Suicidality among gender minorities in Karnataka, South India - Halli, S.S.; Isac, S.; Bhattacharjee, P.; Dutta, S.; Ramesh, B.M.; Lorway, R.; Blanchard, J. (BMC Psychiatry, 2021)
Background: It is argued that Indian gender minorities displayed differential mental health problems and suicide attempts. Hence, the study was intended to understand the prevalence of anxiety, depression and suicidality among this group, specifically those living in a metropolitan city in South India. Methods: The data was generated from a cross-sectional study that employed a structured questionnaire to collect information about experiences of anxiety, depression and suicidal behavior among gender-diverse individuals in Bangalore, the capital city of Karnataka state. The study used stratified simple random sampling of eligible individuals who were 18 years of age and older and who were enrolled in an HIV prevention program implemented for gender-diverse individuals run by the Karnataka Health Promotion Trust and the University of Manitoba at the time of the study (2012). Bivariate and multivariate analyses were used to assess the relative contribution of various factors that affect suicide ideation or actual attempts among the gender diverse participants. Results: Results showed that 62% whose main source of income was Basti (socially sanctioned practice of begging), 52% of Hijras, 56% who lived with their Gurus, 58% who were not happy with their physical appearance, 55% who consumed alcohol daily, and 63% who experienced high depression had ever thought of or attempted suicide in the month prior to the survey. However, multivariate analysis showed that respondents who were not happy with their physical appearance and thought of changing it had significantly higher odds (AOR = 2.861; CI 1.468,5.576; p = 0.002) of either having thoughts that it was better being dead or wished they died. Similarly, those who experienced high depression, their odds of either having had thoughts of or having attempted suicide increased by three times (AOR = 3.997; CI 1.976, 8.071; p < 0.000). Conclusions: It is observed that a high percentage of gender minorities had attempted suicide or thought of suicide during the month preceding the data collection. The findings bring new insights on the proximate determinant of physical appearance on the suicidality of gender minorities assigned male at birth and appropriate to account for this while addressing the mental health issues. © 2021, The Author(s).
Keywords: Anxiety; Depression; Gender minorities; Hijra and Kothi; India; Karnataka; Suicidality

Factors associated with suicide attempts among Australian transgender adults - Zwickl, S.; Wong, A.F.Q.; Dowers, E.; Leemaqz, S.Y.-L.; Bretherton, I.; Cook, T.; Zajac, J.D.; Yip, P.S.F.; Cheung, A.S. (BMC Psychiatry, 2021)
Background: Transgender, including gender diverse and non-binary people, henceforth referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. We aimed to understand the risk and protective factors of a lifetime history of attempted suicide in a community sample of Australian trans adults to guide better mental health support and suicide prevention strategies. Methods: Using a non-probability snowball sampling approach, a total of 928 trans adults completed a cross-sectional online survey between September 2017 and January 2018. The survey assessed demographic data, mental health morbidity, a lifetime history of intentional self-harm and attempted suicide, experiences of discrimination, experiences of assault, access to gender affirming healthcare and access to trans peer support groups. Logistic regression was used to examine the risk or protective effect of participant characteristics on the odds of suicide. Results: Of 928 participants, 85% self-reported a lifetime diagnosis of depression, 63% reported previous self-harm, and 43% had attempted suicide. Higher odds of reporting a lifetime history of suicide attempts were found in people who were; unemployed (adjusted odds ratio (aOR) 1.55 (1.05, 2.29), p = 0.03), had a diagnosis of depression (aOR 3.70 (2.51, 5.45), p < 0.001), desired gender affirming surgery in the future (aOR 1.73 (1.14, 2.61), p = 0.01), had experienced physical assault (aOR 2.01 (1.37, 2.95), p < 0.001) or experienced institutional discrimination related to their trans status (aOR 1.59 (1.14, 2.23), p = 0.007). Conclusion: Suicidality is associated with barriers to gender affirming care, gender based victimisation and institutionalised cissexism. Interventions to increase social inclusion, reduce transphobia and enable timely access to gender affirming care, particularly surgical interventions, are potential areas of intervention. © 2021, The Author(s).
Keywords: Depression; Mental health; Suicide; Transgender

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

Pharmacokinetics of duloxetine self-administered in overdose with quetiapine and other antipsychotic drugs in a Japanese patient admitted to hospital - Adachi, K.; Beppu, S.; Nishiyama, K.; Shimizu, M.; Yamazaki, H. (Journal of Pharmaceutical Health Care and Sciences, 2021)
Background: Combinations of antidepressant duloxetine (at doses of 40–60 mg/day) and other antipsychotics are frequently used in clinical treatment; however, several fatal and nonfatal cases of duloxetine overdose have been documented. We experienced a patient who had taken an overdose of duloxetine (780 mg) in combination with other drugs in a suicide attempt. Case presentation: The patient was a 37-year-old man (body weight, 64 kg) with a history of gender identity disorder and depression. He intentionally took an overdose of duloxetine in combination with three other antipsychotic drugs (18 mg flunitrazepam, 850 mg quetiapine, and 1100 mg trazodone) and was emergently admitted to Kyoto Medical Center. The patient’s plasma concentration of duloxetine during ambulance transport was 57 ng/ml, and the level was still as high as 126 ng/mL at 32 h after administration. Duloxetine disappeared most slowly from plasma, in contrast to quetiapine, which was the fastest to clear among the four medicines determined in this patient. The observed concentrations of duloxetine in this overdose patient were generally within the 95% confidence intervals of the plasma concentration curves predicted using a physiologically based pharmacokinetic (PBPK) model. Conclusion: Even if more than 1 h (the generally recommended period) has passed after administration of duloxetine in such overdose cases, gastric lavage and/or administration of activated charcoal may be effective in clinical practice up to 6 h because of the typically slow elimination behavior illustrated by the PBPK model. Pharmacokinetic profiles visualized using PBPK modeling can inform treatment decisions in cases of drug overdose for medicines such as duloxetine in emergency clinical practice. © 2021, The Author(s).
Keywords: Flunitrazepam; Overdose; Pharmacokinetic modeling; Trazodone

Mental health difficulties among trans and gender diverse young people with an autism spectrum disorder (ASD): Findings from Trans Pathways - Strauss, P.; Cook, A.; Watson, V.; Winter, S.; Whitehouse, A.; Albrecht, N.; Wright Toussaint, D.; Lin, A. (Journal of Psychiatric Research, 2021)
Recent research highlights an overlap of gender diversity and autism spectrum disorders (ASD); however, data on individuals who are trans and also on the autism spectrum are largely from clinical samples and may not be representative of individuals who are trans with ASD in the general population. In addition, there is scant literature on the mental health of these individuals and their experiences in accessing gender-affirming care. We investigated the prevalence of ASD in trans young people, their mental health (psychiatric diagnoses and self-harm and suicidal behaviors) and experiences in accessing gender-affirming care. This is an analysis of data collected in an Australian cross-sectional mixed methods survey (N = 859) of trans young people aged 14–25 years. Overall, 22.5% of participants had ever received a diagnosis of ASD from a health professional. This group was more likely to exhibit current psychopathology, have engaged in self-harming and suicidal behaviors, and was also more likely than the non-ASD diagnosed reference group to have received a psychiatric diagnosis. The ASD-diagnosed group were also more likely to experience barriers in accessing gender-affirming care. This is the first large population-based sample of trans individuals with ASD to report on mental health outcomes and experiences in accessing gender-affirming care. We highlight the necessity for clinicians working with either trans or ASD populations to have awareness of the co-occurrence, and to cultivate skills to work with individuals who are both trans and on the autism spectrum. © 2021 Elsevier Ltd
Keywords: Autism spectrum disorder; Gender affirmative care; Gender identity; Trans; Transgender

Addressing the critical need for long-term mental health data during the COVID-19 pandemic: Changes in mental health from April to September 2020 - Veldhuis, C.B.; Nesoff, E.D.; McKowen, A.L.W.; Rice, D.R.; Ghoneima, H.; Wootton, A.R.; Papautsky, E.L.; Arigo, D.; Goldberg, S.; Anderson, J.C. (Preventive Medicine, 2021)
Despite the large amounts of research currently being conducted and the high number of editorials warning about the potential mental health impacts, there is a stunning lack of longitudinal mental health data on the effects of the pandemic. Yet, the pandemic may have sizable long-term impacts on psychological distress and health behaviors—these effects may be long-lasting and may disproportionately affect some demographic groups more than others. Data came from a longitudinal international study of the impacts of the COVID-19 pandemic on adults' psychological distress and wellbeing (N = 1567). We found high rates of depression (55% were diagnosable with probable depression at baseline), anxiety (65%), and risk for PTSD (51%). More than one-third of participants who reported that they drank alcohol indicated that their drinking had increased since the start of the pandemic. Over time, depressive symptoms and suicidal thoughts and behaviors increased significantly, but acute stress symptoms decreased. Specific demographic groups (people of color and sexual and gender minorities) appeared to be at high risk of distress across analyses. Our findings suggest high rates of depression, anxiety, acute stress, and other signs of distress like isolation, hopelessness, and use of substances to cope—even at five-month follow-up. Our findings suggest a need to prioritize availability of, and access to, mental health care during both the pandemic and the recovery. © 2021 Elsevier Inc.

Differential Sexual Behavior Experiences of LGBQ and Transgender/Nonbinary Young People in Colorado - Kattari, S.K.; Atteberry-Ash, B.; Eugene Walls, N.; Rusow, J.; Klemmer, C.; Kattari, L. (Youth and Society, 2021)
Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth experience numerous disparities, including but not limited to access to health care, HIV risk, safety in school, educational opportunities, and family support. Historically, research on this community lumped together LGBQ experiences with experiences of transgender and nonbinary (trans/NB) individuals, despite sexual orientation and gender identity being unique identities. Using representative statewide data from the 2015 Healthy Kids Colorado Survey (HKCS) (N = 15,970), this study examines sexual behaviors through a more nuanced and intersectional lens. We find that young LGBQ and trans/NB people in Colorado have differential experiences of sexual behavior compared with their heterosexual and cisgender counterparts. Being LGBQ and especially being trans/NB, having current depression, suicidal ideation, and experiencing electronic bullying are all associated with an increase in the likelihood of ever having sex and total number of partners, and lower age of sexual debut. These findings and their implications highlight the importance of inclusive sexuality education and culturally responsive services for all young people. © The Author(s) 2019.
Keywords: gender identity; LGBQ; sexual behavior; sexual orientation; transgender; youth

Gender affirmation surgeries in transgender women: Aesthetic, sexual, and urinary results of an initial series of vaginoplasties - Bernal Riquelme, J.; Falcon Naser, N.; Barros Puertas, J.; Arenas Kalil, J.; Cifuentes Arévalo, M. (Actas Urologicas Espanolas, 2021)
Introduction and objectives: Gender dysphoria is associated with mental health comorbidity, such as depression and suicide. “Gender affirming surgeries” improve sexuality and psychosocial well-being. The goal of vaginoplasty is for the genitalia to resemble in form and function to a biological vagina with a depth of at least 11 cm and a sensitive clitoris. In addition, the urethra must be shortened and allow voiding in a sitting position. Our objective is to describe the aesthetic, sexual and urinary results. Patients and method: Retrospective study of all patients undergoing feminizing genitoplasty, at Hospital Sótero del Río between 2018 and 2019, that met WPATH requirements. Vaginal dimensions, neo-clitoral sensitivity, aesthetic and sexual satisfaction of the neovagina, questionnaires Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS), IPSS-QoL, uroflowmetry and post-void residue were evaluated. Results: 10 women who underwent feminizing genitoplasty were identified. The neovaginal depth average was 14.2 cm. There was no rectal injury or reoperation. There was 100% of Neoclitoris sensitivity and 88% satisfaction with the neovaginal width. The FGSIS averaged 25.4 points and the FSFI averaged 16 points. The IPSS was 6.7 points, the average Qmax was 22 ml/s and post-void residual volume average was 22 ml. There was no neomeatal stenosis. Conclusions: Feminizing Genitoplasty is a complex, demanding and not completely standardized surgery. However, it is a relatively safe procedure that achieves adequate aesthetic, sexual and urinary results. © 2020 AEU
Keywords: Gender dysphoria; Reconstruction genital reassignment; Transgender; Transsexual; Vaginoplasty

Online Self-Injury Activities among Psychiatrically Hospitalized Adolescents: Prevalence, Functions, and Perceived Consequences - Nesi, J.; Burke, T.A.; Lawrence, H.R.; MacPherson, H.A.; Spirito, A.; Wolff, J.C. (Research on Child and Adolescent Psychopathology, 2021)
The majority of adolescents with psychiatric disorders use social media, engaging in a range of online activities that may confer both risks and benefits. Very little work, however, has examined engagement in online activities related to self-injury among these youth, such as posting about self-injury, viewing self-injury related content, or messaging about self-injury with online or offline friends. This study examined the frequency and types of online self-injury activities in which adolescents engage, perceived functions that these activities serve, and associated risk for self-injurious thoughts and behaviors (SITBs). Participants were 589 psychiatrically-hospitalized adolescents (Mage = 14.88), who completed self-report measures assessing online self-injury activities, perceived functions and consequences of these activities, and SITBs. Results indicated that 43.3% of the sample had engaged in online self-injury activities, that the majority (74.8%) used social networking sites (e.g., Snapchat, Instagram) to do so, and that these activities were significantly more common among sexual and gender minority youth. Adolescents who talked about self-injury with friends met online were more likely to report a history of suicide attempt(s). A latent profile analysis revealed three distinct subgroups of youth based on their perceived functions of engaging in online self-injury activities. Subgroups reporting higher levels of engagement for purposes of identity exploration, self-expression, and aiding recovery were at heightened risk for negative perceived consequences of these activities and reported greater suicidal ideation severity. Findings offer new insights for identifying youth who may be at heightened risk for SITBs in the context of social media use. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Adolescents; Online; Self-injury; Social media; Suicide

The moderating role of parenting dimensions in the association between traditional or cyberbullying victimization and mental health among adolescents of different sexual orientation - Desmet, A.; Rodelli, M.; Walrave, M.; Portzky, G.; Dumon, E.; Soenens, B. (International Journal of Environmental Research and Public Health, 2021)
Cyberbullying victimization is associated with mental health problems and reported to occur more in nonheterosexual orientation youth (lesbian, gay, bisexual, and questioning (LGBQ)) than among heterosexual youth. Parental support may protect against mental health problems after being victimized, but nonsupportive parental influences may also exacerbate harm. This study investigated whether parenting dimensions (autonomy support, psychological control) moderated the associations between bullying victimization and mental health problems among heterosexual and LGBQ adolescents. An anonymous survey was completed by 1037 adolescents (M age = 15.2 ± 1.9, 50% female). Regression analyses examined associations between victimization, sexual orienta-tion, and mental health problems, and investigated the moderating role of parenting. Both forms of victimization were associated with higher mental health problems. LGBQ youth experienced more depressive symptoms and suicidal ideation than heterosexual youth. Lower levels of parental psychological control and higher levels of autonomy support were related to having fewer mental health problems. However, perceived autonomy support appeared less protective when adolescents experienced more frequent victimization. Moreover, parental psychological control was related to heightened risk for suicidal plans specifically among LGBQ youth and also exacerbated the association between cyberbullying victimization and stress among LGBQ youth. These findings un-derscore the need to address parenting in whole-school antibullying and mental health promotion programs. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
Keywords: Autonomy support; Cyberbullying; Mental health; Parenting; Psychological control; Sexual orientation; Suicide

Group mindful self-compassion training to improve mental health outcomes for LGBTQIA+ young adults: Rationale and protocol for a randomised controlled trial - Finlay-Jones, A.; Strauss, P.; Perry, Y.; Waters, Z.; Gilbey, D.; Windred, M.-A.; Murdoch, A.; Pugh, C.; Ohan, J.L.; Lin, A. (Contemporary Clinical Trials, 2021)
Background: Young adults who are lesbian, gay, bisexual, trans, queer or questioning, intersex, asexual and other diverse genders and sexualities (LGBTQIA+) are more likely to experience mental health difficulties and are at significantly elevated risk of substance abuse, self-harm and suicide, relative to their heterosexual, endosex and cisgender peers. There is a need for effective mental health interventions for LGBTQIA+ young adults. Mindful Self-Compassion training is a promising approach; among LGBTQIA+ individuals, self-compassion accounts for more variation in mental health outcomes than bullying, victimization, and adverse childhood experiences combined. Furthermore, LGBTQIA+ individuals with high self-compassion report more positive identity and happiness, less self-stigma, and lower suicidality than those with low self-compassion. Method: This paper outlines the rationale and protocol for a single-blind CONSORT-compliant randomised controlled trial, comparing group Mindful Self-Compassion to a delayed-treatment waitlist control group, for improving mental health, decreasing self-criticism and increasing self-compassion in LGBTQIA+ young adults (age 18–25 years). Mindful Self-Compassion training is an 8-week group program that focuses on cultivating self-compassion and mindfulness. While typically delivered as a face-to-face program, the proposed trial will investigate efficacy of the program when provided via videoconferencing. Discussion: Videoconference Mindful Self-Compassion training has the potential to improve the mental health of Australian LGBTQIA+ young adults and provide a possible cost-effective, scalable intervention for this population. The proposed trial will be the first to determine its efficacy for LGBTQIA+ young adults and will provide the first data on the delivery of the program via videoconferencing. © 2021 Elsevier Inc.
Keywords: Gender minority; LGBT*; Mindfulness; Self-compassion; Sexual minority; Telehealth; Youth mental health

Minority stress, distress, and suicide attempts in three cohorts of sexual minority adults: A U.S. probability samplz - Meyer, I.H.; Russell, S.T.; Hammack, P.L.; Frost, D.M.; Wilson, B.D.M. (PLoS ONE, 2021)
During the past 50 years, there have been marked improvement in the social and legal environment of sexual minorities in the United States. Minority stress theory predicts that health of sexual minorities is predicated on the social environment. As the social environment improves, exposure to stress would decline and health outcomes would improve. We assessed how stress, identity, connectedness with the LGBT community, and psychological distress and suicide behavior varied across three distinct cohorts of sexual minority people in the United States. Using a national probability sample recruited in 2016 and 2017, we assessed three a priori defined cohorts of sexual minorities we labeled the pride (born 1956-1963), visibility (born 1974-1981), and equality (born 1990-1997) cohorts. We found significant and impressive cohort differences in coming out milestones, with members of the younger cohort coming out much earlier than members of the two older cohorts. But we found no signs that the improved social environment attenuated their exposure to minority stressors-both distal stressors, such as violence and discrimination, and proximal stressors, such as internalized homophobia and expectations of rejection. Psychological distress and suicide behavior also were not improved, and indeed were worse for the younger than the older cohorts. These findings suggest that changes in the social environment had limited impact on stress processes and mental health for sexual minority people. They speak to the endurance of cultural ideologies such as homophobia and heterosexism and accompanying rejection of and violence toward sexual minorities. © 2021 Meyer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Understanding pathways to e-cigarette use across sexual identity: A multi-group structural equation model - Doxbeck, C.R.; Jaeger, J.A.; Bleasedale, J.M. (Addictive Behaviors, 2021)
This study explored the relationships between sexual violence, smoking behaviors, suicidality and past 30-day e-cigarette use under the theoretical framework of Minority Stress Theory. The 2017 National Youth Risk Behavioral Survey was utilized to study a nationally representative sample of sexual minority (lesbian, gay, bisexual, and unsure) and heterosexual high school students (N = 7882). Multi-group structural equation modeling (SEM) was employed to examine whether sexual violence and suicidality had a direct effect on e-cigarette use, after controlling for prior smoking behaviors (cigarette, cigar, and marijuana use). Suicidality and smoking behaviors were examined as mediators of the relationship between sexual violence and e-cigarette use, and suicidality was examined as a mediator of the relationship between sexual violence and smoking behaviors. This model was tested for invariance across sexual minority and heterosexual students. For both groups, smoking behaviors had significant direct effects on e-cigarette use, yet suicidality revealed no significant direct effects. Both suicidality and sexual violence had significant indirect effects on e-cigarette use through their effects on smoking behaviors. Sexual violence had a significant direct effect on e-cigarette use for sexual minority students, but not for heterosexual students. Despite this notable difference, the model was found to be invariant across the two groups. These findings suggest that students who report sexual violence may experience suicidality and victimization may lead to smoking behaviors and e-cigarette use. Students’ mental health and substance use behaviors should continue to be targeted in schools, particularly among sexual minority youths. © 2020 Elsevier Ltd
Keywords: Mental health; Minority stress; Sexual orientation; Substance use/abuse; Suicide; Tobacco use

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

Sexual minorities, mental health, and religiosity at a religiously conservative university - Klundt, J.S.; Erekson, D.M.; Lynn, A.M.; Brown, H.E. (Personality and Individual Differences, 2021)
With increasing mental health concerns on college campuses and the complex developmental tasks of young adulthood, sexual minority students may be at particular risk for negative mental health and well-being outcomes. This risk may be compounded at highly religious universities that are not affirming of same-sex romantic relationships. The current study examined religiosity, mental health outcomes, and sexual minority identity at a highly religious university using structural equation modeling. All undergraduates were invited to participate, and 7625 students participated, with 996 students indicating a sexual orientation other than “strictly heterosexual.” We found that sexual minority students had significantly worse mental health outcomes and well-being than their heterosexual peers. We also found that religiosity acted as a protective factor for both the sexual minority and the heterosexual group, although the effect was weaker for the sexual minority group. Finally, we found that for sexual minority students, concerns around being accepted by others was the greatest predictor of lower quality of life and higher suicidality, depression, generalized anxiety, social anxiety, and academic distress. We discuss potential strategies to mitigate acceptance concerns for sexual minority students on college campuses. © 2020 Elsevier Ltd
Keywords: LGBQ; Mental health; Religiosity; Religious university; University students; Well-being

Differences in Adolescent Experiences of Polyvictimization and Suicide Risk by Sexual Minority Status - Johns, M.M.; Lowry, R.; Hipp, T.N.; Robin, L.; Shafir, S. (Journal of Research on Adolescence, 2021)
Sexual minority adolescents (SMA) report more suicide risk behaviors than heterosexual adolescents. Polyvictimization (co-occurrence of multiple types of victimization) may be an important, underresearched correlate of this disparity. With the 2017 national Youth Risk Behavior Survey (N = 13,179), national estimates of polyvictimization and suicide risk were assessed among high school students by sexual minority status (SM vs. heterosexual), and multivariate relationships between sexual minority status, polyvictimization, and suicide risk were tested. Additionally, risk profiles of those who experienced polyvictimization (2 + types of victimization; n = 1,932) were compared across sexual minority status. Results confirm that SMA are more likely to experience polyvictimization than heterosexual adolescents (31.8% v. 12.9%, respectively); however, also indicate that polyvictimization does not fully explain elevated suicide risk among SMA. © 2020 Society for Research on Adolescence

It Gets Better Videos for Suicide Prevention in LGBTIQ+ Adolescents: Content Analysis of German-Language Videos - Kirchner, S.; Till, B.; Plöderl, M.; Niederkrotenthaler, T. (Crisis, 2021)
Background: The It Gets Better project aims to help prevent suicide among lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) adolescents. It features personal video narratives portraying how life gets better when struggling with adversities. Research on the contents of messages is scarce. Aims: We aimed to explore the content of videos in the Austrian It Gets Better project regarding the representation of various LGBTIQ+ groups and selected content characteristics. Method: A content analysis of all German-language videos was conducted (N = 192). Messages related to coming out, stressors experienced, suicidal ideation/behavior, and on how things get better were coded. Results: Representation was strong for gay men (n = 45; 41.7%). Coming out to others was mainly positively framed (n = 31; 46.3%) and seen as a tool to make things better (n = 27; 37.5%). Social support (n = 42; 62.7%) and self-acceptance (n = 37; 55.2%) were prevalent topics. Common stressors included a conservative setting (n = 18, 26.9%), and fear of outing (n = 17; 25.4%). Suicidality (n = 9; 4.7%) and options to get professional help (n = 7; 8.2%) were rarely addressed. Limitations: Only aspects explicitly brought up in the videos were codeable. Conclusion: Videos do not fully represent gender identities and sexual orientations. Messaging on suicidality and professional help require strengthening to tailor them better for suicide prevention. © 2020 Hogrefe Publishing.
Keywords: adolescents; LGBTIQ+; prevention videos; qualitative study; suicide prevention

How are consensual, non-consensual, and pressured sexting linked to depression and self-harm? The moderating effects of demographic variables - Wachs, S.; Wright, M.F.; Gámez-Guadix, M.; Döring, N. (International Journal of Environmental Research and Public Health, 2021)
Sexting among adolescents has triggered controversial debates among scholars and the general public. However, questions regarding the associations between different types of sexting, namely consensual, non-consensual, and pressured sexting, depressive symptoms, and non-suicidal self-harm remain. In addition, little attention has been given to whether demographic variables (i.e., gender, ethnicity, disability, sexual minority) might influence these associations. To fill these gaps in the literature, the present study was conducted. Participants were 2506 adolescents (ages 13–16 years old; Mage = 15.17; SDage = 0.89) from eight high schools located in the suburbs of a large Midwestern city in the United States. Adolescents self-identified as female (50%), Caucasian (57%), approximately 15% reported that they had a disability they received school accommodation for, and 18% self-identified as a sexual minority. They completed self-report questionnaires on their sexting behaviors, depressive symptoms, and non-suicidal self-harm. Findings revealed that non-consensual and pressured sexting were positively related to depressive symptoms and non-suicidal self-harm, whereas consensual sexting was unrelated to these outcomes. Boys engaged in more non-consensual sexting compared with girls, girls were more pressured to send sexts compared with boys, and sexual minority adolescents reported greater consensual sexting compared with non-sexual minority adolescents. Moderating effects revealed that girls, non-minority adolescents, and non-sexual minority adolescents experienced greater depressive symptoms and non-suicidal self-harm when they experienced pressured sexting. These findings underscore the importance of considering various types of sexting and adolescents’ demographic variables when examining the negative outcomes of sexting. Disentangling the relationships among different types of sexting, depressive symptoms, and self-harm aids in the development of evidence-based recommendations for sexting harm prevention and sexual education programs. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
Keywords: Depression; Non-consensual; Normalcy discourse; Pressured sexting; Self-harm; Sexting

Experiences of violence and mental health outcomes among Asian American transgender adults in the United States - Becerra, M.B.; Rodriquez, E.J.; Avina, R.M.; Becerra, B.J. (PLoS ONE, 2021)
Purpose We addressed prevalence and factors associated with mental health outcomes (suicidal behavior and psychological distress) among Asian Americans (AA), who identify as transgender, a key group among sexual and gender minorities that is overlooked and understudied. Methods We used data from 2015 United States Transgender Survey during 2019-2020 with our population as census defined AA. Outcomes included suicidal ideation, suicidal thoughts, and serious psychological distress (SPD). Independent variables included any abuse, partner abuse, bathroom-related abuse, and additional covariates. Adjusted odds ratio and 95% confidence interval (aOR; 95% CI) for each outcome are adjusted for age, marital status, citizenship status, education level, employment status, as well as poverty status. Results Nearly 67% reported experiencing any abuse, 52% reported abuse from romantic/sexual partner(s), while 29% reported harassment/abuse when trying to use bathrooms. Moreover, 82% reported suicidal thoughts, 40% reported suicidal attempts, and 39% had SPD. Results demonstrated that any abuse/violence had higher odds of suicidal thoughts (adjusted odds ratio [aOR] = 2.67, 95% confidence interval (CI):[1.98-3.58], suicidal attempts (aOR = 2.83, 95% CI:[2.18-3.68]), and SPD (aOR = 1.56, 95% CI:[1.20, 2.04]). Abuse from romantic/sexual partners had higher odds of suicidal thoughts (aOR = 2.47, 95% CI:[1.76-3.47]), suicidal attempts (aOR = 2.17, 95% CI:[1.68-2.80]), and SPD (aOR = 2.72, 95% CI:[2.03-3.63]). Experience of harassment/abuse during bathroom use had increased odds of suicidal attempts (aOR = 1.81, 95% CI:[1.41-2.31]). Conclusion Exposure to violence is common among AA transgender individuals and related to negative mental health outcomes. Initiatives to reduce exposure to abuse and providing resources for trauma-informed care are imperative to improve health outcomes. © 2021 Public Library of Science. All rights reserved.

