case shows identity crisis suffered by born male person later underwent sex reconstruction surgery. Rejected by his own family, he was accepted by transgender community. Depression and addiction worsened the situation further. After he committed suicide, body was brought for autopsy at Lady Hardinge Medical College. This case report tries to present social, medico-legal and legal aspects related to case to raise awareness among medical fraternity regarding transgender.
Keywords: addiction; adult; article; asphyxia; autopsy; cause of death; cyanosis; depression; female; hanging; human; human tissue; liver cirrhosis; male to female transgender; suicide; transgenderism

Mental Health Disparities Within the LGBT Population: A Comparison between Transgender and Nontransgender Individuals - Su, D.; Irwin, J.A.; Fisher, C.; Ramos, A.; Kelley, M.; Mendoza, D.A.R.; Coleman, J.D. (Transgender Health, 2016)
Purpose: This study assessed within a Midwestern LGBT population whether, and the extent to which, transgender identity was associated with elevated odds of reported discrimination, depression symptoms, and suicide attempts. Methods: Based on survey data collected online from respondents who self-identified as lesbian, gay, bisexual, and/or transgender persons over the age of 19 in Nebraska in 2010, this study performed bivariate t- or chi-square tests and multivariate logistic regression analysis to examine differences in reported discrimination, depression symptoms, suicide attempts, and self-acceptance of LGBT identity between 91 transgender and 676 nontransgender respondents. Results: After controlling for the effects of selected confounders, transgender identity was associated with higher odds of reported discrimination (OR=2.63, p<0.01), depression symptoms (OR=2.33, p<0.05), and attempted suicides (OR=2.59, p<0.01) when compared with nontransgender individuals. Self-acceptance of LGBT identity was associated with substantially lower odds of reporting depression symptoms (OR=0.46, p<0.001). Conclusion: Relative to nontransgender LGB individuals, transgender individuals were more likely to report discrimination, depression symptoms, and attempted suicides. Lack of self-acceptance of LGBT identity was associated with depression symptoms among transgender individuals.
Keywords: adult; article; bisexuality; comparative study; controlled study; depression; female; gender identity; health disparity; homosexual female; homosexual male; human; income; LGBT people; male; mental health; Nebraska; priority journal; self acceptance; sexism; social acceptance; social aspects and related phenomena; social status; suicide attempt; symptom; transgender

Gender Affirmation and Resiliency among Black Transgender Women with and Without HIV Infection - Crosby, R.A.; Salazar, L.F.; Hill, B.J. (Transgender Health, 2016)
Purpose: Among black transgender women (transwomen) at high risk of HIV acquisition or already living with HIV/AIDS, the study examined whether medical or socially based gender affirming factors may contribute differentially to selected measures of resiliency, perceived stress, and a scale measure of mental health outcomes. This question has implications for clinical care and counseling of this population. Methods: Seventy-seven black transwomen were recruited to participate in a private, face-to-face structured interview. Two index measures of gender affirmation (GA) were constructed from the data. One comprised medical aspects only and the other comprised social aspects of GA. Assessed outcomes were personal competence and acceptance of self and life (resiliency), perceived stress and recent anxiety, depression, and suicide ideation (mental health). Associations between GA variables and outcomes were first assessed using bivariate level correlations. Significant bivariate associations were then tested in multivariable regression models adjusting for age and HIV status. Results: Mean age of the sample was 34.5 years. More than one-half of the sample (62.3%) indicated being HIV-infected. None of the bivariate or multivariable associations pertaining to GA medical factors were significant. Conversely, the social GA factors were significant and protective with all four outcomes. In the presence of age and HIV status, greater social GA was significantly associated with greater personal competence, acceptance of self and life, and positive mental health outcome. HIV status had an independent effect on personal competence, acceptance of self and life, with HIV-positive transwomen scoring higher on both measures. Conclusion: Among black transwomen at high risk of HIV acquisition or already HIV-infected, study findings suggest the possibility that socially based GA may play a prominent role in strengthening the resiliency and mental health of black transwomen. This same protective effect may not occur as a consequence of gender affirming body modification practices.
Keywords: adult; African American; aged; anxiety disorder; article; body modification; controlled study; depression; female; gender affirmation; groups by age; high risk population; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; male to female transgender; mental health; outcome assessment; priority journal; psychological resilience; self concept; sex difference; social aspect; physiological stress; structured interview; suicidal ideation

PTSD and Trauma-Related Difficulties in Sexual Minority Women: The Impact of Perceived Social Support - Weiss, B.J.; Garvert, D.W.; Cloitre, M. (Journal of traumatic stress, 2015)
This study examined posttraumatic stress disorder (PTSD) and related symptoms among sexual minority (SM) and heterosexual women and the influence of social support on the relationship between SM status and symptoms. We hypothesized that SM women would endorse higher symptoms of PTSD and related difficulties and that social support would moderate the relationship between SM status and symptoms. The sample, women seeking treatment for PTSD related to interpersonal violence (n = 477; mean age = 36.07 years; 22.9% SM) completed clinician-administered measures of PTSD and self-report measures of trauma-related difficulties and social support. The rate of PTSD diagnosis was higher for SM women. Social support and SM status were significantly associated with suicidality, self-perceptions, depression, somatic complaints, and functional impairment. The interaction between social support and SM status was significant for both functional impairment (β = -.26) and somatic complaints (β = -.39). High social support had an equal, positive effect among SM and nonminority women, whereas low social support had a greater negative impact among SM women. Results suggested the particular salience of social support on functioning and symptom severity among SM women and the potential importance of including interventions addressing social support into PTSD treatments for SM women.
Keywords: adult; childhood trauma survivor; crime victim; exposure to violence; female; homophobia; human; lesbianism; minority group; New York; psychology; sexual crime; social support; statistics and numerical data; posttraumatic stress disorder

Factors influencing the priority of access to food and their effects on the carcass traits for Japanese Black (Wagyu) cattle - Takanishi, N.; Oishi, K.; Kumagai, H.; Uemura, M.; Hirooka, H. (Animal : an international journal of animal bioscience, 2015)
The factors influencing the priority of access to food and the effects of the priority of access to food on their carcass traits were analyzed for Japanese Black (Wagyu) cattle in a semi-intensive fattening production system. The records of 96 clinically healthy steers and heifers were analyzed. The calves at ∼3 to 4 months of age were allocated to pens with four animals per pen; all four animals in the same pen were of the same sex and of similar body size. The ranking of the animals' priority of access to food (1st, 2nd, 3rd and 4th), which was determined by the farm manager, was used as an indicator of social dominance in the present study. Four models including sire line, maternal grandsire line and the difference in the animals' birth dates as fixed effects were used to analyze factors influencing the priority of access to food. Ranking was represented by ordinal scores (highest=4, lowest=1) in Model 1, and the binary scores were assigned in Model 2 (highest=1; 2nd, 3rd and 4th=0), Model 3 (1st and 2nd=1; 3rd and 4th=0) and Model 4 (1st, 2nd and 3rd=1; lowest=0). The results showed that the difference in the animals' birth dates had a significant effect on the establishment of the priority of access to food in Model 3 (P<0.05), suggesting that animals born earlier may become more dominant in the pen. The maternal grandsire line tended to affect the social rank score in Models 2 and 3 (P<0.10). Our results indicated that the maternal grandsire line may affect the temperament of calves through their mothers' genetic performance and thereby more aggressive calves may be more dominant and have higher priority of access to food. On the other hand, there was a significant effect of the priority of access to food on beef marbling score (BMS; P<0.05), and the priority of access to food also tended to influence the carcass weight (P=0.09). The highest BMS was observed for animals with the first rank of the priority of access to food (P<0.05), and the higher-ranking animals had the tendency to be heavier carcass than the lower-ranking animals. Our findings emphasized the importance of information about the priority of access to food determined by farmers' own observation on implementing best management practices in small-scaled semi-intensive beef cattle production systems.
Keywords: analysis; animal; animal behavior; body composition; body weight; bovine; eating; female; Japan; male; meat; phenotype; physiology; theoretical model; time factor

The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women - Valentine, S.E.; Elsesser, S.; Grasso, C.; Safren, S.A.; Bradford, J.B.; Mereish, E.; O'Cleirigh, C. (Journal of urban health : bulletin of the New York Academy of Medicine, 2015)
Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.
Keywords: adult; aged; bisexuality; economics; female; health care cost; human; lesbianism; middle aged; minority group; patient attitude; psychology; socioeconomics; statistics and numerical data; United States; women's health

Health Correlates of Criminal Justice Involvement in 4,793 Transgender Veterans - Brown, G.R.; Jones, K.T. (LGBT health, 2015)
PURPOSE: Transgender (TG) persons are overrepresented in prison settings and in the U.S. veteran population. Health disparities studies of large populations of transgender people involved with the criminal justice system have not been published to date. METHODS: We studied a large cohort of TG veterans who received care in Veterans Health Administration (VHA) facilities during 2007-2013 (n = 4,793) and a 3:1 matched control group of veterans without known TG identification (n = 13,625). Three hundred twenty six (n = 138 TG, 188 non-TG) had received VHA services in programs designed to address the needs of justice involved (JI) veterans. We linked patients in each of the three groups to their medical and administrative data. RESULTS: TG veterans were more likely to be justice involved than controls (2.88% vs. 1.38%; P < .0001). Compared to non-TG JI veterans, TG JI veterans were more likely to have a history of homelessness (80% vs. 67%; P < .05) and to have reported sexual trauma while serving in the military (23% vs. 12%; P < .01). Significant health disparities were noted for TG JI veterans for depression, hypertension, obesity, posttraumatic stress disorder, serious mental illness, and suicidal ideation/attempts. CONCLUSION: These data suggest that TG veterans experience a number of health risks compared to non-TG veterans, including an increased likelihood of justice involvement. TG veterans involved with the criminal justice system are a particularly vulnerable group and services designed to address the health care needs of this population, both while incarcerated and when in the community, should take these findings into account in the development of health screenings and treatment plans.
Keywords: adult; aged; female; health disparity; homeless person; human; male; mental health; middle aged; prisoner; sexual crime; social determinants of health; socioeconomics; statistics and numerical data; transgender; United States; veteran

Early Onset Alcohol Use and Self-Harm: A Discordant Twin Analysis - Few, L.R.; Werner, K.B.; Sartor, C.E.; Grant, J.D.; Trull, T.J.; Nock, M.K.; Bucholz, K.K.; Deitz, S.K.; Glowinski, A.L.; Martin, N.G.; Nelson, E.C.; Statham, D.J.; et al. (Alcoholism: Clinical and Experimental Research, 2015)
Background: Self-harm has considerable societal and economic costs and has been extensively studied in relation to alcohol involvement. Although early onset alcohol use (EAU) has been causally linked to maladaptive clinical outcomes, its association with self-harm is less well characterized. This study aimed to further examine the link between EAU and both nonsuicidal self-injury (NSSI) and suicide attempt (SA), and elucidate shared familial and causal/individual-specific pathways that explain this co-occurrence. Methods: Using data from 6,082 Australian same-sex twin pairs (1,732 monozygotic [MZ] and 1,309 dizygotic [DZ]), ages 23 to 40, we examined prevalence rates of NSSI and SA among twin pairs concordant and discordant for EAU. Conditional logistic regression, controlling for early clinical covariates and the influence of zygosity on EAU, was used to examine the odds ratio (OR) of self-harm within twin pairs discordant for EAU. Results: Prevalence rates of both NSSI and SA were highest among twin pairs concordant for EAU and for twins who reported EAU within discordant twin pairs. Results from discordant twin analyses revealed nearly 4-fold increased odds of SA for the twin who endorsed EAU, and this OR was equal across MZ and DZ twins. EAU also was associated with elevated odds of NSSI (OR = 7.62), although this was only the case for DZ twins in discordant pairs. Conclusions: The equivalent increase in odds of SA for both MZ and DZ twins suggests that causal or individual-specific influences explain the link between EAU and SA. For NSSI, elevated odds for DZ twins and nonsignificant findings for MZ twins implicate correlated genetic factors in the association between EAU and NSSI. Future studies should test mechanisms through which EAU may causally influence SA, as well as examine whether genetic risk for third variables (e.g., negative urgency, stress reactivity) may explain the genetic overlap between EAU and NSSI.
Keywords: alcohol; adult; alcohol consumption; anhedonia; article; Australian; automutilation; bleeding; child sexual abuse; cohort analysis; depression; dizygotic twins; drug intoxication; environmental factor; family history; female; genetic correlation; high risk behavior; human; major clinical study; male; monozygotic twins; priority journal; suicide attempt; twins; wrist injury; zygosity

Unusually large number of mutations in asexually reproducing clonal planarian Dugesia japonica - Nishimura, O.; Hosoda, K.; Kawaguchi, E.; Yazawa, S.; Hayashi, T.; Inoue, T.; Umesono, Y.; Agata, K. (PLoS ONE, 2015)
We established a laboratory clonal strain of freshwater planarian (Dugesia japonica) that was derived from a single individual and that continued to undergo autotomous asexual reproduction for more than 20 years, and we performed large-scale genome sequencing and transcriptome analysis on it. Despite the fact that a completely clonal strain of the planarian was used, an unusually large number of mutations were detected. To enable quantitative genetic analysis of such a unique organism, we developed a new model called the Reference Gene Model, and used it to conduct large-scale transcriptome analysis. The results revealed large numbers of mutations not only outside but also inside gene-coding regions. Non-synonymous SNPs were detected in 74% of the genes for which valid ORFs were predicted. Interestingly, the high-mutation genes, such as metabolism- and defenserelated genes, were correlated with genes that were previously identified as diverse genes among different planarian species. Although a large number of amino acid substitutions were apparently accumulated during asexual reproduction over this long period of time, the planarian maintained normal body-shape, behaviors, and physiological functions. The results of the present study reveal a unique aspect of asexual reproduction.
Keywords: transcriptome; amino acid substitution; article; asexual reproduction; behavior; body build; clonal species; controlled study; Dugesia japonica; gene identification; gene mutation; gene sequence; genetic model; genome size; nonhuman; open reading frame; physiology; single nucleotide polymorphism; transcriptomics; Turbellaria

Asking for help online: Lesbian, gay, bisexual and trans youth, self-harm and articulating the 'failed' self - McDermott, E. (Health (London, England : 1997), 2015)
International evidence suggests that young people are less likely to seek help for mental health problems in comparison with adults. This study focused on lesbian, gay, bisexual and trans young people who are a population group with an elevated risk of suicide and self-harm, and little is known about their help-seeking behaviour. Utilising qualitative virtual methods, lesbian, gay, bisexual and trans youth web-based discussions about seeking help for suicidal feelings and self-harming were investigated. Findings from a thematic analysis indicate that these young people wanted assistance but found it difficult to (1) ask for help, (2) articulate emotional distress and (3) 'tell' their selves as 'failed'. This analysis suggests that key to understanding these problems are emotions such as shame which arise from negotiating norms connected to heterosexuality, adolescence and rationality. I argue that these norms act to regulate what emotions it is possible to feel, what emotions it is possible to articulate and what type of young lives that can be told. The future development of health and social care interventions which aim to reduce lesbian, gay, bisexual and trans youth suicide and self-harm need to work with a nuanced understanding of the emotional life of young people if they are to be effective.
Keywords: adolescent; adult; bisexuality; emotion; female; help seeking behavior; homosexuality; human; Internet; male; mental health; physiology; psychology; qualitative research; automutilation; suicidal ideation; transgender; young adult

Frequency of and risk factors for depression among participants in the swiss HIV Cohort Study (SHCS) - Anagnostopoulos, A.; Ledergerber, B.; Jaccard, R.; Shaw, S.A.; Stoeckle, M.; Bernasconi, E.; Barth, J.; Calmy, A.; Berney, A.; Jenewein, J.; Weber, R. (PLoS ONE, 2015)
Objectives We studied the incidence and prevalence of, and co-factors for depression in the Swiss HIV Cohort Study. Methods Depression-specific items were introduced in 2010 and prospectively collected at semiannual cohort visits. Clinical, laboratory and behavioral co-factors of incident depression among participants free of depression at the first two visits in 2010 or thereafter were analyzed with Poisson regression. Cumulative prevalence of depression at the last visit was analyzed with logistic regression. Results Among 4,422 participants without a history of psychiatric disorders or depression at baseline, 360 developed depression during 9,348 person-years (PY) of follow-up, resulting in an incidence rate of 3.9 per 100 PY (95% confidence interval (CI) 3.5-4.3). Cumulative prevalence of depression during follow-up was recorded for 1,937/6,756 (28.7%) participants. Incidence and cumulative prevalence were higher in injection drug users (IDU) and women. Older age, preserved work ability and higher physical activity were associated with less depression episodes. Mortality (0.96 per 100 PY, 95% CI 0.83-1.11) based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78-3.09), female IDU (2.33, 1.59-3.39) and white heterosexual men (1.32, 0.94-1.84) compared to white heterosexual women and homosexual men (0.53, 0.29-0.95; and 0.71, 0.55-0.92). Compared to participants free of depression, mortality was slightly elevated among participants with a history of depression (1.17, 0.94-1.45 vs. 0.86, 0.71-1.03, P = 0.033). Suicides (n = 18) did not differ between HIV transmission groups (P = 0.50), but were more frequent among participants with a prior diagnosis of depression (0.18 per 100 PY, 95%CI 0.10-0.31; vs. 0.04, 0.02-0.10; P = 0.003). Conclusions Depression is a frequent co-morbidity among HIV-infected persons, and thus an important focus of care.
Keywords: adult; age; alcohol consumption; article; controlled study; depression; disease association; female; heterosexual female; heterosexual male; high risk patient; homosexual male; human; Human immunodeficiency virus infection; incidence; intravenous drug abuse; major clinical study; male; medical history; middle aged; mortality; physical activity; prevalence; prospective study; risk factor; sex difference; smoking; suicide; Switzerland; virus load; virus transmission

Plasmodium parasites mount an arrest response to dihydroartemisinin, as revealed by whole transcriptome shotgun sequencing (RNA-seq) and microarray study - Shaw, P.J.; Chaotheing, S.; Kaewprommal, P.; Piriyapongsa, J.; Wongsombat, C.; Suwannakitti, N.; Koonyosying, P.; Uthaipibull, C.; Yuthavong, Y.; Kamchonwongpaisan, S. (BMC Genomics, 2015)
Background: Control of malaria is threatened by emerging parasite resistance to artemisinin and derivative drug (ART) therapies. The molecular detail of how Plasmodium malaria parasites respond to ART and how this could contribute to resistance are not well understood. To address this question, we performed a transcriptomic study of dihydroartemisinin (DHA) response in P. falciparum K1 strain and in P. berghei ANKA strain using microarray and RNA-seq technology. Results: Microarray data from DHA-treated P. falciparum trophozoite stage parasites revealed a response pattern that is overall less trophozoite-like and more like the other stages of asexual development. A meta-analysis of these data with previously published data from other ART treatments revealed a set of common differentially expressed genes. Notably, ribosomal protein genes are down-regulated in response to ART. A similar pattern of trophozoite transcriptomic change was observed from RNA-seq data. RNA-seq data from DHA-treated P. falciparum rings reveal a more muted response, although there is considerable overlap of differentially expressed genes with DHA-treated trophozoites. No genes are differentially expressed in DHA-treated P. falciparum schizonts. The transcriptional response of P. berghei to DHA treatment in vivo in infected mice is similar to the P. falciparum in vitro culture ring and trophozoite responses, in which ribosomal protein genes are notably down-regulated. Conclusions: Ring and trophozoite stage Plasmodium respond to ART by arresting metabolic processes such as protein synthesis and glycolysis. This response can be protective in rings, as shown by the phenomenon of dormancy. In contrast, this response is not as protective in trophozoites owing to their commitment to a highly active and vulnerable metabolic state. The lower metabolic demands of schizonts could explain why they are less sensitive and unresponsive to ART. The ART response pattern is revealed clearly from RNA-seq data, suggesting that this technology is of great utility for studying drug response in Plasmodium.
Keywords: artemisinin derivative; dihydroartemisinin; transcriptome; animal cell; animal experiment; animal model; article; controlled study; correlation analysis; down regulation; female; gene expression regulation; gene mapping; genetic transcription; glycolysis; in vitro study; in vivo study; malaria falciparum; microarray analysis; mouse; nonhuman; Plasmodium berghei; Plasmodium berghei infection; Plasmodium falciparum; protein phosphorylation; protein synthesis; RNA sequence; schizont; transcriptomics; trophozoite; unfolded protein response; upregulation

Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria - Olson, J.; Schrager, S.M.; Belzer, M.; Simons, L.K.; Clark, L.F. (Journal of Adolescent Health, 2015)
Purpose The purpose of this study was to describe baseline characteristics of participants in a prospective observational study of transgender youth (aged 12-24 years) seeking care for gender dysphoria at a large, urban transgender youth clinic. Methods Eligible participants presented consecutively for care at between February 2011 and June 2013 and completed a computer-assisted survey at their initial study visit. Physiologic data were abstracted from medical charts. Data were analyzed by descriptive statistics, with limited comparisons between transmasculine and transfeminine participants. Results A total of 101 youth were evaluated for physiologic parameters, 96 completed surveys assessing psychosocial parameters. About half (50.5%) of the youth were assigned a male sex at birth. Baseline physiologic values were within normal ranges for assigned sex at birth. Youth recognized gender incongruence at a mean age of 8.3 years (standard deviation = 4.5), yet disclosed to their family much later (mean = 17.1; standard deviation = 4.2). Gender dysphoria was high among all participants. Thirty-five percent of the participants reported depression symptoms in the clinical range. More than half of the youth reported having thought about suicide at least once in their lifetime, and nearly a third had made at least one attempt. Conclusions Baseline physiologic parameters were within normal ranges for assigned sex at birth. Transgender youth are aware of the incongruence between their internal gender identity and their assigned sex at early ages. Prevalence of depression and suicidality demonstrates that youth may benefit from timely and appropriate intervention. Evaluation of these youth over time will help determine the impact of medical intervention and mental health therapy.
Keywords: alanine aminotransferase; estradiol; glucose; gonadorelin agonist; hemoglobin; high density lipoprotein; potassium; prolactin; testosterone; triacylglycerol; adolescent; adult; article; Beck Depression Inventory; blood pressure; body height; body mass; body weight; child; child behavior; demography; depression; DSM-IV-TR; female; gender dysphoria; gender identity; help seeking behavior; heterosexual female; hormonal therapy; human; major clinical study; male; observational study; physical parameters; priority journal; prospective study; sex role; sexual behavior; sexual orientation; standing; suicidal ideation; suicide attempt; transgender

Educating for diversity: An evaluation of a sexuality diversity workshop to address secondary school bullying - Lucassen, M.F.G.; Burford, J. (Australasian Psychiatry, 2015)
Objective: To evaluate the potential of a 60-minute sexuality diversity workshop to address bullying in secondary schools. Methods: Students completed pre- and post-workshop questionnaires. Descriptive statistics were used to summarise results with pre- to immediate post-workshop changes compared using t-tests. Thematic analysis was used to analyse open-ended questionnaire responses. Results: We had 229 students (mean age 13.7 years) attending 10 workshops participate in the study. Three-quarters of students thought the workshop would reduce bullying in schools, and over 95% of the participants thought that other secondary schools should offer the workshop. There was a significant increase in valuing (p < 0.001) and understanding (p < 0.001) sexuality-diverse individuals (e.g. lesbian, gay and bisexual people), between the pre- and post-workshop results. School climates were largely perceived to be 'hard' and included 'bullying/mocking' of sexuality-diverse students; however, many individual students reported a desire to be supportive of their sexuality-diverse peers. Conclusions: Sexuality-based bullying is commonplace in secondary schools. This form of bullying is associated with depression and suicide attempts. Reducing sexuality-based bullying is very likely to have a positive impact on the mental health of young people. Brief workshops, as a part of a wider suite of interventions, have some potential to create safer school environments.
Keywords: adolescent; article; bullying; controlled study; disease association; ethnicity; female; high school; homosexual female; human; human experiment; LGBT people; male; mental health; normal human; peer acceptance; peer group; qualitative analysis; questionnaire; sexual education; sexuality; species diversity; thematic analysis; visual analog scale; workshop

High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America - Mimiaga, M.J.; Biello, K.B.; Robertson, A.M.; Oldenburg, C.E.; Rosenberger, J.G.; O'Cleirigh, C.; Novak, D.S.; Mayer, K.H.; Safren, S.A. (Archives of sexual behavior, 2015)
The HIV epidemic in Latin America is highly concentrated in men who have sex with men (MSM). In the United States, multiple co-occurring psychosocial conditions have been shown to act as intertwined epidemics to potentiate HIV transmission among MSM. To date, no study has examined the role of syndemics and condomless sex among MSM in Latin America. In 2012, an online survey was conducted among members of the largest social/sexual networking website for MSM in Latin America. Participants were asked about demographics, sexual behaviors, HIV/STI diagnoses, and psychosocial well-being, including depression, suicidal ideation, hazardous alcohol use, hard drug use during sex, history of childhood/adolescent sexual abuse, intimate partner violence, and sexual compulsivity. Multivariable logistic generalized estimation equations were used to assess the relationship of syndemic factors and (1) engagement in higher risk condomless anal sex and (2) self-report of prior HIV diagnosis. Among 24,274 survey respondents, 74.6 % of the sample had at least one syndemic factor. In an additive model, syndemics were associated with increased odds of higher risk condomless anal sex, ranging from adjusted odds ratio of 1.31 (95 % CI 1.20, 1.43) for one syndemic factor to 4.06 (95 % CI 3.25, 5.09) for 6/7 syndemic factors. Similarly, syndemics were associated with increased odds of HIV infection (p < .0001). This study provides initial evidence that intertwined syndemics increase HIV risk behavior and HIV infection among MSM in Latin America. In the Latin American context, comprehensive HIV prevention interventions for MSM should be developed and tested that simultaneously address co-occurring psychosocial conditions and HIV risk.
Keywords: adult; cross-sectional study; Human immunodeficiency virus infection; human; male; male homosexuality; prevalence; psychology; South and Central America; statistics and numerical data; unsafe sex; young adult

The Gold-Hope Tang, MD 2015 Humanism in Medicine Essay Contest: Third Place: Gauze and Guns - Gridley, S. (Academic medicine : journal of the Association of American Medical Colleges, 2015)
Keywords: abscess; awards and prizes; bandage; crime victim; human; humanism; literature; posttraumatic stress disorder; psychology; transgender

Effects of minority stress processes on the mental health of Latino men who have sex with men and women: a qualitative study - Holloway, I.W.; Padilla, M.B.; Willner, L.; Guilamo-Ramos, V. (Archives of sexual behavior, 2015)
Emerging literature on minority stress among sexual minority populations has described the negative consequences that multiple minority statuses may exert on mental health and well-being. This literature has tended to focus on individuals whose self-identifications reflect sexual minority sexual categories, such as gay or bisexual, and has explored the intersection of these definitions with ethnic, racial, and class statuses. Few such studies have explored mental health among men who actively deny a sexual minority sexual identity label while engaging in same-sex sexual behaviors. The present study used ethnographic interview data from 20 non-gay-identified bisexually behaving Dominican and Puerto Rican men in New York City. Participants described discovery of same sex sexual behavior as a threat to their intimate relationships, community affiliation, and counter to expectations of Latino masculinity. Recounting a wide range of information management strategies used to avoid open disclosure about their sexual lives, participants experienced the potential consequences of disclosure as extreme and even life threatening. Men anticipated social isolation, depression, self-injury, and suicidality as possible outcomes from disclosing sexual behavior with other men to their female romantic partners. This analysis provides direction for future research on minority stress processes and mental health service delivery among Latino men who have sex with men and women.
Keywords: adult; bisexuality; female; Hispanic; human; male; male homosexuality; mental health; middle aged; minority group; psychology; sexual behavior; sexuality; young adult

Outcomes associated with anxiety and depression among men who have sex with men in Estonia - Parker, R.D.; Lõhmus, L.; Valk, A.; Mangine, C.; Rüütel, K. (Journal of Affective Disorders, 2015)
Abstract Background Evidence supports that gay, lesbian, and transgender populations are at increased risk for mental health problems. The current study was conducted to estimate the prevalence of anxiety and depressive symptoms and related factors among men who have sex with men (MSM) in Estonia. This is the only known study of its type in the Eastern European region. Methods In 2013, an Internet-based survey was conducted among men who have sex with men, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. Results 265 MSM completed the questionnaire (median age 31 years, 90% Estonian, 71% from the capital; 73% employed full-time, 42% with at least college education; 44% in a steady relationship; 72% gay, 23% bisexual; 23% reported illegal drug use in the last 12 months). One third met criteria for problem drinking and depressive symptoms with one quarter for anxiety symptoms. Suicidality was 44% reported lifetime suicidal thoughts and 11% with at least one suicide attempt. Limitations The study instruments, EST-Q and CAGE, only measure symptoms and are not diagnostic tests. A non-random sample which could possibly include persons with easier internet access. Self-reported data and cross-sectional study design are prone to issues with recall bias and temporality. Conclusions With demonstrated high rates of anxiety, depression, drinking, and drug use among MSM which is consistent with similar studies in Western countries, further research could help determine effective MSM focused interventions to address the broad spectrum of issues among MSM.
Keywords: illicit drug; adult; aged; alcohol consumption; anxiety disorder; article; bisexuality; cross-sectional study; depression; drug use; Estonia; Estonian (people); health survey; human; internalization (cell); major clinical study; male; men who have sex with men; mental health; outcome assessment; prevalence; priority journal; questionnaire; self report; sexuality; suicidal behavior; suicidal ideation; suicide attempt

Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults - Coulter, R.W.S.; Blosnich, J.R.; Bukowski, L.A.; Herrick, A.L.; Siconolfi, D.E.; Stall, R.D. (Drug and Alcohol Dependence, 2015)
Background: Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED). Methods: Cross-sectional surveys were completed by 75,192 students aged 18-29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females. Results: Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk. =. 1.42; p=. 0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values. <. 0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values. < 0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR = 3.21, p= 0.011) or verbally threatened (IRR. = 2.42, p= 0.021) in the past year had greater HED days than those who did not experience those forms of victimization. Conclusions: Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.
Keywords: adult; alcohol consumption; alcohol related problem; article; assault; comparative study; controlled study; cross-sectional study; demography; drinking behavior; female; binge drinking; high risk population; human; incidence; male; named groups by sexuality; nontransgender identified female; nontransgender identified male; personal experience; physical assault; prevalence; priority journal; risk factor; self report; sex difference; sexual assault; social problem; suicidal ideation; threat; transgender; United States; verbal threat; victimization; violence; young adult

Sexual Violence Against Men Who Have Sex with Men in Brazil: A Respondent-Driven Sampling Survey - Sabidó, M.; Kerr, L.R.; Mota, R.S.; Benzaken, A.S.; de A Pinho, A.; Guimaraes, M.D.; Dourado, I.; Merchan-Hamman, E.; Kendall, C. (AIDS and behavior, 2015)
We estimated the prevalence of sexual violence (SV) experience among men who have sex with men (MSM) in Brazil and identified its associated risk factors. We recruited 3859 MSM through respondent driven sampling. A multivariable hierarchical analysis was performed using an ecological model. The prevalence of having ever experienced SV was 15.9 % (95 % confidence interval [CI] 14.7-17.1). SV experience was independently associated with discrimination due to sexual orientation (odds ratio [OR] 3.05; 95 % CI 2.10-4.42), prior HIV testing (OR 1.81; 95 % CI 1.25-2.63), ≤14 years at first sex (OR 1.86; 95 % CI 1.28-2.71), first sex with a man (OR 1.89; 95 % CI 1.28-2.79), presenting STI symptoms (last year) (OR 1.66; 95 % CI 1.12-2.47), and having suicidal ideas (last 6 months) (OR 2.08; 95 % CI 1.30-3.35). The high levels of SV against MSM in Brazil place them at a markedly higher risk of SV than the general population. Homophobic prejudice is the strongest determinant of SV and urgently needs to be included at the forefront of the national response to SV.
Keywords: adult; Brazil; cross-sectional study; health survey; Human immunodeficiency virus infection; human; male; male homosexuality; middle aged; multivariate analysis; odds ratio; prevalence; psychology; questionnaire; risk factor; sexual crime; statistics and numerical data

Poorer mental health in UK bisexual women than lesbians: evidence from the UK 2007 Stonewall Women's Health Survey - Colledge, L.; Hickson, F.; Reid, D.; Weatherburn, P. (Journal of public health (Oxford, England), 2015)
BACKGROUND: Bisexual- and lesbian-identified women have significantly worse mental health than heterosexual women. Less evidence exists about mental health differences between lesbian and bisexual women. METHODS: Self-completion survey with community-based, opportunistic sampling recruited 937 bisexual-identified and 4769 lesbian-identified women. Associations between sexual identity and mental health indicators were assessed by logistic regression, controlling for age, income, student status and employment. RESULTS: As a group, bisexual women were younger, poorer, and more likely to be trans-identified, minority ethnic identified and to use marijuana, compared with lesbians. Bisexuals were more likely than lesbians to report eating problems (adjusted odds ratio (AOR) = 1.64, P < 0.001), self-harm (AOR = 1.37, P = 0.001), depressed feelings (AOR = 1.26, P = 0.022) and anxiety (AOR = 1.20, P = 0.037). Fewer bisexual women attended lesbian or bisexual social events, were 'out', or had experienced any sexuality-related discrimination, compared with lesbians. CONCLUSION: More bisexual women reported poor mental health or psychological distress than did lesbians. Bisexual women may be more likely to experience social stress due to the 'double discrimination' of homophobia and biphobia. This stress, experienced mainly as internalized and felt stigma, could result in greater risk for poor mental health compared with lesbians. Addressing both biphobia and homophobia within UK society has important preventative mental health implications.
Keywords: adolescent; adult; bisexuality; cross-sectional study; eating disorder; female; Great Britain; health survey; human; lesbianism; mental health; mental stress; middle aged; psychology; questionnaire; socioeconomics; statistical model; statistics and numerical data; suicidal ideation; young adult

