Suicide attempts among gay and bisexual men: lifetime prevalence and antecedents. - Paul JP; 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: Suicide, Attempted -- Epidemiology; Gay Men -- Psychosocial Factors; Homosexuality; Suicide, Attempted -- Risk Factors; Suicidal Ideation -- Epidemiology; Bisexuals -- Psychosocial Factors; Bisexuality; Funding Source; Epidemiological Research; Cross Sectional Studies; Male; Prevalence; Probability Sample; Telephone; Interviews; Age Factors; Illinois; California; New York; Multimethod Studies; Self Report; Adult; Middle Age; Aged; Aged, 80 and Over; Social Environment; Logistic Regression; Chi Square Test; Correlational Studies; Analysis of Variance; Multiple Logistic Regression; Step-Wise Multiple Regression; Goodness of Fit Chi Square Test; Descriptive Statistics; Human

Suicidality and self-harm among sexual miniorities in Japan. - DiStefano AS (Qualitative Health Research, 2008)
In this study, I used ethnographic methods to examine suicidality and nonsuicidal self-harm among gay, lesbian, bisexual, and transgender persons in Japan. Participants (N = 84) indicated that suicidality and self-harm are serious problems among sexual minorities and tend to be driven by (a) a homophobic/transphobic environment and the negative consequences of sexual minorities either disclosing their true selves or remaining hidden and silent within such an environment; (b) various antecedents to poor mental health; and (c) factors not directly related to being a sexual minority, particularly unemployment and debt in the context of a protracted national economic decline in Japan prior to the study period of 2003-2004. Participants also perceived a potentially higher risk for suicidality and self-harm among sexual minority adolescents and persons in their early 20s; those who work in the entertainment, bar, or sex industries; and survivors of violence perpetrated by intimate partners or family members.
Keywords: Injuries, Self-Inflicted; Minority Groups; Suicidal Ideation; Vulnerability; Adult; Bisexuality; Descriptive Statistics; Female; Grounded Theory; Homosexuality; Interviews; Japan; Male; Middle Age; Participant Observation; Prospective Studies; Qualitative Studies; Risk Factors; Sexual Abuse; Thematic Analysis; Violence; Human

Should Dental Care Make a Transition? - Ludwig, David C.; Morrison, Shane D. (Journal of the American Dental Association (JADA), 2018)
An editorial is presented on the need for transition in dental care inorder to provide dental care to transgenders in the society. It talks about the need for changes in the healthcare industry inorder to provide medical services to transgenders without discrimination. It tells about the importance of having dentists who deal in dental care for transgenders as the characteristics if their teeth and gun differ than other people.
Keywords: Dental Care; Transgender Persons; Dentists -- Psychosocial Factors; Esthetics, Dental; Masculinity; Femininity; Interpersonal Relations; Patient Centered Care

Partner violence and health among HIV-infected jail detainees. - Meyer, Jaimie P; Wickersham, Jeffrey A; Fu, Jeannia J; Brown, Shan-Estelle; Sullivan, Tami P; Springer, Sandra A; Altice, Frederick L (International Journal of Prisoner Health, 2013)
Purpose: Little is known about the association of intimate partner violence (IPV) with specific HIV-treatment outcomes, especially among criminal justice (CJ) populations who are disproportionately affected by IPV, HIV, mental, and substance use disorders (SUDs) and are at high risk of poor post-release continuity of care.Design/methodology/approach: Mixed methods were used to describe the prevalence, severity, and correlates of lifetime IPV exposure among HIV-infected jail detainees enrolled in a novel jail-release demonstration project in Connecticut. Additionally, the effect of IPV on HIV treatment outcomes and longitudinal healthcare utilization was examined.Findings: Structured baseline surveys defined 49 percent of 84 participants as having significant IPV exposure, which was associated with female gender, longer duration since HIV diagnosis, suicidal ideation, having higher alcohol use severity, having experienced other forms of childhood and adulthood abuse, and homo/bisexual orientation. IPV was not directly correlated with HIV healthcare utilization or treatment outcomes. In-depth qualitative interviews with 20 surveyed participants, however, confirmed that IPV was associated with disengagement from HIV care especially in the context of overlapping vulnerabilities, including transitioning from CJ to community settings, having untreated mental disorders, and actively using drugs or alcohol at the time of incarceration.Originality/value: Post-release interventions for HIV-infected CJ populations should minimally integrate HIV secondary prevention with violence reduction and treatment for SUDs.

Family Acceptance in Adolescence and the Health of LGBT Young Adults. - Ryan, Caitlin; Russell, Stephen T.; Huebner, David; Diaz, Rafael; Sanchez, Jorge (Journal of Child & Adolescent Psychiatric Nursing, 2010)
ISSUE: The role of family acceptance as a protective factor for lesbian, gay, bisexual, and transgender (LGBT) adolescents and young adults has not been established. METHODS: A quantitative measure with items derived from prior qualitative work retrospectively assessed family accepting behaviors in response to LGBT adolescents' sexual orientation and gender expression and their relationship to mental health, substance abuse, and sexual risk in young adults ( N= 245). FINDINGS: Family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors. CONCLUSIONS: Family acceptance of LGBT adolescents is associated with positive young adult mental and physical health. Interventions that promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities.
Keywords: Attitude to Sexuality -- Ethnology; Family Attitudes; LGBTQ+ Persons -- Psychosocial Factors; Health Status; Mental Health; Adolescent Psychology; Gender Identity; Socioeconomic Factors; Young Adult; Human; Retrospective Design; Quantitative Studies; Descriptive Statistics; Female; Male; California; Audiorecording; Hispanic Americans; White Persons; Scales; One-Way Analysis of Variance; P-Value; Chi Square Test; Odds Ratio; Confidence Intervals; Logistic Regression; Funding Source; Early Intervention; Nursing Role

Sexual Revictimization and Mental Health: A Comparison of Lesbians, Gay Men, and Heterosexual Women. - Balsam, Kimberly F.; Lehavot, Keren; Beadnell, Blair (Journal of Interpersonal Violence, 2011)
Keywords: Heterosexuals; Lesbians; Gay Men; Mental Health; Sexual Abuse; Human; Child Abuse, Sexual; Female; Male; Cross Sectional Studies; Stress, Psychological; Suicidal Ideation; Alcohol Abuse; Self-Injurious Behavior; Questionnaires; Surveys; Rape; Adult; Adolescence; Middle Age; Aged; Interview Guides; Data Analysis Software; Intraclass Correlation Coefficient; Effect Size; Brief Symptom Inventory; Scales

Epidemiology and outcome of HIV patients in Finland co-infected with tuberculosis 1998-2015. - Holmberg, Ville; Soini, Hanna; Kivelä, Pia; Ollgren, Jukka; Ristola, Matti (BMC Infectious Diseases, 2019)
Background: Tuberculosis (TB) is a major cause of death in HIV patients worldwide. Here we describe the epidemiology and outcome of HIV-TB co-infections in a high-income country with low TB incidence and integrated HIV and TB therapy according to European guidelines.Methods: This study was based on the HIV cohort of the Helsinki University Hospital which includes all HIV patients in the Helsinki region with a population of 1.5 million. Totally, 1939 HIV-positives who have been under follow-up between 1998 and 2015 were included.Results: TB was diagnosed in 53 (2.7%) of the HIV-patients. The TB incidence rate was higher in injecting drug users (IRR 3.15; 95% CI 1.33-7.52) and heterosexuals (IRR 3.46; 95% CI 1.64-7.29) compared to men having sex with men. The incidence rate was also higher in those born in Sub-Saharan Africa (IRR 3.53; 95% CI 1.78-7.03) compared to those born in Finland. There was a significant reduction in the total TB incidence rate of 59% per 6-year period between 1998 and 2015 (p < 0.001). In injecting drug users there was a reduction in incidence rate from 1182 to 88 per 100,000 (p < 0.001) and in people born in Sub-Saharan Africa from 2017 to 195 per 100,000 (p < 0.001). Among the 53 HIV-TB co-infected cases, one female and 15 males died during follow up. HIV was the primary cause of death in five patients but none of the deaths were caused by TB.Conclusion: The incidence rate of tuberculosis among HIV-positives in Finland has been declining between 1998 and 2015. Among injecting drug users, the reduction is probably explained by harm reduction interventions and care in comprehensive care centers in Helsinki. The increased coverage of antiretroviral therapy is probably another main reason for the decline in TB incidence rates. Despite good treatment results for both HIV and TB, the all-cause mortality among Finnish males with HIV-TB was high, and common causes of death were intoxications and suicides.
Keywords: HIV Infections -- Epidemiology; Tuberculosis, Pulmonary -- Epidemiology; Incidence; Young Adult; Finland; Child, Preschool; Heterosexuality; Coinfection; Tuberculosis, Pulmonary -- Complications; Adolescence; Child; Adult; Africa South of the Sahara -- Ethnology; Prospective Studies; Infant, Newborn; Male; Aged; Middle Age; Treatment Outcomes; HIV Infections -- Drug Therapy; HIV Infections -- Complications; Female; Infant; Homosexuality

Information needs of gay, lesbian, bisexual, and transgendered health care professionals: results of an Internet survey. - Fikar CR; Keith L (Journal of the Medical Library Association, 2004)
OBJECTIVES: To obtain basic facts and considered opinions from health care professionals and students (nonlibrarian and librarian) about the information needs of gay, lesbian, bisexual, and transgendered (GLBT) health care professionals and their interactions with medical librarians. METHODS: The survey instrument was a Web-based questionnaire. A nonrandom sample of health care professionals and students (librarian and nonlibrarian) was obtained by posting messages to several large Internet electronic discussion groups (GLBT and general) and to randomly selected members of the Gay and Lesbian Medical Association. A total of 152 forms were analyzed with about 50% of the participants being GLBT persons. RESULTS: GLBT people have specific health information needs and concerns. More than 75% of medical librarians and students believed that GLBT persons have special information needs, with similar response rates by nonlibrarian health professionals and students. The delivery of services needs to be done with privacy and respect for the feelings of the patron. Major areas of need include the topics of health care proxy, cancer, adolescent depression and suicide, adoption, sexual health and practices, HIV infection, surrogate parenting, mental health issues, transgender health issues, intimate partner violence, and intimate partner loss. CONCLUSIONS: Most GLBT health care professionals desire GLBT-friendly health information services. Making GLBT-oriented health information resources available on a library Web page and making an effort to show acceptance of cultural diversity through signs or displays would be helpful. Education directed toward instilling an awareness of GLBT persons may also be advisable. Most survey participants make some use of medical reference services and many find medical librarians to be very helpful and resourceful.
Keywords: Bisexuals; Health Information; Gay Persons; Information Needs; Lesbians; Chi Square Test; Data Collection, Computer Assisted; Descriptive Statistics; Female; Fisher's Exact Test; Health Personnel; Health Sciences Librarians; Internet; Interprofessional Relations; Male; Questionnaires; Surveys; Transsexualism; Human

Psychosocial issues in primary care of lesbian, gay, bisexual, and transgender youth. - Kreiss JL; Patterson DL (Journal of Pediatric Healthcare, 1997)
Lesbian, gay, bisexual, and transgender youth are at risk for a multitude of physical, emotional, and social health problems. During the past decade it has been well documented that these youth have higher-than-average rates of depression, suicide attempts, substance abuse, sexually transmitted diseases, school failure, family rejection, and homelessness. The focus of this article is to outline skills and strategies that can assist the health practitioner in creating an optimal health care experience for sexual minority youth. Models of individual and family adaptation, a clinical path, and a referral list are presented. Current health care delivery sites are examined, and recommendations are given for improvement of both practitioner skills and health care programs targeting these youth.
Keywords: Homosexuality -- In Adolescence; Bisexuality -- In Adolescence; Transsexualism -- In Adolescence; Pediatric Nurse Practitioners; Adolescence; Female; Male; Family -- Psychosocial Factors; Adaptation, Psychological; Adolescent Development; Substance Abuse -- In Adolescence; Depression -- In Adolescence; Suicide -- In Adolescence; Adolescent Health Services; Health Services Accessibility -- In Adolescence; Primary Health Care

Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care. - Blosnich, John R.; Brown, George R.; Shipherd, Jillian C.; Kauth, Michael; Piegari, Rebecca I.; Bossarte, Robert M. (American Journal of Public Health, 2013)
Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk. Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.
Keywords: Sexual and Gender Disorders -- Trends; Suicide -- Risk Factors; Transgender Persons; Veterans -- United States; Military Personnel -- United States; Human; Funding Source; Prevalence; Incidence; Administrative Research; United States Department of Veterans Affairs; Record Review; Retrospective Design; Correlational Studies; Reference Values; Descriptive Research; Descriptive Statistics; United States

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

Safe and Successful ECT in a Female-to-Male Transgender Individual With Major Depression. - Coffey, M. Justin; Stevens,, Jonathan R. (Journal of ECT, 2016)
Keywords: Depression -- Therapy; Depression -- Psychosocial Factors; Electroconvulsive Therapy -- Methods; Antimanic Agents -- Therapeutic Use; Lithium -- Adverse Effects; Lithium -- Therapeutic Use; Psychological Tests; Female; Antimanic Agents -- Adverse Effects; Suicidal Ideation; Gender Affirmation Procedures; Male; Adult

The Co-Occurrence of Mental Illness and High HIV Risk in a Sample of African American MSM: Findings and Implications. - Loue, Sana; Daugherty-Brownrigg, Brittany; Heaphy, Emily; Mendez, Nancy; Sajatovic, Martha (Journal of HIV/AIDS & Social Services, 2012)
African American men who have sex with men often experience rejection and discrimination. Mental illness may contribute to high HIV risk behavior. We assessed the relationship between mental illness and HIV risk among African American men who have sex with men. We assessed 125 African American men who have sex with men aged 18 years or older in Ohio for mental illness, substance use, HIV knowledge, and risk. Bivariate analyses were conducted. Any mental illness was associated with substance abuse (p = .001), child abuse (p = .032), suicide attempts (p = .028), and trading sex for money or drugs (p = .002). Bipolar disorder was associated with trading sex for money or drugs (p = .008). Mood disorders appear undertreated among African American men who have sex with men. More adequate mental health and substance abuse treatment are needed both in the prison system and the community setting to reduce HIV risk and transmission.
Keywords: Men's Health; HIV Infections -- Risk Factors; Sexual Partners; Comorbidity; Mental Disorders; Risk Assessment; Black Persons; Human; Ohio; Male; Young Adult; Adult; Middle Age; Risk Taking Behavior; Health Knowledge; Substance Abuse; Bivariate Statistics; Child Abuse Survivors; Suicidal Ideation; Sex Work; Cross Sectional Studies; Interviews; Interview Guides; Clinical Assessment Tools; Pearson's Correlation Coefficient; Kappa Statistic; Funding Source

Legalization of Same-Sex Marriage and Drop in Adolescent Suicide Rates: Association but Not Causation...Raifman J, Moscoe E, Austin SB, McConnell M. Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts. JAMA Pediatr . 2017;171(4):350-356 . - Kamtchum-Tatuene, Joseph; Noubiap, Jean Jacques; Fogang, Yannick F.; Raifman, Julia; Moscoe, Ellen; Austin, S. Bryn (JAMA Pediatrics, 2017)
Keywords: Marriage -- Legislation and Jurisprudence -- United States; Suicide -- Trends -- In Adolescence; Gay Persons; United States; Adolescence; Depression

Suicidal ideation and attempts in North American school-based surveys: are bisexual youth at increasing risk? - Saewyc EM; Skay CL; Hynds P; Pettingell S; Bearinger LH; Resnick MD; Reis E (Journal of LGBT Health Research, 2007)
Keywords: Adolescent Behavior; Bisexuality; Students, High School -- North America; Suicidal Ideation -- Risk Factors; Suicide, Attempted -- Risk Factors; Adolescence; Age Factors; Comparative Studies; Confidence Intervals; Exploratory Research; Female; Funding Source; Geographic Factors; Heterosexuals; Homosexuality; Lesbians; Logistic Regression; Male; Native Americans; North America; Odds Ratio; Peer Group; Prevalence; Prospective Studies; Secondary Analysis; Sex Factors; Suicide -- Trends; Survey Research; Human

Health of lesbian, gay, bisexual, and transgender youth...reprinted from Journal of Child and Family Nursing. (1999). 2(4), 237-249 - Stevens PE; Morgan S (Journal of Pediatric Healthcare, 2001)
Keywords: Homosexuality -- In Adolescence; Homophobia; Adolescence; Lesbians -- In Adolescence; Patient Advocacy; Gay Men -- In Adolescence; Bisexuals -- In Adolescence; Adolescent Behavior; Truth Disclosure -- In Adolescence; Family Relations; Violence -- In Adolescence; Peer Group -- In Adolescence; Suicide, Attempted -- In Adolescence; Runaways -- In Adolescence; HIV Infections -- Risk Factors -- In Adolescence; Adolescent Health Services; Information Resources

Barriers to insurance coverage for transgender patients. - Learmonth, Claire; Viloria, Rebekah; Lambert, Cei; Goldhammer, Hilary; Keuroghlian, Alex S.; Keuroghlian, Alex (American Journal of Obstetrics & Gynecology, 2018)
Transgender people report discrimination in access to health care that is associated with numerous poor health outcomes, including higher prevalence of HIV infection, substance use disorders, and suicide attempts. The field of obstetrics and gynecology is uniquely positioned to meet a wide range of health care needs for transgender people, and obstetrician-gynecologists can and ought to provide gender-affirming care for these patients. Despite growing evidence that gender-affirming care is both necessary and cost-effective, transgender patients continue to face barriers to securing insurance coverage, which prevents clinicians from practicing standards of care. The purpose of this article is to delineate the major barriers transgender patients face when seeking insurance reimbursement for services routinely available to cisgender (nontransgender) women.
Keywords: Insurance Coverage; Health Services Accessibility; Gynecology; Obstetrics; Insurance, Health, Reimbursement; Prejudice; Female; Family Planning; Male; Healthcare Disparities; Cost Benefit Analysis; Quality-Adjusted Life Years; Gender Affirmation Procedures; Hormones; Patient Protection and Affordable Care Act; Fertility Preservation; Pregnancy; Human; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

Avoiding shame: young LGBT people, homophobia and self-destructive behaviours. - McDermott E; Roen K; Scourfield J; McDermott, Elizabeth; Roen, Katrina; Scourfield, Jonathan (Culture, Health & Sexuality, 2008)
This paper reports on findings from qualitative research conducted in the UK that sought to explore the connections between sexual identities and self-destructive behaviours in young people. International evidence demonstrates that there are elevated rates of suicide and alcohol abuse amongst lesbian, gay, bisexual and transgender (LGBT) youth. Rarely included in this body of research are investigations into young LGBT people's views and experiences of self-destructive behaviours. Data from interviews and focus groups with young LGBT participants suggest a strong link between homophobia and self-destructive behaviours. Utilising a discourse analytic approach, we argue that homophobia works to punish at a deep individual level and requires young LGBT people to manage being positioned, because of their sexual desire or gendered ways of being, as abnormal, dirty and disgusting. At the centre of the complex and multiple ways in which young LGBT people negotiate homophobia are 'modalities of shame-avoidance' such as: the routinization and minimizing of homophobia; maintaining individual 'adult' responsibility; and constructing 'proud' identities. The paper argues that these strategies of shame-avoidance suggest young LGBT people manage homophobia individually, without expectation of support and, as such, may make them vulnerable to self-destructive behaviours.
Keywords: Adaptation, Psychological; LGBTQ+ Persons -- Psychosocial Factors; Homophobia; Self Concept; Self-Injurious Behavior; Shame; Suicide, Attempted; Adolescence; Adolescent Development; Adult; Bisexuality; Coping; Descriptive Statistics; Discourse Analysis; England; Female; Focus Groups; Funding Source; Homosexuality; Interpersonal Relations; Interviews; Male; Qualitative Studies; Secondary Analysis; Social Identity; Stress, Psychological; Support Groups; Transsexualism; Wales; Human

Correlates of suicide attempts in an open cohort of young men who have sex with men. - Botnick MR; Heath KV; Cornelisse PGA; Strathdee SA; Martindale SL; Hogg RS; Botnick, Michael R; Heath, Katherine V; Cornelisse, Peter G A; Strathdee, Steffanie A; Martindale, Stephen L; Hogg, Robert 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% CI 1.30, 4.33), social support scores below the 75th percentile of all scores (AOR = 2.19; 95% CI 1.18, 4.09) and low or moderate self-esteem (AOR = 3.73; 95% CI 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: Suicide, Attempted -- Risk Factors; Homosexuality; Gay Men -- Psychosocial Factors; Bisexuality; Bisexuals -- Psychosocial Factors; Suicide, Attempted -- Epidemiology; Correlational Studies; Cross Sectional Studies; Support, Psychosocial; Self Concept; Substance Abuse -- Complications; Nitrites -- Adverse Effects; Suicidal Ideation -- Psychosocial Factors; Male; Adult; Convenience Sample; Questionnaires; HIV Infections -- Blood; Center for Epidemiological Studies Depression Scale; Impact of Events Scale; Psychological Tests; Rosenberg Self Esteem Scale; Scales; Logistic Regression; Step-Wise Multiple Regression; P-Value; Univariate Statistics; Risk Factors; Child Abuse, Sexual -- Psychosocial Factors; Depression; Odds Ratio; Confidence Intervals; Human

Suicidality and Depression Disparities Between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review. - Marshal, Michael P.; Dietz, Laura J.; Friedman, Mark S.; Stall, Ron; Smith, Helen A.; McGinley, James; Thoma, Brian C.; Murray, Pamela J.; D'Augelli, Anthony R.; Brent, David A. (Journal of Adolescent Health, 2011)
Abstract: Purpose: To examine disparities between sexual minority youth (SMY) and heterosexual youth in rates of suicidality and depression symptoms. Methods: Separate meta-analyses were conducted to examine suicidality and depression disparities. Studies were included if the average age of the participants was <18 years, and if suicidality or depression symptoms were compared across SMY and heterosexual youth. Results: SMY reported significantly higher rates of suicidality (odds ratio [OR] = 2.92) and depression symptoms (standardized mean difference, d = .33) as compared with the heterosexual youth. Disparities increased with the increase in the severity of suicidality (ideation [OR = 1.96], intent/plans [OR = 2.20], suicide attempts [OR = 3.18], suicide attempts requiring medical attention [OR = 4.17]). Effects did not vary across gender, recruitment source, and sexual orientation definition. Conclusions: Disparities in suicidality and depression may be influenced by negative experiences including discrimination and victimization. Clinicians should assess sexual orientation, analyze psychosocial histories to identify associated risk factors, and promote prevention and intervention opportunities for SMY and their families.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Depression; Suicide -- Risk Factors; Sexuality -- In Adolescence; Human; Meta Analysis; Adolescence; Male; Female; Bisexuality; Coding; Data Analysis Software; Literature Searching; Psycinfo; Medline; Effect Size; Odds Ratio; Confidence Intervals; Linear Regression; Descriptive Statistics; Correlation Coefficient; Mental Health Services; Systematic Review

Young adult suicide and sexual orientation: what should counselors know? - Rutter PA (Journal of LGBT Issues in Counseling, 2006)
The current project focused on the suicidal ideation and risk potential of young adults (N = 312) and explored scores on self-report measures of suicidal ideation inclusive of various sexual orientations. Results suggest that the Lesbian, Gay, and Bisexual (LGB) youth surveyed (N = 73) differ in their display of suicide risk with significantly higher Beck Hopelessness Scale (BHS) and Suicide Probability Scale (SPS) scores. Social support served as a mitigating factor relating significantly to lower levels of hopelessness and suicidal ideation, especially among those LGB participants. The SPS held a significant relationship to suicide attempt in the past year, while the BHS held a significant relationship to suicide attempt in the past six months. Implications for counselors serving young adults are addressed, including specific suggestions to enhance counselor education and supervision related to suicide assessment and LGB counselor competency.
Keywords: Bisexuals -- Psychosocial Factors; Heterosexuals -- Psychosocial Factors; Gay Persons -- Psychosocial Factors; Suicide -- Risk Factors; Adolescence; Adult; Asians; Beck Hopelessness Scale; Black Persons; Correlation Coefficient; Counseling; Counselors; Descriptive Statistics; Female; Gender Identity; Hopelessness; Logistic Regression; Male; Multiple Regression; Multivariate Analysis of Variance; Native Americans; Psychological Tests; Questionnaires; Scales; Schools; Social Networks; Suicide -- Prevention and Control; White Persons; Human

