Ten years of lesbian health survey research in the UK West Midlands - Meads, C.; Buckley, E.; Sanderson, P. (BMC Public Health, 2007)
Background. Very little is known about the physical health needs of lesbian and bisexual women in the UK; most research has looked at mental or sexual health only. This article reports the results of four surveys carried out in the West Midlands between 1995 and 2005. Methods. The first two surveys were conducted in 1995-6 by a volunteer group, with participants from a lesbian health conference (n = 69) and in a convenience sample from a wide range of relevant groups and venues (n = 354). The second two surveys were commissioned by the West Midlands South Strategic Health Authority in partnership with the Gay Men's Health Network and were conducted in 2002 (n = 449) and 2005 (n = 166) and again used convenience sampling methods including the internet. Results. The mean age of respondents varied between 29-33 years and 5-7% were from a non-white ethnic background. The smoking rates varied from 42% o 55%, being twice the West Midlands regional average of 21% for women aged 16 or more. Similarly, problems with alcohol were reported in 25-37% of respondents, higher than the West Midlands regional average of 7% for women aged 16+. The prevalence of any mental health problem varied between 31-35% and any suicide attempt between 20-31%. Only 29-45% had revealed their sexual orientation to their GP and of these, approximately 50% had experienced a positive reaction. Conclusion. The results suggest health needs that current UK health services may not be meeting. There is a need to identify and target specific health measures for lesbians and bisexual women in order to ensure improved physical and mental health in the longer term. © 2007 Meads et al; licensee BioMed Central Ltd.
Keywords: adult; article; bisexuality; female; health care utilization; health status; health survey; human; homosexual female; mass screening; mental disease; mental health; prevalence; questionnaire; sexual orientation; suicide attempt; United Kingdom

Lesbian studies and activism in India - Vanita, R. (Journal of Lesbian Studies, 2007)
This essay surveys public debates and writings about lesbianism and the history of activism around lesbian issues in twentieth-century India. Weddings between women and joint suicides by female couples over the last twenty-five years are among the under-researched, but increasingly reported, phenomena that suggest future directions that activism and the study of lesbianism in India may take. © by The Haworth Press, Inc. All rights reserved.
Keywords: article; cultural factor; family size; female; human; human relation; India; homosexual female; male; methodology; perception; personal autonomy; social behavior; social change; university

Drinking patterns, problems, and motivations among collegiate bisexual women - Bostwick, W.B.; McCabe, S.E.; Horn, S.; Hughes, T.; Johnson, T.; Ramirez Valles, J. (Journal of American College Health, 2007)
Objective and Participants: The authors compared the drinking behaviors, motivations, and problems of collegiate bisexual women with those of heterosexual women (N = 2,788; n = 86 bisexual women). Methods: Data came from the 2003 Student Life Survey, a random population-based survey at a large midwestern university. The authors explored the hypothesis that bisexual women would be more likely than heterosexual women to report drinking motivations related to stress and coping as a result of sexual identity stigma. Results: They found that bisexual women drank significantly less than did heterosexual women. There were few differences between the 2 groups in drinking motivations and problems. Bisexual women reported a comparable number of problems related to their drinking but were significantly more likely to report contemplating suicide after drinking than were heterosexual women. Conclusions: More research is needed to understand the finding that despite lower levels of alcohol consumption, bisexual women reported a comparable number of drinking problems. College health educators and health care providers need to be aware of findings related to heightened suicidal risk among bisexual women. Copyright © 2007 Heldref Publications.
Keywords: adult; article; bisexuality; comparative study; drinking behavior; female; heterosexuality; human; motivation; psychological aspect; student; university

Involvement of OS-2 MAP kinase in regulation of the large-subunit catalases CAT-1 and CAT-3 in Neurospora crassa - Yamashita, K.; Shiozawa, A.; Banno, S.; Fukumori, F.; Ichiishi, A.; Kimura, M.; Fujimura, M. (Genes and Genetic Systems, 2007)
Neurospora crassa has four catalase genes-cat-1, cat-2, cat-3, and ctt-1/cat-4. cat-1 and cat-3 encode two fungal-specific large-subunit catalases CAT-1 and CAT-3 normally produced in conidia and growing hyphae, respectively. cat-2 encodes CAT-2 catalase-peroxidase normally produced in conidia. ctt-1 (or cat-4), of which expression was controlled by OS-2 MAP kinase (Noguchi et al., Fungal Genet. Biol. 44, 208-218), encodes a small-subunit catalase with unknown function. To clarify the contribution of OS-2 on the regulation of CAT-1, CAT-2, and CAT-3, we performed quantitative RT-PCR and in-gel catalase activity analyses. When the hyphae were treated with a fungicide (1 ìg/ml fludioxonil) or subjected to an osmotic stress (1 M sorbitol), cat-1 was strongly upregulated and CAT-1 was reasonably induced in the wild-type strain. Interestingly, fludioxonil caused not only the CAT-1 induction but also a remarkable CAT-3 decrease in the wild-type hyphae, implying of an abnormal stimulation of asexual differentiation. These responses were not observed in an os-2 mutant hyphae, indicating an involvement of OS-2 in the cat-1 expression; however, os-2 was dispensable for the production of CAT-1 in conidia. In contrast, the expression of cat-2 was significantly induced by heat shock (45°C) and that of cat-3 was moderately stimulated by an oxidative stress (50 μg/ml methyl viologen) in both the wild-type strain and the os-2 mutant, and corresponding enzyme activities were detected after the treatments. Although basal levels of transcription of cat-1 and cat-3 in an os-2 mutant hyphae were a few-fold lower than in the wild-type hyphae, the os-2 mutant exhibited a considerably lower levels of CAT-3 activity than the wild-type strain. These findings suggest that OS-2 MAP kinase regulated the expression of cat-1 and cat-3 transcriptionally, and probably that of cat-3 posttranscriptionally, even though the presence of another regulatory system for each of these two genes is evident.
Keywords: catalase 1; catalase 3; enzyme; fludioxonil; fungicide; mitogen activated protein kinase; paraquat; sorbitol; unclassified drug; analytic method; article; cat 2 gene; cat 3 gene; controlled study; enzyme activity; fungus hyphae; gene; gene expression; genetic transcription; heat shock; Neurospora crassa; nonhuman; nucleotide sequence; os 2 gene; osmotic stress; reverse transcription polymerase chain reaction; upregulation; wild type

Mental Health and Substance Use Disorders Among Latino and Asian American Lesbian, Gay, and Bisexual Adults - Cochran, S.D.; Mays, V.M.; Alegria, M.; Ortega, A.N.; Takeuchi, D. (Journal of Consulting and Clinical Psychology, 2007)
Growing evidence suggests that lesbian, gay, and bisexual adults may be at elevated risk for mental health and substance use disorders, possibly due to anti-gay stigma. Little of this work has examined putative excess morbidity among ethnic/racial minorities resulting from the experience of multiple sources of discrimination. The authors report findings from the National Latino and Asian American Survey (NLAAS), a national household probability psychiatric survey of 4,488 Latino and Asian American adults. Approximately 4.8% of persons interviewed identified as lesbian, gay, bisexual, and/or reported recent same-gender sexual experiences. Although few sexual orientation-related differences were observed, among men, gay/bisexual men were more likely than heterosexual men to report a recent suicide attempt. Among women, lesbian/bisexual women were more likely than heterosexual women to evidence positive 1-year and lifetime histories of depressive disorders. These findings suggest a small elevation in psychiatric morbidity risk among Latino and Asian American individuals with a minority sexual orientation. However, the level of morbidity among sexual orientation minorities in the NLAAS appears similar to or lower than that observed in population-based studies of lesbian, gay, and bisexual adults. © 2007 American Psychological Association.
Keywords: adult; article; Asian American; bisexual female; bisexual male; depression; female; heterosexual female; heterosexual male; Hispanic; human; homosexual female; major clinical study; male; homosexual male; mental disease; mental health; morbidity; prevalence; sexual orientation; substance abuse

Transgender youth and life-threatening behaviors - Grossman, A.H.; D'Augelli, A.R. (Suicide and Life-Threatening Behavior, 2007)
Sexual minority status is a key risk factor for suicide among lesbian, gay, and bisexual youth; however, it has not been studied among transgender youth. Fifty-five transgender youth reported on their life-threatening behaviors. Nearly half of the sample reported having seriously thought about taking their lives and one quarter reported suicide attempts. Factors significantly related to having made a suicide attempt included suicidal ideation related to transgender identity; experiences of past parental verbal and physical abuse; and lower body esteem, especially weight satisfaction and thoughts of how others evaluate the youths' bodies. Sexual minority status is a key risk factor for life-threatening behaviors among transgender youth. © 2007 The American Association of Suicidology.
Keywords: abuse; adolescent; adult; article; behavior; bisexuality; controlled study; female; human; homosexual female; major clinical study; male; homosexual male; risk factor; satisfaction; sexual and gender minority; suicide; suicide attempt; transsexualism

Successive switching of antiretroviral therapy is associated with high psychological and physical burden - Sherr, L.; Lampe, F.; Norwood, S.; Leake-Date, H.; Fisher, M.; Edwards, S.; Arthur, G.; Anderson, J.; Zetler, S.; Johnson, M.; Harding, R. (International Journal of STD and AIDS, 2007)
HIV treatment and management is constantly evolving. This is as a result of more treatment options coming on stream, tolerance changes and progress in treatment management. HIV infection today, in resource-rich countries and in the presence of combination therapies, is experienced as lifelong treatment punctuated by adjustments to antiretroviral therapy (ART) regimens. People who are diagnosed as HIV positive face a number of challenges and changes around the decision to commence treatment, responses to treatment and changes in treatment regimens. This study was set up to examine the experience of switching treatments and the impact of such switches on psychological parameters. The method used was a cross-sectional questionnaire study. A group of 779 HIV-positive clinic attendees at four clinics in London and South East England participated in the study (86% response rate). They provided detail of their treatment switching experiences as well as demographic details, risk and optimism evaluations, quality of life, symptom burden, adherence and disclosure information. The sample (n = 779) comprised 183 (24%) females, 76 (10%) heterosexual males and 497 gay males (66%). Self-reported ethnicity was 67% white, 25% black, 3% Asian and 5% mixed/other ethnicity. One hundred and fifty-five (21%) were ART-naïve and 624 (79%) were ARTexperienced; 161 (22%) were receiving their first regimen, 135 (18%) had experienced one regimen switch, 196 (26%) had multiple switches and 99 (13.3%) had stopped treatment. Treatment naïve, non-switchers and single switchers generally reported lower symptom burden and higher quality of life. Multiple switchers reported higher physical symptom burden and higher global symptom distress scores. Those who had stopped treatment had significantly lower quality-of-life scores than all other groups. Suicidal ideation was high across the groups and nearly a fifth of all respondents had not disclosed their HIV status to anyone. Reported adherence was suboptimal - 79% of subjects were at least 95% adherent on self-report measures of doses taken over the preceding week. In conclusion, nearly half this clinic sample will have switched treatments. A holistic approach is needed to understand the psychological effects of such switches if lifelong treatment is to be maintained and those on antiretroviral treatment are to attain good quality of life and minimize symptom burden.
Keywords: antiretrovirus agent; article; Asian; body build; Caucasian; controlled study; distress syndrome; drug substitution; drug withdrawal; ethnicity; female; health behavior; heterosexual male; human; Human immunodeficiency virus infection; interpersonal communication; major clinical study; male; homosexual male; nausea; Black person; patient attitude; patient compliance; physical capacity; priority journal; psychological aspect; quality of life; questionnaire; scoring system; side effect; suicidal ideation; United Kingdom

Dating violence, sexual assault, and suicide attempts among urban teenagers - Olshen, E.; McVeigh, K.H.; Wunsch-Hitzig, R.A.; Rickert, V.I. (Archives of Pediatrics and Adolescent Medicine, 2007)
Objective: To evaluate the relationship between dating violence, sexual assault, and suicide attempts among urban adolescents. Design: Secondary analysis of the 2005 New York City Youth Risk Behavior Survey. Setting: Eighty-seven New York City public high schools. Participants: Representative population-based sample of 8080 students, 14 years and older. Main Exposures: Dating violence in the past year and lifetime history of sexual assault. Outcome Measure: One or more suicide attempts in the past year. Results: Respondents were 50.0% female and primarily black (36.0%) or Hispanic (40.1%). In the past year, 11.7% of females and 7.2% of males reported 1 or more suicide attempts. Lifetime history of sexual assault was reported by 9.6% of females and 5.4% of males. Dating violence in the past year was reported by 10.6% of females and 9.5% of males. In multivariate models, controlling for persistent sadness, sexual orientation, and significant risk behaviors, recent dating violence (odds ratio, 1.61; 95% confidence interval, 1.05-2.47) was associated with suicide attempts in adolescent girls, while lifetime history of sexual assault (odds ratio, 3.86; 95% confidence interval, 2.11-7.06) was associated with suicide attempts in adolescent boys. Conclusions: In this population of urban youth, recent dating violence among females and lifetime history of sexual assault among males were significantly associated with suicide attempts. Clinicians and educators should be trained to routinely screen adolescents for violence victimization and should have a low threshold for referring these at-risk teenagers for mental health services. ©2007 American Medical Association. All rights reserved.
Keywords: adolescent; article; confidence interval; controlled study; female; government; high risk behavior; high school student; Hispanic; human; lifespan; major clinical study; male; mental health service; multivariate analysis; Black person; population research; priority journal; sample; school; sexual crime; sexual orientation; statistical model; suicide attempt; teacher; United States; urban area; victim; violence

Suicide among Asian Americans: What do we know? What do we need to know? - Leong, F.T.L.; Leach, M.M.; Yeh, C.; Chou, E. (Death Studies, 2007)
The current review begins with an acknowledgment of the diversity within the Asian American population as well as the scarcity of information on suicide among this particular racial/ethnic minority group. In analyzing what is known and what still needs to be learned about suicide among Asian Americans, the current article provides a critical review of significant factors such as age, gender, religious and spirituality issues, acculturation, social support, familial dynamics, social integration as well as gay/lesbian/bisexual orientations. In examining these factors, recommendations related to interventions and the existing research gaps are also discussed.
Keywords: article; Asian American; bisexuality; cultural factor; female; homosexuality; human; male; psychological aspect; religion; social support; statistics; suicide; United States

The Health and Health Behaviors of Young Men Who Have Sex with Men - Kipke, M.D.; Kubicek, K.; Weiss, G.; Wong, C.; Lopez, D.; Iverson, E.; Ford, W. (Journal of Adolescent Health, 2007)
Purpose: To describe the range of health and mental health problems for which young men who have sex with men (YMSM) may be at risk. Methods: An audio-computer-assisted survey was administered to a large, ethnically diverse sample of 526 YMSM (aged 18-24 years) recruited from bars, clubs, and other social venues using a venue-based probability sampling method. Results: Subjects reported a range of health and mental health problems, and involvement in health-compromising behaviors, such as overweight/obesity, depression, and suicidal thoughts/attempts, and many were found to have high rates of sexually transmitted infections. Moreover, many reported not having insurance coverage and/or limited access to care. Conclusions: Many of the health concerns and risks reported by these young men are preventable and can be addressed by any number of sectors, including health care and social service providers, religious organizations, schools, and employers. © 2007 Society for Adolescent Medicine.
Keywords: adult; African American; article; Caucasian; computer analysis; depression; health behavior; health care access; health insurance; Hispanic; human; major clinical study; male; homosexual male; mental health; obesity; priority journal; probability; risk assessment; sexually transmitted disease; social work; suicidal ideation; suicide attempt

Health priorities and perceived health determinants among South Australians attending GLBTI festival events. - Rogers, G. (Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals, 2007)
ISSUE ADDRESSED: Health differentials related to the social position of people whose sexual attraction or gender identity differs from that of the majority may be the 'forgotten inequity' in contemporary Australian discourses on health inequalities and social inclusion. What sexually- and gender-diverse communities see as health priorities and the social determinants of their health have been little studied in Australia. This survey explored the experience and opinions of a convenience sample of gay, lesbian, bisexual, trangender and intersex (GLBTI) people in South Australia. METHOD: A pencil and paper survey was administered to people attending events associated with the Feast GLBTI festival in Adelaide in 2004 and good participation rates were obtained. Two hundred and fifty-three people completed the survey, of which 122 identified as female, 124 as male and seven as other genders. RESULTS: Depression, HIV, suicide, family relationship problems and alcohol problems were seen as the most important health issues for these communities, while discrimination under the law and in daily life were rated the most important health determinants. CONCLUSIONS: GLBTI South Australians surveyed identified priority health issues for their communities and identified legal and personal discrimination as significant determinants of their health.
Keywords: adolescent; adult; aged; article; Australia; classification; female; gender identity; health care delivery; health care planning; health promotion; human; male; middle aged; organization and management; psychological aspect; qualitative research; sexuality; social environment; social psychology

Self-reported suicide attempts and associated risk and protective factors among secondary school students in New Zealand. - Fleming, T.M.; Merry, S.N.; Robinson, E.M.; Denny, S.J.; Watson, P.D. (The Australian and New Zealand journal of psychiatry, 2007)
OBJECTIVE: To examine associations between individual, family, school and community characteristics and rates of suicide attempts in a national population sample of New Zealand secondary school students. METHOD: A total of 9570 randomly selected 9- to 13-year-old students from 114 schools were surveyed, using the New Zealand Adolescent Health Survey. This is a 523-item anonymous self-report comprehensive questionnaire delivered by Multi-Media Computer-Assisted Self-Interviewing. Multivariate analyses were used to examine correlates of self-reported suicide attempts within the last 12 months. RESULTS: In total, 739 participants (4.7% of males and 10.5% of females) reported having made a suicide attempt within the last 12 months. Depressive symptoms, alcohol abuse, -having a friend or family member attempt suicide, family violence and non-heterosexual attractions were independently associated with increased rates of suicide attempts while parents caring, other family members caring, teachers being fair and feeling safe at school were independently associated with decreased rates of suicide attempts. Caring friendships, attending worship frequently, possible sexual abuse and anxiety symptoms were not independently associated with suicide attempts. Risk and protective factors operated in the same way for male and female students and for those with and without other suicide predictors. CONCLUSIONS: New Zealand secondary school students, particularly female students, report high rates of suicide attempts. Risk of suicide attempts is lower in students reporting caring home and fair, safe school environments and this effect remains once depression is taken into account. This study confirms the importance of depression, substance use, problem behaviour, negative life events, exposure to suicide behaviour by others and the significance of sexual orientation in suicidal behaviour among school students and provides evidence of the importance of the family and school environments in reducing risk among this group.
Keywords: adolescent; article; child; cross-sectional study; depression; family relation; female; health survey; human; male; New Zealand; psychological aspect; questionnaire; risk factor; social environment; statistics; student; suicide attempt

Crystal methamphetamine: A source of added sexual risk for Hispanic men who have sex with men? - Fernández, M.I.; Bowen, G.S.; Warren, J.C.; Ibañez, G.E.; Hernandez, N.; Harper, G.W.; Prado, G. (Drug and Alcohol Dependence, 2007)
Objectives: To determine whether use of crystal methamphetamine increases HIV risk behaviors beyond the risk associated with use of other recreational drugs among Hispanic men who have sex with men (HMSM). Design: We compared the sexual behaviors and psychosocial characteristics of non-recreational drug users (non-users), recreational drug users who did not use crystal (non-crystal drug users), and recreational drug users who used crystal (crystal users). Methods: We recruited 294 HMSM from Internet and 272 from community venues. Eligible men completed an ACASI to assess socio-demographic factors, drug use, sexual behaviors and psychosocial factors and received $50. Results: In the multivariate model, crystal users were more likely than non-crystal drug users to have lower Hispanicism, higher attachment to the gay community, and history of suicide attempts. Crystal users were not significantly different from non-crystal drug users in number of sex partners; however, differences in unprotected receptive anal sex approached significance. Conclusions: The additional risk of crystal above that of other recreational drugs needs to be disentangled from those associated with poly-drug use. Our data suggest that it may depend on how one defines risky sexual behavior and is influenced by psychological, physiologic and social factors. © 2006 Elsevier Ireland Ltd. All rights reserved.
Keywords: methamphetamine; recreational drug; adult; article; controlled study; demography; Hispanic; homosexuality; human; Human immunodeficiency virus infection; infection risk; Internet; major clinical study; male; multivariate analysis; priority journal; sexual behavior; sexual deviation; social psychology; statistical significance; suicide attempt

Sexual orientation and risk factors for suicidal ideation and suicide attempts among adolescents and young adults - Silenzio, V.M.B.; Pena, J.B.; Duberstein, P.R.; Cerel, J.; Knox, K.L. (American Journal of Public Health, 2007)
Same-gender sexual orientation has been repeatedly shown to exert an independent influence on suicidal ideation and suicide attempts, suggesting that risk factors and markers may differ in relative importance between lesbian, gay, and bisexual individuals and others. Analyses of recent data from the National Longitudinal Study of Adolescent Health revealed that lesbian, gay, and bisexual respondents reported higher rates of suicidal ideation and suicide attempts than did heterosexual respondents and that drug use and depression were associated with adverse outcomes among heterosexual respondents but not among lesbian, gay, and bi-sexual respondents.
Keywords: adult; article; controlled study; depression; drug use; human; human experiment; homosexual female; homosexual male; risk factor; sexual orientation; suicidal ideation; suicide attempt

Family and community influences on the social and sexual lives of Latino gay men - Guarnero, P.A. (Journal of Transcultural Nursing, 2007)
The purpose of this study was to explore the effect of family and community on the social and sexual lives of a group of Latino gay men living in a metropolitan area. A secondary analysis of four focus groups with 28 Latino gay men was conducted. Families had a difficult time acknowledging and supporting participants' homosexuality. Participants experienced racism, discrimination, and physical and verbal abuse as a result of their ethnicity and homosexuality. These negative effects contributed to their marginalization and made them vulnerable to depression and suicide. Health care professionals should be aware of the effect of family and culture on the social and sexual lives of Latino gay men so that they can intervene and direct the client to the services needed to manage depression, suicidal ideation, and high-risk sexual behavior. © 2007 Sage Publications.
Keywords: adaptive behavior; article; attitude to health; bisexuality; depression; ethnology; family; gender identity; Hispanic; homosexuality; human; information processing; male; nurse attitude; nursing methodology research; psychological aspect; qualitative research; self concept; self disclosure; semantics; shame; social behavior; social isolation; social psychology; suicide; transsexualism; United States; urban population

Identification and origin of the germline stem cells as revealed by the expression of nanos-related gene in planarians - Sato, K.; Shibata, N.; Orii, H.; Amikura, R.; Sakurai, T.; Agata, K.; Kobayashi, S.; Watanabe, K. (Development Growth and Differentiation, 2006)
The planarian's remarkable regenerative ability is thought to be supported by the stem cells (neoblasts) found throughout its body. Here we report the identification of a subpopulation of neoblasts, which was revealed by the expression of the nanos-related gene of the planarian Dugesia japonica, termed Djnos. Djnos-expressing cells in the asexual planarian were distributed to the prospective ovary or testes forming region in the sexual planarian. During sexualization, Djnos-expressing cells produce germ cells, suggesting that in the asexual state these cells were kept as germline stem cells for the oogonia and spermatogonia. Interestingly, the germline stem cells were indistinguishable from the neoblasts by morphology and X-ray sensitivity and did not seem to contribute to the regeneration at all. Germline stem cells initially appear in the growing infant planarian, suggesting that germline stem cells are separated from somatic stem cells in the planarian. Thus, planarian neoblasts can be classified into two groups; somatic stem cells for regeneration and tissue renewal, and germline stem cells for production of germ cells during sexualization. However, Djnos-positive cells appeared in the newly formed trunk region from the head piece, suggesting that somatic stem cells can convert to germline stem cells. © 2006 The Authors.
Keywords: animal cell; animal experiment; article; asexual reproduction; cell growth; cell regeneration; controlled study; Dugesia japonica; female; gene expression; genetic identification; male; morphology; nonhuman; nucleotide sequence; oocyte; ovary cell; radiosensitivity; somatic cell; spermatogonium; stem cell; testis cell; Turbellaria

A general review of recent reports on homosexuality and lesbianism - Hughes, J.R. (Sexuality and Disability, 2006)
This review deals with the most recent reports on male homosexuality (H) and lesbianism (L). The reviewer checked the most recent 1000 articles in the Internet's Medline to report the major new findings in H and L. First discussed is the presumed etiology or cause, including the "maternal immunization hypothesis" and the evidence for both genetic and environmental factors. Next the prevalence in various countries is reported. The related diseases include HIV+, syphilis and other venereal diseases. Factors like drug involvement, unprotected anal sex, casual partners are included, as is suicidal ideation, violence, child molestation and changes in sexual orientation over time. The goal of this review is to make available to all readers the most recent reports on H and L so that pre-existing problems and any new disorders that have arisen can be better understood and that attempts at their solution can be pursued. © 2006 Springer Science+Business Media, LLC.
Keywords: alcohol abuse; article; bisexuality; child parent relation; child sexual abuse; drug abuse; family relation; female; homosexuality; human; Human immunodeficiency virus infection; lesbianism; lifestyle; male; prevalence; sexual behavior; sexual orientation; sexually transmitted disease; suicidal ideation; syphilis; violence

Follow-up of sex reassignment surgery in transsexuals: A Brazilian cohort - Lobato, M.I.I.; Koff, W.J.; Manenti, C.; Seger, D.D.F.; Salvador, J.; Da Graça Borges Fortes, M.; Petry, A.R.; Silveira, E.; Henriques, A.A. (Archives of Sexual Behavior, 2006)
This study examined the impact of sex reassignment surgery on the satisfaction with sexual experience, partnerships, and relationship with family members in a cohort of Brazilian transsexual patients. A group of 19 patients who received sex reassignment between 2000 and 2004 (18 male-to-female, 1 female-to-male) after a two-year evaluation by a multidisciplinary team, and who agreed to participate in the study, completed a written questionnaire. Mean age at entry into the program was 31.21±8.57 years and mean schooling was 9.2±1.4 years. None of the patients reported regret for having undergone the surgery. Sexual experience was considered to have improved by 83.3% of the patients, and became more frequent for 64.7% of the patients. For 83.3% of the patients, sex was considered to be pleasurable with the neovagina/neopenis. In addition, 64.7% reported that initiating and maintaining a relationship had become easier. The number of patients with a partner increased from 52.6% to 73.7%. Family relationships improved in 26.3% of the cases, whereas 73.7% of the patients did not report a difference. None of the patients reported worse relationships with family members after sex reassignment. In conclusion, the overall impact of sex reassignment surgery on this cohort of patients was positive. © 2006 Springer Science+Business Media, Inc.
Keywords: adult; article; automutilation; Brazil; clinical article; developing country; family history; family life; female; gender dysphoria; hospital admission; human; Human immunodeficiency virus infection; male; mental disease; mental hospital; prognosis; questionnaire; sex reassignment; sexual abuse; sexuality; sexually transmitted disease; suicide attempt; surgical technique; transsexualism; Wechsler intelligence scale

Suicidality among Gay, Lesbian and Bisexual Youth: The Role of Protective Factors - Eisenberg, M.E.; Resnick, M.D. (Journal of Adolescent Health, 2006)
Purpose: Many reports have indicated that gay, lesbian and bisexual (GLB) youth are particularly vulnerable to poor outcomes, including suicide. Certain protective factors are likely to reduce this risk. The present study examines four protective factors (family connectedness, teacher caring, other adult caring, and school safety) and their association with suicidal ideation and attempts among adolescents with same-gender experience. Methods: Data come from the 2004 Minnesota Student Survey of 9th and 12th grade students; 21,927 sexually active youth were grouped according to the gender of their sex partner(s) into GLB and non-GLB groups. Four protective factors and suicidal ideation and attempts were compared across groups. Logistic regression was used to examine the influence of protective factors on suicide, and predicted probabilities of suicidal ideation and attempts were estimated using general linear modeling. Results: There were 2,255 respondents who reported same-gender experience. Over half of GLB students had thought about suicide and 37.4% reported a suicide attempt. GLB youth reported significantly lower levels of each protective factor than their non-GLB peers. Family connectedness, adult caring, and school safety were significantly protective against suicidal ideation and attempts. Risk associated with a GLB sexual orientation is largely mediated through protective factors. Conclusions: Sexual orientation alone accounts for only a small portion of variability in suicidal ideation and attempts. If protective factors were enhanced among GLB youth, suicide in this population is expected to be considerably lower. Protective factors examined here are amenable to change and should be targeted in interventions. © 2006 Society for Adolescent Medicine.
Keywords: adolescent; article; bisexuality; controlled study; data analysis; family; female; homosexuality; human; homosexual female; logistic regression analysis; male; prediction; priority journal; risk assessment; school; sexual behavior; sexual orientation; sexuality; statistical model; statistical significance; suicidal behavior; suicidal ideation; suicide attempt; teacher; United States

Attempted suicide, psychological health and exposure to harassment among Japanese homosexual, bisexual or other men questioning their sexual orientation recruited via the internet - Hidaka, Y.; Operario, D. (Journal of Epidemiology and Community Health, 2006)
Objective: To investigate the rates of attempted suicide and its association with psychological distress, experiences of bullying and verbal harassment, and demographic characteristics among Japanese homosexual, bisexual or other men questioning their sexual orientation. Design: A cross-sectional design using Japanese participants recruited through the internet. Results: Of the 1025 respondents, 154 (15%) of the men reported a history of attempted suicide, 716 (70%) showed high levels of anxiety and 133 (13%) showed high levels of depression. 851 (83%) experienced school bullying and 615 (60%) were verbally harassed because of being perceived by others as homosexual. Independent correlates of attempted suicide were psychological distress, history of being verbally harassed, history of sex with a woman, history of meeting a male through the internet, disclosing sexual orientation to six or more friends and not having a university degree. Conclusions: Mental health services and prevention programmes are needed to deal with the psychological consequences of social stigma for Japanese men who are homosexual, bisexual or questioning their sexual orientation.
Keywords: adolescent; adult; anxiety; article; bisexuality; bullying; controlled study; depression; distress syndrome; homosexuality; human; major clinical study; male; online analysis; psychological aspect; sexual orientation; suicide attempt; verbal hostility

From "male bonding rituals" to "suicide tuesday": A qualitative study of issues faced by gay male ecstasy (MDMA) users - Klitzman, R. (Journal of Homosexuality, 2006)
Use of MDMA and other club drugs has increased among gay men, but questions remain concerning the use, context, and popularity of these drugs; and views of their side effects. We interviewed in-depth 12 gay MDMA users in New York. MDMA had specific appeals to gay men, who often described isolation and stigmatization. Users underwent a period of initiation and social networks often became comprised of greater numbers of other users. Club environments fostered drug use and vice versa. Awareness of potential adverse effects varied and was minimized. Appropriate educational and prevention programs are needed to address these issues, and must take into account the specific contexts of these gay men's lives. © 2006 by The Haworth Press, Inc. All rights reserved.
Keywords: midomafetamine; article; awareness; drug abuse; education program; ethnography; health behavior; homosexuality; human; interview; male; organization; risk assessment; sexual behavior; social aspect; socialization

Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization - Clements-Nolle, K.; Marx, R.; Katz, M. (Journal of Homosexuality, 2006)
To determine the independent predictors of attempted suicide among transgender persons we interviewed 392 male-to-female (MTF) and 123 female-to-male (FTM) individuals. Participants were recruited through targeted sampling, respondent-driven sampling, and agency referrals in San Francisco. The prevalence of attempted suicide was 32% (95% CI = 28% to 36%). In multivariate logistic regression analysis younger age (<25 years), depression, a history of substance abuse treatment, a history of forced sex, gender-based discrimination, and gender-based victimization were independently associated with attempted suicide. Suicide prevention interventions for transgender persons are urgently needed, particularly for young people. Medical, mental health, and social service providers should address depression, substance abuse, and forced sex in an attempt to reduce suicidal behaviors among transgender persons. In addition, increasing societal acceptance of the transgender community and decreasing gender-based prejudice may help prevent suicide in this highly stigmatized population. © 2006 by The Haworth Press, Inc. All rights reserved.
Keywords: article; depression; human; mental health; multivariate logistic regression analysis; predictor variable; prevalence; risk factor; sampling; sexism; sexual behavior; social work; stigma; substance abuse; suicide attempt; transsexualism; United States

Sexual violence among two populations of men at high risk of HIV infection - Braitstein, P.; Asselin, J.J.; Schilder, A.; Miller, M.-L.; Laliberté, N.; Schechter, M.T.; Hogg, R.S. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2006)
This study sought to compare the prevalence of, and relationship between, age at first experience of sexual violence and HIV and other health risk behaviors in two populations of men at high risk of HIV infection. Data were drawn from two cohorts: Vanguard, a prospective study of young men who have sex with men (MSM), and VIDUS, the Vancouver Injection Drug Users Study. Controlling for fixed sociodemographics, multivariate logistic regression was used to assess the relationship between age at first sexual violence (vs. never experiencing it) and several health risk behaviors. There were 140/498 (28%) MSM from Vanguard and 173/932 (19%) injection drug users (IDU) from VIDUS who reported having experienced sexual violence. Among VIDUS men, 130/852 (15%) IDU-only and 43/80 (54%) who were both IDU and MSM reported a history of sexual violence. The prevalence of child sexual abuse was 13% in Vanguard MSM, and 11% among VIDUS IDU-only, but 26% among VIDUS MSM/IDU. The median age of onset was significantly lower among VIDUS IDU-only compared to the two other groups. Experiencing sexual violence first in childhood was strongly related to ever being in the sex trade in both IDU and MSM. MSM in Vanguard who experienced sexual violence in childhood were more likely to have attempted suicide, and have a diagnosed mood disorder. Non-MSM IDU in VIDUS who experienced sexual violence in childhood were more likely to have a diagnosed mental illness, to binge on alcohol, and to have ever accidentally overdosed. In conclusion, men who have ever had sex with men appear to have a higher lifetime prevalence of sexual violence, compared to non-MSM injection drug users. Sexual violence is differentially associated with different health risk behaviors, depending on the age at first occurrence and the primary HIV risk factor (i.e. MSM vs. IDU). © 2006 Taylor & Francis.
Keywords: adult; alcohol abuse; article; child sexual abuse; controlled study; drug overdose; health behavior; health hazard; homosexuality; human; Human immunodeficiency virus infection; intravenous drug abuse; major clinical study; male; mental disease; mood disorder; onset age; prevalence; priority journal; prospective study; risk assessment; risk factor; sexual abuse; sexual behavior; suicide attempt; violence