Parental Rejection Following Sexual Orientation Disclosure: Impact on Internalized Homophobia, Social Support, and Mental Health - Puckett, J.A.; Woodward, E.N.; Mereish, E.H.; Pantalone, D.W. (LGBT health, 2015)
Sexual minority individuals face unique stressors because of their sexual identity. We explored associations between parental reactions to children's coming out, internalized homophobia (IH), social support, and mental health in a sample of 257 sexual minority adults. Path analyses revealed that higher IH and lower social support mediated the association between past parental rejection and current psychological distress. Mental health providers may benefit clients by utilizing interventions that challenge internalized stereotypes about homosexuality, increase social support, and process parental rejection, as well as focusing on how certain crucial experiences of rejection may impact clients' IH and mental health.
Keywords: adolescent; adult; aged; anxiety; depression; father; female; homophobia; human; male; mental health; mother; parent; psychology; sexuality; social support; suicidal ideation; transgender; young adult

Predictors of Suicidal Ideation in a Statewide Sample of Transgender Individuals - Rood, B.A.; Puckett, J.A.; Pantalone, D.W.; Bradford, J.B. (LGBT health, 2015)
Transgender individuals experience violence and discrimination, which, in addition to gender transitioning, are established correlates of psychological distress. In a statewide sample of 350 transgender adults, we investigated whether a history of violence and discrimination increased the odds of reporting lifetime suicidal ideation (SI) and whether differences in SI were predicted by gender transition status. Violence, discrimination, and transition status significantly predicted SI. Compared with individuals with no plans to transition, individuals with plans or who were living as their identified gender reported greater odds of lifetime SI. We discuss implications for SI disparities using Meyer's minority stress model.
Keywords: adult; crime victim; female; human; male; middle aged; minority group; prejudice; psychology; risk factor; socioeconomics; suicidal ideation; transgender; violence

Differentiating suicide attempters from suicide ideators using the Integrated Motivational-Volitional model of suicidal behaviour - Dhingra, K.; Boduszek, D.; O'Connor, R.C. (Journal of Affective Disorders, 2015)
Abstract Background Suicidal behaviour is a significant public health concern, yet little is known about the factors that enable or impede behavioural enactment (engaging in a suicide attempt). Aims Drawing on the Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour (2011), this study examined the factors associated with having thoughts of suicide (ideation) versus those associated with suicide enaction (attempts). Within a multivariate context, it was predicted that the factors associated with ideation formation (motivational factors) would be distinct from those factors which governed behavioural enaction (volitional moderators). Method Healthy adults (N=1, 288) completed an anonymous self-report survey. Analyses compared three groups: suicide attempters (n=230), suicide ideators (n=583), and those without any suicide history (n=475). Results Suicide attempters differed from suicide ideators on all volitional factors (fearlessness about death, impulsivity, and exposure to suicidal behaviour), with the exception of discomfort tolerance. Compared to ideators, attempters were more likely to have a family member and close friend who had self-injured or attempted suicide, and were more impulsive and fearless about death. Conversely, the two suicide groups did not differ on any of the variables (motivational factors) associated with the development of thoughts of death by suicide. Limitations This is a cross-sectional study based on self-report measures. Conclusions Further research efforts to distinguish between suicide ideators and suicide attempters is crucial to inform the development of intervention and treatment approaches.
Keywords: adult; anxiety; article; comparative study; controlled study; death; depression; descriptive research; ethnicity; female; health survey; human; imitation; impulsiveness; major clinical study; male; motivation; priority journal; self report; sexual orientation; suicidal ideation; suicide attempt

The impact of childhood gender expression on childhood sexual abuse and psychopathology among young men who have sex with men - Hidalgo, M.A.; Kuhns, L.M.; Kwon, S.; Mustanski, B.; Garofalo, R. (Child Abuse and Neglect, 2015)
Young men who have sex with men (MSM) are a risk group highly vulnerable to HIV infection and psychiatric symptoms are direct predictors of sexual risk behavior in MSM. Childhood sexual abuse (CSA) is associated with psychiatric symptomology in adolescence, and MSM are disproportionately impacted by CSA compared to heterosexuals. Some evidence suggests that childhood gender nonconformity, a natural variation of human gender expression, is more common in MSM than heterosexual males and places MSM at greater risk for CSA. This study examined whether or not childhood gender expression moderated the association between incidents of unwanted, early sexual experiences occurring before age 13 (ESE) and current psychiatric symptomology in a community-based sample of 449 young MSM aged 16-20. Analyses revealed significant bivariate associations between ESE and psychological symptoms, and significant multivariable associations between ESE, gender nonconformity and psychiatric outcomes. Young MSM with childhood gender nonconformity may be disproportionately victimized by CSA thereby increasing their likelihood of developing psychiatric symptoms in adolescence. Early intervention addressing these factors may help reduce lifetime negative sequelae.
Keywords: adolescent; adult; article; child sexual abuse; controlled study; disease association; early intervention; early sexual experience; gender expression; gender identity; gender nonconformity; heterosexual male; human; impulsiveness; incidence; major clinical study; major depression; male; men who have sex with men; mental disease; outcome assessment; posttraumatic stress disorder; risk assessment; risk factor; sexual behavior; suicidal ideation; suicide attempt; young adult

Sexual (Minority) Trajectories, Mental Health, and Alcohol Use: A Longitudinal Study of Youth as They Transition to Adulthood - Fish, J.N.; Pasley, K. (Journal of youth and adolescence, 2015)
Lesbian, gay, bisexual, and queer/questioning youth health disparities are well documented; however, study limitations restrict our understanding of how the temporal interplay among domains of sexuality (attraction, behavior, and identity) situate individuals to be more or less at risk for poor mental health and alcohol use across the transition to adulthood. Four waves of data from the National Longitudinal Study of Adolescent to Adult Health (n = 12,679; 51.29 % female) were used with repeated measures latent class analysis to estimate sexual trajectory groups designated by prospective reports of romantic attraction, sexual/romantic behavior, and sexual identity from adolescence to adulthood. Five unique trajectories emerged: two heterosexual groups (heterosexual early daters [58.37 %] and heterosexual later daters [29.83 %]) and three sexual minority groups (heteroflexible [6.44 %], later bisexually identified [3.32 %], and LG[B] identified [2.03 %]). These sexual trajectories differentiate risk for depressive symptomology, suicidal thoughts and behaviors, and alcohol use during adolescence and early adulthood. Groups where individuals first reported same-sex attraction and sexual minority identities in adulthood (heteroflexible and later bisexually identified) had similar levels of depression, suicidality, and greater substance use than those who largely reported same-sex attraction and behavior during adolescence (the LG[B] identified group). These later recognition groups showed greater risk for poor outcomes in waves where they also first reported these changes in attraction, behaviors, and identities. The emergence of three sexual minority groups reveal within-group differences in sexuality and sexual trajectories and how these experiences relate to risk and timing of risk across the transition to adulthood.
Keywords: adolescent; adolescent behavior; alcoholism; comorbidity; depression; female; health status; human; longitudinal study; male; mental health; minority group; minority health; psychology; questionnaire; sex ratio; sexuality; statistics and numerical data; young adult

The Role of Social Connectedness and Sexual Orientation in the Prevention of Youth Suicide Ideation and Attempts Among Sexually Active Adolescents - Stone, D.M.; Luo, F.; Lippy, C.; McIntosh, W.L. (Suicide & life-threatening behavior, 2015)
The impact of types of social connectedness-family, other adult, and school-on suicide ideation and attempts among all youth, the relative impact of each type, and effect modification by sexual orientation was assessed. Data were from the 2007-2009 Milwaukee Youth Risk Behavior Surveys. Multivariable logistic regression analyses calculated the risk of suicide ideation and attempts by sexual orientation, types of social connectedness, and their interaction. Among all youth, each type of connectedness modeled singly conferred protective effects for suicide ideation. Family and other adult connectedness protected against suicide attempts. When modeled simultaneously, family connectedness protected against ideation and attempts. Sexual orientation modified the association between other adult connectedness and suicide ideation. Findings suggest that family connectedness confers the most consistent protection among all youth and sexual orientation does not generally modify the association between connectedness and suicidal behavior.
Keywords: adolescent; adolescent behavior; female; high risk behavior; human; human relation; male; protection; psychology; questionnaire; risk assessment; school; sexual behavior; social support; statistics and numerical data; suicidal ideation; suicide attempt; United States

Nonsuicidal self-injury in sexual minority college students: A test of theoretical integration - Muehlenkamp, J.J.; Hilt, L.M.; Ehlinger, P.P.; McMillan, T. (Child and Adolescent Psychiatry and Mental Health, 2015)
Individuals identifying as a sexual minority report engaging in nonsuicidal self-injury (NSSI) at substantially higher rates compared to their heterosexual peers. Given that NSSI is a known risk factor for suicide, it is important to understand the processes unique to being a sexual minority that increases risk for NSSI so that adequate prevention efforts can be established. The current study integrated Minority Stress Theory and the Interpersonal Theory of Suicide to test a model of NSSI and suicide risk. Methods: A total of 137 college students who identified as a sexual minority completed an anonymous on-line study assessing NSSI, suicidal thoughts/behaviors, and constructs of the minority stress and interpersonal theories. Two linear regressions using bootstrapping analyses were conducted to test our hypotheses. Results: Minority stress was directly associated with NSSI and via perceived burdensomeness, explaining 27 % of the variance. NSSI was associated with increased risk for suicide thoughts/behaviors directly, and through acquired capability, explaining 45 % of the variance. Conclusions: These findings provide evidence that unique stressors individuals face as a result of their sexual minority status increases risk for self-harm by influencing cognitive and emotional processes such as burdensomeness and acquired capability. Implications for prevention, intervention, and future research are briefly discussed.
Keywords: adult; article; automutilation; bootstrapping; cognition; college student; controlled study; emotion; female; human; Interpersonal Theory of Suicide; linear regression analysis; male; Minority Stress Theory; online system; priority journal; risk assessment; risk factor; sexual and gender minority; physiological stress; suicidal behavior; suicide; variance

Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them - Dilillo, D.; Mauri, S.; Mantegazza, C.; Fabiano, V.; Mameli, C.; Zuccotti, G.V. (Italian Journal of Pediatrics, 2015)
Epidemiological data suggests suicide is uncommon in childhood but becomes an extremely serious issue among adolescents. Several risk factors have been identified and include the presence of psychiatric illness, a previous suicide attempt, family factors, substance abuse, sexual and physical abuse, disorders in gender identity or bullying. Pediatricians have a primary role in searching for these risk factors, recognizing them and acting synergistically with other specialists to prevent and treat suicidal behavior. Pediatricians should also be able to identify the "warning signs" for suicide since their presence implies a need for immediate action, as attempted suicide may occur in a few hours or days. The use of antidepressant drugs and its association with suicidal risk in pediatric age is another topic of ongoing debate. Food and Drug Administration has recently introduced the so-called "black box" on antidepressants' packages with the aim of gaining attention to the possible risk of suicide among adolescents who are treated with antidepressants, with a warning that the risk of suicide is higher when starting a therapy or while adjusting its dosage.
Keywords: antidepressant agent; adolescent health; article; bullying; child abuse; child health care; child safety; disease association; disease predisposition; drug use; family history; gender dysphoria; human; mental disease; pediatrician; physical abuse; risk factor; sexual abuse; substance abuse; suicide; suicide attempt

Individual- and Structural-Level Risk Factors for Suicide Attempts among Transgender Adults - Perez-Brumer, A.; Hatzenbuehler, M.L.; Oldenburg, C.E.; Bockting, W. (Behavioral Medicine, 2015)
This study assessed individual (ie, internalized transphobia) and structural forms of stigma as risk factors for suicide attempts among transgender adults. Internalized transphobia was assessed through a 26-item scale including four dimensions: pride, passing, alienation, and shame. State-level structural stigma was operationalized as a composite index, including density of same-sex couples; proportion of Gay-Straight Alliances per public high school; 5 policies related to sexual orientation discrimination; and aggregated public opinion toward homosexuality. Multivariable logistic generalized estimating equation models assessed associations of interest among an online sample of transgender adults (N = 1,229) representing 48 states and the District of Columbia. Lower levels of structural stigma were associated with fewer lifetime suicide attempts (AOR 0.96, 95% CI 0.92-0.997), and a higher score on the internalized transphobia scale was associated with greater lifetime suicide attempts (AOR 1.18, 95% CI 1.04-1.33). Addressing stigma at multiple levels is necessary to reduce the vulnerability of suicide attempts among transgender adults.
Keywords: adult; article; attitude to sexuality; female; female to male transgender; gender identity; high school; homosexuality; human; internalized transphobia; major clinical study; male; male to female transgender; phobia; psychological rating scale; public opinion; risk factor; sexual orientation; social isolation; social stigma; suicide attempt; United States

Putting Health and Behavior in Context: Current Knowledge and Future Directions on Research Embracing Ecological Perspectives - Duncan, D.T. (Behavioral Medicine, 2015)
Keywords: hydrocortisone; army; article; behavior; body weight management; coping behavior; disaster; environmental factor; geography; health; health behavior; health care policy; health disparity; health promotion; human; hydrocortisone blood level; mental health; obesity; physical activity; prisoner; risk factor; sexual health; smoking cessation program; social aspect; social behavior; social determinants of health; social norm; social status; physiological stress; suicidal ideation; transgender

Suicide related ideation and behavior among Canadian gay and bisexual men: a syndemic analysis - Ferlatte, O.; Dulai, J.; Hottes, T.S.; Trussler, T.; Marchand, R. (BMC public health, 2015)
BACKGROUND: While several studies have demonstrated that gay and bisexual men are at increased risk of suicide less attention has been given to the processes that generate the inherent inequity with the mainstream population. This study tested whether syndemic theory can explain the excess suicide burden in a sample of Canadian gay and bisexual men. Syndemic theory accounts for co-occurring and mutually reinforcing epidemics suffered by vulnerable groups due to the effects of social marginalization. METHODS: This study used data from Sex Now 2011, a cross-sectional survey of Canadian gay and bisexual men (n = 8382). The analysis measured the extent to which anti-gay marginalization and several psychosocial health problems are associated with suicide related ideation and attempts. Since psychosocial health problems were hypothesized to have an additive effect on suicide related ideation and attempts, the analysis calculated the effect of accumulated psychosocial health problems on suicide behavior. RESULTS: Suicide ideation and attempts were positively associated with each individual marginalization indicator (verbal violence, physical violence, bullying, sexual violence and work discrimination) and psychosocial health problems (smoking, party drugs, depression, anxiety, STIs, HIV risk and HIV). Furthermore, prevalence of suicide ideation and attempts increased with each added psychosocial health problem. Those who reported 3 or more had 6.90 (5.47-8.70) times the odds of experiencing suicide ideation and 16.29 (9.82-27.02) times the odds of a suicide attempt compared to those with no psychosocial health problems. CONCLUSIONS: This investigation suggests that syndemics is a useful theory for studying suicide behavior among gay and bisexual men. Moreover, the findings highlight a need to address gay and bisexual men's health problems holistically and the urgent need to reduce this population's experience with marginalization and violence.
Keywords: adult; bisexuality; Canada; cross-sectional study; epidemiology; health service; human; male; male homosexuality; men's health; mental health; middle aged; perceptive discrimination; prejudice; prevalence; psychology; sexually transmitted disease; statistics and numerical data; suicidal ideation; suicide; suicide attempt; violence

Predictors of switch from depression to mania in bipolar disorder - Niitsu, T.; Fabbri, C.; Serretti, A. (Journal of Psychiatric Research, 2015)
Manic switch is a relevant issue when treating bipolar depression. Some risk factors have been suggested, but unequivocal findings are lacking. We therefore investigated predictors of switch from depression to mania in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) sample. Manic switch was defined as a depressive episode followed by a (hypo)manic or mixed episode within the following 12 weeks. We assessed possible predictors of switch using generalized linear mixed models (GLMM).8403 episodes without switch and 512 episodes with switch (1720 subjects) were included in the analysis. Several baseline variables were associated with a higher risk of switch. They were younger age, previous history of: rapid cycling, severe manic symptoms, suicide attempts, amphetamine use and some pharmacological and psychotherapeutic treatments. During the current depressive episode, the identified risk factors were: any possible mood elevation, multiple mania-associated symptoms with at least moderate severity, and comorbid panic attacks.In conclusion, our study suggests that both characteristics of the disease history and clinical features of the current depressive episode may be risk factors for manic switch.
Keywords: amfebutamone; amphetamine; clozapine; monoamine oxidase inhibitor; opiate; quetiapine; serotonin uptake inhibitor; sertraline; adult; age; alcohol abuse; article; bipolar disorder; Clinical Global Impression scale; cohort analysis; comorbidity; depression; disease severity; drug use; dysthymia; female; follow up; human; major clinical study; male; mania; medical history; mental patient; mixed mania and depression; mood change; multicenter study; onset age; panic; predictive value; priority journal; psychotherapy; risk factor; suicide attempt; transgender

Suicidal risk and sexual orientation in adolescence: a population-based study in Iceland - Arnarsson, A.; Sveinbjornsdottir, S.; Thorsteinsson, E.B.; Bjarnason, T. (Scandinavian journal of public health, 2015)
AIM: Suicidality is an important public health problem, particularly among lesbian, gay, and bisexual (LGB) adolescents and young adults. The purpose of the present study is to compare the rate of suicide ideations and attempts among LGB adolescent to that of non-LGB adolescents in a population-based sample, and to identify important protective factors as well as risk factors Method: We used the Icelandic data set from the 2009/2010 Health Behaviour in School-aged Children (HBSC) study. The sample consisted of 3813 grade 10 Icelandic adolescents; 1876 girls and 1937 boys. The participants were asked about attraction and/or activity, as well as about suicidal ideation and/or attempts. The questionnaire also included various other items regarding health and lifestyle. RESULTS: LGB adolescents were five to six times more likely to have had frequent suicidal ideations. Factors that were associated with less suicide ideations and fewer attempts were easy communication and liking school. The LGB girls were six times more likely to have had frequent suicide attempts, whilst the LGB boys were 17 times more likely to have attempted suicide that often. No specific protective or risk factors were identified for suicidality in LGB adolescents other than bullying. CONCLUSIONS: Adolescents that had engaged in heterosexual activity and those that had LGB attraction had similarly heightened risk for suicidality, but sexually active LGB adolescents were far more likely to have suicidal ideations or to have attempted suicide.
Keywords: adolescent; bisexuality; female; heterosexuality; human; Iceland; lesbianism; male; male homosexuality; protection; psychology; risk assessment; risk factor; sexual behavior; statistics and numerical data; suicidal ideation; suicide attempt

Beyond same-sex attraction: Gender-variant-based victimization is associated with suicidal behavior and substance use for other-sex attracted adolescents - Ioerger, M.; Henry, K.L.; Chen, P.Y.; Cigularov, K.P.; Tomazic, R.G. (PLoS ONE, 2015)
Gender-variant-based victimization is victimization based on the way others perceive an individual to convey masculine, feminine, and androgynous characteristics through their appearance, mannerisms, and behaviors. Previous work identifies gender-variant-based victimization as a risk factor for health-risking outcomes among same-sex attracted youths. The current study seeks to examine this relationship among other-sex attracted youths and same-sex attracted youth, and determine if gender-variant-based victimization is similarly or differentially associated with poor outcomes between these two groups. Anonymous data from a school-based survey of 2,438 racially diverse middle and high school students in the Eastern U.S. was examined. For other-sex attracted adolescents, gender-variantbased victimization was associated with a higher odds of suicidal thoughts and behaviors, regular use of cigarettes, and drug use. When compared to same-sex attracted adolescents, the harmful relationship between gender-variant-based victimization and each of these outcomes was similar in nature. These findings suggest that gender-variant-based victimization has potentially serious implications for the psychological wellbeing and substance use of other-sex attracted adolescents, not just same-sex attracted adolescents, supporting the need to address gender expression as a basis for victimization separate from sexuality- or gender-minority status. The impact that gender-variant-based victimization has on all adolescents should not be overlooked in research and interventions aimed at addressing sexual orientation-based and gender-variant-based victimization, substance use, and suicide prevention.
Keywords: adolescent; adolescent sexual behavior; alcohol consumption; article; female; gender identity; gender variant based victimization; high school student; human; male; middle school student; peer pressure; physical attractiveness; psychological well-being; risk assessment; self report; sex role; sexual orientation; smoking; social interaction; social norm; substance use; suicidal behavior; United States; victim

Correlates of bullying in Quebec high school students: The vulnerability of sexual-minority youth - Cénat, J.M.; Blais, M.; Hébert, M.; Lavoie, F.; Guerrier, M. (Journal of Affective Disorders, 2015)
Purpose Bullying has become a significant public health issue, particularly among youth. This study documents cyberbullying, homophobic bullying and bullying at school or elsewhere and their correlates among both heterosexual and sexual-minority high school students in Quebec (Canada). Method A representative sample of 8194 students aged 14-20 years was recruited in Quebec (Canada) high schools. We assessed cyberbullying, homophobic bullying and bullying at school or elsewhere in the past 12 months and their association with current self-esteem and psychological distress as well as suicidal ideations. Results Bullying at school or elsewhere was the most common form of bullying (26.1%), followed by cyberbullying (22.9%) and homophobic bullying (3.6%). Overall, girls and sexual-minority youth were more likely to experience cyberbullying and other forms of bullying as well as psychological distress, low self-esteem and suicidal ideations. The three forms of bullying were significantly and independently associated with all mental health outcomes. Conclusions The results underscore the relevance of taking into account gender and sexual orientation variations in efforts to prevent bullying experience and its consequences.
Keywords: adolescent; adult; article; bisexuality; bullying; Canada; cyberbullying; distress syndrome; female; heterosexuality; high school student; homophobic bullying; homosexual female; homosexual male; human; major clinical study; male; mental health; priority journal; self esteem; sexual and gender minority; suicidal ideation

Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada - Bauer, G.R.; Scheim, A.I.; Pyne, J.; Travers, R.; Hammond, R. (BMC public health, 2015)
BACKGROUND: Across Europe, Canada, and the United States, 22-43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact. METHODS: The Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks. RESULTS: Among trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10(th) versus 90(th) percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10(th) percentile. CONCLUSIONS: Large effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.
Keywords: adult; epidemiology; female; gender identity; human; male; Ontario; parent; prejudice; prevalence; psychology; self report; social isolation; social support; statistical model; statistics and numerical data; suicidal ideation; suicide; suicide attempt; transgender; transsexualism; United States

Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals - Lytle, M.C.; De Luca, S.M.; Blosnich, J.R.; Brownson, C. (Journal of Affective Disorders, 2015)
Background: Our aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals. Methods: Data from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n=24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation. Results: Across most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation. Limitations: Cross-sectional design and self-reported data. Conclusions: Results corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation.
Keywords: adult; article; bisexuality; college student; cultural factor; ethnicity; female; homosexual female; homosexual male; human; major clinical study; male; priority journal; religion; sexual orientation; suicidal ideation

Overdose of dolutegravir in combination with tenofovir disaproxil fumarate/emtricitabine in suicide attempt in a 21-year old patient - Lee, M.; Eyer, F.; Felgenhauer, N.; Klinker, H.H.F.; Spinner, C.D. (AIDS Research and Therapy, 2015)
A 21 year old MSM patient with newly diagnosed HIV infection was hospitalized in our department after ingestion of an overdose of his antiretroviral therapy (ART) comprising dolutegravir (DTG - Tivicay®) and tenofovir disaproxil fumarate/emtricitabine (Truvada®) in suicidal intention. On admission, the patient did not show any clinical signs of intoxication and laboratory findings were unremarkable. After 6 hours of intensive care monitoring, the patient was referred to a psychiatric clinic. 5 days after the day of intoxication, serum creatinine levels increased to high normal values (1.2 mg/dl). However, levels never exceeded the upper threshold. 8 and 12 weeks later, serum creatinine normalized to levels measured prior to the intoxication. No other adverse events occurred, and the patient does not suffer from permanent impairments.
Keywords: alcohol; creatinine; dolutegravir; emtricitabine plus tenofovir disoproxil; thyrotropin; adult; airway obstruction; alcohol blood level; article; case report; creatinine blood level; drug overdose; human; Human immunodeficiency virus infection; hypothyroidism; IC90; intensive care; male; men who have sex with men; mental health care; patient monitoring; priority journal; suicide attempt; thyrotropin blood level; young adult; tivicay; truvada

Suicide ideation and bullying among US adolescents: examining the intersections of sexual orientation, gender, and race/ethnicity - Mueller, A.S.; James, W.; Abrutyn, S.; Levin, M.L. (American journal of public health, 2015)
OBJECTIVES: We examined how race/ethnicity, gender, and sexual orientation shape adolescents' likelihood of being bullied and vulnerability to suicide ideation. METHODS: We analyzed pooled data from the 2009 and 2011 Youth Risk Behavior Surveys (n = 75 344) to assess race/ethnicity, gender, and sexual orientation variation in being bullied and suicide ideation. RESULTS: White and Hispanic gay and bisexual males, White lesbian and bisexual females, and Hispanic bisexual females were more likely to be bullied than were White heterosexual adolescents. Black lesbian, gay, and bisexual youths' vulnerability to being bullied was not significantly different from that of White heterosexual youths. Black and Hispanic heterosexual youths were less likely to be bullied than were White heterosexual youths. Despite differences in the likelihood of being bullied, sexual minority youths were more likely to report suicide ideation, regardless of their race/ethnicity, their gender, or whether they have been bullied. CONCLUSIONS: Future research should examine how adolescents' intersecting identities shape their experience of victimization and suicidality. School personnel should develop antibullying and antihomophobia policies in response to the disproportionate risk of being bullied and reporting suicidality among sexual minority youths.
Keywords: adolescent; adolescent behavior; ancestry group; bullying; epidemiology; ethnic group; health survey; human; sex difference; sexual behavior; statistics and numerical data; suicidal ideation; suicide; United States

Self-reported sexual and psychosocial health among non-heterosexual Danes - Graugaard, C.; Giraldi, A.; Frisch, M.; Falgaard Eplov, L.; Davidsen, M. (Scandinavian journal of public health, 2015)
RESULTS: Nearly twice as many non-heterosexual than heterosexual men rated their sexual life as bad or very bad (22.5% versus 12.8%), while no statistical difference was seen among women (13.6% versus 10.6%). For both genders, significantly more non-heterosexuals than heterosexuals stated that their sexual needs were not met (17.9% versus 7.7% for men and 14.8% versus 6.9% for women), and significantly more non-heterosexuals reported acts of sexual violence (8.3% versus 2.1% for men and 35.8% versus 13.0% for women). Finally, non-heterosexual respondents had contemplated suicide more than twice as often as heterosexuals (15.9% versus 7.4% for men and 19.7% versus 8.3% for women). Actual suicide attempts were roughly three times more frequent in the non-heterosexual groups (8.3% versus 2.6 % for men and 11.8% versus 4.2% for women). CONCLUSIONS: Overall, non-heterosexual Danes reported higher degrees of sexual and/or psychosocial distress than heterosexuals further research is needed; but scientists, clinicians and public health workers should be aware that non-heterosexuals may pose specific health-related challenges and requirements. INTRODUCTION: Little is known about the sexual and psychosocial health of non-heterosexual Danes. Based on a large population study, the aim of this article was to compare quality-of-life-related key variables of heterosexual and non-heterosexual men and women, aged 16-66. MATERIALS AND METHODS: Cross-sectional data from the nationwide, representative Health and Morbidity Survey (n = 8496) were used to compare variables concerning both general and sexual well-being of self-identified heterosexual and non-heterosexual respondents.
Keywords: adolescent; adult; aged; cross-sectional study; Denmark; epidemiology; female; health survey; heterosexuality; human; lesbianism; male; male homosexuality; mental stress; middle aged; psychology; satisfaction; self evaluation; self report; sexual crime; statistics and numerical data; suicide; young adult

LGBT youth face the risk: Suicide and addictive practices - Firdion, J.-M.; Beckb, F. (Archives de Pediatrie, 2015)
Keywords: addiction; article; human; LGBT people; risk assessment; suicide

Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth - Baams, L.; Grossman, A.H.; Russell, S.T. (Developmental psychology, 2015)
The experience of minority stress is often named as a cause for mental health disparities among lesbian, gay, and bisexual (LGB) youth, including higher levels of depression and suicidal ideation. The processes or mechanisms through which these disparities occur are understudied. The interpersonal-psychological theory of suicide posits 2 key mechanisms for suicidal ideation: perceived burdensomeness and thwarted belongingness (Joiner et al., 2009). The aim of the current study is to assess the mental health and adjustment among LGB youth emphasizing the minority stress model (Meyer, 2003) and the interpersonal-psychological theory of suicide (Joiner et al., 2009). With a survey of 876 LGB self-identified youth, levels of coming-out stress, sexual orientation victimization, perceived burdensomeness, thwarted belongingness, depression, and suicidal ideation were examined. The results of a multigroup mediation model show that for all gender and sexual identity groups, the association of sexual orientation victimization with depression and suicidal ideation was mediated by perceived burdensomeness. For gay, lesbian, and bisexual girls coming-out stress was also found to be related to depression and suicidal ideation, mediated by perceived burdensomeness. The results suggest that feeling like a burden to "people in their lives" is a critical mechanism in explaining higher levels of depression and suicidal ideation among LGB youth. These results have implications for community and social support groups, many of which base their interventions on decreasing social isolation rather than addressing youths' beliefs of burdensomeness. Implications for future research, clinical and community settings are discussed.
Keywords: adolescent; bisexuality; crime victim; depression; female; human; human relation; lesbianism; male; male homosexuality; mental stress; minority group; psychological theory; psychology; risk factor; suicidal ideation; young adult

Male-to-male sex among men who inject drugs in Delhi, India: Overlapping HIV risk behaviours - Armstrong, G.; Jorm, A.F.; Samson, L.; Joubert, L.; Singh, S.; Kermode, M. (International Journal of Drug Policy, 2015)
Background: HIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex. Methods: We analysed data collected in April-May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling. Results: One third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18-24 (OR = 2.4, p = 0.014), illiteracy (OR = 1.9, p = 0.033), having never been married (OR = 2.6, p = 0.007), a main source of income of crime/begging (OR = 3.1, p = 0.019), a duration of injecting drug use greater than 20 years (OR = 3.4, p = 0.035) and suicidal ideation (OR = 1.7, p = 0.048). Conclusion: Male-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men.
Keywords: adult; anal intercourse; anxiety disorder; article; bisexuality; concurrent sexual partnership; condom use; depression; drug abuse pattern; educational status; gender identity; high risk behavior; homosexual male; human; Human immunodeficiency virus infection; India; infection risk; major clinical study; male; medical history; men who have sex with men; poverty; priority journal; safe sex; single (marital status); social psychology; suicidal ideation; transactional sex; unsafe sex

Assessment and treatment of depression in gay and bisexual men in emergency settings - Blackwell, C.W. (Advanced emergency nursing journal, 2015)
Gay and bisexual men are at higher risk for certain mental health disorders, including anxiety, depression, and suicide. These individuals often present to emergency settings in need of evaluation and treatment. Despite the utilization of emergency mental health services by this population, clinicians are often underprepared in responding to their unique needs. This article discusses depression in gay and bisexual men and provides an evidence-based approach in treating these men in emergency settings. Directives for future research and advanced practice nursing education are also presented.
Keywords: anxiety disorder; bisexuality; case report; depression; emergency health service; health care disparity; health personnel attitude; homophobia; human; human relation; male; male homosexuality; mental health service; psychology; suicidal ideation; utilization

Domains of distress among people with sexual orientation obsessions - Williams, M.T.; Wetterneck, C.; Tellawi, G.; Duque, G. (Archives of sexual behavior, 2015)
Although sexual obsessions in obsessive-compulsive disorder (OCD) are not uncommon, obsessions about sexual orientation have not been well studied. These obsessions focus on issues such as the fear of being or becoming gay, fear of being perceived by others as gay, and unwanted mental images involving homosexual acts. Sexual orientation obsessions in OCD are particularly distressing due to the ego-dystonic nature of the obsessions and, often, stigma surrounding a same-sex orientation. The purpose of this study was to better understand distress in people suffering from sexual orientation obsessions in OCD. Data were collected online (n = 1,176) and subjects were 74.6% male, 72.0% heterosexual, and 26.4% with an OCD diagnosis from a professional. The survey consisted of 70 novel questions that were assessed using a principal components analysis and the items separated into six components. These components were then correlated to distress among those with a prior OCD diagnosis and sexual orientation obsessions. Results indicated that sexual orientation obsessions in OCD were related to severe distress, including suicidal ideation. Implications of these findings and future directions for research are discussed.
Keywords: fear; female; heterosexuality; homosexuality; human; male; mental stress; obsession; principal component analysis; psychological rating scale; psychology; questionnaire; sexual behavior; social stigma; statistics and numerical data; suicidal ideation

Understanding linkages between bullying and suicidal ideation in a national sample of LGB and heterosexual youth in the United States - Ybarra, M.L.; Mitchell, K.J.; Kosciw, J.G.; Korchmaros, J.D. (Prevention science : the official journal of the Society for Prevention Research, 2015)
While there is an extant research base regarding suicidal ideation in relation to bullying and peer harassment, how findings may be similar and different for lesbian, gay, and bisexual (LGB) and non-LGB youth is less well understood. To address this gap, we analyzed data from 5,542 13- to 18-year-old youth who were nationally surveyed online in the United States in 2010. Results suggest that the relative odds of suicidal ideation are elevated for youth who are victims of bullying (OR = 5.61, 95 % CI, 4.11, 7.64), as well as those who are victims of peer harassment (OR = 2.06, 95 % CI, 1.53, 2.79). Within the context of other important factors, bullying was associated with odds of suicidal ideation twice that of non-victimized youth (aOR = 2.02, 95 % CI, 1.30, 3.13). Within sexual identity, the relation between bullying and suicidal ideation was particularly strong for gay, lesbian, and queer youth, even after adjusting for other influential factors (aOR = 6.29, 95 % CI, 2.69, 14.66). Across sexual identities, the odds of suicidal ideation are higher for bisexual youth (aOR = 1.77, 95 % CI, 1.23, 2.55) but not for other sexual minority youth when compared with otherwise similar heterosexual youth. Other factors, including depressive symptomatology and low self-esteem, were also predictive of recent ideation across all sexual identities. Findings highlight the complexity of bullying and suicidal ideation. Furthermore, given the relation between bullying and suicidal ideation, and the disproportionate level of bullying experienced by LGB youth, our findings suggest the need for more protective environments for LGB youth.
Keywords: adolescent; bisexuality; bullying; crime victim; female; human; lesbianism; male; male homosexuality; minority group; peer group; psychological theory; psychology; risk factor; sexuality; suicidal ideation; United States

