A choice between fun or health? Relationships between nightlife substance use, happiness, and mental well-being. - Sumnall H; Bellis MA; Hughes K; Calafat A; Juan M; Mendes F (Journal of Substance Use, 2010)
Objective: To examine the substance use behaviours of young adults in Europe and to explore the association with self reported indices of mental well being, and the relative value of health. Method: 1341 16-35-year-olds, representing youth and young adults who routinely engage in nightlife, were surveyed in nine European cities. Participants self-completed questionnaires, designed to gather demographic, social, and behavioural data on historic and current substance use, risk behaviours, and mental well being. Results: Controlling for inter-country differences, we found that early initiation and frequency of use of a range of substances was associated with poorer life satisfaction, suicidal ideation, and hopelessness. Younger, more frequent substance users placed greater value on having fun than maintaining long-term health. Bi/homosexual participants were more likely to report hopelessness, suicidal thoughts, dissatisfaction with life, and preferring fun to health. Younger cocaine initiates were more likely to report considering suicide in the last 12 months than older initiates. Conclusions: These findings confirm the importance of early intervention for young substance users. Whilst our study does not make assumptions on causality, identification of substance use in nightclub attendees may be a good marker of comorbid disorders. It is important to recognize that negative mental states may also partly be a product of lifestyle and socioeconomic factors. Prevention and harm reduction interventions should recognize that the most at risk young people may discount future health gains from reducing their substance use.
Keywords: Personal Satisfaction; Psychological Well-Being; Social Behavior; Substance Abuse -- Epidemiology -- Europe; Substance Abuse -- Psychosocial Factors; Adolescence; Adult; Chi Square Test; Comorbidity; Comparative Studies; Confidence Intervals; Convenience Sample; Cross Sectional Studies; Data Analysis Software; Descriptive Statistics; Epidemiological Research; Europe; Female; Funding Source; Happiness; Hopelessness; Human; Income; Logistic Regression; Mann-Whitney U Test; Marital Status; P-Value; Quality of Life; Questionnaires; Risk Taking Behavior; Secondary Analysis; Self Report; Sexuality; Social Values; Street Drugs; Suicidal Ideation; Surveys

The role of help-seeking in preventing suicide attempts among lesbians, gay men, and bisexuals. - Meyer, Ilan H; Teylan, Merilee; Schwartz, Sharon (Suicide & Life-Threatening Behavior, 2015)
One possible approach to prevention of suicide attempts is to encourage help-seeking among individuals at risk. We assessed whether different forms of treatment were associated with lower odds of a suicide attempt in a diverse group of 388 lesbian, gay, and bisexual (LGB) adults aged 18-59, sampled from New York City venues. Of individuals who attempted suicide, 23% sought mental health or medical treatment and 14% sought religious or spiritual treatment prior to the suicide attempt. Black and Latino LGBs were underrepresented in mental health or medical treatment and Black LGBs were overrepresented in religious or spiritual treatment. Seeking mental health or medical treatment was not associated with lower odds of a suicide attempt; seeking religious or spiritual treatment was associated with higher odds of a suicide attempt. We discuss these results and posit hypotheses for further research of this understudied topic.

The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women. - Valentine, Sarah; Elsesser, Steven; Grasso, Chris; Safren, Steven; Bradford, Judith; Mereish, Ethan; O'Cleirigh, Conall; Valentine, Sarah E; Safren, Steven A; Bradford, Judith B (Journal of Urban Health, 2015)
Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.
Keywords: Women's Health; Lesbians -- Psychosocial Factors; Bisexuality; Health Care Costs -- Statistics and Numerical Data; Patient Attitudes; Minority Groups -- Statistics and Numerical Data; United States; Female; Socioeconomic Factors; Middle Age; Aged; Lesbians -- Statistics and Numerical Data; Adult; Funding Source; Human

Attempted Suicide, LGBT Identity, and Heightened Scrutiny. - Halady, Steven William (American Journal of Bioethics, 2013)
Keywords: Suicide, Attempted; LGBTQ+ Persons; Stigma; Family Role

The needs of students with intersex variations. - Jones, Tiffany (Sex Education, 2016)
To date, people with intersex variations have been mainly studied via small-scale clinical research, with only a small amount of reflective commentary contributed by sociocultural scholars. This paper reports on findings from a 2015 online Australian survey of 272 people with intersex variations, which aimed to redress the gap in research on this groups’ experiences and perspectives concerning education. Participants ranged in age from 16 to 87 years, and represented all Australian states and territories. Most had experienced two medical treatment interventions related to their intersex variation: commonly reported interventions included hormonal treatment and genital surgery delivered to participants when they were aged under 18 years of age. Participants reported various physical and psychological impacts from these treatments. Well-being risks were high; most of the group had engaged in suicidal ideation, particularly when individuals first found out about their variation. This impacted on their schooling – almost one-fifth of survey respondents had received no high school certification due to their early dropout and the overwhelming majority did not attend schools with inclusive puberty/sex education provision or counselling. Most survey participants had not disclosed their intersex variation to staff, although more than half had done so to their classmates. Many had experienced bullying. Only one-quarter of participants rated their overall education experiences positively. Participants suggested improvements to schools’ information provision and support features.
Keywords: Needs Assessment; Students; Disorders of Sex Development -- Therapy; Disorders of Sex Development -- Psychosocial Factors; Human; Australia; Questionnaires; Adolescence; Adult; Middle Age; Aged; Aged, 80 and Over; Hormone Therapy; Genitalia -- Surgery; Psychological Well-Being; Suicidal Ideation; Educational Status; Student Dropouts; Sex Education; Counseling; Truth Disclosure; Bullying; School Policies; Descriptive Statistics; Male; Female; Disorders of Sex Development -- Diagnosis; Disorders of Sex Development -- Classification; Puberty; Faculty-Student Relations; Referral and Consultation; Birth Place; School Health Services; Funding Source

Asian/Pacific Islander adolescent sexual orientation and suicide risk in Guam. - Pinhey TK; Millman SR (American Journal of Public Health, 2004)
OBJECTIVES: We examined the effects of same-sex orientation on suicide risks for Guam's Asian/Pacific Islander adolescents. METHODS: We used a probability sample and logistic regression analysis to identify suicide risk factors. RESULTS: Same-sex orientation was associated with a greater risk of suicide attempt, especially for boys. Adolescents who reported suffering physical abuse in the context of a romantic relationship, engaging in binge drinking, and experiencing feelings of hopelessness were at greater risk for suicidal ideation and attempts. Race/ethnicity was associated with suicide risk for both boys and girls, and patterns suggest that membership in the same racial/ethnic group decreased suicide risk for girls and increased risk of suicide for boys. CONCLUSIONS: Gay, lesbian, and bisexual Asian/Pacific Islander adolescents in Guam deserve intervention and counseling programs to reduce suicide risk.
Keywords: Adolescent Health -- Guam; Asians -- Psychosocial Factors -- Guam; Homosexuality -- Guam; Suicide -- Risk Factors -- In Adolescence; Adolescence; Alcohol Abuse; Descriptive Statistics; Female; Guam; Hopelessness; Logistic Regression; Male; Intimate Partner Violence; Probability Sample; Race Factors; Risk Factors; Sex Factors; Students, High School; Suicidal Ideation -- Risk Factors; Suicide, Attempted; Surveys; Human

Lubricant Use and Rectal Chlamydial and Gonococcal Infections Among Men Who Engage in Receptive Anal Intercourse. - Maierhofer, Courtney; Rice, Cara E.; Shu-Hua Wang; Fields, Karen S.; Ervin, Melissa; Turner, Abigail Norris; Wang, Shu-Hua (Sexually Transmitted Diseases, 2016)
Background: Use of lubricants during anal intercourse is very common among men who have sex with men. However, few studies have evaluated associations between specific lubricants and rectal sexually transmitted infections (STIs).Methods: Between July 2012 and October 2013, we conducted a cross-sectional study of men who have sex with men recruited from an urban, public sexual health clinic. In a self-administered survey, participants identified the lubricants used and frequency of lubricant use in the previous three months. Among men reporting any receptive anal intercourse (RAI) in the previous 3 months, we used multivariable binomial regression models to analyze associations between recent use of 9 specific lubricants and prevalent rectal chlamydia, rectal gonorrhea, and either rectal infection.Results: Twenty-five percent of the 146 participants had rectal chlamydial infection and 21% had rectal gonococcal infection; 37% had either (chlamydial or gonococcal) infection. Three-quarters reported always or almost always using lubricant during recent receptive anal intercourse. After adjustment for age, race, human immunodeficiency virus status, and condom use, Gun Oil (adjusted prevalence ratio [aPR], 1.99; 95% confidence interval [CI], 1.04-3.80) and Slick (aPR, 3.55; 95% CI, 1.38-9.12) were significantly associated with prevalent gonococcal infection. No lubricants were significantly associated with prevalent rectal chlamydia, but in analyses of either rectal infection, precum (aPR, 1.68; 95% CI, 1.06-2.66), Vaseline (aPR, 1.70; 95% CI, 1.10-2.64), and baby oil (aPR, 2.26; 95% CI, 1.43-3.57) were all significantly associated with prevalent rectal infection.Conclusions: Several lubricants were significantly associated with increased prevalence of rectal STI. Longitudinal studies are needed to examine any causal relationship between specific lubricants and STI acquisition.
Keywords: Homosexuality; Rectal Diseases -- Prevention and Control; Sexually Transmitted Diseases -- Prevention and Control; Gonorrhea -- Prevention and Control; Lubricants; Chlamydia Infections -- Prevention and Control; Neisseria; Gonorrhea -- Epidemiology; Chlamydia; Prevalence; Young Adult; Sexuality; Cross Sectional Studies; Male; Prospective Studies; Chlamydia Infections -- Epidemiology; Funding Source; Human

Associations Between Bullying and Engaging in Aggressive and Suicidal Behaviors Among Sexual Minority Youth: The Moderating Role of Connectedness. - Duong, Jeffrey; Bradshaw, Catherine (Journal of School Health, 2014)
ABSTRACT BACKGROUND Research on the extent to which cyberbullying affects sexual minority youth is limited. This study examined associations between experiencing cyber and school bullying and engaging in aggressive and suicidal behaviors among sexual minority youth. We also explored whether feeling connected to an adult at school moderated these associations. METHODS Data came from 951 self-identified lesbian, gay, and bisexual (LGB) youth, who completed the New York City Youth Risk Behavior Survey during fall 2009. We used multiple logistic regression to examine the hypothesized associations and test for effect modification. RESULTS Cyber and school bullying were associated with engaging in aggressive and suicidal behaviors among LGB youth. Youth experiencing both cyber and school bullying had the greatest odds of engaging in aggressive and suicidal behaviors. However, feeling connected to an adult at school moderated these associations such that bullied youth who felt connected were not more likely to report aggressive and suicidal behaviors. CONCLUSIONS The findings highlight the challenges faced by bullied LGB youth. Practitioners should work with school administrators to establish supportive environments for sexual minority youth. Helping victimized LGB youth develop meaningful connections with adults at school can minimize the negative impacts of cyber and school bullying.
Keywords: Bullying -- Classification -- In Adolescence; Suicide, Attempted -- In Adolescence; LGBTQ+ Persons -- In Adolescence; Adult-Child Relations; Human; New York; Questionnaires; Multiple Logistic Regression; Male; Female; Hispanic Americans; Black Persons; Confidence Intervals; Odds Ratio; Cluster Sample; Self Report; Adolescence; Body Mass Index

"Live Chat" Clients at Kids Help Phone: Individual Characteristics and Problem Topics. - Haner, Dilys; Pepler, Debra (Journal of the Canadian Academy of Child & Adolescent Psychiatry, 2016)
Objective: Young people in Canada prefer to use the Internet over face-to-face contact when seeking help for problems of daily living and mental health problems. Kids Help Phone (KHP) provides on-demand, anonymous help to young people via telephone and Live Chat technologies. Methods: Two hundred thirty-two phone clients and 230 Live Chat clients responded to a questionnaire at this otherwise anonymous service, providing previously inaccessible data about their individual characteristics and characterizations of the problems for which they sought help. Results: There was a larger proportion of weighty problems (mental health and suicide) among chatters than callers. There were also more non-heterosexual youth, and those who identified as Asian and Black African or Caribbean, using Live Chat than phone. Conclusions: Implications for training Live Chat counsellors to respond effectively to chatters are discussed.

The intersection of interpersonal and self-directed violence among general adult, college student and sexually diverse samples. - Cramer, Robert J.; Desmarais, Sarah L.; Johnson, Kiersten L.; Gemberling, Tess M.; Nobles, Matt R.; Holley, Sarah R.; Wright, Susan; Van Dorn, Richard (International Journal of Social Psychiatry, 2017)
Background: Suicide and interpersonal violence (i.e. victimization and perpetration) represent pressing public health problems, and yet remain mostly addressed as separate topics. Aims: To identify the (1) frequency and overlap of suicide and interpersonal violence and (2) characteristics differentiating subgroups of violence-related experiences. Methods: A health survey was completed by 2,175 respondents comprised of three groups: college students (n = 702), adult members of a sexuality special interest organization (n = 816) and a community adult sample (n = 657). Latent class analysis was used to identify subgroups characterized by violence experiences; logistic regression was used to identify respondent characteristics differentiating subgroups. Results: Overall rates of violence perpetration were low; perpetration, victimization and self-directed violence all varied by sample. Adults with alternative sexual interests reported high rates of victimization and self-directed violence. Analyses indicated two subgroups: (1) victimization + self-directed violence and (2) self-directed violence only. The victimization + self-directed violence subgroup was characterized by older, White, female and sexual orientation minority persons. The self-directed violence subgroup was characterized by younger, non-White, male and straight counterparts engaging with more sexual partners and more frequent drug use. Conclusion: Findings support the Centers for Disease Control and Prevention (CDC) definition of suicide as self-directed violence. Suicide intervention and prevention should further account for the role of violent victimization by focusing on the joint conceptualization of self-directed and interpersonal violence. Additional prevention implications are discussed.
Keywords: Intimate Partner Violence -- In Adulthood; Students, College; Sexuality; Human; Adult; Suicide -- Epidemiology; Intimate Partner Violence -- Epidemiology; Surveys; Logistic Regression; Aged; Female; Male; Ethnic Groups; Sexual Partners; Substance Abuse; Centers for Disease Control and Prevention (U.S.); Suicide -- Prevention and Control

Ethnic youth and sexual identity: the role of clinical and social support for 'double minorities'. - Wong, Nicole; Menkes, David B. (Australasian Psychiatry, 2018)
Objectives: Sexual-minority youth exhibit increased rates of psychiatric morbidity, subject to various social factors. We examine the impact of ethnicity and culture on these phenomena, with particular reference to Asian youth living in Western societies.Conclusions: Youth from minority ethnic groups who do not identify with their native gender and/or who are not exclusively heterosexual are known as 'double minorities'. Available evidence suggests that such individuals are at particularly increased risk of depression and suicide, but that this may be mitigated by social support. More research is needed to understand the challenges faced by 'double minorities', notably their perception of and ability to access available clinical and social supports.
Keywords: Suicide -- Ethnology; Minority Groups -- Statistics and Numerical Data; Support, Psychosocial; Depression -- Ethnology; Young Adult; Adolescence; New Zealand -- Ethnology; Adult; Impact of Events Scale; Scales; Social Readjustment Rating Scale; Human

Consequences of runaway and thrownaway experiences for sexual minority health during the transition to adulthood. - Pearson, Jennifer; Thrane, Lisa; Wilkinson, Lindsey (Journal of LGBT Youth, 2017)
Sexual minority youth are more likely to run away from home or experience homelessness, leaving them at increased risk of victimization and negative health outcomes. In this study, the authors use a developmental perspective that considers both vulnerable beginnings in families and the risky trajectories that follow to explore the connections between running away or being thrown out by parents and sexual minority women's and men's health in adulthood. Using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the authors consider multiple dimensions of health and several potential intervening mechanisms. Findings suggest that runaway and thrownaway experiences have persistent negative effects on health into adulthood, in part because of their association with sexual victimization, educational attainment, and relationships with parents. Sexual minority men who have been thrown out by parents report a greater likelihood of suicidal ideation, smoking, and substance use into adulthood. Sexual minority women with runaway experiences have poorer health and increased depressive symptoms, while women with thrownaway experiences engage in more health risk behaviors. Sexual victimization stands out as a key mechanism for sexual minority women's health, as more than half of these young women report experiences of sexual victimization.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Family Relations; Runaways -- Psychosocial Factors; Homelessness; Health -- In Adulthood; Human; Female; Male; Adolescence; Adult; Sexual Abuse -- Risk Factors; Depression -- Symptoms; Risk Taking Behavior

Understanding linkages between bullying and suicidal ideation in a national sample of LGB and heterosexual youth in the United States. - Ybarra, Michele L; Mitchell, Kimberly J; Kosciw, Joseph G; Korchmaros, Josephine D (Prevention Science, 2015)
While there is an extant research base regarding suicidal ideation in relation to bullying and peer harassment, how findings may be similar and different for lesbian, gay, and bisexual (LGB) and non-LGB youth is less well understood. To address this gap, we analyzed data from 5,542 13- to 18-year-old youth who were nationally surveyed online in the United States in 2010. Results suggest that the relative odds of suicidal ideation are elevated for youth who are victims of bullying (OR = 5.61, 95 % CI, 4.11, 7.64), as well as those who are victims of peer harassment (OR = 2.06, 95 % CI, 1.53, 2.79). Within the context of other important factors, bullying was associated with odds of suicidal ideation twice that of non-victimized youth (aOR = 2.02, 95 % CI, 1.30, 3.13). Within sexual identity, the relation between bullying and suicidal ideation was particularly strong for gay, lesbian, and queer youth, even after adjusting for other influential factors (aOR = 6.29, 95 % CI, 2.69, 14.66). Across sexual identities, the odds of suicidal ideation are higher for bisexual youth (aOR = 1.77, 95 % CI, 1.23, 2.55) but not for other sexual minority youth when compared with otherwise similar heterosexual youth. Other factors, including depressive symptomatology and low self-esteem, were also predictive of recent ideation across all sexual identities. Findings highlight the complexity of bullying and suicidal ideation. Furthermore, given the relation between bullying and suicidal ideation, and the disproportionate level of bullying experienced by LGB youth, our findings suggest the need for more protective environments for LGB youth.

Sexual Self-Concept Ambiguity and the Interpersonal Theory of Suicide Risk. - Talley, Amelia E.; Brown, Sarah L.; Cukrowicz, Kelly; Bagge, Courtney L. (Suicide & Life-Threatening Behavior, 2016)
Mechanisms (i.e., thwarted belongingness, perceived burdensomeness, hopelessness) derived from the interpersonal theory of suicide which are hypothesized to account for the relation between sexual orientation self-concept ambiguity and active suicide ideation were examined. Participants included 349 women, among whom 42% currently self-ascribed a non-exclusively heterosexual sexual identity. Among women reporting higher levels of sexual self-concept ambiguity, greater risk for active suicide ideation is found when perceptions of burden and feelings of thwarted belonging co-occur with feelings of hopelessness. Results support relevant theory useful for understanding suicide risk among sexual minority women who acknowledge ambiguity with regard to their sexual orientation.
Keywords: Suicidal Ideation; Sexuality; Self Concept; Young Adult; Adolescence; Female; Alcoholism -- Psychosocial Factors; Statistics; Social Identity; Adult; Support, Psychosocial; Scales

Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community. - Bockting WO; Robinson BE; Forberg J; Scheltema K (AIDS Care, 2005)
Despite reports of high prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) among the transgender community, very little prevention education has targeted this population. To fill this gap, we developed and evaluated a transgender-specific intervention, All Gender Health, which incorporates prevention strategies into comprehensive sexuality education. Transgender participants (N=181) attended the two-day seminar in community-based venues. The curriculum was delivered via lectures, panel discussions, videos, music, exercises and small group discussions. Attitudes toward condom use, safer sex self-efficacy and sexual risk behaviour were evaluated before participation in the intervention (pre-test), immediately after participation (post-test) and at three-month follow-up. Compared to pre-test values, significant improvements were seen in attitudes toward condom use and in safer sex self-efficacy at post-test, and in attitudes toward condom use, increased monogamy and decreased sexual risk behaviour at three-month follow-up. Pre-test data identified unprotected anal, vaginal and oral sex as the most commonly reported risk behaviours. Many respondents also indicated problems with social discrimination, depression, suicidal ideation and sexual functioning. Future interventions should address these risk co-factors. Alternative interventions need to be developed to target those who, as a result of social marginalization, are less likely to be reached with an intensive seminar-based intervention.
Keywords: Attitude to Health; Health Promotion -- Methods; HIV Infections -- Prevention and Control; Sex Education; Sexually Transmitted Diseases -- Prevention and Control; Transsexualism -- Psychosocial Factors; Adolescence; Adult; Female; Health Promotion -- Standards; Male; Middle Age; Sex Education -- Standards; Sexuality; Cross-dressing -- Psychosocial Factors; Unsafe Sex -- Prevention and Control; Human

Understanding Suicide Attempts Among Gay Men From Their Self-perceived Causes. - Wang, Jen; Plöderl, Martin; Häusermann, Michael; Weiss, Mitchell G (Journal of Nervous & Mental Disease, 2015)
Gay men are at higher risk of suicidality. This paper describes the causes of suicide attempts as perceived by the men themselves and analyzes their impact on severity and recidivism. Mental health surveys conducted among gay men in Geneva, Switzerland, from two probability-based time-space samples in 2007 and 2011, were merged to yield a combined sample N = 762. Suicide ideation, plans, and attempts were assessed, and respondents who had ever attempted suicide answered open questions about perceived causes which were coded and categorized for analysis within the framework of cultural epidemiology. In all, 16.7% of the respondents reported a suicide attempt in their lifetime (59.5% of them with multiple attempts). At their latest attempt, over two thirds asserted intent to die, and half required medical assistance. There was a wide variety of perceived causes, with most individuals reporting multiple causes and many of the most common causes cited at both the first and most recent subsequent attempts. Social/inter-personal problems constitute the most prominent category. Problems with love/relationship and accepting one's homosexuality figure consistently among the top three causes. Whereas the former tend to be associated with weaker intent to die, the latter are associated with the strongest intent to die and reported at multiple attempts. Problems with family are among the most common perceived causes at first attempt but not at the most recent subsequent attempt. Nevertheless, they tend to be related to the strongest intent to die and the greatest medical severity of all the perceived causes. Ten percent of men attempting suicide cited depression as a cause. Although it tended to be associated with weaker intent to die, depression was most likely to be reported at multiple attempts. Respondent-driven assessment yielded both common and idiosyncratic causes of suicide and their distinct effects. Some of these perceived causes are not prominent in the current literature, yet they have important implications for understanding risk and preventing suicide among gay men.

Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation. - Almeida J; Johnson RM; Corliss HL; Molnar BE; Azrael D (Journal of Youth & Adolescence, 2009)
Keywords: Discrimination; Sexuality; Coefficient Alpha; Depression; Descriptive Statistics; Emotions; Funding Source; LGBTQ+ Persons; Students, High School; Suicide; Surveys; Human

“ It Gets Better ” … but How? Exploring Resilience Development in the Accounts of LGBTQ Adults. - Asakura, Kenta; Craig, Shelley L. (Journal of Human Behavior in the Social Environment, 2014)
As reports of bullying and suicide increase, research on lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth must expand its focus from vulnerabilities to resilience development. The purpose of this inductive qualitative study was to explore resilience development in the accounts of LGBTQ adults by analyzing videos posted for theIt Gets Bettersocial media campaign (n= 21). Four major themes emerged: (1) leaving hostile social environments; (2) experiencing “coming out” in meaningful ways; (3) remembering the social environment; and (4) turning challenges into opportunities and strengths. These findings suggest that, despite the campaign's premise, life did not automatically get better for the LGBTQ participants. Rather, the findings offer a nuanced look at the pathways to resilience development. Implications for social work practice are discussed.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adulthood; Hardiness; Bullying -- Psychosocial Factors; Suicidal Ideation; Discrimination -- Psychosocial Factors; Human; Social Work Practice; Videorecording; Qualitative Studies; Social Media; Purposive Sample; Grounded Theory; Coding; Social Environment; Discourse Analysis; Male; Female; Adult

“ It Gets Better ” … but How? Exploring Resilience Development in the Accounts of LGBTQ Adults. - Asakura, Kenta; Craig, Shelley L. (Journal of Human Behavior in the Social Environment, 2014)
As reports of bullying and suicide increase, research on lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth must expand its focus from vulnerabilities to resilience development. The purpose of this inductive qualitative study was to explore resilience development in the accounts of LGBTQ adults by analyzing videos posted for theIt Gets Bettersocial media campaign (n= 21). Four major themes emerged: (1) leaving hostile social environments; (2) experiencing “coming out” in meaningful ways; (3) remembering the social environment; and (4) turning challenges into opportunities and strengths. These findings suggest that, despite the campaign's premise, life did not automatically get better for the LGBTQ participants. Rather, the findings offer a nuanced look at the pathways to resilience development. Implications for social work practice are discussed.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adulthood; Hardiness; Bullying -- Psychosocial Factors; Suicidal Ideation; Discrimination -- Psychosocial Factors; Human; Social Work Practice; Videorecording; Qualitative Studies; Social Media; Purposive Sample; Grounded Theory; Coding; Social Environment; Discourse Analysis; Male; Female; Adult

Psychosocial Syndemic Associated With Increased Suicidal Ideation Among Men Who Have Sex With Men in Shanghai, China. - Rui Li; Yong Cai; Ying Wang; Zhe Sun; Chengdi Zhu; Yilin Tian; Xueqin Jiang; Feng Gan (Health Psychology, 2016)
Keywords: Suicidal Ideation -- Psychosocial Factors; Gay Men -- China; China; Cross Sectional Studies; Human; Male; Descriptive Statistics; Data Analysis Software; Self Concept; Coefficient Alpha; Psychological Well-Being; Anal Intercourse; Multivariate Analysis; Logistic Regression; Confidence Intervals; Odds Ratio; Center for Epidemiological Studies Depression Scale; Scales; Psychological Tests; Questionnaires; Funding Source

Suicide prevention in transgender youth and adolescents: A poststructural nursing perspective. - Chang, Brie (Journal of Child & Adolescent Psychiatric Nursing, 2019)
The article focuses on nursing practice and care, highlighting issues concerning suicide prevention in transgender youth and adolescents. Information about the importance for nurses to become aware of the dominant discourse around gender issues such as how nurses have come to think about transgender youth.
Keywords: Suicide -- Prevention and Control -- In Adolescence; Transgender Persons -- Psychosocial Factors -- In Adolescence; Nursing Care -- Psychosocial Factors; Adolescence; Young Adult; Sexism; Healthcare Disparities; Conceptual Framework; Health Care Delivery, Integrated; Nursing Outcomes

Risk for reassault in abusive female same-sex relationships. - Glass N; Perrin N; Hanson G; Bloom T; Gardner E; Campbell JC (American Journal of Public Health, 2008)
OBJECTIVES: We revised the Danger Assessment to predict reassault in abusive female same-sex relationships. METHODS: We used focus groups and interviews to evaluate the assessment tool and identify new risk factors and telephone interviews at baseline and at 1-month follow-up to evaluate the revised assessment. RESULTS: The new assessment tool comprised 8 original and 10 new items. Predictors included increase in physical violence (relative risk ratio [RRR]=1.95; 95% confidence interval [CI]=0.84, 4.54), constant jealousy or possessiveness of abuser (RRR = 4.07; 95% CI = 0.61, 27.00), cohabitation (RRR = 1.96; 95% CI = 0.54, 7.12), threats or use of gun by abuser (RRR=1.93; 95% CI=0.79, 4.75), alcoholism or problem drinking of abuser (RRR=1.47; 95% CI=0.79, 2.71), illegal drug use or abuse of prescription medications by abuser (RRR = 1.33; 95% CI = 0.72, 2.46), stalking by abuser (RRR=1.39; 95% CI=0.70, 2.76), failure of individuals to take victim seriously when she sought help (RRR=1.66; 95% CI=0.90, 3.05), victim's fear of reinforcing negative stereotypes (RRR=1.42; 95% CI=0.73, 2.77), and secrecy of abuse (RRR=1.72; 95% CI=0.74, 3.99). Both unweighted (P < .005) and weighted (P < .004) versions of the revised assessment were significant predictors of reassault. CONCLUSIONS: The revised Danger Assessment accurately assesses risk of re-assault in abusive female relationships.
Keywords: Aggression; Battered Women -- Psychosocial Factors; Lesbians; Adult; Female; Focus Groups; Interviews; Predictive Value of Tests; Relative Risk; Human

Women With Amenorrhea and Men With Menstruation: The Qualitative Experiences of People With Disorders of Sex Development in Nigeria. - Sani, Abdurrahman Muhammad; Arif, Ismi Ismail; Arshad, Mohd Mursyid; Mungadi, Ismaila Arzika; Soh, Kim Geok; Soh, Kim Lam (Journal of Nursing Research (Lippincott Williams & Wilkins), 2020)
Background: Disorders of sex development (DSD) affect the quality of life of people who live with this condition. In developing countries, diagnoses of DSD are associated with a delay in presentation until the patients developed ambiguous physical traits and features. Purpose: This study explores the menstrual experiences of people with DSD and sex reassignment in Nigeria. Methods: A qualitative approach with a phenomenological study design was employed in this study to explore and describe the experiences of people with DSD at the Usmanu Danfodiyo University Teaching Hospital in Sokoto, Nigeria. The data were collected using face-to-face interviews, transcribed verbatim, and analyzed using NVivo software. Results: The findings show that the participants experienced menstrual problems: men with menstruation and women with amenorrhea. The female participants generally described amenorrhea as a disappointment and linked menstruation with womanhood. Amenorrhea evinced both emotional and psychological effects. However, some of the female participants considered amenorrhea in a positive light and were happy with their lives without menstruation. The menstrual experiences of male participants included menarche, lower abdominal pain, regular monthly bleeding, and ovulation. The male participants described menstruation as a disaster in their lives and a source of anxiety, suicidal ideation, and depression. Menstruation negatively affected their psychosocial well-being. Conclusions: The menstrual experience of individuals with DSD negatively affects their quality of life. The women with DSD in this study showed a generally poor knowledge of menarche, menstruation, and puberty, indicating that their parents had ignored the initial symptoms of DSD. DSD were only recognized at puberty because of the development of ambiguous physical traits and of the onset of menstruation in men and the confirmation of amenorrhea in women.
Keywords: Women; Amenorrhea; Men; Menstruation; Disorders of Sex Development -- Psychosocial Factors -- Nigeria; Gender Affirmation Surgery -- Psychosocial Factors; Quality of Life; Human; Qualitative Studies; Nigeria; Life Experiences; Menstruation Disorders; Phenomenological Research; Semi-Structured Interview; Data Analysis Software; Descriptive Statistics; Purposive Sample; Adult; Thematic Analysis

A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth. - Mustanski, Brian; Liu, Richard T (Archives of Sexual Behavior, 2013)
Keywords: Bisexuality; Homosexuality; Support, Psychosocial; Suicide, Attempted -- Psychosocial Factors; Transsexualism -- Psychosocial Factors; Adolescence; Crime Victims -- Psychosocial Factors; Crime Victims -- Statistics and Numerical Data; Female; Prospective Studies; Human; Behavior; Male; Questionnaires; Suicide, Attempted; Young Adult

Suicidal ideation in gay men and lesbians in South Korea: a test of the interpersonal-psychological model. - Kim, SungYeon; Yang, Eunjoo (Suicide & Life-Threatening Behavior, 2015)
Gay men and lesbians in South Korea are alienated and stigmatized due to the country's low tolerance of social differences, resulting in distress and suicidal impulses. This study investigated the predictors of suicidal ideation in a gay and lesbian group in South Korea based on the interpersonal-psychological theory of suicide. Differences between the gay and lesbian group and the heterosexual group were found in the direct path between perceived burdensomeness and suicidal ideation. The relationship was significant for both groups, but the path coefficient was greater for lesbians and gay men than for heterosexuals. These findings imply that perceived burdensomeness may be a more critical factor in suicidal ideation of lesbians and gay men.