Reducing nonfatal suicidal behaviour among university students: actuarial analysis of potential effects of treating common mental disorders - Bantjes, J.; Breet, E.; Lochner, C.; Roos, J.; Kessler, R.C.; Stein, D.J. (South African Journal of Psychology, 2021)
Campus-based suicide prevention is an important priority for universities. One approach could be to identify and treat common mental disorders, but it is unclear what potential reduction in suicide might be achieved by such an approach. Our aim was to quantify this potential effect on prevalence of nonfatal suicidal behaviour among first-year students. Data were collected from students at two South African universities (N = 633) via an online survey. We assessed prevalence of nonfatal suicidal behaviour and six common mental disorders and used logistic regression models to identify all main and interaction associations of sociodemographic variables and common mental disorders as predictors of nonfatal suicidal behaviour. Population attributable risk analysis was used to quantify the potential reduction in nonfatal suicidal behaviour achieved by effectively treating common mental disorders, based on the simplifying assumption that the logistic regression coefficients of the common mental disorders represented causal effects on nonfatal suicidal behaviour. Twelve-month prevalence of suicidal ideation, plan, and attempt were 40.9%, 22.3%, and 3.9%, respectively. Increased risk was associated with identifying as Black, female and reporting an atypical sexual orientation. Of the six common mental disorders, major depressive disorder and generalised anxiety disorder were associated with all dimensions of nonfatal suicidal behaviour, bipolar spectrum disorder with increased risk of ideation and plan, attention-deficit/hyperactivity disorder with ideation, and alcohol use disorder with suicide plan. Population attributable risk analysis suggests that treating common mental disorders could yield absolute reductions in suicide ideation, plan, and attempt of 17.0%, 55.0% and 73.8%, respectively. Pragmatic trials are needed to evaluate the effects on nonfatal suicidal behaviour of identifying and treating students with a prior history of common mental disorder early in their university careers. © The Author(s) 2020.
Keywords: common mental disorders; nonfatal suicidal behaviour; South Africa; suicide; suicide prevention; university students

Electroconvulsive Therapy for Depression in Transgender Patients: Case Series and Literature Review - Mormando, C.B.; Dalke, K.; Mikoluk, C.; Garman, J.C.; Francis, A. (The journal of ECT, 2021)
ABSTRACT: There is very limited information regarding the effectiveness of electroconvulsive therapy (ECT) as a treatment for major depressive disorder in transgender patients. This population is also at risk for comorbid conditions, such as posttraumatic stress disorder and substance use that could impact the outcome of ECT. We report our experience with the use of ECT in this population. Clinical and response characteristics of 7 consecutive cases are described in this series. All patients had multiple psychiatric diagnoses and were refractory to pharmacologic intervention. Pretreatment Beck Depression Inventory-II scores were 45.5 ± 3.2 SEM and posttreatment scores were 21.2 ± 6.4 [P < 0.01]. Suicidality scores reduced by greater than 60%, whereas remission of depression was obtained for 2 of 7, and 4 of 7 showed greater than 50% reduction in depression scores. Treatments were tolerated well using conventional treatment procedures. This case series suggests that ECT can be effective for depressed transgender patients with multiple clinical comorbidities. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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

Classifying public policies with Moral Foundations Theory - Wendell, D.G.; Tatalovich, R. (Policy Sciences, 2021)
Morality policy researchers have long grappled with the difficulty of determining objective or empirical criteria for classifying policies with moral content. A newer, but related, critique has suggested that we cannot classify morality policies by their substantive content, because policy debates employ moral frames for strategic purposes. This paper joins this debate by using Moral Foundations Theory to conduct quantitative content analyses of the supporting and opposing arguments in Voter Guides that accompanied referenda on enacting (1) the death penalty, (2) same-sex marriage, (3) physician-assisted suicide, (4) Official English, (5) recreational marijuana, (6) medical marijuana, (7) abortion funding bans, (8) tribal gaming, (9) minimum wage increase, (10) Right to Work legislation, and (11) property tax limits. MFT quantitative content analysis shows that frames with ostensibly instrumental arguments hold moral content. Our findings endorse the argument that researchers should differentiate between pure and mixed morality policies and other non-morality policies with decidedly less moral content. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Content analysis; Framing; Moral Foundations Theory; Morality policy; Rhetoric

Full-Length Transcriptome Analysis of Plasmodium falciparum by Single-Molecule Long-Read Sequencing - Yang, M.; Shang, X.; Zhou, Y.; Wang, C.; Wei, G.; Tang, J.; Zhang, M.; Liu, Y.; Cao, J.; Zhang, Q. (Frontiers in Cellular and Infection Microbiology, 2021)
Malaria, an infectious disease caused by Plasmodium parasites, still accounts for amounts of deaths annually in last decades. Despite the significance of Plasmodium falciparum as a model organism of malaria parasites, our understanding of gene expression of this parasite remains largely elusive since lots of progress on its genome and transcriptome are based on assembly with short sequencing reads. Herein, we report the new version of transcriptome dataset containing all full-length transcripts over the whole asexual blood stages by adopting a full-length sequencing approach with optimized experimental conditions of cDNA library preparation. We have identified a total of 393 alternative splicing (AS) events, 3,623 long non-coding RNAs (lncRNAs), 1,555 alternative polyadenylation (APA) events, 57 transcription factors (TF), 1,721 fusion transcripts in P. falciparum. Furthermore, the shotgun proteome was performed to validate the full-length transcriptome of P. falciparum. More importantly, integration of full-length transcriptomic and proteomic data identified 160 novel small proteins in lncRNA regions. Collectively, this full-length transcriptome dataset with high quality and accuracy and the shotgun proteome analyses shed light on the complex gene expression in malaria parasites and provide a valuable resource for related functional and mechanistic researches on P. falciparum genes. © Copyright © 2021 Yang, Shang, Zhou, Wang, Wei, Tang, Zhang, Liu, Cao and Zhang.
Keywords: alternative splicing; full-length RNA-seq; long non-coding RNA; Plasmodium falciparum; small protein

Suicide thought and behaviors, non-suicidal self-injury, and perceived life stress among sexual minority Mexican college students - Rentería, R.; Benjet, C.; Gutierrez-Garcia, R.A.; Ábrego Ramírez, A.; Albor, Y.; Borges, G.; Covarrubias Díaz Couder, M.A.; Durán, M.D.S.; González González, R.; Guzmán Saldaña, R.; Hermosillo De la Torre, A.E.; Martínez-Jerez, A.M.; et al. (Journal of Affective Disorders, 2021)
Background: Sexual minority college students are at a higher risk for suicidal thoughts and self-injurious behaviors compared to heterosexual students. Minority stress theory proposes sexual minority individuals experience higher stress due to stigma. Using a sample of Mexican college students, this study tested perceived life stress as a mediator of suicide and self-injury outcomes across various sexual orientation groups. Methods: The sample of college students (N=7882) was recruited from nine Mexican universities as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. Participants completed an online survey including demographic questions, measure of perceived life stress, suicide outcomes, and non-suicidal self-injury (NSSI) in the past 12 months. Results: Logistic regression analyses revealed identifying as a sexual minority significantly predicted a higher likelihood of suicide ideation (ORs 2.05-3.00), suicide attempts (ORs 2.48-8.73), and NSSI (ORs 2.92-4.18) compared to heterosexual students reporting no same-gender attraction. Significant indirect effects from mediation path analyses showed perceived life stress mediated the relationship between a sexual minority identity and suicide ideation (range of proportion mediated 10.48-31.48%), attempts (10.48-31.48%), and NSSI (7.69-20.09%) across each group except among asexual students. Limitations: The cross-sectional nature of the survey design precludes drawing causal inferences. Conclusion: Findings from this study contribute to minority stress theory by elucidating the role of perceived life stress as a mediator of suicide ideation and attempts and NSSI among sexual minority college students. Clinical interventions may benefit in focusing on experiences of stress across various life areas when supporting sexual minority college students. © 2020
Keywords: college; Mexico; self-injury; sexual minority; suicide

Investigation to identify individual socioeconomic and health determinants of suicidal ideation using responses to a cross-sectional, community-based public health survey - Mulholland, H.; McIntyre, J.C.; Haines-Delmont, A.; Whittington, R.; Comerford, T.; Corcoran, R. (BMJ open, 2021)
OBJECTIVES: To address a gap in knowledge by simultaneously assessing a broad spectrum of individual socioeconomic and potential health determinants of suicidal ideation (SI) using validated measures in a large UK representative community sample. DESIGN: In this cross-sectional design, participants were recruited via random area probability sampling to participate in a comprehensive public health survey. The questionnaire examined demographic, health and socioeconomic factors. Logistic regression analysis was employed to identify predictors of SI. SETTING: Community setting from high (n=20) and low (n=8) deprivation neighbourhoods across the North West of England, UK. PARTICIPANTS: 4319 people were recruited between August 2015 and January 2016. There were 809 participants from low-deprivation neighbourhoods and 3510 from high-deprivation neighbourhoods. The sample comprised 1854 (43%) men and 2465 (57%) women. PRIMARY OUTCOME MEASURES: SI was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire-9 instrument. RESULTS: 454 (11%) participants reported having SI within the last 2 weeks. Model 1 (excluding mental health variables) identified younger age, black and minority ethnic (BME) background, lower housing quality and current smoker status as key predictors of SI. Higher self-esteem, empathy and neighbourhood belonging, alcohol abstinence and having arthritis were protective against SI. Model 2 (including mental health variables) found depression and having cancer as key health predictors for SI, while identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) and BME were significant demographic predictors. Alcohol abstinence, having arthritis and higher empathy levels were protective against SI. CONCLUSIONS: This study suggests that it could be useful to increase community support and sense of belonging using a public health approach for vulnerable groups (e.g. those with cancer) and peer support for people who identify as LGBTQ and/or BME. Also, interventions aimed at increasing empathic functioning may prove effective for reducing SI. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Keywords: adult psychiatry; mental health; suicide & self-harm

Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood - Salway, T.; Gesink, D.; Ferlatte, O.; Rich, A.J.; Rhodes, A.E.; Brennan, D.J.; Gilbert, M. (Social Psychiatry and Psychiatric Epidemiology, 2021)
Purpose: Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985–2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities. Methods: Age- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders. Results: We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18–20 years of age for both genders) and one peak nearing mid-life (30–35 years of age for men; 35–40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity. Conclusion: In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
Keywords: Age-period-cohort models; Sexual minorities; Social epidemiology; Suicide

Depression and Suicide Risk at the Cross-Section of Sexual Orientation and Gender Identity for Youth - Guz, S.; Kattari, S.K.; Atteberry-Ash, B.; Klemmer, C.L.; Call, J.; Kattari, L. (Journal of Adolescent Health, 2021)
Purpose: Adolescence is a developmental phase in which young people begin to explore their identity and seek to understand how their identity fits into the larger society. Although this is a developmental task for all adolescents, it is especially salient for sexual and gender minority youth. Owing to oppressive social structures and stigmatized identities, adolescents who identify as nonheterosexual or noncisgender are vulnerable to experiencing disproportionate adverse health outcomes. Methods: To further the literature on adolescent mental health among sexual and gender minority youth, this study analyzed a representative statewide sample of high school students (ages 14–18) to analyze how sexual orientation and gender identity are associated with depression and suicidality. Results: Results aligned with previous research demonstrating that sexual and gender minority youth were all at a heightened risk for depression. However, transgender youth and youth questioning their sexuality or gender were at especially heightened risk for experiencing depression and suicidality. Conclusion: The findings of this study indicate a need to target or adapt direct services and programming for sexual and gender minority adolescents. © 2020 Society for Adolescent Health and Medicine
Keywords: Depression; LGBTQ; Mental health; Questioning; Suicidality

Differential Risks for Suicidality and Mental Health Symptoms among Transgender, Nonbinary, and Cisgender Sexual Minority Youth Accessing Crisis Services - Srivastava, A.; Rusow, J.A.; Goldbach, J.T. (Transgender Health, 2021)
Purpose: We examined whether health risks among sexual minority youth (SMY) differ by gender identity (transgender, nonbinary, and cisgender). Methods: Data were collected on suicide attempts (lifetime and someday), depression and post-traumatic stress disorder (PTSD), and minority stress among SMY accessing crisis services. Results: In the multivariate regression models, compared to their cisgender peers, transgender and nonbinary youth were at higher risk for suicide attempt (lifetime and someday), depression, and PTSD. Minority stress was a significant predictor for all the models. Conclusion: Crisis service organizations working to reduce suicidality among SMY should be sensitive to diverse experiences of gender identity. © Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.
Keywords: behavioral health; nonbinary; sexual minority youth; transgender

Affirmative Dialectical Behavior Therapy Skills Training With Sexual Minority Veterans - Cohen, J.M.; Norona, J.C.; Yadavia, J.E.; Borsari, B. (Cognitive and Behavioral Practice, 2021)
Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans’ experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group. © 2020
Keywords: anxiety; depression; dialectical behavior therapy; emotion regulation; sexual minorities

Mental Health and Health Risk Behaviors of Active Duty Sexual Minority and Transgender Service Members in the United States Military - Holloway, I.W.; Green, D.; Pickering, C.; Wu, E.; Tzen, M.; Goldbach, J.T.; Castro, C.A. (LGBT Health, 2021)
Purpose: The aim of this study was to examine health risk behaviors and mental health outcomes among sexual minority and transgender active duty military service members and their heterosexual and cisgender counterparts. Methods: Participants (N = 544) were recruited by using respondent-driven sampling between August 2017 and March 2018 and completed an online survey by using validated measures of cigarette smoking, alcohol use, anxiety, depression, post-Traumatic stress disorder (PTSD), and suicidality. Bayesian random intercept multiple logistic regressions were used to understand differences between sexual minority participants and heterosexual participants as well as between transgender participants and both their cisgender sexual minority and cisgender heterosexual peers. Results: Cisgender sexual minority women service members were more likely to meet criteria for problematic alcohol use (adjusted odds ratio [aOR] = 10.11) and cigarette smoking (aOR = 7.12) than cisgender heterosexual women. Cisgender sexual minority men had greater odds of suicidality (aOR = 4.73) than their cisgender heterosexual counterparts. Transgender service members had greater odds of anxiety, PTSD, depression, and suicidality than their cisgender peers. Conclusion: Military researchers and policymakers who seek to improve the overall health and well-being of sexual minority and transgender service members should consider programs and policies that are tailored to specific health outcomes and unique sexual minority and transgender subgroups. © Copyright 2021, Mary Ann Liebert, Inc., publishers.
Keywords: health disparities; health risk behaviors; mental health; military

Nonsuicidal self-injury, suicide ideation, and suicide attempts among sexual minority children - Blashill, A.J.; Fox, K.; Feinstein, B.A.; Albright, C.A.; Calzo, J.P. (Journal of consulting and clinical psychology, 2021)
OBJECTIVES: Sexual minority adolescents have previously been found to experience disparities in self-injurious thoughts and behaviors (SITBs) compared to heterosexual adolescents. However, there is a paucity of data on SITBs amongst children. Thus, the aim of the current study is to assess the prevalence of SITBs in a large sample of U.S. children and to test whether rates vary by sexual orientation. METHODS: Data were drawn from the 2.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study. The full sample included 11,777raw 9-10-year-old children (sexual minority n = 150raw). Children completed a computerized version of the youth Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5), including items assessing suicide ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Unadjusted and adjusted models compared the prevalence of outcomes by sexual orientation. Models also compared the co-occurrence of NSSI and suicide ideation by sexual orientation. RESULTS: Across all outcomes, sexual minority children reported elevated prevalence rates compared to heterosexual children, with odds ratios ranging from 4.4 to 6.5. Among children who reported NSSI, a greater proportion of sexual minority versus heterosexual children reported co-occurring suicide ideation (OR = 3.8). CONCLUSIONS: In a large sample of 9-10-year-old U.S. children, sexual orientation disparities emerged across NSSI, suicide ideation, and suicide attempts. Results indicate that sexual minority children are a vulnerable population for SITBs. Inclusion of children in prevention programs is encouraged. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effects of Polyvictimization on Mental and Physical Health Outcomes in an LGBTQ Sample - Kassing, F.; Casanova, T.; Griffin, J.A.; Wood, E.; Stepleman, L.M. (Journal of Traumatic Stress, 2021)
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are at elevated risk for violent victimization and often experience increased health disparities compared to their non-LGBTQ counterparts. The present study examined associations between polyvictimization and mental and physical health in an LGBTQ sample. Participants included 385 LGBTQ individuals involved in a larger health-needs assessment of LGBTQ individuals living in the southeastern United States. The sample primarily identified as gay/lesbian (63.4%), cisgender (78.7%), and White (66.5%), and the mean participant age was 34.82 years (SD = 13.45). A latent class analysis (LCA) was conducted on seven items assessing different types of violence exposure. The LCA identified a three-class model, with classes characterized by low trauma exposure (71.4%), nondiscriminatory violence (15.1%), and high trauma exposure (13.5%). Differences in demographic characteristics, perceptions of mental and physical health, and diagnoses of specific health conditions were assessed across classes. The high-trauma class reported poorer perceived physical and mental health compared to the other two classes, with mean differences in past-month poor health days ranging from 11.38 to 17.37. There were no differences between the classes regarding specific physical health conditions; however, the high-trauma and nondiscriminatory violence classes had significantly higher rates of anxiety, depression, drug abuse, and suicidality than the low-trauma class, ORs = 2.39–23.83. The present findings suggest that polyvictimization is an important risk factor for poor health among LGBTQ individuals. These results have implications for addressing health disparities among the broader LGBTQ community. © 2020 International Society for Traumatic Stress Studies

Prevalence and predictors of suicidal thoughts and behaviours among Australian police and emergency services employees - Kyron, M.J.; Rikkers, W.; Page, A.C.; O’Brien, P.; Bartlett, J.; LaMontagne, A.; Lawrence, D. (Australian and New Zealand Journal of Psychiatry, 2021)
Objective: This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors. Method: A stratified random sample of personnel from 33 Australian emergency services organisations were invited to participate in a mental health and wellbeing survey. In total, 14,868 Australian ambulance, fire and rescue, police and state emergency services employees participated and self-reported any suicidal thoughts, plans and/or attempts in the 12 months prior to the survey or at any stage in their life. Logistic regressions assessed factors associated with suicidal thoughts and behaviours. Results: Employees reported notably higher rates of suicidal thoughts and plans than the general Australian adult population, but not attempts. Male, single/divorced, non-heterosexual or longer-serving employees reported higher rates of suicidal thoughts and behaviours across each sector. Perceptions of stigma regarding mental health conditions from others in the workplace, negative impact of work on one’s private life and low meaning of work were associated with suicidal thoughts, while bullying significantly differentiated who planned and attempted suicide from those who reported suicidal thoughts only. Higher resilience and social support were associated with lower suicidal thoughts, while intermittent explosive anger and illegal drug use were associated with higher rates of suicidal thoughts. Post-traumatic stress disorder symptoms significantly differentiated who planned suicide, while misuse of prescription drugs and psychological distress differentiated who attempted suicide from those who only reported suicidal thoughts. Conclusion: Amid inherently stressful occupations, it is important that workplaces function in a way that supports their personnel. Access to mental health services should be promoted and readily available to personnel. © The Royal Australian and New Zealand College of Psychiatrists 2020.
Keywords: Ambulance; depression; firefighters; post-traumatic stress disorder; suicide

Differences in Methods of Suicide Death Among Transgender and Nontransgender Patients in the Veterans Health Administration, 1999-2016 - Blosnich, J.R.; Boyer, T.L.; Brown, G.R.; Kauth, M.R.; Shipherd, J.C. (Medical care, 2021)
BACKGROUND: Limited research suggests that rates of suicide death among transgender people may be higher than their nontransgender peers. OBJECTIVE: The objective of this study was to compare rates of suicide deaths by different means between transgender and nontransgender patients. RESEARCH DESIGN: This secondary analysis used VHA administrative and electronic health record (EHR) data from October 1, 1999 through December 31, 2016. SUBJECTS: Transgender patients (n=8981) were categorized as such based on a set of International Classification of Disease codes, and a comparison sample was selected by randomly choosing 3 nontransgender patients (n=26,924). MEASURES AND ANALYSES: Cause and date of death data are from the National Death Index. Because of low frequencies amid different methods of suicide death, we combined categories into self-poisoning; hanging, strangulation and suffocation; discharge of firearms; and self-harm by all other and unspecified means. We conducted Cox regression analyses to model time-to-event for each method of suicide, adjusted for age, sex based on EHR, race, ethnicity, marital status, and whether patients had ever been diagnosed with depression. RESULTS: Among transgender patients, 73 died by suicide (22 female EHR-based sex, 51 male EHR-based sex), and among nontransgender patients, 71 died by suicide (4 female EHR-based sex, 67 male EHR-based sex). In adjusted models, transgender patients had significantly greater hazards of death by self-poisoning and firearms than their nontransgender peers. CONCLUSIONS: Differences in methods of suicide death suggest that firearms and self-poisoning may be specific areas of concern for transgender individuals experiencing suicidal crisis, which underscore needs for examining effective delivery of evidence-based care. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Mental Health and sexual orientation in adolescents in a school environment - Lorimy, L.; Cosquer, M.; Barron, E.; Jousselme, C. (Encephale, 2021)
Introduction: Although homosexuality is a subject often addressed by the media, little is said about homosexuality in adolescents who are particularly affected by the question of sexual orientation. This work aims to study the mental health of adolescents who report being exclusively attracted to members of the same sex. We explore the evidence for an association between homosexuality and depression, suicide attempts, and consulting a psychiatrist or a psychologist. Methods: We used data from the cross-sectional study “Adolescent Portraits – A Multicenter Epidemiological Survey in Schools in 2013” (CHU Fondation Vallée, Inserm CESP U1018). Data were gathered through the use of an anonymous, self-administered questionnaire (348 questions) given to students between the “4e” and “terminale school” years (comparable to the 8th and 12th grade in the U.S. education system) in three contrasting French geographical areas. The risk of depression was measured using the Adolescent Depression Rating Scale (ADRS). Results: The results reflect the survey responses provided by 15,235 young people. Of these, 1.5 % reported only being attracted to members of the same sex (homosexual group). This group contained twice as many girls as boys. Students who did not report sexual attraction, who reported bisexual attraction, or who did not answer the question were excluded from the results (830 students). In the homosexual group, 24 % presented with depression versus 11.5 % of those attracted exclusively to members of the opposite sex (heterosexual group). There is also a significant difference between sexes: 13.2 % of boys in the homosexual group were depressed compared to 29.3 % of girls in the same group; 6.7 % of boys in the heterosexual group reported being depressed versus 16.1 % of girls in the same group. In the heterosexual group, 10.7 % of respondents reported having already made at least one suicide attempt versus 20.7 % of those in the homosexual group. There was a difference according to sex, since 6.3 % of boys in the heterosexual group had a history of attempted suicide versus 14.9 % of girls in the same group. This gap disappeared completely within the homosexual group, as 21.4 % of boys and 20.4 % of girls had already made at least one suicide attempt at the time of the survey. Depressed adolescents in the homosexual group also reported a higher number of previous suicide attempts than those in the heterosexual group (46.9 % versus 31.6 %). In terms of sex, 25.3 % of depressed boys in the heterosexual group made at least one suicide attempt versus 34.1 % of girls. In the homosexual group, 44.4 % of depressed boys reported having made at least one suicide attempt versus 47.5 % of depressed girls. Adolescents in the homosexual group were significantly more likely to report having consulted a psychiatrist or psychologist than those in the heterosexual group (14.6 % versus 6.5 %), regardless of sex (16.7 % versus 4.7 % for boys; 13.5 % versus 8.2 % for girls). This difference was also found among depressed subjects (26.0 % in the homosexual group versus 15.4 % in the heterosexual group). Sexual activity (having already had sex) was higher in the homosexual group than in the heterosexual group (53.7 % versus 37.5 %), and this difference remained significant after adjusting for age. Fifty percent of the sexually active homosexual respondents reported having engaged in sexual activity of a homosexual nature versus 0.7 % of sexually active heterosexual respondents. In the homosexual group, mental suffering appeared to be more severe among sexually active subjects, in terms of dark thoughts (64 % versus 46 %) and a prior history of attempted suicide (29.3 % versus 10 %), but not in terms of depression (27.9 % versus 18.9 %; NS). Conclusion: Young people who reported being exclusively attracted to members of the same sex presented a higher level of mental distress compared to those who reported being attracted to members of the opposite sex. This was especially the case for boys. These findings led to the identification of risk and protective factors that can inform the development of appropriate preventive measures. © 2020 L'Encéphale, Paris
Keywords: Adolescence; Depression; Homosexuality; Mental health; Suicide attempt

Early adolescent gender diversity and mental health in the Adolescent Brain Cognitive Development study - Potter, A.; Dube, S.; Allgaier, N.; Loso, H.; Ivanova, M.; Barrios, L.C.; Bookheimer, S.; Chaarani, B.; Dumas, J.; Feldstein-Ewing, S.; Freedman, E.G.; Garavan, H.; et al. (Journal of Child Psychology and Psychiatry and Allied Disciplines, 2021)
Background: There are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health. Methods: The ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1-year follow-up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1-year visit assessed felt-gender, gender noncontentedness, and gender nonconformity using a 5-point scale. Mental health measures included youth- and parent-reports. Results: Roughly half a percent of 9/10-year-olds (n = 58) responded ‘yes’ or ‘maybe’ when asked, ‘Are you transgender’ at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, χ2 = 16.0, p <.001). At the 1-year visit, when asked about the three dimensions of gender on a 5-point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed. Conclusions: Similar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt-gender, gender noncontentedness, gender nonconformity) among 10/11-year-olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth. © 2020 Association for Child and Adolescent Mental Health
Keywords: early adolescent; Gender diversity; gender expression; nonconformity; suicidality; transgender

Strange behavior in a transgender teenager - Maffei, S.R.; Dean, A. (Pediatrics in Review, 2021)

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

Trends in the utilization of a peer-supported youth hotline - Kerner, B.; Carlson, M.; Eskin, C.K.; Tseng, C.-H.; Ho, J.-M.G.-Y.; Zima, B.; Leader, E. (Child and Adolescent Mental Health, 2021)
Background: Peer-supported youth hotlines have been in operation for many years but studies on the acceptance of this hotline model or on the demographics of the callers are lacking. This study was performed to examine the utilization of a metropolitan peer-supported youth hotline between 2010 and 2016. Method: The change in demographics, contact channels, and the reasons for contact were analyzed with standard linear regression analysis in 67,478 contacts over 7 years. Results: The data revealed a significant increase in hotline utilization from 8008 annual contacts in 2010 to 12,409 contacts in 2016 (p =.03). The majority of contacts were made by 15-year-old and 16-year-old girls, but contacts by children aged 13 years old and younger have also increased significantly over the years (p =.003). In 2016, anxiety and stress were among the leading reasons for contact (20.14%), followed by sadness and depression (17.21%), suicidal ideation (14.18%), and self-harm (8.15%). Recommendations for follow-up with outside mental health resources were made in 56.22% of contacts. More than 60% of contacts had found information about the hotline on the Internet. More than 30% used text messaging to reach out to the hotline. Conclusions: Our data indicate that adolescents increasingly utilize a peer-supported youth hotline to get help for mental health concerns. Therefore, it should be explored whether this hotline model could also be used for prevention and early intervention. Key Practitioner Message: Peer-supported youth hotlines are well accepted and frequently utilized by adolescents to get help for mental health issues. Our data indicate that peer-supported youth hotlines could be utilized to identify youth at risk for depression and suicide. Further research should evaluate whether peer-supported youth hotlines could serve in the prevention and in early mental health intervention, and how they could be effectively linked to other mental health resources in the community. © 2020 Association for Child and Adolescent Mental Health
Keywords: Adolescence; anxiety; counseling; depression; distress

Risk and protective factors for suicide among sexual minority youth seeking emergency medical services - Horwitz, A.G.; Grupp-Phelan, J.; Brent, D.; Barney, B.J.; Casper, T.C.; Berona, J.; Chernick, L.S.; Shenoi, R.; Cwik, M.; King, C.A.; Pediatric Emergency Care Applied Research Network (Journal of Affective Disorders, 2021)
Background: Differences in risk and protective factors (e.g., victimization, abuse, social support) have been used to explain elevated rates of suicidal ideation and suicide attempts in sexual minority youth (SMY) relative to heterosexual peers. However, little is known regarding how risk and protective factors may explain suicide risk differences among subgroups of SMY. The aims of this study were to 1) examine differences in prevalence and severity for suicide risk and protective factors among SMY, and 2) explore whether risk and protective factors are differentially associated with suicidal ideation and suicide attempts for SMY subgroups. Methods: Participants were 6,423 adolescents (ages 12–17) recruited from 14 Emergency Departments across the United States who completed an assessment of suicide risk and protective factors. SMY were 20% of the sample (n = 1,275) and categorized as bisexual (8%), gay/lesbian (2%), mostly straight (5%), or other sexual minority (5%). Results: Bisexual youth had elevated rates of suicidal ideation and attempts, more risk factors (e.g., bullying victimization, depression), and fewer protective factors (e.g., parent-family connectedness, positive affect) relative to mostly straight and other sexual minority youth. Bisexual and gay/lesbian youth only differed in parent-family connectedness (lower among bisexual youth). Depression and parent-family connectedness had weaker associations with suicidal ideation for bisexual youth. Limitations: Emergency departments were not nationally representative. Study design was cross-sectional, preventing causal inferences. Conclusions: Interventions seeking to mitigate risk factors and promote protective factors are greatly needed for SMY and may benefit from tailoring to address unique stressors for sexual minority subgroups. © 2020
Keywords: Connectedness; Risk factors; Sexual minority youth; Suicidal ideation; Suicide attempts

Religiosity, spirituality, suicide risk and remission of depressive symptoms: a 6-month prospective study of tertiary care Brazilian patients - Mosqueiro, B.P.; Caldieraro, M.A.; Messinger, M.; da Costa, F.B.P.; Peteet, J.R.; P Fleck, M. (Journal of Affective Disorders, 2021)
Religiosity and spirituality (R/S) are increasingly recognized as significant aspects in the evaluation of depressed patients. Limited research, however, has investigated the impact of R/S on outcomes of more severe or chronic depressed patients. The present study investigated the impact of different religiosity dimensions in tertiary care Brazilian depressed patients over suicide risk scores measured at baseline and remission of depressive symptoms in a 6-month prospective follow-up. In 277 individuals interviewed, 226 presented a diagnosis of depressive episode and 192 were assessed in the follow-up. Religiosity was evaluated using the Duke University Religion Index, comprising three dimensions of religiosity (organizational religiosity, non-organizational religiosity, intrinsic religiosity). Other potential predictors of outcomes included the Childhood Trauma Questionnaire (CTQ), Maudsley Staging of illness (MSM), Medical Outcomes Study Social Support Survey (MOS), World Health Organization Spirituality, Religiousness and Personal Beliefs instrument (WHOQOL-SRPB) and Hamilton Depression Scale (HAM-D). Results showed that almost half (46.1%) of the patients reported previous suicide attempts. Linear regression models identified that religious attendance (t-statistic -2.17, P=0.03), intrinsic religiosity (t-statistic -2.42, P=0.01) and WHOQOL-SRPB (t-statistic -3.67, P=0.00) were inversely correlated to suicide risk scores. In a prospective follow-up 16.7 % of patients (n=32/192) achieved remission of depressive symptoms (HAM-D scores ≤7). Religious attendance (OR 1.83, P=0.02) was identified as the main predictor of remission. Findings reinforce the importance of attending to religiosity/spirituality in order to improve outcomes and promote the recovery especially among severely depressed patients with increased suicide risk. © 2020 Elsevier Ltd
Keywords: Depression; Religiosity; Remission; Social Support; Spirituality; Suicide

Attachment Patterns in Children and Adolescents With Gender Dysphoria - Kozlowska, K.; Chudleigh, C.; McClure, G.; Maguire, A.M.; Ambler, G.R. (Frontiers in Psychology, 2021)
The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2 = 52.66; p < 0.001) and had a high rate of unresolved loss/trauma (χ2 = 18.64; p < 0.001). Comorbid psychiatric diagnoses (n = 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88; SD = 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2 = 2.43; p = 0.30) and rates of unresolved loss and trauma (χ2 = 0.70; p = 0.40). Post hoc analyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs. © Copyright © 2021 Kozlowska, Chudleigh, McClure, Maguire and Ambler.
Keywords: attachment; children and adolescents; dynamic maturation model of attachment (DMM); gender dysphoria; transgender

Suicidality risk among adult sexual minorities: Results from a cross-sectional population-based survey - Haney, J.L. (Journal of Gay and Lesbian Social Services, 2021)
Suicide among sexual minority adults is a serious public health issue. Data from the National Survey of Drug Use and Health (2015–2018) were analyzed to evaluate factors associated with past-year suicidality risk (thoughts, plans, or attempts) and self-reported sexual identity. Findings support previous research that sexual minority groups have a higher risk of suicidality compared to heterosexuals. Additionally, significant within-group gender differences were found for bisexuals with reported past-year suicide attempts. The risk ratio trajectory from suicidal ideation to suicidal attempt was the most striking for the gay and lesbian group compared to other populations. Implications and recommendations for future research are discussed. © 2021 Taylor & Francis Group, LLC.
Keywords: NSDUH; sexual identity; sexual minority; sexual orientation; suicidality; suicide attempts; suicide plans; suicide thoughts

Family-of-origin rejection on suicidal ideation among a sexual minority sample - VanBergen, A.M.; Love, H.A. (Journal of Marital and Family Therapy, 2021)
Suicide is a leading cause of death in the United States. Among sexual minority populations, suicide risk is elevated; this can be explained by minority stress. One such source of minority stress is family-of-origin rejection, a known risk factor for suicide among lesbian, gay, and bisexual (LGB) adolescents; however, less is known about this association among sexual minority adults. While navigating the intersection of minority stress theory and the interpersonal theory of suicide, this study sought to evaluate the impact of family-of-origin rejection distress on suicidal ideation among a sample of adults with marginalized sexual orientations. Recruited for two larger studies, 325 LGB participants (64.3% cisgender, 35.7% transgender or nonbinary) completed an online survey concerning minority stressors, depressive symptoms, and suicide. Using cross-sectional mediation analysis, family-of-origin rejection distress was indirectly associated with suicidal thoughts through depressive symptoms. Clinical implications and suggestions for future research are discussed. © 2021 American Association for Marriage and Family Therapy
Keywords: depression; marginalized sexual orientation; minority stress; suicidal thoughts

Health disparities in access to health care for HIV infection, substance abuse, and mental health among Latino men who have sex with men in a U.S.–Mexico Border City - Loza, O.; Provencio-Vasquez, E.; Mancera, B.; De Santis, J. (Journal of Gay and Lesbian Social Services, 2021)
A cross-sectional study among 150 community-dwelling Latino men who have sex with men (MSM) in a U.S.–Mexico border city was conducted to describe health disparities in access to care for HIV infection, substance use/abuse, and mental health. Data were collected in 2013 and 2014. Median age of participants was 26 years, and the majority of participants identified as a sexual minority and born in the United States. Half did not have health insurance and reported suicidal ideation. One-eighth reported living with HIV. Most common substances reported were alcohol, tobacco, and marijuana. Clinicians who provide care for Latino MSM should be aware of intersecting comorbidities. © 2021 Taylor & Francis Group, LLC.
Keywords: Health disparities; HIV/AIDS; mental health; people of color; substance abuse

Suicide Attempts in Association With Traditional and Electronic Bullying Among Heterosexual and Sexual Minority U.S. High School Students - Humphries, K.D.; Li, L.; Smith, G.A.; Bridge, J.A.; Zhu, M. (Journal of Adolescent Health, 2021)
Purpose: The aim of this study was to compare the association between bullying (traditional, electronic, and both) and suicide attempt in heterosexual and lesbian, gay, or bisexual (LGB) U.S. high school students. Methods: Data were obtained from 2015–2017 National Youth Risk Behavior Survey. Results: Nearly 25% of students reported experiencing bullying. Approximately 5.9% of heterosexual and 25.7% of LGB students attempted suicide. Heterosexual students who experienced either traditional or electronic bullying had a higher risk of attempting suicide (1.54 [95% confidence interval 1.19–1.98] and 1.64 [1.23–2.19], respectively). The associations were similar but weaker among LGB students (1.49 [1.08–2.04] and 1.43 [.90–2.27], respectively). Students who experienced both forms of bullying had the highest prevalence of suicide attempt, but the interaction was not statistically significant. Conclusions: LGB students had higher rates of both suicide attempts and experiencing bullying. Traditional and electronic bullying are not synergistic in the risk of attempting suicide, although each form increases that risk. © 2020
Keywords: Attempted; Bullying; Sexual and gender Minorities; Students; Suicide

