Challenges faced by marginalized communities such as transgenders in Pakistan - Shah, H.B.U.; Rashid, F.; Atif, I.; Hydrie, M.Z.; Fawad, M.W.B.; Muzaffar, H.Z.; Rehman, A.; Anjum, S.; Mehroz, M.B.; Haider, A.; Hassan, A.; Shukar, H. (Pan African Medical Journal, 2018)
Introduction: Stigmatization, social exclusion and consequent banishment from the society makes transgender's life even tougher; isolating, pushing and forcing them into inappropriate conducts/habits like selling sex. This study investigates the association of social exclusion/victimization with high-risk behaviors among transgender community of Rawalpindi and Islamabad (Pakistan). Methods: Through a cross-sectional study design, a sample of 189 transgender community living in twin cities of Rawalpindi and Islamabad was selected using snowball sampling technique. A validated close ended questionnaire was used to estimate the high-risk behaviors. Multivariate logistic regression was used to explore the competing outcomes associated with suicidal risk, selling sex and substance abuse. Results: Majority study participants 77.8% experienced physical attacks with institutional discrimination even higher (91.5%). Commercial sex work and drug abuse was reported in 39.2% and 37.6% respectively. The prevalence of suicide ideation was high (38.6%) however, suicide attempted rate was less (18.5%). In the multivariate logistic regression, compared to those with no risk, being physically attacked increased the odds of both attempting (OR=2.18) and contemplating suicide and selling sex (OR=4.10). Nevertheless, the relative impact of institutional victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression (AOR = 6.20, CI = 1.58-24.29, p=0.009). Conclusion: The transgender community is socially excluded by the Pakistani society where they experience high levels of physical abuse and face discriminatory behavior in daily life. Such attitudes make them vulnerable for risky behaviors; forcing them to become commercial sex workers, begging, drugs use and even suicidal ideation.
Keywords: adult; article; community care; controlled study; cross-sectional study; discriminant analysis; gender identity; geographic distribution; health care need; high risk behavior; human; logistic regression analysis; major clinical study; outcome assessment; Pakistan; social discrimination; social exclusion; structured questionnaire; substance abuse; suicidal ideation; transgender

Experiences in bullying and/or Peer Victimization of Vulnerable, Marginalized, and Oppressed Children and Adolescents: An introduction to the special issue - Hong, J.S.; Peguero, A.A.; Espelage, D.L. (American Journal of Orthopsychiatry, 2018)
Keywords: adolescent behavior; article; bullying; child behavior; coping behavior; cystic fibrosis; depression; drug dependence; experience; human; mental disease; peer group; peer pressure; psychological well-being; sexual and gender minority; social exclusion; suicide attempt; victim; vulnerable population

Distinct Coping Profiles Are Associated With Mental Health Differences in Transgender and Gender Nonconforming Adults - Freese, R.; Ott, M.Q.; Rood, B.A.; Reisner, S.L.; Pantalone, D.W. (Journal of clinical psychology, 2018)
OBJECTIVE: This study assessed the unique coping strategies of transgender and gender nonconforming (TGNC) individuals in the United States used to manage gender-related stress, and examined associations between specific coping profiles and mental health. METHODS: Data were from 316 participants in the 2014-2015 Transgender Stress and Health Study, an online study of TGNC mental and sexual health. A factor analysis of the coping measure (Brief COPE) was followed by a k-means cluster analysis to evaluate distinct profiles of coping with gender-related stress. Proportional odds models and logistic regression models indicated how coping profiles related to levels of self-reported depressive symptoms and suicidality. RESULTS: A 4-factor structure was identified with three distinct profiles of coping with gender-related stress, each representative of the frequency (high or low) in which participants used functional and dysfunctional coping strategies: (a) high-functional/low-dysfunctional, (b) high-functional/high-dysfunctional, and (c) low-functional/low-dysfunctional. There were significant differences in depressive symptoms and suicidality based on distinct gender-related coping profiles. The high-functional/high-dysfunctional group reported significantly poorer mental health compared with the high-functional/low-dysfunctional group. CONCLUSION: To improve mental health outcomes in TGNC individuals, health providers and researchers should strive to not only promote functional coping strategies for managing gender-related stress but also decrease dysfunctional coping strategies.
Keywords: adolescent; adult; aged; cluster analysis; coping behavior; depression; factor analysis; female; human; male; mental stress; middle aged; psychology; suicidal ideation; transgender; United States; young adult

Exploring Lived Experience in Gender and Sexual Minority Suicide Attempt Survivors - Williams, S.M.; Frey, L.M.; Stage, D.L.; Cerel, J. (American Journal of Orthopsychiatry, 2018)
Gender and sexual minorities (GSM) are at a higher risk for victimization, discrimination, and emotional distress. GSM also face unique stressors that contribute to negative mental health outcomes, such as family and interpersonal rejection, ostracism and isolation, and internalized gender and sexual stigma. Suicide attempt survivors often experience similar stigma and isolation after an attempt. However, little is known about the specific experiences of GSM individuals who attempt suicide. Transcripts of interviews with 25 GSM attempt survivors conducted as part of the Live Through This project were analyzed using an interpretive phenomenological approach. Five themes that capture the lived experience of suicidality of the participants were identified in the interviews: (a) intersecting identities, (b) identity concealment, (c) internalized stigma and self-hate, (d) the social environment, and (e) the importance of peer support. Findings highlight the compounding stigma that occurs when individuals identify as both a GSM and a suicide attempt survivor. Implications for clinical work include the need for additional peer support for individuals who maintain the dual identity of GSM and suicide attempt survivor. Moreover, there is a need for mental health, crisis, and support resources and services tailored for GSM individuals that emphasize the importance of peer support in healing and recovery after a suicide attempt and in preventing future suicidal behavior. This important information can help us develop strategies to prevent suicide among the GSM population and to provide support for GSM suicide attempt survivors.
Keywords: adult; article; family; family service; family support; female; hate; human; identity; male; peer group; personal experience; qualitative research; self hate; sexual and gender minority; sexual orientation; social environment; social support; stigma; suicidal behavior; suicide attempt; survivor

Recent Suicide Attempts Across Multiple Social Identities Among Gay and Bisexual Men: An Intersectionality Analysis - Ferlatte, O.; Salway, T.; Hankivsky, O.; Trussler, T.; Oliffe, J.L.; Marchand, R. (Journal of homosexuality, 2018)
This study draws from intersectionality to describe variations in recent suicide attempts (RSA) among gay and bisexual men (GBM) across sociodemographics. Using survey data, logistic regression modeling explored RSA in two analytical stages: (1) the individual effects of each sociodemographic were measured; (2) two-way interaction terms between sociodemographics were tested and added to the models created in stage A. In stage A, only education and income achieved significance. In stage B, the study found that (a) education and income interacted significantly such that the odds of RSA increased for those with a lower income and a lower education; (b) sexual orientation and partnership status interacted, resulting in decreased odds among bisexual men in heterosexual partnerships; and (c) income and education interacted with geography; the effects of these variables were significant only among urban men. These findings suggest that GBM are at unequal risk of RSA according to intersecting sociodemographics.
Keywords: adolescent; adult; aged; bisexuality; female; heterosexuality; human; male; male homosexuality; middle aged; questionnaire; sexual behavior; social behavior; socioeconomics; statistical model; statistics and numerical data; suicide attempt; very elderly; young adult

Healthcare Engagement among Gay and Bisexual Men with Recent Suicide Ideation or Attempts - Salway, T.; Ferlatte, O.; Purdie, A.; Shoveller, J.; Trussler, T.; Gilbert, M. (American Journal of Orthopsychiatry, 2018)
Gay and bisexual men experience elevated rates of suicide ideation and attempts, as compared with heterosexual men, but face unique barriers in accessing health services. In this context, the present study sought to describe rates of health care engagement among gay and bisexual men with a recent history of suicide ideation or attempts. An anonymous online survey was conducted with 7,872 Canadian gay and bisexual men in 2014'2015. The sample was restricted to characterize patterns of mental health care engagement among respondents who reported suicide ideation or attempts in the previous 12 months. 'Engagement' was defined as having discussed mental health concerns (depression, substance use, or suicide) with a provider in the previous 12 months. Rates and correlates of engagement were estimated. Nineteen percent of men reported suicide ideation or attempts in the previous 12 months, of whom 58% had discussed mental health concerns with a provider. Older age, larger social support networks, and being out to a health care provider about one's sexuality were all positively associated with mental health care engagement. Among those who had not engaged with the health care system, 88% had some contact with a provider in the previous 12 months. One-third of these men accessed care through a provider other than their family doctor. Drawing on lessons learned from the HIV crises, collaborations between gay and bisexual community organizations and decision-makers within the health system are needed to address elevated rates of suicide ideation and attempts affecting sexual minorities.
Keywords: adult; age; article; bisexual male; Canada; Canadian; depression; general practitioner; health care access; health care personnel; health care system; homosexual male; human; male; medical history; mental health service; sexuality; social support; social welfare; substance use; suicidal ideation; suicide; suicide attempt

Suicidal and Help-Seeking Behaviors Among Youth in an Online Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Social Network - Lytle, M.C.; Silenzio, V.M.B.; Homan, C.M.; Schneider, P.; Caine, E.D. (Journal of homosexuality, 2018)
LGBTQ youth have a great burden for suicidal ideation/behavior compared to their non-LGBTQ peers. While scholars have explored risk factors for suicidal behaviors, little is known about protective factors among LGBTQ youth, let alone within group differences in terms of help-seeking. Data were collected from 203 TrevorSpace (e.g., a social network for LGBTQ youth) users via online survey to examine suicidal and help-seeking behaviors among LGBTQ individuals. Among participants who reported suicidal ideation/behavior, a large proportion did not seek help (73.1% of gay men, 33.3% of bisexual men, 42.9% of bisexual women, 14.3% of lesbian women, 41.2% of queer individuals) when they considered or attempted suicide. Among those who sought support, reaching out to a friend was most common. However, family support was associated with fewer suicidal behaviors. Our findings underscore the need to examine the effectiveness of specific sources of help and the impact of exposure to social connectedness.
Keywords: adolescent; bisexuality; female; help seeking behavior; homosexuality; human; male; psychology; questionnaire; risk factor; sexual and gender minority; sexual behavior; social media; social support; suicidal ideation; suicide; suicide attempt; transgender

Age at Exposure to Parental Suicide and the Subsequent Risk of Suicide in Young People - Lee, K.-Y.; Li, C.-Y.; Chang, K.-C.; Lu, T.-H.; Chen, Y.-Y. (Crisis, 2018)
BACKGROUND: We investigated the age at exposure to parental suicide and the risk of subsequent suicide completion in young people. The impact of parental and offspring sex was also examined. METHOD: Using a cohort study design, we linked Taiwan's Birth Registry (1978-1997) with Taiwan's Death Registry (1985-2009) and identified 40,249 children who had experienced maternal suicide (n = 14,431), paternal suicide (n = 26,887), or the suicide of both parents (n = 281). Each exposed child was matched to 10 children of the same sex and birth year whose parents were still alive. This yielded a total of 398,081 children for our non-exposed cohort. A Cox proportional hazards model was used to compare the suicide risk of the exposed and non-exposed groups. RESULTS: Compared with the non-exposed group, offspring who were exposed to parental suicide were 3.91 times (95% confidence interval [CI] = 3.10-4.92 more likely to die by suicide after adjusting for baseline characteristics. The risk of suicide seemed to be lower in older male offspring (HR = 3.94, 95% CI = 2.57-6.06), but higher in older female offspring (HR = 5.30, 95% CI = 3.05-9.22). Stratified analyses based on parental sex revealed similar patterns as the combined analysis. LIMITATIONS: As only register--based data were used, we were not able to explore the impact of variables not contained in the data set, such as the role of mental illness. CONCLUSION: Our findings suggest a prominent elevation in the risk of suicide among offspring who lost their parents to suicide. The risk elevation differed according to the sex of the afflicted offspring as well as to their age at exposure.
Keywords: adolescent; adult; age; case control study; cause of death; child; cohort analysis; epidemiology; female; human; infant; information retrieval; male; newborn; parental death; preschool child; proportional hazards model; register; retrospective study; risk; risk factor; statistics and numerical data; suicide; Taiwan; young adult

The child transgender patient in primary care: Practical advice for a 10-minute consultation - Cliffe, C.; Hillyard, M.; Joseph, A.; Majeed, A. (BJGP Open, 2018)
Keywords: article; automutilation; case report; child; clinical article; depression; follow up; gender dysphoria; hormonal therapy; human; long term care; male; male to female transgender; patient referral; primary medical care; psychologic assessment; puberty; school; social aspect; suicidal ideation

Deaths in the lesbian, gay, bisexual and transgender United Kingdom communities associated with GHB and precursors - Corkery, J.M.; Loi, B.; Claridge, H.; Goodair, C.; Schifano, F. (Current Drug Metabolism, 2018)
Background: Misuse of gammahydroxybutrate (GHB) and its prodrugs gammabutyrolactone (GBL) and 1,4 butanediol (1,4-BD) has increased greatly since the early 1990s, particularly amongst lesbian, gay, bisexual and transgender (LGBT) individuals in recreational and sexual settings, e.g. ‘chemsex’. Objective and Method: This paper presents an overview of GHB pharmacotoxicology and provides analyses of cases in the LGBT population associated with the use of these substances extracted from the UK’s National Programme on Substance Abuse Deaths database, to which notification is voluntary. Results: From 1995 to September 2013, 21 GHB/GBL-associated fatalities were reported. None involved 1,4-BD. Typical victims were: Male (100%); White (67%), young (mean age 34 years); employed (90%); with a drug misuse history (81%). Most deaths were accidental (67%) or related to recreational drug use (19%), the remaining (poten-tial) suicides. The majority of fatalities (83%) occurred in private residences, typically following recreational use; others occurred in specific ‘gay’-oriented locales including clubs and saunas. Three London boroughs accounted for 62% of all notified deaths, reflecting the concentration of both resident and visiting ‘gay’ individuals. However, this may be an artefact of the voluntary nature of the data submission procedure in particular areas. GHB/GBL alone was implicated in 10% of fatalities. The following substances were implicated either alone or in combination in the remaining cases (percentages may add to more than 100%): cocaine (38%); alcohol (33%); amphetamines (29%); ecstasy (29%); diazepam (24%); ketamine (24%); mephedrone (24%). Post-mortem blood levels: mean 660 (range 22-2335; S.D. 726) mg/L. Conclusion: Significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, stimulants, and ketamine. Risk of death is increased due to their CNS-depressant properties. Of these, ‘chemsex’ drugs such as cocaine, mephedrone and ketamine are of note. More awareness is needed in the ‘gay’ community about risks associated with the consumption of such substances.
Keywords: 1,4 butanediol; 4 hydroxybutyric acid; 4' methylmethcathinone; alcohol; amphetamine derivative; benzodiazepine derivative; cocaine; diazepam; fluoxetine; gamma butyrolactone; ketamine; midomafetamine; psychotropic agent; recreational drug; adult; anesthesia; article; ataxia; confusion; consciousness; death; drug administration route; drug blood level; drug dependence; drug intoxication; drug metabolism; employment; ethnicity; euphoria; female; hallucination; homosexual female; homosexual male; human; hypnosis; male; pharmacokinetics; precursor; risk factor; sedation; substance abuse; suicide; toxicology; tranquilizing activity; transgender; United Kingdom; young adult

Suicidality in Young Men Who Have Sex with Men: A Systematic Review of the Literature - Luong, C.T.; Rew, L.; Banner, M. (Issues in mental health nursing, 2018)
This systematic literature review addresses risk and protective factors associated with suicidal ideation and attempts in young men who have sex with men (YMSM). The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsychArticles, and PsychInfo yielded 14 articles. Risk factors included (1) not being enrolled in school, (2) earlier sexual debut, (3) substance use/abuse, (4) homelessness, (5) bullying and victimization, (6) fear of community violence, (7) and parental abuse. Protective factors included (1) positive sexual minority LGBT stereotypes, (2) family acceptance, (3) school and peer support, (4) high self-esteem, and (5) adaptive coping mechanisms.
Keywords: human; male; male homosexuality; psychology; risk factor; suicide

Mental Health Staff Perceptions and Practice Regarding Self-Harm, Suicidality and Help-Seeking in LGBTQ Youth: Findings from a Cross-Sectional Survey in the UK - Hughes, E.; Rawlings, V.; McDermott, E. (Issues in mental health nursing, 2018)
Young people who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) experience higher levels of suicidality compared to heterosexual or cisgender peers, and face significant barriers accessing mental health services including prejudice from staff. In a cross-sectional survey, mental health staff who reported receiving LGBT awareness training were significantly more likely to report in relation to working with LGBT youth that they routinely discussed issues of sexuality and gender (χ2=8.782, df=2, p < 0.05); to feel that their organisation supported them to work with this group (χ2=14.401, df=2, p < 0.001); and report that they had access to adequate skills training that supported their work with suicidality and self-harm with this group (χ2=21.911, df=2, p <0.001). There is a need to enhance the mental health workforce in LGBTQ awareness, and these findings indicate that awareness training could impact positively on practice.
Keywords: adolescent; adult; automutilation; cross-sectional study; female; health care delivery; health personnel attitude; human; male; mental health service; middle aged; patient attitude; psychology; questionnaire; sexual and gender minority; sexuality; suicide; United Kingdom

'Not Becoming Mother': A Phenomenological Exploration of the Therapeutic Relationship with Transgender Clients - Harmon, K.; Donohue, G. (Issues in mental health nursing, 2018)
LGBTI clients present specific challenges for the mental health profession with key issues for transgender people identified as including isolation, fear, stigma, and family rejection, all of which contribute to the transgender community's high levels of depression, anxiety, substance misuse, self-harm, and suicide. This qualitative research paper explores the experiences of Irish psychotherapists working with transgender clients to explore specifically the nature of the therapeutic relationship. Using an interpretive phenomenological approach, it examines the subjective experience of three participant psychotherapists and endeavours to make sense of the phenomenology that emerged from semi-structured interviews. The phenomenological analysis of the data collected resulted in three salient themes emerging: (i) Therapeutic identification, (ii) Maternal countertransference, and (iii) Confusion. It is hoped that these findings which relate to the therapeutic relationship will be of utmost importance to others working within the mental health profession where recovery is dependent on the strength of this relationship.
Keywords: doctor patient relationship; female; health personnel attitude; human; male; maternal behavior; psychology; psychotherapy; qualitative research; transgender; transsexualism

Medical management of transgender children and adolescents - Castilla-Peón, M.F. (Boletin Medico del Hospital Infantil de Mexico, 2018)
Transgender or gender incongruence (GI) persons identify themselves with a gender that is different from that correspondent to their birth sex. The demand for health services by families with transgender children or adolescents tends to increase. The prevalence of GI in children is unknown; however, it has been estimated to be > 1% in adolescents. Transgender persons are at increased risk of depression, suicide, illicit drug abuse, human immunodeficiency virus infection, and non-accidental injuries. The most accepted model for the care of transgender persons assumes that these adverse outcomes are the consequence of social margination rather than the GI condition itself. Social and physical gender transition seems to be effective in increasing the well-being of people with GI and reducing associated health risks. Mental health professionals can support the child in the process of social transition. The pediatric endocrinologist may offer puberty blockade and cross-sex induction of puberty. Surgical sex reassignment interventions are reserved for adults. Gender identity, gender expression, and sexual orientation are three relatively independent categories that can take any value, which is not necessarily binary (male/female) or fixed. Health professionals should be familiar with these concepts to offer the best resources available to optimize the well-being of each transgender child or adolescent with an individualized approach.
Keywords: testis prosthesis; estrogen; gonadorelin; medroxyprogesterone; testosterone; adolescent; adverse outcome; article; bone mineralization; breast augmentation; child; depression; estrogen therapy; female to male transgender; gender dysphoria; gender identity; gonadal disease; health care personnel; health hazard; health service; hormone substitution; human; hysterectomy; infection risk; male to female transgender; medical decision making; mental disease; mental health; penis amputation; plastic surgery; prepuberty; prevalence; salpingooophorectomy; secondary sexual characteristics; sexual behavior; sexual orientation; suicidal ideation; transgender; treatment planning; vagina reconstruction; wellbeing

Validating the syndemic threat surrounding sexual minority men's health in a population-based study with national registry linkage and a heterosexual comparison - Bränström, R.; Pachankis, J.E. (Journal of Acquired Immune Deficiency Syndromes, 2018)
Background: Research on the syndemic health threats facing sexual minority men suggests that the elevated risk of HIV among this population co-occurs with other psychosocial health disparities. This study aimed to conduct a population-based examination of clinically assessed syndemic predictors of HIV infection among gay and bisexual, compared with heterosexual, men. Setting and Methods: The sample comprised adult men in the Stockholm Public Health Cohort. A total of 29,328 (91.9%) selfidentified as heterosexual, 535 (1.7%) as gay, and 396 (1.2%) as bisexual. We linked survey responses to national health registry data. Results: Gay men had vastly elevated risk of HIV infection (>150 times) compared with heterosexuals. Gay men also had an elevated risk of depression, suicidality, and violent assaults compared with heterosexuals. Bisexual men had 16 times higher risk of being HIVpositive than heterosexual men. The number of psychosocial syndemic conditions was significantly associated with HIV infection among gay men (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [95% CI]: 1.18 to 2.36), but not among bisexual and heterosexual men (AOR = 0.51; 95% CI: 0.07 to 3.59; AOR = 1.92; 95% CI: 0.96 to 3.84). Among gay men, the association between cooccurring syndemic conditions and odds of HIV infection was synergistic (ie, more than additive). Conclusions: This study confirms emerging evidence of the syndemic health threats affecting sexual minority men, finds stronger evidence for syndemics among gay compared with bisexual men, and suggests the need for HIV-prevention interventions that comprehensively address the co-occurring, and synergistically perpetuating, disparities affecting this population.
Keywords: antidepressant agent; adult; aged; alcohol consumption; article; assault; bisexual male; bisexuality; cohort analysis; comparative study; depression; exposure to violence; heterosexual male; heterosexuality; homosexual male; hospitalization; human; Human immunodeficiency virus infection; infection risk; major clinical study; male; men's health; middle aged; population research; priority journal; prospective study; self report; sexual and gender minority; social psychology; suicide attempt; syndemic

Health and life satisfaction for Chinese gay men in Guangzhou, China - Yu, Y.; Xiao, S. (Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences, 2017)
OBJECTIVE: To understand Chinese gay men's health and life satisfaction in Guanzhou, and to analyze the main factors for life satisfaction.  Methods: Male gay participants were recruited through respondent-driven sampling and face-to-face investigations with self-administered questionnaires, including a general demographic questionnaire, a suicide questionnaire, the Depression-Anxiety Stress Scale, the Self-Stigma Scale, the Perceived Social Support Scale, the Rosenberg Self-Esteem Scale, and the Satisfaction with Life Scale.  Results: Surveys were successfully conducted for 420 gay men. High levels of depression, anxiety, and stress were observed among the respondents. A total of 29.3% had suicidal tendency in the past year, 36.5% experienced dating violence, 39.2% had homosexual sex without protection in the past 6 months, and 14.0% were infected with at least one type of infection of sexually transmitted diseases. Multiple linear regression analysis showed that gay men who felt highly satisfied with life exhibited low levels of self-stigma, high self-esteem, and low levels of depression. Moreover, they did not suffer dating violence and playing passive sex roles.  Conclusion: The survey confirmed that gay men in Guangzhou, China, have poor health and lower life satisfaction levels. Self-stigma, self-esteem, sex roles, depression, and dating violence are the main factors that influence the life satisfaction of them.
Keywords: anxiety; China; depression; health status; human; lifestyle; male; male homosexuality; mental stress; partner violence; patient health questionnaire; psychology; regression analysis; satisfaction; self concept; sexual and gender minority; statistics and numerical data

Lifetime prevalence of suicidal ideation among men who have sex with men: A meta-analysis - Luo, Z.; Feng, T.; Fu, H.; Yang, T. (BMC Psychiatry, 2017)
Background: Suicide is a leading cause of death among men who have sex with men (MSM) and suicidal ideation may put individuals at higher risk of suicide. A great disparity of lifetime prevalence of suicidal ideation among MSM was observed across studies, indicating the importance of a reliable estimation of the pooled lifetime prevalence. However, the only one published meta-analysis estimating the pooled lifetime prevalence of suicidal ideation among MSM was conducted in 2008 with only 2 eligible studies. Subsequently, there was a rapid increase of publications about lifetime suicidal ideation among MSM, suggesting that an update on the pooled lifetime prevalence of suicidal ideation among MSM was necessary. Therefore, this study aimed to update the estimation of the pooled lifetime prevalence of suicidal ideation among MSM. Methods: Electronic databases of PubMed, CINAHL, Scopus (social science), Embase and PsycInfo were searched until September 2017 to identify relevant studies. Cross-sectional studies exploring the lifetime prevalence of suicidal ideation among MSM were enrolled. Heterogeneity was evaluated using the Cochran Q test and quantified using the I 2 statistic. The possibility of publication bias was assessed using both Begg's rank test and Egger's linear test, and an Egger's funnel plot for asymmetry was presented. Subgroup analyses were performed according to the geographic area, sample source and HIV status. Results: Nineteen studies with a total of 26,667 MSM were included, of which 9374 were identified with suicidal ideation. A high degree of heterogeneity (P≤0.001, I 2 =99.2%) was observed among the eligible studies, with the reported prevalence ranging from 13.18 to 55.80%. The pooled lifetime prevalence of suicidal ideation among MSM by a random effects model was 34.97% (95% confidence interval: 28.35%-41.90%). Both the Begg's rank test and Egger's linear test indicated low possibility of publication bias. Subgroup analyses showed that the lifetime prevalence of suicidal ideation among MSM differed significantly by geographic area, sample source and HIV status (P<0.05). Conclusions: The high pooled lifetime prevalence of suicidal ideation among MSM found in this meta-analysis significantly underscores the importance of early assessment of suicidal ideation among MSM, as well as the need for strengthening the psychological interventions.
Keywords: article; cultural anthropology; geography; human; Human immunodeficiency virus infection; men who have sex with men; prevalence; sexual behavior; social status; suicidal ideation

Beta-amyloid deposition in patients with major depressive disorder with differing levels of treatment resistance: a pilot study - Li, P.; Hsiao, I.-T.; Liu, C.-Y.; Chen, C.-H.; Huang, S.-Y.; Yen, T.-C.; Wu, K.-Y.; Lin, K.-J. (EJNMMI Research, 2017)
Background: Lack of treatment response in patients with late-life depression is common. The role of brain beta-amyloid (Aβ) deposition in treatment outcome in subjects with late-life depression remains unclear. The present study aimed to investigate brain Aβ deposition in patients with major depressive disorder (MDD) with differing treatment outcomes in vivo using 18F-florbetapir imaging. This study included 62 MDD patients and 18 healthy control subjects (HCs).We first employed the Maudsley staging method (MSM) to categorize MDD patients into two groups according to treatment response: mild treatment resistance (n = 29) and moderate-to-severe treatment resistance (n = 33).The standard uptake value ratio (SUVR) of each volume of interest was analysed, and voxel-wise comparisons were made between the MDD patients and HCs. Vascular risk factors, serum homocysteine level, and apolipoprotein E (ApoE) genotype were also determined. Results: The MDD patients with moderate-to-severe treatment resistance had higher 18F-florbetapir SUVRs than the HCs in the parietal region (P < 0.01). Voxel-wise comparisons further demonstrated elevated SUVRs in MDD patients with moderate-to-severe treatment resistance in the precuneus, parietal, temporal, and occipital regions. The MDD patients with mild treatment resistance were found to have increased 18F-florbetapir uptake mainly in the left frontal and parietal regions as compared with the HCs. In addition, voxel-to-voxel correlation analysis showed that brain Aβ deposition was correlated positively with MSM score in the occipital region. 18F-florbetapir SUVRs were correlated negatively with Mini Mental Status Examination (MMSE) score in the sample of all MDD patients (r = −0.355, P = 0.005). Conclusions: This study provided preliminary evidence that region-specific Aβ deposition was present in some (but not all) MDD patients, especially in those with moderate-to-severe treatment resistance, and their depressive symptoms may represent prodromal manifestations of Alzheimer’s disease (AD). Depressive symptomatology in old age, particularly in subjects with a poor treatment response, may underscore early changes of AD-related pathophysiology.
Keywords: amyloid beta protein; apolipoprotein E; florbetapir f 18; homocysteine; aged; Alzheimer disease; article; controlled study; dementia; depressive psychosis; female; genotype; human; informed consent; major clinical study; major depression; male; Mini Mental State Examination; pilot study; positron emission tomography; priority journal; risk factor; suicide; treatment outcome; treatment response

Digital Self-Harm Among Adolescents - Patchin, J.W.; Hinduja, S. (Journal of Adolescent Health, 2017)
Purpose Despite increased media and scholarly attention to digital forms of aggression directed toward adolescents by their peers (e.g., cyberbullying), very little research has explored digital aggression directed toward oneself. “Digital self-harm” is the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself. The current study examined the extent of digital self-harm among adolescents. Methods Survey data were obtained in 2016 from a nationally representative sample of 5,593 American middle and high school students (12–17 years old). Logistic regression analysis was used to identify correlates of participation in digital self-harm. Qualitative responses were also reviewed to better understand motivations for digital self-harm. Results About 6% of students have anonymously posted something online about themselves that was mean. Males were significantly more likely to report participation (7.1% compared to 5.3%). Several statistically significant correlates of involvement in digital self-harm were identified, including sexual orientation, experience with school bullying and cyberbullying, drug use, participation in various forms of adolescent deviance, and depressive symptoms. Conclusions Digital self-harm is a new problem that demands additional scholarly attention. A deeper inquiry as to the motivations behind this behavior, and how it correlates to offline self-harm and suicidal ideation, can help direct mental health professionals toward informed prevention approaches.
Keywords: adolescent; article; automutilation; bullying; child; cyberbullying; depression; drug use; female; high school student; human; major clinical study; male; middle school student; motivation; priority journal; school child; sex difference; sexual orientation

Suicide in prisons: an international study of prevalence and contributory factors - Fazel, S.; Ramesh, T.; Hawton, K. (The Lancet Psychiatry, 2017)
Background Prison suicide rates, rate ratios, and associations with prison-related factors need clarification and updating. We examined prison suicide rates in countries where reliable information was available, associations with a range of prison-service and health-service related factors, how these rates compared with the general population, and changes over the past decade. Methods We collected data for prison suicides in 24 high-income countries in Europe, Australasia, and North America from their prison administrations for 2011–14 to calculate suicide rates and rate ratios compared with the general population. We used meta-regression to test associations with general population suicide rates, incarceration rates, and prison-related factors (overcrowding, ratio of prisoners to prison officers or health-care staff or education staff, daily spend, turnover, and imprisonment duration). We also examined temporal trends. Findings 3906 prison suicides occurred during 2011–14 in the 24 high-income countries we studied. Where there was breakdown by sex (n=2810), 2607 (93%) were in men and 203 (7%) were in women. Nordic countries had the highest prison suicide rates of more than 100 suicides per 100 000 prisoners apart from Denmark (where it was 91 per 100 000), followed by western Europe where prison suicide rates in France and Belgium were more than 100 per 100 000 prisoners. Australasian and North American countries had rates ranging from 23 to 67 suicides per 100 000 prisoners. Rate ratios, or rates compared with those in the general population of the same sex and similar age, were typically higher than 3 in men and 9 in women. Higher incarceration rates were associated with lower prison suicide rates (b = –0·504, p = 0·014), which was attenuated when adjusting for prison-level variables. There were no associations between rates of prison suicide and general population suicide, any other tested prison-related factors, or differing criteria for defining suicide deaths. Changes in prison suicide rates over the past decade vary widely between countries. Interpretation Many countries in northern and western Europe have prison suicide rates of more than 100 per 100 000 prisoners per year. Individual-level information about prisoner health is required to understand the substantial variations reported and changes over time. Funding Wellcome Trust and the UK National Institute for Health Research (NIHR).
Keywords: adult; article; crowding (area); female; health care; high income country; human; major clinical study; male; population; prevalence; priority journal; correctional facility; prisoner; suicide

Comparing Treatment Response between LGBQ and Heterosexual Individuals Attending a CBT- and DBT-Skills-Based Partial Hospital - Beard, C.; Kirakosian, N.; Silverman, A.L.; Winer, J.P.; Wadsworth, L.P.; Björgvinsson, T. (Journal of Consulting and Clinical Psychology, 2017)
Objective: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ), no prior study has examined mental health treatment outcomes for LGBQ populations receiving standard care. We compared individuals identifying as LGBQ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Method: A total of 441 participants (19% LGBQ; mean age 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment. Results: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities. Conclusions: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ affirmative treatments for specific LGBQ subgroups are superior to traditional treatments.
Keywords: adult; article; automutilation; behavior therapy; cognitive behavioral therapy; comparative study; demography; dialectical behavior therapy; female; generalized anxiety disorder; heterosexuality; hospital; hospital admission; human; major clinical study; male; patient care; Patient Health Questionnaire 9; perception; questionnaire; sexual and gender minority; suicidal ideation; treatment outcome; treatment response

Fifteen-minute consultation in the normal child: Challenges relating to sexuality and gender identity in children and young people - O'Neill, T.; Wakefield, J. (Archives of Disease in Childhood: Education and Practice Edition, 2017)
Lesbian, gay, bisexual and transgender (LGBT+) young people face several challenges in their daily lives, including specific healthcare inequalities. Negative societal attitudes towards sexual and gender minorities, and the effects of regular experiences of bullying and homophobia/transphobia exacerbate the normal trials and tribulations of childhood and adolescence. Barriers to accessing healthy activities, such as sport, are created by perceived stigma and real-life experiences. Healthcare environments are by default heteronormative and contribute to the isolation and exclusion of LGBT+ young people. Paediatricians are well placed to act on these healthcare inequalities and to advocate for LGBT+ youth, through simple changes to individual practice as well as system-wide improvements.
Keywords: alcohol; adolescent; adolescent pregnancy; anxiety disorder; article; attitude; automutilation; bisexuality; bullying; child; consultation; depression; diet; eating disorder; exercise; experience; gender identity; health care; health care access; home; homophobia; homosexual female; homosexual male; human; mental health; pediatrician; personal experience; priority journal; public health; school; sexual and gender minority; sexuality; sport; suicide; transgender; violence

Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland - McLafferty, M.; Lapsley, C.R.; Ennis, E.; Armour, C.; Murphy, S.; Bunting, B.P.; Bjourson, A.J.; Murray, E.K.; O’Neill, S.M. (PLoS ONE, 2017)
Mental health and behavioural problems are common among students commencing university. University life can be stressful and problems often exacerbate during their course of study, while others develop disorders for the first time. The WHO World Mental Health Surveys International College Student Project aims to conduct longitudinal research to examine and monitor student mental health and wellbeing. The Ulster University Student Wellbeing study, which commenced in September 2015 in Northern Ireland (NI), was conducted as part of this initiative (wave 1, n = 739), using the WMH-CIDI to examine psychopathology. Baseline prevalence rates of lifetime and 12-month mental health and substance disorders, ADHD and suicidality were high, with more than half of new undergraduate students reporting any lifetime disorder. Co-morbidity was common with 19.1% of students experiencing three or more disorders. Logistic regression models revealed that females, those over 21, non-heterosexual students, and those from a lower SES background were more likely to have a range of mental health and behavioural problems. Overall, 10% of new entry students received treatment for emotional problems in the previous year. However, 22.3% of students with problems said they would not seek help. The study provides important information for universities, policy makers and practice, on mental health and wellbeing in young people generally but particularly for students commencing university. The findings will assist in the development and implementation of protection and prevention strategies in the university setting and beyond.
Keywords: adult; article; behavior disorder; college student; comorbidity; drug dependence; emotional disorder; female; help seeking behavior; human; major clinical study; male; mental health; Northern Ireland; student attitude; suicidal behavior; undergraduate student; wellbeing

Acute toxicity test of triple fermented barley extracts (fbe) in mice after oral administration - Lim, J.-M.; Park, D.-C.; Cho, H.-R.; Jung, G.-W.; Ku, S.K.; Choi, J.-S. (Toxicology and Environmental Health Sciences, 2017)
The objective of this study was to obtain information on acute (single) oral dose toxicity of triple fermented (using saccharification, Saccharomyces cerevisiae, and Weissella cibaria) barley extracts (Hordeum vulgare L., FBe) in female and male ICR mice, to facilitate the development of natural products as medicinal ingredients and functional food. To investigate toxicity and identify target organs, FBe was orally administered once to female and male ICR mice at doses of 2000, 1000, 500, and 0 mg/kg (of body weight) in a volume of 20 mL/kg, dissolved in distilled water. The mortality, change in body weight, and clinical signs were monitored for 14 days following treatment. Additionally, gross observations of the organs, changes in organ weights, and histopathological measurements of principle organs were compared between treatment and control groups of the same sex. The results showed that a single oral dose of FBe was not associated with mortality in any of the treatment groups over the 14-day experimental period. No FBe treatment-related changes in body and organ weights, clinical signs, or necropsy and histopathological findings were detected in this experiment. The results obtained in this study suggest that FBe is non-toxic in mice and is therefore likely to be safe for clinical use. The LD50 (lethal dose in 50% of animals) and approximate LD in mice following a single oral dose of FBe were determined to be greater than 2000 mg/kg, the recommended dose limit for both female and male rodents. In addition, no specific organ targets or clinical signs were detected.
Keywords: barley extract; plant extract; unclassified drug; animal experiment; animal tissue; article; autopsy; barley; body weight; bronchiole; cell hyperplasia; cell infiltration; controlled study; female; histopathology; LD50; liver parenchyma; lung congestion; male; megakaryocyte; mortality; mouse; nonhuman; organ weight; priority journal; Saccharomyces cerevisiae; submandibular lymph node; thymus cyst; toxicity testing; body weight gain; Weissella