A National Needs Assessment of Nurses Providing Health Care to Adolescents - Saewyc, E.M.; Bearinger, L.H.; McMahon, G.; Evans, T. (Journal of Professional Nursing, 2006)
Nurses, as the largest group of health providers in the United States, and by virtue of their scope of practice, are in an important position to promote the health of adolescents. A national survey of nurse members of the American Public Health Association, the National Association of Pediatric Nurse Associates and Practitioners, and the National Association of School Nurses was conducted in 1997 (n = 520) and was compared with findings from a parallel survey conducted in 1985 that assessed perceived competence in addressing common adolescent health issues, relevance of those issues to nurses' practice, and leadership skills. Findings provided a hopeful yet cautious picture of nurses' competencies. Strong increases in the proportion of nurses who felt equipped to address common health problems of youth suggest improved adolescent health education among nurses. Yet, at least 25% of nurses indicated a low level of knowledge in half of the adolescent health areas, and, like 1985's nurses, most nurses in 1997 did not feel competent to address the needs of gay, lesbian, and bisexual youth. Several priority areas in Healthy People 2010 were considered by 25% or more of the nurses to be irrelevant to their practice, including smoking cessation, suicide, violence, and pregnancy. The task remains to assure that all nurses who work with adolescents are equipped to respond to their diverse and unique health needs. © 2006.
Keywords: adolescent; article; attitude to health; child health care; clinical competence; comparative study; decision making; human; leadership; workforce; needs assessment; nursing; nursing education; United States

Perceptions of lesbian, gay and bisexual people of primary healthcare services - Neville, S.; Henrickson, M. (Journal of Advanced Nursing, 2006)
Aim. This paper reports a study exploring people's perceptions of disclosure about lesbian, gay and bisexual identity to their primary healthcare providers. Background. Disclosure of sexual identity to healthcare professionals is integral to attending to the health needs of lesbian, gay and bisexual populations, as non-disclosure has been shown to have a negative impact on the health of these people. For example, an increased incidence of suicide, depression and other mental health problems have been reported. Method. From April to July 2004, a national survey of lesbian, gay and bisexual persons was carried out in New Zealand. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues, and 2269 people completed the questionnaire, either electronically or via hard copy. The 133-item instrument included a range of closed-response questions in a variety of domains of interest. Results. In this paper, we report results from the health and well-being domain. More women than men identified that the practitioner's attitude toward their non-heterosexual identity was important when choosing a primary healthcare provider. Statistically significantly more women than men reported that their healthcare provider usually or always presumed that they were heterosexual and in addition more women had disclosed their sexual identity to their healthcare provider. Conclusion. Nurses need to reconsider their approach to all users of healthcare services by not assuming everyone is heterosexual, integrating questions about sexual identity into health interviews and ensuring that all other aspects of the assessment process are appropriate and safe for lesbian, gay and bisexual people. © 2006 The Authors.
Keywords: adult; article; bisexuality; female; health personnel attitude; homosexuality; human; homosexual female; male; New Zealand; primary health care; psychological aspect; self disclosure

Sex, gender role orientation, gender role attitudes and suicidal thoughts in three generations: A general population study - Hunt, K.; Sweeting, H.; Keoghan, M.; Platt, S. (Social Psychiatry and Psychiatric Epidemiology, 2006)
Background: Suicide and other suicidal behaviours are markedly (though differently) patterned by gender. The increase in young male suicide rates in many countries has heightened interest in whether suicidal behaviours and ideation (thoughts) are related to masculinity. Relatively little research has explored the relationship between gender role attitudes and orientation and suicidal behaviours and ideation. Most research in this area has been conducted with young people. Objective: We investigated whether gender role orientation (masculinity and femininity scores) and gender role attitudes were related to the reporting of serious suicidal thoughts in three generations (early adulthood, and early and late middle age) in a community sample. Methods: Subjects (653 men and women aged around 23 years, 754 aged around 43 years, 722 aged around 63 years) completed home interviews with nurses as part of an ongoing longitudinal community-based study of social factors and health. These included measures of suicidal ideation (thoughts), attitudes to traditional gender roles, and a validated measure of gender role orientation (masculinity and femininity scores). Results: The prevalence of serious suicidal thoughts was higher in early adulthood (10% men, 15% women) than in early (4% men, 8% women) and late (6% men, 5% women) middle age. In early adulthood only sex was significantly related to suicidal thoughts, with women at higher risk (adjusted OR 1.74, 95% CI 1.01-3.00). In early middle age masculinity scores were negatively related to suicidal thoughts (adjusted OR for each unit increase in score 0.65: 95% CI 0.46-0.93), and more traditional views on gender roles were positively associated with suicidal thoughts (adjusted OR 1.48: 95% CI 1.07-2.04). In late middle age trends were in the same direction as in early middle age, but were not statistically significant. Femininity scores were unrelated to serious suicidal thoughts at any age. Conclusion: The high rates of suicidal thoughts amongst men and women in early adulthood point to the importance of understanding mental health problems at this age. The results raise a number of questions and suggest that suicide researchers should pay more attention to gender roles and attitudes in older adults. © Steinkopff Verlag Darmstadt 2006.
Keywords: adulthood; article; attitude to sexuality; community; confidence interval; controlled study; disease severity; female; femininity; health survey; human; interview; male; masculinity; mental health care; prevalence; scoring system; sex difference; sex role; sexual orientation; social aspect; statistical significance; suicidal ideation

Mental health issues: A comparison of lesbian, bisexual and heterosexual women - Koh, A.S.; Ross, L.K. (Journal of Homosexuality, 2006)
This study examines mental health issues among women of different sexual orientations. An anonymous survey was administered at 33 health care sites across the United States; the sample (N = 1304) included lesbians (n = 524), bisexual (n = 143) and heterosexual women (n = 637). Not only did sexual orientation influence the probability of experiencing emotional stress, but also whether a bisexual woman or lesbian had disclosed her sexual orientation (was "out") impacted the likelihood of having or having had mental health problems. Bisexual women and lesbians experienced more emotional stress as teenagers than did heterosexual women. Bisexual women were more than twice as likely to have had an eating disorder compared to lesbians. If a bisexual woman reported being out she was twice as likely to have had an eating disorder compared to a heterosexual woman. Lesbians who were not out and bisexual women who were out were 2-2.5 times more likely to experience suicidal ideation in the past 12 months. Lesbians and bisexual women who were not out were more likely to have had a suicide attempt compared to heterosexual women. Lesbians used psychotherapy for depression more commonly than did heterosexual or bisexual women. This is one of the few studies that compares lesbians, bisexual and heterosexual women. The implications of these findings are discussed. © 2006 by The Haworth Press, Inc. All rights reserved.
Keywords: adolescence; adult; article; bisexuality; counseling; data analysis; demography; depression; eating disorder; emotion; experience; female; health care; health center; health survey; heterosexuality; human; homosexual female; logistic regression analysis; major clinical study; mental health; psychotherapy; sexual orientation; physiological stress; suicidal ideation; suicide attempt; United States

Factors associated with 'feeling suicidal': The role of sexual identity - Abelson, J.; Lambevski, S.; Crawford, J.; Bartos, M.; Kippax, S. (Journal of Homosexuality, 2006)
This paper examines factors associated with feeling suicidal in a large sample of urban men in Sydney and Melbourne, aged 18-50, including heterosexual, gay and bisexual men, HIV antibody positive and HIV antibody negative. As in previous research, sexuality (being homosexual or bisexual) was found to be a major predictor of suicidality. The research went some way towards explaining the close relationship between feeling suicidal and sexual orientation. Sexuality interacts with feeling bad in that, once men feel moderately bad/depressed, they are more likely to feel suicidal if they are homosexual or bisexual than if they are heterosexual. In addition, the research found that experience of verbal abuse and physical assault (harassment) increased feeling suicidal for both heterosexual and gay/bisexual men, not just for homosexual men as suggested by previous research, and that social isolation in the form of living alone is a further risk factor. Seeking counseling help and taking sexual risks were also independently associated with feeling suicidal. These actions may result from feeling suicidal rather than the reverse, and their association with feeling suicidal warrants further research. Many of the 46 independent variables examined in the research, including HIV antibody status and closeness to the HIV/ AIDS epidemic, were related to feeling suicidal only through their association with being gay/bisexual. Celibacy and general risk taking were not related to feeling suicidal in this study. © 2006 by The Haworth Press, Inc. All rights reserved.
Keywords: Human immunodeficiency virus antibody; acquired immune deficiency syndrome; adult; article; Australia; bisexuality; counseling; disease association; gender identity; heterosexuality; homosexuality; human; major clinical study; male; medical research; multivariate logistic regression analysis; rating scale; risk assessment; risk factor; sexual crime; sexual orientation; statistical analysis; suicidal behavior; urban area; verbal hostility

Anti-androgen flutamide affects gonadal development and reproduction in medaka (Oryzias latipes) - Kang, I.J.; Hano, T.; Oshima, Y.; Yokota, H.; Tsuruda, Y.; Shimasaki, Y.; Honjo, T. (Marine Environmental Research, 2006)
The effects of an anti-androgenic chemical on the reproduction of medaka (Oryzias latipes) were examined. Six mating pairs of medaka were exposed to flutamide (FLU) at measured concentrations of 0.101, 0.202, 0.397, 0.787, or 1.56 mg/L for 3 weeks. During the exposure period, one female died in the 1.56-mg/L treatment group, but no lesions or pathological abnormalities were observed. The fecundity and fertility of paired medaka were significantly decreased at 1.56 mg/L compared with those of the controls. Histological examination showed intersex gonads (testis-ova) in males exposed to FLU at 0.202, 0.397, and 0.787 mg/L. However, concentrations of hepatic vitellogenin (Vtg) in both sexes were not statistically different from those in the controls. These results demonstrate that FLU affected gonadal development in male medaka and reproductive capacity in paired medaka. This is the first report of testis-ova in male medaka exposed to FLU. © 2006 Elsevier Ltd. All rights reserved.
Keywords: antiandrogen; flutamide; liver protein; vitellogenin; animal experiment; animal tissue; article; controlled study; death; drug effect; drug exposure; female; fertility; gonad development; hermaphroditism; histology; male; mating; medical examination; nonhuman; oocyte; Oryzias; reproduction; sex; testis

Familial and sociopsychopathological risk factors for suicide attempt in bulimic and in depressed women: Prospective study - Nickel, M.K.; Simek, M.; Lojewski, N.; Muehlbacher, M.; Fartacek, R.; Kettler, C.; Bachler, E.; Egger, C.; Rother, N.; Buschmann, W.; Gil, F.P.; Kaplan, P.; et al. (International Journal of Eating Disorders, 2006)
Objective: This study was carried out to examine sociopsychopathological predictors of prospective observed suicide attempts in bulimic women purging type without comorbid major depression (BNG) at the time of study entry and in woman with major depression without comorbid eating disorder at the time of study entry (MDG). Method: Data from 28 BNG (age 23.5 ± 3.6) and 126 MDG women (age 33.4 ± 5.1) who had attempted suicide during 12 months' monitoring were compared. Results: A univariate comparison of the two groups revealed various differences. Analysis of risk factors for suicide attempts using stepwise logistic regression was conducted separately for each group. The derived logistic models showed that patients from the BNG group had a history of higher incidence of sexual abuse in childhood, as well as abuse of laxatives and illicit drugs; they also lacked orientation in life, felt lonely despite family and friends, tended to direct their anger outward, and were unable to relax. Conclusion: Sociopsychopathological risk factors for suicide attempts in the BNG and MDG appear to vary. © 2006 by Wiley Periodicals, Inc.
Keywords: anorexigenic agent; illicit drug; laxative; adult; aggression; anger; article; automutilation; bisexuality; body mass; bulimia; child sexual abuse; coping behavior; depression; drug abuse; family history; female; human; human relation; incidence; homosexual female; life satisfaction; major clinical study; mental disease; prediction; priority journal; quality of life; questionnaire; rating scale; relaxation training; risk factor; single parent; substance abuse; suicide attempt; unemployment; violence

Suicidality and sexual orientation: Differences between men and women in a general population-based sample from The Netherlands - De Graaf, R.; Sandfort, T.G.M.; Ten Have, M. (Archives of Sexual Behavior, 2006)
Homosexuality has been shown to be associated with suicidality and mental disorders. It is unclear whether homosexuality is related to suicidality, independently of mental disorders. This study assessed differences in lifetime symptoms of suicidality (death ideation, death wishes, suicide contemplation, and deliberate self-harm) between homosexual and heterosexual men and women, controlling for lifetime psychiatric morbidity. Interaction effects of age and the role of perceived discrimination were also examined. Data were collected on a representative sample of the Dutch population aged 18-64 years. Classification as heterosexual or homosexual was based upon reported sexual behavior in the preceding year. Of those sexually active, 2.8% of 2,878 men and 1.4% of 3,120 women had had same-sex partners. Homosexual men differed from their heterosexual counterparts on all four suicide symptoms (OR ranging from 2.58 to 10.23, with higher ORs for more severe symptoms), and on the sum total of the four symptoms; homosexual women only differed from heterosexual women on suicide contemplation (OR=2.12). Controlling for psychiatric morbidity decreased the ORs, but among men all associations were still significant; the significance for suicide contemplation among women disappeared. Younger homosexuals were not at lower risk for suicidality than older homosexuals in comparison with their heterosexual counterparts. Among homosexual men, perceived discrimination was associated with suicidality. This study suggests that even in a country with a comparatively tolerant climate regarding homosexuality, homosexual men were at much higher risk for suicidality than heterosexual men. This relationship could not only be attributed to their higher psychiatric morbidity. In women, there was no such clear relationship. © 2006 Springer Science+Business Media, Inc.
Keywords: adult; article; controlled study; female; heterosexuality; high risk population; homosexuality; human; information processing; male; mental disease; Netherlands; perceptive discrimination; population based case control study; sex difference; sexual behavior; sexual orientation; suicidal behavior; suicidal ideation; suicide

Self-injurious behaviors in a college population - Whitlock, J.; Eckenrode, J.; Silverman, D. (Pediatrics, 2006)
OBJECTIVE. The goal was to assess the prevalence, forms, demographic and mental health correlates of self-injurious behaviors in a representative college sample. METHODS. A random sample of undergraduate and graduate students at 2 northeastern US universities were invited to participate in an Internet-based survey in the spring of 2005. Thirty-seven percent of the 8300 invited participants responded. RESULTS. The lifetime prevalence rate of having ≥1 self-injurious behavior incident was 17.0%. Seventy-five percent of those students engaged in self-injurious behaviors more than once. Thirty-six percent reported that no one knew about their self-injurious behaviors and only 3.29% indicated that a physician knew. Compared with non-self-injurers, those with repeat self-injurious behavior incidents were more likely to be female, bisexual or questioning their sexual orientation. They were less likely to be Asian/Asian American and >24 years of age. When controlling for demographic characteristics, those with repeat self-injurious behavior incidents were more likely to report a history of emotional abuse or sexual abuse, ever having considered or attempted suicide, elevated levels of psychological distress, and ≥1 characteristic of an eating disorder. A dose-response gradient was evident in each of these areas when single-incident self-injurious behaviors were compared with repeat-incident self-injurious behaviors. CONCLUSIONS. A substantial number of college students reported self-injurious behaviors in their lifetimes. Many of the behaviors occurred among individuals who had never been in therapy for any reason and who only rarely disclosed their self-injurious behaviors to anyone. Single self-injurious behavior incidents were correlated with a history of abuse and comorbid adverse health conditions but less strongly than were repeat self-injurious behavior incidents. The reticence of these clients to seek help or advice renders it critical that medical and mental health providers find effective strategies for detecting and addressing self-injurious behaviors. Copyright © 2006 by the American Academy of Pediatrics.
Keywords: adult; aged; article; Asian; Asian American; automutilation; behavior; college student; comorbidity; eating disorder; emotional stress; ethnic difference; female; health survey; human; Internet; major clinical study; male; mental health; mental stress; postgraduate education; prevalence; priority journal; sex difference; sexual abuse; sexual orientation; suicide attempt; university

Understanding the needs of lesbian, gay, bisexual, and transgender people living with mental illness - Huygen, C. (MedGenMed Medscape General Medicine, 2006)
Keywords: article; awareness; bisexuality; consumer; gender identity; health care need; health practitioner; heterosexuality; homosexuality; human; homosexual female; mental disease; mental health service; mood disorder; patient care; patient decision making; sexual intercourse; sexual orientation; sexuality; substance abuse; suicide; treatment planning

Predictors of suicidal ideation among high school students by gender in South Korea - Park, H.S.; Schepp, K.G.; Jang, E.H.; Koo, H.Y. (Journal of School Health, 2006)
The purpose of this study was to examine the evidence to determine if there are gender differences in suicidal ideation of adolescents. This study examined the main effect of risk factors from 5 domains and protective factors from 1 domain in relation to suicidal ideation by gender and identified the most important predictors of suicidal ideation for males (N = 654) and females (N = 658). This study was a cross-sectional survey, and data were collected through self-report questionnaires. In the univariate analysis, especially, risk factors from behavioral variables and psychosocial-environmental variables appeared to be gender skewed. For males, all behavioral variables were predictive of suicidal ideation. For the females, unlike the males, Wang-tta or victim of bullying behavior and sexual orientation as behavioral variables were predictive of suicidal ideation. For males, parental divorce and parental alcohol abuse as psychosocial-environmental variables were predictive of suicidal ideation. For the females, again unlike for the males, all the psychosocial-environmental variables were not predictive of suicidal ideation. The most important predictors of suicidal ideation for males as a result of the multivariate analysis were history of suicidal attempt, depression, hostility, smoking, parental alcohol abuse, communication with friends, and self-esteem. The most important predictors of suicidal ideation for females as a result of the multivariate analysis were depression, hostility, sexual orientation, and self-esteem. These results would indicate that an effective suicide screening and prevention program for adolescents should consider gender differences. © 2006, American School Health Association.
Keywords: adolescent; article; cross-sectional study; female; forecasting; human; Korea; male; psychological aspect; risk factor; sex difference; social environment; suicide

The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth - Friedman, M.S.; Koeske, G.F.; Silvestre, A.J.; Korr, W.S.; Sites, E.W. (Journal of Adolescent Health, 2006)
This study hypothesized that gender-role nonconformity is associated with suicidality, and bullying mediates this relationship. Gay males retrospectively answered questions pertaining to elementary, middle, and high school. Support for the hypotheses was found. Results can help screen gay youth for suicidality and support the need for policies prohibiting harassment based on sexual orientation. © 2006 Society for Adolescent Medicine.
Keywords: adult; article; bullying; controlled study; homosexuality; human; major clinical study; male; homosexual male; priority journal; retrospective study; sexual orientation; social support; suicidal behavior

Violence against women and suicide risk: The neglected impact of same-sex sexual behaviour - Lhomond, B.; Saurel-Cubizolles, M.-J. (Social Science and Medicine, 2006)
We used data from the National Survey on Violence against Women in France carried out in 2000 on a representative sample of 6970 women to compare the social characteristics of women who had sex with women (WSW) and women who had sex only with men (WSM). The WSW were more likely to be of a high socio-economic level and living in large cities. They were more frequently unmarried, without children, and had a more diverse sexual life, generally beginning younger, with more partners, mainly men. They were also more likely to use tobacco, alcohol and drugs. WSW reported more physical violence in the recent past and more suicide attempts than WSM, despite a lack of difference in psychological distress and stress. These results, in a field little studied in France, are consistent with international findings attesting to the difficulties faced by women in situations involving autonomy and marginality.
Keywords: adult; alcohol consumption; article; childlessness; drug use; female; human; human experiment; mental stress; risk; sexual behavior; sexuality; single woman; smoking; socioeconomics; physiological stress; suicide; violence

Progressive symptoms and signs following institution of highly active antiretroviral therapy and subsequent antituberculosis therapy: Immune reconstitution syndrome or infection? - Miller, R.F.; Shahmanesh, M.; Talbot, M.D.; Wiselka, M.J.; Shaw, P.J.; Bacon, C.; Robertson, C.M. (Sexually Transmitted Infections, 2006)
A 36 year old man presented with weight loss, cough, fever, and exertional dyspnoea shortly after a diagnosis of HIV infection. Symptoms and initial radiological abnormalities worsened after highly active antiretroviral therapy was started. An eventual diagnosis was established but multiple problems occurred throughout the treatment period. Differentiation between immune reconstitution inflammatory syndrome and an infective cause was problematic.
Keywords: antiretrovirus agent; C reactive protein; clarithromycin; cycloserine; efavirenz; ethambutol; gamma interferon; isoniazid; lactate dehydrogenase; lamivudine; macrolide; ofloxacin; protionamide; pyrazinamide; quinoline derived antiinfective agent; rifampicin; tenofovir; zidovudine; adult; article; case report; CD4 lymphocyte count; clinical feature; computer assisted tomography; diagnostic test; differential diagnosis; drug withdrawal; follow up; gene; gene mutation; highly active antiretroviral therapy; homosexuality; human; Human immunodeficiency virus infection; hyperuricemia; immune reconstitution inflammatory syndrome; infection control; inflammatory disease; leukoplakia; male; mental disease; Mycobacterium tuberculosis; patient compliance; peer review; priority journal; rpoB gene; suicidal behavior; thrush; tuberculosis; virus load; QuantiFERON-TB; T.SPOT.TB test

Shotgun identification of proteins from uredospores of the bean rust Uromyces appendiculatus - Cooper, B.; Garrett, W.M.; Campbell, K.B. (Proteomics, 2006)
We are interested in learning more about the proteome of Uromyces appendiculatus, the fungus that causes common bean rust. Knowledge of the proteins that differentiate life-cycle stages and distinguish infectious bodies such as uredospores, germlings, appressoria, and haustoria may be used to define host-pathogen interactions or serve as targets for chemical inhibition of the fungus. We have used 2-D nanoflowLC-MS/MS to identify more than 400 proteins from asexual uredospores. A majority of the proteins appear to have roles in protein folding or protein catabolism. We present a model by which an abundance of heat shock proteins and translation elongation factors may enhance a spore's ability to survive environmental stresses and rapidly initiate protein production upon germination. © 2006 Wiley-VCH Verlag GmbH & Co. KGaA.
Keywords: elongation factor; heat shock protein; amino acid sequence; article; cell survival; fungus; liquid chromatography; mass spectrometry; nonhuman; nucleotide sequence; priority journal; protein analysis; protein degradation; protein folding; physiological stress; Uromyces appendiculatus

Identification of genes up-regulated during conidiation of Fusarium oxysporum through expressed sequence tag analysis - Iida, Y.; Ohara, T.; Tsuge, T. (Fungal Genetics and Biology, 2006)
Fusarium oxysporum produces three kinds of asexual spores, microconidia, macroconidia, and chlamydospores. F. oxysporum produces microconidia and macroconidia in carboxymethyl cellulose-added liquid medium (CMCLM) and exhibits vegetative growth without conidiation in complete liquid medium (CLM). The cDNA libraries were constructed using mRNAs from CLM and CMCLM cultures. A total of 1288 and 1353 clones from CLM (vegetative growth) and CMCLM (conidiation) libraries, respectively, were sequenced, and 641 and 626 unique genes were identified. Of these unique genes, only 130 (∼20%) were common in the two libraries, indicating different patterns of gene expression during vegetative growth and conidiation. The expression levels of 496 CMCLM-specific genes were compared during vegetative growth and conidiation by cDNA dot-blot differential hybridization and real-time quantitative PCR analyses, and 42 genes were identified to display >5-fold increases in mRNA abundance during conidiation. These genes provide ideal candidates for further studies directed at understanding fungal conidiogenesis and its molecular regulation. © 2005 Elsevier Inc. All rights reserved.
Keywords: complementary DNA; messenger RNA; article; DNA determination; DNA library; DNA sequence; dot hybridization; fungal strain; Fusarium oxysporum; gene identification; gene sequence; nonhuman; nucleotide sequence; priority journal; real time polymerase chain reaction

Homophobia and psychotic crimes of violence - Murphy, D. (Journal of Forensic Psychiatry and Psychology, 2006)
Irrationally negative attitudes towards homosexual people, known as homophobia, may cause assaults by mentally ill men. A qualitative study is presented in which homophobic motives are examined in detail. Five hospital in-patients were selected. All suffered from paranoid psychosis in which a homophobic theme was prominent. All had attacked with the intention to kill. Two of the victims died. The case records were studied and each patient participated in a semi-structured interview, which was audio-taped. Transcripts were made and studied using discourse analysis with an emphasis on the narrative of events leading to the crime. These cases are used as a basis for suggesting that it may be useful to categorize homophobic violence into three broad categories: non-psychotic violence, violence arising during typical psychotic illness, and violence arising during atypical or brief psychosis. The study describes and compares features of these homophobic states. Non-psychotic homophobia is an attitude often shared with others. It may lead to severe violence, often premeditated, and may influence the development of psychotic ideas. In those with typical psychotic states, abnormal ideas, often bizarre, of a homophobic nature may arise and can be described in the same way as other abnormal ideas in mental illness. In those with atypical psychosis, both the psychosis and the accompanying homophobic violence may be a reaction to a humiliating failure of gender self-esteem, which can be described as severe internalized homophobia. This may generate extreme and unbearable states of mind leading to both suicide and homicide. Inner conflicts about sexual functioning, associated with shame and rage, lead to paranoid attacks. Distinction between different forms of homophobia may be important in providing advice to courts and in planning therapy. © 2006 Taylor & Francis.
Keywords: adult; article; assault; audio recording; clinical article; controlled study; criminal behavior; discourse analysis; gender; homicide; homophobia; hospital patient; human; legal aspect; male; medical record; patient counseling; patient selection; priority journal; psychosis; qualitative analysis; self esteem; semi structured interview; sexuality; suicide; treatment planning; verbal communication; violence

A segment of the apospory-specific genomic region is highly microsyntenic not only between the apomicts Pennisetum squamulatum and buffelgrass, but also with a rice chromosome 11 centromeric-proximal genomic region. - Gualtieri, G.; Conner, J.A.; Morishige, D.T.; Moore, L.D.; Mullet, J.E.; Ozias-Akins, P. (Plant physiology, 2006)
Bacterial artificial chromosome (BAC) clones from apomicts Pennisetum squamulatum and buffelgrass (Cenchrus ciliaris), isolated with the apospory-specific genomic region (ASGR) marker ugt197, were assembled into contigs that were extended by chromosome walking. Gene-like sequences from contigs were identified by shotgun sequencing and BLAST searches, and used to isolate orthologous rice contigs. Additional gene-like sequences in the apomicts' contigs were identified by bioinformatics using fully sequenced BACs from orthologous rice contigs as templates, as well as by interspecies, whole-contig cross-hybridizations. Hierarchical contig orthology was rapidly assessed by constructing detailed long-range contig molecular maps showing the distribution of gene-like sequences and markers, and searching for microsyntenic patterns of sequence identity and spatial distribution within and across species contigs. We found microsynteny between P. squamulatum and buffelgrass contigs. Importantly, this approach also enabled us to isolate from within the rice (Oryza sativa) genome contig Rice A, which shows the highest microsynteny and is most orthologous to the ugt197-containing C1C buffelgrass contig. Contig Rice A belongs to the rice genome database contig 77 (according to the current September 12, 2003, rice fingerprint contig build) that maps proximal to the chromosome 11 centromere, a feature that interestingly correlates with the mapping of ASGR-linked BACs proximal to the centromere or centromere-like sequences. Thus, relatedness between these two orthologous contigs is supported both by their molecular microstructure and by their centromeric-proximal location. Our discoveries promote the use of a microsynteny-based positional-cloning approach using the rice genome as a template to aid in constructing the ASGR toward the isolation of genes underlying apospory.
Keywords: article; asexual reproduction; bacterial artificial chromosome; Cenchrus; centromere; chromosome walking; DNA sequence; gene; genetic marker; genetics; genome; pearl millet; plant chromosome; Poaceae; rice; synteny

Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men - Courtenay-Quirk, C.; Wolitski, R.J.; Parsons, J.T.; Gómez, C.A. (AIDS Education and Prevention, 2006)
Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used quantitative data from 206 HIV-positive MSM and qualitative data from 250 to document beliefs about HIV/AIDS stigma within the gay community and to measure its effects on sexual risk behaviors, substance use behaviors, serostatus disclosure, and mental health. Stigma was associated with increased levels of anxiety, loneliness, depressive symptoms, engaging in avoidant coping strategies, and history of suicidal ideation. HIV/AIDS stigma exists within the gay community and has a negative effect on the mental health of people living with HIV. HIV/AIDS stigma should be monitored closely so that we may better understand how to address it. © 2006 The Guilford Press.
Keywords: acquired immune deficiency syndrome; adult; aged; anxiety; article; community; controlled study; coping behavior; depression; epidemic; high risk behavior; homosexuality; human; Human immunodeficiency virus infection; loneliness; male; mental health; perception; qualitative analysis; quantitative analysis; serology; sexual behavior; stigma; substance abuse; suicidal ideation

The relationship between self-reported sexual orientation and behavior in a sample of middle-aged male injection drug users. - Washington, T.A.; Galai, N.; Cohn, S.; Celentano, D.D.; Vlahov, D.; Strathdee, S.A. (Archives of sexual behavior, 2006)
Data are sparse on injection drug using (IDU) men who have sex with men (MSM). Previous literature suggests perceived taboos can result in an underreporting of atypical sexual orientation (i.e., bisexuality, homosexuality). As a result, HIV prevention programs have been difficult to mount, particularly programs for IDU-MSM. The association between self-reported sexual orientation and sexual behavior at semi-annual study visits was longitudinally assessed in a population of 1300 male IDUs in Baltimore during the period 1993 to 1998. Overall, a small minority (5%) of the male IDUs inconsistently reported their sexual orientation over time. Logistic regression analyses were performed, which yielded five significant predictors. These men tended to be older, to have been incarcerated, to have attended shooting galleries during follow-up, and were more than twice as likely to be HIV-seropositive (OR, 2.66; 95% CI, 1.62-4.36) compared with those who consistently reported their sexual orientation. Furthermore, men reporting inconsistent sexual orientation tended to engage in higher risk behaviors, suggesting that these men should be especially targeted for interventions.
Keywords: adult; aged; article; confidence interval; health behavior; high risk behavior; homosexuality; human; Human immunodeficiency virus infection; longitudinal study; male; middle aged; psychological aspect; questionnaire; risk; sexuality; statistical model; statistics; substance abuse; United States

Prevalence and correlates of suicidal ideation among young injection vs. noninjection drug users - Havens, J.R.; Sherman, S.G.; Sapun, M.; Strathdee, S.A. (Substance Use and Misuse, 2006)
The objective of this study was to identify correlates of suicidal ideation and to examine the hypothesis that injection drug users (IDUs) were more likely to report suicidal ideation than noninjection drug users (NIDUs). Participants included IDUs (n = 244) and NIDUs (n = 73) from Baltimore, Maryland, aged 15-30 who began snorting or smoking heroin or cocaine/crack (NIDUs) or injecting drugs (IDUs) within the past 5 years who were recruited between August 2000 and March 2002. Among the 317 participants, 42% were female, 59% were white, and median age was 24. The prevalence of suicidal ideation was 27%. IDUs were more likely to report suicidal ideation than NIDUs (31% vs. 14%, p = 0.003). Adjusting for age, gender, and race, IDUs were 2.4 times more likely than NIDUs to report suicidal ideation [95% Confidence Interval (CI): 1.1-5.2]. However, on further adjustment for homelessness, depressive symptoms, and gay/lesbian/bisexual identity, IDU status was no longer independently associated with suicidal ideation. These results suggest that factors associated with injection drug users' lifestyles and mental health status may account for the higher prevalence of suicidal ideation in IDUs vs. NIDUs. Further study into these associations is warranted in identifying avenues for suicide prevention among these populations. Copyright © 2006 Taylor & Francis Inc.
Keywords: cocaine; diamorphine; adolescent; adult; article; correlation analysis; demography; depression; female; gender identity; homelessness; human; hypothesis; intravenous drug abuse; lifestyle; male; mental health; prevalence; priority journal; suicidal ideation

Depression and suicide attempt as risk factors for incident unprovoked seizures - Hesdorffer, D.C.; Allen Hauser, W.; Olafsson, E.; Ludvigsson, P.; Kjartansson, O. (Annals of Neurology, 2006)
Major depression has been shown to increase the risk for development of epilepsy, but prior studies have not evaluated whether this is due to specific symptoms of depression. We conducted a population-based case-control study of all newly diagnosed unprovoked seizures among Icelandic children and adults aged 10 years and older to test the hypothesis that major depression is a risk factor for developing unprovoked seizure and epilepsy, and to address whether specific symptoms of depression account for this increased risk. Cases were matched to the next two same sex births from the population registry. Using standardized interviews, we ascertained symptoms of major depression to make a Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) diagnosis. A history of major depression was 1.7-fold more common among cases than among controls (95% confidence interval, 1.1-2.7). A history of attempted suicide was 5.1-fold more common among cases than among controls (95% confidence interval, 2.2-11.5). Attempted suicide increased seizure risk even after adjusting for age, sex, cumulative alcohol intake, and major depression or number of symptoms of depression. Major depression and attempted suicide independently increase the risk for unprovoked seizure. These data suggest that depression and suicide attempt may be due to different underlying neurochemical pathways, each of which is important in the development of epilepsy. © 2005 American Neurological Association.
Keywords: adolescent; adult; alcohol consumption; article; case control study; controlled study; depression; epilepsy; female; human; Iceland; major depression; male; neurochemistry; priority journal; risk assessment; school child; seizure; suicide attempt

Predicting the suicide attempts of lesbian, gay, and bisexual youth - D'Augelli, A.R.; Grossman, A.H.; Salter, N.P.; Vasey, J.J.; Starks, M.T.; Sinclair, K.O. (Suicide and Life-Threatening Behavior, 2005)
In this study predictors of serious suicide attempts among lesbian, gay, and bisexual (LGB) youth were examined. Three groups were compared: youth who reported no attempts, youth who reported attempts unrelated to their sexual orientation, and youth whose attempts were considered related to their sexual orientation. About one third of respondents reported at least one suicide attempt; however, only half of the attempts were judged serious based on potential lethality. About half of all attempts were related to youths' sexual orientation. Factors that differentiated youth reporting suicide attempts and those not reporting attempts were greater childhood parental psychological abuse and more childhood gender-atypical behavior. Gay-related suicide attempts were associated with identifiability as LGB, especially by parents. Early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behavior were associated with gay-related suicide attempts, especially for males. Assessment of past parental psychological abuse, parental reactions to childhood gender atypical behavior, youths' openness about sexual orientation with family members, and lifetime gay-related verbal abuse can assist in the prediction of suicide attempts in this population. © 2005 The American Association of Suicidology.
Keywords: adolescent; article; bisexuality; child abuse; childhood; female; human; homosexual female; lethality; male; parental attitude; psychotrauma; sexual orientation; suicide attempt; verbal hostility

Suicidality and associated risk factors among lesbian, gay, and bisexual compared to heterosexual Austrian adults - Plöderl, M.; Fartacek, R. (Suicide and Life-Threatening Behavior, 2005)
This is the first study in German-speaking countries to compare the suicidality of lesbian, gay, and bisexual adults (n = 358) with matched heterosexual adults (n = 267). The former had significantly elevated incidences of current suicide ideation (28% vs. 13%) and lifetime suicide attempts defined in three ways (14% vs. 1% to 10% vs. 2%), including higher incidences for most suicidality-related risk factors. Increased psychosocial stress and vulnerability is indicated, especially with respect to a lack of family support. Controlling for risk factors in multivariate analysis diminished the association of sexual orientation with current suicide ideation. © 2005 The American Association of Suicidology.
Keywords: adult; article; bisexuality; female; heterosexuality; human; incidence; homosexual female; male; mental stress; multivariate analysis; risk factor; sexual orientation; social problem; suicidal ideation; suicide; suicide attempt

