The Impact of Positive School Climate on Suicidality and Mental Health Among LGBTQ Adolescents: A Systematic Review. - Ancheta, April J.; Bruzzese, Jean-Marie; Hughes, Tonda L. (Journal of School Nursing, 2021)
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents are more likely to report suicidality and worse mental health than their heterosexual peers. We conducted a systematic review to examine the relationship between positive school climate and suicidality and mental health among LGBTQ adolescents. We searched the literature using PubMed, PsycINFO, and CINAHL. Six studies met inclusion criteria, and all had low to moderate risks of bias. Results indicate that LGBTQ students in schools with more positive school climates were at lower risk of suicidality and reported fewer depressive symptoms compared to students in less positive school climates. Being at the forefront of health in schools, school nurses have the opportunity to advocate for changes in school environments that promote positive mental health for all youth, including LGBTQ adolescents.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Mental Health -- Evaluation; Suicidal Ideation -- Risk Factors; Suicide -- Risk Factors; Risk Assessment; Learning Environment; Human; Systematic Review; PubMed; Psycinfo; CINAHL Database; Depression -- Symptoms; Psychological Distress; Adolescence; Checklists; Affective Disorders -- Symptoms; Descriptive Statistics; Sexual Identity; Students, High School -- Psychosocial Factors; Students, Middle School -- Psychosocial Factors; Child; School Health Nursing; Health Promotion; Funding Source

Self-Reported Conversion Efforts and Suicidality Among US LGBTQ Youths and Young Adults, 2018. - Green, Amy E.; Price-Feeney, Myeshia; Dorison, Samuel H.; Pick, Casey J. (American Journal of Public Health, 2020)
Objectives. To explore associations between undergoing sexual orientation or gender identity conversion efforts (SOGICE) and suicidality among young LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) individuals. Methods. Data were derived from a 2018 online cross-sectional study of young LGBTQ individuals (13–24 years of age) residing in the United States. Multivariate logistic regression was used to determine the relative odds of suicidality among young LGBTQ individuals who experienced SOGICE (in comparison with those who did not) after adjustment for age, race/ethnicity, geography, parents' use of religion to say negative things about being LGBTQ, sexual orientation, gender identity, discrimination because of sexual orientation or gender identity, and physical threats or harm because of sexual orientation or gender identity. Results. Relative to young people who had not experienced SOGICE, those who reported undergoing SOGICE were more than twice as likely to report having attempted suicide and having multiple suicide attempts. Conclusions. The elevated odds of suicidality observed among young LGBTQ individuals exposed to SOGICE underscore the detrimental effects of this unethical practice in a population that already experiences significantly greater risks for suicidality.
Keywords: Sexual and Gender Minorities; LGBTQ+ Persons -- Psychosocial Factors; Sexual and Gender Disorders -- Therapy; Suicide; Risk Assessment; United States; Human; Adolescence; Young Adult; Multiple Logistic Regression; Odds Ratio; Sexuality; Gender Identity; Discrimination; Suicide, Attempted -- Risk Factors

Tobacco Use Status as a Function of Transgender Identity: The Mediating Role of Psychological Distress. - Kittaneh, Ahmad A; Patel, Sweta; Sidhu, Natasha K; Lechner, William V; Kenne, Deric R (Tobacco Use Insights, 2021)
Aim: The current study examined differences between individuals identifying as transgender and people identifying as cisgender in terms of (1) psychological distress (eg, anxiety, depression, and suicidal ideation), (2) rates of combustible and e-cigarette use, and (3) the potential for elevated psychological distress stemming from transgender identification to be associated with increased rates of smoking and vaping. Method: This was a secondary analysis of data from a study examining behavioral health, perceptions and behaviors associated with alcohol and other drug use, and mental health status at a large mid-western university. Differences in current use of cigarette and e-cigarette products were examined between self-identified transgender (n = 253) and cisgender (n = 18 371) respondents. Results: Overall, 17.2% (n = 2727) of the sample endorsed past 30-day use of cigarettes or e-cigarettes. Results demonstrated a significant effect of gender identity, with individuals identifying as transgender reporting higher odds of using cigarettes or e-cigarettes (AOR = 2.82, 95% CI 1.26-6.31). Regression analyses revealed significant effects of transgender identity on symptoms of anxiety (b = 3.45, 95% CI = 1.64, 5.25, P <.001.); depression, (b = 4.14, 95% CI = 2.21, 6.07, P <.001); and suicidal ideation, (b = 2.51, 95% CI = 1.48, 3.55, P <.001.), respectively. Finally, we observed significant indirect effects of transgender identity on cigarette and e-cigarette product use via increased symptoms of depression (indirect effect = 0.13, 95% CI [0.07, 0.19], P <.05), and suicidal ideation (indirect effect = 0.22, 95% CI [0.15, 0.28], P <.05), but not symptoms of anxiety. Discussion: This is the first study of our knowledge to examine the association between psychological symptoms and smoking and vaping products with transgender identity. The results of this study support previous findings that transgender individuals are at risk for elevated substance use and extend the literature by demonstrating this this risk is associated with elevated psychological distress.

Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016–2018. - Blosnich, John R.; Henderson, Emmett R.; Coulter, Robert W. S.; Goldbach, Jeremy T.; Meyer, Ilan H. (American Journal of Public Health, 2020)
Objectives. To examine how sexual orientation change efforts (SOCE) are associated with suicide morbidity after controlling for adverse childhood experiences (ACEs). Methods. Cross-sectional survey data are from the Generations survey, a nationally representative sample of 1518 nontransgender sexual minority adults recruited between March 28, 2016, and March 30, 2018, in the United States. Self-identified transgender individuals were included in a separate, related TransPop study. We used weighted multiple logistic regression analyses to assess the independent association of SOCE with suicidal ideation and suicide attempt while controlling for demographics and ACEs. Results. Approximately 7% experienced SOCE; of them, 80.8% reported SOCE from a religious leader. After adjusting for demographics and ACEs, sexual minorities exposed to SOCE had nearly twice the odds of lifetime suicidal ideation, 75% increased odds of planning to attempt suicide, and 88% increased odds of a suicide attempt with minor injury compared with sexual minorities who did not experience SOCE. Conclusions. Over the lifetime, sexual minorities who experienced SOCE reported a higher prevalence of suicidal ideation and attempts than did sexual minorities who did not experience SOCE. Public Health Implications. Evidence supports minimizing exposure of sexual minorities to SOCE and providing affirming care with SOCE-exposed sexual minorities.
Keywords: Suicidal Ideation -- Risk Factors -- United States; Adverse Childhood Experiences -- Complications; Sexual and Gender Minorities -- Psychosocial Factors -- United States; Sexual Reorientation Programs; Human; Cross Sectional Studies; Surveys; United States; Multiple Logistic Regression; Descriptive Statistics; Odds Ratio; Adult; Transgender Persons

Association of Sexual Orientation Acceptance with Reduced Suicide Attempts Among Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth. - Green, Amy E.; Price-Feeney, Myeshia; Dorison, Samuel H. (LGBT Health, 2021)
Purpose: This study examined the relationship between sexual orientation acceptance from others and suicide attempts among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. Methods: We analyzed data from a 2018 cross-sectional survey of LGBTQ youth between the ages of 13 and 24 years across the United States. Youth reported sexual orientation acceptance levels from parents, other relatives, school professionals, health care professionals, friends, and classmates to whom who they were "out." Adjusted logistic regression analyses were used to examine the association between sexual orientation acceptance and a past-year suicide attempt. Results: All forms of peer and adult acceptance were associated with reduced reports of a past-year suicide attempt, with the strongest associations found for acceptance from parents (adjusted odds ratio [aOR] = 0.52) and straight/heterosexual friends (aOR= 0.54). Youthwho reported high levels of acceptance fromany adult had nearly 40% (aOR= 0.61) lower odds of a past-year suicide attempt compared with LGBTQ peers with little to no acceptance. Youth with high levels of acceptance fromany peer also had significantly lower odds of reporting a past-year suicide attempt (aOR= 0.55). These relationships remained significant even after controlling for the impact of each form of acceptance, suggesting unique associations with suicide risk for both peer and adult acceptance. Conclusion: Interventions aimed at increasing sexual orientation acceptance from supportive adults and peers have strong potential to address the public health burden of LGBTQ youth suicide.
Keywords: Sexual Orientation; LGBTQ+ Persons -- Psychosocial Factors; Suicide -- Prevention and Control -- United States; Suicide, Attempted; Human; Cross Sectional Studies; Surveys; Adolescence; Young Adult; United States; Logistic Regression; Odds Ratio; Questionnaires; Gender Identity; Comparative Studies; Data Analysis Software; Chi Square Test; Descriptive Statistics

Sexual violence among men who have sex with men and two-spirit peoples: A scoping review. - Dame, Jessy; Oliffe, John L.; Hill, Nolan; Carrier, Leah; Evans-Amalu, Kelsey (Canadian Journal of Human Sexuality, 2020)
Sexual violence (SV) is a human rights and public health issue that impacts people from all communities. Men who have sex with men/Two-Spirit (MSM/2S) peoples are up to six times more likely to experience SV compared to heterosexual men. In addition, MSM/2S people are less likely to report SV. Reasons for this lack of reporting include male rape myths, fear of judgment, stigma, shame, homophobia, and/or lack of access to supportive services. The current scoping review offers a synthesis of the recent literature regarding SV among MSM/2S peoples in order to make research, practice, and policy recommendations. Findings indicated consistent SV risk factors, associated negative health outcomes, and barriers to accessing services. Risk factors included being younger, inexperience in MSM/2S communities, and having a history of sexual abuse or violence. Negative health outcomes included increased risk for HIV, depression, anxiety, heart disease, fear, eating disorders, substance use, social isolation, PTSD, and suicide. Help-seeking barriers included limited support services, lack of reporting, and male rape myths. Policy recommendations include targeted efforts to raise awareness of SV among MSM/2S peoples, and affirming the legitimacy of reporting SV through specialized healthcare services and trained professionals.
Keywords: Sexual Abuse; Men Who Have Sex With Men; LGBTQ+ Persons; Masculinity; Human; Systematic Review; Scoping Review; Outcomes (Health Care); Literature Review; Health Care Delivery -- Administration

Recruitment of Schools for Intervention Research to Reduce Health Disparities for Sexual and Gender Minority Students. - Shattuck, Daniel; Hall, Janie Lee; Green, Amy; Greenberg, Cynthia; Peñaloza, Linda; Ramos, Mary; Willging, Cathleen (Journal of School Nursing, 2020)
Recruiting schools for intervention research can be daunting. This study examined the experiences of researchers recruiting public high schools for a randomized controlled trial to reduce suicide disparities for sexual and gender minority (SGM) youth by implementing evidence-based strategies to enhance school environments. We enrolled 42 schools throughout New Mexico between August 2016 and April 2017. Based on qualitative analysis of recruitment efforts, three groups of factors affected enrollment: (1) non-SGM-specific factors, (2) SGM-specific factors, and (3) facilitating factors. Non-SGM-specific factors negatively impacted the willingness or ability to participate (e.g., demanding staff workloads and beliefs that "outsiders" should not assist with school-based interventions). Notable SGM-specific factors centered on influences in socially conservative community environments and beliefs that schools lacked SGM students. Advocacy, leveraging relationships, and persistence were facilitating factors for overcoming recruitment obstacles. Our findings have implications for researchers and school nurses interested in school-based interventions, especially those focused on SGM youth.
Keywords: Health Status Disparities; Suicide -- Prevention and Control -- In Adolescence; Sexual and Gender Minorities -- In Adolescence; Schools, Secondary -- New Mexico; Students, High School; Research Subject Recruitment; Human; School Health Nursing; Research Personnel -- Psychosocial Factors; Healthcare Disparities; Funding Source; New Mexico; Adolescence; Qualitative Studies; Purposive Sample

Differential Risks for Suicidality and Mental Health Symptoms Among Transgender, Nonbinary, and Cisgender Sexual Minority Youth Accessing Crisis Services. - Srivastava, Ankur; Rusow, Joshua A.; Goldbach, Jeremy T. (Transgender Health, 2021)
Purpose: We examined whether health risks among sexual minority youth (SMY) differ by gender identity (transgender, nonbinary, and cisgender). Methods: Data were collected on suicide attempts (lifetime and someday), depression and post-traumatic stress disorder (PTSD), and minority stress among SMY accessing crisis services. Results: In the multivariate regression models, compared to their cisgender peers, transgender and nonbinary youth were at higher risk for suicide attempt (lifetime and someday), depression, and PTSD. Minority stress was a significant predictor for all the models. Conclusion: Crisis service organizations working to reduce suicidality among SMY should be sensitive to diverse experiences of gender identity.
Keywords: Suicidal Ideation -- Risk Factors; Mental Disorders -- Symptoms; Health Services Accessibility; LGBTQ+ Persons; Minority Groups; Gender Identity; Human; Suicide, Attempted; Depression; Stress Disorders, Post-Traumatic; Multivariate Analysis; Regression; Child; Adolescence; Young Adult; Descriptive Statistics; Odds Ratio; Confidence Intervals

Sexual and Gender Minority Status and Firearms in the Household: Findings From the 2017 Behavioral Risk Factor Surveillance System Surveys, California and Texas. - Blosnich, John R.; Clark, Kirsty A.; Mays, Vickie M.; Cochran, Susan D. (Public Health Reports, 2020)
Objectives: Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with firearms in the home, the storage of firearms as stored unloaded, stored as loaded and locked, or stored as loaded and unlocked. Methods: We used data from the 2017 Behavioral Risk Factor Surveillance System surveys from California and Texas (N = 11 694), which were the only states to include items about both sexual orientation and gender identity and the status of firearms in the home. We used logistic regression analysis to assess the association of sexual orientation and gender identity with having firearms in the home while accounting for sociodemographic characteristics and survey state. All analyses were weighted to account for the complex sampling design. Results: Approximately 4.2% of the sample identified as lesbian, gay, and bisexual (LGB). About 18.2% of LGB people reported firearms in the home compared with 29.9% of their heterosexual peers. After adjusting for sex, age, race/ethnicity, educational attainment, and military veteran status, LGB respondents had significantly lower odds of reporting firearms in the home than their heterosexual peers (adjusted odds ratio = 0.47; 95% CI, 0.27-0.84). Among respondents with firearms in the home, firearm storage did not differ by sexual orientation. Conclusions: Further research is needed to examine whether lower odds of firearms in the home are protective against suicide deaths among LGB populations.
Keywords: Sexual and Gender Minorities; Firearms; Suicide, Attempted -- Epidemiology; Suicide -- Prevention and Control; Human; California; Texas; Sexual Orientation; Gender Identity; Logistic Regression; Descriptive Statistics; LGBTQ+ Persons; Heterosexuals; Peer Group; Odds Ratio; Confidence Intervals; Prevalence

Blosnich et al. Respond...Blosnich JR,Henderson ER, Coulter RWS, et al. Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016-2018. Am J Public Health. 2020; 110(7): 1024-1030. - Blosnich, John R.; Meyer, Ilan H.; Goldbach, Jeremy T.; Henderson, Emmett R.; Coulter, Robert W. S. (American Journal of Public Health, 2021)
Keywords: Suicidal Ideation -- Risk Factors; Adverse Childhood Experiences -- Complications; Sexual and Gender Minorities -- Psychosocial Factors

Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicidality...Blosnich JR, Henderson ER, Coulter RWS, et al. Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016–2018. American Journal of Public Health. 2020; 110(7): 1024-1030. - Rosik, Christopher H.; Sullins, D. Paul; Schumm, Walter R.; Van Mol, Andre (American Journal of Public Health, 2021)
Keywords: Sexual Orientation; Adverse Childhood Experiences; Suicidal Ideation -- Risk Factors -- United States; Attitude to Change; Sexual Reorientation Programs; Sexual and Gender Minorities -- Psychosocial Factors -- United States; United States

Associations of physical and sexual violence victimisation, homelessness, and perceptions of safety with suicidality in a community sample of transgender individuals. - Drescher, Christopher F.; Griffin, James A.; Casanova, Tracy; Kassing, Francesca; Wood, Elizabeth; Brands, Susan; Stepleman, Lara M. (Psychology & Sexuality, 2021)
Transgender and gender nonconforming (TGNC) individuals experience hardship and mistreatment. These experiences may contribute to mental health disparities faced by this community, including suicidality. The present study examined the associations between physical- and sexual-violence victimisation, homelessness, perception of safety, and suicidality among TGNC participants (N= 70) in an LGBTQ health needs assessment of the Central Savannah River Area. Half of the participants endorsed a history of sexual violence victimisation and 41.4% endorsed a history of partner physical violence. Just under one-third (30.3%) of the sample endorsed a history of homelessness. Over half of the sample (52.9%) endorsed a suicidal ideation history, while over one-third (37.1%) of the sample endorsed a suicide attempt history. Sexual violence victimisation was significantly correlated with suicidal ideation and attempt history. Hierarchical regression models including sexual violence victimisation, homelessness, and perception of safety significantly predicted histories of both suicidal ideation and suicide attempts; however, perception of safety was the only significant independent stressor in the models with suicidal ideation and suicide attempt as outcome variables. TGNC suicidality is a complex problem with multiple risk factors. Interventions that adopt an approach that helps to address intra- and interpersonal, social, familial, and community factors may be useful.

Depression and Suicide Risk at the Cross-Section of Sexual Orientation and Gender Identity for Youth. - Guz, Samantha; Kattari, Shanna K.; Atteberry-Ash, Brittanie; Klemmer, Cary L.; Call, Jarrod; Kattari, Leonardo (Journal of Adolescent Health, 2021)
Adolescence is a developmental phase in which young people begin to explore their identity and seek to understand how their identity fits into the larger society. Although this is a developmental task for all adolescents, it is especially salient for sexual and gender minority youth. Owing to oppressive social structures and stigmatized identities, adolescents who identify as nonheterosexual or noncisgender are vulnerable to experiencing disproportionate adverse health outcomes. To further the literature on adolescent mental health among sexual and gender minority youth, this study analyzed a representative statewide sample of high school students (ages 14–18) to analyze how sexual orientation and gender identity are associated with depression and suicidality. Results aligned with previous research demonstrating that sexual and gender minority youth were all at a heightened risk for depression. However, transgender youth and youth questioning their sexuality or gender were at especially heightened risk for experiencing depression and suicidality. The findings of this study indicate a need to target or adapt direct services and programming for sexual and gender minority adolescents.
Keywords: Depression -- Risk Factors; Suicide -- Risk Factors; Sexual Orientation; Gender Identity -- In Adolescence; Mental Health -- In Adolescence; Minority Groups; Students, High School; Risk Assessment; Human; Cross Sectional Studies; Adolescence; Sexuality; LGBTQ+ Persons; Random Sample; Data Analysis Software; Descriptive Statistics; Logistic Regression; Models, Statistical; Female; Male; Odds Ratio; Confidence Intervals

A cross-sectional study of mental health, suicidal ideation and suicide attempt among transgender women in Jiangsu province, China. - Chen, Yuanfang; Chen, Shi; Arayasirikul, Sean; Wilson, Erin; McFarland, Willi; Lu, Jing; Chen, Yunting; Yan, Hongjing (Journal of Affective Disorders, 2020)
Objectives: To measure prevalence and risk factors of poor mental health, suicidal ideation, and suicide attempt among transgender women in Jiangsu province, China.Methods: We surveyed 250 transgender women with mean age of 27.9 years from July 2018 to May 2019 in Jiangsu province, China. Logistic regression analysis characterized risk factors for mental health, suicidal ideation, and suicide attempt.Results: Many transgender women experienced discrimination, including verbal abuse (56.0%), physical abuse (32.0%), and sexual violence (32.0%) during their lifetime. Classification by the Kessler Psychological Distress Scale found 32.4%% to be in good mental health, while 24.0%, 16.8%, and 26.8% had mild, moderate, and severe psychological distress respectively. In multivariable logistic regression, severe psychological distress was correlated with bisexual orientation (vs. gay/lesbian, aOR = 2.9, 95%CI = 1.5-5.8), being unsure of sexual orientation (vs. gay/lesbian, aOR = 4.7, 95%CI = 1.8-12.8), experience of verbal abuse (aOR = 1.8, 95%CI = 1.1-3.1), and less severe with alcohol use (aOR = 0.6, 95%CI = 0.3-0.9) (P< 0.05). Many transgender women also reported suicidal ideation (22.0%) and prior suicide attempt (25.6%). Compared to no suicidal ideation, moderate (aOR = 4.9, 95%CI = 1.6-15.2) or severe psychological distress (aOR = 38.6) were associated with prior suicide attempt (P< 0.05). Residing in Jiangsu province (vs. not residing in Jiangsu, aOR = 0.3, 95%CI = 0.1-0.6) and higher income (vs. lower income, aOR = 0.6, 95%CI = 0.4-0.9) were protective factors for suicide attempt (P< 0.05).Conclusion: Chinese transgender women experience high levels of discrimination, abuse, poor mental health, suicidal ideation, and suicide attempts in Jiangsu province. Society-wide interventions need to be developed to mitigate transphobic discrimination among transgender women in China.
Keywords: Suicide, Attempted; Female; Mental Health; China; Cross Sectional Studies; Suicidal Ideation; Human; Adult; Risk Factors; Male; Comparative Studies; Multicenter Studies; Evaluation Research; Validation Studies; Scales

Variation in Suicide Risk among Subgroups of Sexual and Gender Minority College Students. - Horwitz, Adam G.; Berona, Johnny; Busby, Danielle R.; Eisenberg, Daniel; Zheng, Kai; Pistorello, Jacqueline; Albucher, Ronald; Coryell, William; Favorite, Todd; Walloch, Joseph C.; King, Cheryl A. (Suicide & Life-Threatening Behavior, 2020)
Objective: Sexual and gender minorities are at elevated risk for suicide, yet few studies have examined differences in risk within many sexual and gender minority subgroups. The purpose of this study was to examine differences in prevalence for suicide risk factors among a wide range of sexual orientations and gender identities.Method: Forty-one thousand four hundred and twelve college students (62% cis-female, 37% cis-male, 1% transgender/genderqueer) completed a wellness screen that included four suicide risk factors (depression, heavy alcohol use, suicide ideation, suicide attempt).Results: Gender minority students (i.e., transgender, genderqueer/non-binary) had significantly higher rates of depression, suicide ideation, and suicide attempts relative to cisgender peers, although there were no within-group differences among gender minority students. Adjusted odds ratios for endorsing two or more (2+) suicide risk factors were substantially higher for all sexual minority subgroups relative to heterosexuals. Among sexual minorities, those identifying as pansexual, bisexual, queer, or mostly gay/lesbian had greater odds of endorsing 2+ suicide risk factors relative to students identifying as mostly heterosexual, gay/lesbian, asexual, or 'other sexual minority'. Pansexual students had 33% greater odds of endorsing 2+ suicide risk factors relative to bisexual students.Conclusions: These findings highlight significant variation in suicide risk among sexual minority subgroups and the need for targeted interventions for subgroups at highest risk.

Suicide thought and behaviors, non-suicidal self-injury, and perceived life stress among sexual minority Mexican college students. - Rentería, Roberto; Benjet, Corina; Gutierrez-Garcia, Raúl A.; Ábrego Ramírez, Adrián; Albor, Yesica; Borges, Guilherme; Covarrubias Díaz Couder, María Anabell; Durán, María del Socorro; González González, Rogaciano; Guzmán Saldaña, Rebeca; Hermosillo De la Torre, Alicia E.; Martínez-Jerez, Ana María; et al. (Journal of Affective Disorders, 2021)
Background: Sexual minority college students are at a higher risk for suicidal thoughts and self-injurious behaviors compared to heterosexual students. Minority stress theory proposes sexual minority individuals experience higher stress due to stigma. Using a sample of Mexican college students, this study tested perceived life stress as a mediator of suicide and self-injury outcomes across various sexual orientation groups.Methods: The sample of college students (N=7882) was recruited from nine Mexican universities as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. Participants completed an online survey including demographic questions, measure of perceived life stress, suicide outcomes, and non-suicidal self-injury (NSSI) in the past 12 months.Results: Logistic regression analyses revealed identifying as a sexual minority significantly predicted a higher likelihood of suicide ideation (ORs 2.05-3.00), suicide attempts (ORs 2.48-8.73), and NSSI (ORs 2.92-4.18) compared to heterosexual students reporting no same-gender attraction. Significant indirect effects from mediation path analyses showed perceived life stress mediated the relationship between a sexual minority identity and suicide ideation (range of proportion mediated 10.48-31.48%), attempts (10.48-31.48%), and NSSI (7.69-20.09%) across each group except among asexual students.Limitations: The cross-sectional nature of the survey design precludes drawing causal inferences.Conclusion: Findings from this study contribute to minority stress theory by elucidating the role of perceived life stress as a mediator of suicide ideation and attempts and NSSI among sexual minority college students. Clinical interventions may benefit in focusing on experiences of stress across various life areas when supporting sexual minority college students.

Sexual violence as a mediator of sexual orientation disparities in alcohol use, suicidality, and sexual-risk behaviour among female youth. - Scheer, Jillian R.; McConocha, Erin; Behari, Kriti; Pachankis, John E. (Psychology & Sexuality, 2021)
Sexual violence exposure represents a serious public health issue among female youth given its association with female youths' engagement in health-risk behaviours. Sexual minority female youth are particularly vulnerable to sexual violence exposure, alcohol use, suicidality, and sexual-risk behaviour. Using the population-based 2017 Youth Risk Behaviour Survey, we examined sexual violence as a mediator of sexual orientation disparities in health-risk behaviours among female youth. This study included 7,532 female students in grades 9 through 12 across the US. Participants identified their sexual orientation as heterosexual (73.5%); bisexual (12.2%); and, gay or lesbian (2.2%). Compared to heterosexual female youth, sexual violence exposure, alcohol use, binge drinking, and multiple sex partners were more common among bisexual female youth. The elevated risk of suicidality was most notable among gay or lesbian female youth relative to heterosexual female youth and bisexual female youth relative to heterosexual female youth. Mediation analyses showed that sexual violence exposure partially explained the sexual orientation disparity in these co-occurring health-risk behaviours between bisexual female youth and heterosexual female youth. Our findings highlight the need for clinical attention to be paid to assessing and treating the health effects of sexual violence, especially among bisexual female youth.

Suicidal ideation in gender and sexual minority students in the largest Brazilian University. - Ramírez, Erika Gisseth Leon; Delgado, Yuly Katherine; Volpato, Rosa Jacinto; de Claudio, João Carlos M.; Pinho, Paula Hayashi; de Vargas, Divane (Archives of Psychiatric Nursing, 2020)
Identifying the presence of suicidal ideation and associated factors among university students from a public university in Brazil. A cross-sectional study was performed with 72 university students between 18 and 29 years old. Were used a sociodemographic data questionnaire and the Beck's Suicidal Ideation Scale. The suicidal ideation was significantly in the participants, as well as the association of gender, gender identity, sexual orientation and housing with it. The suicidal ideation in this population is important, and there is a need to explore the factors related, such as gender, sexual orientation, gender identity and housing. • The present study presents relevant findings for the LGBT Latin context • Transgender; cisgender women; nonbinary and bisexual individuals had association with suicidal ideation. • "Emerging identities" as Pansexual individuals could have a high risk for the suicide ideation. • Association between transgender individuals and high suicide ideation rates was identified in this study.
Keywords: Suicidal Ideation -- Risk Factors; Sexual and Gender Minorities; Students, Minority -- Psychosocial Factors; Students, College -- Psychosocial Factors; Public Sector; Colleges and Universities -- Brazil; Risk Assessment; Human; Brazil; Cross Sectional Studies; Adolescence; Adult; Questionnaires; Scales; Sexual Orientation; Gender Identity; Housing; LGBTQ+ Persons; Hispanic Americans; Descriptive Statistics; Data Analysis Software; Mann-Whitney U Test; Kruskal-Wallis Test; Poisson Distribution; Regression; Models, Statistical; Male

Preteen Behaviors and Sexual Orientation of High School Students Who Report Depressive Symptoms, United States, 2015-2017. - D'Agati, Douglas; Kahn, Geoffrey D.; Swartz, Karen L. (Public Health Reports, 2021)
Unhealthy preteen behaviors are associated with adolescent depression. However, little is known about preteen factors among sexual minority young people, a group at increased risk for teen depression and suicide. We completed weighted multivariate logistic regression analyses on data from the national 2015 and 2017 Youth Risk Behavior Survey of 30 389 high school students in the United States. Preteen sex, cigarette smoking, and alcohol and marijuana use were significantly more prevalent among lesbian, gay, or bisexual (LGB) and questioning students who reported depressive symptoms than among their heterosexual peers (adjusted prevalence ratio [APR] range, 1.33-2.34; all significant at P <.05). The only exception was that marijuana use among questioning students was not significantly different from use among heterosexual peers (APR = 1.34; P =.11). Assessment of preteen sex and substance use—especially among LGB and questioning young people, who are more prone to depressive symptoms and more likely to initiate risky preteen behaviors than their heterosexual counterparts—will facilitate a life course approach to sexual minority mental health that should begin by early adolescence.
Keywords: Sexual Orientation; Adolescent Behavior; Students, High School; Depression; Health Behavior; Risk Taking Behavior; Human; Secondary Analysis; Smoking; Questionnaires; LGBTQ+ Persons; Multivariate Analysis; Logistic Regression; Cannabis

School Climate & Sexual and Gender Minority Adolescent Mental Health. - Colvin, Sharon; Egan, James E.; Coulter, Robert W. S. (Journal of Youth & Adolescence, 2019)
Sexual/gender minority (Sexual/gender minority people are also referred to as Lesbian, Gay, Bisexual, Transgender, Queer) youth are more likely than cisgender heterosexual youth to exhibit depressive symptoms and be victimized. School climate research indicates that the presence of a Gay–Straight Alliance (a Gay–Straight Alliance or Gender-Sexuality Alliance is also referred to as a GSA and is a youth group to support sexual/gender minority youth), a supportive school climate, and seeking help from teachers are associated with more positive mental health outcomes; however, they are not typically measured together. This study uses a survey that measures all four measures of school environment with a national sample of 240 sexual/gender minority high school students ages 14–18 (mean age 15.77) where 53% of participants had a Gay–Straight Alliance in their school. The sample is 53% cisgender, 100% sexual minority and 62% white. Adjusting for demographics and presence of a Gay–Straight Alliance, fewer depressive symptoms were associated with lower help-seeking intentions for suicidal thoughts. The presence of Gay–Straight Alliance was not statistically associated with past-month help-seeking intentions or behaviors. Additionally, a more supportive school climate was associated with lower anxiety and depressive symptoms. However, the presence of a Gay–Straight Alliance was not statistically associated with anxiety or depressive symptoms. These findings suggest that a supportive school climate and supportive school personnel may be important for supporting the mental health of sexual/gender minority students.
Keywords: Learning Environment -- Evaluation; LGBTQ+ Persons -- Psychosocial Factors; Students, Minority -- Psychosocial Factors; Students, High School -- Psychosocial Factors; Adolescent Health; Mental Disorders -- Risk Factors; Risk Assessment; Human; Surveys; Adolescence; Gay Persons; Transgender Persons; White Persons; Depression -- Risk Factors; Help Seeking Behavior; Suicidal Ideation -- Risk Factors; Anxiety -- Risk Factors; Faculty-Student Relations; Climate; Support, Psychosocial

Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature. - Rew, Lynn; Young, Cara C.; Monge, Maria; Bogucka, Roxanne (Child & Adolescent Mental Health, 2021)
Background: Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking gender‐affirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin‐releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition. Methods: We conducted a critical review of the literature to answer a series of questions about criteria for using puberty‐blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria. Results: Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged 'excellent', five studies met the majority of quality criteria resulting in 'good' ratings, whereas three studies were judged fair and had serious risks of bias. Conclusion: Given the potentially life‐saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples.
Keywords: Transgender Persons -- Psychosocial Factors; Gender Identity; Puberty; Gonadorelin -- Therapeutic Use; Hormone Antagonists -- Therapeutic Use; Human; Systematic Review; Psycinfo; PubMed; Psychological Well-Being; Body Composition

Prevalence and predictors of suicidal thoughts and behaviours among Australian police and emergency services employees. - Kyron, Michael J.; Rikkers, Wavne; Page, Andrew C.; O'Brien, Patrice; Bartlett, Jennifer; LaMontagne, Anthony; David, Lawrence (Australian & New Zealand Journal of Psychiatry, 2021)
Objective: This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors. Method: A stratified random sample of personnel from 33 Australian emergency services organisations were invited to participate in a mental health and wellbeing survey. In total, 14,868 Australian ambulance, fire and rescue, police and state emergency services employees participated and self-reported any suicidal thoughts, plans and/or attempts in the 12 months prior to the survey or at any stage in their life. Logistic regressions assessed factors associated with suicidal thoughts and behaviours. Results: Employees reported notably higher rates of suicidal thoughts and plans than the general Australian adult population, but not attempts. Male, single/divorced, non-heterosexual or longer-serving employees reported higher rates of suicidal thoughts and behaviours across each sector. Perceptions of stigma regarding mental health conditions from others in the workplace, negative impact of work on one's private life and low meaning of work were associated with suicidal thoughts, while bullying significantly differentiated who planned and attempted suicide from those who reported suicidal thoughts only. Higher resilience and social support were associated with lower suicidal thoughts, while intermittent explosive anger and illegal drug use were associated with higher rates of suicidal thoughts. Post-traumatic stress disorder symptoms significantly differentiated who planned suicide, while misuse of prescription drugs and psychological distress differentiated who attempted suicide from those who only reported suicidal thoughts. Conclusion: Amid inherently stressful occupations, it is important that workplaces function in a way that supports their personnel. Access to mental health services should be promoted and readily available to personnel.
Keywords: Suicidal Ideation -- Epidemiology; Suicide, Attempted -- Epidemiology; Police -- Australia; Emergency Medical Technicians -- Australia; Work Environment; Human; Australia; Random Sample; Mental Health; Psychological Well-Being; Surveys; Logistic Regression; Self Report; Male; Female; Sex Factors; Stigma; Hardiness; Support, Psychosocial; Stress Disorders, Post-Traumatic -- Complications; Depression -- Complications

Predictors of sexual victimisation and suicidal ideation among transgender and gender-nonconforming adolescents. - Marx, Robert A.; Hatchel, Tyler; Mehring, Cole B.; Espelage, Dorothy L. (Psychology & Sexuality, 2021)
To better understand the well-being of transgender and gender-nonconforming (TGNC) adolescents, this study examined the relations among bias-based peer victimisation, sexual harassment, parental support, school belonging, sexual violence, and suicidal ideation in a sample of a total of 16,292 high school students from the U.S (TGNC n= 610) Midwest. Students completed self-report measures: 22% of TGNC adolescents reported being forced to take part in sexual activity, and 33% reported being sexually harassed. Tests of the individual parameters revealed four variables that differentiated between those who reported sexual victimisation and those who did not. Results indicated that sexual harassment victimisation, bias-based peer victimisation, problematic drug use, and female sex assigned at birth predicted sexual victimisation. Suicidal ideation was predicted by sexual victimisation, sexual harassment victimisation, bias-based peer victimisation, and problematic drug use. Greater parental support and school belonging were associated with less suicidal ideation. Practitioners, teachers, and school administrators should be sure to intervene in instances of transphobic victimisation and sexual harassment that occur in their classrooms and schools in order to address adverse outcomes for TGNC adolescents.