Sexual violence as a mediator of sexual orientation disparities in alcohol use, suicidality, and sexual-risk behaviour among female youth - Scheer, J.R.; McConocha, E.; Behari, K.; Pachankis, J.E. (Psychology and Sexuality, 2021)
Sexual violence exposure represents a serious public health issue among female youth given its association with female youths’ engagement in health-risk behaviours. Sexual minority female youth are particularly vulnerable to sexual violence exposure, alcohol use, suicidality, and sexual-risk behaviour. Using the population-based 2017 Youth Risk Behaviour Survey, we examined sexual violence as a mediator of sexual orientation disparities in health-risk behaviours among female youth. This study included 7,532 female students in grades 9 through 12 across the US. Participants identified their sexual orientation as heterosexual (73.5%); bisexual (12.2%); and, gay or lesbian (2.2%). Compared to heterosexual female youth, sexual violence exposure, alcohol use, binge drinking, and multiple sex partners were more common among bisexual female youth. The elevated risk of suicidality was most notable among gay or lesbian female youth relative to heterosexual female youth and bisexual female youth relative to heterosexual female youth. Mediation analyses showed that sexual violence exposure partially explained the sexual orientation disparity in these co-occurring health-risk behaviours between bisexual female youth and heterosexual female youth. Our findings highlight the need for clinical attention to be paid to assessing and treating the health effects of sexual violence, especially among bisexual female youth. © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: female youth; health-risk behaviours; Sexual minority youth; sexual violence; youth risk behaviour survey (YRBS)

Differences in Tobacco Product Use by Sexual Orientation and Violence Factors Among United States Youth - Tabaac, A.R.; Charlton, B.M.; Tan, A.S.L.; Cobb, C.O.; Sutter, M.E. (Journal of Pediatrics, 2021)
Objective: To assess differences in the relationship between violence factor exposure and tobacco product pattern use (exclusive and poly), we hypothesized that compared with heterosexuals, sexual minority youth would be more likely to report exclusive-tobacco and poly-tobacco use patterns, and controlling for violence factors would attenuate these associations. Study design: Data from 27 513 US high-school youth were analyzed from the Centers for Disease Control and Prevention's Youth Risk Factor Surveillance System from 2015 and 2017. We fit sex-stratified, weighted, adjusted log-Poisson models to compare past 30-day exclusive combustible, exclusive e-cigarette, and poly-tobacco use in across sexual orientation. Then, models were adjusted for past-year experiences of physical fighting, bullying, attempting suicide, and physical and sexual dating violence. Results: Compared with heterosexual girls with other-sex partners, sexual minority girls were more likely to use exclusive combustible, exclusive e-cigarette, or poly-tobacco products. When adjusting for violence factors, most tobacco use associations were partially attenuated for all sexual minority girls, and completely attenuated for exclusive e-cigarette use among all sexual minority girls. Conclusions: Sexual minority girls have greater exclusive- and poly-tobacco use compared with heterosexual girls. Tobacco interventions for sexual minority youth should address the risks of poly-tobacco use as well as violence-based risk factors. © 2021 Elsevier Inc.
Keywords: electronic nicotine delivery systems; exposure to violence; sexual and gender minorities; tobacco use

Association of Sexual Orientation Acceptance with Reduced Suicide Attempts among Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth - Green, A.E.; Price-Feeney, M.; Dorison, S.H. (LGBT Health, 2021)
Purpose: This study examined the relationship between sexual orientation acceptance from others and suicide attempts among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. Methods: We analyzed data from a 2018 cross-sectional survey of LGBTQ youth between the ages of 13 and 24 years across the United States. Youth reported sexual orientation acceptance levels from parents, other relatives, school professionals, health care professionals, friends, and classmates to whom who they were "out."Adjusted logistic regression analyses were used to examine the association between sexual orientation acceptance and a past-year suicide attempt. Results: All forms of peer and adult acceptance were associated with reduced reports of a past-year suicide attempt, with the strongest associations found for acceptance from parents (adjusted odds ratio [aOR] = 0.52) and straight/heterosexual friends (aOR = 0.54). Youth who reported high levels of acceptance from any adult had nearly 40% (aOR = 0.61) lower odds of a past-year suicide attempt compared with LGBTQ peers with little to no acceptance. Youth with high levels of acceptance from any peer also had significantly lower odds of reporting a past-year suicide attempt (aOR = 0.55). These relationships remained significant even after controlling for the impact of each form of acceptance, suggesting unique associations with suicide risk for both peer and adult acceptance. Conclusion: Interventions aimed at increasing sexual orientation acceptance from supportive adults and peers have strong potential to address the public health burden of LGBTQ youth suicide. © Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.
Keywords: acceptance; minority stress model; sexual orientation; suicide; youth

Examining Profiles of Latinx Sexual Minority Adolescents Associated with Suicide Risk - Giano, Z.; O’Neil, A.M.; Stowe, M.; Hubach, R.D. (Journal of Immigrant and Minority Health, 2021)
Few studies have focused on within-group heterogeneity about specific factors that make lesbian, gay, or bisexual (LGB) Latinx adolescents at greater odds than other LGB adolescents for suicide We take a unique mixture-modeling approach by creating profiles of Latinx LGB adolescents based on suicide risk factors used in previous investigations (bullying, alcohol, sleep, social media, and poor grades). We use these profiles in a logistic regression to investigate suicidality A sample of 686 LGB, Latinx adolescents were used in a latent profile analysis yielding four distinct profiles. Class 4 represented the highest risk, with high rates of bullying, alcohol, poor grades, and use of electronics, while class 3 represented the lowest risk with low rates of bullying and alcohol Results speak to the need to address suicidal ideation through multiple factors, noting the strong association that both bullying and alcohol have with suicidal ideation. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Latent profile analysis; Latinx adolescents; LGB adolescents; Suicidality

Brief report: Differences in self-injurious thoughts and behaviors between sexual minority and heterosexual adolescent girls - Delcourt, M.L.; Tung, I.; Northrup, J.B.; Berona, J.; Stepp, S.D.; Hipwell, A.E.; Keenan, K. (Journal of Gay and Lesbian Mental Health, 2021)
Purpose: Adolescent suicidal ideation (SI) and nonsuicidal self-injury (NSSI) are associated with depression, but few studies adequately represent sexual minorities. This study investigated whether the association between SI/NSSI and depression varies by sexual orientation. Method: SI, NSSI, sexual orientation, and depressive symptoms were measured in a community sample of adolescent girls (n = 1,803). Results: Sexual orientation and depression accounted for unique risk for SI and NSSI in logistic regressions. Sexual orientation moderated the association between depression and NSSI. Conclusions: Results indicate that depression is a less specific predictor of NSSI among sexual minority adolescents compared to their heterosexual peers and indicate a need for future research to delineate which psychosocial factors better account for NSSI risk. © 2021 Taylor & Francis Group, LLC.
Keywords: Adolescence; depression; Mental Health; sexual minority; suicide

Elevated Rates of Violence Victimization and Suicide Attempt Among Transgender and Gender Diverse Patients in an Urban, iSafety Net Health System - Progovac, A.M.; Tran, N.M.; Mullin, B.O.; De Mello Libardi Maia, J.; Creedon, T.B.; Dunham, E.; Reisner, S.L.; McDowell, A.; Bird, N.; Sánchez Román, M.J.; Dunn, M.; Telingator, C.; et al. (World Medical and Health Policy, 2021)
The extent to which violent victimization may explain higher rates of suicidality for transgender and gender diverse (TGD) populations is not well-understood. We identified likely-TGD patients using 2008–2019 electronic health record data and compared them with non-TGD patients to characterize differences in suicide attempt, ideation, and violent victimization. TGD patients (n = 916) had more suicide attempts (5.2 vs. 0.4 percent), ideation (20.5 vs. 1.8 percent), and violent victimization (5.4 vs. 1.7 percent, all p <.001) than non-TGDs (n = 511,026). Violent victimization and TGD cohort were independent predictors of suicide attempt (odds ratios [ORs], 7.23 and 10.84) and ideation (ORs, 6.83 and 11.03, all p <.001). We did not observe a differential impact of violent victimization for gender minorities. TGD patients are at higher baseline risk for suicidality, which is higher still for those experiencing violent victimization. Routine screening for both outcomes, including in primary care settings, may improve treatment. © 2021 Policy Studies Organization
Keywords: electronic health record; LGBTQ; suicide attempt; transgender and gender diverse; victimization

Sexual violence victimization and suicide: Testing a coping-mental health framework - Kaniuka, A.R.; Desmarais, S.L.; Cramer, R.J.; Stoner, J.E.; Veri, S.; Wright, S.; Gemberling, T.M.; Nobles, M.R.; Holley, S.R. (Aggressive Behavior, 2021)
Sexual violence victimization is a prevalent public health concern. However, little research has investigated the factors linking sexual violence victimization to suicidal thoughts and behaviors (STBs). The current study tested the applicability of the psychological mediation framework, a coping-mental health model, for the prevention of STBs among victims of sexual youviolence. Furthermore, the current study explored whether sexual orientation moderated the progression from sexual violence victimization to STBs. Data were drawn from an online survey of victimization experiences and health (N = 2175). Bootstrap mediation tested whether the association of sexual violence victimization and STBs was mediated by emotion regulation strategies (cognitive reappraisal and expressive suppression) and psychopathology (anxiety, depression, and posttraumatic stress disorder). Multiple-groups analysis tested whether links within the mediation effects varied by sexual orientation. Bivariate findings showed that: (1) sexual minority persons were more likely to report sexual violence victimization and (2) cognitive reappraisal was more meaningfully associated with mental health among sexual minority persons. Sexual violence victimization was associated with STBs via a serial mediation through emotion regulation and psychopathology. The association between psychopathology and STBs was stronger among sexual minority compared with heterosexual respondents. Physical violence victimization was associated with STBs for heterosexual but not sexual minority persons in a follow-up model. Findings support an emotion regulation-mental health framework for the prevention of suicide among victims of sexual violence. Research and training implications are discussed. © 2021 Wiley Periodicals LLC
Keywords: emotion regulation; mental health; psychological mediation framework; sexual minority; sexual orientation; sexual violence; suicide

Ambient Discrimination, Victimization, and Suicidality in a Non-Probability U.S. Sample of LGBTQ Adults - Peterson, A.L.; Bender, A.M.; Sullivan, B.; Karver, M.S. (Archives of Sexual Behavior, 2021)
Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are at a higher risk for suicidality compared to the general population. A growing body of research has investigated this risk, particularly with attention to systemic factors such as discrimination and harassment. Unfortunately, research has only examined the impact of direct discrimination on suicidality and has neglected to examine how ambient discrimination (i.e., witnessing or being made aware of discriminatory behaviors directed at someone other than yourself in your group) relates to suicidality. Additionally, although some links exist between discrimination and suicidality, the mechanisms by which these are related are understudied. This study aimed to address these gaps by exploring the effect of ambient discrimination on suicidal ideation and examining psychological pain as a mediator in this relationship. Data were collected from a sample of 200 LGBTQ-identified individuals (M age = 35 years; 53.5% female; 86% White). Results of independent t tests and a one-way multivariate ANOVA revealed greater vulnerability for ambient/direct discrimination and psychache among individuals identifying as transgender, queer, and other. Regression and mediation analyses revealed that while both ambient and direct discrimination predicted suicidal ideation, only direct discrimination accounted for unique variance in the outcome; however, both ambient and direct discrimination contributed unique variance to psychological pain, which fully mediated their relationships to suicidal ideation. Results of this study may begin to provide insight into the pathways of risk and points of intervention for suicidality in the LGBTQ community. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Ambient discrimination; Direct discrimination; Gender identity; Psychache; Sexual orientation; Suicidality

Sexual violence and suicide risk in the transgender population: the mediating role of proximal stressors - Cogan, C.M.; Scholl, J.A.; Lee, J.Y.; Cole, H.E.; Davis, J.L. (Psychology and Sexuality, 2021)
The transgender population is at increased risk for mental and physical health disorders. Previous research indicates these disparities exist as a result of exposure to disproportionately more adverse life events, including multiple forms of violence, and hostile and unaccepting social environments. Minority stress theory posits that exposure to unique types of stressors (i.e. distal stressors and proximal stressors), in addition to the stress experienced by the general population, result in poor health outcomes. A consequence of exposure to these stressors is a high rate of suicide. The current study sought to examine the mediating role of proximal stressors (e.g. internalised stress related to gender identity) on the relationship between sexual violence and suicide risk in a transgender sample. Participants included 155 transgender individuals who completed measures related to experiences of traumatic events, gender minority stress, and suicide risk. The association between experiences of sexual violence and suicide risk was significant (F[1,153] = 33.86, p < .001, R2 = 0.18). Proximal stressors were found to partially mediate the relationship between sexual violence and suicide risk (t[2, 152] = 3.49, p = .006). These findings demonstrate a need for increased resources in sexual violence prevention and competent care for survivors of sexual assault in the transgender community. © 2020 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: gender minority stress theory; sexual violence; suicide risk; Transgender

Risk Factors and Correlates of Self-Injurious Behavior and Suicidal Ideation among College Students - Bakken, N.W. (Deviant Behavior, 2021)
This research examines psychosocial risk factors of non-suicidal self injury (NSSI) and suicidal ideation among a sample of college students. Data were collected from a random sample of 1,153 undergraduate students attending a Midwestern public university. Logistic regression was used to investigate various risk factors of NSSI and suicidal ideation, including respondent demographic characteristics, mental health, sexual victimization, substance use, and academic anxiety. Overall, 7% of the college students reported engaging in NSSI in the past year, while 8% reported suicidal ideation in the past year. Factors associated with significantly higher likelihood of NSSI and suicidal ideation include non-heterosexual orientation, sexual victimization, substance use, depression, and low self-esteem and self-efficacy. Students experiencing psychosocial and health related factors were found to be at an increased risk for NSSI and suicidal ideation. © 2019 Taylor & Francis Group, LLC.

Intersectionality and syndemics: A commentary - Sangaramoorthy, T.; Benton, A. (Social Science and Medicine, 2021)
This commentary addresses the possibilities and pitfalls of putting intersectionality and syndemics into conversation with each other. We engage with two studies published in this issue: the first on the health-related vulnerabilities among LGBTQ + Latinx men in Orlando after the Pulse nightclub shooting, and the other on syndemic health issues brought about by social and structural inequities among young Black gay, bisexual, and other men who have sex with men (GBM). Both manuscripts suggest that intersectionality and sydemics can be integrated or possibly merged to build effective health equity focused interventions for marginalized populations. We, however, argue that there are several methodological, ontological, and epistemological challenges in bringing together intersectionality and syndemics. Our argument coalesces around three key points. First, we contend that while it is feasible to think of their integration as useful to the study of health disparities, syndemics offers no added benefit to health scholarship grounded in intersectional analysis. Second, we argue that assumptions of common ground between intersectionality and syndemics rest on equating theories of interaction and additivity with critiques of mutual configurations of ideology, power structures, and social categories. Finally, we maintain that if intersectionality and syndemics are to be in conversation with each other, it must be done with the recognition and examination of where each framework situates itself relative to methodology, praxis, and power. Using our own work and those of intersectional feminist scholars, we demonstrate how the stakes of intersectionality diverge radically from those of syndemics, and how syndemics has the potential to undermine the significance of intersectionality for addressing issues of health equity. © 2021 Elsevier Ltd
Keywords: Critical race studies; Health equity; HIV; Intersectionality; Syndemics

Syndemic Profiles and Sexual Minority Men’s HIV-Risk Behavior: A Latent Class Analysis - Scheer, J.R.; Clark, K.A.; Maiolatesi, A.J.; Pachankis, J.E. (Archives of Sexual Behavior, 2021)
Syndemic theory posits that “syndemic conditions” (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men’s HIV-risk behavior. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: HIV-risk behavior; Latent class analysis; Sexual minority men; Syndemic

Racial/Ethnic, Sex, Sexual Orientation, and Socioeconomic Disparities in Suicidal Trajectories and Mental Health Treatment Among Adolescents Transitioning to Young Adulthood in the USA: A Population-Based Cohort Study - Xiao, Y.; Lindsey, M.A. (Administration and Policy in Mental Health and Mental Health Services Research, 2021)
Suicide is the second leading cause of death for people aged 10–34 years old. Limited research has documented extant heterogeneities in suicide across the life course and among diverse sociodemographic groups. There is also limited research on the influences of mental health utilization on suicidal trajectories across the life course. This study aims to: (1) identify racial/ethnic, sex, sexual orientation, socioeconomic status, and intersectional differences in suicidal trajectories among adolescents transitioning to adulthood; and (2) examine influences of mental health service utilization on disparities in suicidal trajectories. The study included 9421 respondents (Mage = 14.99 [SD = 1.61]) from Waves I–IV National Longitudinal Study of Adolescent to Adult Health (1994–2008). Latent class growth analyses were used to identify trajectories of suicidal ideation and suicide attempts. Multivariate multinomial logistic regression was used to examine the influences of mental health treatment and sociodemographic characteristics on suicidal trajectories. Three suicidal ideation (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt (low-stable, moderate-decreasing) trajectories were identified. Compared with the low-stable trajectories, the risks of being in high-decreasing suicidal ideation trajectories were higher among females (AOR = 1.45, 95% CI 1.01–2.13) and sexual minorities (AOR = 1.82, 95% CI 1.21–2.74). Sexual minorities (AOR = 2.63, 95% CI 1.69–4.08) and low-SES adolescents (AOR = 1.79, 95% CI 1.08–2.98) were more likely to be in the moderate-decreasing suicide attempt group. Mental health service utilization predicted engagement in high-risk suicidal trajectories. Sociodemographic disparities in suicidal trajectories initiate early and persist over time. Individuals in high-risk trajectories received mental health treatment during adolescence. Suicide prevention should target vulnerable subpopulations and mental health service utilization in the early stage. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
Keywords: Health disparities; Life course; Mental health treatment; Suicidal ideation; Suicidal trajectories; Suicide attempt

Family Belongingness Attenuates Entrapment and Buffers Its Association with Suicidal Ideation in a Sample of Dutch Sexual Minority Emerging Adults - Parra, L.A.; van Bergen, D.D.; Dumon, E.; Kretschmer, T.; La Roi, C.; Portzky, G.; Frost, D.M. (Archives of Sexual Behavior, 2021)
Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N = 675; ages 18–29, M = 21.93 years, SD = 3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Entrapment; Homophobic violence; Minority stress; Sexual orientation; Social belongingness; Suicidal ideation

Associations of physical and sexual violence victimisation, homelessness, and perceptions of safety with suicidality in a community sample of transgender individuals - Drescher, C.F.; Griffin, J.A.; Casanova, T.; Kassing, F.; Wood, E.; Brands, S.; Stepleman, L.M. (Psychology and Sexuality, 2021)
Transgender and gender nonconforming (TGNC) individuals experience hardship and mistreatment. These experiences may contribute to mental health disparities faced by this community, including suicidality. The present study examined the associations between physical- and sexual-violence victimisation, homelessness, perception of safety, and suicidality among TGNC participants (N= 70) in an LGBTQ health needs assessment of the Central Savannah River Area. Half of the participants endorsed a history of sexual violence victimisation and 41.4% endorsed a history of partner physical violence. Just under one-third (30.3%) of the sample endorsed a history of homelessness. Over half of the sample (52.9%) endorsed a suicidal ideation history, while over one-third (37.1%) of the sample endorsed a suicide attempt history. Sexual violence victimisation was significantly correlated with suicidal ideation and attempt history. Hierarchical regression models including sexual violence victimisation, homelessness, and perception of safety significantly predicted histories of both suicidal ideation and suicide attempts; however, perception of safety was the only significant independent stressor in the models with suicidal ideation and suicide attempt as outcome variables. TGNC suicidality is a complex problem with multiple risk factors. Interventions that adopt an approach that helps to address intra- and interpersonal, social, familial, and community factors may be useful. © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: sense of safety; Suicidality; transgender

Gender Diverse Youth on Fertility and Future Family: A Qualitative Analysis - Kerman, H.M.; Pham, A.; Crouch, J.M.; Albertson, K.; Salehi, P.; Inwards-Breland, D.J.; Ahrens, K.R. (Journal of Adolescent Health, 2021)
Purpose: Gender-affirming treatment for transgender and nonbinary adolescents has been shown to decrease anxiety, depression, and suicidality, but treatments have medical consequences. Specifically, hormone replacement and pubertal blocking may impact patients' fertility and childbearing capabilities. We interviewed gender diverse adolescents regarding their thoughts on family and fertility. Methods: We completed semistructured interviews with 23 gender diverse adolescents recruited from the Seattle Children's Gender Clinic. Interviewees included transfeminine, transmasculine, and nonbinary youth. Interviews were recorded, transcribed, and analyzed using Braun and Clarke's theory of thematic analysis, a flexible framework for qualitative analysis. Results: Gender diverse adolescents have myriad views on fertility, but four main themes were identified: (1) an interest in future family, including ideas regarding adoption and biological children; (2) barriers to fertility, including cost and procedure-related dysphoria; (3) factors unique to the developmental stage of adolescents, including the age discordance of making fertility decisions as a teenager and parental influence on decision-making; and (4) suggestions for clinicians approaching fertility counseling with adolescents considering hormone therapy. Conclusions: Many gender diverse youth asserted an interest in building families, although the process of fertility preservation remains fraught. Relative to other studies, our participants were hopeful, imaginative, and interested in having children. Participants wanted to receive specific counseling on fertility, to receive help navigating the logistics of fertility preservation, and to be listened to when their hopes for children (or no children) were stated. Further research is needed to create care paradigms that address fertility of transgender youth in an affirming, developmentally appropriate manner. © 2021 Society for Adolescent Health and Medicine
Keywords: Fertility; Gender diverse; Transgender; Youth

A review of gender affirmation surgery: What we know, and what we need to know - Akhavan, A.A.; Sandhu, S.; Ndem, I.; Ogunleye, A.A. (Surgery (United States), 2021)
Background: Gender-affirmation surgery is a rapidly growing field in plastic surgery, urologic surgery, and gynecologic surgery. These procedures offer significant benefit to patients in reducing gender dysphoria and improving well-being. However, the details of gender-affirmation surgery are less well-known to other surgical subspecialties and other medical subspecialties. The data behind gender-affirmation surgery are comparatively sparse, and due to the recency of the field, large gaps exist in the literature. Methods: PubMed searches were carried out specific to gender-affirming mastectomies, vaginoplasty, vulvaplasty, mastectomy, metoidioplasty, and phalloplasty. Combinations and variants of “gender affirming,” “gender confirming,” “transgender,” and other variants were used to ensure broad capture. Historical articles were also reviewed. The data gathered were collated and summarized. Results: Gender-affirmation surgery is generally safe. Complication rates for gender-affirming mastectomy and breast augmentation are very low, and complication rates for genital surgeries are also reasonably low. Gender-affirmation surgery decreases rates of gender dysphoria, depression, and suicidality, and significantly improves quality-of-life measures. Data regarding facial gender-affirming surgery are limited. There are very few patient-reported outcome measures specific to gender-affirmation surgery. Conclusion: Although the data behind male-to-female gender-affirming surgery are more robust, there are significant gaps in the literature with respect to female-to-male surgery, surgical complication rates for genital surgery, facial masculinization and feminization, and patient-reported outcomes. We therefore present recommendations for further study. © 2021 Elsevier Inc.

University housing reinforces the negative relationship between interpersonal violence, psychological distress, and suicidality in undergraduates, particularly among gender diverse students - Heller, A.T.; Berg, S.S.; Prichard, J.R. (Journal of American College Health, 2021)
Objective: To compare academic and mental health outcomes across diverse gender identities in the context of interpersonal violence and campus housing. Participants: 45,549 students from 124 self-selected post-secondary institutions. Methods: Various academic and health measures from the National College Health Assessment Spring 2017 dataset were analyzed for differences across five gender identities (cis women, cis men, transwomen, transmen, and genderqueer students), and two housing categories (university housing and non-university housing). Results: When compared to cisgender peers, gender diverse students reported greater experiences of interpersonal violence and higher levels of negative academic and mental health outcomes. Living in university housing was associated with an increase in these disparities. Conclusions: University housing, which usually reinforces fixed gender binaries, is associated with worse outcomes for gender diverse students. These data can help higher education institutions better understand and address problems that disproportionately impact transgender and gender diverse students, who represent a growing demographic. © 2021 Taylor & Francis Group, LLC.
Keywords: Academic success; gender; housing; interpersonal violence; mental health; transgender

Suicide exposure in transgender and gender diverse adults - Cerel, J.; Tucker, R.R.; Aboussouan, A.; Snow, A. (Journal of Affective Disorders, 2021)
Objective: The purpose of this study is to examine the psychological effects of suicide exposure for Transgender and Gender Diverse (TGD) adults. Method: Using data from a national online survey of 2784 self-identified TGD adults, the current study investigated the prevalence of suicide death and suicide attempt exposure and demographic and mental health correlates. Results: Nearly sixty percent of the sample (57.9%) reported they were close to at least one person who attempted suicide, and more than a quarter of the sample reported they were close to at least one person who died by suicide. Exposure to either the suicide attempt or death of another individual was related to multiple indicators of psychological distress. Conclusions: Exposure to the suicidal behavior of close others is prevalent in TGD individuals: over half of participants were close to someone who attempted suicide, more than in population-based studies of suicide exposure. Exposure appears to have a potential effect on recent indicators of psychological distress and suicide risk, which is important to consider when working in TGD communities. © 2020
Keywords: Exposure; suicide; Transgender

Gender dysphoria: Prejudice from childhood to adulthood, but no impact on inflammation. a cross-sectional controlled study - Real, A.G.; Fontanari, A.M.V.; Costa, A.B.; Soll, B.M.B.; Bristot, G.; de Oliveira, L.F.; Kamphorst, A.M.; Schneider, M.A.; Lobato, M.I.R. (Trends in Psychiatry and Psychotherapy, 2021)
Introduction: Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one’s gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5). Methods: Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay. Results: Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine. Conclusions: These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers. © 2021, Sociedade de Psiquiatria do Rio Grande do Sul. All rights reserved.
Keywords: Case-control study; Childhood maltreatment; Discrimination; Gender dysphoria; Inflammatory cytokines; Transsexuality

Associations between transgender identity, sleep, mental health and suicidality among a north american cohort of college students - Hershner, S.; Jansen, E.; Gavidia, R.; Matlen, L.; Hoban, M.; Dunietz, G.L. (Nature and Science of Sleep, 2021)
Purpose: The purpose of this study is to examine the associations between transgender identity, sleep, and mental health among a North American cohort of cisgender and transgender college students. Participants and Methods: This cross-sectional study surveyed 221,549 North American college students from the 2016–2017 American College Health Association-National College Health Assessment II. Bivariate and multivariable analysis examined associations among transgender identity and outcomes of insomnia symptoms, daytime sleepiness, sleep disorder diagnoses and treatments. Mental health outcomes included mood symptoms, suicidal behaviors, anxiety and depression diagnoses and treatments. Results: Transgender identity was reported by 1.6% (n=3471) of United States (US) and 1.7% (n=717) Canadian students, respectively. Mean age was 22.5 ±6. Transgender college students have an increased prevalence of daytime sleepiness, insomnia symptoms, diagnoses and/or treatment of insomnia and other sleep disorders as compared to cisgender college students. Mental Health symptoms are more prevalent with a 2-fold increase in depression and anxiety and nearly a 4-fold increase in suicide attempts among transgender students. A higher burden of mood symptoms exists among transgender college students in the US in comparison to Canadian students. Conclusion: Transgender college students have an alarmingly high rate of mood, sleep disturbances and sleep diagnoses, and suicidality. Colleges and universities must provide sufficient resources to address the sleep and mental health needs of transgender students. Institutions must adopt gender affirming policies that promote an inclusive environment. Increased allocation of resources and adoption of policies that enhance the physical and mental health of transgender students could improve sleep, mood, and potentially lower the suicide risk among a population that often experiences health inequities. © 2021 Hershner et al.
Keywords: College student; Insomnia; Mood; Sleep; Suicide; Transgender

A Cotherapy Supervision Approach using Person-Centered Theory with a Gender Fluid Client - Knutson, D.; Koch, J.M. (Clinical Case Studies, 2021)
The authors discuss their work with a young adult client who identified as gender fluid. The client was a college student in a rural, mid-south town. The authors are two faculty members who worked with the client for a period of 2 years using a cotherapy supervision approach. The counseling approach was affirmative and person-centered. By keeping a focus on the exploration of gender foremost, the clinicians saw an abatement of other symptoms (depression, suicidality, self-harm, disordered eating, low self-confidence, emotion dysregulation, dissociation, and so on) and an improvement in wellness (relationships, emotion regulation, self-concept, assertiveness, appropriate boundary-setting, and so on) over time. The authors offer specific interventions such as collaborative letter writing and the creation of a transition roadmap. They also highlight the advantages and utility of a collaborative, person-centered, consent-based, affirmative approach to therapy with rural transgender and nonbinary clients with complex presenting concerns. © The Author(s) 2021.
Keywords: gender; humanistic; LGBT; person-centered; transgender

The Bioethical Dilemma of Gender-Affirming Therapy in Children and Adolescents - Robles, M. (Linacre Quarterly, 2021)
: Since the establishment of the first transgender clinic in the United States in 2007, over sixty clinics associated with children’s hospitals have opened across the nation and are seeing very young children and adolescents with a diagnosis of gender dysphoria (GD). Once known as gender identity disorder, GD has been redefined by the latest version of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) not as a mental illness but as the distress experienced by individuals related to their biological sex. The widely accepted practice of gender-affirming therapy (GAT) to treat a vulnerable population despite the associated health risks, the lack of supportive scientific evidence for the pharmacological and surgical interventions, along with the unqualified claim that these interventions will decrease the rate of suicide in these individuals presents a significant bioethical dilemma. The growing trend of GD not only impacts the individuals diagnosed but also society, culture, and the integrity of the profession of medicine. This article utilizes the five-box method, an ethical decision-making framework, to address the implications of the proposed treatment. Once applied, it becomes clear that the hormonal and surgical approaches used are not scientifically or ethically justified. The patient’s autonomy and preferences should be respected, yet constrained, if there exists a considerable risk to the well-being of the individual without proven benefits. The quality of life of those receiving this treatment has not been shown to be significantly improved long term, and the mental, physical, and spiritual health of individuals with GD is not thoroughly addressed in these clinics. The important social and contextual factors, on both microcosmic and macrocosmic scales, are minimized in favor of promoting an ideology. Ultimately, Catholic moral teaching reveals that this widely recommended treatment violates the body–soul union, disregards the principle of totality and integrity, and debases the dignity of humanity. Summary: This article examines GAT, the paradigm used in treating individuals identifying as transgender, through the lens of an EDMF. Each stage of this widely proposed treatment - social affirmation, pubertal blockade, administration of cross-sex hormones, and sex reassignment surgery - poses harms and risks that are not fully disclosed to minors and families, creating a bioethical dilemma. Dialogue utilizing science and reasoning must be encouraged to assist individuals who experience a gender identity that rejects their biological sex. This approach would also contribute to the well-being of society. © Catholic Medical Association 2021.
Keywords: Adolescent health; Bioethical dilemma; Children; Cross-sex hormones; Ethical decision-making framework; Gender dysphoria; Puberty blockers; Sex reassignment surgery; Suicide; Transgender

A Post-Hoc Comparison of Two Sexual Health Curricula on Sexual Health Knowledge, Perception, and Attitudes - Son, J.; Draws, C. (American Journal of Sexuality Education, 2021)
A post-hoc study was conducted to ascertain the effect of comprehensive sex education on of 7th graders’ knowledge, perceptions, and attitudes regarding sexual health and sexual identities in a small city school district in the Midwest USA. All five middle schools in the district participated, three of which used a comprehensive curriculum and two taught their existing curriculum. A total of 260 online surveys were completed by the 7th graders through Qualtrics. Chi-square tests were conducted, and the outcome showed a statistically significant difference in student perception and attitudes regarding sexual identity and orientation between the two curriculum groups. The comprehensive curriculum group scored higher than the existing curriculum group on items that indicate openness and respect regarding diversity in sexual identities and orientation. Given that LGBTQ+ students are at a greater risk to engage in self-harm and suicidal attempts, the outcome potentially suggests that a more open and accepting school atmosphere can be created by the implementation of a comprehensive sexual health curriculum. It implies that a purposive, systematic, and longitudinal effort to provide comprehensive sexual health education could also help reduce the challenges LGBTQ+ youth face outside of school. © 2020 Taylor & Francis Group, LLC.
Keywords: Adolescent health; and plus (LGBTQ+) health; bisexual; community-based participatory research; comprehensive sexual health curriculum; gay; lesbian; questioning; sexuality; transgender; transgender

Curvilinear associations between sexual orientation and problematic substance use, behavioural addictions and mental health among young Swiss men - Wicki, M.; Marmet, S.; Studer, J.; Epaulard, O.; Gmel, G. (Addictive Behaviors, 2021)
Background and aims: It is well documented that individuals with a minority sexual orientation face greater risks of problematic substance use (e.g. heavy episodic drinking, alcohol use disorder) and mental health problems. Far less is known about how that risk varies within this population and their risk of behavioural addictions. This study estimated the risks of problematic substance use, behavioural addiction and poor mental health across the spectrum of sexual orientation. Sample and method: A sample of young Swiss men (N = 5294; mean age = 25.5, SD = 1.25; representative of 21 of Switzerland's 26 cantons) completed a self-reporting questionnaire on sexual orientation (attraction, 5-point scale) and criterion variables: problematic substance use (e.g. alcohol, cigarettes, cannabis and other illegal drugs), behavioural addictions (gambling, gaming, cybersex, internet, smartphone, work, exercise) and indicators of mental health (e.g. depression, stress). Curvilinear associations between sexual orientation (heterosexual, mostly-heterosexual, bisexual, mostly-homosexual or homosexual individuals) and criterion variables were explored using fractional polynomial regressions. Results: Although there were differences across criterion variables, in general, the highest risks of problematic substance use, behavioural addictions and mental health problems were estimated for mostly-heterosexual, bisexual or mostly-homosexual men, followed by homosexual men, and with heterosexual men facing the lowest risk. Discussion and conclusion: Aggregating the spectrum of sexual orientations into two or three distinct groups blurs important internal group differences. Outcome-specific explanations beyond minority stress and biphobia are necessary to understand the pathways between sexual orientation and risky behaviours. Considering sexual orientation is important to provide targeted healthcare prevention and interventions. © 2020
Keywords: Behavioural addictions; Cohort Study on Substance Use Risk Factors (C-SURF); Problematic substance use; Sexual orientation; Young adults

Dispositional optimism and suicide among trans and gender diverse adults - Snooks, M.P.; McLaren, S. (Death Studies, 2021)
Trans and gender diverse adults are at increased suicide risk. Optimism protects against suicide across multiple populations. Applying the Interpersonal-Psychological Theory of Suicide (IPTS), we examined both factors among 237 adults recruited via social media and online platforms, 79.3% of whom reported serious suicide ideation. Dispositional optimism predicted suicidal ideation and behaviors (SIB), but did not moderate the relationship between the IPTS components and SIB. After controlling for depressive symptoms, hormone therapy and gender-affirming surgery did not predict SIB. Promoting dispositional optimism within a therapeutic framework may reduce SIB in this vulnerable population. © 2021 Taylor & Francis Group, LLC.