Health and social service needs of transgender people in Chicago - Kenagy, G.P.; Bostwick, W.B. (International Journal of Transgenderism, 2005)
A needs assessment of transgender people was conducted in Chicago in 2001 to assess their HIV risks, health and social service needs, and barriers to care. One hundred and eleven transgender individuals, 78 male-to-females (MTFs) and 33 female-to-males (FTMs), participated in the study. Fourteen percent of respondents reported being HIV-positive; they were all male-to-female and the majority was of color. Risk factors for HIV included unprotected sex and willingness to have high-risk sex in the future. Respondents experienced high levels of violence. Two-thirds of respondents had thought of attempting suicide. Respondents reported a high need for health and social services, particularly MTFs and people of color. © 2005 by The Haworth Press, Inc. All rights reserved.
Keywords: adult; aged; article; controlled study; drug use; female; health service; health survey; human; Human immunodeficiency virus infection; infection risk; major clinical study; male; social support; suicide attempt; transsexualism; United States; unsafe sex; violence

Sex, drugs, violence, and HIV status among male-to-female transgender persons in Houston, Texas - Risser, J.M.H.; Shelton, A.; McCurdy, S.; Atkinson, J.; Padgett, P.; Useche, B.; Thomas, B.; Williams, M. (International Journal of Transgenderism, 2005)
To inform the Community Planning Group (Houston, Texas) in setting HIV-prevention priorities, risk behavior surveys were completed by 67 male-to-female (MtF) transgender persons. By self-identification, 58% were preoperative and 48% were self-described heterosexual women. We found this small sample of male-to-female transgender individuals to have high rates of HIV infection, and high prevalence of risky behaviors, intimate partner violence, and suicidal ideation. Twenty-seven percent were infected with HIV. Barriers were seldom used during oral sex and used less than half the time for anal sex with either primary or casual partners. Nearly one-third of the sample reported use of methamphetamines, amyl nitrite or LSD and 40% reported crack or cocaine use. Intimate partner violence and forced sex were reported by 50% and 25%, respectively. Suicidal ideation was reported by 16% in the last 30 days; lifetime suicidal ideation was 60%. © 2005 by The Haworth Press, Inc. All rights reserved.
Keywords: amyl nitrate; cocaine; lysergide; methamphetamine; adult; alcohol abuse; article; controlled study; drug abuse; female; health survey; human; Human immunodeficiency virus infection; infection rate; major clinical study; male; oral sex; sexual behavior; sexual intercourse; sexually transmitted disease; suicidal ideation; transsexualism; United States; violence

Are transgender persons at higher risk for HIV than other sexual minorities? A comparison of HIV prevalence and risks - Bockting, W.; Huang, C.-Y.; Ding, H.; Robinson, B.; Rosser, B.R.S. (International Journal of Transgenderism, 2005)
Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts. © 2005 by The Haworth Press, Inc. All rights reserved.
Keywords: adult; article; condom; controlled study; depression; female; human; human experiment; Human immunodeficiency virus infection; infection risk; male; monogamy; prevalence; risk assessment; sexual health; substance abuse; suicide attempt; transsexualism

A needs assessment of transgendered people of color living in Washington, DC - Xavier, J.M.; Bobbin, M.; Singer, B.; Budd, E. (International Journal of Transgenderism, 2005)
A needs assessment (N = 248) conducted in Washington, DC, revealed that transgendered people of color are at high risk for HIV/AIDS, substance abuse, suicide and violence/crime victimization. Overall HIV prevalence was 25%, with 32% in natal males (MTFs, i.e., male-to-females). Four predictors for HIV positive status were identified through logistic regression-male sex at birth, a history of substance abuse, sexual assault, and unemployment. Substance abuse was found in nearly half the sample (48%) but only half of those (51%) had sought treatment for it. Thirty-eight percent reported experiencing suicidal ideation, with 63% of those attributing it to their gender issues. Of those with suicidal ideation, nearly half (49%, or 16% of the entire sample), went on to make attempt(s) to kill themselves. Forty-three percent had been victims of violence or crime, including 13% who had been sexually assaulted. Knowledge of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association was quite low (9%) and associated with white race, any higher education beyond high school, and access to sex reassignment surgery (SRS). Access to SRS, defined as obtaining vaginoplasties for natal males and chest surgeries for natal females, was just 4%. White race (versus all other races, p < .001) and female at birth (versus male, p < .01) were significantly associated with access to SRS. Use of hormones at some point during their lives was reported by 51% of participants. Thirty-five percent were currently taking hormones, with 72% acquiring their hormones from friends or on the street. Among natal males, 25% had injected silicone. Nineteen percent did not have their own living space, and employment, housing and job training were the most commonly-reported immediate needs of the sample. The results of this needs assessment provide evidence of an urgent need for increased medical and social services specific to transgendered people of color living in the District of Columbia. © 2005 by The Haworth Press, Inc. All rights reserved.
Keywords: silicone; acquired immune deficiency syndrome; adolescent; adult; article; controlled study; female; health service; human; human experiment; Human immunodeficiency virus infection; infection risk; male; prevalence; sexual crime; socioeconomics; substance abuse; suicidal ideation; transsexualism; United States; vagina reconstruction; violence

Sexual risk behavior and substance use among a sample of Asian Pacific Islander transgendered women - Operario, D.; Nemoto, T. (AIDS Education and Prevention, 2005)
We examined the prevalence and correlates of HIV-related sexual risk and substance use behaviors among Asian Pacific Islander (API) male-to-female (MTF) transgendered individuals, referred to here as API transgendered women. As part of a larger study on HIV risk among transgendered women of color (Nemoto, Operario, Keatley, Han, & Soma, 2004), a sample of 110 API transgendered women in San Francisco completed individual interviews, of which 13% reported being HIV-positive. In the past 30 days, one fifth of the sample engaged in unprotected receptive anal intercourse (URAI) with any male partner, nearly one half had sex while under the influence of substances, and over half used illicit drugs. In multivariate models, URAI was associated with commercial sex work (odds ratio [OR] = 4.23, 95% confidence interval [CI] = 1.10, 16.25) and previous attempted suicide (OR = 5.83, 95% CI = 1.02, 33.44). Sex under the influence of substances was associated with commercial sex work (OR = 3.35, 95% CI = 1.11, 10.13) and having a college degree (OR = 5.32, 95% CI = 1.34, 21.18). Illicit drug use was associated with commercial sex work (OR = 7.15, 95% = 2.26, 22.63). Findings suggest that API MTF transgenders are on the front line of HIV risk for the API community, and provide insight into factors within this group that might contribute to unsafe sex and substance use. © 2005 The Guilford Press.
Keywords: illicit drug; adult; anal intercourse; article; Asian; confidence interval; homosexuality; human; Human immunodeficiency virus infection; infection risk; interview; major clinical study; male; Pacific Islander; prevalence; risk; sex transformation; sexual behavior; sexual intercourse; sexuality; substance abuse; suicide

HIV prevalence and correlates of receptive needle sharing among injection drug users in the Mexican-U.S. border city of Tijuana - Magis-Rodríguez, C.; Brouwer, K.C.; Morales, S.; Gayet, C.; Lozada, R.; Ortiz-Mondragón, R.; Ricketts, E.P.; Strathdee, S.A. (Journal of Psychoactive Drugs, 2005)
Injection drug use is a growing but understudied problem in Tijuana, a city situated on the northwestern Mexico-U.S border. The authors studied factors associated with receptive needle sharing in an effort to inform prevention activities. In 2003, street-recruited injection drug users (IDUs) in Tijuana underwent interviews on injection risk behaviors and rapid HIV antibody tests. Logistic regression was used to identify correlates of receptive needle sharing at the last injection episode. Of 402 IDUs, 87.6% were male; the median age was 34. HIV prevalence was 4.01% (95% CI: 2.29-6.51). One third reported receptive needle sharing at last injection. Factors independently associated with receptive needle sharing were years living in Tijuana (Adjusted Odds Ratio [AdjOR]= 0.97 per year, 95% CI: 0.96-0.99), being bisexual/homosexual (AdjOR=2.12; 95% CI: 1.30-3.44), unemployed (AdjOR=2.5; 95% CI: 1.52-4.10), never having an HIV test (AOR: 4.02; 95% CI: 2.44-6.60), having friends who placed importance on avoiding HIV (AdjOR: 0.36; 95% CI: 0.19-0.68) and last injecting in a shooting gallery (AdJOR=1.98; 95% CI: 1.21-3.24). These results underscore the need to increase access to voluntary HIV testing and counseling to IDUs and migrants in Tijuana, as well as expand access to sterile syringes in an effort to avert widespread HIV transmission.
Keywords: cocaine; diamorphine; methamphetamine; adult; article; drug abuse; female; human; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; intravenous drug abuse; major clinical study; male; Mexico; needle; sexually transmitted disease; United States

Gender role, sexual orientation and suicide risk - Fitzpatrick, K.K.; Euton, S.J.; Jones, J.N.; Schmidt, N.B. (Journal of Affective Disorders, 2005)
Background: There has been interest in the relationship between homosexuality, gender role and suicide risk. Though homosexuals are more likely to identify as cross-gender, research has not simultaneously examined sexual orientation and gender role in assessing suicide risk. In the current study, the unique and interactive effects of sexual orientation and gender role were assessed in regard to suicidal ideation, related psychopathology and measures of coping. Methods: 77 participants were recruited from an undergraduate psychology subject pool (n = 47) or from gay, lesbian and transgender student organizations (n = 30) and assessed on measures of gender role, homosexuality, and psychopathology. Results: Consistent with expectations, cross-gender role (i.e., personality traits associated with the opposite sex) is a unique predictor of suicidal symptoms. Moreover, gender role accounted for more of the overall variance in suicidal symptoms, positive problem orientation, peer acceptance and support, than sexual orientation. After accounting for gender role, sexual orientation contributed little to the variance in suicidal symptoms, associated pathology and problem-solving deficits. There was no support for gender role by sexual orientation interaction effects. Limitations: The cross-sectional nature of the data limits statements regarding causality. Conclusions: Cross-gendered individuals, regardless of sexual orientation, appear to have higher risk for suicidal symptoms. Researchers and clinicians should assess gender role in evaluations of youth samples. © 2005 Elsevier B.V. All rights reserved.
Keywords: adolescent; adult; analysis of variance; article; controlled study; female; high risk population; homosexuality; human; homosexual female; male; mental disease; personality; priority journal; problem solving; psychology; risk assessment; sex role; sexual orientation; suicidal behavior; suicide; transsexualism

Restraining orders in California : A look at statewide data - Sorenson, S.B.; Shen, H. (Violence Against Woman, 2005)
The authors tabulated statewide administrative data for all types of restraining orders. On June 6, 2003, there were 227,941 active restraining orders against adults in California; most were for domestic violence. Rates of restraining orders (i.e., restrained persons) were highest for men, African Americans, and 25- to 34-year-olds. In 72.2% of the orders, a woman was to be protected and a man was to be restrained; in 19.3%, the restrained and protected persons were of the same sex. Although state law prohibits the purchase or possession of a firearm by persons against whom a restraining order is issued, 9.2% of the orders documented no firearm restrictions. © 2005 Sage Publications.
Keywords: adult; aged; article; battered woman; community care; female; health care delivery; health service; health services research; human; law enforcement; legal aspect; male; middle aged; organization and management; partner violence; patient attitude; social control; statistics; United States; women's health

Sexual orientation and mental health in a birth cohort of young adults - Fergusson, D.M.; Horwood, L.J.; Ridder, E.M.; Beautrais, A.L. (Psychological Medicine, 2005)
Background. This paper sought to examine the relationship between sexual orientation and mental health in a New Zealand birth cohort studied to age 25 years. Method. The analysis is based on a sample of 967 participants (469 males; 498 females) in the Christchurch Health and Development Study. As part of this study information was gathered on: (a) measures of sexual orientation, same-sex behaviour and sexual attraction obtained at ages 21 and 25 years; (b) measures of mental disorders and suicidal behaviours over the interval 21-25 years; (c) measures of childhood and family background. Results. Latent class analysis was used to combine indicators of sexual orientation, same sex behaviour and attraction to form an empirically based classification of sexual orientation. The best-fitting model classified the sample into three groups: exclusively heterosexual orientation (87.6%); predominantly heterosexual but with same-sex inclinations or experience (9.6%); predominantly homosexual (2.8%). Proportionately more women than men were classified as predominantly heterosexual (14.2% v. 4.8% respectively) or predominantly homosexual (3.9% v. 1.5% respectively). Cohort members with a predominantly homosexual orientation had rates of mental disorder and suicidal behaviours that were between 1.5 and 12 times higher than for those with an exclusively heterosexual orientation. These associations persisted after adjustment for confounding. The associations between sexual orientation and mental health were more marked for males than females. Conclusions. The findings suggest a continuum of sexual preferences amongst young adults. Variations in sexual orientation were clearly associated with mental health. These associations tended to be stronger for males. © 2005 Cambridge University Press.
Keywords: adult; article; child development; cohort analysis; family history; female; gender; heterosexuality; homosexuality; human; life event; major clinical study; male; mental disease; mental health; New Zealand; sexual behavior; sexual orientation; suicidal behavior

Toxic effects of bisphenol A on sexual and asexual reproduction in Hydra oligactis - Fukuhori, N.; Kitano, M.; Kimura, H. (Archives of Environmental Contamination and Toxicology, 2005)
Hydra oligactis, an evolutionarily primitive invertebrate, produced eggs or testes (sexual reproduction) when starved at 10°C, and produced buds (asexual reproduction) when fed at 20°C. Bisphenol A (BPA) at 2-4 mg/L given to male or female hydra had adverse effects on both sexual and asexual reproduction. Despite the estrogenic nature of BPA, testis formation and egg formation were similarly affected. The doses causing these acute toxicities were comparable to those reported earlier in aquatic invertebrates and were much higher than environmentally detected doses, at which the disruption of the endocrine system has been reported in fishes. All these facts indicate that the adverse effects are the results of general toxicity and may not be due to the estrogenic function of the compound. On the other hand, we found that BPA at 1 mg/L (a dose still much higher than environmental doses) stimulated asexual reproduction. No such stimulation of sexual reproduction was seen. When male hydras were fed at 10°C, they produced both buds and testes simultaneously. BPA at 0.5 and 1 mg/L under this condition also stimulated asexual reproduction, whereas it suppressed sexual reproduction more severely than BPA at 2-3 mg/L. There may be some interaction between processes involved in sexual and asexual reproduction under this condition, and the stimulation of asexual reproduction by BPA may cause suppression of sexual reproduction. © 2005 Springer Science+Business Media, Inc.
Keywords: 4,4' isopropylidenediphenol; endocrine disruptor; acute toxicity; animal experiment; animal model; article; asexual reproduction; coelenterate; concentration response; controlled study; endocrine system; estrogen activity; female; fish; invertebrate; mouse; nonhuman; oocyte development; priority journal; reproduction; reproductive toxicity; stimulation; testis development

Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community - Bockting, W.O.; Robinson, B.E.; Forberg, J.; Scheltema, K. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2005)
Despite reports of high prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among the transgender community, very little prevention education has targeted this population. To fill this gap, we developed and evaluated a transgender-specific intervention, All Gender Health, which incorporates prevention strategies into comprehensive sexuality education. Transgender participants (N=181) attended the two-day seminar in community-based venues. The curriculum was delivered via lectures, panel discussions, videos, music, exercises and small group discussions. Attitudes toward condom use, safer sex self-efficacy and sexual risk behaviour were evaluated before participation in the intervention (pre-test), immediately after participation (post-test) and at three-month follow-up. Compared to pre-test values, significant improvements were seen in attitudes toward condom use and in safer sex self-efficacy at post-test, and in attitudes toward condom use, increased monogamy and decreased sexual risk behaviour at three-month follow-up. Pre-test data identified unprotected anal, vaginal and oral sex as the most commonly reported risk behaviours. Many respondents also indicated problems with social discrimination, depression, suicidal ideation and sexual functioning. Future interventions should address these risk co-factors. Alternative interventions need to be developed to target those who, as a result of social marginalization, are less likely to be reached with an intensive seminar-based intervention.
Keywords: adult; aged; all gender health; article; audiovisual equipment; condom; controlled study; curriculum; depression; exercise; female; health education; health program; human; Human immunodeficiency virus infection; infection prevention; infection risk; major clinical study; male; monogamy; music; patient attitude; prevalence; preventive medicine; priority journal; risk reduction; safety; sexual behavior; sexual intercourse; sexuality; sexually transmitted disease; social problem; suicidal behavior

Same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in university students in Turkey - Eskin, M.; Kaynak-Demir, H.; Demir, S. (Archives of Sexual Behavior, 2005)
This questionnaire study investigated the prevalence of, and interrelationships among, self-reported same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in 1262 university students in Turkey. Approximately 7% of the sample reported lifetime or current same-sex sexual attractions, 5% reported that they engaged in same-sex sexual behavior, and almost 2% self-identified as either homosexual or bisexual. Overall, almost 10% of the sample acknowledged some form of a same-sex sexual orientation. Twenty-eight percent of the participants reported at least one instance of sexual abuse during their childhood. Almost 42% of the students reported suicidal ideation during the past 12 months or lifetime, and 7% reported that they attempted to kill themselves during their lifetime or in the past 12 months. Five hypotheses about the interrelationships among same-sex sexual orientation, childhood sexual abuse, and suicidal behavior were developed and tested in the study. Self-reported childhood sexual abuse was associated with same-sex sexual behavior. Participants who engaged in same-sex sexual behavior and those who identified themselves as homosexual or bisexual perceived more distance between themselves and their fathers than those who did not. Being sexually abused by someone of one's own sex was related to same-sex sexual orientation in male participants but not in female participants. Childhood sexual abuse was found to be an independent predictor of both suicidal ideation and attempts during the past 12 months. Only identifying oneself as homosexual or bisexual was associated with an increased risk for suicidal ideation during the past 12 months. © 2005 Springer Science+Business Media, Inc.
Keywords: adult; aged; article; bisexuality; child sexual abuse; college student; female; homosexuality; human; male; prevalence; questionnaire; self report; sexual attraction; sexual behavior; sexual orientation; suicidal behavior; Turkey (republic)

Homelessness and drug abuse among young men who have sex with men in New York city: A preliminary epidemiological trajectory - Clatts, M.C.; Goldsamt, L.; Yi, H.; Gwadz, M.V. (Journal of Adolescence, 2005)
The objective of this paper is to profile the role of homelessness in drug and sexual risk in a population of young men who have sex with men (YMSM). Data are from a cross-sectional survey collected between 2000 and 2001 in New York City (N = 569). With the goal of examining the import of homelessness in increased risk for the onset of drug and sexual risk, we compare and contrast three subgroups: (1) YMSM with no history of homelessness, (2) YMSM with a past history of homelessness but who were not homeless at the time of the interview, and (3) YMSM who were currently homeless. For each group, we describe the prevalence of a broad range of stressful life events (including foster care and runaway episodes, involvement in the criminal justice system, etc.), as well as selected mental health problems (including past suicide attempts, current depression, and selected help-seeking variables). Additionally, we examine the prevalence of selected drug and sexual risk, including exposure to a broad range of illegal substances, current use of illegal drugs, and prevalence of lifetime exposure to sex work. Finally, we use an event history analysis approach (time-event displays and paired t-test analysis) to examine the timing of negative life experiences and homelessness relative to the onset of drug and sexual risk. High levels of background negative life experiences and manifest mental health distress are seen in all three groups. Both a prior experience of homelessness and currently being homeless are both strongly associated with both higher levels of lifetime exposure to drug and sexual risk as well as higher levels of current drug and sexual risk. Onset of these risks occur earlier in both groups that have had an experience of housing instability (e.g., runaway, foster care, etc.) but are delayed or not present among YMSM with no history of housing instability. Few YMSM had used drug prior to becoming homeless. While causal inferences are subject to the limitations of a cross-sectional design, the findings pose an empirical challenge to the prevailing assumption that prior drug use is a dominant causal factor in YMSM becoming homeless. More broadly, the data illustrate the complexity of factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of homelessness and its relationship to the onset of drug and sexual risk among high risk youth populations. © The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.
Keywords: illicit drug; adolescent; adult; article; controlled study; data analysis; depression; drug abuse; experience; foster care; high risk population; homelessness; human; interview; life event; life history; male; prevalence; prostitution; risk assessment; runaway behavior; sexual behavior; statistical analysis; physiological stress; suicide attempt; United States

Affirmative, evidence-based, and ethically sound psychotherapy with lesbian, gay and bisexual clients - Safren, S.A. (Clinical Psychology: Science and Practice, 2005)
Writing from the perspective of heterosexual therapists treating lesbian, gay, and bisexual (LGB) individuals, Eubanks-Carter, Burckell, and Goldfried (this issue) provide important information on how to enhance therapeutic effectiveness with this population. Their manuscript is an example of a refreshing departure from historical views of homosexuality as a pathological psychological condition and from work that supports using therapy to change sexual orientation. Eubanks-Carter et al. document significant improvements both in the provision of psychotherapy, the view of LGB individuals from the mental health field, and the view of LGB individuals from the community. Despite these improvements, continued progress is still needed. The present commentary points to several areas where the science and practice of clinical psychology can further progress regarding the care of LGB clients. This includes improving systems in training and institutions that employ psychologists where bias or discrimination may exist and reducing biased language in psychological research that implies pathology towards homosexual sexual orientations when homosexuality is not a pathological condition. It also includes reducing or eliminating psychological harm that can be caused by psychological interventions that attempt to change sexual orientation by further restricting these practices. © American Psychological Association D12 2005; all rights reserved.
Keywords: anxiety disorder; article; behavior therapy; bisexuality; clinical practice; clinical psychology; cognitive therapy; depression; evidence based medicine; female; health education; homosexuality; human; human relation; homosexual female; male; medical information; mental health; mood disorder; patient care; phobia; psychotherapist; psychotherapy; self esteem; sexual orientation; social behavior; social interaction; social problem; suicidal behavior

Youth risk behavior survey: Bangkok, Thailand - Ruangkanchanasetr, S.; Plitponkarnpim, A.; Hetrakul, P.; Kongsakon, R. (Journal of Adolescent Health, 2005)
Purpose: To identify the prevalence of risk behaviors and related risk factors in adolescents in Bangkok, Thailand. Methods: Youth risk behavior survey questionnaires were collected from 2311 adolescents in 8 schools, 13 communities and 2 Juvenile Home Institutions from January to February 2001. Their mean age was 15.5 ± 1.8 years, and 59% were female. Risk factors of interest were gender, parental marital status, socioeconomic status, family relationship, parental drug addiction, peer group, loneliness, self-esteem, and school performance. Multiple logistic regression was used to identify significant risk factors associated with each risk behavior. Results: The risk behaviors leading to traffic accidents were rarely or never having worn a seat belt (30.6%) or helmet while bicycling (66.9%) and while motorcycling (50.1%), riding with drivers who had consumed alcohol (18.8%), and driving after consuming alcohol (12.1%). The studied group carried weapons (8.5%) and has been involved in a violent event (31.5%). Among 13.9% who were assaulted, 6.7% needed hospitalization; rape was reported by 2.4%. Depression was reported by 19.9%, with 12% having suicidal tendencies and 8% attempting suicide. The lifetime use vs. heavy use prevalence of substance abuse, respectively, was: 15.4% and 3.5% for smoking, 37.3% and 1.7% for alcohol, 37.8% and 4.6% for amphetamine use, and 37.9% and 0.1% for other drugs. Among the 10% who have had sexual intercourse, 1% were homosexual, 7.1% have never used a condom, and 2.1% resulted in pregnancy. Being male was a risk factor for every untoward behavior except depression. Other risk factors included poor self-esteem, poor school performance, and early school leaving. Factors relating to the family included a low socioeconomic status, poor relationships, broken families, and parental substance abuse. Socioenvironmental factors included being in a gang and loneliness. Some risk behaviors started at younger than 8 years old. Schools and media were given as the sources of information regarding sex, human immunodeficiency virus infection, and substance abuse. Conclusions: The prevalence of six major-risk behaviors in adolescents in Bangkok was significantly high. Several risk factors were identified, the knowledge from which may help to form preventive measures in this population. © 2005 Society for Adolescent Medicine. All rights reserved.
Keywords: amphetamine; academic achievement; adolescent; alcohol consumption; article; car driving; child behavior; cigarette smoking; condom; controlled study; depression; drug dependence; family; female; health education; homosexuality; hospitalization; human; Human immunodeficiency virus infection; logistic regression analysis; male; parental behavior; pregnancy; prevalence; priority journal; questionnaire; rape; risk assessment; risk factor; school; self esteem; sex difference; sexual intercourse; social status; substance abuse; suicidal behavior; Thailand; traffic accident; violence; weapon

Sertraline treatment caused elevated plasma prolactin concentrations in a transsexual patient with major depression - Wang, T.-S.; Chou, Y.-H. (Journal of Medical Sciences, 2005)
We report a depressive 20-year-old male-to-female transsexual whose plasma prolactin concentrations became elevated after receiving sertraline treatment (50 mg/day) for major depression. A dechallenge-rechallenge protocol demonstrated a sertraline-related endocrine effect. Thus, transsexual patients with major depression might develop increased prolactin secretion following sertraline treatment. Copyright © 2005 JMS.
Keywords: prolactin; sertraline; zolpidem; adult; apathy; article; case report; drug withdrawal; endocrine system; human; hyperprolactinemia; major depression; male; mood disorder; sleep disorder; suicidal behavior; transsexualism; treatment outcome; zoloft

A catalytic subunit of cyclic AMP-dependent protein kinase, PKAC-1, regulates asexual differentiation in Neurospora crassa - Banno, S.; Ochiai, N.; Noguchi, R.; Kimura, M.; Yamaguchi, I.; Kanzaki, S.-I.; Murayama, T.; Fujimura, M. (Genes and Genetic Systems, 2005)
A cyclic AMP (cAMP)-dependent protein kinase pathway has been shown to regulate growth, morphogenesis and virulence in filamentous fungi. However, the precise mechanisms of regulation through the pathway remain poorly understood. In Neurospora crassa, the cr-1 adenylate cyclase mutant exhibits colonial growth with short aerial hyphae bearing conidia, and the mcb mutant, a mutant of the regulatory subunit of cAMP-dependent protein kinase (PKA), shows the loss of growth polarity at the restrictive temperature. In the present study, we isolated mutants of the catalytic subunit of the PKA gene pkac-1 through the process of repeat-induced point mutation (RIP). PKA activity of the mutants obtained through RIP was undetectable. The genome sequence predicts two distinct catalytic subunit genes of PKA, named pkac-1 (NCU06240.1, AAF75276) and pkac-2 (NCU00682.1), as is the case in most filamentous fungi. The results suggest that PKAC-1 works as the major PKA in N. crassa. The phenotype of the pkac-1 mutants included colonial growth, short aerial hyphae, premature conidiation on solid medium, inappropriate conidiation in submerged culture, and increased thermotolerance. This phenotype of pkac-1 mutants resembled to that of cr-1 mutants, except that the addition of cAMP did not rescue the abnormal morphology of pkac-1 mutants. The loss of growth polarity at the restrictive temperature in the mcb mutant was suppressed by pkac-1 mutation. These results suggest that the signal transduction pathway mediated by PKAC-1 plays an important role in regulation of aerial hyphae formation, conidiation, and hyphal growth with polarity.
Keywords: cyclic AMP; cyclic AMP dependent protein kinase; article; catalysis; conidium; enzyme activity; enzyme subunit; fungal virulence; fungus culture; Neurospora crassa; nonhuman; nucleotide sequence; phenotype; reverse transcription polymerase chain reaction

Transgender health: findings from two needs assessment studies in Philadelphia. - Kenagy, G.P. (Health & social work, 2005)
HIV/AIDS, suicide, violence, and barriers to health care access among transgender people were explored using two needs assessment surveys conducted in Philadelphia in 1997. A total of 182 people responded to a face-to-face interview or self-administered mail survey: 113 male-to-female individuals and 69 female-to-male individuals. About three-fifths of respondents had engaged in unprotected sexual activity during the past 12 months. The risk for HIV infection from unprotected sex was significantly higher among respondents of color than among white respondents. About one-third (30.1 percent) of respondents had attempted suicide. More than half of respondents had been forced to have sex, 56.3 percent had experienced violence in their homes, and 51.3 percent had been physically abused. Twenty-six percent of respondents had been denied medical care because they were transgender. These findings suggest that prevention services that specifically address HIV/AIDS, suicide, and violence among transgender people are urgently needed.
Keywords: adult; article; female; gender identity; health service; human; Human immunodeficiency virus infection; male; patient abandonment; psychological aspect; risk factor; sexual behavior; suicide attempt; transsexualism; United States; violence

Acting (to) out: Approaching homosexuality in a 15-year-old boy with anxiety and depression - Jackson, J.A.; Telingator, C.J.; Pleak, R.R.; Pollack, W.S. (Harvard Review of Psychiatry, 2005)
Keywords: fluoxetine; anxiety disorder; article; bulimia; case report; clinical feature; depression; distress syndrome; eating disorder; emotion; family life; gender dysphoria; homosexuality; human; male; priority journal; privacy; school child; self disclosure; sexual orientation; social phobia; suicidal behavior; symptomatology; violence

Mental health of lesbian, gay, bisexual, and heterosexual siblings: Effects of gender, sexual orientation, and family - Balsam, K.F.; Beauchaine, T.P.; Mickey, R.M.; Rothblum, E.D. (Journal of Abnormal Psychology, 2005)
Self-identified lesbian, gay male, and bisexual (LGB) individuals were recruited via convenience sampling, and they in turn recruited their siblings (79% heterosexual, 19% LGB). The resulting sample of 533 heterosexual, 558 lesbian or gay male, and 163 bisexual participants was compared on mental health variables and their use of mental health services. Multilevel modeling analyses revealed that sexual orientation predicted suicidal ideation, suicide attempts, self-injurious behavior, use of psychotherapy, and use of psychiatric medications over and above the effects of family adjustment. Sexual orientation was unrelated to current psychological distress, psychiatric hospitalizations, and self-esteem. This is the 1st study to model family effects on the mental health of LGB participants and their siblings. Copyright 2005 by the American Psychological Association.
Keywords: psychotropic agent; adjustment; adult; article; automutilation; bisexuality; data analysis; distress syndrome; drug use; family; female; gender; health care utilization; heterosexuality; hospitalization; human; homosexual female; major clinical study; male; mental health; mental health service; mental hospital; model; normal human; prediction; psychotherapy; sampling; self esteem; sexual orientation; sibling; suicide; suicide attempt

Lesbian use and abuse of alcohol: Results of the Boston Lesbian Health Project II - Roberts, S.J.; Grindel, C.G.; Patsdaughter, C.A.; DeMarco, R.; Tarmina, M.S. (Substance Abuse, 2005)
The Boston Lesbian Health Project II, a national survey of 1139 self-identified lesbian women, found higher rates of drinking alcohol, heavy alcohol intake and self reported alcoholism than in national studies of women in general. Several known risk factors for alcoholism were higher in lesbians who self defined as alcoholic in this sample: family history of alcoholism and drug abuse, rape and childhood sexual abuse and report of having made a suicide attempt. These findings are consistent with other studies that found a high rate of drinking alcohol, alcohol abuse and problem drinking among lesbians. The reasons for these findings are not clear and further research is needed to continue to explore the reasons. © 2004 by The Haworth Press, Inc. All rights reserved.
Keywords: adolescent; adult; alcohol abuse; alcoholism; article; child sexual abuse; drinking behavior; drug abuse; family history; female; health survey; human; homosexual female; rape; risk factor; self report; suicide attempt; United States

Recollections of bullying at school and their long-term implications for lesbians, gay men, and bisexuals - Rivers, I. (Crisis, 2004)
This study explores the relationship between experiences of bullying at school, adult mental health status, and symptoms of posttraumatic stress among a sample of 119 UK residents who identified as lesbian, gay, or bisexual. Participants completed a series of questionnaires that focused upon school experiences, suicide ideation at school, sexual history, relationship status and negative affect, recent positive and negative life-events, internalized homophobia, and symptoms associated with posttraumatic stress. The results suggested that posttraumatic stress was a potential issue for 17% of participants who also scored significantly higher for depression, and reported having had more casual sexual partners than their peers. However, those who were found to exhibit symptoms of posttraumatic stress were also more accepting of their sexual orientation. A small number of participants used prescription or nonprescription drugs, or alcohol to help them cope with memories of bullying. It is suggested that posttraumatic stress may be a feature of the adult lives of men and women who experienced frequent and prolonged bullying at school as a result of their actual or perceived sexual orientation.
Keywords: academic achievement; alcohol consumption; article; bisexuality; depression; drug use; homosexuality; human; lesbianism; life event; mental health; posttraumatic stress disorder; questionnaire; school; sexuality; statistical significance; United Kingdom

Rates and predictors of mental illness in gay men, lesbians and bisexual men and women: Results from a survey based in England and Wales - Warner, J.; McKeown, É.; Griffin, M.; Johnson, K.; Ramsay, A.; Cort, C.; King, M. (British Journal of Psychiatry, 2004)
Background: There is a dearth of research into the mental health of gay men, lesbians and bisexual men and women in the UK. Aims: To assess rates and possible predictors of mental illness in these groups. Method: A comprehensive assessment was made of the psychological and social well-being of a sample of gay men, lesbians and bisexual men and women, identified using 'snowball' sampling. Results: Of the 1285 gay, lesbian and bisexual respondents who took part, 556 (43%) had mental disorder as defined by the revised Clinical Interview Schedule (CIS-R). Out of the whole sample, 361 (31%) had attempted suicide. This was associated with markers of discrimination such as recent physical attack (OR=1.7, 95% CI 1.3-2.3) and school bullying (OR=1.4, 95% CI 1.1-2.0), but not with higher scores on the CIS-R. Conclusions: Gay, lesbian and bisexual men and women have high levels of mental disorder, possibly linked with discrimination.
Keywords: adult; age distribution; alcohol consumption; article; bisexuality; controlled study; drug use; experience; female; high risk population; homosexuality; human; homosexual female; major clinical study; male; mental disease; mental health; prediction; quality of life; religion; risk assessment; scoring system; sexism; sexuality; social aspect; social environment; social problem; social psychology; suicide attempt; United Kingdom

