Bringing sexy back: Reclaiming the body aesthetic via self-shooting - Tiidenberg, K. (Cyberpsychology, 2014)
This paper is based on visual narrative analysis of cyber-ethnographic material from a 2.5 year field-research with 'not safe for work' [NSFW] bloggers and self-shooters on tumblr.com. I use Koskela's concept of 'empowering exhibitionism', Waskul's 'erotic looking glass', and Foucault's 'technologies of the self' to analyze self-shooting (taking photos of one-self). Constricting societal norms of sexuality, body shape and body practices influence how my participants (N=20, 10 female, 9 male, 1 transgender, ages 21 - 51, average age 34) live their embodied and sexual lives. Through self-shooting and by negotiating the community specific issues of control, power and the gaze, they are able to construct a new, empowered, embodied identity for themselves. I look at self-shooting and selfie-blogging as a practice of reclaiming control over one's embodied self AND over the body-aesthetic, thus appropriating what is and is not 'sexy'. The NSFW self-shooting community offers a safe space otherwise so hard to find within the body/sexuality-normative mainstream culture. This makes self-shooting a collective therapeutic activity. In their self-images participants construct themselves as 'beautiful', 'sexy', 'devious', 'more than just a mother and an employee' and as someone who 'likes their body instead of trying to not hate it'. The technologies of the self activated through diaristic blogging and selfie sharing, along with the empowerment from interactions with peers take bloggers on a path of sexual awakening and reintroduce them to their own bodies. © 2008 Cyberpsychology: Journal of Psychosocial Research on Cyberspace.
Keywords: Body; Self-identity; Selfies; Sexuality; Visual narrative analysis

Childhood abuse and depressive vulnerability in clients with gender dysphoria - Firth, M.T. (Counselling and Psychotherapy Research, 2014)
Background: Childhood abuse in the early lives of gender variant people has been under-reported, although higher psychiatric morbidity, particularly depression and suicidality, than in the general population is more widely recognised. There are increasing numbers of people seeking advice and treatment for gender dysphoria (GD) some of whose experiences of depression and childhood abuse may be additional treatment considerations. Aim: To illuminate the issues relating to childhood abuse, depression and GD via case examples underpinned by a summary review of the relevant literature, for their combined relevance to therapeutic practice and service provision. Methods: A review of relevant online literature was conducted and two case examples were developed subsequently to capture the core review themes from a practice perspective. Results: Nine studies met the inclusion criteria. Gender variant children and adolescents may experience abuse by peers and teachers, as well as parents and caregivers. Emotional abuse and neglect may have more adverse consequences than more active forms of abuse. Conclusions: This is an under-researched area, and inconsistencies of design, definition, measurement and controls were evident in the literature. While no clear association between depressive vulnerability and childhood abuse could be found, prevalence of such abuse was high. A case is made for clients with GD to have the opportunity to explore the influence and meaning of their adverse childhood experiences on their social and psychological development, and for additional training and education for practitioners. © 2013, British Association for Counselling and Psychotherapy.
Keywords: childhood abuse; depression; gender dysphoria; mental health

Mental Health Implications in Mormon Women's Experiences With Same-Sex Attraction: A Qualitative Study - Jacobsen, J.; Wright, R. (The Counseling Psychologist, 2014)
Given research suggesting that individuals in conservative religions experience conflict between religious beliefs and feelings of same-sex sexuality, this study explores the mental health impact of Mormon women who experience same-sex sexuality. Twenty-three Mormon women participated in semi-structured individual interviews about their experiences with same-sex sexuality. Interview questions asked about participants’ experiences with same-sex sexuality and the LDS Church (The Church of Jesus Christ of Latter-day Saints), how this experience affected their mental health, and what types of mental health treatment they engaged in during their process of reconciliation. Data were analyzed following phenomenological methodology. Themes included the following: experiences with mood disorders, self-worth, suicidality, treatment attempts, reparative therapy, counselor's agenda, impact of family and community, and mental health recovery. When treating women who experience conflict, counselors should assess self-worth, suicidality, and the level of community and familial support. Referral to group counseling can support self-acceptance of same-sex sexuality through normalization. Future research should examine specific practice interventions and explore impacts of other intersecting identities. © 2014, SAGE Publications. All rights reserved.
Keywords: dimensions of diversity; LGBT; psychotherapy; qualitative methodology; religion/spirituality

Attachment-based family therapy interventions - Diamond, G.M. (Psychotherapy, 2014)
Attachment-Based Family Therapy is a treatment model designed specifically for depressed and suicidal adolescents. The primary goal of the treatment is to promote developmentally appropriate adolescent- parent attachment. Three core interventions are discussed: relational reframes; focusing on primary emotions and unmet attachment needs; and facilitating corrective attachment episodes. For each intervention, the theoretical/clinical rationale is presented followed by a brief illustration and relevant research findings. © 2013 American Psychological Association.
Keywords: Attachment; Depression; Family therapy; Suicide

Metapopulation dynamics and the evolution of sperm parasitism - Parvinen, K. (Mathematical Modelling of Natural Phenomena, 2014)
Amazon molly (Poecilia formosa) females reproduce asexually, but they need sperm to initiate the process. Such gynogenetic reproduction can be called sperm parasitism since the DNA in the sperm is not used. Since all offspring of asexually reproducing females are females, they can locally outcompete sexually reproducing ones, but their persistence is threatened by the lack of males. Therefore, the existence of Amazon mollies is puzzling. A metapopulation structure has been suggested to enable the coexistence of gynogenetic and sexual species. Previ- ously only Levins-type metapopulation models have been used to investigate this question, but they are not defined on the individual level. Therefore we investigate the evolution of sperm parasitism in a structured metapopulation model, which incorporates both realistic local popu- lation dynamics and individual-level dispersal. If the reproduction strategy is freely evolving in a large well-mixed population or in the structured metapopulation model, strong discrimination of asexually reproducing females by males results in evolution to full sexuality, whereas mild discrimination leads to too small probability of sexual reproduction, so that the lack of males causes the extinction of the evolving population, resulting in evolutionary suicide. This classifi- cation remains the same also when both sexual reproduction and dispersal are freely evolving. Sexual and asexual behaviour can be observed at the same time in this model in the presence of a trade-off between the reproduction and dispersal traits. However, we do not observe disrup- tive selection resulting in the evolutionarily stable coexistence of fully sexual and fully asexual females. Instead, the presence of sexual and asexual behaviour is due to females with a mixed reproduction trait. © EDP Sciences, 2014.
Keywords: Adaptive dynamics; Cooperation; Metapopulation

'What harbour shelters peace?' on the opera Peter Grimes, exclusion and stigma - Conlan, L. (Advances in Psychiatric Treatment, 2014)
Benjamin Britten's opera Peter Grimes premiered in 1945 and has since enjoyed lasting popular and critical acclaim. Its central character is a fisherman driven to suicide by circumstances beyond his control. It has a wide political and social resonance and is a testament to the damaging psychological effects of exclusion and stigma.

Recent self-harmand psychological measures in the emergency department - Randall, J.R.; Rowe, B.H.; Dong, K.A.; Colman, I. (PeerJ, 2014)
The assessment of self-harm risk is a common, difficult, and perplexing task for many physicians, especially those working in emergency departments (ED). Attempts have been made to determine objective methods for assessing patients with suicidal ideation or self-harm though there is still a lack of knowledge about objective assessments of these patients. A study was conducted where 181 suicidal patients were enrolled in two EDs within the city of Edmonton, Canada. Initial interviews were conducted in the ED which collected basic demographics and medical history as well as psychometric measures including the Beck Hopelessness Scale, Barratt Impulsiveness Scale, Brief Symptom Inventory, Drug Abuse Screening Test 10, and CAGE questionnaire. The results of these measures were compared between those who presented to the ED with self-harmand those who presented only with ideation. Those with recent self-harm scored lower on many of the scales and subscales of distress and impulsivity measured compared to those with no recent self-harm. Possible explanations for this difference include differences in psychological traits between the two groups and possible cathartic effects of self-harm. The lower scores obtained by those that present with self-harm may complicate attempts to use psychometric tools to determine future self-harmrisk. © 2014 Randall et al.
Keywords: Emergency medicine; Psychiatry; Risk assessment; Self-injurious behaviors

Exit strategy (for my grandmother, Margaret Gingrich) - Gingrich-Philbrook, C. (Cultural Studies - Critical Methodologies, 2014)
This autoethnographic essay, based upon the author's performance of the same name, details a nexus of political and personal events that fostered suicidal ideation in the face of religious homophobia, as well as how an artifact of his late grandmother's helped him move past that ideation. It uses the phrase "exit strategy" in multiple ways to reveal the limits of thinking that resistance to oppression can ever rest. © 2013 SAGE Publications.
Keywords: autoethnography; diabolical mimicry; queer performance

Acting strange after trying to 'get numb' - Puri, M.; Hall, E.G.; Erisman, M.; Vwich, Y. (Current Psychiatry, 2014)

Minority stress factors for same-sex attracted mormon adults - Grigoriou, J.A. (Psychology of Sexual Orientation and Gender Diversity, 2014)
In recent years, the institutionalized discrimination of religious individuals with same-sex attraction has been at the forefront of much debate; especially within the Church of Jesus Christ of Latter Day Saints (LDS). Research has turned out myriad studies on the effects of conservative religious attitudes on same-sex attracted (SSA) individuals, linking negative societal responses to poorer mental health outcomes and suicide (North Star, n.d.). Under the framework of minority stress theory, the current study presents an empirically validated rationale outlining the impact that (a) SSA identity, (b) Mormon identity, (c) perceptions of stigmatization in the LDS society (i.e., stigma consciousness), and (d) difficulty in speaking with Mormon social supports about sexual orientation (i.e., social constraints) had on an adult sample of SSA Mormons (n = 142). This study contributes new information linking social constraints, Mormon identity, and SSA identity to symptoms of anxiety and depression. Results show that the social constraint variable was the best predictor for symptoms of anxiety and depression. SSA and Mormon identity were linked to fewer symptoms of anxiety and depression compared with those who could not choose which aspect of their identity was most salient. SSA identity was also moderately and positively associated with perceptions of stigmatization. Contrary to expectations, stigma consciousness was not found to be predictive of mental health outcomes for this sample of SSA Mormon adults. © 2014 American Psychological Association.
Keywords: Minority stress; Mormon identity; Same-sex attraction; Social constraints; Stigma consciousness

Genetic variations within metalloproteinases impact on the prophylaxis of depressive phases in bipolar patients - Drago, A.; Monti, B.; De Ronchi, D.; Serretti, A. (Neuropsychobiology, 2014)
Background: The genetic background of the antidepressant response to pharmacological treatment in bipolar disorder (BD) remains elusive. This issue is of primary relevance in that the depressive phases of BD are difficult to treat and they are associated with suicide. Aim: We investigated the role of a set of genetic variations (single-nucleotide polymorphisms) harbored by matrix metalloproteinases (MMPs) as predictors of response to treatment in depressed BD patients. Methods: 654 BD patients from the publicly available Systematic Treatment Enhancement Program for Bipolar Disorder study were investigated. The outcome was the number of depressive events corrected by the number of times patients were assessed. Clinical and sociodemographic variables were tested as possible stratification factors and included in the analysis if necessary. Genetic predictors were 43 SNPs harbored by 17 MMPs. Imputation, quality check and pruning were conducted according to standards. Results were corrected for multitesting. Results: rs486055 (MMP-10) was associated with the outcome. TT homozygotes had 5.08 ± 3.51 events, CT had 3.47 ± 3.18 and CC had 2.57 ± 2.96 depressive events corrected for the times they had been assessed. The time during which BD patients were observed was not significantly different between the rs486055 genotypes. We found evidence that MMP-10 may be a mediator of the number of depressive phases during BD. Due to the limits of the study including the small-to-medium sample size, the naturalistic design and the possible occurrence of false-positive findings, independent analyses are warranted. © 2014 S. Karger AG, Basel.
Keywords: Bipolar disorder; Gene; Metalloproteinases; Single-nucleotide polymorphism

The Intersectionality of Discrimination Attributes and Bullying Among Youth: An Applied Latent Class Analysis - Garnett, B.R.; Masyn, K.E.; Austin, S.B.; Miller, M.; Williams, D.R.; Viswanath, K. (Journal of Youth and Adolescence, 2014)
Discrimination is commonly experienced among adolescents. However, little is known about the intersection of multiple attributes of discrimination and bullying. We used a latent class analysis (LCA) to illustrate the intersections of discrimination attributes and bullying, and to assess the associations of LCA membership to depressive symptoms, deliberate self harm and suicidal ideation among a sample of ethnically diverse adolescents. The data come from the 2006 Boston Youth Survey where students were asked whether they had experienced discrimination based on four attributes: race/ethnicity, immigration status, perceived sexual orientation and weight. They were also asked whether they had been bullied or assaulted for these attributes. A total of 965 (78 %) students contributed to the LCA analytic sample (45 % Non-Hispanic Black, 29 % Hispanic, 58 % Female). The LCA revealed that a 4-class solution had adequate relative and absolute fit. The 4-classes were characterized as: low discrimination (51 %); racial discrimination (33 %); sexual orientation discrimination (7 %); racial and weight discrimination with high bullying (intersectional class) (7 %). In multivariate models, compared to the low discrimination class, individuals in the sexual orientation discrimination class and the intersectional class had higher odds of engaging in deliberate self-harm. Students in the intersectional class also had higher odds of suicidal ideation. All three discrimination latent classes had significantly higher depressive symptoms compared to the low discrimination class. Multiple attributes of discrimination and bullying co-occur among adolescents. Research should consider the co-occurrence of bullying and discrimination. © 2013 Springer Science+Business Media New York.
Keywords: Attribution; Bullying; Discrimination; Intersectionality; Latent class analysis

A psychocultural comparison of male street prostitutes in Dublin and San Francisco - Mc Cabe, I.; Mills, R.; Murphy, D.; Winders, S.-J.; Hayden, J.; Reynolds, D.; Mc Cabe, J.; McQuaid, A. (Irish Journal of Psychology, 2014)
The present study examined and compared the profiles, demographics and mental health characteristics of male street prostitutes (MSPs) in Dublin, Ireland and San Francisco, USA. A total of twenty-three participants were recruited using a non-random direct approach and a snowball sampling technique. Participants took part in a semi-structured interview. Analysis revealed that, in both cities, the principal predisposing factor for entry into male street-based prostitution was drug addiction, with childhood abuse and early school leaving also reported to act as contributing factors. Several differences were observed, particularly in relation to family circumstances, sexual orientation, access to support and experience of violence. Participants also completed the Beck Depression Inventory, Beck Scale for Suicidal Ideation, Drug Assessment Screening Test, CAGE questionnaire and Coopersmith Self-Esteem Inventory. Results showed statistically significant higher levels of depression amongst the Dublin MSPs compared to those in San Francisco. There were no statistically significant differences in self-esteem, suicidal ideation, or alcohol or other drug dependencies. Similarities and differences between MSPs in Dublin and San Francisco are discussed with reference to the relevant literature. © 2014 Psychological Society of Ireland.
Keywords: abuse; drug dependency; male street prostitution; sex work; sexual orientation

Prevalence, Correlates, And changes in tobacco use between 2006 and 2010 among 13-15 year moroccan school attending adolescents - Shaikh, M.A. (Journal of the Pakistan Medical Association, 2014)
Tobacco use is a preventable cause of disease and death globally. Adolescents using tobacco tend to continue its use in adulthood. Analysis of data from Moroccan Global School-based Student Health Surveys for 2006 and 2010 showed statistically significant differences in prevalence of current cigarette smoking as well as current use of other tobacco products, among school attending 13-15 year old boys and girls within the year 2006 and 2010; with boys having higher prevalence than girls in each year. Combined prevalence of cigarette smoking i.e. between both boys and girls showed statistically significant difference between 2006 and 2010; with a higher prevalence in 2010. Use of tobacco in multivariate analysis of 2010 data, was found to have statistically significant associations with anxiety disorders, gender, truancy, depression, suicidal ideation, inadequate parental monitoring, and parental smoking. © 2014, J Pak Med Assoc. All rights reserved.
Keywords: Adolescents; Morocco; Tobacco Use

"On the internet, nobody knows you're a dog": A twitter case study of anonymity in social networks - Peddinti, S.T.; Ross, K.W.; Cappos, J. (COSN 2014 - Proceedings of the 2014 ACM Conference on Online Social Networks, 2014)
Twitter does not impose a Real-Name policy for usernames, giving users the freedom to choose how they want to be identified. This results in some users being Identifiable (disclosing their full name) and some being Anonymous (disclosing neither their first nor last name). In this work we perform a large-scale analysis of Twitter to study the prevalence and behavior of Anonymous and Identifiable users. We employ Amazon Mechanical Turk (AMT) to classify Twitter users as Highly Identifiable, Identifiable, Partially Anonymous, and Anonymous. We find that a significant fraction of accounts are Anonymous or Partially Anonymous, demonstrating the importance of Anonymity in Twitter. We then select several broad topic categories that are widely considered sensitive-including pornography, escort services, sexual orientation, religious and racial hatred, online drugs, and guns-and find that there is a correlation between content sensitivity and a user's choice to be anonymous. Finally, we find that Anonymous users are generally less inhibited to be active participants, as they tweet more, lurk less, follow more accounts, and are more willing to expose their activity to the general public. To our knowledge, this is the first paper to conduct a large-scale data-driven analysis of user anonymity in online social networks. Copyright © 2014 ACM.
Keywords: Anonymity; Behavioral analysis; Online social networks; Quantify; Twitter

Normative legitimacy: Rules of appropriateness in citizens' assessments of individual judicial decisions - Braman, E.; Easter, B. (Justice System Journal, 2014)
This study investigates the interaction between rules of appropriateness, popular support for judicial decisions, and policy preferences in assessments of the legitimacy of court decisions. We conduct two 3 × 2 × 2 experiments examining participants' perceptions of legitimacy in cases involving the tort liability of gun manufacturers (Experiment 1) and same-sex marriage (Experiment 2). By manipulating the explanation for the judge's decision (bribe, political contribution, ideology, and law), we examine how participants assess the legitimacy of motivations suggesting compliance with, and deviations from, rules of appropriate judicial behavior in relation to one another. We also analyze how such rules interact with other factors theorized to influence assessments of legitimacy. Our findings demonstrate that rules of appropriateness matter most in participants' assessments of the legitimacy of court decisions. Moreover, as hypothesized, the influence of other variables is conditioned on compliance with decision-making rules. In Experiment 1, broad public support for decisions enhances legitimacy assessments, but only where the grounds of decision are not viewed as wholly inappropriate. In Experiment 2, involving the salient issue of same-sex marriage, personal preferences influence legitimacy assessments, but again, not where participants view grounds for decision as particularly suspect. © National Center for State Courts.
Keywords: Judicial decision-making; Legitimacy; Public opinion; Rules of appropriateness

Psychiatrists' views of the genetic bases of mental disorders and behavioral traits and their use of genetic tests - Klitzman, R.; Abbate, K.J.; Chung, W.K.; Marder, K.; Ottman, R.; Taber, K.J.; Leu, C.-S.; Appelbaum, P.S. (Journal of Nervous and Mental Disease, 2014)
We examined how 372 psychiatrists view genetic aspects of mental disorders and behaviors and use genetic tests (GTs). Most thought that the genetic contribution was moderate/high for bipolar disorder, schizophrenia, depression, Alzheimer's, intelligence, creativity, anxiety, and suicidality. In the past 6 months, 14.1% ordered GTs, 18.3% discussed prenatal testing with patients, 36.0% initiated discussions about other GTs, 41.6% had patients ask about GTs, and 5.3% excluded GT results from patient records. Many thought that GTs; were available for schizophrenia (24.3%) and major depression (19.6%). Women were more likely to report that patients asked about GTs; and were less certain about the degree of genetic contribution to several disorders. Psychiatrists perceive strong genetic bases for numerous disorders and traits, and many have discussed and ordered tests for GTs, but have relatively limited knowledge about available tests. These data suggest possible sex differences in psychiatrists' beliefs about genetic contributions to disorders and have implications for future research, education, policy, and care. Copyright © 2014 by Lippincott Williams & Wilkins.
Keywords: decision making; epigenetics; etiology; genetic testing; Genomics

The political safeguards of horizontal federalism - Gerken, H.K.; Holtzblatt, A. (Michigan Law Review, 2014)
For decades, we have debated whether “political safeguards” preserve healthy relations between the states and the federal government and thus reduce or eliminate the need for judges to referee state–federal tussles. No one has made such an argument about relations among the states, however, and the few scholars to have considered the question insist that such safeguards don’t exist. This Article takes the opposite view and lays down the intellectual foundations for the political safeguards of horizontal federalism. If you want to know what unites the burgeoning work on horizontal federalism and illuminates the hidden logic of its doctrine, you need know only one fact: lawyers hate spillovers. Whether it is a state’s decision to license same-sex marriage or set high emissions standards or maintain lax gun-ownership rules, we worry when one state’s regulations affect residents in another state. And just as most scholars aspire to prevent spillovers, most look to the courts to fix the problem. The current state of the law and literature makes clear why no one has thought to develop a safeguards account of horizontal federalism to match the one that dominates debates over vertical federalism. Why bother with political safeguards if politics is the problem and the judiciary is the solution? In this Article, we don’t just question the consensus against spillovers but offer an affirmative account as to why much interstate conflict can or should be left to the free play of politics. Our argument emphasizes the democratic possibilities associated with spillovers and looks to vertical federalism as a model for thinking about how the states ought to interact with each other. Spillovers, after all, occur just as routinely between the state and federal government as they do between the states. State–federal friction, however, is understood to be both a problem and a valuable part of a well-functioning democracy. The same should be true of horizontal federalism. Our goal should not be to suppress friction but to harness it—to shut down damaging spillovers while allowing productive ones to run their course. © 2014 Michigan Law Review. All Rights Reserved.

Voluntary and therapeutic castration of sex offenders in the netherlands (1938-1968) - Van der Meer, T. (International Journal of Law and Psychiatry, 2014)
Between 1938 and 1968 some 400 sex offenders in the Netherlands who by court orders had been put at 'the discretion of the government' and were incarcerated in asylums for the criminally insane, 'voluntarily' submitted themselves to 'therapeutic' castration, the surgical removal of their testes. Prior to 1938, inspired by a Danish castration act from 1929, and urged by asylums that were overcrowded by sex offenders, the ethics of the surgery had been discussed for nearly a decade amongst theologians, (forensic) psychiatrists, jurists and politicians, mostly in the context of eugenic sterilization. Discussions of conflicting Catholic, Protestant and non-denominational points of view vis-à-vis eugenics resulted in consensus about 'therapeutic' and 'voluntary' castration. Sexual deviancy, according to some, was like a tumor located in the testes, which could therefore be removed without moral objections and the person was thus cured of his disease. Although obviously related to forensic psychiatry and concerned with issues like protection of society and treatment of offenders, discussions were never held in a strictly forensic context. Unlike in other countries in which castration policies were enforced, in The Netherlands the surgery was never embodied in law but subject to an informal protocol that covered political accountability. To satisfy Catholic objections references to eugenic aims were omitted from the documents, as were references to castration as a penalty.Based on international and Dutch literature (from both before and after 1938) as well as case histories, this article will show that the compromise about the therapeutic value of castration had no basis in medical knowledge, while 'voluntariness' (as elsewhere) was an acknowledged fallacy once surgeries had started. It was also acknowledged that castration did not really cure deviancy, but curbed libido and helped the castrate to suppress his urges. Nonetheless, because of the eugenic origins of discussions, associated with persistent confusion about the difference between castration and sterilization, it never became fully clear whether the surgery was meant to curb libido or to prevent the offenders from begetting inferior progeny. © 2013 Elsevier Ltd.
Keywords: Castration; Eugenics; Forensics; Sex crime

Correction to Attachment-Based Family Therapy for Suicidal Lesbian, Gay, and Bisexual Adolescents: A Treatment Development Study and Open Trial With Preliminary Findings [Psychotherapy, 49, 1, 62-71] DOI: 10.1037/a0026247 (Psychotherapy, 2013)

Risk behaviors, suicidal ideation and suicide attempts in a nationally representative French sample - Husky, M.M.; Guignard, R.; Beck, F.; Michel, G. (Journal of Affective Disorders, 2013)
Background Data from large nationally representative samples are needed to provide the empirical foundation to inform health policies for the prevention of suicide risk and risk behaviors in men and women. Methods Data were extracted from the 2010 Health Barometer, a large telephone survey on a representative sample of the general population aged 15-85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview (CATI) system was used. Results Overall, 3.9% of respondents aged 15 to 85 reported past year suicidal ideation, and 0.5% reported a suicide attempt in that time period. Increased rates of risky sexual behavior are associated with ideation and attempt in both men and women, after controlling for sociodemographic variables. Homosexuality or bisexuality are associated with suicidal ideation for both men and women, but not with attempts. Substance misuse, physical and sexual assaults are strongly associated with suicidal symptoms for both men and women. Early first experiences with sex, tobacco, and alcohol are associated with suicidal symptoms though somewhat differentially for men and women. Limitations Cross-sectional survey. Conclusion The findings underscore associations between suicidal thoughts and behaviors and risk behaviors such as unprotected sex and substance use in men and women throughout the lifespan. These associations highlight the need for preventive strategies such as screening for risk behaviors in order to identify men and women particularly at risk for suicidal behavior. © 2013 Elsevier B.V.
Keywords: Risk behaviors; Suicidal ideation; Suicide attempts

Gender identity disorder is not simply two in one - Syed Masroor, A.; Abdul Ghani, K. (International Medical Journal Malaysia, 2013)
A Case Report on Gender Identity Disorder with Recurrent Depressive Disorder is presented. Individuals having this disorder often exhibit discomfort about their actual anatomic gender, and they may have wished to alter their bodies. Sex role-stereotypes adopted during childhood are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by one's family and friends, the mass-media, and their community. Since some cultures disapprove of cross-gender behavior, it often results in significant problems for affected individuals and those in close relationships with them. The importance of treatment is not only because of the high rate of mental-health problems, including Depression but with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates Gender Identity Disorder is the case of a young man from Brunei Darussalam, who was seen and treated. This contribution will highlight the cultural and religious perspective of this Disorder.
Keywords: Culture; Depression; Gender identity; Religion; Sexuality

Barriers to well-being for Aboriginal gender-diverse people: Results from the Trans PULSE Project in Ontario, Canada - Scheim, A.I.; Jackson, R.; James, L.; Sharp Dopler, T.; Pyne, J.; Bauer, G.R. (Ethnicity and Inequalities in Health and Social Care, 2013)
Purpose – Despite health inequities experienced by Aboriginal and transgender (trans) communities, little research has explored the well-being of Aboriginal trans (gender-diverse) people. This paper aims to describe barriers to well-being in a sample of Aboriginal gender-diverse people in Ontario, Canada. Design/methodology/approach – In 2009-2010, 433 trans people in Canada's most populous province participated in a multi-mode health survey. In all, 32 participants identified as First Nations, Métis, or Inuit (Aboriginal); unweighted frequencies were calculated to describe their characteristics. Findings – Participants expressed diverse gender identities; 44 per cent identified with the pan-Aboriginal term two-spirit. High levels of poverty (47 per cent), homelessness or underhousing (34 per cent), and ever having to move due to being trans (67 per cent) were reported. In all, 61 per cent reported at least one past-year unmet health care need. Most participants had experienced violence due to being trans (73 per cent) and had ever seriously considered suicide (76 per cent). One-fifth had been incarcerated while presenting in their felt gender. Aboriginal spirituality was practiced by 44 per cent, and 19 per cent had seen an Aboriginal Elder for mental health support. Research limitations/implications – Action is needed to address the social determinants of health among Aboriginal gender-diverse people. Using principles of self-determination, there is a need to increase access to health and community supports, including integration of traditional culture and healing practices. Larger study samples and qualitative research are required. Originality/value – These first published data regarding the health of Aboriginal gender-diverse Ontarians illustrate both their heterogeneity and all-too-common experiences of individual and systemic discrimination, and barriers to care. Results highlight potential impacts of colonialism and social exclusion, and suggest priorities for ameliorative action. © 2013, Emerald Group Publishing Limited
Keywords: Aboriginal; Ethnicity; Health; Transgender; Transsexual; Two-spirit

Does "it get better" for depressed sexual minority youth in young adulthood? - Cardom, R.; Rostosky, S.; Danner, F. (Journal of Adolescent Health, 2013)
Purpose To examine depressive symptoms and suicidality in adolescence and adulthood in a sample of depressed adolescents in five sexual identity groups (heterosexual, mostly heterosexual, bisexual, mostly gay, and gay). Methods Depressed adolescents (N = 1,591) from the National Longitudinal Study of Adolescent Health were examined again in young adulthood. Results Paired t-tests revealed that depressive symptoms declined significantly in all five sexual identity groups. McNemar chi-square tests revealed that the percentage of participants reporting suicidal ideation decreased significantly in all groups except for the mostly gay group. The percentage of participants reporting suicide attempts declined in all groups except the bisexual group. Conclusions Within-group differences are important to consider in delivering effective mental health services. Although depressive symptoms diminished in young adulthood in all groups, suicidality did not. Mostly gay and bisexual young adults did not report the same significant declines as their peers. © 2013 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: Bisexual; Depression; Gay; Homosexuality; Lesbian; Sexual minority; Suicide

Care of the college student - Unwin, B.K.; Goodie, J.; Reamy, B.V.; Quinlan, J. (American Family Physician, 2013)
There are approximately 20 million students in U.S. colleges and universities. Although this population is characterized as having good health, 600,000 students report some form of disability or some type of medical problem, including attention-defcit/hyperactivity disorder, learning disabilities, psychiatric disorders, and chronic illnesses, among others. Physicians can enhance youth transition to an adult model of health care; the use of self-care skills checklists is one recommended method to assist with the transition. Stimulant medications are effective for treating adults with attention-defcit/hyperactivity disorder, but physicians should use caution when prescribing stimulants to college students because of the high rates of medication diversion in this population. Depression, anxiety, posttraumatic stress disorder, sleep problems, and eating disorders are common in college students and can signifcantly impact performance. Emphasis on immunization of students for infuenza, meningococcus, and pertussis is necessary because of the low rates of compliance. Screening and interventions for obesity, tobacco use, and substance abuse are important because of the high prevalence of these problems in college students. Screening for alcohol abuse facilitates identifca-tion of students with problem drinking behaviors. Students who are war veterans should be monitored for suicidal ideation and posttraumatic stress disorder. Lesbian, gay, bisexual, transgender, and questioning students are at risk of harassment and discrimination. Caution should be exercised when prescribing medications to college athletes to avoid violation of National Collegiate Athletic Association eligibility rules. © 2013 American Academy of Family Physicians.