A systematic review of qualitative studies capturing the subjective experiences of Gay and Lesbian individuals' of faith or religious affiliation. - Wilkinson, Dean J.; Johnson, Amy (Mental Health, Religion & Culture, 2020)
Individuals identifying as religious tend to report better health and happiness regardless of affiliation, work and family social support or financial status. Evidence suggests that cultural factors are intertwined with these concepts. Exploration of sexual minorities' experiences has been neglected. Recently, a body of evidence is developing concerning this population, with theoretical speculation for changes of "stressors" for future generations and implications, particularly, on mental health. Lesbian and Gay (LG) individuals of faith (or spirituality) are susceptible to unique "stressors"; however, religion can provide a support network providing protective health benefits. This review systematically explores the existing evidence for the subjective experiences and accounts of LG people of faith. Sexual minority individuals who follow a religion or faith can experience good social support, reducing the risk of negative health outcomes, while for others, potentially serious, negative mental and physical health consequences are experienced (e.g., internalised homophobia, anxiety, rejection and suicidal ideation).
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Religion and Psychology; Spirituality; Mental Health; Human; Systematic Review; Support, Psychosocial; Homophobia -- Prevention and Control; Anxiety -- Risk Factors; Suicidal Ideation -- Risk Factors; Social Behavior; Anxiety -- Prevention and Control; Suicidal Ideation -- Prevention and Control

Clergy Attitudes About Ways to Support the Mental Health of Sexual and Gender Minorities. - Raedel, Daniel B.; Wolff, Joshua R.; Davis, Edward B.; Ji, Peter (Journal of Religion & Health, 2020)
This pilot study explored clergy members' attitudes about ways to support the mental health needs of sexual and gender minorities (SGM; e.g., lesbian, gay, bisexual, and transgender people). Participants (N = 86, 46% female, 26% SGMs) were US clergy members from a variety of religious faiths but mostly were leaders in Christian faith communities in the greater Chicago area. Clergy participants completed quantitative and qualitative items asking what types of resources (e.g., workshops, websites, consultations, or testimonies) and delivery format (online or in-person) they perceived as most helpful in supporting the mental health of SGM members in their faith communities. The results demonstrated that clergy members found all listed resources to be helpful to varying degrees, although suicide and homelessness prevention were prioritized above other resources. Clergy members also prioritized resources related to supporting gender minorities to be more informative, relative to resources for supporting sexual minorities. Finally, clergy member preferred information to be delivered in-person instead of online. The degree of openness to LGBTQ health promotion resources did not vary by clergy religious denomination.
Keywords: Clergy; Attitude; Support, Psychosocial; Mental Health; Sexual and Gender Minorities; Human; Male; Female; Pilot Studies; Christianity; Religion and Religions; Quantitative Studies; Qualitative Studies; Internet; Suicide -- Prevention and Control; Homelessness; LGBTQ+ Persons; Transgender Persons

Exploring School Victimization and Weapon Carrying Among Military-Connected Lesbian, Gay, Bisexual, and Transgender Youth in California Schools. - Pedro, Kris Tunac De; Esqueda, Monica Christina (Journal of Interpersonal Violence, 2020)
Military-connected youth often experience daily stressors that affect their academic success and social and emotional development. Stressors such as multiple deployments and frequent school transitions may weaken the social ties that military-connected youth have with school communities, placing them at risk of social alienation and victimization. Within this youth population, military-connected lesbian, gay, bisexual, and transgender (LGBT) youth may be especially at risk of school victimization. However, to the authors' knowledge, no empirical studies have been conducted on the school experiences of military-connected LGBT youth. Drawing from the California Healthy Kids Survey (CHKS; n = 634,978), this study explored school victimization and weapon carrying among military-connected LGBT youth and their peers. Multivariate logistic regression analyses revealed that military connection, LGB identity, and transgender identity were associated with an increased odds of nonphysical victimization, physical violence, and weapon carrying. Military transgender youth were at an increased risk of weapon carrying (adjusted odds ratio [AOR] = 1.63; 95% confidence interval [CI] = [1.23, 2.16]). Future research is needed to explore risk and protective factors influencing school victimization and weapon carrying among military-connected LGBT youth.
Keywords: School Violence -- California; Victims -- Psychosocial Factors; Weapons; LGBTQ+ Persons -- Psychosocial Factors; Military Family -- Psychosocial Factors; Adolescent Behavior; Bullying; California; Social Alienation; Human; Empirical Research; Multiple Logistic Regression; Assault and Battery; Odds Ratio; Confidence Intervals; Secondary Analysis; Chi Square Test; Male; Female; Descriptive Statistics

Mental Health and Health Risk Behaviors of Active Duty Sexual Minority and Transgender Service Members in the United States Military. - Holloway, Ian W.; Green, Daniel; Pickering, Chad; Wu, Elizabeth; Tzen, Michael; Goldbach, Jeremy T.; Castro, Carl A. (LGBT Health, 2021)
Purpose: The aim of this study was to examine health risk behaviors and mental health outcomes among sexual minority and transgender active duty military service members and their heterosexual and cisgender counterparts. Methods: Participants (N= 544) were recruited by using respondent-driven sampling between August 2017 and March 2018 and completed an online survey by using validated measures of cigarette smoking, alcohol use, anxiety, depression, post-traumatic stress disorder (PTSD), and suicidality. Bayesian random intercept multiple logistic regressions were used to understand differences between sexual minority participants and heterosexual participants as well as between transgender participants and both their cisgender sexual minority and cisgender heterosexual peers. Results: Cisgender sexual minority women service members were more likely to meet criteria for problematic alcohol use (adjusted odds ratio [aOR] = 10.11) and cigarette smoking (aOR = 7.12) than cisgender heterosexual women. Cisgender sexual minority men had greater odds of suicidality (aOR = 4.73) than their cisgender heterosexual counterparts. Transgender service members had greater odds of anxiety, PTSD, depression, and suicidality than their cisgender peers. Conclusion: Military researchers and policymakers who seek to improve the overall health and well-being of sexual minority and transgender service members should consider programs and policies that are tailored to specific health outcomes and unique sexual minority and transgender subgroups.
Keywords: Mental Health; Health Behavior; Risk Taking Behavior; Military Personnel -- United States; Sexual and Gender Minorities; Transgender Persons; Military Services -- United States; Human; United States; Descriptive Statistics; Data Analysis Software; Odds Ratio; Regression; Confidence Intervals; Male; Female; Young Adult; Adult; Bivariate Statistics; Logistic Regression

Perceived Importance of Health Concerns Among Lesbian, Gay, Bisexual, and Transgender Adults in a National, Probability-Based Phone Survey, 2017. - Boynton, Marcella H.; Gilbert, Jeffrey; Shook-Sa, Bonnie E.; Lee, Joseph G. L. (Health Promotion Practice, 2020)
Perceptions of the importance of health problems can drive advocacy, policy change, resource distribution, and individual behaviors. However, little is known about how lesbian, gay, bisexual, and transgender (LGBT), that is, sexual and gender minority (SGM) adults view the health problems facing SGM populations. In a 2017 national, probability-based survey of U.S. SGM adults (N = 453), we asked respondents to identify the most serious health problem facing SGM people today. Participants also rated the seriousness of five specific health problems (HIV/AIDS, suicide, hate crimes, harmful alcohol use, tobacco use). Analyses accounted for the complex sampling design and were stratified by gender identity. One quarter of U.S. SGM adults identified the most serious health problem facing SGM people to be HIV/AIDS (95% confidence interval [20.3, 31.2]). More respondents stated there were no serious LGBT health differences compared with straight/cisgender adults (4.2%, confidence interval [2.6, 5.9]) than identified tobacco use, hate crimes, chronic diseases, cancer, or suicide as the most serious. Importance ratings differed by gender and tobacco/alcohol use were perceived as less serious compared with HIV/AIDS, suicide, and hate crimes. Attention paid to HIV/AIDS by the SGM public, while important, may hinder efforts to address chronic diseases and other health issues affecting SGM people.
Keywords: Health Status -- Psychosocial Factors; Attitude to Health; LGBTQ+ Persons -- In Adulthood; Sexual and Gender Minorities; Human; Surveys; Adult; Confidence Intervals; Descriptive Statistics; Questionnaires; Gender Identity; HIV Infections -- Risk Factors; Suicide; Chronic Disease -- Risk Factors; Sexually Transmitted Diseases -- Education

Disparities in Prescription Opioid Misuse Affecting Sexual Minority Adults Are Attenuated by Depression and Suicidal Ideation. - Morgan, Ethan; Feinstein, Brian A.; Dyar, Christina (LGBT Health, 2020)
Purpose: Heightened rates of prescription opioid misuse have been observed among sexual minority (SM) compared with heterosexual populations. In addition, depression and suicidal ideation are risk factors for misuse, and they are also elevated among SM populations. The purpose of this analysis was to examine whether depression and suicidal ideation attenuate disparities in prescription opioid misuse among SM adults. ***Methods: Data came from a publicly available, nationally representative data set, the National Survey on Drug Use and Health, 2015-2018. Among adults, survey-weighted logistic regression was used to assess the relationship between sexual orientation and past-year opioid misuse adjusting for demographics and either past-year major depressive episode or suicidal ideation. Probabilities of prescription opioid misuse were also assessed under counterfactual rates of depression and suicidal ideation. Analyses were stratified by sex. ***Results: Among participants in the analytic sample (N = 169,759; SM= 11,268), 9254 (5.5%) reported past-year prescription opioid misuse. The overall rate of opioid misuse decreased from 6.2% in 2015 to 4.6% in 2018. The association between sexual orientation and opioid misuse was attenuated downward for gay men, lesbian women, and bisexual individuals (men and women) after adjusting for either major depressive episode or suicidal ideation, but opioid misuse remained higher among most SM groups. In addition, rates of opioid misuse were found to be lower in counterfactual analyses with a nearly 2.5- and 4-fold decrease in depression and suicidal ideation among gay men and bisexual women, respectively. ***Conclusion: Efforts to reduce disparities in depression and suicidal ideation affecting SM individuals may reduce disparities in prescription opioid misuse affecting this population.
Keywords: Sexual and Gender Minorities -- Psychosocial Factors -- In Adulthood; Analgesics, Opioid; Substance Use Disorders -- Risk Factors -- In Adulthood; Depression; Suicidal Ideation; Health Status Disparities -- In Adulthood; Human; Logistic Regression; Sexual Orientation; Adult; United States; Funding Source; Heterosexuals; Descriptive Statistics; Confidence Intervals; Odds Ratio

Kids helping kids: The lived experience of adolescents who support friends with mental health needs. - Roach, Ashley; Thomas, Sandra P.; Abdoli, Samereh; Wright, Megan; Yates, Andria L. (Journal of Child & Adolescent Psychiatric Nursing, 2021)
Problem: Adolescent mental health is a significant health care issue. Friends play an important role in the lives of adolescents with mental health concerns and help to improve outcomes related to depression and suicide. However, little is known about the experiences of adolescents who help their friends with these concerns. Methods: A phenomenological research design involving unstructured interviews was used to answer the question: what is the lived experience of adolescents who provide support to friends with anxiety, depression, or who express suicidal ideation?" Participants for this study were aged 16–17 and included both males (n = 2) and females (n = 3). Findings: Participants described their experience as "Kids Helping Kids" which is defined by the following themes: Being Fearful, Maintaining Vigilance, Seeking Knowledge, Keeping Secrets, Involving Others, Setting Boundaries, and Feeling Honored. Conclusion: Helping a friend with mental health concerns can be challenging yet rewarding. Nurses should be aware of this role that some adolescents undertake and include the friends of adolescents with mental health concerns as part of plans of care.
Keywords: Suicidal Ideation -- Prevention and Control -- In Adolescence; Depression -- Prevention and Control -- In Adolescence; Anxiety -- Prevention and Control -- In Adolescence; Caregiver Support -- Methods -- In Adolescence; Life Experiences -- Evaluation -- In Adolescence; Human Needs (Psychology); Peer Group; Friendship; Human; Male; Female; Transgender Persons; Adolescence; Tennessee; Support Groups; Phenomenological Research; Unstructured Interview; Thematic Analysis; Open-Ended Questionnaires; Audiorecording; Funding Source

Sexual violence and suicide risk in the transgender population: the mediating role of proximal stressors. - Cogan, Chelsea, M.; Scholl, James A.; Lee, Jenny Y.; Cole, Hannah E.; Davis, Joanne L. (Psychology & Sexuality, 2021)
The transgender population is at increased risk for mental and physical health disorders. Previous research indicates these disparities exist as a result of exposure to disproportionately more adverse life events, including multiple forms of violence, and hostile and unaccepting social environments. Minority stress theory posits that exposure to unique types of stressors (i.e. distal stressors and proximal stressors), in addition to the stress experienced by the general population, result in poor health outcomes. A consequence of exposure to these stressors is a high rate of suicide. The current study sought to examine the mediating role of proximal stressors (e.g. internalised stress related to gender identity) on the relationship between sexual violence and suicide risk in a transgender sample. Participants included 155 transgender individuals who completed measures related to experiences of traumatic events, gender minority stress, and suicide risk. The association between experiences of sexual violence and suicide risk was significant (F[1,153] = 33.86, p <.001, R2 = 0.18). Proximal stressors were found to partially mediate the relationship between sexual violence and suicide risk (t[2, 152] = 3.49, p =.006). These findings demonstrate a need for increased resources in sexual violence prevention and competent care for survivors of sexual assault in the transgender community.

Men's Reflections on Their Experiences of Gender-Based Violence. - Sinacore, Ada L.; Durrani, Samir; Khayutin, Sarah (Journal of Interpersonal Violence, 2021)
Using Multicultural and Gender Case Conceptualization (MGCC) epistemology, the aim of this phenomenological study was to explore adult male victims' perceptions of gender and reflections on their experiences of gender-based violence (GBV). Data were analyzed using interpretative phenomenological analysis (IPA). Results indicated that, regardless of sexual orientation, participants experienced verbal and physical abuse due to their feminine gender expression, beginning in primary school and continuing through university and into the workplace. To reduce victimization, the men developed a range of strategies, such as policing their gender and avoiding social situations. The experiences of violence affected the participants' social relationships, choice of occupation, self-esteem, and ability to trust. However, after entering university, heterosexual, gay, and bisexual participants interpreted their experiences differently, whereby heterosexual participants linked the abuse to gender, and gay and bisexual participants viewed it as homophobia. As well, gay and bisexual participants found respite in the gay and bisexual communities, while heterosexual participants remained silent, isolated, and afraid to discuss their experiences. Implications for future research are discussed.
Keywords: Gender-Based Violence -- Psychosocial Factors -- In Adulthood; Crime Victims -- Psychosocial Factors; Patient Attitudes -- Evaluation; Life Experiences -- Evaluation; Gender Identity; Reflection; Men's Health; Human; Phenomenological Research; Adult; Sexuality; Interpersonal Relations; Self Concept; Trust; Homophobia; Heterosexuals; Bisexuals; Gay Men; Social Isolation; Cultural Values; Retrospective Design; Record Review; Purposive Sample; Male; Semi-Structured Interview; Descriptive Statistics; Masculinity; Adolescence; Adverse Childhood Experiences; Support, Psychosocial; Friendship; School Violence; Workplace Violence

Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood. - Salway, Travis; Gesink, Dionne; Ferlatte, Olivier; Rich, Ashleigh J.; Rhodes, Anne E.; Brennan, David J.; Gilbert, Mark (Social Psychiatry & Psychiatric Epidemiology, 2021)
Purpose: Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985-2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities.Methods: Age- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders.Results: We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18-20 years of age for both genders) and one peak nearing mid-life (30-35 years of age for men; 35-40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity.Conclusion: In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course.
Keywords: Suicide, Attempted; Canada; United States; Young Adult; Female; Sexuality; Male; Heterosexuality; Cross Sectional Studies; Adult; Adolescence

Risk and protective factors for suicide among sexual minority youth seeking emergency medical services. - Horwitz, Adam G.; Grupp-Phelan, Jacqueline; Brent, David; Barney, Bradley J.; Casper, T. Charles; Berona, Johnny; Chernick, Lauren S.; Shenoi, Rohit; Cwik, Mary; King, Cheryl A. (Journal of Affective Disorders, 2021)
Background: Differences in risk and protective factors (e.g., victimization, abuse, social support) have been used to explain elevated rates of suicidal ideation and suicide attempts in sexual minority youth (SMY) relative to heterosexual peers. However, little is known regarding how risk and protective factors may explain suicide risk differences among subgroups of SMY. The aims of this study were to 1) examine differences in prevalence and severity for suicide risk and protective factors among SMY, and 2) explore whether risk and protective factors are differentially associated with suicidal ideation and suicide attempts for SMY subgroups.Methods: Participants were 6,423 adolescents (ages 12-17) recruited from 14 Emergency Departments across the United States who completed an assessment of suicide risk and protective factors. SMY were 20% of the sample (n = 1,275) and categorized as bisexual (8%), gay/lesbian (2%), mostly straight (5%), or other sexual minority (5%).Results: Bisexual youth had elevated rates of suicidal ideation and attempts, more risk factors (e.g., bullying victimization, depression), and fewer protective factors (e.g., parent-family connectedness, positive affect) relative to mostly straight and other sexual minority youth. Bisexual and gay/lesbian youth only differed in parent-family connectedness (lower among bisexual youth). Depression and parent-family connectedness had weaker associations with suicidal ideation for bisexual youth.Limitations: Emergency departments were not nationally representative. Study design was cross-sectional, preventing causal inferences.Conclusions: Interventions seeking to mitigate risk factors and promote protective factors are greatly needed for SMY and may benefit from tailoring to address unique stressors for sexual minority subgroups.

Teen Dating Violence and Suicide Risk Among Bisexual Adolescents. - Smith, Ariel U.; Reidy, Dennis; Norris, Anne E. (Journal of Adolescent Health, 2020)
Suicide is a public health problem that disproportionately affects bisexual youth more than heterosexual, lesbian/gay, and other sexual minority youth. Teen dating violence (TDV) consists of physically, emotionally, and/or psychologically aggressive behavior in adolescent relationships and has been linked to increased suicidality among sexual minority youth. Although biological sex differences in suicide and TDV have been noted, limited research currently exists regarding the importance of these differences in bisexual youth. This study employed a cross-sectional descriptive design to investigate the relationship between biological sex, TDV, and suicide risk among bisexual youth in grades 9–12. This study used structural equation modeling to conduct a secondary analysis of pooled 2015 and 2017 national Youth Risk Behavior Surveillance Survey data that examined whether TDV mediated the relationship between biological sex and suicide risk among bisexual youth. Results indicated that TDV did not mediate the relationship between biological sex and suicide risk among bisexual youth. Biological sex was a significant predictor of suicide risk with male youth reporting lower suicide risk than female youth, when controlling for dating history, TDV, age, and race. TDV predicted suicide risk, with youth reporting TDV having higher suicide risk, when controlling for dating history, biological sex, age, and race. In addition, black and Hispanic youth reported lower suicide risk compared to white youth. There is a dire need for research that addresses issues of TDV and suicide among bisexual youth. Understanding factors influencing suicide risk following TDV experiences among bisexual youth will inform interventions to mitigate negative mental health outcomes.
Keywords: Bisexuals -- In Adolescence; Dating Violence -- Psychosocial Factors -- In Adolescence; Suicide -- Risk Factors -- In Adolescence; Adolescent Behavior; Human; Descriptive Research; Cross Sectional Studies; Structural Equation Modeling; Secondary Analysis; Biological Sex; Male; Female; Dating; Adolescent Health; Mental Health; Adolescence

Prevalence and Risk Factors for Nonsuicidal Self-Injury in Transgender and Gender-Expansive Youth at a Rural Gender Wellness Clinic. - Leon, Kimberly; O'Bryan, Jane; Wolf-Gould, Carolyn; Turell, Susan C.; Gadomski, Anne (Transgender Health, 2021)
Purpose: Transgender and gender-expansive (TGE) populations are at increased risk for nonsuicidal self-injury (NSSI). Rural TGE populations are understudied and underserved in terms of mental health services. The purpose of this study was to determine lifetime prevalence of NSSI among TGE youth at a rural gender wellness clinic and identify demographic and clinical characteristics associated with NSSI. Methods: The Gender Wellness Center Pediatric Patient Registry, a comprehensive database of 185 TGE youth ≤25 years of age, provided an estimate of the lifetime prevalence of NSSI. Univariate logistic regression models were utilized to test associations between patient demographic and clinical characteristics and NSSI. Variables that met the threshold for significance in the univariate analyses (p<0.05) were entered into a multivariate logistic regression model. All statistical analyses were conducted in SAS v.9.4. Results: Prevalence of NSSI in the sample was 36.8% (n=68). In unadjusted logistic regression models, risk factors for NSSI included female assigned sex at birth, transmasculine spectrum gender identity, history of mood disorder, history of suicidal ideation (SI) or attempt, and history of abuse (p<0.05). In the adjusted model, variables significantly associated with NSSI included female assigned sex at birth, history of mood disorder, and history of SI or attempt. Conclusion: NSSI was highly prevalent in this sample of rural TGE youth, confirming the need for screening and early interventions that target the unique vulnerabilities of TGE youth. The complex interplay of sex assigned at birth, mood disorders, and NSSI requires further research.
Keywords: Injuries, Self-Inflicted -- Epidemiology -- In Adolescence; Injuries, Self-Inflicted -- Risk Factors -- In Adolescence; Transgender Persons; Rural Health; Ambulatory Care Facilities; Human; Self-Injurious Behavior; Rural Areas; Male; Female; Descriptive Statistics; Data Analysis Software; Child; Adolescence; Young Adult; Adult; Univariate Statistics; Logistic Regression

Early adolescent gender diversity and mental health in the Adolescent Brain Cognitive Development study. - Potter, Alexandra; Dube, Sarahjane; Allgaier, Nicholas; Loso, Hannah; Ivanova, Masha; Barrios, Lisa C.; Bookheimer, Susan; Chaarani, Bader; Dumas, Julie; Feldstein‐Ewing, Sarah; Freedman, Edward G.; Garavan, Hugh; et al. (Journal of Child Psychology & Psychiatry, 2021)
Background: There are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health. Methods: The ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1‐year follow‐up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1‐year visit assessed felt‐gender, gender noncontentedness, and gender nonconformity using a 5‐point scale. Mental health measures included youth‐ and parent‐reports. Results: Roughly half a percent of 9/10‐year‐olds (n = 58) responded 'yes' or 'maybe' when asked, 'Are you transgender' at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, χ2 = 16.0, p <.001). At the 1‐year visit, when asked about the three dimensions of gender on a 5‐point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed. Conclusions: Similar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt‐gender, gender noncontentedness, gender nonconformity) among 10/11‐year‐olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth.
Keywords: Gender Identity; Mental Health -- In Infancy and Childhood; Child Development; Adolescent Development; Human; Child; Male; Female; United States; Prospective Studies; Scales; Chi Square Test; Descriptive Statistics; Adolescence; Transgender Persons; Suicidal Ideation

Differences in Methods of Suicide Death Among Transgender and Nontransgender Patients in the Veterans Health Administration, 1999-2016. - Blosnich, John R.; Boyer, Taylor L.; Brown, George R.; Kauth, Michael R.; Shipherd, Jillian C. (Medical Care, 2021)

Are Sexual Minorities More at Risk? Bullying Victimization Among Lesbian, Gay, Bisexual, and Questioning Youth. - Kahle, Lindsay (Journal of Interpersonal Violence, 2020)
Bullying has garnered the attention of researchers and policy makers alike, because of various negative physical, mental, and educational outcomes that stem from these experiences. Certain youth are more at risk for bullying victimization (ASPA, 2012). Thus, research highlighting and addressing these experiences is crucial to provide safer environments for youth. This study utilizes the 2013 Youth Risk Behavior Surveillance System (YRBSS) data to investigate whether or not experiences of victimization differ for lesbian, gay, bisexual, and questioning (LGBQ) youth. Drawing from a sample of 12,642 9th through 12th grade youth, this study investigates two primary areas: (a) the prevalence of traditional bullying, electronic bullying, and homophobic bullying victimizations among LGBQ youth, and (b) the interaction of sexual orientation and gender with traditional bullying, electronic bullying, and homophobic bullying victimizations. Results suggest that LGBQ youth experience all types of bullying victimization at higher rates than heterosexual youth. Results also highlight the importance of the interaction of sexual orientation and gender in bullying victimization. Findings reveal that LGBQ females, LGBQ males, and heterosexual females experience each type of victimization at higher rates than heterosexual males. Findings confirm that disparities exist in bullying victimization among LGBQ youth, and thus cannot be ignored in schools. School policies must explicitly acknowledge and address how sexual orientation and gender matter within the constructs of youth violence if they wish to create safer learning environments for youth.
Keywords: Bullying -- Risk Factors; Crime Victims -- Psychosocial Factors -- In Adolescence; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Risk Assessment; Human; Adolescence; Male; Female; Risk Taking Behavior; Life Experiences; Bullying -- Epidemiology -- United States; Prevalence; Sexuality; Heterosexuals; Sex Factors; School Violence -- Prevention and Control; School Policies; Learning Environment; Safety; United States; District of Columbia; Self Report; Questionnaires; Probability Sample; Schools; Control (Psychology); Descriptive Statistics; Logistic Regression; Geographic Factors; Bullying -- Classification; Interpersonal Relations

Assessing the Well-being of Sexual Minority Soldiers at a Military Academic Institution. - McDonald, Jennifer L; Ganulin, Michelle L; Dretsch, Michael N; Taylor, Maura R; Cabrera, Oscar A (Military Medicine, 2020)
Introduction: The goal of the present study was to characterize behavioral health rates, behavioral health care utilization, loneliness, and perceived prejudice and support among sexual minority soldiers.Materials and Methods: Cross-sectional survey data were obtained from 640 active-duty U.S. soldiers enrolled in an academic training institute who provided information on their sexual orientation. Survey topics included demographics, behavioral health, behavioral health care utilization, and mitigating factors (eg, perceived prejudice, perceived support, and loneliness). Chi-square analyses were utilized to determine any differences between groups for behavioral health rates and behavioral health care utilization. Robust regression was used for analysis of self-reported loneliness.Results: A higher proportion of lesbian, gay, bisexual (LGB) soldiers than heterosexual soldiers screened positive for anxiety, post-traumatic stress disorder, and suicidality. No between-group differences in behavioral health care utilization were found; however, a higher proportion of LGB soldiers sought help from military family life counselors. No between-group differences for loneliness were found. Finally, perceived prejudice was higher for LGB soldiers and perceived support was lower.Conclusion: Organizational barriers, such as perceived prejudice and lack of support, appear to still exist for sexual minority soldiers. Increasing organizational support and implementing training and education for health care providers in order to better support the LGB soldier community may mitigate these barriers.
Keywords: Military Personnel -- Psychosocial Factors; Health Screening -- Methods; Stress Disorders, Post-Traumatic -- Psychosocial Factors; Stress Disorders, Post-Traumatic -- Diagnosis; Female; Anxiety -- Psychosocial Factors; Health Screening -- Equipment and Supplies; Male; Depression -- Psychosocial Factors; Human; Anxiety -- Diagnosis; Health Screening -- Statistics and Numerical Data; Depression -- Diagnosis; Adolescence; Adult; Cross Sectional Studies; Sexuality; Military Personnel -- Statistics and Numerical Data; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Scales

The Health and Well-Being of Transgender Australians: A National Community Survey. - Bretherton, Ingrid; Thrower, Emily; Zwickl, Sav; Wong, Alex; Chetcuti, Daria; Grossmann, Mathis; Zajac, Jeffrey D.; Cheung, Ada S. (LGBT Health, 2021)
Purpose: Transgender, including gender diverse and nonbinary (trans), people experience significant health disparities. We aimed to better understand the health status and needs of Australian trans people to guide resources and health and well-being programs. Methods: This anonymous, cross-sectional online survey utilized nonprobability snowball sampling of Australian adults (18 years and over) who self-identified as trans between September 2017 and January 2018. This descriptive study assessed demographic data, community views on access to health care, health burden, access to health resources, and priorities for government funding in transgender health. Results: Of 928 participants, 37% reported female, 36% reported male, and 27% reported nonbinary gender identities. Despite 47% having tertiary qualifications, the unemployment rate was 19%, with 33% reporting discrimination in employment due to being trans. Discrimination in accessing health care was reported by 26% and verbal abuse and physical assault were reported by 63% and 22%, respectively. Lifetime diagnosis of depression was reported by 73% and anxiety by 67%. Sixty-three percent reported previous self-harm and 43% had attempted suicide. Autism spectrum disorder and attention-deficit/hyperactivity disorder were reported by 15% and 11%, respectively. The most preferred method of receiving health information was through online resources, with the most popular source being Reddit, an online peer discussion board. Better training for doctors in trans health issues was the top priority for government funding. Conclusions: Barriers, including widespread discrimination and unemployment, contribute to health inequity and prevalent mental health conditions. Better training for health professionals in the provision of safe, genderaffirming and general health care for trans people is urgently required.
Keywords: Transgender Persons -- Australia; Health Status; Health Services Needs and Demand; Psychological Well-Being; Health Services Accessibility; Mental Health; Australia; Human; Cross Sectional Studies; Surveys; Descriptive Research; Male; Female; Sexual and Gender Minorities; Snowball Sample; Adolescence; Adult; Middle Age; Aged; Aged, 80 and Over; Discrimination; Gender Dysphoria; Gender Bias; Depression; Suicide, Attempted; Descriptive Statistics; Data Analysis Software

Evaluation of an electronic consultation service for transgender care. - Singh, Jatinderpreet; Lou, Allison; Green, Michael; Keely, Erin; Greenaway, Mary; Liddy, Clare (BMC Family Practice, 2021)
Background: Access to transgender care in Canada is poor. Although primary care providers are ideally positioned to initiate care, many feel uncomfortable providing transgender care. This study aimed to explore the impact of an electronic consultation (eConsult) service between primary care providers and transgender care specialists on access to care and to explore the content of clinical questions that were asked. Methods: This was a retrospective mixed methods analysis of 62 eConsults submitted between January 2017 and December 2018 by primary care providers to specialists in transgender care in a health region in eastern Ontario, Canada. A descriptive analysis was conducted to assess the average response time and the total time spent by the specialist for the eConsults. An inductive and deductive content analysis was carried out to identify common themes of clinical questions being asked to transgender specialists. A post-eConsult survey completed by primary care providers was assessed to gain insight into avoided face-to-face referrals and overall provider satisfaction. Results: The median specialist response time was 1.2 days (range: 1 h to 5 days) and the average time spent by specialists per eConsult was 18 min (range: 10 to 40 min). The qualitative analysis identified six major themes: 1) interpretation/management of abnormal bloodwork, 2) change in management due to lack of desired effect/hormone levels not a target, 3) initiation of hormone therapy/initial work up, 4) management of adverse effects of hormone therapy, 5) transition related surgery counseling and post-op complications, and 6) management of patients with comorbidities. Approximately one-third of eConsults resulted in an avoided face-to-face referral and 95% of primary care providers rated the value of their eConsult as a 5 (excellent value) or 4. Conclusions: This study demonstrated that a transgender eConsult service has potential to significantly improve access to care for transgender patients. Given the importance that timely access has on improving mental health and reducing suicide attempts, eConsult has the potential to make a substantial clinical impact on this population. Identified themes of eConsult questions provides insight into potential gaps in knowledge amongst primary care providers that could help inform future continuing education events.
Keywords: Remote Consultation -- Canada; Health Services Accessibility -- Evaluation; Transgender Persons; Primary Health Care; Physicians, Family; Human; Female; Male; Canada; Retrospective Design; Multimethod Studies; Descriptive Research; Time Factors; Content Analysis; Thematic Analysis; Surveys; Job Satisfaction; Descriptive Statistics

Experience of Chest Dysphoria and Masculinizing Chest Surgery in Transmasculine Youth. - Mehringer, Jamie E.; Harrison, Jacqueline B.; Quain, Kit M.; Shea, Judy A.; Hawkins, Linda A.; Dowshen, Nadia L. (Pediatrics, 2021)
OBJECTIVES: Transmasculine individuals, those assigned female sex at birth but who identify as masculine, have high rates of suicidal behavior and often suffer from chest dysphoria (discomfort and distress from unwanted breast development). Growing numbers of transmasculine youth are pursuing definitive treatment with masculinizing chest surgery (MCS), and adult studies reveal marked benefits of MCS, although little is known about the impact of chest dysphoria on transmasculine youth or the optimal timing of MCS. In this study, we aimed to explore youth experiences of chest dysphoria and the impact of MCS. METHODS: Transmasculine youth aged 13 to 21 were recruited from a pediatric hospital--based gender clinic. Participants completed a semistructured qualitative interview exploring the experience of chest dysphoria and thoughts about or experiences with MCS. Interview transcripts were coded by 3 investigators employing modified grounded theory, with the median interrater reliability at k = 0.92. RESULTS: Subjects (N = 30) were a mean age of 17.5 years, and 47% had undergone MCS. Youth reported that chest dysphoria triggered strong negative emotions and suicidal ideation, caused a myriad of functional limitations, and was inadequately relieved by testosterone therapy alone. All post-MCS youth reported near or total resolution of chest dysphoria, lack of regret, and improved quality of life and functioning. CONCLUSIONS: We observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth. MCS performed during adolescence, including before age 18, can alleviate suffering and improve functioning. Additional research is needed to develop patient-reported outcome measures to assess the impact of chest dysphoria and MCS.
Keywords: Gender Dysphoria -- Psychosocial Factors -- In Adolescence; Thoracic Surgery; Human; Adolescence

Pediatric Research and Health Care for Transgender and Gender Diverse Adolescents and Young Adults: Improving (Biopsychosocial) Health Outcomes. - Geist, Claudia; Greenberg, Katherine B.; Luikenaar, Rixt A.C.; Mihalopoulos, Nicole L. (Academic Pediatrics, 2021)
Adolescent and young adult (AYA) transgender health care and research have expanded rapidly in the United States and abroad, but the effects of gender-affirming social, hormonal, or surgical care on overall health remain unclear. Gender diverse identities, also termed nonbinary, have often been neglected in favor of (male/female) binary identities, even in the context of transgender health care and research. No high quality studies have assessed how gender-affirming medical care impact health inequities in transgender and gender diverse (TG/GD) adults, much less in AYAs, despite the fact that that TG/GD adults have higher than average morbidity and mortality across a host of health concerns, from human immunodeficiency virus infection to thromboembolism, and that reported depression with suicidal ideation is >10 times higher in TG/GD adults than in the general population. TG/GD youth have related but different needs from TG/GD adults. TG/GD AYA are embedded in family and schools, where stigma may be difficult to escape; mental health during adolescence has areas of increased risk as well as resilience; and the effects of early hormonal and surgical interventions on long-term health are insufficiently studied. Because of this, an inclusive and proactive approach to addressing the needs of TG/GD AYA by pediatric clinicians, researchers, and educators is particularly crucial. This article focuses on what is known and unknown about clinical practice, research, and education related to TG/GD health. We highlight the role of gender affirmation by clinicians as they care and advocate for TG/GD AYAs; the potential challenges of hormonal treatment for peripubertal youth; and short- and long-term effects on physical and reproductive health of medical or surgical interventions. We also discuss how social context influences knowledge gaps and the health-relevant risks faced by TG/GD AYA. The challenges are formidable, but opportunities await: high priority research questions to explore, educational gaps to be filled, and advocacy that needs the voices of pediatricians to promote policies to facilitate positive health outcomes for TG/GD AYA.
Keywords: Transgender Persons; Gender Identity; Health Services Accessibility -- In Adolescence; Health Services Accessibility -- In Adulthood; Pediatric Care; Adolescence; Adult; Adolescent Health; Outcomes (Health Care); Medically Underserved; Research, Medical; Gender Dysphoria; Gender Role

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

Are Developmental Assets Protective Against Suicidal Behavior? Differential Associations by Sexual Orientation. - Toomey, Russell B.; Syvertsen, Amy K.; Flores, Melissa (Journal of Youth & Adolescence, 2019)
Sexual orientation disparities in suicide behavior are well-documented. Yet, few studies have examined how developmental assets – key values, self-perceptions, skills, relationships, and opportunities that have been identified as the building blocks of positive youth development – are associated with suicide behaviors, particularly among sexual minority youth. This study examined concurrent associations between young people's developmental assets and suicidal behavior by sexual orientation using a large sample of 116,925 in-school U.S. adolescents (ages 11 to 19, M = 14.74, SD = 1.78). Most of the sample identified as only heterosexual (90.2%); 5% identified as mostly heterosexual, 3.5% as bisexual, 0.6% as mostly lesbian/gay, and 0.7% as only lesbian/gay. Most participants identified as White, non-Latina/o (62.6%) and as cisgender female (50.3%) or cisgender male (47.8%). Compared to only heterosexual adolescents, youth with all other sexual orientations reported lower levels of internal and external developmental assets except for non-sports extracurricular activity participation and social justice values. Identifying as a racial/ethnic minority, particularly for only heterosexual adolescents, and specifically as Latina/o for sexual minority adolescents was associated with greater risk for suicidal behavior. Further, identifying as a gender minority exacerbated risk for suicidal behavior. Relatedly, when youth reported feeling unsafe with their family, or in their school or neighborhood, they were at greater risk for suicidal behavior, regardless of sexual orientation. Feeling hopeful was associated with lower risk for suicidal behavior for all youth. Regardless of sexual orientation, planning and decision-making skills were associated with lower risk and social-emotional skills were associated with heightened risk for suicidal behavior. School boundaries and social justice values were associated with lower risk for suicidal behavior among bisexual adolescents; there were no additional protective assets for mostly/only lesbian/gay adolescents. In conclusion, sexual orientation disparities exist in the lives of adolescents for several internal and external developmental assets. Disparities in suicidal behavior by sexual orientation, however, were largely unexplained by differential associations between developmental assets and suicidal behavior.
Keywords: Adolescent Development -- United States; Sexual Orientation -- United States; Suicidal Ideation -- Risk Factors -- United States; Human; United States; Child; Adolescence; Young Adult; Heterosexuals; Bisexuals; LGBTQ+ Persons; White Persons; Hispanic Americans; Male; Female; Social Justice; Race Factors; Ethnic Groups; Minority Groups; Sex Factors; Decision Making; Emotions; Health Status Disparities

Identifying Distinct Subgroups of Lesbian, Gay, and Bisexual Youth for Suicide Risk: A Latent Profile Analysis. - Giano, Zachary; Currin, Joseph M.; Deboy, Kyle; Hubach, Randolph D. (Journal of Adolescent Health, 2020)
The purpose of the study was to identify profiles of lesbian, gay, and bisexual (LGB) youth who are at risk for suicidal behavior. Data were collected through the Youth Risk Behavior Surveillance System (N = 2,738). We used latent profile analysis to create identity profiles using variables associated with suicide, including bullying, alcohol use, poor grades, electronics use, and sleep hours. The LPA revealed a 6-class solution. Class 6 represented the highest risk profile with the highest scores in alcohol, bullying, poor grades, electronics use, and the least sleep and were 17 times more likely to attempt suicide compared to class 2 (the lowest-risk class). Classes 1, 3, 4, and 5 had a mixture of both high and low risk mean scores across the variables, with class 3 showing the strongest relationship to suicide (7 times more likely than class 2). Because high-risk classes in our study had multiple factors contributing to associations to suicide, programming aimed at attenuating youth suicide among LGB youth may benefit from addressing multiple issues simultaneously (e.g., substance use and bullying). This would be a departure from more traditional programs for LGB youth which are predicated on one specific risk behavior, such as coping with bullying or substance use separately.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Suicidal Ideation -- Psychosocial Factors -- In Adolescence; Human; Adolescence; Latent Structure Analysis; Questionnaires; Bullying; Alcohol Drinking; Educational Status; Electronics -- Utilization; Sleep; Descriptive Statistics; Risk Taking Behavior; Coping; Surveys; Race Factors; T-Tests; Regression; Odds Ratio

Transgender Health: Sensitivity in Care, Treatment, and Life Care Considerations for Female to Male Transgender Individuals. - Van Duyne, Ingrid M.; Livingstone, Jason (Journal of Life Care Planning, 2019)
People who identify as transgender are not a new global population. They have lived and worked among the general population, but remained hidden due to fear of social and vocational discrimination and harassment. Time, and changing views, brought by changing generational philosophy, has allowed more people who identify as transgender into the forefront. This improved visibility has highlighted similar health care access issues and disparities already realized within many marginalized populations. The problem is compounded as legislation is inconsistent and dynamic with regard to provision of health care and basic rights to this specialized and complex population. Services are warranted; transgender people have a high need for a variety of health care services. Studies support this need with correlations of mental illness and high suicide rates for those who are under-served. Life care planners are in a unique position to provide support and services to this increasingly visible and deserving population.
Keywords: Transgender Persons; Health Services Accessibility; Healthcare Disparities; Mental Disorders; Suicide; LGBTQ+ Persons; Discrimination; Gender Dysphoria; Gender Identity; Communication; Nomenclature; Hormones; Diagnosis, Laboratory; Protocols; Legislation; International Classification of Diseases; Surgery, Operative

Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk. - Dunlop, Brendan J.; Hartley, Samantha; Oladokun, Olayinka; Taylor, Peter J. (Journal of Affective Disorders, 2020)
Background: Bisexual people have been found to be at increased risk of non-suicidal self-injury (NSSI) when compared to heterosexual and gay or lesbian people. The purpose of this review was to update the estimated risk of NSSI for bisexual people and to examine variables that have been associated with NSSI in this population.Methods: The protocol for this paper was pre-registered (CRD42019145299). An electronic search of PsycINFO, CINAHL Plus, PubMed, Ovid Online and Web of Science was undertaken from earliest available date to October 2019. Twenty-four eligible papers were identified. Meta-analyses, including moderator analysis, were conducted to ascertain NSSI risk and a narrative synthesis was undertaken of predictors and correlates. All studies were assessed for risk of bias.Results: Bisexual people had up to six times the odds of engaging in NSSI compared to other sexualities. Mental health variables of anxiety and depression symptoms were found to be most commonly associated with NSSI for this population. The majority of studies had moderate risk of bias. This review demonstrates that bisexual people have an elevated risk of engaging in NSSI. Increased incidence of anxiety and depression and exposure to negative life events may explain this increased risk.Limitations: Studies were found to be consistently cross-sectional in design and limited to western cultures. A limitation of this review was that only English language papers were included.Conclusions: Results are clinically relevant as they suggest early identification and prevention of NSSI can be achieved. Future research should examine bisexual people independently of others.
Keywords: Self-Injurious Behavior -- Epidemiology; Bisexuality; Cross Sectional Studies; Female; Heterosexuality; Human; Meta Analysis; Questionnaires

Substance Use and Sexual Risk Behavior Among Black Men Who Have Sex With Men in New York City: Evidence for Increased Risk During Young Adulthood. - Aivadyan, Christina; Lee, Yong Gun; El-Bassel, Nabila; Wu, Elwin (AIDS Education & Prevention, 2021)
This study evaluated whether the association between substance use and sexual risk behavior varies as a function of age among 1,009 Black men who have sex with men (BMSM) in New York City. Hierarchical linear regression was used to examine the relationship between age (18–26 vs. 27+), substance use, and number of sexual partners and acts of condomless anal sex (CAS) in the past 90 days. Age moderated the relationship between substance use and sexual risk behavior, such that positive associations among binge drinking, marijuana, cocaine, and party drug use and number of male sexual partners and cocaine use and acts of CAS were significantly stronger among young adults than adults. BMSM may engage in more sexual risk behavior during young adulthood, and those who use substances may be at increased risk for HIV transmission—particularly through multiple sex partners. HIV prevention interventions targeting BMSM may benefit from being tailored to age and addressing sexual risk behavior and substance use concurrently.
Keywords: Substance Use Disorders; Risk Taking Behavior; Sexuality; Men Who Have Sex With Men -- New York; Black Persons -- New York; Risk Assessment; New York; Linear Regression; Young Adult; Adult; Sexual Partners; Binge Drinking; Medical Marijuana; Cocaine; HIV Infections; Disease Transmission

Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: three U.S. cities, 2015. - Agnew-Brune, Christine B.; Balaji, Alexandra B.; Mustanski, Brian; Newcomb, Michael E.; Prachand, Nik; Braunstein, Sarah L.; Brady, Kathleen A.; Hoots, Brooke E.; Smith, Justin S.; Paz-Bailey, Gabriela; Broz, Dita (AIDS & Behavior, 2019)
We examined the association between mental health issues, social support, and HIV among adolescent sexual minority males (SMM), who are disproportionally affected by HIV. National HIV Behavioral Surveillance among Young Men Who Have Sex with Men (NHBS-YMSM) data among SMM aged 13–18 years were collected in three cities (Chicago, New York City, and Philadelphia). Separate log-linked Poisson regression models were used to estimate associations between mental health issues and social support (general and family), and 3 HIV-related sexual risk behavior outcomes: past-year condomless anal intercourse (CAI) with a male partner, past-year sex with ≥ 4 partners, and first vaginal or anal sex before age 13. Of 547 adolescent SMM, 22% reported ever attempting suicide and 10% reported past-month suicidal ideation. The majority (52%) reported depression and anxiety. Thirty-nine percent reported CAI, 29% reported ≥ 4 sex partners and 22% reported first sex before age 13. Ever attempting suicide, suicidal ideation, and depression and anxiety were associated with CAI. Separately, ever attempting suicide and lack of family support were associated with ≥ 4 sex partners. None of the mental health or support measures were associated with having sex before age 13. General social support was not associated with any sexual risk behaviors. Mental health issues are common among adolescent SMM and associated with sexual risk behaviors. Including mental health support in comprehensive HIV prevention for adolescent SMM could potentially reduce HIV risk in this population.
Keywords: Sexual Identity -- In Adolescence -- United States; Men Who Have Sex With Men -- In Adolescence; HIV Seronegativity; Mental Health; Support, Psychosocial; HIV Infections -- Risk Factors; Risk Taking Behavior; Human; United States; Male; Poisson Distribution; Suicidal Ideation; Depression; Anxiety; HIV Infections -- Prevention and Control; Adolescence; Funding Source

Up in Smoke: Exploring the Relationship between Bullying Victimization and E-Cigarette Use in Sexual Minority Youths. - Doxbeck, Courtney R. (Substance Use & Misuse, 2020)
E-cigarette use is increasing in popularity for high school students (Singh et al., 2016) and may be accompanied by negative health outcomes (Rankin et al., 2019). Students who identify as sexual minority (lesbian, gay, bisexual, or queer/questioning) may be at an increased risk of bullying victimization and substance use due to their sexual identity (Caputi, 2018). Purpose/Objectives: This study explored the relationship between bullying in school and cyberbullying (i.e. bullying through social media) victimization with past 30-day e-cigarette use for sexual minority youths, an at-risk group for victimization and its negative consequences. Methods: The Youth Risk Behavioral Survey was utilized to study a sample of sexual minority high school students (N = 2302; 69.4% female). Three models were utilized to examine whether bullying in school or cyberbullying victimization were related to e-cigarette use after controlling only for demographics in the demographics model, and then the use of other substances in the substance use model. Cigarette use was combined with e-cigarettes as the dependent variable in the third comparative model. Results: After controlling for age, race, sex, sexual identity, and other substance use, bullying victimization in school and online were significantly related to current e-cigarette use together but not separately. Cyberbullying victimization was significantly related to combined cigarette and e-cigarette use. Conclusions/Importance: These findings suggest that sexual minority students who report cyberbullying victimization may use cigarette products more than their noncyberbullied peers. Cyberbullying prevention and interventions should continue to be targeted in schools, especially for sexual minority youths.
Keywords: School Violence; Bullying -- Psychosocial Factors; Social Media; Crime Victims; Electronic Cigarettes; Vaping; Sexual and Gender Minorities -- In Adolescence; Human; Adolescence; Time Factors; Special Populations; Questionnaires; Students, High School; Male; Female; Substance Abuse; Models, Theoretical; Bullying -- Prevention and Control; School Health Services; School Policies

Gender identity and sexual behavior stigmas, severe psychological distress, and suicidality in an online sample of transgender women in the United States. - Maksut, Jessica L.; Sanchez, Travis H.; Wiginton, John Mark; Scheim, Ayden I.; Logie, Carmen H.; Zlotorzynska, Maria; Lyons, Carrie E.; Baral, Stefan D. (Annals of Epidemiology, 2020)
Purpose: The objective of this study is to (1) quantify burden of perceived, anticipated, and enacted gender identity (GI) and sexual behavior (SB) stigmas and (2) explore associations between GI and SB stigmas with key mental health factors among transgender women in the United States.Methods: We estimated associations between GI and SB stigmas with severe psychological distress, suicidal ideation, and suicide attempt using cross-sectional data from the Transgender Women's Internet Survey and Testing study from March to April, 2019. Modified Poisson regression produced prevalence ratios and 95% confidence intervals for severe psychological distress, suicidal ideation, and suicide attempt with GI and SB stigma items individually, as well as the GI and SB stigma items treated as two scales.Results: Of 381 transgender women, 52% experienced severe psychological distress in the past month, whereas 59.3% and 13.12% reported suicide ideation and attempt in the past year, respectively. In adjusted models, GI and SB stigma scales were significantly, positively associated with severe psychological distress, suicidal ideation, and suicide attempt.Conclusions: Continued training for providers in trans-competent mental health care and the development of newer engagement and delivery strategies for stigma mitigation interventions are needed.
Keywords: Mental Health -- Statistics and Numerical Data; Transsexualism; Suicide; Stigma; Young Adult; Suicide -- Psychosocial Factors; Prevalence; Gender Identity; Suicide, Attempted; Adolescence; Male; Sexuality; Risk Factors; Female; Adult; Questionnaires; Scales

Suicide exposure in transgender and gender diverse adults. - Cerel, Julie; Tucker, Raymond R.; Aboussouan, Alix; Snow, Annie (Journal of Affective Disorders, 2021)
Objective: The purpose of this study is to examine the psychological effects of suicide exposure for Transgender and Gender Diverse (TGD) adults.Method: Using data from a national online survey of 2784 self-identified TGD adults, the current study investigated the prevalence of suicide death and suicide attempt exposure and demographic and mental health correlates.Results: Nearly sixty percent of the sample (57.9%) reported they were close to at least one person who attempted suicide, and more than a quarter of the sample reported they were close to at least one person who died by suicide. Exposure to either the suicide attempt or death of another individual was related to multiple indicators of psychological distress.Conclusions: Exposure to the suicidal behavior of close others is prevalent in TGD individuals: over half of participants were close to someone who attempted suicide, more than in population-based studies of suicide exposure. Exposure appears to have a potential effect on recent indicators of psychological distress and suicide risk, which is important to consider when working in TGD communities.

The Influence of State Policies on the Relationship Between Minority Stressors and Suicide Attempts Among Transgender and Gender-Diverse Adults. - Rabasco, Ana; Andover, Margaret (LGBT Health, 2020)
Purpose: We examined whether the relationship between minority stressors (victimization and discrimination) and suicide attempts (SAs) was moderated by gender identity-specific protective state policies in a sample of transgender and gender-diverse (TGD) adults. ***Methods: TGD adults (n = 133) were recruited online and completed questionnaires. ***Results: Protective state policies moderated the relationship between minority stressors and SAs, with a significant positive association between minority stressors and SAs at low, but not medium and high, policy scores. ***Conclusion: A lack of protective state policies may be a risk factor in the relationship between minority stressors and SAs among TGD individuals.
Keywords: Public Policy; Minority Stress -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Transgender Persons -- In Adulthood; Discrimination -- Evaluation; Gender Identity; Human; Adult; Crime Victims; Female; Male; Social Networking; World Wide Web; Surveys; Questionnaires; Consent (Research); Sexual Orientation; Scales; Internal Consistency; Coefficient Alpha; Descriptive Statistics; Data Analysis Software

LGBTQ Mental Health: What Every Clinician Needs to Know. - Veltman, Albina; La Rose, Tara (Psychiatric Times, 2019)
The article offers psychiatric insights on the lesbian, gay, bisexual, transgender and/or queer (LGBTQ) population in 2019. Topics discussed include the concept of dual alienation on these individuals with mental health issues, the increased mental health risks for them, and treatment approaches. Also noted is the lack of training on LGBTQ-related issues in most health care education programs.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Mental Health Services; Psychiatrists; Health Services Accessibility; DSM; Minority Groups -- Psychosocial Factors; Healthcare Disparities; Suicide -- Risk Factors; Depression -- Risk Factors; Quality of Health Care

Transgender and gender non-conforming bereavement (TGNC): A case study on complicated grief experienced and the effect of partner suicide on interpersonal relationships and subsequent partnerships of the bereaved. - Nolan, Rachael D. (Death Studies, 2020)
Grief, death, bereavement, and loss do not discriminate based on gender identity or sexual orientation. Limited attention has been given to the bereaved partners of transgender and gender non-conforming persons (TGNC). Despite recent efforts to protect the rights of TGNC persons, the death of a TGNC partner is often complicated, marked by family members and friends who might never have known or refused to acknowledge the deceased in his, her, or their preferred gender. The present study adopted a single case study design to examine the death of a TGNC spouse through the unique lens of a bereaved partner.
Keywords: Transgender Persons; Gender Nonconformity; Bereavement; Spouses; Suicide; Interpersonal Relations; Human; Complicated Grief; Human Rights; Family Attitudes; Case Studies

A literature review of the secondary school experiences of trans youth. - McBride, Ruari-Santiago (Journal of LGBT Youth, 2021)
In this article I review 83 empirical studies that provide insight into the secondary school experiences of trans youth. The studies show that while some trans youth have affirming experiences, the majority are exposed to institutionalized cisnormativity that makes them vulnerable to macroaggressions, microaggressions and violence within school settings. Trans youth's exposure to institutionalized cisnormativity was found to intersect with multiple vectors of social power, which subject some trans youth to multiple forms of disadvantage, while affording others degrees of privilege. In conclusion, the findings show that trans youth's educational experiences reflect broader structural inequalities yet defy essentialising explanations.
Keywords: Schools, Secondary -- Psychosocial Factors -- In Adolescence; Transgender Persons -- Psychosocial Factors -- In Adolescence; Students, High School -- Psychosocial Factors -- In Adolescence; Human; Adolescence; Scoping Review; Aggression; School Violence; Power

Non-Heterosexual Medical Students Are Critically Vulnerable to Mental Health Risks: The Need to Account for Sexual Diversity in Wellness Initiatives. - Suárez, Daniel E.; Cardozo, Andres C.; Villarreal, Miguel E.; Trujillo, Elena M. (Teaching & Learning in Medicine, 2021)
Phenomenon: Mental health problems among medical students are a worrisome issue; recent studies have shown that one-third may be suffering major depressive disorder and one out of ten had suicidal ideation. Few studies have evaluated the association of medical students' mental health and their sexual orientation. This study aimed to evaluate differences in mental health indicators among medical students with diverse sexual orientations at a South American medical school. Approach: This study is a secondary analysis of cross-sectional data obtained through an electronic survey. The survey assessed demographics, academic variables, and several mental health scales and indexes, including: World Health Organization Well-being Index, Satisfaction With Life Scale, Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve), Self-Reporting Questionnaire, Athens Insomnia Scale, Eating Attitudes Test, and Alcohol Use Disorders Identification Test. Sexual orientation was assessed using self-identification and responses dichotomized as heterosexual and non-heterosexual. Findings: 554 students completed the survey (response rate: 70%). Mean age was 20.6 years, and the sample was 58.7% women. Eighty-two participants (14.8%) self-identified as non-heterosexual; this group comprised mostly males, fewer of whom lived with their family, and more of whom used loans or scholarships to pay university tuition fees. After adjustment for sex and tuition fee payment, non-heterosexual orientation was significantly associated (adjusted Odds Ratios [aOR] above 3.00) with rating mental health as bad, self-perceiving a need for mental health evaluation/treatment, and reporting last-year use of psychiatric medication. Lastly, non-heterosexual respondents reported more frequent psychiatric symptoms (depression/anxiety scores, suicidal ideation, eating disorder symptoms and substance use) with an aOR between 2.17 and 2.51. Insights: This study suggests that self-identified non-heterosexual medical students exhibit worse mental health outcomes evaluated through validated self-report scales and subjective perception of mental health status. This report specifically indicates that non-heterosexual medical students report family dysfunction more often and have less social support, which serve as additional risk factors. Future studies must assess social support, clarify the impact of family and peer support in mental health problems, and explore students' views on their sexual identity and the burden imposed by experiences of discrimination.
Keywords: Mental Disorders -- Risk Factors; Students, Medical; Sexual Orientation; Schools, Medical -- South America; Health Status Indicators; Human; LGBTQ+ Persons; South America; Student Attitudes; Secondary Analysis; Cross Sectional Studies; Questionnaires; Male; Female; Adult; Descriptive Statistics; Depression; Anxiety; Self Report; Suicidal Ideation; Eating Disorders; Health Status; Support, Psychosocial; Sexual Identity; Discrimination; Scales

Knowing Well, Being Well: well-being born of understanding: Addressing Mental Health and Substance Use Disorders Amid and Beyond the COVID-19 Pandemic. - Johnson, Sara S.; Czeisler, Mark É.; Howard, Mark E.; Rajaratnam, Shantha M. W.; Sumner, Jennifer A.; Koenen, Karestan C.; Kubzansky, Laura D.; Mochari-Greenberger, Heidi; Pande, Reena L.; Mendell, Gary (American Journal of Health Promotion, 2021)
Addressing Mental Health and Substance Use Disorders Amid and Beyond the COVID-19 Pandemic Sara S. Johnson PhD1 182692Pro-Change Behavior Systems, Inc., South Kingstown, RI, USA Pre-pandemic, the prevalence of mental illness was estimated at 1 in 5 adults,[1] and the US was facing an opioid epidemic.[2] Despite the high prevalence of mental health concerns and substance use disorders, numerous barriers to treatment and systematic limitations, including a shortage of professionals, limited access, lack of adequate funding, and stigma meant that as many as 70% of people with these conditions never sought treatment.[3],[4] The cumulative and profound physical, psychological, economic, and social toll of the COVID-19 pandemic has exacerbated the mental health and substance use crisis in America.[4] As Czeisler et al. comprehensively outline in the opening article of this issue of I Knowing Well, Being Well i , there has already been a very significant adverse impact on mental health. Leveraging their role as a gathering place and community hub, many libraries are educating staff and their patrons about mental health and substance use.[14] Some librarians have been trained in mental health first aid, and other libraries are teaming up with mental health professionals to offer workshops and education (e.g., training in naloxone) and/or hiring social workers.[14] Nationally, the Action Alliance's Mental Health & Suicide Prevention National Response to COVID-19 is a public-private partnership dedicated to creating sustainable change in mental health and suicide prevention.[6] Among their 6 priorities is ensuring equitable delivery of comprehensive and effective suicide prevention and mental health services for members of diverse racial and ethnic groups; LGBTQ individuals; and others disproportionately impacted by the pandemic.

Understanding the Mental Health of Transgender and Nonbinary Youth. - Price-Feeney, Myeshia; Green, Amy E.; Dorison, Samuel (Journal of Adolescent Health, 2020)
Currently, there is a lack of nationwide data examining the mental health of transgender and nonbinary youth. Furthermore, relatively little is known about how the mental health of transgender and nonbinary youth compares to that of their cisgender lesbian, gay, bisexual, queer, and questioning peers or differences within subgroups of transgender and nonbinary youth. The goal of the present study was to better understand the mental health of transgender and nonbinary youth. We analyzed responses from a national quantitative cross-sectional survey of more than 25,000 lesbian, gay, bisexual, transgender, queer, and questioning youth, aged between 13 and 24 years, in the U.S. Transgender and nonbinary youth were at increased risk of experiencing depressed mood, seriously considering suicide, and attempting suicide compared with cisgender lesbian, gay, bisexual, queer, and questioning youth. Controlling for sexual orientation–based or gender identity–based experiences of perceived discrimination and physical threats or harm reduced the disparities but did not fully account for them. Within-group analyses highlighted particularly increased risk for negative mental health outcomes among transgender males and nonbinary youth assigned female at birth. Findings point to the need to directly address the needs of transgender and nonbinary youth in prevention and intervention programs and to advance policies that reduce discrimination and victimization based on sexual orientation or gender identity.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Gender Dysphoria -- Psychosocial Factors; Mental Health -- Evaluation; Human; United States; Adolescence; Young Adult; Cross Sectional Studies; Surveys; LGBTQ+ Persons; Comparative Studies; Depression; Suicide -- Risk Factors; Suicide, Attempted -- Risk Factors; Sexism -- Prevention and Control; Sex Factors; Questionnaires; Gender Identity; Sexual Identity; Descriptive Statistics; Multiple Logistic Regression; Chi Square Test; Odds Ratio; Assault and Battery

Issues affecting trans* young people: considerations for mental health nurses. - Litvin, Roy; Trainor, Gemma; Dickinson, Tommy (Mental Health Practice, 2020)
AUTH Why you should read this article: • To understand the correct terminology used with gender identity • To learn about the prevalence of mental health disorders among trans* young people • To recognise the mental health issues that affect trans* young people Trans* is an umbrella term that is used to describe a wide range of individuals who identify with a gender that is different from their assigned sex at birth. Many young trans* people are being referred to gender identity services and/or child and adolescent mental health services (CAMHS) with gender dysphoria and coexisting mental health issues such as depression, anxiety, suicidal ideation and self-harm. This group of young people are at risk of experiencing various challenges, such as stigma, discrimination and lack of understanding from their families, wider communities, educational institutions and healthcare services. This article discusses the growing body of research and best practice guidelines related to the mental health and social needs of young people identifying as trans*. It aims to support mental health nurses to enhance their knowledge and awareness of the unique needs of these young people. It may also provide useful information to parents and/or carers, education providers, policymakers and mental health practitioners.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adulthood; Gender Identity; Mental Health; Needs Assessment; Psychiatric Nursing; Gender Dysphoria -- Nursing; Practice Guidelines; Nursing Role; Nurse-Patient Relations; Human Needs (Physiology); Human Needs (Psychology); Stigma; United Kingdom; DSM; Gender Dysphoria -- Epidemiology -- In Infancy and Childhood; Gender Dysphoria -- Epidemiology -- In Adolescence; Child; Adolescence; Prevalence; Gender Dysphoria -- Diagnosis; Bullying; Adult; Learning Environment; Depression; Suicidal Ideation; Psychotherapy

Suicidal ideation among transgender and gender diverse adults: A longitudinal study of risk and protective factors. - Rabasco, Ana; Andover, Margaret (Journal of Affective Disorders, 2021)
Introduction: Transgender and gender-diverse (TGD) people experience greatly heightened levels of suicidal ideation (SI) compared to the general population. Therefore, it is imperative to understand the risk and protective factors for SI within this population.Methods: The present study explored how victimization, discrimination, community connectedness, and pride impact SI cross-sectionally and longitudinally in a sample of TGD adults (N = 180, 55% transgender women, 76.7% Caucasian, M age = 26.01 years).Results: Cross-sectional results showed that experiencing more types of victimization and discrimination at baseline predicted higher SI severity at baseline, while community connectedness and pride at baseline were not predictive of SI severity at baseline. Longitudinal analyses showed that experiencing fewer types of victimization and discrimination during the 1-month follow-up period were associated with a decrease in SI severity from baseline to follow-up. Medium and high levels of community connectedness were also associated with a decrease in SI severity from baseline to follow-up. Pride was not associated with change in SI from baseline to follow-up.Limitations: Limitations include the limited racial/ethnic diversity of the sample and that frequency of experiencing victimization and discrimination was not assessed.Conclusions: These results suggest victimization and discrimination are strong predictors of SI severity within this population, and the factors of victimization, discrimination, and TGD-community connectedness impact change in SI severity across time. These findings provide evidence for the importance of anti-discrimination laws that apply to TGD people, as well as the utility of connecting TGD clients to the TGD community.

Inequalities in Health and Care Among Lesbian, Gay, and Bisexual People Aged 50 and Older in the United Kingdom: A Systematic Review and Meta-analysis of Sources of Individual Participant Data. - Kneale, Dylan; Thomas, James; French, Robert (Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 2020)
Objectives Modeling the health and care trajectories of lesbian, gay, and bisexual (LGB) is essential to identify inequalities and support needs, yet because of the small sample of LGB people in any one survey, current evidence relies on studies that have poor generalizability and low power. This study assesses the magnitude of health inequalities among older LGB people across 10 outcomes, informed by evidence on the health trajectories and distinct LGB history of the United Kingdom. Method A systematic review was conducted of representative data sources on older LGB and heterosexual people's health and care status in the United Kingdom. Individual Participant Data (IPD) meta-analysis was employed to synthesize data from up to 25 different sources. To account for the intricacies of individual data sets, the analysis employed a two-stage approach where an odds ratio and standard error was calculated for each data set individually, before being meta-analyzed through DerSimonian and Laird random effects models. Results Among men aged 50+, being gay, bisexual, or having another nonheterosexual orientation is associated with an increased risk of reporting long-term illness and health-related limitations. Indicators of mental health also suggest that gay and bisexual men are more likely to report low life satisfaction and to have attempted suicide over their life time. Among women, differences are apparent with regards to self-rated health as well as with engagement with risky health behaviors. Discussion The findings corroborate the minority stress theory, but they also generate new questions for researchers around when and how these inequalities emerge.
Keywords: Healthcare Disparities -- United Kingdom; Health Status Disparities -- United Kingdom; LGBTQ+ Persons -- In Middle Age; LGBTQ+ Persons -- In Old Age; Human; Systematic Review; Meta Analysis; United Kingdom; Descriptive Statistics; Data Analysis Software; Confidence Intervals; Middle Age; Aged; Aged, 80 and Over

Perceived Barriers to Mental Health Services Among Canadian Sexual and Gender Minorities with Depression and at Risk of Suicide. - Ferlatte, Olivier; Salway, Travis; Rice, Simon; Oliffe, John L.; Rich, Ashleigh J.; Knight, Rod; Morgan, Jeffrey; Ogrodniczuk, John S. (Community Mental Health Journal, 2019)
This study examines barriers to mental health services among sexual and gender minorities (SGM) who screened positive for depression and risk of suicide. Data from an online survey of SGM (N = 2778) are analyzed. 37.5% met criteria for depression and 73.6% screened for being at risk of suicide. The most frequently cited barriers to mental health services access were inability to pay (62.3%), insufficient insurance (52.2%), a preference for 'waiting' for the problems to go away (51.5%), discomfort discussing emotions (45.7%), and feeling embarrassed and ashamed about mental health challenges (42.5%). Policy and practices implications of these findings are discussed.
Keywords: Mental Health Services -- Canada; Health Services Accessibility -- Canada; Minority Groups -- Psychosocial Factors -- Canada; Sexuality; Depression -- Diagnosis; Suicide -- Risk Factors; LGBTQ+ Persons -- Psychosocial Factors -- Canada; Human; Canada; Surveys; Insurance, Health; Emotions; Embarrassment; Health Policy; Socioeconomic Factors

Address Exacerbated Health Disparities and Risks to LGBTQ+ Individuals during COVID-19. - WALLACH, SARA; GARNER, ALEX; HOWELL, SEAN; ADAMSON, TYLER; BARAL, STEFAN; BEYRER, CHRIS (Health & Human Rights: An International Journal, 2020)
In the article, the authors discuss the increased health disparities and risks faced by lesbians, transgender, bisexual, transgender and queer+ (LGBTQ+) people during the COVID-19 pandemic. Also cited are the higher risk of suicide, unemployment and human immunodeficiency virus (HIV) facing LGBTQ+ persons, and how the acts of discrimination and violence against LGBTQ+s are human rights violations.
Keywords: COVID-19 Pandemic; LGBTQ+ Persons -- Psychosocial Factors; Healthcare Disparities; Human Rights; HIV Infections; Suicide -- Risk Factors; Risk Assessment; Sexism -- Prevention and Control; Stigma -- Prevention and Control; Mental Health; Health Services Accessibility; Unemployment

Do Anti-Bullying Laws Reduce In-School Victimization, Fear-based Absenteeism, and Suicidality for Lesbian, Gay, Bisexual, and Questioning Youth? - Seelman, Kristie L.; Walker, Mary Beth (Journal of Youth & Adolescence, 2018)
Lesbian, gay, and bisexual youth are at heightened risk for bullying and other forms of in-school victimization. Anti-bullying laws are a potential policy mechanism for addressing this issue, yet there has been little investigation of the impact of such policies for this population using generalizable samples or quasi-experimental designs. The current study explores whether the presence of state anti-bullying laws predicts lower likelihood of bullying victimization, fear-based absenteeism, in-school threats or injury with a weapon, and suicidality for lesbian, gay, bisexual, and questioning high school students in the United States. Based on Youth Risk Behavior Survey data across 22 states from 2005-2015, coupled with data about the presence of general and enumerated anti-bullying laws that include sexual orientation as a protected class, this study analyzes this topic using a quasi-experimental design (linear difference-in-difference models). The results indicate that lesbian, gay, bisexual, and questioning youth (particularly boys aged 15 or younger) experienced less bullying victimization in states with general or enumerated anti-bullying laws. There was modest evidence of a reduction in fear-based absenteeism among boys in states with such laws. However, there was little evidence of a relationship between such policies and in-school threats or injuries or suicidality. Further, lesbian, bisexual, and questioning girls’ likelihood of victimization, absenteeism, or suicidality was generally not related to the presence of anti-bullying laws. The results suggest that general and enumerated anti-bullying laws may help reduce bullying victimization for gay, bisexual, and questioning boys.
Keywords: Bullying -- Prevention and Control; Bullying -- Legislation and Jurisprudence -- United States; Victims; Absenteeism; Suicide -- Prevention and Control; LGBTQ+ Persons -- Psychosocial Factors; Human; United States; Quasi-Experimental Studies; Female; Male; Sex Factors

Sexual Identity-Behavior Profiles and Suicide Outcomes Among Heterosexual, Lesbian, and Gay Sexually Active Adolescents. - Romanelli, Meghan; Xiao, Yunyu; Lindsey, Michael A. (Suicide & Life-Threatening Behavior, 2020)
Objective: Adolescents' sexual behaviors can be incongruent with those assumed to align with their sexual identity. Identity-behavior profiles permit the characterization of youth who might remain undetected using a single-dimensional assessment of sexual orientation. This study examined suicide risks among four distinct sexual identity-behavior profiles of youth: heterosexual with other-sex partners only, heterosexual with any same-sex partners, lesbian or gay (LG) with same-sex partners only, and LG with any other-sex partners.Method: Data were analyzed from the 2017 National Youth Risk Behavior Survey. Participants' reported sex, sexual identity, and the sex of their sexual contacts were used to construct the identity-behavior profiles. Multivariate logistic regression was used to examine the relationship between identity-behavior profiles and suicide outcomes.Results: Compared to heterosexual respondents with other-sex partners only, heterosexual respondents with any same-sex partners and LG respondents with same-sex partners only had greater odds of having a suicide plan; LG respondents with any other-sex partners were over seven times more likely to have suicidal thoughts and attempt suicide and 14 times more likely to have a suicide plan.Conclusions: Health and mental health providers can expand the identification of youth at risk for suicide by assessing both sexual identity and behavior.

Peer Victimization and Mental Health Outcomes for Lesbian, Gay, Bisexual, and Heterosexual Youth: A Latent Class Analysis. - Heiden‐Rootes, Katie; Salas, Joanne; Moore, Rachel; Hasan, Shah; Wilson, Lauren (Journal of School Health, 2020)
BACKGROUND: Lesbian, gay, bisexual, and questioning (LGBQ) adolescents are at increased risk of poor mental health due to minority stress, a chronic stress associated discrimination, social rejection, and victimization brought on by prejudicial attitudes towards LGBQ individuals. To improve understanding of the differential impact of various kinds of victimization on mental health outcomes for LGBQ adolescents, we analyzed data from the 2015 Youth Risk Behavior Survey (YRBS) for victimization and mental health symptom clusters and associations high school youth and compared by sexual orientation and gender. METHODS: Separate Latent Class Analysis (LCA) was conducted to identify profiles of both victimization and mental health symptoms for participants (N = 15,624). Subsequently, stratified weighted logistic regression models were used on an eligible analytic sample of 11,458 to assess differences in the association of victimization and mental health between LGBQ and heterosexual high school students. RESULTS: In each LCA, participants were assigned to one of 3 classes for victimization (minimal, 81.3%; bullying, 12.5%; or physical/sexual violence, 6.2%) and 1 of 2 classes for mental health symptoms (minimal, 81.2%; severe, 18.8%). LGBQ participants were overrepresented in physical/sexual violence and bullying victimization profiles. Both bullying and physical/sexual violence profiles were associated with almost 5 times the odds of endorsing severe mental health symptoms. Conclusions: This study expands our understanding of the relationship between types and effect of peer victimization for LGBQ and heterosexual youth with implications for school health and prevention efforts through increased positive school climate for LGBQ students.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Crime Victims -- Psychosocial Factors; Students, High School -- Psychosocial Factors -- United States; Mental Health -- Evaluation; Mental Disorders -- Risk Factors; Minority Stress; Sexual Identity; Human; United States; Secondary Analysis; Heterosexuals; Bullying; Dating Violence; Sexual Abuse; Sex Factors; School Violence; Adolescence; Young Adult; Female; Male; Structural Equation Modeling; Logistic Regression; Descriptive Statistics; Odds Ratio; Depression; Suicidal Ideation; Data Analysis Software; Chi Square Test; Confidence Intervals

Mental health disparities and high‐risk alcohol use among non‐heterosexual high school students. - Goodin, Amie; Elswick, Alex; Fallin‐Bennett, Amanda (Perspectives in Psychiatric Care, 2019)
Purpose: To examine disparities in mental health and high‐risk alcohol use among high school students by sexual orientation, and the impact of having access to an adult with whom to talk. Design and Methods: Cross‐sectional survey, from the 2015 Kentucky Youth Risk Behavior Survey. Logistic regression estimated the relationship between being "non‐heterosexual" on mental health (e.g, suicidal ideation/attempt) and alcohol behaviors (e.g, binge drinking), controlling for demographics and "having an adult to talk to." Findings: Non‐heterosexual students were more likely to report all adverse outcomes and risk was lower among students who report "having an adult to talk to." Practice Implications: Psychiatric nurses need to assess sexual minority youth for access to positive adult relationships.
Keywords: Mental Health -- Psychosocial Factors -- In Infancy and Childhood; Mental Health -- Psychosocial Factors -- In Adolescence; Healthcare Disparities; Students, High School -- Psychosocial Factors; Alcohol Drinking -- In Infancy and Childhood; Alcohol Drinking -- In Adolescence; Risk Taking Behavior; Sexuality; Interpersonal Relations; Human; Male; Female; Child; Adolescence; Centers for Disease Control and Prevention (U.S.); Surveys; LGBTQ+ Persons -- Psychosocial Factors; Outcome Assessment; Retrospective Design; Secondary Analysis; Cross Sectional Studies; Bivariate Statistics; Chi Square Test; Logistic Regression; Data Analysis Software; Descriptive Statistics; Confidence Intervals; Sex Factors; Odds Ratio

Social and Medical Gender Affirmation Experiences Are Inversely Associated with Mental Health Problems in a U.S. Non-Probability Sample of Transgender Adults. - Hughto, Jaclyn M. W.; Gunn, Hamish A.; Rood, Brian A.; Pantalone, David W. (Archives of Sexual Behavior, 2020)
A dearth of research has explored concurrently the associations between multiple forms of gender affirmation (or transitioning) and the mental health of transgender adults. In 2015, 288 U.S. transgender adults completed a cross-sectional, online survey assessing demographics, gender affirmation experiences, and mental health. Adjusting for age and discrimination experiences, we used mixed-effect logistic regression analyses to examine changes in self-reported suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) before and after initiating the gender affirmation process, and linear regression analyses to examine associations between gender affirmation experiences and self-reported depressive, anxiety, and stress symptoms. Overall, 81.3% of participants identified along the female-to-male, trans masculine gender spectrum (of which 20.9% identified as non-binary) and 18.8% identified along the male-to-female, trans feminine gender spectrum (of which 7.4% identified as non-binary). Nearly all participants (98.6%) reported disclosing their gender identity to family or a coworker; 67.4% endorsed recently using hormones, and 31.3% endorsed a gender-affirming medical procedure. In multivariable models, participants were at greater odds of NSSI, contemplating suicide, and attempting suicide before initiating the gender affirmation process compared to after. In additional models, gender identity disclosure and medical procedure engagement were inversely associated with depressive and anxiety symptoms, whereas gender identity disclosure, hormone use, and medical procedure engagement were inversely associated with stress symptoms. Finally, the number of gender affirmation experiences endorsed was inversely associated with depressive, anxiety, and stress symptoms. Findings support the possibility that social and medical gender affirmation experiences may be protective against mental health problems in transgender adults.
Keywords: Mental Disorders -- Psychosocial Factors; Cross Sectional Studies; Female; Male; United States; Adult; Questionnaires; Social Readjustment Rating Scale

Suicide Attempts Among a Cohort of Transgender and Gender Diverse People. - Mak, Josephine; Shires, Deirdre A.; Zhang, Qi; Prieto, Lucas R.; Ahmedani, Brian K.; Kattari, Leonardo; Becerra-Culqui, Tracy A.; Bradlyn, Andrew; Flanders, W. Dana; Getahun, Darios; Giammattei, Shawn V.; Hunkeler, Enid M.; et al. (American Journal of Preventive Medicine, 2020)
Introduction: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals.Methods: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019.Results: During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged <18 years than among those aged >45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none.Conclusions: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings.

