Hospitalization for Suicide Ideation or Attempt: 2008-2015. - Plemmons, Gregory; Hall, Matthew; Doupnik, Stephanie; Gay, James; Brown, Charlotte; Browning, Whitney; Casey, Robert; Freundlich, Katherine; Johnson, David P.; Lind, Carrie; Rehm, Kris; Thomas, Susan; et al. (Pediatrics, 2018)
OBJECTIVES: Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US children's hospitals from 2008 to 2015. METHODS: We used retrospective analysis of administrative billing data from the Pediatric Health Information System database. RESULTS: There were 115 856 SI and SA encounters during the study period. Annual percentage of all visits for SI and SA almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points [95% confidence intervals (CIs) 0.15 to 0.17]). Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 percentage points [95% CI 0.23 to 0.30]) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points [95% CI 0.21 to 0.27]). Increases were noted in girls (average annual increase 0.14 percentage points [95% CI 0.13 to 0.15]) and boys (average annual increase 0.10 percentage points [95% CI 0.09 to 0.11]), but were higher for girls. Seasonal variation was also observed, with the lowest percentage of cases occurring during the summer and the highest during spring and fall. CONCLUSIONS: Encounters for SI and SA at US children's hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children's hospitals and health care delivery systems.
Keywords: Suicidal Ideation -- Trends -- United States; Suicide, Attempted -- Trends -- United States; Hospitalization -- Trends -- United States; Emergency Service -- Trends -- United States; Hospitals, Pediatric -- United States; Inpatients; Human; United States; Retrospective Design; Billing and Claims; Health Information Systems; Pediatrics; Confidence Intervals; Age Factors; Adolescence; Child; Female; Male; Sex Factors; Seasons; Mental Disorders -- In Infancy and Childhood; Health Care Delivery

Sexual Orientation and Suicide Ideation, Plans, Attempts, and Medically Serious Attempts: Evidence From Local Youth Risk Behavior Surveys, 2001-2009. - Stone, Deborah M.; Feijun Luo; Lijing Ouyang; Lippy, Caroline; Hertz, Marci F.; Crosby, Alex E. (American Journal of Public Health, 2014)
Keywords: Suicide, Attempted -- In Adolescence; Suicidal Ideation -- In Adolescence; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Human; Prospective Studies; Gender Identity; Logistic Regression; Risk Taking Behavior; Massachusetts; Illinois; New York; California; Cross Sectional Studies; Surveys; Questionnaires; Chi Square Test; Odds Ratio; Confidence Intervals; Data Analysis Software; Female; Male; Adolescence; Suicide -- Risk Factors

A Description of Common Mental Disorders in Men Who Have Sex with Men (MSM) Referred for Assessment and Intervention at an MSM Clinic in Cape Town, South Africa. - Stoloff, Kevin; Joska, John; Feast, Dorothy; Swardt, Glenn; Hugo, Johan; Struthers, Helen; McIntyre, James; Rebe, Kevin (AIDS & Behavior, 2013)
Keywords: Mental Disorders -- Diagnosis; Gay Men -- Psychosocial Factors -- South Africa; Mental Disorders -- Therapy; Human; South Africa; Referral and Consultation; Mental Disorders -- Epidemiology; Depression -- Diagnosis; Depression -- Epidemiology; Suicidal Ideation -- Diagnosis; Suicidal Ideation -- Epidemiology; Substance Use Disorders -- Diagnosis; Substance Use Disorders -- Epidemiology; Employment Status; Educational Status; Marital Status; Adolescence; Adult; Middle Age; Aged; Male; Descriptive Research; Mental Health Services; Interviews; Data Analysis Software; Personality Disorders -- Diagnosis; Personality Disorders -- Epidemiology; Anxiety Disorders -- Diagnosis; Anxiety Disorders -- Epidemiology; Interview Guides; Neuropsychological Tests; Psychological Tests; Personality Tests; Questionnaires; Funding Source

The Preference for Strangulation in a Sexually Motivated Serial Killer. - Pettigrew, Mark (International Journal of Offender Therapy & Comparative Criminology, 2019)
The existing literature on the killing method of choice for sexually motivated serial killers suggests strangulation as the preferable means of homicide, when the victim is female. When homicide victims are male, however, existing research suggests that firearms and blades are preferable methods of causing death. A case is presented here of a sexually motivated male serial killer who exclusively targeted males and who chose strangulation as his means of killing. Analysis suggests that not only is the psychological constitution of the killer an important factor in understanding how they kill victims but, also, the nature of the sexual act is an important determinant in the method of killing in male on male sexually motivated killing.
Keywords: Homicide -- Psychosocial Factors; Asphyxia -- Psychosocial Factors; Paraphilias -- Psychosocial Factors; Homicide -- Classification; Motivation; Fantasy; Male; Homosexuality; Adult; Criminal Psychology; Drowning

Harassment and Mental Distress Among Adolescent Female Students by Sexual Identity and BMI or Perceived Weight Status. - Johns, Michelle Marie; Lowry, Richard; Demissie, Zewditu; Robin, Leah (Obesity (19307381), 2017)
Objective: Sexual minority girls (lesbian/bisexual) and girls with overweight/obesity experience high rates of discrimination and mental distress. This study explored whether BMI or perceived weight status might compound sexual minority girls' risk for harassment and mental distress.Methods: Data on female students from the national 2015 Youth Risk Behavior Survey (n = 7,006) were analyzed. Logistic regression was used to examine differences in bullying, harassment, and mental distress across sexual identity/BMI groups: heterosexual/normal-weight, heterosexual/overweight, sexual minority/normal-weight, and sexual minority/overweight. Procedures were repeated with four analogous groups created from sexual identity and perceived weight.Results: Across sexual identity/BMI groups, being overweight increased heterosexual females' odds of being bullied or experiencing suicidal thoughts and behaviors. Regardless of weight status, sexual minority females had greater odds for each outcome than heterosexual females. Sexual minority females who perceived themselves as overweight had greater odds of suicidality than all other sexual minority/perceived weight groups.Conclusions: Double jeopardy may exist for sexual minority female students who perceive themselves as overweight. Professional development with school staff on how to create a positive climate for sexual minorities and those with overweight/obesity and addressing positive identity and body image within school-based suicide prevention efforts may be important to the well-being of adolescent girls.
Keywords: Bullying; Body Weight; Minority Groups; Lesbians; Mental Disorders -- Epidemiology; Bisexuality; Body Mass Index; Students; Risk Assessment; Body Image; Obesity -- Psychosocial Factors; Adolescence; Adolescent Behavior; Mental Disorders -- Psychosocial Factors; Prevalence; Suicide -- Prevention and Control; Mental Disorders -- Diagnosis; Cluster Analysis; Suicidal Ideation; Health Behavior; Suicide -- Psychosocial Factors; Female; Human; Funding Source; Questionnaires

37.1 A PLAUSIBLE EXPLANATION OF INCREASED SUICIDAL BEHAVIORS AMONG TRANSGENDER YOUTHS THROUGH INTERPERSONAL THEORY OF SUICIDE: SYSTEMATIC REVIEW AND CASE SERIES. - Phillip, Antonia; Pellechi, Ashabari N.; DeSilva, Roshi; Semler, Keith F.; Makani, Ramkrishna (Journal of the American Academy of Child & Adolescent Psychiatry, 2020)

A comparison of LGBTQ youth and heterosexual youth in the child welfare system: Mental health and substance abuse occurrence and outcomes. - Scannapieco, Maria; Painter, Kirstin R.; Blau, Gary (Children & Youth Services Review, 2018)
Purpose LGBTQ youth enter the child welfare system often because they are at higher risk of experiencing child maltreatment compared to youth who are heterosexual (Friedman, Marshal, Guadamuz, Wei, Wong, Saewye, & Stall, 2011), and due to family rejection, which places them at higher risk of suicide, higher levels of depression and are more likely to use substances (Ryan, Huebner, Dias & Sanchez, 2009). Using national data from the Substance Abuse and Mental Health Services Administration (SAMHSA), this study had two purposes; first to examine mental health disparities among LGBTQ youth and their heterosexual peers who are involved in the child welfare system, and second to observe the effectiveness of systems of care with youth in child welfare and if any differences exist between LGBTQ youth and heterosexual youth. Methods Chi-square and logistic regression were used to analyze differences at intake between youth who identified as LGBT or Q and their heterosexual counterparts. Repeated linear mixed modeling was used to evaluate the outcomes and to compare the groups at fixed time points (intake, 6-months, and 12-months). Findings The study found LGBTQ youth had higher levels of suicidal ideation, suicide attempts, depression, and gender identity related problems compared to the heterosexual youth in child welfare. All youth in the study experienced significant improvement, further supporting the effectiveness of system of care approaches. Recommendations are also discussed.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Heterosexuals -- Psychosocial Factors; Child Welfare; Mental Health -- Evaluation; Substance Abuse; Child Abuse -- Risk Factors; Health Status Disparities; Human; Adolescence; Treatment Outcomes; Chi Square Test; Logistic Regression; Suicidal Ideation; Suicide, Attempted; Depression; Gender Identity; Social Problems; Linear Regression

Lesbian, gay, bisexual and transgender young people's experiences of distress: resilience, ambivalence and self-destructive behaviour. - Scourfield J; Roen K; McDermott L (Health & Social Care in the Community, 2008)
The research presented in this paper set out to explore the cultural context of youth suicide and more specifically any connections between sexual identity and self-destructive behaviour, in the light of international evidence about the disproportionate risk of suicidal thoughts and suicide attempts in lesbian, gay, bisexual and transgender (LGBT) young people. The empirical basis for the paper is qualitative research that was carried out in the North West of England and South Wales. Focus groups and interviews were conducted with a total of 69 young people, with a purposive sample to reflect diversity of sexual identity, social class and regional and rural-urban location. The paper presents a thematic analysis of the data specifically relating to the experiences of LGBT young people. A range of strategies that LGBT young people employ in the face of distress are described. These are categorised as resilience, ambivalence and self-destructive behaviour (including self-harm and suicide). The potential implications for health and social care of these strategies include the need for ecological approaches and for sexual cultural competence in practitioners, as well as prioritisation of LGBT risk within suicide prevention policies.
Keywords: Adaptation, Psychological; Homosexuality; Self-Injurious Behavior; Transsexualism -- Psychosocial Factors; Adolescence; England; Female; Focus Groups; Interviews; Male; Sexuality; Suicide; Wales; Human

Victimization and Suicidality Among Dutch Lesbian, Gay, and Bisexual Youths. - van Bergen, Diana D.; Bos, Henny M. W.; van Lisdonk, Jantine; Keuzenkamp, Saskia; Sandfort, Theo G. M. (American Journal of Public Health, 2013)
We examined Netherlands Institute for Social Research data, collected between May and August 2009, on 274 Dutch lesbian, gay, and bisexual youths. The data showed that victimization at school was associated with suicidal ideation and actual suicide attempts. Homophobic rejection by parents was also associated with actual suicide attempts. Suicidality in this population could be reduced by supporting coping strategies of lesbian, gay, and bisexual youths who are confronted with stigmatization by peers and parents, and by schools actively promoting acceptance of same-sex sexuality.
Keywords: LGBTQ+ Persons -- In Adolescence -- Netherlands; Victims; Suicide -- Risk Factors; Bullying; Human; Funding Source; Netherlands; Adolescence; Suicidal Ideation; Suicide, Attempted; Parental Attitudes; Coping; School Policies; Secondary Analysis; Surveys -- Netherlands; Descriptive Statistics; Logistic Regression; Odds Ratio; Confidence Intervals

Prevalence rates, reporting, and psychosocial correlates of stalking victimization: results from a three-sample cross-sectional study. - Nobles, Matt R.; Cramer, Robert J.; Zottola, Samantha A.; Desmarais, Sarah L.; Gemberling, Tess M.; Holley, Sarah R.; Wright, Susan (Social Psychiatry & Psychiatric Epidemiology, 2018)
Purpose: Public health and criminal justice stalking victimization data collection efforts are plagued by subjective definitions and lack of known psychosocial correlates. The present study assesses the question of stalking victimization prevalence among three groups. Psychosocial risk and protective factors associated with stalking victimization experiences were assessed.Methods: Archival data (n = 2159) were drawn from a three-sample (i.e., U.S. nationwide sexual diversity special interest group, college student, and general population adult) cross-sectional survey of victimization, sexuality, and health.Results: The range of endorsement of stalking-related victimization experiences was 13.0-47.9%. Reported perpetrators were both commonly known and unknown persons to the victim. Participants disclosed the victimization primarily to nobody or a family member/friend. Bivariate correlates of stalking victimization were female gender, Associates/Bachelor-level education, bisexual or other sexual orientation minority status, hypertension, diabetes, older age, higher weekly drug use, elevated trait aggression, higher cognitive reappraisal skills, lower rape myth acceptance, and elevated psychiatric symptoms. Logistic regression results showed the strongest factors in identifying elevated stalking victimization risk were: older age, elevated aggression, higher cognitive reappraisal skills, lesser low self-control, increased symptoms of suicidality and PTSD re-experiencing, and female and other gender minority status.Conclusions: Behavioral approaches to epidemiological and criminal justice stalking victimization are recommended. Victimization under reporting to healthcare and legal professionals were observed. Further research and prevention programming is needed to capitalize on data concerning personality and coping skills, sexual diversity, and trauma-related psychiatric symptoms.
Keywords: Truth Disclosure; Stalking -- Epidemiology; Crime Victims -- Statistics and Numerical Data; Students -- Psychosocial Factors; Female; Friendship; Male; Aggression; Adult; Prevalence; United States; Logistic Regression; Adolescence; Cross Sectional Studies; Stalking -- Psychosocial Factors; Crime Victims -- Psychosocial Factors; Psychosocial Adjustment to Illness Scale; Questionnaires

Cultural heterosexism and silencing sexual diversity: Anoka-Hennepin School District. - Grozelle, Renee S. (Journal of LGBT Youth, 2017)
In less than 2 years, nine young people within one Minnesota school district committed suicide. As such, the bullying of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth in the Anoka-Hennepin School District continues to be an example of how embedded ideologies of some individuals can substantially impact the treatment of marginalized groups. Using the theory of cultural heterosexism, this paper will look at the ways in which the Anoka-Hennepin School District in Minnesota became a breeding ground for homophobic violence and discrimination. Furthermore, attention will be directed toward how discourses of sexuality, mobilized by conservative Christian groups in the Anoka-Hennepin School District, were used in order to maintain a heteronormative social order.
Keywords: Attitude to Sexuality -- Minnesota; LGBTQ+ Persons -- Psychosocial Factors -- Minnesota; Social Control; Homophobia; Violence; Minnesota; Schools -- Minnesota; Learning Environment -- Psychosocial Factors; Suicide; Christianity; Bullying

School victimization in transgender people: A systematic review. - Martín-Castillo, David; Jiménez-Barbero, José Antonio; Pastor-Bravo, María del Mar; Sánchez-Muñoz, María; Fernández-Espín, María Elvira; García-Arenas, José Joaquín (Children & Youth Services Review, 2020)
• This review examines the factors that influence the victimization of transgender people. • This study establishes a basis for the development of specific school victimization prevention strategies for transgender students. • The support of teachers, students, and family is indicated as an essential element for prevention of school victimization. • The need for the participation of the institutions in the prevention of school victimization of transgender people is highlighted. The term transgender refers to people whose gender identity does not conform to that associated with the sex assigned to them at birth. Scientific evidence has shown that transgender adolescents have an increased risk of being victims of violence during the school stage. This study aims to synthesize and analyze the findings of the individual studies carried out so far in order to report on the circumstances that influence the process of victimization of this collective. A systematic search was carried out following the recommendations of the PRISMA statement in the following databases: Pubmed/Medline, PsycINFO, Cochrane, Lilacs, and Web of Science, where relevant qualitative and quantitative design studies were identified, which met previously established eligibility criteria. Quality was assessed through bias-risk analysis, and data were extracted from a previously elaborated template. The systematic review finally included 19 quantitative studies (N = 23,749). The results of this review indicate the existence of a number of sociodemographic, family, school and individual factors that influence the victimization of transgender people. The high heterogeneity found among the outcome measures of the quantitative studies prevented performing a meta-analysis, as recommended in the PRISMA declaration. The results of this review suggest the importance of identifying the different factors that influence victimization and intervening in them as a relevant measure for the prevention of bullying.
Keywords: Transgender Persons -- Psychosocial Factors; School Violence -- Psychosocial Factors; School Violence -- Prevention and Control; Human; Systematic Review; PubMed; Medline; Psycinfo; Cochrane Library

Self-Injurious Thoughts and Behaviors May Be More Common and Severe Among People Identifying as a Sexual Minority. - Fox, Kathryn R.; Hooley, Jill M.; Smith, Diana M.Y.; Ribeiro, Jessica D.; Huang, Xieyining; Nock, Matthew K.; Franklin, Joseph C. (Behavior Therapy, 2018)
Research indicates that people who identify as a sexual minority are at higher risk of numerous negative outcomes, including self-injurious thoughts and behaviors (SITBs). The minority stress model proposes that people identifying as a sexual minority are at higher risk of these behaviors due to sexual orientation-specific stressors-however, it does not clarify whether SITBs will be more severe among these individuals. The present study tested whether SITBs are more common and more severe among people identifying as a sexual minority using several metrics, including frequency of SITB engagement, age of onset of SITB, desire to discontinue SITB engagement, and likelihood of future SITBs. Four independent research samples were used to test this model. Results were then combined and tested in an internal meta-analysis. Findings converge to indicate a longer and more severe course of SITB engagement among people identifying as a sexual minority. Future research is needed to replicate these findings and to advance the understanding of why this imbalance in risk and severity might exist, and how it can be prevented.
Keywords: Self-Injurious Behavior -- Diagnosis; Thinking; Severity of Illness Indices; Self-Injurious Behavior -- Psychosocial Factors; Retrospective Design; Sexuality; Young Adult; Male; Adolescence; Suicide, Attempted -- Psychosocial Factors; Adult; Suicidal Ideation; Human; Suicide, Attempted -- Prevention and Control; Female; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

Non-suicidal self-injury among sexual minority youth: An etiological and treatment overview. - Smithee, Lauren C.; Sumner, Brock W.; Bean, Roy A. (Children & Youth Services Review, 2019)
Abstract Non-suicidal self-injury (NSSI) among sexual minority youth (SMY) is a problem that is growing in attention yet is understudied and requires an informed response from therapists who engage in clinical work with youth. This paper proposes a unique model of treatment for working with SMY who engage in NSSI, accounting for proximal, distal, and systemic factors that influence the etiology of NSSI. This model is based on a review of two bodies of clinical literature: (a) treating adolescent NSSI and (b) working with SMY and their families. As an etiological theory of self-harm, Nock (2009) is applied to SMY, factoring in the unique stressors experienced by this group that affect intervention. Reviewed treatment approaches include Dialectical Behavioral Therapy for Adolescents (DBT-A) and narrative family therapy. Treatment guidelines are conceptualized and outlined to aid therapists in providing affirmative and informed therapeutic services. While few, if any articles have studied treatment for SMY who engage in NSSI, this article contributes to the literature by proposing culturally competent interventions. Highlights • Prompt treatment is crucial to reduce the emotional burden of NSSI and minority stress. • Minority stress theory clarifies how social stigma may impact NSSI as a regulating and communicative behavior among SMY. • Intervention recommendations include DBT-A and affirmative approaches and narrative family therapy to combat minority stress. • While the treatment approaches were developed from an integration of research, future clinical research is needed.
Keywords: Injuries, Self-Inflicted -- Therapy -- In Adolescence; Sexual Identity; Minority Groups; Self-Injurious Behavior -- Etiology; Human; Family Therapy; Practice Guidelines; Conceptual Framework; Psychotherapists; Cultural Competence; Adolescence

Retrospective Cyberbullying and Suicide Ideation: The Mediating Roles of Depressive Symptoms, Perceived Burdensomeness, and Thwarted Belongingness. - Mitchell, Sean M.; Seegan, Paige L.; Roush, Jared F.; Brown, Sarah L.; Sustaíta, Michael A.; Cukrowicz, Kelly C. (Journal of Interpersonal Violence, 2018)
Research suggests that being cyberbullied is associated with increased risk for suicide ideation; however, few studies have examined the underlying mechanisms of this relation, and fewer have examined this relation within a theory of suicide. Specifically, the interpersonal theory of suicide posits that thwarted belongingness (indicated by loneliness and a lack of reciprocal caring relationships) and perceived burdensomeness (indicated by feelings of liability and self-hatred) increase risk for suicide ideation. The current study aimed to examine depressive symptoms, thwarted belongingness, and perceived burdensomeness as mediators between intensity of being cyberbullied and suicide ideation. Participants were college students (N = 348) who completed assessments of retrospective peer victimization, thwarted interpersonal needs (i.e., thwarted belongingness and perceived burdensomeness), and suicide ideation. The results indicated that after adjusting for sexual orientation, depressive symptoms significantly mediated the relation between intensity of being cyberbullied and suicide ideation. Furthermore, depressive symptoms and perceived burdensomeness serially mediated the relation between intensity of being cyberbullied and suicide ideation; however, thwarted belongingness was not a significant mediator. Clinical and research implications, limitations, and future directions are discussed.
Keywords: Cyberbullying -- Risk Factors; Suicidal Ideation -- Psychosocial Factors; Stress, Psychological; Human; Depression; Peer Pressure; Victims; Hopelessness; Helplessness, Learned; Interpersonal Relations; Adolescence; Young Adult; Students, Undergraduate; Questionnaires; Scales

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

Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis. - Miranda-Mendizábal, A.; Castellví, P.; Parés-Badell, O.; Almenara, J.; Alonso, I.; Blasco, M. J.; Cebrià, A.; Gabilondo, A.; Gili, M.; Lagares, C.; Piqueras, J. A.; Roca, M.; et al. (British Journal of Psychiatry, 2017)
BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.
Keywords: Suicide, Attempted -- Psychosocial Factors; Sexuality; Suicidal Ideation; Risk Factors; Meta Analysis; Questionnaires; Scales

Expert Testimony of the Battered Person Syndrome, Defendant Gender, and Sexual Orientation in a Case of Duress: Evaluating Legal Decisions. - Russell, Brenda; Ragatz, Laurie; Kraus, Shane (Journal of Family Violence, 2012)
The current study examined the utility of expert testimony of the battered person syndrome (BPS) in a case of duress and the extent to which defendant gender, defendant sexual orientation, and participant gender influence mock jury decisions in a case of duress. Participants ( N = 413) read a scenario based on U.S. v. Dixon () and answered questions assessing verdict, guilt, sentence length, duress legal elements, and attributes typically ascribed to victims of abuse. Results showed heterosexual female defendants were assigned the lowest sentences and met more of the legal elements of duress (i.e., were coerced, more likely to be believed, and purchased a gun to prevent harm) and attributes (i.e., experienced severe abuse, learned helplessness) compared to other defendants. When mock jurors received expert testimony, they provided lower rates of guilt and sentencing for defendants. Results also showed the inclusion of BPS expert testimony increased ratings for many of the legal elements of duress and attributes typically associated with intimate partner violence. In addition, results suggested that while heterosexual female defendants are more likely to be believed in a case of duress, expert testimony of BPS is helpful to all defendants. Limitations and future directions for research and practice are discussed.
Keywords: Battered Women -- Legislation and Jurisprudence; Witness, Legal; Intimate Partner Violence -- Legislation and Jurisprudence; Battered Men -- Legislation and Jurisprudence; Coercion; Human; Jury; Sexuality; Punishment; Guilt; Courts; Mental Status; Psychological Theory; Decision Making; Self Defense; Heterosexuals; Lesbians; Female; Male; Adult; Middle Age; Aged; Firearms; Surveys; Internet; Chi Square Test; Sex Factors; Correlation Coefficient; Multivariate Analysis of Variance; Gay Men; Crime; Victims; Helplessness, Learned

Increased Risk of Suicide Attempts Among Black and Latino Lesbians, Gay Men, and Bisexuals. - OÂ¿Donnell, Shannon; Meyer, Ilan H.; Schwartz, Sharon (American Journal of Public Health, 2011)
Members of racial/ethnic minority groups have a lower lifetime prevalence than have Whites of mental disorders, a risk factor for suicide attempts; paradoxically, however, lesbian, gay, and bisexual (LGB) ethnic minority youths may be at increased risk for suicide attempts relative to White LGB youths. We found that the increased risk of suicide attempts among racial/ethnic minority LGB respondents in our sample relative to White respondents was not explained by excess youth onset of depression and substance abuse or by a higher susceptibility to suicide in the racial/ethnic minority LGB group.
Keywords: Suicide, Attempted; Black Persons; Hispanic Americans; LGBTQ+ Persons; Human; Funding Source; White Persons; Age Factors; Prevalence; Young Adult; Adult; Middle Age; Urban Areas -- New York; New York; Snowball Sample; Comparative Studies; Null Hypothesis; Depression; Substance Abuse; Models, Statistical -- Utilization; Odds Ratio; Confidence Intervals

Nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations: an integrative review. - Jackman, Kate; Honig, Judy; Bockting, Walter (Journal of Clinical Nursing (John Wiley & Sons, Inc.), 2016)
Aims and objectives To conduct an integrative review of nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations to better understand the prevalence; to identify the lesbian, gay, bisexual and transgender subgroups at increased risk for nonsuicidal self-injury; and to examine the risk factors associated with nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations. Background Nonsuicidal self-injury, 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 lesbian, gay, bisexual and transgender populations, including anxiety, depression and suicidality, have been documented in the scientific literature with little focus on findings about nonsuicidal self-injury. Design Integrative literature review of published quantitative and qualitative empirical research. Methods A literature search of 11 on-line databases was conducted of articles published through April 2015. Keywords were used to identify articles about lesbian, gay, bisexual and transgender populations and nonsuicidal self-injury. Results After screening by title, abstract and full text, 26 articles were included in this review. The literature synthesised demonstrates a consistent pattern of increased prevalence of nonsuicidal self-injury among sexual and gender minority populations compared with heterosexual peers. This body of literature indicates which subgroups of the lesbian, gay, bisexual and transgender populations appear to be at increased risk for nonsuicidal self-injury and which specific factors contributing to vulnerability to nonsuicidal self-injury among these populations. Conclusions Lesbian, gay, bisexual and transgender populations are at higher risk for nonsuicidal self-injury compared with the general population. Lesbian, gay, bisexual and transgender-specific and general risk factors appear to contribute to this heightened vulnerability. Relevance to clinical practice Clinical nurses should screen for nonsuicidal self-injury and for sexual and gender minority identity in all of their patients. Comprehensive assessment of lesbian, gay, bisexual and transgender patients presenting with nonsuicidal self-injury may lead to identification of risk factors that can be addressed through nursing interventions. Nurse researchers and clinicians should take an active role in developing and implementing evidenced-based tailored interventions to reduce the higher vulnerability to nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations.
Keywords: Lesbians; Gay Men; Bisexuals; Transgender Persons; Self-Injurious Behavior; Human; Systematic Review; Psycinfo; Medline; Male; Female; Adult; Middle Age; Aged; Qualitative Studies; Quantitative Studies; Empirical Research

The Moderating Role of Sexual Identity in Group Teletherapy for Adults Aging with HIV. - Heckman, Bernadette Davantes; Lovejoy, Travis I.; Heckman, Timothy G.; Anderson, Timothy; Grimes, Tiffany; Sutton, Mark; Bianco, Joseph A. (Behavioral Medicine, 2014)
Older adults living with HIV/AIDS experience high rates of depression and suicidal ideation but are less likely than their younger counterparts to seek psychological services. HIV continues to disproportionately impact older men who have sex with men (MSM), many of whom were infected in their 20s and 30s. This study examined whether therapy attendance rates and the efficacies of two group-format teletherapies for the treatment of depression (coping effectiveness group training and supportive-expressive group therapy) were comparable for older MSM and older heterosexuals living with HIV. Intervention-outcome analyses found that older MSM and older heterosexuals living with HIV attended comparable numbers of teletherapy sessions. Older heterosexuals living with HIV who received telephone-administered supportive-expressive group therapy reported significantly greater reductions in depressive symptoms than SOC controls. A similar pattern was not found in older MSM. More research is needed to personalize and tailor group teletherapies for older MSM living with HIV.
Keywords: HIV-Positive Persons -- Psychosocial Factors; Telepsychiatry; Gender Identity; Human; Survey Research; Geriatric Depression Scale; Scales; Male; Female; Random Assignment; Reminder Systems; Chi Square Test; One-Way Analysis of Variance; Two-Tailed Test; Middle Age; Aged; Aged, 80 and Over; Funding Source

Urgent Need for Research to Achieve Health Equity for Sexual and Gender Minority Youth. - Dowshen, Nadia; Ford, Carol A. (Pediatrics, 2019)
The authors discuss a study related to health equity for sexual and gender minority youth (SGMY). Highlights include challenges faced by SGMY to their mental and physical well-being, improvement in mental health outcomes for gender-minority youth receiving medical interventions, and Section 1557 of the Patient Protection and Affordable Care Act.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Minority Groups -- Psychosocial Factors; Substance Abuse -- Therapy; Mental Disorders -- Therapy; Violence -- Therapy; Health Status Disparities; Research, Mental Health; Gender Identity; HIV Infections -- Prevention and Control; Suicide, Attempted -- Prevention and Control; Research Support; Anxiety; Depression; Social Media; Hardiness; Psychological Well-Being; United States

Depression and suicidality among bisexual youth: A nationally representative sample. - Taliaferro, Lindsay A.; Gloppen, Kari M.; Muehlenkamp, Jennifer J.; Eisenberg, Marla E. (Journal of LGBT Youth, 2018)
To address gaps in the literature on bisexual youth, we used the first nationally representative sample of high school students from the United States to determine profiles of behaviors related to depressive symptoms, a suicide attempt, and a medically-serious attempt. We examined the data from 922 bisexual students in grades 9–12 who completed the Centers for Disease Control and Prevention's 2015 National Youth Risk Behavior Survey. Latent class analysis derived three classes reflecting unique patterns of 10 risk and protective behaviors. For both the sexes: one group was high on all the risk behaviors and demonstrated the greatest risk of depression, a suicide attempt, and a medically-serious attempt; another was below average on all the risk and protective behaviors and demonstrated average/moderate risk of the outcomes; and the last demonstrated the highest levels of protective behaviors and the lowest risk of depression and suicidal behavior. Bisexual students are not homogenous with regard to the risk of mental health problems. Greater involvement in several risk behaviors and less involvement in protective behaviors, rather than merely a bisexual identity, might contribute to bisexual adolescents' increased risk of depression and suicidal behavior. Findings have implications for prevention programming, clinical interventions, and future research.
Keywords: Depression; Suicidal Ideation; Suicide, Attempted; Bisexuals -- Psychosocial Factors -- In Adolescence; Student Attitudes -- United States; United States; Adolescence; Human; Students, High School -- United States

