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

Suicide Risk for Sexual Minorities in Middle and Older Age: Evidence From the National Survey on Drug Use and Health - Capistrant, B.D.; Nakash, O. (American Journal of Geriatric Psychiatry, 2019)
Objective: No studies have estimated the difference in suicidal ideation, plans, and attempts for lesbian, gay, or bisexual (LGB) adults aged 50+ compared with heterosexuals using nationally representative data. Methods: We used 2015–2017 National Survey on Drug Use and Health data to estimate the prevalence of self-reported suicidal ideation, plans, and attempts for LGB adults 50+ compared with heterosexuals in the preceding 12 months. Results: Over 185,000 LGB adults aged 50+ in the United States were estimated to have had suicidal ideation in the preceding year. After adjusting for sex and race/ethnicity, LGB individuals aged 50+ had a 4.5 percentage point higher prevalence of suicidal ideation compared with heterosexuals (prevalence difference [PD]: 0.045; 95% confidence interval [CI]: 0.022, 0.067). Of those with suicidal ideation, LGB individuals aged 50+ had a 17.2 percentage point higher prevalence of suicide plans compared with heterosexuals (PD: 0.172; 95% CI: 0.011, 0.332). Conclusion: LGB adults in middle and older age have higher suicidal ideation and plans than heterosexual peers.
Keywords: adult; aged; article; drug use; ethnicity; female; groups by age; health survey; heterosexuality; human; LGBT people; major clinical study; male; middle aged; planning; prevalence; race; risk; self report; sexual and gender minority; suicidal ideation; suicide; United States

Examining the association between prescription opioid misuse and suicidal behaviors among adolescent high school students in the United States - Baiden, P.; Graaf, G.; Zaami, M.; Acolatse, C.K.; Adeku, Y. (Journal of Psychiatric Research, 2019)
Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few studies have examined the effects of prescription opioid misuse on suicidal behaviors among adolescents. The objective of this study was to examine the association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 8830 adolescents aged 14–18 years (50.9% female) were analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and prescription opioid misuse as the main explanatory variable. Of the 8830 adolescents, 13.3% ever misused prescription opioids; 17.7% experienced suicidal ideation, 13.3% made a suicide plan, and 6.5% attempted suicide during the past 12 months. In the multivariate logistic regression models, adolescent students who misused prescription opioids were 1.50 times more likely to have experienced suicidal ideation, 1.44 times more likely to have made a suicide plan, and 1.58 times more likely to have attempted suicide during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant predictors of suicidal behaviors include sexual minority, history of sexual assault, traditional bullying and cyberbullying victimization, feeling sad or hopeless, cigarette smoking, and illicit drug use. The findings of the present study demonstrate the harmful effects of prescription opioid misuse and its association with suicidal behaviors among adolescents.
Keywords: cannabis; codeine; hydrocodone; hydrocodone bitartrate plus paracetamol; illicit drug; opiate; oxycodone; oxycodone plus paracetamol; adolescence; adolescent; adult; African American; American Indian; article; binge drinking; bisexuality; bullying; cannabis use; cigarette smoking; cyberbullying; drug misuse; ethnicity; female; heterosexuality; high school student; homosexual female; homosexual male; human; major clinical study; male; Native Hawaiian; Pacific Islander; prescription; priority journal; receiver operating characteristic; sexual and gender minority; sexual assault; suicidal behavior; suicidal ideation; suicide attempt; United States; young adult

Sexual orientation, suicide ideation and suicide attempt: A population-based study - Nystedt, T.; Rosvall, M.; Lindström, M. (Psychiatry Research, 2019)
The aim is to investigate associations between sexual orientation and experience of suicide thoughts and suicide attempts. The 2012 public health survey in Scania, southern Sweden, is a cross-sectional population-based study including 28,029 participants aged 18–80 with 51.7% participation. The associations between sexual orientation and experience of suicide thoughts and attempts were investigated in multiple logistic regressions. A 8.2% proportion of men and 11.3% of women reported suicide thoughts more than a year ago, and 4.0% of men 4.1% of women had experienced such thoughts during the past year. A 2.6% proportion of men and 4.6% of women reported suicide attempt more than a year ago, and 0.6% of men and 0.7% of women during the past year. In the age- and multiple adjusted models, bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide thoughts than heterosexual men and women. Bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide attempt than heterosexual men and women. After multiple adjustments these patterns largely remained. The results indicate that bisexual men and women and homosexual men have an increased risk of experience of suicide thoughts and suicide attempt.
Keywords: adult; aged; article; bisexual female; bisexual male; cross-sectional study; disease association; economic recession; female; health survey; heterosexual female; heterosexual male; homosexual male; human; major clinical study; male; middle aged; personal experience; physical activity; population research; priority journal; psychological aspect; risk assessment; sex difference; sexual orientation; social status; suicidal behavior; suicidal ideation; suicide attempt; Sweden; young adult

Penile Reconstruction and the Role of Surgery in Gender Dysphoria - Lee, W.G.; Christopher, N.; Ralph, D.J. (European Urology Focus, 2019)
Gender dysphoria is the distress that occurs when there is a mismatch between birth-assigned gender and expressed gender. Penile reconstruction may ameliorate the risk of suicide due to mental illness, social harassment, and isolation commonly experienced by these individuals. The ideal aim is to allow micturition while standing and penetrative intercourse with full sensation, but there is no universal agreement on the ideal flap design. Contemporary options for penile reconstruction include metoidioplasty and phalloplasty using either a pedicled or free flap. The most common flap currently performed is the radial artery forearm free flap. Secondary procedures following phalloplasty may include glansplasty, scrotoplasty, and insertion of penile and testicular prostheses. Patient summary: Penile reconstruction is offered to transgender men as part of their transition from female to male. Penile reconstruction may ameliorate the high risk of suicide due to mental illness, social harassment, and isolation commonly experienced by these individuals. Many techniques can be used for penile reconstruction with good outcomes, but none can fully satisfy all the needs of individuals seeking penile reconstruction. The risk of suicide and mental illness from gender dysphoria is ameliorated by penile reconstruction. The goals are to allow micturition while standing and penetrative intercourse with full sensation. There is no gold standard for penile reconstruction.
Keywords: penis prosthesis; testis prosthesis; article; female to male transgender; free tissue graft; gender dysphoria; glansplasty; harassment; high risk population; human; male genital system surgery; mental disease; metoidioplasty; micturition; penetrative sex; penile reconstruction; peroperative complication; phalloplasty; postoperative complication; radial artery; radial forearm flap; scrotoplasty; sensation; social isolation; suicide; treatment outcome

Autoerotic asphyxia using a plastic bag loosely covering the head over a gas mask - Idota, N.; Nakamura, M.; Tsuboi, H.; Ichioka, H.; Shintani-Ishida, K.; Ikegaya, H. (Legal Medicine, 2019)
Autoerotic death is defined as the accidental death of an individual while masturbating, caused by a device or material used to enhance the sexual response. Here we report an autopsy case of autoerotic death and review the literature. A healthy, single, 33-year-old Japanese male was found dead in his room in a prone position. He was wearing a used gas mask and a plastic bag over his head; the opening of that bag was loosely secured around the neck with a belt. He had no underwear beneath his upper and lower work clothes and the zipper of his pants was open. Adult magazines and DVDs featuring male subjects and other adult toys were found in his room. Images of people wearing gas masks and rubber suits, as well as of individuals whose whole bodies were tied with ropes, were discovered on his personal computer. Records of purchasing full-body tights were also found. Lesions and injuries that could have caused his death were not found in the autopsy or in any of the various examinations. The cause of death was determined to be suffocation assumed to be caused by the plastic bag covering the mask's ventilation. Suicide and homicide were ruled out based on the police investigation of the scene of the victim's death and the attendant circumstances and environment. The death was thus determined to be an accident. We see no major differences in the feature of autoerotic death between Japanese cases and those in the Western countries.
Keywords: electrical equipment; gas mask; general device; personal computer; plastic bag; alcohol; helium; plastic; rubber; accidental death; adult; air conditioning; article; autopsy; beer; cause of death; exhibitionism; histopathology; homicide; homosexuality; human; human tissue; livor mortis; lung congestion; male; medical history; panic; prone position; purchasing; resistance training; saliva; sexual asphyxia; sexual behavior; suffocation; suicide attempt; workplace

Cyberbullying in Academic Medicine: A Framework for Managing Social Media Attacks - Cain, J.; Linos, E.; Chretien, K.C. (Academic medicine : journal of the Association of American Medical Colleges, 2019)
Criticism, scathing comments, and harassment are becoming more common elements of social media discourse. Recent coordinated public attacks directed at higher education faculty illustrate these troubling trends. In several cases, these attacks have been politically motivated by participants who disagree with a faculty member's statements regarding sensitive subjects. Whereas most high-profile cases have included faculty teaching at the undergraduate level who use social media to promote scholarly discussion, medical school faculty may also be at risk, especially if their scholarly pursuits pertain to politically charged issues (e.g., race and diversity, firearms, vaccinations, the health of transgender populations). In today's digital environment of cellphone recordings, forwarded e-mails, and open-access manuscripts, any faculty member who discusses or engages in scholarship of politically sensitive issues on- or offline may be at risk. In this Invited Commentary, the authors discuss the multifaceted problem of cyberbullying of medical school faculty and provide recommendations to faculty and administrators about how to mitigate and manage these situations.
Keywords: adult; female; human; male; medical school; medical student; middle aged; practice guideline; prevention and control; psychology; social media; young adult

The Need and Desire for Mental Health and Substance Use-Related Services Among Clients of Publicly Funded Sexually Transmitted Infection Clinics in Vancouver, Canada - Salway, T.; Ferlatte, O.; Shoveller, J.; Purdie, A.; Grennan, T.; Tan, D.H.S.; Consolacion, T.; Rich, A.J.; Dove, N.; Samji, H.; Scott, K.; Blackwell, E.; et al. (Journal of public health management and practice : JPHMP, 2019)
CONTEXT: Sexually transmitted infections (STI) and mental health and substance use (MHSU) disorders all occur at elevated rates in sexual and gender minorities. These overlapping epidemics, or syndemics, are exacerbated by challenges these same populations face in accessing sexual/gender minority-affirming services. Many publicly funded STI clinics are a low barrier and provide sexual minority-competent care. These sites therefore may be uniquely situated to address clients' MHSU-related needs. OBJECTIVE: We characterize the need and desire for MHSU services among STI clinic clients. DESIGN, SETTING, PARTICIPANTS: We conducted a waiting room survey at 6 STI clinics in Metro Vancouver, Canada. MAIN OUTCOME MEASURES: We calculated the proportion of clients with self-reported unmet MHSU needs in the previous 12 months and, among these clients, barriers to accessing MHSU services and desire for MHSU services within the STI clinic. We also examined social disparities in barriers to accessing MHSU services. RESULTS: Among 1115 respondents-65% of whom were sexual minorities-39% reported a recent need for MHSU-related care, most frequently in relation to anxiety (29%), depression (26%), substance use (10%), or suicide ideation (7%). Seventy-two percent of this group had not yet talked to a provider about their concern. Common barriers included shame (26%) and inability to afford the service (24%). Eighty-three percent of clients with unmet MHSU needs indicated that they were comfortable discussing MHSU concerns with an STI clinic provider, and 94% expressed desire to receive MHSU assessments, referrals, or counseling in the STI clinic. Sexual and gender minorities and those attending a suburban clinic were more likely to report barriers to accessing MHSU services. CONCLUSIONS: More than a quarter of STI clinic clients report unmet MHSU health care needs; moreover, these clients report high levels of comfort with and desire to discuss MHSU concerns with STI clinic providers. Sexually transmitted infections clinics are thus opportune sites for syndemic service integration.
Keywords: adolescent; adult; aged; British Columbia; Canada; drug dependence; female; health service; human; male; mental health service; middle aged; organization and management; outpatient department; psychology; questionnaire; sexually transmitted disease

Racial/Ethnic Differences in Mental Health, Substance Use, and Bullying Victimization Among Self-Identified Bisexual High School-Aged Youth - Feinstein, B.A.; Turner, B.C.; Beach, L.B.; Korpak, A.K.; Phillips, G. (LGBT health, 2019)
Purpose: Sexual minority youth are at increased risk for mental health problems and substance use, and accumulating evidence indicates that bisexual youth are at greatest risk. However, bisexual youth are not a homogenous group and scholars have called for greater attention to the intersections of multiple marginalized identities. As such, we examined racial/ethnic differences in mental health (sadness/hopelessness and suicidal ideation), substance use (cigarette use, binge drinking, marijuana use, and other illicit drug use), and bullying (in-person and electronic) among self-identified bisexual high school-aged youth (overall and by sex). Method: Data from the local versions of the Youth Risk Behavior Survey were pooled across jurisdictions and years (2011-2015), resulting in an analytic sample of 18,515 bisexual youth who were racially/ethnically diverse. Results: Black and Hispanic bisexual youth were less likely to report in-person and electronic bullying than White bisexual youth. In addition, Black bisexual youth were less likely to report sadness/hopelessness and suicidal ideation than White, Hispanic, and Other race/ethnicity bisexual youth. Black bisexual female youth were also less likely to report cigarette use, binge drinking, and other illicit drug use than White bisexual female youth. In contrast to most of our findings, Black bisexual youth were more likely to report marijuana use than White bisexual youth. Most of the significant racial/ethnic differences in mental health and substance use remained significant after controlling for bullying. Conclusion: These findings highlight the heterogeneity of bisexual youth and the need to consider multiple marginalized identities to understand the health disparities affecting this diverse population.
Keywords: adolescent; ancestry group; bullying; drug dependence; ethnic group; female; human; male; mental health; questionnaire; school; sexual and gender minority

Estimating the Magnitude of the Relation Between Bullying, E-Bullying, and Suicidal Behaviors Among United States Youth, 2015 - Kuehn, K.S.; Wagner, A.; Velloza, J. (Crisis, 2019)
Background: Suicide is the second leading cause of death among US adolescents aged 12-19 years. Researchers would benefit from a better understanding of the direct effects of bullying and e-bullying on adolescent suicide to inform intervention work. Aims: To explore the direct and indirect effects of bullying and e-bullying on adolescent suicide attempts (SAs) and to estimate the magnitude of these effects controlling for significant covariates. Method: This study uses data from the 2015 Youth Risk Behavior Surveillance Survey (YRBS), a nationally representative sample of US high school youth. We quantified the association between bullying and the likelihood of SA, after adjusting for covariates (i.e., sexual orientation, obesity, sleep, etc.) identified with the PC algorithm. Results: Bullying and e-bullying were significantly associated with SA in logistic regression analyses. Bullying had an estimated average causal effect (ACE) of 2.46%, while e-bullying had an ACE of 4.16%. Limitations: Data are cross-sectional and temporal precedence is not known. Conclusion: These findings highlight the strong association between bullying, e-bullying, and SA.
Keywords: academic achievement; adolescent; African American; age; bullying; Caucasian; depression; ethnic group; female; Hispanic; human; male; sex factor; sexual and gender minority; sexual crime; sleep; suicide attempt; United States

Is There a Need for LGBT-Specific Suicide Crisis Services? - Goldbach, J.T.; Rhoades, H.; Green, D.; Fulginiti, A.; Marshal, M.P. (Crisis, 2019)
Background: Lesbian, gay, bisexual, and transgender (LGBT) youth are more than twice as likely to attempt suicide than their peers. Although LGBT-specific crisis services have been developed, little is known about the need for these services beyond that of general lifeline services. Aims: The present study sought to (a) describe the primary reasons for calling a specialized provider as opposed to another and (b) examine sociodemographic differences in the primary reason by race, ethnicity, gender, age, and sexual orientation. Method: Data from 657 youth who sought crisis services from an LGBT-specific national service provider in the United States were assessed. Logistic regression models assessed demographic differences. Thematic analysis of open-ended responses regarding reasons for choosing this LGBT-specific crisis service provider followed a consensus model. Results: Most respondents indicated they either would not have contacted another helpline (26%) or were not sure (48%). Nearly half (42%) indicated they called specifically because of LGBT-affirming counselors, a reason more commonly reported by gender minority (transgender and gender nonbinary) and queer or pansexual youth than cisgender, gay, or lesbian youth. Conclusion: LGBT-specific crisis services appear to play an important role in suicide prevention. Further research is needed to understand the use of culturally tailored suicide prevention approaches.
Keywords: adolescent; child; female; hotline; human; male; mental health service; sexual and gender minority; suicide; young adult

A heuristic inquiry on the role of person-environment interaction in suicide risk among transgender youth - Chang, B.; Delaney, K. (Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 2019)
Elevated levels of suicide risk among transgender youth have alarmed both public health officials and researchers from various disciplines. Despite nursing's robust involvement in suicide research, literature reviews indicate a lack of nursing research focused on suicide among transgender youth. Most of the existing literature pertain to predictive factors in either the individual or environmental domain. There is limited research examining how interactions with the environment in of itself might be a predictive factor. This paper treats the subject of suicide risk among transgender youth with a heuristic inquiry into person-environment interaction. The Society to Cell Resiliency Framework and Social Self Preservation Model were used to inform exploration of how person-environment interactions might be associated with suicide risk. Implications of this framework will be discussed in terms of how it may affect advancements in nursing education, practice, and research with transgender youth.
Keywords: adolescent; adult; heuristics; human; psychological model; risk assessment; social environment; suicide; transgender; young adult

Intimate Partner Violence, Suicide, and Their Overlapping Risk in Women Veterans: A Review of the Literature - Iovine-Wong, P.E.; Nichols-Hadeed, C.; Thompson Stone, J.; Gamble, S.; Cross, W.; Cerulli, C.; Levandowski, B.A. (Military medicine, 2019)
INTRODUCTION: Suicidal thoughts and behaviors (STB) and intimate partner violence (IPV) are both serious and prevalent problems in the Veteran population that often occur in tandem, particularly among women Veterans. Women Veterans, the fastest growing segment of the Veteran population, may have unique overlapping risks that are worth exploring. Although the intersection of IPV and STB is well documented in the civilian population, it has not been thoroughly explored in women Veterans. MATERIALS AND METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we conducted a systematic review of the STB and IPV literature specifically related to women Veterans. We only included articles that sampled women Veterans, rather than active duty/reservist/National Guard women; due to the small volume of STB research using samples of only women Veterans, we included studies that used mixed-gender samples. We extracted risk factors for STB and/or IPV involvement from 56 selected articles and placed them into tables for comparison to determine commonalities. RESULTS: Common risk factors fell into three categories: socio-demographic risk factors (young age, unemployment, and sexual minority status) were significant across both bodies of literature; mental health risk factors (general psychopathology, post-traumatic stress disorder (PTSD), depression, sleep disturbance, and substance use/abuse) also had significant overlap; and military service-related risk factors (military sexual trauma (MST) and deployment factors) were also relevant across both bodies of literature. Mental health risk factors, particularly PTSD, were the most common. CONCLUSION: Frequently, the risk factors for IPV and STB are shared and it is important to consider how research, screening and intervention efforts for these serious problems might be integrated. Our exploration of the literature may be used as a basis for future research with women Veterans on the intersection of STB and IPV. Further, Veterans Health Administration clinicians should be aware of these intersecting risk factors to enhance care and improve screening for both issues in women Veteran clients.
Keywords: adolescent; adult; female; human; middle aged; partner violence; prevalence; psychology; risk factor; suicide; veteran

Transgender Dependent Adolescents in the U.S. Military Health Care System: Demographics, Treatments Sought, and Health Care Service Utilization - Van Donge, N.; Schvey, N.A.; Roberts, T.A.; Klein, D.A. (Military medicine, 2019)
INTRODUCTION: Transgender and gender-diverse (TGD) youth are at greater risk for mental health and medical conditions than their cisgender peers; however, poor health outcomes and identity-based discrimination can be minimized in the context of optimal support. Approximately 1.7 million youth may be eligible for care covered by the Military Health System, which includes mental health and gender-affirming medications. The purpose of the current study is to identify sociodemographic characteristics, the psychosocial and behavioral risk profile, and health care utilization patterns of TGD dependent youth cared for in the U.S. military system to inform provider training and resource allocation. MATERIALS AND METHODS: We performed a retrospective chart review by searching all medical records between July 1, 2014 and July 1, 2017 for diagnoses suggesting visits for TGD-services at a regional referral-based adolescent medicine clinic which cares for dependent children of active duty, activated selected reserve, and retired military service members between the ages of 9 and 24 years for a wide range of health care needs. RESULTS: Fifty-three participants were included in this study. Sixty-four percent reported a transmasculine identity, 21% a transfeminine identity, and 15% a non-binary or undecided identity. The mean age at first gender-related visit was 14.5 years (SD 3.2). The mean number of primary care physicians and specialists seen by a given individual in a military treatment facility for any visit type since the implementation of the medical record system in 2005 was 12 (SD 6.8) and 10.2 (SD 7.8), respectively. Thirty-three percent of all patients assigned as female at birth were on testosterone therapy and 23% of all patients assigned as male at birth were on estrogen therapy at their most recent clinic visit. Twelve patients were undergoing pubertal suppression with an injectable or implantable gonadotropin-releasing hormone agonist. Seventy percent reported a history of suicidal ideation, 42% self-harm, 21% at least one suicide attempt, and 33% psychiatric hospitalization. Having strongly supportive parents was significantly associated with recognizing, disclosing and seeking treatment for gender nonconformity at an earlier age (ps ≤ 0.03) and marginally associated with less likelihood of current suicidal ideation (p = 0.06) compared to those with less supportive parents. CONCLUSIONS: This study elucidated the sociodemographic and behavioral risk profile of a sample of TGD youth in the MHS. Military and non-military health care providers across a broad spectrum of specialties should be knowledgeable about the unique psychosocial and medical needs, requisite sensitivity, and available referral options in the care of TGD youth. Assumptions about one's gender identity, sexual orientation, gender expression, or behaviors cannot be made based on birth-assigned sex. Further research is needed to investigate the health and wellbeing of TGD military-affiliated youth over time and to determine quality transgender-related services in support of this vulnerable and underserved population.
Keywords: adolescent; child; demography; female; human; male; patient attitude; psychology; retrospective study; sexual and gender minority; transgender; young adult

Transgender and gender non-conforming bereavement (TGNC): A case study on complicated grief experienced and the effect of partner suicide on interpersonal relationships and subsequent partnerships of the bereaved - Nolan, R.D. (Death studies, 2019)
Grief, death, bereavement, and loss do not discriminate based on gender identity or sexual orientation. Limited attention has been given to the bereaved partners of transgender and gender non-conforming persons (TGNC). Despite recent efforts to protect the rights of TGNC persons, the death of a TGNC partner is often complicated, marked by family members and friends who might never have known or refused to acknowledge the deceased in his, her, or their preferred gender. The present study adopted a single case study design to examine the death of a TGNC spouse through the unique lens of a bereaved partner.
Keywords: article; case report; clinical article; complicated grief; female; gender; human; human relation; male; spouse; suicide; transgender

Prevalence of Self-Injurious Thoughts and Behaviors in Transgender Individuals With Eating Disorders: A National Study - Duffy, M.E.; Henkel, K.E.; Joiner, T.E. (Journal of Adolescent Health, 2019)
Purpose: This study examined prevalence of self-injurious thoughts and behaviors (SITBs) in transgender individuals with eating disorders, as compared to cisgender individuals with eating disorders and transgender individuals without eating disorders. Methods: Data were analyzed from 365,749 individuals (median age 21 years, 71.8% White/Caucasian, 34.9% male, 64.9% female, and 0.2% transgender) who participated in American College Health Association-National College Health Assessment, an annual national assessment of college student health, from 2008 to 2011. Results: Rates of past-year nonsuicidal self-injury, suicidal ideation, and suicide attempts were elevated in transgender participants with eating disorders (74.8%, 75.2%, and 74.8%, respectively), as compared to cisgender participants with eating disorders and transgender participants without eating disorders. Follow-up logistic regression analyses indicated these differences were statistically significant above and beyond the effects of demographic variables and depression. Conclusions: Results found extremely high rates of SITBs in transgender individuals with eating disorders. This combination of identities, each associated with SITBs, may have a compounding effect.
Keywords: academic achievement; adult; article; automutilation; behavior; body mass; Caucasian; college student; depression; eating disorder; ethnicity; female; follow up; gender identity; help seeking behavior; human; major clinical study; male; mental health; prevalence; priority journal; psychotherapy; race; sexual behavior; physiological stress; suicidal ideation; suicide attempt; thinking; transgender; young adult

Disability, sexual orientation, and the mental health outcomes of intimate partner violence: A comparative study of women in the U.S. - Coston, B.M. (Disability and Health Journal, 2019)
Background: Research on disabled non-heterosexual women's post-intimate partner violence mental health outcomes—such as anxiety, depression, suicidal ideation, and alcohol use—is lacking. Objective: To examine the impact of the intersection of disability and sexual orientation on women's post-intimate partner violence mental health outcomes: including difficulty sleeping, missing school or work, or reporting some post-traumatic stress disorder symptomology and a self-reported subjective measure of overall wellbeing. Methods: Data come from the National Intimate Partner and Sexual Violence Survey (2010). A series of chi-square analyses were conducted (applying standardized sample weights and adjusting standard errors for both clustering and stratification for survey data). Results: Bisexual women are significantly more likely than straight women to report being disabled prior to victimization, but all disabled women—regardless of sexual orientation—are equivalently likely to rate their mental health as poor and/or actively experience difficulty sleeping, difficulty going to work or school, and/or PTSD. Conclusions: Aligned with previous work, this study finds that bisexual women are significantly more likely than straight women to be disabled prior to experiencing all forms of intimate partner violence; and that disabled women, generally, are significantly more likely than not-disabled women to experience the negative mental health consequences of that violence. However, contrary to previous work, there are no sexual orientation disparities in said mental health outcomes among disabled women. Clinically, it is important for health care providers to be aware of the significant impact of intimate partner violence on the disabled women they regularly provide care to.
Keywords: adult; article; bisexual female; comparative study; controlled study; disability; disabled person; female; human; major clinical study; mental health; partner violence; personal experience; posttraumatic stress disorder; priority journal; school; sexual orientation; sleep disorder; United States; work disability

Suicides Among Lesbian and Gay Male Individuals: Findings From the National Violent Death Reporting System - Lyons, B.H.; Walters, M.L.; Jack, S.P.D.; Petrosky, E.; Blair, J.M.; Ivey-Stephenson, A.Z. (American Journal of Preventive Medicine, 2019)
Introduction: Information regarding the epidemiology of suicide among lesbian and gay male individuals is limited, and comprehensive information is needed. This study seeks to describe the characteristics and precipitating circumstances of suicide among lesbian and gay male decedents when compared with non-lesbian and non-gay male decedents. Methods: An analysis was conducted of National Violent Death Reporting System data from 18 U.S. states for the years 2003–2014. Sociodemographic characteristics and precipitating circumstances of suicide among lesbian and gay male decedents were compared with non-lesbian and non-gay male decedents. Logistic regression analysis was conducted to examine the association between precipitating circumstances and suicide by sexual orientation. The analysis was conducted in December 2017. Results: There were a total of 123,289 suicide decedents from 18 states participating in National Violent Death Reporting System during 2003–2014; of those, 621 (0.5%) were identified as lesbian, gay, bisexual, or transgender. The majority of lesbian, gay, bisexual, or transgender decedents were identified as gay male (53.9%), followed by lesbian (28.0%), transgender (10.4%), and bisexual (7.5%). The analysis revealed several differences by age, mechanism of injury, and precipitating circumstances, including intimate partner problems among lesbian decedents, suicide planning and intent for both lesbian and gay male decedents, and mental health problems among gay male decedents. Conclusions: Findings highlight differences in the characteristics of suicide among lesbian and gay male and non-lesbian and non-gay male decedents. It is important for suicide prevention efforts to be culturally sensitive and consider the needs of sexual minority populations.
Keywords: adolescent; adult; age; article; bisexuality; controlled study; demography; female; homosexual female; homosexual male; human; injury; male; mental health; mortality; sexual orientation; suicide; transgender

Homophobic crimes: Epidemiological characteristics of homicides against Brazilian MINORITIES - Cavalcanti, A.L.; De Oliveira, T.S.B.; De Oliveira, T.B.S.; Cavalcanti, C.L.; Cavalcanti, A.F.C. (Journal of IMAB - Annual Proceeding (Scientific Papers), 2019)
Purpose: To describe the epidemiological characteristics of homophobic crimes against Brazilian minorities. Materials and Methods: A retrospective study was conducted at the Specialized Police for Homophobic Crimes. Information regarding year, age, schooling, sexual orientation LGBT identity, day of week, shift, place of occurrence, type of injury, number of wounds, weapon, numbers of perpetrators, sex, relationship, drug and alcohol use were collected. For bivariate analyses, the Chi-square and Fisher’s exact, with significance level of 5% were used. Results: The most affected age group was 19 to 28 years old (50.8%) and in relation to schooling, victims with high school education prevailed (62.3%). Regarding sexual orientation, 88.5% were identified as homosexual, 44.3% were gays and 22.9% were transvestite. Crimes occurred during weekdays (68.8%), at night (41%) and in public roads (63.9%). Of the 61 cases, 91.2% were characterized as homophobic crimes. Predominant lesions were lacerations (77%), and most victims presented multiple lesions (96.7%). Most homicides involve firearms (45.7%), followed by a white weapon (36.6%).Victims were assaulted by one perpetrator (59%). There was a statistically significant association for alcohol and drug use by perpetrators (p = 0.004). Conclusion: Lethal violence against minorities showed a homophobic character, evidenced in the type of weapon used, number of lesions and the target regions. Given this scenario, there is an urgent need for the development of strategies linking security, health, education and legal sciences, enabling professionals in this area to deal with this problem.
Keywords: aggression; article; contusion; crime; cross-sectional study; education; firearm; homicide; homophobia; homosexual male; homosexuality; human; intoxication; laceration; offender; physical violence; prevalence; retrospective study; school; sexual and gender minority; sexual orientation; traumatic brain injury

Prevalence of suicide ideation and its relationship with depression among transgender population - Azeem, R.; Zubair, U.B.; Jalil, A.; Kamal, A.; Nizami, A.; Minhas, F. (Journal of the College of Physicians and Surgeons Pakistan, 2019)
Objective: To record the prevalence of suicidal ideation in the transgender population and assess the relationship of depression with the suicidal ideation. Study Design: Cross-sectional study. Methodology: The study group comprised of 156 transgender people of Rawalpindi and Islamabad. Suicidal ideation was assessed by the scale for suicide ideation (SSI). Hamilton rating scale for depression (HAM-D) was used to look for the presence and severity of depression among the target population. Relationship of the age, smoking, family income, illicit substance use, and depression was studied with the presence of suicidal intent among these transgender population of twin cities. Results: One hundred and fifty-six transgender people were included in this study. Mean age of the study participants was 39.26 ±4.28 years. Out of them, 89 (57.1%) had no suicidal ideations, while 67 (42.9%) had suicidal ideation. Fifty-seven (36.5%) did not showed depression, while 99 (63.5%) had depression on HAM-D. With binary logistic regression, depression and illicit substance were found to be significantly related to the presence of suicidal ideations in the target population (p <0.05). Conclusion: A high prevalence of suicidal ideation among the transgender population of twin cities was found in this study. Depression, illicit substance use, and other mental health illnesses should be screened routinely on this high risk population for early recognition and treatment.
Keywords: adult; age; article; city; cross-sectional study; depression; disease association; disease severity; family income; Hamilton Depression Rating Scale; human; major clinical study; Pakistan; population research; prevalence; smoking; substance abuse; suicidal ideation; transgender

A Preliminary Examination of the Association between Adolescent Gender Nonconformity and Suicidal Thoughts and Behaviors - Spivey, L.A.; Prinstein, M.J. (Journal of abnormal child psychology, 2019)
Suicidal thoughts and behaviors are a significant health concern for adolescents. Extant research suggests that sexual and gender minority adolescents are a vulnerable population at elevated risk for suicidal thoughts and behaviors, yet to date few studies have examined the unique associations between adolescent gender nonconformity and suicide risk. This study examined data from the Youth Risk Behavior Surveillance Survey (n = 7730) to estimate the association between gender nonconformity and high school-aged adolescents' likelihood of endorsing four distinct suicide outcomes: suicidal ideation, suicide plans, any suicide attempts, and single vs. multiple suicide attempts. Multivariate logistic regression analyses were utilized to control for other known risk factors for suicidal thoughts and behaviors, including age, sex, sexual minority status, depression symptoms, and suicidal ideation. Results revealed that gender nonconformity was significantly associated with higher odds of reporting suicidal ideation, suicide plans, and multiple suicide attempts in the past year above and beyond other known risk factors. Gender nonconformity is an understudied vulnerability factor that should be taken into consideration by researchers and clinicians seeking to understand adolescents' risk for suicidal thoughts and behaviors.
Keywords: adolescent; adolescent behavior; child; female; human; male; sexual and gender minority; suicidal ideation; suicide attempt

Are Developmental Assets Protective Against Suicidal Behavior? Differential Associations by Sexual Orientation - Toomey, R.B.; Syvertsen, A.K.; Flores, M. (Journal of youth and adolescence, 2019)
Sexual orientation disparities in suicide behavior are well-documented. Yet, few studies have examined how developmental assets - key values, self-perceptions, skills, relationships, and opportunities that have been identified as the building blocks of positive youth development - are associated with suicide behaviors, particularly among sexual minority youth. This study examined concurrent associations between young people's developmental assets and suicidal behavior by sexual orientation using a large sample of 116,925 in-school U.S. adolescents (ages 11 to 19, M = 14.74, SD = 1.78). Most of the sample identified as only heterosexual (90.2%); 5% identified as mostly heterosexual, 3.5% as bisexual, 0.6% as mostly lesbian/gay, and 0.7% as only lesbian/gay. Most participants identified as White, non-Latina/o (62.6%) and as cisgender female (50.3%) or cisgender male (47.8%). Compared to only heterosexual adolescents, youth with all other sexual orientations reported lower levels of internal and external developmental assets except for non-sports extracurricular activity participation and social justice values. Identifying as a racial/ethnic minority, particularly for only heterosexual adolescents, and specifically as Latina/o for sexual minority adolescents was associated with greater risk for suicidal behavior. Further, identifying as a gender minority exacerbated risk for suicidal behavior. Relatedly, when youth reported feeling unsafe with their family, or in their school or neighborhood, they were at greater risk for suicidal behavior, regardless of sexual orientation. Feeling hopeful was associated with lower risk for suicidal behavior for all youth. Regardless of sexual orientation, planning and decision-making skills were associated with lower risk and social-emotional skills were associated with heightened risk for suicidal behavior. School boundaries and social justice values were associated with lower risk for suicidal behavior among bisexual adolescents; there were no additional protective assets for mostly/only lesbian/gay adolescents. In conclusion, sexual orientation disparities exist in the lives of adolescents for several internal and external developmental assets. Disparities in suicidal behavior by sexual orientation, however, were largely unexplained by differential associations between developmental assets and suicidal behavior.
Keywords: adolescent; adolescent behavior; adolescent development; adult; child; cross-sectional study; female; human; male; minority group; psychology; questionnaire; school; sexual behavior; suicidal ideation; United States; young adult

Suicidality Among Gay and Bisexual Men in Taiwan: Its Relationships with Sexuality and Gender Role Characteristics, Homophobic Bullying Victimization, and Social Support - Wang, P.-W.; Ko, N.-Y.; Hsiao, R.C.; Chen, M.-H.; Lin, H.-C.; Yen, C.-F. (Suicide & life-threatening behavior, 2019)
This study aimed to examine the associations of suicidality in emerging adulthood with time of coming out, gender role nonconformity, sexual orientation, traditional and cyber homophobic bullying victimization, and family and peer support during childhood in gay and bisexual men in Taiwan. The frequency of "experiencing suicide ideation" and "attempting suicide" in the past year among 500 gay or bisexual men was examined. The participants' time of coming out, level of subjective masculinity, sexual orientation, experiences of traditional and cyber homophobic bullying victimization, and levels of family and peer support during childhood were also evaluated. In total, 31% (n = 155) of participants reported experiencing suicide ideation (n = 82) or attempting suicide (n = 73). Early coming out, traditional homophobic bullying victimization, and low family support during childhood increased the risk of suicidality in emerging adulthood; by contrast, family support did not moderate the association of early coming out or traditional bullying victimization with current suicidality. A high proportion of participants reported experiencing suicide ideation and attempt in emerging adulthood. Hence, effective suicide prevention is required for gay and bisexual men. Suicide prevention programs should consider time of coming out, traditional homophobic bullying victimization, and level of family support.
Keywords: adult; bisexuality; bullying; crime victim; gender identity; homophobia; human; male; male homosexuality; psychology; questionnaire; sexual and gender minority; social support; suicidal ideation; suicide; suicide attempt; Taiwan; young adult

Minority Stress and Relational Mechanisms of Suicide among Sexual Minorities: Subgroup Differences in the Associations Between Heterosexist Victimization, Shame, Rejection Sensitivity, and Suicide Risk - Mereish, E.H.; Peters, J.R.; Yen, S. (Suicide & life-threatening behavior, 2019)
Despite sexual orientation disparities in suicide, there is limited research examining factors associated with suicide risk among sexual minorities while considering subgroup differences within this group. This study identified differences between sexual minorities at risk for suicide and those not at risk. The study also examined heterosexist victimization, as one form of minority stress, and two relational mechanisms (i.e., shame and rejection sensitivity) as risk factors for suicidality. We examined a moderated-mediation model, in which we tested gender and sexual orientation differences in the mediating effects of the relational mechanisms on the association between heterosexist victimization and suicide risk. Participants were recruited online and completed an online survey. The sample included 719 sexual minority adults. Of the sample, 27.7% were at risk for suicide. Suicide risk varied by age, gender, sexual orientation, income, education, and relationship status. Heterosexist victimization, shame, and rejection sensitivity were significant risk factors for suicide. Shame and rejection sensitivity were mediators of the association between heterosexist victimization and suicide risk for subgroups of sexual minorities, mostly lesbian and gay individuals and to some extent bisexual individuals. The findings underscore minority stress, shame, and rejection sensitivity as key intervention points.
Keywords: adolescent; adult; aged; automutilation; bullying; crime victim; female; homophobia; human; male; middle aged; psychology; risk factor; self concept; sexual and gender minority; shame; suicide; violence; young adult

Is Young Adulthood a Critical Period for Suicidal Behavior among Sexual Minorities? Results from a US National Sample - Fish, J.N.; Rice, C.E.; Lanza, S.T.; Russell, S.T. (Prevention science : the official journal of the Society for Prevention Research, 2019)
The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalences and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experienced anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider age range for sexual minority women (until age 30) relative to sexual minority men (until age 25).
Keywords: adult; female; human; male; psychology; questionnaire; sexual and gender minority; suicidal ideation; United States; young adult

