Mental Health and Substance Use Disorder Comorbidity among Methamphetamine-Using Men Who have Sex with Men - Fletcher, J.B.; Swendeman, D.; Reback, C.J. (Journal of Psychoactive Drugs, 2018)
Men who have sex with men (MSM) exhibit elevated rates of mental health and substance use disorder relative to their non-MSM male counterparts. Methamphetamine use in particular has been associated with both neuronal damage and mental health disorders among MSM, and this study reports on the prevalence and comorbidity of DSM-5 mental health and substance use disorders in a sample of methamphetamine-using MSM. From March 2014 through January 2015, 286 methamphetamine-using MSM enrolled in a study to reduce methamphetamine use and sexual risk behaviors. At baseline, participants demonstrated high rates of current major depressive episode (35.8%), antisocial personality disorder (23.9%), suicide risk (23.2%), obsessive-compulsive disorder (23.2%), and social phobia (20.4%), as well as methamphetamine use disorder (89.1%), marijuana use disorder (41.0%), alcohol use disorder (39.6%), cocaine use disorder (30.9%), and inhalants use disorder (15.4%). Analyses revealed significant (p < 0.05) associations between methamphetamine use disorder severity and all listed mental health disorders, as well as between alcohol use disorder and all listed mental health disorders. Mental health disorder prevalence and substance use disorder severity were both elevated, and both methamphetamine and alcohol use disorder severity were associated with increased likelihood of comorbid mental health disorder. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: DSM-5; men who have sex with men; mental health disorder; methamphetamine; substance use disorder severity

Violence exposure and mental health of college students in the United States - Assari, S.; Lankarani, M.M. (Behavioral Sciences, 2018)
Background: Despite the well-established link between exposure to violence and mental health problems, less is known about this association among college students. The current study aimed to investigate the association between history of exposure to violence and mental health of American college students. Methods: Healthy Mind Study (HMS, 2016–2017) is a national online survey of 41,898 adult college students. The independent variable was lifetime history of exposure to violence (psychological, physical, and sexual). The dependent variables were anxiety, depression, and suicidality. Race, age, gender, sexual orientation, parental education, financial stress, transfer status, enrollment status, and graduate status were covariates. Linear and logistic regression models were used for data analysis. Results: History of exposure to violence was associated with all three aspects of poor mental health, namely general anxiety, depression, and suicidality. These associations were independent of covariates and type of abuse. Conclusions: There is a need to address various mental health needs of college students who have experienced various forms of violence. College students who screen positive for history of violence exposure should be evaluated for anxiety, depression, and suicidal behaviors. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.
Keywords: Abuse; Anxiety; Depression; Sexual abuse; Substance use; Suicidal behaviors; Violence

Practicing care: queer vulnerability in the hospital - Horncastle, J. (Social Identities, 2018)
This discussion paper addresses practicalities of queer resistance to norms about life and identity, in mainstream medical contexts. Queer agency may be compromised at times of illness and/or health-related vulnerability. Although this compromise is part of mundane politics for hardy queers who routinely negotiate mainstream institutions such as hospitals, there are side-effects that may negatively impact non-normative subjectivity. This paper highlights the necessarily contingent nature of being cared for in the clinic, the surgeon’s hands, or the psychiatric ward and reveals what may be overlooked, misunderstood or explicitly rejected in mainstream medical contexts. The salient points from my own hospital experiences are explored to highlight counter-discourses and contentious issues around caring for non-normative (queer) subjectivities. © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: agency; cancer; care; Genderqueer-ness; mad studies; suicidality

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

Depression and Associated Factors Among Gay and Heterosexual Male University Students in Nigeria - Oginni, O.A.; Mosaku, K.S.; Mapayi, B.M.; Akinsulore, A.; Afolabi, T.O. (Archives of Sexual Behavior, 2018)
Homosexuality is a recognized risk factor for depression in high-income countries; however, there is little research investigating the relationship between depression and sexual orientation in developing countries, especially in Africa. In this first study to investigate psychopathology in sexual minority men in Nigeria, the prevalence rates of depression in Nigerian gay and heterosexual individuals were compared as well as the explanatory power of risk and resilience factors in both groups. Eighty-one gay and 81 heterosexual male university students were, respectively, recruited from the Obafemi Awolowo University. Both groups were assessed for depression and other clinical factors, including alcohol and other substance use, suicidal ideation, and resilience. Gay students were further assessed for sexuality-related variables, including minority stress factors such as internalized homophobia and perceived stigma. The prevalence rates of depression among gay and heterosexual students were, respectively, 16 and 4.9% (OR 3.7; 95% CI 1.15–11.82), and this increased likelihood for depression was significantly attenuated by resilience. Clinical factors correlated significantly with depression in both groups, explaining 31% of the variance in depression in gay and heterosexual students, respectively. Sexuality-related variables including internalized homophobia and perceived stigma were further associated with depression in gay students—accounting for a further 14% of the variance of depression in gay students. The findings highlight the importance of minority stress factors in understanding depression among non-heterosexual individuals in a developing country, and the need for further research to investigate the mechanisms of these relationships in such settings. © 2017, Springer Science+Business Media New York.
Keywords: Depression; Homosexuality; Nigeria; Sexual orientation

Have Mischievous Responders Misidentified Sexual Minority Youth Disparities in the National Longitudinal Study of Adolescent to Adult Health? - Fish, J.N.; Russell, S.T. (Archives of Sexual Behavior, 2018)
The National Longitudinal Study of Adolescent to Adult Health (Add Health) has been instrumental in identifying sexual minority youth health disparities. Recent commentary suggested that some Wave 1 youth responders, especially males, intentionally mismarked same-sex attraction and, as a result, published reports of health disparities from these data may be suspect. We use two recently developed approaches to identify “jokesters” and mischievous responding and apply them to the Add Health data. First, we show that Wave 1 same-sex attracted youth, including those who later reported completely heterosexual identities in adulthood, were no more likely than different-sex attracted youth and consistently heterosexual participants to be “jokesters.” Second, after accounting for mischievous responses, we replicated six previously established disparities: depressive symptoms, suicidal ideation and behaviors, alcohol use, cocaine use, parental satisfaction, and school connectedness. Accounting for mischievousness resulted in the elimination of one observed disparity between heterosexual and sexual minority youth: suicidal ideation for males who reported romantic attraction to both sexes. Results also showed that accounting for mischievous responding may underestimate disparities for sexual minority youth, particularly females. Overall, results presented here support previous studies that identified health disparities among sexual minority youth using these data. © 2017, Springer Science+Business Media New York.
Keywords: Add Health; Adolescence; Alcohol; LGB; Mental health; Sexual orientation

A closer look at the psychosocial realities of LGBTQ youth - Vance, S.R., Jr.; Rosenthal, S.M. (Pediatrics, 2018)

Evidence of Multiple Mediating Pathways in Associations Between Constructs of Stigma and Self-Reported Suicide Attempts in a Cross-Sectional Study of Gay and Bisexual Men - Salway, T.; Gesink, D.; Ibrahim, S.; Ferlatte, O.; Rhodes, A.E.; Brennan, D.J.; Marchand, R.; Trussler, T. (Archives of Sexual Behavior, 2018)
Gay and bisexual men (GBM) are more likely to attempt suicide than heterosexual men. This disparity is commonly interpreted using minority stress theory; however, specific pathways from antigay stigma to suicidal behavior are poorly understood. We aimed to estimate associations between multiple constructs of stigma and suicide attempts among adult GBM, and to measure the proportion of these associations mediated by distinct suicide risk factors, thus identifying proximal points of intervention. Data were drawn from a Canadian community-based survey of adult GBM. Structural equation modeling was used to compare associations between three latent constructs—enacted stigma (e.g., discrimination, harassment), anticipated prejudice (worry about encountering antigay/bisexual prejudice), and sexuality concealment—and self-reported suicide attempts (last 12 months). Coefficients were estimated for direct, indirect, and total pathways and evaluated based on magnitude and statistical significance. The proportion of associations mediated by depression, drug/alcohol use, and social isolation was calculated using indirect paths. Among 7872 respondents, 3.4% reported a suicide attempt in the past 12 months. The largest total association was observed for enacted stigma, and this association was partially mediated by depression and drug/alcohol use. The total association of anticipated prejudice was relatively smaller and mediated by depression and social isolation. Concealment had an inverse association with suicide attempts as mediated by depression but was also positively associated with suicide attempts when mediated through social isolation. Multiple constructs of antigay stigma were associated with suicide attempts; however, mediating pathways differed by construct, suggesting that a combination of strategies is required to prevent suicide in adult GBM. © 2017, Springer Science+Business Media, LLC.
Keywords: Gay and bisexual men; Mental health; Minority stress; Sexual orientation; Sexual stigma; Suicide

Mental health of transgender and gender nonconforming youth compared with their peers - Becerra-Culqui, T.A.; Liu, Y.; Nash, R.; Cromwell, L.; Flanders, W.D.; Getahun, D.; Giammattei, S.V.; Hunkeler, E.M.; Lash, T.L.; Millman, A.; Quinn, V.P.; Robinson, B.; et al. (Pediatrics, 2018)
BACKGROUND: Understanding the magnitude of mental health problems, particularly lifethreatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS: Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date. RESULTS: Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4-82) to 144 (95% CI 36-1248). The corresponding range for suicidal ideation was 25 (95% CI 14-45) to 54 (95% CI 18-218). CONCLUSIONS: TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures. © Copyright 2018 by the American Academy of Pediatrics.

Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series - Donaldson, A.A.; Hall, A.; Neukirch, J.; Kasper, V.; Simones, S.; Gagnon, S.; Reich, S.; Forcier, M. (International Journal of Eating Disorders, 2018)
Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high-risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self-harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population. © 2018 Wiley Periodicals, Inc.
Keywords: anorexia; bulimia; disordered eating; eating disorder; gender nonconforming; other specified feeding and eating disorder; transgender

Multiplicative effects of social and psychological risk factors on college students’ suicidal behaviors - Assari, S. (Brain Sciences, 2018)
Less is known about the multiplicative effects of social and psychological risk and protective factors of suicidality on college campuses. The current study aimed to investigate the multiplicative effects of social (identifying oneself as gay/lesbian, financial difficulty, violence victimization, and religiosity) and psychological (anxiety, depression, problem alcohol use, drug use) and risk/protective factors on suicidal behaviors among college students in the United States. Using a cross-sectional design, the Healthy Mind Study (HMS; 2016–2017), is a national online survey of college students in the United States. Social (identifying oneself as gay/lesbian, violence victimization, financial difficulty, and religiosity) and psychological (anxiety, depression, problem alcohol use, and drug use) risk/protective factors were assessed among 27,961 individuals. Three aspects of suicidality, including ideation, plan, and attempt, were also assessed. Logistic regression models were used for data analysis. Financial difficulty, violence victimization, identifying oneself as gay/lesbian, anxiety, depression, and drug use increased, while religiosity reduced the odds of suicidal behaviors. Multiplicative effects were found between the following social and psychological risk factors: (1) financial difficulty and anxiety; (2) financial difficulty and depression; (3) depression and drug use; (4) problem alcohol use and drug use; and (5) depression and problem alcohol use. There is a considerable overlap in the social and psychological processes, such as financial stress, mood disorders, and substance use problems, on risk of suicide in college students. As social and psychological risk factors do not operate independently, comprehensive suicidal risk evaluations that simultaneously address multiple social and psychological risk factors may be superior to programs that only address a single risk factor. © 2018 by the author. Licensee MDPI, Basel, Switzerland.
Keywords: Abuse; Anxiety; College students; Depression; Sexual orientation; Substance use; Suicide; Violence

Transitioning bodies. The case of self-prescribing sexual hormones in gender affirmation in individuals attending psychiatric services - Metastasio, A.; Negri, A.; Martinotti, G.; Corazza, O. (Brain Sciences, 2018)
Self-prescribing of sexual hormones for gender affirmation is a potentially widespread and poorly studied phenomenon that many clinicians are unaware of. The uncontrolled use of hormones poses significant health hazards, which have not been previously reported in the literature. We have collected seven clinical cases in general adult psychiatry settings (both inpatient and outpatients), describing transgender and gender non-conforming individuals’ (TGNC) self-prescribing and self-administering hormones bought from the Internet without any medical consultation. Among these cases, two were taking androgens, and the rest were taking oestrogens. The main reason for self-administration of hormones seems to be the lack of access to specialised care due to discrimination and long waiting lists. We advocate for clinicians to be aware of the phenomenon and proactively help TGNC individuals by enquiring about self-prescribing of hormones, providing information and referring to the most appropriate treatment centre as well as encourage a public debate on the discrimination and the stigma that TGNC population suffer from. Overall, there is an urgent need for the implementation of different and innovative health care services for TGNC individuals as well as more targeted prevention strategies on such underreported and highly risky behaviours. Furthermore, it is necessary for every clinician involved in the care for TGNC people to be aware of their special needs and be able to be an allied and an advocate to help in reducing stigma and discrimination that affect the access to care for this often underserved population. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.
Keywords: Barriers to care; Discrimination; Do it yoursfelf (DIY); Gender affirmation; Gender dysphoria; Gender reassignment; Hormonal replacement therapy (HRT); Identity; LGTBQ health; Self-medication; Transgender

Transgender adolescents and acne: A cases series - Campos-Muñoz, L.; López-De Lara, D.; Rodríguez-Rojo, M.L.; Conde-Taboada, A.; López-Bran, E. (Pediatric Dermatology, 2018)
We describe the difficulties of treating acne in a series of female-to-male transgender adolescents, including concerns about potential hepatotoxicity with concomitant use of testosterone with isotretinoin or tetracyclines. Acne is a foreseeable adverse effect of testosterone treatment in transgender adolescents, so monitoring for acne is advised. The treatment of acne in transgender adolescents is important given that severe acne and transgenderism are associated with higher rates of depression and suicide. © 2018 Wiley Periodicals, Inc.
Keywords: acne; adolescence; isotretinoin; transgender persons

Queer Youth Suicide as Disruptive Revelation of God - Grovijahn, J.M. (Feminist Theology, 2018)
This work positions queer youth suicide as deviant aperture into scandal within divine life through an ‘indecenting’ of kenotic agency located in the Incarnation itself. Refuting a heteronormative gaze that defines queer youth suicide as an expression of pathology, I present a disruptive coming out of God who redeems through scandal by posing these suicides as deaths for others. Drawing from two liberation theologians, I offer a construct of martyrdom within historical contexts of an excess of death that is capable of carrying the weight of their agency within a destructive heteronormative reality. Applying Althaus-Reid’s method of ‘indecenting’ within their last deviant act, both vitiated and vindicated in this kenotic agency of God, queer youth suicide becomes a preferred vehicle of divine delight and reclamation. Although disruptive, this divine eloquence spills out everywhere, cracking open a theological praxis where no one ever falls outside of God, especially in death. © 2018, © The Author(s) 2018.
Keywords: indecenting; Althaus-Reid; deicide; God; martyrdom; queer; Youth suicide

Increasing interest of mass communication media and the general public in the distribution of tweets about mental disorders: Observational study - Alvarez-Mon, M.A.; del Barco, A.A.; Lahera, G.; Quintero, J.; Ferre, F.; Pereira-Sanchez, V.; Ortuño, F.; Alvarez-Mon, M. (Journal of Medical Internet Research, 2018)
Background: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed. Objective: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers. Methods: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV. Results: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P<.001). Conclusions: American mainstream media outlets and the general public demonstrate a preferential interest for psychiatric diseases on Twitter. The heterogeneous weights given by the media outlets analyzed to the different mental health disorders and conditions are reflected in the responses of Twitter followers. © Miguel Angel Alvarez-Mon, Angel Asunsolo del Barco, Guillermo Lahera, Javier Quintero, Francisco Ferre, Victor Pereira-Sanchez, Felipe Ortuño, Melchor Alvarez-Mon.
Keywords: Mental health; Psychiatry; Social media; Twitter

“Invisible During My Own Crisis”: Responses of LGBT People of Color to the Orlando Shooting - Ramirez, J.L.; Gonzalez, K.A.; Galupo, M.P. (Journal of Homosexuality, 2018)
On June 12, 2016, the Pulse nightclub in Orlando, Florida was the target of one of the country’s deadliest mass shootings. Pulse, a gay nightclub, was hosting a Latin Pride Night the evening of the tragedy, which resulted in the death of 49 victims and 53 casualties, over 90% of whom were lesbian, gay, bisexual, and transgender (LGBT) Latinx people, specifically. The present research investigates the narrative responses from LGBT people of color (LGBT-POC) following the tragedy. Results included an analysis of 94 participant narrative responses. Results were collected online from a sample of LGBT-POC with varying sexual, gender, and racial identities. Thematic analysis revealed four major themes: (1) Violence is Not New for LGBT-POC; (2) Personal Identification with Victims; (3) Lack of Intersectionality in Others’ Responses to Orlando; and (4) Acknowledgment of Intersectionality across LGBT-POC. Discussion focuses on describing the ways in which LGBT-POC responded to the shooting regarding their multiple minority identities. Implications of this research reinforce the need for continued intersectional research with LGBT-POC. © 2017 Taylor & Francis.
Keywords: Hate crime; intersectionality; Latinx; LGBT-POC; minority stress; Orlando

The Association between Intentional Overdose and Same-Sex Sexual Intercourse in a Cohort of People who Inject Drugs in Melbourne, Australia - O'Keefe, D.; Bowring, A.; Aitken, C.; Dietze, P. (Substance Use and Misuse, 2018)
Background: People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID. Objectives: To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI. Methods: The sample included 529 participants, from an ongoing cohort of 757 PWID. An “ever” SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression. Results: Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately. © 2018 Taylor & Francis Group, LLC.
Keywords: intentional overdose; lesbian/gay/bisexual; People who inject drugs; sexual orientation; suicide

Characteristics and Correlates of Lifetime Suicidal Thoughts and Attempts Among Young Black Men Who Have Sex With Men (MSM) and Transgender Women - Wilton, L.; Chiasson, M.A.; Nandi, V.; Lelutiu-Weinberger, C.; Frye, V.; Hirshfield, S.; Hoover, D.R.; Downing, M.J., Jr.; Lucy, D.; Usher, D.S.; Koblin, B. (Journal of Black Psychology, 2018)
This study examined characteristics and correlates of lifetime suicidal thoughts and suicide attempts among HIV-negative young Black men who have sex with men (MSM) and transgender women (transwomen) between 16 and 29 years of age (N = 161). In our sample, 36.6% of young Black MSM and transwomen reported a history of lifetime suicidal thoughts, while 16.1% reported prior suicide attempts. Using multivariable analysis, a history of intimate partner violence, greater psychological distress, and higher perceived sexuality discrimination were significantly associated with lifetime suicidal thoughts. Childhood sexual abuse history, greater psychological distress, lower score for outness, and higher perceived sexuality discrimination were significantly related to suicide attempts among young Black MSM and transwomen. Efforts to identify and understand factors associated with lifetime suicidal thoughts and attempts are urgently needed to inform the development and implementation of culturally relevant mental health prevention strategies for young Black MSM and transwomen. © 2018, © The Author(s) 2018.
Keywords: Black men who have sex with men (MSM); Black transgender women; mental health; sexuality; suicide

Ethnic youth and sexual identity: the role of clinical and social support for ‘double minorities’ - Wong, N.; Menkes, D.B. (Australasian Psychiatry, 2018)
Objectives: Sexual-minority youth exhibit increased rates of psychiatric morbidity, subject to various social factors. We examine the impact of ethnicity and culture on these phenomena, with particular reference to Asian youth living in Western societies. Conclusions: Youth from minority ethnic groups who do not identify with their native gender and/or who are not exclusively heterosexual are known as ‘double minorities’. Available evidence suggests that such individuals are at particularly increased risk of depression and suicide, but that this may be mitigated by social support. More research is needed to understand the challenges faced by ‘double minorities’, notably their perception of and ability to access available clinical and social supports. © 2018, © The Royal Australian and New Zealand College of Psychiatrists 2018.
Keywords: depression; ethnic minority; LGBT; sexual minority; suicide

Peer Victimization and Dating Violence Among LGBTQ Youth: The Impact of School Violence and Crime on Mental Health Outcomes - Espelage, D.L.; Merrin, G.J.; Hatchel, T. (Youth Violence and Juvenile Justice, 2018)
This study examined the moderating role of school violence and peer victimization on the association between sexual orientation and mental health. The sample consisted of 11,794 high school students (Mage = 16, SD = 1.23; female assigned at birth = 51%; 1.8% identified as transgender) across 23 schools. Participants completed a self-report survey that assessed sexual orientation, ethnicity, gender identity, victimization experiences (e.g., peer and dating), perceptions of school violence and crime, as well as anxiety and suicidality. Multilevel analyses indicated that lesbian, gay, bisexual, questioning, and transgender (LGBTQ) individuals with lower rates of victimization had significantly lower rates of suicidality compared to LGBTQ individuals with higher rates of victimization. LGBTQ individuals in schools with high student perceptions of school violence and crime had higher suicidality than their non-LGBTQ counterparts. LGBTQ youth in schools with lower school violence and crime levels had lower rates of suicidality than their non-LGBTQ counterparts. Interventions need to consider multiple forms of victimization and school environment as potential risk and protective factors for LGBTQ youth. © 2016, © The Author(s) 2016.
Keywords: LGBTQ youth; school violence and crime; sexual minority youth; teen dating violence; victimization

Accounting for Diversity in Suicide Research: Sampling and Sample Reporting Practices in the United States - Cha, C.B.; Tezanos, K.M.; Peros, O.M.; Ng, M.Y.; Ribeiro, J.D.; Nock, M.K.; Franklin, J.C. (Suicide and Life-Threatening Behavior, 2018)
Research on suicidal thoughts and behaviors (STB) has identified many risk factors, but whether these findings generalize to diverse populations remains unclear. We review longitudinal studies on STB risk factors over the past 50 years in the United States and evaluate the methodological practices of sampling and reporting sample characteristics. We found that articles frequently reported participant age and sex, less frequently reported participant race and ethnicity, and rarely reported participant veteran status or lesbian, gay, bisexual, and transgender status. Sample reporting practices modestly and inconsistently improved over time. Finally, articles predominantly featured White, non-Hispanic, young adult samples. © 2017 The American Association of Suicidology

Sexual risk behaviour, sexual victimisation, substance use and other factors related to depression in men who have sex with men in Wenzhou, China: A cross-sectional study - Pan, X.; Li, R.; Ma, Q.; Wang, H.; Jiang, T.; He, L.; Zeng, S.; Wang, D.; Ye, Z.; Zhu, H.; Zhao, D.; Xia, S. (BMJ Open, 2018)
Objectives Men who have sex with men (MSM) are a marginalised population at high risk for a variety of mental health problems that may mutually facilitate HIV transmission. We assessed factors associated with depressive symptoms among MSM, which can provide some guidance for future mental health interventions with the MSM population for prevention of HIV infection and transmission. Methods A cross-sectional study was conducted in Wenzhou city, China using respondent-driven sampling (RDS) between December 2013 and June 2014. A face-to-face questionnaire survey was employed to collect information about mental and psychosocial health conditions and sexual behaviour characteristics among MSM. Bivariate and multivariable logistic regression analyses were used to identify factors associated with major depressive symptoms. Results Of the 454 participants in the study, prevalence of major depressive symptoms was 34.6%. During the past 6 months, 85% had anal sex with men, and rate of consistent condom use during anal intercourse was 45.1%. Of the respondents, 16.1% reported suicidal ideation, 62.6% had a history of smoking and 41.4% had a history of drinking alcohol, of which 46.3% reported that they were once drunk. Drug use was reported in 3.7% of the sample. Adult sexual violence from same-sex partners was 7.9%, and 5.1% reported childhood sexual abuse. ARDS-weighted multivariable analysis showed that major depressive symptoms among MSM were associated with inconsistent condom use during anal sex with men, multiple oral male sexual partners, suicidal ideation, adult sexual violence from male partners and being once drunk in the past year. Conclusion We found high levels of depressive symptoms, unprotected sex and suicidal ideation among MSM. Comprehensive intervention strategies that combine psychological, behavioural and social aspects are needed to address the mental health issues of MSM, with special attention given to suicidality and high-risk behaviours in mental health and HIV prevention interventions. © 2018 Article author(s).
Keywords: Epidemiology; HIV & AIDS; Mental health; Public health

Stifled [Queer] Voices - Teman, E.D. (Cultural Studies - Critical Methodologies, 2018)
Issues of bullying, suicide, self-expression, self-acceptance, self-harm, among others, within the gay, lesbian, bisexual, transgender, queer, questioning, ally, and others (GLBTQQA+) culture are explored through ethnodrama. I show the suffering, the silenced voices, and the pain endured by GLBTQQA+ college students in rural Wyoming. I act as a story-reteller, where I creatively and strategically edit the interview transcripts to maintain the narrative. The result is an ethnodrama. © 2016, © 2016 SAGE Publications.
Keywords: bullying; ethnodrama; GLBTQQA+; self-acceptance; story-retelling

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

Correctional Policy and Attempted Suicide Among Transgender Individuals - Drakeford, L. (Journal of Correctional Health Care, 2018)
Little research has examined the link between incarceration and suicide among transgender individuals. Transgender inmates face unique circumstances within the correctional setting that expose them to potentially harmful conditions, including correctional policies that limit access to proper medical care and expose them to threats of harassment and violence. Using data from the 2011 National Transgender Discrimination Survey, this article examines the link between incarceration and suicide among transgender individuals by focusing on the link between correctional policies and attempted suicide among transgender individuals who have been incarcerated. Multivariate results suggest that correctional policies regarding health care and housing may deleteriously impact transgender inmates. © 2018, © The Author(s) 2018.
Keywords: incarceration; mental health; policy; suicide; transgender

Suicidal Thoughts and Behaviors Among First-Year College Students: Results From the WMH-ICS Project - Mortier, P.; Auerbach, R.P.; Alonso, J.; Bantjes, J.; Benjet, C.; Cuijpers, P.; Ebert, D.D.; Green, J.G.; Hasking, P.; Nock, M.K.; O'Neill, S.; Pinder-Amaker, S.; et al. (Journal of the American Academy of Child and Adolescent Psychiatry, 2018)
Objective: College entrance may be a strategically well-placed “point of capture” for detecting late adolescents with suicidal thoughts and behaviors (STB). However, a clear epidemiological picture of STB among incoming college students is lacking. We present the first cross-national data on prevalence as well as socio-demographic and college-related correlates for STB among first-year college students. Method: Web-based self-report surveys were obtained from 13,984 first-year students (response rate 45.5%) across 19 colleges in 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, and the United States). Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 32.7%, 17.5%, and 4.3%, respectively. The 12-month prevalence was 17.2%, 8.8%, and 1.0%, respectively. About three-fourths of STB cases had onset before the age of 16 years (Q3 = 15.8), with persistence figures in the range of 41% to 53%. About one-half (53.4%) of lifetime ideators transitioned to a suicide plan; 22.1% of lifetime planners transitioned to an attempt. Attempts among lifetime ideators without plan were less frequent (3.1%). Significant correlates of lifetime STB were cross-nationally consistent and generally modest in effect size (median adjusted odds ratio [aOR] = 1.7). Nonheterosexual orientation (aOR range 3.3−7.9) and heterosexual orientation with some same-sex attraction (aOR range 1.9−2.3) were the strongest correlates of STB, and of transitioning from ideation to plans and/or attempts (aOR range 1.6−6.1). Conclusion: The distribution of STB in first-year students is widespread, and relatively independent of socio-demographic risk profile. Multivariate risk algorithms based on a high number of risk factors are indicated to efficiently link high-risk status with effective preventive interventions. © 2018 American Academy of Child and Adolescent Psychiatry

Clarifying the relation of acculturative stress and anxiety/depressive symptoms: The role of anxiety sensitivity among hispanic college students - Jardin, C.; Mayorga, N.A.; Bakhshaie, J.; Garey, L.; Viana, A.G.; Sharp, C.; Cardoso, J.B.; Zvolensky, M.J. (Cultural Diversity and Ethnic Minority Psychology, 2018)
Objectives: Recent work has highlighted the link between acculturative stress and depression/anxiety symptoms among Hispanic young adults, but the nature of these relations is not well understood. The present study aimed to clarify the relation between acculturative stress and depression/anxiety symptoms by examining anxiety sensitivity, globally and via subfactors, as an explanatory variable. Method: A cross-sectional sample of 788 Hispanic college students (80.8% female; Mage=20.83 years, SD=1.93) was recruited from a southwestern public university and completed an online self-report assessment battery. Results: Acculturative stress exerted an indirect effect, via the global construct of anxiety sensitivity, on depression symptoms, suicidality, anxious arousal, and social anxiety symptoms. Follow-up simultaneous analytic models demonstrated indirect effects via the anxiety sensitivity subfactors that were pathognomonic with each of the specific affective outcomes. Conclusions: These findings suggest the utility of assessing and targeting anxiety sensitivity in the treatment of acculturative stress-related depression/anxiety problems among Hispanic college students. © 2017 American Psychological Association.
Keywords: Acculturative stress; Adulthood (18 years & older); Anxiety sensitivity; Depression/anxiety; Latinos/Latinas

Using a television documentary to prevent suicide in men and boys - Schlichthorst, M.; King, K.; Spittal, M.; Reifels, L.; Phelps, A.; Pirkis, J. (Australasian Psychiatry, 2018)
Objectives: We investigated whether a documentary about masculinity and suicidality (Man Up) could raise males’ awareness of societal pressures to conform to masculine norms and influence their likelihood of connecting with their male friends and seeking help. Methods: We conducted a repeat cross-sectional survey, posting versions of the survey online before and after Man Up was screened. Results: 1287 male respondents completed the survey; 476 completed the pre-screening survey, 811 the post-screening survey (192 had not viewed Man Up, 619 had). Those who had viewed Man Up were more likely to desire closer relationships with their male friends than those who had not, and had greater awareness of societal pressures on males, but were no more likely to seek help. Almost all respondents who saw Man Up indicated they would recommend it to others, and most said it changed the way they thought about the term ‘man up’. They indicated they would be likely to undertake a number of adaptive actions following the show, and provided overwhelmingly positive feedback. Conclusions: Man Up appeared to effectively address factors that place males at heightened risk of suicide. © 2018, © The Royal Australian and New Zealand College of Psychiatrists 2018.
Keywords: connectedness; documentary; help-seeking; intervention; masculinity; men; norms; social support; suicide

The Impact of Cannabis Use Disorder on Suicidal and Nonsuicidal Self-Injury in Iraq/Afghanistan-Era Veterans with and without Mental Health Disorders - Kimbrel, N.A.; Meyer, E.C.; DeBeer, B.B.; Gulliver, S.B.; Morissette, S.B. (Suicide and Life-Threatening Behavior, 2018)
The objective of this study was to assess the association between cannabis use disorder (CUD) and self-injury among veterans. As expected, after adjusting for sex, age, sexual orientation, combat exposure, traumatic life events, traumatic brain injury, posttraumatic stress disorder, depression, alcohol use disorder, and noncannabis drug use disorder, CUD was significantly associated with both suicidal (OR = 3.10, p =.045) and nonsuicidal (OR = 5.12, p =.009) self-injury. CUD was the only variable significantly associated with self-injury in all three models examined. These findings are consistent with prior research among civilians and suggest that CUD may also increase veterans’ risk for self-injurious behavior. © 2017 The American Association of Suicidology

A population-based longitudinal study of symptoms and signs before the onset of psychosis - Livny, A.; Reichenberg, A.; Fruchter, E.; Yoffe, R.; Goldberg, S.; Fenchel, D.; Burshtein, S.; Bachar, E.; Davidson, M.; Weiser, M. (American Journal of Psychiatry, 2018)
Objective: The authors sought to characterize the symptoms of patients later hospitalized for psychotic disorders in primary mental health outpatient settings, and to investigate whether these symptomscan beused to predict later onset of psychotic illness. Method: This was a population-based historical prospective cohort study using national registers of clinical psychiatric services.Thesample (N=114,983)comprised 18- to21-year-olds serving in the Israelimilitary and examined in military mental health outpatient clinics across 72 consecutive months. Results: Overall, 1,092 individuals (0.95%) not diagnosed with a psychotic disorder at the time of examinationwere hospitalized for nonaffective psychotic disorder up to 9 years after the index examination. A principal components analysis of symptoms presented at index examination found that a symptomcluster of thought disorder, perceptual abnormalities, poor orientation, and suicidality was associated with an increased risk for hospitalization for nonaffective psychotic disorderwithin 14 days after examination (hazard ratio=45.80, 95%CI=22.87-91.73), 15-111 days after examination, (hazard ratio=19.59, 95% CI=13.08-29.33), 112-365 days after examination (hazard ratio=4.94, 95% CI=2.59-9.40), and 1-3.5 years after examination (hazard ratio=3.42, 95% CI=2.21-5.28), but not for hospitalization 3.5 years or more after examination (hazard ratio=1.57, 95% CI=0.91-2.71). Despite the increased risk, the positive predictive values of this symptom cluster were low, ranging from 0.54% to 1.99%. Conclusions: In 18- to 21-year-olds, the presence of psychotic symptoms was associated with later hospitalization for a nonaffective psychotic disorder. However, the low positive predictive values of symptoms elicited in primary mental health care settings suggest that symptoms alone are not useful in predicting later hospitalization for nonaffective psychotic disorder. © 2018 American Psychiatric Association. All rights reserved.