Mental Health for Older LGBT Adults. - King, Shawn D.; Richardson, Virginia E. (Annual Review of Gerontology & Geriatrics, 2017)
This chapter examines the mental health of older lesbian, gay, bisexual, and transgender (LGBT) adults. Studies indicate higher levels of depression, suicide, and substance abuse among older LGBT adults compared to older heterosexual adults. Historical influences including outdated views of homosexuality as a mental illness especially affected the current cohort of older LGBT persons who also have been less likely to disclose their sexual identities. These issues as well as best practices, specifically Gay Affirmative Therapy, and core competencies needed when working with older LGBT adults are discussed in this chapter.
Keywords: Geriatrics; LGBTQ+ Persons; Mental Health; Gay Men; Lesbians; Bisexuals; Transgender Persons; Depression; Suicide; Substance Abuse; Heterosexuals; Gender Identity; Psychotherapy -- Methods; Professional Competence

Religion-related stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a South African rural-based university. - Mavhandu-Mudzusi, Azwihangwisi Helen; Sandy, Peter Thomas (Culture, Health & Sexuality, 2015)
This paper reports on the stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a rural university in South Africa. Twenty lesbian, gay, bisexual and transgender students recruited through snowball sampling participated in this study. Interpretative Phenomenological Analysis was used as a framework for data analysis. Findings indicate that religion-related stigma and discrimination are common at a rural-based university in South Africa. Lesbian, gay, bisexual and transgender students are typically ascribed a range of labels, including 'sinners', 'devils' and 'demon possessed'. They are also exposed to a number of discriminatory acts, such as the denial of financial and healthcare services and threats of and/or actual rape. Study participants reported attempts to convert lesbian, gay, bisexual and transgender students' sexual orientation which involved the use of intervention in the form of prayers. Derogatory labelling and associated discriminatory acts, for example the threat of rape, led many students to conceal their sexual identity, not attend specific classes, terminate their studies and even attempt suicide. Universities should develop policies to promote greater social inclusion and the acceptance of lesbian, gay, bisexual and transgender students. Policies should also specify the steps or approaches to be taken in addressing discriminatory practices.
Keywords: Homosexuality; Homophobia -- Psychosocial Factors; Bisexuality; Religion and Psychology; Stigma; Students -- Psychosocial Factors; Rural Population; Young Adult; Female; Male; Homophobia; South Africa; Adult; Stereotyping; Colleges and Universities; Social Readjustment Rating Scale

Examining suicide-related presentations to the emergency department. - Ceniti, Amanda K.; Heinecke, Nicole; McInerney, Shane J. (General Hospital Psychiatry, 2020)
Although the Emergency Department (ED) is a frequent point of contact for individuals with suicide-related behaviour (SRB) or ideation, there is limited literature specifically examining presentations to the ED for SRB. This review examines the international literature published in North America, the United Kingdom and Australia relating to presentations to the ED for SRB, with focus on high-risk groups, screening tools used in the ED, and difficulties in classifying ED presentations of SRB. The database PubMed was searched using relevant terms, and national health care administrative data were reviewed. Psychiatric history, substance use, and lower socioeconomic status were all found to be associated with higher rates of ED presentations for SRB. Limited research exists around ED presentations of SRB by particular high-risk groups, including lesbian, gay, bisexual, and transgender populations and Indigenous peoples. Individuals who present to EDs for SRB are often chronic users of EDs and have a high rate of repeat self-harm and death by suicide. These findings suggest that EDs could serve as a focal point for suicide treatment interventions. Deepening our understanding of ED presentations for SRB could inform further development and implementation of interventions to reduce death by suicide.
Keywords: Suicidal Ideation -- Psychosocial Factors; Help Seeking Behavior; Emergency Service; Health Resource Utilization; Risk Taking Behavior; North America; United Kingdom; Australia; Psychotic Disorders; Substance Use Disorders; Socioeconomic Factors; LGBTQ+ Persons; Indigenous Peoples; Injuries, Self-Inflicted; Suicide -- Prevention and Control; Support, Psychosocial

Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: results from a national survey. - Padilla YC; Crisp C; Rew DL (Social Work, 2010)
Although gay, lesbian, and bisexual (GLB) adolescents face many of the same developmental challenges as do heterosexual adolescents, they must also deal with the stress of being part of a stigmatized group. The purpose of this study was to examine the extent to which family support and involvement with the queer community may buffer the effects of life stress on substance use among GLB youths. Drawing on a large national online survey, the authors examined drug use in 1,906 GLB youths 12 to 17 years of age. Overall, 20 percent of the youths reported using illegal substances in the past 30 days. Results from multivariate analyses revealed that stress, as measured by suicidal ideation, significantly increased the risk of drug use. A positive reaction from the mother to the youth's coming out served as a significant protective factor, whereas involvement in a queer youth group had no effect. The authors found evidence that, for GLB adolescents, parental acceptance of sexual identity is an important aspect of a strong family relationship and, thus, has important ramifications for their healthy development. Implications of the findings for social work practice are discussed.
Keywords: Bisexuals -- In Adolescence; Gay Men -- In Adolescence; Lesbians -- In Adolescence; Parental Attitudes; Substance Abuse -- In Adolescence; Adolescence; Child; Coding; Conceptual Framework; Descriptive Statistics; Female; Funding Source; Gender Identity; Human; Internet; Logistic Regression; Male; Multivariate Analysis; Parents; Psychological Tests; Rosenberg Self Esteem Scale; Scales; Secondary Analysis; Self Disclosure; Social Work; Street Drugs; Stress, Psychological; Substance Abuse -- Epidemiology; Substance Abuse -- Risk Factors; Suicidal Ideation; Support, Psychosocial; Surveys; United States

Clinical Barriers to Effective Treatment of Eating Disorders and Co-occurring Psychiatric Disorders in Transgendered Individuals. - WAGNER, REBECCA; STEVENS, JONATHAN R. (Journal of Psychiatric Practice®, 2017)
Eating disorders (EDs) are complex and difficult to treat illnesses that are often chronic and disabling on their own accord or due to comorbidity with other psychiatric conditions. Historically, EDs have been viewed as illnesses of heterosexual, affluent white females. This stereotype increases the likelihood that these disorders will be underrecognized in the lesbian, gay, bisexual, and transgender community, as well as in different gender, socioeconomic, and ethnic populations. Our case report illustrates the clinical difficulties of managing a patient who presented to inpatient treatment with complaints of depression and suicidality, but who also had an active ED and was transgender.
Keywords: Depression -- Therapy; Male; Depression -- Epidemiology; Adult; Comorbidity; Young Adult; Female; Scales

On hate crime victimization: Rates, types, and links with suicide risk among sexual orientation minority special interest group members. - Cramer, Robert J.; Wright, Susan; Long, Molly M.; Kapusta, Nestor D.; Nobles, Matt R.; Gemberling, Tess M.; Wechsler, Hayley J. (Journal of Trauma & Dissociation, 2018)
Hate crimes remain pressing traumatic events for sexual orientation minority adults. Previous literature documents patterns in which hate crime victimization is associated with elevated risk for poor mental health. The present paper held 2 aims to advance literature. First, we investigated the rates and types of hate crime victimization among sexual orientation minority adults. Second, adopting a mental health amplification risk model, we evaluated whether symptoms of depression, impulsivity, or post-traumatic stress exacerbated the hate crime victimization-suicide risk link. Participants were 521 adult sexual orientation minority-identifying members of the National Coalition for Sexual Freedom (i.e., a bondage and discipline, and sadomasochism-identifying sexuality special interest group). Participants completed demographic and mental health inventories via online administration. Results showed: (1) low rates of total lifetime hate crime victimization and (2) higher rates of interpersonal violence compared to property crime victimization within the sample. Regression results showed: (1) independent positive main effects of all 3 mental health symptom categories with suicide risk; (2) an interaction pattern in which impulsivity was positively associated with suicide risk for non-victims; and (3) an interaction pattern in which post-traumatic stress was positively associated with suicide risk for hate crime victims and non-victims. Results are discussed concerning implications for trauma-informed mental healthcare, mental health amplification models, and hate crime and suicide prevention policies.
Keywords: Suicidal Ideation -- Risk Factors; Crime Victims; Sexuality -- In Adulthood; Depression; Impulsive Behavior; Stress Disorders, Post-Traumatic; Human; Interpersonal Relations; Mental Health; Online Services; Mental Health Services; Adult; Violence; Regression

Relationship among gender-related stress, resilience factors, and mental health in a Midwestern U.S. transgender and gender-nonconforming population. - Brennan, Stephanie L.; Irwin, Jay; Drincic, Andjela; Amoura, N. Jean; Randall, Amanda; Smith-Sallans, Megan (International Journal of Transgenderism, 2017)
Background: Transgender and gender-nonconforming individuals experience more discrimination than their cisgender peers, and this discrimination can be associated with poorer mental health. This study used the gender minority stress model as a framework to examine the relationship among gender-related stressors and resilience factors and mental health outcomes. The study particularly aimed to increase knowledge of the gender-nonconforming population. Methods: A community sample of 83 individuals that identify as a gender different than the sex assigned to them at birth completed an online survey. Depression and anxiety were assessed using the Center for Epidemiological Studies Depression Scale (CES-D) and Beck Anxiety Inventory (BAI), respectively. The Gender Minority Stress and Resilience measure was used to assess distal and proximal stressors and resilience factors. Results: The median CES-D and BAI scores were 16 and 13, respectively. Forty percent had a history of non-suicidal self-injury (NSSI), 75% had experienced suicidal ideation, and 45% had attempted suicide. Proximal stress was found to be a positive predictor of depressive symptoms. Resilience was a weak negative predictor of anxiety symptoms. Distal stress was a positive predictor of suicide attempts, and resilience factors and hormone use were marginal negative predictors of suicide attempt. Trans women were significantly less likely to have engaged in NSSI, but had a significantly higher proximal stress score than trans men and gender-nonconforming individuals. Conclusion: Our study found high rates of mental health problems in the trans and gender-nonconforming sample. Our findings in part support the gender minority stress model, with gender-related stress predicting certain mental health problems and resilience being a negative predictor. Overall, gender-nonconforming individuals have had similar experiences and mental health findings as transgender individuals.
Keywords: Transgender Persons -- Psychosocial Factors -- Midwestern United States; Minority Stress -- Classification; Hardiness -- Evaluation; Mental Health; Midwestern United States; Discrimination; Sample Size; Human; Surveys; Depression; Anxiety; Center for Epidemiological Studies Depression Scale; Scales; Psychological Tests; Descriptive Statistics; Data Analysis Software; Injuries, Self-Inflicted; Suicidal Ideation; Suicide, Attempted; Young Adult; Adolescence; Middle Age; Adult; Aged

Transgender adolescents and legal reform: How improved access to healthcare was achieved through medical, legal and community collaboration. - Telfer, Michelle; Kelly, Fiona; Feldman, Debi; Stone, Georgie; Robertson, Rebekah; Poulakis, Zeffie (Journal of Paediatrics & Child Health, 2018)
Transgender children and adolescents face hardships in all domains of their lives, with many experiencing family rejection, social exclusion, discrimination, bullying and assaults. The mental health implications of these experiences include high rates of depression, anxiety, self-harm and attempted suicide. Gender-affirming social support and medical treatment has been shown to ameliorate the poor mental health outcomes of transgender youth, with those who are supported in their social and medical transition reporting rates of depression and self-worth equivalent to general population levels. Advocacy efforts that improve access to support and medical treatment are therefore likely to produce significant positive health and well-being outcomes for this vulnerable population. The transgender community in Australia identified the legal restrictions placed on children and adolescents accessing medical treatment as a significant barrier to positive psychological well-being. Australian law, unique internationally, required the parents of transgender adolescents to apply for court authorisation prior to the commencement of their child's gender-affirming medical treatment. Concerned by the harm created by this process, a coalition of experts, including transgender children, adolescents and their parents, as well as academic and clinical experts in the fields of law and medicine, was created to advocate for reform. Over a period of approximately 4 years, a collaborative process was undertaken, which ultimately led to law reform and improved access to medical treatment for the transgender community.
Keywords: Health Services Accessibility -- Legislation and Jurisprudence; Male; Australia; Adolescence; Female; Questionnaires; Scales; Social Readjustment Rating Scale

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

Suicidality in Young Men Who Have Sex with Men: A Systematic Review of the Literature. - Luong, Casey T.; Rew, Lynn; Banner, Matthew (Issues in Mental Health Nursing, 2018)
This systematic literature review addresses risk and protective factors associated with suicidal ideation and attempts in young men who have sex with men (YMSM). The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsychArticles, and PsychInfo yielded 14 articles. Risk factors included (1) not being enrolled in school, (2) earlier sexual debut, (3) substance use/abuse, (4) homelessness, (5) bullying and victimization, (6) fear of community violence, (7) and parental abuse. Protective factors included (1) positive sexual minority LGBT stereotypes, (2) family acceptance, (3) school and peer support, (4) high self-esteem, and (5) adaptive coping mechanisms.
Keywords: Suicide -- Risk Factors; Men Who Have Sex With Men; Suicidal Ideation -- Risk Factors; Human; Systematic Review; CINAHL Database; PubMed; Psycinfo; Sexuality; Substance Abuse; Homelessness; Bullying; Child Abuse Survivors; Coping; Self Concept; Content Analysis

AMTA Undergraduate Student Research Award. Music Therapy Students' Preparedness and Training to Work with LGBT Clients. - WILSON, ALEXANDRA; GEIST, KAMILE (Music Therapy Perspectives, 2017)
Background: People in the Lesbian, Gay, Bisexual, and Transgender (LGBT) community are at a significantly higher risk for suicidal ideation (King et al., 2008) and mental illness (Cochran, Sullivan, & Mays, 2003; Liu & Mustanski, 2012), among other health issues, which have been linked to stress caused by discrimination (Meyer, 2003; Hendricks & Testa, 2012). This problem is compounded by LGBT individuals having less access to healthcare (Clift & Kirby, 2012; Bradford, Reisner, Honnold, & Xavier, 2013). Music therapy students may encounter LGBT individuals as clients and colleagues during their practicum experiences and future work as a professional. Therefore, it is important for music therapy students to understand the needs and challenges of LGBT individuals. Related Literature: Whitehead-Pleaux et al. (2013) indicated, in a preliminary report, that music therapists felt unprepared to work with the LGBT community and lacked education about members of the community. Ahessy (2011) found that the majority of music therapy program directors reported that Lesbian, Gay, and Bisexual (LGB) issues were not specifically addressed in their music therapy programs. While this suggests that music therapy professionals may not be prepared to work with the LGBT community, and that music therapy training may not be specifically addressing LGBT issues, we do not know how well prepared music therapy students perceive themselves to work with the LGBT population. Objective: The purpose of this study was to describe self-report data of current preparedness and training to work with LGBT clients from music therapy students at a public university in the United States. Specifically, the researcher sought to answer the following questions: 1) how prepared do students feel to do clinical work with members of the LGBT community; 2) from what sources do students obtain information about the LGBT community and what trainings have they obtained; and 3) what knowledge do students currently have regarding clinical recommendations for the LGBT community. Methods: A questionnaire was developed that included six demographic questions; two questions related to training sources; twelve questions related to knowledge about clinical practice with LGBT people; and five items designed to measure perceived preparedness. Items related to clinical knowledge were informed by best-practices guidelines (Whitehead-Pleaux et al., 2012). Responses regarding perceived preparedness were recorded on a Likert-type scale (from 1 = unprepared to 5 = very prepared). The questionnaire was distributed to music therapy students via e-mail using the university’s roster of currently enrolled undergraduate and graduate students. Results: A total of 43 responses were received out of 106 students contacted (40.6% response rate). Demographics: Most participants were undergraduate students, including freshmen (25.6%), sophomores (14%), juniors (27.9%), seniors (9.3%), and transfer students (4.7%); 7% of respondents were graduate students. The majority ethnicity of music therapy students was Caucasian (93%). Respondents identified their gender as female (79.07%), male (18.6%), and other (2.3%). A minority (27.9%) identified as members of the LGBT community. Training and sources of knowledge: A total of 38.9% of music therapy students had received no formal training related to the LGBT community. Students who had received formal training primarily received it through non-music-therapy course work (30.2%), formal workshops (18.6%), and workplace training (14%). A few students (7%; 3 respondents) received training as part of their music therapy course work. Music therapy students most frequently received knowledge about the LGBT community from LGBT friends and family (93%), popular media (91%), and personal experiences (49%). Students were overall somewhat unfamiliar (M = 1.84; SD = 1.11) with the academic literature regarding the LGBT community. Students were overall neither familiar nor unfamiliar (M = 3.33; SD = 1.25) with LGBT history and culture. Clinical knowledge: The majority (87.5%) of students did not provide a place in clinical documentation for clients to self-identify sexuality, and 81.3% of students did not provide a place for clients to self-identify gender. The majority (75%) defined their clinical approach as open and affirming, while a minority (25%) were not sure how to define their approach. Nearly all students (90–98%) reported that they would be likely to encounter members of the LGBT community in community settings, hospitals, psychiatric facilities, schools, and universities, and a majority perceived that they would encounter LGBT individuals in nursing homes (55.8%) and residential facilities (69.8%). Preparedness: The overall preparedness subscale consisted of 4 items (gender and = .913). On average, students perceived that they were neither prepared nor unprepared (M = 3.35; SD = 1.10) to work with LGBT clients. Students perceived that they were neither prepared nor unprepared (M = 3; SD = 1.4) to talk with LGBT clients about gender and sexuality-related topics; however, responses to both questions appeared to be distributed bimodally. Conclusions: Bimodal distribution of preparedness suggests that there may be two different groups of music therapy students: one group of students who perceive themselves as somewhat prepared and another group who perceive themselves as somewhat unprepared. While students were receiving information about the LGBT community, few were receiving it from music therapy training and academic literature. This education gap was reflected in the reported lack of knowledge regarding clinical recommendations in working with LGBT people.
Keywords: Music Therapy; Students, Undergraduate -- Psychosocial Factors; LGBTQ+ Persons; Human; Health Services Accessibility; Self Report; United States; Questionnaires; Summated Rating Scaling; Male; Female; Health Knowledge; Descriptive Statistics; Coefficient Alpha

Trajectories of Depressive Symptoms and Suicidality Among Heterosexual and Sexual Minority Youth. - Marshal, Michael; Dermody, Sarah; Cheong, JeeWon; Burton, Chad; Friedman, Mark; Aranda, Frances; Hughes, Tonda (Journal of Youth & Adolescence, 2013)
Keywords: Depression -- Symptoms -- In Adolescence; Suicidal Ideation -- Evaluation -- In Adolescence; Heterosexuals -- Psychosocial Factors; LGBTQ+ Persons -- Psychosocial Factors; Students, High School -- Evaluation; Funding Source; Human; Adolescence; Male; Female; Descriptive Statistics; Center for Epidemiological Studies Depression Scale; Psychological Tests; Scales; Structural Equation Modeling; Chi Square Test; P-Value; Sex Factors; Self Report

Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings. - Shearer, Annie; Herres, Joanna; Kodish, Tamar; Squitieri, Helen; James, Kiera; Russon, Jody; Atte, Tita; Diamond, Guy S. (Journal of Adolescent Health, 2016)
Purpose Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal self-injury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14–24 years). Methods Data were collected using the Behavioral Health Screen—a Web-based screening tool that assesses psychiatric symptoms and risk behaviors—during routine well visits. Results Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well. Conclusions Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females.
Keywords: Behavioral Symptoms -- Psychosocial Factors; Primary Health Care -- Methods; LGBTQ+ Persons -- Psychosocial Factors; Human; Questionnaires; Gay Persons; Bisexuals; Male; Female; Adolescence; Young Adult

Suicidality, Self-Harm, and Body Dissatisfaction in Transgender Adolescents and Emerging Adults with Gender Dysphoria. - Peterson, Claire M.; Matthews, Abigail; Copps ‐ Smith, Emily; Conard, Lee Ann (Suicide & Life-Threatening Behavior, 2017)
Prevalence of suicide attempts, self-injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty-seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self-injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female-to-male youth reported a history of suicide attempts and self-harm behaviors than male-to-female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life-threatening behaviors.
Keywords: Body Image; Suicidal Ideation; Self-Injurious Behavior -- Psychosocial Factors; Emotions; Suicide, Attempted; Male; Adolescence; Prevalence; Suicide, Attempted -- Psychosocial Factors; Young Adult; Retrospective Design; Audit; Suicide -- Psychosocial Factors; Female; Psychosocial Adjustment to Illness Scale; Scales

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

Differences in well-being between sexual minority and heterosexual college students. - Crawford, Timothy N.; Ridner, S. Lee (Journal of LGBT Youth, 2018)
This study examines differences in well-being between sexual minority and heterosexual college students and identifies factors associated with well-being among sexual minority college students. A secondary analysis of cross-sectional web-based survey data was conducted. Using propensity score matching, 43 sexual minority students were matched to 43 heterosexual students on age, race, sex, and year in school. Sexual minorities had significantly lower well-being scores compared to heterosexual college students. Among sexual minorities, physical activity, depression, thoughts of suicide, and sleep quality were all predictive of well-being. Understanding issues related to well-being among sexual minorities is important and strategies need to be developed to improve well-being.
Keywords: Psychological Well-Being; LGBTQ+ Persons -- Psychosocial Factors; Heterosexuals -- Psychosocial Factors; Students, College -- Psychosocial Factors; Minority Groups -- Psychosocial Factors; Human; Sexual Identity; Secondary Analysis; Cross Sectional Studies; Surveys; Probability; Age Factors; Race Factors; Physical Activity; Depression; Suicidal Ideation; Sleep; World Wide Web; Educational Status

Articulating identities: Language and practice with multiethnic sexual minority youth. - McInroy, Lauren; Craig, Shelley L. (Counselling Psychology Quarterly, 2012)
Clinicians working with sexual minority youth (SMY) should be knowledgeable about the contemporary language around sexuality and gender used by adolescent clients. Such knowledge contributes to the clinical environment and aids clinicians in developing therapeutic relationships. However, individuals working with SMY should also be aware of the potential impact of social environment and individual context on SMYs language and terminology. This paper discusses the role that socio-demographic and contextual factors may play in access to discourses of sexuality and sexual identity taxonomies for a population of multiethnic sexual minority youth (MSMY) (n = 500) from Miami-Dade County, Florida. The study population is comprised of primarily Black, non-Hispanic (31.4%), and Hispanic (65.4%) SMY; 94.2% identify using traditional sexual identity terminology, including lesbian (38.1%), gay (25.7%), and bisexual (28.1%). The impact on clinical practice and counseling with SMY is discussed throughout.
Keywords: Minority Groups -- Psychosocial Factors; Social Identity; Sexuality; Gender Identity; LGBTQ+ Persons -- Psychosocial Factors; Nomenclature -- Utilization; Florida; Adolescence; Secondary Analysis; Human; Male; Female; Black Persons; Hispanic Americans; Data Analysis Software; Descriptive Statistics; Young Adult; Substance Abuse; Domestic Violence; Homelessness; Safety; School Violence; Cultural Competence; Professional Practice -- Methods; Cross Sectional Studies; Risk Factors; Suicide -- Risk Factors

The Association between Intentional Overdose and Same-Sex Sexual Intercourse in a Cohort of People who Inject Drugs in Melbourne, Australia. - O'Keefe, Daniel; Bowring, Anna; Aitken, Campbell; Dietze, Paul (Substance Use & Misuse, 2018)
Background: People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID. Objectives: To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI. Methods: The sample included 529 participants, from an ongoing cohort of 757 PWID. An “ever” SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression. Results: Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately.
Keywords: Substance Abusers -- Psychosocial Factors; Overdose; Intention; Sexual Intercourse; Gay Persons; Attitude to Sexuality; Australia; Prospective Studies; Interviews; Logistic Regression; Confidence Intervals; Mental Health; Risk Taking Behavior; Odds Ratio

PTSD, Depression, and Substance Use in Relation to Suicidality Risk among Traumatized Minority Lesbian, Gay, and Bisexual Youth. - Smith, Brian C.; Armelie, Aaron P.; Boarts, Jessica M.; Brazil, Miquel; Delahanty, Douglas L. (Archives of Suicide Research, 2016)
Youths who are lesbian, gay, or bisexual (LGB) are more likely than heterosexuals to commit suicide. Substance use, PTSD, and depression are independent risk factors for suicidality; however, the extent to which these factors interact to predict suicidality is unclear. The current study examined the association between substance use, PTSD symptoms (PTSS), depressive symptoms, and suicidality in a sample of 68 traumatized minority LGB youths. Participants were recruited from an LGBT community center and completed a packet of questionnaires. Substance use and depressive symptoms were positively associated with prior suicide attempts. A significant three-way interaction revealed that substance use interacted with both PTSS and depressive symptoms to increase the odds of attempted suicide. Results underscore the importance of integrating substance use components into PTSD/depression treatment to reduce suicide risk in LGB youth.
Keywords: Suicide, Attempted; Stress Disorders, Post-Traumatic -- Epidemiology; Depression -- Epidemiology; Suicidal Ideation; Substance Use Disorders -- Epidemiology; Stress Disorders, Post-Traumatic -- Psychosocial Factors; Suicide; Depression -- Psychosocial Factors; Hispanic Americans -- Psychosocial Factors; Minority Groups -- Statistics and Numerical Data; Black Persons -- Psychosocial Factors; Odds Ratio; Hispanic Americans -- Statistics and Numerical Data; Logistic Regression; Young Adult; Adolescence; Suicide, Attempted -- Psychosocial Factors; Male; Black Persons -- Statistics and Numerical Data; Suicide -- Psychosocial Factors; United States; Ethnic Groups -- Statistics and Numerical Data; Substance Use Disorders -- Psychosocial Factors; Risk Factors; Native Americans -- Psychosocial Factors; Native Americans -- Statistics and Numerical Data; Ethnic Groups -- Psychosocial Factors; Female; Minority Groups -- Psychosocial Factors; Human

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008-2014. - Blosnich, John R.; Lytle, Megan C.; Coulter, Robert W. S.; Whitfield, Darren L. (Archives of Suicide Research, 2018)

The mediating role of emotion regulation strategies on psychopathology and suicidal behaviour following negative childhood experiences. - McLafferty, M.; Bunting, B.P.; Armour, C.; Lapsley, C.; Ennis, E.; Murray, E.; O'Neill, S.M. (Children & Youth Services Review, 2020)
• Adaptive emotion regulation strategies are protective. • Suppression mediates association between parental over-control and psychopathology. • Parental over-control has a negative impact on development of emotion regulation. • Gender variations in emotion regulation strategies impact on mental health. Childhood adversities and maladaptive parenting practices, such as parental over-control, over-protection or over-indulgence can be significant risk factors for psychopathology and suicidal behaviour. Adaptive emotion regulation strategies can be protective. However, individuals may develop maladaptive emotion regulation strategies as a result of these early life experiences. This study aims to determine if emotion regulation strategies (reappraisal and suppression) mediate the impact of negative childhood experiences on psychological health, and to identify predictors of such strategies. The study utilizes data from the Ulster University Student Wellbeing Study, conducted in Northern Ireland (NI) as part of the WHO World Mental Health (WMH) International College Student Initiative (n = 739). The average age of participants was 21 (462 females, 274 males). Mediation analyses examined the role of emotion regulation strategies on psychopathology and suicidality following negative childhood experiences. Mediation analyses revealed that individuals with adaptive emotion regulation strategies were less likely to have psychological problems following negative childhood experiences. The reduced use of suppression was particularly important. However, males and individuals who reported parental over-control were more likely to use suppression. Non-heterosexual students were less likely to use reappraisal which can be adaptive. The study highlights the importance of developing adaptive emotion regulation strategies following negative childhood experiences since such strategies may reduce psychological problems.
Keywords: Emotional Regulation; Psychopathology; Suicidal Ideation; Adverse Childhood Experiences; Parental Behavior; Human; Parent-Child Relations; Ireland; Male; Female; Adult

Cyberbullying and LGBTQ Youth: A Systematic Literature Review and Recommendations for Prevention and Intervention. - Abreu, Roberto L.; Kenny, Maureen C. (Journal of Child & Adolescent Trauma, 2018)
Research has demonstrated that cyberbullying has adverse physical and mental health consequences for youths. Unfortunately, most studies have focused on heterosexual and cisgender individuals. The scant available research on sexual minority and gender expansive youth (i.e., LGBTQ) shows that this group is at a higher risk for cyberbullying when compared to their heterosexual counterparts. However, to date no literature review has comprehensively explored the effects of cyberbullying on LGBTQ youth. A systematic review resulted in 27 empirical studies that explore the effects of cyberbullying on LGBTQ youth. Findings revealed that the percentage of cyberbullying among LGBTQ youth ranges between 10.5% and 71.3% across studies. Common negative effects of cyberbullying of LGBTQ youth include psychological and emotional (suicidal ideation and attempt, depression, lower self-esteem), behavioral (physical aggression, body image, isolation), and academic performance (lower GPAs). Recommendations and interventions for students, schools, and parents are discussed.
Keywords: Cyberbullying -- Trends; Cyberbullying -- Prevention and Control; LGBTQ+ Persons; Human; Systematic Review; Cyberbullying -- Risk Factors; Cyberbullying -- Psychosocial Factors; Suicidal Ideation; Suicide, Attempted; Depression; Self Concept; Aggression; Body Image; Social Isolation; Academic Performance

"It's how we deal": Perceptions of LGB peers' use of alcohol and other drugs to cope and sexual minority adults' own coping motivated substance use following the Pulse nightclub shooting. - Boyle, Sarah C.; LaBrie, Joseph W.; Costine, Lauren D.; Witkovic, Yong D. (Addictive Behaviors, 2017)
Sexual minority stress experiences (e.g. prejudice, victimization, etc.) and peer substance use norms (e.g. peers' frequency of use and quantity consumed) are important correlates of alcohol and drug use in sexual minority populations. The current study incorporates both of these by examining LGB individuals' perceptions of peers' use of alcohol and other drugs to cope with a sexual minority stressor, and whether perceptions of peer coping norms relate to one's own coping-motivated substance use in response to the stressor. Three-hundred and seven sexual minority males and females who identified as gay, lesbian, or bisexual completed an online survey approximately 1month following the Pulse Nightclub Shooting, the deadliest incident of violence against LGBT people in U.S. history, and a stressor experienced within LGB communities throughout the U.S. Results revealed that LGB peers were widely perceived as likely to have coped with alcohol (68%) and drugs (41%) following the Pulse Shooting; however only small proportions of participants themselves reported coping with alcohol (26%) and drugs (7%). Further, multivariate models revealed that even after controlling for other factors including the stress impact of the Pulse shooting, the odds of using alcohol to cope with this event were 15 times greater among participants who held the perception that LGB peers likely used alcohol to cope relative to those who did not share this perception. Similarly, the odds of using drugs to cope with this event were 9 times greater among participants who perceived LGB peers likely to use drugs to cope with Pulse compared to those who did not. Importantly, these findings suggest that personalized normative feedback designed to correct perceptions of peers' coping motivated substance use may have utility as a motivational component in larger interventions seeking to reduce LGBs' substance use.
Keywords: Adaptation, Psychological; Substance Use Disorders -- Psychosocial Factors; Peer Group; Violence -- Psychosocial Factors; Stress, Psychological -- Psychosocial Factors; Perception; Adult; Male; Transsexualism -- Psychosocial Factors; Substance Use Disorders -- Epidemiology; Adolescence; Middle Age; Young Adult; Bisexuality; Homosexuality; Motivation; Transsexualism -- Epidemiology; Female; Impact of Events Scale; Scales