Gender dysphoria "cured" by status epilepticus - Parkinson, J. (Australasian Psychiatry, 2015)
Objective: A case is described pointing to the biological factors in gender identity and personality structure. Methods: The history is presented of a transsexual patient who experienced a change of gender identity and personality following an episode of status epilepticus. Results: The patient presented as convincingly feminine and with features of Borderline Personality Disorder. She had an old brain injury. After a prolonged epileptic episode the Borderline features disappeared and the patient expressed a clearly male identity. Conclusions: The findings are equivocal: they may be seen both as reflecting a change in a neurologically structured identity and as a resetting of psychosocially acquired characteristics.
Keywords: cyproterone; methadone; moclobemide; paroxetine; addiction; adult; alcohol consumption; anosmia; anxiety disorder; article; borderline state; brain cortex atrophy; brain injury; breast augmentation; breast surgery; case report; clinical feature; computer assisted tomography; disease duration; drug abuse; drug efficacy; electroencephalography; emotional disorder; emotional stress; epileptic state; female; femininity; gender dysphoria; gender identity; hormonal therapy; hormone deficiency; human; implantation; impulsiveness; lifestyle modification; male; masculinity; medical history; memory disorder; mood disorder; orchiectomy; personality disorder; sexual anorexic; social isolation; physiological stress; substance abuse; suicide attempt; testis function; transgender; treatment outcome; trisexuality

Mental health of transgender youth in care at an adolescent Urban community health center: A matched retrospective cohort study - Reisner, S.L.; Vetters, R.; Leclerc, M.; Zaslow, S.; Wolfrum, S.; Shumer, D.; Mimiaga, M.J. (Journal of Adolescent Health, 2015)
Purpose Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the present study aimed to fill this gap. Methods A retrospective cohort study of electronic health record data from 180 transgender patients aged 12-29 years seen between 2002 and 2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM with MTF youth on mental health outcomes. Results The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p <.05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use. Conclusions Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.
Keywords: adolescent; adult; anxiety disorder; article; child; controlled study; depression; electronic medical record; ethnic group; female; female to male transgender; gender identity; health center; human; male; male to female transgender; mental health; priority journal; suicidal ideation; suicide attempt; transgender; young adult

Collecting Sexual Orientation and Gender Identity Data in Suicide and Other Violent Deaths: A Step Towards Identifying and Addressing LGBT Mortality Disparities - Haas, A.P.; Lane, A. (LGBT health, 2015)
Sexual orientation and gender identity (SO/GI) are not systematically recorded at time of death, limiting identification of mortality disparities in lesbian, gay, bisexual, and transgender (LGBT) people. LGBT populations are thought to have elevated risk of suicide based on high rates of reported lifetime suicide attempts. Lack of data on suicide deaths, however, hinders understanding of the prevalence and patterns of suicide among LGBT populations and development of targeted interventions and prevention programs. This report describes recent efforts to address this knowledge gap by systematically collecting SO/GI information in the investigation of suicide and other violent deaths.
Keywords: death certificate; female; gender identity; health disparity; human; information processing; male; mortality; procedures; psychology; sexuality; statistics and numerical data; suicide; transgender; United States

Dying to be accepted - Dean, E. (Nursing standard (Royal College of Nursing (Great Britain) : 1987), 2015)
Keywords: adolescent; bisexuality; bullying; case report; female; homophobia; homosexuality; human; nurse; psychology; risk factor; social support; statistics and numerical data; suicide; United Kingdom

Mortality risks among persons reporting same-sex sexual partners: evidence from the 2008 General Social Survey-National Death Index data set - Cochran, S.D.; Mays, V.M. (American journal of public health, 2015)
OBJECTIVES: We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation-associated health risks. METHODS: We used data from the 1988-2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer-related mortality. RESULTS: The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation-associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW. CONCLUSIONS: The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.
Keywords: adult; epidemiology; female; health status; human; male; male homosexuality; middle aged; mortality; questionnaire; risk factor; socioeconomics; statistics and numerical data; suicide; United States

The role of help-seeking in preventing suicide attempts among lesbians, gay men, and bisexuals - Meyer, I.H.; Teylan, M.; Schwartz, S. (Suicide & life-threatening behavior, 2015)
One possible approach to prevention of suicide attempts is to encourage help-seeking among individuals at risk. We assessed whether different forms of treatment were associated with lower odds of a suicide attempt in a diverse group of 388 lesbian, gay, and bisexual (LGB) adults aged 18-59, sampled from New York City venues. Of individuals who attempted suicide, 23% sought mental health or medical treatment and 14% sought religious or spiritual treatment prior to the suicide attempt. Black and Latino LGBs were underrepresented in mental health or medical treatment and Black LGBs were overrepresented in religious or spiritual treatment. Seeking mental health or medical treatment was not associated with lower odds of a suicide attempt; seeking religious or spiritual treatment was associated with higher odds of a suicide attempt. We discuss these results and posit hypotheses for further research of this understudied topic.
Keywords: adolescent; adult; African American; bisexuality; female; health service; Hispanic; human; lesbianism; male; male homosexuality; mental health service; middle aged; New York; patient attitude; religion; risk factor; statistics and numerical data; suicide attempt; utilization; young adult

Psychosocial vulnerability and HIV-related sexual risk among men who have sex with men and women in the United States - Dyer, T.P.; Regan, R.; Pacek, L.R.; Acheampong, A.; Khan, M.R. (Archives of sexual behavior, 2015)
In the U.S., HIV is concentrated among men who have sex with men (MSM), some of whom have had female partners (MSMW). MSMW are disproportionately impacted by psychosocial vulnerabilities, like depression and substance use that increase sexually transmitted infection (STI) and HIV risk. Research on psychosocial vulnerability and HIV-related sexual risk among MSMW is warranted to reduce infection transmission among MSM and to prevent bridging to female partners. We analyzed data from Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health to assess psychosocial vulnerability and HIV risk-taking among MSMW. Using lifetime and past year sexual activity, we classified men as ever having sex with: women only (MSW), men only (MSMO) or MSMW, with further refined categorization of MSMW with male only partners in the past 12 months, only female partners in the past 12 months, and both male and female partners in the past 12 months (N = 6,945). We compared psychosocial vulnerability characteristics and HIV-related risk behaviors among the five categories of men. MSMW were more likely to report depression, suicidality, substance use, and incarceration than MSW and MSMO. Compared to MSW, MSMW with current female partners had greater odds of unprotected sex, exchange sex, and STI. MSMW with male partners in the past year had greater odds of multiple or concurrent partners in the past year. HIV risk and psychosocial vulnerability factors are elevated among MSMW, a priority population for HIV risk reduction. HIV risk reduction interventions should address this and heterogeneity of sexual partnerships among MSMW.
Keywords: adolescent; adult; bisexuality; child; depression; female; high risk behavior; human; Human immunodeficiency virus infection; interview; longitudinal study; male; mental stress; psychology; qualitative research; risk factor; sexually transmitted disease; drug dependence; transmission; United States; unsafe sex; young adult

Suicidal ideation in gay men and lesbians in South Korea: a test of the interpersonal-psychological model - Kim, S.; Yang, E. (Suicide & life-threatening behavior, 2015)
Gay men and lesbians in South Korea are alienated and stigmatized due to the country's low tolerance of social differences, resulting in distress and suicidal impulses. This study investigated the predictors of suicidal ideation in a gay and lesbian group in South Korea based on the interpersonal-psychological theory of suicide. Differences between the gay and lesbian group and the heterosexual group were found in the direct path between perceived burdensomeness and suicidal ideation. The relationship was significant for both groups, but the path coefficient was greater for lesbians and gay men than for heterosexuals. These findings imply that perceived burdensomeness may be a more critical factor in suicidal ideation of lesbians and gay men.
Keywords: adult; case control study; female; heterosexuality; hope; human; human relation; lesbianism; male; male homosexuality; psychological model; psychology; self concept; social distance; social stigma; South Korea; suicidal ideation; young adult

Estimating the number of men who have sex with men by race/ethnicity at the county level in Texas - Campagna, J.; Poe, J.; Robbins, A.; Rowlinson, E. (Journal of urban health : bulletin of the New York Academy of Medicine, 2015)
This analysis presents a method for estimating the population of men who have sex with men (MSM) at the county and metropolitan area level in Texas. Surveillance data consistently demonstrate that MSM experience a high burden of HIV and other sexually transmitted infections (STIs). Numerous studies have shown that MSM are also vulnerable to many other health concerns such as suicide, substance abuse, domestic violence and assault, homelessness, and mental illness. However, compilation of rates of HIV, STIs, and other health issues is dependent on estimation of population denominators. In the absence of systematic, consistent, and direct assessment of sexual orientation and gender identity in national surveys, it is difficult to estimate the size of at-risk populations. Previous estimates at the national and state level have been calculated using varied methodologies. However, to date, statewide estimates at the county level have only been produced for the state of Florida. County-level and metropolitan area estimates of MSM population were produced using three modified models developed by Lieb et al. These models used data on population and same-sex households from the US Census, along with estimates of sexual behavior from the National Survey on Family Growth. These models produce an estimate of 599,683 MSM in Texas (6.4 % of the adult male population). Metropolitan areas with the highest percentage of MSM population include Dallas and Austin (10.3 and 9.8 %, respectively). County-level estimates of MSM population range from 1.0 to 12.9 %. These local estimates are critical to targeting vulnerable populations and effective allocation of resources for prevention and treatment programs.
Keywords: adult; aged; ancestry group; cultural factor; epidemiology; ethnic group; ethnology; health survey; human; male; male homosexuality; middle aged; rural population; sexual behavior; statistical model; statistics and numerical data; Texas; urban population; young adult

Connecting the dots: examining transgender women's utilization of transition-related medical care and associations with mental health, substance use, and HIV - Wilson, E.C.; Chen, Y.-H.; Arayasirikul, S.; Wenzel, C.; Raymond, H.F. (Journal of urban health : bulletin of the New York Academy of Medicine, 2015)
Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems-binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse-comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed.
Keywords: adult; California; female; health care delivery; health service; Human immunodeficiency virus infection; human; male; middle aged; odds ratio; patient attitude; risk factor; socioeconomics; statistics and numerical data; transgender; unsafe sex; utilization; young adult

Frequent callers to crisis helplines: Who are they and why do they call? - Spittal, M.J.; Fedyszyn, I.; Middleton, A.; Bassilios, B.; Gunn, J.; Woodward, A.; Pirkis, J. (Australian and New Zealand Journal of Psychiatry, 2015)
Objective: Frequent callers present a challenge for crisis helplines, which strive to achieve optimal outcomes for all callers within finite resources. This study aimed to describe frequent callers to Lifeline (the largest crisis helpline in Australia) and compare them with non-frequent callers, with a view to furthering knowledge about models of service delivery that might meet the needs of frequent callers. Method: Lifeline provided an anonymous dataset on calls made between December 2011 and May 2013. We assumed calls from the same (encrypted) phone number were made by the same person, and aggregated call level data up to the person level. Individuals who made 0.667 calls per day in any period from 1 week to the full 549 days for which we had data (i.e. 4.7 calls in 7 days, 20 calls in 30 days, 40 calls in 60 days, etc.) were regarded as frequent callers. Results: Our analysis dataset included 411,725 calls made by 98,174 individuals, 2594 (2.6%) of whom met our definition of frequent callers. We identified a number of predictors of being a frequent caller, including being male or transgender, and never having been married. The odds increased with age until 55-64 years, and then declined. Suicidality, self-harm, mental health issues, crime, child protection and domestic violence issues all predicted being a frequent caller. Conclusions: Collectively, frequent callers have a significant impact on crisis lines, and solutions need to be found for responding to them that are in everybody's best interests (i.e. the frequent callers themselves, other callers, telephone crisis supporters who staff crisis lines, and those who manage crisis lines). In striking this balance, the complex and multiple needs of frequent callers must be taken into account.
Keywords: adolescent; adult; article; attitude to health; child care; controlled study; crime; domestic violence; female; health care delivery; help seeking behavior; human; loneliness; major clinical study; male; mental health; risk assessment; self esteem; sexuality; suicide; teleconsultation; transgender; young adult

Suicide and HIV as leading causes of death among gay and bisexual men: a comparison of estimated mortality and published research - Hottes, T.S.; Ferlatte, O.; Gesink, D. (Critical Public Health, 2015)
Gay and bisexual men experience numerous health disparities relative to heterosexual men, including high rates of HIV and suicidal behavior. Systematic community health assessments could provide direct comparisons of the burden of mortality across diseases and thus facilitate the prioritization of public health activities; however, such assessments have been precluded by the absence of sexual orientation information in vital statistics records. In this context, we used population attributable fraction to derive and compare indirect estimates of mortality for both HIV and suicide. Assuming that 2% of Canadian men are gay or bisexual, and that these men are 42 times more likely to die from HIV and 4 times more likely to die from suicide, we estimated that in 2011, suicide resulted in 46 deaths per 100,000 gay and bisexual men, while HIV resulted in 30 deaths per 100,000. Based on these estimates, suicide surpassed HIV as a leading cause of premature mortality for gay and bisexual men in 2007. Despite the large burden of suicide among gay and bisexual men, research attending to the issue in biomedical, psychology, and social science literatures is sparse, with at least 10 times fewer citations than for HIV between 2003 and 2012. We urge researchers, practitioners, and community leaders to broaden the scope of gay and bisexual men’s public health priorities to include suicide and other high burden health inequities.
Keywords: article; death; health disparity; heterosexuality; homophobia; human; Human immunodeficiency virus infection; LGBT people; men who have sex with men; meta analysis (topic); mortality; public health; sensitivity analysis; sexual behavior; sexually transmitted disease; suicidal behavior; suicide; unsafe sex

Mental health disorders in young urban sexual minority men - Burns, M.N.; Ryan, D.T.; Garofalo, R.; Newcomb, M.E.; Mustanski, B. (Journal of Adolescent Health, 2015)
Purpose Very few studies have examined mental disorders among male sexual minority youth. We describe demographic correlates, comorbidity, and history of mental disorders and suicidality in a large sample of male sexual minority youth. Methods Structured diagnostic interviews were conducted with 449 racially diverse urban sexual minority males, aged 16-20 years, who were recruited using a social network-driven sampling methodology. Results Lifetime major depressive episode (MDE) affected 33.2% of the youth. Lifetime conduct disorder (23.6%), alcohol abuse/dependence (19.6%), posttraumatic stress disorder (PTSD; 16.0%), and nicotine dependence (10.7%) were also common. Black participants were less likely than white participants to be diagnosed with lifetime MDE, alcohol abuse/dependence, nicotine dependence, suicidal ideation, and anorexia, as well as past 12-month alcohol abuse/dependence (odds ratios [ORs] range from.08 to.46). Relative to participants identifying as gay, bisexual identified youth were at higher risk for lifetime PTSD (OR = 2.04), and participants who did not identify as gay or bisexual were at higher risk for both lifetime and past 12-month nicotine dependence (OR = 4.36 and 3.46, respectively). Most participants with mental disorders never received treatment, and comorbidity was common. Conclusions MDE, conduct disorder, alcohol abuse/dependence, PTSD, and nicotine dependence are common and infrequently treated in young sexual minority men. Some within-group disparities emerged, suggesting that factors related to racial background and self-identification may help to understand resilience to the unique stressors experienced by these young men.
Keywords: alcohol; nicotine; adolescent; adult; Alaska Native; alcohol abuse; alcoholism; American Indian; anorexia; article; Asian; bisexuality; Black person; bulimia; Caucasian; comorbidity; conduct disorder; disease duration; educational status; follow up; health care utilization; Hispanic; homosexual male; human; major clinical study; major depression; male; medical history; mental disease; multiracial person; onset age; posttraumatic stress disorder; race difference; sexual and gender minority; sexual orientation; social network; social status; structured interview; substance abuse; suicidal ideation; suicide attempt; tobacco dependence; urban population

Turning ‘fate’ into destiny by seizing a second chance at life - Bateman, C. (South African Medical Journal, 2015)
‘What happened in the past is totally out of my control now.’ With that simple yet life-giving affirmation, Daryl Brown, 27, legless in a wheel-chair after jumping into the path of a London underground train on 29 September  last year, sums up the sea-change in his world view.
Keywords: adult; article; cognitive therapy; depression; homosexual male; human; life; male; patient attitude; psychological balance; psychologist; psychotherapy; suicide attempt

Non-suicidal self-injury in patients with eating disorder: Associations with identity formation above and beyond anxiety and depression - Claes, L.; Luyckx, K.; Bijttebier, P.; Turner, B.; Ghandi, A.; Smets, J.; Norre, J.; Van Assche, L.; Verheyen, E.; Goris, Y.; Hoksbergen, I.; Schoevaerts, K. (European Eating Disorders Review, 2015)
In the present study, we investigated the association between non-suicidal self-injury (NSSI) and problems in identity formation among patients with eating disorder (ED). NSSI is highly prevalent in ED, and problems with identity formation are characteristic of both NSSI and ED. Few studies, however, have investigated identity formation in patients with ED with and without NSSI while taking into account comorbid psychopathology (e.g. anxiety and depression). Therefore, we investigated the relationships between NSSI characteristics, identity confusion/synthesis, and anxiety/depression in 99 female patients with ED by means of self-report questionnaires. The results showed that 58.6% of the patients with ED engaged in at least one type of NSSI (most frequently cutting), with no significant differences in rates of NSSI or identity problems among ED subtypes. Presence, versatility and automatic negative reinforcement functions of NSSI were each significantly and positively related to identity confusion and negatively related to identity synthesis. Even after controlling for age, anxiety, and depression, lack of identity synthesis remained a significant predictor of NSSI in patients with ED. Given that NSSI may constitute an effort to deal with identity confusion/synthesis in patients with ED, therapists should take this developmental task into account while treating patients with ED with NSSI.
Keywords: adult; anxiety disorder; article; automutilation; confusion; depression; disease association; eating disorder; emotionality; female; Hospital Anxiety and Depression Scale; human; identity; major clinical study; automutilation; reinforcement; sexual orientation; varimax rotation

Screening for sexual orientation in psychiatric emergency departments - Currier, G.W.; Brown, G.; Walsh, P.G.; Jager-Hyman, S.; Chaudhury, S.; Stanley, B. (Western Journal of Emergency Medicine, 2015)
Introduction: Our goal was to explore whether emergency department (ED) patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods: Participants (n=177) presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants' willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. Results: No participants (0/177) refused to respond to the categorical question about sexual orientation, 168/177 (94.9%) agreed to provide information about prior sexual partners, and 100/109 (91.7%) provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0%) self-identified as heterosexual, 11 (6.2%) as bisexual, 10 (5.6%) as gay or lesbian, and 2 (1.1%) indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB) patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89) reported sexual attraction as other than 'only opposite sex,' and 10.3% (15/142) of sexually active 'heterosexual' participants reported previous same-gender sexual partners. Conclusion: Assessing patients' sexual orientation in the ED by a three-question approach appeared feasible in the ED and acceptable to ED patients. However, since many patients have sexual experiences not suggested by simple labels, self-report of sexual identity alone may not inform clinicians of health risks inherent in same or opposite gender sexual contact.
Keywords: adult; anxiety disorder; article; bisexuality; borderline state; demography; DSM-IV; educational status; emergency health service; emergency patient; emergency ward; employment; female; gender identity; health hazard; heterosexuality; homosexual female; homosexual male; human; income; major clinical study; male; medical history; mood disorder; physical attractiveness; psychiatric treatment; psychosis; risk assessment; screening; self concept; self disclosure; sexual behavior; sexual orientation; sexuality; substance abuse; suicide; suicide attempt; United States

Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real? - Colizzi, M.; Costa, R.; Todarello, O. (Psychiatry Research, 2015)
This study evaluated dissociative symptomatology, childhood trauma and body uneasiness in 118 individuals with gender dysphoria, also evaluating dissociative symptoms in follow-up assessments after sex reassignment procedures were performed. We used both clinical interviews (Dissociative Disorders Interview Schedule) and self-reported scales (Dissociative Experiences Scale). A dissociative disorder of any kind seemed to be greatly prevalent (29.6%). Moreover, individuals with gender dysphoria had a high prevalence of lifetime major depressive episode (45.8%), suicide attempts (21.2%) and childhood trauma (45.8%), and all these conditions were more frequent in patients who fulfilled diagnostic criteria for any kind of dissociative disorder. Finally, when treated, patients reported lower dissociative symptoms. Results confirmed previous research about distress in gender dysphoria and improved mental health due to sex reassignment procedures. However, it resulted to be difficult to ascertain dissociation in the context of gender dysphoria, because of the similarities between the two conditions and the possible limited application of clinical instruments which do not provide an adequate differential diagnosis. Therefore, because the body uneasiness is common to dissociative experiences and gender dysphoria, the question is whether dissociation is to be seen not as an expression of pathological dissociative experiences but as a genuine feature of gender dysphoria.
Keywords: adult; article; childhood injury; controlled study; dissociative disorder; Dissociative Disorders Interview Schedule; female; follow up; gender dysphoria; human; interview; longitudinal study; major clinical study; major depression; male; mental health; prevalence; priority journal; sex reassignment; suicide attempt

Treatment for gender dysphoria in children: The new legal, ethical and clinical landscape - Smith, M.K.; Mathews, B. (Medical Journal of Australia, 2015)
Gender dysphoria is a condition in which a child’s subjectively felt identity and gender are not congruent with her or his biological sex. Because of this, the child suffers clinically significant distress or impairment in social functioning. • The Family Court of Australia has recently received an increasing number of applications seeking authorisation for the provision of hormones to treat gender dysphoria in children. • Some medical procedures and interventions performed on children are of such a grave nature that court authorisation must be obtained to render them lawful. These procedures are referred to as special medical procedures. • Hormonal therapy for the treatment of gender dysphoria in children is provided in two stages occurring years apart. Until recently, both stages of treatment were regarded by courts as special medical treatments, meaning court authorisation had to be provided for both stages. • In a significant recent development, courts have drawn a distinction between the two stages of treatment, permitting parents to consent to the first stage. In addition, it has been held that a child who is determined by a court to be Gillick competent can consent to stage 2 treatment. • The new legal developments concerning treatment for gender dysphoria are of ethical, clinical and practical importance to children and their families, and to medical practitioners treating children with gender dysphoria. Medical practitioners should benefit from an understanding of the recent developments in legal principles. This will ensure that they have up-to-date information about the circumstances under which treatment may be conducted with parental consent, and those in which they must seek court authorisation.
Keywords: estrogen; gonadorelin; testosterone; article; clinical competence; depression; distress syndrome; ethics; gender dysphoria; hormonal therapy; human; jurisprudence; law enforcement; medical decision making; medicolegal aspect; mental disease; parental consent; puberty; suicidal ideation

An examination of health inequities among college students by sexual orientation identity and sex (Journal of Public Health Research, 2015)
Background. Lesbian, gay, and bisexual (LGB) college students may have an increased number of health inequities compared to their heterosexual counterparts. However, to date, no research has provided a comprehensive examination of health-related factors by sexual orientation identity and sex among a national sample of college students. Thus, the purpose of this study was to examine physical, sexual, interpersonal relations/safety, and mental health inequities by sexual orientation identity and sex among a national sample of college students. Design and methods. Participants (n=39,767) completed the National College Health Assessment II during the fall 2008/spring 2009 academic year. Hierarchical binary logistic regression analyses were used to examine health inequities by sexual orientation identity and sex. Results. LGB students compared to heterosexual students, experienced multiple health inequities including higher rates of being verbally threatened and lower rates of physical activity and condom use. Conclusions. An understanding of health inequities experienced by LGB college students is critical as during these years of transition, students engage in protective (e.g., physical activity) and risky (e.g., lack of condom use) health behaviours, establishing habits that could last a lifetime. Future research should be used to design and implement targeted public health strategies and policies to reduce health inequities and improve health-related quality of life among LGB college students.
Keywords: adult; article; college student; condom; depression; female; gynecological examination; health; health behavior; heterosexuality; HIV test; homosexual female; homosexual male; human; human relation; male; mental health; physical activity; physical constitution and health; questionnaire; sexual health; sexual orientation; physiological stress; suicide; young adult

Non-Suicidal Self-Injury in Trans People: Associations with Psychological Symptoms, Victimization, Interpersonal Functioning, and Perceived Social Support - Claes, L.; Bouman, W.P.; Witcomb, G.; Thurston, M.; Fernandez-Aranda, F.; Arcelus, J. (Journal of Sexual Medicine, 2015)
Introduction: There is a paucity of systematic research in the area of non-suicidal self-injury (NSSI) in trans people. Aim: The aim of this study was to investigate the prevalence of NSSI in trans people and the associations with intra- and interpersonal problems. Methods: Participants were 155 untreated individuals with a diagnosis of transsexualism (according to International Classification of Disease-10 criteria) attending a national gender identity clinic. Main Outcome Measures: All participants completed the Self-Injury Questionnaire, the Symptom Checklist-90-Revised, the Rosenberg Self-Esteem Scale, the Hamburg Body Drawing Scale, the Experiences of Transphobia Scale, the Inventory of Interpersonal Problems-32, and the Multidimensional Scale of Perceived Social Support. Results: The sample consisted of 66.5% trans women and 33.5% trans men and 36.8% of them had a history of engaging in NSSI. The prevalence of NSSI was significantly higher in trans men (57.7%) compared with trans women (26.2%). Trans individuals with NSSI reported more psychological and interpersonal problems and perceived less social support compared with trans individuals without NSSI. Moreover, the probability of having experienced physical harassment related to being trans was highest in trans women with NSSI (compared with those without NSSI). The study found that with respect to psychological symptoms, trans women reported significantly more intrapersonal and interpersonal symptoms compared with trans men. Finally, the results of the regression analysis showed that the probability of engaging in NSSI by trans individuals was significantly positively related to a younger age, being trans male, and reporting more psychological symptoms. Conclusions: The high levels of NSSI behavior and its association with interpersonal and interpersonal difficulties and lack of social support need to be taken into consideration when assessing trans individuals. The effect of cross-sex hormones and sex reassignment surgery on psychological functioning, including NSSI behavior, as part of the transitional journey of trans individuals should be explored in future studies.
Keywords: adolescent; adult; anxiety; article; assessment of humans; automutilation; employment status; experiences of transphobia scale; female; hamburg body drawing scale; human; inventory of interpersonal problems 32; major clinical study; male; marriage; mental disease; multidimensional scale of perceived social support; neurosis; automutilation; obsessive compulsive disorder; outcome assessment; paranoia; phobia; physical abuse; priority journal; psychoneuroticism; Rosenberg Self-Esteem Scale; self esteem; self injury questionnaire; sex difference; sexual harassment; social interaction; social support; Symptom Checklist 90; transphobia; transsexualism

Substance-related coping, HIV-related factors, and mental health among an HIV-positive sexual minority community sample - Cramer, R.J.; Colbourn, S.L.; Gemberling, T.M.; Graham, J.; Stroud, C.H. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2015)
HIV-positive status poses a unique set of social stressors, especially among lesbian, gay, and bisexual (LGB) persons. Among these difficulties are the internalization of HIV-related stigma and poor mental health. Unfortunately, substance use as a coping mechanism is also common, dependent on other demographic factors, among HIV-positive and LGB samples. The present study integrates these bodies of literature by examining main and interactive effects of HIV-related experiences (i.e., disclosure of HIV-positive status, fear of disclosure, HIV-related victimization, and internalized HIV-related stigma) and substance-related coping with discrimination as they impact mental health (i.e., stress, anxiety, depressive symptoms, and suicide and self-injury proneness). Participants were 216 HIV-positive LGB community members from an urban community medical clinic. Prominent results included: (1) robust negative effects of internalized HIV-related stigma on all mental health indicators when controlling for other HIV-related experiences and (2) a significant interaction in which substance-related coping significantly increases suicide proneness, only for those who have disclosed HIV-positive status to family or friends. Results are discussed with respect to theoretical perspectives of internalized stigma, implications for clinical work with LGB persons of HIV-positive status, and future research.
Keywords: adult; anxiety; article; automutilation; community sample; coping behavior; depression; female; geography; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; interpersonal communication; LGBT people; major clinical study; male; mental health; personal experience; priority journal; race; sexual and gender minority; sexual orientation; stigma; physiological stress; substance abuse; substance related coping; suicide; urban population

Heavy alcohol use and suicidal behavior among people who use illicit drugs: A cohort study - Kennedy, M.C.; Marshall, B.D.L.; Hayashi, K.; Nguyen, P.; Wood, E.; Kerr, T. (Drug and Alcohol Dependence, 2015)
Background: People who use illicit drugs (PWUD) are known to experience high rates of suicidal behavior. While heavy alcohol use has been associated with suicide risk, its impact on the suicidal behavior of PWUD has not been well characterized. Therefore, we examined the relationship between heavy alcohol use and suicidal behavior among PWUD in Vancouver, Canada. Methods: Data are derived from two prospective cohort studies of PWUD in Vancouver, Canada, from 2005 to 2013. Participants completed questionnaires that elicited information regarding sociodemographics, drug use patterns, and mental health problems, including suicidal behavior. We used recurrent event survival analyses to estimate the independent association between at-risk/heavy drinking (based on National Institute of Alcohol Abuse and Alcoholism [NIAAA] criteria) and risk of incident, self-reported suicide attempts. Results: Of 1757 participants, 162 participants (9.2%) reported 227 suicide attempts over the 8-year study period, resulting in an incidence rate of 2.5 cases per 100 person-years. After adjusting for potential confounders, including intensive illicit drug use patterns, heavy alcohol use (adjusted hazard ratio [AHR] = 1.97; 95% confidence interval [CI] = 1.39, 2.78) was positively associated with an increased risk of suicidal behavior. Conclusions: We observed a high burden of suicidal behavior among a community-recruited sample of PWUD. Heavy alcohol use predicted a higher risk of suicide attempt, independent of other drug use patterns. These findings demonstrate the need for evidence-based interventions to address suicide risk among PWUD, particularly those who are heavy consumers of alcohol.
Keywords: illicit drug; adult; age distribution; alcohol consumption; alcoholism; article; Canada; cocaine dependence; cohort analysis; controlled study; depression; disease association; drinking behavior; drug abuse; drug abuse pattern; female; high risk behavior; human; Human immunodeficiency virus infected patient; incidence; LGBT people; male; mental disease; physical abuse; prediction; priority journal; prospective study; prostitution; recurrent disease; risk factor; self report; sex ratio; sexual abuse; suicide attempt; survival; victim

Psychiatric symptoms in temporal lobe epilepsy with left mesial hippocampal sclerosis - Jang, H.; Kim, S.H.; Park, S.H.; Choo, I.H.; Kim, S.G. (Psychiatry Investigation, 2015)
A 16-year-old woman was referred to us for depression and persistent suicidal and homicidal ideation. From 2010, the patient visited a neurologist due to recurrent grand mal epilepsy, auditory and visual hallucinations, episodic memory loss, and persistent depression. Upon admission, it was revealed through clinical history taking that she had suffered from chronic bullying from same-sex peers and sexual abuse, twice, from an adult male in the neighborhood when she was 10 years old. A brain magnetic resonance imaging study showed left mesial hippocampal sclerosis. The patient exhibited improvement of her psychiatric symptoms after treatment with a combination of fluoxetine (30 mg) and aripiprazole (10 mg). Children and adolescents with epilepsy experience conflicts in the family, challenges at school, stigma, and psychosocial limitations or deprivations due to their comorbid psychiatric symptoms and hence, psychiatric evaluation and early intervention is important when treating these patients.
Keywords: aripiprazole; fluoxetine; adolescent; amnesia; article; blood analysis; case report; depression; drug dose reduction; electroencephalogram; female; follow up; hippocampal sclerosis; human; neuropsychology; nuclear magnetic resonance imaging; personality disorder; seizure threshold; sexual abuse; suicidal ideation; temporal lobe epilepsy

Suffered violence, drug consumption and risk behaviors in homosexual and bisexual individuals - Albuquerque, G.A.; De Lima Garcia, C.; Moreira Belém, J.; Dos Santos Figueiredo, F.W.; Da Silva Paiva, L.; Arraes, T.M.S.N.; Da Silva Quirino, G.; De Abreu, L.C.; Valente, V.E.; Da Silva Maciel, E.; De Alcantara Sousa, L.V.; Adami, F. (International Archives of Medicine, 2015)
Background: This study examined the prevalence of violence suffered, drug use and risk behaviors in homosexual and bisexual individuals. Method: Cross-sectional, quantitative study involving 296 Lesbian, Gay, Bisexual individuals in the municipalities of Crato and Juazeiro do Norte, South of Ceará state, Brazil. Findings: Psychological/verbal abuse is the most prevalent and depressants of the central nervous system are chosen for consumption after victimization. Depressant and stimulant drugs were associated to dependence and risk behaviors in sexual minorities. Conclusion: Gay and bisexual people use drugs after suffering violence, with an association between drug use and developing risk behaviors. Further investigations inherent in these associations are necessary, since other factors may interact to violence, drug use and risk behaviors in sexual minorities.
Keywords: midomafetamine; alcohol; amphetamine; anabolic agent; analgesic agent; cannabis; cocaine; illicit drug; psychedelic agent; psychostimulant agent; tranquilizer; adult; alcohol abuse; article; bisexuality; Brazil; crime; crime victim; cross-sectional study; drug abuse; drug dependence; emotional abuse; female; high risk behavior; homicide; homosexuality; human; LGBT people; major clinical study; male; mental health; physical abuse; prevalence; quantitative study; sexual and gender minority; sexual orientation; substance use; suicide attempt; tobacco; violence; young adult

Prevalence of suicidal ideation and associated factors among HIV-positive MSM in Anhui, China - Wu, Y.; Yang, H.; Wang, J.; Yao, H.; Zhao, X.; Chen, J.; Ding, X.; Zhang, H.; Bi, P.; Sun, Y. (International Journal of STD and AIDS, 2015)
The aim of this study was to investigate the prevalence and factors associated with suicidal ideation among HIV-positive men who have sex with men (MSM) in Anhui, China. A cross-sectional study was conducted to recruit HIV-positive MSM in Anhui, China. A total of 184 HIV-positive MSM gave informed consent and completed the interview. Correlates of suicidal ideation were assessed using multivariable logistic regression. Fifty-seven (31%) of HIV-positive MSM had suicidal ideations within six months before the interview. Multivariable analyses showed that learning of their HIV status in the past 12 months (adjusted odds ratio (AOR) = 3.4, 95% CI = 1.6–7.3), perceived HIV stigma (AOR = 2.4, 95% CI = 1.1–5.2), depression symptoms (AOR = 2.6, 95% CI = 1.1–5.9) and anxiety symptoms (AOR = 2.7, 95% CI = 1.2–6.1) were significantly associated with the suicidal ideation among HIV-positive MSM. The results indicated that suicidal ideation was common among HIV-positive MSM in Anhui, China. There is an urgent need to establish psychological counselling services among HIV-positive MSM in China. Targeting of these potential risk factors could be an effective approach to reduce the suicide risk among this high-risk subgroup by the implementation of early intervention measurements.
Keywords: adult; anxiety; article; bisexuality; China; cross-sectional study; depression; female; heterosexuality; homosexuality; human; Human immunodeficiency virus infection; informed consent; major clinical study; male; men who have sex with men; prevalence; priority journal; risk factor; sexual behavior; stigma; suicidal ideation; suicide attempt

