The intersection of interpersonal and self-directed violence among general adult, college student and sexually diverse samples - Cramer, R.J.; Desmarais, S.L.; Johnson, K.L.; Gemberling, T.M.; Nobles, M.R.; Holley, S.R.; Wright, S.; Van Dorn, R. (International Journal of Social Psychiatry, 2017)
Background: Suicide and interpersonal violence (i.e. victimization and perpetration) represent pressing public health problems, and yet remain mostly addressed as separate topics. Aims: To identify the (1) frequency and overlap of suicide and interpersonal violence and (2) characteristics differentiating subgroups of violence-related experiences. Methods: A health survey was completed by 2,175 respondents comprised of three groups: college students (n = 702), adult members of a sexuality special interest organization (n = 816) and a community adult sample (n = 657). Latent class analysis was used to identify subgroups characterized by violence experiences; logistic regression was used to identify respondent characteristics differentiating subgroups. Results: Overall rates of violence perpetration were low; perpetration, victimization and self-directed violence all varied by sample. Adults with alternative sexual interests reported high rates of victimization and self-directed violence. Analyses indicated two subgroups: (1) victimization + self-directed violence and (2) self-directed violence only. The victimization + self-directed violence subgroup was characterized by older, White, female and sexual orientation minority persons. The self-directed violence subgroup was characterized by younger, non-White, male and straight counterparts engaging with more sexual partners and more frequent drug use. Conclusion: Findings support the Centers for Disease Control and Prevention (CDC) definition of suicide as self-directed violence. Suicide intervention and prevention should further account for the role of violent victimization by focusing on the joint conceptualization of self-directed and interpersonal violence. Additional prevention implications are discussed. © The Author(s) 2016.
Keywords: interpersonal violence; perpetration; physical assault; Self-directed violence; suicide; victimization

Case study: Analysis of a traumatized hemophiliac boy - Scharff, J.S. (International Journal of Psychoanalysis, 2017)
The author presents a case study of a hemophiliac boy in four-times-a-week analysis from the age of four to six and a half years. An extensive narrative of various phases of the analysis including the termination provides the reader access to the material for discussion of therapeutic action. Her analytic technique is based on a developmental point of view and illustrates the use of limits, play, and interpretation based on countertransference. She understands the boy's symptoms of preferring to be a girl, asking to cut his penis off, and wishing to die as defenses against the fear of castration, which in his case is aggravated by the actual threat of repeated medical interventions, and by the underlying fear of a lack of body composition. An unusual feature of the case is the illustration of the symptom, the analysis, and the recovery of the male self, captured in a complex collage that was made over the course of the relatively short analysis. Copyright © 2016 Institute of Psychoanalysis
Keywords: body integrity anxiety; castration anxiety; child analysis; cross-dressing; hemophilia; suicidality

Utopian Hopes or Dystopian Fears? Exploring the Motivational Underpinnings of Moralized Political Engagement - Skitka, L.J.; Hanson, B.E.; Wisneski, D.C. (Personality and Social Psychology Bulletin, 2017)
People are more likely to become politically engaged (e.g., vote, engage in activism) when issues are associated with strong moral convictions. The goal of this research was to understand the underlying motivations that lead to this well-replicated effect. Specifically, to what extent is moralized political engagement motivated by proscriptive concerns (e.g., perceived harms, anticipated regret), prescriptive concerns (e.g., perceived benefits, anticipated pride), or some combination of these processes? And are the motivational pathways between moral conviction and political engagement the same or different for liberals and conservatives? Two studies (combined N = 2,069) found that regardless of political orientation, the association between moral conviction and political engagement was mediated by the perceived benefits of preferred but not the perceived harms of non-preferred policy outcomes, and by both anticipated pride and regret, findings that replicated in two contexts: legalizing same-sex marriage and allowing concealed weapons on college campuses. © 2016, © 2016 by the Society for Personality and Social Psychology, Inc.
Keywords: activism; gun control; moral conviction; moral motives; morality; political engagement; prescription; proscription; same-sex marriage

Mental Health Service Use in a Sample of Gay, Bisexual, and other Men who have Sex with Men Living in Middlesex County, Ontario, Canada: An Exploratory Analysis - Coleman, T.A.; Bauer, G.R.; Aykroyd, G.; Powell, L.; Pugh, D. (Canadian Journal of Community Mental Health, 2017)
Risks of mental health issues (e.g., depression, anxiety/mood disorders, and suicidality) are found to be elevated among Canadian gay, bisexual, and men who have sex with men (GB-MSM). We studied factors impacting mental health care use in a community sample of 202 GB-MSM in London-Middlesex, Ontario. Our results show that, for the entire sample, experiences of both homophobia and internalized homonegativity are associated with increased prevalence of mental health service use over the past year, and suggest that service use is lower among immigrant GB-MSM than among those born in Canada. Implications for mental health and social service providers are discussed.
Keywords: Bisexual; Gay; Men who have sex with men; Mental health service use

Fighting for survival: The experiences of lesbian, gay, bisexual, transgender, and questioning students in religious colleges and universities - Craig, S.L.; Austin, A.; Rashidi, M.; Adams, M. (Journal of Gay and Lesbian Social Services, 2017)
Little is known about the experiences of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students attending religious colleges and universities. This study used grounded theory to analyze the narratives (N = 271) of LGBTQ former and current students. The central theme described by LGBTQ students was a fight for survival with five subthemes: (a) institutionalized homo/transphobia (strict school policies, enforcement of heterosexuality and gender conformity through discipline, conversion therapy); (b) a culture of fear (fear of exposure, homophobic panic and code words, seeking cover); (c) marginalization and isolation; (d) struggle (suffering and suicide, reconciling faith and LGBTQ identity); and (e) coping and resilience (surviving through critical thinking and strategic activism). Implications for practice are provided. © 2017 Taylor & Francis Group, LLC.
Keywords: gay, lesbian, bisexual, and transgender students; hegemony; religious abuse; religious colleges and universities

Queer youth and mental health: What do educators need to know? - Bryan, A. (Irish Educational Studies, 2017)
This paper considers the educational implications of the recent emphasis on the mental health and well-being of lesbian, gay, bisexual, transgender, questioning/queer (LGBTQ) people in Ireland. Operating from the perspective that discourses constitute rather than merely reflect material reality, thereby shaping or ‘structuring’ how we think about, and act, in relation to queer experience, the paper critically engages with discourses which position LGBTQ youth as universally at risk of mental health difficulties, including self-harm and suicidality. It also challenges the corresponding preoccupation with homophobic bullying as the primary lens through which queer experience is understood and addressed in schools, arguing that more space needs to be devoted to other, less harrowing narratives of LGBTQ experience and identity. It highlights some of the more problematic effects of LGBTQ mental health research which frame LGBTQ experience primarily in terms of vulnerability and victimhood and makes the case for a more expansive engagement with LGBTQ identities. The article illuminates the potential that after-queer scholarship holds for a re-imagining of queer youth, sexuality and gender within educational and social research, curriculum materials and educational institutions more generally and concludes with a consideration of specific knowledge and skills that educators should be equipped with in order to disrupt normative understandings of gender and sexuality. © 2017 Educational Studies Association of Ireland.
Keywords: after-queer scholarship; discourse; mental health; sexuality; suicidality

Ideological framing in U.S. news coverage of Sochi Winter Olympic Games - Pan, P.-L.; Lawal, T. (Russian Journal of Communication, 2017)
This study used an ideological approach to examine news coverage of the Sochi Olympic Games in two U.S. mainstream newspapers–the Washington Times and New York Times. Based upon the theoretical framework of public diplomacy framing, findings suggested that the Washington Times framed the Sochi Olympics more negatively, while the New York Times used more neutral frames to report the games. Specifically, the Washington Times was more likely to point the finger at the ills of the city rather than focus on why people went to Sochi for the Olympics and repeat historical events and facts that described Sochi as an unsafe city. However, the New York Times framed the games more thematically that exhibited the issues of the terrorist attacks, suicide bombers, and disturbing violence toward the Lesbian, Gay, Bisexual, and Transgender people in Russia. Limitations and implications were also discussed. © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: International communication; media effects; media framing; public diplomacy; strategic communications

The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample - Trujillo, M.A.; Perrin, P.B.; Sutter, M.; Tabaac, A.; Benotsch, E.G. (International Journal of Transgenderism, 2017)
Introduction: Per the minority stress framework, trans individuals often experience psychological distress given the unique stress engendered by gender identity–related discrimination. Prior research has identified social support as particularly important for psychological distress and has suggested that social support may moderate this relationship. The purpose of the current study was to explore the patterns of connections among discrimination, mental health, and suicidal ideation in trans individuals and whether social support moderates these relationships. Methods: Participants (N = 78) completed measures of these constructs as part of a national online survey. Results: A series of simultaneous multiple regressions found that harassment/rejection discrimination was a unique positive predictor of mental health symptoms and suicidal ideation, with depression positively predicting suicidal ideation. A mediational model indicated that the association between harassment/rejection discrimination and suicidal ideation was fully mediated by depression. Three moderated meditational models were run, and one yielded a significant interaction, such that discrimination predicted suicidal ideation most strongly when participants had low social support from a significant other in comparison to participants who had moderate or high support. Further, conditional direct effects identified that discrimination led to ideation only for individuals with low support from friends or a significant other but not for those with moderate or high support. Conclusions: Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population. © 2017 Taylor & Francis Group, LLC.
Keywords: Discrimination; mental health; social support; suicide

Health disparities between lesbian, gay, and bisexual adults and the general population in South Korea: Rainbow Connection Project I - Yi, H.; Lee, H.; Park, J.; Choi, B.; Kim, S.-S. (Epidemiology and health, 2017)
OBJECTIVES: This study aims to investigate health disparities between lesbian, gay, and bisexual (LGB) adults and the general population in Korea, where there is low public acceptance of sexual minorities and a lack of research on the health of sexual minorities. RESULTS: Korean LGB adults exhibited a statistically significantly higher prevalence of depressive symptoms, suicidal ideation and attempts, and musculoskeletal pain than the general population. Lesbian and bisexual women had a higher risk of poor self-rated health and smoking than the general women population, whereas gay and bisexual men showed no differences with the general men population. Higher prevalence of hazardous drinking was observed among lesbians, gay men, and bisexual women compared to the general population, but was not observed in bisexual men. CONCLUSIONS: The findings suggest that LGB adults have poorer health conditions compared to the general population in Korea. These results suggest that interventions are needed to address the health disparities of Korean LGB adults. METHODS: The research team conducted a nationwide survey of 2,335 Korean LGB adults in 2016. Using the dataset, we estimated the age-standardized prevalence ratios (SPRs) for poor self-rated health, musculoskeletal pain, depressive symptoms, suicidal behaviors, smoking, and hazardous drinking. We then compared the SPRs of the LGB adults and the general population which participated in three different nationally representative surveys in Korea. SPRs were estimated for each of the four groups (i.e., gay men, bisexual men, lesbians, and bisexual women).
Keywords: Health status disparities; Minority health; Republic of Korea; Sexual minorities

Associations of outside-and within-school adult support on suicidality: Moderating effects of sexual orientation - Coulter, R.W.S.; Schneider, S.K.; Beadnell, B.; O'Donnell, L. (American Journal of Orthopsychiatry, 2017)
This study examined sexual-orientation differences in reports of outside- and within-school adult support, and whether sexual orientation moderates the associations between adult support and suicidality (i.e., thoughts, plans, and attempts). At 26 high schools across MetroWest Boston, 22,834 students completed surveys assessing: sexual orientation (heterosexual, gay/lesbian, bisexual, or questioning); presence of outside- and within-school adult support; and past-year suicidality. Multivariable regression analyses with General Estimating Equations (adjusting for gender, grade, and race/ethnicity) examined sexual-orientation subgroup differences in adult support, and how sexual orientation and adult support were associated with suicidality. Interaction terms tested whether relationships between adult support and suicidality were moderated by sexual orientation. Gay/lesbian, bisexual, and questioning youth were each less likely than heterosexuals to report having outside-school adult support (risk ratios range: 0.85- 0.89). Each group also had greater odds than heterosexuals for suicidal thoughts (odds ratios [ORs] range: 1.86 -5.33), plans (ORs range: 2.15-5.22), and attempts (ORs range: 1.98 -7.90). Averaged across sexual-orientation subgroups, outside-school support was more protective against suicidality (ORs range: 0.34-0.35) than within-school support (ORs range: 0.78-0.82). However, sexual orientation moderated the protective effects of outside-school adult support, with support being less protective for bisexual and questioning youth than for heterosexuals. Adult support, and particularly outside-school adult support, is associated with lower suicidality. However, fewer gay/lesbian, bisexual, and questioning youth can rely on outside-school support and, even if present, it may be less protective against suicidality. Interventions are needed to help adults support gay/lesbian, bisexual, and questioning youth and reduce suicidality disparities. © 2016 Global Alliance for Behavioral Health and Social Justice.
Keywords: Adult support; Mental health; Sexual orientation; Suicidality

Older Age Associated with Mental Health Resiliency in Sexual Minority US Veterans - Monin, J.K.; Mota, N.; Levy, B.; Pachankis, J.; Pietrzak, R.H. (American Journal of Geriatric Psychiatry, 2017)
Objectives Objectives were to: (a) identify the mental health needs of older and younger sexual minority and heterosexual U.S. veterans and (b) examine whether sexual minority status confers vulnerability or resiliency in older adulthood. Support and trauma exposure were examined as potential mechanisms for age by sexual orientation differences. Methods Participants were a nationally representative sample of 3,095 U.S. veterans (ages 21 to 96 years). Measures included demographics, military characteristics, sexual orientation (lesbian, gay, or bisexual; LGB), social support, trauma, and mental health indicators (lifetime and present depression and post-traumatic stress disorder (PTSD); lifetime anxiety and suicidal ideation). Results Younger LGB veterans were most likely to report lifetime depression and/or PTSD and current depression compared with older LGB and younger and older heterosexual veterans. Older LGB veterans had low levels of mental health problems, but they reported the smallest social support networks. Conclusions Older and younger LGB veterans have different mental health challenges. Younger LGB veterans are more vulnerable to mental health problems than their older LGB peers. Older LGB veterans are resilient, but they may be at greater risk of social isolation than their younger LGB peers. © 2017 American Association for Geriatric Psychiatry
Keywords: aging; mental health; Sexual minority status; veterans

Suicidal Ideation in Transgender People: Gender Minority Stress and Interpersonal Theory Factors - Testa, R.J.; Michaels, M.S.; Bliss, W.; Rogers, M.L.; Balsam, K.F.; Joiner, T. (Journal of Abnormal Psychology, 2017)
Research has revealed alarmingly high rates of suicidal ideation (SI) and suicide attempts among transgender and gender nonconforming (TGNC) people. This study aims to analyze the role of factors from the gender minority stress and resilience (GMSR) model (Testa, Habarth, Peta, Balsam, & Bockting, 2015), the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005; Van Orden et al., 2010), and the potential integration of these factors, in explaining SI in this population. A convenience sample of 816 TGNC adults responded to measures of current SI, gender minority stressors, and IPTS factors. Path analysis was utilized to test 2 models. Model 1 evaluated the associations between external minority stressors and SI through internal minority stressors. Model 2 examined the relationships between internal minority stressors and SI through IPTS variables (perceived burdensomeness and thwarted belongingness). All GMSR external stressors (rejection, nonaffirmation, victimization, and discrimination), internal stressors (internalized transphobia, negative expectations, and nondisclosure), and IPTS factors (thwarted belongingness and perceived burdensomeness) were related to SI. Both models demonstrated good fit. Model 1 revealed that rejection, nonaffirmation, and victimization were related to SI through experiences of internalized transphobia and negative expectations. Model 2 indicated that internalized transphobia and negative expectations were associated with SI through IPTS factors. The models demonstrate pathways through which GMSR and IPTS constructs relate to one another and confer risk for SI among TGNC individuals. These pathways and several recently proposed constructs examined here provide promising directions for future research and clinical interventions in this area. © 2016 American Psychological Association.
Keywords: Interpersonal theory of suicide; Minority stress; Suicidal ideation; Transgender

Factors associated with self-reported discrimination against men who have sex with men in Brazil - Magno, L.; Dourado, I.; da Silva, L.A.V.; Brignol, S.; Brito, A.M.; Guimarães, M.D.C.; Benzaken, A.; Pinho, A.A.; Kendall, C.; Kerr, L.R.F.S. (Revista de saude publica, 2017)
OBJECTIVE: To estimate self-reported discrimination due to sexual orientation among men who have sex with men (MSM) in Brazil and to analyze associated factors. METHODS: A cross-sectional study of 3,859 MSM recruited in 2008-2009 with respondent driven sampling. Data collection conducted in health centers in 10 Brazilian cities. A face-to-face questionnaire was used and rapid HIV and syphilis tests conducted. Aggregated data were weighted and adjusted odds ratio estimated to measure the association between selected factors and self-reported discrimination due to sexual orientation. RESULTS: The sample was predominantly young, eight plus years of schooling, pardo (brown), single, low-income, and identified themselves as gay or homosexual. The prevalence of self-reported discrimination due to sexual orientation was 27.7% (95%CI 26.2-29.1). Discrimination was independently associated with: age < 30 years, more years of schooling, community involvement and support, history of sexual and physical violence, suicidal thoughts, and unprotected receptive anal intercourse. CONCLUSIONS: The prevalence of self-reported discrimination among MSM in Brazil is high. These results challenge the assumptions that MSM-specific prevention and support programs are not required or that health professionals do not need special training to address MSM needs.

Religious anti-gay prejudice as a predictor of mental health, abuse, and substance use - Sowe, B.J.; Taylor, A.J.; Brown, J. (American Journal of Orthopsychiatry, 2017)
Anti-gay, or homonegative, prejudice is generally considered harmful to the wellbeing of sexual minority individuals. However, the origins or nature of such prejudice may vary. Despite a sizable body of literature suggesting homonegative prejudice is frequently religious-based, the psychological impact of exposure to religious anti-gay prejudice remains largely undetermined. Addressing this research gap, the authors examined whether opposition to same-sex sexuality on religious grounds predicted detrimental outcomes among same- and both-sex attracted individuals, as well as their heterosexual counterparts. A nationwide U.S. sample of 1600 individuals-recruited using contemporary online crowd-sourcing techniques designed to limit selection bias-completed a novel inventory assessing interpersonal exposure to religious (as well as nonreligious) homonegative disapproval. Outcome variables assessed included a number of clinically relevant measures spanning general mental health, social support, suicidality, abuse, and substance use. Analyses revealed that greater exposure to religious anti-gay prejudice predicted higher levels of anxiety, stress, and shame; more instances of physical and verbal abuse; and more problematic alcohol use. Furthermore, while sexual minority individuals tended to fare more poorly than their heterosexual counterparts on almost every outcome measure assessed, homonegative prejudice predicted poorer outcomes among all respondents regardless of their sexual orientation or religious identification. Hence, results are among the first to demonstrate that anti-gay religious exposure is associated with substantial threats to wellbeing, and that such effects may be observed beyond religious sexual minorities. Overall, findings imply that homonegative religious social conditions may be of broader health and mental health concern than is conventionally recognized. © 2017 Global Alliance for Behavioral Health and Social Justice.
Keywords: Anti-gay prejudice; Mental health; Religion; Sexual minority; Substance use

Beyond depression and suicide: The mental health of transgender college students - Oswalt, S.B.; Lederer, A.M. (Social Sciences, 2017)
Research studies examining the mental health of transgender individuals often focus on depression, anxiety, and suicidal ideation through the use of clinic samples. However, little is known about the emerging adult (18-26 years old) transgender population and their mental health. The current study seeks to fill that gap by using a national dataset of college students (N = 547,727) to examine how transgender college students (n = 1143) differ from their cisgender peers regarding 12 different mental health conditions. Chi-square and regression analyses were conducted. Results demonstrate that transgender students have approximately twice the risk for most mental health conditions compared to cisgender female students. A notable exception is schizophrenia, in which transgender individuals have about seven times the risk compared to cisgender females. While these were significant findings, regression analyses indicate that being non-heterosexual is a greater predictor for mental health concerns. Implications for mental health practitioners at colleges and universities are discussed. © 2016 by the author.
Keywords: Anxiety; College health; College student; Depression; Gender identity; Gender nonconforming; Mental health; Schizophrenia; Transgender

Queering the health care system: Experiences of the lesbian, gay, bisexual, transgender community - Lee, A.; Kanji, Z. (Canadian Journal of Dental Hygiene, 2017)
The lesbian, gay, bisexual, transgender (LGBT) community represents a population of people diverse in gender, sex, and sexual orientation. This literature review explores the current research on the health care experiences of LGBT individuals in North America in an attempt to identify the barriers to care that they face and develop strategies to increase their overall health. The health care experiences of LGBT individuals were explored across 7 dimensions: existence, bodily integrity, emotional integrity, worth, uniqueness, expression, and power. The LGBT community has unique health concerns and is at higher risk for mental health conditions, substance use, and suicide. These health disparities have been associated with social discrimination, ignorance, and assumptions made about gender, sex, and sexuality. Such barriers encountered by this population have also led to delayed or discontinued care, non-disclosure of sexuality or gender identity, increased negative health behaviours, and internalized stigma. The experiences that were identified reveal a strong need to reassess and strengthen the cultural sensitivity training and LGBT education provided to health care professionals. © 2017 Canadian Dental Hygienists Association.
Keywords: Barriers; Bisexual; Discrimination; Gay; Health care experience; Health care providers; Lesbian; Queer; Transgender

"Connection is the antidote": Psychological distress, emotional processing, and virtual community building among LGBTQ students after the Orlando shooting - Jackson, S.D. (Psychology of Sexual Orientation and Gender Diversity, 2017)
Scholars have called for increased research on the process by which lesbian, gay, bisexual, transgender, and queer (LGBTQ) people cope with stigma and hate-related incidents. Homophobic hate crimes, for example, may have a ripple effect within the LGBTQ community, in which individuals beyond the immediate victim experience psychological distress and, in some cases, vicarious traumatization. The present case study examines the emotional, cognitive, and behavioral responses of LGBTQ individuals to the 2016 Orlando mass shooting, an event conceptualized as an anti-LGBTQ hate crime. On the day of the Orlando shooting, a group of graduate students who were connected through a listserv related to sexual orientation and gender diversity received a prompt intended to facilitate open discussion and emotional processing regarding the Orlando shooting. Thirty-three LGBTQ psychology graduate students participated in the virtual discussion. The content within this conversation thread was reviewed and organized into six thematic categories: (1) emotional distress, (2) personal significance of the event, (3) feelings of in-group isolation and community connectedness, (4) self-care and coping strategies, (5) the need for action, and (6) expressions of gratitude for the discussion forum. Implications are discussed in light of literature on community reactions to hate-motivated violence, virtual community support, and LGBTQ coping strategies. © 2014 American Psychological Association.
Keywords: Emotional processing; LGBTQ hate crimes; Sexual and gender minorities; Vicarious traumatization; Virtual community support

Physical activity and suicidal behaviors in gay, lesbian, and bisexual Korean adolescents - Jang, S.; So, W.-Y.; Choi, E.-J. (Journal of Men's Health, 2017)
The purpose of this study was to examine whether physical activities were related to suicidal behaviors in gay, lesbian, and bisexual Korean adolescents. In 2015, 68,043 adolescents participated in the 11th Korea Youth Risk Behavior Web-Based Survey project. However, only 628 of these 68,043 participants provided enough information about their romantic and sexual behaviour to be categorized as gay or bisexual boys (n 5 430) or lesbian or bisexual girls (n 5 198). The relationships between physical activities and suicidal behaviours were evaluated by multivariate logistic regression analysis after adjustment for covariate variables such as economic status of the family, mental stress, frequency of smoking, and frequency of drinking. There were no significant relationships between muscle-strengthening exercises and the suicidal behaviour categories (seriously considered, planned, and attempted) both in gay or bisexual boys and in lesbian or bisexual girls. Additionally, there were no significant relationships between vigorous physical activity and the suicidal behaviour categories in gay or bisexual boys. However, there were a significant relationship between vigorous physical activity and suicidal behaviour categories in lesbian or bisexual girls. There were slightly significant relationships between light physical activity (walking) and suicidal behaviour both in gay or bisexual boys and in lesbian or bisexual girls. We concluded that, for gay or bisexual boys, light physical activity might be associated with a reduced risk of suicidal behaviours. However, vigorous physical activity and muscle-strengthening exercises were not associated with suicidal behaviours. For lesbian or bisexual girls, vigorous physical activity might be associated with a reduced risk of suicidal behaviours. However, muscle-strengthening exercises had no association with suicidal behaviours. © 2017 The Dougmar Publishing Group.
Keywords: Bisexual; Gay; Lesbian; Physical activity; Suicidal behaviours; Youth

Perceptions of safety among LGBTQ people following the 2016 Pulse nightclub shooting - Stults, C.B.; Kupprat, S.A.; Krause, K.D.; Kapadia, F.; Halkitis, P.N. (Psychology of Sexual Orientation and Gender Diversity, 2017)
The goals of this manuscript are twofold. First, we provide a brief reaction to this journal's "Special Section: Reflections on the Orlando Massacre on its First Anniversary." Second, we present findings from a study on perceptions of safety among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals following the Pulse shooting. These issues are discussed within the historical context of hate crimes experienced by the LGBTQ population (Herek), media coverage following the shooting (Hancock and Halderman), and the immediate reaction of LGBTQ graduate students to the event (Jackson). Our study sought to examine differences in perceptions of personal and peer safety by race/ethnicity, gender identity, and sexual orientation among a large, diverse sample of LGBTQ people. Findings from our study indicate that there were differences in perceptions of personal safety by gender identity, and differences in perceptions of peer safety by gender identity and sexual orientation. These findings also suggest that subgroups of the LGBTQ community with more marginalized gender and sexual identities (e.g., female, transgender, genderqueer, bisexual, queer respondents) perceived more concerns related to safety, on average, than subgroups with relatively more privilege (e.g., gay, male). Elevated safety concern may exacerbate multiple minority stress burden, a known driver of poor health outcomes among LGBTQ people. These findings are a call to action to health care providers to be well informed and trained to provide the appropriate care and counseling referrals that can address the safety-related concerns of LGBTQ individuals in the aftermath of identity-related attacks. © 2017 American Psychological Association.
Keywords: Collective trauma; LGBTQ people; Mass shooting; Perceptions of safety; Pulse nightclub

Clinical barriers to effective treatment of eating disorders and co-occurring psychiatric disorders in transgendered individuals - Wagner, R.; Stevens, J.R. (Journal of Psychiatric Practice, 2017)
Eating disorders (EDs) are complex and difficult to treat illnesses that are often chronic and disabling on their own accord or due to comorbidity with other psychiatric conditions. Historically, EDs have been viewed as illnesses of heterosexual, affluent white females. This stereotype increases the likelihood that these disorders will be underrecognized in the lesbian, gay, bisexual, and transgender community, as well as in different gender, socioeconomic, and ethnic populations. Our case report illustrates the clinical difficulties of managing a patient who presented to inpatient treatment with complaints of depression and suicidality, but who also had an active ED and was transgender. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: Comorbidity; Eating disorders; Shame; Suicide; Transgender

Between the lines: Media coverage of Orlando and beyond - Hancock, K.A.; Haldeman, D.C. (Psychology of Sexual Orientation and Gender Diversity, 2017)
The relative unresponsiveness of the news media to the racism and homophobia of the Orlando shootings was deeply disturbing to the lesbian, gay, bisexual, and transgender community. The focus on terrorism and gun control (major topics in the 2016 presidential campaign) neglected the fact that this massacre was a hate crime. This article describes some of the fundamentals involved in the process of reporting the news and decision-making in the media that likely contributed to the narrow reporting of this tragedy. It also addresses heteronormativity, the impact of neglecting to highlight racism and homophobia in this shooting, and what might have been gained by more appropriate interpretation of the shooting as a hate crime. Additional suggestions are also offered regarding the roles that psychologists can play. © 2014 American Psychological Association.
Keywords: Heteronormativity and the news; Impact of orlando shooting; LGBT hate crimes and the media; LGBT invisibility; Orlando shooting news coverage

Suicide in trans populations: A systematic review of prevalence and correlates - McNeil, J.; Ellis, S.J.; Eccles, F.J.R. (Psychology of Sexual Orientation and Gender Diversity, 2017)
Trans people experience high rates of attempted suicide and suicidal ideation. No study to date has collated the various findings concerning correlates of trans suicide. This systematic review aimed to summarize the available data and provide recommendations based on this evidence. Articles were included if they were published before November 2016, were in English, were peer reviewed, and presented data concerning trans people's suicide attempts or ideation. Nine databases were searched, and 30 articles were selected. Discrimination emerged as strongly related to suicidal ideation and attempts, whereas positive social interactions and timely access to interventions appeared protective. Limitations included differences in how articles defined trans people or measured suicide and in their largely cross-sectional nature, making assumptions about causality in reference to lifetime ideation or attempts impossible. However, results clearly indicated a need to work at both individual and structural levels to reduce society- and service-level discrimination, enhance peer support, and ensure access to required interventions. The review highlights the need to explore suicidality in the trans population both in relation to general suicide models and in relation to models of minority stress. © 2017 American Psychological Association.
Keywords: Suicidal ideation; Suicide attempts; Systematic review; Transgender

The Stonewall riots: Moving from the margins to the mainstream - Notaro, S.R. (Advances in Education in Diverse Communities: Research, Policy and Praxis, 2017)
This chapter provides evidence that the Stonewall Inn riots were the foundation for a legacy of empowerment and improvements in the civil and political rights of the Lesbian, Gay, Bisexual, and Transgender (LGBT) community in the United States. Increased protections in the United States and globally are needed to fully integrate LGBT individuals into society. The next phase of this work will examine how the failure to extend equitable civil and political rights to LGBT individuals has led to continued stigma and discrimination which, in turn, is associated with a host of LGBT health disparities ranging from HIV to suicide to substance use. Future research will also identify ways to reduce these inequities. Copyright © 2017 by Emerald Publishing Limited.
Keywords: Civil rights; Homosexuality; Legacy; Lgbtq; Riots; Stonewall Inn

On My Terms: Sharing a Story of Hypocrisy and Transformation - Clauss-Ehlers, C.S.; Parham, W.D. (Journal of Multicultural Counseling and Development, 2017)
The 4th interviewee for the Hearing Our Elders series is Mr. Bob Zellner. Mr. Zellner's experience growing up in the segregated South underscores a commitment to stand up to obstacles and societal norms, even when to do so was life threatening. His experiences remind us of a historical time not too long ago that, to hear, one might think could never happen. And yet, witnessing his experience in the context of modern-day struggles portrayed in the civil rights movement; the 2016 Tennessee denial of service law for lesbian, gay, bisexual, transgender, and queer individuals; and the 2016 Orlando shooting outside a gay nightclub reminds us that the historical events of Mr. Zellner's past are not too distant from the present. The interview captures 6 themes: being nonconforming in the face of punitive measures, living a purposeful life, pushing beyond comfort zones, early experiences as resilience building, self-evaluation as a cornerstone for commitment, and giving meaning to grief. El señor Zellner creció en una comunidad segregada del sur, y su experiencia subraya su compromiso para enfrentar obstáculos y normas sociales, aunque hacerlo pueda poner en riesgo la vida. Sus vivencias nos recuerdan un periodo histórico no muy lejano que hoy podría parecer inconcebible. Y aun así, contemplar sus experiencias en el contexto de las luchas actuales del movimiento por los derechos civiles (como la ley de 2016 en Tennessee que permitía denegar servicios a personas lesbianas, gais, bisexuales, transexuales y queer; y el tiroteo de 2016 en Orlando en un club gay) nos recuerda que los eventos históricos del pasado del señor Zellner no están tan alejados del presente. La entrevista captura 6 temas: el inconformismo frente a medidas punitivas, vivir la vida con decisión, salir de las zonas de confort, experiencias tempranas como factores de resiliencia, la autoevaluación como cimiento del compromiso, y darle sentido al sufrimiento. © 2017 American Counseling Association. All rights reserved.
Keywords: a purposeful life; Bob Zellner; Hearing Our Elders

Psycho killers, circus freaks, ordinary people: A brief history of the representation of transgender identities on american tv series - Bermúdez de Castro, J. (Oceanide, 2017)
In 1965, popular TV Series The Alfred Hitchcock Hour (NBC) aired the episode “An Unlocked Window”, in which it is revealed that the nurses killer in the area is a transvestite. It was the first time a transgender character appeared on a TV series, and until the late 80s that was the most stereotypical and basic – because it was minimal – representation of transsexuals on broadcast TV series and films: as psychopaths and serial killers. Other examples are Aldo Lado’s Who Saw Her Die? (1972), Brian de Palma’s Dressed to Killed (1980), Robert Hiltzick’s Sleepaway Camp (1983) and Jonathan Demme’s The Silence of the Lambs (1991). Throughout the 90s the paradigm changed completely and transsexual characters became much more frequent. However, the change was not for good, as they were turned now into objects of mockery and disgust in comedy TV series and films, in which the protagonist heterosexual male was “deceived” into kissing or having sex with an “abhorrent” trans just as a comic device. In the comedies Soapdish (1991), Ace Ventura (1994), and Naked Gun 33 1/3 (1994), the male protagonist ends up literally throwing up when he realizes that the girl he had been kissing was not born a female. Friends (1994-2004) and Ally McBeal (1997-2002) are also series of the late 90s in which the way transgender characters are represented is far from being appropriate. It has not been until the Golden Globe and Emmy awarded TV series Transparent (2014-2016) when transgender issues have been put realistically on the front line with the accuracy and integrity that they deserve. This article traces back the evolution of the representation of transsexual identities on American TV series in the last decades by exploring the ups, downs, twists and turns that this representation has undergone in its long and hard road. © 2017, Sociedad Espanola de Estudios Literarios de Cultura Popular. All rights reserved.
Keywords: Friends; Hitchcock; Transgender characters; Transparent; TV series

Committee Opinion No. 685: Care for Transgender Adolescents - Committee on Adolescent Health Care (Obstetrics and gynecology, 2017)
Gender nonconforming youth are an underserved population who obstetrician-gynecologists are seeing increasingly in their practices. Currently, there are large gaps in training, knowledge, and comfort with transgender patients among obstetrician-gynecologists. The purpose of this document is to review current recommendations that apply to an obstetrician-gynecologist. It is important for obstetrician-gynecologists to be aware of the social and mental health risks for the transgender population. Consensus guidelines support initiating medical therapy after an adolescent has an established diagnosis of transgender identity and has reached Tanner stage II development. Medical management involves the suppression of puberty (typically in the form of gonadotropin-releasing hormone agonists) followed by cross-sex hormone therapy to induce puberty at age 16 years. A variety of surgical options are available, including bilateral mastectomy, hysterectomy with bilateral salpingo-oophorectomy or salpingectomy, and possible neophallus creation. Transgender patients are an at-risk population, and preventive medicine is imperative to their health. This includes proper screening for sexually transmitted infections, screening for suicidal thoughts and mental health issues, and appropriate vaccination. Like all patients, transgender adolescents should have a source for ongoing primary care.