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

Mental Health and the Transgender Population. - Carmel, Tamar C.; Erickson-Schroth, Laura (Journal of Psychosocial Nursing & Mental Health Services, 2016)
Although research into the physical and mental health disparities faced by transgender and gender nonconforming (TGNC) populations is becoming more popular, historically it has been limited. It is now recognized that TGNC people experience disproportionate rates of negative mental health outcomes relative to both their gender-normative, heterosexual peers, as well as their gender-normative lesbian, gay, and bisexual (LGB) peers. The theoretical basis of current transgender mental health research is rooted in the Minority Stress Model, which postulates that we live in a hetero-centric, gender-normative society that stigmatizes and discriminates against lesbian, gay, bisexual, and transgender (LGBT) people, subjecting them to chronic stress (Hendricks & Testa, 2012; Meyer, 1995). This chronic, potentially compounding stress, is responsible for the increased risk of negative mental health outcomes in LGBT populations. TGNC people, in particular, may experience more adverse outcomes than their LGB peers due to rejection and discrimination within society at large as well as within the LGB community.
Keywords: Mental Health -- Evaluation; Education, Continuing (Credit); Transgender Persons; Trauma; Discrimination; Violence; Affective Disorders; Injuries, Self-Inflicted; Suicide; Substance Use Disorders; Anxiety Disorders; Stress Disorders, Post-Traumatic; Psychotic Disorders; Autistic Disorder; Personality Disorders

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: Findings from a community-recruited sample. - Sivasubramanian, Murugesan; Mimiaga, Matthew J.; Mayer, Kenneth H.; Anand, Vivek R.; Johnson, Carey V.; Prabhugate, Priti; Safren, Steven A. (Psychology, Health & Medicine, 2011)
In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD = 5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR = 0.85, 95% CI: 0.78-0.93; social support AOR = 0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR = 0.79, 95% CI: 0.71-0.89; social support AOR = 0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR = 0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.
Keywords: Depression; Anxiety Disorders; Gay Men -- Psychosocial Factors; Stigma; HIV Seropositivity; Support, Psychosocial; India; Male; DSM; Interviews; Descriptive Statistics; Risk Assessment; Odds Ratio; Confidence Intervals; Adult; Questionnaires; Interview Guides; Brief Symptom Inventory; P-Value; Data Analysis Software; Rosenberg Self Esteem Scale; Scales; Logistic Regression; Human; Cross Sectional Studies; Funding Source

Sexual identity development: relationship with lifetime suicidal ideation in sexual minority women. - Dirkes, Jessica; Hughes, Tonda; Ramirez‐Valles, Jesus; Johnson, Tim; Bostwick, Wendy (Journal of Clinical Nursing (John Wiley & Sons, Inc.), 2016)
Aims and objectives This study draws on a life course perspective to evaluate in a sample of sexual minority women: (1) the relationship between age at reaching sexual identity milestones and risk of suicidal ideation, (2) developmental stages or stages of sexual identity development that represent greatest risk and (3) the relationship between age of reaching milestones and parental support. Background Research shows higher rates of suicidal ideation among sexual minority women than heterosexual women. Evidence suggests this is partly accounted for by risk factors including sexual identity development and parental support. However, it remains unclear whether there are stages of particularly high risk. Design This is a cross-sectional study. Data come from a prospective study of sexual minority women that used convenience and respondent-driven sampling methods. Methods Using logistic regression, we examined associations among age at sexual identity developmental milestones, parental support and suicidal ideation in a large ( N = 820), ethnically diverse sample of sexual minority women. Results Compared with women who first wondered about their sexual identity in adulthood, those who first wondered in early, middle or late adolescence had greater odds of lifetime suicidal ideation. Younger age at subsequent milestones (first decided or first disclosed) was not associated with heightened risk of suicidal ideation. Parental support was independently associated with suicidal ideation. Conclusions Findings suggest that where one is in the process of identifying as a sexual minority may be more important than age in understanding risk of suicidal ideation in this population. As individuals come to accept and integrate their sexual minority identity risks associated with younger age diminish. Relevance to Clinical Practice Nurses and other healthcare providers who work with youth should routinely ask about sexual orientation and suicidal ideation and be aware that youth in the earliest stages of coming out as sexual minority may be at particularly high risk of suicide.
Keywords: Suicidal Ideation; Gender Identity; Lesbians; Human Development; Bisexuals; Mental Health; Human; Age Factors; Parent-Child Relations; Cross Sectional Studies; Convenience Sample; Illinois; Adolescence; Young Adult; Female; Support, Psychosocial; Adult; Middle Age; Aged; Aged, 80 and Over; Descriptive Statistics; Descriptive Research; Socioeconomic Factors; Multiple Linear Regression; Bivariate Statistics; Confidence Intervals; Logistic Regression; Race Factors; Black Persons; Hispanic Americans; White Persons

Occurrence of multiple mental health or substance use outcomes among bisexuals: a respondent-driven sampling study. - Bauer, Greta R.; Flanders, Corey; MacLeod, Melissa A.; Ross, Lori E. (BMC Public Health, 2016)
Background: Bisexual populations have higher prevalence of depression, anxiety, suicidality and substance use than heterosexuals, and often than gay men or lesbians. The co-occurrence of multiple outcomes has rarely been studied.Methods: Data were collected from 405 bisexuals using respondent-driven sampling. Weighted analyses were conducted for 387 with outcome data. Multiple outcomes were defined as 3 or more of: depression, anxiety, suicide ideation, problematic alcohol use, or polysubstance use.Results: Among bisexuals, 19.0 % had multiple outcomes. We did not find variation in raw frequency of multiple outcomes across sociodemographic variables (e.g. gender, age). After adjustment, gender and sexual orientation identity were associated, with transgender women and those identifying as bisexual only more likely to have multiple outcomes. Social equity factors had a strong impact in both crude and adjusted analysis: controlling for other factors, high mental health/substance use burden was associated with greater discrimination (prevalence risk ratio (PRR) = 5.71; 95 % CI: 2.08, 15.63) and lower education (PRR = 2.41; 95 % CI: 1.06, 5.49), while higher income-to-needs ratio was protective (PRR = 0.44; 0.20, 1.00).Conclusions: Mental health and substance use outcomes with high prevalence among bisexuals frequently co-occurred. We find some support for the theory that these multiple outcomes represent a syndemic, defined as co-occurring and mutually reinforcing adverse outcomes driven by social inequity.
Keywords: Bisexuality; Substance Use Disorders -- Epidemiology; Mental Disorders -- Epidemiology; Substance Use Disorders -- Prevention and Control; Ontario; Probability Sample; Mental Disorders -- Etiology; Adolescence; Female; Adult; Prevalence; Mental Disorders -- Prevention and Control; Middle Age; Substance Use Disorders -- Etiology; Male; Human; Funding Source

The Impact of Cannabis Use Disorder on Suicidal and Nonsuicidal Self-Injury in Iraq/Afghanistan-Era Veterans with and without Mental Health Disorders. - Kimbrel, Nathan A.; Meyer, Eric C.; DeBeer, Bryann B.; Gulliver, Suzy B.; Morissette, Sandra B. (Suicide & Life-Threatening Behavior, 2018)
The objective of this study was to assess the association between cannabis use disorder (CUD) and self-injury among veterans. As expected, after adjusting for sex, age, sexual orientation, combat exposure, traumatic life events, traumatic brain injury, posttraumatic stress disorder, depression, alcohol use disorder, and noncannabis drug use disorder, CUD was significantly associated with both suicidal (OR = 3.10, p = .045) and nonsuicidal (OR = 5.12, p = .009) self-injury. CUD was the only variable significantly associated with self-injury in all three models examined. These findings are consistent with prior research among civilians and suggest that CUD may also increase veterans' risk for self-injurious behavior.
Keywords: Substance Use Disorders -- Psychosocial Factors; Self-Injurious Behavior -- Psychosocial Factors; Veterans -- Psychosocial Factors; Suicide -- Psychosocial Factors; Self-Injurious Behavior -- Diagnosis; Stress Disorders, Post-Traumatic -- Diagnosis; Comorbidity; Alcoholism -- Psychosocial Factors; Adult; Risk Factors; Female; Suicidal Ideation; Alcoholism -- Diagnosis; Human; Depression -- Diagnosis; Stress Disorders, Post-Traumatic -- Psychosocial Factors; Middle Age; Male; Substance Use Disorders -- Diagnosis; Depression -- Psychosocial Factors; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Impact of Events Scale; Questionnaires

Intersecting Identities and the Association Between Bullying and Suicide Attempt Among New York City Youths: Results From the 2009 New York City Youth Risk Behavior Survey. - LeVasseur, Michael T.; Kelvin, Elizabeth A.; Grosskopf, Nicholas A. (American Journal of Public Health, 2013)
Objectives. We examined the intersections of sexual minority, gender, and Hispanic ethnic identities and their interaction with experiences of bullying in predicting suicide attempt among New York City youths. Methods. We performed secondary data analysis of the 2009 New York City Youth Risk Behavior Survey, using logistic regression to examine the association of sexual identity, gender, ethnicity, and bullying with suicide attempt. We stratified results on these measures and reported adjusted odds ratios. Results. Compared with non-sexual minority youths, sexual minority youths had 4.39 and 1.96 times higher odds, respectively, of attempting suicide and reporting bullying. Identity variables did not interact with bullying in predicting suicide attempt individually; however, a four-way interaction term was significant. The effect of bullying on suicide attempt was strongest among non- Hispanic sexual minority male youths (odds ratio = 21.39 vs 1.65-3.38 for other groups). Conclusions. Sexual minority, gender, and ethnic identities interact with bullying in predicting suicide attempt among New York City youths. Interventions to limit both the prevalence and the effect of bullying among minority youths should consider an intersectional approach that considers ethnic, gender, and sexual identities.
Keywords: Bullying; Suicide, Attempted; Adolescent Behavior; Social Identity; Human; Correlational Studies -- New York; New York; LGBTQ+ Persons; Hispanic Americans; Secondary Analysis; Cross Sectional Studies -- New York; Questionnaires; Logistic Regression; Sex Factors; Male; Female; Adolescence; Predictive Validity; Odds Ratio; Confidence Intervals; White Persons; Minority Groups; Descriptive Statistics; Models, Statistical -- Utilization

Mental health service utilization among men who have sex with men who are at risk of mental health problems in Hong Kong: Prevalence and associated factors. - Mo, Phoenix K. H.; Lau, Joseph T. F.; Lau, Mason M. C.; Yoona Kim (Psychology of Men & Masculinities, 2018)
Mental health problems are prevalent among men who have sex with men (MSM); however, underutilization of mental health services among MSM with mental health problems has been widely documented. To explore factors associated with mental health service utilization (i.e., having sought help from mental health professionals; and intention to seek mental health services if one were to have mental health problems) among 2 subsamples of MSM who were at risk of mental health problems (Subsample 1: those who scored above the cut-off for probable depression or probable anxiety, or had suicidal ideation; Subsample 2: those self-perceived to have had mental health problems in the past 12 months) in Hong Kong. A cross-sectional telephone survey was conducted among MSM (N = 175 for Subsample 1 and N = 143 for Subsample 2). Multivariate logistic regressions showed that factors for having sought help from mental health professionals included disclosure of MSM behavior to all family members and positive attitudes toward seeking professional psychological help for Subsample 1, and positive attitudes toward seeking professional psychological help, ever diagnosed for mental disorders, and enacted stigma for Subsample 2. In addition, factors associated with intention to seek help from mental health professionals included willingness to disclose MSM behavior to mental health professionals for Subsample 1, and positive attitudes toward seeking professional psychological help for both subsamples. Interventions to promote help seeking for mental health problems among MSM should promote positive attitudes toward seeking psychological help and reduce stigma.
Keywords: Mental Health Services -- Utilization; Men Who Have Sex With Men -- Psychosocial Factors; Mental Disorders -- Risk Factors -- Hong Kong; Mental Disorders -- Epidemiology -- Hong Kong; Depression -- Risk Factors; Anxiety -- Risk Factors; Suicidal Ideation -- Risk Factors; Help Seeking Behavior; Human; Hong Kong; Prevalence; Mental Health Personnel -- Psychosocial Factors; Multiple Logistic Regression; Stigma; Self Concept; Cross Sectional Studies; Support, Psychosocial; Mental Disorders -- Diagnosis; Self Disclosure; Mental Disorders -- Therapy

Religious Conflict, Sexual Identity, and Suicidal Behaviors among LGBT Young Adults. - Gibbs, Jeremy J.; Goldbach, Jeremy (Archives of Suicide Research, 2015)
This is the first known study to explore how religious identity conflict impacts suicidal behaviors among lesbian, gay, bisexual, and transgender (LGBT) young adults and to test internalized homophobia as a mediator. A secondary analysis of 2,949 youth was conducted using a national dataset collected by OutProud in 2000. Three indicators of identity conflict and an internalized-homophobia scale (mediator), were included in logistic regressions with three different suicide variable outcomes. Internalized homophobia fully mediates one conflict indicator and partially mediates the other two indicators’ relationship with suicidal thoughts. Internalized homophobia also fully mediates the relationship between one conflict indicator and chronic suicidal thoughts. Two indicators were associated with twice the odds of a suicide attempt. LGBT young adults who mature in religious contexts have higher odds of suicidal thoughts, and more specifically chronic suicidal thoughts, as well as suicide attempt compared to other LGBT young adults. Internalized homophobia only accounts for portions of this conflict.
Keywords: Suicide -- Prevention and Control; Prayer; Suicide -- Psychosocial Factors; Lesbians -- Psychosocial Factors; Gender Identity; Bisexuality; Cross Sectional Studies; Adolescence; Probability; Risk Factors; Suicidal Ideation; Demography; Male; Socioeconomic Factors; Young Adult; Female; Funding Source; Human

Asking for help online: Lesbian, gay, bisexual and trans youth, self-harm and articulating the ‘failed’ self. - McDermott, Elizabeth (Health: An Interdisciplinary Journal for the Social Study of Health, Illness & Medicine, 2015)
International evidence suggests that young people are less likely to seek help for mental health problems in comparison with adults. This study focused on lesbian, gay, bisexual and trans young people who are a population group with an elevated risk of suicide and self-harm, and little is known about their help-seeking behaviour. Utilising qualitative virtual methods, lesbian, gay, bisexual and trans youth web-based discussions about seeking help for suicidal feelings and self-harming were investigated. Findings from a thematic analysis indicate that these young people wanted assistance but found it difficult to (1) ask for help, (2) articulate emotional distress and (3) ‘tell’ their selves as ‘failed’. This analysis suggests that key to understanding these problems are emotions such as shame which arise from negotiating norms connected to heterosexuality, adolescence and rationality. I argue that these norms act to regulate what emotions it is possible to feel, what emotions it is possible to articulate and what type of young lives that can be told. The future development of health and social care interventions which aim to reduce lesbian, gay, bisexual and trans youth suicide and self-harm need to work with a nuanced understanding of the emotional life of young people if they are to be effective.
Keywords: Help Seeking Behavior; Self-Injurious Behavior; Lesbians -- Psychosocial Factors; Gay Persons -- Psychosocial Factors; Bisexuals -- Psychosocial Factors; Transgender Persons -- Psychosocial Factors; Emotions; Heterosexuality; Shame; Suicide; Thematic Analysis; Human; Qualitative Studies; Adolescence

55. Exploring the Association Between Gender- and Sexual Orientation-Based Bullying on Gun Carrying Among Adolescent Males...Society for Adolescent Health and Medicine, Adolescent Health: Transforming Risk to Wellness, 11-14 March 2020, San Diego, California - Ganson, Kyle T.; Nagata, Jason M. (Journal of Adolescent Health, 2020)
Keywords: Sex Factors; Sexuality; Firearms -- Utilization -- In Adolescence; Bullying; Congresses and Conferences -- California; California; Adolescence

Correctional Policy and Attempted Suicide Among Transgender Individuals. - Drakeford, Leah (Journal of Correctional Health Care, 2018)
Little research has examined the link between incarceration and suicide among transgender individuals. Transgender inmates face unique circumstances within the correctional setting that expose them to potentially harmful conditions, including correctional policies that limit access to proper medical care and expose them to threats of harassment and violence. Using data from the 2011 National Transgender Discrimination Survey, this article examines the link between incarceration and suicide among transgender individuals by focusing on the link between correctional policies and attempted suicide among transgender individuals who have been incarcerated. Multivariate results suggest that correctional policies regarding health care and housing may deleteriously impact transgender inmates.
Keywords: Prisoners; Transgender Persons -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Correctional Facilities -- United States; Organizational Policies; Health Services Accessibility; Secondary Analysis; Convenience Sample; Human; Female; Male; Adolescence; Adult; Middle Age; Aged; Aged, 80 and Over; Descriptive Statistics; Data Analysis Software; P-Value; Odds Ratio; Logistic Regression; United States

Mental Health and Substance Use Disorder Comorbidity among Methamphetamine-Using Men Who have Sex with Men. - Fletcher, Jesse B.; Swendeman, Dallas; Reback, Cathy J. (Journal of Psychoactive Drugs, 2018)
Men who have sex with men (MSM) exhibit elevated rates of mental health and substance use disorder relative to their non-MSM male counterparts. Methamphetamine use in particular has been associated with both neuronal damage and mental health disorders among MSM, and this study reports on the prevalence and comorbidity of DSM-5 mental health and substance use disorders in a sample of methamphetamine-using MSM. From March 2014 through January 2015, 286 methamphetamine-using MSM enrolled in a study to reduce methamphetamine use and sexual risk behaviors. At baseline, participants demonstrated high rates of current major depressive episode (35.8%), antisocial personality disorder (23.9%), suicide risk (23.2%), obsessive-compulsive disorder (23.2%), and social phobia (20.4%), as well as methamphetamine use disorder (89.1%), marijuana use disorder (41.0%), alcohol use disorder (39.6%), cocaine use disorder (30.9%), and inhalants use disorder (15.4%). Analyses revealed significant (p < 0.05) associations between methamphetamine use disorder severity and all listed mental health disorders, as well as between alcohol use disorder and all listed mental health disorders. Mental health disorder prevalence and substance use disorder severity were both elevated, and both methamphetamine and alcohol use disorder severity were associated with increased likelihood of comorbid mental health disorder.
Keywords: Methamphetamine -- Administration and Dosage; Substance Use Disorders -- Epidemiology; Mental Disorders -- Epidemiology; Middle Age; Alcoholism -- Epidemiology; Prevalence; Risk Taking Behavior; Mental Health; Adult; Severity of Illness Indices; Mental Disorders -- Physiopathology; Homosexuality; Sexuality; Diagnosis, Dual (Psychiatry); Male; Social Readjustment Rating Scale

College students' conformity to masculine role norms and help-seeking intentions for suicidal thoughts. - McDermott, Ryon C.; Smith, Phillip N.; Borgogna, Nicholas; Booth, Nathan; Granato, Stephani; Sevig, Todd D. (Psychology of Men & Masculinities, 2018)
The present study tested a model interrelating intentions to seek psychological help for suicidal thoughts with conformity to 9 masculine role norms: winning, emotional control, risk-taking, violence, power over women, playboy, self-reliance, primacy of work, and heterosexual self-presentation. In addition, the present study examined the effects of contextual variables, such as participants' gender or race and whether one is seeking formal help (i.e., from a psychologist, medical doctor, or phone line) or informal help (i.e., from a parent, friend, partner, or relative). Structural equation modeling with a college student sample (N = 2,504) indicated that conformity to masculine role norms of emotional control and self-reliance produced the strongest and most robust associations with intentions to seek formal or informal help. Violence, power over women, and heterosexual self-presentation norms also evidenced modest relationships with help-seeking intentions but were significantly stronger for the informal help-seeking scenario. Winning yielded a statistically stronger relationship with help-seeking intentions for the formal help scenario. Measurement and structural invariance tests indicated that race did not moderate the associations between conformity to masculine role norms and help-seeking intentions, whereas mixed evidence suggested that women may have a stronger relationship between the playboy norm and intentions to seek informal help compared with men. These findings highlight the multidimensional nature of masculine roles and suggest that norms of self-reliance and emotional control may be the most salient help-seeking barriers.
Keywords: Students, College -- Psychosocial Factors; Help Seeking Behavior; Suicidal Ideation -- Psychosocial Factors; Masculinity; Support, Psychosocial; Risk Taking Behavior; Violence; Confidence; Heterosexuality; Gender Nonconformity; Control (Psychology); Human; Sex Factors; Race Factors; Psychologists; Telehealth; Interpersonal Relations; Structural Equation Modeling; Female

Risk and Protective Factors in the Lives of Transgender/Gender Nonconforming Adolescents. - Eisenberg, Marla E.; Gower, Amy L.; McMorris, Barbara J.; Rider, G. Nicole; Shea, Glynis; Coleman, Eli (Journal of Adolescent Health, 2017)
Purpose Research suggests that transgender and gender nonconforming (TGNC) youth may be at greatly increased risk of high-risk health behaviors compared with cisgender youth, but existing studies are limited by convenience samples and small numbers. This study uses a large school-based sample of adolescents to describe the prevalence of TGNC identity, associations with health risk behaviors and protective factors, and differences across birth-assigned sex. Methods This study analyzes existing surveillance data provided by 9th and 11th grade students in Minnesota in 2016 (N = 81,885). Students who were transgender, genderqueer, genderfluid, or unsure about their gender identity (TGNC) were compared with those who were not, using χ 2 and t-tests. Outcome measures included four domains of high-risk behaviors and experiences and four protective factors. Results The prevalence of TGNC identity was 2.7% (n = 2,168) and varied significantly across gender, race/ethnicity, and economic indicators. Involvement in all types of risk behaviors and experiences was significantly higher, and reports of four protective factors were significantly lower among TGNC than cisgender youth. For example, almost two-thirds (61.3%) of TGNC youth reported suicidal ideation, which is over three times higher than cisgender youth (20.0%, χ 2 = 1959.9, p < .001). Among TGNC youth, emotional distress and bullying experience were significantly more common among birth-assigned females than males. Conclusions This research presents the first large-scale, population-based evidence of substantial health disparities for TGNC adolescents in the United States, highlighting numerous multilevel points of intervention through established protective factors. Health care providers are advised to act as allies by creating a safe space for young people, bolstering protective factors, and supporting their healthy development.
Keywords: Adolescent Health; Transgender Persons -- Psychosocial Factors; Gender Identity; Health Behavior; Risk Taking Behavior; Suicidal Ideation; Bullying; Health Status Disparities; Human; Students, High School; Descriptive Statistics; Minnesota; T-Tests; Chi Square Test; Female; Male

Transgender Youth in the Inpatient Psychiatric Setting: A Literature Review and Case Report. - HILL, WESLEY J.; SHAPIRO, MICHAEL A. (Journal of Psychiatric Practice®, 2017)
Once considered pathological, transgenderism is now accepted as a variant of normal sexuality. As society has become more accepting of transgenderism, increasing numbers of transgender patients have begun to seek psychiatric care, and younger populations are embracing their gender differences. There is a paucity of literature on how best to serve transgender youth in psychiatric inpatient units. In this article, we share our experience and discuss the need for practical guidelines to help the inpatient psychiatrist navigate key topics related to this population. We then present a case report to illustrate several of these issues. A major goal of this report is to increase the literature base.
Keywords: Depression -- Therapy; Adjustment Disorders -- Therapy; Suicide, Attempted; Psychiatric Service; Human; Female; Male; Adolescence; Depression -- Diagnosis; Adjustment Disorders -- Diagnosis

Victimization of Lesbian, Gay, and Bisexual People in Childhood: Associations with Attempted Suicide. - Flynn, Anna B.; Johnson, Renee M.; Bolton, Shay‐Lee; Mojtabai, Ramin (Suicide & Life-Threatening Behavior, 2016)
Higher rates of attempted suicide have been documented among people who identify themselves as gay, lesbian, and bisexual (LGB) compared with heterosexuals. This study sought to ascertain the association between childhood abuse and neglect and attempted suicide, comparing LGBs and heterosexuals. Childhood sexual abuse among men and childhood sexual and physical abuse among women were found to mediate the association between LGB identity and attempted suicide. The experience of childhood abuse likely plays a significant role in the relationship between LGB identity and attempted suicide, but other factors such as experience of discrimination are also important.
Keywords: Suicide, Attempted -- Psychosocial Factors; Child Abuse -- Psychosocial Factors; Bullying; Crime Victims -- Psychosocial Factors; Adolescence; Cross Sectional Studies; Female; Adult; Child Abuse, Sexual -- Psychosocial Factors; Middle Age; Male; Models, Theoretical; Human

School-Based Protective Factors Related to Suicide for Lesbian, Gay, and Bisexual Adolescents. - Whitaker, Kelly; Shapiro, Valerie B.; Shields, John P. (Journal of Adolescent Health, 2016)
Purpose Research indicates that lesbian, gay, and bisexual (LGB) adolescents are three times more likely to consider suicide than their heterosexual peers. Although research has identified risk factors for suicide among this population, little is known about school-level protective factors among this population, which may buffer the impact of risk.This study aims to understand whether school-based protective factors (e.g., school safety, relationships with caring adults at school, school connectedness) are associated with decreased suicidal ideation for LGB adolescents. Methods Logistic regression analyses were conducted on the data generated by the San Francisco Unified School District's 2011 California Healthy Kids Survey to examine the influence of protective factors related to suicidal ideation for LGB adolescents (n = 356). Results Results indicated that higher levels of school connectedness predicted less suicidal ideation (odds ratio = .59, p =. 005). Conclusions This study provided evidence that school protective factors were related to reduced suicidal ideation for LGB adolescents, controlling for risk factors and demographic variables.
Keywords: Students -- In Adolescence; Lesbians -- In Adolescence; Gay Persons -- In Adolescence; Bisexuals -- In Adolescence; Suicide -- Risk Factors -- In Adolescence; Interpersonal Relations -- In Adolescence; Suicidal Ideation -- In Adolescence; Learning Environment -- In Adolescence; Human; Adolescence; Descriptive Research; Descriptive Statistics; Logistic Regression; Surveys -- California; California; Secondary Analysis; Odds Ratio

Have Mischievous Responders Misidentified Sexual Minority Youth Disparities in the National Longitudinal Study of Adolescent to Adult Health? - Fish, Jessica N.; Russell, Stephen T. (Archives of Sexual Behavior, 2018)
The National Longitudinal Study of Adolescent to Adult Health (Add Health) has been instrumental in identifying sexual minority youth health disparities. Recent commentary suggested that some Wave 1 youth responders, especially males, intentionally mismarked same-sex attraction and, as a result, published reports of health disparities from these data may be suspect. We use two recently developed approaches to identify "jokesters" and mischievous responding and apply them to the Add Health data. First, we show that Wave 1 same-sex attracted youth, including those who later reported completely heterosexual identities in adulthood, were no more likely than different-sex attracted youth and consistently heterosexual participants to be "jokesters." Second, after accounting for mischievous responses, we replicated six previously established disparities: depressive symptoms, suicidal ideation and behaviors, alcohol use, cocaine use, parental satisfaction, and school connectedness. Accounting for mischievousness resulted in the elimination of one observed disparity between heterosexual and sexual minority youth: suicidal ideation for males who reported romantic attraction to both sexes. Results also showed that accounting for mischievous responding may underestimate disparities for sexual minority youth, particularly females. Overall, results presented here support previous studies that identified health disparities among sexual minority youth using these data.
Keywords: Health Status Disparities; Scientific Misconduct; Students; Male; Human; Substance Use Disorders -- Epidemiology; Female; Parent-Child Relations; Young Adult; Interpersonal Relations; Adult; Reproducibility of Results; Prospective Studies; Suicidal Ideation; United States; Adolescence; Depression -- Epidemiology; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires; Scales

A Clinically Neglected Topic: Risk of Suicide in Transgender Individuals. - Yüksel, Şahika; Aslantaş Ertekin, Banu; Öztürk, Mine; Bikmaz, Pervin Sevda; Oğlağu, Zerrin (Archives of Neuropsychiatry / Noropsikiatri Arsivi, 2017)
Introduction: The aim of this study was to determine whether adolescence of transgender individuals is characterized by a high risk of suicide. Methods: In total, 141 participants with transgenderism were questioned using a semi-structured interview to determine whether participants had current suicidal thoughts, had a lifetime history of such thoughts, or had attempted suicide. These findings were cross-referenced to the participants' sociodemographic characteristics, and information about their families' general attitudes toward sexuality, gender identity, and commitment to religious views. In total, 101 participants attended group psychotherapy sessions for at least a year. In these sessions, family and partner relationships, occupational problems, financial problems, medical issues, and religious concerns were discussed. Results: The incidence of suicide attempts, current suicidal thoughts, and lifetime suicidal thoughts were 29.8%, 9.2%, and 55.3%, respectively. In total, 76.7% of the suicide attempts occurred before the age of 21. Conclusion: Transsexual individuals present a high risk of suicide, particularly during adolescence. This finding may be considered a sign for taking action to prevent suicide when working with transgender individuals, particularly during adolescence.
Keywords: Transgender Persons -- In Adolescence; Suicide -- Risk Factors; Human; Adolescence; Psychotherapy, Group; Semi-Structured Interview; Family Attitudes; Gender Identity; Attitude to Sexuality; Suicidal Ideation

37.2 RATES OF DEPRESSION, ANXIETY, PTSD, AND ANTIDEPRESSANT PRESCRIBING IN SUICIDAL LGBT CHILDREN AND ADOLESCENTS. - Haque, Danish; Haq, Taha; Castillo, Lauren; Wallace, Scott; Dunn, Brigham; Alvarado, Carla; Escamilla, Michael (Journal of the American Academy of Child & Adolescent Psychiatry, 2020)

43.10 LONGITUDINAL EXAMINATION OF ATTEMPTS IN LGBTQ AND NON-LGBTQ YOUTH FOLLOWING PARTICIPATION IN A SUICIDE PREVENTION PROGRAM. - King, Jessica D.; Michaels, Molly M.; Solomon, Graziela; Kennard, Betsy D. (Journal of the American Academy of Child & Adolescent Psychiatry, 2020)

A Comparative Analysis of a Community and General Sample of Lesbian, Gay, and Bisexual Individuals. - Kuyper, Lisette; Fernee, Henk; Keuzenkamp, Saskia (Archives of Sexual Behavior, 2016)
Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues ("community sample," N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands ("panel sample," N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexual orientation, were more open about their sexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R (2) of the analyses (which were adjusted for sociodemographic differences) ranged from .08 (suicide plans among men) to .27 (sexual attraction among women). However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed.
Keywords: Mental Health -- Statistics and Numerical Data; Minority Groups -- Statistics and Numerical Data; Lesbians -- Statistics and Numerical Data; Bisexuality; Homosexuality; Residence Characteristics; Young Adult; Stress, Psychological -- Epidemiology; Minority Groups -- Psychosocial Factors; Adult; Middle Age; Female; Lesbians -- Psychosocial Factors; Stress, Psychological -- Psychosocial Factors; Netherlands; Male; Adolescence; Human