Harmful alcohol consumption and patterns of substance use in HIV-infected patients receiving antiretrovirals (ANRS-EN12-VESPA Study): relevance for clinical management and intervention. - Michel L; Carrieri MP; Fugon L; Roux P; Aubin H; Lert F; Obadia Y; Spire B (AIDS Care, 2010)
Alcohol abuse affects secondary prevention and disease progression in HIV-infected patients, and adherence and response to treatment in those chronically treated. The objective of this study was to estimate the prevalence of harmful alcohol consumption (HAC) using various indicators and identify which groups of patients may require specific targeted interventions for HAC risk reduction. A cross-sectional survey, based on a random sample representative of people living with HIV/AIDS (PLWHA) was carried out in 102 French hospital departments delivering HIV care. As alcohol abuse is particularly detrimental to patients receiving highly active antiretroviral therapy (HAART), we focused only on those individuals receiving HAART with complete alcohol assessment (CAGE, AUDIT-C, regular binge drinking, N=2340). Collected information included medical and socio-demographic data, HIV risk behaviors, adherence to treatment and substance and alcohol use, together with depression, anxiety, and experience of attempted suicide or sex work. HAC prevalence was evaluated as follows: 12% (CAGE score ≥2), 27% (AUDIT-C), and 9% (regular binge drinking). Three groups were at higher risk of HAC: men who have sex with men using stimulants, polydrug users, and to a lesser degree, ex-drug users. Innovative intervention strategies to reduce HAC and improve HIV prevention and HAART adherence in various PLWHA populations need urgent testing and implementation. Such interventions for alcohol risk reduction remain central to promoting improved HIV prevention and assuring HAART effectiveness in these populations.
Keywords: Substance Abuse; Alcohol Abuse; HIV Infections -- Psychosocial Factors; Unsafe Sex; Human; Cross Sectional Studies; Questionnaires; Interviews; Clinical Assessment Tools; P-Value; Descriptive Statistics; Odds Ratio; Confidence Intervals

Suicidal risk and sexual orientation in adolescence: A population-based study in Iceland. - Arnarsson, Arsaell; Sveinbjornsdottir, Sigrun; Thorsteinsson, Einar B.; Bjarnason, Thoroddur (Scandinavian Journal of Public Health, 2015)
Keywords: Suicide -- Risk Factors -- Iceland; Sexuality -- In Adolescence -- Iceland; Suicide -- Prevention and Control -- Iceland; Human; Descriptive Statistics; Iceland; LGBTQ+ Persons; Male; Female; Suicidal Ideation; Adolescence; Questionnaires; Odds Ratio; Confidence Intervals; Data Analysis Software; Logistic Regression; Prevalence; Sex Factors; Funding Source

Where risks and protective factors operate differently: homeless sexual minority youth and suicide attempts. - Walls NE; Potter C; Van Leeuwen J (Child & Adolescent Social Work Journal, 2009)
Keywords: Homelessness -- In Adolescence; Sexuality; Social Work Service; Suicide, Attempted; Adolescence; Adult; Child; Child Welfare; Funding Source; Logistic Regression; Male; Questionnaires; Sex Factors; Substance Abuse; United States; Urban Areas; Human

Sexual violence among two populations of men at high risk of HIV infection. - Braitstein P; Asselin JJ; Schilder A; Miller M; Laliberté N; Schechter MT; Hogg RS (AIDS Care, 2006)
This study sought to compare the prevalence of, and relationship between, age at first experience of sexual violence and HIV and other health risk behaviors in two populations of men at high risk of HIV infection. Data were drawn from two cohorts: Vanguard, a prospective study of young men who have sex with men (MSM), and VIDUS, the Vancouver Injection Drug Users Study. Controlling for fixed sociodemographics, multivariate logistic regression was used to assess the relationship between age at first sexual violence (vs. never experiencing it) and several health risk behaviors. There were 140/498 (28%) MSM from Vanguard and 173/932 (19%) injection drug users (IDU) from VIDUS who reported having experienced sexual violence. Among VIDUS men, 130/852 (15%) IDU-only and 43/80 (54%) who were both IDU and MSM reported a history of sexual violence. The prevalence of child sexual abuse was 13% in Vanguard MSM, and 11% among VIDUS IDU-only, but 26% among VIDUS MSM/IDU. The median age of onset was significantly lower among VIDUS IDU-only compared to the two other groups. Experiencing sexual violence first in childhood was strongly related to ever being in the sex trade in both IDU and MSM. MSM in Vanguard who experienced sexual violence in childhood were more likely to have attempted suicide, and have a diagnosed mood disorder. Non-MSM IDU in VIDUS who experienced sexual violence in childhood were more likely to have a diagnosed mental illness, to binge on alcohol, and to have ever accidentally overdosed. In conclusion, men who have ever had sex with men appear to have a higher lifetime prevalence of sexual violence, compared to non-MSM injection drug users. Sexual violence is differentially associated with different health risk behaviors, depending on the age at first occurrence and the primary HIV risk factor (i.e. MSM vs. IDU).
Keywords: Child Abuse, Sexual; HIV Infections; Gay Men; Substance Abuse, Intravenous; Adolescence; Adult; Age Factors; Chi Square Test; Child Abuse, Sexual -- Psychosocial Factors; Confidence Intervals; Demography; Descriptive Statistics; Funding Source; Logistic Regression; Male; Multivariate Analysis; Odds Ratio; P-Value; Prevalence; Prospective Studies; Risk Factors; Risk Taking Behavior; Socioeconomic Factors; Step-Wise Multiple Regression; T-Tests; Two-Tailed Test; Violence; Wilcoxon Rank Sum Test; Human

Get it off your chest: men and mental health. - Kemple M (British Journal of Healthcare Management, 2009)
Keywords: Men; Mental Health; Age Factors; Economics; Emotions; Employment; Ethnic Groups; Family; Friendship; Help Seeking Behavior; Gay Persons; Interpersonal Relations; Suicide; Support, Psychosocial

The NHS England Fundamental Information Standard for Monitoring Sexual Orientation. - Pollard, Alex; Bradley, Jasmin; Cooper, Max; Sadhwani, Shanu; Northam, Antonia; Llewellyn, Carrie (British Journal of General Practice, 2019)
The article focuses on the general practice staff in England towards monitoring sexual orientation. It mentions that significant and unaddressed health inequities exist among lesbian, gay, and bisexual (LGB) people compared with the general population, including: self-harm and suicide, smoking, alcohol use, domestic abuse, some cancers, and increased isolation in old age, as well as men's sexual health; and also mentions LGB patients would be willing to disclose sexual orientation.
Keywords: Medical Records, Personal -- Ethical Issues; Population Surveillance -- Methods; Sexuality; Stigma; Coding -- Administration; Medical Records, Personal; Coding -- Ethical Issues; Health Policy; England; National Health Programs; Healthcare Disparities; Questionnaires

Orlando Health Nurse Leaders Reflect on the Pulse Tragedy. - Willis, Jayne; Philp, Louise (Nurse Leader, 2017)
In the predawn hours of Sunday, June 12, 2016, dozens of people hit by gunfire poured into Orlando Regional Medical Center's (ORMC) emergency department (ED) in Orlando, Florida. The largest mass-casualty shooting in American history happened just a few blocks from ORMC, Orlando Health's flagship hospital and the region's only level one trauma center. The gunman had opened fire at Pulse, a popular gay nightclub, during a crowded Latin night. Due to the close proximity of the nightclub to ORMC, first responders loaded victims into police cars and the backs of trucks, and transported them to the ED. The shooting resulted in the treatment of 44 total victims in just a few hours’ time, testing the effectiveness of the disaster planning preparedness and the resiliency of team members. Nurse leaders played an important coordinating role during the unfolding disaster, and interprofessional collaboration became crucial to ensure that patients received optimal care. In the time that has elapsed since the 2016 tragedy, the Orlando Health team has been applauded on the national and international stages for their heroic initial response and for the care provided in the days and months that ensued. As nurse leaders reflect on lessons learned, successes can be attributed to 3 major themes: preparedness, teamwork, and a culture of resiliency.
Keywords: Mass Casualty Incidents -- Florida; Emergency Care -- Florida; Florida; Disaster Planning; Multidisciplinary Care Team; Emergency Nursing; Collaboration; Professional Recognition; Teamwork

American health improvement depends upon addressing class disparities. - Schroeder, Steven A. (Preventive Medicine, 2016)
The gap in health status between the United States and other (OECD) developed countries not only persists but has widened over the past decade. This has occurred despite major declines in smoking prevalence. But as with other health problems, such as obesity, gun violence, and teenage pregnancy, progress against smoking has disproportionately benefitted the better off segments of the American population. Thus smoking, as well as other problems, is now concentrated among the vulnerable members of our society: the poor and less educated, as well as disadvantaged groups such as those with mental illness and substance use disorders, the homeless, those who are incarcerated, and the LGBT community. Although this is a national issue, these problems, as well as overall poverty, are especially concentrated in the Southeastern part of the country. Compared with the other OECD countries, the U.S. has much greater inequality of income and wealth. Furthermore, we are unique in leaving substantial portions of our population not covered by health insurance, again most prominently in the southeastern region. This national health disparity is not simply a factor of the multicultural nature of American society, because it persists when the health of the whites only is compared with the more racially homogeneous OECD nations. The complexity of our poor health performance rules out a single intervention. But it is clear that without focusing on the less fortunate members of our society, especially those in the Southeast, our performance will continue to lag, and possibly deteriorate further.
Keywords: Health Status Disparities; Socioeconomic Factors; Health Status; Chronic Disease; Developed Countries; Smoking -- Epidemiology; Obesity -- Epidemiology; United States; Prevalence; Population

Effects of minority stress processes on the mental health of Latino men who have sex with men and women: a qualitative study. - Holloway, Ian W; Padilla, Mark B; Willner, Lauren; Guilamo-Ramos, Vincent (Archives of Sexual Behavior, 2015)
Emerging literature on minority stress among sexual minority populations has described the negative consequences that multiple minority statuses may exert on mental health and well-being. This literature has tended to focus on individuals whose self-identifications reflect sexual minority sexual categories, such as gay or bisexual, and has explored the intersection of these definitions with ethnic, racial, and class statuses. Few such studies have explored mental health among men who actively deny a sexual minority sexual identity label while engaging in same-sex sexual behaviors. The present study used ethnographic interview data from 20 non-gay-identified bisexually behaving Dominican and Puerto Rican men in New York City. Participants described discovery of same sex sexual behavior as a threat to their intimate relationships, community affiliation, and counter to expectations of Latino masculinity. Recounting a wide range of information management strategies used to avoid open disclosure about their sexual lives, participants experienced the potential consequences of disclosure as extreme and even life threatening. Men anticipated social isolation, depression, self-injury, and suicidality as possible outcomes from disclosing sexual behavior with other men to their female romantic partners. This analysis provides direction for future research on minority stress processes and mental health service delivery among Latino men who have sex with men and women.

Can Glucksberg survive Lawrence? Another look at the end of life and personal automony. Reprinted with permission from the Michigan Law Review, June 2008, Vol. 106, No. 8. Copyright © 2008 by The Michigan Law Review Association. - Kamisar Y (Issues in Law & Medicine, 2008)
Keywords: Civil Rights -- Legislation and Jurisprudence -- United States; Privacy and Confidentiality -- Legislation and Jurisprudence -- United States; Suicide, Assisted -- Legislation and Jurisprudence -- United States; Terminally Ill Patients -- Legislation and Jurisprudence -- United States; Gay Persons -- Legislation and Jurisprudence -- United States; Palliative Care -- Legislation and Jurisprudence -- United States; Terminal Care; Treatment Refusal; United States

Prevalence of suicidal ideation and associated factors among HIV-positive MSM in Anhui, China. - Wu, Yi-Le; Yang, Hui-Yun; Wang, Jun; Yao, Hui; Zhao, Xue; Chen, Jian; Ding, Xiu-Xiu; Zhang, Hong-Bo; Bi, Peng; Sun, Ye-Huan (International Journal of STD & AIDS, 2015)
The aim of this study was to investigate the prevalence and factors associated with suicidal ideation among HIV-positive men who have sex with men (MSM) in Anhui, China. A cross-sectional study was conducted to recruit HIV-positive MSM in Anhui, China. A total of 184 HIV-positive MSM gave informed consent and completed the interview. Correlates of suicidal ideation were assessed using multivariable logistic regression. Fifty-seven (31%) of HIV-positive MSM had suicidal ideations within six months before the interview. Multivariable analyses showed that learning of their HIV status in the past 12 months (adjusted odds ratio (AOR) = 3.4, 95% CI = 1.6-7.3), perceived HIV stigma (AOR = 2.4, 95% CI = 1.1-5.2), depression symptoms (AOR = 2.6, 95% CI = 1.1-5.9) and anxiety symptoms (AOR = 2.7, 95% CI = 1.2-6.1) were significantly associated with the suicidal ideation among HIV-positive MSM. The results indicated that suicidal ideation was common among HIV-positive MSM in Anhui, China. There is an urgent need to establish psychological counselling services among HIV-positive MSM in China. Targeting of these potential risk factors could be an effective approach to reduce the suicide risk among this high-risk subgroup by the implementation of early intervention measurements.

Suicide among Asian Americans: What Do We Know? What Do We Need to Know? - Leong FTL; Leach MM; Yeh C; Chou E (Death Studies, 2007)
The current review begins with an acknowledgment of the diversity within the Asian American population as well as the scarcity of information on suicide among this particular racial/ethnic minority group. In analyzing what is known and what still needs to be learned about suicide among Asian Americans, the current article provides a critical review of significant factors such as age, gender, religious and spirituality issues, acculturation, social support, familial dynamics, social integration as well as gay/lesbian/bisexual orientations. In examining these factors, recommendations related to interventions and the existing research gaps are also discussed.
Keywords: Asians -- Psychosocial Factors; Suicide -- Psychosocial Factors; Acculturation; Asians; Bisexuality; Female; Homosexuality; Male; Prayer; Spirituality; Support, Psychosocial; United States

Suicide attempts among people living with HIV in France. - Preau M; Bouhnik A; Peretti-Watel P; Obadia Y; Spire B (AIDS Care, 2008)
This study examined the prevalence and characteristics of attempted suicide among a representative sample of French Human Immunodeficiency virus (HIV) infected individuals. In 2003, a face-to-face survey was conducted among people living with HIV/AIDS (PLWHA) selected in a random, stratified sample of French hospital departments. Among solicited individuals, 2,932 agreed to participate and were asked if they had ever AS. Among the respondents, 23% had AS. Female gender, younger age, native French citizenship, reporting household financial difficulties, having been HIV-contaminated through homosexual contact or through injection drug use and suffering from lipodystrophy-related symptoms were all independently associated with AS. HIV-discrimination and the lack of social support from family remained independently associated with AS. Our findings indicate a high level of AS among PLWHA and emphasize the multiple roles of factors associated with living with HIV, together with sociodemographic factors. The results enable the possibility for vulnerable groups to be targeted for specific future interventions in order to prevent attempted suicide.
Keywords: Discrimination; HIV Infections; Suicide, Attempted; Age Factors; Confidence Intervals; Data Collection, Computer Assisted; Female; France; Funding Source; Lipodystrophy; Male; Odds Ratio; P-Value; Prevalence; Random Sample; Sex Factors; Human

Educating for diversity: an evaluation of a sexuality diversity workshop to address secondary school bullying. - Lucassen, Mathijs F. G.; Burford, James (Australasian Psychiatry, 2015)
Objective: To evaluate the potential of a 60-minute sexuality diversity workshop to address bullying in secondary schools.Methods: Students completed pre- and post-workshop questionnaires. Descriptive statistics were used to summarise results with pre- to immediate post-workshop changes compared using t-tests. Thematic analysis was used to analyse open-ended questionnaire responses.Results: We had 229 students (mean age 13.7 years) attending 10 workshops participate in the study. Three-quarters of students thought the workshop would reduce bullying in schools, and over 95% of the participants thought that other secondary schools should offer the workshop. There was a significant increase in valuing (p < 0.001) and understanding (p < 0.001) sexuality-diverse individuals (e.g. lesbian, gay and bisexual people), between the pre- and post-workshop results. School climates were largely perceived to be 'hard' and included 'bullying/mocking' of sexuality-diverse students; however, many individual students reported a desire to be supportive of their sexuality-diverse peers.Conclusions: Sexuality-based bullying is commonplace in secondary schools. This form of bullying is associated with depression and suicide attempts. Reducing sexuality-based bullying is very likely to have a positive impact on the mental health of young people. Brief workshops, as a part of a wider suite of interventions, have some potential to create safer school environments.
Keywords: Education; Adolescent Behavior; Prejudice -- Prevention and Control; Bullying -- Prevention and Control; Sexuality; Adolescence; Female; Schools; Male; Human

Benefits and Potential Harms of Human Immunodeficiency Virus Self-Testing Among Men Who Have Sex With Men in China: An Implementation Perspective. - Yilu Qin; Weiming Tang; Nowacki, Amy; Mollan, Katie; Reifeis, Sarah A.; Hudgens, Michael G.; Ngai-Sze Wong; Haochu Li; Tucker, Joseph D.; Chongyi Wei; Qin, Yilu; Tang, Weiming; et al. (Sexually Transmitted Diseases, 2017)
Background: Human immunodeficiency virus self-testing (HIVST) holds great promise for reaching high-risk key populations who do not access facility-based services. We sought to characterize unsupervised HIVST implementation among men who have sex with men in China.Methods: We conducted a nationwide online survey in China. Eligible men were at least 16 years, had anal sex with a man, and had recent condomless sex. We assessed benefits (first-time testing, increased testing frequency, confirmatory testing) and potential harms (coercion, violence, suicidality) of HIVST. Among men who have sex with men who reported ever testing for human immunodeficiency virus (HIV), we identified correlates of HIVST as first-time HIV test being a self-test using multivariable logistic regression.Results: Among 1610 men who met the eligibility criteria and started the survey, 1189 (74%) completed it. Three hundred forty-one (29%) of 1189 reported ever self-testing for HIV. Human immunodeficiency virus prevalence was 7% (24/341) among self-testers and 5% (15/306) among non-self-testers. Two hundred (59%) of 341 men who self-tested reported HIVST as a first-time HIV test. Thirty-one (9%) men experienced coercion with HIVST. Thirty-one (78%) of 40 men with positive HIV self-tests sought confirmation. Multivariable analysis revealed that HIVST as first-time HIV test was associated with younger age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.99), not being "out" (OR, 2.28; 95% CI, 1.60-3.28), not using the internet to meet sex partners (OR, 0.39; 95% CI, 0.22-0.69), and group sex (OR, 1.74; 95% CI, 1.02-2.9).Conclusions: Human immunodeficiency virus self-testing reached high-risk individuals that had never received facility-based testing. Further implementation research is needed to better understand HIVST outside of research programs.

Transgender health: findings from two needs assessment studies in Philadelphia. - Kenagy GP (Health & Social Work, 2005)
HIV/AIDS, suicide, violence, and barriers to health care access among transgender people were explored using two needs assessment surveys conducted in Philadelphia in 1997. A total of 182 people responded to a face-to-face interview or self-administered mail survey: 113 male-to-female individuals and 69 female-to-male individuals. About three-fifths of respondents had engaged in unprotected sexual activity during the past 12 months. The risk for HIV infection from unprotected sex was significantly higher among respondents of color than among white respondents. About one-third (30.1 percent) of respondents had attempted suicide. More than half of respondents had been forced to have sex, 56.3 percent had experienced violence in their homes, and 51.3 percent had been physically abused. Twenty-six percent of respondents had been denied medical care because they were transgender. These findings suggest that prevention services that specifically address HIV/AIDS, suicide, and violence among transgender people are urgently needed.
Keywords: Health Services Accessibility; HIV Infections -- Risk Factors; Suicide, Attempted; Transsexualism; Violence; Adult; Empirical Research; Female; Focus Groups; Health Status; Male; Needs Assessment; Nonprobability Sample; Pennsylvania; Race Factors; Risk Taking Behavior; Snowball Sample; Structured Interview; Surveys; Transsexualism -- Psychosocial Factors; Human

Importance of Health and Social Care Research into Gender and Sexual Minority Populations in Nepal. - Regmi, Pramod R.; van Teijlingen, Edwin (Asia-Pacific Journal of Public Health, 2015)
Despite progressive legislative developments and increased visibility of sexual and gender minority populations in the general population, mass media often report that this population face a wide range of discrimination and inequalities. LGBT (lesbian, gay, and bisexual, and transgender) populations have not been considered as priority research populations in Nepal. Research in other geographical settings has shown an increased risk of poor mental health, violence, and suicide and higher rates of smoking, as well as alcohol and drugs use among LGBT populations. They are also risk for lifestyle-related illness such as cancer, diabetes, and heart diseases. Currently, in Nepal, there is a lack of understanding of health and well-being, social exclusion, stigma, and discrimination as experienced by these populations. Good-quality public health research can help design and implement targeted interventions to the sexual and gender minority populations of Nepal.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Gay Men; Mental Health; Authorship; Public Health; Population; Minority Groups; Behavioral Research; Nepal

Sociodemographic Characteristics and Psychological Adjustment Among Transsexuals in Spain. - Guzmán-Parra, José; Sánchez-Álvarez, Nicolás; Diego-Otero, Yolanda; Pérez-Costillas, Lucía; Esteva de Antonio, Isabel; Navais-Barranco, Miriam; Castro-Zamudio, Serafina; Bergero-Miguel, Trinidad; Guzmán-Parra, José; Sánchez-Álvarez, Nicolás; de Diego-Otero, Yolanda; Pérez-Costillas, Lucía (Archives of Sexual Behavior, 2016)
This study examined the sociodemographic characteristics and the psychological adjustment of transsexuals in Andalusia (Spain), and also analyzed the differences between female-to-male (FtM) and male-to-female (MtF) transsexuals. The sample included 197 transsexuals (101 MtF and 96 FtM) selected from those who visited the Transsexual and Gender Identity Unit at the Carlos Haya Hospital in Malaga between 2011 and 2012. Our analyses indicated that MtF transsexuals were more likely to have lower educational levels, live alone, have worked less frequently throughout their lifetime, and have engaged in prostitution. For FtM transsexuals, there were more frequent references to the mother's psychiatric history and more social avoidance and distress. Multivariate analysis showed that the number of personality dysfunctional traits and unemployment status were associated with depression in the entire sample. The following three conclusions can be made: there are significant differences between MtF and FtM transsexuals (mainly related to sociodemographic variables), depression was high in both groups, and a remarkable percentage of transsexuals have attempted suicide (22.8 %) or have had suicidal thoughts (52.3 %).
Keywords: Transsexualism -- Psychosocial Factors; Adaptation, Psychological; Spain; Female; Gender Identity; Adult; Sexuality; Young Adult; Male; Human

Caring for Our Transgender Troops--The Negligible Cost of Transition-Related Care. - Belkin, Aaron (New England Journal of Medicine, 2015)
The author discusses the cost of transition-related care for transgender members of American military troops. He agrees with the lifting a ban on service by transgender individuals citing the lower cost to the military at 438 dollars per member or 5.6 million dollars annually. Also discussed are 15,500 transgender personnel serving in the military with a 2,581,000 total force, mitigation of serious conditions such as suicidal tendencies and prevention of psychological and medical consequences.
Keywords: Military Personnel; Health Care Costs -- Statistics and Numerical Data; Transgender Persons -- Statistics and Numerical Data; Gender Affirmation Procedures -- Economics; United States; Male; Female; Questionnaires

Measures of Sexual Minority Status and Suicide Risk among Young Adults in the United States. - Almazan, Elbert P; Roettger, Michael E; Acosta, Pauline S (Archives of Suicide Research, 2014)
Keywords: Bisexuality; Health Status Disparities; Homosexuality; Minority Groups -- Statistics and Numerical Data; Suicidal Ideation; Suicide; Suicide, Attempted; Adult; Female; Human; Logistic Regression; Male; Minority Groups -- Psychosocial Factors; Relative Risk; Suicide -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; United States; Young Adult

Non-Suicidal Self-Injury in a Large Online Sample of Transgender Adults. - dickey, lore m.; Reisner, Sari L.; Juntunen, Cindy Lee (Professional Psychology: Research & Practice, 2015)
Non-suicidal self-injury (NSSI) has been increasing in clinical as well as nonclinical populations in recent years. There are few published reports examining lifetime occurrence of this behavior in transgender and gender nonconforming (TGNC) people. An online survey was conducted with self- identified TGNC adults (n = 773) in the United States over the course of 6 months in 2009. The mean age for the sample was 40.4 years (SD = 13.9). Most participants identified on the trans masculine spectrum (female-to-male or FTM; 52.0%), 33.9% identified on the trans feminine spectrum (male-to-female or MTF), and 8.0% identified as genderqueer. Participants completed the Body Investment Scale, the Depression, Anxiety, and Stress Scales, and the Inventory of Statements about Self-Injury. Results indicated that 41.9% of participants had a lifetime history of NSSI. Scores on the subscales of Protection and Feeling from the Body Investment Scale were found to be statistically predictive of NSSI. These findings shed new light on the lifetime prevalence of NSSI in this online TGNC respondent sample. Practice implications are discussed for mental health professionals who work with TGNC clients in addition to research recommendations.
Keywords: Self-Injurious Behavior -- Prevention and Control; Transgender Persons -- Psychosocial Factors; Injuries, Self-Inflicted -- Prevention and Control; Male; Human; Funding Source; Female; Survey Research; United States; Adolescence; Adult; Middle Age; Convenience Sample; Cross Sectional Studies; Questionnaires; Self Report; Scales; Psychological Tests; Internet

Sieccan newsletter. Research exploring the health, wellness, and safety concerns of sexual minority youth. - Wells K (Canadian Journal of Human Sexuality, 2009)
This article provides an overview of the critical risk factors that negatively impact the health, safety, personal Wellness, and educational achievement of sexual minority youth. Contemporary and landmark studies of the key Stressors faced by sexual minority are reviewed with an emphasis on Canadian data. Sexual minority youth often encounter multiple risk factors, have fewer protective factors (such as a sense of connectedness to school and family), and experience more bullying, harassment, alienation, suicide ideation, and substance abuse than do their heterosexual peers. Over a decade of research evidence dearly indicates that educational institutions have a legal, ethical, and professional responsibility to respond appropriately to the urgent health, safety, and educational needs of sexual minority youth (Grace & Wells, 2005, 2009; Wells, 2008). A failure to respond by important adults in the lives of such youth, places vulnerable youth at significant risk and denies them access to important protective factors in their lives.
Keywords: LGBTQ+ Persons -- In Adolescence; Health Status; Minority Groups -- Psychosocial Factors; Research; Adolescence; Bullying -- Risk Factors; Homelessness; Substance Abuse -- Risk Factors; Suicide -- Risk Factors; Violence -- Risk Factors

Sexual Assault Risk and School Facility Restrictions in Gender Minority Youth. - Ehrensaft, Diane; Rosenthal, Stephen M. (Pediatrics, 2019)
The authors comment on a study published within the issue which found an increased risk of sexual assault among transgender and gender nonbinary adolescents who were not allowed from using school restrooms and locker rooms that match their gender identity. Topics covered include verbal and physical harassment facing transgender youth who express their gender identity, and the role of pediatricians in decreasing the risk of sexual assault directed at transgender and gender nonbinary youth.
Keywords: Transgender Persons -- Psychosocial Factors -- In Adolescence; Gender Identity -- United States; Sexual Abuse -- Risk Factors -- In Adolescence; School Violence -- Risk Factors -- In Adolescence; Toilet Facilities -- United States; Crime Victims -- Psychosocial Factors -- In Adolescence; Sexual Abuse -- Epidemiology -- United States; School Violence -- Epidemiology -- United States; LGBTQ+ Persons -- Psychosocial Factors; Public Policy; Sexual Abuse -- Legislation and Jurisprudence; Adolescence; United States

Explaining the suicide risk of sexual minority individuals by contrasting the minority stress model with suicide models. - Plöderl, Martin; Sellmeier, Maximilian; Fartacek, Clemens; Pichler, Eva-Maria; Fartacek, Reinhold; Kralovec, Karl (Archives of Sexual Behavior, 2014)
Keywords: Bisexuality; Lesbians -- Psychosocial Factors; Homosexuality; Models, Psychological; Psychological Theory; Suicide -- Psychosocial Factors; Adult; Depression -- Psychosocial Factors; Female; Human; Male; Middle Age; Minority Groups; Questionnaires; Relative Risk; Self-Injurious Behavior -- Psychosocial Factors; Sexuality; Stress, Psychological; Young Adult

Creating and Maintaining Safe and Responsive Schools for Lesbian, Gay, Bisexual, Transgender, and Queer Youths: Introduction to the Special Issue. - Savage, Todd A.; Schanding, G. Thomas (Journal of School Violence, 2013)
Children and adolescents spend a great deal of their time in schools. As microcosms of the larger society in which they are embedded, schools recreate and enforce the heterosexist, sexist, homophobic, and transphobic characteristics of the larger culture. Those students with emerging or declared lesbian, gay, bisexual, transgender, or queer (LGBTQ) identities are, thus, particularly vulnerable to the impact of heterosexist, sexist, homophobic, and transphobic attitudes and the potential resulting violence present in the school setting. Therefore, it is imperative school personnel, including administrators, teachers, school psychologists, and school counselors, among others, become aware of how anti-LGBTQ bias and discrimination are present in schools and what they can do to create and maintain safe and responsive schools for LGBTQ youths. In this introduction to the special issue, some of the challenges faced by LGTBQ youths in schools are outlined and the theme of each article is highlighted.
Keywords: Schools; Safety; LGBTQ+ Persons; School Violence; Serial Publications; Sexism; Students; Social Media; Bullying; Organizational Policies; Professional Development; Schools -- Administration

Euthanasia and physician-assisted suicide in homosexual men with AIDS. - Bindels PJE; Krol A; van Ameijden E; Mulder-Folkerts DKF; van den Hoek JAR; van Griensven GPJ; Coutinho RA; Bindels, P J; Krol, A; van Ameijden, E; Mulder-Folkerts, D K; van den Hoek, J A; et al. (Lancet, 1996)
Background: In the Netherlands a nationwide study has shown that, in 38% of deaths, there have been medical decisions concerning the end of life (MDEL); 2.1% of all deaths were brought about by euthanasia or physician- assisted suicide (PAS). We investigated the incidence of MDEL in homosexual men with AIDS, suspecting that it might be higher, and studied the effect of euthanasia/PAS on survival time.Methods: The patients were 131 male homosexual participants in a cohort study in Amsterdam, diagnosed between 1985 and 1992 as having AIDS; all had died before Jan 1, 1995. Clinical and laboratory data and information on mode of death were obtained from their physicians and by review of hospital records. Those who died by euthanasia/PAS or in whom there had been other MDEL were then compared with those who died naturally.Findings: 29 men (22%) had died by euthanasia/PAS and in 17 (13%) another MDEL had been made; thus, more than one-third of these men had made medical decisions concerning the end of life. The greatest difference between the groups was in age at time of diagnosis-72% aged 40 or more in the euthanasia/PAS group compared with 38% in the natural death group. The likelihood (relative risk) of euthanasia/PAS increased with duration of survival after AIDS diagnosis. Comparison of the groups in terms of three laboratory markers (CD4+ and CD8+ cells and phytohaemagglutinin responses) in the two years before death, and estimates of these markers at the time of death, did not indicate any substantial shortening of life by euthanasia/PAS; in the judgment of the physicians, most of these patients would have died naturally within one month.Interpretation: A possible reason for the high incidence of MDEL in this cohort was a good knowledge of the characteristics of AIDS acquired through long-term awareness of HIV infection. The higher rate of euthanasia in those with long survival from AIDS diagnosis could reflect either additional suffering or the greater opportunity to discuss this option with friends and physicians. Our findings indicate that euthanasia and other MDEL did little to shorten life; rather, they were an extreme form of palliation, applied in the terminal phase of a lethal disease.
Keywords: AIDS Patients; Suicide, Assisted; Terminally Ill Patients; Euthanasia; Acquired Immunodeficiency Syndrome -- Mortality; Gay Men; Male; Acquired Immunodeficiency Syndrome -- Diagnosis; CD4 Lymphocyte Count; Netherlands; Survival; Adult; Middle Age; Relative Risk; Time Factors; Prospective Studies; Human

The Role of Social Connectedness and Sexual Orientation in the Prevention of Youth Suicide Ideation and Attempts Among Sexually Active Adolescents. - Stone, Deborah M; Luo, Feijun; Lippy, Caroline; McIntosh, Wendy LiKamWa (Suicide & Life-Threatening Behavior, 2015)
The impact of types of social connectedness-family, other adult, and school-on suicide ideation and attempts among all youth, the relative impact of each type, and effect modification by sexual orientation was assessed. Data were from the 2007-2009 Milwaukee Youth Risk Behavior Surveys. Multivariable logistic regression analyses calculated the risk of suicide ideation and attempts by sexual orientation, types of social connectedness, and their interaction. Among all youth, each type of connectedness modeled singly conferred protective effects for suicide ideation. Family and other adult connectedness protected against suicide attempts. When modeled simultaneously, family connectedness protected against ideation and attempts. Sexual orientation modified the association between other adult connectedness and suicide ideation. Findings suggest that family connectedness confers the most consistent protection among all youth and sexual orientation does not generally modify the association between connectedness and suicidal behavior.