Mental Health Disparities Among Canadian Transgender Youth - Veale, J.F.; Watson, R.J.; Peter, T.; Saewyc, E.M. (Journal of Adolescent Health, 2017)
Purpose This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14–18 and 19–25). Methods A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Results Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. Conclusions Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable. © 2016 Society for Adolescent Health and Medicine
Keywords: Depression; Mental health; Self-harm; Suicide; Transgender

Committee Opinion No. 685 Summary: Care for Transgender Adolescents (Obstetrics and gynecology, 2017)
Gender nonconforming youth are an underserved population who obstetrician-gynecologists are seeing increasingly in their practices. Currently, there are large gaps in training, knowledge, and comfort with transgender patients among obstetrician-gynecologists. The purpose of this document is to review current recommendations that apply to an obstetrician-gynecologist. It is important for obstetrician-gynecologists to be aware of the social and mental health risks for the transgender population. Consensus guidelines support initiating medical therapy after an adolescent has an established diagnosis of transgender identity and has reached Tanner stage II development. Medical management involves the suppression of puberty (typically in the form of gonadotropin-releasing hormone agonists) followed by cross-sex hormone therapy to induce puberty at age 16 years. A variety of surgical options are available, including bilateral mastectomy, hysterectomy with bilateral salpingo-oophorectomy or salpingectomy, and possible neophallus creation. Transgender patients are an at-risk population, and preventive medicine is imperative to their health. This includes proper screening for sexually transmitted infections, screening for suicidal thoughts and mental health issues, and appropriate vaccination. Like all patients, transgender adolescents should have a source for ongoing primary care.

Exploring Rural Disparities in Medical Diagnoses among Veterans with Transgender-related Diagnoses Utilizing Veterans Health Administration Care - Bukowski, L.A.; Blosnich, J.; Shipherd, J.C.; Kauth, M.R.; Brown, G.R.; Gordon, A.J. (Medical Care, 2017)
Objectives: Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. Methods: This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Results: Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. Conclusions: This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research. © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: transgender; urban/rural; veterans; Veterans Affairs

Issues of gender & sexuality in Special Needs children: Keeping students with autism & learning disability safe at school - Lawson, W.B. (Journal of Intellectual Disability - Diagnosis and Treatment, 2017)
The following paper addresses some of the issues presented by students with Special Needs, (especially autism) at school. It particularly focusses upon sexuality and gender. For example, autism and gender dysphoria appear to co-occur more often than in typically developing students. However, these young people may not understand how their reality translates to living within the public arena. This is also true of sexuality. Acceptance, understanding and accommodation of these students needs to inform our measures for keeping safe at school; this is of utmost priority. © 2017 Lifescience Global.
Keywords: Autism; Gender; Gender Dysphoria; Gender Variance; Learning disability; Safety; School; Sexuality; Special needs; Suicide

Women firefighters and workplace harassment associated suicidality and mental health sequelae - Hom, M.A.; Stanley, I.H.; Spencer-Thomas, S.; Joiner, T.E. (Journal of Nervous and Mental Disease, 2017)
This cross-sectional study investigated the association between harassment, career suicidality, and psychiatric symptoms among women firefighters. Women firefighters (n = 290) completed self-report measures of experiences with harassment on the job, career suicidality, and various psychiatric symptoms. Logistic regression analyses and one-way analyses of variance were used to address study aims. Of the sample, 21.7% reported having experienced sexual harassment and 20.3% reported having been threatened or harassed in another way on their firefighting job. Sexual harassment and other threats/harassment on the job were both significantly associated with a greater likelihood of reporting career suicidal ideation, as well as reporting more severe psychiatric symptoms. Harassment and threats experienced on the job may be associated with increased suicide risk and more severe psychiatric symptoms among women firefighters. Efforts are needed to reduce the occurrence of harassment and threats within the fire service and provide support for women firefighters who have been harassed or threatened. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: Firefighter; Harassment; Suicide; Women; Workplace

Suicide in university students in Bogotá, Colombia, 2004-2014 - Franco, S.A.; Gutiérrez, M.L.; Sarmiento, J.; Cuspoca, D.; Tatis, J.; Castillejo, A.; Barrios, M.; Ballesteros-Cabrera, M.P.; Zamora, S.; Rodríguez, C.I. (Ciencia e Saude Coletiva, 2017)
We report the results of a retrospective, descriptive, qualitative study of suicide among university students in Bogotá, Colombia. The objective of this study was to document the magnitude, principal characteristics, and impact of this phenomenon in the selected population. A semi-structured survey was employed to collect information from 66 individuals linked to the universities. A total of 45 cases of suicide were documented in the study period (2004-2014). Of these, 69% occurred in males and 31% in females. The age range was 17-27 years, with 62% of the cases in the 19-22 year-old group. The most common mechanisms employed were suffocation and poisoning, followed by intentional falls, use of a firearm, and drug overdose. The selected location was the place of residence in 52% of cases and the university campus in 16% of cases. The distribution of students by area of knowledge showed a predominance of social and human science (44%) followed by engineering (22%). A history of difficulties in family and affective relationships was common among victims, as was a history of exposure to intolerance of differences in sexual orientation. The individuals surveyed expressed a wide range of interpretations of the significance of suicide, both positive (courage, self-affirmation, autonomy) and negative (defeat, despair, and an inability to adapt). © 2017, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.
Keywords: Colombia; Qualitative research; Suicide; Universities

Overview of young people attempting suicide by drug overdose and prevention and protection services - Bilginer, C.; Cop, E.; Goker, Z.; Hekim, O.; Sekmen, E.; Uneri, O. (Dusunen Adam, 2017)
Objective: Suicide is the second leading cause of death among 15-29 year-old-people in the world. The aim of this study is to present the characteristics of children and adolescents attempting suicide by drug overdose and to draw attention to preventive measures that can be taken in Turkey. Method: Records of the patients who admitted to a training and research hospital in one year period due to a suicide attempt by drug overdose were reviewed retrospectively. Sociodemographic data and psychiatric evaluation records of attempters were documented. Results: During the study period, 163 adolescents applied to the hospital with suicidal drug overdose. Child psychiatry consultation was ordered for 61.3% (n=100) of them. It was the first attempt of 90% of the cases. The frequency of having previous psychiatric diagnosis was significantly higher in patients with recurrent suicide attempts. In both impulsive and planned suicide attempts, the most preferred times were evening and night time. Women more often attempted suicide due to family conflict, while men attempted due to emotional relationship problems. All cases without psychiatric disorder or with externalizing problems attempted impulsive suicide. The most preferred drugs for suicide were, nonsteroidal anti-inflammatory drugs, antidepressants, paracetamol, antibiotics and antipsychotics. Of the all cases, 22.5% attempted suicide by self medications. It has not been possible to maintain pediatric psychiatric follow up of the 71% of the cases. Conclusion: It is considered that public attention should be drawn to the increasing number of adolescent suicide attempts in order to prevent this issue. Family-oriented protective approaches, school-based preventive programs and new legal regulations on drug safety could help to reduce the frequency of suicide attempts.
Keywords: Emergency psychiatric services; Prevention and control; Suicide; Youth

Breaking up is hard to do: Teen dating violence victims' responses to partner suicidal ideation - Fitzpatrick, J.M. (Sociological Studies of Children and Youth, 2017)
Purpose: Adolescence is a period of new experiences, including dating. Romantic relationships can be a source of stress; one-third of teens experience dating violence (Molidor & Tolman, 1998; Straus, 2004). Teens are also at a heightened risk for suicide; it is the third leading cause of death among teens (Center for Disease Control [CDC], 2013a). Suicidal ideation, threats, and attempts occur within the context of a relationship where there is also dating violence (Chan, Straus, Brownridge, Tiwari, & Leung, 2008; Else, Goebert, Bell, Carlton, & Fukuda, 2009). Due to life course, adolescence may not have knowledge, experience, or skills to manage these situations. Furthermore, these experiences may shape romantic relationship expectations as adults. Both dating violence and suicidality have short- and long-term effects (for example, see Castellví et al., 2017; Coker et al., 2000; Exner-Cortens, Eckenrode, & Rothman, 2013; Holmes & Sher, 2013; Jouriles, Garrido, Rosenfield, & McDonald, 2009; Magdol et al., 1997; Zaha, Helm, Baker, & Hayes, 2013). However, little is known about how young women that experience teen dating violence and partner suicidality respond (except, see Baker, Helm, Bifulco, & Chung-Do, 2015). This study seeks to explore this gap. Methodology/approach: As part of a larger study, 16 young women who had experienced a "bad dating relationship" as a teenager also disclosed that their boyfriends had threatened suicide. These young women completed indepth, retrospective interviews to discuss their experiences. Interviews were transcribed and analyzed using HyperResearch. Life course and grounded theory guided this research. Findings: The young women that experienced suicidal threats by their dating partners were also victims of a range of abusive behaviors in their dating relationships, including verbal, physical, and sexual abuses and controlling behaviors. The young women struggled with how to deal with the suicidal ideation and the abuse concurrently. Some of the young women believed that the threats of suicide were real, and had concerns for their boyfriends' wellbeing. Others believed that their boyfriend was using this as a manipulative tactic to get them the stay in the unhealthy relationship. This impacted how young women dealt with and reacted to the abuse, including if they chose to stay in the relationship or not. Research limitations/implications - This study provides narratives from young women in relationships where there is dating violence and threats of suicide, which adds to our understanding of the dynamics of how life course impacts both dating violence and suicide. The sample is small and not generalizable. Future research should include both partners to provide a more holistic picture of the relationship. Additional research should also examine any differences of experiences based on gender, race and ethnicity, social class, and sexual orientation. Practical and social implications: This has serious implications for prevention education and intervention. Policy-makers may want to consider: (1) mandating additional training for teachers and other adults that work with teens, in order to identify warning signs of both dating violence and suicidal ideation, (2) require education for teens on these topics, and (3) ensure evidenced-based interventions are accessible to teens dealing with these issues. Originality/value: This paper provides a deeper understanding of teen experiences with suicidal threats and how they respond to them within the context of an abusive dating relationship. Policy-makers, advocates, school personnel, and youth may benefit from these findings, particularly in regard to developing appropriate prevention education and interventions. © Copyright 2018 by Emerald Publishing Limited.
Keywords: Life course; Teen dating violence; Teen suicide

Gendering Ethnic Religion in 1940s and 1950s Yunnan: Sexuality in the Gua sa la Festival and the Worship of the Goddess Baijie - Bryson, M. (NAN NU, 2017)
Chinese intellectuals adopted the concepts minzu (ethnicity or "nationality") and zongjiao (religion) from Japan in the late nineteenth century as part of the wider discourse of modernity. This article examines the gendered dimensions of these concepts through writings about sexuality in two examples from Dali, Yunnan (home to the Bai minzu) from the late Republican period (1911-49) to the early years of the People's Republic of China. The first example, the Gua sa la festival, involves sexually explicit songs, cross-dressing, and possibly also sexual encounters with strangers. The second example, the cult of the local goddess Baijie, celebrates the fidelity and chastity of an eighth-century queen who committed suicide rather than marry her husband's killer. The examination of writings about Gua sa la and Baijie demonstrates how intellectuals in the 1940s and 1950s selectively invoked concepts of minzu, zongjiao, and sexuality to affirm these apparently opposing phenomena as representations of Bai ethnic culture. Though the political and discursive climate changed significantly throughout this period, in the 1940s and 1950s Gua sa la and Baijie both remained positive images, which was only possible because intellectuals elided either zongjiao or sexuality in their descriptions. © 2017 Koninklijke Brill NV, Leiden, The Netherlands.
Keywords: Dali; minzu; sexuality; Yunnan; zongjiao

Psychopathology screening in medical school students - Galván-Molina, J.F.; Jiménez-Capdeville, M.E.; Hernández-Mata, J.M.; Arellano-Cano, J.R. (Gaceta Medica de Mexico, 2017)
Objective: Screening of psychopathology and associated factors in medical students employing an electronic self-report survey. Method: A transversal, observational, and comparative study that consisted of the following instruments: Sociodemographic survey; 2. Adult Self-Report Scale-V1 (ASRS); State-Trait Anxiety Inventory (STAI); Zung and Conde Self-Rating Depression Scale, Almonte-Herskovic Sexual Orientation Self-Report; Plutchik Suicide Risk Scale; Alcohol Use Disorders Identification Test Identification (AUDIT); Fagerström Test for Nicotine Dependence; 9. Maslach Burnout Inventory (MBI); Eating Disorder Inventory 2 (EDI). Results: We gathered 323 student surveys from medical students of the first, third and sixth grades. The three more prevalent disorders were depression (24%), attention deficit disorders with hyperactivity (28%) and anxiety (13%); the prevalence of high-level burnout syndrome was 13%. Also, the fifth part of the students had detrimental use of tobacco and alcohol. Conclusion: Sixty percent of medical students had either one or more probable disorder or burnout. An adequate screening and treatment of this population could prevent severe mental disorders and the associated factors could help us to create a risk profile. This model is an efficient research tool for screening and secondary prevention. © 2017, Academia Nacional de Medicina. All rights reserved.
Keywords: Anxiety; Burnout; Depression; Stress; Students

Usage of Riot Control Agents and other methods resulting in physical and psychological injuries sustained during civil unrest in Turkey in 2013 - Unuvar, U.; Yilmaz, D.; Ozyildirim, I.; Dokudan, E.Y.; Korkmaz, C.; Doğanoğlu, S.; Kutlu, L.; Fincanci, S.K. (Journal of Forensic and Legal Medicine, 2017)
Turkey has experienced a wave of demonstrations in the summer of 2013, called Gezi Park Demonstrations. Between 31 May and 30 August, 297 people who had been subjected to trauma by several methods of demonstration control and Riot Control Agents applied to the Human Rights Foundation of Turkey Rehabilitation Centers to receive treatment/rehabilitation and/or documentation. 296 patients except one 5-year-old child were included in the study. Of the 296 patients; 175 were male, 120 were female, and one was a transgender individual. The highest number of applications was received by the Istanbul center with 216 patients. The mean age of applicants was 33.85, and the age range was 15–71 years. While 268 of applicants (91%) stated that they had been exposed to Riot Control Agents, 62 patients suffered only chemical exposure who had no other traumatic injuries whereas 234 patients suffered at least one blunt trauma injury. Blunt trauma injuries are due to being shot by gas canisters in 127 patients (43%), by plastic bullets in 31 patients (10%). 59 patients (20%) were severely beaten, and 30 patients (10%) were injured by pressurized cold water ejected by water cannons. Thirteen patients (4.4%) suffered injuries that caused loss of vision or eye. Psychiatric evaluations were carried out for 117 patients while 43% of them were diagnosed with Acute Stress Disorder. Post Traumatic Stress Disorder and Major Depressive Disorder followed this diagnosis. This study includes the medical evaluation of injuries allegedly sustained during Gezi Park demonstrations in 2013 as a result of several methods of demonstration control and/or by being exposed to Riot Control Agents. The aim is to discuss different types of injuries due to those methods and health consequences of Riot Control Agents. © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine
Keywords: Acute Stress Disorder; Demonstration control; Gas canister; Plastic bullet; Post Traumatic Stress Disorder; Riot Control Agents; Tear gas

Type of sexual intercourse experience and suicidal ideation, plans, and attempts among youths: a cross-sectional study in South Korea - Kim, G.H.; Ahn, H.S.; Kim, H.J. (BMC Public Health, 2016)
Background: Despite abundant theoretical evidence of higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and types of sexual intercourse experience in youths. This study examines the association between the type of intercourse experience and suicide risk outcomes (SROs: suicidal ideation, plans for suicide, suicidal attempts) from the Korea Youth Risk Behavior Web-based Survey. Methods: We analyzed cross-sectional data from 146,621 students aged 12-17 years for the years 2012 and 2013. We defined lesbian, gay, or bisexual youth as youths who engaged in a type of sexual intercourse (same-sex or both-sex intercourse). A chi-square test and logistic regression analysis were used to evaluate the association between intercourse experience and SROs. Results: The results showed that the prevalence of suicidal ideation was higher among youths with same-sex intercourse experience (45.9% for females, 33.7% for males) than among youths with opposite-sex intercourse experience (42.2% for females, 23.8% for males) and those with no experience in intercourse (21.0% for females, 12.7% for males). After adjusting for revealed risk factors that were associated with suicide risks, among males, suicide risks based on intercourse experience seemed to increase in the following order: no experience in sexual intercourse, opposite-sex, same-sex, and then both-sexes sexual intercourse experience. Same- and both-sexes intercourse related SROs are strongly linked to violence (being physically assaulted, threatened, or bullied) and sexually transmitted diseases (STDs), including HIV infection. Those having no sexual intercourse experience showed the least probability of suicide risks among youths. Conclusion: The SROs of youths with same-sex or both-sex intercourse experience had strong associations with gender (males), violence, and STDs. Therefore, school educators must continue to advocate for and to implement LGB inclusive policies and programs in order to promote safe and supportive learning environments where all students are protected from health risk behaviors. © 2016 The Author(s).
Keywords: Bisexual; Gay; Lesbian; Sexual intercourse; Sexually transmitted diseases; Suicide; Violence; Youths

Use of mental health care and unmet needs for health care among lesbian and bisexual Chinese-, Korean-, and Vietnamese-American women - Hahm, H.C.; Lee, J.; Chiao, C.; Valentine, A.; Cook, B.L. (Psychiatric Services, 2016)
Objective: This study examined associations between sexua orientation of Asian-American women and receipt of menta health care and unmet need for health care Methods: Computer-Assisted self-interviews were conducte with 701 unmarried Chinese-, Korean-, and Vietnamese American women ages 18 to 35. Multivariate regressio models examined whether lesbian and bisexual participant differed from exclusively heterosexual participants in use o mental health care and unmet need for health care Results: After the analyses controlled for mental healt status and other covariates, lesbian and bisexual wome were more likely than exclusively heterosexual women t have received any past-year mental health services an reported a greater unmet need for health care. Sexualminorit women were no more likely to have receive minimally adequate care Conclusions: Given the high rates of mental health problem among Asian-American sexual-minority women, effort are needed to identify and overcome barriers to receip of adequate mental health care and minimize unmet healt care needs.

Sexual identity development: relationship with lifetime suicidal ideation in sexual minority women - Dirkes, J.; Hughes, T.; Ramirez-Valles, J.; Johnson, T.; Bostwick, W. (Journal of Clinical Nursing, 2016)
Aims and objectives: This study draws on a life course perspective to evaluate in a sample of sexual minority women: (1) the relationship between age at reaching sexual identity milestones and risk of suicidal ideation, (2) developmental stages or stages of sexual identity development that represent greatest risk and (3) the relationship between age of reaching milestones and parental support. Background: Research shows higher rates of suicidal ideation among sexual minority women than heterosexual women. Evidence suggests this is partly accounted for by risk factors including sexual identity development and parental support. However, it remains unclear whether there are stages of particularly high risk. Design: This is a cross-sectional study. Data come from a prospective study of sexual minority women that used convenience and respondent-driven sampling methods. Methods: Using logistic regression, we examined associations among age at sexual identity developmental milestones, parental support and suicidal ideation in a large (N = 820), ethnically diverse sample of sexual minority women. Results: Compared with women who first wondered about their sexual identity in adulthood, those who first wondered in early, middle or late adolescence had greater odds of lifetime suicidal ideation. Younger age at subsequent milestones (first decided or first disclosed) was not associated with heightened risk of suicidal ideation. Parental support was independently associated with suicidal ideation. Conclusions: Findings suggest that where one is in the process of identifying as a sexual minority may be more important than age in understanding risk of suicidal ideation in this population. As individuals come to accept and integrate their sexual minority identity risks associated with younger age diminish. Relevance to Clinical Practice: Nurses and other healthcare providers who work with youth should routinely ask about sexual orientation and suicidal ideation and be aware that youth in the earliest stages of coming out as sexual minority may be at particularly high risk of suicide. © 2016 John Wiley & Sons Ltd
Keywords: bisexual women; lesbian; mental health; sexual minority women; sexual minority youth; sexuality; suicidal ideation; suicide; women's health

Psychological pathway to suicidal ideation among men who have sex with men in Shanghai, China: A structural equation model - Li, R.; Cai, Y.; Wang, Y.; Gan, F.; Shi, R. (Journal of Psychiatric Research, 2016)
We aimed to explore the relationships and develop an inter-theoretical model among psychological variables in the progression to suicidal ideation among men who have sex with men (MSM). A cross-sectional study was conducted among 547 MSM in four districts in Shanghai from March to May in 2014. Socio-demographic, psychological, and behavioral information of the participants was collected. A structural equation model (SEM)-Path Analysis was constructed to interpret the intricate relationships among various psychological variables. Suicidal ideation among MSM during the past year was 10.6%. The developed model agreed well with existing suicide models and had a good fit to the data (χ2/df = 2.497, comparative fit index = 0.983, root mean squared error of approximation = 0.052). Suicidal ideation was predicted by perceived defeat and entrapment (β = 0.21, p < 0.001), which was in turn predicted by temperament (β = 0.60, p < 0.001) and perceived social support (β = 0.34, p < 0.001). Perceived social support fully mediated the relationships among mood states, perceived social status, and perceived defeat and entrapment. MSM with certain types of temperament might be predisposed to a higher perception of defeat and entrapment. Perceived social support can effectively alleviate the negative appraisals and emotions and lower the risk for suicidal ideation among MSM. © 2016 Elsevier Ltd
Keywords: Men who have sex with men; Psychological pathway; Structural equation model; Suicidal ideation

Physical victimization, gender identity and suicide risk among transgender men and women - Barboza, G.E.; Dominguez, S.; Chance, E. (Preventive Medicine Reports, 2016)
We investigated whether being attacked physically due to one's gender identity or expression was associated with suicide risk among trans men and women living in Virginia. The sample consisted of 350 transgender men and women who participated in the Virginia Transgender Health Initiative Survey (THIS). Multivariate multinomial logistic regression was used to explore the competing outcomes associated with suicidal risk. Thirty-seven percent of trans men and women experienced at least one physical attack since the age of 13. On average, individuals experienced 3.97 (SD = 2.86) physical attacks; among these about half were attributed to one's gender identity or expression (mean = 2.08, SD = 1.96). In the multivariate multinomial regression, compared to those with no risk, being physically attacked increased the odds of both attempting and contemplating suicide regardless of gender attribution. Nevertheless, the relative impact of physical victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression. Finally, no significant association was found between multiple measures of institutional discrimination and suicide risk once discriminatory and non-discriminatory physical victimization was taken into account. Trans men and women experience high levels of physical abuse and face multiple forms of discrimination. They are also at an increased risk for suicidal tendencies. Interventions that help transindividuals cope with discrimination and physical victimization simultaneously may be more effective in saving lives. © 2016
Keywords: Gender-based discrimination; Institutional discrimination; Physical violence; Transgendered

Substance use among adolescent sexual minority athletes: A secondary analysis of the youth risk behavior survey - Veliz, P.; Boyd, C.J.; McCabe, S.E. (Addictive Behaviors Reports, 2016)
Aims: While a robust literature exists regarding substance use patterns among adolescent athletes, no studies have examined substance use among adolescent sexual minority athletes; a subpopulation of adolescents that may experience greater rates of substance use due to their marginalized status within the context of sport. Methods: This study uses data from the Youth Risk Behavior Survey (2009-2013). Adolescents (N = 26,940) from four states were included in the analyses that assessed past 30-day cigarette use, alcohol use, binge drinking and marijuana use among sexual minority athletes, heterosexual athletes, heterosexual non-athletes, and sexual minority non-athletes. Results: Approximately 4% of the sample included athletes who identified as a sexual minority (3.7% males and 5.3% females). While the bivariate analyses found that sexual minority athletes had higher past 30-day prevalence rates of substance use when compared to heterosexual athletes and non-athletes, these rates were similar to sexual minority non-athletes. Moreover, when demographic characteristics and history of substance use were included in the multivariate analytic models, many of these differences were no longer statistically significant. These results were generally consistent for both males and females. Conclusions: The results of the study suggest that the context of sport may not be an additional site for stress among adolescent athletes who identify as a sexual minority, and subsequently may have little impact on substance use behaviors. However, participating in sport may not serve as a protective context for adolescent sexual minorities given that substance use behaviors may be learned and reinforced. © 2016 .
Keywords: Adolescents; Sexual minorities; Sports; Substance use; Youth Risk Behavior Survey

Psychiatric comorbidities in transsexualism: Study of a Lebanese transgender population - Ibrahim, C.; Haddad, R.; Richa, S. (Encephale, 2016)
Introduction The question of whether gender dysphoria is associated with psychiatric comorbidity has been addressed in several studies. Several cohort studies have shown that psychiatric comorbidity is one of the main features of poor prognosis following sex change therapy. Gender dysphoria is rare, with an estimated prevalence of 0.001% to 0.002% globally. The literature shows a high prevalence of psychiatric comorbidities in people with gender dysphoria, and that they are more common in male to female transsexuals. Data on long-term mortality show that transsexuals present a 51 % increase in mortality compared to the general population. This is mainly attributed to a six-fold increase in the number of suicides and a higher rate of psychiatric disorders and risky behaviors leading to HIV infection and substance abuse. Purpose Assess psychiatric comorbidity in a population of Lebanese transgender individuals and compare it to the general population. The hypothesis of our study is that the Lebanese transgenders suffer from more psychiatric comorbidities than the general population. Our second objective was to determine the specific mental health needs of this population in order to adapt our services to their medical needs and their specific concerns. Methods Our objective was to acquire 20 transgender participants and 20 control subjects. We chose a snowball sampling method. The evaluation consisted of three questionnaires including a general demographic questionnaire, the MINI 5.0.0 Arabic version for axis I disorders and the SCID-II for axis II disorders. Results The mean age of both groups was 23.55 years. Fifty-five percent (n = 11) transgender participants had active suicidal thoughts against 0 % in controls. Within the group of transgender, 45 % (n = 9) had a major depressive episode, 5 % (n = 1) had a generalized anxiety disorder, 5 % (n = 1) had a posttraumatic stress disorder and 10 % (n = 2) had a major depressive episode with comorbid posttraumatic stress disorder. We noted a significant difference between the two groups regarding the presence of suicidal ideation (P = 0.000) and the presence of axis I disorders (P = 0.039). Discussion In our study, we noted demographic and economic characteristics specific to the population of transgender individuals. We found a significant difference in the level of education, economic status and household composition. Transgender individuals suffer from more psychiatric pathologies compared to the general population. This may be due to social and familial discrimination and ostracism. These results demonstrate the vulnerability of this population. An awareness program for mental health professionals is essential in order to adapt care to the specific needs of this population. A list of non “transphobic” mental health professionals should be established. © 2016 L'Encéphale, Paris
Keywords: Lebanon; Psychiatric comorbidity; Suicide; Transsexual

Prevalence and correlates of substance use among youth living with HIV in clinical settings - Gamarel, K.E.; Brown, L.; Kahler, C.W.; Fernandez, M.I.; Bruce, D.; Nichols, S. (Drug and Alcohol Dependence, 2016)
Objectives The purpose of this study was to better understand the prevalence and correlates of substance use behaviors among HIV-infected adolescents in HIV care settings. Methods A cross-sectional sample of 2216 youth living with HIV (YLWH; ages 12–26) were recruited through the Adolescent Trials Network for HIV Interventions. Participants completed a one-time survey on sociodemographic factors, substance use and health behaviors. We used logistic regression models to understand the correlates of substance use outcomes. Results Overall, weekly or more frequent tobacco use was reported by 32.9% of participants, 27.5% marijuana use, and 21.3% alcohol use; and 22.5% reported any other illicit drug use. In multivariable models, young MSM had higher odds of reporting each substance use behavior, and transgender women had increased odds of marijuana and other illicit drug use. Criminal justice involvement, unstable housing, condomless sex, and suboptimal antiretroviral therapy was associated with increased risk of substance use behaviors. Conclusions Study findings highlight the need for regular screening for substance use in HIV care settings in order to improve access to and delivery of culturally competent substance use prevention and treatment services. © 2016 Elsevier Ireland Ltd
Keywords: HIV; Substance use; Youth

Gender differences in compulsive buying disorder: Assessment of demographic and psychiatric co-morbidities - De Mattos, C.N.; Kim, H.S.; Requião, M.G.; Marasaldi, R.F.; Filomensky, T.Z.; Hodgins, D.C.; Tavares, H. (PLoS ONE, 2016)
Compulsive buying is a common disorder found worldwide. Although recent research has shed light into the prevalence, etiology and clinical correlates of compulsive buying disorder, less is known about gender differences. To address this empirical gap, we assessed potential gender differences in demographic and psychiatric co-morbidities in a sample of 171 compulsive buyers (20 men and 151 women) voluntarily seeking treatment in São Paulo, Brazil. A structured clinical interview confirmed the diagnosis of compulsive buying. Of the 171 participants, 95.9% (n = 164) met criteria for at least one co-morbid psychiatric disorder. The results found that male and female compulsive buyers did not differ in problem severity as assessed by the Compulsive Buying Scale. However, several significant demographic and psychiatric differences were found in a multivariate binary logistic regression. Specifically, male compulsive buyers were more likely to report being non-heterosexual, and reported fewer years of formal education. In regards to psychiatric co-morbidities, male compulsive buyers were more likely to be diagnosed with sexual addiction, and intermittent explosive disorder. Conversely, men had lower scores on the shopping subscale of the Shorter PROMIS Questionnaire. The results suggest that male compulsive buyers are more likely to present with co-morbid psychiatric disorders. Treatment planning for compulsive buying disorder would do well to take gender into account to address for potential psychiatric co-morbidities. © 2016 Nicoli de Mattos 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.