Improving the Mental Health Outcomes of LGBTQ Youth and Young Adults: A Longitudinal Study - Painter, K.R.; Scannapieco, M.; Blau, G.; Andre, A.; Kohn, K. (Journal of Social Service Research, 2018)
The purpose of this groundbreaking study was to evaluate outcomes of 482 LGBTQ (lesbian, gay, bisexual, transgender, or questioning) youth and young adults who received services and supports through the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Program (CMHI). This study was a secondary data analysis using data from a larger study of 3208 LGBTQ and non-LGBTQ youth ages 11 through 21 who had a serious emotional disturbance (SED). This study is significant in that it evaluates functional outcomes for young people identified as LGBTQ based on a specialized service framework (i.e., system of care approach). In essence, do LGBTQ youth with SED benefit from a specific approach to intervention? In addition, a comparison at intake on suicidality, bullying and victimization was conducted between the LGBTQ and non-LGBTQ identifying youth from the larger sample. The youth and a caregiver were interviewed face-to-face separately at intake, 6-months, and 12-months. Significant improvements were found across all of the dependent variables, supporting the viability of SOC for improving outcomes for LGBTQ youth. Future research should continue to build on this study by adding to the design a control group to improve internal validity of the findings. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: LGBTQ Youth and Young Adults; Serious Mental Disturbance; Systems of Care

Micro-Exclusions, Raunch Aesthetics and In-Jokes: A Rogue Hmong Raciosexual Parody - Schein, L.; Vang, B. (Visual Anthropology, 2018)
This essay reads closely into the racial politics of “Thao Does Walt,” a YouTube parody of one particular scene in Eastwood’s Gran Torino, featuring Bee Vang, the lead actor from the original. The short, co-created by the authors and a Hmong artistic team, sought to trouble clichéd Asian American masculinities, not by defying them but by caricaturing dominant tropes, deploying camp, humor, raunch and queering tactics to make visible the turgidity of stereotyping. Moving from a production-studies approach that interrogates how the team’s use of silliness and hyperbole in scripting and shooting was to suggest complex personhood and its erasure, we turn to the “failures” of reception, reflecting on how canons of lockstep legibility contravened our queer satiric approach to counter-representation. © 2018, Copyright © Taylor & Francis Group, LLC.

Youth Experiences Survey (YES): Exploring the Scope and Complexity of Sex Trafficking in a Sample of Youth Experiencing Homelessness - Middleton, J.S.; Gattis, M.N.; Frey, L.M.; Roe-Sepowitz, D. (Journal of Social Service Research, 2018)
In the United States, sex trafficking victims have been identified at ages across the lifespan but young persons (under age 25) have been found to have unique vulnerabilities. At-risk youth, such as those who run away from home or those experiencing homelessness, are also at an increased risk of sexual exploitation. To better understand the scope and complexity of sex trafficking among these at-risk youth, a convenience sample of 131 homeless youth aged 12 to 25 years old experiencing homelessness recruited from Kentuckiana youth service providers completed an enhanced version of the Youth Experiences Survey (YES). Univariate and bivariate analyses were conducted. Results indicated that 41.2% of the homeless youth were victims of sex trafficking. The sex trafficked youth were more likely to report previous self-harm behaviors, suicide attempts, and substance use. This study not only provides support for improved service delivery, but also provides essential statistics that should inform internal policy and procedures for youth serving agencies in Kentucky and Indiana. Findings highlight a need for trauma-informed interventions designed to treat not only females but also males and LGBTQ youth. Additionally, service providers should consider partnering with victim providers and clinicians to offer therapeutic groups, individual therapy, and supportive services that increase prevention, education, and wraparound care for clients. In regards to future research, findings point towards a need to better understand the role that trauma and adverse childhood experiences may play in making young people vulnerable to sex trafficking, and encourage the need for testing prevention and early intervention practices among vulnerable youth. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: at-risk youth; homeless youth; human trafficking; sex trafficking; sexual exploitation; trauma

Association of recent gay-related stressful events and emotional distress with suicidal behaviors over 12 months in Chinese men who have sex with men - Yu, L.; Li, Y.; Liu, L.; Li, S.; Na, J.; An, X.; Zhou, Y.; Gu, Y.; Bi, X.; Mu, H.; Zhang, R.; Dong, W.; et al. (Asia-Pacific Psychiatry, 2018)
Introduction: The study was designed to assess the association of gay-related stressful events (GRSEs) and emotional distress with suicidal behaviors over a 12-month period in Chinese men who have sex with men (MSM). Methods: A total of 807 MSM were recruited using a respondent-driven sampling method from 4 cities in northeastern China. The GRSEs were measured using the Gay-related Stressful Life Events Scale, depression using the Self-rating Depression Scale, and anxiety using the Self-rating Anxiety Scale. Results: A total of 26.0% of study participants experienced GRSEs during the 3 months, and their average Self-rating Depression Scale and Self-rating Anxiety Scale scores were significantly lower than the national norms. Over a 12-month period, the prevalence of suicidal ideation, plan, and attempt was 9.7%, 4.0%, and 3.0%, respectively, each of which is at least 3 to 4 times greater than that of male adults in the general population of China. Multiple logistic regression analysis showed that GRSEs significantly increased the risk of suicidal ideation (odds ratio [OR] = 2.3, 95% confidence interval [CI], 1.4-3.7) and plan (OR = 2.8, 95% CI, 1.3-6.0). Depressive symptoms significantly increased the risk of suicidal ideation (OR = 3.5, 95% CI, 2.1-5.8), plan (OR = 4.4, 95% CI, 2.0-9.6), and attempt (OR = 5.6, 95% CI, 21.94.8). Anxiety symptoms (OR = 3.4, 95% CI, 1.4-8.4) and cohabitation with a same sex partner (OR = 3.0, 95% CI, 1.2-7.9) significantly increased the risk of suicide attempt. Discussion: More efforts to reduce GRSE are worth investigating as a strategy to reduce suicidal thoughts and behaviors in Chinese MSM. © 2017 John Wiley & Sons Australia, Ltd
Keywords: anxiety symptoms; depression symptom; gay related stressful event; men who have sex with men; suicidal behaviors

An Application of Syndemic Theory to Identify Drivers of the Syphilis Epidemic among Gay, Bisexual, and Other Men Who Have Sex with Men - Ferlatte, O.; Salway, T.; Samji, H.; Dove, N.; Gesink, D.; Gilbert, M.; Oliffe, J.L.; Grennan, T.; Wong, J. (Sexually Transmitted Diseases, 2018)
Background We applied syndemic theory to explore the degree to which syndemic conditions explain the syphilis epidemic affecting Canadian gay and bisexual men who have sex with men (GBMSM). Methods Data from a national survey comprising 7872 GBMSM were analyzed using multivariable logistic regression to measure associations between recent syphilis diagnosis (RSD; in previous 12 months) and the following variables: (1) sociodemographic information (sexuality, HIV status, age, income, ethnicity, relationship status), (2) antigay stigma (bullying, physical violence, sexual violence, career discrimination, health care discrimination), (3) syndemic conditions (suicidality, intimate partner violence, depression, illicit substance use, binge drinking), (4) sexual behaviors, (5) health care discrimination, and (6) the cumulative count of antigay experiences and syndemic conditions. Results Three percent (n = 235) of GBMSM surveyed reported an RSD. Men were more likely to report an RSD if they were HIV positive (adjusted odds ratio [AOR], 6.27; 95% confidence interval [CI], 4.66-8.43). Recent syphilis diagnosis was also positively associated with career discrimination, health care discrimination, substance use, and intimate partner violence. Furthermore, prevalence of RSD increased with each additional form of stigma or syndemic condition. The odds of reporting RSD was 5.2 (95% CI, 1.0-25.9) times higher for men who reported experiencing all 4 forms of antigay stigma compared with those who reported no stigma, after adjusting for sociodemographics. Similarly, the adjusted odds of reporting RSD was 12.2 (95% CI, 2.0%-74.8%) times higher for GBMSM experiencing 5 syndemic conditions compared with those reporting no syndemic conditions. Conclusions Evidence from this large cross-sectional study suggests that the Canadian syphilis epidemic among GBMSM is being driven by a syndemic constituted by multiple social and psychological conditions. Interventions addressing specific psychosocial health outcomes that increase the risk for syphilis should be developed and integrated within targeted sexual health services and syphilis prevention initiatives. Copyright © 2018 by the American Sexually Transmitted Diseases Association. Unauthorized reproduction of this article is prohibited.

Life experiences of sexual minorities in Iran: limitations, adaptations and challenges - Mohammadi, N. (Quality and Quantity, 2018)
The purpose of this study is to present a description, theming, and status comparison of sexual minorities, such as transgender persons and transsexuals in the Islamic society of Iran. Cultural as well as religious sensitivities have made the living conditions of sexual minorities, as an individual and a social being, extremely challenging. Using a hermeneutic interpretation (interpretative phenomenological analysis) a number of 18 semi-structured interviews were conducted with transgender individuals; from the interviews, three main themes: self-confidence, legal respect (in terms of the self) and social esteem were revealed. These individuals were categorized into three groups: transgender individuals (pre-sex reassignment surgery), transsexuals (under hormone therapy), and transsexuals (post-sex reassignment surgery). The findings indicate that social dignity in relation to transgender individuals is a critical issue. More than other social groups, transgender individuals are under a higher level of mental stress pertaining to role conflict, disappointment in romantic relationships, high risk of suicide, being discriminated against, based on sexual orientation, and physical, verbal and sexual abuse. The interviews also introduced exclusion and the inability to adapt/adjust in socially professional situations, as the leading context condition losing social dignity in all three groups. These difficulties have also been noticed in post-surgical transsexuals, especially from those that have undergone male to female sex reassignment surgeries. These findings support the rights of sexual minorities and more specifically transgender individuals in the Civil Rights Charter which has recently been submitted to the Iranian parliament. Moreover, the establishment of transgender health training centers is proposed in order to complete the medical process of sex reassignment and to facilitate appropriate behavioral adjustment to the reassigned sex, especially for male to female sex reassignment transgender individuals. © 2017, Springer Science+Business Media Dordrecht.
Keywords: Bodily purgatory; Body modification; Iran; Transgender; Transsexual

Coming out under the gun: Exploring the psychological dimensions of seeking refugee status for lgbt claimants in Canada - Kahn, S.; Alessi, E.J. (Journal of Refugee Studies, 2018)
Over the past decade, human rights activists have documented the increase in refugee claims related to sexual orientation and gender identity. Refugee claims processes have been found to result in negative psychological consequences for claimants in general; however, lesbian, gay, bisexual and transgender (LGBT) individuals have the added burden of 'proving' that they are members of a sexual or gender minority group. Despite this unique requirement, research on the psychological impact of the refugee claim for LGBT individuals is scarce. To investigate the issue, this grounded theory study explored the perspectives of 22 providers of services to LGBT forced migrants (attorneys, mental health providers and advocates), supplemented by interviews with seven LGBT forced migrants. The findings suggest that early disclosure of sexual violence, compressed timelines for filing a refugee claim and coming out before they are ready contribute to mental health crises and identity confusion for LGBT claimants. The discussion concludes with recommendations for policy and practice. © The Author 2017. Published by Oxford University Press. All rights reserved.
Keywords: Asylum seekers; Gender minorities; LGBT; Mental health; Refugees; Sexual

Cyberbullying and LGBTQ Youth: A Systematic Literature Review and Recommendations for Prevention and Intervention - Abreu, R.L.; Kenny, M.C. (Journal of Child and Adolescent Trauma, 2018)
Research has demonstrated that cyberbullying has adverse physical and mental health consequences for youths. Unfortunately, most studies have focused on heterosexual and cisgender individuals. The scant available research on sexual minority and gender expansive youth (i.e., LGBTQ) shows that this group is at a higher risk for cyberbullying when compared to their heterosexual counterparts. However, to date no literature review has comprehensively explored the effects of cyberbullying on LGBTQ youth. A systematic review resulted in 27 empirical studies that explore the effects of cyberbullying on LGBTQ youth. Findings revealed that the percentage of cyberbullying among LGBTQ youth ranges between 10.5% and 71.3% across studies. Common negative effects of cyberbullying of LGBTQ youth include psychological and emotional (suicidal ideation and attempt, depression, lower self-esteem), behavioral (physical aggression, body image, isolation), and academic performance (lower GPAs). Recommendations and interventions for students, schools, and parents are discussed. © 2017, Springer International Publishing AG.
Keywords: correlates; cyberbullying; effects; LGBT youth; prevalence; prevention

Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: A nationwide, retrospective cohort study - Zhao, Y.; Wu, Z.; McGoogan, J.M.; Shi, C.X.; Li, A.; Dou, Z.; Ma, Y.; Qin, Q.; Brookmeyer, R.; Detels, R.; Montaner, J.S.G. (Clinical Infectious Diseases, 2018)
Background. Clinical trials have demonstrated that immediate initiation of antiretroviral therapy (ART) reduces AIDS-related morbidity and mortality. We tested the hypothesis that initiating ART ≤30 days after human immunodeficiency virus (HIV) diagnosis would be associated with reduced mortality among people living with HIV (PLWH) with CD4 counts >500 cells/μL. Methods. PLWH enrolled in the Chinese National HIV Information System between January 2012 and June 2014 with CD4 counts >500 cells/μL were followed for 12 months. Cox proportional hazards model was used to determine hazard ratios (HRs) for PLWH who initiated ART after HIV diagnosis. ART initiation was treated as a time-dependent variable. Results. We enrolled 34 581 PLWH with CD4 >500 cells/μL; 1838 (5.3%) initiated ART ≤30 days after diagnosis (immediate ART group), and 19 deaths were observed with a mortality rate of 1.04 per 100 person-years (PY). Fifty-eight deaths were documented among the 5640 PLWH in the delayed ART group with a mortality rate of 2.25 per 100 PY. There were 713 deaths among the 27 103 PLWH in the no ART group with a mortality rate of 2.39 per 100 PY. After controlling for potential confounding factors, ART initiation at ≤30 days (adjusted HR, 0.37 [95% confidence interval, .23-.58]) was a statistically significant protective factor. Conclusions. We found that immediate ART is associated with a 63% reduction in overall mortality among PLWH with CD4 counts >500 cells/μL in China, supporting the recommendation to initiate ART immediately following HIV diagnosis. © The Author(s) 2017.
Keywords: Antiretroviral therapy; CD4 count; HIV/AIDS; Mortality; Treatment initiation

A young transgender woman with fatigue, malnutrition, and a previous suicide attempt - Robitz, R.; Gajaria, A.; Stoklosa, H.; Jones, E.; Baldwin, S.B. (Psychiatric Annals, 2018)

Payback: The Custom of Assault and Rape of Sistergirls and Brotherboys; Australia's Trans and Sex/Gender Diverse First Peoples - Kerry, S. (Violence and Gender, 2018)
To date, little research has been conducted into the lives of trans Indigenous Australians, also known as sistergirls and brotherboys. The author recently completed a 3-year research project into the lives of trans people living in Australia's remotely located Northern Territory as well as sistergirls and brotherboys. This research is groundbreaking because it analyses, for the first time, the issues impacting these populations. This article draws out the most pressing difficulties sistergirls and brotherboys experience, that is, transphobia within traditional Aboriginal communities. It has become a push factor for many sistergirls and brotherboys to leave their communities, yet, migrating to large residential areas leads to further discrimination. There may be racism within predominantly white trans communities and difficulties with language because, for example, English, for many Indigenous Australians, is their third or fourth language. Furthermore, sistergirls and brotherboys may experience a loss of identity because community and country are essential aspects of Indigenous Australian's sense of self, well-being, and spirituality. Transphobia in traditional Aboriginal communities manifests in the so-called custom of payback, through which retribution for social transgressions is brought on community members. To illustrate this custom, this article focuses on Crystal, one of the author's interviewees. Crystal is a sistergirl from the remote Tiwi Islands on the north coast of Australia and, for decades, her family and community enacted payback because she is a sistergirl. This payback took the form of verbal harassment, physical assault, and rape not only against Crystal herself but also immediate members of her family, and, as a result, several committed suicide. She rejects the notion that payback should be a protected custom; rather she demands that it is her human rights and the human rights of all sistergirls and brotherboys that need protecting. Crystal refuses to be silenced and she advocates on behalf of sistergirls and brotherboys. In 2012, Crystal was elected to the local Tiwi Island council and, in doing so, became the first sistergirl and trans woman to be elected to an Australian government office. Crystal is known as Aunty because she helps the younger generation, but because she has won the respect of her community, she is now also known as Elder. © 2018, Mary Ann Liebert, Inc.
Keywords: Aboriginal; Australia; brotherboys; Indigenous; sex/gender diverse; sistergirls; transgender

Correlation of Minority Status, Cyberbullying, and Mental Health: A Cross-Sectional Study of 1031 Adolescents - Duarte, C.; Pittman, S.K.; Thorsen, M.M.; Cunningham, R.M.; Ranney, M.L. (Journal of Child and Adolescent Trauma, 2018)
Adolescent cyberbullying is increasingly prevalent. Depression and suicidal ideation are also common, particularly among minority adolescents and cyberbullied adolescents. Little data exists to establish whether minority cyberbullied adolescents are at greater risk of negative mental health outcomes associated with cyberbullying. This cross-sectional study of 1031 adolescents presenting to an emergency room examines the prevalence of cyberbullying in minority and non-minority populations. Using logistic regression, we compared mental health symptoms between minority and non-minority cyberbullying-involved adolescents (accounting for demographic factors), and examined the correlation between use of multiple forms of online technology, minority status, and prevalence of cyberbullying. Sexual orientation was the only demographic factor to strongly correlate with cyberbullying involvement or to correlate with negative mental health symptoms. Increased use of social media platforms also correlated with cyberbullying involvement. This analysis provides a baseline for future work around targeted cyberbullying interventions for minority adolescent populations. © 2018, Springer International Publishing AG, part of Springer Nature.
Keywords: Adolescent; Cyberbullying; Demographics; Mental health; Social media

Sexual Violence and Intimate Partner Violence in College Women with a Mental Health and/or Behavior Disability - Bonomi, A.; Nichols, E.; Kammes, R.; Green, T. (Journal of Women's Health, 2018)
Objectives: We address questions about (1) how college women with a disability experience sexual violence (SV) and intimate partner violence (IPV) across partners, including disability-specific abuse and (2) how SV/IPV impacts psychological, behavioral, physical, and academic life domains. Methods/Design: Twenty-seven female college students (mean age, 21.2; 66.6% white; 66.6% heterosexual) were randomly sampled from university registrar records. To be eligible for the study, students had to have at least one experience of SV/IPV since age 18 and a disability (88.8% reported one or more mental health conditions; 11.1% reported other conditions, such as attention deficit and hyperactivity disorder; with the majority of women indicating their disability preceded SV/IPV victimization). Using the Centers for Disease Control and Prevention's definitions of SV/IPV as guides, clinically trained master's level interviewers conducted semistructured interviews to ascertain SV/IPV patterns across students' three most recent relationships and related life impacts. Results: SV/IPV was pervasive in college women with a disability, within hookup settings and/or recurring SV/IPV with a long-term partner. For some women, SV spanned multiple abusive partners. For women in relationships marked by chronic abuse, in addition to SV, the relationship dynamic included disability-specific abuse, social isolation, threats/intimidation, and technology-related abuse. For women experiencing SV events within hookup settings, alcohol was a common facilitator, with some abusers using a disability to manipulate a sexual connection. All but one participant reported exacerbated adverse mental health consequences (e.g., depression, anxiety, post-traumatic stress disorder, suicidal ideation/attempts, stress) after victimization. These adverse mental health consequences coincided with adverse behavioral (e.g., becoming less social, avoiding usual study lounge areas on campus), physical (e.g., problems sleeping, bruising, pregnancy concerns, and sexually transmitted disease), and academic outcomes (e.g., skipping and/or dropping class, grades suffering). Discussion: Our results underscore the need for continued investment in campus programs that improve response to SV/IPV, including prevention programs and support services tailored to the specific needs and vulnerabilities of women with underlying mental health conditions. © Copyright 2018, Mary Ann Liebert, Inc. 2018.
Keywords: campus assault; college women; intimate partner violence; mental health; sexual violence

Characteristics of stress and suicidal ideation in the disclosure of sexual orientation among young french LGB adults - Charbonnier, E.; Dumas, F.; Chesterman, A.; Graziani, P. (International Journal of Environmental Research and Public Health, 2018)
Background: Lesbians, gays, and bisexual people (LGB) present high levels of suicidal ideation. The disclosure of sexual orientation is a stressful experience which presents a high suicide risk. Research has not paid sufficient attention to stress during this disclosure in order to understand suicide among LGB people. The aims of this study were to investigate: (1) the characteristics of stress during this revelation, more precisely cognitive appraisal, emotions, and coping; and (2) associations between these characteristics and suicidal ideation. Method: A total of 200 LGB young adults answered the “Stressful situation assessment questionnaire”, focusing on the most stressful disclosure of sexual orientation they have ever experienced. Results: Avoidance coping is a good predictor of suicidal ideation, and mediates the association between primary appraisal (risk “Harm myself and others”) and suicidal ideation. Conclusions: Our study illustrates the need to better understand stress during the disclosure of sexual orientation to prevent and care for suicide risk among LGB young adults. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.
Keywords: Disclosure of sexual orientation; LGB young adults; Stress; Suicide

Norms and normalisation: understanding lesbian, gay, bisexual, transgender and queer youth, suicidality and help-seeking - McDermott, E.; Hughes, E.; Rawlings, V. (Culture, Health and Sexuality, 2018)
Young people who identify as lesbian, gay, bisexual, and queer transgender have elevated rates of suicidality. Despite the increased risk, there is a paucity of research on lesbian, gay, bisexual, transgender and queer help-seeking and suicidality. We report on a UK sequential exploratory, two-stage, mixed-method study. Stage 1 involved 29 online and face-to-face semi-structured interviews with lesbian, gay, bisexual, transgender and queer youth aged 16–25 years old. Stage 2 utilised an online youth questionnaire employing a community-based sampling strategy (n = 789). Results indicated that participants only asked for help when they reached a crisis point because they were normalising their emotional distress. Those who self-harmed, had attempted or planned suicide or had experience of abuse related to their sexuality or gender were most likely to seek help. Results suggested that the reluctance to seek help was due to three interconnecting factors: negotiating sexuality, gender, mental health and age norms; being unable to talk about emotions; and coping and self-reliance. Policies aiming to prevent lesbian, gay, bisexual, transgender and queer youth suicide recognise that norms and normalising processes connected to sexual orientation and gender identity are additional difficulties that youth have accessing mental health support. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Keywords: gender; help-seeking; sexuality; suicide; Youth

Sexual Identity, Adverse Childhood Experiences, and Suicidal Behaviors - Clements-Nolle, K.; Lensch, T.; Baxa, A.; Gay, C.; Larson, S.; Yang, W. (Journal of Adolescent Health, 2018)
Purpose: The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on suicidal behaviors in a population-based sample of high school students. Methods: A two-stage cluster random sampling design was used to recruit 5,108 students from 97 high schools. A total of 4,955 students (97%) provided information that allowed for classification of sexual identity into three groups: (1) lesbian, gay, or bisexual (LGB) (10%); (2) not sure (4.6%); and (3) heterosexual (85.4%). Five measures of childhood abuse and household dysfunction were summed, and the ACE score was categorized as 0, 1, 2, and 3–5 ACEs. Weighted logistic regression was used to assess the influence of sexual identity, ACEs, and their interaction on suicide ideation and attempts in the past 12 months. Results: Compared with heterosexual students, those who were LGB and were not sure had higher odds of suicide ideation and attempts. There was also a graded relationship between cumulative ACE exposure and suicidal behaviors. Although sexual identity/ACE interaction was not observed, LGB/not sure students who experienced a high number of ACEs were disproportionately affected. Compared with heterosexual students with 0 ACE, LGB/not sure students with 0 ACE (adjusted odds ratio [AOR] = 3.32, 95% confidence interval [CI] = 1.96–5.61), 1 ACE (AOR = 6.58, 95% CI = 4.05–10.71), 2 ACEs (AOR 13.50, 95% CI = 8.45–21.58), and 3–5 ACEs (AOR = 14.04, 95% CI = 8.72, 22.62) had higher odds of suicide ideation. A similar pattern was observed for suicide attempts. Conclusions: LGB and students not sure of their sexual identity with greater exposure to ACEs have disproportionately high levels of suicide ideation and attempts. Trauma-informed interventions for these populations are warranted. © 2017 The Society for Adolescent Health and Medicine
Keywords: Adverse childhood experiences; High school students; Sexual identity; Suicidal behaviors

Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates - Li, D.H.; Turner, B.C.; Mustanski, B.; Phillips, G.L., II (Addictive Behaviors, 2018)
Objective Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse. Method Using data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use. Results Adjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7–2.5). Most sexual orientation disparities among females remained significant with the addition of victimization and mental health covariates but attenuated completely after controlling for other illicit drug use. The effect for unsure males attenuated when victimization variables were included, but the effect for gay males remained significant through the final model. Controlling for other illicit drug use, mental health variables remained significant correlates for females whereas only forced sex was significant for males. Conclusion These results suggest experiences of victimization and mental health partially account for the disparities in prescription drug misuse between SMA and heterosexual adolescents, and their effects may differ by sex. A combination of structural, individual coping, and universal drug prevention approaches should be used to make the largest impact on reducing these disparities. © 2017 Elsevier Ltd
Keywords: Adolescent; Bisexual; Gay; Lesbian; Prescription drugs; Sexual minority; Victimization

New data on intimate partner violence and intimate relationships: Implications for gun laws and federal data collection - Sorenson, S.B.; Spear, D. (Preventive Medicine, 2018)
Age at first marriage has risen substantially and birth rates are at a record low; people are spending more time in relationships that, by comparison, have fewer emotional, financial, and legal commitments. Little research has examined intimate partner violence (IPV) prevalence in current and former adult (vs. adolescent) dating relationships. Such information is relevant to federal firearms policies that are based on the nature of an intimate relationship. We examined assaultive behaviors by the type and status of the relationship – current spouse, former spouse, current boyfriend or girlfriend, and former boyfriend or girlfriend – in 31,206 IPV incidents responded to by Philadelphia police in 2013. Over 80% of the IPV incidents involved individuals in non-marital relationships. Incidents involving current boyfriends or girlfriends had the highest percentage of violent behaviors (e.g., punch, strangle). They also were more likely than current spouses to use bodily weapons (hands, fists, or feet) or non-gun weapons (knives, bats, etc.) (AOR = 1.19 and 1.43, respectively), to injure their victims (AOR = 1.37), and to be arrested (AOR = 1.46). Former unmarried partners had the highest odds of stalking their intimate (AOR = 3.37) and violating a restraining order (AOR = 2.61). Gun use was similar across relationship type. A growing portion of the population is not protected by federal policies designed to keep guns out of the hands of abusers. Current boyfriends and girlfriends are a risk to their intimates. Federal data collection practices and firearm policies merit updating to more fully take into account dating, same-sex marriage, and other partnerships. © 2018 Elsevier Inc.
Keywords: Domestic violence; Firearms; Guns; Policy

Gender differences in causes of death among persons with HIV/AIDS in San Francisco, California, 1996–2013 - Hessol, N.A.; Schwarcz, S.K.; Hsu, L.C.; Shumway, M.; Machtinger, E.L. (International Journal of STD and AIDS, 2018)
The objective was to examine gender differences in causes of death using the San Francisco HIV/AIDS and death registries. Data from San Francisco residents diagnosed with HIV/AIDS who died from 1996 to 2013 were analyzed. Age, race/ethnicity, year, and gender-adjusted standardized mortality ratios and Poisson 95% confidence intervals were calculated for underlying causes of death. Among the 6268 deaths, deaths attributed to drug use, mental disorders due to substance use, cerebrovascular disease, chronic obstructive pulmonary disease, renal disease, and septicemia were more likely among women than among men. Compared to the California population, women had elevated standardized mortality ratios for drug overdose (25.37), mental disorders due to substance abuse (27.21), cerebrovascular disease (2.83), chronic obstructive pulmonary disease (7.37), heart disease (2.37), and liver disease (5.54), and these were higher than the standardized mortality ratios for the men in our study. Men, but not women, had elevated standardized mortality ratios for suicide (2.70), undetermined intent (3.88), renal disease (2.29), and non-AIDS cancer (1.68) compared to population rates. Continued efforts to reduce HIV-related illnesses and an increased emphasis on diagnosing and treating preventable causes of death, including substance use, heart disease, and mental health disorders, are needed as part of comprehensive HIV care. © 2017, © The Author(s) 2017.
Keywords: AIDS; epidemiology; HIV; mortality; North America

A post-mortem study of the cause of death and concomitant diseases of refugees in Munich (2014–2015) - Gleich, S.; Domingo, O.; Ackermann, N.; Schwerer, M.; Graw, M.; Schöpfer, J. (Rechtsmedizin, 2018)
Background: There was a clear increase in the influx of refugees in Germany in 2014 and 2015. The majority of them came from countries without regular access to medical care. There are often precarious hygienic conditions during the flight. An above-average prevalence for infectious diseases, such as tuberculosis and blood-borne viral diseases is described for this group of persons. There are no available data on the causes of death and concomitant diseases in this group. In the Institute of Forensic Medicine at the University of Munich autopsies were carried out on a significant number of refugees for the first time. Material and methods: The macromorphological findings during the autopsies and the prosecution files were evaluated. Blood and urine samples were analyzed for alcohol and drugs by chromatography and mass spectrometry. Femoral vein blood samples (whole blood) were analyzed for human immunodeficiency virus (HIV), hepatitis B and C by the polymerase chain reaction (PCR). The formalin-fixed parenchymatous organs were histologically examined and assessed. The statistical evaluation of the obtained data was carried out using SPSS (version 23). Results: A total of 20 deceased refugees were autopsied during the investigation period and the average age was 26 years. The main countries of origin were Syria, Afghanistan and Eritrea. In 14 cases an unnatural death was detected, in 2 a natural death and in 4 cases the cause of death remained unclear. The cases of unnatural death were caused by drowning accidents, suicide, traffic accidents, drug abuse and one homicide and the cases of natural death by pneumonia and heart failure. In three cases an infectious or parasitic accompanying disease was diagnosed (tuberculosis or roundworm disease). In 12 of the deceased there were non-infectious concomitant diseases, 6 of which were psychiatric diseases. Conclusion: According to our knowledge for the first time a professional overview of autopsies of refugees, their causes of death and existing concomitant diseases can be given. The indications for a medicolegal autopsy of this group are no different from the general German population. Striking was the low average age of the deceased and the leading cause of death in this small study was drowning of non-swimmers during the summer. None of the autopsied refugees had a contagious disease which could be transmitted to third parties. Despite the young age more than half of the cases were caused by internal diseases, which were the cause of death in two cases. No particular danger for infection existed for the personnel involved in the autopsies of the subjects. © 2017, Springer Medizin Verlag GmbH.
Keywords: Asylum applicants; Cause of death; Forensic autopsy; Histological analysis; Infectious diseases

School Counseling Toward an LGBTQ-Inclusive School Climate: Implementing the SCEARE Model - Asplund, N.R.; Ordway, A.M. (Journal of LGBT Issues in Counseling, 2018)
The school environment is often perceived as hostile by sexual minority youth. Lesbian, gay, bisexual, transgender, queer (LGBTQ) students experience high rates of bullying and suicidal ideation yet are often underserved by school counselors. School counselors are uniquely situated to facilitate systemic change within a school. The proposed School Counselors: Educate, Affirm, Respond, and Empower (SCEARE, pronounced SKEER) model outlines components of an LGBTQ-inclusive school climate. It is designed to be a practical tool for helping school counselors conceptualize their interventions, and a theory of how systemic change might occur. It empowers school counselors to be catalysts of change toward an LGBTQ-inclusive school climate. © 2018 Taylor & Francis Group, LLC.
Keywords: inclusive; LGBTQ; school climate; school counseling; systemic change

Mental Health Staff Perceptions and Practice Regarding Self-Harm, Suicidality and Help-Seeking in LGBTQ Youth: Findings from a Cross-Sectional Survey in the UK - Hughes, E.; Rawlings, V.; McDermott, E. (Issues in Mental Health Nursing, 2018)
Young people who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) experience higher levels of suicidality compared to heterosexual or cisgender peers, and face significant barriers accessing mental health services including prejudice from staff. In a cross-sectional survey, mental health staff who reported receiving LGBT awareness training were significantly more likely to report in relation to working with LGBT youth that they routinely discussed issues of sexuality and gender (χ2=8.782, df=2, p < 0.05); to feel that their organisation supported them to work with this group (χ2=14.401, df=2, p < 0.001); and report that they had access to adequate skills training that supported their work with suicidality and self-harm with this group (χ2=21.911, df=2, p <0.001). There is a need to enhance the mental health workforce in LGBTQ awareness, and these findings indicate that awareness training could impact positively on practice. © 2018 Taylor & Francis Group, LLC.