Putting stigma in context: Do perceptions of group stigma interact with personally experienced discrimination to predict mental health? - McGarrity, L.A.; Huebner, D.M.; McKinnon, R.K. (Group Processes and Intergroup Relations, 2013)
Research has linked experiences of personal discrimination with negative mental health consequences, but less is known about the role of group stigma (perceived stigma against one's group as a whole). The theoretical literature has offered mixed predictions. The present study examined the independent and interactive effects of group stigma and personal discrimination on depressive symptoms and suicidal ideation in a sample of gay and bisexual men (N = 986). Experiences of personal discrimination predicted depressive symptoms and suicidal ideation regardless of group stigma. However, group stigma was associated with depressive symptoms contextually-only when level of perceived personal discrimination was low. Personal discrimination may be a relatively more powerful force in the lives of stigmatized group members that overwhelms the influence of group stigma in harming mental health. © The Author(s) 2013.
Keywords: felt stigma; gay; group discrimination; mental health; personal discrimination

Cyberbullying and the innocence narrative - Gilden, A. (Harvard Civil Rights-Civil Liberties Law Review, 2013)
This Article critically examines recent debates about the bullying and harassment of gay teens. A string of suicides in the fall of 2010 yielded a wide range of legal reforms at both the state and federal levels. The accompanying debates, however, have largely employed one-dimensional accounts of the difficulties faced by gay teens, excluding more nuanced, complex, and empowered accounts of teenage sexuality. Although many gay teens are certainly vulnerable to bullying and harassment, these entrenched narratives of innocence and vulnerability have been used to justify both strong protectionism - e.g., through questionable hate crimes prosecutions - and ubiquitous paternalism - e.g., through "antibullying" monitoring and reporting - while obscuring the sexual agency of gay teens. This Article will (1) track the persistent use of a gay teen innocence narrative in several legal and cultural contexts; (2) explore how recent antibullying efforts reify such innocence at the potential expense of gay teens' social and sexual agency; and (3) situate this filtering of gay teens' experiences within the broader context of the LGBT rights movement.

Compulsive sexual behavior and psychopathology among treatment-seeking men in São Paulo, Brazil - Scanavino, M.D.T.; Ventuneac, A.; Abdo, C.H.N.; Tavares, H.; Amaral, M.L.S.D.; Messina, B.; Reis, S.C.D.; Martins, J.P.L.B.; Parsons, J.T. (Psychiatry Research, 2013)
This study examined compulsive sexual behavior (CSB) and psychopathology in a treatment-seeking sample of men in São Paulo, Brazil. Eighty-six men (26% gay, 17% bisexual, 57% heterosexual) who met diagnostic criteria for excessive sexual drive and sexual addiction completed assessments consisting of the Mini International Neuropsychiatric Interview, a structured clinical interview for DSM-IV Axis I Disorders-Clinical Version (segment for Impulse Control Disorder), Sexual Compulsivity Scale (SCS), and questions about problematic CSB. The average SCS score for our sample was above the cut-off score reported in other studies, and 72% of the sample presented at least one Axis I psychiatric diagnosis. There were no differences among gay, bisexual, and heterosexual men on SCS scores and psychiatric conditions, but gay and bisexual men were more likely than heterosexual men to report casual sex and sex with multiple casual partners as problematic behaviors. SCS scores were associated with psychiatric co-morbidities, mood disorder, and suicide risk, but diagnosis of a mood disorder predicted higher SCS scores in a regression analysis. The study provides important data on the mental health needs of men with CSB in São Paulo, Brazil. © 2013 Elsevier Ireland Ltd.
Keywords: Hypersexual disorder; Hypersexuality; Mental disorders; Psychiatric disorder; Sexual addiction; Sexual behavior; Sexual compulsivity

Conditions of Living: Queer Youth Suicide, Homonormative Tolerance, and Relative Misery - Cover, R. (Journal of LGBT Youth, 2013)
Despite the increasing social tolerance accorded nonheterosexual persons in many Western countries, queer youth suicide rates remain high. This opens the need to question not only how broad social conditions continue to make lives unlivable for many queer youth but whether queer community formations and representations that emerge within a tolerance framework provide supportive environments for fostering youth resilience. This article presents a theoretical approach to understanding the continuity of youth suicide by considering how queer community formations built on tolerance create new exclusions for some queer youth that can make a life unlivable in relation to peers. The article articulates the tolerance framework through a return to Dennis Altman's 40-year-old Homosexual Oppression and Liberation and the more recent "homonormativity" critique of queer politics. It examines how tolerance and homonormativity are implicated in exclusions and suicidality through the "relative misery" suicide thesis and the concept of frustrated aspiration. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: Community; gay liberation; GLBT youth; homonormativity; suicide; tolerance

Comparing Trans-Spectrum and Same-sex-Attracted Youth in Australia: Increased Risks, Increased Activisms - Jones, T.; Hillier, L. (Journal of LGBT Youth, 2013)
Tran-spectrum youth include those who are gender questioning, transgender, intersex, genderqueer, and androgynous. Drawing on data from an Australian study of more than 3,000 same-sex-attracted and trans-spectrum youth aged 14 to 21, this article compares a group of 91 trans-spectrum youth from the study to "cisgender" same-sex-attracted peers (who feel their gender identity aligns more fully with their ascribed sex). Comparisons are made on topics including identity disclosure and support; experience of abuse; suicide and self-harm; and school experiences. The trans-spectrum respondents particularly reported experiencing homophobic abuse and suicide attempts in response to homophobia and cissexism significantly more often than their cisgender counterparts. However, an exciting finding of the study was that some of these youth were able to reframe social rejection of their identities using a variety of self-affirming strategies. They were also more likely to respond to discrimination through activism, and many held high hopes for the ways in which they might impact their worlds in the future. The article finally reflects on the special provisions needed for this group in areas such as youth services and education, and the need for individuals to be supportive of trans-spectrum youth who disclose their identities to them. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: Abuse; activism; Australia; gender; gender identity; intersex; queer; resilience; suicide; transgender; youth

Health consequences of racist and antigay discrimination for multiple minority adolescents - Thoma, B.C.; Huebner, D.M. (Cultural Diversity and Ethnic Minority Psychology, 2013)
Individuals who belong to a marginalized group and who perceive discrimination based on that groupmembership suffer from a variety of poor health outcomes. Many people belong to more than onemarginalized group, and much less is known about the influence of multiple forms of discrimination onhealth outcomes. Drawing on literature describing the influence of multiple stressors, three models ofcombined forms of discrimination are discussed: additive, prominence, and exacerbation. The currentstudy examined the influence of multiple forms of discrimination in a sample of African Americanlesbian, gay, or bisexual (LGB) adolescents ages 14-19. Each of the three models of combined stressorswere tested to determine which best describes how racist and antigay discrimination combine to predictdepressive symptoms, suicidal ideation, and substance use. Participants were included in this analysis ifthey identified their ethnicity as either African American (n = 156) or African American mixed (n =120). Mean age was 17.45 years (SD = 1.36). Results revealed both forms of mistreatment wereassociated with depressive symptoms and suicidal ideation among African American LGB adolescents. Racism was more strongly associated with substance use. Future intervention efforts should be targetedtoward reducing discrimination and improving the social context of multiple minority adolescents, andfuture research with multiple minority individuals should be attuned to the multiple forms of discriminationexperienced by these individuals within their environments. © 2013 American Psychological Association.
Keywords: Adolescents; African american; Bisexual (LGB); Discrimination; Gay; Lesbian; Mental health

Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care - Blosnich, J.R.; Brown, G.R.; Shipherd, J.C.; Kauth, M.; Piegari, R.I.; Bossarte, R.M. (American Journal of Public Health, 2013)
Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk. Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.

Practice parameter for cultural competence in child and adolescent psychiatric practice - Pumariega, A.J.; Rothe, E.; Mian, A.; Carlisle, L.; Toppelberg, C.; Harris, T.; Gogineni, R.R.; Webb, S.; Smith, J. (Journal of the American Academy of Child and Adolescent Psychiatry, 2013)
The United States faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural. In consequence, cultural and racial factors relating to mental illness and emotional disturbances deserve closer attention and consideration. This Practice Parameter outlines clinical applications of the principle of cultural competence that will enable child and adolescent mental health clinicians to better serve diverse children, adolescents, and their families. © 2013 American Academy of Child and Adolescent Psychiatry.
Keywords: culture ethnicity race cultural competence acculturation

Partner violence and health among HIV-infected jail detainees - Meyer, J.P.; Wickersham, J.A.; Fu, J.J.; Brown, S.-E.; Sullivan, T.P.; Springer, S.A.; Altice, F.L. (International Journal of Prisoner Health, 2013)
Purpose - Little is known about the association of intimate partner violence (IPV) with specific HIV-treatment outcomes, especially among criminal justice (CJ) populations who are disproportionately affected by IPV, HIV, mental, and substance use disorders (SUDs) and are at high risk of poor post-release continuity of care. Design/methodology/approach - Mixed methods were used to describe the prevalence, severity, and correlates of lifetime IPV exposure among HIV-infected jail detainees enrolled in a novel jail-release demonstration project in Connecticut. Additionally, the effect of IPV on HIV treatment outcomes and longitudinal healthcare utilization was examined. Findings - Structured baseline surveys defined 49 percent of 84 participants as having significant IPV exposure, which was associated with female gender, longer duration since HIV diagnosis, suicidal ideation, having higher alcohol use severity, having experienced other forms of childhood and adulthood abuse, and homo/bisexual orientation. IPV was not directly correlated with HIV healthcare utilization or treatment outcomes. In-depth qualitative interviews with 20 surveyed participants, however, confirmed that IPV was associated with disengagement from HIV care especially in the context of overlapping vulnerabilities, including transitioning from CJ to community settings, having untreated mental disorders, and actively using drugs or alcohol at the time of incarceration. Originality/value - Post-release interventions for HIV-infected CJ populations should minimally integrate HIV secondary prevention with violence reduction and treatment for SUDs. Copyright © 2013 Emerald Group Publishing Limited. All rights reserved.
Keywords: Criminal justice system; HIV; Intimate partner violence; Pre-trial detention; Substance abuse; Women's health

The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men - Wang, J.; Häusermann, M.; Berrut, S.; Weiss, M.G. (Journal of Affective Disorders, 2013)
Background High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland. Methods In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time-space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011. Results 43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from -18% to -28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression. Limitations Community-level assessment with no control. Conclusions Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking. © 2013 Elsevier B.V.
Keywords: Depression; Homosexuality; Intervention; Mental health literacy; Suicidality

Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation - Craig, S.L.; Austin, A.; Alessi, E. (Clinical Social Work Journal, 2013)
Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY. © 2012 Springer Science+Business Media New York.
Keywords: Clinical case study; Cognitive behavioural therapy; Gay affirmative therapy; Intervention; Sexual minority youth

The relationship of cumulative stressors, chronic illness and abuse to the self-reported suicide risk of black and hispanic sexual minority youth - Craig, S.L.; Mcinroy, L. (Journal of Community Psychology, 2013)
Sexual minority youth [SMY] are a population who experience considerable stress related to their sexual identities. Previous investigations have identified individual risk factors that contribute to suicide among SMY, yet little research has focused on cumulative stressors that may exacerbate negative outcomes for multiethnic sexual minority youth [MSMY]. This study used hierarchical logistic regression to explore the relationship between cumulative risks and their relationship to self-reported suicide risk for MSMY. The community-based clinical sample (n = 137) reported high co-occurrence of risks, with an average of 9. Overall, MSMY with a higher number of cumulative risk factors were twice as likely to express self-reported suicide risk. Specifically, experiencing chronic illness and physical or sexual abuse resulted in threefold higher odds of self-reported suicide risk among MSMY. These findings address a gap in the literature about the relationship of cumulative and specific stressors to the self-reported suicide risk for an understudied, vulnerable population. © 2013 Wiley Periodicals, Inc.

Interpersonal psychotherapy with transgender clients - Budge, S.L. (Psychotherapy, 2013)
Interpersonal therapy (IPT) is a particularly useful approach to use when working with clients who identify as transgender or gender nonconforming. All transgender individuals will experience changes and adjustment throughout their identity process, often referred to as transitioning. IPT offers specific interventions for psychotherapists to use with clients whose presenting concerns are specifically related to transitions. The current article outlines a case example of a transgender man who is experiencing difficulty with "role transitions" and offers four transgender-specific clinical intervention strategies derived within the traditional IPT framework. © 2013 American Psychological Association.
Keywords: Interpersonal; Intervention; IPT; Transgender; Transition

State politics: Guns, gays, drugs and taxes in Colorado (Economist (United Kingdom), 2013)

Trajectories of Depressive Symptoms and Suicidality Among Heterosexual and Sexual Minority Youth - Marshal, M.P.; Dermody, S.S.; Cheong, J.; Burton, C.M.; Friedman, M.S.; Aranda, F.; Hughes, T.L. (Journal of Youth and Adolescence, 2013)
Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53 % female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs. © 2013 Springer Science+Business Media New York.
Keywords: Depressive symptoms; Latent growth curve modeling; Lesbian, gay, and bisexual youth; Sexual minority youth; Sexual orientation; Suicidality; Trajectories

Sexual obsessions in pediatric obsessive-compulsive disorder: Clinical characteristics and treatment outcomes - Fernández De La Cruz, L.; Barrow, F.; Bolhuis, K.; Krebs, G.; Volz, C.; Nakatani, E.; Heyman, I.; Mataix-Cols, D. (Depression and Anxiety, 2013)
Background Sexual obsessions are common in adults with obsessive-compulsive disorder (OCD), cause great distress, and are sometimes misinterpreted as indicating risk to others. Little is known about the prevalence, clinical correlates, and prognosis of such symptoms in young people. Methods Three hundred and eighty-three patients referred to a specialist pediatric OCD clinic were administered a series of measures at intake and, for those treated at the clinic, again after treatment. Patients with and without sexual obsessions were compared on socio-demographic and clinical characteristics. Mixed model analyses of variance compared treatment outcomes in both groups. Results A quarter of patients had sexual obsessions at baseline (age range 8-17); they had slightly more severe OCD symptoms and were more depressed than those without sexual obsessions. Aggressive and religious obsessions, magical thinking, fear of saying certain things, repeating rituals, superstitious games, mental rituals, and the need to tell, ask, or confess were more frequent in participants with sexual obsessions. Crucially, no differences in treatment outcome were found between the groups. Conclusions Sexual obsessions are common in pediatric OCD, even in very young children. Although they may be associated with particular clinical features, they do not interfere with treatment response. The occurrence of sexual obsessions in children should be recognized and these symptoms understood as ordinary, nonthreatening OCD symptoms, which pose no risk to others. They respond to the standard treatment strategies, so children and families should receive the usual message of optimism regarding the chances of recovery. © 2013 Wiley Periodicals, Inc.
Keywords: adolescents; children; obsessive-compulsive disorder; risk; sexual obsessions

Bullying among adolescents: A challenge in primary care - Klein, D.A.; Myhre, K.K.; Ahren, D.M. (American Family Physician, 2013)

Race, class, and values in post-New Deal presidential politics: Inverted class loyalties as a trend in presidential elections, 2000-2012 - Sheppard, S. (New Political Science, 2013)
This article analyzes the role of race, class, and values as a determinant of voting behavior in recent presidential elections. Over the past decade the What's the Matter with Kansas? thesis has been cited to argue that the culture wars over social issues (civil rights, homosexual rights, feminism, gun control) have inverted the class determinant of partisan choice to the point where lower-income white voters favor the Republican Party while professionals have shifted toward the Democratic Party. The article concludes that there is significant evidence that the class loyalties as determinants of partisan identity established by the New Deal have been superseded by values-driven imperatives, which are themselves trumped by racial identities. As a result, traditionally Democratic prematerialist white blue-collar constituencies have moved toward the Republican Party, while the opposite has occurred in traditionally Republican post-materialist suburban constituencies. © 2013 Caucus for a New Political Science.

It Gets Better: Queer Futures, Critical Frustrations, and Radical Potentials - Goltz, D.B. (Critical Studies in Media Communication, 2013)
In 2010, responding to several widely reported Lesbian, Gay, Bisexual, Transgendered, and/or Queer (LGBTQ) youth suicides, the It Gets Better project was developed to offer hope and outreach to alienated queer youths in crisis through personalized YouTube messages. Queer critiques of the project and its founder, Dan Savage, were quick to challenge the privileged and homonormative investments from the outset of the campaign, rejecting the campaign as passive, impractical, homogenizing, and exclusionary. This paper argues that the queer critiques launched at It Gets Better work to both strengthen and obscure the radical queer potentials of the campaign. Read as a project of queering future, It Gets Better enacts a mediated form of generativity, while continually expanding the possible significations for the symbol of "better," in order to queer sedimented logics that cast LGBTQ persons as without future. Rejecting critical tragedy in favor of a model of critical frustration, this paper works with and through queer criticisms of It Gets Better to embrace and extend the multivocal and contradictory potentials of the project. © 2013 Copyright National Communication Association.
Keywords: Critical Tragedy; Future; Gay; Generativity; Queer; Suicide

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth - Levine, D.A. (Pediatrics, 2013)
The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004.This technical report reflects the rapidly expanding medical and psychosocial literature about sexual minority youth. Pediatricians should be aware that some youth in their care may have concerns or questions about their sexual orientation or that of siblings, friends, parents, relatives, or others and should provide factual, current, nonjudgmental information in a confidential manner. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to increased mental health issues for sexual minority youth. LGBTQ and MSM/WSW (men having sex with men and women having sex with women) adolescents, in comparison with heterosexual adolescents, have higher rates of depression and suicidal ideation, higher rates of substance abuse, and more risky sexual behaviors. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. This includes having supportive, engaging office staff members who ensure that there are no barriers to care. For transgender youth, pediatricians should provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender. Referral of transgender youth to a qualified mental health professional is critical to assist with the dysphoria, to educate them, and to assess their readiness for transition. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood. Pediatrics 2013;132:e297-e313. Copyright © 2013 by the American Academy of Pediatrics.
Keywords: Adolescents; Bisexual; Gay; Homosexuality; Lesbian; Sexual behaviors; Sexual identity; Sexual minority; Sexual orientation; Transgender

Sexuality and suicidality: Matched-pairs analyses reveal unique characteristics in non-heterosexual suicidal behaviors - Harris, K.M. (Archives of Sexual Behavior, 2013)
The present findings offer new perspectives on differences between suicide-risk heterosexuals and non-heterosexuals (lesbian, gay, bisexual, and questioning: LGBQ). Results from an anonymous online survey, employing standardized scales, showed that LGBQ participants reported significantly greater suicide-risk than heterosexuals. Seventy-nine matched pairs of suicide-risk LGBQ and heterosexuals were examined by individual suicide risk factors. Results showed no significant differences on separate measures of suicidal ideation; however, LGBQ participants were more likely to report suicide attempts, disclosure of suicidal intentions, and prediction of future suicide attempts. The LGBQ group also indicated greater likelihood of going online to develop new personal relationships. Multiple regression modeling was conducted to guide outreach and support efforts, revealing unique factors predicting help-seeking denial of suicide-risk LGBQ. Implications include the importance of online support and considering sexual minorities not just as a potential high-risk group, but also as a population with unique suicide risks and behaviors. © 2013 Springer Science+Business Media New York.
Keywords: Gay; Internet; Sexual orientation; Social support; Suicide

Differential Reports of Suicidal Ideation and Attempts of Questioning Adults Compared to Heterosexual, Lesbian, Gay, and Bisexual Individuals - Woodward, E.N.; Pantalone, D.W.; Bradford, J. (Journal of Gay and Lesbian Mental Health, 2013)
Many sexual minority individuals attempt suicide each year, but little is known about the suicidality of individuals who are questioning their sexual orientation. This study assessed suicidal ideation and attempts of questioning individuals compared with lesbian/gay, bisexual, and heterosexual individuals. This cross-sectional study enrolled participants (N = 2,841) from a community health center. Questioning (OR = 4.286, 95% CI [2.119-8.671]), lesbian/gay (OR = 3.024, 95% CI [2.351-3.890]), and bisexual (OR = 4.389, 95% CI [2.942-6.575]) individuals had significantly greater odds of considering suicide compared to heterosexuals. However, questioning individuals had non-significant odds of attempting suicide compared to heterosexuals. We discuss possible explanations for these findings. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: LGB; questioning; sexual minority individuals; suicidal ideation; suicide attempts

Office-based care for lesbian gay bisexual transgender and questioning youth (Pediatrics, 2013)
The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/ HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood. Pediatrics 2013;132:198-203. Copyright © 2013 by the American Academy of Pediatrics.
Keywords: Adolescents; Bisexual; Gay; Homosexuality; Lesbian; Sexual behaviors; Sexual identity; Sexual minority; Sexual orientation; Transgender

Schooling, Sexual Orientation, Law, and Policy: Making Schools Safe for All Students - Patterson, C.J. (Theory into Practice, 2013)
Sexual minority youth are in the news as never before, and they are the topic of many public controversies. Research suggests that lesbian, gay, bisexual, and transgender (LGBT) youth are often exposed to school environments that are hostile to them. As one might expect in these circumstances, sexual minority youth report feeling depressed, isolated, and even suicidal more often than do their peers. Laws and policies designed to make schools safer for sexual minority youth, greater inclusion of LGBT-related material in the curriculum, and establishment of Gay-Straight Alliances (GSAs) have all been proposed as ways to make schools safer for sexual minority students. The limited research evidence available now shows that the social climate for LGBT youth is more positive at schools with GSAs, but much remains to be learned. Overall, making schools safer for LGBT youth will require cooperation among school officials, teachers, parents, and others. © 2013 Copyright Taylor and Francis Group, LLC.