The Second National Canadian Homeless Youth Survey: Mental Health and Addiction Findings: La Deuxième Enquête Nationale Auprès des Jeunes Sans Abri : Résultats en Matière De Santé Mentale et de Toxicomanie - Kidd, S.A.; Gaetz, S.; O’Grady, B.; Schwan, K.; Zhao, H.; Lopes, K.; Wang, W. (Canadian Journal of Psychiatry, 2021)
Objective: Youth experiencing homelessness represent a major social problem in Canada and, as demonstrated in the first national survey of this population conducted in 2015, are experiencing significant mental health challenges. The present study examines the findings of a second national survey completed in 2019. These findings afford the opportunity to examine the reliability of the findings of the first study with another large, representative sample and to attempt to articulate the unique characteristics of youth experiencing the greatest distress among this at-risk population. Methods: This study analyzed the mental-health-related data from the 2019 Without a Home–National Youth Homelessness Survey that was administered through convenience sampling at 98 agencies serving homeless youth in 49 communities across Canada. The survey was cross-sectional and self-administered, assessing a range of demographic information, pre- and post-homelessness variables, and mental health indicators. Multinomial logistic regression and linear regression were implemented to evaluate associations with distress level. Results: Survey data were obtained from 1,375 youth accessing Canadian homeless services in 9 provinces. Thirty-five percent reported at least 1 suicide attempt, and 33.1% reported a drug overdose requiring hospitalization. The findings of this survey replicated most of the key findings from the 2015 survey. The current findings emphasized, for this high-risk population, the heightened adversity faced by young women, Lesbian, Gay, Bisexual, Transgender, Queer, Two-Spirit (LGBTQ2S), and Indigenous subpopulations, as well as the centrality of violence exposure in determining risk and distress. Sexual violence, in particular, emerged as a key factor in the identification of youth experiencing the greatest distress with risk buffered by contact with family. Conclusions: These findings can inform prevention and intervention policies and services and reinforce the importance of attending to violence exposure and trauma as central to the mental health trajectories of youth who have experienced homelessness. © The Author(s) 2021.
Keywords: addictions; homeless adolescent; homeless youth; mental illness; street youth

Predictors of sexual victimisation and suicidal ideation among transgender and gender-nonconforming adolescents - Marx, R.A.; Hatchel, T.; Mehring, C.B.; Espelage, D.L. (Psychology and Sexuality, 2021)
To better understand the well-being of transgender and gender-nonconforming (TGNC) adolescents, this study examined the relations among bias-based peer victimisation, sexual harassment, parental support, school belonging, sexual violence, and suicidal ideation in a sample of a total of 16,292 high school students from the U.S (TGNC n= 610) Midwest. Students completed self-report measures: 22% of TGNC adolescents reported being forced to take part in sexual activity, and 33% reported being sexually harassed. Tests of the individual parameters revealed four variables that differentiated between those who reported sexual victimisation and those who did not. Results indicated that sexual harassment victimisation, bias-based peer victimisation, problematic drug use, and female sex assigned at birth predicted sexual victimisation. Suicidal ideation was predicted by sexual victimisation, sexual harassment victimisation, bias-based peer victimisation, and problematic drug use. Greater parental support and school belonging were associated with less suicidal ideation. Practitioners, teachers, and school administrators should be sure to intervene in instances of transphobic victimisation and sexual harassment that occur in their classrooms and schools in order to address adverse outcomes for TGNC adolescents. © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: bullying; LGBT; parental support; school belonging; substance use; Suicidal ideation

Long-Term Care Expectations and Plans of Transgender and Nonbinary Older Adults - Knochel, K.A.; Flunker, D. (Journal of Applied Gerontology, 2021)
Problem: Transgender and nonbinary (TNB) older adults endure discrimination from medical providers and expect it in institutional long-term care. Gender identity–based discrimination is connected to negative health outcomes and reluctance to access needed care. Objective: The aim of this study is to explore how gender identity affects TNB older adults’ fears, hopes, and plans for use of institutional long-term care. Method: Co-investigators conducted semi-structured interviews with 24 TNB older adults in Minnesota, collaboratively analyzed the results using reflexive thematic analysis, and member-checked emergent themes. Findings: Oppression is central to participants’ consideration of future long-term care. They fear mistreatment and loss of authentic gender expression and recognition in long-term care facilities. Fears of oppression factor into consideration of suicide and physical transition, although some participants hope societal shifts will lead to unbiased long-term care. Conclusion: Creation of anti-oppressive institutional and community-based long-term care options is critical to effectively serve TNB people as they age into dependence. © The Author(s) 2021.
Keywords: discrimination; health-related quality of life; institutional care; long-term care; transgender

The impact of the first three months of the COVID-19 pandemic on the Australian trans community - Zwickl, S.; Angus, L.M.; Qi, A.W.F.; Ginger, A.; Eshin, K.; Cook, T.; Leemaqz, S.Y.; Dowers, E.; Zajac, J.D.; Cheung, A.S. (International Journal of Transgender Health, 2021)
Background: Trans and gender diverse individuals (people who identify with a gender different to what was presumed for them at birth) are one of the most medically and socially marginalized groups in our community. The COVID-19 pandemic may compound preexisting depression and thoughts of self-harm or suicide. Aim: We aimed to explore the impact of the COVID-19 pandemic on the Australian trans community. Methods: An online cross-sectional survey was conducted between 1st May 2020 and 30th June 2020, amidst strict Australia-wide social restrictions. Australian trans people aged ≥16 years were eligible to participate. Survey questions explored the impact of the COVID-19 pandemic on living situation, employment, financial situation, and healthcare. Logistic regression to assess negative impacts due to COVID-19 on depression and thoughts of self-harm or suicide (measured by Patient Health Questionnaire-9 (PHQ-9) are presented as odds ratios (95% confidence interval)). Results: Of 1019 participants, 49.6% reported experiencing financial strain, 22% had reduced working hours, and 22.4% were unemployed (three times the national rate). Concerningly, 61.1% experienced clinically significant symptoms of depression (Patient Health Questionnaire-9 score ≥10), considerably higher than pre-COVID rates for the trans community and over twice the national rate. Moreover, 49% reported thoughts of self-harm or suicide (over three times the national rate) which was more likely if a person experienced cancelation or postponement of gender-affirming surgery (OR 1.56 (1.04, 2.35)), financial strain (OR 1.80 (1.36, 2.38)), or felt unsafe or afraid in their household (OR 1.96 (1.23, 3.08)). Discussion: Given rates of clinically significant depression and thoughts of self-harm or suicide are far higher in trans people than the general population, specific strategies to improve mental health in the trans community during the COVID-19 pandemic must be made a priority for policymakers, researchers, and health service providers to prevent suicide. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1890659. © 2021 Taylor & Francis Group, LLC.
Keywords: Coronavirus; COVID-19; depression; suicidality; transgender

Suicidal ideation among transgender and gender diverse adults: A longitudinal study of risk and protective factors - Rabasco, A.; Andover, M. (Journal of Affective Disorders, 2021)
Introduction: Transgender and gender-diverse (TGD) people experience greatly heightened levels of suicidal ideation (SI) compared to the general population. Therefore, it is imperative to understand the risk and protective factors for SI within this population. Methods: The present study explored how victimization, discrimination, community connectedness, and pride impact SI cross-sectionally and longitudinally in a sample of TGD adults (N = 180, 55% transgender women, 76.7% Caucasian, M age = 26.01 years). Results: Cross-sectional results showed that experiencing more types of victimization and discrimination at baseline predicted higher SI severity at baseline, while community connectedness and pride at baseline were not predictive of SI severity at baseline. Longitudinal analyses showed that experiencing fewer types of victimization and discrimination during the 1-month follow-up period were associated with a decrease in SI severity from baseline to follow-up. Medium and high levels of community connectedness were also associated with a decrease in SI severity from baseline to follow-up. Pride was not associated with change in SI from baseline to follow-up. Limitations: Limitations include the limited racial/ethnic diversity of the sample and that frequency of experiencing victimization and discrimination was not assessed. Conclusions: These results suggest victimization and discrimination are strong predictors of SI severity within this population, and the factors of victimization, discrimination, and TGD-community connectedness impact change in SI severity across time. These findings provide evidence for the importance of anti-discrimination laws that apply to TGD people, as well as the utility of connecting TGD clients to the TGD community. © 2020
Keywords: Discrimination; Pride; Social support; Suicide; Transgender; Victimization

PTSD Symptoms, Suicidal Ideation, and Suicide Risk in University Students: The Role of Distress Tolerance - Kratovic, L.; Smith, L.J.; Vujanovic, A.A. (Journal of Aggression, Maltreatment and Trauma, 2021)
Posttraumatic stress disorder (PTSD) is associated with suicidal ideation and suicide attempts. Distress tolerance, or the perceived capacity to tolerate negative emotional states, is a cognitive-affective factor with clinical relevance to PTSD-suicide relations. No studies to date have examined the associations of PTSD symptoms, distress tolerance, and suicidal ideation or suicide risk among university students, a population at risk for suicidal ideation and behavior. It was hypothesized that greater PTSD symptom severity and lower perceived distress tolerance, respectively, would be associated with greater suicidal ideation and suicide risk; and that PTSD symptom severity would exert an indirect effect on suicidal ideation and risk through perceived distress tolerance. Covariates included trauma load, negative affectivity, and gender. Participants were comprised of 819 trauma-exposed university students (78.0% female; Mage = 22.0), who completed a battery of questionnaires. Mediation analyses were conducted, and results indicated that greater PTSD symptom severity and lower distress tolerance, respectively, were significantly associated with greater suicidal ideation and suicide risk. PTSD symptom severity exerted an indirect effect on suicidal ideation and suicide risk through perceived distress tolerance. Effects were demonstrated after controlling for theoretically relevant covariates. Clinical and research implications are discussed. © 2020 Taylor & Francis.
Keywords: distress tolerance; posttraumatic stress; PTSD; suicidal ideation; suicidal risk; suicide; trauma; university students

Epidemiologic considerations on gender incongruence in adults, adolescents and children and mental health issues: A review of the literature - Di Grazia, M.; Sammartano, F.; Taverna, C.; Knowles, A.; Trombetta, C.; Barbone, F. (Sexologies, 2021)
Epidemiological research may offer a key to interpreting gender incongruence (GI) and identifying the medical needs of people with GI. Currently, it is difficult to estimate the real prevalence of GI due to the use of different definitions. The data on GI prevalence are influenced by case definition and by the different methodologies applied by researchers to assess cases. Estimations of prevalence therefore vary widely and are estimated between 0.1% and 1.1% among adults, with a male-to-female (MtF) – female-to-male (FtM) sex ratio of 1–6. For children, the literature reports a prevalence ranging from 1% to 4.7%, with a predominance of MtF for children and from 1.2% to 16.1% in adolescents, among whom FtM appears to be predominant. Studies based on access to gender clinics may underestimate GI prevalence while studies focused on self- or parent-reported data may overestimate the phenomenon. The literature describes high rates of affective and anxiety disorders (18–80%) and frequent personality disorders (20–70%), suicide attempts, suicide and self-harm among people with GI. These problems seem to improve after gender affirmation treatment. Some authors report a high prevalence of Autistic Spectrum Disorders (ASD) (6–14%) among youth with GI. Mortality rates, HIV infection and sexually transmitted diseases are high among the transgender population, probably related to lack of prevention. It is crucial to determine the true prevalence of GI in order to deliver adequate medical support. Future studies should be based on large multicenter cohorts or population-based surveys, and should adopt respondent-driven sampling while including individuals who do not seek services offered at gender clinics, to limit the selection bias. © 2020 Sexologies
Keywords: Adolescents; Adults; Autism; Children; Epidemiology; Gender incongruence; Health; Mental disorders; Mortality; Prevalence

Spatial analysis and risk factors of suicide among people living with HIV/AIDS who committed suicide - Zhang, H.; Feng, Y.; Li, Z.; Xiu, X.; Wang, L. (International Journal of STD and AIDS, 2021)
Poor mental health may confer worse health outcomes among people living with HIV/AIDS (PLWH). Suicidal behaviors are symptoms of a depressive episode. The goal was to explore characteristics for spatial distribution and risk factors for suicide among PLWH. This study was conducted in Mainland China with the annual newly reported data of PLWH from 2013 to 2018. We compared the spatial distribution differences between the HIV epidemic and suicide mortality and analyzed the global and local spatial analysis of suicide. Further, we explored the possible risk factors of suicide in PLWH by multivariate regression and a decision tree model. High suicide mortality regions in PLWH in China were inconsistent with that of the high prevalence of PLWH, which showed that there was distribution discordance between the HIV epidemic and suicide mortality. Multivariate regression showed that the possible risk factors of PLWH who committed suicide were younger age, with Han nationality, single, having a higher educational level, and homosexual infection route. The decision tree model showed that age was the primary factor. In conclusion, there was a discordance between HIV prevalence and suicide mortality; lower HIV prevalence regions might have higher mortality due to suicide. Concern is merited amongst PLWH with poor mental health. © The Author(s) 2021.
Keywords: HIV; mortality; spatial; suicide

Characteristics of Transgender Patient Cases Managed by a Toxicologist: an Analysis of the Toxicology Investigator’s Consortium (ToxIC) Registry: January 2017–June 2019 - Surmaitis, R.M.; Greenberg, M.R.; Ebeling-Koning, N.E.; Grenz, P.M.; McWhirter, C.R.; Careyva, B.A.; Sabino, J.N.; Cook, M.D.; Cannon, R.D.; Koons, A.L.; Katz, K.D.; Kincaid, H.; et al. (Journal of Medical Toxicology, 2021)
Introduction: The Toxicology Investigators Consortium (ToxIC) database, created in 2010 by the American College of Medical Toxicology (ACMT), compiles data recorded by medical toxicologists. In January 2017, the data field for transgender (and if transgender, male-to-female or female-to-male) was added to the ToxIC form. Little is known regarding trends in poisonings among transgender patients. We sought to review consultations managed by a bedside toxicologist and provide descriptive data in trends among types of exposures within the transgender demographic. Methods: A retrospective ToxIC database evaluation of cases in which the patient identified as transgender were reviewed from January 2017–June 2019 and descriptive demographics reported. Results: The registry contained 113 cases that involved transgender patients. Of those with complete data, 41 (36.6%) were male-to-female, 68 (60.7%) were female-to-male, and 3 (2.7%) identified as gender non-conforming. Of those with complete data, the most common reason for encounter was intentional use of a pharmaceutical drug (N = 97, 85.8%), of which 85 (87.6%) were classified as intentional pharmaceutical use intended for self-harm. Analgesics were the most common class of drugs used out of those reported (N = 24, 22%). Forty-six (90.2%) patients aged 13–18 with complete data were identified as encounters due to self-harm. Attempt at self-harm was the most common reason for intentional pharmaceutical encounter among the sample of transgender patients with complete data (N = 85, 87.6%); with female-to-male patients having an N = 53 (77.9%). Conclusion: Among transgender patients in the ToxIC registry, the most common primary reason for the encounter was intentional use of a pharmaceutical drug intended for self-harm. In this small cohort, there were some age and transition differences in prevalence. These findings may inform poisoning prevention practices as well as sex- and gender-based management of patients in this vulnerable population. © 2020, American College of Medical Toxicology.
Keywords: Drug misuse and abuse; ToxIC; Toxicological exposure; Transgender

Negotiating mental health amongst transgender parents in Australia - Charter, R.; Ussher, J.; Perz, J.; Robinson, K. (International Journal of Transgender Health, 2021)
Background: Many transgender (trans) parents experience challenges related to their mental health, which can affect and impact on their experiences of parenting, however there is scant research on how Australian trans parents contextualize and experience their mental health, the support they receive for it, and impacts within the family context. Aims: The present study aims to address these gaps in the literature, through examining how Australian trans parents contextualize and experience issues around their mental health, and their experience of formal and informal support for their mental health? Methods: This study aimed to explore these experiences, through a qualitative research design using online open-ended survey data and one-on-one interviews, with 66 trans parents, aged 24–67 years old. Data was analyzed using thematic analysis. Results: Many participants reported significant challenges in relation to their mental health: such as depression, anxiety, and suicidal ideation, which reportedly made parenting challenging. However, participants reported that gender affirmation as well as family and social support had a positive impact on their mental health. The majority of participants reported feeling they had to educate their therapist, that they were pigeon-holed by their gender identity or, had concerns about confidentiality. However, some participants expressed positive interactions with therapists, particularly therapists specializing in, or knowledgeable of, trans health. Conclusion: The results reinforced the need for mental health professionals and associated services to be competent in treating trans parents and reiterated the positive impact of family and social support, as well as support for gender affirmation, on the mental health of trans parents and their ability to parent. © 2021 Taylor & Francis Group, LLC.
Keywords: Gender affirmation; mental health; mental health support; parenthood; trans; transgender

Trans and Gender-Diverse peoples’ experiences of crisis helpline services - Lim, G.; Waling, A.; Lyons, A.; Pepping, C.A.; Brooks, A.; Bourne, A. (Health and Social Care in the Community, 2021)
Crisis helplines are typically easily accessible and deliver interventions in a timely manner, regardless of geographical location. The efficacy and user experiences of these services are the subject of considerable interest within the field, but the experiences of trans and gender-diverse individuals remain unexplored despite high rates of mental ill health being documented in this population. A total of 134 trans and gender-diverse Australians were surveyed about their experiences of personal crises and of utilising crisis helplines. Within our sample, 84.2% (n = 113) of participants recognised at least one service – however, only 32.8% (n = 44) utilised a service to cope with a personal crisis. Participants cited poor recognition and understanding of the challenges specific to trans and gender-diverse individuals among helpline workers as a primary reason for avoiding these services, and articulated needs which were a poor fit for the one-off intervention model commonly employed by helpline services. In order for helpline services to be viable avenues of support for trans and gender-diverse individuals during a personal crisis, helpline workers must be sufficiently equipped to work with trans and gender-diverse callers and to facilitate their enrolment in ‘traditional’ mental health services. © 2021 John Wiley & Sons Ltd
Keywords: discrimination; gender and community care; mental health services; suicide; support services; transgender and gender diverse

Correlates of depressive symptoms in transgender women initiating HIV treatment in Argentina - Aristegui, I.; Radusky, P.D.; Zalazar, V.; Cardozo, N.; Fabian, S.; Duarte, M.; Frola, C.; Cahn, P.; Sued, O. (Journal of Gay and Lesbian Mental Health, 2021)
Introduction: Transgender women (TGW) experience high prevalence of depression worldwide. Methods: This study analyzed the prevalence and correlates of depressive symptoms among 61 HIV + TGW (age: M = 29.87 years, SD = 6.51) from Argentina; through questionnaires assessing psychosocial vulnerability, gender identity stigma (GIS) and violence, mental health, substance use, and protective factors. Results: Half of the respondents showed significant depressive symptoms. In the multivariable logistic regression model, unstable housing, GIS from police, anxiety, and lifetime suicide attempts predicted increased odds of depressive symptoms. Conclusion: The role of institutional GIS and psychosocial vulnerability in the development of depression should be considered in HIV and mental health care for TGW. © 2021 Taylor & Francis Group, LLC.
Keywords: CES-D; depression; gender identity stigma; HIV; Transgender women

Suicide in dispute: A critical approach to the association between suicide and non-heteronormative sexualities - Villaa, E.O.O. (Saude e Sociedade, 2021)
This study analyzes how social groups with nonheteronormative sexualities are often associated with suicide and posits some consequences of this association in academic and social contexts. This reflection contributes to a necessary conversation that extends beyond the theoretical positions of researchers and has a social effect. In this paper I highlight some of the experienced effects produced by the association between suicide and sexual diversity by acknowledging how sexuality assumes a specific social meaning. The article is divided into four sections. In the first two, I analyze how the notion of epidemiological risk becomes an identity trait in populations with non-heteronormative sexualities. In the third section, I reflect on academic research regarding the association between gender and suicide. The last section presents a proposal for interpreting suicidal behavior from a gender perspective that problematizes the affective and political meaning of the association. © 2021, UNIV SAOPAULO. All rights reserved.
Keywords: Gender; LGBTIQ; Mental Health; Risk; Suicide; Suicidology

Intersex adolescents seeking help for their depression: the case study of SPARX in New Zealand - Lucassen, M.F.G.; Perry, Y.; Frampton, C.; Fleming, T.; Merry, S.N.; Shepherd, M.; Stasiak, K. (Australasian Psychiatry, 2021)
Objective: SPARX is a computerized cognitive behavioral therapy self-help program for adolescent depression that is freely available in New Zealand. At registration, users identify themselves as either male, female, intersex, or transgender. We aimed to describe the mental health of adolescent intersex users. Method: A secondary analysis of SPARX usage data over 5 years. Results: Of the 8922 adolescents users, 0.6% (n = 50) identified as intersex. Based on Patient Health Questionnaire 9 – modified for Adolescents (PHQ-A) results, 78.3% of intersex users had high levels of depression and/or self-harm and suicidal ideation. The mean PHQ-A scores for intersex users were significantly higher than for males and females (p <.001). As only three intersex users completed SPARX Level 4 or more (of the seven-level program), we were unable to meaningfully investigate any reductions in their depressive symptoms over time. Conclusions: There is a dearth of empirical data on the mental health of intersex adolescents. These results suggest that intersex adolescents seeking help from an online resource have high mental health needs compared with other young people, possibly because they defer seeking help. © The Royal Australian and New Zealand College of Psychiatrists 2021.
Keywords: adolescent; depression; diverse sex development; intersex; variations of sex characteristics

“Alone in the Rain(bow)”: Existential Therapy for Loneliness in LGBTQ + Clients - Ratanashevorn, R.; Brown, E.C. (Journal of LGBT Issues in Counseling, 2021)
Loneliness and isolation are major concerns for LGBTQ + clients who experience marginalization, discrimination and alienation in society and social networks. These experiences of increased loneliness and isolation can lead to other detrimental mental health outcomes, such as substance abuse, HIV, and suicide. Loneliness and isolation are central concerns of existential therapy which makes this a compatible approach for addressing these issues among LGBTQ + clients. This article uses an existential therapy lens to examine the issue of loneliness among LGBTQ + clients and provides a case illustration to demonstrate its application. © 2020 Taylor & Francis Group, LLC.
Keywords: existential isolation; existential therapy; LGBTQ+; Loneliness

Associations between periods of COVID-19 quarantine and mental health in Canada - Daly, Z.; Slemon, A.; Richardson, C.G.; Salway, T.; McAuliffe, C.; Gadermann, A.M.; Thomson, K.C.; Hirani, S.; Jenkins, E.K. (Psychiatry Research, 2021)
Since the onset of the COVID-19 pandemic, many jurisdictions, including Canada, have made use of public health measures such as COVID-19 quarantine to reduce the transmission of the virus. To examine associations between these periods of quarantine and mental health, including suicidal ideation and deliberate self-harm, we examined data from a national survey of 3000 Canadian adults distributed between May 14-29, 2020. Notably, participants provided the reason(s) for quarantine. When pooling all reasons for quarantine together, this experience was associated with higher odds of suicidal ideation and deliberate self-harm in the two weeks preceding the survey. These associations remained even after controlling for age, household income, having a pre-existing mental health condition, being unemployed due to the pandemic, and living alone. However, the associations with mental health differed across reasons for quarantine; those who were self-isolating specifically due to recent travel were not found to have higher odds of suicidal ideation or deliberate self-harm. Our research suggests the importance of accounting for the reason(s) for quarantine in the implementation of this critical public health measure to reduce the mental health impacts of this experience. © 2020
Keywords: COVID-19; Mental health; Public Health; Quarantine; self-harm; Self-isolation; Suicide

On integrative social contracts theory and corporate decision-making in a polarized political economy - Baird, C.; Mayer, D. (Business and Society Review, 2021)
The priority rules in Donaldson and Dunfee's Integrative Social Contracts Theory (ISCT) provide a useful tool for firms facing polarizing social issues in the United States. ISCT and its priority rules are applied here to divisive social issues such as contraception, gun control, and LGBTQ rights. The ISCT process also benefits firms that serve parts of the world where norms are evolving, and can help firms clarify and communicate their own values. © 2021 W. Michael Hoffman Center for Business Ethics at Bentley University
Keywords: corporate political activity; decision making; integrative social contract theory (ISCT)

Decent and indecent exposures: naked veterans and militarized (counter-)violences after war - McMullin, J.R. (International Feminist Journal of Politics, 2021)
This article analyzes the multiple and contradictory functions of barracks nostalgia for a veterans’ organization in the United States (US), Irreverent Warriors, and for its principal activity, Silkies Hikes. These are day-long events across the US in which military veterans, both men and women, convene to hike in their underwear to prevent veteran suicide. The Hikes are more than exhibitionistic gatherings of nearly naked veterans; they are elaborate rituals where veterans expose and deploy their bodies to navigate and survive return from war. Drawing on feminist and queer theoretical insights, I develop a reparative case study of the Hikes to explore three arguments. First, militarized nudity can be more than, and other than, violation. Second, nurturing militarized masculinity might be experienced as necessary for some veterans’ post-war adjustment. Third, nostalgic re-enactments are not either re-militarizing or de-militarizing; rather, Silkies Hikers are militarized subjects undergoing a de-militarization process that they experience as violent and traumatic, so they in turn seek out, or even demand, re-militarization–but re-militarization re-cast as a counter-violent maneuver. Consequently, Silkies Hikes represent a critical opportunity to elaborate theories of militarized masculinity and foreground dilemmas involved in calling on endangered bodies to do the work of de-militarization. © 2021 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: militarized masculinity; Military veterans; nudity; post-war adjustment; veteran suicide

Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19 - O'Hayer, C.V. (Cognitive and Behavioral Practice, 2021)
Our team at the Jefferson Center City Clinic for Behavioral Medicine has recently been challenged to find a synthesis between the need to adapt to circumstances associated with the COVID-19 pandemic, while at the same time retaining the spirit and essential components of comprehensive DBT. This fine balance between unwavering centeredness and compassionate flexibility is central to DBT (Linehan, 1993), and has proven essential during these times of uncertainty. This short article highlights challenges and innovations faced by our DBT Team, Skills Group, individual DBT sessions, phone coaching, and also our community at large, as we strive to help our patients and team members build a life worth living during and following a pandemic. © 2021
Keywords: behavioral medicine; COVID-19; Dialectical Behavior Therapy; suicidality; transgender

Bullying Victimization: Investigating the Unique Contribution of Homophobic Bias on Adolescent Non-suicidal Self-injury and the Buffering Role of School Support - Esposito, C.; Affuso, G.; Amodeo, A.L.; Dragone, M.; Bacchini, D. (School Mental Health, 2021)
Research on bullying victimization has expanded to specific forms of harassment based on discriminatory bias, which involve aggressive behavior targeting an individual's identity characteristics, such as sexual orientation and/or gender expression. Recent studies have documented elevated health risks associated with victimization based on homophobic bias, above and beyond general victimization. The aim of the current study was to test the unique contribution of homophobic victimization on adolescent non-suicidal self-injury (NSSI) and to analyze the buffering role of teachers and classmates support. Participants were 770 adolescents (55.5% females; Mage = 15.35, SD = 1.62) enrolled in Italian public schools in grade nine (N = 483) and 12 (N = 287). All measures were collected during Spring 2016 using self-reported questionnaires. Zero-inflated Poisson regression analyses suggested that homophobic victimization had a unique contribution on NSSI frequency of engagement once initiated, but not on the probability of engaging in NSSI at least once. High classmates support was negatively associated with adolescents’ engagement in NSSI. Furthermore, higher levels of classmates support were associated with a lower NSSI frequency only for youth who reported low levels of homophobic victimization. In contrast, the association between classmates support and NSSI frequency was nonsignificant when youth reported high levels of homophobic victimization. No significant effects were found for teachers support. Overall, our findings underscore the need to address the serious concern of homophobic victimization within schools and the importance of promoting healthy and positive identity development in adolescence. © 2021, The Author(s).
Keywords: Adolescence; Bullying victimization; Classmates support; Homophobic victimization; Non-suicidal self-injury; School support; Teachers support