Tobacco Use and Cessation Among a National Online Sample of Men Who Have Sex With Men in Malaysia. - Lim, Sin How; Daghar, Lujain; Bullen, Christopher; Faiz, Hanisah Muhammad; Akbar, Mohd; Amer Nordin, Amer Siddiq; Yee, Anne (Asia-Pacific Journal of Public Health, 2020)
Previous studies documented the health disparities in smoking among sexual minority populations, including men who have sex with men (MSM). However, smoking behaviors have never been examined among Malaysian MSM, a sexual minority group in a predominantly Muslim country. A total of 622 Malaysian MSM completed an anonymous online survey in 2017. Data on the demographics, smoking and substance use behaviors, psychosocial factors, and attitudes toward smoking cessation were collected and analyzed. The mean age was 28 years and 67% of participants were of Malay ethnicity. The prevalence of current smoking was 23% (n = 143), while former smokers were 9% (n = 59). Current smoking status was associated with HIV-positive status and risk behaviors, such as suicidality, alcohol use, and illicit drug use (P =.001). Almost two thirds of current smokers had attempted to quit in the past year. Hence, comprehensive smoking cessation interventions addressing the psychosocial needs of MSM should be prioritized.
Keywords: Men Who Have Sex With Men -- Psychosocial Factors -- Malaysia; Attitude to Health -- Evaluation; Smoking -- Epidemiology; Smoking Cessation; Human; Male; Adult; Malaysia; Questionnaires; Descriptive Statistics; Pearson's Correlation Coefficient; Chi Square Test; One-Way Analysis of Variance; Health Behavior; HIV Infections; Risk Taking Behavior; Suicidal Ideation; Alcohol Drinking; Health Status Disparities; Depression; Educational Status; Substance Abuse; Center for Epidemiological Studies Depression Scale; Psychological Tests; Funding Source

Suicide Attempt Rates and Associations with Discrimination Are Greatest in Early Adulthood for Sexual Minority Adults Across Diverse Racial and Ethnic Groups. - Layland, Eric K.; Exten, Cara; Mallory, Allen B.; Williams, Natasha D.; Fish, Jessica N. (LGBT Health, 2020)
Purpose: The study purpose was to investigate differences in past 5-year suicide attempts among racially/ ethnically diverse sexual minority (SM) and heterosexual adults across the life course and examine the association of discrimination with past 5-year suicide attempts among SM adults. ***Methods: Using nationally representative data collected from 2012 to 2013, we assessed differences in agevarying prevalence of past 5-year suicide attempts among Black, Hispanic, and White SM and heterosexual adults (ages 18-60). We tested whether the association between discrimination and suicide attempts differed by race/ethnicity among SM adults. All secondary data analyses were approved by the Institutional Review Boards of The Pennsylvania State University and University of Maryland. ***Results: Compared with heterosexual adults of any race/ethnicity, SM adults exhibited elevated suicide attempt rates until the late twenties when prevalence for Black and Hispanic SM adults declined. Disparities persisted into the mid-40s for White SM adults. Among SM adults of all races/ethnicities, the relationship between SM discrimination and suicide attempts was strongest between ages 18 and 25. For SM adults reporting SM discrimination, odds of suicide attempts were 3.6 times higher for White SM adults and 4.5 times higher for Black and Hispanic SM adults, relative to same-race/ethnicity SM adults who did not report SM discrimination. The effect of SM discrimination was robust among Black and Hispanic SM young adults even when accounting for racial/ethnic discrimination. ***Conclusions: SM adults of all racial/ethnic groups demonstrated disparities when contrasted with heterosexual adults of any race/ethnicity, although ages characterized by heightened prevalence rates of suicide attempts differed by race/ethnicity. Early adulthood is a critical period for intervention seeking to disrupt the association between SM discrimination and suicide attempts.
Keywords: Suicide, Attempted -- Epidemiology -- In Adulthood; Sexism; Sexual and Gender Minorities; Race Factors; Human; Male; Female; Adolescence; Adult; Middle Age; Ethnic Groups

Correlates to Lifetime Suicide Attempts, Thoughts, and Planning Behaviors Among African American Transgender Individuals. - Andrew Yockey, R.; King, Keith A.; Vidourek, Rebecca A. (Journal of Primary Prevention, 2020)

Connecting the dots: a comparison of network analysis and exploratory factor analysis to examine psychosocial syndemic indicators among HIV-negative sexual minority men. - Lee, J. S.; Bainter, S. A.; Carrico, A. W.; Glynn, T. R.; Rogers, B. G.; Albright, C.; O'Cleirigh, C.; Mayer, K. H.; Safren, S. A. (Journal of Behavioral Medicine, 2020)
Syndemics, or comorbid and mutually reinforcing psychosocial problems, are associated with increased HIV risk among men who have sex with men (MSM). Although the dynamic interplay among syndemic indicators is theorized to be crucial for increasing risk of HIV acquisition, novel approaches are needed to understand how these syndemic problems interrelate. This study examined the associations between nine self-reported syndemic indicators in 194 MSM at high risk of HIV acquisition. We compared exploratory factor analyses (EFA) to a network analysis. In the present study, network analysis consisted of edges representing bidirectional partial polychoric correlations between nodes, which represent psychosocial syndemic indicators. EFA yielded a 1-factor solution including suicidal ideation (SI), injection drug use (IDU), depression, social anxiety, intimate partner violence, substance use, and sexual compulsivity, and excluded heavy drinking and childhood sexual abuse. Network analysis yielded a pattern of interconnectedness with the most central nodes being SI, IDU, substance use, and depression. Statistically significant relationships (absolute edge weights) were found between SI and depression, social anxiety, and IDU, and IDU and substance use. These results suggest that depression and substance use, especially more severe presentations of these conditions such as SI and IDU, are prominent interconnected components of the HIV syndemic among MSM at high risk for HIV acquisition. SI, IDU, substance use, and depression may indeed be prudent targets of intervention. Future research on the inclusion of these syndemic indicators in analytical models involving interaction terms may be warranted.
Keywords: Men Who Have Sex With Men -- Psychosocial Factors; Syndemic; HIV Seronegativity; Human; Factor Analysis -- Methods; Suicidal Ideation; Intravenous Drug Users; Depression; Anxiety; Intimate Partner Violence; Comparative Studies

Bias From Potentially Mischievous Responders on Large-Scale Estimates of Lesbian, Gay, Bisexual, or Questioning (LGBQ)-Heterosexual Youth Health Disparities. - Cimpian, Joseph R.; Timmer, Jennifer D.; Birkett, Michelle A.; Marro, Rachel L.; Turner, Blair C.; Phillips II, Gregory L. (American Journal of Public Health, 2018)
Objectives. To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities are to the presence of potentially mischievous responders. Methods. We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness.WeestimatedLGBQ- heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. Results. Accounting for suspected mischievousness reduced estimates of the average LGBQ-heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. Conclusions. Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Heterosexuals -- Psychosocial Factors; Health Status Disparities -- Evaluation; Human; Sexual Identity; Machine Learning; Bullying; Suicidal Ideation; Risk Taking Behavior; Students, High School -- Psychosocial Factors; Public Health; Regression; Male; Female; Health Screening; Adolescence; Alcohol Abuse; Substance Abuse; Sex Factors; Questionnaires

Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. - Bränström, Richard; Pachankis, John E. (American Journal of Psychiatry, 2020)
Objective: Despite professional recommendations to consider gender-affirming hormone and surgical interventions for transgender individuals experiencing gender incongruence, the long-term effect of such interventions on mental health is largely unknown. The aim of this study was to ascertain the prevalence of mood and anxiety disorder health care visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender incongruence diagnosis and gender-affirming hormone and surgical treatment in the entire Swedish population.Methods: This study used the Swedish Total Population Register (N=9,747,324), linked to the National Patient Register and the Prescribed Drug Register. Among individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015 (N=2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming hormone and surgical treatment. Outcome measures were mood and anxiety disorder health care visits, antidepressant and anxiolytic prescriptions, and hospitalization after a suicide attempt.Results: Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98).Conclusions: In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.
Keywords: Affective Disorders -- Therapy; Anxiety -- Etiology; Affective Disorders -- Etiology; Anxiety -- Therapy; Human; Antidepressive Agents -- Therapeutic Use; Adult; Female; Male; Suicidal Ideation; Sexual and Gender Disorders -- Therapy; Mental Health -- Statistics and Numerical Data; Sexual and Gender Disorders -- Epidemiology; Sweden; Sexual and Gender Disorders -- Diagnosis; Prevalence; Antianxiety Agents -- Therapeutic Use; Mental Health Services -- Statistics and Numerical Data; Patient Attitudes; Sexual and Gender Disorders -- Psychosocial Factors; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires

Substance use, violence experiences, and mental health issues: are these health risks associated with HIV testing among sexually experienced U.S. high school students? - Pampati, Sanjana; Lowry, Richard; Steiner, Riley J. (AIDS Care, 2019)
HIV testing is a critical strategy for prevention of HIV yet testing among sexually experienced adolescents is sub-optimal. The purpose of this study is to examine associations between risk behaviors and experiences related to substance use, violence, and mental health and suicide and receipt of testing. We analyzed cross-sectional data from the 2017 national Youth Risk Behavior Survey, a nationally representative sample of U.S. high school students in grades 9–12. Analyses were limited to sexually experienced participants (n = 5192). Measures included nine indicators related to substance use, violence, and mental health and suicide. Unadjusted and adjusted prevalence ratios were calculated for each indicator to examine associations with testing. Adjusted models controlled for same-sex sexual behavior, sexual risk, and demographic characteristics. Prevalence of HIV testing was 17.2%. In adjusted models, forced sexual intercourse, injection drug use, other illicit drug use, and persistent feelings of sadness or hopelessness were associated with a higher likelihood of testing. Prevalence of HIV testing in this sexually experienced sample was low. Some behaviors and experiences that may be indicative of HIV risk, including sexual dating violence and prescription opioid misuse, were not associated with testing.
Keywords: Risk Taking Behavior -- Evaluation -- In Adolescence; Substance Abuse -- Complications -- In Adolescence; Sexual Abuse -- Complications -- In Adolescence; Mental Disorders -- Complications -- In Adolescence; Suicide -- Complications -- In Adolescence; HIV Infections -- Risk Factors -- In Adolescence; HIV Infections -- Diagnosis -- In Adolescence; Students, High School -- Psychosocial Factors -- United States; Human; United States; Cross Sectional Studies; Surveys; Adolescence; Prevalence; Homosexuality; Unsafe Sex; Sexual Intercourse; Substance Abuse, Intravenous; Street Drugs; Sadness; Hopelessness; Dating Violence; Narcotics

Sexual orientation and mental health over the life course in a birth cohort. - Spittlehouse, J. K.; Boden, J. M.; Horwood, L. J. (Psychological Medicine, 2020)
Background: Sexual minority individuals consistently report higher rates of mental disorder than heterosexuals. However, much of the research has methodological limitations related to the classification of sexuality, the use of cross-sectional data and problematic sampling procedures such as using convenience samples. Methods: We used longitudinal data from a birth cohort enrolled in the Christchurch Health and Development Study (n = 1040). Latent class analysis was used to classify participants sexuality based on self-report data of sexual behaviour, attraction, identity and fantasy, gathered over five assessments between the ages of 18 and 35 years. Mental health and substance use outcome data were gathered at four assessments between the ages of 21 and 35 years. Potential covariate variables were collected during childhood. Results: The latent class analysis identified four groups interpreted as: 'heterosexual' 82%, 'mostly heterosexual' 12.6%, 'bisexual' 3.5% and 'gay/lesbian' 1.9%. In the sexual minority groups, women outnumbered men by at least 2:1. Pooled rates for mental health disorders of depression, anxiety disorders, suicidal ideation, cannabis abuse and total disorders, after adjustment for childhood covariate variables, were significantly higher in the sexual minority groups (p < 0.01). The strength of association between sexuality group and mental health outcomes did not differ according to sex. Fluidity in sexuality reports appeared unrelated to risk of mental health outcomes. Conclusions: Over the life course, membership of a sexual minority group is clearly associated with mental health problems of depression, anxiety and suicidal ideation regardless of the age when same-sex attraction, behaviour, identity or fantasy is expressed.
Keywords: Sexual Orientation; Sexual and Gender Minorities -- Psychosocial Factors; Mental Disorders -- Risk Factors; Risk Assessment; Human; Adult; Adolescence; Cross Sectional Studies; Convenience Sample; Prospective Studies; Self Report; Fantasy -- Evaluation; Mental Health -- Evaluation; Substance Use Disorders -- Risk Factors; Heterosexuals -- Psychosocial Factors; Bisexuals -- Psychosocial Factors; Lesbians -- Psychosocial Factors; Gay Persons -- Psychosocial Factors; Depression -- Risk Factors; Anxiety -- Risk Factors; Suicidal Ideation -- Risk Factors; Age Factors; Sex Factors

Suicidality and clinical correlates in Chinese men who have sex with men (MSM) with HIV infection. - Wang, Yuan-Yuan; Dong, Min; Zhang, Qinge; Xu, Dan-Dan; Zhao, Jin; Ng, Chee H.; Ungvari, Gabor S.; Jia, Fu-Jun; Xiang, Yu-Tao (Psychology, Health & Medicine, 2019)
Little is known about suicidality in Chinese men who has sex with men (MSM) infected with human immunodeficiency virus (HIV). This study investigated suicidality and its clinical correlates in Chinese MSM with HIV infection. Suicidality, demographic and clinical characteristics were assessed in 410 MSM with HIV infection consecutively recruited from a public HIV clinic in China. The prevalence of suicidality was 10.7% in Chinese HIV-infected MSM. Compared with those without suicidality, MSM with suicidality were more likely to be younger, unmarried and unemployed, and have more frequent insomnia, lower CD4 lymphocyte counts, and higher GAD-7 and CSE-D total scores. Multiple logistic regression analyses revealed that suicidality was independently associated with unemployment (p = 0.03, OR = 0.3, 95% CI = 0.1-0.9), age (p < 0.01, OR = 0.9, 95% CI = 0.8-0.9), CD4 lymphocyte counts (p = 0.02, OR = 0.9, 95% CI = 0.9-1.0), and the GAD-7 total score (p < 0.001, OR = 1.3, 95% CI = 1.1-1.5). Suicidality is common in Chinese MSM with HIV infection. There is an urgent need to develop comprehensive suicide prevention program and mental health services for this population.
Keywords: Suicidal Ideation -- Risk Factors; Men Who Have Sex With Men -- Psychosocial Factors -- China; HIV Infections -- Psychosocial Factors -- China; Chinese; Human; China; Prevalence; Single Person; Unemployment; Insomnia; CD4 Lymphocyte Count; Center for Epidemiological Studies Depression Scale; Multiple Logistic Regression; Odds Ratio; Confidence Intervals; Mental Health Services; Hospitals, Public -- China; Psychological Tests; Scales; Suicidal Ideation -- Prevention and Control

Suicidal Thoughts and Behaviors Among LGBTQ Youth: Meta-Analyses and a Systematic Review. - Hatchel, Tyler; Polanin, Joshua R.; Espelage, Dorothy L. (Archives of Suicide Research, 2021)

Pride in all Who Served: Development, Feasibility, and Initial Efficacy of a Health Education Group For LGBT Veterans...VHA Innovation Network Demo Day in Washington, D.C. in August 2018. - Lange, Tiffany M.; Hilgeman, Michelle M.; Portz, Kaitlin J.; Intoccia, Vincent A.; Cramer, Robert J. (Journal of Trauma & Dissociation, 2020)
Many of the more than 1 million military veterans who identify as lesbian, gay, bisexual, and/or transgender (LGBT) have encountered "rejecting experiences in the military" and stigma from prior "Don't Ask Don't Tell" policies. Associated minority stress and social isolation have been linked to a disproportionate risk for depression and suicide, as well as a reluctance to seek medical care at Veterans Health Administration (VHA) facilities. This paper describes feasibility and preliminary outcomes of the newly developed, Pride in All Who Served Health Education Group created to meet the unique needs of sexual and gender minority veterans. The 10-week, closed, health education group (e.g., continuums of identity, military culture) enables open dialogue, fosters social connectedness, and empowers veterans to be more effective self-advocates within the healthcare system. Feedback from formative evaluations (n = 29 LGBT veterans and n = 25 VHA stakeholders) was incorporated before conducting a small scale, non-randomized pilot. Preliminary pre-post surveys (n = 18) show promise (i.e., Cohen's d range ± 0.40 to 1.59) on mental health symptoms (depression/anxiety, suicidal ideation), resilience indicators (identity affirmation, community involvement, problem-focused coping), and willingness to access care within the VA system (satisfaction with VA services, perception of staff competence). Results suggest that the 10-week Pride Group may be an effective tool for addressing minority-related stress in LGBT veterans. A full-scale, randomized clinical trial of this intervention is needed to determine short and long-term impacts on clinical and healthcare access-related outcomes.
Keywords: Health Education; LGBTQ+ Persons -- Education; Veterans -- Education; Outcomes of Education; Human; Congresses and Conferences -- District of Columbia; Sexual and Gender Minorities -- Education; District of Columbia; Empowerment; Feedback; Stakeholder Participation; Surveys; Depression; Anxiety; Suicidal Ideation; Hardiness; Coping

LGBQ+ Self-Acceptance and Its Relationship with Minority Stressors and Mental Health: A Systematic Literature Review. - Camp, Jake; Vitoratou, Silia; Rimes, Katharine A. (Archives of Sexual Behavior, 2020)
Many individuals who identify as lesbian, gay, bisexual, queer, and with other non-heterosexual orientations (LGBQ+) experience stigma, prejudice, and/or discrimination because of their sexuality. According to minority stress and identity development theories, these experiences can contribute to difficulties with self-acceptance of sexuality. Lower self-acceptance is considered a risk factor for adverse mental health outcomes. The current review aims to investigate whether self-acceptance of sexuality is associated with minority stressors or difficulties with mental health in LGBQ+ individuals, as well as whether there are differences in self-acceptance between different sexual orientations. Five bibliographic databases were searched. Thirteen studies were identified which used quantitative methodology to investigate associations between self-acceptance, minority stressors, and/or mental health within LGBQ+ samples, or differences in self-acceptance between different sexual orientations. The results from these cross-sectional studies suggested that lower self-acceptance of sexuality was associated with higher levels of self-reported minority stressors, including a lack of acceptance from friends and family, a lack of disclosure to others, and internalized heterosexism. Lower self-acceptance of sexuality was associated with poorer mental health outcomes, including greater global distress, depression symptoms, and lower psychological well-being. There was no significant relationship with suicidality. Studies also found that LGBQ+ individuals had lower general self-acceptance compared to heterosexual participants, bisexual individuals had lower sexuality self-acceptance compared to lesbian/gay individuals, and lesbian women had lower sexuality self-acceptance compared to gay men. Given the potential importance of self-acceptance for LGBQ+ populations, further research is required with more robust methodology. Self-acceptance could be a potential target in clinical interventions for LGBQ+ individuals.

Questions of faith: Religious affiliations and suicidal ideation among sexual minority young adults. - Blosnich, John R.; De Luca, Susan; Lytle, Megan C.; Brownson, Chris (Suicide & Life-Threatening Behavior, 2020)

Religiosity, spirituality, suicide risk and remission of depressive symptoms: a 6-month prospective study of tertiary care Brazilian patients. - Mosqueiro, Bruno Paz; Caldieraro, Marco Antônio; Messinger, Mateus; da Costa, Felipe Bauer Pinto; Peteet, John R.; P Fleck, Marcelo (Journal of Affective Disorders, 2021)
Religiosity and spirituality (R/S) are increasingly recognized as significant aspects in the evaluation of depressed patients. Limited research, however, has investigated the impact of R/S on outcomes of more severe or chronic depressed patients. The present study investigated the impact of different religiosity dimensions in tertiary care Brazilian depressed patients over suicide risk scores measured at baseline and remission of depressive symptoms in a 6-month prospective follow-up. In 277 individuals interviewed, 226 presented a diagnosis of depressive episode and 192 were assessed in the follow-up. Religiosity was evaluated using the Duke University Religion Index, comprising three dimensions of religiosity (organizational religiosity, non-organizational religiosity, intrinsic religiosity). Other potential predictors of outcomes included the Childhood Trauma Questionnaire (CTQ), Maudsley Staging of illness (MSM), Medical Outcomes Study Social Support Survey (MOS), World Health Organization Spirituality, Religiousness and Personal Beliefs instrument (WHOQOL-SRPB) and Hamilton Depression Scale (HAM-D). Results showed that almost half (46.1%) of the patients reported previous suicide attempts. Linear regression models identified that religious attendance (t-statistic -2.17, P=0.03), intrinsic religiosity (t-statistic -2.42, P=0.01) and WHOQOL-SRPB (t-statistic -3.67, P=0.00) were inversely correlated to suicide risk scores. In a prospective follow-up 16.7 % of patients (n=32/192) achieved remission of depressive symptoms (HAM-D scores ≤7). Religious attendance (OR 1.83, P=0.02) was identified as the main predictor of remission. Findings reinforce the importance of attending to religiosity/spirituality in order to improve outcomes and promote the recovery especially among severely depressed patients with increased suicide risk.

Changes in Anxiety and Depression from Intake to First Follow-Up Among Transgender Youth in a Pediatric Endocrinology Clinic. - Cantu, Annette L.; Moyer, Danielle N.; Connelly, Kara J.; Holley, Amy L. (Transgender Health, 2020)
Monitoring acute distress in transgender youth initiating gender-affirming care is important given their increased risk for significant mental health symptoms. The current study examined changes in anxiety, depression, and suicidality from initial appointment to first follow-up in 80 youth, ages 11–18. Average time between visits was ∼4 months but varied across participants. Results revealed no change in acute distress from intake to follow-up. Neither distance from medical center nor initiation of hormone therapy was associated with symptom changes. While research shows decreased distress with initiation of hormones, study findings suggest changes may actually take longer to occur.
Keywords: Anxiety; Depression; Transgender Persons -- In Adolescence; Hospitals, Pediatric; Endocrinology; Suicidal Ideation; Attitude to Sexuality; Human; Child; Adolescence; Psychological Distress; Gender Dysphoria; Health Services Accessibility

The myth of Achilles: non‐binary vulnerability and the intergenerational transmission of trauma. - Lord, Susan A. (Journal of Family Therapy, 2020)
This paper offers a case study of individual family‐focused work with a non‐binary identified person who is working on identity formation, ongoing suicidality, and difficulties with intimate relationships. Using a combination of psychoanalytic and systemic models, issues of power, control and attachment are addressed as important to understanding intergenerational trauma. While M has always had difficulty identifying as female, the many layers of their struggle for control of a life separate from their family have impacted M's development and current life circumstances. Much of our work has to do with separating out what they carry that is theirs from what they are carrying for prior generations of their family. Practitioner points: Individual family‐focused work is a treatment of choice with certain clients, particularly when there has been a history of traumaPsychoanalytic and systemic models of treatment can be combined to deliver what is helpful to the client/client systemTrauma is said to be transmitted intergenerationally through nature and/or nurturePower, control, narrative and attachment are significant elements of trauma.
Keywords: Family Therapy -- Methods; Individualized Medicine -- Methods; Vulnerability; Historical Trauma -- Therapy; Suicidal Ideation -- Therapy; Gender Identity; Intimacy; Psychoanalysis; Models, Theoretical; Power; Control (Psychology); Attachment Behavior; Adult; Narratives

Extending a Rejection Sensitivity Model to Suicidal Thoughts and Behaviors in Sexual Minority Groups and to Transgender Mental Health. - Wells, Tony T.; Tucker, Raymond P.; Kraines, Morganne A. (Archives of Sexual Behavior, 2020)
The authors comment on an article by B. A. Feinstein on how a rejection sensitivity (RS) model contributes to the understanding of the etiology and maintenance of mental health issues in sexual minorities. Topics include areas deserving of additional consideration in the context of developing RS model, RS sensitivity application to transgender and gender diverse individuals, and the potential for the RS model proposed by Feinstein to contribute to understanding of sexual minority mental health.
Keywords: Mental Health; Suicidal Ideation; Minority Groups; Questionnaires; Scales

Alcohol Use and Suicidality by Sexual Orientation Among U.S. Youth, 2009-2017. - Phillips II, Gregory L.; Turner, Blair C.; Felt, Dylan; Marro, Rachel L.; Wang, Xinzi; Ruprecht, Megan M.; Broschart, Jacob; Beach, Lauren B.; Phillips, Gregory L 2nd (American Journal of Preventive Medicine, 2020)
Introduction: Alcohol use and suicidality remain serious risks for U.S. youth. Research has established that disparities exist in these outcomes between heterosexual and sexual minority youth. However, research into the associations between alcohol use and suicidality has yet to consider the differential role of sexual orientation.Methods: Using a pooled, diverse sample from the 2009-2017 Youth Risk Behavior Survey, associations of alcohol use and suicidality by sex and sexual orientation, and changes in these outcomes over time, were investigated. Analyses were conducted in 2019.Results: Suicidality was highest among nonheterosexuals, who ranged from twofold to sevenfold higher odds to report suicidality across all time points, with the most striking disparities among male sexual minority youth. Rates among all students remained stable or increased over time; notable exceptions included a decrease in suicide attempts among bisexual students. Among all students, current alcohol use was associated with elevated levels of suicidality. For female students, the association between drinking and suicidality did not significantly differ by sexual identity; for male students, it was significant regardless of sexual identity and most pronounced among not sure youth.Conclusions: These results emphasize the need for additional research into the relationship between contemporaneous alcohol use and suicidality, with attention to differences based on sex, sexual orientation, and other factors that may impact these relationships. There is a particular need for research to examine the temporal nature of the association such that evidence-informed, high-impact interventions can be developed to improve suicidality outcomes among sexual minority youth.

Group sex, suicidality and online partners: implications for HIV and suicide prevention: a short report. - Kongjareon, Yamol; Samoh, Nattharat; Lim, Sin How; Peerawaranun, Pimnara; Jonas, Kai J.; Guadamuz, Thomas E. (AIDS Care, 2020)
HIV-related factors and suicide-risk status were assessed among YMSM aged 18–24 years recruited through various MSM-related online social apps in Bangkok (N = 1394). The online survey assessed demographic characteristics, sexual behaviours and suicide-risk status. Measure of suicide risk was taken from the Suicidal Behaviors Questionnaire-Revised (cut-off score of seven or higher). Among participants, 249 (17.9%) reported suicide-risk. In multivariable logistic regression, correlates of suicide-risk status included having sometimes or often ever participated in group sex (AOR=1.58, 95% CI: 1.17–2.14), having received money or opportunities for sex (AOR=1.54, 95% CI: 1.09–2.17), often seeking partners online (AOR=1.59, 95% CI: 1.05–2.39), inconsistent condom use (AOR=1.67, 95% CI: 1.26–2.21), and self-assessed as having "medium" or "high" HIV risk (AOR=2.53, 95% CI: 1.61–3.98 and AOR=3.35, 95% CI: 1.92–5.82, respectively). Findings suggest that HIV risk behaviours shown by YMSM are significantly associated with higher risk of suicide.
Keywords: HIV Infections -- Prevention and Control; Suicide -- Prevention and Control; Suicidal Ideation -- Prevention and Control; Sexuality; Sexual Partners; Internet; Risk Taking Behavior; Human; Female; Male; Adolescence; Young Adult; Mobile Applications; Surveys; Questionnaires; Risk Assessment; Multivariate Analysis; Logistic Regression; Descriptive Statistics; Confidence Intervals; Condoms

Intimate Partner Violence, Suicide, and Their Overlapping Risk in Women Veterans: A Review of the Literature. - Iovine-Wong, Paige E; Nichols-Hadeed, Corey; Stone, Jennifer Thompson; Gamble, Stephanie; Cross, Wendi; Cerulli, Catherine; Levandowski, Brooke A; Thompson Stone, Jennifer (Military Medicine, 2019)
Introduction: Suicidal thoughts and behaviors (STB) and intimate partner violence (IPV) are both serious and prevalent problems in the Veteran population that often occur in tandem, particularly among women Veterans. Women Veterans, the fastest growing segment of the Veteran population, may have unique overlapping risks that are worth exploring. Although the intersection of IPV and STB is well documented in the civilian population, it has not been thoroughly explored in women Veterans.Materials and Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we conducted a systematic review of the STB and IPV literature specifically related to women Veterans. We only included articles that sampled women Veterans, rather than active duty/reservist/National Guard women; due to the small volume of STB research using samples of only women Veterans, we included studies that used mixed-gender samples. We extracted risk factors for STB and/or IPV involvement from 56 selected articles and placed them into tables for comparison to determine commonalities.Results: Common risk factors fell into three categories: socio-demographic risk factors (young age, unemployment, and sexual minority status) were significant across both bodies of literature; mental health risk factors (general psychopathology, post-traumatic stress disorder (PTSD), depression, sleep disturbance, and substance use/abuse) also had significant overlap; and military service-related risk factors (military sexual trauma (MST) and deployment factors) were also relevant across both bodies of literature. Mental health risk factors, particularly PTSD, were the most common.Conclusion: Frequently, the risk factors for IPV and STB are shared and it is important to consider how research, screening and intervention efforts for these serious problems might be integrated. Our exploration of the literature may be used as a basis for future research with women Veterans on the intersection of STB and IPV. Further, Veterans Health Administration clinicians should be aware of these intersecting risk factors to enhance care and improve screening for both issues in women Veteran clients.
Keywords: Veterans -- Psychosocial Factors; Suicide -- Psychosocial Factors; Human; Prevalence; Middle Age; Adolescence; Adult; Risk Factors; Female; Veterans -- Statistics and Numerical Data; Suicide; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires

Sexual Assault and Co-Occurrence of Mental Health Outcomes Among Cisgender Female, Cisgender Male, and Gender Minority U.S. College Students. - Parr, Nicholas J. (Journal of Adolescent Health, 2020)
The aim of this study was to examine the co-occurrence of mental health (depression, anxiety, nonsuicidal self-injury, and suicide ideation) and substance use outcomes among cisgender female, cisgender male, and gender minority college students exposed to sexual assault (SA). Data were drawn from a 2018 U.S. national survey of college student well-being (N = 50,438). Inverse propensity-weighted three-step latent class analysis was used to examine co-occurrence of outcomes while adjusting for 31 potential confounders of the relation between SA and outcome classes. Four latent classes were identified for cisgender female and male participants and two for gender minority participants, reflecting a range from low to high risk of co-occurring outcomes. SA was associated with significantly and substantially increased odds (odds ratio: 2.03–3.64) of membership to the highest-risk outcome class compared with the lowest-risk class across gender identity subgroups. SA in the college setting is associated with substantially increased odds of co-occurring depression, anxiety, nonsuicidal self-injury, and suicide ideation, regardless of gender identity.
Keywords: Students, College -- United States; LGBTQ+ Persons; Sexual Abuse; Mental Health; Substance Abuse; Minority Groups; Human; Female; Male; United States; Odds Ratio; Descriptive Statistics; Confidence Intervals

My preferred pronoun is she: Understanding transgender identity and oral health care needs. - Macri, Diana; Wolfe, Kate (Canadian Journal of Dental Hygiene, 2019)
Objective: This literature review summarizes current research and evidence regarding transgender persons and oral health. Methods: A search of the literature was conducted in the following databases: PubMed, Google Scholar, EBSCO Host, Science Direct, and Wiley Online Library using the keywords "transgender identity, gender non-conforming, discrimination, transition, binary systems, transgender oral cavity, transgender, transgender oral health, transgender dental health." Articles published from 2000 to 2017 in both peer-reviewed and non-peer reviewed journals, which reported information regarding the oral health status of transgender populations, were selected for review. Results: The search revealed 18 articles, only 7 of which pertained to the oral health status of transgender client populations. Five other articles were eliminated due to either poor quality or irrelevance. Discussion: The 13 articles included in the review revealed a need for oral health care professionals to be aware that gender is not binary, nor is it a mental health disorder. Transgender people face heightened risk of discrimination, violence, anxiety, depression, suicidality, substance abuse, and sexually transmitted diseases, as well as significant barriers to health care of which oral health professionals should be made aware. Conclusions: Transgender people have the same rights as everyone else to oral health care. Oral health care providers are responsible for ensuring that transgender clients receive care that aligns with their needs and for providing that care in a culturally competent manner. This requires an understanding of the basics of gender nonconformance and its impact on oral-systemic health. Additional research is needed to increase the scientific knowledge base to facilitate improved health outcomes for this client population.
Keywords: Transgender Persons -- Psychosocial Factors; Oral Health; Health Services Accessibility; Human; Systematic Review; PubMed; Discrimination; Health Services Needs and Demand; Narratives

Sexual Orientation and Gender Identity Change Efforts are Unethical and Harmful. - Fish, Jessica N.; Russell, Stephen T. (American Journal of Public Health, 2020)
An introduction is presented of an article published in the same issue concerning the detrimental impact of sexual orientation and gender identity change efforts (SOGICE), also known as conversion or reparative therapy to LGBTQ youth which states SOGICE exposure is dangerous and unethical.
Keywords: Sexual and Gender Minorities; LGBTQ+ Persons -- Psychosocial Factors; Suicide; Sexuality; Sexual Identity; Sexual Reorientation Programs; United States; Gender Identity; Discrimination; Suicide, Attempted -- Risk Factors; Risk Assessment

APA/Psi Chi Edwin B. Newman Graduate Research Award: Andrew Young Choi. (American Psychologist, 2020)
The Edwin B. Newman Graduate Research Award is sponsored jointly by Psi Chi, the national honor society in psychology, and the APA. The award is presented annually to the psychology graduate student who submits the best research paper that was published or presented at a national, regional, or state psychological association conference during the past calendar year. The Edwin B. Newman Graduate Research Award was established in 1979. The award was established to recognize young researchers at the beginning of their professional lives and to commemorate both the 50th anniversary of Psi Chi and the 100th anniversary of psychology as a science (dating from the founding of Wundt's laboratory). It was named for Dr. Edwin B. Newman, the first national president of Psi Chi (1929) and one of its founders. He was a prolific researcher and a long-time chair of the Department of Psychology at Harvard University. Newman was a member of APA's Board of Directors, served as recording secretary of the board from 1962 to 1967, and was parliamentarian for the APA Council of Representatives for many years. He served both Psi Chi and APA in a distinguished manner for half a century. The APA/Psi Chi Edwin B. Newman Graduate Research Award is given jointly by APA and Psi Chi. For an outstanding research paper examining the syndemic theory of health disparities among bisexual adolescents, using national data to model patterns of co-occurrence across sexual risk, substance use, and victimization. Results identified six distinctive subpopulations--Low Risk, Alcohol Use, Peer-Victimization, Sexually Active, Syndemic, and Risk-taking-- which covaried differentially with demographics and suicidality. His paper, titled 'Syndemic Behavioral Risk and Suicidality Among Bisexual Adolescents: A Latent Class Analysis,' and coauthored by Drs. Tania Israel and Karen Nylund-Gibson, was the basis for Dr. Andrew (Andy) Young Choi's selection as the recipient of this research award.
Keywords: Awards and Honors; Students, Graduate; Psychology; Research, Medical

Physician Advocacy for Public Health. - Gusmano, Michael K. (Journal of Health Politics, Policy & Law, 2019)
This article documents the public positions taken by the American Academy of Pediatrics, the American College of Physicians, and the American Medical Association on five topics with implications for public health: access to care for undocumented patients, fracking, gun control, climate change, and same-sex marriage. There are stark divisions on each of these issues between political parties, and taking a strong public position on them runs the risk of alienating some members of Congress, but each of these associations has done so. At the same time, there is a clear distinction between the public positions of these organizations and the priority given to them by their offices in Washington, DC. Drawing on an organizational maintenance framework, the author argues that taking these public positions is explained, in part, by a growth in the number of women and the number of physicians that affiliate with the Democratic Party in the United States.
Keywords: Legislation, Medical; Government Regulations; Public Health; Human; Organizational Culture; Homosexuality; Firearms; Fracking; Climate Change -- Adverse Effects; Health Policy -- United States; Physician Attitudes; United States; Health Services Accessibility; Insurance, Health; Physician's Role; Health Care Delivery; Gun Violence -- Prevention and Control; Undocumented Immigrants; Public Relations; Physician-Patient Relations

Association of Nondiscrimination Policies With Mental Health Among Gender Minority Individuals. - McDowell, Alex; Raifman, Julia; Progovac, Ana M.; Rose, Sherri (JAMA Psychiatry, 2020)
Importance: In the past decade, many states have implemented policies prohibiting private health insurers from discriminating based on gender identity. Policies banning discrimination have the potential to improve access to care and health outcomes among gender minority (ie, transgender and gender diverse) populations.Objective: To evaluate whether state-level nondiscrimination policies are associated with suicidality and inpatient mental health hospitalizations among privately insured gender minority individuals.Design, Setting, and Participants: In this cohort study, difference-in-differences analysis comparing changes in mental health outcomes among gender minority enrollees before and after states implemented nondiscrimination policies in 2009-2017 was conducted. A sample of gender minority children and adults was identified using gender minority-related diagnosis codes obtained from private health insurance claims. The present study was conducted from August 1, 2018, to September 1, 2019.Exposure: Living in states that implemented policies banning discrimination based on gender identity in 2013, 2014, 2015, and 2016.Main Outcomes and Measures: The primary outcome was suicidality. The secondary outcome was inpatient mental health hospitalization.Results: The study population included 28 980 unique gender minority enrollees (mean [SD] age, 26.5 [15] years) from 2009 to 2017. Relative to comparison states, suicidality decreased in the first year after policy implementation in the 2014 policy cohort (odds ratio [OR], 0.72; 95% CI, 0.58-0.90; P = .005), the 2015 policy cohort (OR, 0.50; 95% CI, 0.39-0.64; P < .001), and the 2016 policy cohort (OR, 0.61; 95% CI, 0.44-0.85; P = .004). This decrease persisted to the second postimplementation year for the 2014 policy cohort (OR, 0.48; 95% CI, 0.41-0.57; P < .001) but not for the 2015 policy cohort (OR, 0.81; 95% CI, 0.47-1.38; P = .43). The 2013 policy cohort experienced no significant change in suicidality after policy implementation in all 4 postimplementation years (2014: OR, 1.19; 95% CI, 0.85-1.67; P = .31; 2015: OR, 0.94; 95% CI, 0.73-1.20; P = .61; 2016: OR, 0.82; 95% CI, 0.65-1.03; P = .10; and 2017: OR, 1.29; 95% CI, 0.90-1.88; P = .18). Mental health hospitalization rates generally decreased or stayed the same for individuals living in policy states vs the comparison group.Conclusions and Relevance: Implementation of a state-level nondiscrimination policy appears to be associated with decreased or no changes in suicidality among gender minority individuals living in states that implemented these policies from 2013 to 2016. Given high rates of suicidality among gender minority individuals in the US, health insurance nondiscrimination policies may offer a mechanism for reducing barriers to care and mitigating discrimination.
Keywords: Public Policy -- Legislation and Jurisprudence; Discrimination -- Legislation and Jurisprudence; Insurance, Health -- Legislation and Jurisprudence; Suicide; Human; Male; Prospective Studies; United States; Health Policy -- Legislation and Jurisprudence; Young Adult; Female; Time Factors; Middle Age; Adult; Adolescence; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