Mental health among men who have sex with men in Cambodia: Implications for integration of mental health services within HIV programmes. - Siyan Yi; Sovannary Tuot; Pheak Chhoun; Khuondyla Pal; Sok Chamreun Choub; Gitau Mburu (International Journal for Equity in Health, 2016)
Background: Poor mental health contributes to poor HIV prevention, treatment and care outcomes. This paper documents factors associated with psychological distress among men who have sex with men (MSM) in Cambodia and discusses potential ways in which routine mental health management could be integrated into HIV services. Methods: A cross-sectional study was conducted in 2014 among 394 MSM randomly selected from two provinces using a two-stage cluster sampling method. A structured questionnaire was used to assess psychological distress, sexual behaviors, substance use, adverse childhood experiences and family dysfunction. Multivariate logistic regression analysis was performed to explore factors associated with levels of psychological distress. Results: In total, 10.7 % of the respondents reported having suicidal thoughts and 6.6 % reported having attempted to commit suicide in the past three months, while 38.8 % had a higher level of psychological distress (GHQ-12 > 3), which indicates poor mental health. Higher levels of psychological distress were independently associated with older age (AOR = 1.09, 95 % CI 1.03-1.14), alcohol use (AOR = 3.3, 95 % CI 1.36-7.83), illicit drug use (AOR = 3.53, 95 % CI 1.12-11.18), poor self-reported quality of life (AOR = 7.45, 95 % CI 1.79-3.04), and reduced condom use at last sex (AOR = 0.40, 95 % G 0.21-0.73). MSM with higher levels of psychological distress were significantly more likely to report that a family member said hurtful things to them (AOR = 1.80, 95 % O 1.10-2.97), a parent or guardian had been physically abused (AOR = 3.51, 95 % CI 1.86-6.62), and a family member had been mentally ill (AOR = 4.01, 95 % CI 2.06-7.81) when they were growing up. Conclusions: In order to mitigate psychological distress among MSM in Cambodia, integration of mental health interventions within HIV programmes should be strengthened. To achieve optimal impact, these interventions should also address alcohol and other substance use, and low condom use among distressed MSM. In addition, training of clinical and non-clinical HIV service providers to screen for mental health symptoms, and subsequent provision of peer-based outreach and social support for MSM identified with psychological distress is required.
Keywords: Mental Health -- Evaluation -- Cambodia; Men Who Have Sex With Men -- Psychosocial Factors -- Cambodia; Men's Health; Human; Male; Cambodia; Cross Sectional Studies; Structured Questionnaires; Treatment Outcomes; Cluster Sample; Two-Stage Cluster; Health Screening; Condoms -- Utilization; Odds Ratio; Multiple Logistic Regression; Confidence Intervals; Support, Psychosocial; Questionnaires; LGBTQ+ Persons; Mental Health Services; Unsafe Sex

Association Among Subtypes of Bullying Status and Sexually-Risky Behaviors of Urban African American Adolescents in Chicago. - Hong, Jun; Voisin, Dexter; Cho, Sujung; Espelage, Dorothy (Journal of Immigrant & Minority Health, 2016)
Bullying is found to be associated with various negative psychosocial outcomes. However, few studies have explored the association between bullying involvement and sexually-risky behaviors. Youth were recruited from three high schools, one youth church group, two community youth programs, and four public venues. Six hundred-and-thirty-eight urban African American adolescents (aged 12-22) in Chicago completed a self-report questionnaire. Major findings indicated that males were more likely than females to have sex with someone in exchange for drugs. Bullying perpetration, victimization, and perpetration-victimization were negatively associated with having sex with a condom. Older youth, and those identified as perpetrators and perpetrator-victims were more likely to have impregnated someone or been pregnant. Stress and coping framework should be considered. Bullying prevention should provide youth with several healthy coping strategies for reducing sexually-risky behaviors. Community-based and school-based violence prevention programs need to consider sexual risk outcomes associated with involvement in bullying.
Keywords: Coping; Bisexuality; Cyberbullying; Black Persons; Behavior; Violence -- Prevention and Control; School Violence; Community Programs; United States; Adolescence; Male; Female

Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men. - O'Leary A; Purcell D; Remien RH; Gomez C (AIDS Care, 2003)
Previous studies have indicated an association between childhood sexual abuse (CSA) and adult sexual risk behaviour among women and among men who have sex with men (MSM). However, no studies to date have tested the hypothesis that a history of CSA predicts sexual behaviour carrying risk of transmission of HIV to others, i.e. in a known HIV-positive cohort. The present study tested this hypothesis among a sample of 456 HIV-positive MSM recruited from community venues in New York and San Francisco. CSA history was found to be significantly associated with past (in the last 90 days) unprotected anal sex acts, both insertive (33% versus 20%, p < 0.05) and receptive (43% versus 27%, p < 0.02), with partners of HIV-negative or unknown serostatus. Further, several potential mediators of this effect were tested, and three found to be predicted by CSA history. Each of these potential mediators was associated with sexual risk behaviour, but differentially: anxiety and hostility were significantly associated with insertive acts, while anxiety, hostility and suicidality were associated with receptive acts. Mediation analyses supported the hypothesis that these factors significantly (albeit partially) accounted for the association of CSA with receptive anal intercourse. Nonsignificant mediation effects were found for insertive sex, suggesting the operation of unmeasured mediating variables. These results highlight the importance of mental health services for individuals who have been sexually abused, both for personal and for public health benefit, and also indicate a need for further research into mediators of CSA effects on transmission-related behaviour.
Keywords: Child Abuse, Sexual -- Psychosocial Factors; HIV Seropositivity -- Transmission; Gay Men -- Psychosocial Factors; Adult; Anal Intercourse; Anger; Anxiety -- Psychosocial Factors; Brief Symptom Inventory; Coefficient Alpha; Depression -- Psychosocial Factors; Descriptive Statistics; HIV Seropositivity -- Psychosocial Factors; Internal Consistency; Interviews; Male; P-Value; Psychological Tests; Qualitative Studies; Questionnaires; Risk Factors; Safe Sex; Scales; T-Tests; Funding Source; Human

What schools can do to help gay/lesbian/bisexual youth: a harm reduction approach. - Van Wormer K; Mckinney R (Adolescence, 2003)
In recognition of the fact that heterosexism is one of the most significant realities of adolescents' day-to-day experiences in school, this paper examines the school environment in terms of disempowering and empowering aspects. It is argued that failure to take a proactive stance to help youth with gender identity issues is a major cause of psychological problems, leading in some cases to suicide, alcohol and other drug abuse, and homelessness.
Keywords: Homosexuality; Lesbians -- Psychosocial Factors; Mental Disorders -- Prevention and Control; Peer Group; Prejudice; Social Environment; Adolescence; Female; Male; Mental Disorders -- Psychosocial Factors; Power; Risk Factors; Schools

Suicide and HIV disease. - Pugh K; O'Donnell I; Catalan J (AIDS Care, 1993)
It has been suggested that HIV infection is associated with an increased risk of suicidal behaviour. This paper reviews the literature on suicide in patients with HIV disease and discusses methodological problems encountered in studying the incidence of suicide in this population. A snowballing method was used to identify cases of suicide in patients who were receiving treatment for HIV disease in a central London health district. The possible under detection of suicides among AIDS patients is considered. The six case reports are described to illustrate the clinical and psychosocial characteristics of suicides, and they are discussed in relation to other findings on suicide in patients with HIV disease and other physical illnesses.
Keywords: HIV Infections -- Psychosocial Factors; Suicide -- Psychosocial Factors; Homosexuality; Great Britain; Validity; Adult; Male

Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. - Liu RT; Mustanski B (American Journal of Preventive Medicine, 2012)
Keywords: Homosexuality; Lesbians -- Statistics and Numerical Data; Self-Injurious Behavior -- Epidemiology; Suicidal Ideation; Adolescence; Behavior -- Epidemiology; Bisexuality; Female; Human; Lesbians -- Psychosocial Factors; Male; Prospective Studies; Risk Factors; Self-Injurious Behavior -- Psychosocial Factors; Support, Psychosocial; Time Factors; Young Adult

Suicide in India - changing trends and challenges ahead. - Ponnudurai, R. (Indian Journal of Psychiatry, 2015)
The article discusses changing trends of suicide in India as of October 2015 and the challenges ahead. Topics include the factors gaining momentum in influencing suicide in the country including problems with parents-in-law and spouses and mental illness, the changing trends in the preferences for the methods adopted for suicide such as cut and stab injuries, and hanging, and the challenges such as media messages and publicity of suicide, and the impact of Internet on suicide.
Keywords: Suicide -- Prevention and Control -- India; Suicide -- Trends -- India; Stress, Psychological; Interpersonal Relations; Employment Status; Marital Status; Parental Role; Farmworkers; Support, Psychosocial; Military Services; Family Conflict; Substance Abuse; Mental Disorders; Social Media; Euthanasia; Lesbians; India

The epidemiology of suicide and attempted suicide among young Australians. - Cantor C; Neulinger K (Australian & New Zealand Journal of Psychiatry, 2000)
OBJECTIVE: This paper summarises a report to the NHMRC the objectives of which were to review research into the epidemiology of youth suicide in Australia and identify gaps in research. METHOD: Literature searches were conducted. A limited amount of new data analysis was included to shed light on reliability issues of official Australian suicide data. RESULTS: The review examined suicide data systems, including issues to do with coroners, the Australian Bureau of Statistics and alternative systems. The epidemiological areas reviewed included: all ages, youth, age and gender, geographical, socioeconomic, marital, indigenous, migrants, suicides in custody and gay and lesbian suicides. CONCLUSION: While much is known about the epidemiology of youth suicide, much remains to be clarified. Study of indigenous issues is perhaps the most neglected area; study of family issues may be potentially be the most productive.
Keywords: Suicide -- Epidemiology -- Australia; Suicide, Attempted -- Epidemiology -- Australia; Suicide -- Trends; Australia; Socioeconomic Factors; Epidemiological Research; Funding Source; Child; Adolescence; Adult; Male; Female; Human

Mental health and interpersonal functioning in self-identified asexual men and women. - Yule, MoragA.; Brotto, LoriA.; Gorzalka, BorisB. (Psychology & Sexuality, 2013)
Human asexuality is defined as a lack of sexual attraction to anyone or anything, and preliminary evidence suggests that it may best be defined as a sexual orientation. As asexual individuals may face the same social stigma experienced by gay, lesbian and bisexual persons, it follows that asexual individuals may experience higher rates of psychiatric disturbance that have been observed among these non-heterosexual individuals. This study explored mental health correlates and interpersonal functioning and compared asexual, non-heterosexual and heterosexual individuals on these aspects of mental health. Analyses were limited to Caucasian participants only. There were significant differences among groups on several measures, including depression, anxiety, psychoticism, suicidality and interpersonal problems, and this study provided evidence that asexuality may be associated with higher prevalence of mental health and interpersonal problems. Clinical implications are indicated, in that asexual individuals should be adequately assessed for mental health difficulties and provided with appropriate interventions that are sensitive to their asexual identity.

Religion and Suicide Risk in Lesbian, Gay and Bisexual Austrians. - Kralovec, Karl; Fartacek, Clemens; Fartacek, Reinhold; Plöderl, Martin (Journal of Religion & Health, 2014)
Keywords: Religion and Psychology; Suicide -- Risk Factors; LGBTQ+ Persons -- Austria; Suicide -- Prevention and Control; Human; Austria; Homophobia -- Risk Factors; Suicide, Attempted -- Prevention and Control; Control Group; Comparative Studies; Heterosexuals; Center for Epidemiological Studies Depression Scale; Scales; Psychological Tests; Odds Ratio; Confidence Intervals; Descriptive Statistics; Regression; Correlational Studies; Catholicism

Mental Health Disorders in Young Urban Sexual Minority Men. - Burns, Michelle Nicole; Ryan, Daniel T.; Garofalo, Robert; Newcomb, Michael E.; Mustanski, Brian (Journal of Adolescent Health, 2015)
Purpose Very few studies have examined mental disorders among male sexual minority youth. We describe demographic correlates, comorbidity, and history of mental disorders and suicidality in a large sample of male sexual minority youth. Methods Structured diagnostic interviews were conducted with 449 racially diverse urban sexual minority males, aged 16–20 years, who were recruited using a social network–driven sampling methodology. Results Lifetime major depressive episode (MDE) affected 33.2% of the youth. Lifetime conduct disorder (23.6%), alcohol abuse/dependence (19.6%), posttraumatic stress disorder (PTSD; 16.0%), and nicotine dependence (10.7%) were also common. Black participants were less likely than white participants to be diagnosed with lifetime MDE, alcohol abuse/dependence, nicotine dependence, suicidal ideation, and anorexia, as well as past 12-month alcohol abuse/dependence (odds ratios [ORs] range from .08 to .46). Relative to participants identifying as gay, bisexual identified youth were at higher risk for lifetime PTSD (OR = 2.04), and participants who did not identify as gay or bisexual were at higher risk for both lifetime and past 12-month nicotine dependence (OR = 4.36 and 3.46, respectively). Most participants with mental disorders never received treatment, and comorbidity was common. Conclusions MDE, conduct disorder, alcohol abuse/dependence, PTSD, and nicotine dependence are common and infrequently treated in young sexual minority men. Some within-group disparities emerged, suggesting that factors related to racial background and self-identification may help to understand resilience to the unique stressors experienced by these young men.
Keywords: Bisexuals; Mental Disorders -- Epidemiology -- In Adolescence; Urban Areas; Human; Male; Adolescence; Young Adult; Structured Interview; Descriptive Statistics; Odds Ratio; Nicotine -- Administration and Dosage; Substance Dependence -- Epidemiology; Ethanol -- Administration and Dosage

Family Rejection, Social Isolation, and Loneliness as Predictors of Negative Health Outcomes (Depression, Suicidal Ideation, and Sexual Risk Behavior) Among Thai Male-to-Female Transgender Adolescents. - Yadegarfard, Mohammadrasool; Meinhold-Bergmann, Mallika E.; Ho, Robert (Journal of LGBT Youth, 2014)
Keywords: Family Relations -- Thailand; Social Isolation; Transsexuals -- Thailand; Depression -- Thailand; Suicidal Ideation -- Thailand; Thailand; Human; Male; Analysis of Variance; Multiple Regression; Risk Taking Behavior; Questionnaires; Summated Rating Scaling; Psychological Tests; Adolescence; Adult

Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis. - Padula, William; Heru, Shiona; Campbell, Jonathan; Padula, William V; Campbell, Jonathan D (JGIM: Journal of General Internal Medicine, 2016)
Background: Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. Objective: To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. Design: Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3% (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). Patients: U.S. transgender population starting before transitional therapy. Interventions: No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. Main Measures: Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. Key Results: Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000-22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints--HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85% of simulations. Conclusions: Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions.
Keywords: Probability; Social Change; Insurance Coverage -- Economics; Cost Benefit Analysis -- Methods; Social Norms; Female; Cost Benefit Analysis -- Statistics and Numerical Data; Insurance Coverage -- Statistics and Numerical Data; Human; Male; United States; Validation Studies; Comparative Studies; Evaluation Research; Multicenter Studies; Ferrans and Powers Quality of Life Index; Impact of Events Scale; Funding Source

PTSD and Trauma-Related Difficulties in Sexual Minority Women: The Impact of Perceived Social Support. - Weiss, Brandon J.; Garvert, Donn W.; Cloitre, Marylène (Journal of Traumatic Stress, 2015)
This study examined posttraumatic stress disorder (PTSD) and related symptoms among sexual minority (SM) and heterosexual women and the influence of social support on the relationship between SM status and symptoms. We hypothesized that SM women would endorse higher symptoms of PTSD and related difficulties and that social support would moderate the relationship between SM status and symptoms. The sample, women seeking treatment for PTSD related to interpersonal violence (n = 477; mean age = 36.07 years; 22.9% SM) completed clinician-administered measures of PTSD and self-report measures of trauma-related difficulties and social support. The rate of PTSD diagnosis was higher for SM women. Social support and SM status were significantly associated with suicidality, self-perceptions, depression, somatic complaints, and functional impairment. The interaction between social support and SM status was significant for both functional impairment (β = -.26) and somatic complaints (β = -.39). High social support had an equal, positive effect among SM and nonminority women, whereas low social support had a greater negative impact among SM women. Results suggested the particular salience of social support on functioning and symptom severity among SM women and the potential importance of including interventions addressing social support into PTSD treatments for SM women.
Keywords: Support, Psychosocial; Homophobia -- Psychosocial Factors; Stress Disorders, Post-Traumatic -- Psychosocial Factors; Sexual Abuse -- Psychosocial Factors; Lesbians -- Psychosocial Factors; Adult; New York; Sexual Abuse; Crime Victims -- Statistics and Numerical Data; Crime Victims -- Psychosocial Factors; Minority Groups -- Psychosocial Factors; Stress Disorders, Post-Traumatic -- Diagnosis; Female; Human

Self-reported Rates of Abuse, Neglect, and Bullying Experienced by Transgender and Gender-Nonbinary Adolescents in China. - Peng, Ke; Zhu, Xuequan; Gillespie, Amy; Wang, Yuanyuan; Gao, Yue; Xin, Ying; Qi, Ji; Ou, JianJun; Zhong, Shaoling; Zhao, Lixian; Liu, Jianbo; Wang, Chaoyue; et al. (JAMA Network Open, 2019)
This survey study assesses the rates of abuse, neglect, and bullying experienced at home or in school by transgender and gender-nonbinary adolescents in China and the associations of these experiences with mental health. Key Points: Question: What are the rates of abuse, neglect, and bullying and their association with poor mental health experienced by Chinese transgender and gender nonbinary adolescents? Findings: In this national survey study of 385 transgender and gender-nonbinary adolescents, 296 respondents reported experiencing parental abuse or neglect and 295 respondents reported experiencing abuse or bullying from classmates or teachers. Reporting experiences of bullying or abuse from classmates or teachers was significantly associated with increased risk of suicidal ideation. Meaning: Greater access to appropriate mental health care may be helpful to address the high rates of mental health issues and abuse, neglect, and bullying experienced by Chinese transgender and gender-nonbinary adolescents. Importance: This is the first comprehensive national study reporting the rates of abuse, neglect, and bullying from family and classmates or teachers among Chinese transgender and gender-nonbinary adolescents and identifying risk factors associated with poor mental health in this population. Objective: To assess the rates of abuse, neglect, and bullying and their association with poor mental health among Chinese transgender and gender nonbinary adolescents. Design, Setting, and Participants: This national survey study used an online self-selecting survey conducted between January 1, 2017, and September 29, 2017, in China. Eligibility criteria included reporting being aged 12 to 18 years and being transgender or gender nonbinary. Data analysis was performed from March 25 to 28, 2019. Main Outcomes and Measures: The main outcome was self-reported poor mental health, including depressive symptoms, anxiety symptoms, and suicidal ideation. Depressive symptoms were measured using the Center for Epidemiological Studies Depression 9-item scale. Anxiety symptoms were measured using the 7-item General Anxiety Disorder scale. Suicidal ideation was measured using standardized questions adapted from previous Chinese studies. Abuse, neglect, and bullying were measured using specifically designed questions. Results: Of 564 responses collected, 385 respondents (mean [SD] age, 16.7 [1.2] years) met inclusion criteria, including 109 (28.3%) transgender adolescent boys, 167 (43.4%) transgender adolescent girls, and 109 (28.3%) gender-nonbinary adolescents. Among 319 respondents who reported that their parents were aware of their gender identity, 296 (92.8%) reported having experienced parental abuse or neglect. Among the full cohort, 295 respondents (76.6%) reported having experienced abuse or bullying owing to being transgender or gender nonbinary in school from classmates or teachers. There were 173 respondents (44.9%) with Center for Epidemiological Studies Depression 9-item scale scores indicating they were at risk of major depressive disorder, and 148 respondents (38.4%) had 7-item General Anxiety Disorder scale scores indicating they were at risk of an anxiety disorder. In univariate analysis, reporting experiences of bullying from a classmate or teacher was significantly associated with suicidal ideation (odds ratio, 1.68 [95% CI, 1.04-2.70]; P =.03), but the association was no longer statistically significant after controlling for level of educational attainment, aversion to assigned sex, and depressed mood at the onset of puberty (odds ratio, 1.63 [95% CI, 0.97-2.73]; P =.06). Conclusions and Relevance: In this survey study, transgender and gender-nonbinary adolescents in China reported high rates of abuse, neglect, and bullying at home and in school and high rates of symptoms associated with poor mental health. This study highlights the importance of reducing home- and school-based abuse, neglect, and bullying of transgender and gender-nonbinary adolescents in China to improve mental health outcomes; however, broader change in the social environment may be required to address the prejudice and stigma aimed at gender minorities.
Keywords: Bullying -- In Adolescence -- China; Transgender Persons -- Psychosocial Factors; Gender Identity; Self Report; Child Abuse; Mental Disorders -- Risk Factors; Human; China; Depression; Anxiety; Suicidal Ideation; Center for Epidemiological Studies Depression Scale; Scales; Adolescence; Male; Female; Parental Behavior; Univariate Statistics; Odds Ratio; Confidence Intervals; Funding Source; Convenience Sample; Snowball Sample; Questionnaires; Logistic Regression; Data Analysis Software

Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study. - Reisner, Sari L.; Vetters, Ralph; Leclerc, M.; Zaslow, Shayne; Wolfrum, Sarah; Shumer, Daniel; Mimiaga, Matthew J. (Journal of Adolescent Health, 2015)
Purpose Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the present study aimed to fill this gap. Methods A retrospective cohort study of electronic health record data from 180 transgender patients aged 12–29 years seen between 2002 and 2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM with MTF youth on mental health outcomes. Results The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p < .05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use. Conclusions Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.
Keywords: LGBTQ+ Persons -- Evaluation -- In Adolescence; Mental Health -- Evaluation -- In Adolescence; Depression -- Epidemiology -- In Adolescence; Anxiety -- Epidemiology -- In Adolescence; Suicidal Ideation -- Evaluation -- In Adolescence; Human; Adolescence; Male; Female; Young Adult; Retrospective Design; Prospective Studies; Logistic Regression; Descriptive Statistics; P-Value; Massachusetts

Plans to hasten death among gay men with HIV/AIDS: relationship to psychological adjustment. - Goggin K; Sewell M; Ferrando S; Evans S; Fishman B; Rabkin J (AIDS Care, 2000)
This study assessed the prevalence and nature of thoughts and future plans to end one's life in a group of gay men with HIV/AIDS over an 18-month period. HIV-positive men (n = 167) participated in a series of clinical interviews which measured current health status, current and past psychiatric disorders, current levels of distress, and thoughts and plans about ending their lives currently or at some future point. A small number of HIV-positive men (17%) reported serious thoughts or plans to end their lives at some point in the future which were stable over an 18-month period. No differences in psychiatric or medical measures were observed among men with and without thoughts/plans at either assessment point. In the absence of current psychiatric disorders, such thoughts or plans about the future may represent one way to maintain control and independence in the face of the uncertainty of life with HIV illness.
Keywords: Acquired Immunodeficiency Syndrome -- Psychosocial Factors; Gay Men; Suicide; Health Status; Attitude to AIDS; Psychological Tests; Hamilton Rating Scale for Depression; Chi Square Test; Interviews; Prevalence; Prospective Studies; P-Value; T-Tests; Descriptive Statistics; Adult; Middle Age; Aged; Male; Human

Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults. - Coulter, Robert W S; Blosnich, John R; Bukowski, Leigh A; Herrick, A L; Siconolfi, Daniel E; Stall, Ron D (Drug & Alcohol Dependence, 2015)
Background: Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED).Methods: Cross-sectional surveys were completed by 75,192 students aged 18-29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females.Results: Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization.Conclusions: Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.

Transgender Affirmative Cognitive Behavioral Therapy: Clinical Considerations and Applications. - Austin, Ashley; Craig, Shelley L. (Professional Psychology: Research & Practice, 2015)
Transgender individuals report pervasive discrimination, microaggressions, and victimization across the life span, contributing to disparate rates of suicide, anxiety, and depression. Clinical interventions must be empirically supported and affirming, competently and sensitively attending to the effect of transphobic discrimination on the lives and experiences of transgender people. Transgender affirmative clinical practice acknowledges and counters the oppressive contexts in which transgender clients often experience health and mental health care. The primary aim of this article is to introduce a transgender-affirming adaptation of a cognitive behavior therapy intervention (TA-CBT) for use with transgender individuals suffering from depression, anxiety, and/or suicidality. Clinical considerations such as the historical context of transgender issues in mental health care, the minority stress framework, current mental health disparities, and resilience will be explored. Transgender-affirming practice applications focused on psychoeducation, modifying problematic thinking styles, enhancing social support, and preventing suicidality will be provided.
Keywords: Transgender Persons -- Psychosocial Factors; Mental Disorders -- Therapy; Cognitive Therapy; Gender Identity; Depression -- Therapy; Anxiety Disorders -- Therapy; Suicidal Ideation -- Prevention and Control; Male; Psychoeducation; Female; Mental Health Services; Discrimination -- Prevention and Control; Curriculum; Hopelessness; Conceptual Framework; Minority Stress

Overview of care for transgender children and youth. - Weiselberg, Eric C.; Shadianloo, Shervin; Fisher, Martin (Current Problems in Pediatric & Adolescent Health Care, 2019)
Over the past decade, more and more children and adolescents are identifying as transgender and gender diverse (TGD). Often, they and their parents first turn to their primary care pediatrician for guidance and support. Therefore, in 2018, the American Academy of Pediatrics (AAP) released a policy statement focusing on the health care of TGD youth.4 The AAP acknowledges that many pediatricians have a lack of training in this area and therefore need to increase their knowledge base and expertise in order to provide culturally competent care. While most sexual and gender minority individuals are healthy and well adjusted, some TGD youth are at an increased risk of mental health concerns, including anxiety, depression, substance abuse, eating disorders and suicidality. This is theorized to be due to the experienced or internalized marginalization, stigmatization, victimization, harassment or rejection and not inherent in having gender dysphoria or being transgender. The pediatrician therefore needs to be knowledgeable of, and skilled to screen for, the health disparities that may exist, as well as to be able to support the individual who may disclose their gender identity status during treatment. Parents and guardians may also turn to the pediatrician for guidance when faced with their child who presents with gender non-conforming behaviors or gender dysphoria. Therefore the pediatrician needs to be able to guide the parents as well, as their acceptance and support of their child's journey to gender identity is probably the most important protective factor against health disparities encountered. To deliver optimum care for TGD children and youth, the pediatrician needs to establish an office setting that is inclusive, gender-neutral and TGD friendly. By becoming familiar with the diversity of gender expression and identities, use of gender-appropriate terminology, health disparities often encountered and the importance of providing a safe and welcoming environment, issues that are all covered in this article, the primary care pediatrician will be in position to provide comprehensive health care to this often marginalized population.
Keywords: Health Care Delivery; Physician-Patient Relations; Primary Health Care; Professional-Family Relations; Homeless Persons; Gender Identity; Professional Role; Adolescence; Health Status Disparities

Transgender and Gender-Diverse Adolescents' Experiences of Violence, Depression, Anxiety, and Suicidal Ideation in the People's Republic of China. - Klemmer, Cary L. (JAMA Network Open, 2019)
Keywords: Gender Identity -- In Adolescence; Transgender Persons -- Psychosocial Factors -- China; Bullying -- Psychosocial Factors; Violence; Depression; Anxiety; Suicidal Ideation; China; Adolescence; Mental Disorders; Public Health; Stigma; Social Attitudes