Depressive Symptoms and Suicidal Ideation among Irish Undergraduate College Students. - Horgan, Aine; Kelly, Peter; Goodwin, John; Behan, Laura (Issues in Mental Health Nursing, 2018)
This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population.
Keywords: Students, College -- Psychosocial Factors; Depression -- Epidemiology -- Ireland; Suicidal Ideation -- Epidemiology -- Ireland; Human; Male; Female; Adolescence; Adult; Ireland; Center for Epidemiological Studies Depression Scale; Questionnaires; Scales; Descriptive Statistics; Family Relations; Stress, Psychological; Sexuality; Mental Health; Nursing Role; Cross Sectional Studies; Data Analysis Software; Spearman's Rank Correlation Coefficient; Two-Tailed Test; Mann-Whitney U Test; Chi Square Test; Fisher's Exact Test; ROC Curve; Logistic Regression

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

Health care utilization and health indicators among a national sample of U.S. veterans in same-sex partnerships. - Blosnich, John; Bossarte, Robert; Silver, Eric; Silenzio, Vincent (Military Medicine, 2013)
Objectives: To examine health indicators of same-sex partnered veterans as compared with their opposite-sex partnered veteran and nonveteran peers.Methods: Same-sex partner status was derived by self-reported same-sex partnerships in data from the 2004 Behavioral Risk Factor Surveillance System. Outcome variables included health risk disparities associated with sexual minority status (e.g., frequent mental distress) and veteran status (e.g., firearm ownership). Stratified multiple logistic regression models were used to examine the association of same-sex partnered veteran status with health indicators.Results: Same-sex partnered veterans had higher odds of being overweight and keeping firearms in the house compared with same-sex partnered nonveterans. Same-sex partnered veterans were less likely than opposite-sex partnered veterans to be overweight, and they were more than twice as likely to be current smokers when compared with opposite-sex partnered nonveterans.Conclusions: Findings suggest both that some health disparities patterns identified by same-sex partnership status among the general population also exist among veteran populations, and that some unique distinctions may exist, particularly related to BMI and firearm ownership. Collection of information about sexual minority status within Department of Veterans Affairs data sources is needed to more accurately assess the health of this minority population.
Keywords: Health Services -- Utilization; Health Status; Homosexuality; Spouses; Veterans -- Statistics and Numerical Data; Adult; Cross Sectional Studies; Female; Firearms; Health Behavior; Human; Male; Obesity

Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth. - Russell, Stephen T.; Pollitt, Amanda M.; Li, Gu; Grossman, Arnold H. (Journal of Adolescent Health, 2018)
Abstract Purpose This study aimed to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth. Methods Data come from a community cohort sample of 129 transgender and gender nonconforming youth from three U.S. cities. We assessed chosen name use across multiple contexts and examined its association with depression, suicidal ideation, and suicidal behavior. Results After adjusting for personal characteristics and social support, chosen name use in more contexts was associated with lower depression, suicidal ideation, and suicidal behavior. Depression, suicidal ideation, and suicidal behavior were lowest when chosen names could be used in all four contexts. Conclusion For transgender youth who choose a name different from the one given at birth, use of their chosen name in multiple contexts affirms their gender identity and reduces mental health risks known to be high in this group.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Gender Identity; Depression -- Psychosocial Factors; Suicidal Ideation -- Psychosocial Factors; Human; Adolescence; Young Adult; Mental Health; United States; LGBTQ+ Persons; Sexual Identity; Support, Psychosocial; Regression; Scales; Questionnaires; Funding Source

Social Support, Exposure to Violence and Transphobia, and Correlates of Depression Among Male-to-Female Transgender Women With a History of Sex Work. - Nemoto, Tooru; BÃ¶deker, Birte; Iwamoto, Mariko (American Journal of Public Health, 2011)
Objectives. We determined racial/ethnic differences in social support and exposure to violence and transphobia, and explored correlates of depression among male-to-female transgender women with a history of sex work (THSW). Methods. A total of 573 THSW who worked or resided in San Francisco or Oakland, California, were recruited through street outreach and referrals and completed individual interviews using a structured questionnaire. Results. More than half of Latina and White participants were depressed on the basis of Center For Epidemiologic Studies Depression Scale scores. About three quarters of White participants reported ever having suicidal ideation, of whom 64% reported suicide attempts. Half of the participants reported being physically assaulted, and 38% reported being raped or sexually assaulted before age 18 years. White and African American participants reported transphobia experiences more frequently than did others. Social support, transphobia, suicidal ideation, and levels of income and education were significantly and independently correlated with depression. Conclusions. For THSW, psychological vulnerability must be addressed in counseling, support groups, and health promotion programs specifically tailored to race/ethnicity.
Keywords: Transgender Persons -- California; Support, Psychosocial; Violence -- History; Attitude to Sexuality; Depression; Sex Work; Human; Funding Source; Correlational Studies; Race Factors; Ethnic Groups; Female; California; Hispanic Americans; White Persons; Center for Epidemiological Studies Depression Scale; Scales; Psychological Tests; Suicidal Ideation; Suicide, Attempted; Assault and Battery; Rape; Black Persons; Educational Status; Income; Interviews; Chi Square Test; Analysis of Variance; Multiple Regression; Birth Place; Descriptive Statistics; Adult

The influence of intersecting identities on self-harm, suicidal behaviors, and depression among lesbian, gay, and bisexual individuals. - Lytle, Megan C; De Luca, Susan M; Blosnich, John R (Suicide & Life-Threatening Behavior, 2014)
Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self-directed violence, but very little is known about racial/ethnic differences between LGB populations. This study aimed to examine racial/ethnic differences in self-harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18–24) who indicated their sexual orientation and racial/ethnic identities (n = 89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self-harm, suicidal ideation, suicide attempt, and depression than non-LGB individuals.
Keywords: Bisexuality -- Ethnology; Population -- Psychosocial Factors; Depression -- Ethnology; Lesbians; Homosexuality -- Ethnology; Self-Injurious Behavior -- Ethnology; Suicide, Attempted -- Ethnology; Adolescence; Bisexuality; Depression -- Psychosocial Factors; Female; Lesbians -- Psychosocial Factors; Homosexuality; Human; Male; Self-Injurious Behavior -- Psychosocial Factors; Suicidal Ideation; Suicide, Attempted -- Psychosocial Factors; Young Adult

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

Impersonating culture: The effects of using simulated experiences to teach cultural competence. - Drevdahl, Denise J. (Journal of Professional Nursing, 2018)
The article offers information on effects of using simulated experiences to teach cultural competence. It mentions information on Pregnant partner in lesbian relationship experiencing partner violence; adolescent being bullied; young inner-city gunshot wound victim. It presents information on African American standardized patient with hypertension.
Keywords: Education, Nursing; Simulations; Cultural Competence -- Education; Students, Nursing

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

Dynamic Gender Presentations: Understanding Transition and "De-Transition" Among Transgender Youth. - Turban, Jack L; Keuroghlian, Alex S (Journal of the American Academy of Child & Adolescent Psychiatry, 2018)
The following clinical scenarios are composite cases that illustrate clinically important phenomena based on several patients. Jamie is a 19-year-old who was assigned a female gender at birth and had a history of major depressive disorder in remission. She presented to her primary care physician, psychiatrist, and psychotherapist reporting dysphoria related to gender and requesting gender-affirming hormone therapy. Jamie had symptoms for at least 6 months consistent with DSM-5 criteria for gender dysphoria. After full clinical assessment by her therapist, psychiatrist, and primary care physician, her integrated care team initiated gender-affirming hormone therapy and provided close follow-up from her mental health providers. For 13 months, Jamie was treated with testosterone, changed her pronouns to he/him/his, and began wearing traditionally masculine clothing. Throughout this period, she remained engaged in regular care with her psychotherapist, who was experienced in providing gender-affirming care. Eventually, Jamie informed her care team that after the trial of testosterone and much reflection, she had come to understand her identity as a queer woman and wished to discontinue hormone therapy. Jamie reported being pleased about the hormone therapy trial, because this allowed her to clarify her gender identity. She did not regret her social affirmation or any physical changes that occurred during this process, such as fat redistribution and minor facial hair growth, in the context of otherwise being healthy. Lupita is a 23-year-old who was assigned a male gender at birth and had a history of major depressive disorder and panic disorder. At 18 years of age, after a comprehensive evaluation, she initiated gender-affirming hormone therapy with her primary care provider, changed her name to "Lupita," changed her pronouns to she/her/hers, and started wearing more traditionally feminine clothing. That following year, she started attending college and faced continual gender-based harassment from other students as a result of her gender-nonconforming physical appearance. Her college health services were not affirming of her gender and referred to her repeatedly by her birth name and with he-series pronouns. Lupita became demoralized and after 5 months decided to de-transition. She became progressively more depressed and attempted suicide in her sophomore year. Then she transferred colleges, found gender-affirming clinical providers, and resumed estradiol and spironolactone (an antiandrogen) therapy and her social affirmation through name, pronouns, and style of dress. Her mood improved dramatically and she was able to graduate from college. Lupita now presents seeking breast augmentation surgery.
Keywords: Hormones; Female; Male; Adult; Young Adult; Suicide, Attempted; Scales; Social Readjustment Rating Scale

Prevention case management improves socioeconomic standing and reduces symptoms of psychological and emotional distress among transgender women. - Reback, Cathy J.; Shoptaw, Steven; Downing, Martin J. (AIDS Care, 2012)
Urban transgender women often experience several sociocultural co-factors which contribute to their risk of HIV infection. A transgender-specific HIV Prevention Case Management (PCM) intervention was implemented in a community HIV prevention setting and targeted reducing sex work and homelessness, increasing legal employment and income, and reducing psychological and emotional distress symptoms. Sixty high-risk transgender women were enrolled in the ten-session PCM intervention. Participants completed approximately nine out of the ten sessions (M = 8.7; SD = 2.6) and six-month follow-up evaluations were completed with 97% of the participants. Findings from baseline to follow-up evaluations demonstrated a decrease in homelessness (31.0% vs. 10.3%, p<0.01), less reliance on exchange sex as a primary source of income (41.4% vs. 22.4%, p < 0.05), and significant decreases in symptom complaints across multiple Brief Symptom Inventory sub-scales, including depression, hostility, phobic anxiety, and psychoticism (all significant at p<0.05). Further, socioeconomic improvements following the intervention were significantly associated with psychological and emotional gains. The study suggests that adding a culturally appropriate PCM intervention in a community setting is beneficial in addressing co-factors for HIV infection as well as psychological and emotional distress symptoms among this extremely high-risk population.
Keywords: Transgender Persons -- California; HIV Infections -- Prevention and Control; Case Management; Socioeconomic Factors; Human; Female; White Persons; Hispanic Americans; Black Persons; Homelessness; Mental Disorders; Suicidal Ideation; Counseling; Adult; Middle Age; Brief Symptom Inventory; Psychological Tests; Data Analysis Software; T-Tests; Chi Square Test; Fisher's Exact Test; Regression; Sex Work; Substance Abuse; Income; Funding Source; California

Targeted Victimization and Suicidality Among Trans People: A Web-Based Survey. - Zeluf, Galit; Dhejne, Cecilia; Orre, Carolina; Mannheimer, Louise Nilunger; Deogan, Charlotte; Höijer, Jonas; Winzer, Regina; Thorson, Anna Ekéus (LGBT Health, 2018)
Purpose: The aim of this study was to investigate the associations between a series of empirically known risk and protective factors and suicidality among trans people in Sweden. Methods: Participants were self-selected anonymously to a web-based survey conducted in 2014. Univariable and multivariable logistic regression analyses were performed to assess associations between contributing factors and suicide ideation in the past 12 months and lifetime suicide attempts. Results: The analysis included 796 trans individuals, between 15 and 94 years of age, who live in Sweden. A total of 37% of respondents reported that they have seriously considered suicide during the past 12 months and 32% had ever attempted a suicide. Offensive treatment during the past three months and lifetime exposure to transrelated violence were significantly associated with suicidality. Less satisfaction with contacts with friends and acquaintances and with one's own psychological wellbeing were associated with suicide ideation in the past 12 months. Lack of practical support was associated with lifetime suicide attempts. Conclusions: Our findings show that suicidality is directly correlated with trans-related victimization. Preventing targeted victimization is, therefore, a key preventive intervention against this elevated suicidality.

‘Not Becoming Mother’: A Phenomenological Exploration of the Therapeutic Relationship with Transgender Clients. - Harmon, Kevin; Donohue, Gráinne (Issues in Mental Health Nursing, 2018)
LGBTI clients present specific challenges for the mental health profession with key issues for transgender people identified as including isolation, fear, stigma, and family rejection, all of which contribute to the transgender community's high levels of depression, anxiety, substance misuse, self-harm, and suicide. This qualitative research paper explores the experiences of Irish psychotherapists working with transgender clients to explore specifically the nature of the therapeutic relationship. Using an interpretive phenomenological approach, it examines the subjective experience of three participant psychotherapists and endeavours to make sense of the phenomenology that emerged from semi-structured interviews. The phenomenological analysis of the data collected resulted in three salient themes emerging: (i) Therapeutic identification, (ii) Maternal countertransference, and (iii) Confusion. It is hoped that these findings which relate to the therapeutic relationship will be of utmost importance to others working within the mental health profession where recovery is dependent on the strength of this relationship.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Mental Health; Work Experiences; Psychotherapists; Professional-Patient Relations; Human; Social Isolation; Fear; Stigma; Family Relations; Depression; Anxiety; Substance Abuse; Self-Injurious Behavior; Suicide; Qualitative Studies; Phenomenological Research; Semi-Structured Interview; Thematic Analysis; Ireland; Countertransference (Psychology)

A trait-interpersonal analysis of suicide proneness among lesbian, gay, and bisexual community members. - Cramer, Robert J; Stroud, Caroline H; Fraser, Theresa; Graham, James (Suicide & Life-Threatening Behavior, 2014)
Suicide remains a concerning issue for lesbian, gay, and bisexual (LGB) persons. The integrated effects of five-factor model personality traits and interpersonal-psychological theory of suicide (IPTS) constructs on suicide proneness in a community sample of 336 LGB adults were examined. Results supported a model inclusive of all five-factor model domains predicting IPTS constructs leading to suicide proneness. Effects of neuroticism and extraversion were both mediated by perceived burdensomeness and thwarted belongingness. Thwarted belongingness mediated the effect of agreeableness on suicide proneness. Identified mediation pathways build on existing trait-interpersonal theory and may inform clinical services for sexual minority persons.
Keywords: Bisexuality; Lesbians -- Psychosocial Factors; Homosexuality; Personality; Suicidal Ideation; Suicide -- Psychosocial Factors; Adult; Female; Interpersonal Relations; Male; Middle Age; Psychological Theory; Risk Factors

Amphetamine-Type-Stimulants (ATS) Use and Homosexuality-Related Enacted Stigma Are Associated With Depression Among Men Who Have Sex With Men (MSM) in Two Major Cities in Vietnam in 2014. - Vu, Nga Thi Thu; Holt, Martin; Phan, Huong Thi Thu; La, Lan Thi; Tran, Gioi Minh; Doan, Tung Thanh; Nguyen, Trang Nguyen Nhu; de Wit, John (Substance Use & Misuse, 2017)
Background: Men who have sex with men (MSM) are disproportionately affected by mental health concerns, including depression. Amphetamine-type-stimulants (ATS) use and homosexuality-related stigma and discrimination have been found associated with depression among MSM. Objectives: To assess the prevalence of depression and its associations with ATS use and homosexuality-related stigma and discrimination among MSM in Vietnam. Methods: 622 MSM were conveniently recruited in Hanoi and Ho Chi Minh city, Vietnam, from September to December 2014. We collected information on demographic characteristics, ATS, alcohol and other drug use, sexual behaviors, homosexuality-related and discrimination stigma, and sexual sensation-seeking. Depression and suicidal thoughts were assessed by the Patient Health Questionnaire (PHQ-9). We assessed associations of depression with ATS use and homosexuality-related stigma and discrimination using logistic regression. Results: Of 622 sampled MSM, 11.3% were classified as having major depression, 9.8% reported any suicidal thoughts in the last two weeks, 30.4% ever had used any ATS, 88.8% ever ad drank alcohol and 21.5% had ever used any other drugs. In multivariate analysis, depression was significantly associated with ATS use (Adjusted Odds Ratio [AOR: 2.20; (95% Confidence Interval (CI): 1.32–3.67], younger age of sexual debut with another man (AOR: 0.09; 95% CI: 0.02–0.50), and greater enacted homosexuality-related stigma (AOR: 1.97; 95% CI: 1.19–3.26). Conclusions: We found a moderate prevalence of depression among sampled MSM, which was associated with ATS use and enacted homosexuality-related stigma. We recommend integrating assessment and interventions regarding depression and methamphetamine use into gay-friendly, culturally adapted holistic HIV prevention for MSM in Vietnam.
Keywords: Amphetamines; Homosexuality -- Vietnam; Stigma; Depression; Vietnam; Human; Men Who Have Sex With Men; Urban Population; Alcohol Drinking; Questionnaires

Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors. - Testa, Rylan J.; Michaels, Matthew S.; Bliss, Whitney; Rogers, Megan L.; Balsam, Kimberly F.; Joiner, Thomas (Journal of Abnormal Psychology, 2017)
Research has revealed alarmingly high rates of suicidal ideation (SI) and suicide attempts among transgender and gender nonconforming (TGNC) people. This study aims to analyze the role of factors from the gender minority stress and resilience (GMSR) model (Testa, Habarth, Peta, Balsam, & Bockting, 2015), the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005; Van Orden et al., 2010), and the potential integration of these factors, in explaining SI in this population. A convenience sample of 816 TGNC adults responded to measures of current SI, gender minority stressors, and IPTS factors. Path analysis was utilized to test 2 models. Model 1 evaluated the associations between external minority stressors and SI through internal minority stressors. Model 2 examined the relationships between internal minority stressors and SI through IPTS variables (perceived burdensomeness and thwarted belongingness). All GMSR external stressors (rejection, nonaffirmation, victimization, and discrimination), internal stressors (internalized transphobia, negative expectations, and nondisclosure), and IPTS factors (thwarted belongingness and perceived burdensomeness) were related to SI. Both models demonstrated good fit. Model 1 revealed that rejection, nonaffirmation, and victimization were related to SI through experiences of internalized transphobia and negative expectations. Model 2 indicated that internalized transphobia and negative expectations were associated with SI through IPTS factors. The models demonstrate pathways through which GMSR and IPTS constructs relate to one another and confer risk for SI among TGNC individuals. These pathways and several recently proposed constructs examined here provide promising directions for future research and clinical interventions in this area. (PsycINFO Database Record
Keywords: Suicidal Ideation; Interpersonal Relations; Stress, Psychological -- Psychosocial Factors; Human; Female; Adult; Middle Age; Psychological Theory; Young Adult; Male; Aged; Adolescence

The Current Socio-Political Climate and Psychological Distress Among Transgender People. - Flaskerud, Jacquelyn H.; Lesser, Janna (Issues in Mental Health Nursing, 2018)
The article talks about the socio-political condition and psychological distress among transgender people in the U.S in 2017. Topics discussed include the anti-LGBTQ policies by U.S. President Donald Trump, including the decision to not allow LGBTQ people to serve in the U.S. military; the risk of suicidal thoughts and behaviors in LGBTQ youth; and the social stigma, societal discrimination, and violence toward transgender people in the U.S.
Keywords: Stress, Psychological; Transgender Persons; Politics; Military Personnel; Discrimination; Violence; Stigma; Prejudice; Human Rights

Sexual Orientation and Mortality Among US Men Aged 17 to 59 Years: Results From the National Health and Nutrition Examination Survey III. - Cochran, Susan D.; Mays, Vickie M. (American Journal of Public Health, 2011)
Objectives. We investigated associations between minority sexual orientation and mortality among US men. Methods. We used data from a retrospective cohort of 5574 men aged 17 to 59 years, first interviewed in the National Health and Nutrition Examination Survey III (NHANES III; 1988-1994) and then followed for mortality status up to 18 years later. We classified men into 3 groups: those reporting (1) any same-sex sexual partners (men who have sex with men [MSM]; n=85), (2) only female sexual partners (n=5292), and (3) no sexual partners (n=197). Groups were then compared for all-cause mortality, HIV-related mortality, suicide-related mortality, and non-HIV-related mortality. Results. Compared with heterosexual men, MSM evidenced greater all-cause mortality. Approximately 13% of MSM died from HIV-related causes compared with 0.1% of men reporting only female partners. However, mortality risk from non-HIV-related causes, including suicide, was not elevated among MSM. Conclusions. In the United States, the HIV epidemic continues to be the major contributing factor for premature death rates among MSM. Cohorts such as the NHANES III offer a unique opportunity to track the effects of the HIV epidemic on this population.
Keywords: Sexuality; Mortality; Men; Surveys -- United States; Minority Groups; Human; Funding Source; Secondary Analysis; United States; Prospective Studies; Correlational Studies; Male; Young Adult; Adult; Middle Age; Gay Persons; Heterosexuals; Comparative Studies; Sexual Abstinence; Cause of Death; HIV Infections -- Mortality; Descriptive Statistics; Antiretroviral Therapy, Highly Active -- Utilization; Time Factors; Confidence Intervals; Cox Proportional Hazards Model

On My Terms: Sharing a Story of Hypocrisy and Transformation...Zellner B - Clauss‐Ehlers, Caroline S.; Parham, William D. (Journal of Multicultural Counseling & Development, 2017)
The 4th interviewee for the Hearing Our Elders series is Mr. Bob Zellner. Mr. Zellner's experience growing up in the segregated South underscores a commitment to stand up to obstacles and societal norms, even when to do so was life threatening. His experiences remind us of a historical time not too long ago that, to hear, one might think could never happen. And yet, witnessing his experience in the context of modern‐day struggles portrayed in the civil rights movement; the 2016 Tennessee denial of service law for lesbian, gay, bisexual, transgender, and queer individuals; and the 2016 Orlando shooting outside a gay nightclub reminds us that the historical events of Mr. Zellner's past are not too distant from the present. The interview captures 6 themes: being nonconforming in the face of punitive measures, living a purposeful life, pushing beyond comfort zones, early experiences as resilience building, self‐evaluation as a cornerstone for commitment, and giving meaning to grief. El señor Zellner creció en una comunidad segregada del sur, y su experiencia subraya su compromiso para enfrentar obstáculos y normas sociales, aunque hacerlo pueda poner en riesgo la vida. Sus vivencias nos recuerdan un periodo histórico no muy lejano que hoy podría parecer inconcebible. Y aun así, contemplar sus experiencias en el contexto de las luchas actuales del movimiento por los derechos civiles (como la ley de 2016 en Tennessee que permitía denegar servicios a personas lesbianas, gais, bisexuales, transexuales y queer; y el tiroteo de 2016 en Orlando en un club gay) nos recuerda que los eventos históricos del pasado del señor Zellner no están tan alejados del presente. La entrevista captura 6 temas: el inconformismo frente a medidas punitivas, vivir la vida con decisión, salir de las zonas de confort, experiencias tempranas como factores de resiliencia, la autoevaluación como cimiento del compromiso, y darle sentido al sufrimiento.
Keywords: Life Experiences; Civil Rights; History; Racism; Black Persons; White Persons; Voting; Politics; Health Services Accessibility; LGBTQ+ Persons; Mass Casualty Incidents -- Florida; Florida; Social Norms; Commitment; Parents; Life Purpose; Hardiness; Self Assessment; Grief; Aging; Zellner B

Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso. - Kim, Hae-Young; Grosso, Ashley; Ky-Zerbo, Odette; Lougue, Marcel; Stahlman, Shauna; Samadoulougou, Cesaire; Ouedraogo, Gautier; Kouanda, Seni; Liestman, Benjamin; Baral, Stefan (Annals of Epidemiology, 2018)
Purpose: The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities.Methods: FSWs (N = 350) and MSM (N = 330) aged ≥18 were recruited in Bobo-Dioulasso, Burkina Faso. Perceived health care stigma was defined as either ever being afraid of or avoiding health care services because someone might find out the participant has sex with men (for MSM) or sells sex (for FSW). Correlates of perceived health care stigma were examined using multivariable logistic regression.Results: The prevalence of perceived health care stigma was 14.9% (52/350) and 24.5% (81/330) in FSWs and MSM, respectively. Among FSWs, experienced or social stigma, including verbal harassment (adjusted odds ratio [aOR] = 3.59, 95% confidence interval [CI] 1.48-8.71), feeling rejected by friends (aOR = 2.30, 95% CI 1.14-4.64), and feeling police refused to protect them (aOR = 2.58, 95% CI 1.27-5.25), was associated with perceived health care stigma. Among MSM, experiencing verbal harassment (aOR = 1.95, 95% CI 1.09-3.50) and feeling scared to walk in public (aOR = 2.93, 95% CI 1.47-5.86) were associated with perceived health care stigma.Conclusions: In these key populations, perceived health care stigma was prevalent and associated with experienced and social stigmas. To increase coverage of effective HIV services, interventions should incorporate approaches to comprehensively mitigate stigma.
Keywords: Homosexuality; HIV Infections -- Psychosocial Factors; Patient Attitudes; Stigma; Named Groups -- Psychosocial Factors; Burkina Faso; HIV Infections -- Diagnosis; Prevalence; Male; Cross Sectional Studies; Human; Middle Age; Female; Young Adult; Discrimination; Adult; Suicidal Ideation; HIV Infections -- Epidemiology; Named Groups -- Statistics and Numerical Data; Perception; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires; Scales; Social Readjustment Rating Scale

The impact of intimate partner relationships on suicidal thoughts and behaviours: A systematic review. - Kazan, Dominique; Calear, Alison L.; Batterham, Philip J. (Journal of Affective Disorders, 2016)
Background: A systematic review was conducted to identify the impact of intimate partner relationships on suicidality. The aim of the review was to identify factors within intimate partner relationships that influence suicidal ideation, attempts and completion.Method: Fifty-one articles were identified through Scopus, PubMed and PsycINFO databases. Due to the high heterogeneity of the included studies, a narrative data synthesis was conducted.Results: The research drew attention to specific contingents of the population, for example examining suicide risk in individuals under the age of 35 or lesbian, gay, bisexual and transgender (LGBT) individuals who are experiencing relationship discord, and in males who have recently separated.Limitations: Interpretation of these findings is constrained by methodological limitations prevalent in much of the literature. Limitations of the existing literature and corresponding directions for future research are discussed.Conclusions: Relationship separation and poor quality relationships are likely to be important risk factors for suicidal thoughts and behaviours and are frequent triggers for a suicide attempt. This review highlights intimate partner relationships as a significant component in a suicide risk assessment, regardless of the clinical setting. Consequently, clinicians should be aware that individuals reporting relationship problems are likely to be at increased risk of suicidal thoughts and behaviours.
Keywords: Interpersonal Relations; Suicide, Attempted -- Psychosocial Factors; Suicidal Ideation; Sexual Partners -- Psychosocial Factors; Suicide -- Psychosocial Factors; Risk Factors; Human; Systematic Review

Factors Associated with Suicidality Among a National Sample of Transgender Veterans. - Lehavot, Keren; Simpson, Tracy L.; Shipherd, Jillian C. (Suicide & Life-Threatening Behavior, 2016)
Correlates of past-year suicidal ideation and lifetime suicide risk among a national sample of transgender veterans were examined. An online, convenience sample of 212 U.S. transgender veterans participated in a cross-sectional survey in February-May 2014. We evaluated associations between sociodemographic characteristics, stigma, mental health, and psychosocial resources with past-year suicidal ideation and lifetime suicide plans and attempts. Participants reported high rates of past-year suicidal ideation (57%) as well as history of suicide plan or attempt (66%). Transgender-related felt stigma during military service and current posttraumatic stress disorder and depressive symptoms were associated with suicide outcomes as were economic and demographic factors.
Keywords: Veterans -- Psychosocial Factors; Suicide; Suicidal Ideation; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Depression -- Psychosocial Factors; Stress Disorders, Post-Traumatic -- Psychosocial Factors; Depression -- Etiology; Stress Disorders, Post-Traumatic -- Complications; Female; Male; Stigma; Risk Factors; Demography; Suicide, Attempted; United States; Middle Age; Mental Health; Socioeconomic Factors; Cross Sectional Studies; Adult; Funding Source; Human

A population-based study of sexual orientation identity and gender differences in adult health. - Conron KJ; Mimiaga MJ; Landers SJ (American Journal of Public Health, 2010)
OBJECTIVES: We provide estimates of several leading US adult health indicators by sexual orientation identity and gender to fill gaps in the current literature. METHODS: We aggregated data from the 2001-2008 Massachusetts Behavioral Risk Factor Surveillance surveys (N = 67,359) to examine patterns in self-reported health by sexual orientation identity and gender, using multivariable logistic regression. RESULTS: Compared with heterosexuals, sexual minorities (i.e., gays/lesbians, 2% of sample; bisexuals, 1%) were more likely to report activity limitation, tension or worry, smoking, drug use, asthma, lifetime sexual victimization, and HIV testing, but did not differ on 3-year Papanicolaou tests, lifetime mammography, diabetes, or heart disease. Compared with heterosexuals, bisexuals reported more barriers to health care, current sadness, past-year suicidal ideation, and cardiovascular disease risk. Gay men were less likely to be overweight or obese and to obtain prostate-specific antigen tests, and lesbians were more likely to be obese and to report multiple risks for cardiovascular disease. Binge drinking and lifetime physical intimate partner victimization were more common among bisexual women. CONCLUSIONS: Sexual orientation disparities in chronic disease risk, victimization, health care access, mental health, and smoking merit increased attention. More research on heterogeneity in health and health determinants among sexual minorities is needed.
Keywords: LGBTQ+ Persons -- Massachusetts; Health Status -- In Adulthood; Sex Factors; Adult; Affective Disorders; AIDS Serodiagnosis; Cardiovascular Risk Factors; Comparative Studies; Confidence Intervals; Descriptive Statistics; Discrimination; Female; Funding Source; Health Services Accessibility; Health Status Indicators; Human; Incidence; Intimate Partner Violence; Male; Massachusetts; Middle Age; Obesity; Odds Ratio; Prostate-Specific Antigen; Smoking; Substance Abuse