A methodological synergy of dramatistic discourse analysis and corpus linguistics: From the discourse of US Presidents to Trump's 2016 Orlando speech - Salama, A.H.Y. (Journal of Language and Linguistic Studies, 2021)
The present study offers a novel methodology for corpus-based discourse analysis that combines Kenneth Burke's (1968, 1969) dramatistic method of text analysis and the corpus techniques of keyword extraction and concordance reading. Applying the methodology, a two-stage analysis of Donald Trump's 2016 Orlando speech has been conducted: First, at a micro level, (i) the keywords used by Trump were identified in his speech as compared against the historical reference corpus of US Presidents through WordSmith Tools (Scott, 2012), and (ii) Trump's keyword lexical structures were described and interpreted in the pentadic ratios rhetorically motivated by the "terministic screens"that select and deflect representations of the gay-nightclub-shooting event in the speech; second, at a macro level, the process of substantiating the whole speech event of Orlando was implemented in terms of the different types of substance-geometric, familial, and directional-recognized in the keywords clustering and linking in the speech. The study has reached two findings. First, methodologically, Burke's dramatistic method of text analysis and corpus-linguistics techniques have been synergized in a novel way that contributes to analysing the rhetorical language of political discourse, eventually yielding a corpus-based dramatistic discourse analysis. Second, practically, analysing the pentadic ratios of the speech keywords and their substance types has revealed Trump's rhetoric of selecting and deflecting certain representations of the Orlando political event through a specific ensemble of terministic screens and substantiations. © 2021 JLLS and the Authors-Published by JLLS.
Keywords: Corpus linguistics; Donald Trump; Dramatistic discourse analysis; Kenneth Burke; Keywords; Orlando speech; Pentad; Terministic screens; WordSmith Tools

Early childhood educators' beliefs about child behavior and adult outcomes related to gender and play - McCabe, P.C. (Psychology in the Schools, 2021)
This study explored the beliefs of early childhood educators about a child's current behavior and potential adult adjustment based on a description of the child's gender and play interests. There were 451 early childhood educators from a US sample who, after reading a brief vignette describing a child's play and behavior, responded to questions related to the child's current and future behavior. Respondents also provided demographic information as well as ratings of their gender role beliefs. Results indicated that (a) educators believe strongly masculine or feminine play in early childhood predicts similar displays of masculinity or femininity in adulthood, (b) educator ratings of externalizing problem behaviors were significantly higher in the masculine play vignettes, irrespective of the child's gender, (c) ratings of internalizing problem behaviors were higher in the feminine play vignettes, also independent of child's gender, and (d) there were few differences in ratings between gender role conforming and gender role nonconforming children. However, the gender role nonconforming boy was rated as more likely to contemplate suicide as an adult compared to the gender role nonconforming girl and the gender role conforming boy and girl. Educators' beliefs about gender-related constructs and recommendations for future practice and research were discussed. © 2021 Wiley Periodicals LLC
Keywords: gender; LGBTQ; preschool

“I Never Saw a Future”: Childhood Trauma and Suicidality Among Sexual Minority Women - Creighton, G.M.; Oliffe, J.L.; Broom, A.; Rossnagel, E.; Ferlatte, O.; Darroch, F. (Qualitative Health Research, 2019)
While a significant health concern for sexual minority women, there is little qualitative research investigating their experiences of childhood trauma and suicidality. In this study, we used photovoice methods and an intersectionality framework. Drawing on qualitative interviews, we inductively derived three themes (a) Traumatized and discredited, (b) Cascading marginality, estrangement, and suicidality, (c) Reconstruction and reclaiming resilience. In Traumatized and discredited, we describe the sense of abandonment flowing from childhood trauma heightened by a lack of protection and neglect on the part of parents/guardians. The lack of support to deal with childhood trauma and the layering effects of marginality characterizes the theme Cascading marginality, estrangement, and suicidality. In the third theme, we discuss strategies for reconstruction and reclaiming resilience as participants worked to overcome these challenging experiences. Our study findings offer guidance to suicide prevention counseling programs for sexual minority women and affirm actions to address health inequities. © The Author(s) 2019.
Keywords: bisexuals; Canada; gays and lesbians; mental health and illness; photography; photovoice; qualitative; qualitative methods; suicide; trauma; women’s health

Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: three U.S. cities, 2015 - Agnew-Brune, C.B.; Balaji, A.B.; Mustanski, B.; Newcomb, M.E.; Prachand, N.; Braunstein, S.L.; Brady, K.A.; Hoots, B.E.; Smith, J.S.; Paz-Bailey, G.; Broz, D.; For The NHBS-YMSM Study Group (AIDS and Behavior, 2019)
We examined the association between mental health issues, social support, and HIV among adolescent sexual minority males (SMM), who are disproportionally affected by HIV. National HIV Behavioral Surveillance among Young Men Who Have Sex with Men (NHBS-YMSM) data among SMM aged 13–18 years were collected in three cities (Chicago, New York City, and Philadelphia). Separate log-linked Poisson regression models were used to estimate associations between mental health issues and social support (general and family), and 3 HIV-related sexual risk behavior outcomes: past-year condomless anal intercourse (CAI) with a male partner, past-year sex with ≥ 4 partners, and first vaginal or anal sex before age 13. Of 547 adolescent SMM, 22% reported ever attempting suicide and 10% reported past-month suicidal ideation. The majority (52%) reported depression and anxiety. Thirty-nine percent reported CAI, 29% reported ≥ 4 sex partners and 22% reported first sex before age 13. Ever attempting suicide, suicidal ideation, and depression and anxiety were associated with CAI. Separately, ever attempting suicide and lack of family support were associated with ≥ 4 sex partners. None of the mental health or support measures were associated with having sex before age 13. General social support was not associated with any sexual risk behaviors. Mental health issues are common among adolescent SMM and associated with sexual risk behaviors. Including mental health support in comprehensive HIV prevention for adolescent SMM could potentially reduce HIV risk in this population. © 2019, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
Keywords: Adolescent sexual minority males; HIV risk; Mental health

Major Depression Among Young Men Who Have Sex with Men in Beirut, and Its Association with Structural and Sexual Minority-Related Stressors, and Social Support - Wagner, G.J.; Ghosh-Dastidar, B.; El Khoury, C.; Ghanem, C.A.; Balan, E.; Kegeles, S.; Mutchler, M.G.; Mokhbat, J. (Sexuality Research and Social Policy, 2019)
Guided by the minority stress model, we assessed depression and its relationship to structural and sexual minority-related stressors and social support in a sample of 226 young (age 18–29 years) men who have sex with men in Beirut, Lebanon. The sample was recruited with long-chain peer referrals and administered a survey that included the PHQ-9 measure of depression. Sixteen percent had current major depression based on our PHQ-9 criteria, and 33% reported any lifetime history of suicidal ideation (including 8% who had made an attempt); 69% had experienced any sexual minority-related discrimination in the past year. In bivariate analysis, structural (unemployment, no legal resident status) and sexual minority-related (greater number of types of discrimination experienced, greater discomfort with one’s sexual orientation) stressors were associated with major depression, as was lower social support. Discomfort with one’s sexual orientation was the only correlate of major depression when controlling for other stressors, social support and socio-demographics. These findings highlight a high level of depression, and the potential for community building and social solidarity for mitigating the effects of stressors based in personal security, internalized stigma, and discrimination. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Depression; Lebanon; MENA; MSM; Social support; Stress; Stressors

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

Awareness, willingness to use, and history of HIV PrEP use among gay, bisexual, and other men who have sex with men in Nigeria - Ogunbajo, A.; Iwuagwu, S.; Williams, R.; Biello, K.; Mimiaga, M.J. (PLoS ONE, 2019)
Background Nigerian gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV, with an estimated prevalence of between 11-35%. Pre-exposure prophylaxis (PrEP) has the potential to significantly decrease incident HIV infections among Nigerian GBMSM. Understanding the relationship between socio-demographic, sexual risk behavior, and psychosocial factors with PrEP awareness, willingness to use, and history of use among this group is pivotal to maximizing PrEP uptake. Methods Between March and June 2019, 419 participants completed an interviewer-administered survey assessing PrEP awareness, willingness to use, and history of use; socio-demographics; sexual risk behavior; and psychosocial factors. Bivariate and multivariable logistic regression were used to examine factors associated with PrEP awareness, willingness to use, and history of use. Results 53.6% were aware of PrEP; 80.1% were willing to use PrEP; and 29.7% had previously used PrEP. In multivariable analysis, factors associated with an increased odds of PrEP awareness include residing in Abuja [adjusted odds ratio (aOR) 5.02; 95% confidence interval (CI): 2.13 to 11.83] and Lagos (aOR 12.30; 95% CI: 4.92 to 30.67) vs. residing in Plateau, living with HIV (aOR 2.56; 95% CI: 1.54 to 4.72), using location-based apps for seeking sexual partners (aOR 4.06; 95% CI: 2.28 to 7.24), having health insurance (aOR 2.31; 95% CI: 1.08 to 4.40), history of suicidal thoughts (aOR 2.05; 95% CI: 1.02 to 4.10), and history of PrEP use (aOR 45.5; 95% CI: 5.60 to 370.04). Decreasing clinically significant depressive symptoms was associated with lower willingness to use PrEP (aOR 0.96; 95% CI: 0.92 to 0.99). Lastly, factors associated with increased odds of having a history of PrEP use were those reporting 6 or more insertive anal sex acts in the last 30 days compared to those with none (aOR 5.76; 95% CI: 1.58 to 20.98) and being aware of PrEP (aOR 29.6; 95% CI: 3.78 to 231.84). Discussion Nearly half of the Nigerian GBMSM in this study had no prior awareness of PrEP, but after being informed about its potential benefits, the majority were willing to use it. However, PrEP uptake among Nigerian GBMSM remains low. Findings suggest that educational messages are necessary to ensure appropriate PrEP scale-up, especially tailored towards Nigerian GBMSM. © 2019 Ogunbajo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): Data from the U-SEX GESIda 9416 study - Dolengevich-Segal, H.; Gonzalez-Baeza, A.; Valencia, J.; Valencia-Ortega, E.; Cabello, A.; Tellez-Molina, M.J.; Perez-Elias, M.J.; Serrano, R.; Perez-Latorre, L.; Martin-Carbonero, L.; Arponen, S.; Sanz-Moreno, J.; et al. (PLoS ONE, 2019)
Objectives Sexualized intravenous drug use, also known as slamsex, seems to be increasing among HIV-positive men who have sex with men (MSM). Physical and psychopathological symptoms have previously been reported in this population, although research on the subject of slamsex is scarce. The objectives of our study were to describe the psychopathological background of a sample of HIV-positive MSM who engaged in slamsex during the previous year and to compare physical, psychopathological, and drug-related symptoms between these participants and those who engaged in non-injecting sexualized drug use. Design and methods Participants (HIV-positive MSM) were recruited from the U-Sex study in 22 HIV clinics in Madrid during 2016–17. All participants completed an anonymous cross-sectional online survey on sexual behavior and recreational drug use. When participants met the inclusion criteria, physicians offered them the opportunity to participate and gave them a card with a unique code and a link to access the online survey. The present analysis is based on HIV-positive MSM who had engaged in slamsex and non-injecting sexualized drug use. Results The survey sample comprised 742 participants. Of all the participants who completed the survey, 216 (29.1%) had engaged in chemsex, and of these, 34 (15.7%) had engaged in slamsex. Participants who engaged in slamsex were more likely to have current psychopathology (depression, anxiety, and drug-related disorders) than participants who engaged in non-injecting sexualized drug use. In addition, participants who engaged in slamsex more frequently reported high-risk sexual behaviors and polydrug use and were more often diagnosed with sexually transmitted infections (STIs) and hepatitis C than those who did not inject drugs. Compared with participants who did not inject drugs, participants who engaged in slamsex experienced more severe drug-related symptoms (withdrawal and dependence), symptoms of severe intoxication (loss of consciousness), and severe psychopathological symptoms during or after slamsex (eg, paranoid thoughts and suicidal behaviors). Conclusion Slamsex is closely associated with current psychiatric disorders and severe drug-related and psychiatric symptoms. © 2019 Dolengevich-Segal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Family, School, and Peer Support Are Associated With Rates of Violence Victimization and Self-Harm Among Gender Minority and Cisgender Youth - Ross-Reed, D.E.; Reno, J.; Peñaloza, L.; Green, D.; FitzGerald, C. (Journal of Adolescent Health, 2019)
Purpose: Gender minority (GM) youth experience high rates of violence, and research on protective factors to reduce violence victimization and self-harm is lacking. The purpose of this study was to determine how family, school, peer, and community support influenced rates of violence victimization and self-harm among GM and cisgender adolescents. Methods: This research uses data from the 2017 New Mexico Youth Risk and Resiliency Survey (N = 18,451). The main independent variable was gender, dichotomized into GM and cisgender, and the secondary independent variables were family, school, community, and peer support. Dependent variables were sexual and dating violence, suicide attempts, and nonsuicidal self-injury. Logistic regression models were built for the four dependent variables, including demographics, support scores, and interaction terms between gender and support. Results: Six percent of high school students in New Mexico identified as GM are unsure of their gender. GM students experienced higher rates of violence and self-harm and lower levels of support than cisgender students. Among all students, family support was associated with lower odds of sexual violence and self-harm, while school support was associated with lower odds of dating violence and nonsuicidal self-injury. There were significant interactions between gender, violence, and support. The protective effects of support were less pronounced for GM students than for cisgender students. Conclusions: Family and school support are associated with lower rates of some forms of violence and self-harm among adolescents. Additional support may be necessary to reduce harm among GM adolescents, who are at higher risk for violence and its sequelae. © 2019 Society for Adolescent Health and Medicine
Keywords: Health equity; Intimate partner violence; Protective factors; Self-injurious behavior; Sexual and gender minorities; Sexual violence; Suicide; Transgender persons

Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans - Aboussouan, A.; Snow, A.; Cerel, J.; Tucker, R.P. (Journal of Affective Disorders, 2019)
Background: Transgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans. Method: Data analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI. Results: Results of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals. Limitations: The limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans. Conclusion: NSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent. © 2019
Keywords: Gender non-conforming; Non-suicidal self-injury; Suicide; Transgender; Veteran

Advocacy-in-action: Case portrait of a helping professional pursuing positive social change for transgender and gender-expansive youth - Stark, C.; Crofts, G. (Journal for Social Action in Counseling and Psychology, 2019)
Transgender and gender-expansive youth experience discrimination and marginalization in the healthcare setting, school environment, their communities, and families. These experiences of rejection and adversity are correlated with higher rates of suicidality, depression, and other mental health concerns. Helping professionals play an essential role in mitigating experiences of oppression by advocating for positive social change for their transgender and gender-expansive clientele. Through the provision of a single case portrait, this article explores the advocacy-in-action of Craig, a helping professional and advocate, as he pursues positive social change for transgender and gender-expansive youth. Merriam's (1988) interpretive case study was used to guide data collection and findings. Emergent themes provided concrete examples of how the American Counseling Association (ACA) endorsed an advocacy model, and the Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling Competencies for Counseling Transgender Clients apply to this population. Including the concepts of intrapersonal and interpersonal advocacy to the current advocacy model is critical to advancing the health of transgender and gender-expansive youth. Implications for counselors and counselors in training will also be discussed. © 2019 Stark & Crofts.
Keywords: Advocacy; Counselor; Gender-expansive; Helping professional; Transgender

Heterogeneity of transgender identity nonaffirmation microaggressions and their association with depression symptoms and suicidality among transgender persons - Parr, N.J.; Howe, B.G. (Psychology of Sexual Orientation and Gender Diversity, 2019)
Transgender individuals experience disproportionate rates of depression, suicide ideation, and suicide attempt. Prior work has linked these outcomes to experiencing social stigma and gender-related victimization and discrimination, but an important need has been to quantitatively assess the relation of less overt forms of victimization, such as gender identity-related microaggressions, with occurrence of these outcomes among transgender persons. In the present research, a focus group and survey study were conducted to more fully characterize transgender identity nonaffirmation microaggressions. We investigated how nonaffirmation microaggressions vary in frequency, self-rated emotional intensity, and in the social and emotional responses they elicit, as well as the relation of nonaffirmation microaggressions with the occurrence of depression symptoms and suicidality among transgender individuals. A total of 402 participants completed an online survey questionnaire, responding to 14 situational prompts based on nonaffirmation microaggressions commonly reported in focus groups. In conventional logistic regression analyses, increasing frequency of transgender identity nonaffirmation or denial events was significantly associated with 150-240% increases (odds ratio = 2.54-3.41) in odds of past-year sadness or hopelessness, past-year withdrawal from regular activities, past-year suicide ideation, and lifetime suicide ideation or attempt among transgender respondents (n = 182). Using latent regression analyses that incorporated both frequency and emotional intensity of microaggression events, odds of outcomes were increased by 230-525% (odds ratio = 3.31-6.25). Increasing the number of nonaffirmation microaggressions that produced feelings of weariness or apathy, and nonaffirmation microaggressions that led to decreased interest in social engagement, was also significantly associated with increased odds of past-year depression symptomatology and suicide ideation. © 2019 American Psychological Association.
Keywords: Depression; Microaggressions; Minority stress; Suicide; Transgender

Creative identity (re)Construction, creative community building, and creative resistance: A qualitative analysis of queer ingroup members' tweets after the Orlando Shooting - Jenkins, E.M.; Zaher, Z.; Tikkanen, S.A.; Ford, J.L. (Computers in Human Behavior, 2019)
With the proliferation of social media, a growing body of literature explores the significance of virtual grief, social support, and social capital in the construction of identity and community online. However, there is a dearth of research on how queer members use social media, particularly Twitter, as a tool to claim and re-define their identity—especially when their identity is under threat. The goal of this study is to understand how members of the queer community linguistically responded to the threat to their identity and safety that was caused by the shooting that took place on June 12, 2016, at the Pulse Nightclub in Orlando, Florida. To achieve this goal, we use Social Identity Theory (SIT) as a framework to examine how queer individuals use a creative language strategy to redefine their shared identity when it is threatened. This study used a qualitative iterative analysis of tweets posted by queer individuals to determine how this group identified as ingroup after the Orlando shooting. The study reveals that members of the queer community communicatively responded to the Pulse shooting through social creativity. Specifically, members of the queer community responded to threats through using creative language that fostered stronger ingroup collaborative identities by provoking a) creative identity (re)construction, b) creative community building and c) creative resistance. This study advances SIT by providing additional evidence that the strategy of using creative language by a minority ingroup has the ability to support simultaneously salient and threatened identity. © 2019 Elsevier Ltd
Keywords: Orlando shooting; Queer; Social creativity; Social identity theory; Tweets

Trans and gender diverse young people's attitudes towards game-based digital mental health interventions: A qualitative investigation - Strauss, P.; Morgan, H.; Wright Toussaint, D.; Lin, A.; Winter, S.; Perry, Y. (Internet Interventions, 2019)
Background: Trans and gender diverse (TGD) young people are at high risk for mental health difficulties. Previous research has shown that three in four TGD young people have been diagnosed with an anxiety disorder and/or depression and almost one in two have attempted suicide. TGD young people experience barriers to traditional mental health services, commonly faced with inexperienced providers and discrimination. Video and computer games, as well as online spaces, are sources of resilience for TGD young people. Digital mental health interventions are a feasible, but understudied, approach to consider for this population. Methods: N = 14 TGD young people aged 11–18 years were recruited to take part in focus groups as part of a multistage project. The focus groups were transcribed verbatim and analysed using a general inductive thematic analysis approach. This paper reports on their attitudes towards digital games and game-based digital mental health interventions. Discussion: Aspects of game-based digital mental health interventions should be inclusive of diverse genders and sexuality, moderated appropriately and include content such as storylines and characters who are of diverse sexualities and/or gender. Participants were of the opinion that games should be preventative rather than treatment-focused; however, considering the high rate of mental health difficulties in this population, interventions should ideally address symptoms along the continuum from sub-clinical to clinical. © 2019 The Authors
Keywords: Digital health; Game-based mental health interventions; LGBT; Serious games; Trans and gender diverse; Video games; Youth

Evaluating a Tool to Support the Integration of Gender in Programs to Promote Men’s Health - Struik, L.L.; Abramowicz, A.; Riley, B.; Oliffe, J.L.; Bottorff, J.L.; Stockton, L.D. (American Journal of Men's Health, 2019)
Men’s disproportionate rate of suicide and substance use has been linked to problematic conformity to traditional masculine ideals. Mental health promotion interventions directed toward men should address the gender-specific needs of men; yet, no tools exist to provide such guidance. To address this need, the Check-Mate tool was developed as part of a global evaluation of the Movember Foundation’s Social Innovators Challenge (SIC). The tool provides an initial set of evidence-based guidelines for incorporating gender-related influences in men’s mental health promotion programs. This article describes the development of Check-Mate and an evaluation of its usability and usefulness. Using a qualitative descriptive approach, semistructured interviews were conducted with the leads for eight of the SIC projects; they used the tool for these. Data were analyzed using conventional content analysis. Overall, project leads found the tool user-friendly. Identified strengths of Check-Mate included its practicality, adaptability, usefulness for priming thinking on gender sensitization, and value in guiding program planning and implementation. With respect to limitations, project leads explained that the complexity of men’s mental health promotion programming may limit applicability of some or all approaches included in Check-Mate. They also expressed concern about how using Check-Mate might reinforce hegemonic masculine ideals. It was suggested that examples illustrating the use of Check-Mate would be a helpful accompaniment to the tool. Findings indicate that Check-Mate is a useful guide in men’s mental health promotion programming. In addition to future testing of the tool in different settings, links between the tool’s approaches and program outcomes should be explored. © The Author(s) 2019.
Keywords: gender issues and sexual orientation; health care issues; health promotion and disease prevention; health-care issues; masculinity; mental health; men’s health interventions; men’s health programs

General and LGBTQ-specific factors associated with mental health and suicide risk among LGBTQ students - Gnan, G.H.; Rahman, Q.; Ussher, G.; Baker, D.; West, E.; Rimes, K.A. (Journal of Youth Studies, 2019)
This study investigated general and LGBTQ-specific factors associated with having a current mental health problem, use of mental health services, suicide risk and self-harm in 1948 LGBTQ university students (ages 16-25) who took part in the Youth Chances community study in the UK. In multivariate logistic regression, factors associated with all four outcomes were female gender, sexual abuse, other abuse or violence, and being transgender. Further factors that were significantly associated with one or more of the outcomes included: being bisexual; thinking they were LGBTQ under the age of 10; coming out as LGBTQ under the age of 16; not feeling accepted where they live; having no out staff at university and experiencing LGBTQ-related crime. In addition to general risk factors, negative experiences relating to being LGBTQ may be associated with the increased risk for mental health problems, suicide risk and self-harm in LGBTQ students. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: gender; higher education; Sexuality; suicide; young adulthood

Illicit Drug Use and Social Victimization among Thai Sexual and Gender Minority Adolescents - Guadamuz, T.E.; Cheung, D.H.; Boonmongkon, P.; Ojanen, T.T.; Damri, T.; Samoh, N.; Cholratana, M.; Ratchadapunnathikul, C.; Sass, J. (Substance Use and Misuse, 2019)
Objectives: We examined the prevalence of lifetime illicit drug use and social victimization, and their association, among sexual and gender minority (SGM) and non-SGM Thai adolescents. Methods: In 2013, we conducted a school-based national survey among students grades 7–12 (aged 13–20 years) from 15 secondary schools (n = 2,070) around Thailand. We classified adolescents with same-sex attraction, sexual or gender non-conforming identities as SGM. Generalized estimating equations were used to estimate the odds of illicit drug use by SGM and non-SGM status. Results: Prevalence of lifetime illicit drug use was significantly higher among SGM adolescents than non-SGM adolescents (10.3 vs. 5.3%), but did not differ between those with same-sex attraction and SGM identity (10.3 vs. 10.8%). Among non-SGM adolescents, general social victimization, sexual experience and any school truancy were associated with lifetime illicit drug use (OR = 2.59, 95% CI: 1.53, 4.38; OR = 6.59, 95% CI: 4.90, 8.86; and OR = 4.93, 95% CI: 3.13, 7.75, respectively). Among SGM adolescents, SGM-based social victimization, depressive symptomology and suicidal ideation were associated with lifetime illicit drug use (OR = 3.17, 95% CI: 2.03, 4.95; OR = 5.03, 95% CI: 2.32, 10.90; and OR = 5.03, 95% CI: 2.76, 9.16, respectively). Conclusions: SGM adolescents have higher burden of illicit drug use. Moreover, illicit drug use among SGM adolescents is indicative of depressive symptomology and suicidal ideation. Tailored and comprehensive programs are needed to reduce the gap in burden of illicit drug use between SGM and non-SGM adolescents. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: adolescent; Illicit drug use; LGBT; peer victimization; Thailand

Stigma in the bereavement experiences of gay men who have lost a partner to suicide - Ferlatte, O.; Oliffe, J.L.; Salway, T.; Knight, R. (Culture, Health and Sexuality, 2019)
Despite the high prevalence of suicide in gay communities, the impact of suicide on surviving male partners is poorly understood. This article presents a qualitative case study of two gay men who lost a partner to suicide and explores how stigma may shape gay men’s bereavement experiences. Data were collected using photovoice methods and analysed using a thematic approach. Five themes were inductively derived: (1) trying to prevent the inevitable; (2) guilty of keeping secrets; (3) dreams shattered by suicide; (4) abandoned and alone in grief; and (5) a lonesome road to recovery. Within each theme, the article indentifies how stigma-related challenges associated with suicide, mental illness and minority sexual identity shaped gay men’s bereavement experiences. Practice and policy implications are discussed, including how the provision of tailored clinical and peer supports can assist gay men in the bereavement of a same-sex partner to suicide. The findings detailed in this study highlight the need for interventions to de-stigmatise mental illness and suicide within and outside the gay community. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: bereavement; Gay men; suicide; surviving partners

Mediators of increased self-harm and suicidal ideation in sexual minority youth: A longitudinal study - Oginni, O.A.; Robinson, E.J.; Jones, A.; Rahman, Q.; Rimes, K.A. (Psychological Medicine, 2019)
Background: Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships. Method: In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30-57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling. Results: Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43-3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex. Conclusions: Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression. Copyright © Cambridge University Press 2018.
Keywords: ALSPAC; depression; self-esteem; self-harm; sexual orientation; suicidal ideation

Examining risk factors for self-harm and suicide in LGBTQ+ young people: A systematic review protocol - Williams, A.J.; Arcelus, J.; Townsend, E.; Michail, M. (BMJ Open, 2019)
Introduction Young people who identify as Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (LGBTQ+) are at increased risk for self-harm, suicide ideation and behaviours. However, there has yet to be a comprehensive understanding of what risk factors influence these behaviours within LGBTQ+ young people as a whole. The purpose of this systematic review is to examine risk factors associated with self-harm, suicidal ideation and behaviour in LGBTQ+) young people. Methods and analysis A systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (MEDLINE, Scopus, EMBASE, PsycINFO and Web of Science) will be systematically searched for cross-sectional, prospective, longitudinal, cohort and case-control designs which examine risk factors for self-harm and/or suicidal ideation and behaviour in LGBTQ+ young people (aged 12-25 years). Only studies published in English will be included. No date restrictions will be applied. Study quality assessment will be conducted using the original and modified Newcastle-Ottawa Scales. Meta-analysis or narrative synthesis will be used, dependent on findings. Ethics and dissemination This is a systematic review of published literature and thereby ethical approval was not sought. The review will be submitted to a peer-reviewed journal, be publicly disseminated at conferences focusing on mental health, self-harm and suicide prevention. The findings will also be shared through public engagement and involvement, particularly those related to young LGBTQ+ individuals. © 2019 Author(s).
Keywords: gender identity; protocol; sexual orientation; suicide & self-harm; systematic review; young people

Perceived Barriers to Mental Health Services Among Canadian Sexual and Gender Minorities with Depression and at Risk of Suicide - Ferlatte, O.; Salway, T.; Rice, S.; Oliffe, J.L.; Rich, A.J.; Knight, R.; Morgan, J.; Ogrodniczuk, J.S. (Community Mental Health Journal, 2019)
This study examines barriers to mental health services among sexual and gender minorities (SGM) who screened positive for depression and risk of suicide. Data from an online survey of SGM (N = 2778) are analyzed. 37.5% met criteria for depression and 73.6% screened for being at risk of suicide. The most frequently cited barriers to mental health services access were inability to pay (62.3%), insufficient insurance (52.2%), a preference for ‘waiting’ for the problems to go away (51.5%), discomfort discussing emotions (45.7%), and feeling embarrassed and ashamed about mental health challenges (42.5%). Policy and practices implications of these findings are discussed. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Depression; LGBTQ; Mental health; Sexual and gender minorities; Suicide

Suicidality disparities between transgender and cisgender adolescents - Thoma, B.C.; Salk, R.H.; Choukas-Bradley, S.; Goldstein, T.R.; Levine, M.D.; Marshal, M.P. (Pediatrics, 2019)
BACKGROUND AND OBJECTIVES: Emerging evidence indicates transgender adolescents (TGAs) exhibit elevated rates of suicidal ideation and attempt compared with cisgender adolescents (CGAs). Less is known about risk among subgroups of TGAs because of limited measures of gender identity in previous studies. We examined disparities in suicidality across the full spectrum of suicidality between TGAs and CGAs and examined risk for suicidality within TGA subgroups. METHODS: Adolescents aged 14 to 18 completed a cross-sectional online survey (N = 2020, including 1148 TGAs). Participants reported gender assigned at birth and current gender identity (categorized as cisgender males, cisgender females, transgender males, transgender females, nonbinary adolescents assigned female at birth, nonbinary adolescents assigned male at birth, and questioning gender identity). Lifetime suicidality (passive death wish, suicidal ideation, suicide plan, suicide attempt, and attempt requiring medical care) and nonsuicidal self-injury were assessed. RESULTS: Aggregated into 1 group, TGAs had higher odds of all outcomes as compared with CGAs. Within TGA subgroups, transgender males and transgender females had higher odds of suicidal ideation and attempt than CGA groups. CONCLUSIONS: In this study, we used comprehensive measures of gender assigned at birth and current gender identity within a large nationwide survey of adolescents in the United States to examine suicidality among TGAs and CGAs. TGAs had higher odds of all suicidality outcomes, and transgender males and transgender females had high risk for suicidal ideation and attempt. Authors of future adolescent suicidality research must assess both gender assigned at birth and current gender identity to accurately identify and categorize TGAs. © 2019 by the American Academy of Pediatrics.