FoSTUA, encoding a basic helix-loop-helix protein, differentially regulates development of three kinds of asexual spores, macroconidia, microconidia, and chlamydospores, in the fungal plant pathogen Fusarium oxysporum - Ohara, T.; Tsuge, T. (Eukaryotic Cell, 2004)
The soil-borne fungus Fusarium oxysporum causes vascular wilt of a wide variety of plant species. F. oxysporum produces three kinds of asexual spores, macroconidia, microconidia, and chlamydospores. Falcate macroconidia are formed generally from terminal phialides on conidiophores and rarely from intercalary phialides on hyphae. Ellipsoidal microconidia are formed from intercalary phialides on hyphae. Globose chlamydospores with thick walls are developed by the modification of hyplial and conidial cells. Here we describe FoSTUA of F. oxysporum, which differentially regulates the development of macroconidia, microconidia, and chlamydospores. FoSTUA encodes a basic helix-loop-helix protein with similarity to Aspergillus nidulans StuA, which has been identified as a transcriptional regulator controlling conidiation. Nuclear localization of FoStuA was verified by using strains expressing FoStuA-green fluorescent protein fusions. The FoSTUA-targeted mutants exhibited normal microconidium formation in cultures. However, the mutants lacked conidiophores and produced macroconidia at low frequencies only from intercalary phialides. Thus, FoSTUA appears to be necessary to induce conidiophore differentiation. In contrast, chlamydospore formation was dramatically promoted in the mutants. These data demonstrate that FoStuA is a positive regulator and a negative regulator for the development of macroconidia and chlamydospores, respectively, and is dispensable for microconidium formation in cultures. The disease-causing ability of F. oxysporum was not affected by mutations in FoSTUA. However, the mutants produced markedly fewer macroconidia and microconidia in infected plants than the wild type. These results suggest that FoSTUA also has an important role for microconidium formation specifically in infected plants.
Keywords: complementary DNA; fungal protein; green fluorescent protein; helix loop helix protein; stuA protein, Fungus; amino acid sequence; article; biological model; cell nucleus; fungal gene; fungus spore; Fusarium; gene deletion; gene expression regulation; gene library; gene vector; metabolism; molecular cloning; molecular genetics; mutation; nucleotide sequence; physiology; protein motif; sequence homology; time

Covert cultural sexual abuse of gay male teenagers contributing to etiology of sexual addiction - Kort, J. (Sexual Addiction and Compulsivity, 2004)
Gay male teenagers are at high risk for the development of sexual addiction. There exists a regular assault on the sexuality of gay males. This covert cultural sexual abuse suffered by these gay adolescents predisposes them to reenact this trauma through sexual acting out. The trauma model is useful in conceptualizing how to treat this population and address the post traumatic stress disorder suffered from the cultural victimization of homophobia and heterosexism. Copyright © Taylor & Francis, Inc.
Keywords: acting out; adolescent; article; cultural factor; heterosexuality; high risk population; homosexuality; human; male; phobia; posttraumatic stress disorder; psychotherapy; psychotrauma; sexual abuse; sexual crime; sexual deviation; sexuality; suicide

Differences between matched heterosexual and non-heterosexual college students on defense mechanisms and psychopathological symptoms - Biernbaum, M.A.; Ruscio, M. (Journal of Homosexuality, 2004)
Differences between heterosexual and non-heterosexual college students on measures of defense mechanisms and psychopathological symptoms were examined. Fifty-six (28 heterosexual, 28 non-heterosexual) subjects were drawn from a larger study of college student adjustment. Non-heterosexual subjects were matched to a heterosexual peer on several demographic variables as well as on attachment security/insecurity. Differences between the two groups on the Defense Mechanism Inventory and the Brief Symptom Inventory were tested. Contrary to traditional psychoanalytic conceptions of homosexuality, no differences were found between the two groups on any subscale of the Defense Mechanism Inventory, thereby repudiating one important aspect of traditional psychoanalytic theories on the development of homosexuality. Non-heterosexual students reported significantly higher levels of anxiety, depression, somaticization, paranoid ideation, general symptom severity, and suicidal ideation. These students appear to be at increased risk for psychopathology and suicidal ideation, despite similar defense profiles, when compared to matched heterosexual peers. Additional research is needed to determine the origins of this increased risk, and comprehensive and targeted prevention and intervention programs must be established to ameliorate such risks. © 2004 by The Haworth Press, Inc. All rights reserved.
Keywords: adult; anxiety; article; Brief Symptom Inventory; clinical article; college student; controlled study; defense mechanism; defense mechanism inventory; depression; disease severity; female; heterosexuality; high risk population; homosexuality; human; male; mental disease; paranoia; psychoanalytic theory; psychologic test; risk factor; somatization; suicidal behavior; symptom

Mental health concerns of HIV-infected gay and bisexual men seeking mental health services: An observational study - Berg, M.B.; Mimiaga, M.J.; Safren, S.A. (AIDS Patient Care and STDs, 2004)
Addressing mental health concerns of HIV-positive individuals is an important component of providing quality HIV care. Mental health intake information from patients with HIV can be an important source of data to complement existing research on HIV and mental health because the intake information contains concerns that are both from the perspective of the patients and are significant enough to bring them into treatment. The current study describes the mental health intake information of HIV-positive men who have sex with men (MSM) at an urban community health clinic over a 1-year period. This information included presenting problems, current symptoms from a symptom checklist, ratings of impairments in functioning, and client histories (e.g., substance abuse, emotional, physical, and sexual abuse, previous treatment). It also included clinicians' Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses of the participants, and recommended treatments. Depression was the most prevalent presenting problem (58.1% of clients), followed by anxiety (38.2%). Consistently, depression (96.3%) and low energy (78.2%) were the most frequently endorsed symptoms on a symptom checklist, followed by anxiety (69.2%). HIV-specific problems also played a large role both directly, as a presenting problem, and indirectly as they related to such concerns as relationship issues. Axis I diagnoses included adjustment disorders (50.0%), major depressive disorder (21.4%), and dysthymia (a less severe but more chronic depression) (8.9%). This review highlights the mental health issues that HIV-positive MSM feel are significant enough to require treatment. Because mental health is a key component of overall quality of life, HIV providers who work with MSM can use these data to increase awareness of the types of mental concerns that are most distressing to this population.
Keywords: adjustment disorder; adult; anamnesis; anxiety disorder; article; bisexuality; clinical feature; community care; comorbidity; controlled study; depression; disease severity; dysthymia; functional assessment; health care quality; homosexuality; human; Human immunodeficiency virus infection; major clinical study; major depression; male; mental health; mental health service; psychiatric diagnosis; quality of life; retrospective study; sexual abuse; substance abuse; suicidal behavior; treatment planning; urban population

Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents - Whitbeck, L.B.; Chen, X.; Hoyt, D.R.; Tyler, K.A.; Johnson, K.D. (Journal of Sex Research, 2004)
This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post-traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, were more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.
Keywords: adolescent; alcohol abuse; article; bisexuality; child abuse; child sexual abuse; conduct disorder; controlled study; drug abuse; female; heterosexuality; homelessness; homosexuality; human; homosexual female; longitudinal study; major depression; male; mental disease; posttraumatic stress disorder; risk factor; runaway behavior; sexual abuse; substance abuse; suicide attempt; survival; victim

Major depressive disorder, suicidal ideation, and suicide attempt in twins discordant for cannabis dependence and early-onset cannabis use - Lynskey, M.T.; Glowinski, A.L.; Todorov, A.A.; Bucholz, K.K.; Madden, P.A.F.; Nelson, E.C.; Statham, D.J.; Martin, N.G.; Heath, A.C. (Archives of General Psychiatry, 2004)
Background: Previous research has reported both a moderate degree of comorbidity between cannabis dependence and major depressive disorder (MDD) and that early-onset cannabis use is associated with increased risks for MDD. Objective: To examine whether associations between both lifetime cannabis dependence and early cannabis use and measures of MDD, suicidal ideation, and suicide attempt persist after controlling for genetic and/or shared environmental influences. Design: Cross-sectional survey of twin pairs discordant for lifetime cannabis dependence and those discordant for early cannabis use. Setting: General population sample of twins (median age, 30 years). Participants: Two hundred seventy-seven same-sex twin pairs discordant for cannabis dependence and 311 pairs discordant for early-onset cannabis use (before age 17 years). Main Outcome Measures: Self-report measures of DSM-IV-defined lifetime MDD, suicidal ideation, and suicide attempt. Results: Individuals who were cannabis dependent had odds of suicidal ideation and suicide attempt that were 2.5 to 2.9 times higher than those of their non-cannabis-dependent co-twin. Additionally, cannabis dependence was associated with elevated risks of MDD in dizygotic but not in monozygotic twins. Those who initiated cannabis use before age 17 years had elevated rates of subsequent suicide attempt (odds ratio, 3.5 [95% confidence interval, 1.4-8.6]) but not of MDD or suicidal ideation. Early MDD and suicidal ideation were significantly associated with subsequent risks of cannabis dependence in discordant dizygotic pairs but not in discordant monozygotic pairs. Conclusions: Comorbidity between cannabis dependence and MDD likely arises through shared genetic and environmental vulnerabilities predisposing to both outcomes. In contrast, associations between cannabis dependence and suicidal behaviors cannot be entirely explained by common predisposing genetic and/or shared environmental predispositions: Previously reported associations between early-onset cannabis use and subsequent MDD likely reflect shared genetic and environmental vulnerabilities, although it remains possible that early-onset cannabis use may predispose to suicide attempt.
Keywords: cannabis; adolescent; adult; article; cannabis addiction; comorbidity; controlled study; Diagnostic and Statistical Manual of Mental Disorders; disease association; dizygotic twins; female; genetic predisposition; human; lifespan; major depression; male; monozygotic twins; onset age; prevalence; risk; self report; suicidal behavior; suicide attempt; twin discordance

Ethics and the proposed treatment for a 13-year-old with atypical gender identity - Spriggs, M.P. (Medical Journal of Australia, 2004)
Keywords: estrogen; gestagen; gonadorelin derivative; adolescent; adolescent disease; article; behavior disorder; case report; distress syndrome; emotional disorder; female; gender dysphoria; human; medical decision making; medical ethics; medicolegal aspect; patient counseling; psychotherapy; sex transformation; social isolation; social psychology; suicide attempt

Who are the kids who self-harm? An Australian self-report school survey - De Leo, D.; Heller, T.S. (Medical Journal of Australia, 2004)
Objective: To determine the prevalence and types of deliberate self-harm (DSH) in adolescents, and associated factors. Design: A cross-sectional questionnaire study. Participants and setting: 3757 of 4097 Year 10 and Year 11 students (91.7%) from 14 high schools on the Gold Coast, Queensland, during September 2002. Main outcome measures: DSH behaviour, including descriptions of the last act, psychological symptoms, recent stressors, coping styles, help-seeking behaviour, lifestyle choices, and self-prescribing of medications. Results: 233 students (6.2%) met the criteria for DSH in the previous 12 months, with DSH more prevalent in females than males (OR, 7.5; 95% CI, 5.1-10.9). The main methods were self-cutting (138 respondents; 59.2%) and overdosing with medication (69 respondents; 29.6%). Factors associated with DSH included similar behaviours in friends or family, coping by self-blame, and self-prescribing of medications. Most self-harmers did not seek help before or after their most recent action, with those who did primarily consulting friends. Conclusions: DSH is common in Australian youth, especially in females. Preventive programs should encourage young people to consult health professionals in stressful situations.
Keywords: amphetamine; adolescent; article; Australia; automutilation; child behavior; cigarette smoking; consultation; controlled study; coping behavior; decision making; drug overdose; drug use; family life; female; health practitioner; human; human relation; lifestyle; major clinical study; male; mental stress; patient attitude; prescription; prevalence; psychological aspect; questionnaire; self esteem; self report; sex difference; sexual orientation; suicide; symptom

Sex race/ethnicity, and romantic attractions: Multiple minority status adolescents and mental health - Consolacion, T.B.; Russell, S.T.; Sue, S. (Cultural Diversity and Ethnic Minority Psychology, 2004)
This study examined the association between multiple minority statuses and reports of suicidal thoughts, depression, and self-esteem among adolescents. Data from the National Longitudinal Study of Adolescent Health were used to examine mental health outcomes across racial/ethnic groups for same-sex-attracted youths and female youths. Hispanic/Latino, African American, and White female adolescents reported more suicidal thoughts, higher depression, and lower self-esteem compared with male adolescents in their racial/ethnic group. Same-sex-attracted youths did not consistently demonstrate compromised mental health across racial/ethnic groups. Follow-up analyses show that White same-sex-attracted female adolescents reported the most compromised mental health compared with other White adolescents. However, similar trends were not found for racial/ethnic minority female youths with same-sex attractions.
Keywords: adolescence; adolescent; African American; article; Caucasian; depression; ethnic minority youth; ethnology; female; Hispanic; human; human relation; juvenile; longitudinal study; male; mental health; minority group; multiple minority status; multiple minority status adolescent; normal human; race; romantic attraction; same sex attraction; self esteem; sex; sexual minority youth; social status; suicidal ideation; suicide; thinking

Experiences of harassment, discrimination, and physical violence among young gay and bisexual men - Huebner, D.M.; Rebchook, G.M.; Kegeles, S.M. (American Journal of Public Health, 2004)
Objectives. We examined the 6-month cumulative incidence of anti-gay harassment, discrimination, and violence among young gay/bisexual men and documented their associations with mental health. Methods. Gay/bisexual men from 3 cities in the southwestern United States completed self-administered questionnaires. Results. Thirty-seven percent of men reported experiencing anti-gay verbal harassment in the previous 6 months; 11.2% reported discrimination, and 4.8% reported physical violence. Men were more likely to report these experiences if they were younger, were more open in disclosing their sexual orientation to others, and were HIV positive. Reports of mistreatment were associated with lower self-esteem and increased suicidal ideation. Conclusions. Absent policies preventing anti-gay mistreatment, empowerment and community-building programs are needed for young gay/bisexual men to both create safe social settings and help them cope with the psychological effects of these events.
Keywords: adult; age; article; bisexuality; coping behavior; homosexuality; human; Human immunodeficiency virus infection; logistic regression analysis; male; mental health; normal human; psychological aspect; questionnaire; self esteem; social psychology; suicidal behavior; United States; victim; violence

Asian/Pacific Islander adolescent sexual orientation and suicide risk in Guam - Pinhey, T.K.; Millman, S.R. (American Journal of Public Health, 2004)
Objectives. We examined the effects of same-sex orientation on suicide risks for Guam's Asian/Pacific Islander adolescents. Methods. We used a probability sample and logistic regression analysis to identify suicide risk factors. Results. Same-sex orientation was associated with a greater risk of suicide attempt, especially for boys. Adolescents who reported suffering physical abuse in the context of a romantic relationship, engaging in binge drinking, and experiencing feelings of hopelessness were at greater risk for suicidal ideation and attempts. Race/ethnicity was associated with suicide risk for both boys and girls, and patterns suggest that membership in the same racial/ethnic group decreased suicide risk for girls and increased risk of suicide for boys. Conclusions. Gay, lesbian, and bisexual Asian/Pacific Islander adolescents in Guam deserve intervention and counseling programs to reduce suicide risk.
Keywords: alcohol; abuse; adolescent; article; Asian American; bisexuality; controlled study; drinking behavior; ethnology; female; Guam; homosexuality; human; homosexual female; logistic regression analysis; male; normal human; probability; race difference; risk factor; sexual orientation; suicidal behavior; suicide attempt

Substance use and misuse: Are bisexual women at greater risk? - McCabe, S.E.; Hughes, T.L.; Boyd, C.J. (Journal of Psychoactive Drugs, 2004)
The objective of this study was to compare the prevalence of substance use and alcohol-related consequences among bisexual and heterosexual women. A cross-sectional survey was self-administered to a random sample of undergraduate women. The final sample consisted of 49 self-identified bisexual women and 2,042 self-identified heterosexual women. Bivariate and multivariate results indicated that bisexual women were more likely than heterosexual women to report cigarette smoking, illicit drug use and medically prescribed use of antidepressant prescription medication. Although their drinking behaviors were similar, bisexual women were more likely than heterosexual women to experience adverse alcohol-related consequences. These findings suggest that traditional-age undergraduate women who self-identify as bisexual may be at heightened risk for substance use. However, additional research is needed to replicate these findings with larger samples of bisexual women.
Keywords: midomafetamine; alcohol; antidepressant agent; cannabis; illicit drug; adolescent; adult; alcohol abuse; article; binge drinking; bisexuality; cannabis addiction; cigarette smoking; depression; drinking behavior; drug abuse; female; heterosexuality; high risk population; human; homosexual female; major clinical study; race difference; sexual behavior; substance abuse; suicidal behavior

Suicide by a transvestite or sexual asphyxia? A case report. - Bhardwaj, D.N.; Rautji, R.; Sharma, R.K.; Dogra, T.D. (Medicine, science, and the law, 2004)
Autoerotic asphyxial activity may at times result in unexpected death. Although the majority of deaths that occur during autoerotic asphyxial episodes are accidental, the possibility of suicide must always be entertained. In the case presented here, a 22-year-old married male was found hanging by his neck in his bedroom, which was locked from the inside. He was suspended by a 'lungi' (male wrap-around cloth) from the ceiling fan hook in his room, with his feet touching the ground. He was dressed in a brassiere, panties, and silver anklets. There was no evidence of previous perverse behaviour, and investigation disclosed no evidence of previous autoerotic sexual activity, homosexual behaviour, drug abuse or suicidal ideation.
Keywords: article; asphyxia; case report; forensic medicine; human; male; preschool child; psychological aspect; sexual behavior; suicide; cross-dressing

Distress and Depression in Men Who Have Sex with Men: The Urban Men's Health Study - Mills, T.C.; Paul, J.; Stall, R.; Pollack, L.; Canchola, J.; Chang, Y.J.; Moskowitz, J.T.; Catania, J.A. (American Journal of Psychiatry, 2004)
Objective: This study estimates the prevalence of depression and describes the correlates and independent associations of distress and depression among U.S. men who have sex with men. Method: A household-based probability sample of men who have sex with men (N=2,881) was interviewed between 1996 and 1998 in four large American cities. With cutoff points of 15 and 22 for the Center for Epidemiological Studies Depression Scale, individual correlates and predictors of distress and depression were examined, and multinomial logistic regression was performed. Results: The 7-day prevalence of depression in men who have sex with men was 17.2%, higher than in adult U.S. men in general. Both distress and depression were associated with lack of a domestic partner; not identifying as gay, queer, or homosexual; experiencing multiple episodes of antigay violence in the previous 5 years; and very high levels of community alienation. Distress was also associated with being of other than Asian/Pacific Islander ethnicity and experiencing early antigay harassment. Depression was also associated with histories of attempted suicide, child abuse, and recent sexual dysfunction. Being HIV positive was correlated with distress and depression but not significantly when demographic characteristics, developmental history, substance use, sexual behavior, and current social context were controlled by logistic regression. Conclusions: Rates of distress and depression are high in men who have sex with men. These high rates have important public health ramifications. The predictors of distress and depression suggest prevention efforts that might be effective when aimed at men who have sex with men.
Keywords: adult; aged; article; child abuse; depression; distress syndrome; ethnology; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; prevalence; priority journal; rating scale; sexual dysfunction; suicide attempt; violence

Homophobia and the production of shame: Young people and same sex attraction - Hillier, L.; Harrison, L. (Culture, Health and Sexuality, 2004)
Research among same-sex attracted young people in Western cultures has described a minority group of adolescents whose sexuality is negated by the significant institutions and people in their lives. Very often, there is a silence in the family and at school about same-sex sexuality and when a young person's homosexuality is suspected or disclosed s/he suffers from denial, discrimination and abuse. Not surprisingly, living in hostile environments leaves such young people at high-risk of drug abuse, depression and suicide. This paper describes some of the ways young people resist being positioned in these negative ways. Using autobiographical stories from 200 same-sex attracted young Australians, we document the discursive field of sexuality in which these young people struggle to construct positive identities. Young people were well aware of dominant discourses which characterized homosexuality as 'evil, diseased and unnatural'. Yet they use different strategies to fault, deflect and discount these negative understandings and to highlight other discourse which positions them positively.
Keywords: adolescent; adult; article; Australia; clinical research; controlled study; cultural anthropology; denial; depression; drug abuse; environment; family; female; gender identity; heterosexuality; high risk population; homosexuality; hostility; human; institutionalization; literature; male; minority group; perceptive discrimination; priority journal; sexual abuse; sexual behavior; sexuality; shame; suicide

REN1 is Required for Development of Microconidia and Macroconidia, but Not of Chlamydospores, in the Plant Pathogenic Fungus Fusarium oxysporum - Ohara, T.; Inoue, I.; Namiki, F.; Kunoh, H.; Tsuge, T. (Genetics, 2004)
The filamentous fungus Fusarium oxysporum is a soil-borne facultative parasite that causes economically important losses in a wide variety of crops. F. oxysporum exhibits filamentous growth on agar media and undergoes asexual development producing three kinds of spores: microconidia, macroconidia, and chlamydospores. Ellipsoidal microconidia and falcate macroconidia are formed from phialides by basipetal division; globose chlamydospores with thick walls are formed acrogenously from hyphae or by the modification of hyphal cells. Here we describe rensa, a conidiation mutant of F. oxysporum, obtained by restriction-enzyme-mediated integration mutagenesis. Molecular analysis of rensa identified the affected gene, RENI, which encodes a protein with similarity to MedA of Aspergillus nidulans and Acr1 of Magnaporthe grisea. MedA and Acr1 are presumed transcription regulators involved in conidiogenesis in these fungi. The rensa mutant and REN1-targeted strains lack normal conidiophores and phialides and form rod-shaped, conidium-like cells directly from hyphae by acropetal division. These mutants, however, exhibit normal vegetative growth and chlamydospore formation. Nuclear localization of Ren1 was verified using strains expressing the Ren1-green fluorescent protein fusions. These data strongly suggest that REN1 encodes a transcription regulator required for the correct differentiation of conidiogenesis cells for development of microconidia and macroconidia in F. oxysporum.
Keywords: agar; gene product; green fluorescent protein; fusion protein; macroconidium; microconidium; protein ren1; regulator protein; unclassified drug; acr1 gene; article; asexual reproduction; Aspergillus nidulans; cell activity; conidium; crop production; culture medium; economic aspect; fungus hyphae; Fusarium oxysporum; gene fusion; gene mutation; Magnaporthe grisea; meda gene; mutagenesis; nonhuman; nuclear localization signal; nucleotide sequence; plant disease; priority journal; protein analysis; ren1 gene; rensa gene; restriction mapping; sequence homology; soil microflora; strain identification; transcription regulation

Suicidal behavior of adolescent girls: profile and meaning. - Joseph, H.B.; Reznik, I.; Mester, R. (The Israel journal of psychiatry and related sciences, 2003)
In the last two decades the incidence of adolescent suicides has been very high (though it has been on the decrease in the U.S.A. over the last four years), giving rise to a multitude of empirical and theoretical studies. The extensive knowledge that has accumulated regarding adolescent suicidal behavior has led to a more differentiated attitude. Many studies try to clarify specific needs, motivations and the conceptualization of death and suicide in various adolescent subgroups (minorities, females, homosexuals), thereby enabling more specific and exact methods of evaluation, prevention and intervention. Adolescent girls' suicidal behavior is different in many aspects from boys' suicidal behavior: Girls mortality rate from suicide is a 3-5 times lower rate than boys, but their attempted suicide rate is four to hundreds time higher. Girls suicide mainly by drugs and their suicide is mainly in reaction to interpersonal difficulties. Their motivation is often a cry for help. The comorbidity of suicide and depression is much higher for adolescent girls than boys. These differences generate a different understanding and separate treatment strategies. Two theoretical approaches that may explain the profile which characterizes suicidal girls will be presented. One has a psychological developmental context, and the other a social cultural context. Implications for specific prevention measures include legal action on pack sizes of analgesics, compulsory registration of attempted suicide and more gender specific treatment and prevention programs.
Keywords: adolescent; article; child behavior; female; human; psychological aspect; psychological theory; suicide attempt

Suicide Attempts Among Sexual-Minority Male Youth - Savin-Williams, R.C.; Ream, G.L. (Journal of Clinical Child and Adolescent Psychology, 2003)
The purpose of this study was to provide data addressing Diamond's (this issue) 4 problem areas in sexual orientation research by comparing gay, bisexual, and questioning male youth who report attempting suicide with those who do not. Secondary analyses were conducted with 2 datasets, 1 with a gay support group (n = 51) and the other with online youth (n = 681). Reported suicide attempts ranged from 39% among support-group youth, to 25% among Internet gay support group youth, to 9% among Internet non-support group youth. Sexual orientation, behavior, and identity did not predict suicidal attempt status, but suicide attempters experienced higher levels of both generic life Stressors (low self-esteem, substance use, victimization) and gay-related Stressors, particularly those directly related to visible (femininity) and behavioral (gay sex) aspects of their sexual identity. Support-group attendance was related to higher levels of suicidality and life Stressors, as well as certain resiliency factors. Results suggest that there exists a minority of sexual-minority youth who are at risk but that it would be inappropriate to characterize the entire population as such.
Keywords: addiction; adolescent; adult; article; comparative study; health survey; homosexuality; human; male; mental stress; psychological aspect; self concept; social support; suicide attempt; victim

The death of a patient with AIDS in Turkey: Thoughts on the ethical dimensions - Namal, A. (Nursing Ethics, 2003)
A Turkish patient with AIDS attempted to commit suicide. Turkey is one of the countries where AIDS education in society and for health personnel has started rather late. This article documents what this patient, his sister and his friends, who helped him to survive for a short while, experienced in the hospital environment. This is a real case history and should be considered from various aspects because suicide was attempted by a person with AIDS who was near the terminal stage. The patient's friends made a remarkable effort to help him to survive. They were unsure about what to do because they had not respected his wishes and they experienced deep alienation because of the extremely negative attitude of the medical staff. © 2003 Arnold.
Keywords: acquired immune deficiency syndrome; adult; article; attitude to health; case report; ethics; family; fatality; friend; Health Care and Public Health; health personnel attitude; homosexuality; hospital personnel; human; informed consent; male; patient abandonment; professional-patient relationship; psychological aspect; social psychology; suicide; terminal care; Turkey (republic)

Hypovirus Papain-Like Protease p29 Functions in trans To Enhance Viral Double-Stranded RNA Accumulation and Vertical Transmission - Suzuki, N.; Maruyama, K.; Moriyama, M.; Nuss, D.L. (Journal of Virology, 2003)
The prototypic hypovirus CHV1-EP713 attenuates virulence (hypovirulence) and alters several physiological processes of the chestnut blight fungus Cryphonectria parasitica. The papain-like protease, p29, and the highly basic protein, p40, derived, respectively, from the N-terminal and C-terminal portions of the CHV1-EP713-encoded open reading frame (ORF) A polyprotein, p69, both contribute to reduced pigmentation and sporulation. The p29 coding region was shown to suppress pigmentation and asexual sporulation in the absence of virus infection in transformed C. parasitica, whereas transformants containing the p40-coding domain exhibited a wild-type, untransformed phenotype. Deletion of either p29 or p40 from the viral genome also results in reduced accumulation of viral RNA. We now show that p29, but not p40, functions in trans to enhance genomic RNA accumulation and vertical transmission of p29 deletion mutant viruses. The frequency of virus transmission through conidia was found to decrease with reduced accumulation of viral genomic double-stranded RNA (dsRNA): from almost 100% for wild-type virus to ∼50% for Δp29, and 10 to 20% for Δp69. When expressed from a chromosomally integrated cDNA copy, p29 elevated viral dsRNA accumulation and transmission for Δp29 mutant virus to the level shown by wild-type virus. Increased viral RNA accumulation levels were also observed for a Δp69 mutant lacking almost the entire ORF A sequence. Such enhancements were not detected in transgenic fungal colonies expressing p40. Mutation of p29 residues Cys70 or Cys72, strictly conserved in hypovirus p29 and potyvirus HC-Pro, resulted in the loss of both p29-mediated suppressive activity in virus-free transgenic C. parasitica and in trans enhancement of RNA accumulation and transmission, suggesting a linkage between these functional activities. These results suggest that p29 is an enhancer of viral dsRNA accumulation and vertical virus transmission through asexual spores.
Keywords: complementary DNA; cysteine; double stranded RNA; mutant protein; papain; polyprotein; polyprotein p69; protein chv1 ep713 p29; protein hc pro; protein p40; proteinase p29; unclassified drug; viral protein; virus RNA; amino terminal sequence; animal cell; animal tissue; article; asexual reproduction; bioaccumulation; biotransformation; blight; carboxy terminal sequence; chestnut; controlled study; Cryphonectria parasitica; deletion mutant; enhancer region; enzyme analysis; fungal cell; fungus; gene deletion; gene duplication; Hypovirus; hypovirus chv1 ep713; nonhuman; open reading frame; phenotype; pigmentation; Potyvirus; priority journal; protein domain; protein expression; protein function; residue analysis; RNA analysis; sporogenesis; structure activity relation; trans isomer; vertical transmission; virus; virus attenuation; virus genome; virus infection; virus transmission; virus virulence; wild type

Life on the seesaw: A qualitative study of suicide resiliency factors for young gay men - Fenaughty, J.; Harré, N. (Journal of Homosexuality, 2003)
While considerable research has highlighted the factors that increase gay youth suicide risk, there has been much less emphasis on protective factors. Using grounded theory methodology, we explored the suicide resiliency in eight young gay men in Aotearoa/New Zealand. Common themes emerged, including positive social norms and conditions, high levels of support, identification with role models and high self-esteem. These were integrated with "known" risk factors to form the Seesaw Model of Gay Male Suicide. This model demonstrates that the balance between risk and resiliency may be the key to gay suicide. Depending on the balance of these factors, youth might either be resilient, attempt suicide, or teeter somewhere in between. The current findings indicate that gay youth suicide prevention requires efforts to increase resiliency factors for this group. © 2003 by The Haworth Press, Inc. All rights reserved.
Keywords: adaptation; adaptive behavior; adult; article; coping behavior; family; group psychology; homosexuality; human; interview; male; methodology; model; New Zealand; psychological aspect; psychological theory; qualitative analysis; risk assessment; risk factor; role playing; school; seesaw model of gay male suicide; self concept; self esteem; social aspect; social psychology; social support; suicidal behavior; suicide; suicide attempt; suicide prevention; suicide resiliency factor; suicide risk; support group

A late sex reassignment in 5-α reductase deficiency: Case report - Yücel, B.; Polat, A. (International Journal of Psychiatry in Medicine, 2003)
The syndrome of male pseudohermaphroditism, caused by a deficiency of the enzyme 5-α reductase, results in a selective decrease in dihyrotestosterone. Culture is an important part of the context in which decisions are made on sex assignment of patients with abnormalities of the external genitalia. In Turkey, patients with ambiguious genitalia are diagnosed very late and corrective surgery is usually performed during or after puberty. Here we present a case with 5-α reductase deficiency who was diagnosed at puberty and followed-up for 10 years.
Keywords: androstanolone; steroid 5alpha reductase; adolescent; article; case report; clinical feature; cultural factor; disease course; enzyme deficiency; female; follow up; gender dysphoria; human; male pseudohermaphroditism; medical decision making; patient counseling; puberty; social psychology; suicidal behavior; Turkey (republic)

Predictors of suicide in the old elderly - Waern, M.; Rubenowitz, E.; Wilhelmson, K. (Gerontology, 2003)
Background: Seniors aged 75 and above have the highest suicide rates of all age groups in most industrialized countries. However, research concerning risk factors for suicide in the old elderly is sparse. Objective: The purpose was to determine predictors for suicide among the old elderly (75+). Data concerning the young elderly (65-74 years) are shown for comparison. Methods: 85 consecutive cases of suicide that occurred in western Sweden and 153 control persons with the same sex, birth year, and zip code as the suicide cases were randomly selected from the tax register. The old elderly group included 38 cases and 71 controls; the young elderly group included 47 cases and 82 controls. Data concerning the suicide cases were collected through interviews with close informants; controls were interviewed in person. The interview included questions on past-year life events and mental and physical health. Medical records were reviewed for cases and controls. The Cumulative Illness Rating Scale - Geriatrics was used to rate illness burden. Results: Family conflict, serious physical illness, loneliness, and both major and minor depressions were associated with suicide in the 75+ group. Economic problems predicted suicide in the younger but not in the older elderly. Old elderly suicide victims with depression (major or minor) were less likely to have received depression treatment than their younger counterparts. Conclusions: Better recognition and treatment of both major and minor depression should constitute an important target for the prevention of suicide in the old elderly. Intervention studies with large numbers of senior participants are sorely needed. Copyright © 2003 S. Karger AG, Basel.
Keywords: age distribution; aged; article; controlled study; depression; disease association; economic aspect; family; female; geriatrics; health status; human; informed consent; interview; life event; loneliness; major clinical study; male; medical record; mental health; physical disease; prediction; priority journal; questionnaire; randomization; rating scale; register; senescence; suicidal behavior; Sweden; victim

Internalized homophobia: A factor in depression, anxiety, and suicide in the gay and lesbian population - Igartua, K.J.; Gill, K.; Montoro, R. (Canadian Journal of Community Mental Health, 2003)
Two-hundred and twenty participants recruited through multiple sampling strategies completed a self-report questionnaire examining: (a) whether internalized homophobia predicts depressive and anxious symptoms, suicide, and substance abuse; and (b) the periods of gay-identity development which were particularly risky for suicide. Results indicate that internalized homophobia, particularly negative feelings towards one's own homosexuality (as measured by the Self subscale of the Nungesser Homosexual Attitudes Inventory), accounts for 18% of the variance in depressive scores and 13% of anxiety scores (using the Beck inventories). Internalized homophobia did not predict suicide independently from depression. The period of greatest risk for both suicidal ideation and suicide attempts was the period of disclosure of one's homosexuality to one's immediate family.
Keywords: adult; anxiety disorder; article; attitude; correlation analysis; depression; disease association; female; gender identity; homophobia; homosexuality; human; major clinical study; male; phobia; questionnaire; risk assessment; scoring system; self report; substance abuse; suicidal behavior

Young adults' reactions to gay and lesbian peers who became suicidal following "coming out" to their parents - Cato, J.E.; Cantetto, S.S. (Suicide and Life-Threatening Behavior, 2003)
Rates of nonfatal suicidal behavior among gay and lesbian youth surpass those recorded among their heterosexual peers. A frequently cited precipitant of gay and lesbian nonfatal suicidal behavior is the turmoil associated with coming out to one's family. This study investigated young adults' attitudes toward peers who engaged in suicidal behavior after coming out and being rejected by their parents, and compared them with attitudes toward persons who had become suicidal in response to other stressors (a physical illness, a relationship loss, or an academic failure). Our goal was to explore whether young persons hold beliefs that may encourage lesbian and gay suicidal behavior. We found that gays and lesbians who engaged in suicidal behavior following coming out were not viewed in particularly forgiving or empathic ways, as was the case for persons who became suicidal following an incurable illness. All suicidal persons were perceived as relatively feminine. At the same time, suicidal males were rated as more masculine if they engaged in suicidal behavior because of an academic failure or a physical illness, while suicidal females were viewed as more masculine only if their suicidal behavior followed an academic failure. Finally, we found that both respondent sex and respondent gender-identity influenced evaluations of suicidal persons. Building on these findings, future research should explore attitudes toward the permissibility of a suicidal decision by lesbian and gay persons.
Keywords: adult; article; female; gender identity; group psychology; homosexuality; human; major clinical study; male; masculinity; parent; physical disease; suicidal behavior