Associations of sexual and gender minority status with health indicators, health risk factors, and social stressors in a national sample of young adults with military experience - Blosnich, J.R.; Gordon, A.J.; Fine, M.J. (Annals of Epidemiology, 2015)
Purpose: To assess the associations of self-identified lesbian, gay, bisexual, and questioning sexual orientation or transgender status (LGBTQ) and military experience with health indicators. Methods: We used data from the Fall 2012 National College Health Assessment. The survey included self-identified sociodemographic characteristics, mental (e.g., depression) and physical (e.g., human immunodeficiency virus) conditions, health risk behaviors (e.g., smoking), and social stressors (e.g., victimization). We used modified Poisson regression models, stratified by self-reported military service, to examine LGBTQ-related differences in health indicators, whereas adjusting for sociodemographic characteristics. Results: Of 27,176 in the sample, among the military-experienced group, LGBTQ individuals had increased adjusted risks of reporting a past-year suicide attempt (adjusted risk ratio [aRR]=4.37; 95% confidence interval [CI]= 1.39-13.67), human immunodeficiency virus (aRR=9.90; 95% CI= 1.04-79.67), and discrimination (aRR=4.67; 95% CI= 2.05-10.66) than their non-LGBTQ peers. Among LGBTQ individuals, military experience was associated with a nearly four-fold increased risk of reporting a past-year suicide attempt (aRR=3.61; 95% CI= 1.46-8.91) adjusting for age, sex, race and ethnicity, marital status, depression, and other psychiatric diagnoses. Conclusions: Military experience may moderate health indicators among LGBTQ populations, and likewise, LGBTQ status likely modifies health conditions among military-experienced populations. Results suggest that agencies serving military populations should assess how and if the health needs of LGBTQ individuals are met.
Keywords: adult; army; article; Caucasian; depression; female; gender; gender identity; health hazard; hepatitis; heterosexuality; human; Human immunodeficiency virus infection; LGBT people; major clinical study; male; mental health; military service; priority journal; respiratory tract infection; smoking; social stress; suicidal ideation; suicide attempt; transgender; young adult

Understanding suicide attempts among gay men from their self-perceived causes - Wang, J.; Plöderl, M.; Häusermann, M.; Weiss, M.G. (Journal of Nervous and Mental Disease, 2015)
Gay men are at higher risk of suicidality. This paper describes the causes of suicide attempts as perceived by the men themselves and analyzes their impact on severity and recidivism. Mental health surveys conducted among gay men in Geneva, Switzerland, from two probability-based time-space samples in 2007 and 2011, were merged to yield a combined sample N = 762. Suicide ideation, plans, and attemptswere assessed, and respondentswho had ever attempted suicide answered open questions about perceived causes which were coded and categorized for analysis within the framework of cultural epidemiology. In all, 16.7% of the respondents reported a suicide attempt in their lifetime (59.5% of them with multiple attempts). At their latest attempt, over two thirds asserted intent to die, and half required medical assistance. There was a wide variety of perceived causes, with most individuals reporting multiple causes and many of the most common causes cited at both the first and most recent subsequent attempts. Social/inter-personal problems constitute the most prominent category. Problemswith love/relationship and accepting one's homosexuality figure consistently among the top three causes. Whereas the former tend to be associated with weaker intent to die, the latter are associated with the strongest intent to die and reported at multiple attempts. Problems with family are among the most common perceived causes at first attempt but not at the most recent subsequent attempt. Nevertheless, they tend to be related to the strongest intent to die and the greatest medical severity of all the perceived causes. Ten percent of men attempting suicide cited depression as a cause. Although it tended to be associated with weaker intent to die, depression was most likely to be reported at multiple attempts. Respondent-driven assessment yielded both common and idiosyncratic causes of suicide and their distinct effects. Some of these perceived causes are not prominent in the current literature, yet they have important implications for understanding risk and preventing suicide among gay men.
Keywords: adult; article; clinical assessment; depression; health care survey; homosexual male; homosexuality; human; lifespan; major clinical study; male; medical care; mental health; recidivism; suicidal ideation; suicide; suicide attempt; Switzerland

Differing identities but comparably high HIV and bacterial sexually transmitted disease burdens among married and unmarried men who have sex with men in Mumbai, India - Mayer, K.H.; Gangakhedkar, R.; Sivasubramanian, M.; Biello, K.B.; Abuelezam, N.; Mane, S.; Risbud, A.; Anand, V.; Safren, S.; Mimiaga, M.J. (Sexually Transmitted Diseases, 2015)
Background: Although HIV incidence has declined in India, men and transgender women who have sex with men (MSM) continue to have high rates of HIVand sexually transmitted disease (STD). IndianMSMface substantial pressures to marry and have families, but the HIV/STD burden among married Indian MSM is not well characterized. Methods: A diverse sample of Indian MSM were recruited through respondent-driven sampling. Independent variables that produced a P value of 0.10 or less were then added to a multivariable logistic regression model. Results: Most of the 307 MSM(95 married and 212 unmarried) recruited into the study were younger than 30 years, and less than one-third had more than a high school education. Almost two-thirds of the married men had children, compared with 1.4%of the unmarriedmen (P < 0.001). The numbers of condomless anal sex acts did not differ bymarriage status. Although unmarried MSM more often identified themselves as "kothi" (receptive role), their rates of HIV or bacterial STD were similar to married MSM, with 14.3% being HIV infected. The respondent-driven sampling-adjusted prevalence of any bacterial STD was 18.3% for married MSM and 20% for unmarried MSM (not significant). Participants reported high levels of psychological distress, with 27.4% of married and 20.1% of unmarried MSM reporting depressive symptoms (not significant). Conclusions: Men who have sex with men in Mumbai had high rates of HIV, STD, and behavioral health concerns. Clinicians need to become more comfortable in eliciting sexual histories so that they can identify MSM who need HIV/STD treatment and/or prevention services.
Keywords: adult; age; alcohol consumption; anal intercourse; article; bisexuality; condom use; controlled study; depression; distress syndrome; education; friend; gender identity; high school; human; Human immunodeficiency virus infection; identity; independent variable; Indian; major clinical study; male; married man; men who have sex with men; oral sex; posttraumatic stress disorder; progeny; self esteem; sexual behavior; sexuality; sexually transmitted disease; single man; suicidal ideation; unprotected sex

Transgender care moves into the mainstream - Buchholz, L. (JAMA - Journal of the American Medical Association, 2015)
Keywords: antiandrogen; estrogen; alcoholism; article; blood pressure measurement; body mass; breast cancer; cancer screening; cultural competence; decision making; distress syndrome; doctor patient relationship; dysphoria; feasibility study; gender identity; general practitioner; health care access; health care policy; health care quality; heart infarction; hormonal therapy; human; Human immunodeficiency virus infection; LGBT people; male to female transgender; mastectomy; medical care; medical research; medical school; partial mastectomy; patient care; physician attitude; practice guideline; primary medical care; priority journal; prospective study; prostate cancer; psychosis; psychotherapy; reimbursement; risk factor; self report; sexual orientation; substance abuse; suicide; surgical risk; Thailand; uterine cervix cancer; violence

Internalized homophobia and suicidal ideation among LGB youth - Pereira, H.; Rodrigues, P. (African Journal of Psychiatry (South Africa), 2015)
Objective: The objectives of this study are to evaluate the relation between internalized homophobia and suicidal ideation in young lesbians, gays, bisexuals and heterosexuals; and also assess the influence of gender, discrimination experiences and disclosure of sexual orientation on suicidal ideation. Method: Participants- the sample consists of 389 participants, with a mean age of 19 years old. 51.9% were men and 48.1% were women. Regarding sexual orientation 36.0% were gay, 25.2% bisexual, 21.9% lesbian and17.0% heterosexual. The majority assume having already come out (61.4%). Most of the participants were in high school (51.4%).Instruments-we used a Demographic Questionnaire, the Suicide Ideation Questionnaire (SIQ) (Cronbach's alpha=0,975), and the Internalized Homophobia Questionnaire (Cronbach's alpha=0.81).Procedure - the data collection was done using the Internet. The questionnaires were available on a website built solely for this study. Publicity to this website was done through virtual communities, e-mail and several youth forums. Results: The results support the idea that there is a positive and statistically significant correlation between internalized homophobia and suicidal ideation. In addition, it was found that gay youngsters are the ones who have a stronger internalized homophobia, while young bisexuals are the ones who have higher levels of suicidal ideation. The teenagers who have not, yet, made their disclosure of sexual orientation and those who experienced discrimination, due to their sexual orientation, are those who had higher levels of suicidal ideation. Conclusion: More emphasis should be placed on suicide prevention for younger LGB individuals, in addition to the current emphasis on suicide prevention for adults. Future research should continue to examine unique, understudied LGB communities.
Keywords: adolescent health; adult; article; bisexuality; demography; e-mail; female; heterosexuality; high school student; homophobia; homosexual female; homosexual male; human; internalized homophobia; Internet; interpersonal communication; LGBT people; male; personal experience; questionnaire; sexism; sexual orientation; suicidal ideation

Suicidal ideation among Italian and Spanish young adults: the role of sexual orientation - Baiocco, R.; Ioverno, S.; Lonigro, A.; Baumgartner, E.; Laghi, F. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2015)
The purpose of the current study was to identify demographic, social, and psychological variables associated with suicidal ideation in an Italian sample and a Spanish sample, taking into account the relevance of sexual orientation as a risk factor for suicide. Three hundred twenty gay and bisexual men, 396 heterosexual men, 281 lesbians and bisexual women, and 835 heterosexual women were recruited. In chi-square and multivariable logistic regression analyses we identified several consistent cross-national risk factors for suicidal ideation: having lower education, not being religious, being homosexual or bisexual, not being engaged in a stable relationship, having lower level of peer and parental attachment, and having depressive symptoms. Interestingly, the strongest risk factor in both samples, after depression symptoms, was sexual orientation.
Keywords: adolescent; adult; bisexuality; educational status; epidemiology; female; homosexuality; human; Italy; lesbianism; male; male homosexuality; multivariate analysis; psychology; religion; risk factor; Spain; statistical model; statistics and numerical data; statistics and numerical data; suicidal ideation; suicide attempt; young adult

Constructing the Suicide Risk Index (SRI): does it work in predicting suicidal behavior in young adults mediated by proximal factors? - O'Connor, M.; Dooley, B.; Fitzgerald, A. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2015)
Suicide is a key concern among young adults. The aim of the study was to (1) construct a suicide risk index (SRI) based on demographic, situational, and behavioral factors known to be linked to suicidal behavior and (2) investigate whether the association between the SRI and suicidal behavior was mediated by proximal processes (personal factors, coping strategies, and emotional states). Participants consisted of 7,558 individuals aged 17-25 years (M = 20.35, SD = 1.91). Nearly 22% (n = 1,542) reported self-harm and 7% (n = 499) had attempted suicide. Mediation analysis revealed both a direct effect (ß = .299, 95% CI = [.281, .317], p < .001), and a mediated effect (ß = .204, 95% CI = [.186, .222], p < .001), between the risk index and suicidal behavior. The strongest mediators were levels of self-esteem, depression, and avoidant coping. Interventions to increase self-esteem, reduce depression, and encourage adaptive coping strategies may prevent suicidal behavior in young people.
Keywords: adaptive behavior; adolescent; adult; bisexuality; bullying; depression; divorce; emotion; female; homosexuality; human; male; parent; prevalence; risk assessment; risk factor; self concept; automutilation; sex difference; statistics and numerical data; statistics and numerical data; drug dependence; suicidal ideation; suicide; suicide attempt; young adult

Causes of suicidal behaviors in men who have sex with men in China: a national questionnaire survey - Chen, H.; Li, Y.; Wang, L.; Zhang, B. (BMC public health, 2015)
BACKGROUND: Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the psychological characteristics in Chinese MSM, especially the prevalence of suicidal ideation and attempts. METHODS: A questionnaire survey was conducted on 2,250 MSM recruited from gay bars in 9 large cities in mainland China. Data on the prevalence of suicidal ideation and attempts as well as the underlying causes in the respondents were analyzed. RESULTS: A total of 1530 MSM responded to the question regarding previous suicidal ideation and attempts. Of these respondents, 26.01% had ever considered suicide and 12.55% actually attempted suicide at least once. Romantic gay relationship breakup was the number one cause of suicide behaviors, followed by self-objection to homosexuality, difficulties in finding gay partners or in getting used to heterosexual marriage life, sudden emotional hurts from unexpected events, illegal status of gay marriage in China and disclosure of homosexuality. CONCLUSIONS: The survey study has led to a better understanding of the factors contributing to suicide behaviors of MSM in China, which may have significant implications in developing preventive strategies against suicide behaviors in this unique group of individuals.
Keywords: adult; China; human; life event; male; male homosexuality; prevalence; psychology; questionnaire; self concept; sexuality; statistics and numerical data; suicidal ideation; suicide attempt; young adult

Retrospective autopsy study of deaths due to rodenticides - Venkata Raghava, S.; Sumangala, C.N.; Dileepkumar, K.B.; PradeepKumar, M.P. (Medico-Legal Update, 2015)
Rodents are mammals of the orderRodentia, characterized by a single pair of continuously growing incisors in each of the upper and lower jaws.About forty percent of all species of mammals are rodents, and they are found in vast numbers on all continents except Antartica.Rodenticides are commonly used to kill variety of rodents which cause great loss of food grains. Simple access and easy availability to these rodenticides results in their consumption. A detailed autopsy study of deaths due to rodenticides has been made, thereby studying the various factors like age, sex, manner of death, reasons for death etc. Majority were suicidal deaths, ill-healthbeing the leading reason for death among suicides.
Keywords: rodenticide; accidental death; adolescent; adult; age distribution; article; autopsy; cause of death; child; death; female; human; incidence; infant; intoxication; male; newborn; retrospective study; suicide; transgender

Religion-related stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a South African rural-based university - Mavhandu-Mudzusi, A.H.; Sandy, P.T. (Culture, health & sexuality, 2015)
This paper reports on the stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a rural university in South Africa. Twenty lesbian, gay, bisexual and transgender students recruited through snowball sampling participated in this study. Interpretative Phenomenological Analysis was used as a framework for data analysis. Findings indicate that religion-related stigma and discrimination are common at a rural-based university in South Africa. Lesbian, gay, bisexual and transgender students are typically ascribed a range of labels, including 'sinners', 'devils' and 'demon possessed'. They are also exposed to a number of discriminatory acts, such as the denial of financial and healthcare services and threats of and/or actual rape. Study participants reported attempts to convert lesbian, gay, bisexual and transgender students' sexual orientation which involved the use of intervention in the form of prayers. Derogatory labelling and associated discriminatory acts, for example the threat of rape, led many students to conceal their sexual identity, not attend specific classes, terminate their studies and even attempt suicide. Universities should develop policies to promote greater social inclusion and the acceptance of lesbian, gay, bisexual and transgender students. Policies should also specify the steps or approaches to be taken in addressing discriminatory practices.
Keywords: adult; bisexuality; female; homophobia; homosexuality; human; male; psychology; religion; rural population; social stigma; South Africa; statistics and numerical data; stereotyping; student; transgender; university; young adult

Sexual orientation and non-suicidal self-injury: a meta-analytic review - Batejan, K.L.; Jarvi, S.M.; Swenson, L.P. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2015)
The aim of this study was to conduct the first meta-analysis comparing risk for NSSI between sexual minority and heterosexual persons. Eleven published and 4 unpublished studies were reviewed, describing associations between sexual orientation and NSSI in 7,147 sexual minority and 61,701 heterosexual participants. The overall weighted effect size for the relationship between sexual orientation and NSSI using a random-effects model was OR = 3.00 (95% CI = 2.46-3.66), indicating a medium-to-large effect. Sexual minority adolescents and bisexuals were found to be at particularly high-risk. These findings highlight the need to examine mechanisms linking sexual orientation and NSSI in future research. Building on these findings can add to understanding the associations between sexual orientation, NSSI, and suicidality, as well as prevention/intervention.
Keywords: adolescent; adult; automutilation; human; meta analysis; psychology; risk assessment; sexual behavior; sexuality; suicidal ideation

Risk factors associated with self-injurious behavior among a national sample of undergraduate college students - Taliaferro, L.A.; Muehlenkamp, J.J. (Journal of American college health : J of ACH, 2015)
OBJECTIVE: Nonsuicidal self-injury (NSSI) and suicidality among undergraduates represent important public health issues. This analysis identified risk factors that distinguished 3 groups, those who reported no history of self-harm; self-injury, but no suicide attempts (NSSI only); and self-injury and a suicide attempt (NSSI + SA) in the past year. METHODS: Data came from 16,044 undergraduates who completed the Fall 2010 National College Health Assessment. RESULTS: Over 3% of students reported NSSI, and one third of these individuals also attempted suicide. Factors that distinguished the NSSI only and NSSI + SA groups from the no self-harm group included current depressive symptoms, nonheterosexual orientation, an eating disorder/extreme weight control behavior, and diagnosis of an internalizing disorder. Factors that distinguished the NSSI + SA group from the NSSI only group were current depressive symptoms and diagnosis of an internalizing disorder. CONCLUSIONS: Students experiencing mental health problems demonstrate increased risk for NSSI and/or suicidal behavior.
Keywords: adolescent; depression; female; health survey; human; male; psychology; risk factor; automutilation; statistics and numerical data; student; suicide attempt; university; young adult

Sexual orientation and risk factors for suicidal ideation and suicide attempts: a multi-centre cross-sectional study in three Asian cities - Lian, Q.; Zuo, X.; Lou, C.; Gao, E.; Cheng, Y. (Journal of epidemiology / Japan Epidemiological Association, 2015)
PURPOSE: Despite robust empirical and theoretical evidence for higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and sexual orientation among Asian youths. This study examined differences in prevalence of suicidal ideation and suicide attempts between LGB and heterosexual youths in the cities of Hanoi, Shanghai, and Taipei, China. METHODS: The data are from a community-based multi-centre cross-sectional study conducted from 2006 to 2007, with a sample of 17 016 youths aged 15-24 years from Hanoi, Shanghai, and Taipei. Chi-square test and logistic regression were used to evaluate correlates of suicidal ideation and suicide attempts. RESULTS: The overall prevalence of suicidal ideation and suicide attempts in the preceding 12 months in LGB youths were both higher than in heterosexual youth (12.8% vs. 8.1% and 4.0% vs. 2.4%, respectively). Stratified by city, the prevalence of suicidal ideation was lowest in Hanoi (2.2%), followed by Shanghai (8.0%) and Taipei (17.0%). Similar trends were observed in the prevalence of suicide attempts, which was lowest in Hanoi (0.3%), followed by Shanghai (1.2%) and Taipei (2.5%). Of note, however, multivariate logistic regression results revealed that LGB youth were at a higher risk for suicidal ideation than heterosexual youth only in Taipei (odds ratio 1.65). CONCLUSIONS: Suicidality is common among Asian youth, with higher prevalence observed in urbanized cities. LGB youths are at greater risk of suicidal ideation than their heterosexual counterparts in Taipei than in the other two examined cities.
Keywords: adolescent; bisexuality; China; city; clinical trial; cross-sectional study; female; heterosexuality; human; lesbianism; male; male homosexuality; multicenter study; multivariate analysis; psychology; risk assessment; risk factor; statistical model; statistics and numerical data; suicidal ideation; suicide attempt; young adult

Suicide Risk Among College Student. The Intersection of Sexual Orientation and Race - Shadick, R.; Backus Dagirmanjian, F.; Barbot, B. (Crisis, 2015)
BACKGROUND: Research on young adults in the general population has identified a relationship between sexual minority identification and risk for suicide. Differential rates of suicidal ideation and attempts have also been found across racial and ethnic groups. AIMS: This study examined risk for suicide among university students, based on membership in one or more marginalized groups (sexual minority and racial minority identification). METHOD: Data were collected from first-year college students (N = 4,345) at an urban university. Structural equation modeling was employed to model a suicidality construct, based on which a "risk for suicide" category system was derived. Chi-square and logistic regression analyses were then conducted to estimate the relationship between the background variables of interest and suicide risk. RESULTS: Students who identified as lesbian, gay, or bisexual (LGB) were associated with higher suicide risk than their heterosexual peers. Students of color were slightly less at risk than their heterosexual peers. However, LGB students of color were associated with elevated suicide risk relative to heterosexual peers. CONCLUSION: Results indicate that belonging to multiple marginalized groups may increase one's risk for suicide, though these effects are not simply additive. Findings highlight the complexity of the intersection between marginalized identities and suicidality.
Keywords: adolescent; African American; Alaska Native; American Indian; Asian American; bisexuality; Caucasian; depression; ethnic group; female; heterosexuality; Hispanic; homosexuality; human; male; minority group; psychology; risk assessment; sexual behavior; sexual and gender minority; statistics and numerical data; student; suicidal ideation; suicide; suicide attempt; university

Religious Conflict, Sexual Identity, and Suicidal Behaviors among LGBT Young Adults - Gibbs, J.J.; Goldbach, J. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2015)
This is the first known study to explore how religious identity conflict impacts suicidal behaviors among lesbian, gay, bisexual, and transgender (LGBT) young adults and to test internalized homophobia as a mediator. A secondary analysis of 2,949 youth was conducted using a national dataset collected by OutProud in 2000. Three indicators of identity conflict and an internalized-homophobia scale (mediator), were included in logistic regressions with three different suicide variable outcomes. Internalized homophobia fully mediates one conflict indicator and partially mediates the other two indicators' relationship with suicidal thoughts. Internalized homophobia also fully mediates the relationship between one conflict indicator and chronic suicidal thoughts. Two indicators were associated with twice the odds of a suicide attempt. LGBT young adults who mature in religious contexts have higher odds of suicidal thoughts, and more specifically chronic suicidal thoughts, as well as suicide attempt compared to other LGBT young adults. Internalized homophobia only accounts for portions of this conflict.
Keywords: adolescent; bisexuality; cross-sectional study; demography; female; gender identity; human; lesbianism; male; protection; psychology; religion; risk factor; socioeconomics; suicidal ideation; suicide; transgender; young adult

Experiences of homophobia among gay and bisexual men: results from a cross-sectional study in seven countries - Chard, A.N.; Finneran, C.; Sullivan, P.S.; Stephenson, R. (Culture, health & sexuality, 2015)
Experiences of homophobic discrimination are associated with an increased prevalence of psychological disorders and increased odds of reporting suicidal ideation among gay and bisexual men. We examine two domains of homophobia--external homophobic discrimination and internalised homophobia--and their associations with sexual orientation, demographic characteristics, relationships and social support among a sample of gay and bisexual men from seven countries. Sexually active gay and bisexual men aged over 18 and residing in Australia, Brazil, Canada, South Africa, Thailand, the UK and the USA were recruited through banner advertisements on Facebook. Two outcomes were examined: reporting experiences of homophobic discrimination and reporting feelings of internalised homophobia. No covariates were consistently significantly associated with experiencing external homophobic discrimination across countries. Across all countries, bisexually identifying respondents reported significantly greater feelings of internalised homophobia. Respondents in Brazil and the UK reporting a main partner, and respondents in Australia, Brazil, Canada, South Africa, Thailand and the USA reporting a larger gay/bisexual social network, reported significantly fewer feelings of internalised homophobia. Results suggest an ameliorative effect of social networks on experiencing homophobia. Additional research should focus on the mechanisms through which social networks reduce feelings of internalised homophobia.
Keywords: adult; Australia; bisexuality; Brazil; Canada; cross-sectional study; epidemiology; homophobia; human; male; male homosexuality; middle aged; perception; psychology; sexual behavior; sexuality; South Africa; statistics and numerical data; Thailand; United Kingdom; United States; young adult

Suicides among lesbian, gay, bisexual, and transgender populations in Australia: An analysis of the queensland suicide register - Skerrett, D.M.; Kõlves, K.; De Leo, D. (Asia-Pacific Psychiatry, 2014)
Introduction: Sexual orientation is seldom recorded at death in Australia, and to date there have been no studies on the relationship between those that have died by suicide and sexuality or minority gender identity in Australia. The aim of the present study is to determine whether or not lesbian, gay, bisexual, transgender (LGBT), and intersex individuals who die by suicide constitute a unique subpopulation of those who die by suicide, when compared with non-lesbian, gay, bisexual, transgender, and intersex suicide deaths. Methods: The Queensland Suicide Register holds records of all suicides in Queensland since 1990. All cases from 2000 to 2009 (inclusive; a total of 5,966 cases) were checked for potential indicators of individuals' sexual orientation and gender identification. A total of 35 lesbian (n=10), gay (n=22), bisexual (n=2), and transgender (n=1) suicide cases were identified. Three comparison cases of non-LGBT suicides for each LGBT suicide were then located, matched by age and gender. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals. Results: It was significantly more likely that depression was mentioned in the cases of LGBT suicides than in non-LGBT cases. While 12.4% of the comparison group had been diagnosed with psychotic disorders, there were no such diagnoses among LGBT individuals. LGBT individuals experienced relationship problems more often, with relationship conflict also being more frequent than in non-LGBT cases. Discussion: Despite its limitations, this study - the first of its kind in Australia - seems to indicate that LGBT people would require targeted approaches in mental and general health services.
Keywords: adult; article; Australia; bisexual female; bisexual male; controlled study; death; depression; female; gender identity; homosexual female; homosexual male; human; intersex; major clinical study; male; priority journal; psychosis; register; sexual orientation; suicide; transgender

The intersecting roles of violence, gender, and substance use in the emergency department: A research agenda - Choo, E.K.; Benz, M.; Rybarczyk, M.; Broderick, K.; Linden, J.; Boudreaux, E.D.; Ranney, M.L. (Academic Emergency Medicine, 2014)
The relationship between gender, violence, and substance use in the emergency department (ED) is complex. This article examines the role of gender in the intersection of substance use and three types of violence: peer violence, intimate partner violence, and firearm violence. Current approaches to treatment of substance abuse and violence are similar across both genders; however, as patterns of violence and substance abuse differ by gender, interventions may be more effective if they are designed with a specific gender focus.
Keywords: aggression; alcohol abuse; alcohol consumption; article; binge drinking; consensus; dating violence; domestic violence; drinking behavior; drug abuse; emergency care; emergency treatment; emergency ward; emotion; expectancy; gun violence; heterosexuality; human; men who have sex with men; partner violence; peer violence; sex difference; social dominance; substance use; violence

A trait-interpersonal analysis of suicide proneness among lesbian, gay, and bisexual community members - Cramer, R.J.; Stroud, C.H.; Fraser, T.; Graham, J. (Suicide & life-threatening behavior, 2014)
Suicide remains a concerning issue for lesbian, gay, and bisexual (LGB) persons. The integrated effects of five-factor model personality traits and interpersonal-psychological theory of suicide (IPTS) constructs on suicide proneness in a community sample of 336 LGB adults were examined. Results supported a model inclusive of all five-factor model domains predicting IPTS constructs leading to suicide proneness. Effects of neuroticism and extraversion were both mediated by perceived burdensomeness and thwarted belongingness. Thwarted belongingness mediated the effect of agreeableness on suicide proneness. Identified mediation pathways build on existing trait-interpersonal theory and may inform clinical services for sexual minority persons.
Keywords: adult; bisexuality; female; human; human relation; lesbianism; male; male homosexuality; middle aged; personality; psychological theory; psychology; risk factor; suicidal ideation; suicide

The ‘G’ men: A profile of GBL/GHB users in an area of high drug-related mortality - Durgahee, S.; Allen, G.; Williams, H. (Irish Journal of Psychological Medicine, 2014)
Objectives. Gamma-butyrolactone/gamma-hydroxybutyrate (GBL/GHB) and related analogues are increasingly misused. The study reports on patient characteristics, nature and pattern of use, complications and comorbidity for a cohort of patients presenting to a large Substance Misuse Service in Brighton and Hove City. Method. A retrospective case-note review of routinely collected clinical data on patients with primary GBL/GHB misuse. Results. In all, 24 individuals were male and 3 female, with a mean age of 34 years. A total of 21 males identified themselves as gay and 1 female as bisexual. Just over half (15, 56%), respectively, were living in stable accommodation and were in employment or third-level education. In all, 22 (81%) met criteria for physical dependence and two-thirds (18, 67%) had experienced overdose. The group was using large amounts of GBL (mean 53 ml/day) with a significant number (25, 93%) using ‘around the clock’ (every 1-3 hours). Over one-third (10, 37%) had a diagnosis of HIV and with 24 (89%) having a presumptive diagnosis of anxiety disorder. Conclusions. A profile of gay men with relatively stable lifestyles, but nevertheless with a high rate of complication of GBL/GHB use and with a significant comorbidity (HIV and psychological problems) was identified. The need for integrated specialist services and the importance of liaison with Emergency Departments and HIV services is highlighted. Received 3 April 2014; Revised 2 June 2014; Accepted 8 July 2014; First published online 11 August 2014.
Keywords: 4 hydroxybutyric acid; gamma butyrolactone; adult; age; anorexia; antiviral therapy; anxiety disorder; article; bisexual female; clinical article; cohort analysis; comorbidity; controlled study; drug dependence; drug misuse; drug overdose; educational status; employment status; England; ethnicity; female; group therapy; heterosexuality; high risk behavior; homosexual male; human; Human immunodeficiency virus infection; male; medical record review; mortality; paranoia; patient referral; seizure; self neglect; social status; suicidal ideation; body weight loss; withdrawal syndrome

Minority stress in lesbian, gay, and bisexual young adults in Australia: associations with psychological distress, suicidality, and substance use - Lea, T.; de Wit, J.; Reynolds, R. (Archives of sexual behavior, 2014)
Lesbian, gay, bisexual, and other same-sex attracted young people have been shown to be at a higher risk of mental health problems, including depression, anxiety, suicidality, and substance abuse, compared to their heterosexual peers. Homophobic prejudice and stigma are often thought to underlie these disparities. In this study, the relationship between such experiences of social derogation and mental health and substance use in same-sex attracted young people was examined using Meyer's minority stress theory. An online survey recruited 254 young women and 318 young men who identified as same-sex attracted, were aged 18-25 years, and lived in Sydney, Australia. Multivariate logistic regression analyses showed that internalized homophobia, perceived stigma, and experienced homophobic physical abuse were associated with higher levels of psychological distress and self-reported suicidal thoughts in the previous month. Furthermore, perceived stigma and homophobic physical abuse were associated with reporting a lifetime suicide attempt. The association between minority stress and substance use was inconsistent. While, as expected, higher levels of perceived stigma were associated with club drug dependence, there was an inverse association between internalized homophobia and club drug use, and between perceived stigma and hazardous alcohol use. The findings of this study provide support for the minority stress theory proposition that chronic social stress due to sexual orientation is associated with poorer mental health. The high rates of mental health and substance use problems in the current study suggest that same-sex attracted young people should continue to be a priority population for mental health and substance use intervention and prevention.
Keywords: adolescent; adult; anxiety disorder; Australia; bisexuality; depression; female; gender identity; heterosexuality; homophobia; human; lesbianism; male; male homosexuality; mental stress; minority group; multivariate analysis; perception; prejudice; psychology; statistical model; statistics and numerical data; drug dependence; suicide; young adult

Explaining the suicide risk of sexual minority individuals by contrasting the minority stress model with suicide models - Plöderl, M.; Sellmeier, M.; Fartacek, C.; Pichler, E.-M.; Fartacek, R.; Kralovec, K. (Archives of sexual behavior, 2014)
Many studies have found elevated levels of suicide ideation and attempts among sexual minority (homosexual and bisexual) individuals as compared to heterosexual individuals. The suicide risk difference has mainly been explained by minority stress models (MSTM), but the application of established suicidological models and testing their interrelations with the MSTM has been lacking so far. Therefore, we have contrasted two established models explaining suicide risk, the Interpersonal Psychological Theory (IPT) (Joiner, 2005) and the Clinical Model (CM) (Mann et al., 1999), with the MSTM (Meyer, 2003) in a Bavarian online-sample of 255 adult sexual minority participants and 183 heterosexual participants. The results suggested that the CM and the IPT model can well explain suicide ideation among sexual minorities according to the factors depression, hopelessness, perceived burdensomeness, and failed belongingness. The CM and the IPT were intertwined with the MSTM via internalized homophobia, social support, and early age of coming out. Early coming out was associated with an increased suicide attempt risk, perhaps through violent experiences that enhanced the capability for suicide; however, coming out likely changed to a protective factor for suicide ideation by enhanced social support and reduced internalized homophobia. These results give more insight into the development of suicide risk among sexual minority individuals and may be helpful to tailor minority-specific suicide prevention strategies.
Keywords: adult; automutilation; bisexuality; depression; female; human; lesbianism; male; male homosexuality; mental stress; middle aged; minority group; psychological model; psychological theory; psychology; questionnaire; risk; sexual behavior; suicide; young adult

Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain - Reisner, S.L.; Biello, K.; Rosenberger, J.G.; Austin, S.B.; Haneuse, S.; Perez-Brumer, A.; Novak, D.S.; Mimiaga, M.J. (Archives of sexual behavior, 2014)
Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54%; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged.
Keywords: adolescent; adult; Caribbean; cross-sectional study; cultural factor; female; gender identity; health status indicator; health survey; high risk behavior; Human immunodeficiency virus infection; human; male; middle aged; Portugal; psychology; regression analysis; reproductive health; sexual behavior; socioeconomics; South and Central America; Spain; suicide; transgender; transsexualism; young adult