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

Vulnerability and Psychosocial Risk Factors Regarding People who Identify as Transgender. A Systematic Review of the Research Evidence. - McCann, Edward; Brown, Michael (Issues in Mental Health Nursing, 2018)
The aim of this systematic review was to identify the issues related to the vulnerability and psychosocial risk factors of people who identify as transgender. A search of relevant electronic databases from 2007 to 2017 was conducted. Included studies involved transgender people, vulnerability, and risk factors. Following the application of rigorous inclusion and exclusion criteria, a total of 21 papers were considered suitable for the review. The identified themes included sexual risks, substance use, psychological vulnerability risk factors, and protective factors and behaviors. Nurses are in a strong position to address pertinent concerns and to provide the necessary psychosocial supports to this population.
Keywords: Vulnerability; Transgender Persons -- Psychosocial Factors; Stress, Psychological; Human; Systematic Review; Risk Taking Behavior; Sexuality; Substance Abuse; Support, Psychosocial; CINAHL Database; Medline; Psycinfo; Suicidal Ideation

Factors Associated With Mental Health Disorders Among University Students in France Confined During the COVID-19 Pandemic. - Wathelet, Marielle; Duhem, Stéphane; Vaiva, Guillaume; Baubet, Thierry; Habran, Enguerrand; Veerapa, Emilie; Debien, Christophe; Molenda, Sylvie; Horn, Mathilde; Grandgenèvre, Pierre; Notredame, Charles-Edouard; D'Hondt, Fabien (JAMA Network Open, 2020)
Key Points: Question: What is the mental health state of university students in France who were confined during the coronavirus disease 2019 (COVID-19) pandemic, and what factors are associated with the development of mental health symptoms? Findings: This survey study of 69 054 students who experienced quarantine found high prevalence rates of severe self-reported mental health symptoms. Among risk factors identified, female or nonbinary gender, problems with income or housing, history of psychiatric follow-up, symptoms compatible with COVID-19, social isolation, and low quality of information received were associated with altered mental health. Meaning: The findings of this study suggest that students' mental health is a public health issue that has become even more critical in the context of a pandemic, underlining the need to reinforce prevention, surveillance, and access to care. This survey study measures the prevalence of self-reported mental health symptoms, identifies associated factors, and assesses care seeking among university students in France who experienced quarantine during the coronavirus disease 2019 (COVID-19) pandemic. Importance: The coronavirus disease 2019 (COVID-19) pandemic and quarantine measures have raised concerns regarding their psychological effects on populations. Among the general population, university students appear to be particularly susceptible to experiencing mental health problems. Objectives: To measure the prevalence of self-reported mental health symptoms, to identify associated factors, and to assess care seeking among university students who experienced the COVID-19 quarantine in France. Design, Setting, and Participants: This survey study collected data from April 17 to May 4, 2020, from 69 054 students living in France during the COVID-19 quarantine. All French universities were asked to send an email to their students asking them to complete an online questionnaire. The targeted population was approximately 1 600 000 students. Exposure: Living in France during the COVID-19 quarantine. Main Outcomes and Measures: The rates of self-reported suicidal thoughts, severe distress, stress, anxiety, and depression were assessed using the 22-item Impact of Events Scale–Revised, the 10-item Perceived Stress Scale, the 20-item State-Trait Anxiety Inventory (State subscale), and the 13-item Beck Depression Inventory, respectively. Covariates were sociodemographic characteristics, precariousness indicators (ie, loss of income or poor quality housing), health-related data, information on the social environment, and media consumption. Data pertaining to care seeking were also collected. Multivariable logistic regression analyses were performed to identify risk factors. Results: A total of 69 054 students completed the survey (response rate, 4.3%). The median (interquartile range) age was 20 (18-22) years. The sample was mainly composed of women (50 251 [72.8%]) and first-year students (32 424 [47.0%]). The prevalence of suicidal thoughts, severe distress, high level of perceived stress, severe depression, and high level of anxiety were 11.4% (7891 students), 22.4% (15 463 students), 24.7% (17 093 students), 16.1% (11 133 students), and 27.5% (18 970 students), respectively, with 29 564 students (42.8%) reporting at least 1 outcome, among whom 3675 (12.4%) reported seeing a health professional. Among risk factors identified, reporting at least 1 mental health outcome was associated with female gender (odds ratio [OR], 2.10; 95% CI, 2.02-2.19; P <.001) or nonbinary gender (OR, 3.57; 95% CI, 2.99-4.27; P <.001), precariousness (loss of income: OR, 1.28; 95% CI, 1.22-1.33; P <.001; low-quality housing: OR, 2.30; 95% CI, 2.06-2.57; P <.001), history of psychiatric follow-up (OR, 3.28; 95% CI, 3.09-3.48; P <.001), symptoms compatible with COVID-19 (OR, 1.55; 95% CI, 1.49-1.61; P <.001), social isolation (weak sense of integration: OR, 3.63; 95% CI, 3.35-3.92; P <.001; low quality of social relations: OR, 2.62; 95% CI, 2.49-2.75; P <.001), and low quality of the information received (OR, 1.56; 95% CI, 1.49-1.64; P <.001). Conclusions and Relevance: The results of this survey study suggest a high prevalence of mental health issues among students who experienced quarantine, underlining the need to reinforce prevention, surveillance, and access to care.
Keywords: COVID-19 Pandemic -- Psychosocial Factors; Stay-at-Home Orders -- Psychosocial Factors; Students, College -- Psychosocial Factors; Mental Disorders -- Epidemiology -- France; Mental Disorders -- Symptoms; Mental Disorders -- Risk Factors; Risk Assessment; Self Report; Help Seeking Behavior -- Evaluation; Human; France; Male; Female; Adolescence; Young Adult; Secondary Analysis; State-Trait Anxiety Inventory; Scales; Questionnaires; Sex Factors; Socioeconomic Factors

Aspects of mental health among older lesbian, gay, and bisexual adults. - D'augelli AR; Grossman AH; Hershberger SL; O'connell TS (Aging & Mental Health, 2001)
This study examined aspects of mental health among 416 lesbian, gay, and bisexual adults aged 60 to 91 years old, attending social and recreational programs. Mental health indicators were perceived mental health status; self-esteem; internalized homophobia; loneliness; alcohol and drug abuse; and suicidality. Better mental health was correlated with higher self-esteem, less loneliness, and lower internalized homophobia. Compared to women, men reported significantly more internalized homophobia, alcohol abuse, and suicidality related to their sexual orientation. Less lifetime suicidal ideation was associated with lower internalized homophobia, less loneliness, and more people knowing about participants' sexual orientation.
Keywords: Aging -- Psychosocial Factors; Bisexuality; Homosexuality; Lesbians -- Psychosocial Factors; Mental Disorders -- Psychosocial Factors; Adaptation, Psychological; Aged; Aged, 80 and Over; Female; Gender Identity; Locus of Control; Male; Mental Disorders -- Diagnosis; Middle Age; Myers-Briggs Type Indicator -- Statistics and Numerical Data; Psychometrics; Self Disclosure; Sex Factors; Human

School Indicators of Violence Experienced and Feeling Unsafe of Dutch LGB Versus Non-LGB Secondary Students and Staff, 2006-2010. - Mooij, Ton (Journal of Interpersonal Violence, 2016)
Gender and sexual orientation are expressed in heterosexual, lesbian (L), gay (G), bisexual (B), transgender (T), or queer (Q) interests and behavior. Compared with heterosexual persons, LGBTQ persons seem to experience more antisocial behavior, including negative discrimination and violence. To assess differences in LGBTQ-related discrimination in schools, the question for this research is “Do the degrees of violence experienced and feeling unsafe of LGBTQ students and staff in a school differ from those of non-LGBTQ students and staff in the same school?” Secondary analysis was carried out on data from a Dutch national digital monitor survey on safety in secondary schools. In 2006, 2008, and 2010, participation amounted to 570 schools, 18,300 teaching and support staff, and 216,000 students. Four indicators were constructed at the school level: two Mokken Scale means assessing severity of violence experienced and two Alpha Scale means assessing feeling unsafe. Analysis of mean differences showed that LGB students experienced more violence and felt less safe than non-LGB students; LGB staff felt less safe in school than non-LGB staff. When LGB students experienced more violence at school than non-LGB students, LGB students also felt less safe than non-LGB students for all 3 years. No such relationships existed for LGB staff, or between LGB staff and LGB students. No significant relationships were found between the four LGB school indicators and contextual school variables. The outcomes and uniqueness of the study are discussed. Recommendations are made to improve assessment and promote prosocial behavior of students and staff in schools.
Keywords: LGBTQ+ Persons; Gender Identity; Ships; Student Experiences; School Violence; Schools, Secondary; Sexuality; Students; Scales; Data Collection; Correlation Coefficient; Experimental Studies; Descriptive Statistics; Factor Analysis; Case Studies; Literature Review; Coefficient Alpha; Comparative Studies; Ethnographic Research; Univariate Statistics; Surveys; T-Tests; Data Analysis; Reliability; Questionnaires; Sensitivity and Specificity

Suicide Risk in Trans Populations: An Application of Minority Stress Theory. - Tebbe, Elliot A.; Moradi, Bonnie (Journal of Counseling Psychology, 2016)
Drawing on minority stress theory, the present study tested the relations of minority stressors (i.e., experiences of prejudice and discrimination, internalized antitrans attitudes, fear of antitrans stigma), social support (i.e., friend, family, and significant other support), and substance use (i.e., drug and alcohol use) with depression and suicide risk in a sample of trans individuals. Depression was examined as a mediator of the relations of minority stressors and social support with suicide risk; drug and alcohol use were examined as direct correlates of suicide risk. Participants were 335 trans-identified individuals, diverse in gender identities (e.g., trans men, trans women, nonbinary gender identities). They were recruited using online social networks and they completed the study survey online via Qualtrics. Structural equation modeling was used to test hypothesized relations. Depression fully mediated the relations of perceived experiences of discrimination, fear of antitrans stigma, and friend support with suicide risk, and partially mediated the relation of internalized antitrans attitudes with suicide. Drug use was positively associated with suicide risk, whereas alcohol use was not linked with suicide risk. Exploratory comparisons across gender subgroups suggested that the pattern of relations among study variables was consistent across trans men, trans women, and individuals with nonbinary gender identities. These findings point to minority stressors, friend support, and drug use as potentially fruitful targets of prevention and intervention efforts to reduce depression and suicide risk in trans populations.
Keywords: Psychological Theory; Stress, Psychological; Suicide -- Risk Factors; Transgender Persons -- Psychosocial Factors; Substance Use Disorders; Discrimination; Support, Psychosocial; Human; Adolescence; Young Adult; Adult; Middle Age; Aged; Descriptive Statistics; Male; Female; Sexuality; Depression; Surveys; Structural Equation Modeling; Hypothesis; Stigma; Comparative Studies; Mental Health; Family; Friendship; Gender Identity; Questionnaires; Coefficient Alpha; Scales; Variable; Factor Analysis; Chi Square Test; Confidence Intervals; P-Value

Discrimination, Mental Health, and Suicidal Ideation Among LGBTQ People of Color. - Sutter, Megan; Perrin, Paul B. (Journal of Counseling Psychology, 2016)
Discrimination based on race/ethnicity, sexual orientation, and gender identity has been linked to many negative psychological and physical health outcomes in previous research, including increased suicidal ideation. Two hundred lesbian, gay, bisexual, transgender, and queer (LGBTQ) people of color (POC) were surveyed on their experiences of LGBTQ-based discrimination, racism, mental health (depression, anxiety, satisfaction with life), and suicidal ideation in a national online study based in the United States. A structural equation model (SEM) was created and found that LGBTQ-based discrimination exerted an indirect effect on suicidal ideation through mental health. Racism exerted a direct effect on mental health but was not associated with suicidal ideation in the SEM. The effects of LGBTQ-based discrimination on mental health may be a key area for interventions to reduce suicidal ideation in LGBTQ POC.
Keywords: Suicidal Ideation; Discrimination; Mental Health; Black Persons; LGBTQ+ Persons; Depression; Anxiety; Mental Disorders; Personal Satisfaction; Questionnaires; Human; Male; Female; Adult; Descriptive Statistics; Data Analysis Software; Coefficient Alpha; Univariate Statistics; Chi Square Test; Confidence Intervals; Funding Source; Checklists; Scales

Assessment of college students with the revised Conflict Tactics Scale (CTS2): Sociodemographic characteristics and relationship. - Kim, Suk-hee; Wills, Karrah; Canfield, James P.; Kazimierczuk, Francoise; Harley, Dana; Hyppolite, Melody; Desrosiers, Patricia (Journal of Human Behavior in the Social Environment, 2018)
This paper presents prevalence data gathered from the fast-growing metropolitan southeast in the United States college campus representative sample through an on-line 28-question survey on the sexual, physical, and psychological harm in university/college dating and domestic violence relationships. The study questions were 1) what is the prevalence of dating and domestic violence on college campus? and 2) what are the characteristics of those affected by it? The results, derived from the Revised Conflict Tactics Scale (CTS2) and the dating experiences survey, reveal that college students’ gender identity, sexual orientation, grade point average (GPA), number of missing classes, current relationship status that they were associated with dating and domestic violence among college students. Statistically significant relationships were found between sexual violence and participants’ sexual orientation and the length of their romantic relationship as well as physical violence, including hitting and shoving, and participants’ sexual orientation and their class attendance. Institutional responses to prevent campus violence through prevention training, education, and intervention services could lower the prevalence of dating and help alleviate the adverse effects that it could have on college students.
Keywords: Students, College; Conflict (Psychology); School Violence -- Epidemiology -- Southeastern United States; Interprofessional Relations; Dating Violence -- Epidemiology -- Southeastern United States; Instrument Validation; Scales; Sexual Identity; Sexuality; Prevalence; Southeastern United States; Socioeconomic Factors; Male; Female; Cross Sectional Studies; Quantitative Studies; Convenience Sample; Surveys; T-Tests; One-Way Analysis of Variance; Pearson's Correlation Coefficient; Chi Square Test; Data Analysis Software; Coercion; Sexual Abuse; Adult; Human; Funding Source

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

The Association of Multiple Identities with Self-Directed Violence and Depression among Transgender Individuals. - Lytle, Megan C.; Blosnich, John R.; Kamen, Charles (Suicide & Life-Threatening Behavior, 2016)
Transgender individuals have a high prevalence of self-directed violence; however, there is scant literature focusing on their unique experiences. The differences in self-harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation were examined among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorsed self-directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non-Hispanic White individuals.
Keywords: Depression -- Epidemiology; Suicide, Attempted -- Ethnology; Self-Injurious Behavior -- Diagnosis; Sexuality -- Ethnology; Self-Injurious Behavior -- Psychosocial Factors; Self-Injurious Behavior -- Epidemiology; Sexuality; Suicide, Attempted -- Prevention and Control; Suicide, Attempted -- Psychosocial Factors; Suicide, Attempted; Depression -- Diagnosis; Psychological Techniques; Female; Adult; United States; Students -- Psychosocial Factors; Students -- Statistics and Numerical Data; Adolescence; Heterosexuality; Random Assignment; Male; Suicidal Ideation; Ethnic Groups; Funding Source; Human

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

Bullying victimization and emotional distress: is there strength in numbers for vulnerable youth? - Eisenberg, Marla E.; McMorris, Barbara J.; Gower, Amy L.; Chatterjee, Debanjana (Journal of Psychosomatic Research, 2016)
Objective: The present study examines whether the prevalence of vulnerable peers in school protects the emotional health of youth who are lesbian, gay, bisexual or questioning (LGBQ), overweight, or have a disability, and if the adverse emotional effects of bullying victimization are mitigated by the presence of these peers.Methods: Survey data come from a large school-based sample of adolescents attending 505 schools. The primary independent variable was the percent of students in school with each vulnerability characteristic. Multilevel logistic regression models estimated the odds of internalizing problems, self-harm, suicidal ideation and suicide attempts among students who were LGBQ, overweight or had a disability. Cross-level interaction terms were added to determine if the association between being victimized and emotional distress was moderated by the presence of vulnerable peers.Results: Greater presence of similar students was, on average, protective against emotional distress for LGBQ girls and overweight boys. In contrast, greater presence of students with a disability was, on average, a risk factor among girls with a disability. Several tests of effect modification indicated that odds of emotional distress for those who had been victimized were lower in schools with a higher proportion of vulnerable youth.Conclusions: The presence of a similar peer group may increase the likelihood that a bystander or witness to bullying will react in a helpful way. School personnel, health care providers and other youth service professionals should inquire about social relationships at school, including experiences of harassment and perceptions of peer support, to buffer negative experiences.
Keywords: Stress, Psychological -- Psychosocial Factors; Bullying -- Prevention and Control; Obesity -- Psychosocial Factors; Crime Victims -- Psychosocial Factors; Child, Disabled -- Psychosocial Factors; Mental Health; Stress, Psychological -- Epidemiology; Obesity -- Epidemiology; Students -- Psychosocial Factors; Peer Group; Adolescence; Male; Female; Suicide, Attempted -- Psychosocial Factors; Suicidal Ideation; Human

Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM. - Rodriguez-Hart, Cristina; Nowak, Rebecca G.; Musci, Rashelle; German, Danielle; Ifeanyi Orazulike; Kayode, Blessing; Hongjie Liu; Gureje, Oye; Crowellf, Trevor A.; Baral, Stefan; Charurat, Man; Orazulike, Ifeanyi; et al. (AIDS (02699370), 2017)
Objectives: Sexual stigma affecting MSM in Nigeria may be an important driver of HIV and other sexually transmitted infections (STIs), but potential mechanisms through which this occurs are not well understood. This study assessed the contributions of suicidal ideation and sexual risk behaviors to causal pathways between stigma and HIV/STIs.Design: Data were collected from the TRUST/RV368 Study, a prospective cohort of 1480 MSM from Abuja and Lagos, Nigeria.Methods: Participants enrolled from March 2013 to February 2016 were classified into three stigma subgroups based on a latent class analysis of nine stigma indicators. Path analysis was used to test a model where disclosure led to stigma, then suicidal ideation, then condomless sex with casual sex partners, and finally incident HIV infection and/or newly diagnosed STIs, adjusting the model for age, education, having had female sex partners in the past 12 months, and sex position. Both direct and indirect (mediational) paths were tested for significance and analyses were clustered by city.Results: As stigma increased in severity, the proportion of incident HIV/STI infections increased in a dose-response relationship (low: 10.6%, medium: 14.2%, high 19.0%, P = 0.008). All direct relationships in the model were significant and suicidal ideation and condomless sex partially mediated the association between stigma and incident HIV/STI infection.Conclusion: These findings highlight the importance of the meaningful integration of stigma-mitigation strategies in conjunction with mental health services as part of a broader strategy to reduce STI and HIV acquisitions among Nigerian MSM.
Keywords: Stigma; Sexually Transmitted Diseases -- Transmission; Homosexuality; Sexually Transmitted Diseases -- Epidemiology; Incidence; Suicidal Ideation; Young Adult; Adolescence; Nigeria; HIV Infections -- Transmission; Risk Taking Behavior; Male; Adult; Prospective Studies; HIV Infections -- Epidemiology; Middle Age; Human; Funding Source

Differences in Risk Factors for Suicide Attempts Among 9th and 11th Grade Youth: A Longitudinal Perspective. - Fried, Lise E.; Williams, Sandra; Cabral, Howard; Hacker, Karen (Journal of School Nursing, 2013)
Keywords: Suicide, Attempted -- Risk Factors -- In Adolescence; Adolescent Development; Students, High School; Human; Funding Source; Secondary Analysis; Surveys; Socioeconomic Factors; Cognition; Depression; Substance Abuse; Homosexuality; Public Assistance; Child Abuse, Sexual; Ethnic Groups; Puberty; Stratified Random Sample; Schools, Secondary; United States; Risk Taking Behavior; Health Status; Interviews; Self Report; Summated Rating Scaling; Scales; Descriptive Statistics; Self Concept; Data Analysis Software; Male; Female; Adolescence; Parents; Marital Status; Odds Ratio; Confidence Intervals; P-Value; Risk Assessment; School Health Nursing; Nursing Assessment; Prospective Studies

Gender Expression, Violence, and Bullying Victimization: Findings From Probability Samples of High School Students in 4 US School Districts. - Gordon, Allegra R.; Conron, Kerith J.; Calzo, Jerel P.; White, Matthew T.; Reisner, Sari L.; Austin, S. Bryn (Journal of School Health, 2018)
ABSTRACT: BACKGROUND: Young people may experience school‐based violence and bullying victimization related to their gender expression, independent of sexual orientation identity. However, the associations between gender expression and bullying and violence have not been examined in racially and ethnically diverse population‐based samples of high school students. METHODS: This study includes 5469 students (13–18 years) from the 2013 Youth Risk Behavior Surveys conducted in 4 urban school districts. Respondents were 51% Hispanic/Latino, 21% black/African American, 14% white. Generalized additive models were used to examine the functional form of relationships between self‐reported gender expression (range: 1 = Most gender conforming, 7 = Most gender nonconforming) and 5 indicators of violence and bullying victimization. We estimated predicted probabilities across gender expression by sex, adjusting for sexual orientation identity and potential confounders. RESULTS: Statistically significant quadratic associations indicated that girls and boys at the most gender conforming and nonconforming ends of the scale had elevated probabilities of fighting and fighting‐related injury, compared to those in the middle of the scale (p < .05). There was a significant linear relationship between gender expression and bullying victimization; every unit increase in gender nonconformity was associated with 15% greater odds of experiencing bullying (p < .0001). CONCLUSIONS: School‐based victimization is associated with conformity and nonconformity to gender norms. School violence prevention programs should include gender diversity education.
Keywords: School Violence; Bullying; Victims; Gender Identity; Students, High School; Race Factors; Human; Adolescence; United States; Black Persons; Hispanic Americans; White Persons; Male; Female; Cluster Sample; Descriptive Statistics; Logistic Regression

Making the invisible visible: a systematic review of sexual minority women's health in Southern Africa. - Muller, Alexandra; Hughes, Tonda L. (BMC Public Health, 2016)
Background: Over the past two decades research on sexual and gender minority (lesbian, gay, bisexual and transgender; LGBT) health has highlighted substantial health disparities based on sexual orientation and gender identity in many parts of the world. We systematically reviewed the literature on sexual minority women's (SMW) health in Southern Africa, with the objective of identifying existing evidence and pointing out knowledge gaps around the health of this vulnerable group in this region. Methods: A systematic review of publications in English, French, Portuguese or German, indexed in PubMed or MEDLINE between the years 2000 and 2015, following PRISMA guidelines. Additional studies were identified by searching bibliographies of identified studies. Search terms included (Lesbian OR bisexual OR "women who have sex with women"), (HIV OR depression OR "substance use" OR "substance abuse" OR "mental health" OR suicide OR anxiety OR cancer), and geographical specification. All empirical studies that used quantitative or qualitative methods, which contributed to evidence for SMW's health in one, a few or all of the countries, were included. Theoretical and review articles were excluded. Data were extracted independently by 2 researchers using predefined data fields, which included a risk of bias/quality assessment. Results: Of 315 hits, 9 articles were selected for review and a further 6 were identified through bibliography searches. Most studies were conducted with small sample sizes in South Africa and focused on sexual health. SMW included in the studies were racially and socio-economically heterogeneous. Studies focused predominately on young populations, and highlighted substance use and violence as key health issues for SMW in Southern Africa. Conclusions: Although there are large gaps in the literature, the review highlighted substantial sexual-orientation-related health disparities among women in Southern Africa. The findings have important implications for public health policy and research, highlighting the lack of population-level evidence on the one hand, and the impact of criminalizing laws around homosexuality on the other hand.
Keywords: Women's Health; Africa, Southern; Human; Female; Systematic Review

Social connectedness, stressful life events, and self-injurious thoughts and behaviors among young adults. - Macrynikola, Natalia; Miranda, Regina; Soffer, Ariella (Comprehensive Psychiatry, 2018)
Objectives Preventing self-injurious thoughts and behaviors (SITBs) is particularly challenging on commuter campuses, given lower social cohesion and higher levels of stress than among traditional college populations. The present study examined the relationship between stressful life events (SLEs) and risk for different forms of SITBs, along with the potential buffering role of social connectedness, in a diverse sample of young adults from a commuter college. Methods Participants were 1712 (81% female; 61% racial/ethnic minority; 20% sexual minority) undergraduate and graduate students from a public commuter college in New York City. Participants completed an anonymous survey that inquired about lifetime and recent (past 12 months) history of suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI), along with social connectedness and lifetime history of SLEs. Results Lower levels of social connectedness and exposure to a higher number of SLEs were associated with engaging in SITBs in the past year, particularly both suicide attempts and non-suicidal self-injury. However, social connectedness did not buffer against the impact of SLEs on SITBs. Limitations Data are cross-sectional, limiting conclusions about directionality, and females were overrepresented. Conclusions Identifying ways to increase social connectedness on diverse commuter campuses may help decrease risk of SITBs. However, it may not buffer against the impact of SLEs on risk of SITBs. Future studies should examine contextual variables (e.g., type and timing of social support) that may play a role in protecting against SITBs, particularly for those with a history of adversity.
Keywords: Self-Injurious Behavior -- Risk Factors; Students, College -- Psychosocial Factors; Social Inclusion; Life Change Events; Human; Young Adult; Female; Male; Minority Groups; LGBTQ+ Persons; Suicidal Ideation; Injuries, Self-Inflicted; Cross Sectional Studies

Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in New Zealand secondary school students. - Lucassen, Mathijs F. G.; Merry, Sally N.; Robinson, Elizabeth M.; Denny, Simon; Clark, Terryann; Ameratunga, Shanthi; Crengle, Sue; Rossen, Fiona V. (Australian & New Zealand Journal of Psychiatry, 2011)
Objective: To describe the sexual attractions of New Zealand secondary school students and investigate the associations between sexual attraction and self-reported depression, self-harm, suicidality and help-seeking behaviour. Method: Multiple logistic regression was used to examine the associations between sexual attraction and depressive symptoms, suicidality, self-harming and help-seeking behaviours in a nationally representative secondary school health and well-being survey, undertaken in 2007. Results: Of the students surveyed, 92% were attracted to the opposite sex, 1% to the same sex, 3% to both sexes, 2% were not sure and 2% were attracted to neither sex. Students who were attracted to the same or to both sexes consistently had higher prevalence estimates of depression (p == < 0.0001), suicidality (p == < 0.0001) and self-harming (p == < 0.0001). Odds ratios were highest for students who reported they were attracted to both sexes for depressive symptoms (OR 3.7, 95%CI 2.8--4.7), self-harm (OR 5.8, 95%CI 4.4--7.6) and attempted suicide (OR 7.0, 95%CI 5.2--9.4). Students not exclusively attracted to the opposite sex were more likely to report having seen a health professional for an emotional worry and were more likely to have difficulty accessing help for emotional concerns. Conclusions: The study findings highlight significant mental health disparities faced by students attracted to the same or both sexes, with those attracted to both sexes appearing particularly vulnerable. There is a vital need to ensure primary care and mental health services have the capacity and capability to screen and provide appropriate responsive care for youth who are attracted to the same or both sexes.
Keywords: Students, High School -- Psychosocial Factors; Sexuality; Depression; Help Seeking Behavior; Suicidal Ideation; Self-Injurious Behavior; Gender Identity; Multiple Logistic Regression; Self Report; Odds Ratio; P-Value; Confidence Intervals; New Zealand; Cross Sectional Studies; Male; Female; Adolescence; Surveys; Human

Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature. - Marshall, Ellen; Claes, Laurence; Bouman, Walter Pierre; Witcomb, Gemma L.; Arcelus, Jon (International Review of Psychiatry, 2016)
Literature has described high levels of mental health problems among trans people, such as depression, resulting in increased levels of non-suicidal self-injury (NSSI) behaviour and suicidality (suicidal thoughts, suicide attempts and suicide rates). With the aim of systematically reviewing the available literature in this field, this study identifies 31 papers that explore the rates of NSSI and suicidality in trans people. From reviewing the literature, it was revealed that trans people have a higher prevalence of NSSI and suicidality compared to the cisgender (non-trans) population. There appear to be some gender differences within these rates, with trans men at a greater risk for NSSI behaviour. Prevalence rates differ depending on the different stages of transition, but they are still overall greater than the cisgender population. The study concludes that trans individuals are at a greater risk of NSSI behaviour and suicidality than the cisgender population, and discusses risk factors and the need to develop effective preventative interventions.
Keywords: Transgender Persons -- Psychosocial Factors; Suicidal Ideation -- Risk Factors; Suicide, Attempted; Self-Injurious Behavior -- Risk Factors; Human; Systematic Review; Medline; PubMed; Embase; Psycinfo; Male; Female; Adolescence; Adult

Correlation of Minority Status, Cyberbullying, and Mental Health: A Cross-Sectional Study of 1031 Adolescents. - Duarte, Cassandra; Pittman, Sarah K.; Thorsen, Margaret M.; Cunningham, Rebecca M.; Ranney, Megan L. (Journal of Child & Adolescent Trauma, 2018)
Adolescent cyberbullying is increasingly prevalent. Depression and suicidal ideation are also common, particularly among minority adolescents and cyberbullied adolescents. Little data exists to establish whether minority cyberbullied adolescents are at greater risk of negative mental health outcomes associated with cyberbullying. This cross-sectional study of 1031 adolescents presenting to an emergency room examines the prevalence of cyberbullying in minority and non-minority populations. Using logistic regression, we compared mental health symptoms between minority and non-minority cyberbullying-involved adolescents (accounting for demographic factors), and examined the correlation between use of multiple forms of online technology, minority status, and prevalence of cyberbullying. Sexual orientation was the only demographic factor to strongly correlate with cyberbullying involvement or to correlate with negative mental health symptoms. Increased use of social media platforms also correlated with cyberbullying involvement. This analysis provides a baseline for future work around targeted cyberbullying interventions for minority adolescent populations.
Keywords: Minority Groups; Cyberbullying -- Trends -- In Adolescence; Mental Health -- In Adolescence; Human; Cross Sectional Studies; Depression; Suicidal Ideation; Logistic Regression; Descriptive Statistics; Emergency Service; Prevalence; Internet; Sexuality; Social Media; Cyberbullying -- Epidemiology -- New England; New England; Adolescence

Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study. - Madge, Nicola; Hawton, Keith; McMahon, Elaine; Corcoran, Paul; Leo, Diego; Wilde, Erik; Fekete, Sandor; Heeringen, Kees; Ystgaard, Mette; Arensman, Ella (European Child & Adolescent Psychiatry, 2011)
There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated.
Keywords: Self-Injurious Behavior; Stress, Psychological; Case Studies; Adolescence; Human; Descriptive Statistics; Scales; Multiple Regression; Odds Ratio; Logistic Regression; Chi Square Test; Male; Female; P-Value; Pearson's Correlation Coefficient; Effect Size; Norway; Hungary; Belgium; England; Ireland; Funding Source; Cross Sectional Studies; Confidence Intervals