Transgender college students: Academic resilience and striving to cope in the face of marginalized health. - Messman, Jenna B.; Leslie, Leigh A. (Journal of American College Health, 2019)
Objective: To examine health behavior and outcome disparities between transgender, female, and male participants in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 32,964 undergraduate and graduate students responding to the Fall 2013 American College Health Association-National College Health Assessment; 65.8% were female, 0.4% were transgender, 67.9% were white, and 90.4% were heterosexual. Results: Transgender students reported more mental health diagnoses, trauma, and suicidality; experienced more violence and less safety, reported more sex partners and sexually transmitted infections (STIs); higher rates of illicit and nonprescription substance use and binge drinking use while engaging in less harm reduction behavior; and reported more barriers to academic success. Conclusions: There is an established need for college clinicians and health educators to reduce these disparate outcomes once students arrive on campus through professional training and culturally competent campus prevention and intervention efforts to promote health equity.
Keywords: Transgender Persons -- Psychosocial Factors; Students, College; Health Behavior -- Evaluation; Healthcare Disparities -- Evaluation; Coping; Hardiness; Human; Secondary Analysis; Students, Undergraduate; Students, Graduate; Female; Male; Trauma; Suicide; Violence; Sexual Partners; Sexually Transmitted Diseases; Street Drugs; Substance Abuse; Drugs, Non-Prescription; Binge Drinking; Academic Achievement -- Psychosocial Factors; Harm Reduction

Mind the gap: predicting the positive mental health of adult sexual minority Canadians. - Professor, Tracey Peter Associate Head and Associate (Health Promotion International, 2018)
The goal of the study is to investigate possible predictors of positive mental health, and whether they differ across sexual identity adult groups. Using data from the 2012 Canadian Community Health Survey on Mental Health, multivariate analyses were conducted, including interaction terms, to assess the effects of sexual orientation on various mental illness, health-risk behaviors, and sociological indicators and their correlations with positive mental health. Substantial effect sizes were observed across all sexual identity groups for psychological distress, social provisions and sense of belonging in terms of their influence on positive mental health. However, various mental health disorders, suicidality, and whether or not care needs were being met varied considerably in the disaggregated analysis, suggesting that there are key differences among sexual minority groups when it comes to predicting positive mental health. This study represents perhaps the largest population-based analysis of positive mental health, which is both theoretically informed and psychometrically verified, on sexual minority adults. Findings raise important concerns regarding the lower than average levels of positive mental health for all sexual minorities, which may be explained, at least in part, to the health care system's tendency to focus primarily on individual treatment needs rather than broader socio-structural aspects within a mental health promotion framework.
Keywords: Mental Health; Minority Groups -- Canada; Sexual Identity; Canada; Human; Adult; Multivariate Analysis; Mental Disorders; Risk Taking Behavior; Health Behavior; Effect Size; Stress, Psychological; Suicidal Ideation; Descriptive Statistics; Adolescence; Male; Female; Questionnaires; Summated Rating Scaling; Multiple Regression; Sex Factors; Gay Persons; Bisexuals

Differences in Prevalence Rates of Hopelessness and Suicidal Ideation Among Adolescents by Gang Membership and Latinx Identity. - Whaling, Kelly M.; Sharkey, Jill (Child & Adolescent Social Work Journal, 2020)
Despite the ongoing challenge of preventing youth gang membership in diverse communities across the United States, and increasing recognition of associations between trauma and gang involvement, the nexus between hopelessness, suicide, and gang membership has largely been ignored. We created two random samples of 1000 participants, with 50% identifying as non-Latinx White, and 50% identifying as Latinx of any race from 91,265 participants of the 2014–2015 California Healthy Kids Survey. Four Chi square tests of independence tested differences in prevalence rates of chronic hopelessness and suicidal ideation for self-identified Latinx and non-Latinx White gang and non-gang member youth. Grounded in a systems responsiveness framework, we predicted that hopelessness and suicidal ideation would be higher for groups that are more marginalized, which was supported by our findings. Specifically, gang membership and ethnicity were both associated with suicide and hopelessness. An unexpected finding, not related to the research questions, was the high prevalence of gender and sexual minority (GSM) youth who identified as gang members. This study represents a unique contribution to the adolescent suicidal ideation literature base, as most studies focus on race or ethnicity and neglect gang membership when identifying disproportionalities in suicidal ideation. Implications for practitioners, researchers, and schools and communities are discussed.
Keywords: Hopelessness -- Epidemiology -- In Adolescence; Suicidal Ideation -- Epidemiology -- In Adolescence; Gangs; Membership; Hispanic Americans; Suicidal Ideation -- Risk Factors -- In Adolescence; Risk Assessment; Human; Prevalence; Race Factors; Adolescence; United States; Random Sample; Descriptive Statistics; White Persons; Chi Square Test; Conceptual Framework; Ethnic Groups; Sex Factors; Sexual and Gender Minorities; Mental Health; Health Status Disparities; Criminal Justice

Substance Use and Suicide Attempts Among Adolescent Males Who Are Members of a Sexual Minority: A Comparison of Synthesized Substance-Use Measures. - Turpin, Rodman E; Rosario, Andre D; Dyer, Typhanye V (American Journal of Epidemiology, 2020)
Adolescent sexual minority males (ASMM) are among the highest risk groups for suicide in the United States, with substance use as a significant risk factor. We tested for an association between substance use and suicidality among ASMM from the 2015 and 2017 Youth Risk Behavior Survey (n  = 849). We compared several approaches to synthesizing measures of marijuana, cocaine, heroin, ecstasy, methamphetamines, synthetic marijuana, and prescription drug abuse, including several categorized and continuous indices, latent class analysis based on any use of each substance, and latent profile analysis based on use frequency. Using all approaches, substance use was positively associated with suicide attempts independent of covariates. A continuous cumulative index was the best fit to our data (quasi-information criterion = 853.9969) and detected the largest association, with the highest prevalence of suicide attempts among ASMM who used all substances compared with those who used none (adjusted prevalence ratio = 3.35, 95% confidence interval: 2.41, 4.66). A 3-latent-class model had the second best fit to the data (quasi-information criterion = 878.4464), with the highest prevalence of suicide attempts (adjusted prevalence ratio = 2.54, 95% confidence interval: 1.80, 3.57) among the high-substance-use class compared with the low-use class. Substance use is an especially important focal point for targeted interventions reducing suicidality among ASMM.
Keywords: Substance Use Disorders -- Psychosocial Factors -- In Adolescence; Suicide, Attempted -- Epidemiology -- United States; Sexual and Gender Minorities; Human; Adolescence; Latent Structure Analysis; Male; Comparative Studies; Confidence Intervals; Descriptive Statistics; United States; Risk Taking Behavior -- Evaluation

Prevalence of Exposure to Sexual Orientation Change Efforts and Associated Sociodemographic Characteristics and Psychosocial Health Outcomes among Canadian Sexual Minority Men. - Salway, Travis; Ferlatte, Olivier; Gesink, Dionne; Lachowsky, Nathan J. (Canadian Journal of Psychiatry, 2020)
Objective: Sexual orientation change efforts (SOCE), or "conversion therapy," are pseudoscientific practices intended to suppress or deny sexual attraction to members of the same gender/sex. There are currently no data available to inform estimates of the prevalence of SOCE exposure in Canada. The objective of this study is therefore to describe the prevalence, social-demographic correlates, and health consequences of SOCE among Canadian sexual minority men.Methods: Sex Now 2011 to 2012 was a cross-sectional nonprobability survey of Canadian sexual minority men. Respondents were asked about lifetime SOCE exposure. We estimated prevalence of SOCE exposure by sociodemographic characteristics and examined psychosocial health outcomes among those exposed to SOCE.Results: Of N = 8,388 respondents, 3.5% (95% confidence interval, 3.2% to 4.1%) reported having ever been exposed to SOCE. Exposure to SOCE was higher among gay men (as compared with bisexual men), transgender respondents (as compared with cisgender respondents), those who were "out" about their sexuality (as compared with those who were not "out"), Indigenous men (as compared with White men), other racial minorities (as compared with White men), and those earning a personal income <$30,000 (as compared with those earning ≥$60,000 CAD). Exposure to SOCE was positively associated with loneliness, regular illicit drug use, suicidal ideation, and suicide attempt.Conclusions: SOCE exposure remains prevalent and associated with substantial psychosocial morbidity among sexual minority men in Canada. All levels of government in Canada should consider action to ban SOCE. SOCE survivors likely require intervention and support from the Canadian health-care system.

Maternal Support Is Protective Against Suicidal Ideation Among a Diverse Cohort of Young Transgender Women. - Jin, Harry; Restar, Arjee; Goedel, William C.; Ogunbajo, Adedotun; Biello, Katie; Operario, Don; Kuhns, Lisa; Reisner, Sari L.; Garofalo, Robert; Mimiaga, Matthew J. (LGBT Health, 2020)
Purpose: We assessed if young transgender women (YTW) with parents who are supportive of their transgender identity had lower odds of having suicidal ideation compared with YTW with unsupportive parents. Methods: This study analyzed baseline findings from a diverse sample of 297 sexually active, YTW 16-29 years of age who were enrolled in Project LifeSkills, a randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. Bivariate and multivariable logistic regression were used to assess if parental support was associated with a decreased odds of suicidal ideation. Results: Nearly one-fifth (18.9%) of YTW reported suicidal ideation at baseline. In our adjusted multivariable model, YTW with supportive mothers had 0.37 (95% confidence interval = 0.15-0.90) times the odds of having suicidal ideation compared with YTW with unsupportive mothers. Conclusion: This study found that the odds of suicidal ideation were lower among YTW who had mothers who were supportive of their transgender identity. Our results suggest that parent-focused interventions to improve the relationships between YTW and their parents may lower the odds of YTW having suicidal ideation.
Keywords: Suicidal Ideation -- Risk Factors; Transgender Persons -- Psychosocial Factors; Women's Health; Parent-Child Relations; Safety; Mental Health; Human; Adolescence; Adult; Bivariate Statistics; Logistic Regression; Confidence Intervals; Descriptive Statistics; Odds Ratio; Funding Source

Resilience Factors and Suicide Risk for a Sample of Transgender Clients. - Edwards, Lindsay L.; Torres Bernal, Aníbal; Hanley, Scotty M.; Martin, Shannon (Family Process, 2020)
This study explored how individual‐ and community‐based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross‐sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens by way of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study.
Keywords: Hardiness; Suicide -- Prevention and Control; Transgender Persons; Human; Cross Sectional Studies; Questionnaires; Community Health Centers; Suicide -- Risk Factors; Mental Health; Family Relations; Support, Psychosocial; Social Networks; Minority Stress; Discrimination; Family Therapy

Treating LGBTQIA patients. - DAWSON, MILLY (Contemporary OB/GYN, 2018)
The article looks at five tips from physician Tochi Iroku-Malize, M.D., for physicians to clarify that lesbian, gay, bisexual, transgender, queer, intersexual or asexual patients will be treated with the same respect any other patients receive. Basic preventive screenings is recommended based on the assigned sex at birth. The patient should be asked what pronoun they prefer. A dedicated referral service for members of the queer community has been formed by Northwell Health healthcare system.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Health Care Delivery; Quality of Health Care; Stigma; Primary Health Care; Depression -- Risk Factors; Suicide -- Risk Factors; Physician-Patient Relations; Self Concept; Telemedicine; Waiting Rooms; Gender Identity; Health Promotion

Suicidal Ideation and Behavior Among Sexual Minority and Heterosexual Youth: 1995-2017. - Liu, Richard T.; Walsh, Rachel F. L.; Sheehan, Ana E.; Cheek, Shayna M.; Carter, Sarina M. (Pediatrics, 2020)
OBJECTIVES: In this study, we determined trends in prevalence of suicidal thoughts and behaviors among lesbian, gay, bisexual, and heterosexual youth from 1995 to 2017 using population-based surveillance data. METHODS: Data were drawn from the Massachusetts Youth Risk Behavior Survey from 1995 to 2017 (unweighted N = 41 636). The annual percent change (APC) in prevalence of suicidal ideation, plans, and attempts was stratified by sexual orientation as indexed by sexual identity and sexual behavior. RESULTS: Among sexual minority youth, prevalence rates declined over the entire study period for suicidal ideation (APCsexual identity = -1.25; APC sexual behavior = -1.83), plans (APC sexual identity = -1.88; APC sexual behavior = -1.95), and attempts (APC sexual identity = -2.64; APC sexual behavior = -2.47). Among heterosexual youth, prevalence rates declined from 1995 to 2007 for suicidal ideation (APC sexual identity = -6.67; APC sexual behavior = -6.77) and plans (APC sexual identity = -5.73; APC sexual behavior = -6.25). These declines in ideation and plans were steeper than those for sexual minority youth. Prevalence of suicide attempts declined across the entire study period among heterosexual youth (APC sexual identity = -3.66; APC sexual behavior = -4.01). Prevalence of all 3 outcomes remained markedly high among sexual minority youth across the 23-year study period. CONCLUSIONS: Although suicidal thoughts and behavior have generally declined among sexual minority and heterosexual youth, disparities in these outcomes persist, and their prevalence among sexual minority youth has remained consistently elevated. Prioritized screening for risk for suicidal thoughts and behaviors in this vulnerable population is imperative to reduce disparities and prevalence of these outcomes.
Keywords: Suicidal Ideation -- Trends -- In Adolescence; Suicide, Attempted -- Trends -- In Adolescence; Suicidal Ideation -- Epidemiology; Suicide, Attempted -- Epidemiology; Sexual and Gender Minorities -- In Adolescence; Heterosexuals -- In Adolescence; Human; Male; Female; Adolescence; Self-Injurious Behavior -- Trends -- In Adolescence; Risk Taking Behavior -- Trends -- In Adolescence; Massachusetts

Health or Politics? Organizational Maintenance in the AAFP. - Brophy, Sorcha A. (Journal of Health Politics, Policy & Law, 2019)
In recent years, the American Academy of Family Physicians (AAFP) has debated and developed organizational stances on issues as varied as nuclear disarmament, gay marriage, policing, and climate change. This article considers the relationship of "political" policies to the ongoing maintenance of this professional association over time. The author describes transitions in the organization's policies from broad, neutral statements to more explicitly politicized social policy statements and then discusses debates around the establishment of an organizational policy on same-gender marriage, the term for gay marriage that is used within the AAFP. Results indicate that members use concerns about the maintenance of the organization over time as a lingua franca during debates. Flowever, while members routinely interpret policy in terms of its relationship to the maintenance of the organization, they articulate conflicting visions of maintenance, with those in favor of the policies describing maintenance primarily in terms of external legitimacy and those in opposition describing maintenance primarily in terms of internal cohesion.
Keywords: Politics; Primary Health Care; Health Policy; Human; Medical Organizations -- America; America; Family Practice; Physicians, Family -- Standards; Organizational Culture; Health Services Accessibility; Physician-Patient Relations; Cultural Diversity; Homosexuality -- Legislation and Jurisprudence; Discrimination; Social Problems -- Prevention and Control; Public Health; Gun Violence -- Prevention and Control; Health Care Delivery; Civil Rights; Social Justice; Policy Making

Campus Sexual Violence Prevention Educators' Use of Gender in Their Work: A Critical Exploration. - Marine, Susan B.; Nicolazzo, Z (Journal of Interpersonal Violence, 2020)
Recent studies indicate that sexual violence affects college students who identify as trans* or gender nonconforming (TGNC) at higher proportions than cisgender students with a full 29% reporting an experience with violence in a recent large-scale study. College sexual violence prevention educators (SVPEs) are critical actors in the effort to reduce the incidence of sexual violence, yet little is known about the practices they engage in to support the learning of students of diverse genders, and to educate students about the role of gender in sexual violence. This study explores the practices of SVPEs with respect to gender diversity, and the challenges and strategies they use to be gender inclusive in their work. Using an exploratory qualitative lens, 16 SVPEs were interviewed to better understand how they think about gender in their work, talk about gender as it relates to sexual violence, and deploy teaching and learning strategies regarding gender in their work with undergraduate students. Findings suggest that SVPEs face significant pressures related to compliance with Title IX, and that in terms of their practices related to gender, they occupy a continuum typified by gender defensiveness and unawareness, gender awareness, gender inclusion, and/or gender transformation. Recommendations include advancing opportunities for enhanced gender diversity education and professional development for SVPEs and the need for additional research on cisgender men's and trans* survivors' experiences with campus sexual violence.
Keywords: Sexual Abuse -- Prevention and Control; School Violence -- Prevention and Control; Sexual Abuse -- Education; Students, College -- Psychosocial Factors; LGBTQ+ Persons -- Education; Gender Role; Faculty Role; Faculty Attitudes -- Evaluation; Human; Exploratory Research; Qualitative Studies; Students, Undergraduate; Semi-Structured Interview; Faculty Development; Gender Identity; Male; Female; Social Inclusion; Professional Compliance; Public Policy

An Investigation of the LGBTQ+ Youth Suicide Disparity Using National Violent Death Reporting System Narrative Data. - Ream, Geoffrey L. (Journal of Adolescent Health, 2020)
This study explored law enforcement and medical examiner reports about adolescent and young adult deaths by suicide for novel and understudied risk factors and described variability by sexual orientation and gender identity in those risk factors' prevalence. It also sought to explain why the suicide disparity between lesbian, gay, bisexual, transgender, queer/questioning, and other sexual/gender minority (LGBTQ+) youth and non-LGBTQ+ youth is wider in adolescence than in young adulthood. This study involved coding of law enforcement and medical examiner reports from the National Violent Death Reporting System (NVDRS) for all 394 LGBTQ+ youth who died by suicide in NVDRS participating states between 2013 (the year that NVDRS began coding for sexual orientation and transgender status) and 2016 (the latest year of NVDRS available), along with 394 non-LGBTQ+ cases matched with them on dimensions of sex, urbanicity, race, and military service. Fifty-nine percent of 12- to 17-year-old LGBTQ+'s cases mentioned an LGBTQ+-specific contributing circumstance, whereas only 30% of 18- to 29-year-old LGBTQ+'s cases mentioned an LGBTQ+-specific contributing circumstance. However, there were 3.6 times as many cases of LGBTQ+ 18- to 29-year-olds as there were of LGBTQ+ 12- to 17-year-olds. Cases of gay males, bisexual males, and bisexual females were particularly likely to include family/peer rejection and bullying as contributing circumstances, while lesbians' cases more often mentioned romantic breakups. The LGBTQ+/non-LGBTQ+ suicide disparity may be greater for adolescents because LGBTQ+-specific contributing circumstances are more prevalent among adolescents. Prevention efforts should be tailored to clients' age and specific LGBTQ+ subgroup.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Suicide -- Risk Factors -- In Adulthood; Health Status Disparities; Sexuality; Gender Identity; Risk Assessment; Human; Adolescence; Young Adult; Race Factors; Ethnic Groups; Coding -- Methods; Post Hoc Analysis; Descriptive Statistics; Pearson's Correlation Coefficient

Mental Health and Timing of Gender-Affirming Care. - Sorbara, Julia C.; Chiniara, Lyne N.; Thompson, Shelby; Palmert, Mark R. (Pediatrics, 2020)
BACKGROUND: Gender-incongruent (GI) youth have high rates of mental health problems. Although gender-affirming medical care (GAMC) provides psychological benefit, some GI youth present to care at older ages. Whether a relationship exists between age of presentation to GAMC and mental health difficulties warrants study. METHODS: A cross-sectional chart review of patients presenting to GAMC. Subjects were classified a priori as younger presenting youth (YPY) (<15 years of age at presentation) or older presenting youth (OPY) (≥15 years of age). Self-reported rates of mental health problems and medication use were compared between groups. Binary logistic regression analysis was used to identify determinants of mental health problems. Covariates included pubertal stage at presentation, social transition status, and assigned sex. RESULTS: Of 300 youth, there were 116 YPY and 184 OPY. After presentation, more OPY than YPY reported a diagnosis of depression (46% vs 30%), had self-harmed (40% vs 28%), had considered suicide (52% vs 40%), had attempted suicide (17% vs 9%), and required psychoactive medications (36% vs 23%), with all P < .05. After controlling for covariates, late puberty (Tanner stage 4 or 5) was associated with depressive disorders (odds ratio 5.49; 95% confidence interval [CI]: 1.14-26.32) and anxiety disorders (odds ratio 4.18 [95% CI: 1.22-14.49]), whereas older age remained associated only with psychoactive medication use (odd ratio 1.31 [95% CI: 1.05-1.63]). CONCLUSIONS: Late pubertal stage and older age are associated with worse mental health among GI youth presenting to GAMC, suggesting that this group may be particularly vulnerable and in need of appropriate care.
Keywords: Mental Disorders; Time; Age Factors; Gender Identity; Gender Affirmation Procedures; Human; Cross Sectional Studies; Record Review; Logistic Regression; Odds Ratio; Confidence Intervals; Puberty; Adolescence; Adult; Depression; Injuries, Self-Inflicted; Mental Health

Suicidality, maladaptive externalizing behaviors and sexual orientation: Results from an online representative sample of Canadian men. - Ferlatte, Olivier; Rice, Simon M.; Kealy, David; Oliffe, John L.; Ogrodniczuk, John S. (International Journal of Mental Health, 2020)
Gay and bisexual men (GBM) are a high-risk population for suicide. While evidence is emerging that maladaptive externalizing behaviors such as substance overuse, anger and aggression, and risk-taking may be associated with mood disorder and suicide risk for men in general, the association for GBM has not been well researched. As such, the aim of this study was to examine the relationships between sexual orientation, suicide, and maladaptive externalizing behaviors. The present study analyzed self-reported data for suicide risk and maladaptive externalizing behaviors from an online sample of GBM (n = 74) and heterosexual men (n = 902). Relative to heterosexual men, GBM were at marked risk for suicide (OR = 2.0). Mean scores on maladaptive externalizing behaviors were equivalent between the groups. Logistic regression indicated that anger and aggression, and risk-taking were significant predictors (p's <.001) of suicide risk for heterosexual men, but for not GBM. Maladaptive externalizing behaviors correctly identified the suicide risk status of 80.3% of heterosexual men, and 71.6% of GBM. While GBM were at elevated risk of suicide, maladaptive behaviors were less predictive of this risk than for heterosexual men. Findings underscore the potential need for sub-group approaches to men's mental health research and practice.
Keywords: Suicide -- Risk Factors; Sexual Orientation; Social Behavior; Human; Male; Adult; Middle Age; Self Report; Odds Ratio; Descriptive Statistics; Logistic Regression; Bisexuals -- Psychosocial Factors

Costs and Reimbursements for Mental Health Hospitalizations at Children's Hospitals. - Herndon, Alison C.; Williams, Derek; Hall, Matt; Gay, James C.; Browning, Whitney; Kreth, Heather; Plemmons, Greg; Morgan, Kate; Neeley, Maya; My-Linh Ngo; Clewner-Newman, Lisa; Dalton, Evan; et al. (Journal of Hospital Medicine, 2020)
The financial impact of the rising number of pediatric mental health hospitalizations is unknown. Therefore, this study assessed costs, reimbursements, and net profits or losses for 111,705 mental health and non-mental health medical hospitalizations in children's hospitals with use of the Pediatric Health Information System and Revenue Management Program. Average financial margins were calculated as (reimbursement per day) - (cost per day), and they were lowest for mental health hospitalizations ($136/day), next lowest for suicide attempt ($518/day), and highest for other medical hospitalizations ($611/day). For 10 of 17 hospitals, margin per day for mental health hospitalizations was lower than margin per day for other medical hospitalizations. For these 10 hospitals, the total net loss for inpatient and observation status mental health hospitalizations, compared with other medical hospitalizations, was $27 million (median, $2.2 million per hospital). Financial margins were usually lower for mental health vs non-mental health medical hospitalizations.

Queering the health care system: Experiences of the lesbian, gay, bisexual, transgender community. - Lee, Amber; Kanji, Zul (Canadian Journal of Dental Hygiene, 2017)
The lesbian, gay, bisexual, transgender (LGBT) community represents a population of people diverse in gender, sex, and sexual orientation. This literature review explores the current research on the health care experiences of LGBT individuals in North America in an attempt to identify the barriers to care that they face and develop strategies to increase their overall health. The health care experiences of LGBT individuals were explored across 7 dimensions: existence, bodily integrity, emotional integrity, worth, uniqueness, expression, and power. The LGBT community has unique health concerns and is at higher risk for mental health conditions, substance use, and suicide. These health disparities have been associated with social discrimination, ignorance, and assumptions made about gender, sex, and sexuality. Such barriers encountered by this population have also led to delayed or discontinued care, non-disclosure of sexuality or gender identity, increased negative health behaviours, and internalized stigma. The experiences that were identified reveal a strong need to reassess and strengthen the cultural sensitivity training and LGBT education provided to health care professionals.
Keywords: LGBTQ+ Persons; Life Experiences; Health Services Accessibility; Healthcare Disparities; Human; Systematic Review; Mental Disorders -- Risk Factors; Substance Use Disorders -- Risk Factors; Suicide -- Risk Factors; Self Disclosure; Sexuality; Gender Identity; Health Behavior; Stigma; Cultural Sensitivity; PubMed; CINAHL Database; Web Search Engines; Sexual Identity; Critical Theory; Health Knowledge; Discrimination

Stigma and suicide among gay and bisexual men living with HIV. - Ferlatte, Olivier; Salway, Travis; Oliffe, John L.; Trussler, Terry (AIDS Care, 2017)
HIV positive gay and bisexual men (GBM) continue to struggle with the pervasiveness of HIV stigma, but little is known about the health effects of stigma. In this article, suicidal ideation and attempts are measured among GBM living with HIV, evaluating the extent to which these experiences are associated with stigma and suicide. Drawing from an online national survey of Canadian GBM completed by 7995 respondents, a sub-set of data provided by respondents self-reporting HIV-positive status was used for the current study. The associations between suicidal ideation (SI) and attempts (SA) and four measures of HIV stigma were measured: social exclusion, sexual rejection, verbal abuse and physical abuse. A total of 673 HIV-positive men completed the survey (8% of total sample). Among this group, 22% (n = 150) reported SI and 5% (n = 33) SA in the last 12 months. After adjusting for sociodemographic factors, SI and SA were associated with each of the four measures of HIV stigma: being excluded socially for being HIV positive (SI adjusted odds ratio, AOR 2.0 95% CI 1.4-3.1; SA AOR 3.8 95% CI 1.9-7.9), rejected as a sexual partner (SI AOR 1.6 95% CI 1.1-2.4; SA AOR 2.6 95% CI 1.1-6.0), verbally abused (SI AOR 2.9 95% CI 1.9-4.5; SA AOR 2.4 95% CI 1.1-5.1), and physically abused (SI AOR 4.5 95% CI 1.8-11.7; SA AOR 6.4 95% CI 2.0-20.1). Furthermore, experiencing multiple forms of stigma was associated with significantly increased risk of SI and SA. The authors conclude that HIV positive GBM experience significant levels of stigma that are associated with heightened risk for suicide. The findings affirm the need for targeted interventions to prevent suicide amid public health efforts to de-stigmatize HIV and mental illness.
Keywords: Stigma; Suicide; Men Who Have Sex With Men; Bisexuals; HIV-Positive Persons; Human; Canada; Suicidal Ideation -- Evaluation; Male; Secondary Analysis; Surveys; Descriptive Research; Descriptive Statistics; Odds Ratio; Confidence Intervals; Verbal Abuse; Socioeconomic Factors; Discrimination; Suicide, Attempted; Social Isolation

LGBTQ-Related Individual Differences Predict Emotional Reactions to the Pulse Nightclub Shootings. - Maduro, Ralitsa S.; Sheehan, Brynn E.; Hitson, Phoebe; Shappie, Alexander T.; Derlega, Valerian J. (Violence & Victims, 2020)
This study examined, among 232 lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) participants, the association of identity centrality and public regard with negative affect about the Pulse nightclub shootings in Orlando, Florida. Identification with victims and perceived threat to personal safety were sequential mediators. Identity centrality was associated with greater identification with the shooting victims. In turn, identification with the victims was associated with greater perceived threat, followed by more negative affect. Low public regard was associated with greater perceived threat that, in turn, was associated with more negative affect. The results support the notion that LGBTQ-related individual differences increase distress about anti-sexual/gender minority hate crimes, especially for individuals with a strong LGBTQ identity and who believe that the majority, heterosexual society devalues sexual/gender minority persons.

Victimization, depression, and the suicide cascade in sexual minority youth. - Turpin, Rodman E.; Rosario, Andre; Wang, Min Qi (Journal of Mental Health, 2020)
Background: Suicidality remains disproportionately prevalent among sexual minority youth, necessitating novel methods of understanding suicide risk in this population. Victimization and depression are especially salient suicide risk factors. Aims: We aimed to test if victimization and depression were associated with suicidality at each step of a suicide cascade: Ideation, planning, and suicide attempts. Method: In sample of sexual minorities from the 2015 and 2017 Youth Risk Behavior Survey, we tested nine measures of victimization and depression associated with three outcomes in succession: Suicidal ideation among the full sample (n = 3357), suicide planning among those with ideation (n = 1475), and suicide attempts among those who planned suicide (n = 1073). Results: Depression was associated with suicidal ideation (aPR = 3.93, 95% CI 3.36–4.60), planning (aPR = 1.38, 95% CI 1.12–1.69), and attempts (aPR = 1.78, 95% CI 1.32–2.41) in successive subsamples. Victimization measures had different associations with suicidality at each successive stage, with the strongest associations observed with suicidal ideation in the general sample and suicide attempts among those who planned suicide. Conclusions: This may have implications for anti-victimization intervention effectiveness at each stage of suicidality. Additional research into this association among transgender and gender non-conforming youth is recommended.
Keywords: Violence -- Psychosocial Factors; Depression -- Psychosocial Factors; Suicidal Ideation -- Risk Factors -- In Adolescence; Suicide, Attempted -- Risk Factors -- In Adolescence; Sexual and Gender Minorities -- Psychosocial Factors; Risk Assessment; Human; Adolescence; Risk Taking Behavior; Surveys; Odds Ratio; Confidence Intervals; Mental Health Services

Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers. - van der Miesen, Anna I.R.; Steensma, Thomas D.; de Vries, Annelou L.C.; Bos, Henny; Popma, Arne (Journal of Adolescent Health, 2020)
Transgender adolescents are at risk for internalizing and externalizing problems, along with high suicidality rates, and poor peer relations. The present study compared transgender adolescents before and after gender-affirmative care with a sample of nonclinical age-equivalent cisgender adolescents from the general population on psychological well-being and aimed to investigate the possible effect of transgender care involving puberty suppression. In this cross-sectional study, emotional and behavioral problems were assessed by the Youth Self-Report in a sample of 272 adolescents referred to a specialized gender identity clinic who did not yet receive any affirmative medical treatment and compared with 178 transgender adolescents receiving affirmative care consisting of puberty suppression and compared with 651 Dutch high school cisgender adolescents from the general population. Before medical treatment, clinic-referred adolescents showed more internalizing problems and reported increased self-harm/suicidality and poorer peer relations compared with their age-equivalent peers. Transgender adolescents receiving puberty suppression had fewer emotional and behavioral problems than the group that had just been referred to transgender care and had similar or fewer problems than their same-age cisgender peers on the Youth Self-Report domains. Transgender adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Gender Affirmation Procedures -- In Adolescence; Peer Group; Psychological Well-Being; Puberty; Gonadorelin -- Analogs and Derivatives; Human; Cross Sectional Studies; Adolescence; Child Behavior Disorders; Self Report; Students, High School; Netherlands; Injuries, Self-Inflicted; Suicide; Interpersonal Relations; Gender Dysphoria; Mental Health; Questionnaires; Multivariate Analysis; Models, Statistical; Univariate Statistics; Post Hoc Analysis; Comparative Studies; Descriptive Statistics; Clinical Assessment Tools

Prevalence of Bullying Among Youth Classified as LGBTQ Who Died by Suicide as Reported in the National Violent Death Reporting System, 2003-2017. - Clark, Kirsty A.; Cochran, Susan D.; Maiolatesi, Anthony J.; Pachankis, John E. (JAMA Pediatrics, 2020)
This cohort study uses data from the National Violent Death Reporting System from 2003-2017 to assess the prevalence of bullying among youth classified as LGBTQ who died by suicide.
Keywords: Prevalence; Bullying; LGBTQ+ Persons -- Psychosocial Factors; Suicide -- Risk Factors; Cause of Death; Risk Assessment; Population Surveillance; Human; Record Review; Violence; Centers for Disease Control and Prevention (U.S.); Postmortem Care; Sexual Orientation; Narratives; Child; Adolescence; Coroners and Medical Examiners; Descriptive Statistics; Chi Square Test; Logistic Regression; Male; Female; Sex Factors

Suicidal ideation among transvestites and transsexuals: a social representations and analytical study. - dos Santos Silva, Glauber Weder; Ferreira de Sena, Romeika Carla; da Fonseca Lins, Suerda Lillian; Nunes de Miranda, Francisco Arnoldo (Online Brazilian Journal of Nursing, 2016)
Aim: To analyze the association between suicidal ideation, suicide, its risk factors and social representations in the life of transvestites and transsexuals. Method: a qualitative exploratory study with quantitative analytical approach, conducted with transvestites and transsexuals associated to a non-governmental organization in the State of Rio Grande do Norte using semi-structured interviews. Quantitative data will be analyzed by inferential statistics with the application of chi-square, Mann Whitney and Pearson correlation tests. Qualitative data will be interpreted using content and social representation analysis. Expected results: the aim is to identify suicidal ideation, depressive state and social representations about suicide for transvestites and transsexuals, especially with regard to promoting mental health by identifying signs and risk factors for suicide, reduction of harm in the gender transit experiences, and health prevention in socio-cognitive aspects that surround the phenomenon.
Keywords: Cross-dressers -- Psychosocial Factors; Transsexuals -- Psychosocial Factors; Suicide -- Risk Factors; Depression -- Epidemiology -- Brazil; Suicidal Ideation -- Epidemiology -- Brazil; Qualitative Studies; Exploratory Research; Quantitative Studies; Analytic Research; Semi-Structured Interview; Inferential Statistics; Brazil; Convenience Sample; Scales; Psychological Tests; Questionnaires; Human; Data Analysis Software; P-Value; Chi Square Test; Mann-Whitney U Test; Pearson's Correlation Coefficient; Content Analysis

It is time to mobilize suicide prevention for sexual and gender minorities in Canada. - Ferlatte, Olivier; Salway, Travis; Oliffe, John L.; Saewyc, Elizabeth M.; Holmes, Cindy; Schick, Lynette; Purdie, Aaron; Damstrom-Albach, Diana (Dammy); Mantler, Edward R.G.; Ho, Darren; Knight, Rod (Canadian Journal of Public Health, 2020)

Verbal victimisation, depressive symptoms, and suicide risk among sexual minority adults in France: results from the nationally-representative 2017 Health Barometer survey. - El-Khoury, Fabienne; Heron, Mégane; Van der Waerden, Judith; Leon, Christophe; du Roscoat, Enguerrand; Velter, Annie; Lydié, Nathalie; Sitbon, Audrey (Social Psychiatry & Psychiatric Epidemiology, 2020)

What's Unique About Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth and Young Adult Suicides? Findings From the National Violent Death Reporting System. - Ream, Geoffrey L. (Journal of Adolescent Health, 2019)
The purpose of the study was to explore variability in circumstances around suicide deaths among youth and young adults by sexual/gender identity category (gay male, lesbian/gay female, bisexual male, bisexual female, transgender male, transgender female, non–LGBT [lesbian, gay, bisexual, and transgender] male, and non-LGBT female). Secondary analysis of National Violent Death Reporting System (NVDRS) data for all 12- to 29-year-olds who died by suicide in NVDRS participating states. Coverage begins in 2013, the year that NVDRS began coding for sexual orientation and transgender status, and ends in 2015, the latest year of NVDRS data available. The valid sample was limited to cases in which sexual orientation or transgender status could be determined postmortem, n = 2,209. Almost one quarter (24%) of 12- to 14-year-olds who died by suicide were LGBT, whereas only 8% of 25- to 29-year-olds who died by suicide were LGBT. Most non-LGBT males and bisexual males died by firearm and had intimate partner problems contribute to their deaths. Non-LGBT females and LGBT persons other than bisexual males were generally less likely to use firearms. They were also more likely to have psychiatric diagnoses, prior suicidality, and family problems contributing to their deaths. Rates of many circumstances varied widely among LGBT subgroups. The LGBT versus non-LGBT suicide disparity is greatest at younger ages, and each LGBT subgroup has its own specific risk profile for suicide. Suicide prevention and intervention efforts targeted at LGBT youth may increase their effectiveness by attending to these distinct risk profiles.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Suicide -- Psychosocial Factors -- In Adulthood; Adolescent Behavior; Human; Child; Adolescence; Adult; Age Factors; Secondary Analysis; Firearms; Intimate Partner Violence; Mental Disorders; Suicide, Attempted; Multivariate Analysis; Logistic Regression

Allowing for Nondisclosure in High Suicide Risk Groups. - Podlogar, Matthew C.; Joiner, Thomas E. (Assessment, 2020)
Inaccurate disclosure of information is a significant limitation when relying on self-report for suicide risk screening. However, allowing for an explicit nondisclosure response option in screening items (e.g., "prefer not to disclose") may ultimately improve follow-up assessment validity. This study investigated explicit nondisclosure in suicide risk screening among military service members and veterans (n = 135), men older than 50 years, (n = 187), and LGBTQ (lesbian, gay, bisexual, transgender, or queer) young adults (n = 140); all higher risk and lower help-seeking populations. Results indicated that allowing for explicit nondisclosure minimally affected screening sensitivity and specificity. However, its selection was prevalent among higher risk participants, and was associated with experience of past unhelpful reactions and "avoidance of stigmatized consequences." Allowing for nondisclosure creates potential psychometric and classification advantages, and may be a safe and effective way to encourage discussion of barriers, build trust, maximize patient autonomy, and ultimately facilitate accurate risk disclosure to improve assessment validity.
Keywords: Truth Disclosure; Suicide -- Risk Factors; Health Screening; Risk Assessment; Human; Descriptive Statistics; Military Personnel; Veterans; LGBTQ+ Persons; Young Adult; Middle Age; Stigma; Patient Autonomy; Psychometrics; Help Seeking Behavior; Scales; Questionnaires; Trust; Suicide -- Prevention and Control; Funding Source