Ecstatic abundance: Queer temporalities in LGBTQ studies and music education - Gould, E. (Bulletin of the Council for Research in Music Education, 2016)
Attempts to normalize (some) variant sexualities assume that normativity leads at least to tolerance. Because it occurs in relationship to preestablished norms, normativity is achieved through assimilation. Judith Butler's (1993) theory of performativity demonstrates this in terms of gender/sexuality by which the gendered/sexualized subject is produced as an e?ect of repetitions of coercive (heterosexual) norms that precede the subject. Operating within a temporal logic of norms frst, the subject second, performativity cites the past, projecting heterosexual subjects into the future, leaving queer subjects nowhere, unless we resignify those norms for an assumed transgressive future. Queer subjects must go along to get along: to be normal, but "the trouble with normal" is that it obviates queer culture (Warner, 1999), bequeathing to queer subjects no past. In response to the double bind of no future and no past, I posit queer temporalities of LGBTQ studies and music education as saturated abundant presents in terms of Deleuzian becoming in the queer time of the infnitive: to become. Eliding the past and future, the infnitive is just before and just after. I argue LGBTQ studies, expressing a queer ethic of kinship, activates Sara Ahmed's (2006) "refusal to inherit" the norms of lack, and asserts ecstatic abundance as an exuberant queer erotic. Using Philip Auslander's (2004) performer-centered approach, I analyze Cris Williamson's (1975) song, "Shooting Star" as ecstatic abundance, contingently constituting LGBTQ studies as unquenchable, inexhaustible, unruly. © 2017 Board of Trustees University of Illinois.

Bullying, Suicide, and Social Ghosting in Recent LGBT Narratives - Gordon, P. (Journal of Popular Culture, 2016)

Effect of antioxidants, amino acids and plant growth regulators on in vitro propagation of Rosa centifolia - Akhtar, G.; Jaskani, M.J.; Sajjad, Y.; Akram, A. (Iranian Journal of Biotechnology, 2016)
Background: Rosa centifoliais commercially propagated by asexual means but in vitro propagation ensure the production of disease free and healthy plants and browning of explants creates hurdle in their multiplication. Objectives: The aim was to reduce oxidative browning of shoots of R. centifolia in MS medium during in vitro propagation. Materials and Methods: Axillary buds of R. centifolia were sterilized with 70% ethyl alcohol for 4 min and 5% sodium hypochlorite for 2 min followed by three washing with sterilized double distilled water. In order to control oxidative browning, Ascorbic acid (100 mg.L-1), citric acid (100 mg.L-1) and activated charcoal (3 g.L-1) were used while to control withering of shoots, different concentrations (3.0 mg.L-1, 6.0 mg.L-1, 9.0 mg.L-1) of either glutamine, asparagine and proline were put into trial. Different concentrations of Benzyl aminopurine (BAP) and naphthalene acetic acid (NAA) were used for in vitro shoot and root formation. Results: Minimum browning percentage (20%) was achieved in the presence of activated charcoal (3.0 g.L-1) and pretreatment of explants with running tap water. Asparagin (9.0 mg.L-1) produced maximum shooting (93%), minimum withering (6.67%), and it took longer period (27 days) for shoots to wither. BAP (3.0 mg.L-1) + NAA (0.5 mg.L-1) was produced the highest number of shoots (1.63), in a shortest periods (9 days). For root production, NAA (1.5 mg.L-1) + BAP (0.5 mg.L-1) reduced the time to 11 days with maximum number of roots (4.33) and root length (4.20 cm). Conclusions: The supplement of activated charcoal (3.0 g.L-1), a sparagin (9.0 mg.L-1) and combination of BAP and NAA in the MS medium is effective for in vitro propagation of R. centifolia. © 2016, Kowsar Medical Publishing Company. All Rights Reserved.
Keywords: Activated charcoal; Browning; In vitro propagation; Rosa centifolia

Mental health and suicidal ideation among Chinese women who have sex with men who have sex with men (MSM) - Li, X.; Zhang, B.; Li, Y.; Antonio, A.L.M.; Chen, Y.; Williams, A.B. (Women and Health, 2016)
In China, men who have sex with men (MSM) are the fastest growing population at risk for HIV. They face social stigma due to both MSM behavior and HIV. In addition, concern has been raised about the mental health of wives of MSM. In this cross-sectional study, the authors examine the mental health status of a sample of 135 of these women. Participants completed an Internet-administered questionnaire in Xi’an from April to June, 2012. Most were unaware at the time of marriage that their husbands were MSM. Physical abuse was frequently reported; depressive symptom and mental health (Symptom Checklist, SCL–90) scores were significantly higher than those of the general Chinese adult female population. A majority (59.8%) of women reported suicidal thoughts after discovering their husbands’ MSM behavior; about 10% had attempted suicide. Multiple logistic regression revealed that women’s experience with anal sex was associated with 7.8 times (95% CI: 1.3–65.9) greater odds of suicidal ideation. Also, women who demonstrated mental symptoms on the SCL–90 had 2.3 times (95% CI: 1.04–5.2) the odds of suicidal ideation. These results suggest that wives of MSM have a significant need for mental health care, suicide prevention, HIV education, and social support. © 2016 Taylor & Francis.
Keywords: China; HIV; men who have sex with men; mental health; spouses; suicidal ideation

Prevalence of prior HIV testing and associated factors among MSM in Zhejiang Province, China: a cross-sectional study - Li, R.; Pan, X.; Ma, Q.; Wang, H.; He, L.; Jiang, T.; Wang, D.; Zhang, Y.; Zhang, X.; Xia, S. (BMC Public Health, 2016)
Background: Men who have sex with men (MSM) have become one of high-risk population for human immunodeficiency virus (HIV) infection, due to their multiple sex partners and unprotected anal intercourse. Promoting HIV testing is an effective strategy for the prevention and control of HIV infection. We assessed the factors associated with a prior HIV testing history, which could provide guidance for implementation of future HIV intervention programs. Methods: A cross-sectional study was conducted in three cities of Zhejiang Province, namely, Hangzhou, Ningbo and Wenzhou, using respondent-driven sampling, between December 2013 and June 2014. A face-to-face questionnaire survey was employed to collect relevant information about HIV testing. Univariate and multivariate logistic regression analyses were used to identify the factors associated with a prior HIV testing history. Results: The adjusted rate of prior HIV testing among MSM in Zhejiang Province was 55.9 %. The adjusted rates of HIV and syphilis infections among MSM in Zhejiang Province were 14.0 % and 11.4 %, respectively. A weighted multivariate analysis showed that MSM of older age were more likely to be tested, as were MSM with higher level of education, self-reported homosexuality and a higher frequency of receiving AIDS/sexually transmitted infections educational intervention in the past year. MSM with suicidal inclination and self-perceived lower possibility of HIV infection were less likely to report ever having undergone an HIV test. Conclusions: The prevalence of prior HIV testing among MSM in Zhejiang Province, China is low. Effective and more frequent interventional measures should be adopted to improve risk awareness and psychosocial support for younger, less educated MSM, and to encourage more MSM to undergo HIV testing. © 2016 The Author(s).
Keywords: Associated factors; HIV testing; Men who have sex with men (MSM); Respondent-driven sampling

Clinical and projective understanding of the suicidal act in the young homosexuals: Early traumas’ impact - Barrattini, A.; Mazoyer, A.-V.; Pirlot, G.; Estellon, V. (Annales Medico-Psychologiques, 2016)
We suggest in this research to provide a new approach for the prevalence of the use of the suicidal act within the homosexual population. Indeed, from the Lucas's clinical and projective case, a suicidal young homosexual, we have identified that the repetition of the passages by the suicidal act masked old traumas so putting, in reality, in the background the problem of the sexual orientation as causal factor and initiator of the suicidal acts. We strength of the traumas experienced during Lucas's childhood, their updating in the psychic economy on the identity and sexual development, and highlighted their psychic renewal. We propose then the assumption that the suicidal attempt and homosexuality could be in fact indicative of early traumas. © 2016 Elsevier Masson SAS
Keywords: Acting out; Adolescent; Clinical case; Homosexuality; Psychological trauma; Rorschach; Suicide attempt; Teen

Consideration of clozapine and gender-affirming medical care for an HIV-positive person with schizophrenia and fluctuating gender identity - Gerken, A.T.; McGahee, S.; Keuroghlian, A.S.; Freudenreich, O. (Harvard Review of Psychiatry, 2016)
Keywords: Acquired immunodeficiency syndrome; Clozapine; Gender identity; Hepatitis C; HIV; Psychotic disorders; Schizophrenia; Transgender persons

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

Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort - Cesta, C.E.; Månsson, M.; Palm, C.; Lichtenstein, P.; Iliadou, A.N.; Landén, M. (Psychoneuroendocrinology, 2016)
Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 5–15% of reproductive-aged women and characterized by high levels of circulating androgens. Given that androgens have been implicated in the aetiology of several psychiatric disorders, it was hypothesized that women with PCOS have high risk for psychiatric comorbidity. We aimed to investigate this risk amongst women with PCOS, as well as in their siblings, to elucidate if familial factors underlie any potential associations. Using the Swedish national registers, we identified all women diagnosed with PCOS between 1990 and 2013 (n = 24,385), their full-siblings (n = 25,921), plus matched individuals (1:10/100) from the general population and their full-siblings. Psychiatric disorder diagnoses were identified including schizophrenia, bipolar disorder, depressive and anxiety disorders, eating disorders, personality and gender identity disorder, autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), tics, attempted and completed suicide. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression and adjusted ORs (AOR) were determined by adjustment for comorbid psychiatric disorders. Overall, women with PCOS had an increased odds of having at least one psychiatric disorder (OR = 1.56 [95CI%, 1.51–1.61]). Crude ORs showed associations with nearly all psychiatric disorders included in this study. Following adjustment for comorbid psychiatric disorders, women with PCOS were still at a significantly increased risk for bulimia, schizophrenia, bipolar disorder, depressive and anxiety disorders, personality disorders, with the highest AORs for ASD (AOR = 1.55 [95%CI, 1.32–1.81]) and tics (AOR = 1.65 [95%CI, 1.10–2.47]). Significantly higher AORs were found for ASD in both brothers and sisters of women with PCOS, and for depressive, anxiety, and schizophrenia spectrum disorders in the sisters only. Notably, the crude ORs for attempted suicide were 40% higher in women with PCOS and 16% higher in their unaffected sisters. However, the AORs were greatly attenuated indicating that underlying psychiatric comorbidity is important for this association. Women with PCOS had higher risks for a range of psychiatric disorders not shown before. Elevated risk in their siblings suggests shared familial factors between PCOS and psychiatric disorders. This study is an important first step towards identifying the underlying mechanisms for risk of psychiatric disorders in women with PCOS. Health professionals treating women with PCOS should be aware that these patients – as well as their family members – are important targets for mental health care. © 2016 Elsevier Ltd
Keywords: Androgens; Epidemiology; Polycystic ovary syndrome; Psychiatric disorders; Sibling analysis

The needs of students with intersex variations - Jones, T. (Sex Education, 2016)
To date, people with intersex variations have been mainly studied via small-scale clinical research, with only a small amount of reflective commentary contributed by sociocultural scholars. This paper reports on findings from a 2015 online Australian survey of 272 people with intersex variations, which aimed to redress the gap in research on this groups’ experiences and perspectives concerning education. Participants ranged in age from 16 to 87 years, and represented all Australian states and territories. Most had experienced two medical treatment interventions related to their intersex variation: commonly reported interventions included hormonal treatment and genital surgery delivered to participants when they were aged under 18 years of age. Participants reported various physical and psychological impacts from these treatments. Well-being risks were high; most of the group had engaged in suicidal ideation, particularly when individuals first found out about their variation. This impacted on their schooling – almost one-fifth of survey respondents had received no high school certification due to their early dropout and the overwhelming majority did not attend schools with inclusive puberty/sex education provision or counselling. Most survey participants had not disclosed their intersex variation to staff, although more than half had done so to their classmates. Many had experienced bullying. Only one-quarter of participants rated their overall education experiences positively. Participants suggested improvements to schools’ information provision and support features. © 2016 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: Australia; Intersex; puberty; sex education provision; support

Implementing school nursing strategies to reduce LGBTQ adolescent suicide: A randomized cluster trial study protocol - Willging, C.E.; Green, A.E.; Ramos, M.M. (Implementation Science, 2016)
Background: Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6% of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes. Methods/Design: Mixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP. Discussion: The DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science. Trial registration: ClinicalTrials.gov, NCT02875535 © 2016 The Author(s).
Keywords: Evidence-based practice; Implementation; School nurses-suicide; Sexual and gender minority

Transgender Adults’ Access to College Bathrooms and Housing and the Relationship to Suicidality - Seelman, K.L. (Journal of Homosexuality, 2016)
Transgender and gender non-conforming people frequently experience discrimination, harassment, and marginalization across college and university campuses (Bilodeau, 2007; Finger, 2010; Rankin et al., 2010; Seelman et al., 2012). The minority stress model (Meyer, 2007) posits that experiences of discrimination often negatively impact the psychological wellbeing of minority groups. However, few scholars have examined whether college institutional climate factors—such as being denied access to bathrooms or gender-appropriate campus housing—are significantly associated with detrimental psychological outcomes for transgender people. Using the National Transgender Discrimination Survey, this study analyzes whether being denied access to these spaces is associated with lifetime suicide attempts, after controlling for interpersonal victimization by students or teachers. Findings from sequential logistic regression (N = 2,316) indicate that denial of access to either space had a significant relationship to suicidality, even after controlling for interpersonal victimization. This article discusses implications for higher education professionals and researchers. © 2016 Taylor & Francis.
Keywords: Bathrooms; campus housing; harassment; higher education; minority stress model; suicidality; transgender

A case of first-onset psychosis and repeated relapses secondary to discontinuation of non-prescription estrogen replacement therapy in a transgendered female - Moffitt, O.; Findley, J.C. (Gynecological Endocrinology, 2016)
The estrogen hypothesis of psychosis states that estrogens contribute a protective effect against the development of psychotic disorders. Conversely, hypoestrogenic states have been shown to be associated with the occurrence of psychotic disorders in women. We present the case of a 24-year-old transgendered female who experienced a first-onset psychosis and subsequent relapses associated with discontinuation of non-prescription estrogen replacement therapy. © 2016 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: Central nervous system; depression; estrogen; hormone replacement therapy; psychosis; transgender

Mental health among UK inner city non-heterosexuals: The role of risk factors, protective factors and place - Woodhead, C.; Gazard, B.; Hotopf, M.; Rahman, Q.; Rimes, K.A.; Hatch, S.L. (Epidemiology and Psychiatric Sciences, 2016)
Background. Sexual minorities experience excess psychological ill health globally, yet the UK data exploring reasons for poor mental health among sexual minorities is lacking. This study compares the prevalence of a measure of well-being, symptoms of common mental disorder (CMD), lifetime suicidal ideation, harmful alcohol and drug use among inner city non-heterosexual and heterosexual individuals. It is the first UK study which aims to quantify how much major, everyday and anticipated discrimination; lifetime and childhood trauma; and coping strategies for dealing with unfair treatment, predict excess mental ill health among non-heterosexuals. Further, inner city and national outcomes are compared. Methods. Self-report survey data came from the South East London Community Health study (N = 1052) and the Adult Psychiatric Morbidity Survey (N = 7403). Results. Adjustments for greater exposure to measured experiences of discrimination and lifetime and childhood trauma had a small to moderate impact on effect sizes for adverse health outcomes though in fully adjusted models, non-heterosexual orientation remained strongly associated with CMD, lifetime suicidal ideation, harmful alcohol and drug use. There was limited support for the hypothesis that measured coping strategies might mediate some of these associations. The inner city sample had poorer mental health overall compared with the national sample and the discrepancy was larger for non-heterosexuals than heterosexuals. Conclusions. Childhood and adult adversity substantially influence but do not account for sexual orientation-related mental health disparities. Longitudinal work taking a life course approach with more specific measures of discrimination and coping is required to further understand these associations. Sexual minorities should be considered as a priority in the design and delivery of health and social services. © Cambridge University Press 2015.
Keywords: Cross cultural psychiatry; discrimination; epidemiology; mental health; minority issues

Suicide risk in trans populations: An application of minority stress theory - Tebbe, E.A.; Moradi, B. (Journal of Counseling Psychology, 2016)
Drawing on minority stress theory, the present study tested the relations of minority stressors (i.e., experiences of prejudice and discrimination, internalized antitrans attitudes, fear of antitrans stigma), social support (i.e., friend, family, and significant other support), and substance use (i.e., drug and alcohol use) with depression and suicide risk in a sample of trans individuals. Depression was examined as a mediator of the relations of minority stressors and social support with suicide risk; drug and alcohol use were examined as direct correlates of suicide risk. Participants were 335 trans-identified individuals, diverse in gender identities (e.g., trans men, trans women, nonbinary gender identities). They were recruited using online social networks and they completed the study survey online via Qualtrics. Structural equation modeling was used to test hypothesized relations. Depression fully mediated the relations of perceived experiences of discrimination, fear of antitrans stigma, and friend support with suicide risk, and partially mediated the relation of internalized antitrans attitudes with suicide. Drug use was positively associated with suicide risk, whereas alcohol use was not linked with suicide risk. Exploratory comparisons across gender subgroups suggested that the pattern of relations among study variables was consistent across trans men, trans women, and individuals with nonbinary gender identities. These findings point to minority stressors, friend support, and drug use as potentially fruitful targets of prevention and intervention efforts to reduce depression and suicide risk in trans populations. © 2016 American Psychological Association.
Keywords: Discrimination; Social support; Substance use; Transgender; Transphobia

How do Sexual Identity, and Coming Out Affect Stress, Depression, and Suicidal Ideation and Attempts Among Men Who Have Sex With Men in South Korea? - Cho, B.; Sohn, A. (Osong Public Health and Research Perspectives, 2016)
Objectives This study investigated the status of sexual identity, perceived stigma, stress, depression, and suicidal ideation and attempts. It also examined how sexual identity and “coming out” affect stress, depression, and suicidal ideation and attempts. Methods Suicidal ideation, psychological health status, and health-related behaviors were assessed using the Internet to maximize the confidentiality of the participants, men who have sex with men (MSM). The data were collected from a total of 873 MSM aged between 19 years and 59 years in 2014. Results Only 20.9% of the MSM had come out (18.0% voluntarily and 2.9% by others). The prevalences of perceived stress and depression among MSM were 46.7% and 42.7%, respectively, compared with 20.1% and 7.4% among general men. Approximately 32% of the MSM reported any suicidal ideation, and 3.3% had attempted suicide in the past year. The likelihood of suicidal ideation was significantly associated with being age 30–39 years [odds ratio (OR) = 1.8], high school or less (OR = 1.6), having been outed (OR = 5.2), feeling stressed (OR = 1.8), and feeling depressed (OR = 12.4) after sociodemographic factors and other perceptions were controlled for. Conclusion The present study provides evidence that MSM are at an elevated risk for suicidal ideation and attempts with high stress and depression. Some risk factors were specific to being gay or bisexual in a hostile environment. © 2016
Keywords: coming out; depression; sexual identity; stigma; stress; suicidal ideation and attempts

Negative Treatment by Family as a Predictor of Depressive Symptoms, Life Satisfaction, Suicidality, and Tobacco/Alcohol Use in Vietnamese Sexual Minority Women - Nguyen, T.Q.; Bandeen-Roche, K.; German, D.; Nguyen, N.T.T.; Bass, J.K.; Knowlton, A.R. (LGBT Health, 2016)
Purpose: Research linking family rejection and health outcomes in sexual minority people is mostly limited to North America. We assessed the associations between negative treatment by family members and depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use in sexual minority women (SMW) in Viet Nam. Methods: Data were from an anonymous internet survey (n = 1936). Latent class analysis characterized patterns of negative treatment by family members experienced by respondents. Latent class with distal outcome modeling was used to regress depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use on family treatment class, controlling for predictors of family treatment and for two other types of sexual prejudice. Results: Five latent family treatment classes were extracted, including four negative classes representing varying patterns of negative family treatment. Overall, more than one negative class predicted lower life satisfaction, more depressive symptoms, and higher odds of attempted suicide (relative to the non-negative class), supporting the minority stress hypothesis that negative family treatment is predictive of poorer outcomes. Only the most negative class had elevated alcohol use. The association between family treatment and smoking status was not statistically significant. The most negative class, unexpectedly, did not have the highest odds of having attempted suicide, raising a question about survivor bias. Conclusion: This population requires public health attention, with emphasis placed on interventions targeting the family to promote acceptance and to prevent negative treatment, and interventions supporting those SMW who encounter the worst types of negative family treatment. © Copyright 2016, Mary Ann Liebert, Inc. 2016.
Keywords: family rejection; latent class model; mental health; sexual minority women (SMW); substance use; suicidality

Concealment of Sexual Minority Identities in Interviewer-Administered Government Surveys and Its Impact on Estimates of Suicide Ideation Among Bisexual and Gay Men - Hottes, T.S.; Gesink, D.; Ferlatte, O.; Brennan, D.J.; Rhodes, A.E.; Marchand, R.; Trussler, T. (Journal of Bisexuality, 2016)
Bisexual and gay men are at increased risk of suicide ideation. Characterizing this risk requires self-disclosure of sexual identities; however, many will conceal their identity when interviewed. The authors investigated the impact of the resulting information bias within the Canadian Community Health Survey (CCHS). Expected probabilities of disclosure were derived from a community-based survey of bisexual and gay men, stratified by sexual identity and other social characteristics. Forty percent of bisexual men and 86% of gay men were willing to disclose to CCHS interviewers. The odds of suicide ideation were higher for bisexual (odds ratio [OR] = 4.91) and gay (OR = 3.63) men compared to heterosexual men. After bias analysis these disparities remained significant but were attenuated, with greater attenuation for bisexual (adjusted OR = 3.53) than for gay (adjusted OR = 3.52) men. The authors recommend that researchers continue exploring bias in estimated sexual minority health disparities, and that population surveys be more inclusive of bisexual-identified individuals. © 2016 Taylor & Francis Group, LLC.
Keywords: disclosure; LGB; men; research methods; sampling; sexual identity

Nonsuicidal self-injury, suicidal thoughts and suicide attempts among sexual minority youth in Ireland during their emerging adult years - Power, E.; Coughlan, H.; Clarke, M.; Kelleher, I.; Lynch, F.; Connor, D.; Fitzpatrick, C.; Harley, M.; Cannon, M. (Early Intervention in Psychiatry, 2016)
Aim: This study aimed to examine whether or not sexual minority youth constitute an at-risk group for nonsuicidal self-injury, suicidal ideation or suicide attempts during their emerging adult years. Methods: Using data from the Challenging Times Study, a population-based study of psychopathology and suicide in Ireland, analyses were conducted to test the associations between sexual minority status and the odds of any lifetime experience of nonsuicidal self-injury, suicidal thoughts or suicide attempts among Irish youth aged 19–24 years. Results: Sexual minority youth had 6.6-fold (95% CI 1.7–24.7) increased risk of nonsuicidal self-injury, a 5.0-fold (95% CI 1.3–18.3) increased risk of suicidal ideation, a 7.7-fold (95% CI 1.8–32.0) increased risk of suicide intent and a 6.8-fold (95% CI 1.6–27.6) increased risk of a suicide attempt during their lifetime compared to their heterosexual peers. Conclusions: This study shows that emerging adulthood is a period of risk for suicide and nonsuicidal self-injurious behaviour among sexual minority youth. © 2015 Wiley Publishing Asia Pty Ltd
Keywords: emerging adult; minority group; nonsuicidal self-injury; public health; suicide

Corrigendum: Mental health among UK inner city non-heterosexuals: The role of risk factors, protective factors and place (Epidemiology and Psychiatric Sciences (2018) DOI: 10.1017/S2045796015000645) - Woodhead, C.; Gazard, B.; Hotopf, M.; Rahman, Q.; Rimes, K.A.; Hatch, S.L. (Epidemiology and Psychiatric Sciences, 2016)
In the above-mentioned article of Woodhead et al. (2016) there are errors in the tables. The correct versions of the tables and details of the corrections are given below. The author apologises for these errors. Due to a survey weight calculation correction to the South East London Community Health study (SELCoH) data, all weighted prevalence's, odds ratios and confidence intervals have been amended. The following describes the main relevant updated univariate data in Tables 1-3. Rather than 5.4, 6.6% identified as non-heterosexual (4.8% homosexual, 1.4% bi-sexual and 0.5% 'other'). Marital status ( p = 0.054); reporting having ever been discouraged from continuing education ( p = 0.180); that people ever acted as if they were afraid ( p = 0.168) and not applying for work or training for fear of discrimination ( p = 0.074) was no longer associated with sexual orientation. Associations with anticipated discrimination and everyday discrimination overall remained highly significant and were input into Model C in place of individual items, in analyses described in Table 4. The pattern of effect sizes in each adjustment model (Table 4) remains similar overall to those reported. For each outcome, adjustments for everyday and anticipated discrimination overall had the largest (though small to moderate) impact on effect sizes (Model C). Sexual orientation remained significantly associated with symptoms of common mental disorder (CMD) in each model, with effect sizes ranging from 2.97 (OR 1.69-5.24, p > 0.001) in Model A to 2.46 (OR 1.34-4.54, p > 0.01) in Model C. lifetime suicidal ideation remained highly significantly associated with sexual orientation in each model, with effect sizes ranging from 4.26 (OR 2.38-7.64, p > 0.001) in Model B to 3.52 (OR 2.03-6.09, p > 0.001) in Model C. similarly, past year drug use remained highly significantly associated with sexual orientation in each model, with effect sizes ranging from 3.41 (OR 1.67-6.94, p > 0.001) in Model D to 2.83 (OR 1.51-5.31, p > 0.001) in Model C. in contrast to reported data, harmful alcohol use was no longer significantly associated with sexual orientation following adjustments for childhood sexual abuse and whether ever been a victim of a serious crime (2.37, OR 1.00-5.64). Comparisons with national data (Table 5) indicated the same pattern of findings, with the exception that except SELCOH non-heterosexuals were no longer more likely than the national sample of nonheterosexuals to be harmful alcohol drinkers. (Table Presented). © 2016 Cambridge University Press.

