RESEARCH AND PRACTICE. Suicide Ideation and Bullying Among US Adolescents: Examining the Intersections of Sexual Orientation, Gender, and Race/Ethnicity. - Mueller, Anna S.; James, Wesley; Abrutyn, Seth; Levin, Martin L. (American Journal of Public Health, 2015)
Objectives. We examined how race/ethnicity, gender, and sexual orientation shape adolescents' likelihood of being bullied and vulnerability to suicide ideation. Methods. We analyzed pooled data from the 2009 and 2011 Youth Risk Behavior Surveys (n = 75 344) to assess race/ethnicity, gender, and sexual orientation variation in being bullied and suicide ideation. Results. White and Hispanic gay and bisexual males, White lesbian and bisexual females, and Hispanic bisexual females were more likely to be bullied than were White heterosexual adolescents. Black lesbian, gay, and bisexual youths' vulnerability to being bullied was not significantly different from that of White heterosexual youths. Black and Hispanic heterosexual youths were less likely to be bullied than were White heterosexual youths. Despite differences in the likelihood of being bullied, sexual minority youths were more likely to report suicide ideation, regardless of their race/ethnicity, their gender, or whether they have been bullied. Conclusions. Future research should examine how adolescents' intersecting identities shape their experience of victimization and suicidality. School personnel should develop antibullying and antihomophobia policies in response to the disproportionate risk of being bullied and reporting suicidality among sexual minority youths.
Keywords: Suicidal Ideation -- In Adolescence; Bullying; Self Concept; Adolescence; Human; Male; Female; Retrospective Design; Record Review; School Policies; Surveys; Risk Assessment; Logistic Regression; Data Analysis Software; Odds Ratio; United States

Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results. - Achille, Christal; Taggart, Tenille; Eaton, Nicholas R.; Osipoff, Jennifer; Tafuri, Kimberly; Lane, Andrew; Wilson, Thomas A. (International Journal of Pediatric Endocrinology, 2020)
Background/aims: Transgender youths experience high rates of depression and suicidal ideation compared to cisgender peers. Previous studies indicate that endocrine and/or surgical interventions are associated with improvements to mental health in adult transgender individuals. We examined the associations of endocrine intervention (puberty suppression and/or cross sex hormone therapy) with depression and quality of life scores over time in transgender youths. Methods: At approximately 6-month intervals, participants completed depression and quality of life questionnaires while participating in endocrine intervention. Multiple linear regression and residualized change scores were used to compare outcomes. Results: Between 2013 and 2018, 50 participants (mean age 16.2 + 2.2 yr) who were naïve to endocrine intervention completed 3 waves of questionnaires. Mean depression scores and suicidal ideation decreased over time while mean quality of life scores improved over time. When controlling for psychiatric medications and engagement in counseling, regression analysis suggested improvement with endocrine intervention. This reached significance in male-to-female participants. Conclusion: Endocrine intervention may improve mental health in transgender youths in the US. This effect was observed in both male-to-female and female-to-male youths, but appears stronger in the former.

Norms and normalisation: understanding lesbian, gay, bisexual, transgender and queer youth, suicidality and help-seeking. - McDermott, Elizabeth; Hughes, Elizabeth; Rawlings, Victoria (Culture, Health & Sexuality, 2018)
Young people who identify as lesbian, gay, bisexual, and queer transgender have elevated rates of suicidality. Despite the increased risk, there is a paucity of research on lesbian, gay, bisexual, transgender and queer help-seeking and suicidality. We report on a UK sequential exploratory, two-stage, mixed-method study. Stage 1 involved 29 online and face-to-face semi-structured interviews with lesbian, gay, bisexual, transgender and queer youth aged 16–25 years old. Stage 2 utilised an online youth questionnaire employing a community-based sampling strategy (n= 789). Results indicated that participants only asked for help when they reached a crisis point because they were normalising their emotional distress. Those who self-harmed, had attempted or planned suicide or had experience of abuse related to their sexuality or gender were most likely to seek help. Results suggested that the reluctance to seek help was due to three interconnecting factors: negotiating sexuality, gender, mental health and age norms; being unable to talk about emotions; and coping and self-reliance. Policies aiming to prevent lesbian, gay, bisexual, transgender and queer youth suicide recognise that norms and normalising processes connected to sexual orientation and gender identity are additional difficulties that youth have accessing mental health support.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- South Africa; Suicide -- Prevention and Control -- In Adolescence; Help Seeking Behavior; Human; Adolescence; Adult; South Africa; Multimethod Studies; Social Norms; Semi-Structured Interview; Sexuality; Support, Psychosocial; Attitude to Sexuality

Challenges and Opportunities for Modernizing the National Violent Death Reporting System. - Mays, Vickie M.; Cochran, Susan D. (American Journal of Public Health, 2019)
The article reponsds to an issue article on the coding of self-identified sexual orientation and gender identity (SOGI) in the U.S. National Violent Death Reporting System (NVDRS). Topics include attempts by the U.S. National Center for Health Statistics to modernize the U.S. National Vital Statistics System, the collection of data from electronic health records (EHRs), and the significance of interoperability between various data sources.
Keywords: Violence -- Mortality; Sexuality; Gender Identity; Incident Reports; Serial Publications; Public Health; Police -- Psychosocial Factors; Coroners and Medical Examiners -- Psychosocial Factors; Social Media; Suicide, Attempted; Depression; Case Management; Privacy and Confidentiality; Colombia; Electronic Health Records; Violence -- Risk Factors; Risk Assessment; Centers for Disease Control and Prevention (U.S.)

Interpersonal Psychotherapy for Gender Dysphoria in a Transgender Woman. - Barbisan, Guilherme Kirsten; Moura, Daniel Heidemman; Lobato, Maria Inês Rodrigues; da Rocha, Neusa Sica (Archives of Sexual Behavior, 2020)
We present a case of a 32-year-old natal male seeking medical follow-up care, due to gender dysphoria (GD) along with other complaints (depressive symptoms, anxiety, and suicidal ideation). The attending team chose interpersonal psychotherapy (IPT), with a focus on role transition in order to help her. The patient presented a favorable trajectory throughout treatment and demonstrated personal growth one year after treatment. To our knowledge, little was found in the literature on the use of IPT in the treatment of those with GD; we also did not find any other publication or case report using IPT exclusively to treat the problems accompanying role transition. Psychotherapy was not intended to change the gender identity of this individual. However, further studies will be required to explore possible benefits of IPT for GD treatment.

Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation. - Liu, Richard T.; Bettis, Alexandra H.; Burke, Taylor A. (Psychological Medicine, 2020)
Background: Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear. Methods: We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO. Results: A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons. Conclusions: Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk.
Keywords: Suicidal Ideation -- Psychosocial Factors; Suicidal Ideation -- Epidemiology; Mental Disorders; Comorbidity; Phenomenology; Human; Systematic Review; Meta Analysis; Medline; Psycinfo; Descriptive Statistics; Prevalence; Comparative Studies

Health Disparities Among Transgender Adults in South Korea. - Lee, Hyemin; Operario, Don; van den Berg, Jacob J.; Yi, Horim; Choo, Sungsub; Kim, Seung-Sup (Asia-Pacific Journal of Public Health, 2020)
This study aims to identify health disparities among transgender adults in South Korea (hereafter Korea), where they widely experience social stigma. We assessed prevalence of nine health indicators using a nationwide cross-sectional survey of 255 Korean transgender adults in 2017. Standardized prevalence ratios of these indicators were estimated using four nationally representative surveys in Korea that included the same health measures. Overall, transgender adults had a significantly higher risk of adverse health outcomes than the general population in Korea. Specifically, disparities in mental health outcomes between transgender adults and the general population were statistically significant. The prevalence of depressive symptoms was 6.44 and 9.71 times higher among transgender adults than women and men in the general population, respectively. For suicidal ideation, transgender adults reported 6.49 and 18.83 times greater risk than women and men in the general population, respectively. Our findings indicate that Korean transgender adults are at a higher risk of negative health outcomes than the general population.
Keywords: Transgender Persons -- In Adulthood -- South Korea; Health Status Disparities; Health Status Indicators -- Epidemiology -- South Korea; Human; Descriptive Statistics; South Korea; Adult; Cross Sectional Studies; Surveys; Comparative Studies; Depression -- Epidemiology -- South Korea; Sex Factors; Suicidal Ideation -- Risk Factors; Stigma; Young Adult; Middle Age; Mental Health; Substance Use Disorders; Pain; Self Report

Once‐daily raltegravir with tenofovir disoproxil/emtricitabine as HIV post‐exposure prophylaxis following sexual exposure. - Quah, SP; McIntyre, M; Wood, A; Mc Mullan, K; Rafferty, Paul (HIV Medicine, 2021)
In the article, the authors discuss their study on the effectiveness of once-daily raltegravir with tenofovir disoproxil/emtricitabine as post-exposure prophylaxis against human immunodeficiency virus (HIV) following sexual exposure. Topics include the British national guidance for HIV post-exposure prophylaxis after sexual exposure (PEPSE), and the common side effects of the drugs like nausea, diarrhoea, and poor sleep.
Keywords: Raltegravir -- Administration and Dosage; Tenofovir -- Administration and Dosage; Emtricitabine Tenofovir -- Administration and Dosage; HIV Infections -- Prevention and Control; Postexposure Follow-Up; Sexual Intercourse; Drug Therapy, Combination; Human; Medication Compliance; Retrospective Design; Male; Female; Descriptive Statistics; Adolescence; Adult; Middle Age; Bisexuals; Heterosexuals; Men Who Have Sex With Men; Time Factors; Drug Tolerance; Raltegravir -- Adverse Effects; Tenofovir -- Adverse Effects; Emtricitabine Tenofovir -- Adverse Effects; Prospective Studies; Nausea; Diarrhea; Sleep Disorders; Suicidal Ideation; Abdominal Pain; Sweating; Affective Disorders; Liver Function Tests; Creatinine -- Blood; Sexual Partners

Adolescent Homelessness and Associated Features: Prevalence and Risk Across Eight States. - Cutuli, J. J.; Treglia, Dan; Herbers, Janette E. (Child Psychiatry & Human Development, 2020)
This study utilizes data from the Youth Risk Behavior Survey to estimate the prevalence of adolescent homelessness and relations to five indicators of poor functioning among students attending public high school in eight states. About 3.27% of students experienced homelessness, and nearly 7% of teens who identified as lesbian, gay, or bisexual (LGB) experienced homelessness. Homelessness was related to higher rates of sexual/dating violence as well as having been bullied and feeling unsafe at school. Homelessness and LGB identification predicted higher rates of more-severe problems with alcohol, hard drug use, poor grades, suicidality, and risky sexual behavior, controlling for other factors. There was no interaction effect between homelessness and LGB status, suggesting that these risks are additive.
Keywords: Runaways; Substance Use Disorders -- Epidemiology; Homeless Persons -- Statistics and Numerical Data; Prevalence; Adolescence; Students -- Statistics and Numerical Data; Female; United States; Male; Schools -- Statistics and Numerical Data; Bullying; Risk Taking Behavior

Life satisfaction and mental health among transgender students in Norway. - Anderssen, Norman; Sivertsen, Børge; Lønning, Kari Jussie; Malterud, Kirsti (BMC Public Health, 2020)
Background: Social attitudes to transgender persons and other gender minorities vary around the world, and in many cultures, prejudices and social stigma are common. Consequently, transgender persons face challenges related to discrimination and negative attitudes among the public. The purpose of this study was to compare life satisfaction, loneliness, mental health, and suicidal behavior among transgender students with cisgender students' experiences in a nationwide sample of Norwegian students pursuing higher education.Methods: In total,50,054 full-time Norwegian students completed an online questionnaire (response rate 30.8%), of whom 15,399 were cisgender males, 34,437 cisgender females, 28 individuals who reported being binary transgender (12 transwomen and 16 transmen), and 69 individuals non-binary transgender persons. The measures included questions concerning gender identity, life satisfaction (Satisfaction With Life Scale), loneliness (The Three-Item Loneliness Scale), mental health problems (Hopkins Symptoms Check List), mental disorders, and suicidal ideation, suicidal behavior, and self-harm. Chi-square tests, Independent-Samples Kruskal-Wallis tests, and logistic regression analyses were used to examine differences between gender identities.Results: Transgender students reported significantly more psychosocial burdens on all measures. There were no significant differences in any of the measures between the binary and non-binary transgender students.Conclusion: The findings call for increased awareness about welfare and health for transgender students in Norway. Higher education institutions need to consider measures at various levels to establish a learning environment that is more inclusive for gender minorities.
Keywords: Students -- Psychosocial Factors; Mental Disorders -- Epidemiology; Personal Satisfaction; Young Adult; Female; Colleges and Universities; Adult; Norway; Students -- Statistics and Numerical Data; Loneliness; Male; Suicidal Ideation; Scales

Suicidality Among Gay and Bisexual Men in Taiwan: Its Relationships with Sexuality and Gender Role Characteristics, Homophobic Bullying Victimization, and Social Support. - Wang, Peng‐Wei; Ko, Nai‐Ying; Hsiao, Ray C.; Chen, Mu‐Hong; Lin, Huang‐Chi; Yen, Cheng‐Fang; Wang, Peng-Wei; Ko, Nai-Ying; Chen, Mu-Hong; Lin, Huang-Chi; Yen, Cheng-Fang (Suicide & Life-Threatening Behavior, 2019)
This study aimed to examine the associations of suicidality in emerging adulthood with time of coming out, gender role nonconformity, sexual orientation, traditional and cyber homophobic bullying victimization, and family and peer support during childhood in gay and bisexual men in Taiwan. The frequency of "experiencing suicide ideation" and "attempting suicide" in the past year among 500 gay or bisexual men was examined. The participants' time of coming out, level of subjective masculinity, sexual orientation, experiences of traditional and cyber homophobic bullying victimization, and levels of family and peer support during childhood were also evaluated. In total, 31% (n = 155) of participants reported experiencing suicide ideation (n = 82) or attempting suicide (n = 73). Early coming out, traditional homophobic bullying victimization, and low family support during childhood increased the risk of suicidality in emerging adulthood; by contrast, family support did not moderate the association of early coming out or traditional bullying victimization with current suicidality. A high proportion of participants reported experiencing suicide ideation and attempt in emerging adulthood. Hence, effective suicide prevention is required for gay and bisexual men. Suicide prevention programs should consider time of coming out, traditional homophobic bullying victimization, and level of family support.
Keywords: Suicidal Ideation; Suicide, Attempted -- Psychosocial Factors; Suicide -- Psychosocial Factors; Crime Victims -- Psychosocial Factors; Support, Psychosocial; Homophobia -- Psychosocial Factors; Human; Young Adult; Gender Identity; Male; Bisexuality; Bullying -- Psychosocial Factors; Taiwan; Homosexuality; Adult; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Social Readjustment Rating Scale

HEALTH EDUCATION IN SCHOOLS TO DEAL WITH HOMOPHOBIA. - Guimarães Mongiovi, Vita; Silva de Lima, Ana Wládia; Firmino, Arielle Cecile da Silva; Majoi Fabrício de Melo, Constance; Cavalcante de Araújo, Ednaldo; Pinheiro Ramos, Vânia (Journal of Nursing UFPE / Revista de Enfermagem UFPE, 2018)
Objective: to report the experience of an educative intervention to confront homophobia conducted with adolescents in a school in middle school. Method: a descriptive study, the type experience reports on an educational intervention in the form of workshop for confronting homophobia built with adolescents from a research-action at a school reference in middle school. The participants evaluated the intervention by means of a questionnaire. Results: the workshop is composed of 5 meetings that addressed since contents about gender, sexual diversity, homophobia in schools, homophobic violence and human rights. Conclusion: the workshop constituted itself as a space for participation and dialog for the confronting homophobia in schools. This intersectorial activity obtained its relevance for health promotion and integral formation and a citizen of adolescents in relation to confrontation of social vulnerability and violence, considering the group as a project of social awareness.
Keywords: School Health Education -- In Adolescence; Homophobia -- Prevention and Control -- In Adolescence; Students, Middle School; Descriptive Research; Human; Seminars and Workshops; Action Research; Schools, Middle; Questionnaires; Human Rights; School Violence; Health Promotion; Brazil; Adolescence; Male; Female; Gender Role; Homosexuality; Funding Source

Patterns of Healthcare Discrimination Among Transgender Help-Seekers. - Romanelli, Meghan; Lindsey, Michael A. (American Journal of Preventive Medicine, 2020)
Introduction: Affirmative health care is imperative to address health and mental health disparities faced by transgender communities. Yet, transgender help-seekers experience discrimination that precludes their access to and participation in care. This study uses latent class analysis to examine patterns of healthcare discrimination among transgender help-seekers. Predictors of class membership are investigated to identify subpopulations at highest risk for healthcare discrimination.Methods: Data were obtained from the 2015 U.S. Transgender Survey and analyzed in 2019. Ten healthcare experiences were included as latent class indicators. Latent class analysis and regression were performed in Mplus, version 8 to identify latent subgroups and examine the relationship between respondent characteristics and the latent classes.Results: The final sample included 23,541 respondents. A 3-class model fit best: Class 1 experienced overt discrimination and interfaced with providers with limited trans-competence; Class 2 did not experience healthcare discrimination or report issues related to providers' trans-competence; and Class 3 did not experience discrimination but had providers with low trans-competence. Transmen and respondents who were out as trans to their providers and reported psychological distress, suicidal thoughts, and disabilities were more likely to be members of Class 1 or 3 than Class 2.Conclusions: Experiences of healthcare discrimination are not homogeneous across transgender help-seekers. Predictors of the latent classes indicated that transgender help-seekers holding an additional marginalized identity may be at higher risk for healthcare discrimination or care from providers with limited trans-competence. Targeted engagement and education interventions might improve these transgender help-seekers' access to and connections with care.
Keywords: Healthcare Disparities; United States; Male; Adolescence; Young Adult; Adult; Female; Questionnaires

Using Photovoice to Understand Suicidality Among Gay, Bisexual, and Two-Spirit Men. - Ferlatte, Olivier; Oliffe, John L.; Salway, Travis; Broom, Alex; Bungay, Victoria; Rice, Simon (Archives of Sexual Behavior, 2019)
This study explored the drivers of suicidality from the perspectives of gay, bisexual, and two-spirit men (GB2SM) with a history of suicidality. Twenty-one GB2SM participated in this photovoice study taking photographs to depict and discuss their previous suicidality. Data were collected from in-depth individual interviews in which participants discussed their photographs and in turn offered verbal/narrative accounts of suicidality. Drawing on intersectionality, analyses of the photographs and interview data revealed three interconnected themes. First, adverse childhood events and negative adolescent experiences were described as the root causes of mental health struggles and suicidality. Second, violence and homophobia had disrupted these men's education and employment opportunities and some participants detailed how their lack of capital and challenges for maintaining employment shaped their suicidality. Third, a sociality of stigma and sense of isolation compounded experiences of suicidality. The three themes overlapped and were shaped by multiple intersectional axes including sexuality, class, ethnicity, and mental health status. The findings have implications for services and health professionals working with GB2SM who need to thoughtfully consider life-course trajectories and multiple social axes when assessing and treating GB2SM experiencing suicidality. More so, because these factors relate to social inequities, structural and policy changes warrant targeted attention.
Keywords: Bisexuality; Photography -- Equipment and Supplies; Suicide -- Psychosocial Factors; Sexuality; Narratives; Human; Aged; Male; Adult; Young Adult; Middle Age; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Social Readjustment Rating Scale

Minority Stress Among Transgender Adolescents: The Role of Peer Victimization, School Belonging, and Ethnicity. - Hatchel, Tyler; Valido, Alberto; De Pedro, Kris T.; Huang, Yuanhong; Espelage, Dorothy L. (Journal of Child & Family Studies, 2019)
Transgender youth peer relations is understudied when compared to lesbian, gay, and bisexual youth (LGB). Likewise, transgender youth of color (YOC) are also understudied given the difficulties associated with accessing the sample. This study examines the relations among peer victimization, school belonging, and mental health with an ethnically diverse sample of transgender adolescents (N = 4778). Invariance testing and structural equation modeling were employed to explore these relations as well as the potential moderating role of ethnic minority status. Findings demonstrate that an alarming number of transgender youth were exposed to victimization and that victimization predicted mental health issues like suicidal ideation. Furthermore, analyses showed that peer victimization was associated with diminished school belonging. School belonging was associated with better mental health and appeared to mediate the relation between victimization and mental health issues. Ethnic minority status did not moderate these associations. Implications for research are discussed.
Keywords: Minority Stress; Transgender Persons -- In Adolescence; Peer Group; Victims -- Psychosocial Factors; Ethnic Groups; Minority Groups -- Psychosocial Factors; Mental Health -- Evaluation -- In Adolescence; Schools; Social Identity; Human; Adolescence; Data Analysis, Statistical; Structural Equation Modeling; Suicidal Ideation -- Risk Factors; Gender Nonconformity; Depression -- Symptoms -- In Adolescence; Descriptive Statistics

Psychosocial mediators of perceived stigma and suicidal ideation among transgender women. - Kota, Krishna Kiran; Salazar, Laura F.; Culbreth, Rachel E.; Crosby, Richard A.; Jones, Jamal (BMC Public Health, 2020)
Background: Transgender women (TGW) in the U.S. experience high rates of stigma, depression, and elevated rates of suicide. This study examined correlates of suicidal ideation and estimated the conditional indirect effects of perceived stigma and psychosocial mediators on suicidal ideation.Methods: Using a cross-sectional study design, TGW (N = 92) were recruited through snowball sampling in Atlanta, Georgia. Structured interviews were conducted. Suicidal ideation was assessed by combining two variables that measured suicidal thoughts. Logistic regression models were performed to identify the potential risk and protective factors for suicidal ideation. We examined hypothesized psychosocial factors, including anxiety, depression, psychosocial impact of gender minority status, and substance use behaviors as potential mediators for the relationship between perceived stigma and suicidal ideation. All models were controlled for age, race, education, and homelessness.Results: Suicidal ideation was reported by 33% (N = 30) of the study participants. In multivariable analysis, suicidal ideation was associated with sexual abuse (AOR = 3.17, 95% CI = 1.10-9.30), anxiety (AOR = 1.74, 95% CI = 1.10-2.73), family verbal abuse (AOR = 2.99, 95% CI = 1.10-8.40), stranger verbal abuse (AOR = 3.21, 95% CI = 1.02-10.08), and psychosocial impact of gender minority status (AOR = 3.42, 95% CI = 1.81-6.46). Partner support was found to be the protective factor for suicidal ideation (AOR = 0.34, 95% CI = 0.13-0.90). In the mediation analysis, the psychosocial impact of gender minority status mediated the relationship between perceived stigma and suicidal ideation. The estimated conditional indirect effect was 0.46, (95% CI = 0.12-1.11).Conclusion: Interventions that aim to reduce suicidal behaviors among TGW should address stigma, psychosocial impact of gender minority status, and different forms of violence and abuse.
Keywords: Suicidal Ideation; Stigma; Middle Age; Adolescence; Georgia; Risk Factors; Adult; Cross Sectional Studies; Young Adult; Aged; Male; Female; Impact of Events Scale; Psychosocial Adjustment to Illness Scale; Questionnaires; Scales

Having Our Assumptions Questioned and Our Knowledge Expanded. - Lewis-Hunstiger, Marty (Creative Nursing, 2020)
An introduction is presented in which the editor discusses articles in the issue on the topics including how gender is historical and biopsychosocial construct, a complex mix of biology, psychology, and social world; and portrayal of transgender experience in films, on television, and in theater.
Keywords: Nursing Knowledge; Nursing Care; Minority Groups; Sexual and Gender Minorities; Social Media -- Utilization; Suicide -- Risk Factors; LGBTQ+ Persons; Psychological Distress; Life Experiences

Creative identity (re)Construction, creative community building, and creative resistance: A qualitative analysis of queer ingroup members' tweets after the Orlando Shooting. - Jenkins, Elizabeth M.; Zaher, Zulfia; Tikkanen, Stephanie A.; Ford, Jessica L. (Computers in Human Behavior, 2019)
With the proliferation of social media, a growing body of literature explores the significance of virtual grief, social support, and social capital in the construction of identity and community online. However, there is a dearth of research on how queer members use social media, particularly Twitter, as a tool to claim and re-define their identity—especially when their identity is under threat. The goal of this study is to understand how members of the queer community linguistically responded to the threat to their identity and safety that was caused by the shooting that took place on June 12, 2016, at the Pulse Nightclub in Orlando, Florida. To achieve this goal, we use Social Identity Theory (SIT) as a framework to examine how queer individuals use a creative language strategy to redefine their shared identity when it is threatened. This study used a qualitative iterative analysis of tweets posted by queer individuals to determine how this group identified as ingroup after the Orlando shooting. The study reveals that members of the queer community communicatively responded to the Pulse shooting through social creativity. Specifically, members of the queer community responded to threats through using creative language that fostered stronger ingroup collaborative identities by provoking a) creative identity (re)construction, b) creative community building and c) creative resistance. This study advances SIT by providing additional evidence that the strategy of using creative language by a minority ingroup has the ability to support simultaneously salient and threatened identity. • Creative identity (re)construction. • Creative community building. • Creative resistance.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- Florida; Gender Identity -- Florida; Sexual Identity -- Florida; Twitter -- Utilization -- Florida; Gun Violence -- Florida; Language -- Florida; Creativeness -- Florida; Social Constructionism -- Florida; Safety -- Florida; Human; Qualitative Studies; Florida; Conceptual Framework; Psychological Theory -- Methods; Communication; Collaboration

Lesbian, Gay, Bisexual, and Transgender Hate Crimes and Suicidality Among a Population-Based Sample of Sexual-Minority Adolescents in Boston. - Duncan, Dustin T.; Hatzenbuehler, Mark L. (American Journal of Public Health, 2014)
Keywords: LGBTQ+ Persons -- In Adolescence -- Massachusetts; Crime -- Massachusetts; Suicidal Ideation -- In Adolescence; Minority Groups -- In Adolescence -- Massachusetts; Suicide, Attempted -- In Adolescence; Human; Massachusetts; Female; Male; Adolescence; Residence Characteristics; Social Environment; Questionnaires; Chi Square Test; Descriptive Statistics; Multivariate Analysis; Odds Ratio; Regression; Wilcoxon Rank Sum Test; Mann-Whitney U Test; Data Analysis Software; Intraclass Correlation Coefficient

Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. - Biggs, Michael (Archives of Sexual Behavior, 2020)

The Moderating Role of Community Resiliency on Suicide Risk in the Transgender Population. - Cogan, Chelsea M.; Scholl, James A.; Cole, Hannah E.; Davis, Joanne L. (Journal of LGBT Issues in Counseling, 2020)
Transgender individuals are disproportionately impacted by negative mental and physical health outcomes, including increased suicide risk. The gender minority stress theory proposes a potential pathway to suicide risk through distal and proximal stressors. However, little research has examined how resiliency impacts this relationship. The present study explored the moderating role of resiliency in the relationship between stressors, trauma exposure, and suicide risk. Stressors and trauma exposure were significantly associated with suicide risk, but community resilience was not found to moderate this relationship. The clinical implications of these findings are discussed in depth.
Keywords: Communities; Hardiness; Suicide -- Risk Factors; Transgender Persons; Minority Stress -- Complications; Trauma -- Complications; Human; Sexual and Gender Minorities

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)
This study sought to compare risk factors for suicidal ideation among heterosexual and sexual minority college students from a previously understudied conservative region of the United States. Suicidal ideation, thwarted belongingness (TB), perceived burdensomeness (PB), and capability for suicide were examined. It was found that PB was significantly higher among sexual minorities than heterosexual individuals, TB and capability were not significantly different, and suicidal ideation was not significantly different when controlling for depression but was significant when depression was not a covariate. Additionally, among sexual minorities and heterosexuals, TB and PB were correlated with ideation and that the strength of the relationship between PB and ideation was dependent on how much TB the individual is experiencing. Sexual minorities, when compared to heterosexual individuals, do not have higher TB or capability, but do have higher levels of PB and suicidal ideation.

Coming out in Mainland China: A national survey of LGBTQ students. - Wei, Chongzheng; Liu, Wenli (Journal of LGBT Youth, 2019)
This study examined the school experience and its association with the mental health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students in Mainland China. From 29 Chinese provinces/municipalities, 732 LGBTQ students (Mage = 20.7 ± 2.5) completed an online survey based on the Supporting LGBT Lives study. The findings revealed that most Chinese schools were not inclusive for LGBTQ students. Despite the lack of support of very few LGBTQ-specific school policy, teacher training, and curriculum reported by students, the majority of LGBTQ youth felt safe living and learning at school. As well, most LGBTQ students felt comfortable about their sexual orientation and had come out to someone; however, the majority remained closeted with their siblings, parents, or teachers. Furthermore, Chinese LGBTQ students were at great risk for psychological distresses—about 85% of them felt depressed and around 40% had suicidal thoughts. Having a more inclusive school climate and more school resources, especially a positive LGBTQ role model, were significantly associated with the reduction of LGBTQ students' suicidal ideation. Given these findings, the authors strongly recommend further research, development, and implementation of robust LGBTQ-specific policy, training, and counseling be implemented immediately to improve the lives of Chinese LGBTQ youth.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- China; Student Experiences -- China; Mental Health -- China; Learning Environment -- China; Human; Surveys; China; Lesbians -- Psychosocial Factors; Gay Persons -- Psychosocial Factors; Bisexuals -- Psychosocial Factors; Transgender Persons -- Psychosocial Factors; Young Adult; Adolescence; Support, Psychosocial; School Policies; Curriculum; Sexual Identity; Siblings; Parent-Child Relations; Faculty-Student Relations; Chinese; Stress, Psychological -- Risk Factors; Depression; Suicidal Ideation

Documentation Practices for Transgender Youth Admitted to an Inpatient Psychiatric Unit. - BIEBER, EWA D.; VANDE VOORT, JENNIFER L.; CROARKIN, PAUL E.; VON DREHLE, CASEY T.; SIMON, SUE M.; HOPP, BRIANNA N.; HEIL, HOLLIE M.; ROMANOWICZ, MAGDALENA (Journal of Psychiatric Practice®, 2020)
Background: Population-based surveys estimate that 0.7% of youth (13 to 17 y of age) in the United States identifies as transgender. Transgender youth are at an increased risk of anxiety, depression, and suicide attempts that often require inpatient care. Unfortunately, because of perceived insensitivity to gender identity from their providers, which includes incorrect use of names and/or pronouns, they may delay seeking necessary care. To date, there have been no specific documentation practice guidelines published by the International Association of Child and Adolescent Psychiatry and Allied Professions, American Academy of Child and Adolescent Psychiatry (AACAP), or other professional associations. The main goal of this study was to review documentation practices among multidisciplinary teams caring for hospitalized transgender youth on a child and adolescent inpatient psychiatry unit.Methods: Retrospective chart reviews were completed for 44 transgender patients who were hospitalized between 2008 and 2017. The charts were reviewed for consistency in the documentation of name and gender by the multidisciplinary team. Members included child and adolescent staff psychiatrists, residents, fellows, nurses, nurse practitioners, physician assistants, and social workers. Inconsistency was defined as at least 2 members of the team referring to a patient by a different name and/or gender pronoun in separate notes or >2 interchanges of name and/or gender pronoun in a single note. Kappa coefficient was calculated between each team member role to estimate exact agreement statistics.Results: In 43.2% (n=19) of cases, team members did not have a consistent approach to documenting a patient's name and/or gender pronoun and 18% (n=8) of discharge summaries were also inconsistent in this documentation. The greatest agreement in documentation practices was noted between the team and the staff psychiatrist (κ=0.446).Conclusions: Findings from this study suggest that inpatient treatment teams show inconsistency in documentation practices for youth transgender inpatients. Further work is necessary to understand the implications of these findings for patient satisfaction and clinical outcomes.

Female-to-Male Gender-Confirming Drainless Mastectomy May Be Safe in Obese Males. - Pittelkow, Eric M; Duquette, Stephen P; Rhamani, Farrah; Rogers, Corianne; Gallagher, Sidhbh (Aesthetic Surgery Journal, 2020)
Background: Gender dysphoria is a medical condition associated with suicidality. Transgender men who have undergone female-to-male (FTM) chest reconstruction report higher quality of life and reduced gender dysphoria. It has been reported that transgender men are at higher risk of obesity.Objectives: The objective of this study was to compare perioperative outcomes and complications between different classes of obesity in FTM transgender patients who underwent chest masculoplasty.Methods: A retrospective review of 145 consecutive patients who underwent mastectomy with free nipple graft was conducted. Postoperative outcomes and complications were collected. Patients were divided into nonobese (body mass index [BMI] <30 kg/m2), obese (BMI 30-39.9 kg/m2), morbidly obese (BMI 40-49.9 kg/m2), and super obese (BMI >50 kg/m2) groups.Results: Sixty-six of the 145 patients were not obese, 52 were obese, 22 were morbidly obese, and 5 were super obese. There was a statistically significant increase in amount of breast tissue resected between each of the 4 groups (866.8 g vs 1672.4 g vs 3157.1 g vs 4827.6 g; P ≤ 0.0005) as BMI increased, respectively. There was a significant difference in operative time between the nonobese and obese groups (128.7 vs 134.6 vs 150.5 vs 171 minutes; P = 0.026). A significant increase in postoperative infections was observed between the morbidly obese, super obese, and the nonobese group (P = 0.048).Conclusions: Chest wall reconstruction in FTM and nonbinary transgender people is important in relieving gender dysphoria. Postoperative complications were not significantly increased in obese patients (30-39.9 kg/m2). Delaying surgery for weight loss may not be necessary unless patients are morbidly obese.Level Of Evidence:4:
Keywords: Breast Neoplasms; Obesity, Morbid -- Diagnosis; Obesity, Morbid -- Surgery; Obesity, Morbid -- Complications; Postoperative Complications -- Epidemiology; Mastectomy; Quality of Life; Postoperative Complications -- Etiology; Female; Body Mass Index; Treatment Outcomes; Male; Retrospective Design; Ferrans and Powers Quality of Life Index

Stigma in the bereavement experiences of gay men who have lost a partner to suicide. - Ferlatte, Olivier; Oliffe, John L.; Salway, Travis; Knight, Rod (Culture, Health & Sexuality, 2019)
Despite the high prevalence of suicide in gay communities, the impact of suicide on surviving male partners is poorly understood. This article presents a qualitative case study of two gay men who lost a partner to suicide and explores how stigma may shape gay men's bereavement experiences. Data were collected using photovoice methods and analysed using a thematic approach. Five themes were inductively derived: (1) trying to prevent the inevitable; (2) guilty of keeping secrets; (3) dreams shattered by suicide; (4) abandoned and alone in grief; and (5) a lonesome road to recovery. Within each theme, the article indentifies how stigma-related challenges associated with suicide, mental illness and minority sexual identity shaped gay men's bereavement experiences. Practice and policy implications are discussed, including how the provision of tailored clinical and peer supports can assist gay men in the bereavement of a same-sex partner to suicide. The findings detailed in this study highlight the need for interventions to de-stigmatise mental illness and suicide within and outside the gay community.
Keywords: Stigma; Bereavement; Homosexuality; Suicide -- Psychosocial Factors; Sexual Partners; Photography; Human; Qualitative Studies; Adult; Patient Attitudes; Male; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Impact of Events Scale; Scales

Peer victimization and suicidality among LGBTQ youth: the roles of school belonging, self-compassion, and parental support. - Hatchel, Tyler; Espelage, and Dorothy; Merrin, Gabriel J. (Journal of LGBT Youth, 2019)
Research on lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth's experiences at school has largely focused on stigma, adversity, disparities, and peer victimization. Factors like school climate, individual differences, and social support have also garnered significant attention. However, there has been a dearth of research examining how they relate to both suicidal ideation and suicide attempts. Our goal was to bolster the extant literature by examining the protective role of parental support and psychological mechanisms like school belonging and self-compassion among LGBTQ youth struggling with peer victimization and suicidality. A cross-sectional study was completed with a sample of 934 LGBTQ high school students. Structural equation modeling was employed to analyze direct and indirect effects. Peer victimization was positively associated with both forms of suicidality and negatively associated with school belonging and self-compassion. Psychological processes varied in their in prediction of suicidal ideation and attempts. Parental support did not moderate pathways between victimization and processes, but was associated with diminished suicidality and improved school belonging. Our findings illustrate the critical nature of further developing our understanding of the complexities of suicidality. School programs and interventions that are designed to cultivate belonging, self-compassion, and parental support may prove to be especially beneficial for victimized LGBTQ youth who struggle with suicidality.
Keywords: Crime Victims -- In Adolescence; Suicide -- In Adolescence; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Learning Environment; Compassion -- In Adolescence; Support, Psychosocial; Parental Attitudes -- Evaluation; Human; Self Concept; Cross Sectional Studies; Students, High School; Structural Equation Modeling; Suicide, Attempted; Suicidal Ideation; Adolescence

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)
Objective: The aim was to develop understanding around the experience of suicide in transgender youth. Method: Qualitative analysis with 85 interviews with transgender youth about their histories with suicidality was performed. Participants were recruited from community clinics in three counties (United States, Canada, and Ireland) between 2010 and 2014. Results: Factors that precipitated participants' suicide attempts included rejection based on gender identity and gender dysphoria. Participants demonstrated resilience by attempting to connect with loved ones for support and through self-awareness of mental states, including by regulating behaviors they perceived to adversely affect their mental health. Conclusions: Transgender youth may fear seeking health care due to health professionals' lack of understanding of transgender issues and fear of further victimization. Reframing suicidality as a rational decision-making process in response to stress may further understanding of why people attempt suicide and provide new avenues for intervention.