Religion and religiosity: protective or harmful factors for sexual minority youth? - Longo, Joseph; Walls, N. Eugene; Wisneski, Hope (Mental Health, Religion & Culture, 2013)
Sexual minority youth are disproportionately impacted by a number of psychosocial risks including a greater likelihood of non-suicidal self-injury (NSSI) when compared to heterosexual counterparts. Emerging research seeks to identify the risk and resilience factors that contribute to the mental health of this stigmatised population. Considering that most Americans grow up with at least some religious teachings and that most major world religions have historically condemned same sex sexuality, the current study examines the association between religious tradition, religiosity, and NSSI behaviour. Results indicate that religion plays both a protective and harmful role for sexual minority youth. Those identifying as Christians with high religious guidance had the greatest risk, seculars had a comparatively moderate risk, and Christians with low religious guidance had the least risk. Implications for clinical practice and future areas of research are discussed.
Keywords: Religion and Psychology -- Classification; Sexual Partners -- Psychosocial Factors -- In Adolescence; Self-Injurious Behavior -- Risk Factors -- In Adolescence; Attitude to Sexuality -- In Adolescence; Human; Substance Abuse -- Risk Factors; Homelessness; Adolescence; Stigma; Self Concept; Young Adult; Adult; Male; Female; Questionnaires; Logistic Regression; Descriptive Statistics; Chi Square Test; Conceptual Framework; Multivariate Analysis; Confidence Intervals; Odds Ratio

Elevated Prevalence of Suicide Attempts among Victims of Police Violence in the USA. - DeVylder, Jordan; Frey, Jodi; Sharpe, Tanya; Nam, Boyoung; Cogburn, Courtney; Wilcox, Holly; Oh, Hans; Link, Bruce; DeVylder, Jordan E; Frey, Jodi J; Cogburn, Courtney D; Wilcox, Holly C; et al. (Journal of Urban Health, 2017)
Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Survey of Police-Public Encounters, a population-based survey of adults (N = 1615) residing in four US cities. Surveys assessed lifetime exposure to police victimization based on the World Health Organization domains of violence (i.e., physical, sexual, psychological, and neglect), using the Police Practices Inventory. Logistic regression models tested for associations between police victimization and (1) past 12-month suicide attempts and (2) past 12-month suicidal ideation, adjusted for demographic factors (i.e., gender, sexual orientation, race/ethnicity, income), crime involvement, past intimate partner and sexual victimization exposure, and lifetime mental illness. Police victimization was associated with suicide attempts but not suicidal ideation in adjusted analyses. Specifically, odds of attempts were greatly increased for respondents reporting assaultive forms of victimization, including physical victimization (odds ratio = 4.5), physical victimization with a weapon (odds ratio = 10.7), and sexual victimization (odds ratio = 10.2). Assessing for police victimization and other violence exposures may be a useful component of suicide risk screening in urban US settings. Further, community-based efforts should be made to reduce the prevalence of exposure to police victimization.
Keywords: Police -- Statistics and Numerical Data; Crime Victims -- Statistics and Numerical Data; Crime; Suicide, Attempted; Middle Age; Adolescence; Urban Population; Aged; Female; United States; Prevalence; World Health Organization; Socioeconomic Factors; Male; Suicidal Ideation; Adult; Young Adult; Questionnaires

Mental Health Service Use in a Sample of Gay, Bisexual, and other Men who have Sex with Men Living in Middlesex County, Ontario, Canada: An Exploratory Analysis. - Coleman, Todd A.; Bauer, Greta R.; Aykroyd, Gloria; Powell, Leanne; Pugh, Daniel (Canadian Journal of Community Mental Health, 2016)
Risks of mental health issues (e.g., depression, anxiety/mood disorders, and suicidality) are found to be elevated among Canadian gay, bisexual, and men who have sex with men (GB-MSM). We studied factors impacting mental health care use in a community sample of 202 GB-MSM in London-Middlesex, Ontario. Our results show that, for the entire sample, experiences of both homophobia and internalized homonegativity are associated with increased prevalence of mental health service use over the past year, and suggest that service use is lower among immigrant GB-MSM than among those born in Canada. Implications for mental health and social service providers are discussed.
Keywords: Mental Health Services -- Utilization -- Ontario; Health Resource Utilization -- Evaluation -- Ontario; LGBTQ+ Persons -- Ontario; Ontario; Bisexuals; Human; Exploratory Research; Funding Source; Gay Men; Models, Theoretical; Male; Pretest-Posttest Design; Descriptive Statistics; Coefficient Alpha; Self Report; Adolescence; Adult; Middle Age; Mental Disorders; Confidence Intervals; P-Value; Health Services Accessibility; Convenience Sample; Questionnaires; Attitude Measures; Scales

Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000-2017, USA. - Durham, Marcus D.; Armon, Carl; Mahnken, Jonathan D.; Novak, Richard M.; Palella, Frank J.; Tedaldi, Ellen; Buchacz, Kate; Palella, Frank J Jr (Preventive Medicine, 2020)
Background: Suicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement.Methods: Using clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses.Results: Among 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4 years [IQR: 38.7-50.3], median (IQR) CD4+ cell count was 439 cells/mm3 (IQR: 237-686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50 years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36-2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29-2.38), have CD4+ cell count <350 cells/mm3 (aRR 1.32; 95%CI 1.05-1.65), have a viral load ≥50 copies/mL (aRR 1.49; 95%CI 1.12-1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10-1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67-4.52), and drug overdose (aRR 4.09; 95%CI 2.16-7.71).Conclusion: Routine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions.

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

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

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

Correlates of Cutting Behavior among Sexual Minority Youths and Young Adults. - Walls, N. Eugene; Laser, Julie; Nickels, Sarah J.; Wisneski, Hope (Social Work Research, 2010)
Using secondary analyses of data from a sample of 265 sexual minority youths, the authors examined correlates of cutting behavior to determine whether patterns are similar to those found in studies of self-injury with community samples of predominately heterosexual youths. The sample consisted of youths who received services at an urban social service agency serving the sexual minority community; youths from the region attending social events, who located the survey through the Internet, or who were referred from other youth-serving agencies; and youths from out of state who found the survey through the Internet or were referred by youth-serving agencies. Prevalence of cutting was higher than that found in community-based samples of similar age groups. However, similar patterns of risk were found with regard to peer victimization, homelessness, suicidality, and depression. Female and transgender respondents were more likely to have engaged in cutting behavior than were male respondents. No significant race-based differences emerged. Both age and having knowledge of a supportive adult were associated with decreased likelihood of cutting. Additional findings link higher levels of "outness," higher occurrence of suicidality among social network, and higher rates of smoking to increased likelihood of cutting. Implications for practice and future research are discussed.
Keywords: Young Adult; LGBTQ+ Persons -- In Adolescence; LGBTQ+ Persons -- In Adulthood; Self-Injurious Behavior -- In Adolescence; Self-Injurious Behavior -- In Adulthood; Human; Secondary Analysis; Surveys; Violence; Suicidal Ideation; Depression; Female; Male; Adolescence; Homelessness; Adult; Social Networks; Colorado; Chi Square Test; Univariate Statistics; Descriptive Statistics; Minority Groups; Inferential Statistics; Logistic Regression; Substance Abuse; Suicide, Attempted; Sex Factors; Age Factors; Social Work, Psychiatric; Mental Health

Suicide and HIV as leading causes of death among gay and bisexual men: a comparison of estimated mortality and published research. - Hottes, Travis Salway; Ferlatte, Olivier; Gesink, Dionne (Critical Public Health, 2015)
Gay and bisexual men experience numerous health disparities relative to heterosexual men, including high rates of HIV and suicidal behavior. Systematic community health assessments could provide direct comparisons of the burden of mortality across diseases and thus facilitate the prioritization of public health activities; however, such assessments have been precluded by the absence of sexual orientation information in vital statistics records. In this context, we used population attributable fraction to derive and compareindirectestimates of mortality for both HIV and suicide. Assuming that 2% of Canadian men are gay or bisexual, and that these men are 42 times more likely to die from HIV and 4 times more likely to die from suicide, we estimated that in 2011, suicide resulted in 46 deaths per 100,000 gay and bisexual men, while HIV resulted in 30 deaths per 100,000. Based on these estimates, suicide surpassed HIV as a leading cause of premature mortality for gay and bisexual men in 2007. Despite the large burden of suicide among gay and bisexual men, research attending to the issue in biomedical, psychology, and social science literatures is sparse, with at least 10 times fewer citations than for HIV between 2003 and 2012. We urge researchers, practitioners, and community leaders to broaden the scope of gay and bisexual men’s public health priorities to include suicide and other high burden health inequities.
Keywords: Gay Men; Bisexuality; HIV Infections -- Mortality; Suicide -- Mortality; Human; Male; Canada; Descriptive Statistics; Healthcare Disparities; Vital Statistics; Databases; Mathematics; Sensitivity and Specificity; Chi Square Test; Relative Risk; P-Value; Comparative Studies; Reference Databases, Health

Clinician competencies: Strengths and limitations for work with transgender and gender non-conforming (TGNC) clients. - Whitman, Chassitty N.; Han, Heather (International Journal of Transgenderism, 2017)
Individuals who identify as transgender or gender nonconforming (TGNC) face a number of health disparities compared to individuals who identify as cisgender (those who self-identify with the sex they were assigned at birth). For example, TGNC individuals experience heightened rates of clinical depression, anxiety, general psychological distress, suicidal ideation, and suicide attempts. Despite these troubling disparities, many TGNC individuals report hesitance to seek mental health services due to concerns regarding culturally insensitive or even overtly discriminatory services from providers. In addition to decreasing service utilization among TGNC populations, discriminatory services impair intervention effectiveness even when TGNC individuals persist in seeking mental health services. The American Psychological Association (APA) and the World Professional Association for Transgender Health (WPATH) provide guidelines for culturally competent work with TGNC clients; however, research indicates a profound lack of TGNC-specific training and resources among mental health care providers. To address this gap, the present investigation utilized a mixed-method design to assess training experiences, understanding of terminology, and TGNC competence among mental health care providers at various training levels. Participants were current mental health clinicians across the United States. Implications for improving reported and demonstrated weaknesses are discussed.
Keywords: Transgender Persons -- Psychosocial Factors; Transcultural Care; Clinical Competence; Professional-Patient Relations; Human; Male; Female; Attitude to Sexuality; Help Seeking Behavior; Mental Health Services; Mental Disorders -- Therapy

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

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

Help Seeking and Treatment Use Among Suicidal College Students. - Downs, Marilyn F.; Eisenberg, Daniel (Journal of American College Health, 2012)
Objectives: Many suicidal college students do not receive mental health treatment, and the reasons for this are not fully understood. This study examines how attitudes, beliefs, and social network factors relate to help seeking among suicidal students. Participants: A random sample of 8,487 undergraduate and graduate students from 15 US universities participated. Methods: A Web-based survey administered in spring 2009 examined correlates of mental health service utilization among students reporting serious thoughts of suicide in the previous year (n = 543). Results: Correlates of treatment use included perceived need, beliefs that treatment is effective, contact with service users, lower personal stigma, higher perceived stigma, fewer positive relationships, and sexual minority or Caucasian identity. Conclusions: Help seeking among suicidal students is associated with a range of personal and social network factors. Campus strategies to enhance help seeking should be tailored to address identified facilitators and barriers to treatment use among target populations.
Keywords: Help Seeking Behavior; Students, Undergraduate -- United States; Suicidal Ideation; Mental Health Services -- Utilization; Human; Random Sample; United States; Internet; Students, Graduate; Surveys; Correlational Studies; Health Beliefs; Stigma; White Persons; Social Networks; Questionnaires; Comparative Studies; T-Tests; Descriptive Statistics; Logistic Regression; Odds Ratio; Confidence Intervals

Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults. - Katz-Wise, Sabra; Reisner, Sari; White Hughto, Jaclyn; Budge, Stephanie; Katz-Wise, Sabra L; Reisner, Sari L; White Hughto, Jaclyn M; Budge, Stephanie L (Archives of Sexual Behavior, 2017)
This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and 95 % confidence intervals to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all ps < .05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals.
Keywords: Sexuality; Mental Health; Transsexualism -- Psychosocial Factors; Female; Aged; Odds Ratio; Logistic Regression; Adult; Depression -- Epidemiology; Middle Age; Self Report; Male; Gender Identity; Center for Epidemiological Studies Depression Scale; Funding Source; Psychological Tests; Human

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

Psychopharmacotherapy of Severe Self-injury in an Adolescent with Gender Dysphoria and Comorbidity. - Rice, Timothy; Kufert, Yael; Walther, Andreas; Feldman, Elyana; Garcia-Delgar, Blanca; Coffey, Barbara J.; Garcia-Delgar, Bianca (Journal of Child & Adolescent Psychopharmacology, 2016)
The article presents a case study of a 16-year-old adolescent transgender girl with Gender dysphoria that leads to self-injury. Topics include involvement of adult transgender in suicidal attempts, observation of increment in substance use disorders among transgender youth, addressal of comorbid depression in the patient through selective serotonin reuptake inhibitor, illustration of neuroleptics addition in antidepressants and utilization of sertraline monotherapy as treatment process.
Keywords: Self-Injurious Behavior -- Therapy; Self-Injurious Behavior -- Psychosocial Factors; Comorbidity; Adolescence; Male; Self-Injurious Behavior -- Etiology; Female; Questionnaires

Identity, Relationship Satisfaction, and Disclosure. - Velkoff, Elizabeth A.; Forrest, Lauren N.; Dodd, Dorian R.; Smith, April R. (Psychology of Women Quarterly, 2016)
We tested the usefulness of combining the Interpersonal–Psychological Theory of Suicide and minority stress models in studying suicidality among sexual minority women. According to the Interpersonal–Psychological Theory of Suicide, perceptions of being a burden on others and feelings of failed belongingness predict suicidal ideation. In a sample of sexual minority women (n = 51), we tested first, if the interaction of perceived burdensomeness and failed belongingness predicted lifetime suicidal behavior; second, if identity affirmation was negatively related to perceived burdensomeness and if this relation was moderated by disclosure; and third, if relationship satisfaction was negatively related to failed belongingness and if this relation was moderated by acceptance concerns. The proposed interaction of perceived burdensomeness and failed belongingness predicted lifetime suicide attempts. Moreover, among sexual minority women with greater disclosure of their sexual minority identities, low identity affirmation was related to higher perceived burdensomeness. For sexual minority women with high acceptance concerns, relationship satisfaction did not relate to lower feelings of failed belongingness. These findings suggest that sexual minority related stressors moderate risk factors for suicidality—in particular, perceptions of burdensomeness and failed belongingness. We suggest clinicians and others encourage sexual minority individuals to engage in activities that promote effectiveness and interpersonal closeness. Online slides for instructors who want to use this article for teaching are available to PWQ subscribers on PWQ's website at http://pwq.sagepub.com/supplemental
Keywords: Women; Sexuality; LGBTQ+ Persons; Suicide -- Risk Factors; Risk Assessment; Human; Female; Psychological Theory; Models, Theoretical; Convenience Sample; Power Analysis; Lesbians; Young Adult; Adult; Middle Age; Scales; Questionnaires; Confidence Intervals; Regression

The Case for the World Health Organization's Commission on the Social Determinants of Health to Address Sexual Orientation. - Logie, Carmen (American Journal of Public Health, 2012)
Keywords: World Health Organization; Health Status Disparities; LGBTQ+ Persons; Minority Groups; Stigma; Discrimination; Mental Disorders -- Risk Factors; Suicide -- Risk Factors; Conceptual Framework

Predictors of suicidal ideation among active duty military personnel with posttraumatic stress disorder. - McLean, Carmen P.; Zang, Yinyin; Zandberg, Laurie; Bryan, Craig J.; Gay, Natalie; Yarvis, Jeffrey S.; Foa, Edna B.; STRONG STAR Consortium (Journal of Affective Disorders, 2017)
Background: Given the alarming rate of military suicides, it is critical to identify the factors that increase risk of suicidal thoughts and behaviors among active duty military personnel.Methods: This study examined a predictive model of suicidal ideation among 366 treatment-seeking active duty military personnel with posttraumatic stress disorder (PTSD) following deployments to or near Iraq or Afghanistan. Structural equation modeling was employed to examine the relative contribution of combat exposure, social support, PTSD severity, depressive symptoms, guilt, and trauma-related cognitions on suicidal ideation.Results: The final structural equation model had a highly satisfactory fit [χ2 (2) =2.023, p=.364; RMSEA =.006; CFI =1; GFI =.998]. PTSD severity had an indirect effect on suicidal ideation via trauma-related cognitions. Depression had a direct positive effect on suicidal ideation; it also had an indirect effect via trauma-related cognitions and interpersonal support. Among participants who had made a previous suicide attempt, only depression symptom severity was significantly linked to suicidal ideation.Limitations: Data are cross-sectional, precluding causal interpretations. Findings may only generalize to treatment seeking active duty military personnel with PTSD reporting no more than moderate suicidal ideation.Conclusions: These findings suggest that depression and trauma-related cognitions, particularly negative thoughts about the self, play an important role in suicidal ideation among active duty military personnel with PTSD. Negative cognitions about the self and interpersonal support may be important targets for intervention to decrease suicidal ideation.
Keywords: Stress Disorders, Post-Traumatic -- Psychosocial Factors; Military Personnel -- Psychosocial Factors; Suicidal Ideation; Cross Sectional Studies; Male; United States; Adult; Middle East; Suicide, Attempted -- Psychosocial Factors; Female; Depression -- Psychosocial Factors; Risk Factors; Human

Self-Harm and Suicidality in Children Referred for Gender Dysphoria. - Aitken, Madison; VanderLaan, Doug P.; Wasserman, Lori; Stojanovski, Sonja; Zucker, Kenneth J. (Journal of the American Academy of Child & Adolescent Psychiatry, 2016)
Objective: This study examined rates of self-harm and suicidality (ideation and behavior) in children referred clinically for gender dysphoria compared with their siblings, and referred and nonreferred children from the Child Behavior Checklist (CBCL) standardization sample. Predictors or correlates of self-harm/suicidality were also examined.Method: The sample consisted of 572 gender-referred children, 425 siblings, 878 referred children, and 903 nonreferred children. Parent report for 2 CBCL items was used to assess self-harm and suicidality. CBCL total behavior problems and a metric of peer relationship problems were also used.Results: The gender-referred children and the referred children from the standardization sample had significantly higher scores than siblings and nonreferred children in terms of self-harm/suicidality, total behavior problems, and poor peer relations. Based on logistic regression analyses, gender-referred children were 5.1 times more likely than nonreferred children to talk about suicide and 8.6 times more likely to self-harm/attempt suicide, even after overall behavior problems and peer relationship problems were accounted for. In the final models, group, older age, and more total behavior problems, but not poor peer relations, were significantly associated with an increased likelihood of self-harm/suicidality.Conclusion: By parent report, children with gender dysphoria show an increased rate of self-harm/suicidality as they get older. This risk was not simply an artifact of the presence of behavioral and emotional problems, although these problems were significant correlates of self-harm/suicidality. Clinicians should routinely screen for the presence of suicidal ideation and behavior in children with gender dysphoria, particularly during the second half of childhood.
Keywords: Suicidal Ideation; Child Behavior; Suicide, Attempted; Child; Male; Child, Preschool; Female; Child Behavior Checklist; Funding Source; Checklists

Comparing Health and Mental Health Needs, Service Use, and Barriers to Services among Sexual Minority Youths and Their Peers. - Williams, Kelly A.; Chapman, Mimi V. (Health & Social Work, 2011)
Using a representative national sample (N = 20,745), this article explores health and mental health needs, service use, and barriers to services among sexual minority youths (SMYs) and heterosexual peers. SMYs were defined by ever having a same-sex romantic attraction or having a recent same-sex romantic relationship or sexual partner. SMYs accounted for 7.5 percent of the sample. Data were analyzed to ascertain prevalence of risks and explore group differences. Compared with peers, SMY self-reports indicated higher prevalence rates on all indicators of health and mental health need. SMYs reported more sexual activity, more sexually transmitted disease diagnoses, a higher perceived risk for HIV/AIDS, and more forgone medical care than peers. Also compared with peers, SMYs reported higher levels of anxiety, depression, suicidality, and physical and sexual victimization and higher rates of unmet mental health need. SMYs also reported greater concerns about confidentiality and were less likely to use school-based services. The majority of SMYs reported same-sex attraction only. Social work and other helping professionals should incorporate same-sex attraction questions into assessment protocols to target services for this population. School- and office-based providers must consider whether their services are welcoming and offer sufficient assurances of confidentiality to facilitate access by SMYs.
Keywords: Minority Groups -- In Adolescence; Health Services Needs and Demand -- In Adolescence; Mental Health Services -- Utilization -- In Adolescence; Health Services Accessibility -- In Adolescence; Gay Persons -- In Adolescence; Medical Care -- Utilization -- In Adolescence; Peer Group; Self Report; Prevalence; Sexuality; Sexually Transmitted Diseases; Privacy and Confidentiality; Social Work; Help Seeking Behavior; Human; Secondary Analysis; Interviews; Female; Male; Child; Adolescence; Center for Epidemiological Studies Depression Scale; Questionnaires; Scales; Risk Factors; Data Analysis Software; Surveys; Chi Square Test

Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia. - Saewyc EM; Poon CS; Homma Y; Skay CL (Canadian Journal of Human Sexuality, 2008)
Over the past decade, several large-scale school-based studies of adolescents in Canada and the U.S. have documented health disparities for lesbian, gay and bisexual teens compared to their heterosexual peers, such as higher rates of suicide attempts, homelessness, and substance use. Many of these disparities have been linked to 'enacted stigma,' or the higher rates of harassment, discrimination, and sexual or physical violence that sexual minority youth experience at home, at school, and in the community. An unexpected health disparity for lesbian, gay and bisexual youth is their significantly higher risk of teen pregnancy involvement (between two and seven times the rate of their heterosexual peers), especially in light of declining trends in teen pregnancy across North America since the early 1990s. What is behind this higher risk? Is it getting better or worse? Using the province-wide cluster-stratified British Columbia Adolescent Health Surveys from 1992, 1998, and 2003, this paper explores the trends in pregnancy involvement, related sexual behaviours, and exposure to forms of enacted stigma that may help explain this particular health disparity for gay, lesbian and bisexual youth in Canada.
Keywords: LGBTQ+ Persons; Pregnancy in Adolescence -- Trends -- British Columbia; Stigma; Adolescence; British Columbia; Chi Square Test; Descriptive Statistics; Female; Funding Source; Health Behavior; Male; Odds Ratio; Pregnancy; Prevalence; Prospective Studies -- British Columbia; Risk Taking Behavior; Secondary Analysis; Self Report; T-Tests; Human

Mental health of sexual minorities. A systematic review. - Plöderl, Martin; Tremblay, Pierre (International Review of Psychiatry, 2015)
Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Mental Health; Mental Disorders -- Risk Factors; Depression -- Risk Factors; Anxiety -- Risk Factors; Suicide -- Risk Factors; Suicide, Attempted -- Risk Factors; Substance Abuse -- Risk Factors; Human; Systematic Review; PubMed; Female; Male; Adolescence; Geographic Locations; Lesbians; Gay Men; Bisexuals; Descriptive Statistics; Effect Size; Sex Factors; Adult

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

Mental health and suicidal ideation among Chinese women who have sex with men who have sex with men (MSM). - Li, Xianhong; Zhang, Beichuan; Li, Yang; Antonio, Anna Liza Malazarte; Chen, Yunliang; Williams, Ann Bartley (Women & Health, 2016)
In China, men who have sex with men (MSM) are the fastest growing population at risk for HIV. They face social stigma due to both MSM behavior and HIV. In addition, concern has been raised about the mental health of wives of MSM. In this cross-sectional study, the authors examine the mental health status of a sample of 135 of these women. Participants completed an Internet-administered questionnaire in Xi’an from April to June, 2012. Most were unaware at the time of marriage that their husbands were MSM. Physical abuse was frequently reported; depressive symptom and mental health (Symptom Checklist, SCL–90) scores were significantly higher than those of the general Chinese adult female population. A majority (59.8%) of women reported suicidal thoughts after discovering their husbands’ MSM behavior; about 10% had attempted suicide. Multiple logistic regression revealed that women’s experience with anal sex was associated with 7.8 times (95% CI: 1.3–65.9) greater odds of suicidal ideation. Also, women who demonstrated mental symptoms on the SCL–90 had 2.3 times (95% CI: 1.04–5.2) the odds of suicidal ideation. These results suggest that wives of MSM have a significant need for mental health care, suicide prevention, HIV education, and social support.
Keywords: Mental Health -- Evaluation -- China; Suicidal Ideation -- In Adulthood -- China; Married Women -- Psychosocial Factors -- China; Spouses -- Psychosocial Factors; Men Who Have Sex With Men -- China; China; Human Immunodeficiency Virus; Cross Sectional Studies; Questionnaires; Domestic Violence; Descriptive Statistics; Data Analysis Software; Depression; Checklists; Suicide, Attempted; Multiple Logistic Regression; Anal Intercourse; Confidence Intervals; HIV Education; Support, Psychosocial; Adult; Human; Female; Young Adult; Middle Age

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

Risky Sexual Behaviors as Correlates of Depression and Suicidal Ideation Among Male HIV Test-Seekers at a Voluntary Counseling and Testing Facility in Taiwan. - Lin, Chia-Chun; Lee, Yuan-Ti; Yang, Hao-Jan (Asia-Pacific Journal of Public Health, 2017)
This study aims at determining the level of depression and suicidal status of adult HIV test-seekers. Of the total enrolled 850 males, almost 50% reported some risk behaviors, 38.9% experienced depression, and 7.2% had suicidal ideation. Subjects with risky sexual behaviors in terms of repeated HIV test, had a history of sexually transmitted disease, engaged in one-night stands, or did not use condoms all the time with causal sexual partners were more likely to have depression. Furthermore, subjects who were bisexual/homosexual, engaged in Internet sex, engaged in one-night stands, or used addictive drugs within the past 6 months were more likely to experience suicidal ideation. The HIV testers are at risk of experiencing depression and suicidal ideation; each is associated with different types of risky sexual behaviors. It is essential for the health authority to further provide mental health services for HIV testers and to draw up an effective strategy in reducing unprotected sexual behaviors.
Keywords: Sexual Partners; Sexually Transmitted Diseases -- Risk Factors; Bisexuality; Mental Health Services; Sexually Transmitted Diseases; Human Immunodeficiency Virus; Taiwan; Human; Male; Depression; Suicidal Ideation; Psychological Tests; HIV Infections -- Diagnosis

Initial Assessment and Screening with LGBTQ Clients: A Critical Perspective. - Moe, Jeffry L.; Finnerty, Peter; Sparkman, Narketta; Yates, Chad (Journal of LGBT Issues in Counseling, 2015)
Counseling with people that identify as lesbian, gay, bisexual, transgender, queer (LGBTQ), or who are otherwise nonheterosexual or cisgender identified, should be based on a critical approach to assessment. Although general competencies have been articulated, further guidance is needed to help counselors avoid hetero-normative and cisgender biases in their assessment practice. The authors provide recommendations, based on critical review of the literature, for how counselors can address biases in assessment and screening tools in work with LGBTQ clients.
Keywords: Patient Assessment -- Methods; LGBTQ+ Persons -- Psychosocial Factors -- United States; Prejudice -- Prevention and Control; Counselors -- Psychosocial Factors; Social Justice; Professional Competence; Critical Theory; Professional-Client Relations; Self Disclosure; Gender Identity; Attitude to Sexuality; Suicide, Attempted -- Risk Factors; Suicidal Ideation -- Risk Factors; Substance Abuse -- Evaluation; Scales; Psychological Tests; Intimate Partner Violence -- Evaluation; Questionnaires; United States; Education, Continuing (Credit)

The Relationship Between Sexual History, Bullying Victimization, and Poor Mental Health Outcomes Among Heterosexual and Sexual Minority High School Students: A Feminist Perspective. - Dunn, Hailee K.; Clark, Melissa A.; Pearlman, Deborah N. (Journal of Interpersonal Violence, 2017)
This study uses a feminist theoretical framework to extend the literature on the relationship between sexual history, bullying victimization, and poor mental health outcomes. First, we examined whether an association between the sexual double standard and bullying victimization would apply to sexual minority youth the same way it applies to heterosexual youth. A second aim was to assess whether sexual minority boys, typically stereotyped as effeminate, would report the highest odds of bullying victimization. A third and final aim of our study was to look at the joint effect of sex and sexual intercourse on depression and suicidal ideation. Our analytic sample (N = 9,300) was from the 2009, 2011, and 2013 Rhode Island Youth Risk Behavior Surveys. Findings demonstrated that heterosexual girls who engaged in sexual intercourse had significantly higher adjusted odds of bullying victimization than heterosexual boys who engaged in the same behavior. Similar results were not found for sexual minority adolescents, suggesting the sexual double standard may not apply to sexual minority adolescents in the same way it applies to heterosexual adolescents. Consistent with our second hypothesis, sexual minority boys reported the highest odds of being recently bullied compared with heterosexual boys. Among students who were recently bullied, sexual minority girls displayed the highest adjusted odds of recent depression and suicidal ideation. Our study demonstrated that using a feminist theoretical framework broadens our understanding of why girls and sexual minority boys are particularly vulnerable to bullying victimization and the sequel of depression and suicidal ideation.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Heterosexuals -- Psychosocial Factors; Sexuality -- In Adolescence; Mental Health -- In Adolescence; Bullying -- Psychosocial Factors -- In Adolescence; Students, High School -- Rhode Island; Secondary Analysis; Human; Female; Male; Descriptive Statistics; Data Analysis Software; P-Value; Multiple Logistic Regression; Confidence Intervals; Odds Ratio; Feminism; Conceptual Framework; Models, Theoretical; Sex Factors; Depression -- Risk Factors; Suicidal Ideation -- Risk Factors; Adolescence; Rhode Island

Bisexual People's Experiences with Mental Health Services: A Qualitative Investigation. - Eady, A.; Dobinson, C.; Ross, L. (Community Mental Health Journal, 2011)
Bisexual people experience minority stress and social isolation as a result of their marginalized sexual identities, and likely due to this stigmatization, previous research has identified high rates of psychological distress, anxiety, depression, suicidality, alcohol misuse, and self-harming behaviour among bisexual populations. It is therefore important that mental health service providers are able to provide culturally competent care to bisexual people. This study used focus groups and interviews with 55 bisexual participants across the province of Ontario, Canada, to investigate their experiences with mental health care. Results suggest that bisexual people have both positive and negative experiences with mental health service providers. Specific provider practices which contribute to the perception of positive and negative experiences with mental heath services are described, and the implications for clinical practice discussed.
Keywords: Mental Health Services; Bisexuality; Attitude to Sexuality; Health Services Accessibility; Patient Satisfaction; Stress, Psychological; Qualitative Studies; Human; Ontario; Interviews; Focus Groups; Male; Female; Adolescence; Young Adult; Adult; Middle Age; Aged; Questionnaires; Audiorecording; Descriptive Statistics; Thematic Analysis; Funding Source