Risk and Protective Factors for Self-Harm in a Population-Based Sample of Transgender Youth - Taliaferro, L.A.; McMorris, B.J.; Rider, G.N.; Eisenberg, M.E. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2019)
This study sought to identify factors distinguishing transgender/gender non-conforming (GNC) adolescents across three groups: no self-harm, non-suicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). Data were from the 2016 Minnesota Student Survey. The final analytic sample included 1,635 transgender/GNC students in grades 9 and 11. Logistic regression analyses determined factors that best distinguished transgender/GNC students who reported self-harm (NSSI only or NSSI + SA) from those who reported no self-harm, and transgender/GNC adolescents who reported NSSI + SA from those who reported NSSI only. Final models were developed over 3 stages of analysis that tested associations of variables within risk factor, protective factor, and health-risk behavior domains to self-harm. Over half (51.6%) of transgender/GNC adolescents reported past-year self-harm behavior. Factors that consistently distinguished transgender/GNC youth who reported self-harm from those who reported no self-harm included reports of a mental health problem, depression, running away from home, and substance use (alcohol or marijuana use). Factors that distinguished the NSSI + SA group from the NSSI only group were reports of a mental health problem, physical or sexual abuse, relationship violence, bullying victimization, less parent connectedness, lower grades, lower levels of perceived school safety, and running away from home. Clinicians and school personnel need to be prepared to address risk factors and enhance protective factors that may reduce the likelihood this population of vulnerable youth will engage in NSSI and/or attempt suicide.
Keywords: adolescent; automutilation; bullying; child abuse; child parent relation; child sexual abuse; crime victim; depression; female; human; male; Minnesota; partner violence; prevalence; protection; psychology; risk factor; social environment; statistical model; suicide attempt; transgender; underage drinking

'Meiotic genes' are constitutively expressed in an asexual amoeba and are not necessarily involved in sexual reproduction - Maciver, S.K.; Koutsogiannis, Z.; de Obeso Fernández Del Valle, A. (Biology letters, 2019)
The amoebae (and many other protists) have traditionally been considered as asexual organisms, but suspicion has been growing that these organisms are cryptically sexual or are at least related to sexual lineages. This contention is mainly based on genome studies in which the presence of 'meiotic genes' has been discovered. Using RNA-seq (next-generation shotgun sequencing, identifying and quantifying the RNA species in a sample), we have found that the entire repertoire of meiotic genes is expressed in exponentially growing Acanthamoeba and we argue that these so-called meiotic genes are involved in the related process of homologous recombination in this amoeba. We contend that they are only involved in meiosis in other organisms that indulge in sexual reproduction and that homologous recombination is important in asexual protists as a guard against the accumulation of mutations. We also suggest that asexual reproduction is the ancestral state.
Keywords: amoeba (life cycle stage); asexual reproduction; meiosis; mutation; reproduction

Gender Affirmation Surgery From a Public Health Perspective: Advances, Challenges, and Areas of Opportunity - Williams, E.A.; Patete, C.L.; Thaller, S.R. (The Journal of craniofacial surgery, 2019)
Gender affirmation surgery (GAS) is sought out by approximately 20 to 40% of transgender individuals. These patients possess unique mental and physical health needs. These are compounded by prejudices and lack of education about transgender individuals within the medical system and society at large. Societal and medical barriers are associated with increased risks of violence, suicide, and sexually transmitted infections. This combination of high medical needs and barriers to accessing appropriate care may give rise to a self-perpetuating cycle of risk exposure, stigmatization, prejudice, and eventually poor health outcomes. It is imperative that plastic and reconstructive surgeons understand GAS from a public health perspective, so that they may provide the highest quality of care and help alleviate these disparities. The authors describe unique public health topics in GAS. These are specifically related to healthcare access, surgical education, cultural sensitivity, as well as mental health outcomes for patients who undergo GAS.
Keywords: adult; article; cultural sensitivity; female; gender; health care access; human; male; mental health; prejudice; public health; sexually transmitted disease; suicide; surgeon; surgical training; transgender; violence

Epidemiology and outcome of HIV patients in Finland co-infected with tuberculosis 1998-2015 - Holmberg, V.; Soini, H.; Kivelä, P.; Ollgren, J.; Ristola, M. (BMC Infectious Diseases, 2019)
Background: Tuberculosis (TB) is a major cause of death in HIV patients worldwide. Here we describe the epidemiology and outcome of HIV-TB co-infections in a high-income country with low TB incidence and integrated HIV and TB therapy according to European guidelines. Methods: This study was based on the HIV cohort of the Helsinki University Hospital which includes all HIV patients in the Helsinki region with a population of 1.5 million. Totally, 1939 HIV-positives who have been under follow-up between 1998 and 2015 were included. Results: TB was diagnosed in 53 (2.7%) of the HIV-patients. The TB incidence rate was higher in injecting drug users (IRR 3.15; 95% CI 1.33-7.52) and heterosexuals (IRR 3.46; 95% CI 1.64-7.29) compared to men having sex with men. The incidence rate was also higher in those born in Sub-Saharan Africa (IRR 3.53; 95% CI 1.78-7.03) compared to those born in Finland. There was a significant reduction in the total TB incidence rate of 59% per 6-year period between 1998 and 2015 (p < 0.001). In injecting drug users there was a reduction in incidence rate from 1182 to 88 per 100,000 (p < 0.001) and in people born in Sub-Saharan Africa from 2017 to 195 per 100,000 (p < 0.001). Among the 53 HIV-TB co-infected cases, one female and 15 males died during follow up. HIV was the primary cause of death in five patients but none of the deaths were caused by TB. Conclusion: The incidence rate of tuberculosis among HIV-positives in Finland has been declining between 1998 and 2015. Among injecting drug users, the reduction is probably explained by harm reduction interventions and care in comprehensive care centers in Helsinki. The increased coverage of antiretroviral therapy is probably another main reason for the decline in TB incidence rates. Despite good treatment results for both HIV and TB, the all-cause mortality among Finnish males with HIV-TB was high, and common causes of death were intoxications and suicides.
Keywords: adult; Africa south of the Sahara; article; cause of death; death; female; Finland; follow up; heterosexuality; human; Human immunodeficiency virus infected patient; incidence; infection rate; injection drug user; major clinical study; male; men who have sex with men; mixed infection; outcome assessment; prevalence; retrospective study; tuberculosis; university hospital

Minorities and foreign born are disproportionately affected by injuries due to violence: An analysis based on a National Trauma Registry 2008-2017 - Tiruneh, A.; Radomislensky, I.; Bahouth, H.; Becker, A.; Hadary, A.; Jeroukhimov, I.; Karawani, M.; Kessel, B.; Klein, Y.; Lin, G.; Merin, O.; Miklush, B.; et al. (Israel Journal of Health Policy Research, 2019)
Background: Populations of different ethnicity and country of origin living in the same country may possess particular features of violence-related injuries. This study aims to compare violence-related injury characteristics and circumstances, hospital resource utilization and in-hospital mortality among the major ethnic groups in Israel. Methods: A study based on the Israeli National Trauma Registry database of patients hospitalized due to violence-related injuries between 2008 and 2017. Data included demographic, injury and hospitalization characteristics and in-hospital mortality. Statistical analysis included χ 2-test and multiple logistic regression. Results: During the study period, 16,151 violence related-hospitalizations were reported, of which; 46.1% were Arab Israelis (AI), 3.2% were Israelis born in Ethiopia (IBE), 12.7% were Israelis born in the former Soviet Union (IBFSU) and 38.0% were all other Israelis (AOI). The proportion of violence-related hospitalizations among AI, IBE and IBFSU was greater than their respective proportion in the Israeli population. In comparison to the other groups, stab injuries were significantly greater among IBE (30% vs 39%); unarmed brawl-related injuries were greater among IBFSU (22-41% vs 49%) and firearm injuries were greatest among AI (2-8% vs 23%). These differences in violence mechanism persisted even after accounting for age, gender, injury place and time differences. The foreign born groups had higher rates for injuries sustained on the street/road (58% for IBE, 54% for IBFSU vs 46% for AI and AOI, each), with IBE also showing higher rates for weekend and weeknight injuries compared to the other groups (83% vs 71-75%). IBE were more likely to suffer from severe and critical injuries (19% vs 12-16%), to be admitted to the intensive care unit (17% vs 9-11%) and to have prolonged hospital stays of seven days or more (20% vs 16-17%), with no significant difference in in-hospital mortality between the comparison groups. Conclusions: Characteristics of violence-related casualties differed significantly among diverse ethnic populations living in the same country. Each population group showed specific attributes regarding injury mechanism, circumstances, severity and hospital utilization. Violence prevention programs should be culturally adapted and take into account ethnicity and country of origin of the target population.
Keywords: adolescent; adult; article; child; comparative study; controlled study; demography; descriptive research; disease registry; economics; Ethiopia; ethnic group; evidence based medicine; female; foreign student; geographic information system; global positioning system; government; health care policy; health program; hospital admission; hospital mortality; hospital utilization; hospitalization; human; ICD-9; infant; injury; injury scale; intensive care unit; intervention study; Israel; logistic regression analysis; major clinical study; male; middle aged; newborn; population; priority journal; resuscitation; retrospective study; sexual and gender minority; statistical analysis; traumatic brain injury; violence; young adult

Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso - Grosso, A.L.; Ketende, S.C.; Stahlman, S.; Ky-Zerbo, O.; Ouedraogo, H.G.; Kouanda, S.; Samadoulougou, C.; Lougue, M.; Tchalla, J.; Anato, S.; Dometo, S.; Nadedjo, F.D.; et al. (BMC Infectious Diseases, 2019)
Background: Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa. Methods: This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures' convergent validity, their correlations with expected variables were examined through bivariate logistic regression models. Results: One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach's alpha ranged from 0.71-0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW. Conclusions: Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.
Keywords: adult; article; Burkina Faso; female; health care access; health care disparity; human; male; men who have sex with men; physical abuse; sex worker; sexual abuse; social behavior; social discrimination; social stigma; suicidal ideation; Togo; torture; verbal hostility

Sexual minority children: Mood disorders and suicidality disparities - Blashill, A.J.; Calzo, J.P. (Journal of Affective Disorders, 2019)
Background: Sexual minority (gay, lesbian, and bisexual) individuals experience elevated mood disorders and suicidality compared to their heterosexual counterparts. However, to date, these sexual orientation disparities have yet to be examined among middle childhood-aged participants. Methods: Data were employed from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study, a U.S. representative sample. Population-level weighting was utilized, resulting in an analytic sample of N = 8,204,013 (nunweighted = 4519) children between the ages of 9 and 10 years: with 70,952 (nunweighted= 43) identifying as sexual minories (0.9% of the population). Structured clinical interviews were used to assess mood disorders (i.e., depressive and bipolar disorders) and suicidality. Sexual orientation (sexual minority vs. heterosexual) was examined as the focal independent variable. Results: The overall prevalence of mood disorders was 7.1%. Sexual minority children (22.5%) possessed a higher rate than heterosexual children (6.9%). The overall prevalence of suicidality was 4.8%; sexual minority children (19.1%) possessed a higher rate than heterosexual children (4.6%). Limitations: Sexual orientation assessment did not include attraction, and thus, results may represent a lower bound estimate of sexual minorities. Conclusions: Sexual orientation disparities in mood disorders and suicidality appear to develop as early as middle childhood. Clinicians are encouraged to assess sexual orientation among children as young as 9–10 years old, and provide appropriate normalization of sexual orientation, and referrals for mental health treatment, as indicated.
Keywords: article; child; childhood; health disparity; heterosexuality; human; major clinical study; mental health; mood disorder; prevalence; priority journal; psychologic assessment; sexual and gender minority; sexual orientation; structured interview; suicidal behavior

Sexual orientation and mental health among adults in four U.S. cities - Nam, B.; Jun, H.-J.; Fedina, L.; Shah, R.; DeVylder, J.E. (Psychiatry Research, 2019)
Sexual minorities have higher risk for psychological distress than heterosexual populations. However, this disparity remains under-studied in urban settings, and there likewise has been minimal prior research of potential interactions with gender and race/ethnicity. The present study aimed to examine mental health correlates of sexual minority identification in conjunction with gender and race/ethnicity. A community sample of 1,615 adults from four eastern cities in the United States was used. A series of regression analyses were conducted to examine differences in psychological distress and suicidal ideation across different sexual orientation populations. The results showed that only bisexual individuals had significantly higher psychological distress and risk for suicidal ideation than heterosexual individuals even after adjusting for age and income. The associations were consistent across gender and race/ethnicity. No significant differences between homosexual and heterosexual individuals were found. Health professionals working with people of bisexual orientation in urban settings should attend to potential psychological distress and recent suicidal ideation.
Keywords: adult; article; bisexuality; correlational study; distress syndrome; ethnicity; female; gender; heterosexuality; human; income; male; mental health; priority journal; race; risk factor; sexual and gender minority; sexual orientation; stigma; suicidal ideation; United States

Alcohol and marijuana use as daily predictors of suicide ideation and attempts among adolescents prior to psychiatric hospitalization - Sellers, C.M.; Diaz-Valdes Iriarte, A.; Wyman Battalen, A.; O'Brien, K.H.M. (Psychiatry Research, 2019)
Objective: Little research has been conducted on alcohol use, marijuana use, and suicide ideation and attempts on a daily level, and specifically among adolescents prior to inpatient hospitalization. The purpose of this study was to examine the within (over time) and between (between adolescents) effects of alcohol use and marijuana use on suicide ideation and attempts. Methods: Participants included 50 adolescents (80% female; Mage = 15.8). All participants reported drinking alcohol in the prior three months and were receiving treatment in an inpatient psychiatric hospital. Random and mixed-effect models were used to test study hypotheses. Results: Results from the random effect model indicated that alcohol use, marijuana use, hospitalization and sexual orientation were significant predictors of suicide attempts. Results from the mixed-effect model indicated that marijuana use, hospitalization, and sexual orientation were significant predictors of suicide ideation. Conclusions: Study findings extend current knowledge about the longitudinal and day-to-day relationship between alcohol and marijuana use and suicide ideation and attempts. Results underscore the importance of addressing alcohol and marijuana use in interventions with suicidal adolescents, recognizing that sexual minority youth may be at elevated risk for suicide ideation.
Keywords: alcohol; cannabis; adolescent; article; cannabis use; child hospitalization; child psychiatry; female; human; longitudinal study; male; mental hospital; prediction; priority journal; retrospective study; risk; sexual orientation; suicidal ideation; suicide attempt; underage drinking

LGBTQ youth in unstable housing and foster care - Baams, L.; Wilson, B.D.M.; Russell, S.T. (Pediatrics, 2019)
BACKGROUND AND OBJECTIVES: Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth abstract are suggested to be overrepresented in unstable housing and foster care. In the current study, we assess whether LGBTQ youth are overrepresented in unstable housing and foster care and examine disparities in school functioning, substance use, and mental health for LGBTQ youth versus heterosexual youth in unstable housing and foster care. METHODS: A total of 895 218 students (10-18 years old) completed the cross-sectional California Healthy Kids Survey from 2013 to 2015. Surveys were administered in 2641 middle and high schools throughout California. Primary outcome measures included school functioning (eg, school climate, absenteeism), substance use, and mental health. RESULTS: More youth living in foster care (30.4%) and unstable housing (25.3%) self-identified as LGBTQ than youth in a nationally representative sample (11.2%). Compared with heterosexual youth and youth in stable housing, LGBTQ youth in unstable housing reported poorer school functioning (Bs = 20.10 to 0.40), higher substance use (Bs = 0.26-0.28), and poorer mental health (odds ratios = 0.73-0.80). LGBTQ youth in foster care reported more fights in school (B = 0.16), victimization (B = 0.10), and mental health problems (odds ratios = 0.82-0.73) compared with LGBTQ youth in stable housing and heterosexual youth in foster care. CONCLUSIONS: Disparities for LGBTQ youth are exacerbated when they live in foster care or unstable housing. This points to a need for protections for LGBTQ youth in care and care that is affirming of their sexual orientation and gender identity.
Keywords: adolescent; adult; article; California; child; controlled study; depression; female; fighting; foster care; gender identity; housing; human; LGBT people; male; mental health; priority journal; school attendance; sexual orientation; substance use; suicide attempt; transgender; victim

A New Generation Speaks - Carroll, M. (Clinical Pediatric Emergency Medicine, 2019)
Keywords: mobile phone; article; cyberbullying; economic status; emergency ward; gender identity; gun violence; health care need; health care personnel; human; Internet; internet access; medical education; pediatric emergency medicine; personal experience; sexual orientation; social evolution; social media; substance abuse

Pedophilia, substance-use disorder, and intellectual disability: A case report - Cassiani-Miranda, C.A.; Quintero-Gómez, T.C.; Burbano, A.L.; Eduard, A.-C. (Addictive Disorders and their Treatment, 2019)
Objective: To present a case of pedophilic disorder associated to intellectual disability and substance-use disorder (SUD). Background: Pedophilic disorders often appear in comorbidity with other mental disorders. Case description: A 21-year-old man is hospitalized in an addictive behavior unit, with a history of SUD, an exclusive sexual preference for boys aged 12 or under, associated to interpersonal problems with borderline Intelligence Quotient score, and failure in global functioning. Discussion: The article analyses the criteria related to pedophilic disorder, the difficulties in its diagnosis, the clinical implications of the comorbidity with intellectual disability and SUD. Conclusions: It is important to differentiate between pedophilic disorder, SUD, and intellectual disability. An active search for deviant sexual behavior is recommended in patients with dual diagnosis.
Keywords: quetiapine; sedative agent; addiction; adult; aggression; article; cannabis use; case report; child pornography; clinical article; cocaine smoking; delusion; drug dependence; drug dose increase; drug induced psychosis; emergency ward; hospitalization; human; inhalant abuse; intellectual impairment; intelligence quotient; male; masturbation; pedophilia; priority journal; scoring system; sexual behavior; suicidal ideation; underage drinking; withdrawal syndrome; young adult

Psychosocial Factors Associated With Suicide Attempts, Ideation, and Future Risk in Lesbian, Gay, and Bisexual Youth - Rimes, K.A.; Shivakumar, S.; Ussher, G.; Baker, D.; Rahman, Q.; West, E. (Crisis, 2019)
BACKGROUND: Lesbian, gay, and bisexual (LGB) youth have elevated suicidality rates. AIMS: To investigate LGB-related and other factors associated with suicide attempts, suicidal ideation, and future suicide risk in a large UK sample. METHOD: Logistic regression was used to investigate factors associated with suicidality in 3,275 LGB young adults from the Youth Chances project. RESULTS: Suicide attempts (lifetime) were reported by 13.6% of participants; 45.2 % had suicidal ideation in the past year and 9.5% said future suicide attempts were likely. LGB stigma and discrimination experiences were significantly associated with all three aspects of suicidality. These included school stigma factors (e.g., teachers not speaking out against prejudice, lessons being negative about sexual minorities), negative reactions to coming out from family and friends, and LGB-related harassment or crime experiences. Bisexuality, not feeling accepted where one lives, younger sexual minority identification, and younger coming out were also associated with suicidality. Significant non-LGB factors included female gender, lower social support, anxiety/depression help-seeking, experiences of abuse/violence, and sexual abuse. LIMITATIONS: This study is cross-sectional and further research is needed to test out whether any of these factors have a causal relationship with suicidality. CONCLUSION: A wide range of LGB stigma and discrimination experiences are associated with increased suicidality in LGB youth. Health, social care, and education professionals supporting young people should address LGB-specific risk factors.
Keywords: adult; anxiety; article; bisexuality; crime; education; female; friend; harassment; homosexual female; human; juvenile; male; prejudice; risk factor; sexual abuse; sexual and gender minority; social support; speech; stigma; suicidal ideation; suicide attempt; teacher; young adult

Emotional Distress, Bullying Victimization, and Protective Factors Among Transgender and Gender Diverse Adolescents in City, Suburban, Town, and Rural Locations - Eisenberg, M.E.; Gower, A.L.; McMorris, B.J.; Rider, G.N.; Coleman, E. (The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2019)
PURPOSE: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. METHODS: Data come from a statewide school-based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. FINDINGS: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. CONCLUSIONS: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population.
Keywords: adolescence; adolescent; analysis of covariance; article; bullying; controlled study; depression; emotional stress; female; gender; high school student; human; juvenile; major clinical study; male; mental health; Minnesota; prevalence; social environment; suicidal ideation; transgender

Religion, psychiatry, and alternate sexuality - Darmansjah, D.; Kalra, G.; Ventriglio, A. (East Asian Archives of Psychiatry, 2019)
Religious institutions tend to display a conservative view towards individuals with alternate sexuality or identity. For managing patients with alternate sexuality, it is imperative that clinicians understand and take into account religious views and its effects on a person's mental health. We review the literature on religion, alternate sexuality, and psychiatry to ascertain their interaction and impact on the mental health of individuals with alternate sexuality or identity. Differing but overlapping perspectives on alternate sexuality persist across world religions. Individuals with conflict between religious and sexual identities are prone to have adverse mental health outcomes; adequate social supports result in more positive mental health outcomes. Education on lesbian, gay, bisexual, transgender, queer, and intersex-related topics in mental health professionals leads to better recognition of the issue and provision of respectful, effective mental health care within the context of socio-religious identity and background.
Keywords: article; awareness; gender identity; human; identity; LGBT people; mental health; mental health care; mental health care personnel; psychiatry; religion; sexual and gender minority; sexuality; social support; suicide attempt; World Health Organization

Suicidal ideation and attempted suicide amongst Chinese transgender persons: National population study - Chen, R.; Zhu, X.; Wright, L.; Drescher, J.; Gao, Y.; Wu, L.; Chen, C.; Xi, Y.; Ji, L.; Zhao, H.; Ou, J.; Broome, M.R. (Journal of Affective Disorders, 2019)
Background: This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China. Methods: Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants’ demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China. Results: A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models. Limitations: The cross-sectional study design and lack of follow-up data are limitations of this study. Conclusions: This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population.
Keywords: adult; article; automutilation; Chinese; community sample; cross-sectional study; depression; disease association; educational status; family conflict; female; follow up; human; major clinical study; major depression; male; married person; mental health; mental health service; population research; prevalence; priority journal; risk factor; sex reassignment; sexuality; structured questionnaire; suicidal ideation; suicide attempt; transgender

Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study - Irish, M.; Solmi, F.; Mars, B.; King, M.; Lewis, G.; Pearson, R.M.; Pitman, A.; Rowe, S.; Srinivasan, R.; Lewis, G. (The Lancet Child and Adolescent Health, 2019)
Background: There are few population-based cohort studies of the emergence, development, and persistence of mental health problems in sexual minorities compared with heterosexuals. We compared trajectories of depressive symptoms in sexual-minority adolescents and heterosexual adolescents from when they were aged 10 years to 21 years, and examined self-harm at ages 16 years and 21 years. Methods: The study included 4828 adolescents born between April 1, 1991, and Dec 31, 1992, from the Avon Longitudinal Study of Parents and Children birth cohort (Bristol, UK) who reported their sexual orientation when aged 16 years. Depressive symptoms were assessed with the short Mood and Feelings Questionnaire (sMFQ) at seven timepoints between ages 10 years and 21 years. A self-harm questionnaire was completed at ages 16 years and 21 years. Analyses were linear multilevel models with growth curves (depressive symptoms), logistic multilevel models (self-harm in the previous year at ages 16 years and 21 years), and multinomial regression (lifetime self-harm with and without suicidal intent at age 21 years). Findings: At age 10 years, depressive symptoms were higher in sexual minorities (mean sMFQ 4·58 [SD 3·59]) than in heterosexuals (3·79 [3·36]) and increased with age to a larger extent. Depressive symptoms increased at each timepoint by 0·31 sMFQ points in hetereosexuals (95% CI 0·27–0·34), and by 0·49 sMFQ points in sexual minorities (0·40–0·59). Sexual-minority adolescents were more likely than heterosexual adolescents to report self-harm in the previous year at ages 16 years and 21 years (adjusted odds ratio 4·23, 95% CI 2·90–6·16), with no evidence that this estimate decreased with age (p=0·80). When aged 21 years, sexual minorities were 4·53 (95% CI 3·02 to 6·78) times more likely to report lifetime self-harm (ie, on at least one previous occasion) with suicidal intent than heterosexuals. Interpretation: Mental health disparities between heterosexuals and sexual minorities are present early in adolescence and increase throughout the school years, persisting to young adulthood. Prevention of these mental health problems and early intervention must be a priority. Funding: Medical Research Council, Wellcome Trust.
Keywords: adolescence; adolescent; adult; age distribution; article; automutilation; cohort analysis; depression; female; health disparity; heterosexuality; human; major clinical study; male; mental health; risk assessment; sexual and gender minority; suicide attempt; United Kingdom; young adult

Suicidality and clinical correlates in Chinese men who have sex with men (MSM) with HIV infection - Wang, Y.-Y.; Dong, M.; Zhang, Q.; Xu, D.-D.; Zhao, J.; Ng, C.H.; Ungvari, G.S.; Jia, F.-J.; Xiang, Y.-T. (Psychology, health & medicine, 2019)
Little is known about suicidality in Chinese men who has sex with men (MSM) infected with human immunodeficiency virus (HIV). This study investigated suicidality and its clinical correlates in Chinese MSM with HIV infection. Suicidality, demographic and clinical characteristics were assessed in 410 MSM with HIV infection consecutively recruited from a public HIV clinic in China. The prevalence of suicidality was 10.7% in Chinese HIV-infected MSM. Compared with those without suicidality, MSM with suicidality were more likely to be younger, unmarried and unemployed, and have more frequent insomnia, lower CD4 lymphocyte counts, and higher GAD-7 and CSE-D total scores. Multiple logistic regression analyses revealed that suicidality was independently associated with unemployment (p = 0.03, OR = 0.3, 95% CI = 0.1-0.9), age (p < 0.01, OR = 0.9, 95% CI = 0.8-0.9), CD4 lymphocyte counts (p = 0.02, OR = 0.9, 95% CI = 0.9-1.0), and the GAD-7 total score (p < 0.001, OR = 1.3, 95% CI = 1.1-1.5). Suicidality is common in Chinese MSM with HIV infection. There is an urgent need to develop comprehensive suicide prevention program and mental health services for this population.
Keywords: adult; China; cross-sectional study; human; Human immunodeficiency virus infection; male; male homosexuality; statistics and numerical data; suicide; young adult

13 Reasons Why: Viewing patterns and perceived impact among youths at risk of suicide - Hong, V.; Ewell Foster, C.J.; Magness, C.S.; McGuire, T.C.; Smith, P.K.; King, C.A. (Psychiatric Services, 2019)
Objective: The streaming series 13 Reasons Why generated controversy because of its depiction of teen suicide and concerns about its impact on vulnerable youths. This study examined exposure to and patterns of engagement with the show and the show’s perceived impact in a sample of youths presenting to a psychiatric emergency department (ED) with suicide-related concerns in the year after the series’ premiere. Methods: Participants were 87 parent-youth dyads (youths’ mean6SD age=14.661.8; 71% of youths were female, 26% male, and 2% gender nonconforming) who completed a battery of questionnaires during their ED visit. Results: Half (49%) of the sample viewed at least one episode of 13 Reasons Why, season 1. Most youths (84%) viewed the show alone and were more likely to discuss their reactions with peers (80%) than with a parent (34%). Over half of youth viewers (51%) believed the series increased their suicide risk to a nonzero degree; having a stronger identification with the lead female character was significantly related to this belief (r=.63, df=41, p,0.001). Youths with more depressive symptoms and suicidal ideation were more likely to identify with the lead characters and report negative affect while viewing. Conclusions: To date, this is the first published study examining viewing patterns and reactions to 13 Reasons Why in a high-risk sample. Although further research is needed, the findings suggest a particular vulnerability to the show’s themes among youths at risk of suicide and the importance of prevention strategies to ameliorate risk among these viewers.
Keywords: adolescent; adolescent behavior; adolescent depression; article; emergency ward; emotion; emotional stress; female; health belief; help seeking behavior; hospitalized adolescent; human; major clinical study; male; mental health service; psychiatric emergency service; risk factor; self report; suicidal ideation; suicide; suicide attempt; television viewing

Barriers and stigma experienced by gay fathers and their children - Perrin, E.C.; Hurley, S.M.; Mattern, K.; Flavin, L.; Pinderhughes, E.E. (Pediatrics, 2019)
BACKGROUND: Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality. METHODS: Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a “snowball” method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts. RESULTS: Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections. CONCLUSIONS: Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States’ legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers.
Keywords: adolescent; adoption; adult; article; child; family; father; foster care; friendship; health care; heterosexuality; homosexual male; household income; human; legal aspect; male; neighborhood; priority journal; race; religion; religious group; school; social acceptance; social class; social environment; stigma; surrogate mother; United States; workplace

Discussion of potentially sensitive topics with young people - Santelli, J.S.; Klein, J.D.; Song, X.; Heitel, J.; Grilo, S.; Wang, M.; Yan, H.; Kaseeska, K.; Gorzkowski, J.; Schneider, M.; Dereix, A.E.; Catallozzi, M. (Pediatrics, 2019)
OBJECTIVES: To identify modifiable factors that facilitate discussion of potentially sensitive topics between health care providers and young people at preventive service visits after Patient Protection and Affordable Care Act implementation. METHODS: We used data from a national internet survey of adolescents and young adults (13–26 years old) in the United States. Questionnaire construction was guided by formative research and Fisher’s Information-Motivation-Behavioral Skills model. Those who had seen a regular health care provider in the past 2 years were asked about 11 specific topics recommended by national medical guidelines. Four multivariable regression models were used to identify independent predictors of discussions of (1) tobacco use, (2) drug and/or alcohol use, (3) sexually transmitted infections or HIV, and (4) the number of topics discussed. RESULTS: Fewer than half of young people reported having discussed 10 of 11 topics at their last visit. Predictors were similar across all 4 models. Factors independently associated with health discussions included the following: ever talked with a provider about confidentiality (4/4 models; adjusted odds ratio [aOR] = 1.85–2.00), ever had private time with a provider (1 model; aOR = 1.50), use of health checklist and/or screening questionnaire at last visit (4 models; aOR = 1.78–1.96), and time spent with provider during last visit (4 models). Number of years that young men had seen their regular provider was significant in 1 model. Other independent factors were positive youth attitudes about discussing specific topics (3/3 models) and youth involvement in specific health risk behaviors (3/3 models). CONCLUSIONS: Discussions about potentially sensitive topics between health care providers and young people are associated with modifiable factors of health care delivery, particularly provider explanations of confidentiality, use of screening and/or trigger questionnaires, and amount of time spent with their provider.
Keywords: academic achievement; accident prevention; adolescent; adult; alcohol consumption; article; birth control; checklist; confidentiality; controlled study; cross-sectional study; drug use; emotional stress; female; friend; gun safety; health care delivery; health care personnel; health care policy; high risk behavior; human; Human immunodeficiency virus infection; male; mental health; multivariate analysis; physical abuse; practice guideline; priority journal; questionnaire; safety; sexual abuse; sexual orientation; sexually transmitted disease; social attitude; tobacco use; United States; young adult

Current and Military-Specific Gender Minority Stress Factors and Their Relationship with Suicide Ideation in Transgender Veterans - Tucker, R.P.; Testa, R.J.; Reger, M.A.; Simpson, T.L.; Shipherd, J.C.; Lehavot, K. (Suicide & life-threatening behavior, 2019)
Research suggests the prevalence of suicide ideation and suicide attempts in the transgender veteran community may be upwards of 20 times higher than nontransgender veterans, who are known to be at increased risk than the general US population. This study aimed to understand the potential influence of external and internal minority stress experienced during and after military service on past-year and recent suicide ideation in a sample of 201 transgender veterans. Nonparametric bootstrapping analyses indicated past-year transgender-specific discrimination and rejection (external minority stress) indirectly predicted frequency of both past-year and past 2-week suicide ideation through past-year shame related to gender identity (internal minority stress). This result was significant when controlling for symptoms of depression and demographics. Similar patterns emerged when examining relationships among military external and internal minority stress on suicide outcomes. These results suggest that attempts to reduce both the experience and impact of minority stressors related to gender identity during and after military service may be an important avenue for suicide prevention.
Keywords: adult; depression; female; gender identity; human; male; mental stress; middle aged; psychology; sexual and gender minority; shame; suicidal ideation; suicide attempt; transgender; veteran

LGBT-Specific Education in General Psychiatry Residency Programs: a Survey of Program Directors - Hirschtritt, M.E.; Noy, G.; Haller, E.; Forstein, M. (Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 2019)
OBJECTIVE: Lesbian, gay, bisexual, transgender (LGBT) and other sexual minority individuals are at higher risk than non-LGBT individuals for multiple psychiatric conditions and suicide. However, little is known regarding LGBT-specific training among psychiatric residents. The authors sought to characterize LGBT-specific training among adult psychiatry residency programs. METHODS: An anonymous, cross-sectional survey was electronically distributed to U.S.-based adult psychiatry program directors between February and April 2018. Survey topics included program demographics, characteristics of LGBT-specific training, perceived barriers to implementation, and anticipated needs. RESULTS: Seventy-two program directors (30.8%) provided complete survey responses. Over half (55.6%) of these programs had ≤ 5 h of LGBT-specific training ("lower-hour programs"). Lower- and higher-hour (> 5 h of LGBT-specific education) programs were similar on measured demographic variables, but lower-hour programs covered fewer LGBT-specific topics and program directors were more likely to report lack of interested or topic-expert faculty as a barrier to enhancing LGBT-specific training. CONCLUSIONS: Results of this survey suggest a need for the development and implementation of LGBT-specific educational curricula for use in U.S.-based adult psychiatry programs. In addition, future research may explore effective ways for programs to recruit, retain, and support teaching faculty with LGBT-specific expertise.
Keywords: adult; cross-sectional study; curriculum; education; female; health care disparity; human; medical director; medical education; psychiatry; questionnaire; sexual and gender minority; statistics and numerical data

Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center - Beckwith, N.; McDowell, M.J.; Reisner, S.L.; Zaslow, S.; Weiss, R.D.; Mayer, K.H.; Keuroghlian, A.S. (LGBT health, 2019)
PURPOSE: Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults. METHODS: We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement. RESULTS: Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20-0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01-1.08) and suicide attempt (OR 5.79, 95% CI: 2.08-16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73-173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62-125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72-25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26-16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32-87.53), anxiety disorders (OR 15.84, 95% CI: 2.00-125.72), and MDD (OR 10.45, 95% CI: 2.28-47.98). CONCLUSION: Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement.
Keywords: sex hormone; adult; alcoholism; ambulatory care; anxiety disorder; case management; drug dependence; female; health care delivery; human; major depression; male; mental disease; mental health service; middle aged; odds ratio; posttraumatic stress disorder; prevalence; primary health care; psychology; risk factor; sex reassignment; sexual and gender minority; suicide attempt; transgender; United States; urban population; young adult

Discrimination and Suicidal Ideation Among Transgender Veterans: The Role of Social Support and Connection - Carter, S.P.; Allred, K.M.; Tucker, R.P.; Simpson, T.L.; Shipherd, J.C.; Lehavot, K. (LGBT health, 2019)
PURPOSE: The aim was to examine social support and community connection as moderators of the relationship between discrimination and suicidal ideation (SI) in transgender veterans. METHODS: A national convenience sample of 298 transgender veterans completed an online cross-sectional survey from February to May 2014. Hierarchical regressions using nonparametric bootstrapping assessed associations among gender-related discrimination within the past year, two aspects of social support (social support, social connection) from four sources (family, friends, transgender/LGBT friends, and veterans), and SI in the past 2 weeks. RESULTS: Discrimination was positively associated with SI. Social support from transgender friends and social connection with LGBT and veteran communities moderated the relationship between discrimination and SI. At high and average levels of social support and connection, discrimination was associated with greater SI, whereas at low levels of these variables, SI was consistently elevated and unrelated to discrimination. CONCLUSION: Given that SI was consistently elevated when discrimination was high, these findings emphasize the need for additional research on how to mitigate the detrimental effects of discrimination, with consideration given to interventions targeting discrimination or responses to discrimination. In addition, given that high and average transgender social support and LGBT social connection were associated with reduced SI when discrimination was low, research would benefit from continued exploration of the potential protective elements of social support from a shared stigmatized community.
Keywords: adult; family; female; friend; human; male; middle aged; psychology; sexual and gender minority; social discrimination; social participation; social support; suicidal ideation; transgender; veteran

Transgender college students: Academic resilience and striving to cope in the face of marginalized health - Messman, J.B.; Leslie, L.A. (Journal of American college health : J of ACH, 2019)
OBJECTIVE: To examine health behavior and outcome disparities between transgender, female, and male participants in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 32,964 undergraduate and graduate students responding to the Fall 2013 American College Health Association-National College Health Assessment; 65.8% were female, 0.4% were transgender, 67.9% were white, and 90.4% were heterosexual. RESULTS: Transgender students reported more mental health diagnoses, trauma, and suicidality; experienced more violence and less safety, reported more sex partners and sexually transmitted infections (STIs); higher rates of illicit and nonprescription substance use and binge drinking use while engaging in less harm reduction behavior; and reported more barriers to academic success. CONCLUSIONS: There is an established need for college clinicians and health educators to reduce these disparate outcomes once students arrive on campus through professional training and culturally competent campus prevention and intervention efforts to promote health equity.
Keywords: academic success; adult; article; binge drinking; clinician; college student; counseling; female; gender; graduate student; harm reduction; health education; health educator; health equity; heterosexuality; human; human tissue; injury; male; mental health; sexually transmitted disease; substance use; suicidal ideation; transgender; violence; alcohol

Safeguarding LGBT+ adolescents - Salkind, J.; Bevan, R.; Drage, G.; Samuels, D.; Hann, G. (BMJ (Online), 2019)
Keywords: adolescent; article; automutilation; conversion therapy; family health; home; human; LGBT people; online system; patient referral; pediatrics; priority journal; school; social support; suicide; therapy

Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students - 19 States and Large Urban School Districts, 2017 - Johns, M.M.; Lowry, R.; Andrzejewski, J.; Barrios, L.C.; Demissie, Z.; McManus, T.; Rasberry, C.N.; Robin, L.; Underwood, J.M. (MMWR. Morbidity and mortality weekly report, 2019)
Transgender youths (those whose gender identity* does not align with their sex†) experience disparities in violence victimization, substance use, suicide risk, and sexual risk compared with their cisgender peers (those whose gender identity does align with their sex) (1-3). Yet few large-scale assessments of these disparities among high school students exist. The Youth Risk Behavior Survey (YRBS) is conducted biennially among local, state, and nationally representative samples of U.S. high school students in grades 9-12. In 2017, 10 states (Colorado, Delaware, Hawaii, Maine, Maryland, Massachusetts, Michigan, Rhode Island, Vermont, Wisconsin) and nine large urban school districts (Boston, Broward County, Cleveland, Detroit, District of Columbia, Los Angeles, New York City, San Diego, San Francisco) piloted a measure of transgender identity. Using pooled data from these 19 sites, the prevalence of transgender identity was assessed, and relationships between transgender identity and violence victimization, substance use, suicide risk, and sexual risk behaviors were evaluated using logistic regression. Compared with cisgender males and cisgender females, transgender students were more likely to report violence victimization, substance use, and suicide risk, and, although more likely to report some sexual risk behaviors, were also more likely to be tested for human immunodeficiency virus (HIV) infection. These findings indicate a need for intervention efforts to improve health outcomes among transgender youths.
Keywords: adolescent; crime victim; drug dependence; female; high risk behavior; human; male; psychology; risk; school; sexual behavior; statistics and numerical data; student; suicide; transgender; United States; urban population; violence