Mental Health of Transgender Veterans in US States With and Without Discrimination and Hate Crime Legal Protection. - Blosnich, John R.; Marsiglio, Mary C.; Gao, Shasha; Gordon, Adam J.; Shipherd, Jillian C.; Kauth, Michael; Brown, George R.; Fine, Michael J. (American Journal of Public Health, 2016)
Objectives. To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans' mental health. Methods. We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt. Results. Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased odds of self-directed violence (AOR = 0.57; 95% CI = 0.34, 0.95). Conclusions. Understanding lesbian, gay, bisexual, and transgender social stressors can inform treatment and care coordination for transgender populations.
Keywords: Transgender Persons -- Psychosocial Factors -- United States by Individual State; Veterans -- Psychosocial Factors; Mental Health; Discrimination, Employment -- Legislation and Jurisprudence -- United States by Individual State; Affective Disorders -- Epidemiology; United States by Individual State; Human; Male; Female; LGBTQ+ Persons; Descriptive Statistics; Data Analysis Software; Confidence Intervals; Odds Ratio; Gender Identity; Substance Abuse; Stress Disorders, Post-Traumatic; Suicidal Ideation; Adult; Middle Age; Aged; Funding Source

Personality, spirituality, suicide, and self-injury proneness among lesbian, gay, and bisexual adults. - Stroud, Caroline H.; Cramer, Robert J.; La Guardia, Amanda C.; Crosby, James W.; Henderson, Craig E. (Mental Health, Religion & Culture, 2015)
The present study sought to clarify gaps in current knowledge integrating personality, spirituality, and risk for suicide/self-harm among sample of 336 lesbian, gay, and bisexual community members. It was hypothesised that Neuroticism would positively predict, and Extraversion and Agreeableness would negatively predict, measures of suicide and self-injury proneness. Additionally, it was predicted that spirituality, defined as Spiritual Life Integration (SLI) and Social Justice Commitment, would interact with personality traits to attenuate risk for suicide and self-injury. Results supported the role of Neuroticism, and identified an unexpected predictor of Conscientiousness, at the main effect level. Moderation patterns were observed such that Agreeableness and Extraversion interacted with SLI to attenuate risk, such that high levels of each trait and high levels of spirituality were protective against suicide and self-injury proneness. Theoretical and practical implications with emphasis on counselling intervention implementation and future research are discussed.
Keywords: LGBTQ+ Persons; Spirituality; Personality; Suicide -- Risk Factors; Self-Injurious Behavior -- Risk Factors; Human; Female; Male; Psychological Tests; Neurotic Disorders; Shyness; Lesbians; Gay Men; Bisexuals

Individual- and Structural-Level Risk Factors for Suicide Attempts Among Transgender Adults. - Perez-Brumer, Amaya; Hatzenbuehler, Mark L.; Oldenburg, Catherine E.; Bockting, Walter (Behavioral Medicine, 2015)
This study assessed individual (ie, internalized transphobia) and structural forms of stigma as risk factors for suicide attempts among transgender adults. Internalized transphobia was assessed through a 26-item scale including four dimensions: pride, passing, alienation, and shame. State-level structural stigma was operationalized as a composite index, including density of same-sex couples; proportion of Gay–Straight Alliances per public high school; 5 policies related to sexual orientation discrimination; and aggregated public opinion toward homosexuality. Multivariable logistic generalized estimating equation models assessed associations of interest among an online sample of transgender adults (N= 1,229) representing 48 states and the District of Columbia. Lower levels of structural stigma were associated with fewer lifetime suicide attempts (AOR 0.96, 95% CI 0.92–0.997), and a higher score on the internalized transphobia scale was associated with greater lifetime suicide attempts (AOR 1.18, 95% CI 1.04–1.33). Addressing stigma at multiple levels is necessary to reduce the vulnerability of suicide attempts among transgender adults.
Keywords: Stigma; Suicide, Attempted -- Risk Factors; Transgender Persons -- Psychosocial Factors -- In Adulthood; Human; Adult; Public Opinion; LGBTQ+ Persons; Sexism; Odds Ratio; Confidence Intervals; Scales; Suicidal Ideation -- Prevention and Control

Exploring substance use and mental health for minority transgender youth: Implications for advanced practice nurses. - Raynor, Phyllis A.; Nation, Austin; Outlaw, Freida (Journal of the American Association of Nurse Practitioners, 2020)
Background: Transgender youth, particularly if they are transgender female and of a minority racial or ethnic group (i.e., minority transgender youth [MTY]), are known to have higher incidence of new HIV infections, substance abuse, and suicidality when compared with cisgender youth. Mental health disparities and substance use among MTY, between the ages of 13-24 years, have been underexplored in the United States, although they have serious public health concerns contributing to morbidity and mortality. Objectives: To examine the US literature to discover what is known about the intersection of substance use, mental health disorders, and associated health risks for MTY. Data sources: An integrative review exploring experimental and nonexperimental research was conducted from 2010 to 2018 using Cumulative Index for Nursing and Allied Health (CINAHL), PsycINFO, and PubMed. Articles were selected if the research identified MTY, mental health and/or substance use risks, data-driven outcomes, or considerations that could potentially influence MTY outcomes. Ten articles were included in the final selection. Conclusions: All studies addressed mental health, substance use, and/or health risks, although many of the articles explored all transgender youth outcomes without a particular focus on MTY. Identified factors linked to poor health outcomes included socioeconomic vulnerability, substance use, mood disorders, self-harm, and risky sexual behaviors. Implications for practice: The authors have provided recommendations regarding culturally appropriate, compassionate, evidence-informed practices for engaging MTY and their families to promote greater well-being for all youth, regardless of gender identity.
Keywords: Substance Abuse -- Complications; Mental Health; Minority Groups; Transgender Persons -- In Adolescence; Advanced Practice Nurses; Risk Assessment; Human; Systematic Review; Adolescence; Cumulative Index to Nursing & Allied Health Literature Print Index; Psycinfo; PubMed

Suicide ideation, planning, and attempts: the case of the Latinx LGB youth. - Boyas, Javier F.; Villarreal-Otálora, Tatiana; Alvarez-Hernandez, Luis R.; Fatehi, Mariam (Health Promotion Perspectives, 2019)
Background: Guided by an ecological systems theory (EST) framework, the purpose of the present study was to investigate how multiple micro, mezzo, and macro factors influence the suicidality continuum from suicidal ideation to suicide attempt among Latinx LGB (lesbian, gay, and bisexual) youth living in the United States. Methods: Data for this cross sectional-study included 451 participants who self-identified as Latinx LGB on the 2017-National Youth Risk Behavioral Survey. The analysis explored micro, mezzo, and macro-level factors' association with three suicidality outcomes (ideation, planning, and attempt) at the bivariate and multivariate level. Since the outcome variables were dichotomized, univariate logistic regressions and backward elimination logistic regressions were used. Results: The most commonly reported suicidal behavior was ideation (n = 173; 40%), followed by planning (n = 150; 34%), and then attempt (n = 64; 21%). Findings from the backward elimination logistic regression on suicidal ideation suggest the best set of independent variables are being bullied at school (odds ratio [OR] = 2.81; CI: 1.61–4.89), experiencing sexual assault(OR = 2.32; CI: 1.32–4.07), experiencing depressive symptoms (OR = 1.99; CI: 1.07– 3.69),being cannabis use (OR = 1.76; CI: 1.08–2.89), and being female (OR = 1.72; CI: 1.01–2.93).For suicide planning the model suggested, experiencing depressive symptoms (OR = 3.21; CI:1.74–5.91), cannabis use (OR = 2.46; CI: 1.49–4.07), being bullied at school (OR = 2.04; CI:1.17–3.58), and experiencing sexual assault (OR = 1.88; CI: 1.07–3.31) exhibited the strongest relationships. Suicide attempt was significantly associated with cannabis use (OR = 3.12; CI:1.60–6.08), experiencing depression (OR= 2.89; CI: 1.30–6.43), experiencing sexual assault (OR = 2.77; CI: 1.34–5.71), and being bullied at school (OR = 2.34; CI: 1.12–4.91). Conclusion: Given the findings of this study, it is essential that tailored suicide prevention efforts be established that uniquely address the intersections of race/ethnicity and sexual orientation and how this intersection influences micro, mezzo, and macro factors associated with suicide ideation, planning, and attempt among Latinx LGB adolescents.
Keywords: Suicidal Ideation -- In Adolescence -- United States; Hispanic Americans; Strategic Planning; Suicide, Attempted; LGBTQ+ Persons; Human; Adolescence; Male; Female; United States; Cross Sectional Studies; Secondary Analysis; Cluster Sample; Logistic Regression; Odds Ratio; Confidence Intervals; Surveys; Race Factors; Sexuality

LGBT Youth, Mental Health, and Spiritual Care: Psychiatric Collaboration With Health Care Chaplains. - Adelson, Stewart L; Walker-Cornetta, Emilee; Kalish, Naomi (Journal of the American Academy of Child & Adolescent Psychiatry, 2019)
Lesbian, gay, bisexual, and transgender (LGBT) youth have unique medical and mental health needs. Exposure to stigma such as family non-acceptance is associated with adverse mental health outcomes that are important sources of morbidity and mortality in this population. These include depression, anxiety, substance abuse, suicidality, and risk behaviors that mediate exposure to human immunodeficiency virus and sexually transmitted infections. Different religious and/or spiritual traditions hold various beliefs and attitudes about LGBT people. These can be a factor influencing a youth's risk of experiencing stigma. Other unique developmental challenges of LGBT youth, such as conflicts over identity integration and disclosure, also can be influenced by religious/spiritual factors. Health care chaplains could collaborate with clinicians to support mental health by helping LGBT youth and families integrate religious with other aspects of identity, decreasing religiously based stigma, and supporting family connectedness. This article discusses professional aspects of health care chaplaincy and ways in which health care chaplains can work with psychiatrists and other clinicians to support LGBT youth mental health, including case vignettes. It was developed from a conference at the Pediatric Ethics Committee of the Columbia University Medical Center addressing chaplaincy for LGBT youth.
Keywords: Spiritual Healing; Mental Disorders -- Therapy; Clergy; Mental Disorders -- Psychosocial Factors; Female; Stigma; Adolescence; Male; Questionnaires; Scales; Ways of Coping Questionnaire

Factor associated with risky sexual behaviors among the French general population. - Sicard, Sébastien; Mayet, Aurélie; Duron, Sandrine; Richard, Jean-Baptiste; Beck, François; Meynard, Jean-Baptiste; Deparis, Xavier; Marimoutou, Catherine (Journal of Public Health, 2017)
Background Despite prevention programs, a rising incidence of sexually transmitted infections is currently reported in France. Aims Research factors associated with risky sexual behaviors (RSBs) among the French population. Methods Subjects aged 15-54 years from the French national survey 'Baromètre santé 2010' were included (n = 16 598). RSB was defined as having multiple partners or failure to use condom at first intercourse with a new partner over past 12 months. Factors associated were identified using one logistic regression by gender. Results The overall RSB prevalence was 9.5%, being higher among men (P< 0.001). Factors associated with RSB for both genders were young age (OR = 1.5), single status (men: OR = 7.1; women: OR = 6.4), homosexual relations (men: OR = 2.0; women: OR = 3.2), low incomes (men: OR = 1.5; women: OR = 1.4), use of cannabis (men: OR = 1.4; women: OR = 3.0). Men-specific factors were history of STI (OR = 2.5) and alcohol drunkenness (OR = 2.2), and women-specific factors history of suicide attempt (OR = 1.6) and history of sexual assault (OR = 1.6). Conclusions Confirming most of known determinants of RSB, this study also identified some specific risky patterns for whom preventive actions can be developed: multiusers of psychoactive substances, people living with low incomes, women having sex with women or presenting history of psychological vulnerability (suicide attempts, sexually harassed).
Keywords: Sexually Transmitted Diseases -- Risk Factors -- France; Risk Taking Behavior -- Evaluation -- France; Human; France; Adolescence; Young Adult; Adult; Middle Age; Survey Research; Sexual Partners; Condoms -- Utilization; Male; Female; Sex Factors; Age Factors; Marital Status; Homosexuality; Income; Cannabis; Alcoholic Intoxication; Suicide, Attempted; Sexual Abuse; Multivariate Analysis; Data Analysis Software; Descriptive Statistics; Logistic Regression; Bivariate Statistics; Odds Ratio; Goodness of Fit Chi Square Test; P-Value; Confidence Intervals; Scales

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS). - Diehl, Alessandra; Pillon, Sandra Cristina; Caetano, Raul; Madruga, Clarice Sandi; Wagstaff, Christopher; Laranjeira, Ronaldo (Archives of Psychiatric Nursing, 2020)
To describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals. The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older. 3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM. The findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders. • The prevalence of substance use and violence among sexual minorities individual is high. • Epidemiological studies that evaluated sexual minorities, use of substances and violence are limited • Better understanding about violence and alcohol consumption in sexual minorities individuals might help address the matter and adjust public policy strategies for prevention, intervention, and service development • Sexual minority individuals are more likely to be victims of childhood physical and sexual abuse
Keywords: Domestic Violence; Child Abuse, Sexual -- Brazil; Substance Abuse -- Epidemiology -- Brazil; Sexuality -- Epidemiology; Minority Groups; Homophobia; Life Change Events; Human; Brazil; Prevalence; Child; Consent; Adolescence; Interviews; Race Factors; Open-Ended Questionnaires; Multi-Stage Cluster; Surveys; Random Sample; Confidentiality (Research); Socioeconomic Factors; Sex Factors; Age Factors; Marital Status; Employment Status; Alcohol Drinking; Questionnaires; Data Analysis Software; Chi Square Test; Fisher's Exact Test; Bivariate Statistics; Logistic Regression; Odds Ratio; Confidence Intervals; Female; Male; Descriptive Statistics

Depression and Oral FTC/TDF Pre-exposure Prophylaxis (PrEP) Among Men and Transgender Women Who Have Sex With Men (MSM/TGW). - Defechereux, Patricia; Mehrotra, Megha; Liu, Albert; McMahan, Vanessa; Glidden, David; Mayer, Kenneth; Vargas, Lorena; Amico, K.; Chodacki, Piotr; Fernandez, Telmo; Avelino-Silva, Vivian; Burns, David; et al. (AIDS & Behavior, 2016)
We conducted a longitudinal and cross-sectional analysis of depressive symptomology in iPrEx, a randomized, placebo-controlled trial of daily, oral FTC/TDF HIV pre-exposure prophylaxis (PrEP) in men and transgender women who have sex with men. Depression-related adverse events (AEs) were the most frequently reported severe or life-threatening AEs and were not associated with being randomized to the FTC/TDF arm (152 vs. 144 respectively OR 0.66 95 % CI 0.35-1.25). Center for Epidemiologic Studies Depression scale (CES-D) and a four questions suicidal ideation scale scores did not differ by arm. Participants reporting forced sex at anal sexual debut had higher CES-D scores (coeff: 3.23; 95 % CI 1.24-5.23) and were more likely to have suicidal ideation (OR 2.2; 95 % CI 1.09-4.26). CES-D scores were higher among people reporting non-condom receptive anal intercourse (ncRAI) (OR 1.46; 95 % CI 1.09-1.94). We recommend continuing PrEP during periods of depression in conjunction with provision of mental health services.
Keywords: Depression; Pre-Exposure Prophylaxis; HIV Infections -- Prevention and Control; Men Who Have Sex With Men; Transgender Persons; Suicidal Ideation; Center for Epidemiological Studies Depression Scale; Scales; Unsafe Sex; Anal Intercourse; Mental Health Services; Human

The Relationship Between Suicide-Related Exposure and Personal History of Suicidal Behavior in Transgender and Gender-Diverse Veterans. - Tucker, Raymond P.; Pardue-Bourgeois, Sarah; Snow, Annie; Bradstreet, Mike; Cerel, Julie (LGBT Health, 2019)
Purpose: Transgender and gender-diverse (TGD) veterans experience a high prevalence of suicidal thoughts and behaviors (STBs). Within the general U.S. population, suicide-related exposure is an identified risk factor for STBs. This study explores the impact of suicide-related exposure in TGD veterans. Methods: Self-identified TGD veterans (n = 195) completed an online cross-sectional survey that included selfreport measures of suicide-related exposures, experience of past-year suicidal ideation (SI), and history of suicide attempt (SA)(s). Results: A considerable number of respondents indicated that they were close to someone who attempted suicide (40.5%) or died by suicide (32.8%). When asked about the gender identity of decedents, 6.7% indicated that at least one individual was TGD and 18.5% indicated knowing at least one close TGD individual who attempted suicide. Exposure to SA and to suicide were both independently related to a history of at least one SA. Neither type of suicide exposure was related to past year SI. Participants exposed to the SA of a close TGD individual were more likely to report past-year SI than those not exposed. Conclusion: TGD veterans may be more vulnerable to suicidal behaviors if suicide-related exposures are experienced. Public health suicide prevention initiatives, both inside and outside of the TGD community, may help to reduce suicide in these veterans.

Prescription Drug Misuse: Taking a Lifespan Perspective. - Schepis, Ty S; Klare, Dalton L; Ford, Jason A; McCabe, Sean Esteban (Substance Abuse: Research & Treatment, 2020)
Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities.
Keywords: Drugs, Prescription; Substance Abuse -- Epidemiology -- United States; Substance Abuse -- Risk Factors -- United States; Longevity; Risk Assessment; Human; Systematic Review; Prevalence; United States; Age Factors; Narcotics; Hypnotics and Sedatives; Antianxiety Agents, Benzodiazepine; Aging; Psychopathology; Suicidal Ideation -- Risk Factors; Minority Groups

Treatment-Resistant Depression in an Adolescent Treated with Clozapine: Weighing the Options in a Young Suicidal Patient. - Whitlock, Kevin; Smith, Noah; Poulsen, Raul J.; Coffey, Barbara J. (Journal of Child & Adolescent Psychopharmacology, 2020)
A. was a 13-year-old Hispanic biological female to a male transgender adolescent with a psychiatric history of major depression, anxiety, and trauma who was involuntarily admitted to an inpatient child and adolescent psychiatry unit for recent and recurrent suicide attempts and self-harming behaviors. History of Present Illness Mother reported that A. had experienced significant depressive symptomatology for several years before admission. A. also denied current posttraumatic stress disorder (PTSD) symptoms, including nightmares or flashbacks.

Suicide Prevention From the Perspectives of Gay, Bisexual, and Two-Spirit Men. - Ferlatte, Olivier; Oliffe, John L.; Louie, Dennis R.; Salway, Travis; Ridge, Damien; Broom, Alex (Qualitative Health Research, 2019)
Although gay, bisexual, and two-spirit men (GBTSM) experience high rates of suicidality, there have been few empirical studies of prevention initiatives and policies that could address or reverse this major social problem. This article reports on a photovoice study of 29 GBTSM who had a history of suicidality or lost a fellow GBTSM to suicide. We focused our analysis on participants' perspectives on suicide prevention. Participants described four key considerations for GBTSM suicide prevention: (a) recognizing and addressing enduring homophobia, biphobia, and mental illness stigma; (b) provision of low-barrier, long-term, and GBTSM-affirming counseling; (c) de-isolation through peer support and community connection; and (d) fostering creativity and cultural resilience. By engaging GBTSM affected by suicide through photographs that depict their experiences and points of view, in this study, we offer concrete recommendations to reduce suicidality among GBTSM.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Suicide -- Prevention and Control; Human; Male; Canada; Qualitative Studies; Semi-Structured Interview; Interview Guides; Photography; Thematic Analysis; Consumer Attitudes; Homophobia -- Prevention and Control; Stigma -- Prevention and Control; Attitude to Sexuality; Mental Disorders; Counseling; Peer Group; Support, Psychosocial; Social Inclusion; Hardiness; Self Care; Psychological Well-Being; Funding Source

Psychometric properties of the psychological strain scales (PSS) in suicide attempters and community controls of rural China. - Wei, Yan-Xin; Wang, Xin-Ting; Zhang, Jie; Yao, Zhi-Ying; Liu, Bao-Peng; Jia, Cun-Xian (Journal of Affective Disorders, 2020)
Background: Psychological Strain Scales (PSS) were developed to measure four types of strain comprising value strain, deprivation strain, aspiration strain, and coping strain. This study aimed to evaluate the psychometric properties of the Chinese version of 40-item PSS in suicide attempters and community controls of rural China.Methods: Data of this study came from the investigation of 132 suicide attempters and their paired community controls matched with the same sex, age (±3 years) and residence in five counties in rural Shandong, China. The Chinese version of PSS, the Center for Epidemiologic Studies Depression Scale (CES-D), the Trait Anxiety Inventory (TAI) and the Self-esteem Scale (SES) were administered and reliability test and validity test of the PSS were conducted.Results: Cronbach's α and Guttman Spilt-Half coefficient of PSS was 0.942 and 0.842 for suicide attempters, and 0.950 and 0.874 for community controls. For both suicide attempters and community controls, the Exploratory Factor Analysis indicated a one-factor structure of each strain scale, which accorded with the original factor structure proposed by the authors. The scores of the total PSS and four subscales were positively correlated with the scores of CES-D and TAI; and negatively correlated with the score of SES, which indicated a good performance in convergent validity.Limitations: This study was limited to its generalizability to the Chinese urban population.Conclusions: The Chinese version of the 40-item PSS has satisfactory psychometric properties in terms of reliability and validity in Chinese rural suicide attempters and community controls.
Keywords: Suicide, Attempted; Suicide; Reproducibility of Results; Child, Preschool; China; Psychometrics; Human; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Center for Epidemiological Studies Depression Scale

Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. - Turban, Jack L.; Beckwith, Noor; Reisner, Sari L.; Keuroghlian, Alex S. (JAMA Psychiatry, 2020)
Importance: Gender identity conversion efforts (GICE) have been widely debated as potentially damaging treatment approaches for transgender persons. The association of GICE with mental health outcomes, however, remains largely unknown.Objective: To evaluate associations between recalled exposure to GICE (by a secular or religious professional) and adult mental health outcomes.Design, Setting, and Participants: In this cross-sectional study, a survey was distributed through community-based outreach to transgender adults residing in the United States, with representation from all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico, and US military bases overseas. Data collection occurred during 34 days between August 19 and September 21, 2015. Data analysis was performed from June 8, 2018, to January 2, 2019.Exposure: Recalled exposure to GICE.Main Outcomes and Measures: Severe psychological distress during the previous month, measured by the Kessler Psychological Distress Scale (defined as a score ≥13). Measures of suicidality during the previous year and lifetime, including ideation, attempts, and attempts requiring inpatient hospitalization.Results: Of 27 715 transgender survey respondents (mean [SD] age, 31.2 [13.5] years), 11 857 (42.8%) were assigned male sex at birth. Among the 19 741 (71.3%) who had ever spoken to a professional about their gender identity, 3869 (19.6%; 95% CI, 18.7%-20.5%) reported exposure to GICE in their lifetime. Recalled lifetime exposure was associated with severe psychological distress during the previous month (adjusted odds ratio [aOR], 1.56; 95% CI, 1.09-2.24; P < .001) compared with non-GICE therapy. Associations were found between recalled lifetime exposure and higher odds of lifetime suicide attempts (aOR, 2.27; 95% CI, 1.60-3.24; P < .001) and recalled exposure before the age of 10 years and increased odds of lifetime suicide attempts (aOR, 4.15; 95% CI, 2.44-7.69; P < .001). No significant differences were found when comparing exposure to GICE by secular professionals vs religious advisors.Conclusions and Relevance: The findings suggest that lifetime and childhood exposure to GICE are associated with adverse mental health outcomes in adulthood. These results support policy statements from several professional organizations that have discouraged this practice.
Keywords: Memory; Suicide, Attempted; Suicide, Attempted -- Psychosocial Factors; Gender Identity; Psychotherapy; Human; Cross Sectional Studies; Female; Male; United States; Adult; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Scales

Suicide Risk for Sexual Minorities in Middle and Older Age: Evidence From the National Survey on Drug Use and Health. - Capistrant, Benjamin D.; Nakash, Ora (American Journal of Geriatric Psychiatry, 2019)
Objective: No studies have estimated the difference in suicidal ideation, plans, and attempts for lesbian, gay, or bisexual (LGB) adults aged 50+ compared with heterosexuals using nationally representative data.Methods: We used 2015-2017 National Survey on Drug Use and Health data to estimate the prevalence of self-reported suicidal ideation, plans, and attempts for LGB adults 50+ compared with heterosexuals in the preceding 12 months.Results: Over 185,000 LGB adults aged 50+ in the United States were estimated to have had suicidal ideation in the preceding year. After adjusting for sex and race/ethnicity, LGB individuals aged 50+ had a 4.5 percentage point higher prevalence of suicidal ideation compared with heterosexuals (prevalence difference [PD]: 0.045; 95% confidence interval [CI]: 0.022, 0.067). Of those with suicidal ideation, LGB individuals aged 50+ had a 17.2 percentage point higher prevalence of suicide plans compared with heterosexuals (PD: 0.172; 95% CI: 0.011, 0.332).Conclusion: LGB adults in middle and older age have higher suicidal ideation and plans than heterosexual peers.
Keywords: Suicidal Ideation; Aged; Suicide, Attempted; Human; Male; United States; Female; Prevalence; Middle Age; Surveys; Cross Sectional Studies; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires

Longitudinal predictors of self-injurious thoughts and behaviors in sexual and gender minority adolescents. - Smith, Diana M.; Wang, Shirley B.; Carter, Mikaela L.; Fox, Kathryn R.; Hooley, Jill M. (Journal of Abnormal Psychology, 2020)
Sexual and gender minority (SGM) populations are at increased risk for several negative psychological outcomes, including self-injury. Although correlates of self-injurious thoughts and behaviors (SITBs) have been identified, it is unclear which factors are prospective predictors of SITB engagement in SGM youth. The current study investigated an online sample of 252 SGM adolescents over a 6-month period. Participants reported attitudes based on SGM identity, depression, self-criticism, body image, family support and family strain, friend NSSI engagement, and experiences of everyday discrimination. Lasso and elastic net regularized logistic regressions were used to examine which baseline variables were associated with SITB engagement at follow-up. Models resulted in excellent predictive accuracy of nonsuicidal self-injury and suicidal ideation (mean Area Under the Receiving Operating Characteristics Curve [AUC] of 0.90 and 0.91), good predictive accuracy for suicide plans (mean AUC = 0.85), and fair predictive accuracy for suicidal behaviors (mean AUC = 0.78). Several variables emerged as prospectively related to SITB risk, with varied associations across different SITBs. Results suggest that minority-specific factors may predict SITBs in SGM adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Keywords: Suicidal Ideation; Self-Injurious Behavior -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Prospective Studies; Female; Male; Risk Factors; Adolescence; Scales

Suicides Among Lesbian and Gay Male Individuals: Findings From the National Violent Death Reporting System. - Lyons, Bridget H.; Walters, Mikel L.; Jack, Shane P.D.; Petrosky, Emiko; Blair, Janet M.; Ivey-Stephenson, Asha Z. (American Journal of Preventive Medicine, 2019)
Introduction: Information regarding the epidemiology of suicide among lesbian and gay male individuals is limited, and comprehensive information is needed. This study seeks to describe the characteristics and precipitating circumstances of suicide among lesbian and gay male decedents when compared with non-lesbian and non-gay male decedents.Methods: An analysis was conducted of National Violent Death Reporting System data from 18 U.S. states for the years 2003-2014. Sociodemographic characteristics and precipitating circumstances of suicide among lesbian and gay male decedents were compared with non-lesbian and non-gay male decedents. Logistic regression analysis was conducted to examine the association between precipitating circumstances and suicide by sexual orientation. The analysis was conducted in December 2017.Results: There were a total of 123,289 suicide decedents from 18 states participating in National Violent Death Reporting System during 2003-2014; of those, 621 (0.5%) were identified as lesbian, gay, bisexual, or transgender. The majority of lesbian, gay, bisexual, or transgender decedents were identified as gay male (53.9%), followed by lesbian (28.0%), transgender (10.4%), and bisexual (7.5%). The analysis revealed several differences by age, mechanism of injury, and precipitating circumstances, including intimate partner problems among lesbian decedents, suicide planning and intent for both lesbian and gay male decedents, and mental health problems among gay male decedents.Conclusions: Findings highlight differences in the characteristics of suicide among lesbian and gay male and non-lesbian and non-gay male decedents. It is important for suicide prevention efforts to be culturally sensitive and consider the needs of sexual minority populations.
Keywords: Suicide; Mental Health; Female; United States; Male; Young Adult; Age Factors; Adult; Middle Age; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Adolescence; Human; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

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

Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities. - Mereish, Ethan H.; O’Cleirigh, Conall; Bradford, Judith B. (Psychology, Health & Medicine, 2014)
Research has documented significant relationships between sexual and gender minority stress and higher rates of suicidality (i.e. suicidal ideation and attempts) and substance use problems. We examined the potential mediating role of substance use problems on the relationship between sexual and gender minority stress (i.e. victimization based on lesbian, gay, bisexual, or transgender identity [LGBT]) and suicidality. A nonprobability sample of LGBT patients from a community health center (N = 1457) ranged in age from 19–70 years. Participants reported history of lifetime suicidal ideation and attempts, substance use problems, as well as experiences of LGBT-based verbal and physical attacks. Substance use problems were a significant partial mediator between LGBT-based victimization and suicidal ideation and between LGBT-based victimization and suicide attempts for sexual and gender minorities. Nuanced gender differences revealed that substance use problems did not significantly mediate the relationship between victimization and suicide attempts for sexual minority men. Substance use problems may be one insidious pathway that partially mediates the risk effects of sexual and gender minority stress on suicidality. Substances might be a temporary and deleterious coping resource in response to LGBT-based victimization, which have serious effects on suicidal ideation and behaviors.
Keywords: LGBTQ+ Persons; Victims; Substance Use Disorders; Suicide, Attempted; Stress, Psychological; Suicidal Ideation; Sex Factors; Minority Groups; Young Adult; Adult; Middle Age; Aged; Nonprobability Sample; Cross Sectional Studies; Secondary Analysis; Questionnaires; Sample Size; Descriptive Research; Descriptive Statistics; Regression; Data Analysis Software; Odds Ratio; Confidence Intervals; Human

Mental Health Issues and Complex Experiences of Abuse Among Trans and Gender Diverse Young People: Findings from Trans Pathways. - Strauss, Penelope; Cook, Angus; Winter, Sam; Watson, Vanessa; Toussaint, Dani Wright; Lin, Ashleigh (LGBT Health, 2020)
Purpose: Trans and gender diverse (TGD) young people have reported high levels of mental distress in research studies, specifically depression, anxiety, self-harming, and suicidal behaviors. Rates of abuse are also high in TGD populations, but little is known about how this relates to mental health in populations of TGD young people. This study sought to examine associations between experiences of abuse and mental health outcomes. Methods: A cross-sectional study design was used. An anonymous online questionnaire was conducted to determine rates of abuse among Australian TGD young people (N= 859) and the potential association with poor mental health. Primary outcomes of interest were self-reported psychiatric diagnoses, self-harm and suicidal behaviors, and current anxiety and depressive symptoms. Results: Exposures to six forms of abuse are reported in this article: extrafamilial physical abuse, familial physical abuse, extrafamilial sexual abuse, familial sexual abuse, abuse within an intimate relationship, and other familial abuse (including emotional or verbal abuse and neglect). All six forms of abuse measured were associated with poor mental health overall; risk estimates for some forms of abuse were much stronger than others. Conclusion: The current findings have wide-ranging implications for clinical practice. Those working in TGD health care need to be aware of the high prevalence of violence and abuse among TGD young people and the association with poor mental health outcomes. The findings also have implications for broader societal change and interventions targeting increasing parental support to reduce familial violence against TGD young people.