Psychosocial health conditions and HIV prevalence and incidence in a cohort of men who have sex with men in Bangkok, Thailand: evidence of a syndemic effect - Guadamuz, T.E.; McCarthy, K.; Wimonsate, W.; Thienkrua, W.; Varangrat, A.; Chaikummao, S.; Sangiamkittikul, A.; Stall, R.D.; van Griensven, F. (AIDS and behavior, 2014)
Men who have sex with men (MSM) in Bangkok may experience multiple psychosocial health conditions, such as substance use, suicidality, and a history of sexual abuse. These factors may contribute to HIV vulnerability in a syndemic way. A syndemic is defined as a number of synergistically interacting health conditions producing excess disease in a population. The objective of this study is to examine whether psychosocial health conditions among MSM have a syndemic association with HIV prevalence and HIV incidence. To do this, we evaluated psychosocial health conditions and their associations with unprotected sex, HIV prevalence and HIV incidence in a cohort of Thai MSM (N = 1,292). There was a positive and significant association between the number of psychosocial health conditions and increased levels of unprotected sex and HIV prevalence at study baseline. The number of psychosocial health conditions at baseline was also associated with increased HIV incidence during follow-up (no conditions, HIV incidence = 15.3 %; one to three conditions, 23.7 %; four to five conditions, 33.2 %). The number of psychosocial health conditions was positively associated with HIV risk behavior and HIV prevalence and incidence. Prevention efforts among MSM need to address the existence of multiple psychosocial health conditions and their synergy to effectively decrease the spread of HIV infection.
Keywords: adult; cohort analysis; Human immunodeficiency virus infection; human; incidence; Kaplan Meier method; longitudinal study; male; male homosexuality; prevalence; psychology; risk factor; statistics and numerical data; Thailand; unsafe sex

Novel hepatitis B virus strain developing due to recombination between genotypes H and B strains isolated from a Japanese patient - Uchida, Y.; Kouyama, J.-I.; Naiki, K.; Sugawara, K.; Inao, M.; Nakayama, N.; Mochida, S. (Hepatology Research, 2017)
Aim: In Japan, genotypes B and C are the predominant genotypes isolated from patients with chronic hepatitis B, while genotype A predominates in patients with acute hepatitis B. Globalization, however, appears to have changed the distribution of the hepatitis B virus (HBV) genotypes. Thus, the viral characteristics of HBV genotypes other than genotypes A, B and C were examined. Methods: Screening of genotypes was performed by enzyme immunoassay and/or polymerase chain reaction INVADER method in 222 patients with HBV. The full-length nucleotide sequences of unusual strains were compared to those in the database, followed by construction of a phylogenetic tree. Results: Unusual HBV strains were isolated from two patients: a 27-year-old Japanese bisexual man with acute hepatitis B with HIV co-infection and a 52-year-old Japanese man with chronic hepatitis B. The former strain was classified as genotype H, showing an overall identity of 99.8% to the Thailand strain (EU498228), while the nucleotide sequence of the latter strain showed similarity to the genotype B strains isolated in Malaysia (JQ027316) and Indonesia (JQ429079) between DR2 and DR1 in the X region, with identities of 96.9%. However, this strain was classified as genotype H by full-length sequence analysis, and the sequence between nt2023 and nt2262 showed no similarity to that in any previously reported strains. Conclusion: HBV strains showing recombination between genotype B and H strains were found even in chronic hepatitis patients in Japan. Globalization may yield HBV strains of possible novel genotypes containing novel nucleotide sequences in the precore/core region.
Keywords: acute hepatitis B; adult; article; chronic hepatitis B; controlled study; DNA extraction; enzyme immunoassay; Hepatitis B virus; Hepatitis B virus genotype A; Hepatitis B virus genotype B; Hepatitis B virus genotype C; Hepatitis B virus genotype H; human; Indonesia; major clinical study; Malaysia; male; molecular cloning; nonhuman; nucleotide sequence; phylogenetic tree; polymerase chain reaction; screening; sequence analysis; Thailand; virus isolation; virus recombination; virus strain

Psychiatric disorders, suicidality, and personality among young men by sexual orientation - Wang, J.; Dey, M.; Soldati, L.; Weiss, M.G.; Gmel, G.; Mohler-Kuo, M. (European Psychiatry, 2014)
Personality and its potential role in mediating risk of psychiatric disorders and suicidality are assessed by sexual orientation, using data collected among young Swiss men (n= 5875) recruited while presenting for mandatory military conscription. Mental health outcomes were analyzed by sexual attraction using logistic regression, controlling for five-factor model personality traits and socio-demographics. Homo/bisexual men demonstrated the highest scores for neuroticism-anxiety but the lowest for sociability and sensation seeking, with no differences for aggression-hostility. Among homo/bisexual men, 10.2% fulfilled diagnostic criteria for major depression in the past 2. weeks, 10.8% for ADHD in the past 12. months, 13.8% for lifetime anti-social personality disorder (ASPD), and 6.0% attempted suicide in the past 12. months. Upon adjusting (AOR) for personality traits, their odds ratios (OR) for major depression (OR = 4.78, 95% CI 2.81-8.14; AOR = 1.46, 95% CI 0.80-2.65) and ADHD (OR = 2.17, 95% CI = 1.31-3.58; AOR = 1.00, 95% CI 0.58-1.75) lost statistical significance, and the odds ratio for suicide attempt was halved (OR = 5.10, 95% CI 2.57-10.1; AOR = 2.42, 95% CI 1.16-5.02). There are noteworthy differences in personality traits by sexual orientation, and much of the increased mental morbidity appears to be accounted for by such underlying differences, with important implications for etiology and treatment.
Keywords: adult; algorithm; antisocial personality disorder; anxiety; article; attention deficit disorder; bisexual male; cohort analysis; depression; health survey; homosexual male; human; leisure; major clinical study; major depression; male; mental disease; mental health; neurosis; personality; personality disorder; quality of life; sensation seeking; sexual orientation; Short Form 12; social interaction; suicidal ideation; suicide attempt; Switzerland; young adult

Associations between bullying and engaging in aggressive and suicidal behaviors among sexual minority youth: the moderating role of connectedness - Duong, J.; Bradshaw, C. (The Journal of school health, 2014)
BACKGROUND: Research on the extent to which cyberbullying affects sexual minority youth is limited. This study examined associations between experiencing cyber and school bullying and engaging in aggressive and suicidal behaviors among sexual minority youth. We also explored whether feeling connected to an adult at school moderated these associations. METHODS: Data came from 951 self-identified lesbian, gay, and bisexual (LGB) youth, who completed the New York City Youth Risk Behavior Survey during fall 2009. We used multiple logistic regression to examine the hypothesized associations and test for effect modification. RESULTS: Cyber and school bullying were associated with engaging in aggressive and suicidal behaviors among LGB youth. Youth experiencing both cyber and school bullying had the greatest odds of engaging in aggressive and suicidal behaviors. However, feeling connected to an adult at school moderated these associations such that bullied youth who felt connected were not more likely to report aggressive and suicidal behaviors. CONCLUSIONS: The findings highlight the challenges faced by bullied LGB youth. Practitioners should work with school administrators to establish supportive environments for sexual minority youth. Helping victimized LGB youth develop meaningful connections with adults at school can minimize the negative impacts of cyber and school bullying.
Keywords: adolescent; aggression; bullying; epidemiology; female; high risk behavior; human; Internet; male; minority group; prevalence; psychology; school; sexuality; statistics and numerical data; suicide; suicide attempt; United States

Stressful life events, sexual orientation, and cardiometabolic risk among young adults in the United States - Hatzenbuehler, M.L.; Slopen, N.; McLaughlin, K.A. (Health Psychology, 2014)
Objective: The goal of the present study was to examine whether sexual minority young adults are more vulnerable to developing cardiometabolic risk following exposure to stressful life events than heterosexual young adults. Method: Data came from the National Longitudinal Study for Adolescent Health (Shin, Edwards, & Heeren, 2009; Brummett et al., 2013), a prospective nationally representative study of U.S. adolescents followed into young adulthood. A total of 306 lesbian, gay, and bisexual (LGB) respondents and 6,667 heterosexual respondents met inclusion criteria for this analysis. Measures of cumulative stressful life events were drawn from all 4 waves of data collection; sexual orientation and cardiometabolic biomarkers were assessed at Wave 4 (2008 -2009). Results: Gay/bisexual men exposed to 1-2 (β = 0.71, p = .01) and 5+ (β = 0.87, p = .01) stressful life events had a statistically significant elevation in cardiometabolic risk, controlling for demographics, health behaviors, and socioeconomic status. Moreover, in models adjusted for all covariates, lesbian/bisexual (β = 0.52, p = .046) women with 5+ stressful life events had a statistically significant elevation in cardiometabolic risk. There was no relationship between stressful life events and cardiometabolic risk among heterosexual men or women. Conclusion: Stressful life events during childhood, adolescence, and young adulthood place LGB young adults at heightened risk for elevated cardiometabolic risk as early as young adulthood. The mechanisms underlying this relationship require future study.
Keywords: adult; article; bisexuality; cardiometabolic risk; child sexual abuse; controlled study; death; delinquency; demography; drinking behavior; educational status; female; foster care; health behavior; heterosexuality; homelessness; homosexual female; homosexual male; human; income; life stress; major clinical study; male; partner violence; physical abuse; physical activity; prevalence; prospective study; rape; risk factor; sexual orientation; smoking; social status; suicide; United States; violence; witness

Discovery of carbohybrid-based 2-aminopyrimidine analogues as a new class of rapid-acting antimalarial agents using image-based cytological profiling assay - Lee, S.; Lim, D.; Lee, E.; Lee, N.; Lee, H.-G.; Cechetto, J.; Liuzzi, M.; Freitas-Junior, L.H.; Song, J.S.; Bae, M.A.; Oh, S.; Ayong, L.; et al. (Journal of Medicinal Chemistry, 2014)
New antimalarial agents that exhibit multistage activities against drug-resistant strains of malaria parasites represent good starting points for developing next-generation antimalarial therapies. To facilitate the progression of such agents into the development phase, we developed an image-based parasitological screening method for defining drug effects on different asexual life cycle stages of Plasmodium falciparum. High-throughput screening of a newly assembled diversity-oriented synthetic library using this approach led to the identification of carbohybrid-based 2-aminopyrimidine compounds with fast-acting growth inhibitory activities against three laboratory strains of multidrug-resistant P. falciparum. Our structure-activity relationship study led to the identification of two derivatives (8aA and 11aA) as the most promising antimalarial candidates (mean EC50of 0.130 and 0.096 μM against all three P. falciparum strains, selectivity indices >600, microsomal stabilities >80%, and mouse malaria ED50values of 0.32 and 0.12 mg/kg/day, respectively), targeting all major blood stages of multidrug-resistant P. falciparum parasites.
Keywords: antimalarial agent; pyrimidine derivative; animal experiment; animal model; antimalarial activity; area under the curve; article; asexual reproduction; controlled study; cytology; cytotoxicity; drug absorption; drug blood level; drug dose; drug efficacy; drug synthesis; EC50; high throughput screening; human; human tissue; hydrophobicity; in vitro study; in vivo study; life cycle stage; liver microsome; male; maximum plasma concentration; mitochondrial membrane potential; mouse; multidrug resistance; nonhuman; parasite clearance; Plasmodium chabaudi infection; Plasmodium falciparum; stereochemistry; structure activity relation; time to maximum plasma concentration

Do ask, do tell: High levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers - Cahill, S.; Singal, R.; Grasso, C.; King, D.; Mayer, K.; Baker, K.; Makadon, H. (PLoS ONE, 2014)
Background: The Institute of Medicine and The Joint Commission have recommended asking sexual orientation and gender identity (SOGI) questions in clinical settings and including such data in Electronic Health Records (EHRs). This is increasingly viewed as a critical step toward systematically documenting and addressing health disparities affecting lesbian, gay, bisexual, and transgender (LGBT) people. The U.S. government is currently considering whether to include SOGI data collection in the Stage 3 guidelines for the incentive program promoting meaningful use of EHR. However, some have questioned whether acceptable standard measures to collect SOGI data in clinical settings exist. Methods: In order to better understand how a diverse group of patients would respond if SOGI questions were asked in primary care settings, 301 randomly selected patients receiving primary care at four health centers across the U.S. were asked SOGI questions and then asked follow-up questions. This sample was mainly heterosexual, racially diverse, and geographically and regionally broad. Results: There was a strong consensus among patients surveyed about the importance of asking SOGI questions. Most of the LGBT respondents thought that the questions presented on the survey allowed them to accurately document their SOGI. Most respondents - heterosexual and LGBT - answered the questions, and said that they would answer such questions in the future. While there were some age-related differences, respondents of all ages overwhelmingly expressed support for asking SOGI questions and understood the importance of providers' knowing their patients' SOGI. Conclusions: Given current deliberations within national health care regulatory bodies and the government's increased attention to LGBT health disparities, the finding that patients can and will answer SOGI questions has important implications for public policy. This study provides evidence that integrating SOGI data collection into the meaningful use requirements is both acceptable to diverse samples of patients, including heterosexuals, and feasible.
Keywords: adult; Alaska Native; article; Asian; bisexuality; controlled study; depression; electronic medical record; ethnicity; feasibility study; female; gender identity; government; health care disparity; health center; heterosexuality; Hispanic; homosexual female; human; LGBT people; male; Pacific Islander; primary medical care; public health service; race difference; sexual orientation; suicidal ideation; transgender; Western Hemisphere

Characteristics of female patients admitted to an adolescent secure forensic psychiatric hospital - Hill, S.A.; Brodrick, P.; Doherty, A.; Lolley, J.; Wallington, F.; White, O. (Journal of Forensic Psychiatry and Psychology, 2014)
Bluebird House is the only mixed gender NHS secure forensic psychiatric hospital for adolescents in the South of England. It has admitted more than 30 female patients since the service opened in 2008. The admission criteria are that patients must be detained under the Mental Health Act and present evidence of being a risk of harm to others. This article describes the clinical characteristics of 30 consecutive female patients admitted to a highly specialised adolescent forensic inpatient service. Key results include a very high rate of incidents of risk behaviours exhibited by female patients within the unit but good clinical outcomes. The majority of patients had severe symptoms of mental disorder, especially emotional instability, self-harm behaviours and aggressive behaviours. Few had diagnoses of mental illness. Assessment findings from the Millon Adolescent Clinical Inventory and the Structured Assessment of Violence Risk are discussed, as are parallel with studies from other female secure services.
Keywords: academic achievement; adolescent; adolescent behavior; aggressiveness; anger; article; authority; automutilation; bipolar disorder; borderline state; caregiver burden; child abuse; civil rights; clinical article; clinical feature; conduct disorder; coping behavior; custodial care; depression; disease severity; female; forensic psychiatry; gender dysphoria; general mental disease assessment; hospital discharge; human; impulsiveness; incidence; involuntary commitment; length of stay; medical practice act; mental disease; mental health; mental hospital; mental instability; Millon Adolescent Clinical Inventory; patient attitude; personality; personality assessment; personality disorder; posttraumatic stress disorder; priority journal; protection; psychologic test; psychosis; psychotrauma assessment; risk assessment; risk factor; school; scoring system; social support; stress management; suicide attempt; violence

A compensatory model of risk and resilience applied to adolescent sexual orientation disparities in nonsuicidal self-injury and suicide attempts - Reisner, S.L.; Biello, K.; Perry, N.S.; Gamarel, K.E.; Mimiaga, M.J. (The American journal of orthopsychiatry, 2014)
This study investigated and applied a compensatory model of risk and resilience to differences in past-year nonsuicidal self-injury (NSSI) and suicide attempts by sexual orientation using representative data from the 2007 Massachusetts Youth Risk Behavior Survey (n = 3,131). Self-identified lesbian, gay, bisexual, and questioning (LGBQ) adolescents comprised 7% of the sample, but accounted for 67% of NSSI and 80% of suicide attempts. Compared with heterosexuals, LGBQ adolescents had an increased odds of NSSI (adjusted Odds Ratio (aOR) = 2.76; 95% Confidence Interval (CI) [2.00, 3.81] and suicide attempts (aOR = 2.73; 95% CI [1.47, 5.08]. NSSI was highly associated with suicidality (aOR = 10.87; 95% CI [6.17, 19.18]. Family support was independently associated with a decreased odds of both NSSI (aOR = 0.56; 95% CI [0.35, 0.89] and suicidality (aOR = 0.48; 95% CI [0.29, 0.79] supporting a compensatory model of resilience. Screening and preventive interventions for LGBQ adolescents are warranted, including at the family level. Sexual orientation should be included as a standard demographic to monitor health disparities.
Keywords: adolescent; bisexuality; coping behavior; female; homosexuality; human; male; psychological model; risk; automutilation; statistics and numerical data; suicide attempt; United States

Hormone treatment of children and adolescents with gender dysphoria: an ethical analysis - Abel, B.S. (The Hastings Center report, 2014)
In the context of transgender health, most people are not comfortable with allowing a twelve-year-old child with gender dysphoria to elect to undergo gender reassignment surgery. The likelihood is too high that the child would be unable to fully comprehend the scope of a decision that carries significant, permanent consequences, particularly because the decision to surgically change gender is based upon a conception of gender that can fluctuate during adolescent years. Conversely, however, most people would not contend that this fluidity is reason to wholly deny certain medical care such as hormonal treatments to transgender youth, a demographic with extremely high rates of violent behavior, self-harm, and suicide. This paper will explore ethical considerations to this emerging debate of what therapeutic options should be offered to transgender children and adolescents. Pediatric endocrinologists have been treating gender dysphoric adolescents with puberty-suppressing drugs and, to a lesser extent, with cross-sex hormone therapies for more than twenty years. Clinicians and thought leaders have mentioned ethical components of this emerging practice in the few cohort studies and clinical review articles about the subject. However, ethics have generally been a secondary consideration in the medical academic literature. In this paper, I will provide a brief overview of the practice, summarize the current research on hormone treatment for transgender minors, and provide an ethical analysis of the practice.
Keywords: gonadorelin; adolescent; bioethics; child; decision making; ethics; fertility; gender dysphoria; human; human rights; medicalization; personal autonomy; psychology; sex reassignment; sexual and gender minority

Reducing Health Disparities and Enhancing the Responsible Conduct of Research Involving LGBT Youth - Fisher, C.B.; Mustanski, B. (The Hastings Center report, 2014)
Although there is clearly a need for evidenced-based behavioral or biomedical prevention or treatment programs for suicide, substance abuse, and sexual health targeted to members of the LGBT population under the age of eighteen, few such programs exist, due in substantial part to limited research knowledge. Ambiguities in regulations that govern human subjects protections and the related inconsistencies in institutional review board (IRB) interpretations of regulatory language are the key reason for the lack of rigorous clinical trial evidence to support treatment choices and prevention approaches to reducing health disparities for this population. Given the socially sensitive nature of suicide, substance abuse, and HIV and STI research in general and LGBT research specifically, in the absence of empirical data to guide their decisions, IRBs must often rely on subjective judgments of minimal risk, which can lead to overestimation of the magnitude and probability of psychological, social, and informational harms that might arise from LGBT youth participation in clinical trials. In addition, more than other youth, LGBT adolescents whose families are unaware of their sexual orientation or gender identity or whose families have victimized them on account of it may be reluctant to participate in studies that require guardian permission. This, in turn, intensifies problems of recruitment and unbiased sampling. However, many IRBs are reluctant to apply federal regulations permitting waiver of guardian permission under conditions in which such permission is clearly not "feasible" or "reasonable" to require. Consequently, many investigators have excluded LGBT individuals under eighteen years of age in health intervention research proposals because of anticipated or actual difficulties obtaining IRB approval. This situation is in conflict with current ethical discourse focusing on the right of youths to participate in trials that will protect them from receiving developmentally untested, inappropriate, and unsafe treatments. In this article, we describe these barriers and recommendations for providing LGBT youth safe and fair access to health research.
Keywords: bioethics; confidentiality; ethics; gender identity; health disparity; human; human rights; legal guardian; legislation and jurisprudence; medical research; medicalization; sexual and gender minority; standards

Mental health and substance use among bisexual youth and non-youth in Ontario, Canada - Ross, L.E.; Bauer, G.R.; MacLeod, M.A.; Robinson, M.; MacKay, J.; Dobinson, C. (PLoS ONE, 2014)
Research has shown that bisexuals have poorer health outcomes than heterosexuals, gays, or lesbians, particularly with regard to mental health and substance use. However, research on bisexuals is often hampered by issues in defining bisexuality, small sample sizes, and by the failure to address age differences between bisexuals and other groups or age gradients in mental health. The Risk & Resilience Survey of Bisexual Mental Health collected data on 405 bisexuals from Ontario, Canada, using respondent-driven sampling, a network-based sampling method for hidden populations. The weighted prevalence of severe depression (PHQ-9≥20) was 4.7%, possible anxiety disorder (OASIS≥8) was 30.9%, possible post-traumatic stress disorder (PCL-C≥50) was 10.8%, and past year suicide attempt was 1.9%. With respect to substance use, the weighted prevalence of problem drinking (AUDIT≥5) was 31.2%, and the weighted prevalence of illicit polydrug use was 30.5%. Daily smoking was low in this sample, with a weighted prevalence of 7.9%. Youth (aged 16-24) reported significantly higher weighted mean scores on depression and post-traumatic stress disorder, and higher rates of past year suicidal ideation (29.7% vs. 15.2%) compared with those aged 25 and older. The burden of mental health and substance use among bisexuals in Ontario is high relative to population-based studies of other sexual orientation groups. Bisexual youth appear to be at risk for poor mental health. Additional research is needed to understand if and how minority stress explains this burden. © 2014 Ross et al.
Keywords: illicit drug; adolescent; adult; age distribution; alcoholism; anxiety disorder; article; bisexuality; Canada; controlled study; depression; female; high risk population; human; major clinical study; male; mental disease; posttraumatic stress disorder; prevalence; smoking; substance abuse; suicidal ideation; suicide attempt

The intersectionality of discrimination attributes and bullying among youth: an applied latent class analysis - Garnett, B.R.; Masyn, K.E.; Austin, S.B.; Miller, M.; Williams, D.R.; Viswanath, K. (Journal of youth and adolescence, 2014)
Discrimination is commonly experienced among adolescents. However, little is known about the intersection of multiple attributes of discrimination and bullying. We used a latent class analysis (LCA) to illustrate the intersections of discrimination attributes and bullying, and to assess the associations of LCA membership to depressive symptoms, deliberate self harm and suicidal ideation among a sample of ethnically diverse adolescents. The data come from the 2006 Boston Youth Survey where students were asked whether they had experienced discrimination based on four attributes: race/ethnicity, immigration status, perceived sexual orientation and weight. They were also asked whether they had been bullied or assaulted for these attributes. A total of 965 (78%) students contributed to the LCA analytic sample (45% Non-Hispanic Black, 29% Hispanic, 58% Female). The LCA revealed that a 4-class solution had adequate relative and absolute fit. The 4-classes were characterized as: low discrimination (51%); racial discrimination (33%); sexual orientation discrimination (7%); racial and weight discrimination with high bullying (intersectional class) (7%). In multivariate models, compared to the low discrimination class, individuals in the sexual orientation discrimination class and the intersectional class had higher odds of engaging in deliberate self-harm. Students in the intersectional class also had higher odds of suicidal ideation. All three discrimination latent classes had significantly higher depressive symptoms compared to the low discrimination class. Multiple attributes of discrimination and bullying co-occur among adolescents. Research should consider the co-occurrence of bullying and discrimination.
Keywords: adolescent; adolescent behavior; automutilation; bullying; child psychology; cross-sectional study; depression; female; health survey; human; male; multivariate analysis; psychological model; psychology; social discrimination; statistical model; suicidal ideation; United States

The influence of intersecting identities on self-harm, suicidal behaviors, and depression among lesbian, gay, and bisexual individuals - Lytle, M.C.; De Luca, S.M.; Blosnich, J.R. (Suicide & life-threatening behavior, 2014)
Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self-directed violence, but very little is known about racial/ethnic differences between LGB populations. This study aimed to examine racial/ethnic differences in self-harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18–24) who indicated their sexual orientation and racial/ethnic identities (n = 89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self-harm, suicidal ideation, suicide attempt, and depression than non-LGB individuals.
Keywords: adolescent; ancestry group; automutilation; bisexuality; depression; ethnology; female; human; lesbianism; male; male homosexuality; psychology; suicidal ideation; suicide attempt; young adult

The moderating role of sexual identity in group teletherapy for adults aging with HIV - Heckman, B.D.; Lovejoy, T.I.; Heckman, T.G.; Anderson, T.; Grimes, T.; Sutton, M.; Bianco, J.A. (Behavioral Medicine, 2014)
Older adults living with HIV/AIDS experience high rates of depression and suicidal ideation but are less likely than their younger counterparts to seek psychological services. HIV continues to disproportionately impact older men who have sex with men (MSM), many of whom were infected in their 20s and 30s. This study examined whether therapy attendance rates and the efficacies of two group-format teletherapies for the treatment of depression (coping effectiveness group training and supportive-expressive group therapy) were comparable for older MSM and older heterosexuals living with HIV. Intervention-outcome analyses found that older MSM and older heterosexuals living with HIV attended comparable numbers of teletherapy sessions. Older heterosexuals living with HIV who received telephone-administered supportive-expressive group therapy reported significantly greater reductions in depressive symptoms than SOC controls. A similar pattern was not found in older MSM. More research is needed to personalize and tailor group teletherapies for older MSM living with HIV. © 2014 Copyright © Taylor & Francis Group, LLC.
Keywords: adult; aged; article; clinical assessment; clinical assessment tool; clinical effectiveness; controlled study; coping behavior; depression; female; follow up; gender identity; group therapy; health care quality; heterosexual female; heterosexual male; heterosexuality; human; Human immunodeficiency virus; Human immunodeficiency virus infection; intervention study; male; men who have sex with men; mental health; outcome assessment; personal experience; program effectiveness; randomized controlled trial (topic); self report; telephone coping effectiveness training; telephone supportive expressive group therapy; teletherapy; training

Experiences of community and parental violence among HIV-positive young racial/ethnic minority men who have sex with men - Phillips, G.; Hightow-Weidman, L.B.; Fields, S.D.; Giordano, T.P.; Outlaw, A.Y.; Halpern-Felsher, B.; Wohl, A.R. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2014)
Adolescents and young adults (ages 13-24) in the USA are frequently exposed to violence in their community and home. While studies have examined the prevalence and impact of violence exposure among adolescents, there is a lack of data focusing specifically on adolescent men of color who have sex with men. Eight demonstration sites funded through a Special Projects of National Significance (SPNS) Initiative recruited 363 HIV-positive racial/ethnic minority young men who have sex with men (YMSM) for a longitudinal study between 2006 and 2009. Over two-thirds of participants (83.8%) had witnessed community violence, 55.1% in the prior three months. Witnessing violence committed with a deadly weapon was significantly associated with being African-American, having ever used drugs, and drinking alcohol in the prior two weeks. Fear of violence in the community was significantly associated with depressive symptomatology, having less than a high school degree, not possessing health insurance, and site of enrollment. Having been emotionally or physically abused by a parent or caretaker was significantly associated with depressive symptomatology, attempting suicide, site of enrollment, and increased age. Witnessing violence with a deadly weapon was significantly associated with alcohol and drug use but not with high-risk sexual behaviors. As this was one of the first studies on the prevalence and correlates of violence exposure among racial/ethnic minority YMSM living with HIV, the findings can be used to inform the development of culturally appropriate resilience-focused interventions to address the aftereffects of violence exposures and help develop social support systems outside of the family. © 2013 Taylor & Francis.
Keywords: adolescent; adolescent sexual behavior; adult; African American; age; article; community; cultural factor; depression; drinking behavior; drug abuse; emotional abuse; ethnic group; family violence; high school; human; Human immunodeficiency virus infected patient; major clinical study; male; men who have sex with men; minority group; physical abuse; prevalence; priority journal; race; social support; suicide attempt; symptomatology; United States

Medical treatment in gender dysphoric adolescents endorsed by SIAMS-SIE-SIEDP-ONIG - Fisher, A.D.; Ristori, J.; Bandini, E.; Giordano, S.; Mosconi, M.; Jannini, E.A.; ceGreggio, N.A.; Godano, A.; Manieri, C.; Meriggiola, C.; Ricca, V.; Dettore, D.; et al. (Journal of Endocrinological Investigation, 2014)
Purpose: Despite international guidelines being available, not all gender clinics are able to face gender dysphoric (GD) youth population needs specifically. This is particularly true in Italy. Centers offering specialized support are relatively few and a commonly accepted Italian approach to GD youth has still not been defined. The aim of the present Position Statement is to develop and adhere to Italian guidelines for treatment of GD adolescents, in line with the "Dutch Approach", the Endocrine Society (ES), and the World Professional Association for Transgender Health (WPATH) guidelines. Methods: An in-depth brainstorming on the application of International guidelines in the Italian context was performed by several dedicated professionals. Results: A staged approach, combining psychological support as well as medical intervention is suggested. In the first phase, individuals requesting medical help will undergo a psycho-diagnostic procedure to assess GD; for eligible adolescents, pubertal suppression should be made available (extended diagnostic phase). Finally, from the age of 16 years, cross-sex hormonal therapy can be added, and from the age of 18 years, surgical sex reassignment can eventually be performed. Conclusions: The current inadequacy of Italian services offering specialized support for GD youth may lead to negative consequences. Omitting or delaying treatment is not a neutral option. In fact, some GD adolescents may develop psychiatric problems, suicidality, and social marginalization. With access to specialized GD services, emotional problems, as well as self-harming behavior, may decrease and general functioning may significantly improve. In particular, puberty suppression seems to be beneficial for GD adolescents by relieving their acute suffering and distress and thus improving their quality of life. © 2014 Italian Society of Endocrinology (SIE).
Keywords: androstenedione; calcifediol; estradiol; estradiol valerate; follitropin; glucose; glycosylated hemoglobin; hemoglobin; hydroxyprogesterone; insulin; lipid; luteinizing hormone; sex hormone; testosterone enantate; testosterone propionate; testosterone undecanoate; article; automutilation; body height; body weight; bone age; bone density; brainstorming; cross sex hormonal therapy; drug dose increase; DSM-5; emotional disorder; follicular phase; follow up; gender dysphoria; hormonal therapy; human; human experiment; international relations; Italy; kidney function; liver function; medical ethics; medical society; mental disease; normal human; patient care; physical examination; practice guideline; protocol compliance; pubertal suppression; puberty; quality of life; sex reassignment; social exclusion; social support; suicidal behavior; support group

Risk of adolescent offspring's completed suicide increases with prior history of their same-sex parents' death by suicide - Cheng, C.-C.J.; Yen, W.-J.; Chang, W.-T.; Wu, K.C.-C.; Ko, M.-C.; Li, C.-Y. (Psychological medicine, 2014)
BACKGROUND: To investigate the risk of completed suicide in offspring during adolescence in relation to prior history of the same-sex parent's death by suicide and other causes. METHOD: A total of 500 adolescents who died by suicide at age 15-19 years between 1997 and 2007 were identified from the Taiwan Mortality Registration (TMR). For each case, 30 age- and time-matched controls were selected randomly from all adolescents registered in the Taiwan Birth Registry (TBR). A multivariate conditional logistic regression model was used to assess the risk of adolescent completed suicide in relation to their same-sex parent. RESULTS: Adolescent suicide risk was positively associated with both paternal [odds ratio (OR) 5.38, 95% confidence interval (CI) 2.17-13.33] and maternal suicide (OR 6.59, 95% CI 1.82-23.91). The corresponding risk estimates associated with paternal and maternal deaths from non-suicidal causes were much lower, at 1.88 and 1.94 respectively. The risk of suicide in male adolescents was significantly associated with prior history of paternal death by suicide (OR 8.23, 95% CI 2.96-22.90) but not of maternal death by suicide (OR 3.50, 95% CI 0.41-30.13). On the other contrary, the risk of suicidal death in female adolescents was significantly associated with prior history of maternal suicide (OR 9.71, 95% CI 1.89-49.94) but not of paternal suicide (OR 2.42, 95% CI 0.30-19.57). However, these differences did not reach statistical significance. CONCLUSIONS: Although limited by sample size, our study indicates that adolescent offspring suicidal death is associated with prior history of their same-sex parent's death by suicide.
Keywords: adolescent; adult; child; epidemiology; female; human; male; maternal mortality; parent; parental deprivation; register; risk; sex difference; statistics and numerical data; suicide; Taiwan; young adult

Rural-urban disparities in school nursing: implications for continuing education and rural school health - Ramos, M.M.; Fullerton, L.; Sapien, R.; Greenberg, C.; Bauer-Creegan, J. (The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2014)
PURPOSE: Little is known about the professional and educational challenges experienced by rural school nurses. We conducted this study to describe disparities between the urban and rural professional school nurse workforce in New Mexico and to identify how best to meet the continuing education needs of New Mexico's rural school nurse workforce. METHODS: We analyzed state data from a 2009 New Mexico Department of Health school nurse workforce survey (71.7% response rate). We included all survey respondents who indicated working as a school nurse in a public school setting in any grade K-12 and who identified their county of employment (N = 311). FINDINGS: Rural school nurses were twice as likely as metropolitan nurses to provide clinical services to multiple school campuses (67.3% compared to 30.1%, P < .0001). They were less likely to hold a nursing degree at the baccalaureate level or higher (62.7% compared to 82.3%, P = .0002). Rural school nurses were less likely than metropolitan nurses to have received recent continuing education on anaphylaxis (P < .0001), asthma (P = .027), body mass index (BMI)/healthy weight (P = .0002), diabetes (P < .0001), lesbian, gay, bisexual and transgender (LGBT) health (P = .0004), and suicide risk identification and prevention (P = .015). Online courses and telehealth were identified by rural school nurses as among the preferred means for receiving continuing education. CONCLUSIONS: Our findings support the provision of online courses and telehealth content to address urban-rural disparities in school nursing education and support rural school health.
Keywords: education; health; health care disparity; health services research; human; New Mexico; nursing education; school health nursing; telemedicine