Sexual orientation and self-harm in men and women - Skegg, K.; Nada-Raja, S.; Dickson, N.; Paul, C.; Williams, S. (American Journal of Psychiatry, 2003)
Objective: Recent studies of homosexual people have found higher rates of nonfatal suicidal behavior than among heterosexuals. The purpose of this study was to determine associations between self-harm and sexual orientation for men and women separately, defining sexual orientation by sexual attraction rather than by behavior. Method: In a birth cohort of 1,019 New Zealand young adults eligible to be interviewed at age 26 years, 946 participated in assessments of both sexual attraction and self-harm. Results: Both women and men who had experienced same-sex attraction had higher risks of self-harm. The odds ratios for suicidal ideation in the past year were 3.1 for men and 2.9 for women. Odds ratios for ever having deliberately self-harmed were 5.5 for men and 1.9 for women. Men with same-sex attraction were also significantly more likely to report having attempted suicide. In both sexes, a greater degree of same-sex attraction predicted increasing likelihood of self-harm, with over one-third of men and women with persistent major same-sex attraction reporting this. Men with even a minor degree of same-sex attraction had high rates of self-harm and resulting physical injury. One-quarter of deliberate self-harm among men and one-sixth among women was potentially attributable to same-sex attraction. Conclusions: This study provides evidence of a link between increasing degrees of same-sex attraction and self-harm in both men and women, with the possibility of some difference between the sexes that needs to be explored further.
Keywords: adult; article; cohort analysis; controlled study; female; human; interview; major clinical study; male; priority journal; risk assessment; self report; sex difference; sexual behavior; sexual orientation; statistical significance; suicidal behavior; suicide attempt

Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men - O'Leary, A.; Purcell, D.; Remien, R.H.; Gomez, C. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2003)
Previous studies have indicated an association between childhood sexual abuse (CSA,) and adult sexual risk behaviour among women and among men who have sex with men (MSM). However, no studies to date have tested the hypothesis that a history of CSA predicts sexual behaviour carrying risk of transmission of HIV to others, i.e. in a known HIV-positive cohort. The present study tested this hypothesis among a sample of 456 HIV-positive MSM recruited from community venues in New York and San Francisco. CSA history was found to be significantly associated with past (in the last 90 days) unprotected anal sex acts, both insertive (33% versus 20%, p < 0.05) and receptive (43% versus 27%, p < 0.02), with partners of HIV-negative or unknown serostatus. Further, several potential mediators of this effect were tested, and three found to be predicted by CSA history. Each of these potential mediators was associated with sexual risk behaviour, but differentially: anxiety and hostility were significantly associated with insertive acts, while anxiety, hostility and suicidality were associated with receptive acts. Mediation analyses supported the hypothesis that these factors significantly (albeit partially) accounted for the association of CSA with receptive anal intercourse. Nonsignificant mediation effects were found for insertive sex, suggesting the operation of unmeasured mediating variables. These results highlight the importance of mental health services for individuals who have been sexually abused, both for personal and for public health benefit, and also indicate a need for further research into mediators of CSA effects on transmission-related behaviour.
Keywords: adult; article; child abuse; child sexual abuse; disease transmission; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; priority journal; sexual abuse; sexual behavior; sexual transmission; sexually transmitted disease; virus infection; virus transmission

Sexual orientation and suicide attempt: A longitudinal study of the general Norwegian adolescent population - Wichstrøm, L.; Hegna, K. (Journal of Abnormal Psychology, 2003)
Past and future suicide attempt rates among gay, lesbian, and bisexual (GLB) young people were compared with those of heterosexual young people. A sample of Norwegian students (N = 2,924; grades 7-12) was followed in 3 data collection waves. Risk factors included previous suicide attempt, depressed mood, eating problems, conduct problems, early sexual debut, number of sexual partners, pubertal timing, self-concept, alcohol and drug use, atypical gender roles, loneliness, peer relations, social support, parental attachment, parental monitoring, and suicidal behavior among family and friends. When homosexual attraction, homosexual identity, and same-sex sexual behavior were entered to predict suicide attempt, only same-sex sexual behavior was significantly predictive. The increased odds could not be attributed to GLB students' greater exposure to risk factors for suicide attempt.
Keywords: adolescent; adult; alcohol abuse; article; bisexuality; child; conduct disorder; depression; drug abuse; eating disorder; emotional attachment; female; group psychology; heterosexuality; human; homosexual female; loneliness; longitudinal study; male; Norway; parent; risk factor; self concept; sexual orientation; sexuality; social support; suicidal behavior; suicide attempt

Non-consensual sex experienced by men who have sex with men: Prevalence and association with mental health - Ratner, P.A.; Johnson, J.L.; Shoveller, J.A.; Chan, K.; Martindale, S.L.; Schilder, A.J.; Botnick, M.R.; Hogg, R.S. (Patient Education and Counseling, 2003)
Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews. © 2002 Elsevier Science Ireland Ltd. All rights reserved.
Keywords: adult; alcohol abuse; article; child abuse; controlled study; health practitioner; human; male; mental disease; mental health; mood disorder; priority journal; questionnaire; responsibility; self esteem; sexual abuse; sexual crime; social psychology; suicidal behavior; suicide attempt; violence

Staff knowledge and attitudes towards deliberate self-harm in adolescents - Crawford, T.; Geraghty, W.; Street, K.; Simonoff, E. (Journal of Adolescence, 2003)
This study investigates knowledge, attitudes and training needs concerning deliberate self-harm (DSH) in adolescents, amongst a variety of professionals involved in the assessment and management of adolescence who self-harm. A questionnaire survey was completed by 126 health professionals working with adolescents who harm themselves. The main outcome measures were a knowledge measure and three attitude measures (generated using factor analysis). The mean percentage of correctly answered knowledge questions, across all professional groups, was 60%. With regard to knowlege, over three-quarters of participants were unaware that homosexual young men and those who had been sexually abused are at greater risk of DSH, whilst one third of staff were unaware that adolescents who self-harm are at increased risk of suicide. Staff who felt more effective felt less negative towards this group of patients (B=-0.21, p=0.03). Forty-two per cent of the participants wanted further training in DSH amongst adolescents. © 2003 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.
Keywords: adolescent; adult; article; attitude; automutilation; child behavior; child health care; child sexual abuse; continuing education; controlled study; doctor patient relationship; education; factor analysis; female; health practitioner; homosexuality; human; human relation; intoxication; male; mental health care; nurse attitude; nurse patient relationship; outcomes research; patient referral; physician attitude; psychiatrist; psychologic assessment; psychological aspect; psychologist; psychotherapist; questionnaire; risk assessment; risk factor; sexual abuse; social worker; staff training; suicide; suicide attempt; teaching hospital; United Kingdom; urban population

Prevention of HIV/AIDS in Native American communities: Promising interventions - Vernon, I.S.; Jumper-Thurman, P. (Public Health Reports, 2002)
Objective: This article presents the latest data on trends in AIDS prevalence among Native American men and women and discusses problems of classification, data collection, factors that contribute to high risk, and factors that affect prevention and intervention. It presents a model for building effective prevention and intervention strategies. Observations: The number of people in the United States diagnosed with AIDS has risen by less than 5% per year since 1992, and the slowdown is estimated to continue in coming years. Among Native Americans, however, the number of people diagnosed with AIDS rose 8% in 1997, and nonwhites accounted for more than one-half of all reported AIDS cases through December 2000. For Native Americans, the rate of growth in AIDS prevalence has been steadily increasing since the early 1980s, and AIDS is now the ninth leading killer of Native Americans between the ages of 15 and 44. Factors that contribute to high risk include poverty, homophobia, denial, and mistrust. Conclusions: Effective strategies must include efforts to reduce the risk factors for AIDS. Future research should honor and celebrate diversity among people as an empowering force that facilitates collaboration and shared learning with tribes.
Keywords: acquired immune deficiency syndrome; alcohol consumption; American Indian; article; denial; high risk population; homosexuality; human; Human immunodeficiency virus infection; information processing; partner violence; poverty; prevalence; preventive medicine; priority journal; risk factor; suicide

Sexual orientation of adolescent girls. - Frankowski, B.L. (Current women's health reports, 2002)
It is important for healthcare providers to have a clear understanding of sexual orientation and other components of sexual identity (genetic gender, anatomic gender, gender identity, gender role, and sexual behavior). Knowledge of how a lesbian identity is formed will aide providers in guiding these girls through adolescence. Societal stigma often forces isolation that leads to many risky behaviors that affect health (alcohol and drug use; risky sexual behaviors; truancy and dropping out; running away and homelessness; and depression and suicide). Health providers need to ensure a safe and understanding environment for these girls, to enhance their physical, emotional, and social development to healthy adulthood.
Keywords: addiction; adolescent; article; child behavior; depression; doctor patient relationship; ethnology; female; high risk behavior; homelessness; human; psychological aspect; sexual behavior; social isolation; United States

A patient with primary human immunodeficiency virus infection for whom highly active antiretroviral therapy was successful - Furusyo, N.; Ariyama, I.; Chong, Y.; Harada, M.; Nabeshima, S.; Mitsutake, A.; Kashiwagi, S.; Hayashi, J. (Journal of Infection and Chemotherapy, 2002)
We report the case of a 25-year-old male Japanese homosexual with primary human immunodeficier virus (HIV)-1 infection and early stage syphilis. Approximately 60 days after HIV exposure by sex with another man, the patient abruptly had high fever, after which he experienced a variety of severe, prolonged symptoms such as painful oral mucosa ulcerations, rash, lymphadenopathy, splenomegaly, and a 5.5-kg weight loss. Serum lactate dehydrogenase and liver biochemical test values were elevated. Antibodies to HIV by both enzyme-linked immunosorbent assay (ELISA) and Western blot (WB) test were negative at the time of symptom onset, but serum HIV-1 RNA level was 1585000 copies/ml. Antibody seroconversions were found on day 9 after the onset of symptoms by ELISA and on day 16 by WB test, suggesting primary HIV infection. Within 2 weeks of starting highly active antiretroviral therapy (HAART), all symptoms except lymphadenopathy were resolved, and the serum HIV-1 RNA level dramatically decreased to 5011 copies/ml, eventually becoming undetectable by the standard method. The patient has remained asymptomatic for the 18 months since symptom resolution after HAART, and HIV-1 RNA remains undetectable.
Keywords: antiretrovirus agent; lamivudine; nelfinavir; zidovudine; adult; article; case report; enzyme linked immunosorbent assay; fever; highly active antiretroviral therapy; homosexuality; human; Human immunodeficiency virus infection; lymphadenopathy; lymphocyte count; male; mouth ulcer; rash; seroconversion; splenomegaly; syphilis; body weight loss; Western blotting

Patient characteristics, HIV serostatus, and risk behaviors among gay and bisexual males seeking treatment for methamphetamine abuse and dependence in Los Angeles - Shoptaw, S.; Reback, C.J.; Freese, T.E. (Journal of Addictive Diseases, 2002)
Methamphetamine, a drug used at alarming rates among gay/bisexual males in the West, is often combined with sexual activities, thereby increasing HIV-related risks in an already high-risk group. Findings from 68 gay/bisexual men seeking treatment for methamphetamine dependence in Hollywood, California were analyzed to predict HIV serostatus based on demographic, drug use, or sexual behavior variables. Results showed that more HIV-infected participants than non-infected men reported medical problems (97.6% versus 46.2%; X2 = 24.7, df = 1, p < .0001), histories of genital gonorrhea (59.5% versus 26.9%; X2 = 6.9, df = 1, p < .01), use of injection methods (45.2% versus 19.2%; X2 = 4.8, df = 1, p < .03), and more sexual partners with unprotected receptive anal intercourse in the 30 days prior to intake (5.9 versus 0.7; separate t = 3.5, df = 43.7, p < .001). More non-infected participants (19.2%) reported suicidal thoughts than HIV-infected men (0%; X2 = 4.8, df = 1, p < .03). Discriminant function analysis correctly classified 74.6% of cases into serostatus groupings based on presence of suicidal thoughts, history of gonorrhea, number of sexual partners with unprotected receptive anal intercourse and prior methamphetamine treatment. Findings provide information that may prove helpful in tailoring culturally relevant treatment and prevention messages. © 2002 by The Haworth Press, Inc. All rights reserved.
Keywords: methamphetamine; adult; anamnesis; article; behavior; clinical feature; controlled study; demography; discriminant analysis; disease association; drug dependence; gonorrhea; high risk population; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; prediction and forecasting; prevalence; serodiagnosis; sexual behavior; sexually transmitted disease; suicidal behavior; United States

Sexual orientation and gender identity: an administrative approach to diversity. - Quinn, T.L. (Child welfare, 2002)
Research indicates that gay, lesbian, bisexual, transgender, and questioning (GLBTQ) teens in the care of a northeastern child welfare department do not receive adequate services due to the workers' homophobic attitudes. These teens are at high risk for alcohol and drug abuse, homelessness, prostitution, and suicide. A training module was developed for administrators. Pretest and posttest instruments measured their education and support of GLBTQ issues before and after the training.
Keywords: adolescent; article; child; child health care; cultural anthropology; education; female; gender identity; health personnel attitude; health service; human; in service training; male; public health service; sexual behavior; social psychology; social support; social work; standard; United States

Temporal trends in the incidence of human immunodeficiency virus infection and risk behavior among injection drug users in Baltimore, Maryland, 1988-1998 - Nelson, K.E.; Galai, N.; Safaeian, M.; Strathdee, S.A.; Celentano, D.D.; Vlahov, D. (American Journal of Epidemiology, 2002)
Although the incidence of and mortality from acquired immunodeficiency syndrome have declined recently in the United States, data are needed on the incidence of human immunodeficiency virus (HIV) and risk behaviors among injection drug users (IDUs). The authors studied the temporal trends of HIV incidence and risk behavior, ascertained through semiannual confidential interviews, between 1988 and 1998 in a cohort of 1,532 HIV-seronegative IDUs in Baltimore, Maryland. An additional 338 HIV-negative drug users were recruited in 1994 and were studied by using the same methods. Overall, 277 persons seroconverted to HIV during 8,826.45 person-years of follow-up, an incidence of 3.14 per 100 person-years. The incidence per 100 person-years declined over time from 4.45 in 1988-1990 to 3.35 in 1991-1994 to 1.84 in 1995-1998, a decline of 12% per year. HIV infections were associated with injection of cocaine, more frequent injection, needle sharing, and injection in a shooting galley. Sexual behavior variables associated with HIV incidence included a sexually transmitted infection, male homosexual behavior, and sex with another IDU. These data suggest that high-risk behavior and HIV incidence among IDUs have decreased recently in Baltimore. Nevertheless, additional prevention strategies are needed in these populations.
Keywords: cocaine; acquired immune deficiency syndrome; adult; article; female; follow up; homosexuality; human; Human immunodeficiency virus infection; incidence; infection risk; intravenous drug abuse; major clinical study; male; mortality; sexual behavior; sexually transmitted disease; United States

Suicidality in a venue-based sample of young men who have sex with men - Remafedi, G. (Journal of Adolescent Health, 2002)
Purpose: To examine the incidence, prevalence, and characteristics of suicide attempts in a unique, venue-based sample of young men who have sex with men (YMSM). Methods: Eligible participants were 15-25-year-old men who were living in a major metropolitan area (Minneapolis/St. Paul, Minnesota) and had sex with men within 12 months of the interview. A total of 255 subjects were randomly sampled from popular venues for a structured, 20-min interview (1999) that included four items regarding suicide intentions and attempts. Data were analyzed using bivariate and multivariate tests of statistical significance. Results: Eighty-six percent of eligible individuals completed the survey. One-third of all respondents reported at least one suicide attempt, and 4.7% attempted suicide in the past year. Although suicide attempts were more prevalent among African-Americans and urban residents; only school enrollment was significantly associated with attempts in the multivariate analysis (odds ratio =.55, 95% confidence interval =.31,.97). Conclusions: This study corroborates the findings of prior studies of high rates of suicide attempts among YMSM. In addition, it demonstrates that attempts are more prevalent among out-of-school youths. © Society for Adolescent Medicine, 2002.
Keywords: adolescent; adult; article; clinical article; controlled study; health survey; homosexuality; human; incidence; interview; male; Black person; prevalence; priority journal; school; suicide attempt; urban population

The transsexual: What about the future? - Michel, A.; Ansseau, M.; Legros, J.J.; Pitchot, W.; Mormont, C. (European Psychiatry, 2002)
Since the 1950s, sexual surgical reassignments have been frequently carried out. As this surgical therapeutic procedure is controversial, it seems important to explore the actual consequences of such an intervention and objectively evaluate its relevance. In this context, we have carried out a review of the literature. After looking at the methodological limitations of follow-up studies, the psychological, sexual, social, and professional futures of the individuals subject to a transsexual operation are presented. Finally, prognostic aspects are considered. In the literature, follow-up studies tend to show that surgical transformations have positive consequences for the subjects. In the majority of cases, transsexuals are very satisfied with their intervention and any difficulties experienced are often temporary and disappear within a year after the surgical transformation. Studies show that there is less than 1% of regrets, and a little more than 1% of suicides among operated subjects. The empirical research does not confirm the opinion that suicide is strongly associated with surgical transformation. © 2002 Éditions scientifiques et médicales Elsevier SAS.
Keywords: article; disease association; female; follow up; futurology; human; male; medical literature; patient satisfaction; priority journal; prognosis; psychological aspect; social aspect; suicide; surgical anatomy; surgical technique; transsexualism

Suicide among homosexual youth - Lebson, M. (Journal of Homosexuality, 2002)
The contemporary literature on homosexual youth and suicide risk are reviewed in order to delineate the incidence, development, causes/risk factors, and effects of suicidality among homosexual youth. In comparison to heterosexual youth, homosexual youths are more likely to attempt and complete suicide. They confront more challenges in identity development and face more risk factors for suicidality. In some cases, homosexual youths might use suicidal ideation as a means of rediscovering a will to live. © 2002 by The Haworth Press, Inc. All rights reserved.
Keywords: adolescent; article; depression; gender identity; homosexuality; human; incidence; juvenile; onset age; risk factor; sexual orientation; suicide

Lesbian, gay, and bisexual suicidal behavior: Testing a constructivist model - Mcbee-Strayer, S.M.; Rogers, J.R. (Suicide and Life-Threatening Behavior, 2002)
The present investigation surveyed 162 self-identified lesbian, gay, and bisexual individuals recruited from LGB-related social organizations or contacted through networking procedures with regard to suicidal behaviors, suicide risk factors, and reasons for living. Approximately 41% of the respondents indicated a serious consideration of suicide including the identification of a specific suicide plan (23%) or a past suicide attempt (36%) with significant intent to die (13%). Forty-six percent of the sample indicated at least some degree of chance of attempting suicide in the future. Grounded in the existential-constructivist theory of suicide (Rogers, 2001), empirically and theoretically identified suicide risk factors were found as a group to predict suicidal ideation (R2 = .16) and attempts (R2 = .17), with abuse-related items independently predicting both suicidal ideation (R2 = .03) and attempts (R2 = .08). Items related to self-identity issues and social acceptance were predictive of suicidal ideation (R2 = .04), while substance abuse was predictive of suicidal ideation (R2 = .05) and attempts (R2 = .13) for males only. The established factor structure of the Reasons for Living Inventory (Linehan et al., 1983) was not supported in the current data, suggesting that it may not be an appropriate measure of reasons for living with LGB individuals.
Keywords: adult; article; bisexuality; controlled study; disease association; existentialism; female; gender identity; homosexuality; human; homosexual female; major clinical study; male; risk factor; self concept; sex difference; social structure; suicidal behavior; suicide attempt

Trying to hide: A cross-national study of growing up for non-identified gay and bisexual male youth - Carragher, D.J.; Rivers, I. (Clinical Child Psychology and Psychiatry, 2002)
Research shows that 'out' lesbian, gay and bisexual youth often experience long-term and repeated abuse when they are growing up. Currently, very little is known about the experiences of those youth who do not disclose their sexual orientation at school, but also face discrimination because of their perceived sexual orientation. A cross-cultural comparison of two groups of gay and bisexual men from the US and UK who were non-identified at school was conducted by the authors. Quantitative and qualitative data were analysed focusing upon recollections of sexual orientation developmental milestones, the nature of the victimization experienced in adolescence, alternative behaviours adopted for self-preservation and suicidal ideation. In addition, current functioning in adulthood was also assessed, and measures relating to personal homonegativity and sexual behaviour were compared. The results suggested that there were variations in the nature and correlates of the victimization experienced by US and UK gay and bisexual males during adolescence, including the alternative behaviours adopted for self-preservation. As adults, UK males were more likely to report feelings of internalized homonegativity, however, US males were proportionally more likely to engage in transient sexual encounters. The implications of these findings are discussed.
Keywords: adolescent; adult; article; bisexuality; child behavior; child growth; controlled study; experience; homosexuality; human; male; self disclosure; sexual behavior; sexual intercourse; sexual orientation; social isolation; suicidal behavior; United Kingdom; United States; victim

After a suicide: trying to make sense of the senseless. - Von Ornsteiner, J.B. (The Body positive, 2002)
Keywords: addiction; adult; article; bereavement; case report; homosexuality; human; Human immunodeficiency virus infection; male; psychological aspect; suicide

Changes in the cause of death among HIV positive subjects across Europe: Results from the EuroSIDA study - Mocroft, A.; Brettle, R.; Kirk, O.; Blaxhult, A.; Parkin, J.M.; Antunes, F.; Francioli, P.; D'Arminio Monforte, A.; Fox, Z.; Lundgren, J.D. (AIDS, 2002)
Objectives: The causes of death among HIV-positive patients may have changed since the introduction of highly active antiretroviral therapy (HAART). We investigated these changes, patients who died without an AIDS diagnosis and factors relating to pre-AIDS deaths. Methods: Analyses of 1826 deaths among EuroSIDA patients, an observational study of 8556 patients. Incidence rates of pre-AIDS deaths were compared to overall rates. Factors relating to pre-AIDS deaths were identified using Cox regression. Results: Death rates declined from 15.6 to 2.7 per 100 person-years of follow-up (PYFU) between 1994 and 2001. Pre-AIDS incidence declined from 2.4 to 1.1 per 100 PYFU. The ratio of overall to pre-AIDS deaths peaked in 1996 at 8.4 and dropped to < 3 after 1998. The adjusted odds of dying following one AIDS defining event (ADE) increased yearly (odds ratio, 1.53; P < 0.001), conversely the odds of dying following three or more ADE decreased yearly (odds ratio, 0.79; P < 0.001). The proportion of deaths that followed an HIV-related disease decreased by 23% annually; in contrast there was a 32% yearly increase in the proportion of deaths due to known causes other than HIV-related or suicides. Injecting drug users (IDU) were significantly more likely to die before an ADE than homosexuals (relative hazard, 2.97; P < 0.0001) and patients from northern/eastern Europe (relative hazard, 2.01; P < 0.0001) were more likely to die pre-AIDS than southern patients. Conclusions: The proportion of pre-AIDS deaths increased from 1994 to 2001; however, the incidence of pre-AIDS deaths and deaths overall declined. IDU and subjects from northern/eastern Europe had an increased risk of pre-AIDS death. HIV-positive patients live longer therefore it is essential to continue to monitor all causes of mortality to identify changes. © 2002 Lippincott Williams & Wilkins.
Keywords: antiretrovirus agent; acquired immune deficiency syndrome; adult; article; cause of death; Europe; female; high risk population; highly active antiretroviral therapy; homosexuality; human; Human immunodeficiency virus infection; intravenous drug abuse; leukocyte count; major clinical study; male; mortality; priority journal; side effect; suicide; virus infection

Suicide attempts among gay and bisexual men: Lifetime prevalence and antecedents - Paul, J.P.; Catania, J.; Pollack, L.; Moskowitz, J.; Canchola, J.; Mills, T.; Binson, D.; Stall, R. (American Journal of Public Health, 2002)
Objectives. We examined lifetime prevalence of suicide attempts and psychosocial correlates in a large population-based sample of men who have sex with men (MSM). Methods. A telephone probability sample of US urban MSM (n=2881) were interviewed between November 1996 and February 1998. Results. Twenty-one percent had made a suicide plan; 12% had attempted suicide (almost half of those 12% were multiple attempters). Most who attempted suicide made their first attempt before age 25. Although prevalence of parasuicide (i.e., attempted suicide) has remained constant across birth cohorts, mean age at initial attempts has declined. Conclusions. MSM are at elevated risk for suicide attempts, with such risk clustered earlier in life. Some risk factors were specific to being gay or bisexual in a hostile environment.
Keywords: adult; article; bisexuality; homosexuality; human; major clinical study; male; prevalence; risk factor; social psychology; suicide attempt

Prediction of depressive distress in a community sample of women: The role of sexual orientation - Matthews, A.K.; Hughes, T.L.; Johnson, T.; Razano, L.A.; Cassidy, R. (American Journal of Public Health, 2002)
Objectives. This study compared factors known or hypothesized to influence depressive symptomatology in a community sample of lesbians and heterosexual women. Methods. Data were collected in a multisite survey of lesbians' physical and mental health. Results. Findings confirmed earlier reports suggesting that traumatic life events such as physical and sexual abuse, and individual traits and coping styles are risk factors for depressive distress. However, findings of higher rates of suicidal behavior and of several risk factors for depressive distress among lesbians suggest that risk for depression may differ among lesbians and heterosexual women. Conclusions. Sexual orientation may represent an important but poorly understood risk factor for depressive distress as well as suicidal ideation and behavior.
Keywords: article; community care; comparative study; coping behavior; depression; health survey; heterosexuality; human; hypothesis; mental health; physical activity; prediction; risk factor; sexual abuse; sexual orientation; suicidal behavior; symptom

Risk assessment of adolescents with same-sex relationships - Udry, J.Richard; Chantala, K. (Journal of Adolescent Health, 2002)
Purpose: To compare the risk status on health and behavior for those with same-sex partners and those without. Methods: Add Health data provide a sample of 20,745 adolescents in grades 7 through 12 interviewed at home. The risk statuses of respondents with no partners, same-sex-only partners, and partners of both sexes were compared to respondents with opposite-sex partners only. Respondents were evaluated on selected personal and social attributes (verbal IQ, family structure, masculinity, popularity), and risk status (substance use, depression, suicidal thoughts, anal sex, general delinquency, being physically attacked, perceived risk of being killed or getting AIDS). Data were analyzed by logistic and linear regression using STATA to adjust for clustering and sampling weights. Results: Compared to boys with opposite-sex-only partners, boys with same-sex-only partners were at high risk for emotional problems, but not delinquency or substance use. Boys with partners of both sexes were at high risk for delinquency and substance use, but not for emotional problems. Neither group of boys with same-sex partners is at high risk of being attacked compared to those with opposite-sex partners only. Girls with only same-sex partners are never a high-risk group, while girls with partners of both sexes are the high-risk category in every case. Conclusions: Adolescents with same-sex-only partners do not resemble those with partners of both sexes in risk status. Combining the two categories obscures the unique risk profile of those with both-sex partners, and obscures the low risk on most variables but the high emotional risk of boys with only same-sex partners. © Society for Adolescent Medicine, 2002.
Keywords: adolescent; age; article; controlled study; data analysis; delinquency; emotional stability; female; femininity; homosexuality; human; male; masculinity; normal human; priority journal; risk assessment; sex difference; sexual behavior; social aspect; substance abuse

Links between past abuse, suicide ideation, and sexual orientation among San Diego college students. - Garcia, J.; Adams, J.; Friedman, L.; East, P. (Journal of American college health : J of ACH, 2002)
The authors explored relationships among childhood abuse, suicidal ideation, and sexual orientation of 18- to 30-year-old students enrolled in 2 San Diego area colleges, using responses from anonymous questionnaires. Sixty percent of the 138 eligible respondents were women, and 22% were self-identified gay/bisexual individuals. Women were more likely than men to report at least 1 form of emotional abuse (odds ratio [OR] = 2.3; p =.02) and unwanted sexual touching (OR = 4.3; p = .0004). Lesbian/bisexual women were significantly more likely to report past suicidal ideation than were heterosexual women (OR = 3.7, p = .03). Gay/bisexual men were more likely to report unwanted sexual touching than were heterosexual men (OR = 5.1, p = .04), but the men did not report significantly higher rates of past suicide ideation or suicide attempts. Sexual orientation and a past history of child sexual, physical, and emotional abuse could be compounding risk factors for suicidal ideation among college students.
Keywords: adolescent; adult; article; child sexual abuse; female; human; male; preschool child; psychological aspect; questionnaire; sexual behavior; student; suicide; United States; university

Youth suicide risk and sexual orientation. - Rutter, P.A.; Soucar, E. (Adolescence, 2002)
Using a broad suicide risk assessment (suicidal ideation, hopelessness, hostility) with 100 youth ages 17 to 19, this study examined the relationship between sexual orientation and youth suicide risk. Participants were compared across sexual orientation, as well as level of perceived external support, which may be a mitigating variable in suicide risk. The suicide risk demonstrated by sexual minorities in this study was no greater than that of their heterosexual peers. Youth who reported more external support demonstrated lower overall suicide risk and, specifically, lower levels of hostility, hopelessness, and suicidal ideation. The results indicated that suicide risk is not determined by demographic criteria alone, and may be influenced by psychosocial variables, such as support.
Keywords: adolescent; adult; article; bisexuality; comparative study; female; heterosexuality; homosexuality; human; male; multivariate analysis; psychological aspect; risk assessment; risk factor; sexual behavior; social support; suicide; United States

Enactment of Gay Rights Laws in U.S. States and Trends in Adolescent Suicide: An Investigation of Non-Hispanic White Boys - Jesdale, B.M.; Zierler, S. (Journal of the Gay and Lesbian Medical Association, 2002)
Objective: To estimate the decline in adolescent suicide rates in temporal relation to enactment of state laws offering protection from discrimination against sexual minorities. Methods: From 1990 to 1999,9,639 non-Hispanic White boys aged 11-18 years committed suicide in the United States. We compared rates before and after enactment of laws prohibiting discrimination on sexual orientation. Results: States that enacted antidiscrimination laws had a reduction of 29.1 suicides per million non-Hispanic White boys per year relative to states that have never enacted these laws. Relative to the same states before enactment of protective laws, the rate reduction was 19.7 suicides per million boy-years. Conclusions: Efforts to reduce heterosexual societal prejudice may affect a severe health outcome. Validation of the ecologic assumptions in this analysis is necessary. Complementary approaches are needed to enhance our understanding of this finding.
Keywords: adolescence; adolescent; adult; article; European American; health care policy; heterosexuality; homosexuality; human; human rights; law; major clinical study; male; minority group; protection; risk factor; risk reduction; social aspect; social problem; suicide; United States; validation process

Sexual orientation and mental health: Results from a community survey of young and middle-aged adults - Jorm, A.F.; Korten, A.E.; Rodgers, B.; Jacomb, P.A.; Christensen, H. (British Journal of Psychiatry, 2002)
Background: Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups. Aims: To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals. Method: A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety, depression, suicidality, alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health. Results: The bisexual group was highest on measures of anxiety, depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family. Conclusions: The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.
Keywords: adult; affect; alcohol abuse; anxiety neurosis; article; Australia; bisexuality; child abuse; controlled study; depression; distress syndrome; female; financial management; health survey; heterosexuality; homosexuality; human; life event; major clinical study; male; mental disease; mental health; negative syndrome; regression analysis; risk factor; sexual orientation; suicidal behavior; support group

Correlates of suicide attempts in an open cohort of young men who have sex with men - Botnick, M.R.; Heath, K.V.; Cornelisse, P.G.A.; Strathdee, S.A.; Martindale, S.L.; Hogg, R.S. (Canadian Journal of Public Health, 2002)
Objective: To investigate baseline correlates of attempted suicide in a large cohort of young gay and bisexual men. Methods: Participants completed annual questionnaires asking demographic information, sexual behaviours, history of forced and paid sex, comfort with sexual orientation, use of illicit drugs, and validated measures of depression, social support, alcohol dependency, self-esteem and suicide ideation and attempts. Contingency table analysis and step-wise logistic regression were used to identify potential predictors of self-reported suicide attempts. Results: Of 345 gay and bisexual men eligible for this cross-sectional analysis, 150 (43.5%) reported that they had ever considered suicide and 67 (19.4%) that they had attempted suicide at least once. After adjustment for multiple explanatory variables, the use of nitrite inhalants (poppers) (AOR=2.37; 95%Cl 1.30, 4.33), social support scores below the 75th percentile of all scores (AOR=2.19; 95%Cl 1.18, 4.09) and low or moderate self-esteem (AOR=3.73; 95%Cl 2.03, 6.86) were independently associated with elevated risk of attempted suicide. Conclusion: Our data indicate that men in this analysis who ideate or attempt suicide earlier in life are more likely to report lower social support and self-esteem, and high popper use.
Keywords: illicit drug; nitrite; adult; alcoholism; article; bisexuality; cohort analysis; contingency table; controlled study; correlation analysis; demography; depression; drug abuse pattern; homosexuality; human; logistic regression analysis; major clinical study; male; prediction; prostitution; questionnaire; risk assessment; self esteem; self report; sexual behavior; sexual deviation; sexual orientation; social support; suicide attempt; validation process

Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior - Bontempo, D.E.; D'Augelli, A.R. (Journal of Adolescent Health, 2002)
Purpose: To examine the link between victimization at school and health risk behaviors using representative data comparing lesbian, gay, and bisexual (LGB) youths and heterosexual youths. Methods: Data from the 1995 Youth Risk Behavior Survey taken in Massachusetts and Vermont were examined. This sample included 9188 9th through 12th grade students; 315 of these students were identified as LGB. Analyses of variance were used to examine health risk behaviors by sexual orientation by gender by victimization level. Results: The combined effect of LGB status and high levels of at-school victimization was associated with the highest levels of health risk behaviors. LGB youths reporting high levels of at-school victimization reported higher levels of substance use, suicidality, and sexual risk behaviors than heterosexual peers reporting high levels of at-school victimization. Also, LGB youths reporting low levels of at-school victimization reported levels of substance use, suicidality, and sexual-risk behaviors that were similar to heterosexual peers who reported low at-school victimization. Conclusions: The findings provide evidence that differences in health risks among LGB youth are mediated by victimization at school. Such victimization of LGB youth is associated with health risk behaviors. © Society for Adolescent Medicine, 2002.
Keywords: adolescent; article; bisexuality; child behavior; controlled study; female; health hazard; homosexuality; human; homosexual female; male; priority journal; school; sexual orientation; substance abuse; suicidal behavior; violence

Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students - Robin, L.; Brener, N.D.; Donahue, S.F.; Hack, T.; Hale, K.; Goodenow, C. (Archives of Pediatrics and Adolescent Medicine, 2002)
Objective: To examine associations between health risk behaviors and sexual experience with opposite-, same-, or both-sex partners in representative samples of high school students. Design: We used 1995 and 1997 data from the Vermont and Massachusetts Youth Risk Behavior Surveys. Logistic regression and multiple regression analyses were used to compare health risk behaviors among students who reported sex with opposite-sex partners only (opposite-sex students), with same-sex partners only (same-sex students), and with both male and female sexual partners (both-sex students). Setting: Public high schools in Vermont and Massachusetts. Participants: Representative, population-based samples of high school students. The combined samples had 14623 Vermont students and 8141 Massachusetts students. Main Outcome Measure: Violence, harassment, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices. Results. In both states, both-sex students were significantly more likely to report health risk behaviors than were opposite-sex students. For example, both-sex students had odds 3 to 6 times greater than opposite-sex students of being threatened or injured with a weapon at school, making a suicide attempt requiring medical attention, using cocaine, or vomiting or using laxatives to control their weight. In both states, same-sex students were as likely as opposite-sex students to report most health risk behaviors. Conclusion: Relative to opposite- and same-sex students, both-sex students may be at elevated risk of injury, disease, and death by experiencing serious harassment and engaging in violence, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices.
Keywords: alcohol; adolescent; alcohol consumption; article; child; drug use; female; health behavior; heterosexuality; high school; homosexuality; human; injury; homosexual female; major clinical study; male; prevalence; priority journal; sexual behavior; suicidal behavior; violence