Transgender-inclusive care - Lam, J.S.H.; Abramovich, A. (CMAJ, 2019)
Keywords: estrogen; testosterone; adolescence; anxiety; article; depression; female; fertility preservation; gender dysphoria; gender identity; health care delivery; health care need; hormonal therapy; human; male; mental health; Papanicolaou test; population research; quality of life; suicide attempt; transgender

Risk and protective factors for mental health morbidity in a community sample of female-to-male trans-masculine adults - McDowell, M.J.; White Hughto, J.M.; Reisner, S.L. (BMC Psychiatry, 2019)
Background: Trans-masculine (TM) individuals, who are assigned female sex at birth and identify along the masculine gender spectrum, face mental health disparities relative to cisgender people. Limited research has sought to explore the multi-level risk and protective factors associated with mental health morbidity for TM populations. Methods: Between August 2015-September 2016, 150 TM adults were enrolled in a one-time biobehavioral health study. A survey assessed socio-demographics, past 12-month everyday discrimination, lifetime intimate partner violence (IPV), resilience (using the Brief Resilience Scale), and other factors. Bivariate and multivariable logistic regression analyses examined associations between participant characteristics and four mental health statuses: post-traumatic stress disorder (PTSD), depression, anxiety, and non-suicidal self-injury (NSSI). Results: In this sample (76.7% had a binary gender identity, i.e., man or transgender man; 74.7% were white, 70.0% were under age 30 years), 42.2% had PTSD based on past 30-day symptoms; 25.7% had depression based on past 7-day symptoms; 31.1% had anxiety based on past 7-day symptoms; and 31.3% had engaged in NSSI within the past 12-months. Results from multivariable models: 1) PTSD: unemployment, lifetime IPV and past 12-month discrimination were each associated with increased odds of PTSD, while having a partner was associated with the reduced odds of PTSD. 2) Depression: lower educational attainment and past 12-month discrimination were each associated with the increased odds of depression, while greater resilience was associated with the reduced odds of depression. 3) Anxiety: low annual household income and past 12-month discrimination were each associated with the increased odds of anxiety, while resilience was associated with the reduced odds of anxiety. 4) NSSI: past 12-month discrimination was associated with the increased odds of past 12-month NSSI, while higher age and greater resilience was associated with the reduced odds of NSSI (all p-values < 0.05). Conclusions: Unemployment, low income, limited education, everyday discrimination, and violence were risk factors for poor mental health, while being in a relationship, higher age, and personal resilience were protective against mental health morbidity. Findings highlight the need for interventions to address the individual, interpersonal, and societal factors that may be driving poor mental health in this population.
Keywords: adult; anxiety; article; automutilation; Caucasian; community sample; demography; depression; disease association; educational status; female to male transgender; human; income; major clinical study; male; mental health; morbidity; partner violence; posttraumatic stress disorder; psychological resilience; risk assessment; risk factor; social discrimination; social status; unemployment

Background, experience of abuse, and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample - Tordön, R.; Svedin, C.G.; Fredlund, C.; Jonsson, L.; Priebe, G.; Sydsjö, G. (Nordic Journal of Psychiatry, 2019)
Purpose: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents. Materials and methods: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze. Results: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care. Conclusions: Even where the protective factor ‘senior educational attainment’ is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care.
Keywords: contraceptive agent; narcotic agent; abuse; adolescence; adult; anxiety; article; attention deficit disorder; automutilation; bisexuality; contraception; cross-sectional study; depression; drug use; emotional abuse; female; follow up; health care; heterosexuality; high school student; home care; homosexuality; human; immigrant; immigration; major clinical study; male; mental capacity; mental disease; penetrative sex; personal experience; persuasive communication; physical abuse; Rosenberg Self-Esteem Scale; self esteem; sexual abuse; sexual health; sexual intercourse; sexual orientation; social work; suicide attempt; Swedish citizen

Investigating the association between age at first alcohol use and suicidal ideation among high school students: Evidence from the youth risk behavior surveillance system - Baiden, P.; Mengo, C.; Boateng, G.O.; Small, E. (Journal of Affective Disorders, 2019)
Background: Although various studies have investigated and found a significant link between age at first alcohol use and health risk behaviors, few studies have investigated the effect of age at first alcohol use on suicidal ideation among adolescents. The objective of this study was to investigate the effect of age at first alcohol use on suicidal ideation. Methods: Data for this study were obtained from the 2015 Youth Risk Behavior Surveillance system. A sample of 10,745 adolescents aged 14–18 years (50.9% males) were analyzed using logistic regression with suicidal ideation as the outcome variable and age at first alcohol use as the main explanatory variable. Results: About 17% of adolescents experienced suicidal ideation during the past 12 months and 15.6% started having alcohol before age 13. Adolescents who started having alcohol before age 13 had 1.60 times higher odds of experiencing suicidal ideation and adolescents who started having alcohol by age 13 or over had 1.47 times higher odds of experiencing suicidal ideation. Other significant factors associated with suicidal ideation include experience of forced sex, physical teen dating violence, bullying, and feeling sad or hopeless. Having sufficient sleep lowered the odds of suicidal ideation. Limitations: The use of cross-sectional data limits the extent to which we can make causal claims regarding age at first alcohol use and suicidal ideation. Conclusions: Younger age at first alcohol use was associated with increased likelihood of suicidal ideation. Public health initiatives that seek to address the co-occurring problems of alcohol use and mental health illness, sexual violence, and victimization among sexual minority youth could help in reducing suicidal ideation.
Keywords: alcohol; adolescent; adult; age; alcohol consumption; article; bullying; dating violence; female; forced sex; high school student; hopelessness; human; male; obesity; outcome assessment; physical activity; physical violence; priority journal; sadness; sex difference; sexual intercourse; sleep time; suicidal ideation

Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth - Walls, N.E.; Atteberry-Ash, B.; Kattari, S.K.; Peitzmeier, S.; Kattari, L.; Langenderfer-Magruder, L. (Journal of Adolescent Health, 2019)
Purpose: Partner violence (PV) is prevalent among US adolescents, though little is known about its prevalence and correlates across gender identities and sexual orientations. Existing research has frequently placed lesbian, gay, bisexual (LGB), questioning, and transgender adolescents in the same category, obscuring potential differences in risk of PV. Methods: This study (N = 9,352) uses the 2015 Healthy Kids Colorado Study, a statewide representative survey, to explore how sexual orientation and gender identity are associated with PV victimization among high-school youth, and whether there is a relationship between mental health and bullying victimization and PV. Results: Out of all youth who dated in the past year, 9.4% reported experiencing past-year PV. Compared to their cisgender heterosexual peers, cisgender LGB youth (AOR = 1.48 [1.17, 1.86]) and cisgender questioning youth (AOR = 1.68 [1.13, 2.48]) had elevated risk of experiencing PV. Transgender youth, particularly those who are both transgender and LGB (AOR = 3.25 [2.02, 5.22]) or transgender and questioning their sexual orientation (AOR = 8.57 [4.28, 17.16]), had the highest risk of PV. Depressive symptoms (AOR = 1.99 [1.67, 2.37]), suicidality (AOR = 1.83 [1.62, 2.06]), bullying victimization (AOR = 1.58 [1.31, 1.91]), and online bullying victimization (AOR = 1.98 [1.62, 2.06]) were associated with PV. Conclusions: LGB, questioning and transgender high school students are at elevated risk of PV, with the highest risk among those who are both LGB and transgender. Adolescents who report PV are also more likely to be struggling with bullying, depression, and suicidality. PV prevention and response interventions should use intersectional approaches responsive to the unique needs of LGBT youth.
Keywords: adolescent; article; bisexuality; bullying; controlled study; dating violence; depression; female; gender identity; heterosexuality; human; lateral geniculate body; major clinical study; male; mental health; offender; partner violence; potential difference; priority journal; sexual and gender minority; sexual orientation; suicide attempt

Psychometric assessment of the Persian version of a dimensional instrument to measure gender identity disorder - Haghighat, F.; Shirazi, E.; Ardebili, M.E.; Alavi, K. (Revista Latinoamericana de Hipertension, 2019)
Suicide is a deliberate process of ending life and it is one of the ten leading causes of death in different countries around the world. Averagely, every forty seconds, one individual loses his life due to suicide in the world. Stigma, on the other hand, is a negative tag given by people to the groups and individuals who are different in terms of appearance, race, physical and mental health. Research has shown that Stigma is a barrier to care for those who attempt suicide. Since nurses play an important role in the care of patients with psychiatric disorders, their level of literacy and their attitude and behavior towards this group of patients have an impact on stigmatizing and non-stigmatizing behavior and the quality of nursing care. Therefore, the present study aimed to investigate the correlation be-tween suicidal literacy and stigmatizing attitude towards suicidal patients in nurses working in selected hospitals of Shahid Beheshti University of Medical Sciences in 2018. In this descriptive-correlational study, the samples were selected randomly among nurses working in psychiatric, poisoning, burn and emergency wards of selected hospitals. For data collection, besides questionnaire of demographic data collection, two questionnaires of suicide literacy and stigma questionnaires were used after determining the validity and reliability. Data analysis was performed using the latest version of SPSS software and descriptive and correlation statistics. The findings of the study showed that there is a positive correlation between the two variables of suicide literacy and stigma (p <0.05). It means that, with increasing literacy of nurses in the field of suicide, their attitude is also increased. In other words, increasing the literacy of nurses about suicide will improve their attitude in this regard. Regarding the fact that there is a significant relationship between suicidal literacy and stigma of nurses about the patients with suicide attempts, it can be hoped that increasing literacy of nurses will have a positive effect on their attitude and behavior with these patients and ultimately on the quality of care provided by them.
Keywords: adult; article; attitude to health; burn; content validity; correlation analysis; correlation coefficient; Cronbach alpha coefficient; data analysis software; demography; emergency ward; face validity; female; gender dysphoria; human; human experiment; intoxication; Iran; knowledge; Literacy of Suicide Scale; male; middle aged; nurse; psychiatric department; psychometry; quality of nursing care; questionnaire; rating scale; reliability; statistical analysis; stigma; Stigma of Suicide Scale; suicide; suicide attempt

Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder - Cowie, M.E.; Kim, H.S.; Hodgins, D.C.; McGrath, D.S.; Scanavino, M.D.T.; Tavares, H. (Journal of Behavioral Addictions, 2019)
Background and aims: Gambling disorder (GD) and compulsive sexual behavior (CSB) may commonly co-occur. Yet, the psychiatric correlates of these co-occurring disorders are an untapped area of empirical scrutiny, limiting our understanding of appropriate treatment modalities for this dual-diagnosed population. This study examined the demographic and clinical correlates of CSB in a sample of treatment-seeking individuals with GD (N = 368) in São Paulo, Brazil. Methods: Psychiatrists and psychologists conducted semi-structured clinical interviews to identify rates of CSB and other comorbid psychiatric disorders. The Shorter PROMIS Questionnaire was administered to assess additional addictive behaviors. The TCI and BIS-11 were used to assess facets of personality. Demographic and gambling variables were also assessed. Results: Of the total sample, 24 (6.5%) met diagnostic criteria for comorbid CSB (GD + CSB). Compared to those without compulsive sexual behaviors (GD − CSB), individuals with GD + CSB were more likely to be younger and male. No differences in gambling involvement emerged. Individuals with GD + CSB tended to have higher rates of psychiatric disorders (depression, post-traumatic stress disorder, and bulimia nervosa) and engage in more addictive behaviors (problematic alcohol use, drug use, and exercise) compared to GD − CSB. Those with GD + CSB evidenced less self-directedness, cooperativeness, self-transcendence, and greater motor impulsivity. Logistic regression showed that the predictors of GD + CSB, which remained in the final model, were being male, a diagnosis of bulimia, greater gambling severity, and less self-transcendence. Discussion and conclusion: Given those with GD + CSB evidence greater psychopathology, greater attention should be allocated to this often under studied comorbid condition to ensure adequate treatment opportunities.
Keywords: addiction; adult; agoraphobia; alcoholism; article; behavior disorder assessment; bisexuality; bulimia; comorbidity; compulsive sexual behavior; controlled study; cooperation; demography; depression; disease severity; drug dependence; exercise addiction; female; generalized anxiety disorder; heterosexuality; homosexuality; human; impulsiveness; major clinical study; major depression; male; mini international neuropsychiatric interview; obsessive compulsive disorder; panic; pathological gambling; posttraumatic stress disorder; psychosexual disorder; self transcendence; semi structured interview; sexual behavior; social phobia; suicidal behavior

Risk Factors for Suicidal Ideation in a Sample of Colombian Adolescents and Young Adults who Self-identify as Homosexuals - Pineda-Roa, C.A. (Revista Colombiana de Psiquiatria, 2019)
Background: Research shows higher rates of ideation and attempted suicide in the homosexual population compared to their heterosexual counterparts. To date, there are no known studies in Colombia that investigate risk factors related to suicidal behavior in a male homosexual population. Objective: The objective of the present study is to investigate the risk factors for suicidal ideation in young men living in Bogota (Colombia) who self-identify as homosexuals. Methods: 175 males between 14 and 27 (19.02 ± 2.0) years completed two tests, one for suicidal thoughts and one for internalized homophobia (IH). The snowball non-probability sampling technique was used. Results: 18.4% reported low suicidal ideation, 24.6% a moderate level and 24% declared a high level of suicidal thoughts. IH scores ranged between the expected minimum and maximum (9-45) (21.54 ± 7). Being sexually abused was the main factor associated with suicidal ideation (OR = 4.02; 95%CI, 1.51-10.67; P = 0.005). Adolescents were 3 times more at risk of suicidal thoughts than young adults (OR = 3.63; 95%CI, 1.35-9.76; P = 0.010). High IH scores were twice as likely to experience suicidal thoughts as those with low IH (OR = 2.11; 95%CI, 1.22-3.67; P = 0.008). Conclusions: These findings are consistent with previous research and suggest the need for early preventive interventions in pursuit of non-coercive sexual health, seeking the re-examination of IH through affirmative sexual diversity therapies.
Keywords: adolescent; adult; age; article; Colombian; homosexual male; human; major clinical study; male; sexual abuse; suicidal ideation; young adult

Diminished fronto-limbic functional connectivity in child sexual offenders - Kneer, J.; Borchardt, V.; Kärgel, C.; Sinke, C.; Massau, C.; Tenbergen, G.; Ponseti, J.; Walter, H.; Beier, K.M.; Schiffer, B.; Schiltz, K.; Walter, M.; et al. (Journal of Psychiatric Research, 2019)
Background: Child sexual abuse and neglect have been related to an increased risk for the development of a wide range of behavioral, psychological, and sexual problems and increased rates of suicidal behavior. Contrary to the large amount of research focusing on the negative mental health consequences of child sexual abuse, very little is known about the characteristics of child sexual offenders and the neuronal underpinnings contributing to child sexual offending. Methods and sample: This study investigates differences in resting state functional connectivity (rs-FC) between non-pedophilic child sexual offenders (N = 20; CSO-P) and matched healthy controls (N = 20; HC) using a seed-based approach. The focus of this investigation of rs-FC in CSO-P was put on prefrontal and limbic regions highly relevant for emotional and behavioral processing. Results: Results revealed a significant reduction of rs-FC between the right centromedial amygdala and the left dorsolateral prefrontal cortex in child sexual offenders compared to controls. Conclusion & recommendations: Given that, in the healthy brain, there is a strong top-down inhibitory control of prefrontal over limbic structures, these results suggest that diminished rs-FC between the amygdala and the dorsolateral prefrontal cortex and may foster sexual deviance and sexual offending. A profound understanding of these concepts should contribute to a better understanding of the occurrence of child sexual offending, as well as further development of more differentiated and effective interventions.
Keywords: adult; amygdala; article; attention deficit disorder; behavior; child sexual abuse; controlled study; dorsolateral prefrontal cortex; emotionality; functional connectivity; human; offender; prefrontal cortex; priority journal; sexual arousal; sexual behavior; sexual orientation

The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use - Liu, C.H.; Stevens, C.; Wong, S.H.M.; Yasui, M.; Chen, J.A. (Depression and Anxiety, 2019)
Background: The college years represent a period of increased vulnerability for a wide range of mental health (MH) challenges. The onset of common psychiatric conditions occurs during this period of development. Increases in depression, anxiety, and suicidality among U.S. college students have been observed. This study identified prevalence and correlates of MH diagnoses and suicidality in a recent sample of U.S. college students. Methods: The Spring 2015 American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed MH diagnoses and suicidality from U.S. undergraduate students (n = 67,308) across 108 institutions. Results: Stress was strongly associated with a greater likelihood of suicide attempts and MH diagnoses, even among students reporting 1–2 stressful events (OR [odds ratio] range 1.6–2.6, CI [confidence interval] = 1.2–3.2). Bisexual students were more likely to report MH diagnoses and suicidality, compared to heterosexual and gay/lesbian students (OR range 1.5–3.9, CI = 1.8–4.3), with over half engaging in suicidal ideation and self-harm, and over a quarter reporting suicide attempts. Transgender students reported a higher rate of MH diagnoses and suicidality relative to females (OR range 1.9–2.4, CI = 1.1–3.4). Racial/ethnic minority students were generally less likely to report MH diagnoses relative to Whites, although the likelihood for suicidality was mixed. Conclusions: The high rate of multiple stress exposures among the U.S. college population and the high impacts of stress on MH and suicidality point to an urgent need for service utilization strategies, especially among racial/ethnic, sexual, or gender minorities. Campuses must consider student experiences to mitigate stress during this developmental period.
Keywords: adult; article; bisexuality; college student; confidence interval; ethnicity; female; health care utilization; health disparity; heterosexuality; human; male; mental health; mental stress; odds ratio; prediction; predictor variable; prevalence; priority journal; racism; self report; sex difference; suicidal ideation; suicide; suicide attempt; transgender; United States; young adult

Using the PHQ-9 and GAD-7 to screen for acute distress in transgender youth: Findings from a pediatric endocrinology clinic - Moyer, D.N.; Connelly, K.J.; Holley, A.L. (Journal of Pediatric Endocrinology and Metabolism, 2019)
Transgender and gender nonconforming (TGNC) youth are at higher risk for anxiety and depression than their peers. The referral rate for those seeking specialty medical care has rapidly increased in recent years. This paper examines the use of brief screening tools with clear cutoffs to assist physicians in rapidly identifying TGNC youth in acute distress. A retrospective chart review was conducted for patients aged 11-18 years being treated in a pediatric endocrinology clinic for gender dysphoria. Patient Health Questionnaires for depression (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) were collected for patients attending an initial consultation (n=79) or follow-up appointment (n=115). Screener data identified high rates of acute distress, including depression (47%), anxiety (61%), and suicidal ideation (30%). Distress was not associated with age or gender identity. More youth endorsed clinically significant anxiety at initial consultation appointments versus follow-up appointments. The results support the use of the PHQ-9 and GAD-7 as brief, easy-to-use screening measures that can be administered by physicians to rapidly identify acute distress and inform treatment recommendations among TGNC youth seeking medical intervention.
Keywords: adolescent; adult; anxiety; anxiety assessment; article; child; depression; distress syndrome; female; follow up; gender dysphoria; gender identity; Generalized Anxiety Disorder 7 item; human; major clinical study; male; medical record review; Patient Health Questionnaire 9; screening; suicidal ideation; transgender

Exploring the Temporal Dynamics of the Interpersonal Theory of Suicide Constructs: A Dynamic Systems Modeling Approach - Rogers, M.L.; Joiner, T.E. (Journal of Consulting and Clinical Psychology, 2019)
Objective: The interpersonal theory of suicide has contributed to advances in the understanding and prevention of suicidal behavior, with over a decade of empirical examination. Few studies, however, have used a longitudinal design with repeated short-term follow-ups to examine the temporal trajectories of perceived burdensomeness, thwarted belongingness, and suicidal ideation, nor have any studies to our knowledge investigated the propositions of the interpersonal theory of suicide using a dynamic systems theory approach. The present study examined the temporal dynamics of perceived burdensomeness, thwarted belongingness, and suicidal ideation, as moderated by capability for suicide, using dynamic systems modeling analyses in a sample of 91 adults at high risk for suicide (Mage 27.03 years, SD 8.64; 53.8% female, 44.0% male, 1.1% nonbinary, 1.1% transgender female). Method: Participants completed brief online self-report measures at 6 timepoints, each 3 days apart. Results: Results were generally in support of the interpersonal theory of suicide: perceived burdensomeness, thwarted belongingness, and suicidal ideation exhibited patterns of temporal stability that were accentuated at high levels of capability for suicide; perceived burdensomeness and thwarted belongingness exhibited a reciprocal temporal pattern, as did perceived burdensomeness and suicidal ideation. However, thwarted belongingness did not have an incremental influence on suicidal ideation. Conclusions: Overall, these findings provide additional information about the nature of suicidal ideation and interpersonal risk factors over time and point to nonlinear dynamic systems modeling as an analytic technique that may prove useful in understanding trajectories of suicidal thoughts and behaviors.
Keywords: adult; article; chronicity; controlled study; depression; female; follow up; heterosexuality; high risk patient; human; interpersonal theory; major clinical study; male; marriage; nursing theory; race difference; risk factor; self report; sexual orientation; social behavior; social support; suicidal ideation; suicide; systems theory

Clinical chemistry’s special issue on men’s health - Park, J.Y.; Deutsch, M.B.; Koenig, W.; Lilja, H.; Platz, E.A. (Clinical Chemistry, 2019)
Keywords: accident; article; cardiovascular disease; clinical chemistry; clinical practice; drug overdose; human; male; malignant neoplasm; men's health; professional development; prostate cancer; sex difference; suicide; transgender; women's health

Genetic associations with suicide attempt severity and genetic overlap with major depression - Levey, D.F.; Polimanti, R.; Cheng, Z.; Zhou, H.; Nuñez, Y.Z.; Jain, S.; He, F.; Sun, X.; Ursano, R.J.; Kessler, R.C.; Smoller, J.W.; Stein, M.B.; et al. (Translational Psychiatry, 2019)
In 2015, ~800,000 people died by suicide worldwide. For every death by suicide there are as many as 25 suicide attempts, which can result in serious injury even when not fatal. Despite this large impact on morbidity and mortality, the genetic influences on suicide attempt are poorly understood. We performed a genome-wide association study (GWAS) of severity of suicide attempts to investigate genetic influences. A discovery GWAS was performed in Yale-Penn sample cohorts of European Americans (EAs, n = 2,439) and African Americans (AAs, n = 3,881). We found one genome-wide significant (GWS) signal in EAs near the gene LDHB (rs1677091, p = 1.07 × 10−8) and three GWS associations in AAs: ARNTL2 on chromosome 12 (rs683813, p = 2.07 × 10−8), FAH on chromosome 15 (rs72740082, p = 2.36 × 10−8), and on chromosome 18 (rs11876255, p = 4.61 × 10−8) in the Yale-Penn discovery sample. We conducted a limited replication analysis in the completely independent Army-STARRS cohorts. rs1677091 replicated in Latinos (LAT, p = 6.52 × 10−3). A variant in LD with FAH rs72740082 (rs72740088; r2 = 0.68) was replicated in AAs (STARRS AA p = 5.23 × 10−3; AA meta, 1.51 × 10−9). When combined for a trans-population meta-analysis, the final sample size included n = 20,153 individuals. Finally, we found significant genetic overlap with major depressive disorder (MDD) using polygenic risk scores from a large GWAS (r2 = 0.007, p = 6.42 × 10−5). To our knowledge, this is the first GWAS of suicide attempt severity. We identified GWS associations near genes involved in anaerobic energy production (LDHB), circadian clock regulation (ARNTL2), and catabolism of tyrosine (FAH). These findings provide evidence of genetic risk factors for suicide attempt severity, providing new information regarding the molecular mechanisms involved.
Keywords: aryl hydrocarbon receptor nuclear translocator like 2; fumarylacetoacetase; lactate dehydrogenase B; NMDA receptor regulated 2; piggybac transposable element derived 5; pleckstrin homology like domain family B member 2; protein; unclassified drug; adult; African American; article; chromosome 12; chromosome 15; chromosome 18; circadian rhythm; controlled study; disease severity; drug dependence; energy yield; European American; female; gene replication; genetic association; genetic risk; genome-wide association study; Hispanic; human; major clinical study; major depression; male; race difference; single nucleotide polymorphism; suicide attempt

Sexual Orientation Enumeration in State Antibullying Statutes in the United States: Associations with Bullying, Suicidal Ideation, and Suicide Attempts Among Youth - Meyer, I.H.; Luo, F.; Wilson, B.D.M.; Stone, D.M. (LGBT health, 2019)
PURPOSE: The aim was to assess the associations of antibullying U.S. state statutes that enumerate sexual orientation with exposure to bullying and other stressors and with suicidal ideation and suicide attempts in sexual minority and non sexual minority youth. METHODS: We analyzed data from the 2015 national school-based Youth Risk Behavior Survey, representative of 9th through 12th grade students attending public and private schools in the United States. We reviewed each state's antibullying statutes and classified them on enumeration. RESULTS: Antibullying state laws that enumerate sexual orientation were associated with lower risk for suicide attempts and serious attempts requiring medical attention and lower risk for forced sexual intercourse. They were also associated with feeling safe at school or on the way to or from school. Results did not differ by sexual orientation. CONCLUSIONS: Enumeration of sexual orientation was associated with reduced stressors and suicide attempts, but it is insufficient to remove significant disparities based on sexual orientation. Additional policies and practices are required to address persistent sexual orientation disparities in exposure to bullying and suicidal behavior.
Keywords: adolescent; bullying; epidemiology; female; high risk behavior; human; law; male; mental stress; psychology; questionnaire; school; sexual and gender minority; sexual behavior; statistics and numerical data; suicidal ideation; suicide attempt; United States

A Systematic Review and Meta-Analysis of Disparities in the Prevalence of Suicide Ideation and Attempt Among Bisexual Populations - Salway, T.; Ross, L.E.; Fehr, C.P.; Burley, J.; Asadi, S.; Hawkins, B.; Tarasoff, L.A. (Archives of sexual behavior, 2019)
Sexual minorities are at increased risk of suicide; however, it is unclear whether there are within-sexual minority differences in risk across specific sexual identities-notably between bisexual and lesbian/gay subgroups. We therefore conducted a systematic review and meta-analysis to quantify associations between bisexual identity and self-reported suicide ideation and attempt and the moderation of these associations by gender/sex, age, sampling strategy, and measurement of sexuality. Abstracts and full texts were independently screened by two reviewers, resulting in a total of 46 studies that met inclusion criteria and reported 12-month or lifetime prevalence estimates for suicide ideation or attempt. A consistent gradient was observed across all four outcomes, whereby bisexual respondents reported the highest proportion of suicide ideation or attempt, lesbian/gay respondents the next highest proportion, and heterosexual respondents the lowest proportion. Random-effects meta-analysis comparing bisexual individuals with lesbian/gay individuals yielded odds ratios (ORs) ranging between 1.22-1.52 across the four outcomes examined. Between-study variability in ORs was large. Thirty-one percent of heterogeneity was explained by sample type (e.g., probability vs. non-probability) and 17% by gender/sex. ORs were consistently larger for women (range: 1.48-1.95, all statistically significant at p < .05) than for men (range: 1.00-1.48, all p > .05), suggesting that gender/sex moderates the association between bisexual identity and suicide risk. Within-sexual minority differences in suicide risk may be attributed to structural and interpersonal experiences of monosexism, bisexual erasure and invisibility, or lack of bisexual-affirming social support, each of which may be experienced differently across gender/sex identities.
Keywords: adult; female; human; male; mental health; meta analysis; prevalence; psychology; sexual and gender minority; sexual behavior; suicidal ideation; young adult

Introduction to the Special Section on Bisexual Health: Can You See Us Now? - Bostwick, W.B.; Dodge, B. (Archives of sexual behavior, 2019)
Despite comprising the largest proportion of the "lesbian, gay, and bisexual" population, research focusing on the unique health concerns and needs of bisexual individuals is relatively scarce. While health disparities are increasingly well documented among lesbian, gay, bisexual, and transgender individuals relative to their heterosexual and cisgender counterparts, gaps remain in our basic understanding of how health status, behaviors, and outcomes vary within these groups, especially bisexual individuals. The lack of specified research on bisexual health is even more curious given that, when separated from both heterosexual and gay/lesbian individuals, bisexual individuals consistently report higher rates of a wide range of negative health outcomes, including mood and anxiety disorders, substance use, suicidality, as well as disparities related to healthcare access and utilization. Indeed, in scientific research, mass media, and in public health interventions, bisexual individuals remain relatively invisible. This Special Section represents an effort to shed light on a new generation of quantitative, qualitative, and mixed methods research studies that examine health-related concerns, outcomes, and intervention opportunities specifically among diverse samples of bisexual individuals from a variety of social and cultural contexts. The research herein focuses on intersections of multiple identities, the development of new measures, the use of large national data sets, and diverse groups of self-identified bisexual men (who tend to be least visible in health research). Findings from these studies will significantly advance our knowledge of factors associated with health disparities, as well as health and well-being more generally, among bisexual individuals and will help to inform directions for future health promotion research and intervention efforts.
Keywords: adult; anxiety disorder; article; bisexual male; female; gender identity; health care access; health disparity; health promotion; heterosexuality; human; human tissue; LGBT people; male; mass medium; medical research; mood disorder; population research; public health; quantitative analysis; substance use; suicidal ideation; wellbeing

Violence as Mediating Variable in Mental Health Disparities Associated to Sexual Orientation Among Mexican Youths - Mendoza-Pérez, J.C.; Ortiz-Hernández, L. (Journal of homosexuality, 2019)
In this study, we explored the role of sex as an effect-modifying variable in the association between sexual orientation and mental health in Mexican youth. In addition, we tested if violent experiences in the family and the school and attitudes toward homosexuality could act as mediating variables in such association. Data from three representative surveys performed in 2007, 2009, and 2013 among Mexican high school students were analyzed. Two dimensions of sexual orientation were evaluated: romantic partnership and sexual behavior. The outcomes were negative and positive mood, suicidal ideation and intent, self-concept, and self-esteem. There were differences by gender because in males, there were more disparities in mental health associated with sexual orientation (suicidal ideation and attempt, negative and positive mood, negative self-concept, and family-related self-esteem) than in females (suicidal ideation and negative mood). Experiences of school violence were mediators in the relationship between sexual orientation and most health outcomes in males.
Keywords: adolescent; attitude; ethnology; female; homosexuality; human; male; mental disease; mental health; Mexico; psychology; questionnaire; school; self concept; sexual behavior; sexual characteristics; student; suicidal ideation; violence; young adult

Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data from a Systematic Review - Salway, T.; Plöderl, M.; Liu, J.; Gustafson, P. (American Journal of Epidemiology, 2019)
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.
Keywords: adult; article; Bayesian misclassification correction method; controlled study; diagnostic test accuracy study; exposure; false positive result; heterosexuality; human; information; information bias; methodology; outcome assessment; prevalence; risk; sensitivity and specificity; sexual and gender minority; sexual orientation; social stigma; suicide attempt

Cultural versus classic risk and protective factors for suicide - Chu, J.; Robinett, E.N.; Ma, J.K.L.; Shadish, K.Y.; Goldblum, P.; Bongar, B. (Death studies, 2019)
The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice.
Keywords: adult; cultural factor; ethnic group; female; human; male; protection; psychology; risk factor; sexual and gender minority; suicidal ideation; suicide; suicide attempt; young adult

Exploring Anabolic-Androgenic Steroid Use and Teen Dating Violence Among Adolescent Males - Ganson, K.T.; Cadet, T.J. (Substance use & misuse, 2019)
BACKGROUND: Reports indicate that 4% of the adolescent males in 2015 had taken steroids without a doctor's prescription. Anabolic-androgenic steroids (AAS) are illicit drugs that have commonly been used to help build muscle mass. AAS use is associated with negative biological, psychological, and social side effects including substance use, suicidal behavior, and violent behavior. OBJECTIVES: This exploratory study, guided by an integrated theoretical framework that included the General Aggression Model and the Biopsychosocial Model, examined the relationship between adolescent male AAS use and teen dating violence. METHODS: This cross-sectional, secondary data analysis was conducted using the 2013 and 2015 Massachusetts Youth Health Survey (MYHS). Participants were high school-aged males with a total sample of 2,080. Primary data analysis was conducted using hierarchical logistic regression. RESULTS: Findings suggested that adolescent males who used steroids at least once in their lifetime, compared to those who did not, had greater odds of engaging in teen dating violence. Further, males who identified as a sexual minority had greater odds of using anabolic-androgenic steroids, as were those who had at least one suicide attempt in the previous 12 months. CONCLUSIONS: Adolescent male AAS use is associated with multiple psychosocial factors that practitioners, school personnel, and parents must be aware of.
Keywords: adolescent; aggression; animal experiment; animal model; animal tissue; article; conceptual framework; controlled study; data analysis; dating violence; drug combination; exploratory research; health survey; high school; juvenile; male; Massachusetts; nonhuman; physician; sexual and gender minority; suicide attempt; anabolic agent; endogenous compound

Dolutegravir and lamivudine maintenance therapy in HIV-1 virologically suppressed patients: Results of the ANRS 167 trial (LAMIDOL) - Joly, V.; Burdet, C.; Landman, R.; Vigan, M.; Charpentier, C.; Katlama, C.; Cabié, A.; Benalycherif, A.; Peytavin, G.; Yeni, P.; Mentre, F.; Argoud, A.-L.; et al. (Journal of Antimicrobial Chemotherapy, 2019)
Objectives: To evaluate the dolutegravir+lamivudine combination in virologically suppressed patients living with HIV. Methods: The ANRS 167 LAMIDOL trial was an open-label, single arm, multicentre trial assessing once-daily dolutegravir (50 mg) + lamivudine (300 mg) in virologically suppressed HIV-1 patients on first-line triple-drug regimens. The main criteria for inclusion in the trial were plasma viral load (pVL) ≤50 copies/mL for ≥2 years, CD4 nadir >200 cells/mm3 and WT HIV prior to treatment initiation. From week-8 (W-8) to day 0 (D0) (Phase 1), the current third agent was switched to dolutegravir. From D0 to W48 (Phase 2), patients received once-daily dolutegravir+lamivudine, except if intolerant or if pVL >50 copies/mL during Phase 1. Virological failure was defined as pVL >50 copies/mL in two consecutive samples. The study was designed to show that the strategy had an efficacy of >80%, assuming a 90% success rate with a type I error of 5% and a power of 90%. Results: In total, 104 of 110 patients enrolled in Phase 1 were included in Phase 2. These 104 patients were 86% male, 72% MSM and 87% CDC stage A. Their characteristics were (median): age 45 years, CD4 nadir 339 cells/mm3, baseline CD4 743 cells/mm3 and duration of viral suppression 4.5 years. The overall success rate at W48 was 97% (95% CI: 94%-100%), meeting the design expectation/assumption. Three therapeutic failures occurred: one virological failure at W4, one lost to follow-up at W32 and one interruption of therapeutic strategy at W40 after a blip (pVL 59 copies/mL but control pVL <50 copies/mL). Three viral blips occurred in two additional patients. Neither M184V nor integrase resistance mutations were detected after failure or blips. Conclusions: Dolutegravir+lamivudine is a promising maintenance therapy in HIV-1-infected patients with controlled virological suppression.
Keywords: CD4 antigen; CD8 antigen; dolutegravir; lamivudine; adult; aged; article; CD4 CD8 ratio; depression; drug efficacy; drug safety; drug withdrawal; female; human; Human immunodeficiency virus 1; Human immunodeficiency virus 1 infection; maintenance therapy; major clinical study; male; multicenter study (topic); nonhuman; phase 1 clinical trial (topic); phase 2 clinical trial (topic); suicidal ideation; treatment outcome; virus inhibition; virus load

A latent class analysis of the co-occurrence of sexual violence, substance use, and mental health in youth - Nelon, J.L.; De Pedro, K.T.; Gilreath, T.D.; Patterson, M.S.; Holden, C.B.; Esquivel, C.H. (Substance use & misuse, 2019)
Purpose: The purpose of this study was to understand co-occurrence of sexual violence, substance use, and mental health in youth and see if there are differences in experiences among sexual identities, races, and genders. Methods: The 2017 Youth Risk Behavior Survey sampled 14,638 high school students. Latent class analysis was used to understand the relationship between incidence of sexual violence, substance use, and depression and suicidality in a nationally representative sample. The model controlled for demographic and bullying covariates. Results: A four-class solution provided optimal fit. Classes were low risk (51.8%); low violence, frequent substance use, and high depression and suicidal ideation (29.7%); experienced violence and moderate mental health issues(5.1%); and some violence, high substance use, and high depression and suicidal ideation (13.4%). Youth who identified as sexual minority youth were almost 2.5-5 times more likely to be in the three higher risk classes than their heterosexual peers. Those who identified as "I don't know" were almost 3 times more likely to be in the three higher risk classes than heterosexual youth. Multiracial youth had higher likelihood of being in the three riskier classes compared to Caucasian youth. Females were 2.5 and 3 times more likely to be in the low violence and some violence classes compared to males. Conclusion: The study's finding distinct classes of co-occurring behavioral and mental health outcomes fill gaps in the current literature and informs practitioners that LGB youth and bi/multiracial youth were at an elevated risk of co-occurring victimization, substance use, and mental health problems.
Keywords: adult; article; bullying; Caucasian; controlled study; depression; female; gender identity; heterosexuality; high school student; human; incidence; juvenile; latent class analysis; major clinical study; male; mental health; physician; sexual and gender minority; sexual violence; substance use; suicidal ideation

Preliminary screening results outside the 1945–1965 birth cohort: A forgotten population for hepatitis C? - Winetsky, D.; Zucker, J.; Slowikowski, J.; Scherer, M.; Verna, E.C.; Gordon, P. (Open Forum Infectious Diseases, 2019)
In December 2017, our academic medical center implemented universal hepatitis C virus screening among adult hospitalized patients. We reviewed charts of patients screening positive outside the birth cohort (1945–1965) in the first 6 months after implementation. Documented risk factors were common in younger patients but rare in patients born before 1945.
Keywords: RNA polymerase; alpha hemolytic Streptococcus; article; bacterial infection; birth; cohort analysis; depression; endocarditis; female; follow up; hepatitis C; Hepatitis C virus; hospitalization; human; Human immunodeficiency virus; injection drug user; liver cirrhosis; major clinical study; male; men who have sex with men; mental health; polymerase chain reaction; prevalence; priority journal; public health service; risk factor; screening; suicide; total quality management