An Intake Template for Transgender, Transsexual, Genderqueer, Gender Nonconforming, and Gender Variant College Students Seeking Mental Health Services - Donatone, B.; Rachlin, K. (Journal of College Student Psychotherapy, 2013)
As more students identify as transgender and genderqueer, it is essential that staff at college counseling centers are knowledgeable about gender diversity. This article provides a template for intake and initial assessment with transgender, transsexual, genderqueer, and gender nonconforming students. It familiarizes clinicians with gender-affirming language and offers a list of questions to ask. Topics covered include: gender history, coming out, self-injury, suicide, sexual orientation, binding, transition trajectories, options for gender expression, issues with diagnosis and recordkeeping, and interdisciplinary approaches to treatment. The intake is an opportunity to provide comfort and support for students of all genders. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: college counseling; gender identity; gender variant; genderqueer; intake; transgender

Suicide risk and sexual orientation: A critical review - Plöderl, M.; Wagenmakers, E.-J.; Tremblay, P.; Ramsay, R.; Kralovec, K.; Fartacek, C.; Fartacek, R. (Archives of Sexual Behavior, 2013)
Many studies have reported higher rates of suicide attempts among sexual minority individuals compared with their heterosexual counterparts. For suicides, however, it has been argued that there is no sexual orientation risk difference, based on the results of psychological autopsy studies. The purpose of this article was to clarify the reasons for the seemingly discrepant findings for suicide attempts and suicides. First, we reviewed studies that investigated if the increased suicide attempt risk of sexual minorities resulted from biased self-reports or less rigorous assessments of suicide attempts. Second, we reanalyzed the only two available case-control autopsy studies and challenge their original "no difference" conclusion by pointing out problems with the interpretation of significance tests and by applying Bayesian statistics and meta-analytical procedures. Third, we reviewed register based and clinical studies on the association of suicides and sexual orientation. We conclude that studies of both suicide attempts and suicides do, in fact, point to an increased suicide risk among sexual minorities, thus solving the discrepancy. We also discuss methodological challenges inherent in research on sexual minorities and potential ethical issues. The arguments in this article are necessary to judge the weight of the evidence and how the evidence might be translated into practice. © 2013 Springer Science+Business Media New York.
Keywords: Bayesian statistics; Homosexuality; Sexual minority; Sexual orientation; Suicide

Suicide protective factors among trans adults - Moody, C.; Smith, N.G. (Archives of Sexual Behavior, 2013)
A recent study indicated a suicide attempt rate of 41 % among trans (e.g., trans, transgender, transexual/transsexual, genderqueer, two-spirit) individuals. Although this rate is alarming, there is a dearth of literature regarding suicide prevention for trans individuals. A vital step in developing suicide prevention models is the identification of protective factors. It was hypothesized that social support from friends, social support from family, optimism, reasons for living, and suicide resilience, which are known to protect cis (non-trans) individuals, also protect trans individuals. A sample of self-identified trans Canadian adults (N = 133) was recruited from LGBT and trans LISTSERVs. Data were collected online using a secure survey platform. A three block hierarchical multiple regression model was used to predict suicidal behavior from protective factors. Social support from friends, social support from family, and optimism significantly and negatively predicted 33 % of variance in participants' suicidal behavior after controlling for age. Reasons for living and suicide resilience accounted for an additional 19 % of the variance in participants' suicidal behavior after controlling for age, social support from friends, social support from family, and optimism. Of the factors mentioned above, perceived social support from family, one of three suicide resilience factors (emotional stability), and one of six reasons for living (child-related concerns) significantly and negatively predicted participants' suicidal behavior. Overall, these findings can be used to inform the practices of mental health workers, medical doctors, and suicide prevention workers working with trans clients. © 2013 The Author(s).
Keywords: Protective factors; Suicide; Trans; Transgender; Transsexual

Sociodemographic Factors Contribute to Mental Health Disparities and Access to Services Among Young Men Who Have Sex with Men in New York City - Storholm, E.D.; Siconolfi, D.E.; Halkitis, P.N.; Moeller, R.W.; Eddy, J.A.; Bare, M.G. (Journal of Gay and Lesbian Mental Health, 2013)
Young men who have sex with men (YMSM) may be at increased risk for mental health problems including depression, post-traumatic stress disorder (PTSD), and suicidality. The overriding goal of the current investigation was to examine mental health and mental health services in a diverse sample of YMSM. We analyzed cross-sectional data from a cohort study of 598 YMSM, including sociodemographics, mental health, and mental health care. We then tested for bivariate associations and used multivariable modeling to predict depression, PTSD, suicidality, and mental health care utilization. Lower socioeconomic status, unstable housing, and school nonenrollment predicted depression and PTSD scores, while unstable housing and school nonenrollment predicted recent suicide attempt(s). These recent suicide attempt(s) also predicted current utilization of counseling or treatment, any history of psychiatric hospitalization, and any history of psychiatric diagnosis. Black and Asian/Pacific Islander (API) men were less likely to have ever accessed mental health counseling or treatment. There were significant class-based differences with regard to mental health outcomes but not mental health services. Further, recent crises (i.e., suicide attempt, hospitalization) were strong predictors of accessing mental health services. Improving the mental health of YMSM requires addressing the underlying structural factors that influence mental health outcomes and service access. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: depression; mental health; post-traumatic stress disorder; sociodemographics; suicide; YMSM

The Mediating Roles of Stress and Maladaptive Behaviors on Self-Harm and Suicide Attempts Among Runaway and Homeless Youth - Moskowitz, A.; Stein, J.A.; Lightfoot, M. (Journal of Youth and Adolescence, 2013)
Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and psychosocial background characteristics and self-injurious outcomes through the lens of the stress process paradigm. The model was tested in a sample of runaway and homeless youth from Los Angeles County (N = 474, age 12-24, 41 % female, 17 % White, 32.5 % African American, 21.5 % Hispanic/Latino). Background variables (gender, age, sexual minority status, parental drug use history, and emotional distress) predicted hypothesized mediators of maladaptive behaviors and recent stress. In turn, it was hypothesized that the mediators would predict self-harming behaviors and suicide attempts in the last 3 months. Females and LGBT (lesbian, gay, bisexual, transgender) youth were more likely to have self-harmed and attempted suicide; younger participants reported more self-harming. The mediating constructs were associated more highly with self-harming than suicide attempts bivariately, although differences were modest. Maladaptive behaviors and recent stress were significant predictors of self-harm, whereas only recent stress was a significant predictor of suicide attempts. All background factors were significant predictors of recent stress. Older age, a history of parental drug use, and greater emotional distress predicted problem drug use. Males, younger participants, and participants with emotional distress reported more delinquent behaviors. Significant indirect effects on self-harming behaviors were mediated through stress and maladaptive behaviors. The hypothesized paradigm was useful in explaining the associations among background factors and self-injurious outcomes and the influence of mediating factors on these associations. © 2012 Springer Science+Business Media, LLC.
Keywords: Runaway/homeless youth; Self-injurious behavior; Stress; Suicide attempts

Bullying and quality of life in youths perceived as gay, lesbian, or bisexual in Washington state, 2010 - Patrick, D.L.; Bell, J.F.; Huang, J.Y.; Lazarakis, N.C.; Edwards, T.C. (American Journal of Public Health, 2013)
Objectives. We examined the association between perceived sexual orientation (PSO), bullying, and quality of life (QOL) among US adolescents. Methods. We analyzed data from the 2010 Washington State Healthy Youth Survey collected in public school grades 8, 10, and 12 (n = 27 752). Bullying status was characterized as never bullied, bullied because of PSO, or bullied for other reasons. Survey-weighted regression examined differences in QOL, depressed mood, and consideration of suicide by bullying status. Results. Among male students, 14%, 11%, and 9% reported being bullied because of PSO in 8th, 10th, and 12th grades, respectively; and among female students, 11%, 10%, and 6%. In all gender and grade strata, being bullied because of PSO was associated with lower QOL scores and increased the odds of depressed mood or consideration of suicide. Moreover, the magnitudes of these associations were greater than for being bullied for other reasons. Conclusions. Bullying because of PSO is widely prevalent and significantly affects several facets of youth QOL. Bully-prevention or harm-reduction programs must address bullying because of PSO. Copyright © 2012 by the American Public Health Association®.

Self-perception in a clinical sample of gender variant children - Rijn, A.B.-V.; Steensma, T.D.; Kreukels, B.P.C.; Cohen-Kettenis, P.T. (Clinical Child Psychology and Psychiatry, 2013)
Background: Gender variance (GV) in childhood has a negative impact on the self-concept of children in the general population and can lead to mental health problems and even suicidal ideation in adulthood. This study explored the self-concept of clinically referred gender variant children and examined potential risk factors. Method: The Self-Perception Profile for Children was administered to 147 children, who were referred to a gender identity clinic. Their parents completed the Child Behaviour Checklist and the Gender Identity Questionnaire to assess the degree of GV. Results: The referred children were at risk of developing a negative self-concept; more specifically gender variant girls had low scores on 'global self-worth', 'physical appearance' and 'behavioural conduct' compared to Dutch norms for girls. Gender variant boys had low scores on 'global self-worth', 'scholastic competence', 'athletic competence' and 'physical appearance' compared to Dutch norms for boys. Within the group of referred children, sex differences, but no age effects, were found. The referred girls felt more competent than the referred boys on 'athletic competence' and 'scholastic functioning'. For both boys and girls poor peer relations had a significant negative relationship with self-concept and more GV was related to a lower global self-worth. Conclusions: Clinically referred gender variant children seemed vulnerable to developing a negative self-concept. Poor peer relations and extreme GV might be mediating variables. Interventions might focus on enhancing acceptance of the environment and improving social skills of gender variant children. © The Author(s) 2012.
Keywords: gender identity disorder; Gender variance; self-concept; self-pereption

Inpatient medical-surgical suicidal behavior: A 12-year case-control study - Shekunov, J.; Geske, J.R.; Bostwick, J.M. (General Hospital Psychiatry, 2013)
Objective: To describe a medical center's 12-year experience with medically or surgically hospitalized suicide attempters, with the goal of extending the limited literature on this sentinel event. Patients and Methods: Eight Mayo Clinic Rochester patients' self-inflicting injuries serious enough to trigger mandatory reporting while hospitalized on a medical/surgical unit from January 1, 1998 to December 31, 2010 were matched with four same-sex and same-age controls, admitted to the same unit within 2 months. Cases were identified from Sentinel Event Tracking System and Minnesota Adverse Events Statute records. Data were analyzed with conditional logistic regression. Results: Eight of 777,404 medical/surgical inpatients admitted during 12 years attempted suicide, with significantly more non-Caucasian patients among cases than controls (P= .020). Of 8 attempts, 1 was fatal. More cases than controls had undergone inpatient psychiatric evaluation prior to attempt (P= .020), and elevated risk of attempt was significantly associated with increased number of prior attempts (0.049). Near their attempts, each attempter had an identifiable stressor including inadequately controlled pain in 3, agitation and anxiety in 2 each, and acute delirium, insomnia and psychosocial difficulties in 1 each. Conclusion: First, this study's findings underscore the rarity of reported inpatient medical/surgical suicidal behavior. In this sample, suicide attempters were distinct from nonattempters by the increased likelihood of prior suicide attempts as well as inpatient psychiatric consultations before their attempts. When patients have these characteristics, medical teams should take particular notice and initiate heightened watchfulness for suicidal behavior. © 2013 Elsevier Inc.
Keywords: Inpatient suicide attempters; Medical and surgical; Posttraumatic stress disorder; Suicidal behavior

Adolescent suicide in Australia: Rates, risk and resilience - McNamara, P.M. (Clinical Child Psychology and Psychiatry, 2013)
Adolescent suicide rates in Australia have fallen significantly during recent years. The incidence, however, clearly remains a serious concern for young people, parents, professionals and policy makers. Some groups of Australian youth appear to be at heightened risk. Adolescents within the welfare system, indigenous, rural and refugee youth, along with same sex attracted young people often need very careful monitoring and support. Young men continue to take their lives more frequently than young women. Prevention programmes in Australia aim to develop resilience in young people, families and communities that can serve as protection against self harm and suicide. The improvement of mental health literacy, a fostering of adolescent self-efficacy and better access to early intervention strategies are currently privileged in national and state policies related to young people in Australia. More work is needed, however, to achieve a well integrated mental health framework capable of effectively addressing adolescent suicide prevention into the twenty-first century. © The Author(s) 2012.
Keywords: Adolescent suicide; Australia; rates; risk resilience

Outcomes of child psychiatric treatment - Lundh, A.; Forsman, M.; Serlachius, E.; Lichtenstein, P.; Landén, M. (Acta Psychiatrica Scandinavica, 2013)
Objective: The aim of this study was to investigate outcomes of child psychiatric outpatient treatment as usual and to identify outcome predictors, with special regard to attention-deficit/hyperactivity disorder (ADHD), mood disorder, obsessive-compulsive disorder and conduct disorder. Method: Routinely collected data from 12 613 outpatients between July 2006 and January 2010 in Stockholm, Sweden were analysed. The outcome measure was change in Children's Global Assessment Scale (CGAS) ratings between first visit and case closure (incrementCGAS). Results: CGAS improved during the course of treatment across all diagnostic groups, ranging from a mean change of 4 (mental retardation) to 16 (suicide attempts). incrementCGAS was two times higher in the mood disorder group compared with the ADHD group. In the mood disorder group, several psychotherapies were associated with better outcome but not medication. In the ADHD group, psychotherapeutic interventions were also associated with better outcome, but those who received treatment with central stimulants received less non-medical interventions. Conclusion: Whereas the functional impairment and the level of improvement in mood disorder corresponded to previous efficacy studies, the ADHD patients were more impaired and improved less after treatment. This should prompt a critical discussion as to whether ADHD patients receive the best available treatment in CAMHS in Stockholm and elsewhere. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Keywords: Adolescent; Child; Mental disorders/therapy; Outcome assessment; Psychiatric status rating scales

Epistemic responsibility and critical thinking - Vaidya, A.J. (Metaphilosophy, 2013)
Should we always engage in critical thinking about issues of public policy, such as health care, gun control, and LGBT rights? Michael Huemer (2005) has argued for the claim that in some cases it is not epistemically responsible to engage in critical thinking on these issues. His argument is based on a reliabilist conception of the value of critical thinking. This article analyzes Huemer's argument against the epistemic responsibility of critical thinking by engaging it critically. It presents an alternative account of the value of critical thinking that is tied to the notion of forming and deploying a critical identity. And it develops an account of our epistemic responsibility to engage in critical thinking that is not dependent on reliability considerations alone. The primary purpose of the article is to provide critical thinking students, or those that wish to reflect on the value of critical thinking, with an opportunity to think metacritically about critical thinking by examining an argument that engages the question of whether it is epistemically responsible for one to engage in critical thinking. © 2013 Metaphilosophy LLC and John Wiley & Sons Ltd.
Keywords: critical identities; critical thinking; debating public policy; epistemic responsibility; moral expertise; reliability

Beat Mexico - Tytell, J. (Studies in Latin American Popular Culture, 2013)
William Burroughs, Jack Kerouac, and Allen Ginsberg felt that they needed to leave their own culture in order to see it more clearly, and they were almost magnetically drawn to Mexico. Each of these writers spent formative years in the early 1950s living in Mexico, and each was startled by the perspectives afforded by what Burroughs characterized as an "oriental culture." Mexico was still quite impoverished in the 1950s-Gulf oil development created a middle class in Mexico only in the 1960s. What these writers saw in Mexico and the circumstances of their lives there (e.g., Kerouac's destitution and vagrancy, Burroughs's awareness that drugs would become his subject and his fatal shooting of his common-law wife) would find reflections in Burroughs's novels like Junky, Queer, and Naked Lunch; Kerouac's On the Road and Tristessa; and such poems by Ginsberg as the early "Siesta in Xbalba" and "Howl." Crucial letters, journals, and other writings on the Mexican experience have helped me to chart the evolution of respective views-Kerouac at first sees Mexico as a pastoral idyll, Burroughs as an opportune occasion for libertarianism; Ginsberg experiences a place "beyond Darwin's chain." Such evolving views affected the development of each of their own literary voices. © 2013 by the University of Texas Press.

Gay-straight alliances are associated with student health: A multischool comparison of LGBTQ and heterosexual youth - Poteat, V.P.; Sinclair, K.O.; Digiovanni, C.D.; Koenig, B.W.; Russell, S.T. (Journal of Research on Adolescence, 2013)
Few studies have examined school-based factors associated with variability in the victimization and health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. Among 15,965 students in 45 Wisconsin schools, we identified differences based on Gay-Straight Alliance (GSA) presence. Youth in schools with GSAs reported less truancy, smoking, drinking, suicide attempts, and sex with casual partners than those in schools without GSAs, with this difference being more sizable for LGBTQ than heterosexual youth. GSA-based differences were greatest for sexual minority girls on reported sex while using drugs. GSA effects were nonsignificant for general or homophobic victimization, grades, and school belonging. Findings suggest that GSAs could contribute to attenuating a range of health risks, particularly for LGBTQ youth. © 2012 The Authors. Journal of Research on Adolescence © 2012 Society for Research on Adolescence.

Hard-to-reach youth online: Methodological advances in self-harm research - McDermott, E.; Roen, K.; Piela, A. (Sexuality Research and Social Policy, 2013)
International research has demonstrated that lesbian, gay, bisexual and transgender (LGBT) youth have elevated rates of suicide and self-harm. What is missing from the evidence base, however, is qualitative research investigating LGBT youth perspectives. This is a sensitive subject area presenting ethical, methodological and epistemological challenges, especially in relation to over-sampling the 'visible' sections of a hidden population, retrospective reporting, and capturing complex emotions. We report on our use of qualitative online methodology to examine Internet forums where LGBT youth discuss self-harming. We found that this methodology can address some research dilemmas by generating: (a) diverse samples in terms of sexuality and gender identities; (b) a different type of data, immediate and unmediated by researchers; and (c) complex psychosocial emotional data. We argue that this online data can enhance our understanding of the links among hard-to-reach youth, suicide, self-harm, sexuality and gender, which is crucial to developing effective and appropriate suicide prevention strategies and mental health policies. © 2013 Springer Science+Business Media New York.
Keywords: Gay; Gender; Lesbian; Self-harm; Sexuality; Suicide; Transgender

Intersecting identities and the association between bullying and suicide attempt among new york city youths: Results from the 2009 new york city youth risk behavior survey - LeVasseur, M.T.; Kelvin, E.A.; Grosskopf, N.A. (American Journal of Public Health, 2013)
Objectives. We examined the intersections of sexual minority, gender, and Hispanic ethnic identities and their interaction with experiences of bullying in predicting suicide attempt among New York City youths. Methods. We performed secondary data analysis of the 2009 New York City Youth Risk Behavior Survey, using logistic regression to examine the association of sexual identity, gender, ethnicity, and bullying with suicide attempt. We stratified results on these measures and reported adjusted odds ratios. Results. Compared with non-sexual minority youths, sexual minority youths had 4.39 and 1.96 times higher odds, respectively, of attempting suicide and reporting bullying. Identity variables did not interact with bullying in predicting suicide attempt individually; however, a four-way interaction term was significant. The effect of bullying on suicide attempt was strongest among non-Hispanic sexual minority male youths (odds ratio = 21.39 vs 1.65-3.38 for other groups). Conclusions. Sexual minority, gender, and ethnic identities interact with bullying in predicting suicide attempt among New York City youths. Interventions to limit both the prevalence and the effect of bullying among minority youths should consider an intersectional approach that considers ethnic, gender, and sexual identities.

The Endocrinologist's Office-Puberty Suppression: Saving Children from a Natural Disaster? - Sadjadi, S. (Journal of Medical Humanities, 2013)
In the past few years, the introduction and rapid acceptance of puberty suppression has transformed the clinical treatment of children diagnosed with Gender Identity Disorder. This essay analyzes the narratives used by some advocates of this treatment, particularly the elements of saving children from the looming disaster of puberty and from future abject lives of violence and suicide as transgender adults. It briefly addresses the potential implications of this account for the well being of the children brought under clinical purview. © 2013 Springer Science+Business Media New York.
Keywords: Children; Gender identity disorder; Narrative; Puberty suppression; Queer health; Transgender

Influences on loneliness, depression, sexual-risk behaviour and suicidal ideation among Thai transgender youth - Yadegarfard, M.; Ho, R.; Bahramabadian, F. (Culture, Health and Sexuality, 2013)
This study examined the influence of age, education level and number of sex partners on levels of loneliness, depression, suicidal ideation and sexual-risk behaviour in Thai male-to-female transgender youth. A total of 190 participants filled in the study's questionnaire, designed to tap the primary variables of age, level of education, number of sex partners, loneliness, depression, suicidal ideation and sexual-risk behaviour. Results reveal that level of education has a significant influence on depression and loneliness, the number of sex partners has a significant influence on sexual-risk behaviour and suicidal ideation and age has a significant influence on sexual-risk behaviour and suicidal ideation. Participants with higher levels of education reported more loneliness than participants who did not graduate from high school. In addition, participants who did not graduate from high school reported more depression than participants with some university credit. Furthermore, participants aged 15 to 19 years, compared with those of 20 to 25 years, reported higher level of sexual-risk behaviour and higher levels of suicidal ideation. © 2013 © 2013 Taylor & Francis.
Keywords: depression; loneliness; sexual-risk behaviour; suicidal ideation; Thailand; transgender

The Burgeoning HIV/HCV Syndemic in the Urban Northeast: HCV, HIV, and HIV/HCV Coinfection in an Urban Setting - Morano, J.P.; Gibson, B.A.; Altice, F.L. (PLoS ONE, 2013)
Introduction:Despite recommendations for generation-based HCV and once lifetime HIV screening, thousands of individuals in the U.S. still remain untested and undiagnosed. This cross-sectional study examines the correlates of HCV and HIV monoinfection and HIV/HCV coinfection in an urban Northeast setting.Methods:Utilizing an electronic database from a mobile medical clinic in New Haven, CT from January 2003 to July 2011, 8,311 individuals underwent structured health assessment and screening for HIV and HCV.Results:HIV [N = 601 (8.0%)] and HCV [N = 753 (10.1%)] infection were identified, and 197 (26.1%) of the 753 with HCV were coinfected with HIV. Both monoinfection and coinfection status were independently correlated with crack cocaine use and increasing age. HIV/HCV coinfection was correlated with men having sex with men (MSM) (AOR = 38.53, p<0.0080), shooting gallery use (AOR = 3.06, p<0.0070), and not completing high school (AOR = 2.51, p<0.0370). HCV monoinfection correlated with health insurance (AOR = 2.16, p<0.0020), domestic violence (AOR = 1.99, p<0.0070), and being Hispanic (AOR = 2.63, p<0.0001), while HIV monoinfection correlated with having had syphilis (AOR = 2.66, p<0.0001) and being Black (AOR = 1.73, p = 0.0010).Conclusions:Though HIV and HCV share common transmission risk behaviors, independent correlates with viral infection status in an urban Northeast setting are distinct and have important implications for surveillance, healthcare delivery, disease prevention, and clinical care. © 2013 Morano et al.

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

A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues - Kerr, D.L.; Santurri, L.; Peters, P. (Journal of American College Health, 2013)
Objective: To investigate selected mental health characteristics of lesbians and bisexual undergraduate college women as compared with heterosexual college women. Participants: Self-identified lesbians and bisexual and heterosexual female college students who took part in the American College Health Association National College Health Assessment II (ACHA-NCHA-II) in Fall 2008, Spring 2009, and Fall 2009. Methods: A secondary analysis of the ACHA-NCHA-II data set for 3 semesters was conducted. Comparisons of lesbians and bisexual and heterosexual female college students were made. Results: Bisexual women reported the worst mental health status in all areas studied including anxiety, anger, depressive symptoms, self-injury, and suicidal ideation and attempts. Both bisexual women and lesbians had a far greater likelihood of having these mental health issues when compared with heterosexual women. Lesbians and bisexual women utilized significantly more mental health services (with the exception of clergy) than heterosexual women. Conclusions: College health professionals should recognize and address the mental health needs of bisexual and lesbian undergraduate college women. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: Counseling; Gender; Mental health

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

Does the level of education influence completed suicide? A nationwide register study - Pompili, M.; Vichi, M.; Qin, P.; Innamorati, M.; De Leo, D.; Girardi, P. (Journal of Affective Disorders, 2013)
Objective: To evaluate whether education attainment was associated with completed suicide, a topic only marginally investigated in the literature. Methods: Data for the years between 2006 and 2008 were extracted from the Italian Mortality Database to include all deaths by suicide and natural causes and to obtain information on their education attainment. Results: We found significant differences in education attainment between suicide victims and individuals deceased by natural causes, stratified by sex and broken down by age bands. Of both males and females from 15 to 64 years old, suicide victims were significantly more often to have a higher education attainment compared with the same sex and age counterparts died from natural causes. Persons with higher school attainment, compared with those with a maximum primary school degree, had significantly increased odds ratios of dying from a suicide rather than a natural cause. For persons aged 65-74 years or above, however, the differences were not so much obvious. These observations remained almost the same after adjustment for marital status, region of residence and age. Conclusions: Individual with higher educational achievement may be more prone to suicide risk when facing failures, public shame, and high premorbid functioning. © 2012 Elsevier B.V. All rights reserved.
Keywords: Education; Natural causes of death; Suicide

Is State Gambling Policy "Morality Policy"? Framing Debates Over State Lotteries - Ferraiolo, K. (Policy Studies Journal, 2013)
The politics of so-called "morality policies" including same-sex marriage, abortion, gun control, and gambling have captured the attention of both the public and political scientists in recent years. Many studies have argued that morality policy constitutes a category of public policy that has distinctive characteristics (such as technical simplicity and less amenability to compromise) compared with non-morality policy. However, in a recent contribution Mucciaroni argues that morality "policy" should instead be viewed primarily as a strategy for framing issues. Drawing on examples from the debate over gay rights, Mucciaroni finds that opponents focus on rational-instrumental or procedural frames more so than engaging in "morality talk." In this study, I seek to extend Mucciaroni's analysis to the issue of lottery gambling in the United States. Drawing on data from legislative records in four states, I find that lottery critics mostly avoid private behavior-based morality arguments. Instead, they criticize government's role in sanctioning lotteries and denounce the negative consequences of gambling. Supporters, meanwhile, emphasize the potential benefits of lottery creation and the importance of allowing the state public a voice on the issue. The results indicate that rational-instrumental arguments coexist alongside morality talk in state lottery debates, and that private behavior morality frames are on the decline while governmental morality frames are on the rise. © 2013 Policy Studies Organization.
Keywords: Framing; Gambling; Legislative debate; Morality policy; Public policy; State lotteries

A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth - Mustanski, B.; Liu, R.T. (Archives of Sexual Behavior, 2013)
This short-term prospective study examined general and lesbian, gay, bisexual, and transgender (LGBT)-specific risk and protective factors for suicide attempts in an ethnically diverse sample of LGBT youth (N = 237, 47.7 % male). A structured psychiatric interview assessed clinical depression and conduct disorder symptoms, as well as past and prospective suicide attempts over a 1-year follow-up period (91 % retention). Participants completed questionnaires measuring general risk factors for suicide attempts, including hopelessness, impulsiveness, and perceived social support. They also completed measures of LGBT-specific suicide risk factors, including gender nonconformity, age of first same-sex attraction, and LGBT victimization. Correlation and multivariate regression analyses were conducted to examine the relations between predictors and suicide attempt, and to identify mediators. Of nine variables examined, seven were related to lifetime history of attempted suicide: hopelessness, depression symptoms, conduct disorder symptoms, impulsivity, victimization, age of first same-sex attraction, and low family support. Depressive symptoms and hopelessness mediated the relation between multiple risk and resilience factors and suicide attempts. Suicide attempt history was the strongest predictor of prospective suicide attempts. Participants who previously attempted suicide (31.6 % of the sample) had more than 10 times greater odds of making another attempt in the 1-year follow-up period than were those who had made no previous attempt. These results highlight the need for suicide prevention programs for LGBT youth and suggest the importance of addressing depression and hopelessness as proximal determinants and family support and victimization, which have more distal effects. © 2012 Springer Science+Business Media, LLC.
Keywords: Adolescents; Homosexuality; LGBT; Sexual orientation; Suicide

Health priorities and perceived health determinants among Western Australians attending the 2011 LGBTI Perth Pride Fairday Festival - Comfort, J.; McCausland, K. (Health Promotion Journal of Australia, 2013)
Issue addressed Although data exist demonstrating poorer health indicators on a range of health outcomes for lesbian, gay, bisexual, transsexual and intersex (LGBTI) people, there is little information as to how this group perceives the relative importance of different health issues or what the underlying reasons behind poorer health may be. Method A self-completed survey was administered to people attending the October 2011 LGBTI Perth Pride Fairday Festival. Three hundred and fifty-one people completed the survey, resulting in a total of 335 useable surveys. One hundred and seventy-eight participants identified as female, 145 as male, four as transgender and eight as other genders. Results Depression, anxiety, excessive worry or panic attacks and problems in family relationships were reported as the most important individual health issues, whereas depression, suicide and HIV/AIDS were seen as the most important health issues affecting the LGBTI community. Discrimination was rated the most important social factor impacting on the health and well being of this community. Conclusions When members of the LGBTI community were asked to rank health issues of importance both individually and as a community, the results indicate that mental health issues are of prime concern. Discrimination and the stress of living as part of this minority group were seen as contributing to this. Health promotion and public health need to be responsive to these issues if real gains are to be made in reducing the health inequities affecting this group. So what? This research highlights the link between social justice, social inclusion and health outcomes. The health of LGBTI people is rarely considered by mainstream agencies, despite poorer health outcomes. Sensitive and targeted public health interventions that resonate with the community and that acknowledge the impact of being part of this marginalised group are required. © 2012 Australian Health Promotion Association.
Keywords: bisexual; determinants of health; gay; gender identity; health priorities; lesbian; sexual orientation; transsexual and intersex (LGBTI)

Risk and Protective Factors for Suicidal Thoughts Among Sexual Minority Youth: Evidence from the Add Health Study - Russell, S.T.; Toomey, R.B. (Journal of Gay and Lesbian Mental Health, 2013)
Sexual minority youth are at greater risk for suicidal thoughts compared to heterosexual youth: Directions for prevention and intervention are urgently needed. Few studies have examined a broad range of risk and protective factors that may explain this disparate risk. This study utilized the National Longitudinal Study of Adolescent Health to examine which protective and risk factors for suicidal thoughts behaved distinctly in sexual minority adolescents compared to their heterosexual counterparts. Although many risk factors did not differ for heterosexual and sexual minority adolescents, we found several that were statistically significant for predicting later suicidal thoughts for sexual minorities: personal and friends' school connections, friendship activities, and maternal caring. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: sexual minority; suicide ideation; youth

Differences in Risk Factors for Suicide Attempts Among 9th and 11th Grade Youth: A Longitudinal Perspective - Fried, L.E.; Williams, S.; Cabral, H.; Hacker, K. (Journal of School Nursing, 2013)
The purpose of the study is to assess the relationship between timing of adolescent development and risk factors for suicide. Nationally representative data from the Add Health survey were used. The relationship of sociodemographic characteristics, known risk factors, and physical developmental timing and cognitive developmental style to suicide attempt was assessed. Depression was a risk factor for suicide attempts in both 9th and 11th grade. Other risk factors differed. Use of illegal drugs, homosexual orientation, using public assistance, and physical development were the important risk factors for ninth graders. For 11th graders, sexual abuse, being in counseling, and being of "other" race or ethnicity (mainly Asian or Native American) were risk factors. The cognitive development variable of using a systematic problem-solving method was protective for 11th graders. Recognizing that risk factors for adolescent suicide attempts change over time and with developmental timing of puberty is an important factor for suicide prevention strategies. © The Author(s) 2012.
Keywords: emergency care /crisis intervention; mental health; middle /junior/high school; role promotion /development; screening /risk identification; self-injury; violence