Transgender-inclusive care. - Lam, June Sing Hong; Abramovich, Alex (CMAJ: Canadian Medical Association Journal, 2019)
The article offers information on transgender-inclusive care. Topics discussed include an information that transgender men with a cervix are less likely than cisgender women to have up-to-date Papanicolaou screening; need for discussing fertility preservation should be discussed with transgender individuals before starting hormone therapy; and recommendation for asking transgender individuals about suicidality and their mental health.
Keywords: Health Care Delivery -- Statistics and Numerical Data; Healthcare Disparities -- Statistics and Numerical Data; Male; Fertility Preservation -- Statistics and Numerical Data; Cervical Smears -- Statistics and Numerical Data; Gender Identity; Nomenclature; Documentation; Attitude of Health Personnel; Mental Health; Health Care Delivery -- Standards; Female; Attitude to Health

Genital self-mutilation in a suicide attempt: a rare sequela of a hypochondriacal delusion of infection with HIV. - Mishra, Kshirod K; Reddy, Srikanth; Khairkar, Praveen (International Journal of STD & AIDS, 2014)
Genital self-mutilation is mostly seen among psychotic, affective and gender identity disorder(s). We present here a rare case report of such genital self-mutilation in a person with a hypochondriacal delusion of infection with HIV precipitated by erroneous and anxiety-provoking miscommunication during HIV testing. Such cases remind us of the need for systematic and appropriate pre-test and post-test HIV counseling, to help prevent such outcomes.
Keywords: Antisocial Personality Disorder -- Psychosocial Factors; Delusions -- Psychosocial Factors; Genitalia; HIV Infections -- Psychosocial Factors; Hypochondriasis -- Psychosocial Factors; Injuries, Self-Inflicted -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Adult; HIV Infections -- Complications; Human; Research Subjects; Male; Self-Injurious Behavior -- Psychosocial Factors

Impact of Victimization on Risk of Suicide Among Lesbian, Gay, and Bisexual High School Students in San Francisco. - Shields, John P.; Whitaker, Kelly; Glassman, Jill; Franks, Heather M.; Howard, Kelli (Journal of Adolescent Health, 2012)
Abstract: Purpose: This study investigated the association between sexual orientation, victimization, and suicide risk-related outcomes among youth attending public high schools in San Francisco. Methods: Data from the 2009 Youth Risk Behavior Survey were analyzed using bivariate and logistic regression methods for complex samples to examine the relationship between sexual orientation, victimization, and three suicide risk-related outcomes (sadness/depression, suicide planning, and attempting suicide) while controlling for demographics and substance use. Results: Lesbian, gay, or bisexual (LGB) youth reported significantly higher rates of substance use, victimization, and suicide risk-related outcomes than heterosexual youth. However, in the controlled regression models, victimization was a significant predictor of sadness/depression and suicide attempts, regardless of sexual orientation. There was a significant interaction effect between sexual orientation and victimization on suicide planning, with heterosexual youth more affected than LGB youth. Conclusions: Results underscore the deleterious effect of victimization on suicide risk-related outcomes, regardless of sexual orientation. As LGB youth continue to report higher rates of victimization, effective violence prevention approaches must focus on reducing violence among youth, specifically LGB youth. Additional research should focus on identification of other factors that may help further explain elevated suicide risk among LGB youth.
Keywords: LGBTQ+ Persons -- Evaluation -- In Adolescence; Suicide -- Risk Factors -- In Adolescence; Students, High School -- Psychosocial Factors -- California; Victims -- Psychosocial Factors -- In Adolescence; Human; Adolescence; Male; Female; Surveys; Regression; Descriptive Statistics; California; Depression -- Epidemiology

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 & 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: Bisexuals -- Psychosocial Factors -- Japan; Gay Persons -- Psychosocial Factors -- Japan; Japanese -- Psychosocial Factors; Men -- Psychosocial Factors -- Japan; Sexual Harassment -- Japan; Suicide, Attempted -- Japan; Adolescence; Adult; Anxiety; Bivariate Statistics; Chi Square Test; Confidence Intervals; Cross Sectional Studies; Depression; Internet; Japan; Male; Multivariate Analysis; Odds Ratio; Psychological Tests; Questionnaires; Regression; Revised UCLA Loneliness Scale; Rosenberg Self Esteem Scale; Scales; State-Trait Anxiety Inventory; Human

Transgender Research in the 21st Century: A Selective Critical Review From a Neurocognitive Perspective. - Mueller, Sven C.; De Cuypere, Griet; T'Sjoen, Guy (American Journal of Psychiatry, 2017)
Gender dysphoria describes the psychological distress caused by identifying with the sex opposite to the one assigned at birth. In recent years, much progress has been made in characterizing the needs of transgender persons wishing to transition to their preferred gender, thus helping to optimize care. This critical review of the literature examines their common mental health issues, several individual risk factors for psychiatric comorbidity, and current research on the underlying neurobiology. Prevalence rates of persons identifying as transgender and seeking help with transition have been rising steeply since 2000 across Western countries; the current U.S. estimate is 0.6%. Anxiety and depression are frequently observed both before and after transition, although there is some decrease afterward. Recent research has identified autistic traits in some transgender persons. Forty percent of transgender persons endorse suicidality, and the rate of self-injurious behavior and suicide are markedly higher than in the general population. Individual factors contributing to mental health in transgender persons include community attitudes, societal acceptance, and posttransition physical attractiveness. Neurobiologically, whereas structural MRI data are thus far inconsistent, functional MRI evidence in trans persons suggests changes in some brain areas concerned with olfaction and voice perception consistent with sexual identification, but here too, a definitive picture has yet to emerge. Mental health clinicians, together with other health specialists, have an increasing role in the assessment and treatment of gender dysphoria in transgender individuals.
Keywords: Transsexualism -- Epidemiology; Mental Disorders -- Epidemiology; Mental Disorders -- Psychosocial Factors; Risk Factors; Brain -- Physiopathology; Comorbidity; Transsexualism -- Physiopathology; Clinical Assessment Tools; Questionnaires

Conflating sexual orientation and gender identity. - White, Margaret I. (British Journal of Psychiatry, 2017)
A letter to the editor is presented in response to the article about the differing the sexual orientations and gender identity and the lack of knowledge of LGBT issues among healthcare professionals.
Keywords: Gender Identity; Sexuality; Male; Female; Suicidal Ideation; Adolescence

Longitudinal predictors of past-year non-suicidal self-injury and motives among college students. - Wilcox, H. C.; Arria, A. M.; Caldeira, K. M.; Vincent, K. B.; Pinchevsky, G. M.; O'Grady, K. E. (Psychological Medicine, 2012)
BackgroundNon-suicidal self-injury (NSSI) is the deliberate and direct injuring of body tissue without suicidal intent for purposes not socially sanctioned. Few studies have examined the correlates of NSSI among young adults. This study aimed to identify predictors of lifetime and past-year NSSI, and describe motives for NSSI and disclosure of NSSI to others.MethodInterviews were conducted annually with 1081 students enrolled in the College Life Study, a prospective longitudinal study conducted at a large public mid-Atlantic university. NSSI characteristics were assessed at Year 4. Demographic and predictor variables were assessed during Years 1 to 4. Multivariate logistic regression models were used to identify correlates of lifetime NSSI and predictors of past-year NSSI.ResultsThe prevalence of past-year and lifetime NSSI was 2% and 7% respectively (>70% were female for both lifetime and past-year NSSI). Seven percent of NSSI cases self-injured once, whereas almost half self-injured six or more times. Independent predictors of past-year NSSI were maternal depression, non-heterosexual orientation, affective dysregulation and depression. Independent predictors of lifetime NSSI were depression, non-heterosexual orientation, paternal depression and female sex. One in six participants with NSSI had attempted suicide by young adulthood. The three most commonly reported motives for NSSI were mental distress, coping and situational stressors. Most (89%) told someone about their NSSI, most commonly a friend (68%).ConclusionsThis study identified unique predictors of NSSI, which should help to elucidate its etiology and has implications for early identification and interventions.
Keywords: Self-Injurious Behavior; Injuries, Self-Inflicted; Students, College; Motivation; Human; Interviews; Prospective Studies; Logistic Regression; Injuries, Self-Inflicted -- Epidemiology; Prevalence; Female; Male; Depression; Young Adult; United States; Purposive Sample; Scales; Questionnaires; Summated Rating Scaling; Data Analysis Software; Funding Source

Mental health nursing for transgender people: are we caring? - Brady, Marie; Molloy, Luke (Mental Health Practice, 2018)
Transgender people experience widespread prejudice in society and health professionals are often complicit in this discrimination. Transgender people are at a greater risk of depression, anxiety, self-harm and suicide than the majority of the population. This article presents a literature review that explores issues for mental health nursing and the care of transgender people. The literature identifies that nurses display negative assumptions about transgender people, there is a lack of appropriate education and limited evidence to support practice. Mental health nurses have extensive experience in caring for stigmatised populations; with appropriate knowledge and education, a healthcare environment can be provided that is open, welcoming and safe to transgender people, and steps can be made towards closing the gap in healthcare disparities.
Keywords: Transgender Persons -- Psychosocial Factors; Mental Disorders -- Risk Factors; Psychiatric Nursing; Nursing Role; Healthcare Disparities

Internalized homophobia: a factor in depression, anxiety, and suicide in the gay and lesbian population. - Igartua KJ; 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: Anxiety -- Risk Factors; Depression -- Risk Factors; Homophobia -- Complications; Gay Men -- Psychosocial Factors; Lesbians -- Psychosocial Factors; Mental Health; Suicide -- Risk Factors; Adult; Attitude Measures; Canada; Clinical Assessment Tools; Cognitive Therapy; Convenience Sample; Correlational Studies; Cross Sectional Studies; Descriptive Statistics; Female; Human Development; Male; Middle Age; Multiple Linear Regression; P-Value; Pearson's Correlation Coefficient; Post Hoc Analysis; Psychoanalysis; Psychological Tests; Psychotherapy; Questionnaires; Research, Mental Health; Self Concept; Shame; Stress, Psychological; Funding Source; Substance Abuse -- Psychosocial Factors; Human

Preventing Suicide in Lesbian, Gay, Bisexual, and Transgender Prisoners: A Critique of U.K. Policy. - Read, Max; McCrae, Niall (Journal of Forensic Nursing, 2016)
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Suicide -- Prevention and Control; Public Policy -- United Kingdom; United Kingdom; Correctional Facilities; Sexual Abuse; Victims -- Psychosocial Factors

Gender differences in health and risk behaviors among bisexual and homosexual adolescents. - Saewyc EM; Bearinger LH; Heinz PA; Blum RW; Resnick MD (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 (< or =14 years) and older (> or =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: Risk Taking Behavior -- In Adolescence; Bisexuality -- In Adolescence; Homosexuality -- In Adolescence; Health Behavior -- In Adolescence; Adolescence; Female; Male; Chi Square Test; Sex Factors; Questionnaires; Secondary Analysis; Scales; Funding Source; Human

FROM THE EDITOR-IN-CHIEF. A redesign for our new reality. - Bourgeois, Marc (Canadian Nurse, 2015)
An introduction is presented in which the editor discusses various reports within the issue on topics including developing cultural competence for the sexual minorities, the Supreme Court of Canada ruling on assisted suicide and challenges encountered in nursing workplace.
Keywords: Serial Publications

Leave to Intervene in Cases of Gender Identity Disorder; Normative Causation; Financial Harms and Involuntary Treatment; and the Right to Be Protected From Suicide. - Stewart, Cameron; Cockburn, Tina; Madden, Bill; Callaghan, Sascha; Ryan, Christopher (Journal of Bioethical Inquiry, 2012)
Keywords: Sexuality -- Ethical Issues; Gender Identity -- Ethical Issues; Ethics, Medical; Self Concept; Human Rights; Suicide; Mental Disorders; Consent

5.5 Youth Suicide: How Gender, Sexual Orientation, and Gender-Nonconforming Status Shape Risk and Inform Intervention Strategies. - McCauley, Elizabeth; Adrian, Molly; Curtis, Amy (Journal of the American Academy of Child & Adolescent Psychiatry, 2018)

The relation between sexual orientation and suicide attempts in austria. - Plöderl M; Kralovec K; Fartacek R (Archives of Sexual Behavior, 2010)
Keywords: Sexuality; Suicide, Attempted -- Psychosocial Factors; Adolescence; Adult; Age Factors; Aged; Aged, 80 and Over; Austria; Bisexuality; Educational Status; Female; Heterosexuality; Lesbians -- Psychosocial Factors; Lesbians -- Statistics and Numerical Data; Homosexuality; Male; Middle Age; Risk Factors; Sex Factors; Suicide, Attempted; Young Adult

Suicidal Thoughts and Behaviors Among First-Year College Students: Results From the WMH-ICS Project. - Mortier, Philippe; Auerbach, Randy P.; Alonso, Jordi; Bantjes, Jason; Benjet, Corina; Cuijpers, Pim; Ebert, David D.; Green, Jennifer Greif; Hasking, Penelope; Nock, Matthew K.; O’Neill, Siobhan; Pinder-Amaker, Stephanie; et al. (Journal of the American Academy of Child & Adolescent Psychiatry, 2018)
Objective: College entrance may be a strategically well-placed "point of capture" for detecting late adolescents with suicidal thoughts and behaviors (STB). However, a clear epidemiological picture of STB among incoming college students is lacking. We present the first cross-national data on prevalence as well as socio-demographic and college-related correlates for STB among first-year college students.Method: Web-based self-report surveys were obtained from 13,984 first-year students (response rate 45.5%) across 19 colleges in 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, and the United States).Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 32.7%, 17.5%, and 4.3%, respectively. The 12-month prevalence was 17.2%, 8.8%, and 1.0%, respectively. About three-fourths of STB cases had onset before the age of 16 years (Q3 = 15.8), with persistence figures in the range of 41% to 53%. About one-half (53.4%) of lifetime ideators transitioned to a suicide plan; 22.1% of lifetime planners transitioned to an attempt. Attempts among lifetime ideators without plan were less frequent (3.1%). Significant correlates of lifetime STB were cross-nationally consistent and generally modest in effect size (median adjusted odds ratio [aOR] = 1.7). Nonheterosexual orientation (aOR range 3.3-7.9) and heterosexual orientation with some same-sex attraction (aOR range 1.9-2.3) were the strongest correlates of STB, and of transitioning from ideation to plans and/or attempts (aOR range 1.6-6.1).Conclusion: The distribution of STB in first-year students is widespread, and relatively independent of socio-demographic risk profile. Multivariate risk algorithms based on a high number of risk factors are indicated to efficiently link high-risk status with effective preventive interventions.
Keywords: Suicidal Ideation; International Relations; Suicide, Attempted; Ethnological Research; Students -- Statistics and Numerical Data; Risk Factors; Male; Algorithms; Prevalence; Adult; Young Adult; Human; Colleges and Universities; Female; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires

Group differences in risk across three domains using an expanded measure of sexual orientation. - Loosier PS; Dittus PJ; Loosier, Penny S; Dittus, Patricia J (Journal of Primary Prevention, 2010)
The purpose of this study was to highlight associations between sexual orientation and risk outcomes in late adolescence and early adulthood using an expanded measure of sexual orientation. Recent data indicate higher levels of risk behavior in a newly identified population, mostly heterosexuals, as compared to heterosexuals. Comparisons among groups using an expanded measure of sexual orientation such as this, however, often do not include all possible groups or may restrict comparisons between groups. Data were derived from the National Longitudinal Study of Adolescent Health (Add Health); participants identified as heterosexual, mostly heterosexual, bisexual, mostly gay, or gay. Main risk outcomes were parental mistreatment, home displacement, thoughts of suicide, depressive symptoms, frequency of drinking, and delinquency. A priori planned comparisons examined differences between: (a) heterosexual vs. mostly heterosexual, (b) gay vs. mostly gay, (c) mostly heterosexual vs. bisexual, (d) mostly gay vs. bisexual, (e) mostly heterosexual vs. mostly gay, (f) heterosexual vs. gay, (g) heterosexual vs. bisexual, and (h) gay vs. bisexual. Mostly heterosexual youth were at significantly greater risk than heterosexual youth on all outcomes but did not differ from bisexual or mostly gay youth. Heterosexuals were at lower risk as compared to mostly heterosexuals and bisexuals. This study provides further evidence of differential risk associations for sexual minorities.
Keywords: Group Processes; Minority Groups -- Statistics and Numerical Data; Risk Assessment -- Methods; Sexuality; Adolescence; Adult; Data Collection; Depression -- Psychosocial Factors; Female; Homosexuality; Human; Logistic Regression; Male; Minority Groups -- Psychosocial Factors; Psychometrics; United States; Young Adult

Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse. - McAndrew, S.; Warne, T. (Journal of Psychiatric & Mental Health Nursing (Wiley-Blackwell), 2004)
McANDREW S. & WARNE T. (2004) Journal of Psychiatric and Mental Health Nursing 11, 428–434 Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse International epidemiological studies demonstrate that gay and bisexual males are four times more likely to report a serious suicide attempt than their heterosexual counterparts. Data on completed suicides, usually derived from mortality statistics misrepresent the rate of suicides among homosexual populations. However, an increasing number of studies comparing representative samples of gay, lesbian and bisexual youths with heterosexual controls demonstrate increased rates of mental health problems and subsequent suicide among the homosexual population. Homosexual orientation must therefore be considered a risk factor for mental distress and as such should be a focus for any contemporary public health agenda. One of the difficulties of addressing the problem through a public health agenda is the juxtaposition proffered by our political and social environment. The Diagnostic and Statistical Manual of Mental Disorder ceased to define homosexuality as pathological in 1973 replacing it with a new ‘illness’ of ‘gender identity disorder’. Until recently in England, Section 28 of the Local Government Act (1988), forbidding the promotion of homosexuality, further reinforced negativity towards this group of people. This compounded the negative mental health consequences for those developing a gay sexual orientation in a climate of heterosexism. Current health care policy in England concerns itself with the rising number of suicides among young people but fails to acknowledge the importance of the research findings relating to gay people by integrating them into the development of mental health policy. This paper reviews the literature relating to homosexual people and suicidality, and addresses the seriousness of a policy rhetoric which results from ignoring the evidence while dictating mental health nursing practice.

Alcohol and drug use and related consequences among gay, lesbian and bisexual college students: role of experiencing violence, feeling safe on campus, and perceived stress. - Reed E; Prado G; Matsumoto A; Amaro H; Reed, Elizabeth; Prado, Guillermo; Matsumoto, Atsushi; Amaro, Hortensia (Addictive Behaviors, 2010)
Objective: To examine differences between gay, lesbian, and bisexual (GLB) and non-GLB university students in alcohol and other drug use (AOD) and related consequences as well as the relevance of violence, perceived safety, and stress to any such differences in AOD use and related concerns.Methods: A random representative sample of university students (n=988) were recruited via email for an online survey. Linear regression models assessed associations between identifying as GLB and AOD use and related consequences.Results: Regression models (adjusted for gender) indicated that, in comparison to heterosexual students, GLB students were more likely to report recent illicit drug use (AOR=2.0; 95% CI: 1.1-3.9), more frequent negative AOD consequences (beta=5.5, SE=1.4, p<0.0001), and having seriously thought about/attempted suicide due to AOD use in the past year (AOR=6.6; 95% CI: 3.0-14.3). Study findings also suggested that violence, safety, and stress variables partially contribute to AOD use and related concerns among GLB students.Conclusions: Findings highlight the need for future efforts to investigate and address mechanisms, including aspects of campus life, which contribute to AOD related risks among GLB students.
Keywords: Alcohol Abuse; LGBTQ+ Persons; Students, College -- Psychosocial Factors; Substance Abuse; Human

Sexuality in patients with spinal cord injuries due to attempted suicide. - Lombardi G; Mondaini N; Iazzetta P; Macchiarella A; Popolo GD (Spinal Cord, 2008)
OBJECTIVE: To evaluate the specific characteristics of sexuality in spinal cord injury (SCI) patients resulting from attempted suicide pre- and post-SCI. METHODS: From March 1998 to March 2005, n=27 were compared with a SCI group with similar characteristics. In March 2006, all patients completed a final sexual check-up. Using our database we reviewed their sexuality path. RESULTS: Suicide group (SG): Examination of personal/clinical history revealed in three how sexuality represented a possible co-factor for suicidal tendencies: one female reported a history of sexual abuse, two were homosexual (one gay and one lesbian). Five reported sexual dysfunctions. Nine females consistently showed via the Female Sexual Function Index (FSFI) at least one sexual disorder in all follow-ups; six females were in a stable relationship pre-SCI, seven during the final check-up; eight males in the SG presented erectile dysfunction using the International Index of Erectile Function (IIEF5); and eight were in a stable relationship pre-SCI and seven during the final visit. Control group (CG): Pre-SCI only one male presented erectile dysfunction. Seven females consistently showed sexual disorders. 11 females and 11 males were in stable relationships pre-SCI, respectively, 10 and 11 at the final check-up. In women the overall sexual satisfaction is statistically significant, correlated to the duration of the relationship P<0.05. Nine patients showed erectile dysfunction in the final follow-up. CONCLUSIONS: The SG showed a higher percentage of sexual dysfunction pre-SCI compared with CG, and they presented constant difficulty in establishing a stable relationship causing both an obstacle in the initial sexual rehabilitation and in achieving a satisfactory overall sexual life.
Keywords: Mental Disorders -- Epidemiology; Sexual Dysfunction, Female -- Epidemiology; Sexual Dysfunction, Male -- Epidemiology; Spinal Cord Injuries -- Epidemiology; Suicide, Attempted; Adult; Causal Attribution; Comorbidity; Demography; Female; Homosexuality; Italy; Lesbians -- Psychosocial Factors; Lesbians -- Statistics and Numerical Data; Male; Mental Disorders -- Psychosocial Factors; Middle Age; Personal Satisfaction; Prevalence; Psychology; Psychosexual Disorders -- Psychosocial Factors; Sexual Partners -- Psychosocial Factors; Sexuality; Spinal Cord Injuries -- Psychosocial Factors; Substance Use Disorders -- Epidemiology; Substance Use Disorders -- Psychosocial Factors; Support, Psychosocial

Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. - Blake SM; Ledsky R; Lehman T; Goodenow C; Sawyer R; Hack T (American Journal of Public Health, 2001)
The objectives of this study were to describe the relationships between milk urea concentrations and nutritional management, production, and economic variables in commercial dairy herds. Dairy Herd Improvement (DHI) test-day milk urea data, production data, and information on ration nutrient composition and feeding management programs were collected over a 13-mo period from 53 commercial Ontario dairy herds. Economic variables included gross milk revenue, feed costs, and income over feed costs. Herd mean milk urea concentrations had a positive relationship with dietary levels of crude protein (CP), rumen degradable protein (RDP), and rumen undegradable protein (RUP) and a negative relationship with dietary levels of nonfiber carbohydrates (NFC), forage:concentrate (F:C) ratio, NFC:CP ratio, and NFC:RDP ratio. These findings are consistent with experimental studies that used chemical methods of milk urea analysis. Herd mean milk urea concentration was not associated with feeding management (e.g., total mixed rations, component feeding, feeding frequency, or synchrony of forage and concentrate feeding). Herd mean milk urea was not associated with either mean milk yield or linear score. Herd mean milk urea had a positive relationship with feed costs per cow per day but was not associated with gross milk revenue per cow per day. Herds with a high mean milk urea concentration tended to have lower income over feed costs per cow per day. High herd mean milk urea concentrations were associated with higher feed costs per kilogram of milk fat but lower gross milk revenue and lower income over feed costs per kilogram of milk fat. The results of this study demonstrate that DHI milk urea measurements produced by an infrared test method offer a useful tool for monitoring the efficiency of nitrogen utilization in commercial dairy herds. The results also suggest that diets may be balanced to achieve greater efficiency of nitrogen utilization, lower milk urea concentrations, and lower feed costs, while still achieving high milk production. This may lead to improved income over feed costs.
Keywords: Homosexuality -- In Adolescence; Risk Taking Behavior -- Prevention and Control -- In Adolescence; Bisexuality -- In Adolescence; HIV Education; School Health Services -- Evaluation; Adolescent Behavior; HIV Infections -- Prevention and Control -- In Adolescence; Funding Source; Gay Men; Lesbians; Comparative Studies; Random Sample; Students, High School; Health Educators; Massachusetts; Multi-Stage Cluster; Surveys; Risk Factors; Substance Use Disorders -- Epidemiology -- In Adolescence; Logistic Regression; Analysis of Covariance; Factor Analysis; Data Analysis Software; P-Value; Suicidal Ideation -- Epidemiology -- In Adolescence; Safety -- In Adolescence; Self Report; Sexuality -- In Adolescence; Faculty Attitudes; Adolescence; Male; Female; Human