The Association of Multiple Identities with Self-Directed Violence and Depression among Transgender Individuals - Lytle, M.C.; Blosnich, J.R.; Kamen, C. (Suicide and Life-Threatening Behavior, 2016)
Transgender individuals have a high prevalence of self-directed violence; however, there is scant literature focusing on their unique experiences. The differences in self-harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation were examined among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorsed self-directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non-Hispanic White individuals. © 2016 The American Association of Suicidology

Use of psychostimulants in a sexual context: Analysis of cases reported to the French network of Addictovigilance Centers - Batisse, A.; Peyrière, H.; Eiden, C.; Courné, M.-A.; Djezzar, S. (Therapie, 2016)
The “SLAM” phenomenon is an increasingly popular practice, in Paris and London gay scene, defined by 3 characteristics: injection, sexual party and psychostimulant drugs. The French Medical Agency requested a risk assessment of “SLAM” and more broadly of the use of psychostimulants in a sexual context, by the analysis of complications related to this practice notified to the French Network of Addictovigilance Centers. All cases of complications related to “SLAM” practice, including cases of abuse or dependence, and somatic and psychiatric complications, were analysed. Between January 2008 to December 2013, 51 cases were collected. Users were exclusively men, with a mean age of 40 years, having psychostimulants exposure in a sexual context, mainly in men who have sex with men (MSM) context (100%, n = 35). The prevalence of human immunodeficiency virus (HIV) infection was 82% (n = 32) with a high level of HIV/hepatitis C virus (HCV) co-infection (50%, n = 16). The main psychostimulants reported are synthetic cathinones (89.5%). Cathinones users tended to be polydrug users: 62% also reported use other than psychoactive substances (gamma-butyrolactone [GBL], ketamine, methylenedioxyméthamphetamine [MDMA], lysergic acid diethylamide [LSD]…). The main complications were psychiatric disorders in 50% (psychotic symptoms, agitation, anxiety, suicidal ideas or attempt and forensic problems), acute intoxication in 25% (including 3 deaths), dependence and abuse in 17% and infectious complications in 8% (viral seroconversion). Health professionals as well as users should be aware of the physical (cardiovascular) and behavioural (psychic, fast dependence syndrome) toxicity of cathinones. Risk reduction policy must be targeted to the population of MSM with specific interventions both on risky sexual behavior and substance use. © 2016 Société française de pharmacologie et de thérapeutique
Keywords: Male homosexuality; Sexuality; Substance-related disorders; Synthetic cathinones

A Content Analysis of Literature on Trans People and Issues: 2002-2012 - Moradi, B.; Tebbe, E.A.; Brewster, M.E.; Budge, S.L.; Lenzen, A.; Ege, E.; Schuch, E.; Arango, S.; Angelone, N.; Mender, E.; Hiner, D.L.; Huscher, K.; et al. (Counseling Psychologist, 2016)
This study provides a content analysis of more than a decade (2002-2012) of academic scholarship about trans people and issues. A total of 960 trans-focused publications were coded; there was a close balance of nonempirical (54%) and empirical (46%) publications. The analyses revealed that the literature on trans people and issues is growing, although many publications include trans people and issues nominally without substantive attention. The analyses also pointed to underutilized research designs and methodologies, the need for more clear assessment and more consistent reporting of demographic characteristics, and topics that warrant further attention. Specifically, literature on trans people and issues continues to be needed on the topics of focus thus far, such as psychological and identity-related distress. Scholarship is also needed to address important topics that have been understudied, including self-harm and suicide, positive functioning and mental health promoting factors, developmental issues across the life span, school and workplace experiences, and the training and competencies of health care providers to ensure affirmative and effective services for trans people. © The Author(s) 2016.
Keywords: gender dysphoria; gender identity; gender nonconforming; transgender; transsexual

Factors Associated with Suicidality Among a National Sample of Transgender Veterans - Lehavot, K.; Simpson, T.L.; Shipherd, J.C. (Suicide and Life-Threatening Behavior, 2016)
Correlates of past-year suicidal ideation and lifetime suicide risk among a national sample of transgender veterans were examined. An online, convenience sample of 212 U.S. transgender veterans participated in a cross-sectional survey in February–May 2014. We evaluated associations between sociodemographic characteristics, stigma, mental health, and psychosocial resources with past-year suicidal ideation and lifetime suicide plans and attempts. Participants reported high rates of past-year suicidal ideation (57%) as well as history of suicide plan or attempt (66%). Transgender-related felt stigma during military service and current posttraumatic stress disorder and depressive symptoms were associated with suicide outcomes as were economic and demographic factors. Published 2016. This article is a U.S. Government work and is in the public domain in the USA

Gender identity disorder in an adolescent boy: An attribution of adverse childhood experiences! - Mishra, R.; Kar, S.K.; Goyal, P.; Kumar, D.; Sinha, U.K.; Gupta, S.K. (Journal of Indian Association for Child and Adolescent Mental Health, 2016)
Gender identity disorder (GID) is a relatively rare psychiatric disorder characterized by desire to be of the opposite sex, cross-dressing, cross-sex roles in fantasy plays, desire to participate in games of opposite sex, preference for playmates of opposite sex and persistent discomfort with the assigned sex leading to significant impairment and distress. These manifestations occur in the absence of physical disorders leading to intersex. Comorbidities like depression, anxiety disorder and conduct disorder may be associated with GID. Identifying the co-morbidities, addressing the bio-psycho-social attributes of this disorder is an important and key step to management. Presence of co-morbidities makes the diagnosis and management of GID, a challenge. Adverse childhood experiences like sexual abuse may attribute to the gender identity disorder as well as the externalizing and internalizing behaviors of the child in later part of life. In this case report, we highlightedthe diagnostic and management issues as well as the adverse childhood experiences that might have attributed to GID and co-morbid psychiatric disorders. © 2016, Indian Association for Child and Adolescent Mental Health. All rights reserved.
Keywords: Adverse childhood experiences; Co-morbidities; Conduct disorder; Depression; Gender identity disorder

Violence victimisation - A watershed for young women's mental and physical health - Palm, A.; Danielsson, I.; Skalkidou, A.; Olofsson, N.; Högberg, U. (European Journal of Public Health, 2016)
Purpose: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15-22 years) victimised to one or more types of violence, compared with non-victimised. Methods: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed. Results: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9-20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9-10.2) for anxiety symptoms and 10.8 (CI 5.2-22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation. Conclusion: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association.

The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support - Wilson, E.C.; Chen, Y.-H.; Arayasirikul, S.; Raymond, H.F.; McFarland, W. (AIDS and Behavior, 2016)
Significant health disparities exist for transgender female (trans*female) youth. We assessed differences in mental health outcomes based on exposure to discrimination among transgender female youth in the San Francisco Bay Area aged 16–24 years. Youth were recruited using a combination of respondent driven sampling with online and social media methods. Logistic regression models were used to estimate odds ratios for the mental health outcomes, comparing levels of discrimination and levels of resiliency promoting protective factors among sexually active youth in the sample (N = 216). High transgender-based discrimination was significantly associated with greater odds of PTSD (AOR, 2.6; 95 % CI 1.4–5.0), depression (AOR, 2.6; 95 % CI 1.2–5.9), and stress related to suicidal thoughts (AOR 7.7, 95 % CI 2.3–35.2). High racial discrimination was significantly associated with greater odds of psychological stress (AOR 3.6; 95 % CI 1.2–10.8), PTSD (AOR 2.1; 95 % CI 1.1–4.2) and stress related to suicidal thoughts (AOR 4.3, 95 % CI 1.5–13.3). Parental closeness was related to significantly lower odds of all four mental health outcomes measured, and intrinsic resiliency positively reduced risk for psychological stress, PTSD, and stress related to suicidal thoughts. Transgender and racial discrimination may have deleterious effects on the mental health of trans*female youth. Interventions that address individual and intersectional discrimination and build resources for resiliency and parental closeness may have success in preventing mental health disorders in this underserved population. © 2016, Springer Science+Business Media New York.
Keywords: Discrimination; Mental health; Parental support; Resiliency; Transgender

Between drive and reason: Psychodynamic and sociological aspects of HIV-positive gay men's sexuality. HEPAIG study, 2007–2008, France - Linard, F.; Le Talec, J.-Y. (Evolution Psychiatrique, 2016)
Objectives This paper focuses on the psychodynamic dimension of narratives collected in interviews carried out with HIV-positive gay men, and completes two previous publications concerning the Hepaig-quali study, one centred on sexuality and the other on drug use. The Hepaig-quali study was part of the Hepaig epidemiological survey on acute hepatitis C among HIV-infected gay men, coordinated by the Institut de Veille Sanitaire (InVS, France). In addition to the results gathered from questionnaires, and with a focus on the “hepatitis C event”, the present study aimed to describe sexual practices and drug use among HCV-infected gay men, to assess the motivations of these choices, to position them in relation to their life histories and healthcare experiences, and to explore how they viewed their physical and mental health. Methodology Our study was based on two successive in-depth interviews with 31 men previously included in the Hepaig survey. These interviews, conducted by a sociologist, were fully transcribed, and analysed from a dual psychodynamic and sociological viewpoint, an epistemological stance related to the comprehensive approach to behaviours. Results Thirty-one men were included in this qualitative study. We focused specifically on the mental health of the respondents and the psychodynamic dimension of their narratives. Despite the fact that these interviews were not equivalent to “clinical cases”, psychic issues were very much present. In their own words, the respondents talked of their experiences of stress and depression, and some mentioned suicidal ideations. Most talked readily about their practices and explained them via discourse on achieving pleasure, alongside the rational control of risks. Discussion In many respects, the respondents appeared as “ordinary men”, in particular with respect to their gendered socialisation and their representations of the risks. From a mental health perspective, some specificities were linked to the experiences of discrimination and chronic illness. With the permanent tension between impulse and reason, between the search for pleasure and the need to control their lives, they present the characteristics of the hypermodern individual whose contradictions are revealed in their relationship with the other. Conclusion Accurately informed, the respondents also embraced the positivist medical discourse of their caregivers, which provides them with support and helps them to face the burden of HIV and HCV infections. The evolution of gay sexual culture leads these men, via the rejection of the “condom norm”, to choose practices described as more satisfying, but entailing greater risks. Nevertheless, as with any topic, their behaviours are regulated by other dimensions than knowledge and rationality. The search for pleasure is not always restrained by the hindrance and impediments of reason. This should lead caregivers to better understand and support the efforts that their patients make to reduce risks. © 2016 Elsevier Masson SAS
Keywords: Drive; Drug use; HIV/AIDS; Homosexuality; Jouissance; Male; Psyche; Risk reduction; Sexually transmitted disease; Sociology

A 12-Month prospective study of the effects of PTSD-depression comorbidity on suicidal behavior in Iraq/Afghanistan-era veterans - Kimbrel, N.A.; Meyer, E.C.; DeBeer, B.B.; Gulliver, S.B.; Morissette, S.B. (Psychiatry Research, 2016)
The present study used validated clinical interviews to assess the effect of comorbid PTSD-depression on suicidal behavior over the course of 12 months in 309 Iraq/Afghanistan-era veterans. Logistic regression models demonstrated that comorbid PTSD-depression was a statistically significant predictor of suicide attempts at the 12-month follow-up in both the total sample and in the subset of veterans with PTSD/depression (n=98). In contrast, gender, age, race, sexual orientation, and baseline history of suicide attempts did not have significant effects. These findings suggest that comorbid PTSD-depression may be a significant risk factor for future suicidal behavior in veterans. © 2016
Keywords: Depression; Posttraumatic stress disorder; Suicide attempts

Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people - Kattari, S.K.; Walls, N.E.; Speer, S.R.; Kattari, L. (Social Work in Health Care, 2016)
Using a statewide survey of transgender and gender variant individuals (N = 417), this study examines the association between having a transgender-inclusive provider and three mental health concerns: current experience of depression, lifetime experience of anxiety disorder, and suicidality within the last year. Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality, but not with lifetime experience of having anxiety. Implications for future research and education of providers are discussed. © 2016 Taylor & Francis.
Keywords: Anxiety; cultural competence; depression; mental health; suicidal thoughts; transgender

The Whole Family Serves: Supporting Sexual Minority Youth in Military Families - Gyura, A.N.; McCauley, S.O. (Journal of Pediatric Health Care, 2016)
Sexual minority youth in military families have a unique set of stressors that affect their mental, emotional, and physical health. There is a pronounced gap in data addressing the specific stressors of this population and how they interact to impact the health of the adolescent. The culture of the United States military has historically been heterosexist and homophobic, propelled primarily by policies that restricted the recruitment and service of lesbian, gay, bisexual, or transgender individuals, leading to a continued secrecy around sexual orientation that may affect how sexual minority youth within the community view themselves. Homophobia, social stigma, and victimization lead to significant health disparities among sexual minority youth, and youth connected to the military have additional stressors as a result of frequent moves, parental deployment, and general military culture. Primary care providers must be aware of these stressors to provide a safe environment, thorough screening, and competent care for these adolescents. © 2015 National Association of Pediatric Nurse Practitioners
Keywords: adolescent health; LGBTQ; military families; Sexual minority youth

Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden - Björkenstam, C.; Kosidou, K.; Björkenstam, E.; Dalman, C.; Andersson, G.; Cochran, S. (Journal of Epidemiology and Community Health, 2016)
Background Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence. Methods We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67 980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs. Results Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional selfharm. Conclusions Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.

Mostly Heterosexual and Lesbian/Gay Young Adults: Differences in Mental Health and Substance Use and the Role of Minority Stress - Kuyper, L.; Bos, H. (Journal of Sex Research, 2016)
Individuals mostly attracted to other-sex but also to same-sex partners are a distinct and common sexual orientation group with possibly increased levels of health problems. The current study examined whether mostly heterosexual individuals differed in mental health and substance use from lesbian/gay individuals and whether sexual minority risk and protective factors offer an explanation in a sample of 528 Dutch young adults (16 to 25 years old, M = 21.2 years). Mostly heterosexual participants reported higher levels of psychological distress, suicidality, drug use, and smoking than lesbian/gay participants and equal levels of binge drinking. They also reported higher levels of internalized negativity to same-sex attractions, less openness to family members and others, less community involvement, and lower numbers of lesbian/gay/bisexual friends. However, bootstrapped mediation analysis showed that the differences in minority stress risk and protective factors did not mediate most of the differences in mental health and substance use with one exception: higher levels of psychological distress were mediated by the higher levels of internalized negativity to same-sex attractions. The limited explanatory power of the minority stress factors combined with the elevated level of problems of mostly heterosexual individuals call for future studies examining other risk and protective factors. Copyright © The Society for the Scientific Study of Sexuality.

Suicidal ideation among MSM in three West African countries: Associations with stigma and social capital - Stahlman, S.; Grosso, A.; Ketende, S.; Pitche, V.; Kouanda, S.; Ceesay, N.; Ouedraogo, H.G.; Ky-Zerbo, O.; Lougue, M.; Diouf, D.; Anato, S.; Tchalla, J.; et al. (International Journal of Social Psychiatry, 2016)
Background: Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa. Aims: This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo. Methods: Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation. Results: The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%-17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99). Conclusion: Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa. © The Author(s) 2016.
Keywords: men who have sex with men; social capital; Stigma; suicidal ideation; West Africa

“It Gets Better”: Internet memes and the construction of collective identity - Gal, N.; Shifman, L.; Kampf, Z. (New Media and Society, 2016)
In September 2010, a video titled “It Gets Better” was uploaded to YouTube, responding to suicides of gay teens who had suffered from homophobic bullying. Before long, thousands of Internet users added their own versions of the clip, creating a mass appeal to young people while simultaneously negotiating the norms of lesbian, gay, bisexual, transgender and queer (LGBTQ) collective identity. Conceptualizing this body of videos as an Internet meme, we examine the extent to which participants imitate or alter textual components presented in previous videos. A combined quantitative and qualitative analysis of 200 clips shows that in an arena ostensibly free of formal gatekeepers, participants tend to police themselves, toeing the line with conformist norms. We also identify domains of potential subversion, related not only to the content of the videos but mainly to the forms facilitated by digital media. © 2015, © The Author(s) 2015.
Keywords: Collective identity; It Gets Better; LGBTQ; memes; participation; representation

Psychopharmacotherapy of Severe Self-injury in an Adolescent with Gender Dysphoria and Comorbidity - Kufert, Y.; Walther, A.; Feldman, E.; Coffey, B.J. (Journal of Child and Adolescent Psychopharmacology, 2016)

Gang membership and suicidality in adolescents - Juan, S.-C.; Hemenway, D. (Journal of Gang Research, 2016)
Youth suicide and its association with gang membership is rarely examined in existing literature. Using a representative sample of Boston adolescents (n = 1,878), the present study found that gang youth have a higher proportion of suicidal ideation (20% vs. 11%), suicide attempt (6% vs. 4%), and self-harm (17% vs. 8%) than non-gang youth. Mediation analyses show that sexual and non-sexual victimizations significantly mediate the link between gang membership and suicidal ideation (p < .001). Multivariate analyses indicate that gang membership, homosexuality, low perceived safety, and sexual victimization are unique predictors of female suicidality. To prevent youth suicide, gang membership should be regularly assessed.

Victimization of Lesbian, Gay, and Bisexual People in Childhood: Associations with Attempted Suicide - Flynn, A.B.; Johnson, R.M.; Bolton, S.-L.; Mojtabai, R. (Suicide & life-threatening behavior, 2016)
Higher rates of attempted suicide have been documented among people who identify themselves as gay, lesbian, and bisexual (LGB) compared with heterosexuals. This study sought to ascertain the association between childhood abuse and neglect and attempted suicide, comparing LGBs and heterosexuals. Childhood sexual abuse among men and childhood sexual and physical abuse among women were found to mediate the association between LGB identity and attempted suicide. The experience of childhood abuse likely plays a significant role in the relationship between LGB identity and attempted suicide, but other factors such as experience of discrimination are also important. © 2016 The American Association of Suicidology.

Homonegativity and Associated Factors Among Men Who Have Sex with Men in Estonia - Parker, R.D.; Lõhmus, L.; Mangine, C.; Rüütel, K. (Journal of Community Health, 2016)
Men who have sex with men (MSM) continue to be at higher risk for negative health outcomes including HIV, STIs, depression, substance use, suicidality, and anxiety. Associative relationships between homonegativity (internal and external) and these outcomes are used to explain the observed disproportionate impact. The current study assessed associations between internalized homonegativity and high-risk behaviours, markers of substance use and symptoms of mental illness as well as openness and level of same sex attraction. A 2013 Internet-based survey was conducted among MSM, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. The sample (n = 265) had a median age of 31 years, with 85 % employed at least part-time; at least a college-level education in 43 %; and 87 % lived in an urban setting. Sexual orientation was reported as: gay, 72 %; bisexual 23 %; other 5 %. Almost all men (97 %) reported ever having sex with a man, with more than one-third (36 %) having a steady male partner. Statistically significant higher homonegativity scores were detected among men reporting any level of opposite sex attraction compared to men attracted to only men; mostly men (p = 0.001), men and women equally (p = 0.002), and mostly women (p = 0.004), as well as less openness of same sex attraction to family and friends; >50 % family (p = 0.032), no family knowing (p = 0.042), and few friends knowing (p = 0.011). Anxiety risk and increased homonegativity also had a statistically significant increasing relationship. The identified associations between homonegativity and opposite sex attraction among MSM warrants further exploration as well as the relationship with increased anxiety risk. © 2016, Springer Science+Business Media New York.
Keywords: Eastern Europe; Internalized homonegativity; Men who have sex with men; Risk behaviours

The Missing Pieces in Reporting of Randomized Controlled Trials of External Beam Radiation Therapy Dose Escalation for Prostate Cancer - Zaorsky, N.G.; Egleston, B.L.; Horwitz, E.M.; Dicker, A.P.; Nguyen, P.L.; Showalter, T.N.; Den, R.B. (American Journal of Clinical Oncology: Cancer Clinical Trials, 2016)
Randomized controlled trials (RCTs) are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost-effectiveness of a treatment. For many patients, cancer is a chronic illness; RCTs evaluating treatments for indolent cancers must evolve to facilitate medical decision-making, as "concrete" patient outcomes (eg, survival) will likely be excellent independent of the intervention, and detecting a difference between trial arms may be impossible. In this commentary, we articulate 9 recommendations that we hope future clinical trialists and funding agencies (including those under the National Cancer Institute) will take into consideration when planning RCTs to help guide subsequent interpretation of results and clinical decision making, based on RCTs of external beam radiation therapy dose escalation for the most common indolent cancer in men, that is, prostate cancer. We recommend routinely reporting: (1) race; (2) medical comorbidities; (3) psychiatric comorbidities; (4) insurance status; (5) education; (6) marital status; (7) income; (8) sexual orientation; and (9) facility-related characteristics (eg, number of centers involved, type of facilities, yearly hospital volumes). We discuss how these factors independently affect patient outcomes and toxicities; future clinicians and governing organizations should consider this information to plan RCTs accordingly (to maximize patient accrual and total n), select appropriate endpoints (eg, toxicity, quality of life, sexual function), actively monitor RCTs, and report results so as to identify the optimal treatment among subpopulations. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: comorbidities; ethnic groups; Health Care; insurance status; outcomes; prostate cancer; Quality Assurance; quality of life; radiation oncology; randomized controlled trials; technology; toxicity

“You can't break…when you're already broken”: The importance of school climate to suicidality among LGBTQ youth - Peter, T.; Taylor, C.; Campbell, C. (Journal of Gay and Lesbian Mental Health, 2016)
Suicide has been a longstanding problem among sexual and gender minority youth in Canada. The goal of the article is to examine the link between suicidality and school climate within a theoretically informed framework and a mixed methods approach. Qualitative and quantitative findings are presented using data from more than 3,700 secondary students from the National Climate Survey of Homophobia and Transphobia in Canadian Schools (Taylor & Peter, 2011a). The findings show that even modest efforts to shift the balance of heteronormative discourse on behalf of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) students can have profound effects on the experiences and perceptions of sexual and gender minority youth, which we argue would go a long way in reducing incidents of suicidality among LGBTQ youth. In many jurisdictions across Canada, LGBTQ-inclusive policies have attempted to improve school climates and reduce the effects of homophobia and transphobia in schools. These initiatives, along with the work done by Egale Canada to create a National Youth Suicide Prevention Strategy, are important steps in addressing the needs of LGBTQ youth. © 2016, © Taylor & Francis Group.
Keywords: Discrimination; suicide; youth

Prevalence and correlates of lifetime suicide attempts among transgender persons in argentina - Marshall, B.D.L.; Socías, M.E.; Kerr, T.; Zalazar, V.; Sued, O.; Arístegui, I. (Journal of Homosexuality, 2016)
This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina. © 2016 Taylor & Francis.
Keywords: Argentina; Mental health; Stigma; Suicide; Transgender; Violence

Psychotic panic and feared sexual assault–‘homosexual panic’: the historical role of feared homosexual assault as a contributing factor to self-attack - Goldblatt, M.J.; Maltsberger, J.T. (Scandinavian Psychoanalytic Review, 2016)
Some psychotic patients fall into acute persecutory panic, a subjective experience of helpless terror in the face of anticipated imminent annihilation or dismemberment. These states occur in a wide range of psychotic illnesses and are often associated with command hallucinations and fear of homosexual assault. In a desperate attempt to escape from imaginary enemies, such patients often attack themselves and imagine suicide is survivable. This article addresses the dread of homosexual assault, previously referred to as homosexual panic, and its relationship to patients who attack themselves in a state of desperate psychotic persecution. © 2017 The Scandinavian Psychoanalytic Review.
Keywords: homosexual panic; Paranoia; psychosis; suicide; terror

Bisexuality, Mental Health, and Media Representation - Johnson, H.J. (Journal of Bisexuality, 2016)
There is a mental health crisis in the bisexual community, and though the issues of mental health and media representation are analyzed separately in bisexual literature, they are rarely put side by side. Media such as television, film, and music often contribute to the perpetuation of negative stereotypes and stigmas about people who are bisexual. How do these issues contribute to the high rates of depression, anxiety, and suicide among individuals who are bisexual? What issues do individuals who are bisexual face when they choose to seek help? This research project contributes to bisexual literature by drawing connections between media representation and mental health by firstly examining existing literature on bisexual issues such as biphobia, bisexual erasure, media representation, and mental health, and secondly discussing the results of an online survey to determine how other people who identify as bisexual feel about media representation and its relationship to the mental health crisis in the bisexual community. © 2016 Taylor & Francis Group, LLC.
Keywords: biphobia; bisexuality; film; mental health; mental illness; music; television

Perceived discrimination is an independent risk factor for suicidal ideation among sexual and gender minorities in Nepal - Kohlbrenner, V.; Deuba, K.; Karki, D.K.; Marrone, G. (PLoS ONE, 2016)
Sexual and gender minorities experience an elevated burden of suicidality compared with the general population. Still, little is known about that burden and the factors generating it in the context of low- and middle-income countries. The present study assessed the prevalence of suicidal ideation, planned suicide, and attempted suicide among men who have sex with men (MSM) and transgender people (TG) in Nepal, and examined the association of perceived discrimination on the basis of sexual orientation with suicidal ideation and with attempted suicide. Data were obtained from a surveillance survey among MSM and TG in Nepal in 2012. A sample of 400 MSM and TG, recruited using respondent-driven sampling, completed a structured face-to-face interview. Throughout their lifetime, 26.8% of the participants had experienced suicidal ideation, 12.0% had made a suicide plan, and 9.0% had attempted suicide. In particular, more TG than MSM had experienced suicidal ideation (39.8% vs. 21.3%), had made a suicide plan (19.5% vs. 8.9%), and had attempted suicide (15.3% vs. 6.4%). Overall, the odds of having experienced suicidal ideation was significantly higher among the 38.3% of participants who had perceived discrimination based on their sexual orientation (AOR: 3.17; 95% CI: 1.83-5.48). Moreover, the odds of suicidal ideation was significantly higher as the extent of perceived discrimination increased (AOR: 1.35; 95% CI: 1.15-1.60). However, the odds of attempted suicide was not significantly associated with perceived discrimination (AOR: 1.40; 95% CI: 0.62-3.15). The findings highlight perceived discrimination as an independent risk factor for suicidal ideation. Future suicide prevention programs should target sexual and gender minorities and include elements focusing on discrimination. © 2016 Kohlbrenner 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.

Differences in Mental Health Symptoms Across Lesbian, Gay, Bisexual, and Questioning Youth in Primary Care Settings - Shearer, A.; Herres, J.; Kodish, T.; Squitieri, H.; James, K.; Russon, J.; Atte, T.; Diamond, G.S. (Journal of Adolescent Health, 2016)
Purpose Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal self-injury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14–24 years). Methods Data were collected using the Behavioral Health Screen—a Web-based screening tool that assesses psychiatric symptoms and risk behaviors—during routine well visits. Results Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well. Conclusions Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females. © 2016 Society for Adolescent Health and Medicine
Keywords: Adolescence; LGBQ; Mental health screening; Primary care

Suicide in married couples in Sweden: Is the risk greater in same-sex couples? - Björkenstam, C.; Andersson, G.; Dalman, C.; Cochran, S.; Kosidou, K. (European Journal of Epidemiology, 2016)
Minority sexual orientation is a predictor of suicide ideation and attempts, though its association with suicide mortality is less clear. We capitalize on Sweden’s extensively linked databases, to investigate whether, among married individuals, same-sex marriage is associated with suicide. Using a population-based register design, we analyzed suicide risk among same-sex married women and men (n = 6456), as compared to different-sex married women and men (n = 1181723) in Sweden. We selected all newly partnered or married individuals in the intervening time between 1/1/1996 and 12/31/2009 and followed them with regard to suicide until 12/31/2011. Multivariate Poisson regression was used to calculate adjusted incidence risk ratios (IRR) with 95 % confidence intervals (CI). The risk of suicide was higher among same-sex married individuals as compared to different-sex married individuals (IRR 2.7, 95 % CI 1.5–4.8), after adjustment for time at risk and socioeconomic confounding. Sex-stratified analyses showed a tentatively elevated risk for same-sex married women (IRR 2.5, 95 % CI 0.8–7.7) as compared to different-sex married women. Among same-sex married men the suicide risk was nearly three-fold greater as compared to different-sex married (IRR 2.895 % CI 1.5–5.5). This holds true also after adjustment for HIV status. Even in a country with a comparatively tolerant climate regarding homosexuality such as Sweden, same-sex married individuals evidence a higher risk for suicide than other married individuals. © 2016, Springer Science+Business Media Dordrecht.
Keywords: Gay; Homosexual; Lesbian; LGBT; Marriage; Registered partnership; Sexual minority; Suicide

Depression and Oral FTC/TDF Pre-exposure Prophylaxis (PrEP) Among Men and Transgender Women Who Have Sex With Men (MSM/TGW) - Defechereux, P.A.; Mehrotra, M.; Liu, A.Y.; McMahan, V.M.; Glidden, D.V.; Mayer, K.H.; Vargas, L.; Amico, K.R.; Chodacki, P.; Fernandez, T.; Avelino-Silva, V.I.; Burns, D.; et al. (AIDS and Behavior, 2016)
We conducted a longitudinal and cross-sectional analysis of depressive symptomology in iPrEx, a randomized, placebo-controlled trial of daily, oral FTC/TDF HIV pre-exposure prophylaxis (PrEP) in men and transgender women who have sex with men. Depression-related adverse events (AEs) were the most frequently reported severe or life-threatening AEs and were not associated with being randomized to the FTC/TDF arm (152 vs. 144 respectively OR 0.66 95 % CI 0.35–1.25). Center for Epidemiologic Studies Depression scale (CES-D) and a four questions suicidal ideation scale scores did not differ by arm. Participants reporting forced sex at anal sexual debut had higher CES-D scores (coeff: 3.23; 95 % CI 1.24–5.23) and were more likely to have suicidal ideation (OR 2.2; 95 % CI 1.09–4.26). CES-D scores were higher among people reporting non-condom receptive anal intercourse (ncRAI) (OR 1.46; 95 % CI 1.09–1.94). We recommend continuing PrEP during periods of depression in conjunction with provision of mental health services. © 2015, The Author(s).
Keywords: Depression; FTC/TDF; HIV prevention; iPrEx; Men who have sex with men; PrEP

Bullying victimization and emotional distress: Is there strength in numbers for vulnerable youth? - Eisenberg, M.E.; McMorris, B.J.; Gower, A.L.; Chatterjee, D. (Journal of Psychosomatic Research, 2016)
Objective: The present study examines whether the prevalence of vulnerable peers in school protects the emotional health of youth who are lesbian, gay, bisexual or questioning (LGBQ), overweight, or have a disability, and if the adverse emotional effects of bullying victimization are mitigated by the presence of these peers. Methods: Survey data come from a large school-based sample of adolescents attending 505 schools. The primary independent variable was the percent of students in school with each vulnerability characteristic. Multilevel logistic regression models estimated the odds of internalizing problems, self-harm, suicidal ideation and suicide attempts among students who were LGBQ, overweight or had a disability. Cross-level interaction terms were added to determine if the association between being victimized and emotional distress was moderated by the presence of vulnerable peers. Results: Greater presence of similar students was, on average, protective against emotional distress for LGBQ girls and overweight boys. In contrast, greater presence of students with a disability was, on average, a risk factor among girls with a disability. Several tests of effect modification indicated that odds of emotional distress for those who had been victimized were lower in schools with a higher proportion of vulnerable youth. Conclusions: The presence of a similar peer group may increase the likelihood that a bystander or witness to bullying will react in a helpful way. School personnel, health care providers and other youth service professionals should inquire about social relationships at school, including experiences of harassment and perceptions of peer support, to buffer negative experiences. © 2016 Elsevier Inc.
Keywords: Adolescence; Disability; Mental health; Obesity; School health; Sexual orientation