Untethered lives: barriers to societal integration as predictors of the sexual orientation disparity in suicidality. - Bränström, Richard; van der Star, Arjan; Pachankis, John E. (Social Psychiatry & Psychiatric Epidemiology, 2020)
Purpose: Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration-or a lack of meaning, purpose, and belonging as derived from societal norms, goals, and attachment-have been widely theorized as determinants of suicidality for the general population, they have not been comprehensively explored to explain the sexual orientation disparity in suicidality. The aim of this study was to examine differences in suicidal ideation and attempts between LGB and heterosexual individuals in a nationally representative sample, and to examine barriers to societal integration as a potential explanation for any observed disparities over-and-above the influence of established contributors to sexual orientation disparity in suicidality.Methods: Data come from the cross-sectional Swedish National Public Health Survey, which collected data from unrestricted random samples of individuals (16-84 years of age) living in Sweden, annually from 2010 to 2015 (n = 57,840 individuals [response rates: 48.1-51.3%]; 1281 (2.2%) self-identified as LGB). Analyses examined sexual orientation differences in suicidality (i.e., past-12-month ideation and attempts), and explored the role of barriers to societal integration (i.e., not living with a partner or children, unemployment, and lack of societal trust) in explaining this disparity over-and-above more commonly explored psychological (e.g., depression, substance use) and interpersonal (e.g., discrimination, victimization, lack of social support) suicidality risk factors.Results: Compared to heterosexuals, suicidal ideation and attempts were more common among both gay men/lesbians (adjusted odds ratio [AOR] for suicide ideation: 2.69; 95% confidence intervals [CI]: 2.09, 3.47; AOR for suicide attempts: 5.50; 95% CI: 3.42, 8.83), and bisexuals (AOR for suicide ideation: 3.83; 95% CI: 3.26, 4.51; AOR suicide attempts: 6.78; 95% CI: 4.97, 9.24). Barriers to societal integration mediated the association between sexual orientation and suicidality even in models adjusting for established risk factors for suicidality.Conclusion: Our results suggest that previously under-examined factors, namely the disproportionate barriers to societal integration that LGB individuals experience, are important contributors to the substantially elevated risk of suicidality among sexual minorities. Preventive interventions should consider innovative ways to foster societal integration within sexual minority populations and to adjust hetero-centric social institutions to better include sexual minority individuals.
Keywords: Suicide, Attempted; Social Welfare -- Psychosocial Factors; Health Status Disparities; Sexuality; Depression -- Epidemiology; Suicidal Ideation; Aged; Substance Use Disorders -- Psychosocial Factors; Young Adult; Suicide, Attempted -- Psychosocial Factors; Heterosexuality; Aged, 80 and Over; Sweden; Child; Support, Psychosocial; Cross Sectional Studies; Female; Adult; Risk Factors; Male; Odds Ratio; Adolescence; Substance Use Disorders -- Epidemiology; Depression -- Psychosocial Factors; Middle Age; Questionnaires; Human; Ways of Coping Questionnaire; Funding Source

Nonsuicidal Self-Injury and Suicidality Among Sexual Minority Youth: Risk Factors and Protective Connectedness Factors. - Taliaferro, Lindsay A.; Muehlenkamp, Jennifer J. (Academic Pediatrics, 2017)
OBJECTIVE: We investigated differences in prevalence of repetitive nonsuicidal self-injury (NSSI), suicidal ideation, and a suicide attempt among youth who identified as bisexual, gay/lesbian, and questioning. In addition, we examined which types of social connections were associated with reduced risk of repetitive NSSI and suicidality among youth who identified with a specific sexual minority group. METHODS: Data came from the 2013 Minnesota Student Survey. The analytic sample included 77,758 students in grades 9 and 11. Connectedness factors included parent connectedness, teacher caring, connectedness to other nonparental adults, school safety, and friend caring. Logistic regression analyses, stratified according to sexual minority group, determined social connectedness factors associated with repetitive NSSI, suicidal ideation, and a suicide attempt, as well as moderating effects of significant connectedness factors on different risk factors (depression, anxiety, bullying, and violence victimization). RESULTS: Approximately 3% identified as bisexual or questioning their sexual orientation, and <1% identified as gay/lesbian. Sexual minority youth, particularly bisexual youth, were significantly more likely than heterosexual youth to report repetitive NSSI and suicidality. Effects of connectedness varied across sexual minority groups and outcomes on the basis of types of connections. Parent connectedness emerged as a robust protective factor for all self-harm behaviors across all sexual minority groups. Feeling connected to nonparental adults and safe at school represented additional factors that reduced risk of repetitive NSSI and suicidality among certain groups. CONCLUSIONS: In addition to facilitating connections between youth and parents, clinicians might consider encouraging sexual minority youth to remain connected to trusted nonparental adults who could offer support and care. Schools might consider implementing sociocultural norms of acceptance, tolerance, and positive identity development to reduce risk of self-harm.
Keywords: Self-Injurious Behavior -- Risk Factors -- In Adolescence; Suicidal Ideation -- Risk Factors -- In Adolescence; LGBTQ+ Persons; Minority Groups; Human; Adolescence; Secondary Analysis; Surveys; Logistic Regression; Depression; Anxiety; Bullying; Victims -- In Adolescence; Outcome Assessment

Increased mental health and psychosocial risks in LGBQ youth accessing Australian youth AOD services. - Wishart, Madeline; Davis, Cassandra; Pavlis, Alexia; Hallam, Karen T (Journal of LGBT Youth, 2020)
Research has consistently demonstrated that young people who identify as lesbian, gay, bisexual, or queer (LGBQ) show greater levels of psychosocial risk than general cohorts of young people. Young people engaged with youth alcohol and other drug (AOD) services are some of the most marginalized of all young people. Hitherto research is yet to investigate if young people identifying as LGBQ fare worse in these psychosocial domains than their non-LGBQ co-clients within AOD services. This study compared outcomes for 103 matched pairs of LGBQ identified and non-LGBQ identified young people (N = 206) using youth AOD services in Australia from a youth needs census. The results indicated that youth identifying as LGBQ reported more family dysfunction; and had experienced more violent crime, sexual, physical, and emotional abuse; and accumulated trauma than the non-LGBQ group. They had significantly more substance related harms, greater polysubstance use, and greater severity in their substance use. The LGBQ group also demonstrated poorer psychological health, quality of life, and were more likely to report a history of mental illness, and non-suicidal self-injury according to their youth worker. Overall these data indicate a need to direct more support to this particularly at risk group of young people.
Keywords: Drug Information Services; LGBTQ+ Persons -- Psychosocial Factors -- Australia; Mental Disorders -- Risk Factors -- Australia; Substance Abuse -- Risk Factors -- Australia; Risk Assessment; Human; Australia; Family Relations; Violence -- Psychosocial Factors; Sexual Abuse -- Psychosocial Factors; Psychological Trauma -- Psychosocial Factors; Emotions; Quality of Life; Self-Injurious Behavior -- Diagnosis; Adolescence; Young Adult

Changes in Victimization Risk and Disparities for Heterosexual and Sexual Minority Youth: Trends From 2009 to 2017. - Poteat, V. Paul; Birkett, Michelle; Turner, Blair; Wang, Xinzi; Phillips II, Gregory (Journal of Adolescent Health, 2020)
The aim of this study was to identify sex-stratified trends in victimization risk specific to heterosexual, lesbian, gay, bisexual, and questioning youth while considering changes in sexual orientation-disparities from 2009 to 2017. Youth Risk Behavior Survey (YRBS) data collected biennially (five waves; 2009–2017) were pooled across 56 jurisdictions and 454,715 students for one of the most nationally representative samples of heterosexual and sexual minority youth to date. We analyzed a seven-item victimization risk assessment using the Centers for Disease Control and Prevention's recommended trend analysis approach. We used logistic regression with year-by-identity interactions to test whether sexual orientation-based disparities widened, narrowed, or were maintained over time. Victimization risk declined significantly for male and female bisexual and questioning youth, lesbian, gay, and heterosexual youth. Disparities narrowed between bisexual, questioning, and lesbian females and heterosexual females and between bisexual and heterosexual males. Nevertheless, sexual orientation-based disparities remained significant for all sexual minority youth in 2017. Distinct patterns of change in victimization risk for specific groups of sexual minority youth underscore the need to consider variability within sexual minority youth communities; treating them as a singular group could mask nuanced disparities. Some of the relatively small decreases in victimization risk also suggest the need for interventions to address a more comprehensive set of victimization-related risks beyond bullying and needed efforts that are not limited to the immediate school context.
Keywords: Victims -- Psychosocial Factors; Violence -- Risk Factors; Risk Assessment; Heterosexuality -- In Adolescence; Sexual and Gender Minorities -- In Adolescence; Sexuality -- Trends; Human; LGBTQ+ Persons; Logistic Regression; Bisexuals; Adolescence; Surveys; Substance Abuse; Suicidal Ideation; Cluster Sample; Cross Sectional Studies; Race Factors; Adult; Middle Age; Aged; Aged, 80 and Over; Data Analysis Software; Descriptive Statistics; Linear Regression; Age Factors; Male; Female; Confidence Intervals; Odds Ratio

Out of the darkness and into the shadows: The evolution of contemporary bisexuality. - Taylor, Julia (Canadian Journal of Human Sexuality, 2018)
Bisexuality, as we currently understand it, has evolved over the past 150 years both shaped by and shaping cultural change, scholarly endeavour and individual experience. To understand bisexuality in contemporary Western society it is essential to understand its past. This article explores the history of bisexuality within scholarly literature and social conversation by examining its progression from a largely silent past to a contemporary topic of scholarly investigation, a socio-political concept and a lived experience. With the growing awareness of poor mental health and suicidality among bisexual people in Western society, there has never been a more pressing time to examine bisexuality from its roots to its current existence with the aim of building a foundation from which academics, activists, health professionals and bisexual individuals can work together toward a more positive future where bisexuality can emerge from the shadows and be explored, understood, accepted and celebrated.
Keywords: Bisexuality -- Trends; Interpersonal Relations; Human; Mental Health; Suicidal Ideation; Bisexuals -- Psychosocial Factors; Foundations; Health Personnel

The Synergistic Impact of Sexual Stigma and Psychosocial Well-Being on HIV Testing: A Mixed-Methods Study Among Nigerian Men who have Sex with Men. - the TRUST/RV368 Study Group; Charurat, Man; Nowak, Rebecca G.; Rodriguez-Hart, Cristina; Bradley, Cory; German, Danielle; Musci, Rashelle; Orazulike, Ifeanyi; Baral, Stefan; Liu, Hongjie; Crowell, Trevor A. (AIDS & Behavior, 2018)
Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013-February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake.
Keywords: HIV-Positive Persons; Stigma; Psychological Well-Being; HIV Infections -- Diagnosis; Men Who Have Sex With Men -- Psychosocial Factors -- Nigeria; Human; Male; Female; Nigeria; Interviews; Prospective Studies; Stress, Psychological; Support, Psychosocial; Suicidal Ideation; Mental Health; Health Facilities

The Relationship Between Queer Identity, Social Connection, School Bullying, and Suicidal Ideations Among Youth of Color. - Lardier, David T.; Pinto, Stacy A.; Brammer, Mary Kathryn; Garcia-Reid, Pauline; Reid, Robert J. (Journal of LGBT Issues in Counseling, 2020)
Queer youth, and specifically queer youth of color (YOC), identified in this study as Hispanic/Latinx and African American/Black youth, disproportionately experience suicidal ideations (SI). The nexus of limited social support and school bullying exacerbates the effect on SI among these youth. Using data from a larger Drug-Free Communities grant initiative among YOC (N = 687; 65.6% youth aged 16–18 years; 53% female; 16% queer [i.e., lesbian, gay, bisexual and queer]) this study examined: (1) the mediating role of school bullying between queer identity status and SI and (2) both the mediating and moderating roles of family, social supports, and school importance on the initial mediating model. Findings from this study provide implications that may help prepare counselors to intervene across contexts.
Keywords: Gender Identity; LGBTQ+ Persons -- Psychosocial Factors; Social Networks; Bullying; Suicidal Ideation -- In Adolescence; Minority Groups; Human; Adolescence; Hispanic Americans; Black Persons; Support, Psychosocial; Family; Schools, Secondary

The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US. - Lelutiu-Weinberger, Corina; English, Devin; Sandanapitchai, Priyadharshiny (Behavioral Medicine, 2020)
Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.
Keywords: Sexism; Hardiness; Transgender Persons -- Psychosocial Factors -- United States; Gender Identity; Human; Gender Role; United States; Factor Analysis; Structural Equation Modeling; Suicidal Ideation; Psychological Distress; Substance Use Disorders; HIV Infections -- Diagnosis; Stigma; Surveys; Mental Health; Health Status

Cultural versus classic risk and protective factors for suicide. - Chu, Joyce; Robinett, Emily N.; Ma, Johnson K. L.; Shadish, Katherine Y.; Goldblum, Peter; Bongar, Bruce (Death Studies, 2019)
The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice.
Keywords: Suicide -- Psychosocial Factors; Suicide -- Risk Factors; Culture; Minority Groups; Human; Suicide, Attempted; Hopelessness; Depression

Interpersonal Violence Prevention Considerations for Sexual Minority College Students: Lower Campus Connection, Worse Perceptions of Institutional Support, and more Accurate Understandings of Sexual Consent. - Mennicke, Annelise; Geiger, Elizabeth; Brewster, Melanie (Journal of Family Violence, 2020)
While research has established that sexual minority college students are at increased risk for sexual violence and dating violence, less research has explored their attitudes and beliefs related to bystander self-efficacy, perceptions of institutional support, connectedness to the university, or understandings of sexual consent. These attitudes and beliefs are central to violence prevention and intervention programming and are well-researched among heterosexual students. Minority stress theory suggests that sexual minority people may have different attitudes and beliefs about violence due to these experiences with discrimination. The purpose of this investigation was to explore the relationship between victimization, minority stressors, and sexual identity on bystander self-efficacy, perceptions of institutional support, connectedness to the university, and understandings of sexual consent. Using a subsample of the 2016 Multi-College Bystander Efficacy Evaluation data from one university, data from 542 students were analyzed (271 sexual minority students and 271 randomly selected heterosexual students). Regressions indicated that sexual minority students, compared to heterosexual students, had lower feelings of connectedness to the college, less favorable perceptions of institutional support, and more accurate understandings of sexual consent. Victims of sexual assault had more accurate understandings of sexual consent, but this was not a significant predictor of college connectedness or perceptions of institutional support. These findings suggest a need for tailored prevention and intervention programs that address the specific needs of sexual minority students.
Keywords: School Violence -- Prevention and Control; Sexual and Gender Minorities; Students, College; Interpersonal Relations; Colleges and Universities; Organizational Culture; Support, Psychosocial; Crime Victims; Minority Stress; Sexual Identity; Self-Efficacy; Student Attitudes; Human; Attitude to Sexuality; Random Sample; Regression; Heterosexuals; Comparative Studies; Emotions; Sexual Abuse; Crime -- Prevention and Control; Needs Assessment

Addressing LGBTQ Student Bullying in Massachusetts Schools: Perspectives of LGBTQ Students and School Health Professionals. - Reisner, Sari L.; Sava, Lauren M.; Menino, David D.; Perrotti, Jeff; Barnes, Tia N.; Humphrey, D. Layne; Nikitin, Ruslan V.; Earnshaw, Valerie A. (Prevention Science, 2020)
Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth face disparities in bullying victimization are associated with higher rates of physical injury, psychological distress, and even suicide. Innovative strategies to address bullying victimization are needed to prevent adverse physical and mental health outcomes, including those engaging school health professionals (SHPs; school nurses, psychologists). This mixed-methods study sought to identify factors that facilitate or impede SHPs' reporting and responding to LGBTQ bullying in Massachusetts from the perspectives of LGBTQ students and SHPs. Between August 2017 and July 2018, asynchronous online focus group discussions and a brief survey were conducted separately for 28 LGBTQ students and 19 SHPs in Massachusetts (9-12 participants per group; n = 47 enrolled). Focus groups probed on bullying experiences. Rapid qualitative inquiry was used for thematic coding of facilitators and barriers to address LGBTQ student bullying described by youth and SHPs. Facilitators and barriers largely coalesced around the social ecological model. Youth and SHPs identified factors at multiple levels of the social ecological model: (1) individual (knowledge, skills, attitudes); (2) interpersonal (trust and follow-through, confidentiality and fear of being "outed," close relationships, champion SHPs); and (3) structural (school buy-in, time, reporting and protocols, staff roles, resources, and school culture of inclusivity). LGBTQ students expressed a need for an intersectional lens for SHPs when addressing LGBTQ student bullying. Interventions that help SHPs overcome multilevel barriers and leverage facilitators are needed. Consideration of intersectionality will better equip SHPs to support LGBTQ students and address disparities in LGBTQ student bullying that confer health risks.

Comparison of Perceived Burdensomeness, Thwarted Belongingness, Capability for Suicide, and Suicidal Ideation among Heterosexual and Sexual Minority Individuals in Mississippi. - Pate, Ashley R.; Anestis, Michael D. (Archives of Suicide Research, 2020)

Are the World's National Cultures Becoming More Similar? - Kaasa, Anneli; Minkov, Michael (Journal of Cross-Cultural Psychology, 2020)
Globalization is highlighting existing cultural differences between nations, but what is the future of these differences? We attempt to answer this question by analyzing the evolution of cultural convergence-divergence across 18 select countries representing the existing cross-national cultural diversity across the globe in a balanced way. Using World Values Survey data (28,051 respondents in 18 countries from 1995 to 1998 and 30,453 from the same 18 countries in 2010–2014), we find evidence for a global shift in the direction of cultural traits typical of the rich Western individualist countries. However, different types of traits evolve differently and different national cultures change at different speeds. Thus, we find evidence of global convergence in terms of qualities that parents would like to see in their children (especially a shift away from religion and obedience toward independence and responsibility), divergence in terms of moral ideologies (such as homosexuality, abortion, divorce, and suicide, despite the growing acceptance of these, especially homosexuality), and distance stability in terms of key personal values (such as religion, work, family, friends, and leisure, despite the falling importance of the first two and the growing importance of the last three). Thus, there is no simple single answer to the convergence-divergence question and no evidence allowing us to predict full cultural convergence across the world in the foreseeable future.
Keywords: International Relations; Culture -- Trends; Cultural Diversity; Acculturation; Human; Cultural Values; Religion and Religions; Personal Values; Cultural Bias

Integrating Minority Stress Theory and the Interpersonal Theory of Suicide among Sexual Minority Youth Who Engage Crisis Services. - Fulginiti, Anthony; Goldbach, Jeremy T.; Mamey, Mary Rose; Rusow, Joshua; Srivastava, Ankur; Rhoades, Harmony; Schrager, Sheree M.; Bond, David W.; Marshal, Michael P. (Suicide & Life-Threatening Behavior, 2020)
Objective: The present study sought to integrate minority stress theory (MST) and the interpersonal theory of suicide (ITS) to better understand high rates of suicide among sexual minority youth (SMY). To date, the ITS and MST have largely advanced independently from one another even though the research base for each theory contains gaps that the other theory may help fill.Method: Using data from a national sample of 564 SMY (aged 12-24) recruited from an LGBTQ youth-focused suicide crisis prevention provider, we examined structural equation models to understand how perceived burdensomeness and thwarted belongingness mediate the relationship between minority stress and suicidal ideation and attempt.Results: Sexual minority stress was significantly associated with both perceived burdensomeness and thwarted belongingness in models predicting suicidal ideation and attempt. Moreover, minority stress had a direct effect on suicide attempt and an indirect effect on both suicidal ideation and suicide attempt through burdensomeness.Conclusions: Given that minority stress is associated with greater thwarted belongingness, perceived burdensomeness, and suicide attempts, there should be greater demand for continuing education centered on sexual minority populations and population-specific services. Identifying burdensomeness as a minority stress-suicide mechanism highlights the potential gains of piloting recently developed burdensomeness interventions among SMY.

'Our life is pointless ... ': Exploring discrimination, violence and mental health challenges among sexual and gender minorities from Brazil. - Malta, Monica; Gomes de Jesus, Jaqueline; LeGrand, Sara; Seixas, Michele; Benevides, Bruna; Silva, Maria das Dores; Lana, Jonas Soares; Huynh, Hy V.; Belden, Charles M.; Whetten, Kathryn (Global Public Health, 2020)
Worldwide, Brazil has the highest prevalence of violence and hate crimes against sexual and gender minorities (SGMs) among countries with available data. To explore the impact of this scenario, we conducted a qualitative study with 50 SGMs from Rio de Janeiro, Brazil. Among the participants, 66% screened positive for generalised anxiety disorder, 46% for major depressive disorder and 39% for PTSD. A third reported low self-esteem (32%) and one quarter low social support (26%). Experiences of interpersonal discrimination were highly prevalent (>60%), while institutional discrimination related to employment or healthcare was reported by 46% of participants. Verbal abuse is very common (80%), followed by physical assault (40%). Sexual violence is highly frequent among women. Focus groups analysis highlighted three major domains: (1) stigma and discrimination (family, friends and partners, in schools and health services, influencing social isolation); (2) violence (bullying, harassment, physical and sexual violence); and (3) mental suffering (alcohol and drug abuse, depression, suicidality, anxiety). Our findings suggest a close synergy between experiences of discrimination and violence with selected mental disorders. This complex synergy might be better addressed by longer-term individual and group-level interventions that could foster social solidarity among the different groups that comprise SGMs.
Keywords: Sexism -- Epidemiology -- Brazil; Gender-Based Violence -- Epidemiology -- Brazil; Mental Health; Sexual and Gender Minorities -- Brazil; Human; Adolescence; Adult; Middle Age; Male; Female; Brazil; Multimethod Studies; Exploratory Research; Focus Groups; Interviews; Surveys; Data Analysis -- Methods; Summated Rating Scaling; Coefficient Alpha; Data Analysis Software; Questionnaires; Clinical Assessment Tools; Checklists; Scales; Descriptive Statistics; Funding Source

Mental Health Service Delivery to Sexual Minority and Gender Non-Conforming Students in Schools: A Winnicottian Approach. - Wofford, Nichole (Child & Adolescent Social Work Journal, 2017)
Current research highlights the increased risk factors that sexual minority (lesbian, gay, bisexual) and gender minority (transgender/gender non-conforming) students face as compared to their heterosexual and cisgender peers. These risk factors include higher rates of depression, suicide, substance use, school dropout, sexually transmitted infections, experiences with bullying on school campuses and increased risk of homelessness. Although this research has aided our understanding of the needs and risks of this population of youth, few articles have emerged from these data which offer a comprehensive theoretical approach to work clinically with these adolescents in school-based settings. This article explores how school mental health staff can address the behavioural health needs of sexual and gender minority students through the adoption of a Winnicottian theoretical approach. With an intensive focus on academic achievement, schools have historically been limited in their usage of evidence-based data to create programs which adequately address the mental health needs of student populations on their campuses. Yet, sexual and gender minority students are likely to be present in almost every school in the country. Schools can serve as gateways to mental health access and can offer innovative and culturally responsive practices across racial, ethnic, class, and geographic lines. As the single largest holders of the student population in the United States, schools have the ability to play a significant role in mental health service provision for sexual and gender minority youth.
Keywords: Mental Health Services -- In Adolescence; Minority Groups -- Psychosocial Factors -- In Adolescence; Gender Identity -- In Adolescence; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Human; Adolescence; Mental Disorders -- Risk Factors -- In Adolescence; School Health Services; Social Work Service

Cultural pathways for suicidal ideation and behaviors. - Chu, Joyce; Maruyama, Brian; Batchelder, Holly; Goldblum, Peter; Bongar, Bruce; Wickham, Robert E. (Cultural Diversity & Ethnic Minority Psychology, 2020)
Objective: Goals were to empirically examine cultural suicide pathways initially theorized by the cultural theory and model of suicide, by examining relationships between cultural (family conflict, minority stress, cultural suicide sanctions), general distress (depression, hopelessness), and cultural idioms of distress factors as predictors of suicidal ideation and attempts.Method: Path analysis examined a moderated mediation model with a community sample of 1,077 ethnic minority and/or LGBTQ adults (average age of 24.32 (SD = 10.23) ranging from 18 to 88, 299 LGBTQ, 447 Asian American, 196 Latino/a, 60 Black or African American, 8 Hawaiian or Pacific Islander, 6 Arab American, 2 Native American, 187 mixed race).Results: Multiple pathways of statistical significance emerged. First, cultural life events (family conflict and minority stress) showed direct paths to ideation and attempts and indirect paths through general (depression and hopelessness) and cultural idioms of distress to ideation and attempts. The path from minority stress to ideation was entirely explained by general/cultural distress. Second, cultural suicide sanctions moderated the relationship between family conflict and ideation. Third, cultural idioms of distress was an important component of overall distress, alongside depression and hopelessness, predicting attempts and ideation.Conclusions: Findings elucidated pathways involving both general distress and cultural factors, and pathways from cultural life events to suicide constructs independent of mental illness-related factors. Findings question utilizing mental illness as a primary suicide driver, make theoretical contributions in refining the cultural theory and model of suicide, and advance understandings of roles of cultural factors in suicide research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Keywords: Suicidal Ideation; Depression -- Psychosocial Factors; Self Concept; Minority Groups -- Psychosocial Factors; Female; Young Adult; Male; Risk Factors; Adolescence; Middle Age; Suicide -- Psychosocial Factors; Adult; Questionnaires

Suicide and the Transgender Experience: A Public Health Crisis. - dickey, lore m.; Budge, Stephanie L. (American Psychologist, 2020)
Given the rise in the visibility of the trans community, increasing attention has been paid to mental health disparities in trans populations. Specifically, research findings conclude that suicide is considered 1 of the major health disparities in trans populations. Across several studies it has been found that 40% or more of trans people have attempted suicide at least once in their lifetime. There are a multitude of reasons why trans people experience suicidal ideation and attempt suicide, with minority stress being theorized as a primary cause. To address minority stress-focused suicide, a psychologically adapted public health model is proposed. This model includes the following steps for preventing suicidal thoughts and behaviors: (a) defining the issue, (b) identifying causes and risk factors, (c) developing and testing psychological interventions, and (d) implementing psychological interventions. Key components discussed include the evidence and practice for supporting trans people through their social and medical transition processes, which have been demonstrated to improve mental and physical health outcomes. The implications of the prevention model indicate that psychologists play a key role in supporting trans people, regardless of the clinical concerns that bring them to therapy. Public Significance Statement: This article explores the rates of suicide in the transgender community. The authors discuss the challenges faced by transgender people that may increase the risk of suicidal thinking or behavior. The authors provide recommendations for how suicidal thinking and behavior may be addressed in the clinical setting.
Keywords: Suicide -- Risk Factors; Transgender Persons; Public Health; Suicidal Ideation; Suicide, Attempted; Health Status Disparities; Stress, Psychological; Minority Groups

Experiences of sexual and gender minorities in an urban enclave of Haiti: despised, beaten, stoned, stabbed, shot and raped. - Rahill, Guitele J.; Joshi, Manisha; Galea, Jerome; Ollis, Jenifer (Culture, Health & Sexuality, 2020)
Studies of sexual and gender minorities in Haiti and globally typically involve HIV research and programming with men who have sex with men. We conducted focus groups with individuals in Haiti's Cité Soleil slum whose assigned gender at birth matched neither their gender identity nor contextual heteronormative constructions of gender roles, i.e. transwomen and transmen. The Yogyakarta Principles provided the study framework. Focus group participants offered emic perspectives on overall well-being, identities, biopsychosocial strengths and HIV-protective and risk factors. We found that gender expression that conflicts with contextual norms evoked recurring, humiliating and intentionally injurious sexual assaults against participants, heightening their HIV risk; participants endured beatings, shootings, stabbings, stonings and socio-political violence. Lack of confidentiality and stigma hinder participants' access to scarce HIV resources. Indistinct boundaries between sexuality, gender identity and gender expression merged with traditional gender-based roles to perpetuate sexual violence towards transwomen by cisgender heterosexual men and by transmen towards cisgender heterosexual women. Despite resignation to omnipresent violence, participants showed resilience regarding gender identity. Needed are integrated socio-behavioural and health programmes to challenge existing gender inequities while providing training on human rights and HIV risk reduction for Haitian sexual and gender minorities.

Nonsuicidal Self-Injury Among a Representative Sample of US Adolescents, 2015. - Monto, Martin A.; McRee, Nick; Deryck, Frank S. (American Journal of Public Health, 2018)
Objectives.To provide prevalence estimates of adolescent nonsuicidal self-injury (NSSI) based on large, representative, nonclinical samples of high-school students, and to explore gender differences in health risks associated with NSSI. Methods. We used 2015 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System data to estimate the prevalence of self-injury and variables potentially associated with self-injury for high-school-age boys (n = 32 150) and girls (n = 32 521) in 11 US states. We used logistic regression analysis to consider associations between NSSI and other health risks. Results. Rates of boys reporting purposefully hurting themselves without wanting to die over the past 12 months ranged from 6.4% (Delaware) to 14.8% (Nevada). Rates for girls varied from 17.7% (Delaware) to 30.8% (Idaho). Rates declined with age and varied by race and ethnicity. Depression; suicidal thoughts, plans, and attempts; sexual minority status; being electronically bullied; smoking; and substance use were associated with NSSI. There were minor differences in associations between NSSI and health risk variables by gender. Conclusions. Nonclinical populations of adolescents are at high risk for self-injury. Nonsuicidal self-injury was higher among girls than among boys, but patterns of association with other health risks were similar.
Keywords: Students, High School -- Psychosocial Factors -- United States; Self-Injurious Behavior -- Risk Factors -- United States; Sex Factors; Human; United States; Prevalence; Male; Female; Logistic Regression; Age Factors; Race Factors; Depression; Suicidal Ideation; Suicide, Attempted; LGBTQ+ Persons; Bullying; Smoking; Substance Abuse; Adolescence

Context Matters: Reactive and Proactive Bystander Action to Prevent Sexual and Dating Violence in High Schools. - Banyard, Victoria; Mitchell, Kimberly J.; Waterman, Emily A.; J. Rizzo, Andrew; Edwards, Katie M. (Journal of School Violence, 2020)
Given high rates of relationship violence among adolescents, there is a need to understand variables that influence adolescents' helping behaviors to reduce risk for dating and sexual violence (reactive) and promote prevention before violence happens or risk factors are evident (proactive). The current paper examined individual and school variables related to greater actionism in a large sample of high school students. Baseline, cross-sectional data used in the current analyses were gathered before intervention as part of a prevention program evaluation across 25 high schools in New England from students in grades 9–12 (N= 3,404). Students who self-reported a greater number of proactive actions taken were students who identified as sexual minorities, had a history of victimization, and were in schools with supportive peer norms. The current findings suggest a model for prevention that might include training individuals and attending to school level variables.
Keywords: Child Abuse, Sexual -- Prevention and Control; Dating Violence -- Prevention and Control; School Violence -- Prevention and Control; Students, High School -- Psychosocial Factors; Adolescent Behavior -- Evaluation; Student Attitudes -- Evaluation; Faculty Attitudes -- Evaluation; Human; Social Norms; Social Behavior; Cross Sectional Studies; New England; Schools, Secondary; Self Report; Sexual and Gender Minorities; Crime Victims; Peer Group; Interpersonal Relations

Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men. - O’Cleirigh, Conall; Pantalone, David W.; Batchelder, Abigail W.; Hatzenbuehler, Mark L.; Marquez, Samantha M.; Grasso, Chris; Safren, Steven A.; Mayer, Kenneth H. (Journal of Behavioral Medicine, 2018)
Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether sexual minority specific syndemic indicators were associated with higher health care costs, health care utilization, or the risk of being HIV-infected. Health care consumers at a community health center (N = 1211) completed a brief screening questionnaire collected over 12 months. Self-reported data were linked with participants’ clinical billing records. Adjusted logistic regression models identified that four syndemic indicators (suicidality, substance use, childhood sexual abuse, and intimate partner violence) were each significantly related to each other. Multiple syndemics significantly predicted higher medical care utilization and cost, and were associated with 2.5 times the risk of being HIV-infected (OR 2.49, 95% CI 1.45-4.25). Syndemic indicators did not significantly predict the number of mental health visits or costs per patient. These results confirm and extend earlier findings by relating syndemics to health services use and costs for sexual minority men.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Health Care Costs; Health Resource Utilization; HIV Infections -- Risk Factors; Health Status; Comorbidity; Mental Disorders; Human; Community Health Centers; Questionnaires; Health Screening; Self Report; Logistic Regression; Suicidal Ideation; Substance Abuse; Child Abuse, Sexual; Intimate Partner Violence; Odds Ratio; Confidence Intervals; Male

True Autonomy/False Dichotomies? Genderqueer Kids and the Myth of the Quick Fix. - Baker, Lauren L. (American Journal of Bioethics, 2019)
In this article, the author discusses the challenges in the proposal of the fundamental and legal right of transgender children to access puberty-blocking treatment without parental approval. Topics include challenges for gender-diverse children who identify as having gender other than male or female; challenges of parents who support the transition process but believing transition is not right option for child; importance of support parents with gender-diverse children.
Keywords: Patient Autonomy; Patient Rights; Transgender Persons -- Psychosocial Factors; Parental Role; Gender Identity; Stigma; Decision Making; Suicide -- Prevention and Control; Bioethics

Special Issues in Treating Adolescents With Gender Dysphoria. - van der Miesen, Anna; Arnoldussen, Marijn; de Vries, Annelou (Psychiatric Times, 2019)
The article discusses special treatment issues among adolescents with gender dysphoria (DSM-5), who experience gender identity-gender assignation incongruence as of 2019. Topics covered include the group's higher risk for mental health problems that are predicted by poor peer relations, suicidal ideation, and autism, and their need for tailored support like individualized explorative psychotherapy and gender-affirming care. Also noted is the challenging status of DSM-5 care for adolescents.
Keywords: Gender Dysphoria -- Diagnosis -- In Adolescence; Gender Dysphoria -- Therapy -- In Adolescence; Gender Dysphoria -- Psychosocial Factors -- In Adolescence; Transgender Persons -- Psychosocial Factors -- In Adolescence; Psychiatric Care; Adolescence; Male; Depression -- Risk Factors; Anxiety -- Risk Factors; Suicidal Ideation -- Risk Factors; Autistic Disorder -- Diagnosis; Support, Psychosocial; Gender Dysphoria -- Psychosocial Factors; DSM; Gender Affirmation Surgery -- Methods; Psychotherapy -- Methods; International Classification of Diseases; Mastectomy -- Methods

Sociodemographic differences in barriers to mental health care among college students at elevated suicide risk. - Horwitz, Adam G.; McGuire, Taylor; Busby, Danielle R.; Eisenberg, Daniel; Zheng, Kai; Pistorello, Jacqueline; Albucher, Ronald; Coryell, William; King, Cheryl A. (Journal of Affective Disorders, 2020)
Background: College student mental health (MH) problems and suicide risk have steadily increased over the past decade and a significant number of students with MH problems do not seek treatment. While some barriers to mental health care service utilization (MHSU) have been identified, very little is known regarding how these barriers differ among sociodemographic subgroups of students.Method: Participants were 3,358 college students from four US universities who screened positive for elevated suicide risk (defined as 2 or more of: depression, alcohol misuse, suicidal ideation, suicide attempt) and were not actively receiving MH services. Reported barriers to MHSU were categorized into: Low perceived need, privacy/stigma concerns, questioning helpfulness of treatment, logistics, time constraints, finances, and cultural issues.Results: Adjusted odds ratios indicated that finances were a greater barrier for women, sexual and gender minority students, and Black and Hispanic students. Privacy/stigma concerns were more prominent for men and young undergraduate students. White students and older undergraduate and graduate students were more likely to report a lack of time, and cultural sensitivity issues were significant barriers for sexual and gender minority, and racial/ethnic minority, students.Limitations: Participating sites were not nationally representative. The barriers assessment did not examine the degree to which a specific barrier contributed to lack of MHSU relative to others.Conclusions: In light of the significant variation in barriers based on age, gender identity, race/ethnicity, and sexual orientation, efforts to increase MHSU should be tailored to meet the unique needs of specific sociodemographic student subgroups.
Keywords: Mental Health; Ethnic Groups; Students; Male; Colleges and Universities; Gender Identity; Female; Minority Groups; Questionnaires; Scales

Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries. - Progovac, Ana M.; Mullin, Brian O.; Dunham, Emilia; Reisner, Sari L.; McDowell, Alex; Sanchez Roman, Maria Jose; Dunn, Mason; Telingator, Cynthia J.; Lu, Frederick Q.; Breslow, Aaron Samuel; Forstein, Marshall; Cook, Benjamin Lê (American Journal of Preventive Medicine, 2020)
Introduction: Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities.Methods: This study used 2009-2014 Medicare claims to identify people with gender identity-related diagnosis codes (disabled, n=6,678; older adult, n=2,018) and compared their prevalence of suicidality with a 5% random non-gender minority beneficiary sample (disabled, n=535,801; older adult, n=1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019.Results: Gender minority beneficiaries had higher unadjusted suicidality than non-gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p<0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligibility, depression or behavioral health conditions, avoidable hospitalizations, and violence victimization. In age- and mental health-adjusted logistic regression models, gender minorities had higher odds of suicidality than non-gender minority beneficiaries (disabled, OR=1.95, p<0.0001; older adult, OR=2.10, p<0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region.Conclusions: Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.
Keywords: Medicare -- Statistics and Numerical Data; Disabled -- Statistics and Numerical Data; Suicide -- Trends; Eligibility Determination; Male; Prospective Studies; Middle Age; Suicide; Depression -- Psychosocial Factors; Medicaid -- Statistics and Numerical Data; Aged; Adult; Aged, 80 and Over; United States; Female; Insurance -- Statistics and Numerical Data; Questionnaires

Behavioral Health Concerns and Eligibility Factors Among Adolescents and Young Adults Seeking Gender-Affirming Masculinizing Top Surgery. - Boskey, Elizabeth R.; Jolly, Divya; Tabaac, Ariella R.; Ganor, Oren (LGBT Health, 2020)
Purpose: We evaluated behavioral health histories and eligibility factors for patients seeking chest reconstruction. Methods: One hundred and fifty-eight consecutive transgender patients were seen for initial masculinizing top surgery consults between May 2017 and July 2019. Chart review was used to assess behavioral health and demographic factors, and eligibility factors related to the World Professional Association for Transgender Health (WPATH) Standards of Care. Univariate and age-adjusted regression models were used to examine the relationship between demographic and behavioral health factors and WPATH criteria. Results: The average age of patients at the time of their first consult was 18 (standard deviation = 3.3, range = 14- 33). Eighty-five percent had at least one behavioral health diagnosis; 27% had three or more. Sixty-four percent endorsed a history of self-harm or suicidal ideation, 13% within the last 6 months. Thirty-two percent reported a history of marijuana use and 19% a history of nicotine use. For those prescribed testosterone, additional months on testosterone were significantly associated with male (vs. nonbinary) gender (β = 4.64, 95% confidence interval [CI] 0.37-8.90, p = 0.033), age (β = 0.87, 95% CI 0.41-1.34, p < 0.001), living as one's affirmed gender for over 1 year (β = 6.37, 95% CI 1.37-11.37, p = 0.013), history of marijuana use (β = 4.54, 95% CI 1.10-7.98, p = 0.010), and history of nicotine use (β = 6.23, 95% CI 2.22-10.26, p = 0.003). Conclusion: Patients seeking gender-affirming masculinizing top surgery are behaviorally complex, in ways not necessarily associated with surgical eligibility. Involving a behavioral health provider in perioperative assessment can help identify and address potential risks to recovery and outcomes.