Authors' reply. - Miranda-Mendizábal, Andrea; Alonso, Jordi (British Journal of Psychiatry, 2017)
A reply from the authors of the article about the differing the sexual orientations and gender identity and the lack of knowledge of LGBT issues among healthcare professionals is presented.
Keywords: Suicidal Ideation; Sexuality; Adolescence; Young Adult; Female; Male

Men's sexual orientation and health in Canada. - Brennan DJ; Ross LE; Dobinson C; Veldhuizen S; Steele LS; Brennan, David J; Ross, Lori E; Dobinson, Cheryl; Veldhuizen, Scott; Steele, Leah S (Canadian Journal of Public Health, 2010)
Objectives: Previous large-scale population studies have reported that gay and bisexual men may be at increased risk for health disparities. This study was conducted to determine whether health status and health risk behaviours of Canadian men vary based on sexual orientation identity.Methods: Utilizing the Canadian Community Health Survey data (Cycle 2.1, 2003; n = 49,901), we conducted multivariable logistic regression to assess the independent effects of sexual orientation on health status and health risk behaviours. For all multivariate models, we calculated odds ratios, p-values, standard errors, and 95% confidence intervals (CIs) using the bootstrap re-sampling procedure recommended by Statistics Canada.Results: When compared to heterosexual men, gay and bisexual men did not report more respiratory conditions; had lower rates of obesity and overweight BMI; and reported more mood/anxiety disorders, and a history of lifetime suicidality. Gay and bisexual men did not report higher rates of daily smoking or risky drinking, however, gay men reported an almost six-fold increase in STD diagnoses when compared to heterosexual men.Conclusion: This study represents the largest-known population-based data analysis on health risks and behaviours among men of varying sexual orientations. These findings raise important concerns regarding the impact of sexual orientation on mental and sexual health. Limitations of this data set, including those associated with measurement of sexual orientation, are discussed. Further research is required to understand the mechanisms that influence these health resiliencies and disparities.
Keywords: Health Status; Risk Taking Behavior; Sexuality; Adult; Bisexuality; Canada; Cross Sectional Studies; Homosexuality; Human; Interviews; Logistic Regression; Male; Middle Age

Lesbian, gay, bisexual, sexual-orientation questioning adolescents seeking mental health services: risk factors, worries, and desire to talk about them. - Ciro D; Surko M; Bhandarkar K; Helfgott N; Peake K; Epstein I (Social Work in Mental Health, 2005)
Lesbian, gay, bisexual, and sexual-orientation questioning (LGBQ) adolescents have many of the same health needs as straight adolescents. In addition, they must learn to manage a stigmatized identity that may create confusion, anxiety, and emotional turbulence for them. Beyond stigma, LGBQ youth are often found to be at higher risk for substance abuse, violence, depression, suicide, and sexual health problems. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this article examines the relationship between sexual identity and risk factors related to safety, health, sex, substance use, family and friends, worries, and their desire to talk about these in counseling. Findings indicate that LGBQ youth are at higher risk than straights, and express greater desire to talk about substance use, health, their personal lives, and their friends. Mental health practitioners working with these young persons must properly assess and address their risks by creating a sense of community and safe environment for open discussion.
Keywords: Bisexuals -- In Adolescence; Gay Men -- In Adolescence; Lesbians -- In Adolescence; Adolescence; Female; Gender Identity; Help Seeking Behavior; Male; Mental Health Services; New York; Questionnaires; Risk Factors; Risk Taking Behavior; Self Assessment; Self Report; Substance Abuse; Urban Areas; Human

Self-Harming Thoughts and Behaviors in a Group of Children and Adolescents with Gender Dysphoria. - Skagerberg, Elin; Parkinson, Rachel; Carmichael, Polly (International Journal of Transgenderism, 2013)
This article presents the findings from an audit on self-harm in 125 children and adolescents referred to the Gender Identity Development Service in London. Data concerning self-harming thoughts and behaviors before attending the service were extracted from documents in the patient files and from clinician reports. The findings indicated that suicide attempts and self-harming were more common over the age of 12. Overall, thoughts of self-harm were more common in the natal males whereas actual self-harm was more common in the natal females. The number of suicide attempts did not differ significantly between the two genders. The implications of these findings are discussed. Limitations of the study are also discussed which include that the data was only collected over an 8-month period and that it was extracted from patient files and from clinician reports.
Keywords: Self-Injurious Behavior -- Epidemiology -- United Kingdom; Sexual and Gender Disorders -- Complications; Cognition Disorders -- Epidemiology -- United Kingdom; Human; Audit; Record Review; United Kingdom; Data Analysis Software; Descriptive Statistics; Male; Female; Child; Adolescence; Chi Square Test

Perceptions of lesbian, gay and bisexual people of primary healthcare services. - Neville, Stephen; Henrickson, Mark (Journal of Advanced Nursing (Wiley-Blackwell), 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.

Understanding suicide among sexual minority youth in America: An ecological systems analysis. - Hong JS; Espelage DL; Kral MJ (Journal of Adolescence, 2011)
Keywords: Homosexuality; Minority Groups; Suicide -- Ethnology; Suicide -- Psychosocial Factors; Adolescence; Female; Male; Models, Theoretical; Risk Factors; United States; Young Adult

Achieving standardised reporting of suicide in Australia: rationale and program for change. - De Leo D; Dudley MJ; Aebersold CJ; Mendoza JA; Barnes MA; Harrison JE; Ranson DL; De Leo, Diego; Dudley, Michael J; Aebersold, Caroline J; Mendoza, John A; Barnes, Michael A; et al. (Medical Journal of Australia, 2010)
Suicide and intentional self-harm are issues of major importance in public health and public policy, with rates widely used as progress indicators in these areas. Accurate statistics are vital for appropriately targeted prevention strategies and research, costing of suicide and to combat associated stigma. Underreporting of Australian suicide rates probably grew from 2002 to 2006; Australian Bureau of Statistics (ABS) suicide data were at least 11% or 16% undercounted (depending on case definitions) in 2004. In coronial cases with undetermined intent for 2005 to 2007, intentional self-harm was found in 39%. Systemic reasons for undercounting include: (i) absence of a central authority for producing mortality data; (ii) inconsistent coronial processes for determining intent, as a result of inadequate information inputs, suicide stigma, and high standards of proof; (iii) collection and coding methods that are problematic for data stakeholders; and (iv) lack of systemic resourcing, training and shared expertise. Revision of data after coronial case closure, beginning with ABS deaths registered in 2007, is planned and will reduce undercounting. Other reasons for undercounting, such as missing or ambiguous information (eg, single-vehicle road crashes, drowning), differential ascertainment (eg, between jurisdictions), or lack of recorded information on groups such as Indigenous people and gay, lesbian, bisexual and transgender people require separate responses. A systemic coordinated program should address current inaccuracies, and social stigma about suicide and self-harm must be tackled if widespread underreporting is to stop.
Keywords: Coroners and Medical Examiners -- Statistics and Numerical Data; Death Certificates; Coding -- Administration; Coding -- Statistics and Numerical Data; Statistics; Suicide; Adolescence; Adult; Aged; Aged, 80 and Over; Australia; Data Collection Methods; Data Collection; Data Collection -- Trends; Female; Coding -- Trends; Documentation -- Statistics and Numerical Data; Human; Male; Middle Age; Self-Injurious Behavior -- Epidemiology; Suicide -- Trends; Young Adult

Summing Up an Excellent Year. - Thomas, Sandra P. (Issues in Mental Health Nursing, 2018)
An introduction to the journal is presented in which the editors discusses various reports in the issue on the topics including one on LGBT mental health, depressive symptoms and suicidal ideation among Irish undergraduate college students and low-income African Americans with depressive symptoms.
Keywords: Psychiatric Nursing; Awards and Honors; Personnel Recruitment; Professional Recognition; Serial Publications; Cultural Competence; Psychotherapy

The lifetime prevalence of psychiatric diagnoses in an academic gender reassignment service. - Grobler, Gerhard P. (Current Opinion in Psychiatry, 2017)
Purpose Of Review: To review the literature regarding the prevalence of mental health concerns, including psychiatric diagnoses in the TGNC community.Recent Findings: Gender dysphoria is not the only mental health concern experienced by some members of TGNC people. Stigma and discrimination play a role in the development of mental health concerns. Even after reassignment surgery some members of the TGNC community is almost five times more likely to attempt suicide. Using a structured clinical psychiatric interview improves the likelihood of recognizing the presence of psychiatric diagnoses. Nonaffirming attitudes and behavior seem to predispose to psychiatric symptoms in some members of the TGNC community and impacts on family and peer relationships. Psychiatric symptoms are often hidden for fear of further discrimination.Summary: A significant proportion of the TGNC community present with mental health concerns. Clinicians should screen appropriately for these concerns. Gender affirming interventions generally have an efficacious effect.
Keywords: Gender Affirmation Surgery -- Psychosocial Factors; Suicide -- Prevention and Control; Psychological Techniques; Prevalence; Mental Health; Questionnaires; Scales

Depression and Suicidality in the Transgender Community. - McElligott, Margaret O. (DNA Reporter, 2018)
Keywords: Transgender Persons -- Psychosocial Factors -- United States; Depression; Suicidal Ideation; Social Attitudes; Discrimination -- Psychosocial Factors -- United States; United States; Attitude of Health Personnel -- United States; Refusal to Treat -- Psychosocial Factors

Mental health in sexual minorities: Recent indicators, trends, and their relationships to place in North America and Europe. - Lewis NM (Health & Place, 2009)
This meta-analysis featuring 12 national adult studies and 16 state/regional youth studies of sexuality and mental health finds that sexual minorities-as a likely consequence of place-contingent minority stress-experience mental health outcomes such as depression, anxiety, and suicide ideation much more frequently than their heterosexual counterparts. By interrogating the geographic variations in the findings, such as high rates of poor mental health outcomes in the United Kingdom, large gay-heterosexual disparities in the Netherlands, and lower and improving rates of both outcomes and risk factors in Vermont and British Columbia, this study asserts that policy regimes, health programming, and the ways in which sexual minorities are constructed in places all contribute to their mental health.
Keywords: Mental Disorders -- Etiology; Sexuality; Adult; Bisexuality; Ethnological Research; Europe; Female; Heterosexuality; Lesbians -- Psychosocial Factors; Homosexuality; Human; Male; Mental Disorders -- Epidemiology; Mental Disorders; North America; Prevalence; Risk Taking Behavior; Suicide, Attempted -- Psychosocial Factors

The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. - Díaz RM; Ayala G; Bein E; Henne J; Marin BV (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 nonheterosexual) 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: Homosexuality; Bisexuality; Poverty; Mental Health; Gay Men -- Psychosocial Factors; Hispanic Americans -- Psychosocial Factors; Mental Disorders; Prejudice; Funding Source; Probability Sample; Florida; California; New York; Suicidal Ideation; Anxiety; Depression; Support, Psychosocial; Fieldwork; Anthropology, Cultural; Sampling Methods; Interviews; Scales; Coefficient Alpha; Stress, Psychological -- Epidemiology; Prevalence; Chi Square Test; Confidence Intervals; P-Value; Linear Regression; Models, Theoretical; Self Concept; Male; Adult; Human

Breaking the Silence: Supporting Intimate Relationships for Our Wounded Troops and Their Partners: A Call to Action. - Satcher, David; Tepper, Mitchell S.; Thrasher, Christian; Rachel, Sharon A. (International Journal of Sexual Health, 2012)
Wounded troops in the wars in Iraq and Afghanistan are surviving their injuries at greater rates now than in all previous major American wars, and our returning troops face physical, mental, and sexual health challenges when trying to build and re-establish intimate relationships. We are seeing relationship difficulties like intimate partner violence, child abuse, divorce, partners taking on care giving roles, higher incidence of risky sexual behaviors among single veterans, and special challenges faced by women and gay and lesbian soldiers. Healthy intimate relationships can contribute to a person's recovery from physical and mental trauma, while a lack of them can contribute to ongoing mental health problems and even suicide. Fortunately, we now see greater availability and acceptance of mental health services and resources for supporting intimate relationships in the military.
Keywords: Veterans; Sexual Health; Support, Psychosocial -- Evaluation; Male; Female; LGBTQ+ Persons; Intimate Partner Violence; Child Abuse; Stress Disorders, Post-Traumatic -- Epidemiology; Caregivers

70 U.S. veterans with gender identity disturbances: a descriptive study. - McDuffie E; Brown GR (International Journal of Transgenderism, 2010)
This study describes the largest population of veterans referred for a gender identity disorder (GID) evaluation. Most were self-referred, others were referred by their commanding officer. A search of the English language literature revealed no similar studies on veterans other than a pilot project by the second author. Methods: Retrospective descriptive data were obtained from chart reviews of 70 U.S. veterans who were evaluated by the second author for gender disturbances over a 20-year period (1987 to 2007). The modal veteran with gender identity disturbance was a natal male (91%) identifying as female, >40 years old, Caucasian, employed, with more than 12 years of education. Fifty-seven percent were parents with a history of sexual involvement with opposite sex individuals. Histories of autogynephilia were not elicited in vets interviewed since 1997. Classic 'flight into hypermasculinity' was described by a majority of the natal male vets as a retrospective understanding of why they joined the military. Psychiatric comorbidities (43%) included post traumatic stress disorder (PTSD), depression, schizophrenia (N = 1), substance use disorders (17%), dissociative identity disorder (N = 1), and personality disorders (11%). Ninety-three percent met criteria for diagnosis of GID or GID not otherwise specified; suicidal ideation was reported by 61% with one or more suicide attempts by 11% of 56 responding; and 4% reported genital self-harm. Although 11% expressed active thoughts of surgical self-treatment, most expressed a desire for physician-performed sex reassignment surgery (SRS). Cross-dressing behaviors were common, and currently reported arousal with cross-dressing was reported by 13%, 63% of whom were not diagnosed with GID. Conclusion: Veterans often reported that they joined the military in an attempt to purge their transgender feelings, believing the military environment would 'make men' of them. Most were discharged before completing a 20-year career. More than half received health care at veterans affairs medical centers, often due to medical or psychiatric disabilities incurred during service. Comorbid Axis I diagnoses were common, as were suicidal thoughts and behaviors.
Keywords: Gender Identity; Transgender Persons -- Psychosocial Factors; Transsexualism; Veterans -- Psychosocial Factors -- United States; Adult; Aged; Comorbidity; Descriptive Research; Diagnosis, Psychosocial; Female; Human; Male; Middle Age; Record Review; Retrospective Design; Self Report; Transsexualism -- Diagnosis; United States; Videorecording

Same-Sex Marriage, Sexuality, Suicide. - S. S. N. (Journal of Developmental & Behavioral Pediatrics, 2017)

Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. - D'Augelli AR; Grossman AH (Journal of Interpersonal Violence, 2001)
This study examined the lifetime victimization based on sexual orientation of 416 lesbian, gay, or bisexual (LGB) older adults aged 60 or older. Participants reported the ages at which they were aware of their sexual orientation, self-identified as LGB, and first disclosed their sexual orientation to anyone. Frequencies of nine kinds of verbal and physical victimization were obtained. Nearly three quarters reported some kind of sexual orientation victimization. Men reported more overall victimization than women. The more open participants were about their sexual orientation and the less time they spent before disclosing their sexual orientation, the more victimization they reported. Physical victimization was associated with earlier achievement of sexual orientation milestones and more time being open about one's sexual orientation. Participants who had been physically attacked reported lower self-esteem, more loneliness, and poorer mental health than others. More suicide attempts were reported among those older adults who were physically attacked.
Keywords: Gay Men; Bisexuals; Lesbians; Mental Health; Victims; Survey Research; Questionnaires; Descriptive Statistics; Chi Square Test; P-Value; Rosenberg Self Esteem Scale; Research Instruments; T-Tests; Analysis of Variance; Middle Age; Aged; Aged, 80 and Over; Male; Female; Human

IMPROVED HEALTH CARE FOR SEXUAL MINORITY AND TRANSGENDER VETERAN...References 1. Blosnich JR, Bossarte RM, Silenzio VM. Suicidal ideation among sexual minority veterans: results from the 2005-2010 Massachusetts Behavioral Risk Factor References 1. Blosnich JR, Bossarte RM, Silenzio VM. Suicidal ideation among sexual minority veterans: results from the 2005-2010 Massachusetts Behavioral Risk Factor References 1. Blosnich JR, Bossarte RM, Silenzio VM. Suicidal ideation among sexual minority veterans: results from the 2005-2010 Massachusetts Behavioral Risk Factor References 1. Blosnich JR, Bossarte RM, Silenzio VM. 'Suicidal ideation among sexual minority veterans: results from the 2005-2010 Massachusetts Behavioral Risk Factor Surveillance Survey' Am J Public Health. 2012;102: S44---S47. - Lutwak, Nancy; Dill, Curt; Blosnich, John R.; Bossarte, Robert M.; Silenzio, Vincent M. B. (American Journal of Public Health, 2012)
Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www.editorialmanager. com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu.
Keywords: Minority Groups; Veterans; LGBTQ+ Persons; Suicidal Ideation; Self Concept; Discrimination -- Prevention and Control; Health Services Needs and Demand; United States Department of Veterans Affairs; Health Services Accessibility; Health Status Disparities; Organizational Policies

Preventing bullycides: the school nurse's role in breaking the link between victimization of sexual minority youth and suicide. - Reynolds, Dave V. D. (NASN School Nurse, 2011)
Keywords: Bullying -- Prevention and Control -- In Adolescence; Bullying -- Prevention and Control -- In Infancy and Childhood; LGBTQ+ Persons -- In Adolescence; LGBTQ+ Persons -- In Infancy and Childhood; School Health Nursing; Suicide -- Prevention and Control -- In Adolescence; Suicide -- Prevention and Control -- In Infancy and Childhood; Adolescence; Bullying -- Risk Factors; Child; Documentation; Female; Gender Identity; LGBTQ+ Persons -- Organizations; Learning Environment; Male; Minority Groups; Sex Factors; Sexuality; Suicidal Ideation; Suicide -- Risk Factors; Telephone Information Services

Children and Adolescents With Gender Identity Disorder Referred to a Pediatric Medical Center. - Spack, Norman P.; Edwards-Leeper, Laura; Feldman, Henry A.; Leibowitz, Scott; Mandel, Francie; Diamond, David A.; Vance, Stanley R. (Pediatrics, 2012)
OBJECTIVES: To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients. METHODS: Data gathered on 97 consecutive patients <21 years, with initial visits between January 1998 and February 2010, who fulfilled the following criteria: long-standing cross-gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity. RESULTS: Genotypicmale:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (/> = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 ± 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%). CONCLUSIONS: After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation.
Keywords: Gender Identity; Sexual and Gender Disorders -- Diagnosis; Sexual and Gender Disorders -- Therapy; Human; Male; Female; Child; Adolescence; Hormone Therapy; Psychotherapy; Massachusetts; Adult; Data Analysis Software; Mann-Whitney U Test; Fisher's Exact Test; Puberty; Interviews; Child, Preschool; Mental Health

Smoking and Behavioral Health of Women. - Jessup, Martha A.; Dibble, Suzanne L.; Cooper, Bruce A. (Journal of Women's Health (15409996), 2012)
Background: Using data from a study of reliability and validity of a screening tool for co-occurring substance abuse and mental health problems, our objective was to compare behavioral health issues of female smokers and nonsmokers and explore correlates of smoking. Methods: Using a convenience sample ( n=1021), we recruited participants to complete an online survey conducted in substance abuse treatment, primary care, mental health services, senior, and public settings. The survey included demographic questions, smoking status, the co-occurring disorders screening tool, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) and the Postraumatic Stress Disorder Checklist (PCL)-Civilian. Results: One third of participants self-identified as smokers, and African American, American Indian, and bisexual women reported the highest rates of smoking. Seventy-two percent of women reported at least one mental health problem in the past year; 29% had a past year substance abuse problem, and 26% reported a past year co-occurring disorder of both. Smokers had significantly higher rates of posttraumatic stress disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders. Smokers also had significantly higher rates of lifetime intimate partner violence (IPV) and childhood abuse. Conclusions: Smoking in women was associated with significantly higher rates of mental health and substance abuse problems. Substance abuse, being in a treatment setting, IPV, African American and mixed ethnicity, Medicaid insurance status, reduced income, and no home ownership were identified as predictors of smoking. Screening and evaluation of smoking status, mental health, substance use disorders, and the presence and impact of violence are essential for women's health.
Keywords: Women's Health; Smoking -- Psychosocial Factors; Smoking -- Risk Factors; Mental Disorders -- Complications; Health Behavior; Human; California; Female; Adolescence; Young Adult; Adult; Middle Age; Convenience Sample; Clinical Assessment Tools; Coefficient Alpha; T-Tests; Chi Square Test; Descriptive Statistics; Analysis of Variance; Logistic Regression; Funding Source

Hope and resilience in suicide ideation and behavior of gay and bisexual men following notification of HIV infection. - Siegel K; Meyer IH (AIDS Education & 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 prompting 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: Suicide, Attempted -- Psychosocial Factors; Morale; HIV Infections -- Diagnosis; HIV Infections -- Psychosocial Factors; Gay Men -- Psychosocial Factors; Adaptation, Psychological; Bisexuality; Symbolism (Psychology); Questionnaires; New York; Locus of Control; Attitude to AIDS; Attitude to Death; Goals and Objectives; P-Value; Funding Source; Adult; Male; Human

Assisted dying: promoting a palliative care approach. A response to Gay Lee. - Connolly, Michael P.; Larkin, Philip J. (International Journal of Palliative Nursing, 2011)
Keywords: Palliative Care; Patient Autonomy; Suicide, Assisted

Nonsuicidal Self-Injury Among Lesbian, Gay, Bisexual, and Transgender Populations: An Integrative Review...28th Annual Scientific Session, June 2-6, 2017, Baltimore, Maryland. - Jackman, Kate; Honig, Judy; Bockting, Walter (Nursing Research, 2016)
Background: Nonsuicidal self-injury (NSSI), defined as intentional injury to the body's surface without intent to die, is a significant mental health concern among adolescents and adults. Mental health disparities in LGBT populations, including anxiety, depression, and suicidality, have been documented in the scientific literature. However to date, there has not been a synthesis of research findings about NSSI among LGBT populations. This integrative review of the literature will contribute to a deeper understanding of the problem, provide a basis for further investigation, and inform development of clinical interventions. Purpose: The purpose of the research was to conduct an integrative review of NSSI among LBGT populations. By integrating qualitative and quantitative research findings, the aims were to better understand the prevalence of NSSI among LGBT populations, to identify the LGBT subgroups at increased risk for NSSI, and to examine the risk factors associated with NSSI in LBGT populations. Methods: A literature search of eleven on-line databases was conducted of manuscripts published through April 2015 with no starting date limit. Keywords were used to identify manuscripts about LGBT populations and NSSI. Inclusion criteria required that a definition of NSSI consistent with the DSM-5 criteria was used. Results: After screening by title, abstract, and full text, 26 articles met inclusion criteria for this review. The literature synthesized demonstrates a consistent pattern of increased prevalence of NSSI among sexual and gender minority populations compared to heterosexual peers. Additionally, this body of literature indicates LGBT subgroups who appear to be at increased risk include people who do not identify within the gender binary (e.g. genderqueer individuals) or sexual orientation binary (e.g. bisexual individuals or people who are questioning their sexual orientation). Factors contributing to vulnerability for NSSI are LGBT-specific victimization and harassment, lack of family support, self-punishment, and stress related to concealment of a sexual and/or gender minority identity. Conclusions/Implications: The strong link between NSSI and LGBT populations can be applied in nursing practice. Clinical nurses should screen for NSSI in sexual and gender minority patients. Comprehensive assessment of patients presenting with NSSI may lead to identification of modifiable risk factors which can be addressed through nursing interventions. It is recommended that nurse researchers and clinicians take an active role in developing and implementing evidenced-based tailored interventions to reduce the higher vulnerability to NSSI among LGBT populations.
Keywords: Research, Nursing -- Organizations; Quality of Nursing Care; Congresses and Conferences -- Maryland; Maryland

Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior. - Bontempo DE; D'Augelli AR (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.
Keywords: Gay Persons -- Psychosocial Factors -- In Adolescence; Risk Taking Behavior -- In Adolescence; Victims -- Psychosocial Factors -- In Adolescence; Adolescence; Analysis of Variance; Bisexuals -- In Adolescence; Chi Square Test; Female; Funding Source; Health Behavior -- In Adolescence; Gay Men -- In Adolescence; Lesbians -- In Adolescence; Male; Massachusetts; Schools; Vermont; Human

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

Sexual Minority Status, Abuse, and Self-Harming Behaviors among Incarcerated Girls. - Belknap, Joanne; Holsinger, Kristi; Little, Jani (Journal of Child & Adolescent Trauma, 2012)
Keywords: Juvenile Offenders -- Psychosocial Factors; Women's Health; LGBTQ+ Persons -- In Adolescence; Injuries, Self-Inflicted -- In Adolescence; Child Abuse Survivors; Human; Colorado; Female; Adolescence; Minority Groups; Funding Source; Self Report; Questionnaires; Suicide -- Risk Factors; Chi Square Test; T-Tests; Logistic Regression; Models, Theoretical

Health disparities between lesbian, gay, and bisexual adults and the general population in South Korea: Rainbow Connection Project I. - Yi, Horim; Lee, Hyemin; Park, Jooyoung; Choi, Bokyoung; Kim, Seung-Sup (Epidemiology & Health, 2017)
Objectives: This study aims to investigate health disparities between lesbian, gay, and bisexual (LGB) adults and the general population in Korea, where there is low public acceptance of sexual minorities and a lack of research on the health of sexual minorities.Methods: The research team conducted a nationwide survey of 2,335 Korean LGB adults in 2016. Using the dataset, we estimated the age-standardized prevalence ratios (SPRs) for poor self-rated health, musculoskeletal pain, depressive symptoms, suicidal behaviors, smoking, and hazardous drinking. We then compared the SPRs of the LGB adults and the general population which participated in three different nationally representative surveys in Korea. SPRs were estimated for each of the four groups (i.e., gay men, bisexual men, lesbians, and bisexual women).Results: Korean LGB adults exhibited a statistically significantly higher prevalence of depressive symptoms, suicidal ideation and attempts, and musculoskeletal pain than the general population. Lesbian and bisexual women had a higher risk of poor self-rated health and smoking than the general women population, whereas gay and bisexual men showed no differences with the general men population. Higher prevalence of hazardous drinking was observed among lesbians, gay men, and bisexual women compared to the general population, but was not observed in bisexual men.Conclusions: The findings suggest that LGB adults have poorer health conditions compared to the general population in Korea. These results suggest that interventions are needed to address the health disparities of Korean LGB adults.