Depression and suicidality among bisexual youth: A nationally representative sample - Taliaferro, L.A.; Gloppen, K.M.; Muehlenkamp, J.J.; Eisenberg, M.E. (Journal of LGBT Youth, 2018)
To address gaps in the literature on bisexual youth, we used the first nationally representative sample of high school students from the United States to determine profiles of behaviors related to depressive symptoms, a suicide attempt, and a medically-serious attempt. We examined the data from 922 bisexual students in grades 9–12 who completed the Centers for Disease Control and Prevention's 2015 National Youth Risk Behavior Survey. Latent class analysis derived three classes reflecting unique patterns of 10 risk and protective behaviors. For both the sexes: one group was high on all the risk behaviors and demonstrated the greatest risk of depression, a suicide attempt, and a medically-serious attempt; another was below average on all the risk and protective behaviors and demonstrated average/moderate risk of the outcomes; and the last demonstrated the highest levels of protective behaviors and the lowest risk of depression and suicidal behavior. Bisexual students are not homogenous with regard to the risk of mental health problems. Greater involvement in several risk behaviors and less involvement in protective behaviors, rather than merely a bisexual identity, might contribute to bisexual adolescents' increased risk of depression and suicidal behavior. Findings have implications for prevention programming, clinical interventions, and future research. © 2017 Taylor & Francis.
Keywords: Adolescents; bisexual; depression; suicide

‘Not Becoming Mother’: A Phenomenological Exploration of the Therapeutic Relationship with Transgender Clients - Harmon, K.; Donohue, G. (Issues in Mental Health Nursing, 2018)
LGBTI clients present specific challenges for the mental health profession with key issues for transgender people identified as including isolation, fear, stigma, and family rejection, all of which contribute to the transgender community's high levels of depression, anxiety, substance misuse, self-harm, and suicide. This qualitative research paper explores the experiences of Irish psychotherapists working with transgender clients to explore specifically the nature of the therapeutic relationship. Using an interpretive phenomenological approach, it examines the subjective experience of three participant psychotherapists and endeavours to make sense of the phenomenology that emerged from semi-structured interviews. The phenomenological analysis of the data collected resulted in three salient themes emerging: (i) Therapeutic identification, (ii) Maternal countertransference, and (iii) Confusion. It is hoped that these findings which relate to the therapeutic relationship will be of utmost importance to others working within the mental health profession where recovery is dependent on the strength of this relationship. © 2018 Taylor & Francis Group, LLC.

The use of metaphors in understanding atypical gender identity development and its psychosocial impact - Di Ceglie, D. (Journal of Child Psychotherapy, 2018)
Over the years I have found a number of metaphors which have helped me to deal with particular dynamics in therapeutic work or with group and institutional conflicts involving the Gender Identity Development Service at the Tavistock Centre. This nationwide service, which is for young people with atypical gender identity development and their families, was established in 1989. In this paper I describe some of these metaphors in relation to the particular problems or conflicts which had stimulated their appearance in my mind. The emergence of these metaphors links the vicissitudes of atypical gender identity development to issues regarding symbolisation or symbolic thinking. Metaphors such as ‘working at the edge’ or ‘navigating between Scylla and Charybdis’ allow the professional to hold on to multiple perspectives and to maintain a certain degree of ambiguity in situations in which the interpersonal dynamics can be experienced as rigid and deterministic. The emergence of metaphors can then be perceived by the professional with a sense of relief and freedom of thinking. In this paper, metaphors are linked to: the model of care developed; the therapeutic stance; and the aims, risks and pressures experienced by the professional in this area of work. The association between gender dysphoria in some young people and autistic spectrum features is explored. The paper emphasises the importance of responding flexibly to individual differences and of recognising complexity. © 2018 Association of Child Psychotherapists.
Keywords: atypical gender identity development; autistic spectrum condition (ASC), metaphor; gender dysphoria; Gender identity; gender variance

Suicidality in LGBTQ+ Youth - Vaughan, S.C. (Psychoanalytic Study of the Child, 2018)
In this paper I show the ways in which society, culture, family, and intrapsychic conflict come to play a role in the suicidal ideation and behavior of adolescents within the lesbian, gay, bisexual, transgender, queer plus intersex, asexual, pansexual, polyamorous (LGBTQ+) community. I touch on LGBTQ+ history, review risks such as suicidality that are higher in this population, and consider common developmental challenges to transgender children and adolescents. I then present a clinical vignette of a trans girl with newly emergent transgender feelings in puberty who became suicidal when she learned (prior to transition) that there was a spot on the girls’ (but not the boys’) volleyball team. I will try to show how twice-weekly psychodynamic psychotherapy was useful in creating a more resilient and solid identity in the face of lack of family acceptance and how judicious work with the family around medical issues related to transitioning contributed to the patient’s well-being. © 2018 Claudia Lament, Rona Knight, and Wendy Olesker.
Keywords: development; Gender non-conforming; gender queer; suicidality; transgender

The synergistic impact of sexual stigma and psychosocial well-being on HIV testing: A mixed-methods study among nigerian men who have sex with men - Rodriguez-Hart, C.; Bradley, C.; German, D.; Musci, R.; Orazulike, I.; Baral, S.; Liu, H.; Crowell, T.A.; Charurat, M.; Nowak, R.G. (AIDS and Behavior, 2018)
Although sexual stigma has been linked to decreased HIV testing among men who have sex with men (MSM), mechanisms for this association are unclear. We evaluated the role of psychosocial well-being in connecting sexual stigma and HIV testing using an explanatory sequential mixed methods analysis of 25 qualitative and 1480 quantitative interviews with MSM enrolled in a prospective cohort study in Nigeria from March/2013-February/2016. Utilizing structural equation modeling, we found a synergistic negative association between sexual stigma and suicidal ideation on HIV testing. Qualitatively, prior stigma experiences often generated psychological distress and perceptions of feeling unsafe, which decreased willingness to seek services at general health facilities. MSM reported feeling safe at the MSM-friendly study clinic but still described a need for psychosocial support services. Addressing stigma and unmet mental health needs among Nigerian MSM has the potential to improve HIV testing uptake. © Springer Science+Business Media, LLC, part of Springer Nature 2018.
Keywords: Hiv testing; Latent class analysis; Men who have sex with men; Mental health; Stigma; Suicidal ideation

Validating the syndemic threat surrounding sexual minority men's health in a population-based study with national registry linkage and a heterosexual comparison - Bränström, R.; Pachankis, J.E. (Journal of Acquired Immune Deficiency Syndromes, 2018)
Background: Research on the syndemic health threats facing sexual minority men suggests that the elevated risk of HIV among this population co-occurs with other psychosocial health disparities. This study aimed to conduct a population-based examination of clinically assessed syndemic predictors of HIV infection among gay and bisexual, compared with heterosexual, men. Setting and Methods: The sample comprised adult men in the Stockholm Public Health Cohort. A total of 29,328 (91.9%) selfidentified as heterosexual, 535 (1.7%) as gay, and 396 (1.2%) as bisexual. We linked survey responses to national health registry data. Results: Gay men had vastly elevated risk of HIV infection (>150 times) compared with heterosexuals. Gay men also had an elevated risk of depression, suicidality, and violent assaults compared with heterosexuals. Bisexual men had 16 times higher risk of being HIVpositive than heterosexual men. The number of psychosocial syndemic conditions was significantly associated with HIV infection among gay men (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [95% CI]: 1.18 to 2.36), but not among bisexual and heterosexual men (AOR = 0.51; 95% CI: 0.07 to 3.59; AOR = 1.92; 95% CI: 0.96 to 3.84). Among gay men, the association between cooccurring syndemic conditions and odds of HIV infection was synergistic (ie, more than additive). Conclusions: This study confirms emerging evidence of the syndemic health threats affecting sexual minority men, finds stronger evidence for syndemics among gay compared with bisexual men, and suggests the need for HIV-prevention interventions that comprehensively address the co-occurring, and synergistically perpetuating, disparities affecting this population. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: Depression; HIV; Psychosocial conditions; Sexual minorities; Substance use; Syndemics

Healthcare Engagement among Gay and Bisexual Men with Recent Suicide Ideation or Attempts - Salway, T.; Ferlatte, O.; Purdie, A.; Shoveller, J.; Trussler, T.; Gilbert, M. (American Journal of Orthopsychiatry, 2018)
Gay and bisexual men experience elevated rates of suicide ideation and attempts, as compared with heterosexual men, but face unique barriers in accessing health services. In this context, the present study sought to describe rates of health care engagement among gay and bisexual men with a recent history of suicide ideation or attempts. An anonymous online survey was conducted with 7,872 Canadian gay and bisexual men in 2014'2015. The sample was restricted to characterize patterns of mental health care engagement among respondents who reported suicide ideation or attempts in the previous 12 months. 'Engagement' was defined as having discussed mental health concerns (depression, substance use, or suicide) with a provider in the previous 12 months. Rates and correlates of engagement were estimated. Nineteen percent of men reported suicide ideation or attempts in the previous 12 months, of whom 58% had discussed mental health concerns with a provider. Older age, larger social support networks, and being out to a health care provider about one's sexuality were all positively associated with mental health care engagement. Among those who had not engaged with the health care system, 88% had some contact with a provider in the previous 12 months. One-third of these men accessed care through a provider other than their family doctor. Drawing on lessons learned from the HIV crises, collaborations between gay and bisexual community organizations and decision-makers within the health system are needed to address elevated rates of suicide ideation and attempts affecting sexual minorities. © 2018 Global Alliance for Behavioral Health and Social Justice.

Associaton between violence and drug consumption with suicide in lesbians, gays, bisexuals, transvestites, and transsexuals: Cross-sectional study - Albuquerque, G.A.; Figueiredo, F.W.; Paiva, L.S.; de Araújo, M.F.M.; Maciel, E.S.; Adami, F. (Salud Mental, 2018)
Introduction. Lesbian, gay, bisexual, transvestite, and transgender (LGBT) people are affected by prejudice and psychological, physical, and/or sexual violence due to their sexual orientation. Objective. To analyze the association between violence, drug use, and suicide in LGBT people. Method. We interviewed 316 LGBT people from two cities of the Brazilian Northeast by means of a structured instrument. This included questions about sociodemographic data, sexual orientation, type of violence, type and quantity of drugs consumed, and suicide. Results. There was a positive association between physical violence and anabolic consumption (p = .001) and tranquilizers (p = .012). In relation to psychological and verbal violence, there was a positive association with the use of tranquilizers (p = .021) and negative with the use of amphetamines (p = .027). Suicide attempts were associated with having experienced physical (p = .03) and sexual (p = .037) violence. Drug use, especially ecstasy, cocaine, marijuana, and tranquilizers, was also associated with suicide attempts (p = .002, p = .031, p < .001, p < .001, respectively). The participants who had already attempted suicide were more vulnerable to experience violence and consume drugs within 30 days prior to the interview (p < .001). Discussion and conclusion. Psychological/verbal violence showed to be associated with the use of amphetamines, while physical violence was associated with a higher consumption of tranquilizers and anabolic steroids. Suicide attempts were more common among participants who had suffered physical violence and who were users of substances such as ecstasy, cocaine, marijuana, and tranquilizers. © 2018 Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz.
Keywords: Bisexuality; Homosexuality; Psychotropic medications; Violence

Exploring Lived Experience in Gender and Sexual Minority Suicide Attempt Survivors - Williams, S.M.; Frey, L.M.; Stage, D.L.; Cerel, J. (American Journal of Orthopsychiatry, 2018)
Gender and sexual minorities (GSM) are at a higher risk for victimization, discrimination, and emotional distress. GSM also face unique stressors that contribute to negative mental health outcomes, such as family and interpersonal rejection, ostracism and isolation, and internalized gender and sexual stigma. Suicide attempt survivors often experience similar stigma and isolation after an attempt. However, little is known about the specific experiences of GSM individuals who attempt suicide. Transcripts of interviews with 25 GSM attempt survivors conducted as part of the Live Through This project were analyzed using an interpretive phenomenological approach. Five themes that capture the lived experience of suicidality of the participants were identified in the interviews: (a) intersecting identities, (b) identity concealment, (c) internalized stigma and self-hate, (d) the social environment, and (e) the importance of peer support. Findings highlight the compounding stigma that occurs when individuals identify as both a GSM and a suicide attempt survivor. Implications for clinical work include the need for additional peer support for individuals who maintain the dual identity of GSM and suicide attempt survivor. Moreover, there is a need for mental health, crisis, and support resources and services tailored for GSM individuals that emphasize the importance of peer support in healing and recovery after a suicide attempt and in preventing future suicidal behavior. This important information can help us develop strategies to prevent suicide among the GSM population and to provide support for GSM suicide attempt survivors. © 2018 Global Alliance for Behavioral Health and Social Justice.

Psychometric analysis of the life worries scale for a new generation of sexual minority men: The P18 cohort study - Halkitis, P.N.; Cook, S.H.; Ristuccia, A.; Despotoulis, J.; Levy, M.D.; Bates, F.C.; Kapadia, F. (Health Psychology, 2018)
Objective: Sexual minority men (SMM) in the United States continue to experience adverse health problems and psychosocial burdens. However, there is limited psychometric research seeking to quantify the life worries of this population. Informed by syndemic theory, the Life Worries Scale (LWS) was developed to measure the concerns of young SMM. Method: Analyses of the scale were undertaken using baseline data (n = 665) from an ongoing cohort study of emerging adult, SMM. Results: Exploratory factor analyses (EFA) of an initial set of 24 Likert-type items, followed by confirmatory factor analysis (CFA) and an exploratory structural equation model (ESEM), indicated a structure consisting of 6 domains of worries: financial stability, social stability, self esteem, loneliness, physical appearance, and physical health. These 6 subscales were highly correlated and also demonstrated high levels of internal consistency. Differences in life worries were noted across demographic states, specifically HIV serostatus, sexual attraction, housing status, and self-rated health. High levels of association were also detected between all 6 subscales with both depression and PTSD, while significant correlations were detected between suicidality and both self esteem and loneliness related worries. Conclusions: The results of our analyses provide evidence for the strong psychometric characteristics of the LWS. This newly developed instrument should be utilized in research to examine the extent to which life worries explain health outcomes and risk behaviors in sexual minority males, and may be potentially extended for use in other populations. © 2017 American Psychological Association.
Keywords: Emerging adulthood; Gay and bisexual; HIV; Millennial; Psychometrics

Role of sleep quality in mediating the relationship between sexual minority status and suicidal behavior among Chinese adolescents - Huang, Y.; Li, P.; Lai, Z.; Jia, X.; Xiao, D.; Wang, T.; Guo, L.; Lu, C. (Psychology Research and Behavior Management, 2018)
Background: Studies suggest that sexual minority adolescents experience higher rates of sleep disturbance than their heterosexual peers, and disturbed sleep is a well-known risk factor for suicidality. This study aimed to explore whether sleep quality had mediating effects on the relationship between sexual minority status and suicidal behavior in Chinese adolescents. Methods: We analyzed data collected from 7th to 12th graders from seven randomly selected provinces of People’s Republic of China in the 2015 School-Based Chinese Adolescents Health Survey. The 123,459 students who completed questionnaires regarding sexual attraction, the Pittsburgh Sleep Quality Index, past-year suicidal ideation, and past-year suicide attempts were included in our study (response rate: 95.9%). Results: After adjustment for covariates, sexual minority status was associated with suicidal ideation (adjusted odds ratio =1.82, 95% CI=1.69–1.95) and suicide attempts (adjusted odds ratio =2.16, 95% CI=1.82–2.56). Sleep quality partially mediated the effects of sexual minority status on suicidal ideation (standardized β estimate=0.009, 95% CI=0.007–0.012) and suicide attempts (standardized β estimate=0.004, 95% CI=0.003–0.005). Conclusion: Poor sleep quality partially explained the increased risk of suicidality for Chinese sexual minority adolescents. To prevent subsequent suicidality, suicide interventions targeting sexual minorities should be made, with a focus on their disparities in sleep disturbance and sleep health promotion. © 2018 Huang et al.
Keywords: Adolescents; Mediating effect; Sexual minority; Sleep quality; Suicidal behavior

Deaths in the lesbian, gay, bisexual and transgender United Kingdom communities associated with GHB and precursors - Corkery, J.M.; Loi, B.; Claridge, H.; Goodair, C.; Schifano, F. (Current Drug Metabolism, 2018)
Background: Misuse of gammahydroxybutrate (GHB) and its prodrugs gammabutyrolactone (GBL) and 1,4 butanediol (1,4-BD) has increased greatly since the early 1990s, particularly amongst lesbian, gay, bisexual and transgender (LGBT) individuals in recreational and sexual settings, e.g. ‘chemsex’. Objective and Method: This paper presents an overview of GHB pharmacotoxicology and provides analyses of cases in the LGBT population associated with the use of these substances extracted from the UK’s National Programme on Substance Abuse Deaths database, to which notification is voluntary. Results: From 1995 to September 2013, 21 GHB/GBL-associated fatalities were reported. None involved 1,4-BD. Typical victims were: Male (100%); White (67%), young (mean age 34 years); employed (90%); with a drug misuse history (81%). Most deaths were accidental (67%) or related to recreational drug use (19%), the remaining (poten-tial) suicides. The majority of fatalities (83%) occurred in private residences, typically following recreational use; others occurred in specific ‘gay’-oriented locales including clubs and saunas. Three London boroughs accounted for 62% of all notified deaths, reflecting the concentration of both resident and visiting ‘gay’ individuals. However, this may be an artefact of the voluntary nature of the data submission procedure in particular areas. GHB/GBL alone was implicated in 10% of fatalities. The following substances were implicated either alone or in combination in the remaining cases (percentages may add to more than 100%): cocaine (38%); alcohol (33%); amphetamines (29%); ecstasy (29%); diazepam (24%); ketamine (24%); mephedrone (24%). Post-mortem blood levels: mean 660 (range 22-2335; S.D. 726) mg/L. Conclusion: Significant caution is needed when ingesting GHB/GBL, particularly with alcohol, benzodiazepines, stimulants, and ketamine. Risk of death is increased due to their CNS-depressant properties. Of these, ‘chemsex’ drugs such as cocaine, mephedrone and ketamine are of note. More awareness is needed in the ‘gay’ community about risks associated with the consumption of such substances. © 2018 Bentham Science Publishers.
Keywords: Deaths; GBL; GHB; Lgbt community; Toxicity; United Kingdom (UK)

Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso - Kim, H.-Y.; Grosso, A.; Ky-Zerbo, O.; Lougue, M.; Stahlman, S.; Samadoulougou, C.; Ouedraogo, G.; Kouanda, S.; Liestman, B.; Baral, S. (Annals of Epidemiology, 2018)
Purpose: The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities. Methods: FSWs (N = 350) and MSM (N = 330) aged ≥18 were recruited in Bobo-Dioulasso, Burkina Faso. Perceived health care stigma was defined as either ever being afraid of or avoiding health care services because someone might find out the participant has sex with men (for MSM) or sells sex (for FSW). Correlates of perceived health care stigma were examined using multivariable logistic regression. Results: The prevalence of perceived health care stigma was 14.9% (52/350) and 24.5% (81/330) in FSWs and MSM, respectively. Among FSWs, experienced or social stigma, including verbal harassment (adjusted odds ratio [aOR] = 3.59, 95% confidence interval [CI] 1.48–8.71), feeling rejected by friends (aOR = 2.30, 95% CI 1.14–4.64), and feeling police refused to protect them (aOR = 2.58, 95% CI 1.27–5.25), was associated with perceived health care stigma. Among MSM, experiencing verbal harassment (aOR = 1.95, 95% CI 1.09–3.50) and feeling scared to walk in public (aOR = 2.93, 95% CI 1.47–5.86) were associated with perceived health care stigma. Conclusions: In these key populations, perceived health care stigma was prevalent and associated with experienced and social stigmas. To increase coverage of effective HIV services, interventions should incorporate approaches to comprehensively mitigate stigma. © 2017 Elsevier Inc.
Keywords: Female sex workers; Health care utilization; HIV/AIDS; Men who have sex with men; Stigma

Medical management of transgender children and adolescents - Castilla-Peón, M.F. (Boletin Medico del Hospital Infantil de Mexico, 2018)
Transgender or gender incongruence (GI) persons identify themselves with a gender that is different from that correspondent to their birth sex. The demand for health services by families with transgender children or adolescents tends to increase. The prevalence of GI in children is unknown; however, it has been estimated to be > 1% in adolescents. Transgender persons are at increased risk of depression, suicide, illicit drug abuse, human immunodeficiency virus infection, and non-accidental injuries. The most accepted model for the care of transgender persons assumes that these adverse outcomes are the consequence of social margination rather than the GI condition itself. Social and physical gender transition seems to be effective in increasing the well-being of people with GI and reducing associated health risks. Mental health professionals can support the child in the process of social transition. The pediatric endocrinologist may offer puberty blockade and cross-sex induction of puberty. Surgical sex reassignment interventions are reserved for adults. Gender identity, gender expression, and sexual orientation are three relatively independent categories that can take any value, which is not necessarily binary (male/female) or fixed. Health professionals should be familiar with these concepts to offer the best resources available to optimize the well-being of each transgender child or adolescent with an individualized approach. © 2018. Hospital Infantil de México Federico Gómez, published by Permanyer México SA de CV, all rights reserved.
Keywords: Adolescents; Children; Cross-sex hormones; Gender incongruence; Sexual minority; Transgender persons

Suicidality and intersectionality among students identifying as nonheterosexual and with a disability - King, M.T.; Merrin, G.J.; Espelage, D.L.; Grant, N.J.; Bub, K.L. (Exceptional Children, 2018)
Research about students with disabilities and students identifying as LGBQ (lesbian, gay, bisexual, or questioning) reveals that both populations report more suicidality and peer victimization and less school connectedness than do their peers. No study has previously examined the intersection of these identities with regard to peer victimization, school connectedness, and suicidality. Using a sample of 11,364 high school students, we examined the relationships among these identities, peer victimization, and school connectedness with suicidal ideation. Compared with their peers without either identity, students identifying with one of these identities reported higher levels of suicidal ideation. School connectedness and peer victimization each moderated the association between identity and suicidal ideation. In addition, students who were victimized more than their peers and who identified both with a disability and as LGBQ (n = 250) reported the highest levels of suicidal ideation. School-based victimization and suicide prevention programs should consider students’ multiple identities. © The Author(s) 2017.

Helpful information to whom? An intersectional critique of the ‘it gets better project - Hawkins, B.; Andalibi, N.; Haimson, O. (Proceedings of the Association for Information Science and Technology, 2018)
The ‘It Gets Better Project’ started as an online campaign responding to the suicide deaths of multiple young gay men in Fall 2010. The campaign involved people posting videos providing messages of hope and helpful health information for youth as they finish high school and can move on with their lives. Although there is seemingly good intentions driving this this campaign, we were troubled by the initial positioning of the campaign. In this paper we use an intersectional critique to discuss the lack of inclusivity in these videos and how it created a potential opportunity to engage with more LGBTQ youth. Furthermore, we suggest that future online campaigns for gender/sexual minority populations be more mindful of others' lived experiences and how this may impact how they seek health information. Copyright © 2018 by Association for Information Science and Technology

Experiences in bullying and/or Peer Victimization of Vulnerable, Marginalized, and Oppressed Children and Adolescents: An introduction to the special issue - Hong, J.S.; Peguero, A.A.; Espelage, D.L. (American Journal of Orthopsychiatry, 2018)

Social connectedness, stressful life events, and self-injurious thoughts and behaviors among young adults - Macrynikola, N.; Miranda, R.; Soffer, A. (Comprehensive Psychiatry, 2018)
Objectives Preventing self-injurious thoughts and behaviors (SITBs) is particularly challenging on commuter campuses, given lower social cohesion and higher levels of stress than among traditional college populations. The present study examined the relationship between stressful life events (SLEs) and risk for different forms of SITBs, along with the potential buffering role of social connectedness, in a diverse sample of young adults from a commuter college. Methods Participants were 1712 (81% female; 61% racial/ethnic minority; 20% sexual minority) undergraduate and graduate students from a public commuter college in New York City. Participants completed an anonymous survey that inquired about lifetime and recent (past 12 months) history of suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI), along with social connectedness and lifetime history of SLEs. Results Lower levels of social connectedness and exposure to a higher number of SLEs were associated with engaging in SITBs in the past year, particularly both suicide attempts and non-suicidal self-injury. However, social connectedness did not buffer against the impact of SLEs on SITBs. Limitations Data are cross-sectional, limiting conclusions about directionality, and females were overrepresented. Conclusions Identifying ways to increase social connectedness on diverse commuter campuses may help decrease risk of SITBs. However, it may not buffer against the impact of SLEs on risk of SITBs. Future studies should examine contextual variables (e.g., type and timing of social support) that may play a role in protecting against SITBs, particularly for those with a history of adversity. © 2017 Elsevier Inc.

Same-sex-attracted adolescents in rural Australia: Stressors, depression and suicidality, and barriers to seeking mental health support - Roberts, R.; Black, G.; Hart, T. (Rural and Remote Health, 2018)
Introduction: To address the lack of Australian data examining mental health in same-sex attracted rural adolescents compared with their rural heterosexual peers, this study examined experiences of stressors, symptoms of depression and suicidality, and perceptions of barriers to seeking mental health support, comparing same-sex attracted adolescents with heterosexual adolescents living in rural Australia. Methods: Respondents were recruited through high schools in rural South Australia and completed a questionnaire that included demographic questions, the Kutcher Adolescent Depression Scale (KADS-6) and measures of stressors and perceptions of barriers to seeking mental health support. Participants were 531 adolescents (55% female, 43% male), aged 13 to 18, 31 of whom identified as same-sex attracted. Results: Same-sex attracted adolescents reported significantly more depression symptoms (mean=6.1, standard deviation (SD)=3.9) compared to other adolescents (mean=2.9, SD=3.2, U=2867, p < 0.001, r=0 .16). More adolescents who were same-sex attracted screened positive for depression (54.8% vs 15.9%) and there was a significant difference in responses to the item assessing suicidality between same-sex attracted and other adolescents (mean=1.1, SD=1.1; mean=0.3, SD=0.7, Χ2 (1, N=531)=27.10, p < 0.001, phi=0.24). Same-sex attracted adolescents reported more experiences of stressors relating to relationships, bullying and physical assault than heterosexual adolescents but, contrary to expectations, did not report perceiving more barriers to seeking mental health support (total barriers: same-sex attracted adolescents mean=2.5 (1.8), other adolescents mean=2.5 (1.9), t(527)=0.06, p=0.95, d=0.00). Conclusions: Adolescents who identified as being same-sex attracted are at much greater risk of depression and suicidality than other adolescents in rural South Australia. The finding that same-sex attracted adolescents experienced a higher number of relationship stressors, bullying and assault underscores the need for more focus on addressing these issues for this group of vulnerable adolescents. While same-sex attracted adolescents did not perceive more barriers to seeking mental health support, greater understanding of same-sex attracted adolescents' access to appropriate services in rural areas is needed to be able to improve mental health functioning in this population. In addition, addressing the wider issues (eg stigma) contributing to the greater number of stressors, including victimisation, faced by same-sex attracted adolescents should be a priority. © James Cook University.
Keywords: Adolescent; Australia; Barriers; Depression; Mental health; Sexual minority; Sexuality; Suicide; Youth

Distinct Coping Profiles Are Associated With Mental Health Differences in Transgender and Gender Nonconforming Adults - Freese, R.; Ott, M.Q.; Rood, B.A.; Reisner, S.L.; Pantalone, D.W. (Journal of Clinical Psychology, 2018)
Objective: This study assessed the unique coping strategies of transgender and gender nonconforming (TGNC) individuals in the United States used to manage gender-related stress, and examined associations between specific coping profiles and mental health. Methods: Data were from 316 participants in the 2014–2015 Transgender Stress and Health Study, an online study of TGNC mental and sexual health. A factor analysis of the coping measure (Brief COPE) was followed by a k-means cluster analysis to evaluate distinct profiles of coping with gender-related stress. Proportional odds models and logistic regression models indicated how coping profiles related to levels of self-reported depressive symptoms and suicidality. Results: A 4-factor structure was identified with three distinct profiles of coping with gender-related stress, each representative of the frequency (high or low) in which participants used functional and dysfunctional coping strategies: (a) high-functional/low-dysfunctional, (b) high-functional/high-dysfunctional, and (c) low-functional/low-dysfunctional. There were significant differences in depressive symptoms and suicidality based on distinct gender-related coping profiles. The high-functional/high-dysfunctional group reported significantly poorer mental health compared with the high-functional/low-dysfunctional group. Conclusion: To improve mental health outcomes in TGNC individuals, health providers and researchers should strive to not only promote functional coping strategies for managing gender-related stress but also decrease dysfunctional coping strategies. © 2017 Wiley Periodicals, Inc.
Keywords: coping; depression; mental health; suicide; transgender

The child transgender patient in primary care: Practical advice for a 10-minute consultation - Cliffe, C.; Hillyard, M.; Joseph, A.; Majeed, A. (BJGP Open, 2018)
Keywords: Adolescent transgender; Children transgender; Gender identity; Transgender

Suicidal ideation and suicide attempts in persons with gender dysphoria - García-Vega, E.; Camero, A.; Fernández, M.; Villaverde, A. (Psicothema, 2018)
Background: The little research there is about suicidal behaviour in those with gender dysphoria indicates that they are at a much higher risk of death by suicide and suicidal behaviour than the general population. The objective of this research is to analyse the prevalence of suicidal ideation and suicide attempts reported by people who attended consultations at the Gender Identity Treatment Unit between 2007 and 2017 presenting complaints related to gender dysphoria. Method: An ex-post facto study with a sample of 151 people who were clients at the unit, 97 in the male to female trans group, 54 female to male. Clinical evaluations were carried out assessing variables of suicidal ideation and attempts, along with a possible psychiatric diagnosis. Results: Almost half (48.3%) reported suicidal ideation, 23.8% had attempted suicide. Conclusions: There are higher levels of suicidal ideation and suicide attempts in people with gender dysphoria than in the general population. No differences were seen between groups in terms of gender/sex. Psychiatric morbidity was not an influential variable for suicidal behaviour. This suggests that suicidal ideation is one of the best indicators of the risk of suicidal behaviours. © 2018 Psicothema.
Keywords: Gender dysphoria; Suicidal ideation; Suicide attempts

Challenges faced by marginalized communities such as transgenders in Pakistan - Shah, H.B.U.; Rashid, F.; Atif, I.; Hydrie, M.Z.; Fawad, M.W.B.; Muzaffar, H.Z.; Rehman, A.; Anjum, S.; Mehroz, M.B.; Haider, A.; Hassan, A.; Shukar, H. (Pan African Medical Journal, 2018)
Introduction: Stigmatization, social exclusion and consequent banishment from the society makes transgender's life even tougher; isolating, pushing and forcing them into inappropriate conducts/habits like selling sex. This study investigates the association of social exclusion/victimization with high-risk behaviors among transgender community of Rawalpindi and Islamabad (Pakistan). Methods: Through a cross-sectional study design, a sample of 189 transgender community living in twin cities of Rawalpindi and Islamabad was selected using snowball sampling technique. A validated close ended questionnaire was used to estimate the high-risk behaviors. Multivariate logistic regression was used to explore the competing outcomes associated with suicidal risk, selling sex and substance abuse. Results: Majority study participants 77.8% experienced physical attacks with institutional discrimination even higher (91.5%). Commercial sex work and drug abuse was reported in 39.2% and 37.6% respectively. The prevalence of suicide ideation was high (38.6%) however, suicide attempted rate was less (18.5%). In the multivariate logistic regression, compared to those with no risk, being physically attacked increased the odds of both attempting (OR=2.18) and contemplating suicide and selling sex (OR=4.10). Nevertheless, the relative impact of institutional victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression (AOR = 6.20, CI = 1.58-24.29, p=0.009). Conclusion: The transgender community is socially excluded by the Pakistani society where they experience high levels of physical abuse and face discriminatory behavior in daily life. Such attitudes make them vulnerable for risky behaviors; forcing them to become commercial sex workers, begging, drugs use and even suicidal ideation. © Hassan Bin Usman Shah et al.
Keywords: Commercial sex work; Gender based discrimination; Hijras; Institutional discrimination; Physical violence; Risk behaviors; Social exclusion; Suicide; Transgender

Youth risk behavior surveillance - United States, 2017 - Kann, L.; McManus, T.; Harris, W.A.; Shanklin, S.L.; Flint, K.H.; Queen, B.; Lowry, R.; Chyen, D.; Whittle, L.; Thornton, J.; Lim, C.; Bradford, D.; et al. (MMWR Surveillance Summaries, 2018)
Problem: Health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults in the United States. In addition, significant health disparities exist among demographic subgroups of youth defined by sex, race/ethnicity, and grade in school and between sexual minority and nonsexual minority youth. Population-based data on the most important healthrelated behaviors at the national, state, and local levels can be used to help monitor the effectiveness of public health interventions designed to protect and promote the health of youth at the national, state, and local levels. Reporting Period Covered: September 2016-December 2017. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority healthrelated behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of other health-related behaviors, obesity, and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. Starting with the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts were added to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their questionnaires. This report summarizes results from the 2017 national YRBS for 121 health-related behaviors and for obesity, overweight, and asthma by demographic subgroups defined by sex, race/ethnicity, and grade in school and by sexual minority status; updates the numbers of sexual minority students nationwide; and describes overall trends in health-related behaviors during 1991-2017. This reports also summarizes results from 39 state and 21 large urban school district surveys with weighted data for the 2017 YRBSS cycle by sex and sexual minority status (where available). Results: Results from the 2017 national YRBS indicated that many high school students are engaged in health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 39.2% of high school students nationwide (among the 62.8% who drove a car or other vehicle during the 30 days before the survey) had texted or e-mailed while driving, 29.8% reported current alcohol use, and 19.8% reported current marijuana use. In addition, 14.0% of students had taken prescription pain medicine without a doctor's prescription or differently than how a doctor told them to use it one or more times during their life. During the 12 months before the survey, 19.0% had been bullied on school property and 7.4% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 39.5% of students had ever had sexual intercourse and 9.7% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 53.8% reported that either they or their partner had used a condom during their last sexual intercourse. Results from the 2017 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. Nationwide, 8.8% of high school students had smoked cigarettes and 13.2% had used an electronic vapor product on at least 1 day during the 30 days before the survey. Forty-three percent played video or computer games or used a computer for 3 or more hours per day on an average school day for something that was not school work and 15.4% had not been physically active for a total of at least 60 minutes on at least 1 day during the 7 days before the survey. Further, 14.8% had obesity and 15.6% were overweight. The prevalence of most health-related behaviors varies by sex, race/ethnicity, and, particularly, sexualidentity and sex of sexual contacts. Specifically, the prevalence of many health-risk behaviors is significantly higher among sexual minority students compared with nonsexual minority students. Nonetheless, analysis of long-term temporal trends indicates that the overall prevalence of most health-risk behaviors has moved in the desired direction. Interpretation: Most high school students cope with the transition from childhood through adolescence to adulthood successfully and become healthy and productive adults. However, this report documents that some subgroups of students defined by sex, race/ethnicity, grade in school, and especially sexual minority status have a higher prevalence of many health-risk behaviors that might place them at risk for unnecessary or premature mortality, morbidity, and social problems (e.g., academic failure, poverty, and crime). Public Health Action: YRBSS data are used widely to compare the prevalence of health-related behaviors among subpopulations of students; assess trends in health-related behaviors over time; monitor progress toward achieving 21 national health objectives; provide comparable state and large urban school district data; and take public health actions to decrease health-risk behaviors and improve health outcomes among youth. Using this and other reports based on scientifically sound data is important for raising awareness about the prevalence of health-related behaviors among students in grades 9-12, especially sexual minority students, among decision makers, the public, and a wide variety of agencies and organizations that work with youth. These agencies and organizations, including schools and youth-friendly health care providers, can help facilitate access to critically important education, health care, and high-impact, evidence-based interventions. © 2018.