Position statement on the hormonal management of adult transgender and gender diverse individuals - Cheung, A.S.; Wynne, K.; Erasmus, J.; Murray, S.; Zajac, J.D. (Medical Journal of Australia, 2019)
Introduction: Rising demand for gender-affirming hormone therapy mandates a need for more formalised care of transgender and gender diverse (TGD) individuals in Australia. Estimates suggest that 0.1–2.0% of the population are TGD, yet medical education in transgender health is lacking. We aim to provide general practitioners, physicians and other medical professionals with specific Australian recommendations for the hormonal and related management of adult TGD individuals. Main recommendations: Hormonal therapy is effective at aligning physical characteristics with gender identity and in addition to respectful care, may improve mental health symptoms. Masculinising hormone therapy options include transdermal or intramuscular testosterone at standard doses. Feminising hormone therapy options include transdermal or oral estradiol. Additional anti-androgen therapy with cyproterone acetate or spironolactone is typically required. Treatment should be adjusted to clinical response. For biochemical monitoring, target estradiol and testosterone levels in the reference range of the affirmed gender. Monitoring is suggested for adverse effects of hormone therapy. Preferred names in use and pronouns should be used during consultations and reflected in medical records. While being TGD is not a mental health disorder, individualised mental health support to monitor mood during medical transition is recommended. Changes in management as result of this position statement: Gender-affirming hormone therapy is effective and, in the short term, relatively safe with appropriate monitoring. Further research is needed to guide clinical care and understand long term effects of hormonal therapies. We provide the first guidelines for medical practitioners to aid the provision of gender-affirming care for Australian adult TGD individuals.
Keywords: cyproterone acetate; estradiol; ethinylestradiol; testosterone enantate; testosterone ester; testosterone undecanoate; anticoagulation; article; body dysmorphic disorder; consultation; cryopreservation; depression; dissociative disorder; gender identity; hormonal therapy; human; informed consent; intervention study; medicare; mental health; perioperative period; practice guideline; pre-exposure prophylaxis; psychosis; quality of life; risk factor; self report; suicidal ideation; suicide; transgender; transgender and gender diverse; vein thrombosis

Examining the Association between Weapon Carrying on School Property and Suicide Attempt among Adolescents in the United States - Baiden, P.; Tadeo, S.K.; Graaf, G.; Respress, B.N. (Social work in public health, 2019)
Suicidal behaviors among adolescents in the United States are the second leading cause of death and has been steadily increasing over the years. Although access to and possession of a weapon may facilitate the transition from suicidal ideation to a suicide attempt, few studies have examined the association between weapon carrying and suicide attempts among adolescents. The objective of this study was to examine the association between weapon carrying on school property and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 14,547 adolescents aged 14-18 years old (50.5% female) was analyzed using logistic regression. Of the 14,547 adolescents, 4% carried a weapon on school property, and 7.7% attempted suicide during the past 12 months. In the multivariate logistic regression, adolescents who reported carrying a weapon on school property had more than double the odds of attempting suicide when compared to their counterparts who did not carry a weapon on school property. Other significant predictors of suicide attempt include sexual minority, history of forced sexual intercourse, school bullying and cyberbullying victimization, feeling sad or hopeless, and substance use. Examining the association between weapon carrying and suicide attempt among adolescents would contribute to early identification of adolescents who are likely to engage in suicidal behaviors.
Keywords: adolescent; adolescent behavior; female; high risk behavior; human; male; questionnaire; risk factor; school; statistical model; suicide attempt; United States; weapon

Illicit Drug Use and Social Victimization among Thai Sexual and Gender Minority Adolescents - Guadamuz, T.E.; Cheung, D.H.; Boonmongkon, P.; Ojanen, T.T.; Damri, T.; Samoh, N.; Cholratana, M.; Ratchadapunnathikul, C.; Sass, J. (Substance use & misuse, 2019)
Objectives: We examined the prevalence of lifetime illicit drug use and social victimization, and their association, among sexual and gender minority (SGM) and non-SGM Thai adolescents. Methods: In 2013, we conducted a school-based national survey among students grades 7-12 (aged 13-20 years) from 15 secondary schools (n = 2,070) around Thailand. We classified adolescents with same-sex attraction, sexual or gender non-conforming identities as SGM. Generalized estimating equations were used to estimate the odds of illicit drug use by SGM and non-SGM status. Results: Prevalence of lifetime illicit drug use was significantly higher among SGM adolescents than non-SGM adolescents (10.3 vs. 5.3%), but did not differ between those with same-sex attraction and SGM identity (10.3 vs. 10.8%). Among non-SGM adolescents, general social victimization, sexual experience and any school truancy were associated with lifetime illicit drug use (OR = 2.59, 95% CI: 1.53, 4.38; OR = 6.59, 95% CI: 4.90, 8.86; and OR = 4.93, 95% CI: 3.13, 7.75, respectively). Among SGM adolescents, SGM-based social victimization, depressive symptomology and suicidal ideation were associated with lifetime illicit drug use (OR = 3.17, 95% CI: 2.03, 4.95; OR = 5.03, 95% CI: 2.32, 10.90; and OR = 5.03, 95% CI: 2.76, 9.16, respectively). Conclusions: SGM adolescents have higher burden of illicit drug use. Moreover, illicit drug use among SGM adolescents is indicative of depressive symptomology and suicidal ideation. Tailored and comprehensive programs are needed to reduce the gap in burden of illicit drug use between SGM and non-SGM adolescents.
Keywords: adolescent; crime victim; drug dependence; female; human; male; prevalence; psychology; school; sexual and gender minority; sexual behavior; student; suicidal ideation; Thailand; young adult

Looking beyond the lesbian: The intersectionality of death on Netflix's Orange is the New Black - Ruderman-Looff, A. (Journal of lesbian studies, 2019)
In 2016, GLAAD's "Where We Are On TV" report noted a significant rise in lesbian death. This article addresses this perpetual trend as it manifests within Netflix's Orange is the New Black by considering the deaths of Tricia Miller and Poussey Washington. I use a narrative form of intersectional analysis to argue that lesbian death initiates a powerful critique of the criminal legal system and the prison industrial complex. Specifically, lesbian death points to the way multiple modes of marginalization intersect with homophobia to buttress a system designed to administer social and premature death. My analysis of Tricia's death demonstrates how the school-to-prison pipeline prepares children to take responsibility for their behaviors, but neglects to address how their futures in the justice system are systematically produced and beyond their control. This message corresponds to Tricia's flashbacks and her suicide, which demonstrate how, under neoliberalism, Tricia's failure to "pull herself up" leads to her incarceration. In turning to Poussey, I argue that reading her death as an accident not only dismisses the "one bad apple" myth typically used to account for police brutality, it demonstrates how "accidental death" is systematically and deliberately produced within the prison industrial complex. I analyze flashbacks of both Poussey and her killer, Baxter Bayley, to draw attention to the fact that they have committed the same crimes. I demonstrate how power and criminalization are assigned on the basis of gender, race, sexuality, and class.
Keywords: attitude to death; human; correctional facility; prisoner; psychology; sexual and gender minority; social justice; television

Gender dysphoria in children: Puberty blockers study draws further criticism - Cohen, D.; Barnes, H. (The BMJ, 2019)
Keywords: estrogen; testosterone; article; bone density; child health; child health care; clinical practice; clinical protocol; distress syndrome; early intervention; England; evidence based medicine; gender dysphoria; gender identity; health care policy; human; medical ethics; medical research; mental health; national health service; patient care; patient information; priority journal; puberty; secondary sexual characteristics; suicidal behavior; testosterone synthesis

Cultural Pathways for Suicidal Ideation and Behaviors - Chu, J.; Maruyama, B.; Batchelder, H.; Goldblum, P.; Bongar, B.; Wickham, R.E. (Cultural Diversity and Ethnic Minority Psychology, 2019)
Objective: Goals were to empirically examine cultural suicide pathways initially theorized by the cultural theory and model of suicide, by examining relationships between cultural (family conflict, minority stress, cultural suicide sanctions), general distress (depression, hopelessness), and cultural idioms of distress factors as predictors of suicidal ideation and attempts. Method: Path analysis examined a moderated mediation model with a community sample of 1,077 ethnic minority and/or LGBTQ adults (average age of 24.32 (SD = 10.23) ranging from 18 to 88, 299 LGBTQ, 447 Asian American, 196 Latino/a, 60 Black or African American, 8 Hawaiian or Pacific Islander, 6 Arab American, 2 Native American, 187 mixed race). Results: Multiple pathways of statistical significance emerged. First, cultural life events (family conflict and minority stress) showed direct paths to ideation and attempts and indirect paths through general (depression and hopelessness) and cultural idioms of distress to ideation and attempts. The path from minority stress to ideation was entirely explained by general/cultural distress. Second, cultural suicide sanctions moderated the relationship between family conflict and ideation. Third, cultural idioms of distress was an important component of overall distress, alongside depression and hopelessness, predicting attempts and ideation. Conclusions: Findings elucidated pathways involving both general distress and cultural factors, and pathways from cultural life events to suicide constructs independent of mental illness-related factors. Findings question utilizing mental illness as a primary suicide driver, make theoretical contributions in refining the cultural theory and model of suicide, and advance understandings of roles of cultural factors in suicide research and practice.
Keywords: adult; African American; American Indian; Arab; article; Asian American; community sample; controlled study; cultural factor; distress syndrome; family conflict; Hispanic; hopelessness; human; life event; Pacific Islander; path analysis; race; statistical significance; physiological stress; suicidal ideation; theoretical study; young adult

Supporting Transgender and Gender Diverse Youth: Protection Against Emotional Distress and Substance Use - Gower, A.L.; Rider, G.N.; Brown, C.; McMorris, B.J.; Coleman, E.; Taliaferro, L.A.; Eisenberg, M.E. (American Journal of Preventive Medicine, 2018)
Introduction: Important mental and physical health disparities exist for transgender and gender diverse youth compared with cisgender youth (i.e., those whose birth-assigned sex and gender identity align), yet little is known about factors that protect transgender and gender diverse youth from health problems. The objective of this paper is to identify modifiable protective factors in the lives of transgender and gender diverse adolescents, with the goal of informing efforts to eliminate disparities in depression, suicidality, and substance use in this population. Methods: Secondary data analysis of the 2016 Minnesota Student Survey examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at school) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender. Logistic regressions assessed the role of each protective factor separately and simultaneously. Results: Each protective factor was associated with lower odds of emotional distress and substance use. When protective factors were examined simultaneously, parent connectedness was protective for all measures. Feeling safe at school and connected to adults in one's community protected against depression and suicidality; teacher connectedness buffered risk of substance use. Conclusions: Given that transgender and gender diverse youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender diverse–friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use.
Keywords: adolescent; adolescent development; alcohol consumption; article; binge drinking; cannabis use; community; cross-sectional study; depression; emotional stress; family relation; female; friendship; human; logistic regression analysis; male; relative; safety; sexual and gender minority; substance use; suicidal ideation; suicide; suicide attempt; teacher; tobacco dependence; transgender and gender diverse youth

Examining characteristics of worry in relation to depression, anxiety, and suicidal ideation and attempts - Gorday, J.Y.; Rogers, M.L.; Joiner, T.E. (Journal of Psychiatric Research, 2018)
Background: Pathological worry is defined as worry that is excessive, pervasive, and uncontrollable. Although pathological worry is related to depression, anxiety, and suicidal ideation, less is understood about what specific features of worry confer risk for these mental health conditions. The current study examined associations between four characteristics of worry—frequency, duration, controllability, and content—and self-reported symptoms of depression, anxiety, suicidal ideation, and lifetime suicide attempts. Methods: A sample of 548 community participants (53.6% female, 45.4% male, 0.5% transgender male, 0.2% transgender female, and 0.2% gender non-binary), aged 19–98 years (M = 36.54, SD = 12.33), was recruited via Amazon's MTurk and completed a battery of self-report questionnaires online. Results: Results indicated that controllability of worry was uniquely associated with depression, anxiety, and suicidal ideation above and beyond other characteristics of worry, demographic variables, negative affect, and future-oriented repetitive thinking. Lifetime suicide attempts were found non-significant to these mental health outcomes. Frequency of worry was also positively related to depression. Limitations: This study utilized a cross-sectional design with exclusive self-report measures. Conclusions: Overall, these findings suggest that controllability of one's thoughts may be a key transdiagnostic factor that confers risk for a variety of psychopathology-related concerns. Clinical relevance includes identifying potential risk factors for varying psychopathology. Future research should examine relationships between worry controllability and anxiety, depression, suicidal ideation, and attempts, within clinical samples and utilizing a variety of methodologies.
Keywords: adult; aged; anxiety disorder; article; cross-sectional study; demography; depression; disease association; female; female to male transgender; human; major clinical study; male; male to female transgender; negative syndrome; patient worry; patient-reported outcome; priority journal; prospective study; suicidal ideation; suicide attempt

Childhood maltreatment and age effects on depression and suicide risk among Canadian men - Rice, S.M.; Kealy, D.; Oliffe, J.L.; Seidler, Z.E.; Ogrodniczuk, J.S. (Psychiatry Research, 2018)
Keywords: adult; age; aged; article; bisexuality; Canadian; child abuse; child neglect; child sexual abuse; controlled study; depression; DSM-5; emotional abuse; homosexuality; human; job performance; major clinical study; male; middle aged; online system; Patient Health Questionnaire 9; physical abuse; priority journal; suicidal behavior; very elderly; young adult

Development and characterization of nine polymorphic microsatellite markers for the deep-sea scleractinian coral Deltocyathus magnificus using paired-end Illumina shotgun sequencing - Liu, S.-Y.V.; Cheng, Y.-R. (Molecular Biology Reports, 2018)
Deltocyathus magnificus is an azooxanthellae deep-sea scleractinian coral species that is distributed in the Indo-Pacific region. In order to investigate its genetic structure and connectivity, polymorphic microsatellite markers were isolated and tested on 37 individuals collected from the South China Sea. Twenty loci were selected and primers synthesized for further PCR testing. Nine of 20 were amplified successfully with polymorphism markers. The number of alleles detected in each locus ranged from 2 to 13. The expected and observed heterozygosities of these loci were 0.053–0.819 and 0.054–0.946, respectively. These nine novel polymorphic loci were used to reveal the genetic connectivity pattern among depths and geographic locations in the South China Sea.
Keywords: adult; allele; article; asexual reproduction; clinical article; coral; deep sea; female; gene mutation; gene structure; genetic association; geography; heterozygosity; human; human experiment; male; microsatellite marker; polymerase chain reaction; South China Sea

Estimating the Risk of Attempted Suicide among Sexual Minority Youths - Di Giacomo, E.; Krausz, M.; Colmegna, F.; Aspesi, F.; Clerici, M. (JAMA Pediatrics, 2018)
Importance Suicide is the second-leading cause of death among adolescents. Sexual minority individuals are at a higher risk of suicide and attempted suicide, but a precise and systematic evaluation of this risk among sexual minority youths has not been documented to our knowledge. Objective To examine the risk of attempted suicide among sexual minority adolescents, differentiating for each sexual minority group. Data Sources Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through April 30, 2017, with the following search terms: heterosexual, homosexual, bisexual, transgender, adolescents, teens, and attempted suicide. Study Selection Studies that reported attempted suicide in sexual minority adolescents compared with heterosexual peers were included. Thirty-five studies satisfied criteria for inclusion of 764 records identified. Data Extraction and Synthesis Pooled analyses were based on odds ratios (ORs), with relevant 95% CIs, weighting each study with inverse variance models with random effects. Risk of publication bias and analysis of heterogeneity through univariable and multivariable meta-regressions were also rated. Main Outcomes and Measures The evaluation of increased odds of attempted suicide among sexual minority youths compared with heterosexual peers. Results Thirty-five studies reported in 22 articles that involved a total of 2378987 heterosexual and 113468 sexual minority adolescents (age range, 12-20 years) were included in the analysis. Sexual minority youths were generally at higher risk of attempted suicide (OR, 3.50; 95% CI, 2.98-4.12; c 2 = 3074.01; P <.001; I 2 = 99%). If estimated in each sexual minority group, the OR was 3.71 in the homosexual group (95% CI, 3.15-4.37; c 2 = 825.20; P <.001; I 2 = 97%) and 4.87 in the bisexual group (95% CI, 4.76-4.98; c 2 = 980.02; P <.001; I 2 = 98%); transgender youths were described as an individual group in only 1 study, which reported an OR of 5.87 (95% CI, 3.51-9.82). Meta-regressions weighted for the study weight highlighted that the presence of young participants (12 years old) was associated with heterogeneity in the bisexual group, whereas the year of sampling was associated with heterogeneity in the whole group when combined with other covariates. Conclusions and Relevance Our findings suggest that youths with nonheterosexual identity have a significantly higher risk of life-threatening behavior compared with their heterosexual peers. Public awareness is important, and a careful evaluation of supportive strategies (eg, support programs, counseling, and destigmatizing efforts) should be part of education and public health planning.
Keywords: adolescent; adult; article; awareness; bisexuality; child; counseling; data extraction; education; Embase; female; heterosexuality; homosexuality; human; identity; juvenile; male; Medline; outcome assessment; PsycINFO; public health; publishing; risk assessment; school child; suicide attempt; synthesis; systematic review; transgender

The Synergistic Impact of Sexual Stigma and Psychosocial Well-Being on HIV Testing: A Mixed-Methods Study Among Nigerian Men who have Sex with Men - Rodriguez-Hart, C.; Bradley, C.; German, D.; Musci, R.; Orazulike, I.; Baral, S.; Liu, H.; Crowell, T.A.; Charurat, M.; Nowak, R.G. (AIDS and behavior, 2018)
Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013-February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake.
Keywords: adult; epidemiology; ethnology; evaluation study; human; Human immunodeficiency virus infection; latent class analysis; male; male homosexuality; mass screening; mental health; Nigeria; outpatient department; prospective study; psychology; qualitative research; sexual and gender minority; social stigma; suicidal ideation

The world was not built for us: Improving access to care for transgender youth - Bernstein, S.M.; Lewis, H.C. (Pediatrics, 2018)
Keywords: alcoholism; article; automutilation; depression; drug abuse; gender identity; harassment; health care system; human; LGBTQIA+ people; LGBT people; patient care; patient satisfaction; practice guideline; priority journal; risk factor; self concept; sexually transmitted disease; shared decision making; skin infection; soft tissue infection; substance abuse; suicide

Ethical issues in gender-affirming care for youth - Kimberly, L.L.; Folkers, K.M.; Friesen, P.; Sultan, D.; Quinn, G.P.; Bateman-House, A.; Parent, B.; Konnoth, C.; Janssen, A.; Shah, L.D.; Bluebond-Langner, R.; Salas-Humara, C. (Pediatrics, 2018)
Transgender and gender-nonconforming (TGNC) youth who suffer from gender dysphoria are at a substantially elevated risk of numerous adverse physical and psychosocial outcomes compared with their cisgender peers. Innovative treatment options used to support and affirm an individual's preferred gender identity can help resolve gender dysphoria and avoid many negative sequelae of nontreatment. Yet, despite advances in these relatively novel treatment options, which appear to be highly effective in addressing gender dysphoria and mitigating associated adverse outcomes, ethical challenges abound in ensuring that young patients receive appropriate, safe, affordable treatment and that access to this treatment is fair and equitable. Ethical considerations in gender-affirming care for TGNC youth span concerns about meeting the obligations to maximize treatment benefit to patients (beneficence), minimizing harm (nonmaleficence), supporting autonomy for pediatric patients during a time of rapid development, and addressing justice, including equitable access to care for TGNC youth. Moreover, although available data describing the use of gender-affirming treatment options are encouraging, and the risks of not treating TGNC youth with gender dysphoria are evident, little is known about the long-term effects of both hormonal and surgical interventions in this population. To support ethical decision-making about treatment options, we encourage the development of a comprehensive registry in the United States to track long-term patient outcomes. In the meantime, providers who work with TGNC youth and their families should endeavor to offer ethically sound, patient-centered, gender-affirming care based on the best currently available evidence.
Keywords: estrogen; gonadorelin agonist; testosterone; article; beneficence; child; ethical decision making; gender affirming care; gender dysphoria; gender identity; geographic distribution; health care access; health care cost; health insurance; homelessness; hormonal therapy; human; informed consent; injury; juvenile; mental health; outcome assessment; patient autonomy; patient care; pediatrics; poverty; priority journal; puberty; risk benefit analysis; self care; sexual exploitation; social behavior; social transition; stigma; suicide; United States; violence

Should Gender Reassignment Surgery be Publicly Funded? - Go, J.J. (Journal of bioethical inquiry, 2018)
Transgender people have among the highest rates of suicide attempts of any group in society, driven strongly by the perception that they do not belong in the sex of their physical body. Gender reassignment surgery (GRS) is a procedure that can change the transgender person's physical body to accord with their gender identity. The procedure raises important ethical and distributive justice concerns, given the controversy of whether it is a cosmetic or medical procedure and the economic costs associated with performing the procedure. This paper argues that there is a strong case for funding GRS as a matter of clinical necessity and justice. This paper will be divided in four key sections: First, the state of transgender health will be outlined, including the role of GRS and common objections to it. Second, a number of common objections to GRS will be analysed at the outset and shown to be unconvincing. Third, a constructive argument will be advanced, arguing that publicly funded GRS is clinically necessary, cost-effective, and demanded by principles of justice. Fourth, the paper will briefly discuss moralistic biases and why we demand a higher burden of justification for funding GRS compared with other analogous procedures.
Keywords: bioethics; economics; ethics; female; financial management; health care delivery; human; male; psychology; quality of life; sex reassignment; transgender

Transgender Women's Experiences with Stigma, Trauma, and Attempted Suicide in the Dominican Republic - Budhwani, H.; Hearld, K.R.; Milner, A.N.; Charow, R.; McGlaughlin, E.M.; Rodriguez-Lauzurique, M.; Rosario, S.; Paulino-Ramirez, R. (Suicide & life-threatening behavior, 2018)
Studies on attempted suicide in transgender populations, particularly those in resource-limited settings, are scarce. We examined the relationships between stigma, trauma, and suicide attempts in a national sample of transgender women from the Dominican Republic. Bivariate analysis examined differences between suicide attempters and nonattempters (n = 298). Multivariate analysis reported odds ratios with attempted suicide as the outcome (n = 260). About a quarter of respondents (23.9%) experienced sexual abuse, 12.3% were tortured, and 20.3% experienced a murder attempt. More than a quarter reported using illegal drugs. Independent sample t tests found significant differences between suicide attempters and nonattempters. Attempters were more likely to have experienced sexual abuse, psychological abuse, torture, and a murder attempt (p < .001 for all). Respondents who experienced psychological abuse had over three times higher odds of attempting suicide, compared to respondents who had not (OR = 3.203, p < .01). Experience with torture and attempted murder were associated with higher odds of attempting suicide (OR = 2.967, p < .05 and OR = 2.894, p < .05, respectively). Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are often not consistently enforced. Eliminating stigmatizing policies may reduce rates of negative health outcomes and subsequently improving population health.
Keywords: adult; child abuse survivor; Dominican Republic; epidemiology; female; human; male; multivariate analysis; needs assessment; odds ratio; psychology; social stigma; socioeconomics; statistics and numerical data; suicide attempt; torture; transgender

Greater suicide in LGBT youth - Carson, J. (Nature human behaviour, 2018)
Keywords: article; juvenile; suicide

Chinese sexual minority male adolescents’ suicidality and body mass index - Huang, Y.; Li, P.; Lai, Z.; Jia, X.; Xiao, D.; Wang, T.; Guo, L.; Lu, C. (International Journal of Environmental Research and Public Health, 2018)
Excess weight status may increase the risk of suicidality among sexual minority females, but few studies have examined this suicidality disparity in sexual minority males. This study examined the association between sexual minority status and suicide attempts in Chinese male adolescents and tested whether body mass index (BMI) had a moderating effect on that association. Data were collected from 7th to 12th graders from seven randomly selected provinces of China in the 2015 School-Based Chinese Adolescents Health Survey. In total, 72,409 male students completed the questionnaires regarding sexual attraction, self-reported weight and height, and suicide attempts. After adjustment for covariates, sexual minority status was associated with suicide attempts among male students (AOR = 1.74, 95% CI = 1.57–1.93). Stratification analyses showed that BMI category moderated this association; compared with the results before stratification analyses, sexual minority males who were obese had increased risk of suicide attempts (AOR = 2.15, 95% CI = 1.09–4.24), sexual minority males who were overweight had reduced odds of suicide attempts (AOR = 1.40, 95% CI = 1.01–1.92), and no significant association change was found in sexual minority males who were underweight (AOR = 1.82, 95% CI = 1.43–2.33). Our study indicated that BMI moderated the risk of suicide attempts in sexual minority males. Suicide prevention targeting sexual minority males should be focused on weight status disparity and the creation of a positive climate to reduce minority stressors due to body image.
Keywords: adolescent; adolescent obesity; adult; article; body height; body image; body mass; body weight; child; child psychiatry; China; Chinese; disease association; health survey; heterosexual male; high risk population; human; major clinical study; male; obese patient; prevalence; risk assessment; self report; sexual and gender minority; sexual attraction; sexual behavior; suicidal behavior; suicide attempt; underweight

Violence Victimization, Substance Use, and Suicide Risk Among Sexual Minority High School Students - United States, 2015-2017 - Johns, M.M.; Lowry, R.; Rasberry, C.N.; Dunville, R.; Robin, L.; Pampati, S.; Stone, D.M.; Mercer Kollar, L.M. (MMWR. Morbidity and mortality weekly report, 2018)
Youths identifying as lesbian, gay, bisexual, or another nonheterosexual identity (sexual minority youths) report more violence victimization, substance use, and suicide risk than do heterosexual youths (1). These disparities are generally attributed to minority stress (the process through which stigma directed toward sexual minorities influences health outcomes) (2,3). Sexual minority youths might experience negative outcomes associated with minority stress differently across sexual identities, but to date, no nationally representative study has examined differences in victimization, substance use, and suicide risk within sexual minority youth. Using pooled data from the 2015 and 2017 national Youth Risk Behavior Surveys (YRBS), relationships between sexual identity groups and victimization, substance use, and suicide risk were evaluated with sex-stratified logistic regression models. Compared with heterosexual students, bisexual females and all sexual minority males reported more victimization; lesbian and bisexual females reported more use of alcohol, cigarettes, and marijuana; and all sexual minority youths reported elevated high-risk substance use and suicide risk. Programmatic efforts to reduce and prevent victimization, substance use, and suicide risk among sexual minority youths might benefit from consideration of issues within group differences.
Keywords: adolescent; crime victim; drug dependence; female; human; male; psychology; questionnaire; risk; sexual and gender minority; statistics and numerical data; student; suicide; United States; violence

A media-based school intervention to reduce sexual orientation prejudice and its relationship to discrimination, bullying, and the mental health of lesbian, gay, and bisexual adolescents in western canada: A population-based evaluation - Burk, J.; Park, M.; Saewyc, E.M. (International Journal of Environmental Research and Public Health, 2018)
School interventions to address sexual orientation discrimination can be important tools for fostering inclusive school climate, and improving student wellbeing. In this study, we empirically evaluated a film-based intervention, Out in Schools, designed to reduce sexual orientation prejudice and foster inclusive school attitudes. Our evaluation mapped data about Out in Schools presentations onto student data from the random cluster-stratified, province-wide 2013 British Columbia Adolescent Health Survey (BCAHS) as well as potential confounding variables of Gay-Straight Alliance clubs (GSAs) and inclusive school policies. Outcome measures included past year sexual orientation discrimination, bullying, suicidal ideation, and school connectedness among lesbian, gay, and bisexual (LGB) and heterosexual (HET) students in grades 8 through 12 (ages 13 to 18; unweighted N = 21,075, weighted/scaled N = 184,821). Analyses used complex samples logistic regression, adjusted for sample design, conducted separately by gender and orientation. We found Out in Schools presentations were associated with reduced odds of LGB students experiencing discrimination, and both LGB and HET girl students being bullied or considering suicide, and increased levels of school connectedness, even after controlling for GSAs and policies. Out in Schools appears to have an additive contribution to reducing orientation prejudice and improving LGB and heterosexual student wellbeing within schools.
Keywords: adolescent; adult; article; bisexuality; bullying; Canada; controlled study; female; homosexual female; homosexual male; human; male; mental health; outcome assessment; population research; prejudice; psychological well-being; retrospective study; school; school connectedness; sexism; sexual bullying; sexual orientation prejudice; social behavior; social exclusion; student attitude; suicidal ideation; verbal bullying; videorecording

Military sexual trauma and suicidal behavior among National Guard personnel - White, K.L.; Harris, J.A.; Bryan, A.O.; Reynolds, M.; Fuessel-Herrmann, D.; Bryan, C.J. (Comprehensive Psychiatry, 2018)
Background: Preliminary evidence suggests military sexual trauma (MST) may be associated with increased risk for suicidal behaviors among active duty military personnel and veterans. Among National Guard personnel, a high-risk subgroup, MST and suicide risk have not received much empirical attention. Purpose: To examine the association of MST with suicide ideation and suicide attempts among National Guard personnel. Procedures: N = 997 National Guard personnel from Idaho and Utah participated in an anonymous online survey. Weighted analyses were conducted to minimize sampling bias. Main findings: 9% of participants had a history of MST (6% of men, 28% of women). Among participants reporting MST, 68% reported a service member perpetrator and 44% reported a civilian perpetrator (12% reported both). A history of MST was associated with significantly increased risk for lifetime suicide attempt. MST remained a significant predictor of lifetime suicide attempt even when restricting the sample to the subgroup with a history of suicidal thoughts (n = 257, 27% of full sample). When adjusting for premilitary sexual victimization, MST was no longer significantly associated with lifetime suicide attempts, but premilitary sexual victimization was. Conclusions: The rate of MST among National Guard personnel is comparable to rates among active duty military personnel, although the perpetrators of MST are less likely to be service members. MST is a risk factor for suicide attempts, but premilitary sexual victimization is a relatively stronger risk factor.
Keywords: adult; alcoholism; army; article; automutilation; bisexuality; female; heterosexuality; high risk population; homosexuality; human; Idaho; major clinical study; major depression; male; middle aged; offender; posttraumatic stress disorder; psychiatric diagnosis; sexual assault; sexual violence; military personnel; suicidal ideation; suicide attempt; Utah; veteran; young adult

Nonconforming Gender Expression and Associated Mental Distress and Substance Use among High School Students - Lowry, R.; Johns, M.M.; Gordon, A.R.; Austin, S.B.; Robin, L.E.; Kann, L.K. (JAMA Pediatrics, 2018)
Importance: The cultural roles and expectations attributed to individuals based on their sex often shape health behaviors and outcomes. Gender nonconformity (GNC) (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) is an underresearched area of adolescent health that is often linked to negative health outcomes. Objective: To examine the associations of GNC with mental distress and substance use among high school students. Design, Setting, and Participants: Cross-sectional study based on data from the Youth Risk Behavior Survey (YRBS) conducted in 2015. The setting was 3 large urban US school districts (2 in California and 1 in Florida). Participants were a racially/ethnically diverse population-based sample of 6082 high school students representative of all public school students in grades 9 through 12 attending these 3 school districts. Main Outcomes and Measures: Sex-stratified adjusted prevalence ratios (APRs) (adjusted for race/ethnicity, grade, and sexual identity) for high gender-nonconforming students (very/mostly/somewhat feminine male students or very/mostly/somewhat masculine female students) and moderate gender-nonconforming students (equally feminine and masculine students) relative to a referent group of low gender-nonconforming students (very/mostly/somewhat masculine male students or very/mostly/somewhat feminine female students). Results: Among 6082 high school students, 881 (15.9%) were white, 891 (19.1%) black, 3163 (55.1%) Hispanic, and 1008 (9.9%) other race/ethnicity. Among female students (2919 [50.0% of the study population]), moderate GNC was significantly associated with feeling sad and hopeless (APR, 1.22; 95% CI, 1.05-1.41), seriously considering attempting suicide (APR, 1.41; 95% CI, 1.14-1.74), and making a suicide plan (APR, 1.52; 95% CI, 1.22-1.89); however, substance use was not associated with GNC. Among male students (3139 [50.0% of the study population]), moderate GNC was associated with feeling sad and hopeless (APR, 1.55; 95% CI, 1.25-1.92); high GNC was associated with seriously considering attempting suicide (APR, 1.72; 95% CI, 1.16-2.56), making a suicide plan (APR, 1.79; 95% CI, 1.17-2.73), and attempting suicide (APR, 2.78; 95% CI, 1.75-4.40), as well as nonmedical use of prescription drugs (APR, 1.81; 95% CI, 1.23-2.67), cocaine use (APR, 2.84; 95% CI, 1.80-4.47), methamphetamine use (APR, 4.52; 95% CI, 2.68-7.61), heroin use (APR, 4.59; 95% CI, 2.48-8.47), and injection drug use (APR, 8.05; 95% CI, 4.41-14.70). Conclusions and Relevance: This study suggests mental distress is associated with GNC among female and male students. Substance use also appeared to be strongly associated with GNC among male students. These findings underscore and suggest the importance of implementing school-based programs to prevent substance use and promote student mental health that are inclusive of gender diversity in students..
Keywords: cocaine; diamorphine; methamphetamine; adolescent; adolescent health; alcohol consumption; article; cocaine dependence; disease association; distress syndrome; drug use; ethnicity; female; gender identity; high school student; human; major clinical study; male; methamphetamine dependence; outcome assessment; prescription drug misuse; prevalence; priority journal; race; sex difference; social psychology; substance use; suicide

Disparities in Health Risk Behaviors and Health Conditions Among Rhode Island Sexual Minority and Unsure High School Students - Jiang, Y.; Reilly-Chammat, R.; Cooper, T.; Viner-Brown, S. (The Journal of school health, 2018)
BACKGROUND: Sexual minority students have higher risk for health-related behaviors. We examined 5 domains including 34 health risk behaviors and health conditions among sexual minorities and unsure students in Rhode Island. We also included sexual contact of heterosexually identified students to capture heterosexually identified students who may be considered sexual minorities by their behavior. METHODS: We used the 2007-2015 Rhode Island Youth Risk Behavior Survey data (N = 14,264). We categorized students into 4 groups: students self-identified as heterosexual and reported no sexual contact with same sex only or both sexes (group 1); self-identified as heterosexual and reported sexual contact with same sex only or both sexes (group 2); self-identified as lesbian, gay, bisexual (group 3); and responded as unsure (group 4). We used multivariable adjusted logistic regression analyses to evaluate associations of sexual minority and unsure students with 34 health risk behaviors and health conditions accounting for complex sampling design. RESULTS: Students in groups 2-4 were more likely to engage in health-risk behaviors including violent behaviors, attempted suicide, substance use, and no physical activity than their peers. CONCLUSIONS: As sexual minority youth continue to report higher rates of health-related risk behaviors, targeted evidence-based prevention approaches must focus on reducing these risk behaviors among those youth.
Keywords: adolescent; adolescent behavior; behavioral risk factor surveillance system; comparative study; drug dependence; female; heterosexuality; high risk behavior; human; male; partner violence; psychology; Rhode Island; school; sexual and gender minority; sexuality; statistical model; student

Examining Mechanisms and Moderators of the Relationship Between Discriminatory Health Care Encounters and Attempted Suicide Among U.S. Transgender Help-Seekers - Romanelli, M.; Lu, W.; Lindsey, M.A. (Administration and policy in mental health, 2018)
This study examined how experiences of service denial and discrimination in three health care settings-doctors' offices, emergency rooms, and mental health clinics-might contribute to attempted suicide among transgender adults. Mechanisms of this relationship were examined, including treatment receipt and the use of substances to cope with mistreatment. Perceived emotional social support was also tested as a potential protective factor against the deleterious effects of service denial and discrimination on treatment receipt, substance use, and attempted suicide. The analysis included 4190 respondents from the National Transgender Discrimination Survey. Structural equation modeling was employed to test hypothesized relationships. Being denied a greater number of services and discriminated against in more settings were associated with lower levels of treatment receipt. Service denial was also correlated with increased rates of coping-motivated substance use and elevated rates of attempted suicide. Treatment receipt mediated the relationships between service denial/discrimination and substance use. Substance use mediated the relationship between treatment receipt and attempted suicide. Higher levels of support were protective to treatment receipt when denied services in one setting, but no longer retained protective effects when denied in two or three settings. Results have critical implications for service access and delivery and policies that protect transgender help-seekers in the health care system.
Keywords: adult; coping behavior; drug dependence; female; health care delivery; health care policy; health service; help seeking behavior; hospital emergency service; human; male; mental health service; middle aged; prejudice; protection; psychology; social support; statistics and numerical data; suicide attempt; transgender; United States; young adult

Do Anti-Bullying Laws Reduce In-School Victimization, Fear-based Absenteeism, and Suicidality for Lesbian, Gay, Bisexual, and Questioning Youth? - Seelman, K.L.; Walker, M.B. (Journal of youth and adolescence, 2018)
Lesbian, gay, and bisexual youth are at heightened risk for bullying and other forms of in-school victimization. Anti-bullying laws are a potential policy mechanism for addressing this issue, yet there has been little investigation of the impact of such policies for this population using generalizable samples or quasi-experimental designs. The current study explores whether the presence of state anti-bullying laws predicts lower likelihood of bullying victimization, fear-based absenteeism, in-school threats or injury with a weapon, and suicidality for lesbian, gay, bisexual, and questioning high school students in the United States. Based on Youth Risk Behavior Survey data across 22 states from 2005-2015, coupled with data about the presence of general and enumerated anti-bullying laws that include sexual orientation as a protected class, this study analyzes this topic using a quasi-experimental design (linear difference-in-difference models). The results indicate that lesbian, gay, bisexual, and questioning youth (particularly boys aged 15 or younger) experienced less bullying victimization in states with general or enumerated anti-bullying laws. There was modest evidence of a reduction in fear-based absenteeism among boys in states with such laws. However, there was little evidence of a relationship between such policies and in-school threats or injuries or suicidality. Further, lesbian, bisexual, and questioning girls' likelihood of victimization, absenteeism, or suicidality was generally not related to the presence of anti-bullying laws. The results suggest that general and enumerated anti-bullying laws may help reduce bullying victimization for gay, bisexual, and questioning boys.
Keywords: absenteeism; adolescent; bisexuality; bullying; child; controlled clinical trial (topic); crime victim; cross-sectional study; fear; female; human; legislation and jurisprudence; male; prevention and control; school; sexual and gender minority; statistics and numerical data; student; suicide; United States

Bias From Potentially Mischievous Responders on Large-Scale Estimates of Lesbian, Gay, Bisexual, or Questioning (LGBQ)-Heterosexual Youth Health Disparities - Cimpian, J.R.; Timmer, J.D.; Birkett, M.A.; Marro, R.L.; Turner, B.C.; Phillips, G.L. (American journal of public health, 2018)
OBJECTIVES: To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities are to the presence of potentially mischievous responders. METHODS: We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness. We estimated LGBQ-heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. RESULTS: Accounting for suspected mischievousness reduced estimates of the average LGBQ-heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. CONCLUSIONS: Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates.
Keywords: adolescent; adult; bisexuality; child; female; high risk behavior; homosexuality; human; male; questionnaire; statistical analysis; young adult