Sexual minority youth, social connection and resilience: From personal struggle to collective identity. - DiFulvio, Gloria T. (Social Science & Medicine, 2011)
Abstract: Sexual minority youth are at increased risk for negative health outcomes including substance abuse, depression, anxiety, and suicide. Researchers suggest that sexual orientation victimization is a predictor of such outcomes. Social connectedness—or the importance of belonging where youth perceive they are cared for and empowered within a given context—has been associated with positive youth outcomes. This qualitative study utilized life story methodology. Life stories are considered to be important expressions of one’s identity and are shaped by personal, social, and cultural contexts. Twenty-two interviews were conducted with 15 young people ranging in age from 14 to 22 years. Two focus groups with youth were also conducted. Youth were recruited from rural and urban communities in Massachusetts. This study contributes to the literature on resilience by including the voices of sexual minority youth and explores the meaning of social connection in their lives. Youth discuss the ways in which individual connection and group affiliation served to affirm one’s identity, and provided a forum for moving personal struggle to collective action. The findings suggest the need to reconceptualize consequences of disconnection (such as depression or suicide) from individual pathology and attend to these consequences as a response to discrimination and stigma. Implications for these findings and areas for future research are discussed.
Keywords: Minority Groups -- Psychosocial Factors; Hardiness; Social Identity; Social Behavior; Discrimination; LGBTQ+ Persons -- Psychosocial Factors; Human; Interviews; Adolescence; Adult; Life Experiences; Male; Female; Focus Groups; Attitude to Sexuality

Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health. - Ratner PA; Johnson JL; Shoveller JA; Chan K; Martindale SL; Schilder AJ; Botnick MR; Hogg RS; Ratner, Pamela A; Johnson, Joy L; Shoveller, Jean A; Chan, Keith; et al. (Patient Education & 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.
Keywords: Gay Men; Mental Disorders; Rape; Adult; Affective Disorders; Alcohol Abuse; Bisexuals; British Columbia; Center for Epidemiological Studies Depression Scale; Child Abuse, Sexual; Coefficient Alpha; Correlational Studies; Exploratory Research; Male; Prevalence; Psychological Tests; Questionnaires; Rosenberg Self Esteem Scale; Self Concept; Suicidal Ideation; Human

Sexual minority youth perspectives on the school environment and suicide risk interventions: a qualitative study. - Rutter PA; Leech NL (Journal of Gay & Lesbian Issues In Education, 2006)
This qualitative study explored the experiences of five gay, lesbian, and bisexual adolescents' perspectives on their schools' acceptance of their sexual orientation, and perceptions of these schools' approach to suicide risk intervention. Focus groups were tape recorded, transcribed, and analyzed through constant comparative analysis. Themes that emerged from the data included participants feeling judged by school counselors and teachers, feeling unsafe at school, and concerned about school staff's response to suicide risk and interventions. Implications for school counselors, teachers and administrators are discussed.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Minority Groups -- In Adolescence; Suicide -- Prevention and Control -- In Adolescence; Suicide -- Risk Factors -- In Adolescence; Adolescence; Audiorecording; Constant Comparative Method; Counselors; Faculty-Student Relations; Female; Focus Groups; Gender Identity; Homophobia; Learning Environment; Male; Professional-Student Relations; Qualitative Studies; Semi-Structured Interview; Student Experiences; Teachers; Human

Suicide Risk among Lesbian, Gay, Bisexual, and Transgender Military Personnel and Veterans: What Does the Literature Tell Us? - Matarazzo, Bridget B; Barnes, Sean M; Pease, James L; Russell, Leah M; Hanson, Jetta E; Soberay, Kelly A; Gutierrez, Peter M (Suicide & Life-Threatening Behavior, 2014)
Research suggests that both the military and veteran and the lesbian, gay, bisexual, and transgender (LGBT) populations may be at increased risk for suicide. A literature review was conducted to identify research related to suicide risk in the LGBT military and veteran populations. Despite the paucity of research directly addressing this issue, themes are discussed evident in the literature on LGBT identity and suicide risk as well as LGBT military service members and veterans. Factors such as social support and victimization appear to be particularly relevant. Suggestions are made with respect to future research that is needed on this very important and timely topic.
Keywords: Military Personnel -- Psychosocial Factors; Sexuality; Suicide; Transgender Persons -- Psychosocial Factors; Veterans -- Psychosocial Factors; Adolescence; Adult; Bisexuality; Female; Lesbians -- Psychosocial Factors; Homosexuality; Male; Middle Age; Risk Assessment; Young Adult

Are transgender persons at higher risk for HIV than other sexual minorities? A comparison of HIV prevalence and risks. - Bockting W; Huang C; Ding H; Robinson B; Rosser BRS (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.
Keywords: Gender Identity -- Classification; HIV Infections -- Epidemiology; HIV Infections -- Risk Factors; Risk Taking Behavior; Sexual Health; Adolescence; Adult; Analysis of Variance; Attitude to Risk; Chi Square Test; Comparative Studies; Data Analysis Software; Depression; Descriptive Statistics; Funding Source; Minnesota; Odds Ratio; Questionnaires; Regression; Sexual Partners; Substance Abuse; Suicidal Ideation; Summated Rating Scaling; Human

The relationship between suicide risk and sexual orientation: results of a population-based study. - Remafedi G; French S; Story M; Resnick MD; Blum R (American Journal of Public Health, 1998)
OBJECTIVES: This study examined the relationship between sexual orientation and suicide risk in a population-based sample of adolescents. METHODS: Participants were selected from a cross-sectional, statewide survey of junior and senior public high school students. All males (n = 212) and females (n = 182) who described themselves as bisexual/homosexual were compared with 336 gender-matched heterosexual respondents on three outcome measures: suicidal ideation, intent, and self-reported attempts. Logistic regression analyses were used to examine the association between sexual orientation and outcome measures with adjustment for demographic characteristics. RESULTS: Suicide attempts were reported by 28.1 % of bisexual/homosexual males, 20.5% of bisexual/homosexual females, 14.5% of heterosexual females, and 4.2% of heterosexual males. For males, but not females, bisexual/homosexual orientation was associated with suicidal intent (odds ratio [OR] = 3.61 95% confidence interval [CI = 1.40, 9.36) and attempts (OR=7.10; 95% CI=3.05, 16.53). CONCLUSIONS: There is evidence of a strong association between suicide risk and bisexuality or homosexuality in males.
Keywords: Sexuality; Suicide; Risk Factors; Students, High School; Funding Source; Population-Based Case Control; Cross Sectional Studies; Bisexuality; Homosexuality; Heterosexuality; Logistic Regression; Odds Ratio; Minnesota; Comparative Studies; Summated Rating Scaling; Surveys; Chi Square Test; Sex Factors; P-Value; Adolescence; Male; Female; Human

Eligibility and readiness criteria for sex reassignment surgery: recommendations for revision of the WPATH Standards of Care. - De Cuypere G; Vercruysse H Jr. (International Journal of Transgenderism, 2009)
In a review of the literature on follow-up studies of sex reassignment surgery (SRS) with regard to regret, suicide, and prognosis, this article evaluates the eligibility and readiness criteria of the WPATH Standards of Care-Sixth Version. Because the literature shows a lack of high-quality follow-up studies on large numbers of operated transsexuals, it offers no evidence-based research above evidence Level B or Level C. Nevertheless, our review allows us to conclude that most of the eligibility criteria are evidence-based. Although psychiatric co-morbidity is consistently mentioned in the literature as a negative predictive factor, it is barely addressed in the eligibility and readiness criteria for SRS. Therefore this paper suggests some changes and a shift in emphasis in the eligibility and readiness criteria of the Standards of Care.
Keywords: Health Services -- Standards; Medical Practice, Evidence-Based; Outcomes (Health Care); Practice Guidelines; Professional Organizations; Transgender Persons -- Psychosocial Factors; Transsexualism -- Surgery; Age Factors; Embase; Human; Independent Variable; Medline; Outcomes (Health Care) -- Evaluation; Patient Compliance; Professional Competence; Psychotherapy; Suicide; Systematic Review

Health of lesbian, gay, bisexual, and transgender youth. - Stevens PE; Morgan S (Journal of Child & Family Nursing, 1999)
Keywords: Homosexuality -- In Adolescence; Education, Continuing (Credit); Homophobia -- In Adolescence; Health Services; Lesbians -- In Adolescence; Patient Advocacy; Gay Men -- In Adolescence; Bisexuals -- In Adolescence; Adolescent Behavior; Truth Disclosure -- In Adolescence; Family Relations; Peer Group -- In Adolescence; Suicide, Attempted -- In Adolescence; Runaways -- In Adolescence; HIV Infections -- In Adolescence; Information Resources; Adolescence

Odds ratios for suicide attempts among gay and bisexual men...Paul PJ, Catania J, Pollack L, et al. Suicide attempts among gay and bisexual men: lifetime prevalence and antecedents. Am J Public Health. 2002;92:1338-1345 - Pierce B; Paul JP (American Journal of Public Health, 2003)
Keywords: Gay Men -- Psychosocial Factors; Odds Ratio; Suicide -- Epidemiology -- United States; Suicide -- Risk Factors; Age Factors; Confidence Intervals; Data Analysis, Statistical; United States

Transgender Youth: The Building Evidence Base for Early Social Transition. - Turban, Jack L. (Journal of the American Academy of Child & Adolescent Psychiatry, 2017)
The article focuses on transgender youths whose gender identity does match with their assigned gender who are coming exceedingly in touch with mental health providers because they suffer from depression, anxiety, and suicidal tendency. Topics include transgender adolescents receiving puberty blockers and inter sex hormones as expressed by the World Professional Association of Transgender Health Standards of Care10 and 2009 Endocrine Society.
Keywords: Mental Health; Adolescence; Questionnaires; Social Readjustment Rating Scale

Violence and sexual minority youth. - Lock J (Journal of School Violence, 2002)
Among the most maligned and harassed students in high schools are those who are perceived not to fit the norms for sexual behavior. These include gay and lesbian students, bisexual students, transgendered students, effeminate heterosexual males, and masculine-acting heterosexual females. Together these students are the targets of a wide range of negative behaviors from subtle exclusion to physical assault. In addition, many develop negative attitudes towards themselves which put them at increased risk for self-harm and suicide. The origin of these attitudes and behaviors is societal homophobia that fuels social aggression against this stigmatized group. Although challenging, educators can assist in undermining the effects of homophobia on sexual minorities through teaching tolerance, sponsoring support groups that address these issues, and providing educational opportunities about sexual minority youth.
Keywords: Gay Persons -- In Adolescence; Schools -- Psychosocial Factors; Violence -- Psychosocial Factors; Adolescence; Homophobia; Self Concept; Students, High School

Adolescent sexual orientation and suicide risk: evidence from a national study. - Russell ST; 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: Adolescent Psychology; Gender Identity -- In Adolescence; Suicide -- Risk Factors -- In Adolescence; Sexuality -- In Adolescence; Bisexuality; Homosexuality; Heterosexuality; Cluster Sample; Students, High School; Students, Middle School; Child; Adolescence; Data Collection, Computer Assisted; Interviews; Surveys; Depression -- Complications; Hopelessness; Psychological Tests; Center for Epidemiological Studies Depression Scale; Descriptive Statistics; Confidence Intervals; Logistic Regression; Odds Ratio; Suicidal Ideation -- Epidemiology -- In Adolescence; Suicide, Attempted -- Epidemiology -- In Adolescence; Sex Factors; Male; Female; Human

The attitudes of Australian heterosexual university students toward the suicide of gay, lesbian and heterosexual peers. - Molloy M; McLaren S (Journal of Gay & Lesbian Issues In Education, 2004)
This study sought to examine the attitudes of heterosexual university students to peer suicide when that peer was gay, lesbian, or heterosexual. University students (n = 206) completed several questionnaires, including The Suicide Attitude Vignette Experience. Results indicated that the suicide act was seen as more justified, acceptable, and necessary when the adolescent was gay or lesbian. Further, gay and lesbian youth suicide victims were shown significantly less empathy than heterosexual suicide victims. Participants' level of homophobia was found to be a significant predictor of attitudes toward gay and lesbian youth suicide. Results indicate that the peer group of gay and lesbian youth is unsupportive of their sexual orientation, and these attitudes may be an additional risk factor for gay and lesbian youth suicide.
Keywords: Peer Group; Student Attitudes; Suicide; Adolescence; Adult; Age Factors; Attitude Measures; Attitude to Sexuality; Educational Status; Female; Heterosexuals; Homophobia; Gay Men; Lesbians; Male; Marlowe-Crowne Social Desirability Scale; Middle Age; Multiple Regression; Multivariate Analysis of Covariance; Sex Factors; Students, College; Victoria; Human

Family and community influences on the social and sexual lives of Latino gay men. - Guarnero PA (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.
Keywords: Hispanic Americans; Homosexuality; Gay Men -- Psychosocial Factors; Communities; Culture; Depression; Discrimination; Family -- Psychosocial Factors; Focus Groups; Male; Perception; Qualitative Studies; Race Factors; Racism; Secondary Analysis; Structured Interview; Suicide; Verbal Abuse; Human

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). 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. 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). 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.
Keywords: Gay Men -- In Adolescence; Gay Men -- In Adulthood; Suicide, Attempted -- Epidemiology -- Minnesota; Adolescence; Adult; Chi Square Test; Epidemiological Research; Funding Source; Incidence; Interviews; Logistic Regression; Male; Minnesota; Pearson's Correlation Coefficient; Prevalence; Random Sample; Suicidal Ideation; Human

Domestic violence screening: prevalence and outcomes in a Canadian HIV population. - Siemieniuk RA; Krentz HB; Gish JA; Gill MJ (AIDS Patient Care & STDs, 2010)
There is a strong association between domestic violence victimization and HIV infection. This may lead to poor health outcomes including mental health disorders and reduced access to care. A standardized domestic violence screening interview was incorporated into ongoing care in the large and diverse population living with HIV in Southern Alberta, Canada. Results from May through December 2009 are reported, including the prevalence and outcomes of abuse. Thirty-four percent of 853 patients screened reported abuse. Of these, 16% reported abuse in their current relationship, 58% in a previous relationship, and 57% reported a history of childhood abuse. High-risk groups for abuse included females (43%), gay/bisexual males (35%), and Aboriginals (61%). We found an association between a history of domestic violence and delayed access to care ( p < 0.05), missed appointments ( p < 0.001), and an increased use of clinic resources such as social work ( p < 0.0001) and psychiatry ( p < 0.001). Mental health conditions prior to HIV diagnosis, including depression ( p < 0.0001), suicidal ideation ( p < 0.0001), and anxiety disorder ( p < 0.0001) were associated with abuse at any time, while a history of adjustment disorder was associated with childhood abuse ( p < 0.05). A simple domestic violence screening tool was helpful for identifying patients experiencing abuse in our diverse HIV-infected population. This high prevalence of domestic violence among our HIV patients was associated with poor outcomes and an increased use of medical resources. HIV caregivers should be aware of domestic violence in order to optimize care and refer patients to appropriate support professionals as needed.
Keywords: HIV-Positive Persons; Domestic Violence -- Prevention and Control; Human; Alberta; Descriptive Research; Descriptive Statistics; Convenience Sample; Interviews; Domestic Violence -- Classification; Adult; Male; Female; Chi Square Test; T-Tests; Univariate Statistics; Sex Factors; Life Style; Odds Ratio; Confidence Intervals; Race Factors; Arctic Peoples; Native Americans; White Persons; Mental Health; Health Services Accessibility; CD4 Lymphocyte Count; Outpatients; Self Report; Middle Age

Distress and depression in men who have sex with men: the Urban Men's Health Study. - Mills TC; Paul J; Stall R; Pollack L; Canchola J; Chang YJ; Moskowitz JT; Catania JA (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: Gay Persons -- Psychosocial Factors -- United States; Depression -- Epidemiology -- United States; Stress, Psychological -- Epidemiology -- United States; United States; Male; Men's Health; Probability Sample; Interviews; Psychological Tests; Center for Epidemiological Studies Depression Scale; Logistic Regression; Descriptive Statistics; Significant Other; Gender Role; Violence; Homophobia; Social Values; Interpersonal Relations; Race Factors; Suicide, Attempted; Child Abuse; Sexual Dysfunction, Male; HIV Infections; T-Tests; Chi Square Test; Adult; Middle Age; Aged; Odds Ratio; Data Analysis Software; Goodness of Fit Chi Square Test; Post Hoc Analysis; Confidence Intervals; Funding Source; Human

Prediction of depressive distress in a community sample of women: the role of sexual orientation. - Matthews AK; Hughes TL; Johnson T; Razzano LA; 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: Depression -- Risk Factors; Lesbians -- Psychosocial Factors; Depression -- Symptoms; Homosexuality; Mental Health; Funding Source; Illinois; Minnesota; New York; Convenience Sample; Surveys; Case Control Studies; Questionnaires; Coefficient Alpha; Scales; Descriptive Statistics; Univariate Statistics; T-Tests; Chi Square Test; Pearson's Correlation Coefficient; Logistic Regression; Odds Ratio; Confidence Intervals; P-Value; Heterosexuality; Female; Adult; Middle Age; Comparative Studies; Counseling -- Utilization; Statistical Significance; Suicidal Ideation -- Epidemiology; Suicide, Attempted -- Epidemiology; Child Abuse, Sexual -- Epidemiology; Support, Psychosocial; Coping; Goodness of Fit Chi Square Test; Human

Postacute Care after Pediatric Hospitalizations for a Primary Mental Health Condition. - Gay, James C.; Zima, Bonnie T.; Coker, Tumaini R.; Doupnik, Stephanie K.; Hall, Matthew; Rodean, Jonathan; O'Neill, Margaret; Morse, Rustin; Rehm, Kris P.; Berry, Jay G.; Bardach, Naomi S.; O'Neill, Margaret (Journal of Pediatrics, 2018)
Objectives: To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state.Study Design: Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases. Discharge to PAC was used as a proxy for transfer to an inpatient mental health facility. We derived adjusted logistic regression models to assess the association of patient and hospital characteristics with discharge to PAC.Results: In 2012, 14.7% of hospitalized children (n = 248 359) had a primary mental health diagnosis. Among these, 72% (n = 178 214) had bipolar disorder, depression, or psychosis, of whom 4.9% (n = 8696) were discharged to PAC. The strongest predictors of PAC discharge were homicidal ideation (aOR, 24.9; 96% CI, 4.1-150.4), suicide and self-injury (aOR, 15.1; 95% CI, 11.7-19.4), and substance abuse-related medical illness (aOR, 5.0; 95% CI, 4.5-5.6). PAC use varied widely by state, ranging from 2.2% to 36.3%.Conclusions: The majority of children hospitalized primarily for a mood disorder or psychosis were not discharged to PAC, and safety-related conditions were the primary drivers of the relatively few PAC discharges. There was substantial state-to-state variation. Target areas for quality improvement include improving access to PAC for children hospitalized for mood disorders or psychosis and equitable allocation of appropriate PAC resources across states.
Keywords: Mental Disorders -- Epidemiology; Subacute Care -- Statistics and Numerical Data; Hospitalization -- Statistics and Numerical Data; Retrospective Design; Prospective Studies; United States; Mental Health -- Statistics and Numerical Data; Transfer, Discharge -- Statistics and Numerical Data; Mental Disorders -- Therapy; Male; Child; Child, Preschool; Human; Adolescence; Resource Databases; Young Adult; Female; Patient Discharge -- Statistics and Numerical Data; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

Preventing suicide risk among sexual minority youth. - Russell ST; Marks SR (Prevention Researcher, 2006)
Keywords: Gay Persons -- Psychosocial Factors -- In Adolescence; Suicide -- Prevention and Control -- In Adolescence; Support, Psychosocial -- In Adolescence; Adolescence; Minority Groups; Suicide -- Risk Factors; Vulnerability

Correlates of serious suicidal ideation and attempts in female adult sexual assault survivors. - Ullman SE; Najdowski CJ (Suicide & Life-Threatening Behavior, 2009)
Relations between (a) serious suicidal ideation and attempts and (b) demographics, trauma history, assault characteristics, post-assault outcomes, and psychosocial variables were examined among female adult sexual assault survivors. Younger, minority, and bisexual survivors reported greater ideation. More traumas, drug use, and assault disclosure related to greater attempts, whereas perceived control over recovery was related to fewer attempts. Child sexual abuse and some assault characteristics predicted suicidal behavior. Depression was related to suicidal behavior until psychosocial variables were accounted for. Specifically, using substances to cope and self-blame predicted greater ideation, whereas receiving aid/information support was related to less ideation. Implications for research and treatment are discussed.
Keywords: Sexual Abuse; Suicide -- Psychosocial Factors; Adaptation, Psychological; Aging; Depression; Female; Logistic Regression; Population; Questionnaires; Retrospective Design; Sexuality; Substance Use Disorders; Suicide, Attempted -- Psychosocial Factors; Support, Psychosocial; Thinking; Human

Public health aspects of suicide in children and adolescents. - Nazeer, Ahsan (International Public Health Journal, 2016)
Suicide in children and adolescents is a complex and devastating problem for families and society both nationally and internationally. This review considers various aspects of this phenomenon including its epidemiology, risk factors, protective factors, issues of prevention, and management. Risk factors for suicide have been reviewed including personal characteristics, psychopathology of those committing suicide, history of previous suicide attempts, sexual orientation, familial factors, and access to lethal means of suicide. Protective factors include social support and religion. Principles of prevention have been considered including school-based programs, screening tools, skills training. Gatekeeper training, community-based programs, and health-care programs. Management includes principles involved in management before and after self-harm. Also considered are family therapies and therapies aimed at specific problems such as depression, bullying, substance abuse, and others. Clinicians should be actively involved with their communities to seek prevention of suicide in children and adolescents.
Keywords: Firearms; Suicide -- Risk Factors; Substance Abuse; Suicide, Attempted; Suicide -- Prevention and Control; Community Programs; Adolescence; Child