Sex-specific predictors of suicidality among runaway youth. - Leslie, M.B.; Stein, J.A.; Rotheram-Borus, M.J. (Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 2002)
Examined predictors of suicidality (ideation and attempts) among 348 adolescent runways (197 boys; 56% African American; M age = 16) using sex-specific models that tested the impact of the three domains of the Social Action Model: individual characteristics, interpersonal influences, and life events. Twenty-five percent of the girls and 14% of the boys had attempted suicide at least once. Male suicidality was mainly predicted by individual characteristics: identifying as gay, emotional distress, fewer conduct problems, and avoidant reasons for drug use. The interpersonal influence of suicidal friends also predicted suicidality. Variables from all three domains influenced girls: individual characteristics of lower age, lower self-esteem, and emotional distress; interpersonal influence of suicidal friends; and life events of having lived on the streets and assaults. Findings suggest some sex-specific interventions, but decreasing emotional distress and lessening the influence of suicidal friends may be useful for both boys and girls.
Keywords: adolescent; article; cross-sectional study; female; homelessness; human; incidence; individuality; life event; lifestyle; male; psychological aspect; risk factor; sex difference; social behavior; statistics; suicide attempt; United States; urban population

Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: Results from a twin study - Nelson, E.C.; Heath, A.C.; Madden, P.A.F.; Cooper, M.L.; Dinwiddie, S.H.; Bucholz, K.K.; Glowinski, A.; McLaughlin, T.; Dunne, M.P.; Statham, D.J.; Martin, N.G. (Archives of General Psychiatry, 2002)
Background: Increased risk for serious adverse outcomes has been associated with a history of childhood sexual abuse (CSA). Whether these risks are directly attributable to CSA rather than family background remains controversial. Methods: Structured psychiatric telephone interviews were conducted from February 1996 to September 2000 with both members of 1991 same-sex pairs (1159 female and 832 male pairs) from a young adult Australian volunteer twin panel (mean [SD] age, 29.9 [2.5] years). A binary composite CSA variable was constructed from responses to 5 component questions. The association between CSA and adverse psychosocial outcomes was examined, controlling for family background. Results: A history of CSA, reported by 16.7% of the women and 5.4% of the men, was more common among those reporting parental alcohol-related problems. Significantly increased risk was observed in women reporting a history of CSA for subsequently occurring major depression, suicide attempt, conduct disorder, alcohol dependence, nicotine dependence, social anxiety, rape after the age of 18 years, and divorce; most similar risks reached statistical significance in men. The greatest risks were associated with CSA involving intercourse. Childhood sexual abuse-negative twins (ie, those who denied having experienced CSA) from CSA-discordant pairs compared with other CSA-negative individuals had increased risk for many adverse outcomes suggesting correlated family background risk factors. Childhood sexual abuse - positive members (ie, those who reported having experienced CSA) of CSA-discordant pairs had significantly greater risk for all 8 examined adverse outcomes than their co-twins. Conclusions: Self-reported CSA was associated with increased risk for adverse outcomes, controlling for family background. Family background risk factors also were associated with adverse outcome risk. Discordant pair analysis seems to provide an effective means of controlling for family background risk factors.
Keywords: alcoholism; article; attention deficit disorder; child abuse; childhood; controlled study; depression; female; human; major clinical study; male; rape; risk assessment; risk factor; smoking; social phobia; suicidal behavior; twins

Use of anabolic steroids and associated health risks among gay men attending London gyms - Bolding, G.; Sherr, L.; Elford, J. (Addiction, 2002)
Aim. To examine, by HIV status, the use of anabolic steroids among London gay men and their effect on physical and mental health. Design. Cross-sectional survey using self-administered questionnaire. Setting. Six gyms in central London. Participants. 772 gay men using the gyms in January-February 2000. Measurements. Proportion of gay men who reported (i) using steroids, (ii) sharing injecting equipment. (iii) experiencing side-effects and (iv) having suicidal thoughts or feeling depressed. Findings. Of 772 gay men. 117 (15.2%) had used and 90 (11.7%) had injected steroids in the previous 12 months: HIV positive men (steroid use) 31.7% (40/126), HIV negative men 14.5% (69/477), never-tested for HIV 4.7% (8/169) (p < 0.001). No one reported sharing needles or syringes. HIV positive men were more likely to have used steroids for medical reasons than other men (24.3% versus 5.9%, p = 0.01). Nearly all steroid users (96.4%) reported side effects including testicular atrophy (51.0%), insomnia (47.7%), depression between cycles (25.2%) and hypertension (19.0%). Steroid users were more likely to have had suicidal thoughts in the previous 6 months than non-users (22.6% versus 11.2%. adjusted odds ratio after controlling for HIV status 1.84; 95% CI 1.10-3.12, p = 0.02) or to have felt depressed (49.1% versus 38.5%. adjusted OR 1.52, 95% CI 1.01-2.30, p = 0.047) Conclusion. One in seven gay men surveyed in central London gyms in 2000 said they had used steroids in the previous 12 months. HIV positive men were more likely to have used steroids than other men. some therapeutically. Side effects were reported widely and steroid use was associated with having had suicidal thoughts and feeling depressed, although cause and effect could not be established. Our findings suggest that steroid use among gay men may have serious consequences for both physical and mental health.
Keywords: anabolic agent; adult; article; body building; depression; drug abuse; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; mental health; questionnaire; suicidal behavior; United Kingdom

Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21 - D'Augelli, A.R. (Clinical Child Psychology and Psychiatry, 2002)
The mental health problems of lesbian, gay, and bisexual (Igb) youths were studied using a sample of 542 youths from community settings. Information about the development of sexual orientation, problems related to sexual orientation, parents' reactions, and victimization based on sexual orientation was related to mental health symptoms and suicidality. Lesbian, gay, and bisexual youths were found to demonstrate more symptoms than a comparison group of adolescents. Over one-third of the sample reported a past suicide attempt. More symptoms were related to parents not knowing about youths' sexual orientation or with both parents having negative reactions to youths' sexual orientation. More than three-quarters had been verbally abused because of their sexual orientation, and 15 percent reported physical attacks. More than one-third said they had lost friends because of their sexual orientation. Youths who had experienced more victimization and who had lost friends reported more mental health symptoms. Mental health professionals are urged to attend to the distinct problems of these youths, especially dealing with conflicts with families and peers.
Keywords: adolescent; adult; article; assault; bisexuality; conflict; controlled study; female; homosexuality; human; homosexual female; major clinical study; male; mental disease; mental health; parental behavior; scoring system; sexual orientation; suicidal behavior; symptomatology; verbal behavior; victim

Erotic deaths - Eke, N. (Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology, 2002)
Background. Accidental deaths associated with sexual activities occur but are often unreported in the medical literature. Aim. To review reported cases of such deaths to determine the characteristics. Method. A Medline search from 1966 to June 2001 using such terms as 'coital deaths' was done to obtain publications and relevant references on accidental deaths from sexual intercourse. The data extracted included the gender and age of the victim, the sexual act involved, the marital relationships or status of the participants, the location and immediate cause of death. Results. Deaths from sexual activities affect males and females. The victims were often adolescents. The age correlated with the type of erotic act. Some deaths occurred in consensual heterosexual and homosexual activities as well as autoerotic acts. Often, the consensual sexual act was 'illicit' and took place outside the home of either partner, while autoerotic deaths often occurred in the homes of the victims. The commonest causes of death were myocardial infarction and air embolism in consensual heterosexual intercourse and asphyxia in autoerotic acts. Predisposing factors include older age in myocardial infarction, pregnancy in air embolism and paraphilia in autoerotic deaths. Autoerotic deaths predominantly occurred around the third decade. Psychiatric counseling can prevent autoerotic deaths. Psychological and psychiatric counseling are indicated for relations of victims. Conclusion. It is essential to identify the circumstances of each case to exclude suicide or homicide. Deaths at sexual acts may be merely coincidental and are probably underreported. Legal and social implications demand careful forensic evaluation in each case.
Keywords: accidental death; air embolism; article; asphyxia; cause of death; disease predisposition; erotism; female; forensic pathology; gender; heart infarction; heterosexuality; homicide; homosexuality; human; male; marriage; medical literature; medicolegal aspect; Medline; patient counseling; pregnancy; psychological aspect; publication; sexual behavior; sexual crime; sexual deviation; sexual intercourse; social aspect; suicide; victim

Suicide attempts among sexual-minority youths: Population and measurement issues - Savin-Williams, R.C. (Journal of Consulting and Clinical Psychology, 2001)
Two questions were addressed regarding suicide attempts among sexual-minority youths: Who should be classified as a sexual minority, and what constitutes a suicide attempt? Results from 2 studies indicated that sexual-minority youths, broadly defined in terms of sexual orientation and recruitment venue, were slightly more likely than heterosexual youths to report a suicide attempt. To afford a more accurate assessment of suicide attempts, a detailed measure distinguished true from false attempts. This method eliminated over half of suicide attempt reports among sexual minorities because they were false attempts-ideation rather than a concrete act to end life. Furthermore, many true attempts were not life threatening, suggesting that the reports were attempts to communicate the hardships of lives or to identify with a gay community.
Keywords: accuracy; adult; article; classification; female; heterosexuality; human; major clinical study; male; minority group; sexuality; suicide attempt

Suicidal behaviour in people with HIV/AIDS: A review - Komiti, A.; Judd, F.; Grech, P.; Mijch, A.; Hoy, J.; Lloyd, J.H.; Street, A. (Australian and New Zealand Journal of Psychiatry, 2001)
Objective: To review the existing literature on suicidal behaviour in people with HIV/AIDS infection. Method: A search on the Index Medicus/MEDLINE database was performed, for articles that investigated and/or reviewed suicidal behaviour in people with HIV at any stage of the illness. Only articles written in English were used in this review. Results: Most studies have been done on homosexual/bisexual groups, with little data available for heterosexual populations or women. Studies show an increased rate of suicidal ideation, suicide attempts and completed suicide in individuals with HIV/AIDS. Of note, there is a high prevalence of psychiatric illness and substance abuse in those with suicidal behaviour. Conclusions: The increased rate of suicidal behaviour in HIV-infected persons is consistent with findings in other medically ill groups with chronic, life-threatening disorders. However, assessment of any possible direct effect of HIV/AIDS on suicidal behaviour is confounded by methodological limitations of many of the studies. More longitudinal studies encompassing other affected groups including heterosexual populations and women are needed to elucidate the relationship between suicidal behaviour and HIV/AIDS.
Keywords: acquired immune deficiency syndrome; adult; aged; article; bisexuality; chronic disease; controlled study; data base; female; heterosexuality; homosexuality; human; Human immunodeficiency virus infection; longitudinal study; major clinical study; male; medical literature; Medline; mental disease; methodology; prevalence; psychologic assessment; staging; substance abuse; suicidal behavior; suicide attempt

Autoerotic asphyxia (a case report). - Doychinov, I.D.; Markova, I.M.; Staneva, Y.A. (Folia medica, 2001)
The authors report the case of a young man, 18 years of age, who died as a result of autoerotic asphyxia. In the practice of forensic medicine such cases are presented as deaths from mechanic asphyxia in which, using various means and devices, the neck is constricted or the external respiratory orifices are obstructed with the purpose of achieving sexual gratification as a result of the induced hypoxia. These cases pose serious difficulties to the forensic medicine expert and the coroner because of the difficulties of distinguishing it as homicide, suicide or accident. The young man was found hanging by the neck, suspended on a leather belt attached on the door of his room. A mirror was placed in front of the door, reflecting him in full height. He was dressed in women's clothing (a skirt, a blouse, bikini) and a brassiere padded to resemble female breasts. Pornographic pictures from newspapers and magazines were spread on the floor. The young man had no known history of mental disorders, but there was evidence for bisexual tendencies and behaviour. On the basis of a comprehensive evaluation of the data it was accepted that the death was accidental and was attributed to autoerotic asphyxia. All the characteristic features for an act of autoerotic asphyxia, described in the forensic medicine literature, were found in this case. Autoerotic asphyxia is almost unknown as a distinctive psychopathological entity in this country's forensic medicine practice. The deficiency of theoretical knowledge in this field, as well as the lack of personal practical experience in most of the legal physicians and pathologists could result in erroneous interpretation of such case.
Keywords: accident; adolescent; article; asphyxia; case report; differential diagnosis; forensic medicine; homicide; human; male; masochism; psychosexual disorder; suicide

Phallic narcissism, anal sadism, and oral discord: the case of Yukio Mishima, Part I. - Piven, J. (Psychoanalytic review, 2001)
Thus far I have explored Mishima's traumatic childhood and the experiences leading him toward misogyny, phallic narcissism, and the drive to murder his own weakness and sexual vulnerability. Mishima suffered the extraordinary trauma of being separated from his parents and sequestered to the sickroom of a psychotic grandmother for the first twelve years of his life. Intense rage over abandonment and impingement engendered a disgust for femininity and the need to escape feminine messiness through homosexual pursuits. Mishima's entrenched feelings of shame and weakness gave rise to phallic narcissistic tendencies, as he idealized powerful men and eventually strove to become a powerful and beautiful male. In pursuing this erotic masculine image Mishima continued to fantasize about murdering his weak and shameful self-image, and commingled this sadistic impulse with fantasies of sexual merger with murdered love objects. Finally Mishima was the murderer erotically eradicating his sexual vulnerability as both subject and object. His suicide was a repetition of this erotic sadistic fantasy. In a further article I will continue the discussion by examining Mishima's fantasies of murdering beautiful and abandoning love objects. I will also address the complex nature of his ritual suicide as fantasy of rebirth, sexual merger, the murder of toxic introjects, and escape from death, decay, and regression to helpless infancy.
Keywords: article; drive; gender identity; history; homosexuality; human; Japan; literature; male; narcissism; psychoanalysis; psychoanalytic theory; psychological aspect; psychosexual development; sadism; suicide

Beyond personhood and autonomy: moral theory and the premises of privacy. - Rappaport, A.J. (Utah law review, 2001)
Keywords: article; assisted suicide; bioethics; Bioethics and Professional Ethics; civil rights; contraception; ethical theory; ethics; female; freedom; Griswold v. Connecticut; homosexuality; human; induced abortion; jurisprudence; Legal Approach; legal aspect; morality; On Liberty; personhood; pregnancy; privacy; Washington v. Glucksberg; women's rights

Sexual and drug risk-related behaviours after initiating highly active antiretroviral therapy among injection drug users - Vlahov, D.; Safaien, M.; Lai, S.; Strathdee, S.A.; Johnson, L.; Sterling, T.; Celentano, D.D. (AIDS, 2001)
Objective: To assess whether initiation of highly active antiretroviral therapy (HAART) is associated with a subsequent resumption of sexual and drug use risk behaviors. Methods: Within an ongoing prospective study of HIV-seropositive injection drug users (IDUs), a subsample with at least one CD4 cell count < 500 × 106 cells/l after 1996 (when HAART became available) and three consecutive visits were selected for analysis. Patients underwent semi-annual interviews for risk behaviors and reports of medication use. Data from visits immediately prior to and following initiation of HAART for the treated group, and from consecutive visits for the eligible but untreated group were compared using linear growth curve analysis. Results: Of 316 eligible HIV-seropositive IDUs, 133 reported HAART use during the study period; 95% were African American, 76% were male, and median age at enrollment was 34 years. The proportion who reported any sexual activity increased over time from 55 to 61% for the HAART-treated group, but decreased from 67 to 63% in the untreated group (P = 0.03); the respective values for unprotected sex were 18 versus 20% and 36 versus 28% (P = 0.06). In both treated and untreated groups, the proportion injecting drugs declined (P = 0.04), whereas the proportion reporting needle sharing decreased marginally (P = 0.11). However, trends in use of shooting galleries between the groups differed (P = 0.04) increasing slightly from 2.3 to 3% in the treated group while decreasing from 12 to 5% in the untreated group. Conclusion: In persons treated with HAART, self-report of high-risk behaviors remained stable or showed some increase. Persons initiating HAART should be counselled to refrain from high-risk behaviors. © 2001 Lippincott Williams & Wilkins.
Keywords: antiretrovirus agent; proteinase inhibitor; RNA directed DNA polymerase inhibitor; adult; article; drug abuse; female; growth curve; health promotion; high risk population; homosexuality; human; Human immunodeficiency virus; Human immunodeficiency virus infection; lymphocyte count; major clinical study; male; Black person; patient counseling; priority journal; sexual behavior

Depression, suicidal ideation and STD-related risk in homeless older adolescents - Rohde, P.; Noell, J.; Ochs, L.; Seeley, J.R. (Journal of Adolescence, 2001)
Goals of this study were to examine the frequency of depression and related constructs of suicidal ideation and hopelessness in a sample of homeless older adolescents and their associations with behaviors that may increase the risk of sexually transmitted disease (STD). Diagnostic interviews and blood/urine samples were obtained from 523 homeless adolescents (mean age = 17.8). Overall, 12.2 per cent had a current DSM-IV diagnosis of major depression and 6.5 per cent had dysthymia, with higher rates for female and older participants. Depression appeared to precede rather than follow homelessness and was associated with biologically verified STDs (in older participants), infrequent condom use, a non-heterosexual orientation (in older participants), and lifetime homosexual experience. Unlike depression, suicidal ideation and hopelessness were associated with higher rates of intravenous drug use but lower rates of multiple sex partners and, in young homeless women, less sexual coercion. Depression is frequent in homeless older adolescents and has a complex association with STD-related behaviors. © 2001 The Association for Professionals in Services for Adolescents.
Keywords: illicit drug; adolescence; adolescent; adult; age; article; blood analysis; child behavior; condom; controlled study; depression; diagnostic procedure; disease association; disease classification; dysthymia; emotionality; experience; female; frequency analysis; homelessness; human; incidence; infection risk; interview; intravenous drug abuse; lifespan; major clinical study; male; persuasive communication; psychiatric diagnosis; risk assessment; sampling; sex ratio; sexual behavior; sexual orientation; sexuality; sexually transmitted disease; statistical analysis; suicidal behavior; urinalysis

Integrating gay, lesbian, and bisexual issues into mainstream psychology. - Goldfried, M.R. (The American psychologist, 2001)
Despite the growing clinical and research literature dealing with gay, lesbian, and bisexual (GLB) issues, mainstream psychology has tended to ignore much of the work that has been done in this area. This article illustrates how clinical and research writings on GLB issues continue to remain invisible to mainstream psychology in such areas as life span development and aging, teenage suicide, substance abuse, victimization and abuse, and family and couple relationships. It also deals with some of the determinants of well-being among GLB individuals, such as family support, and notes the benefits accruing to mainstream psychology from studying GLB issues. A network of family members within psychology having GLB relatives has been formed--AFFIRM: Psychologist Affirming Their Gay, Lesbian, and Bisexual Family--and is dedicated to supporting its own family members, encouraging other family members to do likewise, supporting research and clinical work on GLB issues, and closing the gap between GLB clinical and research work and mainstream psychology.
Keywords: article; bisexuality; female; financial management; health personnel attitude; homosexuality; human; homosexual female; male; psychology

Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths - D'Augelli, A.R.; Hershberger, S.L.; Pilkington, N.W. (Suicide and Life-Threatening Behavior, 2001)
Three hundred fifty lesbian, gay, and bisexual youths aged 14 to 21 years were questioned about suicidal thoughts and behaviors, families' reactions to youths' sexual orientation, and suicidality among relatives and friends. Results confirmed an association between sexual orientation and suicidality. Nearly half (42%) had sometimes or often thought of suicide; one third (33%) reported at least one suicide attempt. Many related suicidal ideation and suicide attempts to their sexual orientation. Most attempts followed awareness of same-sex feelings and preceded disclosure of sexual orientation to others. One quarter said a family member had made a suicide attempt, and nearly three quarters said a close friend had attempted suicide.
Keywords: adolescent; adult; article; awareness; behavior; bisexuality; controlled study; female; homosexuality; human; homosexual female; major clinical study; male; risk factor; sexual orientation; suicidal behavior; suicide attempt; thinking

Adolescent sexual orientation and suicide risk: Evidence from a national study - Russell, S.T.; Joyner, K. (American Journal of Public Health, 2001)
Objectives. Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors. Methods. Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects. Results. There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization. Conclusions. The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide.
Keywords: alcohol; adolescent; alcohol abuse; article; controlled study; depression; female; gender identity; human; major clinical study; male; risk factor; sexual behavior; sexual orientation; social support; suicide; victim

Sex differences in risk factors for HIV seroconversion among injection drug users: A 10-year perspective - Strathdee, S.A.; Galai, N.; Safaiean, M.; Celentano, D.D.; Vlahov, D.; Johnson, L.; Nelson, K.E. (Archives of Internal Medicine, 2001)
Background: Injection drug use directly or indirectly accounts for nearly half the annual human immunodeficiency virus (HIV) infections in the United States. Prospective studies that investigate both sexual and parenteral HIV risks among injection drug users (IDUs) are needed. We studied factors for HIV seroconversion among male and female IDUs in Baltimore, Md. Methods: The HIV-negative IDUs (1447 male and 427 female) were recruited into a prospective study from 1988 to 1989 or in 1994. Participants underwent semiannual HIV tests and surveys through December 1998. Poisson regression was used to identify risk factors for HIV seroconversion, stratified by sex. Behaviors were treated as time-dependent covariates that varied at each semiannual period. Results: Subjects were primarily African American (91%), and median age at enrollment was 35 years. Incidence of HIV was 3.14 per 100 person years (95% confidence interval, 2.78-3.53) and did not significantly differ by sex. Younger age independently predicted HIV seroconversion for both men and women. Among men, factors that independently predicted HIV seroconversion were the following: less than a high school education, recent needle sharing with multiple partners, daily injection, and shooting-gallery attendance. The incidence of HIV was double for men recently engaging in homosexual activity and cocaine injection. Among women, the incidence of HIV was more than double for those recently reporting sexually transmitted diseases. Conclusions: The incidence of HIV remained high among IDUs in Baltimore over the past decade. Risk factors for HIV seroconversion differed markedly by sex. Predominant risks among men included needle sharing and homosexual activity; among women, factors consistent with high-risk heterosexual activity were more significant than drug-related risks. Human immunodeficiency virus interventions aimed at IDUs should be sex-specific and incorporate sexual risks.
Keywords: adult; article; cocaine dependence; education; female; homosexuality; human; Human immunodeficiency virus infection; incidence; infection risk; intravenous drug abuse; major clinical study; male; priority journal; prospective study; risk factor; seroconversion; sex difference

Attitudes on end-of-life care and advance care planning in the lesbian and gay community - Stein, G.L.; Bonuck, K.A. (Journal of Palliative Medicine, 2001)
Gay men and lesbians have special interests in documenting their preferences regarding advance care planning and end-of-life care. A 64-item survey instrument was developed to ascertain the preferences of this community regarding approaches to end-of-life care, viewpoints on physician-assisted suicide (PAS) and euthanasia, and practices regarding advance care planning. The survey was completed by 575 participants recruited through community-based health care and social service organizations serving the lesbian and gay community, primarily in the New York metropolitan area. Respondents represent a diverse group of women (36%) and men (63%) from various age, racial/ethnic, and religious/spiritual backgrounds; 10% were human immunodeficiency virus (HIV)-positive. Respondents' perspectives on end-of-life care are generally consistent with findings from other attitudinal studies of U.S. adults: a majority supported legalization of PAS and preferred a palliative approach to end-of-life care. However, the gay community sample revealed even stronger support for assisted suicide and palliative care. Although respondents completed advance directives at a higher rate than adults generally, the legal importance for gay men and lesbians to execute directives should encourage health care providers and community organizations to assume a larger educational role on advance care planning. Results confirm other reports on the need to address provider communication skills. It is speculated that the HIV epidemic was a major influence behind these results because of the overwhelming personal impact of the epidemic on most gay men and lesbians during the past two decades.
Keywords: adult; aged; article; controlled study; doctor patient relationship; ethnic difference; euthanasia; female; health care delivery; health survey; homosexuality; human; Human immunodeficiency virus infection; interpersonal communication; homosexual female; major clinical study; male; medicolegal aspect; palliative therapy; patient attitude; questionnaire; religious group; suicide; terminal care; treatment planning; United States

Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents - Noell, J.W.; Ochs, L.M. (Journal of Adolescent Health, 2001)
Purpose: To explore the relationship of sexual orientation and gender to four sets of factors: (a) family history, (b) incarceration, (c) substance use, and (d) depression and suicide, in a population of homeless adolescents. Methods: A sample of homeless adolescents was recruited in Portland, Oregon and assessed using semi-structured interviews at baseline, three months and six months. A total of 532 youths (216 females and 316 males) provided data on sexual orientation and other variables. Heterosexual (n = 391) and non-heterosexual youths (n = 141) were compared on all sets of factors, primarily using logistic regressions. Results: 44.9% of females identified as lesbian or bisexual, while only 13.9% of males identified as gay or bisexual. Gay, lesbian, bisexual, and 'unsure' (GLBU) youths were less likely to have been in foster care or arrested, but were more likely to have spent time in a locked mental health treatment facility. More than one-third of all participants reported use of injection drugs. GLBU youths were more likely to have recently used amphetamines and to have injected drugs, however, gay-bisexual males were less likely to have recently used marijuana. GLBU status was associated with recent measures of depression and suicidal ideation, but not with lifetime measures. Associations of sexual orientation with several lifetime measures were different than with prospective measures, demonstrating the limitations of using lifetime measures rather than recent or prospective measures. Conclusions: This population of homeless adolescents appears to be higher in its high rate of injection drug use and the large proportion of females who identify as lesbian or bisexual than found in other studies. The high rates of depression and suicidal ideation, especially among GLBU youth, are of great concern. Copyright © 2001 Society for Adolescent Medicine.
Keywords: amphetamine derivative; cannabis; drug; adolescence; adolescent; adult; article; bisexuality; depression; factor analysis; family history; female; foster care; gender; heterosexuality; homelessness; homosexuality; human; injection; interview; male; mental health service; population; priority journal; correctional facility; regression analysis; sample; sexual orientation; substance abuse; suicidal behavior; suicide attempt; United States

Aspects of mental health among older lesbian, gay, and bisexual adults - D'Augelli, A.R.; Grossman, A.H.; Hershberger, S.L.; O'Connell, T.S. (Aging and Mental Health, 2001)
This study examined aspects of mental health among 416 lesbian, gay, and bisexual adults aged 60 to 91 years old, attending social and recreational programs. Mental health indicators were perceived mental health status; self-esteem; internalized homophobia; loneliness; alcohol and drug abuse; and suicidality. Better mental health was correlated with higher self-esteem, less loneliness, and lower internalized homophobia. Compared to women, men reported significantly more internalized homophobia, alcohol abuse, and suicidality related to their sexual orientation. Less lifetime suicidal ideation was associated with lower internalized homophobia, less loneliness, and more people knowing about participants' sexual orientation.
Keywords: adult; alcohol abuse; article; bisexuality; clinical article; controlled study; female; homosexuality; human; homosexual female; loneliness; male; mental health; phobia; priority journal; recreation; self esteem; sex difference; sexual orientation; socialization; suicidal behavior

Sex-specific determinants of HIV infection among injection drug users in Montreal - Bruneau, J.; Lamothe, F.; Soto, J.; Lachance, N.; Vincelette, J.; Vassal, A.; Franco, E.L. (Canadian Medical Association Journal, 2001)
Background: Sex-specific issues have not been extensively addressed in studies of HIV prevalence, despite the strong implications of differences between men and women in the risk of HIV transmission. The objective of this study was to examine sex-specific behaviours associated with HIV infection among injection drug users in Montreal. Methods: A total of 2741 active drug users (2209 [80.6%] men) were recruited between 1988 and 1998. Information was sought on sociodemographic characteristics, drug-related behaviour and sexual behaviour, and participants were tested for HIV antibodies. Sex-specific independent predictors of HIV prevalence were assessed by stepwise logistic regression. Results: The overall prevalence of HIV among study subjects was 11.1%; the prevalence was 12.0% among men and 7.5% among women. In multivariate models, a history of sharing syringes with a known seropositive partner (odds ratio [OR] for men 2.44, 95% confidence interval [CI] 1.72-3.46; OR for women 3.03, 95% CI 1.29-7.13) and of sharing syringes in the past 6 months (OR for men 0.61, 95% CI 0.44-0.85; OR for women 0.32, 95% CI 0.14-0.73) were independently associated with HIV infection. Other variables associated with HIV infection were homosexual or bisexual orientation, cocaine rather than heroin as drug of choice, frequency of injection drug use, and obtaining needles at a pharmacy or through needle exchange programs (for men only) and obtaining needles at shooting galleries and being out of treatment (for women only). Interpretation: These results support the hypothesis that risk factors for HIV seropositivity differ between men and women. These sex-related differences should be taken into account in the development of preventive and clinical interventions.
Keywords: cocaine; diamorphine; adult; article; bisexuality; female; homosexuality; human; Human immunodeficiency virus; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; intravenous drug abuse; major clinical study; male; multivariate analysis; risk factor; sex difference; sexual behavior; virus transmission

The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities - Díaz, R.M.; Ayala, G.; Bein, E.; Henne, J.; Marin, B.V. (American Journal of Public Health, 2001)
Objectives. This study assessed the relation between experiences of social discrimination (homophobia, racism, and financial hardship) and symptoms of psychologic distress (anxiety, depression, and suicidal ideation) among self-identified gay and bisexual Latino men in the United States. Methods. Data were collected from a probability sample of 912 men (self-identified as both Latino and non-heterosexual) recruited from the venues and public social spaces identified as both Latino and gay in the cities of Miami, Los Angeles, and New York. Results. The study showed high prevalence rates of psychologic symptoms of distress in the population of gay Latino men during the 6 months before the interview, including suicidal ideation (17% prevalence), anxiety (44%), and depressed mood (80%). In both univariate and multivariate analyses, experiences of social discrimination were strong predictors of psychologic symptoms. Conclusions. The mental health difficulties experienced by many gay and bisexual Latino men in the United States are directly related to a social context of oppression that leads to social alienation, low self-esteem, and symptoms of psychologic distress.
Keywords: adult; alienation; anxiety; article; bisexuality; depression; ethnology; homophobia; homosexuality; human; major clinical study; male; mental health; multivariate analysis; phobia; poverty; prevalence; race difference; self esteem; physiological stress; suicidal behavior; United States

Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the national comorbidity survey - Gilman, S.E.; Cochran, S.D.; Mays, V.M.; Hughes, M.; Ostrow, D.; Kessler, R.C. (American Journal of Public Health, 2001)
Objectives. This study examined the risk of psychiatric disorders among individuals with same-sex sexual partners. Methods. Data are from the National Comorbidity Survey, a nationally representative household survey. Respondents were asked the number of women and men with whom they had sexual intercourse in the past 5 years. Psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria were assessed with a modified version of the Composite International Diagnostic Interview. Results. A total of 2.1% of men and 1.5% of women reported 1 or more same-sex sexual partners in the past 5 years. These respondents had higher 12-month prevalences of anxiety, mood, and substance use disorders and of suicidal thoughts and plans than did respondents with opposite-sex partners only. Decomposition showed that the elevated same-sex 12-month prevalences were largely due to higher lifetime prevalences. Ages at onset and persistence of disorders did not differ between the same-sex and opposite-sex subsamples. Conclusions. Homosexual orientation, defined as having same-sex sexual partners, is associated with a general elevation of risk for anxiety, mood, and substance use disorders and for suicidal thoughts and plans. Further research is needed to replicate and explore the causal mechanisms underlying this association.
Keywords: adolescent; adult; affective neurosis; anxiety neurosis; article; comorbidity; female; homosexuality; human; homosexual female; major clinical study; male; mental disease; prevalence; psychiatric diagnosis; risk assessment; sexual behavior; sexual intercourse; sexual orientation

Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: The benefits of gay-sensitive HIV instruction in schools - Blake, S.M.; Ledsky, R.; Lehman, T.; Goodenow, C.; Sawyer, R.; Hack, T. (American Journal of Public Health, 2001)
Objectives. This study compared sexual risk behaviors of gay, lesbian, and bisexual (GLB) and heterosexual adolescents and evaluated associations between gay-sensitive HIV instruction and risk behaviors of GLB youths. Methods. A random sample of high school students and HIV education teachers completed surveys. Self-reported risk behaviors of heterosexual and GLB adolescents were compared, with control for student and community demographic characteristics. Sexual risk behaviors of GLB youths in schools with and without gay-sensitive instruction were compared. Results. GLB youths reported more substance use, high-risk sexual behaviors, suicidal thoughts or attempts, and personal safety issues than did heterosexual youths (P<.001). Among those who were sexually active. GLB youths reported more lifetime and recent sexual partners than did heterosexuals (P<.001), and more of them reported alcohol use before last sex (P<.01) and a history of pregnancy (P<.001). GLB youths in schools with gay-sensitive instruction reported fewer sexual partners, less recent sex, and less substance use before last sex than did GLB youths in other schools (P<.05). Conclusions. The findings document increased risk behaviors among GLB youths and demonstrate the potential benefits of providing gay-sensitive HIV instruction in schools.
Keywords: adolescent; adult; article; ethnology; female; high school; homosexuality; human; Human immunodeficiency virus infection; homosexual female; major clinical study; male; risk benefit analysis; risk management; self report; sexual behavior; sexual education; suicidal behavior; suicide attempt

HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention - Clements-Nolle, K.; Marx, R.; Guzman, R.; Katz, M. (American Journal of Public Health, 2001)
Objectives. This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to male transgender persons and determined factors associated with HIV. Methods. We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. Results. HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR - 2.69; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI =1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. Conclusion. High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.
Keywords: adult; article; drug abuse; education; ethnology; female; health care utilization; homosexuality; human; Human immunodeficiency virus infection; homosexual female; major clinical study; male; mental health; population risk; prevalence; risk management; sexual behavior; social work; suicidal behavior

A critique of research on sexual-minority youths - Savin-Williams, R.C. (Journal of Adolescence, 2001)
Developmental scientists should seriously reconsider traditional empirical and theoretical paradigms that narrowly define sexual-minority adolescents in terms of those who adopt a culturally defined sexual identity label. A broader consideration of youth populations who have same-sex desires but who might not necessarily identify as gay, lesbian or bisexual, lead one to a very different understanding of sexual-minority youths than is apparent in most published studies. First, they are in most regards just like all other adolescents with similar developmental needs and concerns. Second, they are not a homogeneous group but vary among themselves in predictable ways. Third, this expanded definition allows us to conclude that same-sex attraction per se does not lead to pathology or to problematic behavior such as drug abuse, suicide, prostitution or HIV infection. Indeed, researchers and clinicians should focus on the resiliency that often characterizes sexual-minority youths. © 2001 The Association for Professionals in Services for Adolescents.
Keywords: adolescent; article; behavior disorder; bisexuality; cultural anthropology; development; drug abuse; female; gender identity; homosexuality; human; Human immunodeficiency virus infection; juvenile; homosexual female; male; medical research; minority group; pathology; population; prediction; prostitution; publication; sexual behavior; suicide; theory