Age at exposure to parental suicide and the subsequent risk of suicide in young people - Lee, K.-Y.; Li, C.-Y.; Chang, K.-C.; Lu, T.-H.; Chen, Y.-Y. (Crisis, 2018)
Background: We investigated the age at exposure to parental suicide and the risk of subsequent suicide completion in young people. The impact of parental and offspring sex was also examined. Method: Using a cohort study design, we linked Taiwan's Birth Registry (1978-1997) with Taiwan's Death Registry (1985-2009) and identified 40,249 children who had experienced maternal suicide (n = 14,431), paternal suicide (n = 26,887), or the suicide of both parents (n = 281). Each exposed child was matched to 10 children of the same sex and birth year whose parents were still alive. This yielded a total of 398,081 children for our non-exposed cohort. A Cox proportional hazards model was used to compare the suicide risk of the exposed and non-exposed groups. Results: Compared with the non-exposed group, offspring who were exposed to parental suicide were 3.91 times (95% confidence interval [CI] = 3.10-4.92 more likely to die by suicide after adjusting for baseline characteristics. The risk of suicide seemed to be lower in older male offspring (HR = 3.94, 95% CI = 2.57-6.06), but higher in older female offspring (HR = 5.30, 95% CI = 3.05-9.22). Stratified analyses based on parental sex revealed similar patterns as the combined analysis. Limitations: As only register-based data were used, we were not able to explore the impact of variables not contained in the data set, such as the role of mental illness. Conclusion: Our findings suggest a prominent elevation in the risk of suicide among offspring who lost their parents to suicide. The risk elevation differed according to the sex of the afflicted offspring as well as to their age at exposure. © 2017 Hogrefe Publishing.
Keywords: Age; Developmental stage; Offspring; Parental suicide; Sex/gender; Suicide

Auto-tracking controversial topics in social-media-based customer dialog: A case study on Starbucks - Yu, B.; Yu, Y. (Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 2018)
This study proposed and validated a topic modeling-based approach for auto-tracking customer dialog on social media, using Starbucks as a case study because of its pioneering social media practice in service industry. A topic model was fit based on nearly 150,000 customer comments posted to Starbucks’ Facebook page in 2013. This model was able to identify not only business-related topics, such as customer responses to marketing campaigns, but also controversial topics regarding community involvement and corporate social responsibility, such as gay, gun, and government. Guided by this topic model, each topic’s evolving dynamics and patterns of user participation were further revealed, providing a bird’s-eye view of the topics and their evolution. The case study has demonstrated that the proposed approach can effectively track the main themes in the customer dialog on social media, zoom in on the controversial topics, measure their time spans, and locate the participants and the vocal activists. Such information would be valuable input for companies to design their intervention strategies and evaluate the outcomes in social media discussions. © Springer International Publishing AG, part of Springer Nature 2018.
Keywords: Customer dialog; Social media; Text mining; Topic modeling

Acting out in a post-contemporary age - Tiscini, G.; Ansermet, F. (Evolution Psychiatrique, 2018)
Objective: The starting-point of this article consists in considering what is contemporary as being post-contemporary. Like the present, what is contemporary is something that cannot be pinned down. It requires hindsight in order to analyse it. Our first objective is to approach our post-contemporary age as being characterised by radicality. This takes the form of a search for origins, which shows up in a return of the religious, alongside the emergence of an anguish reducing things to nothingness. Solitude is a characteristic of this radical position, raising the issue of an otherness that turns anguish into hatred, whether of oneself or of the other. Indeed, the post-contemporary subject acts-out when faced with social ties and a culture that can no longer uphold him. Our second objective is to demonstrate that the effect of this radical position leads the subject to use his body as the only way out. Having become an external organism, the body comes to represent that which is intolerable for the subject. In order to escape anguish turned into hatred, the subject excludes himself from his own body. Finally, the third objective is to show how the free radical subject is a product of ‘liberal’ society, seeking to create his freedom at every moment. Method: Our method uses clinical practice. We work from two contrasting clinical fields; on the one hand acting out in the form of acts of murder or suicide, on the other hand acts of passage from one gender to another. Results: Acting out and acts of passage both relate to these free radical subjects who shape their own body, or who shape the body of the other as though it were their own. Discussion: We will discuss the points of convergence and divergence between these two situations. Conclusion: Our conclusion demonstrates that acts on the body of the other and acts on one's own body coincide. Acting out in the form of murder or suicide masks the wish for an act of passage, which is however impossible. The act of passage from one gender to the other requires an acting out that sometimes cannot be countenanced. With those whose aim is an act of passage, it is an acting out that must be sought. Similarly, with those who act-out, the need is to try to restore, in the aftermath, the possibility of an act of passage. © 2017 Elsevier Masson SAS
Keywords: Act of passage; Acting out; Anguish; Body; Contemporary; Murder; Prison; Psychoanalysis; Radicality; Suicide; Trans-gender

The Bromance: Undergraduate Male Friendships and the Expansion of Contemporary Homosocial Boundaries - Robinson, S.; Anderson, E.; White, A. (Sex Roles, 2018)
The present study provides the first known qualitative examination of heterosexual undergraduate men’s conceptualization and experiences of the bromance, outside research on cinematic representations. Drawing on semi-structured interviews with 30 undergraduate men enrolled in one of four undergraduate sport-degree programs at one university in the United Kingdom, we find these heterosexual men to be less reliant on traditional homosocial boundaries, which have previously limited male same-sex friendships. Contrary to the repressive homosociality of the 1980s and 1990s, these men embrace a significantly more inclusive, tactile, and emotionally diverse approach to their homosocial relationships. All participants provided comparable definitions of what a bromance is and how it operates, all had at least one bromantic friend, and all suggested that bromances had more to offer than a standard friendship. Participants described a bromance as being more emotionally intimate, physically demonstrative, and based upon unrivalled trust and cohesion compared to their other friendships. Participants used their experiences with romances and familial relations as a reference point for considering the conditions of a bromance. Results support the view that declining homophobia and its internalization has had significantly positive implications for male expression and intimacy. Conclusions are made about the bromance’s potential to improve men’s mental health and social well-being because participants indicate these relationships provide a space for emotional disclosure and the discussion of potentially traumatic and sensitive issues. © 2017, Springer Science+Business Media New York.
Keywords: Bromance; Homohysteria; Homosocial; Masculinity; Men; Stoicism; Suicide

Hip nostalgia: Jazz and the politics of representation in three dramedies - Solis, G. (Jazz Research Journal, 2018)
The opening episode of season two of the AMC series Preacher begins with a big reveal that sets in motion the season's subsequent action: God has come to earth and gone missing. The protagonists-a preacher possessed by the powerful, but amoral offspring of the illicit coupling of an angel and a demon, his contract killer girlfriend, and an Irish vampire-track the almighty to a small town strip club in East Texas he has been rumored to frequent. God is not there, mayhem ensues, and in the club's office the manager-before succumbing to a gunshot wound-tells the preacher, with a sigh, 'God didn't come for the girls, you idiot. He came...for the jazz.' The show then cuts to the club's performance space where a piano-less trio led by veteran New Orleans drummer Johnny Vidacovich offers a Coltrane-inflected, hard bop-style tune while pole dancers writhe at the edge of the screen. Jazz is here partly, it turns out, to give the showrunners an excuse to set the season in New Orleans, but it is also here for more than simple exigency. This article plumbs the place of jazz in three contemporary American television shows' soundtracks: AMC's Preacher, Showtime's I'm Dying Up Here, and F/X's Louie. Together they represent a distinct cultural phenomenon in a distinct historical moment: the embrace of jazz as a music signifying creativity and the new; hipness and the bohemian margins of polite society; and elite, left wing intellectualism in an America riven by hope, change, and retrenchment. It is perhaps no surprise that each of these shows has a similar soundtrack-not only inasmuch as each includes new jazz recordings, in fact, but also in the range of other music compiled for their scores. They share a format-the ambivalent 'dramedy'-an auteurish quality, an embrace of indie film aesthetics on the small screen, and a target audience. God aside, each of these shows participates in a signifying chain that links jazz to other aspects of American entertainment that once thrived together in a kind of demimonde, and which have since largely become uncoupled from each other; a Cold War-era world of Playboy clubs and the Rat Pack. What, this article asks, might be at stake in reattaching jazz, stand up comedy, and strippers in these television shows? What does their target audience want from that set of associations? Answering those questions requires a close look not only at the narrative frames in which jazz is made to participate and the televisual techniques with which it is shown, but also at the particular sonic qualities that define jazz for these shows. Jazz is, of course, a famously varied genre label. Each of these shows features the same kind of jazz: an eclectic style based in Miles Davis's approach to texture and form and in John Coltrane's harmonic explorations as elaborated since the 1970s. Notably, in using this style of music they have found a jazz that is neither strongly associated with the middleclass Black project of the 'neo-traditional' resurgence of historical styles starting in the 1990s, nor associated with the Black radical project of hip hop and R & B-tinged Afrofuturist jazz growing in popularity at the time the shows were released. It is not so much that the vision of jazz these shows produce is white, as that it occludes its racial signifiers altogether. In the most critical assessment one might say that this is a (mostly) white, (mostly) male attempt to recapture a moment of white hipness: a chance to make Bohemian America great again. A more sympathetic interpretation may use Svetlana Boym's distinction between restorative and reflective nostalgia to argue that the desire is to recapture the possibility of a different future offered by a selective memory of the past. These shows all make gestures toward a more multicultural world, and a world impacted by feminist and queer movements. This article holds open the possibility that by longing for a moment when jazz was hip these shows may be articulating with an audience's desire for a more critical, more aware, more just future. © Equinox Publishing L
Keywords: I'm Dying Up Here (television programme); Jazz on television; Louie (television programme); Louis C.K.; Preacher (television programme); Sex workers; Stand-up comedy

Lifetime prevalence of suicidal ideation among men who have sex with men: A meta-analysis - Luo, Z.; Feng, T.; Fu, H.; Yang, T. (BMC Psychiatry, 2017)
Background: Suicide is a leading cause of death among men who have sex with men (MSM) and suicidal ideation may put individuals at higher risk of suicide. A great disparity of lifetime prevalence of suicidal ideation among MSM was observed across studies, indicating the importance of a reliable estimation of the pooled lifetime prevalence. However, the only one published meta-analysis estimating the pooled lifetime prevalence of suicidal ideation among MSM was conducted in 2008 with only 2 eligible studies. Subsequently, there was a rapid increase of publications about lifetime suicidal ideation among MSM, suggesting that an update on the pooled lifetime prevalence of suicidal ideation among MSM was necessary. Therefore, this study aimed to update the estimation of the pooled lifetime prevalence of suicidal ideation among MSM. Methods: Electronic databases of PubMed, CINAHL, Scopus (social science), Embase and PsycInfo were searched until September 2017 to identify relevant studies. Cross-sectional studies exploring the lifetime prevalence of suicidal ideation among MSM were enrolled. Heterogeneity was evaluated using the Cochran Q test and quantified using the I 2 statistic. The possibility of publication bias was assessed using both Begg's rank test and Egger's linear test, and an Egger's funnel plot for asymmetry was presented. Subgroup analyses were performed according to the geographic area, sample source and HIV status. Results: Nineteen studies with a total of 26,667 MSM were included, of which 9374 were identified with suicidal ideation. A high degree of heterogeneity (P≤0.001, I 2 =99.2%) was observed among the eligible studies, with the reported prevalence ranging from 13.18 to 55.80%. The pooled lifetime prevalence of suicidal ideation among MSM by a random effects model was 34.97% (95% confidence interval: 28.35%-41.90%). Both the Begg's rank test and Egger's linear test indicated low possibility of publication bias. Subgroup analyses showed that the lifetime prevalence of suicidal ideation among MSM differed significantly by geographic area, sample source and HIV status (P<0.05). Conclusions: The high pooled lifetime prevalence of suicidal ideation among MSM found in this meta-analysis significantly underscores the importance of early assessment of suicidal ideation among MSM, as well as the need for strengthening the psychological interventions. © 2017 The Author(s).
Keywords: Men who have sex with men; Meta-analysis; Prevalence; Suicidal ideation

Fifteen-minute consultation in the normal child: Challenges relating to sexuality and gender identity in children and young people - O'Neill, T.; Wakefield, J. (Archives of Disease in Childhood: Education and Practice Edition, 2017)
Lesbian, gay, bisexual and transgender (LGBT+) young people face several challenges in their daily lives, including specific healthcare inequalities. Negative societal attitudes towards sexual and gender minorities, and the effects of regular experiences of bullying and homophobia/transphobia exacerbate the normal trials and tribulations of childhood and adolescence. Barriers to accessing healthy activities, such as sport, are created by perceived stigma and real-life experiences. Healthcare environments are by default heteronormative and contribute to the isolation and exclusion of LGBT+ young people. Paediatricians are well placed to act on these healthcare inequalities and to advocate for LGBT+ youth, through simple changes to individual practice as well as system-wide improvements. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved.
Keywords: adolescent health; gender; general paediatrics; LGBT; sexuality

Comparing Treatment Response between LGBQ and Heterosexual Individuals Attending a CBT- and DBT-Skills-Based Partial Hospital - Beard, C.; Kirakosian, N.; Silverman, A.L.; Winer, J.P.; Wadsworth, L.P.; Björgvinsson, T. (Journal of Consulting and Clinical Psychology, 2017)
Objective: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ), no prior study has examined mental health treatment outcomes for LGBQ populations receiving standard care. We compared individuals identifying as LGBQ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Method: A total of 441 participants (19% LGBQ; mean age 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment. Results: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities. Conclusions: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ affirmative treatments for specific LGBQ subgroups are superior to traditional treatments. © 2017 American Psychological Association.
Keywords: CBT; Disparities; LGBTQ; Sexual minority; Treatment

Why don't key populations access HIV testing and counselling centres in Nepal? Findings based on national surveillance survey - Shrestha, R.; Philip, S.; Shewade, H.D.; Rawal, B.; Deuba, K. (BMJ Open, 2017)
Objectives: To assess the demographic, behavioural, psychosocial and structural factors associated with non-utilisation of HIV testing and counselling (HTC) services by female sex workers (FSWs) and men who have sex with men/transgender (MSM/TG). Methods: This study involved a cross-sectional design. We used the national surveillance survey data of 2012, which included 610 FSWs and 400 MSM/TG recruited randomly from 22 and three districts of Nepal, respectively. Adjusted prevalence ratio (aPR) and 95% confidence interval (CI) using modified Poisson regression was used to assess and infer the association between outcome (non-utilisation of HTC in last year) and independent variables. Results: Non-utilisation of HTC in the last year was 54% for FSWs and 55% for MSM/TG. The significant factors for non-utilisation of HTC among FSWs were depression (aPR=1.4 (95% CI 1.1 to 1.6)), injectable drug abuse (ever) (aPR=1.4 (95% CI 1.1 to 1.8)), participation (ever) in HIV awareness programmes (aPR=1.2 (95% CI 1.0 to 1.4)), experience of forced sex in previous year (aPR=1.1 (95% CI 1.0 to 1.3)) and absence of dependents in the family (aPR=1.1 (95% CI 1.0 to 1.3)). Non-utilisation of HTC among MSM/TG had significant association with age 16-19 years (aPR=1.4 (95% CI 1.1 to 1.7)), non-condom use (aPR=1.2 (95% CI 1.0 to 1.4)), participation (ever) in HIV awareness programmes (aPR=1.6 (95% CI 1.3 to 2.0)), physical assault in previous year (aPR=1.8 (95% CI 1.0 to 3.1)), experience of forced sex in previous year (aPR=0.5 (95% CI 0.3 to 0.9)). Conclusion: Although limited by cross-sectional design, we found many programmatically relevant findings. Creative strategies should be envisaged for effective behavioural change communication to improve access to HIV testing. Psychosocial and structural interventions should be integrated with HIV prevention programmes to support key populations in accessing HIV testing. © 2017 Article author(s). All rights reserved.
Keywords: FSW; HIV voluntary testing and counselling; key populations; MSM; Nepal; SORT IT; transgender

Health and life satisfaction for Chinese gay men in Guangzhou, China - Yu, Y.; Xiao, S. (Journal of Central South University (Medical Sciences), 2017)
Objective: To understand Chinese gay men's health and life satisfaction in Guanzhou, and to analyze the main factors for life satisfaction. Methods: Male gay participants were recruited through respondent-driven sampling and faceto-face investigations with self-administered questionnaires, including a general demographic questionnaire, a suicide questionnaire, the Depression-Anxiety Stress Scale, the Self-Stigma Scale, the Perceived Social Support Scale, the Rosenberg Self-Esteem Scale, and the Satisfaction with Life Scale. Results: Surveys were successfully conducted for 420 gay men. High levels of depression, anxiety, and stress were observed among the respondents. A total of 29.3% had suicidal tendency in the past year, 36.5% experienced dating violence, 39.2% had homosexual sex without protection in the past 6 months, and 14.0% were infected with at least one type of infection of sexually transmitted diseases. Multiple linear regression analysis showed that gay men who felt highly satisfied with life exhibited low levels of self-stigma, high self-esteem, and low levels of depression. Moreover, they did not suffer dating violence and playing passive sex roles. Conclusion: The survey confirmed that gay men in Guangzhou, China, have poor health and lower life satisfaction levels. Self-stigma, self-esteem, sex roles, depression, and dating violence are the main factors that influence the life satisfaction of them.
Keywords: Gay men; Health; Life satisfaction

Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland - McLafferty, M.; Lapsley, C.R.; Ennis, E.; Armour, C.; Murphy, S.; Bunting, B.P.; Bjourson, A.J.; Murray, E.K.; O’Neill, S.M. (PLoS ONE, 2017)
Mental health and behavioural problems are common among students commencing university. University life can be stressful and problems often exacerbate during their course of study, while others develop disorders for the first time. The WHO World Mental Health Surveys International College Student Project aims to conduct longitudinal research to examine and monitor student mental health and wellbeing. The Ulster University Student Wellbeing study, which commenced in September 2015 in Northern Ireland (NI), was conducted as part of this initiative (wave 1, n = 739), using the WMH-CIDI to examine psychopathology. Baseline prevalence rates of lifetime and 12-month mental health and substance disorders, ADHD and suicidality were high, with more than half of new undergraduate students reporting any lifetime disorder. Co-morbidity was common with 19.1% of students experiencing three or more disorders. Logistic regression models revealed that females, those over 21, non-heterosexual students, and those from a lower SES background were more likely to have a range of mental health and behavioural problems. Overall, 10% of new entry students received treatment for emotional problems in the previous year. However, 22.3% of students with problems said they would not seek help. The study provides important information for universities, policy makers and practice, on mental health and wellbeing in young people generally but particularly for students commencing university. The findings will assist in the development and implementation of protection and prevention strategies in the university setting and beyond. © 2017 McLafferty et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Validation of the Minority Stress Scale among Italian gay and bisexual men - Pala, A.N.; Dell'amore, F.; Steca, P.; Clinton, L.; Sandfort, T.; Rael, C. (Psychology of Sexual Orientation and Gender Diversity, 2017)
The experience of sexual orientation stigma (e.g., homophobic discrimination and physical aggression) generates minority stress, a chronic form of psychosocial stress. Minority stress has been shown to have a negative effect on gay and bisexual men's (GBM's) mental and physical health, increasing the rates of depression, suicidal ideation, and HIV risk behaviors. In conservative religious settings, such as Italy, sexual orientation stigma can be more frequently and/or more intensively experienced. However, minority stress among Italian GBM remains understudied. The aim of this study was to explore the dimensionality, internal reliability, and convergent validity of the Minority Stress Scale (MSS), a comprehensive instrument designed to assess the manifestations of sexual orientation stigma. The MSS consists of 50 items assessing (a) Structural Stigma, (b) Enacted Stigma, (c) Expectations of Discrimination, (d) Sexual Orientation Concealment, (e) Internalized Homophobia Toward Others, (f) Internalized Homophobia toward Oneself, and (g) Stigma Awareness. We recruited an online sample of 451 Italian GBM to take the MSS. We tested convergent validity using the Perceived Stress Questionnaire. Through exploratory factor analysis, we extracted the 7 theoretical factors and an additional 3-item factor assessing Expectations of Discrimination From Family Members. The MSS factors showed good internal reliability (ordinal α >.81) and good convergent validity. Our scale can be suitable for applications in research settings, psychosocial interventions, and, potentially, in clinical practice. Future studies will be conducted to further investigate the properties of the MSS, exploring the association with additional health-related measures (e.g., depressive symptoms and anxiety). © 2017 American Psychological Association.
Keywords: bisexual men; gay; Minority stress; perceived stress; sexual orientation stigma

Enacted Stigma, Mental Health, and Protective Factors among Transgender Youth in Canada - Veale, J.F.; Peter, T.; Travers, R.; Saewyc, E.M. (Transgender Health, 2017)
Purpose: We aimed to assess the Minority Stress Model which proposes that the stress of experiencing stigma leads to adverse mental health outcomes, but social supports (e.g., school and family connectedness) will reduce this negative effect. Methods: We measured stigma-related experiences, social supports, and mental health (self-injury, suicide, depression, and anxiety) among a sample of 923 Canadian transgender 14- to 25-year-old adolescents and young adults using a bilingual online survey. Logistic regression models were conducted to analyze the relationship between these risk and protective factors and dichotomous mental health outcomes among two separate age groups, 14- to 18-year-old and 19- to 25-year-old participants. Results: Experiences of discrimination, harassment, and violence (enacted stigma) were positively related to mental health problems and social support was negatively associated with mental health problems in all models among both age groups. Among 14-18 year olds, we examined school connectedness, family connectedness, and perception of friends caring separately, and family connectedness was always the strongest protective predictor in multivariate models. In all the mental health outcomes we examined, transgender youth reporting low levels of enacted stigma experiences and high levels of protective factors tended to report favorable mental health outcomes. Conversely, the majority of participants reporting high levels of enacted stigma and low levels of protective factors reported adverse mental health outcomes. Conclusion: While these findings are limited by nonprobability sampling procedures and potential additional unmeasured risk and protective factors, the results provide positive evidence for the Minority Stress Model in this population and affirm the need for policies and programs to support schools and families to support transgender youth. © Copyright 2017, 2017.
Keywords: adolescence; family support; mental health; minority stress; school support; stigma

Suicide in prisons: an international study of prevalence and contributory factors - Fazel, S.; Ramesh, T.; Hawton, K. (The Lancet Psychiatry, 2017)
Background Prison suicide rates, rate ratios, and associations with prison-related factors need clarification and updating. We examined prison suicide rates in countries where reliable information was available, associations with a range of prison-service and health-service related factors, how these rates compared with the general population, and changes over the past decade. Methods We collected data for prison suicides in 24 high-income countries in Europe, Australasia, and North America from their prison administrations for 2011–14 to calculate suicide rates and rate ratios compared with the general population. We used meta-regression to test associations with general population suicide rates, incarceration rates, and prison-related factors (overcrowding, ratio of prisoners to prison officers or health-care staff or education staff, daily spend, turnover, and imprisonment duration). We also examined temporal trends. Findings 3906 prison suicides occurred during 2011–14 in the 24 high-income countries we studied. Where there was breakdown by sex (n=2810), 2607 (93%) were in men and 203 (7%) were in women. Nordic countries had the highest prison suicide rates of more than 100 suicides per 100 000 prisoners apart from Denmark (where it was 91 per 100 000), followed by western Europe where prison suicide rates in France and Belgium were more than 100 per 100 000 prisoners. Australasian and North American countries had rates ranging from 23 to 67 suicides per 100 000 prisoners. Rate ratios, or rates compared with those in the general population of the same sex and similar age, were typically higher than 3 in men and 9 in women. Higher incarceration rates were associated with lower prison suicide rates (b = –0·504, p = 0·014), which was attenuated when adjusting for prison-level variables. There were no associations between rates of prison suicide and general population suicide, any other tested prison-related factors, or differing criteria for defining suicide deaths. Changes in prison suicide rates over the past decade vary widely between countries. Interpretation Many countries in northern and western Europe have prison suicide rates of more than 100 per 100 000 prisoners per year. Individual-level information about prisoner health is required to understand the substantial variations reported and changes over time. Funding Wellcome Trust and the UK National Institute for Health Research (NIHR). © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Masculinity and melancholia at the virtual end: Leaving the world (of Warcraft) - Lau, K.J. (Differences, 2017)
Avatar suicide videos ritualize an avatar's final exit from the virtual world. Focusing on such videos in the context of World of Warcraft, this essay argues first that the avatar-player relationship produces a fluid subjectivity; then, drawing on Judith Butler's theory of melancholy gender, the author contends that this subjectivity enables a recognition of the same-sex love and desire prohibited by heterosexist culture through an enactment of its loss. As such, avatar suicide videos dramatize death in order to create an important space of public grieving in which the cultural prohibitions against such recognition and mourning might be suspended. Disrupting norms of aggressive heteromasculinity in dominant gamer culture, these videos might help us imagine alternative ways of living with melancholy gender. © 2017 by Brown University and differences : A Journal of Feminist Cultural Studies.
Keywords: Avatar; Judith Butler; Melancholy gender; World of Warcraft

Digital Self-Harm Among Adolescents - Patchin, J.W.; Hinduja, S. (Journal of Adolescent Health, 2017)
Purpose Despite increased media and scholarly attention to digital forms of aggression directed toward adolescents by their peers (e.g., cyberbullying), very little research has explored digital aggression directed toward oneself. “Digital self-harm” is the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself. The current study examined the extent of digital self-harm among adolescents. Methods Survey data were obtained in 2016 from a nationally representative sample of 5,593 American middle and high school students (12–17 years old). Logistic regression analysis was used to identify correlates of participation in digital self-harm. Qualitative responses were also reviewed to better understand motivations for digital self-harm. Results About 6% of students have anonymously posted something online about themselves that was mean. Males were significantly more likely to report participation (7.1% compared to 5.3%). Several statistically significant correlates of involvement in digital self-harm were identified, including sexual orientation, experience with school bullying and cyberbullying, drug use, participation in various forms of adolescent deviance, and depressive symptoms. Conclusions Digital self-harm is a new problem that demands additional scholarly attention. A deeper inquiry as to the motivations behind this behavior, and how it correlates to offline self-harm and suicidal ideation, can help direct mental health professionals toward informed prevention approaches. © 2017 Society for Adolescent Health and Medicine
Keywords: Cyberbullying; Depressive symptoms; Digital self-harm; Self-cyberbullying; Self-harm; Suicide

Beta-amyloid deposition in patients with major depressive disorder with differing levels of treatment resistance: a pilot study - Li, P.; Hsiao, I.-T.; Liu, C.-Y.; Chen, C.-H.; Huang, S.-Y.; Yen, T.-C.; Wu, K.-Y.; Lin, K.-J. (EJNMMI Research, 2017)
Background: Lack of treatment response in patients with late-life depression is common. The role of brain beta-amyloid (Aβ) deposition in treatment outcome in subjects with late-life depression remains unclear. The present study aimed to investigate brain Aβ deposition in patients with major depressive disorder (MDD) with differing treatment outcomes in vivo using 18F-florbetapir imaging. This study included 62 MDD patients and 18 healthy control subjects (HCs).We first employed the Maudsley staging method (MSM) to categorize MDD patients into two groups according to treatment response: mild treatment resistance (n = 29) and moderate-to-severe treatment resistance (n = 33).The standard uptake value ratio (SUVR) of each volume of interest was analysed, and voxel-wise comparisons were made between the MDD patients and HCs. Vascular risk factors, serum homocysteine level, and apolipoprotein E (ApoE) genotype were also determined. Results: The MDD patients with moderate-to-severe treatment resistance had higher 18F-florbetapir SUVRs than the HCs in the parietal region (P < 0.01). Voxel-wise comparisons further demonstrated elevated SUVRs in MDD patients with moderate-to-severe treatment resistance in the precuneus, parietal, temporal, and occipital regions. The MDD patients with mild treatment resistance were found to have increased 18F-florbetapir uptake mainly in the left frontal and parietal regions as compared with the HCs. In addition, voxel-to-voxel correlation analysis showed that brain Aβ deposition was correlated positively with MSM score in the occipital region. 18F-florbetapir SUVRs were correlated negatively with Mini Mental Status Examination (MMSE) score in the sample of all MDD patients (r = −0.355, P = 0.005). Conclusions: This study provided preliminary evidence that region-specific Aβ deposition was present in some (but not all) MDD patients, especially in those with moderate-to-severe treatment resistance, and their depressive symptoms may represent prodromal manifestations of Alzheimer’s disease (AD). Depressive symptomatology in old age, particularly in subjects with a poor treatment response, may underscore early changes of AD-related pathophysiology. © 2017, The Author(s).
Keywords: 18F-Florbetapir (AV-45/Amyvid); Alzheimer’s disease; Amyloid; Dementia; Major depressive disorder; Treatment resistance

Criterion and divergent validity of the sexual minority adolescent stress inventory - Goldbach, J.T.; Schrager, S.M.; Mamey, M.R. (Frontiers in Psychology, 2017)
Sexual minority adolescents (SMA) consistently report health disparities compared to their heterosexual counterparts, yet the underlying mechanisms of these negative health outcomes remain unclear. The predominant explanatory model is the minority stress theory; however, this model was developed largely with adults, and no valid and comprehensive measure of minority stress has been developed for adolescents. The present study validated a newly developed instrument to measure minority stress among racially and ethnically diverse SMA. A sample of 346 SMA aged 14-17 was recruited and surveyed between February 2015 and July 2016. The focal measure of interest was the 64-item, 11-factor Sexual Minority Adolescent Stress Inventory (SMASI) developed in the initial phase of this study. Criterion validation measures included measures of depressive symptoms, suicidality and self-harm, youth problem behaviors, and substance use; the general Adolescent Stress Questionnaire (ASQ) was included as a measure of divergent validity. Analyses included Pearson and tetrachoric correlations to establish criterion and divergent validity and structural equation modeling to assess the explanatory utility of the SMASI relative to the ASQ. SMASI scores were significantly associated with all outcomes but only moderately associated with the ASQ (r = -0.13 to 0.51). Analyses revealed significant associations of a latent minority stress variable with both proximal and distal health outcomes beyond the variation explained by general stress. Results show that the SMASI is the first instrument to validly measure minority stress among SMA. © 2017 Goldbach, Schrager and Mamey.
Keywords: Adolescents; Behavioral health; LGBT; Mental health; Minority stress

Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM - Rodriguez-Hart, C.; Nowak, R.G.; Musci, R.; German, D.; Orazulike, I.; Kayode, B.; Liu, H.; Gureje, O.; Crowell, T.A.; Baral, S.; Charurat, M. (AIDS, 2017)
Objectives: Sexual stigma affecting MSM in Nigeria may be an important driver of HIV and other sexually transmitted infections (STIs), but potential mechanisms through which this occurs are not well understood. This study assessed the contributions of suicidal ideation and sexual risk behaviors to causal pathways between stigma and HIV/STIs. Design: Data were collected from the TRUST/RV368 Study, a prospective cohort of 1480 MSM from Abuja and Lagos, Nigeria. Methods: Participants enrolled from March 2013 to February 2016 were classified into three stigma subgroups based on a latent class analysis of nine stigma indicators. Path analysis was used to test a model where disclosure led to stigma, then suicidal ideation, then condomless sex with casual sex partners, and finally incident HIV infection and/or newly diagnosed STIs, adjusting the model for age, education, having had female sex partners in the past 12 months, and sex position. Both direct and indirect (mediational) paths were tested for significance and analyses were clustered by city. Results: As stigma increased in severity, the proportion of incident HIV/STI infections increased in a dose-response relationship (low: 10.6%, medium: 14.2%, high 19.0%, P=0.008). All direct relationships in the model were significant and suicidal ideation and condomless sex partially mediated the association between stigma and incident HIV/STI infection. Conclusion: These findings highlight the importance of the meaningful integration of stigma-mitigation strategies in conjunction with mental health services as part of a broader strategy to reduce STI and HIV acquisitions among Nigerian MSM. © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: HIV infections; incidence; MSM; path analysis; sexually transmitted infections; stigma

The kids are OK: It is discrimination, not same-sex parents, that harms children - Knight, K.W.; Stephenson, S.E.M.; West, S.; Delatycki, M.B.; Jones, C.A.; Little, M.H.; Patton, G.C.; Sawyer, S.M.; Skinner, S.R.; Telfer, M.M.; Wake, M.; North, K.N.; et al. (Medical Journal of Australia, 2017)

Stigma and suicide among gay and bisexual men living with HIV - Ferlatte, O.; Salway, T.; Oliffe, J.L.; Trussler, T. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2017)
HIV positive gay and bisexual men (GBM) continue to struggle with the pervasiveness of HIV stigma, but little is known about the health effects of stigma. In this article, suicidal ideation and attempts are measured among GBM living with HIV, evaluating the extent to which these experiences are associated with stigma and suicide. Drawing from an online national survey of Canadian GBM completed by 7995 respondents, a sub-set of data provided by respondents self-reporting HIV-positive status was used for the current study. The associations between suicidal ideation (SI) and attempts (SA) and four measures of HIV stigma were measured: social exclusion, sexual rejection, verbal abuse and physical abuse. A total of 673 HIV-positive men completed the survey (8% of total sample). Among this group, 22% (n = 150) reported SI and 5% (n = 33) SA in the last 12 months. After adjusting for sociodemographic factors, SI and SA were associated with each of the four measures of HIV stigma: being excluded socially for being HIV positive (SI adjusted odds ratio, AOR 2.0 95% CI 1.4–3.1; SA AOR 3.8 95% CI 1.9–7.9), rejected as a sexual partner (SI AOR 1.6 95% CI 1.1–2.4; SA AOR 2.6 95% CI 1.1–6.0), verbally abused (SI AOR 2.9 95% CI 1.9–4.5; SA AOR 2.4 95% CI 1.1–5.1), and physically abused (SI AOR 4.5 95% CI 1.8–11.7; SA AOR 6.4 95% CI 2.0–20.1). Furthermore, experiencing multiple forms of stigma was associated with significantly increased risk of SI and SA. The authors conclude that HIV positive GBM experience significant levels of stigma that are associated with heightened risk for suicide. The findings affirm the need for targeted interventions to prevent suicide amid public health efforts to de-stigmatize HIV and mental illness. © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: bisexual men; discrimination; gay men; HIV stigma; Suicide

On the Boundaries of Framing Terrorism: Guilt, Victimization, and the 2016 Orlando Shooting - Walter, N.; Billard, T.J.; Murphy, S.T. (Mass Communication and Society, 2017)
The 2016 Orlando shooting offers an intriguing lens through which to evaluate the boundaries of media frames in the interpretation of terrorism. Using an experimental design (N = 243), the current study investigated the effects of two dominant frames—the homophobic hate crime and the Islamic terrorist frame—on collective guilt, collective victimization, and pro–lesbian, gay, bisexual, transgender, and queer (LGBTQ) political action. In addition, political partisanship and social network diversity were evaluated as potential moderators. Compared to the Islamic terrorist frame, exposure to the homophobic hate crime frame increased collective guilt and decreased collective victimization, subsequently enhancing support for the LGBTQ community. Moreover, social network diversity was shown to override the framing effect, as individuals who reported high diversity were more likely to sign a petition in solidarity with the LGBTQ community, irrespective of frame condition. Copyright © Mass Communication & Society Division of the Association for Education in Journalism and Mass Communication.