An Interdisciplinary Model for Meeting the Mental Health Needs of Transgender Adolescents and Young Adults: The Mount Sinai Adolescent Health Center Approach - Oransky, M.; Burke, E.Z.; Steever, J. (Cognitive and Behavioral Practice, 2019)
Transgender and gender nonconforming (TGNC) adolescents and young adults face significant mental health disparities, including increased rates of suicidality, depression, and self-harm. These disparities are multidetermined and stem, in part, from the emotional consequences of family rejection, peer and community victimization, social isolation, and discrimination and transphobia in both daily settings (e.g., school) and society as a whole. In order to meet the mental health needs of TGNC youth, we must intervene in multiple levels of youths’ lives and provide gender-affirming evidence-based therapies. In this paper, we describe an integrated model of meeting the mental health needs of TGNC youth, with the ultimate goal of reducing mental health disparities. We provide guidance for macro-level interventions, including efforts to implement social change; mezzo-level interventions, including structuring a health care setting to be gender-affirming; and micro-level interventions, including gender-affirming dialectical behavior therapy, cognitive behavioral therapy, family therapy and support group interventions. Throughout, we highlight our descriptions of interventions with case examples in order to provide additional practical guidance. © 2019
Keywords: gender affirming; gender transition; health disparities; LGBT youth; transgender

A new theory of gender dysphoria incorporating the distress, social behavioral, and body-ownership networks - Gliske, S.V. (eNeuro, 2019)
When postmortem studies related to transgender individuals were first published, little was known about the function of the various identified nuclei. Now, over 2 decades later, significant progress has been made associating function with specific brain regions, as well as in identifying networks associated with groups of behaviors. However, much of this progress has not been integrated into the general conceptualization of gender dysphoria in humans. I hypothesize that in individuals with gender dysphoria, the aspects of chronic distress, gender atypical behavior, and incongruence between perception of gender identity and external primary sex characteristics are all directly related to functional differences in associated brain networks. I evaluated previously published neuroscience data related to these aspects and the associated functional networks, along with other relevant information. I find that the brain networks that give individuals their ownership of body parts, that influence gender typical behavior, and that are involved in chronic distress are different in individuals with and without gender dysphoria, leading to a new theory—that gender dysphoria is a sensory perception condition, an alteration in the sense of gender influenced by the reflexive behavioral responses associated with each of these networks. This theory builds upon previous work that supports the relevance of the body-ownership network and that questions the relevance of cerebral sexual dimorphism in regard to gender dysphoria. However, my theory uses a hierarchical executive function model to incorporate multiple reflexive factors (body ownership, gender typical/atypical behavior, and chronic distress) with the cognitive, reflective process of gender identity. © 2019 Gliske.
Keywords: Body-ownership network; Distress; Gender dysphoria; Sensory perception; Social behavioral network; Transgender

Sounding the Alarm: Perinatally HIV-Infected Youth More Likely to Attempt Suicide Than Their Uninfected Cohort Peers - Kreniske, P.; Mellins, C.A.; Dolezal, C.; Korich, R.; Leu, C.-S.; Wiznia, A.; Abrams, E.J. (Journal of Adolescent Health, 2019)
Purpose: Suicide is the second leading cause of death among youth in the U.S., yet there are few studies on suicide among youth with perinatally acquired HIV infection (YPHIV). Our aim was to determine if suicide attempts differed for YPHIV compared with perinatally HIV-exposed but uninfected peers (YPHEU). Methods: Data come from a longitudinal behavioral health cohort (N = 340) of YPHIV (n = 206) and YPHEU (n = 134) recruited between ages 9 and 16 years and interviewed with psychosocial batteries every 12–18 months. Logistic regression analyses were conducted to assess the association between reported suicide attempt and participants' HIV status. We assessed whether baseline demographic characteristics and sexual orientation were potential confounding factors. Fisher's exact tests were used to evaluate the association between first attempted suicide and HIV status within age groups. Results: YPHIV were more likely to make a suicide attempt than YPHEU (odds ratio = 2.35, 95% confidence interval = 1.28–4.34). Youth most often reported their first attempt between the ages of 14–18 years. Demographic characteristics and sexual orientation were not associated with attempted suicide. Conclusions: YPHIV compared with YPHEU were more likely to report a suicide attempt, and this difference emerged during late adolescence and persisted through young adulthood. © 2019 Society for Adolescent Health and Medicine
Keywords: Adolescence; Continuum of care; HIV; Suicide

Boys don’t cry? Critical phenomenology, self-harm and suicide - Chandler, A. (Sociological Review, 2019)
In this article I argue that critical phenomenology, informed by critical race and intersectional scholarship, offers a useful lens through which to consider suicide and self-harm among men. To illustrate this, I draw on a narrative informed analysis of the accounts of 10 men who had experienced self-harm, read through Sara Ahmed’s queer phenomenology. Two themes are emphasised: gendered, raced, classed bodies that are (unexpectedly) stopped; and bodies that, despite being stopped, still ‘do’ – enacting violence and control against self and other. Critical phenomenology can support much needed examination of the complex ways in which socioeconomic class, race, gender and age structure experiences of distress among different social groups. This approach enables a simultaneous examination of the way that privilege and oppression may shape both the experience of distress, and the way it is responded to – including through violence against the self, and against others. © The Author(s) 2019.
Keywords: gender; phenomenology; self-harm; suicide; whiteness

Parental reactions to transgender and gender diverse children: A literature review - Abreu, R.L.; Rosenkrantz, D.E.; Ryser-Oatman, J.T.; Rostosky, S.S.; Riggle, E.D.B. (Journal of GLBT Family Studies, 2019)
Transgender and gender diverse (TGD) individuals face stigmatization from family members and peers, placing this group at high risk of adverse outcomes including suicidality, substance abuse, and compromised mental health. This article uses a literature review approach to explore the common experiences of parents of TGD individuals as they navigate their relationship with their TGD children. Across 32 identified studies, the experiences of parental reactions include: (a) initial experiences (including noticing gender atypical behavior, diverse emotional reactions, cognitive dissonance and behavioral avoidance, and lack of knowledge); (b) transformation processes (including seeking informative resources and developing cognitive flexibility, seeking support and making TGD connections, facing barriers and isolation, developing awareness of discrimination and building empathy, and acknowledging the toll on mental health); (c) positive outcomes (including relational benefits, affirmation of values and activism, and new personal narratives); and (d) influences on the process (including time, gender, and attribution of the cause of TGD identity). Recommendations for health service providers include acknowledging diverse emotional reactions and cognitive dissonance, cultivating hope, honoring systemic barriers, and helping parents of TGD individuals create new positive narratives. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: literature review; Parental figures; parental reactions; TGD children

“À chacun son Tokyo.”1: Marguerite Yourcenar’s Reading of Yukio Mishima as a Revolutionary Exemplar for Western Literary Art - Genova, P. (Contemporary French and Francophone Studies, 2019)
Marguerite Yourcenar may well be best known for her prize-winning novels that accent the trope of homosexuality, but there is another, equally engaging aspect to her work that highlights her originality: her deeply syncretic cultural perspective. Regarding her strong interest in Japanese culture, she was intrigued by the polemical and ostentatious Japanese writer, Yukio Mishima, and her 1980 text, Mishima ou la vision du vide, stands as an important milestone in the longstanding dialogue of East-West cultural relations. Mishima fascinated Yourcenar, above and beyond his interest in homosexual themes, and she identified in him a uniquely powerful exemplar of rebellion. After forming his own militia, barricading himself in the Tokyo headquarters of Japan’s Self-Defense Forces, holding the commandant hostage, and committing suicide publicly on a balcony of the building through the ritual act of seppuku, Mishima became for Yourcenar a figure of almost hagiographic dimensions. Describing him dramatically as “le martyr […] du Japon héroïque,” Yourcenar presents Mishima as a figure whose art serves as inspiration both for Eastern and Western writers, while she explores his violent ideology, portraying his work as a compelling and paradoxical example of the potential of aesthetics to alter directly human culture. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: East-West Relations; France; Japan; Marguerite Yourcenar; Yukio Mishima

A latent class analysis of the co-occurrence of sexual violence, substance use, and mental health in youth - Nelon, J.L.; De Pedro, K.T.; Gilreath, T.D.; Patterson, M.S.; Holden, C.B.; Esquivel, C.H. (Substance Use and Misuse, 2019)
Purpose: The purpose of this study was to understand co-occurrence of sexual violence, substance use, and mental health in youth and see if there are differences in experiences among sexual identities, races, and genders. Methods: The 2017 Youth Risk Behavior Survey sampled 14,638 high school students. Latent class analysis was used to understand the relationship between incidence of sexual violence, substance use, and depression and suicidality in a nationally representative sample. The model controlled for demographic and bullying covariates. Results: A four-class solution provided optimal fit. Classes were low risk (51.8%); low violence, frequent substance use, and high depression and suicidal ideation (29.7%); experienced violence and moderate mental health issues(5.1%); and some violence, high substance use, and high depression and suicidal ideation (13.4%). Youth who identified as sexual minority youth were almost 2.5–5 times more likely to be in the three higher risk classes than their heterosexual peers. Those who identified as “I don’t know” were almost 3 times more likely to be in the three higher risk classes than heterosexual youth. Multiracial youth had higher likelihood of being in the three riskier classes compared to Caucasian youth. Females were 2.5 and 3 times more likely to be in the low violence and some violence classes compared to males. Conclusion: The study’s finding distinct classes of co-occurring behavioral and mental health outcomes fill gaps in the current literature and informs practitioners that LGB youth and bi/multiracial youth were at an elevated risk of co-occurring victimization, substance use, and mental health problems. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: Adolescents; mental health; sexual minority youth; sexual violence; substance use

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

The association between HIV/AIDS and childhood sexual abuse: An exploratory case study - Diao, X.Y.; Albert, M.; Forstein, M. (Journal of Gay and Lesbian Mental Health, 2019)
The effects of sexual abuse in childhood are serious and far-reaching, and include a number of short- and long-term sequelae, including depression, anxiety, disordered eating, post-traumatic stress disorder (PTSD), substance abuse disorders, suicidal ideation and self-injurious behavior, sexual dysfunction, borderline personality traits, high-risk sexual behavior, and dissociative disorders. MSM (men who have sex with men) with a history of childhood sexual abuse are more likely to engage in high-risk sexual behavior, trade sex for substances and/or money, experience intimate partner violence, and report as being HIV-positive. In this case study, we aim to explore the association between sexual abuse in childhood and HIV/AIDS. We identify a HIV-positive gay man with a history of sexual abuse and review the existing literature on the subject of HIV and sexual abuse, with a focus on victims who are MSM. Early childhood traumas, especially sexual abuse, can have immense and long-lasting psychological sequelae. Here, we report a victim of childhood sexual abuse who suffers from PTSD, selective amnesia, and episodes of dissociation during sex who was diagnosed as being HIV-positive at the height of the HIV/AIDS epidemic in the United States. More research needs to be done to investigate the complex relationship between childhood trauma and HIV infection, with insights into racial, gender, and socioeconomic differences. Counseling and risk-reduction strategies need to be explored with patients with a history of sexual trauma, in tandem with long-term pharmacologic and therapeutic interventions. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: AIDS; HIV; LGBT; sexual abuse

Looking beyond the lesbian: The intersectionality of death on Netflix’s Orange is the New Black - Ruderman-Looff, A. (Journal of Lesbian Studies, 2019)
In 2016, GLAAD’s “Where We Are On TV” report noted a significant rise in lesbian death. This article addresses this perpetual trend as it manifests within Netflix’s Orange is the New Black by considering the deaths of Tricia Miller and Poussey Washington. I use a narrative form of intersectional analysis to argue that lesbian death initiates a powerful critique of the criminal legal system and the prison industrial complex. Specifically, lesbian death points to the way multiple modes of marginalization intersect with homophobia to buttress a system designed to administer social and premature death. My analysis of Tricia’s death demonstrates how the school-to-prison pipeline prepares children to take responsibility for their behaviors, but neglects to address how their futures in the justice system are systematically produced and beyond their control. This message corresponds to Tricia’s flashbacks and her suicide, which demonstrate how, under neoliberalism, Tricia’s failure to “pull herself up” leads to her incarceration. In turning to Poussey, I argue that reading her death as an accident not only dismisses the “one bad apple” myth typically used to account for police brutality, it demonstrates how “accidental death” is systematically and deliberately produced within the prison industrial complex. I analyze flashbacks of both Poussey and her killer, Baxter Bayley, to draw attention to the fact that they have committed the same crimes. I demonstrate how power and criminalization are assigned on the basis of gender, race, sexuality, and class. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: Death; intersectionality; lesbian representation; mass incarceration; Orange is the New Black; prison industrial complex

Mental health disparities and high-risk alcohol use among non-heterosexual high school students - Goodin, A.; Elswick, A.; Fallin-Bennett, A. (Perspectives in Psychiatric Care, 2019)
Purpose: To examine disparities in mental health and high-risk alcohol use among high school students by sexual orientation, and the impact of having access to an adult with whom to talk. Design and Methods: Cross-sectional survey, from the 2015 Kentucky Youth Risk Behavior Survey. Logistic regression estimated the relationship between being “non-heterosexual” on mental health (e.g, suicidal ideation/attempt) and alcohol behaviors (e.g, binge drinking), controlling for demographics and “having an adult to talk to.”. Findings: Non-heterosexual students were more likely to report all adverse outcomes and risk was lower among students who report “having an adult to talk to.”. Practice Implications: Psychiatric nurses need to assess sexual minority youth for access to positive adult relationships. © 2019 Wiley Periodicals, Inc.
Keywords: adolescent alcohol use; adolescent mental health; LGB; sexual orientation

School Climate & Sexual and Gender Minority Adolescent Mental Health - Colvin, S.; Egan, J.E.; Coulter, R.W.S. (Journal of Youth and Adolescence, 2019)
Sexual/gender minority (Sexual/gender minority people are also referred to as Lesbian, Gay, Bisexual, Transgender, Queer) youth are more likely than cisgender heterosexual youth to exhibit depressive symptoms and be victimized. School climate research indicates that the presence of a Gay–Straight Alliance (a Gay–Straight Alliance or Gender-Sexuality Alliance is also referred to as a GSA and is a youth group to support sexual/gender minority youth), a supportive school climate, and seeking help from teachers are associated with more positive mental health outcomes; however, they are not typically measured together. This study uses a survey that measures all four measures of school environment with a national sample of 240 sexual/gender minority high school students ages 14–18 (mean age 15.77) where 53% of participants had a Gay–Straight Alliance in their school. The sample is 53% cisgender, 100% sexual minority and 62% white. Adjusting for demographics and presence of a Gay–Straight Alliance, fewer depressive symptoms were associated with lower help-seeking intentions for suicidal thoughts. The presence of Gay–Straight Alliance was not statistically associated with past-month help-seeking intentions or behaviors. Additionally, a more supportive school climate was associated with lower anxiety and depressive symptoms. However, the presence of a Gay–Straight Alliance was not statistically associated with anxiety or depressive symptoms. These findings suggest that a supportive school climate and supportive school personnel may be important for supporting the mental health of sexual/gender minority students. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Adolescent mental health; Health disparities; School climate; Sexual and gender minority youth

HIV self-testing among men who have sex with men in China: A qualitative implementation research study - Liu, F.; Qin, Y.; Meng, S.; Zhang, W.; Tang, W.; Han, L.; Liu, C.; Zhang, Y.; Huang, S.; Zheng, H.; Yang, B.; Tucker, J.D. (Journal of Virus Eradication, 2019)
Background: HIV self-testing (HIVST) may expand HIV testing, but there have been few pilot programmes among men who have sex with men (MSM). This purpose of this study was to evaluate HIVST implementation among MSM in China using qualitative methods. Methods: We undertook semistructured interviews among MSM and those organising HIVST programmes for MSM. Purposive sampling method was used to ensure men with different HIV serostatuses, ages and HIVST frequencies were included. Men were recruited from MSM community-based organisations and a local HIV clinic. An implementation science framework was used to interpret the findings. Two individuals used a standard code-based methodology to identify themes. Results: Forty-two MSM and six stakeholders were interviewed. Our data showed many MSM and stakeholders preferred HIVST to facility-based testing. Most men reported that HIVST empowered MSM and informed sexual decision making. Many men noted that decreasing the HIVST price may increase demand. Some men noted that HIVST could be scaled up through social media and by modifying bulky packaging. Minimal adverse events were reported. Conclusions: HIVST may expand HIV testing and promote empowerment of MSM. Minimal adverse outcomes were noted, but further implementation research is needed. © 2020 Journal of Virus Eradication.All right reserved.
Keywords: China; HIV; Implementation; Msm; Self-testing

Application of an intersectional framework to understanding the association of disability and sexual orientation with suicidal ideation among Oregon Teens - Higgins Tejera, C.; Horner-Johnson, W.; Andresen, E.M. (Disability and Health Journal, 2019)
Background: Suicide is the second leading cause of death among U.S. youth. Prior research has found that disability and sexual orientation are each independently associated with suicide risk. However, most analyses regarding sexual orientation or disability in relation to teenagers’ health have isolated the effects of these identities via multiple regression models. That approach assumes there is no multiplicative or synergistic effect between the two identities. Objective: To examine the association between suicidal ideation and the intersection of disability and sexual orientation. Methods: Cross-sectional data from the 2015 Oregon Healthy Teens Survey were analyzed using Poisson regression analysis with robust variance to estimate the relationship between the intersection of disability and sexual orientation and youth reports of suicidal ideation. We calculated three measures of interaction: 1) the excess risk due to interaction (RERI); 2) the proportion attributable to interaction (AP); and 3) the synergy index (SI). Results: Sexual minority teenagers with disabilities had higher risk of suicidal ideation (adjusted relative risk [ARR] = 2.82, 95% CI: 2.47–3.21) with respect to heterosexual teenagers without disabilities. The risk was also elevated, to a lesser degree, for heterosexual youth with disabilities (ARR = 1.97, 95% CI: 1.78–2.19) and LGB youth without disabilities (ARR = 2.17, 95% CI: 1.95–2.42) with respect to the reference group. Our measures of interaction were indicative of a synergistic effect between disability and sexual orientation. Conclusions: Our findings suggest the combination of disability and minority sexual orientation may be associated with compounded negative experiences that could exacerbate the risk of suicide. © 2019 Elsevier Inc.
Keywords: Adolescent; Disabled persons; LGB persons; Suicidal ideation

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

Sexual minority status and child maltreatment: How do health outcomes among sexual minority young adults differ due to child maltreatment exposure? - Paul, J.C.; Monahan, E.K. (Child Abuse and Neglect, 2019)
Background: Although prior studies indicate heightened health and well-being concerns for sexual minority (SM) youth, as well as for youth exposed to child maltreatment in the general population, it is unclear whether there are differences in these outcomes among SM youth that have and have not experienced maltreatment. Objective: Our aim was to investigate the unique associations between child maltreatment and emerging health outcomes beyond the impact of SM status. Data was drawn from a nationally representative sample of 648 SM youth in the U.S. in grades 7–12 during the 1994–1995 school year. Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health, descriptive statistics and ordinary least squares regression models were used to investigate differences in SM young adult outcomes by experiences of child maltreatment. Results: Maltreatment among SM individuals showed strong associations with poor adult mental health outcomes (e.g. depression, anxiety, isolation, and suicidal ideation) and fairly strong negative associations with general health outcomes (e.g., heart and lung problems) when compared to their non-maltreated peers. Associations with maltreatment and behavioral health and socioeconomic outcomes were not as strong for this population, which suggests the effects of maltreatment for SM youth are most salient in regards to mental and physical health. Conclusions: Findings provide insight into what areas of health and well-being should be focused on when working with SM youth that have been maltreated, and offer evidence to encourage further exploration of the outcomes of SM maltreated individuals in young adulthood. © 2019 Elsevier Ltd
Keywords: Child maltreatment; Disparities; Health outcomes; Sexual minority; Young adult

Psychological assessment and treatment for LGBTQ+ patients - Hawks, E.M.; Holster, J.; Cowperthwaite, R.; Lewis, A.L.; Hart, J.; Ostermeyer, B.K. (Psychiatric Annals, 2019)
Mental health providers encounter and provide treatment to patients who identify as lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) in various treatment settings. Understanding this unique population is essential in delivering culturally competent, appropriate, and effective care to LGBTQ+ patients. This article begins by discussing the existing stigma and the resulting disparities in mental health problems for LGBTQ+ people compared to their cisgender heterosexual counterparts, such as the increased risk of suicide. Then, presented are practical adaptations for the psychological assessment and treatment of LGBTQ+ patients that maintain fidelity to treatment protocols while allowing for flexibility in addressing their unique values, preferences, and challenges. © SLACK Incorporated.

The australian marriage equality debate: A qualitative analysis of the self-reported lived experience of lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) people - Ecker, S.; Rostosky, S.S.; Riggle, E.D.B.; Riley, E.A.; Byrnes, J.M. (International Perspectives in Psychology: Research, Practice, Consultation, 2019)
This study explored the lived experiences of a sample of lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) people during the Australian Government postal survey on legal recognition of same-sex marriage (August to November 2017). Negative impacts of public voting and debates on marriage equality for LGBTIQ people have been previously documented in United States, but less so in other national contexts. Thematic analysis was conducted using written responses of LGBTIQ participants (N = 5,313) to open-ended questions on a larger survey. Findings revealed that LGBTIQ participants experienced the Australian Marriage Law Postal Survey debate as a pervasive and predominantly negative event. Participants reported experiences of prejudice and discrimination and increased fear, anxiety, anger, and depression. They also described the harm and hurt caused by widespread negative images of and messages about LGBTIQ people. Some participants felt their lives were under threat and reported psychological distress, including thoughts of suicide. Although a few participants noted positive support that helped them cope, most participants perceived the debate and vote as a highly stressful, socially fracturing process that threatened interpersonal relationships with family members, workmates, and communities. Many participants described feeling betrayed by the government, country, and Church. These findings extend previous studies that document the public health impacts of political processes that publicly debate the human rights of LGBTIQ individuals. © 2019 American Psychological Association.
Keywords: Discrimination; LGBTIQ; Mental health; Same-sex marriage; Stress

Relationship Status and Suicidal Behavior in Gay Men: The Role of Thwarted Belongingness and Hope - Riley, K.; McLaren, S. (Suicide and Life-Threatening Behavior, 2019)
Objective: Levels of suicidal behavior among gay men are a significant concern. The Interpersonal Theory of Suicide proposes that being unpartnered is a risk factor for suicidal behavior due to thwarted belongingness; however, this has yet to be tested empirically. Recent studies also indicate that the two components of hope, agency and pathways, may be protective against suicidal behavior. The first aim of the current study was to investigate whether thwarted belongingness mediates the relationship between relationship status and suicidal behavior in gay men. The study also examined whether agency and pathways weaken the association between relationship status and thwarted belongingness, and whether agency weakens the relation between thwarted belongingness and suicidal behavior. Method: A sample of 370 self-identified gay men aged from 18 to 66 years old (M = 26.13, SD = 8.02) completed the Suicidal Behaviors Questionnaire—Revised, the Interpersonal Needs Questionnaire—Revised, and the Adult Dispositional Hope Scale. Results: Results showed that thwarted belongingness mediated the relationship between relationship status and suicidal behavior. The hypothesized moderated-mediation models were not supported. Conclusions: These findings have implications for the development of interventions that aim to reduce suicidal behaviors in gay men. © 2018 The American Association of Suicidology

Intersectionality and Health Behaviors Among US High School Students: Examining Race/Ethnicity, Sexual Identity, and Sex - Gattamorta, K.A.; Salerno, J.P.; Castro, A.J. (Journal of School Health, 2019)
BACKGROUND: Little research exists examining the impact of multiple minority identities, particularly sexual orientation, race/ethnicity, and sex on health-risk behaviors like mental health, substance use, violence, and sexual risk among high school students in the United States. In this study, we use a nationally representative dataset to examine differences between non-Hispanic white heterosexuals (HSs) and non-Hispanic white sexual minority, black HS, black sexual minority, Hispanic HS, and Hispanic sexual minority students. METHODS: Data from the 2015 wave of the Youth Risk Behavioral Surveillance System were used in this study. Chi-square and hierarchical logistic regression models examined differences between the groups on outcomes including: (1) mental health and suicide, (2) alcohol, tobacco, and illicit substances, (3) sexual risk and protective factors, and (4) school and physical and/or sexual violence. RESULTS: Whereas sexual minority youth (SMY) generally demonstrate poorer health outcomes compared to HSs, SMY who are also racial/ethnic minorities often have even poorer health outcomes, particularly relating to substance use, sexual risk behaviors, physical/sexual violence, and suicide. CONCLUSIONS: The need for culturally tailored education and school-based interventions that consider intersections between race/ethnicity, sexual identity, and biological sex are warranted to address health disparities related to mental health and suicide, substance use, sexual risk, and violence. © 2019, American School Health Association
Keywords: health risk-taking; mental health; race/ethnicity; risky sexual behaviors; sexual minorities; substance use; violence

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

Relationship Of Suicide Attempt With Depression And Other Socio-Demographic Factors Among The Transgenders - Zubair, U.B.; Khan, M.A.; Jalil, A.; Kamal, A.; Nizami, A.; Minhas, F.; Tasleem, S. (Journal of Ayub Medical College, Abbottabad : JAMC, 2019)
BACKGROUND: This study was conducted assess the frequency of suicide attempt among the transgender population and analyse the relationship of depression and other socio-demographic factors with the suicide attempt Cross-sectional study. METHODS: The sample population comprised of one hundred and forty-eight transgender people of Rawalpindi and Islamabad. Suicidal attempt was assessed by the simple question that "Have you ever performed an action with the intent to take your own life in your life time?" Answer of yes or no was recorded. Hamilton rating scale for Depression (HAM-D) was used to look for the presence of depression among the target population. Relationship of the age, smoking, family income, illicit substance use and depression was studied with the presence of suicidal attempt among these transgender population of twin cities of Pakistan. RESULTS: A total of 148 transgender people were included in the final analysis. Mean age of the study participants was 38.24±3.18. Out of these, 70.9% had no suicidal attempt in their whole life while 29.1% had one or more suicidal attempts during the course of their life. Twelve had more than one suicidal attempt while 19 had attempt in last one year. Fifty-five did not showed depression while 93 had depression on HAM-D. With binary logistic regression we found that presence of depression and low income had significant association with the presence of suicidal attempt among the target population. CONCLUSIONS: This study showed a high prevalence of suicidal attempts among the transgender population of twin cities of Pakistan. Routine screening for mental health problems should be performed on this high-risk group and adequate employment resources should be generated in order to enable them to earn their livelihood and prevent them from making attempts to take their own life.
Keywords: Depression; Suicide attempt; Trans-genders

Higher Educational Attainment is Associated with Lower Risk of a Future Suicide Attempt Among Non-Hispanic Whites but not Non-Hispanic Blacks - Assari, S.; Schatten, H.T.; Arias, S.A.; Miller, I.W.; Camargo, C.A.; Boudreaux, E.D. (Journal of Racial and Ethnic Health Disparities, 2019)
Purpose: In a sample of patients presenting to the emergency department (ED), the current study was conducted with two aims: (1) to investigate the protective effects of educational attainment (i.e., completing college) on subsequent risk of suicide attempt/death among patients presenting to the ED and (2) to compare this effect between non-Hispanic Black and non-Hispanic White ED patients. Methods: The current study analyzed data from the Emergency Department Safety Assessment and Follow-Up Evaluation (ED-SAFE) study, a quasi-experimental, eight-center study of universal suicide screening and follow-up of ED patients presenting for suicidal ideation and behavior. Our sample included 937 non-Hispanic White and 211 non-Hispanic Blacks. The dependent variable was suicide attempt/death during the 52-week follow-up. The independent variable was completing college. Age, gender, lesbian/gay/bisexual status, psychiatric history, and previous suicide attempts at baseline were covariates. Race/ethnicity was the focal effect modifier. Logistic regression models were used to test the protective effects of educational attainment on suicide risk in the overall sample and by race/ethnicity. Results: In the overall sample, educational attainment was not associated with suicide risk over the follow-up period. A significant interaction was found between race/ethnicity and educational attainment on suicide risk, suggesting a larger protective effect for non-Hispanic Whites compared with non-Hispanic Blacks. In race/ethnicity-specific models, completing college was associated with decreased future suicide risk for non-Hispanic Whites but not Blacks. Conclusions: Consistent with the Minorities’ Diminished Return theory, educational attainment better protected non-Hispanic White than non-Hispanic Blacks against future suicide attempt/death. While Whites who have not completed college may be at an increased risk of suicide, risk of suicide seems to be independent of educational attainment for non-Hispanic Blacks. © 2019, W. Montague Cobb-NMA Health Institute.
Keywords: Blacks; Ethnic health disparities; Ethnicity; Race; Socioeconomic status; Suicide

“TRANS”-questionnaire (TRANS-Q): a novel, validated pre- and postoperative satisfaction tool in 145 patients undergoing gender confirming mastectomies - Wanta, J.; Gatherwright, J.; Knackstedt, R.; Long, T.; Medalie, D.A. (European Journal of Plastic Surgery, 2019)

Suicidal tendencies: Notes toward a queer narratology - Seitler, D. (GLQ, 2019)

Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues - Zucker, K.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. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: DSM-5; Gender dysphoria; Gender identity; Rapid-onset gender dysphoria; Sex ratio; Suicidality

Self-reported Rates of Abuse, Neglect, and Bullying Experienced by Transgender and Gender-Nonbinary Adolescents in China - Peng, K.; Zhu, X.; Gillespie, A.; Wang, Y.; Gao, Y.; Xin, Y.; Qi, J.; Ou, J.; Zhong, S.; Zhao, L.; Liu, J.; Wang, C.; et al. (JAMA network open, 2019)
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.

Sexual orientation disparities in mental health and substance use among Black American young people in the USA: effects of cyber and bias-based victimisation - Mereish, E.H.; Sheskier, M.; Hawthorne, D.J.; Goldbach, J.T. (Culture, Health and Sexuality, 2019)
Few studies have explored sexual orientation disparities in mental health and substance use outcomes among racial minorities. This study examined sexual orientation disparities in depression, suicidality and substance use among Black American young people in the USA, and the mediating role of cyber and bias-based victimisation in accounting for these disparities. Secondary analyses were performed on data from a probability sample of young people (N = 1,129) collected in a school district in the south-eastern USA. Participants reported socio-demographics, depressive symptoms, suicidality, substance use and experiences of bias-based and cyber victimisation. With some exceptions, Black participants who were lesbian, gay, bisexual or mostly heterosexual reported higher rates of depression, suicidal ideation, suicide planning and substance use than Black heterosexual participants. Black lesbian, gay, bisexual and mostly heterosexual participants reported more cyber and bias-based victimisation than Black heterosexual participants. Sexual orientation disparities in mental health and, to some extent, substance use were partially explained by both forms of victimisation. Further research is needed to address the role of bias-based and cyber victimisation in disparities in mental health and substance use among Black sexual minority young people. The present study carries implications for prevention and treatment efforts for racially diverse sexual minorities. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: adolescents; Black; mental health; sexual minority; victimisation

Substance use, violence experiences, and mental health issues: are these health risks associated with HIV testing among sexually experienced U.S. high school students? - Pampati, S.; Lowry, R.; Steiner, R.J. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2019)
HIV testing is a critical strategy for prevention of HIV yet testing among sexually experienced adolescents is sub-optimal. The purpose of this study is to examine associations between risk behaviors and experiences related to substance use, violence, and mental health and suicide and receipt of testing. We analyzed cross-sectional data from the 2017 national Youth Risk Behavior Survey, a nationally representative sample of U.S. high school students in grades 9–12. Analyses were limited to sexually experienced participants (n = 5192). Measures included nine indicators related to substance use, violence, and mental health and suicide. Unadjusted and adjusted prevalence ratios were calculated for each indicator to examine associations with testing. Adjusted models controlled for same-sex sexual behavior, sexual risk, and demographic characteristics. Prevalence of HIV testing was 17.2%. In adjusted models, forced sexual intercourse, injection drug use, other illicit drug use, and persistent feelings of sadness or hopelessness were associated with a higher likelihood of testing. Prevalence of HIV testing in this sexually experienced sample was low. Some behaviors and experiences that may be indicative of HIV risk, including sexual dating violence and prescription opioid misuse, were not associated with testing. ©, This work was authored as part of the Contributor's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law. This is an Open Access article that has been identified as being free of known restrictions under copyright law, including all related and neighboring rights (https://creativecommons.org/publicdomain/mark/1.0/). You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.
Keywords: adolescents; HIV testing; mental health; substance use; violence

Effect of same-sex marriage referendums on the suicidal ideation rate among nonheterosexual people in Taiwan - Lin, I.-H.; Ko, N.-Y.; Huang, Y.-T.; Chen, M.-H.; Lu, W.-H.; Yen, C.-F. (International Journal of Environmental Research and Public Health, 2019)
Taiwan held voter-initiated referendums to determine same-sex marriage legalization on 24 November 2018. This study aims to compare suicidal ideation rates in heterosexual and nonheterosexual participants of a first-wave survey (Wave 1, 23 months before the same-sex marriage referendums) and a second-wave survey (Wave 2, one week after the same-sex marriage referendums) in Taiwan and to examine the influence of gender, age, and sexual orientation on the change in suicidal ideation rates in nonheterosexual participants. In total, 3286 participants in Wave 1 and 1370 participants in Wave 2 were recruited through a Facebook advertisement. Each participant completed an online questionnaire assessing suicidal ideation. The proportions of heterosexual and nonheterosexual participants with suicidal ideation were compared between the Wave 1 and Wave 2 surveys. Suicidal ideation rates between participants in the Wave 1 and Wave 2 surveys were further compared by stratifying nonheterosexual participants according to gender, age, and sexual orientation. Nonheterosexual participants in the Wave 2 survey had a higher suicidal ideation rate than those in the Wave 1 survey, whereas no difference was observed in suicidal ideation rates between heterosexual participants in Wave 2 and Wave 1. Nonheterosexual participants who were female, younger, gay, lesbian, and bisexual in Wave 2 had a higher suicidal ideation rate than those in Wave 1. The suicidal ideation rate significantly increased in nonheterosexual participants experiencing the same-sex marriage referendums in Taiwan. Whether civil rights of sexual minority individuals can be determined through referendums should be evaluated. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.
Keywords: Age; Gender; Same-sex marriage; Sexual orientation; Suicidality

Overview of care for transgender children and youth - Weiselberg, E.C.; Shadianloo, S. (Current Problems in Pediatric and 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. © 2019 Elsevier Inc.