"I don't think they thought I was ready": How pre-transition assessments create care inequities for trans people with complex mental health in Canada. - MacKinnon, Kinnon R.; Grace, Daniel; Ng, Stella L.; Sicchia, Suzanne R.; Ross, Lori E. (International Journal of Mental Health, 2020)
Transgender (trans) people experience high rates of mental health issues including depression and suicidality. Improving access to transition-related medicine such as hormones and surgeries is suggested as an important mechanism to address these mental health issues. Yet clinicians experience challenges assessing and referring trans people for transition-related medicine. Standardized assessment protocols have been therefore recommended to optimize care. Although standardized protocols are purported to expand access to hormones and surgeries for trans people, it is unclear whether these tools achieve this goal. We therefore conducted an institutional ethnography to explicate how standardized readiness assessments coordinate access to hormones and surgeries in Canada. We analyzed key texts, talked with trans people, clinicians, clinician-educators, and administrators (total n = 22), and observed clinician-education workshops. In the context of determining transition readiness, standardized protocols direct clinicians to explore alternative diagnoses and assess the degree to which any complex mental health condition is "managed" prior to initiating hormones or surgeries. In response, we found that trans patients downplay or withhold mental health concerns from clinicians, or otherwise do additional work (e.g., take up unwanted psychiatric interventions) to convince providers they are "mentally ready" to transition. This phenomenon is paradoxical in that transition-related medicine is recommended to mitigate trans people's psychosocial distress, but when patients reveal symptoms of distress they encounter significant barriers to treatment. We conclude that the logic underpinning pre-transition "mental readiness" assessments discredits the claim that standardized protocols optimize access to hormones and surgeries.
Keywords: Transgender Persons -- Psychosocial Factors -- Canada; Mental Disorders -- Diagnosis -- Canada; Protocols; Health Services Accessibility -- Canada; Gender Affirmation Surgery -- Canada; Hormone Therapy -- Canada; Canada; Human; Ethnographic Research; Administrative Personnel; Physician Attitudes; Seminars and Workshops; Psychological Distress -- Prevention and Control

Social isolation and connectedness as determinants of well-being: Global evidence mapping focused on LGBTQ youth. - Garcia, Jonathan; Vargas, Nancy; Clark, Jesse L.; Magaña Álvarez, Mario; Nelons, Devynne A.; Parker, Richard G. (Global Public Health, 2020)
Social isolation describes a lack of a sense of belonging, the inability to engage and connect with others, and the neglect or deterioration of social relationships. This conceptual review describes how social isolation and connectedness affect the well-being of LGBTQ youth. Most studies focused on the psychosocial experience of social isolation, which led to suicide attempt, self-harm, sexual risk, and substance use. Scholarly work has drawn from a variety of frameworks, ranging from minority stress theory to positive youth development, to devise interventions that target isolation and connectedness in schools, community-based organisations, and in online environments. Finally, we discuss the importance of addressing social, cultural, and structural dimensions of social isolation in order to foster enabling environments that allow LGBTQ youth to thrive. This conceptual review suggests that individual and social transformations are the result of young people's meaningful participation in shaping their environment, which is made possible when their capabilities are fostered through social well-being. Our findings suggest the need for measures of social isolation among youth in databanks produced by global institutions, such as the World Health Organization.
Keywords: Social Isolation; Psychological Well-Being; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Interpersonal Relations; Adolescence; Conceptual Framework; Minority Stress; PubMed; Bullying; Systematic Review; Funding Source; Scoping Review; Human; Social Determinants of Health

Health Disparities Between Genderqueer, Transgender, and Cisgender Individuals: An Extension of Minority Stress Theory. - Lefevor, G. Tyler; Boyd-Rogers, Caroline C.; Sprague, Brianna M.; Janis, Rebecca A. (Journal of Counseling Psychology, 2019)
Interpersonal, social, and structural stressors have been identified as key elements that explain health disparities between transgender and cisgender individuals. However, most of this research has focused on binary transgender individuals or has not differentiated between binary and nonbinary individuals; little research has examined the experiences of minority stress or health of those identifying outside the gender binary. Guided by intersectionality and drawing on a sample of 3,568 college students from the Center for Collegiate Mental Health's 2012-2016 database--of whom 892 identified outside the gender binary--we conducted analyses of demographic and outcome measures administered in participants' 1st counseling appointment, examining differences between cisgender, transgender, and genderqueer individuals. We found that genderqueer individuals were harassed, sexually abused, and subjected to traumatic events at higher rates than were either cisgender or binary transgender individuals, with approximately 50% of genderqueer individuals reporting one of these experiences. We found that genderqueer individuals experienced more anxiety, depression, psychological distress, and eating concerns than did binary transgender and cisgender individuals and more social anxiety than did cisgender individuals. Genderqueer individuals more frequently reported self-harm and suicidality than did any other group, with approximately 2/3 of participants' having contemplated and nearly 50% making a suicide attempt. We extend current theorizing about minority stress (Hendricks & Testa, 2012; Meyer, 2003) to include genderqueer individuals and delineate several structural aspects of genderqueer experiences that may be responsible for these trends, including others' lack of knowledge about genderqueer experiences and pronouns, poor access to legal and medical resources, and systemic discrimination.
Keywords: Healthcare Disparities; Transgender Persons; Gender Nonconformity; Attitude to Sexuality; Human; Students, College; Databases; Minority Stress; Models, Theoretical; Counseling; Discrimination; Sexual Abuse; Sexual Harassment; Trauma; Anxiety; Depression; Eating Behavior; Suicidal Ideation

Strengthening Our Schools to Promote Resilience and Health Among LGBTQ Youth: Emerging Evidence and Research Priorities from The State of LGBTQ Youth Health and Wellbeing Symposium. - Johns, Michelle M.; Poteat, V. Paul; Horn, Stacey S.; Kosciw, Joseph (LGBT Health, 2019)
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents face well-documented health disparities in suicide risk, substance use, and sexual health. These disparities are known to stem, in part, from stigma directed toward LGBTQ youth in the form of minority stressors such as violence, discrimination, and harassment. Given the proportion of time that LGBTQ students spend in school, schools provide a critical context within which protective factors may be developed and leveraged to improve the health and wellbeing of these populations. This article provides a summary of key findings from a discussion among researchers, practitioners, and community members who participated in ''The State of LGBTQ Youth Health and Wellbeing: Strengthening Schools and Families to Build Resilience,'' a public symposium held in June 2017. We detail emerging science on and future priorities for school-based research with LGBTQ youth which were identified by attendees at this meeting, with a particular focus on intersectionality, supportive adults in schools, and in-school programs. We call for more school-based research on priority gaps such as how LGBTQ students' intersecting identities affect their in-school experiences, how to design professional development programs that cultivate supportive educators, and how to leverage gay-straight alliances/gender and sexuality alliances as sites of health programming for LGBTQ students.

Late-Onset Transgender Identity Development of Adolescents in Psychotherapy for Mood and Anxiety Problems: Approach to Assessment and Treatment. - Sevlever, Melina; Meyer-Bahlburg, Heino F. L. (Archives of Sexual Behavior, 2019)
The rate of adolescents with gender-nonconforming behavior and/or gender dysphoria seeking mental health care has dramatically increased in the past decade. Many of these youths also present with co-occurring psychiatric problems, including depression, anxiety, suicidality, substance use, and others. This combination may generate a complex clinical picture that challenges the ability of clinicians to accurately diagnose gender distress and develop suitable treatment recommendations. This article illustrates those challenges with two adolescent patients who developed late-onset gender dysphoria in the course of long-term mental health care for diverse psychiatric problems preceding the emergence of gender dysphoria. One underwent full progression from gender dysphoria as a male through social and medical transition to female, the other a less definitive progression from gender dysphoria as female through social transition to male without deciding for any medical treatment. The report provides details on the assessment procedures and the resulting findings, the rationale for treatment recommendations, and short-term follow-up information.
Keywords: Affect; Psychotherapy -- Methods; Anxiety -- Psychosocial Factors; Male; Adolescence; Female; Scales; Short Portable Mental Status Questionnaire; Social Readjustment Rating Scale

Relationship Status and Suicidal Behavior in Gay Men: The Role of Thwarted Belongingness and Hope. - Riley, Kym; McLaren, Suzanne (Suicide & Life-Threatening Behavior, 2019)
Objective: Levels of suicidal behavior among gay men are a significant concern. The Interpersonal Theory of Suicide proposes that being unpartnered is a risk factor for suicidal behavior due to thwarted belongingness; however, this has yet to be tested empirically. Recent studies also indicate that the two components of hope, agency and pathways, may be protective against suicidal behavior. The first aim of the current study was to investigate whether thwarted belongingness mediates the relationship between relationship status and suicidal behavior in gay men. The study also examined whether agency and pathways weaken the association between relationship status and thwarted belongingness, and whether agency weakens the relation between thwarted belongingness and suicidal behavior.Method: A sample of 370 self-identified gay men aged from 18 to 66 years old (M = 26.13, SD = 8.02) completed the Suicidal Behaviors Questionnaire-Revised, the Interpersonal Needs Questionnaire-Revised, and the Adult Dispositional Hope Scale.Results: Results showed that thwarted belongingness mediated the relationship between relationship status and suicidal behavior. The hypothesized moderated-mediation models were not supported.Conclusions: These findings have implications for the development of interventions that aim to reduce suicidal behaviors in gay men.
Keywords: Suicidal Ideation; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Social Behavior; Female; Interpersonal Relations; Adult; Male; Risk Factors; Questionnaires

Family, School, and Peer Support Are Associated With Rates of Violence Victimization and Self-Harm Among Gender Minority and Cisgender Youth...Head to Toe Conference, April 25, 2019, Albuquerque, New Mexico. - Ross-Reed, Danielle E.; Reno, Jessica; Peñaloza, Linda; Green, Dan; FitzGerald, Courtney (Journal of Adolescent Health, 2019)
Gender minority (GM) youth experience high rates of violence, and research on protective factors to reduce violence victimization and self-harm is lacking. The purpose of this study was to determine how family, school, peer, and community support influenced rates of violence victimization and self-harm among GM and cisgender adolescents. This research uses data from the 2017 New Mexico Youth Risk and Resiliency Survey (N = 18,451). The main independent variable was gender, dichotomized into GM and cisgender, and the secondary independent variables were family, school, community, and peer support. Dependent variables were sexual and dating violence, suicide attempts, and nonsuicidal self-injury. Logistic regression models were built for the four dependent variables, including demographics, support scores, and interaction terms between gender and support. Six percent of high school students in New Mexico identified as GM are unsure of their gender. GM students experienced higher rates of violence and self-harm and lower levels of support than cisgender students. Among all students, family support was associated with lower odds of sexual violence and self-harm, while school support was associated with lower odds of dating violence and nonsuicidal self-injury. There were significant interactions between gender, violence, and support. The protective effects of support were less pronounced for GM students than for cisgender students. Family and school support are associated with lower rates of some forms of violence and self-harm among adolescents. Additional support may be necessary to reduce harm among GM adolescents, who are at higher risk for violence and its sequelae.
Keywords: Sexual Abuse -- Epidemiology -- Mexico; Injuries, Self-Inflicted -- Epidemiology -- Mexico; Dating Violence -- Epidemiology -- Mexico; Suicide, Attempted -- Epidemiology -- Mexico; Minority Groups -- Psychosocial Factors -- In Adolescence; Crime Victims -- Psychosocial Factors; Family Relations; Support, Psychosocial; Peer Group; Gender Identity; Human; Congresses and Conferences -- Mexico; Mexico; Adolescence; Secondary Analysis; Logistic Regression; Students, High School -- Psychosocial Factors; Odds Ratio; Transgender Persons -- Psychosocial Factors; Risk Taking Behavior; Students, Middle School -- Psychosocial Factors; Cluster Sample; Descriptive Statistics; Hardiness; Bivariate Statistics; Pearson's Correlation Coefficient; Chi Square Test; Data Analysis Software; Confidence Intervals; Race Factors; Sex Factors; Socioeconomic Factors; Cross Sectional Studies; Injuries, Self-Inflicted -- Prevention and Control; Dating Violence -- Prevention and Control; Sexual Abuse -- Prevention and Control

Why Are We Not Closing the Gap in Suicide Disparities for Sexual Minority Youth? - Mustanski, Brian; Espelage, Dorothy L. (Pediatrics, 2020)
The article comments on two studies about the suicide rate among sexual minority youth (SMY) in the U.S. Topics discussed include the decline in suicidal ideation and behavior in both heterosexual youth and SMY, the diverging results between the decline in self-reported suicide rates and the increase in deaths by suicide, and the availability of evidence-based suicide prevention programs.
Keywords: Suicidal Ideation -- Trends -- United States; Suicide, Attempted -- Trends -- United States; Sexual and Gender Minorities -- Psychosocial Factors -- In Adolescence; Suicide -- Risk Factors; Health Status Disparities; United States; Suicide -- Prevention and Control; Sexual Identity; Adolescent Behavior; Adolescence

Sexual Orientation, Adult Connectedness, Substance Use, and Mental Health Outcomes Among Adolescents: Findings From the 2009 New York City Youth Risk Behavior Survey. - Seil, Kacie S.; Desai, Mayur M.; Smith, Megan V. (American Journal of Public Health, 2014)
Objectives. We examined associations between identifying as lesbian, gay, or bisexual (LGB) and lacking a connection with an adult at school on adolescent substance use and mental health outcomes including suicidality. Methods. We analyzed data from the 2009 New York City Youth Risk Behavior Survey (n = 8910). Outcomes of interest included alcohol use, marijuana use, illicit drug use, depressive symptomatology, suicide ideation, and suicide attempt. Results. The prevalence of each outcome was significantly higher among LGB adolescents than heterosexual adolescents and among those who lacked an adult connection at school than among those who did have such a connection. Even when LGB adolescents had an adult connection at school, their odds of most outcomes were significantly higher than for heterosexual adolescents. Those LGB adolescents who lacked a school adult connection had the poorest outcomes (about 45% reported suicide ideation; 31% suicide attempt). Conclusions. Adolescents who are LGB, particularly those who lack a connection with school adults, are at high risk for substance use and poorer mental health outcomes. Interventions should focus on boosting social support and improving outcomes for this vulnerable group.
Keywords: Risk Taking Behavior -- In Adolescence; Substance Abuse -- In Adolescence; Mental Health -- In Adolescence; Homosexuality -- In Adolescence; Bisexuality -- In Adolescence; Human; Surveys -- New York; New York; Descriptive Research; Descriptive Statistics; Alcohol Drinking; Cannabis; Suicide, Attempted; Suicidal Ideation; Male; Female; Secondary Analysis; Chi Square Test; Confidence Intervals; Odds Ratio; Multiple Logistic Regression; Adult; Cross Sectional Studies; Funding Source; Adolescence

Sexual Orientation, Adult Connectedness, Substance Use, and Mental Health Outcomes Among Adolescents: Findings From the 2009 New York City Youth Risk Behavior Survey - Seil, Kacie S.; Desai, Mayur M.; Smith, Megan V. (American Journal of Public Health, 2014)
Objectives. We examined associations between identifying as lesbian, gay, or bisexual (LGB) and lacking a connection with an adult at school on adolescent substance use and mental health outcomes including suicidality. Methods. We analyzed data from the 2009 New York City Youth Risk Behavior Survey (n = 8910). Outcomes of interest included alcohol use, marijuana use, illicit drug use, depressive symptomatology, suicide ideation, and suicide attempt. Results. The prevalence of each outcome was significantly higher among LGB adolescents than heterosexual adolescents and among those who lacked an adult connection at school than among those who did have such a connection. Even when LGB adolescents had an adult connection at school, their odds of most outcomes were significantly higher than for heterosexual adolescents. Those LGB adolescents who lacked a school adult connection had the poorest outcomes (about 45% reported suicide ideation; 31% suicide attempt). Conclusions. Adolescents who are LGB, particularly those who lack a connection with school adults, are at high risk for substance use and poorer mental health outcomes. Interventions should focus on boosting social support and improving outcomes for this vulnerable group.
Keywords: Risk Taking Behavior -- In Adolescence; Substance Abuse -- In Adolescence; Mental Health -- In Adolescence; Homosexuality -- In Adolescence; Bisexuality -- In Adolescence; Human; Surveys -- New York; New York; Descriptive Research; Descriptive Statistics; Alcohol Drinking; Cannabis; Suicide, Attempted; Suicidal Ideation; Male; Female; Secondary Analysis; Chi Square Test; Confidence Intervals; Odds Ratio; Multiple Logistic Regression; Adult; Cross Sectional Studies; Funding Source; Adolescence

Estimating the Risk of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-analysis. - di Giacomo, Ester; Krausz, Micheal; Colmegna, Fabrizia; Aspesi, Flora; Clerici, Massimo (JAMA Pediatrics, 2018)
This systematic review and meta-analysis examines the risk of attempted suicide among homosexual, bisexual, and transgender youths compared with heterosexual adolescents. Key Points: Question: Are sexual minority youths at higher risk of attempting suicide? Findings: In this systematic review and meta-analysis of nearly 2.5 million adolescents, sexual minority youths were found to have greater risk of life-threatening behaviors compared with their heterosexual peers. Transgender youths were the most affected followed by bisexual and homosexual teens. Meaning: Sexual minority adolescents may have a greater risk of life-threatening behaviors compared with heterosexual peers. Importance: Suicide is the second-leading cause of death among adolescents. Sexual minority individuals are at a higher risk of suicide and attempted suicide, but a precise and systematic evaluation of this risk among sexual minority youths has not been documented to our knowledge. Objective: To examine the risk of attempted suicide among sexual minority adolescents, differentiating for each sexual minority group. Data Sources: Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through April 30, 2017, with the following search terms: heterosexual, homosexual, bisexual, transgender, adolescents, teens, and attempted suicide. Study Selection: Studies that reported attempted suicide in sexual minority adolescents compared with heterosexual peers were included. Thirty-five studies satisfied criteria for inclusion of 764 records identified. Data Extraction and Synthesis: Pooled analyses were based on odds ratios (ORs), with relevant 95% CIs, weighting each study with inverse variance models with random effects. Risk of publication bias and analysis of heterogeneity through univariable and multivariable meta-regressions were also rated. Main Outcomes and Measures: The evaluation of increased odds of attempted suicide among sexual minority youths compared with heterosexual peers. Results: Thirty-five studies reported in 22 articles that involved a total of 2 378 987 heterosexual and 113 468 sexual minority adolescents (age range, 12-20 years) were included in the analysis. Sexual minority youths were generally at higher risk of attempted suicide (OR, 3.50; 95% CI, 2.98-4.12; c2 = 3074.01; P <.001; I2 = 99%). If estimated in each sexual minority group, the OR was 3.71 in the homosexual group (95% CI, 3.15-4.37; c2 = 825.20; P <.001; I2 = 97%) and 4.87 in the bisexual group (95% CI, 4.76-4.98; c2 = 980.02; P <.001; I2 = 98%); transgender youths were described as an individual group in only 1 study, which reported an OR of 5.87 (95% CI, 3.51-9.82). Meta-regressions weighted for the study weight highlighted that the presence of young participants (12 years old) was associated with heterogeneity in the bisexual group, whereas the year of sampling was associated with heterogeneity in the whole group when combined with other covariates. Conclusions and Relevance: Our findings suggest that youths with nonheterosexual identity have a significantly higher risk of life-threatening behavior compared with their heterosexual peers. Public awareness is important, and a careful evaluation of supportive strategies (eg, support programs, counseling, and destigmatizing efforts) should be part of education and public health planning.
Keywords: Suicide, Attempted -- Risk Factors -- In Adolescence; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Human; Systematic Review; Meta Analysis; Adolescence; PubMed; Embase; Psycinfo; Heterosexuals; Gay Persons; Bisexuals; Transgender Persons; Odds Ratio; Confidence Intervals; Univariate Statistics; Multivariate Analysis; Regression; Child; Support, Psychosocial; Counseling; Stigma; Public Health

Mediators of increased self-harm and suicidal ideation in sexual minority youth: a longitudinal study. - Oginni, O. A.; Robinson, E. J.; Jones, A.; Rahman, Q.; Rimes, K. A. (Psychological Medicine, 2019)
Background: Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships. Method: In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30–57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling. Results: Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43–3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex. Conclusions: Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.
Keywords: Injuries, Self-Inflicted; Suicidal Ideation; Self Concept; Depression; Minority Groups; Gender Identity; Human; Prospective Studies; Sex Factors; Sexuality; Socioeconomic Factors; Structural Equation Modeling; Confidence Intervals

Self-injury among trans individuals and matched controls: prevalence and associated factors. - Davey, Amanda; Arcelus, Jon; Meyer, Caroline; Bouman, Walter Pierre (Health & Social Care in the Community, 2016)
This study aims to determine the prevalence rate of current non-suicidal self-injury ( NSSI) among trans individuals, in comparison with a control sample of non-trans adults. It also aims to compare those with current NSSI and those with no history of NSSI in terms of psychological well-being, self-esteem, body dissatisfaction, social support and demographic factors. Participants were 97 adults, diagnosed with transsexualism ( ICD-10, F64.0), attending a national gender clinic in the United Kingdom, and a matched control group. Clinical participants were all engaged on the treatment pathway. Participants completed the following self-report measures: Self-Injury Questionnaire - Treatment Related ( SIQ- TR), Symptom Checklist 90 Revised ( SCL-90-R), Rosenberg Self-Esteem Scale ( RSE), Hamburg Body Drawing Scale ( HBDS) and Multidimensional Scale of Perceived Social Support ( MSPSS). The results showed that the trans participants had a significantly higher prevalence of current NSSI behaviour than the non-trans group, with 19% currently engaging in NSSI. Current NSSI was also significantly more prevalent among trans men than trans women. Compared with both trans and non-trans participants with no history of NSSI, trans participants with current NSSI had significantly higher scores on SCL; significantly lower scores on RSE, HBDS and MSPSS; and were younger in age. The study concludes that trans men, specifically, are more at risk of NSSI than trans women and the general population, even when on the treatment pathway. Those who currently self-injure have greater psychopathology, lower body satisfaction, lower self-esteem, lower social support and tend to be younger, than those who do not engage in NSSI.
Keywords: Injuries, Self-Inflicted; Transgender Persons -- Psychosocial Factors; Psychological Well-Being; Self Concept; Support, Psychosocial; Human; Symptom Checklist-90-Revised; Rosenberg Self Esteem Scale; Questionnaires; Scales; Male; Female; United Kingdom; Snowball Sample

Men Who Have Sex with Men in Kampala, Uganda: Results from a Bio-Behavioral Respondent Driven Sampling Survey. - Hladik, Wolfgang; Sande, Enos; Berry, Mark; Ganafa, Samuel; Kiyingi, Herbert; Kusiima, Joy; Hakim, Avi (AIDS & Behavior, 2017)
We report on the results of a respondent-driven sampling survey among men who have sex with men (MSM) in Kampala, Uganda, where same-sex behavior is criminalized and highly stigmatized. We enrolled 608 MSM aged 18 + years and residing in greater Kampala from June 2012-November 2013. Anonymous data were collected through audio-computer assisted self-interviews; blood was tested for HIV-1 antibodies, CD4 + T cell counts, and viral load. Estimated HIV prevalence was 12.2 % (95 % confidence interval [CI] 8.0-16.1), increasing with age. One in five (19.6 %) stated knowing their HIV-positive status and a similar proportion of HIV-infected MSM were virally suppressed (19.3 %; 95 % CI 3.3-33.1). HIV-related risk behaviors included unprotected anal sex (35.8 % at last sex act), selling sex (38.5 %), having multiple steady (54.3 %) or casual (63.6 %) partners, and ever injecting drugs (31.6 %). Forty percent experienced homophobic abuse; 44.5 % ever experienced suicide ideation. HIV prevalence among MSM remains high whereas knowledge of seropositive status and suppression of viral load remains low. MSM report a wide range of high risk behaviors, frequent homophobic abuse, poor mental health, as well as low levels of testing and treatment. Better access to tailored prevention and treatment services to improve population-level viral load suppression are warranted.
Keywords: Men Who Have Sex With Men -- Uganda; Human Immunodeficiency Virus; Uganda; Human; Surveys; Stigma; Hematologic Tests; Prevalence; Risk Taking Behavior; Viral Load; Unsafe Sex

Substance-related coping, HIV-related factors, and mental health among an HIV-positive sexual minority community sample. - Cramer, Robert J.; Colbourn, Scholar L.; Gemberling, Tess M.; Graham, James; Stroud, Caroline H. (AIDS Care, 2015)
HIV-positive status poses a unique set of social stressors, especially among lesbian, gay, and bisexual (LGB) persons. Among these difficulties are the internalization of HIV-related stigma and poor mental health. Unfortunately, substance use as a coping mechanism is also common, dependent on other demographic factors, among HIV-positive and LGB samples. The present study integrates these bodies of literature by examining main and interactive effects of HIV-related experiences (i.e., disclosure of HIV-positive status, fear of disclosure, HIV-related victimization, and internalized HIV-related stigma) and substance-related coping with discrimination as they impact mental health (i.e., stress, anxiety, depressive symptoms, and suicide and self-injury proneness). Participants were 216 HIV-positive LGB community members from an urban community medical clinic. Prominent results included: (1) robust negative effects of internalized HIV-related stigma on all mental health indicators when controlling for other HIV-related experiences and (2) a significant interaction in which substance-related coping significantly increases suicide proneness, only for those who have disclosed HIV-positive status to family or friends. Results are discussed with respect to theoretical perspectives of internalized stigma, implications for clinical work with LGB persons of HIV-positive status, and future research.
Keywords: HIV-Positive Persons -- Psychosocial Factors; LGBTQ+ Persons -- Psychosocial Factors; Substance Abuse; Coping; Life Experiences; Attitude to AIDS; Stigma; Mental Health; HIV Infections -- Psychosocial Factors; Human; Funding Source; Self Disclosure; Discrimination; Stress, Psychological; Anxiety; Depression; Suicidal Ideation; Self-Injurious Behavior; Crime Victims; Community Health Centers; Urban Areas; Male; Female; Adult; Middle Age; Outpatients; Ethnic Groups; Socioeconomic Factors; Texas; Surveys; Survey Research; Coefficient Alpha; Summated Rating Scaling; Scales; Descriptive Statistics; Multiple Regression; Attitude Measures; Psychological Tests

Sexual identity modifies the association between bullying and suicide planning among adolescents with same-sex sexual partners. - Turpin, Rodman; Boekeloo, Bradley; Dyer, Typhanye (Journal of LGBT Youth, 2019)
Heterosexual adolescents with same-sex sexual partners may be at increased risk for psychological distress from victimization; this may lead to suicidality. We tested if sexual identity modified the association between bullying at school and suicide planning among adolescents with the same-sex sexual partners. We sampled 924 youth with same-sex sexual partners from the 2015 Youth Risk Behavior Survey, testing the association between bullying and suicide planning using log-binomial regression with sexual identity interactions. Sexual identity modified this association, with the greatest association among heterosexual participants (PR = 4.01, 95% CI 2.60–6.18). Anti-homophobia messaging and intervention programs that target these youth may be needed.
Keywords: Gay Persons -- Psychosocial Factors; Sexual Partners -- Psychosocial Factors; Sexual Identity; Bullying -- Psychosocial Factors -- In Adolescence; School Violence -- Psychosocial Factors -- In Adolescence; Suicidal Ideation -- Risk Factors -- In Adolescence; Suicide, Attempted -- Risk Factors -- In Adolescence; Human; Adolescent Behavior; Regression; Heterosexuals; Confidence Intervals; Adolescence; Surveys; Sexual Partners; Questionnaires

Sociocultural barriers in management of gender dysphoria: A case report. - Nathvani, Milan; Saini, Vijay Kumar; Gehlawat, Pratibha (Indian Journal of Psychiatry, 2021)
In the article, the authors discuss the case of a 17-year-old man from low socioeconomic status who was rushed to a clinic due to headache, depressive symptoms, and repeated sexual thoughts with a male partner to analyze the condition called gender dysphoria (GD). He has a history of suicidal attempts. Also cited are the sociocultural barriers in managing GD, including societal pressures
Keywords: Gender Dysphoria -- Diagnosis; Depression; Adolescence; Male; Headache

The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use. - Liu, Cindy H.; Stevens, Courtney; Wong, Sylvia H.M.; Yasui, Miwa; Chen, Justin A. (Depression & Anxiety (1091-4269), 2019)
Background: The college years represent a period of increased vulnerability for a wide range of mental health (MH) challenges. The onset of common psychiatric conditions occurs during this period of development. Increases in depression, anxiety, and suicidality among U.S. college students have been observed. This study identified prevalence and correlates of MH diagnoses and suicidality in a recent sample of U.S. college students.Methods: The Spring 2015 American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed MH diagnoses and suicidality from U.S. undergraduate students (n = 67,308) across 108 institutions.Results: Stress was strongly associated with a greater likelihood of suicide attempts and MH diagnoses, even among students reporting 1-2 stressful events (OR [odds ratio] range 1.6-2.6, CI [confidence interval] = 1.2-3.2). Bisexual students were more likely to report MH diagnoses and suicidality, compared to heterosexual and gay/lesbian students (OR range 1.5-3.9, CI = 1.8-4.3), with over half engaging in suicidal ideation and self-harm, and over a quarter reporting suicide attempts. Transgender students reported a higher rate of MH diagnoses and suicidality relative to females (OR range 1.9-2.4, CI = 1.1-3.4). Racial/ethnic minority students were generally less likely to report MH diagnoses relative to Whites, although the likelihood for suicidality was mixed.Conclusions: The high rate of multiple stress exposures among the U.S. college population and the high impacts of stress on MH and suicidality point to an urgent need for service utilization strategies, especially among racial/ethnic, sexual, or gender minorities. Campuses must consider student experiences to mitigate stress during this developmental period.
Keywords: Mental Disorders -- Epidemiology; Suicidal Ideation; Mental Health -- Statistics and Numerical Data; Students -- Psychosocial Factors; Healthcare Disparities; Suicide, Attempted; Students -- Statistics and Numerical Data; Mental Disorders -- Diagnosis; Ethnic Groups -- Psychosocial Factors; Female; Human; Depression -- Epidemiology; Sexuality; United States; Minority Groups -- Psychosocial Factors; Adult; Minority Groups -- Statistics and Numerical Data; Population -- Psychosocial Factors; Odds Ratio; Stress, Psychological -- Epidemiology; Stress, Psychological -- Prevention and Control; Adolescence; Ethnic Groups -- Statistics and Numerical Data; Young Adult; Colleges and Universities; Surveys; Male; Population; Prevalence; Self-Injurious Behavior -- Epidemiology; Anxiety -- Epidemiology; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

Illicit Drug Use and Social Victimization among Thai Sexual and Gender Minority Adolescents. - Guadamuz, Thomas E.; Cheung, Doug H.; Boonmongkon, Pimpawun; Ojanen, Timo T.; Damri, Thasaporn; Samoh, Nattharat; Cholratana, Mudjalin; Ratchadapunnathikul, Chet; Sass, Justine (Substance Use & Misuse, 2019)
Objectives: We examined the prevalence of lifetime illicit drug use and social victimization, and their association, among sexual and gender minority (SGM) and non-SGM Thai adolescents. Methods: In 2013, we conducted a school-based national survey among students grades 7–12 (aged 13–20 years) from 15 secondary schools (n = 2,070) around Thailand. We classified adolescents with same-sex attraction, sexual or gender non-conforming identities as SGM. Generalized estimating equations were used to estimate the odds of illicit drug use by SGM and non-SGM status. Results: Prevalence of lifetime illicit drug use was significantly higher among SGM adolescents than non-SGM adolescents (10.3 vs. 5.3%), but did not differ between those with same-sex attraction and SGM identity (10.3 vs. 10.8%). Among non-SGM adolescents, general social victimization, sexual experience and any school truancy were associated with lifetime illicit drug use (OR = 2.59, 95% CI: 1.53, 4.38; OR = 6.59, 95% CI: 4.90, 8.86; and OR = 4.93, 95% CI: 3.13, 7.75, respectively). Among SGM adolescents, SGM-based social victimization, depressive symptomology and suicidal ideation were associated with lifetime illicit drug use (OR = 3.17, 95% CI: 2.03, 4.95; OR = 5.03, 95% CI: 2.32, 10.90; and OR = 5.03, 95% CI: 2.76, 9.16, respectively). Conclusions: SGM adolescents have higher burden of illicit drug use. Moreover, illicit drug use among SGM adolescents is indicative of depressive symptomology and suicidal ideation. Tailored and comprehensive programs are needed to reduce the gap in burden of illicit drug use between SGM and non-SGM adolescents.
Keywords: Street Drugs; Substance Abuse -- Epidemiology -- In Adolescence; Crime Victims; Thais; Minority Groups; Sexual Health; Human; Adolescence; Young Adult; Schools, Secondary; Thailand; Gender Identity; Prevalence; Attitude to Sexuality; Odds Ratio; Confidence Intervals; Depression; Suicidal Ideation

Early Sexual Experiences, Mental Health, and Risk Behavior among Black Non-Hispanic and Hispanic / Latino Men Who Have Sex with Men (MSM). - Downing, Martin J.; Benoit, Ellen; Brown, Dominique; Coe, Lauren; Hirshfield, Sabina; Pansulla, Louis; Carballo-Diéguez, Alex (Journal of Child Sexual Abuse, 2020)
Black and Latino men who have sex with men (MSM) are disproportionately affected by childhood sexual abuse (CSA). Investigating these histories is often confounded by underreporting and varied definitions of abuse. Unrecognized abuse may manifest in unhealthy ways, specifically psychological distress, substance use, and high-risk sexual behaviors. Black and Hispanic/Latino MSM in New York City discussed formative sexual experiences in in-person interviews. Eligible men reported a sexual experience occurring before age 16 with a man or woman 18 or older at the time. Among interviewees (n = 61), men living with HIV were significantly younger at the time of their first sexual experience with a male partner compared to HIV-negative men. Approximately half of interviewees (47.5%) scored at or above the diagnostic cutoff for post-traumatic stress disorder (PTSD). Hispanic/Latino men had increased odds of scoring at or above the diagnostic cutoff for PTSD compared to Black non-Hispanic men. Further, nearly half of interviewees (46%) scored at or above the diagnostic cutoff for harmful drug use or possible drug dependence. Study findings have implications for future research using an indirect approach to uncovering potential sexual abuse during childhood, and associations with adult health outcomes.
Keywords: Child Abuse, Sexual; Sexuality; Mental Health; Risk Taking Behavior; Black Persons; Hispanic Americans; Men Who Have Sex With Men; Human; Male; Adolescence; Adult; Middle Age; Child Abuse Survivors; Psychological Distress; Interviews; Substance Abuse; Hardiness; HIV-Positive Persons; Stress Disorders, Post-Traumatic; Descriptive Statistics; Socioeconomic Factors; Psychological Well-Being; Suicidal Ideation; Data Analysis Software; T-Tests; Mann-Whitney U Test; Confidence Intervals; Pearson's Correlation Coefficient; Two-Tailed Test; Spearman's Rank Correlation Coefficient; Funding Source; Checklists

Minority Stress and Relational Mechanisms of Suicide among Sexual Minorities: Subgroup Differences in the Associations Between Heterosexist Victimization, Shame, Rejection Sensitivity, and Suicide Risk. - Mereish, Ethan H.; Peters, Jessica R.; Yen, Shirley (Suicide & Life-Threatening Behavior, 2019)
Despite sexual orientation disparities in suicide, there is limited research examining factors associated with suicide risk among sexual minorities while considering subgroup differences within this group. This study identified differences between sexual minorities at risk for suicide and those not at risk. The study also examined heterosexist victimization, as one form of minority stress, and two relational mechanisms (i.e., shame and rejection sensitivity) as risk factors for suicidality. We examined a moderated-mediation model, in which we tested gender and sexual orientation differences in the mediating effects of the relational mechanisms on the association between heterosexist victimization and suicide risk. Participants were recruited online and completed an online survey. The sample included 719 sexual minority adults. Of the sample, 27.7% were at risk for suicide. Suicide risk varied by age, gender, sexual orientation, income, education, and relationship status. Heterosexist victimization, shame, and rejection sensitivity were significant risk factors for suicide. Shame and rejection sensitivity were mediators of the association between heterosexist victimization and suicide risk for subgroups of sexual minorities, mostly lesbian and gay individuals and to some extent bisexual individuals. The findings underscore minority stress, shame, and rejection sensitivity as key intervention points.
Keywords: Suicide -- Psychosocial Factors; Homophobia -- Psychosocial Factors; Shame; Crime Victims -- Psychosocial Factors; Bullying; Female; Risk Factors; Violence -- Psychosocial Factors; Self-Injurious Behavior -- Psychosocial Factors; Male; Adult; Middle Age; Aged; Self Concept; Young Adult; Adolescence

All‐Cause and Suicide Mortality Among Lesbian, Gay, and Bisexual Veterans Who Utilize Care through the Veterans Health Administration. (Health Services Research, 2020)