Self-Harming Thoughts and Behaviors in a Group of Children and Adolescents with Gender Dysphoria - Skagerberg, E.; Parkinson, R.; Carmichael, P. (International Journal of Transgenderism, 2013)
This article presents the findings from an audit on self-harm in 125 children and adolescents referred to the Gender Identity Development Service in London. Data concerning self-harming thoughts and behaviors before attending the service were extracted from documents in the patient files and from clinician reports. The findings indicated that suicide attempts and self-harming were more common over the age of 12. Overall, thoughts of self-harm were more common in the natal males whereas actual self-harm was more common in the natal females. The number of suicide attempts did not differ significantly between the two genders. The implications of these findings are discussed. Limitations of the study are also discussed which include that the data was only collected over an 8-month period and that it was extracted from patient files and from clinician reports. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: Gender dysphoria; gender noncomformity; self-harm

Dating Violence, Psychological Distress, and Attempted Suicide Among Female Adolescents in the Juvenile Justice System - Buttar, A.; Clements-Nolle, K.; Haas, J.; Reese, F. (Journal of Correctional Health Care, 2013)
The prevalence of mental illness and suicide among female adolescents involved with the juvenile justice system is alarmingly high and there is a need to identify risk factors that may be amenable to intervention. This study examined the independent association between dating violence and poor mental health (psychological distress and attempted suicide) among 305 female adolescents involved with the juvenile justice system in Nevada. Overall, 28% of the sample met the criteria for clinically significant psychological distress and 18% had attempted suicide with intent to die. After controlling for well-established risk factors such as sexual orientation, childhood abuse, and substance abuse, dating violence remained independently associated with psychological distress and attempted suicide. These findings suggest that mental health programming for this population may be more effective if it includes a focus on dating violence. © The Author(s) 2013.
Keywords: dating violence; female adolescents; juvenile justice system; mental health; suicide

Marriage, cohabitation and mortality in denmark: National cohort study of 6.5 million persons followed for up to three decades (1982-2011) - Frisch, M.; Simonsen, J. (International Journal of Epidemiology, 2013)
Background: Living arrangements have changed markedly in recent decades, so we wanted to provide an up-to-date assessment of mortality as a function of marital status and cohabitation status in a complete population. Methods: We studied mortality in a national cohort of 6.5 million Danes followed for 122.5 million person-years during 1982-2011, using continuously updated individual-level information on living arrangements, socio-demographic covariates and causes of deaths. Hazard ratios (HRs) estimated relative mortality in categories of marital status, cohabitation status and combinations thereof. Results: HRs for overall mortality changed markedly over time, most notably for persons in same-sex marriage. In 2000-2011, opposite-sex married persons (reference, HR1/4 1) had consistently lower mortality than persons in other marital status categories in women (HRs 1.37-1.89) and men (HRs 1.37-1.66). Mortality was particularly high for same-sex married women (HR1/4 1.89), notably from suicide (HR1/4 6.40) and cancer (HR1/4 1.62), whereas rates for same-sex married men (HR1/4 1.38) were equal to or lower than those for unmarried, divorced and widowed men. Prior marriages (whether opposite-sex or same-sex) were associated with increased mortality in both women and men (HR1/4 1.16-1.45 per additional prior marriage). Conclusion: Our study provides a detailed account of living arrangements and their associations with mortality over three decades, thus yielding accurate and statistically powerful analyses of public health relevance to countries with marriage and cohabitation patterns comparable to Denmark's. Of note, mortality among same-sex married men has declined markedly since the mid-1990s and is now at or below that of unmarried, divorced and widowed men, whereas same-sex married women emerge as the group of women with highest and, in recent years, even further increasing mortality. © The Author 2013; all rights reserved.
Keywords: Cohabitation; Cohort studies; Cox regression analysis; Epidemiology; Homosexuality; Marriage; Mortality

A description of common mental disorders in men who have sex with men (MSM) referred for assessment and intervention at an MSM clinic in Cape Town, South Africa - Stoloff, K.; Joska, J.A.; Feast, D.; De Swardt, G.; Hugo, J.; Struthers, H.; McIntyre, J.; Rebe, K. (AIDS and Behavior, 2013)
Menwho have sexwith men (MSM) have a higher prevalence of common mental disorders (CMD), as compared with heterosexual men. HIV infection is independently associated with higher rates of CMD. Given this context, and the high background community prevalence of HIV in South Africa,MSM are at even greater risk of developing CMD. The aim of this research was to investigate neuropsychiatric symptoms and disorders in MSM who were referred for assessment and management of mental health problems, in an MSM Clinic in urban Cape Town, South Africa. Twenty-five men were screened using the MINI, AUDIT, DUDIT, and IPDE Screener. Depression, suicidality, as well as alcohol and drug use disorders were highly prevalent in this group (44, 56, 48, and 56 %respectively). The personality disorder screening was suggestive of a high prevalence of personality disorders. The high prevalence of neuropsychiatric disorders in this sample supports the idea that integrated mental health services are needed to address the complex needs of this population. Adequate input into the mental health needs of this population could reduce the potential for HIV acquisition and transmission, improve adherence to treatment and care, and ensure the provision a comprehensive health service for MSM. © Springer Science+Business Media New York 2013.
Keywords: AUDIT; DUDIT; HIV/AIDS; IPDE; Mental health; MINI; MSM; South Africa

Psychosocial Health Problems Associated with Increased HIV Risk Behavior among Men Who Have Sex with Men in Nepal: A Cross-Sectional Survey - Deuba, K.; Ekström, A.M.; Shrestha, R.; Ionita, G.; Bhatta, L.; Karki, D.K. (PLoS ONE, 2013)
Background: Men who have sex with men (MSM) are marginalized, hidden, underserved and at high risk for HIV in Nepal. We examined the association between MSM sub-populations, psychosocial health problems and support, access to prevention and non-use of condoms. Methods: Between September-November of 2010, a cross-sectional survey on HIV-related risk behavior was performed across Nepal through snowball sampling facilitated by non-governmental organizations, recruiting 339 MSM, age 15 or older. The primary outcomes were: (a) non-use of condoms at least once in last three anal sex encounters with men and (b) non-use of condoms with women in the last encounter. The secondary outcome was participation in HIV prevention interventions in the past year. Results: Among the 339 MSM interviewed, 78% did not use condoms at their last anal sex with another man, 35% did not use condoms in their last sex with a woman, 70% had experienced violence in the last 12 months, 61% were experiencing depression and 47% had thought of committing suicide. After adjustment for age, religion, marital status, and MSM subpopulations (bisexual, ta, meti, gay), non-use of condoms at last anal sex with a man was significantly associated with non-participation in HIV interventions, experience of physical and sexual violence, depression, repeated suicidal thoughts, small social support network and being dissatisfied with social support. Depression was marginally associated with non-use of condoms with women. The findings suggest that among MSM who reported non-use of condoms at last anal sex, the ta subgroup and those lacking family acceptance were the least likely to have participated in any preventive interventions. Conclusions: MSM in Nepal have a prevalence of psychosocial health problems in turn associated with high risk behavior for HIV. Future HIV prevention efforts targeting MSM in Nepal should cover all MSM subpopulations and prioritize psychosocial health interventions. © 2013 Deuba et al.

Sexual Minority-Related Victimization as a Mediator of Mental Health Disparities in Sexual Minority Youth: A Longitudinal Analysis - Burton, C.M.; Marshal, M.P.; Chisolm, D.J.; Sucato, G.S.; Friedman, M.S. (Journal of Youth and Adolescence, 2013)
Sexual minority youth (youth who are attracted to the same sex or endorse a gay/lesbian/bisexual identity) report significantly higher rates of depression and suicidality than heterosexual youth. The minority stress hypothesis contends that the stigma and discrimination experienced by sexual minority youth create a hostile social environment that can lead to chronic stress and mental health problems. The present study used longitudinal mediation models to directly test sexual minority-specific victimization as a potential explanatory mechanism of the mental health disparities of sexual minority youth. One hundred ninety-seven adolescents (14-19 years old; 70 % female; 29 % sexual minority) completed measures of sexual minority-specific victimization, depressive symptoms, and suicidality at two time points 6 months apart. Compared to heterosexual youth, sexual minority youth reported higher levels of sexual minority-specific victimization, depressive symptoms, and suicidality. Sexual minority-specific victimization significantly mediated the effect of sexual minority status on depressive symptoms and suicidality. The results support the minority stress hypothesis that targeted harassment and victimization are partly responsible for the higher levels of depressive symptoms and suicidality found in sexual minority youth. This research lends support to public policy initiatives that reduce bullying and hate crimes because reducing victimization can have a significant impact on the health and well-being of sexual minority youth. © 2013 Springer Science+Business Media New York.
Keywords: Depression; Minority stress; Sexual minority youth; Suicidality; Victimization

Learning from the Life Experiences of Male-to-Female Transsexuals - Brown, C.; Dashjian, L.T.; Acosta, T.J.; Mueller, C.T.; Kizer, B.E.; Trangsrud, H.B. (Journal of GLBT Family Studies, 2013)
In this exploratory study, we sought to increase mental health professionals' understanding and awareness of the life and transition experiences of male-to-female transsexuals. A sample of 9 predominately European male-to-female transsexuals, who were mostly middle-aged (M = 33.8, SD = 15.4) and residing in the Midwest region of the United States, were interviewed about their life experiences. Interview data were analyzed using consensual qualitative research (CQR) methods (Hill, Thompson, & Williams, 1997). The results indicated that on average participants realized at five-and-a-half years old that their biological sex was incongruent with their gender identity; they dated women and pursued marriage in order to comply with prescribed gender roles and battled depression and suicidal ideation. Results also revealed that following their decision to transition, participants reported increased quality of life and overall happiness, and varied changes in relationships with family members. Suggestions to include this group in future practice and research agendas are discussed. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: family relationships; male-to-female; transgender; transition; transsexual

Celebrity Suicide and the Search for the Moral High Ground: Comparing Frames in Media and Audience Discussions of the Death of a Flemish Celebrity - van den Bulck, H.; Claessens, N. (Critical Studies in Media Communication, 2013)
Taking a case study and framing approach, this article analyzes media coverage of and (on- and off-line) audience reactions to a gay celebrity's death and its aftermath to see how it triggers discussion about socially and ethically sensitive issues. It starts from the assumption that the celebrity construct is not just a commodity but also acts as a forum to discuss social and ethical issues, norms, and values. Media coverage of the suicide of Flemish singer Yasmine is revealed to be dominated by frames relating to the soap of life (especially divorce), the celebrity's status as a lesbian icon, and her position as a victim of abuse, with framing differing according to media and journalistic style. Audience reactions do not simply mimic these frames, but are mediated in different ways by personal experiences, peers, and parasocial relationships, resulting in active negotiations of the media frames, even creating counter-frames, particularly regarding the act of suicide and the gay status of the celebrity. © 2013 Copyright National Communication Association.
Keywords: Celebrity culture; Media and moral debate; Media culture; Online reception; Parasocial relationships

Complicated suicide versus autoeroticism? A case involving multiple drugs and a porta-potty - Dickerson, E.M.; Jones, P.; Wilkins, D.; Regnier, J.; Prahlow, J.A. (American Journal of Forensic Medicine and Pathology, 2013)
In this report, a unique and bizarre case of complicated suicide is presented. The decedent was found dead in the basin of a porta-potty, wearing women's pantyhose, jewelry, and makeup. The initial investigation was suspect for homicide. Although an autoerotic accidental death cannot be excluded, the patient's medical history and autopsy results provided evidence for suicide, including several substances positive in his serum. Tramadol was quantified to be 140 mg/L, approximately 470 times the therapeutic range. Moreover, formaldehyde was also present, presumably absorbed from the contents of the chemical toilet. An exhaustive search could not reveal similar circumstances of suicide in a porta-potty or with the levels of tramadol found in the decedent. Copyright © 2013 by Lippincott Williams & Wilkins.
Keywords: paraphilia; porta-potty; suicide; tramadol; transvestitism

Attempted Suicide, LGBT Identity, and Heightened Scrutiny - Halady, S.W. (American Journal of Bioethics, 2013)

A Review of gay, lesbian, bisexual, and transgender youth issues for the pediatrician - Steever, J.B.; Cooper-Serber, E. (Pediatric Annals, 2013)

Threshold - Rosen, D. (CMAJ, 2013)

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

HIV-infected mental health patients: Characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients - Schadé, A.; van Grootheest, G.; Smit, J.H. (BMC Psychiatry, 2013)
Objectives: HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems. The majority of HIV-infected patients in the Netherlands (almost 60%) are homosexual men.The main objectives of this study were to describe the clinical and demographic characteristics of patients with HIV who seek treatment for their mental health symptoms in the Netherlands. Secondly, we tested whether HIV infected and non-infected homosexual patients with a lifetime depressive disorder differed on several mental health symptoms.Methods: We compared a cohort of 196 patients who visited the outpatient clinic for HIV and Mental Health with HIV-infected patients in the general population in Amsterdam (ATHENA-study) and with non-HIV infected mental health patients (NESDA-study). DSM-IV diagnoses were determined, and several self-report questionnaires were used to assess mental health symptoms. Results: Depressive disorders were the most commonly occurring diagnoses in the cohort and frequent drug use was common. HIV-infected homosexual men with a depressive disorder showed no difference in depressive symptoms or sleep disturbance, compared with non-infected depressive men. However, HIV-positive patients did express more symptoms like fear, anger and guilt. Although they showed significantly more suicidal ideation, suicide attempts were not more prevalent among HIV-infected patients. Finally, the HIV-infected depressive patients displayed a considerably higher level of drug use than the HIV-negative group. Conclusion: Habitual drug use is a risk factor for spreading HIV. It is also more often diagnosed in HIV-infected homosexual men with a lifetime depression or dysthymic disorder than in the non-infected population. Untreated mental health problems, such as depressive symptoms and use of drugs can have serious repercussions. Therefore, general practitioners and internists should be trained to recognize mental health problems in HIV-infected patients. © 2013 Schadé et al.; licensee BioMed Central Ltd.
Keywords: Depression; Drugs; HIV; Homosexual men; Mental health; Prevention

Victimization and suicidality among dutch lesbian, gay, and bisexual youths - Van Bergen, D.D.; Bos, H.M.W.; Van Lisdonk, J.; Keuzenkamp, S.; Sandfort, T.G.M. (American Journal of Public Health, 2013)
We examined Netherlands Institute for Social Research data, collected between May and August 2009, on 274 Dutch lesbian, gay, and bisexual youths. The data showed that victimization at school was associated with suicidal ideation and actual suicide attempts. Homophobic rejection by parents was also associated with actual suicide attempts. Suicidality in this population could be reduced by supporting coping strategies of lesbian, gay, and bisexual youths who are confronted with stigmatization by peers and parents, and by schools actively promoting acceptance of same-sex sexuality. Copyright © 2012 by the American Public Health Association®.

A place to feel secure. - Lomas, C. (Nursing standard (Royal College of Nursing (Great Britain) : 1987), 2013)
A new health and wellbeing centre has opened in Birmingham to address the health inequalities in the lesbian, gay, bisexual and trans (LGBT) community. Working alongside other service providers to target issues such as attempted suicide, depression, self-harm, smoking, drinking and sexual health, the centre will act as a'one-stop shop' providing ongoing support for LGBT people.

Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth - Hatzenbuehler, M.L.; Keyes, K.M. (Journal of Adolescent Health, 2013)
Purpose: To evaluate whether anti-bullying policies that are inclusive of sexual orientation are associated with a reduced prevalence of suicide attempts among lesbian, gay, and bisexual youths. Methods: A total of 31,852 11th-grade public school students (1,413 lesbian, gay, and bisexual individuals; 4.4%) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. The independent variable was the proportion of school districts in the 34 counties participating in the Oregon Healthy Teens survey that adopted anti-bullying policies inclusive of sexual orientation. The outcome measure was any self-reported suicide attempt in the past 12 months. We stratified results by sexual orientation. Results: Lesbian and gay youths living in counties with fewer school districts with inclusive anti-bullying policies were 2.25 times (95% confidence interval [CI], 1.13-4.49) more likely to have attempted suicide in the past year compared with those living in counties where more districts had these policies. Inclusive anti-bullying policies were significantly associated with a reduced risk for suicide attempts among lesbian and gay youths, even after controlling for sociodemographic characteristics (sex, race/ethnicity) and exposure to peer victimization (odds ratio,.18; 95% CI,.03-.92). In contrast, anti-bullying policies that did not include sexual orientation were not associated with lower suicide attempts among lesbian and gay youths (odds ratio,.38; 95% CI,.02-7.33). Conclusions: Inclusive anti-bullying policies may exert protective effects for the mental health of lesbian and gay youths, including reducing their risk for suicide attempts. © 2013 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: Anti-bullying policies; Sexual orientation; Suicide attempts

“Sensible” Suicide, Brutal Selfishness, and John Hughes's Queer Bonds - Goltz, D.B. (Cultural Studies ? Critical Methodologies, 2013)
Queer bonds conceptualize inventive and resistant modes of belonging, sociability, and relation that push at, through, and outside normative relational systems and their normative commitments. The essay juxtaposes contemporary gay suicide discourse, specifically the “It Gets Better” campaign and 2009's Prayers for Bobby with the 1985 Molly Ringwald made-for-TV film Surviving: A Family in Crisis, examining how normative familial bonds in discourses of heterosexual suicide produce a resistant and relational discourse of brutal selfishness. Contrary to a rhetoric of selfishness, mediated representation of gay youth suicide reproduces a discursive link between gay identity and suicide that constructs gay suicide as problematically logical, sensible, and intelligible. Conceptualizing a queered rhetoric of selfishness, resisting gay suicidal logics, the essay looks to queer bonds forged in John Hughes's ‘Brat Pack” films of otherness as maps of relational resistance and inventive articulations of non-normative modes of queer selfishness and belonging. © 2012, SAGE Publications. All rights reserved.
Keywords: Bonds; Gay and Lesbian; Queer; Relationality; Suicide

Religion and religiosity: Protective or harmful factors for sexual minority youth? - Longo, J.; Walls, N.E.; Wisneski, H. (Mental Health, Religion and Culture, 2013)
Sexual minority youth are disproportionately impacted by a number of psychosocial risks including a greater likelihood of non-suicidal self-injury (NSSI) when compared to heterosexual counterparts. Emerging research seeks to identify the risk and resilience factors that contribute to the mental health of this stigmatised population. Considering that most Americans grow up with at least some religious teachings and that most major world religions have historically condemned same sex sexuality, the current study examines the association between religious tradition, religiosity, and NSSI behaviour. Results indicate that religion plays both a protective and harmful role for sexual minority youth. Those identifying as Christians with high religious guidance had the greatest risk, seculars had a comparatively moderate risk, and Christians with low religious guidance had the least risk. Implications for clinical practice and future areas of research are discussed. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: cutting; non-suicidal self-injury; religion; religiosity; sexual minority youth

Coming together in pain and joy: A multicultural and arts-based suicide awareness project - Silverman, Y.; Smith, F.; Burns, M. (Arts in Psychotherapy, 2013)
The issue of suicide is still taboo in many cultures and the silence surrounding this problem is often destructive. Those affected by suicide have few opportunities to express their pain and their communities are left feeling helpless. The creative arts therapies have been used to address the emotions surrounding suicide, however few projects have studied the use of the arts to promote suicide awareness. Furthermore, there is a lack of multicultural research in this area. This article describes a two-day arts-based symposium that brought together members from diverse cultural communities including Inuit, Mohawk, Jewish, Christian, Baha'i, South-Asian Canadian, Senior and LGBTQ (Lesbian, Gay, Bisexual, Trans-gendered, Queer) communities. Through drama, music, art-making and writing, participants explored this difficult subject, expressed complex feelings and shared their perspectives. An instrumental case study design was employed for this research project. The objectives were to gather information on participants' experience of exploring the issue of suicide within an arts-based approach and to determine if cross-cultural themes would emerge. The findings indicate that using the arts helped to facilitate dialogue and communication and specific cross-cultural themes did emerge. © 2013 Elsevier Inc.
Keywords: Arts-based symposium; Creative arts therapies; Cross-cultural themes; Multicultural; Suicide

For colored kids who committed suicide, our outrage isn't enough: Queer youth of color, bullying, and the discursive limits of identity and safety - Pritchard, E.D. (Harvard Educational Review, 2013)
In recent years anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ) bullying has been a pervasive discussion in popular and scholarly discourse. While such a discussion has documented the negative impact of bullying on the physical, psychological, social, and emotional lives of young people, it has not had a critical and sustained analysis of the ways that race, ethnicity, class, and other identities complicate discussions of how bullying and bias-motivated violence affects a diversity of queer youth. In this article, Eric Darnell Pritchard begins with a framework that assumes that the intersections of LGBTQ identities with race, ethnicity, and class offer unexplored critical possibilities within current discussions of bullying. He argues that in order to be more creative and effective in responding to the epidemic of bullying, we must expose and deeply engage the limits in the ways identity and safety are taken up in bullying discourse, which have resulted in flattened and less effective antibullying measures. Pritchard concludes with implications for practice in terms of curriculum, policy, and advocacy. Copyright © by the President and Fellows of Harvard College.

A tool for the culturally competent assessment of suicide: The cultural assessment of risk for suicide (CARS) measure - Chu, J.; Floyd, R.; Diep, H.; Pardo, S.; Goldblum, P.; Bongar, B. (Psychological Assessment, 2013)
Despite important differences in suicide presentation and risk among ethnic and sexual minority groups, cultural variations have typically been left out of systematic risk assessment paradigms. A new self-report instrument for the culturally competent assessment of suicide, the Cultural Assessment of Risk for Suicide (CARS) measure, was administered to a diverse sample of 950 adults from the general population. Exploratory factor analysis yielded a 39-item, 8-factor structure subsumed under and consistent with the Cultural Theory and Model of Suicide (Chu, Goldblum, Floyd, & Bongar, 2010), which characterizes the vast majority of cultural variation in suicide risk among ethnic and sexual minority groups. Psychometric properties showed that the CARS total and subscale scores demonstrated good internal consistency, convergent validity with scores on other suicide-related measures (the Suicide Ideation Scale, the Beck Depression Inventory suicide item, and the Beck Hopelessness Scale), and an ability to discriminate between participants with versus without history of suicide attempts. Regression analyses indicated that the CARS measure can be used with a general population, providing information predictive of suicidal behavior beyond that of minority status alone. Minorities, however, reported experiencing the CARS cultural risk factors to a greater extent than nonminorities, though effect sizes were small. Overall, results show that the CARS items are reliable, and the instrument identifies cultural suicide risk factors not previously attended to in suicide assessment. The CARS is the first to operationalize a systematic model that accounts for cultural competency across multiple cultural identities in suicide risk assessment efforts. © 2013 American Psychological Association.
Keywords: Assessment; Culture; Diversity; Measurement; Suicide

Suicide Ideation and Suicide Attempts Among White Southern Lesbians - Irwin, J.A.; Austin, E.L. (Journal of Gay and Lesbian Mental Health, 2013)
Several studies find suicide behaviors to be more prevalent among lesbian, gay, and bisexual (LGB) populations than their heterosexual counterparts. Studies of non-LGB populations reveal 13% prevalence of lifetime ideation and 4% prevalence of lifetime attempts. This study analyzed data from the Lesbian Social Life (LSL) study, a primarily online, survey-based research project focusing on lesbians living in the southern United States, and found that more than 40% of participants had seriously considered suicide and more than 15% had attempted suicide. We estimated the likelihood of suicide ideation and attempts by utilizing known general risk factors and lesbian-specific indicators within hierarchical logistic regression. Predictors of suicide ideation and attempts included depressive symptoms, discrimination, social support, self-esteem, and stigma. Results highlight the magnitude of suicide behaviors in southern lesbians and important predictor variables. Analysis shows support for the minority stress theory, and policy and clinical recommendations are provided. © 2013 Copyright Taylor and Francis Group, LLC.
Keywords: mental health; mental illness-suicide; sexual identity-lesbian

If it quacks like a duck: reviewing health care providers' speech restrictions under the first prong of Central Hudson. - Fultz, S.L. (The American University law review, 2013)
The First Amendment protects the speech of health care providers. This protection can limit states' abilities to protect patients from harmful therapies involving speech, such as sexual orientation change efforts. Because providers' speech is more similar to commercial speech than traditional political discourse, it is possible to create a First Amendment review analysis that better balances states' police powers with providers' First Amendment rights. Under a "single-prong" approach, the first prong of Central Hudson can be used to identify quackery, which is analogous to false or misleading commercial speech and would therefore be outside the protection of the First Amendment. Because health care must be tailored to individual patients, restrictions on speech that survive the first prong of Central Hudson would be subject to strict scrutiny in order to leave the therapeutic decision to the provider and her patient, and maintain consistency with current jurisprudence. This Comment examines litigation from California's attempted ban on sexual orientation change therapy to illustrate the conflicts created by the current approach to First Amendment review of health care provider speech. This Comment then demonstrates the benefit of the proposed single-prong approach, including how it simultaneously protects patients from harm while protecting health care providers' speech.

Articulations: Violence, the body and language in Marie Nimier - Gascoigne, D. (Forum for Modern Language Studies, 2013)
In Marie Nimier's second novel, La Girafe, key moments of violence and transgressive sex are marked by a leitmotif of strangulation, which feeds into an existing trauma of the protagonist-narrator Joseph, a zoo employee. Joseph's damaged sexual development finds expression in his infatuation with, and need to dominate, Hedwige, a young female giraffe, in whose death by strangulation he is complicit, and in a subsequent violent homosexual encounter. The strangulation motif also features in Marie Nimier's account in La Reine du silence of her father's abusive relationship with her mother, alongside reference to his attempted suicide. A subtle play of names can be seen as pointing towards an indirect evocation of an episode of rape in Roger Nimier's most famous novel, Le Hussard bleu. In each case, it is not just the physical integrity of the female which is at stake in the act of violence, but access to language, embodied in throat (speech) and wrist (writing). This indissoluble link between body and articulation is acutely problematized in Marie Nimier's writing, and in the view she develops of her identity and her project as a writer. © The Author (2012). Published by Oxford University Press for the Court of the University of St Andrews. All rights reserved.
Keywords: Articulation; Body; Language; Nimier, Marie; Nimier, Roger; Sexual identity; Strangulation; Violence

A measure of polarization on social media NetworksBased on community boundaries - Calais Guerra, P.H.; Meira Jr., W.; Cardie, C.; Kleinberg, R. (Proceedings of the 7th International Conference on Weblogs and Social Media, ICWSM 2013, 2013)
Polarization in social media networks is a fact in several scenarios such as political debates and other contexts such as same-sex marriage, abortion and gun control. Understanding and quantifying polarization is a longterm challenge to researchers from several areas, also being a key information for tasks such as opinion analysis. In this paper, we perform a systematic comparison between social networks that arise from both polarized and non-polarized contexts. This comparison shows that the traditional polarization metric - modularity - is not a direct measure of antagonism between groups, since non-polarized networks may be also divided into fairly modular communities. To bridge this conceptual gap, we propose a novel polarization metric based on the analysis of the boundary of a pair of (potentially polarized) communities, which better captures the notions of antagonism and polarization. We then characterize polarized and non-polarized social networks according to the concentration of high-degree nodes in the boundary of communities, and found that polarized networks tend to exhibit low concentration of popular nodes along the boundary. To demonstrate the usefulness of our polarization measures, we analyze opinions expressed on Twitter on the gun control issue in the United States, and conclude that our novel metrics help making sense of opinions expressed on online media. Copyright © 2013, Association for the Advancement of Artificial Intelligence (www.aaai.org). All rights reserved.