LGBTQ Part 2. - Perron, Tracy; Kartoz, Connie; Himelfarb, Chaya (NASN School Nurse, 2017)
In addition to dealing with the normal challenges of being a teenager, many times LGBTQ youth have to deal with harassment, intimidation, and bullying on a daily basis as they disproportionately experience verbal and physical harassment while in school as a result of their sexual orientation and/or gender identity. This violence adversely affects these students’ health and well-being as reflected in the depression and suicide rate among LGBTQ youth. As Part 2 of a series in articles on caring for LGBTQ youth in a school setting, this article reviews specific health risks in this group of students. School nurses can help reduce disparities in health for LGBTQ youth by understanding risk for psychological consequences of bullying and advocating for a just and responsive social school culture. Implications for school nurses include educating school staff and families as well as providing prompt and appropriate referrals for necessary psychological care.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Healthcare Disparities; Stress, Psychological -- Prevention and Control; School Health Nursing; Bullying -- Psychosocial Factors; Depression -- Prevention and Control; Suicidal Ideation -- Prevention and Control; Nursing Role; Psychophysiologic Disorders; Child Advocacy; Adolescence; Students

Associations of Health-Risk Behaviors and Health Cognition With Sexual Orientation Among Adolescents in School: Analysis of Pooled Data From Korean Nationwide Survey From 2008 to 2012. - Lee, Dong-Yun; Kim, Seo-Hee; Woo, Sook Young; Yoon, Byung-Koo; Choi, DooSeok (Medicine, 2016)
Homosexual adolescents may face significant health disparities. We examined health-risk behaviors and health cognition related to homosexual behavior in a representative sample of adolescents.Data were obtained from 129,900 adolescents between 2008 and 2012 over 5 cycles of the Korean Youth Risk Behavior Survey, a national survey of students in grades 7 to 12. Various health-risk behaviors and aspects of health cognition were compared between homosexual and heterosexual adolescents and analyzed with multiple logistic regression models.Compared with heterosexual adolescents (n = 127,594), homosexual adolescents (n = 2306) were more likely to engage in various health-risk behaviors and to have poor health cognition. In multiple logistic regression analysis, not living with parents, alcohol experience (adjusted odds ratio, 1.50; 95% confidence interval, 1.26-1.78 for males and 1.66; 1.33-2.07 for females), smoking experience (1.80; 1.54-2.10 for males and 3.15; 2.61-3.79 for females), and drug experience (3.65; 2.81-4.80 for males and 3.23; 2.35-4.46 for females) were associated with homosexual behavior. Homosexual adolescents were more likely to use adult internet content (2.82; 2.27-3.50 for males and 7.42; 4.19-13.15 for females), and to be depressed (1.21; 1.03-1.43 for males and 1.32; 1.06-1.64 for females). In addition, suicide ideation (1.51; 1.26-1.81 for males and 1.47; 1.16-1.86 for females) and attempts (1.67; 1.37-2.05 for males and 1.65; 1.34-2.03 for females) were significantly more prevalent among homosexual adolescents.Homosexual adolescents report disparities in various aspects of health-risk behavior and health cognition, including use of multiple substances, adult internet content and inappropriate weight loss methods, suicide ideation and attempts, and depressive mood. These factors should be addressed relevantly to develop specific interventions regarding sexual minorities.
Keywords: Attitude to Health; Homosexuality; Health Behavior; Risk Taking Behavior; Odds Ratio; Demography; Adolescence; Socioeconomic Factors; Adolescent Behavior; Depression -- Epidemiology; Female; Male; Alcohol Drinking -- Epidemiology; Risk Factors; Environment; South Korea; Suicidal Ideation; Internet; Social Environment; Smoking -- Epidemiology; Suicide, Attempted

Increasing Interest of Mass Communication Media and the General Public in the Distribution of Tweets About Mental Disorders: Observational Study. - Alvarez-Mon, Miguel Angel; Barco, Angel Asunsolo del; Lahera, Guillermo; Quintero, Javier; Ferre, Francisco; Pereira-Sanchez, Victor; Ortuño, Felipe; Alvarez-Mon, Melchor; Asunsolo Del Barco, Angel (Journal of Medical Internet Research, 2018)
Background: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed.Objective: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers.Methods: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV.Results: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P<.001).Conclusions: American mainstream media outlets and the general public demonstrate a preferential interest for psychiatric diseases on Twitter. The heterogeneous weights given by the media outlets analyzed to the different mental health disorders and conditions are reflected in the responses of Twitter followers.
Keywords: Social Media -- Trends; Communications Media -- Trends; Communication; Mental Disorders -- Diagnosis; Human; Mental Disorders -- Epidemiology; Male; Female; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires; Social Readjustment Rating Scale

Health priorities and perceived health determinants among South Australians attending GLBTI festival events. - Rogers G; Rogers, Gary (Health Promotion Journal of Australia, 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: Health and Welfare Planning -- Classification; Health Promotion -- Administration; Sexuality; Adolescence; Adult; Aged; Aged, 80 and Over; Female; Gender Identity; Health Services Accessibility; Male; Middle Age; Prejudice; Qualitative Studies; Social Environment; South Australia; Human

The health and health behaviors of young men who have sex with men. - Kipke MD; 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.
Keywords: Bisexuality; Health Behavior; Health Status; Homosexuality; Men; Adolescence; Adult; Center for Epidemiological Studies Depression Scale; Data Analysis Software; Data Collection, Computer Assisted; Depression; Descriptive Research; Diet; Ethnic Groups; Exercise; Funding Source; HIV Infections; Interviews; Male; Personal Satisfaction; Public Spaces; Race Factors; Scales; Suicide; United States; Human

Sexually transmitted disease (STD) diagnoses and mental health disparities among women who have sex with women screened at an urban community health center, Boston, MA, 2007. - Reisner SL; Mimiaga MJ; Case P; Grasso C; O'Brien CT; Harigopal P; Skeer M; Mayer KH; Reisner, Sari L; Mimiaga, Matthew J; Case, Patricia; Grasso, Chris; et al. (Sexually Transmitted Diseases, 2010)
Background: A growing body of research documents mental health disparities among women who have sex with women (WSW) compared with women who have sex with men only (WSM). However, there remains a dearth of research exploring these indicators alongside sexually transmitted diseases (STDs) and WSW sexual health.Methods: A retrospective chart review was conducted of all female patients (n = 368) screened for STDs between July 2007 and December 2007 at an urban community health center in Boston, MA. Deidentified electronic medical record data (e.g., demographics, psychosocial, sexual health) were analyzed and linked to STD positivity. Women who did not have sexual behavior documented in their medical chart (n = 58) were excluded from this analysis. Bivariate and multivariable logistic regression procedures examined sexual and psychosocial health indicators, including sexual preference.Results: Twenty-seven percent of participants were WSW (17% WSW only and 10% WSW/M). Overall, 5% of WSW were diagnosed with a new STD (human papillomavirus, anogenital warts, genital herpes, pelvic inflammatory disease) and 17% had a history of a prior STD. In multivariable models adjusting for demographics, WSW were disproportionately more likely to have mental health and psychosocial issues noted in their medical records, including: a clinical diagnosis of depression, anxiety, and posttraumatic stress disorder, history of suicide attempts, and inpatient psychiatric/mental health treatment. However, WSW were significantly less likely than WSM to engage in "high risk" HIV/STD sexual behavior. In a final multivariable model, same sex behavior was not associated with a different likelihood of being diagnosed with an STD, compared with opposite sex behavior. However, WSW diagnosed with STDs were at increased odds of having bipolar disorder and utilizing outpatient mental health counseling services compared with WSW without STDs. WSW with a history of STDs were at increased odds of having attempted suicide in the past, utilizing both outpatient and inpatient mental health treatment services, and having a history of injection drug use compared with WSW without a history of STDs.Conclusions: WSW with STDs may have presenting psychosocial problems. Further research is warranted to better understand the relationship between sexual behavior and health, as well as to guide the development of interventions to ameliorate health disparities among WSW, particularly in the psychosocial domain.
Keywords: Health Status; Lesbians; Mental Disorders -- Epidemiology; Sexually Transmitted Diseases -- Epidemiology; Adult; Bipolar Disorder -- Epidemiology; Massachusetts; Comorbidity; Female; Human; Logistic Regression; Multivariate Analysis; Retrospective Design

Suicidal ideation among psychiatric patients with HIV: psychiatric morbidity and quality of life. - Haller DL; Miles DR (AIDS & Behavior, 2003)
This study explored suicidality among 190 (68% male) participants in an HIV mental health clinic. Twenty-six percent had suicidal thoughts within 30 days of admission, 49% had a plan, and 48% expressed intent stating there was moderate or high likelihood they would take action. The most prevalent diagnoses among those with suicidal ideation were major depression (64%), drug dependence (52%), and depressive personality disorder (50%). In regression analyses, individuals with major depression, dysthymia, substance abuse, thought disorder, posttraumatic stress disorder, and borderline and avoidant personality disorders were at increased risk for suicidality whereas those with narcissistic personality disorder were at decreased risk. In addition, six of seven quality-of-life variables were associated with suicidal ideation, with the strongest correlations found for leisure/social (r =.36) and family/friends (r =.33). At-risk individuals, especially those with 'dual disorders,' unstable interpersonal relations, and a restricted social environment, should be carefully screened for suicidality.
Keywords: HIV-Positive Persons -- Psychosocial Factors; Psychiatric Patients -- Psychosocial Factors; Quality of Life; Suicide -- Risk Factors; Adult; Bisexuality; Black Persons; Chi Square Test; Coefficient Alpha; Confidence Intervals; Data Analysis Software; Dependent Variable; Depression; Descriptive Statistics; DSM; Employment Status; Epidemiological Research; Female; Funding Source; Heterosexuality; Homosexuality; Income; Insurance, Disability; Insurance, Health; Intravenous Drug Users; Male; Marital Status; Medically Uninsured; Odds Ratio; Personality Disorders; Prevalence; Psychological Tests; Research Subject Recruitment; Residence Characteristics; Risk Taking Behavior; Scales; Self Report; Statistical Significance; Stress Disorders, Post-Traumatic; Structured Interview; Substance Dependence; Summated Rating Scaling; T-Tests; White Persons; Human

Correlates of substance use among homeless youths in eight cities. - Salomonsen-Sautel S; Van Leeuwen JM; Gilroy C; Boyle S; Malberg D; Hopfer C; Salomonsen-Sautel, Stacy; Van Leeuwen, James M; Gilroy, Christine; Boyle, Susan; Malberg, Danielle; Hopfer, Christian (American Journal on Addictions, 2008)
Homeless youths (N = 684) in eight cities participated in this study to understand the rates and correlates of substance use. Rates of lifetime and recent substance use ranged from 66% to 90%. Variability in lifetime and recent substance use was partially explained by being white (ages 14-17); ever attempting suicide (ages 14-17); not being African American (lifetime substance use) or Hispanic (ages 18-24); being male (ages 18-24); identifying as lesbian, gay, or bisexual (ages 18-24); using substances with a parent; beginning substance use at a young age; and having a family history of a substance problem.
Keywords: Alcoholism -- Epidemiology; Runaways -- Statistics and Numerical Data; Substance Use Disorders -- Epidemiology; Adolescence; Adult; Age Factors; Alcoholism -- Diagnosis; Alcoholism -- Psychosocial Factors; Alcoholism; Cross Sectional Studies; Disease Susceptibility -- Psychosocial Factors; Female; Male; Runaways -- Psychosocial Factors; Sex Factors; Statistics; Substance Use Disorders -- Diagnosis; Substance Use Disorders -- Psychosocial Factors; Substance Use Disorders; Suicide, Attempted -- Psychosocial Factors; Suicide, Attempted; Surveys; United States; Human

Health Care and Social Service Providers’ Observations on the Intersection of HIV/AIDS and Violence Among Their Clients and Patients. - DiStefano, Anthony S.; Cayetano, Reggie T. (Qualitative Health Research, 2011)
Associations between HIV/AIDS and several forms of violence have been demonstrated in recent research. We conducted qualitative interviews with 30 providers who offered services related to HIV/AIDS or violence to identify specific manifestations of HIV/AIDS—violence intersections, factors that explain why HIV/AIDS and violence intersect in client/patient populations, and the theoretical salience of providers’ narratives. Providers confirmed links between HIV/AIDS and violent victimization, and yielded new insights into crossover risk between HIV/AIDS and suicidality, nonsuicidal self-harm, and witnessing and perpetrating violence. We also isolated 20 explanatory factors, including substance use, poor mental health, sex work/trading sex, and sexual orientation/gender identity. Narratives were consistent with syndemics theory, indicating that HIV/AIDS and violence fueled each other’s occurrence and magnified the health-related burden on affected client/patient populations, often under conditions of health and social disparity. Providers contribute a novel perspective on our understanding of HIV/AIDS—violence syndemics that shows promise in informing future interventions and practice.
Keywords: Social Work Service; HIV Infections; Violence; Health Personnel; Acquired Immunodeficiency Syndrome; Human; Qualitative Studies; Interviews; Purposive Sample; Descriptive Statistics; Thematic Analysis; Factor Analysis; Gender Identity; Narratives; Mental Disorders; Substance Use Disorders; Poverty; Socioeconomic Factors; Causal Attribution; Funding Source

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.
Keywords: Acquired Immunodeficiency Syndrome -- Ethical Issues; Acquired Immunodeficiency Syndrome -- Psychosocial Factors; Death -- Ethical Issues; Ethics, Medical; Suicide, Attempted -- Ethical Issues; Adult; Attitude of Health Personnel; Attitude to AIDS; Discrimination; Gay Men; Inpatients; Male; Patient Autonomy; Quality of Health Care; Refusal to Treat -- Ethical Issues; Truth Disclosure -- Ethical Issues; Turkey

Attitudes on end-of-life care and advance care planning in the lesbian and gay community. - Stein GL; Bonuck KA (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: Lesbians; Gay Men; Palliative Care; Suicide, Assisted; Euthanasia; Attitude to Death; Survey Research; New York; Attitude Measures; Research Subject Recruitment; Data Analysis Software; Descriptive Statistics; Chi Square Test; Advance Directives; Race Factors; Religion and Religions; Attitude to Death -- Evaluation; Adult; Middle Age; Aged; Aged, 80 and Over; Male; Female; Funding Source; Human

Role of gender in sexual behaviours and response to education in sexually transmitted infections in 17-year-old adolescents. - Rembeck, Gun I.; Gunnarsson, Ronny K. (Midwifery, 2011)
Abstract: Objective: to investigate gender differences in high school students with respect to sexual risk behaviours, and their perceptions of the effect of an educational programme on sexually transmitted infections (STIs). In addition, this study aimed to investigate differences between students in programmes preparing for university compared with vocational programmes. Participants, setting and design: second-year high school adolescents from two communities in south-west Sweden were invited to participate in the study, and completed a questionnaire on sexual experience, sexual risk behaviours and the impact of the educational programme on STIs. Findings: males took less responsibility for STI prevention than females. Furthermore, males perceived themselves to be less influenced by the STI education than females. Females had more experience of same-sex sexuality than males. Conclusions and implications for practice: males take less responsibility for STI prevention than females. When planning STI education, it is important to consider gender, traditions and various learning styles. If STI education fails to reach males, the prevalence of these infections will continue to increase.
Keywords: Gender Role; Sexuality -- In Adolescence; Sexually Transmitted Diseases -- Risk Factors; Sex Education; Sexually Transmitted Diseases -- Education; Human; Risk Taking Behavior; Sweden; Questionnaires; Male; Female; Sex Factors; Adolescence; Chi Square Test; Yates' Continuity Correction; T-Tests; Mann-Whitney U Test; Logistic Regression; Odds Ratio; Confidence Intervals; Data Analysis Software; Sexually Transmitted Diseases -- Prevention and Control; Funding Source

Violence against women and suicide risk: the neglected impact of same-sex sexual behaviour. - Lhomond B; Saurel-Cubizolles M (Social Science & Medicine, 2006)
We used data from the National Survey on Violence against Women in France carried out in 2000 on a representative sample of 6,970 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: Intimate Partner Violence -- Epidemiology -- France; Lesbians; Suicide, Attempted -- Epidemiology -- France; Adult; Battered Women; Clinical Assessment Tools; Comparative Studies; Data Collection; Female; France; Funding Source; International Classification of Diseases; Interviews; Life Histories; Life History Review; Middle Age; Questionnaires; Substance Use Disorders; Human

Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III. - Cochran SD; Mays VM (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: Homosexuality; Gay Men -- Psychosocial Factors; Suicide, Attempted -- Epidemiology; Affective Disorders -- Epidemiology; Epidemiological Research; Surveys; Comparative Studies; DSM; Interviews; Psychological Tests; Data Analysis Software; Prevalence; Univariate Statistics; Regression; Odds Ratio; Heterosexuality; Bisexuality; Confidence Intervals; P-Value; Adolescence; Adult; Male; Funding Source; Human

Health problems of gay and bisexual men. - Ungvarski PJ; Grossman AH (Nursing Clinics of North America, 1999)
Significant mental and physical morbidity occurs among gay and bisexual men because health care providers are often unaware of their actual or potential health concerns. Mental health problems include anxiety, depression, suicide, and both alcohol and substance abuse. Physical health concerns include HIV disease, hepatitis, and other sexually transmitted diseases, as well as an increased risk of heart disease and certain cancers. Health care professionals, who are clinically competent in the care of men who have sex with men, have the opportunity to reduce the risk of disease, while providing unbiased, quality care which recognizes the unique problems of this population of men. Copyright (c) 1999 by W.B. Saunders Company
Keywords: Gay Men; Bisexuality; Men's Health; Health Status; Mental Health; Stigma; Patient History Taking; Discrimination; Coping; Homophobia; Disease Transmission, Horizontal; Violence; Sexual Health; Male

Context of sexual risk behaviour among abused ethnic minority adolescent women. - Champion JD (International Nursing Review, 2011)
Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. This study aims to describe associations between childhood molestation and sexual risk behaviour. African American and Mexican American adolescent women aged 14-18 years ( n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self-report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self-reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported 'getting high' and having sex when out of control as reasons for sex with multiple partners. Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.
Keywords: Risk Taking Behavior -- In Adolescence; Child Abuse -- Complications; Sexuality; Minority Groups; Child Abuse, Sexual -- Complications; Adolescence; Questionnaires; Conceptual Framework; Psychological Theory; Qualitative Studies; Self Report; Factor Analysis; Center for Epidemiological Studies Depression Scale; Scales; Psychological Tests; Interrater Reliability; Multivariate Analysis; T-Tests; Chi Square Test; Risk Taking Behavior -- Prevention and Control; Stress, Psychological -- Etiology; Stress, Psychological -- Therapy; Funding Source; Human; Female

Women's sexual orientation and health: results from a Canadian population-based survey. - Steele LS; Ross LE; Dobinson C; Veldhuizen S; Tinmouth JM (Women & Health, 2009)
The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.
Keywords: Gender Identity; Health Status; Mental Health; Sexuality; Women; Adult; Analysis of Variance; Canada; Chi Square Test; Confidence Intervals; Cross Sectional Studies; Descriptive Statistics; Female; Funding Source; Interviews; Middle Age; P-Value; Women's Health

Attempted suicide and associated risk factors among youth in urban Japan. - Hidaka Y; Operario D; Takenaka M; Omori S; Ichikawa S; Shirasaka T; Hidaka, Yasuharu; Operario, Don; Takenaka, Mie; Omori, Sachiko; Ichikawa, Seiichi; Shirasaka, Takuma (Social Psychiatry & Psychiatric Epidemiology, 2008)
Background: Suicide is a major social and health issue in Japan. We assessed prevalence of attempted suicide and explored individual, interpersonal, behavioral, and psychological risk factors associated with attempted suicide in a general community sample of youth in a metropolitan Japanese city.Method: Survey of 2,095 participants age between 15 and 24 who were recruited using street-intercept techniques.Results: Overall, 6% of males and 11% of females reported a prior suicide attempt. For males, attempted suicide was independently associated with experience of school bullying, being homosexual or bisexual, history of drug use, experience of unwanted sex, history of a diagnosed sexually transmitted infection, and low self-esteem. For females, attempted suicide was independently associated with being younger (ages 15-19 compared to 20-24), experience of school bullying, history of drug use, and history of smoking.Conclusion: Prevention intervention programs for youth in Japan are necessary to achieve national aims to reduce attempted suicides and suicide mortality.
Keywords: Mental Disorders -- Epidemiology; Suicide, Attempted; Urban Population; Adolescence; Adult; Female; Japan; Male; Mental Disorders -- Psychosocial Factors; Prospective Studies; Questionnaires; Risk Factors; Scales; Human

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.
Keywords: Lesbians; Homosexuality; Mental Health; Prejudice; Female; Great Britain; Male; Support, Psychosocial

Sexual orientation and gender identity in youth suicide victims: an exploratory study. - Renaud J; Berlim MT; Begolli M; McGirr A; Turecki G; Renaud, Johanne; Berlim, Marcelo T; Begolli, Melissa; McGirr, Alexander; Turecki, Gustavo (Canadian Journal of Psychiatry, 2010)
Objective: Our study was designed to explore additional outcome variables of a suicide case-control study to determine the association between sexual orientation and gender identity in suicide completion in children and adolescents.Method: Fifty-five child and adolescent suicide victims and 55 community control subjects were assessed using semi-structured, proxy-based interviews and questionnaires regarding sexual orientation and gender issues, psychopathological diagnoses, and service use.Results: In our sample, no significant differences between suicide victims and control subjects were found regarding same-sex sexual orientation nor intimidation related to same-sex sexual orientation. Suicide victims with same-sex sexual orientation were more likely than suicide victims without same-sex sexual orientation, to meet criteria for anxiety disorders. Within the month preceding their deaths, these youth were more likely to have consulted a health professional, a psychiatrist, as well as having been hospitalized, and were more likely to have consulted a psychiatrist in the last year.Conclusions: In our sample, same-sex sexual orientation and gender identity issues do not appear to be more prevalent among youth who die by suicide, compared with youth recruited from the general population, nor for same-sex sexual-related intimidation. While exhibiting comparable levels of general psychopathological diagnoses associated with suicide, suicide victims with same-sex sexual orientation were more likely to meet criteria for anxiety disorders and to have consulted mental health professionals before their deaths.
Keywords: Gender Identity; Sexuality; Suicide -- Psychosocial Factors; Adolescence; Age Factors; Anxiety Disorders; Case Control Studies; Child; Counseling; Cross Sectional Studies; Female; Human; Male; Mental Health Services; Questionnaires; Risk Factors; Suicide

Bullying and homophobia in UK schools: a perspective on factors affecting resilience and recovery. - Rivers I; Cowie H (Journal of Gay & Lesbian Issues In Education, 2006)
This article reports the results of a three-year study focusing on the experiences of a sample of lesbian, gay, and bisexual (LGB) people in the United Kingdom who were victimized by their peers at school. Data collected from 190 LGBs suggested that experiences of victimization at school were both long-term and systematic, and were perpetrated by groups rather than by individuals. Subsequently, data collected from a sub-sample of 119 participants indicated that over 50 percent had contemplated self-harm or suicide at the time they were being harassed, and that 40 percent had engaged in such behavior at least once. As adults, participants were found to exhibit symptoms associated with negative affect when contrasted with heterosexual and non-victimized LGB peers. Seventeen percent exhibited symptoms associated with PTSD. However, the results also demonstrated that the majority of participants did not differ significantly from comparison groups in terms of self-esteem, and they had a positive attitude towards their sexual orientation. These findings are discussed with reference to the current literature about the development of resilience following exposure to violence and trauma.
Keywords: Bullying; Homophobia; Adolescence; Adolescent Development; Adult; Aged; Aggression; Analysis of Covariance; Chi Square Test; Coefficient Alpha; Correlation Coefficient; Depression; Exploratory Research; Factor Analysis; Female; LGBTQ+ Persons; Hardiness; Male; Middle Age; One-Way Analysis of Variance; Prospective Studies; Psychological Tests; Questionnaires; Recovery; Retrospective Design; Scales; Schools, Middle; Schools, Secondary; Self Concept; Stress Disorders, Post-Traumatic; Support, Psychosocial; United Kingdom; Victims; Human