Enacted Stigma, Mental Health, and Protective Factors among Transgender Youth in Canada - Veale, J.F.; Peter, T.; Travers, R.; Saewyc, E.M. (Transgender Health, 2017)
Purpose: We aimed to assess the Minority Stress Model which proposes that the stress of experiencing stigma leads to adverse mental health outcomes, but social supports (e.g., school and family connectedness) will reduce this negative effect. Methods: We measured stigma-related experiences, social supports, and mental health (self-injury, suicide, depression, and anxiety) among a sample of 923 Canadian transgender 14- to 25-year-old adolescents and young adults using a bilingual online survey. Logistic regression models were conducted to analyze the relationship between these risk and protective factors and dichotomous mental health outcomes among two separate age groups, 14- to 18-year-old and 19- to 25-year-old participants. Results: Experiences of discrimination, harassment, and violence (enacted stigma) were positively related to mental health problems and social support was negatively associated with mental health problems in all models among both age groups. Among 14-18 year olds, we examined school connectedness, family connectedness, and perception of friends caring separately, and family connectedness was always the strongest protective predictor in multivariate models. In all the mental health outcomes we examined, transgender youth reporting low levels of enacted stigma experiences and high levels of protective factors tended to report favorable mental health outcomes. Conversely, the majority of participants reporting high levels of enacted stigma and low levels of protective factors reported adverse mental health outcomes. Conclusion: While these findings are limited by nonprobability sampling procedures and potential additional unmeasured risk and protective factors, the results provide positive evidence for the Minority Stress Model in this population and affirm the need for policies and programs to support schools and families to support transgender youth.
Keywords: adolescent; adult; adverse outcome; anxiety; article; automutilation; bilingualism; Canadian; controlled study; depression; female; groups by age; harassment; health survey; human; juvenile; male; online system; outcome assessment; prevalence; priority journal; probability; risk assessment; risk factor; social discrimination; social support; stigma; suicide; transgender; violence; young adult

Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM - Rodriguez-Hart, C.; Nowak, R.G.; Musci, R.; German, D.; Orazulike, I.; Kayode, B.; Liu, H.; Gureje, O.; Crowell, T.A.; Baral, S.; Charurat, M. (AIDS, 2017)
Objectives: Sexual stigma affecting MSM in Nigeria may be an important driver of HIV and other sexually transmitted infections (STIs), but potential mechanisms through which this occurs are not well understood. This study assessed the contributions of suicidal ideation and sexual risk behaviors to causal pathways between stigma and HIV/STIs. Design: Data were collected from the TRUST/RV368 Study, a prospective cohort of 1480 MSM from Abuja and Lagos, Nigeria. Methods: Participants enrolled from March 2013 to February 2016 were classified into three stigma subgroups based on a latent class analysis of nine stigma indicators. Path analysis was used to test a model where disclosure led to stigma, then suicidal ideation, then condomless sex with casual sex partners, and finally incident HIV infection and/or newly diagnosed STIs, adjusting the model for age, education, having had female sex partners in the past 12 months, and sex position. Both direct and indirect (mediational) paths were tested for significance and analyses were clustered by city. Results: As stigma increased in severity, the proportion of incident HIV/STI infections increased in a dose-response relationship (low: 10.6%, medium: 14.2%, high 19.0%, P=0.008). All direct relationships in the model were significant and suicidal ideation and condomless sex partially mediated the association between stigma and incident HIV/STI infection. Conclusion: These findings highlight the importance of the meaningful integration of stigma-mitigation strategies in conjunction with mental health services as part of a broader strategy to reduce STI and HIV acquisitions among Nigerian MSM.
Keywords: condom; adult; article; casual sex; cohort analysis; condom use; dose response; educational status; human; Human immunodeficiency virus; major clinical study; male; men who have sex with men; Nigeria; Nigerian; priority journal; prospective study; sexual behavior; sexually transmitted disease; stigma; suicidal ideation

The kids are OK: It is discrimination, not same-sex parents, that harms children - Knight, K.W.; Stephenson, S.E.M.; West, S.; Delatycki, M.B.; Jones, C.A.; Little, M.H.; Patton, G.C.; Sawyer, S.M.; Skinner, S.R.; Telfer, M.M.; Wake, M.; North, K.N.; et al. (Medical Journal of Australia, 2017)
Keywords: academic achievement; anxiety; article; automutilation; bullying; child parent relation; child protection; depression; distress syndrome; family relation; health hazard; heterosexuality; homophobia; human; LGBT people; peer acceptance; posttraumatic stress disorder; problem behavior; psychological well-being; same-sex marriage; social discrimination; social interaction; social problem; social stigma; suicidal behavior

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

Acne, sexual orientation, and mental health among young adults in the United States: A population-based, cross-sectional study - Gao, Y.; Wei, E.K.; Arron, S.T.; Linos, E.; Margolis, D.J.; Mansh, M.D. (Journal of the American Academy of Dermatology, 2017)
Keywords: acne; adult; article; body image; cross-sectional study; deformity; depression; female; heterosexuality; human; major clinical study; male; mental health; population research; priority journal; sexual and gender minority; sexual orientation; suicidal ideation; United States; young adult

Current Resources for Evidence-Based Practice, November/December 2017 - Carlson, N.S. (Journal of Midwifery and Women's Health, 2017)
Keywords: article; contraception; depression; evidence based practice; experience; gender identity; health care access; health care need; health care quality; health disparity; health education; human; LGBTQIA+ people; priority journal; safe sex; sexual and gender minority; sexual orientation; substance abuse; suicide; wellbeing

The Relationship Between Sexual History, Bullying Victimization, and Poor Mental Health Outcomes Among Heterosexual and Sexual Minority High School Students: A Feminist Perspective - Dunn, H.K.; Clark, M.A.; Pearlman, D.N. (Journal of interpersonal violence, 2017)
This study uses a feminist theoretical framework to extend the literature on the relationship between sexual history, bullying victimization, and poor mental health outcomes. First, we examined whether an association between the sexual double standard and bullying victimization would apply to sexual minority youth the same way it applies to heterosexual youth. A second aim was to assess whether sexual minority boys, typically stereotyped as effeminate, would report the highest odds of bullying victimization. A third and final aim of our study was to look at the joint effect of sex and sexual intercourse on depression and suicidal ideation. Our analytic sample ( N = 9,300) was from the 2009, 2011, and 2013 Rhode Island Youth Risk Behavior Surveys. Findings demonstrated that heterosexual girls who engaged in sexual intercourse had significantly higher adjusted odds of bullying victimization than heterosexual boys who engaged in the same behavior. Similar results were not found for sexual minority adolescents, suggesting the sexual double standard may not apply to sexual minority adolescents in the same way it applies to heterosexual adolescents. Consistent with our second hypothesis, sexual minority boys reported the highest odds of being recently bullied compared with heterosexual boys. Among students who were recently bullied, sexual minority girls displayed the highest adjusted odds of recent depression and suicidal ideation. Our study demonstrated that using a feminist theoretical framework broadens our understanding of why girls and sexual minority boys are particularly vulnerable to bullying victimization and the sequel of depression and suicidal ideation.
Keywords: adolescent; adolescent behavior; bullying; crime victim; depression; female; feminism; heterosexuality; human; male; psychology; Rhode Island; sex factor; sexual and gender minority; sexual behavior; statistics and numerical data; suicidal ideation

Risk and Protective Factors in the Lives of Transgender/Gender Nonconforming Adolescents - Eisenberg, M.E.; Gower, A.L.; McMorris, B.J.; Rider, G.N.; Shea, G.; Coleman, E. (Journal of Adolescent Health, 2017)
Purpose Research suggests that transgender and gender nonconforming (TGNC) youth may be at greatly increased risk of high-risk health behaviors compared with cisgender youth, but existing studies are limited by convenience samples and small numbers. This study uses a large school-based sample of adolescents to describe the prevalence of TGNC identity, associations with health risk behaviors and protective factors, and differences across birth-assigned sex. Methods This study analyzes existing surveillance data provided by 9th and 11th grade students in Minnesota in 2016 (N = 81,885). Students who were transgender, genderqueer, genderfluid, or unsure about their gender identity (TGNC) were compared with those who were not, using χ2 and t-tests. Outcome measures included four domains of high-risk behaviors and experiences and four protective factors. Results The prevalence of TGNC identity was 2.7% (n = 2,168) and varied significantly across gender, race/ethnicity, and economic indicators. Involvement in all types of risk behaviors and experiences was significantly higher, and reports of four protective factors were significantly lower among TGNC than cisgender youth. For example, almost two-thirds (61.3%) of TGNC youth reported suicidal ideation, which is over three times higher than cisgender youth (20.0%, χ2 = 1959.9, p <.001). Among TGNC youth, emotional distress and bullying experience were significantly more common among birth-assigned females than males. Conclusions This research presents the first large-scale, population-based evidence of substantial health disparities for TGNC adolescents in the United States, highlighting numerous multilevel points of intervention through established protective factors. Health care providers are advised to act as allies by creating a safe space for young people, bolstering protective factors, and supporting their healthy development.
Keywords: adolescent; article; bullying; chi square test; emotional stress; ethnicity; female; gender identity; health behavior; health hazard; high risk behavior; human; juvenile; major clinical study; male; prevalence; priority journal; protection; race; student; Student t test; suicidal ideation; transgender

Transgender Women's Drug Use in the Dominican Republic - Budhwani, H.; Hearld, K.R.; Milner, A.N.; McGlaughlin, E.; Charow, R.; Rodriguez-Lauzurique, R.M.; Rosario, S.; Paulino-Ramirez, R. (Transgender Health, 2017)
Purpose: Studies on drug use in transgender populations, particularly those in resource-limited settings, are scarce. Considering that drug use can be a coping mechanism to deal with stigma and traumatic experiences, we examined associations between stigma, trauma, and drug use in a national sample of transgender women from the Dominican Republic. Methods: Bivariate analyses examined differences between drug users and abstainers (n=287). Multivariate analyses reported odds ratios (OR) with general drug, marijuana, and cocaine use as outcomes (n=243). Results: A quarter of respondents (24.5%) experienced sexual abuse, 12.1% were tortured, and 20.1% experienced a murder attempt. More than a quarter reported using illegal drugs (26.1%). Drug users had lower socioeconomic status; 30.0% of drug users had a primary level of education or less (18.2% of abstainers) and 17.6% of drug users had higher income, defined as greater than 10,001 pesos (∼$210 United States Dollars, USD) per month (28.1% of abstainers). More than half of drug users experienced some form of trauma (51.4%) compared to 43.5% of abstainers, and 28.4% of drug users, compared to 17.1% of abstainers, experienced a murder attempt on her life. Independent sample t-tests found significant differences between drug users and abstainers. Transgender women who experienced sexual abuse had three times high odds of using cocaine. Drug users were more likely to have experienced sexual abuse and attempted suicide (p<0.05 for both). Respondents who attempted suicide had higher odds of using drugs generally and using marijuana specifically, compared to respondents who had not attempted suicide (OR=2.665 and 3.168, respectively). Higher scores on the stigma scale were associated with higher odds of any drug use and cocaine use (OR=1.132 and 1.325, respectively). Conclusions: Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are not consistently enforced. Eliminating stigma and stigmatizing policies may reduce rates of drug use as a coping mechanism.
Keywords: cannabis; cocaine; illicit drug; academic achievement; adult; article; cannabis addiction; cocaine dependence; controlled study; Dominican Republic; drug dependence; highest income group; homicide; human; independent variable; major clinical study; male; male to female transgender; outcome assessment; personal experience; priority journal; sexual abuse; social status; stigma; suicide attempt; torture

Elevated Prevalence of Suicide Attempts among Victims of Police Violence in the USA - DeVylder, J.E.; Frey, J.J.; Cogburn, C.D.; Wilcox, H.C.; Sharpe, T.L.; Oh, H.Y.; Nam, B.; Link, B.G. (Journal of urban health : bulletin of the New York Academy of Medicine, 2017)
Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Survey of Police-Public Encounters, a population-based survey of adults (N = 1615) residing in four US cities. Surveys assessed lifetime exposure to police victimization based on the World Health Organization domains of violence (i.e., physical, sexual, psychological, and neglect), using the Police Practices Inventory. Logistic regression models tested for associations between police victimization and (1) past 12-month suicide attempts and (2) past 12-month suicidal ideation, adjusted for demographic factors (i.e., gender, sexual orientation, race/ethnicity, income), crime involvement, past intimate partner and sexual victimization exposure, and lifetime mental illness. Police victimization was associated with suicide attempts but not suicidal ideation in adjusted analyses. Specifically, odds of attempts were greatly increased for respondents reporting assaultive forms of victimization, including physical victimization (odds ratio = 4.5), physical victimization with a weapon (odds ratio = 10.7), and sexual victimization (odds ratio = 10.2). Assessing for police victimization and other violence exposures may be a useful component of suicide risk screening in urban US settings. Further, community-based efforts should be made to reduce the prevalence of exposure to police victimization.
Keywords: adolescent; adult; aged; crime; crime victim; female; human; male; middle aged; police; prevalence; socioeconomics; statistics and numerical data; suicidal ideation; suicide attempt; United States; urban population; World Health Organization; young adult

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008-2014 - Blosnich, J.R.; Lytle, M.C.; Coulter, R.W.S.; Whitfield, D.L. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2017)
Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n = 5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR = 1.92; 95% CI: 1.06, 3.46), dishonors family (OR = 1.83; 95% CI: 1.01, 3.28), or is tired of living (OR = 2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals.
Keywords: adult; causality; classification; community care; epidemiology; female; health disparity; human; male; needs assessment; organization and management; prevalence; procedures; psychology; psychosocial care; risk assessment; risk factor; sexual and gender minority; statistics and numerical data; suicidal ideation; suicide attempt; United States

Amphetamine-Type-Stimulants (ATS) Use and Homosexuality-Related Enacted Stigma Are Associated With Depression Among Men Who Have Sex With Men (MSM) in Two Major Cities in Vietnam in 2014 - Vu, N.T.T.; Holt, M.; Phan, H.T.T.; La, L.T.; Tran, G.M.; Doan, T.T.; Nguyen, T.N.N.; de Wit, J. (Substance use & misuse, 2017)
BACKGROUND: Men who have sex with men (MSM) are disproportionately affected by mental health concerns, including depression. Amphetamine-type-stimulants (ATS) use and homosexuality-related stigma and discrimination have been found associated with depression among MSM. OBJECTIVES: To assess the prevalence of depression and its associations with ATS use and homosexuality-related stigma and discrimination among MSM in Vietnam. METHODS: 622 MSM were conveniently recruited in Hanoi and Ho Chi Minh city, Vietnam, from September to December 2014. We collected information on demographic characteristics, ATS, alcohol and other drug use, sexual behaviors, homosexuality-related and discrimination stigma, and sexual sensation-seeking. Depression and suicidal thoughts were assessed by the Patient Health Questionnaire (PHQ-9). We assessed associations of depression with ATS use and homosexuality-related stigma and discrimination using logistic regression. RESULTS: Of 622 sampled MSM, 11.3% were classified as having major depression, 9.8% reported any suicidal thoughts in the last two weeks, 30.4% ever had used any ATS, 88.8% ever ad drank alcohol and 21.5% had ever used any other drugs. In multivariate analysis, depression was significantly associated with ATS use (Adjusted Odds Ratio [AOR: 2.20; (95% Confidence Interval (CI): 1.32-3.67], younger age of sexual debut with another man (AOR: 0.09; 95% CI: 0.02-0.50), and greater enacted homosexuality-related stigma (AOR: 1.97; 95% CI: 1.19-3.26). CONCLUSIONS: We found a moderate prevalence of depression among sampled MSM, which was associated with ATS use and enacted homosexuality-related stigma. We recommend integrating assessment and interventions regarding depression and methamphetamine use into gay-friendly, culturally adapted holistic HIV prevention for MSM in Vietnam.
Keywords: adolescent; adult; age; amphetamine dependence; city; complication; cross-sectional study; depression; health survey; human; male; male homosexuality; mental health; middle aged; prevalence; psychology; sexual behavior; social stigma; suicidal ideation; Viet Nam; young adult

Psychological characteristics of Italian gender dysphoric adolescents: a case–control study - Fisher, A.D.; Ristori, J.; Castellini, G.; Sensi, C.; Cassioli, E.; Prunas, A.; Mosconi, M.; Vitelli, R.; Dèttore, D.; Ricca, V.; Maggi, M. (Journal of Endocrinological Investigation, 2017)
Purpose: Gender dysphoria (GD) is associated with clinically significant distress and impairment in social, scholastic, and other important areas of functioning, especially when early onset is reported. The aim of the present study is to assess the psychopathological features associated with GD in adolescence, comparing a group of gender dysphoric adolescents (GDs) with a group of non-referred adolescents (NRs), in terms of body uneasiness, suicide risk, psychological functioning, and intensity of GD. Methods: A sample of 46 adolescents with GD and 46 age-matched NRs was evaluated (mean ± SD age = 16.00 ± 1.49 and 16.59 ± 1.11 respectively, p > 0.05). Subjects were asked to complete the Body Uneasiness Test (BUT) to explore body uneasiness, the Youth Self Report (YSR) to measure psychological functioning, the Multi-Attitude Suicide Tendency Scale (MAST) for suicide risk, and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) for GD assessment. Results: Adolescents with GD reported significantly higher levels of body uneasiness (BUT-GSI, F = 380.13, p < 0.0001), as well as a worse psychological functioning (YSR, F = 13.06 and p < 0.0001 for “total problem scale” and F = 12.53, p = 0.001 for “internalizing” scale) as compared to NRs. When YSR subscales were considered, GDs showed significantly higher scores in the “withdrawal/depression”, “anxiety/depression”, and “social problems” (all p < 0.0001). In addition, GDs showed significantly higher levels in the “attraction to death” and “repulsion by life” scales and lower scores in the “attraction to life” scale (all p < 0.0001). Finally, GIDYQ-AA score was significantly lower (meaning a higher level of gender dysphoria symptoms) in GDs vs. NRs (p < 0.0001). Conclusions: GD adolescents reported significantly higher body dissatisfaction and suicidal risk compared to NRs. In addition, results confirmed a significant impairment in social psychological functioning in adolescents with GD.
Keywords: adolescent; adolescent disease; age distribution; anxiety disorder; article; body uneasiness; Body Uneasiness Test; case control study; clinical article; controlled study; depression; female; gender dysphoria; Gender Identity Gender Dysphoria Questionnaire for Adolescents and Adults; human; Italian (citizen); male; mental disease; mental function; Multi Attitude Suicide Tendency Scale; psychologic assessment; psychosocial disorder; rating scale; scoring system; social problem; suicide; withdrawal syndrome; Youth Self Report

Major depressive disorder, suicidal thoughts and behaviours, and cannabis involvement in discordant twins: a retrospective cohort study - Agrawal, A.; Nelson, E.C.; Bucholz, K.K.; Tillman, R.; Grucza, R.A.; Statham, D.J.; Madden, P.A.; Martin, N.G.; Heath, A.C.; Lynskey, M.T. (The Lancet Psychiatry, 2017)
Background Early and frequent cannabis use are associated with an increased likelihood of major depressive disorder (MDD) as well as suicidal thoughts and behaviours. We identify associations between aspects of cannabis use, MDD, and suicidal thoughts and behaviours and examine whether such associations persist after accounting for those predisposing factors, including genetic liability and early family environment, that are shared by identical twins who are discordant for cannabis exposure. Any residual association in such identical pairs might be indicative of individual-specific pathways that might be of a causal nature. Methods We did a logistic regression analysis of cannabis use from retrospective data on same-sex male and female twin pairs drawn from 3 studies that had recruited twins from the Australian Twin Registry, 1992–93 (sample 1), 1996–2000 (sample 2), and 2005–09 (sample 3). We studied associations between early use and frequent use of cannabis and MDD, suicidal ideation (ever and persistent), and suicide plan and attempt in the full sample as well as in pairs of monozygotic and dizygotic twins that were discordant for each measure of cannabis involvement at a single timepoint. Significant monozygotic associations were further adjusted for covariates, such as early alcohol or nicotine use, early dysphoric or anhedonic mood, conduct disorder, and childhood sexual abuse. Interactions between each cannabis measure and sex, sample or study effects, and birth year category were also examined as covariates. Findings In 13 986 twins (6181 monozygotic and 7805 dizygotic), cannabis use ranged from 1345 (30·4%) of 4432 people in sample 1 to 2275 (69·0%) of 3299 in sample 3. Mean age of first cannabis use ranged from 17·9 years (SD 3·3) in sample 3 to 21·1 years (5·2) in sample 1, and frequent use (≥100 times) was reported by 214 (15·9%) of 1345 users in sample 1 and 499 (21·9%) of 2275 in sample 3. The prevalence of suicidal ideation ranged from 1102 (24·9%) of 4432 people in sample 1 to 1644 (26·3%) of 6255 people in sample 2 and 865 (26·2%) of 3299 people in sample 3. Prevalence of MDD ranged from 901 (20·3%) people in sample 1 to 1773 (28·3%) in sample 2. The monozygotic twin who used cannabis frequently was more likely to report MDD (odds ratio 1·98, 95% CI 1·11–3·53) and suicidal ideation (2·47, 1·19–5·10) compared with their identical twin who had used cannabis less frequently, even after adjustment for covariates. For early cannabis use, the monozygotic point estimate was not significant but could be equated to the significant dizygotic estimate, suggesting a possible association with suicidal ideation. Interpretation The increased likelihood of MDD and suicidal ideation in frequent cannabis users cannot be solely attributed to common predisposing factors. Funding National Institute on Drug Abuse, National Institutes of Health, Australian National Health and Medical Research Council.
Keywords: alcohol; cannabis; nicotine; adult; alcohol consumption; anhedonia; article; cannabis use; cohort analysis; conduct disorder; depression; disease predisposition; disease severity; dizygotic twins; dysphoria; female; human; major clinical study; major depression; male; monozygotic twins; onset age; prevalence; priority journal; retrospective study; sexual abuse; sexual behavior; smoking; suicidal ideation; suicide attempt; twin discordance

Prevalence and Correlates of Suicidal Ideation Among Transgender Youth in California: Findings From a Representative, Population-Based Sample of High School Students - Perez-Brumer, A.; Day, J.K.; Russell, S.T.; Hatzenbuehler, M.L. (Journal of the American Academy of Child and Adolescent Psychiatry, 2017)
Objective No representative population-based studies of youth in the United States exist on gender identity-related disparities in suicidal ideation or on factors that underlie this disparity. To address this, this study examined gender identity-related disparities in the prevalence of suicidal ideation; evaluated whether established psychosocial factors explained these disparities; and identified correlates of suicidal ideation among all youth and stratified by gender identity. Method Data were derived from the 2013 to 2015 California Healthy Kids Survey (CHKS; N = 621,189) and a weighted subsample representative of the Californian student population (Biennial Statewide California Student Survey [CSS], N = 28,856). Results Prevalence of past 12-month self-reported suicidal ideation was nearly twice as high for transgender compared with non-transgender youth (33.73% versus 18.85%; χ2 = 35.48, p <.001). In fully adjusted models within the representative sample, transgender youth had 2.99 higher odds (95% CI 2.25–3.98) of reporting past-year suicidal ideation compared with non-transgender youth. Among transgender youth, only depressive symptoms (adjusted odds ratio 5.44, 95% CI 1.81–16.38) and victimization (adjusted odds ratio 2.66, 95% CI 1.26–5.65) remained significantly associated with higher odds of suicidal ideation in fully adjusted models. In multiple mediation analyses, depression attenuated the association between gender identity and suicidal ideation by 17.95% and victimization by 14.71%. Conclusion This study uses the first representative population-based sample of youth in the United States that includes a measurement of gender identity to report on gender identity-related disparities in suicidal ideation and to identify potential mechanisms underlying this disparity in a representative sample.
Keywords: adolescent; article; California; controlled study; correlation analysis; depression; female; gender identity; health survey; high school student; human; juvenile; major clinical study; male; prevalence; priority journal; social psychology; suicidal ideation; transgender

The Plight of Veterans - Lutwak, N. (Academic Emergency Medicine, 2017)
Keywords: air force; alcohol abuse; army; article; battle injury; blast injury; depression; emotional stress; hate; homelessness; human; navy; posttraumatic stress disorder; priority journal; sexual orientation; shame; military personnel; suicide; veterans health

Here/In This Issue and There/Abstract Thinking: The Growing, and Changing, Landscape of Child and Adolescent Mental Healthcare Delivery - Hong, D.S. (Journal of the American Academy of Child and Adolescent Psychiatry, 2017)
Keywords: alcohol; cannabis; adolescent; alcoholism; article; cannabis addiction; child; cost control; depression; drug dependence; gender identity; health care cost; human; mental health care; parental attitude; prevalence; priority journal; self report; substance abuse; suicidal ideation; transgender

Nonsuicidal Self-Injury and Suicidality Among Sexual Minority Youth: Risk Factors and Protective Connectedness Factors - Taliaferro, L.A.; Muehlenkamp, J.J. (Academic Pediatrics, 2017)
Objective We investigated differences in prevalence of repetitive nonsuicidal self-injury (NSSI), suicidal ideation, and a suicide attempt among youth who identified as bisexual, gay/lesbian, and questioning. In addition, we examined which types of social connections were associated with reduced risk of repetitive NSSI and suicidality among youth who identified with a specific sexual minority group. Methods Data came from the 2013 Minnesota Student Survey. The analytic sample included 77,758 students in grades 9 and 11. Connectedness factors included parent connectedness, teacher caring, connectedness to other nonparental adults, school safety, and friend caring. Logistic regression analyses, stratified according to sexual minority group, determined social connectedness factors associated with repetitive NSSI, suicidal ideation, and a suicide attempt, as well as moderating effects of significant connectedness factors on different risk factors (depression, anxiety, bullying, and violence victimization). Results Approximately 3% identified as bisexual or questioning their sexual orientation, and <1% identified as gay/lesbian. Sexual minority youth, particularly bisexual youth, were significantly more likely than heterosexual youth to report repetitive NSSI and suicidality. Effects of connectedness varied across sexual minority groups and outcomes on the basis of types of connections. Parent connectedness emerged as a robust protective factor for all self-harm behaviors across all sexual minority groups. Feeling connected to nonparental adults and safe at school represented additional factors that reduced risk of repetitive NSSI and suicidality among certain groups. Conclusions In addition to facilitating connections between youth and parents, clinicians might consider encouraging sexual minority youth to remain connected to trusted nonparental adults who could offer support and care. Schools might consider implementing sociocultural norms of acceptance, tolerance, and positive identity development to reduce risk of self-harm.
Keywords: adolescent; anxiety; article; automutilation; bisexuality; bullying; child parent relation; depression; friend; heterosexuality; homosexual female; homosexual male; human; human relation; juvenile; Minnesota; prevalence; protection; risk factor; risk reduction; safety; school; sexual and gender minority; sexual orientation; social interaction; suicidal behavior; suicidal ideation; suicide attempt; teacher; victim; violence

Factor associated with risky sexual behaviors among the French general population - Sicard, S.; Mayet, A.; Duron, S.; Richard, J.-B.; Beck, F.; Meynard, J.-B.; Deparis, X.; Marimoutou, C. (Journal of public health (Oxford, England), 2017)
Background: Despite prevention programs, a rising incidence of sexually transmitted infections is currently reported in France. Aims: Research factors associated with risky sexual behaviors (RSBs) among the French population. Methods: Subjects aged 15-54 years from the French national survey 'Baromètre santé 2010' were included (n = 16 598). RSB was defined as having multiple partners or failure to use condom at first intercourse with a new partner over past 12 months. Factors associated were identified using one logistic regression by gender. Results: The overall RSB prevalence was 9.5%, being higher among men (P < 0.001). Factors associated with RSB for both genders were young age (OR = 1.5), single status (men: OR = 7.1; women: OR = 6.4), homosexual relations (men: OR = 2.0; women: OR = 3.2), low incomes (men: OR = 1.5; women: OR = 1.4), use of cannabis (men: OR = 1.4; women: OR = 3.0). Men-specific factors were history of STI (OR = 2.5) and alcohol drunkenness (OR = 2.2), and women-specific factors history of suicide attempt (OR = 1.6) and history of sexual assault (OR = 1.6). Conclusions: Confirming most of known determinants of RSB, this study also identified some specific risky patterns for whom preventive actions can be developed: multiusers of psychoactive substances, people living with low incomes, women having sex with women or presenting history of psychological vulnerability (suicide attempts, sexually harassed).
Keywords: adolescent; adult; age; drug dependence; female; France; high risk behavior; human; male; middle aged; psychology; sex factor; statistics and numerical data; unsafe sex; young adult

Harassment and Mental Distress Among Adolescent Female Students by Sexual Identity and BMI or Perceived Weight Status - Johns, M.M.; Lowry, R.; Demissie, Z.; Robin, L. (Obesity, 2017)
Objective: Sexual minority girls (lesbian/bisexual) and girls with overweight/obesity experience high rates of discrimination and mental distress. This study explored whether BMI or perceived weight status might compound sexual minority girls’ risk for harassment and mental distress. Methods: Data on female students from the national 2015 Youth Risk Behavior Survey (n = 7,006) were analyzed. Logistic regression was used to examine differences in bullying, harassment, and mental distress across sexual identity/BMI groups: heterosexual/normal-weight, heterosexual/overweight, sexual minority/normal-weight, and sexual minority/overweight. Procedures were repeated with four analogous groups created from sexual identity and perceived weight. Results: Across sexual identity/BMI groups, being overweight increased heterosexual females’ odds of being bullied or experiencing suicidal thoughts and behaviors. Regardless of weight status, sexual minority females had greater odds for each outcome than heterosexual females. Sexual minority females who perceived themselves as overweight had greater odds of suicidality than all other sexual minority/perceived weight groups. Conclusions: Double jeopardy may exist for sexual minority female students who perceive themselves as overweight. Professional development with school staff on how to create a positive climate for sexual minorities and those with overweight/obesity and addressing positive identity and body image within school-based suicide prevention efforts may be important to the well-being of adolescent girls.
Keywords: adolescent; article; body mass; body weight; bullying; controlled study; distress syndrome; female; gender identity; harassment; heterosexual female; high school student; hopelessness; human; obesity; sadness; sexual and gender minority; suicidal behavior; suicide; suicide attempt; underweight

The Case of Abel: Religion as Boon and Bane for a Catholic Gay Man - Cerbone, A.R.; Danzer, G. (Journal of clinical psychology, 2017)
Conservative religions that condemn homosexual sexual orientation and acts as unnatural and sinful pose significant challenges for gay persons whose faith is a core part of their identity. The condemnation presents a serious barrier to the acceptance and integration of their sexuality, a primary task of psychosexual development. As a result, they can manifest depression, anxiety, suicidal ideation, and even suicide attempts. The ecclesiastical censure also imposes an untenable dilemma for homosexuals in that they feel pressed to reject their sexual identity or renounce their spiritual identity and heritage. Psychotherapists who treat gay persons caught in this quandary can find themselves facing a similar problem: how to help their homosexual client reconcile their proscribed sexuality with their spiritual commitments. The case presented here recounts the treatment over many years of a gay man suffering from such a conflict and his eventual accommodation of both his homosexuality and his faith. Recommendations are offered for constructive treatment with those torn between two conflicting core identities.
Keywords: case report; Catholicism; conflict; female; human; mental disease; middle aged; psychology; sexual and gender minority

Suicidality, Self-Harm, and Body Dissatisfaction in Transgender Adolescents and Emerging Adults with Gender Dysphoria - Peterson, C.M.; Matthews, A.; Copps-Smith, E.; Conard, L.A. (Suicide & life-threatening behavior, 2017)
Prevalence of suicide attempts, self-injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty-seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self-injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female-to-male youth reported a history of suicide attempts and self-harm behaviors than male-to-female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life-threatening behaviors.
Keywords: adolescent; automutilation; body image; clinical audit; emotion; female; gender dysphoria; human; male; prevalence; psychology; retrospective study; statistics and numerical data; suicidal ideation; suicide; suicide attempt; transgender; young adult

Bisexual-Specific Minority Stressors, Psychological Distress, and Suicidality in Bisexual Individuals: the Mediating Role of Loneliness - Mereish, E.H.; Katz-Wise, S.L.; Woulfe, J. (Prevention science : the official journal of the Society for Prevention Research, 2017)
Bisexual individuals are at higher risk for poor mental health outcomes compared to heterosexual as well as lesbian and gay individuals and experience minority stressors, such as discrimination, from both heterosexual and sexual minority communities. However, there is little research examining the negative effects of bisexual-specific minority stressors on bisexual individuals' mental health as well as psychological factors that might help explain minority stressors' deleterious effects. This research examined the effects of distal minority stressors (i.e., anti-bisexual experiences from both heterosexual as well as lesbian and gay people) and proximal stressors (i.e., internalized heterosexism and sexual orientation concealment) on psychological distress and suicidality among bisexual adults (N = 503). Building on the relational framing of the minority stress model, we also tested one relational factor (i.e., loneliness) as a mediator of the associations between distal and proximal minority stressors and poor mental health (i.e., psychological distress and suicidality). Structural equation modeling analyses were used to test the mediating effects of loneliness on the associations between minority stressors and psychological distress and suicidality. Although distal and proximal minority stressors were not associated with each other, loneliness mediated the effects of distal and proximal minority stressors on psychological distress and suicidality. The results of this study underscore the importance of targeting bisexual-specific minority stressors as well as loneliness in preventive interventions to improve the mental health of bisexual individuals.
Keywords: adolescent; adult; bisexuality; female; human; loneliness; male; mental stress; middle aged; minority group; psychological model; suicidal ideation; young adult

Screening for depression among youth with HIV in an integrated care setting - Walsh, A.S.J.; Wesley, K.L.; Tan, S.Y.; Lynn, C.; O’Leary, K.; Wang, Y.; Nguyen, D.; Chenneville, T.; Rodriguez, C.A. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2017)
Youth living with HIV (YLWH) are at risk for depression. Depressive symptoms can impact treatment engagement, health outcomes, and quality of life. Early identification of symptoms can guide treatment planning. This study aimed to identify trends in depressive symptoms for YLWH in a specialty-care clinic and follow-up clinical treatment procedures. An archival review of a clinical database provided depression screening information for a sample of 130 YLWH between 11 and 25 years old in the southeastern United States. Findings indicated that approximately 24% of the sample screened positive for depression-risk. Most commonly endorsed symptoms included fatigue (54.3%) and sleep difficulties (48.5%). Depressive symptoms did not differ significantly by age, gender, race, ethnicity, or sexual orientation. Youth who acquired HIV behaviorally were more likely to endorse the critical item (i.e., self-harm and/or suicidal ideation) than youth who acquired HIV perinatally. Forty-percent of the sample (i.e., 51 youth) had a follow-up treatment plan. YLWH who endorsed the critical item were more likely to receive follow-up action when compared to those who did not endorse the item. Despite limitations of the study, findings have important implications for clinical care and future research.
Keywords: adolescent; adult; African American; age; article; Asian; automutilation; behavior; bisexuality; Caucasian; child; depression; ethnicity; fatigue; female; follow up; gender; heterosexuality; Hispanic; homosexuality; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; patient counseling; priority journal; race; school child; sexual assault; sexual orientation; sleep disorder; substance use; suicidal ideation; trend study; watchful waiting; young adult

Comprehensive Screening for Suicide Risk in Primary Care - Diamond, G.S.; Herres, J.L.; Krauthamer Ewing, E.S.; Atte, T.O.; Scott, S.W.; Wintersteen, M.B.; Gallop, R.J. (American Journal of Preventive Medicine, 2017)
Introduction Suicide is a major public health problem and a complex clinical challenge. Assessment and early identification could be enhanced with screening tools that look beyond depression. The purpose of this study was to identify profiles of risk behaviors and social stress associated with suicidal ideation and behavior using the Behavioral Health Screen. Methods The study used screening data from 2,513 primary care patients (aged 14–24 years). Data were collected between 2008 and 2012, and were analyzed in 2016. Results Latent class analysis identified a high and low risk profile. Domains of primary influence included substance use, sexual assault, same-sex behavior, and unsafe sex. The high-risk group was 11 times more likely to have made a suicide attempt, five times more likely to report a history of suicidal ideation and behavior, and three times more likely to report recent suicidal ideation and behavior. Conclusions Risk behaviors and social stress contribute to the risk for suicide above and beyond depression and should be assessed during routine primary care visits with adolescents. The Behavioral Health Screen can screen all these domains and thus assist primary care providers in assessing for both psychiatric and social stress factors associated with youth suicide.
Keywords: adolescent; adult; article; behavior assessment; Behavioral Health Screen; clinical assessment tool; controlled study; disease association; female; high risk behavior; high risk population; human; low risk patient; major clinical study; male; medical history; primary medical care; risk assessment; risk factor; screening test; sexual assault; sexual behavior; social stress; substance use; suicidal ideation; suicide attempt; unsafe sex

Adverse childhood experiences and suicide attempts among those with mental and substance use disorders - Choi, N.G.; DiNitto, D.M.; Marti, C.N.; Segal, S.P. (Child Abuse and Neglect, 2017)
Using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions data, we examined the associations of ten types of adverse childhood experiences (ACEs) with (1) lifetime suicide attempts and (2) number and age of attempts among U.S. adults aged 18+. In a case-control design, suicide attempters (5.14% of the full sample) were matched with never attempters (matched sample N = 3912) on nine mental and substance use disorders. ACE rates were higher among attempters (3.30 [SE = 0.07]) than their matched controls (2.19 [SE = 0.06]). Results from multivariable logistic regression analyses showed that sexual abuse and parental/other family member's mental illness were associated with increased odds of having attempted suicide among both genders, and emotional neglect was also a factor for men. Population attributable risk fractions for sexual abuse were 25.75% for women and 8.56% for men. Sexual abuse and a higher number of ACEs were also related to repeated suicide attempts. A higher number of ACEs was associated with a younger first attempt age. Gay/bisexual orientation in men and the lack of college education in both genders were significant covariates. In conclusion, this study underscores that ACEs are significantly associated with lifetime suicide attempts even when mental and substance use disorders are controlled.
Keywords: adult; childhood adversity; aged; article; bisexual male; case control study; controlled study; disease association; disease control; drug dependence; education; experience; female; human; major clinical study; male; mental disease; middle aged; neglect; physical abuse; race; sex difference; sexual abuse; sexual orientation; social welfare; suicide attempt; United States; young adult