Experiences of Suicide in Transgender Youth: A Qualitative, Community-Based Study. - Hunt, Quintin A.; Morrow, Quinlyn J.; McGuire, Jenifer K. (Archives of Suicide Research, 2020)

Relationship between illness representations and mental health among HIV-positive men who have sex with men. - Mo, Phoenix Kit-han; Lau, Joseph Tak-fai; Wu, Xiaobing (AIDS Care, 2018)
Illness representations play a significant role on mental health across various health conditions. The present study explores the associations between illness representations of HIV and mental health (suicidal ideation and depression), and the mediation effects of emotional representations on the associations between cognitive representations and mental health among men who have sex with men who were newly diagnosed with HIV (ND-MSM) in China. A total of 225 ND-MSM were recruited from a non-governmental organisation and were invited to complete a cross-sectional survey. Results showed that 48.0% had suicidal ideation since HIV diagnosis and 48.4% scored higher than the cut-off for mild depression or above. Stepwise regression analyses showed that higher levels of emotional representations of HIV and lower levels of treatment control were associated with both suicidal ideation and depression. Emotional representations were shown to mediate the associations between some cognitive representations variables and mental health. Findings suggest that both cognitive and emotional representations of HIV were important factors of mental health among ND-MSM. Interventions to promote the mental health of ND-MSM are warranted and should seek to improve their cognitive and emotional representations of HIV.
Keywords: Mental Health; Men Who Have Sex With Men -- Psychosocial Factors; HIV Seropositivity; Attitude to Illness; HIV Infections -- Diagnosis -- China; Human; Emotions; Cognition; China; Cross Sectional Studies; Surveys; Suicidal Ideation; Depression; Severity of Illness; Regression; Health Promotion

High Burden of Mental Health Problems, Substance Use, Violence, and Related Psychosocial Factors in Transgender, Non-Binary, and Gender Diverse Youth and Young Adults. - Newcomb, Michael E.; Hill, Ricky; Buehler, Kathleen; Ryan, Daniel T.; Whitton, Sarah W.; Mustanski, Brian (Archives of Sexual Behavior, 2020)
Transgender and gender diverse (TGD) people are disproportionately impacted by various health issues and associated risk factors, but little is known about differences in these outcomes between gender identities within the TGD population. This study characterized the health of a diverse sample of TGD youth and young adults. Data were taken from the baseline visit of two longitudinal studies in the Chicago area, RADAR (N = 1079, M age = 20.8 years) and FAB 400 (N = 488, M age = 19.57 years), which are cohorts of young sexual and gender minorities assigned male at birth (AMAB) and assigned female at birth (AFAB), respectively. There was a combined sample of 214 TGD (128 AFAB, 86 AMAB) individuals across cohorts. We examined differences between gender identities in self-reported health and related psychosocial variables, and compared TGD youth and their cisgender sexual minority peers from their cohort of origin on all variables. Among TGD youth, we found high rates of depression and suicidality (ideation, plan, attempt), violence (trauma, victimization, childhood sexual abuse), and substance use (cigarette, alcohol, illicit drug use). With the exception of depression, transgender women and non-binary AMAB youth reported worse health outcomes than transgender men and non-binary AFAB youth. Non-binary AMAB youth reported the highest rates of certain outcomes, including traumatic experiences and suicidal ideation. TGD youth generally reported worse outcomes than cisgender sexual minority youth; these differences were less pronounced among AFAB youth. Findings point to the diversity of experiences within the TGD population and critical needs for intervention approaches to mitigate health disparities.
Keywords: Psychology -- Methods; Violence -- Psychosocial Factors; Mental Health -- Standards; Substance Use Disorders -- Psychosocial Factors; Adult; Young Adult; Female; Gender Identity; Risk Factors; Male; Prospective Studies; Clinical Assessment Tools; Psychosocial Adjustment to Illness Scale; Questionnaires

Association between perceived public stigma and suicidal behaviors among college students of color in the U.S. - Goodwill, Janelle R.; Zhou, Sasha (Journal of Affective Disorders, 2020)
Background: Suicide is the 2nd leading cause of death among college students and 10 to 34-year-olds in the U.S. While rates of suicide among young people of color have increased, less is known about factors that contribute to suicidality among racial minority students who are sorely underrepresented within existing research. Thus, we sought to explore the association between perceived public stigma of receiving mental health treatment and suicidality among Black, Asian Domestic, Asian International, Latinx, Multiracial, Arab/Arab American, American Indian/Alaska Native, and White college students.Methods: We analyzed cross-sectional survey responses from racially diverse sample of 153, 635 college students who participated in the Healthy Minds Study from years 2007-2018. Multivariable logistic regression was used to examine associations between perceived public stigma and suicide ideation, suicide planning, and suicide attempt.Results: Perceived public stigma was significantly associated with greater odds of suicide ideation, planning, and attempt. Odds of having attempted suicide within the past year were significantly greater among Asian International and Black college students. Sexual minority students broadly, and bisexual students specifically, were also at elevated risk for suicidal behavior.Limitations: Cross-sectional survey responses were assessed and causality cannot be determined.Conclusions: Students who endorsed more perceived public stigma also reported significantly greater odds of having experienced suicide ideation, planning, and attempt within the past 12 months. Subsequent interventions should account for concerns surrounding public perceptions of stigma when working to prevent suicide among students of color.
Keywords: Population; Students -- Statistics and Numerical Data; Stigma; Mental Health; Suicide, Attempted -- Ethnology; Logistic Regression; Population -- Psychosocial Factors; Human; Students -- Psychosocial Factors; Suicide, Attempted; Mental Health -- Statistics and Numerical Data; Suicide, Attempted -- Psychosocial Factors; Cross Sectional Studies; Female; Minority Groups -- Statistics and Numerical Data; Adolescence; Male; Minority Groups -- Psychosocial Factors; Young Adult; United States; Suicidal Ideation; Adult; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires; Scales

65. Protective Factors for Transgender and Gender Non-Binary Youth Experiencing Suicidality: A Systematic Review of the Literature...Society for Adolescent Health and Medicine Virtual Annual Meeting, March 10-13, 2021 - Christensen, Julie; Imhof, Reese; Linder, Katherine; McKean, Alastair (Journal of Adolescent Health, 2021)
Keywords: Transgender Persons; Sexual Identity; Suicidal Ideation -- Risk Factors -- In Adolescence; Congresses and Conferences; Adolescence

Associations of Lesbian, Gay, Bisexual, Transgender, and Questioning–Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students. - Proulx, Chelsea N.; Coulter, Robert W.S.; Egan, James E.; Matthews, Derrick D.; Mair, Christina (Journal of Adolescent Health, 2019)
Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)–inclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth. Data analysis of representative data from the 2015 Youth Risk Behavior Survey and the 2014 School Health Profiles was conducted using multilevel logistic models testing whether youth in states with higher proportions of schools teaching LGBTQ-inclusive sex education had lower odds of reporting being bullied in school and experiencing adverse mental health outcomes, including depressive symptoms and suicidality. After controlling for covariates, protective effects for all youth were found for suicidal thoughts (adjusted odds ratio [AOR]:.91, 95% confidence interval [CI]:.89–.93) and making a suicide plan (AOR:.79; 95% CI:.77–.80). Lesbian and gay youth had lower odds of experiencing bullying in school as the proportion of schools within a state teaching LGBTQ-inclusive sex education increased (AOR:.83; CI:.71–.97). Bisexual youth had significantly lower odds of reporting depressive symptoms (AOR:.92; 95% CI:.87–.98). Students in states with a greater proportion of LGBTQ-inclusive sex education have lower odds of experiencing school-based victimization and adverse mental health. These findings can be used to guide intervention development at the school and state levels.
Keywords: LGBTQ+ Persons -- Education; Sex Education; Students, High School -- Psychosocial Factors -- United States; Bullying -- Prevention and Control; Victims -- Psychosocial Factors; Mental Health; Learning Environment; Human; United States; Cluster Sample; Questionnaires; Sexual Identity; Data Analysis Software; Logistic Regression; Descriptive Statistics; Confidence Intervals; Odds Ratio; Male; Female; School Health Education; Funding Source

Internalized Homophobia, Depressive Symptoms, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in South Korea: An Age-Stratified Analysis. - Hyemin Lee; Operario, Don; Horim Yi; Sungsub Choo; Seung-Sup Kim (LGBT Health, 2019)
Purpose: Little research on internalized homophobia (IHP) and mental health among lesbian, gay, and bisexual (LGB) individuals has been done in South Korea, a context in which LGB populations widely experience societal stigma. This study examined the association between IHP and depressive symptoms and suicidal ideation among Korean LGB adults and investigated whether the association differed by participants' age. Methods: Cross-sectional data from the ''Rainbow Connection Project I - Korean Lesbian, Gay, & Bisexual Adults' Health Study'' were used for this study (N = 2178). Descriptive analyses were conducted to explore the distribution of IHP, depressive symptoms, and suicidal ideation across all covariates. Multivariate analyses were also used to investigate the overall and age-stratified associations between IHP and depressive symptoms and suicidal ideation. Results: The prevalence of high IHP was greater among older LGB adults, whereas the prevalence of depressive symptoms and suicidal ideation was higher among younger LGB adults. LGB individuals with high IHP levels had significantly greater risk of depressive symptoms than those with low IHP levels. In the age-stratified analyses, the associations between IHP and depressive symptoms were statistically significant only among older LGB adults with high IHP levels. Regarding suicidal ideation, the overall association was statistically significant in the full sample, but not in the age-stratified analyses. Conclusion: These findings suggest that mental health interventions are needed for LGB adults who have high IHP levels, especially among older generations. Furthermore, greater efforts are needed to enact protective legislation for sexual minority individuals in South Korea.

Psychological Maltreatment and Medical Neglect of Transgender Adolescents: The Need for Recognition and Individualized Assessment. - Antommaria, Armand H. Matheny; Shapiro, Robert A.; Conard, Lee Ann E. (American Journal of Bioethics, 2019)
The article discusses the psychological maltreatment and medical neglect of transgender adolescents. Topics discusses include information of psychological maltreatment of transgender children such as withdrawn them from school and denied them access to social media; suicide risk in transgender individuals which include social inclusion, trans phobia, and transition; and child protective services concerning children's well-being.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Child Abuse -- Psychosocial Factors; Gender Identity; Adolescent Health; Adolescence; Gender Affirmation Procedures -- Ethical Issues; Stress, Psychological -- Psychosocial Factors; Support, Psychosocial; Hormone Therapy; Insurance, Health; Adolescent Psychology

IMPLICATIONS OF HOMOPHOBIA ON ADOLESCENT HEALTH. - Guimarães Mongiovi, Vita; Cavalcante de Araújo, Ednaldo; Pinheiro Ramos, Vânia (Journal of Nursing UFPE / Revista de Enfermagem UFPE, 2018)
Objective: to identify the implications of the experience of homophobia on the health of adolescents. Method: An integrative review with the original articles in Portuguese/English/Spanish, from 2012 to august 2017, in the databases MEDLINE, Scopus, LILACS and BDENF. The data were presented in figure. Results: we included 11 articles with most publications in 2015. After the comparison and analysis, they classified into 3 thematic subgroups with integrated focus « Characteristics and manifestations homophobia among adolescents »; « Implications of homophobia on adolescent health » and « Confronting homophobia and health promotion ». Conclusion: the experience of homophobia during adolescence has implications for adolescent health such as anxiety, depression, ideation and suicide attempt; however, it is necessary to assist free of prejudices, allowing the population the enjoyment of the right to health, in addition to intersectoral partnerships for actions to fight homophobia and health promotion in school environments.
Keywords: Homophobia -- In Adolescence; Homosexuality -- In Adolescence; LGBTQ+ Persons -- In Adolescence; Adolescent Health; Systematic Review; Human; Medline; Reference Databases, Health; Health Promotion; Violence; Content Analysis; Depression; Suicidal Ideation; Mental Health; Descriptive Statistics; Adolescence

Psychological Correlates of Self-Harm within Gay, Lesbian and Bisexual UK University Students. - Taylor, Peter James; Dhingra, Katie; Dickson, Joanne M.; McDermott, Elizabeth (Archives of Suicide Research, 2020)
This study explores the association between lesbian, gay or bisexual (LGB) status and self-harm in UK higher education students. There is currently limited data on this association, and the role psychological variables have in potentially explaining this link, in UK students. We examine whether LGB status is associated with self-harm (both non-suicidal self-injury [NSSI] and suicide attempts [SA]), and whether 4 psychological variables (depression, anxiety, belongingness, self-esteem) mediate this association. A cross-sectional survey was used. UK university students (n = 707) completed an online survey including measures of self-harm, affective symptoms, belongingness, and self-esteem. Latent Variable Modelling (LVM) was used to test our hypotheses. LGB status remained associated with an elevated risk of NSSI and SA even after accounting for mediating factors. Self-esteem and (in the case of SA but not NSSI) thwarted belongingness, did, however, explain some of this association and were correlated with self-harm risk. The findings suggest that psychological factors may account for the association between LGB status and self-harm and, as such, prevention and intervention efforts directed at these psychological mediators may help to reduce self-harm risk in this population.

Sexual violence and safety: the narratives of transwomen in online forums. - Noack-Lundberg, Kyja; Liamputtong, Pranee; Marjadi, Brahm; Ussher, Jane; Perz, Janette; Schmied, Virginia; Dune, Tinashe; Brook, Eloise (Culture, Health & Sexuality, 2020)
An online forum analysis was conducted to explore experiences of sexual violence and safety among transwomen, with a particular focus on transwomen of colour. Four online forums were chosen for the analysis. Three key themes were identified: dating and violence in intimate relationships; fear of violence and safety strategies; and coping after sexual assault. Forum posters faced heightened gender policing and scrutiny, due to not conforming to normative ideals of femininity. Femininity was also predicated on white, middle-class status, and associated with domesticity and romance. As a result, expressions of femininity from non-white backgrounds could be read as deviant or excessive. The intersection of deviation from gender norms and femininity based on whiteness meant that transwomen of colour faced disproportionate levels of violence, both in public and private spaces. Transwomen of colour also faced disadvantage due to participation in higher-risk forms of sex work, low socioeconomic status and employment, and institutional discrimination. Coping mechanisms to deal with cumulative disadvantage included seeking support from health professionals and transgender community networks. However, it also included more harmful forms of self-medicating such as heavy alcohol and drug use, self-harm and suicide attempts.

"I Never Saw a Future": Childhood Trauma and Suicidality Among Sexual Minority Women. - Creighton, Genevieve M.; Oliffe, John L.; Broom, Alex; Rossnagel, Emma; Ferlatte, Olivier; Darroch, Francine (Qualitative Health Research, 2019)
While a significant health concern for sexual minority women, there is little qualitative research investigating their experiences of childhood trauma and suicidality. In this study, we used photovoice methods and an intersectionality framework. Drawing on qualitative interviews, we inductively derived three themes (a) Traumatized and discredited, (b) Cascading marginality, estrangement, and suicidality, (c) Reconstruction and reclaiming resilience. In Traumatized and discredited, we describe the sense of abandonment flowing from childhood trauma heightened by a lack of protection and neglect on the part of parents/guardians. The lack of support to deal with childhood trauma and the layering effects of marginality characterizes the theme Cascading marginality, estrangement, and suicidality. In the third theme, we discuss strategies for reconstruction and reclaiming resilience as participants worked to overcome these challenging experiences. Our study findings offer guidance to suicide prevention counseling programs for sexual minority women and affirm actions to address health inequities.
Keywords: Women's Health; Adverse Childhood Experiences; Psychological Trauma; Suicidal Ideation; LGBTQ+ Persons -- Psychosocial Factors; Human; Female; Qualitative Studies; Interviews; Hardiness; Photography; Canada; Lesbians; Bisexuals; Exposure to Violence; Domestic Violence; Child Abuse; Feminism; Psychosocial Aspects of Illness; Mental Health; Sexuality; Semi-Structured Interview; Interview Guides; Audiorecording; Constant Comparative Method; Thematic Analysis; Narratives; Suicide -- Prevention and Control

Suicide ideation among Southern U.S. Sexual minority college students. - Wolford-Clevenger, Caitlin; Frantell, Keri A.; Brem, Meagan J.; Garner, Alisa; Rae Florimbio, Autumn; Grigorian, Hannah; Shorey, Ryan C.; Stuart, Gregory L. (Death Studies, 2020)
Sexual minority individuals are at higher risk for suicide ideation compared with heterosexual individuals. We tested whether the interpersonal-psychological theory of suicide explains increased suicide ideation among sexual minority college students living in the southeastern region of the United States. The cross-sectional study assessed correlates of suicide ideation in a convenience sample (n = 82) of sexual minority college students. Perceived burdensomeness and thwarted belongingness correlated with suicide ideation. However, only perceived burdensomeness correlated with suicide ideation while controlling for depressive symptoms. Pending replication, perceived burdensomeness may be a target for suicide prevention and intervention among sexual minority college students.
Keywords: Sexual and Gender Minorities -- Psychosocial Factors -- United States; Students, Minority -- Psychosocial Factors -- United States; Students, College -- Psychosocial Factors -- United States; Suicidal Ideation -- Risk Factors -- United States; Risk Assessment; Human; United States; Psychological Theory; Cross Sectional Studies; Convenience Sample; Depression -- Complications; Suicidal Ideation -- Prevention and Control

ED Visits and Readmissions After Follow-up for Mental Health Hospitalization. - Bardach, Naomi S.; Doupnik, Stephanie K.; Rodean, Jonathan; Zima, Bonnie T.; Gay, James C.; Nash, Carol; Tanguturi, Yasas; Coker, Tumaini R. (Pediatrics, 2020)
OBJECTIVES: A national quality measure in the Child Core Set is used to assess whether pediatric patients hospitalized for a mental illness receive timely follow-up care. In this study, we examine the relationship between adherence to the quality measure and repeat use of the emergency department (ED) or repeat hospitalization for a primary mental health condition. METHODS: We used the Truven MarketScan Medicaid Database 2015-2016, identifying hospitalizations with a primary diagnosis of depression, bipolar disorder, psychosis, or anxiety for patients aged 6 to 17 years. Primary predictors were outpatient follow-up visits within 7 and 30 days. The primary outcome was time to subsequent mental health-related ED visit or hospitalization. We conducted bivariate and multivariate analyses using Cox proportional hazard models to assess relationships between predictors and outcome. RESULTS: Of 22 844 hospitalizations, 62.0% had 7-day follow-up, and 82.3% had 30-day followup. Subsequent acute use was common, with 22.4% having an ED or hospital admission within 30 days and 54.8% within 6 months. Decreased likelihood of follow-up was associated with non-Hispanic or non-Latino black race and/or ethnicity, fee-for-service insurance, having no comorbidities, discharge from a medical or surgical unit, and suicide attempt. Timely outpatient follow-up was associated with increased subsequent acute care use (hazard ratio [95% confidence interval]: 7 days: 1.20 [1.16-1.25]; 30 days: 1.31 [1.25-1.37]). These associations remained after adjusting for severity indicators. CONCLUSIONS: Although more than half of patients received follow-up within 7 days, variations across patient population suggest that care improvements are needed. The increased hazard of subsequent use indicates the complexity of treating these patients and points to potential opportunities to intervene at follow-up visits.
Keywords: Emergency Service; Office Visits; Readmission; Hospitalization; Mental Disorders -- In Infancy and Childhood; Quality of Health Care; Human; Mental Health Services; Child; Adolescence; After Care; Multivariate Analysis; Cox Proportional Hazards Model; Odds Ratio; Confidence Intervals; Acute Care; Outpatient Service; Health Resource Utilization

Advocating for Dialogue: Short and Long-Term Outcomes of Seattle-Based KUOW Radio's "Ask a" Project. - Manusov, Valerie; Stofleth, Daniel; Reynolds, Ross (Howard Journal of Communications, 2020)
In this study, we report on changes to reported attitudes, knowledge, and empathy immediately after and 3 months following a round-robin conversation between "askers" and "answerers" in intergroup sessions created by a local public radio station. Listeners were invited to have short one-on-one in—person conversations with people who were members of an identifiable out-group. These were "Ask A" sessions with Muslims, transgender people, Trump supporters, police officers, formerly homeless, newcomers, immigrants, gun owners, foster parents, journalists, and Special Olympians. We found correlations among our assessed variables for askers (N = 113) going into the interactions and increases in the variables as reported after the event. Two of the expectancy variables remained high three months after the sessions.
Keywords: Radio; Conversation; Interpersonal Relations; Attitude -- Evaluation; Knowledge -- Evaluation; Empathy -- Evaluation; Human; Islam; Transgender Persons -- Psychosocial Factors; Police -- Psychosocial Factors; Homeless Persons -- Psychosocial Factors; Immigrants -- Psychosocial Factors; Foster Parents -- Psychosocial Factors; Athletes -- Psychosocial Factors

Perceived Microaggressions and Mental Health in a Sample of Black Youths Experiencing Homelessness. - Gattis, Maurice N.; Larson, Andrea (Social Work Research, 2017)
The effects of microaggressions targeted at sexual minorities and racial minorities have been well documented. Lesbian, gay, bisexual, and transgender (LGBT) youths and black youths are more likely to experience homelessness than their heterosexual, cisgender, and white peers, and yet little is known about how microaggressions may affect youths during instances of homelessness. This study examines whether perceived LGBT racial microaggressions and perceived racial microaggressions are associated with depressive symptoms and suicidality in a sample of black youths experiencing homelessness. This study uses a cross-sectional design with structured face-to-face interviews of a convenience sample of 89 black youths (ages 16 to 24 years) experiencing homelessness. Results show that whereas both types of perceived microaggressions are positively associated with depressive symptoms, neither form of microaggression is independently associated with suicidality. Depressive symptoms and suicidality are common experiences among black youths dealing with homelessness, and the perception of microaggressions targeted at sexual or racial minority statuses is associated with depressive symptomology. Results underscore the importance of social workers comprehensively addressing how subtle, pervasive forms of heterosexism, gender normativity, and racism affect mental health outcomes among homeless youths.
Keywords: Black Persons -- Psychosocial Factors -- In Adolescence; Homelessness; Mental Health -- Psychosocial Factors -- In Adolescence; Aggression; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Perception; Human; Adolescence; Suicidal Ideation; Cross Sectional Studies; Depression -- Symptoms; Female; Structured Interview; Male; Minority Groups; Race Factors; Racism; Stress, Psychological; Convenience Sample; Young Adult; Psychological Theory; Quantitative Studies; Descriptive Statistics; Wisconsin; Surveys; Center for Epidemiological Studies Depression Scale; Scales; Coefficient Alpha; Self Report; Gender Identity; Variable; P-Value; Odds Ratio; Confidence Intervals

Peer Responses to Trans Youth Tweeting About Self-Harm and Suicidality. - Simms, Drew (Creative Nursing, 2020)
Background: Transgender youth have been found to be at higher risk of experiencing common mental health problems than their cisgender peers, but there has been little research into the mechanisms of peer support among this group. Research into how young people communicate about self-harm and suicidality on social media has found patterns of behavior in which young people encourage each other's risky and self-injurious actions, but whether this holds true among minority groups such as trans youth has not been established. Method: Twitter biographies were searched to find self-identifying trans people aged 14–18 years. The resulting accounts were searched for key words related to common mental health issues. The tweets caught by the search terms and their replies were coded into themes using a combination of inductive and deductive coding. The occurrence of themes were quantified and analyzed using SPSS 24. Results: 1,468 tweets were analyzed from 235 accounts; 133 (56.6%) of the accounts with relevant content received no public replies to tweets mentioning mental health issues. Of the 102 (43.4%) that did receive public replies, 64 (62.7%) received a maximum of two replies. Three themes were found in replies to tweets, Support, Feeling the Same Way, and Advice. Most replies were expressions of support, followed by expressions of feeling the same way; advice was rare. There were no incidents of replies that were dismissive of or encouraged self-injurious behavior. Discussion: Findings differ from existing research on how youth interact with each other online with regard to mental health issues: the trans youth in this study were not found to encourage risky and self-injurious behavior in each other. This has implications for caring for trans youth in mental health settings, where social media use is normally discouraged, as its use may be a protective factor for trans youth specifically.
Keywords: Peer Counseling; Transgender Persons -- In Adolescence; Suicidal Ideation; Injuries, Self-Inflicted; Social Media; Human; Adolescence; Mental Health; Thematic Analysis; Data Analysis Software; Descriptive Statistics; Risk Assessment; Pearson's Correlation Coefficient; Social Norms; Peer Group

Body Dissatisfaction and Mental Health Outcomes of Youth on Gender-Affirming Hormone Therapy. - Kuper, Laura E.; Stewart, Sunita; Preston, Stephanie; Lau, May; Lopez, Ximena (Pediatrics, 2020)
OBJECTIVES: Our first aim was to examine baseline differences in body dissatisfaction, depression, and anxiety symptoms by gender, age, and Tanner (ie, pubertal) stage. Our second aim was to test for changes in youth symptoms over the first year of receiving gender-affirming hormone therapy. Our third aim was to examine potential differences in change over time by demographic and treatment characteristics. Youth experiences of suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) are also reported. METHODS: Participants (n = 148; ages 9-18 years; mean age 14.9 years) were receiving gender- affirming hormone therapy at a multidisciplinary program in Dallas, Texas (n = 25 puberty suppression only; n =123 feminizing or masculinizing hormone therapy). Participants completed surveys assessing body dissatisfaction (Body Image Scale), depression (Quick Inventory of Depressive Symptoms), and anxiety (Screen for Child Anxiety Related Emotional Disorders) at initial presentation to the clinic and at follow-up. Clinicians completed the Quick Inventory of Depressive Symptoms and collected information on youth experiences of suicidal ideation, suicide attempt, and NSSI. RESULTS: Affirmed males reported greater depression and anxiety at baseline, but these differences were small (P < .01). Youth reported large improvements in body dissatisfaction (P < .001), small to moderate improvements in self-report of depressive symptoms (P < .001), and small improvements in total anxiety symptoms (P < .01). No demographic or treatment-related characteristics were associated with change over time. Lifetime and follow- up rates were 81% and 39% for suicidal ideation, 16% and 4% for suicide attempt, and 52% and 18% for NSSI, respectively. CONCLUSIONS: Results provide further evidence of the critical role of gender-affirming hormone therapy in reducing body dissatisfaction. Modest initial improvements in mental health were also evident.
Keywords: Body Dissatisfaction; Mental Health; Gender Affirmation Procedures; Hormone Therapy; Human; Descriptive Statistics; Child; Adolescence; Texas; Depression -- Diagnosis; Anxiety -- Diagnosis; Suicidal Ideation; Suicide, Attempted; Self-Injurious Behavior; Scales; Male; Female; Sex Factors; Outcomes (Health Care)

Perceived stress, wellbeing and mental health of college student during COVID-19 pandemic. - Khadirnavar, Afreenbanu A.; Vanageri, Husenasab; Asagi, Renuka E. (Indian Journal of Psychiatric Social Work, 2020)
Background: Education supports young adults in enhancing coping mechanises, gaining support system, having a good and healthy lifestyle with regular psychological and physical activities example having schedule day, teaching-learning programmes, meeting peers, social contacts as having social interaction which itself reduce the stress of individual and reliefs to have a peaceful mind. Aim: To assess the perceived stress, well-being and mental health of college students who are now out of education because of COVID-19 pandemic. Method: The study followed a cross-sectional study design and purposive sampling method. The sample includes N = 100 from various colleges of Karnataka state. The socio-demographic schedule, perceived stress, general well-being and suicide behaviour scales were used the data and the data was analysed using SPSS version 25. Results: The COVID-19 pandemic impacted negatively on college student's education related plans. They were worried experienced anxiety, stress and also hopelessness, worthlessness and helplessness; the majority of college students were reported of having moderate to high level of stress and use of TV and mobile was reported high during the lockdown and the academic related activities were relatively very less. Conclusion: There is a need for mental health service to address the needs of this specific population.
Keywords: Mental Health; Stress, Psychological; Psychological Well-Being; Students, College; COVID-19 Pandemic; Human; Cross Sectional Studies; Purposive Sample; India; Descriptive Statistics; Data Analysis Software; Mental Health Services; Analysis of Variance; Male; Female; Transgender Persons; Young Adult; Adult

Suicide and nonsuicidal self‐injury among sexual and gender minority adolescents: A stress perspective. - Poon, Jennifer A.; Kerr, Patrick L.; Kim, Kerri L. (Brown University Child & Adolescent Behavior Letter, 2020)
"I don't want to hurt myself — I want to kill myself." Alex [not his real name] was an 18‐year‐old trans male I met during his first psychiatric inpatient admission. Alex was raised in a "holler" in West Virginia. While his peers were navigating the stresses of emerging adulthood, Alex carried the additional burden of experiencing gender dysphoria, a deep sense of incongruence between the biological sex he was assigned at birth (female) and his gender identity (male). Though well‐intentioned, his parents made it clear that his desire to be male was sinful and would not be tolerated in their family. He felt hopeless — "repulsive" even. Alex decided he could suppress his female identity interminably, risk coming out and being rejected by his family and community, or end his life.
Keywords: Suicide -- Risk Factors; Self-Injurious Behavior -- Risk Factors; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Minority Groups -- Psychosocial Factors; Stress, Psychological; Adolescent Behavior; Risk Assessment; Adolescence; Gender Identity; Risk Taking Behavior; Sexuality; Suicidal Ideation; Stigma; Psychological Theory; Homophobia; Male

Mental health inequalities among gay and bisexual men in England, Scotland and Wales: a large community-based cross-sectional survey. - Hickson, Ford; Davey, Calum; Reid, David; Weatherburn, Peter; Bourne, Adam (Journal of Public Health, 2017)
Background Sexual minorities suffer worse mental health than the sexual majority but little is known about differences in mental health within sexual minorities. We aimed to describe inequality in mental health indicators among gay and bisexual men. Methods Using multi-channel community-based opportunistic sampling we recruited 5799 eligible men aged 16 years and over, living in England, Scotland and Wales and who were sexually attracted to other men, to a self-completion Internet health survey. Mental health indicators (depression (PHQ-9), anxiety (GAD-7), suicide attempt and self-harm) were examined for independent associations across common axes of inequality (age, ethnicity, migrancy, education, income, cohabitation and living in London). Results Mental ill-health was common: 21.3% were depressed and 17.1% anxious, while 3.0% had experienced attempted suicide and 6.5% had self-harmed within the last 12 months. All four indicators were associated with younger age, lower education and lower income. Depression was also associated with being a member of visible ethnic minorities and sexual attraction to women as well as men. Cohabiting with a male partnerand living in London were protective of mental health. Conclusion Community interventions to increase mental health among gay and bisexual men should be designed to disproportionately benefit younger men and those living on lower incomes.
Keywords: Mental Disorders -- Psychosocial Factors -- Great Britain; Healthcare Disparities -- Great Britain; Gay Men -- Psychosocial Factors; Bisexuals -- Psychosocial Factors; Human; Funding Source; Great Britain; Male; Surveys; Cross Sectional Studies; Adolescence; Young Adult; Adult; Middle Age; Questionnaires; Logistic Regression; Odds Ratio; Depression; Anxiety; Suicide, Attempted; Mental Health; Outcomes (Health Care); Health Status Indicators; Social Determinants of Health

The Democratization of Facial Feminization Surgery and the Removal of Artificial Barriers. - Gibson, Richard (American Journal of Bioethics, 2018)
The article argues the medical necessity of facial feminization surgery (FFS) in facilitating social intercourse for transfeminine people. Unmet health care needs of trans population having FFS such as risk of depression, self-destructive behavior and suicide, is highlighted. Also mentioned is the discourse over insurance coverage of transition-related interventions for FFS through cosmetic dichotomy.
Keywords: Face -- Surgery; Feminization -- Surgery; Health Services Accessibility; Bioethics; Gatekeeping; Transgender Persons -- Psychosocial Factors; Politics; Cost Benefit Analysis; Insurance Coverage; Gender Dysphoria; Surgery, Plastic

The Presenting Concerns of Transgender and Gender Nonconforming Clients at University Counseling Centers. - Platt, Lisa F. (Counseling Psychologist, 2020)
There is a paucity of research on transgender and gender nonconforming (TGNC) students who present to university counseling centers (UCCs). Using national-level data from the Center for Collegiate Mental Health (2012 to 2015), the current findings indicate that TGNC students seeking services at UCCs are presenting with high acuity and more severe concerns than their cisgender peers. This severity is in nearly every clinical domain including suicidality, history of hospitalization, trauma history, mood disorders, and family distress. Comparing the transgender and gender nonconforming (GNC) collegiate clients, GNC clients have the highest levels of distress and clinical symptoms on nearly every indicator. Overall, these findings for both transgender and GNC clients provide important information for UCCs about treatment and outreach to these high-risk populations. Our findings also mirror the mental health disparities seen in noncollegiate community TGNC samples. We discuss treatment implications, limitations, and suggestions for future research.
Keywords: Transgender Persons -- Psychosocial Factors -- United States; Counseling; Colleges and Universities; Health Services Needs and Demand; Mental Health Services; United States; Human; Descriptive Research; Students, College; Education, Continuing (Credit); Mental Health; Suicide; Hospitalization; Affective Disorders; Psychological Distress

Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. - Turban, Jack L.; King, Dana; Carswell, Jeremi M.; Keuroghlian, Alex S. (Pediatrics, 2020)
BACKGROUND AND OBJECTIVES: Gonadotropin-releasing hormone analogues are commonly prescribed to suppress endogenous puberty for transgender adolescents. There are limited data regarding the mental health benefits of this treatment. Our objective for this study was to examine associations between access to pubertal suppression during adolescence and adult mental health outcomes. METHODS: Using a cross-sectional survey of 20 619 transgender adults aged 18 to 36 years, we examined self-reported history of pubertal suppression during adolescence. Using multivariable logistic regression, we examined associations between access to pubertal suppression and adult mental health outcomes, including multiple measures of suicidality. RESULTS: Of the sample, 16.9% reported that they ever wanted pubertal suppression as part of their gender-related care. Their mean age was 23.4 years, and 45.2% were assigned male sex at birth. Of them, 2.5% received pubertal suppression. After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation (adjusted odds ratio = 0.3; 95% confidence interval = 0.2-0.6). CONCLUSIONS: This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.
Keywords: Transgender Persons -- In Adolescence; Puberty, Precocious -- Prevention and Control; Gonadorelin -- Therapeutic Use; Health Services Accessibility; Suicidal Ideation -- Risk Factors -- In Adulthood; Human; Adolescence; Adult; Cross Sectional Studies; Multiple Logistic Regression; Descriptive Statistics; Odds Ratio; Comparative Studies; Confidence Intervals

Sexual orientation disparities in mental health and substance use among Black American young people in the USA: effects of cyber and bias-based victimisation. - Mereish, Ethan H.; Sheskier, Mikela; Hawthorne, David J.; Goldbach, Jeremy T. (Culture, Health & Sexuality, 2019)
Few studies have explored sexual orientation disparities in mental health and substance use outcomes among racial minorities. This study examined sexual orientation disparities in depression, suicidality and substance use among Black American young people in the USA, and the mediating role of cyber and bias-based victimisation in accounting for these disparities. Secondary analyses were performed on data from a probability sample of young people (N = 1,129) collected in a school district in the south-eastern USA. Participants reported socio-demographics, depressive symptoms, suicidality, substance use and experiences of bias-based and cyber victimisation. With some exceptions, Black participants who were lesbian, gay, bisexual or mostly heterosexual reported higher rates of depression, suicidal ideation, suicide planning and substance use than Black heterosexual participants. Black lesbian, gay, bisexual and mostly heterosexual participants reported more cyber and bias-based victimisation than Black heterosexual participants. Sexual orientation disparities in mental health and, to some extent, substance use were partially explained by both forms of victimisation. Further research is needed to address the role of bias-based and cyber victimisation in disparities in mental health and substance use among Black sexual minority young people. The present study carries implications for prevention and treatment efforts for racially diverse sexual minorities.
Keywords: Substance Use Disorders -- Ethnology; Mental Health; Health Status Disparities; Sexuality; Black Persons -- Statistics and Numerical Data; Crime Victims -- Psychosocial Factors; Adolescence; United States; Heterosexuality; Child; Cross Sectional Studies; Suicidal Ideation; Female; Male; Questionnaires; Scales