Are gay men in worse mental health than heterosexual men? The role of age, shame and guilt, and coming-out. - Bybee J; Sullivan EL; Zielonka E; Moes E (Journal of Adult Development, 2009)
Keywords: Gay Men -- Psychosocial Factors; Mental Health; Adult; Age Factors; Analysis of Variance; Anger; Anxiety; Depression; Guilt; Heterosexuals; Male; Middle Age; Psychological Tests; Questionnaires; Self Concept; Shame; Suicidal Ideation; Human

Intentional self-infection with HIV by long-term partners of HIV-positive homosexual men: four case reports. - Morgan M; Jones J (AIDS Patient Care, 1993)
Keywords: HIV Infections -- Transmission; Gay Men -- Psychosocial Factors; Suicide; Acquired Immunodeficiency Syndrome; Social Isolation; Adult; Male

Social alienation in gay youth. - Sullivan M; Wodarski JS (Journal of Human Behavior in the Social Environment, 2002)
The focus of this article is twofold; first, to review known risk factors for gay youth including: substance abuse, depression, suicide, and HIV risks, secondly, to determine the impact of social support factors; specifically parental, peer and religious support factors for this population. Evidence suggests that gay and lesbian youth are at high risk for isolation and subsequent psychological damage that results from social alienation. Insight into the problems faced by gay youth, along with some helpful intervention strategies for professionals working with a gay adolescent population is discussed.
Keywords: Homosexuality -- In Adolescence; Social Alienation -- Risk Factors -- In Adolescence; Social Identity -- In Adolescence; Stress, Psychological; Parents -- Psychosocial Factors; Spirituality; Substance Abuse -- Epidemiology; Depression -- Epidemiology; Suicide -- Epidemiology; HIV Infections -- Epidemiology; Adolescence; Male; Female

Gay, lesbian, and bisexual adolescents: providing esteem-enhancing care to a battered population. - Nelson JA (Nurse Practitioner, 1997)
Suicide, HIV infection, violent victimization, homelessness, and substance use are known to affect gay (gay males, lesbians, and bisexual persons of both genders) youths at disproportionately high rates. This article explores the difficulties gay youths experience in this society specific to their sexual orientation. These difficulties become internalized by many gay youths, leading to high rates of preventable morbidities and mortalities. Stages of the 'coming out' process for gay persons are reviewed within the framework of child and adolescent development. Barriers within the health care system, as well as within other social systems, specific to gay youths are examined. Such barriers include language use by the provider, sexual and social history questions asked by the provider, environmental images in the health care setting, and the responses of the provider to the adolescent. Strategies such as the use of gender-neutral wording, homosexual inclusive questioning in history taking, and the use of inclusive environmental clues to allow gay adolescents to feel safe and accepted are discussed. Health care providers are encouraged to employ such strategies to help reduce these barriers within various health care settings.
Keywords: Gay Persons -- Psychosocial Factors -- In Adolescence; Support, Psychosocial -- In Adolescence; Professional-Patient Relations; Bisexuality; Homosexuality; Gender Identity; Suicide -- In Adolescence; HIV Infections -- Epidemiology; Violence -- In Adolescence; Social Isolation -- In Adolescence; Adolescence; Male; Female

Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men. - Courtenay-Quirk C; Wolitski RJ; Parsons JT; Gómez CA (AIDS Education & 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.
Keywords: Attitude to AIDS; HIV Seropositivity; Gay Men; Stigma; Adult; Aged; Analysis of Variance; Attitude Measures; Brief Symptom Inventory; California; Chi Square Test; Coefficient Alpha; Cross Sectional Studies; Descriptive Statistics; Homophobia; Internal Consistency; Interpersonal Relations; Male; Marlowe-Crowne Social Desirability Scale; Middle Age; Multiple Regression; Open-Ended Questionnaires; P-Value; Pearson's Correlation Coefficient; Qualitative Studies; Quantitative Studies; Semi-Structured Interview; Funding Source; Human

Adolescent homosexuality and concerns regarding disclosure. - Harrison TW (Journal of School Health, 2003)
Development of sexual identity in middle childhood and early adolescence is a natural process. However, it is more stressful for homosexual adolescents. Society continues to stigmatize and marginalize homosexuality. To avoid rejection and hostility, homosexual adolescents are pressured to hide their sexual identities. This fact compounds the anticipated normal developmental concerns of adolescence, and can create unique problems for the homosexual adolescents. Homosexuality can place them at risk for social stigmatization, isolation, depression, suicide, abuse, and rejection by their families and friends. During this exceptionally stressful time, both adolescent students and their families need anticipatory guidance and support. In providing anticipatory guidance, this article discusses critical roles played by professionals who work with adolescents in community or school settings. Included are insights into development of this normal variant of sexual attraction and orientation, risks that homosexual adolescent students may face as well as their disclosure concerns, and possible reactions families may have following disclosure. Supporting homosexual adolescents and their families is emphasized with regard to sensitively providing information, disclosure decisions, coping with stigmatization, and resiliency factors.
Keywords: Homosexuality -- In Adolescence; Gay Persons -- Psychosocial Factors -- In Adolescence; Adolescent Development; Adolescent Psychology; School Health Services; Counseling; Support, Psychosocial; Homophobia; Stigma; Social Isolation; Stress, Psychological; Self Concept; Self Disclosure; Parents -- Psychosocial Factors; Denial (Psychology); Family Relations; Information Resources; World Wide Web; Male; Female; Child; Adolescence; Human

Clustering of adolescent dating violence, peer violence, and suicidal behavior. - Bossarte RM; Simon TR; Swahn MH (Journal of Interpersonal Violence, 2008)
To understand the co-occurrence of multiple types of violence, the authors developed a behavioral typology based on self-reports of suicidal behaviors, physical violence, and psychological abuse. Using a sample of dating adolescents from a high-risk school district, they identified five clusters of behaviors among the 1,653 students who reported being abusive or violent in the past year. Victimization and perpetration with same-sex peers and dating partners clustered together among the students who reported the highest levels of abusive (n = 357) or violent behavior (n = 146). These students also reported high levels of suicidal behavior. There were few significant demographic differences across clusters. The implications of the results for the need to design and evaluate efforts to prevent multiple types of violence are discussed.
Keywords: Dating -- In Adolescence; Suicidal Ideation -- In Adolescence; Violence -- In Adolescence; Adolescence; Chi Square Test; Cluster Analysis; Data Analysis Software; Female; Heterosexuals; Gay Persons; Male; Peer Group; Questionnaires; Surveys; Human

A needs assessment of transgendered people of color living in Washington, DC. - Xavier JM; 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 regressionmale 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.
Keywords: Gender Identity -- Classification; Health Resource Utilization; Health Services Needs and Demand; HIV Seropositivity -- Risk Factors; Transsexualism -- Classification; Black Persons; Chi Square Test; Convenience Sample; Crime Victims; Data Analysis Software; Descriptive Statistics; District of Columbia; Funding Source; Questionnaires; Regression; Snowball Sample; Substance Abuse -- Therapy; Suicidal Ideation; Summated Rating Scaling; Translations; Human

Is there a right not to know one's sex? The ethics of 'gender verification' in women's sports competition. - Wiesemann, Claudia (Journal of Medical Ethics, 2011)
The paper discusses the current medical practice of 'gender verification' in sports from an ethical point of view. It takes the recent public discussion about 800m runner Caster Semenya as a starting point. At the World Championships in Athletics 2009 in Berlin, Germany, Semenya was challenged by competitors as being a so called 'sex impostor'. A medical examination to verify her sex ensued. The author analyses whether athletes like Semenya could claim a right not to know that is generally acknowledged in human genetics and enforced by international and national genetic privacy laws. The relevance of this right for genetic diagnosis in sports is discussed. To this end, the interests of the athlete concerned and of third parties are balanced according to the expected benefits and harms.Harm is documented in a number of cases and includes unjustified disqualification, severe sex and gender identity crisis, demeaning reactions, social isolation, depression and suicide. Benefits are dubious as most cases of intersex are considered irrelevant for sports competition. It has to be concluded that the benefits to be gained from 'gender verification' in sports via genetic testing do not outweigh the grave individual disadvantages. The current practice of athletic associations to largely ignore the right of competitors not to know does not comply with prevailing ethical provisions on the protection of sensitive personal data. Therefore, genetic 'gender verification' in sports should be abolished.
Keywords: Disorders of Sex Development -- Diagnosis; Reproduction; Sex Determination -- Ethical Issues; Sports -- Ethical Issues; Truth Disclosure -- Ethical Issues; Disorders of Sex Development -- Psychosocial Factors; Female; Genetic Counseling; Male; Sports -- Legislation and Jurisprudence

A national needs assessment of nurses providing health care to adolescents. - Saewyc EM; Bearinger LH; 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. Copyright © 2006 by Elsevier Inc.
Keywords: Adolescent Health; Health Promotion -- In Adolescence; Adolescence; American Public Health Association; Chi Square Test; Descriptive Research; Descriptive Statistics; Education, Nursing, Continuing; Educational Status; Funding Source; Job Experience; Leadership; Mail; National Association of Pediatric Nurse Associates and Practitioners; National Association of School Nurses; Needs Assessment; Nursing Knowledge; Nursing Skills; Professional Competence; Questionnaires; Stratified Random Sample; Summated Rating Scaling; Survey Research; United States; Human

The Social Context of Bullying and Peer Victimization: An Introduction to the Special Issue. - Bradshaw, Catherine P.; Johnson, Renee M. (Journal of School Violence, 2011)
An overlooked aspect of bullying and peer victimization is the social context in which it occurs. To advance the research and effectively prevent bullying, additional research is needed to better understand various aspects of the school context that may influence victimization. Drawing on several theoretical frameworks, this article outlines the rationale for the special issue and its focus on the social context of bullying and peer victimization. The authors identify important themes from across the five empirical articles and invited commentaries. Issues related to the measurement of bullying and peer victimization, and other methodological challenges associated with the study of context, are discussed. Consistent with a public health approach to prevention, the authors discuss implications of these findings for improving the effectiveness of school-based prevention programs.
Keywords: Peer Group; Victims; Bullying -- Prevention and Control; School Violence; Serial Publications; Schools; Gay Persons; Psychological Well-Being

The health and social service needs of transgender people in Philadelphia. - Kenagy GP (International Journal of Transgenderism, 2005)
Two Philadelphia-based HIV service organizations and a local university collaborated on a study of health and social service needs of transgender people. Transgender people were the primary resource for the development of the needs assessment survey. In this article, the survey development process, including two discussion groups and two focus groups, are described. Findings on barriers to care, violence, perception of public safety and comfort, suicide and health and social service needs are presented. Total sample size was 81, with 49 male-to-female and 32 female-to-male transgender individuals. Most (68%) were African American. About half of the respondents had thought about attempting suicide. High levels of violence were reported, especially among male-to-females. Health and social service needs included job training/work, dental care, health care, legal services, transportation, education and housing.
Keywords: Gender Identity -- Classification; Health Services Accessibility; Health Services Needs and Demand; HIV Infections -- Risk Factors; Transsexualism -- Classification; Black Persons; Chi Square Test; Convenience Sample; Crime Victims; Dental Care; Descriptive Statistics; Focus Groups; Funding Source; Housing; Interviews; Pennsylvania; Questionnaires; Snowball Sample; Social Work Service; Suicidal Ideation; T-Tests; Transportation; Human

Crystal methamphetamine: a source of added sexual risk for Hispanic men who have sex with men? - Fernández MI; Bowen GS; Warren JC; Ibañez GE; Hernandez N; Harper GW; Prado G (Drug & 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.
Keywords: Hispanic Americans -- United States; HIV Infections -- Risk Factors; Gay Persons; Methamphetamine; Substance Abuse -- Complications; Adult; Chi Square Test; Coefficient Alpha; Confidence Intervals; Data Collection, Computer Assisted; Funding Source; Hispanic Americans -- Psychosocial Factors; Homophobia; Internet; Kruskal-Wallis Test; Loneliness; Male; Mann-Whitney U Test; Multivariate Analysis; Odds Ratio; One-Way Analysis of Variance; Post Hoc Analysis; Quasi-Experimental Studies; Racism; Scales; Stress, Psychological; Suicide, Attempted; Summated Rating Scaling; United States; Univariate Statistics; Unsafe Sex; Human

Management of suicidal patients with HIV disease. - Valente SM; Saunders JM (JANAC: Journal of the Association of Nurses in AIDS Care, 1994)
Suicidal acts among people with HIV disease exceed those among the general population. Stress from the HIV diagnosis, treatment, and medications can lead to depression, which increases suicide risk. High quality care of depressed persons depends on sound scientific knowledge of evaluation of suicide. Incidence, epidemiology, risk factors, evaluation, and treatment of suicidal people are the core of this article. A patient's comment, 'I'd be better off dead,' deserves investigation as a cry for help and a clue to impending suicide.
Keywords: Suicidal Ideation; HIV-Positive Persons -- Psychosocial Factors; Quality of Life; Terminal Care -- Psychosocial Factors; Home Nursing, Professional; Diagnosis, Psychosocial; Risk Factors; Gay Men

Suicide in athletes: a review and commentary. - Baum AL (Clinics in Sports Medicine, 2005)
Not only are athletes at risk for psychiatric illness, but they are at risk of suicide. In an effort to learn more about suicide in athletes and those connected to the sports arena, a review of the medical literature from 1960 to 2000 was conducted through Medline, and a review of the periodical literature from 1980 to 2000 was conducted through Infotrac. These reviews revealed 71 cases of athletes who have either contemplated, attempted, or completed suicide. In this article, these cases are analyzed by sport, gender, and age. Through inference, an attempt to establish the etiologic basis for these behaviors is undertaken. Intervention and prevention strategies are discussed, based on the available data.
Keywords: Athletes -- Psychosocial Factors; Suicide; Sports Medicine; Psychology, Sports; Medical Practice, Evidence-Based; Medline; Descriptive Statistics; Suicide, Attempted; Adult; Suicide -- Risk Factors; Athletic Injuries -- Psychosocial Factors; Stress, Psychological; Substance Abuse; Retirement -- Psychosocial Factors; Psychopathology; Doping in Sports; Anabolic Steroids; Suicide -- Etiology; Physical Performance -- Psychosocial Factors; Suicide -- Familial and Genetic; Eating Disorders -- Psychosocial Factors; Suicide -- Psychosocial Factors; Homosexuality; Cultural Values; Firearms; Sexual Abuse; Human

Health and social service needs of transgender people in Chicago. - Kenagy GP; Bostwick WB (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 maletofemale 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.
Keywords: Gender Identity -- Classification; Health Services Accessibility; Health Services Needs and Demand; HIV Infections -- Risk Factors; Transsexualism -- Classification; Black Persons; Chi Square Test; Focus Groups; Hispanic Americans; Illinois; Snowball Sample; Social Work Service; Structured Interview; Suicidal Ideation; T-Tests; Human

Use of school-based health centres for mental health support in Cape Breton, Nova Scotia. - Szumilas M; Kutcher S; Leblanc JC; Langille DB; Szumilas, Magdalena; Kutcher, Stan; Leblanc, John C; Langille, Donald B (Canadian Journal of Psychiatry, 2010)
Objective: To determine whether students with self-reported needs for mental health support used school-based health centres (SBHCs) for this purpose.Method: A secondary analysis was conducted on self-reported data collected from 1629 high school students from Cape Breton, Nova Scotia. Descriptive statistics and logistic regression analyses were employed to determine the influence of sex, grade, sexual orientation, socioeconomic status (SES), school performance, social involvement, and health risk-taking behaviours on need for mental health support and use of SBHC for that purpose.Results: One-half of surveyed students reported needs for mental health support. Risk for depression was the most commonly reported indicator of need. Only 13% of students visited a SBHC nurse for mental health support, and 4 times as many females than males used the SBHC for this purpose (20.4%, compared with 5.3%, P < 0.001). There was a significantly increased likelihood of use of SBHC for mental health support, given the presence of a greater number of need factors. Multivariate logistic regression determined that female sex (OR 5.57, 95% CI 3.07 to 10.09), lower SES factor (OR 1.19, 95% CI 1.11 to 1.28), sexual health risk-taking behaviours (OR 1.72, 95% CI 1.28 to 2.31), and suicidal behaviour (OR 1.83, 95% CI 1.48 to 2.27) were significantly associated with the use of SBHCs for mental health support.Conclusions: Substantial need for mental health support and significant unmet need were observed. In particular, male students underused the services relative to their self-reported need. Implications for SBHCs and directions for future research are discussed.
Keywords: Health Services Needs and Demand -- Utilization; Mental Disorders -- Epidemiology; Mental Health Services -- Utilization; Schools, Nursing -- Statistics and Numerical Data; Students -- Psychosocial Factors; Students -- Statistics and Numerical Data; Adolescence; Age Factors; Cross Sectional Studies; Female; Health Behavior; Human; Male; Mental Disorders -- Psychosocial Factors; Nova Scotia; Sex Factors; Social Adjustment; Socioeconomic Factors; Surveys

Suicidal behaviour in people with HIV/AIDS: a review. - Komiti A; Judd F; Grech P; Mijch A; Hoy J; Lloyd JH; Street A (Australian & 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 Immunodeficiency Syndrome; HIV Infections; Suicide; Suicidal Ideation; Prevalence

Hate Crime, Medical Care, and Mental Health Care for Transgender Individuals. - Thomas, Sandra P. (Issues in Mental Health Nursing, 2016)
The editor tackles the issue of hate crime and the medical care and mental health care for transgender individuals in the U.S. Data presented shows hate crime against transgenders such as harassment, physical attacks and discrimination. Studies are cited that provide evidence of high rates of substance abuse and suicide attempts among transgenders and it challenges people to show compassion and become trans-affirmative role models for psychiatric-mental health and medical care providers.
Keywords: Crime; Transgender Persons; Mental Health Services; United States; Discrimination; Psychotherapy; Practice Guidelines; Substance Abuse; Suicide, Attempted

Homophobia and the production of shame: young people and same sex attraction. - Hillier L; Harrison L (Culture, Health & 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: Homophobia; Homosexuality -- In Adolescence; Gay Persons -- In Adolescence; Self Concept -- In Adolescence; Shame; Adolescence; Adult; Age Factors; Australia; Christianity; Cultural Values; Data Analysis Software; Discourse Analysis; Family Relations; Female; Funding Source; Gender Identity; Male; Narratives; Open-Ended Questionnaires; Parental Attitudes; Qualitative Studies; Sex Factors; Support, Psychosocial; Surveys; Human

Bridging the divide: integrating lesbian identity and orthodox Judaism. - Glassgold JM (Women & Therapy, 2008)
Women who consider themselves traditional or conservative in the context of religious practice often experience tremendous conflicts regarding the integration of same-sex emotional and sexual feelings with their religion and spirituality. Current religious teachings about homosexuality make this combination difficult as only heterosexual sexuality within marriage is permitted in most orthodox faiths. Further, the way that spirituality and sexuality are conceptualized as opposing dichotomous categories (e.g., body vs. soul) presents women with a framework where integration does not seem possible. Observant women who come to psychotherapy often experience tremendous distress, guilt, depression, and even suicidality due to the conflict between their sexual feelings and religious doctrine. Relieving the distress, and resolving the conflicts while honoring the emotional complexity of sexual feelings, spirituality, and religious orthodoxy can present tremendous dilemmas for the practitioner as well as the client. Using the example of psychotherapy of an Orthodox Jewish woman who integrated same-sex desire into her life, this article describes psychotherapy process and alternative ways of viewing spirituality and sexuality that permit possible resolutions for clients.
Keywords: Judaism; Lesbians; Psychotherapy -- Methods; Sexuality; Spirituality; Attitude to Sexuality; Conflict (Psychology); Female; Religion and Psychology

Creating a safer school environment for lesbian and gay students. - Treadway L; Yoakam J (Journal of School Health, 1992)
Information obtained from clinical experiences of the University of Minnesota Youth and AIDS Project (YAP), a primary AIDS prevention program for gay and bisexual males ages 14-21, is described. More than 300 YAP clients have been interviewed regarding sexual behavior, suicide attempts, drug use, and experiences in disclosing their homosexuality to peers and parents during their high school years. The authors also have drawn from their experiences as support group leaders for gay, lesbian, and bisexual youth in high school and community settings. Constructive and destructive coping strategies employed by gay, lesbian, and bisexual students are described. Roles and responsibilities of school professionals to create a safer school environment also are presented. Key issues include how school professionals support or deny the existence of homosexuality in young people; how adults' biases against homosexuality, as well as institutionalized heterosexism, prevent lesbian and gay students from succeeding in school; how language, behaviors, and environmental cues contribute to school professionals' approachability; how children of lesbian and gay parents suffer when negative attitudes toward homosexuality are not challenged; and what resources and referrals can help lesbian and gay young people.
Keywords: Lesbians; Gay Men; Coping -- In Adolescence; Homosexuality -- In Adolescence; School Health; Gender Identity; Environment; Adolescence

Authors' reply. - Meader, Nick; Chan, Melissa K. Y. (British Journal of Psychiatry, 2017)
A reply from the authors of the article about the differing the sexual orientations and gender identity and the lack of knowledge of LGBT issues among healthcare professionals is presented.
Keywords: Suicidal Ideation; Sexuality; Female; Young Adult; Adolescence; Male

Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder? - Giordano S (Journal of Medical Ethics, 2008)
Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child's quality of life and even save his or her life, then it is indeed unethical to defer treatment.
Keywords: Puberty -- Drug Effects; Quality of Life; Disorders of Sex Development -- Ethical Issues; Disorders of Sex Development -- Therapy; Decision Making, Ethical; Gender Identity; Phenotype; Disorders of Sex Development -- Drug Therapy; Disorders of Sex Development -- Psychosocial Factors; Transgender Persons

Austerity, inequality and sustainable interventions. - Bhui, Kamaldeep (British Journal of Psychiatry, 2017)
An introduction is presented in which the author discusses articles in the issue on topics including mental heath impact of stigma and social exclusion and inequality, suicidal attempts in young gay and bisexual men, and the need for better hospital staff support and training.