High acceptability of rapid HIV self-testing among a diverse sample of MSM from Buenos Aires, Argentina - Pando, M.A.; Dolezal, C.; Marone, R.O.; Barreda, V.; Carballo-Diéguez, A.; Avila, M.M.; Balán, I.C. (PLoS ONE, 2017)
Introduction The objective of this study was to explore the acceptability of rapid HIV self-testing (RHST) among men who have sex with men (MSM). Methods During 2006–2009, a sample of 500 MSM was recruited through Respondent Driven Sampling for an HIV prevalence/incidence study. Attitude toward RHST was explored among HIV negative MSM. Data were weighted prior to analyses. Results Participants reported they were likely to buy RHST (74%), test themselves more frequently than they currently do (77%), and that the procedure would simplify testing (70%). Furthermore, 71% reported they would probably use it alone, 66% would use it with a steady partner, and 56% with a friend/partner. While a majority acknowledged that RHST use would deprive them of receiving counseling (61%), 74% declared they would go for help if they tested positive; 57% would use an RHST in order to avoid condoms. Probability of use surpassed 70% among gay and non-gay identified MSM as well as those with and without a previous HIV test. Those likely to buy RHST were older (p = 0.025) and more likely to identify as gay (p = 0.036). A total of 17% said they would think about killing themselves and 9% would attempt suicide if they tested positive. These MSM were more likely to be younger (p<0.001), with lower mood level (p<0.001) and greater feelings of loneliness (p = 0.026). Conclusions The high acceptability of RHST found among MSM should encourage the authorities to consider the possibility of offering it for self-testing, as it can improve early diagnosis and prevention of future transmissions. However, further research is needed to understand how to best disseminate RHST among MSM who wish to use it and to offer support and linkage to care for those who test HIV-positive.
Keywords: adult; Argentina; article; attitude to health; friend; help seeking behavior; HIV rapid test; human; incidence; LGBT people; loneliness; lowest income group; male; men who have sex with men; mood change; prevalence; program acceptability; sexual counseling; sexuality; social status; suicide attempt

The 2015 National Canadian Homeless Youth Survey: Mental Health and Addiction Findings - Kidd, S.A.; Gaetz, S.; O'Grady, B. (Canadian Journal of Psychiatry, 2017)
Objective: This study was designed to provide a representative description of the mental health of youth accessing homelessness services in Canada. It is the most extensive survey in this area to date and is intended to inform the development of mental health and addiction service and policy for this marginalized population. Methods: This study reports mental health-related data from the 2015 "Leaving Home" national youth homelessness survey, which was administered through 57 agencies serving homeless youth in 42 communities across the country. This self-reported, point-in-time survey assessed a broad range of demographic information, pre-homelessness and homelessness variables, and mental health indicators. Results: Survey data were obtained from 1103 youth accessing Canadian homelessness services in the Nunavut territory and all Canadian provinces except for Prince Edward Island. Forty-two per cent of participants reported 1 or more suicide attempts, 85.4% fell in a high range of psychological distress, and key indicators of risk included an earlier age of the first episode of homelessness, female gender, and identifying as a sexual and/or gender minority (lesbian, gay, bisexual, transgender, queer, and 2 spirit [LGBTQ2S]). Conclusions: This study provides clear and compelling evidence of a need for mental health support for these youth, particularly LGBTQ2S youth and female youth. The mental health concerns observed here, however, must be considered in the light of the tremendous adversity in all social determinants faced by these youth, with population-level interventions best leveraged in prevention and rapid response.
Keywords: addiction; adult; article; Canada; cross-sectional study; demography; distress syndrome; female; gender; health care policy; health service; homeless youth; human; major clinical study; male; mental health; Nunavut; quality of life; self report; sexual orientation; social determinants of health; substance abuse; suicide attempt

Internal Medicine Resident Attitudes, Prior Education, Comfort, and Knowledge Regarding Delivering Comprehensive Primary Care to Transgender Patients - Johnston, C.D.; Shearer, L.S. (Transgender Health, 2017)
Transgender patients face a multitude of health disparities and often a lack of understanding by healthcare professionals. A survey was undertaken of internal medicine residents in a large urban academic training program to determine prior education, attitudes, comfort, and knowledge in providing care for transgender individuals in a primary care setting. Total N=67 respondents (52% of those eligible). A full 97% of residents believe transgender medical issues are relevant to their practice, but only 45% had prior education about the care of transgender patients. Less than one-third of respondents felt comfortable describing hormonal/surgical therapy options or referring to another physician to meet these patient needs. HIV, gonorrhea, and chlamydia risk was underestimated for the trans woman population. Most medical residents did not feel up to date with screening guidelines. In contrast, most residents correctly identified higher rates of depression/suicidality in transgender individuals, as well as lower adherence to human papillomavirus screening recommendations for trans men.
Keywords: adult; article; Chlamydia; clinical practice; depression; female; female to male transgender; gonorrhea; health care delivery; hormonal therapy; human; Human immunodeficiency virus infection; infection risk; internal medicine; male; male to female transgender; medical decision making; normal human; patient referral; physician attitude; practice guideline; primary medical care; priority journal; professional competence; protocol compliance; residency education; resident; screening test; suicidal behavior; surgical technique; transgender; urban area

Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults - Katz-Wise, S.L.; Reisner, S.L.; White Hughto, J.M.; Budge, S.L. (Archives of sexual behavior, 2017)
This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and 95 % confidence intervals to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all ps < .05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals.
Keywords: adult; aged; depression; female; gender identity; human; male; mental health; middle aged; odds ratio; psychology; self report; sexual behavior; statistical model; transgender; transsexualism

Pathways to Suicide in Lesbian and Gay Populations in Australia: A Life Chart Analysis - Skerrett, D.M.; Kõlves, K.; De Leo, D. (Archives of sexual behavior, 2017)
Given the continued paucity of research into suicide in lesbian and gay (LG) people, there is a need to investigate the characteristics of those LG suicides that are able to be identified. The aim of this article was to analyze pathways to suicide in lesbian and gay individuals by way of life charts. Data were gathered through of 24 psychological autopsy interviews with next-of-kin of an LG person who had died by suicide. The female (n = 5) and male (n = 19) cases in this study clustered into younger and older suicides. The defining feature of the younger suicides was lack of acceptance by family and, to a lesser extent, self, and that of the older suicides was romantic relationship conflict, although this was also common in younger suicides. There appears to have been, furthermore, an accumulation of risk factors, particularly in the period prior to death where these specific risk factors combined with other life stressors, such as work problems. Initiatives to reduce stigma around diversity in sexuality and to support families and young people through the "coming out" process as well as services designed to assist those experiencing problems in same-sex relationships, in particular, would appear to be the most relevant within the trajectories presented.
Keywords: adult; Australia; conflict; family; female; human; male; middle aged; psychology; risk factor; sexual and gender minority; sexual behavior; sexuality; social distance; social stigma; social support; suicide; young adult

Implications of Genital Mutilation at Autopsy - Byard, R.W. (Journal of forensic sciences, 2017)
Given the potential significance of mutilation of the external genitalia in medicolegal fatalities, a review of the literature was undertaken to identify subcategories. Such mutilations may have been sustained sometime before death, around the time of death, or after death. The most common type of ante mortem genital mutilations involves cultural practices such as male circumcision. Less common male mutilations such as subincisions are tribally based. Female genital mutilation is found particularly in African, Middle Eastern, or Asian populations. Self-inflicted genital injuries are most common in males and may be related to attempts at suicide, or to self-harming practices. The latter have a strong association with psychiatric illnesses. Postmortem injuries may arise from animal predation or deliberate mutilation of a corpse. The latter may be associated with ante mortem genital injuries in sadistic homicides. The range of possible causes of genital mutilations in forensic cases necessitates extremely careful evaluation.
Keywords: amputation; animal; automutilation; autopsy; body piercing; circumcision; cultural anthropology; feeding behavior; female; female genital mutilation; female genital system; forensic pathology; homicide; human; injury; male; male genital system; pathology; postmortem change; sadism; transgender

Depression and Suicidality in Gay Men: Implications for Health Care Providers - Lee, C.; Oliffe, J.L.; Kelly, M.T.; Ferlatte, O. (American journal of men's health, 2017)
Gay men are a subgroup vulnerable to depression and suicidality. The prevalence of depression among gay men is three times higher than the general adult population. Because depression is a known risk factor for suicide, gay men are also at high risk for suicidality. Despite the high prevalence of depression and suicidality, health researchers and health care providers have tended to focus on sexual health issues, most often human immunodeficiency virus in gay men. Related to this, gay men's health has often been defined by sexual practices, and poorly understood are the intersections of gay men's physical and mental health with social determinants of health including ethnicity, locale, education level, and socioeconomic status. In the current article summated is literature addressing risk factors for depression and suicidality among gay men including family acceptance of their sexual identities, social cohesion and belonging, internalized stigma, and victimization. Barriers to gay men's help seeking are also discussed in detailing how health care providers might advance the well-being of this underserved subgroup by effectively addressing depression and suicidality.
Keywords: adult; depression; human; male; male homosexuality; masculinity; men's health; mental health; middle aged; patient attitude; professional standard; psychology; statistics and numerical data; suicide

Transgender Noninclusive Healthcare and Delaying Care because of Fear: Connections to General Health and Mental Health among Transgender Adults - Seelman, K.L.; Colón-DIaz, M.J.P.; Lecroix, R.H.; Xavier-Brier, M.; Kattari, L. (Transgender Health, 2017)
Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base. Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health. Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B=-0.26, p<0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation (p<0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health. Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare.
Keywords: adult; article; depression; fear; female; health behavior; health care; health care disparity; health care personnel; health care utilization; health status; human; major clinical study; male; mental health; priority journal; social discrimination; suicidal ideation; suicide attempt; transgender

Varied reports of adult transgender suicidality: Synthesizing and describing the peer-reviewed and gray literature - Adams, N.; Hitomi, M.; Moody, C. (Transgender Health, 2017)
Purpose: This article reports on the findings of a meta-synthesis undertaken on published gray transgender suicidality literature, to determine the average rate of suicidal ideation and attempts in this population. Methods: Studies included in this synthesis were restricted to the 42 that reported on 5 or more Canadian or U.S. adult participants, as published between 1997 and February 2016 in either gray or peer-reviewed health literature. Results: Across these 42 studies an average of 55% of respondents ideated about and 29% attempted suicide in their lifetimes. Within the past year, these averages were, respectively, 51% and 11%, or 14 and 22 times that of the general public. Overall, suicidal ideation was higher among individuals of a male-to-female (MTF) than female-to-male (FTM) alignment, and lowest among those who were gender non-conforming (GNC). Conversely, attempts occurred most often among FTM individuals, then decreased for MTF individuals, followed by GNC individuals. Conclusion: These findings may be useful in creating targeted interventions that take into account both the alarmingly high rate of suicidality in this population, and the relatively differential experience of FTM, MTF, and GNC individuals. Future research should examine minority stress theory and suicidality protection/resilience factors, particularly transition, on this population.
Keywords: adult; article; female to male transgender; gender identity; high risk population; human; male to female transgender; priority journal; risk assessment; suicidal behavior; suicidal ideation; suicide attempt; systematic review; transgender

Mental Health Concerns and Insurance Denials Among Transgender Adolescents - Nahata, L.; Quinn, G.P.; Caltabellotta, N.M.; Tishelman, A.C. (LGBT health, 2017)
RESULTS: Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9-18). Seventy-three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogues, only 8 (29.6%) received insurance coverage. CONCLUSION: Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform. PURPOSE: Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy. METHODS: An IRB-approved retrospective medical record review (2014-2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization.
Keywords: hormone; adolescent; adolescent health; child; crime victim; economics; female; health insurance; human; insurance; male; mental disease; mental health; psychology; retrospective study; transgender

Mental health inequalities among gay and bisexual men in England, Scotland and Wales: a large community-based cross-sectional survey - Hickson, F.; Davey, C.; Reid, D.; Weatherburn, P.; Bourne, A. (Journal of public health (Oxford, England), 2017)
Background: Sexual minorities suffer worse mental health than the sexual majority but little is known about differences in mental health within sexual minorities. We aimed to describe inequality in mental health indicators among gay and bisexual men. Methods: Using multi-channel community-based opportunistic sampling we recruited 5799 eligible men aged 16 years and over, living in England, Scotland and Wales and who were sexually attracted to other men, to a self-completion Internet health survey. Mental health indicators (depression (PHQ-9), anxiety (GAD-7), suicide attempt and self-harm) were examined for independent associations across common axes of inequality (age, ethnicity, migrancy, education, income, cohabitation and living in London). Results: Mental ill-health was common: 21.3% were depressed and 17.1% anxious, while 3.0% had experienced attempted suicide and 6.5% had self-harmed within the last 12 months. All four indicators were associated with younger age, lower education and lower income. Depression was also associated with being a member of visible ethnic minorities and sexual attraction to women as well as men. Cohabiting with a male partner and living in London were protective of mental health. Conclusion: Community interventions to increase mental health among gay and bisexual men should be designed to disproportionately benefit younger men and those living on lower incomes.
Keywords: adolescent; adult; aged; bisexuality; cross-sectional study; England; health care disparity; health survey; human; male; male homosexuality; mental health; middle aged; Scotland; statistics and numerical data; very elderly; Wales; young adult

Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital - Plöderl, M.; Kunrath, S.; Cramer, R.J.; Wang, J.; Hauer, L.; Fartacek, C. (BMC Psychiatry, 2017)
Background: Sexual minority (SM) individuals (gay, lesbian, bisexual, or otherwise nonheterosexual) are at increased risk for mental disorders and suicide and adequate mental healthcare may be life-saving. However, SM patients experience barriers in mental healthcare that have been attributed to the lack of SM-specific competencies and heterosexist attitudes and behaviors on the part of mental health professionals. Such barriers could have a negative impact on common treatment factors such as treatment expectancy or therapeutic alliance, culminating in poorer treatment outcomes for SM versus heterosexual patients. Actual empirical data from general psychiatric settings is lacking, however. Thus, comparing the treatment outcome of heterosexual and SM patients at risk for suicide was the primary aim of this study. The secondary aim was to compare treatment expectation and working alliance as two common factors. Methods: We report on 633 patients from a suicide prevention inpatient department within a public psychiatric hospital. Most patients were at risk for suicide due to a recent suicide attempt or warning signs for suicide, usually in the context of a severe psychiatric disorder. At least one indicator of SM status was reported by 21% of patients. We assessed the treatment outcome by calculating the quantitative change in suicide ideation, hopelessness, and depression. We also ran related treatment responder analyses. Treatment expectation and working alliance were the assessed common factors. Results: Contrary to the primary hypothesis, SM and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis. Contrary to the secondary hypothesis, there were no significant sexual orientation differences in treatment expectation and working alliance. When adjusting for sociodemographics, diagnosis, and length of stay, some sexual orientation differences became significant, indicating that SM patients have better outcomes. Conclusions: These unexpected but positive findings may be due to common factors of therapy compensating for SM-specific competencies. It may also be due to actual presence of SM competencies - though unmeasured - in the department. Replication in other treatment settings and assessment of SM-specific competencies are needed, especially in the field of suicide prevention, before these findings can be generalized.
Keywords: adult; article; controlled study; depression; disease severity; doctor patient relationship; expectation; female; heterosexuality; high risk patient; hopelessness; human; length of stay; major clinical study; male; mental disease; mental hospital; public hospital; sexual and gender minority; sexual orientation; suicidal ideation; suicide; suicide attempt; treatment outcome

Factors associated with suicidal ideation among university students - Santos, H.G.B.D.; Marcon, S.R.; Espinosa, M.M.; Baptista, M.N.; Paulo, P.M.C. (Revista latino-americana de enfermagem, 2017)
Objective:: to analyze the factors associated with suicidal ideation in a representative sample of university students. Methods:: cross-sectional study, carried out with 637 students of the Federal University of Mato Grosso. The presence of suicidal ideation, demographic and socioeconomic variables, use of alcohol through the Alcohol, Smoking and Substance Involvement Screening Test, and depressive symptoms (Major Depression Inventory) were investigated. Bivariate analysis was performed with the Chi-square test and multivariate analysis using the Poisson regression model. Results:: it was found that 9.9% of the students had suicidal thoughts in the previous 30 days and, in the bivariate analysis, the variables economic class, sexual orientation, religious practice, suicide attempts in the family and among friends, alcohol consumption and depressive symptoms were associated with suicidal ideation. In the multivariate analysis sexual orientation, suicide attempts in the family and the presence of depressive symptoms remained as associated factors. Conclusion:: these findings constitute a situational diagnosis that enables the formulation of academic policies and preventive actions to confront this situation on the university campus. Objetivo:: analisar os fatores associados à ideação suicida em uma amostra representativa de estudantes universitários. Método:: estudo transversal analítico, realizado com 637 estudantes de uma Universidade Federal de Mato Grosso. Investigadas variáveis de presença de ideação suicida, demográficas e socioeconômica, uso de álcool por meio do Alcohol, Smoking and Substance Involvement Screening Test, e sintomas depressivos (Inventário de Depressão Maior). A análise bivariada foi realizada com o teste do Qui-quadrado, e a análise múltipla pelo modelo de regressão Poisson. Resultados:: constatou-se que 9,9% dos estudantes tinham ideias suicidas nos últimos 30 dias, e na análise bivariada as variáveis classe econômica, orientação sexual, prática religiosa, tentativas de suicídio na família e entre amigos, consumo de álcool e sintomas depressivos apresentaram associação com ideação suicida. Na análise múltipla permaneceu como fatores associados orientação sexual, tentativas de suicídio na família e presença de sintomas depressivos. Conclusão:: tais achados constituem um diagnóstico situacional que possibilita a formulação de políticas acadêmicas e de ações de prevenção para o enfrentamento dessa situação no campus universitário. Objetivo:: analizar los factores asociados a la ideación suicida en una muestra representativa de estudiantes universitarios. Método:: estudio transversal analítico, realizado con 637 estudiantes en una Universidad Federal de Mato Grosso. Fueron investigadas las variables: presencia de ideación suicida; demográficas y socioeconómicas; uso de alcohol por medio del Alcohol, Smoking and Substance Involvement Screening Test; y síntomas depresivos (Inventario de Depresión Mayor). El análisis bivariado fue realizado con el test de Chi-cuadrado y el análisis múltiple con el modelo de regresión de Poisson. Resultados:: se constató que 9,9% de los estudiantes tuvieron ideas suicidas en los últimos 30 días, y en el análisis bivariado las variables: clase económica; orientación sexual; práctica religiosa; intentos de suicidio en la familia y entre amigos; consumo de alcohol; y síntomas depresivos, presentaron asociación con ideación suicida. En el análisis múltiple permanecieron como factores asociados la orientación sexual, los intentos de suicidio en la familia y la presencia de síntomas depresivos. Conclusión:: estos hallazgos constituyen un diagnóstico situacional que posibilita la formulación de políticas académicas y de acciones de prevención para enfrentar esa situación en el campus universitario.
Keywords: adolescent; adult; cross-sectional study; female; human; male; psychology; risk factor; socioeconomics; student; suicidal ideation; university; young adult

Suicidal Ideation, Resilience, and Healthcare Implications for Newly Diagnosed HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study - Li, H.; Tucker, J.; Holroyd, E.; Zhang, J.; Jiang, B. (Archives of sexual behavior, 2017)
Globally, suicidal ideation and behavior have been widely reported among people living with human immunodeficiency virus (HIV). Knowledge gaps exist regarding the longer life and resilience-related experiences of people living with HIV (PLWH). Specifically, there is a dearth of data about the interaction of perceived risk and resilient factors resulting in a wide spectrum of intentional suicidal ideation outcomes in a Chinese cultural context. This qualitative research drew from a larger ethnographic study of newly diagnosed HIV-positive men who have sex with men (MSM) in Mainland China. Interviews were conducted with 31 MSM within 6 months of diagnosis of HIV infection. Initial suicidal ideation was commonly reported with participants subsequently feeling more resilient to these thoughts through gaining a greater understanding of their prognosis and treatment. Post-HIV diagnosis, some participants reported forming new relationships and receiving increased support from their partners, friends, peers, families, and community-based organizations. At follow-up, these participants generally reported suicidal ideation had declined. However, participants who continued to express suicidal ideation perceived extended pressure from their families' expectations for them to engage in heterosexual marriages and parenthood. Furthermore, these men reported ongoing hardships in their daily life, unemployment, lack of social support, and isolation. Among this Mainland Chinese cohort of HIV-positive MSM, suicidal ideation may be a transient phenomenon experienced initially following HIV diagnosis that resolves with increased and specific familial, social, and service-based support. It is crucial to identify the causes of stress and social suffering associated with HIV diagnosis in order to reduce suicidal ideation. In China, action is needed to develop routine mental health screening and to increase services that support PLWH. Important services mechanism to accomplish this are promoting resilience through intentional activities as well as continued public health campaigns to reduce stigma toward HIV-positive MSM.
Keywords: adolescent; adult; China; Human immunodeficiency virus infection; human; male; male homosexuality; psychology; qualitative research; statistics and numerical data; suicidal ideation; young adult

Needs of a Silent Minority: Mexican Transgender Asylum Seekers - Gowin, M.; Taylor, E.L.; Dunnington, J.; Alshuwaiyer, G.; Cheney, M.K. (Health promotion practice, 2017)
Mexican male to female transgender asylum seekers in the United States suffer from serious health issues that can be attributed to stressors related to their transgender, ethnic minority, and socioeconomic status. This study explored these stressors, the resulting health issues, and the needs of this particularly vulnerable population. Asylum seekers' (n = 45) sworn declarations and psychological evaluations were examined by a multidisciplinary research team using a systematic document review process. The review identified stressors that occurred both in Mexico and the United States: verbal, physical, and sexual assaults; unstable environments; fear for safety/security; hiding undocumented status; and economic insecurity. The health issues that resulted in part from these stressors include posttraumatic stress disorder, depression, anxiety, sleep issues, isolation, avoidance, drug/alcohol use, and suicidal tendencies. Despite suffering from multiple health issues, asylum seekers rarely sought health or social services. Health promotion practitioners can play an important role in serving this silent minority by (1) expanding community-based research focused on the intersection of transgender, ethnic minority, and socioeconomic status; (2) using trusted community members to connect this population to necessary resources; (3) providing communication training/resource development for health care providers; and (4) creating a network of service organizations that understand the needs of transgender asylum seekers.
Keywords: adult; epidemiology; female; health disparity; health service; human; male; mental health; mental stress; Mexican American; middle aged; organization and management; patient attitude; psychology; qualitative research; refugee; socioeconomics; transgender; violence; young adult

Men Who Have Sex with Men in Kampala, Uganda: Results from a Bio-Behavioral Respondent Driven Sampling Survey - Hladik, W.; Sande, E.; Berry, M.; Ganafa, S.; Kiyingi, H.; Kusiima, J.; Hakim, A. (AIDS and behavior, 2017)
We report on the results of a respondent-driven sampling survey among men who have sex with men (MSM) in Kampala, Uganda, where same-sex behavior is criminalized and highly stigmatized. We enrolled 608 MSM aged 18 + years and residing in greater Kampala from June 2012-November 2013. Anonymous data were collected through audio-computer assisted self-interviews; blood was tested for HIV-1 antibodies, CD4 + T cell counts, and viral load. Estimated HIV prevalence was 12.2 % (95 % confidence interval [CI] 8.0-16.1), increasing with age. One in five (19.6 %) stated knowing their HIV-positive status and a similar proportion of HIV-infected MSM were virally suppressed (19.3 %; 95 % CI 3.3-33.1). HIV-related risk behaviors included unprotected anal sex (35.8 % at last sex act), selling sex (38.5 %), having multiple steady (54.3 %) or casual (63.6 %) partners, and ever injecting drugs (31.6 %). Forty percent experienced homophobic abuse; 44.5 % ever experienced suicide ideation. HIV prevalence among MSM remains high whereas knowledge of seropositive status and suppression of viral load remains low. MSM report a wide range of high risk behaviors, frequent homophobic abuse, poor mental health, as well as low levels of testing and treatment. Better access to tailored prevention and treatment services to improve population-level viral load suppression are warranted.
Keywords: adolescent; adult; ethnology; health survey; high risk behavior; human; Human immunodeficiency virus infection; male; male homosexuality; middle aged; prevalence; psychology; sexuality; social stigma; statistics and numerical data; substance abuse; Uganda; unsafe sex; young adult

Impact of Social Determinants of Health on Medical Conditions Among Transgender Veterans - Blosnich, J.R.; Marsiglio, M.C.; Dichter, M.E.; Gao, S.; Gordon, A.J.; Shipherd, J.C.; Kauth, M.R.; Brown, G.R.; Fine, M.J. (American Journal of Preventive Medicine, 2017)
Introduction Transgender individuals experience pronounced disparities in health (e.g., mood disorders, suicide risk) and in the prevalence of social determinants of housing instability, financial strain, and violence. The objectives of this study were to understand the prevalence of social determinants among transgender veterans and assess their associations with medical conditions. Methods This project was a records review using administrative data from the U.S. Department of Veterans Affairs databases for 1997–2014. Transgender veterans (N=6,308) were defined as patients with any of four ICD-9 diagnosis codes associated with transgender status. Social determinants were operationalized using ICD-9 codes and Department of Veterans Affairs clinical screens indicating violence, housing instability, or financial strain. Multiple logistic regression was used to assess the associations of social determinants with medical conditions: mood disorder, post-traumatic stress disorder, alcohol abuse disorder, illicit drug abuse disorder, tobacco use disorder, suicidal risk, HIV, and hepatitis C. Results After adjusting for sociodemographic variables, housing instability and financial strain were significantly associated with all medical conditions except for HIV, and violence was significantly associated with all medical conditions except for tobacco use disorder and HIV. There was a dose response–like relationship between the increasing number of forms of social determinants being associated with increasing odds for medical conditions. Conclusions Social determinants are prevalent factors in transgender patients’ lives, exhibiting strong associations with medical conditions. Documenting social determinants in electronic health records can help providers to identify and address these factors in treatment goals.
Keywords: illicit drug; adult; aged; alcohol abuse; alcoholism; article; Black person; Caucasian; demography; drug abuse; female; financial deficit; hepatitis C; housing; human; Human immunodeficiency virus infection; ICD-9; major clinical study; male; medical record review; middle aged; mood disorder; partner violence; posttraumatic stress disorder; prevalence; secondary analysis; social determinants of health; social status; suicidal behavior; tobacco dependence; transgender; veteran

Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts - Raifman, J.; Moscoe, E.; Austin, S.B.; McConnell, M. (JAMA Pediatrics, 2017)
IMPORTANCE Suicide is the second leading cause of death among adolescents between the ages of 15 and 24 years. Adolescents who are sexual minorities experience elevated rates of suicide attempts. OBJECTIVE To evaluate the association between state same-sex marriage policies and adolescent suicide attempts. DESIGN, SETTING, AND PARTICIPANTS This study used state-level Youth Risk Behavior Surveillance System (YRBSS) data from January 1, 1999, to December 31, 2015, which are weighted to be representative of each state that has participation in the survey greater than 60%. A difference-in-differences analysis compared changes in suicide attempts among all public high school students before and after implementation of state policies in 32 states permitting same-sex marriage with year-to-year changes in suicide attempts among high school students in 15 states without policies permitting same-sex marriage. Linear regression was used to control for state, age, sex, race/ethnicity, and year, with Taylor series linearized standard errors clustered by state and classroom. In a secondary analysis among students who are sexual minorities, we included an interaction between sexual minority identity and living in a state that had implemented same-sex marriage policies. INTERVENTIONS Implementation of state policies permitting same-sex marriage during the full period of YRBSS data collection. MAIN OUTCOMES AND MEASURES Self-report of 1 or more suicide attempts within the past 12 months. RESULTS Among the 762 678 students (mean [SD] age, 16.0 [1.2] years; 366 063 males and 396 615 females) who participated in the YRBSS between 1999 and 2015, a weighted 8.6%of all high school students and 28.5%of students who identified as sexual minorities reported suicide attempts before implementation of same-sex marriage policies. Same-sex marriage policies were associated with a 0.6-percentage point (95%CI, -1.2 to -0.01 percentage points) reduction in suicide attempts, representing a 7%relative reduction in the proportion of high school students attempting suicide owing to same-sex marriage implementation. The association was concentrated among students who were sexual minorities. CONCLUSIONS AND RELEVANCE State same-sex marriage policies were associated with a reduction in the proportion of high school students reporting suicide attempts, providing empirical evidence for an association between same-sex marriage policies and mental health outcomes.
Keywords: adolescent; adolescent health; age; article; controlled study; female; high school student; human; LGBT people; major clinical study; male; priority journal; public policy; race; risk assessment; same-sex marriage; sensitivity and specificity; sex; sexual and gender minority; sexual orientation; suicide attempt; test retest reliability

Study of deaths by suicide of homosexual prisoners in Nazi Sachsenhausen concentration camp - Cuerda-Galindo, E.; López-Muñoz, F.; Krischel, M.; Ley, A. (PLoS ONE, 2017)
Living conditions in Nazi concentration camps were harsh and inhumane, leading many prisoners to commit suicide. Sachsenhausen (Oranienburg, Germany) was a concentration camp that operated from 1936 to 1945. More than 200,000 people were detained there under Nazi rule. This study analyzes deaths classified as suicides by inmates in this camp, classified as homosexuals, both according to the surviving Nazi files. This collective was especially repressed by the Nazi authorities. Data was collected from the archives of Sachsenhausen Memorial and the International Tracing Service in Bad Arolsen. Original death certificates and autopsy reports were reviewed. Until the end of World War II, there are 14 death certificates which state 'suicide' as cause of death of prisoners classified as homosexuals, all of them men aged between 23 and 59 years and of various religions and social strata. Based on a population of 1,200 prisoners classified as homosexuals, this allows us to calculate a suicide rate of 1,167/100,000 (over the period of eight years) for this population, a rate 10 times higher than for global inmates (111/100,000). However, our study has several limitations: not all suicides are registered; some murders were covered-up as suicides; most documents were lost during the war or destroyed by the Nazis when leaving the camps and not much data is available from other camps to compare. We conclude that committing suicides in Sachsenhausen was a common practice, although accurate data may be impossible to obtain.
Keywords: adult; article; autopsy; calculation; cause of death; concentration camp; controlled study; death certificate; Germany; homosexual male; human; major clinical study; male; middle aged; prisoner; religion; social aspect; suicide; young adult

Risky Sexual Behaviors as Correlates of Depression and Suicidal Ideation Among Male HIV Test-Seekers at a Voluntary Counseling and Testing Facility in Taiwan - Lin, C.-C.; Lee, Y.-T.; Yang, H.-J. (Asia-Pacific journal of public health, 2017)
This study aims at determining the level of depression and suicidal status of adult HIV test-seekers. Of the total enrolled 850 males, almost 50% reported some risk behaviors, 38.9% experienced depression, and 7.2% had suicidal ideation. Subjects with risky sexual behaviors in terms of repeated HIV test, had a history of sexually transmitted disease, engaged in one-night stands, or did not use condoms all the time with causal sexual partners were more likely to have depression. Furthermore, subjects who were bisexual/homosexual, engaged in Internet sex, engaged in one-night stands, or used addictive drugs within the past 6 months were more likely to experience suicidal ideation. The HIV testers are at risk of experiencing depression and suicidal ideation; each is associated with different types of risky sexual behaviors. It is essential for the health authority to further provide mental health services for HIV testers and to draw up an effective strategy in reducing unprotected sexual behaviors.
Keywords: adult; counseling; depression; high risk behavior; Human immunodeficiency virus infection; human; male; mass screening; patient attitude; psychology; risk factor; sexual behavior; suicidal ideation; Taiwan; voluntary program; young adult

Perceived Parental Monitoring and Sexual Orientation Moderate Lifetime Acts of Non-Suicidal Self-Injury - Benau, E.M.; Jenkins, A.L.; Conner, B.T. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2017)
Being non-heterosexual, particularly bisexual, is associated with high rates of engagement in NSSI amongst young adults. The goal of the present study was to determine if parenting practices, specifically parental monitoring, and sexual orientation moderate engagement with NSSI. Undergraduates (N = 1,353) completed a survey on sexual orientation, non-suicidal self-injury (NSSI) acts, and multiple aspects of perceived parental monitoring during high school. Moderation analyses revealed that most facets of parental monitoring were similarly negatively correlated with NSSI for both individuals whose sexual orientation where nearly, or entirely, gay and heterosexual youth. Youth who were neither exclusively heterosexual nor exclusively gay (mixed sexual orientation) reported the most NSSI acts, and no facet of parental monitoring predicted reduced NSSI acts for this group. While previous literature shows that many aspects of parental monitoring may be protective against engagement in health risk behaviors, the present study adds to these findings that similar aspects are negatively associated with self-injurious behavior for some, but not all, individuals. More research is needed to better understand the causes of increased NSSI for individuals with a mixed sexual orientation.
Keywords: adolescent; automutilation; bisexuality; child parent relation; female; heterosexuality; homosexuality; human; male; psychology; questionnaire; sexual and gender minority; sexual behavior; sexuality; statistics and numerical data; student; young adult

Preliminary Population Size Estimation of Men Who Have Sex with Men in Kazakhstan: Implications for HIV Testing and Surveillance - Wu, E.; Terlikbayeva, A.; Hunt, T.; Primbetova, S.; Gun Lee, Y.; Berry, M. (LGBT health, 2017)
PURPOSE: The purpose of this study is to estimate the population size of men who have sex with men (MSM) in Kazakhstan and their HIV testing history. METHODS: We conducted structured interviews with MSM in four geographically disparate cities-N = 400 (n = 100/city)-to implement four population estimation methods and ascertain HIV testing history. RESULTS: Approximately 3.2% of men-corresponding to ∼154,000 individuals-in Kazakhstan aged 18-59 are MSM. The 49.9% of the sample who reported taking an HIV test far exceeds the <1% reported as MSM in surveillance data. CONCLUSION: HIV testing surveillance in Kazakhstan has underestimated the number of MSM. This underscores the need to redress social and structural barriers to HIV testing and disclosure of sexual behavior experienced by MSM in Kazakhstan. Recommendations include promoting cultural sensitivity among testing staff through quality assurance and regular training, and increasing protection and public awareness through antidiscrimination policy development.
Keywords: adolescent; adult; health survey; human; Human immunodeficiency virus infection; interview; Kazakhstan; male; male homosexuality; middle aged; population density; theoretical model; young adult

Self-Injury Implicit Association Test: Comparison of Suicide Attempters and Non-attempters - Kene, P. (Psychiatric Quarterly, 2017)
Given the weaknesses of self-report measures, there has been an increased interest in alternative methods of suicide risk assessment, primarily the implicit measures of suicide risk. This study aimed to determine differences in implicit identification with self-injury and implicit attitude towards self-injury between attempters and non-attempters using the self-injury implicit association test (SI-IAT). The SI-IAT is a computer test designed to measure the implicit associations about self-injury. Participants were 100 forensic and civil inpatients at three psychiatric hospitals. A history of attempted suicide was very common in this sample. All participants completed the SI-IAT. Attempters and non-attempters did not significantly differ with respect to implicit identification with self-injury and implicit attitude towards self-injury. Implications are presented for assessment of suicide risk and future research.
Keywords: adult; antisocial personality disorder; article; attitude; automutilation; behavior disorder assessment; bipolar disorder; borderline state; computer; descriptive research; drowning; educational status; exhaust gas; female; firearm; Global Assessment of Functioning; hanging; human; identity; intoxication; jumping; length of stay; major clinical study; major depression; male; marriage; narcissism; paranoid personality disorder; schizoaffective psychosis; schizophrenia; self injury implicit association test; sexual orientation; substance abuse; suicide attempt

Early Sexual Debut and Associated Risk Behaviors Among Sexual Minority Youth - Lowry, R.; Dunville, R.; Robin, L.; Kann, L. (American Journal of Preventive Medicine, 2017)
Introduction Early sexual debut, sexual risk taking, substance use, violent victimization, and suicidal behaviors are more prevalent among sexual minority than sexual nonminority youth. Although associations between early sexual debut and these risk behaviors exist, little is known about such associations among sexual minority youth. This study examined these associations among sexual minority U.S. high school students and their sexual nonminority peers. Methods In 2015, the national Youth Risk Behavior Survey included questions assessing sexual orientation for the first time. In 2016, data from this nationally representative sample of 15,624 U.S. high school students were analyzed to determine if associations between early sexual debut and other health risk behaviors varied by sexual orientation, by calculating adjusted (for sex, race/ethnicity, and age) prevalence ratios (APRs). Results Associations between early sexual debut and other health risk behaviors did not vary significantly by sexual orientation. Early sexual debut (first sexual intercourse before age 13 years) was associated with sexual risk taking, substance use, violent victimization, and suicidal thoughts/attempts among students identifying as lesbian, gay, or bisexual (LGB) and among students identifying as heterosexual, for example, being currently sexually active (LGB students: APR=1.82, 95% CI=1.35, 2.45; heterosexual students: APR=2.50, 95% CI=2.22, 2.81) and not using a condom at last sexual intercourse (LGB students: APR=1.50, 95% CI=1.18, 1.91; heterosexual students: APR=1.29, 95% CI=1.09, 1.52). Conclusions School-based sexual health programs might appropriately utilize strategies that are inclusive of sexual minority students, encourage delay of sexual intercourse, and coordinate with violence and substance use prevention programs.
Keywords: adolescent; adolescent sexual behavior; article; cross-sectional study; ethnicity; female; gender identity; groups by age; health hazard; health program; heterosexuality; high risk behavior; high school student; human; juvenile; LGBT people; male; peer group; prevalence; race; sexual health; sexual intercourse; sexual and gender minority; sexual orientation; substance use; suicidal ideation; suicide attempt; United States; victim; violence

Preventive health care for women who have sex with women - Knight, D.A.; Jarrett, D. (American Family Physician, 2017)
Despite recent shifts in societal attitudes toward same-sex relationships, women who have sex with women face a variety of barriers to optimal health, including a history of negatively perceived interactions in clinical settings that lead them to delay or avoid health care. Women who have sex with women may be at disproportionate risk of obesity, tobacco use, substance use, mental health issues, intimate partner violence, sexually transmitted infections, and some cancers. Disparities can exist throughout the lifetime. Lesbian and bisexual adolescents are vulnerable to bullying, family rejection, and risky sexual behavior that may lead to sexually transmitted infections or unintended pregnancy. Sexual minority stress, which is a response to stigmatization, prejudice, and internalized homophobia, contributes to many of these conditions. Family physicians should foster trust and communication to provide a nonjudgmental, welcoming environment supportive of culturally competent health care and optimal outcomes. When indicated, clinicians should refer women who have sex with women to culturally sensitive community resources and legal advisors for assistance with medical decision making, hospital visitation, conception, and legal recognition of nonbiologic parents.
Keywords: anxiety; article; depression; eating disorder; health insurance; homosexual female; human; Human immunodeficiency virus infection; LGBT people; malignant neoplasm; mammography; mass screening; medical decision making; multiple choice test; non insulin dependent diabetes mellitus; obesity; Papanicolaou test; partner violence; preventive medicine; psychosexual development; sexual and gender minority; sexually transmitted disease; physiological stress; suicide; unplanned pregnancy; unsafe sex; women who have sex with women