Self-injury among trans individuals and matched controls: prevalence and associated factors - Davey, A.; Arcelus, J.; Meyer, C.; Bouman, W.P. (Health and Social Care in the Community, 2016)
This study aims to determine the prevalence rate of current non-suicidal self-injury (NSSI) among trans individuals, in comparison with a control sample of non-trans adults. It also aims to compare those with current NSSI and those with no history of NSSI in terms of psychological well-being, self-esteem, body dissatisfaction, social support and demographic factors. Participants were 97 adults, diagnosed with transsexualism (ICD-10, F64.0), attending a national gender clinic in the United Kingdom, and a matched control group. Clinical participants were all engaged on the treatment pathway. Participants completed the following self-report measures: Self-Injury Questionnaire – Treatment Related (SIQ-TR), Symptom Checklist 90 Revised (SCL-90-R), Rosenberg Self-Esteem Scale (RSE), Hamburg Body Drawing Scale (HBDS) and Multidimensional Scale of Perceived Social Support (MSPSS). The results showed that the trans participants had a significantly higher prevalence of current NSSI behaviour than the non-trans group, with 19% currently engaging in NSSI. Current NSSI was also significantly more prevalent among trans men than trans women. Compared with both trans and non-trans participants with no history of NSSI, trans participants with current NSSI had significantly higher scores on SCL; significantly lower scores on RSE, HBDS and MSPSS; and were younger in age. The study concludes that trans men, specifically, are more at risk of NSSI than trans women and the general population, even when on the treatment pathway. Those who currently self-injure have greater psychopathology, lower body satisfaction, lower self-esteem, lower social support and tend to be younger, than those who do not engage in NSSI. © 2015 John Wiley & Sons Ltd
Keywords: prevalence; psychological well-being; self-injury; trans

White Fear, Dehumanization, and Low Empathy: Lethal Combinations for Shooting Biases - Mekawi, Y.; Bresin, K.; Hunter, C.D. (Cultural Diversity and Ethnic Minority Psychology, 2016)
Objectives: A growing number of studies have documented the existence racial shooting biases againstBlack versus White targets (Correll et al., 2002). Little is known about individual differences that maymoderate these biases. The goals of this study were to examine (a) whether White participants' fear ofracial/ethnic minorities is associated with racial shooing biases, and (b) whether dehumanization andempathy moderate this effect. Method: Participants (N ± 290) completed a dehumanization implicitassociation test and simulated shooting task, then reported their fear of racial minorities (i.e., White fear)and empathic ability. Results: We found that (a) individuals high in White fear showed a shooting bias,such that they had a lower threshold for shooting Black relative to White and East Asian targets, (b)Dehumanization moderated the White fear and shooting bias relation, such that individuals high in Whitefear and high in dehumanization had a significantly more liberal shooting threshold for Black versusWhite targets, and (c) Empathy moderated the White fear and shooting bias relation, such that people whowere high in White fear and low in empathic ability had a more liberal shooting threshold for Blackversus White targets. In sum, fearing racial/ethnic minorities can have devastating shooting biasoutcomes for Black individuals, but this effect is stronger when people also dehumanize Black individuals,and weaker when people have high empathy. Conclusions: These findings contribute to theliterature by identifying theory driven moderators that identify both risk and protective factors inpredicting racial shooting biases. © 2015 American Psychological Association.
Keywords: Dehumanization; Empathy; Shooting biases; Shooting task; White fear

Lubricant use and rectal chlamydial and gonococcal infections among men who engage in receptive anal intercourse - Maierhofer, C.; Rice, C.E.; Wang, S.-H.; Fields, K.S.; Ervin, M.; Turner, A.N. (Sexually Transmitted Diseases, 2016)
Background: Use of lubricants during anal intercourse is very common among men who have sex with men. However, few studies have evaluated associations between specific lubricants and rectal sexually transmitted infections (STIs). Methods: Between July 2012 and October 2013, we conducted a crosssectional study of men who have sex with men recruited from an urban, public sexual health clinic. In a self-administered survey, participants identified the lubricants used and frequency of lubricant use in the previous three months. Among men reporting any receptive anal intercourse (RAI) in the previous 3 months, we used multivariable binomial regression models to analyze associations between recent use of 9 specific lubricants and prevalent rectal chlamydia, rectal gonorrhea, and either rectal infection. Results: Twenty-five percent of the 146 participants had rectal chlamydial infection and 21% had rectal gonococcal infection; 37% had either (chlamydial or gonococcal) infection. Three-quarters reported always or almost always using lubricant during recent receptive anal intercourse. After adjustment for age, race, human immunodeficiency virus status, and condom use, Gun Oil (adjusted prevalence ratio [aPR], 1.99; 95% confidence interval [CI], 1.04-3.80) and Slick (aPR, 3.55; 95% CI, 1.38-9.12) were significantly associated with prevalent gonococcal infection. No lubricants were significantly associated with prevalent rectal chlamydia, but in analyses of either rectal infection, precum (aPR, 1.68; 95%CI, 1.06-2.66),Vaseline (aPR, 1.70; 95% CI, 1.10-2.64), and baby oil (aPR, 2.26; 95% CI, 1.43-3.57) were all significantly associated with prevalent rectal infection. Conclusions: Several lubricants were significantly associated with increased prevalence of rectal STI. Longitudinal studies are needed to examine any causal relationship between specific lubricants and STI acquisition. Copyright © 2016 American Sexually Transmitted Diseases Association. All rights reserved.

Occurrence of multiple mental health or substance use outcomes among bisexuals: A respondent-driven sampling study - Bauer, G.R.; Flanders, C.; MacLeod, M.A.; Ross, L.E. (BMC Public Health, 2016)
Background: Bisexual populations have higher prevalence of depression, anxiety, suicidality and substance use than heterosexuals, and often than gay men or lesbians. The co-occurrence of multiple outcomes has rarely been studied. Methods: Data were collected from 405 bisexuals using respondent-driven sampling. Weighted analyses were conducted for 387 with outcome data. Multiple outcomes were defined as 3 or more of: depression, anxiety, suicide ideation, problematic alcohol use, or polysubstance use. Results: Among bisexuals, 19.0 % had multiple outcomes. We did not find variation in raw frequency of multiple outcomes across sociodemographic variables (e.g. gender, age). After adjustment, gender and sexual orientation identity were associated, with transgender women and those identifying as bisexual only more likely to have multiple outcomes. Social equity factors had a strong impact in both crude and adjusted analysis: controlling for other factors, high mental health/substance use burden was associated with greater discrimination (prevalence risk ratio (PRR) = 5.71; 95 % CI: 2.08, 15.63) and lower education (PRR = 2.41; 95 % CI: 1.06, 5.49), while higher income-to-needs ratio was protective (PRR = 0.44; 0.20, 1.00). Conclusions: Mental health and substance use outcomes with high prevalence among bisexuals frequently co-occurred. We find some support for the theory that these multiple outcomes represent a syndemic, defined as co-occurring and mutually reinforcing adverse outcomes driven by social inequity. © 2016 The Author(s).
Keywords: Epidemiology; Health inequalities; Mental health; Sexual orientation; Substance use

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

Identity, Relationship Satisfaction, and Disclosure: Predicting Suicide Risk Among Sexual Minority Women - Velkoff, E.A.; Forrest, L.N.; Dodd, D.R.; Smith, A.R. (Psychology of Women Quarterly, 2016)
We tested the usefulness of combining the Interpersonal–Psychological Theory of Suicide and minority stress models in studying suicidality among sexual minority women. According to the Interpersonal–Psychological Theory of Suicide, perceptions of being a burden on others and feelings of failed belongingness predict suicidal ideation. In a sample of sexual minority women (n = 51), we tested first, if the interaction of perceived burdensomeness and failed belongingness predicted lifetime suicidal behavior; second, if identity affirmation was negatively related to perceived burdensomeness and if this relation was moderated by disclosure; and third, if relationship satisfaction was negatively related to failed belongingness and if this relation was moderated by acceptance concerns. The proposed interaction of perceived burdensomeness and failed belongingness predicted lifetime suicide attempts. Moreover, among sexual minority women with greater disclosure of their sexual minority identities, low identity affirmation was related to higher perceived burdensomeness. For sexual minority women with high acceptance concerns, relationship satisfaction did not relate to lower feelings of failed belongingness. These findings suggest that sexual minority related stressors moderate risk factors for suicidality—in particular, perceptions of burdensomeness and failed belongingness. We suggest clinicians and others encourage sexual minority individuals to engage in activities that promote effectiveness and interpersonal closeness. Online slides for instructors who want to use this article for teaching are available to PWQ subscribers on PWQ's website at http://pwq.sagepub.com/supplemental © 2015, © The Author(s) 2015.
Keywords: identity; Interpersonal–Psychological Theory of Suicide; relationship satisfaction; sexual orientation; suicide

Stigma, substance use and sexual risk behaviors among HIV-infected men who have sex with men: A qualitative study - Edelman, E.J.; Cole, C.A.; Richardson, W.; Boshnack, N.; Jenkins, H.; Rosenthal, M.S. (Preventive Medicine Reports, 2016)
Background: Public health HIV-service providers, including Medical Case Managers (case managers) and Disease Intervention Specialists (DIS) have a key role to play in identifying and addressing clients' complex mental health needs and substance use which contribute to sexual risk behaviors, yet their understanding and its consensus with HIV-infected men who have sex with men (MSM) have not been well characterized. Methods: Together with an AIDS Service Organization and the Connecticut State Department of Public Health in 2011-2012, we conducted a focus group of case managers (n = 14) and interviewed DIS (n = 7) and HIV-infected MSM (n = 17) in Connecticut. We used the constant comparison method, grounded theory, and a community-based participatory approach to guide analysis. Results: We identified three themes characterizing public health HIV-service providers' and MSM's perspectives regarding factors contributing to substance use and sexual risk behaviors in the context of HIV infection: 1) While both MSM and providers described a co-occurrence of HIV, stigma, substance use, and sexual risk behaviors, only MSM identified a causal relationship between these factors; 2) MSM and providers both described varying levels of self-efficacy in readiness to decrease substance use and sexual risk behaviors among MSM; both identified the social network as the key barrier to overcome; 3) Providers described how the co-occurrence of HIV, stigma and sexual risk behaviors leads to multi-faceted client needs for which they lacked sufficient training and collaboration. Conclusions: Provider education, skills-based training, and interventions targeting social networks may decrease sexual risk behaviors among HIV-infected MSM. © 2016 The Authors.
Keywords: Community-based participatory research; HIV; Homosexuality; Men who have sex with men (MSM); Qualitative research; Risk-taking

Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults - Klein, A.; Golub, S.A. (LGBT Health, 2016)
Purpose: We examined associations between family rejection and risk of suicide attempts and substance misuse among a national sample of transgender and gender nonconforming adults. Methods: Data were drawn from the National Transgender Discrimination Survey (N = 6456). This secondary analysis was restricted to 3458 individuals who self-identified as transgender or gender nonconforming and provided complete data on study variables. We used multivariable logistic regression to examine health risks by level of reported family rejection (low/moderate/high), controlling for relevant sociodemographic characteristics. Results: Overall, 42.3% of the sample reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination. After controlling for age, race/ethnicity, sex assigned at birth, binary gender identity, income, education, and employment status, family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection. Conclusions: Family rejection related to gender identity is an understudied interpersonal stressor that may negatively affect health outcomes for transgender and gender nonconforming individuals. A better understanding of the role of close relationships in both risk and resilience for transgender individuals is critical in the development of effective public health interventions for this community. © Mary Ann Liebert, Inc. 2016.
Keywords: family rejection; substance use; suicide; transgender

Self-Harm and Suicidality in Children Referred for Gender Dysphoria - Aitken, M.; VanderLaan, D.P.; Wasserman, L.; Stojanovski, S.; Zucker, K.J. (Journal of the American Academy of Child and Adolescent Psychiatry, 2016)
Objective This study examined rates of self-harm and suicidality (ideation and behavior) in children referred clinically for gender dysphoria compared with their siblings, and referred and nonreferred children from the Child Behavior Checklist (CBCL) standardization sample. Predictors or correlates of self-harm/suicidality were also examined. Method The sample consisted of 572 gender-referred children, 425 siblings, 878 referred children, and 903 nonreferred children. Parent report for 2 CBCL items was used to assess self-harm and suicidality. CBCL total behavior problems and a metric of peer relationship problems were also used. Results The gender-referred children and the referred children from the standardization sample had significantly higher scores than siblings and nonreferred children in terms of self-harm/suicidality, total behavior problems, and poor peer relations. Based on logistic regression analyses, gender-referred children were 5.1 times more likely than nonreferred children to talk about suicide and 8.6 times more likely to self-harm/attempt suicide, even after overall behavior problems and peer relationship problems were accounted for. In the final models, group, older age, and more total behavior problems, but not poor peer relations, were significantly associated with an increased likelihood of self-harm/suicidality. Conclusion By parent report, children with gender dysphoria show an increased rate of self-harm/suicidality as they get older. This risk was not simply an artifact of the presence of behavioral and emotional problems, although these problems were significant correlates of self-harm/suicidality. Clinicians should routinely screen for the presence of suicidal ideation and behavior in children with gender dysphoria, particularly during the second half of childhood. © 2016 American Academy of Child and Adolescent Psychiatry
Keywords: Child Behavior Checklist; gender dysphoria; suicidality

Mental health and the transgender population - Carmel, T.C.; Erickson-Schroth, L. (Psychiatric Annals, 2016)
Although research has increased remarkably in recent years, exploration of mental health disparities faced by transgender and gender nonconforming (TGNC) populations has historically been limited. TGNC people experience disproportionate rates of discrimination, harassment, violence, and sexual assault, precipitating negative mental health outcomes, as explained by the Minority Stress Model. Further research substantiates an increased risk of depression, substance use disorders, self-injury, and suicidal ideation/attempts in transgender populations. Studies are less conclusive with regard to rates of anxiety disorders, posttraumatic stress disorder, bipolar disorder, psychotic disorders, eating disorders, body dysmorphic disorders, autism spectrum disorders, and personality disorders. Social and familial support are protective factors in this population. © SLACK Incorporated.

Gender dysphoria in children and adolescents: Literature review - Mendes, N.; Lagrange, C.; Condat, A. (Neuropsychiatrie de l'Enfance et de l'Adolescence, 2016)
Background Today in France, specialised consultations for gender dysphoria in children and adolescents are just being developed although specialised teams already address this public abroad since decades. Their experience inspired the medical care in a remarkable way. Methods To illustrate the present state of research in child and adolescents with gender dysphoria, we first made a review of Zucker and al. publication (2013). We then compiled further researches available on the subject (post 2013) as well as precursor works on transsexualism or gender concept in general. We also took into consideration the most recent publications available in scientific journals and the most relevant clinical trials. Results This research allows us to highlight the evolution of diagnostic criteria, prevalence data, comorbidity and associated psychopathologies, biological factors, and available treatments. We also discuss psychodynamics observations and more generic issues based on available data. Conclusion The recurrence of anxious and depressive signs and suicide risk in the studied population demonstrate the need to consider gender dysphoria when providing medical and psychological care to these children and adolescents. The recommended treatments also need to consider possible comorbidity and the frequent related difficulties (such as social ostracism, anxiety, etc.). Currently, there is an urgent need to develop specialised centres and platforms in France to allow clinical practitioners to share their knowledge and researches results. © 2016
Keywords: Diagnosis; DSM; Endocrinology; Gender dysphoria; Genetic; Literature review; Psychopathology; Treatment

Politics, pathology, suicide, and social fates: Tony Kushner's the Intelligent Homosexual's Guide to Capitalism and Socialism with a Key to the Scriptures - Gullette, M.M. (Modern Drama, 2016)
Many older characters in recent plays become, or think they will become, "demented." Being old - the oldest person in the dramatis personae - is suddenly glued to cognitive weakness. The cultural message now spreading throughout our frightened world is this: if a person this old has this future as a fate, considering suicide is almost obligatory. This destiny is one of the not-so-subtle messages emanating from a group of such plays, and from the one that this essay focuses on, Tony Kushner's The Intelligent Homosexual's Guide to Capitalism and Socialism with a Key to the Scriptures. How is it possible that a visionary who rallied so courageously on behalf of people with HIV/ AIDS in the early 1990s fails to find a way of defending a character (and by extension, people) with mild cognitive impairment (MCI)? Kushner's dramatic choices - especially his protagonist Gus's noble political despair - might have made superfluous the choice of Alzheimer's to drive his mourning-play. The real illness of this character is neither Alzheimer's nor a death drive but the impotence of radical activism, individual and collective. © University of Toronto.
Keywords: Age studies; Ageism; Alzheimer's disease; Angels in America; Capitalism; Cognitive impairment; DSM-5; Elegy; Mild cognitive impairment; Tragedy; Unionism

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality - Simonsen, R.K.; Giraldi, A.; Kristensen, E.; Hald, G.M. (Nordic Journal of Psychiatry, 2016)
Background: There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark. Aims: (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978-2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978-2010. Method: Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. Results: Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years. Conclusions: No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others. © 2015 Taylor & Francis.
Keywords: Follow-up; gender identity disorder; mortality; psychiatric morbidity; sex reassignment surgery (SRS); transsexualism

The Association Between Supportive High School Environments and Depressive Symptoms and Suicidality Among Sexual Minority Students - Denny, S.; Lucassen, M.F.G.; Stuart, J.; Fleming, T.; Bullen, P.; Peiris-John, R.; Rossen, F.V.; Utter, J. (Journal of Clinical Child and Adolescent Psychology, 2016)
The purpose of this study was to determine if sexual minority students in supportive school environments experienced fewer depressive symptoms and lower rates of suicide ideation, plans and attempts (“suicidality”) than sexual minority students in less supportive school environments. In 2007, a nationally representative sample (N = 9,056) of students from 96 high schools in New Zealand used Internet tablets to complete a health and well-being survey that included questions on sexual attractions, depressive symptoms, and suicidality. Students reported their experience of supportive environments at school and gay, lesbian, bisexual, and transgender (GLBT) bullying, and these items were aggregated to the school level. Teachers (n = 2,901) from participating schools completed questionnaires on aspects of school climate, which included how supportive their schools were toward sexual minority students. Multilevel models were used to estimate school effects on depressive symptoms and suicidality controlling for background characteristics of students. Sexual minority students were more likely to report higher levels of depressive symptoms and suicidality than their opposite-sex attracted peers (p < .001). Teacher reports of more supportive school environments for GLBT students were associated with fewer depressive symptoms among male sexual minority students (p = .006) but not for female sexual minority students (p = .09). Likewise in schools where students reported a more supportive school environment, male sexual minority students reported fewer depressive symptoms (p = .006) and less suicidality (p < .001) than in schools where students reported less favorable school climates. These results suggest that schools play an important role in providing safe and supportive environments for male sexual minority students. © Taylor & Francis Group, LLC.

Understanding the Effects of Victimization: Applying General Strain Theory to the Experiences of LGBQ Youth - Button, D.M. (Deviant Behavior, 2016)
Using a statewide probability sample of lesbian, gay, bisexual, and queer (LGBQ) youth (N = 484), this study uses a general strain theory framework to better understand the processes that connect LGBQ youths’ experiences with victimization, negative outcomes, and social support. Results show that while victimization reliably predicts negative outcomes, including poor academic performance, substance use, and suicidality, the moderating effects of social support are unreliable and contrary to theoretical expectations. Reconceptualizing social support from a moderating variable to social isolation, an independent variable, helps elucidate the role of social support in LGBQ youths’ experiences with negative outcomes. Implications are discussed. © 2016 Taylor & Francis.

Bisexuality, poverty and mental health: A mixed methods analysis - Ross, L.E.; O'Gorman, L.; MacLeod, M.A.; Bauer, G.R.; MacKay, J.; Robinson, M. (Social Science and Medicine, 2016)
Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health. © 2016 The Authors.
Keywords: Bisexuality; Canada; Mental health; Mixed methods; Poverty; Socioeconomic status

Transgender patients, isotretinoin, and US food and drug administration-mandated risk evaluation and mitigation strategies a prescription for inclusion - Katz, K.A. (JAMA Dermatology, 2016)

Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: Baseline Findings from Project LifeSkills - Reisner, S.L.; Biello, K.B.; Hughto, J.M.W.; Kuhns, L.; Mayer, K.H.; Garofalo, R.; Mimiaga, M.J. (JAMA Pediatrics, 2016)
IMPORTANCE Transgender youth, including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female, or another diverse transfeminine gender identity, represent a vulnerable population at risk for negative mental health and substance use outcomes. Diagnostic clinical interviews to assess prevalence of mental health, substance dependence, and comorbid psychiatric disorders in young transgender women remain scarce. OBJECTIVE To report the prevalence of mental health, substance dependence, and comorbid psychiatric disorders assessed via clinical diagnostic interview in a high-risk community-recruited sample of young transgender women. DESIGN, SETTING, AND PARTICIPANTS Observational study reporting baseline finding from a diverse sample of 298 sexually active, young transgender women aged 16 through 29 years (mean age, 23.4 years; 49.0%black, 12.4%Latina, 25.5%white, and 13.1%other minority race/ethnicity) and enrolled in Project LifeSkills, an ongoing randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. EXPOSURE Transfeminine gender identity. MAIN OUTCOMES AND MEASURES Age- and site-adjusted prevalence and comorbidities of mental health and substance dependence disorders assessed via the Mini-International Neuropsychiatric Interview, including 1 or more diagnoses, 2 or more comorbid diagnoses, major depressive episode (current and lifetime), past 30-day suicidal risk (no/low risk vs moderate/high risk), past 6-month generalized anxiety disorder and posttraumatic stress disorder, and past 12-month alcohol dependence and nonalcohol psychoactive substance use dependence. RESULTS Of the 298 transgender women, 41.5%of participants had 1 or more mental health or substance dependence diagnoses; 1 in 5 (20.1%) had 2 or more comorbid psychiatric diagnoses. Prevalence of specific disorders was as follows: lifetime and current major depressive episode, 35.4%and 14.7%, respectively; suicidality, 20.2%; generalized anxiety disorder, 7.9%; posttraumatic stress disorder, 9.8%; alcohol dependence, 11.2%; and nonalcohol psychoactive substance use dependence, 15.2%. CONCLUSIONS AND RELEVANCE Prevalence of psychiatric diagnoses was high in this community-recruited sample of young transgender women. Improving access to routine primary care, diagnostic screening, psychotherapy, and pharmacologic treatments, and retention in care in clinical community-based, pediatric, and adolescent medicine settings are urgently needed to address mental health and substance dependence disorders in this population. Further research will be critical, particularly longitudinal studies across development, to understand risk factors and identify optimal timing and targets for psychosocial interventions. Copyright 2016 American Medical Association. All rights reserved.

Prevalence and risk factors for lifetime suicide ideation, plan and attempt in Chinese men who have sex with men - Mu, H.; Li, Y.; Liu, L.; Na, J.; Yu, L.; Bi, X.; An, X.; Gu, Y.; Zhou, Y.; Li, S.; Zhang, R.; Jiang, C.; et al. (BMC Psychiatry, 2016)
Background: To describe the level and risk factors for suicidal behaviors in Chinese men who have sex with men (MSM). Methods: A total of 807 MSM were recruited using a respondent-driven sampling method from Anshan, Benxi, Dandong, and Shenyang cities in northeastern China. Results: Chinese MSM had lifetime prevalences of suicide ideation (18.3%), plan (8.7%) and attempt (4.6%) that were about 2.8, 5.8 and 5.8 times greater than that of male adults in the general population of China. The MSM with any psychiatric disorders were 4-7 times more likely to think about, plan or attempt suicide than those MSM with no disorder, and there was a clear relationship between the number of comorbid disorders and suicidal behaviors. Multiple regression analysis showed that major depression, bipolar disorder, dysthymia and alcohol use disorder significantly increased the risk for suicide ideation, but not for suicide attempt. Drug dependence disorder, panic disorder and generalized anxiety disorder significantly increased the risk for suicide attempt, but not for suicide ideation. More advanced education reduced the risk of suicidal behaviors, sexual orientations revealed to or discovered by family members or friends significantly increased risk of these suicidal behaviors. Conclusions: Chinese MSM have significantly increased risk for suicidal behaviors, mental disorders and their comorbidities could be the largest risk factors for the elevated suicidal behaviors in Chinese MSM. Reducing the family and social stigma and rejection of homosexual behavior and early detection and effective treatment of psychiatric disorders and their comorbidities in MSM may help to decrease suicidal behaviors of Chinese MSM. © 2016 Mu et al.
Keywords: Comorbidity; Men who have sex with men; Psychiatric disorder; Suicidal behavior

Making the invisible visible: A systematic review of sexual minority women's health in Southern Africa - Muller, A.; Hughes, T.L. (BMC Public Health, 2016)
Background: Over the past two decades research on sexual and gender minority (lesbian, gay, bisexual and transgender; LGBT) health has highlighted substantial health disparities based on sexual orientation and gender identity in many parts of the world. We systematically reviewed the literature on sexual minority women's (SMW) health in Southern Africa, with the objective of identifying existing evidence and pointing out knowledge gaps around the health of this vulnerable group in this region. Methods: A systematic review of publications in English, French, Portuguese or German, indexed in PubMed or MEDLINE between the years 2000 and 2015, following PRISMA guidelines. Additional studies were identified by searching bibliographies of identified studies. Search terms included (Lesbian OR bisexual OR "women who have sex with women"), (HIV OR depression OR "substance use" OR "substance abuse" OR "mental health" OR suicide OR anxiety OR cancer), and geographical specification. All empirical studies that used quantitative or qualitative methods, which contributed to evidence for SMW's health in one, a few or all of the countries, were included. Theoretical and review articles were excluded. Data were extracted independently by 2 researchers using predefined data fields, which included a risk of bias/quality assessment. Results: Of 315 hits, 9 articles were selected for review and a further 6 were identified through bibliography searches. Most studies were conducted with small sample sizes in South Africa and focused on sexual health. SMW included in the studies were racially and socio-economically heterogeneous. Studies focused predominately on young populations, and highlighted substance use and violence as key health issues for SMW in Southern Africa. Conclusions: Although there are large gaps in the literature, the review highlighted substantial sexual-orientation-related health disparities among women in Southern Africa. The findings have important implications for public health policy and research, highlighting the lack of population-level evidence on the one hand, and the impact of criminalizing laws around homosexuality on the other hand. © 2016 Muller and Hughes.
Keywords: Sexual minority health; Southern Africa; Systematic review; Women's health

The relationship between social support and suicide risk in a national sample of ethnically diverse sexual minority women - Tabaac, A.R.; Perrin, P.B.; Rabinovitch, A.E. (Journal of Gay and Lesbian Mental Health, 2016)
ABSTRACT: This study examined the relationship between three types of social support and suicidal ideation and lifetime attempts among a national sample of ethnically diverse sexual minority women (SMW). Participants (N = 150) completed measures of social support and suicidal ideation/attempts. After controlling for socioeconomic status, social support explained 12.3% of the variance in past suicidal ideation and 10.7% in lifetime suicide attempts. Social support from family and significant other were both inversely associated with suicidal ideation, and social support from family inversely with lifetime attempts. Interventions that strengthen family relationships could be a buffer of suicidality in this population. ©2016 Taylor & Francis Group, LLC.
Keywords: Bisexual; family; lesbian; suicide

Prevalence and Mental Health Correlates of Illegal Cannabis Use Among Bisexual Women - Robinson, M.; Sanches, M.; MacLeod, M.A. (Journal of Bisexuality, 2016)
This study reports the prevalence of cannabis use among bisexual women in Ontario, Canada, and identifies correlations among levels of cannabis use (no use, some use, active use) and measures of mental health and social support. Analysis focused on 262 bisexual women from a bisexual mental health study using respondent-driven sampling. Among networked bisexual women in Ontario, Canada, the weighted prevalence of past-year cannabis use was 33.6%, with 13.8% of bisexual women using cannabis twice or more per week. Cannabis use was positively associated with social support, gay community involvement, outness to family, and depression. There was no significant association between cannabis use and anxiety, posttraumatic stress disorder, antibisexual experiences, or suicidal ideation. Bisexual women's rate of past-year cannabis use is more than 5 times that for Canadian women in general, and is consistent with rates for bisexual women found in U.S. studies. © 2016 Taylor & Francis Group, LLC.
Keywords: biphobia; bisexuality; cannabis; discrimination; internalized biphobia; mental health; sampling

Baseline assessment of campus-wide general health status and mental health: Opportunity for tailored suicide prevention and mental health awareness programming - Hawley, L.D.; MacDonald, M.G.; Wallace, E.H.; Smith, J.; Wummel, B.; Wren, P.A. (Journal of American College Health, 2016)
Objective: A campus-wide assessment examined the physical and mental health status of a midsize midwestern public university. Participants: Two thousand and forty-nine students, faculty, and staff on a single college campus were assessed in March-April 2013. Methods: Participants completed an online survey with sections devoted to demographics, physical and mental health status, and suicide knowledge and experiences. Results: This study captured broad physical and mental health indicators. Students, faculty, and staff in certain demographic groups were more likely to report significant problems associated with mental and physical health. Specifically, women, faculty and staff of color, and nonheterosexual persons reported worse health outcomes. Across 8 mental health indicators, students reported consistently worse mental health than their faculty/staff counterparts. Conclusions: This paper presents findings from a significant campus-wide physical and mental health surveillance initiative. Results indicate the need for targeted physical and mental health support and intervention among these demographic groups. © 2016 Taylor & Francis Group, LLC.
Keywords: Health education; Mental health

Effects of Victimization and Violence on Suicidal Ideation and Behaviors among Sexual Minority and Heterosexual Adolescents - Bouris, A.; Everett, B.G.; Heath, R.D.; Elsaesser, C.E.; Neilands, T.B. (LGBT Health, 2016)
Purpose: Sexual minority youth (SMY) are at higher risk for victimization and suicide than are heterosexual youth (HY). Relatively little research has examined which types of victimization are most closely linked to suicide, which is necessary to develop targeted prevention interventions. The present study was conducted to address this deficit. Methods: The data come from the 2011 Chicago Youth Risk Behavior Survey (n = 1,907). Structural equation modeling (SEM) in Mplus evaluated the direct, indirect, and total effects of sexual orientation on a latent indicator of suicidal ideation and behaviors via seven types of victimization. Four indicators of victimization were school-specific (e.g., harassment due to sexual orientation or gender identity (SO/GID), bullying, threatened or injured with a weapon, and skipping school due to safety concerns), and three indicators assessed other types of victimization (e.g., electronic bullying, intimate partner violence, and sexual abuse). Results: Thirteen percent of youth were classified as SMY. Significantly more SMY than HY reported suicidal ideation (27.95% vs. 13.64%), a suicide plan (22.78% vs. 12.36%), and at least one suicide attempt (29.92% vs. 12.43%) in the past year (all P < .001). A greater percentage of SMY reported SO/GID-related harassment, skipping school, electronic bullying, and sexual abuse. Sexual orientation was not directly related to suicidal ideation and behaviors in SEM. Rather, SMY's elevated risk of suicidality functioned indirectly through two forms of school-based victimization: being threatened or injured with a weapon (B = .19, SE = .09, P ≤ .05) and experiencing SO/GID-specific harassment (B = .40, SE = .15, P ≤ .01). There also was a trend for SMY to skip school as a strategy to reduce suicide risk. Conclusion: Although SMY experience higher rates of victimization than do HY, school-based victimization that involves weapons or is due to one's SO/GID appear to be the most deleterious. That SMY may skip school to reduce their risk of suicidal ideation and behaviors is problematic, and schools should be encouraged to enact and enforce policies that explicitly protect SMY from victimization. © Copyright 2016, Mary Ann Liebert, Inc. 2016.
Keywords: child and adolescent development; LGBT youth; sexual orientation; suicide

A Comparative Analysis of a Community and General Sample of Lesbian, Gay, and Bisexual Individuals - Kuyper, L.; Fernee, H.; Keuzenkamp, S. (Archives of Sexual Behavior, 2016)
Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues (“community sample,” N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands (“panel sample,” N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexual orientation, were more open about their sexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R 2 of the analyses (which were adjusted for sociodemographic differences) ranged from.08 (suicide plans among men) to.27 (sexual attraction among women). However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed. © 2015, Springer Science+Business Media New York.
Keywords: Bisexuality; Gay men; Homosexuality; Lesbians; Minority stress; Sexual orientation

Sexual Self-Concept Ambiguity and the Interpersonal Theory of Suicide Risk - Talley, A.E.; Brown, S.L.; Cukrowicz, K.; Bagge, C.L. (Suicide and Life-Threatening Behavior, 2016)
Mechanisms (i.e., thwarted belongingness, perceived burdensomeness, hopelessness) derived from the interpersonal theory of suicide which are hypothesized to account for the relation between sexual orientation self-concept ambiguity and active suicide ideation were examined. Participants included 349 women, among whom 42% currently self-ascribed a non-exclusively heterosexual sexual identity. Among women reporting higher levels of sexual self-concept ambiguity, greater risk for active suicide ideation is found when perceptions of burden and feelings of thwarted belonging co-occur with feelings of hopelessness. Results support relevant theory useful for understanding suicide risk among sexual minority women who acknowledge ambiguity with regard to their sexual orientation. © 2015 The American Association of Suicidology.