Non-binary and binary transgender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences. - Rimes, Katharine A.; Goodship, Nicola; Ussher, Greg; Baker, Dan; West, Elizabeth (International Journal of Transgenderism, 2019)
Background: Little research has compared the mental health and victimization experiences of non-binary youth depending on their sex assigned at birth (SAAB), or compared these two groups with binary transgender youth. Aims: To compare mental health, self-harm and suicidality, substance use and victimization experiences between non-binary and binary transgender young adults, both male assigned at birth (MAAB) and female assigned at birth (FAAB). Methods: Online survey data from 677 participants from the "Youth Chances" community study of 16 to 25 year olds in the United Kingdom was analyzed, comparing across binary participants (transgender females (n = 105) and transgender males (n = 210)) and non-binary participants (MAAB (n = 93) and FAAB (n = 269)). Results: Female SAAB participants (binary and non-binary) were more likely to report a current mental health condition and history of self-harm than male SAAB participants (binary and non-binary). Similarly, female SAAB participants (binary and non-binary) were more likely to report childhood sexual abuse than male SAAB participants (binary and non-binary); the reverse pattern was found for lifetime physical assault relating to being LGBTQ. Non-binary MAAB participants were less likely than the other groups to report past suicide attempts and previous help-seeking for depression/anxiety. Binary participants reported lower life satisfaction than non-binary participants. For all four groups, mental health problems, self-harm, suicidality, alcohol use and victimization experiences were generally higher than that of youth in general population studies. Conclusions: These findings highlight the importance of considering both non-binary versus binary gender identity and SAAB in relation to mental health problems, self-harm, suicidality and substance use in transgender youth. The roles of sexual abuse, other abuse and discrimination in contributing to increased rates of mental illness and self-harm in non-binary and binary transgender individuals, particularly those who were assigned female at birth, relative to those assigned male, require investigation.
Keywords: Transgender Persons -- Psychosocial Factors; Injuries, Self-Inflicted; Suicidal Ideation; Substance Abuse; Crime Victims; Gender Identity; Mental Disorders; Human; Adolescence; Young Adult; Adult; Male; Female; Surveys; United Kingdom; Health Status; Child Abuse, Sexual; Assault and Battery; LGBTQ+ Persons; Suicide, Attempted; Help Seeking Behavior; Depression; Anxiety; Personal Satisfaction; Alcohol Abuse; Discrimination

Mental Health Promotion for Gender Minority Adolescents. - Tobin, Valerie; Bockting, Walter O.; Hughes, Tonda L. (Journal of Psychosocial Nursing & Mental Health Services, 2018)
The current study uses an ecological model of biopsychosocial vulnerability to guide the description of risk and protective factors for the mental health of gender minority (i.e., transgender and gender non-conforming) adolescents at the individual, family, community, and societal levels. Minority stress is the vulnerability of youth who are lesbian, gay, bisexual, and transgender (LGBT) to adverse mental health outcomes due to stigma. In addition, unlike cisgender (non-transgender) LGB individuals, gender minorities may experience internal stress related to gender dysphoria. Gender dysphoria may lead to interaction with health care providers who may not be educated in the care of gender minority youth. The ecological model is an organizing framework for understanding domains of health risks that aff ect such youth to assist nurses in intervening to promote the health of gender minority adolescents. Specific attention is paid to the potential contributions of psychiatric-mental health nurses to the care of gender minority adolescents.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Health Promotion -- Methods; Mental Health; Minority Groups; Adolescence; Psychiatric Nursing; Minority Stress -- In Adolescence; Gender Dysphoria; Hardiness; Depression -- Risk Factors; Suicide, Attempted -- Risk Factors; Violence; Bullying; Gender Identity

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

Screening for depression among youth with HIV in an integrated care setting. - Walsh, Audra St. John; Wesley, Katherine L.; Tan, Sim Yin; Lynn, Courtney; O'Leary, Kimberly; Wang, Yan; Nguyen, Diep; Chenneville, Tiffany; Rodriguez, Carina A. (AIDS Care, 2017)
Youth living with HIV (YLWH) are at risk for depression. Depressive symptoms can impact treatment engagement, health outcomes, and quality of life. Early identification of symptoms can guide treatment planning. This study aimed to identify trends in depressive symptoms for YLWH in a specialty-care clinic and follow-up clinical treatment procedures. An archival review of a clinical database provided depression screening information for a sample of 130 YLWH between 11 and 25 years old in the southeastern United States. Findings indicated that approximately 24% of the sample screened positive for depression-risk. Most commonly endorsed symptoms included fatigue (54.3%) and sleep difficulties (48.5%). Depressive symptoms did not differ significantly by age, gender, race, ethnicity, or sexual orientation. Youth who acquired HIV behaviorally were more likely to endorse the critical item (i.e., self-harm and/or suicidal ideation) than youth who acquired HIV perinatally. Forty-percent of the sample (i.e., 51 youth) had a follow-up treatment plan. YLWH who endorsed the critical item were more likely to receive follow-up action when compared to those who did not endorse the item. Despite limitations of the study, findings have important implications for clinical care and future research.
Keywords: HIV-Positive Persons -- Psychosocial Factors; Health Screening; Depression -- Diagnosis; Injuries, Self-Inflicted; Human; Male; Female; Child; Adolescence; Young Adult; Adult; Suicidal Ideation; Depression -- Risk Factors

Understanding pathways to e-cigarette use across sexual identity: A multi-group structural equation model. - Doxbeck, Courtney R.; Jaeger, Joseph A.; Bleasedale, Jacob M. (Addictive Behaviors, 2021)
This study explored the relationships between sexual violence, smoking behaviors, suicidality and past 30-day e-cigarette use under the theoretical framework of Minority Stress Theory. The 2017 National Youth Risk Behavioral Survey was utilized to study a nationally representative sample of sexual minority (lesbian, gay, bisexual, and unsure) and heterosexual high school students (N = 7882). Multi-group structural equation modeling (SEM) was employed to examine whether sexual violence and suicidality had a direct effect on e-cigarette use, after controlling for prior smoking behaviors (cigarette, cigar, and marijuana use). Suicidality and smoking behaviors were examined as mediators of the relationship between sexual violence and e-cigarette use, and suicidality was examined as a mediator of the relationship between sexual violence and smoking behaviors. This model was tested for invariance across sexual minority and heterosexual students. For both groups, smoking behaviors had significant direct effects on e-cigarette use, yet suicidality revealed no significant direct effects. Both suicidality and sexual violence had significant indirect effects on e-cigarette use through their effects on smoking behaviors. Sexual violence had a significant direct effect on e-cigarette use for sexual minority students, but not for heterosexual students. Despite this notable difference, the model was found to be invariant across the two groups. These findings suggest that students who report sexual violence may experience suicidality and victimization may lead to smoking behaviors and e-cigarette use. Students' mental health and substance use behaviors should continue to be targeted in schools, particularly among sexual minority youths.

The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support. - Wilson, Erin; Chen, Yea-Hung; Arayasirikul, Sean; Raymond, H.; McFarland, Willi (AIDS & Behavior, 2016)
Significant health disparities exist for transgender female (trans*female) youth. We assessed differences in mental health outcomes based on exposure to discrimination among transgender female youth in the San Francisco Bay Area aged 16-24 years. Youth were recruited using a combination of respondent driven sampling with online and social media methods. Logistic regression models were used to estimate odds ratios for the mental health outcomes, comparing levels of discrimination and levels of resiliency promoting protective factors among sexually active youth in the sample (N = 216). High transgender-based discrimination was significantly associated with greater odds of PTSD (AOR, 2.6; 95 % CI 1.4-5.0), depression (AOR, 2.6; 95 % CI 1.2-5.9), and stress related to suicidal thoughts (AOR 7.7, 95 % CI 2.3-35.2). High racial discrimination was significantly associated with greater odds of psychological stress (AOR 3.6; 95 % CI 1.2-10.8), PTSD (AOR 2.1; 95 % CI 1.1-4.2) and stress related to suicidal thoughts (AOR 4.3, 95 % CI 1.5-13.3). Parental closeness was related to significantly lower odds of all four mental health outcomes measured, and intrinsic resiliency positively reduced risk for psychological stress, PTSD, and stress related to suicidal thoughts. Transgender and racial discrimination may have deleterious effects on the mental health of trans*female youth. Interventions that address individual and intersectional discrimination and build resources for resiliency and parental closeness may have success in preventing mental health disorders in this underserved population.
Keywords: Sexism -- Psychosocial Factors; Transgender Persons -- Psychosocial Factors; Support, Psychosocial; Parent-Child Relations; Human; Female; Sex Factors; California; Adolescence; Adult; Logistic Regression; Odds Ratio; Healthcare Disparities; Stress, Psychological; Confidence Intervals; Parents; Hardiness

Poorer mental health in UK bisexual women than lesbians: evidence from the UK 2007 Stonewall Women's Health Survey. - Colledge, Lisa; Hickson, Ford; Reid, David; Weatherburn, Peter (Journal of Public Health, 2015)
Background Bisexual- and lesbian-identified women have significantly worse mental health than heterosexual women. Less evidence exists about mental health differences between lesbian and bisexual women. Methods Self-completion survey with community-based, opportunistic sampling recruited 937 bisexual-identified and 4769 lesbian-identified women. Associations between sexual identity and mental health indicators were assessed by logistic regression, controlling for age, income, student status and employment. Results As a group, bisexual women were younger, poorer, and more likely to be trans-identified, minority ethnic identified and to use marijuana, compared with lesbians. Bisexuals were more likely than lesbians to report eating problems (adjusted odds ratio (AOR) = 1.64, P< 0.001), self-harm (AOR = 1.37, P = 0.001), depressed feelings (AOR = 1.26, P = 0.022) and anxiety (AOR = 1.20, P = 0.037). Fewer bisexual women attended lesbian or bisexual social events, were ‘out', or had experienced any sexuality-related discrimination, compared with lesbians. Conclusion More bisexual women reported poor mental health or psychological distress than did lesbians. Bisexual women may be more likely to experience social stress due to the ‘double discrimination' of homophobia and biphobia. This stress, experienced mainly as internalized and felt stigma, could result in greater risk for poor mental health compared with lesbians. Addressing both biphobia and homophobia within UK society has important preventative mental health implications.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- Great Britain; Mental Disorders -- Risk Factors; Bisexuals; Lesbians; Human; Female; Great Britain; Surveys; Sexual Identity; Logistic Regression; Age Factors; Odds Ratio; P-Value; Eating Disorders -- Risk Factors; Injuries, Self-Inflicted -- Risk Factors; Stress, Psychological; Stigma; Social Attitudes; Cross Sectional Studies; Questionnaires; Data Analysis Software; Chi Square Test; T-Tests; Wilcoxon Rank Sum Test; Descriptive Statistics; Suicidal Ideation; Convenience Sample; Funding Source; Homophobia

Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data From a Systematic Review. - Salway, Travis; Plöderl, Martin; Liu, Juxin; Gustafson, Paul (American Journal of Epidemiology, 2019)
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.
Keywords: Suicide, Attempted -- Epidemiology; Heterosexuals -- Psychosocial Factors; Transgender Persons -- Psychosocial Factors; Measurement Error; Models, Statistical; Human; Prevalence; Probability; Adult; Meta Analysis; Relative Risk; Sensitivity and Specificity; Confidence Intervals; Systematic Review

Challenges in Timing Puberty Suppression for Gender-Nonconforming Adolescents. - de Vries, Annelou L. C. (Pediatrics, 2020)
The article comments on the report "Mental Health and Timing of Gender-Affirming Care," by Sorbara et al, which focused on the age of clinical presentation for gender-affirming medical interventions and its association with mental health in transgender youth. Findings revealed that puberty suppression should be offered at an early age. It was observed that teenagers presenting at younger age resulted to lower rates of self-reported diagnosed depression, suicide thoughts and self-harm.
Keywords: Gender Nonconformity -- In Adolescence; Gender Dysphoria -- Psychosocial Factors -- In Adolescence; Puberty -- Psychosocial Factors; Gender Affirmation Procedures -- In Adolescence; Adolescence; Gender Identity; Transgender Persons -- Psychosocial Factors; Hormone Therapy; Stress, Psychological -- Prevention and Control; Mental Health; Adolescent Psychology; Psychological Well-Being

Mental Health and Psychosocial Risk and Protective Factors Among Black and Latinx Transgender Youth Compared With Peers. - Vance, Stanley Ray; Boyer, Cherrie B.; Glidden, David V.; Sevelius, Jae (JAMA Network Open, 2021)
Key Points: Question: Do Black and Latinx transgender youth experience greater mental health symptoms than their White transgender and Black and Latinx cisgender peers? Findings: In this survey study of 19 780 participants, analyses of a statewide school-based survey data set indicated that Black and Latinx transgender youth had high rates of depressive symptoms and suicidality, similar to those among White transgender youth but higher than those among Black and Latinx cisgender youth. Meaning: These findings suggest that Black and Latinx transgender youth are susceptible to mental health symptoms that should be addressed through clinical services that consider both race/ethnicity and gender identity. This survey study compares past-year mental health symptoms and psychosocial factors among Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth. Importance: Black and Latinx transgender youth experience stigma that may increase their susceptibility to mental health symptoms. Objective: To compare past-year mental health symptoms and psychosocial factors among Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth. Design, Setting, and Participants: This survey study used data from the 2015-2017 Biennial California Healthy Kids Survey with a weighted sample (N = 45 269) representative of California's secondary school population. The analytic sample (n = 19 780) included Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth in the 9th and 11th grades. Data analysis was conducted from July 2020 to February 2021. Main Outcomes and Measures: Outcomes include past-year depressive symptoms and suicidality. Psychosocial risk factors include school-based victimization, gender-based harassment, sexuality-based harassment, and race-based harassment; protective factors include school connectedness and caring adult relationships. Results: The analytic sample of 19 780 participants (in 9th grade: weighted percentage, 51% [95% CI, 50% to 52%]; female participants: weighted percentage, 50% [95% CI, 49% to 51%]) included 252 Black and Latinx transgender youth (weighted percentage, 1.3% [95% CI, 1.1% to 1.5%]), 104 White transgender youth (weighted percentage, 0.7% [95% CI, 0.6% to 0.8%]), and 19 424 Black and Latinx cisgender youth (weighted percentage, 98.0% [95% CI, 97.8% to 98.2%]). For Black and Latinx transgender youth, estimated prevalence of depressive symptoms and suicidality were 50% (95% CI, 44% to 57%) and 46% (95% CI, 39% to 52%), respectively. Logistic regression models adjusted for grade, living arrangement, and reported sex indicated that compared with White transgender youth, Black and Latinx transgender youth had similar odds of depressive symptoms (adjusted odds ratio, 0.6; 95% CI, 0.4 to 1.1) and suicidality (adjusted odds ratio, 1.1; 95% CI, 0.6 to 1.8) and similar odds of all forms of harassment (eg, race-based harassment: adjusted odds ratio, 1.5; 95% CI, 0.8 to 2.6). Regression models indicated that compared with White transgender youth, Black and Latinx transgender youth had similar levels of victimization (adjusted linear regression coefficient, 0.5; 95% CI, −0.3 to 1.3) and caring adult relationships (adjusted linear regression coefficient, −0.6; 95% CI, −1.4 to 0.09) but lower levels of school connectedness (adjusted linear regression coefficient, −1.6; 95% CI, −2.9 to −0.4). With similar analyses, compared with Black and Latinx cisgender youth, Black and Latinx transgender youth had higher odds of depressive symptoms (adjusted odds ratio, 2.7; 95% CI, 2.0 to 3.7) and suicidality (adjusted odds ratio, 5.9; 95% CI, 4.3 to 8.0), higher odds and levels of all forms of harassment and victimization (eg, race-based harassment: adjusted odds ratio, 3.2; 95% CI, 2.4 to 4.5), and lower levels of school connectedness (adjusted linear regression coefficient, −2.6; 95% CI −3.3 to −1.8) and caring adult relationships (adjusted linear regression coefficient, −0.9; 95% CI −1.3 to −0.5). Conclusions and Relevance: In this study, Black and Latinx transgender youth had high rates of mental health symptoms, with rates comparable with White transgender youth but higher than Black and Latinx cisgender youth. Their unique pattern of psychosocial risk and protective factors for these mental health symptoms should be factored in clinical preventive services and school-based interventions to support them.
Keywords: Transgender Persons -- Psychosocial Factors; Black Persons -- Psychosocial Factors; Hispanic Americans -- Psychosocial Factors; Mental Disorders -- Risk Factors; Human; Male; Female; Adolescence; Support, Psychosocial; Stigma; Depression -- Epidemiology; Suicidal Ideation -- Epidemiology; Sexual Harassment; Racism; Sexism; Peer Group; Interpersonal Relations; Family Relations; Questionnaires; Descriptive Statistics; Odds Ratio; Confidence Intervals; Data Analysis Software; Regression; Gender Identity; Sexuality; School Violence; Bullying; Funding Source

Sounding the Alarm: Perinatally HIV-Infected Youth More Likely to Attempt Suicide Than Their Uninfected Cohort Peers. - Kreniske, Philip; Mellins, Claude Ann; Dolezal, Curtis; Korich, Rehema; Leu, Cheng-Shiun; Wiznia, Andrew; Abrams, Elaine J. (Journal of Adolescent Health, 2019)
Suicide is the second leading cause of death among youth in the U.S., yet there are few studies on suicide among youth with perinatally acquired HIV infection (YPHIV). Our aim was to determine if suicide attempts differed for YPHIV compared with perinatally HIV-exposed but uninfected peers (YPHEU). Data come from a longitudinal behavioral health cohort (N = 340) of YPHIV (n = 206) and YPHEU (n = 134) recruited between ages 9 and 16 years and interviewed with psychosocial batteries every 12–18 months. Logistic regression analyses were conducted to assess the association between reported suicide attempt and participants' HIV status. We assessed whether baseline demographic characteristics and sexual orientation were potential confounding factors. Fisher's exact tests were used to evaluate the association between first attempted suicide and HIV status within age groups. YPHIV were more likely to make a suicide attempt than YPHEU (odds ratio = 2.35, 95% confidence interval = 1.28–4.34). Youth most often reported their first attempt between the ages of 14–18 years. Demographic characteristics and sexual orientation were not associated with attempted suicide. YPHIV compared with YPHEU were more likely to report a suicide attempt, and this difference emerged during late adolescence and persisted through young adulthood.
Keywords: HIV Infections -- Diagnosis -- In Utero; Suicide, Attempted -- Epidemiology -- United States; Suicide, Attempted -- Risk Factors -- In Adolescence; Risk Assessment; Human; Descriptive Statistics; Prospective Studies; Child; Adolescence; Logistic Regression; Sexuality; Fisher's Exact Test; Comparative Studies; Fetus; Interviews; Disease Transmission, Vertical; Adolescent Behavior; Psychological Tests; Young Adult; Adult; Odds Ratio; Confidence Intervals; Funding Source; Male; Female; United States

Counselling Transgender Individuals: Issues and Considerations. - Weir, Cassandra; Piquette, Noëlla (Canadian Psychology, 2018)
Transgender individuals represent a unique population whose voices are often lost within the Lesbian, Gay, Bisexual, and Transgender (LGBT) population. Being transgender challenges the assumptions that people may make regarding sex and gender as they do not adhere to a gender binary. Transgender individuals experience unique life challenges and are at risk for violence as well as mental health concerns, including suicide. With an increase in awareness regarding transgender individuals, as well as recent changes to policies and treatment, it is important that counsellors are aware of this population and the challenges they face. Transgender individuals are often combined with other sexual minorities; however, although they may identify as homosexual and experience homophobia, they also experience transphobia because of their gender identity. The potential for multiple forms of violence, combined with a lack of safe and appropriate supports, can lead to the potential for serious harm and damage among this population. Therefore, counsellors should work toward developing competencies and awareness in how to best serve this population. This article addresses many of the key issues and counselling recommendations.
Keywords: Transgender Persons -- Psychosocial Factors; Counseling; Gender-Based Violence -- Risk Factors; Mental Health; Suicide; Health Policy; Homosexuality; Homophobia; Gender Identity; Minority Groups

LGBT-Specific Education in General Psychiatry Residency Programs: a Survey of Program Directors. - Hirschtritt, Matthew E.; Noy, Gaddy; Haller, Ellen; Forstein, Marshall (Academic Psychiatry, 2019)
Objective: Lesbian, gay, bisexual, transgender (LGBT) and other sexual minority individuals are at higher risk than non-LGBT individuals for multiple psychiatric conditions and suicide. However, little is known regarding LGBT-specific training among psychiatric residents. The authors sought to characterize LGBT-specific training among adult psychiatry residency programs.Methods: An anonymous, cross-sectional survey was electronically distributed to U.S.-based adult psychiatry program directors between February and April 2018. Survey topics included program demographics, characteristics of LGBT-specific training, perceived barriers to implementation, and anticipated needs.Results: Seventy-two program directors (30.8%) provided complete survey responses. Over half (55.6%) of these programs had ≤ 5 h of LGBT-specific training ("lower-hour programs"). Lower- and higher-hour (> 5 h of LGBT-specific education) programs were similar on measured demographic variables, but lower-hour programs covered fewer LGBT-specific topics and program directors were more likely to report lack of interested or topic-expert faculty as a barrier to enhancing LGBT-specific training.Conclusions: Results of this survey suggest a need for the development and implementation of LGBT-specific educational curricula for use in U.S.-based adult psychiatry programs. In addition, future research may explore effective ways for programs to recruit, retain, and support teaching faculty with LGBT-specific expertise.
Keywords: Psychiatry -- Education; Internship and Residency; Curriculum -- Statistics and Numerical Data; Physician Executives; Adult; Healthcare Disparities; Cross Sectional Studies; Female; Questionnaires; Scales; Ways of Coping Questionnaire; Funding Source; Human

Suicidal ideation and attempted suicide amongst Chinese transgender persons: National population study. - Chen, Runsen; Zhu, Xuequan; Wright, Lucy; Drescher, Jack; Gao, Yue; Wu, Lijuan; Ying, Xin; Qi, Ji; Chen, Chen; Xi, Yingjun; Ji, Lanxin; Zhao, Huichun; et al. (Journal of Affective Disorders, 2019)
Background: This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China.Methods: Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants' demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China.Results: A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models.Limitations: The cross-sectional study design and lack of follow-up data are limitations of this study.Conclusions: This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population.
Keywords: Suicide, Attempted; Suicidal Ideation; Depression -- Epidemiology; China; Family Conflict; Mental Health Services; Suicide, Attempted -- Psychosocial Factors; Male; Self-Injurious Behavior -- Psychosocial Factors; Adult; Self-Injurious Behavior -- Epidemiology; Parents; Female; Human; Depression -- Psychosocial Factors; Cross Sectional Studies; Prevalence; Adolescence; Young Adult; Risk Factors; Educational Status; Sexuality; Logistic Regression; Patient Attitudes; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

Current and Military-Specific Gender Minority Stress Factors and Their Relationship with Suicide Ideation in Transgender Veterans. - Tucker, Raymond P.; Testa, Rylan J.; Reger, Mark A.; Simpson, Tracy L.; Shipherd, Jillian C.; Lehavot, Keren (Suicide & Life-Threatening Behavior, 2019)
Research suggests the prevalence of suicide ideation and suicide attempts in the transgender veteran community may be upwards of 20 times higher than nontransgender veterans, who are known to be at increased risk than the general US population. This study aimed to understand the potential influence of external and internal minority stress experienced during and after military service on past-year and recent suicide ideation in a sample of 201 transgender veterans. Nonparametric bootstrapping analyses indicated past-year transgender-specific discrimination and rejection (external minority stress) indirectly predicted frequency of both past-year and past 2-week suicide ideation through past-year shame related to gender identity (internal minority stress). This result was significant when controlling for symptoms of depression and demographics. Similar patterns emerged when examining relationships among military external and internal minority stress on suicide outcomes. These results suggest that attempts to reduce both the experience and impact of minority stressors related to gender identity during and after military service may be an important avenue for suicide prevention.
Keywords: Suicidal Ideation; Gender Identity; Stress, Psychological -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Veterans -- Psychosocial Factors; Depression -- Psychosocial Factors; Human; Adult; Shame; Middle Age; Female; Male; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Funding Source

Psychiatric, Psychological, and Social Determinants of Health in the Nurses' Health Study Cohorts. - Trudel-Fitzgerald, Claudia; Ying Chen; Singh, Ankura; Okereke, Olivia I.; Kubzansky, Laura D. (American Journal of Public Health, 2016)
Objectives. To review the contribution of the Nurses' Health Studies (NHS) on factors that influence mental and physical health. Methods. Narrative review of all published articles using data from the NHS, the NHS II, and the Growing Up Today Study focusing on mental health conditions (e.g., depression, post- traumatic stress disorder, anxiety) and psychosocial resources and stressors (e.g., job strain, interpersonal violence, social relationships, sexual orientation) between 1990 and 2016. Results. Studies have considered a broad array of determinants (e.g., genes, biomarkers, air pollution) and consequent behavioral and disease-related outcomes (e.g., body weight, smoking, cardiometabolic diseases, cancer, autism). Findings suggest anxiety, posttraumatic stress disorder, childhood violence, caregiver burden, and job insecurity may increase the risk of coronary heart disease and diabetes, whereas findings with cancer are mixed. This work directly affects public health actions, as demonstrated by recent inclusion of a gender expression measure in state surveys. Conclusions. The NHS cohorts have produced novel and influential research on the interplay of psychological and social factors with health. Psychological and social variables are important contributors to the maintenance or decline of physical and mental health.
Keywords: Social Determinants of Health; Mental Health; Health Status; Genetics; Biological Markers; Air Pollution; Anxiety; Stress Disorders, Post-Traumatic; Child Abuse; Caregiver Burden; Job Security; Depression; Suicide; Interpersonal Relations; Sexuality; Gender Identity; Violence

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

Calgary Social Workers for Social Justice (CSWSJ): our story. - Valentich, Mary; Schmitz, Yvonne; McFarlane, Linda (Social Work with Groups, 2020)
An account of the emergence in 2011 of Calgary Social Workers for Social Justice, an interest group of the Alberta College of Social Workers. This group of volunteers has dedicated itself to actions related to diverse issues such as poverty reduction, violence against women, medically assisted dying and LGBTQ concerns. In the process, they have gained friendship and strength to pursue positive change.
Keywords: Social Workers -- Psychosocial Factors -- Alberta; Social Justice; Social Welfare; Social Work Practice; Volunteer Workers; Poverty -- Prevention and Control; Violence -- Prevention and Control; Suicide, Assisted; Alberta

Homeless Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth in New York City: Insights from the Field. - Ream, Geofrey L.; Forge, Nicholas R. (Child Welfare, 2014)
This article reviews existing information about homeless lesbian, gay, bisexual, and trans-gender (LGBT) youth in New York City. It describes how the frequently heard narrative about them--"kicked out" of familial homes to the streets for being LGBT, heavy involvement with hard drugs and sex work, broad prevalence of HIV and suicidality--misrepresents the majority. It foregrounds issues that really are faced by most homeless LGBT youth, such as trauma, discrimination in foster care and shelters, structural barriers to exiting homelessness, and emerging adult development.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- New York; Homelessness -- Psychosocial Factors -- In Adolescence; New York; Foster Home Care; Discrimination; Life Change Events; Family Relations; Social Work Service -- Psychosocial Factors; Housing; Substance Abuse; Mental Disorders; HIV Infections -- Risk Factors; Adolescence; Sex Work

The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets. - Xue, Jia; Chen, Junxiang; Chen, Chen; Hu, Ran; Zhu, Tingshao (Journal of Medical Internet Research, 2020)
Background: Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time.Objective: This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter.Methods: We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets.Results: We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence-related news (eg, Tara Reade, Melissa DeRosa).Conclusions: This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks.
Keywords: Disease Outbreaks; Social Media; Pneumonia, Viral -- Epidemiology; Domestic Violence; Coronavirus Infections -- Epidemiology; Domestic Violence -- Legislation and Jurisprudence; Male; Female; Arthritis Impact Measurement Scales; Clinical Assessment Tools; Social Readjustment Rating Scale

The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study. - Research, Elizabeth McDermott Senior Lecturer in Health; Health, Elizabeth Hughes Professor of Applied Mental; Fellow, Victoria Rawlings Teaching (Journal of Public Health, 2018)
Background Lesbian, gay, bisexual and transgender (LGBT) youth have a higher risk of suicidality and self-harm than heterosexual youth populations but little is known about the underlying mechanisms. We aimed to investigate the social determinants of this mental health inequality. Methods A two-stage sequential mixed method study was conducted. Firstly, 29 semi-structured interviews with LGBT youth (aged 13–25 years old) were completed. Data was analysed thematically. Stage 2 involved a self-completed questionnaire employing an online community-based sampling strategy (n = 789). Logistic regression analysis was performed to predict suicidality. Results Five social determinants explained suicidal risk: (i) homophobia, biphobia or transphobia; (ii) sexual and gender norms; (iii) managing sexual and gender identities across multiple life domains; (iv) being unable to talk; (v) other life crises. Youth who were transgender (OR = 1.50, P < 0.022), disabled (OR = 2.23, P < 0.000), had self-harmed (OR = 7.45, P < 0.000), were affected by abuse (OR = 2.14, P < 0.000), and affected by not talking about their emotions (OR = 2.43, P < 0.044) were most likely to have planned or attempted suicide. Conclusions Public health universal interventions that tackle bullying and discrimination in schools, and selected interventions that provide specific LGBT youth mental health support could reduce LGBT mental health inequalities in youth suicidality.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- England; Suicidal Ideation -- Psychosocial Factors; Suicidal Ideation -- Risk Factors; Social Determinants of Health; Human; England; Multimethod Studies; Semi-Structured Interview; Adolescence; Young Adult; Adult; Questionnaires; Logistic Regression; Homophobia -- Psychosocial Factors; Sexuality; Sexual Identity; Gender Identity; Odds Ratio; Mental Disorders; Health Status Disparities; Exploratory Research; Cross Sectional Studies; Thematic Analysis; Descriptive Statistics; Funding Source

Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study. - Tomori, Cecilia; McFall, Allison; Mehta, Shruti; Celentano, David; Srikrishnan, Aylur; Anand, Santhanam; Vasudevan, Canjeevaram; Solomon, Suniti; Solomon, Sunil (AIDS & Behavior, 2016)
Poor psychosocial health contributes to HIV risk behavior and reduced engagement in treatment and care. This study investigates depression and its correlates among 11,992 MSM recruited via respondent driven sampling in 12 cities across India using the Patient Health Questionnaire-9 and supplemented by analysis of qualitative research from 15 sites with 363 MSM. Overall prevalence of depression was 11 %, with substantial variation across sites and subgroups of MSM, and high prevalence of suicidal thoughts among depressed MSM. In multivariable analyses identification as a kothi (feminine sexual identity) [adjusted odds ratio (aOR) = 1.91], disclosure of being MSM to non-family (aOR = 1.7) and family (aOR = 2.4), disclosure of HIV-status (aOR = 5.6), and substance use were associated with significantly higher odds of depression. Qualitative results emphasized dire social consequences of disclosing MSM- and HIV-status, especially to family, including suicidality. Combination prevention interventions should include mental health services that address disclosure, suicidality, and substance use.
Keywords: Depression; Men Who Have Sex With Men -- Psychosocial Factors -- India; Human; India; Multimethod Studies; Sampling Methods; Questionnaires; Qualitative Studies; Suicidal Ideation; Odds Ratio; Truth Disclosure; HIV Seropositivity; Substance Abuse

Ecological factors influencing suicidal ideation-to-action among Latinx adolescents: An exploration of sex differences. - Villarreal-Otálora, Tatiana; Boyas, Javier F.; Alvarez-Hernandez, Luis R.; Fatehi, Mariam (Children & Youth Services Review, 2020)
• Most Latinx youth answered the suicidal desire items, 23% skipped the attempt item. • Latinx youth's suicidality are influenced by system level factors—which varies by sex. • Multiple micro factors were associated with each part of the suicidality spectrum for Latinx youth. • Being bullied at school increased the odds of suicidality for both Latinx youth. • Of the system factors, only micro and mezzo factors influenced Latinx suicidality. Little is known regarding how various system-level factors influence suicidal behaviors between Latinx female and male youth in the US. Using an ideation-to-action and an ecological systems theory framework, this study stratified Latinx adolescent males and females to examine the association between various micro, mezzo, and macro level factors and three suicidality outcome measures. This cross-sectional study used a subsample of self-identified Latinx adolescents (n = 3639) from the 2017-National Youth Risk Behavioral Survey. Multiple micro factors—depressed mood, cannabis use, and sexual assault—were associated with each step of the suicidality continuum. One mezzo factor, physical violence, was unique in the prediction of suicide attempt for Latinx males. At the macro level, no statistically significant relationships were found. Results from the backward elimination logistic regression also revealed that identifying as lesbian, gay, or bisexual showed the strongest association with suicidal ideation and suicide planning for both groups. However, it was the strongest association with suicide attempt among Latinx adolescent males, but not for Latinx adolescent females. Implications for practice, policy, and research are discussed.
Keywords: Suicidal Ideation -- Psychosocial Factors -- In Adolescence; Hispanic Americans -- In Adolescence; Sex Factors -- Evaluation; Human; Adolescence; Female; Male; Cross Sectional Studies; Surveys; Conceptual Framework; Depression; Substance Abuse; Sexual Abuse; Logistic Regression

What is the relationship between rejection and self-harm or suicidality in adulthood? - Cawley, Rosanne; Pontin, Eleanor E; Touhey, Jade; Sheehy, Kate; Taylor, Peter James (Journal of Affective Disorders, 2019)
Background: Rejection is an adverse experience that may help explain the heightened risk of self-harm and suicide amongst many societal groups. The aim of this systematic review was to determine the relationship between rejection experiences and self-harm and suicidal ideation.Method: The databases PsychINFO, CINAHL, Medline and Web of Science were searched from inception until May 2017 using key search terms. Quantitative studies were included if they were; (i) mean sample age over 18; (ii) in the English language; (iii) and had a measure of self-harm or suicidal behaviour and a measure of rejection. The results were synthesised narratively.Results: Eighteen studies were identified for the review. Fifteen out of the eighteen studies found a significant positive association between rejection and self-harm. This association was identified within several marginalised groups known to be at risk of self-harm, including those from lesbian, gay or bisexual sexuality or those who identify as transgender.Limitations: Heterogeneity between the measures of self-harm, suicidal behaviour and rejection, as well as the lack of longitudinal analyses made it difficult to draw firm conclusions.Conclusion: Perceived rejection may leave some individuals at risk of self-harm and might account for the elevated risk in marginalised societal groups. Interventions focused on modifying rejection experiences may help reduce the risk of self-harm in this population.
Keywords: Social Behavior; Suicidal Ideation; Self-Injurious Behavior -- Psychosocial Factors; Adult; Sexuality; Suicide, Attempted; Female; Human; Risk Factors; Male; Systematic Review; Psycinfo; CINAHL Database; Medline

Suicide etiology in youth: Differences and similarities by sexual and gender minority status. - McKay, Tasseli; Berzofsky, Marcus; Landwehr, Justin; Hsieh, Patrick; Smith, Amanda (Children & Youth Services Review, 2019)
Sexual and gender minority (SGM) individuals are at steeply elevated risk for suicide, particularly in adolescence and young adulthood. Evidence on suicide risk factors specific to SGM youth is emerging, but an integrated understanding of the etiology of suicide that accounts for both commonalities and differences between SGM and non-SMG youth is lacking. Using 2018 data from a social media-based sample of SGM (n = 175) and non-SGM (n = 310) youth ages 14–21, we assess the role of constructs from the general-population-based interpersonal-psychological theory of suicide and the SGM-specific minority stress theory in suicide ideation and attempt. Parental support was a strong protective factor shared across the SGM and non-SGM youth samples. The role of other factors, such as racial/ethnic identity, differed by group. Implications for suicide prevention and intervention in schools and other settings that include both SGM- and non-SGM youth are discussed. • Sexual and gender minority youth were more than twice as likely to be suicidal. • Feeling that parents cared was strongly protective against suicidality. • Online and school-based bullying and safety-related truancy put youth at risk.
Keywords: Suicide -- Etiology; LGBTQ+ Persons -- Psychosocial Factors; Minority Groups; Adolescent Health; Human; Adolescence; Social Media; Young Adult; Interpersonal Relations; Psychological Theory; Stress, Psychological; Suicidal Ideation; Suicide, Attempted; Parental Attitudes; Support, Psychosocial; Race Factors; Ethnic Groups; Suicide -- Prevention and Control; School Health Services

"Extra marginalisation within the community": queer individuals' perspectives on suicidality, discrimination and gay pride events. - Schimanski, Irie David; Treharne, Gareth J. (Psychology & Sexuality, 2019)
Suicidality is more common among queer individuals. Past research has overlooked queer individuals' own understandings of suicidality in relation to discrimination and supportive processes potentially achieved through gay pride events. This study applied the decompensation model as a framework to explore queer individuals' perceptions of suicide, discrimination and gay pride events. Seven focus groups were held with a total of 28 queer individuals aged 18-25 years old. Participants had a range of sexualities, genders and ethnicities. Qualitative data from the focus groups were interpreted using an inductive form of thematic analysis, resulting in three themes: the invisibility of suicide; compound discrimination; and processes of normalising queer identities. Participants suggested that greater awareness of suicide is needed and proposed a trajectory from discrimination to suicide, wherein both queer identities and suicidality are discriminated against. Discrimination from within queer communities was problematised and gay pride events were understood to normalise queer identities by providing opportunities for support and fostering activism against inequalities. The results underscore nuanced perspectives on suicidality, discrimination and gay pride events among young queer individuals in Aotearoa/New Zealand and have implications for suicide prevention efforts. These findings also demonstrate the value of applying an intersectional approach to identity, ideology and discrimination in research on suicidality among queer individuals.