Suicide and suicide attempts in the lesbian and gay community. - Millard J (Australian & New Zealand Journal of Mental Health Nursing, 1995)
The most common suicide theories share a widely recognized set of social factors that contribute to suicide and suicide attempts. This paper discusses additional suicide risk factors that affect the gay and lesbian community such as: discrimination, gay adolescence, coming out, establishment of a gay identity, HIV/AIDS, intrapersonal drugs and alcohol, racial/ethnicfactors and limited support structures. Poor awareness of these additional risks, both within mainstream society and within the gay and lesbian community, is also discussed. A review of the literature is conducted that examines the impact of these risk factors and the implications of these issues to mental health nursing.
Keywords: Suicide; Suicide, Attempted; Lesbians -- Psychosocial Factors; Gay Men -- Psychosocial Factors; Attitude to Health; Social Identity -- In Adolescence; Discrimination; Substance Abuse; Stigma; Risk Factors; Psychiatric Nursing; Acquired Immunodeficiency Syndrome; Social Attitudes; Male; Female; Adolescence

Clinical characteristics, psychiatric comorbidities and sociodemographic profile of transsexual patients from an outpatient clinic in Brazil. - Lobato MI; Koff WJ; Schestatsky SS; Chaves CPV; Petry A; Crestana T; Amaral JT; Onófrio FQ; Salvador J; Silveira E; Henriques AA (International Journal of Transgenderism, 2007)
Objective: To provide a description of our transsexual population. Method: This descriptive observational study included 138 patients with a diagnosis of Transsexualism in Brazil, between March 1998 and September 2005. Demographic, clinical and psychiatry data were collected. Results: Age ranged from 16 to 54 years; 88.4% were male. The prevalence of sexually transmitted diseases was 19.5%, and 17.6% were HIV-positive. Hormone therapy was reported by 91.2%, and 47.4% referred drug and alcohol use; 14.2%, attempted suicide; and 12.5%, history of sexual abuse. Self-mutilation was reported by 5.2%s. Fifty-nine patients (42.7%) had at least one currently psychiatric comorbidity (axis I or II). Conclusions: Mental health professionals have a central role in coordinating the multidisciplinary care of transsexuals.
Keywords: Mental Disorders -- Diagnosis -- Brazil; Mental Disorders -- Epidemiology -- Brazil; Socioeconomic Factors; Transsexualism; Transsexuals -- Psychosocial Factors; Adolescence; Adult; Affective Disorders -- Diagnosis; Affective Disorders -- Epidemiology; Brazil; Comorbidity; Data Analysis Software; Descriptive Research; Descriptive Statistics; Educational Status; Female; Fisher's Exact Test; Gender Identity; Hormone Therapy; Human; Intelligence Tests; Male; Mann-Whitney U Test; Middle Age; Nonexperimental Studies; Outpatients; Scales; Self-Injurious Behavior -- Diagnosis; Self-Injurious Behavior -- Epidemiology; Semi-Structured Interview; Sex Factors; Sexually Transmitted Diseases -- Epidemiology; Suicide, Attempted -- Epidemiology; Transsexualism -- Therapy

Impact of sexual harassment victimization by peers on subsequent adolescent victimization and adjustment: a longitudinal study. - Chiodo D; Wolfe DA; Crooks C; Hughes R; Jaffe P (Journal of Adolescent Health, 2009)
PURPOSE: To examine gender differences in prevalence and types of sexual harassment victimization experienced in grade 9 and how it contributes to relationship victimization and psychological adjustment 2.5 years later. METHODS: A total of 1734 students from 23 schools completed self-report surveys at entry to grade 9 and end of grade 11. Self-report data were collected on victimization experiences (sexual harassment, physical dating violence, peer violence, and relational victimization) and adjustment (emotional distress, problem substance use, self-harm, suicidal thoughts, maladaptive dieting, feeling unsafe at school, and perpetration of violent delinquency). Separate analyses by sex were prespecified. RESULTS: Sexual harassment victimization was common among boys (42.4%) and girls (44.1%) in grade 9, with girls reporting more sexual jokes, comments, and unwanted touch than among boys, and with boys reporting more homosexual slurs or receiving unwanted sexual content. For girls, sexual harassment victimization in grade 9 was associated with elevated risk of self-harm, suicidal thoughts, maladaptive dieting, early dating, substance use, and feeling unsafe at school. A similar pattern of risk was found for boys, with the exception of dieting and self-harm behaviors. Adjusted odds ratios (AOR) indicated these students were significantly more likely than nonharassed students to report victimization by peers and dating partners 2.5 years later (AOR for boys and girls, respectively; all p < .01), including sexual harassment (AOR: 2.45; 2.9), physical dating violence (AOR: 2.02; 3.73), and physical peer violence (AOR: 2.75; 2.79). Gr 9 sexual harassment also contributed significantly to emotional distress (AOR: 2.09; 2.24), problem substance use (AOR: 1.79; 2.04), and violent delinquency perpetration (AOR: 2.1; 3.34) 2.5 years later (boys and girls, respectively; all p < .01). CONCLUSIONS: Sexual harassment at the beginning of high school is a strong predictor of future victimization by peers and dating partners for both girls and boys, and warrants greater prevention and intervention efforts.
Keywords: Sex Factors; Sexual Harassment -- Psychosocial Factors -- In Adolescence; Adolescence; Chi Square Test; Confidence Intervals; Data Collection, Computer Assisted; Demography; Descriptive Statistics; Domestic Violence; Female; Funding Source; Injuries, Self-Inflicted; Logistic Regression; Male; Multicenter Studies; Odds Ratio; Ontario; Parents; Schools, Secondary; Self Report; Substance Abuse; Suicidal Ideation; Surveys; Human

Predictors of suicidal ideation among high school students by gender in South Korea. - Park HS; Schepp KG; Jang EH; Koo HY (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.
Keywords: Sex Factors; Students, High School; Suicidal Ideation -- Risk Factors -- In Adolescence; Academic Performance; Adolescence; Center for Epidemiological Studies Depression Scale; Chi Square Test; Coefficient Alpha; Confidence Intervals; Cross Sectional Studies; Depression; Descriptive Statistics; Female; Internal Consistency; Interpersonal Relations; Logistic Regression; Male; Odds Ratio; P-Value; Psychological Tests; Questionnaires; Rosenberg Self Esteem Scale; Scales; Schools, Secondary; Self Concept; Self Report; Sexuality; Socioeconomic Factors; South Korea; Summated Rating Scaling; Surveys; Symptom Checklist-90-Revised; Univariate Statistics; Human

Minority Stress and Mechanisms of Risk for Depression and Suicidal Ideation Among Lesbian, Gay, and Bisexual Youth. - Baams, Laura; Grossman, Arnold H.; Russell, Stephen T. (Developmental Psychology, 2015)
Keywords: LGBTQ+ Persons; Stress, Psychological; Depression -- Risk Factors; Suicidal Ideation -- Risk Factors -- In Adolescence; Minority Groups; Human; Funding Source; Adolescence; Mental Health; Adaptation, Psychological; United States; Prospective Studies; Questionnaires; Multivariate Analysis of Variance; Goodness of Fit Chi Square Test; Data Analysis Software; Models, Statistical; Chi Square Test

Gynecologic care of the female-to-male transgender man. - Dutton L; Koenig K; Fennie K (Journal of Midwifery & Women's Health, 2008)
Transgender men are a vulnerable population whose health care needs have been difficult to identify because of limited research and an inability to identify the population. Limited evidence suggests that transgender men are at increased risk of having polycystic ovarian syndrome, contracting HIV, experiencing violence, and committing suicide. This qualitative study, conducted through face-to-face interviews of a convenient sample, was a three-part interview containing a demographic and health questionnaire, the Norbeck Social Support Questionnaire, as well as the Health Care Relationship Trust Scale. Audio recordings and written notes were reviewed and common themes were identified via content analysis. Six self-identified transgender men between the ages of 19 and 45 years were enrolled in the study. Participants were at varying degrees of social and medical transition. Four major themes were identified: 1) receiving gynecologic care was perceived to be important; 2) breasts caused the most gender identity conflict; 3) transgender men struggle with revealing their gender identity to health care providers; and 4) the male/female boxes on health intake forms, as well as pronoun usage by medical staff, were barriers to receiving health care. This gynecologic health care needs assessment of transgender men begins to characterize the barriers transgender men face when seeking health care.
Keywords: Gynecologic Care; Preventive Health Care; Transgender Persons; Adult; Attitude Measures; Audiorecording; Breast; Cervical Smears; Content Analysis; Convenience Sample; Cultural Competence; Female; Funding Source; Information Resources; Interviews; Male; New England; Norbeck Social Support Questionnaire; Patient Attitudes -- Evaluation; Phenomenological Research; Professional-Patient Relations; Purposive Sample; Questionnaires; Research Subject Recruitment; Snowball Sample; Thematic Analysis; Trust; World Wide Web; Human

Suicide and gay/lesbian/bisexual youth: implications for clinicians. - Morrison, L L; L'Heureux, J (Journal of Adolescence, 2001)
Keywords: Sexuality; Suicide -- Psychosocial Factors; Adolescence; Bisexuality; Female; Lesbians; Homosexuality; Male; Risk Assessment; Risk Factors

Homophobia: a cofactor of HIV disease in gay and lesbian youth. - Grossman AH (JANAC: Journal of the Association of Nurses in AIDS Care, 1994)
Whether they 'come out' or hide their sexual orientation, most gay and lesbian youth experience the effects of prejudice and stigmatization emanating from society's homophobia. Having to cope with a disparaging and oppressive society creates unique stresses and developmental variations in identity development that are cofactors for HIV infection and disease. These cofactors include cognitive, emotional, and social isolation; feelings of alienation and despair; suicidal ideation; alcohol and other substance abuse; and furtive sexual contacts. Nurses and other providers need to be informed aobut these cofactors so they may provide meaningful HIV/AIDS prevention education to gay and lesbian youth.
Keywords: Homosexuality -- In Adolescence; Homophobia; Gay Men -- Psychosocial Factors; HIV Infections -- Prevention and Control -- In Adolescence; Acquired Immunodeficiency Syndrome -- Prevention and Control -- In Adolescence; Social Isolation; Prejudice; Lesbians -- Psychosocial Factors; Risk Taking Behavior -- In Adolescence; Health Belief Model; Health Education -- In Adolescence; Adolescence; Male; Female

Development and health care needs of lesbians. - Lehmann JB; Lehmann CU; Kelly PJ (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: Lesbians -- Psychosocial Factors; Health Services Needs and Demand; Questionnaires; Data Analysis Software; Chi Square Test; Bias (Research); Students, College; Research Subject Recruitment; Adolescence; Adult; Age Factors; Physician-Patient Relations; P-Value; Sexuality; Support, Psychosocial; West Virginia; Human

Health care recommendations for lesbian women. - Roberts SJ (JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 2006)
Objective: To review research literature to provide clinicians with data-based recommendations for care of lesbians. Data Sources: Medline searches and references from selected articles with the search term 'lesbian health.' Study Selection: Literature was selected whether lesbian or women who have sex with women was utilized as a category in the study and results were available on this population. Data Extraction: Data were organized according to specific health problems noted frequently in the research articles. Data Synthesis: Lesbians have previously been invisible in health services and research, but in several areas, data now exists on which to base care. Conclusions: Lesbians are now more comfortable 'coming out' to providers but continue to have lower screening rates than other women. Risk is especially high in this population for cancer, heart disease, depression, and alcohol abuse. Adolescent lesbians are especially at risk for smoking and suicide/depression.
Keywords: Lesbians; Women's Health; Women's Health Services; Alcohol Abuse; Cancer Screening; Cardiovascular Risk Factors; Childbirth; Female; Medline; Mental Health Services; Parenting; Physical Examination; Professional-Patient Relations; Sexually Transmitted Diseases; Human

Sexual orientation and mental health in a birth cohort of young adults. - Fergusson DM; Horwood LJ; Ridder EM; Beautrais AL (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.
Keywords: Mental Health; Sexuality; Adult; Chi Square Test; Female; Funding Source; Male; Mantel-Haenszel Test; New Zealand; Poisson Distribution; Human

A Narrative Inquiry into the Experience of Being a Victim of Gun Violence...28th Annual Scientific Session, June 2-6, 2017, Baltimore, Maryland. - Francis, Mary (Nursing Research, 2016)
Background: Gun violence is a major societal concern for all Americans. The voice of the gun victim has been quiet in the literature. The research question for this study was ''What is the story of being a victim of gun violence from the perspective of the victim?'' The purpose of this study was to describe and gain an understanding of gun violence from the perspective of the victim. Narrative inquiry methodology was used with purposive sampling; interviews were conducted with 16 victims of gun violence. All interviews were transcribed verbatim. Data were coded according to words, phrases, and concepts to solicit a greater understanding of gun violence. Narrative inquiry allowed the participants to tell their story of being a victim of gun violence. The four themes that emerged from the interviews . The knowledge gained by this research has significance to influence nursing science and health care policy. Health care and quality of life should be equally available to everyone, yet gun violence is overrepresented by urban African American males. Purpose: The purpose of this study was to describe and gain an understanding of gun violence from the perspective of the victim. Methods: Narrative Inquiry, a qualitative study that obtains the story of a phenomenon from the participant in the study. All participants were victims of gun violence. Victims were adult male or female . All participants were fluent in English. There will be no limitations on the timeframe from when the participant was shot. Victims with major psychiatric disorders were excluded. The recruitment and interview occurred during the participants follow up visit at the trauma clinic. All interviews were conducted by the same researcher. The interviews were audiotaped then transcribed by a professional transcriptionist verbatim. The transcripts were compared to the audiotapes for accuracy. The stories were read several times until an internal organization emerged. The data were analyzed by a categorical-content perspective. The study consisted of 16 participants, 13 males, 2 females and I transgender. Results: After careful analysis of the interviews four themes emerged: Prevailing nature of everyday violence, feeling abandoned by institutions of society, living in a context of reactive violence fueled by poverty, lack of employable skills and education, evolving of psychological effects following gun violence. Conclusions/Implications: The participants' lives were chaotic and dangerous. Many of the participants shared feelings of hopelessness, they recognized the need to change their situation but lacked the resources to do so. Gun violence is a multifaceted issue of violence and hopelessness. It is a population lacking in finances, appropriate ongoing health care, and knowledge on how to access available resources. A socioeconomic disparity exists for this population and many of their overall health care needs are left unmet. Gun violence needs to be addressed as a health care disparity.
Keywords: Research, Nursing -- Organizations; Quality of Nursing Care; Congresses and Conferences -- Maryland; Maryland

Depression and suicide in gay and lesbian adolescents: a proactive clinical approach to a population at risk. - Allen LB; Glicken AD (Physician Assistant, 1996)
Homosexual (gay and lesbian) adolescents are at increased risk for dropping out of school, depression, drug abuse, and suicide. PAs are in a position to identify these high-risk teenagers and provide them and their families with health education and support group referrals. A clinical approach that encourages open discussion between health care providers and adolescents about issues of sexuality is essential to this process. This article presents theories on the etiology of human homosexuality and the development of a homosexual identity. Emotional problems of gay and lesbian youth are discussed, including specific suicide risk factors. Other issues in medical practice include avoiding assumptions of heterosexuality, ensuring confidentiality, the nonbiased wording of questions, and making appropriate referrals to support groups, mental health services, and family counseling.
Keywords: Depression -- In Adolescence; Suicide -- Prevention and Control -- In Adolescence; Homosexuality -- In Adolescence; Risk Factors -- In Adolescence; Counseling -- In Adolescence; Adolescence; Male; Female

Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students. - Faulkner AH; 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: Risk Taking Behavior -- In Adolescence; Adolescent Behavior; Homosexuality -- In Adolescence; Bisexuality -- In Adolescence; Students, High School; Funding Source; Random Sample; Violence -- In Adolescence; Suicide, Attempted -- In Adolescence; Substance Use Disorders -- In Adolescence; Questionnaires; Massachusetts; Adolescence; Male; Female; Human

Sex, drugs, violence, and HIV status among male-to-female transgender persons in Houston, Texas. - Risser JMH; 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%.
Keywords: Gender Identity -- Classification; Health Services Needs and Demand; HIV Infections -- Prevention and Control; HIV Infections -- Risk Factors; Transsexualism -- Classification; Chi Square Test; Crime Victims; Data Analysis Software; Data Collection, Computer Assisted; Descriptive Statistics; Funding Source; Risk Taking Behavior; Sexual Health; Structured Interview; Substance Abuse; Suicidal Ideation; Texas; Violence; Human

Heterosexual Identity Moderates the Association between Bullying and Suicide Planning among Adolescents with Same-Sex Sexual Partners. - Turpin, Rodman; Boekeloo, Bradley; Dyer, Typhanye (Annals of Epidemiology, 2017)

Same-sex attraction: a model to aid nurses' understanding. - Richardson B (Paediatric Nursing, 2009)
Young people attracted to people of their own sex are at risk of bullying and discrimination. It is often difficult for them to find support. Either emotionally or in relation to their health needs. This article explores a model to aid nurses in understanding the process individuals go through before coming to terms with their sexuality. The model also outlines the steps that nurses can take to enhance the care they provide for this vulnerable group of patients and clients.
Keywords: Bullying; Discrimination; LGBTQ+ Persons; Nursing Role; Sexuality; Gender Identity; Nurse-Patient Relations; Pediatric Nursing; Privacy and Confidentiality; Puberty; Suicidal Ideation; Young Adult

Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. - Gilman SE; Cochran SD; Mays VM; Hughes M; Ostrow D; Kessler RC (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: Homosexuality; Mental Disorders -- Epidemiology; Funding Source; Surveys; Female; Male; Adult; Anxiety Disorders -- Epidemiology; Depression -- Epidemiology; Substance Use Disorders -- Epidemiology; Suicidal Ideation -- Epidemiology; DSM; Interviews; Psychological Tests; Reliability and Validity; Prevalence; Bivariate Statistics; Survival Analysis; Logistic Regression; Odds Ratio; Confidence Intervals; Two-Tailed Test; P-Value; Descriptive Statistics; Chi Square Test; Socioeconomic Factors; Adolescence; Middle Age; Risk Factors; Human

The facts about violence against historically disadvantaged persons: what can psychiatrists do about disproportionately high rates of suicide and violence? - McLeod-Bryant S; Robinson GE; Benton BT; Srinivasaraghavan J; Bialer PA (Psychiatric Times, 2008)
Keywords: Crime Victims -- Psychosocial Factors; Crisis Intervention; Violence -- Complications; Violence -- Epidemiology; Asians; Domestic Violence; Homosexuality; Native Americans; Sexual Abuse; Social Attitudes; Suicide; Women

An exploratory study of correlates, onset, and offset of non-suicidal self-injury. - Deliberto TL; Nock MK (Archives of Suicide Research, 2008)
Keywords: Self-Injurious Behavior -- Epidemiology; Self-Injurious Behavior -- Psychosocial Factors; Adolescence; Adult; Ethnic Groups -- Statistics and Numerical Data; Female; Homosexuality; Male; Risk Factors

Cyber and Bias-based Harassment: Associations With Academic, Substance Use, and Mental Health Problems. - Sinclair, Katerina O.; Bauman, Sheri; Poteat, V. Paul; Koenig, Brian; Russell, Stephen T. (Journal of Adolescent Health, 2012)
Abstract: Purpose: To examine how two forms of interstudent harassment, cyber and bias-based harassment, are associated with academic, substance use, and mental health problems. Methods: We used a population-based survey of 17,366 middle and high school students that assessed harassment due to race/ethnicity or sexual orientation, and harassment through the Internet or text messaging along with other forms of interstudent harassment. Results: Odds ratios indicated that students experiencing both cyber and bias-based harassment were at the greatest risk for adjustment problems across all indicators, with suicidal ideation and attempts having the largest risk differences. Conclusions: Assessments of adolescent health and adjustment should include questions regarding both cyber and bias-based harassment.
Keywords: Mental Disorders; Bullying; Substance Abuse; Academic Performance; Discrimination; Internet -- Utilization; Human; Students, Middle School; Students, High School; Wisconsin; Male; Female; LGBTQ+ Persons; Sexuality; Racism; Analysis of Variance; Descriptive Statistics; Odds Ratio; Cross Sectional Studies; Child; Adolescence

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 & 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 ART experienced; 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: Antiretroviral Therapy, Highly Active -- Methods; HIV Infections -- Physiopathology; HIV Infections -- Psychosocial Factors; Patient Compliance; Quality of Life -- Psychosocial Factors; Adult; Cross Sectional Studies; Demography; England; Ethnic Groups; Female; Heterosexuality; Anti-HIV Agents; Homosexuality; Human Immunodeficiency Virus; Male; Questionnaires; Human

Impact of Social Determinants of Health on Medical Conditions Among Transgender Veterans. - Blosnich, John R; Marsiglio, Mary C; Dichter, Melissa E; Gao, Shasha; Gordon, Adam J; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Fine, Michael J (American Journal of Preventive Medicine, 2017)
Introduction: Transgender individuals experience pronounced disparities in health (e.g., mood disorders, suicide risk) and in the prevalence of social determinants of housing instability, financial strain, and violence. The objectives of this study were to understand the prevalence of social determinants among transgender veterans and assess their associations with medical conditions.Methods: This project was a records review using administrative data from the U.S. Department of Veterans Affairs databases for 1997-2014. Transgender veterans (N=6,308) were defined as patients with any of four ICD-9 diagnosis codes associated with transgender status. Social determinants were operationalized using ICD-9 codes and Department of Veterans Affairs clinical screens indicating violence, housing instability, or financial strain. Multiple logistic regression was used to assess the associations of social determinants with medical conditions: mood disorder, post-traumatic stress disorder, alcohol abuse disorder, illicit drug abuse disorder, tobacco use disorder, suicidal risk, HIV, and hepatitis C.Results: After adjusting for sociodemographic variables, housing instability and financial strain were significantly associated with all medical conditions except for HIV, and violence was significantly associated with all medical conditions except for tobacco use disorder and HIV. There was a dose response-like relationship between the increasing number of forms of social determinants being associated with increasing odds for medical conditions.Conclusions: Social determinants are prevalent factors in transgender patients' lives, exhibiting strong associations with medical conditions. Documenting social determinants in electronic health records can help providers to identify and address these factors in treatment goals.
Keywords: Social Determinants of Health; Veterans -- Statistics and Numerical Data; Aged; Young Adult; Female; Prospective Studies; Male; Adult; Middle Age; United States; Human

Lance: a gay recovering alcoholic misdiagnosed as HIV-positive. - Kus RJ; Carpenter MA (Archives of Psychiatric Nursing, 1991)
Keywords: Homosexuality; Alcoholism; HIV Seropositivity -- Psychosocial Factors; Diagnostic Errors; Suicide, Attempted; Gay Men; Adult; Male

Youth risk behavior survey: Bangkok, Thailand. - Ruangkanchanestr 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.
Keywords: Adolescent Behavior; Risk Factors -- In Adolescence; Risk Taking Behavior -- Epidemiology -- Thailand; Accidents, Traffic; Adolescence; Adolescence -- Psychosocial Factors; Chi Square Test; Confidence Intervals; Female; Funding Source; Male; Multiple Logistic Regression; Odds Ratio; Questionnaires; Sex Factors; Sexuality; Socioeconomic Factors; Substance Abuse; Survey Research; Thailand; Violence; Human

Gays' mental health: new data. (Harvard Mental Health Letter, 2006)
Keywords: Bisexuals; Gay Persons; Injuries, Self-Inflicted -- Risk Factors; Lesbians; Mental Health Services -- Utilization; Personal Satisfaction -- Evaluation; Psychological Well-Being -- Evaluation; Self Concept -- Evaluation; Suicide -- Risk Factors

Staff knowledge and attitudes towards deliberate self-harm in adolescents. - Crawford, Tanya; Geraghty, Wendy; Street, Karen; Simonoff, Emily (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 knowledge, 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.
Keywords: Adolescent Health Services; Attitude of Health Personnel; Poisoning -- Psychosocial Factors; Self-Injurious Behavior -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Urban Population; Adolescence; Child Abuse, Sexual -- Diagnosis; Child Abuse, Sexual -- Psychosocial Factors; Female; Attitude to Health; Homosexuality; Academic Medical Centers; Human; Employee Orientation; England; Male; Poisoning -- Prevention and Control; Referral and Consultation; Risk Factors; Self-Injurious Behavior -- Prevention and Control; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Suicide, Attempted -- Prevention and Control

Book reviews. - Bergmann K; Fairbairn AF; Burns A; Treloar A; Graham N; Barak Y; Garner G; Mastwyk M; Williams B; Bryant C; Beckford LC; Wallace J; et al. (International Psychogeriatrics, 2006)
Keywords: Ageism; Communication; Dementia -- Therapy; Elder Abuse; Geriatric Psychiatry -- Trends; Gerontologic Care; Housing for the Elderly; Lesbians; Psychiatric Nursing; Psychopharmacology; Psychotropic Drugs; Recreational Therapy; Social Work; Suicide, Assisted; Writing

Addressing the Needs of LGBT Patients. - STUMBAR, SARAH E. (American Family Physician, 2017)
The author stresses that sexuality is an integral part of a patient's identity that needs to be uniquely defined by each patient. Topics discussed include the risk for LGBT youth to have many health problems, bullying, depression and suicide, negative interactions with the health care system as a major barrier to medical care for women who have sex with women (WSW), and the associations between self-identified sexual orientation and a variety of self-reported health conditions.
Keywords: Homosexuality

Sexual risk behavior and substance use among a sample of Asian Pacific Islander transgendered women. - Operario D; Nemoto T (AIDS Education & 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.
Keywords: Asians -- Psychosocial Factors; Asians -- United States; Risk Taking Behavior; Sexuality -- Ethnology; Substance Use Disorders -- Epidemiology; Transsexualism -- Ethnology; Adolescence; Adult; California; Center for Epidemiological Studies Depression Scale; Chi Square Test; Confidence Intervals; Data Collection; Descriptive Statistics; Female; Middle Age; Multiple Logistic Regression; Odds Ratio; P-Value; Pacific Islands; Pearson's Correlation Coefficient; Psychological Tests; Risk Assessment; United States; Funding Source; Human