Current Resources for Evidence-Based Practice, November/December 2017 - Carlson, N.S. (Journal of Midwifery and Women's Health, 2017)

Clinical characteristics in a sample of transsexual people - Lerri, M.R.; Romão, A.P.M.S.; dos Santos, M.A.; Giami, A.; Ferriani, R.A.; Lara, L.A.S. (Revista Brasileira de Ginecologia e Obstetricia, 2017)
Purpose To assess the clinical characteristics of subjects with gender dysphoria (GD). Method A cross-sectional study of adults with GD. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic data, clinical data and life habits were recorded. Results Total of 44 subjects participated in the study: 36 (82%) trans women and 8 (18%) trans men. Forty-three (98%) of the GD patients had anxiety (36 [100%] trans women and 7 [87.5%] trans men), and 36 (82%) had depression (29 [80.5%] trans women and 7 [87.5%] trans men). Suicide had been attempted by 32 (73%) subjects. The rates of depression were lower among the subjects living with partners, parents, or other people than among those living alone (p = 0.03), and it was also lower among the subjects who were married compared to those who were dating or single (p = 0.03). Conclusion Improving the relationship status may reduce the prevalence of depressive symptoms in GD patients. There was a high rate of attempted suicide in this sample. © 2017 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil.
Keywords: Anxiety; Depression; Gender dysphoria; Sex reassignment surgery; Transsexual

The Relationship Between Sexual History, Bullying Victimization, and Poor Mental Health Outcomes Among Heterosexual and Sexual Minority High School Students: A Feminist Perspective - Dunn, H.K.; Clark, M.A.; Pearlman, D.N. (Journal of Interpersonal Violence, 2017)
This study uses a feminist theoretical framework to extend the literature on the relationship between sexual history, bullying victimization, and poor mental health outcomes. First, we examined whether an association between the sexual double standard and bullying victimization would apply to sexual minority youth the same way it applies to heterosexual youth. A second aim was to assess whether sexual minority boys, typically stereotyped as effeminate, would report the highest odds of bullying victimization. A third and final aim of our study was to look at the joint effect of sex and sexual intercourse on depression and suicidal ideation. Our analytic sample (N = 9,300) was from the 2009, 2011, and 2013 Rhode Island Youth Risk Behavior Surveys. Findings demonstrated that heterosexual girls who engaged in sexual intercourse had significantly higher adjusted odds of bullying victimization than heterosexual boys who engaged in the same behavior. Similar results were not found for sexual minority adolescents, suggesting the sexual double standard may not apply to sexual minority adolescents in the same way it applies to heterosexual adolescents. Consistent with our second hypothesis, sexual minority boys reported the highest odds of being recently bullied compared with heterosexual boys. Among students who were recently bullied, sexual minority girls displayed the highest adjusted odds of recent depression and suicidal ideation. Our study demonstrated that using a feminist theoretical framework broadens our understanding of why girls and sexual minority boys are particularly vulnerable to bullying victimization and the sequel of depression and suicidal ideation. © 2015, © The Author(s) 2015.
Keywords: adolescence; bullying; feminism; sexual orientation; sexual violence

Acne, sexual orientation, and mental health among young adults in the United States: A population-based, cross-sectional study - Gao, Y.; Wei, E.K.; Arron, S.T.; Linos, E.; Margolis, D.J.; Mansh, M.D. (Journal of the American Academy of Dermatology, 2017)

A case report of gender dysphoria with morbid jealousy in a natal female - Rao, G.; Aparna, B. (Indian Journal of Psychological Medicine, 2017)
Gender dysphoria is a new entity introduced in the Diagnostic and Statistical Manual of Mental Disorder V to address the distress of the previously labeled gender identity disorder patients. It is less commonly seen in natal females, often starting in their childhood. Adults and adolescent natal females with early-onset gender dysphoria are almost always gynephilic. This case report is presented to discuss the interesting evolution of the symptoms in gender dysphoria case with difficulties in adjusting to the assigned sexual role, relationship problems, morbid jealousy, and severe depressive features with suicidal ideations. © 2017 Indian Psychiatric Society.
Keywords: Depressive features; gender dysphoria; morbid jealousy; natal female; relationship problems

Is Morality Policy Different? Testing Sectoral and Institutional Explanations of Policy Change - Hurka, S.; Adam, C.; Knill, C. (Policy Studies Journal, 2017)
We analyze morality policy change from the perspective of punctuated equilibrium theory (PET) to test whether reform dynamics in this policy sector follow a distinct pattern. First, we propose a new measurement scheme capturing changes in the intensity of morality policy output. Second, we demonstrate that morality policy change is strongly punctuated. Finally, and most importantly, we show that the degree of policy punctuations varies between different domains of morality policy, but not according to institutional features operating on the country level, supporting existing PET research, which has discovered similar domain-specific dynamics in changes of public spending. Specifically, punctuations are particularly pronounced in areas of manifest morality policy, that is, policies characterized by strong value conflicts, whereas punctuations are less pronounced for latent morality policies, that is, policies in which other dimensions of conflict are present next to the value dimension. Significant differences in reform dynamics are neither discerned for countries belonging to the religious or the secular world, nor for countries with majoritarian or consensual democracies. The analysis relies on an original dataset capturing legislative changes in five manifest (abortion, euthanasia, prostitution, pornography, and homosexuality), and three latent morality policies (drugs, gambling, and handguns) in 19 European countries (1960–2010). © 2016 Policy Studies Organization
Keywords: abortion policy; comparative public policy; drug policy; morality policy; policy change; punctuated equilibrium

Non-suicidal self-injury in a New Zealand student population: Demographic and self-harm characteristics - Fitzgerald, J.; Curtis, C. (New Zealand Journal of Psychology, 2017)
There is an established international literature on the prevalence of non-suicidal self-injury (NSSI). However, New Zealand information regarding prevalence, attitudes, motivation, co-morbidities, etc., is limited. In this study data were collected using an on-line survey from approximately 850 university students regarding self-injurious behaviour, risk and protective factors, mental health co-morbidity, help-seeking, and addiction. Our data revealed that 293 participants (38%) had engaged in NSSI on at least one occasion in their lifetime, elevated risk for females who were lesbian or bisexual, and different patterns of site and function of injury by gender. Given research suggesting that Māori (indigenous New Zealanders) are at elevated risk for suicide it was surprising that those identifying as Māori were at no greater risk of NSSI than those identifying as New Zealanders of European origin. Females were more likely to exhibit chronic self-injuring and more likely to engage in more 'covert' forms of self-injury that can be hidden or disguised (e.g., scratching and cutting on their wrists, arms or thighs) whereas males were more likely to engage in 'overt' forms of self-injury (e.g., banging or punching themselves or objects with their hands or head). Patterns of NSSI were similar to international comparisons, although prevalence was somewhat elevated. A number of factors differed by gender, including underlying reasons, forms, rates and increasing severity of self-injury, which add to the international literature. © The material published in this issue is copyright to the New Zealand Psychological Society.
Keywords: Non-suicidal self-injury; NSSI; Prevalence; Risk factors; Self-harm; University students

Endocrine treatment of gender-dysphoric/gender-incongruent persons - Radix, A.; Davis, A.M. (JAMA - Journal of the American Medical Association, 2017)

Persecution Experiences and Mental Health of LGBT Asylum Seekers - Hopkinson, R.A.; Keatley, E.; Glaeser, E.; Erickson-Schroth, L.; Fattal, O.; Nicholson Sullivan, M. (Journal of Homosexuality, 2017)
Asylum seekers are a unique population, particularly those who have endured persecution for their sexual orientation or gender identity. Little data exist about the specific experiences and needs of asylum seekers persecuted due to lesbian, gay, bisexual, or transgender (LGBT) identity. Quantitative data were gathered regarding demographics, persecution histories, and mental health of 61 clients from a torture survivors program in New York City who reported persecution due to LGBT identity. Thirty-five clients persecuted due to their LGBT identity were matched by country of origin and sex with clients persecuted for other reasons to explore how persecution and symptoms may differ for LGBT clients. LGBT asylum seekers have a higher incidence of sexual violence, persecution occurring during childhood, persecution by family members, and suicidal ideation. Understanding the type of persecution experiences and how these influence mental health outcomes is an essential step toward designing and delivering effective treatments. © 2017 Taylor & Francis.
Keywords: Asylum; bisexual; gay; lesbian; LGBT; posttraumatic stress disorder; refugee; survivor of torture; transgender; trauma

Relationship among gender-related stress, resilience factors, and mental health in a Midwestern U.S. transgender and gender-nonconforming population - Brennan, S.L.; Irwin, J.; Drincic, A.; Amoura, N.J.; Randall, A.; Smith-Sallans, M. (International Journal of Transgenderism, 2017)
Background: Transgender and gender-nonconforming individuals experience more discrimination than their cisgender peers, and this discrimination can be associated with poorer mental health. This study used the gender minority stress model as a framework to examine the relationship among gender-related stressors and resilience factors and mental health outcomes. The study particularly aimed to increase knowledge of the gender-nonconforming population. Methods: A community sample of 83 individuals that identify as a gender different than the sex assigned to them at birth completed an online survey. Depression and anxiety were assessed using the Center for Epidemiological Studies Depression Scale (CES-D) and Beck Anxiety Inventory (BAI), respectively. The Gender Minority Stress and Resilience measure was used to assess distal and proximal stressors and resilience factors. Results: The median CES-D and BAI scores were 16 and 13, respectively. Forty percent had a history of non-suicidal self-injury (NSSI), 75% had experienced suicidal ideation, and 45% had attempted suicide. Proximal stress was found to be a positive predictor of depressive symptoms. Resilience was a weak negative predictor of anxiety symptoms. Distal stress was a positive predictor of suicide attempts, and resilience factors and hormone use were marginal negative predictors of suicide attempt. Trans women were significantly less likely to have engaged in NSSI, but had a significantly higher proximal stress score than trans men and gender-nonconforming individuals. Conclusion: Our study found high rates of mental health problems in the trans and gender-nonconforming sample. Our findings in part support the gender minority stress model, with gender-related stress predicting certain mental health problems and resilience being a negative predictor. Overall, gender-nonconforming individuals have had similar experiences and mental health findings as transgender individuals. © 2017 Taylor & Francis Group, LLC.
Keywords: Gender-nonconforming; gender-related stress; mental health; non-suicidal self-injury; resilience; transgender

“This Is How You Hetero:” Sexual Minorities in Heteronormative Sex Education - Hobaica, S.; Kwon, P. (American Journal of Sexuality Education, 2017)
The efficacy of sex education has been questioned, as students participate in high rates of unsafe sex after completion. Without exploring various sexual minority (SM) identities (e.g., gay, lesbian, and bisexual) and forms of sex, sex education may be especially unhelpful for SMs by perpetuating the heteronormative (i.e., assuming heterosexuality is normal) environment they typically experience. In the present qualitative study, semistructured interviews were conducted with 12 SMs regarding their experiences with sex education using a grounded theory approach. Participants described sex education as being heteronormative and exclusive of their identities, making them feel invisible, sexually unprepared, and shameful. Sex education also reportedly contributed to sexual hesitance, sexual violence, and risky sexual behaviors. Participants endorsed histories of depression, anxiety, and suicidality, often associated with their identity. To become more informed and sexually prepared, they sought information through conversations with others, online searching, college courses, and trial and error sexual experiences. Participants also advocated for inclusive sex education, which would incorporate all identities and associated safe sex practices. They concluded that inclusivity in curricula could lead to various improved outcomes for SMs, such as safe sex, a sense of community, identity confidence, healthy relationships, and resilience. © 2017 Taylor & Francis.
Keywords: bisexual; gay; Heteronormative; lesbian; LGB; queer; sex education; sexual minorities

Cultural heterosexism and silencing sexual diversity: Anoka-Hennepin School District - Grozelle, R.S. (Journal of LGBT Youth, 2017)
In less than 2 years, nine young people within one Minnesota school district committed suicide. As such, the bullying of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth in the Anoka-Hennepin School District continues to be an example of how embedded ideologies of some individuals can substantially impact the treatment of marginalized groups. Using the theory of cultural heterosexism, this paper will look at the ways in which the Anoka-Hennepin School District in Minnesota became a breeding ground for homophobic violence and discrimination. Furthermore, attention will be directed toward how discourses of sexuality, mobilized by conservative Christian groups in the Anoka-Hennepin School District, were used in order to maintain a heteronormative social order. © 2017 Taylor & Francis.
Keywords: bullying; Cultural heterosexism; LGBTQ rights; schools; sexuality; suicide

Mental Health Service Delivery to Sexual Minority and Gender Non-Conforming Students in Schools: A Winnicottian Approach - Wofford, N.C. (Child and Adolescent Social Work Journal, 2017)
Current research highlights the increased risk factors that sexual minority (lesbian, gay, bisexual) and gender minority (transgender/gender non-conforming) students face as compared to their heterosexual and cisgender peers. These risk factors include higher rates of depression, suicide, substance use, school dropout, sexually transmitted infections, experiences with bullying on school campuses and increased risk of homelessness. Although this research has aided our understanding of the needs and risks of this population of youth, few articles have emerged from these data which offer a comprehensive theoretical approach to work clinically with these adolescents in school-based settings. This article explores how school mental health staff can address the behavioural health needs of sexual and gender minority students through the adoption of a Winnicottian theoretical approach. With an intensive focus on academic achievement, schools have historically been limited in their usage of evidence-based data to create programs which adequately address the mental health needs of student populations on their campuses. Yet, sexual and gender minority students are likely to be present in almost every school in the country. Schools can serve as gateways to mental health access and can offer innovative and culturally responsive practices across racial, ethnic, class, and geographic lines. As the single largest holders of the student population in the United States, schools have the ability to play a significant role in mental health service provision for sexual and gender minority youth. © 2016, Springer Science+Business Media New York.
Keywords: Adolescent mental health; Gender non-conforming youth; School-based mental health services; Sexual minority youth; Winnicottian theoretical approach

The School-to-Coffin Pipeline: Queer Youth, Suicide, and Living the In-Between - Wozolek, B.; Wootton, L.; Demlow, A. (Cultural Studies - Critical Methodologies, 2017)
Written from the perspectives of a tenured high school teacher/researcher, an out bisexual sophomore, and a transgender senior, this article discusses the challenges of being and becoming an out lesbian, gay, bisexual, transgender, questioning (LGBTQ) student in a large, Midwestern high school. Through counternarratives, the authors explore what they call the school-to-coffin pipeline, a system that (un)intentionally positions LGBTQ teens in what has become a horrific, yet normalized, epidemic of queer youth suicide. The authors use the framework of this pipeline to examine what it means to live with/in the in-between of school rhetoric and a dearth of enacted school policy that could literally be life-saving for queer youth. Through an examination of the everyday challenges queer youth encounter, the authors argue that all adults involved in schooling - including teachers, teacher educators, administrators, counselors, and school psychologist - are necessarily (un)knowing participants in the school-to-coffin pipeline, contributing to institutional homophobia and, by extension, LGBTQ youth suicide. The authors argue that by attending to the school-to-coffin pipeline, those who contribute to it can begin to interrupt the current, and possibly continuing, cycle of self-inflicted violence on queer youth bodies. © 2016 SAGE Publications.
Keywords: counternarratives; homophobia; queer youth; school-to-coffin pipeline; suicide

Exploring the affirmative role of gay icons in coming out. - Forenza, B. (Psychology of Popular Media Culture, 2017)
Coming out is a process experienced by many sexual minorities that necessitates the individual disclosure of a personal attribute (i.e., sexual orientation) about him or herself that may otherwise go unnoticed. Compounded by myriad stressors of youth, the coming out process can yield a host of negative outcomes (suicide, depression, etc.) for questioning young people. This research utilized sense of community and collective identity frameworks (specifically, the attribute of symbols that is explicated in both literatures) to explore the affirmative role that gay icons can have in individual coming out processes. Retrospective, open-ended interviews were conducted with 10 "out and proud" gay men in the northeast region of the United States. Interviews were video-recorded, transcribed, and content-analyzed to identify themes. Three themes emerged from the data inductively. Sense of Self refers to the strongest link that participants perceived among all gay icons, Shared Identity refers to the connectedness that participants felt with the icons they mentioned, and Enabler of Coming Out refers to the belief among participants that they received validating messages about their emerging sexualities from the icons with whom they identified. Implications for policy, practice, and future research are also discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved). © 2015 American Psychological Association.
Keywords: collective identity; coming out; LGBT; sense of community; symbols

Can need for affect and sexuality differentiate suicide risk in three community samples? - Cramer, R.J.; Mandracchia, J.; Gemberling, T.M.; Holley, S.R.; Wright, S.; Moody, K.; Nobles, M.R. (Journal of Social and Clinical Psychology, 2017)
Suicide is a pressing community mental health problem, yet remains under investigated in certain vulnerable populations such as the bondage and sadomasochism (BDSM) community. As reflected by the Need for Affect (NFA), the present paper aims to test a new approach to understanding suicide risk from a Preferences in Information Processing perspective. Adult participants (n = 2,097) drawn from community, college, and BDSM community samples completed a health survey via online administration. Bivariate tests were used to identify correlates of elevated suicide risk, and logistic regression was employed to test primary hypotheses. Results yielded the following indicators of elevated suicide risk category membership: (1) female gender, (2) BDSM community membership, (3) lesbian, gay, bisexual and other sexual orientation identity minority status, (4) elevated depressive symptoms, (5) elevated NFA approach, and (6) elevated NFA Avoidance. BDSM and NFA results are largely new, and speak to the need for further attention. Results are discussed with respect to information processing preferences, as well as the intersection of sexuality-based marginalized groups, stigma, and health disparities. Implications for community mental health and suicide prevention are discussed. © 2017 Guilford Publications, Inc.
Keywords: BDSM; College students; Need for affect; Sexual orientation; Suicide

Risk and Protective Factors in the Lives of Transgender/Gender Nonconforming Adolescents - Eisenberg, M.E.; Gower, A.L.; McMorris, B.J.; Rider, G.N.; Shea, G.; Coleman, E. (Journal of Adolescent Health, 2017)
Purpose Research suggests that transgender and gender nonconforming (TGNC) youth may be at greatly increased risk of high-risk health behaviors compared with cisgender youth, but existing studies are limited by convenience samples and small numbers. This study uses a large school-based sample of adolescents to describe the prevalence of TGNC identity, associations with health risk behaviors and protective factors, and differences across birth-assigned sex. Methods This study analyzes existing surveillance data provided by 9th and 11th grade students in Minnesota in 2016 (N = 81,885). Students who were transgender, genderqueer, genderfluid, or unsure about their gender identity (TGNC) were compared with those who were not, using χ2 and t-tests. Outcome measures included four domains of high-risk behaviors and experiences and four protective factors. Results The prevalence of TGNC identity was 2.7% (n = 2,168) and varied significantly across gender, race/ethnicity, and economic indicators. Involvement in all types of risk behaviors and experiences was significantly higher, and reports of four protective factors were significantly lower among TGNC than cisgender youth. For example, almost two-thirds (61.3%) of TGNC youth reported suicidal ideation, which is over three times higher than cisgender youth (20.0%, χ2 = 1959.9, p <.001). Among TGNC youth, emotional distress and bullying experience were significantly more common among birth-assigned females than males. Conclusions This research presents the first large-scale, population-based evidence of substantial health disparities for TGNC adolescents in the United States, highlighting numerous multilevel points of intervention through established protective factors. Health care providers are advised to act as allies by creating a safe space for young people, bolstering protective factors, and supporting their healthy development. © 2017 Society for Adolescent Health and Medicine
Keywords: Gender identity; Health behaviors; Protective factors; Transgender

Transgender Women's Drug Use in the Dominican Republic - Budhwani, H.; Hearld, K.R.; Milner, A.N.; McGlaughlin, E.; Charow, R.; Rodriguez-Lauzurique, R.M.; Rosario, S.; Paulino-Ramirez, R. (Transgender Health, 2017)
Purpose: Studies on drug use in transgender populations, particularly those in resource-limited settings, are scarce. Considering that drug use can be a coping mechanism to deal with stigma and traumatic experiences, we examined associations between stigma, trauma, and drug use in a national sample of transgender women from the Dominican Republic. Methods: Bivariate analyses examined differences between drug users and abstainers (n=287). Multivariate analyses reported odds ratios (OR) with general drug, marijuana, and cocaine use as outcomes (n=243). Results: A quarter of respondents (24.5%) experienced sexual abuse, 12.1% were tortured, and 20.1% experienced a murder attempt. More than a quarter reported using illegal drugs (26.1%). Drug users had lower socioeconomic status; 30.0% of drug users had a primary level of education or less (18.2% of abstainers) and 17.6% of drug users had higher income, defined as greater than 10,001 pesos (∼$210 United States Dollars, USD) per month (28.1% of abstainers). More than half of drug users experienced some form of trauma (51.4%) compared to 43.5% of abstainers, and 28.4% of drug users, compared to 17.1% of abstainers, experienced a murder attempt on her life. Independent sample t-tests found significant differences between drug users and abstainers. Transgender women who experienced sexual abuse had three times high odds of using cocaine. Drug users were more likely to have experienced sexual abuse and attempted suicide (p<0.05 for both). Respondents who attempted suicide had higher odds of using drugs generally and using marijuana specifically, compared to respondents who had not attempted suicide (OR=2.665 and 3.168, respectively). Higher scores on the stigma scale were associated with higher odds of any drug use and cocaine use (OR=1.132 and 1.325, respectively). Conclusions: Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are not consistently enforced. Eliminating stigma and stigmatizing policies may reduce rates of drug use as a coping mechanism. © Copyright 2017, Mary Ann Liebert, Inc. 2017.
Keywords: Dominican Republic; drug use; stigma; transgender women

Elevated Prevalence of Suicide Attempts among Victims of Police Violence in the USA - DeVylder, J.E.; Frey, J.J.; Cogburn, C.D.; Wilcox, H.C.; Sharpe, T.L.; Oh, H.Y.; Nam, B.; Link, B.G. (Journal of Urban Health, 2017)
Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Survey of Police-Public Encounters, a population-based survey of adults (N = 1615) residing in four US cities. Surveys assessed lifetime exposure to police victimization based on the World Health Organization domains of violence (i.e., physical, sexual, psychological, and neglect), using the Police Practices Inventory. Logistic regression models tested for associations between police victimization and (1) past 12-month suicide attempts and (2) past 12-month suicidal ideation, adjusted for demographic factors (i.e., gender, sexual orientation, race/ethnicity, income), crime involvement, past intimate partner and sexual victimization exposure, and lifetime mental illness. Police victimization was associated with suicide attempts but not suicidal ideation in adjusted analyses. Specifically, odds of attempts were greatly increased for respondents reporting assaultive forms of victimization, including physical victimization (odds ratio = 4.5), physical victimization with a weapon (odds ratio = 10.7), and sexual victimization (odds ratio = 10.2). Assessing for police victimization and other violence exposures may be a useful component of suicide risk screening in urban US settings. Further, community-based efforts should be made to reduce the prevalence of exposure to police victimization. © 2017, The New York Academy of Medicine.
Keywords: Aggression; Epidemiology; Police abuse; Sexual assault; Suicide; Violence

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

Amphetamine-Type-Stimulants (ATS) Use and Homosexuality-Related Enacted Stigma Are Associated With Depression Among Men Who Have Sex With Men (MSM) in Two Major Cities in Vietnam in 2014 - Vu, N.T.T.; Holt, M.; Phan, H.T.T.; La, L.T.; Tran, G.M.; Doan, T.T.; Nguyen, T.N.N.; de Wit, J. (Substance Use and Misuse, 2017)
Background: Men who have sex with men (MSM) are disproportionately affected by mental health concerns, including depression. Amphetamine-type-stimulants (ATS) use and homosexuality-related stigma and discrimination have been found associated with depression among MSM. Objectives: To assess the prevalence of depression and its associations with ATS use and homosexuality-related stigma and discrimination among MSM in Vietnam. Methods: 622 MSM were conveniently recruited in Hanoi and Ho Chi Minh city, Vietnam, from September to December 2014. We collected information on demographic characteristics, ATS, alcohol and other drug use, sexual behaviors, homosexuality-related and discrimination stigma, and sexual sensation-seeking. Depression and suicidal thoughts were assessed by the Patient Health Questionnaire (PHQ-9). We assessed associations of depression with ATS use and homosexuality-related stigma and discrimination using logistic regression. Results: Of 622 sampled MSM, 11.3% were classified as having major depression, 9.8% reported any suicidal thoughts in the last two weeks, 30.4% ever had used any ATS, 88.8% ever ad drank alcohol and 21.5% had ever used any other drugs. In multivariate analysis, depression was significantly associated with ATS use (Adjusted Odds Ratio [AOR: 2.20; (95% Confidence Interval (CI): 1.32–3.67], younger age of sexual debut with another man (AOR: 0.09; 95% CI: 0.02–0.50), and greater enacted homosexuality-related stigma (AOR: 1.97; 95% CI: 1.19–3.26). Conclusions: We found a moderate prevalence of depression among sampled MSM, which was associated with ATS use and enacted homosexuality-related stigma. We recommend integrating assessment and interventions regarding depression and methamphetamine use into gay-friendly, culturally adapted holistic HIV prevention for MSM in Vietnam. © 2017 Taylor & Francis Group, LLC.
Keywords: amphetamine-type-stimulants; depression; homosexuality-related stigma and discrimination; Men who have sex with men; Vietnam

Nonsuicidal Self-Injury and Suicidality Among Sexual Minority Youth: Risk Factors and Protective Connectedness Factors - Taliaferro, L.A.; Muehlenkamp, J.J. (Academic Pediatrics, 2017)
Objective We investigated differences in prevalence of repetitive nonsuicidal self-injury (NSSI), suicidal ideation, and a suicide attempt among youth who identified as bisexual, gay/lesbian, and questioning. In addition, we examined which types of social connections were associated with reduced risk of repetitive NSSI and suicidality among youth who identified with a specific sexual minority group. Methods Data came from the 2013 Minnesota Student Survey. The analytic sample included 77,758 students in grades 9 and 11. Connectedness factors included parent connectedness, teacher caring, connectedness to other nonparental adults, school safety, and friend caring. Logistic regression analyses, stratified according to sexual minority group, determined social connectedness factors associated with repetitive NSSI, suicidal ideation, and a suicide attempt, as well as moderating effects of significant connectedness factors on different risk factors (depression, anxiety, bullying, and violence victimization). Results Approximately 3% identified as bisexual or questioning their sexual orientation, and <1% identified as gay/lesbian. Sexual minority youth, particularly bisexual youth, were significantly more likely than heterosexual youth to report repetitive NSSI and suicidality. Effects of connectedness varied across sexual minority groups and outcomes on the basis of types of connections. Parent connectedness emerged as a robust protective factor for all self-harm behaviors across all sexual minority groups. Feeling connected to nonparental adults and safe at school represented additional factors that reduced risk of repetitive NSSI and suicidality among certain groups. Conclusions In addition to facilitating connections between youth and parents, clinicians might consider encouraging sexual minority youth to remain connected to trusted nonparental adults who could offer support and care. Schools might consider implementing sociocultural norms of acceptance, tolerance, and positive identity development to reduce risk of self-harm. © 2016 Academic Pediatric Association
Keywords: connectedness; nonsuicidal self-injury; protective factor; sexual minority; suicide

Young Black Gay/Bisexual and Other Men Who Have Sex With Men: A Review and Content Analysis of Health-Focused Research Between 1988 and 2013 - Wade, R.M.; Harper, G.W. (American Journal of Men's Health, 2017)
Black young gay, bisexual, and other men who have sex with men (YGBMSM) are at high risk for negative health outcomes, though this population is underrepresented in the health literature. An extensive literature review and content analysis of health-related peer-reviewed articles (1988-2013) was conducted that targeted Black YGBMSM, examining five content areas: sexual health, health care, substance use, psychosocial functioning, and sociostructural factors. A coding sheet was created to collect information on all content areas and related subtopics and computed descriptive statistics. Out of 54 articles, most were published after 2004 (N = 49; 90.7%) and addressed some aspect of sexual health (N = 50; 92.6%). Few articles included content on psychosocial functioning, including bullying/harassment, suicide, and racial/ethnic identity. Data on health care delivery/receipt and health insurance were underrepresented; tobacco use and substance abuse were seldom addressed. Important sociostructural factors, including sexual networks and race-based discrimination, were poorly represented. Last, there was a noteworthy deficit of qualitative studies and research exploring intersectional identity and health. This review concludes that studies on Black YGBMSM health places sex at the forefront to the neglect of other critical health domains. More research is needed on the diverse health issues of a vulnerable and underexamined population. © 2015, © The Author(s) 2015.
Keywords: adolescence; behavioral issues; gay health issues; men of color; psychosocial and cultural issues

Erratum: Nonsuicidal Self-Injury and Suicidality Among Sexual Minority Youth: Risk Factors and Protective Connectedness Factors (Academic Pediatrics (2017) 17(7) (715–722) (S1876285916304922)(10.1016/j.acap.2016.11.002)) (Academic Pediatrics, 2017)
In the article by Taliaferro and Muehlenkamp (“Nonsuicidal Self-Injury and Suicidality Among Sexual Minority Youth: Risk Factors and Protective Connectedness Factors” Vol. 17 No. 7, September-October 2017), a statement in the abstract on page 715 is incorrect. The statement “Parent connectedness emerged as a robust protective factor for all self-harm behaviors across all sexual minority groups” should read “Parent connectedness emerged as a robust protective factor for all self-harm behaviors among bisexual and questioning youth.” Also, on page 720, the statement “Perceptions of a safe school environment was particularly protective against NSSI and suicidality among youth who identified as gay/lesbian, which is consistent with other research showing that a supportive social culture can protect against suicide risk.28” incorrectly cites reference28. © 2016 Academic Pediatric Association

Pulse/Second Birth: A Double Bind in Autoethnographic Poetic Response to Tragedy - Whitworth, C. (Qualitative Inquiry, 2017)
Pulse/Second Birth is a poetic response to the Pulse gay club shooting of June, 2016. Following the work modeled by Sandra Faulkner in Poetry as Method (2009), this poem leans into the ways that we may use autoethnographic writing as therapy or sense-making during times of community trauma. Attending to relevant conversations in autoethnography around therapy and aesthetic writing through praxis, the poem reaches towards the hope of queer survival on the horizon. © 2017, © The Author(s) 2017.
Keywords: autoethnography; LGBTQ+; methodology; poetry; trauma