Lesbian, Gay, Bisexual, and Transgender Adolescent School Victimization: Implications for Young Adult Health and Adjustment. - Russell, Stephen T.; Ryan, Caitlin; Toomey, Russell B.; Diaz, Rafael M.; Sanchez, Jorge (Journal of School Health, 2011)
Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long-term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school victimization and young adult psychosocial health and risk behavior. The young adult survey from the Family Acceptance Project included 245 LGBT young adults between the ages of 21 and 25 years, with an equal proportion of Latino and non-Latino White respondents. A 10-item retrospective scale assessed school victimization due to actual or perceived LGBT identity between the ages of 13 and 19 years. Multiple regression was used to test the association between LGBT school victimization and young adult depression, suicidal ideation, life satisfaction, self-esteem, and social integration, while controlling for background characteristics. Logistic regression was used to examine young adult suicide attempts, clinical levels of depression, heavy drinking and substance use problems, sexually transmitted disease (STD) diagnoses, and self-reported HIV risk. Lesbian, gay, bisexual, and transgender-related school victimization is strongly linked to young adult mental health and risk for STDs and HIV; there is no strong association with substance use or abuse. Elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization. Reducing LGBT-related school victimization will likely result in significant long-term health gains and will reduce health disparities for LGBT people. Reducing the dramatic disparities for LGBT youth should be educational and public health priorities.
Keywords: LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Students, High School -- Psychosocial Factors; Homophobia -- In Adolescence; Bullying -- In Adolescence; Risk Taking Behavior -- In Adolescence; Students, Middle School -- Psychosocial Factors; Health Behavior -- In Adolescence; Surveys; Adolescence; Young Adult; Retrospective Design; Suicidal Ideation; Personal Satisfaction; Self Concept; Social Behavior; Suicide, Attempted; Depression; Substance Abuse; Sexually Transmitted Diseases; HIV Infections; California; Descriptive Statistics; Scales; School Violence; Summated Rating Scaling; Internal Validity; Coefficient Alpha; Center for Epidemiological Studies Depression Scale; Psychological Tests; Rosenberg Self Esteem Scale; Unsafe Sex; Analysis of Covariance; Multiple Regression; Logistic Regression; P-Value; Adaptation, Psychological; Ethnic Groups; Male; Female; Odds Ratio; Confidence Intervals; Human; Victims

Student Voices. Nurses can curb LGBTQ bullying in schools. - HOOKER, AMBER L. (Nursing, 2019)
The article explores the role of nurses in curbing bullying of LGBTQ people in schools in the U.S. According to the 2017 National School Climate Survey, about 87 percent of LGBTQ students experienced harassment or assault in 2017. The impact of bullying on the health of LGBTQ people is discussed. School nurses are advised to know the warning signs of bullying, such as withdrawn behavior and depression, and to work with professional organizations and legislators on how to address the issue.
Keywords: Bullying -- Prevention and Control; LGBTQ+ Persons -- Psychosocial Factors; School Health Nursing; Nursing Role; School Violence -- Prevention and Control; Learning Environment; Support, Psychosocial; School Health Services; Bullying -- Complications; Suicide -- Risk Factors; Depression -- Risk Factors; Stress Disorders, Post-Traumatic -- Risk Factors; Bullying -- Symptoms; Information Resources; Bullying -- Legislation and Jurisprudence; School Health Education; Child Advocacy

Ketamine as a Treatment for Adolescent Depression: A Case Report. - Dwyer, Jennifer B.; Beyer, Chad; Wilkinson, Samuel T.; Ostroff, Robert B.; Qayyum, Zheala; Bloch, Michael H. (Journal of the American Academy of Child & Adolescent Psychiatry, 2017)
The article presents case study of a 16-year-old boy who was diagnosed with adolescent depression and attention-deficit/hyperactivity disorder (ADHD). Topics discussed include observation of symptoms like gender dysphoria, hypersomnia, amotivation and irritability; high risk for suicide observed in patients with adolescent depression; and use of ketamine as a treatment for adolescent depression.
Keywords: Depression -- Drug Therapy; Ketamine -- Administration and Dosage; Psychological Tests; Treatment Outcomes; Male; Adolescence

Lesbians in New Zealand: their mental health and satisfaction with mental health services. - Welch S; Collings SC; Howden-Chapman P (Australian & New Zealand Journal of Psychiatry, 2000)
Objectives: To describe the mental health of lesbians in New Zealand, and to document their accounts of their experience of mental health services. Method: This is a descriptive cross-sectional study. A postal questionnaire, the Lesbian Mental Health Survey, was distributed via lesbian newsletters to 1222 women throughout New Zealand. Mental health measures included the General Health Questionnaire (GHQ-28), Interview Schedule for Social Interaction (ISSI), and respondents' histories of sexual abuse and psychiatric histories. Experiences of mental health services were sought. Results: The estimated response rate was 50.8%. The respondent group were predominantly New Zealand European, highly educated, urban women between 25 and 50 years of age. Three-quarters had identified as lesbian for more than 5 years. Recent self-identification as lesbian was associated with higher GHQ score, as was being younger than 35, having a history of sexual abuse, and not living with a partner. Eighty percent of respondents had used mental health services sometime in their lives and nearly 30 percent of users had received 'lesbian-unfriendly' treatment at some point. One-sixth of respondents had experienced discrimination from service providers in the previous 5 years. Conclusion: While the mental health of lesbians is influenced by factors similar to those influencing women's mental health in general, because of social factors, such as stigma and isolation, lesbians may be more vulnerable to common mental illnesses. Health professionals, mental health professionals in particular, need to raise their awareness of the issues lesbians face in dealing with their sexuality, therapeutic relationships and mental health services. Increased training about sexuality for health professionals, as well as further research into areas such as stress and stigma, sexual abuse and attempted suicide among lesbian women, is recommended.
Keywords: Lesbians -- Psychosocial Factors; Lesbians -- Statistics and Numerical Data; Mental Disorders -- Epidemiology; Mental Disorders -- Therapy; Mental Health Services -- Standards; Mental Health Services; Personal Satisfaction; Adult; Child Abuse, Sexual -- Psychosocial Factors; Child; Child, Preschool; Female; Health Status; Middle Age; New Zealand; Prejudice; Questionnaires; Suicide, Attempted; Human

Nonheterosexual adolescents and suicidal ideation: Risks and protective factors. - Cambre, April (Brown University Child & Adolescent Behavior Letter, 2011)
Keywords: Suicidal Ideation -- Risk Factors; LGBTQ+ Persons -- Psychosocial Factors; Suicide, Attempted -- Risk Factors; Male; Adolescence; Substance Abuse; Bisexuals; Gay Men; Serotonin Uptake Inhibitors; Depression; Family Functioning

Health priorities and perceived health determinants among Western Australians attending the 2011 LGBTI Perth Pride Fairday Festival. - Comfort, Jude; McCausland, Kahlia (Health Promotion Journal of Australia, 2013)
Issue addressed Although data exist demonstrating poorer health indicators on a range of health outcomes for lesbian, gay, bisexual, transsexual and intersex (LGBTI) people, there is little information as to how this group perceives the relative importance of different health issues or what the underlying reasons behind poorer health may be. Method A self-completed survey was administered to people attending the October 2011 LGBTI Perth Pride Fairday Festival. Three hundred and fifty-one people completed the survey, resulting in a total of 335 useable surveys. One hundred and seventy-eight participants identified as female, 145 as male, four as transgender and eight as other genders. Results Depression, anxiety, excessive worry or panic attacks and problems in family relationships were reported as the most important individual health issues, whereas depression, suicide and HIV/AIDS were seen as the most important health issues affecting the LGBTI community. Discrimination was rated the most important social factor impacting on the health and well being of this community. Conclusions When members of the LGBTI community were asked to rank health issues of importance both individually and as a community, the results indicate that mental health issues are of prime concern. Discrimination and the stress of living as part of this minority group were seen as contributing to this. Health promotion and public health need to be responsive to these issues if real gains are to be made in reducing the health inequities affecting this group. So what? This research highlights the link between social justice, social inclusion and health outcomes. The health of LGBTI people is rarely considered by mainstream agencies, despite poorer health outcomes. Sensitive and targeted public health interventions that resonate with the community and that acknowledge the impact of being part of this marginalised group are required.
Keywords: Attitude to Health; Health and Welfare Planning; Health Status Indicators; Lesbians -- Psychosocial Factors; Homosexuality; Adolescence; Adult; Aged; Female; Human; Male; Middle Age; Questionnaires; Western Australia; Young Adult

Suicidality in AIDS long-term survivors: what is the evidence? - Rabkin JG; Remien R; Katoff L; Williams JBW (AIDS Care, 1993)
This study was designed to investigate suicidal ideation and attempts, thoughts about living and dying, and the maintenance, diminution and loss of hope in a sample of long-term AIDS survivors. The study sample consisted of 53 gay men enrolled as clients at Gay Mens Health Crisis in New York City who had had an AIDS-defining opportunistic infection at least 3 years prior to study entry. Despite the experience of protracted biological stress associated with life-threatening illness and the psychological stress of living with AIDS, we found low rates of current syndromal mood disorders (6%) or psychiatric distress. While thoughts about death and wishes to die were reported by a significant portion of men, they were context-specific, occurring almost exclusively during serious illness, often accompanied by severe pain or at times of bereavement. Only two men had made a suicide attempt after being diagnosed with AIDS and both had a history of prior (pre AIDS) suicide attempts. While anger was a prominent affect, hopelessness was not. Overall, we found a high level of positive psychological health independent of HIV illness stage or degree of illness-induced physical limitation.
Keywords: Suicide -- Psychosocial Factors; Acquired Immunodeficiency Syndrome -- Psychosocial Factors; Depression -- Epidemiology; Attitude to Death -- Evaluation; Suicide, Attempted -- Psychosocial Factors; Risk Factors; Interviews; Pearson's Correlation Coefficient; Two-Tailed Test; Consent; Karnofsky Performance Status; Gay Persons; DSM; Scales; Open-Ended Questionnaires; Survivors; Demography; Adult; Male; Funding Source; Human

The prevalence of suicidal behaviours in a group of HIV-positive men. - Shelton AJ; Atkinson J; Risser JMH; McCurdy SA; Useche B; Padgett PM (AIDS Care, 2006)
We studied a convenience sample of 54 HIV-positive men, recruited from HIV/AIDS community based service organizations. Data were collected on HIV risk factors and suicidal behaviours. Fifty-nine percent of the sample reported ever thinking about suicide, and 50% of those individuals reported attempting suicide at some point in their lives. Suicide ideation and attempts were more common among white participants. Suicidal behaviours were prevalent in this sample suggesting a need for mental health and suicide interventions targeted for this population.
Keywords: HIV Seropositivity -- Psychosocial Factors; Men -- Psychosocial Factors; Suicidal Ideation -- Epidemiology; Suicide, Attempted -- Epidemiology; Adult; Bisexuality; Chi Square Test; Data Collection, Computer Assisted; Descriptive Statistics; Gay Men; Male; P-Value; Pilot Studies; Prevalence; Risk Taking Behavior; Self Report; Surveys; T-Tests; Texas; Human

Survey of New Mexico School Health Professionals Regarding Preparedness to Support Sexual Minority Students. - Mahdi, Inas; Jevertson, Jenn; Schrader, Ronald; Nelson, Anna; Ramos, Mary M. (Journal of School Health, 2014)
ABSTRACT BACKGROUND For schools to be safe and supportive for students, school health professionals should be aware of the particular challenges lesbian, gay, bisexual, transgender, or questioning ( LGBTQ) students face, especially the risk for discrimination, violent victimization, and depression in the school setting. We assessed school health professionals' preparedness to address needs of LGBTQ students. METHODS We conducted a secondary analysis of data collected during a New Mexico school health conference. This analysis focused on the preparedness of 183 school nurses, counselors, and social workers to address needs of LGBTQ students. Data were analyzed by using chi-square tests, other non-parametric tests, and logistic regression. RESULTS Social workers (84.6%) and counselors (81.5%) were more likely than school nurses (55.8%) to report moderate or high knowledge of LGBTQ youth health risks, including suicide and depression (p < .001). Approximately half of school counselors and social workers reported no or low knowledge of LGBTQ community-based organizations or knowledge of counselors experienced with LGBTQ concerns. CONCLUSION School health professionals in New Mexico do not appear prepared to address needs of LGBTQ students. Schools should consider integrating specific content about LGBTQ health risks and health disparities in trainings regarding bullying, violence, cultural competency, and suicide prevention.
Keywords: LGBTQ+ Persons -- In Infancy and Childhood; LGBTQ+ Persons -- In Adolescence; Minority Groups -- In Infancy and Childhood; Minority Groups -- In Adolescence; Human; New Mexico; Teachers; Support, Psychosocial; School Health Nursing; Social Workers; Counselors; Secondary Analysis; Logistic Regression; Health Knowledge; Cultural Competence; Bullying; Violence; Suicide -- Risk Factors; Depression -- Risk Factors; Health Status Disparities; Surveys; Scales; Pearson's Correlation Coefficient; Chi Square Test; Kruskal-Wallis Test; Post Hoc Analysis; Mann-Whitney U Test; Data Analysis Software; Students, Elementary; Students, Middle School; Students, High School; Self Report; Education, Continuing; Funding Source; Child; Adolescence

Sexual orientation and non-suicidal self-injury: a meta-analytic review. - Batejan, Kristen L; Jarvi, Stephanie M; Swenson, Lance P (Archives of Suicide Research, 2015)
The aim of this study was to conduct the first meta-analysis comparing risk for NSSI between sexual minority and heterosexual persons. Eleven published and 4 unpublished studies were reviewed, describing associations between sexual orientation and NSSI in 7,147 sexual minority and 61,701 heterosexual participants. The overall weighted effect size for the relationship between sexual orientation and NSSI using a random-effects model was OR = 3.00 (95% CI = 2.46-3.66), indicating a medium-to-large effect. Sexual minority adolescents and bisexuals were found to be at particularly high-risk. These findings highlight the need to examine mechanisms linking sexual orientation and NSSI in future research. Building on these findings can add to understanding the associations between sexual orientation, NSSI, and suicidality, as well as prevention/intervention.

Sexual Violence Among Youth in New Mexico: Risk and Resiliency Factors That Impact Behavioral Health Outcomes. - Reed, Danielle; Reno, Jessica; Green, Dan (Family & Community Health, 2016)
Research has consistently demonstrated a relationship between history of forced sex and poor behavioral health outcomes. The objectives of this study were to describe this relationship among high school students and to explore the impact of resiliency factors. Using data from the 2013 New Mexico Youth Risk and Resiliency Survey, we found that history of forced sex was associated with negative behavioral health outcomes for males and females, regardless of sexual orientation and disability status. Furthermore, the presence of a caring adult at home appeared to reduce the risk of substance abuse and suicidality among students with and without a history of forced sex.
Keywords: Mental Health; Sexual Abuse -- Psychosocial Factors; Adolescent Behavior; Male; Sex Factors; Students -- Psychosocial Factors; Adolescence; Adult; Family -- Psychosocial Factors; Female; Sexuality; Sexual Abuse -- Prevention and Control; New Mexico; Support, Psychosocial; Suicide -- Prevention and Control; Risk Taking Behavior; Substance Use Disorders -- Prevention and Control; Human

Correlates of bullying in Quebec high school students: The vulnerability of sexual-minority youth. - Cénat, Jude Mary; Blais, Martin; Hébert, Martine; Lavoie, Francine; Guerrier, Mireille (Journal of Affective Disorders, 2015)
Purpose: Bullying has become a significant public health issue, particularly among youth. This study documents cyberbullying, homophobic bullying and bullying at school or elsewhere and their correlates among both heterosexual and sexual-minority high school students in Quebec (Canada).Method: A representative sample of 8194 students aged 14-20 years was recruited in Quebec (Canada) high schools. We assessed cyberbullying, homophobic bullying and bullying at school or elsewhere in the past 12 months and their association with current self-esteem and psychological distress as well as suicidal ideations.Results: Bullying at school or elsewhere was the most common form of bullying (26.1%), followed by cyberbullying (22.9%) and homophobic bullying (3.6%). Overall, girls and sexual-minority youth were more likely to experience cyberbullying and other forms of bullying as well as psychological distress, low self-esteem and suicidal ideations. The three forms of bullying were significantly and independently associated with all mental health outcomes.Conclusions: The results underscore the relevance of taking into account gender and sexual orientation variations in efforts to prevent bullying experience and its consequences.

Oppression and Suicide. - Lester, David (Suicidology Online, 2014)
Of the four types of suicide described by Durkheim in his classic book on suicide, suicidologists have neglected fatalistic suicide, which Durkheim himself relegated to a single footnote in his book. This essay explores this neglected type of suicide. It discusses the role of oppression in suicide, ranging from the selfimmolation of Tibetan monks protesting the oppression of Tibetans by China, suicides in slaves in early America, suicide in oppressed women around the world, suicide in homosexuals and other stigmatized groups (such as Gypsies), to oppression by peers and family members. Suicide prevention strategies should include political action, freeing individuals and groups from over-regulation and helping empower the oppressed.
Keywords: Suicide -- Etiology; Oppressed Group Behavior; Suicide -- Prevention and Control; Sociological Theory; Suicide -- History; Stigma; Minority Groups; Conceptual Framework; Black Persons; Jews; Politics; Women; Marriage; Depression; World Wide Web; Gay Persons; Employer-Employee Relations; Suicide, Assisted; Female; Adolescence; Child; Male; Adult; Rituals and Ceremonies; Burial Practices; Young Adult

Biological and Psychological Influences of Cross-Sex Hormone in Transgender. - S. L., LING; S., HATTA; B., AZLIN (Medicine & Health (Universiti Kebangsaan Malaysia), 2019)
Transgender is a complex state of bio-psycho-social dimension of human sexuality. It encompasses cognitive-emotional-behavior component that makes the person unique in his or her sexual expression. Transgender tend to use cross-sex hormone in order to eradicate their secondary sexual characteristics and to facilitate the shift to their experienced gender. The common masculinising sex hormone use, i.e. Female to Male Treatment Options (FMTO) is testosterone and for feminising hormone i.e. Male to Female Treatment Options (MFTO) is a combination of estrogen with anti-androgen, respectively. Cross-sex hormone, i.e. FMTO, or MFTO has biological and psychological influences on the transgender individuals. Nevertheless, cross-sex hormone may also pose a range of side effect profiles, varies from the biological to psychosocial impact. The psychological impact can be paramount until it causes severe mental-health problems and even suicide. Numerous ranges of bio-psycho-social influence of cross-sex hormone were highlighted in this review as fundamental core knowledge in the art to know practice when dealing with the treatment options. In psychiatry, the change in the biological appearance may have great influence in the transgender individual, especially in the context of psychosocial and cultural perspective.
Keywords: Sex Hormones; Transgender Persons -- Psychosocial Factors; Attitude to Sexuality; Masculinity; Testosterone; Hormone Therapy -- Methods; Estrogens; Androgen Antagonists; Severity of Illness; Mental Disorders; Suicide; Psychiatric Care; Health Knowledge

Suicidality Among Veterans: Implications of Sexual Minority Status. - Blosnich, John R.; Mays, Vickie M.; Cochran, Susan D. (American Journal of Public Health, 2014)
Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008–2009 and 2012– 2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime suicidal ideation than heterosexual veterans (adjusted odds ratio = 3.00; 95% confidence interval = 1.38, 6.53). Suicide assessment and prevention efforts in LGB veterans could benefit from a life-course perspective regarding suicide risk.
Keywords: LGBTQ+ Persons; Veterans -- Evaluation; Suicidal Ideation -- Evaluation; Funding Source; Human; California; Interviews; Surveys; Adolescence; Adult; Middle Age; Aged; Male; Female; Descriptive Statistics; P-Value; Probability Sample; Chi Square Test; Odds Ratio; Confidence Intervals; Logistic Regression; Data Analysis, Statistical; Data Analysis Software

Australian Trans Men: Development, Sexuality, and Mental Health. - Bolger, Andrea; Jones, Tiffany; Dunstan, Debra; Lykins, Amy (Australian Psychologist, 2014)
The aim of the study reported in this article was to gain an understanding of the experiences, developmental trajectories, and mental health status of Australian trans men. Participants were 279 trans men. The majority preferred to identify as 'male'; from an early age, they had experienced their gender identity as different from that normatively expected of their natally assigned sex and had undertaken practices so as to facilitate their presentation as male in accordance with their gender identity. A majority reported a diagnosis of depression or anxiety within the last 12 months and attributed suicidal ideation and self-harm and attempted suicide to personal issues with gender identity. Going through a masculinisation process and coming out reportedly led to improved mental health. The findings highlight the need to educate mental health and health care professionals on trans issues.
Keywords: Transgender Persons -- Psychosocial Factors -- Australia; Human Development; Sexuality; Mental Health; Gender Identity; Australia; Male; Adolescence; Young Adult; Adult; Questionnaires; Multimethod Studies; Descriptive Statistics; Disorders of Sex Development; Middle Age; Thematic Analysis; Human

High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America. - Mimiaga, Matthew J; Biello, Katie B; Robertson, Angela M; Oldenburg, Catherine E; Rosenberger, Joshua G; O'Cleirigh, Conall; Novak, David S; Mayer, Kenneth H; Safren, Steven A (Archives of Sexual Behavior, 2015)
The HIV epidemic in Latin America is highly concentrated in men who have sex with men (MSM). In the United States, multiple co-occurring psychosocial conditions have been shown to act as intertwined epidemics to potentiate HIV transmission among MSM. To date, no study has examined the role of syndemics and condomless sex among MSM in Latin America. In 2012, an online survey was conducted among members of the largest social/sexual networking website for MSM in Latin America. Participants were asked about demographics, sexual behaviors, HIV/STI diagnoses, and psychosocial well-being, including depression, suicidal ideation, hazardous alcohol use, hard drug use during sex, history of childhood/adolescent sexual abuse, intimate partner violence, and sexual compulsivity. Multivariable logistic generalized estimation equations were used to assess the relationship of syndemic factors and (1) engagement in higher risk condomless anal sex and (2) self-report of prior HIV diagnosis. Among 24,274 survey respondents, 74.6 % of the sample had at least one syndemic factor. In an additive model, syndemics were associated with increased odds of higher risk condomless anal sex, ranging from adjusted odds ratio of 1.31 (95 % CI 1.20, 1.43) for one syndemic factor to 4.06 (95 % CI 3.25, 5.09) for 6/7 syndemic factors. Similarly, syndemics were associated with increased odds of HIV infection (p < .0001). This study provides initial evidence that intertwined syndemics increase HIV risk behavior and HIV infection among MSM in Latin America. In the Latin American context, comprehensive HIV prevention interventions for MSM should be developed and tested that simultaneously address co-occurring psychosocial conditions and HIV risk.

Beyond Bathrooms--Meeting the Health Needs of Transgender People. - Schuster, Mark A.; Reisner, Sari L.; Onorato, Sarah E. (New England Journal of Medicine, 2016)
The article discusses transgender people in the U.S. who have been the victims of verbal harassment and physical assaults when trying to use public bathrooms. The discrimination facing transgender people other than bathroom accessibility that resulted to increased stress, anxiety, depressive symptoms, post-traumatic stress disorder, substance abuse, and suicide is tackled. The crucial role played by the medical community in providing a key voice in gender dysphoria is also explored.
Keywords: Health Care Delivery; Civil Rights -- Legislation and Jurisprudence; Prejudice; Male; Violence; Female; Discrimination -- Psychosocial Factors; Discrimination -- Legislation and Jurisprudence; United States; State Government; Government Regulations

The prevalence and effects of self-reported childhood sexual abuse among sadomasochistically oriented males and females. - Nordling N; Sandnabba NK; Santtila P (Journal of Child Sexual Abuse, 2000)
The prevalence and consequences of self-reported sexual abuse among 164 male and 22 female practitioners of sadomasochistic sex was explored. A questionnaire exploring psychological health, social adjustment, and sexual behavior was distributed among members of two sadomasochistically oriented clubs. The results showed that the prevalence of self-reported sexual abuse was higher among the participants as compared to the general Finnish population norms. Also, the participants that reported abuse were more likely to have attempted suicide, to have sought psychological support, and to have visited a physician due to physical injuries. Self-reported sexual abuse was also associated with poorer social adjustment, and higher sexual neuroticism. Further, the higher the frequency of abuse, the poorer the body image of the abused male participants. In conclusion, even though the majority of the participants did not report childhood sexual abuse, it had adverse consequences and altered some aspects of the sexual behavior of the individuals that had been abused.
Keywords: Child Abuse, Sexual -- Epidemiology; Child Abuse, Sexual -- Psychosocial Factors; Self Report; Child Abuse Survivors -- Psychosocial Factors -- In Adulthood; Finland; Social Adjustment; Sexuality; Comparative Studies; Body Image; Heterosexuality; Gay Persons; Questionnaires; Reliability; Psychological Tests; Attitude to Sexuality; Socioeconomic Factors; Prevalence; Chi Square Test; Cross Sectional Studies; Suicide, Attempted; Mann-Whitney U Test; Adult; Male; Female; Human

Domains of distress among people with sexual orientation obsessions. - Williams, Monnica T; Wetterneck, Chad; Tellawi, Ghazel; Duque, Gerardo (Archives of Sexual Behavior, 2015)
Although sexual obsessions in obsessive-compulsive disorder (OCD) are not uncommon, obsessions about sexual orientation have not been well studied. These obsessions focus on issues such as the fear of being or becoming gay, fear of being perceived by others as gay, and unwanted mental images involving homosexual acts. Sexual orientation obsessions in OCD are particularly distressing due to the ego-dystonic nature of the obsessions and, often, stigma surrounding a same-sex orientation. The purpose of this study was to better understand distress in people suffering from sexual orientation obsessions in OCD. Data were collected online (n = 1,176) and subjects were 74.6% male, 72.0% heterosexual, and 26.4% with an OCD diagnosis from a professional. The survey consisted of 70 novel questions that were assessed using a principal components analysis and the items separated into six components. These components were then correlated to distress among those with a prior OCD diagnosis and sexual orientation obsessions. Results indicated that sexual orientation obsessions in OCD were related to severe distress, including suicidal ideation. Implications of these findings and future directions for research are discussed.

Suicidal ideation, bereavement, HIV serostatus and psychosocial variables in partners of men with AIDS. - Rosengard C; Folkman S (AIDS Care, 1997)
This prospective 2-year study examines suicidal ideation in 86 HIV-positive and 167 HIV-negative caregiving partners of men with AIDS. One hundred and fifty-six of the caregivers became bereaved during the course of the study. The study focuses on the relationship between suicidal ideation and bereavement status (bereaved vs non-bereaved), HIV serostatus (HIV-positive vs HIV-negative), and psycho-social factors (caregiving burdens, social support, coping, and optimism). Bereavement was related to suicidal ideation, but HIV serostatus was not. High suicidal ideators were characterized by feeling burdened by caregiving, perceiving low levels of social support and subjective social integration, and the use of behavioural escape-avoidance coping. Those who reported never having suicidal ideation were characterized by higher levels of optimism. Clinical implications are discussed.
Keywords: Bereavement; Suicidal Ideation; HIV Infections -- Psychosocial Factors; Caregiver Burden; Significant Other -- Psychosocial Factors; Center for Epidemiological Studies Depression Scale; Ways of Coping Questionnaire; Prospective Studies; Gay Men; HIV Seronegativity; HIV Seropositivity; Adaptation, Psychological; Coping; Structured Interview; Psychological Tests; Summated Rating Scaling; Caregiver Support; One-Way Analysis of Variance; Chi Square Test; Multivariate Analysis of Variance; Descriptive Statistics; Male; Human

PTSD as Aftermath for Bullied LGBT Adolescents: The Case for Comprehensive Assessment. - Beckerman, Nancy L.; Auerbach, Charles (Social Work in Mental Health, 2014)
There is overwhelming research that demonstrates a positive correlation between various forms of adolescent bullying and subsequent and serious psychological repercussions such as anxiety, depression, suicidal ideation and attempt as well as posttraumatic stress disorder (PTSD; D’Augelli et al., 2005; Herek & Garnets, 2007; Mustanski, Garofalo, & Emerson, 2010). This study examines a particularly vulnerable adolescent and young adult population: lesbian, gay, and transgendered adolescents who have been bullied (Herek & Garnets, 2006). This study (n = 23) identifies which forms of bullying are more likely to manifest in subsequent symptoms of PTSD. Although there are numerous confounding variables, there are statistically significant findings that demonstrate which forms of bullying are more psychologically treacherous, and employing the PTSD checklist–civilian version (PCL) screening instrument, we learned who and what conditions might predict PTSD in our clients. Clinical implications for comprehensive PTSD screening and assessment are provided for mental health practitioners.
Keywords: Bullying -- In Adolescence; Stress Disorders, Post-Traumatic -- In Adolescence; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Human; Adolescence; Young Adult; Confounding Variable; Cross Sectional Studies; Quantitative Studies; Convenience Sample; New York; New Jersey; Surveys; Checklists; Fisher's Exact Test; Spearman's Rank Correlation Coefficient; Odds Ratio; Female; Male; Stress Disorders, Post-Traumatic -- Diagnosis; Bullying -- Classification; Stress Disorders, Post-Traumatic -- Therapy; Psychotherapy; Vulnerability

Polyamory: a call for increased mental health professional awareness. - Graham, Nicole (Archives of Sexual Behavior, 2014)
Keywords: Depression -- Etiology; Self-Injurious Behavior -- Psychosocial Factors; Sexuality; Adult; Bisexuality; Depression -- Diagnosis; Depression -- Drug Therapy; Female; Psychotherapy -- Methods; Sexual Partners; Suicidal Ideation; Young Adult

From the Editor. - Chaney, Michael P. (Journal of LGBT Issues in Counseling, 2020)
An introduction is presented in which the editor discusses articles in the issue on the topics including how resiliency impacts psychosocial stressors, and suicide risk among transgender individuals; and study utilized interpretative phenomenological analysis to understand the treatment.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Hardiness; Counseling; China; Phenomenology; United Kingdom; Social Conformity

Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. - Zucker, Kenneth J. (Archives of Sexual Behavior, 2019)
This article provides an overview of five contemporary clinical and research issues pertaining to adolescents with a diagnosis of gender dysphoria: (1) increased referrals to specialized gender identity clinics; (2) alteration in the sex ratio; (3) suicidality; (4) "rapid-onset gender dysphoria" (ROGD) as a new developmental pathway; (5) and best practice clinical care for adolescents who may have ROGD.
Keywords: Gender Identity; Female; Male; Adolescence; Scales

THE IMPACT OF NOT LEGALIZING SAME-SEX MARRIAGE ON THE LESBIAN, GAY, BISEXUAL, AND TRANSGENDER COMMUNITY...'Wight RG, LeBlanc AJ, Badgett MVL. Same-sex legal marriage and psychological well-being: findings from the California Health Interview Survey' Am J Public Health. 2013;103(2):339---346. - Lutwak, Nancy; Dill, Curt; Saliba, Antonio (American Journal of Public Health, 2013)
Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www.editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu.
Keywords: Marital Status; LGBTQ+ Persons; Stress, Psychological; Suicidal Ideation; Veterans; Social Isolation

Lesbian, Gay, And Bisexual Adolescent Suicidality: The Impact Of Social Stigma. - Carney, Anthony (Kentucky Nurse, 2014)
The article discusses suicidal tendencies among lesbian, gay and bisexual (LGB) adolescent, who are experiencing fourfold greater risk compared to their heterosexual counterparts. Topics discussed include the findings of a survey of 31,852 Oregon teenagers that found 25.1 percent of LGB youth expressing high suicidality, the possible role to be played by mental health nurses and public health nurses in saving the lives of LGB youth and the need to create support groups in schools.
Keywords: Stigma; LGBTQ+ Persons -- Psychosocial Factors; Suicide -- Prevention and Control; Professional Knowledge; Human; CINAHL Database; PubMed; Systematic Review

Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain. - Reisner, Sari L; Biello, Katie; Rosenberger, Joshua G; Austin, S Bryn; Haneuse, Sebastien; Perez-Brumer, Amaya; Novak, David S; Mimiaga, Matthew J (Archives of Sexual Behavior, 2014)
Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54%; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged.
Keywords: Gender Identity; HIV Infections -- Psychosocial Factors; Transgender Persons -- Psychosocial Factors; Transsexualism -- Psychosocial Factors; Adolescence; Adult; West Indies; Ethnological Research; Cross Sectional Studies; Female; HIV Infections -- Prevention and Control; Health Status Indicators; Human; Latin America; Male; Middle Age; Population Surveillance; Portugal; Regression; Reproductive Health; Risk Taking Behavior; Sexuality; Socioeconomic Factors; Spain; Suicide; Young Adult

Health consequences of racist and antigay discrimination for multiple minority adolescents. - Thoma, Brian C; Huebner, David M (Cultural Diversity & Ethnic Minority Psychology, 2013)
Individuals who belong to a marginalized group and who perceive discrimination based on that group membership suffer from a variety of poor health outcomes. Many people belong to more than one marginalized group, and much less is known about the influence of multiple forms of discrimination on health outcomes. Drawing on literature describing the influence of multiple stressors, three models of combined forms of discrimination are discussed: additive, prominence, and exacerbation. The current study examined the influence of multiple forms of discrimination in a sample of African American lesbian, gay, or bisexual (LGB) adolescents ages 14-19. Each of the three models of combined stressors were tested to determine which best describes how racist and antigay discrimination combine to predict depressive symptoms, suicidal ideation, and substance use. Participants were included in this analysis if they identified their ethnicity as either African American (n = 156) or African American mixed (n = 120). Mean age was 17.45 years (SD = 1.36). Results revealed both forms of mistreatment were associated with depressive symptoms and suicidal ideation among African American LGB adolescents. Racism was more strongly associated with substance use. Future intervention efforts should be targeted toward reducing discrimination and improving the social context of multiple minority adolescents, and future research with multiple minority individuals should be attuned to the multiple forms of discrimination experienced by these individuals within their environments.
Keywords: Black Persons -- Psychosocial Factors; Bisexuality; Health Status; Homosexuality; Minority Groups -- Psychosocial Factors; Racism -- Psychosocial Factors; Adolescence; Adolescent Behavior; Adult; Black Persons -- Statistics and Numerical Data; Depression -- Epidemiology; Depression -- Psychosocial Factors; Ethnic Groups -- Psychosocial Factors; Ethnic Groups -- Statistics and Numerical Data; Female; Male; Minority Groups -- Statistics and Numerical Data; Racism; Discrimination -- Psychosocial Factors; Discrimination; Substance Use Disorders -- Epidemiology; Substance Use Disorders -- Psychosocial Factors; Suicidal Ideation; United States; Young Adult

Rupture, resilience, and risk: Relationships between mental health and migration among gay-identified men in North America. - Lewis, Nathaniel M (Health & Place, 2014)
An established body of research in psychology, psychiatry and epidemiology links social stigma and stress with poor mental and sexual health outcomes among gay-identified men. Less work considers how these linkages are mediated by place and almost none considers the role of movement across places. This qualitative study, based on the migration narratives of 48 gay-identified men living in Ottawa, Ontario, Canada, and Washington, D.C., U.S.A. gives more careful consideration to the ways in which mental and emotional health issues (e.g., anxiety, depression, substance use) in this population both precipitate migration and stem from migration. The narratives show that decisions to migrate often emerge from mens experiences of place-based minority stress and associated health outcomes. At the same time, moving to urban gay communities, when coupled with other life circumstances, can create or reinforce physical and emotional insecurities that lead to low self-esteem, substance use and sexual risk-taking.
Keywords: Homosexuality; Mental Disorders -- Epidemiology; Adult; Anxiety -- Epidemiology; Canada; Depression -- Epidemiology; Homophobia -- Psychosocial Factors; Homophobia; Loneliness -- Psychosocial Factors; Male; Mental Disorders -- Etiology; Middle Age; Hardiness; Rural Population; Self Concept; Social Isolation -- Psychosocial Factors; Suicidal Ideation; United States; Urban Population; Young Adult

Early Onset Alcohol Use and Self-Harm: A Discordant Twin Analysis. - Few, Lauren R.; Werner, Kimberly B.; Sartor, Carolyn E.; Grant, Julia D.; Trull, Timothy J.; Nock, Matthew K.; Bucholz, Kathleen K.; Deitz, Sarah K.; Glowinski, Anne L.; Martin, Nicholas G.; Nelson, Elliot C.; Statham, Dixie J.; et al. (Alcoholism: Clinical & Experimental Research, 2015)
Background Self-harm has considerable societal and economic costs and has been extensively studied in relation to alcohol involvement. Although early onset alcohol use ( EAU) has been causally linked to maladaptive clinical outcomes, its association with self-harm is less well characterized. This study aimed to further examine the link between EAU and both nonsuicidal self-injury ( NSSI) and suicide attempt ( SA), and elucidate shared familial and causal/individual-specific pathways that explain this co-occurrence. Methods Using data from 6,082 Australian same-sex twin pairs (1,732 monozygotic [MZ] and 1,309 dizygotic [DZ]), ages 23 to 40, we examined prevalence rates of NSSI and SA among twin pairs concordant and discordant for EAU. Conditional logistic regression, controlling for early clinical covariates and the influence of zygosity on EAU, was used to examine the odds ratio ( OR) of self-harm within twin pairs discordant for EAU. Results Prevalence rates of both NSSI and SA were highest among twin pairs concordant for EAU and for twins who reported EAU within discordant twin pairs. Results from discordant twin analyses revealed nearly 4-fold increased odds of SA for the twin who endorsed EAU, and this OR was equal across MZ and DZ twins. EAU also was associated with elevated odds of NSSI ( OR = 7.62), although this was only the case for DZ twins in discordant pairs. Conclusions The equivalent increase in odds of SA for both MZ and DZ twins suggests that causal or individual-specific influences explain the link between EAU and SA. For NSSI, elevated odds for DZ twins and nonsignificant findings for MZ twins implicate correlated genetic factors in the association between EAU and NSSI. Future studies should test mechanisms through which EAU may causally influence SA, as well as examine whether genetic risk for third variables (e.g., negative urgency, stress reactivity) may explain the genetic overlap between EAU and NSSI.
Keywords: Twins; Self-Injurious Behavior -- Epidemiology -- Australia; Age of Onset; Alcohol Drinking; Human; Australia; Descriptive Statistics; Odds Ratio; Adult; Suicide, Attempted -- Epidemiology -- Australia; Logistic Regression; Prevalence; Causal Attribution; Male; Female; Clinical Assessment Tools; Data Analysis Software; Confidence Intervals; Chi Square Test; Funding Source

Sexuality and suicidality: matched-pairs analyses reveal unique characteristics in non-heterosexual suicidal behaviors. - Harris, Keith M (Archives of Sexual Behavior, 2013)
Keywords: Sexuality; Suicide; Suicide, Attempted; Adolescence; Adult; Female; Internet; Male; Risk Factors; Self-Injurious Behavior; Support, Psychosocial; Suicide -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; Violence

Racial/Ethnic Disparities in History of Incarceration, Experiences of Victimization, and Associated Health Indicators Among Transgender Women in the U.S. - Reisner, Sari L.; Bailey, Zinzi; Sevelius, Jae (Women & Health, 2014)
Limited national data document the prevalence of incarceration among transgender women, experiences of victimization while incarcerated, and associations of transgender status with health. Data were from the National Transgender Discrimination Survey (NTDS), a large convenience sample of transgender adults in the U.S., collected between September 2008 and March 2009. Respondents who indicated a transfeminine gender identity were included in the current study (n = 3,878). Multivariable logistic regression was used to model ever being incarcerated and experiencing victimization while incarcerated as a function of race/ethnicity and health-related indicators. Overall, 19.3% reported having ever been incarcerated. Black and Native American/Alaskan Native transgender women were more likely to report a history of incarceration than White (non-Hispanic) respondents, and those with a history of incarceration were more likely to report negative health-related indicators, including self-reporting as HIV-positive. Among previously incarcerated respondents, 47.0% reported victimization while incarcerated. Black, Latina, and mixed race transgender women were more likely to report experiences of victimization while incarcerated. Transgender women reported disproportionately high rates of incarceration and victimization while incarcerated, as well as associated negative health-related indicators. Interventions and policy changes are needed to support transgender women while incarcerated and upon release.
Keywords: Transgender Persons -- United States; Race Factors; Ethnic Groups; Women's Health; Public Offenders; Victims; Human; United States; Life Experiences; Convenience Sample; Questionnaires; Logistic Regression; Self Report; HIV Infections; Prevalence; LGBTQ+ Persons -- Organizations; Correctional Health Services; Adolescence; Young Adult; Adult; Middle Age; Socioeconomic Factors; Insurance Coverage; Geographic Factors; Risk Taking Behavior; Sexual Abuse; Suicidal Ideation; Data Analysis Software; Female; Health Services Accessibility; Confidence Intervals; Odds Ratio; Cross Sectional Studies; Epidemiological Research; Discrimination

Connecting the dots: examining transgender women's utilization of transition-related medical care and associations with mental health, substance use, and HIV. - Wilson, Erin C; Chen, Yea-Hung; Arayasirikul, Sean; Wenzel, Conrad; Raymond, H Fisher (Journal of Urban Health, 2015)
Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems-binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse-comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed.

Lesbian, Gay, Bisexual, and Transgender Health Issues, Disparities, and Information Resources. - McKay, Becky (Medical Reference Services Quarterly, 2011)
Lesbian, gay, bisexual, and transgender (LGBT) persons, while widely diverse in many ways, share health disparities related to the stigma and discrimination they experience, including disproportionate rates of psychiatric disorders, substance abuse, and suicide. Lesbians, gay men, bisexuals, and the transgender communities have additional health concerns and disparities unique to each population. This paper highlights the national recognition of these health issues and disparities and presents web-based information resources about them and their mitigation.
Keywords: Gay Persons; Health Services Accessibility; Information Resources; Internet; Discrimination; Cultural Competence; Centers for Disease Control and Prevention (U.S.); Human Rights; Mental Health; Alcoholism; Substance Abuse; Bisexuals; Transgender Persons

Risk of adolescent offspring's completed suicide increases with prior history of their same-sex parents' death by suicide. - Cheng, C.-C. J.; Yen, W.-J.; Chang, W.-T.; Wu, K. C.-C.; Ko, M.-C.; Li, C.-Y. (Psychological Medicine, 2014)
BackgroundTo investigate the risk of completed suicide in offspring during adolescence in relation to prior history of the same-sex parent's death by suicide and other causes.MethodA total of 500 adolescents who died by suicide at age 15–19 years between 1997 and 2007 were identified from the Taiwan Mortality Registration (TMR). For each case, 30 age- and time-matched controls were selected randomly from all adolescents registered in the Taiwan Birth Registry (TBR). A multivariate conditional logistic regression model was used to assess the risk of adolescent completed suicide in relation to their same-sex parent.ResultsAdolescent suicide risk was positively associated with both paternal [odds ratio (OR) 5.38, 95% confidence interval (CI) 2.17–13.33] and maternal suicide (OR 6.59, 95% CI 1.82–23.91). The corresponding risk estimates associated with paternal and maternal deaths from non-suicidal causes were much lower, at 1.88 and 1.94 respectively. The risk of suicide in male adolescents was significantly associated with prior history of paternal death by suicide (OR 8.23, 95% CI 2.96–22.90) but not of maternal death by suicide (OR 3.50, 95% CI 0.41–30.13). On the other contrary, the risk of suicidal death in female adolescents was significantly associated with prior history of maternal suicide (OR 9.71, 95% CI 1.89–49.94) but not of paternal suicide (OR 2.42, 95% CI 0.30–19.57). However, these differences did not reach statistical significance.ConclusionsAlthough limited by sample size, our study indicates that adolescent offspring suicidal death is associated with prior history of their same-sex parent's death by suicide.
Keywords: Suicide -- Risk Factors -- In Adolescence; Parents; Adolescent Behavior -- Taiwan; Suicide -- In Adulthood -- Taiwan; Human; Taiwan; Adolescence; Adult; Logistic Regression; Confidence Intervals; Female; Male; Fisher's Exact Test; T-Tests; Odds Ratio; P-Value; Data Analysis Software; Funding Source

Suicidal ideation and sexual orientation in college students: the roles of perceived burdensomeness, thwarted belongingness, and perceived rejection due to sexual orientation. - Hill RM; Pettit JW (Suicide & Life-Threatening Behavior, 2012)
A theoretical model in which perceived burdensomeness and thwarted belongingness were hypothesized to account for the association between sexual orientation and suicidal ideation among college students was tested. Among 198 college students (mean age 21.28 years), gay, lesbian, and bisexual students (n = 50) reported significantly higher levels of perceived burdensomeness and suicidal ideation than heterosexual students. The relationship between sexual orientation and suicidal ideation was partially accounted for by perceived burdensomeness, but not thwarted belongingness. This indirect effect was stronger at higher levels of perceived or anticipated rejection due to one's sexual orientation. Implications for intervention and prevention science are discussed.
Keywords: Social Behavior; Sexuality; Suicidal Ideation; Adolescence; Adult; Bisexuality; Female; Lesbians -- Psychosocial Factors; Homosexuality; Human; Male; Middle Age; Models, Psychological; Questionnaires; Students -- Psychosocial Factors

The Influence of State Laws on the Mental Health of Sexual Minority Youth. - Hatzenbuehler, Mark L. (JAMA Pediatrics, 2017)
Keywords: Mental Health -- Legislation and Jurisprudence -- United States; LGBTQ+ Persons; State Government; United States; Suicide; Marriage

Cyberbullying: Review of an Old Problem Gone Viral. - Aboujaoude, Elias; Savage, Matthew W.; Starcevic, Vladan; Salame, Wael O. (Journal of Adolescent Health, 2015)
Purpose Despite being relatively new, cyberbullying is now well recognized as a serious public health problem affecting children and adolescents. Scientific exploration has lagged media attention, but a synthesis of studies across several disciplines permits an understanding of its epidemiology, phenomenology, mental health dimensions, and management tools. Methods To assess current knowledge of cyberbullying, we searched the MEDLINE, PubMed and PsycINFO databases for articles on “cyberbullying” and related designations. The Google search engine was used to capture otherwise unpublished legislative, governmental, and community response data and to help identify relevant books and book chapters. Results A significant proportion of children and adolescents (20%–40%) have been victims of cyberbullying, with females and sexual minorities seemingly at higher risk. Perpetrators are more likely to be male. By nature of the electronic platform, there seems to be an easier path to the bully-victim phenomenon (victims who become bullies or vice versa) than that in traditional bullying. A nonlinear relationship with age is suggested, but demographic data overall are preliminary. Accompanying psychopathology, including an increasingly well-established link to suicidality, is common. Several prevention and management approaches have been proposed to help prevent cyberbullying or mitigate its effects. Discussion Cyberbullying's seeming ubiquity, its disproportionate toll on vulnerable populations (e.g., children and sexual minorities), the link with suicidality, and the expected continued rise in Internet penetrance and connectivity make confronting it an urgent matter. A multipronged approach is most likely to succeed and would include: educational media campaigns; school-based programs; parental oversight and involvement; legislative action; and screening and evidence-based interventions by health care providers, especially pediatricians and mental health professionals. Conclusions More research is needed into cyberbullying, but available data suggest a serious problem whose consequences are real and should not be dismissed as a “virtual” by-product of an increasingly digitalized childhood and adolescence.
Keywords: Bullying -- Epidemiology -- In Adolescence; Internet -- Utilization; Cyberbullying; Human; Child; Adolescence; Male; Female; Descriptive Statistics

Making the most of the adolescent male health visit: part 1: history and anticipatory guidance. - Marcell AV; Bell DL (Contemporary Pediatrics, 2006)
A structured psychosocial interview allows you to assess if, and how, a male teenager's lifestyle or home and school environment pose a risk to his mental and physical health. The authors show you the right questions to ask and how to ask them--the keys to getting your patient to open up.
Keywords: Adolescence -- Psychosocial Factors; Adolescent Health; Health Services Needs and Demand -- In Adolescence; Men's Health; Patient History Taking -- In Adolescence; Structured Interview -- Methods; Adolescence; Adolescent Behavior; Adolescent Fathers; Attitude to Sexuality; Bisexuality; Contraception; Education; Education, Continuing (Credit); Exercise; Food Habits -- In Adolescence; Health Education; Health Information; Homosexuality; Information Needs; Information Resources; Male; Masturbation; Mental Health -- In Adolescence; Parent-Child Relations; Parenthood -- In Adolescence; Patient History Taking -- Methods; Physician-Patient Relations; Privacy and Confidentiality; Puberty -- Psychosocial Factors; Risk Taking Behavior; Role Models; Safety; Sexual Abuse; Sexual Dysfunction, Male -- In Adolescence; Substance Abuse -- In Adolescence; Suicidal Ideation -- In Adolescence; Support, Psychosocial; World Wide Web

4.55 The Interpersonal Theory of Suicide and Transgender Teen Suicidality: Clinical Reports and Systematic Review. - Makani, Ramkrishna D.; Sholevar, Ellen H. (Journal of the American Academy of Child & Adolescent Psychiatry, 2018)

The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men. - Wang, Jen; Häusermann, Michael; Berrut, Sylvie; Weiss, Mitchell G (Journal of Affective Disorders, 2013)
Keywords: Depression -- Psychosocial Factors; Information Literacy; Health Promotion; Homosexuality; Mental Health -- Statistics and Numerical Data; Health Literacy; Adult; Data Collection; Depression -- Diagnosis; Depression; Human; Experimental Studies; Male; Middle Age; Patient Education; Prevalence; Suicidal Ideation; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Suicide, Attempted; Switzerland; Young Adult

Depression and anxiety in men with sexual dysfunction: a retrospective study. - Rajkumar, Ravi Philip; Kumaran, Arun Kumar (Comprehensive Psychiatry, 2015)
Background: Comorbid anxiety disorders and depression are commonly seen in men with sexual disorders such as erectile dysfunction (ED) and premature ejaculation (PE). However, they are often undiagnosed and untreated, and their relationship to sexual dysfunction is complex. This study examines the frequency and correlates of comorbid anxiety and depression in men with ED or PE. Methods: The case records of 64 men with ED or PE attending a clinic for psychosexual disorders in a general hospital psychiatry unit during the period 2010-14 were reviewed. Information on comorbid anxiety disorders and depression was extracted from these records, and their clinical and demographic associations were analyzed. Results: Eight (12.5%) men had comorbid depressive disorders, and fifteen (23.4%) had anxiety disorders. These disorders predated the onset of sexual dysfunction in the majority of patients. Generalized anxiety disorder was the commonest anxiety disorder. Men with comorbid depression had significantly elevated rates of suicidal ideation or behavior related to their sexual dysfunction, and were more likely to report a lack of libido. Men with pre-existing anxiety disorders were more likely to experience performance anxiety related to sex, and to have PE without comorbid ED. Conclusions: Depression and anxiety affect a substantial minority of men with sexual dysfunction. Men presenting for the evaluation of ED and PE should be carefully screened for these disorders. The links between anxiety disorders and sexual performance anxiety merit further investigation in this patient group.
Keywords: Sexual and Gender Disorders; Erectile Dysfunction; Semen; Generalized Anxiety Disorder; Anxiety Disorders; Semen Analysis; Depression; Fisher's Exact Test; Male; Case Studies; Record Review; Retrospective Design; Semi-Structured Interview; Scales; Interview Guides; Study Design; Interviews

Estimating the number of men who have sex with men by race/ethnicity at the county level in Texas. - Campagna, Jesse; Poe, Jonathon; Robbins, Ann; Rowlinson, Emily (Journal of Urban Health, 2015)
This analysis presents a method for estimating the population of men who have sex with men (MSM) at the county and metropolitan area level in Texas. Surveillance data consistently demonstrate that MSM experience a high burden of HIV and other sexually transmitted infections (STIs). Numerous studies have shown that MSM are also vulnerable to many other health concerns such as suicide, substance abuse, domestic violence and assault, homelessness, and mental illness. However, compilation of rates of HIV, STIs, and other health issues is dependent on estimation of population denominators. In the absence of systematic, consistent, and direct assessment of sexual orientation and gender identity in national surveys, it is difficult to estimate the size of at-risk populations. Previous estimates at the national and state level have been calculated using varied methodologies. However, to date, statewide estimates at the county level have only been produced for the state of Florida. County-level and metropolitan area estimates of MSM population were produced using three modified models developed by Lieb et al. These models used data on population and same-sex households from the US Census, along with estimates of sexual behavior from the National Survey on Family Growth. These models produce an estimate of 599,683 MSM in Texas (6.4 % of the adult male population). Metropolitan areas with the highest percentage of MSM population include Dallas and Austin (10.3 and 9.8 %, respectively). County-level estimates of MSM population range from 1.0 to 12.9 %. These local estimates are critical to targeting vulnerable populations and effective allocation of resources for prevention and treatment programs.

Buried Above Ground: A University-Based Study of Risk/Protective Factors for Suicidality Among Sexual Minority Youth in Canada. - Peter, Tracey; Taylor, Catherine (Journal of LGBT Youth, 2014)
Keywords: Suicidal Ideation -- Risk Factors; Suicide, Attempted -- Prevention and Control; Students, College -- Psychosocial Factors -- Canada; LGBTQ+ Persons -- Psychosocial Factors -- Canada; Suicidal Ideation -- Prevention and Control; Suicide, Attempted -- Risk Factors; Human; Canada; Bullying; Self Report; Data Analysis Software; Bivariate Statistics; Multivariate Statistics; Male; Female; T-Tests; Center for Epidemiological Studies Depression Scale; Rosenberg Self Esteem Scale; Questionnaires; Scales; Psychological Tests

Suicide protective factors among trans adults. - Moody, Chérie; Smith, Nathan Grant (Archives of Sexual Behavior, 2013)
Keywords: Support, Psychosocial; Suicidal Ideation; Suicide -- Prevention and Control; Suicide, Attempted -- Prevention and Control; Transgender Persons -- Psychosocial Factors; Transsexualism -- Psychosocial Factors; Adolescence; Adult; Aged; Female; Friendship; Human; Male; Middle Age; Risk Factors; Suicide -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors

Sexual Orientation and Anabolic-Androgenic Steroids in US Adolescent Boys. - Blashill, Aaron J.; Safren, Steven A (Pediatrics, 2014)
OBJECTIVES: We compared the lifetime prevalence of anabolic-androgenic steroid (AAS) misuse among sexual minority versus heterosexual US adolescent boys, and secondarily, sought to explore possible intermediate variables that may explain prevalence differences. METHODS: Participants were 17 250 adolescent boys taken from a pooled data set of the 14 jurisdictions from the 2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. Data were analyzed for overall prevalence of AAS misuse and possible intermediary risk factors. RESULTS: Sexual minority adolescent boys were at an increased odds of 5.8 (95% confidence interval 4.1-8.2) to report a lifetime prevalence of AAS (21% vs 4%) compared with their heterosexual counterparts, P < .001. Exploratory analyses suggested that increased depressive symptoms/suicidality, victimization, and substance use contributed to this disparity. CONCLUSIONS: This is the first known study to test and find substantial health disparities in the prevalence of AAS misuse as a function of sexual orientation. Prevention and intervention efforts are needed for sexual minority adolescent boys.
Keywords: Sexuality -- In Adolescence; Anabolic Steroids; Gay Persons; Heterosexuals; Substance Abuse -- Epidemiology -- In Adolescence; Human; Adolescence; Male; Prevalence; Depression; United States; Exploratory Research; Suicidal Ideation; Asthma; Data Analysis Software; Chi Square Test; Odds Ratio; Random Sample; Confidence Intervals; Funding Source

Lesbian, Gay, And Bisexual Adolescent Suicidality: The Impact Of Social Stigma. - Carney, Anthony (Kentucky Nurse, 2014)
Keywords: Stigma; LGBTQ+ Persons -- Psychosocial Factors; Suicide -- Prevention and Control; Professional Knowledge; Human; CINAHL Database; PubMed; Systematic Review

Care of the college student. - Unwin, Brian K; Goodie, Jeffrey; Reamy, Brian V; Quinlan, Jeffrey (American Family Physician, 2013)
There are approximately 20 million students in U.S. colleges and universities. Although this population is characterized as having good health, 600,000 students report some form of disability or some type of medical problem, including attention-deficit/hyperactivity disorder, learning disabilities, psychiatric disorders, and chronic illnesses, among others. Physicians can enhance youth transition to an adult model of health care; the use of self-care skills checklists is one recommended method to assist with the transition. Stimulant medications are effective for treating adults with attention-deficit/hyperactivity disorder, but physicians should use caution when prescribing stimulants to college students because of the high rates of medication diversion in this population. Depression, anxiety, posttraumatic stress disorder, sleep problems, and eating disorders are common in college students and can significantly impact performance. Emphasis on immunization of students for influenza, meningococcus, and pertussis is necessary because of the low rates of compliance. Screening and interventions for obesity, tobacco use, and substance abuse are important because of the high prevalence of these problems in college students. Screening for alcohol abuse facilitates identification of students with problem drinking behaviors. Students who are war veterans should be monitored for suicidal ideation and posttraumatic stress disorder. Lesbian, gay, bisexual, transgender, and questioning students are at risk of harassment and discrimination. Caution should be exercised when prescribing medications to college athletes to avoid violation of National Collegiate Athletic Association eligibility rules.
Keywords: Student Health Services -- Methods; Students -- Psychosocial Factors; Continuity of Patient Care -- Economics; Continuity of Patient Care -- Administration; Acute Disease; Adolescence; Chronic Disease; Insurance Coverage; Insurance, Health; Mental Disorders -- Diagnosis; Mental Disorders -- Therapy; Physician-Patient Relations; Student Health Services -- Economics; Student Health Services -- Administration; United States; Immunization; Young Adult

Comparing Trans-Spectrum and Same-sex-Attracted Youth in Australia: Increased Risks, Increased Activisms. - Jones, Tiffany; Hillier, Lynne (Journal of LGBT Youth, 2013)
Keywords: LGBTQ+ Persons -- Australia; Suicide -- Risk Factors; Gender Identity; Support, Psychosocial; Human; Disorders of Sex Development; Australia; Transsexuals; Transgender Persons; Adolescence; Adult; Student Experiences; Self-Injurious Behavior; Homophobia; Truth Disclosure; Descriptive Statistics; Questionnaires; Chi Square Test; Male; Female

Sexuality education school policy for Australian GLBTIQ students. - Jones, Tiffany Mary; Hillier, Lynne (Sex Education, 2012)
Education is state-run in Australia, and within each of the eight states and territories there are both government and independent schooling systems. This paper details the position of gay, lesbian, bisexual, transgender, intersex and queer (GLBTIQ) students within Australian education policy documents nationally, focusing on the three largest states and educational sectors in Australia. Survey data are used to report on the schooling experiences of over 3000 Australian GLBTIQ young people aged 14–21 years. Data from interviews with key policy informants identify both the obstacles to implementing policies, and how such obstacles have been overcome. Much official policy sees sexuality education as promoting inclusive, protective and affirming messages around GLBTIQ students. There exist significant correlations between policy and a variety of well-being and psycho-social outcomes for GLBTIQ students, including lowered incidence of homophobic abuse and suicide, and the creation of supportive school environments. Ideal policy visions are outlined, along with practical recommendations of relevance to a variety of stakeholders.
Keywords: Sex Education -- Evaluation -- Australia; Public Policy; Social Attitudes; LGBTQ+ Persons -- Psychosocial Factors; School Health Services; Australia; Chi Square Test; Multimethod Studies; Secondary Analysis; Human; Male; Female; Adolescence; Young Adult; Victoria; Queensland; New South Wales; Interviews; Communication Barriers; Gender Identity; Attitude to Sexuality; Discrimination; Homosexuality

The Health and Well-Being of Transgender High School Students: Results From the New Zealand Adolescent Health Survey (Youth'12) - Clark, Terryann C.; Lucassen, Mathijs F.G.; Bullen, Pat; Denny, Simon J.; Fleming, Theresa M.; Robinson, Elizabeth M.; Rossen, Fiona V. (Journal of Adolescent Health, 2014)
Abstract: Purpose: To report the prevalence of students according to four gender groups (i.e., those who reported being non-transgender, transgender, or not sure about their gender, and those who did not understand the transgender question), and to describe their health and well-being. Methods: Logistic regressions were used to examine the associations between gender groups and selected outcomes in a nationally representative high school health and well-being survey, undertaken in 2012. Results: Of the students (n = 8,166), 94.7% reported being non-transgender, 1.2% reported being transgender, 2.5% reported being not sure about their gender, and 1.7% did not understand the question. Students who reported being transgender or not sure about their gender or did not understand the question had compromised health and well-being relative to their non-transgender peers; in particular, for transgender students perceiving that a parent cared about them (odds ratio [OR], .3; 95% confidence interval [CI], .2–.4), depressive symptoms (OR, 5.7; 95% CI, 3.6–9.2), suicide attempts (OR, 5.0; 95% CI, 2.9–8.8), and school bullying (OR, 4.5; 95% CI, 2.4–8.2). Conclusions: This is the first nationally representative survey to report the health and well-being of students who report being transgender. We found that transgender students and those reporting not being sure are a numerically small but important group. Transgender students are diverse and are represented across demographic variables, including their sexual attractions. Transgender youth face considerable health and well-being disparities. It is important to address the challenging environments these students face and to increase access to responsive services for transgender youth.
Keywords: Transgender Persons -- Evaluation -- In Adolescence; Adolescent Health -- Evaluation; Psychological Well-Being -- Evaluation -- In Adolescence; Students, High School -- Evaluation -- New Zealand; Human; Adolescence; Male; Female; Surveys; New Zealand; Descriptive Statistics; Logistic Regression; Odds Ratio; Confidence Intervals

The Health and Well-Being of Transgender High School Students: Results From the New Zealand Adolescent Health Survey (Youth'12). - Clark, Terryann C.; Lucassen, Mathijs F.G.; Bullen, Pat; Denny, Simon J.; Fleming, Theresa M.; Robinson, Elizabeth M.; Rossen, Fiona V. (Journal of Adolescent Health, 2014)
Abstract: Purpose: To report the prevalence of students according to four gender groups (i.e., those who reported being non-transgender, transgender, or not sure about their gender, and those who did not understand the transgender question), and to describe their health and well-being. Methods: Logistic regressions were used to examine the associations between gender groups and selected outcomes in a nationally representative high school health and well-being survey, undertaken in 2012. Results: Of the students (n = 8,166), 94.7% reported being non-transgender, 1.2% reported being transgender, 2.5% reported being not sure about their gender, and 1.7% did not understand the question. Students who reported being transgender or not sure about their gender or did not understand the question had compromised health and well-being relative to their non-transgender peers; in particular, for transgender students perceiving that a parent cared about them (odds ratio [OR], .3; 95% confidence interval [CI], .2–.4), depressive symptoms (OR, 5.7; 95% CI, 3.6–9.2), suicide attempts (OR, 5.0; 95% CI, 2.9–8.8), and school bullying (OR, 4.5; 95% CI, 2.4–8.2). Conclusions: This is the first nationally representative survey to report the health and well-being of students who report being transgender. We found that transgender students and those reporting not being sure are a numerically small but important group. Transgender students are diverse and are represented across demographic variables, including their sexual attractions. Transgender youth face considerable health and well-being disparities. It is important to address the challenging environments these students face and to increase access to responsive services for transgender youth.
Keywords: Transgender Persons -- Evaluation -- In Adolescence; Adolescent Health -- Evaluation; Psychological Well-Being -- Evaluation -- In Adolescence; Students, High School -- Evaluation -- New Zealand; Human; Adolescence; Male; Female; Surveys; New Zealand; Descriptive Statistics; Logistic Regression; Odds Ratio; Confidence Intervals