A transgender woman with intellectual disability and borderline personality disorder - Newman, W.J.; Barnhorst, A.V.; Landess, J.S. (American Journal of Psychiatry, 2018)
What diagnostic criterion is noted to be a central feature for each of the diagnoses of intellectual disability, borderline personality disorder, and gender dysphoria? A. Functional impairment. B. Emotional instability. C. Cognitive dysfunction. D. Neurotic traits. "Ms. A" is a 23-year-old transgender woman (assigned male at birth) with a history of fetal alcohol syndrome, mild intellectual disability (a full-scale IQ of 60), and borderline personality disorder. She received primary care and support through a regional intellectual disability agency but was also well known to psychiatric services for frequent violent outbursts and recurrent self-harm gestures. Ms. A's interactions with the mental health system began before age 5. She was adopted at birth into a home with other special-needs siblings. Early records reflect her difficulty with impulse control and anger management. By age 8, she was frequently wearing makeup or girls' clothing. By age 16, she consistently identified as female, wearing articles of women's clothing at school and soliciting her sisters' boyfriends. She made frequent self-harm gestures, such as cutting herself in the school hallway as well as threatening suicide, and she occasionally responded with violence toward peers or siblings who taunted her. During adolescence, Ms. A used social networking sites to find potential dates, often meeting older men in dangerous situations. Her high-risk behaviors continued; she often threatened "to turn myself into a girl" with knives, and she asked a man to "rape and kill me." By age 23, she had more than 15 referrals to mental health crisis units for behavioral issues, typically leading to inpatient hospitalizations. Despite support in her gender identity by her adoptive mother, she was unable to find services that provided hormone or surgical transition services for transgender youths and therefore had not received either intervention. Her main social service provider for intellectual disability also did not provide resources for transgender youths. Police last brought Ms. A to our facility after she threatened herself with scissors when a peer referred to her as a boy. She appeared tall and thin, looked younger than her age, and had a speech impediment with a significant lisp. She also exhibited dysmorphic facial features consistent with fetal alcohol syndrome, shoulder-length blonde hair, and faint beard growth. She frequently hunched over, hiding her face in her hands or behind her hair. She moved awkwardly and frequently missed social cues, unintentionally provoking anger from peers on the inpatient unit. On admission, Ms. A wore pink pajama pants and a loose-fitting T-shirt. She commonly wore pink T-shirts with adolescent slogans during her stay. She usually engaged readily and eagerly with staff and peers, but she was often childish in her mannerisms, consistent with intellectual disability Throughout her stay, she displayed limited frustration tolerance and frequently responded to misidentification of her gender with dramatic displays of emotion. Staff was unsure how to address Ms. A. Some were outwardly hostile. On one occasion, a staff member was overheard saying, "I'm not going to call that a she." Documentation from Ms. A's previous contacts with service agencies revealed unfamiliarity with transgender terminology and frequent dismissal of her transgender status. Of 15 intake notes, only two referred to her gender with correct pronouns; others documented male pronouns; some used both male and female pronouns; one avoided mentioning gender altogether. One writer noted, "He is trying to be transgender." Others frequently put the transgender modifier in quotation marks. Ms. As treatment team made several attempts to change her recorded gender on her hospital identification to prevent misidentification on subsequent admissions. Although gender misidentification was a trigger for many of her admissions, this was rarely included as part of her treatment plan. Most inpatient treatment focused on bolstering coping mechanisms before discharging her to the care of her service agency. The issue of her transgender status was often unaddressed, sometimes even actively avoided. Ms. A was unable to be discharged back to her adoptive mother's house. She and her mother sought a group home placement through the intellectual disability regional services. However, the local group homes were gender segregated, and the homes for females would not accept Ms. A, who often looked like a young man. Meetings between the family, the mental health team, and intellectual disability regional services revealed no known housing resources in the area that would meet her gender, intellectual, and mental health needs.
Keywords: adopted child; adult; anger; article; automutilation; borderline state; case report; clinical article; face dysmorphia; fetal alcohol syndrome; gender dysphoria; high risk behavior; hospitalization; human; impulse control disorder; intellectual impairment; male; male to female transgender; online dating; priority journal; violence; young adult

"Fear Runs Deep:" The Anticipated Needs of LGBT Older Adults in Long-Term Care - Putney, J.M.; Keary, S.; Hebert, N.; Krinsky, L.; Halmo, R. (Journal of gerontological social work, 2018)
OBJECTIVES: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults' anticipated needs and fears related to nursing homes and assisted living. METHODS: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. RESULTS: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. DISCUSSION: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.
Keywords: aged; cultural competence; fear; female; human; information processing; long term care; male; middle aged; needs assessment; organization and management; procedures; psychology; qualitative research; sexual and gender minority; very elderly

Trajectories of Suicidal Ideation from Adolescence to Adulthood: Does the History of Same-Sex Experience Matter? - Oi, K.; Wilkinson, L. (Archives of sexual behavior, 2018)
The fluidity of same-sex experience (SSE) can be conceptualized as both a risk and a resource that impacts suicidal ideation over time. Considering whether SSE occurs in adolescence, adulthood, or both, this study suggests that SSE in both adolescence and adulthood is associated with depression and low self-esteem throughout the life course, resulting in chronic susceptibility to suicidal ideation. Yet due to variation in both accumulation of risk and resources over time, trajectories of suicidal ideation during the transition to adulthood likely vary by timing of SSE. To test these hypotheses, we fit latent growth curve models to a gender-stratified sample taken from the National Longitudinal Study of Adolescent to Adult Health (7608 men, 8070 women). We created four groups of SSE: no SSE (6322 men, 5981 women), SSE in adolescence only (634 men, 480 women), SSE in adulthood only (372 men, 1081 women), and SSE in adolescence and adulthood (280 men, 528 women). Men and women with SSE in both life stages had the greatest risk of suicidal ideation in adolescence and in adulthood. Yet women with first SSE in adulthood had less of a decline in suicidal ideation over time, relative to those with no SSE and those with SSE in adolescence only, and this was partially due to higher depression and lower self-esteem. Results suggest greater support is needed for adolescents expressing non-normative sexualities and for those with first SSE in adulthood, a group that is more difficult to identify in schools.
Keywords: adolescent; adult; child psychology; depression; female; homosexuality; human; longitudinal study; male; psychology; self concept; sexual behavior; sexuality; suicidal ideation

Prevalence rates, reporting, and psychosocial correlates of stalking victimization: results from a three-sample cross-sectional study - Nobles, M.R.; Cramer, R.J.; Zottola, S.A.; Desmarais, S.L.; Gemberling, T.M.; Holley, S.R.; Wright, S. (Social psychiatry and psychiatric epidemiology, 2018)
PURPOSE: Public health and criminal justice stalking victimization data collection efforts are plagued by subjective definitions and lack of known psychosocial correlates. The present study assesses the question of stalking victimization prevalence among three groups. Psychosocial risk and protective factors associated with stalking victimization experiences were assessed. METHODS: Archival data (n = 2159) were drawn from a three-sample (i.e., U.S. nationwide sexual diversity special interest group, college student, and general population adult) cross-sectional survey of victimization, sexuality, and health. RESULTS: The range of endorsement of stalking-related victimization experiences was 13.0-47.9%. Reported perpetrators were both commonly known and unknown persons to the victim. Participants disclosed the victimization primarily to nobody or a family member/friend. Bivariate correlates of stalking victimization were female gender, Associates/Bachelor-level education, bisexual or other sexual orientation minority status, hypertension, diabetes, older age, higher weekly drug use, elevated trait aggression, higher cognitive reappraisal skills, lower rape myth acceptance, and elevated psychiatric symptoms. Logistic regression results showed the strongest factors in identifying elevated stalking victimization risk were: older age, elevated aggression, higher cognitive reappraisal skills, lesser low self-control, increased symptoms of suicidality and PTSD re-experiencing, and female and other gender minority status. CONCLUSIONS: Behavioral approaches to epidemiological and criminal justice stalking victimization are recommended. Victimization under reporting to healthcare and legal professionals were observed. Further research and prevention programming is needed to capitalize on data concerning personality and coping skills, sexual diversity, and trauma-related psychiatric symptoms.
Keywords: adolescent; adult; aggression; crime victim; cross-sectional study; epidemiology; female; friend; human; interpersonal communication; male; prevalence; psychology; sexual and gender minority; stalking; statistical model; statistics and numerical data; student; United States

Association of Exposure to Police Violence with Prevalence of Mental Health Symptoms among Urban Residents in the United States - Devylder, J.E.; Jun, H.-J.; Fedina, L.; Coleman, D.; Anglin, D.; Cogburn, C.; Link, B.; Barth, R.P. (JAMA Network Open, 2018)
Importance: Police violence is reportedly widespread in the United States and may pose a significant risk to public mental health. Objective: To examine the association between 12-month exposure to police violence and concurrent mental health symptoms independent of trauma history, crime involvement, and other forms of interpersonal violence exposure. Design, Setting, and Participants: This cross-sectional, general population survey study of 1221 eligible adults was conducted in Baltimore, Maryland, and New York City, New York, from October through December 2017. Participants were identified through Qualtrics panels, an internet-based survey administration service using quota sampling. Exposures: Past 12-month exposure to police violence, assessed using the Police Practices Inventory. Subtypes of violence exposure were coded according to the World Health Organization domains of violence (ie, physical, sexual, psychological, and neglectful). Main Outcomes and Measures: Current Kessler Screening Scale for Psychological Distress (K6) score, past 12-month psychotic experiences (World Health Organization Composite International Diagnostic Interview), and past 12-month suicidal ideation and attempts. Results: Of 1221 eligible participants, there were 1000 respondents (81.9% participation rate). The sample matched the adult population of included cities on race/ethnicity (non-Hispanic white, 339 [33.9%]; non-Hispanic black/African American, 390 [39.0%]; Hispanic/Latino, 178 [17.8%]; other, 93 [9.3%]), age (mean [SD], 39.8 [15.2] years), and gender (women, 600 [60.0%]; men, 394 [39.4%]; transgender, 6 [0.6%]) within 10% above or beyond 2010 census distributions. Twelve-month prevalence of police violence was 3.2% for sexual violence, 7.5% for physical violence without a weapon, 4.6% for physical violence with a weapon, 13.2% for psychological violence, and 14.9% for neglect. Police violence exposures were higher among men, people of color, and those identified as homosexual or transgender. Respondents reported suicidal ideation (9.1%), suicide attempts (3.1%), and psychotic experiences (20.6%). The mean (SD) K6 score was 5.8 (6.1). All mental health outcomes were associated with police violence exposure in adjusted logistic regression analyses. Physical violence with a weapon and sexual violence were associated with greater odds of psychotic experiences (odds ratio [95% CI]: 4.34 [2.05-9.18] for physical violence with a weapon; 6.61 [2.52-17.36] for sexual violence), suicide attempts (odds ratio [95% CI]: 7.30 [2.94-18.14] for physical violence with a weapon; 6.63 [2.64-16.64] for sexual violence), and suicidal ideation (odds ratio [95% CI]: 2.72 [1.30-5.68] for physical violence with a weapon; 3.76 [1.72-8.20] for sexual violence). Conclusions and Relevance: Police violence was commonly reported, especially among racial/ethnic and sexual minorities. Associations between violence and mental health outcomes did not appear to be explained by confounding factors and appeared to be especially pronounced for assaultive forms of violence..
Keywords: adult; African American; article; confounding variable; controlled study; emotional abuse; ethnicity; exposure to violence; female; Hispanic; homosexuality; human; Internet; interview; major clinical study; male; Maryland; mental disease; mental stress; neglect; New York; physical violence; police; prevalence; psychosis; race; sexual and gender minority; sexual violence; suicidal ideation; suicide attempt; transgender; urban population; weapon; World Health Organization

Combining intersectionality and syndemic theory to advance understandings of health inequities among Canadian gay, bisexual and other men who have sex with men - Ferlatte, O.; Salway, T.; Trussler, T.; Oliffe, J.L.; Gilbert, M. (Critical Public Health, 2018)
Syndemics (socially produced intertwined epidemics) of psychosocial issues have been shown empirically to increase the risk of HIV infection among gay, bisexual and other men who have sex with men (GBM). However, to intervene effectively identifying those who are most vulnerable is critically important. Using an intersectionality framework, this study analyzed data drawn from 8490 Canadian GBM respondents to an online survey to evaluate demographic factors associated with experiencing a syndemic. A multivariable regression model was used to identify demographic characteristics among those experiencing a syndemic of two or more issues. Then, applying an intersectionality framework, the sample was stratified by gay and bisexual men, and by men partnered with woman (whether they were gay, bisexual or other), and the multivariate analyses for demographic variables were repeated for each strata. Multivariate regression models found that men were more at risk of syndemics if they identified as gay, were single, young (< 30-years-old), did not have a university degree and were low-income earners (< $60,000 per year). On stratified analysis, variations were found between gay, bisexual and female-partnered men where gay men were at greater odds of reporting a syndemic. These results provide further evidence that syndemics of psychosocial issues increase the risk of HIV infection among GBM. More so, the occurrence of syndemics was dependent on every single variable investigated including ethnicity and income. As such, interventions to reduce the effects of syndemics should be targeted to those most at risk and address social and structural inequities.
Keywords: alcohol consumption; anxiety; article; bisexuality; Canada; demography; depression; education; ethnicity; gender identity; homosexual male; Human immunodeficiency virus infection; income; men who have sex with men; psychosocial disorder; social psychology; suicide

Socio-demographic, mental health and childhood adversity risk factors for self-harm and suicidal behaviour in College students in Northern Ireland - O'Neill, S.; McLafferty, M.; Ennis, E.; Lapsley, C.; Bjourson, T.; Armour, C.; Murphy, S.; Bunting, B.; Murray, E. (Journal of Affective Disorders, 2018)
Background: Prevalence estimates of suicidal behaviour in the college student population are consistently higher than rates for the general adult population. This study examines mental health disorders and childhood adversities as predictors of self-harm and suicidal behaviours. Methods: The Ulster University Student Wellbeing study commenced in September 2015 as part of the WHO World Mental Health Surveys International College Student Project. In Northern Ireland (NI) 739 students participated (462 female, 274 male and 3 other specified), with the WMH-CIDI used to examine psychopathology. Mean age was 21 years old. Results: Thirty-one percent endorsed suicidal ideation (24.3% of males and 36.9% of females) with almost 1 in 5 students having made a plan for suicide in the 12 months prior to the survey. Latent profile analysis revealed three profiles of childhood adversity (high, moderate, and low risk). Logistic regression analyses showed that there was an increased likelihood of all queried self-harm and suicidal behaviours in those who were not heterosexual orientation, and among those with either moderate or high levels of childhood adversities. Probable alcohol dependence was associated with a significantly increased likelihood of suicide attempt or self-harm with either a suicide plan or a suicide attempt. Limitations: Influences of self-report measures and the generalizability of the sample are discussed. Conclusions: Policies and strategies for early identification of those with mental illnesses or adversities that increase their risk, should be prioritised. It would also be useful to identify individuals at risk in secondary schools to allow for additional support to be offered to them during the key time of transitioning into higher education.
Keywords: adult; alcoholism; article; automutilation; college student; demography; female; homosexuality; human; logistic regression analysis; major clinical study; male; mental health; Northern Ireland; priority journal; risk factor; suicidal behavior; suicidal ideation; suicide attempt; young adult

Association between sexual minority status and suicidal behavior among Chinese adolescents: A moderated mediation model - Huang, Y.; Li, P.; Lai, Z.; Jia, X.; Xiao, D.; Wang, T.; Guo, L.; Lu, C. (Journal of Affective Disorders, 2018)
Background: Evidence shows sexual minority adolescents have a higher risk of suicidality than their heterosexual peers due to minority stressors or lack of social support, but it remains unclear how the combined effects of these influence factors impact suicidality in this population. In this study, we examine whether school victimization mediates association between sexual minority status and suicidal behavior of adolescents and explore whether such mediation is moderated by interpersonal relationships. Methods: We sampled a large nationally representative dataset comprising data collected from 7th to 12th graders (the 2015 School-based Chinese Adolescents Health Survey) using a multistage, stratified-cluster, random-sampling method. Our sample consisted of 123,459 students who completed questionnaires regarding their sexual minority status, suicidal ideation, suicide attempts, school victimization, classmate relations, and teacher–classmate relations. Results: Using a moderated mediation model, we found that school victimization mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.0296, 95% confidence intervals (CI) = 0.0259–0.0333) and suicide attempts (indirect effect = 0.0086, 95% CI = 0.0074–0.0100). These indirect effects were moderated by interpersonal relationships, and a greater effect was seen among sexual minority students with poor classmate or teacher–classmate relations. Limitations: Our study sample included only students attending school, and interpretation of the direction of the observed associations is limited due to the cross-sectional design. Conclusions: Interpersonal relationships moderate the indirect effects of school victimization on association between sexual minority status and suicidal behavior. Early intervention addressing school violence combined with improving the quality of relationships with school peers would help prevent suicidality in sexual minority adolescents.
Keywords: adolescent; adolescent behavior; alcohol consumption; article; Chinese; female; health behavior; heterosexuality; human; human relation; major clinical study; male; peer group; priority journal; questionnaire; sexual and gender minority; social status; suicidal ideation; suicide attempt

Relationship between illness representations and mental health among HIV-positive men who have sex with men - Mo, P.K.-H.; Lau, J.T.-F.; Wu, X. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2018)
Illness representations play a significant role on mental health across various health conditions. The present study explores the associations between illness representations of HIV and mental health (suicidal ideation and depression), and the mediation effects of emotional representations on the associations between cognitive representations and mental health among men who have sex with men who were newly diagnosed with HIV (ND-MSM) in China. A total of 225 ND-MSM were recruited from a non-governmental organisation and were invited to complete a cross-sectional survey. Results showed that 48.0% had suicidal ideation since HIV diagnosis and 48.4% scored higher than the cut-off for mild depression or above. Stepwise regression analyses showed that higher levels of emotional representations of HIV and lower levels of treatment control were associated with both suicidal ideation and depression. Emotional representations were shown to mediate the associations between some cognitive representations variables and mental health. Findings suggest that both cognitive and emotional representations of HIV were important factors of mental health among ND-MSM. Interventions to promote the mental health of ND-MSM are warranted and should seek to improve their cognitive and emotional representations of HIV.
Keywords: adult; anal intercourse; article; bisexuality; CD4 lymphocyte count; China; cross-sectional study; depression; Depression Anxiety Stress Scale; diseases; emotion; homosexuality; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; men who have sex with men; mental health; prevalence; priority journal; suicidal ideation; suicide attempt; thinking

Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth - Russell, S.T.; Pollitt, A.M.; Li, G.; Grossman, A.H. (Journal of Adolescent Health, 2018)
Purpose: This study aimed to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth. Methods: Data come from a community cohort sample of 129 transgender and gender nonconforming youth from three U.S. cities. We assessed chosen name use across multiple contexts and examined its association with depression, suicidal ideation, and suicidal behavior. Results: After adjusting for personal characteristics and social support, chosen name use in more contexts was associated with lower depression, suicidal ideation, and suicidal behavior. Depression, suicidal ideation, and suicidal behavior were lowest when chosen names could be used in all four contexts. Conclusion: For transgender youth who choose a name different from the one given at birth, use of their chosen name in multiple contexts affirms their gender identity and reduces mental health risks known to be high in this group.
Keywords: adolescent; adult; article; cohort analysis; community sample; depression; disease association; female; gender identity; human; major clinical study; male; mental health; social support; suicidal behavior; suicidal ideation; transgender; United States

Connections that moderate risk of non-suicidal self-injury among transgender and gender non-conforming youth - Taliaferro, L.A.; McMorris, B.J.; Eisenberg, M.E. (Psychiatry Research, 2018)
We examined associations between social connections and non-suicidal self-injury (NSSI) among transgender/gender non-conforming (TGNC) youth. Data came from the 2016 Minnesota Student Survey (N = 2168). Logistic regression analyses determined connectedness factors associated with any past-year NSSI and repetitive NSSI, as well as moderating effects of significant connectedness factors on different risk factors. Almost 55% of TGNC students engaged in NSSI, and 40% of self-injurers reported repetitive self-injury. Parent connectedness, connections to non-parental adults, and school safety emerged as robust protective factors. Strategies to prevent/reduce NSSI should focus on fostering connections with prosocial adults, and ensuring schools represent safe places.
Keywords: academic achievement; adolescent; article; automutilation; bullying; child; child parent relation; controlled study; depression; female; gender and sex; gender non conforming youth; health survey; human; major clinical study; male; priority journal; protection; risk factor; safety; sexism; social interaction; transgender

Towards a greater understanding of anxiety sensitivity across groups: The construct validity of the Anxiety Sensitivity Index-3 - Jardin, C.; Paulus, D.J.; Garey, L.; Kauffman, B.; Bakhshaie, J.; Manning, K.; Mayorga, N.A.; Zvolensky, M.J. (Psychiatry Research, 2018)
The present study examined the factor structure, invariance properties, reliability, and validity of the Anxiety Sensitivity Index-3 (ASI-3, Taylor et al., 2007). Participants were recruited from a large, ethnically diverse southwestern university (n = 3651; 77.8% female; Mage = 22.06 years; 28% non-Hispanic White). Findings supported a bifactor structure for the ASI-3, which demonstrated measurement invariance across sex, race/ethnicity, age, and sexual minority status. Furthermore, the ASI-3 demonstrated strong reliability and validity, with the anxiety sensitivity general and specific factors (physical, cognitive, and social concerns) evidencing unique patterns of relations with symptoms of depression, suicidality, anxious arousal, and social anxiety. Clinically, these findings generally support the validity of the ASI-3 in measuring anxiety sensitivity across sex, age, race/ethnicity, and sexual minority status. Future work is needed to better understand the role anxiety sensitivity plays within specific demographic subgroups, particularly African–Americans, Asian Americans, and sexual minorities.
Keywords: adult; African American; anxiety disorder; Anxiety Sensitivity Index; Anxiety Sensitivity Index 3; article; Asian American; Caucasian; construct validity; controlled study; cross-sectional study; ethnic difference; female; groups by age; heterosexuality; Hispanic; human; male; priority journal; reliability; sex difference; sexual and gender minority; university student; young adult

Creative health promotion methods for young LGBTIQA+ people - Bellamy, R. (Health Education Journal, 2018)
This paper evaluates the potential efficacy of using life writing to address mental health disparities and to promote health and well-being among young LGBTIQA+ persons. It examines the potential benefits of young LGBTIQA+ people engaging with life writing including memoir, autobiography, creative nonfiction, journaling and digital storytelling. These benefits include exploring identity and making sense of one’s experiences, unifying and empowering marginalised communities, providing people with agency, illuminating common experiences, and facilitating the exchange of resources and support. It evaluates current developments in literacy and English education and identifies an increasing trend towards neo-liberalism and economic discourses, potentially at the expense of providing opportunities for young people to develop creativity and engage in self-exploration. It discusses the author’s experiences in running life writing workshops with groups of LGBTIQA+ young people and offers suggestions on how to run similar workshops in educational and wider community settings, including possible prompts, modes of working and debriefing the participants. Overall, the findings suggest that life writing can be used to improve the health and well-being of LGBTIQA+ young people; however, the paper concludes that this sort of intervention needs to be run respectfully, strategically and with full awareness of how sensitive and traumatic the content may be that can emerge for young people. For this reason, the paper presents guidelines and recommendations to provide structure and support.
Keywords: article; automutilation; clinical effectiveness; creativity; curriculum; digital storytelling; economic aspect; education; harassment; health disparity; health promotion; human; LGBT people; life writing; literacy; mental health; narrative therapy; neo liberalism; parameters; pedagogics; personal experience; practice guideline; priority journal; self evaluation; storytelling; suicide; violence; wellbeing; writing

Psychiatry’s ethical involvement in gender-affirming care - D’Angelo, R. (Australasian Psychiatry, 2018)
Objective: To reflect on the role of psychiatry in authorising physical treatments for Gender Dysphoria and to examine the quality of evidence for gender-reassignment. Method: A Medline search was performed with the subject term “transsexualism” or “gender dysphoria” and “outcome” or “follow-up” in the title. Studies published from 2005 onwards reporting psychosocial outcomes were selected for review. Results: Most available evidence indicating positive outcomes for gender reassignment is of poor quality. The few studies with robust methodology suggest that some patients have poor outcomes and may be at risk of suicide. Conclusion: The author raises questions about the implications for ethical treatment of transgender individuals.
Keywords: anxiety; article; depression; Diagnostic and Statistical Manual of Mental Disorders; gender dysphoria; gender identity; human; mental disease; mental health; outcome assessment; psychiatry; quality of life; sex reassignment; social isolation; suicide; transgender; transsexualism; Western world

Transgender adolescent suicide behavior - Toomey, R.B.; Syvertsen, A.K.; Shramko, M. (Pediatrics, 2018)
OBJECTIVES: Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups. METHODS: Data from the Profiles of Student Life: Attitudes and Behaviors survey (N = 120 617 adolescents; ages 11-19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents' highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior. RESULTS: Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts. CONCLUSIONS: Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and nonbinary transgender adolescents.
Keywords: adolescent; adolescent behavior; adult; age; article; bisexuality; child; controlled study; educational status; ethnic difference; female; female to male transgender; gender identity; homosexual female; homosexual male; human; major clinical study; male; male to female transgender; nonheterosexual sexual orientation; prevalence; priority journal; risk; self report; sex difference; sexual orientation; suicidal behavior; suicide attempt; transgender; urban rural difference

Transgender adolescents and legal reform: How improved access to healthcare was achieved through medical, legal and community collaboration - Telfer, M.; Kelly, F.; Feldman, D.; Stone, G.; Robertson, R.; Poulakis, Z. (Journal of Paediatrics and Child Health, 2018)
Transgender children and adolescents face hardships in all domains of their lives, with many experiencing family rejection, social exclusion, discrimination, bullying and assaults. The mental health implications of these experiences include high rates of depression, anxiety, self-harm and attempted suicide. Gender-affirming social support and medical treatment has been shown to ameliorate the poor mental health outcomes of transgender youth, with those who are supported in their social and medical transition reporting rates of depression and self-worth equivalent to general population levels. Advocacy efforts that improve access to support and medical treatment are therefore likely to produce significant positive health and well-being outcomes for this vulnerable population. The transgender community in Australia identified the legal restrictions placed on children and adolescents accessing medical treatment as a significant barrier to positive psychological well-being. Australian law, unique internationally, required the parents of transgender adolescents to apply for court authorisation prior to the commencement of their child's gender-affirming medical treatment. Concerned by the harm created by this process, a coalition of experts, including transgender children, adolescents and their parents, as well as academic and clinical experts in the fields of law and medicine, was created to advocate for reform. Over a period of approximately 4 years, a collaborative process was undertaken, which ultimately led to law reform and improved access to medical treatment for the transgender community.
Keywords: anxiety disorder; article; assault; Australia; automutilation; bullying; child health care; community care; depression; health care access; health care planning; health care policy; human; legal aspect; personal experience; priority journal; psychological well-being; social discrimination; social support; suicide attempt; transgender; vulnerable population

Alleviating the mental health burden of structural discrimination and hate crimes: The role of psychiatrists - Hansen, H.; Riano, N.S.; Meadows, T.; Mangurian, C. (American Journal of Psychiatry, 2018)
Keywords: African American; anxiety disorder; article; Black person; community participation; cooperation; cultural safety; depression; disease burden; fear; harassment; hate; human; immigrant; law enforcement; mental health; mental health care; practice guideline; priority journal; psychiatrist; racism; religion; sexism; sexual orientation; social discrimination; social exclusion; social stigma; social support; suicide; trust; violence

Exploring Cross-Sectional Predictors of Suicide Ideation, Attempt, and Risk in a Large Online Sample of Transgender and Gender Nonconforming Youth and Young Adults - Kuper, L.E.; Adams, N.; Mustanski, B.S. (LGBT health, 2018)
PURPOSE: Rates of suicide ideation and attempt appear to be particularly high in the transgender and gender nonconforming (TGNC) population, yet little is known about which factors are the most salient contributors for TGNC young people and how these contributors vary across suicide-related outcomes. METHODS: Within the largest sample of TGNC young people to date (N = 1896; ages 14-30), we examined the contribution of demographics (age, assigned sex, gender identity, sexual orientation identity, race/ethnicity, and socioeconomic status), minority stress (gender-related affirmation, gender-related self-concept, victimization, and gender-affirming medical treatment desire/access), social support (from family and friends), and depressive symptoms in the cross-sectional prediction of three suicide-related outcomes: past-year attempt, past-year ideation, and a composite measure of suicide risk. RESULTS: Each set of factors explained significant variance in each outcome; however, only several predictors remained significant in each of the full models. Gender-related victimization and depressive symptoms were independent predictors for all three outcomes. Additional predictors varied across outcome. Age, male identity, sexual orientation-based victimization, and friend support were associated with suicide attempt. Age, queer identity, gender-related self-concept negativity, and family support were associated with suicide ideation, and pansexual identity and gender-related self-concept negativity were associated with positive suicide risk screen. CONCLUSION: Prevention and intervention efforts aimed at building support and positive self-concept, decreasing victimization, and treating depression are likely to partially reduce suicide ideation and attempt in TGNC adolescents and young adults. Comprehensive interventions with younger adolescents are particularly critical.
Keywords: adolescent; adult; cross-sectional study; female; human; Internet; male; psychology; risk factor; statistics and numerical data; suicidal ideation; suicide attempt; transgender; young adult

Measuring the Health of an Invisible Population: Lessons from the Colorado Transgender Health Survey - Christian, R.; Mellies, A.A.; Bui, A.G.; Lee, R.; Kattari, L.; Gray, C. (Journal of general internal medicine, 2018)
BACKGROUND: Transgender people, those whose gender identity does not match their sex assigned at birth, face barriers to receiving health care. These include discrimination, prohibitive cost, and difficulty finding transgender-inclusive providers. As transgender identities are not typically recognized in public health research, the ability to compare the health of the transgender population to the overall population is limited. OBJECTIVE: The Colorado Transgender Health Survey sought to explore current disparities and their effects on the health of transgender people in Colorado. DESIGN AND PARTICIPANTS: The Colorado Transgender Health Survey, based on the Behavioral Risk Factor Surveillance System (BRFSS), was developed by the Colorado Department of Public Health and Environment, transgender advocates, and transgender community members. Outreach was targeted to transgender-inclusive events and organizations. MAIN MEASURES: Responses to the 2014 Colorado Transgender Health Survey were compared side by side to Colorado 2014 BRFSS data. RESULTS: Results from 406 transgender or gender-nonconforming adults who live in Colorado were included in the analysis. Forty percent of respondents report delaying medical care due to cost, inadequate insurance, and/or fear of discrimination. Respondents report significant mental health concerns, with 43% reporting depression, 36% reporting suicidal thoughts, and 10% attempting suicide in the past year. Respondents with a transgender-inclusive provider were more likely to receive wellness exams (76 versus 48%), less likely to delay care due to discrimination (24 versus 42%), less depressed (38 versus 54%), and less likely to attempt suicide (7 versus 15%) than those without. CONCLUSIONS: The transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender-inclusive provider is associated with improved mental and physical health and health behaviors. Further population-level research and provider education on transgender health should to be incorporated into national efforts to eliminate health disparities.
Keywords: adolescent; adult; aged; behavioral risk factor surveillance system; Colorado; cultural competence; female; health care disparity; health disparity; health service; health services research; health status; health survey; human; male; mental health; middle aged; needs assessment; procedures; psychology; socioeconomics; transgender; transsexualism; young adult

Retrospective analysis of female unnatural deaths due to thermal injuries - Chaudhari, K.M.; Pathak, A.G.; Devraj, N.A.; Gadhari, R.K. (Indian Journal of Forensic Medicine and Toxicology, 2018)
Thermal injuries produced by the application of heat such as flame, radiant heat, contact with heated solid or liquid substances to the body surface. Thermal injury death is one of the leading causes of unnatural deaths in females in India. Retrospective analysis study at Department of Forensic Medicine and Toxicology, Shri Bhausaheb Hire Govt. Medical College, Dhule revealed 98 females out of all the 136 thermal injury deaths in the entire one year duration of 2016. The data of 98 female thermal injury deaths studied is obtained from the autopsy reports, hospital treatment records and from police inquest and panchnama of the deceased studied. We found 60 (61.22%) female victims in the age group of 21 to 40 years. 70 (80.62%) females were married. Accidents and suicides constituted 66 (67.35%) and 20 (20.41%) female thermal injury deaths respectively. Out of the 82 (83.67%) flame burn type of cases, in 52 (53.06%), kerosene was noted as the most common inflammable substance involved, almost invariably while cooking with kerosene stoves. 46 (46.94%) cases out of the 98 studied, survived between three to seven days. Septicemia due to thermal injuries comprised 61 (62.24%) female victims. Dying declarations were recorded in 47 (47.95%) thermal female victims before their deaths. Lack of immediate crime scene visit with immediate preparation of spot panchnama by police investigation officers in spot thermal deaths and the cases where dying declarations could not be recorded, makes the situation difficult to reach to the exact and factual opinion about manner of death, in almost similarly narrated accidental incidences of the young married burnt females.
Keywords: kerosene; accidental death; adolescent; adult; aged; article; autopsy; blast injury; burn; child; electric accident; female; homicide; human; hypovolemic shock; infant; male; medical ethics; retrospective study; scald; septicemia; single woman; suicide; survival time; thermal injury; transgender; widower

A Systematic Review of Family Victimization Experiences Among Sexual Minority Youth - McGeough, B.L.; Sterzing, P.R. (The journal of primary prevention, 2018)
Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences.
Keywords: adolescent; child sexual abuse; crime victim; domestic violence; ethnology; family; human; psychology; sexual and gender minority

Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans - Tucker, R.P.; Testa, R.J.; Simpson, T.L.; Shipherd, J.C.; Blosnich, J.R.; Lehavot, K. (Psychological medicine, 2018)
BACKGROUND: Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans. METHODS: This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey. RESULTS: Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks. CONCLUSIONS: Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.
Keywords: adult; depression; female; hormone substitution; human; male; middle aged; sex reassignment; statistics and numerical data; suicidal ideation; transgender; United States; veteran

Barriers to insurance coverage for transgender patients - Learmonth, C.; Viloria, R.; Lambert, C.; Goldhammer, H.; Keuroghlian, A.S. (American Journal of Obstetrics and Gynecology, 2018)
Transgender people report discrimination in access to health care that is associated with numerous poor health outcomes, including higher prevalence of HIV infection, substance use disorders, and suicide attempts. The field of obstetrics and gynecology is uniquely positioned to meet a wide range of health care needs for transgender people, and obstetrician-gynecologists can and ought to provide gender-affirming care for these patients. Despite growing evidence that gender-affirming care is both necessary and cost-effective, transgender patients continue to face barriers to securing insurance coverage, which prevents clinicians from practicing standards of care. The purpose of this article is to delineate the major barriers transgender patients face when seeking insurance reimbursement for services routinely available to cisgender (nontransgender) women.
Keywords: article; cost effectiveness analysis; decision making; electronic health record; health care access; health care cost; health care delivery; health care planning; health care policy; health care survey; help seeking behavior; human; insurance; legal aspect; medical society; medicare; patient care; priority journal; reimbursement; transgender

LGBT people and suicidality in youth: A qualitative study of perceptions of risk and protective circumstances - Rivers, I.; Gonzalez, C.; Nodin, N.; Peel, E.; Tyler, A. (Social Science and Medicine, 2018)
Evidence suggests that lesbian, gay, bisexual and trans (LGBT) people are more likely to attempt to take their own lives in their youth when compared to heterosexual and/or cisgender people. This study draws on in-depth interviews with 17 LGBT individuals living in England, and explores the narratives used by participants to better understand their perceptions of risk and protective circumstances to explain suicide attempts in youth. Using a Goffman-informed thematic analysis, results identified three key themes that were linked to attempts to end life in youth. The first theme considers the conflicts resulting from first disclosure of sexual orientation and/or gender identity/trans status and being ‘out’ to others. The second theme explores participants’ accounts of their concurrent mental health issues and how diagnoses of the mental health issues helped them make sense of their own experiences of attempted suicide. The final theme explores the experience of grieving over lost relationships and how that grief is received by others, including health professionals. Our results indicate that some LGBT individuals have effectively, although often arduously, navigated suicidal crises by utilising various approaches to coping. We provide a rich and layered picture of LGBT suicide risk in youth and potential resilience scenarios, although these are a reflection of our specific group of participants’ experiences and realities. We argue that it is important to understand how LGBT individuals with a history of suicide attempts narrate and make sense of their experiences in early life and we suggest that the early negative experiences continue to have an effect on LGBT adults today.
Keywords: adult; article; clinical article; disease association; England; female; gender identity; grief; human; LGBT people; male; perception; population risk; qualitative research; sexual orientation; suicide; suicide attempt

Accidental death in autoerotic maneuvers: Case series - Focardi, M.; Bugelli, V.; Defraia, B.; Gualco, B.; Norelli, G.-A. (Romanian Journal of Legal Medicine, 2018)
Literature describe relatively few studies about accidental death in autoerotic maneuvers. Authors report three new cases on this topic that involved adult male individuals. The purpose of the paper is to increase the knowledge and the classification of the phenomenon and give a contribution for the forensic medicine and psychiatric implications. The dynamics of the investigation of the scene, the autopsy finding and the examination of the medical history are particularly important for forensic professionals that must classify the event as a suicide, homicide or as an accidental event. The Authors describe the phenomenon also from the epidemiological point of view that shows a high prevalence of men, even if in Italy there are not official estimates. Last but not least the Authors and take in consideration and discussed about the existence in the subject of a para-physiological habitude or a real type of pathology as paraphiliac disorders (masochism, fetishism, travestic fetishism).
Keywords: butane; cannabis; cocaine; diazepam; psychotropic agent; sildenafil; accidental death; adult; article; asphyxia; autopsy; bisexuality; cadaver; case report; cause of death; clinical article; death; euphoria; hanging; heterosexuality; histology; homicide; human; human tissue; immunohistochemistry; Italy; male; masochism; masturbation; mesothelium; middle aged; pleasure; pornography; respiratory arrest; sexual asphyxia; skin defect; suicide; tongue disease

Self-Injurious Thoughts and Behaviors May Be More Common and Severe Among People Identifying as a Sexual Minority - Fox, K.R.; Hooley, J.M.; Smith, D.M.Y.; Ribeiro, J.D.; Huang, X.; Nock, M.K.; Franklin, J.C. (Behavior Therapy, 2018)
Research indicates that people who identify as a sexual minority are at higher risk of numerous negative outcomes, including self-injurious thoughts and behaviors (SITBs). The minority stress model proposes that people identifying as a sexual minority are at higher risk of these behaviors due to sexual orientation-specific stressors—however, it does not clarify whether SITBs will be more severe among these individuals. The present study tested whether SITBs are more common and more severe among people identifying as a sexual minority using several metrics, including frequency of SITB engagement, age of onset of SITB, desire to discontinue SITB engagement, and likelihood of future SITBs. Four independent research samples were used to test this model. Results were then combined and tested in an internal meta-analysis. Findings converge to indicate a longer and more severe course of SITB engagement among people identifying as a sexual minority. Future research is needed to replicate these findings and to advance the understanding of why this imbalance in risk and severity might exist, and how it can be prevented.
Keywords: adult; article; automutilation; controlled study; female; human; longitudinal study; major clinical study; male; onset age; retrospective study; self report; sexual and gender minority; sexual orientation; suicide