Why alternative teenagers self-harm: Exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity - Young, R.; Sproeber, N.; Groschwitz, R.C.; Preiss, M.; Plener, P.L. (BMC Psychiatry, 2014)
Background: The term 'self-harm' encompasses both attempted suicide and non-suicidal self-injury (NSSI). Specific adolescent subpopulations such as ethnic or sexual minorities, and more controversially, those who identify as 'Alternative' (Goth, Emo) have been proposed as being more likely to self-harm, while other groups such as 'Jocks' are linked with protective coping behaviours (for example exercise). NSSI has autonomic (it reduces negative emotions) and social (it communicates distress or facilitates group 'bonding') functions. This study explores the links between such aspects of self-harm, primarily NSSI, and youth subculture.Methods: An anonymous survey was carried out of 452 15 year old German school students. Measures included: identification with different youth cultures, i.e. Alternative (Goth, Emo, Punk), Nerd (academic) or Jock (athletic); social background, e.g. socioeconomic status; and experience of victimisation. Self-harm (suicide and NSSI) was assessed using Self-harm Behavior Questionnaire and the Functional Assessment of Self-Mutilation (FASM).Results: An " Alternative" identity was directly (r ≈ 0.3) and a " Jock" identity inversely (r ≈ -0.1) correlated with self-harm. " Alternative" teenagers self-injured more frequently (NSSI 45.5% vs. 18.8%), repeatedly self-injured, and were 4-8 times more likely to attempt suicide (even after adjusting for social background) than their non-Alternative peers. They were also more likely to self-injure for autonomic, communicative and social reasons than other adolescents.Conclusions: About half of 'Alternative' adolescents' self-injure, primarily to regulate emotions and communicate distress. However, a minority self-injure to reinforce their group identity, i.e. 'To feel more a part of a group'. © 2014 Young et al.; licensee BioMed Central Ltd.
Keywords: adolescent; article; automutilation; coping behavior; functional assessment; health behavior; human; major clinical study; sexual and gender minority; social background; social status; suicidal ideation; suicide attempt

Prevalence of sexual victimization and correlates of forced sex in Japanese men who have sex with men - Hidaka, Y.; Operario, D.; Tsuji, H.; Takenaka, M.; Kimura, H.; Kamakura, M.; Ichikawa, S. (PLoS ONE, 2014)
Studies of men who have sex with men (MSM) in diverse geographic and cultural contexts have identified health challenges affecting this population. MSM might be particularly vulnerable to sexual victimization and forced sex. The aim of this research study was to examine prevalence of sexual victimization and correlates of forced sex among Japanese MSM. We recruited a sample of 5,731 Japanese MSM who completed an internet-administered survey. Participants reported on history of different types of sexual victimization, unprotected anal sex, other health risk behaviors, exposure to gay-related teasing and bullying, depression, and suicidality. Over one-fifth of the sample (21.4%) reported experiencing at least one form of sexual victimization, and 8.7% reported a history of forced sex. MSM who had ever experienced forced sex were significantly more likely to report experiencing psychological risks (depression OR = 1.55, 95% CI = 1.28-1.89; attempted suicide OR = 2.25, 95% CI = 1.81-2.81; other forms of bullying OR = 1.38, 95% CI = 1.13-1.68) and other behavioral risks (unprotected anal sex OR = 1.56, 95% CI = 1.29-1.90; sex venue attendance OR = 1.27, 95% CI = 1.04-1.54; methamphetamine use OR = 1.57, 95% CI = 1.05-1.36), compared to MSM who had not experienced forced sex. Efforts to develop holistic and integrated health services for Japanese MSM are warranted, particularly related to psychosocial determinants of HIV prevention. However, due to cultural factors that emphasize familial and social relations and that stigmatize same-sex behavior, Japanese MSM might experience challenges to seeking social support and health services. Interventions must be provided in safe and non-judgmental settings where Japanese MSM feel comfortable disclosing their health and social support needs. © 2014 Hidaka et al.
Keywords: adult; aged; anal intercourse; article; child; controlled study; depression; forced sex; homosexual male; human; Human immunodeficiency virus infection; Japanese (people); male; men who have sex with men; middle aged; prevalence; risk assessment; risk factor; school child; sexual behavior; sexual bullying; sexual victimization; social problem; suicide attempt; unprotected sex; very elderly; young adult

Religion and suicide risk in lesbian, gay and bisexual Austrians - Kralovec, K.; Fartacek, C.; Fartacek, R.; Plöderl, M. (Journal of religion and health, 2014)
Religion is known to be a protective factor against suicide. However, religiously affiliated sexual minority individuals often report a conflict between religion and sexual identity. Therefore, the protective role of religion against suicide in sexual minority people is unclear. We investigated the effect of religion on suicide risk in a sample of 358 lesbian, gay and bisexual Austrians. Religion was associated with higher scores of internalized homophobia, but with fewer suicide attempts. Our data indicate that religion might be both a risk and a protective factor against suicidality in religiously affiliated sexual minority individuals.
Keywords: adult; Austria; bisexuality; conflict; female; homophobia; homosexuality; human; male; protection; psychology; religion; risk; sexual behavior; statistics and numerical data; suicide; suicide attempt

Complex care needs of patients with late-stage HIV disease: A retrospective study - Halman, M.; Chan Carusone, S.; Stranks, S.; Schaefer-Mcdaniel, N.; Stewart, A. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2014)
This retrospective chart review provides a profile of an emerging population of vulnerable HIV patients with complex comorbidities. Data were abstracted from all 83 patients admitted in 2008 to Casey House, a community-based hospital dedicated to supportive and palliative care for persons with HIV in Toronto, Canada. We describe patient characteristics, including medical and psychiatric conditions, and use a Venn diagram and case study to illustrate the frequency and reality of co-occurring conditions that contribute to the complexity of patients' health and health care needs. The mean age at admission was 49.2 years (SD = 10.5). Sixty-seven patients (80.7%) were male. Patients experienced a mean of 5.9 medical comorbidities (SD = 2.3) and 1.9 psychiatric disorders (lifetime Axis I diagnoses). Forty patients (48.2%) experienced cognitive impairment including HIV-associated dementia. Patients were on a mean of 11.5 (SD = 5.3) medications at admission; 74.7% were on antiretroviral medications with 55.0% reporting full adherence. Current alcohol and drug use was common with 50.6% reporting active use at admission. Our Venn diagram illustrates the breadth of complexity in the clients with 8.4% of clients living in unstable housing with three or more medical comorbidities and two or more psychiatric diagnoses.comprehensive HIV program planning should include interventions that can flexibly adapt to meet the multidimensional and complex needs of this segment of patients. Researchers, policy-makers, and clinicians need to have greater awareness of overlapping medical, psychiatric and psychosocial comorbidities. Inclusion of the needs of these most vulnerable patients in the development of evidence-based guidelines is an important step for effectively treating, preventing, and planning for the future of HIV/AIDS care. © 2013 Taylor & Francis.
Keywords: antiretrovirus agent; cannabis; cocaine; adult; alcohol consumption; article; cognitive defect; comorbidity; dementia; depression; drug use; failure to thrive; female; health care need; highly active antiretroviral therapy; HIV associated dementia; homosexuality; hospital admission; hospitalization; human; Human immunodeficiency virus infection; major clinical study; male; medical history; medical record review; medication compliance; mental disease; middle aged; priority journal; retrospective study; substance use; suicide attempt

Genital self-mutilation in a suicide attempt: A rare sequela of a hypochondriacal delusion of infection with HIV - Mishra, K.K.; Reddy, S.; Khairkar, P. (International Journal of STD and AIDS, 2014)
Genital self-mutilation is mostly seen among psychotic, affective and gender identity disorder(s). We present here a rare case report of such genital self-mutilation in a person with a hypochondriacal delusion of infection with HIV precipitated by erroneous and anxiety-provoking miscommunication during HIV testing. Such cases remind us of the need for systematic and appropriate pre-test and post-test HIV counseling, to help prevent such outcomes. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Keywords: antibiotic agent; risperidone; sertraline; adult; anger; antibiotic therapy; anxiety disorder; article; auditory hallucination; automutilation; case report; cystostomy; delusion; delusion of HIV infection; depression; deterioration; electroconvulsive therapy; genital bleeding; genital self mutilation; guilt; heterosexuality; high risk behavior; HIV test; homosexuality; hopelessness; human; Human immunodeficiency virus infection; hypochondriasis; hypogonadism; inguinal region; laceration; male; mental health; neck muscle; patient counseling; physical examination; priority journal; restlessness; sexual behavior; suicidal ideation; suicide attempt; swelling; tertiary care center; testis; unprotected sex; urinary diversion

HIV prevention interventions for young male commercial sex workers - Ballester-Arnal, R.; Gil-Llario, M.D.; Salmeron-Sánchez, P.; Giménez-García, C. (Current HIV/AIDS Reports, 2014)
The sex industry, where men sell sexual services to other men or women, has grown in recent years. These men who offer sexual services are particularly vulnerable to HIV infection due to such factors as: frequency of risky sexual practices, number of sex partners, drug-taking, prevalence of sexually-transmitted infections (STI) and their specific situation of social exclusion which may hinder access to health services. These multi-faceted realities faced by sex workers explain the burgeoning interest in new avenues of scientific research. There are too few preventive programs however aimed at this population group and the studies that evaluate their effectiveness are fewer still. In this article we survey more recent studies on the difficulties of implementing programs for HIV prevention in male sex workers (MSW), as well as the studies that have gauged the impact of preventive programs in this group. © 2013 Springer Science+Business Media.
Keywords: article; attitude; condom use; depression; drug use; empowerment; geographic distribution; health care access; high risk behavior; HIV test; homosexuality; human; Human immunodeficiency virus infection; lifestyle; men who have sex with men; population; prevalence; prostitution; risk factor; self esteem; sexual orientation; sexual practice; sexuality; sexually transmitted disease; social exclusion; social isolation; social network; social work; stigma; suicidal ideation; unprotected sex

Determinants of suicide and accidental or violent death in the Australian HIV observational database - McManus, H.; Petoumenos, K.; Franic, T.; Kelly, M.D.; Watson, J.; O'Connor, C.C.; Jeanes, M.; Hoy, J.; Cooper, D.A.; Law, M.G. (PLoS ONE, 2014)
Background: Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART. Methods: We conducted a nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database (AHOD) between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive date to adjust for potential confounding by these covariates. Risk of suicide and accidental or violent death was estimated using conditional logistic regression. Results: We included 27 cases (17 suicide and 10 violent/accidental death) and 54 controls. All cases were men who have sex with men (MSM) or MSM/ injecting drug use (IDU) mode of exposure. Increased risk was associated with unemployment (Odds Ratio (OR) 5.86, 95% CI: 1.69-20.37), living alone (OR 3.26, 95% CI: 1.06-10.07), suicidal ideation (OR 6.55, 95% CI: 1.70-25.21), and >2 psychiatric/cognitive risk factors (OR 4.99, 95% CI: 1.17-30.65). CD4 cell count of >500 cells/μL (OR 0.25, 95% CI: 0.07-0.87) and HIV-positive date ≥1990 (1990-1999 (OR 0.31, 95% CI: 0.11-0.89), post-2000 (OR 0.08, 95% CI: 0.01- 0.84)) were associated with decreased risk. CD4 cell count ≥500 cells/μL remained a significant predictor of reduced risk (OR 0.15, 95% CI: 0.03-0.70) in a multivariate model adjusted for employment status, accommodation status and HIV-positive date. Conclusions: After adjustment for psychosocial factors, the immunological status of HIV-positive patients contributed to the risk of suicide and accidental or violent death. The number of psychiatric/cognitive diagnoses contributed to the level of risk but many psychosocial factors were not individually significant. These findings indicate a complex interplay of factors associated with risk of suicide and accidental or violent death. © 2014 McManus et al.
Keywords: illicit drug; recreational drug; accidental death; article; Australia; case control study; CD4 lymphocyte count; clinical article; cognitive defect; controlled study; death; human; Human immunodeficiency virus infection; independent living; INJECTING DRUG USE; male; men who have sex with men; mental disease; substance abuse; suicidal ideation; suicide; unemployment; violence; violent death

Symptom-based subtypes of depression and their psychosocial correlates: A person-centered approach focusing on the influence of sex - Rodgers, S.; Grosse Holtforth, M.; Müller, M.; Hengartner, M.P.; Rössler, W.; Ajdacic-Gross, V. (Journal of Affective Disorders, 2014)
Background Reducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex has been widely accepted in depression research. Methods The community-based sample included 373 males and 443 females from the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) manifesting depressive symptoms in the past 12 months. Latent Class Analysis (LCA) was performed separately by sex to extract sex-related depression subtypes. The subtypes were characterized by psychosocial characteristics. Results Three similar subtypes were found in both sexes: a severe typical subtype (males: 22.8%; females: 35.7%), a severe atypical subtype (males: 17.4%; females: 22.6%), and a moderate subtype (males: 25.2%; females: 41.8%). In males, two additional subgroups were identified: a severe irritable/angry- rejection sensitive (IARS) subtype (30%) comprising the largest group, and a small psychomotor retarded subtype (4%). Males belonging to the severe typical subtype exhibited the lowest masculine gender role orientation, while females of the typical subtype showed more anxiety disorders. The severe atypical subtype was associated with eating disorders in both sexes and with alcohol/drug abuse/dependence in females. In contrast, alcohol/drug abuse/dependence was associated with the severe IARS subtype in males. Limitations The study had a cross-sectional design, allowing for no causal inferences. Conclusions This study contributes to a better understanding of sex-related depression subtypes, which can be well distinguished on the basis of symptom profiles. This provides the base for future research investigating the etiopathogenesis and effective treatment of the heterogeneous depression disorder. © 2013 Elsevier B.V.
Keywords: adult; agoraphobia; alcohol abuse; alcoholism; anger; anhedonia; anorexia; anxiety disorder; article; atypical depression; binge eating disorder; bipolar disorder; bulimia; comorbidity; cross-sectional study; demography; depression; drug abuse; drug dependence; dysthymia; eating disorder; fatigue; female; generalized anxiety disorder; guilt; human; hypersomnia; hypomania; increased appetite; insomnia; irritability; loss of appetite; major clinical study; major depression; male; mania; masculinity; memory disorder; middle aged; mood disorder; neurasthenia; obsessive compulsive disorder; panic; personality disorder; phobia; priority journal; psychomotor disorder; psychomotor retardation; psychosis; restlessness; self concept; sex difference; sex role; sexual orientation; social phobia; social psychology; suicide attempt; body weight gain; body weight loss; young adult

Regulation of polyp-to-jellyfish transition in Aurelia aurita - Fuchs, B.; Wang, W.; Graspeuntner, S.; Li, Y.; Insua, S.; Herbst, E.-M.; Dirksen, P.; Böhm, A.-M.; Hemmrich, G.; Sommer, F.; Domazet-Lošo, T.; Klostermeier, U.C.; et al. (Current Biology, 2014)
Background The life cycle of scyphozoan cnidarians alternates between sessile asexual polyps and pelagic medusa. Transition from one life form to another is triggered by environmental signals, but the molecular cascades involved in the drastic morphological and physiological changes remain unknown. Results We show in the moon jelly Aurelia aurita that the molecular machinery controlling transition of the sessile polyp into a free-swimming jellyfish consists of two parts. One is conserved and relies on retinoic acid signaling. The second, novel part is based on secreted proteins that are strongly upregulated prior to metamorphosis in response to the seasonal temperature changes. One of these proteins functions as a temperature-sensitive "timer" and encodes the precursor of the strobilation hormone of Aurelia. Conclusions Our findings uncover the molecule framework controlling the polyp-to-jellyfish transition in a basal metazoan and provide insights into the evolution of complex life cycles in the animal kingdom. © 2014 Elsevier Ltd.
Keywords: hormone; animal; article; DNA microarray; growth, development and aging; in situ hybridization; jellyfish; life cycle stage; metamorphosis; physiology; polymerase chain reaction

Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston. - Duncan, D.T.; Hatzenbuehler, M.L. (American journal of public health, 2014)
We examined whether past-year suicidality among sexual-minority adolescents was more common in neighborhoods with a higher prevalence of hate crimes targeting lesbian, gay, bisexual, and transgender (LGBT) individuals. Participants' data came from a racially/ethnically diverse population-based sample of 9th- through 12th-grade public school students in Boston, Massachusetts (n = 1292). Of these, 108 (8.36%) reported a minority sexual orientation. We obtained data on LGBT hate crimes involving assaults or assaults with battery between 2005 and 2008 from the Boston Police Department and linked the data to the adolescent's residential address. Sexual-minority youths residing in neighborhoods with higher rates of LGBT assault hate crimes were significantly more likely to report suicidal ideation (P = .013) and suicide attempts (P = .006), than were those residing in neighborhoods with lower LGBT assault hate crime rates. We observed no relationships between overall neighborhood-level violent and property crimes and suicidality among sexual-minority adolescents (P > .05), providing evidence for specificity of the results to LGBT assault hate crimes. Neighborhood context (i.e., LGBT hate crimes) may contribute to sexual-orientation disparities in adolescent suicidality, highlighting potential targets for community-level suicide-prevention programs.
Keywords: adolescent; article; crime; ethnology; female; human; male; sexuality; statistics; suicidal ideation; suicide attempt; transsexuality; United States; violence

Protective school climates and reduced risk for suicide ideation in sexual minority youths. - Hatzenbuehler, M.L.; Birkett, M.; Van Wagenen, A.; Meyer, I.H. (American journal of public health, 2014)
We examined whether sexual minority students living in states and cities with more protective school climates were at lower risk of suicidal thoughts, plans, and attempts. Data on sexual orientation and past-year suicidal thoughts, plans, and attempts were from the pooled 2005 and 2007 Youth Risk Behavior Surveillance Surveys from 8 states and cities. We derived data on school climates that protected sexual minority students (e.g., percentage of schools with safe spaces and Gay-Straight Alliances) from the 2010 School Health Profile Survey, compiled by the Centers for Disease Control and Prevention. Lesbian, gay, and bisexual students living in states and cities with more protective school climates reported fewer past-year suicidal thoughts than those living in states and cities with less protective climates (lesbians and gays: odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.99; bisexuals: OR = 0.81; 95% CI = 0.66, 0.99). Results were robust to adjustment for potential state-level confounders. Sexual orientation disparities in suicidal thoughts were nearly eliminated in states and cities with the most protective school climates. School climates that protect sexual minority students may reduce their risk of suicidal thoughts.
Keywords: adolescent; age; article; ethnology; female; human; male; risk factor; school; sex difference; sexuality; statistics; suicidal ideation; suicide attempt; United States

A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. - Mustanski, B.; Andrews, R.; Herrick, A.; Stall, R.; Schnarrs, P.W. (American journal of public health, 2014)
We examined a syndemic of psychosocial health issues among young men who have sex with men (MSM), with men and women (MSMW), and with women (MSW). We examined hypothesized drivers of syndemic production and effects on suicide attempts. Using a pooled data set of 2005 and 2007 Youth Risk Behavior Surveys from 11 jurisdictions, we used structural equation modeling to model a latent syndemic factor of depression symptoms, substance use, risky sex, and intimate partner violence. Multigroup models examined relations between victimization and bullying experiences, syndemic health issues, and serious suicide attempts. We found experiences of victimization to increase syndemic burden among all male youths, especially MSMW and MSM compared with MSW (variance explained = 44%, 38%, and 10%, respectively). The syndemic factor was shown to increase the odds of reporting a serious suicide attempt, particularly for MSM (odds ratio [OR] = 5.75; 95% confidence interval [CI] = 1.36, 24.39; P < .001) and MSMW (OR = 5.08; 95% CI = 2.14, 12.28; P < .001) compared with MSW (OR = 3.47; 95% CI = 2.50, 4.83; P < .001). Interventions addressing multiple psychosocial health outcomes should be developed and tested to better meet the needs of young MSM and MSMW.
Keywords: addiction; adolescent; article; crime victim; depression; ethnology; health disparity; human; male; male homosexuality; partner violence; psychological aspect; sexual behavior; sexuality; statistics; suicide attempt; United States; violence

Sexual orientation and suicide ideation, plans, attempts, and medically serious attempts: evidence from local Youth Risk Behavior Surveys, 2001-2009. - Stone, D.M.; Luo, F.; Ouyang, L.; Lippy, C.; Hertz, M.F.; Crosby, A.E. (American journal of public health, 2014)
We examined the associations between 2 measures of sexual orientation and 4 suicide risk outcomes (SROs) from pooled local Youth Risk Behavior Surveys. We aggregated data from 5 local Youth Risk Behavior Surveys from 2001 to 2009. We defined sexual minority youths (SMYs) by sexual identity (lesbian, gay, bisexual) and sex of sexual contacts (same- or both-sex contacts). Survey logistic regression analyses controlled for a wide range of suicide risk factors and sample design effects. Compared with non-SMYs, all SMYs had increased odds of suicide ideation; bisexual youths, gay males, and both-sex contact females had greater odds of suicide planning; all SMYs, except same-sex contact males, had increased odds of suicide attempts; and lesbians, bisexuals, and both-sex contact youths had increased odds of medically serious attempts. Unsure males had increased odds of suicide ideation compared with heterosexual males. Not having sexual contact was protective of most SROs among females and of medically serious attempts among males. Regardless of sexual orientation measure used, most SMY subgroups had increased odds of all SROs. However, many factors are associated with SROs.
Keywords: adolescent; age; article; ethnology; female; health behavior; human; male; risk factor; sex difference; sexual behavior; sexuality; statistics; suicidal ideation; suicide attempt; United States; violence

EPA Guidance mental health care of migrants - Bhugra, D.; Gupta, S.; Schouler-Ocak, M.; Graeff-Calliess, I.; Deakin, N.A.; Qureshi, A.; Dales, J.; Moussaoui, D.; Kastrup, M.; Tarricone, I.; Till, A.; Bassi, M.; et al. (European Psychiatry, 2014)
Migration is an increasingly commonplace phenomenon for a number of reasons. People migrate from rural to urban areas or across borders for reasons including economic, educational or political. There is increasing recent research evidence from many countries in Europe that indicates that migrants are more prone to certain psychiatric disorders. Because of their experiences of migration and settling down in the new countries, they may also have special needs such as lack of linguistic abilities which must be taken into account using a number of strategies at individual, local and national policy levels. In this guidance document, we briefly present the evidence and propose that specific measures must be taken to improve and manage psychiatric disorders experienced by migrants and their descendants. This improvement requires involvement at the highest level in governments. This is a guidance document and not a systematic review. © 2014 Elsevier Masson SAS.
Keywords: ageism; article; bisexuality; cultural factor; cultural value; dementia; depression; drug dependence; eating disorder; ethnic group; Europe; health care delivery; health care policy; homosexual female; human; immigrant; mental disease; mental health; mental health care; mental health service; mental hospital; migration; practice guideline; priority journal; psychopharmacotherapy; psychotherapy; public health insurance; racism; refugee; sex role; social capital; social isolation; social support; suicidal behavior; transgenderism; treatment response; urban area

Risk and protective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year - Taliaferro, L.A.; Muehlenkamp, J.J. (Suicide & life-threatening behavior, 2014)
Data from the 2010 Minnesota Student Survey was analyzed to identify risk and protective factors that distinguished adolescents across three groups: no suicidality, suicidal ideation only, and suicide attempt. The population-based sample included 70,022 students in grades 9 and 12. Hopelessness and depressive symptoms emerged as important risk factors to distinguish youth who reported suicidal ideation or behavior from those without a history of suicidality. However, these factors were not as important in differentiating adolescents who attempted suicidal from those who considered suicide but did not act on their thoughts. Instead, for both genders, self-injury represented the most important factor to distinguish these youth. Other risk factors that differentiated the latter groups, but not the former groups, for males were dating violence victimization and cigarette smoking, and for females was a same-sex sexual experience. Running away from home also seemed to increase the risk of a suicide attempt among youth in this study. Parent connectedness and academic achievement emerged as important protective factors to differentiate all the groups, yet neighborhood safety appeared to protect against the transition from suicidal thoughts to behavior. Findings from this study suggest risk and protective factors practitioners should target in clinical assessments and intervention programs to help prevent suicidal behavior among youth at greatest risk.
Keywords: adolescent; age; child psychology; cross-sectional study; epidemiology; female; human; male; prevalence; psychology; risk factor; sex difference; statistics and numerical data; suicidal ideation; suicide attempt; United States

Isolation of lesbian, gay, bisexual and transgender youth: A dimensional concept analysis - Johnson, M.J.; Amella, E.J. (Journal of Advanced Nursing, 2014)
Aim: To present the findings of a dimensional analysis of isolation in the context, and from the perspective, of lesbian, gay, bisexual and transgender youth. Background: Lesbian, gay, bisexual and transgender youth are often at greater risk for negative health outcomes compared with heterosexual youth. Isolation is one risk factor cited throughout the literature; however, the concept is complicated and has many uses and thus warrants clarification. Design: Concept Analysis. Data Sources: Sources comprise 35 English language research articles retrieved from CINAHL and EBSCOHost (1987-2012). Methods: A dimensional concept analysis was undertaken to analyse how the concept, isolation, is socially constructed. Results: This dimensional analysis revealed five socially constructed dimensions and four sub-dimensions. These findings indicate that there is substantial variability in the concept of isolation. These differences and variations are most notably observed in the 20 articles (57%) that had more than one dimension. Although some of these articles were explicit with the different meanings and use of the concept, most of the papers had wide variability in the use and meaning of the concept. Conclusion: The disproportionately greater physical and mental health disparities between lesbian, gay, bisexual and transgender and heterosexual youth are a signal to conduct more research to clarify the concept of isolation, to develop instrumentation to identify at-risk youth and to explore predictors and consequences of isolation. Nurses and others can lead the way in translating this knowledge into strategies that will improve the health and lives of these young people. © 2013 John Wiley & Sons Ltd.
Keywords: adolescent; article; bisexuality; child; cognition; concept analysis; emotion; female; homosexuality; human; lesbianism; male; male homosexuality; nursing; nursing research; nursing theory; social isolation; suicide; transsexualism; transsexuality

Survey of New Mexico school health professionals regarding preparedness to support sexual minority students - Mahdi, I.; Jevertson, J.; Schrader, R.; Nelson, A.; Ramos, M.M. (Journal of School Health, 2014)
BACKGROUND: For schools to be safe and supportive for students, school health professionals should be aware of the particular challenges lesbian, gay, bisexual, transgender, or questioning (LGBTQ) students face, especially the risk for discrimination, violent victimization, and depression in the school setting. We assessed school health professionals' preparedness to address needs of LGBTQ students. METHODS: We conducted a secondary analysis of data collected during a New Mexico school health conference. This analysis focused on the preparedness of 183 school nurses, counselors, and social workers to address needs of LGBTQ students. Data were analyzed by using chi-square tests, other non-parametric tests, and logistic regression. RESULTS: Social workers (84.6%) and counselors (81.5%) were more likely than school nurses (55.8%) to report moderate or high knowledge of LGBTQ youth health risks, including suicide and depression (p < .001). Approximately half of school counselors and social workers reported no or low knowledge of LGBTQ community-based organizations or knowledge of counselors experienced with LGBTQ concerns. CONCLUSION: School health professionals in New Mexico do not appear prepared to address needs of LGBTQ students. Schools should consider integrating specific content about LGBTQ health risks and health disparities in trainings regarding bullying, violence, cultural competency, and suicide prevention. © 2013. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
Keywords: adolescent; adult; article; bullying; cultural competence; female; health care personnel; health disparity; human; male; minority group; organization and management; professional competence; school health service; sexual education; sexuality; social support; statistics; suicide; transsexuality; United States; young adult

Characteristics of children and adolescents with gender dysphoria referred to the Hamburg gender identity clinic - Becker, I.; Gjergji-Lama, V.; Romer, G.; Möller, B. (Praxis der Kinderpsychologie und Kinderpsychiatrie, 2014)
Given the increasing demand for counselling in gender dysphoria in childhood in Germany, there is a definite need for empirical data on characteristics and developmental trajectories of this clinical group. This study aimed to provide a first overview by assessing demographic characteristics and developmental trajectories of a group of gender variant boys and girls referred to the specialised Gender Identity Clinic in Hamburg. Data were extracted from medical charts, transcribed and analysed using qualitative content analysis methods. Categories were set up by inductive-deductive reasoning based on the patients', parents' and clinicians' information in the files. Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9 % (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts. Results indicate that the presentation of clinically referred gender dysphoric girls differs from the characteristics boys present in Germany; especially with respect to the most salient age differences. Therefore, these two groups require different awareness and individual treatment approaches. © Vandenhoeck & Ruprecht GmbH & Co. KG, Göttingen 2014.
Keywords: sex hormone; adolescent; age; article; automutilation; child; cooperation; cross-sectional study; drug effect; female; gender identity; Germany; human; interdisciplinary communication; male; outpatient department; patient referral; preschool child; psychological aspect; psychotherapy; puberty; sex difference; suicidal ideation; transsexualism

Structural stigma and all-cause mortality in sexual minority populations - Hatzenbuehler, M.L.; Bellatorre, A.; Lee, Y.; Finch, B.K.; Muennig, P.; Fiscella, K. (Social Science and Medicine, 2014)
Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma-operationalized as living in communities with high levels of anti-gay prejudice-increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR]=3.03, 95% Confidence Interval [CI]=1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations. © 2013 Elsevier Ltd.
Keywords: adult; article; attitude to illness; avoidance behavior; coping behavior; cultural anthropology; female; human; major clinical study; male; motivation; psychosis; psychosocial withdrawal; self esteem; self report; social discrimination; social stigma; validity

Sexual orientation and anabolic-androgenic steroids in US adolescent boys - Blashill, A.J.; Safren, S.A. (Pediatrics, 2014)
OBJECTIVES: We compared the lifetime prevalence of anabolic-androgenic steroid (AAS) misuse among sexual minority versus heterosexual US adolescent boys, and secondarily, sought to explore possible intermediate variables that may explain prevalence differences. METHODS: Participants were 17 250 adolescent boys taken from a pooled data set of the 14 jurisdictions from the 2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. Data were analyzed for overall prevalence of AAS misuse and possible intermediary risk factors. RESULTS: Sexual minority adolescent boys were at an increased odds of 5.8 (95% confidence interval 4.1-8.2) to report a lifetime prevalence of AAS (21% vs 4%) compared with their heterosexual counterparts, P < .001. Exploratory analyses suggested that increased depressive symptoms/suicidality, victimization, and substance use contributed to this disparity. CONCLUSIONS: This is the first known study to test and find substantial health disparities in the prevalence of AAS misuse as a function of sexual orientation. Prevention and intervention efforts are needed for sexual minority adolescent boys. Copyright © 2014 by the American Academy of Pediatrics.
Keywords: androgen; adolescent; article; controlled study; depression; drug misuse; health disparity; heterosexual male; human; male; male by sexual orientation; prevalence; priority journal; risk factor; sexual and gender minority; substance use; suicidal behavior; United States; victim

Lesbian, gay, and bisexual adolescent suicidality: the impact of social stigma. - Carney, A. (Kentucky nurse, 2014)
Keywords: adolescent; article; bisexuality; cultural competence; female; human; lesbianism; male; male homosexuality; psychological aspect; risk factor; social stigma; suicide; United States

Rupture, resilience, and risk: Relationships between mental health and migration among gay-identified men in North America - Lewis, N.M. (Health and Place, 2014)
An established body of research in psychology, psychiatry and epidemiology links social stigma and stress with poor mental and sexual health outcomes among gay-identified men. Less work considers how these linkages are mediated by place and almost none considers the role of movement across places. This qualitative study, based on the migration narratives of 48 gay-identified men living in Ottawa, Ontario, Canada, and Washington, D.C., U.S.A. gives more careful consideration to the ways in which mental and emotional health issues (e.g., anxiety, depression, substance use) in this population both precipitate migration and stem from migration. The narratives show that decisions to migrate often emerge from men[U+05F3]s experiences of place-based minority stress and associated health outcomes. At the same time, moving to urban gay communities, when coupled with other life circumstances, can create or reinforce physical and emotional insecurities that lead to low self-esteem, substance use and sexual risk-taking. © 2014 Elsevier Ltd.
Keywords: adult; anxiety; article; bullying; coping behavior; depression; health disparity; health status; high risk behavior; homosexual male; human; male; mental health; middle aged; migration; North America; priority journal; qualitative research; risk assessment; sexual behavior; social stress; substance use; suicidal ideation

Causes of death in HIV-infected patients from the Cologne-Bonn cohort - Ehren, K.; Hertenstein, C.; Kümmerle, T.; Vehreschild, J.J.; Fischer, J.; Gillor, D.; Wyen, C.; Lehmann, C.; Cornely, O.A.; Jung, N.; Gravemann, S.; Platten, M.; et al. (Infection, 2014)
Purpose: Causes of death in human immunodeficiency virus (HIV)-infected subjects have changed in countries with high resources over the last several years. Acquired immunodeficiency syndrome (AIDS)-related diseases have become less prevalent, whereas deaths due to non-AIDS causes are increasing. The aim of the present study was to analyse causes of death in the Cologne-Bonn cohort. Methods: Causes of death from the Cologne-Bonn cohort between 2004 and 2010 were systematically recorded using the CoDe algorithm (The Coding Causes of Death in HIV Project). Results: In 3,165 patients followed from 2004 to 2010, 182 deaths occurred (5.7%, 153 males, 29 females). The median age at the time of death was 47 years (range 24-85 years). The most frequent causes of death were AIDS-defining events (n = 60, 33%), with non-Hodgkin lymphoma (NHL) (n = 29, 16%) and infections (n = 20, 11%) being the leading entities in this category. Non-AIDS malignancies accounted for 16% (n = 29), non-HIV-related infections for 10% (n = 18), cardiovascular diseases for 7% (n = 14), suicide or accident for 4% (n = 7) and liver diseases for 3% (n = 5) of deaths (unknown n = 47, 26%). Although the majority of patients (92.5%) was on antiretroviral therapy (ART), only 50% were virologically suppressed (HIV-RNA <50 copies/mL) and 44% had a decreased CD4+ count (<200/μL) at their last visit before death. Conclusion: One-third of the causes of death in our cohort between 2004 and 2010 was AIDS-related. Since most of these deaths occur with severe immune suppression, they can possibly be prevented by the early diagnosis and treatment of HIV infection. Care providers must be aware of an increased risk for a broad range of diseases in HIV-infected patients and should apply appropriate preventive measures. © Springer-Verlag 2013.
Keywords: anti human immunodeficiency virus agent; accident; adult; aged; article; cardiovascular disease; cause of death; endemic disease; female; follow up; hemophilia; heterosexuality; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; infection; infection risk; intravenous drug abuse; liver disease; major clinical study; male; men who have sex with men; nonhodgkin lymphoma; suicide