Mental Health Implications in Mormon Women’s Experiences With Same-Sex Attraction: A Qualitative Study. - Jacobsen, Jeanna; Wright, Rachel (Counseling Psychologist, 2014)
Given research suggesting that individuals in conservative religions experience conflict between religious beliefs and feelings of same-sex sexuality, this study explores the mental health impact of Mormon women who experience same-sex sexuality. Twenty-three Mormon women participated in semi-structured individual interviews about their experiences with same-sex sexuality. Interview questions asked about participants’ experiences with same-sex sexuality and the LDS Church (The Church of Jesus Christ of Latter-day Saints), how this experience affected their mental health, and what types of mental health treatment they engaged in during their process of reconciliation. Data were analyzed following phenomenological methodology. Themes included the following: experiences with mood disorders, self-worth, suicidality, treatment attempts, reparative therapy, counselor’s agenda, impact of family and community, and mental health recovery. When treating women who experience conflict, counselors should assess self-worth, suicidality, and the level of community and familial support. Referral to group counseling can support self-acceptance of same-sex sexuality through normalization. Future research should examine specific practice interventions and explore impacts of other intersecting identities.
Keywords: Mental Health; Lesbians; Religion and Psychology; Life Experiences; Human; Female; Interviews; Phenomenological Research; Adult; Middle Age; Audiorecording; Thematic Analysis; Constant Comparative Method

Attachment-based family therapy interventions. - Diamond, Gary M (Psychotherapy, 2014)
Keywords: Depression -- Therapy; Family Therapy -- Methods; Psychoanalytic Theory; Suicidal Ideation; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Adolescence; Communication; Depression -- Diagnosis; Depression -- Psychosocial Factors; Emotions; Family Conflict; Female; Lesbians -- Psychosocial Factors; Male; Parent-Child Relations; Reactive Attachment Disorder -- Psychosocial Factors; Reactive Attachment Disorder -- Therapy; Self Concept; Self Disclosure; Support, Psychosocial

Exploring a Dutch paradox: an ethnographic investigation of gay men's mental health. - Aggarwal, Sanjay; Gerrets, Rene (Culture, Health & Sexuality, 2014)
Despite the Netherlands' reputation as a world leader with respect to gay rights, homosexual Dutch men have much higher rates of mood disorders, anxiety disorders and suicide attempts than heterosexual Dutch men. Epidemiologists report similar disparities elsewhere in Western Europe and North America. These findings have been the focus of a blossoming psychological literature, inspired by minority stress theory and deploying quantitative methods. Our investigation aims to complement this body of work by adopting an ethnographic approach. Drawing from fieldwork conducted in the Netherlands from 2009 to 2010, we explore sociocultural and contextual factors that have received relatively little attention with respect to gay mental health. In the Netherlands - considered a model for gay equality - how can one understand high rates of psychiatric disorders among gay men? This study points to heteronormativity, complex dynamics involving long-term relationships and processes within gay subcultures as key issues. Notwithstanding their putative socioeconomic, legal and political equality, gay men struggled - at various stages of the life cycle - with internalised norms that they found difficult to fulfil. The desire to embody these ideals, and structural constraints in meeting them, could be potent sources of disappointment and distress.
Keywords: Civil Rights; Homosexuality; Men -- Psychosocial Factors; Mental Health; Minority Groups -- Psychosocial Factors; Self Concept; Social Conformity; Stigma; Adult; Anthropology, Cultural; Human; Male; Middle Age; Netherlands; Qualitative Studies

Interventions for LGBTQ Youth Suicide: A Review of Two Books. - Gandy, Megan E. (Journal of LGBT Youth, 2015)
Keywords: LGBTQ+ Persons; Suicide; School Violence -- Prevention and Control

Risk and Protective Factors that Distinguish Adolescents Who Attempt Suicide from Those Who Only Consider Suicide in the Past Year. - Taliaferro, Lindsay A; Muehlenkamp, Jennifer J (Suicide & Life-Threatening Behavior, 2014)
Data from the 2010 Minnesota Student Survey was analyzed to identify risk and protective factors that distinguished adolescents across three groups: no suicidality, suicidal ideation only, and suicide attempt. The population-based sample included 70,022 students in grades 9 and 12. Hopelessness and depressive symptoms emerged as important risk factors to distinguish youth who reported suicidal ideation or behavior from those without a history of suicidality. However, these factors were not as important in differentiating adolescents who attempted suicidal from those who considered suicide but did not act on their thoughts. Instead, for both genders, self-injury represented the most important factor to distinguish these youth. Other risk factors that differentiated the latter groups, but not the former groups, for males were dating violence victimization and cigarette smoking, and for females was a same-sex sexual experience. Running away from home also seemed to increase the risk of a suicide attempt among youth in this study. Parent connectedness and academic achievement emerged as important protective factors to differentiate all the groups, yet neighborhood safety appeared to protect against the transition from suicidal thoughts to behavior. Findings from this study suggest risk and protective factors practitioners should target in clinical assessments and intervention programs to help prevent suicidal behavior among youth at greatest risk.
Keywords: Suicidal Ideation; Suicide, Attempted -- Psychosocial Factors; Adolescence; Age Factors; Cross Sectional Studies; Female; Human; Male; Minnesota; Prevalence; Adolescent Psychology; Risk Factors; Sex Factors; Suicide, Attempted

School safety experiences of high school youth across sexual orientation and gender identity. - Atteberry-Ash, Brittanie; Kattari, Shanna K.; Speer, Stephanie Rachel; Guz, Samantha; Kattari, Leo (Children & Youth Services Review, 2019)
School safety is considered a public health crisis with severe consequences on students' physical and emotional wellbeing. Although previous research highlights the disparities regarding safety in schools for LGBQ and transgender students, few studies examine the nuances between sexual orientation and gender identity. This study (N = 11,986) uses the 2015 Healthy Kids Colorado Study to examine differential experiences of school safety when looking at the various intersections of gender identity and sexual orientation. Logistic regression results indicate that school safety feeling safe at school), bullying, and skipping school due to feeling unsafe are shared experiences, especially among LGBQ and transgender youth, and that these experiences are differentially based on the intersection of sexual orientation and gender identity. • School safety experiences are differential based on the intersection of sexual orientation and gender identity. • Students who identified as transgender, regardless of sexual orientation, were at the highest risk for school safety indicators. • This elevated trend is also present for students who reported they did not know if they were transgender and were LGB or questioning. • Black, Latinx, Native Hawaiian or Other Pacific Islander, and Multiracial students all reported higher odds of skipping school due to safety. • Passing anti-bullying policies at both the state and district level is crucial.
Keywords: Schools, Secondary; Safety; Students, High School -- Psychosocial Factors; Student Attitudes; LGBTQ+ Persons -- Psychosocial Factors; Sexuality; Gender Identity; Human; Logistic Regression; Transgender Persons -- Psychosocial Factors; Bullying -- Psychosocial Factors; Absenteeism; Sexual Identity; School Violence -- Psychosocial Factors

School Counseling Toward an LGBTQ-Inclusive School Climate: Implementing the SCEARE Model. - Asplund, Nancy R.; Ordway, Ann M. (Journal of LGBT Issues in Counseling, 2018)
The school environment is often perceived as hostile by sexual minority youth. Lesbian, gay, bisexual, transgender, queer (LGBTQ) students experience high rates of bullying and suicidal ideation yet are often underserved by school counselors. School counselors are uniquely situated to facilitate systemic change within a school. The proposed School Counselors: Educate, Affirm, Respond, and Empower (SCEARE, pronounced SKEER) model outlines components of an LGBTQ-inclusive school climate. It is designed to be a practical tool for helping school counselors conceptualize their interventions, and a theory of how systemic change might occur. It empowers school counselors to be catalysts of change toward an LGBTQ-inclusive school climate.
Keywords: LGBTQ+ Persons -- Psychosocial Factors; Student Attitudes; Learning Environment; Counseling; Models, Psychological; Suicidal Ideation; Bullying; Counselors; Empowerment

Psychosocial vulnerability and HIV-related sexual risk among men who have sex with men and women in the United States. - Dyer, Typhanye P; Regan, Rotrease; Pacek, Lauren R; Acheampong, Abenaa; Khan, Maria R (Archives of Sexual Behavior, 2015)
In the U.S., HIV is concentrated among men who have sex with men (MSM), some of whom have had female partners (MSMW). MSMW are disproportionately impacted by psychosocial vulnerabilities, like depression and substance use that increase sexually transmitted infection (STI) and HIV risk. Research on psychosocial vulnerability and HIV-related sexual risk among MSMW is warranted to reduce infection transmission among MSM and to prevent bridging to female partners. We analyzed data from Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health to assess psychosocial vulnerability and HIV risk-taking among MSMW. Using lifetime and past year sexual activity, we classified men as ever having sex with: women only (MSW), men only (MSMO) or MSMW, with further refined categorization of MSMW with male only partners in the past 12 months, only female partners in the past 12 months, and both male and female partners in the past 12 months (N = 6,945). We compared psychosocial vulnerability characteristics and HIV-related risk behaviors among the five categories of men. MSMW were more likely to report depression, suicidality, substance use, and incarceration than MSW and MSMO. Compared to MSW, MSMW with current female partners had greater odds of unprotected sex, exchange sex, and STI. MSMW with male partners in the past year had greater odds of multiple or concurrent partners in the past year. HIV risk and psychosocial vulnerability factors are elevated among MSMW, a priority population for HIV risk reduction. HIV risk reduction interventions should address this and heterogeneity of sexual partnerships among MSMW.
Keywords: Bisexuality; HIV Infections -- Transmission; Stress, Psychological -- Epidemiology; Unsafe Sex; Adolescence; Adult; Child; Depression; Female; Human; Interviews; Prospective Studies; Male; Qualitative Studies; Risk Factors; Risk Taking Behavior; Sexually Transmitted Diseases; Substance Use Disorders -- Epidemiology; United States; Young Adult

HIV Risk, Substance Use, and Suicidal Behaviors Among Asian American Lesbian and Bisexual Women. - Lee, Jieha; Hahm, Hyeouk Chris (AIDS Education & Prevention, 2012)
The authors examined the association between lesbian/bisexual identity and three risky health behaviors (HIV risk, substance use, and suicidal behaviors) in a sample of Asian American women. This cross-sectional study was designed to investigate the prevalence of HIV risk behaviors and mental health functioning among unmarried Chinese, Korean, and Vietnamese women ages 18 to 35 who are children of immigrants ( N = 701), using computer-assisted survey interviews (CASI). Approximately one out of five Asian American women in the sample identified themselves as a lesbian and bisexual woman (18%). Overall, Asian American lesbian and bisexual women reported higher proportions of risky health behaviors than did their exclusively heterosexual counterparts. The odds of engaging in HIV risk behaviors, using substances, and experiencing suicidal ideation were two to three times higher for lesbian and bisexual women than for exclusively heterosexual women. These findings suggest that rigorous screening is necessary for identifying women in this lesbian/bisexual subgroup in order to provide them with better assessment and services.
Keywords: HIV Infections -- Risk Factors; Substance Abuse -- Risk Factors; Lesbians; Bisexuality; Suicidal Ideation; Risk Taking Behavior; Asians -- Psychosocial Factors; Acculturation; Female; Human; Cross Sectional Studies; Descriptive Statistics; Data Collection, Computer Assisted; Funding Source; Young Adult; Middle Age; Convenience Sample; Adult; Checklists; P-Value; Odds Ratio; Sexual Partners

Mental illness and resilience among sexual and gender minority refugees and asylum seekers. - White, Lucy Cj; Cooper, Max; Lawrence, David (British Journal of General Practice, 2019)
Keywords: Mental Disorders -- Epidemiology; Refugees -- Statistics and Numerical Data; Hardiness; Suicidal Ideation; Mental Disorders -- Psychosocial Factors; Anxiety Disorders -- Epidemiology; Substance Use Disorders -- Epidemiology; Substance Use Disorders -- Psychosocial Factors; Refugees -- Psychosocial Factors; Violence; Stress Disorders, Post-Traumatic -- Epidemiology; Discrimination; Discrimination -- Psychosocial Factors; Violence -- Psychosocial Factors; Family Practice; Depression -- Psychosocial Factors; Depression -- Epidemiology; Anxiety Disorders -- Psychosocial Factors; Stress Disorders, Post-Traumatic -- Psychosocial Factors

The peripubertal gender-dysphoric child: puberty suppression and treatment paradigms. - Olson, Johanna; Garofalo, Robert (Pediatric Annals, 2014)
Gender-nonconforming youth are emerging at increasingly younger ages, and those experiencing gender dysphoria are seeking medical care at, or sometimes even before, the onset of puberty. Youth with gender dysphoria are at high risk for depression, anxiety, isolation, self-harm, and suicidality at the onset of a puberty that feels wrong. Medical providers would benefit from understanding interventions that help gender-nonconforming children and youth thrive. The use of gonadotropin-releasing hormone (GnRH) agonists to block the onset of an undesired puberty in youth with gender dysphoria is a relatively new practice, particularly in the United States. These medications shut down the hypothalamic-pituitary-gonadal axis (HPG), and the production of either testosterone or estrogen is temporarily halted. Puberty blocking allows a young person to explore gender and participate more fully in the mental health therapy process without being consumed by the fear of an impending developmental process that will result in the acquisition of undesired secondary sexual characteristics. GnRH agonists have been used safely for decades in children with other medical conditions, including central precocious puberty. Potential side effects of GnRH agonists include diminished bone density, injection site problems, emotional instability, and weight gain. Preliminary data have shown GnRH agonists to be very helpful in improving behavioral and overall functioning outcomes. Puberty suppression should ideally begin in the first stages of pubertal development and can be given via intramuscular or subcutaneous injections, or via an implant that is inserted in the upper arm. Monitoring to assure suppression of the HPG axis should occur regularly. Gender-nonconforming youth who remain gender dysphoric can go on to receive cross-sex hormones for phenotypic gender transition when they are older. GnRH agonists have changed the landscape of medical intervention for youth with gender dysphoria and are rapidly becoming the standard of practice.
Keywords: Gonadorelin; Gender Identity; Child Behavior Disorders -- Drug Therapy; Puberty -- Psychosocial Factors; Sexuality; Female; Child; Male; Child, Preschool; United States; Adolescence; Clinical Assessment Tools

The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth. - Hatzenbuehler, MarkL. (Pediatrics, 2011)
OBJECTIVE: To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors. METHODS: A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students. RESULTS: Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96-0.99]). CONCLUSIONS: This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation-related disparities in suicide attempts.
Keywords: Suicide, Attempted -- Risk Factors; LGBTQ+ Persons -- Psychosocial Factors; Social Environment -- Evaluation; Suicide, Attempted -- Epidemiology; Human; Male; Female; Oregon; Adolescence; Questionnaires; School Policies; Factor Analysis; Depression -- Prevention and Control; Support, Psychosocial -- Evaluation; Bullying -- Psychosocial Factors; Confidence Intervals; Odds Ratio; Substance Abuse; Cross Sectional Studies; Social Alienation; Funding Source

Transgender Care Moves Into the Mainstream. - Buchholz, Laura (JAMA: Journal of the American Medical Association, 2015)
The article discusses the accessibility of quality health care among transgender. It offers information on the report "Injustice at Every Turn: A Report of the National Transgender Discrimination Survey," which states on the medical care received by transgender and gender-nonconforming people. It mentions the increase of HIV infection risk in transgender people with a high rate of suicide, substance abuse and violence. Also mentioned a report on identifying the gaps in LGBT health research.
Keywords: Transgender Persons; Health Care Delivery -- Trends; Education, Medical -- Trends; Health Services Needs and Demand; Primary Health Care; Physician-Patient Relations

Sexual orientation and suicidal behaviour in young people. - Meader, Nick; Chan, Melissa K. Y. (British Journal of Psychiatry, 2017)
Lesbian, gay, and bisexual (LGB) young people have been found to be at greater risk of suicidal behaviour. National prevention strategies have identified the need to reduce suicide risk in this population. However, research on specific risk factors for LGB young people that might inform suicide prevention programmes are at an early stage of development.
Keywords: Suicide, Attempted -- Psychosocial Factors; Suicidal Ideation; Sexuality; Female; Questionnaires

Research Review: Gender identity in youth: treatment paradigms and controversies. - Turban, Jack L.; Ehrensaft, Diane (Journal of Child Psychology & Psychiatry, 2018)
Background: Pediatric gender identity has gained increased attention over the past several years in the popular media, political arena, and medical literature. This article reviews terminology in this evolving field, traditional models of gender identity development and their limitations, epidemiology and natural history of cross‐gender identification among children and adolescents, co‐occurring conditions and behaviors, research into the biological and psychosocial determinants of cross‐gender identification, and research into the options regarding and benefits of clinical approaches to gender incongruent youth. Methods: Based on a critical review of the extant literature, both theoretical and empirical, that addresses the issue of pediatric gender identity, the authors synthesized what is presently known and what is in need of further research in order to elucidate the developmental trajectory and clinical needs of gender diverse youth. Results: The field of pediatric gender identity has evolved substantially over the past several years. New research suggests that cross‐gender identification is prevalent (approximately 1% of youth). These youth suffer disproportionately high rates of anxiety, depression, and suicidality. Although research into the etiology of cross‐gender identification is limited, emerging data have shown that affirmative treatment protocols may improve the high rates of mental health difficulties seen among these patients. Conclusions: The field of pediatric gender identity has evolved dramatically. Emerging data suggest that these patients' high rates of anxiety, depression, and suicidality appear to be improved with affirmative protocols, although future longitudinal data are needed. Read the Commentary on this article at doi: 10.1111/jcpp.12997
Keywords: Gender Identity -- In Infancy and Childhood; Gender Identity -- In Adolescence; Comorbidity; Child Behavior; Adolescent Behavior; Gender Dysphoria -- Therapy; Nomenclature; Anxiety; Depression; Suicidal Ideation; Adolescence; Child; Models, Theoretical; Prevalence; Protocols

Attachment-based therapy for suicidal lesbian, gay, and bisexual adolescents: a treatment development study and open trial with preliminary findings. - Diamond, Gary M; Levy, Suzanne; Ladipo, Tonya; Diamond, Guy S; Closs, Cynthia; Siqueland, Lynne (Psychotherapy, 2012)
Keywords: Attachment Behavior; Family Therapy -- Methods; LGBTQ+ Persons -- Psychosocial Factors -- In Adolescence; Suicidal Ideation -- Therapy -- In Adolescence; Adolescence; Bisexuals; Depression; Descriptive Statistics; Funding Source; Gay Men; Human; Lesbians; One-Way Analysis of Variance; Parent-Child Relations; Parents; Pennsylvania; Psychological Tests; Questionnaires; Treatment Outcomes

Oppression and Suicide. - Lester, David (Suicidology Online, 2014)
Of the four types of suicide described by Durkheim in his classic book on suicide, suicidologists have neglected fatalistic suicide, which Durkheim himself relegated to a single footnote in his book. This essay explores this neglected type of suicide. It discusses the role of oppression in suicide, ranging from the selfimmolation of Tibetan monks protesting the oppression of Tibetans by China, suicides in slaves in early America, suicide in oppressed women around the world, suicide in homosexuals and other stigmatized groups (such as Gypsies), to oppression by peers and family members. Suicide prevention strategies should include political action, freeing individuals and groups from over-regulation and helping empower the oppressed.
Keywords: Suicide -- Etiology; Oppressed Group Behavior; Suicide -- Prevention and Control; Sociological Theory; Suicide -- History; Stigma; Minority Groups; Conceptual Framework; Black Persons; Jews; Politics; Women; Marriage; Depression; World Wide Web; Gay Persons; Employer-Employee Relations; Suicide, Assisted; Female; Adolescence; Child; Male; Adult; Rituals and Ceremonies; Burial Practices; Young Adult

Gender identity: Creating a supportive school culture. - Thornton, Stephanie (British Journal of School Nursing, 2016)
The article explains the importance of shaking up pre-conceived ideas regarding gender and offers advice on creating a supportive school culture. It points out that puberty presents a major crisis for a transgender child and offers suggestions to help create school cultures more tolerant and supportive of difference and confusion in gender identity such as taking gender confusion seriously and looking out for clues for gender dysphoria and gender confusion.
Keywords: Gender Identity -- In Infancy and Childhood; Learning Environment -- In Infancy and Childhood; Support, Psychosocial -- In Infancy and Childhood; Sexual and Gender Disorders -- Psychosocial Factors -- In Infancy and Childhood; Transgender Persons -- In Infancy and Childhood; Schools; Information Resources; World Wide Web; Sexual and Gender Disorders -- Familial and Genetic; Support Groups; Family; Peer Group; Puberty; Health Policy; United Kingdom; Male; Female; Child; Adolescence; Bullying; Social Isolation; Suicide; Fetus; Brain -- Physiology; Genitalia -- Physiology; Pregnancy; Child, Preschool; Child Development; Adolescent Development

Screening for Sexual Orientation in Psychiatric Emergency Departments. - Currier, Glenn W.; Brown, Gregory; Walsh, Patrick G.; Jager-Hyman, Shari; Chaudhury, Sadia; Stanley, Barbara (Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 2015)
Keywords: Sexuality; Health Screening -- Methods; Emergency Service; Human; Mental Disorders -- Diagnosis; Suicide -- Risk Factors; Risk Assessment; Interviews; T-Tests; Chi Square Test; Male; Female; Adult; Middle Age; Descriptive Statistics

Lesbian, Gay, and Bisexual Adolescents: Population Estimate and Prevalence of Health Behaviors. - Zaza, Stephanie; Kann, Laura; Barrios, Lisa C. (JAMA: Journal of the American Medical Association, 2016)
In the article, the authors discuss the issues in the lifelong health behaviors of lesbian, gay, bisexual (LGB) adolescent individuals, claiming that LGB people are at higher risk for stigma and discrimination than their heterosexual (straight) counterparts. Also cited are the Youth Risk Behavior Surveys (YRBS) conducted by state and local agencies in the U.S. under the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System.
Keywords: Bisexuality; Lesbians -- Statistics and Numerical Data; Homosexuality; Suicide, Attempted; Female; Gender Identity; Male; Stereotyping; Smoking -- Epidemiology; Students -- Statistics and Numerical Data; Risk Taking Behavior; Sexism; Adolescence; Centers for Disease Control and Prevention (U.S.); United States; Substance Use Disorders -- Epidemiology; Schools -- Statistics and Numerical Data

4.21 Depression, Suicidality, Substance Use, and Abuse History Among Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Adolescents Who Are Psychiatrically Hospitalized. - VanBronkhorst, Sara B.; Edwards, Evonne M.; Roberts, Daniel E.; Kist, Katie; Evans, Darci L.; Mahdasian, Alexandra; Blankenship, Kelly (Journal of the American Academy of Child & Adolescent Psychiatry, 2017)

Victimisation and psychosocial difficulties associated with sexual orientation concerns: a school-based study of adolescents. - Cotter, P; Corcoran, P; McCarthy, J; O'Suilleabháin, F; Carli, V; Hoven, C; Wasserman, C; Sarchiapone, M; Wasserman, D; Keeley, H (Irish Medical Journal, 2014)
Keywords: Adolescent Behavior; Bullying -- Psychosocial Factors; Sexuality; Students -- Psychosocial Factors; Students -- Statistics and Numerical Data; Adolescence; Alcohol Drinking; Female; Human; Interpersonal Relations; Male; Suicidal Ideation

Childhood gender nonconformity and harassment as predictors of suicidality among gay, lesbian, bisexual, and heterosexual Austrians. - Plöderl M; Fartacek R (Archives of Sexual Behavior, 2009)
Keywords: Bisexuality; Child Behavior; Gender Identity; Heterosexuality; Homosexuality; Lesbians -- Psychosocial Factors; Suicide -- Psychosocial Factors; Adolescence; Adult; Aged; Analysis of Variance; Austria; Child; Female; Male; Middle Age; Multivariate Analysis; Perception; Social Behavior; Human

Effects of violence on transgender people. - Testa, Rylan J.; Sciacca, Laura M.; Wang, Florence; Hendricks, Michael L.; Goldblum, Peter; Bradford, Judith; Bongar, Bruce (Professional Psychology: Research & Practice, 2012)
While recent research on transgender populations has demonstrated high rates of experiencing violence, there has been little research attention to the mental health implications of these experiences. This study utilized data collected from the Virginia Transgender Health Initiative Survey (THIS) of transgender people (individuals who described their gender identity as different from their sex assigned at birth) collected from 2005DS2006. Current study analyses were limited to two subgroups: trans women (n = 179) and trans men (n = 92). We hypothesized that, as in the general population, exposure to physical and sexual violence would be related to suicidal ideation, suicide attempts, and substance abuse. Both trans women and trans men in this sample were at high risk for physical and sexual violence, as well as suicidal ideation and suicide attempt. Logistic regression analyses indicated that among both trans women and trans men, those who had endured physical and/or sexual violence were significantly more likely than those who had not had such experiences to report a history of suicide attempt and multiple suicide attempts. In addition, among trans men, history of physical and sexual violence were each related to alcohol abuse. Among trans women, history of sexual violence was related to alcohol abuse and illicit substance use. Patterns of violence against transgender people were identified and are discussed, including frequent gender-related motivation for violence, low prevalence of reporting violence to police, and variety of perpetrators of violence. Clinical implications and recommendations are provided.
Keywords: Mental Health; Transgender Persons -- Psychosocial Factors; Violence -- Psychosocial Factors; Adolescence; Adult; Aged; Chi Square Test; Data Analysis Software; Descriptive Statistics; Female; Human; Logistic Regression; Male; Middle Age; P-Value; Questionnaires; Sexual Abuse -- Psychosocial Factors; Suicidal Ideation; Suicide, Attempted; Survey Research

Complicated suicide versus autoeroticism?: a case involving multiple drugs and a porta-potty. - Dickerson, Evan Matthew; Jones, Prentiss; Wilkins, Dennis; Regnier, Janis; Prahlow, Joseph A (American Journal of Forensic Medicine & Pathology, 2013)
Keywords: Suicide; Toilet Facilities; Cross-dressing; Absorption; Adult; Amphetamine -- Analysis; Analgesics, Opioid -- Analysis; Analgesics, Opioid -- Poisoning; Asphyxia -- Etiology; Central Nervous System Stimulants -- Analysis; Disinfectants -- Analysis; Disinfectants -- Pharmacokinetics; Fever; Forensic Medicine -- Etiology; Formaldehyde; Formaldehyde -- Analysis; Male; Tramadol; Tramadol -- Analysis

Influences on loneliness, depression, sexual-risk behaviour and suicidal ideation among Thai transgender youth. - Yadegarfard, Mohammadrasool; Ho, Robert; Bahramabadian, Fatemeh (Culture, Health & Sexuality, 2013)
This study examined the influence of age, education level and number of sex partners on levels of loneliness, depression, suicidal ideation and sexual-risk behaviour in Thai male-to-female transgender youth. A total of 190 participants filled in the study's questionnaire, designed to tap the primary variables of age, level of education, number of sex partners, loneliness, depression, suicidal ideation and sexual-risk behaviour. Results reveal that level of education has a significant influence on depression and loneliness, the number of sex partners has a significant influence on sexual-risk behaviour and suicidal ideation and age has a significant influence on sexual-risk behaviour and suicidal ideation. Participants with higher levels of education reported more loneliness than participants who did not graduate from high school. In addition, participants who did not graduate from high school reported more depression than participants with some university credit. Furthermore, participants aged 15 to 19 years, compared with those of 20 to 25 years, reported higher level of sexual-risk behaviour and higher levels of suicidal ideation.
Keywords: Depression -- Psychosocial Factors; Loneliness -- Psychosocial Factors; Sexual Partners -- Psychosocial Factors; Suicidal Ideation; Transgender Persons -- Psychosocial Factors; Adolescence; Age Factors; Analysis of Variance; Education; Human; Male; Questionnaires; Thailand; Unsafe Sex; Young Adult

The association between relationship markers of sexual orientation and suicide: Denmark, 1990-2001. - Mathy RM; Cochran SD; Olsen J; Mays VM; Mathy, Robin M; Cochran, Susan D; Olsen, Jorn; Mays, Vickie M (Social Psychiatry & Psychiatric Epidemiology, 2011)
Objective: Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12-year period following legalization of same-sex registered domestic partnerships (RDPs).Method: Using data from death certificates issued between 1990 and 2001 and population estimates from the Danish census, we estimated suicide mortality risk among individuals classified into one of three marital/cohabitation statuses: current/formerly in same-sex RDPs; current/formerly heterosexually married; or never married/registered.Results: Risk for suicide mortality was associated with this proxy indicator of sexual orientation, but only significantly among men. The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married.Conclusions: Suicide risk appears greatly elevated for men in same-sex partnerships in Denmark. To what extent this is true for similar gay and bisexual men who are not in such relationships is unknown, but these findings call for targeted suicide prevention programs aimed at reducing suicide risk among gay and bisexual men.
Keywords: Bisexuality; Cause of Death -- Trends; Homosexuality; Suicide; Adolescence; Adult; Demography; Aged; Denmark; Female; Lesbians -- Psychosocial Factors; Lesbians -- Statistics and Numerical Data; Human; Male; Middle Age; Minority Groups -- Psychosocial Factors; Minority Groups -- Statistics and Numerical Data; Risk Factors; Sexuality; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Suicide, Attempted -- Prevention and Control; Suicide, Attempted -- Psychosocial Factors; Suicide, Attempted

Gender Minority Stress, Depression, and Anxiety in a Transgender High School Student. - Davies, Robert D.; Kessel, Barbara (American Journal of Psychiatry, 2017)
The article offers information on the higher rates of suicidal ideation and depression experienced by transgender individuals than the general population in the U.S. It discusses the four external stress types experienced by transgender individuals posits by gender minority stress model, which include victimization, identity nonaffirmation, discrimination and rejection.
Keywords: Toilet Facilities -- Legislation and Jurisprudence; Anxiety -- Prevention and Control; Depression -- Prevention and Control; Anxiety -- Complications; Male; Students -- Psychosocial Factors; Adolescence; Schools; Depression -- Complications; Female; Questionnaires

Sexual orientation and its relation to mental disorders and suicide attempts: findings from a nationally representative sample. - Bolton SL; Sareen J; Bolton, Shay-Lee; Sareen, Jitender (Canadian Journal of Psychiatry, 2011)
Objective: To compare the rates of all Axis I and II mental disorders and suicide attempts in sexual orientation minorities with rates in heterosexuals using a nationally representative sample.Method: Data used were from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (n = 34 653, response rate = 70.2%). Cross-tabulations and multivariate logistic regression analyses were performed to determine differences in rates of mental disorders and suicide attempts by sexual orientation. All analyses were stratified by sex.Results: Compared with their heterosexual counterparts, lesbians and bisexual women demonstrated a 3-fold increased likelihood of substance use disorders, and gay and bisexual men showed twice the rate of anxiety disorders and schizophrenia and (or) psychotic illness, even after accounting for mental disorder comorbidity. Suicide attempts were independently associated with bisexuality, with odds 3 times higher than in heterosexuals.Conclusion: Findings from our study emphasize the fact that sexual orientation minorities are vulnerable to poor mental health outcomes, including suicide attempts. Clinicians need to be aware of these specific negative mental health consequences when assessing sexual orientation minorities.
Keywords: Bisexuality; Lesbians -- Statistics and Numerical Data; Homosexuality; Mental Disorders -- Epidemiology; Sexuality; Suicide, Attempted; Adult; Aged; Alcoholism -- Epidemiology; Alcoholism -- Psychosocial Factors; Anxiety Disorders -- Epidemiology; Anxiety Disorders -- Psychosocial Factors; Comorbidity; Cross Sectional Studies; Female; Heterosexuality; Lesbians -- Psychosocial Factors; Human; Logistic Regression; Male; Mental Disorders -- Psychosocial Factors; Middle Age; Affective Disorders -- Epidemiology; Affective Disorders -- Psychosocial Factors; Multivariate Analysis; Personality Disorders -- Epidemiology; Personality Disorders -- Psychosocial Factors; Psychotic Disorders -- Epidemiology; Psychotic Disorders -- Psychosocial Factors; Risk Factors; Schizophrenia -- Epidemiology; Psychology; Statistics; Substance Use Disorders -- Epidemiology; Substance Use Disorders -- Psychosocial Factors; Suicide, Attempted -- Psychosocial Factors; United States; Young Adult

What has changed from 2001 to 2012 for sexual minority youth in New Zealand? - Lucassen, Mathijs Fg; Clark, Terryann C; Denny, Simon J; Fleming, Theresa M; Rossen, Fiona V; Sheridan, Janie; Bullen, Pat; Robinson, Elizabeth M (Journal of Paediatrics & Child Health, 2015)
Aim: To provide an overview of the health and well-being of sexual minority high school students in New Zealand, investigate differences between sexual minority youth (SMY) and exclusively opposite-sex-attracted youth (EOSAY), and examine changes across survey waves.Methods: Nationally representative cross-sectional surveys were completed in 2001 (n = 9011), 2007 (n = 8002) and 2012 (n = 8167). Logistic regressions were used to examine the associations between selected outcomes and sexual attraction across survey waves.Results: SMY accounted for 6% of participants in all three waves, with a greater proportion being 'out' in 2012 (P < 0.0001). SMY were more likely to work as volunteers (OR = 1.37) than EOSAY, and the majority of SMY reported good general health, liking school and having caring friends. With the exceptions of binge drinking and being driven dangerously by someone, SMY reported comparatively diminished health and well-being relative to EOSAY. Increasing proportions of SMY had depressive symptoms from 2001 (OR = 2.38) to 2012 (OR = 3.73) compared with EOSAY. There were some differences between the sexes; female SMY were less likely to report positive family relationships (OR = 0.59) and liking school (OR = 0.55), and they were more likely to have been hit (2012 OR = 1.95) than female EOSAY. Male SMY reported especially high rates of suicide attempts (2012 OR = 5.64) compared with male EOSAY.Conclusions: Health services, schools, communities and families must be more responsive to the needs of SMY to ensure that disparities are addressed.