Factors associated with deaths from suicide in a French nationwide HIV-infected cohort - Hentzien, M.; Cabie, A.; Pugliese, P.; Billaud, É.; Poizot-Martin, I.; Duvivier, C.; Valantin, M.-A.; Kaladjian, A.; Dramé, M.; Bani-Sadr, F.; Dellamonica, P.; Cuzin, L.; et al. (HIV Medicine, 2018)
Objectives: People living with HIV (PLHIV) are at a higher risk of dying by suicide than the general population. Epidemiological data regarding determinants of suicide in PLHIV are scarce. The aim of this study was thus to study demographic, socio-economic, psychiatric history and immunovirological characteristics associated with death from suicide in the French multicenter Dat'AIDS cohort, from January 2000 to July 2013. Methods: This was a nested case–control study. All deceased PLHIV during the study period who died by suicide and whose medical files could be checked were included as cases. Controls were selected using incidence density sampling. For each case, up to four controls were selected among all actively followed PLHIV at the index date (date of death of cases). Controls were matched for time from HIV diagnosis (5-year periods) and clinical centre. Results: Seventy cases and 279 controls were included in the study. By multivariable analysis, the factors significantly associated with death from suicide were: not having children, active or substituted drug consumption, alcohol intake > 20 g/day or history of alcohol abuse, history of depressive disorder and/or of attempted suicide, and psychotropic drug intake. Conversely, age, gender, country of birth, positive HCV serology and HIV-related factors, such as AIDS status, use of combination antiretroviral therapy (cART), nadir and current CD4 counts and HIV viral load, were not significantly associated with the risk of death from suicide. Conclusions: In the cART era, HIV-related factors are not associated with a higher risk of suicide mortality. Suicide prevention measures should target PLHIV with the psychological morbidities observed in our cohort.
Keywords: antidepressant agent; anxiolytic agent; efavirenz; neuroleptic agent; psychotropic agent; adult; alcohol abuse; alcohol consumption; anxiety disorder; article; case control study; CD4 lymphocyte count; cohort analysis; controlled study; death; depression; drug use; female; France; hepatitis C; Hepatitis C virus; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; men who have sex with men; middle aged; multicenter study; priority journal; public hospital; schizophrenia; socioeconomics; suicide; suicide attempt; tobacco consumption; virus load

Gender differences in demographic and clinical characteristics of patients with opioid use disorder entering a comparative effectiveness medication trial - Campbell, A.N.C.; Barbosa-Leiker, C.; Hatch-Maillette, M.; Mennenga, S.E.; Pavlicova, M.; Scodes, J.; Saraiya, T.; Mitchell, S.G.; Rotrosen, J.; Novo, P.; Nunes, E.V.; Greenfield, S.F. (American Journal on Addictions, 2018)
Background & Objectives: We investigated gender differences in individuals with opioid use disorder (OUD) receiving inpatient services and entering a randomized controlled trial comparing extended-release naltrexone to buprenorphine. Methods: Participants (N = 570) provided demographic, substance use, and psychiatric information. Results: Women were significantly younger, more likely to identify as bisexual, live with a sexual partner, be financially dependent, and less likely employed. Women reported significantly greater psychiatric comorbidity and risk behaviors, shorter duration but similar age of onset of opioid use. Discussion/Conclusions: Findings underscore economic, psychiatric, and infection vulnerability among women with OUD. Scientific Significance: Interventions targeting these disparities should be explored, as women may face complicated treatment initiation, retention, and recovery. (Am J Addict 2018;27:465–470).
Keywords: buprenorphine; naltrexone; adult; age; anxiety disorder; article; bipolar disorder; bisexual female; bisexual male; Black person; Caucasian; clinical feature; comorbidity; comparative effectiveness; controlled study; demography; drug dependence treatment; employment; female; high risk behavior; human; injection drug user; major clinical study; major depression; male; multicenter study (topic); onset age; opiate addiction; panic; physical abuse; race difference; randomized controlled trial (topic); sex difference; sexual abuse; social status; suicidal behavior; transactional sex

The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study - McDermott, E.; Hughes, E.; Rawlings, V. (Journal of public health (Oxford, England), 2018)
Background: Lesbian, gay, bisexual and transgender (LGBT) youth have a higher risk of suicidality and self-harm than heterosexual youth populations but little is known about the underlying mechanisms. We aimed to investigate the social determinants of this mental health inequality. Methods: A two-stage sequential mixed method study was conducted. Firstly, 29 semi-structured interviews with LGBT youth (aged 13-25 years old) were completed. Data was analysed thematically. Stage 2 involved a self-completed questionnaire employing an online community-based sampling strategy (n = 789). Logistic regression analysis was performed to predict suicidality. Results: Five social determinants explained suicidal risk: (i) homophobia, biphobia or transphobia; (ii) sexual and gender norms; (iii) managing sexual and gender identities across multiple life domains; (iv) being unable to talk; (v) other life crises. Youth who were transgender (OR = 1.50, P < 0.022), disabled (OR = 2.23, P < 0.000), had self-harmed (OR = 7.45, P < 0.000), were affected by abuse (OR = 2.14, P < 0.000), and affected by not talking about their emotions (OR = 2.43, P < 0.044) were most likely to have planned or attempted suicide. Conclusions: Public health universal interventions that tackle bullying and discrimination in schools, and selected interventions that provide specific LGBT youth mental health support could reduce LGBT mental health inequalities in youth suicidality.
Keywords: adolescent; adult; female; homophobia; human; interview; male; psychology; questionnaire; risk factor; sexual and gender minority; social determinants of health; suicidal ideation; suicide attempt; young adult

Constructing and Expanding Suicide Narratives From Gay Men - Salway, T.; Gesink, D. (Qualitative health research, 2018)
In this study, we document life stories of gay men who attempted suicide as adults. Our goal is to expand the collection of narratives used to understand this persistent health inequity. We interviewed seven adult gay men, each of whom had attempted suicide two to four times, and identified five narratives. Pride narratives resist any connection between sexuality and suicide. Trauma-and-stress narratives enable coping through acknowledgment of sexual stigma as a fundamental trauma and cause of subsequent stress and suicidal thoughts. Memorial narratives prevent suicide by maintaining a strong sense of "permanent" identity. Outing narratives demand that the listener confronts the legacy of unjust practices of homosexual surveillance and "outing," which historically resulted in gay suicides. Finally, postgay narratives warn of the risk of suicide among older generations of gay men who feel erased from the goals of modern gay movements. Sexual identity concealment or invisibility featured prominently in all five narratives.
Keywords: adult; aged; coping behavior; human; male; male homosexuality; mental stress; middle aged; psychology; psychotrauma; risk factor; social stigma; suicide attempt

First genome-wide analysis of the endangered, endemic lichen Cetradonia linearis reveals isolation by distance and strong population structure - Allen, J.L.; McKenzie, S.K.; Sleith, R.S.; Alter, S.E. (American journal of botany, 2018)
PREMISE OF THE STUDY: Lichenized fungi are evolutionarily diverse and ecologically important, but little is known about the processes that drive their diversification and genetic differentiation. Distributions are often assumed to be wholly shaped by ecological requirements rather than dispersal limitations. Furthermore, although asexual and sexual reproductive structures are observable, the lack of information about recombination rates makes inferences about reproductive strategies difficult. We investigated the population genomics of Cetradonia linearis, a federally endangered lichen in the southern Appalachians of eastern North America, to test the relative contributions of environmental and geographic distance in shaping genetic structure, and to characterize the mating system and genome-wide recombination. METHODS: Whole-genome shotgun sequencing was conducted to generate data for 32 individuals of C. linearis. A reference genome was assembled, and reads from all samples were aligned to generate a set of single-nucleotide polymorphisms for further analyses. KEY RESULTS: We found evidence for low rates of recombination and for isolation by distance, but not for isolation by environment. The species is putatively unisexual, given that only one mating-type locus was found. Hindcast species distribution models and the distribution of genetic diversity support C. linearis having a larger range during the Last Glacial Maximum in the southern portion of its current extent. CONCLUSIONS: Our findings contribute to the understanding of factors that shape genetic diversity in C. linearis and in fungi more broadly. Because all populations are highly genetically differentiated, the extirpation of any population would mean the loss of unique genetic diversity; therefore, our results support the continued conservation of this species.
Keywords: endangered species; fungal genome; genetic variation; genetics; genome-wide association study; lichen (organism); physiology; population dynamics; reproduction; sequence alignment; single nucleotide polymorphism; United States

Mindfulness and other psycho-social resources protective against mental illness and suicidality among gay men - Wang, J.; Häusermann, M.; Ambresin, A.-E. (Frontiers in Psychiatry, 2018)
Background: There is considerable evidence of health disparities among gay men characterized by higher levels of stress and distress. Psycho-social resources have been linked to numerous positive health outcomes and shown to act as buffers in the stress-distress pathway. Methods: With data from the 3rd Geneva Gay Men's Health Survey carried out in 2011 using time-space sampling (n = 428), a relatively elaborate profile of 14 psycho-social resources-including mindfulness-is presented. Using their original scores, latent class analysis created an index variable dividing the respondents into meaningful groups. Psycho-social resources-the index variable as well as each resource individually-were then compared to two recent outcomes-i.e., serious mental illness in the past 4 weeks and short-term disability in the past 2 weeks-using a series of logistic regression models, controlling for all other psycho-social resources and socio-demographic confounders. To assess their potential role as buffers, a similar series of logistic regression models were erected using victimization and three outcomes-i.e., major depression, suicidal ideation, and suicide attempt-in the past 12 months. Results: According to the latent class analyses, (1) 5.1% of this sample had a low level of psycho-social resources (i.e., one standard deviation (SD) below the group means), (2) 25.2% a medium-low level, (3) 47.4% a medium level (i.e., at the group means), and (4) 22.2% a high level of psycho-social resources (i.e., one SD above the group means). Psycho-social resources appeared to strongly protect against recent mental morbidity and buffer against the impact of victimization on major depression and suicidality in the past 12 months, reducing the adjusted odds ratios below statistical significance. The explained variance and the individual psycho-social resources which remained independent in the models differed for each outcome. Conclusions: There may be disparities in several psycho-social resources among gay men, and as strong compensatory and protective factors, they may explain in part the well-established disparities in stress and distress in this population. While multiple psycho-social resources should be promoted in this population, gay men under 25 years should receive particular attention as all three disparities are most pronounced in this age group.
Keywords: adult; article; controlled study; cross-sectional study; demography; distress syndrome; homosexual male; human; latent class analysis; major depression; male; mindfulness; social psychology; physiological stress; suicidal ideation; suicide attempt

On hate crime victimization: Rates, types, and links with suicide risk among sexual orientation minority special interest group members - Cramer, R.J.; Wright, S.; Long, M.M.; Kapusta, N.D.; Nobles, M.R.; Gemberling, T.M.; Wechsler, H.J. (Journal of Trauma and Dissociation, 2018)
Hate crimes remain pressing traumatic events for sexual orientation minority adults. Previous literature documents patterns in which hate crime victimization is associated with elevated risk for poor mental health. The present paper held 2 aims to advance literature. First, we investigated the rates and types of hate crime victimization among sexual orientation minority adults. Second, adopting a mental health amplification risk model, we evaluated whether symptoms of depression, impulsivity, or post-traumatic stress exacerbated the hate crime victimization–suicide risk link. Participants were 521 adult sexual orientation minority-identifying members of the National Coalition for Sexual Freedom (i.e., a bondage and discipline, and sadomasochism-identifying sexuality special interest group). Participants completed demographic and mental health inventories via online administration. Results showed: (1) low rates of total lifetime hate crime victimization and (2) higher rates of interpersonal violence compared to property crime victimization within the sample. Regression results showed: (1) independent positive main effects of all 3 mental health symptom categories with suicide risk; (2) an interaction pattern in which impulsivity was positively associated with suicide risk for non-victims; and (3) an interaction pattern in which post-traumatic stress was positively associated with suicide risk for hate crime victims and non-victims. Results are discussed concerning implications for trauma-informed mental healthcare, mental health amplification models, and hate crime and suicide prevention policies.
Keywords: article; avoidance behavior; bisexuality; controlled study; depression; follow up; human; impulsiveness; LGBT people; major clinical study; mental health; posttraumatic stress disorder; prevalence; priority journal; risk factor; sexual assault; sexual orientation; suicide

Sexual minority status and suicidal behaviour among Chinese adolescents: A nationally representative cross-sectional study - Huang, Y.; Li, P.; Guo, L.; Gao, X.; Xu, Y.; Huang, G.; Deng, X.; Lu, C. (BMJ Open, 2018)
Objectives Suicidality among sexual minority adolescents has generated worldwide concern in recent decades, and previous Western studies have demonstrated that sexual minority status is associated with adolescent suicidality. However, whether this association exists in Chinese adolescents remains largely unknown. This study aimed to estimate the associations between sexual minority status and suicidal behaviour among Chinese adolescents. Design Cross-sectional survey. Setting A total of 506 high schools in 7 provinces of China. Participants A total of 150 822 students in grades 7-12 who completed the questionnaires (response rate of 95.9%) were included. Main outcome measures Suicidal ideation and suicide attempts were used to measure suicidal behaviour, and sexual attraction (opposite sex, same sex or both sex) was used as a measure for sexual minority status. Results Of the 150 822 adolescents analysed, 4.1% self-reported as sexual minorities and 17.3% were unsure. Compared with heterosexual and unsure adolescents, same-sex romantic attraction (SSA) and both-sex romantic attraction (BSA) adolescents reported a higher prevalence of past-year suicidal ideation (SSA: 21.6% for males and 30.4% for females; BSA: 34.7% for males and 42.3% for females) and suicide attempts (SSA: 6.9% for males and 8.9% for females; BSA: 12.2% for males and 10.9% for females). After adjustment for covariates, SSA and BSA adolescents were more likely to have past-year suicidal ideation and suicide attempts than their heterosexual and unsure peers. BSA adolescents reported the highest risk of suicidal ideation (males: adjusted OR (AOR) 2.42, 95% CI 2.03 to 2.88; females: AOR 2.61, 95% CI 2.41 to 2.82) and suicide attempts (males: AOR 3.83, 95% CI 2.85 to 5.14; females: AOR 2.59, 95% CI 2.19 to 3.06). Conclusions Our study suggested that Chinese sexual minority adolescents were at increased risk of suicidality, and those with BSA had an especially high risk in this population. These findings emphasised the urgent need to develop targeted interventions to effectively address suicide-related problems among Chinese sexual minority adolescents.
Keywords: adolescent; adolescent behavior; adolescent sexual behavior; adolescent smoking; alcohol consumption; article; both sex romantic attraction; bullying; Chinese; comparative study; controlled study; cross-sectional study; female; heterosexuality; high risk behavior; high school; homosexuality; human; major clinical study; male; prevalence; same sex romantic attraction; sexual and gender minority; suicidal behavior; suicidal ideation; suicide attempt; transgender; underage drinking

Relation between sexual and gender minority status and suicide attempts among veterans seeking treatment for military sexual trauma - Sexton, M.B.; Davis, M.T.; Anderson, R.E.; Bennett, D.C.; Sparapani, E.; Porter, K.E. (Psychological services, 2018)
There is limited study of suicidal behaviors among veterans identifying as sexual and gender minorities (SGMs), despite previous research indicating rates of suicide attempts are high within civilian SGM populations. Further, some research incorporating military service members suggests those identifying as SGMs are disproportionately exposed to military sexual trauma (MST), an additional risk factor for negative psychiatric sequelae. To address health care research disparities among minority veterans (i.e., women, those endorsing MST, SGMs), we examined presentations of veterans (N = 277) who attended initial consultation appointments for MST-related treatment and completed a semistructured clinical interview including demographic characteristics, history of suicide attempts (HSA), and a diagnostic evaluation. Twenty-eight (10.1%) veterans identified as SGMs. SGM/non-SGM groups were contrasted on suicidal and psychiatric morbidity outcomes. Overall, endorsement of HSA was high (30.7%). Despite similar clinical profiles, 53.6% of veterans who identified as SGM endorsed HSA in contrast with 28.1% of peers identifying as heterosexual and nontransgender, a significant effect of small-to-moderate size. Findings suggest assessment and clinical management of suicidality is of critical importance for clinicians providing services to veterans pursuing recovery from MST, generally, and may be especially so when delivering care to SGM. Further, results underscore the need for culturally competent delivery of trauma-focused interventions. (PsycINFO Database Record
Keywords: crime victim; female; human; male; posttraumatic stress disorder; psychology; risk factor; sex factor; sexual and gender minority; sexual crime; military personnel; suicidal ideation; suicide attempt; transcultural care; veteran

Sexual orientation, gender, and attempted suicide among adolescent psychiatric inpatients - DeCou, C.R.; Lynch, S.M. (Psychological services, 2018)
Lesbian, gay, bisexual, and queer (LGBQ) and female youth report disproportionately high rates of attempted suicide. Previous studies have not addressed the association between sexual orientation, gender, and attempted suicide among adolescent psychiatric inpatients. This study examined LGBQ orientation as a correlate of attempted suicide above and beyond other risk factors (e.g., age, rurality, trauma exposure, psychopathology), and also examined the interaction between gender and sexual orientation with regard to attempted suicide. We conducted a chart review study that included 550 adolescent psychiatric inpatients admitted to a public psychiatric hospital. Adolescents completed standardized intake assessments and self-report measures of sociodemographics, history of attempted suicide, psychopathology, and trauma history. Sexual orientation, gender, and their interaction were evaluated as predictors of attempted suicide using sequential logistic regression. LGBQ youth were more than 3 times more likely (odds ratio [OR] = 3.08) than non-LGBQ peers to have attempted suicide, and female youth were more than twice as likely to have attempted suicide compared with male patients (OR = 2.44). There was not a significant LGBQ orientation by gender interaction. These findings demonstrate the importance of LGBQ orientation and female gender as risk factors for suicidal behavior in a sample of adolescent psychiatric inpatients. Although limited by the self-report and retrospective nature of the data collected, these findings suggest the importance of initial and ongoing assessment of gender, sexual orientation, and suicidality in inpatient youth and the need for additional research to inform effective intervention efforts in this high-risk population. (PsycINFO Database Record
Keywords: adolescent; child; female; gender identity; hospital patient; human; male; mental disease; psychology; risk factor; sex factor; sexual and gender minority; sexuality; suicide attempt

Homelessness, Mental Health and Suicidality Among LGBTQ Youth Accessing Crisis Services - Rhoades, H.; Rusow, J.A.; Bond, D.; Lanteigne, A.; Fulginiti, A.; Goldbach, J.T. (Child psychiatry and human development, 2018)
LGBTQ youth experience increased risks of homelessness, mental health disorder symptoms, and suicidality. Utilizing data from LGBTQ youth contacting a suicide crisis services organization, this study examined: (a) rates of homelessness among crisis services users, (b) the relationship between disclosure of LGBTQ identity to parents and parental rejection and homelessness, and (c) the relationship between homelessness and mental health disorder outcomes and suicidality. A nationwide sample of LGBTQ youth was recruited for a confidential online survey from an LGBTQ-focused crisis services hotline. Overall, nearly one-third of youth contacting the crisis services hotline had experienced lifetime homelessness, and those who had disclosed their LGBTQ identity to parents or experienced parental rejection because of LGBTQ status experienced higher rates of homelessness. Youth with homelessness experiences reported more symptoms of several mental health disorders and higher rates of suicidality. Suggestions for service providers are discussed.
Keywords: adolescent; child; female; homeless person; hotline; human; male; mental disease; mental health; psychology; questionnaire; sexual and gender minority; suicidal ideation; suicide; young adult

Religion, Sexual Orientation, and Suicide Attempts Among a Sample of Suicidal Adolescents - Shearer, A.; Russon, J.; Herres, J.; Wong, A.; Jacobs, C.; Diamond, G.M.; Diamond, G.S. (Suicide & life-threatening behavior, 2018)
Despite condemnation of same-sex attraction by certain religious groups, few studies have explored the relationship between religion, same-sex attraction, and suicidality. This study examined the moderating effect of same-sex attraction on the relationship between parent/adolescent religiosity and suicide ideation/attempts in a suicidal adolescent sample (N = 129). Linear and negative binomial regressions tested the effects of a two-way dichotomous (same-sex attraction, yes/no) by continuous (religiosity) interaction on ideation and attempts, respectively. The interaction was not significant for ideation. However, high religiosity was associated with more attempts in youth reporting same-sex attraction but fewer attempts in those reporting opposite-sex attraction only.
Keywords: adolescent; epidemiology; female; human; male; psychology; religion; risk factor; sexual behavior; statistics and numerical data; suicidal ideation; suicide attempt; United States

Mind the gap: predicting the positive mental health of adult sexual minority Canadians - Peter, T. (Health promotion international, 2018)
The goal of the study is to investigate possible predictors of positive mental health, and whether they differ across sexual identity adult groups. Using data from the 2012 Canadian Community Health Survey on Mental Health, multivariate analyses were conducted, including interaction terms, to assess the effects of sexual orientation on various mental illness, health-risk behaviors, and sociological indicators and their correlations with positive mental health. Substantial effect sizes were observed across all sexual identity groups for psychological distress, social provisions and sense of belonging in terms of their influence on positive mental health. However, various mental health disorders, suicidality, and whether or not care needs were being met varied considerably in the disaggregated analysis, suggesting that there are key differences among sexual minority groups when it comes to predicting positive mental health. This study represents perhaps the largest population-based analysis of positive mental health, which is both theoretically informed and psychometrically verified, on sexual minority adults. Findings raise important concerns regarding the lower than average levels of positive mental health for all sexual minorities, which may be explained, at least in part, to the health care system's tendency to focus primarily on individual treatment needs rather than broader socio-structural aspects within a mental health promotion framework.
Keywords: Canada; cross-sectional study; female; health survey; human; male; mental disease; mental health; mental stress; middle aged; psychology; sexual and gender minority; statistics and numerical data

Suicide in sexual minority populations: A systematic review of evidence-based studies - Yıldız, E. (Archives of psychiatric nursing, 2018)
Sexual minority populations are exposed to more forms of distress than heterosexual individuals, thereby increasing the risk of suicidal behavior. It therefore seems surprising that suicidal behavior in sexual minorities is not sufficiently addressed in the nursing literature.The aim of this review was to integrate evidence-based knowledge and experiences related to suicide in sexual minorities into the nursing literature. This study has been conducted according to PRISMA guidelines, which contains a basic systematic screening process. Fourteen articles met the research criteria. The evaluation encompassed 4 themes: 1) Suicide attempts; 2) Thoughts of suicide; 3) Suicide attempts and completed suicide; 4) Suicidal thoughts and suicide attempts. Most studies focused on the dimensions of attempted suicide. The key finding was that young people in sexual minority groups exhibit more suicidal ideation, more suicide attempts and are more at risk of completed suicide than heterosexual individuals. Family-centered care for young people can therefore be one of the basic principles of nursing practice. Nurses can routinely ask adolescents about their sexual orientation and identity to provide appropriate assessment and care. Additionally, nurses can use educational, counseling, case manager and therapist roles to avoid negative experiences such as homophobia, stigmatization and the discrimination of sexual minorities.
Keywords: evidence based practice; human; nurse attitude; risk factor; sexual and gender minority; suicidal ideation; suicide attempt

Suicidal ideation and suicide attempts in persons with gender dysphoria - García-Vega, E.; Camero, A.; Fernández, M.; Villaverde, A. (Psicothema, 2018)
BACKGROUND: The little research there is about suicidal behaviour in those with gender dysphoria indicates that they are at a much higher risk of death by suicide and suicidal behaviour than the general population. The objective of this research is to analyse the prevalence of suicidal ideation and suicide attempts reported by people who attended consultations at the Gender Identity Treatment Unit between 2007 and 2017 presenting complaints related to gender dysphoria. METHOD: An ex-post facto study with a sample of 151 people who were clients at the unit, 97 in the male to female trans group, 54 female to male. Clinical evaluations were carried out assessing variables of suicidal ideation and attempts, along with a possible psychiatric diagnosis. RESULTS: Almost half (48.3%) reported suicidal ideation, 23.8% had attempted suicide. CONCLUSIONS: There are higher levels of suicidal ideation and suicide attempts in people with gender dysphoria than in the general population. No differences were seen between groups in terms of gender/sex. Psychiatric morbidity was not an influential variable for suicidal behaviour. This suggests that suicidal ideation is one of the best indicators of the risk of suicidal behaviours.
Keywords: adolescent; adult; aged; child; complication; female; gender dysphoria; human; male; middle aged; psychology; statistics and numerical data; suicidal ideation; suicide attempt; young adult

Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men - O'Cleirigh, C.; Pantalone, D.W.; Batchelder, A.W.; Hatzenbuehler, M.L.; Marquez, S.M.; Grasso, C.; Safren, S.A.; Mayer, K.H. (Journal of behavioral medicine, 2018)
Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether sexual minority specific syndemic indicators were associated with higher health care costs, health care utilization, or the risk of being HIV-infected. Health care consumers at a community health center (N = 1211) completed a brief screening questionnaire collected over 12 months. Self-reported data were linked with participants' clinical billing records. Adjusted logistic regression models identified that four syndemic indicators (suicidality, substance use, childhood sexual abuse, and intimate partner violence) were each significantly related to each other. Multiple syndemics significantly predicted higher medical care utilization and cost, and were associated with 2.5 times the risk of being HIV-infected (OR 2.49, 95% CI 1.45-4.25). Syndemic indicators did not significantly predict the number of mental health visits or costs per patient. These results confirm and extend earlier findings by relating syndemics to health services use and costs for sexual minority men.
Keywords: adult; child abuse survivor; complication; drug dependence; economics; health care cost; human; Human immunodeficiency virus infection; male; patient attitude; risk factor; sexual and gender minority; statistical model; statistics and numerical data; suicidal ideation; young adult

Nonsuicidal Self-Injury Among a Representative Sample of US Adolescents, 2015 - Monto, M.A.; McRee, N.; Deryck, F.S. (American journal of public health, 2018)
OBJECTIVES: To provide prevalence estimates of adolescent nonsuicidal self-injury (NSSI) based on large, representative, nonclinical samples of high-school students, and to explore gender differences in health risks associated with NSSI. METHODS: We used 2015 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System data to estimate the prevalence of self-injury and variables potentially associated with self-injury for high-school-age boys (n = 32 150) and girls (n = 32 521) in 11 US states. We used logistic regression analysis to consider associations between NSSI and other health risks. RESULTS: Rates of boys reporting purposefully hurting themselves without wanting to die over the past 12 months ranged from 6.4% (Delaware) to 14.8% (Nevada). Rates for girls varied from 17.7% (Delaware) to 30.8% (Idaho). Rates declined with age and varied by race and ethnicity. Depression; suicidal thoughts, plans, and attempts; sexual minority status; being electronically bullied; smoking; and substance use were associated with NSSI. There were minor differences in associations between NSSI and health risk variables by gender. CONCLUSIONS: Nonclinical populations of adolescents are at high risk for self-injury. Nonsuicidal self-injury was higher among girls than among boys, but patterns of association with other health risks were similar.
Keywords: adolescent; automutilation; cross-sectional study; female; high risk behavior; human; male; prevalence; risk factor; United States

Retrospective Cyberbullying and Suicide Ideation: The Mediating Roles of Depressive Symptoms, Perceived Burdensomeness, and Thwarted Belongingness - Mitchell, S.M.; Seegan, P.L.; Roush, J.F.; Brown, S.L.; Sustaíta, M.A.; Cukrowicz, K.C. (Journal of interpersonal violence, 2018)
Research suggests that being cyberbullied is associated with increased risk for suicide ideation; however, few studies have examined the underlying mechanisms of this relation, and fewer have examined this relation within a theory of suicide. Specifically, the interpersonal theory of suicide posits that thwarted belongingness (indicated by loneliness and a lack of reciprocal caring relationships) and perceived burdensomeness (indicated by feelings of liability and self-hatred) increase risk for suicide ideation. The current study aimed to examine depressive symptoms, thwarted belongingness, and perceived burdensomeness as mediators between intensity of being cyberbullied and suicide ideation. Participants were college students ( N = 348) who completed assessments of retrospective peer victimization, thwarted interpersonal needs (i.e., thwarted belongingness and perceived burdensomeness), and suicide ideation. The results indicated that after adjusting for sexual orientation, depressive symptoms significantly mediated the relation between intensity of being cyberbullied and suicide ideation. Furthermore, depressive symptoms and perceived burdensomeness serially mediated the relation between intensity of being cyberbullied and suicide ideation; however, thwarted belongingness was not a significant mediator. Clinical and research implications, limitations, and future directions are discussed.
Keywords: adolescent; crime victim; depression; female; human; human relation; loneliness; male; psychology; retrospective study; student; suicidal ideation; young adult

Trend Disparities in Emotional Distress and Suicidality Among Sexual Minority and Heterosexual Minnesota Adolescents From 1998 to 2010 - Porta, C.M.; Watson, R.J.; Doull, M.; Eisenberg, M.E.; Grumdahl, N.; Saewyc, E. (The Journal of school health, 2018)
BACKGROUND: Sexual minority young people have demonstrated higher rates of emotional distress and suicidality in comparison to heterosexual peers. Research to date has not examined trends in these disparities, specifically, whether there have been disparity reductions or increases and how outcomes have differed over time by sex and sexual orientation group. METHODS: Minnesota Student Survey data, collected from 9th and 12th graders in 3 cohorts (1998, 2004, 2010) were used to examine emotional distress and suicidality rates. Logistic regression analyses were completed to examine outcome changes over time within and across sexual orientation/sex groups. RESULTS: With few exceptions, sexual minority youth are at increased risk of endorsing emotional distress and suicidality indicators in each surveyed year between 1998 and 2010. Young people with both-sex partners reported more emotional distress across all health indicators compared to their opposite-sex partnered peers. With a few exceptions, gaps in disparities between heterosexual and sexual minority have not changed from 2004 to 2010. CONCLUSIONS: Disparities in emotional health persist among youth. Research is needed to advance understanding of mental health disparities, with consideration of sexual orientation differences and contextualized to sociocultural status and changes over time. Personalized prevention strategies are needed to promote adolescent mental health.
Keywords: adolescent; female; heterosexuality; human; longitudinal study; male; Minnesota; minority group; psychology; school health service; sexual and gender minority; sexual behavior; sexuality; suicidal ideation

Risk of suicidal behavior with use of efavirenz: Results from the strategic timing of antiretroviral treatment trial - Arenas-Pinto, A.; Grund, B.; Sharma, S.; Martinez, E.; Cummins, N.; Fox, J.; Klingman, K.L.; Sedlacek, D.; Collins, S.; Flynn, P.M.; Chasanov, W.M.; Kedem, E.; et al. (Clinical Infectious Diseases, 2018)
Background Randomized trials have shown increased risk of suicidality associated with efavirenz (EFV). The START (Strategic Timing of Antiretroviral Treatment) trial randomized treatment-naive human immunodeficiency virus (HIV)-positive adults with high CD4 cell counts to immediate vs deferred antiretroviral therapy (ART). Methods The initial ART regimen was selected prior to randomization (prespecified). We compared the incidence of suicidal and self-injurious behaviours (suicidal behavior) between the immediate vs deferred ART groups using proportional hazards models, separately for those with EFV and other prespecified regimens, by intention to treat, and after censoring participants in the deferred arm at ART initiation. Results Of 4684 participants, 271 (5.8%) had a prior psychiatric diagnosis. EFV was prespecified for 3515 participants (75%), less often in those with psychiatric diagnoses (40%) than without (77%). While the overall intention-to-treat comparison showed no difference in suicidal behavior between arms (hazard ratio [HR], 1.07, P =.81), subgroup analyses suggest that initiation of EFV, but not other ART, is associated with increased risk of suicidal behavior. When censoring follow-up at ART initiation in the deferred group, the immediate vs deferred HR among those who were prespecified EFV was 3.31 (P =.03) and 1.04 (P =.93) among those with other prespecified ART; (P =.07 for interaction). In the immediate group, the risk was higher among those with prior psychiatric diagnoses, regardless of prespecified treatment group. Conclusions Participants who used EFV in the immediate ART group had increased risk of suicidal behavior compared with ART-naive controls. Those with prior psychiatric diagnoses were at higher risk.
Keywords: antidepressant agent; efavirenz; recreational drug; RNA directed DNA polymerase inhibitor; adult; alcohol consumption; antiretroviral therapy; article; automutilation; bipolar disorder; CD4 lymphocyte count; controlled study; drug safety; female; follow up; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; incidence; intention to treat analysis; major clinical study; major depression; male; men who have sex with men; multicenter study; priority journal; psychiatric diagnosis; randomized controlled trial; risk factor; schizophrenia; suicidal behavior; suicidal ideation; suicide attempt

Association of recent gay-related stressful events with depressive symptoms in Chinese men who have sex with men - Liu, Y.; Jiang, C.; Li, S.; Gu, Y.; Zhou, Y.; An, X.; Zhao, L.; Pan, G. (BMC Psychiatry, 2018)
Background: To assess the association of different gay-related stressful events (GRSEs) with depressive symptoms in Chinese men who have sex with men (MSM). Method: A total of 807 MSM were recruited using respondent-driven sampling from four cities in northeastern China. GRSEs were measured using the Gay Related Stressful Life Events Scale, and depressive symptoms were assessed using the Self-Rating Depression Scale (SDS). Results: A total of 26.0% of study participants experienced GRSEs in the past three months, and the average SDS score was lower than the previously reported national average for China. The study participants had significantly elevated risks of depression (SDS score ≥ 53) due to recent troubles with a boss (OR = 4.92, 95% CI = 1.87-12.97) or a workmate (OR = 3.68, 95% CI = 1.52-8.88), loss of a close friend (OR = 2.41, 95% CI = 1.39-4.18), argument with a close friend (OR = 2.07, 95% CI = 1.33-3.22), and being physically assaulted (OR = 2.08, 95% CI = 0.98-4.43). Arguments with family members or classmates had no significant effect on depression. Multiple logistic regression analysis showed that the number of GRSEs, a lower level of education, more advanced age, and HIV infection significantly increased the risk of depression. Conclusions: There are large differences in the associations of different types of GRSEs with depressive symptoms. Reducing the stigmatization and discrimination toward MSM in all social environments and improving the capability of MSM to cope with different types of GRSEs may improve their emotional wellbeing.
Keywords: adult; article; China; Chinese; controlled study; depression; disease association; education; emotion; female; homosexual male; human; Human immunodeficiency virus infection; Life Events Scale; major clinical study; major depression; male; men who have sex with men; multivariate logistic regression analysis; prevalence; psychological aspect; rating scale; scoring system; social environment; social network; social support; socioeconomics; suicide attempt; wellbeing; Zung Self Rating Depression Scale

Characteristics of adolescents referred to a gender clinic: Are youth seen now different from those in initial reports? - Chiniara, L.N.; Bonifacio, H.J.; Palmert, M.R. (Hormone Research in Paediatrics, 2018)
Background/Aims: To examine characteristics, including mental health comorbidities, among adolescents presenting to a transgender clinic and to compare these data to previous reports. Methods: Retrospective chart review among youth seen at The Hospital for Sick Children between January 2014 and June 2016. Demographic data, clinical characteristics, and mental health comorbidities were assessed. Baseline and repeat blood work were also examined. Results: Charts from 203 adolescents aged 12-18 years were reviewed (156 assigned female at birth [AFAB] (77%) aged 16.3 ± 1.63 years, 47 assigned male at birth [AMAB] aged 16.1 ± 1.70 years). There was no statistically significant difference between gender groups except for Tanner stage (AFAB, mean 4.42 ± 0.8 and AMAB, mean 4.03 ± 1.1, p = 0.040). Individuals from racial/ethnic minority populations were under-represented compared to the background population. Self-report and baseline psychological questionnaires showed high levels of gender dysphoria, mood disorders, and suicidal ideation, with higher levels of anxiety detected on questionnaires among AFAB (p = 0.03). Laboratory abnormalities identified on baseline and repeat testing were minor; on cross-sex hormones, hemoglobin levels increased slightly in AFAB (p = 0.002, highest = 166 g/L) and decreased among AMAB (p = 0.02, lowest = 132 g/L). Conclusion: Our study supports an evolving demographic trend with more AFAB than AMAB youth now presenting to gender clinics. The data also corroborate studies indicating that extensive laboratory testing may not be a necessary part of caring for these youths. Why more AFAB are now presenting to clinic and racial/ethnic minorities are underrepresented is not clear, but these trends have important implications for clinical care and warrant further study.
Keywords: estradiol; leuprorelin; testosterone cipionate; adolescent; article; Beck Depression Inventory; body mass; comorbidity; female; gender dysphoria; human; major clinical study; male; mental health; mood disorder; priority journal; puberty; retrospective study; screening; sex determination; suicidal ideation; transgender

The S axis in PDM-2. Symptom patterns: The subjective experience - Mundo, E.; Persano, H.; Moore, K. (Psychoanalytic Psychology, 2018)
In this paper we address the main innovations included in the Subjective Experience chapter (S Axis) of the PDM-2, that is, its conceptualization of adult symptom patterns. We include some comparison between, and discussion of, ICD-10, DSM-5, and PDM-2. A primary goal of the PDM is to consider both biological and psychological susceptibility factors in shaping specific symptom patterns in adults; we pursue this goal by considering specific sections; for example, suicidal behaviors. We discuss the core PDM-2 innovations: a better definition of the subjective experience of symptoms and symptom patterns, the inclusion of (and the assessment guidelines for) suicide and suicidal and parasuicidal behavior, the inclusion of the subjective experience of the therapist when encountering a specific subject with specific symptom patterns, and the addition of the description of some nonpathological conditions that may require clinical attention (i.e., demographic minorities, lesbian, gay, and bisexual populations, and gender incongruent populations). With respect to the gender incongruent subjects, we note as a significant step forward the depathologization of this condition, formerly termed "gender identity disorder" and now, in DSM-5, termed "gender dysphoria." We make a case for the value of including a section on nonpathological conditions in a psychodynamically oriented diagnostic manual. Finally, we discuss the implications and limitations of such PDM-2 innovations with respect to clinical settings and future clinical research purposes.
Keywords: article; bisexuality; demography; disease classification; DSM-5; experience; gender dysphoria; homosexual female; homosexual male; human; ICD-10; PDM-2; practice guideline; S Axis; suicidal behavior; suicide; symptom