Suicide and gay/lesbian/bisexual youth: Implications for clinicians - Morrison, L.L.; L'Heureux, J. (Journal of Adolescence, 2001)
The research indicating the incidence rates and specific risks for suicide in the gay, lesbian, bisexual, and questioning (GLBQ) adolescent population is reviewed. An ecological model of suicide risk assessment for GLBQ youth is presented based on Bronfenbrenner's model of human development. The model argues for individual, micro, and macro levels of assessment to increase clinical judgement and accuracy in determining high risk GLBQ adolescents. The model also delineates both primary and secondary intervention strategies which could be utilized to prevent GLBQ youth suicide. © 2001 The Association for Professionals in Services for Adolescents.
Keywords: accuracy; adolescence; adolescent; article; bisexuality; ecology; health practitioner; high risk population; homosexuality; human; incidence; juvenile; language development; homosexual female; medical research; model; population; questionnaire; risk; risk assessment; suicide

Playing it safe: Addressing the emotional and physical health of lesbian and gay pupils in the U.K. - Warwick, I.; Aggleton, P.; Douglas, N. (Journal of Adolescence, 2001)
Compared to young people in general, young lesbians and gay men can face specific challenges to their physical and emotional well-being. These include discrimination, victimization, homophobic bullying and an elevated suicide risk. Relative to initiatives which attempt to address bullying in general, little has been done in schools in the U.K. to address physical and verbal homophobic bullying. This paper reports on an exploratory study to examine teachers' perceptions of homophobic bullying, the responses made to this form of bullying, and the factors which impact on the provision of education and support to lesbian and gay pupils. Findings suggested that teachers were aware of homophobic bullying but were confused, unable or unwilling to address the needs of lesbian and gay pupils. Implications for policy, practice and research are discussed. While current U.K. Government policy promoting Healthy Schools and Citizenship education offers hope for the future, much remains to be done to ensure that such initiatives are inclusive of all pupils. © 2001 The Association for Professionals in Services for Adolescents.
Keywords: adolescent; article; controlled study; education; emotional stability; female; futurology; government; health; health promotion; heterosexuality; homophobia; human; juvenile; homosexual female; male; medical research; perception; phobia; policy; pupil; risk; suicide; teacher; United Kingdom; victim; wellbeing

Adolescent suicide attempts: Risks and protectors - Borowsky, I.W.; Ireland, M.; Resnick, M.D. (Pediatrics, 2001)
Objective. In 1997, suicide was the third leading cause of death among 10- to 19-year-olds in the United States, with the greatest increases in suicide rates in the previous decade experienced by black and other minority youth. The purpose of this study was to identify risk and protective factors for suicide attempts among black, Hispanic, and white male and female adolescents. Methods. We used data from the National Longitudinal Study of Adolescent Health, conducted in 1995 and 1996. A nationally representative sample of 13 110 students in grades 7 through 12 completed 2 in-home interviews, an average of 11 months apart. We examined Time 1 factors at the individual, family, and community level that predicted or protected against Time 2 suicide attempts. Results. Perceived parent and family connectedness was protective against suicide attempts for black, Hispanic, and white girls and boys, with odds ratios ranging from 0.06 to 0.32. For girls, emotional well-being was also protective for ali of the racial/ethnic groups studied, while a high grade point average was an additional protective factor for all of the boys. Cross-cutting risk factors included previous suicide attempt, violence victimization, violence perpetration, alcohol use, marijuana use, and school problems. Additionally, somatic symptoms, friend suicide attempt or completion, other illicit drug use, and a history of mental health treatment predicted suicide attempts among black, Hispanic, and white females. Weapon-carrying at school and same-sex romantic attraction were predictive for all groups of boys. Calculating the estimated probabilities of attempting suicide for adolescents with increasing numbers of risk and protective factors revealed that the presence of 3 protective factors reduced the risk of a suicide attempt by 70% to 85% for each of the gender and racial/ethnic groups, including those with and without identified risk factors. Conclusions. In these national samples of black, Hispanic, and white youth, unique and cross-cutting factors derived from a resiliency framework predicted or protected against attempting suicide. In addition to risk reduction, promotion of protective factors may offer an effective approach to primary as well as secondary prevention of adolescent suicidal behavior.
Keywords: adolescent; alcohol consumption; article; ethnic difference; female; human; major clinical study; male; mental health; priority journal; risk factor; substance abuse; suicide attempt; United States; violence

Depression does not influence basal ganglia-mediated psychomotor speed in HIV-1 infection - Giesen, H.-J.V.; Bäcker, R.; Hefter, H.; Arendt, G. (Journal of Neuropsychiatry and Clinical Neurosciences, 2001)
The authors examined the effects of depressive mood (Hamilton Rating Scale for Depression [Ham-D]) on basal ganglia-mediated psychomotor speed (motor test battery) in 202 HIV-1 seropositive homosexual males with no prior history of antiretroviral treatment. HIV-1 seropositive patients showed a significant slowing of most rapid alternating movements (MRAM) and significantly prolonged contraction times (CT) compared with 66 HIV-1 seronegative male control subjects. Factor analysis of Ham-D scores isolated a factor containing the items depressed mood, suicide, and psychic and somatic anxiety. This factor did not correlate with MRAM or CT. Depression and psychomotor speed are independent in HIV-1 infection.
Keywords: adult; article; basal ganglion; clinical examination; data analysis; depression; homosexuality; human; Human immunodeficiency virus 1; Human immunodeficiency virus infection; major clinical study; male; motor performance; priority journal; psychometry; psychomotor performance; rating scale; reaction time; seroconversion

A model of predictors and outcomes of outness among lesbian and bisexual women - Morris, J.F.; Waldo, C.R.; Rothblum, E.D. (American Journal of Orthopsychiatry, 2001)
In a structural equation model of 2,401 lesbian and bisexual women, three variables of lesbian sexual identity were found to predict outness, which predicted lower psychological distress, which, in turn, predicted lower suicidality. The model held true for the subsamples of European-American and African-American women, and to a lesser extent for those of Latina, Asian-American, Native-American, and Jewish women.
Keywords: adolescent; adult; aged; article; bisexuality; distress syndrome; ethnic group; female; human; homosexual female; major clinical study; model; outcomes research; self concept; sexual behavior; sexual orientation

Homosexuality and suicide: A case report - Tamam, L.; Özpoyraz, N.; Diler, R.S. (Annals of Medical Sciences, 2001)
Despite the inconsistency in data concerning the higher prevalence of mental disorders among homosexuals than heterosexuals, suicidality in homosexuals, particularly among adolescents and young adults have been consistently reported to be higher over the past 25 years. It has been recently stated that gay youth are 2 to 3 times more likely to attempt suicide than other young people which may comprise up to 30% of completed youth suicides annually. In this case report, we presented a young gay patient who attempted suicide and discussed the major causes of this attempt, primarily sexual prejudice of the society and possible therapeutic approaches.
Keywords: article; data analysis; homosexuality; human; risk factor; suicide; suicide attempt

Improving adolescent preventive care in community health centers - Klein, J.D.; Allan, M.J.; Elster, A.B.; Stevens, D.; Cox, C.; Hedberg, V.A.; Goodman, R.A. (Pediatrics, 2001)
Objective. To evaluate implementation of the Guidelines for Adolescent Preventive Services (GAPS) in Community and Migrant Health Centers (CMHCs). Design. Before and after comparison of health center policy, clinician and adolescent self-report, and chart reviews in 5 CMHCs. Participants. Eighty-one preintervention and 80 one-year postintervention providers and 318 preintervention and 331 postintervention 14- to 19- year-old adolescent patients being seen for well visits at 5 CMHCs. Intervention. Health center staff were trained to implement GAPS and were provided resource materials, patient questionnaires, and clinician manuals. Main Outcome Measures. Delivery of and receipt of preventive services and perceived access to care. Results. CMHC systems changes were related to stronger leadership commitment to adolescent care. Providers reported high levels of preventive services delivery before and after guideline implementation. After guideline implementation, adolescents reported increases in having discussed prevention content with providers in 19 of 31 content areas, including increased discussion of physical or sexual abuse (10% before to 22% after), sexual orientation (13% to 27%), fighting (6% to 21%), peer relations (37% to 52%), suicide (7% to 22%), eating disorders (11% to 28%), weapons (5% to 22%), depression (16% to 34%), smokeless tobacco (10% to 29%), and immunizations (19% to 48%). Adolescents were also more likely to report knowing where to get reproductive or mental health services and were more likely to have received health education materials. Implementation also increased documentation of recommended screening and counseling in 51 of 79 specific content areas assessed in chart reviews. Conclusion. Implementing GAPS increased the receipt of preventive services at these health centers. Adolescents received more comprehensive screening and counseling, more health education materials, and had greater access to care after implementation. GAPS implementation may help improve the quality of care for adolescents.
Keywords: adolescent; article; counseling; depression; eating disorder; health care delivery; health care policy; health care quality; health center; health education; human; immunization; mental health service; practice guideline; priority journal; reproductive health; self report; sexual abuse; sexual orientation; suicide

Female-to-male transsexual with 47,XXX karyotype - Turan, M.T.; Eşel, E.; Dündar, M.; Candemir, Z.; Baştürk, M.; Sofuǒlu, S.; Özkul, Y. (Biological Psychiatry, 2000)
Background: There are few reports describing chromosomal abnormalities in transsexuals. In rare cases, transsexualism and sexual chromosomal multiplicity coexist. Six cases of male-to-female transsexuals with 47,XYY chromosomal pattern have been previously reported. We have not encountered any female transsexual cases with 47,XXX karyotype in the literature. Methods: A 21-year-old female patient came to our outpatient department with depressive symptoms and suicidal thoughts. On psychiatric interview, she reported that she had feelings of discomfort with her gender identity and had desired to be male since her childhood. Then, we performed cytogenetic investigation using blood culture and G chromosome banding. Results: Histology and DNA histograms of the patient revealed a chromosomal pattern of 47,XXX. Conclusions: We conclude that sexual chromosomal abnormalities in some transsexuals may cause a vulnerability to development of a gender identity disorder. (C) 2000 Society of Biological Psychiatry.
Keywords: adult; article; blood culture; case report; chromosome aberration; chromosome G band; cytogenetics; depression; electroencephalogram; female; gender identity; histogram; histology; human; karyotype; priority journal; sex chromosome; suicide; transsexualism

Suicidal acts and ideation in homosexual and bisexual young people: A study of prevalence and risk factors - Van Heeringen, C.; Vincke, J.; Van Heeringen, C. (Social Psychiatry and Psychiatric Epidemiology, 2000)
Background: Suicide attempts are the most robust clinical predictor of suicide, which is now the second cause of death among young people in many countries. Previous research has shown an increased risk of attempted suicide associated with a homosexual orientation. However, the mechanisms underlying this increased risk are not yet clear. This study therefore aimed to determine the risk of attempted suicide and the effect of potential risk factors on the occurrence of suicidal ideation and behaviour among homosexual youngsters. Methods: The association between suicidal ideation and behaviour and potential risk factors was assessed by means of a questionnaire in a general population sample of homosexual or bisexual young people and a control sample consisting of school pupils. Results: A twofold increased risk of suicidal ideation was found associated with a homosexual or bisexual orientation. A significantly increased risk of attempted suicide associated with homosexuality or bisexuality was found in females. Independent of sexual orientation, depression was identified as a significant risk factor for suicidal ideation, while suicidal behaviour was associated with low self-esteem, higher levels of hopelessness and suicidal behaviour in someone close. Among homosexual or bisexual young people, less satisfying homosexual friendships were an additional risk factor for suicidal behaviour. Conclusions: The identified increased risk of suicidal ideation among homosexual or bisexual young people is associated with depression and may lead to suicidal behaviour, independent of sexual orientation, especially in the presence of a role model of suicidal behaviour, and among those with unsatisfying friendships.
Keywords: article; bisexuality; controlled study; female; high risk population; homosexuality; human; life satisfaction; major clinical study; male; prevalence; risk factor; role playing; self report; sex difference; suicide

Sex reassignment surgery in France: analysis of the legal framework and current procedures and its consequences for transsexuals. - Meningaud, J.P.; Descamps, M.A.; Herve, C. (Medicine and law, 2000)
MAIN OBJECTIVES: In France there is no specific law that recognizes either sex reassignment surgery (SRS) or changes in civil status. This practice is based on a set of rules that have been devised by those practitioners in the disciplines involved. This study has been directed to evaluate the perceptions of French surgeons regarding their own activity in the area of the SRS with the implications that these perceptions may have on the management of patients and to contribute to a useful international collection of material on this difficult topic in terms both of report and interpretation. METHODS: Personal interviews with 10 surgeons representing almost all of teams involved in transsexualism in France. The data were collected during 1998. FINDINGS: Surgeons alone cannot evaluate the motivation of each patient's request. Their decision whether or not to operate is made in consultation with both a psychiatrist and an endocrinologist. They never urge patients to undergo SRS. An assessment lasting at least two years before making a recommendation for surgery is routine. The rate of postoperative suicides is very low. Among surgeons, postoperative regrets are minimal (postoperative regrets by patients were not directly evaluated in the framework of this study). The diagnosis seems to be made with satisfactory reliability, but at the cost of a tedious process for the patient. As a consequence some decide to be operated on abroad. However not all are true transsexuals. CONCLUSION: SRS represents a good example of the collaboration of certain disciplines as surgery, medicine, psychiatry and law to reaffirm the meaning that society gives to the status of the individual while protecting the respect of some unusual situations.
Keywords: article; civil rights; clinical practice; Empirical Approach; female; France; Health Care and Public Health; human; male; patient selection; psychological aspect; transsexualism

Generating stories of resilience: helping gay and lesbian youth and their families. - Sanders, G.L.; Kroll, I.T. (Journal of marital and family therapy, 2000)
Lesbian, gay, and bisexual youth have often been forgotten in the provision of care to families. Not only are 10%-12% of all youth lesbian, gay, or bisexual, they all have families of origin and many also have "families of choice" that are dramatically increasing the numbers of persons who are directly affected. These youth can suffer disqualification ranging from internalized poor esteem and suicidality to physical danger, often at the hands of those very persons who are expected to care for them--families, educators, and health care providers. This article examines both how homophobia and heterosexism are both manifest and recovered from using case examples and offering therapeutic suggestions to clinicians.
Keywords: adolescent; article; family; family therapy; female; homosexuality; human; homosexual female; male; psychological aspect

Factors associated with willingness to participate in HIV vaccine trials among HIV-negative injection drug users and young gay and bisexual men - Strathdee, S.A.; Hogg, R.S.; Cornelisse, P.G.A.; Martindale, S.L.; Currie, S.L.; O'shaughnessy, M.V.; Schechter, M.T. (AIDS and Behavior, 2000)
We identified factors associated with willingness to participate in HIV vaccine trials among HIV-negative injection drug users (IDU) and young men having sex with men (MSM) enrolled in prospective cohort studies in Vancouver. Of 435 IDU and 330 MSM, 83% and 63% were willing to participate in HIV vaccine trials, respectively. In both samples, greater willingness was associated with high perceived HIV threat, and with initiating injection or first having sex with men at younger ages. Among IDU, frequent needle exchange programs attenders were more willing to participate than infrequent attenders (p = .004). Among MSM, those with a higher depression score were more willing to participate (p < .001). In logistic regression models, independent predictors of willingness to participate included frequent needle exchange attendance among IDU, and high depression score and high perceived HIV threat among MSM. This suggests that needle exchange programs are ideal venues for recruiting high-risk IDU into HIV vaccine trials. Since MSM reporting more depressive symptoms were more willing to participate, HIV vaccine trials should provide appropriate counseling to safeguard participants' psychological and physical health.
Keywords: adult; article; attitude; bisexuality; depression; female; health program; homosexuality; human; Human immunodeficiency virus infection; infection control; intravenous drug abuse; major clinical study; male; needle; scoring system; suicide; vaccination; virus infection

Eating disorders in males: A comparison with female patients - Bramon-Bosch, E.; Troop, N.A.; Treasure, J.L. (European Eating Disorders Review, 2000)
It is controversial whether males and females with eating disorders differ in a relevant way. We present a comparison of 30 male and 30 female patients assessed at The Maudsley Hospital in 2.5 years. Of the male group 33 per cent were anorexic, 50 per cent were bulimic, and 17 per cent met criteria for an eating disorder not otherwise specified. The female sample was matched to the males by diagnosis. Male and female patients are essentially similar, in particular there are no differences in severity of eating disorder. However, homosexuality appears to be more frequent among males. Moreover, males with an eating disorder show a stronger psychiatric co-morbidity and a higher rate of suicide attempts. Copyright (C) 2000 John Wiley and Sons, Ltd and Eating Disorders Association.
Keywords: laxative; adult; anorexia; anxiety neurosis; article; binge eating disorder; bulimia; child abuse; comorbidity; comparative study; depression; diet; drug abuse; eating disorder; exercise; female; homosexuality; human; major clinical study; male; sex difference; social adaptation; suicide attempt; vomiting

Sexual attitudes and associated psychiatric features among youths in a community sample - Feldman, M.J.; Bird, H.R.; Hoven, C.; Moore, R.E.; Bin, F. (Journal of the American Academy of Child and Adolescent Psychiatry, 2000)
Objective: Using an epidemiological sample of adolescents, this study examined associations between the acceptability of potential sex partners and psychiatric status. Method: Subjects aged 14 to 17 years (N = 161) from the Columbia site of the National Institute of Mental Health (NIMH) Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study were grouped according to their responses about the acceptability of youths their age having sex with partners of (1) the opposite sex, (2) neither sex, and (3) either sex. Youths endorsing either sex were compared with youths endorsing the other two types of partners according to psychiatric indicators obtained from the Diagnostic Interview Schedule for Children Version 2.3. Results: Higher-than-expected proportions of male and female youths endorsed sex partners of either sex as potentially acceptable for peers. Youths who did so abused substances and used mental health services more than peers but did not differ in rates of suicidal ideation or attempts. Males endorsing either sex also had higher rates of mood disorders and, compared with males endorsing only the opposite sex, a higher intelligence level. Conclusions: Attitudes about the potential acceptability of sex partners for peers are associated with psychiatric morbidity and mental health service use in the respondent as well as with intelligence level in males. Youths who endorsed potential sex partners of either sex, especially males, appear to be at higher risk for multiple psychiatric problems.
Keywords: adolescent; article; attitude; female; high risk population; homosexuality; human; intelligence test; major clinical study; male; mental disease; mental health service; population research; priority journal; psychiatric diagnosis; psychological aspect; sex role; sexual behavior; sexual orientation; suicide attempt

Theoretical perspectives on suicide in gay men with AIDS - McNaught, A.; Spicer, J. (Social Science and Medicine, 2000)
Suicide among gay men with AIDS constitutes a significant theoretical and practical problem. In order to understand this problem it is necessary to consider the specific circumstances that surround these individuals. Whilst there are many theories of suicide with which to address the problem, few are able to capture the special context within which gay men with AIDS live. This article explores three broad concepts from the theoretical literature on suicide that have explanatory potential in this unique context. The three concepts are: the search for meaning in the midst of suffering, Shneidman's [Shneidman, E., 1985. Definition of Suicide. John Wiley, New York] notion of unendurable psychological pain, and hopelessness. This article attempts to demonstrate how these three concepts can incorporate the experiences of gay men with AIDS and contribute to understanding the problem of suicide in this population. Copyright (C) 2000 Elsevier Science Ltd.
Keywords: acquired immune deficiency syndrome; article; distress syndrome; emotion; homosexuality; human; life expectancy; male; pain; social support; suicide; theory

Plans to hasten death among gay men with HIV/AIDS: Relationship to psychological adjustment - Goggin, K.; Sewell, M.; Ferrando, S.; Evans, S.; Fishman, B.; Rabkin, J. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2000)
This study assessed the prevalence and nature of thoughts and future plans to end one's life in a group of gay men with HIV/AIDS over an 18-month period. HIV-positive men (n = 167) participated in a series of clinical interviews which measured current health status, current and past psychiatric disorders, current levels of distress, and thoughts and plans about ending their lives currently or at some future point. A small number of HIV-positive men (17%) reported serious thoughts or plans to end their lives at some point in the future which were stable over an 18-month period. No differences in psychiatric or medical measures were observed among men with and without thoughts/plans at either assessment point. In the absence of current psychiatric disorders, such thoughts or plans about the future may represent one way to maintain control and independence in the face of the uncertainty of life with HIV illness.
Keywords: acquired immune deficiency syndrome; adult; aged; article; distress syndrome; health status; homosexuality; human; Human immunodeficiency virus infection; interview; major clinical study; male; mental disease; priority journal; psychological aspect; suicide

Neurochemical variables in subjects with adjustment disorder after suicide attempts - Tripodianakis, J.; Markianos, M.; Sarantidis, D.; Leotsakou, C. (European Psychiatry, 2000)
The investigation of biological correlates of suicidal behavior is important for identifying high-risk subjects. The objective of this study was to examine the neurochemical variables' platelet MAO activity and urinary MHPG, 5HIAA and HVA, the main metabolites of noradrenaline, serotonin and dopamine, neurotransmitters that are considered to be involved in the pathophysiology of suicidal behavior, as well as plasma cortisol, in a group of subjects with adjustment disorder after a suicide attempt. Fifty-three patients, 42 females and 11 males, were included in the study and were compared to a group of 50 healthy controls, 25 females and 25 males. Platelet MAO activity was found to be significantly lower in both male and female patients compared to controls of the same sex (P < 0.001 for both comparisons). 5HIAA and HVA were not different between patients and controls, but MHPG was significantly higher in the patients group (P = 0.008). Moreover, plasma levels of cortisol were significantly higher in the patients compared to the controls (P < 0.001). Our results confirm the hypothesis of low platelet MAO activity as a biological characteristic of patients who attempt suicide. They also point to a possible parallel activation of the noradrenergic system. (C) 2000 Editions scientifiques et medicales Elsevier SAS.
Keywords: 4 hydroxy 3 methoxyphenylethylene glycol; 5 hydroxyindoleacetic acid; amine oxidase (flavin containing); dopamine; homovanillic acid; hydrocortisone; noradrenalin; serotonin; adult; article; controlled study; enzyme activity; female; human; hydrocortisone blood level; major clinical study; maladjustment; male; neurochemistry; noradrenergic system; priority journal; suicide attempt; thrombocyte

Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: Results from NHANES III - Cochran, S.D.; Mays, V.M. (American Journal of Public Health, 2000)
Objectives. This study examined lifetime prevalence of suicide symptoms and affective disorders among men reporting a history of same-sex sexual partners. Methods. In the third National Health and Nutrition Examination Survey, men aged 17 to 39 years were assessed for lifetime history of affective disorders and sexual behavior patterns. The study classified this subset of men into 3 groups: those reporting same-sex sexual partners, those reporting only female sexual partners, and those reporting no sexual partners. Groups were compared for histories of suicide symptoms and affective disorders. Results. A total of 2.2% (95% confidence interval [CI]=1.3%, 3.1%) of men reported same-sex sexual partners. These men evidenced greater lifetime prevalence rates of suicide symptoms than men reporting only female partners. However, homosexually/bisexually experienced men were no more likely than exclusively heterosexual men to meet criteria for lifetime diagnosis of other affective disorders. Conclusions. These data provide further evidence of an increased risk for suicide symptoms among homosexually experienced men. Results also hint at a small, increased risk of recurrent depression among gay men, with symptom onset occurring, on average, during early adolescence.
Keywords: adolescent; adult; affective neurosis; article; bisexuality; demography; depression; distress syndrome; heterosexuality; homosexuality; human; major clinical study; male; prevalence; risk factor; sexual behavior; sexual orientation; suicidal behavior; suicide attempt; United States

HIV among people with mental illness: contributing factors, prevention needs, barriers, and strategies. - Brown, E.J.; Jemmott, L.S. (Journal of psychosocial nursing and mental health services, 2000)
1. Findings suggest that PWMI, including those with serious mental illness, are sexually active although some individuals, including mental health professionals, perceive them to be asexual or not sexually active. 2. PWMI may be particularly susceptible to HIV risk-related behaviors due to poor judgment, limited impulse control, deficits in problem-solving skills, and suicidal intent and self-destructive behavior. 3. Nurses, due to their close interaction with PWMI, are in key positions to document HIV risk-related behaviors and to advocate for integrating HIV risk reduction strategies into the therapeutic milieu.
Keywords: acquired immune deficiency syndrome; article; female; high risk behavior; human; Human immunodeficiency virus infection; male; mental disease; preventive health service; psychiatric nursing; psychological aspect; sexual behavior

Early sexual abuse and lifetime psychopathology: A co-twin-control study - Dinwiddie, S.H.; Heath, A.C.; Dunne, M.P.; Bucholz, K.K.; Madden, P.A.F.; Slutske, W.S.; Bierut, L.J.; Statham, D.B.; Martin, N.G. (Psychological Medicine, 2000)
Background. This study was designed to determine lifetime prevalence of psychiatric disorders among twins who reported childhood sexual abuse (CSA), and to compare these rates with those among non-abused co-twins. The contribution of familial and individual-specific factors to reported sexual abuse was also examined. Method. Information about lifetime psychopathology and substance use was obtained by structured telephone interviews with 5995 Australian twins. Twins who reported a history of childhood sexual abuse (CSA) were contrasted on lifetime psychopathology with subjects without such a history; in addition, comparisons were made between same-sex twin pairs discordant for CSA. Results. A history of CSA was reported by 5.9% of the women and 2.5% of the men. In the sample as a whole, those reporting CSA were more likely to receive lifetime diagnoses of major depression, conduct disorder, panic disorder and alcoholism, and were more likely to report suicidal ideation and a history of suicide attempt. Abused women, but not men, were also more likely to report social phobia. When comparisons were restricted to non-abused co-twins, no differences in psychopathology were seen. However, rates of major depression, conduct disorder and suicidal ideation were higher if both co-twins were abused than if the respondent alone reported CSA. Model-fitting indicated that shared environmental factors influenced risk for reported CSA in women, but not in men. Conclusion. The association between CSA and psychopathology arises at least in part through the influence of shared familial factors on both risk of victimization and risk of psychopathology.
Keywords: adult; alcoholism; article; attention deficit disorder; child abuse; controlled study; depression; female; human; major clinical study; male; mental disease; panic; sexual abuse; social phobia; suicide attempt; twins

Preventive services in a health maintenance organization: How well do pediatricians screen and educate adolescent patients? - Halpern-Felsher, B.L.; Ozer, E.M.; Millstein, S.G.; Wibbelsman, C.J.; Fusler, C.D.; Elster, A.B.; Irwin Jr., C.E. (Archives of Pediatrics and Adolescent Medicine, 2000)
Objective: To determine whether pediatricians in managed care settings adhere to national guidelines concerning the provision of clinical preventive services. Design: Surveys were mailed between September 1996 and April 1997 to all pediatricians practicing in a California group-model health maintenance organization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior. Results: The response rate was 66.2% (N = 366). Pediatricians, on average, screened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual intercourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, and driving after drinking alcohol; fewer than 20% for use of smokeless tobacco, sexual orientation, sexual and physical abuse, and riding a bike or swimming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior. Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Female physicians, physicians who saw a greater proportion of older adolescents, and recent medical school graduates were more likely to provide preventive services. Conclusions: Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations but at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent mortality and for patients who screen positive for a risk behavior.
Keywords: adolescence; adolescent; article; child health care; clinical practice; health maintenance organization; human; patient education; pediatrician; preventive medicine; priority journal; screening test

Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents - Safren, S.A.; Heimberg, R.G. (Journal of Consulting and Clinical Psychology, 1999)
In the present study, the researchers examined factors related to depression, hopelessness, and suicidality in gay, lesbian, and bisexual adolescents, compared with demographically similar heterosexual adolescents. Sexual minority adolescents reported greater depression, hopelessness, and past and present suicidality than did heterosexual adolescents. However, when controlling for other psychosocial predictors of present distress, significant differences between the 2 samples disappeared. For past suicidality scores, the effects of sexual orientation were reduced, but still significant, when accounting for the other predictor variables. These results suggest that environmental factors associated with sexual orientation, which can be targeted and changed through prevention and intervention efforts, play a major role in predicting distress in this population.
Keywords: adolescent; article; bisexuality; depression; emotional stress; environmental factor; heterosexuality; human; homosexual female; sexual orientation; suicidal behavior

Male gender identity and sexual behaviour - Chused, J.F. (International Journal of Psycho-Analysis, 1999)
One consequence of a heightened interest in intersubjectivity in the current psychoanalytic literature has been a relative neglect of the examination of unconscious fantasies. Presenting material from the analysis of three males, each of whom, in childhood and/or adolescence, hid his penis between his legs and looked at himself in a mirror naked, the author demonstrates the importance of attending to both unconscious fantasies and their manifestations within the interactive field of analysis. The first patient is a young child with a gender identity disorder, whose wish to be like his mother was a response to the emotional loss of her during early childhood. The second patient is an adolescent, whose behaviour in front of a mirror was a manifestation of his desire to possess his mother and be her, to humiliate and sadistically control her, and at the same time, to experience the masochistic sexual gratification of being a seemingly helpless victim. The third patient, a 48-year-old male, came to analysis filled with suicidal impulses and self-hatred related to homosexual impulses. His repeated examination of himself in a mirror, with penis hidden, reflected severe castration anxiety, related to an ambivalent relationship with an angry mother and a longing for attention from an unavailable father. The article closes with a description of the similarities and differences in the dynamics of these three males as well as a discussion of the meaning of similar behaviour in other males seen in consultation.
Keywords: adolescent; adult; anxiety; article; case report; child; fantasy; gender identity; human; male; psychoanalysis; sexual behavior

Sexual orientation and suicidality: A co-twin control study in adult men - Herrell, R.; Goldberg, J.; True, W.R.; Ramakrishnan, V.; Lyons, M.; Eisen, S.; Tsuang, M.T. (Archives of General Psychiatry, 1999)
Background: Several recent studies have found a higher lifetime prevalence of suicide attempts in homosexual males compared with heterosexual control subjects or population rates. These studies used either convenience samples, most without controls, or population-based samples in which confounding factors such as depression and substance abuse were not measured. Methods: This study used twins from the population-based Vietnam Era Twin Registry, Hines, Ill. An analytic sample of 103 middle-aged male-male twin pairs from the registry was identified in which one member of the pair reported male sex partners after age 18 years while the other did not. Four lifetime symptoms of suicidality as measured by the Diagnostic Interview Schedule were analyzed: thoughts about death, wanting to die, thoughts about committing suicide, and attempted suicide. A composite measure of reporting at least one suicidality symptom was also assessed. Results: Same-gender sexual orientation is significantly associated with each of the suicidality measures. Unadjusted matched-pair odds ratios follow: 2.4 (95% confidence interval [CI], 1.2 - 4.6) for thoughts about death; 4.4 (95% CI, 1.7 - 11.6) for wanted to die; 4.1 (95% CI, 2.1 - 8.2) for suicidal ideation; 6.5 (95% CI, 1.5 - 28.8) for attempted suicide; and 5.1 (95% CI, 2.4 - 10.9) for any of the suicidal symptoms. After adjustment for substance abuse and depressive symptoms (other than suicidality), all of the suicidality measures remain significantly associated with same-gender sexual orientation except for wanting to die (odds ratio, 2.5 [95% CI, 0.7 - 8.8]). Conclusions: The substantially increased lifetime risk of suicidal behaviors in homosexual men is unlikely to be due solely to substance abuse or other psychiatric comorbidity. While the underlying causes of the suicidal behaviors remain unclear, future research needs to address the inadequacies in the measurement of both sexual orientation and suicidality in population-based samples.
Keywords: adult; article; comorbidity; depression; heterosexuality; homosexuality; human; major clinical study; male; population research; sex difference; sexual orientation; substance abuse; suicide attempt; twins

Is sexual orientation related to mental health problems and suicidality in young people? - Fergusson, D.M.; Horwood, L.J.; Beautrais, A.L. (Archives of General Psychiatry, 1999)
Background: This study examines the extent to which gay, lesbian, and bisexual young people are at increased risk of psychiatric disorder and suicidal behaviors using data gathered on a New Zealand birth cohort studied to age 21 years. Methods: Data were gathered during the course of the Christchurch Health and Development Study, a 21-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand. At 21 years of age, 1007 sample members were questioned about their sexual orientation and relationships with same-sex partners since the age of 16 years. Twenty- eight subjects (2.8%) were classified as being of gay, lesbian, or bisexual sexual orientation. Over the period from age 14 to 21 years, data were gathered on a range of psychiatric disorders that included major depression, generalized anxiety disorder, conduct disorder, and substance use disorders. Data were also gathered on suicidal ideation and suicide attempts. Results: Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95% CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3). Conclusions: Findings support recent evidence suggesting that gay, lesbian, and bisexual young people are at increased risk of mental health problems, with these associations being particularly evident for measures of suicidal behavior and multiple disorder.
Keywords: adult; article; attitude; bisexuality; cohort analysis; female; homosexuality; human; major clinical study; male; mental health; New Zealand; research; risk assessment; sex difference; sexual orientation; suicide attempt

PCR detection of Epstein-Barr virus, herpes simplex virus and human papillomavirus from the anal mucosa in HIV-seropositive and HIV-seronegative homosexual men - Löwhagen, G.-B.; Bergbrant, I.M.; Bergström, T.; Ryd, W.; Voog, E. (International Journal of STD and AIDS, 1999)
This study aimed to examine the prevalence of the Epstein-Barr virus (EBV), herpes simplex virus (HSV) and human papillomavirus (HPV) in the anal and oral mucosa of homosexual men with and without HIV infection and to correlate these findings to CD4+ count and anal cytology. Anal and oral cell samples from 20 HIV-infected and 14 non-infected homosexual men attending the STD clinic at Sahlgrenska University Hospital, Goteborg were examined for EBV, HSV and HPV by the polymerase chain reaction (PCR) technique. Proctoscopy was performed in all patients and swabs for cytology were taken. EBV was demonstrated in 32% (6/19) of anal cell samples from the HIV-positive group but in none from 13 HIV-negative men. Asymptomatic shedding of HSV type 2 from the anus was detected in 3 of 19 HIV-positive men, all with low CD4+ counts and abnormal cytology. No patient in the HIV-negative group shed HSV from the anus. HPV was demonstrated in 16 of 17 anal cell samples in the HIV-infected group and in 7 of 13 HIV-negative men. More than one HPV type was detected in 7 HIV-infected men. Five (29%) of 17 HIV-positive patients exhibited abnormal cytology whereas none did so in the HIV-negative group. Those with abnormal cytology all had CD4+ counts below 0.35 and were infected with multiple HPV types including HPV 16/18. In conclusion, our results demonstrate an enhanced expression of HPV as well as EBV from the anus in HIV-infected homosexual men. In this small number of patients EBV was not related to low CD4+ count or to abnormal cytology.
Keywords: CD4 antigen; adult; anus; article; clinical article; cytology; Epstein Barr virus; Herpes simplex virus; Herpes simplex virus 2; homosexuality; human; human cell; Human immunodeficiency virus infection; male; mouth mucosa; polymerase chain reaction; prevalence; priority journal; rectoscopy; rectum mucosa; sexually transmitted disease; symptom; virus expression; virus infection; Wart virus