Nonheterosexual adolescents and suicidal ideation: Risks and protective factors. - Cambre, April (Brown University Child & Adolescent Behavior Letter, 2011)
The article presents a case study of a 16-year old male who was taken to an inpatient unit after reporting suicidal ideation and vague homicidal ideation following an incident of criminal and intoxication behavior. He reported depression for several months and frequent substance abuse with occasional black-out episodes. He began to identify himself as a gay during his hospitalization. The study indicates that LGBT youth are at risk of suicidal ideation compared to heterosexual youth.
Keywords: Suicidal Ideation -- Risk Factors; LGBTQ+ Persons -- Psychosocial Factors; Suicide, Attempted -- Risk Factors; Male; Adolescence; Substance Abuse; Bisexuals; Gay Men; Serotonin Uptake Inhibitors; Depression; Family Functioning

A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: time for a new public health research and practice agenda. - Bouris A; Guilamo-Ramos V; Pickard A; Shiu C; Loosier PS; Dittus P; Gloppen K; Michael Waldmiller J; Bouris, Alida; Guilamo-Ramos, Vincent; Pickard, Angela; Shiu, Chengshi; et al. (Journal of Primary Prevention, 2010)
Relatively little is known about how parents influence the health and well-being of lesbian, gay, and bisexual (LGB) adolescents and young adults. This gap has led to a paucity of parent-based interventions for LGB young people. A systematic literature review on parental influences on the health of LGB youth was conducted to better understand how to develop a focused program of applied public health research. Five specific areas of health among LGB young people aged 10-24 years old were examined: (a) sexual behavior; (b) substance use; (c) violence and victimization; (d) mental health; and (e) suicide. A total of 31 quantitative articles were reviewed, the majority of which were cross-sectional and relied on convenience samples. Results indicated a trend to focus on negative, and not positive, parental influences. Other gaps included a dearth of research on sexual behavior, substance use, and violence/victimization; limited research on ethnic minority youth and on parental influences identified as important in the broader prevention science literature; and no studies reporting parent perspectives. The review highlights the need for future research on how parents can be supported to promote the health of LGB youth. Recommendations for strengthening the research base are provided.
Keywords: Health Services Research -- Methods; Homosexuality; Lesbians -- Psychosocial Factors; Parents -- Psychosocial Factors; Public Health; Public Health -- Methods; Adaptation, Psychological; Adolescence; Adult; Age Factors; Attitude to Health; Bisexuality; Child; Female; Health Status; HIV Infections -- Psychosocial Factors; Human; Lesbians -- Statistics and Numerical Data; Male; Mental Health; Psychometrics; Risk Taking Behavior; Sexuality; Sexually Transmitted Diseases -- Psychosocial Factors; Stress, Psychological; Suicide -- Psychosocial Factors; Systematic Review; United States; Young Adult

Lost in the Margins? Intersections Between Disability and Other Nondominant Statuses With Regard to Peer Victimization. - McGee, Marjorie G. (Journal of School Violence, 2014)
This study examined the extent to which disability status, alone and in combination with other social identities, was associated with differential levels of exposure to peer victimization. Logistic analyses of survey responses from eleventh graders completing the 2008 Oregon Healthy Teen survey (N = 7,091) utilized an intersectional, intercategorical method. Findings revealed that youth with disabilities were significantly more likely to report exposure to peer victimization, compared to youth without disabilities. The highest odds of exposure to peer victimization were found among disabled sexual minority males (adjusted odds ratio [AOR] = 10.8 [5.84, 19.9]) and females (AOR = 4.0 [3.06, 5.25]). In order to effectively address the problem of peer victimization, it will be important to focus on youth with multiple marginalized identities including disability.
Keywords: Peer Group; Victims; School Violence -- Oregon; Disabled; Oregon; Human; Sex Factors; Conceptual Framework; Social Identity; Bullying; Race Factors; Secondary Analysis; Bivariate Statistics; Logistic Regression; Descriptive Statistics; Female; Male; Gay Persons; Odds Ratio

Injury in the transgender population: What the trauma surgeon needs to know. - Morrison, Shane D.; Kolnik, Sarah M.; Massie, Jonathan P.; Crowe, Christopher S.; Dugi III, Daniel; Friedrich, Jeffrey B.; Pham, Tam N.; Berli, Jens U.; O'Keefe, Grant E.; Bulger, Eileen M.; Maier, Ronald V.; Mandell, Samuel P.; et al. (Journal of Trauma & Acute Care Surgery, 2018)
Gender dysphoria, or the distress caused by the incongruence between a person's assigned and experienced gender, can lead to significant psychosocial sequelae and increased risk of suicide (>40% of this population) and assault (>60% of this population). With an estimated 25 million transgender individuals worldwide and increased access to care for the transgender population, trauma surgeons are more likely to care for patients who completed or are in the process of medical gender transition. As transgender health is rarely taught in medical education, knowledge of the unique health care needs and possible alterations in anatomy is critical to appropriately and optimally treat transgender trauma victims. Considerations of cross-gender hormones and alterations of the craniofacial, laryngeal, chest, and genital systems are offered in this review. Further research on the optimal treatment mechanisms for transgender patients is needed.
Keywords: Wounds and Injuries -- Surgery; Gender Affirmation Surgery; Genitalia, Female -- Surgery; Hormones; Male; Female; Breast Reconstruction; Face -- Surgery; Genitalia, Male -- Surgery; Tissue; Psychosocial Adjustment to Illness Scale

Suicidal ideation and attempt among adolescents reporting "unsure" sexual identity or heterosexual identity plus same-sex attraction or behavior: forgotten groups? - Zhao Y; Montoro R; Igartua K; Thombs BD; Zhao, Yue; Montoro, Richard; Igartua, Karine; Thombs, Brett D (Journal of the American Academy of Child & Adolescent Psychiatry, 2010)
Objective: To compare risk of suicide ideation and attempts in adolescents with 1) gay, lesbian, or bisexual (GLB) identity, 2) "unsure" identity, or 3) heterosexual identity with same-sex attraction/fantasy or behavior, to heterosexual identity without same-sex attraction/fantasy or behavior.Method: A total of 1,856 students 14 years of age and older from 14 public and private high schools in Montréal, Québec, were surveyed anonymously. The survey included items assessing sexual orientation, health risk behaviors, and suicidal ideation and attempts. Multiple logistic regression models were used to assess risk factors for suicidal ideation and attempts.Results: In all, 58 (3.1%) adolescents self-identified as GLB, 59 (3.2%) as unsure, and 115 (6.2%) as heterosexual with same-sex attraction/fantasy or behavior. Compared with heterosexually identified youth without same-sex attraction/fantasy or behavior (N = 1,624; 87.5%), in multivariable analyses, 12-month suicidal ideation was significantly higher for both GLB (odds ratio [OR] = 2.31, 95% confidence interval [CI] = 1.22-4.37) and unsure youth (OR = 2.64, 95% CI = 1.38-5.08). Twelve-month suicide attempts were significantly elevated for GLB youth (OR = 2.23, 95% CI = 1.15-4.35) and high, although not statistically significant, for unsure youth (OR = 1.61, 95% CI = 0.77-3.36). Heterosexual identity with same-sex attraction/fantasy or behavior was not significantly associated with increased suicidal ideation (OR = 1.26, 95% CI = 0.76-2.08) or attempts (OR = 1.03, 95% CI = 0.55-1.91) in multivariable analyses.Conclusion: Compared with heterosexual youth without same-sex attraction/fantasy or behavior, adolescents with GLB and unsure identities were at greater risk of suicidality. However, youth who reported same-sex attraction or behavior but a heterosexual identity were not at elevated risk.
Keywords: Gender Identity; Lesbians -- Psychosocial Factors; Lesbians -- Statistics and Numerical Data; Homosexuality; Suicide, Attempted -- Psychosocial Factors; Suicide, Attempted; Adolescence; Aggression -- Psychosocial Factors; Child Abuse -- Psychosocial Factors; Child Abuse; Child Abuse, Sexual -- Psychosocial Factors; Child Abuse, Sexual; Cross Sectional Studies; Depression -- Epidemiology; Depression -- Psychosocial Factors; Female; Surveys; Human; Probability; Male; Quebec; Risk Factors; Sexuality; Statistics; Substance Use Disorders -- Epidemiology; Substance Use Disorders -- Psychosocial Factors; Unsafe Sex

Structural stigma and all-cause mortality in sexual minority populations. - Hatzenbuehler, Mark L.; Bellatorre, Anna; Lee, Yeonjin; Finch, Brian K.; Muennig, Peter; Fiscella, Kevin (Social Science & Medicine, 2014)
Abstract: Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma—operationalized as living in communities with high levels of anti-gay prejudice—increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR] = 3.03, 95% Confidence Interval [CI] = 1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4–20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations.
Keywords: LGBTQ+ Persons; Cause of Death -- Evaluation; Mortality -- Risk Factors; Stigma -- Evaluation; Human; Prospective Studies; Male; Female; Adult; Middle Age; Descriptive Statistics; Confidence Intervals

Conditions of Living: Queer Youth Suicide, Homonormative Tolerance, and Relative Misery. - Cover, Rob (Journal of LGBT Youth, 2013)
Keywords: Depression; LGBTQ+ Persons -- Psychosocial Factors; Suicide; Communities; Child; Adolescence; Attitude to Sexuality; Homophobia -- Prevention and Control; Self Concept; Conceptual Framework; Politics; Social Attitudes; Social Environment; Culture; Social Identity

Correlates of Depressed Mood among Young Stimulant-Using Homeless Gay and Bisexual Men. - Nyamathi, Adeline; Branson, Catherine; Idemundia, Faith; Reback, Cathy; Shoptaw, Steven; Marfisee, Mary; Keenan, Colleen; Khalilifard, Farinaz; Liu, Yihang; Yadav, Kartik (Issues in Mental Health Nursing, 2012)
Homeless gay and bisexual (G/B) men are at risk for suicide attempts and have high risk of depressed mood, defined as elevated level of depressive symptoms. This study describes baseline socio-demographic, cognitive, psychosocial, and health- and drug-related correlates of depressed mood in 267 stimulant-using homeless G/B young men who entered a study designed to reduce drug use. G/B men without social support were 11 times more likely to experience depressed mood than their counterparts who had support; those who reported severe body pain were almost six times more likely to report depressed mood than those without pain. Other factors that increased risk of depressed mood included being homeless in the last four months, injecting drugs, reporting poor or fair health status, and high levels of internalized homophobia. This study is one of the first studies to draw a link between pain experienced and depressed mood in homeless young G/B men. Understanding the correlates of depressed mood among homeless G/B young men can help service providers design more targeted treatment plans and provide more appropriate referrals to ancillary care services.
Keywords: Depression; Homeless Persons; Gay Men; Bisexuality; Substance Abuse; Male; Human; Random Sample; Clinical Trials; California; Adult; Scales; Data Analysis Software; Descriptive Statistics; Center for Epidemiological Studies Depression Scale

Different relational models underlie prototypical left and right positions on social issues. - Simpson, Ain; Laham, Simon M. (European Journal of Social Psychology, 2015)
Social issues are important dividing lines in the 'culture wars' between the political left and right. Despite much research into social issue stance and ideology, little research has explored these with Relational Models Theory (RMT). RMT proposes four distinct models that people use to construe social relations, each entailing distinct moral considerations. In two studies, participants read summaries of the models, rated how relevant each was to their positions on several social issues (e.g., capital punishment), and expressed issue positions. In Study 1, Communal Sharing and Equality Matching construals predicted prototypical liberal positions across a range of issues; Authority Ranking and Market Pricing construals predicted prototypical conservative positions. By using multilevel modelling in Study 2, individual differences in average Communal Sharing and Authority Ranking construals predicted prototypical liberal and conservative positions, respectively, independent of several factors known to predict social issue stance. In issue-specific analyses (e.g., focusing on euthanasia), all models showed effects independent of self-reported ideology, while for certain issues (same-sex marriage, animal testing, gun control, and flag burning), issue construal using different models predicted opposing positions, implicating relational models in moral disagreement. This paper provides novel tests of Relationship Regulation Theory and suggests that RMT is relevant in understanding political ideology, social issue stance, and moral judgement.
Keywords: Social Attitudes; Models, Statistical; Authority; Human; Male; Female; Adult; Students, Undergraduate; Australia; Summated Rating Scaling; Scales; Survey Research; Middle Age; Descriptive Statistics; Data Analysis Software; Pearson's Correlation Coefficient

Suicidality among gay, lesbian and bisexual youth: the role of protective factors. - Eisenberg ME; Resnick MD (Journal of Adolescent Health, 2006)
PURPOSE: Many reports have indicated that gay, lesbian and bisexual (GLB) youth are particularly vulnerable to poor outcomes, including suicide. Certain protective factors are likely to reduce this risk. The present study examines four protective factors (family connectedness, teacher caring, other adult caring, and school safety) and their association with suicidal ideation and attempts among adolescents with same-gender experience. METHODS: Data come from the 2004 Minnesota Student Survey of 9th and 12th grade students; 21,927 sexually active youth were grouped according to the gender of their sex partner(s) into GLB and non-GLB groups. Four protective factors and suicidal ideation and attempts were compared across groups. Logistic regression was used to examine the influence of protective factors on suicide, and predicted probabilities of suicidal ideation and attempts were estimated using general linear modeling. RESULTS: There were 2,255 respondents who reported same-gender experience. Over half of GLB students had thought about suicide and 37.4% reported a suicide attempt. GLB youth reported significantly lower levels of each protective factor than their non-GLB peers. Family connectedness, adult caring, and school safety were significantly protective against suicidal ideation and attempts. Risk associated with a GLB sexual orientation is largely mediated through protective factors. CONCLUSIONS: Sexual orientation alone accounts for only a small portion of variability in suicidal ideation and attempts. If protective factors were enhanced among GLB youth, suicide in this population is expected to be considerably lower. Protective factors examined here are amenable to change and should be targeted in interventions.
Keywords: Bisexuals -- Psychosocial Factors -- In Adolescence; Gay Persons -- Psychosocial Factors -- In Adolescence; Suicidal Ideation -- Risk Factors -- In Adolescence; Suicide, Attempted -- Risk Factors -- In Adolescence; Adolescence; Bivariate Statistics; Chi Square Test; Coefficient Alpha; Confidence Intervals; Female; Funding Source; Heterosexuals; Logistic Regression; Male; Minnesota; Multiple Logistic Regression; Odds Ratio; Sexuality; Students, High School; Survey Research; Human

Gender-Related Victimization, Perceived Social Support, and Predictors of Depression Among Transgender Australians. - Boza, Crystal; Nicholson Perry, Kathryn (International Journal of Transgenderism, 2014)
ABSTRACT.This study examined mental health outcomes, gender-related victimization, perceived social support, and predictors of depression among 243 transgender Australians (n= 83 assigned female at birth,n= 160 assigned male at birth). Overall, 69% reported at least 1 instance of victimization, 59% endorsed depressive symptoms, and 44% reported a previous suicide attempt. Social support emerged as the most significant predictor of depressive symptoms (p>.05), whereby persons endorsing higher levels of overall perceived social support tended to endorse lower levels of depressive symptoms. Second to social support, persons who endorsed having had some form of gender affirmative surgery were significantly more likely to present with lower symptoms of depression. Contrary to expectations, victimization did not reach significance as an independent risk factor of depression (p=.053). The pervasiveness of victimization, depression, and attempted suicide represents a major health concern and highlights the need to facilitate culturally sensitive health care provision.
Keywords: Support, Psychosocial; Depression -- Psychosocial Factors; Transgender Persons -- Psychosocial Factors -- Australia; Discrimination -- Psychosocial Factors; Mental Health; Human; Australia; Male; Female; Suicide -- Psychosocial Factors; Cultural Sensitivity; Descriptive Statistics; Adolescence; Adult; Middle Age; Aged; Questionnaires; Purposive Sample; Center for Epidemiological Studies Depression Scale; Violence -- Psychosocial Factors; Multiple Regression; Spearman's Rank Correlation Coefficient; Data Analysis Software

The impact of hate violence on victims: emotional and behavioral responses to attacks. - Barnes A; Ephross PH (Social Work, 1994)
Criminal acts stemming from prejudice based on race, religion, sexual orientation, or ethnicity -- frequently referred to as 'hate violence' -- have increased during recent years. This study explored the nature of hate attacks and victims' responses to them. The sample consisted of 59 victims and included black, white, and Southeast Asian people. Data were obtained through focus group meetings, individual interviews, and questionnaires. More than half of the victims reported experiencing a series of attacks rather than a single attack. Anger, fear, and sadness were the emotional responses most frequently reported by victims. About one-third of the victims reported behavioral responses such as moving from the neighborhood or purchasing a gun. The response of hate violence victims were similar to those of victims of other types of personal crime. Implications for social work intervention are discussed.
Keywords: Racism; Violence; Victims; Coping; Exploratory Research; Pilot Studies; Focus Groups; Interviews; Questionnaires; Sampling Methods; Behavioral Changes; Emotions; Asians; Black Persons; White Persons; Hispanic Americans; Adolescence; Adult; Middle Age; Aged; Male; Female; Human

The health and health care of lesbian, gay, and bisexual adolescents. - Coker TR; Austin SB; Schuster MA (Annual Review of Public Health, 2010)
Adolescents face a variety of challenges in their transition to adulthood; lesbian, gay, and bisexual adolescents face these typical challenges as well as additional challenges that are related to the social stigma of their sexual orientation. For some lesbian, gay, and bisexual adolescents, this stigma may induce psychosocial stress, leading to increased health risk behaviors and poorer health outcomes. In this article, we review data on the health and health care of LGB adolescents. We examine health indicators and health risks for LGB youth, including substance use, eating disorders, suicidality, risky sexual behaviors, violence exposure and victimization, and homelessness. We also examine health care provision and utilization for LGB youth. Lastly, we discuss ways in which researchers and clinicians can improve LGB adolescent health and health care.
Keywords: Bisexuality; Health Status; Lesbians; Homosexuality; Adolescence; Adolescent Health Services; Crime Victims; Eating Disorders; Female; Homeless Persons; Male; Risk Taking Behavior; Sexuality; Substance Use Disorders; Suicide; Violence

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

A Protocol Analysis of the Reasons for Living Scale Items with a Sample of Gay, Lesbian, and Bisexual Adults. - Garrett, Karmen M.; Waehler, Charles A.; Rogers, James R. (Suicidology Online, 2012)
A sample of gay, lesbian, and bisexual adults (N=19) was interviewed regarding their perception of the relevance and interpretation of items in the Reasons for Living Inventory (Linehan et al., 1983). Interviews revealed that many RFL items were relevant to these LGB participants. However, participants also revealed that a number of the items conveyed assumptions of traditional heterosexual lifespan trajectories and belief systems with limited relevance to LGB experiences. Overall, the findings of these interviews suggest that previous research with LGB adults indicating fewer reasons to live as endorsed on the RLF, may have been an artifact of the lack of alignment of the items with the experiences of members of this population. Based on these findings, suggestions are made for the development of a version of the RFL using more inclusive language, specifically focused on the experiences of LGB individuals.
Keywords: Attitude to Life; LGBTQ+ Persons -- Psychosocial Factors -- In Adulthood; Instrument Validation; Life Experiences; Adolescence; Adult; Factor Analysis; Family Relations; Female; Human; Interview Guides; Interviews; Male; Middle Age; Protocols; Psychological Tests; Questionnaires; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Validation Studies

The Effect of Negative School Climate on Academic Outcomes for LGBT Youth and the Role of In-School Supports. - Kosciw, Joseph G.; Palmer, Neal A.; Kull, Ryan M.; Greytak, Emily A. (Journal of School Violence, 2013)
For many lesbian, gay, bisexual, and transgender (LGBT) youth, intolerance and prejudice make school a hostile and dangerous place. This study examined simultaneously the effects of a negative school climate on achievement and the role that school-based supports—safe school policies, supportive school personnel, and gay–straight alliance (GSA) clubs—may have in offsetting these effects. Data were drawn from a survey of a diverse sample of 5,730 LGBT youths who had attended secondary schools in the United States. Results from structural equation modeling showed that victimization contributed to lower academic outcomes and lower self-esteem; however, school-based supports contributed to lower victimization and better academic outcomes. Moderating effects of supports on esteem and academic outcomes were also examined through hierarchical linear regression. Results suggested that a hostile school climate has serious ramifications for LGBT students but institutional supports can play a significant role in making schools safer for these students.
Keywords: Schools, Secondary; LGBTQ+ Persons; Discrimination; Academic Achievement; Victims; Human; Surveys; Adolescence; Adult; White Persons; Black Persons; Hispanic Americans; Asians; Native Americans; School Violence; Psychological Well-Being; Curriculum; Organizational Policies; Structural Equation Modeling; Self Concept; Psychological Tests

Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso. - Grosso, Ashley L.; Ketende, Sosthenes C.; Stahlman, Shauna; Ky-Zerbo, Odette; Ouedraogo, Henri Gautier; Kouanda, Seni; Samadoulougou, Cesaire; Lougue, Marcel; Tchalla, Jules; Anato, Simplice; Dometo, Sodji; Nadedjo, Felicity D.; et al. (BMC Infectious Diseases, 2019)
Background: Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa.Methods: This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures' convergent validity, their correlations with expected variables were examined through bivariate logistic regression models.Results: One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach's alpha ranged from 0.71-0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW.Conclusions: Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.
Keywords: Named Groups -- Psychosocial Factors; Homosexuality; Stigma; Logistic Regression; Male; Female; Burkina Faso; Reproducibility of Results; Young Adult; Adult; Togo; Human; Funding Source

Gay Children and Suicidality: The Importance of Professional Nurturance. - McAndrew, Sue; Warne, Tony (Issues in Mental Health Nursing, 2012)
Suicidality among young people is a global concern, with international studies demonstrating an increased prevalence among young gay men. Being gay is not inevitably linked to mental illness, but growing up gay in a heterosexist society can compromise mental well being. This qualitative study, using free association narrative interviewing, offers an in-depth understanding of gay men's experience. One shared experience that emerged was 'knowing and not knowing,' the story of gay children growing up in a heterosexist society. This story provides valuable insights for mental health nurses becoming more attuned to the importance of providing professional nurturing of gay children.
Keywords: Suicide -- Risk Factors; Homosexuality; Psychological Well-Being; Support, Psychosocial; Child Welfare; Prevalence; Human; Narratives; Interviews; Male; Qualitative Studies; Psychoanalytic Theory; Audiorecording; Exploratory Research; Adolescence; Child

In the Wake of Don't Ask Don't Tell: Suicide Prevention and Outreach for LGB Service Members. - Wilder, Heather; Wilder, Jami (Military Psychology (Taylor & Francis Ltd), 2012)
It is estimated that lesbian, gay, and bisexual (LGB) individuals are three to five times more likely to attempt suicide than their heterosexual counterparts. Factors linked to increased LGB suicide risk are overt and covert discrimination, internalized oppression, nondisclosure of sexual orientation, and lack of adequate social support. As the U.S. military adjusts to the repeal of Don't Ask Don't Tell (DADT), it will be imperative to understand and support service people who are struggling with many of these same issues. This article explores factors linked to suicidality and provides education for professionals working with LGB service people. Emphasis is placed on strategies for the provision of support and suicide prevention for members of this population.
Keywords: Suicide -- Prevention and Control; LGBTQ+ Persons -- Psychosocial Factors; Military Personnel -- Psychosocial Factors; Discrimination -- Prevention and Control; Military Personnel -- Legislation and Jurisprudence -- United States; LGBTQ+ Persons -- Legislation and Jurisprudence -- United States; Military Services; Suicide -- Risk Factors; Stress, Occupational; United States; Family Relations

Gender dysphoria in youth: An overview for primary care providers. - Kameg, Brayden N.; Nativio, Donna G. (Journal of the American Association of Nurse Practitioners, 2018)
Background and purpose: Primary care providers who encounter children are often the first line of contact for individuals with gender dysphoria, which occurs when sex assigned at birth is incongruent with one's true, expressed sexual identity. Because those with untreated gender dysphoria are at risk of a variety of negative outcomes, including mood symptomatology, suicidality, substance use disorders, and other psychosocial risk factors, it is critical that health care providers are adept in the provision of holistic, patient-centered care. The purpose of this report is to provide an updated review of the current evidence from the literature pertaining to the identification, treatment, and coordination of care among children with gender dysphoria within the primary care setting or medical home. Methods: Using PubMed and CINAHL, a literature review spanning from 2012 to the present was conducted using the following key words: gender dysphoria, transgender health, LGBT health, and hormone therapy. Reference lists of identified articles were also explored for relevance. Conclusions: Treatment may include a social transition, hormone antagonist therapy, or the administration of crosssex hormone therapy, with a medical home needed to facilitate coordination of care. Best practice guidelines vary across pediatric and developmental groups and include both reversible and nonreversible modalities. Screening for negative psychosocial sequelae must be completed to include mood symptomatology, suicidality, substance use disorders, and risky sexual behavior, so that appropriate screening, identification, and treatment interventions can be implemented. Implications for practice: The primary care medical home must act as a foundation for the identification of gender dysphoria and/or associated comorbidities and must treat, when able, or refer, when indicated. In addition, because of structural barriers and stigmatization, public policy often fails the transgender community and can exacerbate the aforementioned psychosocial comorbidities faced by the transgender youth community. Health care providers, particularly nurse practitioners, are in a unique position to expand on the face-to-face care provided to the community and engage in advocacy efforts to dismantle structural barriers impeding transgender individuals and communities while also providing primary health care, anticipatory guidance, and care coordination.
Keywords: Gender Dysphoria -- In Infancy and Childhood; Gender Dysphoria -- In Adolescence; Primary Health Care; Hormone Therapy; Practice Guidelines; Transgender Persons; Sexual Identity; PubMed; CINAHL Database; Gender Dysphoria -- Risk Factors; Puberty; Child; Adolescence; Gender Dysphoria -- Complications; Gender Dysphoria -- Symptoms; Gender Dysphoria -- Psychosocial Factors; Gender Dysphoria -- Therapy; Substance Use Disorders; Nurse Practitioners

Connecting the invisible dots: reaching lesbian, gay, and bisexual adolescents and young adults at risk for suicide through online social networks. - Silenzio VMB; Duberstein PR; Tang W; Lu N; Tu X; Homan CM (Social Science & Medicine, 2009)
Young lesbian, gay, and bisexual (young LGB) individuals report higher rates of suicide ideation and attempts from their late teens through early twenties. Their high rate of Internet use suggests that online social networks offer a novel opportunity to reach them. This study explores online social networks as a venue for prevention research targeting young LGB. An automated data collection program was used to map the social connections between LGB self-identified individuals between 16 and 24 years old participating in an online social network. We then completed a descriptive analysis of the structural characteristics known to affect diffusion within such networks. Finally, we conducted Monte Carlo simulations of peer-driven diffusion of a hypothetical preventive intervention within the observed network under varying starting conditions. We mapped a network of 100,014 young LGB. The mean age was 20.4 years. The mean nodal degree was 137.5, representing an exponential degree distribution ranging from 1 through 4309. Monte Carlo simulations revealed that a peer-driven preventive intervention ultimately reached final sample sizes of up to 18,409 individuals. The network's structure is consistent with other social networks in terms of the underlying degree distribution. Such networks are typically formed dynamically through a process of preferential attachment. This implies that some individuals could be more important to target to facilitate the diffusion of interventions. However, in terms of determining the success of an intervention targeting this population, our simulation results suggest that varying the number of peers that can be recruited is more important than increasing the number of randomly-selected starting individuals. This has implications for intervention design. Given the potential to access this previously isolated population, this novel approach represents a promising new frontier in suicide prevention and other research areas.
Keywords: Bisexuals; Gay Persons; Internet; Lesbians; Online Systems; Social Networks; Suicidal Ideation -- In Adolescence; Adolescence; Crisis Intervention; Female; Funding Source; Human; Male; Simulations; Suicide -- Prevention and Control; Young Adult

Moving Beyond the Basics of the Binary: Addressing Mental Health Needs and Suicidality Among Transgender Youth. - Sitkin, Nicole A.; Murota, Dinora (Journal of the American Academy of Child & Adolescent Psychiatry, 2017)
The article presents the study that investigates ways of resolving the suicidality problem and mental health necessities of transgender youth. The topics discussed the correlation between the gender and sex in different cultures, the definitions of sex and gender identity, and the hormonal characteristics used in classifying individuals as female and male at birth.
Keywords: Suicide; Adolescence; California; Students; Suicidal Ideation; Mental Health; Prevalence; Ways of Coping Questionnaire