Prevalence of condomless anal intercourse and recent HIV testing and their associated factors among men who have sex with men in Hangzhou, China: A respondent-driven sampling survey - Li, R.; Wang, H.; Pan, X.; Ma, Q.; Chen, L.; Zhou, X.; Jiang, T.; He, L.; Chen, J.; Zhang, X.; Luo, Y.; Xi, S.; et al. (PLoS ONE, 2017)
Men who have sex with men (MSM) are a large high-risk population for HIV infection in recent years in China. A cross-sectional survey was conducted in Hangzhou, China, to determine rates of condomless anal intercourse (CAI), recent HIV testing (in the recent year) and associated factors using respondent-driven sampling. Questionnaires using faceto-face interviews were employed to collect data on sexual risk behaviors and HIV testing. Five hundred eleven MSM were recruited, of which 459 (89.8%) had anal intercourse in the past 6 months. Of these 459 participants, 457 (99.6%) answered whether they had taken an HIV test in the recent year, so only their data were analyzed. Weighted data were analyzed using bivariate and multivariate logistic regression analysis. The CAI rate with male partners in the past 6 months was 43.7% (95% confidence interval [CI], 34.0-51.5%), while the rate of condomless vaginal intercourse (CVI) was 21.6% (95% CI, 15.6-32.3%). The prevalence of recent HIV testing was 56.8% (95% CI, 48.7-66.5%), while the prevalence of HIV and syphilis were 8.8% and 6.5%, respectively. Multivariate analysis indicated that CAI was associated with earlier homosexual debut, suicidal inclinations, childhood sexual abuse, HIV testing in the recent year, and lower estimate of HIV prevalence. Recent HIV testing was associated with homosexual debut age, engaging in CAI with male partners in the past 6 months, having oral sex in the past 6 months, self-perceived higher likelihood of HIV infection, knowing about antiretroviral therapy for HIV/AIDS, receiving AIDS/sexually transmitted infection (STI) interventions in the past year, and syphilis infection. Given high prevalence of HIV and syphilis, high levels of CAI and CVI, and low HIV testing rate, the results indicated high risk of HIV infection and transmission among MSM. HIV prevention interventions should target MSM with early homosexual debut and psychosocial health problems, while HIV/AIDS education among MSM should focus on increasing knowledge of HIV risk, estimated HIV prevalence and antiretroviral therapy, and improving risk perception of HIV acquisition.
Keywords: acquired immune deficiency syndrome; adolescent; adult; age; aged; anal intercourse; antiretroviral therapy; article; bisexual male; blood sampling; child; child sexual abuse; China; coitus; concurrent sexual partnership; condom use; condomless anal intercourse; condomless vaginal intercourse; controlled study; cross-sectional study; disease transmission; heterosexual male; high risk population; HIV education; HIV test; homosexual male; homosexuality; human; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; income; insurance; intervention study; major clinical study; male; marriage; men who have sex with men; oral sex; patient counseling; prevalence; questionnaire; risk assessment; risk factor; sexual behavior; sexual orientation; sexual violence; sexually transmitted disease; social psychology; suicidal behavior; syphilis

A tailored compassion-focused therapy program for sexual minority young adults with depressive symotomatology: study protocol for a randomized controlled trial - Pepping, C.A.; Lyons, A.; McNair, R.; Kirby, J.N.; Petrocchi, N.; Gilbert, P. (BMC psychology, 2017)
BACKGROUND: Lesbian, gay, and bisexual (LGB) men and women represent one of the highest-risk populations for depressive symptomatology and disorders, with young LGB adults being at greatest risk. To date, there have been no randomized controlled trials (RCT) to specifically target depressive symptoms in young LGB adults. This is despite research highlighting unique predictors of depressive symptomatology in this population. Here we outline a protocol for an RCT that will test the preliminary efficacy of a tailored compassion-focused therapy (CFT) intervention for young LGB adults compared with a self-directed cognitive behavioral therapy (CBT) program with no specific tailoring for LGB individuals. METHODS: The CFT intervention consists of 8 units with self-directed reading and activities tailored to LGB young adults, and 8 x weekly 1-hour consultations with a therapist. The CBT intervention consists of 8 units with self-guided reading and activities, with 1 x 1-hour session with a therapist at the mid-point of therapy. Fifty LGB individuals with scores of 13 or above on the Beck Depression Inventory-II will be randomized to either the CFT or CBT condition. The primary outcome measure is depressive symptomatology. Secondary outcome measures are symptoms of anxiety, suicidal ideation, internalized homophobia, self-compassion, and shame and guilt proneness. Assessments will occur at pre-intervention, post-intervention, and at 3-month post-intervention. DISCUSSION: This study is an RCT to test the preliminary efficacy of an LGB-tailored compassion-focused intervention for young LGB adults with depressive symptomatology. If this intervention is efficacious, this could begin to address the substantial mental health disparities amongst sexual minorities. TRIAL REGISTRATION: ACTRN12616001018404 . Prospective registration, registered 02/08/2016.
Keywords: adolescent; adult; clinical protocol; cognitive therapy; comparative study; controlled study; depression; empathy; female; human; male; mental stress; methodology; procedures; psychology; psychotherapy; quality of life; randomized controlled trial; sexual behavior; sexual and gender minority; shame; suicidal ideation; young adult

A clinically neglected topic: Risk of suicide in transgender individuals - Yüksel, Ş.; Aslantaş Ertekın, B.; Öztürk, M.; Bikmaz, P.S.; Oğlağu, Z. (Noropsikiyatri Arsivi, 2017)
Introduction: The aim of this study was to determine whether adolescence of transgender individuals is characterized by a high risk of suicide. Methods: In total, 141 participants with transgenderism were questioned using a semi-structured interview to determine whether participants had current suicidal thoughts, had a lifetime history of such thoughts, or had attempted suicide. These findings were cross-ref-erenced to the participants’ sociodemographic characteristics, and information about their families’ general attitudes toward sexuality, gender identity, and commitment to religious views. In total, 101 participants attended group psychotherapy sessions for at least a year. In these sessions, family and partner relationships, occupational problems, financial problems, medical issues, and religious concerns were discussed. Results: The incidence of suicide attempts, current suicidal thoughts, and lifetime suicidal thoughts were 29.8%, 9.2%, and 55.3%, respectively. In total, 76.7% of the suicide attempts occurred before the age of 21. Conclusion: Transsexual individuals present a high risk of suicide, particularly during adolescence. This finding may be considered a sign for taking action to prevent suicide when working with transgender individuals, particularly during adolescence.
Keywords: adolescence; adult; article; family attitude; family relation; female; financial deficit; gender dysphoria; gender identity; high risk patient; human; major clinical study; male; medical history; occupational disease; psychotherapy; religion; risk; semi structured interview; suicidal ideation; suicide; suicide attempt; transgender

LGBTQ Part 2 - Perron, T.; Kartoz, C.; Himelfarb, C. (NASN school nurse (Print), 2017)
In addition to dealing with the normal challenges of being a teenager, many times LGBTQ youth have to deal with harassment, intimidation, and bullying on a daily basis as they disproportionately experience verbal and physical harassment while in school as a result of their sexual orientation and/or gender identity. This violence adversely affects these students' health and well-being as reflected in the depression and suicide rate among LGBTQ youth. As Part 2 of a series in articles on caring for LGBTQ youth in a school setting, this article reviews specific health risks in this group of students. School nurses can help reduce disparities in health for LGBTQ youth by understanding risk for psychological consequences of bullying and advocating for a just and responsive social school culture. Implications for school nurses include educating school staff and families as well as providing prompt and appropriate referrals for necessary psychological care.
Keywords: adolescent; bisexuality; bullying; female; health personnel attitude; human; male; nurse attitude; nursing staff; practice guideline; prevention and control; psychology; school health nursing; standards; student; transgender; United States; violence

School connectedness and suicidal thoughts and behaviors: A systematic meta-analysis - Marraccini, M.E.; Brier, Z.M. (School psychology quarterly : the official journal of the Division of School Psychology, American Psychological Association, 2017)
Among the protective factors associated with reduced risk for suicide, scientific inquiries into school connectedness are especially important considering that schools are ideally situated to provide interventions reaching the vast majority of youth. Although there is a wealth of research that supports the association between school connectedness and reduced self-report of adolescents having a suicidal thought or making a suicide attempt, inconsistencies in the way studies have measured and operationalized school connectedness limit synthesis across findings. This meta-analytic study investigates the literature exploring associations between school connectedness and suicidal thoughts and behaviors across general and subpopulations (high risk and sexual minority youth) using a random effects model. Eligible studies examined a measure of school connectedness explicitly referred to as "school connectedness" or "connections at school" in relation to suicidal ideation or suicide attempts among youth enrolled in school (Grades 6-12). Multiple metaregression analyses were conducted to explore the influence of school connectedness measurement variation, as well as participant characteristics. Results, including 16 samples, support that higher school connectedness is associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] = 0.536), high-risk (OR = 0.603), and sexual minority (OR = 0.608) adolescents. Findings are consistent when analyzed separately for suicidal ideation (OR = 0.529) and suicide attempts (OR = 0.589) and remain stable when accounting for measurement variability. Although limited by its cross-sectional nature, findings support recent calls to increase school connectedness and proffer important implications for screening and intervention efforts conducted in schools. (PsycINFO Database Record
Keywords: adolescent; adolescent behavior; female; human; human relation; male; meta analysis; psychology; suicidal ideation; suicide attempt

Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health - Fredlund, C.; Svedin, C.G.; Priebe, G.; Jonsson, L.; Wadsby, M. (Child and Adolescent Psychiatry and Mental Health, 2017)
Background: Sex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury. Methods: A representative national sample of 5750 students in the 3rd year of Swedish high school, with a mean age of 18 years was included in the study. The study was questionnaire-based and the response rate was 59.7%. Mostly descriptive statistics were used and a final logistic regression model was made. Results: Sex as self-injury was reported by 100 (3.2%) of the girls and 20 (.8%) of the boys. Few correlations to sociodemographic factors were noted, but the group was burdened with more experiences of sexual, physical and emotional abuse. Non-heterosexual orientation, trauma symptoms, non-suicidal self-injury and healthcare for suicide attempts, depression and eating disorders were common. Conclusions: Sex used as self-injury seems to be highly associated with earlier traumas such as sexual abuse and poor mental health. It is a behavior that needs to be conceptualized in order to provide proper help and support to a highly vulnerable group of adolescents.
Keywords: abuse; adolescent; alcohol abuse; article; automutilation; behavior; child abuse; demography; disease association; drug abuse; eating disorder; emotional abuse; experience; female; high risk behavior; high school student; human; incidence; male; emotional abuse; mental health; physical abuse; questionnaire; self report; sex as self injury; sex difference; sexual abuse; sexual behavior; sexual orientation; sexual risk behavior; suicide attempt; Swedish citizen; symptom; trauma symptom; voluntary sexual experience

“It's how we deal”: Perceptions of LGB peers' use of alcohol and other drugs to cope and sexual minority adults' own coping motivated substance use following the Pulse nightclub shooting - Boyle, S.C.; LaBrie, J.W.; Costine, L.D.; Witkovic, Y.D. (Addictive Behaviors, 2017)
Sexual minority stress experiences (e.g. prejudice, victimization, etc.) and peer substance use norms (e.g. peers' frequency of use and quantity consumed) are important correlates of alcohol and drug use in sexual minority populations. The current study incorporates both of these by examining LGB individuals' perceptions of peers' use of alcohol and other drugs to cope with a sexual minority stressor, and whether perceptions of peer coping norms relate to one's own coping-motivated substance use in response to the stressor. Three-hundred and seven sexual minority males and females who identified as gay, lesbian, or bisexual completed an online survey approximately 1 month following the Pulse Nightclub Shooting, the deadliest incident of violence against LGBT people in U.S. history, and a stressor experienced within LGB communities throughout the U.S. Results revealed that LGB peers were widely perceived as likely to have coped with alcohol (68%) and drugs (41%) following the Pulse Shooting; however only small proportions of participants themselves reported coping with alcohol (26%) and drugs (7%). Further, multivariate models revealed that even after controlling for other factors including the stress impact of the Pulse shooting, the odds of using alcohol to cope with this event were 15 times greater among participants who held the perception that LGB peers likely used alcohol to cope relative to those who did not share this perception. Similarly, the odds of using drugs to cope with this event were 9 times greater among participants who perceived LGB peers likely to use drugs to cope with Pulse compared to those who did not. Importantly, these findings suggest that personalized normative feedback designed to correct perceptions of peers' coping motivated substance use may have utility as a motivational component in larger interventions seeking to reduce LGBs' substance use.
Keywords: alcohol; adult; alcohol consumption; alcoholism; article; bisexuality; controlled study; coping behavior; drinking behavior; drug dependence; feedback system; female; Florida; health survey; homosexual female; human; LGBT people; major clinical study; male; motivation; online analysis; peer group; perception; risk factor; sexual and gender minority; sexual violence; social media; social norm; social support; physiological stress; substance use; United States

Maternal and paternal personality profiles of adolescent suicide attempters - Bolat, N.; Kadak, T.; Eliacik, K.; Sargin, E.; Incekas, S.; Gunes, H. (Psychiatry Research, 2017)
Personality features have been correlated with suicidal behaviors in recent decades. Given its neurobiological background, Cloninger's model of personality, the Temperament and Character Inventory (TCI), may help to identify the maternal and paternal personality dimensions associated with adolescent suicide attempts. The present study is the first that specifically compares the temperament and character profiles of both mothers and fathers of the adolescent suicide attempters with a control group, by considering the influence of demographic and clinical factors. The study group comprised 117 parents of 71 adolescent suicide attempters and 119 parents of 71 age- and gender-matched adolescents without a suicide attempt included as a control group. The TCI and Brief Symptom Inventory (BSI) were applied to the parents in both groups. Logistic regression analysis, which was performed to adjust confounding factors, demonstrated significantly higher scores for harm avoidance among the mothers and lower scores of self-directedness among the fathers of the adolescent suicide attempters. New psychotherapeutic modalities considering the high-risk parental personality traits would be beneficial to support parent-adolescent relationships and may have a preventative effect on adolescent suicide.
Keywords: acute stress disorder; adjustment disorder; adolescent; adult; anxiety; article; attention deficit disorder; Brief Symptom Inventory; character; child parent relation; conduct disorder; controlled study; conversion disorder; depression; disease association; drug dependence; dysthymia; female; gender dysphoria; generalized anxiety disorder; high risk population; hostility; human; major clinical study; male; maternal attitude; obsessive compulsive disorder; paranoia; paternal attitude; personality; posttraumatic stress disorder; priority journal; psychological distress assessment; risk factor; social phobia; somatization; suicide attempt; temperament; Temperament and Character Inventory

Suicide risk in a representative sample of people receiving HIV care: Time to target most-at-risk populations (ANRS VESPA2 French national survey) - Carrieri, M.P.; Marcellin, F.; Fressard, L.; Préau, M.; Sagaon-Teyssier, L.; Suzan-Monti, M.; Guagliardo, V.; Mora, M.; Roux, P.; Dray-Spira, R.; Spire, B.; Allègre, T.; et al. (PLoS ONE, 2017)
Background: Suicide risk is high among people living with HIV (PLHIV). This study aimed to identify major correlates of suicide risk in a representative sample of PLHIV in France, in order to help target individuals who would benefit from suicide risk screening and psychiatric care. Methods: The ANRS VESPA2 cross-sectional survey (April 2011-January 2012) collected sociodemographic, medical and behavioral data from 3,022 PLHIV recruited in 73 French HIV hospital departments. The study sample comprised the 2,973 participants with available self-reported data on suicide risk (defined as having either thought about and planned to commit suicide during the previous 12 months or attempted suicide during the same period of time) and medical data on comorbidities. Weighted Poisson models adjusted for HCV coinfection and significant clinical variables were used to estimate the relationship between suicide risk and HIV transmission groups, experience with HIV disease and other psychosocial factors. Results: Suicide risk was reported by 6.3% of PLHIV in the study sample. After adjustment for HIV immunological status and HCV co-infection, women (IRR [95%CI]:1.93 [1.17; 3.19]) and men who have sex with men (MSM) (1.97 [1.22; 3.19]) had a higher suicide risk than the rest of the sample. Moreover, the number of discrimination-related social contexts reported (1.39 [1.19; 1.61]), homelessness (4.87 [1.82; 13.02]), and reporting a feeling of loneliness (4.62 [3.06; 6.97]) were major predictors of suicide risk. Conclusions: Reducing the burden of precarious social conditions and discrimination is an important lever for preventing suicide risk among PLHIV in France. Comprehensive care models involving peer/community social interventions targeted at women and MSM need to be implemented to lower the risk of suicide in these specific subgroups of PLHIV.
Keywords: adult; article; cohort analysis; comorbidity; controlled study; cross-sectional study; disease transmission; female; health survey; homelessness; hospital department; human; Human immunodeficiency virus infected patient; loneliness; male; men who have sex with men; middle aged; risk factor; social environment; social psychology; suicide; young adult

What family physicians can do to combat bullying - McClowry, R.J.; Miller, M.N.; Mills, G.D. (Journal of Family Practice, 2017)
Keywords: alcohol consumption; anxiety; article; bisexuality; bullying; community program; depression; family functioning; family violence; fighting; general practitioner; harassment; high risk population; human; learning disorder; obesity; parental behavior; patient counseling; physical disability; physical well-being; problem behavior; risk factor; sexual abuse; smoking; social media; social psychology; social status; suicide; transgender

The intersection of interpersonal and self-directed violence among general adult, college student and sexually diverse samples - Cramer, R.J.; Desmarais, S.L.; Johnson, K.L.; Gemberling, T.M.; Nobles, M.R.; Holley, S.R.; Wright, S.; Van Dorn, R. (The International journal of social psychiatry, 2017)
BACKGROUND: Suicide and interpersonal violence (i.e. victimization and perpetration) represent pressing public health problems, and yet remain mostly addressed as separate topics. AIMS: To identify the (1) frequency and overlap of suicide and interpersonal violence and (2) characteristics differentiating subgroups of violence-related experiences. METHODS: A health survey was completed by 2,175 respondents comprised of three groups: college students ( n = 702), adult members of a sexuality special interest organization ( n = 816) and a community adult sample ( n = 657). Latent class analysis was used to identify subgroups characterized by violence experiences; logistic regression was used to identify respondent characteristics differentiating subgroups. RESULTS: Overall rates of violence perpetration were low; perpetration, victimization and self-directed violence all varied by sample. Adults with alternative sexual interests reported high rates of victimization and self-directed violence. Analyses indicated two subgroups: (1) victimization + self-directed violence and (2) self-directed violence only. The victimization + self-directed violence subgroup was characterized by older, White, female and sexual orientation minority persons. The self-directed violence subgroup was characterized by younger, non-White, male and straight counterparts engaging with more sexual partners and more frequent drug use. CONCLUSION: Findings support the Centers for Disease Control and Prevention (CDC) definition of suicide as self-directed violence. Suicide intervention and prevention should further account for the role of violent victimization by focusing on the joint conceptualization of self-directed and interpersonal violence. Additional prevention implications are discussed.
Keywords: adolescent; adult; crime victim; female; human; human relation; male; middle aged; psychology; questionnaire; sexuality; statistical model; statistics and numerical data; student; suicide; United States; violence; young adult

Utopian Hopes or Dystopian Fears? Exploring the Motivational Underpinnings of Moralized Political Engagement - Skitka, L.J.; Hanson, B.E.; Wisneski, D.C. (Personality & social psychology bulletin, 2017)
People are more likely to become politically engaged (e.g., vote, engage in activism) when issues are associated with strong moral convictions. The goal of this research was to understand the underlying motivations that lead to this well-replicated effect. Specifically, to what extent is moralized political engagement motivated by proscriptive concerns (e.g., perceived harms, anticipated regret), prescriptive concerns (e.g., perceived benefits, anticipated pride), or some combination of these processes? And are the motivational pathways between moral conviction and political engagement the same or different for liberals and conservatives? Two studies (combined N = 2,069) found that regardless of political orientation, the association between moral conviction and political engagement was mediated by the perceived benefits of preferred but not the perceived harms of non-preferred policy outcomes, and by both anticipated pride and regret, findings that replicated in two contexts: legalizing same-sex marriage and allowing concealed weapons on college campuses.
Keywords: attitude; emotion; female; human; male; morality; motivation; politics

Associations of outside-and within-school adult support on suicidality: Moderating effects of sexual orientation - Coulter, R.W.S.; Schneider, S.K.; Beadnell, B.; O'Donnell, L. (American Journal of Orthopsychiatry, 2017)
This study examined sexual-orientation differences in reports of outside- and within-school adult support, and whether sexual orientation moderates the associations between adult support and suicidality (i.e., thoughts, plans, and attempts). At 26 high schools across MetroWest Boston, 22,834 students completed surveys assessing: sexual orientation (heterosexual, gay/lesbian, bisexual, or questioning); presence of outside- and within-school adult support; and past-year suicidality. Multivariable regression analyses with General Estimating Equations (adjusting for gender, grade, and race/ethnicity) examined sexual-orientation subgroup differences in adult support, and how sexual orientation and adult support were associated with suicidality. Interaction terms tested whether relationships between adult support and suicidality were moderated by sexual orientation. Gay/lesbian, bisexual, and questioning youth were each less likely than heterosexuals to report having outside-school adult support (risk ratios range: 0.85- 0.89). Each group also had greater odds than heterosexuals for suicidal thoughts (odds ratios [ORs] range: 1.86 -5.33), plans (ORs range: 2.15-5.22), and attempts (ORs range: 1.98 -7.90). Averaged across sexual-orientation subgroups, outside-school support was more protective against suicidality (ORs range: 0.34-0.35) than within-school support (ORs range: 0.78-0.82). However, sexual orientation moderated the protective effects of outside-school adult support, with support being less protective for bisexual and questioning youth than for heterosexuals. Adult support, and particularly outside-school adult support, is associated with lower suicidality. However, fewer gay/lesbian, bisexual, and questioning youth can rely on outside-school support and, even if present, it may be less protective against suicidality. Interventions are needed to help adults support gay/lesbian, bisexual, and questioning youth and reduce suicidality disparities.
Keywords: adult; article; bisexuality; controlled study; ethnicity; female; health survey; heterosexuality; high school; high school student; homosexual female; homosexual male; human; major clinical study; male; outside school adult support; psychosocial care; regression analysis; sex difference; sexual orientation; suicidal behavior; suicidal ideation; suicide attempt; United States; within school adult support

Older Age Associated with Mental Health Resiliency in Sexual Minority US Veterans - Monin, J.K.; Mota, N.; Levy, B.; Pachankis, J.; Pietrzak, R.H. (American Journal of Geriatric Psychiatry, 2017)
Objectives Objectives were to: (a) identify the mental health needs of older and younger sexual minority and heterosexual U.S. veterans and (b) examine whether sexual minority status confers vulnerability or resiliency in older adulthood. Support and trauma exposure were examined as potential mechanisms for age by sexual orientation differences. Methods Participants were a nationally representative sample of 3,095 U.S. veterans (ages 21 to 96 years). Measures included demographics, military characteristics, sexual orientation (lesbian, gay, or bisexual; LGB), social support, trauma, and mental health indicators (lifetime and present depression and post-traumatic stress disorder (PTSD); lifetime anxiety and suicidal ideation). Results Younger LGB veterans were most likely to report lifetime depression and/or PTSD and current depression compared with older LGB and younger and older heterosexual veterans. Older LGB veterans had low levels of mental health problems, but they reported the smallest social support networks. Conclusions Older and younger LGB veterans have different mental health challenges. Younger LGB veterans are more vulnerable to mental health problems than their older LGB peers. Older LGB veterans are resilient, but they may be at greater risk of social isolation than their younger LGB peers.
Keywords: adult; age; aged; article; coping behavior; depression; female; heterosexuality; human; male; mental health; posttraumatic stress disorder; self concept; self report; sexual and gender minority; social support; suicidal ideation; United States; very elderly; veteran

Usage of Riot Control Agents and other methods resulting in physical and psychological injuries sustained during civil unrest in Turkey in 2013 - Unuvar, U.; Yilmaz, D.; Ozyildirim, I.; Dokudan, E.Y.; Korkmaz, C.; Doğanoğlu, S.; Kutlu, L.; Fincanci, S.K. (Journal of Forensic and Legal Medicine, 2017)
Turkey has experienced a wave of demonstrations in the summer of 2013, called Gezi Park Demonstrations. Between 31 May and 30 August, 297 people who had been subjected to trauma by several methods of demonstration control and Riot Control Agents applied to the Human Rights Foundation of Turkey Rehabilitation Centers to receive treatment/rehabilitation and/or documentation. 296 patients except one 5-year-old child were included in the study. Of the 296 patients; 175 were male, 120 were female, and one was a transgender individual. The highest number of applications was received by the Istanbul center with 216 patients. The mean age of applicants was 33.85, and the age range was 15–71 years. While 268 of applicants (91%) stated that they had been exposed to Riot Control Agents, 62 patients suffered only chemical exposure who had no other traumatic injuries whereas 234 patients suffered at least one blunt trauma injury. Blunt trauma injuries are due to being shot by gas canisters in 127 patients (43%), by plastic bullets in 31 patients (10%). 59 patients (20%) were severely beaten, and 30 patients (10%) were injured by pressurized cold water ejected by water cannons. Thirteen patients (4.4%) suffered injuries that caused loss of vision or eye. Psychiatric evaluations were carried out for 117 patients while 43% of them were diagnosed with Acute Stress Disorder. Post Traumatic Stress Disorder and Major Depressive Disorder followed this diagnosis. This study includes the medical evaluation of injuries allegedly sustained during Gezi Park demonstrations in 2013 as a result of several methods of demonstration control and/or by being exposed to Riot Control Agents. The aim is to discuss different types of injuries due to those methods and health consequences of Riot Control Agents.
Keywords: plastic; riot control agent; tear gas; water; acute stress disorder; adjustment disorder; adolescent; adult; aged; anxiety disorder; article; blunt trauma; burn; civil disorder; contusion; eye injury; female; fracture; gunshot injury; head injury; hematoma; human; injury; laceration; major clinical study; major depression; male; multiple trauma; posttraumatic stress disorder; skin contusion; tooth injury; Turkey (republic); visual impairment

Mental Health Disparities Among Canadian Transgender Youth - Veale, J.F.; Watson, R.J.; Peter, T.; Saewyc, E.M. (Journal of Adolescent Health, 2017)
Purpose This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14–18 and 19–25). Methods A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Results Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. Conclusions Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable.
Keywords: adolescent; adolescent health; age; article; automutilation; Canada; depression; distress syndrome; female; gender identity; health disparity; human; major clinical study; major depression; male; mental health; prevalence; priority journal; risk assessment; suicide; transgender

Suicidal Ideation in Transgender People: Gender Minority Stress and Interpersonal Theory Factors - Testa, R.J.; Michaels, M.S.; Bliss, W.; Rogers, M.L.; Balsam, K.F.; Joiner, T. (Journal of Abnormal Psychology, 2017)
Research has revealed alarmingly high rates of suicidal ideation (SI) and suicide attempts among transgender and gender nonconforming (TGNC) people. This study aims to analyze the role of factors from the gender minority stress and resilience (GMSR) model (Testa, Habarth, Peta, Balsam, & Bockting, 2015), the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005; Van Orden et al., 2010), and the potential integration of these factors, in explaining SI in this population. A convenience sample of 816 TGNC adults responded to measures of current SI, gender minority stressors, and IPTS factors. Path analysis was utilized to test 2 models. Model 1 evaluated the associations between external minority stressors and SI through internal minority stressors. Model 2 examined the relationships between internal minority stressors and SI through IPTS variables (perceived burdensomeness and thwarted belongingness). All GMSR external stressors (rejection, nonaffirmation, victimization, and discrimination), internal stressors (internalized transphobia, negative expectations, and nondisclosure), and IPTS factors (thwarted belongingness and perceived burdensomeness) were related to SI. Both models demonstrated good fit. Model 1 revealed that rejection, nonaffirmation, and victimization were related to SI through experiences of internalized transphobia and negative expectations. Model 2 indicated that internalized transphobia and negative expectations were associated with SI through IPTS factors. The models demonstrate pathways through which GMSR and IPTS constructs relate to one another and confer risk for SI among TGNC individuals. These pathways and several recently proposed constructs examined here provide promising directions for future research and clinical interventions in this area.
Keywords: adult; aged; anxiety; article; depression; female; human; life stress; major clinical study; male; prevalence; psychological model; physiological stress; suicidal ideation; theory; transgender

Psychopathology screening in medical school students - Galván-Molina, J.F.; Jiménez-Capdeville, M.E.; Hernández-Mata, J.M.; Arellano-Cano, J.R. (Gaceta Medica de Mexico, 2017)
Objective: Screening of psychopathology and associated factors in medical students employing an electronic self-report survey. Method: A transversal, observational, and comparative study that consisted of the following instruments: Sociodemographic survey; 2. Adult Self-Report Scale-V1 (ASRS); State-Trait Anxiety Inventory (STAI); Zung and Conde Self-Rating Depression Scale, Almonte-Herskovic Sexual Orientation Self-Report; Plutchik Suicide Risk Scale; Alcohol Use Disorders Identification Test Identification (AUDIT); Fagerström Test for Nicotine Dependence; 9. Maslach Burnout Inventory (MBI); Eating Disorder Inventory 2 (EDI). Results: We gathered 323 student surveys from medical students of the first, third and sixth grades. The three more prevalent disorders were depression (24%), attention deficit disorders with hyperactivity (28%) and anxiety (13%); the prevalence of high-level burnout syndrome was 13%. Also, the fifth part of the students had detrimental use of tobacco and alcohol. Conclusion: Sixty percent of medical students had either one or more probable disorder or burnout. An adequate screening and treatment of this population could prevent severe mental disorders and the associated factors could help us to create a risk profile. This model is an efficient research tool for screening and secondary prevention.
Keywords: anxiety; article; attention deficit disorder; comparative study; depression; eating disorder; Fagerstrom Test for Nicotine Dependence; human; hyperactivity; mental disease assessment; plutchik suicide risk scale; prevalence; State Trait Anxiety Inventory; Zung Self Rating Depression Scale

Predictors of Sexual Minority Youth's Reported Suicide Attempts and Mental Health - Puckett, J.A.; Horne, S.G.; Surace, F.; Carter, A.; Noffsinger-Frazier, N.; Shulman, J.; Detrie, P.; Ervin, A.; Mosher, C. (Journal of homosexuality, 2017)
Lesbian, gay, and bisexual youth (LGBY) report higher rates of mental health concerns compared to heterosexual youth due to minority stressors. This study examined the interpersonal and intrapersonal variables that predict psychological distress and self-reported suicide attempts in a sample of 61 LGBY in the Mid-South, which is a highly overlooked regional area for LGBY research. Youth who lost friends when coming out were 29 times more likely to report suicide attempts, and those who experienced psychological maltreatment from caregivers were 9.5 times more likely to report a suicide attempt. Internalized heterosexism, feelings of guilt or shame, and psychological maltreatment from caregivers were significant predictors of depression and anxiety symptoms. This study highlights the importance of creating affirming spaces for LGBY, particularly in areas of the country that experience greater political oppression of sexual minorities, such as the Mid-South.
Keywords: adolescent; anxiety; bisexuality; defense mechanism; depression; female; heterosexuality; human; lesbianism; male; male homosexuality; mental disease; mental health; psychology; sexual and gender minority; shame; suicide attempt; young adult

Suicidality and Associated Factors Among Men Who Have Sex With Men in Estonia - Rüütel, K.; Valk, A.; Lõhmus, L. (Journal of homosexuality, 2017)
Many studies over the last decade provide strong evidence of elevated rates of suicidality among lesbian, gay, bisexual, and transgender populations compared to heterosexual populations. The aim of the current study was to investigate suicidal ideation and attempts and related factors among men who have sex with men (MSM) in Estonia. We conducted a nationwide Internet-based study among MSM with 265 eligible participants. Our results reveal high rates of self-reported suicidal ideation (lifetime prevalence 45%) and attempts (lifetime prevalence 11%) as well as a high rate of problem drinking (33%) and depressive symptoms (32%) among MSM. Recent suicidal ideation (14% had thought about suicide in the last 12 months) was related to depressive symptoms and lower socioeconomic situation. There is a need to develop specific interventions to address these issues among MSM and to provide gay-friendly mental health services.
Keywords: adolescent; adult; depression; Estonia; heterosexuality; human; male; male homosexuality; prevalence; psychology; questionnaire; sexual and gender minority; suicidal ideation; young adult

Accidental death due to autoerotic asphyxia coupled with fetishistic transvestism - Meena, M.C.; Chadha, S. (International Journal of Medical Toxicology and Forensic Medicine, 2017)
Fetishistic transvestism is a disorder of sexual perversion associated with fantasies and sexual urges to dress in opposite gender clothing as a means of arousal and adjunct to masturbation and coitus. However, transvestism has been described in schizophrenia and psychosis and fetishism in the course of simple schizophrenia. Our reported case is a 26 year-old male found hanging in transvestite attire wearing blouse and petticoat. There was no psychiatric background and no known previous suicidal behavior of the deceased. The manner of death was finally considered to be an accident. The cause of the death was accidental hanging provoked by fatal autoerotic asphyxia.
Keywords: accidental death; adult; article; autopsy; case report; conjunctival hemorrhage; forensic pathology; forensic psychiatry; hanging; human; livor mortis; lung edema; male; petechia; rigor mortis; sexual asphyxia; transvestic fetishism

Overview of young people attempting suicide by drug overdose and prevention and protection services - Bilginer, C.; Cop, E.; Goker, Z.; Hekim, O.; Sekmen, E.; Uneri, O. (Dusunen Adam, 2017)
Objective: Suicide is the second leading cause of death among 15-29 year-old-people in the world. The aim of this study is to present the characteristics of children and adolescents attempting suicide by drug overdose and to draw attention to preventive measures that can be taken in Turkey. Method: Records of the patients who admitted to a training and research hospital in one year period due to a suicide attempt by drug overdose were reviewed retrospectively. Sociodemographic data and psychiatric evaluation records of attempters were documented. Results: During the study period, 163 adolescents applied to the hospital with suicidal drug overdose. Child psychiatry consultation was ordered for 61.3% (n=100) of them. It was the first attempt of 90% of the cases. The frequency of having previous psychiatric diagnosis was significantly higher in patients with recurrent suicide attempts. In both impulsive and planned suicide attempts, the most preferred times were evening and night time. Women more often attempted suicide due to family conflict, while men attempted due to emotional relationship problems. All cases without psychiatric disorder or with externalizing problems attempted impulsive suicide. The most preferred drugs for suicide were, nonsteroidal anti-inflammatory drugs, antidepressants, paracetamol, antibiotics and antipsychotics. Of the all cases, 22.5% attempted suicide by self medications. It has not been possible to maintain pediatric psychiatric follow up of the 71% of the cases. Conclusion: It is considered that public attention should be drawn to the increasing number of adolescent suicide attempts in order to prevent this issue. Family-oriented protective approaches, school-based preventive programs and new legal regulations on drug safety could help to reduce the frequency of suicide attempts.
Keywords: antibiotic agent; antidepressant agent; neuroleptic agent; nonsteroid antiinflammatory agent; paracetamol; adolescent; article; child; child abuse; child psychiatry; clinical feature; consultation; controlled study; demography; depression; drug overdose; emotional disorder; family conflict; family counseling; female; follow up; gender dysphoria; human; human relation; impulsiveness; major clinical study; male; peer pressure; preventive medicine; protection; psychologic assessment; retrospective study; school health service; school stress; sex difference; suicide attempt; Turkey (republic)

Religious anti-gay prejudice as a predictor of mental health, abuse, and substance use - Sowe, B.J.; Taylor, A.J.; Brown, J. (American Journal of Orthopsychiatry, 2017)
Anti-gay, or homonegative, prejudice is generally considered harmful to the wellbeing of sexual minority individuals. However, the origins or nature of such prejudice may vary. Despite a sizable body of literature suggesting homonegative prejudice is frequently religious-based, the psychological impact of exposure to religious anti-gay prejudice remains largely undetermined. Addressing this research gap, the authors examined whether opposition to same-sex sexuality on religious grounds predicted detrimental outcomes among same- and both-sex attracted individuals, as well as their heterosexual counterparts. A nationwide U.S. sample of 1600 individuals-recruited using contemporary online crowd-sourcing techniques designed to limit selection bias-completed a novel inventory assessing interpersonal exposure to religious (as well as nonreligious) homonegative disapproval. Outcome variables assessed included a number of clinically relevant measures spanning general mental health, social support, suicidality, abuse, and substance use. Analyses revealed that greater exposure to religious anti-gay prejudice predicted higher levels of anxiety, stress, and shame; more instances of physical and verbal abuse; and more problematic alcohol use. Furthermore, while sexual minority individuals tended to fare more poorly than their heterosexual counterparts on almost every outcome measure assessed, homonegative prejudice predicted poorer outcomes among all respondents regardless of their sexual orientation or religious identification. Hence, results are among the first to demonstrate that anti-gay religious exposure is associated with substantial threats to wellbeing, and that such effects may be observed beyond religious sexual minorities. Overall, findings imply that homonegative religious social conditions may be of broader health and mental health concern than is conventionally recognized.
Keywords: abuse; adult; aged; alcohol consumption; Alcohol Use Disorders Identification Test; anti gay prejudice; anxiety; article; attitude to sexuality; behavior disorder assessment; conflict; controlled study; Depression Anxiety Stress Scale; drug use; feeling scale; female; gender bias; health hazard; homonegative prejudice inventory; human; human experiment; individuality; male; mental health; outcome assessment; personal experience; Personal Feelings Questionnaire 2; physical abuse; predictor variable; psychologic assessment; psychologic test; psychological aspect; questionnaire; religion; Religious Commitment Measure; responsibility; self evaluation; self responsibility; sexual and gender minority; sexual orientation; sexuality; shame; social support; social support assessment; physiological stress; substance use; suicidal behavior; Suicidal Behaviors Questionnaire; Three Component Individualism Scale; United States; verbal hostility; wellbeing