Experiences of harassment, discrimination, and physical violence among young gay and bisexual men. - Huebner DM; Rebchook GM; Kegeles SM (American Journal of Public Health, 2004)
OBJECTIVES: We examined the 6-month cumulative incidence of anti-gay harassment, discrimination, and violence among young gay/bisexual men and documented their associations with mental health. METHODS: Gay/bisexual men from 3 cities in the southwestern United States completed self-administered questionnaires. RESULTS: Thirty-seven percent of men reported experiencing anti-gay verbal harassment in the previous 6 months; 11.2% reported discrimination, and 4.8% reported physical violence. Men were more likely to report these experiences if they were younger, were more open in disclosing their sexual orientation to others, and were HIV positive. Reports of mistreatment were associated with lower self-esteem and increased suicidal ideation. CONCLUSIONS: Absent policies preventing anti-gay mistreatment, empowerment and community-building programs are needed for young gay/bisexual men to both create safe social settings and help them cope with the psychological effects of these events.
Keywords: Bisexuals -- Psychosocial Factors; Discrimination; Gay Men -- Psychosocial Factors; Life Experiences; Verbal Abuse; Violence; Adult; Age Factors; Arizona; Bisexuality; Coefficient Alpha; Confidence Intervals; Cross Sectional Studies; Funding Source; HIV Infections; Homosexuality; Incidence; Logistic Regression; Male; Multiple Regression; New Mexico; Odds Ratio; P-Value; Psychological Tests; Questionnaires; Rosenberg Self Esteem Scale; Self Concept; Self Report; Suicidal Ideation; Summated Rating Scaling; Texas; Human

Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people. - Kattari, Shanna K.; Walls, N. Eugene; Speer, Stephanie Rachel; Kattari, Leonardo (Social Work in Health Care, 2016)
Using a statewide survey of transgender and gender variant individuals (N = 417), this study examines the association between having a transgender-inclusive provider and three mental health concerns: current experience of depression, lifetime experience of anxiety disorder, and suicidality within the last year. Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality, but not with lifetime experience of having anxiety. Implications for future research and education of providers are discussed.
Keywords: Transgender Persons -- Psychosocial Factors; Mental Health Services; Healthcare Disparities; Health Services Accessibility; Human; Surveys; Cultural Competence; Anxiety Disorders; Depression; Suicidal Ideation; Discrimination; Secondary Analysis; Colorado; Descriptive Statistics; Chi Square Test; Logistic Regression; Sample Size; Male; Female; Educational Status; Adult; P-Value; Variable; Mental Health; Confidence Intervals; Odds Ratio

Minority stress in lesbian, gay, and bisexual young adults in australia: associations with psychological distress, suicidality, and substance use. - Lea, Toby; de Wit, John; Reynolds, Robert (Archives of Sexual Behavior, 2014)
Keywords: Bisexuality; Heterosexuality; Lesbians -- Psychosocial Factors; Homosexuality; Stress, Psychological -- Psychosocial Factors; Substance Use Disorders -- Epidemiology; Suicide -- Psychosocial Factors; Adolescence; Adult; Anxiety Disorders; Australia; Depression; Female; Gender Identity; Homophobia; Human; Logistic Regression; Male; Minority Groups -- Psychosocial Factors; Minority Groups -- Statistics and Numerical Data; Multivariate Analysis; Prejudice; Perception; Suicide; Young Adult

Oscar Pistorius: disability discourses in homosexual forums. - Brennan, Joseph (Disability & Society, 2017)
This article performs textual analysis of discourse on Oscar Pistorius that appears on the homosexual discussion forums DataLounge and JustUsBoys. ‘Before’ and ‘after’ discourses – divided by Pistorius’s 2013 fatal shooting of his girlfriend – read Pistorius and his crime along sexuality and disability lines. I argue that it is worthwhile analysing how disability is constructed from different positions of marginalisation, especially when this at times yields discriminatory narratives. Pistorius, his disability, and his infamy are read by a community that itself exists outside the realm of mainstream debate, offering insight into disability and (homo)sexuality, adding greater dimension to ‘intersectional’ approaches to both.
Keywords: Disabled; Discourse Analysis; Homosexuality; Public Figures; Discussion; Crime; Debates and Debating

Sexual orientation and risk factors for suicidal ideation and suicide attempts among adolescents and young adults. - Silenzio VM; Pena JB; Duberstein PR; Cerel J; Knox KL (American Journal of Public Health, 2007)
Same-gender sexual orientation has been repeatedly shown to exert an independent influence on suicidal ideation and suicide attempts, suggesting that risk factors and markers may differ in relative importance between lesbian, gay, and bisexual individuals and others. Analyses of recent data from the National Longitudinal Study of Adolescent Health revealed that lesbian, gay, and bisexual respondents reported higher rates of suicidal ideation and suicide attempts than did heterosexual respondents and that drug use and depression were associated with adverse outcomes among heterosexual respondents but not among lesbian, gay, and bisexual respondents.
Keywords: Adolescent Behavior -- Ethnology; Bisexuality -- Ethnology; Bisexuality; Heterosexuality -- Ethnology; Heterosexuality; Homosexuality -- Ethnology; Homosexuality; Suicide, Attempted; Adolescence; Adult; Depression -- Epidemiology; Female; Lesbians -- Psychosocial Factors; Lesbians; Male; Odds Ratio; Prospective Studies; Risk Factors; Substance Use Disorders -- Epidemiology; Suicide, Attempted -- Ethnology; United States; Human

The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample. - Trujillo, Michael A.; Perrin, Paul B.; Sutter, Megan; Tabaac, Ariella; Benotsch, Eric G. (International Journal of Transgenderism, 2017)
Introduction: Per the minority stress framework, trans individuals often experience psychological distress given the unique stress engendered by gender identity–related discrimination. Prior research has identified social support as particularly important for psychological distress and has suggested that social support may moderate this relationship. The purpose of the current study was to explore the patterns of connections among discrimination, mental health, and suicidal ideation in trans individuals and whether social support moderates these relationships. Methods: Participants (N = 78) completed measures of these constructs as part of a national online survey. Results: A series of simultaneous multiple regressions found that harassment/rejection discrimination was a unique positive predictor of mental health symptoms and suicidal ideation, with depression positively predicting suicidal ideation. A mediational model indicated that the association between harassment/rejection discrimination and suicidal ideation was fully mediated by depression. Three moderated meditational models were run, and one yielded a significant interaction, such that discrimination predicted suicidal ideation most strongly when participants had low social support from a significant other in comparison to participants who had moderate or high support. Further, conditional direct effects identified that discrimination led to ideation only for individuals with low support from friends or a significant other but not for those with moderate or high support. Conclusions: Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population.
Keywords: Transgender Persons -- Psychosocial Factors; Support, Psychosocial; Mental Health; Human; Surveys; Multiple Regression; Suicidal Ideation; Discrimination; Minority Stress; Depression; Descriptive Statistics; Data Analysis Software

Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care. - Bukowski, Leigh A.; Blosnich, John; Shipherd, Jillian C.; Kauth, Michael R.; Brown, George R.; Gordon, Adam J. (Medical Care, 2017)
Objectives: Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses.Methods: This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions.Results: Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest.Conclusions: This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.
Keywords: Healthcare Disparities; Veterans -- Psychosocial Factors; Rural Population; United States Department of Veterans Affairs; Substance Use Disorders -- Diagnosis; Retrospective Design; Stress Disorders, Post-Traumatic -- Diagnosis; Human; United States; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires

Comprehensive Screening for Suicide Risk in Primary Care. - Diamond, Guy S.; Herres, Joanna L.; Krauthamer Ewing, E. Stephanie; Atte, Tita O.; Scott, Syreeta W.; Wintersteen, Matt B.; Gallop, Robert J. (American Journal of Preventive Medicine, 2017)
Introduction: Suicide is a major public health problem and a complex clinical challenge. Assessment and early identification could be enhanced with screening tools that look beyond depression. The purpose of this study was to identify profiles of risk behaviors and social stress associated with suicidal ideation and behavior using the Behavioral Health Screen.Methods: The study used screening data from 2,513 primary care patients (aged 14-24 years). Data were collected between 2008 and 2012, and were analyzed in 2016.Results: Latent class analysis identified a high and low risk profile. Domains of primary influence included substance use, sexual assault, same-sex behavior, and unsafe sex. The high-risk group was 11 times more likely to have made a suicide attempt, five times more likely to report a history of suicidal ideation and behavior, and three times more likely to report recent suicidal ideation and behavior.Conclusions: Risk behaviors and social stress contribute to the risk for suicide above and beyond depression and should be assessed during routine primary care visits with adolescents. The Behavioral Health Screen can screen all these domains and thus assist primary care providers in assessing for both psychiatric and social stress factors associated with youth suicide.
Keywords: Suicide -- Prevention and Control; Primary Health Care -- Methods; Substance Use Disorders -- Diagnosis; Depression -- Diagnosis; Stress, Psychological -- Diagnosis; Female; Risk Assessment -- Methods; Substance Use Disorders -- Psychosocial Factors; Risk Factors; Young Adult; Stress, Psychological -- Psychosocial Factors; Behavioral Sciences -- Methods; Depression -- Psychosocial Factors; Self-Injurious Behavior; Sexuality; Suicide -- Psychosocial Factors; Violence -- Psychosocial Factors; Adolescence; Male; Adult; Human

Suicidal ideation and attempts among sexual minority youths receiving social services. - Walls NE; Freedenthal S; Wisneski H (Social Work, 2008)
The increased risk of suicidal ideation and attempts among sexual minority youths have been documented in studies using both convenience samples and representative community samples. However, as most youths do not access social services, these studies do not necessarily represent the sexual minority youths that community-based social workers may encounter in their day-to-day practice. As such, the present study on risk and protective factors related to suicidality surveyed 182 sexual minority youths (14 to 21 years of age) who sought assistance at a community-based social services agency in Denver. Similar to existing literature, the findings suggest that risk factors related to suicidality include hopelessness, methamphetamine use, homelessness, and in-school victimization. However, unlike studies of the general youth population, this study found that African American and male sexual minority youths were not at a lower risk of suicidality than sexual minority youths who were, respectively, white or female. In addition, our findings suggest that the presence of gay-straight alliances in schools may function as a protective resource for sexual minority youths. Implications for social work practice are discussed.
Keywords: LGBTQ+ Persons -- In Adolescence; Minority Groups -- In Adolescence; Suicidal Ideation -- Risk Factors -- In Adolescence; Suicide, Attempted -- Risk Factors -- In Adolescence; Adolescence; Adult; Black Persons; Colorado; Community Health Services; Descriptive Statistics; Female; Homelessness; Hopelessness; Logistic Regression; Male; Questionnaires; Race Factors; School Violence; Self Disclosure; Sex Factors; Sexuality; Social Work; Substance Abuse; Surveys; White Persons; Human

Difference-in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts. - Raifman, Julia; Moscoe, Ellen; Austin, S. Bryn; McConnell, Margaret (JAMA Pediatrics, 2017)
Keywords: Marriage; Gay Persons; Suicide -- In Adolescence; Human; Adolescence; Record Review; Students, High School; State Government -- United States; United States; Female; Male; Confidence Intervals; P-Value; Linear Regression

Risk factors for suicide among gay, lesbian, and bisexual youths. - Proctor CD; Groze VK (Social Work, 1994)
The study described in this article explores risk factors for suicide among gay, lesbian, and bisexual youths. A convenience sample of 221 self-identified gay, lesbian, and bisexual youths who attended youth groups across the United States and Canada were given the Adolescent Health Questionnaire, which assessed family issues, the social environment, and self-perceptions. The youths' scores were significantly associated with suicidal ideation and attempts. Implications for social services are discussed.
Keywords: Suicidal Ideation -- In Adolescence; Suicide, Attempted -- In Adolescence; Gay Persons; Risk Factors; Exploratory Research; Psychological Tests; Summated Rating Scaling; Surveys; Sampling Methods; Discriminant Analysis; Self Concept; Family Relations; Social Environment; Urban Areas; Peer Group; Support, Psychosocial; Adolescence; Male; Female; Human

Out yonder: sexual-minority adolescents in rural communities in British Columbia. - Poon CS; Saewyc EM (American Journal of Public Health, 2009)
OBJECTIVES: We compared sexual-minority adolescents living in rural communities with their peers in urban areas in British Columbia, exploring differences in emotional health, victimization experiences, sexual behaviors, and substance use. METHODS: We analyzed a population-based sample of self-identified lesbian, gay, or bisexual respondents from the British Columbia Adolescent Health Survey of 2003 (weighted n=6905). We tested rural-urban differences separately by gender with the chi2 test and logistic regressions. RESULTS: We found many similarities and several differences. Rural sexual-minority adolescent boys were more likely than were their urban peers to report suicidal behaviors and pregnancy involvement. Rural sexual-minority adolescents, especially girls, were more likely to report various types of substance use. Rural status was associated with a lower risk of dating violence and higher risk of early sexual debut for sexual-minority girls and a higher risk of dating violence and lower risk of early sexual debut for sexual-minority boys. CONCLUSIONS: Location should be a demographic consideration in monitoring the health of sexual-minority adolescents. Lesbian, gay, and bisexual adolescents in rural communities may need additional support and services as they navigate adolescence.
Keywords: LGBTQ+ Persons; Health Behavior; Rural Areas -- British Columbia; Sexuality -- In Adolescence; Adolescence; British Columbia; Chi Square Test; Comparative Studies; Descriptive Statistics; Female; Funding Source; Logistic Regression; Male; Mental Health; Minority Groups -- Psychosocial Factors; Pregnancy; Pregnancy in Adolescence; Risk Taking Behavior; Secondary Analysis; Sex Factors; Substance Abuse; Suicidal Ideation; Surveys; Victims; Violence; Human

Systematic review of the psychometric properties of transphobia scales. - Morrison, Melanie A.; Bishop, CJ; Gazzola, Stephanie B.; McCutcheon, Jessica M.; Parker, Kandice; Morrison, Todd G. (International Journal of Transgenderism, 2017)
Introduction: Prejudice and discrimination against transgender individuals (i.e., transphobia) is pervasive and has been shown to have pernicious effects on the physical (e.g., substance abuse and other self-harm behaviors) and psychological (e.g., depression and suicidal ideation) well-being of those targeted. Aims: To date, a review of the psychometric properties of scales assessing transphobia has not been conducted; this gap compromises researchers' ability to make informed measurement decisions. Methods: In the current study, 61 articles that contained 83 scales were identified, and their adherence to best practices in psychometric testing was evaluated. Results: Most of the transphobia scales included in the current review did not provide sufficient information about item generation and refinement, scale dimensionality, scale score reliability, or validity. Each scale was entered into a table and was ranked on the basis of its total score. A score of 1 was issued for each psychometric feature that adhered to best practice guidelines, with total scores ranging from 0 to 5 (i.e., higher scores denote greater psychometric soundness). Discussion: Properties of the reviewed scales are summarized and recommendations are made for future transphobia scale development and validation. The measures that emerged as possessing the highest scores and, subsequently, the greatest utility are identified.
Keywords: Scales; Psychometrics -- Evaluation; Discrimination -- Classification; Transgender Persons -- Psychosocial Factors; Prejudice -- Classification; Human; Systematic Review; Reliability and Validity; Practice Guidelines; Instrument Construction; Instrument Validation

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

Gender identity and the management of the transgender patient: a guide for non-specialists. - Joseph, Albert; Cliffe, Charlotte; Hillyard, Miriam; Majeed, Azeem (Journal of the Royal Society of Medicine, 2017)
In this review, we introduce the topic of transgender medicine, aimed at the non-specialist clinician working in the UK. Appropriate terminology is provided alongside practical advice on how to appropriately care for transgender people. We offer a brief theoretical discussion on transgenderism and consider how it relates to broader understandings of both gender and disease. In respect to epidemiology, while it is difficult to assess the exact size of the transgender population in the UK, population surveys suggest a prevalence of between 0.2 and 0.6% in adults, with rates of referrals to gender identity clinics in the UK increasing yearly. We outline the legal framework that protects the rights of transgender people, showing that is not legal for physicians to deny transgender people access to services based on their personal beliefs. Being transgender is often, although not always, associated with gender dysphoria, a potentially disabling condition in which the discordance between a person's natal sex (that assigned to them at birth) and gender identity results in distress, with high associated rates of self-harm, suicidality and functional impairment. We show that gender reassignment can be a safe and effective treatment for gender dysphoria with counselling, exogenous hormones and surgery being the mainstay of treatment. The role of the general practitioner in the management of transgender patients is discussed and we consider whether hormone therapy should be initiated in primary care in the absence of specialist advice, as is suggested by recent General Medical Council guidance.
Keywords: Gender Identity; Transsexualism -- Therapy; Transsexualism -- Epidemiology; Transsexualism -- Psychosocial Factors; Prejudice; Human; Gender Affirmation Procedures -- Methods; Physicians, Family; Female; Male; National Health Programs

Links between past abuse, suicide ideation, and sexual orientation among San Diego college students. - Garcia J; Adams J; Friedman L; East P (Journal of American College Health, 2002)
The authors explored relationships among childhood abuse, suicidal ideation, and sexual orientation of 18- to 30-year-old students enrolled in 2 San Diego area colleges, using responses from anonymous questionnaires. Sixty percent of the 138 eligible respondents were women, and 22% were self-identified gay/bisexual individuals. Women were more likely than men to report at least 1 form of emotional abuse (odds ratio [OR] = 2.3; p =.02) and unwanted sexual touching (OR = 4.3; p = .0004). Lesbian/bisexual women were significantly more likely to report past suicidal ideation than were heterosexual women (OR = 3.7, p = .03). Gay/bisexual men were more likely to report unwanted sexual touching than were heterosexual men (OR = 5.1, p = .04), but the men did not report significantly higher rates of past suicide ideation or suicide attempts. Sexual orientation and a past history of child sexual, physical, and emotional abuse could be compounding risk factors for suicidal ideation among college students.
Keywords: Sexuality; Child Abuse, Sexual -- Psychosocial Factors; Students, College -- Psychosocial Factors; Suicide -- Psychosocial Factors; Colleges and Universities -- California; California; Male; Female; Adolescence; Adult; Child, Preschool; Questionnaires; Epidemiological Research; Convenience Sample; Research Subject Recruitment; Structured Interview; Descriptive Statistics; Confidence Intervals; White Persons; Black Persons; Asians; Hispanic Americans; Native Americans; Statistical Significance; Human

Experiences of homophobia among gay and bisexual men: results from a cross-sectional study in seven countries. - Chard, Anna N.; Finneran, Catherine; Sullivan, Patrick S.; Stephenson, Rob (Culture, Health & Sexuality, 2015)
Experiences of homophobic discrimination are associated with an increased prevalence of psychological disorders and increased odds of reporting suicidal ideation among gay and bisexual men. We examine two domains of homophobia – external homophobic discrimination and internalised homophobia – and their associations with sexual orientation, demographic characteristics, relationships and social support among a sample of gay and bisexual men from seven countries. Sexually active gay and bisexual men aged over 18 and residing in Australia, Brazil, Canada, South Africa, Thailand, the UK and the USA were recruited through banner advertisements on Facebook. Two outcomes were examined: reporting experiences of homophobic discrimination and reporting feelings of internalised homophobia. No covariates were consistently significantly associated with experiencing external homophobic discrimination across countries. Across all countries, bisexually identifying respondents reported significantly greater feelings of internalised homophobia. Respondents in Brazil and the UK reporting a main partner, and respondents in Australia, Brazil, Canada, South Africa, Thailand and the USA reporting a larger gay/bisexual social network, reported significantly fewer feelings of internalised homophobia. Results suggest an ameliorative effect of social networks on experiencing homophobia. Additional research should focus on the mechanisms through which social networks reduce feelings of internalised homophobia.
Keywords: Perception; Sexual Partners -- Psychosocial Factors; Homophobia -- Psychosocial Factors; Homosexuality; Bisexuality; Thailand; South Africa; Sexuality; Homophobia; Brazil; Young Adult; United States; Middle Age; Male; Adult; Cross Sectional Studies; Canada; Great Britain; Australia; Human; Funding Source

Gay adolescents and suicide: understanding the association. - Kitts RL (Adolescence, 2005)
Suicide among gay adolescents is a major public health concern, but it is still under-emphasized within mainstream healthcare. This article brings together information garnered from past studies, articles, and experiences to create a more in-depth understanding of why gay adolescents are at a higher risk for suicide. By creating a better understanding, this article attempts to push forward the significance of this issue and encourages physicians to take a more active role in suicide prevention. The article initially explores why issues involving homosexuality are seldom discussed and provides evidence for an increased risk in suicide among gay adolescents. By addressing major psychosocial issues faced by gay adolescents, it spends the majority of time facilitating an understanding of the increased risk. In this article 'gay' refers to homosexual males and females, and bisexuals unless otherwise indicated.
Keywords: Homosexuality -- In Adolescence; Stigma; Suicide -- Risk Factors -- In Adolescence; Adolescence; Female; Male

Committee Opinion No. 685: 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: Gynecology; Obstetrics; Gender Identity; Gender Affirmation Procedures; Fertility Preservation; Female; Referral and Consultation; Male; Adolescence; Questionnaires; Social Readjustment Rating Scale

Mental Health Disparities Among Canadian Transgender Youth. - Veale, Jaimie F.; Watson, Ryan J.; Peter, Tracey; Saewyc, Elizabeth M. (Journal of Adolescent Health, 2017)
Purpose This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14–18 and 19–25). Methods A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Results Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. Conclusions Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable.
Keywords: Mental Disorders -- In Adolescence -- Canada; Transgender Persons -- In Adolescence -- Canada; Health Status Disparities -- In Adolescence -- Canada; Canada; Human; Adolescence; Young Adult; Mental Disorders -- Epidemiology; Nonprobability Sample; Questionnaires; World Wide Web -- Utilization; Research Subject Recruitment; Stress, Psychological; Self-Injurious Behavior; Depression; Suicide; Male; Female; Sex Factors; British Columbia; Descriptive Statistics; Descriptive Research; Comparative Studies

Needs of a Silent Minority: Mexican Transgender Asylum Seekers. - Gowin, Mary; Taylor, E. Laurette; Dunnington, Jamie; Alshuwaiyer, Ghadah; Cheney, Marshall K. (Health Promotion Practice, 2017)
Mexican male to female transgender asylum seekers in the United States suffer from serious health issues that can be attributed to stressors related to their transgender, ethnic minority, and socioeconomic status. This study explored these stressors, the resulting health issues, and the needs of this particularly vulnerable population. Asylum seekers’ (n = 45) sworn declarations and psychological evaluations were examined by a multidisciplinary research team using a systematic document review process. The review identified stressors that occurred both in Mexico and the United States: verbal, physical, and sexual assaults; unstable environments; fear for safety/security; hiding undocumented status; and economic insecurity. The health issues that resulted in part from these stressors include posttraumatic stress disorder, depression, anxiety, sleep issues, isolation, avoidance, drug/alcohol use, and suicidal tendencies. Despite suffering from multiple health issues, asylum seekers rarely sought health or social services. Health promotion practitioners can play an important role in serving this silent minority by (1) expanding community-based research focused on the intersection of transgender, ethnic minority, and socioeconomic status; (2) using trusted community members to connect this population to necessary resources; (3) providing communication training/resource development for health care providers; and (4) creating a network of service organizations that understand the needs of transgender asylum seekers.
Keywords: Transgender Persons -- Mexico; Hispanic Americans; Mexico; United States; Social Determinants of Health; Healthcare Disparities; Qualitative Studies; Mental Health

Psychometric analysis of the Life Worries Scale for a new generation of sexual minority men: The P18 Cohort Study. - Halkitis, Perry N.; Cook, Stephanie H.; Ristuccia, Annie; Despotoulis, James; Levy, Michael D.; Bates, Francesca C.; Kapadia, Farzana (Health Psychology, 2018)
Objective: Sexual minority men (SMM) in the United States continue to experience adverse health problems and psychosocial burdens. However, there is limited psychometric research seeking to quantify the life worries of this population. Informed by syndemic theory, the Life Worries Scale (LWS) was developed to measure the concerns of young SMM. Method: Analyses of the scale were undertaken using baseline data (n = 665) from an ongoing cohort study of emerging adult, SMM. Results: Exploratory factor analyses (EFA) of an initial set of 24 Likert-type items, followed by confirmatory factor analysis (CFA) and an exploratory structural equation model (ESEM), indicated a structure consisting of 6 domains of worries: financial stability, social stability, self esteem, loneliness, physical appearance, and physical health. These 6 subscales were highly correlated and also demonstrated high levels of internal consistency. Differences in life worries were noted across demographic states, specifically HIV serostatus, sexual attraction, housing status, and self-rated health. High levels of association were also detected between all 6 subscales with both depression and PTSD, while significant correlations were detected between suicidality and both self esteem and loneliness related worries. Conclusions: The results of our analyses provide evidence for the strong psychometric characteristics of the LWS. This newly developed instrument should be utilized in research to examine the extent to which life worries explain health outcomes and risk behaviors in sexual minority males, and may be potentially extended for use in other populations.
Keywords: Psychometrics; LGBTQ+ Persons -- United States; Human; Prospective Studies; Scales; Male; United States; Adult; Factor Analysis; Self Concept; Loneliness; Body Constitution; Health Status; Demography; AIDS Serodiagnosis

Digital Self-Harm Among Adolescents. - Patchin, Justin W.; Hinduja, Sameer (Journal of Adolescent Health, 2017)
Purpose Despite increased media and scholarly attention to digital forms of aggression directed toward adolescents by their peers (e.g., cyberbullying), very little research has explored digital aggression directed toward oneself. “Digital self-harm” is the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself. The current study examined the extent of digital self-harm among adolescents. Methods Survey data were obtained in 2016 from a nationally representative sample of 5,593 American middle and high school students (12–17 years old). Logistic regression analysis was used to identify correlates of participation in digital self-harm. Qualitative responses were also reviewed to better understand motivations for digital self-harm. Results About 6% of students have anonymously posted something online about themselves that was mean. Males were significantly more likely to report participation (7.1% compared to 5.3%). Several statistically significant correlates of involvement in digital self-harm were identified, including sexual orientation, experience with school bullying and cyberbullying, drug use, participation in various forms of adolescent deviance, and depressive symptoms. Conclusions Digital self-harm is a new problem that demands additional scholarly attention. A deeper inquiry as to the motivations behind this behavior, and how it correlates to offline self-harm and suicidal ideation, can help direct mental health professionals toward informed prevention approaches.
Keywords: Self-Injurious Behavior -- Epidemiology -- In Adolescence; Cyberbullying -- Epidemiology -- In Adolescence; Social Media -- In Adolescence; Adolescent Behavior; Students, Middle School; Students, High School; Logistic Regression; Qualitative Studies; Motivation; Male; Female; Child; Adolescence; Descriptive Statistics; Sexual Identity; Substance Abuse; Depression; Human

Mental health as an advocacy priority in the lesbian, gay, bisexual, and transgender communities. - Pandya, Anand (Journal of Psychiatric Practice®, 2014)
This column reviews the evolution of lesbian, gay, bisexual, and transgender (LGBT) mental health advocacy in relation to modern mental health advocacy efforts. In addition to developments in organized psychiatry (e.g., American Psychiatric Association's LGBT caucus), grassroots LGBT community initiatives are playing an important role (e.g., Trevor Project providing crisis intervention/suicide prevention services to LGBT youth, face-to-face mental health services in LGBT community centers). Studies have found that LGBT individuals are at increased risk for mental health problems (e.g., depression, anxiety, substance misuse, suicidal ideation, self-harm). Mental health advocacy in the LGBT community has been slowed by the long-standing association of the concept of homosexuality with psychopathology in mainstream psychiatry (e.g., homosexuality was only removed from the DSM in 1973, ego dystonic homosexuality still appears in the ICD-10). However, positive developments in LGBT mental health advocacy have been fostered by the proposed minority stress model (i.e., that elevated risk of mental illness in LGBT individuals is a consequence of a hostile stressful environment). A particularly encouraging initiative is the It Gets Better Project, in which thousands of videos, some by prominent individuals, have been posted online to send a message of hope to LGBT youth facing harassment and low self-esteem. (Journal of Psychiatric Practice 2014;20:225-227.
Keywords: Bisexuality; Lesbians -- Psychosocial Factors; Homosexuality; Mental Disorders -- Etiology; Mental Disorders -- Prevention and Control; Mental Disorders -- Psychosocial Factors; Patient Advocacy; Suicide -- Prevention and Control; Transgender Persons -- Psychosocial Factors; Community Mental Health Services -- Administration; Crisis Intervention -- Methods; Crisis Intervention; Female; Human; Male; Needs Assessment; Risk Assessment; Social Adjustment; Social Environment; Suicide -- Psychosocial Factors; United States

Progress Regarding Transgender Issues? - Thomas, Sandra P. (Issues in Mental Health Nursing, 2019)
The article reports on issues of the transgendered individuals. Topics include several statistics document high rates of anxiety, HIV, substance use disorders, and post-traumatic stress disorder in transgender people; issues of mental health explained by sexual minority stress theory that points to societal stigma, discrimination, and harassment; and increase in the research on the health of transgender individuals.
Keywords: Transgender Persons -- Psychosocial Factors; Homicide; Suicide; HIV Infections; Substance Abuse; Stress Disorders, Post-Traumatic; Mental Disorders; Hardiness

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

Psychology In and Out of the Shadows. - O'Neill, Patrick (Canadian Psychology, 2016)
The first few years of the new millennium have thrust an assortment of troublesome social issues on Western societies, from immigration to gun control to torture of military prisoners. Organized psychology has taken stands on some of these public matters. In this article I will discuss 3 such issues and the way they were handled by the Canadian Psychological Association and the American Psychological Association: capital punishment, marriage and adoption rights for gay and lesbian parents, and the relationship between ethics and international law regarding the treatment of prisoners. On the first 2 issues the 2 associations took similar stands, but on the third they diverged.
Keywords: Capital Punishment; Marriage; Adoption; Human Rights; Gay Men; Lesbians; Parents; Prisoners -- Ethical Issues; Legislation; International Relations

Suicidal ideation in gay adolescents in the context of cultural stigma and criminalized homosexuality in Sri Lanka. - Chandradasa, Miyuru (International Journal of Social Psychiatry, 2019)
The article offers information on the higher burden of suicidality and psychological distress faced by homosexual individuals considering the social discrimination that homosexuals faced in the Sri Lankan context.
Keywords: Suicidal Ideation; Gay Persons -- Psychosocial Factors -- In Adolescence; Stigma; Homosexuality -- Legislation and Jurisprudence -- Sri Lanka; Criminal Justice; Sri Lanka; Marriage; Sexuality; Psychiatrists; Human Rights; Men Who Have Sex With Men; Heterosexuals -- Psychosocial Factors; Adolescence

Sociodemographic Antecedent Validators of Suicidal Behavior: A Review of Recent Literature. - Conejero, Ismael; Lopez-Castroman, Jorge; Giner, Lucas; Baca-Garcia, Enrique (Current Psychiatry Reports, 2016)
Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known impact of age and gender, sociodemographic variables such as marital and parental status, education, occupation, income, employment status, religion, migration or minority status, and sexual orientation are repeatedly reported to play an important role in suicidal behavior. This narrative review aimed to summarize recent research on sociodemographic risk factors for suicidal behavior and to elicit possible implications for suicide prevention.
Keywords: Suicide -- Psychosocial Factors; Suicide -- Prevention and Control; Female; Socioeconomic Factors; Risk Factors; Human; Systematic Review

Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. - Meyer IH; Dietrich J; Schwartz S (American Journal of Public Health, 2008)
Past studies have reported little about variability in mental disorders among lesbians, gay men, and bisexual individuals. We assessed the prevalence of psychiatric disorders in 388 lesbian, gay, and bisexual Black, Latino, and White individuals. Black lesbians, gay men, and bisexual individuals had lower prevalence of all disorders than did Latino and White individuals; younger cohorts had fewer mood disorders than did older cohorts; bisexual persons had more substance use disorders than did gay men and lesbians; and Latino respondents attempted suicide more often than did White respondents.
Keywords: Bisexuality; Homosexuality; Mental Disorders -- Epidemiology; Suicide, Attempted -- Psychosocial Factors; Suicide, Attempted; Adolescence; Adult; Female; Logistic Regression; Male; Middle Age; Prevalence; Human

The impact of ‘gay cure’ in the mental health. - Nascimento Arrais, Tereza Maria Siqueira; Rolim Neto, Modesto Leite (International Journal of Social Psychiatry, 2018)
Keywords: Mental Health; Gay Men -- Psychosocial Factors; LGBTQ+ Persons; Homosexuality; Communities; Mental Disorders; Mental Health Personnel; Lesbians; Bisexuals; Cross-dressers; Transsexuals; Suicide -- Risk Factors -- Brazil; Brazil; Homicide; Sexual Identity

Homophobic bullying in Mexico: Results of a national survey. - Baruch-Dominguez, Ricardo; Infante-Xibille, Cesar; Saloma-Zuñiga, Claudio E. (Journal of LGBT Youth, 2016)
Homophobic and transphobic bullying, through teasing, physical violence, and other forms of aggression, is a problem that affects lesbian, gay, bisexual, and transgender students at all levels of education. Even though there have been legal changes in Mexico to protect human rights of lesbian, gay, bisexual, and transgender people, schools are spaces where discrimination and violence toward them are still common. In 2012, using an online survey asking participants about their experiences with bullying, its consequences, and responses from adults, the authors collected responses from 912 participants younger than 30 years of age who self-identified as lesbian, gay, bisexual, or transgender and who lived in the 32 states of Mexico. Two thirds of participants said that they were victims of bullying during their school years; the majority of these students indicated that they did not have support from teachers or parents to avoid or stop the violence. The consequences of bullying were truancy, dropouts, depression, and suicide attempts. Attitudes that normalize bullying may impede the effective prevention of or response to homophobic and transphobic bullying by teachers and parents. To eliminate homophobic bullying in school, there is a need for sexual diversity trainings for teachers and media campaigns for the general public.
Keywords: Homophobia; Bullying; LGBTQ+ Persons; Schools; Victims; Human; Human Rights; Mexico; Surveys; Bullying -- Prevention and Control; Teachers; Cross Sectional Studies; Adolescence; Young Adult; Adult; Social Networks; Male; Female; Faculty Attitudes; Variable; Open-Ended Questionnaires; Stereotyping; School Administrators; Parental Attitudes; Self Report

Suicide risk factors among trans feminine individuals in Lebanon. - Kaplan, Rachel L.; Nehme, Simon; Aunon, Frances; de Vries, David; Wagner, Glenn (International Journal of Transgenderism, 2016)
Transgender women are disproportionately affected by high rates of depression and suicide attempts. It is therefore important to identify factors that influence suicidal risk, particularly in the Middle East, where little research has examined the mental health of transgender women. We examined risk factors associated with suicide attempts among 54 trans feminine individuals in Beirut, Lebanon. Data were collected using interviewer-administered questionnaires and were analyzed using bivariate statistics. Twenty-five (46%) participants reported having ever attempted suicide. Among them, only one participant had received some kind of counseling in response to the attempted suicide. Low general social support, low social integration, and low support from peers were significantly associated with a history of attempted suicide, as were being more open about transgender identity in public and any hormone use (past or current). These findings suggest that progression in gender transition can have unintended consequences related to mental health and suicide risk, while social support systems can mitigate the impact of mental health problems. Some of these findings mirror other contexts around the globe and can inform mental health services for trans feminine individuals in Lebanon, the greater Middle East region, and other international settings.
Keywords: Transgender Persons -- Psychosocial Factors -- Lebanon; Suicidal Ideation -- Psychosocial Factors -- Lebanon; Human; Female; Depression -- Risk Factors; Questionnaires; Bivariate Statistics; Descriptive Statistics; Femininity; Lebanon; Middle East

Suicidal ideation among MSM in three West African countries: Associations with stigma and social capital. - Stahlman, Shauna; Grosso, Ashley; Ketende, Sosthenes; Pitche, Vincent; Kouanda, Seni; Ceesay, Nuha; Ouedraogo, Henri G.; Ky-Zerbo, Odette; Lougue, Marcel; Diouf, Daouda; Anato, Simplice; Tchalla, Jules; et al. (International Journal of Social Psychiatry, 2016)
Background: Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa. Aims: This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo. Methods: Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation. Results: The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%–17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99). Conclusion: Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa.
Keywords: Suicidal Ideation -- Evaluation -- Africa, Western; Suicidal Ideation -- Psychosocial Factors; Men Who Have Sex With Men; Stigma; Social Capital; Human; Africa, Western; Respondent Validation; Snowball Sample; Descriptive Statistics; Surveys; Logistic Regression; Bivariate Statistics; Multivariate Statistics; Odds Ratio; Confidence Intervals; Intimate Partner Violence; Sexual Abuse

A Content Analysis of Literature on Trans People and Issues. - Moradi, Bonnie; Tebbe, Elliot A.; Brewster, Melanie E.; Budge, Stephanie L.; Lenzen, Alex; Ege, Engin; Schuch, Elena; Arango, Sarah; Angelone, Nicholas; Mender, Eli; Hiner, Dylan L.; Huscher, Kileigh; et al. (Counseling Psychologist, 2016)
This study provides a content analysis of more than a decade (2002–2012) of academic scholarship about trans people and issues. A total of 960 trans-focused publications were coded; there was a close balance of nonempirical (54%) and empirical (46%) publications. The analyses revealed that the literature on trans people and issues is growing, although many publications include trans people and issues nominally without substantive attention. The analyses also pointed to underutilized research designs and methodologies, the need for more clear assessment and more consistent reporting of demographic characteristics, and topics that warrant further attention. Specifically, literature on trans people and issues continues to be needed on the topics of focus thus far, such as psychological and identity-related distress. Scholarship is also needed to address important topics that have been understudied, including self-harm and suicide, positive functioning and mental health promoting factors, developmental issues across the life span, school and workplace experiences, and the training and competencies of health care providers to ensure affirmative and effective services for trans people.
Keywords: Transgender Persons; Gender Identity; LGBTQ+ Persons; Mental Health; Literature; Research; Minority Groups; Ego; Human; Gender Identity -- Evaluation; Empirical Research; Data Collection Methods; Data Collection; Focus Groups; Cross Sectional Studies; Literature Review; Field Notes; Case Studies; Qualitative Studies; Thematic Analysis; Random Sample; Nonprobability Sample; External Validity; Snowball Sample; Data Analysis; Surveys; Interviews; Narratives; Descriptive Statistics

Baseline Physiologic and Psychosocial Characteristics of Transgender Youth Seeking Care for Gender Dysphoria. - Olson, Johanna; Schrager, Sheree M.; Belzer, Marvin; Simons, Lisa K.; Clark, Leslie F. (Journal of Adolescent Health, 2015)
Purpose The purpose of this study was to describe baseline characteristics of participants in a prospective observational study of transgender youth (aged 12–24 years) seeking care for gender dysphoria at a large, urban transgender youth clinic. Methods Eligible participants presented consecutively for care at between February 2011 and June 2013 and completed a computer-assisted survey at their initial study visit. Physiologic data were abstracted from medical charts. Data were analyzed by descriptive statistics, with limited comparisons between transmasculine and transfeminine participants. Results A total of 101 youth were evaluated for physiologic parameters, 96 completed surveys assessing psychosocial parameters. About half (50.5%) of the youth were assigned a male sex at birth. Baseline physiologic values were within normal ranges for assigned sex at birth. Youth recognized gender incongruence at a mean age of 8.3 years (standard deviation = 4.5), yet disclosed to their family much later (mean = 17.1; standard deviation = 4.2). Gender dysphoria was high among all participants. Thirty-five percent of the participants reported depression symptoms in the clinical range. More than half of the youth reported having thought about suicide at least once in their lifetime, and nearly a third had made at least one attempt. Conclusions Baseline physiologic parameters were within normal ranges for assigned sex at birth. Transgender youth are aware of the incongruence between their internal gender identity and their assigned sex at early ages. Prevalence of depression and suicidality demonstrates that youth may benefit from timely and appropriate intervention. Evaluation of these youth over time will help determine the impact of medical intervention and mental health therapy.
Keywords: Gender Dysphoria; Gender Specific Care; Transgender Persons -- Psychosocial Factors -- In Adolescence; Human; Adolescence; Young Adult; Transgender Persons; Gender Identity; Physiological Processes; Gender Dysphoria -- Complications; Depression

HIV understanding, experiences and perceptions of HIV-positive men who have sex with men in Amazonian Peru: a qualitative study. - Tattsbridge, Jasmine; Wiskin, Connie; de Wildt, Gilles; Clavé Llavall, Anna; Ramal-Asayag, César (BMC Public Health, 2020)
Background: HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences and perceptions of HIV-positive men who have sex with men and healthcare professionals in Loreto.Methods: Twenty qualitative interviews with HIV-positive men who have sex with men and one focus group with HIV-specialist healthcare professionals were conducted in Loreto, January-February 2019. Interviews were transcribed per verbatim. Thematic content analysis and deviant case analysis were used.Results: A culture of isolation and discrimination was identified, propagated by poor public knowledge surrounding HIV transmission and treatment. Employment potential was hampered and 7/20 patients had suicidal thoughts post-diagnosis. Barriers to care included: shame, depression, travel cost/times, a preference for traditional plant-based medicine and side-effects of antiretroviral therapy. Facilitators included: education, family and clinic support, disease acceptance and lifestyle changes.Conclusion: More effective, focussed community education and workplace discrimination investigations are recommended to reduce stigma and increase adherence to treatment in this population.
Keywords: Health Personnel -- Psychosocial Factors; Attitude to Health; HIV Infections -- Psychosocial Factors; Stigma; Male; Anti-Retroviral Agents -- Therapeutic Use; HIV Infections -- Drug Therapy; Qualitative Studies; Adult; Human Immunodeficiency Virus; Peru; Focus Groups; Middle Age; Questionnaires

Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015. - Caputi, Theodore L.; Smith, Davey; Ayers, John W. (JAMA: Journal of the American Medical Association, 2017)
The article discusses research regarding the suicide risk behaviors of sexual minority adolescents in the U.S., and it the 2015 National Youth Risk Behavior Survey and the suicide risks that are associated with heterosexual, bisexual, LGBT, and questioning teenagers in America. Stigma and diversity among sexual minorities are examined, along with information about attempted suicides and suicide planning. Mental health services for adolescents are examined.

Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women. - Reisner, Sari L.; Biello, Katie B.; White Hughto, Jaclyn M.; Kuhns, Lisa; Mayer, Kenneth H.; Garofalo, Robert; Mimiaga, Matthew J. (JAMA Pediatrics, 2016)
Keywords: Transgender Persons -- Psychosocial Factors; Psychiatric Patients; Comorbidity; Adolescent Psychiatry; Child Psychiatry; Female; Special Populations; Mental Health -- Evaluation; Observational Methods; Suicidal Ideation; Health Services Accessibility; Interviews; Chi Square Test; Data Analysis; Funding Source

Fidelity of Implementation of a State Antibullying Policy With a Focus on Protected Social Classes. - Hall, William J.; Chapman, Mimi V. (Journal of School Violence, 2018)
Bullying threatens the mental and educational well-being of students. All states have enacted antibullying laws. This study surveyed 634 educators about the implementation of the North Carolina School Violence Prevention Act, which enumerated social classes protected from bullying: race, national origin, gender, socioeconomic status, sexual orientation, gender identity, appearance, and disability. Results showed that local antibullying policies most often included race as a protected class and least often included sexual orientation and gender identity. More educators had been trained on bullying based on race than any other social class. Students were more often informed that bullying based on race was prohibited and were least often informed about prohibitions regarding sexual orientation and gender identity. Reporting, investigating, and remediating bullying was highest for racial bullying, followed by disability bullying, and was lowest for bullying based on sexual orientation and gender identity.
Keywords: Bullying -- Prevention and Control; Bullying -- Legislation and Jurisprudence; Schools; Social Class; Program Implementation; Surveys; Students -- Psychosocial Factors; Psychological Well-Being; Learning Environment; School Violence; Faculty Attitudes; Geographic Factors; Sex Factors; Bullying -- Education; Teachers -- Education; Socioeconomic Factors; Sexism; Gender Identity; Attitude to Disability; Racism -- Education; Racism; Bullying -- Psychosocial Factors

Homophobic Bullying and Suicidal Behavior Among US Heterosexual Youth. - Parent, Mike C.; Johnson, Karen E.; Russell, Stephen; Gobble, Teresa (Journal of the American Academy of Child & Adolescent Psychiatry, 2020)
Homophobic bullying is pervasive in schools, and has been linked with suicidality among sexual minority youth. In prior studies, heterosexual adolescents have typically served as the reference group to understand disparities facing sexual minority youth. Yet, heterosexual adolescents may also face homophobic bullying. We assessed the associations between homophobic bullying and risk factors for suicide (sadness/hopelessness, considering suicide, planning suicide, and attempting suicide) among youth who identify as heterosexual.

A Minority Stress Model for Suicidal Ideation in Gay Men. - Michaels, Matthew S.; Parent, Mike C.; Torrey, Carrie L. (Suicide & Life-Threatening Behavior, 2016)
There is a dearth of research on mechanisms underlying higher rates of suicidal ideation among gay men compared to heterosexual men. The purpose of this study was to establish the link between social/psychological predictor variables and suicidal ideation by testing a hypothesized minority stress model. Structural equation modeling was used to assess the relationships posited in the model using data from a community sample of 167 gay men. Model fit was adequate and hypothesized relationships were partially supported. Also, depressive symptoms partially mediated the relationship between (less) outness predicting suicidal ideation. These findings imply that therapeutic approaches targeting the coming out process may be more effective than approaches targeting internalized homophobia when suicidal ideation is indicated in the clinical presentation of gay and bisexual men.
Keywords: Stress, Psychological -- Psychosocial Factors; Models, Psychological; Suicidal Ideation; Minority Groups -- Psychosocial Factors; Homosexuality; Depression -- Psychosocial Factors; Middle Age; Minority Groups -- Statistics and Numerical Data; Young Adult; Adult; Aged; Male; Human

Transgender teens who receive pubertal suppression hormones have significantly less suicidal ideation as adults. (Brown University Child & Adolescent Psychopharmacology Update, 2020)
Keywords: Transgender Persons -- In Adolescence; Suicidal Ideation; Sex Hormones; Outcome Assessment; Mental Health; Self Report; Adolescence

Suicide in Transgender Veterans: Prevalence, Prevention, and Implications of Current Policy. - Tucker, Raymond P. (Perspectives on Psychological Science, 2019)
Transgender adults serve in the U.S. military at 2 to 3 times the rate of the general adult population. Unfortunately, transgender veterans die by suicide at twice the rate of their cisgender veteran peers and approximately 5.85 times the rate of the general population. This article reviews the literature regarding the prevalence of suicidal thoughts and behaviors in transgender veterans. Suicide risk and resilience factors are reviewed, and future areas of study are detailed that incorporate findings from the broader suicide-prevention literature and research on transgender mental-health disparities. Individual services and broader prevention considerations are discussed, including the adaptation of evidence-based suicide-specific psychological interventions, national transgender health-training resources, and relevant veteran suicide-prevention initiatives. Finally, U.S. Department of Defense and U.S. Department of Veterans Affairs policies regarding transgender service and health care are reviewed. State-level policies relevant to transgender veteran suicide such as firearm ownership and nondiscrimination laws are also reviewed, and their implications for suicide prevention are discussed. The aim of this article is to provide a broad review of research findings from multiple fields of study to assist health-care providers, researchers, and policymakers in their efforts to prevent transgender veteran suicide.
Keywords: Transgender Persons -- Psychosocial Factors; Veterans -- Psychosocial Factors; Suicide -- Epidemiology; Suicidal Ideation -- Epidemiology; Suicide -- Prevention and Control; United States; Suicide -- Risk Factors; Hardiness; Mental Health; Health Status Disparities; Health Policy; Physician-Patient Relations; Research Personnel -- Psychosocial Factors; Suicidal Ideation -- Prevention and Control; Researcher-Subject Relations; Public Policy

Preliminary Population Size Estimation of Men Who Have Sex with Men in Kazakhstan: Implications for HIV Testing and Surveillance. - Wu, Elwin; Terlikbayeva, Assel; Hunt, Timothy; Primbetova, Sholpan; Yong Gun Lee; Berry, Mark (LGBT Health, 2017)
Purpose: The purpose of this study is to estimate the population size of men who have sex with men (MSM) in Kazakhstan and their HIV testing history. Methods: We conducted structured interviews with MSM in four geographically disparate cities--N= 400 (n = 100/city)--to implement four population estimation methods and ascertain HIV testing history. Results: Approximately 3.2% of men--corresponding to ~154,000 individuals--in Kazakhstan aged 18-59 are MSM. The 49.9% of the sample who reported taking an HIV test far exceeds the <1% reported as MSM in surveillance data. Conclusion: HIV testing surveillance in Kazakhstan has underestimated the number of MSM. This underscores the need to redress social and structural barriers to HIV testing and disclosure of sexual behavior experienced by MSM in Kazakhstan. Recommendations include promoting cultural sensitivity among testing staff through quality assurance and regular training, and increasing protection and public awareness through antidiscrimination policy development.

A comparison of health disparities among transgender adults in Colorado (USA) by race and income. - Seelman, Kristie L.; Young, Sarah R.; Tesene, Megan; Alvarez-Hernandez, Luis R.; Kattari, Leo (International Journal of Transgenderism, 2017)
Transgender individuals face heightened risks for discrimination, harassment, and violence that impact their psychosocial well-being and physical health. However, few studies have thoroughly examined the general physical and mental health of transgender adults or within-group health differences by race/ethnicity and income. To that end, after controlling for health insurance status, age, and engagement in exercise, this study asks: (a) Are transgender people of color more likely than White transgender individuals to experience poor health outcomes? and (b) Is lower annual household income among transgender adults associated with poorer health outcomes? The study analyzes secondary data from a survey of transgender adults (N= 417) in one state in the western United States using multiple linear regression and logistic regression models. Results showed that transgender people of color had significantly greater odds than their White counterparts of having arthritis/rheumatoid arthritis/gout/lupus/fibromyalgia, or asthma but lower odds of being told by a provider that they had depression. Having a lower income was significantly associated with worse general health as well as multiple indicators of poor physical and mental health, including depression, anxiety, and suicidal ideation. We discuss implications for health care delivery for transgender people and for future research.
Keywords: Health Status Disparities -- Colorado; Transgender Persons -- Psychosocial Factors -- Colorado; Colorado; Human; Male; Female; Age Factors; Race Factors; Linear Regression; Logistic Regression; Outcomes (Health Care); Socioeconomic Factors; Chronic Disease -- Risk Factors; Surveys

Suicidal ideation among Italian and Spanish young adults: the role of sexual orientation. - Baiocco, Roberto; Ioverno, Salvatore; Lonigro, Antonia; Baumgartner, Emma; Laghi, Fiorenzo (Archives of Suicide Research, 2015)
The purpose of the current study was to identify demographic, social, and psychological variables associated with suicidal ideation in an Italian sample and a Spanish sample, taking into account the relevance of sexual orientation as a risk factor for suicide. Three hundred twenty gay and bisexual men, 396 heterosexual men, 281 lesbians and bisexual women, and 835 heterosexual women were recruited. In chi-square and multivariable logistic regression analyses we identified several consistent cross-national risk factors for suicidal ideation: having lower education, not being religious, being homosexual or bisexual, not being engaged in a stable relationship, having lower level of peer and parental attachment, and having depressive symptoms. Interestingly, the strongest risk factor in both samples, after depression symptoms, was sexual orientation.

Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth. - Levine, David A. (Pediatrics, 2013)
The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.
Keywords: Pediatric Care -- Standards; Homosexuality -- In Adolescence; Attitude of Health Personnel; American Academy of Pediatrics -- Standards; Adolescence; Pediatricians; Sexuality; Homophobia; Sexual Health; Sexually Transmitted Diseases -- Prevention and Control; HIV Infections -- Prevention and Control; Physician's Role

Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth. - Levine, David A. (Pediatrics, 2013)
The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.
Keywords: Pediatric Care -- Standards; Homosexuality -- In Adolescence; Attitude of Health Personnel; American Academy of Pediatrics -- Standards; Adolescence; Pediatricians; Sexuality; Homophobia; Sexual Health; Sexually Transmitted Diseases -- Prevention and Control; HIV Infections -- Prevention and Control; Physician's Role

Do close supportive relationships moderate the effect of depressive symptoms on suicidal ideation? - Murray, Aja L.; McKenzie, Karen; Murray, Kara R.; Richelieu, Marc (British Journal of Guidance & Counselling, 2016)
Depressive symptoms, a lack of close supportive relationships and suicidal ideation are important risk factors for suicidal acts. Previous studies have primarily focused on the additive effects of close relationships and depressive symptoms on suicide risk. Here we explored whether, in addition, close relationships moderated the impact of depressive symptoms on suicidal ideation. An analysis of pre-existing data from 319 attendees at a student counselling service using moderated regression models indicated that when the student has close supportive relationships, the association between depressive symptoms and suicidal ideation is weaker than when he/she feels an absence of close relationships. This confirms the need to include enquiries about the presence of close relationships and depression as part of any suicide risk assessment.
Keywords: Suicidal Ideation; Transgender Persons; Symptoms; Suicide -- Risk Factors; Social Isolation; Mental Health

LGBTQ Youth Part 1. - Perron, Tracy; Kartoz, Connie; Himelfarb, Chaya (NASN School Nurse, 2017)
In order to provide holistic care, school nurses must be culturally competent by being sensitive to health disparities experienced by students in at-risk populations. Despite the growing acceptance toward gender and sexual minorities, LGBTQ youth remain an at-risk population in our communities and our schools. School nurses as well as school counselors, social workers, and psychologists can increase their cultural competence in caring for this group of students by increasing their understanding of appropriate terminology and risks associated with this vulnerable group. This article is Part 1 of a two-article series designed to increase school nurses’ abilities to advocate and care for LGBTQ youth in school settings. This first article provides information regarding proper terminology and current percentages of youth who identify as LGBTQ and concludes with implications for school nurses, including resources for nurses, school staff, and families.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; School Health Nursing; Cultural Competence; Information Resources; Adolescence; Nursing Role; Bullying; Suicidal Ideation; Depression; Healthcare Disparities; Child Advocacy; Professional Development; Nomenclature; LGBTQ+ Persons -- History; Gender Identity; Sexuality

Drinking Patterns, Problems, and Motivations Among Collegiate Bisexual Women. - Bostwick WB; McCabe SE; Horn S; Hughes T; Johnson T; Valles JR (Journal of American College Health, 2007)
OBJECTIVE AND PARTICIPANTS: The authors compared the drinking behaviors, motivations, and problems of collegiate bisexual women with those of heterosexual women (N = 2,788; n = 86 bisexual women). METHODS: Data came from the 2003 Student Life Survey, a random population-based survey at a large midwestern university. The authors explored the hypothesis that bisexual women would be more likely than heterosexual women to report drinking motivations related to stress and coping as a result of sexual identity stigma. RESULTS: They found that bisexual women drank significantly less than did heterosexual women. There were few differences between the 2 groups in drinking motivations and problems. Bisexual women reported a comparable number of problems related to their drinking but were significantly more likely to report contemplating suicide after drinking than were heterosexual women. CONCLUSIONS: More research is needed to understand the finding that despite lower levels of alcohol consumption, bisexual women reported a comparable number of drinking problems. College health educators and health care providers need to be aware of findings related to heightened suicidal risk among bisexual women.
Keywords: Alcohol Drinking; Bisexuality; Colleges and Universities; Heterosexuality; Motivation; Students -- Psychosocial Factors; Adult; Alcohol Drinking -- Epidemiology; Female

De-Privatizing Self-Harm: Remembering the Social Self in How to Forget. - Danylevich, Theodora (Journal of Bioethical Inquiry, 2016)
This article reads Malu De Martino's 2010 film Como Esqueçer (How to Forget) as a case study in self-harm as a mode of expression and self-inquiry. Drawing on disability and queer theory, psychoanalysis, and sociology of medicine, the author argues that How to Forget charts a 'crip' epistemology of self-harm and theorizes a 'social self.' That is to say, the film models an orientation towards self-harm that offers a coalitional and social therapeutic understanding. Based on this reading, the author suggests the application of practices of knowing-with, or knowing-in-relation as 'cripistemology' to a broader therapeutic, research, and lay context.
Keywords: Sociology; Firearms; Feminism; Ego; Injuries, Self-Inflicted; Research; Theory; DSM

Self-injury, suicide ideation, and sexual orientation: differences in causes and correlates among high school students. - DeCamp, Whitney; Bakken, Nicholas W. (Journal of Injury & Violence Research, 2016)
Background: Research has suggested that sexual minority youth are more likely to experience a number of behavioral and health-related risk factors due to their exposure to negative attitudes and beliefs about sexual minorities. Few studies, however, have examined the prevalence of non-suicidal self-injury (NSSI) among sexual minority youth. With self-cutting and suicidal ideation common in middle and high schools, understanding the antecedents and correlates of such behavior may help identify troubled students and initiate preventative measures. Methods: Bivariate probit regression analyses are performed using data from 7,326 high school students collected via the Delaware Youth Risk Behavior Survey. Results: Results indicate that bullying victimization, fighting, substance use, sexual behavior, depression, and unhealthy dieting behaviors were generally associated with NSSI and suicidal ideation. Some effects - including those from sexual activity, substance use, and unhealthy dieting behaviors -- significantly differed based on gender and orientation. Conclusions: Risk factors for suicide and NSSI vary by gender and orientation. Both prevention/intervention specialists and researchers should consider the intersection of these risk factors with sexual orientation in their efforts.
Keywords: Injuries, Self-Inflicted; Suicidal Ideation -- Risk Factors; Sexuality; Students, High School; Human; Behavior Modification; Minority Groups; Surveys; Adolescence; Data Collection; Centers for Disease Control and Prevention (U.S.); Male; Female; Interviews; Dependent Variable; Independent Variable; Substance Abuse; Cocaine -- Adverse Effects; Sexual Abuse

Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt. - Bailey, Louis; Ellis, Sonja J.; McNeil, Jay (Mental Health Review Journal, 2014)
Purpose -- The purpose of this paper is to present findings from the Trans Mental Health Study (McNeil et al., 2012) -- the largest survey of the UK trans population to date and the first to explore trans mental health and well-being within a UK context. Findings around suicidal ideation and suicide attempt are presented and the impact of gender dysphoria, minority stress and medical delay, in particular, are highlighted. Design/methodology/approach -- This represents a narrative analysis of qualitative sections of a survey that utilised both open and closed questions. The study drew on a non-random sample (n = 889), obtained via a range of UK-based support organisations and services. Findings -- The study revealed high rates of suicidal ideation (84 per cent lifetime prevalence) and attempted suicide (48 per cent lifetime prevalence) within this sample. A supportive environment for social transition and timely access to gender reassignment, for those who required it, emerged as key protective factors. Subsequently, gender dysphoria, confusion/denial about gender, fears around transitioning, gender reassignment treatment delays and refusals, and social stigma increased suicide risk within this sample. Research limitations/implications -- Due to the limitations of undertaking research with this population, the research is not demographically representative. Practical implications -- The study found that trans people are most at risk prior to social and/or medical transition and that, in many cases, trans people who require access to hormones and surgery can be left unsupported for dangerously long periods of time. The paper highlights the devastating impact that delaying or denying gender reassignment treatment can have and urges commissioners and practitioners to prioritise timely intervention and support. Originality/value -- The first exploration of suicidal ideation and suicide attempt within the UK trans population revealing key findings pertaining to social and medical transition, crucial for policy makers, commissioners and practitioners working across gender identity services, mental health services and suicide prevention.
Keywords: Suicide -- Risk Factors -- United Kingdom; Suicidal Ideation -- Risk Factors; Suicide, Attempted -- Risk Factors; Transgender Persons -- Psychosocial Factors; Sexual and Gender Disorders; Stigma; Psychological Well-Being; Human; United Kingdom; Questionnaires; Snowball Sample; Female; Male

Self-reported suicide attempts and associated risk and protective factors among secondary school students in New Zealand. - Fleming TM; Merry SN; Robinson EM; Denny SJ; Watson PD (Australian & New Zealand Journal of Psychiatry, 2007)
OBJECTIVE: To examine associations between individual, family, school and community characteristics and rates of suicide attempts in a national population sample of New Zealand secondary school students. METHOD: A total of 9570 randomly selected 9- to 13-year-old students from 114 schools were surveyed, using the New Zealand Adolescent Health Survey. This is a 523-item anonymous self-report comprehensive questionnaire delivered by Multi-Media Computer-Assisted Self-Interviewing. Multivariate analyses were used to examine correlates of self-reported suicide attempts within the last 12 months. RESULTS: In total, 739 participants (4.7% of males and 10.5% of females) reported having made a suicide attempt within the last 12 months. Depressive symptoms, alcohol abuse, -having a friend or family member attempt suicide, family violence and non-heterosexual attractions were independently associated with increased rates of suicide attempts while parents caring, other family members caring, teachers being fair and feeling safe at school were independently associated with decreased rates of suicide attempts. Caring friendships, attending worship frequently, possible sexual abuse and anxiety symptoms were not independently associated with suicide attempts. Risk and protective factors operated in the same way for male and female students and for those with and without other suicide predictors. CONCLUSIONS: New Zealand secondary school students, particularly female students, report high rates of suicide attempts. Risk of suicide attempts is lower in students reporting caring home and fair, safe school environments and this effect remains once depression is taken into account. This study confirms the importance of depression, substance use, problem behaviour, negative life events, exposure to suicide behaviour by others and the significance of sexual orientation in suicidal behaviour among school students and provides evidence of the importance of the family and school environments in reducing risk among this group.
Keywords: Suicide, Attempted; Adolescence; Child; Cross Sectional Studies; Depression -- Diagnosis; Depression -- Epidemiology; Depression -- Psychosocial Factors; Family Relations; Female; Male; New Zealand; Questionnaires; Risk Factors; Social Environment; Students -- Psychosocial Factors; Students -- Statistics and Numerical Data; Suicide, Attempted -- Prevention and Control; Suicide, Attempted -- Psychosocial Factors; Surveys; Human

Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol. - Willging, Cathleen E.; Green, Amy E.; Ramos, Mary M. (Implementation Science, 2016)