Minority Stress Among Transgender Adolescents: The Role of Peer Victimization, School Belonging, and Ethnicity - Hatchel, T.; Valido, A.; De Pedro, K.T.; Huang, Y.; Espelage, D.L. (Journal of Child and Family Studies, 2019)
Transgender youth peer relations is understudied when compared to lesbian, gay, and bisexual youth (LGB). Likewise, transgender youth of color (YOC) are also understudied given the difficulties associated with accessing the sample. This study examines the relations among peer victimization, school belonging, and mental health with an ethnically diverse sample of transgender adolescents (N = 4778). Invariance testing and structural equation modeling were employed to explore these relations as well as the potential moderating role of ethnic minority status. Findings demonstrate that an alarming number of transgender youth were exposed to victimization and that victimization predicted mental health issues like suicidal ideation. Furthermore, analyses showed that peer victimization was associated with diminished school belonging. School belonging was associated with better mental health and appeared to mediate the relation between victimization and mental health issues. Ethnic minority status did not moderate these associations. Implications for research are discussed. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Depression; Gender nonconformity; Intersectionality; LGBT; Suicidality; Suicide

Research on relationships between sexual identity, adverse childhood experiences and non-suicidal self-injury among rural high school students in less developed areas of China - Li, X.; Zheng, H.; Tucker, W.; Xu, W.; Wen, X.; Lin, Y.; Jia, Z.; Yuan, Z.; Yang, W. (International Journal of Environmental Research and Public Health, 2019)
Purpose: The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on non-suicidal self-injury (NSSI) among rural high school students in less developed areas of China. Methods: Behavior risk factors data collected from 1810 students from a high school in Jiangxi province, China. Five measures of childhood abuse and household dysfunction were summarized, and ACE was divided into 0, 1, 2, 3–5 ACEs. Logistic regression analysis was used to explore the influence of sexual identity, adverse childhood experiences, and their interaction with non-suicidal self-injury. Results: Compared with heterosexual students, high school students who identify as lesbian, gay, or bisexual (LGB) have a higher tendency of non-suicidal self-injury (AOR = 3.250, 95% CI = 1.69–6.28, p < 0.01). There was also a graded relationship between cumulative ACEs exposure and non-suicidal self-injury behaviors (AOR = 1.627, 95% CI = 1.02–2.60, p < 0.05). Odds for NSSI are higher among students with both experienced ACEs and identified as LGB (AOR = 2.821, 95% CI = 1.51–5.29, p < 0.05). Conclusions: Non-suicidal self-injury is associated with ACEs exposure and with those who identify as LGB, and the NSSI odds are greater when students identify as LGB and have experienced ACEs. More interventions to reduce non-suicidal self-injury should focus on LGB and ACEs and more attention needs to be paid to those who identify as LGB and have been exposed to ACEs. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.
Keywords: Adverse childhood experiences; High school students; Less developed areas of China; Non-suicidal self-injury; Sexual identity

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

Non-binary gender and transgender youth: A literature review - Poirier, F.; Condat, A.; Laufer, L.; Rosenblum, O.; Cohen, D. (Neuropsychiatrie de l'Enfance et de l'Adolescence, 2019)
Background: Recently international scientific literature has been increasingly interested in situations where gender identity is unconventional – neither male nor female, part-time male part-time female, male and female. Binary transgender identity and gender dysphoria are now well recognized. However, this is not the case for non-binary gender identities. Objective: In the current report, we aim at reviewing the literature on non-binary gender and genderqueer identities in order to appreciate the interest of this recognition in medicine and its understanding by the health professionals. Methods: The article is based on a literature review on non-binary gender and genderqueer identities and on the accompaniment of binary and non-binary transgender youth. The results are presented within different themes. Results: Research shows that non-binary/genderqueer people tend to be young, urban, have a higher level of education, and to remain often as students or unemployed. If non-binary trans people are mostly teenagers and young adults between the ages of 14 and 25, it is not simply a question of considering non-binary gender identity as an adolescent process, or even simply a recent societal phenomenon. Indeed, the issues that are facing these adolescents and young people are very specific, starting with marginalization and precariousness. According to previous studies, psychic difficulties (including self-aggressive gestures, suicidal thoughts and behaviors, eating disorders, anxiety and depression) are more or less equal or superior to those of binary transgender people. It is necessary to consider the different methodological biases, or the cultural and geographical context of a study. The rate of indecision is particularly high among non-binary youth, but access to care is more complicated when they are ready to make a change. Then, the physical transformations desired will vary, depending on the needs, but frequently only the cross-sex hormones and/or top surgery are needed. In that way, non-binary gender youth tend to have a better relationship with their own bodies than binary transgender youth. Conclusion: The scientific literature is increasingly trying to raise the question of the inclusivity of all genres in national surveys and in the accompaniment of people. A better understanding of these questions will allow better support of young people questioning their gender in a binary or non-binary perspective. © 2018 Elsevier Masson SAS
Keywords: Agender; Cisgender; Gender dysphoria; Gender-affirming care; Gender-fluid; Genderqueer; Non-binary gender; Non-conforming gender; Transgender; Youth

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

Gender affirming medical care of transgender youth - Salas-Humara, C.; Sequeira, G.M.; Rossi, W.; Dhar, C.P. (Current Problems in Pediatric and Adolescent Health Care, 2019)
The number of gender diverse and transgender youth presenting for treatment are increasing. This is a vulnerable population with unique medical needs; it is essential that all pediatricians attain an adequate level of knowledge and comfort caring for these youth so that their health outcomes may be improved. There are several organizations which provide clinical practice guidelines for the treatment of transgender youth including the WPATH and the Endocrine Society and they recommend that certain eligibility criteria should be met prior to initiation of gender affirming hormones. Medical intervention for transgender youth can be broken down into stages based on pubertal development: pre-pubertal, pubertal and post-pubertal. Pre-pubertally no medical intervention is recommended. Once puberty has commenced, youth are eligible for puberty blockers; and post-pubertally, youth are eligible for feminizing and masculinizing hormone regimens. Treatment with gonadotropin releasing hormone agonists are used to block puberty. Their function is many-fold: to pause puberty so that the youth may explore their gender identity, to delay the development of (irreversible) secondary sex characteristics, and to obviate the need for future gender affirmation surgeries. Masculinizing hormone regimens consists of testosterone and feminizing hormone regimens consist of both estradiol as well as spironolactone. In short term studies gender affirming hormone treatment with both estradiol and testosterone has been found to be safe and improve mental health and quality of life outcomes; additional long term studies are needed to further elucidate the implications of gender affirming hormones on physical and mental health in transgender patients. There are a variety of surgeries that transgender individuals may desire in order to affirm their gender identity; it is important for providers to understand that desire for medical interventions is variable among persons and that a discussion about individual desires for surgical options is recommended. © 2019 Elsevier Inc.

Predicting Attitudes towards Lesbians and Gay Men: The Effects of Social Conservatism, Religious Orientation, and Cultural Humility - Choe, E.; Srisarajivakul, E.; Davis, D.E.; DeBlaere, C.; Van Tongeren, D.R.; Hook, J.N. (Journal of Psychology and Theology, 2019)
This study explores the role cultural humility plays in attitudes and discrimination towards people identifying as gay or lesbian among religious individuals. Specifically, we explore cultural humility as a possible predictor of less discriminatory attitudes towards lesbians and gay men above and beyond the effects of conservatism and religious orientation. Consistent with prior work, we expected that (a) intrinsic religious orientation, extrinsic religious orientation, and conservatism would be positively related to discriminatory attitudes and (b) that quest religious orientation and cultural humility would be negatively related to discriminatory attitudes. Participants (N = 231) were recruited through MTurk after the 2016 Pulse Nightclub shooting in Orlando, Florida to understand the attitudes and experiences held by Americans. Participants completed measures of religious orientation, attitudes, and behaviors towards lesbians and gay men, and cultural humility regarding LGBT issues. Results supported the hypothesis that cultural humility predicts less discrimination towards lesbians and gay men beyond conservatism and religious orientation. Results, limitations, and future directions are discussed. © Author(s) 2019.
Keywords: multicultural issues; positive psychology; psychology of religion; virtues

Bisexual women's experiences of microaggressions and microaffirmations and their relation to mental health - Salim, S.; Robinson, M.; Flanders, C.E. (Psychology of Sexual Orientation and Gender Diversity, 2019)
Bisexual women report worse mental health outcomes compared to heterosexual and lesbian women. To explore potential factors related to bisexual women's mental health and wellbeing, we examined bisexual women's daily experiences with sexual identity microaggressions and microaffirmations as they relate to depression, suicidality, and happiness. We used a 5-day online daily diary study design. The first day participants completed a survey with information on demographics, sexual identity, social support, depression, and self-esteem. For Days 2 through 5 participants completed daily diary entries consisting of the Bisexual Microaggression and Microaffirmation Scales, measures of depression, suicidality, and happiness. Data were analyzed using a multilevel model with two levels-repeated daily diary measures nested within each participant. We assessed the relationship between daily microaggressions and microaffirmations and mental health within individuals, and how mental health may differ between individuals based on social support, connectedness to LGBTQ community, self-esteem, and internalized binegativity (negative feelings about one's bisexual identity). There was a significant relationship between daily microaggressions and depression, suicidality, and happiness within individuals. Between individuals, there was a relationship between some of the mental health outcomes and Day 1 depression, self-esteem, trans identity, and racialized identity. © 2019 American Psychological Association.
Keywords: Bisexuality; Daily diary study; Microaffirmations; Microaggressions

Coping, stress, and negative childhood experiences: The link to psychopathology, self-harm, and suicidal behavior - McLafferty, M.; Armour, C.; Bunting, B.; Ennis, E.; Lapsley, C.; Murray, E.; O'Neill, S. (PsyCh Journal, 2019)
Early life experiences, such as childhood adversities or poor parenting practices, can impact on the ability to cope with stressors across the lifespan. Furthermore, poor coping skills can lead to the development of mental illnesses, self-harm, and suicidal behavior. This study aimed to examine demographic differences in stress levels and to determine if those who had endured negative childhood experiences would be more likely to develop psychological problems and display suicidal behavior when current stress levels were accounted for. The study also explored the link between coping and mental health problems. Finally, it aimed to predict risk and protective factors related to good coping skills. The study utilized data obtained from the Ulster University Student Wellbeing Study, conducted across four university campuses in Northern Ireland in 2015 (n = 716) as part of the World Health Organization World Mental Health (WMH) International College Student Initiative. Mental health problems and early childhood experiences were examined using questions adapted from the WMH Composite International Diagnostic Interview, with self-harm and suicidal behavior measured using the Self-Injurious Thoughts and Behaviors Interview (SITBI). Females, non-heterosexuals, and older students experienced more current stress. When current stress levels were high, childhood adversities and parental overcontrol and overindulgence were related to higher rates of mental health problems, self-harm, and suicidal behavior. Poor coping skills were associated with negative mental health outcomes. Social support and good emotion-regulation strategies were related to effective coping, while parental overcontrol and overindulgence, female gender, and younger age were related to poorer coping. The study highlights the importance of developing good coping skills to deal with life stressors, thereby minimizing the risk of psychological problems and suicidal behavior. The findings provide support for initiatives to help parents improve their parenting skills and other programs to help young people cope with stress, and to develop social networks and adaptive emotion-regulation strategies. © 2019 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd
Keywords: childhood adversity; coping; mental health; stress

Antennatula katumotoi, a new euantennariaceous sooty mould, with a Hormisciomyces-like synasexual morph from central Honshu, Japan - Sugiyama, J.; Hosoya, T. (Mycoscience, 2019)
A new species of euantennariaceous sooty mould, Antennatula katumotoi, is described and illustrated. It has a Hormisciomyces-like synasexual morph and inhabits twigs of the conifer Abies veitchii in Sugenuma (alt. ca. 1719 m), Katashina-mura, Tone-gun, Gunma Prefecture, central Honshu, Japan. The expected Euantennaria-like sexual morph linked to this genus was not seen in the specimen studied. This is the first proof that the genus Antennatula of the family Euantennariaceae also occurs in Japan. In addition, A. katumotoi also occurs with another metacapnodiaceous sooty mould that is composed of characteristic moniliform, barrel-shaped hyphae probably of a Capnobotrys-like asexual morph, but this is a minor inhabitant in the subicula. © 2019 The Mycological Society of Japan
Keywords: Euantennariaceae; Geographical distribution; Pleomorphic fungi; Sexual morph-asexual morph connection

The Nature of Bias Crime Injuries: A Comparative Analysis of Physical and Psychological Victimization Effects - Fetzer, M.D.; Pezzella, F.S. (Journal of Interpersonal Violence, 2019)
The core justification of bias crime statutes concerns whether bias-motivated crimes are qualitatively different from otherwise motivated crimes. We test the hypothesis that bias crimes are more detrimental than non-bias crimes by testing for multi-dimensional injuries to victims of bias and non-bias-motivated criminal conduct. Using National Crime Victimization Survey (NCVS) Extract 2013 Collection Year Incident-level Extract File, we analyzed physical injuries and psychological trauma to NCVS victims during 2013. We found a range of covariates consistent with the likelihood of physical injury and psychological trauma. These included whether the incident was bias motivated, whether weapons (firearms, knives, other or unknown type of weapons) were involved, whether the incident involved multiple offenders or strangers, or whether drugs or alcohol were involved. Our findings reinforce previous studies that detected empirical evidence of multi-dimensional physical and psychological injuries to bias crime victims. © The Author(s) 2016.
Keywords: hate crimes; LGBTQ; vicarious trauma; violence against; violence exposure

Trinh T. Minh-Ha: Essaying ethics - Fausty, J. (Afterall, 2019)
I regret the ‘his or her’ ending, particularly in a piece on transcending binaries: Not ‘the [singular] writing self and his or her living other’ (as I put it) but rather writing selves and their living others. Yet here we are: A new ban on transgender soldiers by an American president who separates families, cages children, and, obsessed with building his ‘wall of insecurity’1, ‘jokes’ about shooting migrants at the southern border. As Trinh notes, ‘although living in two dualistic worlds (here versus there) proves to be still acceptable to the rational mind, living in two and many non-opposing worlds – all located in the very same place as where one is – inevitably inscribes silence’.2 Not only does silence tempt where power demands black-or-white, us-and-them, with-me-or-againstme ‘ready-mades’; but also, despite everything, we still do not know how to live with multiplicity. Trinh eludes the inevitability of silence, discovering ways to hear/read/ speak/write that admit the nearly silent, slight, slippery bits, the heart-bits;3 transrationally exploring, questioning, articulating complexity, difference, interconnection; illuminating new horizons for consciousness with urgency, immediacy and perspective – over time, sure, yet also and especially here and now, in this very space we might together learn to share. — JF. © 2017, University of Chicago Press. All rights reserved.

Transgender Expressions and Psychosis: Towards an Ethics of Sexual Difference - Gherovici, P. (British Journal of Psychotherapy, 2019)
Psychoanalysis has a regrettable history of pathologizing non-normative expressions of gender and sexuality; this tendency is even more prevalent with analysands who identify as trans. However, this has not been Jacques Lacan's position. In order to flesh out Lacan's complex intervention in the domain of transsexualism and to show his nuanced position that has often been misinterpreted, I will discuss three of his clinical interventions with patients presenting ‘transgender expressions’. Examining Lacan's work, I propose moving towards a differential clinic, a clinic where the diagnosis preserves the subjectivity of the patient and is a tool in the direction of the treatment and not a label. This type of structural diagnosis is not standardized but decided case by case, based on the particulars of each treatment. © 2019 BPF and John Wiley & Sons Ltd
Keywords: Freud; Lacan; Psychoanalysis; Psychosis; Sexuality; Transsexualism

Comparison of male and female victims of intimate partner homicide and bidirectionality - An analysis of the national violent death reporting system - Velopulos, C.G.; Carmichael, H.; Zakrison, T.L.; Crandall, M. (Journal of Trauma and Acute Care Surgery, 2019)
Intimate partner violence (IPV) is a public health crisis, affecting at least 1:4 women and 1:9 men. A recent multicenter 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. METHODS This is a 2003-2015 retrospective review of the National Violent Death Reporting System, a Centers for Disease Control and Prevention 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 A total of 6,131 persons in opposite-sex relationships and 181 in same-sex relationships were murdered as a result of 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 intimate partner homicide. 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 caused by 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 sexes, 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 Retrospective secondary data analysis, level III. © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: homicide-suicide; intimate partner homicide; Intimate partner violence; violence prevention

Using Photovoice to Understand Suicidality Among Gay, Bisexual, and Two-Spirit Men - Ferlatte, O.; Oliffe, J.L.; Salway, T.; Broom, A.; Bungay, V.; Rice, S. (Archives of Sexual Behavior, 2019)
This study explored the drivers of suicidality from the perspectives of gay, bisexual, and two-spirit men (GB2SM) with a history of suicidality. Twenty-one GB2SM participated in this photovoice study taking photographs to depict and discuss their previous suicidality. Data were collected from in-depth individual interviews in which participants discussed their photographs and in turn offered verbal/narrative accounts of suicidality. Drawing on intersectionality, analyses of the photographs and interview data revealed three interconnected themes. First, adverse childhood events and negative adolescent experiences were described as the root causes of mental health struggles and suicidality. Second, violence and homophobia had disrupted these men’s education and employment opportunities and some participants detailed how their lack of capital and challenges for maintaining employment shaped their suicidality. Third, a sociality of stigma and sense of isolation compounded experiences of suicidality. The three themes overlapped and were shaped by multiple intersectional axes including sexuality, class, ethnicity, and mental health status. The findings have implications for services and health professionals working with GB2SM who need to thoughtfully consider life-course trajectories and multiple social axes when assessing and treating GB2SM experiencing suicidality. More so, because these factors relate to social inequities, structural and policy changes warrant targeted attention. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Gay and bisexual men’s health; Intersectionality; Male suicide; Photovoice; Sexual orientation

“The Problem isn’t Yourself Overcoming, it’s Other People Overcoming You:” A Decolonizing Mental Health DSE Curricular Cripstemology Reading of Daniel and Luna’s Intersectional Dis/ability Experiences - Hernández-Saca, D.I.; Kahn, L.G. (Educational Studies - AESA, 2019)
This study brings together 2 case studies to interrogate the intersectional experiences of historically marginalized youth at the intersections of power and identity from a decolonizing mental health disability studies in education (DSE) cripstemology approach. Specifically, we analyzed how US schools create normalized meanings of mental health. Daniel was a 1st-generation Mexican American to the United States, bilingual in both Spanish and English, and was labeled with a learning disability and a speech and language impairment. Daniel was born in Pinole, a southwestern major urban city and was in the 8th grade. Luna, a 16-year-old 10th-grader who lived at home with his mother and his stepfather and identifies as an Arab American, was on an individual education program for his disabilities including mild cerebral palsy, apraxia, and dysarthria. Luna identified as a pansexual and transgender individual and experiences depression and suicide ideation. There were similarities and differences between Daniel and Luna’s experiences related to intersectional disability oppressions that were interpersonal and institutional, their identity processes around school contexts tied to their ethnicities, language use, sexuality, and their experiences with colonial mental health hegemony. Our framework created new knowledge for theory, research, and praxis within US schools. © 2019, © 2019 American Educational Studies Association.

Sex Education Inclusivity and Sexual Minority Health: The Perceived Inclusivity of Sex Education Scale - Keiser, G.H.; Kwon, P.; Hobaica, S. (American Journal of Sexuality Education, 2019)
Minority stress research has demonstrated negative health outcomes in sexual minority populations. However, the influence of sex education on these outcomes remains unclear. In the current study, the Perceived Inclusivity of Sex Education Scale (PISES) was developed and administered to sexual minorities (N = 263) to assess the associations between sex education climate and health outcomes. Greater perceived inclusivity was associated with lower anxiety, depression, and suicidality, but was not associated with sexual risk-taking and substance use. We hypothesized that a number of resilience factors would moderate these relationships, but no interactions were found. These findings may help guide further research on sex education among sexual minorities. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: health outcomes; inclusivity; LGB; Sex education

Protective Factors of Suicide and Suicidal Behavior Relevant to Emergency Healthcare Settings: A Systematic Review and Narrative Synthesis of Post-2007 Reviews - McClatchey, K.; Murray, J.; Chouliara, Z.; Rowat, A. (Archives of Suicide Research, 2019)
Suicide is a major public health concern and, with recent societal changes, such as economic and technological changes, there may be emerging protective factors that mitigate suicide risk that are unrecognized in emergency healthcare. This systematic review aims to identify protective factors for suicide that can feasibly be assessed in time-limited emergency healthcare settings. A systematic review of reviews was conducted via PsycINFO, CINAHL and Medline (2007–2015). Reviews were assessed for methodological quality using AMSTAR. A total of 24 reviews met the inclusion criteria and 8 were assessed as high quality and included in a narrative synthesis. Known protective factors were identified (e.g., social support), along with emerging protective factors (e.g., internet support). The review synthesizes recent research evidence on protective factors and discusses their relevance to emergency healthcare. © 2019, © 2019 International Academy for Suicide Research.
Keywords: protective factors; socioeconomic factors; suicide; systematic review

We need to talk about Fabian: Klein’s ‘lost’ theory of projective identification and the social construction of gender/queer objects - Clarke, J. (Psychoanalytic Psychotherapy, 2019)
Melanie Klein’s seminal concept of projective identification provides an important theoretical mechanism for working through the Oedipus complex. Klein saw it as the key to achieving emotional maturity. As well as the choice of object, which decides our sexual identity, Klein sees a second choice to be made as subject, which shapes our gender. The question is not only ‘what does a woman (or man) want?’, as Freud and Jones argued, but ‘who (and how) does a woman (or man) become?’, as Simone de Beauvoir memorably asked. How is our gender acquired for us and by us? Queer theory asks us to refuse gender normativity. That is one response. But unless we arrive at our own answer to gender, says Klein, the capacities both to love and to be loved will remain elusive. Klein invites us to leave Oedipus behind in Ancient Thebes and move the stage to Paris in 1920, the setting for a novel by Julien Green, If I Were You. Our Modern hero is a young man, Fabian Especel. This article rediscovers Fabian and adds to Klein’s theory of internal objects the role of queer objects as Weberian ‘abject types’, to update the Oedipus complex today. © 2019, © 2019 The Association for Psychoanalytic Psychotherapy in the NHS.
Keywords: abjection; negative gender capability & sensibility; projective identification; queer objects

Cyberbullying and health: A preliminary investigation of the experiences of Canadian gay and bisexual adult men - Lam, S.; Ferlatte, O.; Salway, T. (Journal of Gay and Lesbian Social Services, 2019)
The majority of cyberbullying studies are within the school environment. This quantitative study investigates cyberbullying among Canadian gay and bisexual men outside of the educational setting through a cross-sectional survey. Of the 7,430 respondents, 4.6% reported cyberbullying in the past year, with younger, Aboriginal, lower-educated, lower-income respondents reporting higher odds of experiencing cyberbullying. Victimization from cyberbullying was significantly associated with experiences of antigay discrimination as well as worry about antigay prejudice. A variety of negative health outcomes were also associated with cyberbullying, including intimate partner violence and suicidality. Implications for social service providers and future research are discussed. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: bisexual men; cyberbullying; gay men; homophobia

Sexual identity modifies the association between bullying and suicide planning among adolescents with same-sex sexual partners - Turpin, R.; Boekeloo, B.; Dyer, T. (Journal of LGBT Youth, 2019)
Heterosexual adolescents with same-sex sexual partners may be at increased risk for psychological distress from victimization; this may lead to suicidality. We tested if sexual identity modified the association between bullying at school and suicide planning among adolescents with the same-sex sexual partners. We sampled 924 youth with same-sex sexual partners from the 2015 Youth Risk Behavior Survey, testing the association between bullying and suicide planning using log-binomial regression with sexual identity interactions. Sexual identity modified this association, with the greatest association among heterosexual participants (PR = 4.01, 95% CI 2.60–6.18). Anti-homophobia messaging and intervention programs that target these youth may be needed. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: Bullying; identity; LGB; sexuality; suicide

Correction to: The politics of shame in the motivation to virtue: Lessons from the shame, pride, and humility experiences of LGBT conservative Christians and their allies (Journal of Moral Education, (2019), 48, 1, (109-125), 10.1080/03057240.2018.1534088) (Journal of Moral Education, 2019)
Article title: The politics of shame in the motivation to virtue: Lessons from the shame, pride, and humility experiences of LGBT conservative Christians and their allies Authors: Tobin, T. W. and Moon, D. Journal: Journal of Moral EducationBibliometrics: Volume 48, Number 1, pages 109-125 DOI: http://dx.doi.org/10.1080/03057240.2018.1534088 In the final version of the above article errors were introduced in the placement and order of notes 2-4, and in the respondent’s heart rate on p.114. These errors have been corrected as follows: Notes 2-4 placed correctly in the text and corrected in the endnote section: Page 121 2. Cisgender means agreeing with the sex assignment given at birth; not transgender. 3. We leave open the possibility that anger may be a morally appropriate and psychologically healthy response in extreme conditions of structural injustice or oppression that routinely assault their personhood and psyche (hooks, 1995; Lugones, 2003). 4. Alicia Crosby, of the CFI, assisted us by interviewing LGBTQI people of color who might not have wished to be interviewed by white women. After being briefed on our interviewing methods by Moon, she conducted 40 of our 113 interviews, averaging 60 minutes. 5. As a qualitative sociologist, Moon trained Tobin in these methods. Page 114–corrected paragraph Many LGBT participants speak of experiencing shame’s effects as toxic, poisoning not just relationships, but their mental and even physical health. Some speak of depression and attempts at suicide, and others speak of surprising physical consequences, including a black respondent in her twenties being hospitalized with uncontrollable asthma attacks, a healthy mixed-race respondent in her early twenties being hospitalized with a heart rate of 19, and a former Nashville Christian music superstar contracting a rare and life-threatening auto-immune disorder (Strudwick, 2014), all of which doctors could only attribute to the intense stress caused by their shame around gender and sexuality and the fear that they would lose their places in the church. © 2019, © 2019 Journal of Moral Education Ltd.

Suicide Prevention From the Perspectives of Gay, Bisexual, and Two-Spirit Men - Ferlatte, O.; Oliffe, J.L.; Louie, D.R.; Ridge, D.; Broom, A.; Salway, T. (Qualitative Health Research, 2019)
Although gay, bisexual, and two-spirit men (GBTSM) experience high rates of suicidality, there have been few empirical studies of prevention initiatives and policies that could address or reverse this major social problem. This article reports on a photovoice study of 29 GBTSM who had a history of suicidality or lost a fellow GBTSM to suicide. We focused our analysis on participants’ perspectives on suicide prevention. Participants described four key considerations for GBTSM suicide prevention: (a) recognizing and addressing enduring homophobia, biphobia, and mental illness stigma; (b) provision of low-barrier, long-term, and GBTSM-affirming counseling; (c) de-isolation through peer support and community connection; and (d) fostering creativity and cultural resilience. By engaging GBTSM affected by suicide through photographs that depict their experiences and points of view, in this study, we offer concrete recommendations to reduce suicidality among GBTSM. © The Author(s) 2018.
Keywords: bisexuals; gays and lesbians; interview; mental health and illness; photovoice; qualitative; resilience; resistance; sexual health; sexuality; stigma; suicide; Vancouver

Suicide etiology in youth: Differences and similarities by sexual and gender minority status - McKay, T.; Berzofsky, M.; Landwehr, J.; Hsieh, P.; Smith, A. (Children and Youth Services Review, 2019)
Sexual and gender minority (SGM)individuals are at steeply elevated risk for suicide, particularly in adolescence and young adulthood. Evidence on suicide risk factors specific to SGM youth is emerging, but an integrated understanding of the etiology of suicide that accounts for both commonalities and differences between SGM and non-SMG youth is lacking. Using 2018 data from a social media-based sample of SGM (n = 175)and non-SGM (n = 310)youth ages 14–21, we assess the role of constructs from the general-population-based interpersonal-psychological theory of suicide and the SGM-specific minority stress theory in suicide ideation and attempt. Parental support was a strong protective factor shared across the SGM and non-SGM youth samples. The role of other factors, such as racial/ethnic identity, differed by group. Implications for suicide prevention and intervention in schools and other settings that include both SGM- and non-SGM youth are discussed. © 2019 Elsevier Ltd

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

Mass media representation of suicide in a high suicide state in India: An epidemiological comparison with suicide deaths in the population - Armstrong, G.; Vijayakumar, L.; Pirkis, J.; Jayaseelan, M.; Cherian, A.; Soerensen, J.B.; Arya, V.; Niederkrotenthaler, T. (BMJ Open, 2019)
Objectives Suicide rates in India are among the highest in the world, equating to over 200 000 suicides annually. Reports of suicides are a routine feature in major newspapers in India, and reporters may selectively present â € newsworthy' suicide stories. The aim of this paper was to systematically investigate whether mass media reports of suicides reflect the epidemiological data on suicide in a high suicide state in India. Design We undertook a content analysis study to extract sociodemographic data on suicides reported among nine of the most highly read daily newspapers in the high suicide southern state of Tamil Nadu between June and December 2016. A total of 1258 newspaper articles were retrieved containing reports on 1631 suicides. Two-tailed binomial tests on aggregate frequencies assessed whether the sociodemographic characteristics of suicides in the newspaper articles were different to the population suicide statistics for Tamil Nadu. Results We identified some statistically significant discrepancies between suicide characteristics in the population and the media. Suicides involving females (p<0.001), those aged under 30 years (p<0.001), separated or widowed males (p<0.001), unmarried females (p<0.001), those using methods with a higher case fatality rate (ie, hanging (p<0.001), jumping off high structures (p<0.001) and coming under vehicles (p<0.001) and those who were students (p<0.001) or working in the agricultural sector (p<0.001) were significantly over-reported relative to their occurrence in the broader population. Suicides involving men (p<0.001), those aged over 30 years and above (p<0.001), those who were married and suicides by poisoning (p<0.001) were significantly under-reported relative to their occurrence in the broader population. Conclusions The suicide characteristics in the print media were not entirely representative of suicides in the broader Tamil Nadu population, which may lead the general public to develop misunderstandings about suicide in their state. The discrepancies we identified will inform tailored suicide prevention education for media professionals. © 2019 Author(s).
Keywords: journalism (see medical journalism); mental health

Coding for Write ℓ-step-up Memories - Chee, Y.M.; Kiah, H.M.; Vinck, A.J.H.; Vu, V.K.; Yaakobi, E. (IEEE International Symposium on Information Theory - Proceedings, 2019)
In this work, we propose and study a new class of non-binary rewriting codes, called write ℓ-step-up memories (WℓM) codes. From an information-theoretic point of view, this coding scheme is a generalization of non-binary write-once memories (WOM) codes. From a practical point of view, this coding scheme can be used not only to increase the lifetime of flash memories but also mitigate their over-shooting problem. We first provide an exact formula for the capacity region and the maximum sum-rate of WℓM codes. Lastly, we present several explicit constructions of high-rate WℓM codes with efficient encoding/decoding algorithms. © 2019 IEEE.