The relationship between gender-based victimization and suicide attempts in transgender people. - Goldblum, Peter; Testa, Rylan J.; Pflum, Samantha; Hendricks, Michael L.; Bradford, Judith; Bongar, Bruce (Professional Psychology: Research & Practice, 2012)
This article presents empirical research findings from a subsample of 290 transgender participants in the Virginia Transgender Health Initiative Survey (THIS) who reported whether or not they had experienced hostility or insensitivity related to their gender identity or expression during high school, termed in-school gender-based victimization (GBV). The purpose of this study was to assess the impact of in-school GBV on rates of suicide attempts among transgender people. Of the 290 respondents, 44.8% reported they had experienced in-school GBV, and 28.5% reported a history of suicide attempt. Among those who had attempted, 32.5% reported having made one attempt, 28.6% reported a history of two attempts, and 39.0% reported having made three or more attempts. Participants who reported experiencing GBV were approximately four times more likely to have attempted suicide than those who did not. Among the subgroups of 147 trans women and 81 trans men, GBV was associated both with history of suicide attempt, and with a higher number of suicide attempts over the life span. Implications for policy and clinical interventions are discussed.
Keywords: Bullying; Discrimination; Suicide, Attempted; Transgender Persons -- Psychosocial Factors; Adolescence; Adult; Aged; Chi Square Test; Descriptive Statistics; Female; Gender Identity; Human; Male; Middle Age; Questionnaires; Schools; Suicide, Attempted -- Epidemiology; Suicide, Attempted -- Risk Factors; Survey Research

Mediating suicide: print journalism and the categorization of queer youth suicide discourses. - Cover R (Archives of Sexual Behavior, 2012)
Keywords: Communications Media; Newspapers; Sexuality; Suicide; Suicide -- Psychosocial Factors; Adolescence; Bisexuality; Bullying -- Psychosocial Factors; Depression -- Psychosocial Factors; Female; Guilt; Homosexuality; Male; Shame; Young Adult

Managing uncertainty: A grounded theory of stigma in transgender health care encounters. - Poteat, Tonia; German, Danielle; Kerrigan, Deanna (Social Science & Medicine, 2013)
Abstract: A growing body of literature supports stigma and discrimination as fundamental causes of health disparities. Stigma and discrimination experienced by transgender people have been associated with increased risk for depression, suicide, and HIV. Transgender stigma and discrimination experienced in health care influence transgender people's health care access and utilization. Thus, understanding how stigma and discrimination manifest and function in health care encounters is critical to addressing health disparities for transgender people. A qualitative, grounded theory approach was taken to this study of stigma in health care interactions. Between January and July 2011, fifty-five transgender people and twelve medical providers participated in one-time in-depth interviews about stigma, discrimination, and health care interactions between providers and transgender patients. Due to the social and institutional stigma against transgender people, their care is excluded from medical training. Therefore, providers approach medical encounters with transgender patients with ambivalence and uncertainty. Transgender people anticipate that providers will not know how to meet their needs. This uncertainty and ambivalence in the medical encounter upsets the normal balance of power in provider–patient relationships. Interpersonal stigma functions to reinforce the power and authority of the medical provider during these interactions. Functional theories of stigma posit that we hold stigmatizing attitudes because they serve specific psychological functions. However, these theories ignore how hierarchies of power in social relationships serve to maintain and reinforce inequalities. The findings of this study suggest that interpersonal stigma also functions to reinforce medical power and authority in the face of provider uncertainty. Within functional theories of stigma, it is important to acknowledge the role of power and to understand how stigmatizing attitudes ...
Keywords: Transgender Persons -- Psychosocial Factors; Stigma -- Evaluation; Professional-Patient Relations -- Evaluation; Human; Grounded Theory; Qualitative Studies; Interviews

Men’s sexual orientation and suicide: Evidence for U.S. adolescent-specific risk. - Russell, Stephen T.; Toomey, Russell B. (Social Science & Medicine, 2012)
Abstract: There is strong consensus in the research literature that adolescent and adult men who report same-sex sexual orientations, identities, and behaviors are at higher risk for suicide. Recent studies of general adolescent suicide risk have identified developmental trajectories that peak during the teenage years. Because the adolescent years are characterized by the development and heightened awareness of gender roles and sexual scripts closely tied to dominant cultural ideals of masculinity and heterosexuality, an adolescent-focused developmental trajectory for suicide risk might be particularly relevant for males with adolescent same-sex sexual orientations. We provide the first prospective examination of adolescent-specific risk for suicidality based on adolescent same-sex sexual orientation using data from the United States, the National Longitudinal Study of Adolescent Health. Tracing suicide ideation and attempts across four assessments from adolescence (Wave 1 average age 15.3 years) to young adulthood (Wave 4 average age 28.2), we documented that the risk for suicidal thoughts and attempts for adolescent same-sex attracted males is developmental in nature. Specifically, the risk for suicidal thoughts and attempts for males with same-sex attractions is largely limited to the adolescent years. These results offer new insights for suicide prevention and intervention for male adolescents and adults with same-sex sexual orientations.
Keywords: Homosexuality -- Evaluation; Suicide -- Risk Factors; Suicidal Ideation -- Evaluation; Human; Male; Adolescence; Young Adult; Prospective Studies; Descriptive Statistics

Men’s sexual orientation and suicide: Evidence for U.S. adolescent-specific risk - Russell, Stephen T.; Toomey, Russell B. (Social Science & Medicine, 2012)
Abstract: There is strong consensus in the research literature that adolescent and adult men who report same-sex sexual orientations, identities, and behaviors are at higher risk for suicide. Recent studies of general adolescent suicide risk have identified developmental trajectories that peak during the teenage years. Because the adolescent years are characterized by the development and heightened awareness of gender roles and sexual scripts closely tied to dominant cultural ideals of masculinity and heterosexuality, an adolescent-focused developmental trajectory for suicide risk might be particularly relevant for males with adolescent same-sex sexual orientations. We provide the first prospective examination of adolescent-specific risk for suicidality based on adolescent same-sex sexual orientation using data from the United States, the National Longitudinal Study of Adolescent Health. Tracing suicide ideation and attempts across four assessments from adolescence (Wave 1 average age 15.3 years) to young adulthood (Wave 4 average age 28.2), we documented that the risk for suicidal thoughts and attempts for adolescent same-sex attracted males is developmental in nature. Specifically, the risk for suicidal thoughts and attempts for males with same-sex attractions is largely limited to the adolescent years. These results offer new insights for suicide prevention and intervention for male adolescents and adults with same-sex sexual orientations.
Keywords: Homosexuality -- Evaluation; Suicide -- Risk Factors; Suicidal Ideation -- Evaluation; Human; Male; Adolescence; Young Adult; Prospective Studies; Descriptive Statistics

School Violence and Bullying Among Sexual Minority High School Students, 2009-2011. - O'Malley Olsen, Emily; Kann, Laura; Vivolo-Kantor, Alana; Kinchen, Steve; McManus, Tim (Journal of Adolescent Health, 2014)
Purpose School-based victimization has short- and long-term implications for the health and academic lives of sexual minority students. This analysis assessed the prevalence and relative risk of school violence and bullying among sexual minority and heterosexual high school students. Methods Youth Risk Behavior Survey data from 10 states and 10 large urban school districts that assessed sexual identity and had weighted data in the 2009 and/or 2011 cycle were combined to create two large population-based data sets, one containing state data and one containing district data. Prevalence of physical fighting, being threatened or injured with a weapon, weapon carrying, and being bullied on school property and not going to school because of safety concerns was calculated. Associations between these behaviors and sexual identity were identified. Results In the state data, sexual minority male students were at greater risk for being threatened or injured with a weapon, not going to school because of safety concerns and being bullied than heterosexual male students. Sexual minority female students were at greater risk than heterosexual female students for all five behaviors. In the district data, with one exception, sexual minority male and female students were at greater risk for all five behaviors than heterosexual students. Conclusions Sexual minority students still routinely experience more school victimization than their heterosexual counterparts. The implementation of comprehensive, evidence-based programs and policies has the ability to reduce school violence and bullying, especially among sexual minority students.
Keywords: School Violence -- In Adolescence; Bullying -- In Adolescence; LGBTQ+ Persons -- In Adolescence; Discrimination -- In Adolescence; Students, Minority; Human; Adolescence; Questionnaires; Geographic Factors; Adolescent Behavior; Male; Female

Hormone Treatment of Children and Adolescents with Gender Dysphoria: An Ethical Analysis. - Abel, Brendan S. (Hastings Center Report, 2014)
In the context of transgender health, most people are not comfortable with allowing a twelve-year-old child with gender dysphoria to elect to undergo gender reassignment surgery. The likelihood is too high that the child would be unable to fully comprehend the scope of a decision that carries significant, permanent consequences, particularly because the decision to surgically change gender is based upon a conception of gender that can fluctuate during adolescent years. Conversely, however, most people would not contend that this fluidity is reason to wholly deny certain medical care such as hormonal treatments to transgender youth, a demographic with extremely high rates of violent behavior, self-harm, and suicide. This paper will explore ethical considerations to this emerging debate of what therapeutic options should be offered to transgender children and adolescents. Pediatric endocrinologists have been treating gender dysphoric adolescents with puberty-suppressing drugs and, to a lesser extent, with cross-sex hormone therapies for more than twenty years. Clinicians and thought leaders have mentioned ethical components of this emerging practice in the few cohort studies and clinical review articles about the subject. However, ethics have generally been a secondary consideration in the medical academic literature. In this paper, I will provide a brief overview of the practice, summarize the current research on hormone treatment for transgender minors, and provide an ethical analysis of the practice.
Keywords: Sexual and Gender Disorders -- Drug Therapy -- In Infancy and Childhood; Hormone Therapy; Child; Adolescence; Transgender Persons; Gender Identity; Puberty; Autonomy; Holistic Care; Decision Making

Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska natives. - Evans-Campbell T; Walters KL; Pearson CR; Campbell CD; Evans-Campbell, Teresa; Walters, Karina L; Pearson, Cynthia R; Campbell, Christopher D (American Journal of Drug & Alcohol Abuse, 2012)
Background: Systematic efforts of assimilation removed many Native children from their tribal communities and placed in non-Indian-run residential schools.Objectives: To explore substance use and mental health concerns among a community-based sample of 447 urban two-spirit American Indian/Alaska Native adults who had attended boarding school as children and/or who were raised by someone who attended boarding school.Method: Eighty-two respondents who had attended Indian boarding school as children were compared to respondents with no history of boarding school with respect to mental health and substance use.Results: Former boarding school attendees reported higher rates of current illicit drug use and living with alcohol use disorder, and were significantly more likely to have attempted suicide and experienced suicidal thoughts in their lifetime compared to non-attendees. About 39% of the sample had been raised by someone who attended boarding school. People raised by boarding school attendees were significantly more likely to have a general anxiety disorder, experience posttraumatic stress disorder symptoms, and have suicidal thoughts in their lifetime compared to others.
Keywords: Native Americans -- Psychosocial Factors; Arctic Peoples -- Psychosocial Factors; Mental Disorders -- Epidemiology; Substance Use Disorders -- Epidemiology; Acculturation; Adult; Alaska; Alcohol-Related Disorders -- Epidemiology; Alcohol-Related Disorders -- Ethnology; Anxiety Disorders -- Epidemiology; Anxiety Disorders -- Ethnology; Cross Sectional Studies; Female; Surveys; Human; Native Americans -- Statistics and Numerical Data; Arctic Peoples -- Statistics and Numerical Data; Male; Mental Disorders -- Ethnology; Middle Age; Schools; Stress Disorders, Post-Traumatic -- Epidemiology; Stress Disorders, Post-Traumatic -- Ethnology; Substance Use Disorders -- Ethnology; Suicidal Ideation; Suicide, Attempted; United States; Urban Population

Suicide risk and sexual orientation: a critical review. - Plöderl, Martin; Wagenmakers, Eric-Jan; Tremblay, Pierre; Ramsay, Richard; Kralovec, Karl; Fartacek, Clemens; Fartacek, Reinhold (Archives of Sexual Behavior, 2013)
Keywords: Sexuality; Suicide, Attempted; Probability; Female; Human; Male; Relative Risk; Risk Factors; Suicide -- Psychosocial Factors; Suicide; Suicide, Attempted -- Psychosocial Factors

Does “It Get Better” for Depressed Sexual Minority Youth in Young Adulthood? - Cardom, Robert; Rostosky, Sharon; Danner, Fred (Journal of Adolescent Health, 2013)
Abstract: Purpose: To examine depressive symptoms and suicidality in adolescence and adulthood in a sample of depressed adolescents in five sexual identity groups (heterosexual, mostly heterosexual, bisexual, mostly gay, and gay). Methods: Depressed adolescents (N = 1,591) from the National Longitudinal Study of Adolescent Health were examined again in young adulthood. Results: Paired t-tests revealed that depressive symptoms declined significantly in all five sexual identity groups. McNemar chi-square tests revealed that the percentage of participants reporting suicidal ideation decreased significantly in all groups except for the mostly gay group. The percentage of participants reporting suicide attempts declined in all groups except the bisexual group. Conclusions: Within-group differences are important to consider in delivering effective mental health services. Although depressive symptoms diminished in young adulthood in all groups, suicidality did not. Mostly gay and bisexual young adults did not report the same significant declines as their peers.
Keywords: Depression -- Symptoms -- In Adolescence; Suicidal Ideation -- Evaluation -- In Adolescence; Sexuality -- Evaluation -- In Adolescence; Human; Prospective Studies; Adolescence; Young Adult; Descriptive Statistics; Paired T-Tests; McNemar's Test

Does “It Get Better” for Depressed Sexual Minority Youth in Young Adulthood? - Cardom, Robert; Rostosky, Sharon; Danner, Fred (Journal of Adolescent Health, 2013)
Abstract: Purpose: To examine depressive symptoms and suicidality in adolescence and adulthood in a sample of depressed adolescents in five sexual identity groups (heterosexual, mostly heterosexual, bisexual, mostly gay, and gay). Methods: Depressed adolescents (N = 1,591) from the National Longitudinal Study of Adolescent Health were examined again in young adulthood. Results: Paired t-tests revealed that depressive symptoms declined significantly in all five sexual identity groups. McNemar chi-square tests revealed that the percentage of participants reporting suicidal ideation decreased significantly in all groups except for the mostly gay group. The percentage of participants reporting suicide attempts declined in all groups except the bisexual group. Conclusions: Within-group differences are important to consider in delivering effective mental health services. Although depressive symptoms diminished in young adulthood in all groups, suicidality did not. Mostly gay and bisexual young adults did not report the same significant declines as their peers.
Keywords: Depression -- Symptoms -- In Adolescence; Suicidal Ideation -- Evaluation -- In Adolescence; Sexuality -- Evaluation -- In Adolescence; Human; Prospective Studies; Adolescence; Young Adult; Descriptive Statistics; Paired T-Tests; McNemar's Test

Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. - Ryan C; Huebner D; Diaz RM; Sanchez J (Pediatrics, 2009)
OBJECTIVE: We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. METHODS: On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. RESULTS: Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. CONCLUSIONS: This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.
Keywords: Bisexuality -- Ethnology; Hispanic Americans; Homosexuality -- Ethnology; Lesbians; Parent-Child Relations -- Ethnology; Social Behavior; Adult; Age Factors; Bisexuality; Female; Health Status; Hispanic Americans -- Psychosocial Factors; Homosexuality; Lesbians -- Psychosocial Factors; Male; Retrospective Design; Human

Suicidal Ideation Among Sexual Minority Veterans: Results From the 2005-2010 Massachusetts Behavioral Risk Factor Surveillance Survey. - Blosnich, John R.; Bossarte, Robert M.; Silenzio, Vincent M. B. (American Journal of Public Health, 2012)
Suicide is a public health problem disproportionately associated with some demographic characteristics (e.g., sexual orientation, veteran status). Analyses of the Massachusetts Behavioral Risk Factor Surveillance Survey data revealed that more lesbian, gay, and bisexual (i.e., sexual minority) veterans reported suicidal ideation compared with heterosexual veterans. Decreased social and emotional support contributed to explaining the association between sexual minority status and suicidal ideation. More research is needed about suicide risk among sexual minority veterans; they might be a population for outreach and intervention by the Veterans Health Administration.
Keywords: Suicidal Ideation -- Risk Factors; Veterans; Sexuality; Minority Groups; Human; Lesbians; Gay Persons; Bisexuals; Comparative Studies; Heterosexuals; Disease Surveillance -- Massachusetts; Massachusetts; Questionnaires; Social Isolation; Correlational Studies; Secondary Analysis; Surveys -- Massachusetts

Relationship of sexual orientation to substance use, suicidal ideation, suicide attempts, and other factors in a population of homeless adolescents. - Noell JW; Ochs LM (Journal of Adolescent Health, 2001)
PURPOSE: To explore the relationship of sexual orientation and gender to four sets of factors: (a) family history, (b) incarceration, (c) substance use, and (d) depression and suicide, in a population of homeless adolescents. METHODS: A sample of homeless adolescents was recruited in Portland, Oregon and assessed using semi-structured interviews at baseline, three months and six months. A total of 532 youths (216 females and 316 males) provided data on sexual orientation and other variables. Heterosexual (n = 391) and non-heterosexual youths (n = 141) were compared on all sets of factors, primarily using logistic regressions. RESULTS: 44.9% of females identified as lesbian or bisexual, while only 13.9% of males identified as gay or bisexual. Gay, lesbian, bisexual, and 'unsure' (GLBU) youths were less likely to have been in foster care or arrested, but were more likely to have spent time in a locked mental health treatment facility. More than one-third of all participants reported use of injection drugs. GLBU youths were more likely to have recently used amphetamines and to have injected drugs, however, gay-bisexual males were less likely to have recently used marijuana. GLBU status was associated with recent measures of depression and suicidal ideation, but not with lifetime measures. Associations of sexual orientation with several lifetime measures were different than with prospective measures, demonstrating the limitations of using lifetime measures rather than recent or prospective measures. CONCLUSIONS: This population of homeless adolescents appears to be higher in its high rate of injection drug use and the large proportion of females who identify as lesbian or bisexual than found in other studies. The high rates of depression and suicidal ideation, especially among GLBU youth, are of great concern.
Keywords: Homeless Persons -- Psychosocial Factors -- In Adolescence; Substance Use Disorders -- Epidemiology -- In Adolescence; Heterosexuality -- In Adolescence; Homosexuality -- In Adolescence; Bisexuality -- In Adolescence; Suicide, Attempted -- Epidemiology -- In Adolescence; Oregon; Semi-Structured Interview; Female; Suicidal Ideation -- Epidemiology -- In Adolescence; Male; Adolescence; Pearson's Correlation Coefficient; Adult; Odds Ratio; Confidence Intervals; Depression -- Epidemiology -- In Adolescence; Sex Factors; Substance Abuse, Intravenous -- Epidemiology -- In Adolescence; Funding Source; Human

Coming out to talk about suicide: gay men and suicidality. - McAndrew S; Warne T (International Journal of Mental Health Nursing, 2010)
International studies report increased rates of mental health problems and subsequent suicidality among homosexual populations. While international health-care policy is concerned with reducing suicide among young people, important research findings relating to gay people and suicidality remain unacknowledged in the Suicide Prevention Strategy for England. This qualitative study, utilizing single case studies, was used to gain an in-depth understanding of the life experiences contributing to the suicidality of four gay men. The methodology was psychoanalytically informed, using free association narrative interviewing. The initial data analysis involved interpretation of each of the case studies and a subsequent analysis exploring the shared experiences found in each of the individual narratives. Thematically, these are described as 'knowing and not knowing', 'the centrality of the father-son relationship', 'the loneliness of outsiderness', 'leading a double life', and 'crime and punishment'. The significance of the life experiences these themes illustrate reveal why some gay men might not only experience long-term mental health problems, but also engage in suicidality. Individually and collectively, the analyses provide important insights for mental health nurses becoming more attuned to provide sensitive mental health care to those who have a gay sexual orientation.
Keywords: Conflict (Psychology); Gay Men -- Psychosocial Factors; Life Experiences; Suicide -- Prevention and Control; Adult; England; Human; Interviews; Male; Narratives; Psychiatric Nursing; Purposive Sample; Qualitative Studies

Adolescent suicide in New York City: plenty of room for new research. - Ganz, Debora; Sher, Leo (International Journal of Adolescent Medicine & Health, 2012)
Abstract The act of adolescent suicide continues to threaten adolescent populations in New York City (NYC). Consistent positive correlations have been found between a plethora of risk factors present in NYC adolescent populations and suicidal ideations and behaviors. Psychiatric conditions that may contribute to the rate of adolescent suicide in NYC include depression, bipolar disorder, substance abuse and schizophrenia. Unique factors that have been found to contribute to increased rates of completed suicides in NYC include the phenomena of railway suicides and suicide tourism. Homelessness and income inequality in NYC have also been consistently correlated with increased suicidality; with one study finding suicide attempts reported by a significant percentage of new admissions to homeless shelters. Adolescent populations in NYC that have been identified as particularly vulnerable to suicidality include runaway youth, homosexual youth, victimized adolescents and adolescents with a recent history of posttraumatic stress disorder (PTSD). Longitudinal studies in NYC have found that physical and sexual abuse is highly predictive of adolescent suicidality, with variations by ethnic group. Currently, there is a disturbing lack of sufficient research on adolescent suicide in NYC, specifically regarding causal factors, the effects of television on suicide, comorbid suicidality and drug abuse, and cultural factors contributing to suicide. This dearth of literature may be related to the ethical problems inherent in suicide research, self reports and/or post mortem analyses.
Keywords: Adolescent Behavior -- Drug Effects; Adolescent Behavior; Child Abuse -- Prevention and Control; Mental Disorders -- Complications; Mental Disorders -- Epidemiology; Mental Disorders -- Psychosocial Factors; Substance Use Disorders -- Complications; Suicide -- Prevention and Control; Suicide -- Psychosocial Factors; Suicide; Adolescence; Adolescent Health Services -- Statistics and Numerical Data; Child Abuse -- Psychosocial Factors; Comorbidity; Female; Human; Prospective Studies; Male; Mental Health Services -- Statistics and Numerical Data; Needs Assessment; New York; Research; Risk Factors; Socioeconomic Factors; Substance Use Disorders -- Psychosocial Factors; Television

COMPARISON OF MALE AND FEMALE VICTIMS OF INTIMATE PARTNER HOMICIDE AND BIDIRECTIONALITY- AN ANALYSIS OF THE NATIONAL VIOLENT DEATH REPORTING SYSTEM. - Velopulos, Catherine G; Carmichael, Heather; Zakrison, Tanya L; Crandall, Marie (Journal of Trauma & Acute Care Surgery, 2019)
Introduction: Intimate partner violence (IPV) is a public health crisis, affecting at least 1:4 women and 1:9 men. A recent multi-center trial on universal screening in trauma patients showed similar rates of positive screens between men and women. Few studies have explored the bidirectional violence in opposite sex or same sex relationships. Our goal was to estimate prevalence and risk factors for the most severe manifestation of IPV: intimate partner homicide (IPH).Methods: This is a 2003-2015 retrospective review of the National Violent Death Reporting System (NVDRS), a CDC database of surveillance data. Deaths were coded IPV if the primary relationship between the suspect and victim fell into the categories of "current partner" or "ex-partner." Bivariable and multivariable analysis examined differences between groups for factors and circumstances.Results: 6,131 persons in opposite-sex relationships and 181 in same-sex relationships were murdered due to IPV. Women and Black men were disproportionately affected, and alcohol and preceding arguments were a factor in a higher proportion of male victims. Abuse preceded homicide in many women with almost half of male suspects attempting or committing suicide at the time of IPH. Women were more likely than men to use a stabbing instrument, although firearms were still the most common means for each group. In 46.5% of homicides of women, the male suspect attempted suicide (p <0.001). Bidirectionality was highest in male victims of female perpetrators, and in same-sex pairings regardless of sex of the victim.Conclusion: Homicide due to IPV is a significant public health crisis for both men and women, with women and Black men at particular risk. Firearms are the most commonly used weapon for homicide in both genders, and mental illness is not a common risk factor. A staggering proportion of these homicides involve suicide of the suspect, suggesting that each potential incident has two victims to target for prevention and intervention. Interventional programs to prevent such bidirectional mortality are urgently needed.Level Of Evidence: III STUDY TYPE: Retrospective Secondary Data Analysis.

A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. - Hendricks, Michael; Testa, Ryland J (Professional Psychology: Research & Practice, 2012)
In the last few years, transgender and gender nonconforming people have become more visible in our society, which has sparked a marked increase in awareness, interest, and attention among psychologists. Questions have emerged about the extent to which psychologists are able to work competently with this population. This article presents a framework for understanding key clinical issues that psychologists who work with transgender and gender nonconforming individuals will likely encounter in their clinical work. This article does not address the knowledge and skills required to provide services related to gender transition, but rather to provide other psychological services that these clients may need, in light of the high levels of gender-related victimization and discrimination to which they are exposed. An adaptation of the Minority Stress Model (Meyer, 2003) is presented and translated to incorporate the unique experiences encountered by transgender and gender nonconforming individuals. In particular, we examine adverse experiences that are closely related to gender identity and expression, resulting expectations for future victimization or rejection, and internalized transphobia. The impact of Minority Stress Model factors on suicide attempts is presented as a detailed example. Mechanisms by which transgender and gender nonconforming persons develop resilience to the negative psychological effects of these adverse experiences are also discussed. Recommendations for clinicians are then made to assist psychologists in developing competence in working with this population.
Keywords: Mental Health; Minority Groups -- Psychosocial Factors; Stress, Psychological; Transgender Persons -- Psychosocial Factors; Conceptual Framework; Discrimination; Gender Identity; Hardiness; Homophobia -- Psychosocial Factors; Mental Health Services; Models, Psychological; Suicide, Attempted; Violence -- Psychosocial Factors

Adolescent suicide in Australia: Rates, risk and resilience. - McNamara, Patricia M. (Clinical Child Psychology & Psychiatry, 2013)
Adolescent suicide rates in Australia have fallen significantly during recent years. The incidence, however, clearly remains a serious concern for young people, parents, professionals and policy makers. Some groups of Australian youth appear to be at heightened risk. Adolescents within the welfare system, indigenous, rural and refugee youth, along with same sex attracted young people often need very careful monitoring and support. Young men continue to take their lives more frequently than young women. Prevention programmes in Australia aim to develop resilience in young people, families and communities that can serve as protection against self harm and suicide. The improvement of mental health literacy, a fostering of adolescent self-efficacy and better access to early intervention strategies are currently privileged in national and state policies related to young people in Australia. More work is needed, however, to achieve a well integrated mental health framework capable of effectively addressing adolescent suicide prevention into the twenty-first century.
Keywords: Suicide -- Risk Factors -- Australia; Suicide -- Trends -- Australia; Hardiness -- Evaluation -- Australia; Australia; Adolescence; Incidence; Support, Psychosocial; Suicide -- Prevention and Control -- Australia; Mental Health; Self-Efficacy; Early Intervention; Health Policy

Self-perception in a clinical sample of gender variant children. - Rijn, Anouk Balleur -- van; Steensma, Thomas D; Kreukels, Baudewijntje PC; Cohen-Kettenis, Peggy T (Clinical Child Psychology & Psychiatry, 2013)
Background: Gender variance (GV) in childhood has a negative impact on the self -- concept of children in the general population and can lead to mental health problems and even suicidal ideation in adulthood. This study explored the self -- concept of clinically referred gender variant children and examined potential risk factors. Method: The Self -- Perception Profile for Children was administered to 147 children, who were referred to a gender identity clinic. Their parents completed the Child Behaviour Checklist and the Gender Identity Questionnaire to assess the degree of GV. Results: The referred children were at risk of developing a negative self -- concept; more specifically gender variant girls had low scores on 'global self -- worth', 'physical appearance' and 'behavioural conduct' compared to Dutch norms for girls. Gender variant boys had low scores on 'global self -- worth', 'scholastic competence', 'athletic competence' and 'physical appearance' compared to Dutch norms for boys. Within the group of referred children, sex differences, but no age effects, were found. The referred girls felt more competent than the referred boys on 'athletic competence' and 'scholastic functioning'. For both boys and girls poor peer relations had a significant negative relationship with self -- concept and more GV was related to a lower global self -- worth. Conclusions: Clinically referred gender variant children seemed vulnerable to developing a negative self -- concept. Poor peer relations and extreme GV might be mediating variables. Interventions might focus on enhancing acceptance of the environment and improving social skills of gender variant children.
Keywords: Self Concept; Gender Identity; Human; Child; Scales; Female; Male; Netherlands; Social Behavior; Child Behavior Checklist

The Top Social Justice News Stories of 2017. - Sofer, Dalia (AJN American Journal of Nursing, 2018)
The article focuses on the changes in the regulations regarding the use and production of guns and rifles after the mass shooting which occurred at Las Vegas, Nevada. It talks about the regulations regarding the lesbian, gay, bisexual and transgender (LGBT) rights which allows the LGBT community from using public bathrooms, on changing of birth certificates and achieving equal rights. It tells about the policy changes of the Affordable Care Act (ACA).
Keywords: Social Justice; Public Policy -- Legislation and Jurisprudence -- United States; Human Rights -- Legislation and Jurisprudence -- United States; United States; Legislation; Health Services Accessibility; LGBTQ+ Persons; Patient Protection and Affordable Care Act; Refugees; Contraception

Rethinking Concepts in Participatory Action Research and Their Potential for Social Transformation: Post-structuralist Informed Methodological Reflections from LGBT and Trans-Collective Projects. - Johnson, Katherine; Martínez Guzmán, Antar (Journal of Community & Applied Social Psychology, 2013)
ABSTRACT Participatory Action Research (PAR) aims to articulate knowledge production and transformative action. In this paper, we outline the sociopolitical background to our interest in LGBT and trans-collectives as an important territory where PAR might make some intervention in the social conditions of LGBT lives by transforming dominant forms of representation that have emerged from a history of psychological and medical pathology. We present two projects, from UK and Spain that utilize post-structuralist informed methods (interviews, photo-production, discourse analysis, narrative production) within a PAR framework. We examine their potential for problematising representations of sexuality and gender by reflecting on the knowledge produced and the transformative action they provoke. We rethink power relationships inherent in PAR concepts of 'participation' and 'empowerment' through a post-structuralist lens and argue that the achievements of PAR projects can be better understood as 'co-produced artifacts'. These (e.g. photo-exhibition) are co-owned by community members and researchers and their deployment in different settings (e.g. community or university) impacts on the meanings they convey and the action they provoke. Finally, we argue that through the use of post-structuralist methods PAR can enable effective transformative action, but caution against the practice of reinstating normative representations in the invitation to participate under specific identity categories (e.g. LGBT, Trans, mental health service user). PAR projects can do this by considering naturalized definitions of who is vulnerable or marginalized as the object and field of social transformation, and the starting point for collective and political action. Copyright © 2012 John Wiley & Sons, Ltd.
Keywords: Research, Medical; LGBTQ+ Persons; Community Programs; Patient Attitudes; Human; United Kingdom; Spain; Interviews; Narratives; Qualitative Studies; Thematic Analysis; Suicide -- Prevention and Control