Corrigendum: The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study...McDermott E, Hughes E, and Rawlings V. The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study. J Public Health. 2018. 40 (3). e244-e251. - McDermott, Elizabeth; Hughes, Elizabeth; Rawlings, Victoria (Journal of Public Health, 2018)
A correction to the article "The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study" by Elizabeth McDermott, Elizabeth Hughes and Victoria Rawlings is presented.
Keywords: LGBTQ+ Persons -- England; Suicidal Ideation; Social Determinants of Health; England

Protective School Climates and Reduced Risk for Suicide Ideation in Sexual Minority Youths. - Hatzenbuehler, Mark L.; Birkett, Michelle; Van Wagenen, Aimee; Meyer, Ilan H. (American Journal of Public Health, 2014)
Objectives. We examined whether sexual minority students living in states and cities with more protective school climates were at lower risk of suicidal thoughts, plans, and attempts. Methods. Data on sexual orientation and past-year suicidal thoughts, plans, and attempts were from the pooled 2005 and 2007 Youth Risk Behavior Surveillance Surveys from 8 states and cities. We derived data on school climates that protected sexual minority students (e.g., percentage of schools with safe spaces and Gay-Straight Alliances) from the 2010 School Health Profile Survey, compiled by the Centers for Disease Control and Prevention. Results. Lesbian, gay, and bisexual students living in states and cities with more protective school climates reported fewer past-year suicidal thoughts than those living in states and cities with less protective climates (lesbians and gays: odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.99; bisexuals: OR = 0.81; 95% CI = 0.66, 0.99). Results were robust to adjustment for potential state-level confounders. Sexual orientation disparities in suicidal thoughts were nearly eliminated in states and cities with the most protective school climates. Conclusions. School climates that protect sexual minority students may reduce their risk of suicidal thoughts.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Suicidal Ideation -- Risk Factors -- In Adolescence; School Policies; Students, Minority; Human; Minority Groups; Female; Male; Adolescence; Surveys; Prospective Studies; Confounding; Self Report; Illinois; Delaware; Maine; Massachusetts; New York; California; Vermont; Rhode Island; Probability Sample; Questionnaires; Organizational Culture; Learning Environment; Data Analysis Software; Statistical Significance; Chi Square Test; Odds Ratio; Confidence Intervals; Sample Size; Funding Source

Violence victimisation--a watershed for young women's mental and physical health. - Palm, Anna; Danielsson, Ingela; Skalkidou, Alkistis; Olofsson, Niclas; Högberg, Ulf (European Journal of Public Health, 2016)
Purpose: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15-22 years) victimised to one or more types of violence, compared with non-victimised. Methods: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed. Results: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9-20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9-10.2) for anxiety symptoms and 10.8 (CI 5.2-22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation. Conclusion: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources.
Keywords: Violence; Mental Disorders; Victims; Women; Human; Female; Self Report; Sweden; Questionnaires; Odds Ratio; Confidence Intervals; Socioeconomic Factors; Cross Sectional Studies; Randomized Controlled Trials; Adolescence; Young Adult; Descriptive Statistics; Data Analysis Software; T-Tests; Pearson's Correlation Coefficient; Fisher's Exact Test; Funding Source

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

Childhood abuse and depressive vulnerability in clients with gender dysphoria. - Firth, Malcolm T. (Counselling & Psychotherapy Research, 2014)
Background:Childhood abuse in the early lives of gender variant people has been under-reported, although higher psychiatric morbidity, particularly depression and suicidality, than in the general population is more widely recognised. There are increasing numbers of people seeking advice and treatment for gender dysphoria (GD) some of whose experiences of depression and childhood abuse may be additional treatment considerations.Aim:To illuminate the issues relating to childhood abuse, depression and GD via case examples underpinned by a summary review of the relevant literature, for their combined relevance to therapeutic practice and service provision.Methods:A review of relevant online literature was conducted and two case examples were developed subsequently to capture the core review themes from a practice perspective.Results:Nine studies met the inclusion criteria. Gender variant children and adolescents may experience abuse by peers and teachers, as well as parents and caregivers. Emotional abuse and neglect may have more adverse consequences than more active forms of abuse.Conclusions:This is an under-researched area, and inconsistencies of design, definition, measurement and controls were evident in the literature. While no clear association between depressive vulnerability and childhood abuse could be found, prevalence of such abuse was high. A case is made for clients with GD to have the opportunity to explore the influence and meaning of their adverse childhood experiences on their social and psychological development, and for additional training and education for practitioners.
Keywords: Child Abuse -- Complications; Depression -- Risk Factors; Sexual and Gender Disorders -- Complications; Human; Medline; CINAHL Database; Psycinfo; Embase; Male; Female; Adult; Adolescence; Suicidal Ideation; Young Adult; Middle Age; Self-Injurious Behavior -- Etiology; Depression -- Therapy; Gender Affirmation Procedures; Gender Identity

Sexual (Minority) Trajectories, Mental Health, and Alcohol Use: A Longitudinal Study of Youth as They Transition to Adulthood. - Fish, Jessica; Pasley, Kay (Journal of Youth & Adolescence, 2015)
Keywords: Gay Persons -- In Adolescence; Mental Health -- In Adolescence; Alcohol Drinking -- In Adolescence; Human; Adolescence; Depression; Suicidal Ideation; Minority Groups; Sex Maturation; Data Analysis Software; Repeated Measures; Female; Male; White Persons; Black Persons; Hispanic Americans; Asians; Dating; Gay Persons -- Psychosocial Factors; Funding Source

LGBT people and suicidality in youth: A qualitative study of perceptions of risk and protective circumstances. - Rivers, Ian; Gonzalez, Cesar; Nodin, Nuno; Peel, Elizabeth; Tyler, Allan (Social Science & Medicine, 2018)
Evidence suggests that lesbian, gay, bisexual and trans (LGBT) people are more likely to attempt to take their own lives in their youth when compared to heterosexual and/or cisgender people. This study draws on in-depth interviews with 17 LGBT individuals living in England, and explores the narratives used by participants to better understand their perceptions of risk and protective circumstances to explain suicide attempts in youth. Using a Goffman-informed thematic analysis, results identified three key themes that were linked to attempts to end life in youth. The first theme considers the conflicts resulting from first disclosure of sexual orientation and/or gender identity/trans status and being ‘out’ to others. The second theme explores participants' accounts of their concurrent mental health issues and how diagnoses of the mental health issues helped them make sense of their own experiences of attempted suicide. The final theme explores the experience of grieving over lost relationships and how that grief is received by others, including health professionals. Our results indicate that some LGBT individuals have effectively, although often arduously, navigated suicidal crises by utilising various approaches to coping. We provide a rich and layered picture of LGBT suicide risk in youth and potential resilience scenarios, although these are a reflection of our specific group of participants' experiences and realities. We argue that it is important to understand how LGBT individuals with a history of suicide attempts narrate and make sense of their experiences in early life and we suggest that the early negative experiences continue to have an effect on LGBT adults today.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- England; Suicidal Ideation -- Prevention and Control; Suicidal Ideation -- Risk Factors; Attitude to Risk; Qualitative Studies; Human; Interviews; England; Adolescence; Thematic Analysis; Sexuality; Gender Identity; Mental Health; Mental Disorders -- Diagnosis; Grief; Health Personnel; Coping; Hardiness

The link between LGBTQ-supportive communities, progressive political climate, and suicidality among sexual minority adolescents in Canada. - Saewyc, Elizabeth M.; Li, Gu; Gower, Amy L.; Watson, Ryan J.; Erickson, Darin; Corliss, Heather L.; Eisenberg, Marla E. (Preventive Medicine, 2020)
Despite supportive structural changes to reduce stigma towards lesbian, gay, and bisexual, transgender, queer, and questioning (LGBTQ) Canadian residents, sexual minority youth still face disparities compared to heterosexual peers. We aimed to characterize LGBTQ-supportive environments and political climates, and examine their links to suicidal behavior among sexual minority adolescents in western Canada. Data were from the 2013 British Columbia Adolescent Health Survey, a cluster-stratified random cross-sectional survey of public school students in BC, Canada; We sampled 2678 self-identified LGB and mostly heterosexual students (69% girls) from 274 schools, representing an estimated provincial population of 24,624 sexual minority students in weighted models. Student reports of past-year suicidal ideation, suicidal attempts, and self-harm behaviors were merged with community-level data assessing diverse aspects of LGBTQ-supportive resources and progressive political climates in communities surrounding the schools. Adjusted multilevel models showed that for sexual minority adolescent girls, higher community LGBTQ-supportiveness predicted marginally significant lower suicidal ideation (aOR = 0.94, 95% CI [0.88, 1.01]) and suicidal attempts (aOR = 0.91, 95% CI [0.83, 1.00]) and significantly lower self-harm behaviors (aOR = 0.91, 95% CI [0.85, 0.98]). Further, progressive political climates predicted marginally significant lower suicidal ideation (aOR = 0.89, 95% CI [0.78, 1.02]) and significantly lower self-harm behaviors (aOR = 0.87, 95% CI [0.77, 0.99]). For sexual minority adolescent boys, no community-level variables were associated with suicidal behavior in adjusted models. Thus, LGBTQ-supportive communities and progressive political climates appear to be protective against suicidal behavior among sexual minority adolescent girls, but not sexual minority adolescent boys.

The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients. - Rider, G. Nic; Vencill, Jennifer A.; Berg, Dianne R.; Becker-Warner, Rachel; Candelario-Pérez, Leonardo; Spencer, Katherine G. (International Journal of Transgenderism, 2019)
Background: The limited research on nonbinary individuals suggests that this community experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals. Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA's therapeutic interventions are designed to promote positive gender identity development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired). Results: The core components of the GALA model are individualized to each client's unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals. Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette.
Keywords: Gender Identity; Male; Young Adult; Psychotherapy; Conceptual Framework; Health Status Disparities; Mental Disorders; Psychological Well-Being; Hardiness; Sexuality; Empowerment; Vignettes; Human

A heuristic inquiry on the role of person‐environment interaction in suicide risk among transgender youth. - Chang, Brie; Delaney, Kathleen (Journal of Child & Adolescent Psychiatric Nursing, 2019)
Elevated levels of suicide risk among transgender youth have alarmed both public health officials and researchers from various disciplines. Despite nursing's robust involvement in suicide research, literature reviews indicate a lack of nursing research focused on suicide among transgender youth. Most of the existing literature pertain to predictive factors in either the individual or environmental domain. There is limited research examining how interactions with the environment in of itself might be a predictive factor. This paper treats the subject of suicide risk among transgender youth with a heuristic inquiry into person–environment interaction. The Society to Cell Resiliency Framework and Social Self Preservation Model were used to inform exploration of how person–environment interactions might be associated with suicide risk. Implications of this framework will be discussed in terms of how it may affect advancements in nursing education, practice, and research with transgender youth.
Keywords: Suicide -- Risk Factors; Transgender Persons -- Psychosocial Factors -- In Adolescence; Environment; Adolescence; Conceptual Framework; Hardiness; Self Concept; Models, Psychological

Risk and Protective Factors for Self-Harm in a Population-Based Sample of Transgender Youth. - Taliaferro, Lindsay A.; McMorris, Barbara J.; Rider, G. Nicole; Eisenberg, Marla E. (Archives of Suicide Research, 2019)
This study sought to identify factors distinguishing transgender/gender non-conforming (GNC) adolescents across three groups: no self-harm, non-suicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). Data were from the 2016 Minnesota Student Survey. The final analytic sample included 1,635 transgender/GNC students in grades 9 and 11. Logistic regression analyses determined factors that best distinguished transgender/GNC students who reported self-harm (NSSI only or NSSI + SA) from those who reported no self-harm, and transgender/GNC adolescents who reported NSSI + SA from those who reported NSSI only. Final models were developed over 3 stages of analysis that tested associations of variables within risk factor, protective factor, and health-risk behavior domains to self-harm. Over half (51.6%) of transgender/GNC adolescents reported past-year self-harm behavior. Factors that consistently distinguished transgender/GNC youth who reported self-harm from those who reported no self-harm included reports of a mental health problem, depression, running away from home, and substance use (alcohol or marijuana use). Factors that distinguished the NSSI + SA group from the NSSI only group were reports of a mental health problem, physical or sexual abuse, relationship violence, bullying victimization, less parent connectedness, lower grades, lower levels of perceived school safety, and running away from home. Clinicians and school personnel need to be prepared to address risk factors and enhance protective factors that may reduce the likelihood this population of vulnerable youth will engage in NSSI and/or attempt suicide.
Keywords: Self-Injurious Behavior -- Epidemiology; Suicide, Attempted; Depression -- Epidemiology; Social Environment; Bullying; Minnesota; Self-Injurious Behavior -- Psychosocial Factors; Depression -- Psychosocial Factors; Adolescence; Prevalence; Female; Parent-Child Relations; Suicide, Attempted -- Psychosocial Factors; Logistic Regression; Child Abuse; Risk Factors; Male; Child Abuse, Sexual; Probability; Crime Victims -- Statistics and Numerical Data; Crime Victims -- Psychosocial Factors; Questionnaires; Scales

A Systematic Review of Characteristics of Nonprobability Community Venue Samples of Sexual Minority Individuals and Associated Methods for Assessing Selection Bias. - Salway, Travis J.; Morgan, Jeffrey; Ferlatte, Olivier; Hawkins, Blake; Lachowsky, Nathan J.; Gilbert, Mark (LGBT Health, 2019)
The majority of research on sexual minority individuals relies on nonprobability community venue samples. These samples are prone to selection bias; however, empirical syntheses of evidence of these biases are not available. We conducted, therefore, a systematic review of published sexual minority health research to summarize methods used to identify characteristics and health outcomes found to differ in nonprobability samples. We searched five health and social science databases to identify observational studies that included a nonprobability sexual minority community sample and applied an empirical method to infer selection bias. We extracted data regarding sociodemographic characteristics, behaviors, and health outcomes and examined whether the nonprobability sample was found to differ disproportionately (over- or underrepresenting the characteristic) based on appropriate statistical tests ( p < 0.05 was considered statistically significant). A total of 21 studies were included. Nineteen studies used a cross-sample comparison, one used time/location sampling weights, and one used frequency of venue attendance adjustment to assess differences. The evidence was mostly consistent, that is, associations were in the same direction in >50% of studies examined, for nine variables. Nonprobability community venue samples tended to overrepresent sexual minority individuals with the following characteristics: higher income, current employment, lesbian/gay-identified, greater number of sex partners, past-year sexually transmitted infection diagnosis, suicidal ideation, alcohol use, and substance use; nonprobability community venue samples tended to underrepresent married/partnered sexual minority individuals. This review provides a nuanced empirical picture of aggregate differences in sample characteristics presumed to threaten the validity of nonprobability sexual minority community venue studies, and highlights feasible methods that can be applied to future studies to add specificity to researchers' description of selection biases.

Intersectionality and Health Behaviors Among US High School Students: Examining Race/Ethnicity, Sexual Identity, and Sex. - Gattamorta, Karina A.; Salerno, John P.; Castro, Amanda J. (Journal of School Health, 2019)
BACKGROUND: Little research exists examining the impact of multiple minority identities, particularly sexual orientation, race/ethnicity, and sex on health‐risk behaviors like mental health, substance use, violence, and sexual risk among high school students in the United States. In this study, we use a nationally representative dataset to examine differences between non‐Hispanic white heterosexuals (HSs) and non‐Hispanic white sexual minority, black HS, black sexual minority, Hispanic HS, and Hispanic sexual minority students. METHODS: Data from the 2015 wave of the Youth Risk Behavioral Surveillance System were used in this study. Chi‐square and hierarchical logistic regression models examined differences between the groups on outcomes including: (1) mental health and suicide, (2) alcohol, tobacco, and illicit substances, (3) sexual risk and protective factors, and (4) school and physical and/or sexual violence. RESULTS: Whereas sexual minority youth (SMY) generally demonstrate poorer health outcomes compared to HSs, SMY who are also racial/ethnic minorities often have even poorer health outcomes, particularly relating to substance use, sexual risk behaviors, physical/sexual violence, and suicide. CONCLUSIONS: The need for culturally tailored education and school‐based interventions that consider intersections between race/ethnicity, sexual identity, and biological sex are warranted to address health disparities related to mental health and suicide, substance use, sexual risk, and violence.
Keywords: Ethnic Groups; Health Behavior; Students, High School -- United States; Sexual Identity; Heterosexuals; LGBTQ+ Persons; Healthcare Disparities; Human; United States; Chi Square Test; Logistic Regression; Mental Health; Suicide; Substance Use Disorders; Risk Taking Behavior; Sexual Abuse; Black Persons; Hispanic Americans; Questionnaires; Sex Education; Male; Female; Adolescence; Funding Source

“Fear Runs Deep:” The Anticipated Needs of LGBT Older Adults in Long-Term Care. - Putney, Jennifer M.; Keary, Sara; Hebert, Nicholas; Krinsky, Lisa; Halmo, Rebekah (Journal of Gerontological Social Work, 2018)
Objectives: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. Discussion: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.
Keywords: Community Living; Long Term Care -- In Old Age; LGBTQ+ Persons -- In Old Age; Human Needs (Physiology); Nursing Homes; Fear; Assisted Living; Aged; Quality of Health Care; Qualitative Studies; Focus Groups; Thematic Analysis; Stress, Psychological; New England; Residential Care; Purposive Sample; Middle Age; Aged, 80 and Over; Male; Female; Semi-Structured Interview; Interview Guides; Coding; Health Care Costs; Caregivers; Dementia; Patient Safety; Suicide; Questionnaires; Health Promotion; Public Policy; Human; Funding Source

Transgender Adolescent Suicide Behavior. - Toomey, Russell B.; Syvertsen, Amy K.; Shramko, Maura (Pediatrics, 2018)
OBJECTIVES: Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups. METHODS: Data from the Profiles of Student Life: Attitudes and Behaviors survey (N = 120 617 adolescents; ages 11--19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents' highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior. RESULTS: Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts. CONCLUSIONS: Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and nonbinary transgender adolescents.
Keywords: Suicidal Ideation; Transgender Persons -- Psychosocial Factors; Gender Identity; Socioeconomic Factors; Prevalence; Human; Male; Female; Student Attitudes; Surveys; Adolescence; Young Adult; Self Report; Age Factors; Educational Status; Sexuality; Race Factors; Ethnic Groups; Urban Population; Risk Assessment

Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth. - Walls, N. Eugene; Atteberry-Ash, Brittanie; Kattari, Shanna K.; Peitzmeier, Sarah; Kattari, Leo; Langenderfer-Magruder, Lisa (Journal of Adolescent Health, 2019)
Abstract Purpose Partner violence (PV) is prevalent among US adolescents, though little is known about its prevalence and correlates across gender identities and sexual orientations. Existing research has frequently placed lesbian, gay, bisexual (LGB), questioning, and transgender adolescents in the same category, obscuring potential differences in risk of PV. Methods This study (N = 9,352) uses the 2015 Healthy Kids Colorado Study, a statewide representative survey, to explore how sexual orientation and gender identity are associated with PV victimization among high-school youth, and whether there is a relationship between mental health and bullying victimization and PV. Results Out of all youth who dated in the past year, 9.4% reported experiencing past-year PV. Compared to their cisgender heterosexual peers, cisgender LGB youth (AOR = 1.48 [1.17, 1.86]) and cisgender questioning youth (AOR = 1.68 [1.13, 2.48]) had elevated risk of experiencing PV. Transgender youth, particularly those who are both transgender and LGB (AOR = 3.25 [2.02, 5.22]) or transgender and questioning their sexual orientation (AOR = 8.57 [4.28, 17.16]), had the highest risk of PV. Depressive symptoms (AOR = 1.99 [1.67, 2.37]), suicidality (AOR = 1.83 [1.62, 2.06]), bullying victimization (AOR = 1.58 [1.31, 1.91]), and online bullying victimization (AOR = 1.98 [1.62, 2.06]) were associated with PV. Conclusions LGB, questioning and transgender high school students are at elevated risk of PV, with the highest risk among those who are both LGB and transgender. Adolescents who report PV are also more likely to be struggling with bullying, depression, and suicidality. PV prevention and response interventions should use intersectional approaches responsive to the unique needs of LGBT youth.
Keywords: Intimate Partner Violence -- Psychosocial Factors -- In Adolescence; Gender Identity; Sexuality; Mental Health; Bullying; United States; Human; Intimate Partner Violence -- Risk Factors; Female; Male; Adolescence; Students, High School; Prevalence; Surveys; Random Sample; Data Analysis Software; Logistic Regression; Descriptive Statistics

- Perspectives Worth Sharing - Transcending Transgender: Camps for Gender Minority Youth. - Erdlitz, Katie; Williams, Susan; Buckner, Ellen (CompassPoint, 2016)
Transgender youth can experience all the developmental benefits of camp, especially when the camp is affirming of their gender identity. Interviews with two experts describe the positive effect of a welcoming environment for youth with gender variations. For kids who identify as transgender/gender variant, a camp where they can truly be themselves, unite with others who share their uniqueness and nurture their talents and beauty, is invaluable.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Minority Groups -- Psychosocial Factors; Camps; Adolescence; Stigma; Gender Identity; Family Attitudes; Support, Psychosocial; Suicide -- Risk Factors; Substance Abuse -- Risk Factors

A latent class analysis of the co-occurrence of sexual violence, substance use, and mental health in youth. - Nelon, Jordan L.; De Pedro, Kris T.; Gilreath, Tamika D.; Patterson, Megan S.; Holden, Caitlin B.; Esquivel, Christi H. (Substance Use & Misuse, 2019)
Purpose: The purpose of this study was to understand co-occurrence of sexual violence, substance use, and mental health in youth and see if there are differences in experiences among sexual identities, races, and genders. Methods: The 2017 Youth Risk Behavior Survey sampled 14,638 high school students. Latent class analysis was used to understand the relationship between incidence of sexual violence, substance use, and depression and suicidality in a nationally representative sample. The model controlled for demographic and bullying covariates. Results: A four-class solution provided optimal fit. Classes were low risk (51.8%); low violence, frequent substance use, and high depression and suicidal ideation (29.7%); experienced violence and moderate mental health issues(5.1%); and some violence, high substance use, and high depression and suicidal ideation (13.4%). Youth who identified as sexual minority youth were almost 2.5–5 times more likely to be in the three higher risk classes than their heterosexual peers. Those who identified as "I don't know" were almost 3 times more likely to be in the three higher risk classes than heterosexual youth. Multiracial youth had higher likelihood of being in the three riskier classes compared to Caucasian youth. Females were 2.5 and 3 times more likely to be in the low violence and some violence classes compared to males. Conclusion: The study's finding distinct classes of co-occurring behavioral and mental health outcomes fill gaps in the current literature and informs practitioners that LGB youth and bi/multiracial youth were at an elevated risk of co-occurring victimization, substance use, and mental health problems.
Keywords: Comorbidity; Sexual Abuse -- Prevention and Control -- In Adolescence; Substance Abuse -- Prevention and Control -- In Adolescence; Mental Disorders -- Prevention and Control -- In Adolescence; Sexual Identity; Race Factors -- Psychosocial Factors; Sex Factors; Adolescent Behavior; Human; Questionnaires; Risk Taking Behavior; Students, High School -- Psychosocial Factors; Depression; Incidence; Substance Abuse; Bullying; Risk Management; Minority Groups; Heterosexuals; Peer Group; White Persons; Female; Male; LGBTQ+ Persons -- Psychosocial Factors; Crime Victims; Sexual Abuse -- Risk Factors; Substance Abuse -- Risk Factors; Mental Disorders -- Risk Factors; Adolescence

Association of Religiosity With Sexual Minority Suicide Ideation and Attempt. - Lytle, Megan C.; Blosnich, John R.; De Luca, Susan M.; Brownson, Chris (American Journal of Preventive Medicine, 2018)
Introduction: The purpose of this study is to explore how the associations between importance of religion and recent suicide ideation, recent suicide attempt, and lifetime suicide attempt vary by sexual orientation.Methods: Survey data were collected from the 2011 University of Texas at Austin's Research Consortium data from 21,247 college-enrolled young adults aged 18-30 years. Respondents reported sexual identity as heterosexual, gay/lesbian, bisexual, or questioning. Two sets of multivariable models were conducted to explore the relations of religious importance and sexual orientation with the prevalence of suicidal behavior. The first model was stratified by sexual orientation and the second model was stratified by importance of religion. To explore potential gender differences in self-directed violence, the models were also stratified by gender identity. The main outcome measures were recent suicidal ideation, recent suicide attempt, and lifetime suicide attempt.Results: Overall, increased importance of religion was associated with higher odds of recent suicide ideation for both gay/lesbian and questioning students. The association between sexual orientation and self-directed violence were mixed and varied by strata. Lesbian/gay students who viewed religion as very important had greater odds for recent suicidal ideation and lifetime suicide attempt compared with heterosexual individuals. Bisexual and questioning sexual orientations were significantly associated with recent suicide ideation, recent attempt, and lifetime attempt across all strata of religious importance, but the strongest effects were among those who reported that religion was very important.Conclusions: Religion-based services for mental health and suicide prevention may not benefit gay/lesbian, bisexual, or questioning individuals. Religion-based service providers should actively assure their services are open and supportive of gay/lesbian, bisexual, or questioning individuals.
Keywords: Religion and Psychology; Suicide, Attempted; Stigma; Suicidal Ideation; Young Adult; Male; Texas; Female; Suicide, Attempted -- Psychosocial Factors; Human; Adult; Suicide, Attempted -- Prevention and Control; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Self-Directed Learning Readiness Scale

Mental Health and Suicidality Among Racially/Ethnically Diverse Sexual Minority Youths. - Bostwick, Wendy B.; Meyer, Ian; Aranda, Frances; Russell, Stephen; Hughes, Tonda; Birkett, Michelle; Mustanski, Brian (American Journal of Public Health, 2014)
Objectives. We examined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents. Methods. Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72 691. Results. Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds. Conclusions. Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.
Keywords: Suicide -- Risk Factors -- In Adolescence; Gender Identity -- Classification; Minority Groups -- Classification; Mental Health -- Classification; Human; Funding Source; Correlational Studies; Questionnaires; Cross Sectional Studies -- United States; United States; Adolescence; Secondary Analysis; Linear Regression; Descriptive Statistics; Race Factors -- Classification; Ethnic Groups -- Classification; Heterosexuals; LGBTQ+ Persons; Odds Ratio; Confidence Intervals; Predictive Validity; Depression -- Risk Factors; Suicidal Ideation -- Risk Factors; Suicide, Attempted -- Risk Factors; Sex Factors

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

Mortality Risks Among Persons Reporting Same-Sex Sexual Partners: Evidence From the 2008 General Social Survey—National Death Index Data Set. - Cochran, Susan D.; Mays, Vickie M. (American Journal of Public Health, 2015)
Objectives. We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation–associated health risks. Methods. We used data from the 1988–2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer–related mortality. Results. The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation–associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW. Conclusions. The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.
Keywords: Homosexuality; Mortality -- Epidemiology; Sexual Partners; Mortality -- Risk Factors; Human; Questionnaires; Prevalence; Epidemiological Research; Funding Source; Mortality -- Classification; HIV Infections -- Mortality; Suicide -- Mortality; Breast Neoplasms -- Mortality; Interviews; Probability Sample; Self Report; International Classification of Diseases; Data Analysis Software; Cox Proportional Hazards Model; Confidence Intervals; Odds Ratio; Adult; Multiple Regression; Geographic Factors; Self Disclosure; Sex Factors; Male; Female

Baseline assessment of campus-wide general health status and mental health: Opportunity for tailored suicide prevention and mental health awareness programming. - Hawley, Lisa D.; MacDonald, Michael G.; Wallace, Erica H.; Smith, Julia; Wummel, Brian; Wren, Patricia A. (Journal of American College Health, 2016)
Objective: A campus-wide assessment examined the physical and mental health status of a midsize midwestern public university. Participants: Two thousand and forty-nine students, faculty, and staff on a single college campus were assessed in March–April 2013. Methods: Participants completed an online survey with sections devoted to demographics, physical and mental health status, and suicide knowledge and experiences. Results: This study captured broad physical and mental health indicators. Students, faculty, and staff in certain demographic groups were more likely to report significant problems associated with mental and physical health. Specifically, women, faculty and staff of color, and nonheterosexual persons reported worse health outcomes. Across 8 mental health indicators, students reported consistently worse mental health than their faculty/staff counterparts. Conclusions: This paper presents findings from a significant campus-wide physical and mental health surveillance initiative. Results indicate the need for targeted physical and mental health support and intervention among these demographic groups.
Keywords: Health Status -- Evaluation; Colleges and Universities; Mental Health -- Evaluation; Suicide -- Prevention and Control; Mental Health Services; Human; Midwestern United States; Students, College; Faculty; School Administrators; Sex Factors; Male; Female; Race Factors; Minority Groups; Adolescence; Adult; Questionnaires; Data Analysis Software; T-Tests; Multiple Regression; Middle Age; P-Value; LGBTQ+ Persons; Descriptive Statistics; Funding Source

Evidence of Multiple Mediating Pathways in Associations Between Constructs of Stigma and Self-Reported Suicide Attempts in a Cross-Sectional Study of Gay and Bisexual Men. - Salway, Travis; Gesink, Dionne; Ibrahim, Selahadin; Ferlatte, Olivier; Rhodes, Anne E.; Brennan, David J.; Marchand, Rick; Trussler, Terry (Archives of Sexual Behavior, 2018)
Gay and bisexual men (GBM) are more likely to attempt suicide than heterosexual men. This disparity is commonly interpreted using minority stress theory; however, specific pathways from antigay stigma to suicidal behavior are poorly understood. We aimed to estimate associations between multiple constructs of stigma and suicide attempts among adult GBM, and to measure the proportion of these associations mediated by distinct suicide risk factors, thus identifying proximal points of intervention. Data were drawn from a Canadian community-based survey of adult GBM. Structural equation modeling was used to compare associations between three latent constructs-enacted stigma (e.g., discrimination, harassment), anticipated prejudice (worry about encountering antigay/bisexual prejudice), and sexuality concealment-and self-reported suicide attempts (last 12 months). Coefficients were estimated for direct, indirect, and total pathways and evaluated based on magnitude and statistical significance. The proportion of associations mediated by depression, drug/alcohol use, and social isolation was calculated using indirect paths. Among 7872 respondents, 3.4% reported a suicide attempt in the past 12 months. The largest total association was observed for enacted stigma, and this association was partially mediated by depression and drug/alcohol use. The total association of anticipated prejudice was relatively smaller and mediated by depression and social isolation. Concealment had an inverse association with suicide attempts as mediated by depression but was also positively associated with suicide attempts when mediated through social isolation. Multiple constructs of antigay stigma were associated with suicide attempts; however, mediating pathways differed by construct, suggesting that a combination of strategies is required to prevent suicide in adult GBM.
Keywords: Homosexuality; Bisexuality; Suicide, Attempted; Stigma; Canada; Cross Sectional Studies; Depression -- Epidemiology; Middle Age; Self Report; Male; Substance Use Disorders -- Epidemiology; Adult; Human; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires; Social Readjustment Rating Scale

Sexual Identity, Adverse Childhood Experiences, and Suicidal Behaviors. - Clements-Nolle, Kristen; Lensch, Taylor; Baxa, Amberlee; Gay, Christopher; Larson, Sandra; Yang, Wei (Journal of Adolescent Health, 2018)
Purpose The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on suicidal behaviors in a population-based sample of high school students. Methods A two-stage cluster random sampling design was used to recruit 5,108 students from 97 high schools. A total of 4,955 students (97%) provided information that allowed for classification of sexual identity into three groups: (1) lesbian, gay, or bisexual (LGB) (10%); (2) not sure (4.6%); and (3) heterosexual (85.4%). Five measures of childhood abuse and household dysfunction were summed, and the ACE score was categorized as 0, 1, 2, and 3–5 ACEs. Weighted logistic regression was used to assess the influence of sexual identity, ACEs, and their interaction on suicide ideation and attempts in the past 12 months. Results Compared with heterosexual students, those who were LGB and were not sure had higher odds of suicide ideation and attempts. There was also a graded relationship between cumulative ACE exposure and suicidal behaviors. Although sexual identity/ACE interaction was not observed, LGB/not sure students who experienced a high number of ACEs were disproportionately affected. Compared with heterosexual students with 0 ACE, LGB/not sure students with 0 ACE (adjusted odds ratio [AOR] = 3.32, 95% confidence interval [CI] = 1.96–5.61), 1 ACE (AOR = 6.58, 95% CI = 4.05–10.71), 2 ACEs (AOR 13.50, 95% CI = 8.45–21.58), and 3–5 ACEs (AOR = 14.04, 95% CI = 8.72, 22.62) had higher odds of suicide ideation. A similar pattern was observed for suicide attempts. Conclusions LGB and students not sure of their sexual identity with greater exposure to ACEs have disproportionately high levels of suicide ideation and attempts. Trauma-informed interventions for these populations are warranted.
Keywords: Psychological Trauma -- In Infancy and Childhood; Suicide -- Risk Factors -- In Adolescence; Sexual Identity -- In Adolescence; Students, High School; Suicidal Ideation -- Evaluation -- In Adolescence; Human; Adolescence; Male; Female; Random Sample; Cluster Sample; Multicenter Studies; Lesbians; Bisexuals; Men Who Have Sex With Men; Heterosexuals; Logistic Regression; Descriptive Statistics; Odds Ratio; Confidence Intervals; Descriptive Research; Child