An Affirmative Mindfulness Approach for Lesbian, Gay, Bisexual, Transgender, and Queer Youth Mental Health - Iacono, G. (Clinical Social Work Journal, 2019)
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth (ages 14–18), commonly referred as sexual and gender minority youth (SGMY) in the literature, experience elevated mental health risks and vulnerabilities (Almeida et al., J Youth Adolesc 38(7):1001–1014, 2009), including: depression (Martin-Storey and Crosnoe, J Adolesc 35(4):1001–1011, 2012; King et al., BMC Psychiatry 8:70, 2008), substance misuse (Mustanski et al., Am J Public Health 104(2):287–294, 2014), and increased suicidality (Marshal et al., J Adolesc Health 49:115–123, 2011; Marshal et al., J Youth Adolesc 42(8):1243–1256, 2013). Furthermore, there is a notable gap in the study of empirically supported mental health interventions for SGMY (Craig and Austin, Children Youth Serv Rev 64:136–144, 2016). This conceptual paper will explore the feasibility of mindfulness-based interventions as a mental health approach for SGMY. In light of the promising research evidence for mindfulness-based interventions (Tan, Clin Child Psychol Psychiatry 21(2):193–207, 2016), this paper proposes the use of mindfulness to help address mental health vulnerabilities experienced by SGMY. A brief review of the mindfulness-based intervention literature for youth will be provided. Finally, utilizing minority stress theory (Meyer, in Minority stress and mental health in gay men, Columbia University Press, New York, NY, 2003) and an affirmative-based practice conceptualization, adapting mindfulness-based interventions to address mental health issues among SGMY will be explored. Drawing on the author’s clinical and community based experience working with SGMY, this paper will build a case for the systematic investigation of culturally-appropriate affirmative mindfulness-based interventions for SGMY. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Affirmative practice; Clinical interventions; Clinical social work; LGBTQ youth; Mental health; Mindfulness

Why and how to support depsychiatrisation of adult transidentity in ICD-11: A French study - Askevis-Leherpeux, F.; de la Chenelière, M.; Baleige, A.; Chouchane, S.; Martin, M.-J.; Robles-García, R.; Fresán, A.; Quach, A.; Stona, A.-C.; Reed, G.; Roelandt, J.-L. (European Psychiatry, 2019)
Background: For the 11th version of the International Classification of Diseases, the WHO recommended to rename transgender transidentity as “gender incongruence”, to remove it from the chapter of mental and behavioral disorders, and to put it in a new category titled “Conditions related to sexual health”. This should contribute to reduce stigmatisation while maintaining access to medical care. One argument in favor of depsychiatrisation is to demonstrate that essential features of gender identity disorders, namely psychological distress and functional impairment, are not necessarily reported by every transgender person, and may result from social rejection and violence rather than dysphoria itself. Initially confirmed in Mexico, these hypotheses were tested in a specific French medical context, where access to care does not require any prior mental health evaluation or diagnosis. Method: In 2017, 72 transgender persons completed retrospective interviews which focused on the period when they became aware that they might be transgender and perhaps would need to do something about it. Results: Results showed that psychological distress and functional impairment were not reported by every participant, that they may result from rejection and violence, and especially from rejection and violence coming from coworkers and schoolmates. Additional data showed that the use of health services for body transformation did not depend on distress and dysfunction. Finally, participants preferred ICD 11 to employ “transgender” or “transidentity” rather than “gender incongruence”. Conclusion: Results support depsychiatrisation. They are discussed in terms of medical, ethical, legal, and social, added values and implications of depsychiatrisation. © 2019
Keywords: Clinical protocols; Depsychiatrisation; Health policy; Human rights; International Classification of Diseases; Transgender identity

Lessons from a community-based participatory research study with transgender and gender nonconforming youth and their families - Katz-Wise, S.L.; Pullen Sansfaçon, A.; Bogart, L.M.; Rosal, M.C.; Ehrensaft, D.; Goldman, R.E.; Bryn Austin, S. (Action Research, 2019)
Community-based participatory research (CBPR) involves community members collaborating with academic investigators in each step of the research process. CBPR may be especially useful for research involving marginalized populations with unique perspectives and needs. In this paper, we discuss successes and challenges of using a CBPR approach for the Trans Teen and Family Narratives Project, a longitudinal mixed-methods study to examine how the family environment affects the health and well-being of transgender and gender nonconforming youth. We describe considerations for using a CBPR approach with this population, including defining the community of transgender and gender nonconforming youth and families, engaging the community in the research process, managing conflicting agendas for community partner meetings, addressing insider/outsider status of the researchers, resolving researcher/community tensions regarding data collection tools, integrating academic and community members into a cohesive research team, developing safety plans to address participant suicidality disclosures, and differentiating the role of academics as researchers vs. advocates. We conclude by sharing lessons learned, which can inform future research to address the needs of transgender and gender nonconforming youth and families. © The Author(s) 2018.
Keywords: Community-based participatory research (CBPR); family systems; gender nonconforming; transgender health

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

An affirmative coping skills intervention to improve the mental and sexual health of sexual and gender minority youth (Project Youth AFFIRM): Protocol for an implementation study - Craig, S.L.; McInroy, L.B.; Eaton, A.D.; Iacono, G.; Leung, V.W.Y.; Austin, A.; Dobinson, C. (JMIR Research Protocols, 2019)
Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. Objective: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. Methods: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. Results: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. Conclusions: AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact. © Shelley L Craig, Lauren B McInroy, Andrew David Eaton, Gio Iacono, Vivian WY Leung, Ashley Austin, Cheryl Dobinson. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 06.06.2019.
Keywords: Cognitive behavioral therapy; Coping behavior; Implementation science; Pragmatic clinical trial; Sexual and gender minorities; Youth

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

Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative - Ebert, D.D.; Franke, M.; Kählke, F.; Küchler, A.-M.; Bruffaerts, R.; Mortier, P.; Karyotaki, E.; Alonso, J.; Cuijpers, P.; Berking, M.; Auerbach, R.P.; Kessler, R.C.; et al. (International Journal of Methods in Psychiatric Research, 2019)
Background: The majority of university students with mental health problems are untreated. Only a small empirical literature exists on strategies to increase mental health service use. Aims: To investigate the effects and moderators of a brief acceptance-facilitating intervention on intention to use mental health services among university students. Method: Within the German site of the World Health Organization's World Mental Health International College Student (WMH-ICS) initiative, 1,374 university students were randomized to an intervention condition (IC; n = 664) or a control condition (CC; n = 710) that was implemented in the survey itself. Both conditions received the questions assessing mental disorders and suicidality that were included in other WMH-ICS surveys. The IC group then additionally received: Internet-based personalized feedback based on subject symptom severity in the domains of depression, anxiety, substance use, suicidal thoughts and behaviors, and nonsuicidal self-injury; psychoeducation tailored to the personal symptom profile; and information about available university and community mental health services. The primary outcome was reported intention to use psychological interventions in the next semester, which was the last question in the survey. A broad range of potential moderating factors was explored. Results: There was a significant main effect of the intervention with students randomized to IC, reporting significantly higher intentions to seek help in the next semester than students in the CC condition (d = 0.12, 95% CI: 0.02 to 0.23). Moderator analyses indicated that the intervention was more effective among students that fulfilled the criteria for lifetime (d = 0.34; 95% CI: −0.08 to 0.7) and 12-month panic-disorder (d = 0.32; 95% CI: −0.10 to 0.74) compared with those without lifetime (d = 0.11; 95% CI: 0.00 to 0.22) or 12-month panic disorder (d = 0.11; 95% CI: 0.00 to 0.22), students with lower (d = 0.37; 95% CI: −0.77 to 1.51) than higher (d = −0.01; 95% CI: −0.36 to 0.34) self-reported physical health, and students with nonheterosexual (d = 0.38; 95% CI: 0.08 to 0.67) compared with heterosexual (d = 0.06; 95% CI: −0.06 to 0.17) sexual orientation. The intervention had no effects among students who reported that they recognized that they had an emotional problem and “are already working actively to change it” (Stage 4 “stages of change”). Conclusions: A simple acceptance-facilitating intervention can increase intention to use mental health services, although effects, are on average, small. Future studies should investigate more personalized approaches with interventions tailored to barriers and clinical characteristics of students. In order to optimize intervention effects, the development and evaluation should be realized in designs that are powered to allow incremental value of different intervention components and tailoring strategies to be evaluated, such as in multiphase optimization designs. © 2018 John Wiley & Sons, Ltd.
Keywords: health behavior; psychoeducation; public mental health; risk factors

Instances of online suicide, the law and potential solutions - Phillips, J.G.; Diesfeld, K.; Mann, L. (Psychiatry, Psychology and Law, 2019)
To understand the social and legal issues posed by suicide-related communications over the Internet (messages of threatened suicide and advocated suicide), this article examines a selection of cases involving different types of online baiting and harassment that illustrate different legal and technological issues. The anonymity afforded by computer-mediated communication allows bullies to harass vulnerable individuals and leak (disclose) their personal information. Computer mediation of communication potentially diffuses responsibility; imposes a temporal asynchrony between signified intent and audience response; and reduces the empathy that might motivate observers or witnesses to intervene and render assistance, factors that make online baiting a serious social, legal and technological problem. Potential actions (both legal and technological) for addressing this problem are outlined. © 2019, © 2019 The Australian and New Zealand Association of Psychiatry, Psychology and Law.
Keywords: Internet; intervention; legal; suicide; webcam

What's Unique About Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth and Young Adult Suicides? Findings From the National Violent Death Reporting System - Ream, G.L. (Journal of Adolescent Health, 2019)
Purpose: The purpose of the study was to explore variability in circumstances around suicide deaths among youth and young adults by sexual/gender identity category (gay male, lesbian/gay female, bisexual male, bisexual female, transgender male, transgender female, non–LGBT [lesbian, gay, bisexual, and transgender] male, and non-LGBT female). Methods: Secondary analysis of National Violent Death Reporting System (NVDRS) data for all 12- to 29-year-olds who died by suicide in NVDRS participating states. Coverage begins in 2013, the year that NVDRS began coding for sexual orientation and transgender status, and ends in 2015, the latest year of NVDRS data available. The valid sample was limited to cases in which sexual orientation or transgender status could be determined postmortem, n = 2,209. Results: Almost one quarter (24%) of 12- to 14-year-olds who died by suicide were LGBT, whereas only 8% of 25- to 29-year-olds who died by suicide were LGBT. Most non-LGBT males and bisexual males died by firearm and had intimate partner problems contribute to their deaths. Non-LGBT females and LGBT persons other than bisexual males were generally less likely to use firearms. They were also more likely to have psychiatric diagnoses, prior suicidality, and family problems contributing to their deaths. Rates of many circumstances varied widely among LGBT subgroups. Conclusions: The LGBT versus non-LGBT suicide disparity is greatest at younger ages, and each LGBT subgroup has its own specific risk profile for suicide. Suicide prevention and intervention efforts targeted at LGBT youth may increase their effectiveness by attending to these distinct risk profiles. © 2018 Society for Adolescent Health and Medicine
Keywords: Adolescent; LGBT; NVDRS; Suicide; Young adult

Associations of Lesbian, Gay, Bisexual, Transgender, and Questioning–Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students - Proulx, C.N.; Coulter, R.W.S.; Egan, J.E.; Matthews, D.D.; Mair, C. (Journal of Adolescent Health, 2019)
Purpose: Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)–inclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth. Methods: Data analysis of representative data from the 2015 Youth Risk Behavior Survey and the 2014 School Health Profiles was conducted using multilevel logistic models testing whether youth in states with higher proportions of schools teaching LGBTQ-inclusive sex education had lower odds of reporting being bullied in school and experiencing adverse mental health outcomes, including depressive symptoms and suicidality. Results: After controlling for covariates, protective effects for all youth were found for suicidal thoughts (adjusted odds ratio [AOR]:.91, 95% confidence interval [CI]:.89–.93) and making a suicide plan (AOR:.79; 95% CI:.77–.80). Lesbian and gay youth had lower odds of experiencing bullying in school as the proportion of schools within a state teaching LGBTQ-inclusive sex education increased (AOR:.83; CI:.71–.97). Bisexual youth had significantly lower odds of reporting depressive symptoms (AOR:.92; 95% CI:.87–.98). Conclusions: Students in states with a greater proportion of LGBTQ-inclusive sex education have lower odds of experiencing school-based victimization and adverse mental health. These findings can be used to guide intervention development at the school and state levels. © 2018 Society for Adolescent Health and Medicine
Keywords: Bullying; Inclusive sex education; Mental health; School climate; Sexual minority youth

Suicide Risk for Sexual Minorities in Middle and Older Age: Evidence From the National Survey on Drug Use and Health - Capistrant, B.D.; Nakash, O. (American Journal of Geriatric Psychiatry, 2019)
Objective: No studies have estimated the difference in suicidal ideation, plans, and attempts for lesbian, gay, or bisexual (LGB) adults aged 50+ compared with heterosexuals using nationally representative data. Methods: We used 2015–2017 National Survey on Drug Use and Health data to estimate the prevalence of self-reported suicidal ideation, plans, and attempts for LGB adults 50+ compared with heterosexuals in the preceding 12 months. Results: Over 185,000 LGB adults aged 50+ in the United States were estimated to have had suicidal ideation in the preceding year. After adjusting for sex and race/ethnicity, LGB individuals aged 50+ had a 4.5 percentage point higher prevalence of suicidal ideation compared with heterosexuals (prevalence difference [PD]: 0.045; 95% confidence interval [CI]: 0.022, 0.067). Of those with suicidal ideation, LGB individuals aged 50+ had a 17.2 percentage point higher prevalence of suicide plans compared with heterosexuals (PD: 0.172; 95% CI: 0.011, 0.332). Conclusion: LGB adults in middle and older age have higher suicidal ideation and plans than heterosexual peers. © 2018 American Association for Geriatric Psychiatry
Keywords: Aged; middle-aged; sexual and gender minorities; suicidal ideation; suicide

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

Examining the association between prescription opioid misuse and suicidal behaviors among adolescent high school students in the United States - Baiden, P.; Graaf, G.; Zaami, M.; Acolatse, C.K.; Adeku, Y. (Journal of Psychiatric Research, 2019)
Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few studies have examined the effects of prescription opioid misuse on suicidal behaviors among adolescents. The objective of this study was to examine the association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 8830 adolescents aged 14–18 years (50.9% female) were analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and prescription opioid misuse as the main explanatory variable. Of the 8830 adolescents, 13.3% ever misused prescription opioids; 17.7% experienced suicidal ideation, 13.3% made a suicide plan, and 6.5% attempted suicide during the past 12 months. In the multivariate logistic regression models, adolescent students who misused prescription opioids were 1.50 times more likely to have experienced suicidal ideation, 1.44 times more likely to have made a suicide plan, and 1.58 times more likely to have attempted suicide during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant predictors of suicidal behaviors include sexual minority, history of sexual assault, traditional bullying and cyberbullying victimization, feeling sad or hopeless, cigarette smoking, and illicit drug use. The findings of the present study demonstrate the harmful effects of prescription opioid misuse and its association with suicidal behaviors among adolescents. © 2019 Elsevier Ltd
Keywords: Adolescents; Prescription opioid misuse; Suicidal ideation; Suicide attempt; Suicide plan

The Need and Desire for Mental Health and Substance Use-Related Services among Clients of Publicly Funded Sexually Transmitted Infection Clinics in Vancouver, Canada - Salway, T.; Ferlatte, O.; Shoveller, J.; Purdie, A.; Grennan, T.; Tan, D.H.S.; Consolacion, T.; Rich, A.J.; Dove, N.; Samji, H.; Scott, K.; Blackwell, E.; et al. (Journal of Public Health Management and Practice, 2019)
Context: Sexually transmitted infections (STI) and mental health and substance use (MHSU) disorders all occur at elevated rates in sexual and gender minorities. These overlapping epidemics, or syndemics, are exacerbated by challenges these same populations face in accessing sexual/gender minority-affirming services. Many publicly funded STI clinics are a low barrier and provide sexual minority-competent care. These sites therefore may be uniquely situated to address clients' MHSU-related needs. Objective: We characterize the need and desire for MHSU services among STI clinic clients. Design, Setting, Participants: We conducted a waiting room survey at 6 STI clinics in Metro Vancouver, Canada. Main Outcome Measures: We calculated the proportion of clients with self-reported unmet MHSU needs in the previous 12 months and, among these clients, barriers to accessing MHSU services and desire for MHSU services within the STI clinic. We also examined social disparities in barriers to accessing MHSU services. Results: Among 1115 respondents - 65% of whom were sexual minorities - 39% reported a recent need for MHSU-related care, most frequently in relation to anxiety (29%), depression (26%), substance use (10%), or suicide ideation (7%). Seventy-two percent of this group had not yet talked to a provider about their concern. Common barriers included shame (26%) and inability to afford the service (24%). Eighty-three percent of clients with unmet MHSU needs indicated that they were comfortable discussing MHSU concerns with an STI clinic provider, and 94% expressed desire to receive MHSU assessments, referrals, or counseling in the STI clinic. Sexual and gender minorities and those attending a suburban clinic were more likely to report barriers to accessing MHSU services. Conclusions: More than a quarter of STI clinic clients report unmet MHSU health care needs; moreover, these clients report high levels of comfort with and desire to discuss MHSU concerns with STI clinic providers. Sexually transmitted infections clinics are thus opportune sites for syndemic service integration. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: delivery of health care; mental health; sexual and gender minorities; sexually transmitted diseases

Sexual orientation, suicide ideation and suicide attempt: A population-based study - Nystedt, T.; Rosvall, M.; Lindström, M. (Psychiatry Research, 2019)
The aim is to investigate associations between sexual orientation and experience of suicide thoughts and suicide attempts. The 2012 public health survey in Scania, southern Sweden, is a cross-sectional population-based study including 28,029 participants aged 18–80 with 51.7% participation. The associations between sexual orientation and experience of suicide thoughts and attempts were investigated in multiple logistic regressions. A 8.2% proportion of men and 11.3% of women reported suicide thoughts more than a year ago, and 4.0% of men 4.1% of women had experienced such thoughts during the past year. A 2.6% proportion of men and 4.6% of women reported suicide attempt more than a year ago, and 0.6% of men and 0.7% of women during the past year. In the age- and multiple adjusted models, bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide thoughts than heterosexual men and women. Bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide attempt than heterosexual men and women. After multiple adjustments these patterns largely remained. The results indicate that bisexual men and women and homosexual men have an increased risk of experience of suicide thoughts and suicide attempt. © 2019
Keywords: Bisexual; Economic stress; Homosexual; Suicide attempt; Suicide ideation; Suicide thoughts; Sweden

Transgender dependent adolescents in the U.S. military health care system: Demographics, treatments sought, and health care service utilization - Van Donge, N.; Schvey, N.A.; Roberts, T.A.; Klein, D.A. (Military Medicine, 2019)
Introduction: Transgender and gender-diverse (TGD) youth are at greater risk for mental health and medical conditions than their cisgender peers; however, poor health outcomes and identity-based discrimination can be minimized in the context of optimal support. Approximately 1.7 million youth may be eligible for care covered by the Military Health System, which includes mental health and gender-affirming medications. The purpose of the current study is to identify sociodemographic characteristics, the psychosocial and behavioral risk profile, and health care utilization patterns of TGD dependent youth cared for in the U.S. military system to inform provider training and resource allocation. Materials and Methods: We performed a retrospective chart review by searching all medical records between July 1, 2014 and July 1, 2017 for diagnoses suggesting visits for TGD-services at a regional referral-based adolescent medicine clinic which cares for dependent children of active duty, activated selected reserve, and retired military service members between the ages of 9 and 24 years for a wide range of health care needs. Results: Fifty-three participants were included in this study. Sixty-four percent reported a transmasculine identity, 21% a transfeminine identity, and 15% a non-binary or undecided identity. The mean age at first gender-related visit was 14.5 years (SD 3.2). The mean number of primary care physicians and specialists seen by a given individual in a military treatment facility for any visit type since the implementation of the medical record system in 2005 was 12 (SD 6.8) and 10.2 (SD 7.8), respectively. Thirty-three percent of all patients assigned as female at birth were on testosterone therapy and 23% of all patients assigned as male at birth were on estrogen therapy at their most recent clinic visit. Twelve patients were undergoing pubertal suppression with an injectable or implantable gonadotropin-releasing hormone agonist. Seventy percent reported a history of suicidal ideation, 42% self-harm, 21% at least one suicide attempt, and 33% psychiatric hospitalization. Having strongly supportive parents was significantly associated with recognizing, disclosing and seeking treatment for gender nonconformity at an earlier age (ps = 0.03) and marginally associated with less likelihood of current suicidal ideation (p = 0.06) compared to those with less supportive parents. Conclusions: This study elucidated the sociodemographic and behavioral risk profile of a sample of TGD youth in the MHS. Military and non-military health care providers across a broad spectrum of specialties should be knowledgeable about the unique psychosocial and medical needs, requisite sensitivity, and available referral options in the care of TGD youth. Assumptions about one's gender identity, sexual orientation, gender expression, or behaviors cannot be made based on birth-assigned sex. Further research is needed to investigate the health and wellbeing of TGD military-affiliated youth over time and to determine quality transgender-related services in support of this vulnerable and underserved population. © Association of Military Surgeons of the United States 2018.

Preliminary screening results outside the 1945–1965 birth cohort: A forgotten population for hepatitis C? - Winetsky, D.; Zucker, J.; Slowikowski, J.; Scherer, M.; Verna, E.C.; Gordon, P. (Open Forum Infectious Diseases, 2019)
In December 2017, our academic medical center implemented universal hepatitis C virus screening among adult hospitalized patients. We reviewed charts of patients screening positive outside the birth cohort (1945–1965) in the first 6 months after implementation. Documented risk factors were common in younger patients but rare in patients born before 1945. © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Keywords: HCV epidemiology; Hepatitis C infection; Quality improvement; Social vulnerability; Universal screening

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

Penile Reconstruction and the Role of Surgery in Gender Dysphoria - Lee, W.G.; Christopher, N.; Ralph, D.J. (European Urology Focus, 2019)
Gender dysphoria is the distress that occurs when there is a mismatch between birth-assigned gender and expressed gender. Penile reconstruction may ameliorate the risk of suicide due to mental illness, social harassment, and isolation commonly experienced by these individuals. The ideal aim is to allow micturition while standing and penetrative intercourse with full sensation, but there is no universal agreement on the ideal flap design. Contemporary options for penile reconstruction include metoidioplasty and phalloplasty using either a pedicled or free flap. The most common flap currently performed is the radial artery forearm free flap. Secondary procedures following phalloplasty may include glansplasty, scrotoplasty, and insertion of penile and testicular prostheses. Patient summary: Penile reconstruction is offered to transgender men as part of their transition from female to male. Penile reconstruction may ameliorate the high risk of suicide due to mental illness, social harassment, and isolation commonly experienced by these individuals. Many techniques can be used for penile reconstruction with good outcomes, but none can fully satisfy all the needs of individuals seeking penile reconstruction. The risk of suicide and mental illness from gender dysphoria is ameliorated by penile reconstruction. The goals are to allow micturition while standing and penetrative intercourse with full sensation. There is no gold standard for penile reconstruction. © 2019 European Association of Urology
Keywords: gender dysphoria; Penile reconstruction; phalloplasty

A heuristic inquiry on the role of person-environment interaction in suicide risk among transgender youth - Chang, B.; Delaney, K. (Journal of Child and Adolescent Psychiatric Nursing, 2019)
Elevated levels of suicide risk among transgender youth have alarmed both public health officials and researchers from various disciplines. Despite nursing's robust involvement in suicide research, literature reviews indicate a lack of nursing research focused on suicide among transgender youth. Most of the existing literature pertain to predictive factors in either the individual or environmental domain. There is limited research examining how interactions with the environment in of itself might be a predictive factor. This paper treats the subject of suicide risk among transgender youth with a heuristic inquiry into person–environment interaction. The Society to Cell Resiliency Framework and Social Self Preservation Model were used to inform exploration of how person–environment interactions might be associated with suicide risk. Implications of this framework will be discussed in terms of how it may affect advancements in nursing education, practice, and research with transgender youth. © 2019 Wiley Periodicals, Inc
Keywords: minority stress; nursing; person–environment interaction; social evaluative threat; suicide risk; transgender health

Validation of the innowell platform: Protocol for a clinical trial - Davenport, T.A.; LaMonica, H.M.; Whittle, L.; English, A.; Iorfino, F.; Cross, S.; Clinical, M.; Hickie, I.B. (JMIR Research Protocols, 2019)
Background: New electronic health technologies are being rapidly developed to improve the delivery of mental health care for both health professionals and consumers and better support self-management of care. We developed a Web-based platform (the InnoWell Platform) that supports the prevention, early intervention, treatment, and continuous monitoring of mental health and maintenance of well-being in people aged 2 years and older. The platform is a customizable digital tool kit that operates through existing service providers who utilize the system to provide their consumers with access to evidence-based assessments and feedback, intervention options, and outcome monitoring. It does this by collecting, storing, and reporting personal and health information back to consumers and their health professionals to promote collaborative care partnerships that aim to improve the management of mental ill health and maintenance of well-being Objective: The aim of this study was to describe the research protocol for a naturalistic prospective clinical trial wherein all consumers presenting for care to a traditional face-to-face or Web-based mental health service in which the InnoWell Platform is being offered as part of standard clinical care will be given the opportunity to use the platform. Methods: The Web-based platform is a configurable and customizable digital tool that assists in the assessment, monitoring and management of mental ill health, and maintenance of well-being. It does this by collecting, storing, and reporting health information back to the person and his or her clinician to enable transformation to person-centered care. The clinical trial will be conducted with individuals aged 2 years and older presenting to participating services for care, including persons from the veteran community, Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, the lesbian, gay, bisexual, transgender, and intersex community, and those from broader education and workforce sectors, as well as people with disabilities, lived experience of comorbidity, complex disorders, and suicidality. Results: Project Synergy was funded in June 2017, and data collection began in November 2018 at a youth mental health service. At the time of this publication, 5 additional services have also begun recruitment, including 4 youth mental health services and a veteran's service. The first results are expected to be submitted in 2020 for publication. Conclusions: This clinical trial will promote access to comprehensive, high-quality mental health care to improve outcomes for consumers and health professionals. The data collected will be used to validate a clinical staging algorithm designed to match consumers with the right level of care and reduce the rate of suicidal thoughts and/or behaviors and suicide by suggesting pathways to care that are appropriate for the identified level of need, while simultaneously enabling a timely service response. © Tracey A Davenport, Haley M LaMonica, Lisa Whittle, Amelia English, Frank Iorfino, Shane Cross, Ian B Hickie.
Keywords: Clinical trial protocol; Medical informatics; Mental health; Suicide

Autoerotic asphyxia using a plastic bag loosely covering the head over a gas mask - Idota, N.; Nakamura, M.; Tsuboi, H.; Ichioka, H.; Shintani-Ishida, K.; Ikegaya, H. (Legal Medicine, 2019)
Autoerotic death is defined as the accidental death of an individual while masturbating, caused by a device or material used to enhance the sexual response. Here we report an autopsy case of autoerotic death and review the literature. A healthy, single, 33-year-old Japanese male was found dead in his room in a prone position. He was wearing a used gas mask and a plastic bag over his head; the opening of that bag was loosely secured around the neck with a belt. He had no underwear beneath his upper and lower work clothes and the zipper of his pants was open. Adult magazines and DVDs featuring male subjects and other adult toys were found in his room. Images of people wearing gas masks and rubber suits, as well as of individuals whose whole bodies were tied with ropes, were discovered on his personal computer. Records of purchasing full-body tights were also found. Lesions and injuries that could have caused his death were not found in the autopsy or in any of the various examinations. The cause of death was determined to be suffocation assumed to be caused by the plastic bag covering the mask's ventilation. Suicide and homicide were ruled out based on the police investigation of the scene of the victim's death and the attendant circumstances and environment. The death was thus determined to be an accident. We see no major differences in the feature of autoerotic death between Japanese cases and those in the Western countries. © 2019 Elsevier B.V.
Keywords: Autoerotic asphyxia; Gas mask; Plastic bag; Suffocation

A Vector Threshold Model for the Simultaneous Spread of Correlated Influence - Zhuang, Y.; Yagan, O. (IEEE International Conference on Communications, 2019)
Spread of influence is one of the most widely studied propagation processes in the literature on complex networks. Examples include the rise of collective action to join a riot and diffusion of beliefs, norms, and cultural fads, to name a few. Most existing works on modeling influence propagation consider a single content (e.g., an opinion, decision, product, political view, etc.) spreading over a network independent from everything else. However, most real-life examples involve multiple correlated contents spreading simultaneously and exhibiting positive (e.g., opinions on same-sex marriage and gun control) or negative (e.g., opinions on universal health care and tax-relief for the "rich") correlation. To accommodate these cases, this paper proposes the vector threshold model, as an extension of the widely used Watts threshold model for complex contagions. Here, the state of a node is represented by a binary vector representing their opinion on a number of content items. Nodes switch their states based on the influence they receive from their neighbors in the network. The influence is represented by a vector containing the proportion of neighbors who support each content; both positively and negatively correlated contents can be captured in this formulation by using different rules for switching node states. Our main result is concerned with the expected size of global cascades, i.e., cases where a randomly chosen node can initiate a propagation that eventually reaches a positive fraction of the whole population. We also derive conditions on network structure for global cascades to be possible. Analytic results are supported by a numerical study. © 2019 IEEE.

Exploring Anabolic-Androgenic Steroid Use and Teen Dating Violence Among Adolescent Males - Ganson, K.T.; Cadet, T.J. (Substance Use and Misuse, 2019)
Background: Reports indicate that 4% of the adolescent males in 2015 had taken steroids without a doctor’s prescription. Anabolic-androgenic steroids (AAS) are illicit drugs that have commonly been used to help build muscle mass. AAS use is associated with negative biological, psychological, and social side effects including substance use, suicidal behavior, and violent behavior. Objectives: This exploratory study, guided by an integrated theoretical framework that included the General Aggression Model and the Biopsychosocial Model, examined the relationship between adolescent male AAS use and teen dating violence. Methods: This cross-sectional, secondary data analysis was conducted using the 2013 and 2015 Massachusetts Youth Health Survey (MYHS). Participants were high school-aged males with a total sample of 2,080. Primary data analysis was conducted using hierarchical logistic regression. Results: Findings suggested that adolescent males who used steroids at least once in their lifetime, compared to those who did not, had greater odds of engaging in teen dating violence. Further, males who identified as a sexual minority had greater odds of using anabolic-androgenic steroids, as were those who had at least one suicide attempt in the previous 12 months. Conclusions: Adolescent male AAS use is associated with multiple psychosocial factors that practitioners, school personnel, and parents must be aware of. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: adolescent males; Anabolic-androgenic steroids; steroid use; suicidal behavior; teen dating violence

Is Young Adulthood a Critical Period for Suicidal Behavior among Sexual Minorities? Results from a US National Sample - Fish, J.N.; Rice, C.E.; Lanza, S.T.; Russell, S.T. (Prevention Science, 2019)
The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalences and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experienced anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider age range for sexual minority women (until age 30) relative to sexual minority men (until age 25). © 2018, Society for Prevention Research.
Keywords: LGB; Lifespan; Sexual minority; Suicidal behavior; Suicidality; Time-varying effect modeling; Young adulthood

A Preliminary Examination of the Association between Adolescent Gender Nonconformity and Suicidal Thoughts and Behaviors - Spivey, L.A.; Prinstein, M.J. (Journal of Abnormal Child Psychology, 2019)
Suicidal thoughts and behaviors are a significant health concern for adolescents. Extant research suggests that sexual and gender minority adolescents are a vulnerable population at elevated risk for suicidal thoughts and behaviors, yet to date few studies have examined the unique associations between adolescent gender nonconformity and suicide risk. This study examined data from the Youth Risk Behavior Surveillance Survey (n = 7730) to estimate the association between gender nonconformity and high school-aged adolescents’ likelihood of endorsing four distinct suicide outcomes: suicidal ideation, suicide plans, any suicide attempts, and single vs. multiple suicide attempts. Multivariate logistic regression analyses were utilized to control for other known risk factors for suicidal thoughts and behaviors, including age, sex, sexual minority status, depression symptoms, and suicidal ideation. Results revealed that gender nonconformity was significantly associated with higher odds of reporting suicidal ideation, suicide plans, and multiple suicide attempts in the past year above and beyond other known risk factors. Gender nonconformity is an understudied vulnerability factor that should be taken into consideration by researchers and clinicians seeking to understand adolescents’ risk for suicidal thoughts and behaviors. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Adolescence; Gender nonconformity; Suicidal thoughts and behaviors; Suicide

Association between risky sexual behavior and a psychosocial syndemic among Nigerian men who have sex with men - Oginni, O.A.; Mapayi, B.M.; Afolabi, O.T.; Ebuenyi, I.D.; Akinsulore, A.; Mosaku, K.S. (Journal of Gay and Lesbian Mental Health, 2019)
Background: The HIV epidemic among men who have sex with men (MSM) is reinforced by a psychosocial syndemic, but this has not been investigated in sub-Saharan Africa. This study investigated the psychosocial syndemic and its relationship with risky sexual behavior among Nigeria MSM. Methods: Eighty-one MSM and 81 heterosexual men were compared for risky sexual behavior and psychosocial adversity variables—childhood adversity, intimate partner violence, depressive symptoms, suicidal ideation, substance use, and a derived psychosocial syndemic score. The association between syndemic scores and risky sexual behavior was examined among MSM. Results: MSM had significantly higher rates of individual psychosocial adversities except substance use. There were significant interrelationships between the variables, and syndemic scores were associated with higher-risk sexual behavior. Conclusion: This is the first study to investigate the psychosocial syndemic and its relationship with HIV risk among African MSM. The findings highlight the role of psychosocial adversities in exacerbating the HIV epidemic among MSM in developing countries. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: MSM; Nigeria; psychosocial adversity; risky sexual behavior; syndemic