Empiricism as Change Agent - Kravitz, R.L. (Journal of General Internal Medicine, 2016)

Sociodemographic Characteristics and Psychological Adjustment Among Transsexuals in Spain - Guzmán-Parra, J.; Sánchez-Álvarez, N.; de Diego-Otero, Y.; Pérez-Costillas, L.; Esteva de Antonio, I.; Navais-Barranco, M.; Castro-Zamudio, S.; Bergero-Miguel, T. (Archives of Sexual Behavior, 2016)
This study examined the sociodemographic characteristics and the psychological adjustment of transsexuals in Andalusia (Spain), and also analyzed the differences between female-to-male (FtM) and male-to-female (MtF) transsexuals. The sample included 197 transsexuals (101 MtF and 96 FtM) selected from those who visited the Transsexual and Gender Identity Unit at the Carlos Haya Hospital in Malaga between 2011 and 2012. Our analyses indicated that MtF transsexuals were more likely to have lower educational levels, live alone, have worked less frequently throughout their lifetime, and have engaged in prostitution. For FtM transsexuals, there were more frequent references to the mother’s psychiatric history and more social avoidance and distress. Multivariate analysis showed that the number of personality dysfunctional traits and unemployment status were associated with depression in the entire sample. The following three conclusions can be made: there are significant differences between MtF and FtM transsexuals (mainly related to sociodemographic variables), depression was high in both groups, and a remarkable percentage of transsexuals have attempted suicide (22.8 %) or have had suicidal thoughts (52.3 %). © 2015, Springer Science+Business Media New York.
Keywords: Gender dysphoria; Psychosocial adjustment; Sociodemographic characteristics; Transgender; Transsexualism

Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis - Padula, W.V.; Heru, S.; Campbell, J.D. (Journal of General Internal Medicine, 2016)
BACKGROUND: Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. OBJECTIVE: To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. DESIGN: Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3 % (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). PATIENTS: U.S. transgender population starting before transitional therapy. INTERVENTIONS: No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. MAIN MEASURES: Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. KEY RESULTS: Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000–22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints —HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85 % of simulations. CONCLUSIONS: Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions. © 2015, Society of General Internal Medicine.
Keywords: budget impact analysis; cost-effectiveness analysis; health insurance coverage; health law; preventive care; transgender health

Hands on My Hips: Politics of a Subversive Fish - Teman, E.D. (Qualitative Inquiry, 2016)
These interpretive autoethnographic tales are about my life experiences, growing up in rural Ohio as a queer male. I relive several of the innumerable unfortunate encounters with bullies who have haunted me over the years, partly as a therapeutic means to cope with the lasting effects of those torturous years and partly to potentially reach and touch the lives of others similarly affected. I use performative texts as a powerful means of portraying and articulating my message and persuasively voicing the emotion experienced. I also reflect on the queer predicament and how it has shaped my life. © 2015, © The Author(s) 2015.
Keywords: autoethnography; bullying; LGBT; narrative; queer; suicide

Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study - Brown, G.R.; Jones, K.T. (LGBT Health, 2016)
Purpose: There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status. Methods: Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population. Results: In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups. Conclusion: This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems. © Copyright 2016, Mary Ann Liebert, Inc. 2016.
Keywords: disparity; gender dysphoria; military; transgender; veteran

Gender Dysphoria in Adults - Zucker, K.J.; Lawrence, A.A.; Kreukels, B.P.C. (Annual Review of Clinical Psychology, 2016)
Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities. Copyright ©2016 by Annual Reviews. All rights reserved.
Keywords: Causal mechanisms; Gender dysphoria; Gender identity disorder; Transsexualism; Treatment

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

Sexual orientation and symptoms of common mental disorder or low wellbeing: Combined meta-analysis of 12 UK population health surveys - Semlyen, J.; King, M.; Varney, J.; Hagger-Johnson, G. (BMC Psychiatry, 2016)
Background: Previous studies have indicated increased risk of mental disorder symptoms, suicide and substance misuse in lesbian, gay and bisexual (LGB) adults, compared to heterosexual adults. Our aims were to determine an estimate of the association between sexual orientation identity and poor mental health and wellbeing among adults from 12 population surveys in the UK, and to consider whether effects differed for specific subgroups of the population. Methods: Individual data were pooled from the British Cohort Study 2012, Health Survey for England 2011, 2012 and 2013, Scottish Health Survey 2008 to 2013, Longitudinal Study of Young People in England 2009/10 and Understanding Society 2011/12. Individual participant meta-analysis was used to pool estimates from each study, allowing for between-study variation. Results: Of 94,818 participants, 1.1 % identified as lesbian/gay, 0.9 % as bisexual, 0.8 % as 'other' and 97.2 % as heterosexual. Adjusting for a range of covariates, adults who identified as lesbian/gay had higher prevalence of common mental disorder when compared to heterosexuals, but the association was different in different age groups: apparent for those under 35 (OR = 1.78, 95 % CI 1.40, 2.26), weaker at age 35-54.9 (OR = 1.42, 95 % CI 1.10, 1.84), but strongest at age 55+ (OR = 2.06, 95 % CI 1.29, 3.31). These effects were stronger for bisexual adults, similar for those identifying as 'other', and similar for 'low wellbeing'. Conclusions: In the UK, LGB adults have higher prevalence of poor mental health and low wellbeing when compared to heterosexuals, particularly younger and older LGB adults. Sexual orientation identity should be measured routinely in all health studies and in administrative data in the UK in order to influence national and local policy development and service delivery. These results reiterate the need for local government, NHS providers and public health policy makers to consider how to address inequalities in mental health among these minority groups. © 2016 Semlyen et al.
Keywords: Anxiety disorders; Depression; Health surveys; Homosexuality; Mental disorders; Meta-analysis; Mood disorders; Neurotic disorders; Sexual orientation; Sexuality

Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America - Biello, K.B.; Oldenburg, C.E.; Safren, S.A.; Rosenberger, J.G.; Novak, D.S.; Mayer, K.H.; Mimiaga, M.J. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2016)
Latin America has some of the highest levels of antiretroviral therapy (ART) coverage of any developing region in the world. Early initiation and optimal adherence to ART are necessary for improved health outcomes and reduction in onward transmission. Previous work has demonstrated the role of psychosocial problems as barriers to uptake and adherence to ART, and recently, a syndemic framework has been applied to the role of multiple psychosocial syndemic factors and adherence to ART, in the USA. However, to our knowledge, these associations have not been investigated outside of the USA, nor in a multi-country context. To address these gaps, we assessed the association between multiple co-occurring psychosocial factors and engagement in HIV-related medical care and adherence to ART among a large, multinational sample of sexually-active HIV-infected men who have sex with men in Latin America.Among the 2020 respondents, 80.7% reported currently receiving HIV-related medical care, 72.3% reported currently receiving ART; among those, 62.5% reported 100% adherence. Compared with experiencing no psychosocial health problems, experiencing five or more psychosocial health problems is associated with 42% lower odds of currently receiving HIV-related medical care (adjusted odds ratio, aOR = 0.58, 95% CI 0.36, 0.95) and of currently receiving ART (aOR = 0.58, 95% CI 0.38, 0.91). The number of psychosocial health problems experienced was associated with self-reported ART adherence in a dose-response relationship; compared to those with none of the factors, individuals with one syndemic factor had 23% lower odds (aOR = 0.77, 95% CI 0.60, 0.97) and individuals with five or more syndemic factors had 72% lower odds (aOR = 0.28, 95% CI 0.14, 0.55) of reporting being 100% adherent to ART. Addressing co-occurring psychosocial problems as potential barriers to uptake and adherence of ART in Latin America may improve the effectiveness of secondary prevention interventions. © 2016 The Author(s).
Keywords: ART; HIVHIV/AIDS; Latin America; Men who have sex with men; Psychosocial

Reshaping Time: Recommendations for Suicide Prevention in LBGT Populations: Reflections on “Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations” From Journal of Homosexuality 58(1) - Mullaney, C. (Journal of Homosexuality, 2016)
This article serves as one of the supplementary pieces of this special issue on “Mapping Queer Bioethics,” in which we take a solipsistic turn to “map” the Journal of Homosexuality itself. Here, the author examines the journal’s 2011 consensus recommendations for the prevention of LGBT suicide. Invoking the axiom approach of Eve Kosovsky Sedgwick’s seminal Epistemology of the Closet, the author argues that merely offering practical guidelines at the level of the demonstrative and the instructive may not be sufficient models to address the urgency of suicide rates in LGBTQ youth populations. © 2016 Taylor & Francis.
Keywords: Bioethics; childhood sexuality; gender identity; LGBT education; LGBT youth; psychiatry; suicide; suicide prevention; suicide risk; the closet

Mental health of transgender veterans in US States with and without discrimination and hate crime legal protection - Blosnich, J.R.; Marsiglio, M.C.; Gao, S.; Gordon, A.J.; Shipherd, J.C.; Kauth, M.; Brown, G.R.; Fine, M.J. (American Journal of Public Health, 2016)
Objectives. To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans' mental health. Methods. We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt. Results. Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased odds of self-directed violence (AOR = 0.57; 95% CI = 0.34, 0.95). Conclusions. Understanding lesbian, gay, bisexual, and transgender social stressors can inform treatment and care coordination for transgender populations.

"Do you love me?": The question of the queer child of psychoanalysis - Cavitch, M. (Psychoanalysis, Culture and Society, 2016)
Queer children and LGBT youth often continue to find in the psychotherapeutic setting and the clinical literature an ill-prepared and even aversive reception. Suicidality among such children draws especially sharp attention to the need for better alternatives to current treatment modalities-the focus here is chiefly on the relational area, with its emphasis on the coupling norm and attachment theory-and, more broadly, for the further comprehensive development of queer-and LGBT-affirmative psychoanalytic theory and practice. In advocating for at-risk queer children, I also argue that the queer child is a meaningful transferential figure for the improved lifechances of psychoanalysis itself and for the enhanced role of psychoanalytic theory and practice in the realm of social transformation. © 2016 Macmillan Publishers Ltd.
Keywords: Children; Gender; Homosexuality; Queer; Relationalism; Suicide

Risk Factors for Non-Suicidal Self-Injury Among Trans Youth - Arcelus, J.; Claes, L.; Witcomb, G.L.; Marshall, E.; Bouman, W.P. (Journal of Sexual Medicine, 2016)
Introduction: Previous research has reported high levels of non-suicidal self-injury (NSSI) in trans populations and younger age has been identified as a risk factor. Aims: To explore the prevalence of NSSI in a large group of young trans people and to identify risk factors for this group. Main Outcome Measures: Sociodemographic variables and measurements of NSSI (Self-Injury Questionnaire), psychopathology (Symptom Checklist-90-Revised), self-esteem (Rosenberg Self-Esteem Scale), victimization (Experiences of Transphobia Scale), interpersonal functioning (Inventory of Interpersonal Problems), and social support (Multidimensional Scale of Perceived Social Support). Methods: Two hundred sixty-eight young people attending a national gender clinic completed questionnaires assessing presence and frequency of NSSI and levels of general psychopathology, depression, anxiety, interpersonal problems, self-esteem, social support, transphobia, and information on hormone treatment. Results: A lifetime presence of NSSI was identified in 46.3% of patients and 28.73% reported currently engaging in NSSI (within at least the past few months). Analyses showed that those with a lifetime presence of NSSI had significantly greater general psychopathology, lower self-esteem, had suffered more transphobia, and experienced greater interpersonal problems than those without NSSI. Findings were similar when comparing current with non-current NSSI. Overall, natal male patients reported less social support than natal female patients, but current NSSI was more common in natal female patients. Regression analyses confirmed that natal female gender and greater general psychopathology predicted current and lifetime NSSI. Further analyses confirmed that general psychopathology itself could be predicted by transphobic experiences, low self-esteem, and interpersonal problems, but not by the use of cross-sex hormones. Conclusion: These findings confirm that NSSI is common in trans youth and emphasize the need for interventions that decrease transphobia, increase social support, and help trans youth navigate their relationships with others to decrease psychopathology and NSSI. © 2016 International Society for Sexual Medicine.
Keywords: Gender Dysphoria; Non-Suicidal Self-Injury; Psychopathology; Suicide; Trans; Transgender; Transsexual; Young People; Youth

Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death - Simonsen, R.K.; Hald, G.M.; Kristensen, E.; Giraldi, A. (Sexual Medicine, 2016)
Introduction: Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark. Aims: To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010. Methods: Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register. Main Outcome Measures: Somatic morbidity and cause of death. Results: Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male). Conclusion: Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality. © 2016 .
Keywords: Follow-Up; Gender Identity Disorder; Sex-Reassignment Surgery; Somatic Morbidity; Transsexualism

Approach to children and adolescents with gender dysphoria - Lopez, X.; Stewart, S.; Jacobson-Dickman, E. (Pediatrics in Review, 2016)
The definition of gender dysphoria (GD) includes the experience of a body that is incongruent with gender identity. The prevalence of GD is not as yet known, but the current proposed numbers are likely underestimated. Prevalence studies are complicated by several confounding factors and results may be misleading. (5)(7). On the basis of strong evidence from retrospective studies of relevant populations, clinicians should be especially vigilant in identifying GD in patients who are peripubertal because the onset of puberty heightens the risk of depression, anxiety, selfdestructive choices, and suicide. (8)(13). On the basis of strong evidence, "reparative psychotherapy" is both unsuccessful and psychologically deleterious. (15)(16)(17) (18) On the basis of expert consensus, the "gender affirmative model" is more accepted. (19). On the basis of strong evidence, adolescents treated with a protocol of pubertal suppression followed by hormone replacement therapy during adolescence and gender reassignment surgery in adulthood have improved psychological outcomes and quality of lives compared with age-matched adults from the general population. (10)(29). A large national transgender survey revealed that 41% of adult respondents had attempting suicide. On the basis of strong evidence, youth who are validated in their transgender identity by supportive family and social environments have much more favorable psychological outcomes. (11) The primary care clinician has a unique role and responsibility to identify patients with possible GD and provide anticipatory guidance, counseling, and family support. Primary health care clinicians can provide the impetus and means to greatly improve the lifelong psychological well-being of their patients with GD and potentially save lives. (9)(11)(13)(30). Copyright © 2016 by the American Academy of Pediatrics. All rights reserved.

Transgender patients, hospitalists, and ethical care - McCarthy, M.W.; Reis, E.; Fins, J.J. (Perspectives in Biology and Medicine, 2016)
Meeting the needs of current and future transgender individuals is a pressing medical concern. The transgender community faces unique health issues, including an elevated risk of HIV infection in male-to-female transgender people and high rates of violence, suicide, and substance abuse. Unfortunately, many trans people avoid seeking treatment because they have experienced discrimination, hostility, and refusal of medical care because of their status. Health-care workers who are not transphobic simply may not understand enough about the medical process of transitioning to adequately care for these patients. Hospitalists—specialists in inpatient medicine— are uniquely positioned to change this trajectory. We believe that as this burgeoning cohort of doctors takes on an expanded role in medicine, they should take the lead in the care of hospitalized transgender patients and in providing education to trainees about medical issues pertinent to this group of underserved and marginalized patients. © 2017 by Johns Hopkins University Press.

Tennessee's Diverse Populations: How You Care Matters - Lauderdale, J. (Tennessee nurse / Tennessee Nurses Association, 2016)

The Roman Catholic Church and the Repugnant Conclusion - Shaw, D. (Journal of Bioethical Inquiry, 2016)
Keywords: Catholicism; Consequentialism; Derek Parfit; Religion and medical ethics

LGBT youth missing out on support - Dean, E. (Nursing standard (Royal College of Nursing (Great Britain) : 1987), 2016)
According to a Department of Health-funded study young LGBT people are at increased risk of self-harm and suicide. The Queer Futures project has also revealed that mental health professionals lack access to the training they need to support these young people.

Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study - Swannell, S.; Martin, G.; Page, A. (Australian and New Zealand Journal of Psychiatry, 2016)
Objectives: This study investigated associations between sexual orientation and measures of suicidality and non-suicidal self-injury in Australian adults. Previous studies of sexual orientation and suicidality have been limited by unclear conceptualisations of suicidal intent, failure to differentiate between homosexuality and bisexuality, inattention to gender differences and use of convenience-based samples. Methods: A large (N = 10,531) representative national sample of Australian adults was used to investigate associations between sexual orientation (heterosexual, homosexual, bisexual) and (1) suicidal ideation, (2) attempted suicide and (3) non-suicidal self-injury, for males and females separately, in a series of sequentially adjusted logistic regression models. Results: Sexual minority participants were at greater risk of suicidality and self-injury than heterosexuals, after adjusting for age and other covariates, with patterns of risk differing by sexual orientation and gender. Compared with their heterosexual counterparts, gay men, but not bisexual men, were more likely to report suicidal ideation (odds ratio = 3.05, 95% confidence interval = [1.65, 5.60]) and suicide attempts (odds ratio = 4.16, confidence interval = [2.18, 7.93]). Bisexual women, but not lesbian women, were more likely to report suicidal ideation (odds ratio = 4.40, confidence interval = [3.00, 6.37]) and suicide attempts (odds ratio = 4.46, confidence interval = [2.41, 8.24]). Neither bisexual nor gay men were more likely than heterosexual men to report self-injury. However, bisexual women, but not lesbian women, were more likely than heterosexual women to report self-injury (odds ratio = 19.59, confidence interval = [9.05, 42.40]). Overall, bisexual females were at greatest risk of suicidality and self-injury. Conclusion: Clinicians working with sexual minority populations are encouraged to openly discuss suicidal and self-injurious thoughts and behaviours with their clients and may consider using therapeutic strategies to reduce internalised stigma and enhance personal and social resources. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Keywords: bisexuality; Homosexuality; non-suicidal self-injury; sexual orientation; suicidal ideation

Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study - Tomori, C.; McFall, A.M.; Srikrishnan, A.K.; Mehta, S.H.; Solomon, S.S.; Anand, S.; Vasudevan, C.K.; Solomon, S.; Celentano, D.D. (AIDS and Behavior, 2016)
Poor psychosocial health contributes to HIV risk behavior and reduced engagement in treatment and care. This study investigates depression and its correlates among 11,992 MSM recruited via respondent driven sampling in 12 cities across India using the Patient Health Questionnaire-9 and supplemented by analysis of qualitative research from 15 sites with 363 MSM. Overall prevalence of depression was 11 %, with substantial variation across sites and subgroups of MSM, and high prevalence of suicidal thoughts among depressed MSM. In multivariable analyses identification as a kothi (feminine sexual identity) [adjusted odds ratio (aOR) = 1.91], disclosure of being MSM to non-family (aOR = 1.7) and family (aOR = 2.4), disclosure of HIV-status (aOR = 5.6), and substance use were associated with significantly higher odds of depression. Qualitative results emphasized dire social consequences of disclosing MSM- and HIV-status, especially to family, including suicidality. Combination prevention interventions should include mental health services that address disclosure, suicidality, and substance use. © 2015, Springer Science+Business Media New York.
Keywords: Depression; HIV; India; Men who have sex with men; Suicidality

Psychosocial syndemic associated with increased suicidal ideation among men who have sex with men in Shanghai, China - Li, R.; Cai, Y.; Wang, Y.; Sun, Z.; Zhu, C.; Tian, Y.; Jiang, X.; Gan, F. (Health Psychology, 2016)
Objective: We intended to verify the syndemic effect of psychosocial health conditions on suicidal ideation among men who have sex with men (MSM) in Shanghai, China; design a comprehensive framework for the identification of the MSM with suicidal ideation; and provide suggestion for suicidality intervention among MSM. Method: A cross-sectional study was conducted among 547 MSM in 4 districts in Shanghai. Sociodemographic, psychosocial, and suicidal ideation information of the participants was collected. Logistic regressions were performed to assess the relationship between psychosocial variables and suicidal ideation and to verify the syndemic effect of psychosocial factors. Results: Of the MSM sample, 10.6% reported suicidal thoughts in the past year. In univariate analysis, depression, anxiety, loneliness, impulsivity, involuntary subordination (IS), social support, and risky sex were associated with suicidal ideation. Multivariate analysis found that IS (ORm = 2.92, 95% confidence interval [CI] = 1.55-5.51) and risky sex (ORm = 3.79, 95% CI = 1.44 -9.97) remained significant. The MSM with more than 5 psychosocial health problems were nearly 4 times more likely (adjusted odds ratio = 4.68, 95% CI = 2.23-9.80) to have had suicidal ideation in the past year. Conclusions: The study confirmed the syndemic effect of psychosocial health problems in magnifying the risk of suicidality among MSM. More integrated and holistic approaches in the identification of high-risk groups and intervention of suicidality among MSM are needed. © 2015 American Psychological Association.
Keywords: Men who have sex with men; Psychosocial; Suicidal ideation; Syndemic

Non-suicidal self-injury and suicidal thoughts and behaviors in heterosexual and sexual minority young adults - Tsypes, A.; Lane, R.; Paul, E.; Whitlock, J. (Comprehensive Psychiatry, 2016)
Objective Despite consistently greater rates of non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs; i.e., suicidal ideation, method/plan, and attempts) in lesbian, gay, and bisexual (LGB) individuals, prevalence, characteristics, and relations between these dangerous thoughts and behaviors are equivocal. The present study sought to examine and compare the rates of NSSI and STBs in a large sample of sexual minority and majority young adults. Methods Participants were 12,422 college students (ages 18-29; 57.3% female) who self-reported demographic characteristics, NSSI frequency, the number of NSSI forms used, the number of NSSI functions, as well as STB history (i.e., ideation, method/plan, and attempts). Each participant's degree of SA was assessed via a 7-point scale (i.e., K0-K6) from Alfred Kinsey's research of sexual attraction and sexual experiences. This scale was collapsed to create five categories of SA: exclusively other SA (K0), mostly other SA (K1/2), equally other and same SA (K3), mostly same SA (K4/5), and exclusively same SA (K6). Results Consistent with previous research, we found that being a sexual minority young adult was associated with significantly higher odds of STBs compared to being a heterosexual young adult. In addition, compared to the exclusively other SA group (K0), being in the mostly other SA group (K1/2), equally other and same SA group (K3), or mostly same SA group (K4/5) was associated with significantly higher odds of NSSI engagement. Among those with NSSI, we found that the number of NSSI forms was significantly associated with suicide attempts, but was not associated with either suicidal ideation or suicide method/plan in the mostly other SA group (K1/2) or in the equally other and same SA group (K3). We also found a significant curvilinear relation between NSSI frequency and STBs in the mostly other SA group (K1/2) and between NSSI frequency and suicide method/plan and attempt in the exclusively other SA group (K0). In addition, we revealed specificity with regard to the relation between the number of lifetime NSSI episodes and risk for STBs among the equally other and same SA (K3), mostly same SA (K4/5), and exclusively same SA (K6) groups. Conclusion Our findings suggest that among sexual minority young adults, equally other and same SA individuals may be at higher risk of NSSI and STBs than their sexual minority counterparts. In addition, these findings extend previous research by suggesting that the relations between NSSI frequency, number of forms, and number of functions and STBs might vary according to SA. A multi-theory based explanation is provided to explain the key findings and the study implications are discussed. © 2015 Elsevier Inc. All rights reserved.

Content validity of Patient-Reported Outcomes Measurement Information System (PROMIS) items in the context of HIV clinical care - Edwards, T.C.; Fredericksen, R.J.; Crane, H.M.; Crane, P.K.; Kitahata, M.M.; Mathews, W.C.; Mayer, K.H.; Morales, L.S.; Mugavero, M.J.; Solorio, R.; Yang, F.M.; Patrick, D.L. (Quality of Life Research, 2016)
Purpose: To assess content validity and patient and provider prioritization of Patient-Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, fatigue, and alcohol use items in the context of clinical care for people living with HIV (PLWH), and to develop and assess new items as needed. Methods: We conducted concept elicitation interviews (n = 161), item pool matching, prioritization focus groups (n = 227 participants), and cognitive interviews (n = 48) with English-speaking (~75 %) and Spanish-speaking (~25 %) PLWH from clinical sites in Seattle, San Diego, Birmingham, and Boston. For each domain we also conducted item review and prioritization with two HIV provider panels of 3–8 members each. Results: Among items most highly prioritized by PLWH and providers were those that included information regarding personal impacts of the concept being assessed, in addition to severity level. Items that addressed impact were considered most actionable for clinical care. We developed additional items addressing this. For depression we developed items related to suicide and other forms of self-harm, and for all domains we developed items addressing impacts PLWH and/or providers indicated were particularly relevant to clinical care. Across the 4 domains, 16 new items were retained for further psychometric testing. Conclusion: PLWH and providers had priorities for what they believed providers should know to provide optimal care for PLWH. Incorporation of these priorities into clinical assessments used in clinical care of PLWH may facilitate patient-centered care. © 2015, Springer International Publishing Switzerland.
Keywords: Clinical practice; HIV; Patient-centered outcomes; PROMIS

Factors associated with suicide outcomes 12 months after screening positive for suicide risk in the emergency department - Arias, S.A.; Miller, I.; Camargo, C.A.; Sullivan, A.F.; Goldstein, A.B.; Allen, M.H.; Manton, A.P.; Boudreaux, E.D. (Psychiatric Services, 2016)
Objective: The main objective was to identify which patient characteristics have the strongest association with suicide outcomes in the 12 months after an index emergency department (ED) visit. Methods: Data were analyzed fromthe first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE). The ED-SAFE study, a quasiexperimental, interrupted time-series design, involved participation from eight general medical EDs across the United States. Participants included adults presenting to the ED with active suicidal ideation or an attempt in the past week. Data collection included baseline interview; six-and 12-month chart reviews; and six-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. Regression analyseswere conducted. Results: Among 874 participants, the median age was 37 years (interquartile range 27-47), with 56% of the sample being female (N=488), 74% white (N=649), and 13% Hispanic (N=113). At baseline, 577 (66%) participants had suicidal ideation only, whereas 297 (34%) had a suicide attempt in the past week. Data sufficient to determine outcomes were available for 782 (90%). In the 12 months after the index ED visit, 195 (25%) had documentation of at least one suicide attempt or suicide. High school education or less, an ED visit in the preceding six months, prior nonsuicidal self-injury, current alcohol misuse, and suicidal intent or plan were predictive of future suicidal behavior. Conclusions: Continuing to build an understanding of the factors associated with future suicidal behaviors for this population will help guide design and implementation of improved suicide screening and interventions in the ED and better allocation of scarce resources.

A month for reflecting on suicide prevention - Jorm, A. (Australian and New Zealand Journal of Psychiatry, 2016)

Juvenile Sexual Homicide Offenders - Khachatryan, N.; Heide, K.M.; Hummel, E.V.; Chan, H.C. (International Journal of Offender Therapy and Comparative Criminology, 2016)
Sexual homicide by a juvenile offender occurs approximately 9 times per year in the United States. Little is known about the post-incarceration adjustment of these offenders. The current study was designed to follow up 30 years later on a sample of eight adolescent sexual homicide offenders who were convicted of murder and sentenced to adult prison. The results indicated that six out of eight offenders were released from prison, and their mean sentence length was 12 years and 2 months. Four offenders out of the six released were rearrested, but none of the arrests were for homicide, sexual or otherwise. The post-incarceration arrests were for violent, drug-related, and property crimes, as well as possession of a firearm. Three out of the four recidivists have been recommitted to prison. Implications concerning the comparability of results to past research, time served in prison, and types of post-release offenses are discussed. © 2014 SAGE Publications.
Keywords: gay male sexual murder; juvenile homicide offenders; recidivism; sex offenders; sexual murder

PTSD, Depression, and Substance Use in Relation to Suicidality Risk among Traumatized Minority Lesbian, Gay, and Bisexual Youth - Smith, B.C.; Armelie, A.P.; Boarts, J.M.; Brazil, M.; Delahanty, D.L. (Archives of Suicide Research, 2016)
Youths who are lesbian, gay, or bisexual (LGB) are more likely than heterosexuals to commit suicide. Substance use, PTSD, and depression are independent risk factors for suicidality; however, the extent to which these factors interact to predict suicidality is unclear. The current study examined the association between substance use, PTSD symptoms (PTSS), depressive symptoms, and suicidality in a sample of 68 traumatized minority LGB youths. Participants were recruited from an LGBT community center and completed a packet of questionnaires. Substance use and depressive symptoms were positively associated with prior suicide attempts. A significant three-way interaction revealed that substance use interacted with both PTSS and depressive symptoms to increase the odds of attempted suicide. Results underscore the importance of integrating substance use components into PTSD/depression treatment to reduce suicide risk in LGB youth. © 2016, Copyright © International Academy for Suicide Research.
Keywords: depression; LGB; PTSD; substance use; suicide

Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature - Marshall, E.; Claes, L.; Bouman, W.P.; Witcomb, G.L.; Arcelus, J. (International Review of Psychiatry, 2016)
Literature has described high levels of mental health problems among trans people, such as depression, resulting in increased levels of non-suicidal self-injury (NSSI) behaviour and suicidality (suicidal thoughts, suicide attempts and suicide rates). With the aim of systematically reviewing the available literature in this field, this study identifies 31 papers that explore the rates of NSSI and suicidality in trans people. From reviewing the literature, it was revealed that trans people have a higher prevalence of NSSI and suicidality compared to the cisgender (non-trans) population. There appear to be some gender differences within these rates, with trans men at a greater risk for NSSI behaviour. Prevalence rates differ depending on the different stages of transition, but they are still overall greater than the cisgender population. The study concludes that trans individuals are at a greater risk of NSSI behaviour and suicidality than the cisgender population, and discusses risk factors and the need to develop effective preventative interventions. © 2015 © 2015 Institute of Psychiatry.