Pulsing - Borchard, K. (Qualitative Inquiry, 2017)
I first learned about the mass shooting at a gay nightclub in Orlando, Florida, through the television. Popular news anchors provided “on the scene” reporting. I saw interviews with officials, with those present at the shooting, and with families and friends of victims. The media narrative unfolded against a visual backdrop of the club, almost always a great distance off, blocked by police cars and tape. I thought hard about that distance. I felt the repetition of the information, the personalization of the event through “selfie” photos of individual victims, and the witness accounts emphasizing the ringing of cell phones in the silence following the rampage. Reporters discussed the killer’s radical politics and his use of social media during his killing spree. Beyond these details of an emergent tragedy, though, was a well-rehearsed, overly familiar narrative frame. A recurring spectacle now grows less and less spectacular. © 2017, © The Author(s) 2017.
Keywords: FL; gun control; LGBTQ; mass shooting; media studies; Orlando

Psychological characteristics of Italian gender dysphoric adolescents: a case–control study - Fisher, A.D.; Ristori, J.; Castellini, G.; Sensi, C.; Cassioli, E.; Prunas, A.; Mosconi, M.; Vitelli, R.; Dèttore, D.; Ricca, V.; Maggi, M. (Journal of Endocrinological Investigation, 2017)
Purpose: Gender dysphoria (GD) is associated with clinically significant distress and impairment in social, scholastic, and other important areas of functioning, especially when early onset is reported. The aim of the present study is to assess the psychopathological features associated with GD in adolescence, comparing a group of gender dysphoric adolescents (GDs) with a group of non-referred adolescents (NRs), in terms of body uneasiness, suicide risk, psychological functioning, and intensity of GD. Methods: A sample of 46 adolescents with GD and 46 age-matched NRs was evaluated (mean ± SD age = 16.00 ± 1.49 and 16.59 ± 1.11 respectively, p > 0.05). Subjects were asked to complete the Body Uneasiness Test (BUT) to explore body uneasiness, the Youth Self Report (YSR) to measure psychological functioning, the Multi-Attitude Suicide Tendency Scale (MAST) for suicide risk, and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) for GD assessment. Results: Adolescents with GD reported significantly higher levels of body uneasiness (BUT-GSI, F = 380.13, p < 0.0001), as well as a worse psychological functioning (YSR, F = 13.06 and p < 0.0001 for “total problem scale” and F = 12.53, p = 0.001 for “internalizing” scale) as compared to NRs. When YSR subscales were considered, GDs showed significantly higher scores in the “withdrawal/depression”, “anxiety/depression”, and “social problems” (all p < 0.0001). In addition, GDs showed significantly higher levels in the “attraction to death” and “repulsion by life” scales and lower scores in the “attraction to life” scale (all p < 0.0001). Finally, GIDYQ-AA score was significantly lower (meaning a higher level of gender dysphoria symptoms) in GDs vs. NRs (p < 0.0001). Conclusions: GD adolescents reported significantly higher body dissatisfaction and suicidal risk compared to NRs. In addition, results confirmed a significant impairment in social psychological functioning in adolescents with GD. © 2017, Italian Society of Endocrinology (SIE).
Keywords: Adolescents; Body uneasiness; Gender dysphoria; Psychological functioning; Suicidal risk

Prevalence and Correlates of Suicidal Ideation Among Transgender Youth in California: Findings From a Representative, Population-Based Sample of High School Students - Perez-Brumer, A.; Day, J.K.; Russell, S.T.; Hatzenbuehler, M.L. (Journal of the American Academy of Child and Adolescent Psychiatry, 2017)
Objective No representative population-based studies of youth in the United States exist on gender identity-related disparities in suicidal ideation or on factors that underlie this disparity. To address this, this study examined gender identity-related disparities in the prevalence of suicidal ideation; evaluated whether established psychosocial factors explained these disparities; and identified correlates of suicidal ideation among all youth and stratified by gender identity. Method Data were derived from the 2013 to 2015 California Healthy Kids Survey (CHKS; N = 621,189) and a weighted subsample representative of the Californian student population (Biennial Statewide California Student Survey [CSS], N = 28,856). Results Prevalence of past 12-month self-reported suicidal ideation was nearly twice as high for transgender compared with non-transgender youth (33.73% versus 18.85%; χ2 = 35.48, p <.001). In fully adjusted models within the representative sample, transgender youth had 2.99 higher odds (95% CI 2.25–3.98) of reporting past-year suicidal ideation compared with non-transgender youth. Among transgender youth, only depressive symptoms (adjusted odds ratio 5.44, 95% CI 1.81–16.38) and victimization (adjusted odds ratio 2.66, 95% CI 1.26–5.65) remained significantly associated with higher odds of suicidal ideation in fully adjusted models. In multiple mediation analyses, depression attenuated the association between gender identity and suicidal ideation by 17.95% and victimization by 14.71%. Conclusion This study uses the first representative population-based sample of youth in the United States that includes a measurement of gender identity to report on gender identity-related disparities in suicidal ideation and to identify potential mechanisms underlying this disparity in a representative sample. © 2017 American Academy of Child and Adolescent Psychiatry
Keywords: gender-identity disparities; LGBT; suicide; youth mental health

The Plight of Veterans - Lutwak, N. (Academic Emergency Medicine, 2017)

The Presence of Self-Stigma, Perceived Stress, and Suicidal Ideation among Selected LGBT Filipinos - Reyes, M.E.S.; Davis, R.D.; Dacanay, P.M.L.; Antonio, A.S.B.; Beltran, J.S.R.; Chuang, M.D.; Leoncito, A.L.I. (Psychological Studies, 2017)
Minority group members experience what is known as “minority stress,” by which individuals suffer stress because of their membership in stigmatized social categories. In turn, minority stress may lead to self-stigmatization. This occurs when minority group members experience a sense of shame created by the view of the majority culture and then incorporate the majority opinion into their self-image. Because it is cumulative with the stress an individual is already experiencing, self-stigmatization may become a significant stressor itself, possibly contributing to the development of suicidal ideation. A total of 609 self-identified LGBT individuals were asked to answer a battery of psychological tests to assess the interrelationships between self-stigma, perceived stress, and suicidal ideation. As expected, perceived stress predicted suicidal ideation, whereas self-stigmatization predicted both perceived stress and suicidal ideation. Structural equation modeling confirms the predictive value of self-stigma together with perceived stress in determining the suicidal ideation present among LGBT Filipinos. Self-stigma exerted a direct effect upon suicidal ideation not accounted for by perceived stress. © 2017, National Academy of Psychology (NAOP) India.
Keywords: LGBT Filipinos; Perceived stress; Self-stigma; Suicidal ideation

Here/In This Issue and There/Abstract Thinking: The Growing, and Changing, Landscape of Child and Adolescent Mental Healthcare Delivery - Hong, D.S. (Journal of the American Academy of Child and Adolescent Psychiatry, 2017)

Major depressive disorder, suicidal thoughts and behaviours, and cannabis involvement in discordant twins: a retrospective cohort study - Agrawal, A.; Nelson, E.C.; Bucholz, K.K.; Tillman, R.; Grucza, R.A.; Statham, D.J.; Madden, P.A.; Martin, N.G.; Heath, A.C.; Lynskey, M.T. (The Lancet Psychiatry, 2017)
Background Early and frequent cannabis use are associated with an increased likelihood of major depressive disorder (MDD) as well as suicidal thoughts and behaviours. We identify associations between aspects of cannabis use, MDD, and suicidal thoughts and behaviours and examine whether such associations persist after accounting for those predisposing factors, including genetic liability and early family environment, that are shared by identical twins who are discordant for cannabis exposure. Any residual association in such identical pairs might be indicative of individual-specific pathways that might be of a causal nature. Methods We did a logistic regression analysis of cannabis use from retrospective data on same-sex male and female twin pairs drawn from 3 studies that had recruited twins from the Australian Twin Registry, 1992–93 (sample 1), 1996–2000 (sample 2), and 2005–09 (sample 3). We studied associations between early use and frequent use of cannabis and MDD, suicidal ideation (ever and persistent), and suicide plan and attempt in the full sample as well as in pairs of monozygotic and dizygotic twins that were discordant for each measure of cannabis involvement at a single timepoint. Significant monozygotic associations were further adjusted for covariates, such as early alcohol or nicotine use, early dysphoric or anhedonic mood, conduct disorder, and childhood sexual abuse. Interactions between each cannabis measure and sex, sample or study effects, and birth year category were also examined as covariates. Findings In 13 986 twins (6181 monozygotic and 7805 dizygotic), cannabis use ranged from 1345 (30·4%) of 4432 people in sample 1 to 2275 (69·0%) of 3299 in sample 3. Mean age of first cannabis use ranged from 17·9 years (SD 3·3) in sample 3 to 21·1 years (5·2) in sample 1, and frequent use (≥100 times) was reported by 214 (15·9%) of 1345 users in sample 1 and 499 (21·9%) of 2275 in sample 3. The prevalence of suicidal ideation ranged from 1102 (24·9%) of 4432 people in sample 1 to 1644 (26·3%) of 6255 people in sample 2 and 865 (26·2%) of 3299 people in sample 3. Prevalence of MDD ranged from 901 (20·3%) people in sample 1 to 1773 (28·3%) in sample 2. The monozygotic twin who used cannabis frequently was more likely to report MDD (odds ratio 1·98, 95% CI 1·11–3·53) and suicidal ideation (2·47, 1·19–5·10) compared with their identical twin who had used cannabis less frequently, even after adjustment for covariates. For early cannabis use, the monozygotic point estimate was not significant but could be equated to the significant dizygotic estimate, suggesting a possible association with suicidal ideation. Interpretation The increased likelihood of MDD and suicidal ideation in frequent cannabis users cannot be solely attributed to common predisposing factors. Funding National Institute on Drug Abuse, National Institutes of Health, Australian National Health and Medical Research Council. © 2017 Elsevier Ltd

Factor associated with risky sexual behaviors among the French general population - Sicard, S.; Mayet, A.; Duron, S.; Richard, J.-B.; Beck, F.; Meynard, J.-B.; Deparis, X.; Marimoutou, C. (Journal of Public Health (United Kingdom), 2017)
Background Despite prevention programs, a rising incidence of sexually transmitted infections is currently reported in France. Aims Research factors associated with risky sexual behaviors (RSBs) among the French population. Methods Subjects aged 15-54 years from the French national survey 'Baromètre santé 2010' were included (n ¼ 16 598). RSB was defined as having multiple partners or failure to use condom at first intercourse with a new partner over past 12 months. Factors associated were identified using one logistic regression by gender. Results The overall RSB prevalence was 9.5%, being higher among men (P, 0.001). Factors associated with RSB for both genders were young age (OR ¼ 1.5), single status (men: OR ¼ 7.1; women: OR ¼ 6.4), homosexual relations (men: OR ¼ 2.0; women: OR ¼ 3.2), low incomes (men: OR ¼ 1.5; women: OR ¼ 1.4), use of cannabis (men: OR ¼ 1.4; women: OR ¼ 3.0). Men-specific factors were history of STI (OR ¼ 2.5) and alcohol drunkenness (OR ¼ 2.2), and women-specific factors history of suicide attempt (OR ¼ 1.6) and history of sexual assault (OR ¼ 1.6). Conclusions Confirming most of known determinants of RSB, this study also identified some specific risky patterns for whom preventive actions can be developed: multiusers of psychoactive substances, people living with low incomes, women having sex with women or presenting history of psychological vulnerability (suicide attempts, sexually harassed). © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
Keywords: Polysubstance use; Precariousness; Psychosocial vulnerability; Risky sexual behaviors; Sexually transmitted infections

Harassment and Mental Distress Among Adolescent Female Students by Sexual Identity and BMI or Perceived Weight Status - Johns, M.M.; Lowry, R.; Demissie, Z.; Robin, L. (Obesity, 2017)
Objective: Sexual minority girls (lesbian/bisexual) and girls with overweight/obesity experience high rates of discrimination and mental distress. This study explored whether BMI or perceived weight status might compound sexual minority girls’ risk for harassment and mental distress. Methods: Data on female students from the national 2015 Youth Risk Behavior Survey (n = 7,006) were analyzed. Logistic regression was used to examine differences in bullying, harassment, and mental distress across sexual identity/BMI groups: heterosexual/normal-weight, heterosexual/overweight, sexual minority/normal-weight, and sexual minority/overweight. Procedures were repeated with four analogous groups created from sexual identity and perceived weight. Results: Across sexual identity/BMI groups, being overweight increased heterosexual females’ odds of being bullied or experiencing suicidal thoughts and behaviors. Regardless of weight status, sexual minority females had greater odds for each outcome than heterosexual females. Sexual minority females who perceived themselves as overweight had greater odds of suicidality than all other sexual minority/perceived weight groups. Conclusions: Double jeopardy may exist for sexual minority female students who perceive themselves as overweight. Professional development with school staff on how to create a positive climate for sexual minorities and those with overweight/obesity and addressing positive identity and body image within school-based suicide prevention efforts may be important to the well-being of adolescent girls. © 2017 The Obesity Society

The Case of Abel: Religion as Boon and Bane for a Catholic Gay Man - Cerbone, A.R.; Danzer, G. (Journal of Clinical Psychology, 2017)
Conservative religions that condemn homosexual sexual orientation and acts as unnatural and sinful pose significant challenges for gay persons whose faith is a core part of their identity. The condemnation presents a serious barrier to the acceptance and integration of their sexuality, a primary task of psychosexual development. As a result, they can manifest depression, anxiety, suicidal ideation, and even suicide attempts. The ecclesiastical censure also imposes an untenable dilemma for homosexuals in that they feel pressed to reject their sexual identity or renounce their spiritual identity and heritage. Psychotherapists who treat gay persons caught in this quandary can find themselves facing a similar problem: how to help their homosexual client reconcile their proscribed sexuality with their spiritual commitments. The case presented here recounts the treatment over many years of a gay man suffering from such a conflict and his eventual accommodation of both his homosexuality and his faith. Recommendations are offered for constructive treatment with those torn between two conflicting core identities. © 2017 Wiley Periodicals, Inc.
Keywords: gay; homosexuality; psychotherapy; religion; spirituality

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

Something old and something blue - Something for everyone, me and you? - Mulder, R. (Australian and New Zealand Journal of Psychiatry, 2017)

Suicidality, Self-Harm, and Body Dissatisfaction in Transgender Adolescents and Emerging Adults with Gender Dysphoria - Peterson, C.M.; Matthews, A.; Copps-Smith, E.; Conard, L.A. (Suicide and Life-Threatening Behavior, 2017)
Prevalence of suicide attempts, self-injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty-seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self-injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female-to-male youth reported a history of suicide attempts and self-harm behaviors than male-to-female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life-threatening behaviors. © 2016 The American Association of Suicidology

Physical and/or sexual abuse is associated with increased psychological and emotional distress among transgender women - Kussin-Shoptaw, A.L.; Fletcher, J.B.; Reback, C.J. (LGBT Health, 2017)
Purpose: Transgender women have consistently reported elevated rates of lifetime physical and sexual abuse. This study examined the associations between reported physical and/or sexual abuse and symptoms of psychological and emotional distress among a sample of urban, high-risk transgender women. Methods: From June 2005 through July 2012, 99 transgender women enrolled in a Comprehensive Risk Counseling and Services program in Hollywood, CA. Seemingly unrelated regression equations (SURE) were used to simultaneously regress psychiatric symptom reports on participant sociodemographic characteristics and self-reported history of physical/sexual abuse. Results: Participants were African American/Black (33.3%), Caucasian/White (28.3%), or Hispanic/Latina (24.2%). Average age was 35 years (standard deviation [SD] = 9), and 37.4% of participants self-reported an HIV-positive status. Most (84.9%) participants reported experiencing physical or sexual abuse at some point in their lifetime, and symptoms of psychological and emotional distress (as measured by the Brief Symptom Inventory) among those who reported abuse were more severe than those observed in cisgender psychiatric in-patient populations. After controlling for participant sociodemographics, prior experience of physical and/or sexual abuse was associated with significantly increased psychological and emotional distress across all measured symptom domains except psychoticism [χ2(9) = 17.56; p < 0.05]. Conclusion: Given these associations as well as the high prevalence of physical and/or sexual abuse among transgender women, mental health professionals and social service providers working with this population should be sensitive to the abuse history and mental health needs of the transgender women with whom they work. © Mary Ann Liebert, Inc. 2017.
Keywords: mental health; physical abuse; sexual abuse; suicide; transgender women

The prevalence of psychiatric distress and associated risk factors among college students using GHQ-28 questionnaire - Poorolajal, J.; Ghaleiha, A.; Darvishi, N.; Daryaei, S.; Panahi, S. (Iranian Journal of Public Health, 2017)
Background: Adolescent and young adults are at increased risk of psychiatric distress and serious disability. We estimated the prevalence and associated risk factors of psychiatric distress among the college students of Hamadan University of Medical Sciences, Iran. Methods: We performed this cross-sectional study, from Jan to May 2016 at Hamadan University of Medical Sciences, Hamadan, Iran. Students filled out voluntarily an anonymous self-administered questionnaire, including demographic characteristics, personal information, behavioral risk factors, and a validated Persian version of the GHQ-28 questionnaire, including somatic symptoms (items 1-7), anxiety/insomnia (items 8-14), social dysfunctions (items 15-21), and severe depression (items 22-28). Results: Of 1259 participants, 518 (41.1%) had psychiatric distress, 166 (13.2%) had heterosexual intercourse, 100 (8.0%) had homosexual intercourse, 204 (16.2%) were smokers (31.6% in males and 6.3% in females), 124 (9.9%) reported a history of using opium/psychedelic substances, 204 (16.2%) reported suicide thought, and 103 (8.2%) had attempted suicide at least once in the past. After adjusting odds ratio (95% CI) for age and sex, psychiatric distress were significantly associated with emotional breakdown 2.67 (2.09, 3.40), heterosexual intercourse 2.56 (1.82, 3.62), homosexual intercourse 2.42 (1.57, 3.71), smoking 3.19 (2.29, 4.45), substance abuse 5.03 (3.26, 7.76), suicide thought 7.81 (5.42, 11.27), suicide attempt 5.64 (3.49, 9.12), uninterested in the discipline 2.29 (1.70, 3.07), and non-optimistic about future 2.16 (1.63, 2.86). Conclusion: A majority of college students had psychiatric distress and a substantial number of them reported one or more high-risk behaviors that if neglected, may severely impair the students' function and influence their subsequent development and productive lives. © 2017, Iranian Journal of Public Health. All rights reserved.
Keywords: Mental disorders; Smoking; Substance-related disorders; Suicide; Unsafe sex

The Relationship between Sexual Minority Status and Suicidal Ideations among Urban Hispanic Adolescents - Lardier Jr, D.T.; Bermea, A.M.; Pinto, S.A.; Garcia-Reid, P.; Reid, R.J. (Journal of LGBT Issues in Counseling, 2017)
Youth identifying as lesbian, gay, bisexual, transgender, and queer (LGBTQ), and more specifically Hispanic youth identifying as LGBTQ, experience suicidal ideation (SI) at disproportionate rates. Furthermore, adolescents identifying as LGBTQ are likely to experience high rates of bullying, depression, and limited social support, increasing SI. Counselors often have difficulty working with youth at the intersection of sexual and ethnic minority statuses. Using structural equation modeling techniques, the present study examined sexual minority status as a predictor of school bullying, depression, social support, and SI, among urban Hispanic youth (N = 538). The authors also tested social support as a buffering mechanism. © 2017 Taylor & Francis Group, LLC.
Keywords: Bullying; Hispanic urban adolescents; sexual minorities; social support; suicidal ideation

Re-tailoring Can Themba’s “The Suit”: Queer Temporalities in Two Stories by Makhosazana Xaba - Stobie, C. (Current Writing, 2017)
Can Themba’s iconic story, “The Suit” (1963), tells of a devastating punishment visited upon an adulterous wife, Matilda, by her husband, Philemon. This article begins by examining some implications of Themba’s story and touching on subsequent adaptations that have re-imagined this haunting tale from various perspectives. I then move on to consider two stories by Makhosazana Xaba (2013) which add significant elements to the original fable. “Behind ‘The Suit’” is written in epistolary form by Philemon’s dying male lover to his daughter, thus queering the narrative. “‘The Suit’ Continued: The Other Side” is recounted in first-person narration by Matilda, after her suicide. It delineates the affair between Matilda and another woman, and their plan to have a baby, adding further queer temporalities. Citing theorists of queer and bisexual temporalities, I provide a close reading of the effects Xaba creates in her re-fashionings of Themba’s Ur-text. I argue that both stories critique hetero-patriarchy; they queer marriage, procreation, Sophiatown, black communities and the South African nation; and they contribute meaningfully to postcolonial queer writing and reading. © 2017 The Editorial Board, Current Writing.
Keywords: Can Themba; Makhosazana Xaba; postcolonialism; queer temporalities; re-visioning; “The Suit”

Archetypal Hatred: Orlando Consciousness - Gleason, B. (Psychological Perspectives, 2017)
The massacre at the gay nightclub Pulse in Orlando, Florida, which killed 49 and wounded 53 people on June 12, 2016, has been termed a terrorist act, another example of the rampant issue of gun control in America, and, of course, a tragedy. It has also been called a hate crime, but most media and other commentary have shied away from a focus on the gay aspect. This article focuses on why the gay community seemed specifically targeted, and what that intentionality represents from a Jungian perspective. Jung's essay on Wotan (a god in Germanic mythology), with a focus on the archetypal underpinnings of Nazi Germany, as well as his thoughts on taboo, specifically relationship taboo in tribal cross-cousin marriages explored in Aion, are examined in an attempt to underscore the importance of an underlying hatred and hostility toward gay men that existed in the unconscious of the shooter, and which may exist in the culture at large. Backlashes from religious groups that occur as gay rights are extended, as well as specific hate crimes like the Orlando shooting, point toward this underlying hostility toward gay men. This hostility is part of a dangerous unconsciousness suffered by the so-called modern world, a reminder of the thin veil of civility we live under: vulnerable, in moments like Orlando, or in larger contexts such as Nazi Germany, to explosion in the form of massacre, despotism, and other tragic and hideous manifestations. © 2017, Copyright © C. G. Jung Institute of Los Angeles.

Screening for depression among youth with HIV in an integrated care setting - Walsh, A.S.J.; Wesley, K.L.; Tan, S.Y.; Lynn, C.; O’Leary, K.; Wang, Y.; Nguyen, D.; Chenneville, T.; Rodriguez, C.A. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2017)
Youth living with HIV (YLWH) are at risk for depression. Depressive symptoms can impact treatment engagement, health outcomes, and quality of life. Early identification of symptoms can guide treatment planning. This study aimed to identify trends in depressive symptoms for YLWH in a specialty-care clinic and follow-up clinical treatment procedures. An archival review of a clinical database provided depression screening information for a sample of 130 YLWH between 11 and 25 years old in the southeastern United States. Findings indicated that approximately 24% of the sample screened positive for depression-risk. Most commonly endorsed symptoms included fatigue (54.3%) and sleep difficulties (48.5%). Depressive symptoms did not differ significantly by age, gender, race, ethnicity, or sexual orientation. Youth who acquired HIV behaviorally were more likely to endorse the critical item (i.e., self-harm and/or suicidal ideation) than youth who acquired HIV perinatally. Forty-percent of the sample (i.e., 51 youth) had a follow-up treatment plan. YLWH who endorsed the critical item were more likely to receive follow-up action when compared to those who did not endorse the item. Despite limitations of the study, findings have important implications for clinical care and future research. © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: depression; HIV; mental health; screening; Youth

The 2015 National Canadian Homeless Youth Survey: Mental Health and Addiction Findings - Kidd, S.A.; Gaetz, S.; O'Grady, B. (Canadian Journal of Psychiatry, 2017)
Objective: This study was designed to provide a representative description of the mental health of youth accessing homelessness services in Canada. It is the most extensive survey in this area to date and is intended to inform the development of mental health and addiction service and policy for this marginalized population. Methods: This study reports mental health-related data from the 2015 "Leaving Home" national youth homelessness survey, which was administered through 57 agencies serving homeless youth in 42 communities across the country. This self-reported, point-in-time survey assessed a broad range of demographic information, pre-homelessness and homelessness variables, and mental health indicators. Results: Survey data were obtained from 1103 youth accessing Canadian homelessness services in the Nunavut territory and all Canadian provinces except for Prince Edward Island. Forty-two per cent of participants reported 1 or more suicide attempts, 85.4% fell in a high range of psychological distress, and key indicators of risk included an earlier age of the first episode of homelessness, female gender, and identifying as a sexual and/or gender minority (lesbian, gay, bisexual, transgender, queer, and 2 spirit [LGBTQ2S]). Conclusions: This study provides clear and compelling evidence of a need for mental health support for these youth, particularly LGBTQ2S youth and female youth. The mental health concerns observed here, however, must be considered in the light of the tremendous adversity in all social determinants faced by these youth, with population-level interventions best leveraged in prevention and rapid response. © Canadian Psychiatric Association.
Keywords: addictions; Canada; homeless adolescent; homeless youth; mental health; mental illness; national; street youth

High acceptability of rapid HIV self-testing among a diverse sample of MSM from Buenos Aires, Argentina - Pando, M.A.; Dolezal, C.; Marone, R.O.; Barreda, V.; Carballo-Diéguez, A.; Avila, M.M.; Balán, I.C. (PLoS ONE, 2017)
Introduction The objective of this study was to explore the acceptability of rapid HIV self-testing (RHST) among men who have sex with men (MSM). Methods During 2006–2009, a sample of 500 MSM was recruited through Respondent Driven Sampling for an HIV prevalence/incidence study. Attitude toward RHST was explored among HIV negative MSM. Data were weighted prior to analyses. Results Participants reported they were likely to buy RHST (74%), test themselves more frequently than they currently do (77%), and that the procedure would simplify testing (70%). Furthermore, 71% reported they would probably use it alone, 66% would use it with a steady partner, and 56% with a friend/partner. While a majority acknowledged that RHST use would deprive them of receiving counseling (61%), 74% declared they would go for help if they tested positive; 57% would use an RHST in order to avoid condoms. Probability of use surpassed 70% among gay and non-gay identified MSM as well as those with and without a previous HIV test. Those likely to buy RHST were older (p = 0.025) and more likely to identify as gay (p = 0.036). A total of 17% said they would think about killing themselves and 9% would attempt suicide if they tested positive. These MSM were more likely to be younger (p<0.001), with lower mood level (p<0.001) and greater feelings of loneliness (p = 0.026). Conclusions The high acceptability of RHST found among MSM should encourage the authorities to consider the possibility of offering it for self-testing, as it can improve early diagnosis and prevention of future transmissions. However, further research is needed to understand how to best disseminate RHST among MSM who wish to use it and to offer support and linkage to care for those who test HIV-positive. © 2017 Pando et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Pathways to Suicide in Lesbian and Gay Populations in Australia: A Life Chart Analysis - Skerrett, D.M.; Kõlves, K.; De Leo, D. (Archives of Sexual Behavior, 2017)
Given the continued paucity of research into suicide in lesbian and gay (LG) people, there is a need to investigate the characteristics of those LG suicides that are able to be identified. The aim of this article was to analyze pathways to suicide in lesbian and gay individuals by way of life charts. Data were gathered through of 24 psychological autopsy interviews with next-of-kin of an LG person who had died by suicide. The female (n = 5) and male (n = 19) cases in this study clustered into younger and older suicides. The defining feature of the younger suicides was lack of acceptance by family and, to a lesser extent, self, and that of the older suicides was romantic relationship conflict, although this was also common in younger suicides. There appears to have been, furthermore, an accumulation of risk factors, particularly in the period prior to death where these specific risk factors combined with other life stressors, such as work problems. Initiatives to reduce stigma around diversity in sexuality and to support families and young people through the “coming out” process as well as services designed to assist those experiencing problems in same-sex relationships, in particular, would appear to be the most relevant within the trajectories presented. © 2016, Springer Science+Business Media New York.
Keywords: Gay; Lesbian; Psychological autopsy; Risk factors; Sexual orientation; Suicide

Internal Medicine Resident Attitudes, Prior Education, Comfort, and Knowledge Regarding Delivering Comprehensive Primary Care to Transgender Patients - Johnston, C.D.; Shearer, L.S. (Transgender Health, 2017)
Transgender patients face a multitude of health disparities and often a lack of understanding by healthcare professionals. A survey was undertaken of internal medicine residents in a large urban academic training program to determine prior education, attitudes, comfort, and knowledge in providing care for transgender individuals in a primary care setting. Total N=67 respondents (52% of those eligible). A full 97% of residents believe transgender medical issues are relevant to their practice, but only 45% had prior education about the care of transgender patients. Less than one-third of respondents felt comfortable describing hormonal/surgical therapy options or referring to another physician to meet these patient needs. HIV, gonorrhea, and chlamydia risk was underestimated for the trans woman population. Most medical residents did not feel up to date with screening guidelines. In contrast, most residents correctly identified higher rates of depression/suicidality in transgender individuals, as well as lower adherence to human papillomavirus screening recommendations for trans men. © Copyright 2017, Mary Ann Liebert, Inc.
Keywords: health maintenance; medical education; primary care

Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults - Katz-Wise, S.L.; Reisner, S.L.; White Hughto, J.M.; Budge, S.L. (Archives of Sexual Behavior, 2017)
This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and 95 % confidence intervals to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all ps <.05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals. © 2016, Springer Science+Business Media New York.
Keywords: Gender minority; Mental health; Sexual fluidity; Sexual orientation; Transgender

Varied reports of adult transgender suicidality: Synthesizing and describing the peer-reviewed and gray literature - Adams, N.; Hitomi, M.; Moody, C. (Transgender Health, 2017)
Purpose: This article reports on the findings of a meta-synthesis undertaken on published gray transgender suicidality literature, to determine the average rate of suicidal ideation and attempts in this population. Methods: Studies included in this synthesis were restricted to the 42 that reported on 5 or more Canadian or U.S. adult participants, as published between 1997 and February 2016 in either gray or peer-reviewed health literature. Results: Across these 42 studies an average of 55% of respondents ideated about and 29% attempted suicide in their lifetimes. Within the past year, these averages were, respectively, 51% and 11%, or 14 and 22 times that of the general public. Overall, suicidal ideation was higher among individuals of a male-to-female (MTF) than female-to-male (FTM) alignment, and lowest among those who were gender non-conforming (GNC). Conversely, attempts occurred most often among FTM individuals, then decreased for MTF individuals, followed by GNC individuals. Conclusion: These findings may be useful in creating targeted interventions that take into account both the alarmingly high rate of suicidality in this population, and the relatively differential experience of FTM, MTF, and GNC individuals. Future research should examine minority stress theory and suicidality protection/resilience factors, particularly transition, on this population. © Mary Ann Liebert, Inc. 2017.
Keywords: marginalization; suicide; transgender

Depression and Suicidality in Gay Men: Implications for Health Care Providers - Lee, C.; Oliffe, J.L.; Kelly, M.T.; Ferlatte, O. (American Journal of Men's Health, 2017)
Gay men are a subgroup vulnerable to depression and suicidality. The prevalence of depression among gay men is three times higher than the general adult population. Because depression is a known risk factor for suicide, gay men are also at high risk for suicidality. Despite the high prevalence of depression and suicidality, health researchers and health care providers have tended to focus on sexual health issues, most often human immunodeficiency virus in gay men. Related to this, gay men’s health has often been defined by sexual practices, and poorly understood are the intersections of gay men’s physical and mental health with social determinants of health including ethnicity, locale, education level, and socioeconomic status. In the current article summated is literature addressing risk factors for depression and suicidality among gay men including family acceptance of their sexual identities, social cohesion and belonging, internalized stigma, and victimization. Barriers to gay men’s help seeking are also discussed in detailing how health care providers might advance the well-being of this underserved subgroup by effectively addressing depression and suicidality. © 2017, © The Author(s) 2017.
Keywords: depression; gay men’s health; men’s health; men’s help seeking; suicidality

Adverse childhood experiences and suicide attempts among those with mental and substance use disorders - Choi, N.G.; DiNitto, D.M.; Marti, C.N.; Segal, S.P. (Child Abuse and Neglect, 2017)
Using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions data, we examined the associations of ten types of adverse childhood experiences (ACEs) with (1) lifetime suicide attempts and (2) number and age of attempts among U.S. adults aged 18+. In a case-control design, suicide attempters (5.14% of the full sample) were matched with never attempters (matched sample N = 3912) on nine mental and substance use disorders. ACE rates were higher among attempters (3.30 [SE = 0.07]) than their matched controls (2.19 [SE = 0.06]). Results from multivariable logistic regression analyses showed that sexual abuse and parental/other family member's mental illness were associated with increased odds of having attempted suicide among both genders, and emotional neglect was also a factor for men. Population attributable risk fractions for sexual abuse were 25.75% for women and 8.56% for men. Sexual abuse and a higher number of ACEs were also related to repeated suicide attempts. A higher number of ACEs was associated with a younger first attempt age. Gay/bisexual orientation in men and the lack of college education in both genders were significant covariates. In conclusion, this study underscores that ACEs are significantly associated with lifetime suicide attempts even when mental and substance use disorders are controlled. © 2017 Elsevier Ltd
Keywords: Adverse childhood experiences; Mental disorders; Sexual abuse; Substance use disorders; Suicide attempts

Transgender Noninclusive Healthcare and Delaying Care because of Fear: Connections to General Health and Mental Health among Transgender Adults - Seelman, K.L.; Colón-DIaz, M.J.P.; Lecroix, R.H.; Xavier-Brier, M.; Kattari, L. (Transgender Health, 2017)
Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base. Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health. Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B=-0.26, p<0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation (p<0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health. Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare. © Kristie L. Seelman et al. 2017; Published by Mary Ann Liebert, Inc. 2017.
Keywords: discrimination; health; healthcare; mental health; minority stress model; transgender