Aborigines, colonizers and newcomers: ThE landscape of transcultural psychiatry research in Australia - Zubaran, C.; Foresti, K.; de Moore, G. (Transcultural Psychiatry, 2013)
The authors present an analysis of transcultural psychiatry research in relation to three main population groups in Australia: Aboriginal Australians, documented immigrants, and refugees. The pioneering reports produced by Western psychiatrists in Aboriginal communities are examined in this article. Additional quantitative and qualitative studies developed with Aboriginal people in the context of a traumatic acculturation process are also reviewed. Subsequently, the authors examine the challenges faced by immigrants with mental disorders in a health care system still unequipped to treat a new array of clinical presentations unfamiliar to the clinical staff. The authors also highlight the development of policies aimed at providing quality mental health care to a mosaic of cultures in an evolving multicultural society. Lastly, the psychiatric manifestations of refugees and asylum seekers are analysed in the context of a series of vulnerabilities and deprivations they have experienced, including basic human rights. © 2013, SAGE Publications. All rights reserved.
Keywords: Australia; Australian Aborigines; immigrants; refugees; transcultural psychiatry

Overrepresentation and disparate outcomes: Examining health disparities based on sexual orientation in the context of homeless youths - Gattis, M.N. (Advances in Education in Diverse Communities: Research, Policy and Praxis, 2012)
Purpose-This chapter discusses a study that examined outcomes between homeless sexual minority youths and their heterosexual counterparts regarding family, peer behaviors, school, mental health (suicide risk and depression), stigma, discrimination, substance use, and sexual risk behaviors. Methodology-Structured interviews were conducted with individuals ages 16-24 at three drop-in programs serving homeless youths in downtown Toronto (N=147). Findings-Bivariate analyses indicate statistically significant differences between homeless sexual minorities (n=66) and their heterosexual counterparts (n=81) regarding all parameters except school engagement, including family communication, peer behaviors, stigma, discrimination, mental health, substance use, and sexual risk behaviors. Specifically, homeless sexual minority youths fared more poorly than their heterosexual counterparts. Implications-Improving family communication may be a worthwhile intervention for the youths who are still in contact with their families. Future research should focus on victimization in the context of multiple systems. Copyright © 2012 by Emerald Group Publishing Limited.
Keywords: Discrimination; Gay; Homeless; Mental health; Substance use

HIV risk, substance use, and suicidal behaviors among Asian American lesbian and bisexual women - Lee, J.; Hahm, H.C. (AIDS Education and Prevention, 2012)
The authors examined the association between lesbian/bisexual identity and three risky health behaviors (HIV risk, substance use, and suicidal behaviors) in a sample of Asian American women. This cross-sectional study was designed to investigate the prevalence of HIV risk behaviors and mental health functioning among unmarried Chinese, Korean, and Vietnamese women ages 18 to 35 who are children of immigrants (N = 701), using computer-assisted survey interviews (CASI). Approximately one out of five Asian American women in the sample identified themselves as a lesbian and bisexual woman (18%). Overall, Asian American lesbian and bisexual women reported higher proportions of risky health behaviors than did their exclusively heterosexual counterparts. The odds of engaging in HIV risk behaviors, using substances, and experiencing suicidal ideation were two to three times higher for lesbian and bisexual women than for exclusively heterosexual women. These findings suggest that rigorous screening is necessary for identifying women in this lesbian/bisexual subgroup in order to provide them with better assessment and services. © 2012 The Guilford Press.

The role of the Shari'ah in contemporary moral and social development - Kadouf, H.A. (Australian Journal of Basic and Applied Sciences, 2012)
The modern world has increasingly witnessed paucity of people with impeccable moral standards. All forms of moral bankruptcy are being witnessed across nations of the world. Muslim nations are also not excluded from this. This ranges from homosexuality, same sex marriage, abortion, suicide, euthanasia, and corruption to mention but a few. This ultimately calls to question the impact, which the law has in the moral and social development of nations. The problem seems to be aggravated as a result of the gap and disconnection between law and morality. The tremendous impact of this on moral and social development of the society is better imagined than real. Based on this premise, the paper analyses the role of the Shari'ah in contemporary moral and social development. In doing this, it analyses how the Shari'ah puts in place mechanisms to ensure moral and social developments in the society. It further discusses the perspectives of the Shari'ah to the contemporary moral issues. For this purpose, the verses of the Qur'an, Sunnah of the Prophet (s.a.w.) and opinions of learned Muslim scholars are used.

Suicidal punishment in the ant acromyrmex versicolor - Pollock, G.B.; Cabrales, A.; Rissing, S.W.; Binmore, K.G. (Evolutionary Ecology Research, 2012)
Background: Several queens of the desert leaf-cutter ant Acromyrmex versicolor often establish nests in common. Before the emergence of workers, a single founding queen undertakes the risky but necessary task of foraging on behalf of the whole colony. The queen who previously took on the specialized task of removing soil from the nest during excavation usually also acts as the forager. Rissing et al. (1996) revealed that a queen that refuses the foraging task in such circumstances is not replaced by her cofoundresses. Shirking on the part of the nominated forager is therefore punished in a manner that results in the colony's demise. Question: How is such suicidal punishment to be explained? Methods: We model cofoundress options as a game in asexual haploid strategies where self-preserving replacement of a shirking foundress exists as an alternative to the observed behaviour (Pollock et al., 2004). Embedding this game in the natural history of A. versicolor, we simulate populations for 500,000 years with various mutation regimes and parameter sets, the latter sometimes deviating significantly from A. versicolor. We follow the simulations with a formal game-theoretic analysis. Results: In our simulations, stability is stochastic. However, there is a parameter range in which self-preservation never outperforms suicidal punishment, although the former can recur and drift upwards for some time. We conclude that suicidal punishment survives because it sustains the efficient coordination mechanism by means of which the foraging queen is chosen. Our formal game-theoretic analysis supports that conclusion. © 2012 Kenneth G. Binmore.
Keywords: Acromyrmex Versicolor; Coordination Mechanism; Group Selection; Pleiotropy; Self-Preservation; Stochastic Stability; Subgame Perfection; Suicidal Punishment; Viscous Dispersal

The 'Other' in Sociological Canons: Reading the Trinity through Critical Post-colonial Lens - Datta, A. (Journal of Intercultural Studies, 2012)
The imagery of 'otherness' played a significant role in modern Europe's cognisance of the orient, the colonised, the feminine and the homosexual which were viewed as threats to the values of a 'rational, progressive and civilised' society. But how was 'the non-European other' represented in classical sociology's canons authored by the trinity of Durkheim, Weber and Marx? The paper focuses on Durkheim's examination of the Hindu sati as an altruistic suicide, Weber's theorisation that the European Protestant Christianity could only produce rationality and capitalism, and Marx's non-reflexive neglect of the progressive pre-modern from India's pre-colonial past. A critical post-colonial reading of the selected texts identifies the ahistorical, orientalist, racialised, colonialist and historicist fault lines that crisscross the sociological canons. The time is ripe to rectify the denial of subjecthood to the 'non-western other' that we often encounter in the sociological canons. The paper concludes that the 'non-western other' is capable of being a subject in her own right. The critical engagement with the sociological canons is a small step towards building the ground for a more reflexive and historically specific global sociology in the post-colonial era. As an intellectual endeavour of the post-colonial era, global sociology should be vigilant about global capitalism's tendency towards obliterating the diverse ways of thinking and acting. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: Classical Sociology; Durkheim; Global Capitalism; Global Sociology; Hindu Sati; India; Marx; Non-western Modernity; Post-colonial Sociology; Weber

Protection of genetic heritage in the era of cloning - de Oliveira Júnior, E.Q.; de Oliveira, P.B.Q. (Revista Brasileira de Hematologia e Hemoterapia, 2012)
Research on human beings has expanded greatly due to progress and the evolution of society as well as customs. Not only the unceasing development of research on human beings, but also interference in the beginning and end of life with homologous and heterogonous human reproduction, surrogate motherhood, cloning, gene therapies, eugenics, euthanasia, dysthanasia, orthothanasia, assisted suicide, genetic engineering, reassignment surgery in cases of transsexuality, the use of recombinant DNA technology and embryonic stem cells, transplantation of human organs and tissues, biotechnology and many other scientific advances. Scientific progress goes faster than the real needs of human beings, who are the final recipient of the entire evolutionary progress. Hence, there is the need to scrutinize whether new technologies are necessary, suitable and timely so that humanity can achieve its postulate of bene vivere. Human cloning, as an abrupt scientific fact, has presented itself to the world community as a procedure that can be performed with relative success and with little difficulty, since it achieved its objectives with the cloning of Dolly the sheep. This issue became the topic of discussion not only in the scientific community but in the lay population, and it received from both, global disapproval. The conclusion is that the human being is unique, with a life cycle defined by the rules of nature. Reversal will cause a violation of the genetic heritage and, above all, will confront the constitutional principle of human dignity.
Keywords: Cloning; Exposure to biological agents/legislation &; Genetic heritage; Genome; Human; Jurisprudence; Organisms/legislation &; Organisms/utilization; Research/legislation &; Stem cells

Suicide thoughts and attempts of suicide in adolescents with hetero and homoerotic sexual practices - Teixeira-Filho, F.S.; Rondini, C.A. (Saude e Sociedade, 2012)
This survey, which had as the target population adolescents aged between 12 and 20 years living in three municipalities in São Paulo, sought to investigate the associations between sexual orientation and ideation and suicide attempts. Confirming international research findings, it is showed that non-heterosexuals are more likely to attempt and think about suicide, compared to heterosexuals. However, we found that among the group of teenagers who assumed to be non-heterosexuals, the most vulnerable are those who define themselves as bisexual and "other", which constitute the group of people less assumed, among non-heterosexuals. Similarly, it was found that the respondents have different homophobic, sexist and heterocentric opinions and values, which turn out to be the school environment, where these young non-heterosexual study, loaded with enough discriminatory discursive positions. We conclude that the issue of suicide is a public health problem and that the population of young non-heterosexual needs specific approaches for prevention and care in respect to this conduct.
Keywords: Adolescence; Homophobia; Homosexuality; Sexual identity; Suicide; Violence

Improving the lives of students, gay and straight alike: Gay-straight alliances and the role of school psychologists - Murphy, H.E. (Psychology in the Schools, 2012)
Lesbian, gay, bisexual, and transgender (LGBT) students face many risk factors every day when they enter their school's door. These students often fear for their safety at school, are victimized, have academic difficulties, suffer from issues with their identity development, and are at risk for suicide. School-based Gay-Straight Alliances (GSAs) have been shown to reduce the risk for LGBT students in these areas. School psychologists are in a unique position to be instrumental in alleviating many of the problems LGBT students face every day by being a GSA advisor. This article reviews the literature on LGBT student risk in terms of the benefits of a GSA and guides school psychologists on how to start and advise a GSA in their schools. © 2012 Wiley Periodicals, Inc.

Bullying Explains Only Part of LGBTQ-Heterosexual Risk Disparities: Implications for Policy and Practice - Robinson, J.P.; Espelage, D.L. (Educational Researcher, 2012)
Students who identify as lesbian, gay, bisexual, transgender, and questioning (LGBTQ) experience higher rates of victimization by bullying than do their heterosexual-identified peers. In this article, we investigate the extent to which this difference in rates of victimization can explain LGBTQ youths' greater rates of suicidal ideation, suicide attempts, and unexcused absences from school. Our sample consisted of 11,337 students in Grades 7 through 12 from 30 schools in Dane County, Wisconsin. Using both multilevel covariate-adjusted models and propensity-score-matching models, we found that although victimization does explain a portion of the LGBTQ-heterosexual risk disparities, substantial differences persist even when the differences in victimization are taken into account. For example, LGBTQ-identified students were 3.3 times as likely to think about suicide (p < .0001), 3.0 times as likely to attempt suicide (p = .007), and 1.4 times as likely to skip school (p = .047) as propensity-score-matched heterosexual-identified students within the same school who reported equivalent levels of peer victimization. Moreover, in our propensity-score-matched samples, we found substantial differences in suicidal ideation and suicide attempts at both higher and lower levels of victimization. This consistent pattern of findings suggests that policies aimed simply at reducing bullying may not be effective in bringing LGBTQ youth to the level of their heterosexual peers in terms of psychological and educational outcomes. Additional policies may be needed to promote safe, supportive school environments. © 2012 AERA.
Keywords: equity; gay/lesbian studies; hierarchical linear modeling; propensity score matching; stress/coping

In the Wake of Don't Ask Don't Tell: Suicide Prevention and Outreach for LGB Service Members - Wilder, H.; Wilder, J. (Military Psychology, 2012)
It is estimated that lesbian, gay, and bisexual (LGB) individuals are three to five times more likely to attempt suicide than their heterosexual counterparts. Factors linked to increased LGB suicide risk are overt and covert discrimination, internalized oppression, nondisclosure of sexual orientation, and lack of adequate social support. As the U.S. military adjusts to the repeal of Don't Ask Don't Tell (DADT), it will be imperative to understand and support service people who are struggling with many of these same issues. This article explores factors linked to suicidality and provides education for professionals working with LGB service people. Emphasis is placed on strategies for the provision of support and suicide prevention for members of this population. © 2012 Copyright Division 19 (Society for Military Psychology) of the American Psychological Association.

Sexuality education school policy for Australian GLBTIQ students - Jones, T.M.; Hillier, L. (Sex Education, 2012)
Education is state-run in Australia, and within each of the eight states and territories there are both government and independent schooling systems. This paper details the position of gay, lesbian, bisexual, transgender, intersex and queer (GLBTIQ) students within Australian education policy documents nationally, focusing on the three largest states and educational sectors in Australia. Survey data are used to report on the schooling experiences of over 3000 Australian GLBTIQ young people aged 14-21 years. Data from interviews with key policy informants identify both the obstacles to implementing policies, and how such obstacles have been overcome. Much official policy sees sexuality education as promoting inclusive, protective and affirming messages around GLBTIQ students. There exist significant correlations between policy and a variety of well-being and psycho-social outcomes for GLBTIQ students, including lowered incidence of homophobic abuse and suicide, and the creation of supportive school environments. Ideal policy visions are outlined, along with practical recommendations of relevance to a variety of stakeholders. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: Australia; GLBTIQ; policy; schools; sexuality education

When Christianity and Homosexuality Collide: Understanding the Potential Intrapersonal Conflict - Subhi, N.; Geelan, D. (Journal of Homosexuality, 2012)
Reconciling sexual orientation with religious and spiritual beliefs can be challenging for Christian homosexuals, since many Christian churches teach that homosexual behavior is sinful. A qualitative study of 10 male and 10 female Christian homosexuals was conducted via semistructured interviews. This article seeks to explore the potential conflict between Christianity and homosexuality faced by the respondents. Participants' life stories and experiences varied widely. A few respondents were unaffected by the potential conflict between Christianity and homosexuality, however, the majority were affected. Effects included depression, guilt, anxiety, suicidal ideation, and alienation. Implications of the findings for support personnel are included. © 2012 Copyright Taylor & Francis Group, LLC.
Keywords: Christianity; conflict; homosexuality; interview

Long-term cross-sex hormone treatment is safe in transsexual subjects - Meriggiola, M.C.; Berra, M. (Asian Journal of Andrology, 2012)
The European Journal of Endocrinology recently published a paper (Asscheman et al.) presenting mortality data from more than a thousand transsexuals followed for a median time of 18 years and who had undergone previous or were currently on long term cross-sex hormonal treatment. Transsexualism is a rare condition and in scientific literature there are few reports on the long-term safety of different treatment protocols and on the physical and psychological outcomes of medical treatments. The safety of long-term high doses oestrogen or testosterone in subjects of the opposite sex has been debated and data on long term effects are scant at best. The Asscherman paper therefore represents a very important and reassuring reference for professionals working in this field suggesting that mortality is increased among transsexuals although due to causes unrelated to cross sex replacement therapy. These results will benefit the care and treatment of these subjects. © 2012 AJA, SIMM & SJTU. All rights reserved.

Shooting charles henri ford: Cecil beaton and the erotics of the 'low' in the new york tabloids - Linkof, R. (Etudes Photographiques, 2012)
In the mid-1930s, during one of his periodic visits to his employers at Vogue in New York City, the British photographer Cecil Beaton photographed the young American writer Charles Henri Ford sprawled out on a bed of tabloid newspapers. This Ford portrait expresses Beaton's homoerotic investment in the rough edges of American low culture. By re-examining Beaton's response to the violent culture of New York City, and its sensationalized representation in the tabloids, Beaton's photograph of Ford is positioned within a transatlantic frame. Contextualized as such, the photograph is exemplary of the British revulsion - with equal measure of fascination and excitement - at some of the excesses of American mass culture. Because Ford was such an outspoken public voice for the New York homosexual subculture, the image is rife with homoeroticized cues and clues. Beaton utilizes the aesthetics (as well as the actual physical material) of the New York tabloids to create a photograph that is simultaneously violent and erotic, 'high' art and 'low' culture. © Etudes photographiques.

Effects of violence on transgender people - Testa, R.J.; Sciacca, L.M.; Wang, F.; Hendricks, M.L.; Goldblum, P.; Bradford, J.; Bongar, B. (Professional Psychology: Research and Practice, 2012)
While recent research on transgender populations has demonstrated high rates of experiencing violence, there has been little research attention to the mental health implications of these experiences. This study utilized data collected from the Virginia Transgender Health Initiative Survey (THIS) of transgender people (individuals who described their gender identity as different from their sex assigned at birth) collected from 2005-2006. Current study analyses were limited to two subgroups: trans women (n = 179) and trans men (n = 92). We hypothesized that, as in the general population, exposure to physical and sexual violence would be related to suicidal ideation, suicide attempts, and substance abuse. Both trans women and trans men in this sample were at high risk for physical and sexual violence, as well as suicidal ideation and suicide attempt. Logistic regression analyses indicated that among both trans women and trans men, those who had endured physical and/or sexual violence were significantly more likely than those who had not had such experiences to report a history of suicide attempt and multiple suicide attempts. In addition, among trans men, history of physical and sexual violence were each related to alcohol abuse. Among trans women, history of sexual violence was related to alcohol abuse and illicit substance use. Patterns of violence against transgender people were identified and are discussed, including frequent gender-related motivation for violence, low prevalence of reporting violence to police, and variety of perpetrators of violence. Clinical implications and recommendations are provided. © 2012 American Psychological Association.
Keywords: Physical violence; Sexual violence; Substance abuse; Suicide attempt; Transgender

Mediating suicide: Print journalism and the categorization of queer youth suicide discourses - Cover, R. (Archives of Sexual Behavior, 2012)
This article undertakes textual analysis to examine some of the ways in which knowledge around sexualityrelated youth suicide and its causes are produced and made available through news media discourses and news-making processes. Four categories of sexuality-related suicide discourses were identified in news stories and features over the past 20 years: statistical research that makes non-heterosexuality implicit as a cause of suicide; stories aboutdeviancy,guilt, and shame; suicide survivor stories; and bullying/harassment of non-heterosexual persons by individuals in schools and other institutions as suicide cause. Through processes of news productionandmeaning-making, use of expertopinionsofprimary definers, experiential accounts, reliance on citations of quantitative data, private accounts given as entertainment, and the newsworthiness of suicide as drama, public knowledge on queer youth suicide is guided by contemporary journalism. In all cases, the underlying relationship between heteronormativity, mental health, depression, and despair were frequently excluded in news journalism on queer youth suicide. © Springer Science+Business Media, LLC 2012.
Keywords: Bullying; Discourse; News; Queer youth; Sexual orientation; Suicide

The relationship between gender-based victimization and suicide attempts in transgender people - Goldblum, P.; Testa, R.J.; Pflum, S.; Hendricks, M.L.; Bradford, J.; Bongar, B. (Professional Psychology: Research and Practice, 2012)
This article presents empirical research findings from a subsample of 290 transgender participants in the Virginia Transgender Health Initiative Survey (THIS) who reported whether or not they had experienced hostility or insensitivity related to their gender identity or expression during high school, termed in-school gender-based victimization (GBV). The purpose of this study was to assess the impact of in-school GBV on rates of suicide attempts among transgender people. Of the 290 respondents, 44.8% reported they had experienced in-school GBV, and 28.5% reported a history of suicide attempt. Among those who had attempted, 32.5% reported having made one attempt, 28.6% reported a history of two attempts, and 39.0% reported having made three or more attempts. Participants who reported experiencing GBV were approximately four times more likely to have attempted suicide than those who did not. Among the subgroups of 147 trans women and 81 trans men, GBV was associated both with history of suicide attempt, and with a higher number of suicide attempts over the life span. Implications for policy and clinical interventions are discussed. © 2012 American Psychological Association.
Keywords: Bullying; Gender nonconforming; Gender-based victimization; Suicide attempt; Transgender

Suicidal ideation and sexual orientation in college students: The roles of perceived burdensomeness, thwarted belongingness, and perceived rejection due to sexual orientation - Hill, R.M.; Pettit, J.W. (Suicide and Life-Threatening Behavior, 2012)
A theoretical model in which perceived burdensomeness and thwarted belongingness were hypothesized to account for the association between sexual orientation and suicidal ideation among college students was tested. Among 198 college students (mean age 21.28 years), gay, lesbian, and bisexual students (n = 50) reported significantly higher levels of perceived burdensomeness and suicidal ideation than heterosexual students. The relationship between sexual orientation and suicidal ideation was partially accounted for by perceived burdensomeness, but not thwarted belongingness. This indirect effect was stronger at higher levels of perceived or anticipated rejection due to one's sexual orientation. Implications for intervention and prevention science are discussed. © 2012 The American Association of Suicidology.

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

Correlates of depressed mood among young stimulant-using homeless gay and bisexual men - Nyamathi, A.; Branson, C.; Idemundia, F.; Reback, C.; Shoptaw, S.; Marfisee, M.; Keenan, C.; Khalilifard, F.; Liu, Y.; Yadav, K. (Issues in Mental Health Nursing, 2012)
Homeless gay and bisexual (G/B) men are at risk for suicide attempts and have high risk of depressed mood, defined as elevated level of depressive symptoms. This study describes baseline socio-demographic, cognitive, psychosocial, and health- and drug-related correlates of depressed mood in 267 stimulant-using homeless G/B young men who entered a study designed to reduce drug use. G/B men without social support were 11 times more likely to experience depressed mood than their counterparts who had support; those who reported severe body pain were almost six times more likely to report depressed mood than those without pain. Other factors that increased risk of depressed mood included being homeless in the last four months, injecting drugs, reporting poor or fair health status, and high levels of internalized homophobia. This study is one of the first studies to draw a link between pain experienced and depressed mood in homeless young G/B men. Understanding the correlates of depressed mood among homeless G/B young men can help service providers design more targeted treatment plans and provide more appropriate referrals to ancillary care services. © 2012 Informa Healthcare USA, Inc.

Suicidal behaviours in adolescents in Nova Scotia, Canada: Protective associations with measures of social capital - Langille, D.B.; Asbridge, M.; Kisely, S.; Rasic, D. (Social Psychiatry and Psychiatric Epidemiology, 2012)
Purpose: Few studies of adolescent suicidality have examined its associations with social capital. We explored associations of measures of individual level social capital with self-reported suicide ideation and suicide attempt in adolescents in Cape Breton, Nova Scotia, Canada, controlling for other factors known to be associated with adolescent suicidality. Methods: We surveyed 1,597 grade 10-12 students at three high schools in 2006 using self-completion questionnaires. Both sexes were combined for analysis. Outcome measures were suicidal ideation and attempt in the previous year. Measures of social capital included perceptions of trustworthiness and helpfulness of others at school, frequency of religious attendance and participation in extracurricular activities. Logistic regressions were carried out to determine associations of social capital with suicidality while controlling for other factors. Results: Perceived trustworthiness and helpfulness were protective for suicidal ideation and suicide attempt in the previous year. In adjusted analyses, there were interactions of gender and social capital-females reporting more social capital were more protected from suicide attempt relative to males with similar levels of social capital. Conclusion:s: This study provides initial evidence of protective associations of individual level social capital with adolescent suicidality. Our findings suggest that among adolescents low social capital as measured by perceptions of trust and helpfulness of others at school may be a warning sign for suicidality, particularly for females. It may be helpful to inquire of young people how they perceive the trustworthiness and helpfulness of their school environment as a measure of how supportive that environment might be to them when they are facing challenges to their mental health. © Springer-Verlag 2011.
Keywords: Adolescent; Sexual orientation; Social capital; Suicidality

Taiwan field vole (Microtus kikuchii) herbivory facilitates Yushan cane (Yushania niitakayamensis) asexual reproduction in alpine meadows - Yeh, S.-H.; Hsu, J.-T.; Lin, Y.K. (Journal of Mammalogy, 2012)
Herbivores can sometimes benefit the plants they consume. We investigated the interaction between an herbivore species, the Taiwan field vole (Microtus kikuchii), and its major food plant, the Yushan cane (Yushania niitakayamensis) of alpine meadows. We observed consumption of Yushan canes by voles in the field and laboratory, performed 2 field manipulative experiments and 2 laboratory cafeteria feeding experiments, and carried out chemical analyses on different Yushan cane parts to test 2 hypotheses: Taiwan field voles feed preferentially on certain Yushan cane parts due to their different chemical constituents, which vary with season; and herbivory by the Taiwan field vole has positive effects on fitness of Yushan cane. Our results showed that, although Taiwan field voles could exert a strong herbivorous pressure on Yushan canes through their near year-round preference for feeding on Yushan cane leaves, the presence of Taiwan field voles actually increases the emergence of Yushan cane shoots over time. The feeding preference of voles for different plant parts can be explained by plant chemical constituents. We demonstrated that the consumption behavior of voles, which reduces the canopy and creates large litter piles, could facilitate the production of Yushan cane shoots by creating favorable shooting conditions. This study suggests a behavioral mechanism of overcompensation where the gain in asexual reproduction by Yushan cane more than compensates the loss to herbivory by the Taiwan field vole. © 2012 American Society of Mammalogists.
Keywords: bamboo; cafeteria trial; compensation; mutualism; nutrient; plant-herbivore interactions; tolerance

Expert Testimony of the Battered Person Syndrome, Defendant Gender, and Sexual Orientation in a Case of Duress: Evaluating Legal Decisions - Russell, B.; Ragatz, L.; Kraus, S.W. (Journal of Family Violence, 2012)
The current study examined the utility of expert testimony of the battered person syndrome (BPS) in a case of duress and the extent to which defendant gender, defendant sexual orientation, and participant gender influence mock jury decisions in a case of duress. Participants (N = 413) read a scenario based on U. S. v. Dixon (2006) and answered questions assessing verdict, guilt, sentence length, duress legal elements, and attributes typically ascribed to victims of abuse. Results showed heterosexual female defendants were assigned the lowest sentences and met more of the legal elements of duress (i. e., were coerced, more likely to be believed, and purchased a gun to prevent harm) and attributes (i. e., experienced severe abuse, learned helplessness) compared to other defendants. When mock jurors received expert testimony, they provided lower rates of guilt and sentencing for defendants. Results also showed the inclusion of BPS expert testimony increased ratings for many of the legal elements of duress and attributes typically associated with intimate partner violence. In addition, results suggested that while heterosexual female defendants are more likely to be believed in a case of duress, expert testimony of BPS is helpful to all defendants. Limitations and future directions for research and practice are discussed. © 2012 Springer Science+Business Media, LLC.
Keywords: Battered person syndrome; Duress; Expert testimony; Gender; Guilt; Sexual orientation; Verdict

Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity - McLaughlin, K.A.; Hatzenbuehler, M.L.; Xuan, Z.; Conron, K.J. (Child Abuse and Neglect, 2012)
Objectives: Lesbian, gay, and bisexual (LGB) populations exhibit elevated rates of psychiatric disorders compared to heterosexuals, and these disparities emerge early in the life course. We examined the role of exposure to early-life victimization and adversity-including physical and sexual abuse, homelessness, and intimate partner violence-in explaining sexual orientation disparities in mental health among adolescents and young adults. Methods: Data were drawn from the National Longitudinal Study of Adolescent Health, Wave 3 (2001-2002), a nationally representative survey of adolescents. Participants included gay/lesbian (. n=. 227), bisexual (. n=. 245), and heterosexual (. n=. 13,490) youths, ages 18-27. We examined differences in the prevalence of exposure to child physical or sexual abuse, homelessness or expulsion from one's home by caregivers, and physical and sexual intimate partner violence according to sexual orientation. Next we examined the associations of these exposures with symptoms of psychopathology including suicidal ideation and attempts, depression, binge drinking, illicit drug use, tobacco use, alcohol abuse, and drug abuse. Finally, we determined whether exposure to victimization and adversity explained the association between sexual orientation and psychopathology. Results: Gay/lesbian and bisexual respondents had higher levels of psychopathology than heterosexuals across all outcomes. Gay/lesbian respondents had higher odds of exposure to child abuse and housing adversity, and bisexual respondents had higher odds of exposure to child abuse, housing adversity, and intimate partner violence, than heterosexuals. Greater exposure to these adversities explained between 10 and 20% of the relative excess of suicidality, depression, tobacco use, and symptoms of alcohol and drug abuse among LGB youths compared to heterosexuals. Exposure to victimization and adversity experiences in childhood and adolescence significantly mediated the association of both gay/lesbian and bisexual orientation with suicidality, depressive symptoms, tobacco use, and alcohol abuse. Conclusions: Exposure to victimization in early-life family and romantic relationships explains, in part, sexual orientation disparities in a wide range of mental health and substance use outcomes, highlighting novel targets for preventive interventions aimed at reducing these disparities. © 2012 Elsevier Ltd.
Keywords: Childhood adversity; Disparities; LGB; Psychopathology; Sexual orientation; Victimization

The pistol in the suitcase: Motive, temporality, queer youth suicide - Coviello, P.M. (English Studies in Canada, 2012)

Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska natives - Evans-Campbell, T.; Walters, K.L.; Pearson, C.R.; Campbell, C.D. (American Journal of Drug and Alcohol Abuse, 2012)
Background: Systematic efforts of assimilation removed many Native children from their tribal communities and placed in non-Indian-run residential schools. Objectives: To explore substance use and mental health concerns among a community-based sample of 447 urban two-spirit American Indian/Alaska Native adults who had attended boarding school as children and/or who were raised by someone who attended boarding school. Method: Eighty-two respondents who had attended Indian boarding school as children were compared to respondents with no history of boarding school with respect to mental health and substance use. Results: Former boarding school attendees reported higher rates of current illicit drug use and living with alcohol use disorder, and were significantly more likely to have attempted suicide and experienced suicidal thoughts in their lifetime compared to non-attendees. About 39% of the sample had been raised by someone who attended boarding school. People raised by boarding school attendees were significantly more likely to have a general anxiety disorder, experience posttraumatic stress disorder symptoms, and have suicidal thoughts in their lifetime compared to others. © 2012 Informa Healthcare USA, Inc.
Keywords: American Indian/Alaska Native; Boarding school; Mental health; Substance use

Leave to Intervene in Cases of Gender Identity Disorder; Normative Causation; Financial Harms and Involuntary Treatment; and the Right to Be Protected From Suicide - Stewart, C.; Cockburn, T.; Madden, B.; Callaghan, S.; Ryan, C.J. (Journal of Bioethical Inquiry, 2012)

Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men - Greacen, T.; Friboulet, D.; Fugon, L.; Hefez, S.; Lorente, N.; Spire, B. (Sexually Transmitted Infections, 2012)
Objectives: Although not authorised in France, HIV self-tests are easily available online. The authors questioned French-speaking internet-using men who have sex with men (MSM) concerning their access to and use of such tests. Methods: Online questionnaire on sex websites and gay and HIV community websites. A multivariate logistic regression for rare events was used to identify factors associated with accessing self-tests. Results: 9169 MSM completed the questionnaire. 2748 (30%) were aware of online self-tests, but only 82 of those aware and not already HIV positive (3.5%) declared having accessed one and only 69 using it. In the multivariate model, living one's sex-life with men in absolute secrecy (odds ratio (OR)=3.90, 95% CI 1.73 to 8.76), knowing of the tests via a sex partner (OR=3.42, CI 1.39 to 8.41) or an internet search engine (OR=2.18, CI 1.26 to 3.74) but not through the general (OR=0.21, CI 0.11 to 0.42) or the gay press (OR=0.34, CI 0.16 to 0.73), having unprotected anal intercourse with a casual partner in the preceding year (OR=1.90, CI 1.17 to 3.06), using self-tests for other diseases (OR=2.66, CI 1.43 to 4.90), using poppers (OR=2.23, CI 1.35 to 3.67) and doping products (OR=3.53, CI 1.55 to 8) in the preceding year, having done a traditional HIV test but not in the preceding year (OR=1.93, CI 1.14 to 3.32), never having had suicidal thoughts (OR=0.54, CI 0.32 to 0.90) and living in the provinces (OR=1.80, CI 1.01 to 3.25) were all independently associated with accessing self-tests. Conclusions: Although readiness to admit use of unauthorised medical products may have influenced results, few MSM aware of the existence of self-tests actually declared having accessed one. Accessing the self-test was independently associated with both living one's sex-life with men in total secrecy and having had unprotected anal intercourse in the last 12 months, indicating that autonomous self-testing may reduce barriers to testing for this vulnerable population.

The Co-Occurrence of Mental Illness and High HIV Risk in a Sample of African American MSM: Findings and Implications - Loue, S.; Daugherty-Brownrigg, B.; Heaphy, E.; Mendez, N.; Sajatovic, M. (Journal of HIV/AIDS and Social Services, 2012)
African American men who have sex with men often experience rejection and discrimination. Mental illness may contribute to high HIV risk behavior. We assessed the relationship between mental illness and HIV risk among African American men who have sex with men. We assessed 125 African American men who have sex with men aged 18 years or older in Ohio for mental illness, substance use, HIV knowledge, and risk. Bivariate analyses were conducted. Any mental illness was associated with substance abuse (p =.001), child abuse (p =.032), suicide attempts (p =.028), and trading sex for money or drugs (p =.002). Bipolar disorder was associated with trading sex for money or drugs (p =.008). Mood disorders appear undertreated among African American men who have sex with men. More adequate mental health and substance abuse treatment are needed both in the prison system and the community setting to reduce HIV risk and transmission. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: African American; African American men who have sex with men; HIV risk; mental illness; sexual behavior

High levels of psychological distress in MSM are independent of HIV status - Gibbie, T.M.; Mijch, A.; Hay, M. (Journal of Health Psychology, 2012)
This study assessed psychological distress (PD) in men who have sex with men (MSM) accessing primary health clinics in Australia. Relationships between PD, HIV status and substance use were explored. A cross-sectional convenience sample of 250 MSM completed the Personality Assessment Screener (PAS). One-third (n = 83) scored in the PAS clinically significant range, suggesting significant mental health symptoms. Negative Affect (27 per cent clinically significant), Suicidal Thinking (29 per cent clinically significant) and Amphetamine use significantly positively correlated with PD. There were no significant differences between HIV diagnostic groups on PD. A third of MSM displayed PD. Psychological screening may provide valuable information for improving the psychological well-being of MSM, regardless of their HIV status. © The Author(s) 2011.
Keywords: HIV/AIDS; men who have sex with men; psychological distress

Smoking and behavioral health of women - Jessup, M.A.; Dibble, S.L.; Cooper, B.A. (Journal of Women's Health, 2012)
Background: Using data from a study of reliability and validity of a screening tool for co-occurring substance abuse and mental health problems, our objective was to compare behavioral health issues of female smokers and nonsmokers and explore correlates of smoking. Methods: Using a convenience sample (n=1021), we recruited participants to complete an online survey conducted in substance abuse treatment, primary care, mental health services, senior, and public settings. The survey included demographic questions, smoking status, the co-occurring disorders screening tool, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) and the Postraumatic Stress Disorder Checklist (PCL)-Civilian. Results: One third of participants self-identified as smokers, and African American, American Indian, and bisexual women reported the highest rates of smoking. Seventy-two percent of women reported at least one mental health problem in the past year; 29% had a past year substance abuse problem, and 26% reported a past year co-occurring disorder of both. Smokers had significantly higher rates of posttraumatic stress disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders. Smokers also had significantly higher rates of lifetime intimate partner violence (IPV) and childhood abuse. Conclusions: Smoking in women was associated with significantly higher rates of mental health and substance abuse problems. Substance abuse, being in a treatment setting, IPV, African American and mixed ethnicity, Medicaid insurance status, reduced income, and no home ownership were identified as predictors of smoking. Screening and evaluation of smoking status, mental health, substance use disorders, and the presence and impact of violence are essential for women's health. © 2012 Mary Ann Liebert, Inc.

Correlates of consistent condom use among young migrant men who have sex with men (MSM) in Beijing, China - Liu, Y.; Li, X.; Zhang, L.; Li, S.; Jiang, S.; Stanton, B. (European Journal of Contraception and Reproductive Health Care, 2012)
Objectives The prevalence of sexually transmitted infections (STIs), including HIV, among men who have sex with men (MSM) has risen in China, mainly due to unprotected sexual intercourse. Migrant MSM might be more vulnerable to the risk of STIs/HIV because of their low socioeconomic status. This study aims at exploring the correlates of consistent condom use among young migrant MSM (aged 18-29 years) in Beijing. Methods Multivariate logistic regression analysis. Results The mean age of the sample was 23.7 years. Rural-to-urban migrant MSM accounted for 46% of the sample, and urban-to-urban migrant MSM for 54%. Of 307 migrant MSM, 178 (54%) reported having used a condom every time in the last three sexual episodes with both stable and casual sexual partners. Multivariate logistic regression analysis showed that MSM who had a low monthly income, had often experienced alcohol intoxication, did not use a condom at first sex, and had fewer lifetime male sexual partners were less likely to use condoms consistently. Conclusions Consistent condom use among young migrant MSM was relatively low and was associated with socioeconomic status and alcohol use. Future STIs/HIV prevention programmes should strengthen empowerment, access to condoms, and reduction of alcohol consumption within this socio-economically marginalised group. © 2012 The European Society of Contraception and Reproductive Health.
Keywords: China; Consistent condom use; Migrants; MSM; STIs/HIV prevention

A novel combination HIV prevention strategy: Post-exposure prophylaxis with contingency management for substance abuse treatment among methamphetamine- using men who have sex with men - Landovitz, R.J.; Fletcher, J.B.; Inzhakova, G.; Lake, J.E.; Shoptaw, S.; Reback, C.J. (AIDS Patient Care and STDs, 2012)
Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of contingency management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8h (range 12.5-68.0h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI +1-+3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM. © Copyright 2012, Mary Ann Liebert, Inc. 2012.

Gay children and suicidality: The importance of professional nurturance - McAndrew, S.; Warne, T. (Issues in Mental Health Nursing, 2012)
Suicidality among young people is a global concern, with international studies demonstrating an increased prevalence among young gay men. Being gay is not inevitably linked to mental illness, but growing up gay in a heterosexist society can compromise mental well being. This qualitative study, using free association narrative interviewing, offers an in-depth understanding of gay men's experience. One shared experience that emerged was "knowing and not knowing," the story of gay children growing up in a heterosexist society. This story provides valuable insights for mental health nurses becoming more attuned to the importance of providing professional nurturing of gay children. © 2012 Informa Healthcare USA, Inc.

Depression and dementia - Chong, S. (Australian Journal of Pharmacy, 2012)

Antidepressant agents and suicide death among US department of veterans affairs patients in depression treatment - Valenstein, M.; Kim, H.M.; Ganoczy, D.; Eisenberg, D.; Pfeiffer, P.N.; Downing, K.; Hoggatt, K.; Ilgen, M.; Austin, K.L.; Zivin, K.; Blow, F.C.; McCarthy, J.F. (Journal of Clinical Psychopharmacology, 2012)
Background: Studies report mixed findings regarding antidepressant agents and suicide risks, and few examine suicide deaths. Studies using observational data can accrue the large sample sizes needed to examine suicide death, but selection biases must be addressed. We assessed associations between suicide death and treatment with the 7 most commonly used antidepressants in a national sample of Department of Veterans Affairs patients in depression treatment. Multiple analytic strategies were used to address potential selection biases. Methods: We identified Department of Veterans Affairs patients with depression diagnoses and new antidepressant starts between April 1, 1999, and September 30, 2004 (N = 502,179). Conventional Cox regression models, Cox models with inverse probability of treatment weighting, propensity-stratified Cox models, marginal structural models (MSM), and instrumental variable analyses were used to examine relationships between suicide and exposure to bupropion, citalopram, fluoxetine, mirtazapine, paroxetine, sertraline, and venlafaxine. Results: Crude suicide rates varied from 88 to 247 per 100,000 person-years across antidepressant agents. In multiple Cox models and MSMs, sertraline and fluoxetine had lower risks for suicide death than paroxetine. Bupropion had lower risks than several antidepressants in Cox models but not MSMs. Instrumental variable analyses did not find significant differences across antidepressants. DISCUSSION: Most antidepressants did not differ in their risk for suicide death. However, across several analytic approaches, although not instrumental variable analyses, fluoxetine and sertraline had lower risks of suicide death than paroxetine. These findings are congruent with the Food and Drug Administration meta-analysis of randomized controlled trials reporting lower risks for "suicidality" for sertraline and a trend toward lower risks with fluoxetine than for other antidepressants. Nevertheless, divergence in findings by analytic approach suggests caution when interpreting results. Copyright © 2012 by Lippincott Williams & Wilkins.
Keywords: depression; suicide; veterans

You are a Flaw in the Pattern: Difference, Autonomy and Bullying in YA Fiction - Lopez-Ropero, L. (Children's Literature in Education, 2012)
Though portrayals of bullying in children's books stretch back to Victorian public school stories, this article sees a new subgenre about bullying in young adult novels emerging in the post-Columbine years. Selected works by Jerry Spinelli, Walter Dean Myers, Jaime Adoff, Carol Plum-Ucci and Rita Williams-Garcia are examined, although the article begins by looking at a precursor of this subgenre, Robert Cormier's classic The Chocolate War. In this subgenre, it is argued that bullying is not presented as dysfunctional adolescent behavior, but as a tool for addressing issues of difference and discrimination on the grounds of race, class, sexual orientation or personality; issues that filter into adolescent culture. High schools are thus portrayed as totalitarian microcosms where bullying functions as a means of social control, curbing deviance from masculine, heterosexual, middle-class and white norms. The narrative techniques and themes of these books-around homophobia, jock culture, rampage shootings and girl-on-girl violence-will be examined. © 2011 Springer Science+Business Media, LLC.
Keywords: Bullying; Difference; Girl-on-girl violence; Homophobia; Racism; Young adult

Depression associated with antiretroviral drug therapy in HIV: Case report and overview - Kaestner, F.; Anneken, K.; Mostert, C.; Reichelt, D.; Rothermundt, M.; Evers, S.; Husstedt, I.W. (International Journal of STD and AIDS, 2012)
Summary: Depression is the main psychiatric symptom in patients living with HIV. Genetic predisposition, stress from disease as well as the antiretroviral therapy itself are discussed as pathogenic factors. We report a 35-year-old HIV-positive man suffering from bipolar disorder who developed major depression shortly after commercing combination antiretroviral therapy (cART) on three occasions. The first two times the patient ceased therapy autonomously, and the depression disappeared completely. The close connection between cART and major depression in the present case supports the depression-inducing potential of cART. Additionally, we present an overview of literature.
Keywords: Adherence; Adverse effects; Affective disorders; Antiretroviral therapy; Depression; HIV/AIDS

Unmet Mental Health and Substance Abuse Treatment Needs of Sexual Minority Elders - Jessup, M.A.; Dibble, S.L. (Journal of Homosexuality, 2012)
In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55-64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed. © 2012 Taylor and Francis Group, LLC.
Keywords: co-occurring disorders; LGB; mental health; substance abuse

Cyber and bias-based harassment: Associations with academic, substance use, and mental health problems - Sinclair, K.O.; Bauman, S.; Poteat, V.P.; Koenig, B.; Russell, S.T. (Journal of Adolescent Health, 2012)
Purpose: To examine how two forms of interstudent harassment, cyber and bias-based harassment, are associated with academic, substance use, and mental health problems. Methods: We used a population-based survey of 17,366 middle and high school students that assessed harassment due to race/ethnicity or sexual orientation, and harassment through the Internet or text messaging along with other forms of interstudent harassment. Results: Odds ratios indicated that students experiencing both cyber and bias-based harassment were at the greatest risk for adjustment problems across all indicators, with suicidal ideation and attempts having the largest risk differences. Conclusions: Assessments of adolescent health and adjustment should include questions regarding both cyber and bias-based harassment. © 2012 Society for Adolescent Health and Medicine.
Keywords: Cyber bullying; Race-based harassment; Sexual orientation-based harassment; Substance use; Suicide

Hormone treatment of gender identity disorder in a cohort of children and adolescents - Hewitt, J.K.; Paul, C.; Kasiannan, P.; Grover, S.R.; Newman, L.K.; Warne, G.L. (Medical Journal of Australia, 2012)
Objective: To describe the experience of hormone treatment of gender identity disorder (GID) in children and adolescents within a specialist clinic. Design, patients and setting: Cohort study by medical record review of children aged 0-17 years referred during 2003-2011 for management at the GID clinic in a tertiary paediatric referral centre - the Royal Children's Hospital, Melbourne, Victoria. Main outcome measures: Clinical characteristics of the patient population, hormone treatment provided, frequency of referrals with time. Results: Thirty-nine children and adolescents were referred for gender dysphoria. Seventeen individuals were pubertal with persistent GID, and were considered eligible for hormone treatment. Seven patients, comprising three biological males and four biological females, had legally endorsed hormone treatment. In this group, gender dysphoria was first noted at 3-6 years of age. Hormone treatment with GnRH analogue to suppress pubertal progression (phase 1) was given at 10-16 years of age. Treatment with cross-sex hormones (phase 2) was given at 15.6-16 years. One patient purchased cross-sex hormone treatment overseas. One patient received oestrogen and progesterone for menstrual suppression before phase 1. The annual frequency of new referrals increased continuously over the study period. Conclusions: Hormone treatment for pubertal suppression and subsequent gender transition needs to be individualised within stringent protocols in multidisciplinary specialist units.

Self-Cutting and Suicidal Ideation among Adolescents: Gender Differences in the Causes and Correlates of Self-Injury - Bakken, N.W.; Gunter, W.D. (Deviant Behavior, 2012)
In recent years, non-suicidal self-injury (NSSI) among adolescents has been identified as alarmingly common place. Some studies have suggested that more than one in eight adolescents have engaged in self-cutting or other self-injuring behaviors. Even more of a concern is that self-injury often foreshadows suicide or suicide attempts. With self-cutting common in middle and high schools, understanding the antecedents and correlates of such behavior may help counselors and others public health officials identify troubled students and initiate preventative measures. This study utilizes data from 2,639 high school students from the Delaware Youth Risk Behavior Survey to investigate the gender differences in NSSI and suicidal ideation. Overall, 13% reported engaging in NSSI within the past year, with females reporting significantly higher rates (17%) of NSSI than males (9%). Results indicate that there are significant gender differences in NSSI and suicidal thoughts based upon previous victimization experiences, reported substance use, depression, health behaviors, and sexual orientation. © 2012 Copyright Taylor and Francis Group, LLC.

Development stage-specific proteomic profiling uncovers small, lineage specific proteins most abundant in the Aspergillus Fumigatus conidial proteome - Suh, M.-J.; Fedorova, N.D.; Cagas, S.E.; Hastings, S.; Fleischmann, R.D.; Peterson, S.N.; Perlin, D.S.; Nierman, W.C.; Pieper, R.; Momany, M. (Proteome Science, 2012)
Background: The pathogenic mold Aspergillus fumigatus is the most frequent infectious cause of death in severely immunocompromised individuals such as leukemia and bone marrow transplant patients. Germination of inhaled conidia (asexual spores) in the host is critical for the initiation of infection, but little is known about the underlying mechanisms of this process.Results: To gain insights into early germination events and facilitate the identification of potential stage-specific biomarkers and vaccine candidates, we have used quantitative shotgun proteomics to elucidate patterns of protein abundance changes during early fungal development. Four different stages were examined: dormant conidia, isotropically expanding conidia, hyphae in which germ tube emergence has just begun, and pre-septation hyphae. To enrich for glycan-linked cell wall proteins we used an alkaline cell extraction method. Shotgun proteomic resulted in the identification of 375 unique gene products with high confidence, with no evidence for enrichment of cell wall-immobilized and secreted proteins. The most interesting discovery was the identification of 52 proteins enriched in dormant conidia including 28 proteins that have never been detected in the A. fumigatus conidial proteome such as signaling protein Pil1, chaperones BipA and calnexin, and transcription factor HapB. Additionally we found many small, Aspergillus specific proteins of unknown function including 17 hypothetical proteins. Thus, the most abundant protein, Grg1 (AFUA_5G14210), was also one of the smallest proteins detected in this study (M.W. 7,367). Among previously characterized proteins were melanin pigment and pseurotin A biosynthesis enzymes, histones H3 and H4.1, and other proteins involved in conidiation and response to oxidative or hypoxic stress. In contrast, expanding conidia, hyphae with early germ tubes, and pre-septation hyphae samples were enriched for proteins responsible for housekeeping functions, particularly translation, respiratory metabolism, amino acid and carbohydrate biosynthesis, and the tricarboxylic acid cycle.Conclusions: The observed temporal expression patterns suggest that the A. fumigatus conidia are dominated by small, lineage-specific proteins. Some of them may play key roles in host-pathogen interactions, signal transduction during conidial germination, or survival in hostile environments. © 2012 Suh et al.; licensee BioMed Central Ltd.
Keywords: APEX; Aspergillus fumigatus; Conidia; Fungi; Germination; Hypothetical proteins; LC-MS/MS; Mass spectrometry; Shotgun proteomics; Spore

Broom closet or fish bowl? an ethnographic exploration of a university queer center and oneself - Teman, E.D.; Lahman, M.K.E. (Qualitative Inquiry, 2012)
The authors detail an educational ethnography of a university queer cultural center's role on campus and in the surrounding community. The data include participant observation, in-depth interviews, and artifacts. The authors review lesbian, gay, bisexual, transgender, ally, and questioning (LGBTAQ) issues in higher education, heterosexual attitudes, and queer theory. The findings of barriers to the Center's mission plus the suicide of a Center student prompted the authors to explore research poetry as a means to express the inexpressible. Furthermore, they illustrate tensions between contemporary queer and gay theories through the telling of a straight tale (traditional research report) and a gay tale (experiential research report), interrupted with queer tales (poetic interludes) and queer asides. At the heart of the tale is the transformation of the first author, a gay male, to a researcher and scholar of gay issues. This tale is therefore at all times queer, gay, and straight. © SAGE Publications 2012.
Keywords: cultural center; ethics; ethnography; GLBT; higher education; LGBT; poetry; queer; suicide; tale; university; violence

Sexual Minority Status, Abuse, and Self-Harming Behaviors among Incarcerated Girls - Belknap, J.; Holsinger, K.; Little, J. (Journal of Child and Adolescent Trauma, 2012)
This self-report study of 404 incarcerated youth found extraordinarily high rates of sexual minority status (SMS; i.e., lesbian/gay or bisexual) among the girls, particularly girls of color. Further analyses of the 107 girls 16 and older found that SMS girls reported being the victims of abuse and engaging in self-harming behaviors more than non-SMS (straight) girls. Structural equation models indicated that regardless of sexual identity, abuse was a risk factor for self-harming. This relationship held for physical or sexual abuse and for abuse by family members or people outside the family. Relative to non-SMS girls, SMS girls demonstrated higher rates of sexual abuse, primarily family sexual abuse, which mediated the relationship between SMS and self-harming. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: bisexual; child abuse; cutting; delinquents; lesbian; self-injury; sexual identity; suicide; youth

Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco - Shields, J.P.; Whitaker, K.; Glassman, J.; Franks, H.M.; Howard, K. (Journal of Adolescent Health, 2012)
Purpose: This study investigated the association between sexual orientation, victimization, and suicide risk-related outcomes among youth attending public high schools in San Francisco. Methods: Data from the 2009 Youth Risk Behavior Survey were analyzed using bivariate and logistic regression methods for complex samples to examine the relationship between sexual orientation, victimization, and three suicide risk-related outcomes (sadness/depression, suicide planning, and attempting suicide) while controlling for demographics and substance use. Results: Lesbian, gay, or bisexual (LGB) youth reported significantly higher rates of substance use, victimization, and suicide risk-related outcomes than heterosexual youth. However, in the controlled regression models, victimization was a significant predictor of sadness/depression and suicide attempts, regardless of sexual orientation. There was a significant interaction effect between sexual orientation and victimization on suicide planning, with heterosexual youth more affected than LGB youth. Conclusions: Results underscore the deleterious effect of victimization on suicide risk-related outcomes, regardless of sexual orientation. As LGB youth continue to report higher rates of victimization, effective violence prevention approaches must focus on reducing violence among youth, specifically LGB youth. Additional research should focus on identification of other factors that may help further explain elevated suicide risk among LGB youth. © 2012 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: Lesbian, gay, and bisexual youth; Logistic regression; Suicide risk; Victimization; Youth Risk Behavior Survey (YRBS)

Longitudinal predictors of past-year non-suicidal self-injury and motives among college students - Wilcox, H.C.; Arria, A.M.; Caldeira, K.M.; Vincent, K.B.; Pinchevsky, G.M.; O'Grady, K.E. (Psychological Medicine, 2012)
Background Non-suicidal self-injury (NSSI) is the deliberate and direct injuring of body tissue without suicidal intent for purposes not socially sanctioned. Few studies have examined the correlates of NSSI among young adults. This study aimed to identify predictors of lifetime and past-year NSSI, and describe motives for NSSI and disclosure of NSSI to others. Method Interviews were conducted annually with 1081 students enrolled in the College Life Study, a prospective longitudinal study conducted at a large public mid-Atlantic university. NSSI characteristics were assessed at Year 4. Demographic and predictor variables were assessed during Years 1 to 4. Multivariate logistic regression models were used to identify correlates of lifetime NSSI and predictors of past-year NSSI. Results The prevalence of past-year and lifetime NSSI was 2% and 7% respectively (>70% were female for both lifetime and past-year NSSI). Seven percent of NSSI cases self-injured once, whereas almost half self-injured six or more times. Independent predictors of past-year NSSI were maternal depression, non-heterosexual orientation, affective dysregulation and depression. Independent predictors of lifetime NSSI were depression, non-heterosexual orientation, paternal depression and female sex. One in six participants with NSSI had attempted suicide by young adulthood. The three most commonly reported motives for NSSI were mental distress, coping and situational stressors. Most (89%) told someone about their NSSI, most commonly a friend (68%). Conclusions This study identified unique predictors of NSSI, which should help to elucidate its etiology and has implications for early identification and interventions. © 2011 Cambridge University Press.
Keywords: College students; deliberate self-harm; NSSI; self-injurious behavior; young adults

Mental Health Service Contacts Among Sexual Minority and Heterosexual Girls in Boston Public High Schools - Kidd, J.D.; White, J.L.; Johnson, R.M. (Journal of Gay and Lesbian Mental Health, 2012)
Although sexual minority (SM) adolescent girls are at high risk for suicidal behavior, little is known about their use of mental health services (MHS). Therefore, we examined survey data from a sample of Boston high school students to compare the prevalence of MHS use among SM and heterosexual girls.We used chi-square tests to assess the statistical significance of group differences. To test whether SM status moderated the association between MHS use and mental health need (i.e., whether the student reported self-harm, suicidal ideation, or a suicide attempt in the past year), we entered mental health need, SM status, and the interaction term of the two into a regression model that predicted past 12-month MHS use.SM girls (n = 89) were significantly more likely than heterosexual girls (n = 800) to report suicidal ideation, suicide attempts, and self-harm. SM girls were also more likely to have reported a past 12-month MHS contact (54% vs. 26%, p < 0.0001); this finding held for those with and without a high level of mental health need. The interaction term was not statistically significant, indicating that SM status does not moderate the effect of mental health need on MHS use. These results indicate that SM girls, particularly those experiencing suicidality, are likely to report a MHS contact. Future research is needed to elucidate when/how SM girls come to use MHS and what types of services they are receiving. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: girls; mental health services; school services; sexual minority; suicide attempts; youth

Assessing gender identity concerns in children and adolescents: Evaluation, treatments, and outcomes - Leibowitz, S.F.; Telingator, C. (Current Psychiatry Reports, 2012)
Child and adolescent psychiatrists are increasingly evaluating youth who present with gender-nonconforming behaviors and identities. The lack of discipline-specific guidelines has made assessment and treatment of children and adolescents presenting with these concerns more difficult. Several new guidelines have recently been published, and research efforts are advancing to broaden the scope of understanding of gender identity assessment and treatment in children and adolescents. Familiarity with the latest standards of care, recent research advances, and current knowledge gaps is important to help improve clinical competency in treating mental health issues in this population. © Springer Science+Business Media, LLC 2012.
Keywords: Adolescents; Assessment; Children; Evaluation; Gender dysphoria; Gender identity; Gender nonconforming; Gender variance; Outcomes; Sexuality; Transgender; Treatment

Social dichotomy versus gender dichotomy: A case report of gender identity disorder - Gupta, M.; Kumar, K. (Indian Journal of Psychological Medicine, 2012)
Gender identity disorder is one of the most controversial diagnoses of DSM-IV and almost incomparable in the complexity of its social, ethical and political considerations to any other diagnosis. We present a case of 30 year-old male who presented with complaints of suggestive of depressive disorder with a recent suicidal attempt. Careful history taking reveals underlying conflicts with prominent gender dysphoria and social complexities. The patient is managed primarily by pharmacotherapy and harm reduction model. Our case reflects a unique coping strategy against the present sociocultural values and ambiguity of law in this part of the world.
Keywords: Gender identity; Gender role; Socio-cultural

Juvenile Homosexual Homicide - Myers, W.C.; Chan, H.C.O. (Behavioral Sciences and the Law, 2012)
Limited information exists on juvenile homosexual homicide (JHH), that is, youths who perpetrate sexual homicides against same-sex victims. Only a handful of cases from the United States and internationally have been described in the literature. This study, the first of its kind, examines the epidemiology, victimology, victim-offender relationship, and weapon-use patterns in JHH offenders using a large U.S. database on homicide spanning three decades. The data for this study were derived from the Federal Bureau of Investigation's Supplementary Homicide Reports (SHRs) for the years 1976 through 2005. A total of 93 cases of JHH were identified. On average, three of these crimes occurred annually in the U.S., and there was a marked decline in its incidence over the study period. Ninety-five percent were male offender-male victim cases and 5% were female offender-female victim cases. JHH offenders were over-represented amongst all juvenile sexual murderers, similar to their adult counterparts. The majority of these boys were aged 16 or 17 and killed adult victims. They were significantly more likely to kill adult victims than other age groups, to be friends or acquaintances of the victims, and to use contact/edged weapons or firearms. Most offenders killed same-race victims, although Black offenders were significantly more likely than White offenders to kill interracially. A case report is provided to illustrate JHH. Further research is needed to promote our understanding of the pathogenesis, etiology, and associated risk factors for this aberrant form of murder by children. © 2012 John Wiley & Sons, Ltd.