Suicide risk factors among trans feminine individuals in Lebanon - Kaplan, R.L.; Nehme, S.; Aunon, F.; de Vries, D.; Wagner, G. (International Journal of Transgenderism, 2016)
Transgender women are disproportionately affected by high rates of depression and suicide attempts. It is therefore important to identify factors that influence suicidal risk, particularly in the Middle East, where little research has examined the mental health of transgender women. We examined risk factors associated with suicide attempts among 54 trans feminine individuals in Beirut, Lebanon. Data were collected using interviewer-administered questionnaires and were analyzed using bivariate statistics. Twenty-five (46%) participants reported having ever attempted suicide. Among them, only one participant had received some kind of counseling in response to the attempted suicide. Low general social support, low social integration, and low support from peers were significantly associated with a history of attempted suicide, as were being more open about transgender identity in public and any hormone use (past or current). These findings suggest that progression in gender transition can have unintended consequences related to mental health and suicide risk, while social support systems can mitigate the impact of mental health problems. Some of these findings mirror other contexts around the globe and can inform mental health services for trans feminine individuals in Lebanon, the greater Middle East region, and other international settings. © 2016 Taylor & Francis Group, LLC.
Keywords: Lebanon; MENA; mental health; Middle East; suicide; trans feminine

Implicit Measure of Life/Death Orientation Predicts Response of Suicidal Ideation to Treatment in Psychiatric Inpatients - Ellis, T.E.; Rufino, K.A.; Green, K.L. (Archives of Suicide Research, 2016)
In this study, we set out to extend empirical research on the Life-Death Implicit Association Test (IAT) by administering the measure to an adult psychiatric inpatient population with suicidal ideation. We sought to examine its association with other suicide-relevant measures and to determine whether it adds predictive utility beyond that offered by other measures of suicide risk. The IAT was administered (N = 124) at biweekly intervals as part of an assessment battery at an inpatient facility for complex, treatment resistant psychiatric disorders (average length of stay: approximately 6 weeks). Multiple regression procedures were utilized to examine relationships among the measures and their predictive utility with respect to suicidal ideation at discharge. Consistent with prior research with other populations, significant associations were found between IAT performance and explicit (self-report and interview) measures of suicide risk. Moreover, the IAT was found to predict suicidal ideation at discharge above and beyond number of prior suicide attempts and admission scores on measures of depression, suicidal ideation, and hopelessness. Change in IAT performance over the course of treatment was observed. The IAT shows promise as an addition to explicit measures conventionally used to estimate suicide risk in psychiatric patients. These findings are consistent with a cognitive vulnerability model of suicide risk. © 2016, Copyright © International Academy for Suicide Research.
Keywords: cognition; Implicit Association Test; psychiatric inpatients; suicide risk assessment

Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course - Blosnich, J.R.; Nasuti, L.J.; Mays, V.M.; Cochran, S.D. (American Journal of Orthopsychiatry, 2016)
This investigation explored suicide-related characteristics and help-seeking behavior by sexual orientation. Population-based data are from the California Quality of Life Surveys, which included 1,478 sexual minority (lesbian, gay, bisexual, and homosexually experienced individuals) and 3,465 heterosexual individuals. Bisexual women had a nearly six-fold increased risk of lifetime suicide attempts than heterosexual women (RR = 5.88, 95%CI: 3.89-8.90), and homosexually experienced men had almost 7 times higher risk of lifetime suicide attempts than heterosexual men (RR = 6.93, 95%CI: 3.65-13.15). Sexual minority men and women were more likely than heterosexual men and women to have disclosed suicide attempts to a medical professional (RR = 1.48 and RR = 1.44, respectively). Among persons who ever attempted suicide, sexual minority women had a younger age of index attempt than heterosexual women (15.9 vs. 19.6 years of age, respectively). Healthcare professionals should be aware of suicidal risk heterogeneity among sexual minority individuals, including vulnerable points of risk and evidenced-based treatments. © 2016.
Keywords: Bisexual; Gay; Lesbian; Mental disorders; Sexual minority; Suicide

Suicide ideation and suicide attempt among young lesbian and bisexual filipina women: Evidence for disparities in the philippines - Manalastas, E.J. (Asian Women, 2016)
Using archival data from a national survey of N=8,891 young Filipina women ages 15 to 24, this paper aimed to examine links between sexual-minority status and thinking about and attempting suicide. Similar to previous results from young Filipino men and to findings in the global LGBT mental health literature, sexual-minority status was associated with both suicide ideation and suicide attempt across measures of same-sex attraction and same-sex romantic relationships. Sexual-minority Filipina youth had higher odds of having thought about suicide and having attempted suicide, compared to heterosexual peers. Following a minority stress framework, this paper explored a number of correlates of suicide ideation and attempt, including normative risk factors such as depression, recent suicide attempt of a friend, and experiences of threat and victimization.
Keywords: Bisexual; Lesbian; Sexual orientation; Suicide attempt; Suicide ideation

Discrimination, Mental Health, and Suicidal Ideation Among LGBTQ People of Color - Sutter, M.; Perrin, P.B. (Journal of Counseling Psychology, 2016)
Discrimination based on race/ethnicity, sexual orientation, and gender identity has been linked to many negative psychological and physical health outcomes in previous research, including increased suicidal ideation. Two hundred lesbian, gay, bisexual, transgender, and queer (LGBTQ) people of color (POC) were surveyed on their experiences of LGBTQ-based discrimination, racism, mental health (depression, anxiety, satisfaction with life), and suicidal ideation in a national online study based in the United States. A structural equation model (SEM) was created and found that LGBTQ-based discrimination exerted an indirect effect on suicidal ideation through mental health. Racism exerted a direct effect on mental health but was not associated with suicidal ideation in the SEM. The effects of LGBTQ-based discrimination on mental health may be a key area for interventions to reduce suicidal ideation in LGBTQ POC. © 2016 American Psychological Association.
Keywords: Discrimination; LGBTQ; Mental health; Racial/ethnic minorities; Suicidal ideation

Preventing suicide in lesbian, gay, bisexual, and transgender prisoners: A critique of U.K. policy - Read, M.; Mccrae, N. (Journal of Forensic Nursing, 2016)
Suicide is a global problem in prisons. As in society generally, gay men in prison have a higher risk of attempting suicide compared with their heterosexual peers. The Howard League for Penal Reform Sex in Prison Commission 2015 reveals a pervasive culture of consensual and coercive sexual relations, with gay men more likely to be targeted for unsolicited sex. Research shows an inadequate institutional response to such abuse. Victims of sexual assault in prison have high rates of psychological problems, which can lead to self-harm and suicide. The Assessment, Care in Custody and Teamwork procedure to assess and manage risk of suicide in prisoners, however, makes no reference to the needs of the lesbian, gay, bisexual, and transgender prison population, despite national policy and best practice guidance that advocates an individualized approach to suicide risk with due consideration of vulnerable group status. This article argues that the Assessment, Care in Custody and Teamwork procedure should be tuned to the requirements of the Equality Act 2010 to ensure that lesbian, gay, bisexual, and transgender prisoners are not exposed to the double jeopardy of sexual assault and related suicidal tendencies. © 2016 International Association of Forensic Nurses.
Keywords: Assessment; care in custody; LGBT; prison; prisoners; sexual assault; suicide; teamwork

The Interrelations Between Internalized Homophobia, Depressive Symptoms, and Suicidal Ideation Among Australian Gay Men, Lesbians, and Bisexual Women - McLaren, S. (Journal of Homosexuality, 2016)
Internalized homophobia has been linked to depression among gay men, lesbians, and bisexuals. Relatively little research has investigated the link between internalized homophobia and suicidal thoughts and behaviors. The current research investigated the interrelations among internalized homophobia, depressive symptoms, and suicidal ideation by testing additive, mediation, and moderation models. Self-identified Australian gay men (n = 360), lesbians (n = 444), and bisexual women (n = 114) completed the Internalized Homophobia Scale, the Center for Epidemiological Studies Depression Scale, and the suicide subscale of the General Health Questionnaire. Results supported the additive and partial mediation models for gay men and the mediation and moderation models for lesbians. None of the models were supported for bisexual women. The findings imply that clinicians should focus on reducing internalized homophobia and depressive symptoms among gay men and lesbians, and depressive symptoms among bisexual women, to reduce suicidal ideation. © 2016 Taylor & Francis.
Keywords: Depressive symptoms; internalized homophobia; suicidal ideation

Suicidal ideation among transvestites and transsexuals: A social representations and analytical study - Silva, G.W.S.; de Sena, R.C.F.; Lins, S.L.F.; de Miranda, F.A.N. (Online Brazilian Journal of Nursing, 2016)
Aim: To analyze the association between suicidal ideation, suicide, its risk factors and social representations in the life of transvestites and transsexuals. Method: a qualitative exploratory study with quantitative analytical approach, conducted with transvestites and transsexuals associated to a non-governmental organization in the State of Rio Grande do Norte using semi-structured interviews. Quantitative data will be analyzed by inferential statistics with the application of chi-square, Mann Whitney and Pearson correlation tests. Qualitative data will be interpreted using content and social representation analysis. Expected results: the aim is to identify suicidal ideation, depressive state and social representations about suicide for transvestites and transsexuals, especially with regard to promoting mental health by identifying signs and risk factors for suicide, reduction of harm in the gender transit experiences, and health prevention in socio-cognitive aspects that surround the phenomenon.
Keywords: Health care; Mental health; Suicide; Transgender people

Mental Health Disparities Within the LGBT Population: A Comparison between Transgender and Nontransgender Individuals - Su, D.; Irwin, J.A.; Fisher, C.; Ramos, A.; Kelley, M.; Mendoza, D.A.R.; Coleman, J.D. (Transgender Health, 2016)
Purpose: This study assessed within a Midwestern LGBT population whether, and the extent to which, transgender identity was associated with elevated odds of reported discrimination, depression symptoms, and suicide attempts. Methods: Based on survey data collected online from respondents who self-identified as lesbian, gay, bisexual, and/or transgender persons over the age of 19 in Nebraska in 2010, this study performed bivariate t- or chi-square tests and multivariate logistic regression analysis to examine differences in reported discrimination, depression symptoms, suicide attempts, and self-acceptance of LGBT identity between 91 transgender and 676 nontransgender respondents. Results: After controlling for the effects of selected confounders, transgender identity was associated with higher odds of reported discrimination (OR=2.63, p<0.01), depression symptoms (OR=2.33, p<0.05), and attempted suicides (OR=2.59, p<0.01) when compared with nontransgender individuals. Self-acceptance of LGBT identity was associated with substantially lower odds of reporting depression symptoms (OR=0.46, p<0.001). Conclusion: Relative to nontransgender LGB individuals, transgender individuals were more likely to report discrimination, depression symptoms, and attempted suicides. Lack of self-acceptance of LGBT identity was associated with depression symptoms among transgender individuals. © Dejun Su et al. 2016; Published by Mary Ann Liebert, Inc. 2016.
Keywords: depression symptoms; discrimination; LGBT; LGBT identity acceptance; transgender

Motivations for activists’ participation in the ‘it gets better project’ - Honda, L.P. (Public Relations Inquiry, 2016)
In response to multiple LGBTQ (lesbian, gay, bisexual, transgender, and queer) youth suicides in 2010, columnist Dan Savage and his husband Terry Miller sought to provide messages of hope to at-risk LGBTQ youth through the creation of the YouTube-based ‘It Gets Better Project’ (IGBP). With data gathered from 20 IGBP participants through Skype-and Google Hangouts-based in-depth interviews, the study reveals how the intersection of participants’ identities and structural oppressions contributed to their motivations for participation in the suicide prevention public relations (PR) awareness campaign. This critical empirical study offers PR scholars and practitioners insight into participants’ multidimensional motivations for campaign participation, and implications for both audiences are discussed. © The Author(s) 2016.
Keywords: Activism; Intersectionality; Matrix of domination; Social movement; Suicide; ‘It gets better project’

School-Based Protective Factors Related to Suicide for Lesbian, Gay, and Bisexual Adolescents - Whitaker, K.; Shapiro, V.B.; Shields, J.P. (Journal of Adolescent Health, 2016)
Purpose Research indicates that lesbian, gay, and bisexual (LGB) adolescents are three times more likely to consider suicide than their heterosexual peers. Although research has identified risk factors for suicide among this population, little is known about school-level protective factors among this population, which may buffer the impact of risk.This study aims to understand whether school-based protective factors (e.g., school safety, relationships with caring adults at school, school connectedness) are associated with decreased suicidal ideation for LGB adolescents. Methods Logistic regression analyses were conducted on the data generated by the San Francisco Unified School District's 2011 California Healthy Kids Survey to examine the influence of protective factors related to suicidal ideation for LGB adolescents (n = 356). Results Results indicated that higher levels of school connectedness predicted less suicidal ideation (odds ratio =.59, p =. 005). Conclusions This study provided evidence that school protective factors were related to reduced suicidal ideation for LGB adolescents, controlling for risk factors and demographic variables. © 2016 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: Protective factors; School connectedness; Sexual orientation; Suicide

Homophobic bullying in Mexico: Results of a national survey - Baruch-Dominguez, R.; Infante-Xibille, C.; Saloma-Zuñiga, C.E. (Journal of LGBT Youth, 2016)
Homophobic and transphobic bullying, through teasing, physical violence, and other forms of aggression, is a problem that affects lesbian, gay, bisexual, and transgender students at all levels of education. Even though there have been legal changes in Mexico to protect human rights of lesbian, gay, bisexual, and transgender people, schools are spaces where discrimination and violence toward them are still common. In 2012, using an online survey asking participants about their experiences with bullying, its consequences, and responses from adults, the authors collected responses from 912 participants younger than 30 years of age who self-identified as lesbian, gay, bisexual, or transgender and who lived in the 32 states of Mexico. Two thirds of participants said that they were victims of bullying during their school years; the majority of these students indicated that they did not have support from teachers or parents to avoid or stop the violence. The consequences of bullying were truancy, dropouts, depression, and suicide attempts. Attitudes that normalize bullying may impede the effective prevention of or response to homophobic and transphobic bullying by teachers and parents. To eliminate homophobic bullying in school, there is a need for sexual diversity trainings for teachers and media campaigns for the general public. © 2016 Taylor & Francis.
Keywords: Bullying; Homophobia; LGBT; Teachers

Perceived racial, sexual identity, and homeless status-related discrimination among black adolescents and young adults experiencing homelessness: Relations with depressive symptoms and suicidality - Gattis, M.N.; Larson, A. (American Journal of Orthopsychiatry, 2016)
There is a dearth of empirical evidence that addresses how racial minority, sexual minority, and homeless statuses, with their accompanying experiences of stigma and discrimination, are related to mental health in adolescent and young adult populations. The current study addresses this gap by examining the associations between multiple forms of discrimination, depressive symptoms, and suicidality in a sample of 89 Black adolescents and young adults (52% female; 47% nonheterosexual, ages 16-24) experiencing homelessness. Results from a series of ordinary least squares and logistic regressions suggested that perceived homelessness stigma and racial discrimination were associated with higher levels of depressive symptoms, controlling for gender, age, and other types of discrimination, while perceived sexual identity discrimination showed no association. Having ever spent a homeless night on the street, an indicator of homelessness severity, accounted for a substantial amount of the association between homelessness stigma and depressive symptoms. In contrast, suicidality was not significantly associated with any measure of discrimination, homelessness severity, or personal characteristics. We also found no indication that the associations between perceived discrimination targeted at racial and homelessness statuses and mental health differed by sexual minority status. Our results suggest that depressive symptoms and suicidality are prevalent among Black homeless youth, and that depressive symptoms are particularly associated with racial discrimination and indicators of homelessness. The roles of discrimination and a lack of safe housing may be taken into account when designing programs and policies that address the mental health of Black adolescents and young adults experiencing homelessness. © 2015 American Orthopsychiatric Association.
Keywords: Black youth; Discrimination; Homeless; Homophobia; Mental health; Racism

Self-injury, suicide ideation, and sexual orientation: differences in causes and correlates among high school students - DeCamp, W.; Bakken, N.W. (Journal of injury & violence research, 2016)

'The darkest times of my life': Recollections of child abuse among forced migrants persecuted because of their sexual orientation and gender identity - Alessi, E.J.; Kahn, S.; Chatterji, S. (Child Abuse and Neglect, 2016)
Numerous studies demonstrate that lesbian, gay, bisexual, and transgender (LGBT) children and youth are likely to experience abuse by peers, parents, and other adults and that these experiences correlate with a host of mental health problems. However, there is little understanding of the experiences of LGBT children and youth living in countries where social and legal protections for sexual and gender minorities are limited or nonexistent. This qualitative study used thematic analysis to explore the child and adolescent abuse experiences and their impact on the pre-migration mental health of LGBT forced migrants. We analyzed 26 interviews with individuals who obtained refugee or asylee status in the United States or Canada on the basis of sexual orientation or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: abuse by parents and caregivers, abuse by peers and school personnel, having nowhere to turn, and dealing with psychological distress. Findings indicate that participants experienced severe verbal, physical, and sexual abuse throughout childhood and adolescence and that this abuse occurred at home, in school, and in the community. Furthermore, there were no resources or sources of protection available to them. Participants linked their abuse to subjective experiences of depression, anxiety, and traumatic stress, as well as suicidal ideation and suicide attempts. We conclude with implications for refugee adjudication practices, mental health care, and international policy. © 2015 Elsevier Ltd.
Keywords: Child abuse; International child protection; LGBT children; LGBT youth; Thematic analysis

Factors related to suicide in LGBT populations: A psychological autopsy case-control study in Australia - Skerrett, D.M.; Kõlves, K.; De Leo, D. (Crisis, 2016)
Background: There is evidence of heightened vulnerability to nonfatal suicidal behaviors among LGBT populations yet a paucity of studies into fatal behaviors. Aim: The specific aim of this article was to identify factors related to suicide in LGBT individuals in Australia. Method: The psychological autopsy (PA) method with a matched case-control study design was used. PA interviews were conducted with 27 next-ofkin of an LGBT person that had died by suicide. Three living LGBT controls per suicide case, matched by age and gender, were also interviewed. Results: The key factors relating to suicide in LGBT people were a lack of acceptance by family and self (reflected in higher internalized homophobia and shame), negative feelings about own sexuality/gender, and dissatisfaction with appearance. LGBT people who died by suicide also tended to go through coming out milestones 2 years earlier than controls. There was a higher prevalence of aggressive behaviors and a more predominant history of physical and sexual abuse. Additionally, there was greater incidence of depression and anxiety and alcohol and substance use disorders. Conclusion: Specific predictive factors for suicide in LGBT populations in Australia were identified, including significantly poorer mental health outcomes and more violence across an array of measures. © 2016 Hogrefe Publishing.
Keywords: LGBT; Psychological autopsy; Risk factors; Suicide

The protective role of gay-straight alliances for lesbian, gay, bisexua and questioning students: A prospective analysis - Ioverno, S.; Baiocco, R.; Belser, A.B.; Grossman, A.H.; Russell, S.T. (Psychology of Sexual Orientation and Gender Diversity, 2016)
Prior studies show a strong association between gay-straight alliances (GSAs) and the well-being and safety of sexual minority students at school. However, nearly all existing literature has relied on cross-sectional data. Using data from the first 2 panels of a multisite longitudinal study on risk and protective factors for suicide among lesbian, gay, bisexual, and questioning (LGBQ) youth in 3 U.S. cities, we examined the influence of presence of and participation in a GSA on perceptions of safety at school, homophobic bullying experiences, and psychosocial adjustment (depression and self-esteem) in 327 LGBQ students across 2 school years. LGBQ students who had GSAs in their schools or were members of GSAs in the prior year showed no differences in psychological adjustment, but they reported perceptions of more school safety and less homophobic bullying in the following school year. Further, changes in GSA presence (gaining a GSA) and changes in participation (from nonparticipation to participation) were independently associated with stronger perceived safety in the subsequent school year. This study provides the first prospective evidence of the lasting positive role of GSAs for high school students, and documents that changes in GSA presence and participation are associated with safety at school. Education policy and practice implications are discussed. © 2014 American Psychological Association.
Keywords: Bullying; Depression; Gay-straight alliance; School safety; Self-esteem

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

Suicide by transgender: A crisis of identity - Chouksey, V.K.; Band, R.; Rani, M.; Rani, Y. (Journal of Forensic Medicine and Toxicology, 2016)
Transgender community is socially isolated and most discriminated against group in India and world over. Black and white depiction of humans into male and female ignores the gray shades of transsexuals. Present case shows identity crisis suffered by born male person later underwent sex reconstruction surgery. Rejected by his own family, he was accepted by transgender community. Depression and addiction worsened the situation further. After he committed suicide, body was brought for autopsy at Lady Hardinge Medical College. This case report tries to present social, medico-legal and legal aspects related to case to raise awareness among medical fraternity regarding transgender. © 2018, Medicolegal Society. All rights reserved.
Keywords: Identity; Suicide; Transgender

Emotional Health of Lesbian, Gay, Bisexual and Questioning Bullies: Does It Differ from Straight Bullies? - Eisenberg, M.E.; Gower, A.L.; McMorris, B.J. (Journal of Youth and Adolescence, 2016)
Research demonstrates that young people involved in bullying are at greater risk for poor emotional health outcomes, but this association may not be consistent for youth of different sexual orientations. Understanding the unique needs of lesbian, gay, bisexual and questioning (LGBQ) youth may suggest important opportunities for intervention and prevention. This study, therefore, examines whether involvement with bullying is differentially associated with emotional well-being across sexual orientation. Survey data were collected from a large statewide sample of 9th and 11th grade students in 2013 (N = 79,039, 49.8 % female, 74.6 % white). Logistic regression tested associations between sexual orientation, physical or relational bullying perpetration and five measures of emotional health. In the full sample, those reporting bullying perpetration had significantly elevated odds of emotional health problems. However, interaction terms and stratified models indicated that in nine out of ten physical bullying models and two out of ten relational bullying models, perpetration was not as strongly associated with poor emotional health among LGBQ adolescents as it was among heterosexual youth. Possible explanations for this finding include unhealthy coping strategies or masking one’s own vulnerable status as LGBQ. Continued efforts to prevent bullying are needed for all youth. © 2015, Springer Science+Business Media New York.
Keywords: Bullying; Emotional health; Sexual orientation; Suicide

Effects of state nondiscrimination laws on transgender and gender-nonconforming individuals’ perceived community stigma andmental health - Gleason, H.A.; Livingston, N.A.; Peters, M.M.; Oost, K.M.; Reely, E.; Cochran, B.N. (Journal of Gay and Lesbian Mental Health, 2016)
In this study, we investigated the potential effects of statewide nondiscrimination laws on community stigma, as well as its relationshipwith psychosocial stressors andmental health outcomes. Gender minority individuals (N = 120) completed an online survey containing psychosocial and mental health outcome measures. The experiences of participants who resided in states with and without nondiscrimination laws were compared in regard to perceived community stigma. Hierarchical and logistic regression were used to test the hypothesized relationships between community stigma and lifetime discrimination and victimization; current depression, anxiety, and substance use; and lifetime suicide attempts. Approximately 60% of participants reported residing in a state without nondiscrimination laws (n = 74). These participants reported higher levels of perceived community stigma, and stigma was positively associated with reports of lifetime discrimination and victimization. The observed relationship between stigma and current anxiety symptoms was marginally significant. Logistic regression results indicate that stigma was positively related to the odds of reporting a lifetime suicide attempt. Analyses suggest that statewide nondiscrimination laws are associated with lower rates of perceived stigma at the community level, which, in turn, is associated with lower rates of discrimination, victimization, anxiety, and risk for attempted suicide. © 2016 Taylor and Francis Group, LLC.
Keywords: Law; Mental health; Stigma; TGNC; Transgender

Transgender youth and suicidal behaviors: Applying the interpersonal psychological theory of suicide - Grossman, A.H.; Park, J.Y.; Russell, S.T. (Journal of Gay and Lesbian Mental Health, 2016)
The interpersonal psychological theory of suicide (IPTS) was used to examine suicidal thoughts and behaviors among 129 transgender and gender nonconforming (TGNC) youth. Youth were categorized according to their gender identities: female to male (FTM), male to female (MTF), female to different gender (FTDG), and male to different gender (MTDG). Higher percentages of suicidal ideation were reported by FTDG and FTM youth; higher percentages of suicide attempts were reported by FTDG and MTDG youth. Perceived burdensomeness and thwarted belongingness were significantly related to suicidal ideation and/or suicide attempts. Experiences of painful, provocative, and harmful events and acquired capability significantly predicted suicide attempts. The findings support IPTS in explaining suicidal behaviors among TGNC youth. Implications for prevention and intervention efforts are discussed. © 2016 Taylor and Francis Group, LLC.
Keywords: Female to different gender (FTDG); Female to male (FTM); Gender nonconforming; Interpersonal psychological theory of suicide (IPTS); Male to different gender (MTDG); Male to female (MTF); Suicidal ideation; Suicide attempt; Thwarted belongingness; Transgender; Youth

Gender Affirmation and Resiliency among Black Transgender Women with and Without HIV Infection - Crosby, R.A.; Salazar, L.F.; Hill, B.J. (Transgender Health, 2016)
Purpose: Among black transgender women (transwomen) at high risk of HIV acquisition or already living with HIV/AIDS, the study examined whether medical or socially based gender affirming factors may contribute differentially to selected measures of resiliency, perceived stress, and a scale measure of mental health outcomes. This question has implications for clinical care and counseling of this population. Methods: Seventy-seven black transwomen were recruited to participate in a private, face-to-face structured interview. Two index measures of gender affirmation (GA) were constructed from the data. One comprised medical aspects only and the other comprised social aspects of GA. Assessed outcomes were personal competence and acceptance of self and life (resiliency), perceived stress and recent anxiety, depression, and suicide ideation (mental health). Associations between GA variables and outcomes were first assessed using bivariate level correlations. Significant bivariate associations were then tested in multivariable regression models adjusting for age and HIV status. Results: Mean age of the sample was 34.5 years. More than one-half of the sample (62.3%) indicated being HIV-infected. None of the bivariate or multivariable associations pertaining to GA medical factors were significant. Conversely, the social GA factors were significant and protective with all four outcomes. In the presence of age and HIV status, greater social GA was significantly associated with greater personal competence, acceptance of self and life, and positive mental health outcome. HIV status had an independent effect on personal competence, acceptance of self and life, with HIV-positive transwomen scoring higher on both measures. Conclusion: Among black transwomen at high risk of HIV acquisition or already HIV-infected, study findings suggest the possibility that socially based GA may play a prominent role in strengthening the resiliency and mental health of black transwomen. This same protective effect may not occur as a consequence of gender affirming body modification practices. © Richard A. Crosby et al. 2016; Published by Mary Ann Liebert, Inc. 2016.
Keywords: black; gender affirmation; HIV infections; transgender women

Resilience in individuals with gender dysphoria: Association with perceived social support and discrimination - Başar, K.; Öz, G. (Turk Psikiyatri Dergisi, 2016)
Objective: Psychological distress associated with discrimination has been proposed to have an indirect effect on the development of mental disorders through negative influence on an individual's cognitive, affective, and social coping strategies. The aim of this study was to investigate the association between resilience, perceived social support, and perceived discrimination in individuals with gender dysphoria. Method: Individuals with gender dysphoria were assessed with Turkish validated forms of Resilience Scale for Adults (RSA), Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Discrimination Scale (PDS), and Beck Depression Inventory (BDI). Diagnoses of mental disorders, history of suicide attempt, and non-suicidal self-injury were assessed by clinical interviews. Self-report forms were used to obtain demographic information and gender transition-related features. Results: The participants (n=116, 88 trans men) had a median age of 25. Significantly low RSA scores, indicating poor resilience, were obtained from participants with lifetime (59.5%) and present (27.6%) diagnosis of any mental disorder and history of suicide attempt (23.3%). There was significant direct correlation between RSA and MSPSS scores, inverse correlation with BDI, and personal PDS scores, but not with group PDS. Regression analysis revealed that only the friends domain score in MSPSS predicted better resilience, whereas the personal PDS predicted poor resilience. Conclusion: Based on our data, these findings support the association between poor resilience and vulnerability to mental and behavioral problems in individuals with gender dysphoria. The associations reveal the significance of addressing discrimination and assisting individuals with gender dysphoria to develop strategies for peer support in mental health services.
Keywords: Discrimination; Gender dysphoria; Social support

The role of gender affirmation in psychological well-being among transgender women - Glynn, T.R.; Gamarel, K.E.; Kahler, C.W.; Operario, D.; Iwamoto, M.; Nemoto, T. (Psychology of Sexual Orientation and Gender Diversity, 2016)
High prevalence of psychological distress, including greater depression, lower self-esteem, and suicidal ideation, has been documented across numerous samples of transgender women and has been attributed to high rates of discrimination and violence. According to the gender affirmation framework (Sevelius, 2013), access to sources of gender-affirmative support can offset such negative psychological effects of social oppression. However, critical questions remain unanswered in regards to how and which aspects of gender affirmation are related to psychological well-being. The aims of this study were to investigate the associations among 3 discrete areas of gender affirmation (psychological, medical, and social) and participants' reports of psychological well-being. A community sample of 573 transgender women with a history of sex work completed a 1-time self-report survey that assessed demographic characteristics, gender affirmation, and mental health outcomes. In multivariate models, we found that social, psychological, and medical gender affirmation were significant predictors of lower depression and higher self-esteem whereas no domains of affirmation were significantly associated with suicidal ideation. Findings support the need for accessible and affordable transitioning resources for transgender women to promote better quality of life among an already vulnerable population. However, transgender individuals should not be portrayed simplistically as objects of vulnerability, and research identifying mechanisms to promote wellness and thriving is necessary for future intervention development. As the gender affirmation framework posits, the personal experience of feeling affirmed as a transgender person results from individuals' subjective perceptions of need along multiple dimensions of gender affirmation. Thus, personalized assessment of gender affirmation may be a useful component of counseling and service provision for transgender women. © 2016 American Psychological Association.
Keywords: Gender affirmation; Psychological well-being; Transgender women

A Minority Stress Model for Suicidal Ideation in Gay Men - Michaels, M.S.; Parent, M.C.; Torrey, C.L. (Suicide and Life-Threatening Behavior, 2016)
There is a dearth of research on mechanisms underlying higher rates of suicidal ideation among gay men compared to heterosexual men. The purpose of this study was to establish the link between social/psychological predictor variables and suicidal ideation by testing a hypothesized minority stress model. Structural equation modeling was used to assess the relationships posited in the model using data from a community sample of 167 gay men. Model fit was adequate and hypothesized relationships were partially supported. Also, depressive symptoms partially mediated the relationship between (less) outness predicting suicidal ideation. These findings imply that therapeutic approaches targeting the coming out process may be more effective than approaches targeting internalized homophobia when suicidal ideation is indicated in the clinical presentation of gay and bisexual men. © 2015 The American Association of Suicidology.