Same-sex-attracted adolescents in rural Australia: stressors, depression and suicidality, and barriers to seeking mental health support - Roberts, R.; Black, G.; Hart, T. (Rural and remote health, 2018)
INTRODUCTION: To address the lack of Australian data examining mental health in same-sex attracted rural adolescents compared with their rural heterosexual peers, this study examined experiences of stressors, symptoms of depression and suicidality, and perceptions of barriers to seeking mental health support, comparing same-sex attracted adolescents with heterosexual adolescents living in rural Australia. METHODS: Respondents were recruited through high schools in rural South Australia and completed a questionnaire that included demographic questions, the Kutcher Adolescent Depression Scale (KADS-6) and measures of stressors and perceptions of barriers to seeking mental health support. Participants were 531 adolescents (55% female, 43% male), aged 13 to 18, 31 of whom identified as same-sex attracted. RESULTS: Same-sex attracted adolescents reported significantly more depression symptoms (mean=6.1, standard deviation (SD)=3.9) compared to other adolescents (mean=2.9, SD=3.2, U=2867, p<0.001, r=0 .16). More adolescents who were same-sex attracted screened positive for depression (54.8% vs 15.9%) and there was a significant difference in responses to the item assessing suicidality between same-sex attracted and other adolescents (mean=1.1, SD=1.1; mean=0.3, SD=0.7, χ2 (1, N=531)=27.10, p<0.001, phi=0.24). Same-sex attracted adolescents reported more experiences of stressors relating to relationships, bullying and physical assault than heterosexual adolescents but, contrary to expectations, did not report perceiving more barriers to seeking mental health support (total barriers: same-sex attracted adolescents mean=2.5 (1.8), other adolescents mean=2.5 (1.9), t(527)=0.06, p=0.95, d=0.00). CONCLUSIONS: Adolescents who identified as being same-sex attracted are at much greater risk of depression and suicidality than other adolescents in rural South Australia. The finding that same-sex attracted adolescents experienced a higher number of relationship stressors, bullying and assault underscores the need for more focus on addressing these issues for this group of vulnerable adolescents. While same-sex attracted adolescents did not perceive more barriers to seeking mental health support, greater understanding of same-sex attracted adolescents' access to appropriate services in rural areas is needed to be able to improve mental health functioning in this population. In addition, addressing the wider issues (eg stigma) contributing to the greater number of stressors, including victimisation, faced by same-sex attracted adolescents should be a priority.
Keywords: adolescent; child psychology; depression; female; health care delivery; homosexuality; human; lesbianism; male; male homosexuality; mental health service; mental stress; psychological rating scale; psychology; rural population; South Australia; statistics and numerical data; suicidal ideation

Depressive Symptoms and Suicidal Ideation among Irish Undergraduate College Students - Horgan, A.; Kelly, P.; Goodwin, J.; Behan, L. (Issues in mental health nursing, 2018)
This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population.
Keywords: adolescent; adult; cross-sectional study; depression; female; human; Ireland; male; prevalence; psychology; student; suicidal ideation; young adult

Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A Multiple Mediation Analysis - Fraser, G.; Wilson, M.S.; Garisch, J.A.; Robinson, K.; Brocklesby, M.; Kingi, T.; O'Connell, A.; Russell, L. (Archives of suicide research : official journal of the International Academy for Suicide Research, 2018)
Despite increasing interest in the prevalence and correlates of Non-Suicidal Self-Injury (NSSI) in adolescent populations, relatively few studies have examined NSSI among lesbian, gay and bisexual (LGB) adolescents. The current study explored sexuality concerns and elevated emotion dysregulation as potential mechanisms underlying the relationship between sexual orientation and elevated non-suicidal self-injury (NSSI). A community sample of 1,799 adolescents completed a questionnaire assessing NSSI, sexual orientation, sexuality concerns, and emotion regulation. Across the study, 20.6% of adolescents reported a history of NSSI. Adolescents who identify as "mostly heterosexual," "bisexual," and "mostly homosexual" were more likely to engage in NSSI than gay/lesbian, heterosexual, and asexual adolescents. Multiple mediation analysis showed that emotion regulation, but not sexuality concerns, mediated the relationship between sexual orientation and NSSI. The current study tested two theoretical pathways by which sexual orientation could predict NSSI engagement. Findings suggest that literature on general psychological processes, as well as group-specific minority stressors, can shed light on high rates of NSSI among LGB populations. Specifically, the challenges faced by LGB adolescents may undermine the development of emotion regulation. As such, this should be a key target of intervention with LGB adolescents engaging in NSSI.
Keywords: adolescent; automutilation; emotion; female; human; male; mental stress; New Zealand; psychology; risk factor; self control; sexual and gender minority; sexuality

Evaluation of an avatar-based training program to promote suicide prevention awareness in a college setting - Rein, B.A.; McNeil, D.W.; Hayes, A.R.; Hawkins, T.A.; Ng, H.M.; Yura, C.A. (Journal of American college health : J of ACH, 2018)
OBJECTIVE: Training programs exist that prepare college students, faculty, and staff to identify and support students potentially at risk for suicide. Kognito is an online program that trains users through simulated interactions with virtual humans. This study evaluated Kognito's effectiveness in preparing users to intervene with at-risk students. PARTICIPANTS: Training was completed by 2,727 university students, faculty, and staff from April, 2014 through September, 2015. METHODS: Voluntary and mandatory participants at a land-grant university completed Kognito modules designed for higher education, along with pre- and post-assessments. RESULTS: All modules produced significant gains in reported Preparedness, Likelihood, and Self-Efficacy in intervening with troubled students. Despite initial disparities in reported abilities, after training participants reported being similarly capable of assisting at-risk students, including LGBTQ and veteran students. CONCLUSIONS: Kognito training appears to be effective, on a large scale, in educating users to act in a facilitative role for at-risk college students.
Keywords: adolescent; attitude to health; female; health promotion; human; male; procedures; program evaluation; psychology; student; suicide; teaching; university; West Virginia

Youth Risk Behavior Surveillance - United States, 2017 - Kann, L.; McManus, T.; Harris, W.A.; Shanklin, S.L.; Flint, K.H.; Queen, B.; Lowry, R.; Chyen, D.; Whittle, L.; Thornton, J.; Lim, C.; Bradford, D.; et al. (Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 2018)
PROBLEM: Health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults in the United States. In addition, significant health disparities exist among demographic subgroups of youth defined by sex, race/ethnicity, and grade in school and between sexual minority and nonsexual minority youth. Population-based data on the most important health-related behaviors at the national, state, and local levels can be used to help monitor the effectiveness of public health interventions designed to protect and promote the health of youth at the national, state, and local levels. REPORTING PERIOD COVERED: September 2016-December 2017. DESCRIPTION OF THE SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of other health-related behaviors, obesity, and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. Starting with the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts were added to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their questionnaires. This report summarizes results from the 2017 national YRBS for 121 health-related behaviors and for obesity, overweight, and asthma by demographic subgroups defined by sex, race/ethnicity, and grade in school and by sexual minority status; updates the numbers of sexual minority students nationwide; and describes overall trends in health-related behaviors during 1991-2017. This reports also summarizes results from 39 state and 21 large urban school district surveys with weighted data for the 2017 YRBSS cycle by sex and sexual minority status (where available). RESULTS: Results from the 2017 national YRBS indicated that many high school students are engaged in health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 39.2% of high school students nationwide (among the 62.8% who drove a car or other vehicle during the 30 days before the survey) had texted or e-mailed while driving, 29.8% reported current alcohol use, and 19.8% reported current marijuana use. In addition, 14.0% of students had taken prescription pain medicine without a doctor's prescription or differently than how a doctor told them to use it one or more times during their life. During the 12 months before the survey, 19.0% had been bullied on school property and 7.4% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 39.5% of students had ever had sexual intercourse and 9.7% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 53.8% reported that either they or their partner had used a condom during their last sexual intercourse. Results from the 2017 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. Nationwide, 8.8% of high school students had smoked cigarettes and 13.2% had used an electronic vapor product on at least 1 day during the 30 days before the survey. Forty-three percent played video or computer games or used a computer for 3 or more hours per day on an average school day for something that was not school work and 15.4% had not been physically active for a total of at least 60 minutes on at least 1 day during the 7 days before the survey. Further, 14.8% had obesity and 15.6% were overweight. The prevalence of most health-related behaviors varies by sex, race/ethnicity, and, particularly, sexual identity and sex of sexual contacts. Specifically, the prevalence of many health-risk behaviors is significantly higher among sexual minority students compared with nonsexual minority students. Nonetheless, analysis of long-term temporal trends indicates that the overall prevalence of most health-risk behaviors has moved in the desired direction. PUBLIC HEALTH ACTION: YRBSS data are used widely to compare the prevalence of health-related behaviors among subpopulations of students; assess trends in health-related behaviors over time; monitor progress toward achieving 21 national health objectives; provide comparable state and large urban school district data; and take public health actions to decrease health-risk behaviors and improve health outcomes among youth. Using this and other reports based on scientifically sound data is important for raising awareness about the prevalence of health-related behaviors among students in grades 9-12, especially sexual minority students, among decision makers, the public, and a wide variety of agencies and organizations that work with youth. These agencies and organizations, including schools and youth-friendly health care providers, can help facilitate access to critically important education, health care, and high-impact, evidence-based interventions. INTERPRETATION: Most high school students cope with the transition from childhood through adolescence to adulthood successfully and become healthy and productive adults. However, this report documents that some subgroups of students defined by sex, race/ethnicity, grade in school, and especially sexual minority status have a higher prevalence of many health-risk behaviors that might place them at risk for unnecessary or premature mortality, morbidity, and social problems (e.g., academic failure, poverty, and crime).
Keywords: adolescent; adolescent behavior; behavioral risk factor surveillance system; child; epidemiology; female; health survey; high risk behavior; human; male; psychology; United States; young adult

Increasing Interest of Mass Communication Media and the General Public in the Distribution of Tweets About Mental Disorders: Observational Study - Alvarez-Mon, M.A.; Asunsolo Del Barco, A.; Lahera, G.; Quintero, J.; Ferre, F.; Pereira-Sanchez, V.; Ortuño, F.; Alvarez-Mon, M. (Journal of medical Internet research, 2018)
BACKGROUND: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed. OBJECTIVE: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers. METHODS: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV. RESULTS: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P<.001). CONCLUSIONS: American mainstream media outlets and the general public demonstrate a preferential interest for psychiatric diseases on Twitter. The heterogeneous weights given by the media outlets analyzed to the different mental health disorders and conditions are reflected in the responses of Twitter followers.
Keywords: female; human; interpersonal communication; male; mass medium; mental disease; social media; trends

Mental Health and Substance Use Disorder Comorbidity among Methamphetamine-Using Men Who have Sex with Men - Fletcher, J.B.; Swendeman, D.; Reback, C.J. (Journal of Psychoactive Drugs, 2018)
Men who have sex with men (MSM) exhibit elevated rates of mental health and substance use disorder relative to their non-MSM male counterparts. Methamphetamine use in particular has been associated with both neuronal damage and mental health disorders among MSM, and this study reports on the prevalence and comorbidity of DSM-5 mental health and substance use disorders in a sample of methamphetamine-using MSM. From March 2014 through January 2015, 286 methamphetamine-using MSM enrolled in a study to reduce methamphetamine use and sexual risk behaviors. At baseline, participants demonstrated high rates of current major depressive episode (35.8%), antisocial personality disorder (23.9%), suicide risk (23.2%), obsessive-compulsive disorder (23.2%), and social phobia (20.4%), as well as methamphetamine use disorder (89.1%), marijuana use disorder (41.0%), alcohol use disorder (39.6%), cocaine use disorder (30.9%), and inhalants use disorder (15.4%). Analyses revealed significant (p < 0.05) associations between methamphetamine use disorder severity and all listed mental health disorders, as well as between alcohol use disorder and all listed mental health disorders. Mental health disorder prevalence and substance use disorder severity were both elevated, and both methamphetamine and alcohol use disorder severity were associated with increased likelihood of comorbid mental health disorder.
Keywords: cannabis; cocaine; methamphetamine; psychedelic agent; adult; alcoholism; antisocial personality disorder; anxiety; anxiety disorder; article; comorbidity; depression; DSM-5; dysthymia; human; hypomania; major clinical study; male; mania; men who have sex with men; mental health; nerve injury; obsessive compulsive disorder; panic; posttraumatic stress disorder; prevalence; social phobia; substance use; suicide attempt

Association of Religiosity With Sexual Minority Suicide Ideation and Attempt - Lytle, M.C.; Blosnich, J.R.; De Luca, S.M.; Brownson, C. (American Journal of Preventive Medicine, 2018)
Introduction: The purpose of this study is to explore how the associations between importance of religion and recent suicide ideation, recent suicide attempt, and lifetime suicide attempt vary by sexual orientation. Methods: Survey data were collected from the 2011 University of Texas at Austin's Research Consortium data from 21,247 college-enrolled young adults aged 18–30 years. Respondents reported sexual identity as heterosexual, gay/lesbian, bisexual, or questioning. Two sets of multivariable models were conducted to explore the relations of religious importance and sexual orientation with the prevalence of suicidal behavior. The first model was stratified by sexual orientation and the second model was stratified by importance of religion. To explore potential gender differences in self-directed violence, the models were also stratified by gender identity. The main outcome measures were recent suicidal ideation, recent suicide attempt, and lifetime suicide attempt. Results: Overall, increased importance of religion was associated with higher odds of recent suicide ideation for both gay/lesbian and questioning students. The association between sexual orientation and self-directed violence were mixed and varied by strata. Lesbian/gay students who viewed religion as very important had greater odds for recent suicidal ideation and lifetime suicide attempt compared with heterosexual individuals. Bisexual and questioning sexual orientations were significantly associated with recent suicide ideation, recent attempt, and lifetime attempt across all strata of religious importance, but the strongest effects were among those who reported that religion was very important. Conclusions: Religion-based services for mental health and suicide prevention may not benefit gay/lesbian, bisexual, or questioning individuals. Religion-based service providers should actively assure their services are open and supportive of gay/lesbian, bisexual, or questioning individuals.
Keywords: adult; article; automutilation; bisexuality; college student; disease association; female; gender identity; heterosexuality; homosexual female; homosexual male; human; male; mental health service; prevalence; religion; sex difference; sexual and gender minority; suicidal ideation; suicide attempt; Texas; university student; young adult

Transgender adolescents and acne: A cases series - Campos-Muñoz, L.; López-De Lara, D.; Rodríguez-Rojo, M.L.; Conde-Taboada, A.; López-Bran, E. (Pediatric Dermatology, 2018)
We describe the difficulties of treating acne in a series of female-to-male transgender adolescents, including concerns about potential hepatotoxicity with concomitant use of testosterone with isotretinoin or tetracyclines. Acne is a foreseeable adverse effect of testosterone treatment in transgender adolescents, so monitoring for acne is advised. The treatment of acne in transgender adolescents is important given that severe acne and transgenderism are associated with higher rates of depression and suicide.
Keywords: benzoyl peroxide; contraceptive agent; doxycycline; isotretinoin; retinoic acid; testosterone; acne; adolescent; adult; article; case report; case study; clinical article; depression; disease severity; drug withdrawal; female; female to male transgender; follow up; human; liver function; priority journal; recurrent disease; sexual intercourse; treatment duration

Mental health of transgender and gender nonconforming youth compared with their peers - Becerra-Culqui, T.A.; Liu, Y.; Nash, R.; Cromwell, L.; Flanders, W.D.; Getahun, D.; Giammattei, S.V.; Hunkeler, E.M.; Lash, T.L.; Millman, A.; Quinn, V.P.; Robinson, B.; et al. (Pediatrics, 2018)
BACKGROUND: Understanding the magnitude of mental health problems, particularly lifethreatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS: Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date. RESULTS: Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4-82) to 144 (95% CI 36-1248). The corresponding range for suicidal ideation was 25 (95% CI 14-45) to 54 (95% CI 18-218). CONCLUSIONS: TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures.
Keywords: adolescent; article; attention deficit disorder; automutilation; California; child; cohort analysis; depression; electronic medical record; ethnicity; female; female to male transgender; Georgia (U.S.); groups by age; health care system; human; major clinical study; male; male to female transgender; mental health; peer group; prevalence; priority journal; race; suicidal ideation; transgender

Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series - Donaldson, A.A.; Hall, A.; Neukirch, J.; Kasper, V.; Simones, S.; Gagnon, S.; Reich, S.; Forcier, M. (International Journal of Eating Disorders, 2018)
Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high-risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self-harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population.
Keywords: gonadorelin derivative; adolescent; anorexia nervosa; anxiety; article; automutilation; binge eating disorder; body mass; body weight loss; body weight maintenance; bradycardia; bullying; case report; clinical article; clinical feature; delayed puberty; depression; diet restriction; disease duration; disease exacerbation; eating disorder; emotional stress; faintness; feeding behavior; female; gender dysphoria; high risk behavior; human; hypotension; mastectomy; obsessive compulsive disorder; physical abuse; priority journal; risk factor; suicidal ideation; suicide

Transitioning bodies. The case of self-prescribing sexual hormones in gender affirmation in individuals attending psychiatric services - Metastasio, A.; Negri, A.; Martinotti, G.; Corazza, O. (Brain Sciences, 2018)
Self-prescribing of sexual hormones for gender affirmation is a potentially widespread and poorly studied phenomenon that many clinicians are unaware of. The uncontrolled use of hormones poses significant health hazards, which have not been previously reported in the literature. We have collected seven clinical cases in general adult psychiatry settings (both inpatient and outpatients), describing transgender and gender non-conforming individuals’ (TGNC) self-prescribing and self-administering hormones bought from the Internet without any medical consultation. Among these cases, two were taking androgens, and the rest were taking oestrogens. The main reason for self-administration of hormones seems to be the lack of access to specialised care due to discrimination and long waiting lists. We advocate for clinicians to be aware of the phenomenon and proactively help TGNC individuals by enquiring about self-prescribing of hormones, providing information and referring to the most appropriate treatment centre as well as encourage a public debate on the discrimination and the stigma that TGNC population suffer from. Overall, there is an urgent need for the implementation of different and innovative health care services for TGNC individuals as well as more targeted prevention strategies on such underreported and highly risky behaviours. Furthermore, it is necessary for every clinician involved in the care for TGNC people to be aware of their special needs and be able to be an allied and an advocate to help in reducing stigma and discrimination that affect the access to care for this often underserved population.
Keywords: androgen; estradiol; estrogen; finasteride; insulin; sex hormone; spironolactone; testosterone; adult; anxiety disorder; article; case report; clinical article; depression; female; gender dysphoria; health care access; hormone substitution; hospital admission; human; insulin dependent diabetes mellitus; interview; male; mental instability; perceptive discrimination; personality disorder; self medication; sex reassignment; sexism; sexual bullying; stigma; suicide attempt; transgender; young adult

Multiplicative effects of social and psychological risk factors on college students’ suicidal behaviors - Assari, S. (Brain Sciences, 2018)
Less is known about the multiplicative effects of social and psychological risk and protective factors of suicidality on college campuses. The current study aimed to investigate the multiplicative effects of social (identifying oneself as gay/lesbian, financial difficulty, violence victimization, and religiosity) and psychological (anxiety, depression, problem alcohol use, drug use) and risk/protective factors on suicidal behaviors among college students in the United States. Using a cross-sectional design, the Healthy Mind Study (HMS; 2016–2017), is a national online survey of college students in the United States. Social (identifying oneself as gay/lesbian, violence victimization, financial difficulty, and religiosity) and psychological (anxiety, depression, problem alcohol use, and drug use) risk/protective factors were assessed among 27,961 individuals. Three aspects of suicidality, including ideation, plan, and attempt, were also assessed. Logistic regression models were used for data analysis. Financial difficulty, violence victimization, identifying oneself as gay/lesbian, anxiety, depression, and drug use increased, while religiosity reduced the odds of suicidal behaviors. Multiplicative effects were found between the following social and psychological risk factors: (1) financial difficulty and anxiety; (2) financial difficulty and depression; (3) depression and drug use; (4) problem alcohol use and drug use; and (5) depression and problem alcohol use. There is a considerable overlap in the social and psychological processes, such as financial stress, mood disorders, and substance use problems, on risk of suicide in college students. As social and psychological risk factors do not operate independently, comprehensive suicidal risk evaluations that simultaneously address multiple social and psychological risk factors may be superior to programs that only address a single risk factor.
Keywords: alcohol consumption; anxiety; article; college student; cross-sectional study; depression; female; human; information processing; male; risk assessment; risk factor; sampling; sexual orientation; substance use; suicidal behavior; suicidal ideation; violence

Have Mischievous Responders Misidentified Sexual Minority Youth Disparities in the National Longitudinal Study of Adolescent to Adult Health? - Fish, J.N.; Russell, S.T. (Archives of sexual behavior, 2018)
The National Longitudinal Study of Adolescent to Adult Health (Add Health) has been instrumental in identifying sexual minority youth health disparities. Recent commentary suggested that some Wave 1 youth responders, especially males, intentionally mismarked same-sex attraction and, as a result, published reports of health disparities from these data may be suspect. We use two recently developed approaches to identify "jokesters" and mischievous responding and apply them to the Add Health data. First, we show that Wave 1 same-sex attracted youth, including those who later reported completely heterosexual identities in adulthood, were no more likely than different-sex attracted youth and consistently heterosexual participants to be "jokesters." Second, after accounting for mischievous responses, we replicated six previously established disparities: depressive symptoms, suicidal ideation and behaviors, alcohol use, cocaine use, parental satisfaction, and school connectedness. Accounting for mischievousness resulted in the elimination of one observed disparity between heterosexual and sexual minority youth: suicidal ideation for males who reported romantic attraction to both sexes. Results also showed that accounting for mischievous responding may underestimate disparities for sexual minority youth, particularly females. Overall, results presented here support previous studies that identified health disparities among sexual minority youth using these data.
Keywords: adolescent; adult; child parent relation; depression; drug dependence; female; health disparity; human; human relation; longitudinal study; male; reproducibility; scientific misconduct; sexual and gender minority; student; suicidal ideation; United States; young adult

Depression and Associated Factors Among Gay and Heterosexual Male University Students in Nigeria - Oginni, O.A.; Mosaku, K.S.; Mapayi, B.M.; Akinsulore, A.; Afolabi, T.O. (Archives of sexual behavior, 2018)
Homosexuality is a recognized risk factor for depression in high-income countries; however, there is little research investigating the relationship between depression and sexual orientation in developing countries, especially in Africa. In this first study to investigate psychopathology in sexual minority men in Nigeria, the prevalence rates of depression in Nigerian gay and heterosexual individuals were compared as well as the explanatory power of risk and resilience factors in both groups. Eighty-one gay and 81 heterosexual male university students were, respectively, recruited from the Obafemi Awolowo University. Both groups were assessed for depression and other clinical factors, including alcohol and other substance use, suicidal ideation, and resilience. Gay students were further assessed for sexuality-related variables, including minority stress factors such as internalized homophobia and perceived stigma. The prevalence rates of depression among gay and heterosexual students were, respectively, 16 and 4.9% (OR 3.7; 95% CI 1.15-11.82), and this increased likelihood for depression was significantly attenuated by resilience. Clinical factors correlated significantly with depression in both groups, explaining 31% of the variance in depression in gay and heterosexual students, respectively. Sexuality-related variables including internalized homophobia and perceived stigma were further associated with depression in gay students-accounting for a further 14% of the variance of depression in gay students. The findings highlight the importance of minority stress factors in understanding depression among non-heterosexual individuals in a developing country, and the need for further research to investigate the mechanisms of these relationships in such settings.
Keywords: adult; depression; drug dependence; heterosexuality; homophobia; human; male; male homosexuality; Nigeria; psychological resilience; psychology; sexual and gender minority; social stigma; student; suicidal ideation; university; young adult

Evidence of Multiple Mediating Pathways in Associations Between Constructs of Stigma and Self-Reported Suicide Attempts in a Cross-Sectional Study of Gay and Bisexual Men - Salway, T.; Gesink, D.; Ibrahim, S.; Ferlatte, O.; Rhodes, A.E.; Brennan, D.J.; Marchand, R.; Trussler, T. (Archives of sexual behavior, 2018)
Gay and bisexual men (GBM) are more likely to attempt suicide than heterosexual men. This disparity is commonly interpreted using minority stress theory; however, specific pathways from antigay stigma to suicidal behavior are poorly understood. We aimed to estimate associations between multiple constructs of stigma and suicide attempts among adult GBM, and to measure the proportion of these associations mediated by distinct suicide risk factors, thus identifying proximal points of intervention. Data were drawn from a Canadian community-based survey of adult GBM. Structural equation modeling was used to compare associations between three latent constructs-enacted stigma (e.g., discrimination, harassment), anticipated prejudice (worry about encountering antigay/bisexual prejudice), and sexuality concealment-and self-reported suicide attempts (last 12 months). Coefficients were estimated for direct, indirect, and total pathways and evaluated based on magnitude and statistical significance. The proportion of associations mediated by depression, drug/alcohol use, and social isolation was calculated using indirect paths. Among 7872 respondents, 3.4% reported a suicide attempt in the past 12 months. The largest total association was observed for enacted stigma, and this association was partially mediated by depression and drug/alcohol use. The total association of anticipated prejudice was relatively smaller and mediated by depression and social isolation. Concealment had an inverse association with suicide attempts as mediated by depression but was also positively associated with suicide attempts when mediated through social isolation. Multiple constructs of antigay stigma were associated with suicide attempts; however, mediating pathways differed by construct, suggesting that a combination of strategies is required to prevent suicide in adult GBM.
Keywords: adult; bisexuality; Canada; cross-sectional study; depression; drug dependence; human; male; male homosexuality; middle aged; psychology; questionnaire; self report; social stigma; suicide attempt

Family Functioning and Mental Health of Transgender and Gender-Nonconforming Youth in the Trans Teen and Family Narratives Project - Katz-Wise, S.L.; Ehrensaft, D.; Vetters, R.; Forcier, M.; Austin, S.B. (Journal of sex research, 2018)
Transgender and gender-nonconforming (TGN) youth are at increased risk for adverse mental health outcomes, but better family functioning may be protective. This study describes TGN youth's mental health and associations with family functioning in a community-based sample. Participants were from 33 families (96 family members) and included 33 TGN youth, ages 13 to 17 years; 48 cisgender (non-transgender) caregivers; and 15 cisgender siblings. Participants completed a survey with measures of family functioning (family communication, family satisfaction) and mental health of TGN youth (suicidality, self-harm, depression, anxiety, self-esteem, resilience). TGN youth reported a high risk of mental health concerns: suicidality (15% to 30%), self-harm (49%), clinically significant depressive symptoms (61%); and moderate self-esteem (M = 27.55, SD = 7.15) and resiliency (M = 3.67, SD = 0.53). In adjusted models, better family functioning from the TGN youth's perspective was associated with better mental health outcomes among TGN youth (β ranged from -0.40 to -0.65 for self-harm, depressive symptoms, and anxious symptoms, and 0.58 to 0.70 for self-esteem and resiliency). Findings from this study highlight the importance of considering TGN youth's perspectives on the family to inform interventions to improve family functioning in families with TGN youth.
Keywords: adolescent; anxiety; automutilation; depression; female; human; male; nuclear family; psychological resilience; psychology; self concept; sexual and gender minority; suicidal ideation

The Role of Distal Minority Stress and Internalized Transnegativity in Suicidal Ideation and Nonsuicidal Self-Injury Among Transgender Adults - Staples, J.M.; Neilson, E.C.; Bryan, A.E.B.; George, W.H. (Journal of sex research, 2018)
Transgender people are at elevated risk for nonsuicidal self-injury (NSSI) and suicidal ideation compared to the general population. Transgender (trans) refers to a diverse group of people who experience incongruence between their gender identity and sex assigned at birth. The present study is guided by the minority stress model and the psychological mediation framework, which postulate that sexual minority groups experience elevated stress as a result of anti-minority prejudice, contributing to negative mental health outcomes. This study utilized these theories to investigate the role of internalized transnegativity-internalization of negative societal attitudes about one's trans identity-in the relationships of distal trans stress to suicidal ideation and NSSI. A U.S. national sample of trans adults (N = 237) completed a battery of online measures. Structural equation modeling (SEM) was used to compare models with mediation and moderation effects. Results suggested that internalized transnegativity acts as both a mediator and a moderator in the relationship between distal trans stress and suicidal ideation. Log likelihood comparisons suggested moderation models had the superior fit for these data. Results suggest that clinical interventions should directly target individuals' internalized transnegativity as well as societal-level transnegativity.
Keywords: adult; automutilation; female; human; male; mental stress; prejudice; psychology; sexual and gender minority; suicidal ideation; transgender

The Association between Intentional Overdose and Same-Sex Sexual Intercourse in a Cohort of People who Inject Drugs in Melbourne, Australia - O'Keefe, D.; Bowring, A.; Aitken, C.; Dietze, P. (Substance use & misuse, 2018)
BACKGROUND: People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID. OBJECTIVES: To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI. METHODS: The sample included 529 participants, from an ongoing cohort of 757 PWID. An "ever" SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression. RESULTS: Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately.
Keywords: adolescent; adult; Australia; drug overdose; drug use; female; homosexuality; human; male; psychology; sexual behavior; substance abuse; suicide attempt; young adult

Sexual Orientation Discordance and Nonfatal Suicidal Behaviors in U.S. High School Students - Annor, F.B.; Clayton, H.B.; Gilbert, L.K.; Ivey-Stephenson, A.Z.; Irving, S.M.; David-Ferdon, C.; Kann, L.K. (American Journal of Preventive Medicine, 2018)
Introduction: Studies among adults have documented association between sexual orientation discordance and some suicide risk factors. However, studies examining sexual orientation discordance and nonfatal suicidal behaviors in youth are rare. This study examines the association between sexual orientation discordance and suicidal ideation/suicide attempts among a nationally representative sample of U.S. high school students. Methods: Using sexual identity and sex of sexual contact measures from the 2015 national Youth Risk Behavior Survey (n=6,790), a sexual orientation discordance variable was constructed describing concordance and discordance (agreement and disagreement, respectively, between sexual identity and sex of sexual contacts). Three suicide-related questions (seriously considered attempting suicide, making a plan about how they would attempt suicide, and attempting suicide) were combined to create a two-level nonfatal suicide risk variable. Analyses were restricted to students who identified as heterosexual or gay/lesbian, who had sexual contact, and who had no missing data for sex or suicide variables. The association between sexual orientation discordance and nonfatal suicide risk was assessed using logistic regression. Analyses were performed in 2017. Results: Approximately 4.0% of students experienced sexual orientation discordance. High suicide risk was significantly more common among discordant students compared with concordant students (46.3% vs 22.4%, p<0.0001). In adjusted models, discordant students were 70% more likely to have had suicidal ideation/suicide attempts compared with concordant students (adjusted prevalence ratio=1.7, 95% CI=1.4, 2.0). Conclusions: Sexual orientation discordance was associated with increased likelihood of nonfatal suicidal behaviors. Discordant adolescents may experience unique stressors that should be considered when developing and implementing suicide prevention programs.
Keywords: article; female; gender identity; health survey; heterosexuality; high school student; homosexual female; homosexual male; human; male; prevalence; sexual orientation; suicidal ideation; suicide attempt; United States

Suicidal Thoughts and Behaviors Among First-Year College Students: Results From the WMH-ICS Project - Mortier, P.; Auerbach, R.P.; Alonso, J.; Bantjes, J.; Benjet, C.; Cuijpers, P.; Ebert, D.D.; Green, J.G.; Hasking, P.; Nock, M.K.; O'Neill, S.; Pinder-Amaker, S.; et al. (Journal of the American Academy of Child and Adolescent Psychiatry, 2018)
Objective: College entrance may be a strategically well-placed “point of capture” for detecting late adolescents with suicidal thoughts and behaviors (STB). However, a clear epidemiological picture of STB among incoming college students is lacking. We present the first cross-national data on prevalence as well as socio-demographic and college-related correlates for STB among first-year college students. Method: Web-based self-report surveys were obtained from 13,984 first-year students (response rate 45.5%) across 19 colleges in 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, and the United States). Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 32.7%, 17.5%, and 4.3%, respectively. The 12-month prevalence was 17.2%, 8.8%, and 1.0%, respectively. About three-fourths of STB cases had onset before the age of 16 years (Q3 = 15.8), with persistence figures in the range of 41% to 53%. About one-half (53.4%) of lifetime ideators transitioned to a suicide plan; 22.1% of lifetime planners transitioned to an attempt. Attempts among lifetime ideators without plan were less frequent (3.1%). Significant correlates of lifetime STB were cross-nationally consistent and generally modest in effect size (median adjusted odds ratio [aOR] = 1.7). Nonheterosexual orientation (aOR range 3.3−7.9) and heterosexual orientation with some same-sex attraction (aOR range 1.9−2.3) were the strongest correlates of STB, and of transitioning from ideation to plans and/or attempts (aOR range 1.6−6.1). Conclusion: The distribution of STB in first-year students is widespread, and relatively independent of socio-demographic risk profile. Multivariate risk algorithms based on a high number of risk factors are indicated to efficiently link high-risk status with effective preventive interventions.
Keywords: adolescent; adolescent behavior; article; college student; female; heterosexuality; high risk patient; human; Internet; lifespan; major clinical study; male; multicenter study; onset age; prevalence; priority journal; rating scale; self report; sexual intercourse; sexual orientation; suicidal ideation; suicide attempt; Suicide Severity Rating Scale

Clarifying the relation of acculturative stress and anxiety/depressive symptoms: The role of anxiety sensitivity among hispanic college students - Jardin, C.; Mayorga, N.A.; Bakhshaie, J.; Garey, L.; Viana, A.G.; Sharp, C.; Cardoso, J.B.; Zvolensky, M.J. (Cultural Diversity and Ethnic Minority Psychology, 2018)
Objectives: Recent work has highlighted the link between acculturative stress and depression/anxiety symptoms among Hispanic young adults, but the nature of these relations is not well understood. The present study aimed to clarify the relation between acculturative stress and depression/anxiety symptoms by examining anxiety sensitivity, globally and via subfactors, as an explanatory variable. Method: A cross-sectional sample of 788 Hispanic college students (80.8% female; Mage=20.83 years, SD=1.93) was recruited from a southwestern public university and completed an online self-report assessment battery. Results: Acculturative stress exerted an indirect effect, via the global construct of anxiety sensitivity, on depression symptoms, suicidality, anxious arousal, and social anxiety symptoms. Follow-up simultaneous analytic models demonstrated indirect effects via the anxiety sensitivity subfactors that were pathognomonic with each of the specific affective outcomes. Conclusions: These findings suggest the utility of assessing and targeting anxiety sensitivity in the treatment of acculturative stress-related depression/anxiety problems among Hispanic college students.
Keywords: acculturative stress; adult; age; anxiety disorder; arousal; article; clinical outcome; college student; correlational study; cross-sectional study; demography; depression; female; follow up; Hispanic; human; male; self report; sexual and gender minority; social phobia; social status; physiological stress; suicidal behavior

Using a television documentary to prevent suicide in men and boys - Schlichthorst, M.; King, K.; Spittal, M.; Reifels, L.; Phelps, A.; Pirkis, J. (Australasian Psychiatry, 2018)
Objectives: We investigated whether a documentary about masculinity and suicidality (Man Up) could raise males’ awareness of societal pressures to conform to masculine norms and influence their likelihood of connecting with their male friends and seeking help. Methods: We conducted a repeat cross-sectional survey, posting versions of the survey online before and after Man Up was screened. Results: 1287 male respondents completed the survey; 476 completed the pre-screening survey, 811 the post-screening survey (192 had not viewed Man Up, 619 had). Those who had viewed Man Up were more likely to desire closer relationships with their male friends than those who had not, and had greater awareness of societal pressures on males, but were no more likely to seek help. Almost all respondents who saw Man Up indicated they would recommend it to others, and most said it changed the way they thought about the term ‘man up’. They indicated they would be likely to undertake a number of adaptive actions following the show, and provided overwhelmingly positive feedback. Conclusions: Man Up appeared to effectively address factors that place males at heightened risk of suicide.
Keywords: adult; article; awareness; cross-sectional study; emotion; heterosexual male; high risk population; homosexual male; human; human experiment; male; masculinity; outcome variable; positive feedback; social problem; suicide; television viewing

Ethnic youth and sexual identity: the role of clinical and social support for ‘double minorities’ - Wong, N.; Menkes, D.B. (Australasian Psychiatry, 2018)
Objectives: Sexual-minority youth exhibit increased rates of psychiatric morbidity, subject to various social factors. We examine the impact of ethnicity and culture on these phenomena, with particular reference to Asian youth living in Western societies. Conclusions: Youth from minority ethnic groups who do not identify with their native gender and/or who are not exclusively heterosexual are known as ‘double minorities’. Available evidence suggests that such individuals are at particularly increased risk of depression and suicide, but that this may be mitigated by social support. More research is needed to understand the challenges faced by ‘double minorities’, notably their perception of and ability to access available clinical and social supports.
Keywords: article; Asian; cultural anthropology; depression; ethnic group; ethnicity; gender identity; human; perception; sexual and gender minority; social support; suicide

Sexual risk behaviour, sexual victimisation, substance use and other factors related to depression in men who have sex with men in Wenzhou, China: A cross-sectional study - Pan, X.; Li, R.; Ma, Q.; Wang, H.; Jiang, T.; He, L.; Zeng, S.; Wang, D.; Ye, Z.; Zhu, H.; Zhao, D.; Xia, S. (BMJ Open, 2018)
Objectives Men who have sex with men (MSM) are a marginalised population at high risk for a variety of mental health problems that may mutually facilitate HIV transmission. We assessed factors associated with depressive symptoms among MSM, which can provide some guidance for future mental health interventions with the MSM population for prevention of HIV infection and transmission. Methods A cross-sectional study was conducted in Wenzhou city, China using respondent-driven sampling (RDS) between December 2013 and June 2014. A face-to-face questionnaire survey was employed to collect information about mental and psychosocial health conditions and sexual behaviour characteristics among MSM. Bivariate and multivariable logistic regression analyses were used to identify factors associated with major depressive symptoms. Results Of the 454 participants in the study, prevalence of major depressive symptoms was 34.6%. During the past 6 months, 85% had anal sex with men, and rate of consistent condom use during anal intercourse was 45.1%. Of the respondents, 16.1% reported suicidal ideation, 62.6% had a history of smoking and 41.4% had a history of drinking alcohol, of which 46.3% reported that they were once drunk. Drug use was reported in 3.7% of the sample. Adult sexual violence from same-sex partners was 7.9%, and 5.1% reported childhood sexual abuse. ARDS-weighted multivariable analysis showed that major depressive symptoms among MSM were associated with inconsistent condom use during anal sex with men, multiple oral male sexual partners, suicidal ideation, adult sexual violence from male partners and being once drunk in the past year. Conclusion We found high levels of depressive symptoms, unprotected sex and suicidal ideation among MSM. Comprehensive intervention strategies that combine psychological, behavioural and social aspects are needed to address the mental health issues of MSM, with special attention given to suicidality and high-risk behaviours in mental health and HIV prevention interventions.
Keywords: alcohol; adolescent; adult; aged; anal intercourse; article; China; condom use; cross-sectional study; depression; drinking behavior; drug use; human; Human immunodeficiency virus infection; infection prevention; major clinical study; major depression; male; medical history; men who have sex with men; mental health; oral sex; psychosocial care; questionnaire; sexual abuse; sexual behavior; sexual victimisation; sexual violence; sexuality; smoking; substance use; suicidal ideation; victim

Accounting for Diversity in Suicide Research: Sampling and Sample Reporting Practices in the United States - Cha, C.B.; Tezanos, K.M.; Peros, O.M.; Ng, M.Y.; Ribeiro, J.D.; Nock, M.K.; Franklin, J.C. (Suicide & life-threatening behavior, 2018)
Research on suicidal thoughts and behaviors (STB) has identified many risk factors, but whether these findings generalize to diverse populations remains unclear. We review longitudinal studies on STB risk factors over the past 50 years in the United States and evaluate the methodological practices of sampling and reporting sample characteristics. We found that articles frequently reported participant age and sex, less frequently reported participant race and ethnicity, and rarely reported participant veteran status or lesbian, gay, bisexual, and transgender status. Sample reporting practices modestly and inconsistently improved over time. Finally, articles predominantly featured White, non-Hispanic, young adult samples.
Keywords: adolescent; adult; age; ancestry group; cultural diversity; ethnic group; female; human; longitudinal study; male; meta analysis; middle aged; prospective study; research; risk factor; sex factor; sexual and gender minority; statistics and numerical data; suicide; United States; veteran; young adult