'What harbour shelters peace?' on the opera Peter Grimes, exclusion and stigma - Conlan, L. (Advances in Psychiatric Treatment, 2014)
Benjamin Britten's opera Peter Grimes premiered in 1945 and has since enjoyed lasting popular and critical acclaim. Its central character is a fisherman driven to suicide by circumstances beyond his control. It has a wide political and social resonance and is a testament to the damaging psychological effects of exclusion and stigma.
Keywords: accidental death; alienation; article; dehydration; fisherman; homosexuality; human; identity; jurisprudence; meditation; mental disease; mental patient; neglect; self identity; shame; social acceptance; social exclusion; stigma; student; suicide

Discreet and indiscreet barriers to adolescent health-seeking efforts - Anthony, I. (Clinical Pediatrics, 2014)
Keywords: adolescent health seeking; article; criminal justice; health care; health care access; health care system; health service; help seeking behavior; high risk behavior; human; responsibility; sexual assault; sexual and gender minority; sexual orientation; sexuality; sexually transmitted disease; substance use; suicidal ideation; suicide attempt; work schedule

Out on the street: A public health and policy Agenda for lesbian, gay, bisexual, and transgender youth who are homeless - Keuroghlian, A.S.; Shtasel, D.; Bassuk, E.L. (American Journal of Orthopsychiatry, 2014)
A disproportionate number of lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violentvictimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth experiencing homelessness, it is imperative to understand their unique experiences and develop responsive practices and policies. The range and severity of health risks vary across subgroups of all homeless LGBT youth, and because the population is nonhomogeneous, their particular needs must be identified and addressed. Thus, the purpose of this article is to review the causes of homelessness among LGBT youth, discuss the mental health and victimization risks faced by this population, address differences among homeless LGBT subgoups, and recommend effective interventions and best practices. The authors conclude by discussing promising future research and public policy directions. © 2014 American Orthopsychiatric Association.
Keywords: amphetamine derivative; cocaine; methamphetamine; article; child sexual abuse; childhood; clinical effectiveness; clinical practice; clinical research; cocaine dependence; condom use; ethnic difference; family violence; health care policy; health hazard; heterosexuality; high risk behavior; HIV test; homelessness; human; Human immunodeficiency virus infection; Internet; juvenile; LGBT people; major depression; mental health; mental health research; mental health service; methamphetamine dependence; partner violence; posttraumatic stress disorder; public health; risk factor; sex difference; sexual abuse; sexual behavior; sexual orientation; standardization; substance abuse; suicidal ideation; suicide attempt; survival rate; transgenderism; victim

The peripubertal gender-dysphoric child: Puberty suppression and treatment paradigms - Olson, J.; Garofalo, R. (Pediatric Annals, 2014)
Gender-nonconforming youth are emerging at increasingly younger ages, and those experiencing gender dysphoria are seeking medical care at, or sometimes even before, the onset of puberty. Youth with gender dysphoria are at high risk for depression, anxiety, isolation, self-harm, and suicidality at the onset of a puberty that feels wrong. Medical providers would benefit from understanding interventions that help gender-nonconforming children and youth thrive. The use of gonadotropin-releasing hormone (GnRH) agonists to block the onset of an undesired puberty in youth with gender dysphoria is a relatively new practice, particularly in the United States. These medications shut down the hypothalamic-pituitary-gonadal axis (HPG), and the production of either testosterone or estrogen is temporarily halted. Puberty blocking allows a young person to explore gender and participate more fully in the mental health therapy process without being consumed by the fear of an impending developmental process that will result in the acquisition of undesired secondary sexual characteristics. GnRH agonists have been used safely for decades in children with other medical conditions, including central precocious puberty. Potential side effects of GnRH agonists include diminished bone density, injection site problems, emotional instability, and weight gain. Preliminary data have shown GnRH agonists to be very helpful in improving behavioral and overall functioning outcomes. Puberty suppression should ideally begin in the first stages of pubertal development and can be given via intramuscular or subcutaneous injections, or via an implant that is inserted in the upper arm. Monitoring to assure suppression of the HPG axis should occur regularly. Gender-nonconforming youth who remain gender dysphoric can go on to receive cross-sex hormones for phenotypic gender transition when they are older. GnRH agonists have changed the landscape of medical intervention for youth with gender dysphoria and are rapidly becoming the standard of practice. © SLACK Incorporated.
Keywords: gonadorelin agonist; histrelin; leuprorelin; amenorrhea; anxiety; article; behavior; bone density; breast development; depression; feminization; gender dysphoria; gender identity; hot flush; human; hypothalamus hypophysis gonad system; injection site abscess; leg pain; mental instability; mood disorder; precocious puberty; rash; sex reassignment; social isolation; thorax wall reconstruction; transgenderism; vagina discharge; body weight gain

Mental health and suicidality among racially/ethnically diverse sexual minority youths. - Bostwick, W.B.; Meyer, I.; Aranda, F.; Russell, S.; Hughes, T.; Birkett, M.; Mustanski, B. (American journal of public health, 2014)
We examined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents. Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72,691. Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds. Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.
Keywords: adolescent; ancestry group; article; ethnic group; female; human; lesbianism; male; male homosexuality; mental health; minority group; psychological aspect; risk factor; statistics; suicidal ideation; suicide attempt; United States

Exploring a Dutch paradox: an ethnographic investigation of gay men's mental health. - Aggarwal, S.; Gerrets, R. (Culture, health & sexuality, 2014)
Despite the Netherlands' reputation as a world leader with respect to gay rights, homosexual Dutch men have much higher rates of mood disorders, anxiety disorders and suicide attempts than heterosexual Dutch men. Epidemiologists report similar disparities elsewhere in Western Europe and North America. These findings have been the focus of a blossoming psychological literature, inspired by minority stress theory and deploying quantitative methods. Our investigation aims to complement this body of work by adopting an ethnographic approach. Drawing from fieldwork conducted in the Netherlands from 2009 to 2010, we explore sociocultural and contextual factors that have received relatively little attention with respect to gay mental health. In the Netherlands - considered a model for gay equality - how can one understand high rates of psychiatric disorders among gay men? This study points to heteronormativity, complex dynamics involving long-term relationships and processes within gay subcultures as key issues. Notwithstanding their putative socioeconomic, legal and political equality, gay men struggled - at various stages of the life cycle - with internalised norms that they found difficult to fulfil. The desire to embody these ideals, and structural constraints in meeting them, could be potent sources of disappointment and distress.
Keywords: adult; article; civil rights; cultural anthropology; human; male; male homosexuality; mental health; middle aged; minority group; Netherlands; psychological aspect; qualitative research; self concept; social psychology; social stigma

Suicidality among veterans: implications of sexual minority status. - Blosnich, J.R.; Mays, V.M.; Cochran, S.D. (American journal of public health, 2014)
Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008-2009 and 2012-2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime suicidal ideation than heterosexual veterans (adjusted odds ratio = 3.00; 95% confidence interval = 1.38, 6.53). Suicide assessment and prevention efforts in LGB veterans could benefit from a life-course perspective regarding suicide risk.
Keywords: age; article; female; human; male; middle aged; minority group; sex difference; sexuality; socioeconomics; statistics; suicidal ideation; suicide; suicide attempt; United States; veteran

Sexual orientation, adult connectedness, substance use, and mental health outcomes among adolescents: findings from the 2009 New York City Youth Risk Behavior Survey. - Seil, K.S.; Desai, M.M.; Smith, M.V. (American journal of public health, 2014)
We examined associations between identifying as lesbian, gay, or bisexual (LGB) and lacking a connection with an adult at school on adolescent substance use and mental health outcomes including suicidality. We analyzed data from the 2009 New York City Youth Risk Behavior Survey (n=8910). Outcomes of interest included alcohol use, marijuana use, illicit drug use, depressive symptomatology, suicide ideation, and suicide attempt. The prevalence of each outcome was significantly higher among LGB adolescents than heterosexual adolescents and among those who lacked an adult connection at school than among those who did have such a connection. Even when LGB adolescents had an adult connection at school, their odds of most outcomes were significantly higher than for heterosexual adolescents. Those LGB adolescents who lacked a school adult connection had the poorest outcomes (about 45% reported suicide ideation; 31% suicide attempt). Adolescents who are LGB, particularly those who lack a connection with school adults, are at high risk for substance use and poorer mental health outcomes. Interventions should focus on boosting social support and improving outcomes for this vulnerable group.
Keywords: addiction; adolescent; article; depression; female; high risk behavior; human; male; mental health; psychological aspect; sexuality; social support; socioeconomics; statistics; suicidal ideation; suicide; suicide attempt; United States

Voluntary and therapeutic castration of sex offenders in the netherlands (1938-1968) - Van der Meer, T. (International Journal of Law and Psychiatry, 2014)
Between 1938 and 1968 some 400 sex offenders in the Netherlands who by court orders had been put at 'the discretion of the government' and were incarcerated in asylums for the criminally insane, 'voluntarily' submitted themselves to 'therapeutic' castration, the surgical removal of their testes. Prior to 1938, inspired by a Danish castration act from 1929, and urged by asylums that were overcrowded by sex offenders, the ethics of the surgery had been discussed for nearly a decade amongst theologians, (forensic) psychiatrists, jurists and politicians, mostly in the context of eugenic sterilization. Discussions of conflicting Catholic, Protestant and non-denominational points of view vis-à-vis eugenics resulted in consensus about 'therapeutic' and 'voluntary' castration. Sexual deviancy, according to some, was like a tumor located in the testes, which could therefore be removed without moral objections and the person was thus cured of his disease. Although obviously related to forensic psychiatry and concerned with issues like protection of society and treatment of offenders, discussions were never held in a strictly forensic context. Unlike in other countries in which castration policies were enforced, in The Netherlands the surgery was never embodied in law but subject to an informal protocol that covered political accountability. To satisfy Catholic objections references to eugenic aims were omitted from the documents, as were references to castration as a penalty.Based on international and Dutch literature (from both before and after 1938) as well as case histories, this article will show that the compromise about the therapeutic value of castration had no basis in medical knowledge, while 'voluntariness' (as elsewhere) was an acknowledged fallacy once surgeries had started. It was also acknowledged that castration did not really cure deviancy, but curbed libido and helped the castrate to suppress his urges. Nonetheless, because of the eugenic origins of discussions, associated with persistent confusion about the difference between castration and sterilization, it never became fully clear whether the surgery was meant to curb libido or to prevent the offenders from begetting inferior progeny. © 2013 Elsevier Ltd.
Keywords: testosterone; article; attitude; castration; climacterium; criminal law; depression; ejaculation; exhibitionism; feminization; forensic psychiatrist; forensic psychiatry; government regulation; guilt; heredity; hormone deficiency; hot flush; human; human rights; intermethod comparison; libido; limb defect; male homosexuality; masculinity; medical ethics; medical genetics; mental disease; mental hospital; Netherlands; nymphomania; obesity; orchiectomy; osteoporosis; ovariectomy; patient satisfaction; pedophilia; penis erection; policy; postoperative complication; prepuberty; progeny; psychiatrist; psychosexual disorder; psychotherapy; public figure; punishment; recidivism; rehabilitation care; religion; reproduction; safety; salpingectomy; self control; sexual arousal; sexual crime; sexual intercourse; shame; suicide; therapeutic castration; treatment failure; vasectomy; voluntary castration

Effects of Different Steps in Gender Reassignment Therapy on Psychopathology: A Prospective Study of Persons with a Gender Identity Disorder - Heylens, G.; Verroken, C.; De Cock, S.; T'Sjoen, G.; De Cuypere, G. (Journal of Sexual Medicine, 2014)
Introduction: At the start of gender reassignment therapy, persons with a gender identity disorder (GID) may deal with various forms of psychopathology. Until now, a limited number of publications focus on the effect of the different phases of treatment on this comorbidity and other psychosocial factors. Aims: The aim of this study was to investigate how gender reassignment therapy affects psychopathology and other psychosocial factors. Methods: This is a prospective study that assessed 57 individuals with GID by using the Symptom Checklist-90 (SCL-90) at three different points of time: at presentation, after the start of hormonal treatment, and after sex reassignment surgery (SRS). Questionnaires on psychosocial variables were used to evaluate the evolution between the presentation and the postoperative period. The data were statistically analyzed by using SPSS 19.0, with significance levels set at P<0.05. Main Outcome Measures: The psychopathological parameters include overall psychoneurotic distress, anxiety, agoraphobia, depression, somatization, paranoid ideation/psychoticism, interpersonal sensitivity, hostility, and sleeping problems. The psychosocial parameters consist of relationship, living situation, employment, sexual contacts, social contacts, substance abuse, and suicide attempt. Results: A difference in SCL-90 overall psychoneurotic distress was observed at the different points of assessments (P=0.003), with the most prominent decrease occurring after the initiation of hormone therapy (P<0.001). Significant decreases were found in the subscales such as anxiety, depression, interpersonal sensitivity, and hostility. Furthermore, the SCL-90 scores resembled those of a general population after hormone therapy was initiated. Analysis of the psychosocial variables showed no significant differences between pre- and postoperative assessments. Conclusions: A marked reduction in psychopathology occurs during the process of sex reassignment therapy, especially after the initiation of hormone therapy. © 2013 International Society for Sexual Medicine.
Keywords: agoraphobia; anxiety; article; depression; distress syndrome; drug abuse; employment; female; gender dysphoria; hormonal therapy; hostility; human; major clinical study; male; mental disease; paranoia; postoperative period; priority journal; prospective study; sex reassignment; sexual behavior; sleep disorder; social behavior; social psychology; somatization; substance abuse; suicide attempt; Symptom Checklist 90

The prevalence of antiretroviral multidrug resistance in highly active antiretroviral therapy-treated patients with HIV/AIDS between 2004 and 2009 in South Korea - Choi, J.-Y.; Kwon, O.-K.; Choi, B.-S.; Kee, M.-K.; Park, M.; Kim, S.S. (Journal of Clinical Virology, 2014)
Background: Highly active antiretroviral therapy (HAART) including protease inhibitors (PIs) has been used in South Korea since 1997. Currently, more than 20 types of antiretroviral drugs are used in the treatment of human immunodeficiency virus-infected/acquired immune deficiency syndrome patients in South Korea. Despite the rapid development of various antiretroviral drugs, many drug-resistant variants have been reported after initiating HAART, and the efficiency of HAART is limited by these variants. Objectives: To investigate and estimate the annual antiretroviral drug resistance and prevalence of antiretroviral multi-class drug resistance in Korean patients with experience of treatment. Study design: The amplified HIV-1 pol gene in 535 patients requested for genotypic drug resistance testing from 2004 to 2009 by the Korea Centers for Disease Control and Prevention was sequenced and analyzed annually and totally. The prevalence of antiretroviral drug resistance was estimated based on "SIR" interpretation of the Stanford sequence database. Results: Of viruses derived from 787 specimens, 380 samples (48.3%) showed at least one drug class-related resistance. Predicted NRTI drug resistance was highest at 41.9%. NNRTI showed 27.2% resistance with 23.3% for PI. The percent of annual drug resistance showed similar pattern and slightly declined except 2004 and 2005. The prevalence of multi-class drug resistance against each drug class was: NRTI/NNRTI/PI, 9.8%; NRTI/PI, 21.9%; NNRTI/PI, 10.4%; and NRTI/NNRTI, 21.5%. Conclusions: About 50% and less than 10% of patients infected with HIV-1 have multidrug and multiclass resistance linked to 16 antiretroviral drugs, respectively. The significance of this study lies in its larger-scale examination of the prevalence of drug-resistant variants and multidrug resistance in HAART-experienced patients in South Korea. © 2014 Elsevier B.V.
Keywords: anti human immunodeficiency virus agent; nonnucleoside reverse transcriptase inhibitor; proteinase inhibitor; RNA directed DNA polymerase inhibitor; acquired immune deficiency syndrome; adolescent; adult; aged; article; blood transfusion; CD4 lymphocyte count; controlled study; demography; female; gene amplification; genotype; heterosexuality; highly active antiretroviral therapy; homosexuality; human; major clinical study; male; multidrug resistance; prevalence; priority journal; South Korea; structural gene; very elderly; virus mutation

Psychiatrists' views of the genetic bases of mental disorders and behavioral traits and their use of genetic tests - Klitzman, R.; Abbate, K.J.; Chung, W.K.; Marder, K.; Ottman, R.; Taber, K.J.; Leu, C.-S.; Appelbaum, P.S. (Journal of Nervous and Mental Disease, 2014)
We examined how 372 psychiatrists view genetic aspects of mental disorders and behaviors and use genetic tests (GTs). Most thought that the genetic contribution was moderate/high for bipolar disorder, schizophrenia, depression, Alzheimer's, intelligence, creativity, anxiety, and suicidality. In the past 6 months, 14.1% ordered GTs, 18.3% discussed prenatal testing with patients, 36.0% initiated discussions about other GTs, 41.6% had patients ask about GTs, and 5.3% excluded GT results from patient records. Many thought that GTs; were available for schizophrenia (24.3%) and major depression (19.6%). Women were more likely to report that patients asked about GTs; and were less certain about the degree of genetic contribution to several disorders. Psychiatrists perceive strong genetic bases for numerous disorders and traits, and many have discussed and ordered tests for GTs, but have relatively limited knowledge about available tests. These data suggest possible sex differences in psychiatrists' beliefs about genetic contributions to disorders and have implications for future research, education, policy, and care. Copyright © 2014 by Lippincott Williams & Wilkins.
Keywords: adult; Alzheimer disease; anorexia; anxiety; article; behavior; bipolar disorder; creativity; dysthymia; female; genetic screening; genetics; health care policy; homosexuality; human; intelligence; major clinical study; major depression; male; medical education; mental disease; obsessive compulsive disorder; panic; pedophilia; professional knowledge; psychiatrist; schizophrenia; sex difference; social phobia; suicidal behavior

Prevalence, Correlates, And changes in tobacco use between 2006 and 2010 among 13-15 year moroccan school attending adolescents - Shaikh, M.A. (Journal of the Pakistan Medical Association, 2014)
Tobacco use is a preventable cause of disease and death globally. Adolescents using tobacco tend to continue its use in adulthood. Analysis of data from Moroccan Global School-based Student Health Surveys for 2006 and 2010 showed statistically significant differences in prevalence of current cigarette smoking as well as current use of other tobacco products, among school attending 13-15 year old boys and girls within the year 2006 and 2010; with boys having higher prevalence than girls in each year. Combined prevalence of cigarette smoking i.e. between both boys and girls showed statistically significant difference between 2006 and 2010; with a higher prevalence in 2010. Use of tobacco in multivariate analysis of 2010 data, was found to have statistically significant associations with anxiety disorders, gender, truancy, depression, suicidal ideation, inadequate parental monitoring, and parental smoking.
Keywords: adolescent; anxiety disorder; article; depression; disease association; female; gender dysphoria; health survey; human; male; parental attitude; parental smoking; prevalence; smoking; suicidal ideation; tobacco use

Recent self-harmand psychological measures in the emergency department - Randall, J.R.; Rowe, B.H.; Dong, K.A.; Colman, I. (PeerJ, 2014)
The assessment of self-harm risk is a common, difficult, and perplexing task for many physicians, especially those working in emergency departments (ED). Attempts have been made to determine objective methods for assessing patients with suicidal ideation or self-harm though there is still a lack of knowledge about objective assessments of these patients. A study was conducted where 181 suicidal patients were enrolled in two EDs within the city of Edmonton, Canada. Initial interviews were conducted in the ED which collected basic demographics and medical history as well as psychometric measures including the Beck Hopelessness Scale, Barratt Impulsiveness Scale, Brief Symptom Inventory, Drug Abuse Screening Test 10, and CAGE questionnaire. The results of these measures were compared between those who presented to the ED with self-harmand those who presented only with ideation. Those with recent self-harm scored lower on many of the scales and subscales of distress and impulsivity measured compared to those with no recent self-harm. Possible explanations for this difference include differences in psychological traits between the two groups and possible cathartic effects of self-harm. The lower scores obtained by those that present with self-harm may complicate attempts to use psychometric tools to determine future self-harmrisk.
Keywords: adult; alcohol abuse; anxiety; article; attention; Barratt Impulsiveness Scale; Beck Hopelessness Scale; Brief Symptom Inventory; CAGE questionnaire; cognition; compulsion; demography; depression; distress syndrome; emergency ward; female; hopelessness; hostility; human; impulsiveness; interview; major clinical study; male; motor activity; paranoia; perseveration; psychology; psychosis; psychotherapy; questionnaire; risk assessment; self control; automutilation; sensitivity analysis; somatization; suicidal ideation; suicide attempt; transgender

How gay-straight alliance groups mitigate the relationship between gay-bias victimization and adolescent suicide attempts - Davis, B.; Royne Stafford, M.B.; Pullig, C. (Journal of the American Academy of Child and Adolescent Psychiatry, 2014)
Objective We examined the relationships between victimization from being bullied, suicide, hopelessness, and the presence of a Gay-Straight Alliance (GSA) on a school campus. Method We analyzed data from the California Healthy Kids Survey from 2005 to 2007 using hierarchical modeling. Results We found that gay-bias (versus non-gay-bias) victimization is meaningfully connected with the inwardly destructive behavior of attempted suicide among adolescents. We also found that hopelessness helps explain associations between gay-bias victimization and suicide attempts and that the presence of a GSA club on a school's campus attenuates significant connections between gay-bias victimization and suicide attempts by reducing hopelessness. Conclusion Gay-bias victims are more likely than other victims to attempt suicide while also feeling more hopeless. The presence of a GSA on campus may help to reduce the attempted suicide and hopelessness associated with gay-bias victimization.
Keywords: adolescent; adolescent behavior; African American; age; article; Asian; automutilation; bullying; Caucasian; controlled study; correlational study; female; gay straight alliance; gender; gender identity; Hispanic; homosexuality; hopelessness; human; major clinical study; male; school; social aspect; suicide attempt; victim

Acting strange after trying to 'get numb' - Puri, M.; Hall, E.G.; Erisman, M.; Vwich, Y. (Current Psychiatry, 2014)
Keywords: midomafetamine; epinephrine; androstenedione; antacid agent; antidepressant agent; caffeine; chlorpheniramine; chlorpheniramine maleate plus paracetamol; cyclizine; dextromethorphan; dimenhydrinate; diphenhydramine; ephedrine; fluoxetine; guaifenesin; hydrocodone; laxative; methylephedrine; nicotine gum; non prescription drug; phenylpropanolamine; piperazine; pseudoephedrine; risperidone; acne; adolescent; agitation; anhedonia; anorexia; article; bedtime dosage; behavior change; behavior disorder; cannabis addiction; case report; coma; concentration loss; confusion; convulsion; coughing; delirium; depression; drowsiness; drug abuse; emotional stress; euphoria; fatigue; flushing; gastrointestinal symptom; gender dysphoria; hallucination; headache; heart beat; hospital admission; human; major depression; male; medical history; mental health; micturition disorder; nausea; nervousness; neurologic examination; nose obstruction; paresthesia; priapism; psychomotor retardation; psychosis; seizure; sleep deprivation; somnolence; substance abuse; suicide attempt; tachycardia; thorax pain; tobacco dependence; tremor; unsteadiness; vomiting

Adolescent gender-related abuse, androphilia, and HIV risk among transfeminine people of color in New York City - Hwahng, S.J.; Nuttbrock, L. (Journal of homosexuality, 2014)
Public health research has indicated extremely high HIV seroprevalence (13%-63%) among low-income transfeminine people of color of African, Latina, and Asian descent living in the U.S. This article combines two data sets. One set is based on an ethnographic study (N = 50, 120 hours of participant observation). The other set is based on a longitudinal quantitative study (baseline N = 600, N = 275 followed for 3 years). Transfeminine people of color are much more likely to be androphilic and at high HIV risk. A greater understanding of adolescent gender-related abuse and trauma-impacted androphilia contributes toward a holistic conceptual model of HIV risk. A theoretical model is proposed that incorporates findings from both studies and integrates sociostructural, interpersonal, and intrapsychic levels of HIV risk.
Keywords: adolescent; adult; age; ancestry group; child abuse; major depression; epidemiology; female; gender identity; Human immunodeficiency virus infection; human; male; middle aged; prevalence; psychology; risk factor; sex difference; sexual behavior; statistics and numerical data; suicidal ideation; transgender; United States; young adult

Victimisation and psychosocial difficulties associated with sexual orientation concerns: a school-based study of adolescents - Cotter, P.; Corcoran, P.; McCarthy, J.; O'Suilleabháin, F.; Carli, V.; Hoven, C.; Wasserman, C.; Sarchiapone, M.; Wasserman, D.; Keeley, H. (Irish medical journal, 2014)
This study examined victimisation, substance misuse, relationships, sexual activity, mental health difficulties and suicidal behaviour among adolescents with sexual orientation concerns in comparison to those without such concerns. 1112 Irish students (mean age 14 yrs) in 17 mixed-gender secondary schools completed a self-report questionnaire with standardised scales and measures of psychosocial difficulties. 58 students (5%) reported having concerns regarding their sexual orientation. Compared with their peers, they had higher levels of mental health difficulties and a markedly-increased prevalence of attempted suicide (29% vs. 2%), physical assault (40% vs. 8%), sexual assault (16%vs. 1%) and substance misuse. Almost all those (90%) with sexual orientation concerns reported having had sex compared to just 4% of their peers. These results highlight the significant difficulties associated with sexual orientation concerns in adolescents in Ireland. Early and targeted interventions are essential to address their needs.
Keywords: adolescent; adolescent behavior; bullying; drinking behavior; female; human; human relation; male; psychology; sexual behavior; statistics and numerical data; student; suicidal ideation

Correlates of suicide ideation among LGBT Nebraskans - Irwin, J.A.; Coleman, J.D.; Fisher, C.M.; Marasco, V.M. (Journal of homosexuality, 2014)
The aim of this investigation is to outline correlates of suicide ideation among LGBT individuals living in Nebraska. A community-based participatory research approach was utilized to develop a 30-minute, online anonymous survey. Almost half of the sample had seriously considered suicide at some point in their lives. Significant correlates of increased likelihood of suicide ideation are age, gender, transgender identity, income, depression, and discrimination. Suicide ideation is a serious concern for the health of LGBT Nebraskans. Steps should be taken to incorporate individuals who fall into these high-risk categories in suicide outreach programs.
Keywords: adult; age; aged; bisexuality; depression; epidemiology; female; health care delivery; homophobia; homosexuality; human; income; information processing; lesbianism; male; male homosexuality; middle aged; psychology; sex difference; statistics and numerical data; suicidal ideation; transgender; United States; young adult

Measures of sexual minority status and suicide risk among young adults in the United States - Almazan, E.P.; Roettger, M.E.; Acosta, P.S. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2014)
Multiple measures of sexual minority status are necessary to accurately describe the diversity of attractions, identities, and behaviors in sexual minority populations. We investigated whether four measures of sexual minority status (sexual minority attraction, sexual minority identity, sexual minority lifetime behavior, and sexual minority recent 12-month behavior) were associated with suicidal thoughts and suicide attempts among young adults ages 24 to 34 in the United States. We analyzed data from Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health. We employed logistic regression models in the analysis. Multiple sexual minority status measures had significant associations with increased suicidal thoughts among women and men. Multiple sexual minority status measures had significant associations with increased suicide attempts among women, but not among men. Diverse sexual minority populations are at increased risk for suicidal thoughts and suicide attempts. Multiple measures of sexual minority status should be utilized in future studies of sexual minority status and suicide risk. Suicide prevention programs should ensure intervention is available across diverse sexual minority populations.
Keywords: adult; bisexuality; female; health disparity; homosexuality; human; male; minority group; psychology; risk; statistical model; statistics and numerical data; suicidal ideation; suicide; suicide attempt; United States; young adult

Suicidal ideation in Spanish and Italian lesbian and gay young adults: the role of internalized sexual stigma - Baiocco, R.; Ioverno, S.; Cerutti, R.; Santamaria, F.; Fontanesi, L.; Lingiardi, V.; Baumgartnert, E.; Laghi, F. (Psicothema, 2014)
BACKGROUND: A growing body of research claims that sexual minority individuals have nearly twice the suicidal ideation rate of heterosexual individuals. METHOD: The main objective of the current study was to test a model wherein internalized sexual stigma (ISS) mediates the association between some gay-related stressors and suicidal ideation. The present cross-sectional survey involved two samples of lesbian and gay young adults from Spain (N = 209) and Italy (N = 345). The total sample included 316 gay men and 228 lesbian women. Path analysis was used to test the direct and indirect (mediated) effects of the variables from different domains on repulsion by life. RESULTS: In both the Spanish and Italian samples, past victimization experiences and ISS had a significant direct effect on repulsion by life. In both samples, ISS acted as a significant mediator in the effect of the concealment of one's sexual orientation and the religious involvement of repulsion by life. CONCLUSION: The current study indicates that ISS is a potential moderator of the effect of concealing one's sexual orientation, religious involvement, and past experiences of victimization on suicidal attitudes.
Keywords: adolescent; adult; cross-sectional study; female; human; Italy; lesbianism; male; male homosexuality; psychology; social stigma; Spain; suicidal ideation; young adult

Risk behaviors, suicidal ideation and suicide attempts in a nationally representative French sample - Husky, M.M.; Guignard, R.; Beck, F.; Michel, G. (Journal of Affective Disorders, 2013)
Background Data from large nationally representative samples are needed to provide the empirical foundation to inform health policies for the prevention of suicide risk and risk behaviors in men and women. Methods Data were extracted from the 2010 Health Barometer, a large telephone survey on a representative sample of the general population aged 15-85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview (CATI) system was used. Results Overall, 3.9% of respondents aged 15 to 85 reported past year suicidal ideation, and 0.5% reported a suicide attempt in that time period. Increased rates of risky sexual behavior are associated with ideation and attempt in both men and women, after controlling for sociodemographic variables. Homosexuality or bisexuality are associated with suicidal ideation for both men and women, but not with attempts. Substance misuse, physical and sexual assaults are strongly associated with suicidal symptoms for both men and women. Early first experiences with sex, tobacco, and alcohol are associated with suicidal symptoms though somewhat differentially for men and women. Limitations Cross-sectional survey. Conclusion The findings underscore associations between suicidal thoughts and behaviors and risk behaviors such as unprotected sex and substance use in men and women throughout the lifespan. These associations highlight the need for preventive strategies such as screening for risk behaviors in order to identify men and women particularly at risk for suicidal behavior. © 2013 Elsevier B.V.
Keywords: adolescent; adult; aged; alcohol abuse; article; bisexuality; female; France; gender; high risk behavior; homosexuality; human; major clinical study; male; priority journal; sexual assault; sexual behavior; substance abuse; suicidal behavior; suicidal ideation; suicide attempt; symptomatology; tobacco dependence

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

Care of the college student - Unwin, B.K.; Goodie, J.; Reamy, B.V.; Quinlan, J. (American Family Physician, 2013)
There are approximately 20 million students in U.S. colleges and universities. Although this population is characterized as having good health, 600,000 students report some form of disability or some type of medical problem, including attention-defcit/hyperactivity disorder, learning disabilities, psychiatric disorders, and chronic illnesses, among others. Physicians can enhance youth transition to an adult model of health care; the use of self-care skills checklists is one recommended method to assist with the transition. Stimulant medications are effective for treating adults with attention-defcit/hyperactivity disorder, but physicians should use caution when prescribing stimulants to college students because of the high rates of medication diversion in this population. Depression, anxiety, posttraumatic stress disorder, sleep problems, and eating disorders are common in college students and can signifcantly impact performance. Emphasis on immunization of students for infuenza, meningococcus, and pertussis is necessary because of the low rates of compliance. Screening and interventions for obesity, tobacco use, and substance abuse are important because of the high prevalence of these problems in college students. Screening for alcohol abuse facilitates identifca-tion of students with problem drinking behaviors. Students who are war veterans should be monitored for suicidal ideation and posttraumatic stress disorder. Lesbian, gay, bisexual, transgender, and questioning students are at risk of harassment and discrimination. Caution should be exercised when prescribing medications to college athletes to avoid violation of National Collegiate Athletic Association eligibility rules. © 2013 American Academy of Family Physicians.
Keywords: midomafetamine; 4 hydroxybutyric acid; amfebutamone; amphetamine; atomoxetine; cannabis; central stimulant agent; cocaine; flunitrazepam; ketamine; methamphetamine; methylphenidate; unclassified drug; alcohol abuse; anxiety; article; attention deficit disorder; chronic disease; college student; depression; eating disorder; health service; human; immunization; influenza; learning disorder; mental disease; Neisseria meningitidis; obesity; pertussis; physician; posttraumatic stress disorder; substance abuse; suicidal ideation; tobacco dependence; ritalin; strattera; wellbutrin

Does "it get better" for depressed sexual minority youth in young adulthood? - Cardom, R.; Rostosky, S.; Danner, F. (Journal of Adolescent Health, 2013)
Purpose To examine depressive symptoms and suicidality in adolescence and adulthood in a sample of depressed adolescents in five sexual identity groups (heterosexual, mostly heterosexual, bisexual, mostly gay, and gay). Methods Depressed adolescents (N = 1,591) from the National Longitudinal Study of Adolescent Health were examined again in young adulthood. Results Paired t-tests revealed that depressive symptoms declined significantly in all five sexual identity groups. McNemar chi-square tests revealed that the percentage of participants reporting suicidal ideation decreased significantly in all groups except for the mostly gay group. The percentage of participants reporting suicide attempts declined in all groups except the bisexual group. Conclusions Within-group differences are important to consider in delivering effective mental health services. Although depressive symptoms diminished in young adulthood in all groups, suicidality did not. Mostly gay and bisexual young adults did not report the same significant declines as their peers. © 2013 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: adolescence; adolescent; adult; adulthood; article; bisexuality; child; depression; disease course; female; heterosexuality; human; major clinical study; male; homosexual male; mental health service; priority journal; school child; sexual and gender minority; suicidal behavior; suicidal ideation; suicide attempt; symptomatology