Young, Gay, and Suicidal: Dynamic Nominalism and the Process of Defining a Social Problem with Statistics - Waidzunas, T. (Science Technology and Human Values, 2012)
Since 1989, widely circulating statistics on gay teen suicide in the United States have acted as catalysts for institutional reforms, scientific research, and the creation of an identity category "gay youth." While one figure has been replicated scientifically, these numbers originated not from a scientific research study but as risk estimates developed by a social worker and published in a government document. Many people within the public took up these original numbers, attributing their author the status of scientific researcher. In effect, the numbers became "black boxed," often traveling without citation. Drawing on Ian Hacking's "dynamic nominalist" perspective, this article utilizes interviews with the author of these statistics and other key claimants, along with textual analysis, to trace the origins, uptake, and effects of these figures. While making vital policy contributions, the numbers have led to some ironic consequences including the fostering of gay youth identification with suicide as a potential correlate of their identity and the potential antigay redeployment of decontextualized numbers. They have also led to a reaction in the form of "resilience" narratives. © SAGE Publications 2012.
Keywords: epistemology; gay youth; historical ontology; looping effects; statistics

Falling through the cracks: The gap between evidence and policy in responding to depression in gay, lesbian and other homosexually active people in Australia - Carman, M.; Corboz, J.; Dowsett, G.W. (Australian and New Zealand Journal of Public Health, 2012)
Objective: To examine the evidence for a national policy response to depression among gay, lesbian and other homosexually active people in Australia. Methods: A literature review using database searches on depression among non-heterosexual people then a web-based search of national policy investigating how mental health needs in this population are addressed in Australia. Results: The literature review found that non-heterosexual people experience depression at higher rates, but the literature on interventions was sparse. The policy analysis found no mention of depression or the broader mental health needs of non-heterosexual people in key national mental health policy documents. These documents outline a policy approach for population groups with a higher prevalence of mental health problems, and stigma and discrimination are relevant associated factors, but only the National Suicide Strategy considers non-heterosexual people an 'at-risk group'. Conclusions: The results suggest that the evidence on higher rates of depression in non-heterosexual people is strong, but that this is not recognised in current national policy. Implications: Defining non-heterosexual people as an 'at-risk' group is appropriate, as is prioritising access to mental health services that are socially and culturally appropriate. Addressing homophobia as an associated factor would require a strategic policy approach across a range of sectors. © 2012 The Authors. ANZJPH.
Keywords: Bisexuality; Evidence-based practice; Homosexuality; Mental health; Policy

Differences in Motivations of Cutting Behavior Among Sexual Minority Youth - Nickels, S.J.; Walls, N.E.; Laser, J.A.; Wisneski, H. (Child and Adolescent Social Work Journal, 2012)
This aim of this study is to examine predictors of specific motivations for engaging in cutting behavior among a community sample of sexual minority youth. The study involved secondary analysis of data collected by a community-based organization serving lesbian, gay, bisexual, and transgender (LGBT) youth and their allies. Descriptive and logistic regression analyses were conducted using a final sample of 131 sexual minority youth ages 13-24. Analyses indicate that cutting occurs at high rates among sexual minority youth and that certain demographic characteristics, psychosocial variables, and mental health issues significantly predict endorsement of particular motivations for cutting among youth in this sample. Implications for social work assessment and intervention with sexual minority youth are discussed. © 2011 Springer Science+Business Media, LLC.
Keywords: Bisexual; Cutting; Gay; Lesbian; Non-suicidal self-injury; Sexual minority; Transgender; Youth

Drivers of disparity: Differences in socially based risk factors of self-injurious and suicidal behaviors among sexual minority college students - Blosnich, J.; Bossarte, R. (Journal of American College Health, 2012)
Lesbian, gay, and bisexual (ie, sexual minority) populations have increased prevalence of both self-injurious and suicidal behaviors, but reasons for these disparities are poorly understood. Objective: To test the association between socially based stressors (eg, victimization, discrimination) and self-injurious behavior, suicide ideation, and suicide attempt. Participants: A national sample of college-attending 18- to 24-year-olds. Methods: Random or census samples from postsecondary educational institutions that administered the National College Health Assessment during the Fall 2008 and Spring 2009 semesters. Results: Sexual minorities reported more socially based stressors than heterosexuals. Bisexuals exhibited greatest prevalence of self-injurious and suicidal behaviors. In adjusted models, intimate partner violence was most consistently associated with self-injurious behaviors. Conclusions: Sexual minorities elevated risks of self-injurious and suicidal behaviors may stem from higher exposure to socially based stressors. Within-group differences among sexual minorities offer insight to specific risk factors that may contribute to elevated self-injurious and suicidal behaviors in sexual minority populations. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: bisexuality; homosexuality; mental health; self-injurious behavior

Substance Use and Mental Health Disparities among Sexual Minority Girls: Results from the Pittsburgh Girls Study - Marshal, M.P.; Sucato, G.; Stepp, S.D.; Hipwell, A.; Smith, H.A.; Friedman, M.S.; Chung, T.; Markovic, N. (Journal of Pediatric and Adolescent Gynecology, 2012)
Purpose: To examine substance use and mental health disparities between sexual minority girls and heterosexual girls. Methods: Data from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms. Results: Compared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD, ODD, and CD symptoms. Conclusions: Sexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit. © 2012 North American Society for Pediatric and Adolescent Gynecology.
Keywords: Adolescent mental health disparities; Adolescent substance use; LGBT health; Sexual minority girls

Men's sexual orientation and suicide: Evidence for U.S. adolescent-specific risk - Russell, S.T.; Toomey, R.B. (Social Science and Medicine, 2012)
There is strong consensus in the research literature that adolescent and adult men who report same-sex sexual orientations, identities, and behaviors are at higher risk for suicide. Recent studies of general adolescent suicide risk have identified developmental trajectories that peak during the teenage years. Because the adolescent years are characterized by the development and heightened awareness of gender roles and sexual scripts closely tied to dominant cultural ideals of masculinity and heterosexuality, an adolescent-focused developmental trajectory for suicide risk might be particularly relevant for males with adolescent same-sex sexual orientations. We provide the first prospective examination of adolescent-specific risk for suicidality based on adolescent same-sex sexual orientation using data from the United States, the National Longitudinal Study of Adolescent Health. Tracing suicide ideation and attempts across four assessments from adolescence (Wave 1 average age 15.3 years) to young adulthood (Wave 4 average age 28.2), we documented that the risk for suicidal thoughts and attempts for adolescent same-sex attracted males is developmental in nature. Specifically, the risk for suicidal thoughts and attempts for males with same-sex attractions is largely limited to the adolescent years. These results offer new insights for suicide prevention and intervention for male adolescents and adults with same-sex sexual orientations. © 2010 Elsevier Ltd.
Keywords: Adolescence; Adolescent development; Adolescents; Bisexual; Gay; Longitudinal; Sexual identity; Sexual orientation; Suicidality; Suicide; USA

Sexual Attraction and Trajectories of Mental Health and Substance Use During the Transition from Adolescence to Adulthood - Needham, B.L. (Journal of Youth and Adolescence, 2012)
Previous research suggests that sexual minority youth have poorer health-related outcomes than their heterosexual peers. The purpose of this study is to determine whether sexual orientation disparities in mental health and substance use increase, decrease, or remain the same during the transition from adolescence to adulthood. Data are from Waves 1-4 of the National Longitudinal Study of Adolescent Health (n = 8,322; 55% female). Respondents were in grades 7-12 at Wave 1 and aged 24-32 at Wave 4. Latent growth curve modeling is used to compare the mental health and substance use trajectories of youth who consistently report heterosexual attraction versus those who consistently report lesbian, gay, or bisexual (LGB) attraction, those who report a transition to LGB attraction, and those who report a transition to heterosexual attraction. Among women and men, sexual orientation disparities in depressive symptoms and suicidal thoughts persist, but do not increase, during the transition from adolescence to adulthood. The same pattern is observed for disparities in smoking, heavy drinking, and marijuana use among women. Among men, disparities in substance use are only observed between those who report consistent heterosexual attraction and those who transition to heterosexual attraction. Disparities between these groups persist over time for heavy drinking and marijuana use but decrease over time for smoking. While this study finds evidence of numerous disparities in mental health and substance use outcomes during adolescence and young adulthood, particularly among young women, there is no indication that these disparities get larger over time. © 2011 Springer Science+Business Media, LLC.
Keywords: Mental health; Sexual orientation; Substance use; Transition to adulthood

Help seeking and treatment use among suicidal college students - Downs, M.F.; Eisenberg, D. (Journal of American College Health, 2012)
Objectives: Many suicidal college students do not receive mental health treatment, and the reasons for this are not fully understood. This study examines how attitudes, beliefs, and social network factors relate to help seeking among suicidal students. Participants: A random sample of 8,487 undergraduate and graduate students from 15 US universities participated. Methods: A Web-based survey administered in spring 2009 examined correlates of mental health service utilization among students reporting serious thoughts of suicide in the previous year (n = 543). Results: Correlates of treatment use included perceived need, beliefs that treatment is effective, contact with service users, lower personal stigma, higher perceived stigma, fewer positive relationships, and sexual minority or Caucasian identity. Conclusions: Help seeking among suicidal students is associated with a range of personal and social network factors. Campus strategies to enhance help seeking should be tailored to address identified facilitators and barriers to treatment use among target populations. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: college students; help seeking; mental health; stigma; suicide; suicide prevention

Reprint of: Bullying victimisation, self harm and associated factors in Irish adolescent boys - McMahon, E.M.; Reulbach, U.; Keeley, H.; Perry, I.J.; Arensman, E. (Social Science and Medicine, 2012)
School bullying victimisation is associated with poor mental health and self harm. However, little is known about the lifestyle factors and negative life events associated with victimisation, or the factors associated with self harm among boys who experience bullying. The objectives of the study were to examine the prevalence of bullying in Irish adolescent boys, the association between bullying and a broad range of risk factors among boys, and factors associated with self harm among bullied boys and their non-bullied peers. Analyses were based on the data of the Irish centre of the Child and Adolescent Self Harm in Europe (CASE) study (boys n=1870). Information was obtained on demographic factors, school bullying, deliberate self harm and psychological and lifestyle factors including negative life events. In total 363 boys (19.4%) reported having been a victim of school bullying at some point in their lives. The odds ratio of lifetime self harm was four times higher for boys who had been bullied than those without this experience. The factors that remained in the multivariate logistic regression model for lifetime history of bullying victimisation among boys were serious physical abuse and self esteem. Factors associated with self harm among bullied boys included psychological factors, problems with schoolwork, worries about sexual orientation and physical abuse, while family support was protective against self harm. Our findings highlight the mental health problems associated with victimisation, underlining the importance of anti-bullying policies in schools. Factors associated with self harm among boys who have been bullied should be taken into account in the identification of boys at risk of self harm. © 2010 Elsevier Ltd.
Keywords: Adolescence; Boys; Bullying; Deliberate self harm; Ireland; Mental health; Risk factors; Schools

Psychological characteristics in high-risk MSM in China - Chen, G.; Li, Y.; Zhang, B.; Yu, Z.; Li, X.; Wang, L.; Yu, Z. (BMC Public Health, 2012)
Background: Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the behavioral, social and psychological characteristics in Chinese MSM, which makes the implementation of preventive and therapeutic strategies for this high-risk subpopulation of people extremely difficult. Methods. A total of 714 questionnaires were retrieved from the database of a Chinese government-sponsored National Key Research Project titled "Risk Analysis and Strategic Prevention of HIV Transmission from MSM to the General Population in China". The respondents were categorized into a high-risk group and a control group. Their behavioral, social and psychological characteristics were comparatively analyzed. Results: Of the 714 MSM analyzed, 59 (8.26%) had high-risk homosexual behaviors. This sub-group of MSM had a higher in-marriage rate, a higher monthly income, heavier alcohol consumption and more serious problems with sexual abuse in childhood, intentional suicide attempts and mistaken assumption on condom's role in protecting HIV infection, as compared with the control group (P < 0.05). In contrast, the two groups did not differ significantly the sexual orientation, level of education, types of profession, drug use, condom use and experience of social stigma and discrimination (P > 0.05). A vast majority of the individuals in both behavior categories expressed support of legally protected gay clubs as well as gay marriage legislation in China. There was a strong correlation between high-risk behaviors and sexual abuse in childhood, alcohol drinking, income level and a mistaken belief in perfect HIV protection through the use of condoms. Conclusions: MSM with and without high-risk homosexual behaviors have different social and psychological characteristics, which should be taken into account when implementing behavioral and therapeutic interventions aimed at preventing HIV/AIDS transmission among MSM as well as from MSM to the general population in China. © 2012 Chen et al; licensee BioMed Central Ltd.
Keywords: China; HIV infection; MSM; Psychological characteristics; Sexual risk behavior

Sexual Minority Youth Victimization and Social Support: The Intersection of Sexuality, Gender, Race, and Victimization - Button, D.M.; O'Connell, D.J.; Gealt, R. (Journal of Homosexuality, 2012)
In comparison to heterosexual youth, sexual minority youth are more likely to experience victimization. Multiple studies have connected anti-gay prejudice and anti-gay victimization to negative outcomes. Research shows that social support may protect sexual minorities from the harmful effects of anti-gay victimization. However, rates of victimization and the negative outcomes linked to sexual identity within the sexual minority community have been relatively unexplored. Using data from three years of statewide data from heterosexual and sexual minority adolescents in grades 9-12, this study examines victimization, substance use, suicidality, and access to social support by sexuality. Results indicate that sexual minority youth are at increased risk for victimization, substance use, suicidality, and social isolation compared to their heterosexual counterparts. Results also indicate that there is very little bivariate difference within the sexual minority community. Multivariate results indicate differences among sexual minorities' experiences with victimization and substance use. © 2012 Taylor and Francis Group, LLC.
Keywords: gay; lesbian; questioning; sexual minority youth; social support; victimization; violence against sexual minorities

Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth - Liu, R.T.; Mustanski, B. (American Journal of Preventive Medicine, 2012)
Background: Suicide is the third-leading cause of death among adolescents and nonsuicidal self-harm occurs in 13%45% of individuals within this age group, making these phenomena major public health concerns. Lesbian, gay, bisexual, and transgender (LGBT) youth particularly are at risk for engaging in these behaviors. Nevertheless, relatively little is known about the specific risk factors associated with suicidal ideation and self-harm behaviors in the population. Purpose: This study provides a longitudinal evaluation of the relative contributions of general and LGBT-specific risk factors as well as protective factors to the occurrence of suicidal ideation and self-harm in an ethnically diverse sample of LGBT youth. Methods: A community sample of 246 LGBT youth (aged 1620 years) was followed prospectively over five time points at regular 6-month intervals. Participants completed a baseline structured interview assessing suicide attempt history and questionnaires measuring gender nonconformity, impulsivity, and sensation-seeking. At follow-up assessments, participants completed a structured interview assessing self-harm and questionnaires for suicidal ideation, hopelessness, social support, and LGBT victimization. Data were collected from 2007 to 2011, and HLM analyses were conducted in 2011. Results: A history of attempted suicide (p=0.05); impulsivity (p=0.01); and prospective LGBT victimization (p=0.03) and low social support (p=0.02) were associated with increased risk for suicidal ideation. Suicide attempt history (p<0.01); sensation-seeking (p=0.04); female gender (p<0.01); childhood gender nonconformity (p<0.01); and prospective hopelessness (p<0.01) and victimization (p<0.01) were associated with greater self-harm. Conclusions: General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population. © 2012 American Journal of Preventive Medicine.

Suicidality and sexual orientation among men in Switzerland: Findings from 3 probability surveys - Wang, J.; Häusermann, M.; Wydler, H.; Mohler-Kuo, M.; Weiss, M.G. (Journal of Psychiatric Research, 2012)
Few population-based surveys in Europe have examined the link between suicidality and sexual orientation. The objective of this study was to assess the prevalences of and risk for suicidality by sexual orientation, especially among adolescent and young adult men. Data came from three probability-based surveys in Switzerland from 2002: 1) Geneva Gay Men's Health Survey (GGMHS) with 571 gay/bisexual men, 2) Swiss Multicenter Adolescent Survey on Health (SMASH) with 7,428 16-20 year olds, and 3) Swiss Recruit Survey (ch-x) with 22,415 new recruits. In GGMHS, suicidal ideation (12 months/lifetime) was reported by 22%/55%, suicide plans 12%/38%, and suicide attempts 4%/19%. While lifetime prevalences and ratios are similar across age groups, men under 25 years reported the highest 12-month prevalences for suicidal ideation (35.4%) and suicide attempts (11.5%) and the lowest attempt ratios (1:1.5 for attempt to plan and 1:3.1 for attempt to ideation). The lifetime prevalence of suicide attempts among homo/bisexual men aged 16-20 years varies from 5.1% in ch-x to 14.1% in SMASH to 22.0% in GGMHS. Compared to their heterosexual counterparts, significantly more homo/bisexual men reported 12-month suicidal ideation, plans, and attempts (OR = 2.09-2.26) and lifetime suicidal ideation (OR = 2.15) and suicide attempts (OR = 4.68-5.36). Prevalences and ratios vary among gay men by age and among young men by both sexual orientation and study population. Lifetime prevalences and ratios of non-fatal suicidal behaviors appear constant across age groups as is the increased risk of suicidality among young homo/bisexual men. © 2012 Elsevier Ltd.
Keywords: Adolescent; Attempted suicide; Homosexuality; Suicidal ideation; Switzerland; Young adult

Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings - Diamond, G.M.; Diamond, G.S.; Levy, S.; Closs, C.; Ladipo, T.; Siqueland, L. (Psychotherapy, 2012)
The objective of this paper is to adapt attachment-based family therapy (ABFT) for use with suicidal lesbian, gay, and bisexual (LGB) adolescents and to obtain preliminary data on the feasibility and efficacy of the treatment with this population. In Phase I, a treatment development team modified ABFT to meet the unique needs of LGB suicidal youth. In Phase II, 10 suicidal LGB youth were offered 12 weeks of LGB sensitive ABFT. Adolescents' report of suicidal ideation, depressive symptoms, and maternal attachment-related anxiety and avoidance were gathered at pretreatment, 6 weeks, and 12 weeks (posttreatment). In Phase I, the treatment was adapted to: (a) include more individual time working with parents in order to process their disappointments, pain, anger, and fears related to their adolescent's minority sexual orientation; (b) address the meaning, implications, and process of acceptance; and (c) heighten parents' awareness of subtle yet potent invalidating responses to their adolescents' sexual orientation. Results of Phase II suggest this population can be recruited and successfully treated with a family based therapy, evidenced by high levels of treatment retention and significant decreases in suicidal ideation, depressive symptoms, and maternal attachment-related anxiety and avoidance. This is the first family-based treatment adapted and tested specifically for suicidal LGB adolescents. Though promising, the results are preliminary and more research on larger samples is warranted. © 2011 American Psychological Association.
Keywords: Adolescents; Family therapy; Gay; Lesbian; Suicide

Mental health in violent crime victims: Does sexual orientation matter? - Cramer, R.J.; McNiel, D.E.; Holley, S.R.; Shumway, M.; Boccellari, A. (Law and Human Behavior, 2012)
The present study investigates victim sexual orientation in a sample of 641 violent crime victims seeking emergency medical treatment at a public-sector hospital. Victim sexual orientation was examined as it: (a) varies by type of violent crime and demographic characteristics, (b) directly relates to psychological symptoms, and (c) moderates the relationship between victim and crime characteristics (i.e., victim gender, victim trauma history, and type of crime) and psychological symptoms (i.e., symptoms of acute stress, depression, panic, and general anxiety). Results showed that lesbian, gay, bisexual, and transgender (LGBT) victims were more likely to be victims of sexual assault. Heterosexual victims were more likely to be victims of general assault and shootings. LGBT victims demonstrated significantly higher levels of acute stress and general anxiety. Moreover, victim sexual orientation moderated the association of type of crime with experience of panic symptoms. Also, victim sexual orientation moderated the relation of victim trauma history and general anxiety symptoms. Results are discussed in relation to victimization prevalence rates, sexual prejudice theory, and assessment and treatment of violent crime victims. © 2011 American Psychological Association.
Keywords: anxiety; LGBT victim; sexual assault; sexual orientation; violent crime

More than half a million California adults seriously thought about suicide in the past year. - Grant, D.; Caldwell, J.; Padilla-Frausto, D.I.; Aydin, M.; Aguilar-Gaxiola, S. (Policy brief (UCLA Center for Health Policy Research), 2012)
In 2009, nearly 2.4 million adults in California reported having seriously thought about suicide during their lifetimes. Among these adults, more than half a million had thought seriously about suicide sometime during the past year. Members of sexual minorities were almost three times as likely as all adults in California to have had suicidal thoughts during the past year. This policy brief, based on data from the 2009 California Health Interview Survey (CHIS), presents a comprehensive overview of risk factors associated with suicidal thoughts among adults ages 18 and older and highlights differences in suicidal ideation among demographic groups and geographic regions in California.

Virtual communities and translation into physical reality in the ‘It gets better’ project - Muller, A. (Journal of Media Practice, 2012)
This article explores the founding of the You Tube-based ‘It Gets Better’ project as an online community and the project's influence in effecting real-world change. The It Gets Better project is a You Tube-based initiative that seeks to offer support for troubled LGBTQ (Lesbian, Gay, Bi, Trans, Queer) youth who may be contemplating suicide. It was created by American columnist Dan Savage and his partner Terry following a number of youth suicides that had resulted from bullying in 2010. The article situates the virtual initiative within the traditional definitions of community, and individual engagement is investigated by way of online and real-world ramifications. Finally the project's aim is problematized through analysis of the aesthetics, structure and reception of, and social discourse surrounding, the original video posting. © 2012 Taylor & Francis Group, LLC.
Keywords: Bullying; Dan Savage; It Gets Better; Lgbtq; Online community; Virtual engagement

Don't ask, don't tell? Does disclosure of gay identity affect partner performance? - Everly, B.A.; Shih, M.J.; Ho, G.C. (Journal of Experimental Social Psychology, 2012)
Supporters of policies that force gay and lesbian individuals to conceal their sexual orientation in the workplace argue that working with openly gay individuals undermines performance. We examine this claim in two studies and find the opposite effect. Specifically, participants working with openly gay partners performed better on a cognitive task (i.e., a math test) and a sensory-motor task (i.e., a Wii shooting game) than individuals left to wonder about the sexual orientation of their partners. These results suggest that policies, such as "Don't Ask, Don't Tell," that introduce uncertainty into social interactions harm rather than protect performance. © 2011 Elsevier Inc.
Keywords: Disclosure; Identity; Performance; Stigma

Lesbians and Alcohol Abuse: Identifying Factors for Future Research - Ricks, J.L. (Journal of Social Service Research, 2012)
This article explores the reasons why lesbians become substance abusers more frequently than individuals in the heterosexual population. A variety of reasons for this phenomenon are explored using 18 studies to assist in helping to identify reasons for the higher rate of substance abuse among the lesbian population. Factors identified as crucial for further research include: self-esteem, social identity and the influence of bars on substance abuse, the prevalence of suicide, disclosure identification, coming out, religious influence, sexual abuse, and gender self-presentation (butch-appearing masculine/femme-appearing effeminate). © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: Alcohol abuse; butch; femme; gay; gender presentation; homosexuality; lesbian; substance abuse; suicide

Gender dysphoria: Recognition and assessment - Eden, K.; Wylie, K.; Watson, E. (Advances in Psychiatric Treatment, 2012)
The role of the mental health professional, and of the psychiatrist in particular, is evolving and changing. As the recognition of transsexualism and gender identity disorder expands across the transgender spectrum, it has been recommended that gender dysphoria should replace existing diagnostic terminology. Patient-focused care is evolving and this ar ticle considers the limitations of current healthcare settings and how the mental health professional can support patients undergoing the real-life experience. Differentiation from other mental health conditions that may present as gender dysphoria is outlined, as well as specific clinical situations.