Suicidality Disparities Between Transgender and Cisgender Adolescents. - Thoma, Brian C.; Salk, Rachel H.; Choukas-Bradley, Sophia; Goldstein, Tina R.; Levine, Michele D.; Marshal, Michael P. (Pediatrics, 2019)
BACKGROUND AND OBJECTIVES: Emerging evidence indicates transgender adolescents (TGAs) exhibit elevated rates of suicidal ideation and attempt compared with cisgender adolescents (CGAs). Less is known about risk among subgroups of TGAs because of limited measures of gender identity in previous studies. We examined disparities in suicidality across the full spectrum of suicidality between TGAs and CGAs and examined risk for suicidality within TGA subgroups. METHODS: Adolescents aged 14 to 18 completed a cross-sectional online survey (N = 2020, including 1148 TGAs). Participants reported gender assigned at birth and current gender identity (categorized as cisgender males, cisgender females, transgender males, transgender females, nonbinary adolescents assigned female at birth, nonbinary adolescents assigned male at birth, and questioning gender identity). Lifetime suicidality (passive death wish, suicidal ideation, suicide plan, suicide attempt, and attempt requiring medical care) and nonsuicidal self-injury were assessed. RESULTS: Aggregated into 1 group, TGAs had higher odds of all outcomes as compared with CGAs. Within TGA subgroups, transgender males and transgender females had higher odds of suicidal ideation and attempt than CGA groups. CONCLUSIONS: In this study, we used comprehensive measures of gender assigned at birth and current gender identity within a large nationwide survey of adolescents in the United States to examine suicidality among TGAs and CGAs. TGAs had higher odds of all suicidality outcomes, and transgender males and transgender females had high risk for suicidal ideation and attempt. Authors of future adolescent suicidality research must assess both gender assigned at birth and current gender identity to accurately identify and categorize TGAs.
Keywords: Suicidal Ideation -- Risk Factors -- In Adolescence; Suicide, Attempted -- Risk Factors -- In Adolescence; Risk Assessment -- United States; Adolescent Health; Human; Adolescence; Cross Sectional Studies; Internet; Surveys; Gender Identity; Male; Female; Transgender Persons; Self-Injurious Behavior -- Risk Factors; Odds Ratio; United States

God Bless You? The Association of Religion and Spirituality with Reduction of Suicide Ideation and Length of Hospital Stay among Psychiatric Patients at Risk for Suicide. - Plöderl, Martin; Kunrath, Sabine; Fartacek, Clemens (Suicide & Life-Threatening Behavior, 2020)
Objective: Religion and spirituality (R&S) were protective against suicidal behavior in the majority of studies. In prospective studies, R&S were associated with improved outcome for patients with depression, a main risk factor for suicide. Thus, R&S may also improve recovery from suicidal crisis, but related data is lacking.Method: We explored how aspects of R&S were associated with reduction of suicide ideation and length of hospital stay among 351 patients admitted to a psychiatric crisis intervention ward specialized in suicide prevention. We analyzed the results separately by gender and sexual orientation due to the known specific effects of R&S in these groups.Results: Overall, there were only small and non-significant associations between R&S and reduction of suicide ideation and length of hospital stay. For heterosexual men, some R&S variables were associated with less optimal outcome. Contrary to our hypothesis, R&S were not less or even more beneficial for sexual minority than heterosexual patients.Conclusions: Religion and spirituality were not or only weakly associated with improvement of suicide ideation and shorter hospital stay. Further studies are needed to account for selection biases and other limitations in our study. Based on our findings, R&S may not be major sources to recover from suicidal crisis in a psychiatric setting.
Keywords: Prayer; Spirituality; Mental Disorders -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Suicidal Ideation; Female; Risk Factors; Adult; Prospective Studies; Length of Stay; Middle Age; Male; Depression -- Psychosocial Factors; Questionnaires

Evaluation of an avatar-based training program to promote suicide prevention awareness in a college setting. - Rein, Benjamin A.; McNeil, Daniel W.; Hayes, Allison R.; Hawkins, T. Anne; Ng, H. Mei; Yura, Catherine A. (Journal of American College Health, 2018)
Objective: Training programs exist that prepare college students, faculty, and staff to identify and support students potentially at risk for suicide. Kognito is an online program that trains users through simulated interactions with virtual humans. This study evaluated Kognito's effectiveness in preparing users to intervene with at-risk students. Participants: Training was completed by 2,727 university students, faculty, and staff from April, 2014 through September, 2015. Methods: Voluntary and mandatory participants at a land-grant university completed Kognito modules designed for higher education, along with pre- and post-assessments. Results: All modules produced significant gains in reported Preparedness, Likelihood, and Self-Efficacy in intervening with troubled students. Despite initial disparities in reported abilities, after training participants reported being similarly capable of assisting at-risk students, including LGBTQ and veteran students. Conclusions: Kognito training appears to be effective, on a large scale, in educating users to act in a facilitative role for at-risk college students.
Keywords: Health Promotion; Program Evaluation; Students, College -- Psychosocial Factors; Online Services; Suicide -- Prevention and Control; Risk Taking Behavior; Human; Faculty; Support, Psychosocial; Education, Masters; Self-Efficacy; Veterans -- Psychosocial Factors; LGBTQ+ Persons -- Psychosocial Factors; Self Report

IS ANYONE LISTENING? - Harris, Phil (Community Practitioner, 2018)
The article discusses the lessening healthcare access by trans young people with mental and physical health issues in Great Britain and steps for addressing the problem as of May 2018. Topics covered include these children's attempted suicides, and experiences of discrimination and bullying, and the continuing stigma in how they are treated by parents, professionals and wider society. Also noted are nurses' and schools' possible facilitation of professional services access to these group.
Keywords: Trauma -- Psychosocial Factors; Stigma; Transsexuals; United Kingdom; Child; Health; Happiness

Understanding suicide risk and eating disorders in college student populations: Results from a National Study. - Lipson, Sarah K.; Sonneville, Kendrin R. (International Journal of Eating Disorders, 2020)
Objective: To examine suicide risk by eating disorder severity and symptom presentation in a nationwide sample of college students. Method: The Healthy Minds Study is the largest mental health survey of college populations in the United States. We analyzed the most recent available data (2015–2017) with 71,712 randomly selected students from 77 campuses. We estimated associations between two measures of suicidality (ideation and attempts) and three validated measures of eating disorder symptoms (the SCOFF, weight concerns scale, and the eating disorder examination questionnaire binge and purge items). Importantly, we also controlled for co‐occurring symptoms of depression and anxiety, based on validated screening tools. The large, diverse sample provided a unique opportunity to assess whether certain individual characteristics were associated with increased risk. Results: Eating disorder symptoms, even at subthreshold levels, were highly predictive of suicidality. Relative to students with no apparent eating disorder symptoms, students with the highest symptom levels (a SCOFF score of 5) had 11 times higher odds of attempting suicide, while those with subthreshold symptoms had two times higher odds. We also observed a strong association between suicide attempts and eating disorder presentations that included purging. Students from marginalized backgrounds, particularly gender and sexual minorities, were at increased risk for suicide and eating disorders. Discussion: In the largest known study to date, findings suggest that eating disorders should be a priority within broader campus suicide prevention efforts, should be assessed along a continuum of severity and symptom presentation, and should focus on reaching vulnerable students.
Keywords: Students, College -- United States; Suicide -- Risk Factors; Risk Assessment; Eating Disorders -- Diagnosis; Eating Disorders -- Symptoms; Severity of Illness; Human; United States; Random Sample; Suicidal Ideation; Suicide, Attempted; Questionnaires; Mental Disorders; Comorbidity

The Link between Discrimination and Worst Point Suicidal Ideation among Sexual and Gender Minority Adults. - Salentine, Cassidy M.; Hilt, Lori M.; Muehlenkamp, Jennifer J.; Ehlinger, Peter P. (Suicide & Life-Threatening Behavior, 2020)
Objective: Sexual and gender minority (SGM) adults often report a disproportionately high rate of suicidal ideation compared to their heterosexual and cisgender counterparts. The current study aimed to understand the relationship between discrimination for one's sexual orientation or gender identity and suicidal ideation. We hypothesized that discrimination would be associated with suicidal ideation at one's worst point through the indirect effects of hopelessness regarding thwarted belongingness and perceived burdensomeness.Method: A sample of 178 SGM adults (M age = 30.34, range 18-69; 76% white) completed an online questionnaire assessing minority-specific stressors and suicide-related thoughts and behaviors.Results: A mediation model with bootstrapping indicated that greater discrimination was associated with more frequent suicidal ideation at one's worst point through the indirect effect of hopelessness regarding thwarted belongingness.Conclusions: The current study provides evidence that the pathway between discrimination and worst point suicidal ideation may be partially explained by the perception that one will never belong. These findings support the utility of an understudied Interpersonal Theory of Suicide hypothesis for research among SGM adults.
Keywords: Suicidal Ideation; Discrimination -- Psychosocial Factors; Interpersonal Relations; Self Concept; Female; Risk Factors; Adolescence; Aged; Adult; Middle Age; Male; Human; Young Adult; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires; Scales

Rural school experiences of South African gay and transgender youth. - Daniels, Joseph; Struthers, Helen; Maleke, Kabelo; Catabay, Christina; Lane, Tim; McIntyre, James; Coates, Tom (Journal of LGBT Youth, 2019)
Low educational attainment, often a lack of a high school diploma or matriculation degree, has been linked to negative health outcomes and lower quality of life for sexual and gender minorities globally. However, optimism and resiliency have been demonstrated to provide buffering effects on school dropout. We conducted a study in a South African rural setting to understand the school experiences of gay men, drag queens, and transgender women in Mpumalanga, South Africa. We recruited 35 HIV-positive participants using a purposive sampling method and then conducted a series of focus group discussions. A semi-structured focus group protocol was used, which covered three main domains: educational attainment and goals, experiences as a gender or sexual minority in school before matriculation, and personal and social values placed on education. Through a constant comparison analytical approach, we identified four themes to include school violence and discrimination, dropping out or staying silent to cope, competition between drag queens and girls, and education is social power. Our study suggests that sexual and gender minority youth navigate harassment and discrimination, which negatively impacts their educational attainment, but there is opportunity to support their academic achievement and leadership in society by building upon their acts of resiliency.
Keywords: Schools -- Psychosocial Factors -- South Africa; Gay Men -- Psychosocial Factors -- In Adolescence; Transgender Persons -- Psychosocial Factors -- In Adolescence; Rural Areas; Human; South Africa; Adolescence; Cross-dressers -- Psychosocial Factors; HIV-Positive Persons; Purposive Sample; Focus Groups; Personal Values; Social Values; Minority Groups -- Psychosocial Factors; Constant Comparative Method; School Violence; Discrimination; Student Dropouts; Coping; Academic Achievement; Leadership; Hardiness; Support, Psychosocial

Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans. - Aboussouan, Alix; Snow, Annie; Cerel, Julie; Tucker, Raymond P. (Journal of Affective Disorders, 2019)
Background: Transgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans.Method: Data analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI.Results: Results of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals.Limitations: The limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans.Conclusion: NSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent.
Keywords: Veterans -- Statistics and Numerical Data; Suicide, Attempted; Self-Injurious Behavior -- Epidemiology; Suicidal Ideation; Risk Factors; Middle Age; Self Report; Hospitalization -- Statistics and Numerical Data; Prevalence; Self-Injurious Behavior -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Female; Human; Probability; Adult; Young Adult; Cross Sectional Studies; Patient Attitudes; Male; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires

Grazoprevir/elbasvir for the immediate treatment of recently acquired HCV genotype 1 or 4 infection in MSM. - Boyd, Anders; Miailhes, Patrick; Chas, Julie; Valantin, Marc-Antoine; Yazdanpanah, Yazdan; Rosenthal, Eric; Chevaliez, Stephane; Piroth, Lionel; Rougier, Hayette; Peytavin, Gilles; Pialoux, Gilles; Girard, Pierre-Marie; et al. (Journal of Antimicrobial Chemotherapy (JAC), 2020)
Background: In Europe, increases in HCV infection have been observed over the last two decades in MSM, making them a key population for recently acquired HCV. Alternative combinations of direct-acting antiviral agents against early HCV infection need to be assessed.Patients and Methods: In this pilot trial, MSM with recently acquired genotype 1 or 4 HCV infection were prospectively included and received 8 weeks of oral grazoprevir 100 mg and elbasvir 50 mg in a fixed-dose combination administered once daily. The primary endpoint was sustained virological response evaluated 12 weeks after the end of treatment (EOT) (SVR12). Secondary endpoints were the virological characterization of failures, the quality of life before, during and after treatment and the rate of reinfection.Results: In a 15 month period, 30 patients were enrolled, all of whom were MSM. Of the 29 patients completing follow-up, 28 (96%, 95% CI = 82%-99%) achieved SVR12. One patient interrupted follow-up (suicide) but had undetectable plasma HCV RNA at EOT. One patient with suboptimal adherence confirmed by plasma drug monitoring relapsed and developed NS3, NS5A and NS5B resistance-associated substitutions (V36M, M28V and S556G). The most common adverse events related to study drug were diarrhoea (n = 4, 13%), insomnia (n = 2, 7%) and fatigue (n = 2, 7%), although no patient discontinued treatment. No HIV RNA breakthrough was reported in the 28 patients with HIV coinfection. At Week 48, reinfection was diagnosed in three patients.Conclusions: Our data support the use of grazoprevir/elbasvir for immediate treatment against HCV in order to reduce HCV transmission in MSM.

Trans Adolescents' Perceptions and Experiences of Their Parents' Supportive and Rejecting Behaviors. - Johnson, Kelly C.; LeBlanc, Allen J.; Sterzing, Paul R.; Deardorff, Julianna; Antin, Tamar; Bockting, Walter O. (Journal of Counseling Psychology, 2020)
Transgender (trans) adolescents consistently report higher rates of adverse mental health outcomes compared to their cisgender peers. Parental support is a recognized adolescent protective factor; however, little is known about the specific parental behaviors that trans adolescents perceive as most or least supportive. To address this gap, we analyzed data from qualitative interviews conducted with an ethnically diverse, urban-based sample of trans adolescents (N = 24; 16–20 years old) to describe (a) the spectrum of specific parental behaviors across 3 categories—rejecting, supportive, and mixed (i.e., simultaneous supportive and rejecting behaviors)—and (b) the perceived psychosocial consequences across these 3 categories of parental behaviors. Qualitative data were gathered through lifeline interviews (i.e., visual representations from birth to present) and photo elicitation (i.e., photographs representing parental support and/or rejection). Supportive behaviors included instances where parents made independent efforts to learn about trans issues or help their child obtain gender-affirming health care. Rejecting behaviors included instances when parents refused to use their child's name or pronouns or failed to show empathy when their child struggled with gender-identity-related challenges. Mixed behaviors included examples when parents expressed support of their child's gender identity, but not of their sexual orientation (or vice versa). Overall, participants reported that rejecting and mixed parental behaviors contributed to a range of psychosocial problems (e.g., depression and suicidal ideation), while supportive behaviors increased positive wellbeing. These findings expand upon descriptions of parental support and rejection within the trans adolescent literature and can help practitioners target specific behaviors for interventions. Public Significance Statement: This study qualitatively describes the specific parental behaviors that trans adolescents perceive as rejecting, supportive, or mixed (i.e., simultaneous supportive and rejecting behaviors). Overall, participants perceived that rejecting and mixed parental behaviors contributed to a range of psychosocial problems (e.g., depression and suicidal ideation), while supportive behaviors increased positive wellbeing. Interventions should target these specific parental behaviors to improve trans adolescent mental health and well-being.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Parents -- Psychosocial Factors; Parental Behavior; Support, Psychosocial; Human; Adolescence; Young Adult; Mental Health; Interviews; Qualitative Studies; Sex Factors; Sexuality; Depression; Suicidal Ideation; Psychological Well-Being

Homonegativity and Associated Factors Among Men Who Have Sex with Men in Estonia. - Parker, R.; Lõhmus, Liilia; Mangine, Cara; Rüütel, Kristi (Journal of Community Health, 2016)
Men who have sex with men (MSM) continue to be at higher risk for negative health outcomes including HIV, STIs, depression, substance use, suicidality, and anxiety. Associative relationships between homonegativity (internal and external) and these outcomes are used to explain the observed disproportionate impact. The current study assessed associations between internalized homonegativity and high-risk behaviours, markers of substance use and symptoms of mental illness as well as openness and level of same sex attraction. A 2013 Internet-based survey was conducted among MSM, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. The sample (n = 265) had a median age of 31 years, with 85 % employed at least part-time; at least a college-level education in 43 %; and 87 % lived in an urban setting. Sexual orientation was reported as: gay, 72 %; bisexual 23 %; other 5 %. Almost all men (97 %) reported ever having sex with a man, with more than one-third (36 %) having a steady male partner. Statistically significant higher homonegativity scores were detected among men reporting any level of opposite sex attraction compared to men attracted to only men; mostly men ( p = 0.001), men and women equally ( p = 0.002), and mostly women ( p = 0.004), as well as less openness of same sex attraction to family and friends; >50 % family ( p = 0.032), no family knowing ( p = 0.042), and few friends knowing ( p = 0.011). Anxiety risk and increased homonegativity also had a statistically significant increasing relationship. The identified associations between homonegativity and opposite sex attraction among MSM warrants further exploration as well as the relationship with increased anxiety risk.
Keywords: Men Who Have Sex With Men -- Psychosocial Factors; Gay Men -- Psychosocial Factors; Estonia; Male; Geographic Locations; Outcomes (Health Care); HIV Infections -- Risk Factors; Sexually Transmitted Diseases -- Risk Factors; Depression -- Diagnosis; Substance Abuse; Suicidal Ideation; Risk Taking Behavior; Europe, Eastern; Internet; Anxiety -- Diagnosis; Surveys; Research Subject Recruitment; Odds Ratio; Confidence Intervals; Adult; Urban Areas; Rural Areas; Education; Funding Source

Sexual Orientation and Suicide Attempt Disparities Among US Adolescents: 2009-2017. - Raifman, Julia; Charlton, Brittany M.; Arrington-Sanders, Renata; Chan, Philip A.; Rusley, Jack; Mayer, Kenneth H.; Stein, Michael D.; Austin, S. Bryn; McConnell, Margaret (Pediatrics, 2020)
BACKGROUND: Sexual minority adolescents face mental health disparities relative to heterosexual adolescents. We evaluated temporal changes in US adolescent reported sexual orientation and suicide attempts by sexual orientation. METHODS: We used Youth Risk Behavioral Surveillance data from 6 states that collected data on sexual orientation identity and 4 states that collected data on sex of sexual contacts continuously between 2009 and 2017. We estimated odds ratios using logistic regression models to evaluate changes in reported sexual orientation identity, sex of consensual sexual contacts, and suicide attempts over time and calculated marginal effects (MEs). RESULTS: The proportion of adolescents reporting minority sexual orientation identity nearly doubled, from 7.3% in 2009 to 14.3% in 2017 (ME: 0.8 percentage points [pp] per year; 95% confidence interval [CI]: 0.6 to 0.9 pp). The proportion of adolescents reporting any same-sex sexual contact increased by 70%, from 7.7% in 2009 to 13.1% in 2017 (ME: 0.6 pp per year; 95% CI: 0.4 to 0.8 pp). Although suicide attempts declined among students identifying as sexual minorities (ME: -0.8 pp per year; 95% CI: -1.4 to -0.2 pp), these students remained >3 times more likely to attempt suicide relative to heterosexual students in 2017. Sexual minority adolescents accounted for an increasing proportion of all adolescent suicide attempts. CONCLUSIONS: The proportion of adolescents reporting sexual minority identity and same-sex sexual contacts increased between 2009 and 2017. Disparities in suicide attempts persist. Developing and implementing approaches to reducing sexual minority youth suicide is critically important.
Keywords: Sexuality -- In Adolescence; Minority Groups; Suicide, Attempted -- Trends -- United States; Health Status Disparities; Mental Disorders; Human; Adolescence; United States; Odds Ratio; Logistic Regression; Sexual Identity; Sex Factors; Descriptive Statistics; Confidence Intervals

Perceptions of LGBQ+ youth and experts of suicide prevention video messages targeting LGBQ+ youth: qualitative study. - Kirchner, Stefanie; Till, Benedikt; Plöderl, Martin; Niederkrotenthaler, Thomas (BMC Public Health, 2020)
Background: Young lesbian, gay, bisexual, transgender, queer as well as other sexual/gender minorities (LGBTQ+) persons have higher rates of suicidal ideation and behavior compared to their non-LGBTQ+ peers, particularly during their coming out. The "It Gets Better" project is a multi-national media campaign that aims to reduce suicide among LGBTQ+ adolescents by providing personal narratives of hope delivered by mainly adult LGBTQ+ persons. There is only little knowledge so far on how young LGBTQ+ people as well as experts in suicide prevention and counseling perceive these videos, and how to potentially improve the videos based on their perceptions.Methods: A total of n = 19 LGBQ+ adolescents and young adults and n = 9 experts participated in focus groups to discuss perceptions of a selection of "It Gets Better" videos. Eight focus groups were conducted to assess perceptions on the process of watching the videos, possible effects on young LGBQ+ viewers in general, and suicidal LGBQ+ youth in particular, as well as factors that were relevant to their perceptions.Results: Messages were found to be helpful in terms of promoting hope. LGBQ+ youth identified several key strategies to increase identification with messages, which they considered crucial for their effectiveness. Criticism emerged from a perceived lack of diversity in terms of portrayed sexual identities, and some shallowness in the portrayal of suicidal ideation and how things can get better. The experts' perceptions of the videos were largely consistent with LGBQ+ youth, highlighting a positive potential of videos to support coming out and identity building processes.Conclusions: Young people and experts view the videos as helpful and relevant, but identified several strategies to better tailor them to the needs of LGBTQ+ adolescents, including suicidal peers. The insights gained are useful to the increasing number of suicide prevention projects using personal narratives of coping delivered via media to help prevent suicide.
Keywords: Homosexuality; Suicidal Ideation; Health Education; Suicide -- Psychosocial Factors; Adaptation, Psychological; Qualitative Studies; Female; Gender Identity; Transsexualism; Male; Young Adult; Sexuality; Peer Group; Perception; Adolescence; Lesbians; Focus Groups; Communications Media; Adult; Bisexuality; Scales; Arthritis Impact Measurement Scales; Personal Resource Questionnaire; Questionnaires

Transgender Adolescents' Uses of Social Media for Social Support. - Selkie, Ellen; Adkins, Victoria; Masters, Ellie; Bajpai, Anita; Shumer, Daniel (Journal of Adolescent Health, 2020)
Transgender adolescents are at higher risk for negative mental health outcomes, such as depression, anxiety, and suicidality, compared with cisgender adolescents. Social media may be an effective venue for addressing these health disparities because most adolescents have access to online information and socialization. This study used qualitative inquiry to explore transgender adolescents' uses of social media for social support. Transgender adolescents between the ages of 15 and 18 years with a social media profile were recruited from a pediatric gender clinic in the Midwestern U.S. A 30- to 60-minute semistructured interview assessed ways participants used social media to access transgender-related support. Thematic analysis was used to develop categories and code the transcripts. Coding discrepancies were resolved by two researchers following initial coding. Results represent data from 25 interviews comprising 13 transmasculine, 11 transfeminine, and one nonbinary participant(s), with 68% of the sample identifying as white, non-Hispanic. Categories emerged regarding forms of support participants received from transgender-related online communities including emotional support through peers and role models, appraisal support for validating their experiences, and informational support for navigating health decisions and educating family and friends. Participants also referenced negative experiences, including harassment and exclusionary behavior online. Social media platforms represent hubs of community for transgender adolescents. These communities provide emotional, appraisal, and informational support that transgender youth may not otherwise be able to access. Future research should use the affordances of social media to identify approaches to addressing health disparities and improving the well-being of transgender adolescents.
Keywords: Transgender Persons -- Psychosocial Factors; Social Media -- Utilization -- In Adolescence; Support, Psychosocial; Healthcare Disparities; Human; Adolescence; Midwestern United States; Thematic Analysis; Internet; Access to Information; Semi-Structured Interview; Data Analysis Software; Emotions; Interpersonal Relations; Gender Bias; Qualitative Studies; Funding Source

Continuing Education Credits and Questions: CE Questions for 14(1). (Journal of LGBT Issues in Counseling, 2020)
A Continuing Education Unit (CEU) from the National Board for Certified Counselors on the topics including Moderating Role of Community Resiliency on Suicide Risk in the Transgender Population; and Clinical Issues among Chinese Gay Males in Counseling is presented.
Keywords: Suicide -- Risk Factors; Counseling; Life Experiences; Gender Dysphoria; Femininity; Education, Continuing (Credit); Gay Men; Transgender Persons; Sexual and Gender Minorities

Predictors of Suicidal Ideation and Attempts among LGBTQ Adolescents: The Roles of Help-seeking Beliefs, Peer Victimization, Depressive Symptoms, and Drug Use. - Hatchel, Tyler; Ingram, Katherine M.; Mintz, Sasha; Hartley, Chelsey; Valido, Alberto; Espelage, Dorothy L.; Wyman, Peter (Journal of Child & Family Studies, 2019)
Objectives: Suicide is a leading causes of death for adolescents, and is a developmental period with the highest rates of suicide attempts. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are a high-risk population for suicidal ideations and behaviors when compared with their non-LGBTQ counterparts. However, a dearth of research exists on the protective factors for suicidal ideation and attempts specifically within the LGBTQ population. The current study proposes a model in which peer victimization, drug use, depressive symptoms, and help-seeking beliefs predict suicidal ideation and attempts among a statewide sample of LGBTQ adolescents. Methods: Among 4867 high school students in 20 schools, 713 self-identified as LGBTQ and had higher rates of attempts and ideation than their non-LBGTQ peers. Two logistic regression analyses were used to predict suicidal ideation and attempts among the 713 LGBTQ students (M = age 15 years). Results: Results indicated that intentions to use drugs, peer victimization, and elevated depressive symptoms predicted both suicidal ideation and attempts. Additionally, help-seeking beliefs predicted suicidal attempts but not ideation, while the interaction of help-seeking beliefs and depressive symptoms significantly predicted suicidal ideation. Conclusions: These findings underscore the importance of increasing access to effective treatment services for depression and promoting safe and accepting school and community cultures for LGBTQ youth in particular.
Keywords: Suicidal Ideation -- Risk Factors -- In Adolescence; LGBTQ+ Persons -- In Adolescence; Bullying; Depression -- Symptoms; Substance Abuse; Help Seeking Behavior; Human; Adolescence; Students, High School; Logistic Regression; Descriptive Statistics; Aggression

Characteristics of offending and non-offending CSA helpline users explored. - Wilpert, Julia; Janssen, Ellen (Journal of Forensic Practice, 2020)
Purpose: This study aims to exploratively compare several characteristics of 330 offending and non-offending Dutch subjects, seeking advice/help from child sexual abuse (CSA) prevention helpline Stop it Now!-The Netherlands (SiN-NL). Design/methodology/approach: With a retrospective cross-sectional design, SiN-NL contact logs between March 2012 and June 2016 were investigated. Findings: Results revealed a few interesting differences and similarities. Contrary to earlier findings, attraction to minors and especially boys did not distinguish offenders and non-offenders. However, intimate partner status, suicidal tendencies and expectation of the helpline differed significantly between the study samples. Also, the relevance of several self-reported CSA promoting and impeding factors varied between groups. The non-offender group more often indicated fear of consequences and avoidance of risk situations to be constraining factors, whilst the offender group more frequently suggested benefiting from professional help and social support. Practical implications: The results of this study might inform different forms of prevention and treatment programs aimed at similar help-seeking individuals. Because of their perceived CSA promoting potential by help seekers, access to children and substance abuse are important topics to address by operators and taken into account when assessing offending risk. In contrast to earlier findings, sexual orientation did not differentiate offenders from non-offenders and might play a less significant role. Higher rates of suicidal tendencies and need for help and therapy could imply that, compared to non-offenders, offenders require a more cautious approach and additional care. Originality/value: To our knowledge this is the first study to investigate self-reports of offending and non-offending subjects, seeking advice/help from a CSA prevention helpline.
Keywords: Child Abuse, Sexual -- Prevention and Control -- Netherlands; Help Seeking Behavior; Sex Offenders -- Psychosocial Factors; Telephone Information Services; Netherlands; Human; Retrospective Design; Cross Sectional Studies; Paraphilias -- Psychosocial Factors; Support, Psychosocial; Substance Abuse; Sexuality; Self Report

It is Time to Start Counting Kids Who are LGBTQ in Child Welfare (Second Issue). - Feild, Tracey (Child Welfare, 2018)
An introduction is presented in which the author discusses various reports within the special issue of the journal on topics including child welfare and foster care services for LGBTQ children and youth, the experiences of homeless LGBTQ children, and sexual orientation.
Keywords: Child Welfare; LGBTQ+ Persons -- Psychosocial Factors; Foster Home Care -- In Infancy and Childhood; Foster Home Care -- In Adolescence; Race Factors; Ethnic Groups; Gender Identity; Sexuality; Religion and Religions; Psychological Well-Being; Discrimination; Sexual Harassment; Child Abuse; Public Policy; United States Department of Health and Human Services; Homelessness; Support, Psychosocial; Mental Disorders; Trauma; Stigma; Social Isolation; Institutionalization; Policy Making; Government Agencies; Cultural Competence; Suicide, Attempted; Socioeconomic Factors; Child; Adolescence

Gay-Straight Alliances are Associated with Lower Levels of School-Based Victimization of LGBTQ+ Youth: A Systematic Review and Meta-analysis. - Marx, Robert; Kettrey, Heather (Journal of Youth & Adolescence, 2016)
Gay-straight alliances (GSAs) are school-based organizations for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth and their allies that often attempt to improve school climate for sexual and gender minority youth. This meta-analysis evaluates the association between school GSA presence and youth's self-reports of school-based victimization by quantitatively synthesizing 15 primary studies with 62,923 participants. Findings indicate GSA presence is associated with significantly lower levels of youth's self-reports of homophobic victimization, fear for safety, and hearing homophobic remarks, and these results are robust, controlling for a variety of study-level factors. The findings of this meta-analysis provide evidence to support GSAs as a means of protecting LGTBQ+ youth from school-based victimization.
Keywords: LGBTQ+ Persons -- Organizations -- United States; LGBTQ+ Persons -- Psychosocial Factors; Heterosexuals -- Psychosocial Factors; Bullying -- Trends -- United States; School Violence -- Trends -- United States; Attitude to Sexuality -- In Adolescence; Meta Analysis; Systematic Review; Human; Self Report; United States; ERIC Database; Psycinfo; PubMed; Data Collection Methods; Descriptive Statistics; Data Analysis Software; P-Value; Confidence Intervals; Odds Ratio; Regression; Fear; Safety; Female; Male; Schools -- United States; Adolescence

Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis. - Hottes, Travis Salway; Bogaert, Laura; Rhodes, Anne E.; Brennan, David J.; Gesink, Dionne (American Journal of Public Health, 2016)
Background. Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay, and bisexual (LGB) persons (sexual minorities), compared with heterosexual groups, but these were restricted to general population studies, thereby excluding individuals sampled through LGB community venues. Each sampling strategy, however, has particular methodological strengths and limitations. For instance, general population probability studies have defined sampling frames but are prone to information bias associated with underreporting of LGB identities. By contrast, LGB community surveys may support disclosure of sexuality but overrepresent individuals with strong LGB community attachment. Objectives. To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community-based samples. Search methods. In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities. Selection criteria. We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand. Data collection and analysis. Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using t2. Main results. We pooled 30 cross-sectional studies, including 21 201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95%CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability. Author's conclusions. Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide. Public health implications. Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Suicide, Attempted -- Epidemiology; Health Status Disparities; Human; Systematic Review; Meta Analysis; Medline; Embase; Psycinfo; CINAHL Database; Female; Male; Regression; Confidence Intervals; Post Hoc Analysis; Descriptive Statistics; Data Analysis Software; Adult; Prevalence

Co-occurring risk factors among U.S. high school students at risk for suicidal thoughts and behaviors. - Flores, Jean P.; Swartz, Karen L.; Stuart, Elizabeth A.; Wilcox, Holly C. (Journal of Affective Disorders, 2020)
Background: Suicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent.  The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings.Method: Data are from the CDC's 2015 and 2017 National Youth Risk Behavior Survey of US high school students. Among students reporting depression symptoms, latent class analysis is used to identify subtypes at risk for STBs based on personal characteristics, risk behaviors and environments.Results: Two distinct subtypes of youth were found to be at high risk for STBs: The first, larger subtype (22%) is predominately females in early high school, many of whom identify as bisexual, experienced past-year bullying, and are likely to have experienced sexual victimization.  These students have low levels of externalizing risk behaviors making them difficult to detect.  The second high-risk subtype (7%) is characterized by students with significant social integration challenges, with extremely high levels of substance abuse, fighting, physical and sexual victimization and poor academic performance.  Many of these students have low English fluency, and identify as sexual minority.Limitations: Due to attrition or language barriers, experiences of some students at high-risk for STBs may not have been captured by this survey.Conclusion: Universal screening in clinical settings, and universally focused suicide prevention programs in school-based settings are needed and should be introduced early on. Interventions should be tailored to reach high-risk students with language, cultural and social integration challenges.
Keywords: Adolescent Behavior; United States; Risk Factors; Students; Female; Risk Taking Behavior; Schools; Suicidal Ideation; Adolescence

Self-reported history of concussions is associated with risk factors for suicide completion among high school students. - Mantey, Dale S.; Omega-Njemnobi, Onyinye; Barroso, Cristina S.; Kelder, Steven H. (Journal of Affective Disorders, 2020)
Background: Suicide is the third leading cause of death among adolescents. While research has found concussions to be a risk factor for suicide in adults, this relationship is not well studied in nationally representative samples of youth. This study examines the relationship between self-reported history of sports-related concussion and five risk factors for suicide completion.Methods: Data were obtained from the 2017 Youth Risk Behavior Surveillance Survey (n=13,353). Multivariate logistic regression models assessed the relationship between self-reported, sports-related concussion and five risk factors for suicide completion. Analyses controlled for sex, race/ethnicity, grade, bullying victimization, and sexual orientation. Subsample analyses were conducted stratified by sex. Interaction models examined biological sex as a possible effect modifier.Results: Overall, 15.0% of high school students reported a sports-related concussion in the past 12-months. Self-reported, sports-related concussion was significantly associated with greater odds of feeling sad/hopeless (Adj OR: 1.20; 95% CI:1.02-1.42), suicidal ideations (Adj OR: 1.25; 95% CI:1.02-1.55), suicide attempt (Adj OR: 1.60; 95% CI:1.31-1.96), and suicide attempt treated by a doctor/nurse (Adj OR: 2.35; 95% CI:1.68-3.29), adjusting for covariates. Stratified analyses demonstrated differences by sex, however, no direct evidence of effect modification was observed in interaction models.Limitations: Data are cross-sectional, prohibiting causal inferences. Measures were assessed via self-report. No pre-concussion measures of mental health.Conclusion: Self-reported sports-related concussion was associated with risk factors for suicide completion. No direct evidence of effect modification was observed but stratified analyses suggest biological sex may impact the observed relationship.
Keywords: Suicide; Brain Concussion -- Epidemiology; Brain Concussion -- Complications; Students -- Psychosocial Factors; Suicide, Attempted; Self Concept; Female; Male; Adolescence; Mental Health; Risk Factors; Crime Victims; Suicidal Ideation; Risk Taking Behavior; Sexuality; Self Report; Bullying; Cross Sectional Studies; Impact of Events Scale; Questionnaires

Reducing the Treatment Gap for LGBT Mental Health Needs: the Potential of Telepsychiatry. - Whaibeh, Emile; Mahmoud, Hossam; Vogt, Emily L. (Journal of Behavioral Health Services & Research, 2020)
The high prevalence of psychiatric conditions and the concomitant increase in need for mental illness have posed a challenge across the USA. Patients continue to encounter many barriers to accessing care with only 43% receiving treatment. This situation is even more challenging for LGBT individuals, who experience higher rates of some mental health conditions, with an increased risk of suicidality, due to stressors such as discrimination and trauma. Simultaneously, LGBT individuals face specific barriers at the individual level, clinician level, and systemic level. Telepsychiatry has emerged as an approach that can help overcome some of the challenges faced by LGBT individuals when it comes to healthcare access. This paper examines the ways in which telepsychiatry can overcome the aforementioned barriers and provides recommendations to enhance the quality of telepsychiatry services for LGBT patients. Recommendations include improving medical education, enhancing health-force training on cultural competency, and expanding culturally affirming telehealth programs.

Testing Basic Assumptions of the Interpersonal Needs Questionnaire-15 in a Sample of Clinically Depressed and Suicidal Youth. - Hunt, Quintin A.; Weiler, Lindsey M.; McGuire, Jenifer; Mendenhall, Tai; Kobak, Roger; Diamond, Guy S. (Suicide & Life-Threatening Behavior, 2020)
Objective: Suicide is a leading cause of death in adolescence. The mechanisms of adolescent suicidality, however, are not fully understood. Although the Interpersonal-Psychological Theory of Suicide, as assessed by the Interpersonal Needs Questionnaire-15 (INQ), may be a promising framework, systematic study of its utility during adolescence is lacking.Method: To this end, we utilized factor analyses and hierarchical regression analyses to test the factor structure, correlates, and predictive validity of the INQ in a sample of clinically depressed and suicidal adolescents (N = 120, aged 12-18). The sample was mostly female (81.9%), ethnically diverse (68.2% non-White) and with nearly a third identifying as a sexual minority (31.8%).Results: Contrary to studies including adult samples in which a two-factor solution is identified, results within this sample indicated three factors: perceived burdensomeness, thwarted belongingness, and perceived isolation. Perceived burdensomeness and the interaction between perceived burdensomeness and perceived isolation predicted suicide ideation above and beyond depression, but thwarted belongingness and perceived isolation did not.Conclusion: Perceived burdensomeness appears to play a role in adolescent suicidality and may be a point of intervention, yet the notable deviation from previous findings and the relative weakness of two of the factors warrant further study.