Comprehensive Screening for Suicide Risk in Primary Care - Diamond, G.S.; Herres, J.L.; Krauthamer Ewing, E.S.; Atte, T.O.; Scott, S.W.; Wintersteen, M.B.; Gallop, R.J. (American Journal of Preventive Medicine, 2017)
Introduction Suicide is a major public health problem and a complex clinical challenge. Assessment and early identification could be enhanced with screening tools that look beyond depression. The purpose of this study was to identify profiles of risk behaviors and social stress associated with suicidal ideation and behavior using the Behavioral Health Screen. Methods The study used screening data from 2,513 primary care patients (aged 14–24 years). Data were collected between 2008 and 2012, and were analyzed in 2016. Results Latent class analysis identified a high and low risk profile. Domains of primary influence included substance use, sexual assault, same-sex behavior, and unsafe sex. The high-risk group was 11 times more likely to have made a suicide attempt, five times more likely to report a history of suicidal ideation and behavior, and three times more likely to report recent suicidal ideation and behavior. Conclusions Risk behaviors and social stress contribute to the risk for suicide above and beyond depression and should be assessed during routine primary care visits with adolescents. The Behavioral Health Screen can screen all these domains and thus assist primary care providers in assessing for both psychiatric and social stress factors associated with youth suicide. © 2017 American Journal of Preventive Medicine

Implications of Genital Mutilation at Autopsy - Byard, R.W. (Journal of Forensic Sciences, 2017)
Given the potential significance of mutilation of the external genitalia in medicolegal fatalities, a review of the literature was undertaken to identify subcategories. Such mutilations may have been sustained sometime before death, around the time of death, or after death. The most common type of ante mortem genital mutilations involves cultural practices such as male circumcision. Less common male mutilations such as subincisions are tribally based. Female genital mutilation is found particularly in African, Middle Eastern, or Asian populations. Self-inflicted genital injuries are most common in males and may be related to attempts at suicide, or to self-harming practices. The latter have a strong association with psychiatric illnesses. Postmortem injuries may arise from animal predation or deliberate mutilation of a corpse. The latter may be associated with ante mortem genital injuries in sadistic homicides. The range of possible causes of genital mutilations in forensic cases necessitates extremely careful evaluation. © 2017 American Academy of Forensic Sciences
Keywords: animal predation; female genital mutilation; forensic science; genital mutilation; psychosis; sadistic homicide; suicide

LGBTQ Student Victimization and Its Relationship to School Discipline and Justice System Involvement - Palmer, N.A.; Greytak, E.A. (Criminal Justice Review, 2017)
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) students experience higher rates of school-based victimization than their peers, and this victimization contributes to higher risk of suicide, substance misuse, mental disorder, and unsafe sexual experiences. In addition, these experiences may increase LGBTQ students’ interactions with school authorities and, subsequently, increase their risk of school discipline and involvement in the justice system. Using a sample of 8,215 LGBTQ middle and high school students in the United States surveyed online in 2015, this article explores the relationships between peer victimization and higher school disciplinary and justice system involvement among LGBTQ youth. Results indicate that LGBTQ youth who are victimized at school experience greater school discipline, including disciplinary referrals to school administration, school detention, suspension, and expulsion; and greater involvement in the justice system as a result of school discipline, including arrest, adjudication, and detention in a juvenile or adult facility. Moreover, school staff responses to victimization partially explain this relationship: Students reporting that staff responded to victimization in a discriminatory or unhelpful fashion experienced higher rates of school discipline and justice system involvement than those reporting that staff responded more effectively. Schools must confront pervasive anti-LGBTQ victimization and ineffective or biased responses from school staff to reduce unnecessary disciplinary involvement. © 2017, © 2017 Georgia State University.
Keywords: exclusionary discipline; gender minority; school-to-prison pipeline; sexual minority

Mental health inequalities among gay and bisexual men in England, Scotland and Wales: A large community-based cross-sectional survey - Hickson, F.; Davey, C.; Reid, D.; Weatherburn, P.; Bourne, A. (Journal of Public Health (United Kingdom), 2017)
Background Sexual minorities suffer worse mental health than the sexual majority but little is known about differences in mental health within sexual minorities. We aimed to describe inequality in mental health indicators among gay and bisexual men. Methods Using multi-channel community-based opportunistic sampling we recruited 5799 eligible men aged 16 years and over, living in England, Scotland and Wales and who were sexually attracted to other men, to a self-completion Internet health survey. Mental health indicators (depression (PHQ-9), anxiety (GAD-7), suicide attempt and self-harm) were examined for independent associations across common axes of inequality (age, ethnicity, migrancy, education, income, cohabitation and living in London). Results Mental ill-health was common: 21.3% were depressed and 17.1% anxious, while 3.0% had experienced attempted suicide and 6.5% had self-harmed within the last 12 months. All four indicators were associated with younger age, lower education and lower income. Depression was also associated with being a member of visible ethnic minorities and sexual attraction to women as well as men. Cohabiting with a male partner and living in London were protective of mental health. Conclusion Community interventions to increase mental health among gay and bisexual men should be designed to disproportionately benefit younger men and those living on lower incomes. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
Keywords: gender; mental health; social determinants

Towards Bi-Inclusive Policies: Suggestions Based on Research on Dutch Same-Sex Attracted Young People - van Lisdonk, J.; Keuzenkamp, S. (Sexuality Research and Social Policy, 2017)
Dutch national LGBT policies are not bi-inclusive and this study provides suggestions for improvement, based on empirical research. Attention for bisexuality in policy appears simply to pay lip service and to endorse the construction of sexual orientation as a hetero/homo binary. The outcomes of our survey (n = 1449) and in-depth interviews (n = 38) of Dutch same-sex attracted young people suggest that special attention for bisexual people is warranted. Compared to exclusively same-sex attracted participants, the equally both-sex attracted participants scored worse on openness about their sexual attraction, visibility discomfort, perceived acceptance, and suicide attempts. Unique issues for bisexual-identified young people were identified as follows: marginalization of bisexuality; difficulty expressing bisexuality, particularly in relationships; and a lack of bisexual or bi-inclusive communities. These issues were all related to the hetero/homo binary and mononormativity. Suggested implications for more bi-inclusive policies focus on awareness of marginalization and invisibility of bisexuality, biphobia, community and capacity building, and comprehensive sexuality and gender education. Furthermore, rather than policies focusing on sameness, a comprehensive diversity perspective on sexuality and gender offers more space for bisexuality. This may be particularly relevant for young people who are exploring their sexuality and developing a sense of their sexual self. © 2016, The Author(s).
Keywords: Biphobia; Bisexuality; Diversity; Equality; LGBT; LGBT policy; Mononormativity; Netherlands; Same-sex sexuality; Sexual diversity; Sexual orientation; Youth

Hidden Rainbows: Gay Bars as Safe Havens in a Socially Conservative Area Since the Pulse Nightclub Massacre - Croff, J.M.; Hubach, R.D.; Currin, J.M.; Frederick, A.F. (Sexuality Research and Social Policy, 2017)
Gay and lesbian bars are considered a safe haven. Safe havens exist because of the larger cultural environment that makes safe places necessary. Some communities have noted reductions in the need for gay and lesbian bars due to growing acceptance within the community. However, many states and communities within the South and Bible Belt continue to propose and pass bills which target or restrict the freedoms of LGBT persons. These cultural overtones may support or encourage targeted violence, including the Pulse Nightclub Massacre which was the deadliest incidence of violence targeted at LGBT persons in the USA. This manuscript presents two studies: one at gay bars in Tulsa, Oklahoma, a socially conservative city/state, and the other examines four US communities following the Pulse Nightclub Massacre. Study 1 included interviews at entrance to the bar, exit from the bar, and within a week of leaving the bar in order to identify feelings of safety and comfort. Study 2 seeks to compare gay bar attendance and feelings of comfort and safety in gay bars in regions of the USA with varying structural stigma. Results of study 1 suggest that the participants felt safe (82.4%, n = 42) and comfortable (72.5%, n = 37). In study 2, individuals from Tulsa, Oklahoma were compared to individuals in New York and the DC metro area and were significantly less likely to attend gay bars after the Pulse shooting (t = 2.53 and 3.66, p ≤ 0.01 and p ≤ 0.001, respectively). Moreover, compared to individuals living in the DC metro area and Philadelphia, participants residing in the city in a conservative state felt significantly less safe attending gay bars (t = −2.03 and −2.30, respectively; p ≤ 0.05). No differences across the communities were noted by comfort within the gay bar space. In light of a changing political landscape, additional programming efforts may be necessary at gay bars in communities with high structural stigma. These efforts may include supporting the naturally occurring feelings of community connectedness and facilitating community building. © 2017, Springer Science+Business Media New York.
Keywords: Community participatory research; Gay; Gay bar; Prevention

Mental Health Concerns and Insurance Denials among Transgender Adolescents - Nahata, L.; Quinn, G.P.; Caltabellotta, N.M.; Tishelman, A.C. (LGBT Health, 2017)
Purpose: Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-Affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy. Methods: An IRB-Approved retrospective medical record review (2014-2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization. Results: Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9-18). Seventy-Three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-Traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogues, only 8 (29.6%) received insurance coverage. Conclusion: Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform. © Copyright 2017, Mary Ann Liebert, Inc. 2017.
Keywords: adolescents; disparities; insurance coverage; mental health; transgender

Erratum: Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts (JAMA Pediatrics (2017) DOI: 10.1001/jamapediatrics.2016.4529) (JAMA Pediatrics, 2017)
Incorrect Sample Size in a Table: In the Original Investigation titled "Differencein- Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts," published in the April issue of JAMA Pediatrics,1 an incorrect sample size appeared in Table 2. In the first column of that table, the sample size for all students, which was given as 765039, should be replaced with 762 678. This article was corrected online. © 2017 American Medical Association. All rights reserved.

Differences in Parental Monitoring Components and Their Associated Health Indicators Between Sexual-Minority and Heterosexual Girls - Montano, G.T.; McCauley, H.L.; Miller, E.; Chisolm, D.J.; Marshal, M.P. (Journal of GLBT Family Studies, 2017)
Our study sought to assess whether parental monitoring and their associations with health behaviors differed for heterosexual girls compared to sexual-minority girls (girls who identified as lesbian or bisexual, endorsed same-sex attraction, or had same-sex romantic or sexual partners). We analyzed three components of parental monitoring—adolescent disclosure, parental solicitation, and parental knowledge—between heterosexual and sexual-minority girls. We also tested if the associations between these three constructs and adolescent relationship abuse, suicidality, heavy drinking, binge drinking, anxiety symptoms, and depressive symptoms were different for heterosexual girls compared to sexual-minority girls. Sexual-minority girls were less likely to disclose accurately to their parents their location and activities and perceived their parents asked less and knew less about their location and activities than did heterosexual girls. Heterosexual girls who reported higher levels of adolescent disclosure were less likely than were sexual-minority girls to report suicidality and anxiety symptoms. Additionally, heterosexual girls who reported higher levels of parental knowledge were also less likely than were sexual-minority girls to report anxiety and depressive symptoms. These findings suggest that parental monitoring may not be as protective for sexual-minority girls as it is for heterosexual girls. © 2017 Taylor & Francis Group, LLC.
Keywords: Familial relationships; mental health; parental monitoring; sexual-minority girls; substance use

Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital - Plöderl, M.; Kunrath, S.; Cramer, R.J.; Wang, J.; Hauer, L.; Fartacek, C. (BMC Psychiatry, 2017)
Background: Sexual minority (SM) individuals (gay, lesbian, bisexual, or otherwise nonheterosexual) are at increased risk for mental disorders and suicide and adequate mental healthcare may be life-saving. However, SM patients experience barriers in mental healthcare that have been attributed to the lack of SM-specific competencies and heterosexist attitudes and behaviors on the part of mental health professionals. Such barriers could have a negative impact on common treatment factors such as treatment expectancy or therapeutic alliance, culminating in poorer treatment outcomes for SM versus heterosexual patients. Actual empirical data from general psychiatric settings is lacking, however. Thus, comparing the treatment outcome of heterosexual and SM patients at risk for suicide was the primary aim of this study. The secondary aim was to compare treatment expectation and working alliance as two common factors. Methods: We report on 633 patients from a suicide prevention inpatient department within a public psychiatric hospital. Most patients were at risk for suicide due to a recent suicide attempt or warning signs for suicide, usually in the context of a severe psychiatric disorder. At least one indicator of SM status was reported by 21% of patients. We assessed the treatment outcome by calculating the quantitative change in suicide ideation, hopelessness, and depression. We also ran related treatment responder analyses. Treatment expectation and working alliance were the assessed common factors. Results: Contrary to the primary hypothesis, SM and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis. Contrary to the secondary hypothesis, there were no significant sexual orientation differences in treatment expectation and working alliance. When adjusting for sociodemographics, diagnosis, and length of stay, some sexual orientation differences became significant, indicating that SM patients have better outcomes. Conclusions: These unexpected but positive findings may be due to common factors of therapy compensating for SM-specific competencies. It may also be due to actual presence of SM competencies - though unmeasured - in the department. Replication in other treatment settings and assessment of SM-specific competencies are needed, especially in the field of suicide prevention, before these findings can be generalized. © 2017 The Author(s).
Keywords: Common factors; Gay; Lesbian; Suicide; Treatment

Factors associated with suicidal ideation among university students - Santos, H.G.B.D.; Marcon, S.R.; Espinosa, M.M.; Baptista, M.N.; Paulo, P.M.C. (Revista latino-americana de enfermagem, 2017)
Objective:: to analyze the factors associated with suicidal ideation in a representative sample of university students. Methods:: cross-sectional study, carried out with 637 students of the Federal University of Mato Grosso. The presence of suicidal ideation, demographic and socioeconomic variables, use of alcohol through the Alcohol, Smoking and Substance Involvement Screening Test, and depressive symptoms (Major Depression Inventory) were investigated. Bivariate analysis was performed with the Chi-square test and multivariate analysis using the Poisson regression model. Results:: it was found that 9.9% of the students had suicidal thoughts in the previous 30 days and, in the bivariate analysis, the variables economic class, sexual orientation, religious practice, suicide attempts in the family and among friends, alcohol consumption and depressive symptoms were associated with suicidal ideation. In the multivariate analysis sexual orientation, suicide attempts in the family and the presence of depressive symptoms remained as associated factors. Conclusion:: these findings constitute a situational diagnosis that enables the formulation of academic policies and preventive actions to confront this situation on the university campus. Objetivo:: analisar os fatores associados à ideação suicida em uma amostra representativa de estudantes universitários. Método:: estudo transversal analítico, realizado com 637 estudantes de uma Universidade Federal de Mato Grosso. Investigadas variáveis de presença de ideação suicida, demográficas e socioeconômica, uso de álcool por meio do Alcohol, Smoking and Substance Involvement Screening Test, e sintomas depressivos (Inventário de Depressão Maior). A análise bivariada foi realizada com o teste do Qui-quadrado, e a análise múltipla pelo modelo de regressão Poisson. Resultados:: constatou-se que 9,9% dos estudantes tinham ideias suicidas nos últimos 30 dias, e na análise bivariada as variáveis classe econômica, orientação sexual, prática religiosa, tentativas de suicídio na família e entre amigos, consumo de álcool e sintomas depressivos apresentaram associação com ideação suicida. Na análise múltipla permaneceu como fatores associados orientação sexual, tentativas de suicídio na família e presença de sintomas depressivos. Conclusão:: tais achados constituem um diagnóstico situacional que possibilita a formulação de políticas acadêmicas e de ações de prevenção para o enfrentamento dessa situação no campus universitário. Objetivo:: analizar los factores asociados a la ideación suicida en una muestra representativa de estudiantes universitarios. Método:: estudio transversal analítico, realizado con 637 estudiantes en una Universidad Federal de Mato Grosso. Fueron investigadas las variables: presencia de ideación suicida; demográficas y socioeconómicas; uso de alcohol por medio del Alcohol, Smoking and Substance Involvement Screening Test; y síntomas depresivos (Inventario de Depresión Mayor). El análisis bivariado fue realizado con el test de Chi-cuadrado y el análisis múltiple con el modelo de regresión de Poisson. Resultados:: se constató que 9,9% de los estudiantes tuvieron ideas suicidas en los últimos 30 días, y en el análisis bivariado las variables: clase económica; orientación sexual; práctica religiosa; intentos de suicidio en la familia y entre amigos; consumo de alcohol; y síntomas depresivos, presentaron asociación con ideación suicida. En el análisis múltiple permanecieron como factores asociados la orientación sexual, los intentos de suicidio en la familia y la presencia de síntomas depresivos. Conclusión:: estos hallazgos constituyen un diagnóstico situacional que posibilita la formulación de políticas académicas y de acciones de prevención para enfrentar esa situación en el campus universitario.

Suicidality and Associated Factors Among Men Who Have Sex With Men in Estonia - Rüütel, K.; Valk, A.; Lõhmus, L. (Journal of Homosexuality, 2017)
Many studies over the last decade provide strong evidence of elevated rates of suicidality among lesbian, gay, bisexual, and transgender populations compared to heterosexual populations. The aim of the current study was to investigate suicidal ideation and attempts and related factors among men who have sex with men (MSM) in Estonia. We conducted a nationwide Internet-based study among MSM with 265 eligible participants. Our results reveal high rates of self-reported suicidal ideation (lifetime prevalence 45%) and attempts (lifetime prevalence 11%) as well as a high rate of problem drinking (33%) and depressive symptoms (32%) among MSM. Recent suicidal ideation (14% had thought about suicide in the last 12 months) was related to depressive symptoms and lower socioeconomic situation. There is a need to develop specific interventions to address these issues among MSM and to provide gay-friendly mental health services. © 2017 Taylor & Francis.
Keywords: Depression; HIV; internalized homonegativity; men who have sex with men; outness; problem drinking; suicide

Predictors of Sexual Minority Youth’s Reported Suicide Attempts and Mental Health - Puckett, J.A.; Horne, S.G.; Surace, F.; Carter, A.; Noffsinger-Frazier, N.; Shulman, J.; Detrie, P.; Ervin, A.; Mosher, C. (Journal of Homosexuality, 2017)
Lesbian, gay, and bisexual youth (LGBY) report higher rates of mental health concerns compared to heterosexual youth due to minority stressors. This study examined the interpersonal and intrapersonal variables that predict psychological distress and self-reported suicide attempts in a sample of 61 LGBY in the Mid-South, which is a highly overlooked regional area for LGBY research. Youth who lost friends when coming out were 29 times more likely to report suicide attempts, and those who experienced psychological maltreatment from caregivers were 9.5 times more likely to report a suicide attempt. Internalized heterosexism, feelings of guilt or shame, and psychological maltreatment from caregivers were significant predictors of depression and anxiety symptoms. This study highlights the importance of creating affirming spaces for LGBY, particularly in areas of the country that experience greater political oppression of sexual minorities, such as the Mid-South. © 2017 Taylor & Francis.
Keywords: Anxiety; depression; harassment; internalized heterosexism; LGB youth; sexual minority youth; suicide

Men Who Have Sex with Men in Kampala, Uganda: Results from a Bio-Behavioral Respondent Driven Sampling Survey - Hladik, W.; Sande, E.; Berry, M.; Ganafa, S.; Kiyingi, H.; Kusiima, J.; Hakim, A. (AIDS and Behavior, 2017)
We report on the results of a respondent-driven sampling survey among men who have sex with men (MSM) in Kampala, Uganda, where same-sex behavior is criminalized and highly stigmatized. We enrolled 608 MSM aged 18 + years and residing in greater Kampala from June 2012-November 2013. Anonymous data were collected through audio-computer assisted self-interviews; blood was tested for HIV-1 antibodies, CD4 + T cell counts, and viral load. Estimated HIV prevalence was 12.2 % (95 % confidence interval [CI] 8.0–16.1), increasing with age. One in five (19.6 %) stated knowing their HIV-positive status and a similar proportion of HIV-infected MSM were virally suppressed (19.3 %; 95 % CI 3.3–33.1). HIV-related risk behaviors included unprotected anal sex (35.8 % at last sex act), selling sex (38.5 %), having multiple steady (54.3 %) or casual (63.6 %) partners, and ever injecting drugs (31.6 %). Forty percent experienced homophobic abuse; 44.5 % ever experienced suicide ideation. HIV prevalence among MSM remains high whereas knowledge of seropositive status and suppression of viral load remains low. MSM report a wide range of high risk behaviors, frequent homophobic abuse, poor mental health, as well as low levels of testing and treatment. Better access to tailored prevention and treatment services to improve population-level viral load suppression are warranted. © 2016, Springer Science+Business Media New York (outside the USA).
Keywords: Africa; HIV; Men who have sex with men; Respondent driven sampling; Uganda

Suicidal Ideation, Resilience, and Healthcare Implications for Newly Diagnosed HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study - Li, H.; Tucker, J.; Holroyd, E.; Zhang, J.; Jiang, B. (Archives of Sexual Behavior, 2017)
Globally, suicidal ideation and behavior have been widely reported among people living with human immunodeficiency virus (HIV). Knowledge gaps exist regarding the longer life and resilience-related experiences of people living with HIV (PLWH). Specifically, there is a dearth of data about the interaction of perceived risk and resilient factors resulting in a wide spectrum of intentional suicidal ideation outcomes in a Chinese cultural context. This qualitative research drew from a larger ethnographic study of newly diagnosed HIV-positive men who have sex with men (MSM) in Mainland China. Interviews were conducted with 31 MSM within 6 months of diagnosis of HIV infection. Initial suicidal ideation was commonly reported with participants subsequently feeling more resilient to these thoughts through gaining a greater understanding of their prognosis and treatment. Post-HIV diagnosis, some participants reported forming new relationships and receiving increased support from their partners, friends, peers, families, and community-based organizations. At follow-up, these participants generally reported suicidal ideation had declined. However, participants who continued to express suicidal ideation perceived extended pressure from their families’ expectations for them to engage in heterosexual marriages and parenthood. Furthermore, these men reported ongoing hardships in their daily life, unemployment, lack of social support, and isolation. Among this Mainland Chinese cohort of HIV-positive MSM, suicidal ideation may be a transient phenomenon experienced initially following HIV diagnosis that resolves with increased and specific familial, social, and service-based support. It is crucial to identify the causes of stress and social suffering associated with HIV diagnosis in order to reduce suicidal ideation. In China, action is needed to develop routine mental health screening and to increase services that support PLWH. Important services mechanism to accomplish this are promoting resilience through intentional activities as well as continued public health campaigns to reduce stigma toward HIV-positive MSM. © 2016, Springer Science+Business Media New York.
Keywords: China; HIV; Men who have sex with men; Resilience; Sexual orientation; Suicidal ideation

Needs of a Silent Minority: Mexican Transgender Asylum Seekers - Gowin, M.; Taylor, E.L.; Dunnington, J.; Alshuwaiyer, G.; Cheney, M.K. (Health Promotion Practice, 2017)
Mexican male to female transgender asylum seekers in the United States suffer from serious health issues that can be attributed to stressors related to their transgender, ethnic minority, and socioeconomic status. This study explored these stressors, the resulting health issues, and the needs of this particularly vulnerable population. Asylum seekers’ (n = 45) sworn declarations and psychological evaluations were examined by a multidisciplinary research team using a systematic document review process. The review identified stressors that occurred both in Mexico and the United States: verbal, physical, and sexual assaults; unstable environments; fear for safety/security; hiding undocumented status; and economic insecurity. The health issues that resulted in part from these stressors include posttraumatic stress disorder, depression, anxiety, sleep issues, isolation, avoidance, drug/alcohol use, and suicidal tendencies. Despite suffering from multiple health issues, asylum seekers rarely sought health or social services. Health promotion practitioners can play an important role in serving this silent minority by (1) expanding community-based research focused on the intersection of transgender, ethnic minority, and socioeconomic status; (2) using trusted community members to connect this population to necessary resources; (3) providing communication training/resource development for health care providers; and (4) creating a network of service organizations that understand the needs of transgender asylum seekers. © 2017, Society for Public Health Education.
Keywords: health disparities; health research; Latino; LGBT; minority health; minority health; qualitative research; social determinants of health

Associations between korean adolescents’ sexual orientation and suicidal ideation, plans, attempts, and medically serious attempts - Kwak, Y.; Kim, J.-S. (Iranian Journal of Public Health, 2017)
Background: Despite growing interest in the public health of sexual minority, youth around the world due to the high rates of suicidal ideation and attempts in this population, few studies on the sexual orientation of Korean adolescents have been conducted. Therefore, this study investigated the relationship between the sexual orientation of Korean adolescents and their suicide-related behavior. Methods: Raw data from the tenth Korea Youth Risk Behavior Web-based Survey were analyzed by logistic regression analysis. The sample consisted of 3603 adolescents who provided selected demographic variables and reported on their experience of sexual intercourse with the same or the opposite sex, along with lifestyle and suicide-related behaviors. Results: Rates of suicidal ideation, plans, attempts, and medically serious attempts were higher in both homosexual and bisexual than heterosexual groups. Suicidal ideation (odds ratio 95% confidence interval: 1.09–2.08), suicidal plans (odds ratio 95% confidence interval: 1.01–2.09), and suicide attempts (odds ratio 95% confidence interval: 1.28–2.88) had the strongest associations with homosexuality after multivariate adjustment. In contrast, bisexuality was only significantly associated with suicidal attempts (odds ratio 95% confidence interval: 1.01–2.97) after multivariate adjustment. Conclusion: Effective suicide prevention interventions are required for homosexual and bisexual adolescents, in the form of targeted programs to improve their mental health status and ability to cope with stress. © 2017, Iranian Journal of Public Health. All rights reserved.
Keywords: Adolescents; Bisexual; Gay; Heterosexual; Homosexual; Korea; Suicide

Oscar Pistorius: disability discourses in homosexual forums - Brennan, J. (Disability and Society, 2017)
This article performs textual analysis of discourse on Oscar Pistorius that appears on the homosexual discussion forums DataLounge and JustUsBoys. ‘Before’ and ‘after’ discourses–divided by Pistorius’s 2013 fatal shooting of his girlfriend–read Pistorius and his crime along sexuality and disability lines. I argue that it is worthwhile analysing how disability is constructed from different positions of marginalisation, especially when this at times yields discriminatory narratives. Pistorius, his disability, and his infamy are read by a community that itself exists outside the realm of mainstream debate, offering insight into disability and (homo)sexuality, adding greater dimension to ‘intersectional’ approaches to both. © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: cultural studies; disability; discourse; homosexuality; Oscar Pistorius

Perceived Parental Monitoring and Sexual Orientation Moderate Lifetime Acts of Non-Suicidal Self-Injury - Benau, E.M.; Jenkins, A.L.; Conner, B.T. (Archives of Suicide Research, 2017)
Being non-heterosexual, particularly bisexual, is associated with high rates of engagement in NSSI amongst young adults. The goal of the present study was to determine if parenting practices, specifically parental monitoring, and sexual orientation moderate engagement with NSSI. Undergraduates (N = 1,353) completed a survey on sexual orientation, non-suicidal self-injury (NSSI) acts, and multiple aspects of perceived parental monitoring during high school. Moderation analyses revealed that most facets of parental monitoring were similarly negatively correlated with NSSI for both individuals whose sexual orientation where nearly, or entirely, gay and heterosexual youth. Youth who were neither exclusively heterosexual nor exclusively gay (mixed sexual orientation) reported the most NSSI acts, and no facet of parental monitoring predicted reduced NSSI acts for this group. While previous literature shows that many aspects of parental monitoring may be protective against engagement in health risk behaviors, the present study adds to these findings that similar aspects are negatively associated with self-injurious behavior for some, but not all, individuals. More research is needed to better understand the causes of increased NSSI for individuals with a mixed sexual orientation. © 2017, Copyright © International Academy for Suicide Research.
Keywords: bisexuality; college students; family relationships; LGB; resilience

Help-seeking for nonsuicidal self-injury in sexual minority adolescent and young adult females - Zaki, L.F.; Gross, M.; Pachankis, J.E. (Journal of Gay and Lesbian Mental Health, 2017)
Subgroups of sexual minority adolescent and young adult females (e.g., lesbian, bisexual, questioning) have been underrepresented in youth health research. However, evidence suggests they experience compromised coping strategies compared to heterosexual female peers and may be reluctant to seek professional help due to stigma. An Internet survey (N = 482) examined nonsuicidal self-injury (NSSI), suicidal ideation, and help-seeking for NSSI in sexual minority and heterosexual adolescent and young adult females with histories of NSSI. Compared to heterosexual female youth, lesbian youth reported lower rates of NSSI and greater help-seeking from professionals, whereas bisexual youth reported greater suicidal ideation and a reluctance to seek professional help, favoring the help of romantic partners instead. Results extend research on help-seeking for risk behaviors in sexual minority female youth subgroups, while echoing the need to reduce sexual minority stigma in healthcare. © 2017 Taylor & Francis Group, LLC.
Keywords: Help-seeking; nonsuicidal self-injury; sexual minority; youth

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

Clinician competencies: Strengths and limitations for work with transgender and gender non-conforming (TGNC) clients - Whitman, C.N.; Han, H. (International Journal of Transgenderism, 2017)
Individuals who identify as transgender or gender nonconforming (TGNC) face a number of health disparities compared to individuals who identify as cisgender (those who self-identify with the sex they were assigned at birth). For example, TGNC individuals experience heightened rates of clinical depression, anxiety, general psychological distress, suicidal ideation, and suicide attempts. Despite these troubling disparities, many TGNC individuals report hesitance to seek mental health services due to concerns regarding culturally insensitive or even overtly discriminatory services from providers. In addition to decreasing service utilization among TGNC populations, discriminatory services impair intervention effectiveness even when TGNC individuals persist in seeking mental health services. The American Psychological Association (APA) and the World Professional Association for Transgender Health (WPATH) provide guidelines for culturally competent work with TGNC clients; however, research indicates a profound lack of TGNC-specific training and resources among mental health care providers. To address this gap, the present investigation utilized a mixed-method design to assess training experiences, understanding of terminology, and TGNC competence among mental health care providers at various training levels. Participants were current mental health clinicians across the United States. Implications for improving reported and demonstrated weaknesses are discussed. © 2017 Taylor & Francis Group, LLC.
Keywords: competence; gender nonconforming; mental health; TGNC; Transgender

Supporting Transgender College Students: Implications for Clinical Intervention and Campus Prevention - Swanbrow Becker, M.A.; Nemeth Roberts, S.F.; Ritts, S.M.; Branagan, W.T.; Warner, A.R.; Clark, S.L. (Journal of College Student Psychotherapy, 2017)
This study examines the experiences of transgender college students in coping with stress in comparison to their cisgender peers. Undergraduate and graduate students from 73 colleges, totaling 26,292 participants, of which 47 identified as transgender completed an online survey. Transgender students reported greater exposure to trauma and higher rates of suicidal experiences, as well as different precipitants to reported stressful periods and sources of support than their cisgender peers. Implications for individual and group counseling as well as outreach and prevention to better support transgender students are explored. © 2017 Taylor & Francis.
Keywords: college student; coping; suicide; transgender; trauma

A comparison of health disparities among transgender adults in Colorado (USA) by race and income - Seelman, K.L.; Young, S.R.; Tesene, M.; Alvarez-Hernandez, L.R.; Kattari, L. (International Journal of Transgenderism, 2017)
Transgender individuals face heightened risks for discrimination, harassment, and violence that impact their psychosocial well-being and physical health. However, few studies have thoroughly examined the general physical and mental health of transgender adults or within-group health differences by race/ethnicity and income. To that end, after controlling for health insurance status, age, and engagement in exercise, this study asks: (a) Are transgender people of color more likely than White transgender individuals to experience poor health outcomes? and (b) Is lower annual household income among transgender adults associated with poorer health outcomes? The study analyzes secondary data from a survey of transgender adults (N = 417) in one state in the western United States using multiple linear regression and logistic regression models. Results showed that transgender people of color had significantly greater odds than their White counterparts of having arthritis/rheumatoid arthritis/gout/lupus/fibromyalgia, or asthma but lower odds of being told by a provider that they had depression. Having a lower income was significantly associated with worse general health as well as multiple indicators of poor physical and mental health, including depression, anxiety, and suicidal ideation. We discuss implications for health care delivery for transgender people and for future research. © 2017 Taylor & Francis Group, LLC.
Keywords: health; income; mental health; race; Transgender

Minority Sexual Orientation, Gender Identity Status and Suicidal Behavior: Serial Indirect Effects of Hope, Hopelessness and Depressive Symptoms - Hirsch, J.K.; Cohn, T.J.; Rowe, C.A.; Rimmer, S.E. (International Journal of Mental Health and Addiction, 2017)
Death by suicide, and suicidal behaviors, are a significant public mental health problem, and individuals who are lesbian, gay, bisexual, transgendered and questioning (LGBTQ), may be at increased risk. Potential underlying mechanisms of this association are unknown, but may involve the impact of LGBTQ status on future orientation and mood. Our purpose was to determine the influence of sexual identity, sequentially, on cognitive and emotional functioning, and consequent relation to suicidal behavior. In a sample of 349 college students, we used serial mediation models to investigate the relation between self-identification as LGBTQ and suicidal behavior, with hope and hopelessness as first-order mediators and depression as a second order mediator. Supporting hypotheses, we found that LGBTQ status was related to less hope and greater hopelessness and, in serial fashion, to depressive symptoms and consequent suicidal behavior. Our findings may have clinical implications. Resolution of hopelessness and depression, and promotion of hopefulness, perhaps via Motivational Interviewing and Cognitive Behavioral Therapy strategies, such as goal-setting, may reduce suicidal risk in LGBTQ young adults. © 2016, Springer Science+Business Media New York.
Keywords: College students; Depression; Gender identity; LGBTQ; Sexual minority; Suicidal behavior; Trait hope

Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts - Raifman, J.; Moscoe, E.; Austin, S.B.; McConnell, M. (JAMA Pediatrics, 2017)
IMPORTANCE Suicide is the second leading cause of death among adolescents between the ages of 15 and 24 years. Adolescents who are sexual minorities experience elevated rates of suicide attempts. OBJECTIVE To evaluate the association between state same-sex marriage policies and adolescent suicide attempts. DESIGN, SETTING, AND PARTICIPANTS This study used state-level Youth Risk Behavior Surveillance System (YRBSS) data from January 1, 1999, to December 31, 2015, which are weighted to be representative of each state that has participation in the survey greater than 60%. A difference-in-differences analysis compared changes in suicide attempts among all public high school students before and after implementation of state policies in 32 states permitting same-sex marriage with year-to-year changes in suicide attempts among high school students in 15 states without policies permitting same-sex marriage. Linear regression was used to control for state, age, sex, race/ethnicity, and year, with Taylor series linearized standard errors clustered by state and classroom. In a secondary analysis among students who are sexual minorities, we included an interaction between sexual minority identity and living in a state that had implemented same-sex marriage policies. INTERVENTIONS Implementation of state policies permitting same-sex marriage during the full period of YRBSS data collection. MAIN OUTCOMES AND MEASURES Self-report of 1 or more suicide attempts within the past 12 months. RESULTS Among the 762 678 students (mean [SD] age, 16.0 [1.2] years; 366 063 males and 396 615 females) who participated in the YRBSS between 1999 and 2015, a weighted 8.6%of all high school students and 28.5%of students who identified as sexual minorities reported suicide attempts before implementation of same-sex marriage policies. Same-sex marriage policies were associated with a 0.6-percentage point (95%CI, -1.2 to -0.01 percentage points) reduction in suicide attempts, representing a 7%relative reduction in the proportion of high school students attempting suicide owing to same-sex marriage implementation. The association was concentrated among students who were sexual minorities. CONCLUSIONS AND RELEVANCE State same-sex marriage policies were associated with a reduction in the proportion of high school students reporting suicide attempts, providing empirical evidence for an association between same-sex marriage policies and mental health outcomes. © 2017 American Medical Association.