Exploring Rural Disparities in Medical Diagnoses among Veterans with Transgender-related Diagnoses Utilizing Veterans Health Administration Care - Bukowski, L.A.; Blosnich, J.; Shipherd, J.C.; Kauth, M.R.; Brown, G.R.; Gordon, A.J. (Medical Care, 2017)
Objectives: Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. Methods: This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Results: Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. Conclusions: This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.
Keywords: illicit drug; adult; aged; alcoholism; article; female; health care disparity; high risk population; human; Human immunodeficiency virus infection; major clinical study; male; mood disorder; posttraumatic stress disorder; priority journal; retrospective study; suicidal ideation; suicide attempt; tobacco use; transgender; urban rural difference; veterans health

Committee Opinion No. 685 Summary: Care for Transgender Adolescents (Obstetrics and gynecology, 2017)
Gender nonconforming youth are an underserved population who obstetrician-gynecologists are seeing increasingly in their practices. Currently, there are large gaps in training, knowledge, and comfort with transgender patients among obstetrician-gynecologists. The purpose of this document is to review current recommendations that apply to an obstetrician-gynecologist. It is important for obstetrician-gynecologists to be aware of the social and mental health risks for the transgender population. Consensus guidelines support initiating medical therapy after an adolescent has an established diagnosis of transgender identity and has reached Tanner stage II development. Medical management involves the suppression of puberty (typically in the form of gonadotropin-releasing hormone agonists) followed by cross-sex hormone therapy to induce puberty at age 16 years. A variety of surgical options are available, including bilateral mastectomy, hysterectomy with bilateral salpingo-oophorectomy or salpingectomy, and possible neophallus creation. Transgender patients are an at-risk population, and preventive medicine is imperative to their health. This includes proper screening for sexually transmitted infections, screening for suicidal thoughts and mental health issues, and appropriate vaccination. Like all patients, transgender adolescents should have a source for ongoing primary care.
Keywords: gonadorelin; adolescent; female; gender identity; human; psychology; sexual maturation; transgender; transsexualism

Persecution Experiences and Mental Health of LGBT Asylum Seekers - Hopkinson, R.A.; Keatley, E.; Glaeser, E.; Erickson-Schroth, L.; Fattal, O.; Nicholson Sullivan, M. (Journal of homosexuality, 2017)
Asylum seekers are a unique population, particularly those who have endured persecution for their sexual orientation or gender identity. Little data exist about the specific experiences and needs of asylum seekers persecuted due to lesbian, gay, bisexual, or transgender (LGBT) identity. Quantitative data were gathered regarding demographics, persecution histories, and mental health of 61 clients from a torture survivors program in New York City who reported persecution due to LGBT identity. Thirty-five clients persecuted due to their LGBT identity were matched by country of origin and sex with clients persecuted for other reasons to explore how persecution and symptoms may differ for LGBT clients. LGBT asylum seekers have a higher incidence of sexual violence, persecution occurring during childhood, persecution by family members, and suicidal ideation. Understanding the type of persecution experiences and how these influence mental health outcomes is an essential step toward designing and delivering effective treatments.
Keywords: adult; case control study; female; gender identity; human; male; mental health; New York; prejudice; psychology; refugee; sexual behavior; sexual and gender minority; suicidal ideation; survivor; torture; transgender; violence

Factors associated with self-reported discrimination against men who have sex with men in Brazil - Magno, L.; Dourado, I.; da Silva, L.A.V.; Brignol, S.; Brito, A.M.; Guimarães, M.D.C.; Benzaken, A.; Pinho, A.A.; Kendall, C.; Kerr, L.R.F.S. (Revista de saude publica, 2017)
OBJECTIVE: To estimate self-reported discrimination due to sexual orientation among men who have sex with men (MSM) in Brazil and to analyze associated factors. METHODS: A cross-sectional study of 3,859 MSM recruited in 2008-2009 with respondent driven sampling. Data collection conducted in health centers in 10 Brazilian cities. A face-to-face questionnaire was used and rapid HIV and syphilis tests conducted. Aggregated data were weighted and adjusted odds ratio estimated to measure the association between selected factors and self-reported discrimination due to sexual orientation. RESULTS: The sample was predominantly young, eight plus years of schooling, pardo (brown), single, low-income, and identified themselves as gay or homosexual. The prevalence of self-reported discrimination due to sexual orientation was 27.7% (95%CI 26.2-29.1). Discrimination was independently associated with: age < 30 years, more years of schooling, community involvement and support, history of sexual and physical violence, suicidal thoughts, and unprotected receptive anal intercourse. CONCLUSIONS: The prevalence of self-reported discrimination among MSM in Brazil is high. These results challenge the assumptions that MSM-specific prevention and support programs are not required or that health professionals do not need special training to address MSM needs.
Keywords: adolescent; adult; Brazil; clinical trial; human; Human immunodeficiency virus infection; interview; male; male homosexuality; multicenter study; perceptive discrimination; prevalence; psychology; questionnaire; risk factor; self report; socioeconomics; statistics and numerical data; young adult

Health disparities between lesbian, gay, and bisexual adults and the general population in South Korea: Rainbow Connection Project I - Yi, H.; Lee, H.; Park, J.; Choi, B.; Kim, S.-S. (Epidemiology and health, 2017)
OBJECTIVES: This study aims to investigate health disparities between lesbian, gay, and bisexual (LGB) adults and the general population in Korea, where there is low public acceptance of sexual minorities and a lack of research on the health of sexual minorities. RESULTS: Korean LGB adults exhibited a statistically significantly higher prevalence of depressive symptoms, suicidal ideation and attempts, and musculoskeletal pain than the general population. Lesbian and bisexual women had a higher risk of poor self-rated health and smoking than the general women population, whereas gay and bisexual men showed no differences with the general men population. Higher prevalence of hazardous drinking was observed among lesbians, gay men, and bisexual women compared to the general population, but was not observed in bisexual men. CONCLUSIONS: The findings suggest that LGB adults have poorer health conditions compared to the general population in Korea. These results suggest that interventions are needed to address the health disparities of Korean LGB adults. METHODS: The research team conducted a nationwide survey of 2,335 Korean LGB adults in 2016. Using the dataset, we estimated the age-standardized prevalence ratios (SPRs) for poor self-rated health, musculoskeletal pain, depressive symptoms, suicidal behaviors, smoking, and hazardous drinking. We then compared the SPRs of the LGB adults and the general population which participated in three different nationally representative surveys in Korea. SPRs were estimated for each of the four groups (i.e., gay men, bisexual men, lesbians, and bisexual women).
Keywords: adult; depression; drinking behavior; female; health disparity; health survey; human; male; middle aged; musculoskeletal pain; prevalence; psychology; sexual and gender minority; smoking; South Korea; statistics and numerical data; suicidal ideation; suicide attempt; violence; young adult

Women firefighters and workplace harassment associated suicidality and mental health sequelae - Hom, M.A.; Stanley, I.H.; Spencer-Thomas, S.; Joiner, T.E. (Journal of Nervous and Mental Disease, 2017)
This cross-sectional study investigated the association between harassment, career suicidality, and psychiatric symptoms among women firefighters. Women firefighters (n = 290) completed self-report measures of experiences with harassment on the job, career suicidality, and various psychiatric symptoms. Logistic regression analyses and one-way analyses of variance were used to address study aims. Of the sample, 21.7% reported having experienced sexual harassment and 20.3% reported having been threatened or harassed in another way on their firefighting job. Sexual harassment and other threats/harassment on the job were both significantly associated with a greater likelihood of reporting career suicidal ideation, as well as reporting more severe psychiatric symptoms. Harassment and threats experienced on the job may be associated with increased suicide risk and more severe psychiatric symptoms among women firefighters. Efforts are needed to reduce the occurrence of harassment and threats within the fire service and provide support for women firefighters who have been harassed or threatened.
Keywords: Acquired Capability for Suicide Scale Fearlessness About Death; adult; Alcohol Use Disorders Identification Test; Anxiety Sensitivity Index; Anxiety Sensitivity Index 3; article; behavior disorder assessment; career; Center for Epidemiologic Studies Depression Scale Revised; cross-sectional study; depression assessment; DSM-5; female; fire fighter; heterosexuality; human; Insomnia Severity Index; Interpersonal Needs Questionnaire; major clinical study; mental disease; mental disease assessment; non-sexual harassment; Quality of Worklife Module; Self Injurious Thoughts and Behaviors Interview Short Form; self report; sexual harassment; sexual orientation; Suicidal Behaviors Questionnaire Revised; suicidal ideation; threat; workplace violence

Clinical barriers to effective treatment of eating disorders and co-occurring psychiatric disorders in transgendered individuals - Wagner, R.; Stevens, J.R. (Journal of Psychiatric Practice, 2017)
Eating disorders (EDs) are complex and difficult to treat illnesses that are often chronic and disabling on their own accord or due to comorbidity with other psychiatric conditions. Historically, EDs have been viewed as illnesses of heterosexual, affluent white females. This stereotype increases the likelihood that these disorders will be underrecognized in the lesbian, gay, bisexual, and transgender community, as well as in different gender, socioeconomic, and ethnic populations. Our case report illustrates the clinical difficulties of managing a patient who presented to inpatient treatment with complaints of depression and suicidality, but who also had an active ED and was transgender.
Keywords: amfebutamone; mirtazapine; noradrenalin; serotonin uptake inhibitor; zolpidem; adult; anorexia nervosa; article; bipolar depression; bisexuality; case report; clinical article; depression; eating disorder; ethnic group; heterosexuality; hospital patient; human; major depression; male; mental disease; sex difference; social status; stereotypy; suicidal behavior; suicide attempt; transgender; treatment resistant depression; young adult

Physical activity and suicidal behaviors in gay, lesbian, and bisexual Korean adolescents - Jang, S.; So, W.-Y.; Choi, E.-J. (Journal of Men's Health, 2017)
The purpose of this study was to examine whether physical activities were related to suicidal behaviors in gay, lesbian, and bisexual Korean adolescents. In 2015, 68,043 adolescents participated in the 11th Korea Youth Risk Behavior Web-Based Survey project. However, only 628 of these 68,043 participants provided enough information about their romantic and sexual behaviour to be categorized as gay or bisexual boys (n 5 430) or lesbian or bisexual girls (n 5 198). The relationships between physical activities and suicidal behaviours were evaluated by multivariate logistic regression analysis after adjustment for covariate variables such as economic status of the family, mental stress, frequency of smoking, and frequency of drinking. There were no significant relationships between muscle-strengthening exercises and the suicidal behaviour categories (seriously considered, planned, and attempted) both in gay or bisexual boys and in lesbian or bisexual girls. Additionally, there were no significant relationships between vigorous physical activity and the suicidal behaviour categories in gay or bisexual boys. However, there were a significant relationship between vigorous physical activity and suicidal behaviour categories in lesbian or bisexual girls. There were slightly significant relationships between light physical activity (walking) and suicidal behaviour both in gay or bisexual boys and in lesbian or bisexual girls. We concluded that, for gay or bisexual boys, light physical activity might be associated with a reduced risk of suicidal behaviours. However, vigorous physical activity and muscle-strengthening exercises were not associated with suicidal behaviours. For lesbian or bisexual girls, vigorous physical activity might be associated with a reduced risk of suicidal behaviours. However, muscle-strengthening exercises had no association with suicidal behaviours.
Keywords: adolescent; article; bisexuality; drinking; female; homosexual female; homosexual male; human; Korean (people); major clinical study; male; mental stress; multivariate logistic regression analysis; muscle training; physical activity; priority journal; risk reduction; sexual orientation; smoking; suicidal behavior; suicidal ideation; suicide; suicide attempt

Type of sexual intercourse experience and suicidal ideation, plans, and attempts among youths: a cross-sectional study in South Korea - Kim, G.H.; Ahn, H.S.; Kim, H.J. (BMC public health, 2016)
BACKGROUND: Despite abundant theoretical evidence of higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and types of sexual intercourse experience in youths. This study examines the association between the type of intercourse experience and suicide risk outcomes (SROs: suicidal ideation, plans for suicide, suicidal attempts) from the Korea Youth Risk Behavior Web-based Survey. METHODS: We analyzed cross-sectional data from 146,621 students aged 12-17 years for the years 2012 and 2013. We defined lesbian, gay, or bisexual youth as youths who engaged in a type of sexual intercourse (same-sex or both-sex intercourse). A chi-square test and logistic regression analysis were used to evaluate the association between intercourse experience and SROs. RESULTS: The results showed that the prevalence of suicidal ideation was higher among youths with same-sex intercourse experience (45.9% for females, 33.7% for males) than among youths with opposite-sex intercourse experience (42.2% for females, 23.8% for males) and those with no experience in intercourse (21.0% for females, 12.7% for males). After adjusting for revealed risk factors that were associated with suicide risks, among males, suicide risks based on intercourse experience seemed to increase in the following order: no experience in sexual intercourse, opposite-sex, same-sex, and then both-sexes sexual intercourse experience. Same- and both-sexes intercourse related SROs are strongly linked to violence (being physically assaulted, threatened, or bullied) and sexually transmitted diseases (STDs), including HIV infection. Those having no sexual intercourse experience showed the least probability of suicide risks among youths. CONCLUSION: The SROs of youths with same-sex or both-sex intercourse experience had strong associations with gender (males), violence, and STDs. Therefore, school educators must continue to advocate for and to implement LGB inclusive policies and programs in order to promote safe and supportive learning environments where all students are protected from health risk behaviors.
Keywords: adolescent; adolescent behavior; cross-sectional study; female; health behavior; high risk behavior; human; male; psychology; risk factor; sexual behavior; South Korea; student; suicide

Effect of antioxidants, amino acids and plant growth regulators on in vitro propagation of Rosa centifolia - Akhtar, G.; Jaskani, M.J.; Sajjad, Y.; Akram, A. (Iranian Journal of Biotechnology, 2016)
Background: Rosa centifoliais commercially propagated by asexual means but in vitro propagation ensure the production of disease free and healthy plants and browning of explants creates hurdle in their multiplication. Objectives: The aim was to reduce oxidative browning of shoots of R. centifolia in MS medium during in vitro propagation. Materials and Methods: Axillary buds of R. centifolia were sterilized with 70% ethyl alcohol for 4 min and 5% sodium hypochlorite for 2 min followed by three washing with sterilized double distilled water. In order to control oxidative browning, Ascorbic acid (100 mg.L-1), citric acid (100 mg.L-1) and activated charcoal (3 g.L-1) were used while to control withering of shoots, different concentrations (3.0 mg.L-1, 6.0 mg.L-1, 9.0 mg.L-1) of either glutamine, asparagine and proline were put into trial. Different concentrations of Benzyl aminopurine (BAP) and naphthalene acetic acid (NAA) were used for in vitro shoot and root formation. Results: Minimum browning percentage (20%) was achieved in the presence of activated charcoal (3.0 g.L-1) and pretreatment of explants with running tap water. Asparagin (9.0 mg.L-1) produced maximum shooting (93%), minimum withering (6.67%), and it took longer period (27 days) for shoots to wither. BAP (3.0 mg.L-1) + NAA (0.5 mg.L-1) was produced the highest number of shoots (1.63), in a shortest periods (9 days). For root production, NAA (1.5 mg.L-1) + BAP (0.5 mg.L-1) reduced the time to 11 days with maximum number of roots (4.33) and root length (4.20 cm). Conclusions: The supplement of activated charcoal (3.0 g.L-1), a sparagin (9.0 mg.L-1) and combination of BAP and NAA in the MS medium is effective for in vitro propagation of R. centifolia.
Keywords: 1 naphthylacetic acid; 6 n benzyladenine; activated carbon; alcohol; amino acid; antioxidant; ascorbic acid; asparagine; citric acid; glutamine; hypochlorite sodium; phytohormone; proline; tap water; article; axillary bud; controlled study; in vitro propagation; nonhuman; plant browning; plant root; Rosa centifolia; rose; shoot

Substance use among adolescent sexual minority athletes: A secondary analysis of the youth risk behavior survey - Veliz, P.; Boyd, C.J.; McCabe, S.E. (Addictive Behaviors Reports, 2016)
Aims: While a robust literature exists regarding substance use patterns among adolescent athletes, no studies have examined substance use among adolescent sexual minority athletes; a subpopulation of adolescents that may experience greater rates of substance use due to their marginalized status within the context of sport. Methods: This study uses data from the Youth Risk Behavior Survey (2009-2013). Adolescents (N = 26,940) from four states were included in the analyses that assessed past 30-day cigarette use, alcohol use, binge drinking and marijuana use among sexual minority athletes, heterosexual athletes, heterosexual non-athletes, and sexual minority non-athletes. Results: Approximately 4% of the sample included athletes who identified as a sexual minority (3.7% males and 5.3% females). While the bivariate analyses found that sexual minority athletes had higher past 30-day prevalence rates of substance use when compared to heterosexual athletes and non-athletes, these rates were similar to sexual minority non-athletes. Moreover, when demographic characteristics and history of substance use were included in the multivariate analytic models, many of these differences were no longer statistically significant. These results were generally consistent for both males and females. Conclusions: The results of the study suggest that the context of sport may not be an additional site for stress among adolescent athletes who identify as a sexual minority, and subsequently may have little impact on substance use behaviors. However, participating in sport may not serve as a protective context for adolescent sexual minorities given that substance use behaviors may be learned and reinforced.
Keywords: alcohol; cannabis; adolescent; alcohol consumption; article; athlete; binge drinking; bivariate analysis; cannabis addiction; controlled study; demography; drug dependence; female; gender identity; health behavior; health survey; heterosexuality; high risk behavior; human; juvenile; major clinical study; male; multivariate analysis; secondary analysis; sexual and gender minority; smoking; sport; physiological stress; substance abuse; substance use; suicidal ideation

Psychiatric comorbidities in transsexualism: Study of a Lebanese transgender population - Ibrahim, C.; Haddad, R.; Richa, S. (Encephale, 2016)
Introduction The question of whether gender dysphoria is associated with psychiatric comorbidity has been addressed in several studies. Several cohort studies have shown that psychiatric comorbidity is one of the main features of poor prognosis following sex change therapy. Gender dysphoria is rare, with an estimated prevalence of 0.001% to 0.002% globally. The literature shows a high prevalence of psychiatric comorbidities in people with gender dysphoria, and that they are more common in male to female transsexuals. Data on long-term mortality show that transsexuals present a 51 % increase in mortality compared to the general population. This is mainly attributed to a six-fold increase in the number of suicides and a higher rate of psychiatric disorders and risky behaviors leading to HIV infection and substance abuse. Purpose Assess psychiatric comorbidity in a population of Lebanese transgender individuals and compare it to the general population. The hypothesis of our study is that the Lebanese transgenders suffer from more psychiatric comorbidities than the general population. Our second objective was to determine the specific mental health needs of this population in order to adapt our services to their medical needs and their specific concerns. Methods Our objective was to acquire 20 transgender participants and 20 control subjects. We chose a snowball sampling method. The evaluation consisted of three questionnaires including a general demographic questionnaire, the MINI 5.0.0 Arabic version for axis I disorders and the SCID-II for axis II disorders. Results The mean age of both groups was 23.55 years. Fifty-five percent (n = 11) transgender participants had active suicidal thoughts against 0 % in controls. Within the group of transgender, 45 % (n = 9) had a major depressive episode, 5 % (n = 1) had a generalized anxiety disorder, 5 % (n = 1) had a posttraumatic stress disorder and 10 % (n = 2) had a major depressive episode with comorbid posttraumatic stress disorder. We noted a significant difference between the two groups regarding the presence of suicidal ideation (P = 0.000) and the presence of axis I disorders (P = 0.039). Discussion In our study, we noted demographic and economic characteristics specific to the population of transgender individuals. We found a significant difference in the level of education, economic status and household composition. Transgender individuals suffer from more psychiatric pathologies compared to the general population. This may be due to social and familial discrimination and ostracism. These results demonstrate the vulnerability of this population. An awareness program for mental health professionals is essential in order to adapt care to the specific needs of this population. A list of non “transphobic” mental health professionals should be established.
Keywords: article; awareness; clinical article; comorbidity; controlled study; educational status; generalized anxiety disorder; household; human; Lebanese; major depression; posttraumatic stress disorder; sampling; social status; Structured Clinical Interview for DSM Disorders; suicidal ideation; transgender; transsexualism

Physical victimization, gender identity and suicide risk among transgender men and women - Barboza, G.E.; Dominguez, S.; Chance, E. (Preventive Medicine Reports, 2016)
We investigated whether being attacked physically due to one's gender identity or expression was associated with suicide risk among trans men and women living in Virginia. The sample consisted of 350 transgender men and women who participated in the Virginia Transgender Health Initiative Survey (THIS). Multivariate multinomial logistic regression was used to explore the competing outcomes associated with suicidal risk. Thirty-seven percent of trans men and women experienced at least one physical attack since the age of 13. On average, individuals experienced 3.97 (SD = 2.86) physical attacks; among these about half were attributed to one's gender identity or expression (mean = 2.08, SD = 1.96). In the multivariate multinomial regression, compared to those with no risk, being physically attacked increased the odds of both attempting and contemplating suicide regardless of gender attribution. Nevertheless, the relative impact of physical victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression. Finally, no significant association was found between multiple measures of institutional discrimination and suicide risk once discriminatory and non-discriminatory physical victimization was taken into account. Trans men and women experience high levels of physical abuse and face multiple forms of discrimination. They are also at an increased risk for suicidal tendencies. Interventions that help transindividuals cope with discrimination and physical victimization simultaneously may be more effective in saving lives.
Keywords: adult; article; educational status; female; gender identity; high risk behavior; housing; human; major clinical study; male; patient counseling; personal experience; physical abuse; physical violence; priority journal; psychotherapy; sexism; social support; suicidal ideation; suicide attempt; transgender; victim; Virginia

Psychological pathway to suicidal ideation among men who have sex with men in Shanghai, China: A structural equation model - Li, R.; Cai, Y.; Wang, Y.; Gan, F.; Shi, R. (Journal of Psychiatric Research, 2016)
We aimed to explore the relationships and develop an inter-theoretical model among psychological variables in the progression to suicidal ideation among men who have sex with men (MSM). A cross-sectional study was conducted among 547 MSM in four districts in Shanghai from March to May in 2014. Socio-demographic, psychological, and behavioral information of the participants was collected. A structural equation model (SEM)-Path Analysis was constructed to interpret the intricate relationships among various psychological variables. Suicidal ideation among MSM during the past year was 10.6%. The developed model agreed well with existing suicide models and had a good fit to the data (χ2/df = 2.497, comparative fit index = 0.983, root mean squared error of approximation = 0.052). Suicidal ideation was predicted by perceived defeat and entrapment (β = 0.21, p < 0.001), which was in turn predicted by temperament (β = 0.60, p < 0.001) and perceived social support (β = 0.34, p < 0.001). Perceived social support fully mediated the relationships among mood states, perceived social status, and perceived defeat and entrapment. MSM with certain types of temperament might be predisposed to a higher perception of defeat and entrapment. Perceived social support can effectively alleviate the negative appraisals and emotions and lower the risk for suicidal ideation among MSM.
Keywords: adolescent; adult; aged; article; China; cross-sectional study; drug industry; emotion; human; major clinical study; male; men who have sex with men; mood; perception; prevalence; priority journal; psychological aspect; social status; social support; structural equation modeling; suicidal ideation; temperament

Prevalence and correlates of substance use among youth living with HIV in clinical settings - Gamarel, K.E.; Brown, L.; Kahler, C.W.; Fernandez, M.I.; Bruce, D.; Nichols, S. (Drug and Alcohol Dependence, 2016)
Objectives The purpose of this study was to better understand the prevalence and correlates of substance use behaviors among HIV-infected adolescents in HIV care settings. Methods A cross-sectional sample of 2216 youth living with HIV (YLWH; ages 12–26) were recruited through the Adolescent Trials Network for HIV Interventions. Participants completed a one-time survey on sociodemographic factors, substance use and health behaviors. We used logistic regression models to understand the correlates of substance use outcomes. Results Overall, weekly or more frequent tobacco use was reported by 32.9% of participants, 27.5% marijuana use, and 21.3% alcohol use; and 22.5% reported any other illicit drug use. In multivariable models, young MSM had higher odds of reporting each substance use behavior, and transgender women had increased odds of marijuana and other illicit drug use. Criminal justice involvement, unstable housing, condomless sex, and suboptimal antiretroviral therapy was associated with increased risk of substance use behaviors. Conclusions Study findings highlight the need for regular screening for substance use in HIV care settings in order to improve access to and delivery of culturally competent substance use prevention and treatment services.
Keywords: antiretrovirus agent; illicit drug; adolescent; adult; alcohol consumption; article; cannabis use; child; comorbidity; criminal justice; cross-sectional study; female; housing; human; Human immunodeficiency virus infection; major clinical study; male; male to female transgender; men who have sex with men; patient compliance; prevalence; priority journal; social support; substance use; suicidal ideation; tobacco use; unprotected sex; young adult

Gender differences in compulsive buying disorder: Assessment of demographic and psychiatric co-morbidities - De Mattos, C.N.; Kim, H.S.; Requião, M.G.; Marasaldi, R.F.; Filomensky, T.Z.; Hodgins, D.C.; Tavares, H. (PLoS ONE, 2016)
Compulsive buying is a common disorder found worldwide. Although recent research has shed light into the prevalence, etiology and clinical correlates of compulsive buying disorder, less is known about gender differences. To address this empirical gap, we assessed potential gender differences in demographic and psychiatric co-morbidities in a sample of 171 compulsive buyers (20 men and 151 women) voluntarily seeking treatment in São Paulo, Brazil. A structured clinical interview confirmed the diagnosis of compulsive buying. Of the 171 participants, 95.9% (n = 164) met criteria for at least one co-morbid psychiatric disorder. The results found that male and female compulsive buyers did not differ in problem severity as assessed by the Compulsive Buying Scale. However, several significant demographic and psychiatric differences were found in a multivariate binary logistic regression. Specifically, male compulsive buyers were more likely to report being non-heterosexual, and reported fewer years of formal education. In regards to psychiatric co-morbidities, male compulsive buyers were more likely to be diagnosed with sexual addiction, and intermittent explosive disorder. Conversely, men had lower scores on the shopping subscale of the Shorter PROMIS Questionnaire. The results suggest that male compulsive buyers are more likely to present with co-morbid psychiatric disorders. Treatment planning for compulsive buying disorder would do well to take gender into account to address for potential psychiatric co-morbidities.
Keywords: NCT02138058; adult; agoraphobia; anxiety disorder; article; behavior disorder assessment; binge eating disorder; Brazil; bulimia; cognitive behavioral therapy; comorbidity; compulsive buying; Compulsive Buying Scale; demography; disease severity; dysthymia; educational status; female; generalized anxiety disorder; heterosexuality; human; intermittent explosive disorder; internet addiction; kleptomania; major clinical study; male; mental disease; mood disorder; motivational interviewing; obsessive compulsive disorder; panic; posttraumatic stress disorder; sex difference; sexual addiction; social phobia; Structured Clinical Interview for DSM Disorders; structured interview; suicidal behavior; trichotillomania

Use of mental health care and unmet needs for health care among lesbian and bisexual Chinese-, Korean-, and Vietnamese-American women - Hahm, H.C.; Lee, J.; Chiao, C.; Valentine, A.; Cook, B.L. (Psychiatric Services, 2016)
Objective: This study examined associations between sexua orientation of Asian-American women and receipt of menta health care and unmet need for health care Methods: Computer-Assisted self-interviews were conducte with 701 unmarried Chinese-, Korean-, and Vietnamese American women ages 18 to 35. Multivariate regressio models examined whether lesbian and bisexual participant differed from exclusively heterosexual participants in use o mental health care and unmet need for health care Results: After the analyses controlled for mental healt status and other covariates, lesbian and bisexual wome were more likely than exclusively heterosexual women t have received any past-year mental health services an reported a greater unmet need for health care. Sexualminorit women were no more likely to have receive minimally adequate care Conclusions: Given the high rates of mental health problem among Asian-American sexual-minority women, effort are needed to identify and overcome barriers to receip of adequate mental health care and minimize unmet healt care needs.
Keywords: adult; article; Asian American; bisexual female; Chinese; comparative study; controlled study; depression; ethnic difference; female; gender identity; health care disparity; health care need; health care utilization; heterosexual female; homosexual female; human; Korean (people); major clinical study; mental health service; prevalence; sexual and gender minority; suicidal ideation; Vietnamese

Sexual identity development: relationship with lifetime suicidal ideation in sexual minority women - Dirkes, J.; Hughes, T.; Ramirez-Valles, J.; Johnson, T.; Bostwick, W. (Journal of clinical nursing, 2016)
RESULTS: Compared with women who first wondered about their sexual identity in adulthood, those who first wondered in early, middle or late adolescence had greater odds of lifetime suicidal ideation. Younger age at subsequent milestones (first decided or first disclosed) was not associated with heightened risk of suicidal ideation. Parental support was independently associated with suicidal ideation. CONCLUSIONS: Findings suggest that where one is in the process of identifying as a sexual minority may be more important than age in understanding risk of suicidal ideation in this population. As individuals come to accept and integrate their sexual minority identity risks associated with younger age diminish. AIMS AND OBJECTIVES: This study draws on a life course perspective to evaluate in a sample of sexual minority women: (1) the relationship between age at reaching sexual identity milestones and risk of suicidal ideation, (2) developmental stages or stages of sexual identity development that represent greatest risk and (3) the relationship between age of reaching milestones and parental support. BACKGROUND: Research shows higher rates of suicidal ideation among sexual minority women than heterosexual women. Evidence suggests this is partly accounted for by risk factors including sexual identity development and parental support. However, it remains unclear whether there are stages of particularly high risk. DESIGN: This is a cross-sectional study. Data come from a prospective study of sexual minority women that used convenience and respondent-driven sampling methods. METHODS: Using logistic regression, we examined associations among age at sexual identity developmental milestones, parental support and suicidal ideation in a large (N = 820), ethnically diverse sample of sexual minority women. RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare providers who work with youth should routinely ask about sexual orientation and suicidal ideation and be aware that youth in the earliest stages of coming out as sexual minority may be at particularly high risk of suicide.
Keywords: adolescent; adult; aged; cross-sectional study; ethnology; female; gender identity; human; Illinois; mental disease; middle aged; minority group; nursing; prospective study; psychology; risk factor; sexual and gender minority; statistical model; suicidal ideation; very elderly; young adult

Prevalence of prior HIV testing and associated factors among MSM in Zhejiang Province, China: a cross-sectional study - Li, R.; Pan, X.; Ma, Q.; Wang, H.; He, L.; Jiang, T.; Wang, D.; Zhang, Y.; Zhang, X.; Xia, S. (BMC public health, 2016)
BACKGROUND: Men who have sex with men (MSM) have become one of high-risk population for human immunodeficiency virus (HIV) infection, due to their multiple sex partners and unprotected anal intercourse. Promoting HIV testing is an effective strategy for the prevention and control of HIV infection. We assessed the factors associated with a prior HIV testing history, which could provide guidance for implementation of future HIV intervention programs. METHODS: A cross-sectional study was conducted in three cities of Zhejiang Province, namely, Hangzhou, Ningbo and Wenzhou, using respondent-driven sampling, between December 2013 and June 2014. A face-to-face questionnaire survey was employed to collect relevant information about HIV testing. Univariate and multivariate logistic regression analyses were used to identify the factors associated with a prior HIV testing history. RESULTS: The adjusted rate of prior HIV testing among MSM in Zhejiang Province was 55.9 %. The adjusted rates of HIV and syphilis infections among MSM in Zhejiang Province were 14.0 % and 11.4 %, respectively. A weighted multivariate analysis showed that MSM of older age were more likely to be tested, as were MSM with higher level of education, self-reported homosexuality and a higher frequency of receiving AIDS/sexually transmitted infections educational intervention in the past year. MSM with suicidal inclination and self-perceived lower possibility of HIV infection were less likely to report ever having undergone an HIV test. CONCLUSIONS: The prevalence of prior HIV testing among MSM in Zhejiang Province, China is low. Effective and more frequent interventional measures should be adopted to improve risk awareness and psychosocial support for younger, less educated MSM, and to encourage more MSM to undergo HIV testing.
Keywords: adolescent; adult; aged; China; cross-sectional study; health care survey; Human immunodeficiency virus infection; human; male; male homosexuality; mass screening; middle aged; prevalence; statistics and numerical data; young adult

Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort - Cesta, C.E.; Månsson, M.; Palm, C.; Lichtenstein, P.; Iliadou, A.N.; Landén, M. (Psychoneuroendocrinology, 2016)
Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 5–15% of reproductive-aged women and characterized by high levels of circulating androgens. Given that androgens have been implicated in the aetiology of several psychiatric disorders, it was hypothesized that women with PCOS have high risk for psychiatric comorbidity. We aimed to investigate this risk amongst women with PCOS, as well as in their siblings, to elucidate if familial factors underlie any potential associations. Using the Swedish national registers, we identified all women diagnosed with PCOS between 1990 and 2013 (n = 24,385), their full-siblings (n = 25,921), plus matched individuals (1:10/100) from the general population and their full-siblings. Psychiatric disorder diagnoses were identified including schizophrenia, bipolar disorder, depressive and anxiety disorders, eating disorders, personality and gender identity disorder, autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), tics, attempted and completed suicide. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression and adjusted ORs (AOR) were determined by adjustment for comorbid psychiatric disorders. Overall, women with PCOS had an increased odds of having at least one psychiatric disorder (OR = 1.56 [95CI%, 1.51–1.61]). Crude ORs showed associations with nearly all psychiatric disorders included in this study. Following adjustment for comorbid psychiatric disorders, women with PCOS were still at a significantly increased risk for bulimia, schizophrenia, bipolar disorder, depressive and anxiety disorders, personality disorders, with the highest AORs for ASD (AOR = 1.55 [95%CI, 1.32–1.81]) and tics (AOR = 1.65 [95%CI, 1.10–2.47]). Significantly higher AORs were found for ASD in both brothers and sisters of women with PCOS, and for depressive, anxiety, and schizophrenia spectrum disorders in the sisters only. Notably, the crude ORs for attempted suicide were 40% higher in women with PCOS and 16% higher in their unaffected sisters. However, the AORs were greatly attenuated indicating that underlying psychiatric comorbidity is important for this association. Women with PCOS had higher risks for a range of psychiatric disorders not shown before. Elevated risk in their siblings suggests shared familial factors between PCOS and psychiatric disorders. This study is an important first step towards identifying the underlying mechanisms for risk of psychiatric disorders in women with PCOS. Health professionals treating women with PCOS should be aware that these patients – as well as their family members – are important targets for mental health care.
Keywords: adult; alcoholism; anorexia; anxiety disorder; article; Asperger syndrome; attention deficit disorder; autism; bipolar disorder; bulimia; cohort analysis; comorbidity; controlled study; depression; eating disorder; female; gender dysphoria; heritability; human; male; mental disease; obsessive compulsive disorder; ovary polycystic disease; personality disorder; population research; priority journal; risk; schizophrenia; sibling; social phobia; suicide; tic; transsexualism

American health improvement depends upon addressing class disparities - Schroeder, S.A. (Preventive Medicine, 2016)
The gap in health status between the United States and other (OECD) developed countries not only persists but has widened over the past decade. This has occurred despite major declines in smoking prevalence. But as with other health problems, such as obesity, gun violence, and teenage pregnancy, progress against smoking has disproportionately benefitted the better off segments of the American population. Thus smoking, as well as other problems, is now concentrated among the vulnerable members of our society: the poor and less educated, as well as disadvantaged groups such as those with mental illness and substance use disorders, the homeless, those who are incarcerated, and the LGBT community. Although this is a national issue, these problems, as well as overall poverty, are especially concentrated in the Southeastern part of the country. Compared with the other OECD countries, the U.S. has much greater inequality of income and wealth. Furthermore, we are unique in leaving substantial portions of our population not covered by health insurance, again most prominently in the southeastern region. This national health disparity is not simply a factor of the multicultural nature of American society, because it persists when the health of the whites only is compared with the more racially homogeneous OECD nations. The complexity of our poor health performance rules out a single intervention. But it is clear that without focusing on the less fortunate members of our society, especially those in the Southeast, our performance will continue to lag, and possibly deteriorate further.
Keywords: adolescent pregnancy; article; developed country; drug dependence; educational status; geographic distribution; gunshot injury; health disparity; health insurance; health status; homelessness; human; income; infant mortality; LGBT people; life expectancy; lung cancer; maternal mortality; medically uninsured; mental disease; obesity; poverty; prevalence; priority journal; prisoner; smoking; United States; vulnerable population

Clinical and projective understanding of the suicidal act in the young homosexuals: Early traumas’ impact - Barrattini, A.; Mazoyer, A.-V.; Pirlot, G.; Estellon, V. (Annales Medico-Psychologiques, 2016)
We suggest in this research to provide a new approach for the prevalence of the use of the suicidal act within the homosexual population. Indeed, from the Lucas's clinical and projective case, a suicidal young homosexual, we have identified that the repetition of the passages by the suicidal act masked old traumas so putting, in reality, in the background the problem of the sexual orientation as causal factor and initiator of the suicidal acts. We strength of the traumas experienced during Lucas's childhood, their updating in the psychic economy on the identity and sexual development, and highlighted their psychic renewal. We propose then the assumption that the suicidal attempt and homosexuality could be in fact indicative of early traumas.
Keywords: acting out; article; gender identity; homosexuality; human; prevalence; psychotrauma; sexual development; sexual orientation; suicide; suicide attempt

Consideration of clozapine and gender-affirming medical care for an HIV-positive person with schizophrenia and fluctuating gender identity - Gerken, A.T.; McGahee, S.; Keuroghlian, A.S.; Freudenreich, O. (Harvard Review of Psychiatry, 2016)
Keywords: cannabis; clozapine; darunavir; lamivudine plus zidovudine; raltegravir; ritonavir; tenofovir; adult; aggression; article; assault; auditory hallucination; battering; cannabis addiction; case report; CD4 lymphocyte count; disorientation; drug dose titration; evening dosage; gender dysphoria; hepatitis C; highly active antiretroviral therapy; homosexual male; hospitalization; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; male; medical care; mental health center; middle aged; non insulin dependent diabetes mellitus; outpatient; paranoia; patient referral; posttraumatic stress disorder; priority journal; schizophrenia; suicidal ideation; visual hallucination