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

Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses. - Lipson, Sarah Ketchen; Raifman, Julia; Abelson, Sara; Reisner, Sari L (American Journal of Preventive Medicine, 2019)
Introduction: The purpose of this study was to examine mental health status by gender identity among undergraduate and graduate students.Methods: Data came from the 2015-2017 Healthy Minds Study, a mobile survey of randomly selected students (N=65,213 at 71 U.S. campuses, including 1,237 gender minority [GM] students); data were analyzed in 2018. Outcomes were symptoms of depression, anxiety, eating disorders, self-injury, and suicidality based on widely used, clinically validated screening instruments. Bivariable and multivariable analyses explored differences between GM and cisgender (non-GM) students as well as by assigned sex at birth.Results: Across mental health measures, a significantly higher prevalence of symptoms was observed in GM students than cisgender students. Compared with 45% of cisgender students, 78% of GM students met the criteria for 1 or more of the aforementioned mental health outcomes. GM status was associated with 4.3 times higher odds of having at least 1 mental health problem (95% CI=3.61, 5.12).Conclusions: Findings from this largest campus-based study of its kind using representative data with both gender identity and mental health measures underscore the importance of recognizing and addressing GM mental health burdens, such as by screening for mental health and providing gender-affirming services. There is broad urgency to identify protective factors and reduce mental health inequities for this vulnerable population.
Keywords: Behavioral Symptoms -- Epidemiology; Students -- Psychosocial Factors; Mental Health -- Statistics and Numerical Data; Health Status Disparities; Male; Cross Sectional Studies; Behavioral Symptoms -- Prevention and Control; United States; Students -- Statistics and Numerical Data; Adult; Behavioral Symptoms -- Psychosocial Factors; Prevalence; Behavioral Symptoms -- Diagnosis; Young Adult; Human; Colleges and Universities -- Statistics and Numerical Data; Adolescence; Female; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

Prevalence of Self-Injurious Thoughts and Behaviors in Transgender Individuals With Eating Disorders: A National Study. - Duffy, Mary E.; Henkel, Kristin E.; Joiner, Thomas E. (Journal of Adolescent Health, 2019)
Abstract Purpose This study examined prevalence of self-injurious thoughts and behaviors (SITBs) in transgender individuals with eating disorders, as compared to cisgender individuals with eating disorders and transgender individuals without eating disorders. Methods Data were analyzed from 365,749 individuals (median age 21 years, 71.8% White/Caucasian, 34.9% male, 64.9% female, and 0.2% transgender) who participated in American College Health Association-National College Health Assessment, an annual national assessment of college student health, from 2008 to 2011. Results Rates of past-year nonsuicidal self-injury, suicidal ideation, and suicide attempts were elevated in transgender participants with eating disorders (74.8%, 75.2%, and 74.8%, respectively), as compared to cisgender participants with eating disorders and transgender participants without eating disorders. Follow-up logistic regression analyses indicated these differences were statistically significant above and beyond the effects of demographic variables and depression. Conclusions Results found extremely high rates of SITBs in transgender individuals with eating disorders. This combination of identities, each associated with SITBs, may have a compounding effect.
Keywords: Self-Injurious Behavior; Transgender Persons -- Psychosocial Factors; Eating Disorders; Human; Young Adult; Male; Female; Students, College; Suicidal Ideation; Logistic Regression; Depression; Anorexia; Bulimia; Data Analysis Software; Descriptive Statistics; Odds Ratio; Confidence Intervals

School Restroom and Locker Room Restrictions and Sexual Assault Risk Among Transgender Youth. - Murchison, Gabriel R.; Agénor, Madina; Reisner, Sari L.; Watson, Ryan J. (Pediatrics, 2019)
BACKGROUND: Transgender and gender nonbinary adolescents experience high rates of peer victimization, but the prevalence of sexual assault in this population has not been established. Some schools restrict transgender and nonbinary students from using restrooms and locker rooms that match their gender identity, with unknown effects on sexual assault risk. We tested whether these restrictions were associated with the 12-month prevalence of sexual assault victimization. METHODS: Survey responses were analyzed from 3673 transgender and nonbinary US adolescents in grades 7 through 12 who participated in the cross-sectional 2017 LGBTQ Teen Study. We estimated the association between school restroom and locker room restrictions and sexual assault, adjusting for potential social and behavioral confounders, using logistic regression. We also tested potential mediators. RESULTS: The 12-month prevalence of sexual assault was 26.5% among transgender boys, 27.0% among nonbinary youth assigned female at birth, 18.5% among transgender girls, and 17.6% among nonbinary youth assigned male at birth. Youth whose restroom and locker room use was restricted were more likely to experience sexual assault compared with those without restrictions, with risk ratios of 1.26 (95% confidence interval [CI]: 1.02-1.52) in transgender boys, 1.42 (95% CI: 1.10-1.78) in nonbinary youth assigned female at birth, and 2.49 (95% CI: 1.11-4.28) in transgender girls. Restrictions were not associated with sexual assault among nonbinary youth assigned male at birth. CONCLUSIONS: Pediatricians should be aware that sexual assault is highly prevalent in transgender and nonbinary youth and that restrictive school restroom and locker room policies may be associated with risk.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Gender Identity; Toilet Facilities; School Violence -- Risk Factors -- In Adolescence; School Violence -- Epidemiology -- United States; Sexual Abuse -- Risk Factors -- In Adolescence; Sexual Abuse -- Epidemiology -- United States; Crime Victims -- Psychosocial Factors -- In Adolescence; Human; Surveys; United States; Adolescence; Cross Sectional Studies; Students, Middle School -- Psychosocial Factors; Students, High School -- Psychosocial Factors; LGBTQ+ Persons -- Psychosocial Factors; Social Behavior; Logistic Regression; Prevalence; Male; Female; Sex Factors; Odds Ratio; Confidence Intervals; School Policies; Pediatricians; Professional Knowledge

Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A Multiple Mediation Analysis. - Fraser, Gloria; Wilson, Marc Stewart; Garisch, Jessica Anne; Robinson, Kealagh; Brocklesby, Madeleine; Kingi, Tahlia; O’Connell, Angelique; Russell, Lynne; O'Connell, Angelique (Archives of Suicide Research, 2018)
Despite increasing interest in the prevalence and correlates of Non-Suicidal Self-Injury (NSSI) in adolescent populations, relatively few studies have examined NSSI among lesbian, gay and bisexual (LGB) adolescents. The current study explored sexuality concerns and elevated emotion dysregulation as potential mechanisms underlying the relationship between sexual orientation and elevated non-suicidal self-injury (NSSI). A community sample of 1,799 adolescents completed a questionnaire assessing NSSI, sexual orientation, sexuality concerns, and emotion regulation. Across the study, 20.6% of adolescents reported a history of NSSI. Adolescents who identify as "mostly heterosexual," "bisexual," and "mostly homosexual" were more likely to engage in NSSI than gay/lesbian, heterosexual, and asexual adolescents. Multiple mediation analysis showed that emotion regulation, but not sexuality concerns, mediated the relationship between sexual orientation and NSSI. The current study tested two theoretical pathways by which sexual orientation could predict NSSI engagement. Findings suggest that literature on general psychological processes, as well as group-specific minority stressors, can shed light on high rates of NSSI among LGB populations. Specifically, the challenges faced by LGB adolescents may undermine the development of emotion regulation. As such, this should be a key target of intervention with LGB adolescents engaging in NSSI.
Keywords: Emotions; Stress, Psychological -- Psychosocial Factors; Self-Injurious Behavior -- Psychosocial Factors; Sexuality; Adolescence; Risk Factors; Stress, Psychological -- Epidemiology; Male; Female; New Zealand; Self-Injurious Behavior -- Epidemiology; Human; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires

Mental Health Treatment Barriers Among Racial/Ethnic Minority Versus White Young Adults 6 Months After Intake at a College Counseling Center. - Miranda, Regina; Soffer, Ariella; Polanco-Roman, Lillian; Wheeler, Alyssa; Moore, Alyssa (Journal of American College Health, 2015)
Objective: This study examined mental health treatment barriers following intake at a counseling center among racially/ethnically diverse college students.Methods: College students (N= 122) seen for intake at a college counseling center in 2012–2013 completed self-reports of depressive symptoms, suicidal ideation, and mental health treatment barriers 6 months later.Results: Racial/ethnic minority students less often reported previous mental health treatment and treatment after being seen at the counseling center, compared with white students. They also endorsed more treatment barriers—most commonly, financial concerns and lack of time—and more often endorsed stigma-related concerns. Treatment barriers were associated with not following through with counseling center recommendations and with greater depressive symptom severity but not with suicidal ideation during follow-up.Conclusions: Improving mental health treatment seeking among racial/ethnic minority college students should involve decreasing treatment barriers, improving access to affordable options, providing flexible scheduling or time-limited options, and decreasing stigma.,
Keywords: Counseling -- Psychosocial Factors; Health Services Accessibility; Race Factors; Students, Minority; Human; Male; Female; Descriptive Statistics; Data Analysis Software; Confidence Intervals; Depression -- Symptoms; Suicidal Ideation; Healthcare Disparities; Students, College -- Psychosocial Factors; Minority Groups; Community Mental Health Services -- Utilization; Adolescence; Adult; Odds Ratio; Transgender Persons; Chi Square Test; Questionnaires; Funding Source

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

Emotional Distress, Bullying Victimization, and Protective Factors Among Transgender and Gender Diverse Adolescents in City, Suburban, Town, and Rural Locations. - Eisenberg, Marla E.; Gower, Amy L.; McMorris, Barbara J.; Rider, G. Nicole; Coleman, Eli (Journal of Rural Health, 2019)
Purpose: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. Methods: Data come from a statewide school‐based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. Findings: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. Conclusions: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population.
Keywords: Emotions; Stress, Psychological; Bullying; Sex Factors; Transgender Persons -- Psychosocial Factors -- In Adolescence; Students, High School -- Psychosocial Factors -- In Adolescence; Residence Characteristics -- Trends -- Minnesota; Human; Surveys; Suburban Areas; Rural Areas; Urban Areas; Minnesota; Analysis of Covariance; Prevalence; Depression; Suicidal Ideation; Adolescence; Support, Psychosocial; Crime Victims -- Psychosocial Factors

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

Bullying and Quality of Life in Youths Perceived as Gay, Lesbian, or Bisexual in Washington State, 2010. - Patrick, Donald L.; Bell, Janice F.; Jon Y. Huang; Lazarakis, Nicholas C.; Edwards, Todd C. (American Journal of Public Health, 2013)
Objectives. We examined the association between perceived sexual orientation (PSO), bullying, and quality of life (QOL) among US adolescents. Methods. We analyzed data from the 2010 Washington State Healthy Youth Survey collected in public school grades 8, 10, and 12 (n = 27 752). Bullying status was characterized as never bullied, bullied because of PSO, or bullied for other reasons. Survey-weighted regression examined differences in QOL, depressed mood, and consideration of suicide by bullying status. Results. Among male students, 14%, 11%, and 9% reported being bullied because of PSO in 8th, 10th, and 12th grades, respectively; and among female students, 11%, 10%, and 6%. In all gender and grade strata, being bullied because of PSO was associated with lower QOL scores and increased the odds of depressed mood or consideration of suicide. Moreover, the magnitudes of these associations were greater than for being bullied for other reasons. Conclusions. Bullying because of PSO is widely prevalent and significantly affects several facets of youth QOL. Bully-prevention or harm-reduction programs must address bullying because of PSO.
Keywords: Quality of Life; Bullying; Sexuality -- In Adolescence; Gay Persons; Lesbians; Human; Regression; Depression; Surveys; Data Analysis Software; Multivariate Analysis; Socioeconomic Factors; Adolescence

Disparities in Health Risk Behaviors and Health Conditions Among Rhode Island Sexual Minority and Unsure High School Students. - Jiang, Yongwen; Reilly‐Chammat, Rosemary; Cooper, Tara; Viner‐Brown, Samara (Journal of School Health, 2018)
BACKGROUND Sexual minority students have higher risk for health‐related behaviors. We examined 5 domains including 34 health risk behaviors and health conditions among sexual minorities and unsure students in Rhode Island. We also included sexual contact of heterosexually identified students to capture heterosexually identified students who may be considered sexual minorities by their behavior. METHODS: We used the 2007‐2015 Rhode Island Youth Risk Behavior Survey data (N = 14,264). We categorized students into 4 groups: students self‐identified as heterosexual and reported no sexual contact with same sex only or both sexes (group 1); self‐identified as heterosexual and reported sexual contact with same sex only or both sexes (group 2); self‐identified as lesbian, gay, bisexual (group 3); and responded as unsure (group 4). We used multivariable adjusted logistic regression analyses to evaluate associations of sexual minority and unsure students with 34 health risk behaviors and health conditions accounting for complex sampling design. RESULTS: Students in groups 2‐4 were more likely to engage in health‐risk behaviors including violent behaviors, attempted suicide, substance use, and no physical activity than their peers. CONCLUSIONS: As sexual minority youth continue to report higher rates of health‐related risk behaviors, targeted evidence‐based prevention approaches must focus on reducing these risk behaviors among those youth.
Keywords: Students, Minority -- Psychosocial Factors -- Rhode Island; Students, High School -- Psychosocial Factors; Sexual Identity; Health Status Disparities; Risk Taking Behavior -- Prevention and Control; Human; Rhode Island; Male; Female; Adolescence; Sexuality; Heterosexuals; LGBTQ+ Persons; Surveys; Multiple Logistic Regression; Secondary Analysis; Health Status; Data Analysis Software; Confidence Intervals; Odds Ratio; Support, Psychosocial; Health Promotion; Student Attitudes

Sexual Minority Youth Report High-Intensity Binge Drinking: The Critical Role of School Victimization. - Fish, Jessica N.; Schulenberg, John E.; Russell, Stephen T. (Journal of Adolescent Health, 2019)
Abstract Purpose To examine standard binge drinking (≥4 drinks for females, ≥5 drinks for males) and high-intensity binge drinking (≥8 drinks for females, ≥10 drinks for males) among heterosexual and sexual minority youth in the US and whether reports of school-based victimization mediate this association. Methods Survey data are from the 2015 Youth Risk Behavior Survey (YRBS; n = 10,839, M age = 16.07). Logistic regression adjusted for race/ethnicity and age compared rates of standard and high-intensity binge drinking among heterosexual and sexual minority youth and whether experiences of school-based victimization mediated this association. Effects were tested in full sample and sex-stratified models. Results Lesbian and bisexual girls and girls with male and female partners were more likely than heterosexual girls to report standard rates of binge drinking. Lesbian girls and girls reporting male and female sexual partners were more likely than heterosexual girls to report high-intensity binge drinking in the past 30 days. Compared with heterosexual boys, gay boys were significantly less likely to participate in high-intensity binge drinking. School-based victimization mediated all significant associations between sexual minority status and standard and high-intensity binge drinking, with the exception of lesbian girls. Conclusion Lesbian and behaviorally bisexual girls have elevated risk for high-intensity binge drinking relative to heterosexual girls. Findings point to the importance of policies that reduce school-based victimization as these experiences are associated with higher rates of standard and high-intensity binge drinking among sexual minority girls.
Keywords: LGBTQ+ Persons -- United States; Binge Drinking; Bullying; School Violence; Human; Male; Female; Adolescence; United States; Surveys; Logistic Regression; Heterosexuals; Sexual Partners; Two-Stage Cluster; Data Analysis Software; Confidence Intervals; Descriptive Statistics; Funding Source; Questionnaires; Odds Ratio; Sex Factors

Suicidality and the lesbian, gay, bisexual, and transgender (LGBT) youth: A review. - Greydanus, Donald E. (International Journal of Child Health & Human Development, 2017)
Homosexuality has been a form of sexuality placed in the center of controversy of homo sapiens existence for countless millennia. The removal of homosexuality as a psychiatric illness by the American Psychiatric Association and the American Psychological Association in the 1970s changed the paradigm for perceiving gay and lesbian individuals. Views in the United States mental health community changed from linking homosexuality to psychiatric disorders over four decades ago to identifying depression and suicidality in gay and lesbian persons because of societal insouciance, impuissant aesculapian response, and implacable sacerdotal dogma. This article reviews issues involving the LGBT population and suicidality.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Suicide -- Risk Factors -- In Adolescence; Adolescence; Sexuality; Social Isolation; Discrimination; Social Attitudes

Editorial. - Yakeley, Jessica (Psychoanalytic Psychotherapy, 2017)
Keywords: Psychoanalytic Theory; Transgender Persons; Suicide

Barriers and Stigma Experienced by Gay Fathers and Their Children. - Perrin, Ellen C.; Hurley, Sean M.; Mattern, Kathryn; Flavin, Lila; Pinderhughes, Ellen E. (Pediatrics, 2019)
BACKGROUND: Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality. METHODS: Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a "snowball" method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts. RESULTS: Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections. CONCLUSIONS: Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States' legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers.
Keywords: Gay Men -- Psychosocial Factors -- United States; Stigma; Parent-Child Relations; Psychological Well-Being; Social Behavior; Human; Male; United States; Surveys; Internet; Adoption -- Legislation and Jurisprudence; Fatherhood; Socioeconomic Factors; Parenting; Religion and Religions; Adult; Lesbians -- Psychosocial Factors

Supporting Transgender and Gender Diverse Youth: Protection Against Emotional Distress and Substance Use. - Gower, Amy L.; Rider, G. Nic; Brown, Camille; McMorris, Barbara J.; Coleman, Eli; Taliaferro, Lindsay A.; Eisenberg, Marla E. (American Journal of Preventive Medicine, 2018)
Introduction: Important mental and physical health disparities exist for transgender and gender diverse youth compared with cisgender youth (i.e., those whose birth-assigned sex and gender identity align), yet little is known about factors that protect transgender and gender diverse youth from health problems. The objective of this paper is to identify modifiable protective factors in the lives of transgender and gender diverse adolescents, with the goal of informing efforts to eliminate disparities in depression, suicidality, and substance use in this population.Methods: Secondary data analysis of the 2016 Minnesota Student Survey examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at school) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender. Logistic regressions assessed the role of each protective factor separately and simultaneously.Results: Each protective factor was associated with lower odds of emotional distress and substance use. When protective factors were examined simultaneously, parent connectedness was protective for all measures. Feeling safe at school and connected to adults in one's community protected against depression and suicidality; teacher connectedness buffered risk of substance use.Conclusions: Given that transgender and gender diverse youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender diverse-friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use.
Keywords: Stress, Psychological -- Prevention and Control; Substance Use Disorders -- Prevention and Control; Probability; Suicidal Ideation; Female; Adolescence; Minnesota; Male; Scales

Autoethnographic poetic inquiry: therapeutically engaging with violence toward queers. - Teman, Eric D. (Journal of Poetry Therapy, 2019)
Therapeutic applications of poetry provide a powerful means of exploring and portraying lived experiences of queer individuals. In this article, autoethnographic poetic inquiry is used to explore the author's life. Bullying, suicide, moments of strength and weakness, othering, and stifling of voice are some of the issues explored through this poetic journey. The author reflects on each of the poems he has written and roots such explorations in methodological literature of arts-based qualitative research. The overall purpose of the article is to document parts of the author's life as he demonstrates how poetry has begun to help him heal. Through the act of writing poetry and reflecting on the meanings of said poems, the author takes the reader on a journey through his therapeutic healing process.
Keywords: Authors -- Psychosocial Factors; LGBTQ+ Persons; Violence; Poetry; Anthropology, Cultural; Life Experiences; Art Therapy

Attachment-Based Family Therapy for Suicidal Lesbian, Gay, and Bisexual Adolescents: A Case Study. - Levy, Suzanne A.; Russon, Jody; Diamond, Gary M. (Australian & New Zealand Journal of Family Therapy, 2016)
The majority of sexual minority adolescents are well-adjusted and healthy, however, on average, 28% report suicidal ideation and between 15% and 40% make a suicide attempt each year. These rates are two to seven times higher than those found among heterosexual youths. Research has shown the protective function of parental support and acceptance, as well as the deleterious effects of parental criticism, invalidation, and rejection on the mental health of sexual minority adolescents. Given these risk and protective factors, these adolescents might benefit from an intervention that targets family relationships. Toward this goal, Attachment-Based Family Therapy ( ABFT) specifically aims to improve the quality of adolescent-parent relationships. In prior treatment developmental work, ABFT was adapted and pilot tested for depressed and suicidal lesbian, gay, and bisexual ( LGB) adolescents. By adopting an evidence-based case study format, this paper provides a case summary to illustrate how the therapy was conducted. The case study consists of a vignette, followed by therapy task descriptions and illustrative transcripts. Examples of key therapeutic moments in ABFT, for depressed and suicidal LGB adolescents, are discussed in the context of the case.
Keywords: Family Therapy; Suicidal Ideation -- Prevention and Control; Suicide, Attempted -- Prevention and Control; LGBTQ+ Persons -- In Adolescence; Mother-Child Relations; Adolescence; Depression -- Prevention and Control; Suicidal Ideation -- Risk Factors; Suicide, Attempted -- Risk Factors; Parental Attitudes; Female; Treatment Outcomes

A comparison of mental health symptomatology and levels of social support in young treatment seeking transgender individuals who identify as binary and non-binary. - Thorne, Nat; Witcomb, Gemma L.; Nieder, Timo; Nixon, Elena; Yip, Andrew; Arcelus, Jon (International Journal of Transgenderism, 2019)
Background: Previous research has consistently reported high rates of mental health symptomatology and lower social support in young treatment seeking transgender individuals. However, these studies have failed to distinguish between transgender people who identify within the gender binary and those who identify as non-binary. Aims: This study aimed to compare levels of mental health symptomatology (anxiety, depression, and non-suicidal self-injury behavior) and social support of treatment seeking non-binary transgender young individuals with those self-identified as binary transgender young individuals. All participants attended a national transgender health service in the UK during a 2-year period. Measures: Age and gender identity descriptors were collected, as well as clinical measures of anxiety and depression (Hospital Anxiety and Depression Scale), self-esteem (The Rosenberg Self-Esteem Scale), non-suicidal self-injury (Non-Suicidal Self-Injury: Treatment Related), and social support (Multidimensional Scale of Perceived Social Support). Results: A total of 388 young people, aged 16–25 years, agreed participation; 331 (85.3%) identified as binary and 57 (14.7%) as non-binary. Analysis of the data showed the non-binary group experienced significantly more anxiety and depression and had significantly lower self-esteem than the binary group. There were no significant differences between groups in the likelihood of engaging in non-suicidal self-injury behavior or levels of social support.Conclusions: Non-binary identifying treatment seeking transgender youth are at increased risk of developing anxiety, depression, and low self-esteem compared to binary transgender youth. This may reflect the even greater barriers and feelings of discrimination that may be faced by those whose identity does not fit the notion of binary gender that is pervasive in how society views both cis- and transgender populations.
Keywords: Support, Psychosocial -- Evaluation; Help Seeking Behavior; Transgender Persons -- Psychosocial Factors; Anxiety -- Diagnosis; Depression -- Diagnosis; Self-Injurious Behavior -- Diagnosis; Human; Anxiety -- Therapy; Depression -- Therapy; Self-Injurious Behavior -- Therapy; Health Services -- United Kingdom; United Kingdom; Age Factors; Gender Identity; Self Concept; Psychological Tests; Self-Esteem Inventory; Scales; Young Adult; Adult; Anxiety -- Risk Factors; Depression -- Risk Factors; Health Services Accessibility; Emotions; Discrimination

A Comparison of Lesbian, Bisexual, and Heterosexual College Undergraduate Women on Selected Mental Health Issues. - Kerr, Dianne L.; Santurri, Laura; Peters, Patricia (Journal of American College Health, 2013)
Objective: To investigate selected mental health characteristics of lesbians and bisexual undergraduate college women as compared with heterosexual college women.Participants: Self-identified lesbians and bisexual and heterosexual female college students who took part in the American College Health Association National College Health Assessment II (ACHA-NCHA-II) in Fall 2008, Spring 2009, and Fall 2009.Methods: A secondary analysis of the ACHA-NCHA-II data set for 3 semesters was conducted. Comparisons of lesbians and bisexual and heterosexual female college students were made.Results: Bisexual women reported the worst mental health status in all areas studied including anxiety, anger, depressive symptoms, self-injury, and suicidal ideation and attempts. Both bisexual women and lesbians had a far greater likelihood of having these mental health issues when compared with heterosexual women. Lesbians and bisexual women utilized significantly more mental health services (with the exception of clergy) than heterosexual women.Conclusions: College health professionals should recognize and address the mental health needs of bisexual and lesbian undergraduate college women.
Keywords: Students, Undergraduate -- United States; Women; Lesbians; Bisexuals; Heterosexuals; Mental Health; Human; Descriptive Research; Comparative Studies; United States; Questionnaires; Secondary Analysis; Repeated Measures; Cross Sectional Studies; Anxiety Disorders; Anger; Depression; Injuries, Self-Inflicted; Suicidal Ideation; Suicide, Attempted; Female; Mental Health Services -- Utilization; Descriptive Statistics; Chi Square Test; T-Tests; Odds Ratio; Confidence Intervals

Transgender and non-conforming persons' mental healthcare experiences: An integrative review. - White, Bradley Patrick; Fontenot, Holly B. (Archives of Psychiatric Nursing, 2019)
Abstract Introduction Transgender and gender non-conforming (TGNC) people in the United States face disproportionate rates of mental health disorders, including suicidality, depression, anxiety, and substance use disorders than the general population. Patients' experiences utilizing mental healthcare is a determinant in their care-seeking behaviors and treatment success. Aim/question The purpose of this integrative review is to better understand the firsthand mental healthcare experiences of TGNC persons. Method The authors sought to locate recent English-language articles that described the mental healthcare experiences of TGNC persons. To do so, only articles that conducted data collection with a TGNC sample were considered for review. Results Seven articles met criteria for review. Four themes emerged that depicted experiences of health promotion (welcoming environments , staff knowledge and response) and health prevention (enacted stigma , racial disparities and intersectional insensitivity). Discussion Themes indicated that TGNC persons have mixed experiences (excellent to harmful/damaging) when receiving mental healthcare. There is room for healthcare provider growth in skills to increase TGNC cultural competency. Implications for practice Mental healthcare providers and nurses would benefit from interventions to promote TGNC culturally competent care, including in-service training or continuing education for the current work force as well as incorporating TGNC content into pre-licensure educational curricula.
Keywords: Transgender Persons -- United States; Gender Nonconformity -- United States; Mental Health Services -- Utilization; Patient Attitudes; Human; Systematic Review; United States; Health Promotion; Stigma; Racism; Cultural Competence; Education, Continuing; Curriculum Development; CINAHL Database; PubMed; Psycinfo; Psychiatric Nursing; Nursing Knowledge; Professional Development; Gender Identity; Qualitative Studies; Quantitative Studies

Mental Health Staff Perceptions and Practice Regarding Self-Harm, Suicidality and Help-Seeking in LGBTQ Youth: Findings from a Cross-Sectional Survey in the UK. - Hughes, Elizabeth; Rawlings, Victoria; McDermott, Elizabeth (Issues in Mental Health Nursing, 2018)
Young people who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) experience higher levels of suicidality compared to heterosexual or cisgender peers, and face significant barriers accessing mental health services including prejudice from staff. In a cross-sectional survey, mental health staff who reported receiving LGBT awareness training were significantly more likely to report in relation to working with LGBT youth that they routinely discussed issues of sexuality and gender (χ2=8.782, df=2,p< 0.05); to feel that their organisation supported them to work with this group (χ2=14.401, df=2,p< 0.001); and report that they had access to adequate skills training that supported their work with suicidality and self-harm with this group (χ2=21.911, df=2,p<0.001). There is a need to enhance the mental health workforce in LGBTQ awareness, and these findings indicate that awareness training could impact positively on practice.
Keywords: Mental Health Personnel; Attitude of Health Personnel; Self-Injurious Behavior; Suicidal Ideation; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Help Seeking Behavior; Human; Adolescence; Cross Sectional Studies; United Kingdom; Prejudice; Qualitative Studies; Interviews; Data Analysis Software; Chi Square Test; Questionnaires; Funding Source

Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center. - Beckwith, Noor; McDowell, Michal J.; Reisner, Sari L.; Zaslow, Shayne; Weiss, Roger D.; Mayer, Kenneth H.; Keuroghlian, Alex S. (LGBT Health, 2019)
Purpose: Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults. Methods: We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement. Results: Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20-0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01-1.08) and suicide attempt (OR 5.79, 95% CI: 2.08-16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73-173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62-125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72- 25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26-16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32-87.53), anxiety disorders (OR 15.84, 95% CI: 2.00-125.72), and MDD (OR 10.45, 95% CI: 2.28-47.98). Conclusion: Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement.

"Alone in the Rain(bow)": Existential Therapy for Loneliness in LGBTQ + Clients. - Ratanashevorn, Rattanakorn; Brown, Emily C. (Journal of LGBT Issues in Counseling, 2021)
Loneliness and isolation are major concerns for LGBTQ + clients who experience marginalization, discrimination and alienation in society and social networks. These experiences of increased loneliness and isolation can lead to other detrimental mental health outcomes, such as substance abuse, HIV, and suicide. Loneliness and isolation are central concerns of existential therapy which makes this a compatible approach for addressing these issues among LGBTQ + clients. This article uses an existential therapy lens to examine the issue of loneliness among LGBTQ + clients and provides a case illustration to demonstrate its application.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Loneliness; Psychotherapy; Mental Health; Social Isolation; Social Networks; Mental Disorders -- Therapy

Evaluation of Suicide Mortality Among Sexual Minority US Veterans From 2000 to 2017. - Lynch, Kristine E.; Gatsby, Elise; Viernes, Benjamin; Schliep, Karen C.; Whitcomb, Brian W.; Alba, Patrick R.; DuVall, Scott L.; Blosnich, John R. (JAMA Network Open, 2020)
This cohort study compares suicide mortality among sexual minority veterans with suicide mortality in the general US and veteran populations. Key Points: Question: How does suicide mortality among sexual minority veterans compare with suicide mortality in the general US and veteran populations? Findings: In this cohort study of 96 893 sexual minority veterans, risk of death from suicide was higher among sexual minority veterans compared with the general US population and the general veteran population. Meaning: These findings suggest that sexual minority veterans have an increased risk of suicide mortality and that understanding whether and to what extent prevention efforts reach this population should be the focus of future research. Importance: Identification of subgroups at greatest risk for suicide mortality is essential for prevention efforts and targeting interventions. Sexual minority individuals may have an increased risk for suicide compared with heterosexual individuals, but a lack of sufficiently powered studies with rigorous methods for determining sexual orientation has limited the knowledge on this potential health disparity. Objective: To investigate suicide mortality among sexual minority veterans using Veterans Health Administration (VHA) electronic health record data. Design, Setting, and Participants: This retrospective population-based cohort study used data on 8.1 million US veterans enrolled in the VHA after fiscal year 1999 that were obtained from VHA electronic health records from October 1, 1999 to September 30, 2017. Data analysis was carried out from March 1, 2020 to October 31, 2020. Exposure: Veterans with documentation of a minority sexual orientation. Documentation of sexual minority status was obtained through natural language processing of clinical notes and extraction of structured administrative data for sexual orientation in VHA electronic health records. Main Outcomes and Measures: Suicide mortality rate using data on the underlying cause of death obtained from the National Death Index. Crude and age-adjusted mortality rates were calculated for all-cause death and death from suicide among sexual minority veterans compared with the general US population and the general population of veterans. Results: Among the 96 893 veterans with at least 1 sexual minority documentation in the electronic health record, the mean (SD) age was 46 (16) years, 68% were male, and 70% were White. Of the 12 591 total deaths, 3.5% were from suicide. Veterans had a significantly higher rate of mortality from suicide (standardized mortality ratio, 4.50; 95% CI, 4.13-4.99) compared with the general US population. Suicide was the fifth leading cause of death in 2017 among sexual minority veterans (3.8% of deaths) and the tenth leading cause of death in the general US population (1.7% of deaths). The crude suicide rate among sexual minority veterans (82.5 per 100 000 person-years) was higher than the rate in the general veteran population (37.7 per 100 000 person-years). Conclusions and Relevance: The results of this population-based cohort study suggest that sexual minority veterans have a greater risk for suicide than the general US population and the general veteran population. Further research is needed to determine whether and how suicide prevention efforts reach sexual minority veterans.
Keywords: Suicide -- Mortality; Mortality -- Trends; Sexual and Gender Minorities; Veterans -- United States; Suicide -- Prevention and Control; Human; Funding Source; United States; Suicide -- Risk Factors; Retrospective Design; Prospective Studies; Sexual Orientation; Adolescence; Adult; Middle Age; Aged; Aged, 80 and Over; Male; Female; Confidence Intervals; Cox Proportional Hazards Model; Data Analysis Software; Descriptive Statistics; Stress, Psychological; Depression; Stress Disorders, Post-Traumatic

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

Nonconforming Gender Expression and Associated Mental Distress and Substance Use Among High School Students. - Lowry, Richard; Johns, Michelle M.; Gordon, Allegra R.; Austin, S. Bryn; Robin, Leah E.; Kann, Laura K. (JAMA Pediatrics, 2018)
Key Points: Question: What is the association between gender nonconformity (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) and indicators of mental distress and substance use among adolescents? Findings: In this cross-sectional study of 6082 high school students, gender nonconformity was associated with feeling sad and hopeless, as well as suicidal thoughts and/or behaviors, among female and male students. In addition, gender nonconformity was strongly associated with substance use among male students. Meaning: These findings underscore the importance of implementing school-based programs to prevent substance use and promote mental health that are inclusive of gender-diverse students. This cross-sectional study based on data from the Youth Risk Behavior Survey examines the associations of gender nonconformity with mental distress and substance use among high school students in 3 large urban US school districts (2 in California and 1 in Florida). Importance: The cultural roles and expectations attributed to individuals based on their sex often shape health behaviors and outcomes. Gender nonconformity (GNC) (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) is an underresearched area of adolescent health that is often linked to negative health outcomes. Objective: To examine the associations of GNC with mental distress and substance use among high school students. Design, Setting, and Participants: Cross-sectional study based on data from the Youth Risk Behavior Survey (YRBS) conducted in 2015. The setting was 3 large urban US school districts (2 in California and 1 in Florida). Participants were a racially/ethnically diverse population-based sample of 6082 high school students representative of all public school students in grades 9 through 12 attending these 3 school districts. Main Outcomes and Measures: Sex-stratified adjusted prevalence ratios (APRs) (adjusted for race/ethnicity, grade, and sexual identity) for high gender-nonconforming students (very/mostly/somewhat feminine male students or very/mostly/somewhat masculine female students) and moderate gender-nonconforming students (equally feminine and masculine students) relative to a referent group of low gender-nonconforming students (very/mostly/somewhat masculine male students or very/mostly/somewhat feminine female students). Results: Among 6082 high school students, 881 (15.9%) were white, 891 (19.1%) black, 3163 (55.1%) Hispanic, and 1008 (9.9%) other race/ethnicity. Among female students (2919 [50.0% of the study population]), moderate GNC was significantly associated with feeling sad and hopeless (APR, 1.22; 95% CI, 1.05-1.41), seriously considering attempting suicide (APR, 1.41; 95% CI, 1.14-1.74), and making a suicide plan (APR, 1.52; 95% CI, 1.22-1.89); however, substance use was not associated with GNC. Among male students (3139 [50.0% of the study population]), moderate GNC was associated with feeling sad and hopeless (APR, 1.55; 95% CI, 1.25-1.92); high GNC was associated with seriously considering attempting suicide (APR, 1.72; 95% CI, 1.16-2.56), making a suicide plan (APR, 1.79; 95% CI, 1.17-2.73), and attempting suicide (APR, 2.78; 95% CI, 1.75-4.40), as well as nonmedical use of prescription drugs (APR, 1.81; 95% CI, 1.23-2.67), cocaine use (APR, 2.84; 95% CI, 1.80-4.47), methamphetamine use (APR, 4.52; 95% CI, 2.68-7.61), heroin use (APR, 4.59; 95% CI, 2.48-8.47), and injection drug use (APR, 8.05; 95% CI, 4.41-14.70). Conclusions and Relevance: This study suggests mental distress is associated with GNC among female and male students. Substance use also appeared to be strongly associated with GNC among male students. These findings underscore and suggest the importance of implementing school-based programs to prevent substance use and promote student mental health that are inclusive of gender diversity in students.
Keywords: Students, High School -- Psychosocial Factors -- United States; Gender Nonconformity; Stress, Psychological; Substance Abuse; Human; Cross Sectional Studies; Questionnaires; Surveys; Urban Areas -- United States; United States; California; Florida; Race Factors; Ethnic Groups; Odds Ratio; Confidence Intervals; Male; Female; White Persons; Black Persons; Hispanic Americans; Hopelessness; Suicide, Attempted; Cocaine; Methamphetamine; Heroin; Sex Factors; Femininity; Masculinity; Emotions; Adolescent Health; Sexual Identity