Erratum: Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts (JAMA Pediatrics (2017) DOI: 10.1001/jamapediatrics.2016.4529) (JAMA Pediatrics, 2017)
Corrections for the Abstract and a Table: In the Original Investigation titled "Difference- in-Differences Analysis of the Association Between State Same-Sex Marriage Policies and Adolescent Suicide Attempts," published February 20, 2017, in JAMAPediatrics,1anerror occurred in the Abstract and a footnote was omitted from Table 2. In the Results portion of the Abstract, the first sentence should not have included a denominator for the percentage of students who identified as sexual minorities and reported suicide attempts. That sentence should have read, "Among the 762 678students (mean [SD] age, 16.0[1.2] years;366 063males and 396 615 females)who participated in the YRBSS between 1999and 2015, aweighted8.6% of all high school students and 28.5%of students who identified as sexual minorities reported suicide attempts before implementation of same-sex marriage policies." In addition, Table 2 should have included a footnote cited in the first column, at the end of the second row, that read, "The sample size includes students who identified as straight as well as those who identified as sexual minorities in states that collected dataonsexual orientation. The analysis of sexual minority adolescents was based on interacting a term for state same-sex marriage implementation and adolescents identifying as sexual minorities. The full results can be found in eTable 4 in the Supplement." This article was corrected online. © 2017 American Medical Association.

Disparities in mental well-being between non-minority and sexual minority male youth in Bangkok, Thailand: Quantitative findings from a mixed method study - Sopitarchasak, S.; Kihara, M.; Soe, K.M.; Ono-Kihara, M. (Journal of Population and Social Studies, 2017)
This paper investigates whether there are differences in mental well-being between non-minority and sexual minority adolescents. We also explore the experiences of victimization among sexual minority adolescents, compared to their non-minority peers. While the study used mixed methods, with an initial qualitative phase and a subsequent quantitative phase, this paper focuses on the quantitative findings. Male students from five secondary schools (n=1,250) in Bangkok were asked to answer an online questionnaire. Among all participants, 81.8% identified themselves as non-minority and 12.5% as sexual minority with 5.7% missing or unidentifiable responses. The results indicated a higher risk of depression for sexual minority participants than for non-minority participants (odds ratio: 1.85). Sexual minority participants were also more likely than their non-minority peers to have considered (23.2% vs. 9.8%) or attempted (10.3% vs. 2.9%) suicide, and to have been victimized and/or experienced sexual coercion during the past semester. The findings conform to results from previous studies worldwide. Although a causal relationship cannot be inferred from this study, the disparity in mental well-being can be due to the victimization that sexual minority adolescents experience more frequently than their non-minority counterparts. © 2017, Mahidol University, Institute for Population and Social Research.
Keywords: Adolescents; Depression; Sexuality; Suicide; Victimization

Study of deaths by suicide of homosexual prisoners in Nazi Sachsenhausen concentration camp - Cuerda-Galindo, E.; López-Muñoz, F.; Krischel, M.; Ley, A. (PLoS ONE, 2017)
Living conditions in Nazi concentration camps were harsh and inhumane, leading many prisoners to commit suicide. Sachsenhausen (Oranienburg, Germany) was a concentration camp that operated from 1936 to 1945. More than 200,000 people were detained there under Nazi rule. This study analyzes deaths classified as suicides by inmates in this camp, classified as homosexuals, both according to the surviving Nazi files. This collective was especially repressed by the Nazi authorities. Data was collected from the archives of Sachsenhausen Memorial and the International Tracing Service in Bad Arolsen. Original death certificates and autopsy reports were reviewed. Until the end of World War II, there are 14 death certificates which state 'suicide' as cause of death of prisoners classified as homosexuals, all of them men aged between 23 and 59 years and of various religions and social strata. Based on a population of 1,200 prisoners classified as homosexuals, this allows us to calculate a suicide rate of 1,167/100,000 (over the period of eight years) for this population, a rate 10 times higher than for global inmates (111/100,000). However, our study has several limitations: not all suicides are registered; some murders were covered-up as suicides; most documents were lost during the war or destroyed by the Nazis when leaving the camps and not much data is available from other camps to compare. We conclude that committing suicides in Sachsenhausen was a common practice, although accurate data may be impossible to obtain. © 2017 Cuerda-Galindo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Impact of Social Determinants of Health on Medical Conditions Among Transgender Veterans - Blosnich, J.R.; Marsiglio, M.C.; Dichter, M.E.; Gao, S.; Gordon, A.J.; Shipherd, J.C.; Kauth, M.R.; Brown, G.R.; Fine, M.J. (American Journal of Preventive Medicine, 2017)
Introduction Transgender individuals experience pronounced disparities in health (e.g., mood disorders, suicide risk) and in the prevalence of social determinants of housing instability, financial strain, and violence. The objectives of this study were to understand the prevalence of social determinants among transgender veterans and assess their associations with medical conditions. Methods This project was a records review using administrative data from the U.S. Department of Veterans Affairs databases for 1997–2014. Transgender veterans (N=6,308) were defined as patients with any of four ICD-9 diagnosis codes associated with transgender status. Social determinants were operationalized using ICD-9 codes and Department of Veterans Affairs clinical screens indicating violence, housing instability, or financial strain. Multiple logistic regression was used to assess the associations of social determinants with medical conditions: mood disorder, post-traumatic stress disorder, alcohol abuse disorder, illicit drug abuse disorder, tobacco use disorder, suicidal risk, HIV, and hepatitis C. Results After adjusting for sociodemographic variables, housing instability and financial strain were significantly associated with all medical conditions except for HIV, and violence was significantly associated with all medical conditions except for tobacco use disorder and HIV. There was a dose response–like relationship between the increasing number of forms of social determinants being associated with increasing odds for medical conditions. Conclusions Social determinants are prevalent factors in transgender patients’ lives, exhibiting strong associations with medical conditions. Documenting social determinants in electronic health records can help providers to identify and address these factors in treatment goals. © 2017

Risky Sexual Behaviors as Correlates of Depression and Suicidal Ideation among Male HIV Test-Seekers at a Voluntary Counseling and Testing Facility in Taiwan - Lin, C.-C.; Lee, Y.-T.; Yang, H.-J. (Asia-Pacific Journal of Public Health, 2017)
This study aims at determining the level of depression and suicidal status of adult HIV test-seekers. Of the total enrolled 850 males, almost 50% reported some risk behaviors, 38.9% experienced depression, and 7.2% had suicidal ideation. Subjects with risky sexual behaviors in terms of repeated HIV test, had a history of sexually transmitted disease, engaged in one-night stands, or did not use condoms all the time with causal sexual partners were more likely to have depression. Furthermore, subjects who were bisexual/homosexual, engaged in Internet sex, engaged in one-night stands, or used addictive drugs within the past 6 months were more likely to experience suicidal ideation. The HIV testers are at risk of experiencing depression and suicidal ideation; each is associated with different types of risky sexual behaviors. It is essential for the health authority to further provide mental health services for HIV testers and to draw up an effective strategy in reducing unprotected sexual behaviors. © Asia-Pacific Academic Consortium for Public Health.
Keywords: correlates; depression; HIV testing; psychological distress; risky sexual behavior; suicidal ideation

Proteogenomic analysis greatly expands the identification of proteins related to reproduction in the apogamous fern Dryopteris affinis ssp. affinis - Grossmann, J.; Fernández, H.; Chaubey, P.M.; Valdés, A.E.; Gagliardini, V.; Cañal, M.J.; Russo, G.; Grossniklaus, U. (Frontiers in Plant Science, 2017)
Performing proteomic studies on non-model organisms with little or no genomic information is still difficult. However, many specific processes and biochemical pathways occur only in species that are poorly characterized at the genomic level. For example, many plants can reproduce both sexually and asexually, the first one allowing the generation of new genotypes and the latter their fixation. Thus, both modes of reproduction are of great agronomic value. However, the molecular basis of asexual reproduction is not well understood in any plant. In ferns, it combines the production of unreduced spores (diplospory) and the formation of sporophytes from somatic cells (apogamy). To set the basis to study these processes, we performed transcriptomics by next-generation sequencing (NGS) and shotgun proteomics by tandem mass spectrometry in the apogamous fern D. affinis ssp. affinis. For protein identification we used the public viridiplantae database (VPDB) to identify orthologous proteins from other plant species and new transcriptomics data to generate a "species-specific transcriptome database" (SSTDB). In total 1,397 protein clusters with 5,865 unique peptide sequences were identified (13 decoy proteins out of 1,410, protFDR 0.93% on protein cluster level). We show that using the SSTDB for protein identification increases the number of identified peptides almost four times compared to using only the publically available VPDB. We identified homologs of proteins involved in reproduction of higher plants, including proteins with a potential role in apogamy. With the increasing availability of genomic data from non-model species, similar proteogenomics approaches will improve the sensitivity in protein identification for species only distantly related to models. © 2017 Grossmann, Fernández, Chaubey, Valdés, Gagliardini, Cañal, Russo and Grossniklaus.
Keywords: Apogamy; Apomixis; Dryopteris affinis ssp. affinis; Fern; Gametophyte; Proteogenomics

Preventive health care for women who have sex with women - Knight, D.A.; Jarrett, D. (American Family Physician, 2017)
Despite recent shifts in societal attitudes toward same-sex relationships, women who have sex with women face a variety of barriers to optimal health, including a history of negatively perceived interactions in clinical settings that lead them to delay or avoid health care. Women who have sex with women may be at disproportionate risk of obesity, tobacco use, substance use, mental health issues, intimate partner violence, sexually transmitted infections, and some cancers. Disparities can exist throughout the lifetime. Lesbian and bisexual adolescents are vulnerable to bullying, family rejection, and risky sexual behavior that may lead to sexually transmitted infections or unintended pregnancy. Sexual minority stress, which is a response to stigmatization, prejudice, and internalized homophobia, contributes to many of these conditions. Family physicians should foster trust and communication to provide a nonjudgmental, welcoming environment supportive of culturally competent health care and optimal outcomes. When indicated, clinicians should refer women who have sex with women to culturally sensitive community resources and legal advisors for assistance with medical decision making, hospital visitation, conception, and legal recognition of nonbiologic parents. © 2017 American Academy of Family Physicians.

Early Sexual Debut and Associated Risk Behaviors Among Sexual Minority Youth - Lowry, R.; Dunville, R.; Robin, L.; Kann, L. (American Journal of Preventive Medicine, 2017)
Introduction Early sexual debut, sexual risk taking, substance use, violent victimization, and suicidal behaviors are more prevalent among sexual minority than sexual nonminority youth. Although associations between early sexual debut and these risk behaviors exist, little is known about such associations among sexual minority youth. This study examined these associations among sexual minority U.S. high school students and their sexual nonminority peers. Methods In 2015, the national Youth Risk Behavior Survey included questions assessing sexual orientation for the first time. In 2016, data from this nationally representative sample of 15,624 U.S. high school students were analyzed to determine if associations between early sexual debut and other health risk behaviors varied by sexual orientation, by calculating adjusted (for sex, race/ethnicity, and age) prevalence ratios (APRs). Results Associations between early sexual debut and other health risk behaviors did not vary significantly by sexual orientation. Early sexual debut (first sexual intercourse before age 13 years) was associated with sexual risk taking, substance use, violent victimization, and suicidal thoughts/attempts among students identifying as lesbian, gay, or bisexual (LGB) and among students identifying as heterosexual, for example, being currently sexually active (LGB students: APR=1.82, 95% CI=1.35, 2.45; heterosexual students: APR=2.50, 95% CI=2.22, 2.81) and not using a condom at last sexual intercourse (LGB students: APR=1.50, 95% CI=1.18, 1.91; heterosexual students: APR=1.29, 95% CI=1.09, 1.52). Conclusions School-based sexual health programs might appropriately utilize strategies that are inclusive of sexual minority students, encourage delay of sexual intercourse, and coordinate with violence and substance use prevention programs. © 2017

Perceived microaggressions and mental health in a sample of black youths experiencing homelessness - Gattis, M.N.; Larson, A. (Social Work Research, 2017)
The effects of microaggressions targeted at sexual minorities and racial minorities have been well documented. Lesbian, gay, bisexual, and transgender (LGBT) youths and black youths are more likely to experience homelessness than their heterosexual, cisgender, and white peers, and yet little is known about how microaggressions may affect youths during instances of homelessness. This study examines whether perceived LGBT racial microaggressions and perceived racial microaggressions are associated with depressive symptoms and suicidality in a sample of black youths experiencing homelessness. This study uses a cross-sectional design with structured face-to-face interviews of a convenience sample of 89 black youths (ages 16 to 24 years) experiencing homelessness. Results show that whereas both types of perceived microaggressions are positively associated with depressive symptoms, neither form of microaggression is independently associated with suicidality. Depressive symptoms and suicidality are common experiences among black youths dealing with homelessness, and the perception of microaggressions targeted at sexual or racial minority statuses is associated with depressive symptomology. Results underscore the importance of social workers comprehensively addressing how subtle, pervasive forms of heterosexism, gender normativity, and racism affect mental health outcomes among homeless youths. © 2017 National Association of Social Workers.
Keywords: And transgender people; Bisexual; Black or African Americans; Gay; Homelessness; Lesbian; Mental health Microaggressions

Prevalence of condomless anal intercourse and recent HIV testing and their associated factors among men who have sex with men in Hangzhou, China: A respondent-driven sampling survey - Li, R.; Wang, H.; Pan, X.; Ma, Q.; Chen, L.; Zhou, X.; Jiang, T.; He, L.; Chen, J.; Zhang, X.; Luo, Y.; Xi, S.; et al. (PLoS ONE, 2017)
Men who have sex with men (MSM) are a large high-risk population for HIV infection in recent years in China. A cross-sectional survey was conducted in Hangzhou, China, to determine rates of condomless anal intercourse (CAI), recent HIV testing (in the recent year) and associated factors using respondent-driven sampling. Questionnaires using faceto-face interviews were employed to collect data on sexual risk behaviors and HIV testing. Five hundred eleven MSM were recruited, of which 459 (89.8%) had anal intercourse in the past 6 months. Of these 459 participants, 457 (99.6%) answered whether they had taken an HIV test in the recent year, so only their data were analyzed. Weighted data were analyzed using bivariate and multivariate logistic regression analysis. The CAI rate with male partners in the past 6 months was 43.7% (95% confidence interval [CI], 34.0-51.5%), while the rate of condomless vaginal intercourse (CVI) was 21.6% (95% CI, 15.6-32.3%). The prevalence of recent HIV testing was 56.8% (95% CI, 48.7-66.5%), while the prevalence of HIV and syphilis were 8.8% and 6.5%, respectively. Multivariate analysis indicated that CAI was associated with earlier homosexual debut, suicidal inclinations, childhood sexual abuse, HIV testing in the recent year, and lower estimate of HIV prevalence. Recent HIV testing was associated with homosexual debut age, engaging in CAI with male partners in the past 6 months, having oral sex in the past 6 months, self-perceived higher likelihood of HIV infection, knowing about antiretroviral therapy for HIV/AIDS, receiving AIDS/sexually transmitted infection (STI) interventions in the past year, and syphilis infection. Given high prevalence of HIV and syphilis, high levels of CAI and CVI, and low HIV testing rate, the results indicated high risk of HIV infection and transmission among MSM. HIV prevention interventions should target MSM with early homosexual debut and psychosocial health problems, while HIV/AIDS education among MSM should focus on increasing knowledge of HIV risk, estimated HIV prevalence and antiretroviral therapy, and improving risk perception of HIV acquisition. © 2017 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

LGBTQ Youth Part 1 - Perron, T.; Kartoz, C.; Himelfarb, C. (NASN school nurse (Print), 2017)
In order to provide holistic care, school nurses must be culturally competent by being sensitive to health disparities experienced by students in at-risk populations. Despite the growing acceptance toward gender and sexual minorities, LGBTQ youth remain an at-risk population in our communities and our schools. School nurses as well as school counselors, social workers, and psychologists can increase their cultural competence in caring for this group of students by increasing their understanding of appropriate terminology and risks associated with this vulnerable group. This article is Part 1 of a two-article series designed to increase school nurses' abilities to advocate and care for LGBTQ youth in school settings. This first article provides information regarding proper terminology and current percentages of youth who identify as LGBTQ and concludes with implications for school nurses, including resources for nurses, school staff, and families.
Keywords: bullying; depression; LGBTQ youth; professional issues; school nurse role; suicide

A tailored compassion-focused therapy program for sexual minority young adults with depressive symotomatology: Study protocol for a randomized controlled trial - Pepping, C.A.; Lyons, A.; McNair, R.; Kirby, J.N.; Petrocchi, N.; Gilbert, P. (BMC Psychology, 2017)
Background: Lesbian, gay, and bisexual (LGB) men and women represent one of the highest-risk populations for depressive symptomatology and disorders, with young LGB adults being at greatest risk. To date, there have been no randomized controlled trials (RCT) to specifically target depressive symptoms in young LGB adults. This is despite research highlighting unique predictors of depressive symptomatology in this population. Here we outline a protocol for an RCT that will test the preliminary efficacy of a tailored compassion-focused therapy (CFT) intervention for young LGB adults compared with a self-directed cognitive behavioral therapy (CBT) program with no specific tailoring for LGB individuals. Methods: The CFT intervention consists of 8 units with self-directed reading and activities tailored to LGB young adults, and 8 x weekly 1-hour consultations with a therapist. The CBT intervention consists of 8 units with self-guided reading and activities, with 1 x 1-hour session with a therapist at the mid-point of therapy. Fifty LGB individuals with scores of 13 or above on the Beck Depression Inventory-II will be randomized to either the CFT or CBT condition. The primary outcome measure is depressive symptomatology. Secondary outcome measures are symptoms of anxiety, suicidal ideation, internalized homophobia, self-compassion, and shame and guilt proneness. Assessments will occur at pre-intervention, post-intervention, and at 3-month post-intervention. Discussion: This study is an RCT to test the preliminary efficacy of an LGB-tailored compassion-focused intervention for young LGB adults with depressive symptomatology. If this intervention is efficacious, this could begin to address the substantial mental health disparities amongst sexual minorities. Trial registration:ACTRN12616001018404. Prospective registration, registered 02/08/2016. © 2017 The Author(s).
Keywords: Bisexual; Compassion; Depression; Gay; Lesbian; Sexual minority

School connectedness and suicidal thoughts and behaviors: A systematic meta-analysis - Marraccini, M.E.; Brier, Z.M.F. (School Psychology Quarterly, 2017)
Among the protective factors associated with reduced risk for suicide, scientific inquiries into school connectedness are especially important considering that schools are ideally situated to provide interventions reaching the vast majority of youth. Although there is a wealth of research that supports the association between school connectedness and reduced self-report of adolescents having a suicidal thought or making a suicide attempt, inconsistencies in the way studies have measured and operationalized school connectedness limit synthesis across findings. This meta-analytic study investigates the literature exploring associations between school connectedness and suicidal thoughts and behaviors across general and subpopulations (high risk and sexual minority youth) using a random effects model. Eligible studies examined a measure of school connectedness explicitly referred to as "school connectedness" or "connections at school" in relation to suicidal ideation or suicide attempts among youth enrolled in school (Grades 6-12). Multiple metaregression analyses were conducted to explore the influence of school connectedness measurement variation, as well as participant characteristics. Results, including 16 samples, support that higher school connectedness is associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] = 0.536), high-risk (OR = 0.603), and sexual minority (OR = 0.608) adolescents. Findings are consistent when analyzed separately for suicidal ideation (OR = 0.529) and suicide attempts (OR = 0.589) and remain stable when accounting for measurement variability. Although limited by its cross-sectional nature, findings support recent calls to increase school connectedness and proffer important implications for screening and intervention efforts conducted in schools. © 2016 American Psychological Association.
Keywords: Adolescent; Meta-analysis; School connectedness; Sexual minority; Suicide

A clinically neglected topic: Risk of suicide in transgender individuals - Yüksel, Ş.; Aslantaş Ertekın, B.; Öztürk, M.; Bikmaz, P.S.; Oğlağu, Z. (Noropsikiyatri Arsivi, 2017)
Introduction: The aim of this study was to determine whether adolescence of transgender individuals is characterized by a high risk of suicide. Methods: In total, 141 participants with transgenderism were questioned using a semi-structured interview to determine whether participants had current suicidal thoughts, had a lifetime history of such thoughts, or had attempted suicide. These findings were cross-ref-erenced to the participants’ sociodemographic characteristics, and information about their families’ general attitudes toward sexuality, gender identity, and commitment to religious views. In total, 101 participants attended group psychotherapy sessions for at least a year. In these sessions, family and partner relationships, occupational problems, financial problems, medical issues, and religious concerns were discussed. Results: The incidence of suicide attempts, current suicidal thoughts, and lifetime suicidal thoughts were 29.8%, 9.2%, and 55.3%, respectively. In total, 76.7% of the suicide attempts occurred before the age of 21. Conclusion: Transsexual individuals present a high risk of suicide, particularly during adolescence. This finding may be considered a sign for taking action to prevent suicide when working with transgender individuals, particularly during adolescence. © 2017 by Turkish Association of Neuropsychiatry.
Keywords: Adolescence; Group psychotherapy; Suicide; Transgender

LGBTQ Part 2 - Perron, T.; Kartoz, C.; Himelfarb, C. (NASN school nurse (Print), 2017)
In addition to dealing with the normal challenges of being a teenager, many times LGBTQ youth have to deal with harassment, intimidation, and bullying on a daily basis as they disproportionately experience verbal and physical harassment while in school as a result of their sexual orientation and/or gender identity. This violence adversely affects these students' health and well-being as reflected in the depression and suicide rate among LGBTQ youth. As Part 2 of a series in articles on caring for LGBTQ youth in a school setting, this article reviews specific health risks in this group of students. School nurses can help reduce disparities in health for LGBTQ youth by understanding risk for psychological consequences of bullying and advocating for a just and responsive social school culture. Implications for school nurses include educating school staff and families as well as providing prompt and appropriate referrals for necessary psychological care.
Keywords: behavioral problems; bullying; depression; LGBTQ youth; sexuality; suicide

Self-Injury Implicit Association Test: Comparison of Suicide Attempters and Non-attempters - Kene, P. (Psychiatric Quarterly, 2017)
Given the weaknesses of self-report measures, there has been an increased interest in alternative methods of suicide risk assessment, primarily the implicit measures of suicide risk. This study aimed to determine differences in implicit identification with self-injury and implicit attitude towards self-injury between attempters and non-attempters using the self-injury implicit association test (SI-IAT). The SI-IAT is a computer test designed to measure the implicit associations about self-injury. Participants were 100 forensic and civil inpatients at three psychiatric hospitals. A history of attempted suicide was very common in this sample. All participants completed the SI-IAT. Attempters and non-attempters did not significantly differ with respect to implicit identification with self-injury and implicit attitude towards self-injury. Implications are presented for assessment of suicide risk and future research. © 2016, Springer Science+Business Media New York.
Keywords: Implicit attitudes; Inpatient; Risk factor; Suicide attempts

Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health - Fredlund, C.; Svedin, C.G.; Priebe, G.; Jonsson, L.; Wadsby, M. (Child and Adolescent Psychiatry and Mental Health, 2017)
Background: Sex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury. Methods: A representative national sample of 5750 students in the 3rd year of Swedish high school, with a mean age of 18 years was included in the study. The study was questionnaire-based and the response rate was 59.7%. Mostly descriptive statistics were used and a final logistic regression model was made. Results: Sex as self-injury was reported by 100 (3.2%) of the girls and 20 (.8%) of the boys. Few correlations to sociodemographic factors were noted, but the group was burdened with more experiences of sexual, physical and emotional abuse. Non-heterosexual orientation, trauma symptoms, non-suicidal self-injury and healthcare for suicide attempts, depression and eating disorders were common. Conclusions: Sex used as self-injury seems to be highly associated with earlier traumas such as sexual abuse and poor mental health. It is a behavior that needs to be conceptualized in order to provide proper help and support to a highly vulnerable group of adolescents. © 2017 The Author(s).
Keywords: Adolescents; Indirect self-injury; Non-suicidal self-injury (NSSI); Revictimization; Self-harm; Selling sex; Sex as self-injury (SASI); Sexual abuse; Trauma

Factors associated with suicidal ideation among university students - Dos Santos, H.G.B.; Marcon, S.R.; Espinosa, M.M.; Baptista, M.N.; De Paulo, P.M.C. (Revista Latino-Americana de Enfermagem, 2017)
Objective: to analyze the factors associated with suicidal ideation in a representative sample of university students. Methods: cross-sectional study, carried out with 637 students of the Federal University of Mato Grosso. The presence of suicidal ideation, demographic and socioeconomic variables, use of alcohol through the Alcohol, Smoking and Substance Involvement Screening Test, and depressive symptoms (Major Depression Inventory) were investigated. Bivariate analysis was performed with the Chi-square test and multivariate analysis using the Poisson regression model. Results: it was found that 9.9% of the students had suicidal thoughts in the previous 30 days and, in the bivariate analysis, the variables economic class, sexual orientation, religious practice, suicide attempts in the family and among friends, alcohol consumption and depressive symptoms were associated with suicidal ideation. In the multivariate analysis sexual orientation, suicide attempts in the family and the presence of depressive symptoms remained as associated factors. Conclusion: these findings constitute a situational diagnosis that enables the formulation of academic policies and preventive actions to confront this situation on the university campus. © 2017 Revista Latino-Americana de Enfermagem.
Keywords: Adolescent; Risk Factors; Students; Suicidal Ideation; Univesities

“It's how we deal”: Perceptions of LGB peers' use of alcohol and other drugs to cope and sexual minority adults' own coping motivated substance use following the Pulse nightclub shooting - Boyle, S.C.; LaBrie, J.W.; Costine, L.D.; Witkovic, Y.D. (Addictive Behaviors, 2017)
Sexual minority stress experiences (e.g. prejudice, victimization, etc.) and peer substance use norms (e.g. peers' frequency of use and quantity consumed) are important correlates of alcohol and drug use in sexual minority populations. The current study incorporates both of these by examining LGB individuals' perceptions of peers' use of alcohol and other drugs to cope with a sexual minority stressor, and whether perceptions of peer coping norms relate to one's own coping-motivated substance use in response to the stressor. Three-hundred and seven sexual minority males and females who identified as gay, lesbian, or bisexual completed an online survey approximately 1 month following the Pulse Nightclub Shooting, the deadliest incident of violence against LGBT people in U.S. history, and a stressor experienced within LGB communities throughout the U.S. Results revealed that LGB peers were widely perceived as likely to have coped with alcohol (68%) and drugs (41%) following the Pulse Shooting; however only small proportions of participants themselves reported coping with alcohol (26%) and drugs (7%). Further, multivariate models revealed that even after controlling for other factors including the stress impact of the Pulse shooting, the odds of using alcohol to cope with this event were 15 times greater among participants who held the perception that LGB peers likely used alcohol to cope relative to those who did not share this perception. Similarly, the odds of using drugs to cope with this event were 9 times greater among participants who perceived LGB peers likely to use drugs to cope with Pulse compared to those who did not. Importantly, these findings suggest that personalized normative feedback designed to correct perceptions of peers' coping motivated substance use may have utility as a motivational component in larger interventions seeking to reduce LGBs' substance use. © 2016 Elsevier Ltd
Keywords: Alcohol use; Drinking motives; Sexual minorities; Social norms

Suicide risk in a representative sample of people receiving HIV care: Time to target most-at-risk populations (ANRS VESPA2 French national survey) - Carrieri, M.P.; Marcellin, F.; Fressard, L.; Préau, M.; Sagaon-Teyssier, L.; Suzan-Monti, M.; Guagliardo, V.; Mora, M.; Roux, P.; Dray-Spira, R.; Spire, B.; Allègre, T.; et al. (PLoS ONE, 2017)
Background: Suicide risk is high among people living with HIV (PLHIV). This study aimed to identify major correlates of suicide risk in a representative sample of PLHIV in France, in order to help target individuals who would benefit from suicide risk screening and psychiatric care. Methods: The ANRS VESPA2 cross-sectional survey (April 2011-January 2012) collected sociodemographic, medical and behavioral data from 3,022 PLHIV recruited in 73 French HIV hospital departments. The study sample comprised the 2,973 participants with available self-reported data on suicide risk (defined as having either thought about and planned to commit suicide during the previous 12 months or attempted suicide during the same period of time) and medical data on comorbidities. Weighted Poisson models adjusted for HCV coinfection and significant clinical variables were used to estimate the relationship between suicide risk and HIV transmission groups, experience with HIV disease and other psychosocial factors. Results: Suicide risk was reported by 6.3% of PLHIV in the study sample. After adjustment for HIV immunological status and HCV co-infection, women (IRR [95%CI]:1.93 [1.17; 3.19]) and men who have sex with men (MSM) (1.97 [1.22; 3.19]) had a higher suicide risk than the rest of the sample. Moreover, the number of discrimination-related social contexts reported (1.39 [1.19; 1.61]), homelessness (4.87 [1.82; 13.02]), and reporting a feeling of loneliness (4.62 [3.06; 6.97]) were major predictors of suicide risk. Conclusions: Reducing the burden of precarious social conditions and discrimination is an important lever for preventing suicide risk among PLHIV in France. Comprehensive care models involving peer/community social interventions targeted at women and MSM need to be implemented to lower the risk of suicide in these specific subgroups of PLHIV. © 2017 Carrieri et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Supporting LGBT Lives? Complicating the suicide consensus in LGBT mental health research - Bryan, A.; Mayock, P. (Sexualities, 2017)
This article locates itself within an emergent, counter-discursive body of scholarship that is critical of universalizing depictions portraying queer-identified or LGBT youth as vulnerable and ‘at-risk’ of a range of negative mental health outcomes, including self-harm and suicidality. Drawing on key findings from a large-scale, mixed-methods study exploring the mental health and well-being of LGBT people, we seek to contribute to the development of a more expansive understanding of LGBT lives by demonstrating the diverse ways people engage with their sexuality and gender identity and illuminating the complex meanings that those LGBT people who have experienced psychological and suicidal distress ascribe to their feelings, thoughts and actions. © 2016, © The Author(s) 2016.
Keywords: Discourse; heteronormativity; LGBT youth; mixed-methods; suicidality

What family physicians can do to combat bullying - McClowry, R.J.; Miller, M.N.; Mills, G.D. (Journal of Family Practice, 2017)

Maternal and paternal personality profiles of adolescent suicide attempters - Bolat, N.; Kadak, T.; Eliacik, K.; Sargin, E.; Incekas, S.; Gunes, H. (Psychiatry Research, 2017)
Personality features have been correlated with suicidal behaviors in recent decades. Given its neurobiological background, Cloninger's model of personality, the Temperament and Character Inventory (TCI), may help to identify the maternal and paternal personality dimensions associated with adolescent suicide attempts. The present study is the first that specifically compares the temperament and character profiles of both mothers and fathers of the adolescent suicide attempters with a control group, by considering the influence of demographic and clinical factors. The study group comprised 117 parents of 71 adolescent suicide attempters and 119 parents of 71 age- and gender-matched adolescents without a suicide attempt included as a control group. The TCI and Brief Symptom Inventory (BSI) were applied to the parents in both groups. Logistic regression analysis, which was performed to adjust confounding factors, demonstrated significantly higher scores for harm avoidance among the mothers and lower scores of self-directedness among the fathers of the adolescent suicide attempters. New psychotherapeutic modalities considering the high-risk parental personality traits would be beneficial to support parent-adolescent relationships and may have a preventative effect on adolescent suicide. © 2016 Elsevier Ireland Ltd
Keywords: Adolescent; Parents; Suicide; Temperament and character traits