Mental health and suicidal ideation among Chinese women who have sex with men who have sex with men (MSM) - Li, X.; Zhang, B.; Li, Y.; Antonio, A.L.; Chen, Y.; Williams, A.B. (Women & health, 2016)
In China, men who have sex with men (MSM) are the fastest growing population at risk for HIV. They face social stigma due to both MSM behavior and HIV. In addition, concern has been raised about the mental health of wives of MSM. In this cross-sectional study, the authors examine the mental health status of a sample of 135 of these women. Participants completed an Internet-administered questionnaire in Xi'an from April to June, 2012. Most were unaware at the time of marriage that their husbands were MSM. Physical abuse was frequently reported; depressive symptom and mental health (Symptom Checklist, SCL-90) scores were significantly higher than those of the general Chinese adult female population. A majority (59.8%) of women reported suicidal thoughts after discovering their husbands' MSM behavior; about 10% had attempted suicide. Multiple logistic regression revealed that women's experience with anal sex was associated with 7.8 times (95% CI: 1.3-65.9) greater odds of suicidal ideation. Also, women who demonstrated mental symptoms on the SCL-90 had 2.3 times (95% CI: 1.04-5.2) the odds of suicidal ideation. These results suggest that wives of MSM have a significant need for mental health care, suicide prevention, HIV education, and social support.
Keywords: adult; Asian continental ancestry group; bisexuality; China; cross-sectional study; depression; female; human; Human immunodeficiency virus infection; Internet; male; male homosexuality; mental health; mental stress; psychology; questionnaire; sexual behavior; spouse; statistical model; suicidal ideation; suicide; suicide attempt; transmission

Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol - Willging, C.E.; Green, A.E.; Ramos, M.M. (Implementation science : IS, 2016)
BACKGROUND: Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes. METHODS/DESIGN: Mixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP. DISCUSSION: The DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02875535.
Keywords: NCT02875535; adolescent; adolescent behavior; bisexuality; bullying; cluster analysis; controlled study; female; homosexuality; human; male; methodology; New Mexico; prevention and control; procedures; psychology; randomized controlled trial; school health nursing; sexual and gender minority; sexuality; suicide; transsexualism

A case of first-onset psychosis and repeated relapses secondary to discontinuation of non-prescription estrogen replacement therapy in a transgendered female - Moffitt, O.; Findley, J.C. (Gynecological Endocrinology, 2016)
The estrogen hypothesis of psychosis states that estrogens contribute a protective effect against the development of psychotic disorders. Conversely, hypoestrogenic states have been shown to be associated with the occurrence of psychotic disorders in women. We present the case of a 24-year-old transgendered female who experienced a first-onset psychosis and subsequent relapses associated with discontinuation of non-prescription estrogen replacement therapy.
Keywords: estradiol; fluoxetine; lorazepam; risperidone; sertraline; add on therapy; adult; anxiety; appendectomy; article; asthma; auditory hallucination; bedtime dosage; case report; child sexual abuse; depression; drug dose titration; estrogen therapy; female; feminization; human; male to female transgender; medical history; priority journal; psychosis; relapse; sex reassignment; substance abuse; suicidal ideation; suicide attempt; thinking; treatment withdrawal; visual hallucination; young adult

Mental health among UK inner city non-heterosexuals: The role of risk factors, protective factors and place - Woodhead, C.; Gazard, B.; Hotopf, M.; Rahman, Q.; Rimes, K.A.; Hatch, S.L. (Epidemiology and Psychiatric Sciences, 2016)
Background. Sexual minorities experience excess psychological ill health globally, yet the UK data exploring reasons for poor mental health among sexual minorities is lacking. This study compares the prevalence of a measure of well-being, symptoms of common mental disorder (CMD), lifetime suicidal ideation, harmful alcohol and drug use among inner city non-heterosexual and heterosexual individuals. It is the first UK study which aims to quantify how much major, everyday and anticipated discrimination; lifetime and childhood trauma; and coping strategies for dealing with unfair treatment, predict excess mental ill health among non-heterosexuals. Further, inner city and national outcomes are compared. Methods. Self-report survey data came from the South East London Community Health study (N = 1052) and the Adult Psychiatric Morbidity Survey (N = 7403). Results. Adjustments for greater exposure to measured experiences of discrimination and lifetime and childhood trauma had a small to moderate impact on effect sizes for adverse health outcomes though in fully adjusted models, non-heterosexual orientation remained strongly associated with CMD, lifetime suicidal ideation, harmful alcohol and drug use. There was limited support for the hypothesis that measured coping strategies might mediate some of these associations. The inner city sample had poorer mental health overall compared with the national sample and the discrepancy was larger for non-heterosexuals than heterosexuals. Conclusions. Childhood and adult adversity substantially influence but do not account for sexual orientation-related mental health disparities. Longitudinal work taking a life course approach with more specific measures of discrimination and coping is required to further understand these associations. Sexual minorities should be considered as a priority in the design and delivery of health and social services.
Keywords: adolescent; adult; adulthood; alcohol consumption; anticipation; article; childhood; controlled study; coping behavior; drug abuse; effect size; female; health disparity; health hazard; health status; health survey; heterosexual female; heterosexual male; heterosexuality; human; lifespan; major clinical study; male; mental disease; middle aged; personal experience; prediction; prevalence; psychological well-being; psychotrauma; risk assessment; risk factor; self report; sexual orientation; social discrimination; suicidal ideation; symptom; United Kingdom; urban area; young adult

Nonsuicidal self-injury, suicidal thoughts and suicide attempts among sexual minority youth in Ireland during their emerging adult years - Power, E.; Coughlan, H.; Clarke, M.; Kelleher, I.; Lynch, F.; Connor, D.; Fitzpatrick, C.; Harley, M.; Cannon, M. (Early Intervention in Psychiatry, 2016)
Aim: This study aimed to examine whether or not sexual minority youth constitute an at-risk group for nonsuicidal self-injury, suicidal ideation or suicide attempts during their emerging adult years. Methods: Using data from the Challenging Times Study, a population-based study of psychopathology and suicide in Ireland, analyses were conducted to test the associations between sexual minority status and the odds of any lifetime experience of nonsuicidal self-injury, suicidal thoughts or suicide attempts among Irish youth aged 19–24 years. Results: Sexual minority youth had 6.6-fold (95% CI 1.7–24.7) increased risk of nonsuicidal self-injury, a 5.0-fold (95% CI 1.3–18.3) increased risk of suicidal ideation, a 7.7-fold (95% CI 1.8–32.0) increased risk of suicide intent and a 6.8-fold (95% CI 1.6–27.6) increased risk of a suicide attempt during their lifetime compared to their heterosexual peers. Conclusions: This study shows that emerging adulthood is a period of risk for suicide and nonsuicidal self-injurious behaviour among sexual minority youth.
Keywords: adult; adulthood; article; automutilation; bisexuality; emerging adulthood; heterosexuality; high risk population; homosexuality; human; Ireland; juvenile; longitudinal study; nonsuicidal self injury; priority journal; sexual and gender minority; suicidal ideation; suicide attempt

Use of psychostimulants in a sexual context: Analysis of cases reported to the French network of Addictovigilance Centers - Batisse, A.; Peyrière, H.; Eiden, C.; Courné, M.-A.; Djezzar, S. (Therapie, 2016)
The “SLAM” phenomenon is an increasingly popular practice, in Paris and London gay scene, defined by 3 characteristics: injection, sexual party and psychostimulant drugs. The French Medical Agency requested a risk assessment of “SLAM” and more broadly of the use of psychostimulants in a sexual context, by the analysis of complications related to this practice notified to the French Network of Addictovigilance Centers. All cases of complications related to “SLAM” practice, including cases of abuse or dependence, and somatic and psychiatric complications, were analysed. Between January 2008 to December 2013, 51 cases were collected. Users were exclusively men, with a mean age of 40 years, having psychostimulants exposure in a sexual context, mainly in men who have sex with men (MSM) context (100%, n = 35). The prevalence of human immunodeficiency virus (HIV) infection was 82% (n = 32) with a high level of HIV/hepatitis C virus (HCV) co-infection (50%, n = 16). The main psychostimulants reported are synthetic cathinones (89.5%). Cathinones users tended to be polydrug users: 62% also reported use other than psychoactive substances (gamma-butyrolactone [GBL], ketamine, methylenedioxyméthamphetamine [MDMA], lysergic acid diethylamide [LSD]…). The main complications were psychiatric disorders in 50% (psychotic symptoms, agitation, anxiety, suicidal ideas or attempt and forensic problems), acute intoxication in 25% (including 3 deaths), dependence and abuse in 17% and infectious complications in 8% (viral seroconversion). Health professionals as well as users should be aware of the physical (cardiovascular) and behavioural (psychic, fast dependence syndrome) toxicity of cathinones. Risk reduction policy must be targeted to the population of MSM with specific interventions both on risky sexual behavior and substance use.
Keywords: midomafetamine; cathinone; gamma butyrolactone; ketamine; lysergide; psychostimulant agent; adult; agitation; anxiety disorder; article; behavior disorder; cardiovascular disease; drug abuse; drug dependence; drug exposure; forensic pathology; hepatitis C; Hepatitis C virus; human; Human immunodeficiency virus infection; infectious complication; intoxication; major clinical study; male; men who have sex with men; mental disease; mixed infection; prevalence; priority journal; psychosomatic disorder; risk reduction; sexual behavior; substance use; suicidal ideation; suicide attempt

Gender identity disorder in an adolescent boy: An attribution of adverse childhood experiences! - Mishra, R.; Kar, S.K.; Goyal, P.; Kumar, D.; Sinha, U.K.; Gupta, S.K. (Journal of Indian Association for Child and Adolescent Mental Health, 2016)
Gender identity disorder (GID) is a relatively rare psychiatric disorder characterized by desire to be of the opposite sex, cross-dressing, cross-sex roles in fantasy plays, desire to participate in games of opposite sex, preference for playmates of opposite sex and persistent discomfort with the assigned sex leading to significant impairment and distress. These manifestations occur in the absence of physical disorders leading to intersex. Comorbidities like depression, anxiety disorder and conduct disorder may be associated with GID. Identifying the co-morbidities, addressing the bio-psycho-social attributes of this disorder is an important and key step to management. Presence of co-morbidities makes the diagnosis and management of GID, a challenge. Adverse childhood experiences like sexual abuse may attribute to the gender identity disorder as well as the externalizing and internalizing behaviors of the child in later part of life. In this case report, we highlightedthe diagnostic and management issues as well as the adverse childhood experiences that might have attributed to GID and co-morbid psychiatric disorders.
Keywords: fluoxetine; adolescent; anger management therapy; article; assertive training; automutilation; behavior change; behavior disorder; behavior therapy; bullying; case report; character disorder; child abuse; child sexual abuse; comorbidity; concentration loss; cross-dressing; depression; divorced parent; domestic violence; draw-a-person test; drug dose escalation; empathy; family history; gender dysphoria; guilt; human; impulsiveness; intellectual assessment; irritability; loneliness; loss of appetite; male; Malin Intelligence Scale for Indian children; mental health; neuropsychological test; patient compliance; physical abuse; prostitution; psychosocial care; psychosocial withdrawal; recreation; Rorschach test; sibling relation; sleep disorder; social behavior; suicidal ideation; suicide attempt; thematic apperception test; thought disorder; treatment duration

How do Sexual Identity, and Coming Out Affect Stress, Depression, and Suicidal Ideation and Attempts Among Men Who Have Sex With Men in South Korea? - Cho, B.; Sohn, A. (Osong Public Health and Research Perspectives, 2016)
Objectives This study investigated the status of sexual identity, perceived stigma, stress, depression, and suicidal ideation and attempts. It also examined how sexual identity and “coming out” affect stress, depression, and suicidal ideation and attempts. Methods Suicidal ideation, psychological health status, and health-related behaviors were assessed using the Internet to maximize the confidentiality of the participants, men who have sex with men (MSM). The data were collected from a total of 873 MSM aged between 19 years and 59 years in 2014. Results Only 20.9% of the MSM had come out (18.0% voluntarily and 2.9% by others). The prevalences of perceived stress and depression among MSM were 46.7% and 42.7%, respectively, compared with 20.1% and 7.4% among general men. Approximately 32% of the MSM reported any suicidal ideation, and 3.3% had attempted suicide in the past year. The likelihood of suicidal ideation was significantly associated with being age 30–39 years [odds ratio (OR) = 1.8], high school or less (OR = 1.6), having been outed (OR = 5.2), feeling stressed (OR = 1.8), and feeling depressed (OR = 12.4) after sociodemographic factors and other perceptions were controlled for. Conclusion The present study provides evidence that MSM are at an elevated risk for suicidal ideation and attempts with high stress and depression. Some risk factors were specific to being gay or bisexual in a hostile environment.
Keywords: adult; age distribution; aged; article; attitude to sexuality; coming out; controlled study; depression; educational status; gender identity; health behavior; high school; human; male; men who have sex with men; mental health; middle aged; prevalence; priority journal; risk assessment; risk factor; social behavior; social isolation; South Korea; stigma; physiological stress; suicidal ideation; suicide attempt; young adult

Between drive and reason: Psychodynamic and sociological aspects of HIV-positive gay men's sexuality. HEPAIG study, 2007–2008, France - Linard, F.; Le Talec, J.-Y. (Evolution Psychiatrique, 2016)
Objectives This paper focuses on the psychodynamic dimension of narratives collected in interviews carried out with HIV-positive gay men, and completes two previous publications concerning the Hepaig-quali study, one centred on sexuality and the other on drug use. The Hepaig-quali study was part of the Hepaig epidemiological survey on acute hepatitis C among HIV-infected gay men, coordinated by the Institut de Veille Sanitaire (InVS, France). In addition to the results gathered from questionnaires, and with a focus on the “hepatitis C event”, the present study aimed to describe sexual practices and drug use among HCV-infected gay men, to assess the motivations of these choices, to position them in relation to their life histories and healthcare experiences, and to explore how they viewed their physical and mental health. Methodology Our study was based on two successive in-depth interviews with 31 men previously included in the Hepaig survey. These interviews, conducted by a sociologist, were fully transcribed, and analysed from a dual psychodynamic and sociological viewpoint, an epistemological stance related to the comprehensive approach to behaviours. Results Thirty-one men were included in this qualitative study. We focused specifically on the mental health of the respondents and the psychodynamic dimension of their narratives. Despite the fact that these interviews were not equivalent to “clinical cases”, psychic issues were very much present. In their own words, the respondents talked of their experiences of stress and depression, and some mentioned suicidal ideations. Most talked readily about their practices and explained them via discourse on achieving pleasure, alongside the rational control of risks. Discussion In many respects, the respondents appeared as “ordinary men”, in particular with respect to their gendered socialisation and their representations of the risks. From a mental health perspective, some specificities were linked to the experiences of discrimination and chronic illness. With the permanent tension between impulse and reason, between the search for pleasure and the need to control their lives, they present the characteristics of the hypermodern individual whose contradictions are revealed in their relationship with the other. Conclusion Accurately informed, the respondents also embraced the positivist medical discourse of their caregivers, which provides them with support and helps them to face the burden of HIV and HCV infections. The evolution of gay sexual culture leads these men, via the rejection of the “condom norm”, to choose practices described as more satisfying, but entailing greater risks. Nevertheless, as with any topic, their behaviours are regulated by other dimensions than knowledge and rationality. The search for pleasure is not always restrained by the hindrance and impediments of reason. This should lead caregivers to better understand and support the efforts that their patients make to reduce risks.
Keywords: article; attitude to health; clinical article; drug dependence; health status; hepatitis C; homosexual male; human; Human immunodeficiency virus infected patient; male; mental health; personal experience; psychodynamics; qualitative research; risk reduction; sexual behavior; sexuality; social aspect; social behavior

Transgender Adults' Access to College Bathrooms and Housing and the Relationship to Suicidality - Seelman, K.L. (Journal of homosexuality, 2016)
Transgender and gender non-conforming people frequently experience discrimination, harassment, and marginalization across college and university campuses (Bilodeau, 2007; Finger, 2010; Rankin et al., 2010; Seelman et al., 2012). The minority stress model (Meyer, 2007) posits that experiences of discrimination often negatively impact the psychological wellbeing of minority groups. However, few scholars have examined whether college institutional climate factors-such as being denied access to bathrooms or gender-appropriate campus housing-are significantly associated with detrimental psychological outcomes for transgender people. Using the National Transgender Discrimination Survey, this study analyzes whether being denied access to these spaces is associated with lifetime suicide attempts, after controlling for interpersonal victimization by students or teachers. Findings from sequential logistic regression (N = 2,316) indicate that denial of access to either space had a significant relationship to suicidality, even after controlling for interpersonal victimization. This article discusses implications for higher education professionals and researchers.
Keywords: adolescent; adult; aged; bullying; crime victim; female; housing; human; male; middle aged; psychology; sanitation; sexual and gender minority; social behavior; student; suicide; transgender; university; young adult

Suicide risk in trans populations: An application of minority stress theory - Tebbe, E.A.; Moradi, B. (Journal of counseling psychology, 2016)
Drawing on minority stress theory, the present study tested the relations of minority stressors (i.e., experiences of prejudice and discrimination, internalized antitrans attitudes, fear of antitrans stigma), social support (i.e., friend, family, and significant other support), and substance use (i.e., drug and alcohol use) with depression and suicide risk in a sample of trans individuals. Depression was examined as a mediator of the relations of minority stressors and social support with suicide risk; drug and alcohol use were examined as direct correlates of suicide risk. Participants were 335 trans-identified individuals, diverse in gender identities (e.g., trans men, trans women, nonbinary gender identities). They were recruited using online social networks and they completed the study survey online via Qualtrics. Structural equation modeling was used to test hypothesized relations. Depression fully mediated the relations of perceived experiences of discrimination, fear of antitrans stigma, and friend support with suicide risk, and partially mediated the relation of internalized antitrans attitudes with suicide. Drug use was positively associated with suicide risk, whereas alcohol use was not linked with suicide risk. Exploratory comparisons across gender subgroups suggested that the pattern of relations among study variables was consistent across trans men, trans women, and individuals with nonbinary gender identities. These findings point to minority stressors, friend support, and drug use as potentially fruitful targets of prevention and intervention efforts to reduce depression and suicide risk in trans populations. (PsycINFO Database Record
Keywords: adolescent; adult; aged; depression; female; friend; gender identity; human; male; mental stress; middle aged; minority group; prejudice; psychological theory; psychology; questionnaire; risk; social stigma; social support; statistics and numerical data; drug dependence; suicide; transgender; young adult

The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support - Wilson, E.C.; Chen, Y.-H.; Arayasirikul, S.; Raymond, H.F.; McFarland, W. (AIDS and behavior, 2016)
Significant health disparities exist for transgender female (trans*female) youth. We assessed differences in mental health outcomes based on exposure to discrimination among transgender female youth in the San Francisco Bay Area aged 16-24 years. Youth were recruited using a combination of respondent driven sampling with online and social media methods. Logistic regression models were used to estimate odds ratios for the mental health outcomes, comparing levels of discrimination and levels of resiliency promoting protective factors among sexually active youth in the sample (N = 216). High transgender-based discrimination was significantly associated with greater odds of PTSD (AOR, 2.6; 95 % CI 1.4-5.0), depression (AOR, 2.6; 95 % CI 1.2-5.9), and stress related to suicidal thoughts (AOR 7.7, 95 % CI 2.3-35.2). High racial discrimination was significantly associated with greater odds of psychological stress (AOR 3.6; 95 % CI 1.2-10.8), PTSD (AOR 2.1; 95 % CI 1.1-4.2) and stress related to suicidal thoughts (AOR 4.3, 95 % CI 1.5-13.3). Parental closeness was related to significantly lower odds of all four mental health outcomes measured, and intrinsic resiliency positively reduced risk for psychological stress, PTSD, and stress related to suicidal thoughts. Transgender and racial discrimination may have deleterious effects on the mental health of trans*female youth. Interventions that address individual and intersectional discrimination and build resources for resiliency and parental closeness may have success in preventing mental health disorders in this underserved population.
Keywords: adolescent; California; complication; depression; female; human; mental disease; mental health; mental stress; odds ratio; parent; perceptive discrimination; prevalence; psychology; questionnaire; risk factor; sexual behavior; social stigma; social support; statistical model; statistics and numerical data; suicidal ideation; transgender; transsexualism; young adult

The Association of Multiple Identities with Self-Directed Violence and Depression among Transgender Individuals - Lytle, M.C.; Blosnich, J.R.; Kamen, C. (Suicide & life-threatening behavior, 2016)
Transgender individuals have a high prevalence of self-directed violence; however, there is scant literature focusing on their unique experiences. The differences in self-harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation were examined among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorsed self-directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non-Hispanic White individuals.
Keywords: adolescent; adult; depression; ethnic group; ethnology; female; heterosexuality; human; male; psychological and psychiatric procedures; psychology; questionnaire; randomization; automutilation; sexual behavior; statistics and numerical data; student; suicidal ideation; suicide attempt; transgender; United States

Factors Associated with Suicidality Among a National Sample of Transgender Veterans - Lehavot, K.; Simpson, T.L.; Shipherd, J.C. (Suicide & life-threatening behavior, 2016)
Correlates of past-year suicidal ideation and lifetime suicide risk among a national sample of transgender veterans were examined. An online, convenience sample of 212 U.S. transgender veterans participated in a cross-sectional survey in February-May 2014. We evaluated associations between sociodemographic characteristics, stigma, mental health, and psychosocial resources with past-year suicidal ideation and lifetime suicide plans and attempts. Participants reported high rates of past-year suicidal ideation (57%) as well as history of suicide plan or attempt (66%). Transgender-related felt stigma during military service and current posttraumatic stress disorder and depressive symptoms were associated with suicide outcomes as were economic and demographic factors.
Keywords: adult; complication; cross-sectional study; demography; depression; epidemiology; female; human; male; mental health; middle aged; posttraumatic stress disorder; psychology; risk factor; social stigma; socioeconomics; statistics and numerical data; suicidal ideation; suicide; suicide attempt; transgender; United States; veteran

Violence victimisation-a watershed for young women's mental and physical health - Palm, A.; Danielsson, I.; Skalkidou, A.; Olofsson, N.; Högberg, U. (European journal of public health, 2016)
PURPOSE: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15-22 years) victimised to one or more types of violence, compared with non-victimised.  METHODS: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed.  RESULTS: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9-20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9-10.2) for anxiety symptoms and 10.8 (CI 5.2-22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation.  CONCLUSION: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources.
Keywords: adolescent; adult; bullying; comparative study; crime victim; domestic violence; female; health status; human; mental health; odds ratio; psychology; questionnaire; risk factor; socioeconomics; statistics and numerical data; Sweden; young adult

Negative Treatment by Family as a Predictor of Depressive Symptoms, Life Satisfaction, Suicidality, and Tobacco/Alcohol Use in Vietnamese Sexual Minority Women - Nguyen, T.Q.; Bandeen-Roche, K.; German, D.; Nguyen, N.T.; Bass, J.K.; Knowlton, A.R. (LGBT health, 2016)
PURPOSE: Research linking family rejection and health outcomes in sexual minority people is mostly limited to North America. We assessed the associations between negative treatment by family members and depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use in sexual minority women (SMW) in Viet Nam. METHODS: Data were from an anonymous internet survey (n = 1936). Latent class analysis characterized patterns of negative treatment by family members experienced by respondents. Latent class with distal outcome modeling was used to regress depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use on family treatment class, controlling for predictors of family treatment and for two other types of sexual prejudice. RESULTS: Five latent family treatment classes were extracted, including four negative classes representing varying patterns of negative family treatment. Overall, more than one negative class predicted lower life satisfaction, more depressive symptoms, and higher odds of attempted suicide (relative to the non-negative class), supporting the minority stress hypothesis that negative family treatment is predictive of poorer outcomes. Only the most negative class had elevated alcohol use. The association between family treatment and smoking status was not statistically significant. The most negative class, unexpectedly, did not have the highest odds of having attempted suicide, raising a question about survivor bias. CONCLUSION: This population requires public health attention, with emphasis placed on interventions targeting the family to promote acceptance and to prevent negative treatment, and interventions supporting those SMW who encounter the worst types of negative family treatment.
Keywords: adolescent; adult; alcoholism; depression; family; female; human; Internet; mental stress; prejudice; psychological model; psychology; questionnaire; satisfaction; sexual and gender minority; suicide; tobacco dependence; Viet Nam; young adult

A 12-Month prospective study of the effects of PTSD-depression comorbidity on suicidal behavior in Iraq/Afghanistan-era veterans - Kimbrel, N.A.; Meyer, E.C.; DeBeer, B.B.; Gulliver, S.B.; Morissette, S.B. (Psychiatry Research, 2016)
The present study used validated clinical interviews to assess the effect of comorbid PTSD-depression on suicidal behavior over the course of 12 months in 309 Iraq/Afghanistan-era veterans. Logistic regression models demonstrated that comorbid PTSD-depression was a statistically significant predictor of suicide attempts at the 12-month follow-up in both the total sample and in the subset of veterans with PTSD/depression (n=98). In contrast, gender, age, race, sexual orientation, and baseline history of suicide attempts did not have significant effects. These findings suggest that comorbid PTSD-depression may be a significant risk factor for future suicidal behavior in veterans.
Keywords: adult; Afghanistan; age; article; comorbidity; depression; disease association; female; follow up; gender; human; interview; Iraq; major clinical study; male; posttraumatic stress disorder; priority journal; prospective study; race; risk factor; sexual orientation; suicidal behavior; suicide attempt; veteran

Suicidal ideation among MSM in three West African countries: Associations with stigma and social capital - Stahlman, S.; Grosso, A.; Ketende, S.; Pitche, V.; Kouanda, S.; Ceesay, N.; Ouedraogo, H.G.; Ky-Zerbo, O.; Lougue, M.; Diouf, D.; Anato, S.; Tchalla, J.; et al. (The International journal of social psychiatry, 2016)
BACKGROUND: Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa. AIMS: This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo. METHODS: Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation. RESULTS: The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%-17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99). CONCLUSION: Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa.
Keywords: adult; Africa; cross-sectional study; female; Human immunodeficiency virus infection; human; male; male homosexuality; mental health; multivariate analysis; odds ratio; psychology; social capital; social stigma; statistical model; suicidal ideation; violence; young adult

Mostly Heterosexual and Lesbian/Gay Young Adults: Differences in Mental Health and Substance Use and the Role of Minority Stress - Kuyper, L.; Bos, H. (Journal of sex research, 2016)
Individuals mostly attracted to other-sex but also to same-sex partners are a distinct and common sexual orientation group with possibly increased levels of health problems. The current study examined whether mostly heterosexual individuals differed in mental health and substance use from lesbian/gay individuals and whether sexual minority risk and protective factors offer an explanation in a sample of 528 Dutch young adults (16 to 25 years old, M = 21.2 years). Mostly heterosexual participants reported higher levels of psychological distress, suicidality, drug use, and smoking than lesbian/gay participants and equal levels of binge drinking. They also reported higher levels of internalized negativity to same-sex attractions, less openness to family members and others, less community involvement, and lower numbers of lesbian/gay/bisexual friends. However, bootstrapped mediation analysis showed that the differences in minority stress risk and protective factors did not mediate most of the differences in mental health and substance use with one exception: higher levels of psychological distress were mediated by the higher levels of internalized negativity to same-sex attractions. The limited explanatory power of the minority stress factors combined with the elevated level of problems of mostly heterosexual individuals call for future studies examining other risk and protective factors.
Keywords: adolescent; adult; bisexuality; drug dependence; female; homosexuality; human; human relation; male; mental stress; psychology; sexual and gender minority; suicidal ideation; young adult

Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people - Kattari, S.K.; Walls, N.E.; Speer, S.R.; Kattari, L. (Social work in health care, 2016)
Using a statewide survey of transgender and gender variant individuals (N = 417), this study examines the association between having a transgender-inclusive provider and three mental health concerns: current experience of depression, lifetime experience of anxiety disorder, and suicidality within the last year. Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality, but not with lifetime experience of having anxiety. Implications for future research and education of providers are discussed.
Keywords: adult; aged; cultural competence; female; health care personnel; health personnel attitude; human; male; mental disease; mental health service; middle aged; organization and management; psychology; questionnaire; transgender; very elderly

Factors Related to Suicide in LGBT Populations - Skerrett, D.M.; Kõlves, K.; De Leo, D. (Crisis, 2016)
BACKGROUND: There is evidence of heightened vulnerability to nonfatal suicidal behaviors among LGBT populations yet a paucity of studies into fatal behaviors. AIM: The specific aim of this article was to identify factors related to suicide in LGBT individuals in Australia. METHOD: The psychological autopsy (PA) method with a matched case-control study design was used. PA interviews were conducted with 27 next-of-kin of an LGBT person that had died by suicide. Three living LGBT controls per suicide case, matched by age and gender, were also interviewed. RESULTS: The key factors relating to suicide in LGBT people were a lack of acceptance by family and self (reflected in higher internalized homophobia and shame), negative feelings about own sexuality/gender, and dissatisfaction with appearance. LGBT people who died by suicide also tended to go through coming out milestones 2 years earlier than controls. There was a higher prevalence of aggressive behaviors and a more predominant history of physical and sexual abuse. Additionally, there was greater incidence of depression and anxiety and alcohol and substance use disorders. CONCLUSION: Specific predictive factors for suicide in LGBT populations in Australia were identified, including significantly poorer mental health outcomes and more violence across an array of measures.
Keywords: adult; case control study; drug dependence; employment; female; human; major depression; male; middle aged; psychology; risk factor; sexual and gender minority; statistics and numerical data; suicidal ideation; suicide; suicide attempt; young adult

The Whole Family Serves: Supporting Sexual Minority Youth in Military Families - Gyura, A.N.; McCauley, S.O. (Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 2016)
Sexual minority youth in military families have a unique set of stressors that affect their mental, emotional, and physical health. There is a pronounced gap in data addressing the specific stressors of this population and how they interact to impact the health of the adolescent. The culture of the United States military has historically been heterosexist and homophobic, propelled primarily by policies that restricted the recruitment and service of lesbian, gay, bisexual, or transgender individuals, leading to a continued secrecy around sexual orientation that may affect how sexual minority youth within the community view themselves. Homophobia, social stigma, and victimization lead to significant health disparities among sexual minority youth, and youth connected to the military have additional stressors as a result of frequent moves, parental deployment, and general military culture. Primary care providers must be aware of these stressors to provide a safe environment, thorough screening, and competent care for these adolescents.
Keywords: adolescent; bullying; child health care; child parent relation; crime victim; doctor patient relationship; epidemiology; female; health disparity; health education; homophobia; human; lesbianism; male; male homosexuality; military family; organization and management; psychology; social stigma; social support; standards; statistics and numerical data; suicidal ideation; transgender; United States; young adult

Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden - Björkenstam, C.; Kosidou, K.; Björkenstam, E.; Dalman, C.; Andersson, G.; Cochran, S. (Journal of epidemiology and community health, 2016)
BACKGROUND: Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence. METHODS: We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67 980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs. RESULTS: Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm. CONCLUSIONS: Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.
Keywords: adult; automutilation; female; human; male; self report; sexual and gender minority; suicidal ideation; suicide attempt; Sweden

The Missing Pieces in Reporting of Randomized Controlled Trials of External Beam Radiation Therapy Dose Escalation for Prostate Cancer - Zaorsky, N.G.; Egleston, B.L.; Horwitz, E.M.; Dicker, A.P.; Nguyen, P.L.; Showalter, T.N.; Den, R.B. (American Journal of Clinical Oncology: Cancer Clinical Trials, 2016)
Randomized controlled trials (RCTs) are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost-effectiveness of a treatment. For many patients, cancer is a chronic illness; RCTs evaluating treatments for indolent cancers must evolve to facilitate medical decision-making, as "concrete" patient outcomes (eg, survival) will likely be excellent independent of the intervention, and detecting a difference between trial arms may be impossible. In this commentary, we articulate 9 recommendations that we hope future clinical trialists and funding agencies (including those under the National Cancer Institute) will take into consideration when planning RCTs to help guide subsequent interpretation of results and clinical decision making, based on RCTs of external beam radiation therapy dose escalation for the most common indolent cancer in men, that is, prostate cancer. We recommend routinely reporting: (1) race; (2) medical comorbidities; (3) psychiatric comorbidities; (4) insurance status; (5) education; (6) marital status; (7) income; (8) sexual orientation; and (9) facility-related characteristics (eg, number of centers involved, type of facilities, yearly hospital volumes). We discuss how these factors independently affect patient outcomes and toxicities; future clinicians and governing organizations should consider this information to plan RCTs accordingly (to maximize patient accrual and total n), select appropriate endpoints (eg, toxicity, quality of life, sexual function), actively monitor RCTs, and report results so as to identify the optimal treatment among subpopulations.
Keywords: article; body mass; clinical decision making; comorbidity; depression; diabetes mellitus; educational status; external beam radiotherapy; health care facility; health insurance; heart disease; human; income; lung disease; marriage; prostate cancer; quality of life; race; radiation dose escalation; randomized controlled trial (topic); sexual function; sexual orientation; suicide

Homonegativity and Associated Factors Among Men Who Have Sex with Men in Estonia - Parker, R.D.; Lõhmus, L.; Mangine, C.; Rüütel, K. (Journal of community health, 2016)
Men who have sex with men (MSM) continue to be at higher risk for negative health outcomes including HIV, STIs, depression, substance use, suicidality, and anxiety. Associative relationships between homonegativity (internal and external) and these outcomes are used to explain the observed disproportionate impact. The current study assessed associations between internalized homonegativity and high-risk behaviours, markers of substance use and symptoms of mental illness as well as openness and level of same sex attraction. A 2013 Internet-based survey was conducted among MSM, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. The sample (n = 265) had a median age of 31 years, with 85 % employed at least part-time; at least a college-level education in 43 %; and 87 % lived in an urban setting. Sexual orientation was reported as: gay, 72 %; bisexual 23 %; other 5 %. Almost all men (97 %) reported ever having sex with a man, with more than one-third (36 %) having a steady male partner. Statistically significant higher homonegativity scores were detected among men reporting any level of opposite sex attraction compared to men attracted to only men; mostly men (p = 0.001), men and women equally (p = 0.002), and mostly women (p = 0.004), as well as less openness of same sex attraction to family and friends; >50 % family (p = 0.032), no family knowing (p = 0.042), and few friends knowing (p = 0.011). Anxiety risk and increased homonegativity also had a statistically significant increasing relationship. The identified associations between homonegativity and opposite sex attraction among MSM warrants further exploration as well as the relationship with increased anxiety risk.
Keywords: adult; anxiety; attitude; cross-sectional study; depression; drug dependence; epidemiology; Estonia; high risk behavior; homophobia; human; male; male homosexuality; psychology; statistics and numerical data

Sexual and Gender Minority Youth Suicide: Understanding Subgroup Differences to Inform Interventions - O'Brien, K.H.; Putney, J.M.; Hebert, N.W.; Falk, A.M.; Aguinaldo, L.D. (LGBT health, 2016)
Sexual and gender minority (SGM) youth are disproportionately affected by suicide-related thoughts and behaviors relative to their heterosexual and/or non-transgender peers. Theory and empirical evidence suggest that there are unique factors that contribute to this elevated risk, with distinguishable differences among SGM subgroups. Although SGM youth suicide prevention research is in its nascence, initial findings indicate that interventions which focus on family support and acceptance may be beneficial. It is critical that we develop and test tailored interventions for SGM youth at risk for suicide, with specific attention to subgroup differences and reductions in suicide-related thoughts and behaviors as outcomes.
Keywords: ethnology; human; psychological model; psychology; risk; sexual and gender minority; suicide

Psychotic panic and feared sexual assault–‘homosexual panic’: the historical role of feared homosexual assault as a contributing factor to self-attack - Goldblatt, M.J.; Maltsberger, J.T. (Scandinavian Psychoanalytic Review, 2016)
Some psychotic patients fall into acute persecutory panic, a subjective experience of helpless terror in the face of anticipated imminent annihilation or dismemberment. These states occur in a wide range of psychotic illnesses and are often associated with command hallucinations and fear of homosexual assault. In a desperate attempt to escape from imaginary enemies, such patients often attack themselves and imagine suicide is survivable. This article addresses the dread of homosexual assault, previously referred to as homosexual panic, and its relationship to patients who attack themselves in a state of desperate psychotic persecution.
Keywords: article; automutilation; clinical examination; fear; feared homosexual assault; homosexuality; human; mental patient; panic; psychoanalytic theory; psychosis; sexual assault

Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings - Shearer, A.; Herres, J.; Kodish, T.; Squitieri, H.; James, K.; Russon, J.; Atte, T.; Diamond, G.S. (Journal of Adolescent Health, 2016)
Purpose Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal self-injury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14–24 years). Methods Data were collected using the Behavioral Health Screen—a Web-based screening tool that assesses psychiatric symptoms and risk behaviors—during routine well visits. Results Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well. Conclusions Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females.
Keywords: adolescent; adult; anxiety disorder; article; depression; distress syndrome; female; heterosexuality; high risk behavior; human; LGBT people; major clinical study; male; mental disease; mental health; primary medical care; priority journal; suicide