Dying to tell: Sexuality and suicide in imperial Japan - Robertson, J. (Signs, 1999)
Keywords: article; cultural factor; economics; education; ethnology; female; history; human; human relation; Japan; legal aspect; homosexual female; perception; physiology; psychological aspect; sexuality; social stigma; suicide; women's health; women's rights

Domestic violence and sexual abuse in women physicians: Associated medical, psychiatric and professional difficulties - Doyle, J.P.; Frank, E.; Saltzman, L.E.; McMahon, P.M.; Fielding, B.D. (Journal of Women's Health and Gender-Based Medicine, 1999)
Physicians have been called on to identify victims of domestic violence (DV) and sexual abuse (SA). Few data exist, however, on the prevalence of DV and SA in physicians themselves or on the personal or professional sequelae of such experiences. We determined the reported lifetime prevalence of DV and SA among women physicians and the personal characteristics, health-related factors, and work-related factors associated with these forms of abuse. We used data from the Women Physicians' Health Study, a large (n = 4501 respondents), nationally distributed questionnaire study that included questions on DV and SA histories, personal characteristics, and psychiatric, medical, and work-related histories. We compared the characteristics of women physicians with and without histories of DV or SA. The logistic models indicate that women physicians reporting DV histories (3.7% of the population) were significantly (p < 0.05) less likely to be single and significantly more likely to report depression histories, suicide attempts, substance abuse, current or past cigarette smoking, severe daily stress at home, chronic fatigue syndrome, and DV experienced by their mothers. Women physicians reporting SA histories (4.7% of the population) were significantly more likely to be younger than 60 years, identify themselves as homosexual or bisexual, to have specialized in psychiatry, obstetrics and gynecology, or emergency medicine, and to report histories of depression, suicide attempts, eating disorders, and fair or poor perceived health status. Although the reported lifetime prevalence of DV and SA among women physicians is below other reported figures, such experiences are associated with medical and psychiatric difficulties that could negatively affect them personally and professionally.
Keywords: adult; aged; anamnesis; article; bisexuality; chronic fatigue syndrome; cigarette smoking; depression; eating disorder; emergency medicine; family history; family life; family violence; female; female physician; gynecology; health status; human; homosexual female; major clinical study; marriage; medical specialist; obstetrics; priority journal; psychiatrist; questionnaire; sexual abuse; statistical model; physiological stress; substance abuse; suicide attempt

Attitudes of patients before and after transplantation towards various allografts - Schlitt, H.J.; Brunkhorst, R.; Schmidt, H.H.J.; Nashan, B.; Haverich, A.; Raab, R. (Transplantation, 1999)
Background. The presence of an allogeneic graft inside the body may have psychological impact on transplant patients. It was the aim of this study to evaluate the attitude of patients before and after different types of organ transplantation towards organ allografts. Methods. A total of 1,049 patients (722 patients after and 327 patients on the waiting list for either kidney, liver, heart, or lung transplantation) under care of a single transplant center were studied using a questionnaire with blinded analysis of the data. Mental condition of the patients, their attitude towards the allograft and its donor, emotional stress caused by a graft, and correlation of the attitudes with clinical and demographic parameters were analyzed. Results. The self-reported mental condition of the patients was markedly and consistently better after organ transplantation; 27% of patients before and 60% after transplantation were in good mental condition. Sixty-two percent of transplant patients considered the graft as their own organ, 37% regarded it as a foreign organ now belonging to their body, and 1% considered it as a foreign body; among waiting list patients, 40%, 55%, and 5% assumed they would perceive their graft accordingly. The graft caused considerable emotional stress for 2% of transplant patients, whereas for 70% it did not cause any stress; the latter was assumed by 47% of patients before transplantation. Eleven percent of transplant patients frequently think about the origin of their graft, and 30% would like to have information about their donor. Knowledge about different religion, opposite sex, homosexuality, suicidal death, and age above 65 years of their donor would be of moderate or major concern for 0%, 3%, 21%, 24%, and 38% of the patients, respectively. Conclusions. The comprehensive survey shows that transplant patients incorporate their graft well into their body image. Emotional stress caused by the graft is very low and is generally less than assumed before transplantation. Knowledge about certain characteristics of the donor may cause increased concerns in some patients.
Keywords: allograft; article; body image; human; major clinical study; organ donor; organ transplantation; patient attitude; priority journal; physiological stress

Sexual orientation and risk of suicide attempts among a representative sample of youth - Garofalo, R.; Wolf, R.C.; Wissow, L.S.; Woods, E.R.; Goodman, E. (Archives of Pediatrics and Adolescent Medicine, 1999)
Objective: To examine whether sexual orientation is an independent risk factor for reported suicide attempts. Design: Data were from the Massachusetts 1995 Centers for Disease Control and Prevention Youth Risk Behavior Survey, which included a question on sexual orientation. Ten drug use, 5 sexual behavior, and 5 violence/victimization variables chosen a priori were assessed as possible mediating variables. Hierarchical logistic regression models determined independent predictors of suicide attempts. Selling: Public high schools in Massachusetts. Participants: Representative, population-based sample of high school students. Three thousand three hundred sixty-five (81%) of 4167 responded to both the suicide attempt and sexual orientation questions. Main Outcome Measure: Self-reported suicide attempt in the past year. Results: One hundred twenty-nine students (3.8%) selfidentified as gay, lesbian, bisexual, or not sure of their sexual orientation (GLBN). Gender, age, race/ethnicity, sexual orientation, and all 20 health-risk behaviors were associated with suicide attempt (P<.001). Gay, lesbian, bisexual, or not sure youth were 3.41 times more likely to report a suicide attempt. Based on hierarchical logistic regression, female gender (odds ratio [OR], 4.43; 95% confidence interval [CI], 3.30-5.93), GLBN orientation (OR, 2.28; 95% CI, 1.39-3.37), Hispanic ethnicity (OR, 2.21; 95% CI, 1.44-3.99), higher levels of violence/victimization (OR, 2.06; 95% CI, 1.80-2.36), and more drug use (OR, 1.31; 95% CI, 1.22-1.41) were independent predictors of suicide attempt (P<.001). Genderspecific analyses for predicting suicide attempts revealed that among males the OR for GLBN orientation increased (OR, 3.74; 95% CI, 1.92-7.28), while among females GLBN orientation was not a significant predictor of suicide. Conclusions: Gay, lesbian, bisexual, or not sure youth report a significantly increased frequency of suicide attempts. Sexual orientation has an independent association with suicide attempts for males, while for females the association of sexual orientation with suicidality may be mediated by drug use and violence/victimization behaviors.
Keywords: adolescent; adult; article; bisexuality; drug abuse; female; health behavior; homosexuality; human; major clinical study; male; population research; priority journal; risk assessment; sexual orientation; suicide attempt; victim; violence

Difficulties inherent in certifying people with gender dysphoria - Feinberg, M. (Aviation Space and Environmental Medicine, 1999)
This is a first report of the aeromedical implications of an airman undergoing gender transformation. It is clear that during the period of instituting high-dose hormones to undergo sexual transformation appropriate observation periods should be implemented due to the strong effects of these drugs on the psyche.
Keywords: adult; airplane crew; article; case report; depression; dysphoria; gender identity; human; male; medical examination; mental disease; suicide attempt

Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey - Lock, J.; Steiner, H. (Journal of the American Academy of Child and Adolescent Psychiatry, 1999)
Objective: Health problems of gay, lesbian, and bisexual (GLB) youth are reported as differing from those of heterosexual youth. Increased depression, suicide, substance use, homelessness, and school dropout have been reported. Most studies of GLB youth use clinical or convenience samples. The authors conducted a community school-based health survey that included an opportunity to serf-identify as GLB. Method: An anonymous self-report health care questionnaire was used during a community-based survey in 2 high schools in an upper middle class district. Results: Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk- taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy. Conclusions: Self-identified GLB youth in community settings are at greater risk for mental health, sexual risk-taking, and poorer general health maintenance than their heterosexual peers.
Keywords: adolescent; article; bisexuality; community care; controlled study; depression; emotional stress; female; health hazard; homelessness; homosexuality; human; homosexual female; major clinical study; male; mental health; priority journal; sexual behavior; social problem; substance abuse; suicide

Hope and resilience in suicide ideation and behavior of gay and bisexual men following notification of HIV infection - Siegel, K.; Meyer, I.H. (AIDS Education and Prevention, 1999)
Upon being notified that they are positive for HIV, people often experience terror and confusion. At the beginning stages of coping with HIV diagnosis, suicide ideation and behavior may arise as the infected person begins to envision frightening images of a future life with AIDS. We examined the narratives of gay men who contemplated or attempted suicide soon after they had learned of their HIV infection. We found that suicidal ideation and attempt often provoked a process of coping with HIV disease, leading to a redefinition of the meaning of HIV, enhancing one's sense of control over life, and promoting a renewed effort at self-help and help seeking, a new commitment to life, and a reappraisal of personal goals. We recommend that clinicians and HIV counselors be cognizant of these positive symbolic functions of suicidality in coping with HIV infection. Allowing people who were recently diagnosed with HIV to discuss suicidality may allow them to move toward acceptance and commitment to life.
Keywords: acquired immune deficiency syndrome; adult; article; confusion; coping behavior; counseling; homosexuality; human; Human immunodeficiency virus infection; life; male; self help; suicidal behavior; suicide attempt

Suicide and homosexual youth. (The Harvard mental health letter / from Harvard Medical School, 1998)
Keywords: adolescent; article; comparative study; female; heterosexuality; homosexuality; human; male; psychological aspect; statistics; suicide; suicide attempt

Psychological adjustment and suicidal ideation in patients with AIDS - Gil, F.; Passik, S.; Rosenfeld, B.; Breitbart, W. (AIDS Patient Care and STDs, 1998)
This article assesses the psychosocial adjustment to illness and examines the relationship between adjustment and psychosocial and medical variables in 91 ambulatory HIV-infected patients. The 91 subjects were receiving ambulatory medical care in hospitals (Memorial Hospital, New York Hospital, and St. Vincent's Hospital) and in private medical consult (Gay Men's Health Crisis) in New York. The majority (74.5%) of subjects had AIDS. The sample was composed principally of white Roman Catholic homosexual men living alone. However, 49.5% were black or hispanic, 31.9% had intravenous drug use as their HIV risk behavior, 54.9% had past psychiatric history (including illegal drug use), and 22% had previous suicide attempts. Self- report measures of psychological adjustment (Psychological Adjustment to Illness Scale), mood (Brief Symptom Inventory), physical (PHYS) and psychological (PSYCH) symptoms from the Memorial Symptom Assessment Scale- Short Form (MSAS-SF), social support (Social Support Questionnaire-Short Report), suicidal ideation (Scale for Suicide Ideation Self-Report), and measures of disease status (Karnofsky Performance Rating Scale, HIV CDC Classification, and Absolute CD4+ Lymphocyte Count) were used in the study. The average age of subjects was 40 years (SD = 6.80). Fifty-two (63.4%) subjects acknowledged some indication of suicidal ideation. Variables that correlated with poor medical adjustment (health-care posture) were current suicide ideation (0.32, p = 0.003), number of psychological symptoms (0.45, p = 0.0001), physical symptoms (0.31, p = 0.006), social support (-0.24, p = 0.03), and satisfaction with the social support received (-0.36, p = 0.001). Poor sexual adjustment was related to current suicide ideation (0.39, p = 0.0004), number of psychological symptoms (0.40, p = 0.0003), satisfaction with the social support received (-0.28, p = 0.01), and number of physical symptoms (0.35, p = 0.002). In patients with a diagnosis of AIDS, the number of psychological symptoms (Beta = 0.29, R2 = 0.07, p - 0.02) and the satisfaction with the social support received (Beta = -0.38, R2 = 0.14, p - 0.003) were clear predictors of poor medical adjustment (health-care posture). Likewise, the predictors of poor sexual adjustment were psychological symptoms (Beta = 0.33, R2 = 0.10, p = 0.003) and suicidal ideation (Beta = 0.40, R2 = 0.10, p = 0.002). The results suggest that suicide ideation is associated with poor adjustment, rather than serving as an adaptive function, as has been suggested by others.
Keywords: acquired immune deficiency syndrome; adult; article; coping behavior; female; homosexuality; human; Human immunodeficiency virus; major clinical study; male; outpatient care; patient satisfaction; social support; suicide

Homosexual homicides - Gojanovic, M.D. (Journal of Clinical Forensic Medicine, 1998)
This report describes four cases of male homosexual homicide committed in Split County, Croatia, in 1991 and 1995. The homosexual orientation of the victims was determined by police investigation. Three middle-aged to elderly person were killed by an unknown offender or offenders, in very similar ways within a few months of end other in 1991. The bodies were found in their houses with multiple blunt force injuries to the head. One victim also had marks of manual strangulation, and was choked with a handkerchief which had been put in his mouth. The last victim was a 45-year-old man, found in the bathroom with 33 stab wounds, mostly in the neck and back, and with two shots in the head from an underwater gun. He was killed by two adolescent males at the beginning of sexual intercourse. The presented cases show a high level of violence with multiple injuries may be associated with male homosexual homicide.
Keywords: adult; aged; airway obstruction; article; blunt trauma; case report; Croatia; gunshot injury; head injury; homicide; homosexuality; human; male; multiple trauma; offender; police; sexual intercourse; stab wound; strangulation; victim

HIV positive tests at Coronial Services in Victoria 1989-1996: Lessons for HIV surveillance - Thompson, S.C.; Manjikian, A.; Ambrose, A.; Ireland, L.A.; Stevenson, E.M. (Australian and New Zealand Journal of Public Health, 1998)
Results of routine testing at other sites can supplement surveillance of the HIV epidemic in Australia which is largely based upon voluntary testing. Since 1989, systematic onsite HIV testing has been undertaken on all bodies taken to the Victorian Institute of Forensic Medicine (VIFM). Information was collected on all cases of HIV infection detected at VIFM between 1989 and 1996, and matched to surveillance databases. In 8 years, 75 people were diagnosed with HIV; all except one were male. The age range was 14-70 years, mean 37.4 years. The major causes of death were suicide 35%, AIDS 27%, drug toxicity 16%, natural causes 12% and injury 7%. The major exposure categories were male homosexual 51%, male bisexual 11%, homosexual/bisexual IDU 16%, IDU other 8%, and haemophiliac 7%. For only two was exposure information unavailable. Seropositivity for anti-HCV and HBsAg was 37% and 11% respectively. The deceased was recorded as having HIV/AIDS on the police report in 73% of cases, and at least 90% of subjects had been diagnosed with HIV prior to their death. The study suggests there is relatively little undiagnosed HIV infection in Victoria, that HIV infection has not moved outside traditional risk groups, and that many tests for HIV are undertaken using false namecodes. Many patients could not be matched on the HIV/AIDS databases, identifying a problem with HIV surveillance systems in Victoria, and the need to capture all information on HIV positives detected at VIFM.
Keywords: acquired immune deficiency syndrome; adolescent; adult; aged; article; Australia; bisexuality; cause of death; data base; drug toxicity; female; hemophilia; high risk population; homosexuality; human; Human immunodeficiency virus infection; injury; intravenous drug abuse; male; suicide

Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior - DuRant, R.H.; Krowchuk, D.P.; Sinal, S.H. (Journal of Pediatrics, 1998)
Objective: To examine the relationship between the number of male sexual partners of adolescent males and the frequency of victimization at school, missed school because of fear, used drugs at school, and engagement of fighting and weapon carrying both in and out of school. Study design: Sexually active male adolescents (NT = 3886) in 8th through 12th grades were administered the 1995 Vermont Youth Risk Behavior Survey. Results: A total of 8.7% of male adolescents reported one or more male sexual partners. Alcohol, marijuana, and smokeless tobacco use at school, not attending school because of fear, having been threatened or injured with a weapon at school, and weapon carrying at school accounted for 15.8% of the variation in the number of male sexual partners (p < 0.0001). Suicide attempts, school absence because of fear, cigarette smoking, alcohol use, and smokeless tobacco use at school, frequency of fighting requiring medical treatment, carrying a weapon, and carrying a weapon at school accounted for 17.2% out of 100% of the variation in the number of male sexual partners (p ≤ 0.00001). Conclusion: The number of male sexual partners reported by sexually active male adolescents correlated with a higher frequency of victimization, use of violence, and drug use at school. Frequency of suicide attempts and fighting outside of school were also correlated with the number of same-sex sexual partners.
Keywords: cannabis; adolescent; article; cigarette smoking; drug abuse; homosexuality; human; male; normal human; priority journal; school; sexual behavior; suicide; tobacco; victim; violence

Gender differences in health and risk behaviors among bisexual and homosexual adolescents - Saewyc, E.M.; Bearinger, L.H.; Heinz, P.A.; Blum, R.W.; Resnick, M.D. (Journal of Adolescent Health, 1998)
Objective: This study explored gender differences in the health and risk behaviors of 394 self-identified bisexual and homosexual adolescents who participated in an anonymous, school-based survey. Methods: Respondents included 182 girls and 212 boys; girls were significantly younger than boys (p < 0.001), so respondents were further grouped as younger (≤14 years) and older (≤15 years) for analysis. Chi-square was used to test for gender differences in health perceptions and risk behaviors. Items included general health perceptions and health care access, body image and disordered eating behaviors, sexual behaviors, alcohol use, and emotional health measures including mood, life satisfaction, and suicidal ideation and attempts. Results: Both younger and older girls were significantly more likely than their male age mates to report a history of sexual abuse, dissatisfaction with weight, a negative body image, more frequent dieting, and an earlier age at onset of sexual intercourse. Both younger and older boys were significantly more likely than girls to have a positive body image, to rate themselves as healthier than peers, to report no regular source of health care, to be sexually experienced, and to drink alcohol more often and in greater quantity; a significantly greater proportion of older boys than older girls reported alcohol use before school (19.0% vs. 3.9%; p < 0.05). No significant gender differences were found for measures of emotional health, including suicidal ideation and attempts; however, nearly 1 of 3 older boys and girls reported at least one suicide attempt. Conclusions: Gender is a substantive source of variation in health and risk behaviors among bisexual and homosexual adolescents. Health care providers should incorporate gender- specific approaches to health promotion and risk reduction with young people who self-identify as gay, lesbian, or bisexual.
Keywords: adolescent; alcohol consumption; article; bisexuality; body image; child; controlled study; eating disorder; emotion; female; health behavior; health care access; homosexuality; human; major clinical study; male; priority journal; risk; sex difference

Suicidal ideation, suicide attempts, and HIV infection - Kelly, B.; Raphael, B.; Judd, F.; Perdices, M.; Kernutt, G.; Burnett, P.; Dunne, M.; Burrows, G. (Psychosomatics, 1998)
A cross-sectional study was performed to investigate the prevalence and predictors of suicidal ideation and past suicide attempt in an Australian sample of human imumunodeficiency virus (HIV)-positive and HIV-negative homosexual and bisexual men. Sixty-five HIV-negative and 164 HIV-positive men participated. A suicidal ideation score was derived from using five items selected from the Beck Depression Inventory and the General Health Questionnaire (28-item version). Lifetime and current prevalence rates of psychiatric disorder were evaluated with the Diagnostic Interview Schedule Version-III-R. The HIV-positive (Centers for Disease Control and Prevention [CDC] Stage IV) men (n = 85) had significantly higher total suicidal ideation scores than the asymptomatic HIV-positive men (CDC Stage II/III) (n = 79) and the HIV-negative men. High rates of past suicide attempt were detected in the HIV-negative (29%) and HIV-positive men (21%). Factors associated with suicidal ideation included being HIV positive, the presence of current psychiatric disorder, higher neuroticism scores, external locus of control, and current unemployment. In the HIV-positive group analyzed separately, higher suicidal ideation was discriminated by the adjustment to HIV diagnosis (greater hopelessness and lower fighting spirit), disease factors (greater number of current acquired immunodeficiency syndrome [AIDS]-related conditions), and background variables (neuroticism). Significant predictors of a past attempted suicide were a positive lifetime history of psychiatric disorder (particularly depression diagnoses), a life-time history of injection drug use, and a family history of suicide attempts. The findings indicate increased levels of suicidal ideation in symptomatic HIV-positive men and high-light the role that multiple psychosocial factors associated with suicidal ideation and attempted suicide play in this population.
Keywords: acquired immune deficiency syndrome; adult; aged; article; Australia and New Zealand; depression; female; human; Human immunodeficiency virus infection; major clinical study; male; prediction; prevalence; risk factor; scoring system; seroconversion; social psychology; suicide attempt

The University of Minnesota Youth and AIDS Projects' Adolescent Early Intervention Program: A model to link HIV-seropositive youth with care - Remafedi, G. (Journal of Adolescent Health, 1998)
The survival of human immunodeficiency virus (HIV)-positive adolescents may be abbreviated by delays in health care delivery. Methods of linking youth with services have not been well studied. With support from the Special Projects of National Significance Program, the Youth and Acquired Immunodeficiency Syndrome (AIDS) Projects' (YAP) Adolescent Early Intervention Program offers early intervention health care services to all affected youth in Minnesota, a state with mandatory reporting of HIV/AIDS cases. The conceptual framework is a novel application of traditional public health disease surveillance strategies to link HIV-positive adolescents with health care services. The target population is composed of all 13-22-year- old HIV-positive persons reported to the Minnesota Department of Health (MDH). MDH staff locate and contact HIV-positive youth, conduct structured interviews regarding health status and needs, and facilitate enrollment at YAP. Sixteen male and 20 female participants (mean age 21 years; 56% people of color; 32% gay or bisexual) reported serious health risks, including inconsistent condom use (83%), poverty (78%), high school dropout (56%), unemployment (50%), illegal conduct (50%), medical debt (42%), unstable living situations (33%), running away (33%), substance abuse (33%) and attempted suicide (28%). More than one third reported each of six HIV- related symptoms. Seventy-five percent of participants sought advocacy/case coordination; 56%, clinical trials of experimental therapies; and 50%, vocational training and access to entitlement/eligibility programs. Linking HIV-positive youth to care is a valuable extension of the work of disease intervention specialists in states with similar reporting systems.
Keywords: acquired immune deficiency syndrome; adolescent; adult; article; disease control; female; health program; high risk population; human; Human immunodeficiency virus infection; major clinical study; male; poverty; priority journal; sexual behavior; socioeconomics; substance abuse; suicide; unemployment

A process model for assessing adolescent risk for suicide - Stoelb, M.; Chiriboga, J. (Journal of Adolescence, 1998)
As the incidence of adolescent suicide within our society continues to rise, it becomes increasingly important for the mental health professional to be able to accurately assess suicide risk in adolescents who seek help. This process model discusses primary risk factors (previous attempt, affective disorders, and hopelessness), secondary risk factors (substance abuse and personality or behavioral disorders), situational risk factors (family functioning, suicide exposure, social support, life stressors, and homosexuality), and their combined implications and significance in determining an adolescent's level or risk for suicide. Use of both empirical data and clinical intuition are integrated to form a working client model that is continuously reassessed in four stages, guiding the mental health professional through a comprehensive assessment process.
Keywords: adolescent; adult; affective neurosis; article; behavior disorder; child psychiatry; family; homosexuality; human; life event; personality disorder; risk assessment; social support; substance abuse; suicide; suicide attempt

Health and development of gay and lesbian youths: Implications for HIV/AIDS - Perrin, E.C.; Sack, S. (AIDS Patient Care and STDs, 1998)
Health and behavioral issues of gay and lesbian adolescents have recently become a focus of research and interest. A well conceived framework within which to consider thoughtfully the uniqueness of problems faced by homosexual youths and the role of health-care providers is needed. The prevalence, sociocultural history, and theories of origin of the homosexual orientation (biologic, psychoanalytic, and social processes) as well as general issues in adolescent development (biologic, cognitive, and emotional) all contribute to the development of a comprehensive perspective through which better health care and education can be provided. Responsible sexual behavior, depression, and suicide are health-care issues that physicians must be sensitive to and address openly. Up to 50% of gay youths have 'seriously contemplated,' suicide and 25% are estimated to have attempted suicide, according to the literature. In one study, up to 38% of pediatricians were uncomfortable in caring for homosexual adolescents within their practice. Practical suggestions include reviewing the language in office information forms and brochures providing appropriate literature that demonstrates acceptance of homosexual and bisexual orientations, and avoiding heterosexist bias in questions inquiring about sexuality. Physicians have an opportunity to modify the health and psychosocial risks faced by gay and lesbian youths by restructuring professional settings and accepting broader responsibilities for raising community awareness.
Keywords: acquired immune deficiency syndrome; article; bisexuality; depression; development; health behavior; homosexuality; human; Human immunodeficiency virus infection; homosexual female; psychological aspect; sexual behavior; social aspect; suicide; theory

Reasons for living in homosexual and heterosexual young adults - Hirsch, J.K.; Ellis, J.B. (Archives of Suicide Research, 1998)
For researchers, suicide is a major concern in young adults. The additional stressors that may be present for gay or lesbian individuals may promote less adaptive characteristics than in heterosexual individuals. Gay and lesbian and heterosexual subjects completed the Reasons for Living Inventory (RFL) to determine levels of adaptive characteristics that may prevent suicidal behaviors. Results indicated that gay men and lesbian women endorsed less reasons for living than did heterosexual individuals. This reduced level of coping skills may be a result of increased responsibilities, demands, and stressors associated with choosing a homosexual lifestyle.
Keywords: adaptive behavior; adult; article; coping behavior; female; heterosexuality; homosexuality; human; human experiment; male; priority journal; suicidal behavior

HIV infection and suicide risk: An epidemiological inquiry among male homosexuals in Switzerland - Cochand, P.; Bovet, P. (Social Psychiatry and Psychiatric Epidemiology, 1998)
Conflicting results have been published about suicidality among HIV+ subjects; part of the alleged increased risk may be linked to premorbid risk factors such as drug addiction and homosexuality. In order to cope with these confounding factors, we assessed the degree of suicidal ideation in a sample of Swiss male homo- and bisexuals, comparing HIV- and HIV+ subjects. A total of 164 subjects returned a self-administered, home-completed questionnaire, which had been circulated among homosexuals in the French speaking part of Switzerland. Suicidal ideation was assessed through Poldinger's scale. Serostatus was known for 149 subjects, among whom 65 were HIV+. A high rate of suicide attempts was found among homosexuals, both HIV- and HIV+. Scores on Poldinger's scale are significantly, though moderately, higher among HIV+ subjects, and this finding seems to be a direct consequence of HIV infection.
Keywords: adult; aged; article; bisexuality; controlled study; drug dependence; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; questionnaire; rating scale; risk factor; serology; suicidal behavior; suicide attempt; Switzerland

The association between health risk behaviors and sexual orientation among a school-based sample of adolescents - Garofalo, R.; Wolf, R.C.; Kessel, S.; Palfrey, J.; DuRant, R.H. (Pediatrics, 1998)
Objective. This study is one of the first to examine the association between sexual orientation and health risk behaviors among a representative, school-based sample of adolescents. Design. This study was conducted on an anonymous, representative sample of 4159 9th- to 12th-grade students in public high schools from Massachusetts' expanded Centers for Disease Control and Prevention 1995 Youth Risk Behavior Survey. Sexual orientation was determined by the following question: 'Which of the following best describes you?' A total of 104 students self-identified as gay, lesbian, or bisexual (GLB), representing 2.5% of the overall population. Of GLB youth, 66.7% were male and 70% were white (not Hispanic). Health risk and problem behaviors were analyzed comparing GLB youth and their peers. Those variables found to be significantly associated with GLB youth were then analyzed by multiple logistic regression models. Results. GLB youth were more likely than their peers to have been victimized and threatened and to have been engaged in a variety of risk behaviors including suicidal ideation and attempts, multiple substance use, and sexual risk behaviors. Four separate logistic regression models were constructed. Model I, Onset of Behaviors Before Age 13, showed use of cocaine before age 13 years as strongly associated with GLB orientation (odds ratio [OR]: 6.10; 95% confidence interval [CI] = 2.45- 15.20). Early initiation of sexual intercourse (2.15; 10.6-4.38), marijuana use (1.98; 1.04-4.09), and alcohol use (1.82; 1.03-3.23) also was associated with GLB orientation. Model II, Lifetime Frequencies of Behaviors, showed that frequency of crack cocaine use (1.38; 1.06-1.79), inhalant use (1.30; 1.05-1.61), and number of sexual partners (1.27; 1.06-1.43) was associated with GLB orientation. Model III, Frequency of Recent Behaviors, showed smokeless tobacco use in the past 30 days (1.38; 1.20-1.59) and number of sexual partners in the previous 3 months (1.47; 1.31-1.65) were associated with GLB orientation. Model IV, Frequency of Behaviors at School, showed having one's property stolen or deliberately damaged (1,23; 1.08-1.40) and using marijuana (1.29; 1.05-1.59) and smokeless tobacco (1.53; 1.30-1.81) were associated with GLB orientation. Overall, GLB respondents engaged disproportionately in multiple risk behaviors, reporting an increased mean number of risk behaviors (mean = 6.81 ± 4.49) compared with the overall student population (mean = 3.45 ± 3.15). Conclusion. GLB youth who self- identify during high school report disproportionate risk for a variety of health risk and problem behaviors, including suicide, victimization, sexual risk behaviors, and multiple substance use. In addition, these youth are more likely to report engaging in multiple risk behaviors and initiating risk behaviors at an earlier age than are their peers. These findings suggest that educational efforts, prevention programs, and health services must be designed to address the unique needs of GLB youth.
Keywords: alcohol; cannabis; cocaine; adolescence; adolescent; alcohol abuse; article; bisexuality; drug abuse; female; high risk population; homosexuality; human; homosexual female; major clinical study; male; priority journal; sexual behavior; sexual orientation; suicide

Long-term trends in self-reported HIV risk behavior: Injection drug users in Los Angeles, 1987 through 1995 - Longshore, D.; Annon, J.; Anglin, M.D. (Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 1998)
This article reviews trends in self-reported HIV risk behaviors across serial samples of injection drug-using (IDU) arrestees interviewed in Los Angeles. Between 1987 and 1995, a gradual decrease occurred in the percentage who share needles. However, measured over a past-year recall period, the prevalence of needle sharing remained high until 1994 to 1995, when it abruptly declined. Needle sharing with strangers and needle sharing at shooting galleries declined gradually throughout the study period. Among IDUs who shared needles, bleach use increased rapidly until 1991 but leveled off thereafter. No change occurred in number of sex partners, but condom use gradually increased among IDUs with 2 or more partners. Concurrent change in local needle exchange policy and practice may explain the abrupt decline in past-year needle sharing. New strategies may be needed to promote further increases in bleach use and condom use.
Keywords: bleaching agent; article; condom; drug abuse; drug use; health care policy; human; Human immunodeficiency virus; Human immunodeficiency virus infection; intrauterine contraceptive device; long term care; priority journal; risk assessment; risk factor; sexual orientation; sexually transmitted disease; United States

Antecedents and consequences of victimization of lesbian, gay, and bisexual young people: a structural model comparing rural university and urban samples. - Waldo, C.R.; Hesson-McInnis, M.S.; D'Augelli, A.R. (American journal of community psychology, 1998)
Research indicates that antigay victimization is widespread and that lesbian, gay, and bisexual young people may be very vulnerable to such victimization. The current study builds upon previous work by Hershberger and D'Augelli (1995), who studied the consequences of sexual orientation-based victimization in 194 urban lesbian, gay, and bisexual youths. Using structural equation modeling, the present study models both antecedents and consequences (including psychological distress, self-esteem, and suicidality) of victimization via a secondary analysis of their data set. In addition, a second sample of 54 lesbian, gay, and bisexual youths from a rural university setting was examined to cross-validate and generalize the relationships found in urban settings. Results indicated that a revised model of victimization exhibited sufficient fit to the urban sample data and provided preliminary support for the generalizability of the model beyond the initial sample. Additional similarities were found between the urban and rural university community samples, including a high prevalence of reported suicide attempts: 42% of the urban sample and 32% of the rural university sample had attempted suicide at least once. Results indicated that victimization based on sexual orientation has similar correlates for young people in different community settings.
Keywords: article; bisexuality; comparative study; female; homosexuality; human; homosexual female; male; rural population; self concept; statistics; suicide attempt; urban population; victim

Dilemma. James' right to information. (Accident and emergency nursing, 1998)
Keywords: adult; article; case report; chemically induced disorder; confidentiality; emergency nursing; heart arrest; homosexuality; human; interpersonal communication; intoxication; legal aspect; male; medical ethics; methodology; nursing; psychological aspect; suicide; United Kingdom

Development and health care needs of lesbians - Lehmann, J.B.; Lehmann, C.U.; Kelly, P.J. (Journal of Women's Health, 1998)
Lesbians have complained about the lack of awareness and sensitivity of their health care providers, resulting in unnecessary examinations and inappropriate focus on reproductive issues. This study attempted to identify psychosocial and health care needs of lesbians, to assess relationships with primary care providers and disclosure of sexual orientation, and to describe the chronologic features of a sexual identity and lifestyle. An anonymous, self-administered, written questionnaire was distributed through a campus lesbian organization. Fifty-three women (median age 23 years) completed the questionnaire. Whereas 60% had disclosed their sexual orientation to their parents, only 31% had 'come out' to their health care provider. Of participants who had disclosed their sexual preference to a provider, 27% reported a negative effect on their health care, 57% of participants who never had penile intercourse had annual Papanicolaou smears, and 16% felt pressured in the past to accept birth control from a physician. Lesbian sexuality was associated with several risk factors, such as childhood abuse (20%), alcohol or drug problems (39%), suicide attempts (27%), depression (49%), and physical or verbal abuse at school (34%). Average age of awareness of sexual orientation was 15 years, and average age of first homosexual activity was 17 years. Lesbians are at risk for depression, substance abuse, and suicide attempts. Although most would like to confide in their physician, few do because of fears of negative reactions. Communication must be improved to better address their specific health care needs.
Keywords: article; birth control; clinical examination; depression; female; gender identity; health care delivery; health care need; human; homosexual female; lifestyle; Papanicolaou test; primary medical care; priority journal; questionnaire; reproduction; risk factor; sexual intercourse; sexual orientation; social psychology; substance abuse; suicide attempt

Assisted suicide. (AIDS policy & law, 1998)
Keywords: acquired immune deficiency syndrome; article; assisted suicide; human; male; transsexualism; United States

Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students - Faulkner, A.H.; Cranston, K. (American Journal of Public Health, 1998)
Objectives. This study documented risk behaviors among homosexually and bisexually experienced adolescents. Methods. Data were obtained from a random sample of high school students in Massachusetts. Violence, substance use, and suicide behaviors were compared between students with same-sex experience and those reporting only heterosexual contact. Differences in prevalence and standard errors of the differences were calculated. Results. Students reporting same-sex contact were more likely to report fighting and victimization, frequent use of alcohol, other drug use, and recent suicidal behaviors. Conclusions. Students with same-sex experience may be at elevated risk of injury, disease, and death resulting from violence, substance abuse, and suicidal behaviors.
Keywords: adolescent; alcohol consumption; article; female; heterosexuality; high school; homosexuality; human; human experiment; male; normal human; sexual behavior; substance abuse; suicide; violence