An equal struggle (psychodynamic assessment following repeated episodes of deliberate self harm) - Jones A (Journal of Psychiatric & Mental Health Nursing (Wiley-Blackwell), 1996)
Psychodynamic psychotherapy is a complex method of enabling a person to engage with life difficulties. This narrative paper investigates the value of psychodynamic psychotherapy within the framework of the 'Health of the Nation' document (Department of Health 1992). The paper explores an encounter with a young gay man who was admitted to the medical unit following an episode of deliberate self harm, in response to profound and thematic relationship difficulties. The writer (a liaison mental health nurse, working in a general hospital setting) examines the complexities of the transference, countertransference relationship. A case is made for the facilitation of choice as a primary goal of therapy. It is suggested that the inauguration of transference resolution is determined through an equitable relationship, in which therapist and client are engaged equally in the struggle toward understanding. The paper concludes with the suggestion that psychotherapy is an appropriate and effective method for dealing with relational conflict. However, personal, temporal and social resources may not provide the client with what is, in Kleinian terms, a necessary holding environment. The assessment process nevertheless can provide important learning and enable significant changes to be made in supportive networks.
Keywords: Psychotherapy; Suicide, Attempted -- Therapy; Nursing Assessment; Transference (Psychology); Conceptual Framework; Adult; Male

Theoretical perspectives on suicide in gay men with AIDS. - McNaught A; Spicer J (Social Science & 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.
Keywords: Suicide -- Psychosocial Factors; Gay Men -- Psychosocial Factors; Attitude to AIDS; Psychological Theory; Life Purpose; Male

Erotomania in an adolescent: clinical and theoretical considerations. - Urbach, J R; Khalily, C; Mitchell, P P (Journal of Adolescence, 1992)
Erotomania is a relatively rare delusional syndrome, typically seen in heterosexual women of middle-age or beyond. This is the first reported occurrence in an adolescent, and one of very few involving homosexual orientation. A detailed case report is discussed in the context of adolescent developmental phenomena, including "crushes", identity formation, and the resolution of sexual orientation. The presentation of erotomania as alleged sexual abuse, and a possible etiologic role for childhood sexual trauma, are considered.
Keywords: Delusions; Mental Disorders -- Psychosocial Factors; Sexuality; Students -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Adolescence; Adolescent Behavior; Chlorpromazine -- Administration and Dosage; Chlorpromazine -- Therapeutic Use; Female; Homosexuality; Interpersonal Relations; Lithium -- Administration and Dosage; Lithium -- Therapeutic Use; Mental Disorders -- Drug Therapy; Mental Health; Teaching

Mental health issues among young lesbians and gay men bullied in school. - Rivers I (Health & Social Care in the Community, 1995)
Keywords: Gay Persons -- Psychosocial Factors -- In Adolescence; Student Experiences -- United Kingdom; Mental Health; Suicidal Ideation; United Kingdom; Homophobia; Social Conformity; Self Concept; Peer Pressure; Adolescence; Male; Female

Lesbian use and abuse of alcohol: results of the Boston Lesbian Health Project II. - Roberts SJ; Grindel CG; Patsdaughter CA; DeMarco R; Tarmina MS (Substance Abuse, 2004)
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.
Keywords: Alcohol Abuse -- Epidemiology; Alcoholism -- Epidemiology; Alcoholism -- Risk Factors; Lesbians; Adult; Alcohol Abuse -- Etiology; Alcohol Abuse -- Trends; Alcohol Rehabilitation Programs; Alcoholism -- Etiology; Alcoholism -- Trends; Child Abuse, Sexual; Clinical Assessment Tools; Descriptive Statistics; Female; Health Status; Massachusetts; Questionnaires; Replication Studies; Self Report; Snowball Sample; Substance Abuse -- Familial and Genetic; Survey Research; Human

CORRECTION...Raifman J, Moscoe E, Austin SB, McConnell M. Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts [published online February 20, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2016.4529 (JAMA Pediatrics, 2017)
Keywords: Suicide, Attempted; Adolescence

Risk assessment of adolescents with same-sex relationships. - Undry JR; 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.
Keywords: Bisexuality -- In Adolescence; Heterosexuality -- In Adolescence; Homosexuality -- In Adolescence; Risk Taking Behavior -- In Adolescence; Adolescence; Female; Intelligence Tests; Interviews; Linear Regression; Logistic Regression; Male; Risk Assessment; Scales; Sex Factors; T-Tests; Human

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

Association of adolescent catatonia with increased mortality and morbidity: evidence from a prospective follow-up study. - Cornic F; Consoli A; Tanguy ML; Bonnot O; Périsse D; Tordjman S; Laurent C; Cohen D; Cornic, Françoise; Consoli, Angèle; Tanguy, Marie-Laure; Bonnot, Olivier; et al. (Schizophrenia Research, 2009)
This paper examined outcomes among youth with catatonic syndrome and determined whether the characteristics suggesting the relevance of chronic catatonic schizophrenia (CCS) at index episode remained stable at follow-up. From 1993 to 2004, 35 individuals aged 12 to 18 years were prospectively admitted for management of catatonic syndrome and followed up after discharge. Mean duration from discharge to follow-up was 3.9 years (range 1-10). Four patients were lost to follow-up. Among the remaining 31 subjects (mean age=19.5 years, range 15-26), life-time diagnosis using the Diagnostic Interview for Genetic Studies was unchanged in 28 patients, and included schizophrenia (all subtypes; N=20), major depressive episode (N=5), bipolar disorder type I (N=4) and brief psychotic episode (N=2). Mortality (all-cause Standardized Mortality Ratio=6266; 95% CI=1181-18,547) and morbidity were severe, with 3 deaths (including 2 suicides), 6 patients presenting with a causal organic condition and 14 subjects needing continuous psychiatric care. All males in the study (N=8) who had chronic catatonic schizophrenia at the index episode still had chronic catatonic signs at follow-up. Catatonia is one of the most severe psychiatric syndromes in adolescents. It is associated with a 60-fold increased risk of premature death, including suicide, when compared to the general population of same sex and age. This increased risk of premature death remains higher than the one measured in former adolescent psychiatric patients (all-cause SMR=221; 95% CI=156-303; Engqvist and Rydelius, 2006), or in schizophrenia irrespective to age and subtype (all-cause SMR=157; 95% CI=153-160; Harris and Barraclough, 1998).
Keywords: Catatonia -- Epidemiology; Catatonia -- Mortality; Adolescence; Adult; Catatonia -- Diagnosis; Female; Interview Guides; Male; Morbidity; Prospective Studies; Psychological Tests; Psychometrics; Retrospective Design; Risk Factors; Severity of Illness Indices; Sex Factors; Socioeconomic Factors; Human

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 > or =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 > or =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.
Keywords: Self-Injurious Behavior -- Epidemiology; Students, College; Adolescence; Adult; Colleges and Universities; Confidence Intervals; Data Analysis Software; Descriptive Statistics; Dose-Response Relationship; Female; Funding Source; Logistic Regression; Male; Odds Ratio; Prevalence; Questionnaires; Random Sample; Sex Factors; United States; Univariate Statistics; Human

Depression and suicide attempt as risk factors for incident unprovoked seizures. - Hesdorffer DC; Hauser WA; 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.
Keywords: Depression -- Complications; Seizures -- Etiology; Suicide, Attempted; Adolescence; Adult; Child; Depression -- Physiopathology; Epilepsy -- Diagnosis; Epilepsy -- Physiopathology; Female; Iceland; Male; Middle Age; Risk Factors; Seizures -- Physiopathology; Human

Homelessness and drug abuse among young men who have sex with men in New York city: a preliminary epidemiological trajectory. - Clatts, Michael C; Goldsamt, Lloyd; Yi, Huso; Gwadz, Marya Viorst (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.
Keywords: Homeless Persons -- Psychosocial Factors; Homosexuality; Substance Use Disorders -- Epidemiology; Adolescence; Adult; Epidemiological Research; Human; Male; New York; Risk Taking Behavior; Street Drugs

Prevalence of prior HIV testing and associated factors among MSM in Zhejiang Province, China: a cross-sectional study. - Li, Runhua; Pan, Xiaohong; Ma, Qiaoqin; Wang, Hui; He, Lin; Jiang, Tingting; Wang, Dayong; Zhang, Yan; Zhang, Xingliang; Xia, Shichang (BMC Public Health, 2016)
Background: Men who have sex with men (MSM) have become one of high-risk population for human immunodeficiency virus (HIV) infection, due to their multiple sex partners and unprotected anal intercourse. Promoting HIV testing is an effective strategy for the prevention and control of HIV infection. We assessed the factors associated with a prior HIV testing history, which could provide guidance for implementation of future HIV intervention programs.Methods: A cross-sectional study was conducted in three cities of Zhejiang Province, namely, Hangzhou, Ningbo and Wenzhou, using respondent-driven sampling, between December 2013 and June 2014. A face-to-face questionnaire survey was employed to collect relevant information about HIV testing. Univariate and multivariate logistic regression analyses were used to identify the factors associated with a prior HIV testing history.Results: The adjusted rate of prior HIV testing among MSM in Zhejiang Province was 55.9 %. The adjusted rates of HIV and syphilis infections among MSM in Zhejiang Province were 14.0 % and 11.4 %, respectively. A weighted multivariate analysis showed that MSM of older age were more likely to be tested, as were MSM with higher level of education, self-reported homosexuality and a higher frequency of receiving AIDS/sexually transmitted infections educational intervention in the past year. MSM with suicidal inclination and self-perceived lower possibility of HIV infection were less likely to report ever having undergone an HIV test.Conclusions: The prevalence of prior HIV testing among MSM in Zhejiang Province, China is low. Effective and more frequent interventional measures should be adopted to improve risk awareness and psychosocial support for younger, less educated MSM, and to encourage more MSM to undergo HIV testing.
Keywords: HIV Infections -- Diagnosis; HIV Infections -- Prevention and Control; Homosexuality; Health Screening -- Statistics and Numerical Data; Surveys; Adolescence; Prevalence; Adult; Cross Sectional Studies; Middle Age; Aged; Male; Young Adult; China; Human

Love Thy Neighbor: A Guide for Implementing Safe School Initiatives for LGBTQ Students in Nonaffirming Religious Communities. - Ginicola, Misty; Smith, Cheri; Rhoades, Elizabeth (Journal of LGBT Issues in Counseling, 2016)
Although setting up a safe school is an important task for a school counselor, his or her efforts may be resisted when attempting to develop a safe school initiative in a religious community; for example, one conservative-based website gives parents explicit instructions on how to fight a school's safe schools initiatives. This article provides a review of the issues involved and a specific framework for school counselors who wish to set up a Safe Schools Initiative in the context of a resistant atmosphere, using a social justice framework.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Discrimination -- Prevention and Control; School Health Services; Counseling; Religion and Religions; Education, Continuing (Credit); Social Justice; Program Implementation; School Violence -- Prevention and Control; Students -- Psychosocial Factors

Adolescent suicide attempts: risks and protectors. - Borowsky IW; Ireland M; Resnick MD (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 all 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: Risk Factors -- In Adolescence; Suicide, Attempted -- In Adolescence; Secondary Analysis; Odds Ratio; Descriptive Statistics; Stratified Random Sample; Questionnaires; Interviews; Logistic Regression; Confidence Intervals; Black Persons; White Persons; Hispanic Americans; Adolescence; Male; Female; Funding Source; Human

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 EL; Bruneau, J; Lamothe, F; Soto, J; Lachance, N; Vincelette, J; et al. (CMAJ: 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: Substance Abuse, Intravenous; HIV Infections -- Epidemiology -- Quebec; Sex Factors; Quebec; Female; Male; Prospective Studies; Structured Interview; Logistic Regression; HIV Seropositivity; Odds Ratio; Confidence Intervals; Step-Wise Multiple Regression; P-Value; Descriptive Statistics; Risk Factors; Funding Source; Human

The health beliefs, values, and practices of gay adolescents. - Wells SA (Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 1999)
Barriers to optimal health in the gay adolescent population include a lack of recognition or acceptance by healthcare providers, homophobic attitudes, and an absence of awareness regarding the healthcare needs of this vulnerable population. The literature suggests that gay youths experience such problems as lack of self-esteem, school truancy and dropout, runaway behavior and subsequent homelessness, drug and alcohol abuse, prostitution and sexually transmitted diseases, depression, and suicide. Advanced practice nurses have the opportunity to improve the health of gay youths through recognition, education, outreach, and advocacy.
Keywords: Mental Health -- In Adolescence; Health Beliefs -- In Adolescence; Nursing Role; Health Behavior -- In Adolescence; Gay Persons -- In Adolescence; Advanced Practice Nurses; Adolescent Behavior; Social Networks -- In Adolescence; Substance Abuse -- In Adolescence; Adolescent Psychology; Sexuality -- In Adolescence; Schools, Secondary; Homelessness -- In Adolescence; Suicide -- In Adolescence; Adolescence

Connectedness Factors that Protect Against Repetitive Non-Suicidal Self-Injury Among Sexual Minority Youth Who Self-Injure...Cultivating Connections: The Importance of Relationships in Adolescent and Young Adult Health, 08 March 2017- 11 March 2017 - Taliaferro, Lindsay A.; Muehlenkamp, Jennifer J. (Journal of Adolescent Health, 2017)
Keywords: Self-Injurious Behavior -- Prevention and Control -- In Adolescence; LGBTQ+ Persons -- In Adolescence; Interpersonal Relations -- In Adolescence; Social Behavior -- In Adolescence; Human; Adolescence

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 = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 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. CONCLUSIONS: 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: HIV Infections -- Epidemiology; Risk Taking Behavior; Health Resource Utilization; Mental Health; Transsexualism -- Psychosocial Factors; Funding Source; HIV Infections -- Risk Factors; Convenience Sample; Interviews; Prevalence; Center for Epidemiological Studies Depression Scale; Psychological Tests; Enzyme-Linked Immunosorbent Assay; Blotting, Western; Saliva -- Analysis; Chi Square Test; Fisher's Exact Test; Adult; Middle Age; Aged; Male; Female; Confidence Intervals; Odds Ratio; P-Value; Quantitative Studies; Descriptive Research; Educational Status; Safe Sex; California; Sexuality; Sexual Partners; Substance Abuse, Intravenous -- Epidemiology; Transsexualism -- Complications; Race Factors; Human

CORRECTION...Raifman J, Moscoe E, Austin SB, McConnell M. Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts [published online February 20, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2016.4529 (JAMA Pediatrics, 2017)
Keywords: Breast Feeding; Conflict of Interest; Mucocutaneous Lymph Node Syndrome; Marriage; Suicide

Restraining orders in California: a look at statewide data. - Sorenson SB; Shen H (Violence Against Women, 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.
Keywords: Battered Women; Domestic Violence -- Legislation and Jurisprudence -- California; Domestic Violence -- Prevention and Control; Adult; Age Factors; California; Data Collection Methods; Databases; Descriptive Research; Descriptive Statistics; Female; Firearms; Legislation; Male; Intimate Partner Violence -- Legislation and Jurisprudence; Race Factors; Safety; Sex Factors; Funding Source; Human

Domestic violence and sexual abuse in women physicians: associated medical, psychiatric, and professional difficulties. - Doyle JP; Frank E; Saltzman LE; McMahon PM; Fielding BD (Journal of Women's Health & 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: Domestic Violence -- Psychosocial Factors; Physicians, Women -- Psychosocial Factors; Sexual Abuse -- Psychosocial Factors; Female; Adult; Middle Age; Prevalence; United States; Questionnaires; Statistical Significance; P-Value; Surveys; Telephone; Data Analysis Software; Databases; T-Tests; Chi Square Test; Logistic Regression; Confidence Intervals; Human

Assessment and Treatment of Depression in Gay and Bisexual Men in Emergency Settings. - Blackwell, Christopher W. (Advanced Emergency Nursing Journal, 2015)
Gay and bisexual men are at higher risk for certain mental health disorders, including anxiety, depression, and suicide. These individuals often present to emergency settings in need of evaluation and treatment. Despite the utilization of emergency mental health services by this population, clinicians are often underprepared in responding to their unique needs. This article discusses depression in gay and bisexual men and provides an evidence-based approach in treating these men in emergency settings. Directives for future research and advanced practice nursing education are also presented.
Keywords: Gay Men -- Psychosocial Factors; Bisexuals -- Psychosocial Factors; Depression; Emergency Care -- Psychosocial Factors; Depression -- Diagnosis; Depression -- Drug Therapy; Depression -- Etiology; Professional Competence; Clinical Competence; LGBTQ+ Persons; Individualized Medicine; Physician-Patient Relations; Trust; Medical Practice, Evidence-Based; Cultural Competence

Caring for adolescents and families in crisis. - Parsons C (Nursing Clinics of North America, 2003)
Nurses are likely to see adolescents and their families in a variety of practice settings. Recognizing the youth and family at risk is significant in helping them resolve a stressful situation by mobilizing resources and strengthening coping and problem-solving skills. This article has focused on several areas, including suicide and depression, sex-related issues, substance abuse, and poor academic performance. Helping the youth and family in crisis challenges the nurse to use astute assessment skills that support a patient-centered crisis intervention model. During a time when cost-effective mental health care is a necessity, this model offers nurses an opportunity to provide quality health care. Copyright © 2003 by Elsevier Science (USA).
Keywords: Family -- Psychosocial Factors; Psychiatric Nursing; Crisis Intervention -- In Adolescence; Nursing Interventions; Nursing Assessment; Risk Factors; Coping; Depression; Suicide; Substance Abuse; Pregnancy in Adolescence; Homosexuality; Family Assessment; Problem Solving; Support, Psychosocial; Models, Theoretical; Adolescence; Female

Two more precautions...'What can you do to prevent teen suicide?'... 'Tooth avulsion,' Action stat - Boardman KD (Nursing, 2006)
Keywords: Adolescence; Gloves; Gay Persons -- In Adolescence; Suicidal Ideation -- In Adolescence; Tooth Avulsion; Universal Precautions

A cluster analytic investigation of school violence victimization among diverse students. - Felix ED; Furlong MJ; Austin G (Journal of Interpersonal Violence, 2009)
Despite nationwide improvements in school safety, victimization at school continues and affects the well-being of a significant number of students. This study uses the California Healthy Kids Survey, a statewide surveillance instrument administered to students in grades 7, 9, and 11 in California (N = 70,600) to address the multiple victimization experiences of students at school. The authors identify subgroups of students based on victimization experience; assess how perceptions of being targeted due to bias relate to cluster membership; and relate victimization to perceptions of school safety, depression, grades, truancy, and internal assets. Victimization rates are given across grade, gender, and ethnicity. Cluster analysis reveals five victimization subgroups-nonvictims, polyvictims, and victims who are predominantly sexually harassed, predominantly physically victimized, and predominantly teased. Compared to nonvictims, students who are victimized report worse outcomes on measures of psychosocial adjustment, with polyvictims faring the worst. Victims are more likely to perceive that they are targeted due to their gender or perceived sexual orientation. Implications for research and practice are provided.
Keywords: Bullying -- In Adolescence; Bullying -- In Infancy and Childhood; School Violence; Victims -- In Adolescence; Victims -- In Infancy and Childhood; Adaptation, Psychological; Adolescence; California; Chi Square Test; Child; Child Safety; Cluster Analysis; Cultural Diversity; Demography; Discrimination; Female; Logistic Regression; Male; Perception; Prejudice; Questionnaires; Race Factors; Sex Factors; Sexual Harassment; Social Adjustment; Surveys; Human

Adjustment to Violent and Natural Deaths in Later and Earlier Life for Black and White Widows. - Kitson, Gay C. (Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 2000)
Explores and compares the ability of white versus black widows to adjust to violent and natural deaths in later and earlier life. High level of distress among widows of men who died from violent, sudden and natural deaths; Higher distress level among middle-aged and young widows verses aged widows; Stigma of suicide among black persons.

Sexual violence and aggressive behavior among teenage boys in the general population and in juvenile prison, in Russia: a descriptive analysis. - Masagutov RM; Anderson PB (International Electronic Journal of Health Education, 2003)
The present research analysed the prevalence and consequences of sexual violence experienced by teenage males in two separate samples. One sample was drawn from the general school population and the other was drawn from the juvenile prison population in the Bashkir Republic of Russia. The data comes from an author-designed questionnaire about aggressive behaviour experienced by schoolboys and imprisoned young men. Seventy percent of schoolboys, who reported being sexually abused, were sexually abused in their childhood (3-11 years). Only 23% of imprisoned boys, who admitted being sexually abused, reported being abused in their childhood. The consequences of the sexual abuse of boys consisted primarily of Posttraumatic Stress Disorder (PTSD) symptoms, autoaggression, disturbances of sexual identity, and emotional instability. Psychological trauma as a consequence of sexual violence led to an increase in aggression for some teenagers. Almost all the cases of reported sexual aggression experienced by young men in this sample were homosexual, both in childhood and in prison. These victims of sexual violence were marked by high levels of depression, suicide, mental disorders, the use of alcohol and drugs, difficulties in familial relations, and sexual problems.
Keywords: Sexual Abuse -- Complications -- In Adolescence; Sexual Abuse -- Epidemiology -- In Adolescence; Sexual Abuse -- In Adolescence -- Russia; Adolescence; Affective Disorders -- Etiology -- In Adolescence; Aggression -- Etiology -- In Adolescence; Descriptive Statistics; Gender Identity -- In Adolescence; Identity Crisis -- In Adolescence; Juvenile Offenders -- Russia; Male; Questionnaires; Russia; Schools, Middle; Schools, Secondary; Self Report; Stress Disorders, Post-Traumatic -- Etiology -- In Adolescence; Human

The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. - Friedman MS; Koeske GF; Silvestre AJ; Korr WS; Sites EW (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.
Keywords: Bullying; Gay Men -- Psychosocial Factors; Social Behavior; Suicidal Ideation; Support, Psychosocial; Adolescence; Adult; Bivariate Statistics; Child; Coefficient Alpha; Correlational Studies; Male; Path Analysis; Questionnaires; Regression; Retrospective Design; Scales; Students, Elementary; Students, High School; Students, Middle School; Test-Retest Reliability; Human

Implication for Services With Gay Men and Lesbians Who Have Served. - Pelts, Michael D.; Rolbiecki, Abigail J.; Albright, David L. (Social Work in Mental Health, 2014)
Gay men and lesbians are marginalized in most areas of society. Throughout history, they have served in all branches of the military. All social workers are likely to encounter veterans that identify as gay or lesbian. This article provides social workers an overview of the description of gay and lesbian military members and introduces readers to areas of consideration when working with this population.
Keywords: Mental Health Services; LGBTQ+ Persons; Social Work Practice; Veterans; Sexism; Sexual Harassment; Lesbians; Gay Persons; Suicide -- Risk Factors; Stress Disorders, Post-Traumatic -- Risk Factors; Oppressed Group Behavior; Cultural Competence; Social Identity

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: Adolescent Health Services -- Administration; HIV Infections -- Therapy -- In Adolescence; Minnesota; Adolescence; Adult; Case Management; Female; Male; Program Evaluation; Risk Factors; AIDS Serodiagnosis -- In Adolescence; HIV Infections -- Prevention and Control -- In Adolescence; Early Intervention -- In Adolescence; Funding Source

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

Experience of racism as a correlate of developmental and health outcomes among urban adolescent mental health clients. - Surko M; Ciro D; Blackwood C; Nembhard M; Peake K (Social Work in Mental Health, 2005)
Correlates of race/ethnicity and perceived racism among 760 urban, predominantly Hispanic/Latino and African-American, adolescent mental health clients were investigated using an exploratory, clinical data-mining approach. All racial/ethnic groups reported substantial rates of racism, ranging from 80.0% for Asian/Pacific Islanders to 32.4% for Hispanic/Latinos. Racism was associated with significantly elevated environmental risk (e.g., violence, sexual abuse or assault, exposure to drug use), behavioral risk (e.g., drug use) and worry (e.g., worry about hurting self or others, worry about doing dangerous things). Overall, racism was significantly associated with more negative health and well-being outcomes than ability to get a gun, sexual orientation, and being enrolled in school. The authors conclude that experience of racism should be routinely assessed at intake to mental health services along with traumatic experiences such as physical or sexual abuse.
Keywords: Mental Disorders -- In Adolescence; Racism -- In Adolescence; Acculturation; Adolescence; Adolescent Development; Asians; Chi Square Test; Child; Correlational Studies; Exploratory Research; Female; Help Seeking Behavior; Hispanic Americans; Male; Questionnaires; Race Factors; Risk Factors; Risk Taking Behavior; Self Assessment; Sex Factors; Urban Areas; Human