Bullying victimization and emotional distress: Is there strength in numbers for vulnerable youth? - Eisenberg, M.E.; McMorris, B.J.; Gower, A.L.; Chatterjee, D. (Journal of Psychosomatic Research, 2016)
Objective: The present study examines whether the prevalence of vulnerable peers in school protects the emotional health of youth who are lesbian, gay, bisexual or questioning (LGBQ), overweight, or have a disability, and if the adverse emotional effects of bullying victimization are mitigated by the presence of these peers. Methods: Survey data come from a large school-based sample of adolescents attending 505 schools. The primary independent variable was the percent of students in school with each vulnerability characteristic. Multilevel logistic regression models estimated the odds of internalizing problems, self-harm, suicidal ideation and suicide attempts among students who were LGBQ, overweight or had a disability. Cross-level interaction terms were added to determine if the association between being victimized and emotional distress was moderated by the presence of vulnerable peers. Results: Greater presence of similar students was, on average, protective against emotional distress for LGBQ girls and overweight boys. In contrast, greater presence of students with a disability was, on average, a risk factor among girls with a disability. Several tests of effect modification indicated that odds of emotional distress for those who had been victimized were lower in schools with a higher proportion of vulnerable youth. Conclusions: The presence of a similar peer group may increase the likelihood that a bystander or witness to bullying will react in a helpful way. School personnel, health care providers and other youth service professionals should inquire about social relationships at school, including experiences of harassment and perceptions of peer support, to buffer negative experiences.
Keywords: adolescent; article; automutilation; bullying; controlled study; emotional stability; emotional stress; female; human; independent variable; major clinical study; male; multivariate logistic regression analysis; obesity; prevalence; risk factor; sex difference; sexual orientation; suicidal ideation; suicide attempt

Suicide in married couples in Sweden: Is the risk greater in same-sex couples? - Björkenstam, C.; Andersson, G.; Dalman, C.; Cochran, S.; Kosidou, K. (European Journal of Epidemiology, 2016)
Minority sexual orientation is a predictor of suicide ideation and attempts, though its association with suicide mortality is less clear. We capitalize on Sweden’s extensively linked databases, to investigate whether, among married individuals, same-sex marriage is associated with suicide. Using a population-based register design, we analyzed suicide risk among same-sex married women and men (n = 6456), as compared to different-sex married women and men (n = 1181723) in Sweden. We selected all newly partnered or married individuals in the intervening time between 1/1/1996 and 12/31/2009 and followed them with regard to suicide until 12/31/2011. Multivariate Poisson regression was used to calculate adjusted incidence risk ratios (IRR) with 95 % confidence intervals (CI). The risk of suicide was higher among same-sex married individuals as compared to different-sex married individuals (IRR 2.7, 95 % CI 1.5–4.8), after adjustment for time at risk and socioeconomic confounding. Sex-stratified analyses showed a tentatively elevated risk for same-sex married women (IRR 2.5, 95 % CI 0.8–7.7) as compared to different-sex married women. Among same-sex married men the suicide risk was nearly three-fold greater as compared to different-sex married (IRR 2.895 % CI 1.5–5.5). This holds true also after adjustment for HIV status. Even in a country with a comparatively tolerant climate regarding homosexuality such as Sweden, same-sex married individuals evidence a higher risk for suicide than other married individuals.
Keywords: adult; article; cause of death; controlled study; educational status; female; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; married man; married woman; mortality risk; population research; same-sex marriage; sexual orientation; suicide; Sweden

Perceived discrimination is an independent risk factor for suicidal ideation among sexual and gender minorities in Nepal - Kohlbrenner, V.; Deuba, K.; Karki, D.K.; Marrone, G. (PLoS ONE, 2016)
Sexual and gender minorities experience an elevated burden of suicidality compared with the general population. Still, little is known about that burden and the factors generating it in the context of low- and middle-income countries. The present study assessed the prevalence of suicidal ideation, planned suicide, and attempted suicide among men who have sex with men (MSM) and transgender people (TG) in Nepal, and examined the association of perceived discrimination on the basis of sexual orientation with suicidal ideation and with attempted suicide. Data were obtained from a surveillance survey among MSM and TG in Nepal in 2012. A sample of 400 MSM and TG, recruited using respondent-driven sampling, completed a structured face-to-face interview. Throughout their lifetime, 26.8% of the participants had experienced suicidal ideation, 12.0% had made a suicide plan, and 9.0% had attempted suicide. In particular, more TG than MSM had experienced suicidal ideation (39.8% vs. 21.3%), had made a suicide plan (19.5% vs. 8.9%), and had attempted suicide (15.3% vs. 6.4%). Overall, the odds of having experienced suicidal ideation was significantly higher among the 38.3% of participants who had perceived discrimination based on their sexual orientation (AOR: 3.17; 95% CI: 1.83-5.48). Moreover, the odds of suicidal ideation was significantly higher as the extent of perceived discrimination increased (AOR: 1.35; 95% CI: 1.15-1.60). However, the odds of attempted suicide was not significantly associated with perceived discrimination (AOR: 1.40; 95% CI: 0.62-3.15). The findings highlight perceived discrimination as an independent risk factor for suicidal ideation. Future suicide prevention programs should target sexual and gender minorities and include elements focusing on discrimination.
Keywords: adolescent; article; female; homophobia; human; male; male to female transgender; men who have sex with men; Nepalese; prevalence; sexual and gender minority; sexual orientation; structured interview; suicidal ideation; suicide attempt

Prevalence and Correlates of Lifetime Suicide Attempts Among Transgender Persons in Argentina - Marshall, B.D.; Socías, M.E.; Kerr, T.; Zalazar, V.; Sued, O.; Arístegui, I. (Journal of homosexuality, 2016)
This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina.
Keywords: adult; Argentina; cross-sectional study; epidemiology; female; gender identity; human; male; middle aged; prevalence; social stigma; statistics and numerical data; suicidal ideation; suicide attempt; transgender

Depression and Oral FTC/TDF Pre-exposure Prophylaxis (PrEP) Among Men and Transgender Women Who Have Sex With Men (MSM/TGW) - Defechereux, P.A.; Mehrotra, M.; Liu, A.Y.; McMahan, V.M.; Glidden, D.V.; Mayer, K.H.; Vargas, L.; Amico, K.R.; Chodacki, P.; Fernandez, T.; Avelino-Silva, V.I.; Burns, D.; et al. (AIDS and behavior, 2016)
We conducted a longitudinal and cross-sectional analysis of depressive symptomology in iPrEx, a randomized, placebo-controlled trial of daily, oral FTC/TDF HIV pre-exposure prophylaxis (PrEP) in men and transgender women who have sex with men. Depression-related adverse events (AEs) were the most frequently reported severe or life-threatening AEs and were not associated with being randomized to the FTC/TDF arm (152 vs. 144 respectively OR 0.66 95 % CI 0.35-1.25). Center for Epidemiologic Studies Depression scale (CES-D) and a four questions suicidal ideation scale scores did not differ by arm. Participants reporting forced sex at anal sexual debut had higher CES-D scores (coeff: 3.23; 95 % CI 1.24-5.23) and were more likely to have suicidal ideation (OR 2.2; 95 % CI 1.09-4.26). CES-D scores were higher among people reporting non-condom receptive anal intercourse (ncRAI) (OR 1.46; 95 % CI 1.09-1.94). We recommend continuing PrEP during periods of depression in conjunction with provision of mental health services.
Keywords: anti human immunodeficiency virus agent; emtricitabine; tenofovir; adolescent; adult; controlled study; cross-sectional study; depression; female; Human immunodeficiency virus infection; human; longitudinal study; male; male homosexuality; middle aged; pre-exposure prophylaxis; psychology; randomized controlled trial; sexual behavior; statistics and numerical data; transgender

Lubricant use and rectal chlamydial and gonococcal infections among men who engage in receptive anal intercourse - Maierhofer, C.; Rice, C.E.; Wang, S.-H.; Fields, K.S.; Ervin, M.; Turner, A.N. (Sexually Transmitted Diseases, 2016)
Background: Use of lubricants during anal intercourse is very common among men who have sex with men. However, few studies have evaluated associations between specific lubricants and rectal sexually transmitted infections (STIs). Methods: Between July 2012 and October 2013, we conducted a crosssectional study of men who have sex with men recruited from an urban, public sexual health clinic. In a self-administered survey, participants identified the lubricants used and frequency of lubricant use in the previous three months. Among men reporting any receptive anal intercourse (RAI) in the previous 3 months, we used multivariable binomial regression models to analyze associations between recent use of 9 specific lubricants and prevalent rectal chlamydia, rectal gonorrhea, and either rectal infection. Results: Twenty-five percent of the 146 participants had rectal chlamydial infection and 21% had rectal gonococcal infection; 37% had either (chlamydial or gonococcal) infection. Three-quarters reported always or almost always using lubricant during recent receptive anal intercourse. After adjustment for age, race, human immunodeficiency virus status, and condom use, Gun Oil (adjusted prevalence ratio [aPR], 1.99; 95% confidence interval [CI], 1.04-3.80) and Slick (aPR, 3.55; 95% CI, 1.38-9.12) were significantly associated with prevalent gonococcal infection. No lubricants were significantly associated with prevalent rectal chlamydia, but in analyses of either rectal infection, precum (aPR, 1.68; 95%CI, 1.06-2.66),Vaseline (aPR, 1.70; 95% CI, 1.10-2.64), and baby oil (aPR, 2.26; 95% CI, 1.43-3.57) were all significantly associated with prevalent rectal infection. Conclusions: Several lubricants were significantly associated with increased prevalence of rectal STI. Longitudinal studies are needed to examine any causal relationship between specific lubricants and STI acquisition.
Keywords: lubricating agent; oil; adult; anal intercourse; article; Chlamydia; chlamydiasis; condom use; cross-sectional study; disease association; female; gonorrhea; health survey; human; Human immunodeficiency virus; major clinical study; male; men who have sex with men; race; rectum disease; sexual health; urban area; young adult

Physiological and proteomic investigations to study the response of tomato graft unions under temperature stress - Muneer, S.; Ko, C.H.; Wei, H.; Chen, Y.; Jeong, B.R. (PLoS ONE, 2016)
Background: Grafting is an established practice for asexual propagation in horticultural and agricultural crops. The study on graft unions has become of interest for horticulturists using proteomic and genomic techniques to observe transfer of genetic material and signal transduction pathways from root to shoot and shoot to root. Another reason to study the graft unions was potentially to observe resistance against abiotic stresses. Using physiological and proteomic analyses, we investigated graft unions (rootstock and scions) of tomato genotypes exposed to standard-normal (23/23 and 25/18°C day/night) and high-low temperatures (30/15°C day/night). Results: Graft unions had varied responses to the diverse temperatures. High-low temperature, but not standard-normal temperature, induced the production of reactive oxygen species (ROS) in the form of H2O2 and O2-1 in rootstock and scions. However, the expression of many cell protection molecules was also induced, including antioxidant enzymes and their immunoblots, which also show an increase in their activities such as superoxide dismutase (SOD), catalase (CAT), and ascorbate peroxidase (APX). The graft interfaces thus actively defend against stress by modifying their physiological and proteomic responses to establish a new cellular homeostasis. As a result, many proteins for cellular defense were regulated in graft unions under diverse temperature, in addition to the regulation of photosynthetic proteins, ion binding/transport proteins, and protein synthesis. Moreover, biomass, hardness, and vascular transport activity were evaluated to investigate the basic connectivity between rootstock and scions. Conclusions: Our study provides physiological evidence of the grafted plants' response to diverse temperature. Most notably, our study provides novel insight into the mechanisms used to adapt the diverse temperature in graft unions (rootstock/scion).
Keywords: ascorbate peroxidase; catalase; hydrogen peroxide; oxygen; reactive oxygen metabolite; superoxide dismutase; article; biomass; controlled study; enzyme activity; genotype; high temperature; low temperature; nonhuman; plant defense; plant grafting; plant physiology; plant response; protein analysis; protein expression; protein synthesis; proteomics; rhizome; temperature stress; tomato

Occurrence of multiple mental health or substance use outcomes among bisexuals: a respondent-driven sampling study - Bauer, G.R.; Flanders, C.; MacLeod, M.A.; Ross, L.E. (BMC public health, 2016)
BACKGROUND: Bisexual populations have higher prevalence of depression, anxiety, suicidality and substance use than heterosexuals, and often than gay men or lesbians. The co-occurrence of multiple outcomes has rarely been studied. METHODS: Data were collected from 405 bisexuals using respondent-driven sampling. Weighted analyses were conducted for 387 with outcome data. Multiple outcomes were defined as 3 or more of: depression, anxiety, suicide ideation, problematic alcohol use, or polysubstance use. RESULTS: Among bisexuals, 19.0 % had multiple outcomes. We did not find variation in raw frequency of multiple outcomes across sociodemographic variables (e.g. gender, age). After adjustment, gender and sexual orientation identity were associated, with transgender women and those identifying as bisexual only more likely to have multiple outcomes. Social equity factors had a strong impact in both crude and adjusted analysis: controlling for other factors, high mental health/substance use burden was associated with greater discrimination (prevalence risk ratio (PRR) = 5.71; 95 % CI: 2.08, 15.63) and lower education (PRR = 2.41; 95 % CI: 1.06, 5.49), while higher income-to-needs ratio was protective (PRR = 0.44; 0.20, 1.00). CONCLUSIONS: Mental health and substance use outcomes with high prevalence among bisexuals frequently co-occurred. We find some support for the theory that these multiple outcomes represent a syndemic, defined as co-occurring and mutually reinforcing adverse outcomes driven by social inequity.
Keywords: adolescent; adult; bisexuality; female; human; male; mental disease; middle aged; Ontario; prevalence; psychology; questionnaire; drug dependence

Stigma, substance use and sexual risk behaviors among HIV-infected men who have sex with men: A qualitative study - Edelman, E.J.; Cole, C.A.; Richardson, W.; Boshnack, N.; Jenkins, H.; Rosenthal, M.S. (Preventive Medicine Reports, 2016)
Background: Public health HIV-service providers, including Medical Case Managers (case managers) and Disease Intervention Specialists (DIS) have a key role to play in identifying and addressing clients' complex mental health needs and substance use which contribute to sexual risk behaviors, yet their understanding and its consensus with HIV-infected men who have sex with men (MSM) have not been well characterized. Methods: Together with an AIDS Service Organization and the Connecticut State Department of Public Health in 2011-2012, we conducted a focus group of case managers (n = 14) and interviewed DIS (n = 7) and HIV-infected MSM (n = 17) in Connecticut. We used the constant comparison method, grounded theory, and a community-based participatory approach to guide analysis. Results: We identified three themes characterizing public health HIV-service providers' and MSM's perspectives regarding factors contributing to substance use and sexual risk behaviors in the context of HIV infection: 1) While both MSM and providers described a co-occurrence of HIV, stigma, substance use, and sexual risk behaviors, only MSM identified a causal relationship between these factors; 2) MSM and providers both described varying levels of self-efficacy in readiness to decrease substance use and sexual risk behaviors among MSM; both identified the social network as the key barrier to overcome; 3) Providers described how the co-occurrence of HIV, stigma and sexual risk behaviors leads to multi-faceted client needs for which they lacked sufficient training and collaboration. Conclusions: Provider education, skills-based training, and interventions targeting social networks may decrease sexual risk behaviors among HIV-infected MSM.
Keywords: adult; article; case manager; clinical article; clinical effectiveness; depression; disease intervention specialist; female; health care organization; health care personnel; health service; high risk behavior; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; interview; male; medical specialist; men who have sex with men; participatory research; public health; qualitative research; self concept; sexual behavior; social behavior; social environment; social isolation; social network; social support; stigma; substance use; suicidal behavior; United States

Self-Harm and Suicidality in Children Referred for Gender Dysphoria - Aitken, M.; VanderLaan, D.P.; Wasserman, L.; Stojanovski, S.; Zucker, K.J. (Journal of the American Academy of Child and Adolescent Psychiatry, 2016)
Objective This study examined rates of self-harm and suicidality (ideation and behavior) in children referred clinically for gender dysphoria compared with their siblings, and referred and nonreferred children from the Child Behavior Checklist (CBCL) standardization sample. Predictors or correlates of self-harm/suicidality were also examined. Method The sample consisted of 572 gender-referred children, 425 siblings, 878 referred children, and 903 nonreferred children. Parent report for 2 CBCL items was used to assess self-harm and suicidality. CBCL total behavior problems and a metric of peer relationship problems were also used. Results The gender-referred children and the referred children from the standardization sample had significantly higher scores than siblings and nonreferred children in terms of self-harm/suicidality, total behavior problems, and poor peer relations. Based on logistic regression analyses, gender-referred children were 5.1 times more likely than nonreferred children to talk about suicide and 8.6 times more likely to self-harm/attempt suicide, even after overall behavior problems and peer relationship problems were accounted for. In the final models, group, older age, and more total behavior problems, but not poor peer relations, were significantly associated with an increased likelihood of self-harm/suicidality. Conclusion By parent report, children with gender dysphoria show an increased rate of self-harm/suicidality as they get older. This risk was not simply an artifact of the presence of behavioral and emotional problems, although these problems were significant correlates of self-harm/suicidality. Clinicians should routinely screen for the presence of suicidal ideation and behavior in children with gender dysphoria, particularly during the second half of childhood.
Keywords: adolescent; adult; article; automutilation; child; Child Behavior Checklist; controlled study; female; gender dysphoria; gender identity; human; logistic regression analysis; major clinical study; male; Netherlands; peer group; prevalence; priority journal; problem behavior; sibling; standardization; suicidal behavior; suicidal ideation; suicide

Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults - Klein, A.; Golub, S.A. (LGBT health, 2016)
PURPOSE: We examined associations between family rejection and risk of suicide attempts and substance misuse among a national sample of transgender and gender nonconforming adults. METHODS: Data were drawn from the National Transgender Discrimination Survey (N = 6456). This secondary analysis was restricted to 3458 individuals who self-identified as transgender or gender nonconforming and provided complete data on study variables. We used multivariable logistic regression to examine health risks by level of reported family rejection (low/moderate/high), controlling for relevant sociodemographic characteristics. RESULTS: Overall, 42.3% of the sample reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination. After controlling for age, race/ethnicity, sex assigned at birth, binary gender identity, income, education, and employment status, family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection. CONCLUSIONS: Family rejection related to gender identity is an understudied interpersonal stressor that may negatively affect health outcomes for transgender and gender nonconforming individuals. A better understanding of the role of close relationships in both risk and resilience for transgender individuals is critical in the development of effective public health interventions for this community.
Keywords: adolescent; adult; aged; attitude; drug dependence; family; female; human; Internet; male; middle aged; odds ratio; perceptive discrimination; psychology; questionnaire; socioeconomics; statistical model; suicide attempt; transgender; very elderly; young adult

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality - Simonsen, R.K.; Giraldi, A.; Kristensen, E.; Hald, G.M. (Nordic Journal of Psychiatry, 2016)
Background: There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark. Aims: (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978-2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978-2010. Method: Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. Results: Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years. Conclusions: No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.
Keywords: adult; anxiety disorder; article; cancer mortality; cause of death; controlled study; Denmark; depersonalization; depression; female; follow up; heart disease; human; major clinical study; male; malignant neoplasm; mental disease; morbidity; mortality; personality disorder; psychosis; sex reassignment; substance abuse; suicide; transsexualism; ulcer

Bisexuality, poverty and mental health: A mixed methods analysis - Ross, L.E.; O'Gorman, L.; MacLeod, M.A.; Bauer, G.R.; MacKay, J.; Robinson, M. (Social Science and Medicine, 2016)
Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health.
Keywords: adolescent; adult; aged; anxiety; article; bisexuality; Canada; controlled study; cultural competence; depression; distress syndrome; employment; female; geography; health care access; human; income; Internet; major clinical study; male; mental health; personal experience; posttraumatic stress disorder; poverty; semi structured interview; sexism; social discrimination; physiological stress; suicidal ideation; suicide attempt

Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: Baseline Findings from Project LifeSkills - Reisner, S.L.; Biello, K.B.; Hughto, J.M.W.; Kuhns, L.; Mayer, K.H.; Garofalo, R.; Mimiaga, M.J. (JAMA Pediatrics, 2016)
IMPORTANCE Transgender youth, including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female, or another diverse transfeminine gender identity, represent a vulnerable population at risk for negative mental health and substance use outcomes. Diagnostic clinical interviews to assess prevalence of mental health, substance dependence, and comorbid psychiatric disorders in young transgender women remain scarce. OBJECTIVE To report the prevalence of mental health, substance dependence, and comorbid psychiatric disorders assessed via clinical diagnostic interview in a high-risk community-recruited sample of young transgender women. DESIGN, SETTING, AND PARTICIPANTS Observational study reporting baseline finding from a diverse sample of 298 sexually active, young transgender women aged 16 through 29 years (mean age, 23.4 years; 49.0%black, 12.4%Latina, 25.5%white, and 13.1%other minority race/ethnicity) and enrolled in Project LifeSkills, an ongoing randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. EXPOSURE Transfeminine gender identity. MAIN OUTCOMES AND MEASURES Age- and site-adjusted prevalence and comorbidities of mental health and substance dependence disorders assessed via the Mini-International Neuropsychiatric Interview, including 1 or more diagnoses, 2 or more comorbid diagnoses, major depressive episode (current and lifetime), past 30-day suicidal risk (no/low risk vs moderate/high risk), past 6-month generalized anxiety disorder and posttraumatic stress disorder, and past 12-month alcohol dependence and nonalcohol psychoactive substance use dependence. RESULTS Of the 298 transgender women, 41.5%of participants had 1 or more mental health or substance dependence diagnoses; 1 in 5 (20.1%) had 2 or more comorbid psychiatric diagnoses. Prevalence of specific disorders was as follows: lifetime and current major depressive episode, 35.4%and 14.7%, respectively; suicidality, 20.2%; generalized anxiety disorder, 7.9%; posttraumatic stress disorder, 9.8%; alcohol dependence, 11.2%; and nonalcohol psychoactive substance use dependence, 15.2%. CONCLUSIONS AND RELEVANCE Prevalence of psychiatric diagnoses was high in this community-recruited sample of young transgender women. Improving access to routine primary care, diagnostic screening, psychotherapy, and pharmacologic treatments, and retention in care in clinical community-based, pediatric, and adolescent medicine settings are urgently needed to address mental health and substance dependence disorders in this population. Further research will be critical, particularly longitudinal studies across development, to understand risk factors and identify optimal timing and targets for psychosocial interventions.
Keywords: adolescent; adult; age; alcoholism; article; comorbidity; generalized anxiety disorder; human; Human immunodeficiency virus infection; infection prevention; major clinical study; major depression; male; male to female transgender; mental disease; mental health; mini international neuropsychiatric interview; observational study; outcome assessment; posttraumatic stress disorder; prevalence; priority journal; substance abuse; suicidal ideation

Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis - Hottes, T.S.; Bogaert, L.; Rhodes, A.E.; Brennan, D.J.; Gesink, D. (American journal of public health, 2016)
BACKGROUND: Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay, and bisexual (LGB) persons (sexual minorities), compared with heterosexual groups, but these were restricted to general population studies, thereby excluding individuals sampled through LGB community venues. Each sampling strategy, however, has particular methodological strengths and limitations. For instance, general population probability studies have defined sampling frames but are prone to information bias associated with underreporting of LGB identities. By contrast, LGB community surveys may support disclosure of sexuality but overrepresent individuals with strong LGB community attachment. OBJECTIVES: To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community-based samples. SEARCH METHODS: In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities. SELECTION CRITERIA: We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand. DATA COLLECTION AND ANALYSIS: Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using τ(2). MAIN RESULTS: We pooled 30 cross-sectional studies, including 21,201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability. AUTHOR'S CONCLUSIONS: Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide. PUBLIC HEALTH IMPLICATIONS: Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
Keywords: adult; cross-sectional study; demography; epidemiology; female; human; male; meta analysis; middle aged; minority group; prevalence; sexuality; statistics and numerical data; suicidal ideation; suicide attempt; United States

Prevalence and risk factors for lifetime suicide ideation, plan and attempt in Chinese men who have sex with men - Mu, H.; Li, Y.; Liu, L.; Na, J.; Yu, L.; Bi, X.; An, X.; Gu, Y.; Zhou, Y.; Li, S.; Zhang, R.; Jiang, C.; et al. (BMC Psychiatry, 2016)
Background: To describe the level and risk factors for suicidal behaviors in Chinese men who have sex with men (MSM). Methods: A total of 807 MSM were recruited using a respondent-driven sampling method from Anshan, Benxi, Dandong, and Shenyang cities in northeastern China. Results: Chinese MSM had lifetime prevalences of suicide ideation (18.3%), plan (8.7%) and attempt (4.6%) that were about 2.8, 5.8 and 5.8 times greater than that of male adults in the general population of China. The MSM with any psychiatric disorders were 4-7 times more likely to think about, plan or attempt suicide than those MSM with no disorder, and there was a clear relationship between the number of comorbid disorders and suicidal behaviors. Multiple regression analysis showed that major depression, bipolar disorder, dysthymia and alcohol use disorder significantly increased the risk for suicide ideation, but not for suicide attempt. Drug dependence disorder, panic disorder and generalized anxiety disorder significantly increased the risk for suicide attempt, but not for suicide ideation. More advanced education reduced the risk of suicidal behaviors, sexual orientations revealed to or discovered by family members or friends significantly increased risk of these suicidal behaviors. Conclusions: Chinese MSM have significantly increased risk for suicidal behaviors, mental disorders and their comorbidities could be the largest risk factors for the elevated suicidal behaviors in Chinese MSM. Reducing the family and social stigma and rejection of homosexual behavior and early detection and effective treatment of psychiatric disorders and their comorbidities in MSM may help to decrease suicidal behaviors of Chinese MSM.
Keywords: adult; agoraphobia; alcoholism; alcoholism; article; bipolar disorder; China; Chinese; comorbidity; controlled study; drug dependence; dysthymia; educational status; generalized anxiety disorder; homosexuality; human; major depression; male; men who have sex with men; obsessive compulsive disorder; panic; prevalence; risk factor; sexual orientation; social rejection; social stigma; suicidal ideation; suicide attempt

Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis - Padula, W.V.; Heru, S.; Campbell, J.D. (Journal of General Internal Medicine, 2016)
BACKGROUND: Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. OBJECTIVE: To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. DESIGN: Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3 % (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). PATIENTS: U.S. transgender population starting before transitional therapy. INTERVENTIONS: No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. MAIN MEASURES: Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. KEY RESULTS: Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000–22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints —HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85 % of simulations. CONCLUSIONS: Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions.
Keywords: article; cost effectiveness analysis; depression; drug abuse; health care cost; health insurance; health service; hidden Markov model; hormone substitution; human; Human immunodeficiency virus infection; quality adjusted life year; sex reassignment; suicidal behavior; transgender; United States

Empiricism as Change Agent - Kravitz, R.L. (Journal of General Internal Medicine, 2016)
Keywords: proton pump inhibitor; American; article; baby boomer; behavior change; Catholic; Clostridium difficile infection; cost effectiveness analysis; depression; doctor patient relationship; drug abuse; dyspepsia; empiricism; gastroesophageal reflux; health care access; health care associated pneumonia; health care cost; health care need; health care policy; health care quality; health insurance; homosexual female; homosexual male; hospital readmission; human; Human immunodeficiency virus infection; inappropriate prescribing; intensive care unit; interpersonal communication; public opinion; randomized controlled trial (topic); same-sex marriage; sex reassignment; suicide; systematic review (topic); transgender; United States; unnecessary procedure

Sexual Violence Among Youth in New Mexico: Risk and Resiliency Factors That Impact Behavioral Health Outcomes - Reed, D.; Reno, J.; Green, D. (Family & community health, 2016)
Research has consistently demonstrated a relationship between history of forced sex and poor behavioral health outcomes. The objectives of this study were to describe this relationship among high school students and to explore the impact of resiliency factors. Using data from the 2013 New Mexico Youth Risk and Resiliency Survey, we found that history of forced sex was associated with negative behavioral health outcomes for males and females, regardless of sexual orientation and disability status. Furthermore, the presence of a caring adult at home appeared to reduce the risk of substance abuse and suicidality among students with and without a history of forced sex.
Keywords: adolescent; adolescent behavior; adult; epidemiology; family; female; high risk behavior; human; male; mental health; New Mexico; prevention and control; psychology; questionnaire; sex difference; sexual behavior; sexual crime; social support; student; drug dependence; suicide

Sexual Self-Concept Ambiguity and the Interpersonal Theory of Suicide Risk - Talley, A.E.; Brown, S.L.; Cukrowicz, K.; Bagge, C.L. (Suicide & life-threatening behavior, 2016)
Mechanisms (i.e., thwarted belongingness, perceived burdensomeness, hopelessness) derived from the interpersonal theory of suicide which are hypothesized to account for the relation between sexual orientation self-concept ambiguity and active suicide ideation were examined. Participants included 349 women, among whom 42% currently self-ascribed a non-exclusively heterosexual sexual identity. Among women reporting higher levels of sexual self-concept ambiguity, greater risk for active suicide ideation is found when perceptions of burden and feelings of thwarted belonging co-occur with feelings of hopelessness. Results support relevant theory useful for understanding suicide risk among sexual minority women who acknowledge ambiguity with regard to their sexual orientation.
Keywords: adolescent; adult; alcoholism; female; human; psychology; self concept; sexual behavior; social behavior; social support; statistics; suicidal ideation; young adult

A Comparative Analysis of a Community and General Sample of Lesbian, Gay, and Bisexual Individuals - Kuyper, L.; Fernee, H.; Keuzenkamp, S. (Archives of sexual behavior, 2016)
Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues ("community sample," N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands ("panel sample," N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexual orientation, were more open about their sexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R (2) of the analyses (which were adjusted for sociodemographic differences) ranged from .08 (suicide plans among men) to .27 (sexual attraction among women). However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed.
Keywords: adolescent; adult; bisexuality; demography; epidemiology; female; human; lesbianism; male; male homosexuality; mental health; mental stress; middle aged; minority group; Netherlands; psychology; questionnaire; statistics and numerical data; young adult

Sociodemographic Characteristics and Psychological Adjustment Among Transsexuals in Spain - Guzmán-Parra, J.; Sánchez-Álvarez, N.; de Diego-Otero, Y.; Pérez-Costillas, L.; Esteva de Antonio, I.; Navais-Barranco, M.; Castro-Zamudio, S.; Bergero-Miguel, T. (Archives of sexual behavior, 2016)
This study examined the sociodemographic characteristics and the psychological adjustment of transsexuals in Andalusia (Spain), and also analyzed the differences between female-to-male (FtM) and male-to-female (MtF) transsexuals. The sample included 197 transsexuals (101 MtF and 96 FtM) selected from those who visited the Transsexual and Gender Identity Unit at the Carlos Haya Hospital in Malaga between 2011 and 2012. Our analyses indicated that MtF transsexuals were more likely to have lower educational levels, live alone, have worked less frequently throughout their lifetime, and have engaged in prostitution. For FtM transsexuals, there were more frequent references to the mother's psychiatric history and more social avoidance and distress. Multivariate analysis showed that the number of personality dysfunctional traits and unemployment status were associated with depression in the entire sample. The following three conclusions can be made: there are significant differences between MtF and FtM transsexuals (mainly related to sociodemographic variables), depression was high in both groups, and a remarkable percentage of transsexuals have attempted suicide (22.8 %) or have had suicidal thoughts (52.3 %).
Keywords: adaptive behavior; adult; female; gender identity; human; male; psychology; questionnaire; sexual behavior; Spain; transsexualism; young adult

Effects of Victimization and Violence on Suicidal Ideation and Behaviors Among Sexual Minority and Heterosexual Adolescents - Bouris, A.; Everett, B.G.; Heath, R.D.; Elsaesser, C.E.; Neilands, T.B. (LGBT health, 2016)
PURPOSE: Sexual minority youth (SMY) are at higher risk for victimization and suicide than are heterosexual youth (HY). Relatively little research has examined which types of victimization are most closely linked to suicide, which is necessary to develop targeted prevention interventions. The present study was conducted to address this deficit. METHODS: The data come from the 2011 Chicago Youth Risk Behavior Survey (n = 1,907). Structural equation modeling (SEM) in Mplus evaluated the direct, indirect, and total effects of sexual orientation on a latent indicator of suicidal ideation and behaviors via seven types of victimization. Four indicators of victimization were school-specific (e.g., harassment due to sexual orientation or gender identity (SO/GID), bullying, threatened or injured with a weapon, and skipping school due to safety concerns), and three indicators assessed other types of victimization (e.g., electronic bullying, intimate partner violence, and sexual abuse). RESULTS: Thirteen percent of youth were classified as SMY. Significantly more SMY than HY reported suicidal ideation (27.95% vs. 13.64%), a suicide plan (22.78% vs. 12.36%), and at least one suicide attempt (29.92% vs. 12.43%) in the past year (all P < .001). A greater percentage of SMY reported SO/GID-related harassment, skipping school, electronic bullying, and sexual abuse. Sexual orientation was not directly related to suicidal ideation and behaviors in SEM. Rather, SMY's elevated risk of suicidality functioned indirectly through two forms of school-based victimization: being threatened or injured with a weapon (B = .19, SE = .09, P ≤ .05) and experiencing SO/GID-specific harassment (B = .40, SE = .15, P ≤ .01). There also was a trend for SMY to skip school as a strategy to reduce suicide risk. CONCLUSION: Although SMY experience higher rates of victimization than do HY, school-based victimization that involves weapons or is due to one's SO/GID appear to be the most deleterious. That SMY may skip school to reduce their risk of suicidal ideation and behaviors is problematic, and schools should be encouraged to enact and enforce policies that explicitly protect SMY from victimization.
Keywords: adolescent; bullying; crime victim; epidemiology; female; heterosexuality; human; Illinois; male; psychology; regression analysis; risk; school; sexual and gender minority; statistics and numerical data; suicide; violence

Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study - Brown, G.R.; Jones, K.T. (LGBT health, 2016)
PURPOSE: There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status. METHODS: Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population. RESULTS: In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups. CONCLUSION: This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.
Keywords: adult; aged; case control study; electronic health record; female; gender dysphoria; government; health disparity; human; longitudinal study; male; mental disease; mental health; middle aged; psychology; retrospective study; statistics and numerical data; transgender; transsexualism; United States; very elderly; veteran; veterans health

Gender Dysphoria in Adults - Zucker, K.J.; Lawrence, A.A.; Kreukels, B.P.C. (Annual Review of Clinical Psychology, 2016)
Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities.
Keywords: cyproterone acetate; gonadorelin agonist; sex hormone; spironolactone; adult; article; automutilation; biological phenomena and functions concerning the entire organism; comorbidity; connectome; disease association; DSM-5; female to male transgender; gender dysphoria; genetics; hormonal therapy; human; ICD-11; incidence; male to female transgender; mental disease; mental disease assessment; mental health care personnel; nomenclature; patient counseling; personal experience; phenomenology; prevalence; psychologic assessment; psychotherapy; self report; sex difference; sex ratio; sex reassignment; sex role; social psychology; suicidal behavior; transsexualism

Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America - Biello, K.B.; Oldenburg, C.E.; Safren, S.A.; Rosenberger, J.G.; Novak, D.S.; Mayer, K.H.; Mimiaga, M.J. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2016)
Latin America has some of the highest levels of antiretroviral therapy (ART) coverage of any developing region in the world. Early initiation and optimal adherence to ART are necessary for improved health outcomes and reduction in onward transmission. Previous work has demonstrated the role of psychosocial problems as barriers to uptake and adherence to ART, and recently, a syndemic framework has been applied to the role of multiple psychosocial syndemic factors and adherence to ART, in the USA. However, to our knowledge, these associations have not been investigated outside of the USA, nor in a multi-country context. To address these gaps, we assessed the association between multiple co-occurring psychosocial factors and engagement in HIV-related medical care and adherence to ART among a large, multinational sample of sexually-active HIV-infected men who have sex with men in Latin America.Among the 2020 respondents, 80.7% reported currently receiving HIV-related medical care, 72.3% reported currently receiving ART; among those, 62.5% reported 100% adherence. Compared with experiencing no psychosocial health problems, experiencing five or more psychosocial health problems is associated with 42% lower odds of currently receiving HIV-related medical care (adjusted odds ratio, aOR = 0.58, 95% CI 0.36, 0.95) and of currently receiving ART (aOR = 0.58, 95% CI 0.38, 0.91). The number of psychosocial health problems experienced was associated with self-reported ART adherence in a dose-response relationship; compared to those with none of the factors, individuals with one syndemic factor had 23% lower odds (aOR = 0.77, 95% CI 0.60, 0.97) and individuals with five or more syndemic factors had 72% lower odds (aOR = 0.28, 95% CI 0.14, 0.55) of reporting being 100% adherent to ART. Addressing co-occurring psychosocial problems as potential barriers to uptake and adherence of ART in Latin America may improve the effectiveness of secondary prevention interventions.
Keywords: anti human immunodeficiency virus agent; adult; alcohol consumption; antiviral therapy; article; child sexual abuse; depression; dose response; drug use; health; health care access; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; medical care; men who have sex with men; partner violence; patient compliance; priority journal; psychosocial disorder; self report; sexual behavior; social psychology; South and Central America; suicidal ideation

Mental health among men who have sex with men in Cambodia: Implications for integration of mental health services within HIV programmes - Yi, S.; Tuot, S.; Chhoun, P.; Pal, K.; Choub, S.C.; Mburu, G. (International Journal for Equity in Health, 2016)
Background: Poor mental health contributes to poor HIV prevention, treatment and care outcomes. This paper documents factors associated with psychological distress among men who have sex with men (MSM) in Cambodia and discusses potential ways in which routine mental health management could be integrated into HIV services. Methods: A cross-sectional study was conducted in 2014 among 394 MSM randomly selected from two provinces using a two-stage cluster sampling method. A structured questionnaire was used to assess psychological distress, sexual behaviors, substance use, adverse childhood experiences and family dysfunction. Multivariate logistic regression analysis was performed to explore factors associated with levels of psychological distress. Results: In total, 10.7 % of the respondents reported having suicidal thoughts and 6.6 % reported having attempted to commit suicide in the past three months, while 38.8 % had a higher level of psychological distress (GHQ-12 > 3), which indicates poor mental health. Higher levels of psychological distress were independently associated with older age (AOR = 1.09, 95 % CI 1.03-1.14), alcohol use (AOR = 3.3, 95 % CI 1.36-7.83), illicit drug use (AOR = 3.53, 95 % CI 1.12-11.18), poor self-reported quality of life (AOR = 7.45, 95 % CI 1.79-3.04), and reduced condom use at last sex (AOR = 0.40, 95 % CI 0.21-0.73). MSM with higher levels of psychological distress were significantly more likely to report that a family member said hurtful things to them (AOR = 1.80, 95 % CI 1.10-2.97), a parent or guardian had been physically abused (AOR = 3.51, 95 % CI 1.86-6.62), and a family member had been mentally ill (AOR = 4.01, 95 % CI 2.06-7.81) when they were growing up. Conclusions: In order to mitigate psychological distress among MSM in Cambodia, integration of mental health interventions within HIV programmes should be strengthened. To achieve optimal impact, these interventions should also address alcohol and other substance use, and low condom use among distressed MSM. In addition, training of clinical and non-clinical HIV service providers to screen for mental health symptoms, and subsequent provision of peer-based outreach and social support for MSM identified with psychological distress is required.
Keywords: adult; alcohol consumption; article; Cambodia; child abuse; condom use; cross-sectional study; disease association; distress syndrome; family stress; human; Human immunodeficiency virus infection; male; men who have sex with men; mental health; mental health service; priority journal; quality of life; sexual behavior; structured questionnaire; substance abuse; suicidal ideation