Risk Factors Associated With Self-injurious Behavior Among a National Sample of Undergraduate College Students. - Taliaferro, Lindsay A.; Muehlenkamp, Jennifer J. (Journal of American College Health, 2015)
Objective: Nonsuicidal self-injury (NSSI) and suicidality among undergraduates represent important public health issues. This analysis identified risk factors that distinguished 3 groups, those who reported no history of self-harm; self-injury, but no suicide attempts (NSSI only); and self-injury and a suicide attempt (NSSI + SA) in the past year.Methods: Data came from 16,044 undergraduates who completed the Fall 2010 National College Health Assessment.Results: Over 3% of students reported NSSI, and one third of these individuals also attempted suicide. Factors that distinguished the NSSI only and NSSI + SA groups from the no self-harm group included current depressive symptoms, nonheterosexual orientation, an eating disorder/extreme weight control behavior, and diagnosis of an internalizing disorder. Factors that distinguished the NSSI + SA group from the NSSI only group were current depressive symptoms and diagnosis of an internalizing disorder.Conclusions: Students experiencing mental health problems demonstrate increased risk for NSSI and/or suicidal behavior.
Keywords: Injuries, Self-Inflicted -- Risk Factors; Suicidal Ideation -- Risk Factors; Behavior Therapy -- Methods; Human; Students, College; Florida; Academic Medical Centers; Adult; Male; Female; Data Analysis Software; Chi Square Test; Linear Regression; Odds Ratio; Confidence Intervals; Logistic Regression; Mental Health; Values Clarification; Self Care -- Education

Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans. - Tucker, Raymond P.; Testa, Rylan J.; Simpson, Tracy L.; Shipherd, Jillian C.; Blosnich, John R.; Lehavot, Keren (Psychological Medicine, 2018)
Background: Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans. Methods: This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey. Results: Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks. Conclusions: Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.
Keywords: Veterans -- Psychosocial Factors; Transgender Persons -- Psychosocial Factors; Gender Affirmation Surgery -- Psychosocial Factors; Hormone Therapy -- Psychosocial Factors; Depression; Suicidal Ideation; Cross Sectional Studies; Human; Self-Diagnosis; Self Report; Internet; Surveys; Gender Identity; Income; Thoracic Surgery; Genitalia -- Surgery; Policy Making

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

The relationship of the UPPS model of impulsivity on bulimic symptoms and non-suicidal self-injury in transgender youth. - Peterson, Claire M.; Mara, Constance A.; Conard, Lee Ann E.; Grossoehme, Daniel (Eating Behaviors, 2020)
Objective: This brief report examined the relationship of negative urgency (the tendency to act rashly in response to negative emotional states), (lack of) perseverance, (lack of) premeditation, and sensation seeking in association with non-suicidal self-injury (NSSI) and symptoms of bulimia nervosa (BN) in a sample of treatment-seeking transgender (TG) youth.Method: Eighty-six TG youth with a mean age of 17 (sd = 3.2) agreed to participate in the study. The majority of our sample identified as TG male (n = 60) with 20 participants identifying as TG female and 6 identifying as non-binary. The racial ethnic breakdown of our sample was 8.2% Black, 8.2% Multi-racial, 1.2% Native American, and 82.4% White. Over ¼ of our sample endorsed at least one episode of objective binge eating in the last 28 days and 62% endorsed a history of NSSI.Results: Negative urgency was significantly associated with the odds of NSSI, objective binge eating, and general eating disorder symptoms. Lack of premeditation was significantly related to the odds of NSSI only. No other factors were significantly associated with NSSI or symptoms of BN.Conclusions: Negative urgency appears to be an important personality construct in understanding increased risk for NSSI and BN symptoms in transgender youth.
Keywords: Bulimia; Self-Injurious Behavior; Bulimia Nervosa; Female; Adolescence; Male; Behavior; Human; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Clinical Assessment Tools; Questionnaires

Characteristics and Correlates of Lifetime Suicidal Thoughts and Attempts Among Young Black Men Who Have Sex With Men (MSM) and Transgender Women. - Wilton, Leo; Chiasson, Mary Ann; Nandi, Vijay; Lelutiu-Weinberger, Corina; Frye, Victoria; Hirshfield, Sabina; Hoover, Donald R.; Downing, Martin J.; Lucy, Debbie; Usher, DaShawn; Koblin, Beryl (Journal of Black Psychology, 2018)
This study examined characteristics and correlates of lifetime suicidal thoughts and suicide attempts among HIV-negative young Black men who have sex with men (MSM) and transgender women (transwomen) between 16 and 29 years of age (N = 161). In our sample, 36.6% of young Black MSM and transwomen reported a history of lifetime suicidal thoughts, while 16.1% reported prior suicide attempts. Using multivariable analysis, a history of intimate partner violence, greater psychological distress, and higher perceived sexuality discrimination were significantly associated with lifetime suicidal thoughts. Childhood sexual abuse history, greater psychological distress, lower score for outness, and higher perceived sexuality discrimination were significantly related to suicide attempts among young Black MSM and transwomen. Efforts to identify and understand factors associated with lifetime suicidal thoughts and attempts are urgently needed to inform the development and implementation of culturally relevant mental health prevention strategies for young Black MSM and transwomen.
Keywords: Suicidal Ideation; Suicide, Attempted -- Psychosocial Factors; Black Persons -- Psychosocial Factors; Men Who Have Sex With Men -- Psychosocial Factors; Transgender Persons -- Psychosocial Factors; HIV Seronegativity -- Psychosocial Factors; Life Style; Human; Female; Male; Adolescence; Young Adult; Adult; Multivariate Analysis; Intimate Partner Violence; Stress, Psychological; Child Abuse, Sexual; Program Development; Program Implementation; Sexism

Religious belief, age, and sexual orientation on attributions of younger and older gay and heterosexual men. - Kane, Michael; Jacobs, Robin J.; Sherman, Diane (Mental Health, Religion & Culture, 2015)
Using 4 vignettes and 20 response items, this exploratory study investigated attributions about older or younger gay or heterosexual men with a history of multiple sex partners, substance abuse, and legal problems. The character is diagnosed with a terminal illness and two options for care: no treatment or an aggressive treatment protocol with a small chance of recovery. When controlling for respondents’ (N = 324) religious identification, frequency of attendance at religious services, and ethno-cultural identification, a General Linear Model was significant (F = 57.014, df = 20,p < .001). Differences in the vignette responses centred on perceptions of quality of life, the character's lifestyle, and suicide.
Keywords: Religion and Religions; Gay Persons -- Florida; Heterosexuals -- Florida; Social Values; Human; Substance Abuse; Ageism; Female; Male; White Persons; Black Persons; Hispanic Americans; Florida; Vignettes; Suicide; Life Style

13 Reasons Why: Viewing Patterns and Perceived Impact Among Youths at Risk of Suicide. - Hong, Victor; Ewell Foster, Cynthia J.; Magness, Christina S.; McGuire, Taylor C.; Smith, Patricia K.; King, Cheryl A. (Psychiatric Services, 2019)
Objective: The streaming series 13 Reasons Why generated controversy because of its depiction of teen suicide and concerns about its impact on vulnerable youths. This study examined exposure to and patterns of engagement with the show and the show's perceived impact in a sample of youths presenting to a psychiatric emergency department (ED) with suicide-related concerns in the year after the series' premiere.Methods: Participants were 87 parent-youth dyads (youths' mean±SD age=14.6±1.8; 71% of youths were female, 26% male, and 2% gender nonconforming) who completed a battery of questionnaires during their ED visit.Results: Half (49%) of the sample viewed at least one episode of 13 Reasons Why, season 1. Most youths (84%) viewed the show alone and were more likely to discuss their reactions with peers (80%) than with a parent (34%). Over half of youth viewers (51%) believed the series increased their suicide risk to a nonzero degree; having a stronger identification with the lead female character was significantly related to this belief (r=.63, df=41, p<0.001). Youths with more depressive symptoms and suicidal ideation were more likely to identify with the lead characters and report negative affect while viewing.Conclusions: To date, this is the first published study examining viewing patterns and reactions to 13 Reasons Why in a high-risk sample. Although further research is needed, the findings suggest a particular vulnerability to the show's themes among youths at risk of suicide and the importance of prevention strategies to ameliorate risk among these viewers.
Keywords: Suicide -- Psychosocial Factors; Suicide; Adolescent Behavior; Emergency Service -- Statistics and Numerical Data; Communication; Relative Risk; United States; Female; Peer Group; Male; Parents; Adult; Human; Adolescence; Young Adult; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Impact of Events Scale; Questionnaires; Scales

The Mental Health of Transgender Youth: Advances in Understanding. - Connolly, Maureen D.; Zervos, Marcus J.; IIBarone, Charles J.; Johnson, Christine C.; Joseph, Christine L.M. (Journal of Adolescent Health, 2016)
This review provides an update on the growing body of research related to the mental health of transgender youth that has emerged since the 2011 publication of the Institute of Medicine report on the health of lesbian, gay, bisexual, and transgender people. The databases PubMed and Ovid Medline were searched for studies that were published from January 2011 to March 2016 in English. The following search terms were used: transgender, gender nonconforming, gender minority, gender queer, and gender dysphoria. Age limits included the terms youth, child, children, teenager*, and adolescen*. The combined search produced 654 articles of potential relevance. The resulting abstracts went through a tiered elimination system, and the remaining 15 articles, which presented quantitative data related to the prevalence of transgender youth and their mental health, were included in the present review. In addition to providing new estimates of the number of young people who identify as transgender (.17%–1.3%), studies since 2011 have shown that transgender youth have higher rates of depression, suicidality and self-harm, and eating disorders when compared with their peers. Gender-affirming medical therapy and supported social transition in childhood have been shown to correlate with improved psychological functioning for gender-variant children and adolescents. Recent research has demonstrated increased rates of psychiatric morbidity among transgender youth compared to their peers. Future work is needed to understand those youth who identify as gender nonbinary, improve methods to capture and understand diverse gender identities and related health disparities, and delineate the social determinants of such disparities.
Keywords: Transgender Persons; Mental Health; Human; Systematic Review; PubMed; Medline; Child; Adolescence; Depression; Suicidal Ideation; Self-Injurious Behavior; Eating Disorders

The necessity of social support for transgender people in China. - Xie, Zhibo; Gao, Ya; Ho, Chiakang; Cheng, Xinyu; Zhang, Yifan (Lancet, 2021)
About 400 000 transgender people live in China.[1] These individuals might not have equal rights at work or equal rights to education and thus many find themselves unable to fully participate in society or experiencing suicidal ideation. According to one survey of 1309 Chinese transgender people, the lifetime prevalence of suicidal ideation was 56-4% (732/1298), and the lifetime prevalence of suicide attempt was 16-1% (209/1298).[2] Family support and social acceptance could considerably help transgender individuals. Family support significantly reduces the prevalence of self-harm.[3] However, transgender individuals are rarely met with acceptance from their families in China, especially in less developed areas, because the traditional Chinese belief is that carrying on the family line is natural and inevitable in human life.

Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. - Mustanski BS; Garofalo R; Emerson EM (American Journal of Public Health, 2010)
OBJECTIVES: We examined associations of race/ethnicity, gender, and sexual orientation with mental disorders among lesbian, gay, bisexual, and transgender (LGBT) youths. METHODS: We assessed mental disorders by administering a structured diagnostic interview to a community sample of 246 LGBT youths aged 16 to 20 years. Participants also completed the Brief Symptom Inventory 18 (BSI 18). RESULTS: One third of participants met criteria for any mental disorder, 17% for conduct disorder, 15% for major depression, and 9% for posttraumatic stress disorder. Anorexia and bulimia were rare. Lifetime suicide attempts were frequent (31%) but less so in the prior 12 months (7%). Few racial/ethnic and gender differences were statistically significant. Bisexually identified youths had lower prevalences of every diagnosis. The BSI 18 had high negative predictive power (90%) and low positive predictive power (25%) for major depression. CONCLUSIONS: LGBT youths had higher prevalences of mental disorder diagnoses than youths in national samples, but were similar to representative samples of urban, racial/ethnic minority youths. Suicide behaviors were similar to those among representative youth samples in the same geographic area. Questionnaires measuring psychological distress may overestimate depression prevalence among this population.
Keywords: LGBTQ+ Persons; Mental Disorders; Stress, Psychological; Suicide, Attempted; Adolescence; Bisexuals; Brief Symptom Inventory; Chi Square Test; Comparative Studies; Confidence Intervals; Correlational Studies; Depression; Funding Source; Geographic Factors; Human; Illinois; Interview Guides; Logistic Regression; Null Hypothesis; Odds Ratio; Prevalence; Social Behavior Disorders; Stress Disorders, Post-Traumatic; Young Adult

Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series. - Donaldson, Abigail A.; Hall, Allison; Neukirch, Jodie; Kasper, Vania; Simones, Shannon; Gagnon, Sherry; Reich, Steven; Forcier, Michelle (International Journal of Eating Disorders, 2018)
Abstract: Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high‐risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self‐harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Eating Disorders -- Therapy -- In Adolescence; Multidisciplinary Care Team; Eating Disorders -- Risk Factors; Case Studies; Retrospective Design; Human; Thematic Analysis; Injuries, Self-Inflicted -- Risk Factors; Suicide -- Risk Factors; Mental Disorders -- Risk Factors; Treatment Delay -- Adverse Effects; Female; Male; Adolescence

Peer Victimization and Dating Violence Among LGBTQ Youth. - Espelage, Dorothy L.; Merrin, Gabriel J.; Hatchel, Tyler (Youth Violence & Juvenile Justice, 2018)
This study examined the moderating role of school violence and peer victimization on the association between sexual orientation and mental health. The sample consisted of 11,794 high school students (Mage = 16, SD = 1.23; female assigned at birth = 51%; 1.8% identified as transgender) across 23 schools. Participants completed a self-report survey that assessed sexual orientation, ethnicity, gender identity, victimization experiences (e.g., peer and dating), perceptions of school violence and crime, as well as anxiety and suicidality. Multilevel analyses indicated that lesbian, gay, bisexual, questioning, and transgender (LGBTQ) individuals with lower rates of victimization had significantly lower rates of suicidality compared to LGBTQ individuals with higher rates of victimization. LGBTQ individuals in schools with high student perceptions of school violence and crime had higher suicidality than their non-LGBTQ counterparts. LGBTQ youth in schools with lower school violence and crime levels had lower rates of suicidality than their non-LGBTQ counterparts. Interventions need to consider multiple forms of victimization and school environment as potential risk and protective factors for LGBTQ youth.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Crime Victims -- Psychosocial Factors; Students, High School -- Psychosocial Factors; Dating Violence -- Prevention and Control; School Violence -- Prevention and Control; Mental Disorders; Sexuality; Peer Group; Human; Adolescence; Female; Transgender Persons; Consumer Participation; Self Report; Surveys; Ethnic Groups; Gender Identity; Anxiety; Suicidal Ideation -- Risk Factors; Learning Environment; Community Programs

An Analysis of Themes in Popular Songs from 2010 to 2014 for Clinical Application with Adolescents. - Waddelow, Chelsea S.; Taul, Ashley L. (Canadian Journal of Music Therapy, 2016)
Song discussion using popular music can be an effective way to address issues in adolescent populations, yet there are few resources available to assist music therapists in selecting current popular songs for the purposes of song discussion. In this study the authors selected 126 popular songs from 2010 to 2014 and analyzed the music for therapeutic themes and clinical applications appropriate for song discussion with adolescents. Genres included pop, rock/alternative, electronic, hip hop/R&B, and country. A thematic textual analysis was completed on the lyrics, and themes of identity, coming of age, relationships, and being alone emerged across all genres. The authors identified broad clinical applications including abuse/trauma, anxiety, bullying, coping skills, depression, divorce/family issues, eating disorders, grief/bereavement, LGBTQ issues, perfectionism, self-esteem, self-harm, substance use, and suicide. Special considerations regarding explicit language, adult themes, and music selection for use with this population are discussed
Keywords: Music Therapy; Music; Self Concept; Eating Disorders; Discussion; Diethylstilbestrol; Adolescence; Adult

Sexual minority children: Mood disorders and suicidality disparities. - Blashill, Aaron J.; Calzo, Jerel P. (Journal of Affective Disorders, 2019)
Background: Sexual minority (gay, lesbian, and bisexual) individuals experience elevated mood disorders and suicidality compared to their heterosexual counterparts. However, to date, these sexual orientation disparities have yet to be examined among middle childhood-aged participants.Methods: Data were employed from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study, a U.S. representative sample. Population-level weighting was utilized, resulting in an analytic sample of N = 8,204,013 (nunweighted = 4519) children between the ages of 9 and 10 years: with 70,952 (nunweighted = 43) identifying as sexual minories (0.9% of the population). Structured clinical interviews were used to assess mood disorders (i.e., depressive and bipolar disorders) and suicidality. Sexual orientation (sexual minority vs. heterosexual) was examined as the focal independent variable.Results: The overall prevalence of mood disorders was 7.1%. Sexual minority children (22.5%) possessed a higher rate than heterosexual children (6.9%). The overall prevalence of suicidality was 4.8%; sexual minority children (19.1%) possessed a higher rate than heterosexual children (4.6%).Limitations: Sexual orientation assessment did not include attraction, and thus, results may represent a lower bound estimate of sexual minorities.Conclusions: Sexual orientation disparities in mood disorders and suicidality appear to develop as early as middle childhood. Clinicians are encouraged to assess sexual orientation among children as young as 9-10 years old, and provide appropriate normalization of sexual orientation, and referrals for mental health treatment, as indicated.
Keywords: Health Status Disparities; Affective Disorders -- Etiology; Suicidal Ideation; Child; Risk Factors; Female; Affective Disorders -- Psychosocial Factors; Affective Disorders -- Diagnosis; Affective Disorders -- Epidemiology; Male; Psychological Tests; Prevalence; United States; Prospective Studies; Human; Funding Source

Constructing and Expanding Suicide Narratives From Gay Men. - Salway, Travis; Gesink, Dionne (Qualitative Health Research, 2018)
In this study, we document life stories of gay men who attempted suicide as adults. Our goal is to expand the collection of narratives used to understand this persistent health inequity. We interviewed seven adult gay men, each of whom had attempted suicide two to four times, and identified five narratives. Pride narratives resist any connection between sexuality and suicide. Trauma-and-stress narratives enable coping through acknowledgment of sexual stigma as a fundamental trauma and cause of subsequent stress and suicidal thoughts. Memorial narratives prevent suicide by maintaining a strong sense of “permanent” identity. Outing narratives demand that the listener confronts the legacy of unjust practices of homosexual surveillance and “outing,” which historically resulted in gay suicides. Finally, postgay narratives warn of the risk of suicide among older generations of gay men who feel erased from the goals of modern gay movements. Sexual identity concealment or invisibility featured prominently in all five narratives.
Keywords: Gay Men -- Psychosocial Factors; Suicide; Narratives; Human; Male; Adult; Middle Age; Aged; Purposive Sample; Interviews; Funding Source

Adolescent suicide: what can pediatricians do? - Breslin, Kirsten; Balaban, Julie; Shubkin, Catherine D. (Current Opinion in Pediatrics, 2020)
Purpose Of Review: Suicide is a major public health concern and the second leading cause of death for adolescents. Faced with an already-high prevalence and increasing rates over the past decade, pediatricians feel inadequately prepared to manage a suicidal patient. This article will review the changing rates of suicide, discuss recent literature on risk factors, identify methods to screen for suicidal thoughts and suggest an approach to counseling a suicidal patient. Finally, there will be a brief discussion on safety planning and public health measures to help reduce suicide rates.Recent Findings: Rates of attempted suicide and death by suicide have been increasing for more than a decade. Risk assessment of potential suicidality remains very challenging, as the risk factors are multifactorial. However, some common risk factors persist including sexual minority identification and family or personal history of mental health issues. Although keeping these and other risk factors in mind, regular screening of adolescents for depression and self-harm is important. Finally, the best safety plans and treatment methods appear to be team-based.Summary: It remains the responsibility of pediatricians to stay aware of risk factors, regularly screen adolescents and prioritize collaborative safety planning for suicidal patients.
Keywords: Suicide, Attempted; Self-Injurious Behavior -- Psychosocial Factors; Suicide -- Psychosocial Factors; Risk Factors; Health Screening; Adolescence; Suicidal Ideation; Clinical Assessment Tools; Personal Resource Questionnaire; Questionnaires

The Relationship between Sexual Minority Status and Suicidal Ideations among Urban Hispanic Adolescents. - Lardier Jr., David T.; Bermea, Autumn M.; Pinto, Stacy A.; Garcia-Reid, Pauline; Reid, Robert J. (Journal of LGBT Issues in Counseling, 2017)
Youth identifying as lesbian, gay, bisexual, transgender, and queer (LGBTQ), and more specifically Hispanic youth identifying as LGBTQ, experience suicidal ideation (SI) at disproportionate rates. Furthermore, adolescents identifying as LGBTQ are likely to experience high rates of bullying, depression, and limited social support, increasing SI. Counselors often have difficulty working with youth at the intersection of sexual and ethnic minority statuses. Using structural equation modeling techniques, the present study examined sexual minority status as a predictor of school bullying, depression, social support, and SI, among urban Hispanic youth (N = 538). The authors also tested social support as a buffering mechanism.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Suicide -- Prevention and Control; Suicidal Ideation -- Evaluation; Hispanic Americans -- Psychosocial Factors; Support, Psychosocial -- Evaluation; Bullying -- Psychosocial Factors; Urban Areas; Human; Structural Equation Modeling; Adolescence; Child

School-Based Gay-Affirmative Interventions: First Amendment and Ethical Concerns. - Meyer, Ilan H.; Bayer, Ronald (American Journal of Public Health, 2013)
Public health professionals and educators have developed effective school-based interventions to reduce prejudice and stigma against lesbian, gay, bisexual, and transgender (LGBT) students. Such interventions can reduce the harm caused to sexual minority youths by stigma and can improve health outcomes. However, critics have warned that these interventions attempt to control speech and religious beliefs protected by the First Amendment. We review this critique and assess the legal and ethical arguments. We conclude that, both legally and ethically, there is great leeway for schools to implement LGBT-affirmative interventions. Still, we recommend that interventionists attend critics' concerns using principles of community-based participatory research (CBPR). Using CBPR approaches, interventionists can achieve better community acceptance and cooperation and more successful interventions.
Keywords: LGBTQ+ Persons; Schools; Affirmative Action -- Legislation and Jurisprudence -- United States; Civil Rights -- Ethical Issues; School Policies; Prejudice -- Prevention and Control; Minority Groups; Community Role; United States; Religion and Religions; Curriculum Development; Criticism; Child Safety; School Violence -- Prevention and Control

Caring for the Transgender Adolescent: It Takes a Village. - Agana, Marisha; Apple, Roger; Alavi, Zakia; Gibb, Tyler; Soares, Neelkamal; Augustyn, Marilyn (Journal of Developmental & Behavioral Pediatrics, 2019)
Case: Christa is a 15-year-old male-to-female (MTF) transgender patient who comes to your Developmental-Behavioral Pediatrics office for consultation on attention deficit/hyperactivity disorder (ADHD) management and concerns about worsening anxiety. Review of medical history included mild persistent asthma managed with steroid inhaler and leukotriene antagonist. She was diagnosed with ADHD at 12 years and has been placed on methylphenidate and clonidine over the years with little improvement. She struggles in school, with barely passing grades, and feels that she cannot focus on her assignments.She was diagnosed with MTF transition gender dysphoria, social anxiety disorder, and depressive disorder at 13 years by a psychiatrist and was treated with sertraline with some mood improvement. More recently, she reports having thoughts of wanting to hurt people and "wanting to watch them wither away." She expressed being terrified by these thoughts, which lasted for a couple of days but have since resolved. She denied any suicidal thoughts recently and gives credit to her "best girlfriend" for her overall improved mood, improved sleep pattern, and increased energy level. She expressed having deepening feelings for this girlfriend but admitted to not having acted on these feelings as she is afraid of the consequences. She currently uses the pronouns she/her/hers.Family history is pertinent for paternal bipolar disorder. There is considerable psychosocial stress as Christa is estranged from her father, who is not supportive of her transition, although mother is. Unfortunately, she is dependent on her father for medical insurance coverage, and he is refusing to give authorization to proceed with the evaluations and diagnostic workup for the transformation. Christa has been repeatedly encouraged to seek counseling but has declined because of previous poor experiences with counselors. Her primary care clinician in Family Medicine has been administering hormonal replacement therapy because she cannot access the regional center of excellence because of above-mentioned insurance issues. She presents to you now with her mother for management suggestions and diagnostic clarification. What is your next step?
Keywords: Attention Deficit Hyperactivity Disorder -- Therapy; Hormone Replacement Therapy; Female; Adolescence; Psychosocial Adjustment to Illness Scale; Questionnaires; Social Readjustment Rating Scale

Surgeon General's Warning: Gender Is Bad for Your Health. - Lindemann, Hilde (Hastings Center Report, 2019)
Gender, most feminists agree, isn't a fact about people in the same way that height or hair color is. Genders are constructed within and are part of a power system circulating through all of society that sets standards for men's and women's identities and places men's interests above women's. The system is bad for all of us, but especially for women, genderqueer people, and men of color. Here, I want to point out ways in which it's bad for our health. I'll start with abortion, as laws recently passed in a number of states have restricted women's access to the point where it's nearly nonexistent.
Keywords: Sexism; Gender Identity; Abortion, Induced -- Legislation and Jurisprudence -- United States; United States; Childbirth -- Legislation and Jurisprudence; Community Violence; Firearms -- Legislation and Jurisprudence; Health Policy

Religion, Sexual Orientation, and Suicide Attempts Among a Sample of Suicidal Adolescents. - Shearer, Annie; Russon, Jody; Herres, Joanna; Wong, Amanda; Jacobs, Carrie; Diamond, Gary M.; Diamond, Guy S. (Suicide & Life-Threatening Behavior, 2018)
Despite condemnation of same-sex attraction by certain religious groups, few studies have explored the relationship between religion, same-sex attraction, and suicidality. This study examined the moderating effect of same-sex attraction on the relationship between parent/adolescent religiosity and suicide ideation/attempts in a suicidal adolescent sample (N = 129). Linear and negative binomial regressions tested the effects of a two-way dichotomous (same-sex attraction, yes/no) by continuous (religiosity) interaction on ideation and attempts, respectively. The interaction was not significant for ideation. However, high religiosity was associated with more attempts in youth reporting same-sex attraction but fewer attempts in those reporting opposite-sex attraction only.
Keywords: Religion and Psychology; Suicide, Attempted; Suicide, Attempted -- Prevention and Control; Suicide, Attempted -- Psychosocial Factors; Sexuality; Male; Female; Suicidal Ideation; Risk Factors; Adolescence; United States; Questionnaires

Trend Disparities in Emotional Distress and Suicidality Among Sexual Minority and Heterosexual Minnesota Adolescents From 1998 to 2010. - Porta, Carolyn M.; Watson, Ryan J.; Doull, Marion; Eisenberg, Marla E.; Grumdahl, Nathan; Saewyc, Elizabeth (Journal of School Health, 2018)
ABSTRACT: BACKGROUND: Sexual minority young people have demonstrated higher rates of emotional distress and suicidality in comparison to heterosexual peers. Research to date has not examined trends in these disparities, specifically, whether there have been disparity reductions or increases and how outcomes have differed over time by sex and sexual orientation group. METHODS: Minnesota Student Survey data, collected from 9th and 12th graders in 3 cohorts (1998, 2004, 2010) were used to examine emotional distress and suicidality rates. Logistic regression analyses were completed to examine outcome changes over time within and across sexual orientation/sex groups. RESULTS: With few exceptions, sexual minority youth are at increased risk of endorsing emotional distress and suicidality indicators in each surveyed year between 1998 and 2010. Young people with both‐sex partners reported more emotional distress across all health indicators compared to their opposite‐sex partnered peers. With a few exceptions, gaps in disparities between heterosexual and sexual minority have not changed from 2004 to 2010. CONCLUSIONS: Disparities in emotional health persist among youth. Research is needed to advance understanding of mental health disparities, with consideration of sexual orientation differences and contextualized to sociocultural status and changes over time. Personalized prevention strategies are needed to promote adolescent mental health.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Heterosexuals -- Psychosocial Factors -- In Adolescence; Stress, Psychological -- Trends -- In Adolescence; Suicidal Ideation -- Trends -- In Adolescence; Suicide, Attempted -- Trends -- In Adolescence; Mental Health -- In Adolescence; Healthcare Disparities -- In Adolescence; Adolescent Psychology; Human; Funding Source; Surveys; Minnesota; Logistic Regression; Cross Sectional Studies; Trend Studies; Students, Middle School; Students, High School; Schools, Middle; Schools, Secondary; Male; Female; Adolescence; Odds Ratio; Confidence Intervals; Affective Symptoms

43.11 MEASURING PERCEIVED BURDENSOMENESS AND THWARTED BELONGINGNESS IN LGBTQ AND NON-LGBTQ YOUTH AT BASELINE AND 6-MONTH FOLLOW-UP OF A SUICIDE-PREVENTION INTENSIVE OUTPATIENT PROGRAM. - Michaels, Molly M.; Kennard, Betsy D.; King, Jessica D.; Emslie, Graham J.; Solomon, Graziela (Journal of the American Academy of Child & Adolescent Psychiatry, 2020)

A Syndemic of Psychosocial Health Disparities and Associations With Risk for Attempting Suicide Among Young Sexual Minority Men. - Mustanski, Brian; Andrews, Rebecca; Herrick, Amy; Schnarrs, Phillip W.; Stall, Ron (American Journal of Public Health, 2014)
Objectives. We examined a syndemic of psychosocial health issues among young men who have sex with men (MSM), with men and women (MSMW), and with women (MSW). We examined hypothesized drivers of syndemic production and effects on suicide attempts. Methods. Using a pooled data set of 2005 and 2007 Youth Risk Behavior Surveys from 11 jurisdictions, we used structural equation modeling to model a latent syndemic factor of depression symptoms, substance use, risky sex, and intimate partner violence. Multigroup models examined relations between victimization and bullying experiences, syndemic health issues, and serious suicide attempts. Results. We found experiences of victimization to increase syndemic burden among all male youths, especially MSMW and MSM compared with MSW (variance explained = 44%, 38%, and 10%, respectively). The syndemic factor was shown to increase the odds of reporting a serious suicide attempt, particularly for MSM (odds ratio [OR] = 5.75; 95% confidence interval [CI] = 1.36, 24.39; P < .001) and MSMW (OR = 5.08; 95% CI = 2.14, 12.28; P < .001) compared with MSW (OR = 3.47; 95% CI = 2.50, 4.83; P < .001). Conclusions. Interventions addressing multiple psychosocial health outcomes should be developed and tested to better meet the needs of young MSM and MSMW.
Keywords: Gay Persons -- Psychosocial Factors -- In Adolescence; Suicide, Attempted -- Risk Factors -- In Adolescence; Mental Health -- Evaluation; Funding Source; Human; Male; Adolescence; Surveys; Structural Equation Modeling; Descriptive Statistics; Odds Ratio; Confidence Intervals; P-Value; Relative Risk; Data Analysis, Statistical; Data Analysis Software; Chi Square Test; Cross Sectional Studies

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

Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study. - Swannell, Sarah; Martin, Graham; Page, Andrew (Australian & New Zealand Journal of Psychiatry, 2016)
Objectives: This study investigated associations between sexual orientation and measures of suicidality and non-suicidal self-injury in Australian adults. Previous studies of sexual orientation and suicidality have been limited by unclear conceptualisations of suicidal intent, failure to differentiate between homosexuality and bisexuality, inattention to gender differences and use of convenience-based samples. Methods: A large (N = 10,531) representative national sample of Australian adults was used to investigate associations between sexual orientation (heterosexual, homosexual, bisexual) and (1) suicidal ideation, (2) attempted suicide and (3) non-suicidal self-injury, for males and females separately, in a series of sequentially adjusted logistic regression models. Results: Sexual minority participants were at greater risk of suicidality and self-injury than heterosexuals, after adjusting for age and other covariates, with patterns of risk differing by sexual orientation and gender. Compared with their heterosexual counterparts, gay men, but not bisexual men, were more likely to report suicidal ideation (odds ratio = 3.05, 95% confidence interval = [1.65, 5.60]) and suicide attempts (odds ratio = 4.16, confidence interval = [2.18, 7.93]). Bisexual women, but not lesbian women, were more likely to report suicidal ideation (odds ratio = 4.40, confidence interval = [3.00, 6.37]) and suicide attempts (odds ratio = 4.46, confidence interval = [2.41, 8.24]). Neither bisexual nor gay men were more likely than heterosexual men to report self-injury. However, bisexual women, but not lesbian women, were more likely than heterosexual women to report self-injury (odds ratio = 19.59, confidence interval = [9.05, 42.40]). Overall, bisexual females were at greatest risk of suicidality and self-injury. Conclusion: Clinicians working with sexual minority populations are encouraged to openly discuss suicidal and self-injurious thoughts and behaviours with their clients and may consider using therapeutic strategies to reduce internalised stigma and enhance personal and social resources.
Keywords: Suicidal Ideation; Suicide, Attempted; LGBTQ+ Persons -- Australia; Australia; Sexuality; Attitude to Sexuality; Heterosexuals; Human; Questionnaires; Male; Female; Adult; Middle Age; Aged; Aged, 80 and Over; Descriptive Statistics; Data Analysis Software; Odds Ratio; Confidence Intervals

Experiences of community and parental violence among HIV-positive young racial/ethnic minority men who have sex with men. - Phillips, Gregory; Hightow-Weidman, Lisa B.; Fields, Sheldon D.; Giordano, Thomas P.; Outlaw, Angulique Y.; Halpern-Felsher, Bonnie; Wohl, Amy R. (AIDS Care, 2014)
Adolescents and young adults (ages 13–24) in the USA are frequently exposed to violence in their community and home. While studies have examined the prevalence and impact of violence exposure among adolescents, there is a lack of data focusing specifically on adolescent men of color who have sex with men. Eight demonstration sites funded through a Special Projects of National Significance (SPNS) Initiative recruited 363 HIV-positive racial/ethnic minority young men who have sex with men (YMSM) for a longitudinal study between 2006 and 2009. Over two-thirds of participants (83.8%) had witnessed community violence, 55.1% in the prior three months. Witnessing violence committed with a deadly weapon was significantly associated with being African-American, having ever used drugs, and drinking alcohol in the prior two weeks. Fear of violence in the community was significantly associated with depressive symptomatology, having less than a high school degree, not possessing health insurance, and site of enrollment. Having been emotionally or physically abused by a parent or caretaker was significantly associated with depressive symptomatology, attempting suicide, site of enrollment, and increased age. Witnessing violence with a deadly weapon was significantly associated with alcohol and drug use but not with high-risk sexual behaviors. As this was one of the first studies on the prevalence and correlates of violence exposure among racial/ethnic minority YMSM living with HIV, the findings can be used to inform the development of culturally appropriate resilience-focused interventions to address the aftereffects of violence exposures and help develop social support systems outside of the family.
Keywords: Parent-Child Relations -- Evaluation; Gay Men; Violence -- Epidemiology; AIDS Patients -- Psychosocial Factors -- In Adolescence; Race Factors; Human; Adolescence; Young Adult; Male; United States; Descriptive Statistics; Questionnaires; Interviews; Center for Epidemiological Studies Depression Scale; Psychological Tests; Scales; Odds Ratio; Confidence Intervals; Black Persons; Hispanic Americans; P-Value; Cross Sectional Studies; Convenience Sample