Gender Dysphoria and Social Anxiety: An Exploratory Study in Spain - Bergero-Miguel, T.; García-Encinas, M.A.; Villena-Jimena, A.; Pérez-Costillas, L.; Sánchez-Álvarez, N.; de Diego-Otero, Y.; Guzman-Parra, J. (Journal of Sexual Medicine, 2016)
Introduction Social anxiety in gender dysphoria is still under investigation. Aim To determine the prevalence and associated factors of social anxiety in a sample of individuals with gender dysphoria. Methods A cross-sectional design was used in a clinical sample attending a public gender identity unit in Spain. The sample consisted of 210 individuals (48% trans female and 52% trans male). Main outcome measures Mini-International Neuropsychiatric Interview (MINI) for diagnosis of social anxiety disorder, Structured Clinical Interview, Exposure to Violence Questionnaire (EVQ), Beck Depression Inventory (BDI-II), and Functional Social Support Questionnaire (Duke-UNC-11). Results Of the total sample, 31.4% had social anxiety disorder. Social anxiety disorder was highly correlated with age (r = −0.181; CI = 0.061–0.264; P =.009) and depression (r = 0.345; CI = 0.213–0.468; P < .001); it is strongly associated to current cannabis use (relative risk [RR] = 1.251; CI = 1.070–1.463; P =.001) and lifetime suicidal ideation (RR = 1.902; CI 1.286–2.814; P <.001). Moreover, it is significantly associated to lifetime nonsuicidal self-injury (RR = 1.188; CI 1.018–1.386; P =.011), nationality (RR = 7.792; CI 1.059–57.392; P =.013), perceived violence at school during childhood and adolescence (r = 0.169; CI = 0.036–0.303; P =.014), unemployment (RR = 1.333; CI 1.02–1.742; P =.021), and hospitalization of parents in childhood (RR = 1.146; CI = 1.003–4.419; P =.046). Using multivariable analysis, the highly significant variables within the model were depression score (odds ratio [OR] = 1.083; CI = 1.045–1.123; P <.001) and current cannabis use (OR = 3.873; CI = 1.534–9.779, P =.004), also age (OR = 0.948; CI = 0.909–0.989; P =.012), hospitalization of parents during childhood (OR = 2.618; CI = 1.107–6.189; P =.028), and nationality (OR = 9.427; CI = 1.065–83.457; P =.044) were associated with social anxiety disorder. Conclusion This study highlights the necessity of implementing actions to prevent and treat social anxiety in this high-risk population. © 2016 International Society for Sexual Medicine
Keywords: Social Anxiety; Social Phobia; Transgender; Transsexuals; Victimization

A pilot study to assess emotional distress and quality of life among transgenders in South India - Poguri, M.; Sarkar, S.; Nambi, S. (Neuropsychiatry, 2016)
Background and aims: Transgenders face several social disadvantages in the Indian cultural context, and often live on the fringe of the society. Presence of adverse life circumstances predisposes them to have psychological morbidity. In the absence of previous systematic evidence, this pilot study aimed to assess emotional distress and quality of life among transgenders attending a clinic in south India. Methods: This hospital based cross-sectional study assessed transgenders attending a specialized multi-speciality clinic. Participants were assessed for relevant demographic and clinical information. Anxiety and depression were assessed using Hospital Anxiety and Depression Scale (HADS), while General Health Questionnaire (GHQ) was used to assess for general emotional distress. WHOQOL Bref was used to assess quality of life. Results: The pilot study included 15 transgenders with a median age of 30 years. All the participants had experienced sexual abuse in childhood, and 11/15 (73.3%) had a lifetime suicide attempt. The median HADS anxiety, HADS depression and GHQ scores were 9, 14 and 8 respectively. About 66.7% of the sample had significant anxiety symptoms while 100% had significant depressive symptoms as per HADS cut-off. The quality of life scores were particularly low for the 'social' domain. Conclusion: Transgenders experience considerable emotional distress and have poor social quality of life. Medical professionals need to be sensitive to the health-care needs of transgenders to improve their psychological wellbeing. © 2016 Neuropsychiatry (London).
Keywords: Anxiety; Depression; India; Quality of life; Transgender

Lady with erotic preference for diapers - Cernovsky, Z.; Bureau, Y. (Mental Illness, 2016)
A patient in her 20s was referred to us for psychological assessment due to her depression and suicide attempts. She mentioned being anorgasmic except when diapered and emphasized her erotic preference for diapers. Her childhood included maternal deprivation in an impecunious family headed by an irritable physically disabled father on social assistance. Given the maternal deprivation in childhood, her erotic fixation on diapers parallels the emotional attachment to diapers observed by Harlow in mother deprived infant monkeys. Etiological hypotheses should also include the paradigm of avoidance learning from theories of behavior therapy. Our patient does not wish to change her sexual preference: in such cases, fetishism is not considered as an illness by DSM5. However, she needs to be treated for pathological levels of depression with suicidal ideation and low self-esteem. © Z. Cernovsky, and Y. Bureau, 2016.
Keywords: Anorgasmia; Avoidant conditioning; Diaper fetish; Repetition compulsion; Suicidal ideation

Sexual violence among youth in New Mexico: Risk and resiliency factors that impact behavioral health outcomes - Reed, D.; Reno, J.; Green, D. (Family and Community Health, 2016)
Research has consistently demonstrated a relationship between history of forced sex and poor behavioral health outcomes. The objectives of this study were to describe this relationship among high school students and to explore the impact of resiliency factors. Using data from the 2013 New Mexico Youth Risk and Resiliency Survey, we found that history of forced sex was associated with negative behavioral health outcomes for males and females, regardless of sexual orientation and disability status. Furthermore, the presence of a caring adult at home appeared to reduce the risk of substance abuse and suicidality among students with and without a history of forced sex. © Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: Adolescents; Mental health; Resiliency; Sexual violence; Substance use

Church communication highlights 2015 - Erlandson, G.; Crowe, G.R. (Church, Communication and Culture, 2016)
This paper endeavors to provide, through a selection of eight topics, some of the most significant issues and events related to Catholic Church Communications in 2015. The selection is of course subjective and limited due to the scope of the paper, but the authors have chosen these topics either because they received wide media coverage or because they have long-term and significant implications for the Church and for society. The highlights are: The publication of Pope Francis’s second encyclical, Laudato Si’; The immigration and refugee crises; The papal visit to the United States; The Ordinary Synod of Bishops on the Family; The persecution of Christians and battles over religious liberty; Efforts to legalize gay marriage; The various controversies and scandals besetting the Vatican; Developments with regard to the legalization and promotion of physician-assisted suicide. © 2016, © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Keywords: Catholic church; family; Laudato Si; Pope Francis; refugee; religious liberty

Invisible Victims: Delayed Onset Depression among Adults with Same-Sex Parents - Sullins, D.P. (Depression Research and Treatment, 2016)
The relationship of elevated depression risk recently discovered among adult persons raised by same-sex parents with possible precipitating conditions in childhood has not previously been acknowledged. This study tests whether such inattention is supportable. Logistic regression based risk ratios were estimated from longitudinal measures of mental health outcomes observed in three waves (at ages 15, 22, and 28) of the US National Survey of Adolescent to Adult Health (n=15,701). At age 28, the adults raised by same-sex parents were at over twice the risk of depression (CES-D: risk ratio 2.6, 95% CI 1.4-4.6) as persons raised by man-woman parents. These findings should be interpreted with caution. Elevated risk was associated with imbalanced parental closeness and parental child abuse in family of origin; depression, suicidality, and anxiety at age 15; and stigma and obesity. More research and policy attention to potentially problematic conditions for children with same-sex parents appears warranted. © 2016 D. Paul Sullins.

Characteristics of self-identified sexual addicts in a behavioral addiction outpatient clinic - Wéry, A.; Vogelaere, K.; Challet-Bouju, G.; Poudat, F.-X.; Caillon, J.; Lever, D.; Billieux, J.; Grall-Bronnec, M. (Journal of Behavioral Addictions, 2016)
Background and aims: Research on sexual addiction flourished during the last decade, promoted by the development of an increased number of online sexual activities. Despite the accumulation of studies, however, evidence collected in clinical samples of treatment-seeking people remains scarce. The aim of this study was to describe the characteristics (socio-demographics, sexual habits, and comorbidities) of self-identified "sexual addicts." Methods: The sample was composed of 72 patients who consulted an outpatient treatment center regarding their sexual behaviors. Data were collected through a combination of structured interviewing and self-report measures. Results: Most patients were males (94.4%) aged 20-76 years (mean 40.3 ± 10.9). Endorsement of sexual addiction diagnosis varied from 56.9% to 95.8% depending on the criteria used. The sexual behaviors reported to have the highest degree of functional impairment were having multiple sexual partners (56%), having unprotected sexual intercourse (51.9%), and using cybersex (43.6%). Ninety percent of patients endorsed a comorbid psychiatric diagnosis, and 60.6% presented at least one paraphilia. Conclusions: Results showed highly different profiles in terms of sexual preferences and behaviors, as well as comorbidities involved. These findings highlight the need to develop tailored psychotherapeutic interventions by taking into account the complexity and heterogeneity of the disorder. © 2016 The Author(s).
Keywords: Comorbidities; Excessive sexual behavior; Hypersexuality; Sexual addiction

The classically liberal roberts court - Stachiw, M. (New York University Journal of Law and Liberty, 2016)
When John Roberts was nominated by President George Bush to be the next Chief Justice of the Supreme Court after Chief Justice William Rehnquist, it marked a shift in constitutional jurisprudence. With some exceptions, the Roberts Court has produced classically liberal decisions on a whole host of constitutional issues. Classically liberal decisions have been produced in the realms of free speech, campaign finance, gun rights, gay rights, searches and seizures, and religious freedom. The member Justices have produced these decisions consistent with natural law and libertarianism both unanimously and in close decisions, including decisions involving Justices voting against their traditional liberal-conservative blocs. Despite creating a litany of libertarian decisions, no single member of the Roberts Court selfidentifies as a libertarian. This has puzzled academics and commentators, leading many to write off the Roberts Court as simply inconsistent. The Justices of the Roberts Court, including new Justices Sonia Sotomayor and Elena Kagan, offer differing jurisprudences richer than the popular bimodal right-left paradigm. Both liberal and conservative Justices, despite their vast differences on Constitutional topics like textualism and purposivism, have arrived at classically liberal conclusions in their rulings, advancing individual rights instead of government regulations. The Declaration of Independence, Constitution, and Bill of Rights were written with natural law and classical liberal principles in the fore-front of the Founder's minds, which means that a Supreme Court charged with upholding the Constitution should produce results consistent with libertarianism. A libertarian impulse grounded in natural law sets the stage for the Roberts Court deciding opinions that are classically liberal. This libertarian instinct model, however, is not perfect and does not explain many decisions because the Court is not intentionally libertarian. Although no single Justice is classically liberal, however, the Roberts Court as a whole is more classically liberal than any of its members.

Short duration response-guided treatment is effective for most individuals with recent hepatitis C infection: The ATAHC II and DARE-C i studies - Martinello, M.; Hellard, M.; Shaw, D.; Petoumenos, K.; Applegate, T.; Grebely, J.; Yeung, B.; Maire, L.; Iser, D.; Lloyd, A.; Thompson, A.; Sasadeusz, J.; et al. (Antiviral Therapy, 2016)
Background: Individuals with recent HCV infection may beneit from shortened duration therapy. These studies evaluated the eficacy and safety of response-guided regimens with pegylated interferon-α2a and ribavirin for people with recent HCV infection. Methods: Participants with recent hepatitis C (duration of infection ≤18 months) enrolled in the ATAHC II (pegylated interferon-α2a ± ribavirin) and DARE-C I (pegylated interferon- α2a, ribavirin and telaprevir) studies were included for analysis. Treatment duration was response-guided (ATAHC II: 8, 16, 24 or 48 weeks; DARE-C I: 8, 12 or 24 weeks) and dependent on time to irst undetectable HCV RNA using Roche Taqman HCV RNA testing. The primary eficacy end point was sustained virological response at 12 weeks (SVR12) by intention-to-treat. Logistic regression analyses were used to identify predictors of SVR. Results: A total of 82 participants (62% HIV-positive) were enrolled in ATAHC II (treated, n=52) and 14 (79% HIV-positive) in DARE-C I. The predominant modes of HCV acquisition were injecting drug use (ATAHC II 55%, DARE-C I 36%) and sexual intercourse with a partner of the same sex (ATAHC II 39%, DARE-C I 64%). SVR12 was 71% in both ATAHC II (37/52) and DARE-C I (10/14) with 56% in ATAHC II receiving shortened therapy (8 or 16 weeks). SVR was associated with a rapid virological response (odds ratio 10.80; P=0.001). Conclusions: The majority of participants were able to receive short duration response-guided therapy with pegylated interferon-α2a and ribavirin. Response-guided therapy for recent hepatitis C infection could be considered in the absence of available interferon-free therapies. © 2016 International Medical Press.

A study on adverse drug reactions to first-line antiretroviral therapy in HIV infected patients at a tertiary care hospital in Northeast India - Jain, A.; Lihite, R.J.; Lahkar, M.; Baruah, S.K. (HIV and AIDS Review, 2016)
Background Assam state of Northeast India is surrounded with the states which are very critical in terms of HIV/AIDS. The first line drugs recommended by National AIDS Control Organization for the treatment of HIV infected patients consist of zidovudine (AZT), lamivudine (3TC), nevirapine (NVP), efavirenz (EFV), tenofovir (TDF), and stavudine (d4T). It was observed that the reporting of adverse drug reactions (ADRs) due to these antiretroviral drugs from this region is very low. Aim To study and identify adverse drug reactions to first line treatment in HIV infected patients reported by the nodal centre of antiretroviral therapy (ART) at a tertiary care hospital. Method In this cross-sectional study, 100 HIV infected patients with ADR were reported within 2 months from the nodal ART Centre of Gauhati Medical College and Hospital (GMCH) situated at Guwahati, Assam, Northeast India. WHO-system organ class-body system was used to classify reported ADRs. Causality assessments to reported ADRs were performed by using WHO-UMC causality assessment system. Results In this study, most of the patients have received TDF + 3TC + EFV (83%) regimen followed by AZT + 3TC + NVP (10%), AZT + 3TC + EFV (4%), TDF + 3TC + NVP (2%), and d4T + 3TC + EFV (1%). Efavirenz was commonly implicated drug which was suspected in 81 patients. In this study, 216 ADRs were reported during study period. Of which, 87 ADRs were related to nervous system disorders and 81 ADRs were under gastrointestinal disorders as per WHO-system organ class-body system. Vertigo (22.68%) and vomiting (13.88%) were commonly reported ADR. In this study, substitution of ART regimen was done in 15 patients after detecting ADR while in 85 patients regimen was continued without any change. As per WHO-UMC causality assessment system, causality was possible in 85 patients while it was probable in 15 patients. Conclusion Vertigo and vomiting were the most commonly reported ADR and regimens containing EFV were more likely to induce ADR. © 2016 Polish AIDS Research Society
Keywords: ADR; ART; EFV; HIV; WHO-UMC

The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women - Valentine, S.E.; Elsesser, S.; Grasso, C.; Safren, S.A.; Bradford, J.B.; Mereish, E.; O’Cleirigh, C. (Journal of Urban Health, 2015)
Previous studies documenting sexual minority women’s disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women. © 2015, The New York Academy of Medicine.
Keywords: Bisexual; Health care costs; Health care utilization; Lesbian; Mental health; Sexual minority

Assessment and Treatment of Depression in Gay and Bisexual Men in Emergency Settings - Blackwell, C.W. (Advanced Emergency Nursing Journal, 2015)
Gay and bisexual men are at higher risk for certain mental health disorders, including anxiety, depression, and suicide. These individuals often present to emergency settings in need of evaluation and treatment. Despite the utilization of emergency mental health services by this population, clinicians are often underprepared in responding to their unique needs. This article discusses depression in gay and bisexual men and provides an evidence-based approach in treating these men in emergency settings. Directives for future research and advanced practice nursing education are also presented. Copyright © 2015 Wolters Kluwer Health, Inc.
Keywords: anxiety; bisexual; depression; emergency; gay men; homosexual; mental health; psychiatric; suicide

Health correlates of criminal justice involvement in 4,793 transgender veterans - Brown, G.R.; Jones, K.T. (LGBT Health, 2015)
Purpose: Transgender (TG) persons are overrepresented in prison settings and in the U.S. veteran population. Health disparities studies of large populations of transgender people involved with the criminal justice system have not been published to date. Methods: We studied a large cohort of TG veterans who received care in Veterans Health Administration (VHA) facilities during 2007-2013 (n = 4,793) and a 3:1 matched control group of veterans without known TG identification (n = 13,625). Three hundred twenty six (n = 138 TG, 188 non-TG) had received VHA services in programs designed to address the needs of justice involved (JI) veterans. We linked patients in each of the three groups to their medical and administrative data. Results: TG veterans were more likely to be justice involved than controls (2.88% vs. 1.38%; P < .0001). Compared to non-TG JI veterans, TG JI veterans were more likely to have a history of homelessness (80% vs. 67%; P < .05) and to have reported sexual trauma while serving in the military (23% vs. 12%; P < .01). Significant health disparities were noted for TG JI veterans for depression, hypertension, obesity, posttraumatic stress disorder, serious mental illness, and suicidal ideation/attempts. Conclusion: These data suggest that TG veterans experience a number of health risks compared to non-TG veterans, including an increased likelihood of justice involvement. TG veterans involved with the criminal justice system are a particularly vulnerable group and services designed to address the health care needs of this population, both while incarcerated and when in the community, should take these findings into account in the development of health screenings and treatment plans. © Mary Ann Liebert, Inc. 2015.
Keywords: disparity; incarceration; justice; transgender; veteran

An autopsy study of 74 cases of cut throat injuries - Rao, D. (Egyptian Journal of Forensic Sciences, 2015)
The present prospective autopsy study was carried out during the period July 2009 to May 2012 in Kingston, Jamaica. A total of 74 cases of cut throat injury were studied. All the cut throat injuries irrespective of those directly or indirectly contributing to the death were studied. Males dominated the list of victims, contributing to 71.62% (n=53). Majority of those were in the age group 21-30 (n=25) and 31-40 (n=26) which contributed to 33.78% and 35.13% respectively. Majority of the cases were homicides contributing to 97.29% (n=72) of cases, only 2.7% were suicides and accidental cut throat were never reported. Males dominated the homicides category contributing to 72.22% (n=52) of the cases. Gang and relationship crisis (homosexual and heterosexual) were the major motivating factors, each contributing to 39.19% (n=29) and 32.43% (n=24) of the cases, respectively. The disease suffered by individuals were the least motivating factors contributing to 1.35% of cases (n=01). The most common cause of death was exsanguinations in 49.95% (n=34) of cases followed closely by asphyxia due to aspiration of blood i.e. 36.49% (n=27) of cases and air embolism was the least cause of death, contributing to 4.05% (n=03) of cases. Cut throat injury was associated with other injuries like gunshot wound, chop wounds and stab wounds in 13.52% of (n=10) autopsies. Chop injuries contributed to maximum number of other injuries in homicides (n=46). The most preferred place for the crime was an open field or farm (n=26). Majority of the cut throat wounds were situated in zone II level contributing to 66.21% (n=49) of cases. Majority of the wounds were directed from left to right in 75.68% (n=56) of cases and the cervical vertebra was affected in 8.11% (n=06) of cases. Major weapon of choice was machete contributing to 83.78% (n=62) of injuries. The low income group was the most affected group contributing to 91.89% (n=68) of cases. © 2014.
Keywords: Cervical vertebra; Cut throat injury; Machete; Neck; Weapon

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

Frequency of and risk factors for depression among participants in the swiss HIV Cohort Study (SHCS) - Anagnostopoulos, A.; Ledergerber, B.; Jaccard, R.; Shaw, S.A.; Stoeckle, M.; Bernasconi, E.; Barth, J.; Calmy, A.; Berney, A.; Jenewein, J.; Weber, R. (PLoS ONE, 2015)
Objectives We studied the incidence and prevalence of, and co-factors for depression in the Swiss HIV Cohort Study. Methods Depression-specific items were introduced in 2010 and prospectively collected at semiannual cohort visits. Clinical, laboratory and behavioral co-factors of incident depression among participants free of depression at the first two visits in 2010 or thereafter were analyzed with Poisson regression. Cumulative prevalence of depression at the last visit was analyzed with logistic regression. Results Among 4,422 participants without a history of psychiatric disorders or depression at baseline, 360 developed depression during 9,348 person-years (PY) of follow-up, resulting in an incidence rate of 3.9 per 100 PY (95% confidence interval (CI) 3.5-4.3). Cumulative prevalence of depression during follow-up was recorded for 1,937/6,756 (28.7%) participants. Incidence and cumulative prevalence were higher in injection drug users (IDU) and women. Older age, preserved work ability and higher physical activity were associated with less depression episodes. Mortality (0.96 per 100 PY, 95% CI 0.83-1.11) based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78-3.09), female IDU (2.33, 1.59-3.39) and white heterosexual men (1.32, 0.94-1.84) compared to white heterosexual women and homosexual men (0.53, 0.29-0.95; and 0.71, 0.55-0.92). Compared to participants free of depression, mortality was slightly elevated among participants with a history of depression (1.17, 0.94-1.45 vs. 0.86, 0.71-1.03, P = 0.033). Suicides (n = 18) did not differ between HIV transmission groups (P = 0.50), but were more frequent among participants with a prior diagnosis of depression (0.18 per 100 PY, 95%CI 0.10-0.31; vs. 0.04, 0.02-0.10; P = 0.003). Conclusions Depression is a frequent co-morbidity among HIV-infected persons, and thus an important focus of care. © 2015 Anagnostopoulos 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.

Personality, spirituality, suicide, and self-injury proneness among lesbian, gay, and bisexual adults - Stroud, C.H.; Cramer, R.J.; La Guardia, A.C.; Crosby, J.W.; Henderson, C.E. (Mental Health, Religion and Culture, 2015)
The present study sought to clarify gaps in current knowledge integrating personality, spirituality, and risk for suicide/self-harm among sample of 336 lesbian, gay, and bisexual community members. It was hypothesised that Neuroticism would positively predict, and Extraversion and Agreeableness would negatively predict, measures of suicide and self-injury proneness. Additionally, it was predicted that spirituality, defined as Spiritual Life Integration (SLI) and Social Justice Commitment, would interact with personality traits to attenuate risk for suicide and self-injury. Results supported the role of Neuroticism, and identified an unexpected predictor of Conscientiousness, at the main effect level. Moderation patterns were observed such that Agreeableness and Extraversion interacted with SLI to attenuate risk, such that high levels of each trait and high levels of spirituality were protective against suicide and self-injury proneness. Theoretical and practical implications with emphasis on counselling intervention implementation and future research are discussed. © 2015 Taylor & Francis.
Keywords: and bisexual (LGB); Five-Factor Model; gay; lesbian; personality; physical unhealthiness; self-injury; spirituality; suicide

Plasmodium parasites mount an arrest response to dihydroartemisinin, as revealed by whole transcriptome shotgun sequencing (RNA-seq) and microarray study - Shaw, P.J.; Chaotheing, S.; Kaewprommal, P.; Piriyapongsa, J.; Wongsombat, C.; Suwannakitti, N.; Koonyosying, P.; Uthaipibull, C.; Yuthavong, Y.; Kamchonwongpaisan, S. (BMC Genomics, 2015)
Background: Control of malaria is threatened by emerging parasite resistance to artemisinin and derivative drug (ART) therapies. The molecular detail of how Plasmodium malaria parasites respond to ART and how this could contribute to resistance are not well understood. To address this question, we performed a transcriptomic study of dihydroartemisinin (DHA) response in P. falciparum K1 strain and in P. berghei ANKA strain using microarray and RNA-seq technology. Results: Microarray data from DHA-treated P. falciparum trophozoite stage parasites revealed a response pattern that is overall less trophozoite-like and more like the other stages of asexual development. A meta-analysis of these data with previously published data from other ART treatments revealed a set of common differentially expressed genes. Notably, ribosomal protein genes are down-regulated in response to ART. A similar pattern of trophozoite transcriptomic change was observed from RNA-seq data. RNA-seq data from DHA-treated P. falciparum rings reveal a more muted response, although there is considerable overlap of differentially expressed genes with DHA-treated trophozoites. No genes are differentially expressed in DHA-treated P. falciparum schizonts. The transcriptional response of P. berghei to DHA treatment in vivo in infected mice is similar to the P. falciparum in vitro culture ring and trophozoite responses, in which ribosomal protein genes are notably down-regulated. Conclusions: Ring and trophozoite stage Plasmodium respond to ART by arresting metabolic processes such as protein synthesis and glycolysis. This response can be protective in rings, as shown by the phenomenon of dormancy. In contrast, this response is not as protective in trophozoites owing to their commitment to a highly active and vulnerable metabolic state. The lower metabolic demands of schizonts could explain why they are less sensitive and unresponsive to ART. The ART response pattern is revealed clearly from RNA-seq data, suggesting that this technology is of great utility for studying drug response in Plasmodium. © 2015 Shaw et al.
Keywords: Dihydroartemisinin; Malaria; Microarray; Plasmodium; RNA-seq; Transcriptome

Effects of Minority Stress Processes on the Mental Health of Latino Men Who Have Sex with Men and Women: A Qualitative Study - Holloway, I.W.; Padilla, M.B.; Willner, L.; Guilamo-Ramos, V. (Archives of Sexual Behavior, 2015)
Emerging literature on minority stress among sexual minority populations has described the negative consequences that multiple minority statuses may exert on mental health and well-being. This literature has tended to focus on individuals whose self-identifications reflect sexual minority sexual categories, such as gay or bisexual, and has explored the intersection of these definitions with ethnic, racial, and class statuses. Few such studies have explored mental health among men who actively deny a sexual minority sexual identity label while engaging in same-sex sexual behaviors. The present study used ethnographic interview data from 20 non-gay-identified bisexually behaving Dominican and Puerto Rican men in New York City. Participants described discovery of same sex sexual behavior as a threat to their intimate relationships, community affiliation, and counter to expectations of Latino masculinity. Recounting a wide range of information management strategies used to avoid open disclosure about their sexual lives, participants experienced the potential consequences of disclosure as extreme and even life threatening. Men anticipated social isolation, depression, self-injury, and suicidality as possible outcomes from disclosing sexual behavior with other men to their female romantic partners. This analysis provides direction for future research on minority stress processes and mental health service delivery among Latino men who have sex with men and women. © 2014, Springer Science+Business Media New York.
Keywords: Bisexual; Latino; Men Who Have Sex with Men; Mental health; Sexual orientation; Stress

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

Sexual Violence Against Men Who Have Sex with Men in Brazil: A Respondent-Driven Sampling Survey - Sabidó, M.; Kerr, L.R.F.S.; Mota, R.S.; Benzaken, A.S.; de A. Pinho, A.; Guimaraes, M.D.C.; Dourado, I.; Merchan-Hamman, E.; Kendall, C. (AIDS and Behavior, 2015)
We estimated the prevalence of sexual violence (SV) experience among men who have sex with men (MSM) in Brazil and identified its associated risk factors. We recruited 3859 MSM through respondent driven sampling. A multivariable hierarchical analysis was performed using an ecological model. The prevalence of having ever experienced SV was 15.9 % (95 % confidence interval [CI] 14.7–17.1). SV experience was independently associated with discrimination due to sexual orientation (odds ratio [OR] 3.05; 95 % CI 2.10–4.42), prior HIV testing (OR 1.81; 95 % CI 1.25–2.63), ≤14 years at first sex (OR 1.86; 95 % CI 1.28–2.71), first sex with a man (OR 1.89; 95 % CI 1.28–2.79), presenting STI symptoms (last year) (OR 1.66; 95 % CI 1.12–2.47), and having suicidal ideas (last 6 months) (OR 2.08; 95 % CI 1.30–3.35). The high levels of SV against MSM in Brazil place them at a markedly higher risk of SV than the general population. Homophobic prejudice is the strongest determinant of SV and urgently needs to be included at the forefront of the national response to SV. © 2015, Springer Science+Business Media New York.
Keywords: Brazil; MSM; Respondent-driven sampling; Risk factors; Sexual violence

Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria - Olson, J.; Schrager, S.M.; Belzer, M.; Simons, L.K.; Clark, L.F. (Journal of Adolescent Health, 2015)
Purpose The purpose of this study was to describe baseline characteristics of participants in a prospective observational study of transgender youth (aged 12-24 years) seeking care for gender dysphoria at a large, urban transgender youth clinic. Methods Eligible participants presented consecutively for care at between February 2011 and June 2013 and completed a computer-assisted survey at their initial study visit. Physiologic data were abstracted from medical charts. Data were analyzed by descriptive statistics, with limited comparisons between transmasculine and transfeminine participants. Results A total of 101 youth were evaluated for physiologic parameters, 96 completed surveys assessing psychosocial parameters. About half (50.5%) of the youth were assigned a male sex at birth. Baseline physiologic values were within normal ranges for assigned sex at birth. Youth recognized gender incongruence at a mean age of 8.3 years (standard deviation = 4.5), yet disclosed to their family much later (mean = 17.1; standard deviation = 4.2). Gender dysphoria was high among all participants. Thirty-five percent of the participants reported depression symptoms in the clinical range. More than half of the youth reported having thought about suicide at least once in their lifetime, and nearly a third had made at least one attempt. Conclusions Baseline physiologic parameters were within normal ranges for assigned sex at birth. Transgender youth are aware of the incongruence between their internal gender identity and their assigned sex at early ages. Prevalence of depression and suicidality demonstrates that youth may benefit from timely and appropriate intervention. Evaluation of these youth over time will help determine the impact of medical intervention and mental health therapy. © 2015 Society for Adolescent Health and Medicine.
Keywords: Cross sex hormone therapy; Gender transition; Sex reassignment; Transgender; Transgender youth

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

The Gold-Hope Tang, MD 2015 Humanism in Medicine Essay Contest: Third Place: Gauze and Guns - Gridley, S. (Academic Medicine, 2015)