Sexual orientation and symptoms of common mental disorder or low wellbeing: Combined meta-analysis of 12 UK population health surveys - Semlyen, J.; King, M.; Varney, J.; Hagger-Johnson, G. (BMC Psychiatry, 2016)
Background: Previous studies have indicated increased risk of mental disorder symptoms, suicide and substance misuse in lesbian, gay and bisexual (LGB) adults, compared to heterosexual adults. Our aims were to determine an estimate of the association between sexual orientation identity and poor mental health and wellbeing among adults from 12 population surveys in the UK, and to consider whether effects differed for specific subgroups of the population. Methods: Individual data were pooled from the British Cohort Study 2012, Health Survey for England 2011, 2012 and 2013, Scottish Health Survey 2008 to 2013, Longitudinal Study of Young People in England 2009/10 and Understanding Society 2011/12. Individual participant meta-analysis was used to pool estimates from each study, allowing for between-study variation. Results: Of 94,818 participants, 1.1 % identified as lesbian/gay, 0.9 % as bisexual, 0.8 % as 'other' and 97.2 % as heterosexual. Adjusting for a range of covariates, adults who identified as lesbian/gay had higher prevalence of common mental disorder when compared to heterosexuals, but the association was different in different age groups: apparent for those under 35 (OR = 1.78, 95 % CI 1.40, 2.26), weaker at age 35-54.9 (OR = 1.42, 95 % CI 1.10, 1.84), but strongest at age 55+ (OR = 2.06, 95 % CI 1.29, 3.31). These effects were stronger for bisexual adults, similar for those identifying as 'other', and similar for 'low wellbeing'. Conclusions: In the UK, LGB adults have higher prevalence of poor mental health and low wellbeing when compared to heterosexuals, particularly younger and older LGB adults. Sexual orientation identity should be measured routinely in all health studies and in administrative data in the UK in order to influence national and local policy development and service delivery. These results reiterate the need for local government, NHS providers and public health policy makers to consider how to address inequalities in mental health among these minority groups.
Keywords: adult; age; article; bisexuality; cohort analysis; female; General Health Questionnaire; health survey; heterosexuality; homosexual female; homosexual male; human; major clinical study; male; mental disease; middle aged; population research; prevalence; psychological well-being; sexual orientation; United Kingdom

Approach to children and adolescents with gender dysphoria - Lopez, X.; Stewart, S.; Jacobson-Dickman, E. (Pediatrics in Review, 2016)
The definition of gender dysphoria (GD) includes the experience of a body that is incongruent with gender identity. The prevalence of GD is not as yet known, but the current proposed numbers are likely underestimated. Prevalence studies are complicated by several confounding factors and results may be misleading. (5)(7). On the basis of strong evidence from retrospective studies of relevant populations, clinicians should be especially vigilant in identifying GD in patients who are peripubertal because the onset of puberty heightens the risk of depression, anxiety, selfdestructive choices, and suicide. (8)(13). On the basis of strong evidence, "reparative psychotherapy" is both unsuccessful and psychologically deleterious. (15)(16)(17) (18) On the basis of expert consensus, the "gender affirmative model" is more accepted. (19). On the basis of strong evidence, adolescents treated with a protocol of pubertal suppression followed by hormone replacement therapy during adolescence and gender reassignment surgery in adulthood have improved psychological outcomes and quality of lives compared with age-matched adults from the general population. (10)(29). A large national transgender survey revealed that 41% of adult respondents had attempting suicide. On the basis of strong evidence, youth who are validated in their transgender identity by supportive family and social environments have much more favorable psychological outcomes. (11) The primary care clinician has a unique role and responsibility to identify patients with possible GD and provide anticipatory guidance, counseling, and family support. Primary health care clinicians can provide the impetus and means to greatly improve the lifelong psychological well-being of their patients with GD and potentially save lives. (9)(11)(13)(30).
Keywords: adolescent; anticipatory guidance; anxiety disorder; article; awareness; case report; comorbidity; depression; distress syndrome; gender; gender dysphoria; gender identity; health education; hormonal therapy; human; male; mental health; patient counseling; prevalence; puberty; sex; sexual maturity; sexual orientation; social acceptance; suicidal behavior; transgender

Risk Factors for Non-Suicidal Self-Injury Among Trans Youth - Arcelus, J.; Claes, L.; Witcomb, G.L.; Marshall, E.; Bouman, W.P. (Journal of Sexual Medicine, 2016)
Introduction: Previous research has reported high levels of non-suicidal self-injury (NSSI) in trans populations and younger age has been identified as a risk factor. Aims: To explore the prevalence of NSSI in a large group of young trans people and to identify risk factors for this group. Main Outcome Measures: Sociodemographic variables and measurements of NSSI (Self-Injury Questionnaire), psychopathology (Symptom Checklist-90-Revised), self-esteem (Rosenberg Self-Esteem Scale), victimization (Experiences of Transphobia Scale), interpersonal functioning (Inventory of Interpersonal Problems), and social support (Multidimensional Scale of Perceived Social Support). Methods: Two hundred sixty-eight young people attending a national gender clinic completed questionnaires assessing presence and frequency of NSSI and levels of general psychopathology, depression, anxiety, interpersonal problems, self-esteem, social support, transphobia, and information on hormone treatment. Results: A lifetime presence of NSSI was identified in 46.3% of patients and 28.73% reported currently engaging in NSSI (within at least the past few months). Analyses showed that those with a lifetime presence of NSSI had significantly greater general psychopathology, lower self-esteem, had suffered more transphobia, and experienced greater interpersonal problems than those without NSSI. Findings were similar when comparing current with non-current NSSI. Overall, natal male patients reported less social support than natal female patients, but current NSSI was more common in natal female patients. Regression analyses confirmed that natal female gender and greater general psychopathology predicted current and lifetime NSSI. Further analyses confirmed that general psychopathology itself could be predicted by transphobic experiences, low self-esteem, and interpersonal problems, but not by the use of cross-sex hormones. Conclusion: These findings confirm that NSSI is common in trans youth and emphasize the need for interventions that decrease transphobia, increase social support, and help trans youth navigate their relationships with others to decrease psychopathology and NSSI.
Keywords: adult; article; automutilation; Experiences of Transphobia Scale; female; female to male transgender; human; human relation; Inventory of Interpersonal Problems; male; male to female transgender; mental disease; Multidimensional Scale of Perceived Social Support; phobia; priority journal; questionnaire; rating scale; Rosenberg Self-Esteem Scale; self esteem; Self Injury Questionnaire; social support; social support assessment; Symptom Checklist 90; transgender; transphobia

Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death - Simonsen, R.K.; Hald, G.M.; Kristensen, E.; Giraldi, A. (Sexual Medicine, 2016)
Introduction: Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark. Aims: To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010. Methods: Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register. Main Outcome Measures: Somatic morbidity and cause of death. Results: Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male). Conclusion: Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.
Keywords: alcohol; adult; alcohol liver cirrhosis; article; cardiovascular disease; cause of death; cohort analysis; controlled study; Danish citizen; death certificate; disease registry; female; follow up; heart disease; hormonal regulation; human; ICD-10; ICD-8; lung disease; male; malignant neoplasm; morbidity; mortality; muscle disease; musculoskeletal disease; priority journal; sex ratio; sex reassignment; smoking; somatic morbidity; suicide; transsexualism; ulcer

Mental Health of Transgender Veterans in US States With and Without Discrimination and Hate Crime Legal Protection - Blosnich, J.R.; Marsiglio, M.C.; Gao, S.; Gordon, A.J.; Shipherd, J.C.; Kauth, M.; Brown, G.R.; Fine, M.J. (American journal of public health, 2016)
OBJECTIVES: To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans' mental health. METHODS: We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt. RESULTS: Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased odds of self-directed violence (AOR = 0.57; 95% CI = 0.34, 0.95). CONCLUSIONS: Understanding lesbian, gay, bisexual, and transgender social stressors can inform treatment and care coordination for transgender populations.
Keywords: adult; aged; female; human; legislation and jurisprudence; male; mental health; middle aged; mood disorder; politics; prejudice; psychology; socioeconomics; statistics and numerical data; posttraumatic stress disorder; drug dependence; suicidal ideation; suicide attempt; transgender; veteran

Tennessee's Diverse Populations: How You Care Matters - Lauderdale, J. (Tennessee nurse / Tennessee Nurses Association, 2016)
Keywords: cultural anthropology; empathy; female; health personnel attitude; human; lesbianism; male; male homosexuality; nurse attitude; nurse patient relationship; nursing care; organization; organization and management; psychology; suicide; Tennessee; transcultural care

The Roman Catholic Church and the Repugnant Conclusion - Shaw, D. (Journal of bioethical inquiry, 2016)
Keywords: assisted suicide; Catholicism; contraception; ethical theory; ethics; happiness; homosexuality; human; human rights; human rights abuse; imagination; induced abortion; legislation and jurisprudence; medical ethics; personal autonomy; population growth; public policy; quality of life; religion; United States

LGBT youth missing out on support - Dean, E. (Nursing standard (Royal College of Nursing (Great Britain) : 1987), 2016)
According to a Department of Health-funded study young LGBT people are at increased risk of self-harm and suicide. The Queer Futures project has also revealed that mental health professionals lack access to the training they need to support these young people.
Keywords: adolescent; female; human; male; workforce; mental health service; sexual behavior; United Kingdom

Content validity of Patient-Reported Outcomes Measurement Information System (PROMIS) items in the context of HIV clinical care - Edwards, T.C.; Fredericksen, R.J.; Crane, H.M.; Crane, P.K.; Kitahata, M.M.; Mathews, W.C.; Mayer, K.H.; Morales, L.S.; Mugavero, M.J.; Solorio, R.; Yang, F.M.; Patrick, D.L. (Quality of Life Research, 2016)
Purpose: To assess content validity and patient and provider prioritization of Patient-Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, fatigue, and alcohol use items in the context of clinical care for people living with HIV (PLWH), and to develop and assess new items as needed. Methods: We conducted concept elicitation interviews (n = 161), item pool matching, prioritization focus groups (n = 227 participants), and cognitive interviews (n = 48) with English-speaking (~75 %) and Spanish-speaking (~25 %) PLWH from clinical sites in Seattle, San Diego, Birmingham, and Boston. For each domain we also conducted item review and prioritization with two HIV provider panels of 3–8 members each. Results: Among items most highly prioritized by PLWH and providers were those that included information regarding personal impacts of the concept being assessed, in addition to severity level. Items that addressed impact were considered most actionable for clinical care. We developed additional items addressing this. For depression we developed items related to suicide and other forms of self-harm, and for all domains we developed items addressing impacts PLWH and/or providers indicated were particularly relevant to clinical care. Across the 4 domains, 16 new items were retained for further psychometric testing. Conclusion: PLWH and providers had priorities for what they believed providers should know to provide optimal care for PLWH. Incorporation of these priorities into clinical assessments used in clinical care of PLWH may facilitate patient-centered care.
Keywords: adult; alcohol consumption; amnesia; anxiety; article; automutilation; CD4 lymphocyte count; content validity; depression; disease severity; fatigue; female; human; Human immunodeficiency virus infection; information processing; information system; interview; major clinical study; male; men who have sex with men; outcome assessment; patient care; patient reported outcome measurement information system; self report; social interaction; suicidal ideation; suicide

Psychosocial syndemic associated with increased suicidal ideation among men who have sex with men in Shanghai, China - Li, R.; Cai, Y.; Wang, Y.; Sun, Z.; Zhu, C.; Tian, Y.; Jiang, X.; Gan, F. (Health Psychology, 2016)
Objective: We intended to verify the syndemic effect of psychosocial health conditions on suicidal ideation among men who have sex with men (MSM) in Shanghai, China; design a comprehensive framework for the identification of the MSM with suicidal ideation; and provide suggestion for suicidality intervention among MSM. Method: A cross-sectional study was conducted among 547 MSM in 4 districts in Shanghai. Sociodemographic, psychosocial, and suicidal ideation information of the participants was collected. Logistic regressions were performed to assess the relationship between psychosocial variables and suicidal ideation and to verify the syndemic effect of psychosocial factors. Results: Of the MSM sample, 10.6% reported suicidal thoughts in the past year. In univariate analysis, depression, anxiety, loneliness, impulsivity, involuntary subordination (IS), social support, and risky sex were associated with suicidal ideation. Multivariate analysis found that IS (ORm = 2.92, 95% confidence interval [CI] = 1.55-5.51) and risky sex (ORm = 3.79, 95% CI = 1.44 -9.97) remained significant. The MSM with more than 5 psychosocial health problems were nearly 4 times more likely (adjusted odds ratio = 4.68, 95% CI = 2.23-9.80) to have had suicidal ideation in the past year. Conclusions: The study confirmed the syndemic effect of psychosocial health problems in magnifying the risk of suicidality among MSM. More integrated and holistic approaches in the identification of high-risk groups and intervention of suicidality among MSM are needed.
Keywords: adult; anxiety; article; China; conceptual framework; cross-sectional study; demography; depression; health hazard; high risk population; human; impulsiveness; loneliness; major clinical study; male; men who have sex with men; mental health; psychosocial disorder; psychosocial syndemic; risk assessment; sexual behavior; social interaction; social psychology; social support; suicidal ideation

Anti-inflammatory effects of Juncus effusus extract (JEE) on LPS-stimulated RAW 264.7 cells and edema models - Park, N.-Y.; Kim, S.-G.; Park, H.-H.; Jeong, K.-T.; Lee, Y.J.; Lee, E. (Pharmaceutical Biology, 2016)
Context: Juncus effusus L. var. decipiens BUCHEN. f. leschenaultii GAY has been used in traditional medicine for the treatment of anxiety and insomnia.Objective: The objective of this study was to evaluate the effects of ethanol extract from the pith of Juncus effusus (JEE) on anti-inflammatory activities in RAW 264.7 cells.Materials and methods: The production of inflammatory mediators and the underlying mechanisms using 3.1, 6.3, and 12.5 g/mL concentrations of JEE were investigated. In addition, the topical anti-inflammatory effects of JEE (0.5, 1, and 2 mg/mL) on 12-O-tetradecanoylphorobol-13 acetate (TPA)-induced ear edema and oral administration of JEE (50, 100, and 200 mg/kg) on carrageenan-induced paw-edema were studied in mice.Results: JEE reduced the release of nitric oxide (NO, IC50 value = 1.98 g/mL), prostaglandin E2 (IC50 value = 5.5 g/mL), and pro-inflammatory cytokines, IL-1β (IC50 value = 4.74 g/mL) and IL-6 (IC50 value = 20.48 g/mL). JEE also suppressed the protein expression of inducible NO synthase and cyclooxygenase-2 in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells. Mechanism studies showed attenuation of LPS-induced activation of NF-B by JEE via abrogation of IBα degradation and a subsequent decrease in nuclear p65 level. Phosphorylation of all three MAP kinases (ERK, JNK, and p38) in LPS-stimulated RAW 264.7 cells was also suppressed in a dose-dependent manner. In acute inflammation models of mice, topical application (1 and 2 mg) and oral administration (50, 100, and 200 mg/kg) of JEE ameliorated TPA-induced ear edema and carrageenan-induced paw edema, respectively, in dose-dependent manners.Discussion and conclusion: These results indicate that JEE exhibited anti-inflammatory activities by suppressing the production of inflammatory mediators in LPS-stimulated RAW 264.7 cells and by attenuating edema in mice.
Keywords: alcohol; antiinflammatory agent; cyclooxygenase 2; immunoglobulin enhancer binding protein; inducible nitric oxide synthase; interleukin 1beta; interleukin 6; Juncus effusus extract; lipopolysaccharide; mitogen activated protein kinase; mitogen activated protein kinase p38; nitric oxide; phorbol 13 acetate 12 myristate; plant extract; prostaglandin E2; stress activated protein kinase; transcription factor RelA; unclassified drug; animal cell; animal experiment; animal model; antiinflammatory activity; article; carrageenan-induced paw edema; cell line; cell stimulation; concentration response; cytokine release; dose response; ear edema; enzyme phosphorylation; Juncus effusus; mediator release; mouse; mouse model; nonhuman; Poales; protein degradation; protein expression; RAW 264.7 cell line

Non-suicidal self-injury and suicidal thoughts and behaviors in heterosexual and sexual minority young adults - Tsypes, A.; Lane, R.; Paul, E.; Whitlock, J. (Comprehensive Psychiatry, 2016)
Objective Despite consistently greater rates of non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs; i.e., suicidal ideation, method/plan, and attempts) in lesbian, gay, and bisexual (LGB) individuals, prevalence, characteristics, and relations between these dangerous thoughts and behaviors are equivocal. The present study sought to examine and compare the rates of NSSI and STBs in a large sample of sexual minority and majority young adults. Methods Participants were 12,422 college students (ages 18-29; 57.3% female) who self-reported demographic characteristics, NSSI frequency, the number of NSSI forms used, the number of NSSI functions, as well as STB history (i.e., ideation, method/plan, and attempts). Each participant's degree of SA was assessed via a 7-point scale (i.e., K0-K6) from Alfred Kinsey's research of sexual attraction and sexual experiences. This scale was collapsed to create five categories of SA: exclusively other SA (K0), mostly other SA (K1/2), equally other and same SA (K3), mostly same SA (K4/5), and exclusively same SA (K6). Results Consistent with previous research, we found that being a sexual minority young adult was associated with significantly higher odds of STBs compared to being a heterosexual young adult. In addition, compared to the exclusively other SA group (K0), being in the mostly other SA group (K1/2), equally other and same SA group (K3), or mostly same SA group (K4/5) was associated with significantly higher odds of NSSI engagement. Among those with NSSI, we found that the number of NSSI forms was significantly associated with suicide attempts, but was not associated with either suicidal ideation or suicide method/plan in the mostly other SA group (K1/2) or in the equally other and same SA group (K3). We also found a significant curvilinear relation between NSSI frequency and STBs in the mostly other SA group (K1/2) and between NSSI frequency and suicide method/plan and attempt in the exclusively other SA group (K0). In addition, we revealed specificity with regard to the relation between the number of lifetime NSSI episodes and risk for STBs among the equally other and same SA (K3), mostly same SA (K4/5), and exclusively same SA (K6) groups. Conclusion Our findings suggest that among sexual minority young adults, equally other and same SA individuals may be at higher risk of NSSI and STBs than their sexual minority counterparts. In addition, these findings extend previous research by suggesting that the relations between NSSI frequency, number of forms, and number of functions and STBs might vary according to SA. A multi-theory based explanation is provided to explain the key findings and the study implications are discussed.
Keywords: 7 point scale; adult; article; assessment of humans; automutilation; bisexuality; college student; controlled study; demography; female; heterosexuality; homosexual female; human; major clinical study; male; medical history; prevalence; self report; sexual and gender minority; suicidal ideation; suicide attempt; young adult

Factors associated with suicide outcomes 12 months after screening positive for suicide risk in the emergency department - Arias, S.A.; Miller, I.; Camargo, C.A.; Sullivan, A.F.; Goldstein, A.B.; Allen, M.H.; Manton, A.P.; Boudreaux, E.D. (Psychiatric Services, 2016)
Objective: The main objective was to identify which patient characteristics have the strongest association with suicide outcomes in the 12 months after an index emergency department (ED) visit. Methods: Data were analyzed fromthe first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE). The ED-SAFE study, a quasiexperimental, interrupted time-series design, involved participation from eight general medical EDs across the United States. Participants included adults presenting to the ED with active suicidal ideation or an attempt in the past week. Data collection included baseline interview; six-and 12-month chart reviews; and six-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. Regression analyseswere conducted. Results: Among 874 participants, the median age was 37 years (interquartile range 27-47), with 56% of the sample being female (N=488), 74% white (N=649), and 13% Hispanic (N=113). At baseline, 577 (66%) participants had suicidal ideation only, whereas 297 (34%) had a suicide attempt in the past week. Data sufficient to determine outcomes were available for 782 (90%). In the 12 months after the index ED visit, 195 (25%) had documentation of at least one suicide attempt or suicide. High school education or less, an ED visit in the preceding six months, prior nonsuicidal self-injury, current alcohol misuse, and suicidal intent or plan were predictive of future suicidal behavior. Conclusions: Continuing to build an understanding of the factors associated with future suicidal behaviors for this population will help guide design and implementation of improved suicide screening and interventions in the ED and better allocation of scarce resources.
Keywords: adult; age; alcohol abuse; anxiety disorder; army; article; attention deficit disorder; automutilation; bipolar disorder; bisexuality; Brief Symptom Inventory; Caucasian; cerebrovascular accident; chronic pain; cohabitation; death; depression; diabetes mellitus; drug misuse; eating disorder; educational status; Emergency Department Safety Assessment and Follow up Evaluation; emergency ward; female; follow up; gender; health care utilization; health status; heart infarction; heterosexuality; Hispanic; homosexual female; homosexual male; human; Human immunodeficiency virus infection; major clinical study; male; married person; medical documentation; medical history; medical record review; mental disease assessment; mental health; mental patient; neoplasm; outcome assessment; quality of life; risk assessment; risk factor; schizophrenia; somatization; substance use; suicidal behavior; suicidal ideation; suicide; suicide attempt; telephone interview; time series analysis; toxicity assay; unemployment; United States; violence

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

A Minority Stress Model for Suicidal Ideation in Gay Men - Michaels, M.S.; Parent, M.C.; Torrey, C.L. (Suicide & life-threatening behavior, 2016)
There is a dearth of research on mechanisms underlying higher rates of suicidal ideation among gay men compared to heterosexual men. The purpose of this study was to establish the link between social/psychological predictor variables and suicidal ideation by testing a hypothesized minority stress model. Structural equation modeling was used to assess the relationships posited in the model using data from a community sample of 167 gay men. Model fit was adequate and hypothesized relationships were partially supported. Also, depressive symptoms partially mediated the relationship between (less) outness predicting suicidal ideation. These findings imply that therapeutic approaches targeting the coming out process may be more effective than approaches targeting internalized homophobia when suicidal ideation is indicated in the clinical presentation of gay and bisexual men.
Keywords: adult; aged; depression; human; male; male homosexuality; mental stress; middle aged; minority group; psychological model; psychology; statistics and numerical data; suicidal ideation; young adult

Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study - Tomori, C.; McFall, A.M.; Srikrishnan, A.K.; Mehta, S.H.; Solomon, S.S.; Anand, S.; Vasudevan, C.K.; Solomon, S.; Celentano, D.D. (AIDS and behavior, 2016)
Poor psychosocial health contributes to HIV risk behavior and reduced engagement in treatment and care. This study investigates depression and its correlates among 11,992 MSM recruited via respondent driven sampling in 12 cities across India using the Patient Health Questionnaire-9 and supplemented by analysis of qualitative research from 15 sites with 363 MSM. Overall prevalence of depression was 11 %, with substantial variation across sites and subgroups of MSM, and high prevalence of suicidal thoughts among depressed MSM. In multivariable analyses identification as a kothi (feminine sexual identity) [adjusted odds ratio (aOR) = 1.91], disclosure of being MSM to non-family (aOR = 1.7) and family (aOR = 2.4), disclosure of HIV-status (aOR = 5.6), and substance use were associated with significantly higher odds of depression. Qualitative results emphasized dire social consequences of disclosing MSM- and HIV-status, especially to family, including suicidality. Combination prevention interventions should include mental health services that address disclosure, suicidality, and substance use.
Keywords: adolescent; adult; cross-sectional study; depression; ethnology; human; Human immunodeficiency virus infection; India; interpersonal communication; male; male homosexuality; middle aged; multivariate analysis; prevalence; psychology; qualitative research; questionnaire; social stigma; social support; drug dependence; suicide; urban population; young adult

Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature - Marshall, E.; Claes, L.; Bouman, W.P.; Witcomb, G.L.; Arcelus, J. (International Review of Psychiatry, 2016)
Literature has described high levels of mental health problems among trans people, such as depression, resulting in increased levels of non-suicidal self-injury (NSSI) behaviour and suicidality (suicidal thoughts, suicide attempts and suicide rates). With the aim of systematically reviewing the available literature in this field, this study identifies 31 papers that explore the rates of NSSI and suicidality in trans people. From reviewing the literature, it was revealed that trans people have a higher prevalence of NSSI and suicidality compared to the cisgender (non-trans) population. There appear to be some gender differences within these rates, with trans men at a greater risk for NSSI behaviour. Prevalence rates differ depending on the different stages of transition, but they are still overall greater than the cisgender population. The study concludes that trans individuals are at a greater risk of NSSI behaviour and suicidality than the cisgender population, and discusses risk factors and the need to develop effective preventative interventions.
Keywords: article; automutilation; depression; dysphoria; Embase; human; information retrieval; Medline; prevalence; primary prevention; priority journal; PsycINFO; risk factor; sex difference; suicidal behavior; suicidal ideation; suicide attempt; systematic review; transgender; transsexualism

Perceived racial, sexual identity, and homeless status-related discrimination among black adolescents and young adults experiencing homelessness: Relations with depressive symptoms and suicidality - Gattis, M.N.; Larson, A. (American Journal of Orthopsychiatry, 2016)
There is a dearth of empirical evidence that addresses how racial minority, sexual minority, and homeless statuses, with their accompanying experiences of stigma and discrimination, are related to mental health in adolescent and young adult populations. The current study addresses this gap by examining the associations between multiple forms of discrimination, depressive symptoms, and suicidality in a sample of 89 Black adolescents and young adults (52% female; 47% nonheterosexual, ages 16-24) experiencing homelessness. Results from a series of ordinary least squares and logistic regressions suggested that perceived homelessness stigma and racial discrimination were associated with higher levels of depressive symptoms, controlling for gender, age, and other types of discrimination, while perceived sexual identity discrimination showed no association. Having ever spent a homeless night on the street, an indicator of homelessness severity, accounted for a substantial amount of the association between homelessness stigma and depressive symptoms. In contrast, suicidality was not significantly associated with any measure of discrimination, homelessness severity, or personal characteristics. We also found no indication that the associations between perceived discrimination targeted at racial and homelessness statuses and mental health differed by sexual minority status. Our results suggest that depressive symptoms and suicidality are prevalent among Black homeless youth, and that depressive symptoms are particularly associated with racial discrimination and indicators of homelessness. The roles of discrimination and a lack of safe housing may be taken into account when designing programs and policies that address the mental health of Black adolescents and young adults experiencing homelessness.
Keywords: adolescent; adult; article; depression; female; homelessness; homophobia; human; male; racism; sexual and gender minority; sexual orientation; social discrimination; social stigma; suicidal behavior; suicidal ideation; suicide attempt; young adult

'The darkest times of my life': Recollections of child abuse among forced migrants persecuted because of their sexual orientation and gender identity - Alessi, E.J.; Kahn, S.; Chatterji, S. (Child Abuse and Neglect, 2016)
Numerous studies demonstrate that lesbian, gay, bisexual, and transgender (LGBT) children and youth are likely to experience abuse by peers, parents, and other adults and that these experiences correlate with a host of mental health problems. However, there is little understanding of the experiences of LGBT children and youth living in countries where social and legal protections for sexual and gender minorities are limited or nonexistent. This qualitative study used thematic analysis to explore the child and adolescent abuse experiences and their impact on the pre-migration mental health of LGBT forced migrants. We analyzed 26 interviews with individuals who obtained refugee or asylee status in the United States or Canada on the basis of sexual orientation or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: abuse by parents and caregivers, abuse by peers and school personnel, having nowhere to turn, and dealing with psychological distress. Findings indicate that participants experienced severe verbal, physical, and sexual abuse throughout childhood and adolescence and that this abuse occurred at home, in school, and in the community. Furthermore, there were no resources or sources of protection available to them. Participants linked their abuse to subjective experiences of depression, anxiety, and traumatic stress, as well as suicidal ideation and suicide attempts. We conclude with implications for refugee adjudication practices, mental health care, and international policy.
Keywords: administrative personnel; adolescent abuse; adult; Africa; anxiety; article; Asia; asylum seeker; Canada; caregiver; Caribbean; child; child abuse; depression; distress syndrome; domestic violence; Eastern Europe; female; gender identity; human; interview; LGBT people; male; mental health; Middle East; migrant; parent; peer group; physical abuse; posttraumatic stress disorder; qualitative research; refugee; sexual abuse; sexual orientation; South and Central America; suicidal ideation; suicide attempt; thematic analysis; United States; verbal hostility; young adult

School-Based Protective Factors Related to Suicide for Lesbian, Gay, and Bisexual Adolescents - Whitaker, K.; Shapiro, V.B.; Shields, J.P. (Journal of Adolescent Health, 2016)
Purpose Research indicates that lesbian, gay, and bisexual (LGB) adolescents are three times more likely to consider suicide than their heterosexual peers. Although research has identified risk factors for suicide among this population, little is known about school-level protective factors among this population, which may buffer the impact of risk.This study aims to understand whether school-based protective factors (e.g., school safety, relationships with caring adults at school, school connectedness) are associated with decreased suicidal ideation for LGB adolescents. Methods Logistic regression analyses were conducted on the data generated by the San Francisco Unified School District's 2011 California Healthy Kids Survey to examine the influence of protective factors related to suicidal ideation for LGB adolescents (n = 356). Results Results indicated that higher levels of school connectedness predicted less suicidal ideation (odds ratio =.59, p =. 005). Conclusions This study provided evidence that school protective factors were related to reduced suicidal ideation for LGB adolescents, controlling for risk factors and demographic variables.
Keywords: adolescent; article; female; heterosexuality; human; LGBT people; male; priority journal; protection; risk factor; school; suicidal ideation; suicide; United States

Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course - Blosnich, J.R.; Nasuti, L.J.; Mays, V.M.; Cochran, S.D. (American Journal of Orthopsychiatry, 2016)
This investigation explored suicide-related characteristics and help-seeking behavior by sexual orientation. Population-based data are from the California Quality of Life Surveys, which included 1,478 sexual minority (lesbian, gay, bisexual, and homosexually experienced individuals) and 3,465 heterosexual individuals. Bisexual women had a nearly six-fold increased risk of lifetime suicide attempts than heterosexual women (RR = 5.88, 95%CI: 3.89-8.90), and homosexually experienced men had almost 7 times higher risk of lifetime suicide attempts than heterosexual men (RR = 6.93, 95%CI: 3.65-13.15). Sexual minority men and women were more likely than heterosexual men and women to have disclosed suicide attempts to a medical professional (RR = 1.48 and RR = 1.44, respectively). Among persons who ever attempted suicide, sexual minority women had a younger age of index attempt than heterosexual women (15.9 vs. 19.6 years of age, respectively). Healthcare professionals should be aware of suicidal risk heterogeneity among sexual minority individuals, including vulnerable points of risk and evidenced-based treatments.
Keywords: adolescent; adult; age distribution; article; bisexual female; controlled study; disease severity; exploratory research; female; health care personnel; health survey; help seeking behavior; heterosexual female; heterosexual male; high risk population; homosexual female; homosexual male; human; interpersonal communication; lifespan; major clinical study; male; population research; sex difference; sexual and gender minority; sexual orientation; suicidal behavior; suicide attempt; symptom; United States

Short duration response-guided treatment is effective for most individuals with recent hepatitis C infection: The ATAHC II and DARE-C i studies - Martinello, M.; Hellard, M.; Shaw, D.; Petoumenos, K.; Applegate, T.; Grebely, J.; Yeung, B.; Maire, L.; Iser, D.; Lloyd, A.; Thompson, A.; Sasadeusz, J.; et al. (Antiviral Therapy, 2016)
Background: Individuals with recent HCV infection may beneit from shortened duration therapy. These studies evaluated the eficacy and safety of response-guided regimens with pegylated interferon-α2a and ribavirin for people with recent HCV infection. Methods: Participants with recent hepatitis C (duration of infection ≤18 months) enrolled in the ATAHC II (pegylated interferon-α2a ± ribavirin) and DARE-C I (pegylated interferon- α2a, ribavirin and telaprevir) studies were included for analysis. Treatment duration was response-guided (ATAHC II: 8, 16, 24 or 48 weeks; DARE-C I: 8, 12 or 24 weeks) and dependent on time to irst undetectable HCV RNA using Roche Taqman HCV RNA testing. The primary eficacy end point was sustained virological response at 12 weeks (SVR12) by intention-to-treat. Logistic regression analyses were used to identify predictors of SVR. Results: A total of 82 participants (62% HIV-positive) were enrolled in ATAHC II (treated, n=52) and 14 (79% HIV-positive) in DARE-C I. The predominant modes of HCV acquisition were injecting drug use (ATAHC II 55%, DARE-C I 36%) and sexual intercourse with a partner of the same sex (ATAHC II 39%, DARE-C I 64%). SVR12 was 71% in both ATAHC II (37/52) and DARE-C I (10/14) with 56% in ATAHC II receiving shortened therapy (8 or 16 weeks). SVR was associated with a rapid virological response (odds ratio 10.80; P=0.001). Conclusions: The majority of participants were able to receive short duration response-guided therapy with pegylated interferon-α2a and ribavirin. Response-guided therapy for recent hepatitis C infection could be considered in the absence of available interferon-free therapies.
Keywords: NCT01336010; NCT01743521; efavirenz; peginterferon alpha2a; ribavirin; telaprevir; virus RNA; abscess; adult; anemia; antiviral therapy; anxiety disorder; article; axillary abscess; axillary abscess; clinical effectiveness; controlled study; disease duration; drug dose reduction; drug efficacy; drug response; drug safety; lack of drug effect; fatigue; female; hepatitis C; human; Human immunodeficiency virus infection; intravenous drug abuse; major clinical study; male; mixed infection; neutropenia; patient compliance; priority journal; prospective study; rash; reinfection; sexual behavior; short duration response guided treatement; sialolithiasis; skin carcinoma; suicide attempt; treatment duration; virus transmission

Gender Dysphoria and Social Anxiety: An Exploratory Study in Spain - Bergero-Miguel, T.; García-Encinas, M.A.; Villena-Jimena, A.; Pérez-Costillas, L.; Sánchez-Álvarez, N.; de Diego-Otero, Y.; Guzman-Parra, J. (Journal of Sexual Medicine, 2016)
Introduction Social anxiety in gender dysphoria is still under investigation. Aim To determine the prevalence and associated factors of social anxiety in a sample of individuals with gender dysphoria. Methods A cross-sectional design was used in a clinical sample attending a public gender identity unit in Spain. The sample consisted of 210 individuals (48% trans female and 52% trans male). Main outcome measures Mini-International Neuropsychiatric Interview (MINI) for diagnosis of social anxiety disorder, Structured Clinical Interview, Exposure to Violence Questionnaire (EVQ), Beck Depression Inventory (BDI-II), and Functional Social Support Questionnaire (Duke-UNC-11). Results Of the total sample, 31.4% had social anxiety disorder. Social anxiety disorder was highly correlated with age (r = −0.181; CI = 0.061–0.264; P =.009) and depression (r = 0.345; CI = 0.213–0.468; P < .001); it is strongly associated to current cannabis use (relative risk [RR] = 1.251; CI = 1.070–1.463; P =.001) and lifetime suicidal ideation (RR = 1.902; CI 1.286–2.814; P <.001). Moreover, it is significantly associated to lifetime nonsuicidal self-injury (RR = 1.188; CI 1.018–1.386; P =.011), nationality (RR = 7.792; CI 1.059–57.392; P =.013), perceived violence at school during childhood and adolescence (r = 0.169; CI = 0.036–0.303; P =.014), unemployment (RR = 1.333; CI 1.02–1.742; P =.021), and hospitalization of parents in childhood (RR = 1.146; CI = 1.003–4.419; P =.046). Using multivariable analysis, the highly significant variables within the model were depression score (odds ratio [OR] = 1.083; CI = 1.045–1.123; P <.001) and current cannabis use (OR = 3.873; CI = 1.534–9.779, P =.004), also age (OR = 0.948; CI = 0.909–0.989; P =.012), hospitalization of parents during childhood (OR = 2.618; CI = 1.107–6.189; P =.028), and nationality (OR = 9.427; CI = 1.065–83.457; P =.044) were associated with social anxiety disorder. Conclusion This study highlights the necessity of implementing actions to prevent and treat social anxiety in this high-risk population.
Keywords: adolescent; adult; age; article; automutilation; Beck Depression Inventory; cannabis use; controlled study; correlation analysis; cross-sectional study; depression; exploratory research; Exposure to Violence Questionnaire; female; Functional Social Support Questionnaire; gender dysphoria; hospitalization; human; major clinical study; male; mini international neuropsychiatric interview; multivariate analysis; prevalence; priority journal; questionnaire; social phobia; Spain; Spaniard; structured interview; suicidal ideation; unemployment; violence

“Live chat” clients at kids help phone: Individual characteristics and problem topics - Haner, D.; Pepler, D. (Journal of the Canadian Academy of Child and Adolescent Psychiatry, 2016)
Objective: Young people in Canada prefer to use the Internet over face-to-face contact when seeking help for problems of daily living and mental health problems. Kids Help Phone (KHP) provides on-demand, anonymous help to young people via telephone and Live Chat technologies. Methods: Two hundred thirty-two phone clients and 230 Live Chat clients responded to a questionnaire at this otherwise anonymous service, providing previously inaccessible data about their individual characteristics and characterizations of the problems for which they sought help. Results: There was a larger proportion of weighty problems (mental health and suicide) among chatters than callers. There were also more non-heterosexual youth, and those who identified as Asian and Black African or Caribbean, using Live Chat than phone. Conclusions: Implications for training Live Chat counsellors to respond effectively to chatters are discussed.
Keywords: adolescent; African; anxiety; article; Asian; Canada; Caribbean; child; client server application; counseling; daily life activity; family relation; female; help seeking behavior; human; human relation; Internet; interpersonal communication; male; mental disease; mental health; mood; questionnaire; social problem; suicide; telephone