Compulsive sexual behavior and psychopathology among treatment-seeking men in São Paulo, Brazil - Scanavino, M.D.T.; Ventuneac, A.; Abdo, C.H.N.; Tavares, H.; Amaral, M.L.S.D.; Messina, B.; Reis, S.C.D.; Martins, J.P.L.B.; Parsons, J.T. (Psychiatry Research, 2013)
This study examined compulsive sexual behavior (CSB) and psychopathology in a treatment-seeking sample of men in São Paulo, Brazil. Eighty-six men (26% gay, 17% bisexual, 57% heterosexual) who met diagnostic criteria for excessive sexual drive and sexual addiction completed assessments consisting of the Mini International Neuropsychiatric Interview, a structured clinical interview for DSM-IV Axis I Disorders-Clinical Version (segment for Impulse Control Disorder), Sexual Compulsivity Scale (SCS), and questions about problematic CSB. The average SCS score for our sample was above the cut-off score reported in other studies, and 72% of the sample presented at least one Axis I psychiatric diagnosis. There were no differences among gay, bisexual, and heterosexual men on SCS scores and psychiatric conditions, but gay and bisexual men were more likely than heterosexual men to report casual sex and sex with multiple casual partners as problematic behaviors. SCS scores were associated with psychiatric co-morbidities, mood disorder, and suicide risk, but diagnosis of a mood disorder predicted higher SCS scores in a regression analysis. The study provides important data on the mental health needs of men with CSB in São Paulo, Brazil. © 2013 Elsevier Ireland Ltd.
Keywords: adult; aged; article; bisexual male; Brazil; casual sex; compulsion; compulsive sexual behavior; concurrent sexual partnership; disease association; DSM-IV; help seeking behavior; heterosexual male; human; libido; major clinical study; male; homosexual male; mental health; priority journal; psychologic assessment; psychological rating scale; sexual addiction; Sexual Compulsivity Scale

Practice parameter for cultural competence in child and adolescent psychiatric practice - Pumariega, A.J.; Rothe, E.; Mian, A.; Carlisle, L.; Toppelberg, C.; Harris, T.; Gogineni, R.R.; Webb, S.; Smith, J. (Journal of the American Academy of Child and Adolescent Psychiatry, 2013)
The United States faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural. In consequence, cultural and racial factors relating to mental illness and emotional disturbances deserve closer attention and consideration. This Practice Parameter outlines clinical applications of the principle of cultural competence that will enable child and adolescent mental health clinicians to better serve diverse children, adolescents, and their families. © 2013 American Academy of Child and Adolescent Psychiatry.
Keywords: cytochrome P450 2D6; psychotropic agent; adaptation; article; behavior; Child Behavior Checklist; child psychiatry; child welfare; clinical practice; cultural competence; cultural factor; cultural value; decision making; drug tolerability; emotional disorder; ethnic group; ethnicity; genetic risk; genetic variability; genotype environment interaction; health care system; heredity; human; immigration; language disability; mental disease; mental health service; patient satisfaction; personalized medicine; pharmacogenomics; priority journal; race difference; randomized controlled trial (topic); sexual orientation; side effect; social psychology; social status; speech therapy; suicidal ideation; systematic review; treatment outcome; treatment planning; treatment response; United States

Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care. - Blosnich, J.R.; Brown, G.R.; Shipherd Phd, J.C.; Kauth, M.; Piegari, R.I.; Bossarte, R.M. (American journal of public health, 2013)
We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.
Keywords: article; confidence interval; electronic medical record; female; gender identity; government; human; male; prevalence; psychological aspect; public hospital; risk assessment; statistics; suicide; transsexualism; United States; veteran

Health consequences of racist and antigay discrimination for multiple minority adolescents - Thoma, B.C.; Huebner, D.M. (Cultural Diversity and Ethnic Minority Psychology, 2013)
Individuals who belong to a marginalized group and who perceive discrimination based on that groupmembership suffer from a variety of poor health outcomes. Many people belong to more than onemarginalized group, and much less is known about the influence of multiple forms of discrimination onhealth outcomes. Drawing on literature describing the influence of multiple stressors, three models ofcombined forms of discrimination are discussed: additive, prominence, and exacerbation. The currentstudy examined the influence of multiple forms of discrimination in a sample of African Americanlesbian, gay, or bisexual (LGB) adolescents ages 14-19. Each of the three models of combined stressorswere tested to determine which best describes how racist and antigay discrimination combine to predictdepressive symptoms, suicidal ideation, and substance use. Participants were included in this analysis ifthey identified their ethnicity as either African American (n = 156) or African American mixed (n =120). Mean age was 17.45 years (SD = 1.36). Results revealed both forms of mistreatment wereassociated with depressive symptoms and suicidal ideation among African American LGB adolescents. Racism was more strongly associated with substance use. Future intervention efforts should be targetedtoward reducing discrimination and improving the social context of multiple minority adolescents, andfuture research with multiple minority individuals should be attuned to the multiple forms of discriminationexperienced by these individuals within their environments. © 2013 American Psychological Association.
Keywords: adolescent; adult; African American; article; bisexuality; depression; ethnicity; female; human; homosexual female; LGBT people; major clinical study; male; homosexual male; minority group; racism; sexism; social environment; substance abuse; suicidal ideation

The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men - Wang, J.; Häusermann, M.; Berrut, S.; Weiss, M.G. (Journal of Affective Disorders, 2013)
Background High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland. Methods In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time-space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011. Results 43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from -18% to -28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression. Limitations Community-level assessment with no control. Conclusions Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking. © 2013 Elsevier B.V.
Keywords: adult; article; attitude to health; depression; distress syndrome; health care survey; health literacy; human; knowledge; major clinical study; male; homosexual male; medical specialist; mental health; morbidity; outcome assessment; prevalence; priority journal; suicidal ideation; Switzerland

Interpersonal psychotherapy with transgender clients - Budge, S.L. (Psychotherapy, 2013)
Interpersonal therapy (IPT) is a particularly useful approach to use when working with clients who identify as transgender or gender nonconforming. All transgender individuals will experience changes and adjustment throughout their identity process, often referred to as transitioning. IPT offers specific interventions for psychotherapists to use with clients whose presenting concerns are specifically related to transitions. The current article outlines a case example of a transgender man who is experiencing difficulty with "role transitions" and offers four transgender-specific clinical intervention strategies derived within the traditional IPT framework. © 2013 American Psychological Association.
Keywords: anxiety disorder; article; depression; eating disorder; hopelessness; human; human relation; personal experience; personality; psychotherapist; psychotherapy; reinforcement; social support; substance abuse; suicidal ideation; transgenderism

Sexual Minority-Related Victimization as a Mediator of Mental Health Disparities in Sexual Minority Youth: A Longitudinal Analysis - Burton, C.M.; Marshal, M.P.; Chisolm, D.J.; Sucato, G.S.; Friedman, M.S. (Journal of Youth and Adolescence, 2013)
Sexual minority youth (youth who are attracted to the same sex or endorse a gay/lesbian/bisexual identity) report significantly higher rates of depression and suicidality than heterosexual youth. The minority stress hypothesis contends that the stigma and discrimination experienced by sexual minority youth create a hostile social environment that can lead to chronic stress and mental health problems. The present study used longitudinal mediation models to directly test sexual minority-specific victimization as a potential explanatory mechanism of the mental health disparities of sexual minority youth. One hundred ninety-seven adolescents (14-19 years old; 70 % female; 29 % sexual minority) completed measures of sexual minority-specific victimization, depressive symptoms, and suicidality at two time points 6 months apart. Compared to heterosexual youth, sexual minority youth reported higher levels of sexual minority-specific victimization, depressive symptoms, and suicidality. Sexual minority-specific victimization significantly mediated the effect of sexual minority status on depressive symptoms and suicidality. The results support the minority stress hypothesis that targeted harassment and victimization are partly responsible for the higher levels of depressive symptoms and suicidality found in sexual minority youth. This research lends support to public policy initiatives that reduce bullying and hate crimes because reducing victimization can have a significant impact on the health and well-being of sexual minority youth. © 2013 Springer Science+Business Media New York.
Keywords: adolescent; article; bisexuality; bullying; child psychology; depression; female; health disparity; homophobia; human; lesbianism; longitudinal study; male; male homosexuality; mental stress; minority group; minority health; psychological aspect; psychological model; statistical model; suicidal ideation; United States; victim

Sexual obsessions in pediatric obsessive-compulsive disorder: Clinical characteristics and treatment outcomes - Fernández De La Cruz, L.; Barrow, F.; Bolhuis, K.; Krebs, G.; Volz, C.; Nakatani, E.; Heyman, I.; Mataix-Cols, D. (Depression and Anxiety, 2013)
Background Sexual obsessions are common in adults with obsessive-compulsive disorder (OCD), cause great distress, and are sometimes misinterpreted as indicating risk to others. Little is known about the prevalence, clinical correlates, and prognosis of such symptoms in young people. Methods Three hundred and eighty-three patients referred to a specialist pediatric OCD clinic were administered a series of measures at intake and, for those treated at the clinic, again after treatment. Patients with and without sexual obsessions were compared on socio-demographic and clinical characteristics. Mixed model analyses of variance compared treatment outcomes in both groups. Results A quarter of patients had sexual obsessions at baseline (age range 8-17); they had slightly more severe OCD symptoms and were more depressed than those without sexual obsessions. Aggressive and religious obsessions, magical thinking, fear of saying certain things, repeating rituals, superstitious games, mental rituals, and the need to tell, ask, or confess were more frequent in participants with sexual obsessions. Crucially, no differences in treatment outcome were found between the groups. Conclusions Sexual obsessions are common in pediatric OCD, even in very young children. Although they may be associated with particular clinical features, they do not interfere with treatment response. The occurrence of sexual obsessions in children should be recognized and these symptoms understood as ordinary, nonthreatening OCD symptoms, which pose no risk to others. They respond to the standard treatment strategies, so children and families should receive the usual message of optimism regarding the chances of recovery. © 2013 Wiley Periodicals, Inc.
Keywords: adolescent; article; child; comparative study; compulsion; controlled study; depression; disease severity; fear; homosexuality; human; magic; major clinical study; obsession; onset age; patient referral; prevalence; priority journal; prognosis; school child; sexual behavior; sexual obsession; suicidal ideation; treatment outcome; treatment response

Trajectories of Depressive Symptoms and Suicidality Among Heterosexual and Sexual Minority Youth - Marshal, M.P.; Dermody, S.S.; Cheong, J.; Burton, C.M.; Friedman, M.S.; Aranda, F.; Hughes, T.L. (Journal of Youth and Adolescence, 2013)
Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53 % female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs. © 2013 Springer Science+Business Media New York.
Keywords: adolescent; adolescent behavior; article; comorbidity; depression; female; heterosexuality; human; human relation; longitudinal study; male; minority group; minority health; psychological aspect; statistics; suicide attempt; United States

Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth - Hatzenbuehler, M.L.; Keyes, K.M. (Journal of Adolescent Health, 2013)
Purpose: To evaluate whether anti-bullying policies that are inclusive of sexual orientation are associated with a reduced prevalence of suicide attempts among lesbian, gay, and bisexual youths. Methods: A total of 31,852 11th-grade public school students (1,413 lesbian, gay, and bisexual individuals; 4.4%) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. The independent variable was the proportion of school districts in the 34 counties participating in the Oregon Healthy Teens survey that adopted anti-bullying policies inclusive of sexual orientation. The outcome measure was any self-reported suicide attempt in the past 12 months. We stratified results by sexual orientation. Results: Lesbian and gay youths living in counties with fewer school districts with inclusive anti-bullying policies were 2.25 times (95% confidence interval [CI], 1.13-4.49) more likely to have attempted suicide in the past year compared with those living in counties where more districts had these policies. Inclusive anti-bullying policies were significantly associated with a reduced risk for suicide attempts among lesbian and gay youths, even after controlling for sociodemographic characteristics (sex, race/ethnicity) and exposure to peer victimization (odds ratio,.18; 95% CI,.03-.92). In contrast, anti-bullying policies that did not include sexual orientation were not associated with lower suicide attempts among lesbian and gay youths (odds ratio,.38; 95% CI,.02-7.33). Conclusions: Inclusive anti-bullying policies may exert protective effects for the mental health of lesbian and gay youths, including reducing their risk for suicide attempts. © 2013 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: article; bisexuality; bullying; clinical evaluation; demography; female; health care policy; human; independent variable; homosexual female; major clinical study; male; homosexual male; outcome assessment; prevalence; priority journal; risk reduction; self report; sexual orientation; social class; suicide attempt; United States

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth - Levine, D.A. (Pediatrics, 2013)
The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004.This technical report reflects the rapidly expanding medical and psychosocial literature about sexual minority youth. Pediatricians should be aware that some youth in their care may have concerns or questions about their sexual orientation or that of siblings, friends, parents, relatives, or others and should provide factual, current, nonjudgmental information in a confidential manner. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to increased mental health issues for sexual minority youth. LGBTQ and MSM/WSW (men having sex with men and women having sex with women) adolescents, in comparison with heterosexual adolescents, have higher rates of depression and suicidal ideation, higher rates of substance abuse, and more risky sexual behaviors. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. This includes having supportive, engaging office staff members who ensure that there are no barriers to care. For transgender youth, pediatricians should provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender. Referral of transgender youth to a qualified mental health professional is critical to assist with the dysphoria, to educate them, and to assess their readiness for transition. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood. Pediatrics 2013;132:e297-e313. Copyright © 2013 by the American Academy of Pediatrics.
Keywords: adolescence; adulthood; ambulatory care; article; bullying; confidentiality; depression; dysphoria; eating disorder; friend; gender identity; health care access; health care delivery; health care disparity; health disparity; health statistics; heterosexuality; homophobia; homosexuality; human; LGBT people; medical literature; medical society; men who have sex with men; mental health; parent; patient education; pediatrician; pediatrics; priority journal; relative; reproductive health; sexual health; sexual and gender minority; sexual orientation; sibling; social psychology; social stigma; substance abuse; suicidal ideation; unsafe sex; victim; women who have sex with women

Office-based care for lesbian gay bisexual transgender and questioning youth (Pediatrics, 2013)
The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/ HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood. Pediatrics 2013;132:198-203. Copyright © 2013 by the American Academy of Pediatrics.
Keywords: adolescent behavior; article; bisexuality; child psychology; depression; drug dependence; health disparity; health promotion; heterosexuality; HIV test; homophobia; homosexuality; human; Human immunodeficiency virus infection; juvenile; homosexual female; patient referral; pediatrician; priority journal; public health service; sexual behavior; sexual counseling; sexual education; sexual health; sexual and gender minority; sexually transmitted disease; suicidal ideation; support group; transgenderism

Bullying and quality of life in youths perceived as gay, lesbian, or bisexual in Washington State, 2010. - Patrick, D.L.; Bell, J.F.; Huang, J.Y.; Lazarakis, N.C.; Edwards, T.C. (American journal of public health, 2013)
We examined the association between perceived sexual orientation (PSO), bullying, and quality of life (QOL) among US adolescents. We analyzed data from the 2010 Washington State Healthy Youth Survey collected in public school grades 8, 10, and 12 (n = 27,752). Bullying status was characterized as never bullied, bullied because of PSO, or bullied for other reasons. Survey-weighted regression examined differences in QOL, depressed mood, and consideration of suicide by bullying status. Among male students, 14%, 11%, and 9% reported being bullied because of PSO in 8th, 10th, and 12th grades, respectively; and among female students, 11%, 10%, and 6%. In all gender and grade strata, being bullied because of PSO was associated with lower QOL scores and increased the odds of depressed mood or consideration of suicide. Moreover, the magnitudes of these associations were greater than for being bullied for other reasons. Bullying because of PSO is widely prevalent and significantly affects several facets of youth QOL. Bully-prevention or harm-reduction programs must address bullying because of PSO.
Keywords: adolescent; article; bisexuality; bullying; cohort analysis; cross-sectional study; depression; female; health survey; human; lesbianism; male; male homosexuality; psychological aspect; quality of life; regression analysis; school; self report; sex difference; statistics; suicidal ideation; United States

The Mediating Roles of Stress and Maladaptive Behaviors on Self-Harm and Suicide Attempts Among Runaway and Homeless Youth - Moskowitz, A.; Stein, J.A.; Lightfoot, M. (Journal of Youth and Adolescence, 2013)
Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and psychosocial background characteristics and self-injurious outcomes through the lens of the stress process paradigm. The model was tested in a sample of runaway and homeless youth from Los Angeles County (N = 474, age 12-24, 41 % female, 17 % White, 32.5 % African American, 21.5 % Hispanic/Latino). Background variables (gender, age, sexual minority status, parental drug use history, and emotional distress) predicted hypothesized mediators of maladaptive behaviors and recent stress. In turn, it was hypothesized that the mediators would predict self-harming behaviors and suicide attempts in the last 3 months. Females and LGBT (lesbian, gay, bisexual, transgender) youth were more likely to have self-harmed and attempted suicide; younger participants reported more self-harming. The mediating constructs were associated more highly with self-harming than suicide attempts bivariately, although differences were modest. Maladaptive behaviors and recent stress were significant predictors of self-harm, whereas only recent stress was a significant predictor of suicide attempts. All background factors were significant predictors of recent stress. Older age, a history of parental drug use, and greater emotional distress predicted problem drug use. Males, younger participants, and participants with emotional distress reported more delinquent behaviors. Significant indirect effects on self-harming behaviors were mediated through stress and maladaptive behaviors. The hypothesized paradigm was useful in explaining the associations among background factors and self-injurious outcomes and the influence of mediating factors on these associations. © 2012 Springer Science+Business Media, LLC.
Keywords: adaptive behavior; addiction; adolescent; article; automutilation; child; cross-sectional study; factor analysis; female; homelessness; human; interview; juvenile delinquency; male; mental stress; psychological aspect; psychological model; self report; statistical model; suicide attempt; young adult

Outcomes of child psychiatric treatment - Lundh, A.; Forsman, M.; Serlachius, E.; Lichtenstein, P.; Landén, M. (Acta Psychiatrica Scandinavica, 2013)
Objective: The aim of this study was to investigate outcomes of child psychiatric outpatient treatment as usual and to identify outcome predictors, with special regard to attention-deficit/hyperactivity disorder (ADHD), mood disorder, obsessive-compulsive disorder and conduct disorder. Method: Routinely collected data from 12 613 outpatients between July 2006 and January 2010 in Stockholm, Sweden were analysed. The outcome measure was change in Children's Global Assessment Scale (CGAS) ratings between first visit and case closure (incrementCGAS). Results: CGAS improved during the course of treatment across all diagnostic groups, ranging from a mean change of 4 (mental retardation) to 16 (suicide attempts). incrementCGAS was two times higher in the mood disorder group compared with the ADHD group. In the mood disorder group, several psychotherapies were associated with better outcome but not medication. In the ADHD group, psychotherapeutic interventions were also associated with better outcome, but those who received treatment with central stimulants received less non-medical interventions. Conclusion: Whereas the functional impairment and the level of improvement in mood disorder corresponded to previous efficacy studies, the ADHD patients were more impaired and improved less after treatment. This should prompt a critical discussion as to whether ADHD patients receive the best available treatment in CAMHS in Stockholm and elsewhere. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Keywords: central stimulant agent; adolescent; adult; anxiety disorder; article; attention deficit disorder; autism; bipolar disorder; child; child psychiatry; cognitive therapy; communication disorder; conduct disorder; diagnosis related group; dissociative disorder; eating disorder; enuresis; feces incontinence; female; functional disease; gender dysphoria; human; learning disorder; major clinical study; male; mental deficiency; mental health care; motor dysfunction; obsessive compulsive disorder; oppositional defiant disorder; outcome variable; outpatient; outpatient care; patient counseling; posttraumatic stress disorder; preschool child; priority journal; psychiatric treatment; psychopharmacotherapy; psychosocial disorder; psychotherapy; schizophrenia; school child; sleep disorder; social network; social psychology; somatoform disorder; special education; suicide attempt; Sweden; treatment outcome; treatment response

Inpatient medical-surgical suicidal behavior: A 12-year case-control study - Shekunov, J.; Geske, J.R.; Bostwick, J.M. (General Hospital Psychiatry, 2013)
Objective: To describe a medical center's 12-year experience with medically or surgically hospitalized suicide attempters, with the goal of extending the limited literature on this sentinel event. Patients and Methods: Eight Mayo Clinic Rochester patients' self-inflicting injuries serious enough to trigger mandatory reporting while hospitalized on a medical/surgical unit from January 1, 1998 to December 31, 2010 were matched with four same-sex and same-age controls, admitted to the same unit within 2 months. Cases were identified from Sentinel Event Tracking System and Minnesota Adverse Events Statute records. Data were analyzed with conditional logistic regression. Results: Eight of 777,404 medical/surgical inpatients admitted during 12 years attempted suicide, with significantly more non-Caucasian patients among cases than controls (P= .020). Of 8 attempts, 1 was fatal. More cases than controls had undergone inpatient psychiatric evaluation prior to attempt (P= .020), and elevated risk of attempt was significantly associated with increased number of prior attempts (0.049). Near their attempts, each attempter had an identifiable stressor including inadequately controlled pain in 3, agitation and anxiety in 2 each, and acute delirium, insomnia and psychosocial difficulties in 1 each. Conclusion: First, this study's findings underscore the rarity of reported inpatient medical/surgical suicidal behavior. In this sample, suicide attempters were distinct from nonattempters by the increased likelihood of prior suicide attempts as well as inpatient psychiatric consultations before their attempts. When patients have these characteristics, medical teams should take particular notice and initiate heightened watchfulness for suicidal behavior. © 2013 Elsevier Inc.
Keywords: adult; African American; aged; agitation; alcohol withdrawal syndrome; alcoholism; anxiety disorder; article; Asian; cancer patient; case control study; comorbidity; controlled study; delirium; drug overdose; dyspnea; emotional stress; female; hospital patient; human; insomnia; length of stay; major clinical study; major depression; male; orthopedic surgery; pain; personality disorder; physical stress; posttraumatic stress disorder; prevalence; psychosocial disorder; risk assessment; risk factor; suicidal behavior; suicidal ideation; suicide attempt; surgical patient; thorax pain

Self-perception in a clinical sample of gender variant children. - Rijn, A.B.; Steensma, T.D.; Kreukels, B.P.; Cohen-Kettenis, P.T. (Clinical child psychology and psychiatry, 2013)
Gender variance (GV) in childhood has a negative impact on the self-concept of children in the general population and can lead to mental health problems and even suicidal ideation in adulthood. This study explored the self-concept of clinically referred gender variant children and examined potential risk factors. The Self-Perception Profile for Children was administered to 147 children, who were referred to a gender identity clinic. Their parents completed the Child Behaviour Checklist and the Gender Identity Questionnaire to assess the degree of GV. The referred children were at risk of developing a negative self-concept; more specifically gender variant girls had low scores on 'global self-worth', 'physical appearance' and 'behavioural conduct' compared to Dutch norms for girls. Gender variant boys had low scores on 'global self-worth', 'scholastic competence', 'athletic competence' and 'physical appearance' compared to Dutch norms for boys. Within the group of referred children, sex differences, but no age effects, were found. The referred girls felt more competent than the referred boys on 'athletic competence' and 'scholastic functioning'. For both boys and girls poor peer relations had a significant negative relationship with self-concept and more GV was related to a lower global self-worth. Clinically referred gender variant children seemed vulnerable to developing a negative self-concept. Poor peer relations and extreme GV might be mediating variables. Interventions might focus on enhancing acceptance of the environment and improving social skills of gender variant children.
Keywords: article; child; female; gender dysphoria; gender identity; Gender variance; human; human relation; male; parent; psychological aspect; questionnaire; self concept; self concept; self concept; social behavior; transsexuality

Adolescent suicide in Australia: rates, risk and resilience. - McNamara, P.M. (Clinical child psychology and psychiatry, 2013)
Adolescent suicide rates in Australia have fallen significantly during recent years. The incidence, however, clearly remains a serious concern for young people, parents, professionals and policy makers. Some groups of Australian youth appear to be at heightened risk. Adolescents within the welfare system, indigenous, rural and refugee youth, along with same sex attracted young people often need very careful monitoring and support. Young men continue to take their lives more frequently than young women. Prevention programmes in Australia aim to develop resilience in young people, families and communities that can serve as protection against self harm and suicide. The improvement of mental health literacy, a fostering of adolescent self-efficacy and better access to early intervention strategies are currently privileged in national and state policies related to young people in Australia. More work is needed, however, to achieve a well integrated mental health framework capable of effectively addressing adolescent suicide prevention into the twenty-first century.
Keywords: adolescent; Adolescent suicide; article; Australia; coping behavior; female; health service; human; incidence; male; mental disease; psychological aspect; rates; risk; risk resilience; self concept; statistics; suicide

Suicide protective factors among trans adults. - Moody, C.; Smith, N.G. (Archives of sexual behavior, 2013)
A recent study indicated a suicide attempt rate of 41 % among trans (e.g., trans, transgender, transexual/transsexual, genderqueer, two-spirit) individuals. Although this rate is alarming, there is a dearth of literature regarding suicide prevention for trans individuals. A vital step in developing suicide prevention models is the identification of protective factors. It was hypothesized that social support from friends, social support from family, optimism, reasons for living, and suicide resilience, which are known to protect cis (non-trans) individuals, also protect trans individuals. A sample of self-identified trans Canadian adults (N = 133) was recruited from LGBT and trans LISTSERVs. Data were collected online using a secure survey platform. A three block hierarchical multiple regression model was used to predict suicidal behavior from protective factors. Social support from friends, social support from family, and optimism significantly and negatively predicted 33 % of variance in participants' suicidal behavior after controlling for age. Reasons for living and suicide resilience accounted for an additional 19 % of the variance in participants' suicidal behavior after controlling for age, social support from friends, social support from family, and optimism. Of the factors mentioned above, perceived social support from family, one of three suicide resilience factors (emotional stability), and one of six reasons for living (child-related concerns) significantly and negatively predicted participants' suicidal behavior. Overall, these findings can be used to inform the practices of mental health workers, medical doctors, and suicide prevention workers working with trans clients.
Keywords: adolescent; adult; aged; article; female; friend; human; male; middle aged; psychological aspect; risk factor; social support; suicidal ideation; suicide; suicide attempt; transsexualism; transsexuality

Sexuality and suicidality: matched-pairs analyses reveal unique characteristics in non-heterosexual suicidal behaviors. - Harris, K.M. (Archives of sexual behavior, 2013)
The present findings offer new perspectives on differences between suicide-risk heterosexuals and non-heterosexuals (lesbian, gay, bisexual, and questioning: LGBQ). Results from an anonymous online survey, employing standardized scales, showed that LGBQ participants reported significantly greater suicide-risk than heterosexuals. Seventy-nine matched pairs of suicide-risk LGBQ and heterosexuals were examined by individual suicide risk factors. Results showed no significant differences on separate measures of suicidal ideation; however, LGBQ participants were more likely to report suicide attempts, disclosure of suicidal intentions, and prediction of future suicide attempts. The LGBQ group also indicated greater likelihood of going online to develop new personal relationships. Multiple regression modeling was conducted to guide outreach and support efforts, revealing unique factors predicting help-seeking denial of suicide-risk LGBQ. Implications include the importance of online support and considering sexual minorities not just as a potential high-risk group, but also as a population with unique suicide risks and behaviors.
Keywords: adolescent; adult; article; automutilation; female; human; Internet; male; psychological aspect; risk factor; sexuality; social support; statistics; suicide; suicide attempt; violence

Self-perception in a clinical sample of gender variant children - Rijn, A.B.; Steensma, T.D.; Kreukels, B.P.; Cohen-Kettenis, P.T. (Clinical child psychology and psychiatry, 2013)
BACKGROUND: Gender variance (GV) in childhood has a negative impact on the self-concept of children in the general population and can lead to mental health problems and even suicidal ideation in adulthood. This study explored the self-concept of clinically referred gender variant children and examined potential risk factors. METHOD: The Self-Perception Profile for Children was administered to 147 children, who were referred to a gender identity clinic. Their parents completed the Child Behaviour Checklist and the Gender Identity Questionnaire to assess the degree of GV. RESULTS: The referred children were at risk of developing a negative self-concept; more specifically gender variant girls had low scores on 'global self-worth', 'physical appearance' and 'behavioural conduct' compared to Dutch norms for girls. Gender variant boys had low scores on 'global self-worth', 'scholastic competence', 'athletic competence' and 'physical appearance' compared to Dutch norms for boys. Within the group of referred children, sex differences, but no age effects, were found. The referred girls felt more competent than the referred boys on 'athletic competence' and 'scholastic functioning'. For both boys and girls poor peer relations had a significant negative relationship with self-concept and more GV was related to a lower global self-worth. CONCLUSIONS: Clinically referred gender variant children seemed vulnerable to developing a negative self-concept. Poor peer relations and extreme GV might be mediating variables. Interventions might focus on enhancing acceptance of the environment and improving social skills of gender variant children.
Keywords: child; female; gender identity; human; human relation; male; parent; psychology; questionnaire; self concept; social behavior; transgender

Adolescent suicide in Australia: rates, risk and resilience - McNamara, P.M. (Clinical child psychology and psychiatry, 2013)
Adolescent suicide rates in Australia have fallen significantly during recent years. The incidence, however, clearly remains a serious concern for young people, parents, professionals and policy makers. Some groups of Australian youth appear to be at heightened risk. Adolescents within the welfare system, indigenous, rural and refugee youth, along with same sex attracted young people often need very careful monitoring and support. Young men continue to take their lives more frequently than young women. Prevention programmes in Australia aim to develop resilience in young people, families and communities that can serve as protection against self harm and suicide. The improvement of mental health literacy, a fostering of adolescent self-efficacy and better access to early intervention strategies are currently privileged in national and state policies related to young people in Australia. More work is needed, however, to achieve a well integrated mental health framework capable of effectively addressing adolescent suicide prevention into the twenty-first century.
Keywords: adolescent; Australia; coping behavior; female; health service; human; incidence; male; mental disease; psychology; risk; self concept; statistics and numerical data; suicide

Suicide protective factors among trans adults - Moody, C.; Smith, N.G. (Archives of sexual behavior, 2013)
A recent study indicated a suicide attempt rate of 41 % among trans (e.g., trans, transgender, transexual/transsexual, genderqueer, two-spirit) individuals. Although this rate is alarming, there is a dearth of literature regarding suicide prevention for trans individuals. A vital step in developing suicide prevention models is the identification of protective factors. It was hypothesized that social support from friends, social support from family, optimism, reasons for living, and suicide resilience, which are known to protect cis (non-trans) individuals, also protect trans individuals. A sample of self-identified trans Canadian adults (N = 133) was recruited from LGBT and trans LISTSERVs. Data were collected online using a secure survey platform. A three block hierarchical multiple regression model was used to predict suicidal behavior from protective factors. Social support from friends, social support from family, and optimism significantly and negatively predicted 33 % of variance in participants' suicidal behavior after controlling for age. Reasons for living and suicide resilience accounted for an additional 19 % of the variance in participants' suicidal behavior after controlling for age, social support from friends, social support from family, and optimism. Of the factors mentioned above, perceived social support from family, one of three suicide resilience factors (emotional stability), and one of six reasons for living (child-related concerns) significantly and negatively predicted participants' suicidal behavior. Overall, these findings can be used to inform the practices of mental health workers, medical doctors, and suicide prevention workers working with trans clients.
Keywords: adolescent; adult; aged; female; friend; human; male; middle aged; psychology; risk factor; social support; suicidal ideation; suicide; suicide attempt; transgender; transsexualism

Sexuality and suicidality: matched-pairs analyses reveal unique characteristics in non-heterosexual suicidal behaviors - Harris, K.M. (Archives of sexual behavior, 2013)
The present findings offer new perspectives on differences between suicide-risk heterosexuals and non-heterosexuals (lesbian, gay, bisexual, and questioning: LGBQ). Results from an anonymous online survey, employing standardized scales, showed that LGBQ participants reported significantly greater suicide-risk than heterosexuals. Seventy-nine matched pairs of suicide-risk LGBQ and heterosexuals were examined by individual suicide risk factors. Results showed no significant differences on separate measures of suicidal ideation; however, LGBQ participants were more likely to report suicide attempts, disclosure of suicidal intentions, and prediction of future suicide attempts. The LGBQ group also indicated greater likelihood of going online to develop new personal relationships. Multiple regression modeling was conducted to guide outreach and support efforts, revealing unique factors predicting help-seeking denial of suicide-risk LGBQ. Implications include the importance of online support and considering sexual minorities not just as a potential high-risk group, but also as a population with unique suicide risks and behaviors.
Keywords: adolescent; adult; automutilation; female; human; Internet; male; psychology; risk factor; sexuality; social support; statistics and numerical data; suicide; suicide attempt; violence

Intersecting identities and the association between bullying and suicide attempt among New York city youths: results from the 2009 New York city youth risk behavior survey. - LeVasseur, M.T.; Kelvin, E.A.; Grosskopf, N.A. (American journal of public health, 2013)
We examined the intersections of sexual minority, gender, and Hispanic ethnic identities and their interaction with experiences of bullying in predicting suicide attempt among New York City youths. We performed secondary data analysis of the 2009 New York City Youth Risk Behavior Survey, using logistic regression to examine the association of sexual identity, gender, ethnicity, and bullying with suicide attempt. We stratified results on these measures and reported adjusted odds ratios. Compared with non-sexual minority youths, sexual minority youths had 4.39 and 1.96 times higher odds, respectively, of attempting suicide and reporting bullying. Identity variables did not interact with bullying in predicting suicide attempt individually; however, a four-way interaction term was significant. The effect of bullying on suicide attempt was strongest among non-Hispanic sexual minority male youths (odds ratio = 21.39 vs 1.65-3.38 for other groups). Sexual minority, gender, and ethnic identities interact with bullying in predicting suicide attempt among New York City youths. Interventions to limit both the prevalence and the effect of bullying among minority youths should consider an intersectional approach that considers ethnic, gender, and sexual identities.
Keywords: adolescent; article; bullying; child; cross-sectional study; ethnic group; female; health survey; high risk behavior; Hispanic; human; male; self report; sex difference; sexual behavior; statistical model; statistics; suicide attempt; United States

The Endocrinologist's Office-Puberty Suppression: Saving Children from a Natural Disaster? - Sadjadi, S. (Journal of Medical Humanities, 2013)
In the past few years, the introduction and rapid acceptance of puberty suppression has transformed the clinical treatment of children diagnosed with Gender Identity Disorder. This essay analyzes the narratives used by some advocates of this treatment, particularly the elements of saving children from the looming disaster of puberty and from future abject lives of violence and suicide as transgender adults. It briefly addresses the potential implications of this account for the well being of the children brought under clinical purview. © 2013 Springer Science+Business Media New York.
Keywords: gonadorelin; adolescent; article; child; drug effect; endocrinology; gender identity; health care facility; human; psychological aspect; puberty; sexual maturation; suicide; transsexualism; violence