Children and adolescents with gender identity disorder referred to a pediatric medical center - Spack, N.P.; Edwards-Leeper, L.; Feldman, H.A.; Leibowitz, S.; Mandel, F.; Diamond, D.A.; Vance, S.R. (Pediatrics, 2012)
OBJECTIVES: To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients. METHODS: Data gathered on 97 consecutive patients <21 years, with initial visits between January 1998 and February 2010, who fulfilled the following criteria: long-standing cross-gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity. RESULTS: Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 6 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%). CONCLUSIONS: After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation. Copyright © 2012 by the American Academy of Pediatrics.
Keywords: Cross-sex hormones; Gender identity disorder; Gender management service; GnRH analog; Pubertal suppression; Transgender

Self-Castration by a Transsexual Woman: Financial and Psychological Costs: A Case Report - St. Peter, M.; Trinidad, A.; Irwig, M.S. (Journal of Sexual Medicine, 2012)
Introduction. The out-of-pocket cost for an elective orchiectomy, which is often not covered by health insurance, is a significant barrier to male-to-female transsexuals ready to proceed with their physical transition. This and other barriers (lack of access to a surgeon willing to perform the operation, waiting times, and underlying psychological and psychiatric conditions) lead a subset of transsexual women to attempt self-castration. Little information has been published on the financial costs and implications of self-castration to both patients and health care systems. Aim. We compare the financial and psychological costs of elective surgical orchiectomy vs. self-castration in the case of a transsexual woman in her 40s. Methods. We interviewed the patient and her providers and obtained financial information from local reimbursement and billing specialists. Results. After experiencing minor hemorrhage following the self-castration, our patient presented to the emergency department and underwent a bilateral inguinal exploration, ligation and removal of bilateral spermatic cords, and complicated scrotal exploration, debridement, and closure. She was admitted to the psychiatric service for a hospital stay of three days. The total bill was US $14,923, which would compare with US $4,000 for an elective outpatient orchiectomy in the patient's geographical area. Conclusions. From a financial standpoint, an elective orchiectomy could have cost the health care system significantly less than a hospital admission with its associated additional costs. From a patient safety standpoint, elective orchiectomy is preferable to self-castration which carries significant risks such as hemorrhage, disfigurement, infection, urinary fistulae, and nerve damage. Healthcare providers of transsexual women should carefully explore patient attitudes toward self-castration and work toward improving access to elective orchiectomy to reduce the number of self-castrations and costs to the overall health care system. Further research on the financial implications of self-castration from different health care systems and from a series of patients is needed. © 2012 International Society for Sexual Medicine.
Keywords: Cost; Economics; Orchiectomy; Self-castration; Sex reassignment surgery; Transsexual

Breaking the Silence: Supporting Intimate Relationships for Our Wounded Troops and Their Partners: A Call to Action - Satcher, D.; Tepper, M.S.; Thrasher, C.; Rachel, S.A. (International Journal of Sexual Health, 2012)
Wounded troops in the wars in Iraq and Afghanistan are surviving their injuries at greater rates now than in all previous major American wars, and our returning troops face physical, mental, and sexual health challenges when trying to build and re-establish intimate relationships. We are seeing relationship difficulties like intimate partner violence, child abuse, divorce, partners taking on care giving roles, higher incidence of risky sexual behaviors among single veterans, and special challenges faced by women and gay and lesbian soldiers. Healthy intimate relationships can contribute to a person's recovery from physical and mental trauma, while a lack of them can contribute to ongoing mental health problems and even suicide. Fortunately, we now see greater availability and acceptance of mental health services and resources for supporting intimate relationships in the military. © 2012 Copyright Taylor and Francis Group, LLC.
Keywords: Gay and lesbian health; mental disability; physical disability; sexual health promotion

Which books are challenged more - classics or contemporary? - Akers, C.G. (New Library World, 2012)
Purpose: This paper aims to compare the American Library Association's statistics on the most frequently challenged books in the years 2000-2010 that appear on the ALA's "Banned and Challenged Classics" list versus those that are contemporary that are found in the ALA published Banned Book Resource Guide. Design/methodology/approach: Analyses were made to determine whether classics were challenged more than contemporary books, and if there has been a rise in contemporary challenged books. To find out the similarities and difference in contemporary and classic books, the reasons for challenges were broken down into the categories of: drugs, homosexuality, offensive language, parental permission, racism, religious viewpoint, sexually explicit, suicide, unsuited to age group, violence, witchcraft, challenged, and "other". Findings: The study found that contemporary books were challenged more than classic books between 2000-2010, but there has not been a rise in the number of challenges. The similarities and differences show that a small percentage of difference is seen in some of the reasons for the challenges, but the largest percentage for being sexually explicit, and the largest margin of difference in the percentages in racism. Research limitations/implications: Because the Banned Book Resource Guide was published in 2010, the statistics for challenged books in the year 2010 are incomplete. A suggestion for further research would be conducting the study when a later version of the Resource Guide is available and includes the 2010 statistics. Originality/value: By examining patterns that have taken place in book challenges over the past ten years, the paper helps those interested in censorship and its many complications to better understand its trends. © Emerald Group Publishing Limited.
Keywords: Banned books; Books; Censorship; Challenge; Classics; Contemporary literature; Social norms; United States of America

Reflections on homophobia and education in schools in the interior of sao paulo state - Teixeira-Filho, F.S.; Rondini, C.A.; Bessa, J.C. (Educacao e Pesquisa, 2011)
This is a survey conducted in 2009 with 2,282 students of both sexes enrolled in the three grades of high school in three cities of the west of Sao Paulo state (Assis, Presidente Prudente and Ourinhos). The data collection instrument was a self-administered and anonymous questionnaire with 131 questions. In this article, we reflect on how in schools the research participants reproduce and reinforce the hegemonic discourses of control of sexualities guided by the attempt to promote heterosexuality as the only form of sexual intelligibility, to the detriment of other forms of expression of sexuality. We discuss how homophobia and the devices of social control of sexuality (re) produce prejudices and stereotypies, resulting in vulnerabilities that non-heterosexual teenagers have, such as homophobic victimization, social and affective isolation, ideations and suicide attempts. The study shows that the invariant were discrimination, homophobic violence and the insults that are perpetrated in the values and discourses of adolescents at school and in their family, demonstrating the institutionalization of homophobia as a regulatory practice of the psychological and social construction of gender and sexual identities. We highlight how important it is for the school to appropriate the means of deconstruction of heterocentric normativity to preserve the rights and citizenship of the people who do not identify with the prevailing models of heterosexuality.
Keywords: Adolescence; Homophobia and education; Homophobic violence; Homosexuality; Sexuality

A better understanding of the potential conflict between christianity and homosexuality - Subhi, N.; Geelan, D.; Mcmahon, M.; Jusoff, K.; Mohamad, S.M.; Sarnon, N.; Nen, S.; Hoesni, S.M.; Chong, S.T.; Fauziah, I.; Alavi, K. (World Applied Sciences Journal, 2011)
Most organized religions including Christianity still regard homosexuality as being against their teachings, as sinful and contrary to scripture. Thus the matter of reconciling sexual orientation with religious and spiritual beliefs can be a very challenging and complicated process for those homosexual persons who uphold Christianity as their religion. This paper seeks to explore the potential conflict between Christianity and homosexuality faced by the respondents. A qualitative study was conducted via in-depth semi-structured interviews with purposively selected homosexual persons. The result found that a small percentage of respondents were unaffected by the potential conflict between Christianity and homosexuality. Nevertheless, the majority, eighty percent, were affected by the conflict, implying that both Christianity and homosexuality were important components of their lives. The most common personal effects of conflict between Christianity and homosexuality indentified include depression, self-blame/guilt, anxiety, suicidal ideation and alienation. Some implications for practice are presented at two few different levels: (1) mental health professionals and (2) church leaders and clergymen. © IDOSI Publications, 2011.
Keywords: Christianity; Homosexuality; Intrapersonal conflict; Sexual identity

Accidental strangulation resulted from hypoxyphilia associated with multiple paraphilias and substance abuse: A psychological autopsy case report - Skugarevsky, O.; Ehrlich, E.; Sheleg, S. (Romanian Journal of Legal Medicine, 2011)
We report a case of a 34-year-old male who was found hanged by his neck in his own apartment. The deceased was dressed in women's nylon panties, bra, nylon pantyhose, and a wig. The immediate cause of his death was found to be asphyxia due to hanging but the manner of his death was initially considered to be equivocal. The psychological autopsy based on the structured interview with the deceased's parents, sexual partner, and closed friends using Beck's Suicide Intent Scale (SIS), Paykel's Interview for Recent Life Events (IRLE), Duke Social Support Index (DSSI), the Structured Clinical Interview for DSM-IV-TR (SCID-I), Hamilton Depression Rating Scale (HAM-D), and our structured suicide information questionnaire based on the pamphlet "Suicide Prevention and Psychological Autopsy" (Department of U.S. Army) and some published articles was performed and the data were analyzed. The interviews with the informants showed that the deceased was single; was engaged in homosexual behavior; was well educated with a university degree; was employed; has not been diagnosed with any chronic illnesses; never had suicidal attempts in the past; didn't have any history of alcohol and drug abuse; wasn't recently emotionally upset; didn't have any chronic and recent interpersonal problems with his family, sexual partner, and friends; had plans for the future. The deceased has not being diagnosed with any psychiatric illnesses during his life. But the scrupulous crime scene investigation was indicative that diseased was meeting the DSM-IV-TR diagnostic criteria for substance abuse, multiple paraphilias involving sexual masochism (hypoxyphilia), transvestic fetishism, and agalmatophilia (a paraphilia that involves being sexually attracted to a doll, statue or mannequin). Integration of the psychological autopsy data with the crime scene findings allowed identification of this event as an accidental death (autoerotic asphyxia). © 2011 Romanian Society of Legal Medicine.
Keywords: Agalmatophilia; Autoerotic asphyxia; Hypoxyphilia; Psychological autopsy; Sexual masochism; Substance abuse; Transvestic fetishism

Suicidal ideation among patients with gender identity disorder - Terada, S.; Matsumoto, Y.; Sato, T.; Okabe, N.; Kishimoto, Y.; Uchitomi, Y. (Psychiatry Research, 2011)
In this study, we tried to clarify the prevalence of suicidal ideation and self-mutilation including suicide attempts among patients with gender identity disorder (GID) and the relationship of those behaviors to demographic characteristics. A total of 500 consecutive Japanese GID patients without any other psychiatric comorbidity were evaluated at the outpatient GID Clinic of Okayama University Hospital. The lifetime rate of suicidal ideation was 72.0% of the total sample. There were no significant differences in the prevalence of suicidal ideation among groups divided by sex, age, age at onset or education. The lifetime prevalence of self-mutilation including suicide attempts was 31.8% of the total sample. Low level of education was significantly related to self-mutilation among both male-to-female and female-to-male GID patients. Younger age at onset was a significant factor affecting self-mutilation only among MTF GID patients. A lack of strategies to cope with severe distress among persons with lower education might induce a high frequency of self-mutilation including suicidal attempt. GID patients with a low level education might be at high risk of self-mutilation and should be watched with special attention to self-mutilation. © 2011 Elsevier Ireland Ltd.
Keywords: Gender; Gender identity disorder; Self-mutilation; Suicidal ideation

Perinatal and psychosocial circumstances associated with risk of attempted suicide, non-suicidal self-injury and psychiatric service use. A longitudinal study of young people - Young, R.; Riordan, V.; Stark, C. (BMC Public Health, 2011)
Background: Past studies using large population based datasets link certain perinatal circumstances (birth weight, parity, etc) with mental health outcomes such as suicide, self-harm and psychiatric problems. Problematically, population datasets omit a number of social confounds. The aim of this study is to replicate past research linking perinatal circumstances and mental health (suicidality and use of psychiatric services) and to determine if such associations remain after adjusting for social circumstances. Methods. A longitudinal school-based survey of 2157 young people (surveyed at age 11, 13, 15) followed up in early adulthood (age 19). At age 11 parents of participants provided information about perinatal circumstances (birth weight, birth complications, etc.) and psychiatric service use. Participants provided data about their mental health at age 15 (attempted suicide, suicidal thoughts) and at ages 19 (self-harm, psychiatric service use). In addition, data were collected about their social and psychosocial circumstances (gender, deprivation, religion, sexual behaviour, etc.). Results: Predictably, social factors were linked to mental health outcomes. For example, those with same sex partners were more likely (OR 4.84) to self-harm than those without a same sex partner. With a single exception, in both unadjusted and adjusted models, perinatal circumstances were not or only marginally associated with mental health outcomes. The exception was the number of birth complications; young people with two or more complications were approximately 2-3 times more likely than those without complications to use psychiatric services. Conclusions: While we failed to replicate results found using large population based datasets, some of our results are compatible with prior research findings. Further, evidence from this study supports the influence of perinatal circumstances (birth complications) on later psychiatric problems, or at least higher than expected contact with psychiatric service. © 2011 Young et al; licensee BioMed Central Ltd.

Lesbian, Gay, Bisexual, and Transgender Health Issues, Disparities, and Information Resources - McKay, B. (Medical Reference Services Quarterly, 2011)
Lesbian, gay, bisexual, and transgender (LGBT) persons, while widely diverse in many ways, share health disparities related to the stigma and discrimination they experience, including disproportionate rates of psychiatric disorders, substance abuse, and suicide. Lesbians, gay men, bisexuals, and the transgender communities have additional health concerns and disparities unique to each population. This paper highlights the national recognition of these health issues and disparities and presents web-based information resources about them and their mitigation. © 2011 Copyright Taylor and Francis Group, LLC.
Keywords: Bisexual; gay; health disparities; health issues; lesbian; LGBT; transgender

Understanding suicide among sexual minority youth in America: An ecological systems analysis - Hong, J.S.; Espelage, D.L.; Kral, M.J. (Journal of Adolescence, 2011)
This article examines major risk factors for suicide among sexual minority youth using Bronfenbrenner's ecological systems theory. Although suicidal behavior among sexual minority youth is a major public concern in the United States, understanding of this phenomenon has been limited since the majority of empirical research studies have addressed individual level characteristics without much consideration to the larger environmental contexts. This review integrates past and current empirical findings on suicidal behaviors of sexual minority youth within the context of micro-, meso-, exo-, macro-, and chrono-systems levels. Finally, it draws implications for assessment, prevention, and intervention strategies. © 2011 The Foundation for Professionals in Services for Adolescents.
Keywords: Ecological systems theory; Sexual minority; Sexuality; Suicide; Youth

Inequities in educational and psychological outcomes between LGBTQ and straight students in middle and high school - Robinson, J.P.; Espelage, D.L. (Educational Researcher, 2011)
This study finds that, compared with straight-identified youth, youth who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) are at greater risk of suicidal thoughts, suicide attempts, victimization by peers, and elevated levels of unexcused absences from school. Results disaggregated by LGBTQ subgroups reveal heterogeneity within the broad LGBTQ group, with bisexual youth appearing to be particularly at risk. Also, although the risk gaps in school belongingness and unexcused absences are significant in high school, we find that these gaps are significantly greater in middle school, suggesting heightened early risk for LGBTQ-identified students. By raising awareness of educational inequities related to LGBTQ identification, this study lays the descriptive groundwork for interventions aimed at improving psychological and educational outcomes for these students. © 2011 AERA.
Keywords: at-risk students; gay/lesbian studies; multilevel mod- eling; stress/coping

The effects of general and homophobic victimization on adolescents' psychosocial and educational concerns: The importance of intersecting identities and parent support - Poteat, V.P.; Mereish, E.H.; DiGiovanni, C.D.; Koenig, B.W. (Journal of Counseling Psychology, 2011)
Many adolescents experience peer victimization, which often can be homophobic. Applying the minority stress model with attention to intersecting social identities, this study tested the effects of general and homophobic victimization on several educational outcomes through suicidality and school belonging among 15,923 adolescents in Grades 7 through 12 on account of their sexual orientation and race/ethnicity. Parent support also was tested as a moderator of these effects. Homophobic victimization had different effects on suicidality across groups, indicating the importance of considering individuals' multiple social identities. However, homophobic victimization had universal negative effects on school belonging for all groups. Nearly all indirect effects of general and homophobic victimization on reported grades, truancy, and importance of graduating were significant through suicidality and school belonging across groups. Parent support was most consistent in moderating the effects of general and homophobic victimization on suicidality for heterosexual White and racial/ethnic minority youth. In nearly all cases, it did not moderate the effects of general or homophobic victimization for lesbian, gay, bisexual, transgender, and questioning youth. Furthermore, in most cases, parent support did not moderate the effects of general or homophobic victimization on school belonging. Findings underscore the need for counseling psychologists to work with parents of all youth on ways to provide support to those who experience homophobic victimization. Furthermore, they highlight the need for counseling psychologists to be involved as social justice advocates in the passage and implementation of school policies that address homophobic bullying and other forms of bias-based bullying and harassment. © 2011 American Psychological Association.
Keywords: Bullying; Homophobia; Minority stress; Parent support; Sexual orientation

It's Not Burnout, It's More: Queer College Activists of Color and Mental Health - Vaccaro, A.; Mena, J.A. (Journal of Gay and Lesbian Mental Health, 2011)
A phenomenological study of the experiences of self-identified queer activists of color revealed how they coped with the competing demands of academics, family, and activism. While participants exhibited innumerable strengths, they often contended with external and internal pressures, limited social support, poor boundaries, and lack of self-care. The absence of social support, in conjunction with poor self-care, a heightened sense of responsibility for others, and multiple minority identity explorations, left college student activists experiencing burnout, compassion fatigue, and in some cases suicidal ideation. © 2011 Copyright Taylor and Francis Group, LLC.
Keywords: burnout; college students; compassion fatigue; race; sexual orientation

Social support, exposure to violence and transphobia, and correlates of depression among male-to-female transgender women with a history of sex work - Nemoto, T.; Bödeker, B.; Iwamoto, M. (American Journal of Public Health, 2011)
We determined racial/ethnic differences in social support and exposure to violence and transphobia, and explored correlates of depression among male-to-female transgender women with a history of sex work (THSW). Methods. A total of 573 THSW who worked or resided in San Francisco or Oakland, California, were recruited through street outreach and referrals and completed individual interviews using a structured questionnaire. Results. More than half of Latina and White participants were depressed on the basis of Center For Epidemiologic Studies Depression Scale scores. About three quarters of White participants reported ever having suicidal ideation, of whom 64% reported suicide attempts. Half of the participants reported being physically assaulted, and 38% reported being raped or sexually assaulted before age 18 years. White and African American participants reported transphobia experiences more frequently than did others. Social support, transphobia, suicidal ideation, and levels of income and education were significantly and independently correlated with depression. Conclusions. For THSW, psychological vulnerability must be addressed in counseling, support groups, and health promotion programs specifically tailored to race/ethnicity.

Psychological characteristics, stressful life events and deliberate self-harm: Findings from the child & adolescent self-harm in Europe (CASE) study - Madge, N.; Hawton, K.; McMahon, E.M.; Corcoran, P.; De Leo, D.; De Wilde, E.J.; Fekete, S.; Van Heeringen, K.; Ystgaard, M.; Arensman, E. (European Child and Adolescent Psychiatry, 2011)
There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from singleepisode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated. © Springer-Verlag 2011.
Keywords: Adolescence; Anxiety; Cross-cultural; Depression; Impulsivity; Psychological characteristics; Self-esteem; Self-harm; Stressful life events

Interpersonal trauma and discriminatory events as predictors of suicidal and nonsuicidal self-injury in gay, lesbian, bisexual, and transgender persons - House, A.S.; van Horn, E.; Coppeans, C.; Stepleman, L.M. (Traumatology, 2011)
Recent research suggests that gay, lesbian, bisexual, and transgender (GLBT) persons are at greater risk for mental health problems, including suicidal and nonsuicidal self-injury, than heterosexuals. However, few studies have investigated factors that may be linked to this increased risk. This study investigated interpersonal violence, victimization, and discriminatory events as possible predictors of suicidal and nonsuicidal self-injury in a sample of sexual minorities (i.e., a GLBT sample). Participants were 1,126 self-identified gay, lesbian, bisexual, and/or transgender (GLBT) individuals who responded to an Internet-based survey. Results indicated that both experiences of interpersonal trauma and sexual discrimination were associated with increased likelihoods of engaging in suicidal and nonsuicidal self-injury. In addition, participants at the greatest risk were those experiencing high levels of both interpersonal trauma and sexual discrimination. Clinical implications of these results are discussed. © The Author(s) 2011.
Keywords: interpersonal trauma; self-injury; sexual discrimination; sexual minority; suicidal behavior

Creating safe environments for students with disabilities who identify as Lesbian, Gay, bisexual, or transgender - Morgan, J.J.; Mancl, D.B.; Kaffar, B.J.; Ferreira, D. (Intervention in School and Clinic, 2011)
Adolescence is an important time in human development. Teenagers spend much time questioning their core belief structures and developing the foundations of their identity. For students who identify as lesbian, gay, bisexual, or transgender (LGBT), this path of development is difficult in American schools because of strongly held homophobic beliefs. Barriers in sexuality identity development could cause problems for students with disabilities, including low self-esteem, psychological problems, and suicidal ideations. This article addresses action steps that educators can take to support this student population. © Hammill Institute on Disabilities 2011.
Keywords: classroom environment; classroom management; cultural and linguistic diversity; sexuality education

Correlates of engaging in survival sex among homeless youth and young adults - Walls, N.E.; Bell, S. (Journal of Sex Research, 2011)
Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium, crack cocaine, alcohol, Coricidin, and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed. Copyright © The Society for the Scientific Study of Sexuality.

Male street prostitution in Dublin: A psychological analysis - McCabe, I.; Acree, M.; O'Mahony, F.; McCabe, J.; Kenny, J.; Twyford, J.; Quigley, K.; McGlanaghy, E. (Journal of Homosexuality, 2011)
This study assessed the mental health characteristics of 12 male street prostitutes (MSPs) in Dublin, with particular regard to issues of homelessness, substance abuse, depression, suicidal ideation, and self-esteem. Participants completed five psychometric tests, which indicated that all of the participants had above average levels of depression and suicidal ideation and low levels of selfesteem. This study found that candidates likely to become MSPs are young males with a combination of factors, including a background of childhood sexual or physical abuse, leaving school early, running away from home, and a dependence on heroin. © Taylor & Francis Group, LLC.
Keywords: Abuse; Drugs; Dublin; Gay; HIV; Homeless; Male mental health; Male prostitution

Racial and sexual identity-related maltreatment among minority YMSM: Prevalence, perceptions, and the association with emotional distress - Hightow-Weidman, L.B.; Phillips, G.; Jones, K.C.; Outlaw, A.Y.; Fields, S.D.; Smith, J.C. (AIDS Patient Care and STDs, 2011)
Bullying is a form of violence characterized as an aggressive behavior that is unprovoked and intended to cause harm. Prior studies have found that lesbian, gay, bisexual, and transgender (LGBT) youth experience high levels of bullying related to their sexuality and this harassment can lead to engagement in risk behaviors, depression, and suicide. Ethnic/racial minority young men who have sex with men (YMSM) may experience dual levels of stigma and maltreatment due to both their sexuality and their race. The aim of the current study was to assess the prevalence and perceptions of racial and sexual identity-based abuse among a sample of minority YMSM, and whether this maltreatment plays a role in the emotional distress of these youth. We found that overall 36% and 85% of participants experienced racial and sexuality-related bullying, respectively. There was a significant association between experiencing a high level of sexuality-related bullying and depressive symptomatology (p=0.03), having attempted suicide (p=0.03), and reporting parental abuse (p=0.05). We found no association between racial bullying and suicide attempts. In a multivariable logistic regression model, experiencing any racial bullying and high sexuality-related bullying were significant predictors of having a CES-D score ≥16; adjusted odds ratio (OR) 1.83 and 2.29, respectively. These findings contribute to the existing literature regarding the negative experiences and daily stressors facing LGBT youth with regard to both their minority status and LGBT identities. Future interventions for racial/ethnic minority YMSM should provide assistance to achieve a positive view of self that encompasses both their racial and sexual identities. © Copyright 2011, Mary Ann Liebert, Inc.

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: Findings from a community-recruited sample - Sivasubramanian, M.; Mimiaga, M.J.; Mayer, K.H.; Anand, V.R.; Johnson, C.V.; Prabhugate, P.; Safren, S.A. (Psychology, Health and Medicine, 2011)
In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD=5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR=0.85, 95% CI: 0.78-0.93; social support AOR=0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR=0.79, 95% CI: 0.71-0.89; social support AOR=0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR=0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs. © 2011 Taylor & Francis.
Keywords: anxiety; depression; India; men who have sex with men (MSM); mental health; Mumbai; suicide

Age of MSM sexual debut and risk factors: Results from a multisite study of racial/ethnic minority YMSM living with HIV - Outlaw, A.Y.; Phillips, G.; Hightow-Weidman, L.B.; Fields, S.D.; Hidalgo, J.; Halpern-Felsher, B.; Green-Jones, M. (AIDS Patient Care and STDs, 2011)
The average reported age of sexual debut for youth in the United States is 14.4 years, with approximately 7% reporting their sexual debut prior to age 13. While the research literature on sexual debut for youth addresses gender and ethnic differences (with males and African-American youth experiencing earlier sexual debut), there is limited data regarding factors associated with sexual debut for young men who have sex with men (YMSM). Early sexual debut poses potential health risks, such as contracting HIV with an increased risk of unprotected intercourse. Given current high HIV infection rates for racial/ethnic minority YMSM, learning more about their sexual debuts and associated risk factors of this population is of great importance. This study investigated risk behaviors and emotional distress, and their association with MSM sexual debut for a multisite cohort of racial/ethnic minority YMSM living with HIV. We hypothesized that a MSM sexual debut younger than age 16 would be associated with engagement in more high-risk sexual behaviors (unprotected sex and exchange sex), substance use, and emotional distress than a MSM sexual debut at age 16 or older. Results indicated that participants having a MSM sexual debut before the age of 16 reported more exchange sex; drug use (specifically marijuana); emotional/psychological problems related to substance use; and a history of suicide attempts, compared to participants with later MSM sexual debuts. Comprehensive interventions that are racially/ethnically sensitive, inquire about initial sexual experiences, and focus on sexual health and healthy relationships are needed to improve health outcomes for this population. © Copyright 2011, Mary Ann Liebert, Inc.

Bisexual people's experiences with mental health services: A qualitative investigation - Eady, A.; Dobinson, C.; Ross, L.E. (Community Mental Health Journal, 2011)
Bisexual people experience minority stress and social isolation as a result of their marginalized sexual identities, and likely due to this stigmatization, previous research has identified high rates of psychological distress, anxiety, depression, suicidality, alcohol misuse, and selfharming behaviour among bisexual populations. It is therefore important that mental health service providers are able to provide culturally competent care to bisexual people. This study used focus groups and interviews with 55 bisexual participants across the province of Ontario, Canada, to investigate their experiences with mental health care. Results suggest that bisexual people have both positive and negative experiences with mental health service providers. Specific provider practices which contribute to the perception of positive and negative experiences with mental heath services are described, and the implications for clinical practice discussed. © Springer Science+Business Media, LLC 2010.
Keywords: Barriers to care; Bisexual; Mental health; Service satisfaction

Religious Abuse: Implications for Counseling Lesbian, Gay, Bisexual, and Transgender Individuals - Super, J.T.; Jacobson, L. (Journal of LGBT Issues in Counseling, 2011)
Religion is often the place a lesbian, gay, bisexual, or transgender (LGBT) individual may turn to understand and navigate their sexual orientation identity development. However, religious abuse may occur when a religious group or leader, whether intentionally or unintentionally, uses coercion, threats, rejection, condemnation, or manipulation to force the individual into submission of the religious views about sexuality. The abuse may result in great harm to the victim by causing low self-esteem, guilt, shame, spirituality loss, substance abuse, or thoughts of suicide. Counselors need to be aware of religious abuse to help clients navigate any spiritual divide between religious beliefs and sexuality. Therefore, the purpose of this article is to (a) describe the differences between religion and spirituality,(b) define religious abuse, (c) describe the effects of religious abuse on LGBT individuals and society, and (d) delineate the counseling implications of religious abuse in working with LGBT individuals. © 2011 Copyright Taylor and Francis Group, LLC.
Keywords: counseling; LGBT individuals; religious abuse; religious and sexual identity conflict; religious identity; sexual identity

The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals - Meier, S.L.C.; Fitzgerald, K.M.; Pardo, S.T.; Babcock, J. (Journal of Gay and Lesbian Mental Health, 2011)
Hormonal interventions are an often-sought option for transgender individuals seeking to medically transition to an authentic gender. Current literature stresses that the effects and associated risks of hormone regimens should be monitored and well understood by health care providers (Feldman & Bockting, 2003). However, the positive psychological effects following hormone replacement therapy as a gender affirming treatment have not been adequately researched. This study examined the relationship of hormone replacement therapy, specifically testosterone, with various mental health outcomes in an Internet sample of more than 400 self-identified female-tomale transsexuals. Results of the study indicate that female-to-male transsexuals who receive testosterone have lower levels of depression, anxiety, and stress, and higher levels of social support and health related quality of life. Testosterone use was not related to problems with drugs, alcohol, or suicidality. Overall findings provide clear evidence that HRT is associated with improved mental health outcomes in female-to-male transsexuals. © Taylor & Francis Group, LLC.
Keywords: Female-to-male transsexual; FTM; Gender affirmation treatment; Hormone replacement therapy; Testosterone; Transgender