Homelessness, Mental Health and Suicidality Among LGBTQ Youth Accessing Crisis Services. - Rusow, Joshua A.; Goldbach, Jeremy T.; Rhoades, Harmony; Bond, David; Lanteigne, Amy; Fulginiti, Anthony (Child Psychiatry & Human Development, 2018)
LGBTQ youth experience increased risks of homelessness, mental health disorder symptoms, and suicidality. Utilizing data from LGBTQ youth contacting a suicide crisis services organization, this study examined: (a) rates of homelessness among crisis services users, (b) the relationship between disclosure of LGBTQ identity to parents and parental rejection and homelessness, and (c) the relationship between homelessness and mental health disorder outcomes and suicidality. A nationwide sample of LGBTQ youth was recruited for a confidential online survey from an LGBTQ-focused crisis services hotline. Overall, nearly one-third of youth contacting the crisis services hotline had experienced lifetime homelessness, and those who had disclosed their LGBTQ identity to parents or experienced parental rejection because of LGBTQ status experienced higher rates of homelessness. Youth with homelessness experiences reported more symptoms of several mental health disorders and higher rates of suicidality. Suggestions for service providers are discussed.
Keywords: Suicide -- Psychosocial Factors; Homeless Persons -- Psychosocial Factors; Mental Health; Suicidal Ideation; Mental Disorders -- Psychosocial Factors; Adolescence; Female; Child; Telephone Information Services; Young Adult; Male; Human; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies

Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans. - Tucker, Raymond P.; Testa, Rylan J.; Simpson, Tracy L.; Shipherd, Jillian C.; Blosnich, John R.; Lehavot, Keren (Psychological Medicine, 2018)
Background: Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans. Methods: This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey. Results: Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks. Conclusions: Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.
Keywords: Transgender Persons -- Psychosocial Factors; Veterans -- Psychosocial Factors; Hormone Therapy -- Psychosocial Factors; Gender Affirmation Surgery -- Psychosocial Factors; Suicidal Ideation; Depression -- Symptoms -- In Old Age; Human; Aged; Cross Sectional Studies; Self Report; Self-Diagnosis; Internet; Surveys; Gender Identity; Income; Thoracic Surgery; Genitalia -- Surgery; Policy Making

Exploring Anabolic-Androgenic Steroid Use and Teen Dating Violence Among Adolescent Males. - Ganson, Kyle T.; Cadet, Tamara J. (Substance Use & Misuse, 2019)
Background: Reports indicate that 4% of the adolescent males in 2015 had taken steroids without a doctor's prescription. Anabolic-androgenic steroids (AAS) are illicit drugs that have commonly been used to help build muscle mass. AAS use is associated with negative biological, psychological, and social side effects including substance use, suicidal behavior, and violent behavior. Objectives: This exploratory study, guided by an integrated theoretical framework that included the General Aggression Model and the Biopsychosocial Model, examined the relationship between adolescent male AAS use and teen dating violence. Methods: This cross-sectional, secondary data analysis was conducted using the 2013 and 2015 Massachusetts Youth Health Survey (MYHS). Participants were high school-aged males with a total sample of 2,080. Primary data analysis was conducted using hierarchical logistic regression. Results: Findings suggested that adolescent males who used steroids at least once in their lifetime, compared to those who did not, had greater odds of engaging in teen dating violence. Further, males who identified as a sexual minority had greater odds of using anabolic-androgenic steroids, as were those who had at least one suicide attempt in the previous 12 months. Conclusions: Adolescent male AAS use is associated with multiple psychosocial factors that practitioners, school personnel, and parents must be aware of.
Keywords: Anabolic Steroids -- Adverse Effects -- In Adolescence; Dating Violence -- Risk Factors -- In Adolescence; Conceptual Framework -- Massachusetts; Models, Theoretical; Aggression; Human; Street Drugs; Muscle Strength; Exploratory Research; Adolescence; Male; Cross Sectional Studies; Secondary Analysis; Massachusetts; Surveys; Adolescent Health; Students, High School; Logistic Regression; Odds Ratio; Minority Groups; Consciousness

Depression and Associated Factors Among Gay and Heterosexual Male University Students in Nigeria. - Oginni, Olakunle A.; Mosaku, Kolawole S.; Mapayi, Boladale M.; Akinsulore, Adesanmi; Afolabi, Temitope O. (Archives of Sexual Behavior, 2018)
Homosexuality is a recognized risk factor for depression in high-income countries; however, there is little research investigating the relationship between depression and sexual orientation in developing countries, especially in Africa. In this first study to investigate psychopathology in sexual minority men in Nigeria, the prevalence rates of depression in Nigerian gay and heterosexual individuals were compared as well as the explanatory power of risk and resilience factors in both groups. Eighty-one gay and 81 heterosexual male university students were, respectively, recruited from the Obafemi Awolowo University. Both groups were assessed for depression and other clinical factors, including alcohol and other substance use, suicidal ideation, and resilience. Gay students were further assessed for sexuality-related variables, including minority stress factors such as internalized homophobia and perceived stigma. The prevalence rates of depression among gay and heterosexual students were, respectively, 16 and 4.9% (OR 3.7; 95% CI 1.15-11.82), and this increased likelihood for depression was significantly attenuated by resilience. Clinical factors correlated significantly with depression in both groups, explaining 31% of the variance in depression in gay and heterosexual students, respectively. Sexuality-related variables including internalized homophobia and perceived stigma were further associated with depression in gay students-accounting for a further 14% of the variance of depression in gay students. The findings highlight the importance of minority stress factors in understanding depression among non-heterosexual individuals in a developing country, and the need for further research to investigate the mechanisms of these relationships in such settings.
Keywords: Homosexuality; Students -- Psychosocial Factors; Depression -- Epidemiology; Homophobia; Adult; Male; Colleges and Universities; Depression -- Diagnosis; Young Adult; Hardiness; Heterosexuality; Nigeria; Substance Use Disorders -- Epidemiology; Stigma; Suicidal Ideation; Questionnaires; Scales

Same-sex-attracted adolescents in rural Australia: stressors, depression and suicidality, and barriers to seeking mental health support. - Roberts, Rachel; Black, Georgina; Hart, Teegan (Rural & Remote Health, 2018)
Introduction: To address the lack of Australian data examining mental health in same-sex attracted rural adolescents compared with their rural heterosexual peers, this study examined experiences of stressors, symptoms of depression and suicidality, and perceptions of barriers to seeking mental health support, comparing same-sex attracted adolescents with heterosexual adolescents living in rural Australia. Methods: Respondents were recruited through high schools in rural South Australia and completed a questionnaire that included demographic questions, the Kutcher Adolescent Depression Scale (KADS-6) and measures of stressors and perceptions of barriers to seeking mental health support. Participants were 531 adolescents (55% female, 43% male), aged 13 to 18, 31 of whom identified as same-sex attracted. Results: Same-sex attracted adolescents reported significantly more depression symptoms (mean=6.1, standard deviation (SD)=3.9) compared to other adolescents (mean=2.9, SD=3.2, U=2867, p<0.001, r=0 .16). More adolescents who were same-sex attracted screened positive for depression (54.8% vs 15.9%) and there was a significant difference in responses to the item assessing suicidality between same-sex attracted and other adolescents (mean=1.1, SD=1.1; mean=0.3, SD=0.7, χ² (1, N=531)=27.10, p<0.001, phi=0.24). Same-sex attracted adolescents reported more experiences of stressors relating to relationships, bullying and physical assault than heterosexual adolescents but, contrary to expectations, did not report perceiving more barriers to seeking mental health support (total barriers: same-sex attracted adolescents mean=2.5 (1.8), other adolescents mean=2.5 (1.9), t(527)=0.06, p=0.95, d=0.00). Conclusions: Adolescents who identified as being same-sex attracted are at much greater risk of depression and suicidality than other adolescents in rural South Australia. The finding that same-sex attracted adolescents experienced a higher number of relationship stressors, bullying and assault underscores the need for more focus on addressing these issues for this group of vulnerable adolescents. While same-sex attracted adolescents did not perceive more barriers to seeking mental health support, greater understanding of same-sex attracted adolescents' access to appropriate services in rural areas is needed to be able to improve mental health functioning in this population. In addition, addressing the wider issues (eg stigma) contributing to the greater number of stressors, including victimisation, faced by same-sex attracted adolescents should be a priority.
Keywords: Gay Persons -- Psychosocial Factors -- Australia; Students, High School -- Psychosocial Factors -- Australia; Stress, Psychological; Depression -- Risk Factors; Suicidal Ideation -- Risk Factors; Health Services Accessibility; Mental Health Services; Support, Psychosocial; Adolescent Health Services; Rural Health Services; Human; Australia; Questionnaires; Scales; Male; Female; Adolescence; Bullying; Stigma; Crime Victims

Transgender Women's Experiences with Stigma, Trauma, and Attempted Suicide in the Dominican Republic. - Budhwani, Henna; Hearld, Kristine R.; Milner, Adrienne N.; Charow, Rebecca; McGlaughlin, Elaine M.; Rodriguez‐Lauzurique, Mayra; Rosario, Santo; Paulino‐Ramirez, Robert; Rodriguez-Lauzurique, Mayra; Paulino-Ramirez, Robert (Suicide & Life-Threatening Behavior, 2018)
Studies on attempted suicide in transgender populations, particularly those in resource-limited settings, are scarce. We examined the relationships between stigma, trauma, and suicide attempts in a national sample of transgender women from the Dominican Republic. Bivariate analysis examined differences between suicide attempters and nonattempters (n = 298). Multivariate analysis reported odds ratios with attempted suicide as the outcome (n = 260). About a quarter of respondents (23.9%) experienced sexual abuse, 12.3% were tortured, and 20.3% experienced a murder attempt. More than a quarter reported using illegal drugs. Independent sample t tests found significant differences between suicide attempters and nonattempters. Attempters were more likely to have experienced sexual abuse, psychological abuse, torture, and a murder attempt (p < .001 for all). Respondents who experienced psychological abuse had over three times higher odds of attempting suicide, compared to respondents who had not (OR = 3.203, p < .01). Experience with torture and attempted murder were associated with higher odds of attempting suicide (OR = 2.967, p < .05 and OR = 2.894, p < .05, respectively). Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are often not consistently enforced. Eliminating stigmatizing policies may reduce rates of negative health outcomes and subsequently improving population health.
Keywords: Child Abuse Survivors -- Psychosocial Factors; Suicide, Attempted -- Prevention and Control; Suicide, Attempted -- Psychosocial Factors; Torture -- Psychosocial Factors; Child Abuse Survivors -- Statistics and Numerical Data; Stigma; Suicide, Attempted; Adult; Dominican Republic; Male; Female; Needs Assessment; Socioeconomic Factors; Odds Ratio; Multivariate Analysis

Accounting for Diversity in Suicide Research: Sampling and Sample Reporting Practices in the United States. - Cha, Christine B.; Tezanos, Katherine M.; Peros, Olivia M.; Ng, Mei Yi; Ribeiro, Jessica D.; Nock, Matthew K.; Franklin, Joseph C. (Suicide & Life-Threatening Behavior, 2018)
Research on suicidal thoughts and behaviors (STB) has identified many risk factors, but whether these findings generalize to diverse populations remains unclear. We review longitudinal studies on STB risk factors over the past 50 years in the United States and evaluate the methodological practices of sampling and reporting sample characteristics. We found that articles frequently reported participant age and sex, less frequently reported participant race and ethnicity, and rarely reported participant veteran status or lesbian, gay, bisexual, and transgender status. Sample reporting practices modestly and inconsistently improved over time. Finally, articles predominantly featured White, non-Hispanic, young adult samples.

Association between sexual minority status and suicidal behavior among Chinese adolescents: A moderated mediation model. - Huang, Yeen; Li, Pengsheng; Lai, Zhisheng; Jia, Xiaofei; Xiao, Di; Wang, Tian; Guo, Lan; Lu, Ciyong (Journal of Affective Disorders, 2018)
Background: Evidence shows sexual minority adolescents have a higher risk of suicidality than their heterosexual peers due to minority stressors or lack of social support, but it remains unclear how the combined effects of these influence factors impact suicidality in this population. In this study, we examine whether school victimization mediates association between sexual minority status and suicidal behavior of adolescents and explore whether such mediation is moderated by interpersonal relationships.Methods: We sampled a large nationally representative dataset comprising data collected from 7th to 12th graders (the 2015 School-based Chinese Adolescents Health Survey) using a multistage, stratified-cluster, random-sampling method. Our sample consisted of 123,459 students who completed questionnaires regarding their sexual minority status, suicidal ideation, suicide attempts, school victimization, classmate relations, and teacher-classmate relations.Results: Using a moderated mediation model, we found that school victimization mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.0296, 95% confidence intervals (CI) = 0.0259-0.0333) and suicide attempts (indirect effect = 0.0086, 95% CI = 0.0074-0.0100). These indirect effects were moderated by interpersonal relationships, and a greater effect was seen among sexual minority students with poor classmate or teacher-classmate relations.Limitations: Our study sample included only students attending school, and interpretation of the direction of the observed associations is limited due to the cross-sectional design.Conclusions: Interpersonal relationships moderate the indirect effects of school victimization on association between sexual minority status and suicidal behavior. Early intervention addressing school violence combined with improving the quality of relationships with school peers would help prevent suicidality in sexual minority adolescents.
Keywords: Adolescent Behavior; Asians -- Psychosocial Factors; Suicidal Ideation; Students -- Statistics and Numerical Data; Minority Groups; China; Crime Victims -- Statistics and Numerical Data; Male; Adolescence; Female; Human; Cross Sectional Studies; Suicide, Attempted; Bullying; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Ferrans and Powers Quality of Life Index; Impact of Events Scale; Questionnaires; Social Readjustment Rating Scale

Stigma Burden as a Predictor of Suicidal Behavior among Lesbians and Gays in the Philippines. - Reyes, Marc Eric S.; Davis, Roger D.; David, Alyson Jane A.; Del Rosario, Camille Joy C.; Dizon, Anna Patricia S.; Fernandez, Julienne Lara M.; Viquiera, Michaela A. (Suicidology Online, 2017)
Suicide is a serious concern worldwide. Understanding the dynamics of suicidal behavior may help prevent it. Meyer's minority stress model (2003) holds that minority groups, such as the lesbian, gay, bisexual, and transgender (LGBT) community, experience group-specific stressors, collectively termed "stigma." In the current study, stigma was divided into two portions, perceived stigma and self-stigma. Perceived stigma regards negative opinions about a minority group experienced from the majority culture. Self-stigma results when such negative opinions are internalized to become negative opinions of the self. The present study found that among 61 Filipino lesbians and 124 Filipino gays, suicidal behavior increased as a function of both internalized and self-stigma, with each making an independent to suicidal behavior. Nearly 25% of suicidal behavior could be predicted by this total stigma burden. Further, Filipino gays and lesbians differ in their suicidal behaviors with lesbians being more at risk. These findings raise awareness about the impact of stigma, prejudice, and discrimination, which in turn, may reduce suicidal behavior among the Filipino lesbian and gay community.
Keywords: Stigma; Suicidal Ideation; Lesbians -- Psychosocial Factors -- Philippines; Gay Persons -- Psychosocial Factors -- Philippines; Philippines; Minority Stress; Prejudice; Discrimination; Cognition; Human

Transgender and gender‐expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families. - Michels, Susan; Kovar, Cheryl L. (Journal of Child & Adolescent Psychiatric Nursing, 2020)
Topic: Society's blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifically nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary. Purpose: To clarify the areas of potential impact in the nurse's role and to discuss ways in which they can better equip themselves to promote effective communication and culturally competent care. Thus, we envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self‐harm, and suicidal ideation in our transgender and gender‐expansive youth. Sources Used: Utilizing PubMed, nationally recognized websites, and current textbooks/pamphlets, a literature review was conducted to ascertain pertinent information related to transgender, gender‐expansive youth, and nursing education. Included references were from 2012 to the present. Conclusions: Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources.
Keywords: Transcultural Nursing; Cultural Competence; Transgender Persons -- In Adolescence; Family; Nursing Role; Communication; Nurse-Patient Relations; Adolescence; Stress, Psychological -- Prevention and Control; Depression -- Prevention and Control; Injuries, Self-Inflicted -- Prevention and Control; Suicidal Ideation -- Prevention and Control; Nursing Practice, Evidence-Based; Gender Identity; Support, Psychosocial; Empowerment; Education, Nursing, Continuing

Bisexual-Specific Minority Stressors, Psychological Distress, and Suicidality in Bisexual Individuals: the Mediating Role of Loneliness. - Mereish, Ethan; Katz-Wise, Sabra; Woulfe, Julie; Mereish, Ethan H; Katz-Wise, Sabra L (Prevention Science, 2017)
Bisexual individuals are at higher risk for poor mental health outcomes compared to heterosexual as well as lesbian and gay individuals and experience minority stressors, such as discrimination, from both heterosexual and sexual minority communities. However, there is little research examining the negative effects of bisexual-specific minority stressors on bisexual individuals' mental health as well as psychological factors that might help explain minority stressors' deleterious effects. This research examined the effects of distal minority stressors (i.e., anti-bisexual experiences from both heterosexual as well as lesbian and gay people) and proximal stressors (i.e., internalized heterosexism and sexual orientation concealment) on psychological distress and suicidality among bisexual adults (N = 503). Building on the relational framing of the minority stress model, we also tested one relational factor (i.e., loneliness) as a mediator of the associations between distal and proximal minority stressors and poor mental health (i.e., psychological distress and suicidality). Structural equation modeling analyses were used to test the mediating effects of loneliness on the associations between minority stressors and psychological distress and suicidality. Although distal and proximal minority stressors were not associated with each other, loneliness mediated the effects of distal and proximal minority stressors on psychological distress and suicidality. The results of this study underscore the importance of targeting bisexual-specific minority stressors as well as loneliness in preventive interventions to improve the mental health of bisexual individuals.
Keywords: Stress, Psychological; Minority Groups; Suicidal Ideation; Bisexuality; Loneliness; Adult; Young Adult; Female; Adolescence; Models, Psychological; Middle Age; Male; Human

Impact of a simulation on educator support of LGBTQ youth. - Bradley, Elizabeth; Albright, Glenn; McMillan, Jeremiah; Shockley, Kristen (Journal of LGBT Youth, 2019)
LGBTQ youth frequently experience bullying and harassment in the school setting. Teachers are in an ideal position to prevent student harassment, yet most don't have adequate training. This study evaluated the effectiveness of "Step In Speak Up," an interactive online simulation. In a randomized controlled trial, 1390 participants received "Step In Speak Up" or no intervention. Participants were assessed pre- and post-intervention on the Gatekeeper Behavior Scale and attitudes toward the simulation. Results demonstrated significant differences (p < 0.001, multivariate η2partial = 0.17) between the training and control groups on learners preparedness, likelihood, and self-confidence in managing bullying behavior.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Bullying -- Education; Teachers -- Education; Bullying -- Prevention and Control; Internet; Computer Simulation; Support, Psychosocial; Faculty-Student Relations; Human; Adolescence; Multivariate Analysis; School Violence -- Prevention and Control; Scales; Confidence; Adolescent Behavior

Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. - Becerra-Culqui, Tracy A.; Yuan Liu; Nash, Rebecca; Cromwell, Lee; Flanders, W. Dana; Getahun, Darios; Giammattei, Shawn V.; Hunkeler, Enid M.; Lash, Timothy L.; Millman, Andrea; Quinn, Virginia P.; Robinson, Brandi; et al. (Pediatrics, 2018)
BACKGROUND: Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS: Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/ or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date. RESULTS: Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4-82) to 144 (95% CI 36-1248). The corresponding range for suicidal ideation was 25 (95% CI 14 - 45) to 54 (95% CI 18-218). CONCLUSIONS: TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures.
Keywords: Mental Health; Transgender Persons -- Psychosocial Factors; Gender Identity; Peer Group; Mental Disorders -- Diagnosis; Mental Disorders -- Therapy; Record Review; Child, Preschool; Child; Human; Male; Female; California; Georgia; Prevalence; Attention Deficit Hyperactivity Disorder; Depression; Confidence Intervals; Injuries, Self-Inflicted; Suicidal Ideation; Support, Psychosocial

Corrigendum to Bisexuality and Non-Suicidal Self-Injury (NSSI): A narrative synthesis of associated variables and a meta-analysis of risk. Journal of Affective Disorders, 276 (2020) 1159-1172. - Dunlop, Brendan J; Hartley, Samantha; Oladokun, Olayinka; Taylor, Peter J (Journal of Affective Disorders, 2020)

Patient Suicide: Impact on Clinicians. - Tillman, Jane G. (Psychiatric Times, 2014)
The article discusses the impact of a patient suicide on the mental health practitioner. Topics include the suicide of actor Robin Williams and some transgender youths, the effects of a suicide on survivors as outlined by suicidology pioneer Edwin Shneidman and the interview survey results on twelve clinicians' experiences with patient's suicide. The workshops at the American Psychiatric Association with physicians Eric Plakun and Edward Shapiro were also mentioned.
Keywords: Suicide; Mental Health Personnel -- Psychosocial Factors; Survivors; Occupational Health; Stress, Psychological; Self Care; Stigma; Vignettes; Depression

Suicide and the Human Service Professions in the Twenty-First Century: Current Issues and Future Directions. - Westefeld, John S.; Rinaldi, Anthony P. (Journal of Loss & Trauma, 2018)
Five current issues of importance to human service professionals and the field of suicidology are examined, including Joiner's theory of suicide, suicide in the LGBT population, bullying and suicide, the relationship between firearm availability and suicidal risk, and suicide in the military. Implications and recommendations for the human service professions are addressed.
Keywords: Suicide -- Psychosocial Factors; Social Work Service -- Trends; LGBTQ+ Persons -- Psychosocial Factors; Bullying; Firearms; Suicidal Ideation -- Risk Factors; Military Personnel -- Psychosocial Factors; Psychological Theory

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

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

Mental Health Status of Cisgender and Gender-Diverse Secondary School Students in China. - Wang, Yuanyuan; Yu, Hui; Yang, Yong; Drescher, Jack; Li, Ronghua; Yin, Weijia; Yu, Renjie; Wang, Shuilan; Deng, Wei; Jia, Qiufang; Zucker, Kenneth J.; Chen, Runsen (JAMA Network Open, 2020)
This cross-sectional study uses data from questionnaires completed by adolescents in secondary schools in Suzhou city, China, to investigate the mental health challenges of youth identifying as transgender and gender nonconforming compared with cisgender adolescents. Key Points: Question: What factors are associated with mental health outcomes among transgender or gender nonconforming (TGNC) adolescents in China? Findings: In this cross-sectional survey study of 12 108 adolescents in China, TGNC adolescents reported poorer mental health, including a higher level of anxiety, depression, and sleeping problems, compared with their cisgender counterparts. TGNC adolescents were more likely to report being bullied, experienced more suicidal thoughts and behaviors, and harmed themselves more often than cisgender adolescents. Meaning: Compared with cisgender adolescents, TGNC adolescents in China appear to face a higher level of various mental health challenges. Importance: Transgender or gender nonconforming (TGNC) adolescents face a wide range of physical and mental health concerns. However, there has been no school-based study to explore the prevalence and mental health status of these adolescents in mainland China. Objectives: To assess the mental well-being of TGNC adolescents in China by comparing them with their cisgender peers. Design, Setting, and Participants: This was a cross-sectional survey study. Of the 12 354 adolescents who completed the questionnaire, 246 did not specify to which sex they identified and were therefore excluded from further analysis. Therefore, a total of 12 108 adolescents were included from 18 secondary schools in Suzhou city, China, from June 2019 to July 2019. Participants provided consent and answered questions on sex assigned at birth and gender identity. Main Outcomes and Measures: All participants completed questionnaires, including the Patient Health Questionnaire for the measurement of depressive symptoms, a generalized anxiety disorder screening, the Pittsburgh Sleep Quality Index, and a self-harm and suicide risk checklist. The frequency of being bullied at school was also measured. Participants who reported their perceived gender as the opposite of their assigned sex at birth were classified as transgender, those who identified as neither male nor female were classified as nonbinary, and those who were not sure about their perceived gender were classified as questioning. All of these participants were categorized as TGNC adolescents. Results: A total of 12 108 adolescents (mean [SD] age, 15.8 [1.0] years; 6518 [53.8%] assigned male at birth [AMAB]) participated in the study. Of the 6518 participants AMAB in the sample, 5855 (89.8%) were classified as cisgender boys, 208 (3.2%) as transgender girls (transgender youth who perceive their current gender identity to be female), 138 (2.1%) as nonbinary youth AMAB, and 317 (4.9%) as questioning youth AMAB. Of the 5590 participants assigned female at birth (AFAB), 4142 (74.1%) were classified as cisgender girls, 861 (15.4%) as transgender boys (transgender youth who perceive their current gender identity to be male), 112 (2.0%) as nonbinary youth AFAB, and 475 (8.5%) as questioning youth AFAB. Compared with cisgender adolescents, TGNC adolescents reported significantly higher health concerns including lower overall health (t11 872 = –7.36; P <.001), poorer sleep (t11 683 = 10.49; P <.001), higher depression and anxiety symptoms (t11 830 = 12.43 and t11 847 = 11.47, respectively; P <.001), and higher rate of self-harm and suicide ideation (t11 860 = 12.22; P <.001). The TGNC youth who were AMAB were also more likely to be bullied at school than cisgender boys (transgender girls: odds ratio [OR], 2.34 [95% CI, 1.64-3.33]; nonbinary youth AMAB: OR, 1.97 [95% CI, 1.23-3.16]; and questioning youth AMAB: OR, 1.95 [95% CI, 1.43-2.67]). The TGNC groups also reported significantly greater amounts of thoughts of self-harm (transgender girls: OR, 3.06 [95% CI, 2.24-4.19]; transgender boys: OR, 4.06 [95% CI, 3.47-4.74]; nonbinary youth AMAB: OR, 2.86 [95% CI, 1.93-4.23]; nonbinary youth AFAB: OR, 3.71 [95% CI, 2.46-5.59]; questioning youth AMAB: OR, 2.61 [95% CI, 1.98-3.44]; and questioning youth AFAB: OR, 3.35 [95% CI, 2.70-4.16]), thoughts of suicide (transgender girls: OR, 3.93 [95% CI, 2.88-5.38]; transgender boys: OR, 3.71 [95% CI, 3.10-4.21]; nonbinary youth AMAB: OR, 3.13 [95% CI, 2.11-4.63]; nonbinary youth AFAB: OR, 3.78 [95% CI, 2.50-5.71]; questioning youth AMAB: OR, 2.53 [95% CI, 1.93-3.33]; and questioning youth AFAB: OR, 3.94 [95% CI, 3.17-4.88]), suicide plan formation (transgender girls: OR, 4.44 [95% CI, 2.88-6.83]; transgender boys: OR, 2.66 [95% CI, 2.03-3.50]; nonbinary youth AMAB: OR, 5.36 [95% CI, 3.22-8.93]; nonbinary youth AFAB: OR, 4.06 [95% CI, 2.25-7.30]; and questioning youth AFAB: OR, 2.36 [95% CI, 1.63-3.43]), deliberate self-harm during the last month (cisgender girls: OR, 1.49 [95% CI, 1.33-1.68]; transgender girls: OR, 2.74 [95% CI, 1.93-3.91]; transgender boys: OR, 3.06 [95% CI, 2.57-3.66]; nonbinary youth AMAB: OR, 2.56 [95% CI, 1.66-3.94]; nonbinary youth AFAB: OR, 3.06 [95% CI, 1.95-4.81]; questioning youth AMAB: OR, 2.14 [95% CI, 1.56-2.92]; and questioning youth AFAB: OR, 2.53 [95% CI, 2.00-3.01]), and attempts of suicide (transgender girls: OR, 4.35 [95% CI, 2.88-6.56]; transgender boys: OR, 2.92 [95% CI, 2.26-3.76]; nonbinary youth AMAB: OR, 3.94 [95% CI, 2.36-6.55]; nonbinary youth AFAB: OR, 3.06 [95% CI, 1.67-5.63]; questioning youth AMAB: OR, 2.61 [95% CI, 1.73-3.94]; and questioning youth AFAB: OR, 1.93 [95% CI, 1.33-2.81]) compared with cisgender boys. Conclusions and Relevance: Results of this cross-sectional survey study suggest poor mental health status among TGNC adolescents in China; in addition, findings suggest a compelling need for researchers, practitioners, and policy makers to address these mental health problems. Particular school-based interventions are recommended to support the mental health well-being of TGNC adolescents.
Keywords: Health Status; Mental Health; Students, High School -- China; Transgender Persons; Gender Identity; China; Human; Cross Sectional Studies; Surveys; Descriptive Statistics; Data Analysis Software; Confidence Intervals; Odds Ratio; Male; Female; Adolescence

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008-2014. - Blosnich, John R; Lytle, Megan C; Coulter, Robert W S; Whitfield, Darren L (Archives of Suicide Research, 2017)
Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n = 5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR = 1.92; 95% CI: 1.06, 3.46), dishonors family (OR = 1.83; 95% CI: 1.01, 3.28), or is tired of living (OR = 2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals.
Keywords: Suicide, Attempted -- Psychosocial Factors; Suicide, Attempted -- Prevention and Control; Suicide, Attempted; Suicidal Ideation; Community Networks -- Administration; Causal Attribution; Risk Assessment -- Methods; Female; Health Status Disparities; Prevalence; Risk Assessment -- Statistics and Numerical Data; Adult; Risk Factors; United States; Needs Assessment; Male; Human; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Questionnaires; Social Readjustment Rating Scale

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

Drivers of Disparity: Differences in Socially Based Risk Factors of Self-injurious and Suicidal Behaviors Among Sexual Minority College Students. - Blosnich, John; Bossarte, Robert (Journal of American College Health, 2012)
Lesbian, gay, and bisexual (ie, sexual minority) populations have increased prevalence of both self-injurious and suicidal behaviors, but reasons for these disparities are poorly understood. Objective: To test the association between socially based stressors (eg, victimization, discrimination) and self-injurious behavior, suicide ideation, and suicide attempt. Participants: A national sample of college-attending 18- to 24-year-olds. Methods: Random or census samples from postsecondary educational institutions that administered the National College Health Assessment during the Fall 2008 and Spring 2009 semesters. Results: Sexual minorities reported more socially based stressors than heterosexuals. Bisexuals exhibited greatest prevalence of self-injurious and suicidal behaviors. In adjusted models, intimate partner violence was most consistently associated with self-injurious behaviors. Conclusions: Sexual minorities’ elevated risks of self-injurious and suicidal behaviors may stem from higher exposure to socially based stressors. Within-group differences among sexual minorities offer insight to specific risk factors that may contribute to elevated self-injurious and suicidal behaviors in sexual minority populations.
Keywords: Self-Injurious Behavior -- Risk Factors; Suicidal Ideation -- Risk Factors; LGBTQ+ Persons; Students, College; Minority Groups -- Psychosocial Factors; Social Environment; Students, Minority; Human; Correlational Studies; Discrimination; Young Adult; Random Sample; Questionnaires; Bisexuals; Prevalence; Models, Statistical -- Utilization; Surveys; Secondary Analysis; Chi Square Test; Bivariate Statistics; Multiple Logistic Regression; Descriptive Statistics; Mental Disorders; Confidence Intervals; Odds Ratio; Heterosexuals; Comparative Studies; Violence -- Psychosocial Factors

Measuring the Health of an Invisible Population: Lessons from the Colorado Transgender Health Survey. - Christian, Robin; Mellies, Amy Anderson; Bui, Alison Grace; Lee, Rita; Kattari, Leo; Gray, Courtney (JGIM: Journal of General Internal Medicine, 2018)
Background: Transgender people, those whose gender identity does not match their sex assigned at birth, face barriers to receiving health care. These include discrimination, prohibitive cost, and difficulty finding transgender-inclusive providers. As transgender identities are not typically recognized in public health research, the ability to compare the health of the transgender population to the overall population is limited.Objective: The Colorado Transgender Health Survey sought to explore current disparities and their effects on the health of transgender people in Colorado.Design and Participants: The Colorado Transgender Health Survey, based on the Behavioral Risk Factor Surveillance System (BRFSS), was developed by the Colorado Department of Public Health and Environment, transgender advocates, and transgender community members. Outreach was targeted to transgender-inclusive events and organizations.Main Measures: Responses to the 2014 Colorado Transgender Health Survey were compared side by side to Colorado 2014 BRFSS data.Results: Results from 406 transgender or gender-nonconforming adults who live in Colorado were included in the analysis. Forty percent of respondents report delaying medical care due to cost, inadequate insurance, and/or fear of discrimination. Respondents report significant mental health concerns, with 43% reporting depression, 36% reporting suicidal thoughts, and 10% attempting suicide in the past year. Respondents with a transgender-inclusive provider were more likely to receive wellness exams (76 versus 48%), less likely to delay care due to discrimination (24 versus 42%), less depressed (38 versus 54%), and less likely to attempt suicide (7 versus 15%) than those without.Conclusions: The transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender-inclusive provider is associated with improved mental and physical health and health behaviors. Further population-level research and provider education on transgender health should to be incorporated into national efforts to eliminate health disparities.
Keywords: Health Status Disparities; Surveys; Middle Age; Transsexualism -- Psychosocial Factors; Health Services Research -- Methods; Colorado; Mental Health -- Statistics and Numerical Data; Aged; Socioeconomic Factors; Cultural Competence; Adolescence; Female; Adult; Health Status; Young Adult; Male; Healthcare Disparities -- Statistics and Numerical Data; Risk Assessment; Needs Assessment

Prostate cancer in transgender women. - Ingham, Matthew D.; Lee, Richard J.; MacDermed, Dhara; Olumi, Aria F. (Urologic Oncology, 2018)
Introduction: As the transgender patient population continues to increase, urologists and other providers who treat genitourinary malignancies will increasingly encounter cases of prostate cancer in transgender women. Little exists in the current literature to help summarize the challenges and opportunities which face this unique patient population. Similarly, little exists to provide guidance on how we may best diagnose, manage, and follow transgender women diagnosed with prostate cancer. We sought to review the available literature in hopes of providing a resource for providers moving forward.Materials and Methods: We collaboratively reviewed the currently available literature, guidelines, and statements of best practice to compile a comprehensive review of this emerging and important topic.Results: Transgender persons face numerous systemic barriers to care with well documented increased risks of suicide and poor health outcomes. Though uncommon, the diagnosis of prostate cancer in transgender women is often associated with significant disease. While many options for management remain in line with standard guidelines, the unique aspects of care in this population-prior/current hormone usage, gender-affirming surgical procedures etc.-must be considered. Surgical, radiation, and hormonal treatments all play a potential role in appropriate treatment. Longitudinal studies are currently lacking and clinical trials are often structured with exclusive language which may lead to further marginalization of this patient population.Conclusion: Transgender persons will almost certainly continue to grow as a population encountered and treated by healthcare professionals. Better training and understanding are needed to ensure all healthcare needs are met as best possible. Prostate cancer represents an area in which great strides may be made to improve both diagnosis and treatment. Urologists, and others who manage urologic cancers, must take the lead to improve the care of transgender persons with genitourinary malignancies.
Keywords: Disorders of Sex Development -- Physiopathology; Prostatic Neoplasms -- Epidemiology; Prognosis; Female; Male; Human