Targeted Victimization and Suicidality Among Trans People: A Web-Based Survey - Zeluf, G.; Dhejne, C.; Orre, C.; Mannheimer, L.N.; Deogan, C.; Höijer, J.; Winzer, R.; Thorson, A.E. (LGBT health, 2018)
PURPOSE: The aim of this study was to investigate the associations between a series of empirically known risk and protective factors and suicidality among trans people in Sweden. METHODS: Participants were self-selected anonymously to a web-based survey conducted in 2014. Univariable and multivariable logistic regression analyses were performed to assess associations between contributing factors and suicide ideation in the past 12 months and lifetime suicide attempts. RESULTS: The analysis included 796 trans individuals, between 15 and 94 years of age, who live in Sweden. A total of 37% of respondents reported that they have seriously considered suicide during the past 12 months and 32% had ever attempted a suicide. Offensive treatment during the past three months and lifetime exposure to trans-related violence were significantly associated with suicidality. Less satisfaction with contacts with friends and acquaintances and with one's own psychological wellbeing were associated with suicide ideation in the past 12 months. Lack of practical support was associated with lifetime suicide attempts. CONCLUSIONS: Our findings show that suicidality is directly correlated with trans-related victimization. Preventing targeted victimization is, therefore, a key preventive intervention against this elevated suicidality.
Keywords: adolescent; adult; aged; crime victim; female; human; Internet; male; middle aged; psychology; questionnaire; statistics and numerical data; suicide; Sweden; transgender; very elderly; young adult

Correctional Policy and Attempted Suicide Among Transgender Individuals - Drakeford, L. (Journal of correctional health care : the official journal of the National Commission on Correctional Health Care, 2018)
Little research has examined the link between incarceration and suicide among transgender individuals. Transgender inmates face unique circumstances within the correctional setting that expose them to potentially harmful conditions, including correctional policies that limit access to proper medical care and expose them to threats of harassment and violence. Using data from the 2011 National Transgender Discrimination Survey, this article examines the link between incarceration and suicide among transgender individuals by focusing on the link between correctional policies and attempted suicide among transgender individuals who have been incarcerated. Multivariate results suggest that correctional policies regarding health care and housing may deleteriously impact transgender inmates.
Keywords: female; human; male; policy; correctional facility; statistics and numerical data; suicide attempt; transgender

Association of recent gay-related stressful events and emotional distress with suicidal behaviors over 12 months in Chinese men who have sex with men - Yu, L.; Li, Y.; Liu, L.; Li, S.; Na, J.; An, X.; Zhou, Y.; Gu, Y.; Bi, X.; Mu, H.; Zhang, R.; Dong, W.; et al. (Asia-Pacific Psychiatry, 2018)
Introduction: The study was designed to assess the association of gay-related stressful events (GRSEs) and emotional distress with suicidal behaviors over a 12-month period in Chinese men who have sex with men (MSM). Methods: A total of 807 MSM were recruited using a respondent-driven sampling method from 4 cities in northeastern China. The GRSEs were measured using the Gay-related Stressful Life Events Scale, depression using the Self-rating Depression Scale, and anxiety using the Self-rating Anxiety Scale. Results: A total of 26.0% of study participants experienced GRSEs during the 3 months, and their average Self-rating Depression Scale and Self-rating Anxiety Scale scores were significantly lower than the national norms. Over a 12-month period, the prevalence of suicidal ideation, plan, and attempt was 9.7%, 4.0%, and 3.0%, respectively, each of which is at least 3 to 4 times greater than that of male adults in the general population of China. Multiple logistic regression analysis showed that GRSEs significantly increased the risk of suicidal ideation (odds ratio [OR] = 2.3, 95% confidence interval [CI], 1.4-3.7) and plan (OR = 2.8, 95% CI, 1.3-6.0). Depressive symptoms significantly increased the risk of suicidal ideation (OR = 3.5, 95% CI, 2.1-5.8), plan (OR = 4.4, 95% CI, 2.0-9.6), and attempt (OR = 5.6, 95% CI, 21.94.8). Anxiety symptoms (OR = 3.4, 95% CI, 1.4-8.4) and cohabitation with a same sex partner (OR = 3.0, 95% CI, 1.2-7.9) significantly increased the risk of suicide attempt. Discussion: More efforts to reduce GRSE are worth investigating as a strategy to reduce suicidal thoughts and behaviors in Chinese MSM.
Keywords: adult; anxiety; article; bisexuality; Chinese; cohabitation; depression; emotional stress; homosexual male; human; Life Events Scale; major clinical study; male; men who have sex with men; prevalence; priority journal; risk factor; Self-rating Anxiety Scale; social support; suicidal behavior; suicidal ideation; suicide attempt; young adult

An Application of Syndemic Theory to Identify Drivers of the Syphilis Epidemic among Gay, Bisexual, and Other Men Who Have Sex with Men - Ferlatte, O.; Salway, T.; Samji, H.; Dove, N.; Gesink, D.; Gilbert, M.; Oliffe, J.L.; Grennan, T.; Wong, J. (Sexually Transmitted Diseases, 2018)
Background We applied syndemic theory to explore the degree to which syndemic conditions explain the syphilis epidemic affecting Canadian gay and bisexual men who have sex with men (GBMSM). Methods Data from a national survey comprising 7872 GBMSM were analyzed using multivariable logistic regression to measure associations between recent syphilis diagnosis (RSD; in previous 12 months) and the following variables: (1) sociodemographic information (sexuality, HIV status, age, income, ethnicity, relationship status), (2) antigay stigma (bullying, physical violence, sexual violence, career discrimination, health care discrimination), (3) syndemic conditions (suicidality, intimate partner violence, depression, illicit substance use, binge drinking), (4) sexual behaviors, (5) health care discrimination, and (6) the cumulative count of antigay experiences and syndemic conditions. Results Three percent (n = 235) of GBMSM surveyed reported an RSD. Men were more likely to report an RSD if they were HIV positive (adjusted odds ratio [AOR], 6.27; 95% confidence interval [CI], 4.66-8.43). Recent syphilis diagnosis was also positively associated with career discrimination, health care discrimination, substance use, and intimate partner violence. Furthermore, prevalence of RSD increased with each additional form of stigma or syndemic condition. The odds of reporting RSD was 5.2 (95% CI, 1.0-25.9) times higher for men who reported experiencing all 4 forms of antigay stigma compared with those who reported no stigma, after adjusting for sociodemographics. Similarly, the adjusted odds of reporting RSD was 12.2 (95% CI, 2.0%-74.8%) times higher for GBMSM experiencing 5 syndemic conditions compared with those reporting no syndemic conditions. Conclusions Evidence from this large cross-sectional study suggests that the Canadian syphilis epidemic among GBMSM is being driven by a syndemic constituted by multiple social and psychological conditions. Interventions addressing specific psychosocial health outcomes that increase the risk for syphilis should be developed and integrated within targeted sexual health services and syphilis prevention initiatives.
Keywords: adult; anal intercourse; article; binge drinking; Canada; career; concurrent sexual partnership; cross-sectional study; depression; epidemic; health care access; health care disparity; human; illicit drug inhalation; LGBT people; major clinical study; male; men who have sex with men; partner violence; prophylaxis; sexism; sexual behavior; social stigma; substance use; suicidal ideation; syndemic theory; syphilis; theory

Cyberbullying and LGBTQ Youth: A Systematic Literature Review and Recommendations for Prevention and Intervention - Abreu, R.L.; Kenny, M.C. (Journal of Child and Adolescent Trauma, 2018)
Research has demonstrated that cyberbullying has adverse physical and mental health consequences for youths. Unfortunately, most studies have focused on heterosexual and cisgender individuals. The scant available research on sexual minority and gender expansive youth (i.e., LGBTQ) shows that this group is at a higher risk for cyberbullying when compared to their heterosexual counterparts. However, to date no literature review has comprehensively explored the effects of cyberbullying on LGBTQ youth. A systematic review resulted in 27 empirical studies that explore the effects of cyberbullying on LGBTQ youth. Findings revealed that the percentage of cyberbullying among LGBTQ youth ranges between 10.5% and 71.3% across studies. Common negative effects of cyberbullying of LGBTQ youth include psychological and emotional (suicidal ideation and attempt, depression, lower self-esteem), behavioral (physical aggression, body image, isolation), and academic performance (lower GPAs). Recommendations and interventions for students, schools, and parents are discussed.
Keywords: academic achievement; age; article; bullying; cyberbullying; depression; educational status; ethnicity; gender; gender identity; harassment; heterosexuality; human; parental behavior; prevalence; race; self esteem; sexual and gender minority; social support; suicidal ideation; suicide attempt; systematic review

Correlation of Minority Status, Cyberbullying, and Mental Health: A Cross-Sectional Study of 1031 Adolescents - Duarte, C.; Pittman, S.K.; Thorsen, M.M.; Cunningham, R.M.; Ranney, M.L. (Journal of Child and Adolescent Trauma, 2018)
Adolescent cyberbullying is increasingly prevalent. Depression and suicidal ideation are also common, particularly among minority adolescents and cyberbullied adolescents. Little data exists to establish whether minority cyberbullied adolescents are at greater risk of negative mental health outcomes associated with cyberbullying. This cross-sectional study of 1031 adolescents presenting to an emergency room examines the prevalence of cyberbullying in minority and non-minority populations. Using logistic regression, we compared mental health symptoms between minority and non-minority cyberbullying-involved adolescents (accounting for demographic factors), and examined the correlation between use of multiple forms of online technology, minority status, and prevalence of cyberbullying. Sexual orientation was the only demographic factor to strongly correlate with cyberbullying involvement or to correlate with negative mental health symptoms. Increased use of social media platforms also correlated with cyberbullying involvement. This analysis provides a baseline for future work around targeted cyberbullying interventions for minority adolescent populations.
Keywords: adolescent; article; bullying; child abuse; cross-sectional study; depression; female; human; male; mental health; Patient Health Questionnaire 9; psychosis; sexual assault; sexual orientation; social network; suicidal ideation

Sexual Violence and Intimate Partner Violence in College Women with a Mental Health and/or Behavior Disability - Bonomi, A.; Nichols, E.; Kammes, R.; Green, T. (Journal of Women's Health, 2018)
Objectives: We address questions about (1) how college women with a disability experience sexual violence (SV) and intimate partner violence (IPV) across partners, including disability-specific abuse and (2) how SV/IPV impacts psychological, behavioral, physical, and academic life domains. Methods/Design: Twenty-seven female college students (mean age, 21.2; 66.6% white; 66.6% heterosexual) were randomly sampled from university registrar records. To be eligible for the study, students had to have at least one experience of SV/IPV since age 18 and a disability (88.8% reported one or more mental health conditions; 11.1% reported other conditions, such as attention deficit and hyperactivity disorder; with the majority of women indicating their disability preceded SV/IPV victimization). Using the Centers for Disease Control and Prevention's definitions of SV/IPV as guides, clinically trained master's level interviewers conducted semistructured interviews to ascertain SV/IPV patterns across students' three most recent relationships and related life impacts. Results: SV/IPV was pervasive in college women with a disability, within hookup settings and/or recurring SV/IPV with a long-term partner. For some women, SV spanned multiple abusive partners. For women in relationships marked by chronic abuse, in addition to SV, the relationship dynamic included disability-specific abuse, social isolation, threats/intimidation, and technology-related abuse. For women experiencing SV events within hookup settings, alcohol was a common facilitator, with some abusers using a disability to manipulate a sexual connection. All but one participant reported exacerbated adverse mental health consequences (e.g., depression, anxiety, post-traumatic stress disorder, suicidal ideation/attempts, stress) after victimization. These adverse mental health consequences coincided with adverse behavioral (e.g., becoming less social, avoiding usual study lounge areas on campus), physical (e.g., problems sleeping, bruising, pregnancy concerns, and sexually transmitted disease), and academic outcomes (e.g., skipping and/or dropping class, grades suffering). Discussion: Our results underscore the need for continued investment in campus programs that improve response to SV/IPV, including prevention programs and support services tailored to the specific needs and vulnerabilities of women with underlying mental health conditions.
Keywords: adult; alcohol consumption; anxiety disorder; article; attention deficit disorder; behavior disorder; bisexuality; Caucasian; clinical article; college student; depression; disability; female; heterosexual female; homosexual female; human; mental disease; partner violence; posttraumatic stress disorder; pregnancy; priority journal; school dropout; semi structured interview; sexual abuse; sexual behavior; sexual violence; sexually transmitted disease; skin contusion; sleep disorder; social isolation; suicidal ideation; threat; university; victim; young adult

Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: A nationwide, retrospective cohort study - Zhao, Y.; Wu, Z.; McGoogan, J.M.; Shi, C.X.; Li, A.; Dou, Z.; Ma, Y.; Qin, Q.; Brookmeyer, R.; Detels, R.; Montaner, J.S.G. (Clinical Infectious Diseases, 2018)
Background. Clinical trials have demonstrated that immediate initiation of antiretroviral therapy (ART) reduces AIDS-related morbidity and mortality. We tested the hypothesis that initiating ART ≤30 days after human immunodeficiency virus (HIV) diagnosis would be associated with reduced mortality among people living with HIV (PLWH) with CD4 counts >500 cells/μL. Methods. PLWH enrolled in the Chinese National HIV Information System between January 2012 and June 2014 with CD4 counts >500 cells/μL were followed for 12 months. Cox proportional hazards model was used to determine hazard ratios (HRs) for PLWH who initiated ART after HIV diagnosis. ART initiation was treated as a time-dependent variable. Results. We enrolled 34 581 PLWH with CD4 >500 cells/μL; 1838 (5.3%) initiated ART ≤30 days after diagnosis (immediate ART group), and 19 deaths were observed with a mortality rate of 1.04 per 100 person-years (PY). Fifty-eight deaths were documented among the 5640 PLWH in the delayed ART group with a mortality rate of 2.25 per 100 PY. There were 713 deaths among the 27 103 PLWH in the no ART group with a mortality rate of 2.39 per 100 PY. After controlling for potential confounding factors, ART initiation at ≤30 days (adjusted HR, 0.37 [95% confidence interval, .23-.58]) was a statistically significant protective factor. Conclusions. We found that immediate ART is associated with a 63% reduction in overall mortality among PLWH with CD4 counts >500 cells/μL in China, supporting the recommendation to initiate ART immediately following HIV diagnosis.
Keywords: antiretrovirus agent; adult; all cause mortality; antiretroviral therapy; article; candidiasis; cardiovascular disease; cause of death; CD4 lymphocyte count; central nervous system infection; China; cohort analysis; cryptococcal meningitis; cryptosporidiosis; drug intoxication; educational status; female; gastrointestinal disease; hepatitis B; hepatitis C; herpes virus infection; heterosexuality; human; Human immunodeficiency virus infection; intravenous drug abuse; major clinical study; male; malignant neoplasm; medical information system; men who have sex with men; metabolic disorder; mortality rate; mortality risk; observational study; pneumocystosis; pneumonia; priority journal; recurrent disease; respiratory tract disease; retrospective study; risk reduction; sex difference; suicide; therapy delay; time to treatment; tuberculosis; wasting syndrome

Characteristics of stress and suicidal ideation in the disclosure of sexual orientation among young french LGB adults - Charbonnier, E.; Dumas, F.; Chesterman, A.; Graziani, P. (International Journal of Environmental Research and Public Health, 2018)
Background: Lesbians, gays, and bisexual people (LGB) present high levels of suicidal ideation. The disclosure of sexual orientation is a stressful experience which presents a high suicide risk. Research has not paid sufficient attention to stress during this disclosure in order to understand suicide among LGB people. The aims of this study were to investigate: (1) the characteristics of stress during this revelation, more precisely cognitive appraisal, emotions, and coping; and (2) associations between these characteristics and suicidal ideation. Method: A total of 200 LGB young adults answered the “Stressful situation assessment questionnaire”, focusing on the most stressful disclosure of sexual orientation they have ever experienced. Results: Avoidance coping is a good predictor of suicidal ideation, and mediates the association between primary appraisal (risk “Harm myself and others”) and suicidal ideation. Conclusions: Our study illustrates the need to better understand stress during the disclosure of sexual orientation to prevent and care for suicide risk among LGB young adults.
Keywords: adult; article; avoidance behavior; controlled study; coping behavior; disease association; emotion; female; Frenchman; human; LGBT people; major clinical study; male; questionnaire; sexual orientation; physiological stress; suicidal ideation

Sexual Identity, Adverse Childhood Experiences, and Suicidal Behaviors - Clements-Nolle, K.; Lensch, T.; Baxa, A.; Gay, C.; Larson, S.; Yang, W. (Journal of Adolescent Health, 2018)
Purpose: The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on suicidal behaviors in a population-based sample of high school students. Methods: A two-stage cluster random sampling design was used to recruit 5,108 students from 97 high schools. A total of 4,955 students (97%) provided information that allowed for classification of sexual identity into three groups: (1) lesbian, gay, or bisexual (LGB) (10%); (2) not sure (4.6%); and (3) heterosexual (85.4%). Five measures of childhood abuse and household dysfunction were summed, and the ACE score was categorized as 0, 1, 2, and 3–5 ACEs. Weighted logistic regression was used to assess the influence of sexual identity, ACEs, and their interaction on suicide ideation and attempts in the past 12 months. Results: Compared with heterosexual students, those who were LGB and were not sure had higher odds of suicide ideation and attempts. There was also a graded relationship between cumulative ACE exposure and suicidal behaviors. Although sexual identity/ACE interaction was not observed, LGB/not sure students who experienced a high number of ACEs were disproportionately affected. Compared with heterosexual students with 0 ACE, LGB/not sure students with 0 ACE (adjusted odds ratio [AOR] = 3.32, 95% confidence interval [CI] = 1.96–5.61), 1 ACE (AOR = 6.58, 95% CI = 4.05–10.71), 2 ACEs (AOR 13.50, 95% CI = 8.45–21.58), and 3–5 ACEs (AOR = 14.04, 95% CI = 8.72, 22.62) had higher odds of suicide ideation. A similar pattern was observed for suicide attempts. Conclusions: LGB and students not sure of their sexual identity with greater exposure to ACEs have disproportionately high levels of suicide ideation and attempts. Trauma-informed interventions for these populations are warranted.
Keywords: adolescent; adult; childhood adversity; article; bisexuality; confidence interval; female; gender identity; heterosexuality; high school student; homosexual female; homosexual male; human; logistic regression analysis; major clinical study; male; odds ratio; population research; priority journal; psychotrauma; scoring system; suicidal behavior; suicidal ideation; suicide attempt

Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates - Li, D.H.; Turner, B.C.; Mustanski, B.; Phillips, G.L. (Addictive Behaviors, 2018)
Objective Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse. Method Using data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use. Results Adjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7–2.5). Most sexual orientation disparities among females remained significant with the addition of victimization and mental health covariates but attenuated completely after controlling for other illicit drug use. The effect for unsure males attenuated when victimization variables were included, but the effect for gay males remained significant through the final model. Controlling for other illicit drug use, mental health variables remained significant correlates for females whereas only forced sex was significant for males. Conclusion These results suggest experiences of victimization and mental health partially account for the disparities in prescription drug misuse between SMA and heterosexual adolescents, and their effects may differ by sex. A combination of structural, individual coping, and universal drug prevention approaches should be used to make the largest impact on reducing these disparities.
Keywords: adolescent; article; bisexuality; cannabis smoking; controlled study; disease association; drug misuse; ethnic difference; female; forced sexual intercourse; high risk population; homosexual male; hopelessness; human; major clinical study; male; mental disease; prevalence; race difference; sadness; sex difference; sexual intercourse; sexual and gender minority; sexual orientation; suicidal ideation; victim

A post-mortem study of the cause of death and concomitant diseases of refugees in Munich (2014–2015) - Gleich, S.; Domingo, O.; Ackermann, N.; Schwerer, M.; Graw, M.; Schöpfer, J. (Rechtsmedizin, 2018)
Background: There was a clear increase in the influx of refugees in Germany in 2014 and 2015. The majority of them came from countries without regular access to medical care. There are often precarious hygienic conditions during the flight. An above-average prevalence for infectious diseases, such as tuberculosis and blood-borne viral diseases is described for this group of persons. There are no available data on the causes of death and concomitant diseases in this group. In the Institute of Forensic Medicine at the University of Munich autopsies were carried out on a significant number of refugees for the first time. Material and methods: The macromorphological findings during the autopsies and the prosecution files were evaluated. Blood and urine samples were analyzed for alcohol and drugs by chromatography and mass spectrometry. Femoral vein blood samples (whole blood) were analyzed for human immunodeficiency virus (HIV), hepatitis B and C by the polymerase chain reaction (PCR). The formalin-fixed parenchymatous organs were histologically examined and assessed. The statistical evaluation of the obtained data was carried out using SPSS (version 23). Results: A total of 20 deceased refugees were autopsied during the investigation period and the average age was 26 years. The main countries of origin were Syria, Afghanistan and Eritrea. In 14 cases an unnatural death was detected, in 2 a natural death and in 4 cases the cause of death remained unclear. The cases of unnatural death were caused by drowning accidents, suicide, traffic accidents, drug abuse and one homicide and the cases of natural death by pneumonia and heart failure. In three cases an infectious or parasitic accompanying disease was diagnosed (tuberculosis or roundworm disease). In 12 of the deceased there were non-infectious concomitant diseases, 6 of which were psychiatric diseases. Conclusion: According to our knowledge for the first time a professional overview of autopsies of refugees, their causes of death and existing concomitant diseases can be given. The indications for a medicolegal autopsy of this group are no different from the general German population. Striking was the low average age of the deceased and the leading cause of death in this small study was drowning of non-swimmers during the summer. None of the autopsied refugees had a contagious disease which could be transmitted to third parties. Despite the young age more than half of the cases were caused by internal diseases, which were the cause of death in two cases. No particular danger for infection existed for the personnel involved in the autopsies of the subjects.
Keywords: adult; arteriosclerosis; article; ascariasis; autopsy; body mass; cause of death; comorbidity; controlled study; depression; drowning; drug dependence; epilepsy; female; general aspects of disease; granuloma; heart hypertrophy; heart right ventricle hypertrophy; hepatitis B; hepatitis C; homicide; human; ischemic heart disease; liver injury; lung emphysema; lung tuberculosis; male; necrosis; parasitosis; polymerase chain reaction; real time polymerase chain reaction; refugee; schizoaffective psychosis; sex reassignment; suicide; traffic accident

Gender differences in causes of death among persons with HIV/AIDS in San Francisco, California, 1996–2013 - Hessol, N.A.; Schwarcz, S.K.; Hsu, L.C.; Shumway, M.; Machtinger, E.L. (International Journal of STD and AIDS, 2018)
The objective was to examine gender differences in causes of death using the San Francisco HIV/AIDS and death registries. Data from San Francisco residents diagnosed with HIV/AIDS who died from 1996 to 2013 were analyzed. Age, race/ethnicity, year, and gender-adjusted standardized mortality ratios and Poisson 95% confidence intervals were calculated for underlying causes of death. Among the 6268 deaths, deaths attributed to drug use, mental disorders due to substance use, cerebrovascular disease, chronic obstructive pulmonary disease, renal disease, and septicemia were more likely among women than among men. Compared to the California population, women had elevated standardized mortality ratios for drug overdose (25.37), mental disorders due to substance abuse (27.21), cerebrovascular disease (2.83), chronic obstructive pulmonary disease (7.37), heart disease (2.37), and liver disease (5.54), and these were higher than the standardized mortality ratios for the men in our study. Men, but not women, had elevated standardized mortality ratios for suicide (2.70), undetermined intent (3.88), renal disease (2.29), and non-AIDS cancer (1.68) compared to population rates. Continued efforts to reduce HIV-related illnesses and an increased emphasis on diagnosing and treating preventable causes of death, including substance use, heart disease, and mental health disorders, are needed as part of comprehensive HIV care.
Keywords: acquired immune deficiency syndrome; adolescent; adult; age; aged; article; cause of death; cerebrovascular disease; chronic obstructive lung disease; death certificate; drug overdose; drug use; female; heart disease; human; Human immunodeficiency virus infection; kidney disease; liver disease; major clinical study; male; mental disease; middle aged; mortality rate; opportunistic infection; pneumonia; priority journal; race difference; septicemia; sex difference; standardized mortality ratio; substance abuse; substance use; suicide; transgender; virus hepatitis

New data on intimate partner violence and intimate relationships: Implications for gun laws and federal data collection - Sorenson, S.B.; Spear, D. (Preventive Medicine, 2018)
Age at first marriage has risen substantially and birth rates are at a record low; people are spending more time in relationships that, by comparison, have fewer emotional, financial, and legal commitments. Little research has examined intimate partner violence (IPV) prevalence in current and former adult (vs. adolescent) dating relationships. Such information is relevant to federal firearms policies that are based on the nature of an intimate relationship. We examined assaultive behaviors by the type and status of the relationship – current spouse, former spouse, current boyfriend or girlfriend, and former boyfriend or girlfriend – in 31,206 IPV incidents responded to by Philadelphia police in 2013. Over 80% of the IPV incidents involved individuals in non-marital relationships. Incidents involving current boyfriends or girlfriends had the highest percentage of violent behaviors (e.g., punch, strangle). They also were more likely than current spouses to use bodily weapons (hands, fists, or feet) or non-gun weapons (knives, bats, etc.) (AOR = 1.19 and 1.43, respectively), to injure their victims (AOR = 1.37), and to be arrested (AOR = 1.46). Former unmarried partners had the highest odds of stalking their intimate (AOR = 3.37) and violating a restraining order (AOR = 2.61). Gun use was similar across relationship type. A growing portion of the population is not protected by federal policies designed to keep guns out of the hands of abusers. Current boyfriends and girlfriends are a risk to their intimates. Federal data collection practices and firearm policies merit updating to more fully take into account dating, same-sex marriage, and other partnerships.
Keywords: act; article; assault; firearm; human; human relation; incident report; intimate relationship; marriage; partner violence; Pennsylvania; police; policy; priority journal; stalking; victim; violence against women act

Norms and normalisation: understanding lesbian, gay, bisexual, transgender and queer youth, suicidality and help-seeking - McDermott, E.; Hughes, E.; Rawlings, V. (Culture, health & sexuality, 2018)
Young people who identify as lesbian, gay, bisexual, and queer transgender have elevated rates of suicidality. Despite the increased risk, there is a paucity of research on lesbian, gay, bisexual, transgender and queer help-seeking and suicidality. We report on a UK sequential exploratory, two-stage, mixed-method study. Stage 1 involved 29 online and face-to-face semi-structured interviews with lesbian, gay, bisexual, transgender and queer youth aged 16-25 years old. Stage 2 utilised an online youth questionnaire employing a community-based sampling strategy (n = 789). Results indicated that participants only asked for help when they reached a crisis point because they were normalising their emotional distress. Those who self-harmed, had attempted or planned suicide or had experience of abuse related to their sexuality or gender were most likely to seek help. Results suggested that the reluctance to seek help was due to three interconnecting factors: negotiating sexuality, gender, mental health and age norms; being unable to talk about emotions; and coping and self-reliance. Policies aiming to prevent lesbian, gay, bisexual, transgender and queer youth suicide recognise that norms and normalising processes connected to sexual orientation and gender identity are additional difficulties that youth have accessing mental health support.
Keywords: adolescent; adult; coping behavior; emotion; female; help seeking behavior; human; interview; male; psychology; questionnaire; sexual and gender minority; suicidal ideation; young adult

The use of metaphors in understanding atypical gender identity development and its psychosocial impact - Di Ceglie, D. (Journal of Child Psychotherapy, 2018)
Over the years I have found a number of metaphors which have helped me to deal with particular dynamics in therapeutic work or with group and institutional conflicts involving the Gender Identity Development Service at the Tavistock Centre. This nationwide service, which is for young people with atypical gender identity development and their families, was established in 1989. In this paper I describe some of these metaphors in relation to the particular problems or conflicts which had stimulated their appearance in my mind. The emergence of these metaphors links the vicissitudes of atypical gender identity development to issues regarding symbolisation or symbolic thinking. Metaphors such as ‘working at the edge’ or ‘navigating between Scylla and Charybdis’ allow the professional to hold on to multiple perspectives and to maintain a certain degree of ambiguity in situations in which the interpersonal dynamics can be experienced as rigid and deterministic. The emergence of metaphors can then be perceived by the professional with a sense of relief and freedom of thinking. In this paper, metaphors are linked to: the model of care developed; the therapeutic stance; and the aims, risks and pressures experienced by the professional in this area of work. The association between gender dysphoria in some young people and autistic spectrum features is explored. The paper emphasises the importance of responding flexibly to individual differences and of recognising complexity.
Keywords: abnormal thinking; adolescent; anxiety; article; automutilation; child development; clinical decision making; DSM-III; follow up; gender dysphoria; gender identity; human; literature; male; mental health; psychoanalysis; psychotherapy; questionnaire; self concept; social psychology; suicidal behavior; visual hallucination

Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso - Kim, H.-Y.; Grosso, A.; Ky-Zerbo, O.; Lougue, M.; Stahlman, S.; Samadoulougou, C.; Ouedraogo, G.; Kouanda, S.; Liestman, B.; Baral, S. (Annals of Epidemiology, 2018)
Purpose: The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities. Methods: FSWs (N = 350) and MSM (N = 330) aged ≥18 were recruited in Bobo-Dioulasso, Burkina Faso. Perceived health care stigma was defined as either ever being afraid of or avoiding health care services because someone might find out the participant has sex with men (for MSM) or sells sex (for FSW). Correlates of perceived health care stigma were examined using multivariable logistic regression. Results: The prevalence of perceived health care stigma was 14.9% (52/350) and 24.5% (81/330) in FSWs and MSM, respectively. Among FSWs, experienced or social stigma, including verbal harassment (adjusted odds ratio [aOR] = 3.59, 95% confidence interval [CI] 1.48–8.71), feeling rejected by friends (aOR = 2.30, 95% CI 1.14–4.64), and feeling police refused to protect them (aOR = 2.58, 95% CI 1.27–5.25), was associated with perceived health care stigma. Among MSM, experiencing verbal harassment (aOR = 1.95, 95% CI 1.09–3.50) and feeling scared to walk in public (aOR = 2.93, 95% CI 1.47–5.86) were associated with perceived health care stigma. Conclusions: In these key populations, perceived health care stigma was prevalent and associated with experienced and social stigmas. To increase coverage of effective HIV services, interventions should incorporate approaches to comprehensively mitigate stigma.
Keywords: condom; adult; article; Burkina Faso; demography; employment status; female; friend; harassment; health care utilization; human; Human immunodeficiency virus infection; major clinical study; male; marriage; men who have sex with men; mental health; personal experience; police; prevalence; priority journal; protection; public health service; sex worker; sexual orientation; sexual practice; social behavior; social capital; social rejection; social stigma; socioeconomics; suicidal ideation; verbal communication

Psychometric analysis of the life worries scale for a new generation of sexual minority men: The P18 cohort study - Halkitis, P.N.; Cook, S.H.; Ristuccia, A.; Despotoulis, J.; Levy, M.D.; Bates, F.C.; Kapadia, F. (Health Psychology, 2018)
Objective: Sexual minority men (SMM) in the United States continue to experience adverse health problems and psychosocial burdens. However, there is limited psychometric research seeking to quantify the life worries of this population. Informed by syndemic theory, the Life Worries Scale (LWS) was developed to measure the concerns of young SMM. Method: Analyses of the scale were undertaken using baseline data (n = 665) from an ongoing cohort study of emerging adult, SMM. Results: Exploratory factor analyses (EFA) of an initial set of 24 Likert-type items, followed by confirmatory factor analysis (CFA) and an exploratory structural equation model (ESEM), indicated a structure consisting of 6 domains of worries: financial stability, social stability, self esteem, loneliness, physical appearance, and physical health. These 6 subscales were highly correlated and also demonstrated high levels of internal consistency. Differences in life worries were noted across demographic states, specifically HIV serostatus, sexual attraction, housing status, and self-rated health. High levels of association were also detected between all 6 subscales with both depression and PTSD, while significant correlations were detected between suicidality and both self esteem and loneliness related worries. Conclusions: The results of our analyses provide evidence for the strong psychometric characteristics of the LWS. This newly developed instrument should be utilized in research to examine the extent to which life worries explain health outcomes and risk behaviors in sexual minority males, and may be potentially extended for use in other populations.
Keywords: article; cohort analysis; confirmatory factor analysis; depression; ethnicity; exploratory factor analysis; exploratory structural equation model; health; human; Human immunodeficiency virus infected patient; internal consistency; Life Worries Scale; loneliness; male; mathematical model; mental health; patient worry; physical appearance; posttraumatic stress disorder; psychologic assessment; psychometry; rating scale; scoring system; self esteem; sexual and gender minority; social status; suicidal ideation; suicide attempt

Social connectedness, stressful life events, and self-injurious thoughts and behaviors among young adults - Macrynikola, N.; Miranda, R.; Soffer, A. (Comprehensive Psychiatry, 2018)
Objectives Preventing self-injurious thoughts and behaviors (SITBs) is particularly challenging on commuter campuses, given lower social cohesion and higher levels of stress than among traditional college populations. The present study examined the relationship between stressful life events (SLEs) and risk for different forms of SITBs, along with the potential buffering role of social connectedness, in a diverse sample of young adults from a commuter college. Methods Participants were 1712 (81% female; 61% racial/ethnic minority; 20% sexual minority) undergraduate and graduate students from a public commuter college in New York City. Participants completed an anonymous survey that inquired about lifetime and recent (past 12 months) history of suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI), along with social connectedness and lifetime history of SLEs. Results Lower levels of social connectedness and exposure to a higher number of SLEs were associated with engaging in SITBs in the past year, particularly both suicide attempts and non-suicidal self-injury. However, social connectedness did not buffer against the impact of SLEs on SITBs. Limitations Data are cross-sectional, limiting conclusions about directionality, and females were overrepresented. Conclusions Identifying ways to increase social connectedness on diverse commuter campuses may help decrease risk of SITBs. However, it may not buffer against the impact of SLEs on risk of SITBs. Future studies should examine contextual variables (e.g., type and timing of social support) that may play a role in protecting against SITBs, particularly for those with a history of adversity.
Keywords: adult; article; automutilation; behavior; cross-sectional study; ethnic group; female; human; life event; life stress; major clinical study; male; questionnaire; sexual and gender minority; social aspect; social connectedness; suicidal ideation; suicide attempt; thinking; young adult

Acting out in a post-contemporary age - Tiscini, G.; Ansermet, F. (Evolution Psychiatrique, 2018)
Objective: The starting-point of this article consists in considering what is contemporary as being post-contemporary. Like the present, what is contemporary is something that cannot be pinned down. It requires hindsight in order to analyse it. Our first objective is to approach our post-contemporary age as being characterised by radicality. This takes the form of a search for origins, which shows up in a return of the religious, alongside the emergence of an anguish reducing things to nothingness. Solitude is a characteristic of this radical position, raising the issue of an otherness that turns anguish into hatred, whether of oneself or of the other. Indeed, the post-contemporary subject acts-out when faced with social ties and a culture that can no longer uphold him. Our second objective is to demonstrate that the effect of this radical position leads the subject to use his body as the only way out. Having become an external organism, the body comes to represent that which is intolerable for the subject. In order to escape anguish turned into hatred, the subject excludes himself from his own body. Finally, the third objective is to show how the free radical subject is a product of ‘liberal’ society, seeking to create his freedom at every moment. Method: Our method uses clinical practice. We work from two contrasting clinical fields; on the one hand acting out in the form of acts of murder or suicide, on the other hand acts of passage from one gender to another. Results: Acting out and acts of passage both relate to these free radical subjects who shape their own body, or who shape the body of the other as though it were their own. Discussion: We will discuss the points of convergence and divergence between these two situations. Conclusion: Our conclusion demonstrates that acts on the body of the other and acts on one's own body coincide. Acting out in the form of murder or suicide masks the wish for an act of passage, which is however impossible. The act of passage from one gender to the other requires an acting out that sometimes cannot be countenanced. With those whose aim is an act of passage, it is an acting out that must be sought. Similarly, with those who act-out, the need is to try to restore, in the aftermath, the possibility of an act of passage.
Keywords: acting out; anguish; article; biogenesis; body build; body movement; clinical practice; convergent evolution; cultural anthropology; emotion; evolution; freedom; hate; homicide; human; post contemporary age; psychoanalysis; radicality; religion; self concept; social behavior; social interaction; species coexistence; suicide; transgender

"Invisible During My Own Crisis": Responses of LGBT People of Color to the Orlando Shooting - Ramirez, J.L.; Gonzalez, K.A.; Galupo, M.P. (Journal of homosexuality, 2018)
On June 12, 2016, the Pulse nightclub in Orlando, Florida was the target of one of the country's deadliest mass shootings. Pulse, a gay nightclub, was hosting a Latin Pride Night the evening of the tragedy, which resulted in the death of 49 victims and 53 casualties, over 90% of whom were lesbian, gay, bisexual, and transgender (LGBT) Latinx people, specifically. The present research investigates the narrative responses from LGBT people of color (LGBT-POC) following the tragedy. Results included an analysis of 94 participant narrative responses. Results were collected online from a sample of LGBT-POC with varying sexual, gender, and racial identities. Thematic analysis revealed four major themes: (1) Violence is Not New for LGBT-POC; (2) Personal Identification with Victims; (3) Lack of Intersectionality in Others' Responses to Orlando; and (4) Acknowledgment of Intersectionality across LGBT-POC. Discussion focuses on describing the ways in which LGBT-POC responded to the shooting regarding their multiple minority identities. Implications of this research reinforce the need for continued intersectional research with LGBT-POC.
Keywords: adolescent; adult; aged; ancestry group; ethnic group; ethnology; female; Florida; human; male; middle aged; psychology; sexual and gender minority; transgender; violence; young adult

Mental Health of Transgender People in Hong Kong: A Community-Driven, Large-Scale Quantitative Study Documenting Demographics and Correlates of Quality of Life and Suicidality - Suen, Y.T.; Chan, R.C.H.; Wong, E.M.Y. (Journal of homosexuality, 2018)
A community-driven survey of 106 transgender people (the first such survey in Hong Kong) showed that: (1) more than half the sample (50.9%) had a university degree or higher qualification; (2) despite this, 43.4% had a monthly income below HK$6,000 (about USD$775); (3) 66% reported "fair" or "poor" quality of life; (4) 67% of the sample (87.1% of respondents aged 15-24 years) had contemplated suicide; and (5) 20.8% of the sample (35.5% of respondents aged 15-24 years) had attempted suicide. It was found that (1) those who were single, had a lower monthly income, and identified as transgender women reported lower quality of life; and (2) those who were younger and on a lower income expressed higher suicidality. The findings suggest that service providers and policy makers urgently need to address the mental health needs of transgender people, particular younger transgender people.
Keywords: adolescent; adult; demography; female; Hong Kong; human; income; male; mental health; middle aged; psychology; quality of life; questionnaire; statistics and numerical data; suicide attempt; transgender; transsexualism